SUPPORTIVE SUPERVISION REPORT DISTRICT SATNA – MADHYA PRADESH DR. SHIVANGI VATS CONSULTANT NRHM- I 1 Page DISTRICT SATNA, M.P Executive Summary: NRHM has initiated Action oriented monitoring and provide Supportive Supervision to High Focus Districts of India that will reflect in the DHA Plan of a District and to help improve the NRHM indicators of a district and bring about the positive changes so as to achieve the set targets within a committed timeframe. A visit was planned for the same purpose to District Satna, in M.P, identified as High Focus District. The District Satna is situated in mid northern part of Rewa Commissioner's Division in Madhya Pradesh state of India. The districts take its name from Satna, the head quarters town, which in its turn takes it from Satna Rewa which flows near the town. In the north, the district boundary marches with that of Banda District of Uttar Pradesh state. Eastern boundary of the district runs with the Teonther, Sirmour and Huzur tehsils of Rewa district and very small portions of Sidhi District. The entire western boundary of the district is made by Panna district while the southern boundary touches the Jabalpur district in the west and Umaria and Shahdol district on the east. During the field visits, District Hospital (Satna), Civil Hospital (Maiher), 1 Community Health Centre (Nagod), 2 Primary Health Centres ( Singhpur & Sohawal), 4 Sub-Centres ( Tighara Kalan, Sitpura, Singhpur & Karahaiya) were visited. Key Observations & Findings: Implementation processes needs to be strengthened from the state level. Construction of wards should be completed on priority basis and handed over within a set timeline. Proper Monitoring should be done in this regard. The main areas of concern for ANMs and ASHAs are lack of support from community members. Community education and participation needs to be strengthened in a district. For this a proper Monitoring mechanism and capacity building is needed. IEC Component should be strengthened further in Satna, messages should be conveyed in a pictorial form than in a textual communication, to make it easy for illiterate communities. Serious attempts from State to bridge the gaps in HR availability have been made. There is a need to recruit CEmONC trained personnel considering the patient load in the district hospital. Lakshaya Prapti register for monitoring the Family Planning procedures were missing. Proper Monitoring needs to be strengthened in Satna. The training sessions should be more frequent for BMOs and BPMs for strengthening of facilities and better functioning. Selection process for ASHAs needs to be strengthened. Many highly educated ASHAs can be trained for higher level of capacity building. ASHA Monitoring system should be established in Satna. 2 Page DISTRICT SATNA, M.P Nutrition Rehabilitation Centers are established for undernourished children in district. Proper records are maintained of children, Nutritional nurses are well versed with their responsibilities. There is a lack of basic amenities like safe drinking water in Nutrition Rehabilitation Centre. There is a scarcity of water for the disposal of human waste enhancing the risks of infection. Water Tanks should be established for adequate storage of water. Better Quality of food should be provided to the mother of children in Nutrition Rehabilitation Centre. Regular Monitoring should be incorporated. The participation of village health committees is poor, which is reflected by the scanty utilization of funds, deficient understanding of role clarity and responsibilities. Intensified implementation and monitoring of DOTS Program is needed to decrease the prevalence and incidence rate of TB in Satna. Community participation and education should be strengthened. IEC messages in pictorial form can play a major role in this regard. District Hospital’s RKS faces resistance from Community for fund raising activities, media influence is high which hype such issues. Community should be educated about the role, responsibility and existence of RKS. Public display of utilization of RKS fund can help in better understanding of RKS by community. The management committee of Satna’s DH is doing a commendable job in the minimal resources available to them. The whole caesarian section load is managed by one specialist. She is providing services to the population of 22.5 lakh of Satna and also to the neighboring districts like Panna, Umaria, Banda etc. The SNCU of Satna is state of the art and can be a model for other districts. The SEWA SANKALP, a kitchen outsourced by RKS of DH to a group of businessmen for food to patient’s attendants is an innovative model which can be replicable by other districts. 3 Page DISTRICT SATNA, M.P CONTENTS : S.NO. CONTENTS PAGE NO. 1. Cover Page 1 2. Executive Summary 2 3. List of Contents 4 4. List of Abbreviations 5 5. Background 8 6. Objectives of the Visit 8 7. Scope of the Study 9 8. Study tools & Data Collection 11 9. District Profile 12 10. Functional Healthcare Facilities of the District 12 11. Mapping of Healthcare Facilities in a District 13 12. Gap Findings in a district 14 12.a. Key findings in regard to New Born Care & FP 14 12.b. Dearth Of Manpower 14 12.c. Training status 16 12.d. RCH Sub Plan 17 12.e. Disease Control Program 19 12.f. RKS Funds 20 12.g. Beneficiaries 21 12.h. VHSC 21 13. Key Findings of Inspected Healthcare Facilities 22 13.a. CHC- Nagod 22 13.b. CH- Maiher 26 13.c. DH- Satna 29 13.d. PHC- Singhpur 33 13.e. PHC- Sohawal 34 13.f. SC- Tighara Kalan 35 13.g. SC- Sitpura 36 13.h. SC- Karahaiya 37 14. Annexure – 1 15. Annexure – 2 16. Annexure - 3 4 Page DISTRICT SATNA, M.P LIST OF ABBREVIATIONS AMG Annual Maintenance Grants ASHA Accredited Social Health Activist AWW Anganwadi worker AYUSH Ayurveda, Yoga, Naturopathy, Unani, Siddha and Homeopathy BEmONC Basic Emergency Obstetric & Neonatal Care BHW Basic health worker BPHC Block Primary Health Centre CEmONC Complicated Emergency Obstetric & Neonatal Care CH Civil Hospital CHC Community Health Centre DAM District Accounts Manager DH District Hospital DHA District Health Action Plans DGO Diploma in Gynecology & Obstetrics. DIO District Immunization Officer DPM District program manager DPMU District program management Unit EAG Empowered Action Group FP Family Planning FRU First Referral Unit HSC Health Sub Centre IFA Iron Folic Acid IMNCI Integrated Management of Neonates & Child Illness IMR Infant Mortality Rate IP In Patients IPD Inpatient Department IPHS Indian Public Health Standards JSK Jansankhya Sthirata Kosh JSY Janani Suraksha Yojana LBW Low Birth Weight LHV Lady Health Visitor MMR Maternal Mortality Ratio MMU Mobile Medical Unit MO Medical Officer MoHFW Ministry of Health and Family Welfare MPW Multipurpose Worker MTP Medical Termination of Pregnancy NFHS-3 National Family Health Survey - 3, 2005-06 NRC Nutritional Rehabilitation Centre 5 NRHM National Rural Health Mission Page DISTRICT SATNA, M.P NSV Non Scalpel Vasectomy OP Out Patients OPD Out Patient Department ORS Oral Re-hydration Solution OT Operation Theatre PHC Primary Health Centre PWD Public Works Department RCH Reproductive and Child Health RKS Rogi Kalyan Samiti RTI/STI Reproductive Tract Infection/ Sexually Transmitted infection SC Sub Centre SNCU Sick New Born Care Unit UF Untied Funds 6 Page DISTRICT SATNA, M.P SUPPORTIVE SUPERVISION REPORT DISTRICT SATNA – MADHYA PRADESH 7 Page DISTRICT SATNA, M.P BACKGROUND The NRHM was launched in April 2005 with the objective of providing universal access to equitable, affordable and quality health care. The mission seeks to integrate different vertical health programmes, decentralize healthcare service delivery at the village level and improve intersectoral action. The poor in India have always lived in hope; the National Rural Health Mission has become a new hope for them. The mission aims to improve the access of rural people, especially poor women and children, to equitable, affordable, accountable and effective primary healthcare. The NRHM is expected to substantially reduce maternal and infant mortality and communicable diseases within the next five years. It is focused on 18 EAG states that have weak public health indicators, including the seven northeastern states, and 11 states in north and eastern India. Within a span of 5 years we have achieved a lot but still there are miles to go to attain our set targets and commitments. In order to fulfill our commitment to achieve the MDG’s within the set timeframe, 235 districts have been identified as high focus districts out of 642 from various EAG states where intensified monitoring is required to improve the various health deliverables. Ministry of Health & Family Welfare, Govt. of India under the guidance of Secretary H&FW has developed an action oriented monitoring plan and joint teams have been formed to visit the 122 districts for the monitoring in 1st Phase. For the purpose of action oriented monitoring of these high focus districts , teams of consultants will be monitoring the high focused districts and visit health facilities like Sub-centres, PHCs and Block CHC and various service providers and stakeholders and beneficiaries to track their progress in terms of various parameters which will help to assist States in improving the measurable indicators and deliverables of RCH and NRHM flexipool components in order to bring the positive changes on NRHM indicators. To highlight the best practices and innovations that can be utilized as role models for other states. A visit of 3 days to District Satna in state of Madhya Pradesh was planned for Action oriented Monitoring, as it is one of the High Focus districts out of 16 identified in Madhya Pradesh state in Phase-1. OBJECTIVES OF THE VISIT : Long Term Objective : Objective of the study is to conduct action oriented monitoring and provide Supportive Supervision to Satna , district of State M.P, identified as High Focus District which will reflect in the DHA Plan of a District and to help improve the NRHM indicators of a district and bring about the positive changes so as to achieve the set targets within a committed timeframe.