Rapid Appraisal of National Rural Health Mission
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Rapid Appraisal of National Rural Health Mission District: Anuppur (Madhya Pradesh) Kotma Anuppur Pushprajgarh Jaithari Population Research Centre Ministry of Health & Family Welfare Department of General & Applied Geography (Government of India) Dr. H. S. Gour Central University Ni rman Bhavan Sagar (M. P.) 470003 New Delhi – 110 108 Draft Report i Contents Acknowledgement ii List of Tables iii Key Findings vi Chapter Title Page Chapter 1: Introduction and State Profile 1 Chapter 2: District Profile 12 Chapter 3: Community Health Centre 20 Chapter 4: Primary Health Centre 38 Chapter 5: Sub Centre 60 Chapter 6: Household Survey 81 Chapter 7: Status and Performance of ASHA 114 Chapter 8: Role, Awareness and Involvement of Gram Panchayat 121 Chapter 9: Quality of Care and Client Satisfaction – IPD Exit Interview 125 Chapter 10: Quality of Care and Client Satisfaction – OPD Exit Interview 140 Appendix-1: District Schedule 153 Appendix-2: Standard of Living Index 173 i Acknowledgements The PRC study on Rapid Appraisal of NRHM Implementation in Madhya Pradesh and Chhattisgarh could be completed with the immense help from many persons. I take this opportunity to express my gratitude towards them. I am thankful to the Ministry of Health and Family Welfare, Government of India for assigning this study to the PRC, GIPE. We are grateful to the authorities of the MOHFW, particularly to Dr. Ratan Chand (Chief Director, Statistics), Shri Praveen Srivastava (Director, Statistics) and Shri Rajesh Bhatia (Joint Director, Statistics), for their help and input they provided at various stages of the study. I am grateful to Prof. R.S. Agarwal, (the then Vice-Chancellor of our university) and Prof. N. S. Gajbhiye, Vice-Chancellor of our University for their valuable support and encouragement. This exercise could have not been completed without painstaking involvement and zeal of Dr. (Mrs.) Reena Basu (Assistant Director, PRC Sagar) and Mr. Nikhilesh Parchure (Field Investigator, PRC Sagar). Both are the core members of the PRC who have shared all the responsibility of the study. I am thankful to the staff of the PRC, Shri Manoj Namdeo for managing entire office work and coordination of activities at university level. Thanks are also due to Dr. R. Nagarajan, of PRC, Pune for his valuable support in solving problems related to data entry and table generation software as and when needed. I am also thankful to administrative and accounts staff of our university for their help to carry out the study smoothly. I would like to thank specially, Dr. D. K. Kori, Chief Medical and Health Officer (CMHO) and Shri Ravindra Dube, District Programme Manager, NRHM, Anuppur for their excellent help and support to carry out the fieldwork in the district. I also express my gratitude to the officials of the District Hospital, Anuppur and of the selected Community Health Centres and Primary Health Centres and the staff of the Sub Centres for helping us with providing data on health facilities and supporting us to carry out the household survey. We cannot ignore to acknowledging the sincere efforts of our 22 investigators who carried out the difficult job of taking interviews of respondents. Last but not least, credit goes to those respondents who patiently answered to the long questionnaire without any expectation of any kind. (Prof. Santosh Shukla) Director PRC, Sagar ii LIST OF TABLES Table Title Page 1 The sampling design for the selection of health facilities/households/ 7 respondents for the rapid appraisal of NRHM 2 Schedules canvassed for the study and survey period 8 3 List of selected District Hospital, CHCs, PHCs, SCs and Villages for the survey 9 in Anuppur District as per the sample design C1 Coverage and availability of infrastructure 28 C2 Position of Medical Staff and Paramedical Staff 30 C3 Availability of specific services in CHC 31 C4 Status of specific interventions 31 C5 Status of residential facilities for Doctors and other staff 31 C6 Availability of laboratory facilities 32 C7 Number of Lab tests done in CHC in last 3 calendar months 32 C8 Number of surgeries performed during 2007-2008 33 C9 Reasons for not conducting surgeries 33 C10 Status of performance of Labour Room during 2007-2008 33 C11 Reasons for not conducting deliveries 34 C12 Status of availability of equipments and drugs 34 C13 Availability of specific services 36 C14 Service outcome (based on data for last three months) 37 P1 Coverage and facilities of Primary Health Centre 47 P2 Primary Health Centres by infrastructure 48 P3 Staff position in Primary Health Centre 49 P4 Status of training of personnel at Primary Health Centre 50 P5 Availability of Labour Room in Primary Health Centre 50 P6 Status of performance of Labour Room during 2007-2008 50 P7 Availability of Laboratory Testing in PHC 51 P8 Number of tests done in PHC in last three calendar months 51 P9 Status of specific interventions 52 P10 Availability of selected equipments in PHC 53 P11 Status of availability of drugs 54 P12A Service outcome (based on data for last three months) – PHC, Amiliya 55 P12B Service outcome (based on data for last three months) – PHC, Amarpur 56 P12C Service outcome (based on data for last three months) – PHC, Mada 57 P12D Service outcome (based on data for last three months) – PHC, Khutar 58 P13 Status of record maintenance 59 S1 Sub Centres coverage 68 S2 Sub Centres infrastructure 69 S3 Sub Centres with ANM staying with or away from SC village by distance from 70 Sub Centre and reasons for not staying in Sub Centre S4 Sub Centres with staff in position 70 S5 Availability of Labour Room in Sub Centre 71 S6A Number of deliveries performed during 2007-2008 71 S6B Sub-Centres with arrangement for deliveries between 8 PM to 8 AM 72 iii Table Title Page S7A Sub Centres with availability of equipments 72 S7B Percentage of SCs with functional equipments (among the SCs reported the 73 availability of the equipment) S8 Status of availability of drugs on the date of survey 74 S9 Status of specific skills and procedures 75 S10 Service outcome (based on data for last 3 months) 76 S11 Status of record maintenance 77 S12A Status of awareness of ANM about JSY scheme 78 S12B Status of procedure under JSY scheme 78 S13 Status of performance of ANM under JSY scheme 79 S14 Status of Untied Grants 80 H1 Characteristics of the respondents 95 H2 Characteristics of the household 96 H3 Percent distribution of households by their waste disposal, stagnation of waste 97 water and mosquito breeding around the house and system of medicine preferred by them H4 Percent distribution of household respondents by their information about 98 availability of health worker, health facilities and transport used to take serious patients H5 Percent distribution of household respondents by their knowledge about 99 NRHM, ASHA and her activities, VHND, VHSC and JSY H6 Percent distribution of JSY beneficiaries by their background characteristics 100 H7 Timing, person and place of registration for JSY scheme 101 H8 Receipt of JSY card, role of ASHA in getting JSY card and difficulties 101 faced by the beneficiary in getting the JSY card H9 Role of ASHA during the pregnancy of the beneficiaries 102 H10 Place of delivery and reason for opting institutional delivery 102 H11 Transport of the beneficiaries to reach the health institution 103 H12 Waiting time at the health facility, type of delivery, amount spent at the health 104 facility and satisfaction regarding services available in the health facility. H13 Reason for the JSY beneficiary to opt home delivery, in spite of cash incentives 104 being available under the JSY scheme H14 Cash incentive received by the beneficiary under JSY scheme 105 H15 Utilization of government health facility in last 6 months 106 H16 Characteristics of the respondents who have availed the services in government 106 health facility in last 6 months H17 Type of health facility visited, purpose of visit and client satisfaction regarding 107 behaviour of health worker, privacy and availability of medicines H18 User fees and extra charges 108 H19 Services for the BPL patients 108 H20 Outbreak of selected diseases (Malaria, Measles, Gastroenteritis, Jaundice & 109 Other Diseases) in the respondents’ area in last six months H21 Action to be taken for selected diseases (diarrhoea, high fever, persistent cough, 110 loose motion, persistent cough and breathing problems for a child) H22 Awareness about spacing methods and ideal gap between 1st & 2nd child 111 iv Table Title Page H23 Awareness about modes of getting AIDS, source of information about AIDS 112 and awareness about VCTC H24 Suggestions given by the respondents 113 A1 Status of ASHA 119 A2 Role and Performance of ASHA 119 A3 Distribution of ASHAs by reported types of difficulties faced and kind of 120 support required A4 Distribution of ASHAs by reported awareness on different aspects 120 G1 Status of Gram Panchayats covered 123 G2 Level of awareness and involvement of Gram Panchayats 124 EI-1 Background characteristics of the in-patients 130 EI-2 Purpose of admission in the Health Institution 131 EI-3 Waiting time 131 EI-4 Satisfaction regarding waiting time 132 EI-5 Behaviour of staff 133 EI-6 Unique/innovative measure taken to improve the staff behaviour 134 EI-7 Privacy 134 EI-8 Patient-Doctor/Provider Communication 135 EI-9 Cleanliness of the facility 136 EI-10 Satisfaction of patients regarding cleanliness of the facility 137 EI-11 Crowding in the facility 138 EI-12 Amenities provided by the hospital 139 EI-13 Continuity of treatment 139 EO-1 Background