RAPID Assessment District Bhiwani

24 June – 6 July, 2013 RAPID Assessment District Bhiwani Facility Readiness Assessment for Essential Newborn Care and Resuscitation Child Health Division, NRHM, Haryana in technical collaboration with Table of Contents Sr. No. Content Page No. 1. Objectives 2 2. Materials and Methods 2 3. List of facilities visited 2-3 4. General findings of District 3-4 5. Quantitative findings of facilities 5-11 6. Qualitative findings of facilities 6 a. General Hospital, Bhiwani 20-21 6 b. GH, Charkhi Dadri 22 6 c. GH, Devrala 22 6 d. GH,Bhawani Khera 23 6 e. GH,Shivani 23 6 f. ESI Hospital 23 6 g. CHC Gopi 24 6 h. CHC Bondkalan 24 6 i. CHC Jhojhukalan 25 6 j. CHC Loharu 25 6 k. CHC Dhanana 26 6 l. CHC Miran 26 6 m. CHC Tosham 27 6 n. CHC Manheru 27 6 o. CHC Kairu 28 6 p. PHC Bahal 28 6 q. PHC Bamla 28 6 r. PHC Bhadhra 29 6 s. PHC Gurera 30 6 t. PHC Alakhpur 30 6 u. PHC Jhumpakalan 30 6 v. PHC Kadma 31 6 w. PHC Lilus 31 6 x. PHC Harodi 32 6 y. PHC Sui 32 6 z. PHC Chang 33 6 aa. PHC Bhushan 33 6 ab. PHC Chappar 34 6 ac. PHC Dhani Jamalpur 34 6 ad. PHC DHani Mahu 35 6 ae. PHC Dhigava 35 6 af PHC Dinod 36 6 ag PHC Kharak Kalan 37 6 ah PHC Mai Kalan 37 1 6 ai PHC Manakawas 38 6 aj PHC Pur 38 6 ak PHC Ranila 38 6 al PHC Santokpura 39 6 am PHC Sanwar 40 6 an PHC Sohansada 40 6 ao PHC Talu 41 6 ap PHC Nakipur 41 6 aq PHC Biran 42 6 ar PHC Achina 42 6 as PHC Sandhwa 42 6 at PHC Chiriya 43 6 au SC Dangkalan 43 6 av SC Mandhana 44 6 aw SC Durjanpur 44 Objectives: 1. Qualitative and quantitative assessment of readiness of our health facilities for essential newborn care and resuscitation. 2. To assess the quality of essential newborn care provided to each and every neonate immediately after birth. 3. To understand the existing knowledge, skills, attitudes and practices of the health service providers. 4. On job trainings to the service providers on novelties in essential newborn care and resuscitation. Materials and Methods 1. A structured and tested assessment tool has been used to assess the facilities on 8 parameters viz. facility identification and infrastructure, availability of services, human resource, Equipment and supplies, Register and client case records, protocols and guidelines, individual case records, knowledge and practices. 2. Knowledge and skill assessment has been done on the newborn simulators (mannequins). 3. The current and ideal practices in essential newborn care and resuscitation have been demonstrated to the service providers on the mannequins. 2 Our teams visited 50 facilities in the district, from 24th June, 2013 to 6th July, 2013 including General Hospitals, ESI Hospital all CHCs and PHCs and the delivery huts with monthly delivery load of 3 or more. Following is the list of facilities visited: Sr. No. Name of Facility 1. General Hospital, Bhiwani 2. GH, Charkhi Dadri 3. GH, Devrala 4. GH,Bhawani Khera 5. GH,Shivani 6. ESI Hospital 7. CHC Gopi 8. CHC Bondkalan 9. CHC Jhojhukalan 10. CHC Loharu 11. CHC Dhanana 12. CHC Miran 13. CHC Tosham 14. CHC Manheru 15. CHC Kairu 16. PHC Bamla 17. PHC Bahal 18. PHC Bhadhra 19. PHC Gurera 20. PHC Alakhpur 21. PHC Lilus 22. PHC Harodi 23. PHC Sui 24. PHC Chang 25. PHC Bhusan 26. PHC Chappar 27. PHC Dhani Jamalpur 28. PHC Dhani Mahu 29. PHC Dhigawa 30. PHC Dinod 31. PHC Jhumpakalan 32. PHC Juikalan 33. PHC Kadma 34. PHC Kharak kalan 35. PHC Maikalan 36. PHC Manakawas 37. PHC Pur 3 38. PHC Ranila 39. PHC Santokpura 40. PHC Sanwar 41. PHC Sohansada 42. PHC Talu 43. PHC Nakipur 44. PHC Biran 45. PHC Achina 46. PHC Sandhwa 47. SC Chiriya 48. SC Dangkalan 49. SC Mandhana 50. SC Durjanpur The findings of district Bhiwani in general are as follows: 1. Availability of infrastructure and supplies in most of the facilities. 2. Trainings of newly recruited staff nurses for SBA and NSSK 3. Refreshers for trained staff nurses 4. Baby clothes (clean sheets for drying and wrapping newborns) are not available in most of the facilities. 5. Birth dose Hepatitis-B, BCG and Vitamin K not given at the time of birth. 6. Room thermometers to know the exact temperature of the delivery room are not available in most of the facilities. Low reading clinical thermometers (alcohol thermometers) to check the temperature of newborns are not available. 7. Vitamin K for newborn is not available in many facilities. 8. Disposable D Lee Mucus Extractors are cheap and best devised for suction when electric or foot operated suction machines are either not available or cannot be used, but in most of the facilities Disposable D Lee Mucus Extractors are not available. 9. Effective hand washing (washing hands following six golden steps) before delivery is not in practice. 10. Record of essential services provided to the newborn immediately after birth is not kept at any of the facilities. Baby notes on essential newborn care are not maintained. 11. Use of double gloves during delivery and newborn care process is not in practice. 12. Use of oxytocin for induction/augmentation of labour is still in practice which has to be discouraged. 13. In most of the facilities suction of every new born, regardless of her/his condition, is rampantly in practice. 14. Even after widespread campaign for exclusive breast feeding and initiation of early breast feeding (within one hour of birth), the breastfeeding usually begins after one hour of birth in most of the facilities. 4 15. Thermal care is considered as one of the most important component of essential newborn care which is best advocated through skin-to-skin contact between mother and newborn, but not in practice in majority of facilities. 16. There is standard infection prevention protocols for disinfection and sterilization of the equipment and instruments used routinely but in most of the facilities these protocols are not being adhered to. 17. Rational and adequate display of Information, Education& Communication (IEC) materials and Job Aids is essential to reflect the correct message to the beneficiaries as well as to the providers, this was lacking in majority of the facilities. 18. The bed head tickets or Case sheets are not available in the delivery huts. 19. Knowledge of service providers for essential newborn care and resuscitation has room for great improvement. 20. The skills required for essential newborn care and resuscitation have been found below average in general. The chronology of these skills is of paramount importance and needs repeated refresher trainings. 5 Table 1. Quantitative Results and Scores (>75 Good, 50-75 Average, <50 Poor) DELIV ESSENTI ERY Register PROVID FACIL AL PROTOC AND s and ER ITY DRUG OLS Name of Infrastru NEWB Case K0WLE OVER EQUIPM AND Facility cture ORN records DGE ALL ENT GUIDELI CARE complete AND AVER AND NES SERVI ness SKILL AGE SUPPLY CES PHC 81 75 64 53 56 46 62 SANWAR PHC 75 65 63 53 62 53 62 DINOD GH Bhiwani 88 70 76 41 63 28 61 Khera PHC 73 70 69 35 67 51 61 JUIKALAN CHC Jojhu 88 75 64 29 56 49 60 kalan PHC MAIKALA 71 70 69 41 49 61 60 N CHC 88 75 67 29 58 39 59 TOSHAM SDH 87 75 64 47 37 45 59 DADRI PHC SOHANSA 71 70 69 35 49 60 59 DA PHC 67 75 67 41 58 41 58 Gurera 6 CHC 79 75 65 41 41 47 58 Manheru PHC SANTOKP 79 75 61 53 39 37 57 URA DELIV ESSENTI ERY Register PROVID FACIL AL PROTOC AND s and ER ITY DRUG OLS Name of Infrastru NEWB Case K0WLE OVER EQUIPM AND Facility cture ORN records DGE ALL ENT GUIDELI CARE complete AND AVER AND NES SERVI ness SKILL AGE SUPPLY CES PHC Dhani 85 75 69 41 45 29 57 Jamalpur District 72 67 61 37 35 39 52 Average PHC MANKAW 79 75 61 53 24 50 57 AS GH Bhiwani 98 75 76 29 9 52 57 PHC 71 70 70 53 18 56 56 CHHAPAR CHC BONDKAL 67 65 64 41 54 46 56 AN PHC Chang 62 75 67 53 52 28 56 PHC Biran 75 75 58 35 63 30 56 PHC 79 75 65 41 39 30 55 Kharak 7 kalan GH Shiwani 77 70 56 35 63 28 55 PHC 77 70 55 29 44 52 55 KADMA CHC Kairu 73 65 70 35 47 31 53 CHC JHUMPAK 58 65 57 29 62 49 53 ALAN DELIVER FACILIT ESSENTIA Registers PROVIDE Y AND PROTOCO Y L DRUG and Case R Name of Infrastructu NEWBOR LS AND OVERAL EQUIPME records K0WLEDG Facility re N CARE GUIDELIN L NT AND completene E AND SERVICE ES AVERAG SUPPLY ss SKILL S E PHC 63 80 63 47 18 46 53 Alakhpura PHC Harodi 65 70 72 29 49 28 52 District 72 67 61 37 35 39 52 Average PHC 65 70 58 35 48 36 52 BAMLA District 72 67 61 37 35 39 52 Average PHC 81 75 47 35 50 23 52 Nakipur PHC Badra 71 75 63 53 0 49 52 PHC 69 70 61 35 35 38 52 BAHAL CHC 71 70 60 35 34 34 51 MIRAN 8 PHC Ranila 81 75 61 24 41 23 51 PHC TALU 56 50 62 24 48 60 50 PHC 69 70 61 35 26 35 49 BARWA CHC Gopi 81 60 65 29 9 52 49 Phc 71 65 53 35 48 23 49 Dhigawa CHC 79 60 65 29 9 52 49 Dhanana GH Devrala 63 55 50 41 49 35 49 DELIVER FACILIT ESSENTIA Registers PROVIDE Y AND PROTOCO Y L DRUG and Case R Name of Infrastructu NEWBOR LS AND OVERAL EQUIPME records K0WLEDG Facility re N CARE GUIDELIN L NT AND completene E AND SERVICE ES AVERAG SUPPLY ss SKILL S E PHC 67 75 55 41 18 37 49 Bhusan District 72 67 61 37 35 39 52 Average PHC Dhani 69 65 58 35 34 27 48 Mahu PHC Lilus 75 50 65 29 9 52 47 PHC Sui 75 50 65 29 9 52 47 PHC Achina 75 65 68 24 0 34 44 SC 56 70 51 41 0 39 43 Mandhana SC DANG 62 65 50 29 0 39 41 KALAN 9 PHC Puri 42 60 45 12 42 24 38 SC 52 55 47 29 0 34 36 CHIRIYA PHC 48 50 48 29 0 12 31 Sandwa PHC 56 0 59 35 0 0 25 BALKARA Graph 1.

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