Supportive Supervision of Dhamtari District Chhattisgarh

Supportive supervision of Dhamtari District Chhattisgarh

Mr. Pradeep Tandan Consultant NRHM I Ministry of Health and Family Welfare, Nirman Bhavan New Delhi. [email protected] Contents Executive summery ...... 3 Approach and methodology: ...... 9 Background ...... 10 Health facility in the district ...... 15 Performance in last one year (2009-10 ...... 20 Qualitative report of Dhamtari district ...... 22 Health Sub Centers:- ...... 22 Primary Health Centers ...... 25 Community Health Centers ...... 25 District Hospital ...... 26 Maternal and child heath ...... 26 Janani Suraksha Yojana ...... 27 Home delivery ...... 27 Village Health and Nutrition Day ...... 27 Mitanin ...... 27 Communitization Processes ...... 29 Bio Medical waste management ...... 29 Human Resource ...... 30 District Hospital Dhamtari ...... 31 CHC Magarlod-CHC ...... 34 CHC Nagri ...... 36 CHC Gujra ...... 38 CHC Kurud ...... 39 PHC Kareli bodi ...... 41 PHC Bhatgaon ...... 43 HSC Bandha ...... 45 HSC Kukrel ...... 45 HSC Dokal ...... 46 HSC Gajkhanhar ...... 46 Appendix ...... 116

Executive summery

For the Supportive Supervision of High Focused Districts, first visit to the district of Dhamtari in Chhattisgarh from 16th June 2010 to 19th June 2010 was done. The facilities visited and key persons visited for monitoring are enumerated in the Table 1 shown below. The monitoring visit was made to all 4 blocks. In this visit consultant interact with programme management unit at district and block level both. Consultant also interacted with Health staff including the Medical Officers, Nursing Staff and Mitanin and attained the meeting of district health society, to gain a better understanding of the processes and difficulties in functioning of health system of Dhamtari district.

Table 1: Blocks and Persons visited for Supportive Supervision

Date District/ Block Places/Health Persons Visited Activity Facilities Visited 16.06.2010 Dhamtari District hospital SPM, MO Visit of district (night visit 10:30 ) hospital and meet with some patient at night 17.06.2010 Dhamtari District Hospital DPM, Civil  Baseline data Dhamtari Surgeon, MO, collected from Administrative staff district hospital  Discussions with the Civil Surgeon about the functioning of the various components of the District hospital.  Inspection of the District Hospital 17.06.2010 Magarload CHC Magarlod BPM, BMO Collect base line PHC Kareli(bodi) Administrative, data from facilities VHSC VHSC members, Visit to CHC Mitanin Magarlod and PHC Karelibodi 18.06.2010 Gugja PHC Bhatgaon MO, District Collect base line Kurud CHC Gujra Magistrate Dhamtari data from visited DM Dhamtari BMO Kurud and facility and attained CHC Kurud some Beneficiaries regular meeting of Mitanin district health society. 19.06.2010 Nagri CHC Nagri BMO Nagri Collect base line HSC Bandha ANM and Mitanin data from visited HSC Kukrel health facility. HSC Dokal HSC Kajkanhar

Brief Review: - Dhamtri District is located in eastern part of Chhattisgarh state, with total population of 7, 03,569 (2001 Censes). The Public health system is existent in the form of one district hospital , 4 CHCs, 22PHCs ,165 HSCs and catering health services to the rural and urban population The District’s visit depict that, there is need to address the following issues. Major issues are

 BPM post of 2 block is vacant, and Maintenance fund and JDS among that is affecting the monitoring part BMOs and MOs in the district. in Kurud and Gujra Bock.  Security issue in the PHCs like in  Immunization storage point, during Bhatgaon , all the glass window were visit it was found that none of the broken by some people in the visited centres had not maintained village( There was no boundary wall the records properly. in Bhatgaon and Karelibodi PHC)  There is no biomedical disposal  OPD area of the district hospital is mechanism in the district. None of very less. the visited facilities had the  Very less IEC material display in the recommended waste segregation and PHC and CHC (in visited CHC and disposal mechanisms. PHC).  Poor maintenance and repairs of the  Labour room condition in the Gujra equipments in health facilities (PHC, CHC, Bhatgaon PHC was very poor. CHC) and laboratory is noted.  Accreditation of all sub centres for  Lack of awareness and utilization JSY. process about Untied Fund

Situation: 5 PHCs and 16 HSCs are in construction phase. Additional construction work is going on CHC Gujra and CHC Nagri .It was noticed during the interaction that the health officials (especially district hospital staff) in Dhamtari district they are enthusiastic for improvement of health services delivery. Their motivation can be maintained with periodic encouragement from the state officials. District collector is also taking interest to improve the health indicator of district and her approach towards district health system is good and hope on her leadership district will make some difference in next one year.

List of Tables

Table 1: Blocks and Persons visited for Supportive Supervision

Table 2 Major health indicator of Dhamtari District

Table 3 Demographic Characteristics of Dhamtari District

Table 4 Public Health Facilities in Dhamtari District

Table 5 Catchment area of CHCs in Dhamtari District

Table 6 Public Health infrastructure in Dhamtari District

Table 7 Private Health Facility in Dhamtari District

Table 8 Private Health Facility Accredited for JSY and Family Planning

Table 9 Details of Mitanin and DRP in Dhamtari District

Table 10 Trainings situation of Mitanin

List of Graphs and Figures

Figure 1 Dhamtari District

Figure 2 Health Facility Dhamtari District

Graph 1 Electricity in Sub Centers of Dhamtri District

Graph 2 Water Facility in The Sub Centers of Dhamtari District

Graph 3 Stay Facility for ANM in the Sub Centre of Dhamtari District

Graph 4 Sub Centre New Born Baby Corner in Dhamtari District

Graph 5 Percentage of Sub Centre conducting delivery in the Dhamtari District

Graph 6 Human Resources Shortfall in Dhamtari District

Graph 7 Patient load in District Hospital Dhamtari

Graph 8 OPD and IPD cases (2009-10) District Hospital Dhamtari

Graph 9 Facility Assessment of District Hospital Dhamtari

Graph 10 Patient Load in Magarlod CHC ( 2005-2009)

Graph 11 Facility Assessment of CHC Magarload

Graph 12 Patient load in CHC Nagri ( 2005-2009 )

Graph 13 Facility Assessment of CHC Nagri

Graph 14 Patient Load in Gujra CHC ( 2005-2009 )

Graph 15 Facility Assessment of CHC Gujra

Graph 16 Patient load in CHC Kurud ( 2005-2009)

Graph 17 Facility assessment of CHC Kurud

Graph 18 OPD cases in Kareli ( Bodi ) PHC (2010-11)

Graph 19 Facility Assessment of PHC Kareli (bodi)

Graph 20 Facility Assessment of PHC Bhatgaon

Graph 21 Facility Assessment of Health Sub Centre Bandha

Graph 22 Facility Assessment of Health Sub Centre Kukrel

Graph 23 Facility Assessment of Health Sub Centre Gajkhahar

Acronyms Acronyms

ARI Acute respiratory infection MO Medical officer AWW Anganwadi worker MTP Medical termination of pregnancy ANC Anti natal care MPW Multi purpose worker ASO Assistant statistical officer NNT Neo natal care ANM Auxiliary nurse midwife NSV Non scalpel vasectomy BEE Block extension educator OT Operation theatre BMO Block Medical Officer ORS Oral dehydration solution BPMU Block Programme OPD Out patient department Management Unit CHC Community health center PRI Panchayati Raj institutions CHV Community health visitor PF Plasmodium Falcipurum CBR Crude birth rate PP Post partum centre DTK Dai Delivery Kit PHC Primary Health centre DTC District training center PHNTC Public health nurse training centre FRU First referral unit IPD In patient Department IMR Infant mortality rate RSBY Rashtriya Swasthya Beema Yojna IEC Information education and RTI Reproductive tract infections communication IUD Intra uterine device SBA Skilled Birth Attendance IFA Iron folic acid SHC Sub Health Centre JSY Janani Suraksha Yojna STI Sexually transmitted infections LHV Lady health visitor VHSC Village Health & Sanitation Committee

MCH Maternal and child health VHND Village Health And Nutrition Day MMR Maternal mortality rate

Approach and methodology: The visit to Dhamtari District of Chhattisgarh state was conduct from June 16th to 19st of 2010.The observation method with inspection approach was used in this visit for supportive supervision of the high focus district Dhamtari. 1st went to State Programme Management unit then went to district. A meeting was conducted with civil surgeon. The format was shared and discussed in the meeting and the objective of the visit was communicated with district Programme unit. In meeting, planning for the field visit was done with district programme unit.

Secondary Data was collected for the structured format from the state and district HMIS data format that was already available at the respective Programme Management Units. Primary data was collected as per the guidelines in the format during interactions with the health staff at the time of visits to the health facilities.

Assessment of the health facility was done based on the monitoring format by inspecting every part of the health institution. The format was shared with the Medical Officers in detail to communicate the expected standards and scoring pattern. With the medical officers, ANM, Mitanin Jeevan Deep Samiti and VHSC members discuss the different issue related to health services at the visited facilities.

Background

Figure 3 Dhamtari District

Figure 4 Health Facility Dhamtari District

Background

Dhamtari district was formed on 6th July 1998 by incorporating 4 blocks Dhamtari, Kurud, Nagari and Magarlod. It is located in south-eastern Chhattisgarh and is surrounded by Raipur district [North-East]; Durg district [North-West ] ; Kanker district [South West] and western boundary of Orissa state [ in the South- East]. The district head quarter is located in Dhamtari town. Dhamtari is a small district covering a total land area 4081.93 Sqr.Km. and has total population of 7, 03,569 (2001 Censes). Major health indicators of district are.

Table 2 Major health indicator of Dhamtari District Vital Current Position Target Up to Health S.No DLHS - CMHO Office Year 2010 Indicators II (FY 2008-09)* 2002

1. I M R 75.12 27.86 Below 30

2. M M R 53 Below 1.00

3. C B R 16.647 19.87 Below 21

4. Death Rate 5.68 4.82 Below 5

5. T F R 1.967 Below 2.1

6. C P R 76 Upto 40

7. Malnutrition 44% Below 20%

Among these 4 blocks - Nagari is a tribal block. Male female ratio of this district is 1000:1005 according to 2001 censes.34% of the total population belong to Schedule castes and tribes. The Total Literacy Rate is 75.16 and break down of TLR shows that male literacy is slightly higher at 85% to 65% of that of females. Common demographic characteristics of district are

Table 3 Demographic Characteristics of Dhamtari District

Characteristics Dhamtari State

Area (sq.km.) 4081.93 135191.00

Population 2001 **

Persons 706591 20833803

Male 352524 10474218 Total Female 354067 10359585

Persons 613007 16648056

Rural Male 305531

Female 307436

Persons 93584 4185747

Urban Male 46993

Female 46591

Population (0 to 6 yrs)

Total 116514 3554916

Males 58960 1800413

Females 57554 1754503

Population Density 1991 174 130

(Persons /sq.km.) 2001 208 154

Share Of C.G.s Population (%)** 3.38 100

Decadal Growth Rate (1991-2001)** 19.72 18.06

Sex Ratio Female per 1000 males ** 1004 990

Distribution of Scheduled caste %** 7% 11.60%

Distribution of Scheduled Tribe %** 26.30% 31.80%

Life expectancy at birth** 64 Yrs

Age at Marriage (F) 18 +

Literacy rate **

Persons 75.16 65.18

Male 86.76 77.86

Female 63.60 52.40

Total Number of Block 4

Total Number of Gram Panchayat 639

Total Number of villages 633 20978

Total Number of Majra/Tolas 1235

Total Number of Depot Holders 1263

Total Number of Anganwadis

Total 894

Rural 833

Urban 61

Total Number of Mitanins 1627

Total Number of Hand pumps 7336

Total Number of wells 12757

Small size of the district and presence of untapped and unlimited natural resources such as rivers, rivulets, dams, mountain range, forest area, mineral resources, agriculture land etc. there are ample scope of development in the years to come.

The famous Ravishankar Sagar Project dam (also known as Gangrel dam) is about 13 kms from district Head quarters. This dam provides water for irrigation to 60,000 hectares of land. The other important water resources of Gangrel Project are Sondhur Dam, Dudhawa Canal and Madhamsilli Canal. Pairi Dam provides water to Dhamtari district. The forest of Dhamtari consists of Sal, Teak, Bija, Harra, Bahera and Kusum trees.

Agriculture is their main occupation in the district . In most area of Dhamtari, two successful paddy crops are sowed. The Singpur sector of Magarlod, tail areas of Gangarel Dam (Duban Kshetra) of Dhamtari and Nagari block have high tribal population. Kamars are special protected primitive tribals living in scattered villages of Nagari and Magarlod. Sterilization of this population under family welfare program is prohibited. Apart from agriculture, Tendupatta, Salbeej collection and selling of forest products are important sources of income in the Dhamtari district.

Health facility in the district DISTRIBUTION OF PUBLIC HEALTH FACILITIES IN DHAMTARI DISTRICT

Table 4 Public Health Facilities in Dhamtari District

District Civil Community Block PHC FRU PP Centers PHC Hospital Hospital Health Centres

1 -- 4 0 3 1 22

Through public health system One district hospital ( 100 bedded) 4 Community health center among them 3 are working as FRU , one PP Centre, 22 PHCs and 165 HSC are providing the health facility to the district population.

Table 5 Catchment area of CHCs in Dhamtari District

Name of CHC Populatio PHC Number of No. of No. of Size of village as per Block/ Area n sub-centers/ Gram villages population urban panchay health ats 0-499 500-999 1000+ centres

Gujra (Dhamtari) 1 CHC 185290 4 35 87 144 35 38 71

Kurud 1 CHC 209548 7 39 101 134 9 39 86

Magarlod 1 CHC 114424 4 25 64 115 48 20 47

Nagari 1 CHC 175702 7 66 87 240 145 55 40

1 District Dhamtari Hospital 98514 0 0 0 0 ------Urban + civil Dispens ary

Public health infrastructure Table 6 Public Health infrastructure in Dhamtari District

Health Facility Number Facilities Buildings’ Status Sanctioned Govt. Rented Building Any Remarks Buildings-all (Building not sanctioned not available (including those sanctioned) in which construction is on-going) 100 +20 (eye District ward) bedded Hospital/Medical 1 0 0 district College Hospital hospital Sub District/Rural 0 0 0 0 Hospitals UFWC 1 1 0 0 CHCs are CHC Identified 3 3 0 0 identified as FRUs FRUs Newly sanctioned Under CHCs 1 1 0 CHC, functioning construction in Old PHC Building These are 7 Already functioning in working in govt. either sub centres PHCs 22 building + 10 0 5 Or some other sanctioned/under govt. building on cons. local arrangement These are 75 Already exist functioning in Sub-centre 165 + 87 sanctioned/ 0 13 other govt. under cons. building on local arrangement 7 Already exist Ayurvedic 29 + 18 sanctioned/ 0 4 Dispensary under cons.

Homeopathic 1 1 0 0 Dispensary

[(Source: CMHO office)

PRIVATE SERVICES

Table 7 Private Health Facility in Dhamtari District

Private Service facilities Name and location in case of Number of beds if any/surgical sub district facilities care/ Gynec care

Multi-Specialty Nursing Homes DCH (District Level) 370

5 nursing homes at district level Solo Qualified Practitioners + 1 nursing home at sub district NA level in KURUD

Practitioners from AYUSH NA NA

Approved MTP centers in Private

sector

RMPs (Less than formal qualified

practitioner)

Data :-CMHO office & BMO office

ACCREDETION DETAILS OF PRIVATE NURSING HOMES IN THE DISTRICT

Table 8 Private Health Facility Accredited for JSY and Family Planning

Sl Name of the Hospital / Accredited for No of Patients Location no Nursing Home Beds Turnout rate 1 Dhamtari Chrisitian Hospital JSY, Family 300 250 to 300 Dhamtari City, Planning, RSBY per day 2 Upadhayay Nursing Home JSY, RSBY 30 60 per day Dhamtari City 3 Dr Gupta Hospital JSY, Family 75 50 to 60 per day Dhamtari City Planning, RSBY 4 Ojaswi Nursing Home JSY, Family 30 25 to 30 per day Dhamtari City Planning, RSBY 5 Aditya Nursing Home JSY, RSBY 20 25 to 30 per day Dhamtari City 6 Dr Sunita Jain Nursing Home JSY, RSBY 10 15 to 20 per day Dhamtari City

Performance in last one year (2009-10)

Expected delivery in the district during year 2009-10 was 20657 and total reposted delivery was 16309 (78.95% of the expected delivery).Among total reported delivery 58.30% (9509) was institutional delivery and 41.69% was home delivery. Among total reported delivery 22.93% (3740) was conducted by the non SBA trained person. Institutional delivery against total expected delivery was 46.03% while it was 24.6% in DLHS-3 (15.7% NFHS-3 2005). Percentage of maternal complication treated was 11.08% during the year 2008-09. High risk pregnancies identify during 2009-10 was 9.31%.Male sterilization was 35.83% (253/706) against the district target and female sterilization was 91.40 (5814/6361) against district target. Male sterilization was 4.35 % against total female sterilization. Case detection rate of TB among new sputum positive patient was 54% and ABER for Malaria was 14%. Percentage of VHNDs conducted against planned was 95.81% ( 8221/8580) in the district.

Qualitative report of Dhamtari district

Health Sub Centers:- Health Sub Centres are mostly maintained by one ANM’s in the district. ANM’s are providing OPD’s in the morning and regular community visit in days. They dispense family planning, ANC commodities and assist in routine immunization & Polio immunization programme. In Dhamtari district ANM are providing facility of normal delivery in sub centre. 86% Sub Centres have infrastructure. 9% Sub Centres among Sanctioned 165 are without any infrastructure. 6 % Sub Centres out of 165 are under construction.

Electricity in Subcenters of Dhamtari District

Electricity yes 38%

61.81% Electricity no

Graph 24 Electricity in Sub Centers of Dhamtri District

Water Facility in the Subcenter of Dhamtari District

Water No, 73.33% Water Yes, 26.66%

Graph 25 Water Facility in The Sub Centers of Dhamtari District

Stay facilities for ANM in the Subcenter of Dhamtari District

Yes, 82.42% No, 17.57 %

Graph 26 Stay Facility for ANM in the Sub Centre of Dhamtari District

Subcenters with New Born Baby Corner

yes, 32.72 %

no, 67.27 %

Graph 27 Sub Centre New Born Baby Corner in Dhamtari District

Sub Centre Conducting Delivery

Yes , 33.9 %

No , 66.1 %

Graph 28 percentage of Sub Centre conducting delivery in the Dhamtari District

18(2 Gujra Block, 9 Magarlod Block and 7 Nagri Block) sub centers in District with infrastructure, electricity facility and stay facility for ANM are not conducting deliveries. 4 Sub Centre in the district are providing delivery services but not accredited for JSY.

Primary Health Centers There are 22 PHCs in the Dhamtari District. On an average each CHC has 5 PHCs ranging from 4 to 8 per CHC. In the term of population coverage and accessibility the PHCs in the Dhamtari is good and easily accessible by all the villages under their care. 54% (12/22) PHCs have infrastructure and working in government building. 22.72 % (5/22) PHCs are under construction and 22.72 % have no facility. Total 45% (10/22) PHCs are presently are functioning in either Sub Centers or some other government building on local arrangemen.54% (12/22) PHCs are providing delivery services to the community. In 9 % PHCs have infrastructure and stay facility for doctors and Medical staff but delivery facility is not available.

Community Health Centers There are 4CHCs in the Dhamtari district. Additional constructions in the 2 CHC Nagari and Gujra are going on. CHCs are providing 24x 7 services. Presently none of the CHCs is providing specialist services. Cold storage for vaccines is present in all 4 CHCs but during visit none of the facilities were popery maintained the temperature records. Some CHCs MS are posted (like CHC Gujra ) but due to lack of infrastructure they are not able to provide specialist services. New buildings are good and after shifting, we can hope for good services. BPHC Gujra is upgraded to CHC in the financial year 07-08, but it does not have adequate staff, required for providing the basic services of a CHC. CHC Gujra is still in the phase of up gradation . There are some villages especially tail areas of Gangrel Dam where communication is not possible during rainy time of the year.

There are 3 CHC’s, i.e. one in each block of Nagari, Kurud & Magarlod providing FRU services. Primarily, it is the sustained unavailability of specialists, general duty doctors and para- medical staff (and their functional competence), which holds the key to the functionality of the First Referral Units. To overcome this gap in service delivery Rural Medical Assistants (RMA) have been already posted in all PHCs & female RMAs have been posted at all CHCs. Service availability at Nagri and Magarlod are not up to the mark for a FRU. Improvements are need in service availability and availability of clinical staff and proper management in the both Nagri and Magralod for proper functioning as FRU.

District Hospital

At Dhamtari district hospital was started in 1976 with capacity of 50 bedded and posting of 5 medical officers. District hospital consisted of 5 OPD rooms, one major O.T., one minor OT, office, and Kitchen. Later on, it was in years 2000 when Dhamtari was formed district it was upgraded to 100-bedded hospitals along with a 20-bedded Eye hospital. For upgraded district hospital, government sanctioned 15 post of medical officers and 11 posts of specialists. It is also centre for IDSP, ICTC, and RSBY, which are running in old building. It is main referral center from all peripheral rural health units. District hospital is still in the process of transition. The up gradation process is not complete even after 9 year.

Maternal and child heath In the interaction with ANM, Mitanin it was revealed that focus of Anti Natal Care (ANC) was restricted to the distribution of iron and folic acid tablets and T.T injections; however Mitanin were alarmingly unaware of the critical parts such as measurement of blood pressure and its importance from the maternal health point of view but ANM were aware. Secondly substantial numbers of health workers were not able to provide comprehensive information on nutrition related issues in the pregnant women. Going further it is noticed that, although women receive iron supplementation and T.T. injection they hardly receive complete ANC check-up by doctors. There was lack of diagnostic facilities at PHC level due to non-availability of lab technicians. During interaction it was revealed that Referred cases do not go to referral points and Referral patients did not get proper attention at FRUs.

In the case of intra natal care it was found that, due to JSY the numbers of women undergoing institutional deliveries are on the rise. But the condition of labor room is not good. In long run sustainability of institutional delivery will affect by the present poor infrastructure and the poor hygienic condition of the labor room and wards in PHCs and CHCs district.

During interaction with Mitanin and ANM it was found that they are doing PNC visits in the community. 24 houses stay was maintaining in the District hospital and CHCs but lacking in HSCs and PHCs.

Routine immunization was conducting on Tuesday and Friday in district. Mitanin are also helping in routine immunization in district Tuesday is also fix day for the ANC checkup in the district along with village health and nutrition day. There is no sick new born unites in the

26 district. There is no “child care skill” trained ANM in the district. There are no newborn child care equipments in the any facility of district.

In the Dhamtari district, it seems that there is not much difference between home and hospital deliveries in terms of quality of care as the facilities are lacking in resources. Bringing the pregnant women to the institution for delivery does not address the basic need for appropriate and optimal care during delivery as there is lack of resources in the facilities of district.

Janani Suraksha Yojana The percentage of institutional delivery in Dhamtari has increased from 26% in 2006-07 to 46%, in 2008-09 further 58.30 % 2009-10(internal data against total reported delivery). The main attribution is due to introduction of motivational scheme Janani Suraksha Yojana during 2005-06. Still the increase has not been as high as the desired level. In the hired sub-centre buildings, there is no space to keep a single bed where the mother and neonate could be advised to rest for few hours after delivery. In certain sub-centre, the ANM is not residential and hence, cannot perform delivery at night or at any time other than office hours.

Home delivery Total reported home delivery in the district was 41.69% of the total reported delivery. Among total reported delivery 22.93 was conducted by the non SBA trained person which, is very high because total reported delivery was 78.95% against total expected delivery.

Village Health and Nutrition Day Tuesday is fix day for Village Health and Nutrition Day in the district. During the year 2009-10, 95.81% Village Health and Nutrition Day was conducted against planned (8221/8580). Village Health and Nutrition Day and routine immunization are conduct from same centre. ANM are providing the Immunization and ANC check up services, Anganwadi worker are providing the nutrition support and Mitanin provides support to both of them.

Mitanin The concept of “Mitanin” is to select & train a health volunteer at community level-called the Mitanin (means a friend) – to act as link between government health provider & community. Role of Mitanin is:

 Providing elementary health Education,  Assuming leadership in community action for health,  Imparting First aid & OTC drugs,

 Treatment of minor ailments,  Ensuring timely referrals,

Table 9 Details of Mitanin and DRP in Dhamtari District

Detail of DRP/MT/Mitanin

Sl. Name of Nodel Officer Numbers DRPs and MTs and Mitanin No. Block District Block No. of Total No. of No. Of No. of DRPs DRPs MT Mitanin Mitanin (NGOs) Trained in 13th Govt. Non Phase Govt. 1 2 3 4 5 6 7 8 9

1 Dhamtari 1 1 2 20 400 400 2 Kurud 1 1 2 20 427 427 3 Magarlod 1 1 2 14 286 286 4 Nagari 1 1 2 25 514 514

Total 1 4 4 8 79 1627 1627

The Mitanin program at present has seen considerable grass root success, especially in Kurud & Magarlod block. At present, there are 1627 Mitanins that have been identified & are at various levels of training. Out of these 1627 have completed training till 13th round.

Table 10 Trainings situation of Mitanin

BLOCK MITANINS (No) Village Training Rounds

Dhamtari (Gujra) 400 144 13th round completed Kurud 427 134 13th round completed Magarlod 286 115 13th round completed Nagri 514 240 13th round completed

Total 1627 633

Constraints:

 Training & keeping high Quality Facilitators is a challenge.  Target of selection & training of 100 urban Mitanins in backward slum area wards is still not completed due to inadequate guidelines.  In 4 blocks all 1627 Mitanins completed 13th rounds of trainings,  Drug kits for trained Mitanins sanctioned & distributed.  Day 1 interventions by Mitanins have proved useful & good results are achieved in safe delivery, early onset of breast feeding & weight at birth.

Communitization Processes One of the important components of NRHM is Community participation. For community participation there are many strategies incorporated under the NRHM. Main strategies of community participation in Dhamtari district are Mitanin, Village Health and Sanitation Committee, Jeevan deep Samiti Swasth Panchayat Scheme. All the PHC, CHC and District hospital have Jeevan Deep Samiti. During interaction with the MO, BMO and RMA it was revealed that they are not much aware about the fund utilization of JDS Untied funs and maintains fund. It was also revealed that doctors are motivated and they are interested to utilize the fund in proper manner. There is need of some kind of training or orientation progarmme for the MO and BMO for proper utilization of fund in the district.

Total 633 villages are in the Dhamtari district among them 529 are the revenue villages and all of them have Village Health and Sanitation Committee. During interaction with one village health and Sanitation Committee it was revealed that there is good understating of health programme among the members, and they are involve in process of “Nirmal Gram” to develop healthy village but there is some confusion about the utilization of fund. In Nagri block total utilization of fund by VHSC was 48%.

At the time of district Visit there was meeting of District health society on 18th June 2010 chaired by District magistrate Dhamtri. Active involvement of the district collector in the District health society and her approach in different health problem of district was very good. During meeting it was found that district collector is keen to improve the health situation of the district. There was no involvement of Block programme management unit in the meeting. There is need to involve the block programme management unit in such meeting.

Bio Medical waste management The waste disposal method being followed in Dhamtari is still either deep burial or burning of wastes within 48 hours. During visit it was found that none of the hospital was using any dust bin or colour coded buckets for biomedical waste. There were no proper bio-medical waste management mechanisms in any of the facility in the district. Bio- medical waste was

29 spread in the Magarlod CHC. In district hospital burial pit is easily approachable for the animal. Syringes were spread in the Gujra CHC. There is need to develop a proper bio medical waste management mechanism in Dhamtari district.

Human Resource

There is an acute shortage of technical staff, both medical & non-medical at sector level & block level. None of the block hospitals has postgraduate specialists posted as per IPHS norms. Post of Block manager is vacant in 2 blocks Kurud and Gujra. In all 4 block post of BMO is vacant and assistance surgeons in the respective facilities are in charge BMOs. So, clinical hands are also looking administration in the district. RMAs are posted in all the 22 PHCs.

Human Resources Shortfall in Dhamtari District 100 % 100 % 100.0 90.0 82.4 % 80 % 80 % 80.0 66.7 % 70.0 60 % 60.0 45.5% 49.1 % 46.9 % 50.0 40.0 30.0 20.9 % 20.0 7.3% 10.0 3.2 % 0% 0.0

Graph 29 Human Resources Shortfall in Dhamtari District

District Hospital Dhamtari Dhamtari district hospital was started in 1976 with capacity of 50 bedded. Later on in years 2000 when Dhamtari was become district it was upgraded to 100 bedded hospitals along with a 20 bedded Eye hospital. It is also the centre for IDSP, ICTC, and RSBY, which are running in old building. It is main referral center from all peripheral rural health units. During interaction it was revealed that hospital administrator is mostly involve in non technical work or clerical work. There is need to address the issue and involve the hospital administrator in management work like hospital operational issue, quality indicator development and management inventory management, housekeeping management, supply chain management in the hospital administrative management.

Patient Load in District Hospital Dhamtari

100000 90046 85335 86105 85596 83563 80000

60000 OPD 40000 Inpatients

20000 5734 6292 6497 2823 4001 0 2005 2006 2007 2008 2009

Graph 30 Patient load in District Hospital Dhamtari

Dhamtari District Hospital OPD and IPD Cases 2009-10

April 10000 March May 8000 February 6000 June 4000 2000 OPD January 0 July IPD

December August

November September October

Graph 31 OPD and IPD cases (2009-10) District Hospital Dhamtari

District Hospital Dhamtari 100.0 100.0 85.7 90.0 80.0 72.7 71.4 75.0 80.0 66.7 70.0 52.9 60.0 50.0 50.0 37.5 40.0 30.0 20.0 10.0 0.0

Graph 32 Facility Assessment of District Hospital Dhamtari

District hospital Dhamtari scored 79 out of 120 based on the facility assessment format. Dhamtari district hospital scored well on central sterilization unit and OT equipments but scored

32 poor in Bio-medical waste management. Infrastructure is also poor as compare to IPHS norms for district hospital. There are many issues in District hospital some of them are

1) Existing OPD building is 30 year old and has lack of space more than three medical officers are sharing one chamber 2) Existing overhead tank is very old and have various leakages and dangerous. Store department is present in existing building. It lacking in space.

3) Waiting area is less in existing OPD Block there need of more space according to outpatient crowd 4) Present OT is very old which requires renovation to maintain proper sterilization and asepsis. 5) Boundary wall is incomplete, height is less so stray animals and unwanted elements create nuisance. 6) Many medical officers are looking after various district. Health programs which hampers their regular duty. 7) At present 2 Lab technicians, 1Labattendant, 2 Pharmacists, are working here and post of medical record officer, matron, are vacant. 8) Lack of these clerical staff causes lots of difficulty in proper management of administrative working 9) At present two blood banks refrigerator are in irreparable condition. 10) 4 stretchers are available needs to be replaced.( which are very old and repeatedly repaired)

Commitment given by the Facility incharge (for next 3 month)

1) Improve in the sing board display 2) Improvement in Water supply – New over head tank with water cooler.

Recommendation 1) There need to give more freedom to Hospital Administrator for proper management of the hospital, Hospital Administrative needs to involve in more hospital operational management issue. 2) Construction of new OPD building for proper functioning. 3) Development of proper bio medical waste mechanism in district. 4) There is need to improve the sing board and IEC material display in the district hospital premises.

CHC Magarlod-CHC CHC Magarlod was visited on 17th June 2010. CHC Magarlod catering the population of 114424 approximate (64 Gram Panchayat, 115 villages). It has 4 PHCs and 25 Sub centers. . In CHC Magarlod 2 Assistance Surgeon and 1 RMA are providing services to the community. Among two-assistance surgeon, one is working as BMO so, Clinical purpose one MBBS and 1 RMA is available in the hospital. During visit, it was found that no IPD patient was admitted. Maintenance and calibration of equipments are not done regularly and properly. Labour wards need to improve floors are not clean and immunization recodes was not properly maintained. There was no any functional O.T. and condemned article stored in wards.

Patient Load in Magarlod CHC

48986 50000 45000 40000 35000 30086 29589 31161 30000 26396 25000 20000 15000 551 1419 10000 503 1357 940 5000 0 2005 2006 2007 2008 2009

OPD Inpatient

Graph 33 Patient Load in Magarlod CHC ( 2005-2009)

CHC Magarlod 70.0 66.7 70.0 57.1 60.0 50.0 50.0 50.0 50.0 50.0 42.4 42.9

40.0 29.4 30.0 20.0 10.0 0.0

Graph 34 Facility Assessment of CHC Magarload

CHC magarlod scored 53 out of 120 based on the facility assessment format CHC Magarlod scored well on equipments supplies and records. Infrastructure service and services out sourced is poor in the CHC Magarlod. During visit it was found that floor was not clean and temperature record for vaccine store was not recorded from last one month other records was maintained properly. Condition of labour room was poor. Only two assistance surgeons are posted in the CHC, among two one MO is also working as BMO and providing administrative service to the hospital. CHC Magarlod needs more clinical staff according to the patient load to the hospital. During interaction it was found that BMO is keen to improve the hospital services but subordinate staffs are not supportive.

Commitment given by the Facility in charge (for next 3 month)

1) Cleanness of hospital 2) Name plates of working staff with photograph 3) Proper maintain drugs supply to patient

Recommendation

1) Hospital is presently poorly managed. District Hospital Administrator and Block Programme Manager both can be use for properly organize the things in the CHC Magarload.( labour room management , building management including with the housekeeping and different other operational issue in the hospital). 2) Motivational meetings or programme for subordinates staffs ( 4th grad staffs) for proper function of hospital. 3) According to work load on BMO and patient load in the CHC there need of more clinical hands in the CHC. 4) There is need to display of the duty roster of staffs in front of OPD area.

CHC Nagri CHC Nagri was visited on 19 June 2010. CHC Nagri is a Tribal block. CHC Nagri catering the population of 175702 approximate (87 Gram Panchayat 240 Villages). It has seven PHCs and 66-sub centre. One pediatrician and 2-assistance surgeon are providing the service to the community. Additional construction for CHC is going on. According to population, one additional CHC is required in the area or there is need to improve the medical staff in the block.

Patient Load in Nagri CHC

58354 53666 60000 47918 50324 50000 38737 40000 30000 20000 2712 3984 2628 2894 3682 10000 0 2005 2006 2007 2008 2009

OPD Inpatient

Graph 35 Patient load in CHC Nagri ( 2005-2009 )

CHC Nagri 70.0 66.7 70.0 57.6 60.0 50.0 50.0 50.0 42.9 50.0 37.5 40.0 29.4 28.6 30.0 20.0 10.0 0.0

Graph 36 Facility Assessment of CHC Nagri CHC Nagri scored 55 out of 120 based on the facility assessment format. CHC Nagri scored well on equipments supplies and records. CHC Nagri scored very poor on the other assessment parameters like equipments in OT, infrastructure and Bio-Medical waste management. Condemned articles are stored in labour room .Labour room and O.T need to improvement.

Commitment given by the Facility incharge (for next 3 month)

1) Display of name with photograph of all doctors 2) Modification of meeting hall 3) 24 hour drinking water facility for patient 4) Conversion of old CHC building in IOL operation after shifting to new building 5) 24 hour electricity by installing a good generator back up. 6) Display board related to all national health programme on hospital building Recommendations 1) There is need to improve the labour room and O.T. condition in the hospital. 2) BMO, District Hospital Administrator, BPM Should make a proper plan before shifting of CHC in new building

CHC Gujra CHC Gujra was visited on 18 June 2010. CHC Gujra catering the population of 185290 approximate (87 Gram Panchayat, 144 villages). It has four PHC and 35-sub center. Two assistance surgeon and one ayurvedic doctor are providing service to the community. Additional construction for CHC is going on.

Patient Load in Gujra CHC

11616 12000 10000 8000 6247 5342 5523 5769 6000 4000 721 729 162 102 316 2000 0 2005 2006 2007 2008 2009

OPD Inpatients

Graph 37 Patient Load in Gujra CHC ( 2005-2009 )

CHC Gujra

80.0 70.0 71.4 70.0 60.0 50.0 50.0 41.7 50.0 33.3 33.3 40.0 29.4 30.0 14.3 12.5 20.0 10.0 0.0

Graph 38 Facility Assessment of CHC Gujra CHC Gujra scored 44 out of 120 based on the facility assessment format. CHC Gujra scored well on equipments and supplies. But very poor scored in biomedical waste management and services out sourced. During visit it was found that labour room was very dirty. Essential instruments were also not present in the labour room during visit. Management in the hospital was poor.

Recommendation 1) According to local authority, CHC is soon shifting to new building, BMO , BPM with the help of District Hospital Administrator should make a proper plan for operation of CHC in new building. CHC Kurud

CHC Kurud was visited on 18th June 2010. CHC Kurud catering the population of 209548 approximate (101 Gram Panchayat, 134 villages) .It has 7 PHCs and 39 Sub centers. 5 assistance surgeons are providing services. Among 5 assistance surgeon 1 is MD Anesthesia, and one is DCH and but they are posted as assistance surgeon. Blood bank is on construction phase.

Patient Load in CHC Kurud

OPD Inpatient

14616 14715 13472 12917 13196

1760 840 859 1041 1073

2005 2006 2007 2008 2009

Graph 39 Patient load in CHC Kurud ( 2005-2009)

CHC Kurud

90.0 85.7 90.0 75.0 80.0 63.6 66.7 70.0 52.9 57.1 60.0 50.0 50.0 50.0 37.5 40.0 30.0 20.0 10.0 0.0

Graph 40 Facility assessment of CHC Kurud

CHC Kurud scored 75 out of 120 based on the facility assessment format.CHC Kurud is well maintained hospital. CHC Kurud well scored in equipments supplies and labour room condition. In last 4 year out patient and in patient flow is continuously increased in the CHC. During interaction it was revealed that working BMO is keen to improve the services in the hospital. During the year 2009-10 fund utilization was below 50%.

Commitment given by the Facility incharge ( for next 3 month)

1) Caesarian section will start with in 3 month 2) Separate OPD counter 3) Improve IEC material display 4) Training for improvement of skilled knowledge of ANM and staff nurse.

Recommendation

1) There is need of separate OPD building for CHC Kurud 2) According to patient load there is need to arrange some specialist doctors on local level ( may be through JDS of untied fund) 3) Availability of OT equipment is good so, with some more Hospital Staff BMO should plan for caesarian services and minor operation in the CHC. 4) There is need to improve the fund utilization in CHC.

PHC Kareli bodi PHC Kareli bodi was visited on 17th June 2010. One RMA is providing the services to the community. OPD and delivery services are providing to the community. There is no boundary wall in PHC. PHC Karelibodi scored 45 out of 96 based on the facility assessment format. PHC Karelibodi Scored well in equipment and infrastructure but scores poor in service availability and service out –sourced. There is no MO in the PHC. RMA is providing the clinical service in PHC.

OPD Patient in Kareli(bodi) PHC in 2010- 11

748 754 734 800 682 671 704 700 529 569 600 489 503 465 500 416 400 300 200 OPD 100 0

Graph 41 OPD cases in Kareli ( Bodi ) PHC (2010-11)

PHC Karali(bodi) 70.0 70.0 55.9 60.0 50.0 50.0 50.0 41.7 50.0 33.3 40.0 26.3 30.0 16.7 20.0 10.0 0.0

Graph 42 Facility Assessment of PHC Kareli (bodi)

Commitment given by the Facility incharge ( for next 3 month)

1) Drinking water facility for the patient 2) Motor cycle stand shade.

Recommendation

1) There is need to improve the condition of labour room in the PHC (Both equipment availability and cleanness.

PHC Bhatgaon

PHC Bhatgaon was visited on 18th June 2010. One medical officer and one RMA are providing the services to the community. Only 22.5% fund was utilized in last financial year. It is a newly constructed building. . During interaction it was revealed that security is a major concern in PHC Bhatgaon (All the window glasses were broken by some antisocial aliments). Boundary wall is also not present for the PHC.

PHC Bhatgaon

70.0 66.7 70.0 60.0 50.0 50.0 50.0 41.2 40.0 33.3 26.3 25.0 30.0 16.7 20.0 10.0 0.0

Graph 43 Facility Assessment of PHC Bhatgaon

PHC Bhatgaon scored 40 out of 96 based on the facility assessment format. PHC scored well in equipments and records but poor in services out-sourced and bio medical waste Management. During visit it was found that labour room was not properly clean. There was very less instrument for the safe delivery. There was very poor IEC display in the PHC.

Commitment given by the Facility incharge (for next 3 month)

1) Clean labour room 2) Improve IEC display in the hospital building 3) Provide safe drinking water for patients 4) Proper sitting arrangement for OPD cases. Recommendation

1) Security is a one of the most important issue for Bhatgaon PHC. The construction of boundary wall need immediate attention ( all the glass window were broken by some village people) 2) There is also need to improve the labour room condition.

HSC Bandha

SHC Bandha

100.0 89.5 100.0 72.6 80.0 60.0 33.3 40.0 20.0 0.0 Building Condition of Services & Biomedical condition toilets performance Waste Management

Graph 44 Facility Assessment of Health Sub Centre Bandha

HSC Bandha was visited on 19th June 2010. SHC scored 71 out of 90 based on the facility assessment format. SHC Bandha was scored well in the condition of toilets and building condition but poor on biomedical waste management. During visit it was found that SHC was well maintained. But IEC display was poor and there was no display of services availability in the sub centre.ANM of the Bandha Sub Centre is motivated and keen to provide the services to the community. HSC Kukrel HSC Kukrel was visited on 19th June 2010.HSC scored 60 out of 90 based on the facility assessment format.SHC Kukrel scored well in the building condition and services and performance of the Sub Centre. But HSC Kukrel scored poor in condition of toilets and biomedical waste management. During visit it was found that there was security problem in the sub centre building. Some nuisance people creating problem for ANM . During visit DPM gives immediate instruction to the ANM and help to provide proper renovation of building for security purpose .

SHC Kukrel

89.5 100.0 66.1 80.0 60.0 28.6 33.3 40.0 20.0 0.0 Building Condition of Services & Biomedical condition toilets performance Waste Management

Graph 45 Facility Assessment of Health Sub Centre Kukrel

HSC Dokal HSC Dokal was visited on 19th 2010. There was no building for the HSC Dokal . ANM provides services through community visit. For delivery services she used near PHC.

HSC Gajkhanhar HSC Kajkhanhar was visited on 19th June 2010. HSC scored 45 out of 90 based on the facility assessment format. HSC scored well in building condition and poor in biomedical waste management. During interaction with ANM it was revealed that building is newly constructed and still electricity is not available in the Sub Centre. ANM only provides OPD services in the Sub Centre. ANM also provides delivery services in the home.

HSC Gajkhanhar

73.3 80.0 70.0 57.1 60.0 45.2 50.0 33.3 40.0 30.0 20.0 10.0 0.0 Building Condition of Services & Biomedical condition toilets performance Waste Management

Graph 46 Facility Assessment of Health Sub Centre Gajkhahar

Recommendation for District

1) District health authority should plan to start delivery services in the 18 Sub Centers (2 Gujra Block, 9 Magarlod Block and 7 Nagri Block) in District where infrastructure, electricity facility and stay facility for ANM are present.

2) 4 Sub Centre in the district are providing delivery services but not accredited for JSY. District health authority should accredit these 4 Sub Centre for JSY as early as possible. 3) BPM post of 2 blocks are vacant, and that is affecting the monitoring part in Kurud and Gujra Bocks ,district health authority should try to fill the post for better programme implementation in the both blocks. 4) There is no bio medical waste disposal mechanism in the district, district health authority should plan a proper strategies for develop a good bio medical waste disposal mechanism. 5) During visit it was found that records of temperature maintain was not properly recorded in any of the visited facility (immunization points). District health authority should take immediate action in the issue. 6) District programme management unit should plan a workshop for BMO and MO for utilization of funds. 7) District health authority should plan for additional building in district hospital for OPD services. 8) District health authority involve hospital administrator on management work ( technical inputs can be taken for CHC hospitals also) 9) Improper facilities for conducting deliveries need to be addressed in PHC and CHC. 10) Security is a major issue for CHC and PHC; district health authority should plan for a proper security of Batgaon CHC.

Form A: Supportive Supervision Form Yearly Monitoring Format Name of Consultant: Pradeep Tandan Name of the District and State: Dhamtari, Chhattisgarh Date: 17th to 19th June 2010

Infrastructure: DH CHCs BPHCs PHCs APHCs/ HSC NPHC’s Blocks Population 1.Dhamtari 188739 1 0 4 0 35 ( Gujra ) 2.Kurud 209548 1 0 7 0 39 3.Magarlod 115773 1 0 4 0 25 4.Nagri 177516 1 0 7 0 66 5.Dhamtari Urban 99884 1 0 0 0 0 0 6. 7. Total (In Position) 1 4 0 22 0 165 791460 Total Functional 1 4 0 22 0 165 Total Functional 1 4 0 12 0 54 (providing delivery services) Target for 0 0 0 5 0 13 New Constructions (2010-11) Target for Operationlization Number of new 0 1 0 5 0 16 constructio ns (PHC, CHC etc) initiated before April 2008 and not yet completed. Number of major 0 0 0 0 0 0 civil works initiated (constructio n of

49 labour rooms, wards etc. In existing premises) before April 2009 and not yet completed.

Facility 2009-10 In position Target 2010-2011

SNCU 1 1 Stabilization Unit (CHC/BPHC)

Human resources available in the district State: As on District: month June 2010

Category Regular Contractual Total Required Shortfall Target available for the 2010-11 existing facilities* Sanctioned In Sanctioned In post position post position (available (available Mid wives ANM 192 178 0 7* 185 192 14 14 LHV 33 18 0 0 18 33 15 15 PHN 0 0 0 0 0 0 0 0 Nurse 13+18 12+18 0 8 12+8 31 1 1 Total Other technical Health workers 169 86 0 0 86 169 83 83 [male] Lab technician 17+2 2+2 0 1+0 5+2 17+2 14+0 14+0 Pharmacist 30+2 15+2 0 0 15+2 30+2 15+0 15+0 Radiographer 4+2 0+2 0+0 0+0 0+2 4+2 4+0 4+0 Total 220+6 103+6 0+0 1+0 209+6 220+6 116+0 116+0 Medical MO/GDMO 52+15 30+16 0+0 2+0 32+16 52+15 14+0 14+0 Specialist 4+1 0+0 0+0 0+0 0+0 4+1 4+1 4+1 Obstetrics

“ paediatrics 4+1 1+1 0+0 0+0 1+1 4+1 3+0 3+0 “ anaesthesia 4+1 0+1 0+0 0+0 0+1 4+1 4+0 4+0 Surgery 4+1 0+1 0+0 0+0 0+1 4+1 4+0 4+0 Medicine 4+1 0+0 0+0 0+0 0+0 4+1 4+1 4+1 Opthalmology 0+1 0+1 0+0 0+0 0+1 0+1 0+0 0+0 Total 72+21 31+20 0+0 2+0 36+20 72+21 33+2 33+2 *Also analyse requirements as per services provided by the facilities qualitatively H.R performance Data (District level) No. Of OPD cases per doctor in the district 4298 No of Obstetricians performing C.Sections out of Total available 0/1 Number of C-sections performed per obstetrician at Level 3 facility 0/1 No of Ophthalmologists performing Cataract Surgeries out of Total available 2/2 Number of cataract surgeries performed per ophthalmologist 2575 No. of LSAS trained personnel providing services 2 CHC level No. of EmOC trained personnel providing services 2 CHC level Percentage of deliveries performed by SBA trained personnel’s 45% {[( deliveries performed by SBA trained personals / total number of deliveries]*100} Number of deliveries performed per SBA 20 Average number of outpatient cases seen by the mobile medical unit (MMU) 0

Training Activity / Measurable indicator 2009-10 Target 2010-2011

Percentage of ANMs trained as SBAs 10.67% 25 (SBA trained ANMs/Total Number of ANM*100) Percentage of nurses trained as SBAs 35% 10 (SBA trained nurses/Total Number of nurses *100) Number of Doctors trained on EmOC 1 2 Number of Doctors trained on LSAS 1 Number of Doctors trained in NSV/ 1 Conventional vasectomy Number of Doctors trained in Abdominal 3 Tubectomy (Minilap) Number of Doctors trained in Laproscopic 2 Tubectomy Number of Personnel trained in FIMNCI 0 Number of ASHAs completed four modules of training

Financial Indicators Percent expenditure of funds through Non Governmental Organization (NGO) NIL Number of facilities with less than 50% utilization of the untied grants (BPHC 1

51 and above) Percentage of JSY payments pending as on 31 March 2010 (with regards to 5.66% institutional deliveries in the public facilities only)

Indicators Activity / Measurable indicator 2009-10 Target 2010- 2011 Deliveries 1. Total expected 20657 20657 2. Total Reported 16309 - a. Institutional 9509 125000 b. Home SBA 3060 NA c. Home Non SBA 3740 NA 3. Total Unreported (1-2) 4348 NA 4. Percentage of Institutional Deliveries 46.03% 60.51% {[(Institutional/total expected)]*100} 5. Percentage of C- sections performed (w.r.t 9.46% institutional deliveries): {[(no. of C section performed/ institutional deliveries)]*100)} 6. Percentage of C- sections performed (w.r.t. 4.35% expected deliveries: {[(no. of C section performed / expected deliveries)]*100)} 7. Percentage of maternal complication (medical and 23.44% surgical)treated against total institutional deliveries {[( maternal complication treated / institutional deliveries)]*100)} 8. Percentage of maternal complication (medical and 11.08% surgical) treated (w.r.t. expected deliveries): {[(no. of maternal complication treated / expected deliveries)]*100)} 9. High risk pregnancies identified {[(no. of high risk 9.31% pregnancies identified / No. Of ANC registered)]*100)} Percentage of pregnant women tracked 83.52% Percentage of fully immunized children 97.5% Family Planning 1. Male sterilisation (in numbers) 253 706 2. Female Sterilization 5814 6361 3. No. of IUD insertion 2997 3800 No. Of Facilities providing safe abortion services* 5 0 Disease control Case Detection Rate of TB among new sputum positive 54% 660 patients Treatment Success Rate among new sputum positive 85%

52 patients initiated on DOTS ABER for Malaria (14%)124814 110825 API for Malaria 0.71% No. of Reconstructive surgeries performed under NLEP Annual New Case Detection Rate for Leprosy 34.5% *Explore qualitatively the methods of safe abortion used Service Delivery Percentage of Medical camps conducted against planned {[medical camps 0 conducted/medical camps planned]*100} Percent of VHNDs conducted against planned 95.81% Number of functional Mobile Medical Units (MMU)1 0

Other Indicators Is community based monitoring system existent in the district? (Yes / no ) Yes Percent of data elements uploaded in last quarter of 2009-10 100% Percentage of functional/ working ILR points2 71.05% {[number of functional ILR points]/ [number of total ILR points]}*100 Qualitative explore plan for inaccessible areas [in details]

* Following this is the RCH sub plan for the district. * District ( Total ) + District Hospital

1 Analyze as per state policy 2 ILR : Ice Line Refrigerator

Form B: Supportive Supervision Form Quarterly Monitoring Format Name of Consultant : Pradeep Tandan Name of the District and State: Dhamtari, Chhattisgaarh Date 17th June 2010

* For all the below indicators cumulative figures from the month of the consultant’s last visit upto the month previous to the current visit have to be recorded unless otherwise specified. Infrastructure DH CHCs BPHCs PHCs APHCs/ HSC NPHCs New constructions initiated 0 0 0 0 0 0 Major Civil Works 1 1 2 1.Initiated 0 0 0 0 0 0 2.competed 0 0 0 0 0 0

Facility Target Q I Q II Q III Q IV 2010-2011 SNCU 1 Stabilization Unit (CHC/BPHC) 1 Functional Mobile Medical Units (MMU)3

Human resources: New Recruitments in the district State:Chhattisgarh As on month District:Dhamtari June 2010

Category Target New recruitment New 2010- [regular] recruitment 11 [contractual] Mid wives ANM 14 0 0 LHV 15 0 0 PHN 0 0 0 Nurse 1 0 0 Total 30 0 0 Health workers [male] 83 0 0 Lab technician 14 0 0 Pharmacist 15 0 0 Radiographer 4 0 0 Total 116 0 0

3 Analyze as per DHAP

MO/GDMO 14 0 3 Specialist Obstetrics 5 0 0 “ paediatrics 3 0 0 “ anaesthesia 4 0 0 Surgery 4 0 0 Medicine 5 0 0 Ophthalmology 0 0 0 Total 35 0 3

H.R performance Data (District level) Indicator Last Cumulative from Quarter April 2010 till previous month of the visit No. Of OPD cases per doctor in the district 1148 659 No of Obstetricians performing C.Sections out of Total 0/1 1/1 available Number of C-sections performed per obstetrician at Level 3 0 2 facility No of Ophthalmologists performing Cataract Surgeries out of 2/2 2/2 Total available Number of cataract surgeries performed per ophthalmologist 1070 165 Percentage of deliveries performed by SBA trained 44% 43.92 personnel’s {[( deliveries performed by SBA trained personals / total number of deliveries]*100} Number of deliveries performed per SBA 4.34 2.16 No. of LSAS trained personnel providing services No. of Emoc trained personnel providing services 1 1 Average number of outpatient cases seen by the mobile 0 0 medical unit (MMU)

Training in the respective visits (New trainings conducted in the Quarter till the date of the visit) Activity / Measurable Target 2010- Visit in Q Visit in Q Visit in Q Visit in Q 2011 I II III IV indicator

Number of ANMs trained as 25 4 under SBAs training Percentage of ANMs trained as 4% SBAs(SBA trained ANMs/Total Number of ANM*100)

Number of Doctors trained on 2 0 EmoC Number of Doctors trained on 1 LSAS Number of Doctors trained in NSV/ Conventional vasectomy Number of Doctors trained in NA Abdominal Tubectomy (Minilap) Number of Doctors trained in NA Laproscopic Tubectomy Number of Personnel trained in NA IMNCI Number of ASHAs completed NA four modules of training

Financial Indicators Number of facilities with less than 50% utilization of the untied grants (BPHC 1 and above) Percentage of JSY payments pending as on day of visit (with regards to 31.45% institutional deliveries in the public facilities only)

Indicators* Activity / Measurable indicator Target 2010- Achievement Achievement 2011 from April 2010 from April till Month 2010 till previous to the Month Month of Visit previous to the (in numbers) Month of Visit (in %) Deliveries 10. Total Reported 206571 2286 11.06 d. Institutional 12500 1540 12.32% e. Home SBA NA 329 14.39 f. Home Non SBA NA 417 18.24% 11. Percentage of C- sections performed NA 136 8.83% (w.r.t institutional deliveries): {[(no. of C section performed/ institutional deliveries)]*100)} 12. Percentage of C- sections performed 136 0.65% (w.r.t. expected deliveries: {[(no. of C section performed / expected deliveries)]*100)} 13. Percentage of maternal complication NA 127 8.24% (medical and surgical)treated against

total institutional deliveries {[( maternal complication treated / institutional deliveries)]*100)} 14. Percentage of maternal complication 127 0.61% (medical and surgical) treated (w.r.t. expected deliveries): {[(no. of maternal complication treated / expected deliveries)]*100)} 15. High risk pregnancies identified {[(no. (260/3267)*100 7.96% of high risk pregnancies identified / No. Of ANC registered)]*100)} Family Planning 1. Male sterilisation (in numbers) 706 4 0.57% 2. Female Sterilization 6361 19 0.30% 3. No. of IUD insertion 3800 204 No. Of Facilities providing safe abortion - 5 - services Disease control Case Detection Rate of TB among new 165 sputum positive patients Treatment Success Rate among new sputum 85% positive patients initiated on DOTS ABER for Malaria 110825 29106 3.3% API for Malaria Annual New Case Detection Rate for Leprosy 34.5% prevalence Cataract Surgeries performed in the District 4500 329 7.31% No. of Reconstructive surgeries performed under NLEP

Service Delivery (For previous month) Percentage of Medical camps conducted against planned {[medical 0 camps conducted/medical camps planned]*100} Percent of VHNDs conducted against planned* 2014/2145(93.89%) Functional Mobile Medical Units (MMU)4 *In last 3 months according to the VHND microplan (check the Sub Centre Register) Other Indicators (previous month data) Percent of data elements uploaded 100% Percentage of functional/ working ILR points5 (71.05%) 27/38 {[number of functional ILR points]/ [number of total ILR points]}*100

4 Analyze as per state policy 5 ILR : ice line refrigerator

Inspection format for health facilities

Name of the Consultant Pradeep Tandan State Chhattisgarh District Dhamtari Health Facility District Hospital Dhamtari Date and Time 17.06.10 Time: 10:00 am

I. Infrastructure

Item MOV Criteria Score Building a. Walls and floor and roof intact 0 3 condition b. Electrical wires not exposed 1 c. Electric switch boards not broken 1 7 points, d. Electric bulbs in wards / pathways / toilets 1 e. Whitewashed 0 Each statement f. Signage boards present 0 carries 1 marks g. Rooms not dumped with condemned articles 0 Total marks = 07 Condition of a) Mosquito screens present and devoid of holes 0 2 wards b) Condemned articles not stored in the wards 0 c) window glasses not broken 1 (5 points × 1 marks = d) Door / Screens / Curtains / present for ensuring 5 marks) privacy of patient 0 e) Availability of ceiling fans in wards1

Water supply a. Running water available for 24 hours in Labour 10 room 2 (5 points × 2 marks = b. Running water available for 24 hours in OT 2 10 marks) c. Running water available for 24 hours in Toilets 2 d. Purified drinking water available for drinking for patients in OP 2 e. Purified drinking water available for drinking for patients in IP 2

Condition of a. Doors are not damaged 0 1

58 toilets b. Floors are clean 0 (6 points × 1 = 6 c. Basins are not stained 0 marks) d. water taps not damaged 0 e. pathway is not dirty 0 f. Separate for male and female 1

Patient a. Seating arrangements are present in the OPD 2 amenities area 1 (3 points × 1 = b. Stools or chairs for attendants in the wards 3marks) present 0 c. Inpatients are provided with blankets in winter 1

Furniture a. Cots are not rusted, not broken 0 0 b. Mattress not worn out, cloth not torn, (2 points x 1 = 2 cotton/coir not coming out 0 marks)

Drainage a. Drainage system not clogged (1 point x 1 = 1) 0

III. Services available (applicable for BPHCs and above)

Sl.no Service Means of verification Score 1. 24 hour doctor available Duty roster, casualty register 2 19 2. 24 hour nurse available Duty roster, casualty register 2

3. 24 hour delivery services Delivery register 2 Available available services get 2 4. 24 hour newborn care Delivery register, Paediatric ward register, mark each services available Immunization register 0 5. 24 hour caesarean services Delivery register 2 26 marks (if FRU) 6. Tubectomy services FP register 2 available 7. Safe abortion services MTP register 0 available 8. 24 hour blood transfusion Blood transfusion register / Blood bank services master register 2

9. Laboratory Services Equipments and reagents for conducting the tests are present, lab record shows tests are 1. Haemogram √ conducted 2. Sputum Examination√ 1 3. Lipid Profile× 4. × Hormone Assay Lab register 2 5. Urine Examination √

10. Availability of ECG Facility ECG machine available & working 2 11. X Ray Facility with X-ray X ray register – working status 2 Technician available 12. Ultrasound services USG register – working status 0 available 13. Ambulance Records of operation [Number of ambulances, average (if more than one ambulance) number of breakdowns in the last one week, number of drivers available per shift] maintained 2 1. Functional telephone Telephone number with dial tone 1 5 2. Adolescent sexual and OP register – number of adolescent 7 X 1= 7 reproductive health services beneficiaries 1 3. Whether fixed day antenatal ANC register 1 clinics are conducted 4. Whether fixed day RTI/STI OPD Register 1 clinics are conducted 5. Whether fixed day Register 1 sterilization clinics are conducted 6. Whether IEC material 0 displayed 7 Public Display of JSY 0 Beneficiaries

IV. Services Out-Sourced

Sl. Item Means of verification Score no 1. House a. Floor is cleaned with disinfectant on keeping the day of visit 1 5 b. rainbow linen color maintained 0 c. OT fumigated 1 Each statement carries 1 mark, total marks 7 2. Generator a. Generator in working condition with designated horse power 1 b. Fuel for operation present 1

3. Food a. Food served to inpatients 1 b. Food chart for inpatients 0

V) Equipments and supplies

Item MOV condition Score Trolley a. In working condition1 b. Trolley without rust 2 1 Marks for each item, Wheelchair a. In working condition scored only if both b. Wheelchair without rust 0 conditions are satisfied = 3 marks Stretcher a. Stretcher without rust 1 b. not broken

Sterilised gloves Sterilised gloves available 1 1 1mark if sterilised gloves are available Average number of OP Drug stock register 3 3 drugs available (monthly) % availability estimated, 100% availability gets 4 marks, 10% gets 1 mark Availability of life saving Availability of 2 2 drugs present Total 2 marks if all are

present, if not 0. a. Oxytocin √ b. Misoprostol √ c. Magnesium Sulphate √ d. IV antibiotics√

VI. Equipments in Labour room

Equipment MOV Score 1. Spot light in labour room 1 9 2. Vacuum extractor 0

3. Resuscitation equipment for newborn – Bag and Instrument in working mask 1 condition (demonstrates) 4. Resuscitation equipment for newborn – Laryngoscope and full set of endo-tracheal tubes 1 1mark each 5. Baby resuscitation table with infant warmer 1 Total marks 12 6. Mucous sucker 1

7. Baby weighing machine 1 8. Partograph 1

9. Privacy in Labour room (curtains etc) 1

10. Toilet attached to Labour room 0

11. Protocols displayed: Active management of 3rd stage of labour (also check case sheets) 0

12. Labour board not rusted, not broken and not blood stained 1

VII)Equipments in OT

Equipments MOV score

1. Ceiling OT light/ Floor OT light (shadowless) 1 6 2. Oxygen cylinder 1

3. Boyles apparatus (only FRU) 1 1 mark each Total marks 7 4. Suction apparatus 1 5. Adequate quantity of linen6 1 6. Spinal anaesthesia set (FRU) 0 7. Ante room present 1

VIII)Bio-medical Waste Management

Item MOV Score Waste a. Color coded buckets used 0 3 management b. Deep burial pit available where anatomical waste is disposed 0 8 points, 1 mark each c. Needle cutter in working condition 1 for each statement d. no mix of infectious or non-infectious waste done 0 Total: 8 marks e. waste bins not overfilled 0 f. needles and syringes mutilated and disinfected before putting in waste bin 1 g. metal sharps disposed in puncture proof containers 0 h. disposable gloves and masks not reused 1

IX) Central sterilization unit

MOV Score Autoclave a. Functioning autoclave 2 2 ‘a’ carries 1 mark, b. Usage of signalac tape c. usage of biological indicator b / c / d (either) carries 1 mark d. swab test of sterile packs Total 2 marks

6 3 sets of linen per surgery per day. (Calculate average number of surgeries per Day )

X) Records and reports

Item MOV score Separate column (in delivery register) for recording major complications leading to maternal death 0 2 Delivery register mentions about the details of the baby and Each statement carries 1 condition of the mother 1 marks, total 3 marks Referral slips are issued to patients 1

XI) Finance

Head Number of mothers yet to receive the JSY money Score

RKS Full utilization of funds in 2009-10 0 2 Marks for each point JSY JSY payments not pending till last week of the visit 2 2x2=4

Appendix 1

Inspection scoring sheet for health facilities

Name of the inspecting officer: Pradeep Tandan

Date & time: 17 June 2010

District: Dhamtari

Facility : District Hospital Dhamtari

Total marks: 125

Item Maximum Facility marks Score I. Infrastructure 34 18

II. Human Resource Self improvement score

III. Services available (applicable for BPHCs 33 24 and above)

IV. Services Out-Sourced 7 5

V) Equipments and supplies 10 8 VI)Equipments in Labour room 12 9 VII)Equipments in OT 7 6 VIII) Bio-medical Waste Management 8 3 IX) Central sterilization unit 2 2 X) Records and reports 3 2 XI) Finance 4 2 Total Score 120 79

Inspection format for health facilities

Name of the Consultant Pradeep Tandan State Chhattisgarh District Dhamtari Health Facility CHC Magarlod Date and Time 17.06.10Time: 5:00 pm

I. Infrastructure

Item MOV Criteria Score Building a. Walls and floor and roof intact 1 3 condition b. Electrical wires not exposed 0 c. Electric switch boards not broken 0 7 points, d. Electric bulbs in wards / pathways / toilets 1 e. Whitewashed 1 Each statement f. Signage boards present 0 carries 1 marks g. Rooms not dumped with condemned articles 0 Total marks = 07 Condition of a. Mosquito screens present and devoid of holes 0 1 wards b. Condemned articles not stored in the wards 0 c. window glasses not broken 0 (5 points × 1 marks d. Door / Screens / Curtains / present for ensuring = 5 marks) privacy of patient 0 e. Availability of ceiling fans in wards1

Water supply a. Running water available for 24 hours in Labour 4 room 0 (5 points × 2 marks b. Running water available for 24 hours in OT 0 = 10 marks) c. Running water available for 24 hours in Toilets 0 d. Purified drinking water available for drinking for patients in OP 2 e. Purified drinking water available for drinking for patients in IP 2

Condition of a. Doors are not damaged 0 1 toilets b. Floors are clean 0 (6 points × 1 = 6

c. Basins are not stained 0 marks) d. water taps not damaged 0 e. pathway is not dirty 0 f. Separate for male and female 1

Patient a. Seating arrangements are present in the OPD 1 amenities area 0 (3 points × 1 = b. Stools or chairs for attendants in the wards 3marks) present 0 c. Inpatients are provided with blankets in winter 1

Furniture a. Cots are not rusted, not broken 0 0 b. Mattress not worn out, cloth not torn, (2 points x 1 = 2 cotton/coir not coming out 0 marks)

Drainage a. Drainage system not clogged (1 point x 1 = 1) 0

b. Services available (applicable for BPHCs and above)

Sl.no Service Means of verification Score 1. 24 hour doctor available Duty roster, casualty register 0 2. 24 hour nurse available Duty roster, casualty register 2 11

3. 24 hour delivery services Delivery register 2 Available available services get 2 4. 24 hour newborn care Delivery register, Paediatric ward register, mark each services available Immunization register 0 5. 24 hour caesarean services Delivery register 0 26 marks (if FRU) 6. Tubectomy services FP register 0 available 7. Safe abortion services MTP register 0 available 8. 24 hour blood transfusion Blood transfusion register / Blood bank services master register 0 9. Laboratory Services Equipments and reagents for conducting the

tests are present, lab record shows tests are 6. Haemogram √ conducted 7. Sputum Examination√ 1 8. Lipid Profile× 9. × Hormone Assay Lab register 2 10. Urine Examination √

10. Availability of ECG Facility ECG machine available & working 2 11. X Ray Facility with X-ray X ray register – working status 2 Technician available 12. Ultrasound services USG register – working status 0 available 13. Ambulance Records of operation [Number of ambulances, average (if more than one ambulance) number of breakdowns in the last one week, number of drivers available per shift] maintained 2 1. Functional telephone Telephone number with dial tone 1 3 2. Adolescent sexual and OP register – number of adolescent 7 X 1= 7 reproductive health services beneficiaries 0 3. Whether fixed day antenatal ANC register 1 clinics are conducted 4. Whether fixed day RTI/STI OPD Register 0 clinics are conducted 5. Whether fixed day Register 1 sterilization clinics are conducted 6. Whether IEC material 0 displayed 7 Public Display of JSY 0 Beneficiaries

V. Services Out-Sourced

Sl. Item Means of verification Score no 1. House a. Floor is cleaned with disinfectant keeping on the day of visit 0 3 b. rainbow linen color maintained 0 c. OT fumigated 1 Each statement carries 1 mark, total

2. Generator a. Generator in working condition marks 7 with designated horse power 1 b. Fuel for operation present 1

3. Food a. Food served to inpatients 0 b. Food chart for inpatients 0

V) Equipments and supplies

Stretcher a. Stretcher without rust 1 b. not broken

Sterilised gloves Sterilised gloves available 1 1 1mark if sterilised gloves are available Average number of OP Drug stock register 2 2 drugs available (monthly) % availability estimated, 100% availability gets 4 marks, 10% gets 1 mark Availability of life saving Availability of 2 2 drugs present Total 2 marks if all are a. Oxytocin √

b. Misoprostol √ present, if not 0. c. Magnesium Sulphate √ d. IV antibiotics√

VII. Equipments in Labour room

Equipment MOV Score 13. Spot light in labour room 0 6 14. Vacuum extractor 0

15. Resuscitation equipment for newborn – Bag and Instrument in working mask 1 condition (demonstrates) 16. Resuscitation equipment for newborn – Laryngoscope and full set of endo-tracheal tubes 1 1mark each 17. Baby resuscitation table with infant warmer 1 Total marks 12 18. Mucous sucker 1

19. Baby weighing machine 1 20. Partograph 0

21. Privacy in Labour room (curtains etc) 0

22. Toilet attached to Labour room 0

23. Protocols displayed: Active management of 3rd stage of labour (also check case sheets) 0

24. Labour board not rusted, not broken and not blood stained 1

VII)Equipments in OT

Equipments MOV score 8. Ceiling OT light/ Floor OT light (shadowless) 1 4 9. Oxygen cylinder 1

10. Boyles apparatus (only FRU) 1 1 mark each Total marks 7 11. Suction apparatus 1 12. Adequate quantity of linen7 0 13. Spinal anaesthesia set (FRU) 0 14. Ante room present 0

VIII)Bio-medical Waste Management

Item MOV Score Waste a. Color coded buckets used 0 4 management b. Deep burial pit available where anatomical waste is disposed 0 8 points, 1 mark each c. Needle cutter in working condition 1 for each statement d. no mix of infectious or non-infectious waste done 0 Total: 8 marks e. waste bins not overfilled 1 f. needles and syringes mutilated and disinfected before putting in waste bin 1 g. metal sharps disposed in puncture proof containers 0 h. disposable gloves and masks not reused 1

IX) Central sterilization unit

MOV Score Autoclave a. Functioning autoclave 1 1 b. Usage of signalac tape ‘a’ carries 1 mark, c. usage of biological indicator d. swab test of sterile packs b / c / d (either) carries 1 mark

Total 2 marks

7 3 sets of linen per surgery per day. (Calculate average number of surgeries per Day )

X) Records and reports

XI) Finance

Head Number of mothers yet to receive the JSY money Score

RKS Full utilization of funds in 2009-10 0 2 Marks for each point JSY JSY payments not pending till last week of the visit 2 2x2=4

Appendix 1

Inspection scoring sheet for health facilities

Name of the inspecting officer: Pradeep Tandan

Date & time: 17 June 2010

District: Dhamtari

Facility : CHC Magarlod

Total marks: 120

Item Maximum Facility marks Score II. Infrastructure 34 10

e. Human Resource Self improvement score

IV. Services available (applicable for BPHCs and 33 14 above)

V. Services Out-Sourced 7 3

V) Equipments and supplies 10 7 VI)Equipments in Labour room 12 6 VII)Equipments in OT 7 4 VIII) Bio-medical Waste Management 8 4 IX) Central sterilization unit 2 1 X) Records and reports 3 2 XI) Finance 4 2 Total Score 120 53

Inspection format for health facilities

Name of the Consultant Pradeep Tandan State Chhattisgarh District Dhamtari Health Facility CHC Gujra Date and Time 18.06.2010 Time: 1:30 pm

II. Infrastructure

Item MOV Criteria Score Building a. Walls and floor and roof intact 1 4 condition b. Electrical wires not exposed 1 c. Electric switch boards not broken 1 7 points, d. Electric bulbs in wards / pathways / toilets 0 e. Whitewashed 1 Each statement f. Signage boards present 0 carries 1 marks g. Rooms not dumped with condemned articles 0 Total marks = 07 Condition of a. Mosquito screens present and devoid of holes 1 wards 0 b. Condemned articles not stored in the wards 0 (5 points × 1 marks c. window glasses not broken 0 = 5 marks) d. Door / Screens / Curtains / present for ensuring privacy of patient 0 e. Availability of ceiling fans in wards1

Condition of a. Doors are not damaged 0 0 toilets b. Floors are clean 0 (6 points × 1 = 6 c. Basins are not stained 0 marks) d. water taps not damaged 0 e. pathway is not dirty 0 f. Separate for male and female 0

Furniture a. Cots are not rusted, not broken 0 0 b. Mattress not worn out, cloth not torn, (2 points x 1 = 2 cotton/coir not coming out 0 marks)

Drainage a. Drainage system not clogged (1 point x 1 = 1) 0

b. Services available (applicable for BPHCs and above)

Sl.no Service Means of verification Score 1. 24 hour doctor available Duty roster, casualty register 0 2. 24 hour nurse available Duty roster, casualty register 2 9

services master register 0 9. Laboratory Services Equipments and reagents for conducting the tests are present, lab record shows tests are 11. Haemogram √ conducted 12. Sputum Examination√ 1 13. Lipid Profile× 14. × Hormone Assay Lab register 2 15. Urine Examination √

10. Availability of ECG Facility ECG machine available & working 0 11. X Ray Facility with X-ray X ray register – working status 0 Technician available 12. Ultrasound services USG register – working status 0 available 13. Ambulance Records of operation [Number of ambulances, average (if more than one ambulance) number of breakdowns in the last one week, number of drivers available per shift] maintained 2 1. Functional telephone Telephone number with dial tone 0 2 2. Adolescent sexual and OP register – number of adolescent 7 X 1= 7 reproductive health services beneficiaries 0 3. Whether fixed day antenatal ANC register 1 clinics are conducted 4. Whether fixed day RTI/STI OPD Register 1 clinics are conducted 5. Whether fixed day Register 0 sterilization clinics are conducted 6. Whether IEC material 0 displayed 7 Public Display of JSY 0 Beneficiaries

VI. Services Out-Sourced

Sl. Item Means of verification Score no 1. House a. Floor is cleaned with disinfectant on keeping the day of visit 0 1 b. rainbow linen color maintained 0 c. OT fumigated 1 Each statement carries 1 mark, total

2. Generator a. Generator in working condition with marks 7 designated horse power 0 b. Fuel for operation present 0

3. Food a. Food served to inpatients 0 b. Food chart for inpatients 0

V) Equipments and supplies

Sterilised gloves Sterilised gloves available 1 1 1mark if sterilised gloves are available Average number of OP Drug stock register 3 3 drugs available % availability estimated, (monthly) 100% availability gets 4 marks, 10% gets 1 mark Availability of life saving Availability of 1 2

77 drugs present Total 2 marks if all are a. Oxytocin × present, if not 0. b. Misoprostol × c. Magnesium Sulphate × d. IV antibiotics √

VIII. Equipments in Labour room

Equipment MOV Score 25. Spot light in labour room 0 5 26. Vacuum extractor 0

27. Resuscitation equipment for newborn – Bag and Instrument in working mask 1 condition (demonstrates) 28. Resuscitation equipment for newborn – Laryngoscope and full set of endo-tracheal tubes 0 1mark each 29. Baby resuscitation table with infant warmer 0 Total marks 12 30. Mucous sucker 1

31. Baby weighing machine 1 32. Partograph 0

33. Privacy in Labour room (curtains etc) 1

34. Toilet attached to Labour room 0

35. Protocols displayed: Active management of 3rd stage of labour (also check case sheets) 0

36. Labour board not rusted, not broken and not blood stained 1

VII)Equipments in OT

Equipments MOV score 15. Ceiling OT light/ Floor OT light (shadowless) 1 5 16. Oxygen cylinder 1

17. Boyles apparatus (only FRU) 0 1 mark each Total marks 7 18. Suction apparatus 1 19. Adequate quantity of linen8 1 20. Spinal anaesthesia set (FRU) 1 21. Ante room present 0

VIII)Bio-medical Waste Management

Item MOV Score Waste a. Color coded buckets used 0 1 management b. Deep burial pit available where anatomical waste is disposed 0 8 points, 1 c. Needle cutter in working condition 0 mark each for d. no mix of infectious or non-infectious

waste done 0 each statement e. waste bins not overfilled 0 f. needles and syringes mutilated and Total: 8 marks disinfected before putting in waste bin 0 g. metal sharps disposed in puncture proof containers 0 h. disposable gloves and masks not reused 1

IX) Central sterilization unit

MOV Score Autoclave a. Functioning autoclave 1 1 b. Usage of signalac tape ‘a’ carries 1 mark, c. usage of biological indicator

8 3 sets of linen per surgery per day. (Calculate average number of surgeries per Day )

d. swab test of sterile packs b / c / d (either) carries 1 mark

Total 2 marks

X) Records and reports

XI) Finance

Head Number of mothers yet to receive the JSY money Score

RKS Full utilization of funds in 2009-10 0 2 Marks for each point JSY JSY payments not pending till last week of the visit 2 2x2=4

Appendix 1

Inspection scoring sheet for health facilities

Name of the inspecting officer: Pradeep Tandan

Date & time: 17 June 2010

District: Dhamtari

Facility : CHC Gujra

Total marks: 120

Item Maximum Facility marks Score III. Infrastructure 34 10

e. Human Resource Self improvement score

V. Services available (applicable for BPHCs and 33 11 above)

VI. Services Out-Sourced 7 1

V) Equipments and supplies 10 7 VI)Equipments in Labour room 12 5 VII)Equipments in OT 7 5 VIII) Bio-medical Waste Management 8 1 IX) Central sterilization unit 2 1 X) Records and reports 3 1 XI) Finance 4 2 Total Score 120 44

Inspection format for health facilities

Name of the Consultant Pradeep Tandan State Chhattisgarh District Dhamtari Health Facility CHC Kurud Date and Time 18.06.2011 Time: 6 pm

a. Infrastructure

Water supply a. Running water available for 24 hours in Labour 6 room 2 (5 points × 2 marks b. Running water available for 24 hours in OT 2 = 10 marks) c. Running water available for 24 hours in Toilets 2 d. Purified drinking water available for drinking for patients in OP 0 e. Purified drinking water available for drinking for patients in IP 0

Condition of a. Doors are not damaged 1 3 toilets b. Floors are clean 0 (6 points × 1 = 6

c. Basins are not stained 0 marks) d. water taps not damaged 0 e. pathway is not dirty 1 f. Separate for male and female 1

Furniture a. Cots are not rusted, not broken 0 1 b. Mattress not worn out, cloth not torn, (2 points x 1 = 2 cotton/coir not coming out 1 marks)

Drainage a) Drainage system not clogged (1 point x 1 = 1) 1

IV. Services available (applicable for BPHCs and above)

Sl.no Service Means of verification Score 1. 24 hour doctor available Duty roster, casualty register 2 2. 24 hour nurse available Duty roster, casualty register 2 15

3. 24 hour delivery services Delivery register 2 Available available services get 2 4. 24 hour newborn care Delivery register, Paediatric ward register, mark each services available Immunization register 2 5. 24 hour caesarean services Delivery register 0 26 marks (if FRU) 6. Tubectomy services FP register 0 available 7. Safe abortion services MTP register 0 available 8. 24 hour blood transfusion Blood transfusion register / Blood bank services master register 0 9. Laboratory Services Equipments and reagents for conducting the

tests are present, lab record shows tests are 16. Haemogram √ conducted 17. Sputum Examination√ 1 18. Lipid Profile× 19. × Hormone Assay Lab register 2 20. Urine Examination √

10. Availability of ECG Facility ECG machine available & working 2 11. X Ray Facility with X-ray X ray register – working status 2 Technician available 12. Ultrasound services USG register – working status 0 available 13. Ambulance Records of operation [Number of ambulances, average (if more than one ambulance) number of breakdowns in the last one week, number of drivers available per shift] maintained 2 1. Functional telephone Telephone number with dial tone 1 6 2. Adolescent sexual and OP register – number of adolescent 7 X 1= 7 reproductive health services beneficiaries 0 3. Whether fixed day antenatal ANC register 1 clinics are conducted 4. Whether fixed day RTI/STI OPD Register 1 clinics are conducted 5. Whether fixed day Register 1 sterilization clinics are conducted 6. Whether IEC material 1 displayed 7 Public Display of JSY 1 Beneficiaries

VII. Services Out-Sourced

Sl. Item Means of verification Score no 1. House a. Floor is cleaned with disinfectant on keeping the day of visit 1 4 b. rainbow linen color maintained 0 c. OT fumigated 1 Each statement carries 1 mark, total marks 7 2. Generator a. Generator in working condition with designated horse power 1 b. Fuel for operation present 1

3. Food a. Food served to inpatients 0 b. Food chart for inpatients 0

V) Equipments and supplies

Item MOV condition Score Trolley a. In working condition1 b. Trolley without rust 3 1 Marks for each item, Wheelchair a. In working condition scored only if both b. Wheelchair without rust 1 conditions are satisfied = 3 marks Stretcher a. Stretcher without rust 1 b. not broken

e. IV antibiotics √

IX. Equipments in Labour room

Equipment MOV Score 37. Spot light in labour room 0 9 38. Vacuum extractor 0

39. Resuscitation equipment for newborn – Bag and Instrument in working mask 1 condition (demonstrates) 40. Resuscitation equipment for newborn – Laryngoscope and full set of endo-tracheal tubes 1 1mark each 41. Baby resuscitation table with infant warmer 1 Total marks 12 42. Mucous sucker 1

43. Baby weighing machine 1 44. Partograph 1

45. Privacy in Labour room (curtains etc) 1

46. Toilet attached to Labour room 1

47. Protocols displayed: Active management of 3rd stage of labour (also check case sheets) 0

48. Labour board not rusted, not broken and not blood stained 1

VII)Equipments in OT

Equipments MOV score 22. Ceiling OT light/ Floor OT light (shadowless) 1 6 23. Oxygen cylinder 1

24. Boyles apparatus (only FRU) 1 1 mark each Total marks 7 25. Suction apparatus 1 26. Adequate quantity of linen9 1 27. Spinal anaesthesia set (FRU) 1 28. Ante room present 0

VIII)Bio-medical Waste Management

Item MOV Score Waste f. Color coded buckets used 0 3 management g. Deep burial pit available where anatomical waste is disposed 0 8 points, 1 mark each h. Needle cutter in working condition 0 for each statement i. no mix of infectious or non-infectious waste done 0 Total: 8 marks j. waste bins not overfilled 1 k. needles and syringes mutilated and disinfected before putting in waste bin 1 l. metal sharps disposed in puncture proof containers 0 m. disposable gloves and masks not reused 1

IX) Central sterilization unit

MOV Score Autoclave e. Functioning autoclave 1 1

9 3 sets of linen per surgery per day. (Calculate average number of surgeries per Day )

f. Usage of signalac tape ‘a’ carries 1 mark, g. usage of biological indicator h. swab test of sterile packs b / c / d (either) carries 1 mark

Total 2 marks

X) Records and reports

XI) Finance

Head Number of mothers yet to receive the JSY money Score

RKS Full utilization of funds in 2009-10 0 2 Marks for each point JSY JSY payments not pending till last week of the visit 2 2x2=4

Appendix 1

Inspection scoring sheet for health facilities

Name of the inspecting officer: Pradeep Tandan

Date & time: 17 June 2010

District: Dhamtari

Facility : CHC Kurud

Total marks: 120

Item Maximum Facility marks Score V. Infrastructure 34 18

 Human Resource Self improvement score

VI. Services available (applicable for BPHCs and 33 21 above)

VII. Services Out-Sourced 7 4

V) Equipments and supplies 10 9 VI)Equipments in Labour room 12 9 VII)Equipments in OT 7 6 VIII) Bio-medical Waste Management 8 3 IX) Central sterilization unit 2 1 X) Records and reports 3 2 XI) Finance 4 2 Total Score 120 75

Inspection format for health facilities

Name of the Consultant Pradeep Tandan State Chhattisgarh District Dhamtari Health Facility CHC Nagri Date and Time 19.06.2010 Time: 12:30 pm

I. Infrastructure

Item MOV Criteria Score

Building a) Walls and floor and roof intact 1 2 condition b) Electrical wires not exposed 0 c) Electric switch boards not broken 0 7 points, d) Electric bulbs in wards / pathways / toilets 0 e) Whitewashed 1 Each statement carries f) Signage boards present 0 1 marks g) Rooms not dumped with condemned articles 0 Total marks = 07 Condition of a) Mosquito screens present and devoid of holes 0 2 wards b) Condemned articles not stored in the wards 0 c) window glasses not broken 1 (5 points × 1 marks = 5 d) Door / Screens / Curtains / present for ensuring marks) privacy of patient 0 e) Availability of ceiling fans in wards 1 Water supply a) Running water available for 24 hours in Labour 2 room 0 (5 points × 2 marks = b) Running water available for 24 hours in OT 0 10 marks) c) Running water available for 24 hours in Toilets 2 d) Purified drinking water available for drinking for patients in OP 0 e) Purified drinking water available for drinking for patients in IP 0 Condition of a) Doors are not damaged 1 2 toilets b) Floors are clean 0 (6 points × 1 = 6 marks) c) Basins are not stained 0 d) water taps not damaged 0 e) pathway is not dirty 0

f) Separate for male and female 1 Patient a) Seating arrangements are present in the OPD 2 amenities area 1 (3 points × 1 = 3marks) b) Stools or chairs for attendants in the wards present 0 c) Inpatients are provided with blankets in winter 1

Furniture a) Cots are not rusted, not broken 0 0 b) Mattress not worn out, cloth not torn, cotton/coir (2 points x 1 = 2 marks) not coming out 0

Drainage a) Drainage system not clogged 0 (1 point x 1 = 1) 0

II. Services available (applicable for BPHCs and above)

Sl.no Service Means of verification Score 1. 24 hour doctor available Duty roster, casualty register 2 2. 24 hour nurse available Duty roster, casualty register 2 15

3. 24 hour delivery services Delivery register 2 Available available services get 2 4. 24 hour newborn care Delivery register, Paediatric ward register, mark each services available Immunization register 0 5. 24 hour caesarean services Delivery register 0 26 marks (if FRU) 6. Tubectomy services FP register 2 available 7. Safe abortion services MTP register 0 available 8. 24 hour blood transfusion Blood transfusion register / Blood bank services master register 0 9. Laboratory Services Equipments and reagents for conducting the tests are present, lab record shows tests are 21. Haemogram √ conducted 22. Sputum Examination√ 1 23. Lipid Profile×

24. Hormone Assay × Lab register 2 25. Urine Examination √

10. Availability of ECG Facility ECG machine available & working 0 11. X Ray Facility with X-ray X ray register – working status 2 Technician available 12. Ultrasound services USG register – working status 0 available 13. Ambulance Records of operation [Number of ambulances, average (if more than one ambulance) number of breakdowns in the last one week, number of drivers available per shift] maintained 2 1. Functional telephone Telephone number with dial tone 1 4 2. Adolescent sexual and OP register – number of adolescent 7 X 1= 7 reproductive health services beneficiaries 0 3. Whether fixed day antenatal ANC register 1 clinics are conducted 4. Whether fixed day RTI/STI OPD Register 1 clinics are conducted 5. Whether fixed day Register 1 sterilization clinics are conducted 6. Whether IEC material 0 displayed 7 Public Display of JSY 0 Beneficiaries

VIII. Services Out-Sourced

Sl. Item Means of verification Score no 1. House b) Floor is cleaned with disinfectant on the day of keeping visit 1 3 c) rainbow linen color maintained 0 d) OT fumigated 0 Each statement 2. Generator a) Generator in working condition with designated carries 1 mark, horse power 1 total marks 7 b) Fuel for operation present 1 3. Food i. Food served to inpatients 0 ii. Food chart for inpatients 0

V) Equipments and supplies

Item MOV condition Score Trolley a) In working condition1 b) Trolley without rust 2 1 Marks for each item, Wheelchair a) In working condition scored only if both b) Wheelchair without rust conditions are satisfied = 3 marks Stretcher a) Stretcher without rust 1 b) not broken

d) IV antibiotics √

X. Equipments in Labour room

Equipment MOV Score 49. Spot light in labour room 0 6 50. Vacuum extractor 1

51. Resuscitation equipment for newborn – Bag and Instrument in working mask 1 condition (demonstrates) 52. Resuscitation equipment for newborn – Laryngoscope and full set of endo-tracheal tubes 0 1mark each 53. Baby resuscitation table with infant warmer 1 Total marks 12 54. Mucous sucker 0

55. Baby weighing machine 1 56. Partograph 0

57. Privacy in Labour room (curtains etc) 1

58. Toilet attached to Labour room 0

59. Protocols displayed: Active management of 3rd stage of labour (also check case sheets) 0

60. Labour board not rusted, not broken and not blood stained 1

VII)Equipments in OT

Equipments MOV score 29. Ceiling OT light/ Floor OT light (shadowless) 0 2 30. Oxygen cylinder 1

31. Boyles apparatus (only FRU) 0 1 mark each Total marks 7 32. Suction apparatus 0 33. Adequate quantity of linen10 1 34. Spinal anaesthesia set (FRU) 0 35. Ante room present 0

VIII)Bio-medical Waste Management

Item MOV Score Waste a) Color coded buckets used 0 3 management b) Deep burial pit available where anatomical waste is disposed 0 8 points, 1 mark each c) Needle cutter in working condition 1 for each statement d) no mix of infectious or non-infectious waste done 0 Total: 8 marks e) waste bins not overfilled 0 f) needles and syringes mutilated and disinfected before putting in waste bin 1 g) metal sharps disposed in puncture proof containers 0 h) disposable gloves and masks not reused 1

IX) Central sterilization unit

MOV Score Autoclave i. Functioning autoclave 1 1 j. Usage of signalac tape ‘a’ carries 1 mark, k. usage of biological indicator

10 3 sets of linen per surgery per day. (Calculate average number of surgeries per Day )

l. swab test of sterile packs b / c / d (either) carries 1 mark

Total 2 marks

X) Records and reports

XI) Finance

Head Number of mothers yet to receive the JSY money Score

RKS Full utilization of funds in 2009-10 0 2 Marks for each point JSY JSY payments not pending till last week of the visit 2 2x2=4

Appendix 1

Inspection scoring sheet for health facilities

Name of the inspecting officer: Pradeep Tandan

Date & time: 17 June 2010

District: Dhamtari

Facility : CHC Nagri

Total marks: 120

Item Maximum Facility marks Score Infrastructure 34 10 c) Human Resource Self improvement score

VII. Services available (applicable for BPHCs 33 19 and above)

VIII. Services Out-Sourced 7 3

V) Equipments and supplies 10 7 VI)Equipments in Labour room 12 6 VII)Equipments in OT 7 2 VIII) Bio-medical Waste Management 8 3 IX) Central sterilization unit 2 1 X) Records and reports 3 2 XI) Finance 4 2 Total Score 120 55

Inspection format for health facilities

Name of the Consultant Pradeep Tandan State Chhattisgarh District Dhamtari Health Facility Bhatgaon PHC Date and Time 17.06.201 Time: 02:30 pm Doctors MBBS :1 RMA:1 Nurses - ANMs 1 SBA/SAB trained 1 No of Beds 6 MCH Beds -

b. Infrastructure

Item MOV Criteria Score Building a) Walls and floor and roof intact (1) condition b) Electrical wires not exposed (1) (4/7) c) Electric switch boards not broken (1) d) Electric bulbs in wards / pathways / toilets (0) e) Whitewashed (1) f) Signage boards present (0) g) Rooms not dumped with condemned articles (0)

Condition of a) Mosquito screens present and devoid of holes (0) (2/5) wards b) Condemned articles not stored in the wards (0) c) window glasses not broken (0) d) Door / Screens / Curtains / present for ensuring privacy of patient (1) e) Availability of ceiling fans in wards (1)

Water supply a) Running water available for 24 hours in Labour room (2) b) Running water available for 24 hours in OT (0) (4/10) c) Running water available for 24 hours in Toilets(2) d) Purified drinking water available for drinking for patients in OP (0) e) Purified drinking water available for drinking for patients in IP

(0)

Condition of a) Doors are not damaged (0) toilets b) Floors are clean (0) (1/6) c) Basins are not stained (0) d) water taps not damaged (0) e) pathway is not dirty (0) f) Separate for male and female (1)

Patient amenities a) Seating arrangements are present in the OPD area (1) b) Stools or chairs for attendants in the wards present (1) (3 /3) c) Inpatients are provided with blankets in winter (1)

Furniture a) Cots are not rusted, not broken (1) b) Mattress not worn out, cloth not torn, cotton/coir not coming out (0) (1/ 2)

Drainage a) Drainage system not clogged (0) (0/1)

c. Human Resource (Self improvement score)

Staff performance Baseline data (1st Subsequent visit survey) * (monthly figure ) % improvement Number of deliveries conducted per SBA Data not available Number of OP cases per doctor Data not available Bed occupancy rate* - Number of CS per Obstetrician - Number of cataract operations per - ophthalmologist Chest symptomatic sputum population - examination rate Minor surgeries per doctor - Antenatal care severely anaemic (under 7 gm%) Data not available managed rate IUD insertions per trained nurse MTP services per trained doctor -

o Indicative column; subsequent visits (2nd, 3rd etc. Would be scored on improvement and in a fresh inspection form) o Bed occupancy rate=(inpatient days of care/bed days available)×100

d. Services available (applicable for BPHCs and above)

Sl.no Service Means of verification Score 1. 24 hour doctor available (0) Duty roster, casuality register 2. 24 hour nurse available (2) Duty roster, casuality register

3. 24 hour delivery services Delivery register available (2) 4/12 4. 24 hour newborn care services Delivery register, Paediatric ward register, available (0) Immunization register 5. 24 hour caesarean services (if Delivery register FRU) 6. Tubectomy services available FP register 7. Safe abortion services MTP register available 8. 24 hour blood transfusion Blood transfusion register / Blood bank master services register 9. Laboratory Services (0) Equipments and reagents for conducting the tests are present, lab record shows tests are conducted 26. Haemogram 27. Sputum Examination Lab register 28. Lipid Profile 29. Hormone Assay 30. Urine Examination

10. Availability of ECG Facility ECG machine available & working 11. X Ray Facility with X-ray X ray register – working status Technician available 12. Ultrasound services available USG register – working status

100

2. Adolescent sexual and OP register – number of adolescent beneficiaries (1/7) reproductive health services (0) 3. Whether fixed day antenatal ANC register clinics are conducted (1) 4. Whether fixed day RTI/STI OPD Register clinics are conducted (0) 5. Whether fixed day Register sterilization clinics are conducted (0) 6. Whether IEC material displayed (0) 7 Public Display of JSY (0) Beneficiaries

e. Services Out-Sourced

Sl. Item Means of verification Score no 1. House a) Floor is cleaned with disinfectant on the day of visit (1) keeping b) rainbow linen colour maintained (0) c) OT fumigated (1/ 7) 2. Generator a) Generator in working condition with designated horse power (0) b) Fuel for operation present (0)

3. Food a) Food served to inpatients (0) b) Food chart for inpatients (0)

f. Equipments and supplies

Item MOV condition Score Trolley a) In working condition

101

b) Trolley without rust(1) (2/3 ) Wheelchair a) In working condition b) Wheelchair without rust (0)

Stretcher a) Stretcher without rust b) not broken (1)

Sterilised gloves Sterilised gloves available 1 mark if sterilised gloves are (1) available Average number of OP Drug stock register (3) % availability estimated, 100% drugs available (monthly) availability gets 4 marks, 10% gets 1 mark Availability of life saving Availability of; (1) Total 2 marks if all are present, if not drugs present 0. n. Oxytocin o. Misoprostol p. Magnesium Sulphate × q. IV antibiotics

a. Equipments in Labour room

Equipment MOV Score 61. Spot light in labour room (0) 62. Vacuum extractor (0)

63. Resuscitation equipment for newborn – Bag and Instrument in working mask (0) condition (demonstrates) 64. Resuscitation equipment for newborn – Laryngoscope and full set of endo-tracheal tubes (4/ 12) 65. Baby resuscitation table with infant warmer (0) 66. Mucous sucker (0) 67. Baby weighing machine (1) 68. Partograph (0)

102

69. Privacy in Labour room (curtains etc) (0)

70. Toilet attached to Labour room (1)

71. Protocols displayed: Active management of 3rd stage of labour (also check case sheets) (0)

72. Labour board not rusted, not broken and not blood stained (1)

b. Equipments in OT

Equipments MOV score 36. Ceiling OT light/ Floor OT light (shadowless) 1 mark each Total marks 7 37. Oxygen cylinder 38. Boyles apparatus (only FRU) 39. Suction apparatus 40. Adequate quantity of linen11 41. Spinal anaesthesia set (FRU) 42. Ante room present

c. Bio-Medical Waste Management

Item MOV Score Waste a) Colour coded buckets used (0) (2/8) management b) Deep burial pit available where anatomical waste is disposed (0) c) Needle cutter in working condition (0) d) no mix of infectious or non-infectious waste done (0) e) waste bins not overfilled (1) f) needles and syringes mutilated and disinfected before putting in waste bin (0) g) metal sharps disposed in puncture proof containers (0) h) disposable gloves and masks not reused (1)

11 3 sets of linen per surgery per day. (Calculate average number of surgeries per Day )

103

d. Central sterilization unit MOV Score Autoclave a) Functioning autoclave (1) (1/ 2) b) Usage of signalac tape c) usage of biological indicator d) swab test of sterile packs

e. Records and reports Item MOV score Separate column (in delivery register) for recording major complications leading to maternal death Delivery register mentions about the details of the baby and condition of the (2/ 3) mother (1) Referral slips are issued to patients (1)

f. Finance Head Number of mothers yet to receive the JSY money Score

RKS Full utilization of funds in 2009-10 (0) 2/4 JSY JSY payments not pending till last week of the visit (2)

104

Appendix 1

Inspection scoring sheet for health facilities

Name of the Consultant: Pradeep Tandan

Date & Time : 18.06.2010, 10:30a.m.

District: Dhamtari

Total marks: 105

Name of Facility (APHC/BPHC /Referral/ SD/Sadar): PHC Bhatgaon

Item Maximum Facility marks Score I. Infrastructure 34 14

II. Human Resource Self improvement score

III. Services available (applicable for BPHCs 19 5 and above)

IV. Services Out-Sourced 6 1

V. Equipments and supplies 10 7 VI. Equipments in Labour room 12 4 VII. Equipments in OT - - VIII. Bio-medical Waste Management 8 2 IX. Central sterilization unit 2 1 X. Records and reports 3 2 XI. Finance 4 2 Total Score 96 40

105

Inspection format for health facilities

Name of the Consultant Pradeep Tandan State Chhattisgarh District Dhamtari Health Facility Kareli (bodi) PHC Date and Time 17.06.201 Time: 02:30 pm Doctors RMA:1 Nurses 1 ANMs 1 SBA/SAB trained 1 No of Beds 6 MCH Beds -

g. Infrastructure

Item MOV Criteria Score Building h) Walls and floor and roof intact (1) condition i) Electrical wires not exposed (1) (4/7) j) Electric switch boards not broken (1) k) Electric bulbs in wards / pathways / toilets (0) l) Whitewashed (1) m) Signage boards present (0)

106

n) Rooms not dumped with condemned articles (0)

Condition of f) Mosquito screens present and devoid of holes (0) (2/5) wards g) Condemned articles not stored in the wards (0) h) window glasses not broken (0) i) Door / Screens / Curtains / present for ensuring privacy of patient (1) j) Availability of ceiling fans in wards (1)

Water supply f) Running water available for 24 hours in Labour room (0) g) Running water available for 24 hours in OT (0) (4/10) h) Running water available for 24 hours in Toilets(0) i) Purified drinking water available for drinking for patients in OP (2) j) Purified drinking water available for drinking for patients in IP (2)

Condition of g) Doors are not damaged (1) toilets h) Floors are clean (1) (4/6) i) Basins are not stained (0) j) water taps not damaged (0) k) pathway is not dirty (1) l) Separate for male and female (1)

Patient amenities d) Seating arrangements are present in the OPD area (1) e) Stools or chairs for attendants in the wards present (0) (3 /3) f) Inpatients are provided with blankets in winter (1)

Furniture c) Cots are not rusted, not broken (1) d) Mattress not worn out, cloth not torn, cotton/coir not coming out (1) (2/ 2)

Drainage b) Drainage system not clogged (0) (0/1)

h. Human Resource (Self improvement score)

Staff performance Baseline data (1st Subsequent visit survey) * (monthly figure ) % improvement Number of deliveries conducted per SBA Data not available

107

Number of OP cases per doctor Data not available Bed occupancy rate* - Number of CS per Obstetrician - Number of cataract operations per - ophthalmologist Chest symptomatic sputum population - examination rate Minor surgeries per doctor - Antenatal care severely anaemic (under 7 gm%) Data not available managed rate IUD insertions per trained nurse MTP services per trained doctor -

o Indicative column; subsequent visits (2nd, 3rd etc. Would be scored on improvement and in a fresh inspection form) o Bed occupancy rate=(inpatient days of care/bed days available)×100

i. Services available (applicable for BPHCs and above)

Sl.no Service Means of verification Score 1. 24 hour doctor available (0) Duty roster, casuality register 2. 24 hour nurse available (2) Duty roster, casuality register 3. 24 hour delivery services Delivery register available (2) 4/12 4. 24 hour newborn care services Delivery register, Paediatric ward register, available (0) Immunization register 5. 24 hour caesarean services (if Delivery register FRU) 6. Tubectomy services available FP register 7. Safe abortion services MTP register available 8. 24 hour blood transfusion Blood transfusion register / Blood bank master services register 9. Laboratory Services (0) Equipments and reagents for conducting the tests are present, lab record shows tests are conducted 31. Haemogram 32. Sputum Examination Lab register 33. Lipid Profile

108

34. Hormone Assay 35. Urine Examination

13. Ambulance (0) Records of operation [Number of ambulances, average (if more than one ambulance) number of breakdowns in the last one week, number of drivers available per shift] maintained 1. Functional telephone (1) Telephone number with dial tone 2. Adolescent sexual and OP register – number of adolescent beneficiaries (1/7) reproductive health services (0) 3. Whether fixed day antenatal ANC register clinics are conducted (1) 4. Whether fixed day RTI/STI OPD Register clinics are conducted (0) 5. Whether fixed day Register sterilization clinics are conducted (0) 6. Whether IEC material displayed (0) 7 Public Display of JSY (0) Beneficiaries

j. Services Out-Sourced

Sl. Item Means of verification Score no 1. House d) Floor is cleaned with disinfectant on the day of visit (1) keeping e) rainbow linen colour maintained (0) f) OT fumigated

109

2. Generator c) Generator in working condition with designated horse power (1/ 6) (0) d) Fuel for operation present (0)

3. Food c) Food served to inpatients (0) d) Food chart for inpatients (0)

k. Equipments and supplies

Item MOV condition Score Trolley c) In working condition d) Trolley without rust(1) (2/3 ) Wheelchair c) In working condition d) Wheelchair without rust (1)

Stretcher c) Stretcher without rust d) not broken (1)

Sterilised gloves Sterilised gloves available 1 mark if sterilised gloves are (1) available Average number of OP Drug stock register (3) % availability estimated, 100% drugs available (monthly) availability gets 4 marks, 10% gets 1 mark Availability of life saving Availability of; (1) Total 2 marks if all are present, if not drugs present 0. r. Oxytocin s. Misoprostol t. Magnesium Sulphate × u. IV antibiotics ×

a. Equipments in Labour room

Equipment MOV Score

110

73. Spot light in labour room (0) 74. Vacuum extractor (0)

75. Resuscitation equipment for newborn – Bag and Instrument in working mask (0) condition (demonstrates) 76. Resuscitation equipment for newborn – Laryngoscope and full set of endo-tracheal tubes (0) (5/ 12) 77. Baby resuscitation table with infant warmer (1) 78. Mucous sucker (1) 79. Baby weighing machine (1) 80. Partograph (0)

81. Privacy in Labour room (curtains etc) (0)

82. Toilet attached to Labour room (1)

83. Protocols displayed: Active management of 3rd stage of labour (also check case sheets) (0)

84. Labour board not rusted, not broken and not blood stained (1)

b. Equipments in OT

Equipments MOV score 43. Ceiling OT light/ Floor OT light (shadowless) 1 mark each Total marks 7 44. Oxygen cylinder 45. Boyles apparatus (only FRU) 46. Suction apparatus 47. Adequate quantity of linen12 48. Spinal anaesthesia set (FRU) 49. Ante room present

12 3 sets of linen per surgery per day. (Calculate average number of surgeries per Day )

111

c. Bio-Medical Waste Management

Item MOV Score Waste i) Colour coded buckets used (0) (4/8) management j) Deep burial pit available where anatomical waste is disposed (0) k) Needle cutter in working condition (1) l) no mix of infectious or non-infectious waste done (0) m) waste bins not overfilled (1) n) needles and syringes mutilated and disinfected before putting in waste bin (1) o) metal sharps disposed in puncture proof containers (0) p) disposable gloves and masks not reused (1)

d. Central sterilization unit MOV Score Autoclave e) Functioning autoclave (1) (1/ 2) f) Usage of signalac tape g) usage of biological indicator h) swab test of sterile packs

e. Records and reports Item MOV score Separate column (in delivery register) for recording major complications leading to maternal death Delivery register mentions about the details of the baby and condition of the (1/ 3) mother (1) Referral slips are issued to patients (0)

f. Finance Head Number of mothers yet to receive the JSY money Score

RKS Full utilization of funds in 2009-10 (0) 2/4

112

JSY JSY payments not pending till last week of the visit (2)

Appendix 1

Inspection scoring sheet for health facilities

Name of the Consultant: Pradeep Tandan

Date & Time : 18.06.2010, 10:30p.m.

District: Dhamtari

Total marks: 105

Name of Facility (APHC/BPHC /Referral/ SD/Sadar): PHC Karali (Bodi)

Item Maximum Facility marks Score XII. Infrastructure 34 19

XIII. Human Resource Self improvement score

XIV. Services available (applicable for BPHCs 19 5 and above)

XV. Services Out-Sourced 6 1

XVI. Equipments and supplies 10 7 XVII. Equipments in Labour room 12 5 XVIII. Equipments in OT - - XIX. Bio-medical Waste Management 8 4 XX. Central sterilization unit 2 1 XXI. Records and reports 3 1

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XXII. Finance 4 2 Total Score 96 45

Inspection format for SHCs

Name of the inspecting officer: Pradeep Tandan

Date & time: 19.06.2010,

District: Dhamtari

Total marks: 94

Location of Facility: SHC Kukrel

Building: Govt.

Stay in the SHC – Yes

SBA trained Yes Conduct deliveries in the HSC / Supervised deliveries at home/ both (√)

Electricity : Available

Item MOV Criteria Score Building condition a) Walls and floor and roof intact (2) (17/19) b) Electrical wires not exposed (2) c) Electric switch boards not broken (2) d) Whitewashed (2) e) overhead tank and running water available (0) f) electricity available (2) g) floor is clean on the day of visit (2) h) ANM stay in the SHC (5)

114

Item MOV Criteria Score Condition of toilets a) Doors are not damaged (0) b) Floors are clean & Basins are not (0/7) stained (0) c) Running water present (0) Services & performance a) Services offered and timings a gets 10 marks displayed (0) b to k 10 points, 2 marks b) Pregnant women and infant tracking for each register maintained (0) c) Micro plan for VHNDs available; at least 90% of planned VHNDs held in l and m gets 10 marks the last quarter (2) each d) Nischay kit available (2) e) Kit A and B available* (2) n and o gets 5 marks each f) Delivery kit available (at least 2) (2) p gets 2 marks g) Weighing machine (mother / baby) Total – 62 marks and BP apparatus (and stethoscope) available (2) h) Hb estimations done (0) i) Male worker present (0) j) Records of vector control activities undertaken present (spraying, blood slides etc.) (2) k) HMIS/IDSP formats getting reported (2) l) ANM stays in the SHC (10) m) SHC conducts deliveries (10) n) The ANM is SBA trained (5) o) 2nd ANM present (0) p) Immunization cards updated (2) Biomedical Waste a) Colour coded buckets used (0)

115

Item MOV Criteria Score Management b) Deep burial pit available where (2/6) anatomical waste is disposed (if the SHC conducts deliveries) (0) c) Needle cutter in working condition (2) *Look for paracetamol and cotrimoxazole

Qualitative responses ( elaborated in the report )

Appendix 1

Inspection scoring sheet for health facilities

Name of the inspecting officer: Pradeep Tandan

Date & time: 19.06.2010, 11:30a.m.

District: Dhamtri Total marks: 94

Location of Facility: SHC Kukrel

Item Maximum score SHC score

Building condition 19 17

Condition of toilets 7 0

Services & performance 62 41

Biomedical Waste Management 6 2

Total Score 94 60

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Inspection format for SHCs

Name of the inspecting officer: Pradeep Tandan

Date & time: 19.06.2010,

District: Dhamtari

Total marks: 94

Location of Facility: SHC Gajkhanhar

Building: Govt.

Stay in the SHC – Yes

SBA trained No Conduct deliveries in the HSC / Supervised deliveries at home (√ )

Electricity : Not Available

Item MOV Criteria Score Building condition i) Walls and floor and roof intact (2) (11/15) j) Electrical wires not exposed (0) k) Electric switch boards not broken (0) l) Whitewashed (2) o) overhead tank and running water available (0) p) electricity available (0)

117

Item MOV Criteria Score q) floor is clean on the day of visit (2) r) ANM stay in the SHC (5) Condition of toilets d) Doors are not damaged (2) e) Floors are clean & Basins are not (4/7) stained (2) f) Running water present (0) Services & performance q) Services offered and timings a gets 10 marks displayed (0) b to k 10 points, 2 marks r) Pregnant women and infant tracking for each register maintained (2) s) Micro plan for VHNDs available; at least 90% of planned VHNDs held in l and m gets 10 marks the last quarter (2) each t) Nischay kit available (2) u) Kit A and B available* (2) n and o gets 5 marks each v) Delivery kit available (at least 2) (2) p gets 2 marks w) Weighing machine (mother / baby) Total – 62 marks and BP apparatus (and stethoscope) available (2) x) Hb estimations done (0) y) Male worker present (0) z) Records of vector control activities undertaken present (spraying, blood slides etc.) (2) aa) HMIS/IDSP formats getting reported (2) bb) ANM stays in the SHC (10) cc) SHC conducts deliveries (0) dd) The ANM is SBA trained (0) ee) 2nd ANM present (0)

118

Item MOV Criteria Score ff) Immunization cards updated (2) Biomedical Waste d) Colour coded buckets used (0) Management e) Deep burial pit available where (2/6) anatomical waste is disposed (if the SHC conducts deliveries) (0) f) Needle cutter in working condition (2) *Look for paracetamol and cotrimoxazole

Qualitative responses ( elaborated in the report )

Appendix 1

Inspection scoring sheet for health facilities

Name of the inspecting officer: Pradeep Tandan

Date & time: 19.06.2010, 11:30p.m.

District: Dhamtri Total marks: 94

Location of Facility: SHC GajKanhar

Item Maximum score SHC score

Building condition 15 11

Condition of toilets 7 4

Services & performance 62 28

Biomedical Waste Management 6 2

Total Score 90 45

119

Inspection format for SHCs

Name of the inspecting officer: Pradeep Tandan

Date & time: 19.06.2010,

District: Dhamtari

Total marks: 94

Location of Facility: SHC Bandha

Building: Govt.

Stay in the SHC – Yes

SBA trained Yes Conduct deliveries in the HSC / Supervised deliveries at home/Both (√ )

Electricity : Available

Item MOV Criteria Score

Building condition m) Walls and floor and roof intact (17/19) (2) n) Electrical wires not exposed (0) o) Electric switch boards not broken (2)

120

Item MOV Criteria Score

p) Whitewashed (2) s) overhead tank and running water available (2) t) electricity available (2) u) floor is clean on the day of visit (2) v) ANM stay in the SHC (5) Condition of toilets g) Doors are not damaged (2) h) Floors are clean & Basins are not (7/7) stained (2) i) Running water present (3) Services & performance gg) Services offered and timings a gets 10 marks displayed (2) b to k 10 points, 2 marks hh) Pregnant women and infant for each tracking register maintained (2) ii) Micro plan for VHNDs available; at least 90% of planned VHNDs held in l and m gets 10 marks the last quarter (2) each jj) Nischay kit available (2) kk) Kit A and B available* (2) n and o gets 5 marks each ll) Delivery kit available (at least 2) (2) p gets 2 marks mm) Weighing machine (mother / Total – 62 marks baby) and BP apparatus (and stethoscope) available (2) nn) Hb estimations done (0) oo) Male worker present (0) pp) Records of vector control activities undertaken present (spraying, blood slides etc.) (2) qq) HMIS/IDSP formats getting

121

Item MOV Criteria Score

reported (2) rr) ANM stays in the SHC (10) ss) SHC conducts deliveries (10) tt) The ANM is SBA trained (5) uu) 2nd ANM present (0) vv) Immunization cards updated (2) Biomedical Waste g) Colour coded buckets used (0) Management h) Deep burial pit available where (2/6) anatomical waste is disposed (if the SHC conducts deliveries) (0) i) Needle cutter in working condition (2) *Look for paracetamol and cotrimoxazole

Qualitative responses ( elaborated in the report )

Appendix 1

Inspection scoring sheet for health facilities

Name of the inspecting officer: Pradeep Tandan

Date & time: 19.06.2010, 11:30p.m.

District: Dhamtri Total marks: 94

Location of Facility: SHC GajKanhar

Item Maximum score SHC score

Building condition 19 17

122

Condition of toilets 7 7

Services & performance 62 45

Biomedical Waste Management 6 2

Total Score 94 71

123