Monitoring Report for Uttar Pradesh; Jan – Mar 2013 National Health Systems Resource Center, New Delhi 1 The quarterly report of Uttar Pradesh is based on the HMIS data analysis and field monitoring visits to the high priority district of Faizabad State and District Profile UP is the most populous state of the country with the population of 19,95,81,477 as per the census 2011. State has 18 divisions, 72 districts and 821 blocks. The Total Fertility Rate of the State is 3.6 (AHS, 2011). The Infant Mortality Rate is 57(SRS, 2012) and Maternal Mortality Ratio is 440 (SRS 2004 - 2006) which are higher than the National average. The Sex Ratio in the State is 904 (as compared to 933 for the country) Faizabad is one of the high-focus districts of the state with highest IMR (98) and MMR (faizabad mandal – 451) as per the AHS 2011. Faizabad has a population of 24,68,371 and CBR of 25.5. Faizabad district has 11 blocks with 3 DH, 11 CHCs, 27 PHCs and 248 SCs. There are 37 SCs which are conducting more than 3 deliveries/month, six 24x7 PHC and 8 APHCs conducting more than 10 deliveries per month. District indicators are – Comparative Indicators Indicator Uttar Pradesh Faizabad 3 ANC 75% 79% % of women given 100 IFA 66% 36% tablets Institutional delivery rate 36% 44% Home delivery rate against 62% 69% reported deliveries C-section rate 3% 4% Fully immunized Children 82% 62% Low birth weighed Children 22% 19% Female Sterilization** 17.5% 12% Male Sterilization** 0.2% 0.2% IUD insertion** 1% 0.3% *HMIS 2012-13 ** AHS 2010-11 2 Public Health Infrastructure Over the years under NRHM, the state has nominal increase in number of health facilities. As per RHS statistics, no new SCs and PHCs are constructed by the state. State has constructed only 143 new CHC and upgraded some of the facilities. Shortfall of health infrastructure is highly evident as per the population norms in district Faizabad. There is shortfall of 50% of SCs, 67% of PHCs and 54% of CHCs. Faizabad District Facilities Expected facilities as per census Existing facilities Shortfall 2011 population norms SC 493 248 245 PHC 82 27 55 CHC 24 11 13 DH 3 3 0 State has issued a government order in 2010 stating, all the BPHCs are to be upgraded to CHCs and all APHCs should have nomenclature as PHCs. Out of total 06 BPHCs – 4 are completed and handed over to concerned in-charge and 2 are under construction (BPHC Mawai has been upgraded to CHC (30 beds) in September 2012 but it is not operationalized yet as furniture and adequate HR is not available). Infrastructure construction is outsourced to a private agency, whose construction process is very slow and results in hindrance in handing over newly upgraded facilities. All the APHCs have been named as PHCs but facilities provided by APHC are not up to the par as PHCs. Their bed strength even after the change in nomenclature remains same as 2 beds . 3 Facilities Sanctioned Existing Under Existing in Existing in government Construction rented building building SC 248 246 48 48 198 PHC 06 06 0 0 06 CHC 05 05 0 0 05 DH 03 03 0 0 03 SDH 01 0 1 0 01 APHC 27 27 0 0 27 Tertiary care 01 0 1 0 1 Hospital Urban Health 05 05 0 0 5 Post It has been identified that, 100% of PHCs, CHCs and DH are functional in government building and 19% of SCs are functional in rented building (SC under rented building are under construction). One 300 bedded tertiary care hospital was sanctioned in 2011 and currently it is under construction. Quarters for accommodation are existing in all he facilities. As per 500 secondary care beds per 10 lakh population norm district is having 153 beds per 10 lakh population with total deficit of around 700 secondary care beds. Facility Strengthening Services provided by public health facilities are categorized as per the level of institutions. District and District women hospital are providing specialty care services including Surgery, Medicines, obstetrics & gynaecology, cardiology, Emergency, Trauma care, ophthalmology, ENT, family planning services and ancillary services of blood bank, radiology with, pathology etc. CHCs and 24x7 PHCs (18 PHCs) are centric to providing RCH services with focus on minor surgeries, mild inpatient management and 3 specialty care OPDs(Medicine, gynae, CHC-FRUs are not conducting c-section deliveries, complication management is minimal and no blood storage unit. 80% of SCs are providing ANC services, immunization, IUD insertion and OPDs only. 20% of SCs are conducting deliveries in the district. SCs are not conducting Hb tests as well as blood pressure check during ANC. Haemoglobinometer are not available at SC and digital BP apparatus are available at SCs but ANMs are not conducting BP checks (ANM is conducting BP check at tahseenpur SC but not recording and reporting it ). AYUSH OPDs are not provided at the facility level as AYUSH medicines are not available in the stock. 4 Equipments for blood storage unit lying idle at CHC Rudauli Faizabad District – Delivery points Faizabad District – Non-Delivery points CHC PHC APHC SC CHC PHC APHC SC 5 6 10 49 0 0 17 197 Category wise delivery load Total Deliveries Deliveries Deliveries conducted Deliveries deliveries conducted by DH conducted by FRU by 24x7 PHCs conducted by SC (other than DWH) 32129 22.3% 12.3% 39.6% 26.2% Bed occupancy is 100% in the district hospital and 68% in the health centers. Maximum bed occupancy is accounted from delivery cases in all health facilities. Bed strength of Faizabad District Male district Hospital Female district hospital DSW hospital Total (CHC+PHC+APHC+SC) 212 120 85 174 100% 100% 87.66% 63.08% Bed Occupancy rate in Faizabad district (CHC+PHC+APHC+SC Bed occupancy rate 2010-11 Bed occupancy rate 2011-12 Bed occupancy rate 2012-13 5 55.10% 58.03% 63.08% User charges User charges for utilizing the services are charged for certain services in public health facilities of Faizabad district. User charges for OPD and IPD (OPD registration - Re 1 for 15 days and IPD - Re 1 for admission), X-ray (30rs per x-ray), lab test (4-7 Rs for haemogram and stool test each) are present. In CHC Bikapur, IP admission charges are 13 Rs, ECG – 16 Rs and ambulance is free (however it is displayed that user charges for ambulance – 10rs/Km, major surgery – 400 Rs, minor – 268Rs). In bikapur CHC, 30 Rs is charged for undergoing pregnancy test. User charges are exempted for pregnant women as under JSSK, all the services are free of cost. User charges were not levied for sick neonates and pregnant women coming for ANC due to lack of awareness among user charge collecting personnel. Apart from it, out-of pocket expenditure is mainly for travel from home, diagnostics and drugs that are not available in facility. Ancillary services Laboratories at CHC/PHC are providing very basic services like haemogram, stool test, blood smear and sputum test. SCs are not conducting haemoglobin test and even weighing machine is not functional at most of the facilities. Radiography services at CHC/BPHC include x-rays only. Other laboratory and radiography tests like HIV, VDRL, Biochemistry test, USG, mammography etc are present at the district hospital. It has been identified, drugs are available free of cost except those drugs which are not available at the facilities. Human Resources Medical Officers and Specialists District has a total of 105 MOs currently in position as against the sanctioned strength of 121 MOs. The availability of General Medical Officers in 24*7 PHCs/CHCs as against IPHS norms is as shown below: Required MOs (IPHS General Medical Facility name Type of the Facility norms) Officers DWH DWH-FRU 13 2 Rudauli CHC-FRU 2 3 Bikapur CHC-FRU 2 4 Sohawal CHC-FRU 2 3 Milkipur CHC-Non FRU 2 7 Poorabazar CHC-Non FRU 2 6 Mayabazar 24*7 PHC 2 3 6 Khandasa 24*7 PHC 2 3 Mawai 24*7 PHC 2 4 Herringtonganj 24*7 PHC 2 2 Tarun 24*7 PHC 2 6 Masaudha 24*7 PHC 2 3 District faces huge dearth of specialists. None of the 5 CHCs (including 3 CHC FRUs) is conducting C- section deliveries because of absence of requisite team of specialists. Some facilities are also hiring specialists on call basis to conduct sterilization operations. The availability of specialists across the facilities (CHC & above) is as follows: Anesthetists Gynecologists Facility Type of the Pediatricians (Contractual/ (Contractual/ name Facility (Contractual/Regulars) Regulars) Regulars) DWH DWH – FRU 2 1 5 Rudauli CHC-FRU 1 Bikapur CHC-FRU 1 1 Sohawal CHC-FRU 1 1 Milkipur CHC-Non FRU Poorabazar CHC-Non FRU To fill the service delivery gaps, training of MOs on EmOC, LSAS, BEmOC, Minilap and MTP should be expedited. Nursing and Paramedical staff Irregular recruitments have led to major vacancies in the category of Staff Nurses, MPWs and X-ray technicians. Shown below is the availability status of Nursing and Paramedical staff in the PHC/CHCs of the district: Regular Contractual Personnel category Sanctioned Vacant Sanctioned Vacant Staff Nurses 27 18 18 2 ANMs 294 32 91 1 7 MPWs 102 91 90 0 Pharmacists 49 1 9 1 LTs 21 1 3 0 X-Ray Technicians 9 5 3 0 ASHAs 2056 91 Deployment of AYUSH MOs AYUSH MOs have helped in filling the gaps in service delivery. There are 23 AYUSH MOs working as General Duty Medical Officers (GDMOs) in PHCs where MBBS MOs aren’t present.