District Jamtara, Jharkhand
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2010 Supportive Supervision Report: District Jamtara, Jharkhand Shivangini Kar MINISTRY OF HEALTH & FAMILY WELFARE 13/06/2010 Table of Contents EXECUTIVE SUMMARY ...................................................................................................................................... 4 Approach & methodology ................................................................................................................................... 8 Supportive supervision process chart ........................................................................................................... 9 Health facilities visited:................................................................................................................................ 10 Methodology ................................................................................................................................................. 10 Objectives of the visit: .................................................................................................................................. 11 Situation Analysis & Gap Identification ..................................................................................................... 12 Sadar Hospital, Jamtara ................................................................................................................................... 13 STRENGTH ................................................................................................................................................ 13 WEAKNESSES............................................................................................................................................ 16 Major actionable points .......................................................................................................................... 17 District Health AS-IS Report: ........................................................................................................................... 18 CHC Narayanpur .................................................................................................................................... 20 CHC NALA .......................................................................................................................... 23 PHC Pabia .............................................................................................................................................. 26 Sub-centre BANKHET ...................................................................................................................................... 28 Village Bhagakudi: Angandwadi centre ......................................................................................................... 29 Rationalisation of manpower ...................................................................................................................... 31 Health facilities preparedness ..................................................................................................................... 31 Sub-Centre Untied Fund .............................................................................................................................. 32 2 Introduction 3 EXECUTIVE SUMMARY Since 1951, on voluntary basis with democratic manner the Government of India, Ministry of Health and Family Welfare is being implemented different type of the programs for improvement of maternal, child health, and family welfare. After ICPD conference, several changes took place in Indian health and family welfare services. In the light of Millennium Development Goals (MDG), National Population Policy (NPP) and National Health Policy (NHP) the Government of India, Ministry of Health and FW planned and launched National Rural Health Mission (NRHM) from April 2005. All efforts under NRHM directly and indirectly aimed to provide accessible, affordable and effective health care to all citizens and particular to the poor and venerable sections of society. Recently 235 high focused districts throughout the country have been identified, which are low performing districts, based on rankings on 13 indicators from the DLHS-III data prepared by the Statistics Division of the Ministry, districts with 35% or more with SC/ST population, 33 districts Left Wing Extremists Affected Districts prepared for focused planning. District Planning Teams have been constituted for visiting the high focus districts to observe and facilitate the planning and ensure adequate attention to these districts in the planning process. Jamtara is a newly formed district of Jharkhand State. It came into existence on 26th April 2001. The small district of Jharkhand state comprises of only 4 blocks. It was created by carving out four blocks from DUMKA District. In Jamtara district, 132 Health Sub Centres, 15 PHC (Additional Primary Health Centres), 4 CHC (Primary Health Centres), 1 FRUs and One Sub - Divisional Hospital (recently notified in District Hospital) are functioning. The key observations and findings during the visit are: Infrastructure: . Out of 132 existing Health Sub-Centre 62 HSCs are running in Government building, 70 HSCs are running in rented building. Almost all the Government buildings are in poor conditions and immediately renovation / new constructions are required. 4 Block PHCs are in process of upgradation to CHCs; new infrastructure has been constructed though it was observed that the residential quarters of the medical officer incharge as well as the staff in the same premises 4 are still in poor and dilapidated condition; which needs immediate attention. Service delivery . In the process majority of the facilities visited could not be certified as 24X7. The scenario today is that in our endeavour to provide health services in all the public health facilities, we are not able to provide comprehensive health facility at majority of the locations in the district. As it has been a request from the service providers (ANMs), re-locating the Sub centres within the village premises is a necessity, as well as accommodation arrangements for the ANM should be made at the same place. If we are able to provide comprehensive round the clock services at one institution in a PHC, it will be a big assurance to people giving them a sense of security and faith on the public health system. In the SCs weekly or bi-weekly OPDs can be held to screen cases and deserving cases can be referred to the PHC/CHC/Sub divisional hospital/ District Hospital. In addition normal deliveries can be continued by the ANMs and Staff Nurses in all the PHCs. Service environment elements such as Privacy of the patient, drinking water, cleanliness within the premises etc, are not upto the mark in almost all the health facilities. Making available graded standard treatment guidelines and essential drug list can guide wide range of health care providers for providing better services to the needy. There is minimal provision of delivery at Sub-centre level and most of the deliveries are being conducted at home. At PHCs normal deliveries are being conducted but the case load is low. PHCs which are designated 24X7 are also not providing facilities round the clock due to shortage of manpower and proper accommodation facilities. 5 . New- Born Corner is absent in all the facilities though it was observed that malnutrition treatment unit (MTU) was present in the district hospital to overcome the problem of malnutrition in the district. Manpower : . There is acute shortage of trained manpower in the entire district; during the visit it was observed that the system lacks specialists like gynaecologist and anesthetists, In effect, the C-sections are not being done at almost all the public facilities, which tends to increase the out of pocket expenditure of the poor. Multi skilling is one good option for getting right skill mix required within the available human resource for which training is required. Untied funds utilization for the sub centre : . It has been observed that there has been poor utilization of the untied funds by the Sub centres. The untied funds are used to improve the condition of the sub centre and to equip the manpower, though the system lacks such initiation from existing manpower. No record has been maintained regarding the breakup of expenditure done as of now. Janani Suraksha Yojana: . There has been sharp rise in the institutional deliveries over the years and this has in turn put tremendous pressure on the public health system to improve its performance but during the visit it was observed that there have been untimely payments of JSY and unnecessary delays in the reimbursements. Laboratory & diagnostic services: . During the visit to the district hospital it was observed that the lab services are fairly nice and acceptable, some improvements are being made in the CHC level during the upgradation from PHCs and the level tapers to even lesser degree at PHCs and SC level. 6 . There is little focus of reaching the standards as such except for the visible diagnostic of X-ray machine & Ultrasound at District Hospital and in some of the recently upgraded CHCs. In addition to this there is gross shortage of laboratory technicians in the system. Logistics and supplies: . In most of the facilities visited absolute availability of life saving drugs was a question, which needs immediate attention of the concerned authority. Regularity in drug supply was poor in the sub centres. Early stock out and poor estimation of consumption pattern can be a cause. Wastage of low turnover drugs have been