JHARKHAND

1. District Major observations of Field Survey Unit, Patna about the Evaluation work in Pakur, in December 2009 Districts of State in Feb. 2010 and March 2010 respectively. I. Details of the visited Institutions: District Visited PHCs visited HSCs visited 1. Pakur PHC-,Amarapara Mohanpur, Dangapara, Torai, and Maheshpur Dumarchir, Tilaipara, Alubera, Birkitinorth, Birkit south and Bankur

II. Major Observations: 1. Formation of VHSCs and RKS: a. Village Health & Sanitation Committee was constituted in 821 villages in the district. It is reported that All VHSCs have ASHA(SAHIYA called in Jharkhand) as a member. b. Rogikalyan Samiti is called as Hospital Management Society in the state. HMS was constituted and its registration is under process but the meetings of these societies for improving the services are reported to be conducted regularly. 2. Services of ASHA: a. ASHA scheme is implemented and all existing 1209 villages of the district are undertaken for the scheme. b. It was reported that 855 ASHA were in position and also trained in all the modules. c. All 855 ASHAs were provided with drug kits. d. In the visited PHCs, the target of ASHA has been fulfilled and maximum villages were also covered. 3. Untied Fund: a. Partial details about untied funds could be available from the district office. Rs.688133 were released from DFWB to the PHCs during the financial year 2009-10 but no details about CHC and HSC level untied funds provided by the district office. b. As SOE from the District, Rs.49973 were spent by the PHCs during the period from 1.4.2009 to 31.1.2010. c. In the visited PHCs, Rs. 25,000 were received during 2009-10 but the details of expenditure were not made available. 4. Services of JSY: a. Janani Surakha Yojna has been implemented in the district but its progress report was not made available to the team. b. In visited PHC at Hiranpur out of 365 beneficiaries under JSY only 80 beneficiaries have been paid with their incentives during 2008-09 and rest 285 cases were pending. 5. Physical infrastructure: (i) Sub Centres: a. HSCs visited in the district were in Govt. building but labour room facility was not there. Residential quarters for ANM were provided but they were not staying there due to lack of facility of toilet and electiricty. b. Furniture and equipment like Cupboard, Meintsh Sheet, Ambu bag, torch, foot stool, BP apparatus, bench for clients and delivery table were not found there. (ii) PPC/CHC/FRU and PHC: a. There was no CHC/PPC/FRU in the district. b. All the visited pHCs were running in Govt. building with residential quarter of MO/Paramedical staff. PHCs were having telephone facility/Electricity and water supply facility. No scarcity of essential drugs was found there. 6. Knowledge & Opinion of the Community about health services : a. Mothers who were eligible for ANC and PNC services contacted and found to be satisfied with the services provided by the concerned ANMs. b. Mothers had FW as ell as RCH Services in due time for ANC, PNCand new born care from the health personnel. c. During the field visit the team found that the Meical officer and Paramedical staff of the concern institution were found prompted in discharging their duty and facilities under NRHM programme. 7. Maintenance of Records and Registers: a. Performance report for sterilization, IUD, OP and Nirodh for the year 2008-09 was not made available by the District Office. b. Due to lack of IUD registers, reported figures could not be verified at visited PHCs. c. Eligible couple survey register was not maintained at any of the visited PHCs since more than 5 years. d. Register for Sterilisation,Cu-T, OP Condom users Child Immunization and ANC services were not properly maintained at all PHCs. e. PNC services were not mostly updated in the service registers at PHCs visited. f. Stock register of spacing method were not found at Hiranpur and Maheshpur PHCs. The same register was not maintained properly at Amarapara PHC. g. Sterilization case cards were also not issued at the PHCs. h. Performance report was not being reported as per HMIS formats. 2. District Sahibganj Major observations of Field Survey Unit, Patna about the Evaluation work in Simdega in December 2009 Districts of Jharkhand State in Feb. 2010 and March 2010 respectively. I. Details of the visited Institutions:

2. Sahibganj PHC-Sadar, , Bhaga-bandh,Lakhimpur, and Barhet Mahadev Ganj, Jaamnagar, Mandai, Maalin,Ranigram and Ghobdiah II. Major Observations: 1. Services of ASHA: a. ASHA is called SAHIYA in the state. It was reported that all 1406 villages in the district were covered under the scheme and there were 1251 ASHA in position. b. The district was targeted for 1406 SAHIYA but presently selected 1251 and trained them up to fourth module. c. No Drug Kit provided to any SAHIYA in the district. d. In the visited PHCs no ASHA was working with the kits. 2. Untied Fund: Details of Untied fund at visited PHCs are as below: Sl.No. Particulars Sadar PHC Rajmahal PHC Barharwa PHC Barhet PHC 08-09 09-10 08-09 09-10 08-09 09-10 08-09 09-10 1 Untied Fund Received 25000 50000 25000 50000 25000 50000 25000 50000 2 Expenditure Incurred 25000 29590 25000 50000 17637 NIL NIL 39700 3 Balance NIL 20410 NIL 50000 7363 50000 25000 10300 b. Funds provision for the whole district was not made available at district office. 3. Services of JSY: a. The funds under Janani Surakha Yojna are being provided to the institutions at periphery level in the district. b. It is observed that maximum beneficiaries in the visited PHCs were not paid with their incentives inspite of the funds were available. c. As reported 2482 beneficiaries in the PHC Sadar, 889 in PHC Rajmahal and 350 beneficiaries in PHC Barhet in the year 2008-2009 were waiting for their incentive. Similarly, 601 in PHC Sadar, 1830 in PHC Rajmahal and 413 beneficiaries in PHC Barhet were yet to be paid during 2009-10. 4. Physical infrastructure: (i) Sub Centres Lakhimpur In Lakhipur sub centre, there was no electricity and toilet facilties. Furniture like examination table, foot stool and delivery table were also not provided to this centre. (ii) PHCs: a. The visited PHCs at Rajmahal and Barhet had Govt. building but maintenance of hospital building at these centres was poor. Cleanliness was also observed not up to the mark. b. Surgical equipments for minor operation was not available in the PHCs. 5. Maintenance of Records and Registers: a. Eligible couple survey register was not maintained at any of the visited PHCs. b. Register for Sterilisation,Cu-T, OP/ Condom Users, Child Immunization and ANC/PNC Services were not properly maintained at PHCs Sadar, Rajmahal and Barhet and same was not provided at PHC Barharwa. c. Stock register of spacing method were not maintained properly at PHCs Rajmahal and Barhet and not provided at PHCs Sadar Barharwa d. Sterilization case cards were also not issued at any PHC. 6. Miscellaneous Observations: a. Due to lack of Supervision, proper guidance in periphery level staff was not getting in time b. The meeting of the Rogi Kalyan Samiti is not being conducted on regular basis. c. In some of the places during visit to Barharwa PHC the labour room was locked since a long period. d. The posts of the Health workers (M) at HSCs were vacant. e. Performance of NSV was found poor in the district.

3. District Hazaribag

Major observations of Regional Evaluation Team, Patna about the Evaluation work in Hazaribag Districts of Jharkhand State in July, 2009.

I. Details of the visited Institutions:

District Visited PHCs visited HSCs visited 1.Hazaribag PHCs- Barkattha, Sadar, HSCs- Surajkund, Harhad, Barkagaon, Sindur, Sikari, Kathautiya, and Hatkauna, Pabara, Sahpur, Pandey Bara, Chaikala and Bedna

II. Major Observations: 1. Functioning of Village Health & Sanitation Committee (VHSCs) and Hospital Management Society (HMS): a. Only 359 Village Health & Sanitation Committee were functioning out of 1211 VHSCs set up in the district. It was reported that all VHSCs have ASHA( known as SAHIYA in the State ) as a member. b. Hospital Management Society (HMS) is functioning in the state as Rogi kalyan Samithi. HMS was Constituted in the Sadar Hospital and all PHCs in the district. It is observed that the meetings of HMS were not being conducted regularly at visited PHCs. 2. Services of ASHA: a. District has Population of 1565262 and all 1202 villages were covered under the scheme. b. As per requirement 2657 ASHAs have been selected in the District and process of training in all modules was going on the status of training was not made available to the team at the district level. However, it was reported at PHCs that ASHAs are undergoing training indifferent modules. 3. Untied Fund: a. It is observed that untied funds to the centres are not being provided in time in the district. b. Untied funds in two installments for the year 2006-07 and 2007-08 were released to the PHCs during 2007-08, but the funds for 2009-10 not povided. c. No funds have been provided to the sub centres during the year 2008-09 & 2009-10. d. The funds to 359 VHSCs were released first time in the district during the current financial year. 4. Services of JSY: a. There was no scarcity of funds in the visited PHCs for providing incentives to the beneficiaries. b. As per record there were 352 beneficiaries waiting for their payments from last year under the scheme at PHC Katkamsandi c. During field verification, it was observed that 3 ANC services were not provided to the beneficiaries; MCH Cards of the beneficiaries were also not properly filled up. 5. Physical infrastructure: (i) Sub Centres: a. HSC at Hatkauna under PHC Katkamsandi does not has its own building. b. HSC Pabara’s building was not maintained for clinic purpose. c. Water supply, electricity, toilet and labor room were not found there. d. The team observed that the condition of furniture & the availability of equipments and printed materials (Registers) in these centres was very poor. e. EC Pills, Metronidazole Tablets, Ampicilin capsules, Kit-A & Kit-B were also not available in these centres (ii) PHC: a. PHC Katkamsandi was functioning in government building. There was no supply of running water. b. Maintenance of cold chain was difficult due to irregular supply of power and hence vaccines vials for immunization were being collected from district head quarter. c. AYUSH Medical Officer was not posted there. d. Resuscitation equipment was not supplied there. e. Residential quarters of Medical officers was found in dilapidated condition. 6. Knowledge & Opinion of Mothers: a. 9 mothers each in the areas of HSC Hatkauna and HSC Pabara were contacted to know their opinion and knowledge on the services rendered by the concerned female workers. b. Most opf them were not satisfied with the availability of ANM at the time of need. c. It was observed that community especially women in the reproductive age need to be educated about RCH and FW services like Baby weight after birth, use of DDK during home delivery, awareness about 3 Ante Natal check up, danger sign of ARI, advantages of using ORS during diarrhea and proper use & side effects of contraceptives. 7. Reconciliation of the reporting performance: a. It was found that the sterilization performance reported by District office for PHCs was over reported for the year 2008-09. b. Actually, sterilizations operated by private institutions reported the figures to the district office for further reporting purpose and the same figures are also collected by PHCs from these private hospitals which are located in PHC area. The district office reported the PHC performance adding the figures of private hospitals that are also included by the PHC itself in its performance, hence double counting the figures. c. The team had verified the sterilization performance of PHCs at Barkattha, Sadar, Barkagaon, Kathamsandi and Chauparan for 2008-09. A total 765 sterilisations of these five PHCs were reported to the district office including the figures of private hospitals and the district office reported 2694 sterilisations including extra 1929 figures of the same private hospitals. d. The reported figures under Cu-T could not be verified for the year 2008-09 and 2009-2010 (upto June 2009) due to absence of complete registers at the head quarters of PHCs visited. 8. Declining number of Institutional Deliveries: It was observed that the lady Medical Officers posted at different PHCs in the district were working in the Sadar Hospital at district head quarter, Hazaribag on deputation basis as a result performance of Institutional deliveries was not up to the mark.

9. Maintenance of Records and Registers: a. Eligible couple survey has not been conducted in any centre since more than 5 years. b. PNC services were not mostly updated in the service registers at PHCs visited. c. Sterilization Case Card registers were not maintained at any PHC. d. Monitoring and supervision needs to strengthened by the state authority for proper maintenance , updating and timely submission of information/data.

4. District Bokaro Major observations of Regional Evaluation Team, Patna about the Evaluation work in Bokaro Districts of Jharkhand State in July, 2009.

2.Bokaro PHCs- Kasmar, Petarwar and Chas HSCs-Murhur Suddi, Kudibera, Balidih, Ordana, Kashi Jharia and Algadda

II. Major Observations: 1. Functions of Village Health & Sanitation Committee (VHSC) and Hospital Management Society (HMS): a. Village Health & Sanitation Committee has been constituted in all 775 villages in the district. It is reported that All VHSCs have ASHA(called SAHIYA in Bihar) as a member. b. Hospital Management Society is functioning in the state as Rogi kalyan Samithi. Though HMS has been constituted in all the visited PHCs in the district but the meetings were not been conducted regularly at the centres. 2.Services of ASHA a. District has Population of 2058852 and all the villages were covered under the scheme. b. District has selected 1416 ASHAs and 1413 of them are trained in all the modules. c. All ASHAs were provided with drug kits. 3. Untied Fund a. Untied Fund during 2008-2009 and 2009-10 were not provided to visited PHCs/Sub Centres. b. Previous funds were also not utilized by PHC Chas. c. Overall utilization of fund for strengthening the services of sub-centres was found very poor by the team. 4. Services of JSY a. Fund were provided to the PHCs in time. b. In the PHCs Kasmar, Petarwar and Chas, 513 beneficiaries of last year and 311 beneficiaries of current year are yet to be paid JSY incentive money. c. During field verification, it was observed that MCH Cards of contacted beneficiaries were not properly filled; 3 ANC were also not provided to any contacted beneficiary. d. Transport was self arranged by beneficiaries. 5. 24x7 PHC/FRU Services a. 24X7 PHC services scheme has not been implemented at visited PHCs Kasmar and Chas. b. Specialists were not available for providing this service in the PHCs.

6. Physical infrastructure i) Sub Centres a. HSCs at Murhur Suddi and Khudibera were functioning in rented building. Building at both the places was not maintained properly for clinic purpose. b. Well was the source of water at HSC Murhar and Handpump was main source at HSC Khudibera. c. Electricity, toilet and labor room facility were not available at the centres. d. Furniture and Equipments like delivery table, Mclntosh sheet, Ambu bag/suction, were not found available there by the visited team. e. Supplies and Drugs like DDKs, Chloroquine tablets, Ampicilin capsules, Gentamycine injection and Kit A & B were also lacking in these centres. ii)PHC: a. PHC at Kasmar was functioning in government building . b. Telephone service in the PHC was not available since last two years due to non-payment of bills. c. Toilet facility for patient and staff was not there. d. AYUSH Medical officer was not posted; residential quarters of Medical Officers were not available at this PHC. e. BP apparatus, minor surgical equipments, labor room, OT, EC pills and Vitamin-A tablets etc. were not found there. 7. Community Satisfaction towards Services a. 9 mothers each were contacted in the area of HSC Murhur Suddi and Khudibera to acess their opinion and knowledge on the services rendered by the concerned female workers. b. Most of them were satisfied with the availability of ANM. c. It was observed that community especially women in reproductive age need to educate about RCH and FW services like Baby weight after birth, use of DDK during home delivery, awareness about 3 Ante Natal check up, awareness about danger sign of ARI, use of ORS and proper use & side effects of contraceptives. 8. Maintenance of Records and Registers a. Maintenance of eligible couple survey register is the vital record for Family Welfare and RCH services which is neglected at Sub-Centre level since very long period. b. Eligible couple survey has not been conducted at any centre. c. ANC & PNC and Child Immunization registers were not found updated at PHCs Kasmar, Petarwar and Chas. d. The details of Service registers’ of Cu-T, Oral Pills and Condom were not recorded and updated properly at all visited PHCs. e. Stock register of spacing methods were maintained without relevant details and updated a at visited PHCs. f. Sterilization Case Cards were not issued by any PHC.