1.District: Kaushambi

Major observations of Regional Evaluation Team, about the Evaluation work in of Uttar Pradesh in May, 2011

I. Details of the visited Institutions:

District visited PHCs/CHCs visited SCs visited Kaushambi CHCs: Kanaili and Itaila, Mayhar, Anetha, Malaksaddi, PHC: Chayal Salahpur and Manauri

II.Major observations 1. Health Human Resources: a. In the Medical category, 20 posts of MO out of 73 sanctioned and 2 posts of specialist out of 15 sanctioned were lying vacant in the district. b. In the Para-medical category, 35 posts of ANM (out of 204 sanctioned), 63 posts of MPW (M) (out of 83 sanctioned), 23 posts of Health Supervisor (M) (out of 32 sanctioned) and 23 posts of Staff Nurse/GNM (out of 33 sanctioned) were also lying vacant. c. In the visited CHC, Kanaili, 5 of the 23 sanctioned posts of ANM, 8 of the 9 sanctioned posts of MPW (M), 4 of the 6 sanctioned posts of Health Supervisor (M), 1 of the 3 sanctioned posts of Staff Nurse and 1 of the 5 sanctioned posts of specialist were lying vacant. In CHC, Sirathu 2 of the 25 sanctioned posts of ANM, 9 of the 12 sanctioned posts of MPW (M), 5 of the 7 sanctioned posts of Health Supervisor (M), 3 of the 5 sanctioned posts of Staff Nurse, 4 of the 12 sanctioned posts of Medical Officer and 1 of the 5 sanctioned posts of specialist were lying unfilled. d. 2 of the 27 sanctioned posts of ANM, 11 of the 13 sanctioned posts of MPW (M), 5 of the 7 sanctioned posts of Health Supervisor (M) and 2 of the 8 sanctioned posts of Medical Officer in PHC Chayal were lying vacant. 2. Functioning of Rogi Kalyan Samiti (RKS): a. It was reported that Rogi Kalyan Samiti (RKS) was registered in each of the Block level PHCs/CHCs and also in the District Hospital. Meeting of executive body was conducted every month during the year 2010-11. b. Funds including Untied Fund, Annual Maintenance Grant etc. are kept at the disposal of Rogi Kalyan Samiti as RKS fund. Details of expenditure, equipments purchased etc. in the visited CHC/PHCs and the approvals taken from the RKS in this regard were not recorded in the registers. c. It was also observed that meeting of advisory body of RKS was not being conducted in the visited centres. 3. Functioning of ASHA Scheme: a. As reported, 1370 ASHAs were in position out of 1600 selected in the district during 2010-11. 1303 ASHAs were reported to have been trained but are working without drug kits. b. In the visited Sub Centres at Italia, Mayhar, Anetha, Malaksadi, Slahpur and Manauri, required number of ASHAs were working in the field and trained up to 4th module. c. 8 ASHAs were interviewed and as informed all were trained and receiving an annual average performance based remuneration of about Rs. 5000- 6000. 4. Functioning of Village Health & Sanitation Committee (VHSCs): a. It was reported that 440 VHSCs were formed and joint bank accounts in the name of concerned ANM and Gram Panchayat Pradhan have also been opened to handle the funds. In the year 2010-11 funds Rs. 10,000 were provided to each VHSC for undertaking sanitation work in the villages. b. The total budget for the VHSCs in the district was allotted to the tune of Rs. 86,10,000 for 861 revenue villages during 2010-11, but no details of expenditure were available at district office and also visited PHC/CHCs. c. Meetings of the VHSCs were not being conducted regularly in the visited Sub Centres. 5. Untied Funds: a. Details of the budget provision and expenditure incurred in the district for the year 2010-11 are reported as under:

Sr.No Particulars of Untied In the year 2010-11 ( in Rs) Fund For Sub centres For CHCs/PHCs 1 Fund allotted 17,60,000 4,50,000 2 Total Expenditure 17,40,000 4,48,071 3 Balance amount 20,000 1,929

b. Funds @ Rs. 10,000 to each Sub centres and @ Rs. 50,000 to each CHCs/PHCs per year are released by district to block level CHCs/PHCs. It has been observed that in the visited CHCs at Kanaili, Sirathu and PHC at Chayal funds @ Rs. 50,000 were allotted during 2010- 11. c. Funds were utilized in contingency and development work like buying of stationary, POL of vehicle, electrical equipments and battery of inverter etc. after getting approval in the meeting of RKS. d. Statement of expenditure regarding untied fund at Sub centres was not maintained at CHCs/PHCs or Sub centre level. 6. Janani Suraksha Yojana (JSY): a. The district had spent more amount than the allotted budget for the year 2010-11. Out of funds of Rs. 5,68,84,000 allotted to the district for the year 2010-11, the expenditure reported was to the tune of Rs. 6,01,85,980. The excess amount of expenditure Rs. 33,01,980 was met from flexi pool fund. b. The budget provision and expenditure at the visited PHC/CHC is reported as given below:

Sr. No. Particulars For the year 2010-11 ( in RS) CHC Kanaili CHC Sirathu PHC Chail 1 Total fund available 48,69,100 58,63,800 94,50,000 2 Total expenditure under JSY47,76,650 58,41,450 94,17,550 3 Total balance amount 92,450 22,350 32,450

c. 45 JSY beneficiaries were contacted in the visited area of the Centres in the district for on the field verification. All the beneficiaries stated that they had received incentives through cheque by the concerned CHCs and PHCs. 7. 24x7 delivery care services: a. 9 institutions were identified to provide 24x7 delivery care services in the district. No additional budget for these services was released to these Centres. b. During visit to the Centres, the performance under institutional delivery was found good during 2010-11. 2282 deliveries in CHC Kanaili, 2583 in CHC Sirathu and 1718 deliveries in PHC Chail were conducted during 2010-11. Facilities for caring mother and new born baby were there in all the visited institutions under the scheme.

8. Physical infrastructure (HSC/PHC/CHC) (i) CHC/ PHCs: a. During visit to the CHCs Kanaili and Sirathu, team found that both the CHC were functioning in Govt. building but their maintenance was not up to the mark. b. Jeep, Blood Storage unit, Injections Quinine and Arteether were not available in both visited CHCs. c. Visited PHC at Chail was functioning in Govt. buildings. Jeep was not available at PHC Chail. d. AYUSH Medical Officer was posted but Pharmacist and medicines under this segment were lacking in the PHC. (ii) Health Sub Centres: a. Visited Sub centres at Itaila, Mayhar, Anetha, Malaksaddi, Salahpur and Manauri were functioning in Govt. buildings. ANMs were not staying at their sub centre head quarters. Electricity was not available at Itaila, Mayhar, Anetha, Malaksaddi and Manauri sub centres. b. It was observed that no delivery was being conducted in the visited Sub centres except at Sub Centre Salahpur. c. Ambu bag/suction, Nischay pregnancy test kit, RDT kit, Heamoglobinometer, Sanitary Napkins and Paracetamol tablets were not available in the visited Sub centres. d. Delivery table, Maclntsh sheet, ORS packets, DDKs, Nirodh, Oral Pills and EC Pills were not available at Sub centres Itaila, Anetha and Manauri. e. Gloves, CuT, Co-trimoxazole and Paracetamol tablets were not available at Sub centres Itaila, Malaksaddi and Salahpur. f. Foot stool, Chloroquine, Paracetamol, Metronidazole, Oxytocin tablets, Ampicillin capsules and Gentamycine injection were not available at Sub centres Mayhar, Anetha, Malaksaddi and Manauri. g. IFA tablets, Oral Pills, Nirodh, EC Pills, Antiseptic solution, Bleaching powder, Chloroquine, Metronidazole, Oxytocin tablets, Ampicillin capsules and Gentamycine injection were not available at Sub centre Salahpur. h. Antiseptic solution in Sub Centre at Itaila, BP apparatus, Co-trimoxazole tablets, CuT, Oral Pills and Sanitary Napkins at Sub Centre Mayhar, Weighing machine (Infant), CuT and Sanitary Napkins at Sub Centre Anetha, Delivery table, DDK, Gloves, ORS packets, Vitamin- A, Oral Pills, Nirodh, EC Pills and Bleaching powder at Sub Centre Malaksadi, Co-trimoxazole tablets, Antiseptic solution and Bleaching powder at Sub centre Manauri were not available. 9. Assessment and opinion of the Community on Health Services: (i) Services of ANM- a. 54 mothers having child up to one year of age from the area of 6 visited sub centres were interviewed by the team to assess their opinion about the services rendered by the ANMs. b. 15 (28%) Mothers were not aware about danger sign of ARI, 17 (31%) were not aware about use of ORS and 8 (15%) replied that their babies were not weighed at the time of birth. 19 (35%) mothers did not receive three Post Natal checkups. c. It was also observed that 26 (48%) mothers did not aware about contraceptive methods. (ii) Services of PHC- a. 30 Persons who were generally utilising the services at visited PHC/CHCs were interviewed and it was found that they were satisfied with the services provided by the Medical officers and others staff of PHCs/CHC. b. The team also contacted persons from different target groups like pregnant women, recently delivered women, mother of 2 year old child and village leaders. Team found that some pregnant women are not registered within the 16 weeks of pregnancy. Futhrer, mothers were aware about danger sign in pregnancy breast feeding practices. 10. IT Infrastructure and Mother & Child Tracking System: a. Team found that computers were available at district level and at Block level (one in each Block) but internet connectivity was not available in any visited CHC/ PHC. b. MCH Tracking formats were available in each Sub centres. c. Health functionaries were sensitized in MCH formats at PHC/ CHC level. They are capturing data in the formats and making data entry at PHC/ CHC level through cyber cafe. 11. Registers, records and reports maintained at the visited centres: a. Service registers for IUD, Oral Pills and Nirodh cases were not being maintained at any of the PHC/CHC head quarter. Performance reported under CuT at CHCs Kanaili, Sirathu and PHC at Chayal could not be verified due to want of consolidated registers. b. Eligible Couple register, Cash book for untied fund and VHSC proceeding registers were not being maintained at any of the visited centres. c. Registers for Family Planning services, Stock book, Monthly Reporting format and Cash book for untied fund were not supplied in printed forms to Sub Centres by higher authority.

2. District: Major observations of Regional Evaluation Team, Lucknow about the Evaluation work in of Uttar Pradesh in May, 2011

I.Details of the visited Institutions:

District visited PHCs/CHCs visited SCs visited Ballia CHC: Sonvani Haldi, Bigahi, Halpur, Mudiyari, PHCs: and Beruabari Sukhpura and Sultanpur

II Major Observations

1. Health Human Resources: a. 20 posts of MO out of 100 sanctioned and 44 posts of specialists out of 60 sanctioned were lying vacant in the district. b. Similarly, skilled personnel under Para Medical category like 10 ANMs (out of 426 sanctioned), 94 MPWs (M) (out of 136 sanctioned), 41 Health Supervisors (M) (out of 147 sanctioned), 11 HEOs (out of 18 sanctioned posts) and one each sanctioned posts of District Program Manager, District Account Manager and District Community Immobilizer were also lying vacant in the district. c. In the visited CHC, Sonvani, 4 of the 20 sanctioned posts of ANM, all 9 sanctioned posts of MPW (M), 4 of the 7 sanctioned posts of Health Supervisor (M), 5 of the 7 sanctioned posts of Medical Officer, 4 of the 5 sanctioned posts of specialist and 1 of the 3 sanctioned posts of Staff Nurse were vacant. d. 3 of the 31 sanctioned posts of ANM, all 8 sanctioned posts of MPW (M), 2 of the 4 sanctioned posts of LHV, 1 of the 6 sanctioned posts of Health Supervisor (M), all 3 sanctioned posts of Staff Nurse and 2 of the 7 sanctioned posts of Medical Officer in PHC, Bansdih and 1 of the 16 sanctioned posts of ANM, 5 of the 8 sanctioned posts of MPW (M), 1 of the 6 sanctioned posts of Health Supervisor (M) and 1 of the 8 sanctioned posts of Medical Officer in PHC Beruabari were lying unfilled. 2. Functioning of Rogi Kalyan Samiti (RKS): a. Rogi Kalyan Samiti (RKS) was registered in each of the Block level PHC/CHC in the district. Meeting of executive body of RKS was not being conducted every month. b. RKS fund including Untied Fund and Annual Maintenance Grant etc. are kept at the disposal of Rogi Kalyan Samiti and utilised on the development activities such as repairing of vehicle, electricity and purchasing of equipments etc. It was observed that expenditure incurred at CHC/PHCs was not approved by the RKS. The concerned record was not made available to the team in visited CHC at Sonvani and PHC at Bansdih. c. It was also observed that meetings of advisory body of RKS were not being conducted in the visited centres. 3. Functioning of ASHA Scheme: a. 2567 ASHAs have been selected in the district under the scheme. Out of these 2456 ASHAs were trained and working in the field without having drug kits during 2010-11. No new ASHA was proposed to be inducted during 2011-12 in the district. b. During field visit, 12 ASHAs were interviewed, all were trained and receiving performance based remuneration on an average Rs. 30,000- 35,000 yearly. ASHAs were not given drug kits. 4. Functioning of Village Health & Sanitation Committee (VHSCs): a. It was observed that 833 VHSCs were formed and joint bank account in the name of concerned ANM and Gram Panchayat Pradhan has been opened only in 609 VHSCs to handle the funds. In the year 2010-11 funds @ Rs. 10,000 were provided to each VHSC for undertaking sanitation work in the villages. b. It was reported that every revenue village is provided funds @ Rs. 10,000 under the scheme in the district. The total budget to the tune of Rs. 1,83,10,000 for 1831 revenue villages for the VHSCs in the district was allotted during 2010-11. Records of expenditure were not available at the visited PHC/CHCs/SCs. c. It was reported that Rs. 4,50,000 to CHC Sonvani, Rs. 15,90,000 to PHC Bansdih and Rs. 8,90,000 to PHC Beruabari were released as VHSC fund. d. VHSCs fund was not released to the district during current year 2011-12 up to the month of visit. 5. Untied Funds: a. During the year 2010-11 district had allotted untied funds to the tune of Rs. 36,60,000 for 366 Sub Centres and Rs. 11,50,000 for 10 CHCs and 13 PHCs @ Rs. 10,000 to each Sub Centre and @ Rs. 50,000 to each PHC/CHCs. b. During visit to the centres it was observed that most of the Untied Funds were utilised on maintenance/ beautification of building. c. It was also noticed that Sub Centre level Untied Fund are given to the concerned PHC/ CHC and the Sub Centres who have bank accounts receive funds from PHC/CHC. Every year PHC Bansdih received Untied Fund for its 20 Sub Centres but released the funds to only 14 Sub Centres who have opened their bank accounts. Balance of Rs. 60,000 for 6 Sub Centres is lying unspent at PHC Bansdih every year. d. In the year 2011-12 untied fund was not received from State headquarter till the month of visit by the team. 6. Janani Suraksha Yojana (JSY): a. The district spent Rs. 7,63,83,873 out of funds of Rs. 7,63,88,573 allotted for the year 2010- 11. b. As per details received as many as 37454 beneficiaries were provided cash assistance and there were 5610 beneficiaries waiting for their payments under the scheme during 2010-11 in the district. c. During visit to the centres it was observed that all the registers relating to JSY were maintained properly with relevant details at PHC/ CHC level and also checked by concerned MOs regularly. Cheques to the beneficiaries are provided by the concerned CHC/ PHC directly within a week from date of delivery. Team found that most of the delivered mothers are relieved from the institution within 20 to 24 hours after delivery. d. 65 JSY beneficiaries were contacted in the area of the visited centres in the district. All the beneficiaries stated that they had received cash incentives and services in time. 7. 24x7 delivery care services:

a. 23 institutions were identified to provide 24x7 delivery care services in the district.

b. As reported, total 31755 deliveries were conducted in the year 2010-11 by 23 institutions (PHC/ FRU) in the district. Facilities for caring mothers and new born babies were not adequate in all the visited institutions under the scheme.

c. Baby warmer and Photo therapy machine was not functioning in PHC Bansdih.

8. Physical infrastructure (HSC/PHC/CHC) (i) CHC/ PHCs: a. During visit to the CHC Sonvani, team found that the CHC was functioning in Govt. building but their maintenance was not up to the mark. b. Blood Storage unit, Quinine and Artether injections were not available in CHC Sonvani. c. Visited PHCs at Bansdih and Beruabari were functioning in Govt. buildings. Telephone facility and stock of contraceptive items were not available in the visited PHCs. d. AYUSH Medical Officer was posted in the visited PHCs, but Unani/ Ayurvedic and Homeopathic medicines under this segment were lacking there. 24x7 services are available in the PHCs. (ii) Health Sub Centres: a. Except Sub centre Bigahi all visited Sub centres i.e., centres at Haldi, Halpur, Mudiyari, Sukhpura and Sultanpur were functioning in Govt. buildings. b. It was observed that no delivery was being conducted in the visited Sub centre at Sultanpur. c. RDT kit, Nischay Pregnancy Test Kits, DDKs, Oxytocin tablets, Ampicillin capsules and Gentamycine injection were not available in the visited Sub centres. d. Foot stool, Delivery table, Maclntsh sheet, Ambu bag/suction, Weighing machine (Infant), ORS packets, EC Pills and Paracetamol tablets were not available at Sub centres Haldi and Sultanpur. e. CuT, Oral Pills, Nirodh, Chlorin solution, Co-trimoxazole, Chloroquine, Metronidazole and Paracetamol tablets were not available at Sub centres Haldi, Bigahi and Halpur. f. Antiseptic solution, Chlorin solution, EC Pills, Paracetamol and Metronidazole tablets were not available at Sub centre Sukhpura. g. Electricity, Benches, Delivery kit, BP apparatus, Sanitary Napkins, Vitamin- A and IFA were not available at Sub centre Haldi. h. Foot stool, Ambu bag/suction, ORS packets, DDKs, Vitamin- A and IFA at Sub centre Bigahi, Electricity, Toilet facility, Ambu bag/suction and Steam Sterilizer at Sub centre Halpur, Ambu bag/suction, Steam Sterilizer, Oral Pills and Paracetamol tablets at Sub centre Mudiyari and Antiseptic solution at Sub centre Sultanpur were not available. 9. Assessment and opinion of the Community on Health Services: (i) Services of ANM- a. 54 mothers having child up to one year of age from the area of 6 visited sub centres were interviewed by the team to assess their opinion about the services rendered by the ANMs. b. 12 (22%) mothers were not aware about danger sign of ARI and use of ORS and 10 (18%) replied that their babies were not weighed at the time of birth. 14 (26%) mothers did not receive three Post Natal checkups. c. It was also observed that 37 (68%) mothers were not aware of contraceptive methods and 34 (63%) regarding side effects of contraceptive use. (ii) Services of PHC- a. 30 Persons who were generally utilising the services at visited PHC/CHCs were interviewed and it was found that most of them were satisfied with the services provided by the Medical officers and others staff of PHCs/CHC. b. The team also contacted different target groups like pregnant women, recently delivered women, mother of 2 year old child and village leaders. Team found that about 17% pregnant women are not registered within the 16 weeks of pregnancy and recently delivered women have no knowledge of referral mechanisms. 33% mothers were not aware of the danger sign of sick new born. 10. IT Infrastructure and Mother & Child Tracking System: a. Team found that computers were available at district level and at Block level (one in each Block) though internet connectivity was not available in any visited CHC/ PHC. b. MCH Tracking formats were available in each Sub centres. c. Health functionaries were sensitized in MCH formats at PHC/ CHC level. They are capturing data in the formats and making data entry at PHC/ CHC level through cyber cafe. 11. Registers, records and reports maintained at the visited centres: a. Service registers for IUD, Oral Pills and Nirodh cases were not being maintained at any of the PHC/CHC head quarter. Performance reported under CuT at CHC Sonvani, PHCs at Bansdih and Beruabari could not be verified due to want of consolidated registers. b. Eligible Couple register which is one of the most important records for FW services had not been maintained in the Sub centres at Haldi and Halpur. Monthly Reporting format and Cash book for untied fund were also not maintained in these centres. c. Family Planning services and Stock registers for FW items was not maintained in the visited sub centres at Haldi, Halpur and Sukhpura. d. JSY beneficiary card, ANC and Immunization cards were not found to be maintained at sub centre Halpur.

3. District: Dehat

Major observations of Regional Evaluation Team, Lucknow about the Evaluation work in of Uttar Pradesh in June, 2011

I. Details of the visited Institutions:

District PHCs/CHCs visited SCs visited visited Kanpur CHCs: & Akabarpur Pahadipur, Kahi Jiri, Nariha, Dehat PHC: Muktapur, Bairi Sawai and Sivali

II. Major observations

1. Health Human Resources: a. In the Medical category, 15 posts of MO out of 115 sanctioned and 18 posts of specialist out of 40 sanctioned were lying vacant in the district. b. In the Para-medical category, 77 posts of ANM (out of 285 sanctioned), 91 posts of MPW (M) (out of 100 sanctioned), 56 posts of Health Supervisor (M) (out of 70 sanctioned), 5 posts of Staff Nurse/GNM (out of 34 sanctioned) and 2 posts of Lab Technician (out of 29 sanctioned) were lying vacant. c. In the visited CHC, Rasulabad, 10 of the 34 sanctioned posts of ANM, 13 of the 14 sanctioned posts of MPW (M), 2 of the 4 sanctioned posts of Health Supervisor (F), 2 of the 4 sanctioned posts of Staff Nurse and 4 of the 6 sanctioned posts of specialist were lying vacant. In CHC, Akabarpur, all 3 sanctioned posts of MPW (M), 4 of the 6 sanctioned posts of Health Supervisor (M) and all sanctioned posts of specialist were lying unfilled. d. 5 of the 29 sanctioned posts of ANM, 2 of the 8 sanctioned posts of MPW (M), all 6 sanctioned posts of Health Supervisor (M) and 1 of the 3 sanctioned posts of Staff Nurse in PHC Maitha were lying vacant.

2. Functioning of Rogi Kalyan Samiti (RKS): a. It was reported that Rogi Kalyan Samiti (RKS) was registered in each of the Block level PHCs/CHCs and also in the District Hospital. Meeting of executive body was conducted every month during the year 2010-11. b. Funds including Untied Fund, Annual Maintenance Grant etc. are kept at the disposal of Rogi Kalyan Samiti as RKS fund. Details of expenditure, equipments purchased etc. in the visited CHC/PHCs and the approvals taken from the RKS in this regard were not recorded in the registers. c. It was also observed that meeting of advisory body of RKS was not being conducted in the visited centres. 3. Functioning of ASHA Scheme: a. As reported, 1663 ASHAs were in position out of 1700 selected in the district during 2010-11. 1303 ASHAs were reported to have been trained but working without drug kits. b. In the visited Sub Centres at Pahadipur, Kahi Jiri, Nariha, Muktapur, Bairi Sawai and Sivali, required number of ASHAs were working in the field and trained up to 5th module. c. 8 ASHAs were interviewed and as informed all were trained and receiving an annual average performance based remuneration of about Rs. 3500- 4500. 4. Functioning of Village Health & Sanitation Committee (VHSCs): a. It was reported that 612 VHSCs were formed in 1032 villages and joint bank accounts in the name of concerned ANM and Gram Panchayat Pradhan have also been opened to handle the funds. In the year 2010-11 funds @ Rs. 10,000 were provided to each VHSC for undertaking sanitation work in the villages. b. The total budget for the VHSCs in the district was to the tune of Rs. 1,03,20,000 for 1032 revenue villages during 2010-11. Though the funds were reported to be utilized fully, no details of expenditure were available at district office and also at visited SCs/PHC/CHCs. c. Meetings of the VHSCs were not being conducted regularly in the visited Sub Centres. 5. Untied Funds: a. Details of the budget provision and expenditure incurred in the district for the year 2010-11 are reported as under:

Sr.No Particulars of Untied In the year 2010-11 ( in Rs) Fund For Sub centres For CHCs/PHCs 1 Fund allotted 22,60,000 12,61,500 2 Total Expenditure 22,60,000 12,61,500

b. Funds @ Rs. 10,000 to each Sub centre and @ Rs. 50,000 to each CHC/PHC per year are released by district to block level CHCs/PHCs. But it has been observed that in the jurisdiction of CHC Akabarpur & PHC Maitha Untied Funds @ Rs. 5,000 to each Sub centre were allotted during 2010-11. Fund was not released in the year 2011-12. c. Funds were utilized in contingency and development work like buying of stationary and PVC Goods, printing of OPD and Indoor slip etc. after getting approval in the meeting of RKS. d. Statement of expenditure regarding untied fund at Sub centres was not maintained at CHCs/PHCs or Sub centre level. 6. Janani Suraksha Yojana (JSY): a. Almost all JSY beneficiaries paid with the cash assistance during last two years in the district and no case was pending for the payment in the district during this period. It is reported that 23068 beneficiaries in the year 2010-11 and 2328 beneficiaries during 2011-12 were provided with JSY incentive. b. The district had spent more amount than the allotted budget for the year 2010-11. Out of funds of Rs. 4,25,92,000 allotted to the district for the year 2010-11, the expenditure reported was to the tune of Rs. 4,57,71,062. The excess amount of expenditure Rs. 31,79,062 was met from flexi pool fund. However, in the year 2011-12, the district spent an amount of Rs. 42,96,350 out of alloted fund of Rs. 1,03,00,000 under the scheme. c. The budget provision and expenditure at the visited PHC/CHC is reported as given below:

Sr. Particulars For the year 2010-11 ( in RS) No. CHC Rasulabad CHC Akabarpur PHC Maitha 1 Total fund available 75,61,000 18,89,200 27,68,700 2 Total expenditure under 75,19,000 23,25,900 31,40,300 JSY 3 Total balance amount 42,000 (-) 4,36,700 (-)3,71,600 For the year 2011-12 ( in RS) 1 Total fund available 20,00,000 5,00,000 8,00,000 2 Total expenditure under JSY1,89,300 1,83,400 2,92,400 3 Total balance amount 18,10,700 3,16,600 5,07,600

d. 49 JSY beneficiaries were contacted in the visited area of the Centres in the district for on the field verification. All the beneficiaries stated that they had received incentives through cheque from the concerned CHCs and PHCs. JSY register was maintained properly and that register was regularly checked by the concerned Medical officer. 7. 24x7 delivery care services: a. 12 institutions were identified to provide 24x7 delivery care services in the district. No additional budget for these services was released to these Centres. b. During visit to the Centres, the performance under institutional delivery was found good during 2010-11. 3735 deliveries in CHC Rasulabad, 688 in CHC Akabarpur and 1389 deliveries in PHC Maitha were conducted during 2010-11. Facilities for caring mother and new born baby were there in all the visited institutions under the scheme. 8. Physical infrastructure (HSC/PHC/CHC) (i) CHC/ PHCs: a. During visit to the CHCs Rasulabad and Akbarpur, team found that both the CHC were functioning in Govt. building but their maintenance was not up to the mark. b. Blood Storage unit, Injections Quinine and Arteether were not available in both visited CHCs. c. Visited PHC at Maitha was functioning in Govt. buildings. Jeep was not available at PHC Maitha. d. AYUSH Medical Officer was posted but Pharmacist and medicines under this segment were lacking in the PHC. (ii) Health Sub Centres: a. Visited Sub centres at Pahadipur, Kahi Jiri, Nariha, Muktapur, Bairi Sawai and Maitha were functioning in Govt. buildings. At Sub Centres Nariha and Bairi Sawai, ANMs were not staying at their sub centre head quarters. Electricity was not available at Pahadipur, Kahi Jiri, Nariha and Muktapur sub centres. b. It was observed that delivery was being conducted in the visited Sub centres except at Kahi Jiri, Nariha and Bairi Sawai Sub centres. c. Nischay pregnancy test kit, RDT kit, Heamoglobinometer and Sanitary Napkins were not available in the visited Sub centres. d. ORS packets, DDKs, EC Pills, Oxytocin tablets, Ampicillin capsules and Gentamycine injection were not available at Sub centres Rasulabad, Nariha, Muktapur, Bairi Sawai and Siwali. e. Examination table, Delivery table, Maclntsh sheet, Ambu bag/suction, Steam sterilizer, Stove, Weighing machine (Infant), BP apparatus, Gloves, IFA tablets, Cloroquine, Paracetamol, Metronidazole and Co-trimoxazole tablets were not available at Sub centre Nariha. f. Steam sterilizer, ORS packets and EC Pills at Sub Centre Pahadipur, Ambu bag/suction and BP apparatus in Sub Centre at Rasulabad, DDK, Gloves and ORS packets at Sub Centre Muktapur, Ambu bag/suction, Steam sterilizer, Delivery kit, Stove, Vitamin- A, IFA and Co- trimoxazole tablets at Sub Centre Bairi Sawai and Steam sterilizer, IFA, Cloroquine and Co- trimoxazole tablets at Sub Centre Siwali were not available. 9. Assessment and opinion of the Community on Health Services: (i) Services of ANM- a. 54 mothers having child up to one year of age from the area of 6 visited sub centres were interviewed by the team to assess their opinion about the services rendered by the ANMs. b. 24 (44%) Mothers were not aware about danger sign of ARI, 17 (31%) were not aware about use of ORS and 5 (9%) replied that their babies were not weighed at the time of birth. 6 (11%) mothers did not receive three Post Natal checkups. c. It was also observed that 27 (50%) mothers did not know about side effects of contraceptive methods. (ii) Services of PHC- a. 30 Persons who were generally utilising the services at visited PHC/CHCs were interviewed and it was found that they were satisfied with the services provided by the Medical officers and others staff of PHCs/CHC. b. The team also contacted persons from different target groups like pregnant women, recently delivered women, mother of 2 year old child and village leaders. Team found that all pregnant women are registered within the 16 weeks of pregnancy and also aware about danger sign in pregnancy, breast feeding practices and referral mechanisms.

10. IT Infrastructure and Mother & Child Tracking System: a. Team found that computers were available at district level and at Block level (one in each Block) but internet connectivity was not available in any visited CHC/ PHC. b. MCH Tracking formats were available in each Sub centres. c. Health functionaries were sensitized in MCH formats at PHC/ CHC level. They are capturing data in the formats and making data entry at PHC/ CHC level through cyber cafe. 11. Registers, records and reports maintained at the visited centres: a. Performance reported under CuT at CHCs Rasulabad, Akbarpur and PHC at Maitha could not be verified due to want of consolidated registers. Oral Pills and Nirodh distribution registers were not maintained properly in the centres visited. b. Eligible Couple register, Cash book for untied fund and VHSC proceeding registers were not being maintained at any of the visited centres. c. Registers for Family Planning services, Stock book, Monthly Reporting format and Cash book for untied fund were not supplied in printed form to Sub Centres by higher authority.

4. District: Hamirpur Major observations of Regional Evaluation Team, Lucknow about the Evaluation work in Hamirpur district of Uttar Pradesh in June, 2011

II. Details of the visited Institutions:

District PHCs/CHCs visited SCs visited visited Hamirpur CHC: Maudaha Makaraw, Maudaha (Dehat), PHCs: Bharua Sumerpur & Muskara Lalpur, Chandra Purawa, Niwada and Chili

II. Major observations

1. Health Human Resources: a. 28 posts of MO out of 58 sanctioned and 18 posts of specialists out of 28 sanctioned were lying vacant in the district. b. Similarly, skilled personnel under Para Medical category like 66 ANMs (out of 249 sanctioned), 78 MPWs (M) (out of 81 sanctioned), 9 LHV/ Health Supervisors (F) (out of 41 sanctioned) and one sanctioned post each of District Account Manager & District Data Account Assistant, 7 Staff Nurse/ GNM (out of 13 sanctioned) and 3 Lab Technician (out of 14 sanctioned) were also lying vacant in the district. c. In the visited CHC, Maudaha, 29 of the 40 sanctioned posts of ANM, all 18 sanctioned posts of MPW (M), all 6 sanctioned posts of specialist and 1 of the 3 sanctioned posts of Staff Nurse were vacant. d. One sanctioned post each of Lab Technician, ICC and UDC in PHC, B. Sumerpur, 7 of the 29 sanctioned posts of ANM, 14 of the 16 sanctioned posts of MPW (M) and 1 of the 4 sanctioned posts of Health Supervisor (F) in PHC Muskara were lying vacant. 2. Functioning of Rogi Kalyan Samiti (RKS): a. Rogi Kalyan Samiti (RKS) was registered in each of the Block level PHC/CHC in the district. b. RKS fund including Untied Fund and Annual Maintenance Grant etc. are kept at the disposal of Rogi Kalyan Samiti. Meeting of executive body of RKS were being conducted for the approval of incurring expenditure on the development activities. c. It was also observed that meetings of advisory body of RKS were not being conducted in the visited centres. 3. Functioning of ASHA Scheme: a. 866 ASHAs have been selected in the district under the scheme. Out of these 803 ASHAs were trained and working in the field without having drug kits during 2010-11. No new ASHA was proposed to be inducted during 2011-12 in the district. b. During field visit, 15 ASHAs were interviewed, all were trained and receiving performance based remuneration on an average Rs. 40,000- 45,000 yearly. ASHAs were not given drug kits. 4. Functioning of Village Health & Sanitation Committee (VHSCs): a. It was observed that 506 VHSCs were formed and joint bank account in the name of concerned ANM and Gram Panchayat Pradhan has been opened in all VHSCs to handle the funds. b. It was reported that every revenue village is provided funds @ Rs. 10,000 under the scheme in the district. The total budget to the tune of Rs. 50,60,000 for 506 revenue villages for the VHSCs in the district was allotted during 2010-11. Funds were mostly utilised for conducting activities of sanitation & repairing of drains, spray, sanitation and filling up of pits, fogging & bleaching work etc. c. It was reported that Rs. 9,10,000 to CHC Maudaha, Rs. 8,70,000 to PHC B. Sumerpur and Rs. 6,10,000 to PHC Muskara were released as VHSC fund. d. VHSCs fund was not released to the district during current year 2011-12 up to the month of visit. 5. Untied Funds: a. During the year 2010-11, district had allotted untied funds to the tune of Rs. 21,50,000 for 214 Sub Centres and out of that funds Rs. 21,20,000 was utilised for strengthing of sub centre services. b. During the year 2010-11 district had allotted untied funds to the tune of Rs. 13,00,000 for 3 CHCs, @ Rs. 50,000 for 5 PHCs and @ Rs. 25,000 for 36 Addl. PHCs. It was observed that the maximum fund were utilised on the development activities such as repairing of vehicle, electricity, repairing of window glass, purchasing of chair, bench, invertors and battery etc. c. In the year 2011-12 untied fund was not received from State headquarter till the month of visit by the team. 6. Janani Suraksha Yojana (JSY): a. During the year 2010-11, district had spent to the tune of Rs. 3,41,64,000 out of allotted funds of Rs. 3,67,66,880. Similarly, an amount of Rs. 27,40,950 was utilised against the available amount of Rs. 67,02,880 during current year. b. As per details received as many as 18946 beneficiaries in the year 2010-11 and 1585 beneficiaries of current year were paid incentive under the scheme. c. The budget provision and expenditure at the visited PHC/CHC is reported as given below:

Sr. Particulars For the year 2010-11 ( in RS) No. CHC Maudaha PHC B. Sumerpur PHC Muskara 1 Total fund available 73,03,880 69,33,050 47,17,750 2 Total expenditure under JSY70,27,300 67,01,900 44,86,450 3 Total balance amount 2,76,580 2,31,150 1,31,300 For the year 2011-12 ( in RS) 1 Total fund available 12,76,580 12,31,150 3,31,300 2 Total expenditure under JSY58,500 5,76,550 3,08,850 3 Total balance amount 6,96,580 6,54,600 22,450

d. During visit to the centres, it was observed that all the registers relating to JSY were maintained properly with relevant details at PHC/ CHC level and also checked by concerned MOs regularly. Cheques to the beneficiaries are provided by the concerned CHC/ PHC directly within a week from date of delivery. Team found that most of the delivered mothers are discharged from the institution within 20 to 24 hours after delivery. e. 53 JSY beneficiaries were contacted in the area of the visited centres in the district. All the beneficiaries stated that they had received cash incentives and services in time. 7. 24x7 delivery care services:

a. 8 institutions were identified to provide 24x7 delivery care services in the district.

b. As reported, total 18946 deliveries were conducted in the year 2010-11 by 8 institutions (PHC/ FRU) in the district. Facilities for caring mothers and new born babies were not adequate in all the visited institutions under the scheme.

8. Physical infrastructure (HSC/PHC/CHC) (i) CHC/ PHCs: a. During visit to the CHC Maudaha, team found that the CHC was functioning in Govt. building but their maintenance was not up to the mark. b. Blood Storage unit and Incinerator were not available in CHC Maudaha. c. Visited PHCs at B. Sumerpur and Muskara were functioning in Govt. buildings but their maintenance was not up to the mark. d. AYUSH Medical Officer was posted in the visited PHCs, but Unani/ Ayurvedic and Homeopathic medicines under this segment were lacking there. 24x7 services are available in the PHCs. (ii) Health Sub Centres: a. All visited Sub centres i.e., centre at Makaraw, Maudaha (Dehat), Lalpur, Chandra Purawa, Niwada and Chili were functioning in Govt. buildings. b. It was observed that no delivery was being conducted in the visited Sub centre at Maudaha (Dehat). c. RDT kit, Nischay Pregnancy Test Kits, DDKs, Oxytocin tablets, Ampicillin capsules and Gentamycine injection were not available in the visited Sub centres. d. Co-trimoxazole and Metronidazole tablets were not available at Sub centres Makaraw and Lalpur. e. Thermometer, Gloves, ORS packets, Examination table, Steam Sterilizer, BP apparatus, Metronidazole and Paracetamol tablets were not available at Sub centre Maudaha Dehat. f. ORS packets, EC Pills, Vitamin- A, Chlorin solution and Sanitary Napkins at Sub centre Makaraw, Chloroquine and Paracetamol tablets at Sub centre Lalpur, Ambu bag/suction at Sub centre Chandra Purawa, Steam Sterilizer, CuT insertion kit, ORS packets, Chloroquine and Co-trimoxazole tablets at Sub centre Niwada, ORS packets and Kerosene oil at Sub centre Chili were not available. 9. Assessment and opinion of the Community on Health Services: (i) Services of ANM- a. 54 mothers having child up to one year of age from the area of 6 visited sub centres were interviewed by the team to assess their opinion about the services rendered by the ANMs. b. 15 (33%) mothers were not aware about danger sign of ARI, 7 (13%) use of ORS and 100% replied that their babies were not weighed at the time of birth. 2 (4%) mothers did not receive three Post Natal checkups. c. It was also observed that 13 (24%) mothers were not aware of contraceptive methods and 9 (17%) regarding side effects of contraceptive use. (ii) Services of PHC- 30 Persons who were generally utilising the services at visited PHC/CHCs were interviewed and it was found that most of them were satisfied with the services provided by the Medical officers and others staff of PHCs/CHC. 10. IT Infrastructure and Mother & Child Tracking System: a. Team found that computers were available at district level and at Block level (one in each Block) though internet connectivity was not available in any visited CHC/ PHC. b. MCH Tracking formats were available in each Sub centres. c. Health functionaries were sensitized in MCH formats at PHC/ CHC level. They are capturing data in the formats and making data entry at PHC/ CHC level through cyber cafe. 11. Registers, records and reports maintained at the visited centres: a. Service registers for IUD, Oral Pills and Nirodh cases were not being maintained at any of the PHC/CHC head quarter. Performance reported under CuT at CHC Maudaha, PHCs at B.Sumerpur and Muskara could not be verified due to want of consolidated registers. b. Eligible Couple register which is one of the most important records for FW services had not been maintained in the Sub centres at Makaraw and Niwada. c. Family Planning services, Monthly Reporting format and Cash book for untied fund were not maintained at all the visited centres. d. Stock registers for FW items was not maintained in the visited sub centres at Makaraw, Maudaha (Dehat), Lalpur, Chandra Purawa and Chili. e. JSY beneficiary card, ANC and Immunization cards were not found to be maintained at sub centres Lalpur and Chili.

5. District: Major observations of Regional Evaluation Team, Lucknow about the Evaluation work in Meerut and district of Uttar Pradesh in July, 2011

I. Details of the visited Institutions:

District PHCs/CHCs visited SCs visited visited Meerut CHC: Sardhana Kusawali, Salva, Bijauli, PHCs: Kharakauda and Pipli Khera, Makhan Nagar, Ganeshpur and More Khurd

II. Major observations 1. Health Human Resources: a. 63 posts of ANM (out of 377 sanctioned), 119 posts of MPW (M) (out of 142 sanctioned), 4 posts of LHV/HS (F) (out of 86 sanctioned), 30 posts of Health Supervisor (M) (out of 89 sanctioned), 5 posts of Staff Nurse/GNM (out of 43 sanctioned) and 7 posts of Lab Technician (out of 24 sanctioned) were lying vacant in the district. Position of Medical Officer and Specialist was not readily available in the district office. b. In the visited CHC, Sardhana, 4 of the 29 sanctioned posts of ANM, all 10 sanctioned posts of MPW (M), 2 of the 7 sanctioned posts of Health Supervisor (M), 3 of the 8 sanctioned posts of Medical officer and 1 of the 6 sanctioned posts of specialist were lying vacant. c. In PHC, Hastinapur, 8 of the 25 sanctioned posts of ANM, all 14 sanctioned posts of MPW (M), 1 of the 5 sanctioned posts of LHV, 5 of the 8 sanctioned posts of Health Supervisor (M) and 5 of the 12 sanctioned posts of Medical officer were lying unfilled. 4 of the 23 sanctioned posts of ANM, 11 of the 12 sanctioned posts of MPW (M) and 2 of the 8 sanctioned posts of Health Supervisor (M) were lying vacant in PHC Kharkhoda. 2. Functioning of Rogi Kalyan Samiti (RKS): a. It was reported that Rogi Kalyan Samiti (RKS) was registered in each Block level PHC/CHC and also in the District (Male & Female) Hospitals. Meeting of executive body was conducted every month during the year 2010-11. b. Funds including Untied Fund and Annual Maintenance Grant etc. are kept at the disposal of Rogi Kalyan Samiti as RKS fund. Details of expenditure, equipments purchased etc. in the visited CHC/PHCs and the approvals taken from the RKS in this regard were not recorded in the registers. c. It was observed that meeting of advisory body of RKS was not being conducted in the visited centres. 3. Functioning of ASHA Scheme: a. As reported, 1375 ASHAs were in position out of 1431 selected in the district during 2010-11. 1110 ASHAs were reported to have been trained but are working without drug kits in the district. b. In the visited Sub Centres at Kusawali, Salva, Bijauli, Pipli Khera, Makhan Nagar, Ganeshpur and More Khurd, required number of ASHAs were working in the field and they were observed to be trained up to 4th module. c. 20 ASHAs were interviewed in the area of 7 HSCs visited. All were trained and receiving an annual average performance based remuneration of about Rs. 3500- 4500. ASHA is a member of VHSC. 4. Functioning of Village Health & Sanitation Committee (VHSCs): a. It was reported that 460 VHSCs have been formed and funds were being operated by opening joint bank accounts in the name of concerned ANM and Gram Panchayat Pradhan. In the year 2010-11 funds @ Rs. 10,000 were provided to the VHSCs for each revenue village for undertaking sanitation work in the villages. b. The total budget for the VHSCs in the district was allotted to the tune of Rs. 67,40,000 for 674 revenue villages through CHCs/ PHCs and out of that Rs. 59,95,000 spent by the VHSCs during 2010-11. c. It was observed that, entire amount of Rs. 67,40,000 provided by the district was not released by CHCs/ PHCs to the VHSC for the revenue villages during 2010-11 due to non-opening of joint accounts by some of the VHSCs and about Rs. 1,80,000 were kept in the account of different CHCs/PHCs. The team reported that in PHC Hastinapur account opened only for 18 VHSCs out of 23 VHSCs. Similarly, in PHC Kharkhonda the fund received for 34 VHSCs but accounts are operated only in 29 VHSCs. d. During visit to the centres, it was observed that the funds are being utilized, but no details of expenditure were available at district office and also visited SCs/PHCs/CHC. Meetings of the VHSCs were not being conducted regularly in the visited Sub Centres. 5. Untied Funds: a. Untied Fund @ Rs. 10,000 to each Sub centre, @ Rs. 50,000 to each CHC/PHC and Rs. 25,000 to Addl. PHC is provided through block level CHCs and PHCs in every year in the district. No untied fund was released to the institutions during the year 2011-12. Details of the fund provision and expenditure incurred in the district for the year 2010-11 are reported as under: Sr.No Particulars of Untied In the year 2010-11 ( in Rs) Fund For Sub centres For CHCs/PHCs 1 Fund allotted 31,90,000 13,75,000 2 Total Expenditure 29,74,906 13,27,477 3 Total Balance 2,15,094 47,523

b. It was also observed that CHCs and PHCs provided Untied Funds to the Sub centres where bank accounts are opened. In CHC Sardhana, 26 SCs opened accounts out of 28, in PHC Hastinapur, 18 SCs opened accounts out of 23 and in PHC Kharkhoda, 17 SCs opened accounts out of 22. The amount received from district office meant for the SCs with no bank account has kept in the respective CHC/ PHC account. c. Team visited 7 Sub centres and found that ANMs are not updated their Cashbook/ Passbook of untied fund. Out of 7 Sub centres, 5 Sub centres utilised funds for purchasing BP apparatus digital, Hubcutter, Weighing scale, ANM bag lock etc. In Sub Centre Piplikhera funds were not utilised due to non cooperation of village Pradhan and in Sub Centre Makhanpur record was not made available to the team. d. At the CHC/ PHC level, Untied Fund utilized as per norms in contingency and development work like buying of stationary and banner of Sub centre, Weighing Machine, Examination table, BP apparatus, Hubcutter lock, Invertor with battery, repairing of ILR X-ray film, printing of Immunisation card, OPD and Indoor slip etc. after getting approval from RKS. e. Statement of expenditure regarding untied fund at Sub centres was not maintained at CHCs/PHCs or at Sub centres. 6. Janani Suraksha Yojana (JSY): a. During the year 2010-11, district had spent funds to the tune of Rs. 3,13,65,250 out of allotted funds of Rs. 3,37,98,000. Similarly, an amount of Rs. 53,55,000 was utilised against the available amount of Rs. 1,14,07,750 during current year up to June, 2011. b. As per details received as many as 18141 JSY beneficiaries in the year 2010-11 and 3311 JSY beneficiaries in current year up to June, 2011 have been paid with cash incentive under the scheme. c. The budget provision and expenditure at the visited PHC/CHC as reported is given below: Sr. No. Particulars For the year 2010-11 ( in RS) CHC Sardhana PHC Hastinapur PHC Kharkhoda 1 Total fund available 46,66,700 15,89,850 13,88,400 2 Total expenditure under 45,76,450 13,92,200 13,93,100 JSY 3 Total balance amount 90,250 1,97,650 (-) 4,700 For the year 2011-12 ( in RS) 1 Total fund available 10,90,250 1,97,650 2,95,300 2 Total expenditure under 8,61,800 2,20,500 2,75,300 JSY 3 Total balance amount 2,28,450 (-) 22,850 20,000

d. 47 JSY beneficiaries were contacted in the area of visited Centres in the district. All the beneficiaries stated that they had received incentives through cheque from the concerned CHCs/ PHCs within a week from the date of delivery. JSY registers found maintained but was not being checked by the concerned Medical Officer regularly. 7. 24x7 delivery care services: a. 13 institutions were identified to provide 24x7 delivery care services in the district. No additional budget for these services was released to these Centres. b. During visit to the Centres, the performance under institutional delivery was found good during 2010-11. 1154 deliveries in CHC Sardhana, 130 in PHC Hastinapur and 215 deliveries in PHC Kharkhoda were conducted during 2010-11. Facilities for caring mother and new born baby were there in all the visited institutions under the scheme. 8. Physical infrastructure (HSC/PHC/CHC) (i) CHC/ PHCs: a. CHC Sardhana was functioning in Govt. building. New building was under construction. b. Seting up of Blood Storage unit was under process in the CHC. Jeep, Injections Quinine and Arteether were not available in CHC Sardhana. c. Visited PHCs at Hastinapur and Kharkhoda were functioning in Govt. buildings. Both the PHCs were having required equipments and other supplies. d. AYUSH Pharmacist and relating medicines were not available in the visited PHCs. (ii) Health Sub Centres: a. Visited Sub centres at Kusawali, Salva, Bijauli, Pipli Khera, Makhan Nagar, Ganeshpur and More Khurd were functioning in Govt. buildings. At Sub Centres Kusawali, Salva, Bijauli and Makhan Nagar, ANMs were not staying at their Sub Centre head quarters. b. It was observed that labour room was available but no delivery was being conducted in the visited Sub Centres except at Sub Centre Makhan Nagar. c. Nischay Pregnancy Test Kit, RDT Kit, Heamoglobinometer, Sanitary Napkins, Oxytocin Tablets, Ampicillin Capsules and Gentamycine Injection were not available in the visited Sub Centres. d. Ambu bag/suction and Steam sterilizer were not available at Sub centres Bijauli, Pipli Khera and Makhan Nagar. e. ORS packets, DDKs and EC Pills were not available at Sub Centres Kusawali, Salva and Pipli Khera. f. Delivery Kit, Bleaching Powder, Cloroquine and Metronidazole tablets at Sub Centre; Kusawali, Ambu bag/suction and Disposable syringes at Sub Centre Salva; Examination table, DDKs, Nirodh, Co-trimoxazole and Cloroquine tablets at Sub Centre Bijauli; Foot stool, Delivery table, Delivery kit, Gloves, ORS packets, Vitamin- A and Co-trimoxazole tablets at Sub Centre Pipli Khera; EC Pills, Cloroquine and Metronidazole tablets at Sub Centre Ganeshpur and DD kits at Sub Centre More Khurd were not available. 9. Assessment and opinion of the Community on Health Services: (i) Services of ANM- a. 63 mothers having child up to one year of age from the area of 7 visited sub centres were interviewed by the team to assess their opinion about the services rendered by the ANMs. b. 37 (59%) Mothers were not aware about danger sign of ARI, 12 (19%) were not aware about use of ORS and 4 (6%) replied that their babies were not weighed at the time of birth. 13 (21%) mothers did not receive three Post Natal checkups. c. It was also observed that 28 (44%) mothers were not sufficiently aware of contraceptive methods.

(ii) Services of PHC- a. 35 Persons who were generally utilising the services at visited PHCs/CHC were interviewed and it was found that they were satisfied with the services provided by the Medical officers and others staff of PHCs/CHC. b. The team also contacted persons from different target groups like pregnant women, recently delivered women, mother of 2 year old child and village leaders in the PHCs/ CHC areas. Mostly people were satisfied with the services provided at PHCs and CHC. 10. IT Infrastructure and Mother & Child Tracking System: a. Team found that computers were available at district level and at Block level (one in each Block) but internet connectivity was not available in the visited CHC/ PHCs. b. MCH Tracking formats were available in each Sub centre. c. Health functionaries were sensitized in MCH formats at PHC/ CHC level. They are capturing data in the formats and making data entry at PHC/ CHC level through cyber cafe. 11. Registers, records and reports maintained at the visited centres: a. Performance reported under CuT at CHC Sardhana and PHCs at Hastinapur and Kharkhoda could not be verified due to want of service registers. Oral Pills and Nirodh distribution registers were also not maintained properly in the centres visited. b. Eligible Couple register, Cash book for untied fund and VHSC proceeding registers were not being maintained at any of the visited centres. c. Registers for Family Planning services, Stock book, Monthly Reporting format and Cash book for untied fund were not supplied in printed forms to Sub Centres by higher authority.

6. District: Mathura Major observations of Regional Evaluation Team, Lucknow about the Evaluation work in of Uttar Pradesh in July, 2011

II. Details of the visited Institutions:

District PHCs/CHCs visited SCs visited visited Mathura CHCs: Gobardhan and Farah Adig, Radha Khurd and Oal

II. Major observations

1. Health Human Resources: a. 15 posts of MO out of 108 sanctioned and 6 posts of specialists out of 14 sanctioned were lying vacant in the district. b. Similarly, skilled personnel under Para Medical category like 56 ANMs (out of 256 sanctioned), 100 MPWs (M) (out of 107 sanctioned), 16 Staff Nurse/ GNM (out of 24 sanctioned) and 4 Lab Technician (out of 14 sanctioned) posts were also lying vacant in the district. c. In the visited CHC, Gobardhan, 5 of the 26 sanctioned posts of ANM, 6 of the 7 sanctioned posts of MPW (M), 3 of the 7 sanctioned posts of Health Supervisors (M) and 2 of the 6 sanctioned posts of Staff Nurse were vacant. Similarly, 1 of the 20 sanctioned posts of ANM, 6 of the 7 sanctioned posts of MPW (M) and 1 of the 3 sanctioned posts of LHVs/Health Supervisor (F), 3 of the 10 sanctioned posts of Health Supervisor (M) and 2 of the 6 sanctioned posts of Staff Nurse were lying vacant in CHC Farah. 2. Functioning of Rogi Kalyan Samiti (RKS): Rogi Kalyan Samiti (RKS) was registered in 11 Block level PHC/CHC and 2 District level hospitals in the district. Registers and records which are required for assessing the functioning of RKSs were not made available to the team in the visited CHCs. 3. Functioning of ASHA Scheme: a. As reported, 1341 ASHAs were in position out of 1544 selected in the district during 2010-11. 1110 ASHAs were reported to have been trained but were working without drug kits. 81 new ASHAs were proposed to be inducted during 2011-12 in the district. b. During visit to the Sub Centres areas, 7 ASHAs were interviewed, and they were trained and receiving performance based remuneration on an average Rs. 3,000- 4,000 yearly. ASHA was not a member in any VHSC in the district. 4. Functioning of Village Health & Sanitation Committee (VHSCs): a. It was observed that 479 VHSCs were formed but joint bank account in the name of concerned ANM and Gram Panchayat Pradhan has been opened in 476 VHSCs to handle the funds. b. It was reported that every revenue village is provided funds @ Rs. 10,000 under the scheme in the district. The total budget to the tune of Rs. 87,50,000 for 875 revenue villages in the district was allotted during 2010-11. Though, the funds were reported to be utilized fully, but no details of expenditure were available at district office and also in the visited SCs/PHC/CHCs. c. Meetings of the VHSCs were not being conducted regularly in the visited Sub Centres. d. VHSCs fund was not released to the district during current year 2011-12 up to the month of visit. 5. Untied Funds: a. During the year 2010-11 district had allotted untied funds to the tune of Rs. 21,50,000 for 215 Sub Centres and the amount was utilised fully for strengthing the services of the Sub Centre. But it was observed that expenditure incurred on untied fund at the Sub Centres are not maintained at district level and also at the Sub Centre level. Also, no alloted fund was utilised in the visited Sub centres at Adig and Radhakund. b. Apart from the above, district had allotted untied funds to the tune of Rs. 12,00,000 for CHCs/PHCs during the year 2010-11 and Rs. 1,07,207 utilised on the development activities i.e. Street light with fitting and sodium light, glass window, purchasing of Chair and Notice Board etc. c. In the year 2011-12 untied fund was not received in the district from State headquarter till the month of visit by the team. 6. Janani Suraksha Yojana (JSY): a. 21236 JSY mothers in the year 2010-11 and 4759 mothers in current the year up to June, 2011 benefited with cash incentive under the scheme in the district. The district had spent Rs. 3,99,50,950 out of allotted funds of Rs. 4,58,00,000 in the year 2010-11. There was an expenditure of Rs. 85,95,250 against the available fund of Rs. 84,49,050 during current year up to June 2011 in the district. b. During visit to the centres, it was observed that all the registers relating to JSY were maintained properly with relevant details except date of relieving from institution at PHC/ CHC level. Register was not checked by concerned MOs regularly. c. 17 JSY beneficiaries were contacted in the area of the visited centres in the district. All the beneficiaries stated that they had received cash incentives and services in time. Cheques to the beneficiaries are provided by the concerned CHC/ PHC directly within a week from date of delivery. Team found that most of the delivered mothers are relieved from the institution within 10 to 20 hours after delivery. 7. 24x7 Delivery Care Services:

a. 11 institutions were providing 24x7 delivery care services in the district. No additional budget was released to these Centres. b. As reported, total 21236 deliveries were conducted in the year 2010-11 by 11 institutions (PHC/ FRU) in the district. It was reported that facilities for caring mothers and new born babies were adequate in all the visited institutions under the scheme.

8. Physical infrastructure (HSC/PHC/CHC) (i) CHC/ PHCs: a. CHCs Gobardhan and Farah were functioning in Govt. buildings. CHC Gobardhan is situated out of locality and maintenance of the hospital was not up to the mark. b. Facility for Ambulance/ Jeep, Blood Storage unit and bio-medical waste disposal etc. were not available in the visited CHCs. c. Short supply of Injections Quinine and Artether was observed in the CHCs. (ii) Health Sub Centres: a. Sub centres visited at Adig, and Oal were functioning in Govt. buildings. At Sub Centres Adig and Radha Kund, ANMs were not staying at their sub centre head quarters. b. It was observed that no delivery was being conducted in all the visited Sub Centres. c. Ambu bag/suction, Steam Sterilizer, BP apparatus, Heamoglobinometer, RDT kit, Nischay Pregnancy Test Kits, Sanitary Napkins, EC Pills, Thermometer, DDKs, Bleaching powder, Cloroquine, Oxytocin tablets, Ampicillin capsules and Gentamycine injection were not available in the visited Sub Centres. d. Delivery kit, Weighing machine (Adult & Infant), Gloves, Stove, Kerosene oil and CuT were not available at Sub Centres Adig and Radha Kund. e. Oral Pills and Metronidazole tablets at Sub Centre Adig, Electricity, Toilet, Examination table, Delivery table, Disposable syringes and CuT insertion kit at Sub centre Radha Kund and Torch, Stove, AD and Disposable syringes at Sub Centre Oal were not available. 9. Assessment and opinion of the Community on Health Services: (i) Services of ANM- a. 27 mothers having child up to one year of age from the area of 3 visited Sub Centres were interviewed by the team to assess their opinion about the services rendered by the ANMs. b. 16 (59%) mothers were not aware about danger sign of ARI, 10 (37%) did not know about the use of ORS and 6 (22%) mothers did not receive three Post Natal checkups. c. It was also observed that 19 (70%) mothers were not sufficiently aware of contraceptive methods. (ii) Services of PHC- 35 Persons who were generally utilising the services at visited CHCs were interviewed and it was found that most of them were satisfied with the services provided by the Medical Officers and others staff of the CHCs. In the visiting area, proper attention to register the AN mothers within 16 weeks of pregnancy and improve the awareness about danger sign of sick new born need to be increased. 10. IT Infrastructure and Mother & Child Tracking System: a. Team found that computers were available at district level and at Block level (one in each Block) though internet connectivity was not available in any visited CHC/ PHC. b. MCH Tracking formats were available in each Sub centres. c. Health functionaries were sensitized in MCH formats at PHC/ CHC level. They are capturing data in the formats and making data entry at PHC/ CHC level through cyber cafe. 11. Registers, records and reports maintained at the visited centres: a. Service registers for IUD, Oral Pills and Nirodh cases were not being maintained at any of the PHC/CHC head quarter. Performance reported under CuT at CHCs Gobardhan and Farah could not be verified due to want of service registers. b. Eligible Couple register which is one of the most important records for FW services had not been maintained in any of the visited Sub centres. c. Cash book for untied fund and VHSC proceeding registers were not being maintained at any of the visited centres. d. Registers for Family Planning services, Stock book, Monthly Reporting format and Cash book for untied fund were not supplied in printed forms to Sub Centres by higher authority.

7.District: Major observations of Regional Evaluation Team, Lucknow about the Evaluation work carried out in of Uttar Pradesh in August, 2011 I. Details of the visited Institutions:

District visited PHCs/CHCs visited SCs visited Farrukhabad CHCs: Kayamganj and Nawabganj Raipur, , Pahadpur, PHC: Faijbag Bhatasa, Kainmini, Rajendra Nagar and Mohd. Pur Dhani

II. Major observations 1. Health Human Resources: a. 34 posts of Specialist (out of 36 sanctioned), 17 posts of ANM (out of 229 sanctioned), 74 posts of MPW (M) (out of 77 sanctioned), 5 posts of LHV/HS (F) (out of 38 sanctioned), 34 posts of Health Supervisor (M) (out of 46 sanctioned), 8 posts of Staff Nurse/GNM (out of 24 sanctioned) and 9 posts of Lab Technician (out of 24 sanctioned) were lying vacant in the district. b. In CHC, Kayamganj, 7 of the 33 sanctioned posts of ANM, 8 of the 9 sanctioned posts of MPW (M), all 4 sanctioned posts of Health Supervisor (M), 3 of the 4 sanctioned posts of Medical officer, 5 of the 7 sanctioned posts of specialist and 1 of the 2 sanctioned posts of Lab Technician were lying vacant. Similarly, 4 of the 26 sanctioned posts of ANM, all 5 sanctioned posts of MPW (M), 2 of the 5 sanctioned posts of LHV, all 5 sanctioned posts of Health Supervisor (M), 2 of the 4 sanctioned posts of Medical officer, all 6 sanctioned posts of specialist and 1 of the 3 sanctioned posts of Staff Nurse in CHC Nawabganj were lying vacant. c. In PHC, Faizbag, 3 of the 29 sanctioned posts of ANM, 5 of the 6 sanctioned posts of MPW (M), 4 of the 6 sanctioned posts of LHV, all 6 sanctioned posts of Health Supervisor (M), 1 of the 6 sanctioned posts of Medical officer, 2 sanctioned posts each of Staff Nurse and Lab Technician were lying unfilled. 2. Functioning of Rogi Kalyan Samiti (RKS): a. It was reported that Rogi Kalyan Samiti (RKS) was registered in each of the Block level PHCs/CHCs and also in the District (Male & Female) Hospital. Meeting of executive body was conducted every month during the year 2010-11. b. Funds including Untied Fund and Annual Maintenance Grant etc. are kept at the disposal of Rogi Kalyan Samiti as RKS fund. Details of expenditure (equipments purchased etc. in the visited CHC/PHCs) and the approvals taken from the RKS in this regard were not recorded in the registers. c. It was also observed that meeting of advisory body of RKS was not being conducted in the visited centres. 3. Functioning of ASHA Scheme: a. As reported, 1449 ASHAs were in position out of 1497 selected in the district during 2010-11. 1147 ASHAs were reported to have been trained but are working without drug kits in the district. b. In the visited Sub Centres at Raipur, Pahadpur, Bhatasa, Kainmini, Rajendra Nagar and Mohd. Pur Dhani, required numbers of ASHAs were working in the field and trained up to 4th module. No ASHA is posted in Sub Centre at Kampil. c. 7 ASHAs were interviewed in the area of 7 HSCs visited. All were trained and receiving an annual average performance based remuneration of about Rs. 3500- 4500. ASHA is involved in each VHSNC as a member. 4. Functioning of Village Health Sanitation & Nutrition Committee (VHSNCs): a. It was reported that 917 VHSNCs have been formed covering 1008 villages and funds were being operated by opening joint bank accounts in the name of concerned ANM and Gram Panchayat Pradhan. In the year 2010-11, funds @ Rs. 10,000 were provided to each revenue village for undertaking sanitation work in the villages. b. The total budget for the VHSNCs in the district was allotted to the tune of Rs. 1,00,80,000 for 1008 revenue villages through CHCs / PHCs and out of that Rs. 91,70,000 spent by the VHSNCs during 2010-11. c. During visit to the centres, the funds reported to be utilized, but no details of expenditure were available at visited SCs. Meetings of the VHSNCs were not being conducted regularly in the visited Sub Centres. 5. Untied Funds: a. Untied Fund @ Rs. 10,000 to each Sub centre, @ Rs. 50,000 to each CHC/PHC and @ Rs. 25,000 to Addl. PHC are provided through block level CHCs and PHCs in every year in the district. No untied fund was released to the institutions during the year 2011-12. Details of the fund provision and expenditure incurred in the district for the year 2010-11 are reported as under: Sr. Particulars of Untied In the year 2010-11 ( in Rs) No Fund For Sub centres For CHCs/PHCs 1 Fund allotted 18,50,000 9,00,000 2 Total Expenditure 18,50,000 6,06,201 3 Total Balance Nil 2,93,799

b. Team visited 7 Sub centres and found that ANMs had not updated their Cashbook/ Passbook of untied funds. Out of 7 Sub centres, 3 Sub centres utilised the fund for purchasing chair, gas cylinder, bed sheet, table cloth, bucket, jug and stationary etc. Funds were not provided to the Sub centre Khinmini. c. At the CHC/ PHC level, Untied Funds were utilized as per norms in contingency and development work like buying of Inverter with battery, stationary, construction of Generator-set shadow and white wash in CHC Kayamganj, white wash in CHC Nawabganj and printing of OPD and Indoor slip, purchasing of stationary, LCD & DVD, Inverter with battery, gen set & cold chain equipment and electricity fitting in PHC Faizbag etc. after getting approval of RKS. d. Statement of expenditure regarding untied funds was not updated/ maintained in the visited Sub centres. 6. Janani Suraksha Yojana (JSY): a. During the year 2010-11, district had spent funds to the tune of Rs. 2,96,92,700 out of allotted budget of Rs. 3,42,37,450. Similarly, an amount of Rs. 87,00,700 was utilised against the available amount of Rs. 2,43,96,750 during current year up to July, 2011. b. As per details received, as many as 16,446 JSY beneficiaries in the year 2010-11 and 4,864 JSY beneficiaries in current year up to July, 2011 have been paid with cash incentive under the scheme. c. The budget provision and expenditure at the visited PHC/CHCs is as reported given below:

Sr. No. Particulars For the year 2010-11 ( in Rs) CHC Kayamganj CHC Nawabganj PHC Faizbag 1 Total fund available 59,00,500 35,94,580 29,35,427 2 Total expenditure under 55,88,100 37,33,950 27,51,450 JSY 3 Total balance amount 3,12,400 8,64,630 1,83,977 For the year 2011-12 up to July, 2011 ( in Rs) 1 Total fund available 23,24,800 8,64,630 8,65,100 2 Total expenditure under 19,53,750 6,51,150 7,12,500 JSY 3 Total balance amount 3,71,050 2,13,480 1,52,600

d. 29 JSY beneficiaries were contacted in the area of visited Centres in the district. All the beneficiaries stated that they had received incentives through cheque from the concerned CHCs and PHCs within a week of the date of delivery. Most of the mothers informed that they were discharge within 10 to 15 hours from the hospital after delivery. JSY registers were found maintained properly except date of relieving from the hospital. 7. 24x7 delivery Care Services: a. 7 institutions were identified to provide 24x7 delivery care services in the district. No additional budget for these services was released to these Centres. b. During visit to the Centres, the performance under institutional delivery was found good during 2010-11. 806 out of total 1407 deliveries in CHC Nawabganj and 452 out of total 1035 deliveries in PHC Faizbag were reported to have been conducted in night hours during 2010- 11. c. Facilities for caring mother and new born baby were adequate in all the visited institutions under the scheme. 8. Physical infrastructure (HSC/PHC/CHC) (i) CHC/ PHCs: a. Visited CHCs at Kayamganj and Nawabganj were functioning in Govt. building but the maintenance of the hospitals was not up to the mark. b. Blood Storage unit was not set up in both the visited CHCs. Incinerator was not available there but bio-medical waste is handed over to the agency outsourced and listed by the district office but that service is not provided since last 6 months. Injections Quinine and Arteether were not available in the visited CHCs. c. Visited PHC at Faizbag was functioning in Govt. building. Except Jeep most of the required equipments and other supplies were found available in the PHC. d. AYUSH Medical Officer was not posted in this PHC. (ii) Health Sub Centres: a. Out of 7 visited Sub centres, 6 Sub centres i.e. Raipur, Kampil, Bhatasa, Kainmini, Rajendra Nagar and Mohd. Pur Dhani were functioning in Govt. buildings and Sub Centre Pahadpur was functioning in a rented accommodation. At Sub Centres Kinmini, Rajendra Nagar and Mohd. Pur Dhani, ANMs were not staying at their Sub Centre head quarters. b. It was observed that labour room was available in 6 Sub Centres but delivery was not being conducted in the visited Sub centres. c. Ambu bag/suction, Nischay pregnancy test kit, RDT kit, Heamoglobinometer, Sanitary Napkins, DDKs, Oxytocin tablets, Ampicillin capsules and Gentamycine injection were not available in the visited Sub centres. d. Co-trimoxazole, Cloroquine tablets and Bleaching powder were not available at Sub centres Pahadpur, Bhatasa and Khainmini. e. Co-trimoxazole, Cloroquine, IFA tablets and EC Pills at Sub Centre Raipur, Antiseptic solution, Bleaching powder, Disposable syringes, EC Pills and Nirodh at Sub Centre Kampil, Examination table, Foot stool, Weighing machine (Infant), Metronidazole tablets and Nirodh at Sub Centre Pahadpur, Foot stool, Gloves, ORS packets, Vitamin- A, EC Pills and Nirodh at Sub Centre Bhatasa, Weighing machine (Infant), Antiseptic solution and Metronidazole tablets at Sub Centre Khinmini, Weighing machine (Infant), Steam sterilizer, ORS packets, Cloroquine, Metronidazole tablets, EC Pills and Nirodh at Sub Centre Rajendra Nagar, Delivery kit, Gloves, ORS packets, Co-trimoxazole tablets and Bleaching powder at Sub Centre Mohd. Pur Dhani were not available. 9. Assessment and opinion of the Community on Health Services: (i) Services of ANM- a. 63 mothers having child up to one year of age from the area of 7 visited sub centres were interviewed by the team to assess their opinion about the services rendered by the ANMs. b. 21 (33%) Mothers were not aware about danger sign of ARI, 16 (25%) were not aware about use of ORS and 20 (32%) replied that their babies were not weighed at the time of birth. 14 (22%) mothers did not receive three Post Natal checkups. c. It was also observed that 24 (38%) mothers were not sufficiently aware of contraceptive methods. (ii) Services of PHC- a. 35 Persons who were generally utilising the services at visited PHC/CHCs were interviewed and it was found that they were satisfied with the services provided by the Medical officers and others staff of PHC/CHCs. b. The team also contacted persons from different target groups like pregnant women, recently delivered women, mother of 2 year old child and village leaders in the PHC/ CHC areas. Mostly people were satisfied with the services provided at PHC and CHCs. In the visiting area, proper attention to register the AN mothers within the 16 weeks of pregnancy and improve the awareness about danger sign of sick new born need to be increased. 10. IT Infrastructure and Mother & Child Tracking System: a. Team found that computers were available at district level and at Block level (one in each Block). Internet connectivity was available at district and CHC level only. b. MCH Tracking formats were available in each Sub centres. c. Health functionaries were sensitized in MCH formats at PHC/ CHC level. They are capturing data in the formats and making data entry at PHC/ CHC level through cyber cafe. 11. Registers, records and reports maintained at the visited centres: a. Performance reported under CuT at CHCs Kayamganj, Nababganj and PHC at Faijbag could not be verified due to want of service registers. Oral Pills and Nirodh distribution registers were also not maintained properly in the centres visited. b. Eligible Couple register, Cash book for untied fund and VHSC proceeding registers were not being maintained at any of the visited centres. c. Printed registers for Family Planning services, Stock book, Monthly Reporting format and Cash book for untied fund were not supplied to Sub Centres.

8.District: Hardoi Major observations of Regional Evaluation Team, Lucknow about the Evaluation work carried out in of Uttar Pradesh in August, 2011

II. Details of the visited Institutions:

District visited PHCs/CHCs visited SCs visited Hardoi District Women Hospital Hardoi Jaraua, Harriya and Behata PHCs: Kothawa and Bhawan

II. Major observations 1. Health Human Resources: a. Though the staff position for the posts of MO, specialist, Staff Nurse/ GNM and Lab Technician was not made available to the team, Some of skilled personnel under Para Medical category like 30 ANMs (out of 488 sanctioned), 23 MPWs (M) (out of 76 sanctioned), 26 LHVs/Health Supervisor (F) (out of 81 sanctioned) and 71 posts of Health Supervisors (M) (out of 128 sanctioned) were reported to be lying vacant in the district. b. Under district Programme Management Unit of NRHM, posts of the District Programme Manager and the District Account Manager were lying vacant in the district. c. In the visited PHC, Kothawan, 5 of the 23 sanctioned posts of ANM, 7 of the 8 sanctioned posts of MPW (M), 1 each of the 4 each sanctioned posts of LHV and Health Supervisor (M), both sanctioned posts of Staff Nurse and 2 of the 9 sanctioned posts of Medical Officer were vacant. Similarly, 4 of the 30 sanctioned posts of ANM, all 10 sanctioned posts of MPW (M), 2 of the 4 sanctioned posts of LHVs/Health Supervisor (F) and all 7 sanctioned posts of Health Supervisor (M) in PHC Bawan were lying unfilled. 2. Functioning of Rogi Kalyan Samiti (RKS): a. Rogi Kalyan Samiti (RKS) was registered in 11 Block level PHC/CHC and 2 District level hospitals in the district. b. Registers and records which required for assessing the functioning of RKS were not made available to the team in the visited PHCs. 3. Functioning of ASHA Scheme: a. As reported, 2747 ASHAs were in position out of 2865 selected in the district during 2010-11. 2608 ASHAs trained up to 5th module but were working without drug kits in the district. b. During visit to the Sub centres at Jaraua, Harriya and Gokul Behata, it was observed that ASHAs were trained up to 4th module and drug kits were given in two places. 4 ASHAs were interviewed, all were receiving performance based remuneration on an average Rs. 3,000- 4,000 yearly. ASHA is involved in each VHSNC as a member. 4. Functioning of Village Health Sanitation & Nutrition Committee (VHSNCs): a. As reported, 1101 VHSNCs were functioning in 1901 revenue villages in the district and joint bank account in the name of concerned ANM and Gram Panchayat Pradhan has been opened in the all 1101 VHSNCs to handle the funds. b. As reported, every revenue village is given Rs. 10,000 every year as VHSNC fund under the scheme in the district. Though there was unspent amount of Rs. 10,56,000, the district had provided Rs. 1,81,24,000 for the year 2010-11. No details of expenditure were available at district office as well as in the visited SCs/PHCs. c. Meetings of the VHSNCs were not being conducted regularly in the visited Sub Centres. d. VHSNCs fund was not released to the district during current year 2011-12 up to the month of visit. 5. Untied Funds: a. Provision of Untied Fund and expenditure at Sub centre and PHC level during 2010-11 in the district are reported as under:

Sr. Particulars of Untied In the year 2010-11 ( in Rs) No Fund For Sub centres For CHCs/PHCs 1 Fund allotted 57,80,000 17,75,920 2 Total Expenditure 55,77,296 16,77,389 3 Total Balance 2,02,704 98,531

No Untied Fund was released to the institutions in the district during the year 2011-12. b. In the visited 3 Sub Centres, the team observed that ANMs had not updated their Cashbook/ Passbook of untied funds. Out of 3 Sub Centres, 2 Sub Centres i.e. Jaraua and Behatagokul utilised funds for purchasing of BP apparatus, Hub cutter, Uristix, Phenyl, Dari, Bed sheet, Chair and Table etc. In Sub Centre Harriya fund was not utilised. c. Untied Funds were utilized as per norms in contingency and development work like repairing of vehicle, buying of Diesel, plantation and pits for waste disposal by PHC Kothawan. Record regarding utilisation of untied fund was not made available to the team in PHC Bawan. 6. Janani Suraksha Yojana (JSY): a. 55,776 JSY mothers in the year 2010-11 and 11,213 mothers in the current year up to June, 2011 benefited with cash incentive under the scheme in the district. b. The district had spent funds to the tune of Rs. 10,71,71,410 out of allotted funds of Rs. 10,92,99,916 in the year 2010-11. Similarly, there was an expenditure of Rs. 1,98,31,650 against the available fund of Rs. 2,57,32,000 during the current year up to June, 2011 under JSY in the district. c. During visit to the centres it was observed that JSY fund was sufficiently available there and all the registers relating to JSY services were maintained properly. In District Female Hospital, Hardoi, yearly number, date of admission and date of discharge from institution were not recorded in the register. d. 27 JSY beneficiaries were contacted out of 29 selected in the area of the visited centres in the district for on the spot verification. All the beneficiaries stated that they had received cash incentives and services in time. Cheques to the beneficiaries are provided by the concerned DH/ PHC directly within a week from date of delivery. Team found that most of the delivered mothers are relieved from the institution within 10 to 12 hours of delivery due to insufficient availability of beds/ space. 7. 24x7 Delivery Care Services:

a. 18 institutions were providing 24x7 delivery care services in the district. No additional budget for these services was released to these Centres. b. As reported, 55776 deliveries in the year 2010-11 were conducted in the district. It was reported that facilities for caring mothers and new born babies were adequate in the visited PHC Kothawan. As many as 674 deliveries in the night hours out of total 3408 deliveries conducted in PHC Kothawan were reported during 2010-11.

8. Physical infrastructure (HSC/PHC/DH): (i) District Women Hospital, Hardoi: a. Blood Storage unit is available at District Male Hospital, Hardoi and services are being taken from DMH Hardoi. Bio-medical waste disposal system is being provided by NGO in the Hospital. b. As against the sanctioned strength of 64 beds, 82 beds are available in the DWH, Hardoi. Moreover some of the existing beds needed repair or condemnation. There was short supply of Injections Quinine and Artether observed in the hospital. (ii) PHCs: a. PHCs Kothawan and Bawan were functioning in Govt. buildings. PHC Bawan is situated out of locality and maintenance of the hospital was not up to the mark. Ambulance/ Jeep were not provided there. In PHC Kothawan, Jeep was found off road and Cold Chain Equipments were kept in district headquarter, Hardoi. b. Short supply of Oral Pills was observed in both visited PHCs. (ii) Health Sub Centres: a. Sub centres visited at Harriya and Gokul Behata were functioning in Govt. buildings. However, Sub Centres Jaraua was not having Govt. accommodation. ANMs were not staying at their Sub Centre head quarters. b. It was observed that no delivery was being conducted in Sub centres at Jaraua and Harriya in spite of having labour room facility. c. Electricity, RDT kit, Nischay Pregnancy Test Kits, Sanitary Napkins, Heamoglobinometer, ORS packets, EC Pills, DDKs, Paracetamol, Oxytocin tablets, Ampicillin capsules and Gentamycine injection were not available in the visited Sub centres. d. Delivery table, Ambu bag/suction, Torch and Stove were not available at Sub centres Jaraua and Harriya. e. Foot stool, Thermometer, IFA and Metronidazole tablets were not available at Sub centres Jaraua and Gokul Behata. f. Examination table, Delivery kit, Steam Sterilizer, Weighing machine (Adult),Oral Pills, Bleaching powder and Cloroquine tablets at Sub centres Jaraua, Kerosene oil and Disposable syringes at Sub centre Harriya were not available. 9. Assessment and opinion of the Community on Health Services: (i) Services of ANM- a. 27 mothers having child up to one year of age from the area of 3 visited sub centres were interviewed by the team to assess their opinion about the services rendered by the ANMs. b. 6 (22%) mothers were not aware about danger sign of ARI, 1 (4%) about use of ORS and 3 (11%) replied that their babies were not weighed at the time of birth. 3 (11%) mothers did not receive three Post Natal checkups. c. It was also observed that 15 (56%) mothers were not sufficiently aware about contraceptive methods. (ii) Services of PHC- 15 Persons who were generally utilising the services at visited PHCs were interviewed and it was found that most of them were satisfied with the services provided by the Medical officers and others staff of PHCs. 10. IT Infrastructure and Mother & Child Tracking System: a. Team found that computers were available at district level and at Block level (one in each Block) though internet connectivity was not available in any visited PHCs. b. MCH Tracking formats were available in each Sub centre. c. Health functionaries were sensitized in MCH formats at PHC/ CHC level. They are capturing data in the formats and making data entry at PHC/ CHC level through cyber cafe. 11. Registers, records and reports maintained at the visited centres: a. Service registers for IUD; Oral Pills and Nirodh cases were not being maintained at any of the PHC head quarters. Performance reported under CuT at PHCs Kothawan and Bawan could not be verified due to want of service registers. b. Eligible Couple register which is one of the most important records for FW services had not been maintained in any of the visited Sub centres. c. Cash book for untied fund and VHSC proceeding registers were not being maintained at any of the visited centres. d. Printed registers for Family Planning services, Stock book and Cash book for untied fund were not supplied to Sub Centres.

9. District: Lucknow

Major observations of Regional Evaluation Team, Lucknow about the Evaluation work carried out in of Uttar Pradesh in September, 2011

I. Details of the visited Institutions:

District visited PHCs/CHCs visited SCs visited Lucknow CHCs: Bakhsi Ka Talab, Shivpuri, Madiyaw, Sonawa, Tikara, Nigoha, Mohanlal Ganj and Mall Lalpur, Ranipara and Narainpur

II. Major observations

1. Health Human Resources: a. The sanctioned staff strength as a whole in the district was not available at district office. Therefore, the team couldn’t assess the staff position vis-à-vis sanctioned strength. However, as observed Contractual staff required in the district was mostly filled in. There were 7 Specialists, 11 Medical officers, 15 Staff Nurses and 30 ANMs posted in the district on contractual basis. b. All the posts in DPMU i.e. District Programme Manager, District Account Manager, District Community Mobilizer and Data Entry Operator were filled in. c. In CHC, Bakhsi Ka Talab, 2 of the 32 sanctioned posts of ANM, 26 of the 32 sanctioned posts of MPW (M), 2 each of 6 sanctioned posts each of Health Supervisor (M) and Health Supervisor (F) and 3 of the 6 sanctioned posts of Staff Nurse were lying vacant. Similarly, 4 of the 52 sanctioned posts of ANM, 10 of the 14 sanctioned posts of MPW (M), 2 of the 8 sanctioned posts of Health Supervisor (F), 3 of the 9 sanctioned posts of Health Supervisor (M), 2 of the 6 sanctioned posts of Staff Nurse, 3 of the 8 sanctioned posts of Medical officer and 5 of the 8 sanctioned posts of Specialist were lying vacant in CHC Mohanlal Ganj. d. In PHC Mall, 21 of the 36 sanctioned posts of ANM, 8 of the 12 sanctioned posts of MPW (M), 5 of the 6 sanctioned posts of each of Health Supervisor (M) and Health Supervisor (F), 2 of the 3 sanctioned posts of Staff Nurse, 1 of the 6 sanctioned posts of Medical officer and 2 of the 6 sanctioned posts of Specialist were lying vacant.

2. Functioning of Rogi Kalyan Samiti (RKS): a. It was reported that Rogi Kalyan Samiti (RKS) was registered in each of the Block level PHCs/CHCs and also in the District (Male & Female) Hospitals. Meeting of executive body was conducted every month during the year 2010-11. b. The grant received under this head in every year is kept at the disposal of Rogi Kalyan Samiti as RKS fund. Details of expenditure made for developmental activities in the visited CHC/PHCs and the approvals taken from the RKS in this regard were not recorded in the registers. c. It was also observed that meeting of advisory body of RKS was not being conducted in the visited centres. 3. Functioning of ASHA Scheme: a. As reported, 1454 ASHAs were selected and in position in the district during 2010-11. 1214 ASHAs were reported to have been trained but were working without drug kits in the district. No new ASHA proposed to be inducted in the district. b. In the visited Sub Centres at Shivpuri, Sonawa, Tikara, Nigoha, Lalpur, Ranipara and Narainpur, required numbers of ASHAs were working in the field and trained up to 4th module. c. 8 ASHAs were contacted in the area of HSCs visited; as informed they were trained and receiving an annual average performance based remuneration of about Rs. 5000- 6000. ASHA is involved in each VHSNC as a member. 4. Functioning of Village Health Sanitation & Nutrition Committee (VHSNCs): a. It has been reported that 511 VHSNCs were functioning in all 835 revenue villages in the district and joint bank account in the name of concerned ANM and Gram Panchayat Pradhan has been opened in all 511 VHSNCs to handle funds. In the year 2010-11, funds @ Rs. 10,000 were provided to each revenue village for undertaking sanitation work in the villages. b. The total budget for the VHSNCs in the district was allotted to the tune of Rs 83,40,000 for 835 revenue villages through CHCs/ PHCs, but no details of expenditure were available at visited CHCs/ PHCs/SCs and also district headquarter office for the 2010-11. c. During visit to the centres, team found that the district had released Rs. 11,60,000 as VHSNCs fund to CHC Mohanlal Ganj, but CHC had shown an amount of Rs. 4,10,000 in the record and also no details of expenditure were made available to the team. District had allotted Rs. 9,50,000 to CHC Bakhsi Ka Talab as VHSNCs fund for 95 revenue villages though 19 revenue villages of this CHC were already covered under the same scheme by Nagar Panchayat fund. d. During visit to the centres, the funds reported to be utilized, but no details of expenditure were available at visited SCs. ANMs of visited SC stated that funds were utilised by Village Pradhan and they didn’t receive the vouchers and records, so records was not maintained at Sub Centre level. This put a question mark on proper utilisation of funds. e. it was observed that meetings of the VHSNCs were not being conducted regularly in the visited Sub Centres. 5. Untied Funds: a. Untied Funds @ Rs. 10,000 to each Sub centre, @ Rs. 50,000 to each CHC/PHC and @ Rs. 25,000 to Addl. PHC were provided through block level PHCs and CHCs in every year in the district. b. Details of the fund provided and expenditure incurred in the district for the year 2010-11 are reported as under: Sr. Particulars of Untied Fund In the year 2010-11 ( in Rs) No For Sub centres For CHCs/PHCs 1 Fund allotted 34,30,000 11,25,000 2 Expenditure incurred 6,10,000 3,96,818 3 Balance 28,20,000 24,97,861 c. No untied fund was released to the institutions during the year 2011-12. d. It was observed that, ANMs have not updated their Untied funds, Cashbook/ Passbook as untied fund for Sub Centres in the year 2010-11 was released in the month of March/ April 2011 by CHCs. e. During visit to the centres, team found that the district had released Rs. 3,60,000 to PHC Mall and Rs. 4,00,000 to CHC Mohanlal Ganj for the year 2010-11 for their Sub Centre as untied funds but PHC Mall showed only an amount of Rs. 1,80,000 in the record and CHC Mohanlal Ganj showed Rs. 5,00,000 in its record. The record of expenditure was not made available to the team at visited institutions at PHC Mall, CHCs Mohanlal Ganj and Bakhsi Ka Talab regarding utilization of untied funds. f. As reported to the team, Untied Funds were utilized for buying of Inverter with battery, stationary, POL of vehicle, electrical equipments and printing of OPD and discharge slip in PHC Mall. Similarly, this funds were also utilised for making arrangement of drinking water and civil work in CHC Bakhsi Ka Talab and purchased Inverter with battery, stationary, POL of vehicle, electrical equipments and printing of OPD and discharge slip etc. in CHC Mohanlal Ganj. 6. Janani Suraksha Yojana (JSY): a. During the year 2010-11, district had spent funds to the tune of Rs. 6,60,91,808 out of allotted budget of Rs. 7,16,38,802 under the scheme. Similarly, an amount of Rs. 2,34,65,437 was utilised against the available amount of Rs. 4,21,30,000 during current year (up to August, 2011). b. As per details received, as many as 45,532 JSY beneficiaries in the year 2010-11 and 16,798 JSY beneficiaries in current year up to August, 2011 have been paid with cash incentive under the scheme. c. The budget provision and expenditure at the visited PHC/CHCs is reported as below: Sr. Particulars For the year 2010-11 ( in Rs) No. CHC Bakhsi Ka CHC Mohanlal Ganj CHC Mall Talab 1 Total fund available 22,31,530 54,87,790 54,50,000 2 Total expenditure under JSY 18,44,400 51,40,800 54,49,549 3 Total balance amount 3,87,130 3,46,990 451 For the year 2011-12 up to August, 2011 ( in Rs) 1 Total fund available 1,50,000 17,00,000 23,00,000 2 Total expenditure under JSY 1,20,370 16,33,300 NA 3 Total balance amount 29,630 66,700 NA

d. 41 JSY beneficiaries were contacted in the area of visited Centres in the district. All the beneficiaries stated that they had received incentives through cheque from the concerned CHCs / PHCs within a week of the date of delivery. Most of the mothers were relieved from the hospital within 10 to 20 hours of delivery. JSY registers found to be maintained properly and checked by concerned MOs regularly. 7. 24x7 Delivery Care Services: a. 9 institutions were identified to provide 24x7 delivery care services in the district. No additional budget for these services was given to these Centres. b. It was reported that out of 18,274 institutional deliveries conducted by 24x7 institutions/ FRUs in the year 2010-11, 9323 deliveries were conducted in the night hours. c. In the visited CHC Mohanlalganj, 765 deliveries were reported to were conducted in night hours during 2010-11. Such records were not maintained at CHC Bakhsi Ka Talab and PHC Mall. Facilities for caring mother and new born baby were found to be satisfactory in all the visited institutions under the scheme. 8. Physical infrastructure (HSC/PHC/CHC) (i) CHCs/ PHC: a. Visited CHCs at Bakhsi Ka Talab and Mall were functioning in Govt. building but the maintenance of the hospitals was not up to the mark. b. Jeep, Blood Storage unit was not available in both visited CHCs. Incinerator was not available there but bio-medical waste is handed over to the agency outsourced and listed by the district office. Injections Quinine and Arteether were not available in the visited CHCs. c. Visited FRU at Mohanlalganj was functioning in Govt. buildings but the maintenance of the hospital was not up to the mark. Blood Storage unit was non functional in the CHC. Incinerator was not available there but bio-medical waste is handed over to the agency outsourced and listed by the district office. Injections Quinine and Arteether were not available there. (ii) Health Sub Centres: a. Out of 8 visited Sub centres 7 Sub centres i.e. Shivpuri, Madiyaw, Sonawa, Tikara, Nigoha, Lalpur and Narainpur were functioning in Govt. buildings and Sub Centre Ranipara was functioning in Panchayat building. ANMs were not staying at their Sub Centre head quarters at Sub Centres Shivpuri, Tikara and Ranipara. b. It was observed that labour room was available in 6 Sub Centres i.e. Shivpuri, Sonawa, Tikara, Nigoha, Lalpur and Narainpur but deliveries were being conducted in the Sub centres at Nigoha and Lalpur only. c. Ambu bag/suction, Nischay pregnancy test kit, RDT kit, Heamoglobinometer, Sanitary Napkins, DDKs and EC Pills were not available in the visited Sub centres. No supply of Kits- A & B was observed in the visited Sub centres at Shivpuri, Madiyaw, Nigoha, Lalpur, Ranipara and Narainpur d. Oxytocin tablets, Ampicillin capsules and Gentamycine injection were not available at Sub centres Shivpuri, Madiyaw, Sonawa, Tikara, Nigoha, Lalpur and Ranipara. e. Some of the equipments Mclntsh sheet, Delivery kits, Steam Sterilizer, IUD insertion kit, Delivery table and Steam Sterilizer were not mostly available at the centres visited. f. ORS packets, Co-trimoxazole and IFA tablets need to be made available at the Sub Centres. g. CuT, Oral Pills, Nirodh, Cloroquine and Bleaching powder were not available at Sub centres Madiyaw and Sonawa. Cloroquine, Bleaching powder and Metronidazole tablets were not available at Sub centres Tikara and Ranipara. h. Weighing machine (Adult/Infant), BP apparatus, Nirodh and Antiseptic solution at Sub Centre Shivpuri, Gloves and Metronidazole tablets at Sub Centre Madiyaw, Examination table at Sub Centre Sonawa, Thermometer, Oral Pills, Antiseptic solution and Paracetamol tablets at Sub Centre Tikara, CuT, Oral Pills and Cloroquine at Sub Centre Nigoha, Vitamin- A and Cloroquine at Sub Centre Lalpur, Examination table, Gloves and Nirodh at Sub Centre Ranipara were not available. 9. Assessment and opinion of the Community on Health Services: (i) Services of ANM- a. 72 mothers having child up to one year of age from the area of 8 visited sub centres were interviewed by the team to assess their opinion about the services rendered by the ANMs. b. 40 (56%) mothers were not aware about danger sign of ARI, 21 (29%) were not aware about use of ORS and 5 (7%) replied that their babies were not weighed at the time of birth. 27 (38%) mothers did not receive three Post Natal checkups. c. It was also observed that 43 (60%) mothers were not sufficiently aware of contraceptive methods and 37 (51%) mothers about its side effects. (ii) Services of PHC- a. 40 Persons who were generally utilising the services at visited PHC/CHCs were interviewed and it was found that they were satisfied with the services provided by the Medical officers and others staff of PHCs/CHC. b. The team also contacted persons from different target groups like pregnant women, recently delivered women, mother of 2 year old child and village leaders in the PHC/ CHC areas. Mostly people were mostly satisfied with the services provided at PHCs and CHC. However, proper attention to register the AN mothers within the 16 weeks of pregnancy and improve the awareness about danger sign of pregnancy, sick new born care and breast feeding practices need to be increased.

10. IT Infrastructure and Mother & Child Tracking System: a. Team found that computers were available at district level and at Block level (one in each Block). However, Internet connectivity was available at district and CHC level only. b. MCH Tracking formats were available in each Sub centres. c. Health functionaries were sensitized in MCH formats at PHC/ CHC level. They are capturing data in the formats and making data entry at PHC/ CHC level through cyber cafe. 11. Registers, records and reports maintained at the visited centres: a. Performance reported under CuT at CHCs Bakhsi Ka Talab, Mohanlal Ganj and Mall could not be verified due to want of service registers. Oral Pills and Nirodh distribution registers were also not maintained in the centres visited. b. Eligible Couple register, Cash book for untied funds and VHNSC proceeding registers were not being maintained at any of the visited centres. c. Printed Registers for Family Planning services, Stock book, Monthly Reporting format and Cash book for untied fund were not supplied to Sub Centres by higher authority.

10. District: Rampur

Major observations of Regional Evaluation Team, Lucknow about the Evaluation work carried out in of Uttar Pradesh in September, 2011

II. Details of the visited Institutions:

District visited PHCs/CHCs visited SCs visited Rampur CHCs: Swar and Kumariya Kala, Milak Khanam, Keorar and PHC: Rajpura Loha Bhola Hata

II. Major observations

1. Health Human Resources: a. Some of the skilled personnel under Medical and Para Medical category like 63 posts of ANM (out of 244 sanctioned), 5 posts of LHVs/Health Supervisor (F) (out of 40 sanctioned), 14 posts of Medical Officer (out of 107 sanctioned), 15 posts of Specialist (out of 25 sanctioned) and 3 Staff Nurse/ GNM (out of 15 sanctioned) were reported to be lying vacant in the district as a whole. b. Under Programme Management Units of NRHM, posts of the District Programme Manager and 1 post of Block Data Entry Operator was lying vacant in the district. c. In the visited CHC Swar, 15 of the 34 sanctioned posts of ANM, 3 each of the 6 sanctioned posts each of LHVs and Health Supervisors (M) and 5 of the 6 sanctioned posts of specialists were vacant. As per the records provided, 2 of the 7 sanctioned posts of specialists were laying vacant in CHC Milak. d. 5 of the 43 sanctioned posts of ANM, all 5 sanctioned posts of MPW (M), one each of the 5 sanctioned posts of each LHV and Health Supervisor (M) and only sanctioned post of Staff Nurse was lying vacant in PHC Rajpura. 2. Functioning of Rogi Kalyan Samiti (RKS): a. Rogi Kalyan Samiti (RKS) was registered in each Block level PHC/CHC in the district. Meeting of executive body was conducted every month in a year. b. Funds including Untied Fund and Annual Maintenance Grant etc. are kept at the disposal of Rogi Kalyan Samiti as RKS fund. It was observed that expenditure was incurred in the visited CHC/PHCs for development activities without taking prior approval from the RKS. c. It was also observed that meeting of advisory body of RKS was not being conducted in the visited centres. 3. Functioning of ASHA Scheme: a. As reported, 1500 ASHAs were in position out of 1535 selected in the district during 2010-11. All of them were trained up to 5th module but working without drug kits in the district. No new ASHA was proposed to be inducted during 2011-12. b. During visit to the Sub centres at Kumariya Kala, Milak Khanam, Keorar and Loha Bhola Hata, 12 ASHAs were interviewed and as intimated most of them were receiving performance based remuneration on an average Rs. 30,000- 35,000 yearly. 4. Functioning of Village Health Sanitation & Nutrition Committee (VHSNCs): a. It was reported that 580 VHSNCs were functioning for 1089 revenue villages in the district and joint bank account in the name of concerned ANM and Gram Panchayat Pradhan has been opened in 580 all VHSNCs to handle the funds. b. As reported, every revenue village is given Rs. 10,000 every year as VHSNC fund under the scheme in the district. The district had received Rs. 1,08,90,000 as VHSNC funds for the year 2010-11 and allotted funds to VHSNC though PHC/CHC, but no details of expenditure were available at district office as well visited SCs/PHCs. 5. Untied Funds: a. Untied Funds @ Rs. 10,000 to each Sub centre, @ Rs. 50,000 to each CHC/PHC and @ Rs. 25,000 to Addl. PHC are provided through block level CHCs and PHCs in every year in the district. b. Details of the fund provision and expenditure incurred in the district for the year 2010-11 are reported as under: Sr. Particulars of Untied Fund In the year 2010-11 ( in Rs) No For Sub centres For CHCs/PHCs 1 Fund allotted 21,10,000 10,50,000 2 Total Expenditure 21,10,000 NA

c. In the year 2010-11 district had released Rs. 10,50,000 to CHCs/PHCs as untied funds, but record regarding utilisation of fund were not made available during visit of team. No Untied Fund was released to the institutions in the district during the year 2011-12. d. ANM of Sub Centre Kumariya Kala reported that she couldn’t withdraw Sub Centre untied fund due to non cooperation of Gram Pradhan of respective villages. It was observed that ANMs were not updating their Cashbook/ Passbook of untied funds. e. As reported, Untied Funds were utilized for buying of Inverter with battery, stationary, wring of cold chain equipment, electrical equipments and water cooler in PHC Rajpura. Similarly, this funds also utilised for purchased of Inverter with battery, stationary, POL of vehicle, electrical equipments and printing of OPD and discharge slip etc. in CHC Swar. 6. Janani Suraksha Yojana (JSY): a. During the year 2010-11, district had spent funds to the tune of Rs. 2,70,93,210 more than allotted budget of Rs. 2,70,11,900. Similarly, an amount of Rs. 99,93,700 was utilised against the available amount of Rs. 1,88,13,000 during current year up to August, 2011. b. As per details received, as many as 15,120 JSY beneficiaries in the year 2010-11 and 5,869 JSY beneficiaries in current year up to August, 2011 have been paid with cash incentive under the scheme. c. The budget provision and expenditure at the visited PHC/CHCs is a reported given below: Sr. Particulars For the year 2010-11 ( in Rs) No. CHC Swar PHC Rajpura FRU Milak 1 Total fund available 23,14,200 23,00,000 NA 2 Total expenditure under JSY 25,63,000 25,36,300 45,75,100 3 No. of JSY mothers paid incentive 1394 282 3282 For the year 2011-12 up to August, 2011 ( in Rs) 1 Total fund available 16,00,000 4,50,000 24,00,000 2 Total expenditure under JSY 14,45,000 7,69,169 16,90,600 3 No. of JSY mothers paid incentive 780 123 1227

d. 28 JSY beneficiaries were contacted out of 47 selected in the area of visited Centres in the district. All the beneficiaries stated that they had received incentives through cheque by the concerned CHCs and PHCs within a week from the date of delivery. Most of the mothers were relieved from the hospital within 10 to 20 hours of delivery. JSY registers were maintained properly and checked by concerned MOs regularly. e. During visit to the CHC at Swar and PHC at Rajpura, it was observed that most of the funds were utilised against the allotted budget under the scheme during 2010-11 and in the year 2011-12 up to August 2011. 7. 24x7 Delivery Care Services:

a. 24x7 delivery care services was implemented in the district. b. During visit to the district, the report regarding institutional/ night hours delivery conducted by institutions was not made available to the team by the district office. c. In the visited centres, all 915 deliveries in CHC Swar and 915 out of 3282 deliveries in FRU Milak were reported to have been conducted in night hours during 2010-11. Number of deliveries conducted at night hours was not maintained at PHC Rajpura. Facilities for caring mother and new born baby found to be satisfactory in all the visited institutions under the scheme. 8. Physical infrastructure (HSC/PHC/CHC/FRU): (i) CHC/FRU: a. During visit to the CHC Swar and FRU Milak, it was observed that, Blood Storage unit, Jeep and Anesthesia equipment and Bio-medical waste disposal system were not available at CHC Swar. b. FRU Milak was functioning in CHC building but their maintenance was not up to the mark. Blood Storage unit was available there but the same was not functional till the time visit of team. As against the sanctioned strength of 30 beds, 40 beds were available in the FRU Milak. c. Short supply of Injections Quinine and Artether was observed in CHC Swar and FRU Milak. (ii) PHCs: a. PHC Rajpura is functioning in Govt. building but maintenance of the hospital was not up to the mark. PHC is situated 2.5 KM away from main road. Telephone facility not available there. Most of the PHC staff and Doctor are were available in the PHC but sitting at another CHC building at Milak. b. AYUSH Medical Officer was posted in this PHC, but Ayurvedic medicines under this segment were lacking there. Without Medical Officer, 24x7 services were being provided in the PHC.

(ii) Health Sub Centres: a. Sub Centres visited at Milak Khanam, Keorar and Loha Bhola Hata were functioning in Govt. buildings. However, Sub Centres Kumariya Kala was not having Govt. accommodation. b. RDT kit, Nischay Pregnancy Test Kits, DDKs, Oxytocin tablets, Ampicillin capsules and Gentamycine injection were not available in the visited Sub centres. c. Electricity, Labour room, Delivery table, Mclntsh sheet, Ambu bag/suction, Steam Sterilizer and Weighing machine were not available at Sub Centres Kumariya Kala and Loha Bhola Hata. d. Short supply of Co-trimoxazole and Metronidazole tablets was observed at Sub Centres Kumariya Kala and Milak Khanam. e. Source of Water, Toilet, Delivery kit, BP apparatus, Thermometer, Gloves, EC Pills, Chlorine solution, Chloroquine tablets, Antiseptic solution and Sanitary Napkins at Sub Centre Kumariya Kala, Weighing machine (Infant), ORS packets, Paracetamol tablets and Antiseptic solution at Sub Centre Milak Khanam, Ambu bag/suction and Chloroquine tablets at Sub Centre Keorar, Foot Stool, ORS packets and Kerosene oil at Sub Centre Loha Bhola Hata were not available. 9. Assessment and opinion of the Community on Health Services: (i) Services of ANM- a. 36 mothers having child up to one year of age from the area of 4 visited sub centres were interviewed by the team to assess their opinion about the services rendered by the ANMs. 9 (25%) mothers replied that ANMs were not available when needed most b. 17 (47%) mothers were not aware about danger sign of ARI, 5 (14%) about use of ORS. 4 (11%) mothers did not receive three Post Natal checkups. c. It was also observed that 22 (61%) mothers were not sufficiently aware about contraceptive methods and 26 (72%) about side effects of contraceptive uses. (ii) Services of PHC- a. 20 Persons who were generally utilising the services at visited PHC/CHC were interviewed and it was found that most of the house holds were not satisfied regarding regular availability of Medical officers and others staff of PHC headquarter of PHC Rajpura. b. The team also contacted persons from different target groups like pregnant women, recently delivered women, mother of 2 year old child and village leaders in the PHC/ CHC areas.

10. IT Infrastructure and Mother & Child Tracking System: a. Team found that computers were available at district level and at Block level (one in each Block) though internet connectivity was not available in any visited PHC/ CHCs. b. MCH Tracking formats were available in each Sub centre. c. Health functionaries were sensitized in MCH formats at PHC/ CHC level. They are capturing data in the formats and making data entry at PHC / CHC level through cyber cafe.

11. Registers, records and reports maintained at the visited centres: a. Service registers for IUD, Oral Pills and Nirodh cases were not being maintained at any of the PHC/CHC head quarter. Performance reported under CuT at CHC Swar, FRU Milak and PHC Rajpura could not be verified due to want of service registers. b. Eligible Couple register were not been maintained in the visited Sub centres of Kumariya Kala and Loha Bhola Hata. c. Cash book for untied fund was not being maintained in the visited centres of Kumariya Kala and Milak Khanam. d. Registers for Family Planning services i.e. Sterilisation cases, CuT acceptors, Oral Pills and Nirodh users were not maintained in the centres visited. e. Stock register for family planning items i.e. CuT, Oral Pills and Nirodh were not maintained in the Centres of Kumariya Kala, Keorar and Loha Bhola Hata.

11.District Gonda

Major observations of Regional Evaluation Team, Lucknow on the Evaluation work carried out in of Uttar Pradesh in January, 2012 I. Details of the visited Institutions: District visited PHCs/CHCs visited SCs visited Gonda CHC: Colonel Ganj Nachani, Chakraut, Bisunpur Tewari at PHCs: Itiyathok & Maskanawa Sangam, Babaganj, Mahraj Ganj Grant and Babhnan

II Major observations 1. Health Human Resources: a. Skilled personnel under Medical and Para Medical categories like 48 posts of ANM out of 381 sanctioned, 138 posts of MPW (M) out of 151 sanctioned, 60 posts of Health Supervisor (M) out of 102 sanctioned, 26 posts of Medical Officer out of 105 sanctioned, 2 posts of Specialist out of 15 sanctioned, 9 posts of Staff Nurse/ GNM out of 24 sanctioned and 3 posts Lab Technician out of 27 sanctioned were reported to be lying vacant in the district. b. Under Programme Management Units of NRHM, one post each of the District Account Manager and District Community Mobilizer was lying vacant in the district. c. In CHC, Colonel Ganj, 6 of the 26 sanctioned posts of ANM, 6 of the 8 sanctioned posts of MPW (M), 1 of the 3 sanctioned posts of LHV/ Health Supervisor (F), 2 of the 6 sanctioned posts of Health Supervisor (M), 2 of the 6 sanctioned posts of Specialist and 2 of the 6 sanctioned posts of Staff Nurse were lying vacant. d. In PHC Itiyathok, 5 of the 21 sanctioned posts of ANM, 7 of the 8 sanctioned posts of MPW (M), 1 of the 4 sanctioned posts of Health Supervisor (M) and 3 of the 10 sanctioned posts of Medical officer were lying vacant. However, record of the sanctioned staff strength was not available at PHC Maskanawa. 2. Functioning of ASHA Scheme: a. As reported, there were 1370 ASHAs functioning out of 1600 ASHAs selected in the district during 2010-11. 1303 ASHAs were reported to have been trained but no drug kits provided to them. b. In the visited Sub Centres at Nachani, Chakraut, Bisunpur Tewari at Sangam, Babaganj, Mahraj Ganj Grant and Babhnan, required numbers of ASHAs were working in the field and trained up to 4th module. c. 8 ASHAs were contacted in the area of HSCs visited; as informed they were trained and receiving an annual average performance based remuneration of about Rs. 5000- 6000. ASHA is functioning in each VHSNC as a member. 3. Functioning of Village Health Sanitation & Nutrition Committee (VHSNCs): a. It has been reported that 1054 VHSNCs were functioning in all 1726 revenue villages in the district and joint bank account in the name of concerned ANM and Gram Panchayat Pradhan has been opened in all VHSNCs to handle funds. In the year 2010-11, funds @ Rs. 10,000 were provided to VHSNCs for each revenue village for undertaking sanitation work in the villages under the scheme. b. The total budget for the VHSNCs in the district was allotted to the tune of Rs 1,72,60,000 for 1726 revenue villages through CHCs/ PHCs, but no details of expenditure were available at visited CHCs/ PHCs/SCs and also district headquarter office for the 2010-11. c. It was observed that VHSNCs are constituted but their meetings were not being conducted in the visited Sub centres areas. 4. Untied Funds: a. Untied Funds @ Rs. 10,000 to each Sub centre, @ Rs. 50,000 to each CHC/PHC were provided in every year in the district. b. An amount of Rs. 32,20,000 at Sub Centre level and Rs. 20,50,000 at CHC/ PHC level was provided as untied funds during 2010-11 and the amount was utilised fully by the Centres. c. No untied funds were released to the institutions during the year 2011-12 up to the month of visit. d. The records for Cashbook/ Passbook, Vouchers and other registers were not made available in the visited Sub Centres to the team. e. During field check, the team observed that the district had released Rs. 2,30,000 to CHC Colonelganj in the year 2010-11 as Sub Centre level untied funds in CHC area. CHC Colenganj returned the whole amount to CMO (FW) for central purchasing the equipments i.e. Haemoglobinometer, Weighing machine, BP apparatus, Haemoglobin Scale, Pregnancy Test Kits, Stethoscope and Uristix etc. for use of 20 SCs. f. In the area of PHC Itiyathok, no record of expenditure of Untied Fund was available at PHC as well as SCs. This PHC had released Rs. 1,90,000 to its Sub Centres as untied fund for the year 2010-11. The record of expenditure was also not made available to the team at PHC Maskanwa regarding utilization of untied funds. g. As reported to the team, Untied Funds were utilized for repairing of building, chairs, almirah, table and hand pump etc. in PHC Itiyathok. 5. Janani Suraksha Yojana (JSY): a. As per details received, as many as 34,856 JSY beneficiaries in the year 2010-11 and 25,149 JSY beneficiaries in the current year up to December, 2011 have been paid cash incentive under the scheme in the district. b. As reported by the District office, an amount of Rs. 6,51,40,000 was available during 2010-11 under the scheme which was fully utilised. Similarly, an amount of Rs. 4,50,39,000 was utilised against the available amount of Rs. 4,64,11,000 during current year (up to December, 2011) under the scheme. c. The budget provision and expenditure at the visited PHC/CHCs is reported as below: Sr. Particulars For the year 2010-11 ( in Rs) No. CHC Colonelganj PHC Itiyathok 1 Total fund available 57,13,681 40,67,500 2 Total expenditure under JSY 57,13,300 38,44,000 3 Total balance amount 381 2,23,500 For the year 2011-12 up to August, 2011 ( in Rs) 1 Total fund available *35,50,381 *33,23,500 2 Total expenditure under JSY 32,60,000 33,21,200 3 Total balance amount 2,90,381 2,300 * including previous balance for the year 2010-11 Detail of fund provision and expenditure was not made available to the team at visited PHC Maskanwa. d. 22 JSY beneficiaries were contacted in the area of visited Centres in the district. Almost all contacted beneficiaries stated that they had received incentives through cheque from the concerned CHCs / PHCs. Most of the mothers were relieved from the hospital within 5 to 10 hours of delivery. JSY registers were found to be maintained properly and checked by concerned MOs regularly. e. The team observed that new born babies were having dirty clothes in the hospital. There was also no system of displaying the names of JSY beneficiaries in health facilities and there was no grievance redressal for JSY. 6. 24x7 Delivery Care Services: a. 16 institutions were identified to provide 24x7 delivery care services in the district. No additional budget was given to these Centres for these services. b. It was reported that total 34,856 and 30,529 institutional deliveries conducted collectively by 24x7 institutions/ FRUs and District hospital in the year 2010-11 and 2011-12 (up to December, 2012) respectively. c. In the visited CHC Colonelganj, 797 deliveries out of total 2140 were reported to be conducted in night hours during 2010-11 and 1114 deliveries out of total 2827 were reported to be conducted in night hours during 2011-12 (up to December, 2012). Such records were not maintained at PHCs Itiyathok & Maskanawa. d. Facilities for caring mother and new born baby were found to be inadequate in the visited PHCs under the scheme. 7. Physical infrastructure (HSC/PHC/CHC) (i) CHC/ PHCs: a. Visited CHC at Colonelganj was functioning in Govt. building but the maintenance of the hospital was not up to the mark. b. Blood Storage unit was non functional in the CHC. Incinerator was not available there but bio- medical waste is handed over to the agency outsourced and listed by the district office. Injections Quinine and Arteether were not available in the CHC. c. Visited PHCs at Itiyathok & Maskanawa were functioning in Govt. buildings. Maintenance of the hospital was not up to the mark in PHC Itiyathok. Record regarding stock of contraceptive items & Prophylactic drugs like IFA and Vitamin- A were not made available to the team at PHC Itiyathok. However, AYUSH Medical Officer was posted in PHC Maskanawa, but AYUSH Pharmacist and Ayurvedic medicines were lacking there. (ii) Health Sub Centres: a. Out of 6 visited Sub centres 3 Sub centres i.e. Chakraut, Babaganj and Babhnan were functioning in Govt. buildings. ANMs in visited Sub Centers were not staying at their head quarters. b. It was reported that, the Sub Centre Nachani was functioning in one rented dark room in the village and rent was dues since last two years. Sub Centre Bisunpur Tewari has no accommodation and operated the activities of the centre from village Sangam where only one house is situated. Under jurisdiction of this sub centre Seven villages are situated two- three km. from village Sangam which is not approachable by vehicle. Similarly, Sub Centre Mahraj Ganj Grant was not having proper accommodation and there was also no sitting arrangement. c. It was found that Electricity connection and labour room was available in the Sub Centre at Babhnan only. d. Ambu bag/suction, Nischay pregnancy test kit, RDT kit, Heamoglobinometer, Sanitary Napkins, DDKs, Kerosene oil, Cloroquine, Paracetamol, Metronidazole, Oxitocine tablets, Ampiciline capsules and Gentamycine injection were not available in the visited Sub centres. e. Bench, Cupbord for drugs, Delivery table, Mclntsh sheet, Co-trimoxazole, IFA tablets and Bleaching powder were not available at Sub centres Nachani, Bisunpur Tewari at Sangam and Mahraj Ganj Grant. f. No supply of Kits- A & B, ORS packets and Antiseptic solution was observed in the visited Sub centres at Nachani, Chakraut and Mahraj Ganj Grant. g. Thermometer, Gloves, Oral Pills, Nirodh and EC Pills should be made available at the Sub Centres Mahraj Ganj Grant and Babhnan. h. Examination table, Steam Sterilizer and Torch at Sub Centre Nachini; Examination table, Mclntsh sheet, Torch, Weighing machine, Steam Sterilizer, Thermometer, Gloves and CuT at Sub Centre Chakaraut; Examination table, IUD insertion kit, Delivery kit, Torch, Stove, CuT, EC Pills and Nirodh at Sub Centre Bisunpur Tewari at Sangam; ORS packets, Bleaching powder and Kits- A & B at Sub Centre Babaganj, Delivery kit, Stove, Weighing machine (Adult/Infant) and CuT at Sub Centre Mahraj Ganj Grant; Delivery table, Steam Sterilizer, Stove, Weighing machine (Adult/Infant), ORS packets, Co-trimoxazole tablets, Antiseptic solution and Bleaching powder at Sub Centre Babhanan were not available. 8. Assessment and opinion of the Community on Health Services: (i) Services of ANM- a. 54 mothers having child up to one year of age from the area of 6 visited sub centres were interviewed by the team to assess their opinion about the services rendered by the ANMs. b. 31 (57%) mothers were not aware about danger sign of ARI, 25 (46%) were not aware about use of ORS and 36 (67%) replied that their babies were not weighed at the time of birth. 29 (54%) mothers did not receive three Post Natal checkups. c. It was also observed that 38 (70%) mothers were not sufficiently aware of contraceptive methods and 37 (69%) mothers about its side effects. (ii) Services of PHC- a. 30 Persons who were generally utilising the services at visited PHC/CHCs were interviewed and it was found that they were satisfied with the services provided by the Medical officers and others staff of PHCs/CHC. b. The team also contacted persons from different target groups like pregnant women, recently delivered women, mother of 2 year old child and village leaders in the PHC/ CHC areas. People were mostly satisfied with the services provided at PHCs and CHC. However, proper attention to register the AN mothers within the 16 weeks of pregnancy and improve the awareness about danger sign in pregnancy, sick new born care and breast feeding practices need to be increased. 9. IT Infrastructure and Mother & Child Tracking System: a. Team found that computers were available at district level and at Block level PHCs/CHCs (one in each Block). However, Internet connectivity was available at district level only. b. MCH Tracking formats were available in each Sub centres. c. Health functionaries were sensitized in MCH formats at PHC/ CHC level. They are capturing data in the formats and making data entry at PHC/ CHC level through cyber cafe. 10. Registers, records and reports maintained at the visited centres: a. Performance reported under CuT at CHC Colonel Ganj and at PHCs Itiyathok & Maskanawa could not be verified due to want of service registers. Oral Pills and Nirodh distribution registers were also not maintained in the centres visited. b. Eligible Couple register which is one of the most important records for FW services had not been maintained in most of the visited Sub centres. c. Printed Registers for Family Planning services, Immunisation register, Stock book and Cash book for untied fund were not supplied to Sub Centres. d. Cash book for untied funds and VHNSC proceeding registers were not being maintained at any of the visited centres. e. Team reported that, proceeding register of Rogi Kalyan Samiti (RKS) was not made available to the team in all the visited institutions in the District.