Project Report
Study of Civil Dispensaries & Urban-Primary Health Centers in Madhya Pradesh
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis FINAL REPORT
Study of Civil Dispensaries & Urban-Primary Health Centres in Madhya Pradesh
September 2018
STATE HEALTH RESOURCE CENTER (SHRC) ATAL BIHARI VAJPAYEE INSTITUTE OF GOOD GOVERNANCE AND POLICY ANALYSIS
A Study of Civil Dispensaries & Urban Primary Health Centres in Madhya Pradesh 2018
About the Report
This study report is an attempt to bridge the information gap on current situation of urban health initiatives undertaken by the Urban Health Mission Madhya Pradesh. The State Health Resource Centre is the technical support unit for Department of Health and Family Welfare, Government of Madhya Pradesh. Based on their request to conduct study and develop report reflecting current situation of Civil Dispensaries and Urban Primary Health Centre’s. The basis of the current report is analysis of department records, Health Portal HMIS and facility survey data. It is part of a series of SHRC Reports for strengthening the Public Health System of Madhya Pradesh.
Ms. Preeti Upadhyay Advisor- SHRC prepared the report under the guidance of Mr. Madan Mohan Upadhyay, Principal Advisor- Social Sector Development and Mr. Akhilesh Argal, Director AIGGPA.
Study Team
Mr. Madan Mohan Upadhyay Principal Advisor Ms. Preeti Upadhyay Advisor Dr. Konika Jain Research Associate Dr. Sapna Anchal Research Associate Dr. Sumit Chouhan Research Associate Dr. Karan Dandotiya Research Associate Ms. Leena Singh Research Associate
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Abbreviation
ANC Antenatal Care ANM Auxiliary Nurse Midwife CD Civil Dispensary DHFW Department of Health and Family Welfare HCF Health Care Facility IEC Information Education Communication IUD Intra Uterine Device JNNURM Jawaharlal Nehru National Urban Renewal Mission MCH Maternal and Child Health MoHFW Ministry of Health and Family Welfare MP Madhya Pradesh MPW Multi-Purpose Worker NUHM National Urban Health Mission UPHC Urban Primary Health Centre
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Executive Summary
Background: With the introduction of the NUHM, the state systematically addresses the issues of primary health care services in urban areas in year 2013. Similar to the rural PHC, the urban PHCs envisaged as the nodal point for delivery of health care services under the NUHM. Government of India has recognised that urban areas are shrinking due to increased population and have congested especially slum and slum like habitations, and with poor or no proper sanitation, water supply, garbage disposal mechanism there is resurgence in urban infectious diseases in these areas. It is expected that Urban PHC’s shall be responsible for health needs/vulnerability assessment, facility based service provision, outreach services, referral services, disease surveillance and epidemic control and convergence with other national programs.
This study conducted to get an overview of the current situation of civil dispensaries and urban primary health centers in the state. The special focus is to understand the availability of health facilities, physical infrastructure and human resource and services provisions.
Quantitative and qualitative data collected and analyzed to meet the study objectives. The In-depth discussion and observation tools were prepared for facility survey. The staff and OPD related HMIS records collected from health department. Detailed report based on the primary and secondary data has tried to capture the following:
Geo location of the Civil Dispensary and Urban Primary Health Centers in MP. Status of human resource and out patient load as per the records of the HMIS portal. Availability and accesses to infrastructure, services and management of the selected urban primary health centers for the study.
Major Findings: Service Records The urban health centers were Geo-mapped as per HMIS records of the existing health facilities. The geo mapping of the health facilities reveal that urban health Centres are prominently present in the densely populated urban areas. Data from Gwalior, Bhopal, Indore, Jabalpur and Sagar regions show high density of urban health facilities. However, substantial non-functional health facilities are also located in the same regions.
The study highlights that there is great shortage of manpower at UPHC. In total 125 UPHC, only 537 persons posted which is about 30.7 percent of the recommended staff strength. The study finds that staff is very limited as compared to the responsibility and workload assigned to the UPHC and Civil Dispensaries. There are only 54 Medical officers and 9 contractual Medical officers in total 109 Civil Dispensaries covered that
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A Study of Civil Dispensaries & Urban Primary Health Centres in Madhya Pradesh 2018 means the functional status of CDs are doubtful. The proportion of non-functional Civil Dispensaries are large than Urban-PHC in Madhya Pradesh.
The HMIS OPD record of last year reveals about the types of health related reasons for which patients visited the urban health facilities. As per the OPD records people visited health facility for general health reasons, treatment of hypertension, diabetes, ophthalmic care, dental care and general illness including psychological and emotional ones. About 170 health centers inclusive of Urban PHCs and Civil Dispensaries provide services related to maternal health, child health & nutrition and Vector borne disease. The essential services confined to general consultation and they mostly referred to nearby government health facility.
Major Findings: Facility Survey All the surveyed Urban-PHCs are situated within the prescribed limit of distance and they either are situated within slum or are adjacent to them. However, it was difficult to locate some of the facilities due to incorrect location address and absence of direction signs. Facilities like separate dressing room, seating arrangement and appropriate waiting space were not available in all the facilities. The provision of safe drinking water for staff and patients was not found in a portion of the health facilities. It is important to mention here that internet facility was also not available at any facility. Facilities follow the practice of manual registration of OPD cases. The facilities do not have separate arrangement for examination of patients related to RCH and this highlights the fact that there is no emphasis on arrangements for privacy and confidentiality. The government has attempted to establish UPHCs and other health facilities in the urban areas. At present majority of the facilities are being run from the rented buildings that were not constructed for running health facilities and that is the reason of shortage of space for almost all the activities.
Majority of the Urban-PHCs follow the GOI pattern for operating the OPD services and are providing service from12 noon to 8 pm. Few UPHCs depend on the staff attached to the facility and due to this reason, the facilities are forced to operate for a lesser period of time that is 4 hours in a day. Civil Dispensaries have a different practice and the either provide OPD services in the morning or in morning or evening both.
At present, most of the health staff working in urban health facilities has very limited exposure and knowledge about their wider role of UPHC and other urban health institutions. Data also highlights the fact that limited efforts taken to protect the staff from health risks.
At present, the health facilities lack basic infrastructure to offer basic lab services. This forces the doctors and health staff either to refer the cases to district hospital or to get tests done through private pathology. Moreover, almost all the facilities face the problem of limited or non-availability of necessary equipment.
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The situation of availability of basic drugs is much better than other indicators. Health staff informed that basic drugs are always available in the facility. In case of shortage or requirement of any particular drug, demand of drugs to the district authorities that is send and these drugs are available to the facility within 7-10 days.
Study also identified key barriers vis-à-vis access to basic services provided by urban health facilities and the barriers are linked to the lack of basic physical amenities in the buildings in terms of adequate space for different service, provision for privacy and confidentiality, separate toilets, safe drinking water. Lack of sufficient staff also increases the workload on the existing staff and pending decisions demotivates them from taking initiatives.
The status of managing and disposing biomedical waste is very poor due to shortage of staff, proper orientation of existing staff, and lack of necessary facilities. Proper segregation of the biomedical waste was not in place. The sharp edge waste items were mixed with the other waste items. In some facilities, infectious and noninfectious waste was observed in the same bins. The study also found that the Medical Officers posted in Urban-PHC were also not aware about fund status.
Conclusion Government has attempted to establish UPHC and equip other urban Civil Dispensaries so that they are able to cater health services to most vulnerable population of urban areas of the state. At present the Urban Health facilities are in their nascent stage and lack basic orientation, infrastructure and equipment necessary run an UPHC. All these urban health facilities require proper attention and support from the existing health management system. Identifying proper and specious building, posting proper and sufficient staff and appropriate training and orientation is necessary to run the UPHC as per the expectations of National Health Mission. Government need to mainstream the process of planning for extending health services to urban poor. It becomes more important when the shift from rural to urban areas is very rapid and majority of the distressed rural population is migrating and coming as vulnerable and deprived population of the urban slums.
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Recommendations Based on study findings, the suggested recommendations are as below:
1. Administration: During the process of verification, some of the facilities found relocated or closed. It is very important to verify all the functional Civil Dispensaries and Urban PHCs in the state. It revealed that staff posted in the Urban PHCs and Civil Dispensaries are not full time staff and thus are under multiple administrative control. It is worth recommending here to have only one administrative control at district level to avoid multiple instructions.
2. Access and Infrastructure: Study recommends that UPHC and CDs to have separate and proper room for consultation, dressing, pharmacy and lab with seating arrangements for the patients. Ramp or hand railing, proper light and ventilation in the facility must be ensure before finalization of the Structure. Regular maintenance of the government buildings (majority of Civil Dispensaries) is highly recommended as it creates a bad visual and environmental impact on the staff and patient apart from other problem.
3. Human Resource/Health Staff: In order to improve the health care services provided by the Civil Dispensaries and Urban-PHCs, recruitment and posting of staff as per norms and capacity building needs to be done on priority basis.
4. Service Provision: Basic laboratory and required equipment’s must be provided to all the facilities for timely identification, diagnosis and treatment to avoid undue pressure in district hospitals. National health programme guidelines need to be followed for implementation at the urban centers. To avoid delays and non-availability of drugs and equipment at the centers, the provision of advance planning and demand should be made.
5. Convergence and Partnership: This is one of the significant areas that needs to be explored by the department. It is recommended to explore potential partnerships available at district level. It could be in primary diagnostic area like basic pathological tests and digital X-ray. It would help by nominating/appointing the state and district level nodal officers.
6. Fund: Comprehensive mapping of activities and financial planning should be done in coordination with NUHM i.e. multiple PIP of national programme, NHM, UHM should be avoided. Electronic transfers of funds must be brought in practice.
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Contents
1. Background ...... 9 2. Study - Present Situation of Civil Dispensary and Urban-PHC ...... 11 2.1 Study Objectives ...... 11 2.2. Methodology ...... 12 2.2.1 Service Records ...... 12 2.2.2 Facility Survey ...... 12 2.2.3 Execution Steps ...... 13 3. Findings - Service Records ...... 15 3.1 Geo-mapping of Civil Dispensaries and Urban-PHCs ...... 15 3.2 Status of Human Resource ...... 17 3.3 Service Provision ...... 22 4. Findings - Facility Survey ...... 25 4.1 Infrastructure ...... 25 4.2 Human Resource ...... 30 4.3 Service Provision ...... 32 4.5 Referral Services ...... 45 4.6 Management ...... 46 4.7 Convergence and Partnership ...... 52 5. Conclusion ...... 53 6. Recommendations ...... 55 7. Limitations ...... 57 8. References ...... 58 Annexure ...... 59
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1. Background
The Bhore Committee, in 1946, introduced the Primary Health Centres in India to provide an integrated curative and preventive health care to rural population. In urban areas there have not been any coordinated efforts for primary health care. Urban India have had many versions of the PHC, varying from state to state under various projects, providing a range of services such as urban health posts, urban health and family welfare centres, urban health centres and civil hospitals. It is important to mention here that all such health services in urban areas have been sporadic and unsystematic in their population coverage, service package and locations.
Urbanization is one of the most significant demographic trends of the 21st century. Unplanned and rapid urbanization has led to massive growth in the number of urban poor population, especially those living in slum areas. However, most of the Indian towns, lack the necessary infrastructure in terms of proper housing, water and sanitation, basic services such as health care and education to accommodate and meet the needs of poor migrants. The poor living conditions have implications for health, wellbeing and productivity. While on one hand the cities are considered full of opportunities and affluence, paradoxically they become hubs of marginalization, poverty and disease.
The urban poor not only suffer from poor health status with higher burdens of mortality, morbidity and under-nutrition compared to rest of the urban population but also the incidence of vector borne diseases, tuberculosis and respiratory infections are significantly higher (WHO, 2009). Despite the supposed proximity of the urban poor to health facilities, their access to these is severely restricted. Social exclusion, lack of information, unavailability of assistance at the secondary and tertiary hospitals further restricts their access to health care services. Ineffective outreach and weak referral system inhibits them from accessing the available healthcare facilities. The lack of economic resources limits their access to the available private facilities. Keeping this in view, Government of India approved the Urban Health Mission as a sub-mission of National Health Mission (NHM) on 1st May 2013. The objective of the National Urban Health Mission is to address the primary health care needs of the urban poor and marginalized population.
It is clear from NUHM guidelines that the U-PHC may cater to a slum population ranging from 25,000 to 30,000. The guidelines also specify that depending on the spatial distribution of the slum population, the population covered by a U-PHC may vary from 50,000 for cities with sparse slum population to 75,000 for highly concentrated slums. Centre, through NUHM has made it clear that the UPHC must be located within a distance of not more than ½ a kilometre from a slum or slum-like habitation, to ensure easy access by the most vulnerable of the urban population.
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The guidelines strictly clarify that the hours of operation of the UPHC must enable the urban working population to conveniently access the UPHC. With this precondition the NUHM has given liberty to state for providing 8 hours of service, which is convenient to the community it caters to. NUHM has recommended that the U-PHC should preferably operate from 12 noon to 8 pm. If states opt for dual shifts, this shall entail employing additional staff. High caseloads may be a criterion for allocating additional staff to UPHCs. NUHM has also suggested staff pattern for U-PHC. As per the suggestion of NUHM there should be One MO I/C, one part time MO, One LHV, Nurse, Lab Technician, Pharmacist, Public Health Manager/ Mobilization Officer, M & E Unit, 3 Support Staff and 3 to 5 ANMs.
National Urban Health Mission envisages to cater the health care needs of the population with special focus on urban poor, by making available essential primary health care services. This will be achieved by strengthening the existing health care service delivery system, targeting the people living in slums and converging with various schemes relating to wider determinants of health like drinking water, sanitation, school education, etc. programme implemented by the Ministries of Urban Development, Housing & Urban Poverty Alleviation, Human Resource Development and Women & Child Development.
The framework of the National Urban Health Mission visualizes provision of primary healthcare to the slum dwellers and vulnerable groups through targeted outreach services. Unlike in rural areas, sub-centers are not being set up in the urban areas as distances are relatively small and transportation facilities are easily available. While routine health services at the Urban-PHCs, package of certain identified services would be provided through targeted outreach services in non-accessible clusters. ANM would provide the outreach services to these vulnerable populations in slum areas. In addition, special outreach services would also be organized for these identified slum & vulnerable population pockets periodically as per the specific local healthcare needs. The National Health Mission (NHM) has identified following segments of population as high focus clusters that are in line with National Health Policy 2017:
Urban Poor Population living in listed and unlisted slums All other vulnerable population such as homeless, rag-pickers, street children, rickshaw pullers, construction and brick and lime kiln workers, sex workers, and other temporary migrants. Public health thrust on sanitation, clean drinking water, vector control, etc. Strengthening public health capacity of urban local bodies.
Given the large presence of private sector in urban areas, national Health Policy 2017 also recommends exploring the possibilities of developing sustainable models of partnership with for profit and not for profit sector for urban health care delivery.
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2. Study - Present Situation of Civil Dispensary and Urban-PHC
The aim of National Urban Health Mission is to provide comprehensive preventive, promotive and no domiciliary curative care services to urban poor population. It is expected from urban primary health centers to provide health services like OPD (consultation), basic diagnosis services, drug /contraceptive dispensing and delivery of Reproductive & Child Health (RCH) care services including preventive and promotive care for communicable and non-communicable diseases.
In Madhya Pradesh, Urban Health Mission began its operation since its inception in year 2013. Prior to urban health mission, the Civil Dispensaries were already established in urban areas for providing primary health care services. Under urban health mission, new Urban Primary Health Centres were created in addition to Civil Dispensaries to address the health needs of slum population. In order to understand the current situation of Civil Dispensaries and urban primary health centers in Madhya Pradesh, this study was conceptualized.
The present report is the outcome of the study conducted by AIGGPA for Department of Health and Family Welfare Madhya Pradesh to get an overview of the current situation of civil dispensaries and urban primary health centers. The special focus of the study is to understand the availability of health facilities, physical infrastructure, human resources and service provisions.
2.1 Study Objectives
The main purpose of the study is to undertake situation analysis of Civil Dispensaries and Urban Primary Health Centers in Madhya Pradesh.
The specific objectives of the study were:
1. To Geo-map all the Civil Dispensaries and Urban-PHCs in Madhya Pradesh. 2. To assess the human resource gaps (against NUHM norms) in all Civil Dispensaries and Urban-PHCs in the state. 3. To study the OPD records of all Civil Dispensaries and Urban-PHCs in last one year from MP Health Management Information System database. 4. To study the services related barriers faced by staff of Civil Dispensaries and Urban-PHCs in the state. 5. To identify the potential stakeholders, service collaborates (Public Private Partner) and referral points of selected Civil Dispensaries and Urban-PHCs in the state.
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2.2. Methodology
The current study is primarily a cross section study, a mix of primary and secondary data analysis. In study, quantitative and qualitative data collected and analyzed to meet the study objectives.
2.2.1 Service Records
The records related to Human Resource of Civil Dispensaries and urban primary health centers from Department of Health and Family Welfare Madhya Pradesh and National Health Mission MP collected and analyzed. In addition, Health Management Information System (HMIS) database of last one year (April 2017 to March 2018) collected to understand the OPD profile of patients who visited Civil Dispensaries and Urban-PHCs. The discrepancies related to number of Civil Dispensaries and Urban- PHCs were observed during data analysis. Subsequently, district wise data triangulation exercise was performed to verify the facility name from HMIS and HR records to ensure the actual number of Civil Dispensaries and Urban-PHCs reported in records.
2.2.2 Facility Survey
In addition to service records, a survey of urban health facilities was also conducted in the state. Considering the representation of all the 10 divisions, 11 districts were selected randomly. Further, within the selected districts, 1 Civil Dispensary and 1 Urban-PHC were chosen randomly. The facility survey was conducted at the following locations in May 2018: Table 1: List of facility survey locations Sl. Division Survey Locations No. District Civil Dispensary Urban-PHC 1 Bhopal Bhopal 1. CD Anand Nagar 1. Sai baba Nagar 2 Chambal Bhind 2. CD Bhind 2. B.T.I. Road 3 Gwalior Gwalior 3. CD Palka Bazar - 4. CD Gol Pahariya - 4 Indore Indore 5. CD Bhanwarkuan - Dhar 6. CD Branch 2 3. Ganji Khana 5 Jabalpur Jabalpur 7. CD Gohalpur Ward 4. Ghamapur 6 Narmadapuram Harda - 5. Harda 7 Rewa Rewa 8. CD Univ Rewa 6. Bodabag 8 Sagar Sagar 9. CD Bhagwanganj 7. Bina 9 Shahdol Umaria - 8. Loharganj 10 Ujjain Ujjain 10. CD Madhavnagar 9. Pawasa Note: Civil Dispensary is not available in any of the districts in Narmadapuram & Shahdol Divisions. One Civil Dispensary from Indore was selected randomly considering the size of the town.
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2.2.3 Execution Steps
2.2.3.1 Development of tool and testing:
The study tools i.e. In-depth Interview guideline consisting of structured, semi- structured and open-ended questions were developed for collection of primary data. The In-depth interview guideline developed by AIGGPA in consultation with National Health Systems Resource Centre (NHSRC) New Delhi and R.D. Gardi Medical Collage Ujjain. The draft study tool was shared with Urban Health Mission Government of Madhya Pradesh for their inputs. The study tool was finalized after incorporating all the inputs. The AIGGPA team also visited Sehore district to test the study tool before commencement of survey.
2.2.3.2 Training of study team:
A team of four members having community medicine educational background was constitutes to conduct the field operation. In May 2018, one day orientation for study team was conducted at AIGGPA wherein representative from Urban Health Mission GoMP was also present. The training included classroom training for understanding the Urban Health Mission operations, study objectives and data collection procedure. The detail discussion on in-depth-guideline (study tool) was done in participatory way. Eventually, study team made a field visit at Civil Dispensary Bhopal to have an idea about working of Civil Dispensary and its operations.
2.2.3.3 Data collection:
Primary data were collected by the study team in the month of May 2018. The AIGGPA representative also visited the field during the survey period to ensure the quality of data and hand holding of the study team.
From secondary sources, Civil Dispensary and Urban-PHC wise health staff status, OPD records from Health Management Information System (HMIS), Directorate of Health and Family Welfare and National Health Mission Madhya Pradesh offices were collected. Following records were referred for secondary data analysis:
i. Directorate of Health and Family Welfare Madhya Pradesh: List of Medical officers working in Civil Dispensaries in Madhya Pradesh ii. Health Management Information System (HMIS): List of Civil Dispensary and Urban PHC iii. Health Management Information System (HMIS): Civil Dispensary and Urban PHC wise OPD summary of last one year 2017-18 iv. HR Department NHM Madhya Pradesh: List of health staff posted in Civil Dispensaries and Urban PHCs
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2.2.3.4 Data processing and Report development:
After collection of primary and secondary data from various sources, electronic transfer of primary data and data compilation was done by the study team. The Primary tables were generated as per the analysis plan. The primary data analysis was limited to information available through interaction with the health staff presents at the time of facility survey. The frequency tables with respect to infrastructure, human resource, health services, management of facility and partnership were generated. The analysis plan developed based on the study objectives and further discussed with the Department of Urban Health. Accordingly, primary and secondary data analyses were done. The presentation of data in the form of summary tables, detail tables with appropriate illustration was developed. Subsequently, the detailed study report was prepared as per the chapter plan of the study.
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3. Findings - Service Records
3.1 Geo-mapping of Civil Dispensaries and Urban-PHCs
The first objective of the study is to geo-map all the Civil Dispensaries and Urban- PHCs in Madhya Pradesh. The map below shows the presence of Civil Dispensary and Urban-PHC across the state. The map below indicates the functional and non- functional status of Civil Dispensaries and urban-PHCs which is based on the HMIS and HR records. It is evident from the map that the presence of urban health centres is prominent in the densely populated urban area. Data from the Gwalior, Bhopal, Indore, Jabalpur and Sagar regions show the high density of urban health facilities. However, substantial non-functional health facilities are also located in the same regions.
Figure 3.1(a): Distribution of Civil Dispensary and Urban-PHCs in Madhya Pradesh
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Figure 3.1(b): Distribution of all functional Civil Dispensaries and Urban-PHCs in Madhya Pradesh
Figure 3.1(c): Distribution of all the non-functional Civil Dispensaries and Urban-PHCs in Madhya Pradesh
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3.2 Status of Human Resource
One of the main objectives of the study was to understand the human resource gaps in Civil Dispensary and Urban-PHC across state. The HR data received from NHM about health staff was analysed in line with NUHM guidelines. The guideline1 suggests that the health facility should have Medical Officer, Pharmacist, Lab Technician, LHV, Account keeping & MIS, Public Health Manager, Community Mobiliser, Staff Nurse, ANM and support staff. The figure below shows the current position of health staff of Urban-PHCs and Civil Dispensaries in Madhya Pradesh.
Figure 3.2 (a) Who Provides health services in Urban-PHCs and Civil Dispensaries? No of health staff posted in 125 Urban PHC and 25 Civil Dispensaries according to NHM records
Urban-PHC Civil Dispensary 244
111 62 68 36 40 38 9 6 1 14 2 2
Medical Staff Nurse Lab Pharmacist LDC/MIS ANM Other Officer Technician
According to NHM, total 633 health staff posted in 125 Urban-PHCs and 25 Civil Dispensaries in 46 districts in Madhya Pradesh. The figure above shows the category wise health staff posted in Urban-PHCs and Civil Dispensaries.
In case of Urban-PHC, total 537 health staff posted in 125 centres. The number of ANM and staff nurse is higher than other health staff posted in Urban-PHC. However, number of Lab Technician, Pharmacist is less than Medical Office and MIS in Urban- PHCs. The figure above revels that there is a huge gap for the position of medical officer, lab technician and Pharmacist. The number of health staff posted in urban health centres shows the demand of the health staff.
According to NHM-HR records, total 96 health staff is posted in 25 Civil Dispensaries in Madhya Pradesh. The posting of other staff category includes Orthopedic Specialist, Ophthalmic & Assistant, Dental Attendant, Dresser, Female Health Supervisor, Multipurpose Worker Male MPW, and Support Staff, non-Medical Assistant, Peon & Sweeper, Ward boy, Mess Servant and Aaya & Dai show area of concern. In HR records, lot of ambiguity related to designation of paramedical health staff also noticed.
1 Quality Standards for Urban Primary Health Centre, October 2015http://nhm.gov.in/images/pdf/NUHM/ Atal Bihari Vajpayee Institute of Good Governance and Policy Analysis
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According to the reports from directorate of health, total 92 Civil Dispensaries exists in 22 districts. The figure below shows that in 11 districts, the post of medical officer is vacant. Four districts namely Alirajpur, Chhatarpur, Guna and Datia are having one Medical Officer for each of the Civil Dispensary. In 6 districts, there is no medical officer posted. It is interesting to note that Bhopal has 18 Civil Dispensaries with posting of 19 medical officers.
Figure 3.2 (b) Is Medical Officer posted in all the Civil Dispensaries? District wise number of Civil Dispensaries and number of medical officers posted
No of Civil Dispensary No of MO Posted
18 Bhopal 19 15 Gwalior 11 13 Indore 8 10 Jabalpur 5 7 Sagar 3 3 Morena 2 2 Rajgarh 1 2 Datia 2 1 Guna 1 1 Chhatarpur 1 1 Aliragpur 1 Ujjain 5
Dhar 3
Rewa 2
Khargone 2
Tikamgarh 1
Sehore 1
Satna 1
Ratlam 1
Chhindwara 1
Bhind 1
Badwani 1
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An attempt has been made in the study to understand the current status of medical officer and other staff posted in Civil Dispensaries using administrative records of directorate of health services and office of national health mission. According to the health department and NHM records, total 106 Civil Dispensaries exist in 22 districts. Out of total 22 districts, 10 districts did not show any health staffs posted in 18 Civil Dispensaries.
Table 2: District wise number of Medical Officer (MO) posted in Civil Dispensary according to health department and NHM
Sl. Districts No of Civil MO MO Other Staff No. Dispensary (Regular) (NHM) (NHM) 1 Alirajpur 1 1 0 0 2 Badwani 1 0 0 0 3 Bhind 1 0 0 0 4 Bhopal 21 19 0 19 5 Chhatarpur 1 1 0 0 6 Chhindwara 1 0 0 0 7 Datia 2 2 0 0 8 Dhar 3 0 0 0 9 Guna 1 1 0 0 10 Gwalior 19 11 4 14 11 Indore 19 8 5 51 12 Jabalpur 10 5 0 0 13 Khargone 2 0 0 0 14 Morena 3 2 0 0 15 Rajgarh 2 1 0 0 16 Ratlam 1 0 0 0 17 Rewa 2 0 0 0 18 Sagar 7 3 0 0 19 Satna 2 0 0 3 20 Sehore 1 0 0 0 21 Tikamgarh 1 0 0 0 22 Ujjain 5 0 0 0 Total 106 54 9 87
In order to understand the human resource gap in Urban-PHC, the HR reports of NHM were analyzed. Urban Health Mission has suggested minimum number of staff in different categories to run an Urban PHC. The finding suggests that the many Urban- PHCs do not have sufficient staff like Medical Officer, Staff Nurse, Lab Technician, Pharmacist, LDC/MIS and ANM. Figure 3.2 (c) shows the availability of staff with Urban PHC.
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Figure 3.2 (c) Whether Urban-PHCs are equipped with minimum required health staff? Number of Urban-PHC with minimum required against existing health staff
Minimum Required Staff Existing Staff
375 375
250 244
125 125 125 125 125 125 111
62 68 36 14 2 0 0
MO (FT) MO(PT) Nurse LHV Lab Pharmacist ANM PHM/CM M & E Technician
According to NHM HR-Report, total 125 Urban-PHCs reported availability of at least one health staff in the facility. The figure above shows the gap of health staff according to different category. The figure 3.2 (c) above explains the status of existing staff against required minimum staff as per the norms of the urban health mission. It is evident from the above figure that there is a shortage of the staff category in all the 125 Urban PHCs. The human resource gap is three fold in case of Lab technician, half of the Urban-PHC does not have Medical Officers and 35 Urban-PHC with non- availability of ANM is a matter of concern.
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Figure 3.2 (d) Type of health staff posted at Urban-PHCs and Civil dispensaries Number and type of health staff with nature of appointment
Regular Contractual 235
177
119 105 105
67 51 51 36 30 15 10 17 14 4 0 1 0
Specialist MO PHM Staff Nurse ANM Pharmasist Lab LHV Other staff Technician
The figure 3.2 (d) above explains the status of existing staff according to JD (National Urban Mission) Office NHM. According to JD Office records, total 1037 heath staff posted in 245 civil dispensaries and Urban PHCs in Madhya Pradesh. Out of total 1037 health staff 479 staff members are regular and 558 staff members are in contractual. The figure 3.2 (d) shows the designation wise health staff with regular post and contractual post.
It is evident from the above figure that the contractual staff in terms of medical officer, staff nurse and ANM is higher than regular position. However, other staff in regular scale is higher than contractual in civil dispensaries and Urban PHCs.
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3.3 Service Provision
The Health Management Information System (HMIS) Figure 3.3 (a): whether all the facilities are data from Department of functional? Health and Family Welfare No Update in Government of Madhya HMIS 31% Pradesh collected and analyzed to understand the service provision in Civil Dispensaries and urban- Update in PHCs through outpatient HMIS records. The last one year 69% (April 2017 to March 2018) data shows in Figure 3.3 (a) that out of total 245 health facilities, 75 (31%) facilities were not registered any outpatient record in HMIS whereas, 170 (69%) facilities were functional and engaged in outpatient services (OPD) with regular update records in HMIS.
The table below shows that the proportion of non-functional Civil Dispensaries are large than Urban-PHC in Madhya Pradesh. Out of total 109, only 71 Civil Dispensaries are functional and register outpatient records in HMIS whereas, only 4 Urban-PHCs have not updated outpatient records in last year HMIS.
Table 3: Status of HMIS Update health facility
Facility Type Update in HMIS No Update in HMIS Total No. (Percent) No. (Percent)
Civil Dispensary 38 (35%) 71 (65%) 109 Urban-PHC 132 (97%) 4 (3%) 136 Total 170 (69%) 75 (31%) 245
The table 4 shows that volume of OPD in 170 facilities. The HMIS outpatient records show that more than 18 lakh patients visited urban health facilities to avail primary health care services in Madhya Pradesh. However, more than 50 thousand patient benefited through Ayush facilities.
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Table 4: Status of OPD in HMIS Update Health facility
Facility Type Outpatient registered in HMIS (Year 2017-18) Allopathic facility Ayush facility No. of Facility No. of Patients No. of facility No. of Patients Civil Dispensary 38 125,614 5 23,663 Urban-PHC 132 1,678,742 12 30,985 Total 170 1,804,356 17 54,648
Although, provision of detail outpatient registration is available in HMIS but the details was not registered by all the Civil Dispensary and Urban-PHCs. Out of total 170 functional health facilities only 99 (11 Civil Dispensaries and 88 Urban-PHCs) facilities updated OPD detail in last year HMIS. Out of total 132 Urban-PHCs only 88 Urban- PHCs updated detail outpatient records in HMIS. However, number of Civil Dispensaries which update HMIS is not very encouraging and only 11 Civil Dispensaries registered details of outpatient records in HMIS during last year.
Table 5: Status of OPD detail
Facility Type Number of health facilities (Percent) Update OPD detail in Not Update OPD detail in Total HMIS HMIS Civil Dispensary 11 (10%) 98 (90%) 109 Urban-PHC 88 (65%) 48 (35%) 136 Total 99 (40%) 146 (60%) 245
The report of Health Management Information System also shows the outpatient cases registered in Civil Dispensaries and Urban-PHCs.
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The classification of OPD records is mentioned the figure 3.3 (b) below.
The Figure revels that the detail of outpatient Figure 3.3 (b): Various reasons to visit Urban- records of HMIS from 99 PHCs health facilities. In 99 facilities out of total 13 Other Lakh outpatient records 94% Diabetes 94% patients visited 2% health facility for general health reasons in last Hypertension 2% one year. The percent of diabetes (2%), Ophthalmic Dental Related 1% hypertension (2%), 1% ophthalmic (1%) and dental reason (1%) cannot be ignored.
The volume of OPD records shows that from 1st April 2017 to 31st March 2018 more than 27 thousand outpatients visited Urban- PHC for hypertension related reason. The other health reasons registered were diabetes, ophthalmic and dental. It is important to notice that substantial outpatient records were found in relation to Mental illness related followed by Acute Heart Diseases, Epilepsy and Stroke (Paralysis).
Figure 3.3 (c): Why patient visits Urban Primary Health Care Centres? Disease wise outpatient number registered in HMIS (April'17- March'18)
27,099
20,890 18,141
12,573
1,588 1,392 596 283
Hypertension Diabetes Ophthalmic Dental Mental illness Acute Heart Epilepsy Stroke Related Diseases (Paralysis)
Urban-PHCs are the nearest health centre so people visit there for all types of health challenges initial which includes mental illness, acute heart disease, Epilepsy and stroke. Data presented in the graph 3.3 (c) also highlights this fact.
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4. Findings - Facility Survey
Facility survey tried to observe the field level situation in the selected urban health facilities in the sample area. The focus of the field survey was to observe the physical infrastructure, human resource, services provided and managed by the facilities. During discussions opinion were also taken on the difficulties faced and ways to improve health care services. The current section of the study tries to highlight the findings of the facility survey.
4.1 Infrastructure
A. Accessibility An attempt has been made to find out whether the slum population can access health facilities with suitable timings conveniently? As per National guideline the Urban-PHC (Structure) must be located within a distance not more than ½ kilometers from the slum or similar habitation to ensure easy access by the most vulnerable urban population. In survey, study team observed that all the Urban-PHCs situated adjacent to the slum areas and are connected with all-weather approach road. In most of the facilities, display boards with facility name noticed. However, it was difficult to locate the facility due to incorrect location address and absence of direction signs. In Dhar district, the Urban-PHC GanjiKhana was difficult to locate by study team as there was no sign board in front of the building. The team realized that there is need to put proper sign boards with directions to identify, locate facility without hassle. It was mentioned by the facility providers that in most of the places, the slum dwellers are not aware of the location of the facility in their area.
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B. OPD Timings The OPD timing of Urban-PHC should enable the slum population to avail health services to their convenience. The NUHM guidelines suggest that the OPD timing could be of 8 hours availability of health services. The recommended OPD timing is 12.00 noon to 8.00 pm.
In the survey, out of total 9 Urban-PHCs, 8 Urban-PHCs follow the fixed timings from 12 noon to 8 pm. Only 1 Urban- PHC Sagar provides OPD services from 4 pm to 8 pm because OPD Timing Medical Officer was attached to Bina Community Health Center 12 noon to 8.00 pm: 8 Urban-PHCs (CHC) at the time of survey. In 4.00 pm to 8.00 pm: 1 Urban-PHC total 10 Civil Dispensaries visited 8.00 am to 1.00 pm: 10 Civil Dispensaries by the study team, 3 Civil 5.00 pm to 6.00 pm: 7 Civil Dispensaries Dispensaries follow only morning session i.e. 8 am to 1 pm whereas 7 Civil Dispensaries follow timings from 8 am to 1 pm and 5 pm to 6 pm. Thus the morning OPD facilities were found to give 3 hours which is less than the prescribed 8 hours.
C. Physical Infrastructure Proper physical infrastructure is significant for health facility to provide health care services. The study team during the facility survey observed current infrastructure facilities of selected Urban-PHC and Civil Dispensaries and recorded primarily condition of building, space arrangement for OPD and other necessary facilities.
All the 9 Urban-PHCs were reported to Figure 4.1 (a): Type of ownership have rented building whereas out of 10 Civil Dispensaries only 2 Civil Govt Building Rented Building Dispensaries, (Jabalpur and Sagar 9 8 districts) reported rental buildings and rest 8 Civil Dispensaries have government building. 2
In survey, 3 health facilities namely Civil Dispensary Bhagwanganj in Sagar, Urban-PHC Civil Dispensary Urban-PHC in Jabalpur and Civil Dispensary Golpharia in Gwalior run in a double story building wherein the OPD was located on the first floor. The absence of hassle free entrance and ramps denied easy access for old and physically challenged patients.
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In survey, basic infrastructure facilities were recorded. The figure below shows the infrastructure of the Urban-PHC and Civil Dispensaries recorded during the survey.
Figure 4.1 (b) Whether health facilities equipped enough in terms of infrastructure? Number of surveyed health facilities with basic facilities
Yes No
2 3 4 7 10
19 19 19 19 17 16 15 12 9
OPD Pharmacy Regular water Regular Dressing room Seating Waitaing Privacy and Separate Consultation Medicine room supply electricity arrangement space confidentiality toilets room supply
The key facilities like OPD cum consultation room, pharmacy room found in all the facility visited. Separate dressing room, seating arrangement and appropriate waiting space were not found in all the facilities. The health staff posted in all the health facilities confirmed that facilities have regular water and electricity supply.
In Civil Dispensary Dhar, facility does not have water supply within the premises and health staff reported that they bring water from nearby hand pump as per their requirement. The provision of safe drinking water for staff as well as patients was not found in most of the health facilities. In survey, no separate toilet for men and women in the facility was one of the major observations in all the facilities.
The absence of separate toilet for male and female is a matter of concern, as patients have to face difficulty using single toilet. The staff reported that absence of separate toilet facility for them dismay their long hours of work. The study team also recorded other supplementary facilities.
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The figure 4.1 (c) below shows that computer; internet is not available where as IEC and BCC material found adequately in centers. Manual registration process is followed in all the facility.
Figure 4.1 (c) Whether health facilities equipped with supplementary facilities? Number of Health facilitates equipped with supplementary facilities
Yes No
1 5 9 10 13 14 16 18 18 14 10 9 6 5 3 1 Registration IEC/BCC Citizen Charter Complaint box Suggesation box Internet Computer & Telephone System material accessories
Key issues related to basic infrastructure reported by health staff were:
1. Dangerous Structure in Jabalpur: In Jabalpur district, the Civil Dispensary building was found in very bad condition as the building can fall anytime. After enquiry, health staff responded that formal notice is issued by the local authority to vacate the building but facility is still operational in the same building due to local political influence.
2. Need for Systematic Rent Payment: There is need for systematic and regular rent payment provision.
3. Lack of Proper Spaces: In most of the Urban-PHC buildings, availability of appropriate space for essential services was found to be a major issue. Lack of space leads compromised services as congested arrangements and overcrowding of patients. In such situation, patients and care taker keep
stand for long, major discomfort.
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4. Lack of Privacy for Pregnant Women: The reproductive and child health care services are one of the main health service provisions with maintaining dignity and privacy of patient. Unfortunate, no emphasis on arrangements for privacy and confidentiality of the patients found in any of the visited Urban-PHCs.
5. Availability of Safe Drinking Water: Regular water availability was found in all the facilities visited except Dhar Civil Dispensary. However, safe drinking water was absent in almost all the facilities. In such situation patients forced to drink unsafe water available in the premises. The availability of safe drinking water is possible as it was notice in only one Urban PHC Pawasa Ujjain.
6. Lack of Separate Male and Female Toilet: One of the essential facility i.e. separate toilet for male and female was missing in most of the facility visited. Only one toilet in the premises was found in 11 facilities and it became a common toilet for all. This is not good for health staff and patients. In Dhar Civil Dispensary, there is no toilet facility available. The health staff and patients uses the Sulabh Jan Suvadhaye situated nearby the facility.
Inappropriate constructed toilets, soiled and damaged toilets are wearisome for the health staff and patients. Importantly, NO HAND WASH facility arrangements found
in most of the facilities.
7. Unhygienic Environment: Practices related to hygiene and sanitation were almost absence in most of the facilities visited. There is need to make check Atal Bihari Vajpayee Institute of Good Governance and Policy Analysis
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for cleanliness and maintenance of the buildings and its premises. Although most of the facilities need immediate action to improve cleanliness as maintained by Ujjain Civil Dispensary Chhatri Chowk.
8. Lack of Telephone and internet Facilities: Some essential facilities like telephone, internet and computer with accessories are either not available or were not functional.
4.2 Human Resource a. Health Staff According to national indicative norms for Urban-PHCs, a set of health staff was proposed. In survey, category wise health staff availability was recorded.
Figure 4.2 (a) Whether survey facilities having appropriate health staff? Number of health facility with and without health staff
Available Not Available
4 6 5
11 12 12 14 16 18 17 15 13 14
8 7 7 5 3 1 2 MO (FT) MO (PT) Staff Nurse Pharmacist Lab LHV ANM PHM/ CM LCD/MIS Support Technician Staff
The primary data reveals that out of total 19 facilities visited only 13 facilities had full time medical officers and 3 facilities had part time medical officers. The study team learnt that 2 Urban-PHCs (Harda and Dhar), 4 Civil Dispensaries (Dhar, Ujjain, Bhind, Jabalpur) did not have any full time medical officers. These urban health facilities are managed by paramedical health staff in the facility. However, 6 Civil Dispensaries reported full time medical officers. In Bhopal Civil Dispensary, medical officer is there but he has not resumed his service after long leave at the time of survey. One public health manager/community mobiliser posted in Bhopal Urban-PHC with additional charge of MIS.
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In the total 19 facilities, total 103 health staff recorded. There were 15 fulltime and 7 part time medical officers, 30 ANM, 18 support staff and 11 staff nurse were reported by the health staff. The table below highlights the position of paramedic staff and medical officers in the survey facilities. Lack of health staff with specific skill overburdens the existing staff with multiple tasks and affects quality of service.
Table 6: District wise number of health staff according to category in survey facilities
Sl. Facility MO MO PHM/ Support District SN Pharma LT LHV ANM MIS No. type (FT) (PT) CM Staff 1 Bhopal CD 1 - 1 1 - 1 2 - - - 2 UPHC 1 - - - - - 1 1 - 1 3 Harda UPHC - 1 1 - - - 1 - - 1 4 Sagar CD 1 - - 1 1 - - - - 1 5 UPHC 1 - - - - 1 - - 1 1 6 Indore CD 1 - 1 - 1 - 2 - - 1 7 Dhar CD - - - - - 1 1 - - - 8 UPHC ------2 - - 1 9 Ujjain CD - 4 1 1 1 1 5 - - 2 10 UPHC 1 - - 1 1 1 2 - - 1 11 Bhind CD ------2 - - 2 12 UPHC 1 1 2 - - - 2 - - - 13 Gwalior CD 3 - - - - 1 2 - - 1 14 CD 1 - - - - - 2 - - 2 15 Jabalpur CD - - - 1 - - - - - 1 16 UPHC 1 - 3 - 1 1 3 - 1 1 17 Umaria UPHC 1 - 1 1 - - 3 - - 1 18 Rewa CD 1 - - 1 - - - - - 1 19 UPHC 1 1 1 ------Total 15 7 11 7 5 7 30 1 2 18 b. Health staff - Trainings and orientation The training and orientation is one of the key aspects to ensure the quality of health care services. During facility visit a question was asked about training of health staff. Most of the health facility reported that the basic induction and orientation has not been conducted. The health staff starts routine services soon after posting. c. Health staff - Health Risk Protection The health care providers are in regular contact with the patients and are likely to acquire infections in the facility setting. In survey, a question was asked to know whether vaccines like Hepatitis B and Tetanus Toxoid (TT) protected staffs. The information related to immunization statue of health staff was collected for 103 health personnel (48 Urban PHC; 55 Civil Dispensaries). Atal Bihari Vajpayee Institute of Good Governance and Policy Analysis
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Table 7: facility wise details of protection of health staff
Sl. Districts Hepatitis B Tetanus Toxoid (TT) Health Insurance No. Urban Civil Urban- Civil Urban- Civil -PHC Dispensary PHC Dispensary PHC Dispensary 1 Bhopal 1/4 3/6 4/4 6/6 1/4 0/6 2 Harda 1/4 NA 1/4 NA 1/4 NA 3 Sagar 1/4 0/4 2/4 3/4 1/4 1/4 4 Indore NA 1/6 NA 4/6 NA 1/6 5 Dhar 0/3 0/2 2/3 1/2 3 1/2 6 Ujjain 0/7 1/15 3/7 8/15 0/7 1/15 7 Bhind 2/5 0/5 4/5 9/5 0/5 0/5 8 Gwalior NA 7/12 NA 7/12 NA 3/12 9 Jabalpur 4/11 0/2 5/11 1/2 2/11 0/2 10 Umaria 1/7 NA 3/7 NA 1/7 NA 11 Rewa 2/3 1/3 2/3 2/3 0/3 1/3 Total 12/48 13/55 26/48 35/55 8/48 8/55 Note: (1) There were 48 total staff available in total 9 Urban-PHC and 55 staff in Civil Dispensaries at the time of survey. (2) Numerator – no of staff covered with specific risk/denominator total staff available in the facility
The table 7 above shows the availability of mechanism for protecting health workers from the risk that is associated with various kinds of diseases. There are about 48 health staff in 9 urban PHCs and 55 health staff in 10 Civil Dispensaries, selected for the study. The data reveals that only 12 staff members in Urban-PHC and 13 staff in Civil Dispensaries immunized with hepatitis B vaccine. However, 26 staff members in Urban-PHC and 35 from Civil Dispensaries were immunized to Tetanus Toxoid. It was interesting to note that only 16 out of total 103 staff have been covered under health insurance scheme.
4.3 Service Provision
The main purpose of urban-PHCs and Civil Dispensaries is to provide comprehensive preventive, promotive and non-domiciliary curative care among urban poor. According to UHM guidelines, the Urban-PHC health services include OPD-consultation, basic diagnosis services, and Reproductive & Child Health (RCH) services, prevention of communicable and non-communicable diseases. The services also include drugs prescription and timely referral.
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A Study of Civil Dispensaries & Urban Primary Health Centres in Madhya Pradesh 2018 a. Essential health services The status of service, at facility, service provision in all the 19 health facilities visited are compiled and analysed with reference to the essential health services suggested under NUHM guidelines. The table below shows the availability of services in 19 facilities.
Table 8: Status of Essential health services available in the facilities surveyed
Sl. Essential Health Service Available Civil Urban-PHC Total No. Dispensary (N-9) facility (N-10) (N-19) 1 Maternal health 7 7 14 2 Family welfare 7 8 15 3 Child health and nutrition 8 9 17 4 RTI/STI 8 9 17 5 Nutritional deficiency disorders 8 8 16 6 Vector borne diseases 7 8 15 7 Chest infections -TB/Asthma 6 8 14 (Diagnosis/treatment/referral) 8 Cardiovascular diseases 6 7 13 (Diagnosis/treatment/referral) 9 Trauma care (burns & injuries) 5 6 11 10 Oral Health (Diagnosis/referral) 2 6 8 11 Diabetes (Diagnosis/treatment/referral) 4 6 10 12 Cancer (Identification/referral/follow-up) 1 4 5 13 Mental Health (Initial screening/referral) 2 4 6 14 Other surgical interventions 0 0 0 (Identification/referral)
Data presented in the table-8 suggests that provision of 13 essential services were available. The services related to maternal health, child health & nutrition, RTI/STI and Vector borne disease provided by large number of Urban PHCs and Civil Dispensaries. The essential services are confined general consultation and mostly referred to nearby government health facility.
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Page 33 of 84 Table 9: Provision of Health Services in Civil Dispensary and Urban-PHC: Summary Sl. Essential Health Civil Dispensary Urban-PHC Remark No. Service 1 Maternal health If MO is not available If MO is not Most of the facilities (ANC/PNC/referral) ANM/LHV manage available ANM do not provide all most of the cases, /LHV handles required services due except complicated maternal service to lack of staff; cases except Need for EmOC complicated cases training 2 Family welfare ANM/LHV/Staff Nurse ANM/Staff Nurse Only Condom (OCP/CC/IUD provide services provides services distribution; staff is insertion/referral not trained in IUCD for sterilization/) insertion and removal 3 Child health and Medical officer provides Medical Officer Ensure availability of nutrition services , if not than provides services Medical Officer 1. Diagnosis/ ANM provide services if not than staff Staff treatment/ referral In Rewa MO & nurse /ANM Nurse/ANM/Pharmacis of acute/chronic Pharmacist t provide services illness 2. Identification/ referral of neonatal sickness 4 RTI/STI Medical Officer Medical Officer Treatment is based (Symptomatic on sign and Diagnosis/primary symptoms; lack of lab treatment/referral) test facility 5 Nutrition MO provides service if Medical officer Mostly referred to NRC deficiency not than ANM/Staff provides service if of District Hospital in disorders Nurse provides not than case of malnourished (Diagnosis/ ANM/staff nurse treatment/referral) provides 6 Vector borne MO provides the MO provides the Most of the facility diseases service if not than service test for Malaria is ANM/ staff nurse carried out; provides Non availability of Laboratory facility limits diagnose and other investigation 7 Mental Health Not Available MO provides the Referral on the basis (Initial Service of symptoms screening/referral)
A Study of Civil Dispensaries & Urban Primary Health Centres in Madhya Pradesh 2018
Sl. Essential Health Civil Dispensary Urban-PHC Remark No. Service 8 Oral Health Mostly service is not Service is Need of Dental (Diagnosis and available, if available it provided by specialist needs to be referral) is provided by Medical Medical Officer if posted at CD and Officer only in Sagar, available UPHC Indore and Gwalior 9 Chest infections - Service provided by Service provided Urban-PHC and CD TB/Asthma Medical Officer by Medical Officer needs to be linked TB (Diagnosis/ Cell at district for treatment/referral) treatment/follow-up; Medicine for registered patient can be provided at Urban- PHC and CD 10 Cardiovascular Service provided by Service provided diseases Medical Officer by Medical Officer (Diagnosis/ treatment/referral) 11 Diabetes Service provided by Service provided Well-equipped lab and (Diagnosis/ Medical Officer by Medical Officer technician would help treatment/referral) on time diagnose and hassle free treatment; Basic equipment - glucometer not available in the facility 12 Cancer Service provided by Service provided Patient are referred to (Identification/ Medical Officer by Medical Officer district hospital or referral/ higher center for follow-up) further investigation and treatment 13 Trauma care - Service provided by Service provided Training to manage burns & injuries Medical Officer for by Medical Officer medical emergency injuries and trauma for injuries and required; Most of the trauma; Not all facilities lack practice medical of aseptic technique of emergencies are dressing; treated No medico legal certificate and documentation is done; referred to DH 14 Other surgical No Service No service interventions
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A Study of Civil Dispensaries & Urban Primary Health Centres in Madhya Pradesh 2018 b. Other support services Besides essential health care services, the provision of prevention of communicable and non-communicable disease is one of the focus areas of urban PHC and Civil Dispensary. It was observed, during the visit to health facilities, that IEC (information education and communication) materials and materials related to BCC (Behavior Change Communication) was displayed here and there on the walls of facilities. The materials were not displayed on strategic locations ensuring proper information dissemination and spread of messages among the masses.
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A Study of Civil Dispensaries & Urban Primary Health Centres in Madhya Pradesh 2018 c. Basic Lab services Diagnosis is one of the essential services required for the health care and treatment. According to national Urban health care guideline for primary care, provision of basic lab infrastructure with trained staff need to be placed in Urban-PHC. In this survey, the basic lab services like Urine Microscopy Acetone Bile Salt and Bile Pigments Serum, Cholesterols, Stool Exam LBR, ESR were not available in all the Urban-PHC. Moreover, non-availability of necessary equipment’s and lab technicians were main reasons reported. It is seen that blood and urine test facilities are available at very few facilities and that too only a few tests are conducted. Lab tests services are affected due to the shortage of lab technicians and necessary items required to conduct various tests.
Figure 4.3 (a): Diagnosis services in place in all Urban-PHCs and Civil Dispensaries? Number of facilities according to various lab test proposed by Urban Health Mission
Yes No
Urine Pregnancy Test 12 7 HB Scale 10 9 Blood Sugar 9 10 Urine Sugar Albumin leucocyte Esterase 8 11 Slide Collection for pVivex and P Falciparum 7 12 HB(Sahli)method 6 13 Typhoid Card Test 4 15 BTCT 2 17 ESR 2 17 Serum Bilirubin 2 17 Serum Urea 2 17 LBR 1 18 Stool Exam 1 18 Serum Cholesterols 1 18 Urine Microscopy 1 18
The purpose of basic lab services in Urban-PHC and Civil Dispensary is primarily to diagnoses communicable and non-communicable disease and help in providing quick and appropriate treatment. There is need for improving the basic lab facilities with availability of lab technician. The availability of lab services in urban-PHC would certainly reduce the pressure on district hospital. In addition, effective lab services would reduce the financial burden on the slum dwellers and build trust among community.
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Table 10: Essential Laboratory services recommended as per NHM guidelines
Essential Laboratory Routine Test: Urine, stool and blood tests (Hb%, platelets services count, total RBC, WBC, bleeding and clotting time). Diagnosis: RTI/STDs with wet mounting, Grams stain, etc. Sputum testing for mycobacterium (as per guidelines of RNTCP). Blood smear examination malarial Blood for grouping and Rh typing RDK for Plasmodium falciparum malaria in endemic districts. Rapid tests for pregnancy. RPR test for Syphilis/YAWS surveillance (endemic districts). Rapid test kit for fecal contamination of water. Estimation of chlorine level of water using ortho-toludine reagent. Blood Sugar Desirable Blood Cholesterol ECG Validation of Periodic validation of lab reports needs to be done by DH for reports Quality Assurance. Periodic calibration of Laboratory and PHC equipment’s
It is important to note that none of the 19 urban health facilities had all the essential tests facility available at the centre.
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A Study of Civil Dispensaries & Urban Primary Health Centres in Madhya Pradesh 2018 d. Drug Supply At the time of survey, the study team observed stock registers. Question related to drug and its availability was also asked to the health staff. Health staff reported that around 56 to 75 listed drugs, under essential drug list, were available. The health staff reported that the basic drugs are always available in the facility. Further, they said that at the time of particular drug requirement or in case of any drug falls short, demand request is forwarded to the district authorities. The staff further informed that demanded drugs are made available to the facility within 7-10 working days.
Table 11: Availability of Essential Drugs List at Facility
Essential Drugs (ED) and Civil Dispensary Urban PHC Essential Drugs List (EDL) Available Not Available Not at the time Available at at the time Available at of survey the time of of survey the time of survey survey Essential Drugs available at 9 1 8 1 facility EDL displayed in the facility 5 5 5 4
Table 11 shows that the essentials drugs were available in most of the facilities except for Civil Dispensary situated at Anand Nagar in Bhopal and Urban-PHC of Sagar. The display of essential drug list was found in 5 Urban-PHCs and 5 Civil Dispensaries. In most of the facilities, the phamarcy was maintained properly with systematice arrangment of drugs.
Availability and arrangement of drugs
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A Study of Civil Dispensaries & Urban Primary Health Centres in Madhya Pradesh 2018 e. Availability of Medical Care Equipment In survey, availability of basic equipment was also observed by the study team. List of equipment were categorized in three differed categories that are (1) List of equipment required for OPD; (2) list of equipment required for lab test; and (3) list of equipment required for other/general purposes. Data presented in the table 12 shows the availability of basic equipment in Urban-PHCs and Civil Dispensaries.
Table 12: List of equipment required at OPD services and its availability in Civil Dispensaries and Urban-PHCs at the time of visit
Sl. OPD Equipment Civil Urban- No. Dispensary PHC (N-10) (N-9) 1 Adult weighing scale 9 9 2 Baby weighing scale 3 6 3 Bowl for antiseptic solution for soaking cotton swabs 7 3 4 Chairs, Stool 10 9 5 Examination couch, steps 10 6 6 Height measuring Scale 2 2 7 IUCD insertion kit 4 2 8 Measuring tape 4 3 9 Minor OT instruments 3 1 10 Spot light 2 1 11 Standard Surgical Set 1 1 12 Stethoscope 7 8 13 Thermometers Alcohol (stem) 4 7 14 Torch without batteries – 2 4 4
Data presented in the table 12 reveals that the basic equipment like adult weighing scale was not available in 7 Civil Dispensaries and 3 UPHCs. During the study the team visited Civil Dispensary Bhind and observed that adult weighing scale was not available at the facility. The standard surgical set found in only one Civil Dispensary and one Urban-PHC. The basic equipment required for OPD like Baby weighing scale, Bowl for antiseptic solution for soaking cotton swabs, Height measuring Scale, IUCD insertion kit, Measuring tape, Minor OT instruments, Spot light, Thermometers Alcohol (stem) and Torch without batteries were not available in many facilities.
The set of equipment required for laboratory test mentioned in the table 13 shows that many of the equipment are not available in many of the facilities selected for the study.
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Table 13: List of equipment required for lab test and its availability in Civil Dispensaries and Urban-PHCs at the time of visit
Sl. Lab Equipment Civil Dispensary Urban-PHC No. (N-10) (N-9) 1 Refrigerator 3 5 2 Battery dry cells 1.5 volt 3 4 (large size) – 4 3 Binocular microscope 4 1 4 Domestic refrigerator 2 3 5 Equipment/reagents for essential lab 4 4 investigations 6 H2 S Strip test bottles 1 7 Kits for testing residual chlorine in 2 2 drinking water
More than 4 Civil Dispensaries and Urban-PHCs not reported to have Refrigerator, Battery dry cells 1.5 volt (large size), Binocular microscope, Equipment/reagents for essential lab investigations, H2 S Strip test bottles, Kits for testing residual chlorine in drinking water at the time of survey.
Further, list of equipment according to general purposes were reviewed in terms of availability at Civil Dispensaries and Urban-PHCs. The table 14 below specifies that 18 equipments were used for general purposes in Civil Dispensaries and Urban-PHCs were not available in all the facility at the timer of survey. The data revels that equipment like Autoclave, Cold Boxes (Small & Large), ECG machine, Equipment for National Programmes, Fire extinguisher, Freeze Tag: 2 per ILR bimonthly, Hand washing facilities & Alcohol based hand-rub, Ice box, ILR (Small) and DF (Small) with Voltage Stabilizer, ice pack boxes per vaccine carrier, Standard Surgical Set , Stretcher, Suction machine, Tray containing chlorine solution for keeping soiled instruments, Trolley, Vaccine Carriers with 4 Icepacks, Waste disposal twin bucket, hypochlorite solution/ bleach less than 5 facilities were equipped to provide services.
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Table 14: List of equipment required for other/general purposes and its availability in Civil Dispensaries and Urban-PHCs at the time of visit
Sl. Other/General purpose Civil Urban- No. Dispensary PHC (N-10) (N-9) 1 Autoclave 2 1 2 Cold Boxes (Small & Large): Small- one, Large – two 6 4 3 ECG machine 4 Equipment for National Programmes 3 3 5 Fire extinguisher 1 3 6 Freeze Tag: 2 per ILR bimonthly 4 2 7 Hand washing facilities & Alcohol based hand-rub 6 7 8 Ice box 4 5 9 ILR (Small) and DF (Small) with Voltage Stabilizer 5 5 10 Spare ice pack box: 8, 25 & 60 ice pack boxes per 5 4 vaccine carrier, 11 Stretcher 3 12 Tray containing chlorine solution for keeping soiled 5 2 instruments 13 Trolley 2 14 Vaccine Carriers with 4 Icepacks: 5 6 15 Waste disposal twin bucket, hypochlorite solution/ 4 5 bleach
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A Study of Civil Dispensaries & Urban Primary Health Centres in Madhya Pradesh 2018 f. Barrier of Service Provision One of the study objectives was to ascertain services related challenges as perceived by service providers. In this regard, a set of question were asked to available health staff at the time of visit. The reported barriers were classified in three categories and are sited in table 15.
Table 15: Barriers of Service Provision
Category Key Barriers Infrastructure Lack of maintenance of Physical Infrastructure Unhygienic condition of toilets and no separate toilet for men and women Poor equipped lab/Lab services for name sake Poorly located and facilities with inadequate spaces and poor status of water supply Human Resource Lack of trained personnel and adequate staff In the absence equipped centers and MOs ,staff lose confidence Non availability/irregularity of medical officer Delayed decision/ignorance from higher authority
Health Services Facility Level No transport facility for referral cases Gap in follow up services Facility not equipped to manage emergency services No monitoring Community Level Nuisance created by alcoholic persons in late evening Patients do not follow prescriptions Environment Facilities are surrounded by unhygienic and dirty environment;
Description of key barriers reported by the service providers:
i. Physical Amenities: Basic physical amenities in the buildings in terms of adequate space for different service, provision for privacy and confidentiality, separate toilets, safe drinking water. ii. Facilities Related to Computer and Internet: Facilities related to computer and internet interrupts smooth administrative work and updating the HMIS reports. iii. Transportation Facilities: Lack of transportation facilities such as ambulance services etc. iv. Coordination, Roles Clarity and Work Pressure
The health staff not aware about their roles and responsibility in the implementation of national health programmes.
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Staff is unable to take any initiative in the absence of timely instructions and guidelines. The senior staff is attached to the other health facility that affects the functioning of Civil Dispensary and Urban-PHC. Existing staff has to perform additional activities; conduct multitasks and keeps working for long hours in the absence of sufficient of staff at facility. Lack of coordination among staff affects the performance of the facility.
4.4 Outreach services
Outreach services are an integral part of public health services. It facilitates improving health behaviors among community. The outreach services create trust and confidence within community. As per guideline, Outreach, services would be provided through Female Health Workers (FHWs)/ANMs at Urban-PHC and then move to their respective areas for outreach services (including school health) on designated days.
In survey, a question was asked to understand to what extend the outreach services being provided by the facility. The table below shows that three forth of the total Urban-PHC and Civil Dispensary were providing regular outreach services through Urban Health and Nutrition Day (UHND) and special outreach camps.
Table 16: Outreach Activity in the Facilities Surveyed
Outreach activity Civil Dispensary Urban-PHC Total (N-10) (N-9) (N-19) Urban Health & Nutrition Day Calendar 6 6 12 developed Urban Health & Nutrition Day conducted 6 7 13 Special Outreach Camp conducted 6 8 14
During field visit, the study team noticed that in the absence of the medical officers and sufficient number of ANM the outreach services are affected. Lack of confidence among ANM on counseling techniques discourages them to initiate communication with target group.
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4.5 Referral Services
Response related to referral services presented in the table 17. In the absence of lab facilities and lab technician, patients are referred to the nearby district hospitals. The patients who require specialized services were often referred to the district hospital.
Table 17: Referral Services at the Facility
Major reasons for referral Civil Urban- Total Dispensary PHC (N-19) (N-10) (N-9) 1. Medical officer not posted in the facility 3 3 6 2. Patient refer for lab test 1. No lab technician at facility 6 5 11 2. No lab equipment 1. Chronic/major illness & specialist opinion 1 1 2 2. Advance investigation/need special care and treatment
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4.6 Management
4.6.1 Biomedical Waste Management Management of waste generated in the BIO MEDICAL WASTE COLLECTION health facilities causes a direct health impact on health staff but also on the Bio-medical waste should be collected on surroundings. It is mandatory and daily basis from each ward of the hospital prime responsibility of the health at a fixed interval of time. There can be facility administrators to manage waste multiple collections from wards during the in most safe and eco-friendly manner. day.
HCF should ensure collection, According to the Bio Medical Waste transportation, treatment and disposal of Management Rules (2016), the bio- bio-medical waste within 48 hours. medical waste can be categorized in Collection times should be fixed and following steps. appropriate to the quantity of waste 1. Waste Segregation (at source of produced in each area of the health-care generation); facility. 2. Pre-treat Laboratory and Highly General waste should not be collected at infectious waste [Yellow (h) waste; the same time or in the same trolley in 3. Collection and Storage of which biomedical waste is collected. segregated waste in color coded Collection should be daily for most bags/ containers/ bins; wastes, with collection timed to match 4. Intra-mural transportation from the pattern of waste generation during generation site to central storage the day. For example, in An IPD ward area; where the morning routine begins with 5. Storage; the changing of dressings, infectious 6. Treatment (within 48 hours of waste waste could be collected mid-morning to generation) prevent soiled bandages remaining in the 7. Disposal area for longer than necessary. Collect general waste immediately after First five steps (Segregation, the visiting hours of the HCFs, as visitors Collection, pre-treatment Intramural coming to facility generate a lot of Transportation and Storage) are general waste. The collection timings exclusive responsibility of the Health must enable the HCF to minimize or Care Facility while next two Treatment nullify the use of interim storage of waste and Disposal are primarily in the departments. responsibility of CBWTF (Common Bio-medical waste collected by the staff, Biomedical Waste Treatment Facility) should be provided with PPE (Personal operator except for lab and highly Protective Equipment). infectious waste requires pre-treatment by the HCF. The the study team at the time of visit observed biomedical waste management practices of Civil Dispensary and Urban-PHCs were.
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Figure 4.6 (a): Is Bio-medical Waste Management in place? No of Civil Dispensary and Urban-PHC with biomedical waste management practices
Civil Dispensary Urban-PHC
7
4
3
1 1 1 1 1
Collected and send Collected but not Van comes for Waste collected by Thrown inside to District Hospital Discared Waste collection nagar Nigam Van Hospital compound
The above figure 4.6 (a) shows that the waste generated by one Civil Dispensary and Urban-PHC surrender to the district hospital. The district hospital waste collection van collects biomedical waste from 11 facilities (7 Civil Dispensaries and 4 urban PHCs) whereas, 3 facilities were depended on local urban body/Nagar Nigam. Status of following and implementation of Bio-Medical Waste Management Rules, 2016, has been studied in 19 facilities. Compliance against basic indicators related to Bio-Medical Waste Management Rules (2016) was observed and recorded. The findings have been tabulated in table 18 and presented below.
Table 18: Status of Compliance of Provisions related to BWM
Sl. Particular Civil Urban-PHC Total No. Dispensary (N-9) (N-19) (N-10) 1 Biomedical Waste Registration 7 3 10 2 Facility use color coded Bins 5 3 8 3 Needle destructed and discard in Bins 4 7 11 4 Sterilization facility 3 6 9 (spirit/Autoclave/Boiling ) 5 Linkages with agency for common 10 7 17 treatment of waste
In study, out of total 19 facilities, 10 facilities reported to have Biomedical waste registration but none of the facility shows the registration number or certificate at the time of visit. The renewal of the Bio medical waste registration number was due for Civil Dispensary Indore. During discussion with the facility staff, study team learnt that the staff is not clear about Bio medical waste registration number. Atal Bihari Vajpayee Institute of Good Governance and Policy Analysis
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Essentials for Proper Waste Segregation
In order to ensure the proper BMW segregation at the point of source HCF has to ensure following: Display work instructions like posters for waste segregation at the point of generation Provide proper sized and adequate number of color coded bins, bags and containers at the point of generation as per the expected. Provide PPEs (Personal Protective Equipment) to waste handlers for waste segregation and collection
Some of the observations related to biomedical waste management were recorded are: a) Study team observed the status of use of bins at facilities. It was found that in some places the bins were filled up to 3/4th level and in most the facilities the bins were overfilled with biomedical waste; b) Segregation, of biomedical waste, was not done properly. The sharp waste items were found mixed with the other waste items. The Infectious and noninfectious waste were dumped in same bins in some of the facilities. c) The biomedical waste kept in the bins for more than 48 hours. d) None of the staff trained enough to manage
biomedical waste management protocol. e) Suggested practice of disinfecting before disposing the Recyclables waste and sharp waste materials such as IV set, bottles, syringes, latex gloves, catheters etc. are not followed.
Use of Colour coded bins: The colour coded bins were available only in 8 facilities. Rest of the facilities discard biomedical waste in general bins. Segregation of biomedical waste was not according to the guidelines.
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Classification of Bio-Medical Waste
Rules (2016)
The bio-medical waste generated from the health care facility into four categories based on the segregation pathway and colour code. 1. Yellow Category 2. Red Category 3. White Category 4. Blue Category
Sterilization, Destruction and Discarding of Equipment: The used needles were destroyed and discarded properly in 11 facilities but not kept in the right bin. In all the facilities, sterilization of instruments was in practice. Majority of the facilities were using boiling method or spirit as sterilizer. No sterilization dates found in any of the instruments checked at the time of visit.
Disposal of non-infectious waste: It was observed that Harda and Bhind Urban-PHC either burns the Bio-medical waste or dumps outside the hospital Important Points premise. This leads to inviting the flies, insects, rodents, cats and dogs in the nearby areas. This 1. Incorrect waste practice also increases the Also, rag pickers are at a segregation practices risk of getting tetanus and other infections. 2. Mix of biomedical Linkages with common treatment facility: and non infectious In survey, Bhopal Civil Dispensary reported that the waste facility has tied up with MP Pollution Control Board 3. Lack of monitoring and Civil Dispensary Jabalpur tied up with Elite by district authority Engineers for management of biomedical waste. However, 7 facilities are using Nagar Nigam van for
waste disposal.
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Dressing: good practice and malpractice
4.6.2 Record and Documentation The record maintenance system was also observed at the time of visit. The update registers were found in most of the Civil Dispensary and Urban-PHCs. It is evident from the table below that register related to OPD, maternal and child health, national health programme, immunization and health staff registers were in place in most of the facility visited.
Table 19: Registers Maintained by the Facilities
Register/Document Civil Dispensary Urban-PHC Total (N-10) (N-9) (N-19) OPD registers 9 9 18 HMIS formats 9 7 16 ANM registers 6 7 13 ANC/PNC/Eligible couple register 6 7 13 Report-National Health Programmes 5 8 13 ASHA Diary 5 7 12 Immunization register 5 6 11 lab Registers 6 5 11 Referral Registers 3 6 9 Stock Registers 3 3 6 Monthly Report Register 1 1 2 RKS Register 2 0 2 Indent Book 1 1 2 Balance Register 1 0 1 Daily Patient Record Register 1 0 1 Family Planning Register 0 1 1
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4.6.3 Fund flow and utilization In survey, information related to fund management was also enquired from the health staff. Health staff posted in Civil Dispensary and Urban-PHCs did not have any information about status of fund to the facility. The Medical Officer posted in Urban- PHC was also not aware about fund status. The fund flow and utilization of Civil Dispensary manage by Civil Surgeon whereas fund management of Urban-PHC was managed by Chief Medical Officer.
4.6.4 Monitoring and Supervision The monitoring and supervision of Civil Dispensaries and Urban-PHCs was also investigated at the time of visit. The table below describes the response of health staff regarding monitoring of the facility. It is interesting to note that multiple authorities were involved in monitoring and supervision.
Table 20: Supervision Practice
Sl. District At Civil Dispensary At Urban-PHC No. 1 Bhopal Civil Surgeon APM 2 Harda - CMHO 3 Sagar Civil Surgeon NUHM - Bhopal 4 Indore Medical Officer/Civil Surgeon - 5 Dhar Civil Surgeon/RMO DPM/CMHO DTO 6 Ujjain For Family Planning - LHV/CMHO DHO For TB – Staff Nurse/DTO Dispensary - Civil Surgeon 7 Bhind Civil Surgeon NO 8 Gwalior CMHO 9 Jabalpur NO CMHO 10 Umaria - NO 11 Rewa NO CMHO
The District authority was mostly engage in redeploying the health staff from one facility to another facility. There is no focus on ensuring delivery of better quality of services through health facilities and outreach services. Civil surgeon mostly managed the Civil Dispensaries whereas Chief Health and Medical Officer (CMHO) managed Urban-PHC.
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4.7 Convergence and Partnership
National Urban Health Mission promotes inter-sectoral and intra-sectoral convergence to avoid duplication of resources and efforts. In study, the understanding about convergence within health and outside health departments was explored by the study team.
The convergence with other department was found in initial stage. Most of the health staff was not aware about the possibility to engage other departments for health services at their level. However, Bhopal Sai baba Urabn-PHC is successfully undertaking a disease surveillance project in partnership with AIIMS Bhopal. The Urban Local Body is actively involved in Jabalpur and Umaria Urban-PHC. During field visit the study team learnt about the Rotary Club support in OPD services in Ratlam Civil Dispensary.
Key findings related to convergence:
i. Formats were available in all the facility related to National Disease Control Programme ii. Department of Ayush - services of AYUSH doctor available iii. Distribution of condoms and IEC materials iv. Coordination among frontline workers, i.e. ANM and Aganwadi workers etc. v. Possibility to link with school health programme vi. Lack of awareness among health staff to explore possibility of potential partnership with the Department of Urban Development & Housing, Urban Poverty Alleviation and Jawaharlal Nehru National Urban Renewal Mission (JnNURM).
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5. Conclusion
National Urban Health Mission envisage to meet health care needs of the urban population with special focus on urban poor, by providing essential primary health care services with easy access. It could be achieve by strengthening the existing health care service delivery system particular urban primary health care services in the state. An attempt has been undertaken to understand current situation of Urban Primary health care services provided by Civil Dispensaries and Urban- Primary Health Centres in Madhya Pradesh.
The present study has utilized the primary and secondary source of data. The service data highlights the geographical distribution of urban health centers engage in primary health care delivery and its Out Patient performance of the last year. The National Health Mission - HR data also referred to understand the existing human resource gap.
The geographical distribution of Civil Dispensaries and Urban Primary Health Centers highlights the current status in terms of physical structure, distance between two or more facilities and density. Study brings out the need for verification of actual number of functional Civil Dispensaries and Urban-PHCs for performance monitoring. In order to understand the actual number of Civil Dispensary and Urban-PHC in Madhya Pradesh two dataset (1) HMIS facility database (2) NHM-HR records were analyzed through data triangulation method. It was found that no uniform list of Civil Dispensary and Urban-PHC is in use by all the departments.
The health staff posted in Civil Dispensaries and Urban-PHCs found to be big challenge as there is no single Human Resource unit or cell responsible to keep and update HR data. The mix of regular and contractual staff posted in Civil Dispensaries and Urban- PHCs with frequent attachment to the district hospital creates ambiguity in facility performance.
The Health Management Information System was used to ascertain the general health profile of the patients who visited Civil Dispensaries and Urban-PHCs from April 2017 to March 2018. Most of the facilities updated only total OPD records in HMIS with details of non-communicable disease. The volume of patients found high with hypertension, followed by diabetes, ophthalmic and dental problems. It is important to know the substantial outpatient records related to Mental illness reasons, Acute Heart Diseases, Epilepsy and Stroke (Paralysis) at Urban-PHC.
The urban health mission has a mandate to improve the urban health care services with special focus on poor and deprive population. The health service provision faces services related challenges like availability of medical and paramedical staff. Most compromised services were found to be lab services due to non-availability of lab technician. No mechanism of continuous capacity building and minimum supportive
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A Study of Civil Dispensaries & Urban Primary Health Centres in Madhya Pradesh 2018 supervision leads lack of confidence among health staff. Investment and maintenance of physical infrastructure of the health facility was another barrier to build the trust among community and staff.
It was expected to utilize potential inter-sectoral and intra-sectoral development partner to improve the urban health in Madhya Pradesh. Lack of awareness among health staff with limited knowledge and ignorance of district administration is a challenge to unfold the opportunity. Following key components affects urban health care services
Infrastructure & Sanitation facilities
Administrative Availability of Medical Officer issues & Health staff
Factors affect Urban Primary Health Confidence Care Services among Health Lab Facility Staff
Inter Supportive department Supervision coordination
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6. Recommendations
Administration: It is very important to verify and made available list of all the functional Civil Dispensary and Urban-PHC to all the departments. It is recommended to have only one administrative control at district level to avoid any discrepancy in service delivery.
Access and Infrastructure: It is recommended to have disabled friendly infrastructure to avail OPD services with ease. Ramp, Hand- railing, proper lightning etc. must be provided. The infrastructure should have separate and proper rooms for consultation, dressing, pharmacy and lab with seating arrangements for the patients. The display boards with location indicators of health facilities help easy identification for vulnerable population. There must be provision of timely rent payment to avoid inconvenience of the service providers and patients. It is recommended to ensure the provision of basic facilities like safe drinking water, hand wash and separate toilets for men and women. Maintenance of the buildings and premises is highly recommended
Human Resource/Health Staff: In order to improve the lab services in Civil Dispensaries and Urban-PHCs, recruitment and posting of lab technician needs to be done on priority basis. The availability of Medical Officers on regular basis (avoid deputation to District Hospital) at facility would help in creating the trust among community members. There is need for capacity building of health staff on counseling, family planning methods, management and referral of maternal and neonatal complicated cases, screening and identification of cervical/breast cancer, mental health to improve the confidence level as well meeting the objectives of urban health mission. It is recommended that the service requirement would be shared with Nursing Training Institutions to bridge the knowledge gap at the time of joining.
Service Provision: It is recommended to have uniform service provision for all the Civil Dispensaries and Urban-PHC with single point of contact at district level. The primary care should be made at facility level and referral should be made for advance treatment. Basic lab with sufficient essential equipment’s must be provided to all the facilities for timely identification, diagnosis and treatment.
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Table 21: Issue wise key recommendations to strengthen the urban primary health care services in Madhya Pradesh
1 Administration Recommendations Suggested methods 1.1 Verification of functional status Through enforcement actual number of of all the Civil Dispensaries and urban health centers engage in primary Urban-PHCs health services can be verified Referred list of urban health facilities enclosed as annexure in the report 1.2 Either CMHO or CS should be Release of Office order by the State that made responsible for overall CMHO or CS should be responsible for functioning of the urban health overall function of urban primary health care facilitates 1.3 Availability of uniform list of all Online display list of facilities with in- the civil dispensary and Urban- charge details PHCs across department 1.4 Uniform services of all the health Ensuring uniform norms and services at facilities engage in primary the Civil dispensary and UPHC; health care services Develop an online system of monitoring the functioning of health facilities 1.5 Ensuring Quality Assurance of Regular monitoring and implementation of Urban PHCs quality assurance system.
2 Infrastructure and sanitation facilities Recommendations Suggested methods 2.1 Basic infrastructure of the Regular Monitoring of basic Infrastructure centers should be of good and sanitation facility condition with adequate space for basic amenities specific ally separate toilets for men and women 2.2 Maintenance of buildings and Proper implementation of Quality premises Assurance guidelines for regular monitoring 2.3 Timely rent payment Develop online payment system
2.4 Separate rooms for consultation, Float public advertisement for requirement dressing, pharmacy and lab with of building with required specifications seating arrangements Check list with specifications for exploring the new building with requisite facilities
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3 Human Resource/Health Staff Recommendations Suggested methods 3.1 Availability of MO and health Develop a pool of doctors to post as MO in staff urban areas Part time services of private doctors for example Red Cross Hospital 4 Lab Facility Recommendations Suggested methods 4.1 Basic lab with essential Explore outsource possibility of lab equipment should be made services available Recruitment and posting of lab technician at vacant posts Ensuring advance and proper planning and requisition of essential drug list and equipment. 5 Confidence among health staff Recommendations Suggested methods 5.1 Training of health staff to handle Appoint district level mentor for supportive MCH services/screening of supervision and capacity building of health patients for communicable and staff non-communicable diseases Service requirement would be shared with the public and private Nursing Institutions to bridge the knowledge gap 6 Interdepartmental coordination Recommendations Suggested methods 6.1 Convergence with other Appoint state and district level nodal department would help in officers to explore potential partner for addressing the urban primary convergence and partnership health care services
7. Limitations
1. In study, various service records were referred and analyzed. The discrepancies in total number of Civil Dispensaries and Urban-PHCs in the various reports were found. Hence, the total number of Civil Dispensaries and Urban-PHCs varies from HR records and HMIS reports.
2. It was expected to identify the potential stakeholders; service partners (Public Private Partnership) and referral points of Civil Dispensaries and Urban-PHCs in the study. However, in survey, very limited information related to partnership was reported due to lack of awareness among health staff.
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8. References
1. A Review of Existing Regulatory Mechanisms To address the Shortage of Doctors in Rural, Remote and Underserved Areas: A Study Across Five States In India NHSRC 2016 2. Framework for Implementation National Urban Health Mission Ministry of Health & Family Welfare Government of India May 2013 3. Global Health Risk Mortality and burden of disease attributable to selected major risks WHO 2009 4. Healthy Cities Initiative: Approaches and Experience in the African Region WHO 2002 5. Implementation Guidelines for Management of Healthcare Waste in Health Care Facilities as per Bio Medical Waste Management Rules, 2016; National Health System Resource Centre GOI 6. Operational Guidelines Conducting Outreach Sessions in Urban Areas, Ministry of Health & Family Welfare 2015 7. Strengthening the District Hospital (DH) for multi-specialty care & as a site for training, NHSRC 2017 8. State of Urban Health in Madhya Pradesh Urban Health Resource Centre 2006 9. Terms of Reference, 10th Common Review Mission National Health Mission Ministry of Health & Family Welfare 2016
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Annexure
Table A1: District wise list of Urban-PHC and Civil Dispensary where facility survey conducted
Sl. District Proposed Facility Survey conducted Remark No. 1 Bhopal CD Anand Nagar CD Anand Nagar 2 Bhopal UPHC Sai baba Nagar UPHC Sai baba Nagar 3 Bhind CD Bhind CD Bhind 4 Bhind UPHC B.T. I. Road UPHC B.T. I. Road 5 Gwalior CD Falka Bazar CD Falka Bazar 6 Gwalior UPHC Gol Pahariya CD Gol Pahariya U-PHC closed; staff shifted to DH; CD- Operation same building 7 Indore CD Bhanwarkuan CD Bhanwarkuan 8 Dhar CD Branch 2 CD Branch 1 CD closed; non functional 9 Dhar UPHC Ganji Khana UPHC Ganji Khana 10 Jabalpur CD Gohalpur Ward CD Gohalpur Ward 11 Jabalpur UPHC Ghamapur UPHC Ghamapur 12 Harda UPHC Harda UPHC Harda 13 Rewa CD Univ Rewa CD Univ Rewa 14 Rewa UPHC Bodabag UPHC Bodabag 15 Sagar CD Bhagwanganj CD Bhagwanganj 16 Sagar UPHC Bina UPHC Bina 17 Umaria UPHC Loharganj UPHC Loharganj 18 Ujjain CD Madhavnagar CD Chattichowk CD closed; difficult to locate 19 Ujjain UPHC Pawasa UPHC Pawasa
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Table A2: District wise NHM health staff posted in Urban-PHCs
Sl. District Urban- MO RBSK Staff Lab Pharm LDC for ANM Total No. PHC AMO Nurse Tech -acist MIS (no) 1 Ashoknagar 1 - - 2 - - 1 4 7 2 AgarMalwa ------3 Alirajpur ------4 Anuppur ------5 Balaghat 1 - - 1 - - - 1 6 Barwani 2 1 - 4 - - 2 4 11 7 Betul 2 2 - 1 1 2 1 5 12 8 Bhind 3 2 - 4 - - 1 14 21 9 Bhopal 8 6 - - 2 - 6 - 14 10 Burhanpur 2 1 - 3 1 1 - - 6 11 Chhatarpur 2 1 - 2 1 - - - 4 12 Chhindwara 2 1 - 2 - - - - 3 13 Damoh 1 - - 1 - - - - 1 14 Datia 1 - - 1 - - 1 - 2 15 Dindori 0 ------16 Dhar 0 ------17 Dewas 2 2 - 1 1 - 2 3 9 18 Guna 3 2 - 4 1 - 2 15 24 19 Gwalior 14 7 - 9 6 2 16 32 72 20 Harda 1 - 1 - - - 1 2 21 Hoshangabad 3 - 6 1 - 2 8 17 22 Indore 13 8 - 3 4 1 3 22 41 23 Jabalpur 16 7 - 21 10 1 10 44 93 24 Jhabua 1 - - 1 - - 1 2 25 Katni 2 1 - 1 2 - 1 4 9 26 Khandwa 2 2 - 2 1 1 1 1 8 27 Khargone 1 1 - 2 - - 1 3 7 28 Mandla 1 1 - - - 1 1 3 29 Mandsaur 1 - - 1 - - 1 1 3 30 Morena 1 - - 1 - - - - 1 31 Narsinghpur 2 1 - 4 - - - 4 9 32 Neemuch 1 - - - - - 1 - 1 33 Panna 1 - - 1 - - - - 1 34 Raisen 1 1 - - - 1 - 2 35 Rajgarh 1 - - 1 - 1 - - 2 36 Ratlam 4 1 - 4 3 2 3 6 19 37 Rewa 2 1 - 2 - - 1 4 8 38 Sagar 2 3 - 3 - - - 5 11
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Sl. District Urban- MO RBSK Staff Lab Pharm LDC for ANM Total No. PHC AMO Nurse Tech -acist MIS (no) 39 Satna 2 - 2 - - - 7 9 40 Sehore 2 1 - 2 - - 1 8 12 41 Seoni 1 - 2 - - 1 3 6 42 Shahdol 1 1 - 1 - - - 3 5 43 Shajapur 2 1 - 2 - - - 1 4 44 Sheopur 1 - - 1 - - 1 1 3 45 Shivpuri 1 - - - 1 - 1 - 2 46 Sidhi 1 - - 1 - - 1 3 5 47 Singrauli 1 - - 2 - - 1 - 3 48 Tikamgarh 1 - - 2 - - - 6 8 49 Ujjain 7 3 2 - - 1 3 9 18 50 Umaria 1 1 - 1 - 1 - 3 6 51 Vidisha 4 3 - 7 - 1 1 18 30 Total 125 62 2 111 36 14 68 244 537
Table A3: District wise NHM health staff posted in District Programme Management Unit
Sl. District DPMU MO Ayush APM Staff Lab ANM Total No. MO Urban Nurse Technician Health 1 Bhopal DPMU Bhopal - - 1 - - - 1 2 Dewas DPMU Dewas - - 1 - - - 1 3 Dhar DPMU Dhar - - - - 2 2 4 Gwalior DPMU Gwalior - - 1 - - - 1 5 Jabalpur DPMU - - 1 - - - 1 Jabalpur 6 Katni DPMU Katni - - 1 - - - 1 7 Satna DPMU Satna - - 1 - - - 1 8 Ujjain DPMU Ujjain - - 1 - - - 1 9 Indore DPMU 1 1 1 1 2 6 Malharganj Total 1 1 7 1 1 4 15
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Table A4: District wise Regular and NHM health staff posted in Civil Dispensary
Sl. District Civil Dispensary MO MO Other Staff No. (Regular) (NHM) (NHM) 1 Alirajpur CD Branch Dispensary 1 0 0 2 Badwani CD Rajpur (Harijan) 0 0 0 3 Bhind CD Bhind 0 0 0 4 Bhopal CD Satpuda Bhawan 1 0 0 5 Bhopal CD Vindhyachal Bhawan 1 0 0 6 Bhopal CD Vallabh Bhawan 1 0 0 7 Bhopal CD Govt. Press 1 0 0 8 Bhopal CD Raj Bhawan 3 0 0 9 Bhopal CD MLA Rest House 1 0 0 10 Bhopal CD Vidhan Sabha 2 0 0 11 Bhopal CD Professor Colony 1 0 0 12 Bhopal CD Panchshil Nagar 1 0 3 13 Bhopal CD 1100 Quarters 2 0 4 14 Bhopal CD Govindpura 0 0 0 15 Bhopal CD Ahmedabad 0 0 0 16 Bhopal CD Kotra 1 0 0 17 Bhopal CD Bagsevania 1 0 0 18 Bhopal CD Barkhera Pathani 1 0 0 19 Bhopal CD Anand Nagar 1 0 0 20 Bhopal CD Sevania Gaud 1 0 0 21 Bhopal CD Misrod 0 0 0 22 Bhopal C.D. PIPLANI 0 0 1 23 Bhopal C.D. RUKMABAI 0 0 5 24 Bhopal C.D. TELAJAMALPURA 0 0 6 25 Chhatarpur CD Harijan Dispensary 1 0 0 26 Chhindwara CD Gandhiganj 0 0 0 27 Datia CD Datia 1 0 0 28 Datia CD Ward No 11 (Chhalapura) 1 0 0 29 Dhar CD Branch 0 0 0 30 Dhar CD Branch 0 0 0 31 Dhar CD Manabar 0 0 0 32 Guna CD Cant 1 0 0 33 Gwalior CD Thatipur 0 0 0 34 Gwalior CD Falka Bazar 2 0 0 35 Gwalior CD Janakganj 1 0 5 36 Gwalior CD AG Office 1 1 0 37 Gwalior CD Fort 1 0 0 38 Gwalior CD Gole Pahardia 1 0 0 39 Gwalior CD Motimahal 2 1 0
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Sl. District Civil Dispensary MO MO Other Staff No. (Regular) (NHM) (NHM) 40 Gwalior CD Shabdpratap Ashram 1 1 2 41 Gwalior CD Gole ka Mandir 1 0 0 42 Gwalior CD Hemsingh Ki Pared 1 0 0 43 Gwalior CD Harijan Dispensary 0 0 0 44 Gwalior CD Harijan Dispensary 0 0 0 45 Gwalior CD Harijan Dispensary 0 0 0 46 Gwalior CD Harijan Dispensary 0 0 0 47 Gwalior CD Harijan Dispensary 0 0 0 48 Gwalior CD Deendayal 1 49 Gwalior CD High Court 1 0 50 Gwalior CD MH Birlanagar 5 51 Gwalior CD MH Laxmiganj 1 52 Indore CD Baanganga (HD) 1 0 0 53 Indore CD Bhanwarkuan 1 1 0 54 Indore CD Harsiddhi 1 1 7 55 Indore CD Residency 1 0 0 56 Indore CD Hukumchand 1 0 0 57 Indore CD DRP Line 1 0 0 58 Indore CD Juni Indore (HD) 0 1 2 59 Indore CD Krishnapura 1 0 2 60 Indore CD Bhagirathpur (HD) 0 0 0 61 Indore CD Jabran Colony 0 0 0 62 Indore CD Vinoba Nagar 0 0 0 63 Indore CD Aranya Hospital (HD) 1 0 3 64 Indore CD Baanganga 0 0 0 65 Indore CD Azad Nagar (sanyogitaganj) 1 0 66 Indore CD Brindawan Colony (Nanda Nagar) 7 67 Indore CD KHAJRANA (SANYOGITAGANJ) 2 68 Indore CD MANGILAL CHURIYA(NANDA NAGAR) 7 69 Indore CD MOG LINE (MALHARGANJ) 1 14 70 Indore CD MOHTA NAGAR (NANDA NAGAR) 7 71 Jabalpur CD Shankarshah Nagar 1 0 0 72 Jabalpur CD Gohalpur Ward 0 0 0 73 Jabalpur CD Agriculture College 0 0 0 74 Jabalpur CD Govt. Eng. College 0 0 0 75 Jabalpur CD Govt. College 0 0 0 76 Jabalpur CD Ghamapur 0 0 0 77 Jabalpur CD Gorakhpur 1 0 0 78 Jabalpur CD Miloniganj 1 0 0 79 Jabalpur CD Adhartal 1 0 0 80 Jabalpur CD Kotwali 1 0 0
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Sl. District Civil Dispensary MO MO Other Staff No. (Regular) (NHM) (NHM) 81 Khargone CD Harijan Dispensary Maheswar 0 0 0 82 Khargone CD Harijan Dispensary Kasraabad 0 0 0 83 Morena CD Sabalgarh (Ward 1 0 0 84 Morena CD Morena (Ward 0 0 0 85 Morena CD Morena 1 0 0 86 Rajgarh CD Khilchipur (Ward 2) 0 0 0 87 Rajgarh CD Narsinghgarh (Ward 2) 1 0 0 88 Ratlam CD Mominpura 0 0 0 89 Rewa CD Univ., Rewa 0 0 0 90 Rewa CD Engg. College 0 0 0 91 Sagar CD Sagar 1 0 0 92 Sagar CD Bhagwanganj 0 0 0 93 Sagar CD Vitthal Nagar 0 0 0 94 Sagar CD Mahaveer Ward, Rehli 0 0 0 95 Sagar CD Ward No 1, Khurai 1 0 0 96 Sagar CD Ward No 10, Khurai 1 0 0 97 Sagar CD Ward No 1, Bina 0 0 0 98 Satna CD Sindhi Colony 0 0 0 99 Satna CD Dhawari 0 0 3 100 Sehore CD Riot Affected Area 0 0 0 101 Tikamgarh CD Ward 10 0 0 0 102 Ujjain CD Chhatrichowk 0 0 0 103 Ujjain CD Kartikchowk 0 0 0 104 Ujjain CD Bherugarh, Ujjain 0 0 0 105 Ujjain CD Sanjay Nagar 0 0 0 106 Ujjain CD Jaysingh Pura 0 0 0 Total 54 9 87
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Table A5: Cadre wise staff strength against NHM norm in survey facilities
Sl. Cadre Proposed Staff at Staff at Civil Total No. basic staff by Urban- Dispensary NHM PHC 1 MO full time 1 6/9 9/10 15/19 2 MO Part Time 1 3/9 4/10 7/19 3 ANM 3-5 14/9 16/10 30/19 4 Staff Nurse 3 8/9 3/10 11/19 5 Pharmacist 1 2/9 5/10 7/19 6 Lab Technician 1 2/9 3/10 5/19 7 LHV 1 3/9 4/10 7/19 8 Account keeping and MIS 2 2/9 0/10 2/19 9 Support Staff 1 7/9 11/10 18/19 10 Public Health Manager/Community 1 1/9 0/10 1/19 Mobiliser
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Table A6: Status of Civil Dispensary according to HMIS, HR -Directorate of Health and NHM
Sl. District Facility Name HMIS Directorate- NHM-HR No. Name MO 1 Alirajpur CDU Branch Dispensary N Y NA 2 Barwani CDU Rajpur Harijan N N NA 3 Bhind CDU Bhind N N NA 4 Bhopal CDU 1100 Quarters Y Y Y 5 Bhopal CDU 23rd Btln Y NA NA 6 Bhopal CDU 25th Btln Y NA NA 7 Bhopal CDU 7th Btln Y NA NA 8 Bhopal CDU Ahmedabad Y N NA 9 Bhopal CDU Anand Nagar Y Y NA 10 Bhopal CDU Bagsevania N Y NA 11 Bhopal CDU Barkhera Pathani Y Y NA 12 Bhopal CDU Govindpura N N NA 13 Bhopal CDU Govt. Press Y Y NA 14 Bhopal CDU Kamala Nagar Y NA NA 15 Bhopal CDU Kotra Y Y NA 16 Bhopal CDU Misrod Y N NA 17 Bhopal CDU MLA Rest House N Y NA 18 Bhopal CDU Panchshil Nagar Y Y Y 19 Bhopal CDU Piplani Y NA Y 20 Bhopal CDU Professor Colony N Y NA 21 Bhopal CDU Raj Bhawan Y Y NA 22 Bhopal CDU Satpuda Bhawan Y Y NA 23 Bhopal CDU Sevania Gaud Y Y NA 24 Bhopal CDU Vallabh Bhawan Y Y NA 25 Bhopal CDU Vidhan Sabha Y Y NA 26 Bhopal CDU Vindhyachal Bhawan Y Y NA 27 Bhopal C.D. RUKMABAI NA NA Y 28 Bhopal C.D. TELAJAMALPURA NA NA Y 29 Chhatarpur CDU Harijan Dispensary Y Y NA 30 Chhindwada CDU Gandhiganj N N NA 31 Datia CDU Datia N Y NA 32 Datia CDU Ward No 11 Chhalapura N Y NA 33 Dhar CDU Manabar N N NA 34 Dhar CDU NALCHA DARWAJA Y N NA 35 Dhar CDU RAJWADA Y N NA 36 Guna CD Cant NA Y NA 37 Gwalior CD DEENDAYAL NAGAR Y NA Y 38 Gwalior CD FPAI KAMPOO NGO Y NA NA 39 Gwalior CD FPAI KHEDAPATI NGO Y NA NA 40 Gwalior CD JANAKGANJ Y Y Y 41 Gwalior CD LADHEDI PRASUTIGARH Y NA NA 42 Gwalior CD SABDPRATAP ASHRAM Y Y Y
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Sl. District Facility Name HMIS Directorate- NHM-HR No. Name MO 43 Gwalior CDU 13th BATT SAF N NA NA 44 Gwalior CDU 14th BATT SAF N NA NA 45 Gwalior CDU 2ND BATT SAF N NA NA 46 Gwalior CDU AG Office N Y Y 47 Gwalior CDU Fort N Y NA 48 Gwalior CDU Gole ka Mandir N Y NA 49 Gwalior CDU Govt Press N NA NA 50 Gwalior CDU Harijan Dispensary 1 N N NA 51 Gwalior CDU Harijan Dispensary 2 N N NA 52 Gwalior CDU Harijan Dispensary 3 N N NA 53 Gwalior CDU Harijan Dispensary 4 N N NA 54 Gwalior CDU Harijan Dispensary 5 N N NA 55 Gwalior CDU Motimahal N Y Y 56 Gwalior CD Thatipur NA N NA 57 Gwalior CD Falka Bazar NA Y NA 58 Gwalior CD Gole Pahardia NA Y NA 59 Gwalior CD Hemsingh Ki Pared NA Y NA 60 Gwalior CD MH Birlanagar NA NA Y 61 Gwalior CD MH Laxmiganj NA NA Y 62 Gwalior CD High Court NA NA Y 63 Indore CD ARANYA Y Y Y 64 Indore CD AZAD NAGAR Y NA Y 65 Indore CD Bhanwarkuan N Y Y 66 Indore CD HARSIDDHI Y Y Y 67 Indore CD KHAJRANA Y NA Y 68 Indore CD Mohta Nagar Y NA Y 69 Indore CD RADIO COLONY Y NA NA 70 Indore CDU Baanganga HD N Y NA 71 Indore CDU Baanganga ii N N NA 72 Indore CDU Bhagirathpur HD N N NA 73 Indore CDU DRP Line N Y NA 74 Indore CDU Jabran Colony N N NA 75 Indore CDU Juni Indore HD N N Y 76 Indore CDU Krishnapura N Y Y 77 Indore CDU Residency N Y NA 78 Indore CDU Vinoba Nagar N N NA 79 Indore CD Hukumchand NA Y NA 80 Indore C.D.BRINDAWAN COLONY(NANDA NAGAR) NA NA Y 81 Indore C.D.MANGILAL CHURIYA(NANDA NAGAR) NA NA Y 82 Indore C.D.MOG LINE(MALHARGANJ) NA NA Y 83 Jabalpur CDU Agriculture College N N NA 84 Jabalpur CDU Ghamapur N N NA 85 Jabalpur CDU Gohalpur Ward N N NA 86 Jabalpur CDU Gorakhpur N Y NA
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Sl. District Facility Name HMIS Directorate- NHM-HR No. Name MO 87 Jabalpur CDU Govt. College N N NA 88 Jabalpur CDU Govt. Eng. College N N NA 89 Jabalpur CDU Kotwali N Y NA 90 Jabalpur CDU Miloniganj N Y NA 91 Jabalpur CDU Shankarshah Nagar N Y NA 92 Jabalpur CD Adhartal NA Y NA 93 Khargone CD Christian Dispensary Kasrawad N NA NA 94 Khargone CDU Christian Dispensary Kasrawad N NA NA 95 Khargone CDU Harijan Dispensary Kasraabad N N NA 96 Khargone CDU Harijan Dispensary Maheswar N N NA 97 Khargone CDU Police Line Khargone Y NA NA 98 Morena CDU Morena N Y NA 99 Morena CDU Morena Ward 8 N N NA 100 Morena CDU Sabalgarh Ward 8 N Y NA 101 Rajgarh CDU Khilchipur Ward 2 N N NA 102 Rajgarh CDU Narsinghgarh Ward 2 Y Y NA 103 Ratlam CDU Mominpura N N NA 104 Rewa CDU Engg. College Y N NA 105 Rewa CDU Univ Rewa Y N NA 106 Sagar CDU Bhagwanganj N N NA 107 Sagar CDU Govt Eng College N NA NA 108 Sagar CDU Mahaveer Ward Rehli N N NA 109 Sagar CDU Sagar N Y NA 110 Sagar CDU Vitthal Nagar N N NA 111 Sagar CDU Ward No 1 Bina N N NA 112 Sagar CDU Ward No 1 Khurai N Y NA 113 Sagar CDU Ward No 10 Khurai N Y NA 114 Satna CDU Sindhi Colony N N NA 115 Satna CD Dhawari NA NA Y 116 Sehore CDU Riot Affected Area N N NA 117 Sehore CDU Sehore N NA NA 118 Tikamgarh CDU Ward 10 N N NA 119 Ujjain CDU Bherugarh N N NA 120 Ujjain CDU Chhatrichowk N N NA 121 Ujjain CDU Engineering College N NA NA 122 Ujjain CDU Jaysingh Pura N N NA 123 Ujjain CDU Kartikchowk N N NA 124 Ujjain CDU Madhavnagar N NA NA 125 Ujjain CDU Sanjay Nagar N N NA
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Table A7: District wise status of Urban-PHC according to HMIS and NHM - HR Cell
Sl. No. District Name Facility Name HMIS NHM-HR 1 Agar Malwa UPHC Agar Y NA 2 Ashok Nagar UPHC Ashok Nagar Y Y 3 Balaghat UPHC Balaghat Y Y 4 Barwani UPHC Barwani Y Y 5 Barwani UPHC Sendhwa Y Y 6 Betul UPHC Betul Y Y 7 Betul UPHC Sarani Y Y 8 Bhind UPHC Bhawanipura Y Y 9 Bhind UPHC Gohad Y Y 10 Bhind UPHC Vikrampura Y Y 11 Bhopal UPHC Anandnagar Y Y 12 Bhopal UPHC Ashoka Garden Y Y 13 Bhopal UPHC Bagsewaniya Y Y 14 Bhopal UPHC Berkheda Pathani Y NA 15 Bhopal UPHC Kokta Y Y 16 Bhopal UPHC Kolua Y Y 17 Bhopal UPHC Kotra Y Y 18 Bhopal UPHC Saibaba Nagar Y Y 19 Bhopal UPHC Alamganj Y Y 20 Bhopal UPHC Doulatpura Y Y 21 Bhopal UPHC Chhatarpur Y Y 22 Bhopal UPHC Tatoriya Y Y 23 Bhopal UPHC Lalbag Y Y 24 Bhopal UPHC Sukludhana Y Y 25 Damoh UPHC Damoh Y Y 26 Datia UPHC Datia Y Y 27 Dewas UPHC Bawadia Y Y 28 Dewas UPHC Itawa Y Y 29 Dhar UPHC Brahmakundi Y NA 30 Dhar UPHC Pithampur N NA 31 Dhar UPHC Veersanwarkar Ganjikhana Y NA 32 Guna UPHC Boode Balaji Y Y 33 Guna UPHC Cantt Y Y 34 Guna UPHC Raghogarh Y Y 35 Gwalior UPHC Bahodapur N Y 36 Gwalior UPHC CD Falka Bazar Y Y 37 Gwalior UPHC CD Gol Pahadiya Y Y 38 Gwalior UPHC Dabra Y Y 39 Gwalior UPHC Gudagudi ka Naka Y Y 40 Gwalior UPHC Harijan Basti Dullapur Y Y 41 Gwalior UPHC Harijan Basti Gendewali Sadak Y Y 42 Gwalior UPHC Hathikhana Y Y 43 Gwalior UPHC Hurawali Y Y
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Sl. No. District Name Facility Name HMIS NHM-HR 44 Gwalior UPHC Ohadpur Y Y 45 Gwalior UPHC Panth Nagar Y Y 46 Gwalior UPHC Purani Chhawani Y Y 47 Gwalior UPHC Shankarpur Y Y 48 Harda UPHC Harda Y Y 49 Hoshangabad UPHC Gwaltoli Y Y 50 Hoshangabad UPHC Itarasi Y Y 51 Hoshangabad UPHC Malakhedi Y Y 52 Indore UPHC Baabu Murai Y Y 53 Indore UPHC BHAWARKUAN Y Y 54 Indore UPHC BRINDAWAN COLONY Y Y 55 Indore UPHC Gwaltoli Y NA 56 Indore UPHC KAMLAKANT MODi Y Y 57 Indore UPHC KRISHNAPURA Y Y 58 Indore UPHC Kulkarni ka Bhatta Y Y 59 Indore UPHC Mhow N NA 60 Indore UPHC Musakhedi Y Y 61 Indore UPHC Nihalpurmandi Y Y 62 Indore UPHC Sadar Bazar Y Y 63 Indore UPHC Shivbaag Y Y 64 Indore UPHC Shivbrahm Nagar Y Y 65 Indore UPHC Sirpur Y Y 66 Indore UPHC Sudama Nagar Y Y 67 Jabalpur UPHC ADHARTAL Y Y 68 Jabalpur UPHC Amanpur Y NA 69 Jabalpur UPHC Bara Pathar Y Y 70 Jabalpur UPHC Cherital Y NA 71 Jabalpur UPHC Ganga nagar Y NA 72 Jabalpur UPHC Gupteshwar Y Y 73 Jabalpur UPHC Hanumantala N NA 74 Jabalpur UPHC Kajarwada Y Y 75 Jabalpur UPHC Lalmati Y NA 76 Jabalpur UPHC Motinala Maqsuda Y Y 77 Jabalpur UPHC Polipathar Y Y 78 Jabalpur UPHC Richai Y NA 79 Jabalpur UPHC Shanti Nagar Y Y 80 Jabalpur UPHC Suhagi Y NA 81 Jabalpur UPHC TILWARA Y Y 82 Jabalpur UPHC Ukhari Y Y 83 Jabalpur Urban PHC Ghamapur, Jabalpur NA Y 84 Jabalpur Urban PHC Gohalpur,Ram Nagar, Jabalpur NA Y 85 Jabalpur Urban PHC Chandmari, Jabalpur NA Y 86 Jabalpur Cantt, Jabalpur NA Y 87 Jabalpur Urban PHC Sneh Nagar, Jabalpur NA Y 88 Jabalpur Urban PHC Paraswara, Jabalpur NA Y
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Sl. No. District Name Facility Name HMIS NHM-HR 89 Jabalpur Urban PHC Prasutika Grah,Kotwali, Jabalpur NA Y 90 Jhabua UPHC Jhabua Y Y 91 Katni UPHC Rafi Ahmed Kidwai Y Y 92 Katni UPHC Vivekanand Y Y 93 Khandwa UPHC Ram Nagar Y Y 94 Khandwa UPHC Sanjay Nagar Y Y 95 Khargone UPHC Aurangpura Y NA 96 Khargone UPHC Khargone Y Y 97 Mandla UPHC Mandla Y Y 98 Mandsaur UPHC Mandsaur Y Y 99 Morena UPHC Morena Y Y 100 Morena UPHC Ram Nagar Y NA 101 Narsinghpur UPHC Gadarwada Y Y 102 Narsinghpur UPHC Narsinghpur Y Y 103 Neemuch UPHC Neemuch Y Y 104 Panna UPHC Panna Y Y 105 Raisen UPHC Mandideep Y Y 106 Raisen UPHC Raisen Y NA 107 Rajgarh UPHC Biaora Y Y 108 Ratlam UPHC Dilip Nagar Y Y 109 Ratlam UPHC Hakeemwada Y Y 110 Ratlam UPHC Jaora Y Y 111 Ratlam UPHC TIT Road Y Y 112 Rewa UPHC Bodabag Y Y 113 Rewa UPHC Ratahara Y Y 114 Sagar UPHC Bina Y Y 115 Sagar UPHC Khurai Y NA 116 Sagar UPHC Sagar Y Y 117 Sagar UPHC Vitthal Nagar Y NA 118 Satna UPHC Hanuman Nagar Y Y 119 Satna UPHC Kasaudhan Y Y 120 Sehore UPHC Ashta Y Y 121 Sehore UPHC Sehore Y Y 122 Seoni UPHC Chhindwara Chowk Y Y 123 Shahdol UPHC Sohagpur Y Y 124 Shajapur UPHC Shajapur Y Y 125 Shajapur UPHC Shujalpur Y Y 126 Sheopur UPHC Sheopur Y Y 127 Shivpuri UPHC Karaundi Y NA 128 Shivpuri UPHC Shivpuri Y Y 129 Sidhi UPHC Madariya Y Y 130 Singroli UPHC Navjeevan Vihar Y Y 131 Tikamgarh UPHC Tikamgarh Y Y 132 Ujjain UPHC Adarshnagar Y Y 133 Ujjain UPHC Bherugarh Y Y
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Sl. No. District Name Facility Name HMIS NHM-HR 134 Ujjain UPHC Jaisinghpura Y Y 135 Ujjain UPHC Mitranagar Y Y 136 Ujjain UPHC Nagda Y NA 137 Ujjain UPHC Pawasa Y Y 138 Ujjain UPHC Sanjaynagar Y Y 139 Umaria UPHC Umaria Y Y 140 Vidisha UPHC Basoda Y Y 141 Vidisha UPHC Karaiyakheda Y Y 142 Vidisha UPHC Mohangiri Y Y 143 Vidisha UPHC Sironj Y Y
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Table A8: District wise status of Urban-PHC according to HMIS and detail of health staff
Health Staff Sl. District Name Facility Name HMIS LDC/ Phar RBSK No. ANM LT MO SN Total MIS ma AMO 1 Agar Malwa UPHC Agar Y 2 Ashok Nagar UPHC Ashok Nagar Y 4 1 2 7 3 Balaghat UPHC Balaghat Y 1 1 4 Barwani UPHC Barwani Y 2 1 1 2 6 5 Barwani UPHC Sendhwa Y 2 1 2 5 6 Betul UPHC Betul Y 5 1 1 1 1 9 7 Betul UPHC Sarani Y 1 1 1 3 8 Bhind UPHC Bhawanipura Y 8 1 2 11 9 Bhind UPHC Gohad Y 1 1 10 Bhind UPHC Vikrampura Y 6 1 2 9 11 Bhopal UPHC Anandnagar Y 1 1 1 3 UPHC Ashoka 12 Bhopal Y 1 1 Garden 13 Bhopal UPHC Bagsewaniya Y 1 1 2 UPHC Berkheda 14 Bhopal Y Pathani 15 Bhopal UPHC Kokta Y 1 1 16 Bhopal UPHC Kolua Y 1 1 2 17 Bhopal UPHC Kotra Y 1 1 1 3 UPHC Saibaba 18 Bhopal Y 1 1 2 Nagar 19 Bhopal UPHC Alamganj Y 1 1 2 20 Bhopal UPHC Doulatpura Y 1 1 2 4 21 Bhopal UPHC Chhatarpur Y 1 1 1 3 22 Bhopal UPHC Tatoriya Y 1 1 23 Bhopal UPHC Lalbag Y 1 1 2 24 Bhopal UPHC Sukludhana Y 1 1 25 Damoh UPHC Damoh Y 1 1 26 Datia UPHC Datia Y 1 1 2 27 Dewas UPHC Bawadia Y 3 1 1 1 1 7 28 Dewas UPHC Itawa Y 1 1 2 UPHC 29 Dhar Y Brahmakundi 30 Dhar UPHC Pithampur N UPHC 31 Dhar Veersanwarkar Y Ganjikhana 32 Guna UPHC Boode Balaji Y 5 1 2 8 33 Guna UPHC Cantt Y 5 1 1 1 8 34 Guna UPHC Raghogarh Y 5 1 2 8 35 Gwalior UPHC Bahodapur N 3 1 2 1 7 UPHC CD Falka 36 Gwalior Y 4 2 1 7 Bazar
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Health Staff Sl. District Name Facility Name HMIS LDC/ Phar RBSK No. ANM LT MO SN Total MIS ma AMO UPHC CD Gol 37 Gwalior Y 2 1 1 4 Pahadiya 38 Gwalior UPHC Dabra Y 1 1 UPHC Gudagudi ka 39 Gwalior Y 3 1 1 1 2 8 Naka UPHC Harijan Basti 40 Gwalior Y 1 2 3 Dullapur UPHC Harijan Basti 41 Gwalior Y 2 1 3 Gendewali Sadak 42 Gwalior UPHC Hathikhana Y 4 1 1 1 1 2 10 43 Gwalior UPHC Hurawali Y 2 1 3 6 44 Gwalior UPHC Ohadpur Y 3 1 1 1 6 45 Gwalior UPHC Panth Nagar Y 4 1 1 6 UPHC Purani 46 Gwalior Y 2 1 1 2 6 Chhawani 47 Gwalior UPHC Shankarpur Y 2 1 1 1 5 48 Harda UPHC Harda Y 1 1 2 49 Hoshangabad UPHC Gwaltoli Y 3 1 1 2 7 50 Hoshangabad UPHC Itarasi Y 4 3 7 51 Hoshangabad UPHC Malakhedi Y 1 1 1 3 52 Indore UPHC Baabu Murai Y 2 2 UPHC 53 Indore Y 2 2 BHAWARKUAN UPHC BRINDAWAN 54 Indore Y 2 2 COLONY 55 Indore UPHC Gwaltoli Y UPHC KAMLAKANT 56 Indore Y 1 1 2 MODi UPHC 57 Indore Y 1 1 KRISHNAPURA UPHC Kulkarni ka 58 Indore Y 2 1 1 4 Bhatta 59 Indore UPHC Mhow N 60 Indore UPHC Musakhedi Y 2 1 1 1 5 UPHC 61 Indore Y 2 1 1 1 5 Nihalpurmandi 62 Indore UPHC Sadar Bazar Y 2 1 1 4 63 Indore UPHC Shivbaag Y 2 1 1 4 UPHC Shivbrahm 64 Indore Y 1 1 2 Nagar 65 Indore UPHC Sirpur Y 1 1 2 UPHC Sudama 66 Indore Y 2 1 1 1 1 6 Nagar 67 Jabalpur UPHC ADHARTAL Y 8 1 1 1 11 68 Jabalpur UPHC Amanpur Y
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Health Staff Sl. District Name Facility Name HMIS LDC/ Phar RBSK No. ANM LT MO SN Total MIS ma AMO 69 Jabalpur UPHC Bara Pathar Y 3 1 1 5 70 Jabalpur UPHC Cherital Y 71 Jabalpur UPHC Ganga nagar Y 72 Jabalpur UPHC Gupteshwar Y 1 1 1 1 1 5 UPHC 73 Jabalpur N Hanumantala 74 Jabalpur UPHC Kajarwada Y 2 1 1 1 5 75 Jabalpur UPHC Lalmati Y UPHC Motinala 76 Jabalpur Y 4 1 2 7 Maqsuda 77 Jabalpur UPHC Polipathar Y 3 1 1 1 5 11 78 Jabalpur UPHC Richai Y 79 Jabalpur UPHC Shanti Nagar Y 2 1 1 1 5 80 Jabalpur UPHC Suhagi Y 81 Jabalpur UPHC TILWARA Y 1 1 2 82 Jabalpur UPHC Ukhari Y 1 1 1 1 4 Urban PHC 83 Jabalpur Ghamapur, NA 1 1 1 3 Jabalpur Urban PHC 84 Jabalpur Gohalpur, Ram NA 6 1 1 8 Nagar, Jabalpur Urban PHC 85 Jabalpur Chandmari, NA 2 2 Jabalpur 86 Jabalpur Cantt, Jabalpur NA 1 1 1 3 Urban PHC Sneh 87 Jabalpur NA 2 1 2 5 Nagar, Jabalpur Urban PHC 88 Jabalpur Paraswara, NA 4 1 1 1 7 Jabalpur Urban PHC 89 Jabalpur Prasutika Grah, NA 5 1 1 3 10 Kotwali, Jabalpur 90 Jhabua UPHC Jhabua Y 1 1 2 UPHC Rafi Ahmed 91 Katni Y 2 1 1 1 5 Kidwai 92 Katni UPHC Vivekanand Y 2 1 1 4 93 Khandwa UPHC Ram Nagar Y 1 1 1 1 4 UPHC Sanjay 94 Khandwa Y 1 1 1 1 4 Nagar 95 Khargone UPHC Aurangpura Y 96 Khargone UPHC Khargone Y 3 1 1 2 7 97 Mandla UPHC Mandla Y 1 1 1 3 98 Mandsaur UPHC Mandsaur Y 1 1 1 3 99 Morena UPHC Morena Y 1 1 Atal Bihari Vajpayee Institute of Good Governance and Policy Analysis
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Health Staff Sl. District Name Facility Name HMIS LDC/ Phar RBSK No. ANM LT MO SN Total MIS ma AMO 100 Morena UPHC Ram Nagar Y 101 Narsinghpur UPHC Gadarwada Y 1 2 3 102 Narsinghpur UPHC Narsinghpur Y 3 1 2 6 103 Neemuch UPHC Neemuch Y 1 1 104 Panna UPHC Panna Y 1 1 105 Raisen UPHC Mandideep Y 1 1 2 106 Raisen UPHC Raisen Y 107 Rajgarh UPHC Biaora Y 1 1 2 108 Ratlam UPHC Dilip Nagar Y 2 1 1 2 6 UPHC 109 Ratlam Y 1 1 1 1 1 5 Hakeemwada 110 Ratlam UPHC Jaora Y 1 1 2 111 Ratlam UPHC TIT Road Y 2 1 1 1 1 6 112 Rewa UPHC Bodabag Y 3 1 1 5 113 Rewa UPHC Ratahara Y 1 1 1 3 114 Sagar UPHC Bina Y 1 1 115 Sagar UPHC Khurai Y 116 Sagar UPHC Sagar Y 5 2 3 10 117 Sagar UPHC Vitthal Nagar Y UPHC Hanuman 118 Satna Y 4 1 5 Nagar 119 Satna UPHC Kasaudhan Y 3 1 4 120 Sehore UPHC Ashta Y 4 1 5 121 Sehore UPHC Sehore Y 4 1 1 1 7 UPHC Chhindwara 122 Seoni Y 3 1 2 6 Chowk 123 Shahdol UPHC Sohagpur Y 3 1 1 5 124 Shajapur UPHC Shajapur Y 1 1 125 Shajapur UPHC Shujalpur Y 1 1 1 3 126 Sheopur UPHC Sheopur Y 1 1 1 3 127 Shivpuri UPHC Karaundi Y 128 Shivpuri UPHC Shivpuri Y 1 1 2 129 Sidhi UPHC Madariya Y 3 1 1 5 UPHC Navjeevan 130 Singroli Y 1 2 3 Vihar 131 Tikamgarh UPHC Tikamgarh Y 6 2 8 132 Ujjain UPHC Adarshnagar Y 1 1 1 3 133 Ujjain UPHC Bherugarh Y 2 1 3 134 Ujjain UPHC Jaisinghpura Y 2 1 1 4 135 Ujjain UPHC Mitranagar Y 2 1 1 4 136 Ujjain UPHC Nagda Y 137 Ujjain UPHC Pawasa Y 1 1 138 Ujjain UPHC Sanjaynagar Y 2 1 3 139 Umaria UPHC Umaria Y 3 1 1 1 6 140 Vidisha UPHC Basoda Y 5 1 2 8
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A Study of Civil Dispensaries & Urban Primary Health Centres in Madhya Pradesh 2018
Health Staff Sl. District Name Facility Name HMIS LDC/ Phar RBSK No. ANM LT MO SN Total MIS ma AMO UPHC 141 Vidisha Y 4 1 1 1 1 8 Karaiyakheda 142 Vidisha UPHC Mohangiri Y 5 1 2 8 143 Vidisha UPHC Sironj Y 4 2 6 Total 244 36 68 62 14 2 111 537
Atal Bihari Vajpayee Institute of Good Governance and Policy Analysis
Page 77 of 84 Table A9: District wise status of essential services in selected Civil Dispensary Sl. District No. Essential Heath Service Provision Bhopal Sagar Indore Dhar Ujjain Bhind Gwalior Gwalior Jabalpur Rewa 1 Maternal health (ANC, PNC, initial management of complicated √ - √ √ √ - delivery cases and referral, management of regular maternal health conditions, referral of complicated cases) √ - 2 Family welfare (Distribution of OCP/ CC, IUD insertion, referral for √ √ - √ √ √ - sterilization, management of contraceptive related complications) - √ - 3 Child health and nutrition √ √ √ √ - √ √ √ - √ 4 RTI/STI (including HIV/AIDS) (Symptomatic Diagnosis and primary √ √ √ √ √ treatment and referral of complicated cases) - - - - - 5 Nutrition deficiency disorders (Diagnosis and treatment of seriously √ √ √ √ √ √ √ deficient patients, referral of acute deficiency cases) - - - 6 Vector borne diseases (Diagnosis and treatment, referral of √ √ √ √ √ √ terminally ill cases) - √ - - 7 Mental Health (Initial screening and referral) ------√ 8 Oral Health (Diagnosis and referral) - √ √ - - - √ - - - 9 Chest infections -TB/Asthma (Diagnosis and treatment, referral of √ √ √ √ √ √ complicated cases) - - √ - 10 Cardiovascular diseases (Diagnosis and treatment and referral √ √ √ √ √ √ during specialist visits) - - - - 11 Diabetes (Diagnosis and treatment, referral of complicated cases) √ - √ - √ √ - - - - 12 Cancer (Identification and referral, follow-up) - - √ ------13 Trauma care -burns & injuries (First aid , emergency resuscitation, √ √ √ documentation for MLC (if applicable) referral) - √ - - √ - √ 14 Other surgical interventions (Identification and referral) ------
A Study of Civil Dispensaries & Urban Primary Health Centres in Madhya Pradesh 2018
Table A10: District wise status of essential services in selected Urban-PHC
Sl. District No. Essential Heath Service Provision Bhopal Harda Sagar Dhar Ujjain Bhind Jabalpur Umaria Rewa 1 Maternal health (ANC, PNC, initial management of complicated √ √ - - √ √ √ √ - delivery cases and referral, management of regular maternal health conditions, referral of complicated cases) 2 Family welfare (Distribution of OCP/ CC, IUD insertion, referral for √ √ √ - √ √ √ √ √ sterilization, management of contraceptive related complications) 3 Child health and nutrition √ √ √ - √ √ √ √ √ 4 RTI/STI (including HIV/AIDS) (Symptomatic Diagnosis and - √ √ - √ √ √ √ √ primary treatment and referral of complicated cases) 5 Nutrition deficiency disorders (Diagnosis and treatment of √ √ √ - √ √ √ √ - seriously deficient patients, referral of acute deficiency cases) 6 Vector borne diseases (Diagnosis and treatment, referral of √ √ √ - √ √ √ √ √ terminally ill cases) 7 Mental Health (Initial screening and referral) √ - - - - - √ - √ 8 Oral Health (Diagnosis and referral) √ √ √ - √ - √ - - 9 Chest infections -TB/Asthma (Diagnosis and treatment, referral of √ √ √ - - √ √ √ √ complicated cases) 10 Cardiovascular diseases (Diagnosis and treatment and referral √ √ √ - √ - √ √ √ during specialist visits) 11 Diabetes (Diagnosis and treatment, referral of complicated cases) √ √ - - √ - √ √ √ 12 Cancer (Identification and referral, follow-up of √ - √ - √ - - √ - 13 Trauma care -burns & injuries (First aid , emergency √ √ √ - √ - √ - √ resuscitation, documentation for MLC (if applicable) and referral) 14 Other surgical interventions (Identification and referral) ------
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A Study of Civil Dispensaries & Urban Primary Health Centres in Madhya Pradesh 2018
Table A11: District wise availability OPD equipment in Urban -PHC
Sl. Equipments Bhopal Harda Sagar Dhar Ujjain Bhind Jabalpur Umaria Rewa No. 1 Adult weighing scale √ √ √ √ √ √ √ √ √ 2 Baby weighing scale - √ - √ - √ √ √ - 3 Bowl for antiseptic solution for soaking cotton swabs - - - - - √ √ √ √ 4 Chairs, Stool √ √ √ √ √ √ √ √ √ 5 Examination couch, steps, etc √ √ √ - √ - √ √ √ 6 Height measuring Scale - √ ------√ 7 IUCD insertion kit - - - - √ - - - √ 8 Measuring tap ------√ √ √ 9 Minor OT instruments - - - - - √ - - - 10 Spot light - - - - √ - - - - 11 Standard Surgical Set ------12 Stethoscope √ √ √ √ √ √ √ - √ 13 Thermometers Alcohol (stem) √ √ √ - √ √ √ - √ 14 Torch without batteries – 2 - - √ - √ √ √ √ √
Table A12: District wise availability of Lab equipment in Urban -PHC Sl. Equipments Bhopal Harda Sagar Dhar Ujjain Bhind Jabalpur Umaria Rewa No. 1 Refrigerator √ √ - - - √ √ √ √ 2 Battery dry cells 1.5 volt (large size) – 4 - - √ - √ √ √ - √ 3 Binocular microscope √ ------4 Domestic refrigerator √ ------√ √ 5 Equipment/reagents - essential laboratory investigations - √ - - √ - - √ √ 6 H2 S Strip test bottles - - - - - √ - - - 7 Kits for testing residual chlorine in drinking water - - - - - √ - - √
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Table A13: District wise availability of Other/Genera equipments in Urban -PHC
Sl. Equipments Bhopal Harda sagar Dhar Ujjain Bhind Jabalpur Umaria Rewa No. 1 Autoclave - - - - - √ - - - 2 Cold Boxes (Small & Large): Small- one, Large – two √ - - √ - √ √ - √ 3 ECG machine ------4 Equipments under various National Programmes - - - - - √ √ √ √ 5 Fire extinguisher √ - - - √ √ - - - 6 Freeze Tag: 2 per ILR bimonthly √ - - - - √ √ - - 7 Hand washing facilities & Alcohol based hand-rub √ √ - - √ √ √ √ √ 8 Ice box √ - - - - √ √ - √ 9 ILR (Small) and DF (Small) with Voltage Stabilizer √ - - √ - √ √ - - 10 Lead apron ------11 Spare ice pack box: 8, 25 & 60 ice pack boxes per vaccine √ - - - - √ √ - √ carrier, Small cold box & Large cold box respectively 12 Standard Surgical Set ------13 Stretcher ------14 Suction machine ------15 Tray containing chlorine solution for keeping soiled - - - - - √ - - √ instruments 16 Trolley ------17 Vaccine Carriers with 4 Icepacks: √ - - √ - √ √ - √ 18 Waste disposal twin bucket, hypochlorite solution/ bleach √ - - - - √ √ √ √
Atal Bihari Vajpayee Institute of Good Governance and Policy Analysis
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A Study of Civil Dispensaries & Urban Primary Health Centres in Madhya Pradesh 2018
Table A14: District wide availability of OPD equipments in Civil Dispensary Sl. Equipments No. Bhopal Sagar Indore Dhar Ujjain Bhind Gwalior Gwalior Jabalpur Rewa 1 Adult weighing scale √ √ √ √ √ - √ √ √ √ 2 Baby weighing scale √ - √ ------√ 3 Bowl for antiseptic solution for soaking cotton swabs √ - √ - √ √ √ √ - √ 4 Chairs, Stool √ √ √ √ √ √ √ √ √ √ 5 Examination couch, steps, etc √ √ √ √ √ √ √ √ - √ 6 Height measuring Scale √ - √ - - - √ - - - 7 IUCD insertion kit - - √ - √ - - √ - - 8 Measuring tap - √ √ - - - √ - - √ 9 Minor OT instruments - - √ - - √ - - - √ 10 Spot light - - √ - √ - - - - - 11 Standard Surgical Set - - √ ------12 Stethoscope √ - - √ √ √ √ √ - √ 13 Thermometers Alcohol (stem) - - √ √ √ - - - - √ 14 Torch without batteries – 2 - - √ √ √ - √ - - -
Table A15 : District wise availability of Lab equipment in Civil Dispensary Sl. Equipments Bhopal Sagar Indore Dhar Ujjain Bhind Gwalior Gwalior Jabalpur Rewa No. 1 Refrigerator - - √ - - - √ √ - - 2 Battery dry cells 1.5 volt (large size) – 4 - - √ - √ - √ - - - 3 Binocular microscope √ √ √ - √ - - - - - 4 Domestic refrigerator - - √ - - - √ - - - 5 Equipment/reagents- essential laboratory √ - √ - √ - - √ - - investigations 6 H2 S Strip test bottles ------7 Kits for testing residual chlorine in drinking water - - - - - √ - √ - -
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A Study of Civil Dispensaries & Urban Primary Health Centres in Madhya Pradesh 2018
Table A16: District wise availability other/general Equipment in Civil Dispensary Sl. Equipments Bhopal Sagar Indore Dhar Ujjain Bhind Gwalior Gwalior Jabalpur Rewa No. 1 Autoclave - - - - √ - - √ - - 2 Cold Boxes (Small & Large): Small- one, √ - √ - √ - √ √ - - Large – two 3 ECG machine ------4 Equipments under various National √ - √ - √ - - √ - - Programmes 5 Fire extinguisher - - √ - √ - - - - - 6 Freeze Tag: 2 per ILR bimonthly - - √ - √ - √ √ - - 7 Hand washing facilities & Alcohol based √ √ √ - - √ √ √ - - hand-rub 8 Ice box √ - √ - √ - √ √ - - 9 ILR (Small) and DF (Small) with Voltage √ - √ - √ - √ √ - - Stabilizer 10 Lead apron ------11 Spare ice pack box: 8, 25 & 60 ice pack √ - √ - √ - √ √ - - boxes per vaccine carrier, Small cold box & Large cold box respectively 12 Standard Surgical Set - - √ ------13 Stretcher - - √ - √ - - - - √ 14 Suction machine ------15 Tray containing chlorine solution for - - √ - - √ √ √ - √ keeping soiled instruments 16 Trolley - - √ - √ - - - - - 17 Vaccine Carriers with 4 Icepacks: √ - √ - √ - √ √ - - 18 Waste disposal twin bucket, hypochlorite √ - √ - √ - √ - - - solution/ bleach
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