Jharkhand Monitoring Visit Report Period: Fourth Quarter
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Latehar Jharkhand Monitoring Visit Report DR NAVNEET Period: Fourth Quarter (January to March-2013) RANJAN CONSULTANT - PHP,NHSRC 30/04/2013 Page 1 of 48 Abbreviations ANC Ante Natal Care ACMO Additional Chief Medical Officer ANM Auxiliary Nurse Midwife AMG Annual Maintenance Grant AYUSH Ayurveda Yoga Unani Siddha Homeopathy BSU Blood Storage Unit BEmOC Basic Emergency Obstetric Care CEmOC Comprehensive Emergency Obstetric Care CHC Community Health Center CMO Chief Medical Officer CS / C-section Caesarean Section DF Deep Freezer DH District Hospital DHAP District Health Action Plan DMO District Malaria Officer DP Delivery Points DPM District Programme Manager DPMU District Programme Management Unit EMRI Emergency Medical Research Institute FRU First Referral Unit HMIS Health Management Information System I/C In-charge IFA Iron Folic Acid IPD In-patient IEC / BCC Information Education communication / Behaviour Change Communication IUD Intra Uterine Device ILR Ice Line Refrigerator JSY Janani Suraksha Yojana LHV Lady Health Visitor LSAS Life Saving Anaesthesia Skills MCTS Mother & Child Tracking System MTC Malnutrition Treatment Centre NBCC New Born Care Corner NRHM National Rural Health Mission NSSK Navjat Shishu Suraksha Karyakram OBGY Obstetric and Gynaecologist ORS Oral Rehydration Salt PNC Post Natal Care PPP Public Private Partnership PPS Post Partum Sterilisation PW Pregnant Woman RIMS Rajendra Institute of medical sciences SC Sub Center SN Staff Nurse SNCU Sick Newborn Care Unit SAM Severely Acute Malnourishment VHND Village Health & Nutrition Day VHSC Village Health & Sanitation Committee Page 2 of 48 Executive Summary The Fourth quarter monitoringreport for Jharkhand is based on the HMIS data of the state and a field visit to Latehar. The visit was conducted during 02nd -05th April 2013. This visit was carried out by a team with representatives from NHSRC, New Delhi, Govt. of Jharkhand and District health officials with an objective to review the progress of NRHM/RCH program including, implementation of JSSK scheme. Maternal health: Maternal Mortality Ratio (MMR) has been reduced from 312 (SRS 04-06) to 261 (SRS 07-09). However it is higher than the National average of 212 maternal deaths per 100,000 live births (SRS 2007-09). Institutional arrangement: The state has 23 DH, 188 CHC, 330 PHC, and 3958 SC to cater the health care needs of 32,966,238 people. In the visited district 19 sub centers, 3 PHC, 6CHC and district hospital are prioritized for RCH services. The civil works for 2 sub centers are undergoing. In Chandawa block-the building of Laharsi PHC is completed but not yet notified as PHC. Health Service delivery indicators: As per HMIS (2012-13) ANC3 coverage in the district is 71% However, only 40% pregnant women received IFA tablets. The shortage of IFA tablets was also observed during the district visit. No record of hemoglobin levels of pregnant women was maintained to identify high risk pregnancies (anaemic). 47% deliveries are institutional and equal number are home deliveries. Only 1.7% deliveries are identified as complicated and most of them are attended at district hospital. The DH started conducting C-sections after the establishment of blood bank. The post natal care is poor as only few PW remain stayed at facility. Only district hospital was found to be providing safe abortion services and that too to a very small number of clients. JSY: JSY payments are made through bearer cheques to the beneficiaries. List of JSY beneficiaries was available at facility. HMIS 2012-13 statistics shows 88% mothers of reported institutional deliveries received JSY payment. Maternal Death Review: Total 450 maternal deaths were reported in the state of Jharkhand. The review highlighted severe hypertension(31%),Bleeding(24%) and Obstructed/prolonged labour(24%) are the leading cause of maternal deaths. In Latehar total 5 deaths were reported, which were all were reviewed. Page 3 of 48 Janani-Shishu Suraksha Karyakram (JSSK): The level of awareness about cashless services for pregnant women and sick infants was found very low. Although signage for JSSK was displayed at facilities visited. OPD,IPD and diagnostic services are free across the facilities visited. The prescribed drugs are ensured free of cost to most of the beneficiaries, however few beneficiaries reported to have incurred OOPs on purchasing medicine from private pharmacy . Free diet is available up to CHC level. Nearly 40% of the interviewed women used Mamta Vahan to reach the facility, while remaining came by hired or personal vehicles. Informal payments to avail the medical services were also reported by beneficiaries There No robust mechanism for redressal of grievances exists in facilities visited. Human Resources: Total 28 positions of doctor/specialist are lying vacant in the district. The position of District Malaria officer, District Filaria officer and District Leprosy officer is vacant. One paediatrician and two gynaecologists under regular employment are in position at Balumath CHC and district hospital respectively. However there is no anaesthetist available in the district. Two and three MOs are trained in LSAS and EmOC respectively, while 53 SN/ANM are SBA trained Child Health: In Latehar district 9 NBCC are present but no NBSU and SNCUs are available. A six bedded NBSU for DH was approved in FY 2012-13 but not yet to be operationalised. There is an urgent need to operationalise NBSU with appropriate human resources in DH to improve newborn survival. Immunization: As per HMIS analysis (Apr’12-Mar’13) fully immunized against estimated live births was 74%, very close to the last year’s figure (73%). Malnutrition Treatment Centre (MTC): There are 3 MTC established in the district. At Chandawa, a 6 bedded NRC was functional, however only 50% beds were occupied. There is 1 doctor and 3 ANMs deployed at this NRC. So far there were 267 admissions,out of whch 245 were discharged, 7 readmitted, 9 referred and 21 were LAMA cases. At district hospital only 4 children were admitted against the 15 beds. The utilization of MTCs is poor. There is need to sensitize the community about malnutrition and improved convergence of ASHA and AWW for identification and referral of SAM cases. Family Planning: As per HMIS (2012-13) sterilization (34% of all methods) is the most accepted method of family planning.. Page 4 of 48 There is need to improve the uptake ofspacing methods like IUD and PPIUD. IEC related to family planning seems to be neglected. Outreach Services: Out of 4 MMUs, 3 are functional in the district to cover 7 blocks. They are run and managed by NGOs under PPP. There is need to monitor and analyze the performance of MMU. Proactive involvement of ASHA and ANMs is required for effective utilization of MMU. School Health program (SHP): Total 466 schools have been covered so far under SHP. Out of 187,074 students 154,637 have been screened and 27,020 health cards distributed. Adolescent Reproductive and Sexual Health (ARSH): There are 7 ARSH clinics established in the district and all are functional. Every six months kishori Swasthya Pakhwara is being observed. During these periods special focus is given to identify severely anaemic adolescent girl and their further management. ASHA There are 1325 ASHAs in position in the district. During the visit Round one training of module 6 was undergoing. District has distributed drug kits to all ASHAs however, many ASHAs complaint about not refilling of drug kit. Shayiya Helpdesk was functional at district hospital and Manika CHC. This helpdesk also redress grievances of patient Disease Control Program; Status of NPCDCS: The NPCDCS program was piloted in Bokaro in year 2010-11 andscaled up to two more districts i.e. Ranchi and Dhanbad next year. The screening statistics shows that proportion of suspected hypertension cases (6. 6%) is higher than the proportion of suspected diabetics (5.6%). Quality of Services: Deep pits for disposal of bio medical waste were found at all the facilities visited. Colour coded bins for biomedical waste disposal was being used in visited DH & CHCs. The infection prevention practices were observed in the facility visited but it varied from facility to facility. Equipments were available at the facility visited as per the facility norms. The radiant warmers were not functional due to poor power supply and voltage. Stabilizer may be installed to make radiant warmer functional. Program Management and Support services: The position of District Data Manager is vacant however recruitment is going on for all 7 Block Data Manager. At block level, position of 2 BPM and 1 BAM is lying vacant. Power backup and security personnel were available at every facility. Mobile/Internet connectivity is poor in the district that affects service delivery and data entry Page 5 of 48 1.1 Introduction The Fourth quarter monitoring report for Jharkhand is based on visit to Latehar district and the HMIS data analysis. Latehar is one among the 30 districts classified for IAP 1 across the country. The visit was conducted during 02nd -05th April 2013. There are 97 SC, 07 PHC, 7 CHC, 2 Malnutrition treatment centre (MTC) and a district hospital functional in Latehar. Out of these 1 SHC, 1 PHC, 2 CHC, 2NRC and DH were selected as sample facilities to visit and understand program management and implementation at field level. After this visit the findings were shared with concerned officers at district level and state level. Table 1 shows the visit schedule and team composition. Table1- Visit Schedule and Team composition Date 03rd April 2013 04th April 2013 Facility visited Latehar District Hospital, Chipadohar PHC, Chandwa CHC, Manika CHC, Latdag SHC, NRC Latehar NRC Chandawa, ASHAs training at Latehar Team Members Dr Navneet Ranjan,Consultant, NHSRC Mr Deepak Tubid, State Consultant, Quality Assurance. Ms Jaya Reshma Xaxa , DPM Latehar Mr. Pramod kumar sahoo, DAM, Latehar 1.1.