“Rural Health Training Center, Khirasara, Rajkot” Department of Community Medicine, P.D.U. Government Medical College, Rajko

A summary report of

“Rural Health Training Center, Khirasara, Rajkot”

Department of Community Medicine, P.D.U. Government Medical college, Rajkot

Index

Sr. Index Page No. No. 1 Introduction 3 General information of RHTC 4 2 Roadmap to Khiirasara 5 3 Activities at RHTC 9 UG teaching activities 11 Transect walk 13 Intern activity 15 4 Minutes of meeting conducted by Community Medicine Department with 20 Staff of PHC Khirasara 5 List of Case Studies done by Residents under RHTC 24 DLIMS 25 E- Mamta 27 6 Participation in Routine Immunization Monitoring activity 33 7 Participation in Special Immunization Week Monitoring activity 34 8 Participation in Anti Malaria Month activity 36 9 Participation in Intensified Diarrhoea Control Fortnight (IDCF) Monitoring 39 activity

10 Health System Review Meetings attended by Residents 40 11 Annexure 41 Annexure-I: Staff of RHTC 41 Annexure-II: Staff position of Khirasara PHC 42 Annexure-III: List of Lab. Testing 43 Annexure-IV: Demographic profile of Khirasara OPD utilization & 44 MCH related data Annexure-V: Resident duty list 48

Introduction

The primary aim of the having a Rural Health Training Centre (RHTC) is that medical students learn patients and their disease in holistic perspectives, i.e. Understanding the patient with its environment-physical, social, economical etc. Also know about the different health care delivery system available in the community.

There are total 47 Primary Health Centers in Rajkot district providing health services to rural masses. Among them, PHC Khirasara has been developed as Rural Health training centre (RHTC) of Community Medicine department, PDUMC, Rajkot. Recently it has been accredited by NABH

It caters health services to 13 villages of Rajkot covering population of over 18940. Six Sub-centers including the PHC village itself are the field practice area.

RHTC building is located adjacent to the Primary Health Centre, Khirasara. Two rooms containing three beds each providing hostel facility for boys & girls separately are available. A hall is used for student training purpose as and when it required. Open space around the RHTC is available for camp.

One Student vehicle (mini bus) is provided for RHTC field visit for UG/PG students, staff and interns posted in department

General Information of RHTC/PHC (2015-16)

Population 18940 – PHC Khirasara 3103 – Khirasara village

Distance from Medical college 20 km Sub-Centre 06 Villages 13 OPD 100 – 140/day Indoor Male : 2-4/month, Female: 8-12/month Investigations 30/day, 15 P/S for M/P per day MPS & FHS 1 MPS present 1 MPS & FHS: vacant HW FHW 4, MPW 2 Deliveries in PHC 3-4/month Birth Rate 15.80/1000 Mid Year Population Crude Death Rate 3.93/1000 Mid Year Population IMR 23.22/1000Live Birth MMR 0 Sex Ratio 890 Female/1000 Male Malaria cases in last year 56 Anganwadi centres in PHC 19 Schools in PHC 19 – Primary schools, 2 - High schools Mamta Day is celebrated on Monday in PHC, Wed & Sat in SC & villages.

ICTC staff (1 Lab Tec & 1 counselor) attends PHC Mamta Divas on Monday & other Mamta divas of SC & villages on Wed & Sat. Gynecologist attending Gynec OPD at PHC Khirasara on every Wednesday

Ophthalmic assistant attends every Wednesday at PHC. It is a 24* 7 PHC

SC Names: Khirasara(Ranmalji), Metoda, Haripar Pal, Chibhda, Vadvajdi, Sanganva

Road map showing the route from PDUMC, Rajkot to RHTC, Khirasara

Primary Health Training Center,

Khirasara

Accredited by NABH

Map showing the field practice area with important landmarks

Map of PHC

Activities at RHTC

A. Curative services in conjugation with PHC Khirasara

 OPD services  Minor surgical treatment  Specialist services like Gynecologist and ophthalmology services  Laboratory & other diagnostics services

B. Preventive & Promotive activities:

 Immunization Clinic  ANC Clinic – Mamta Divas on every Monday  Non Communicable Disease cell  Family Planning services  IEC activities: IYCF, Adolescent Health etc

C. Training:

 Under Graduate Students’ Educational Visits  Intern Doctors’ Posting  Post Graduation Students’ Posting  Link Person’s Training  Family study And Care  Project work & Research activities

(D) Outreach activities:

 Participation in various ongoing National Health Programs i.e. IPPI, Mamta Divas monitoring, IDD, NCD, etc  Mobile clinics: Mamta sessions  Health education camps  Medical camps  Coordination with ICDS services  Health education activities at schools

Teaching Activities for Undergraduate Students in Rural Areas

As a part of MBBS curriculum, the following visits of UG students are done by Faculties as well as Residents of Community Medicine department in rural areas:

 PHC visit:

We introduce the students to infrastructure of PHCs, staff pattern, primary health care services provided through the PHCs, role of the PHCs in delivering various national health programs, registers maintained. The students are sensitized to components of Primary Health care like:

o Maternal and child health care, including family planning o Promotion of proper nutrition o Immunization against major infectious diseases o An adequate supply of safe water o Basic sanitation o Prevention and control of locally endemic diseases o Appropriate treatment for common diseases and injuries

UG student visit to PHC Khirasara

 CHC visit:

The students are introduced to infrastructure of CHC, staff pattern, role of CHCs in delivering services under various national health programs, registers maintained, etc.

Basic information regarding various secondary health care services provided at CHC is provided to students. e.g.:

-Care of routine and emergency -Referral and transport services cases in surgery & medicines

-Delivery services

-Essential and emergency obstetric care

-Family planning services

-Safe abortion services

-Newborn care

-Essential lab services

 Visit to Sub-centre & Anganwadi centre: Students are facilitated to visit the Sub-centre & Anganwadi centre. Here students themselves learn by interacting with Health workers, ANMs, as well as ICDS staff. They learn regarding infrastructure, staff as well as various facilities available at these centers.

The students understand the difficulties faced by these staff members as well as are sensitised to the basic concerns of the communities.

Visit of Anganwadi Centre of PHC

 Transit walk visit: o PHC village are visited. o Students develop vision for environmental, biological, socio- Cultural condition of village and its application in relation to the health. o Availability of health facilities, various organizations (panchayat, school, mandalis, bank etc.), availability of transport facility. UG student Transit walk visit at NAVA NARANKA village

 Family visit: Students are divided in small groups & families are visited in PHC areas.

Students learn through their experience regarding the housing conditions, environmental condition, socio-cultural factors, nutritional status, immunization status & all these factors & their relation to the health of the community.

Report of Transit Walk in Rural Areas by Staff of PSM Department

Place of visit- Khandheri

Date of visit - 29/09/2015

Objective of transit walk – to make uniformity in content of UG students teaching s & field visits, all faculties took visit of village together

All faculties, residents and MSW of Community Medicine Department participated in visit to Khandheri village.

In the bus itself active discussion about the teachings & field visits for UG students was held amongst faculty members.

Dr .A. M .Kadri (Proff & Head) discussed purpose of the visit as well as some of the key aspects to be observed during the visit to the village.

He divided all the staff members into various different teams

Every team was assigned a task to observe & report for during their visit.

Dr Kadri & his team visited the Sarpanch house in the village. He first explained the purpose of the visit following which he inquired about the facilities available in the village (Health, education, transport, etc)

There was also discussion regarding a few of the problems the villagers face & its solutions.

Then the team had visited other households in the village to inquire about the basic facilities available in the village.

Special focus was given to the health related issues & how these could be corrected & improved

Other teams focussed on water & sanitation related issues, Housing conditions, Drainage related issues, etc.

All the residents were asked to visit one house each & study the above mentioned conditions amongst the villagers. They had also checked for chlorination of the water using the OT test & instructed the villagers accordingly.

This visit had provided a new dimension of thought amongst the faculties, their understanding of community situation was strengthened & consequently a visit plan for the UGs was developed to teach the same.

Intern Activities during RHTC Posting

In the Community Medicine Department of P.D.U. Govt. medical college following activities are undertaken for the interns.

Sr. No. Place of Posting Duration Implementing & Supervisory Officer

1 UHTC / CPGP 15 days Professor & Head (CM) (Community Medicine Dept.) Asst. Professor (UHTC)

2 RHTC (PHC & SC) 15 days Asst. Professor (RHTC) Medical Officer (PHC) 3 Rural Hospital One month* Superintendent of Hosp. (CHC /Taluka Hospital )

*One week from this posting is utilized for NGO posting as per the availability

RHTC POSTING  Interns are posted to PHC Khirasara for 15 days. At PHC they attend OPD, malaria clinic, antenatal clinic, epidemic/accident management, DOTS centre. They practice giving IM/IV injections as well as performing wound suturing & dressing activities. They are involved in providing primary health care services to the villagers. They assist the MO PHC in providing basic services as well as performing deliveries. Interns also participate in Health camps at PHC, School health activities as well as other out-reach activities.

Interns participating in School Health activities

 From PHC interns also visit nearby Sub-centre for assisting ANM in conducting Village Health & Nutrition day sessions. They also do home visits of at least 50 Beneficiaries and assessing their benefit perception.

 During their RHTC posting they are also given a research project/case study from department under the guidance of a teacher. They have to present their findings in department in presence of other teachers & then submit their report.

Intern presenting her project work in department

List of Project work done by the internee on the following topics.

Sr. Topics Name of Student Name of Guide No. 1. Profile of ICTC clients (socio Dr. Nupur P Dr. Devangi demographic) Chaudhari Dholakia

2. Profile of ART clients (socio Dr. Dipa H Ruparel Dr. Shital Bhalodiya demographic) 3. Addiction /Habit of substance abuse in Dr. Ankita Bhalala Dr. Nirav Joshi medical students 4. Weaning practices of child aged 6 month Dr. Kinjal K Dr. Asutosh Jogia to 18 months Chaudhari 5. Clinco-epidomilogical profile of ARI Dr. Parth Katariya Dr. Anupam cases Banerjee 6. Clinco-epidomilogical profile of HT cases Dr. Ravi Mansuriya Dr. Bharat Gohel

7. Clinco-epidomilogical profile of CAD Dr.Dhaval Gosai Dr. Kshama Gajera cases 8. Clinco-epidomilogical profile of DM Ajindarsinh Maan Dr. Chikitsa Amin cases 9. Socio demographical profile of HT cases Aneri Rathod Dr. Vibha Gosalia 10. Socio demographical profile of CAD Tapan Ankleshwaria Dr. Bharat Gohel cases 11. Socio demographical profile of DM cases Rupala Ankit Dr. Vibha Gosalia 12. Socio demographical profile of TB cases Maskar Taskin Dr. Nirav Joshi 13. Knowledge attitude & behavior of health Jindani Shahna Dr. Chintan staff about bio medical waste Dashratha management in civil hospital

14. Awareness & belief about HIV in Payal Padalia Dr. Chintan community Dashratha 15. Awareness & belief about TB in Rukshar Saiyad Dr. Prerna Agarwal community 16. Awareness &belief about Ankit Kasundra Dr. Shital Bhalodiya CONTRACEPTION in community 17. Awareness &belief about NUTRITION in Ridham Kandheriya Dr. Devangi community Dholakia 18. Awareness &belief about Deep jansania Dr. Rajendra IMMUNAIZATION in community chauhan 19. Knowledge attitude & behavior about Vachhani Akshay Dr. Dipesh sexuality in medical students Zalavadia 20. B.M.I. &Risk behavior about NCD in Bhumi patel Dr. Nirav Joshi medical students 21. Cultural belief behavior & practice in Nidhi Parmar Dr. Kshama Gajera child rearing 22. Cultural belief behavior & practice in Dharmishta parmar Dr. Aarohi Mitra pregnancy 23. Cultural belief behavior & practice in Raiyani Rupa Dr. Dhara Thakrar dietary practices 24. Awareness about first aids in medical Dudhatara Swati Dr. Bhavesh students Kanabar 25. Nutritional awareness in medical students Kanani Dipti Dr. Jasmin Oza 26. Knowledge, attitude behavior about blood Shraddha Malpara Dr. Asutosh Jogia donation in medical students 27. Awareness about protecting one self from Ankita Boricha Dr. Anupam common diseases in community Banerjee 28. Awareness about protecting one self from Twinkle Rajani Dr. Chikitsa Amin common diseases in medical students 29. Housing environment in urban slums Krupa Patel Dr. Kshama Gajera 30. Housing environment in rural community Darshak Makwana Dr. Bharat Gohel 31. Dietary history in urban family Parth Jani Dr. Kirti Rahul 32. Dietary history in rural family Banshidhar Ramani Dr. Rajendra chauhan 33. Health seeking behavior for child health Sonal Goriya Dr. Asutosh Jogia problems 34. Health seeking behavior for female health Mayuri Shah Dr. Vaidehi Gohil problems 35. A Rapid appraisal of functioning of five Parita Dodiya Dr. Nirav Nimavat ASHA 36. A Rapid appraisal of functioning of five Ankita Chotaliya Dr. Zalak Matariya AW 37. A Rapid appraisal of functioning of FSW Hardik Raiyani Dr. Dhara Thakrar 38. A Rapid appraisal of functioning of Abhi Halola Dr. Harshida MHW Namera

39. Awareness about different health care Keyur Jawiya Dr. Anupam provided to mother in rural population Banerjee 40. Client satisfaction of OPD services Shweta Mehta Dr. Chikitsa Amin 41. Client satisfaction about RNTCP services Kunjal Adedra Dr. Kshama Gajera 42. Client satisfaction about child health Ankita Madhvani Dr. Vibha Gosalia services 43. Client satisfaction about contraceptive Vivek Patel Dr. Bharat Gohel services 44. Immunization coverage survey Sagar Katudiya Dr. Vaidehi Gohil 45. Functioning of village health & sanitation Vaibhav Daftary Dr. Chintan committee Dashratha 46. Client satisfaction of beneficiaries under Dhanji Chaudhary Dr. Prerna Agarwal chiranjeevi scheme 47. Client satisfaction of beneficiaries under Anil Sanjava Dr. Shital Bhalodiya janani surksha scheme 48. Perception of utility of 108 services Nishant Mehta Dr. Devangi Dholakia 49. Awareness about the common diseases Heti Mistry Dr. Rajendra and their causes in community Chauhan 50. Key Informants Interview (FIVE) in Madhuri Rathod Dr. Dipesh maternal health problem & services Zalavadia available 51. Beenu saini Dr. Nirav Joshi Key Informants Interview (FIVE) on child health problems &services available under (PHC)under PHC 52. Key Informants Interview (FIVE) on Chanchal Varshney Dr. Kirti Rahul population explosion & services available under (PHC) 53. Key Informants Interview (FIVE) on Pratik Solanki Dr. Prerna Agarwal HIV/AIDS & services available under (PHC) 54. Case study of ICTC facility at CHC/PHC Menat Hasmukh Dr. Nirav Nimavat 55. Case study of DOTS at village level Vibharti Bagri K Dr. Zalak Matariya

56. Case study of designated microscopic Hiral Sarvaiya Dr. Dhara Thakrar centre 57. Staff pattern & infrastructure of PHC Meena Rishi Singh Dr. Harshida Namera 58. Functions of PHC Vaja Faizan I. Dr. Vaidehi Gohil 59. Finance, logistics & supply of PHC Mansi Vadgama Dr. Nirav Nimavat 60. Services Provided by PHC Prateek Patel Dr. Zalak Matariya 61. Maintenance of cold chain Nirav Patel Dr. Anupam Banerjee 62. Birth & Death Registration Abhishek Mistry Dr. Chikitsa Amin 63. Management of Epidemic Bhoomi Bhadesia Dr. Kshama Gajera

64. Different Meetings held in last three Siddharth Raiyani Dr. Vibha Gosaliya months. 65. Rogi Kalyan Samiti, its structure & Shraddha Vaghela Dr. Bharat Gohel functions 66. Water supply and its purification in a Radhika Vadaviya Dr. Dhara Thakrar village 67. Waste management at Village level Sonagra Nandlal Dr. Chintan Dasaratha 68. Premonsoon Preparedness activities Meena Mahendra Dr. Prerna Agarwal Kumar 69. Planning & Activities for Mamata days. Moiz Vora Dr. Shital Bhalodia 70. e-mamta & its functioning Jay Vadodaniya Dr. Devangi Dholakia 71. Functioning of IDSP at PHC/SC Hitesh Valera Dr. Rajendra Chauhan 72. Activities under Kishori Shakti Yojna in a Jalpa Rathod Dr. Dipesh village Zalawadiya 73. UHTC-setup,Register,Reports Heena Rathod Dr.Nirav Joshi 74. Maintenance of cold chain Purandar Ribadia Dr. Kirti Rahul 75. Staff pattern & infrastructure of CHC Bansi Popat Dr. Dhara Jahangirporia 76. Functions of CHC Vatsaraj Shreem Dr. Chintan Dashratha 77. Finance, logistics & supply of CHC Dr. Nupur P Dr. Devangi Chaudhari Dholakia

Minutes of meeting conducted by Community Medicine Department with Khirasara PHC staff Date & Time: Friday, 6th November, 2015 (2 pm to 5 pm) Place: PHC-Khirasara

Meeting was called at 2 pm by head of dept of Community Medicine, PDUMC, Rajkot MO of Khirasara at PHC-Khirasara.

Meeting participants:

Dr. A. M. Kadri, Professor & Head, Community Medicine Dept., PDUMC, Rajkot Dr. R. G. Mahajan, Associate professor, Community Medicine Dept., PDUMC, Rajkot Dr. Kaushik Lodhiya, Assistant Professor, Community Medicine Dept., PDUMC, Rajkot Dr. Bhavesh Kanabar, Resident doctor, Community Medicine Dept., PDUMC, Rajkot Dr. Dhara Jhangirporiya, Resident doctor, Community Medicine Dept., PDUMC, Rajkot Dr. Harshida Namera, Resident doctor, Community Medicine Dept., PDUMC, Rajkot Dr. Nirav NImavat, Resident doctor, Community Medicine Dept., PDUMC, Rajkot Dr. Vaidehi Gohil, Resident doctor, Community Medicine Dept., PDUMC, Rajkot Dr. Zalak Matariya, Resident doctor, Community Medicine Dept., PDUMC, Rajkot Dr. J. M. Borkatariya, AYUSH MO, Khirasara PHC Pharmacist, ANM, FHW, MPW of Khirasara PHC

Agenda topics:

 Meeting began by Dr. Bhavesh Kanabar and discussed the aim and objectives of meeting. Though it was a review of various health indicators, he clarified that this wasn’t supervision but to find out the gaps and help to complete them. All 2nd year residents were active participants of meeting and free to ask queries related to reports which were given to them. Review was based on reports of October, 2015 Khirasara PHC. Dr. A.M Kadri, Dr. Mahajan and Dr. Kaushik Lodhiya were observing the methods of asking questions, helping to modify it and giving suggestions to solve it.  All sub centers (11) of Khirasara PHC reports were reviewed and various queries related to health indicators were asked directly to the worker of that particular sub center.  Though activities of each sub center were appreciable but still some gaps were found in achieving monthly target of TL operations, Cu-T insertion, distribution of Iron tablets, JSY beneficiaries etc. However yearly target achievement was according to workload.  Other issues discussed in meeting were post partum IUCD expulsion rate was high, so they prefer to insert after 2-3 months of delivery. Certain schools of village were not allowing vaccination because of side effects fear.  There were 12 home deliveries up till now. So various reasons for home given by staff were like delay in transportation to hospital, rumors, beliefs etc. It was also discussed that

JSY beneficiaries were less because targets were given according to BPL line listing, problems in documentation and frequent visit to bank for opening a bank account. Resident doctors would try to find out the hurdles associated in opening a bank account and would try to overcome.  The reason for high birth rate compared to ANC registration was twin’s delivery.  Maternal and child death review done at 3 to 4 months regularly and hard copy of report sent to district.

Main challenges-

. Mismatch between workload and survey population . Less beneficiaries of KPSY & JSY . Expulsion of PPIUCD . Issue of home delivery . Mamta card retained in zanana hospital . Refusal of vaccination (T.T) in certain schools of village etc.

Actions-

. Resident doctors will try to find out problems associated with various issues whether they are at field level, worker level, administrative level etc. After identifying problems they will try to help at every level and solve the issues. . It was decided that Dr. Harshida Namera would enlist specific reasons and circumstances of all these home deliveries. Dr. Vaidehi Gohil would deal with workload related issues. Dr. Nirav Niamavt would deal with issues related to opening of bank account for JSY, KPSY etc schemes. Dr.Zalak Matariya would give health education to various schools of Village and make them to understand importance of immunization etc. Dr Dhara Jhangirporiya would find out reasons for higher rate of PPIUCD expulsion. . MDR/XDR- report review, analysis and support . Visit with ANM and MPHW . Reasons (challenges) for low performance in JSY/KPSY . Case study on MAA and RBSK . Report review, Analysis and Support

Minutes of meeting conducted by Community Medicine Department with Khirasara PHC staff Date & Time: Friday, 29th November, 2015 (2 pm to 5 pm) Place: PHC-Khirasara

Meeting was called at 02:00 PM by resident doctors and Medical Officer (MO) of PHC Khirasara, Rajkot

Participants:

Dr. Aarohi Mitra, Resident doctor, Community Medicine Dept., PDUMC, Rajkot Dr. Dhara Jahangirporia, Resident doctor, Community Medicine Dept., PDUMC, Rajkot Dr. Harshida Namera, Resident doctor, Community Medicine Dept., PDUMC, Rajkot Dr. Nirav NImavat, Resident doctor, Community Medicine Dept., PDUMC, Rajkot Dr. Vaidehi Gohil, Resident doctor, Community Medicine Dept., PDUMC, Rajkot Dr. Zalak Matariya, Resident doctor, Community Medicine Dept., PDUMC, Rajkot Dr. Manthan Makadiya, MO, PHC Khirasara Dr. J. M. Borkhatariya, AYUSH MO, PHC Khirasara Pharmacist, ANM, FHW, MPW of PHC Khirasara

Agenda topics:

 Meeting began by Dr. Aarohi Mitra and discussed the objectives of the meeting. The objectives were to review various health indicators and help them to fill the gaps in reporting and service delivery. It was of supervisory type of review. All 2nd year residents were active participants of meeting and free to ask queries related to monthly reports which were given to them. Review was based on reports of November 2015 at PHC Khirasara.  All 11 sub centers of PHC Khirasara reports were reviewed and various queries related to health indicators were asked to ANM, FHW and MPW of that particular sub center.  Though activities of each sub center were appreciable but still some gaps were found in achieving monthly target of Cu-T insertion and monthly target of JSY beneficiaries etc. Certain schools of villages were not allowing iron tablets because of fear of side effects.  Maternal and child death review done at 3 to 4 months regularly and hard copy of report sent to district.  All MPW were asked about the survey and activities related to malaria and dengue.  All MPW and ANM were asked about fogging and spraying activities.  Advised MPW that the family members of should be given medicines and blood smears should be taken if the containers is positive for larva.  The blood smear of contacts of p. falciparum malaria cases.

 Visit of TB patients by MPWs.  Advised to regular update the line listing of family health survey.  Reviewed the work of ANM related to Gestational Diabetes Mellitus (GDM) and National Iron Plus Initiative (NIPI)  Reviewed the utilization of grant for starting vaccination centre in new subcenters.

Main challenges-

. Mismatch between workload and target of health indicators . Less beneficiaries of KPSY & JSY . Issue of home delivery . Issue of birth registration . Mamta card retained in zanana hospital . Refusal of iron tablets at some schools.

Actions-

. Resident doctors will try to find out problems associated with various issues whether they are at field, implementation and administrative level. After identifying problems they will try to solve the issues . Visits with ANM and MPHW in field . Reasons (challenges) for low performance in JSY/KPSY . Case study on e-mamta and HMIs . Report review, Analysis and Support

List of Case Studies done by Residents under RHTC

1] A case study on Govt. Institutional delivery discussion in review meeting of Taluka Health Officers and Medical Officers of PHCs of Rajkot, Gondal, Dhoraji and Jetpur block of Rajkot district -----Dr. Matib

2] A case study on Action plan of RCH 2 of Primary Health Centre (PHC) -----Dr. Ankit

3] A case study of Special Immunization Week (SIW) activity in March 2014 ----Dr. Ashutosh

4] A case study of activities by FHW in rural areas ----Dr. Ashutosh

5] A case study on Mamta Day (VHND) of Rajkot Corporation -----Dr. Jasmin

6] A case study of activities of ASHA in rural area ------Dr. Jasmin

7] A Case study of NID monitoring round of Polio of Rajkot District -----Dr. Dhara

8] A Case study of activities by ANM in urban area -----Dr. Dhara

9] A case study of NID monitoring micro plan in Rajkot Corporation -----Dr. Aarohi

10] A case study of activities by Link person (USHA) in urban area ----Dr. Aarohi

11] A case study on micro planning of Mamta Day (VHND) of Rajkot District ----Dr. Bhavesh

12] A case study of activities by CDPO in ICDS ------Dr. Bhavesh

13] A case study on “World No Tobacco Day” ------Dr. Bhavesh

14] A case study on “Reporting system of Sub-centre and PHC”----Dr. Zalak

15] A case study on “DLIMS”----Dr. Harshida

16] A case study on “E-Mamta”----Dr. Dhara

17] A case study on “HMIS”----Dr. Nirav

18] A case study on “Operational Aspects of Sub-Centre”----Dr. Zalak

19] A case study on “SWOTS analysis of PHC Khirasara”----Dr. Harshida

Case study on on Implementation status, Process & Situational analysis, Challenges and Uses DLIMS

 PHC – Khirasara  District – Rajkot  Date of Visit – 05/01/2016  Time of Visit – 2:00 p.m.

I have Visited PHC Khirasara & met to Jitendrabhai Nimavat (pharmacist) for getting information regarding DLIMS implementation at PHC level & its current Status.

DLIMS (Drug logistics Information and Management System) is an online web-based application. DLIMS has been developed by National Informatics Center (NIC) integrating various inter-related activities of the Centre Medical Stores Organization Office.

It was started since 2012 at PHC Khirasara. In this application, data entry of drugs (tablets, capsules, injections & syrups) and surgical items (gloves, needles, syringes) stock & its usage will be entered every monthly. So that available drug stock can be seen online & managed accordingly. Data entry is done between 1st -10th of every month by pharmacist.

Distinctive Features:

 Due to centralized data base accuracy increased as all activities are inter-related and using same data base.  System is hosted in central server of NIC hence data disaster, backup etc. are all taken care by NIC’s technical resources.  Management of drug procurement and supply improved due to continuous online monitoring.  As the system is online and all concern employees and officers uses the system at their own, a different working culture has developed with enhance computer literacy and in turn lead to human resource development.

Distinctive features of DLIMS

Advantage  Data duplication will not occur.  Facilitate continuous online monitoring of all PHC’s Drug & logistics.  As the system is online, enhance computer literacy.  Using latest information and communication technology to improve various functions like procurement; indenting, placing order, bill payment etc. to serve in a better and effective manner.

Issues related to DLIMS faced by Pharmacist:

 Interruption of continuous internet services, so difficulty in online entry.  Data entry regarding drug stock is possible but, indenting procedure & placing order is still done manually by pharmacist.  Work load is increased because duplication of work due to online data entry maintaining drug stock registers.

A case study on Implementation status, Process & Situational analysis, Challenges and Uses of E-mamta

 Place of visit: Primary Health Centre Khirasara  Block: Lodhika  District: Rajkot  Date of visit: 25/02/2016  Time of visit: 03:30 P.M. to 05:30 P.M.  Introduction: Tracking of Pregnant mothers and children has been recognized as a priority area for providing effective healthcare services to this group. As a major initiative in this regard, the Mother and Child Tracking system (MCH) is name based pregnant mother and child tracking system, an online application system also called E- mamta to monitor the services given to pregnant women & children of the state. It was developed and designed by Department of Health and Family Welfare of Gujarat in technical collaboration with NIC GUJARAT.  Goal of E- mamta: Reduction in IMR, MMR and drop outs of MCH services  Rationale of E-mamta: To develop management tools to provide quality MCH services, track drop outs and ensure complete service delivery for reducing IMR and MMR, to establish a credible monitoring system for MCH services, to increase the quality of service delivery  Basic components of E-mamta: 1. District Family Health survey 2. Verification & Validation of the data 3. Registration of mother and child 4. Tracking & Service provision  On the day of visit: we 3 resident doctors reached to PHC Khirasara at 03:30 PM. After reaching, we met the Medical Officer of PHC and told him that the purpose of our visit is to know the current situation and implementation of e-mamta at PHC level, Challenges faced and uses of e- mamta. Then we met Data entry operator and explained him the same. Then they explained us the points practically one by one.

 The official website of E- mamta is www.emamta.gujarat.gov.in  For any kind of information or help: [email protected]  After going to this site, first the operator has to log in. There are different ID and passwords of different PHCs and CHCs. One PHC operator knows his password only. Data entry operator does data entry of Family Health Survey, Registration, and Services to be provided. He generates Reports for review, Work plan, and Family Health Survey verification.  He generates work plans for new registration, ANC mothers, PNC mothers, delivery services, PNC mothers, PNC child, Child immunization, adolescent services, anaemia, malnutrition, institutional deliveries, FHS verification, Aadhar card collection, Family planning work plan both for males and females, Child screening both by FHW and MO, In child screening by MO- both Appetite test conducted and not conducted. The operator enters information according to mamta card. If there is any change e.g. new subcentres are opened, the data operator sends this information to nic. And the changes will be done by nic in the system. After the entry is done the unique family id, each member id, pregnancy id, mother id and child id will be generated. The ANM does Family Health Survey Update/Verification, receive workplan in timely manner and submit it duly filled, records e-Mamta generated unique ID in Register 4 & 5 and Mamta card, provides Mamta generated ID to beneficiaries counsels to keep Mamta card and ID when attending facilities. For e.g. before 1 week of mamta session, the operator sends blank format of workplan of immunization to ANM and then the ANM fills the according to due list, gives services, sends back to operator. Then the operator enters the given services to e- mamta format.  Medical officer ensures completeness and verification of Family Health Survey, ensures completeness for ANC and child registration, coordinates between staff for data entry and work plan, Validates and Verifies e-Mamta and HMIS, checks the updated information, services & data entry, review the performance of sub centres.  For mother data entry, 2 options are available. Mother/ pregnancy registration and direct data entry from delivery work plan.

 Steps for data entry for registration of pregnant mothers in E-Mamta: 1.For data entry at DH/CHC/PHC/ Private institution open the E-Mamta website using the following URL: http://e-mamta.guj.nic.in 2. Log in E-mamta software using your user id and password. 3. Select your district------4. Select the data entry type “mother entry registration” Click if the mother is the resident of village yes or no. b. If she is not the resident of that village than go to step “t”. c. If she is resident of that village then select her name. (All mother name will be displayed) d. Select the category of mother (From combo box) e. Enter her mobile no f. Select her blood group (From Combo box) g. Click CY beneficiary Yes/ No h. Click RTI/ STI checked: Yes/ No i. Click Home delivery kit given Yes/ No j. Click BPL yes/ No k. Click JSY beneficiary Yes/ No l. Enter the no of children presently alive m. Select the family planning method adopted previously. (From Combo box) n. Select the date of pregnant women registration (From Calendar) o. Select the last date of MC (From calendar) p. The expected date of delivery will be automatically computed. q. Select Para (From Combo box) r. Select the date of TT-1. (From calendar) s. Select the presentation of Womb (Gharb). (From Combo box) and click save t. If the mother’s name was not in the list, than verify and cross verify using search option in reports section, if still her name is not found than enter her name and other details and then save as new registration. Enter the services of that mother (Compiled through work plan).

6. Select the name of mother (If the name of mother is registered) from the date of registration, if name is not in the list, then verify, cross verify and do the new registration. 7. Select the services option and select various services 8. For TT-1, select the date of TT-1 given (from the calendar.) 9. For TT-booster, select the date of TT-booster given (from the calendar.) 10. For maternal death select the time, place and reason and date of death (From combo box) 11. Click if verbal autopsy is done and click save 12. For HB/ BP/ Weight data entry Separate module is provided. a. Select the month of pregnancy. (From combo box) b. Enter the HB of (in mg). c. The no of IFA tablets will automatically be selected based on HB measurement. d. Enter the weight of mother in kg. e. Enter the amount of albumin and sugar found in urine test. f. Enter the number of ration packets provided. g. Select the amount of iodized salt provided. (From Combo box). h. Enter the value of BP in numbers (high and low). i. Enter special note if any. j. Click save. k. You can also generate the graph of BP and weight. 13. For ANC.

a. Select the number of ANC (1st, 2nd, 3rd other) from combo box b. Select the date of ANC provided (from calendar) c. Select danger signs, if any. (From Combo box) d. If referral done, click yes e. Select the result of treatment. And save 14. For delivery a. Select the date of delivery (from calendar) b. Select the type of delivery (Combo box) (Normal/ Complicated/ C-section) c. Enter the number of live births and click Save

 Steps for data entry of child health services in E-Mamta: 1. For data entry at DH/CHC/PHC and private institution open the E-Mamta website using the following URL:http://e-mamta.guj.nic.in 2. Log in E-mamta software using your user id and password. 3. Select your district------(In case of child registration or the entry of child health services it is compulsory). 4. Select the data entry form of child registration. a. Select the mothers name from the list (A list of all mothers of that village will be displayed) b. If the mother’s name is not in the list than follow the step “k”. c. Select the name of child, if available (From combo box) d. If the name of child is not available, enter the name of child. e. Select the date of registration (From calendar) f. Select the date of birth of child (From calendar) g. Select the blood group of child (From combo box) h. Birth registered, click Yes/ No i. If yes, than Enter the birth registration number (CRS) j. Click infant death yes/ no and Click save k. if the name is not in the list than verify and cross verify using search option, If still name is not found than register the mother in new registration module and then start data entry for child. 5. For child growth a. Select the date of visit (From calendar) b. Enter the weight of child in kg c. Select age in month (From combo box) d. Click if IFA small is given e. Select if any child disease is found (From combo box) f. Click yes if complementary feeding is given g. If yes than click how many packets are given

h. Nutrition candy for the child of 3-5 years of age. Click for how many days nutrition candy is given i. Click for how many days RTA j. The growth chart of child can also be generated. k. Click save 6. For immunization service. a. Select the date of vaccine given. b. Enter the batch no of vaccine If any case of AEFI is reported. c. Click save.

 Challenges: More work load, internet connection problem, in case of power failure data of children are lost. When un-immunized child is found, for his entry first registration of the mother is compulsory. After tracing it in past the mother registration have to be done.  Lastly, we thanked all for giving the information of e- mamta and returned back at 05:30 PM

A Brief Report on State Routine Immunization Monitoring Activity

Introduction:

Department of Community Medicine, P. D. U. Govt. Medical college-Rajkot carries out monitoring of State Routine Immunization of Rajkot, Morbi and Kutch districts and Rajkot municipal corporation area. Designated staff of department along with one of the Residents visits PHC/UHC and Subcenter/anganwadi of allotted district/corporation on Wednesday/Monday. According to micro plan of respective PHC/UHC, subcenter or anganwadi is selected where mamta day session is held and with prior information visit is carried out with check list. Aspects of mamta day session to be observed are infrastructure, staff, logistics, Immunization, Maternal and child health services etc. Over 30 visits have been carried out for the current financial year.

These visits provide learning opportunities for the residents regarding Mamta Divas activities & field situations. A few of the photographs below depicts the same.

Report of Special Immunization Week (SIW) monitoring in Rajkot District & Corporation by Residents, Dept. of Community Medicine, PDU Govt. Medical College, Rajkot

SIW VISIT LIST

Name of Date of visit Rural Urban Residents Block PHC Dr. Aarohi 24/04/2014 Jasdan Block PHC Bhadla - 25/04/2014 Jetpar Block PHC Amarnagar 26/04/2014 PHC Santhali Dr. Matib 26/05/2014 - - Redcross Sadar 27/05/2014 Nandanvan Champak bhai Vora Dispensary Bhagvatipara Dr. Jasmin 29/05/2014 Wankaner Block PHC Lunsar - 30/05/2014 Jasdan Block PHC Bhadli Dr. Dhara 9/07/2014 - - Vijayplot 10/07/2014 Ambedkarnagar 11/07/2014 Railnagar Dr. Aarohi 9/07/2014 - - Ramnathpara 10/07/2014 Hudko 11/07/2014 Bhagvatipara Dr. Jasmin 9/07/2014 Morbi PHC Lalpar - 11/07/2014 Wankaner PHC Lunsar 12/07/2014 Rajkot PHC Sardhar Some of the Common key findings from SIW monitoring were:

Micro planning:

 Mostly the activity was planned in the same area where routine immunization session (Mamta day) is also carried out. As a result the no. of beneficiaries due for immunization found to be very less. As a result the main purpose of reaching the underserved areas during the SIW rounds was missed  Due to non availability of staff and measles surveillance activity (as per the talk with MO, UHC) certain sessions were postponed. Session site:

 The location was appropriate at all places but inadequacy of the space was found. So ANM despite of being aware of advising the care taker to wait for 30 minutes after vaccination was not able to do so.

Vaccine and logistics:

 All vaccines along with the diluents as well as logistics were available in adequate quantity at all session sites  Due list was not available with ANM as well as the mobilizer (link person/Anganwadi helper)  No IEC material was found to be displayed at most of the session site. Vaccination and post vaccination procedure:

 The recapping of the syringe after vaccination was observed at a few sites  Lack of proper BMW segregation was observed at most of the sites  Out of the 4 key messages to be delivered to caregivers, most of the ANMs were not explaining about what vaccine was given and which disease would be prevented by it Observation from House to house visit:

 In a few of the areas completely or partially unimmunized children were found. The common reasons were o Parents resistance o The families were out of the station on the day of session o Child was suffering from fever, so parents decided against giving vaccination o Link person of that area was on leave on the day of session, so possibly some of the beneficiaries were not mobilized only on the session day Recommendations:

 The concept and rationale of SIW round should be made clear to all MOs before making of the micro plan. Reviewing of the micro plan should be done by senior authorities before finalizing it.  Site selected must be hard to reach/underserved area  Before finalizing the date for SIW, it must be ensured that all the staff remains present on the day of round.  The Provision of fund for rent of the house/room of sufficient space on the Mamta day/SIW round should be considered to improve quality of the service provided  It would be better if a video of an ideal practice of vaccination activity to be done is shown in the training to all workers as it may eliminate their misconceptions and can understand their own mistakes that were done in the last round  Need of increasing IEC activities. At least banner of mamta session/SIW round should be made available to all session sites.  The training for development of counseling skills of peripheral health workers should be organized, so that they can convince resistant beneficiaries for the various health services provided by the government.

Participation in Anti Malarial Month Activities

Vector borne diseases are major problem in India. Out of all Vector borne disease, Malaria morbidity and mortality are major public health concerns in India. The disease is greatly affected by social and economic conditions and is referred to as both a disease of the poor and a cause of poverty. For this reason, National Vector Borne Disease Control Programme (NVBDCP) was launched in year 2002.

For prevention and control of malaria, Anti Malarial Month is observed every year in the month of June throughout the country prior to the onset of monsoon and high transmission season.

All the residents visited various sites where Anti Malarial Month activities were conducted like Indoor Residual Spray (IRS), Abate application, MLO & Larvivorous fish application at Vajdi vad, Metoda GIDC and Haripal pal under PHC Khirasara

INDOOR RESIDUAL SPRAY (IRS)

On 22/05/2014, Residents visited Vajdi vad village under PHC Khirasara for observing Indoor Residual Spray (IRS) activity.

They met team squads and supervisor then supervisor saw various equipments used for IRS activity like bucket, measuring mug & jug, other mechanical tools. Alphacypermethrin was used for IRS EQUIPMENTS for IRS activity

They had observed suspension process for IRS activity, spraying activity carried out by team members in houses as well as house marking after spraying.

ABATE APPLICATION

 On 13/06/2014, Residents had visited for Abate (TEMIFOS) application activity at Metoda GIDC under PHC Khirasara

 During visit first they met supervisor, ASHA & FHW who were involved in the activity. The workers then inspected various water tanks for identifying mosquito larve following which there was abate application. This was then documented in appropriate registers.

Searching larva by Health Abate Application by FHW Documentation activity Supervisor

Mosquito Larvicidal Oil (MLO) & larvivorous fish application

On 23/06/2014, Residents had visited for Mosquito Larvicidal Oil (MLO) application and larvivorous fish (Guppy Fish) activities in a pond at Haripal pal and Vajdi vad villages under PHC Khirasara

During visit, they observed MLO preparation by using cloth & factory machinery oil. A parcel of stone & cloth wrapped over it was made. This was then dipped in MLO, following which it was thrown into the ponds from various places covering the entire pond.

 Residents also visited Larvivorous fish ( Guppy fish) farming pond and also observed how to release fish in water tank

Guppy fish Release Guppy fish in water tank

Intensified Diarrhoea Control Fortnight Supervision

 Date : 05/08/2014 & 07/08/2014

 PHC visited : Gadhka, Sardhar, Khirasara, Sarapdad, Shivrajgadh , Derdi , Mota dadva, Ramod

 Objective of Visit: Supportive supervision of activities done under IDCF

Residents of PSM department, Rajkot along with health officials visited Health facilities of the above mentioned PHCs. In some of the PHCs there was no ORS corner. So upon consulting with the MO PHC, immediate corrective actions were taken & ORS corner was developed. On the contrary however, a few of the PHCs had well maintained ORS corners (Banners, ORS sachets, Zinc tablets, containers, potable water & requisite IEC materials) for which the residents also praised the officials & reported the findings to Health Department.

Residents also visited ASHA workers & AWW in all the PHC as well as SC areas. They inquired about sufficient supply of ORS & Zinc tablets & approximate number of diarrhea case per month. They also studied the management of diarrhea case by health workers & did suggest a few corrections. They asked for any on the job difficulties of workers & tried to solve them by consulting the Health Officials.

After visiting the Health facility, they visited a few households in the community. They did focus group discussion with mothers regarding diarrhoea & its management and also demonstrated ORS preparation to them.

Attending District & Block Level Health Staff Meetings Of Rajkot

Every month a district review meeting of Rajkot district is held in conference hall situated at Rajkot Jilla Panchayat. Residents of PSM department, PDU Govt. medical college, Rajkot regularly attends these meetings as a part of their routine training activities under RHTC. From March 2015 to Dec 2015, seven district meetings were held. Our residents have attended six of them while one meeting could not be attended due to other simultaneous departmental activities. The main purpose for which residents attend these meetings is to know about various managerial aspects & technical aspects concerning functioning any Govt. programme. Simultaneously residents also come to know about the real field situation as against the ideal as studied in books, various manpower & material issues in the field, about financial aspects of various activities, about community response to various activities. After attending the meetings, the key points are discussed with the Head of Department of PSM as well as Assistant Professor in-charge of RHTC. The minutes of meeting attended are documented in RHTC file. The key observations of the residents are as follows: CDHO is the chairperson and RCHO, ADHO, QAMO and Epidemic medical officer are the key persons involved in review of activities for the last month as well as planning for next month activities. All the MO of PHCs of Rajkot district attend these meetings and discuss the last month performance of their PHCs as well as the problems faced in delivering services to the community. In general the following points are discussed in Meeting: 1. Any Health related day celebration in last month and in upcoming month 2. Any new Yojana started by Gujarat Government or by Union government 3. Any new guideline received in last months 4. Reviews of the various activities done by PHCs in last month in comparison to their Target 5. Problems faced by staff members Review activities focused on the following issues: RCH Activities

a. Early Registration & Institutional delivery b. PNC services c. Immunization d. Family Planning NVBDCP Activities RNTCP Activities

Annexure I

Staff for Rural Training Health Center (Including field work and epidemiological studies)

1. Dr. Vibha Gosalia Assistant Professor 9913465721

2. Dr Shital Bhalodiya LMO 9724552348

3. Dr. Harshida Namera Resident * 9033379307 4. Dr. Ruchita Lunagariya Resident * 9925004694 5. Mrs. Jyotiben Sorathia PHN 9725293711 6. Ms. Jyotsna Goswami Lab. Tech. 9925248849 7. Ms. Pipaliya Anila MSW 8980049347 8. Mr. Ashwin Sosa MSW 8866389517 9. Ms. Jalpabe Trivedi Health Educator 9979287501 10. Bhavdeep Vaghela Health Inspectior 706934 8582 11. Mr. A. P. Vania Store Keeper/record clerk 12. Mahavirsinh Zala Driver 9824873931 13. Gauriben Sagathiya Peon 14. Harun bhai Chandani Sweeper 9824047304 15. Bharatbhai Sodha Sweeper

*On Rotation basis

 R 3: Dr Bhavesh Kanabar  R2: Dr. Nirav Nimavat  R1: Dr. Rajan Upadhyay  R 3: Dr. Jasmin Oza  R2: Dr. Vaidehi Gohil  R1:Dr. Nidhi Mangrola  R 3: Dr Aarohi Mitra  R2: Dr. Zalak Hardik  R1: Dr. Ruchita Lunagariya  R3: Dr. Ashutosh Jogiya  R2: Dhara Jahangirporia  R 3: Dr Dhara Thakar  R2: Namera Harshida

Annexure II - STAFF POSITION PHC –KHIRASARA

Sr.No. Staff Name Designation Head Quater Mobile No. 1 Dr. Makadiya MO Khirasara 9909987811 2 Dr.J.M.Borkhatriya MO Ayurv. Khirasara 9909987827 3 Mr. J.D.Nimavat Pharma Khirasara 9428157848 4 Mrs. K.K. Trivedi Lab.Tech. Khirasara 9537306508 5 Mr. S.D.Senjaliya MPHS Khirasara 9409383324 6 Mrs.G.D.Jadeja FHS (I/C) Khirasara 9909954816 7 Mrs.G.D.Jadeja FHW Vad Vajdi 8 Mrs.S.P.Gosai FHW Khirasara 7567877896 9 Mrs.M.V. Nagvadriya FHW Metoda 9909987820 10 MRS. R.C. Bokhani FHW Chibhda 11 M.M. Pandya MPW Vajdi 12 D.C. Pandya MPW Chibhda 13 Mr.A.B.Sarvaiya Comp. Operator Khirasara 7567877879 14 Mr.V.K.Katir ICTC coun. Khirasara 9978025152 15 Mrs.B.K.Vala Aaya Khirasara 16 Mrs.N.R.Parmar Swiper Khirasara

Annexure III

List of Laboratory Tests being done at RHTC/PHC

1. Hemoglobin by sahli”s method 2. Blood grouping 3. Total count/ Direct count 4. ESR by westergreen method 5. Malaria by p/s 6. Urine : Routine & Micro 7. Pregnancy detection - UPT 8. Typhoid by Widal 9. Syphilis by RPR 10. HIV by combed (Stand alone ICTC) 11. Sputum is collected for AFB & is sent to Rajkot civil Hospital for AFB staining & reporting.

Annexure IV

 OPD data  ANC service data  Immunization service data  Family Planning service data  Laboratory investigations related data

RHTC Performance Indicators

Indicator Year Year 2014- Year April 2016 2013-14 15 2015-16 Total OPD cases 32059 39500 38304 2759 Lab. Investigations MP 20214 21307 19699 686 Hb 1879 2282 1829 119 Blood group 765 987 1307 71 Blood sugar 1581 989 1983 269 HIV 3335 3759 5838 199 Urine A/S 1871 2472 772 97 Pregnancy test 664 696 502 51 VDRL 793 980 871 185 WIDAL 208 405 313 13 BS/BP 310 66 35 11 TC/DC 1100 1022 183 4 Urine R/M 517 606 2 0 HbsAg 1 0 3357 71 ESR 8 0 0 0 Total 33246 35571 36691 1360 ANC services No. Of ANC mothers 1651 1796 1761 42 No. of early ANC registration 1218 1354 1344 37 No. of ANC registered in JSY 146 108 137 4 No. of pregnant women with 3 ANC 1287 1322 1505 52 check up No. of pregnant women given TT-1 1334 1472 1481 34 No. of pregnant women given TT-2 1539 1696 1746 59 & booster No. of ANC given 100 IFA tablets 1255 1541 1702 48 No. of pregnant women with 0 0 0 0 hypertension No. of newly diagnosed 0 0 0 0 hypertension cases among pregnant women No. of eclampsia cases managed 0 0 0 0 No. of pregnant women with 0 0 0 0 anaemia No. of pregnant women with 1061 962 829 15 Hb<11 gm% No. of pregnant women with Hb<7 0 0 0 0 gm% and treated No. of home deliveries 21 12 14 0

No. of newborns visited among 16 12 14 0 home deliveries No. of deliveries in PHC 71 49 38 0 No. of mothers discharged within 71 49 38 0 48 hours among them No. of deliveries in sub centre 21 19 10 0 No. of mothers discharged within 21 19 10 0 48 hours among them No. of deliveries in other 676 762 826 19 private/trust hospitals No. of mothers discharged within 676 762 826 19 48 hours among them No. of deliveries by C-section 127 142 0 No. of C-section deliveries in PHC 11 0 0 0 No. of C-section deliveries in other 116 142 153 0 private/trust hospitals No. of total live births 793 845 894 20 No. of still births 10 6 5 0 No. of abortions 0 3 0 0 No. of newborns <2.5 kg birth 2 0 0 0 weight No. of newborns initiated with 793 844 894 20 breastfeeding within an hour No. of pregnant women with 0 0 0 0 obstetric complications No. of complicated cases treated 0 0 0 0 No. of post natal check up done 789 841 888 19 within 48 hours of delivery No. of post natal check up done 789 841 888 19 after 48 hours to 14 days No. of postnatal women with 0 0 0 0 complications & treated Family planning services No. of Cu-T inserted 613 659 683 11 No. of OC pills cycles distributed 2066 2033 2145 110 No. of Condoms distributed 5288 18468 37830 1638 Immunization services No. of children given BCG 1383 1432 1706 39 No. of fully immunized infants 1543 1542 1666 37 No. of fully immunized children 1322 1298 1579 42 between 12-23 months No. of AEFI reported 186 93 118 7

Population of Khirasara PHC

Resident duty list

July- 2015 to September- 2015

Sr. No. Name Place of posting 1 Dr. Jasmin Oza 2 Dr. Nirav Nimavat R.H.T.C. Khirasara 3 Dr. Nidhi Mangrola 4 Dr. Dhara Jahangirporia

October - 2015 to December - 2015

Sr. No. Name Place of posting 1 Dr. Ashutosh Jogia 2 Dr. Bhavesh Kanabar R.H.T.C. Khirasara 3 Dr. Harshida Namera 4 Dr. Rajan Upadhyay

January- 2016 to March- 2016

Sr. No. Name Place of posting 1 Dr. Nirav Nimavat 2 Dr. Ruchita Lunagariya R.H.T.C. Khirasara 3 Dr. Zalak Matariya 4 Dr. Vaidehi Gohil

April – 2016 to June – 2016

Sr. No. Name Place of posting 1 Dr. Ruchita Lunagariya 2 Dr. Dhara Jahangirporia R.H.T.C. Khirasara 3 Dr. Harshida Namera 4 Dr. Rajan upadhyay