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5 Common Review Mission Andhra Pradesh National Rural Health Mission

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5 Common Review Mission Andhra Pradesh National Rural Health Mission 5th Common Review Mission Andhra Pradesh 9th to 15th November 2011 National Rural Health Mission Ministry of Health and Family Welfare Government of India 1 Table of Contents List of abbreviations: .............................................................................................. 4 Executive Summary: .............................................................................................. 6 Chapter I – Team – Andhra Pradesh for the 5th CRM .............................................. 9 Chapter II – Introduction to the State .................................................................. 11 Chapter III - Major findings of CRM ...................................................................... 15 Chapter IV Recommendations of the 5th CRM .................................................... 45 th Annexure 1: Data for the 5 CRM: ....................................................................... 49 2 3 List of abbreviations: AH Area Hospital ANM Auxiliary Nurse Midwife APVVP Andhra Pradesh Vaidya Vidhan Parishad ASHA Accredited Social Health Activist AYUSH Ayurveda, Yoga, Unani, Siddha and Homeopathy CAO Chief Administrative Officer CAS Civil Assistant SUrgeon CES Coverage Evaluation Survey CFO Chief Finance Officer CHC Community Health Center CHNC Community Health and Nutrition Cluster CPO Chief Programme Officer CRM Common Review Mission DCHS District Coordinator of Hospital Services DH District Hospital DHIS - 2 District Health Information Software - 2 DHS District Health Society DLHS-3 District Level Household Survey-3 DM&HO District Medical and Health Officer DOTS Directly Observed Treatment, Short course DPMU District Programme Management Unit EMRI Emergency Management and Research Institute FDHS Fixed Day Health Services (104) GoAP Government of Andhra Pradesh HDS Hospital Development Society (Rogi Kalyan Samiti) HMIS Health Management Information System HR Human Resources IEC Information Education and Communication IMEP Infection Management and Environment Protection IMR Infant Mortality Rate IPHS Indian Public Health Standards JSSK Janani Shishu Suraksha Karyakram JSY Janani Suraksha Yojana MCTS Mother and Child tracking System MD Mission Director MIS Management Information System 4 MMR Maternal Mortality Ratio MO Medical Officer MoHFW Ministry of Health and Family Welfare, India MPHEO Multi-Purpose Health Education Officer MPHS Multi Purpose Health Supervisor MPW Multi-Purpose Worker (male) NSV Non Scalpel Vasectomy NVBDCP National Vector Borne Diseases Control Programme PC&PNDT Pre-Conception & Pre-natal Diagnostic Techniques PHC Primary Health Center PMU Programme Management Unit RHS Rural Health Statistics RNTCP Revised National Tuberculosis Control Programme SC Sub-Center SPHO Senior Public Health Officer SPMU State Programme Management Unit SRS Sample Registration System TFR Total Fertility Rate VHND Village Health and Nutrition Day VHSNC Village Health Sanitation and Nutrition Committee 5 Executive Summary: 5th Common Review Mission was undertaken in Andhra Pradesh during 9th November to 15th November 2011. The two selected districts were Guntur and Warangal of which Guntur is a better performing district. The key findings of the 5th CRM is as follows: Infrastructure: The State has in the current phase of NRHM focused on development of facilities and infrastructure at Community Health Centre and Sub-Divisional level. Overall, the infrastructure was found to be good in terms of buildings and at many places community has donated land and buildings for health facilities. However, the District Hospital in Guntur and the CHC at Macherla require major strengthening. Despite of having a dedicated corporation in the state for civil works, there is a huge delay in completion of new works. Human Resources: There are huge HR crunches in the Specialists, Radiographers, Male Multi- Purpose Workers (male) lab technicians and nursing staff at PHCs and CHCs. There are more than 17% vacancies in the posts of paramedics and lab technicians. No pool of lab technicians is created at the facility-level in secondary care institutions. New posts paramedics are proposed to be sanctioned in the areas with acute shortage. Further, the State is also taking steps to address vacancies due to doctors on PG-LIEN is underway. Compulsory rural service for doctors after completeion of Post-Graduation study is planned to be implemented since 2012. Training: Only 6.24% of the total intake for nursing and paramedical training in the State is in the Government Institutions. Quality of the training being provided by private institutions is not being ascertained and monitored. Training plan/training calendars are not available. Many trainings like Multi-skilling of doctors(esp. LSAS and EmOC), training for IUD and spacing methods are not taking place. Service Delivery: Laboratory services in both the districts were highly unsatisfactory. Round the clock lab services were not available in any of the 24x7 facilities or even in the District Hospital of guntur District. Public facilities remain underutilised particularly at night. Ancillary services, EMRI services were being provided. There is no robust mechanism to redress Grievance in the State. Convergence and coordination with AYUSH is lacking at all levels. There is a shortage of AYUSH drugs and AYUSH equipment at AYUSH facilities visited. There is no shortage of medicines at most facilities visited. PHCs in Guntur spend up to Rs. 20000 – 25000 per annum on procurement of drugs. No Procurement Manuals/ Guidelines exist in the State. 6 Infection Management and Environment Protection: Infection Control measures and Biomedical Waste Management was poor in both the districts. Reproductive and Child Health: Haemoglobin estimation is being done by paper method in the sub-centres and in many PHCs which is less reliable than the Sahli’s method. Health facilities are not ready for rollout of JSSK. Partograph, AMTSL, essential newborn care protocols not being followed. JSY benefits not being paid in APVVP hospitals with delayed payment in some cases. TFR goals are prescribed even for the sub-district levels including for Sub-centres. There is an over-emphasis on sterilisation and complete neglect of spacing methods in the State. Safe abortion services are not available in both the districts. Adolescent anaemia control has not received adequate attention. Convergence of RH with HIV/PPTCT is good. Implementation of PC&PNDT Act needs strengthening. Violations/irregularities in maintenance of F-forms have been taken lightly and charge sheets are not filed. Disease Control Programmes: There are some vacancies in key supervisory positions in Disease Control Programmes. The quality of blood slide examination needs improvement. The coordination with the sentinel surveillance unit in the Medical College was lacking for diagnosis of dengue. Strengthening of CHCs is required for sustaining efforts for management of lymph - oedema and hydrocele operations. Case detection rate/ cure rate under RNTCP is good. Programme Management: Well established Programme Management Structures at State and district levels with good coordination between Health Directorate and PMU. However, coordination between the District Medical and Health Office and District Coordinator of Hospital Services (APVVP) is weak. State and Districts are not sending any Reports on HMIS. Decentralised Local Action for Health: DHAPs are of very bad quality and do not reflect the need of the district. ASHAs are creating demand for Maternal, Child Health and Family Planning services. Financial Management: Guidelines issued by GOI in December, 2006 on Delegation of Financial & Administrative Powers have not been implemented. The assistants working at Blocks level are not very well conversant with the accounting procedures. AMG and Untied Funds have not been given to each facility on a regular basis. The blocks are not regular in sending the reports (FMR) regularly the same is either sent at the end of the year or whenever there are funds received from DHMO Office. 7 Based on the findings, the following areas for improvement are suggested: Delay in completion of infrastructure projects needs to be checked. Regular monitoring of progress of the projects could be initiated. All health Facilities must be provided with barrier free access for disabled and infirm/old people. Quality of training needs to be ensured including in the private training institutions. Multi-skilling, MTP, IUDs trainings need to be restarted. Performance of CHC, FRUs and 24 x7 PHCs can be further optimized. Strengthening of strategically identified CHCs could be done. This would reduce congestion at secondary and tertiary level facilities. Laboratory services need to be strengthened, particularly in the CHCs, AHS and DHs. Better convergence with AYUSH should be done. Protocols, guidelines, training and facilities for segregation, storage, monitoring and disposal of waste need to be introduced and implemented. Protocols for ensuring asepsis in labor rooms and OTs needs to be introduced. Protocols of Newborn care need to be implemented. New Born Care Corners (NBCC), NB Stabilisation Units (NBSU) and Special Newborn Care Units (SNCU) need to be established in concurrence with the national guidelines. Adolescent anemia control programme needs to be introduced. Safe abortion services need to be provided and made easily accessible. Sub-district TFR goals need to be removed and spacing methods needs to be introduced. Irregularities related to Form F needs to be prosecuted
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