MAHARASHTRA 1.District Major observations of Regional Evaluation Team, Chennai about the Evaluation work in of State in November, 2009. I. Details of the visited Institutions:

District Visit RH and accredited Hosp PHCs visited HSCs visited visited Akola RH: Akot, Balapur and PHCs: Mahan, Paras Mahan Main Center, Barsi Takli and Kapsi Godga, Diwsa, Parasi, AH: Lokhande Prite Hospital Gaigaon, imbimalukar Akot, Dr.Valsinghe Nursing and Goregaon Home and Maheswari Hospital

II. Major Observations:

1. Human Resources: a. The District authorities reported that 10 Posts of LHVs against 39 sanctioned, 21 posts of Lab Technicians out of 34 sanctioned posts and 36 posts of Male Health Worker against posts of 214 sanctioned were lying vacant in the in the district. b. In the visited RH and PHCs, quality health care delivery to the people was beinsuffered due to non filling of the vacant posts of MOs, Specialists, ANMs and LHVs . 2. Functioning of Janani Suraksha Yojna(JSY): a. During 2008-09, Rs. 49.9 lakhs were spent and during 2009-10 Rs. 18.11 lakhs were spent in the district under the scheme. b. The number of beneficiaries has been increased from 5368 during 2007-08 to 6391 in 2008-09 in the district. c. In PHC at Paras, 261 mothers benefitted under the scheme during 2008-09 and during 2009-10 there were 184 beneficiaries, out of them 69 mothers were waiting for their incentive money. d. In PHC at Kapsi, there were 222 beneficiaries in 2008-09 and for the current year there were 150 mothers who were paid incentive money.

1 of 9 e. The team noticed variation in the number of JSY beneficiaries reported by the district office and the PHC at Kapsi . During 2008-09, as per the district figures, Kapsi PHC had 139 JSY beneficiaries but as per the PHC register it was 222. Similarly for 2009- 10 the district figure was 35 but at the PHC achievement of JSY was shown as 176. 3. Untied Funds: a. There was no shortage of funds in the district. Untied funds were regularly being received in the district and distributed to the Periphery level institutes for utilisation. b. In the visited institution the funds were being utilized mostly, but some places i.e., PHC at ,Paras, Balapur and Kapsi the utilization of funds was poor during the last year. c. It was observed that at PHC Paras the funds were received towards the end of the 2007-08 and most of it could not be spent for want of proper guidelines 4. Implementation of Rogi Kalyan Samiti(RKS): a. RKSs have been formed in 37 institutions in the district and all these Samitis were functioning well in the visited centres. b. The funds under the scheme were being utilized for uplifting the facilities. 5. Service of ASHA: a. 763 ASHAs were selected out of 1133 required in the district. b. At the time of visit seven day induction training to the ASHAs was going on. It was reported that are provided to the ASHSs after completion of the training. c. There was no ASHA in the area of RHs and SDHs. 6. Village Health and Sanitation Committee (VHSC): During visit to PHC at Kapsi, it was noticed that VHSC funds couldn’t spent for want of proper guidelines. 7. 24X7 hours services: a. There are 15 PHCs functioning as 24X7 under IPHS standard in the district. b. Though PHC at Kapsi was working as24 hours service centre, but there was only AYUSH MO and a single Pharmacist. 8. Physical Infrastructure: (i) Rural Hospital a. All the facilities were available in RH Akot except Jeep, incinerator and residential quarters for MOs and staffs. The hospital has only 30 beds which were not sufficient to accommodate all the patients. A proposal has been sent to make it a 50 bedded hospital.

2 of 9 b. RH Barsi Takli was located in the old PHC building with very limited facilities. There were only 2 MOs including a DGO. There was no facility of X-ray, blood storage, resuscitation, Boyle’s apparatus and incinerator in the centre. c. RH Balapur was functioning in a very old congested and dilapidated building with no proper facilities. (ii) PHC/HSC a. PHC Mahan have of 6 sanctioned beds but there were 16 beds. Lab technician post was not filled up, Ambulance was not working in the centre. There was no stock of BCG and Measles vaccines in the centre at the time of visit b. AYUSH MO was not available at PHCs Mahan and Paras. c. In PHC Kapsi, there were 2 MOs both from AYUSH. The PHC was well maintained. d. HSCs visited in the district were well equipped. Some of the drugs like Amplicillin Tab, Gentamycine Injection, Kits A & B and EC Pills were not available in most of the centres. 9. Knowledge and opinions of community on Health services: a. The team interviewed 30 mothers in the sub centres area to know their knowledge and opinion about the health services being rendered by the health functionaries in area of health centres and found that the services of ANMs are available regularly as and when needed. All of them had visited either anganwadi centres or sub center for services of ANC/PNC or nutritional advise. All of them have visited the immunization site for IFA or TT injection and none of them had any problem in the previous pregnancy and received timely advice. b. All the mothers were aware of exclusive breast feeding and complimentary feeds. c. 20 (66.7%) respondents were not aware about contraceptive methods and knowledge of ARI. d. The team has evaluated the work of 3 male health workers of HSCs at Goregaon, Zodka and Diwasa and found that they were well skilled and also working properly. 10. Sample verification of FW acceptors: a. The team had selected a total of 138 FW acceptors and out of them 108 (78.3%) were contacted for sample verification on the spot . b. Minor discrepancies were noticed in the age of acceptors, spouse and in the number of children. Field staffs should be more careful while recording the demographic details in the service registers in this regard. c. Follow up service by the field staff was provided to 101 (93.5%) acceptors. 3 of 9

11. Maintenance of Registers and Records: a. The team found that the maintenance of registers and records is satisfactory in the centres visited. b. Case cards for sterilization operations were not maintained at the performing centers. 12. Suggestions and Observations: a. The district has done 627 NSVs in the current year which is commendable. b. It was satisfactory to note that the district was implementing the JSY together with the support of 30 private accredited hospitals. Out of there 12 were in the rural area and the rest were in the urban area. c. It was informed by the MO of PHC Mahan that the payment of Rs. 250/- was notsufficient for referral transportation charges to GH Akola which was about 40 km from the PHC. It may be increased to Rs. 500/- for the emergency patients. d. It was informed by the MOs of the peripheral level institutions that periodic changes in Guidelines lead to lot of confusion in implementing the programme. For example, the state Government vide its notification had stopped payment of JSY incentives for home deliveries from 4/09 to 10/09 but later on in Nov. 09 through another notification it has allowed Rs. 500/- incentive for home delivery. e. It was appreciated that the JSY money is being given to the beneficiaries PHC/HSC only through cheque in the district. f. It was observed that in addition to the JSY incentive approved by the Govt. of , Maharastra Govt. is giving incentive @ 400 per case under Mathruthwa Anudan Yojana for first and second deliveries irrespective of the community, whether the beneficiary is under APL, BPL or SC/ST category. g. In VHSCs, Sarpach is the president and Anganwadi Worker is the secretary. Quite often, they don’t bother to keep vouchers and records of expenditure.It is, therefore, suggested that the secretary of the VHSC may be nominated from the either MPHW (male) or ANM for smooth functioning of VHSCs. h. It was informed that, the MOs of the PHCs were not trained in implementing NRHM activities. They don’t know how to keep accounts of NRHM. There was no PHC level supervisor under NRHM. This may be looked into to ease the work load of MO. i. Citizen charter was exhibited in all the centers visited except in RH Balapur. j. The sanitation in the villages of SC Nimbimalukar under PHC Kapsi need to be improved. k. In the district majority of MOs are from AYUSH who were appointed as regular MOs 4 of 9

since only few MBBS MOs are available in the district. These MOs were not practicing any AYUSH activities.

2.District Akola Major observations of Regional Evaluation Team, Chennai about the Evaluation work in Buldana District of Maharashtra State in November, 2009.

I. Details of the visited Institutions:

District Visited PHCs , GH visited HSCs, RHs visited Buldana GH:Buldana HSCs: Kelwa, Kinola, Vadugamali, PHCs: Kinola, Delugaon Mali, Chaygaon, Nagzari and Main Center Sultanpet, Tarketkhed and Jawala Jawal B.K. B.K RH: Singeraja and Mekar and District HQ Scan Center Buldana

II. Major Observations:

1. Human Resources: a. In the district, a large number of posts of Medical Officers are laying vacant. Under the PHCs under the control of DHO, out of 105 posts of MOs, only 18 were in position. b. In the district HQ hospital, out of 33 MOs only 18 were in position. In the RHs and SDHs, out of 15 class I MOs only 3 were in position. Regarding class II MO posts, out of total 112 posts, 36 posts were lying vacant. In the HQ hospital, out of 85 posts of staff nurses, 15 were lying vacant. 2. Constitution of Rogi Kalyan Samiti and VHSC: a. it was reported that 68 Rogi Kalyan Samitis have been constituted in the district and the team found that RKS were functioning in the visited centers. b. There were total 1297 VHSCs formed in the district and ASHA was not nominated in the committee. c. Team was observed that the members of the Committee (VHSC) need to sensitize about the village sanitation and maintenance of proper registers and vouchers.

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3. ASHA Scheme: a. In the district 813 ASHAs have been selected but none of them has been trained till now. b. Drug Kits were also not provided to them. ASHA programme is covered rural level areas and the institutions functioning in urban or semi-urbans like RHs, SDHs and DHQ hospital were not included. c. In the visited PHCs, ASHAs have not been selected some places and training was also not conducted for them. 4. Untied Funds: a. There were sufficient funds available in all the centres visited in the district. b PHC Kinola spent Rs.4247 out of funds received Rs. 46040 for the current year. In PHC Thakerkhed though Rs.25000 received in 2007-08, no expenditure was incurred and the funds spent all in 2008-09 and 2009-10. In PHC Jwala BK, most of the funds were spent during 2007-08 and 2008-09. The details of funds were not made available to the team in PHC Sultanpet. c. HSC Vadugamali did not receive the funds for the current year. 5. Services under JSY: a. There was a sufficient fund for JSY services in the PHCs visited. b. Performance report received from the PHCs shows good numbers of beneficiaries are being benefitted under the scheme. 6. 24 x7 hours Services: In the district, out of 52PHCs, only 32PHCs were functioning as 24 hour delivery care centres. Besides that there were 15 RHs and SDHs serving for 24 hours in the district. 7. Physical infrastructure: (i) CHC/FRU Facility: a. In District hospital, Buldana, all the buildings are scattered and very old, the process for renovation and up-gradation of the building is reported under consideration with the State. b. In RH Mekar, facilities of jeep and blood storage were not found. c. Residential quarters for MO and Staff, blood storage unit, jeep and also incinerator were not available in RH Singeraja. (ii) PHCs: a. PHCs visited in the districts were not having AYUSH, M.O. b. Some of the PHCs were lacking toilets, regular water supply and residential quarter for MO.

6 of 9 c. In PHC Sultanpet resuscitation equipment was not available and team observed PHC was not maintained hygienically. d. It was observed that the PHCs were well equipped and were having essential items. However, some equipments and supplies like EC Pills stock in PHC Kinola, boyles apparatus in PHC Jwala and Microscope in PHC Thakherkhed was not available on the visiting day. (iii) HSCs: a. Out of six HSC visited Khelwa HSC did not have basic facilities, equipment and drugs like water, toilet, electricity, labor room delivery table, ambu bag etc. This centre was lacking Mclntsh sheets, IUD insertion Kit, IUDs, emergency contraceptive pills, Oxytocin tablets and Gentamycin injection were not available. b. HSC Kinola had no building. Emergency contraceptive pills and chlorine solution/bleaching were also not available there. c. In Vadugamali Centre, Govt. accommodation, steam sterilizer, Gloves, AD and disposable syringes and needles were not found there. d. HSCs at Nagzari and Chaygaon had no water supply facility. Ambu bag/suction and drugs like emergency contraceptive pills, Paracetamol tablets, Metranidazole, Cap Ampicillin and Gentamycin injection were also not available in the facility. e. HSC at Jwala BK was having maximum supplies. Some of the drugs like emergency contraceptive pills, chlorine solution/bleaching, Chloroquine Tablets, Cap Ampicillin, Gentamycin Injection and supply of Kit “A” and Kit “B” (for current year) was not found there. 8. Community Satisfaction/Opinion on Health Services : a. The team has interviewed as many as 20 mothers of having upto one year old child in the visited area of the sub centre and found that i. 5(25%) mothers reported that they breast fed their babies within half an hour of delivery. ii. 4(20%) contacted mothers were not aware of the use of ORS and also informed that their baby was not weighed at the birth. iii. ARI awareness was not found in 13 (65%) mothers. iv. 6(30%) mothers have no knowledge about the possible side effects of `contraceptive use. v. 8(40%) mothers had not followed by the health personnel for post natal care services. b. The team has contacted Anganwadi workers, ASHAs, link leaders and the general public in the area of RHs & PHCs visited. They expressed full satisfaction on the functioning of the MOs and Staff of the PHCs visited. 7 of 9

9. Sample verification of F.W. acceptors: a. The team had selected a total of 112 FW cases for sample verification, out of which 89 (79.5%) acceptors could be contacted. b. Minor discrepancies were noticed in the data recorded for age of acceptor, number and spilt up of children. c. Two acceptors (1-IUD and 1-OP) found to have been false. 10. Reconcilation of the reporting figures of Sterilisations. The figures reported by the District office under sterilization for the year 2008-09 were varying with that of the figures reported at DH Buldhana and PHC Kinola. 11. Other Observations and Suggestions : a. Since some of the VHSCs found not keeping the vouchers for the expenditure, the DHO and Zila parishad officials should insist them to maintain the same. b. In PHC Delugaonmali, there is no cots and insufficient number of quarters. Even the few constructed quarters seem not fit to stay since no proper maintenance. c. Transport facility can be improve in the needy centres in the district for implementing State scheme like “108 Ambulance service”. d. DPM post under NRHM was lying vacant in the district. Similarly there was no post like supervisor or data entry operator at the PHC level who can monitor the activities under NRHM. e. It was observed by the team that no serious effort was done in the district for construction or renovation of PHC and HSC buildings and staff quarters. f. Immediate attention should be given to improve the basic hygiene, sanitation and overall quality of services at PHC Sultanpet. g. The sex ratio is alarming. It is reported to be 850 females for 1000 males in the district. Implementation of PNDT activities should be strengthened to improve the present status

3. DISTRICT PARBHANI Major observations of Regional Evaluation Team, Chennai about the Evaluation work in Parbhani Districts of Maharashtra State in January, 2010.

I. Details of the visited Institutions:

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District RH/DH/SDH PHCs visited HSCs visited Visited Parbhani RH: Jintur and Pathari PHCs: Pathergavan, Kasapuri, Yeldari,Sonepath, Pedgaon, Pathergavan, Mahatpuri and Jheri Banegaon, Arvi, Kokand Shelgaon

II. Major Observations: 1. Health Human Resources: a. The District authority reported that 11 posts of MO (MBBS) against were lying vacant in the district. Out of 214 contractual posts of ANMs under NRHM only 53 could be filled up. b. In the visited RHs and PHCs, quality health care delivery to the people was suffering due to non filling of the vacant posts of MOs, Specialists, and ANMs. 2. Functioning of Janani Suraksha Yojna(JSY): a. Janani Surksha Yojna is successfully implemented in the district. b. however, it was observed that during 2009-10 (up to Dec.09), in PHC Pathergavan 41 cases and in HSC Pathergavan 4 cases were found pending for cash incentive due to insufficient funds. c. The team contacted 19 JSY beneficiaries in the district and observed that they were in receipt of the cash incentive, antenatal and post natal services.

3. Untied Funds: a. In the visited PHCs at Mahatpuri and Pedgaon, the funds were observed to have been received and being utilized. b. PHC Mahatpuri has spent 79% of the RKS funds received for the past 3 years and in PHC Pedgaon has spent about 50% of the funds received under various heads.

4. Functioning of Rogi Kalyan Samiti (RKS): RKS has been constituted in as many as 41 institutions in the district and it was observed that these Samitis were functioning in proper way in the visited centres. The meetings of RKSs were also being held regularly.

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5. Services of ASHA: a. 564 ASHAs have been selected in the district and 461 of them have received first module of the training. Further trainings were under process. b. Drug kits reported to be provided to the ASHSs only after completion of the training.

6. Village Health and Sanitation Committee (VHSC): a. 820 VHSCs were formed in the district. Team observed that some of the visited VHSCs were not keeping vouchers and records of financial matters and regular activities. b. ASHAs involment in VHSC has not yet started since no ASHA has received training in all modules and they are recently selected in the district.

7. 24X7 hours services: a. 24 hours delivery care system for promotion of institutional deliveries in rural based area was implemented at 16 PHCs in the district. b. PHC Mahatpuri, PHC Pedgaon, PHC Eldari and RH Jintur has condueted 4,15, 224,229 and 338 deliveries during 2008-09 and 3,11,160,338 and 279 deliveries durin 2009-10 respectively. Other 8. Physical Infrastructure and Stock Position: (i) RHs: a. RH at Jintur was located in a 20 year old building with 30 beds. There was no functional blood storage unit in the hospital. Tough there is a OT, but the condition of the room and the OT table were not satisfactory. No boyels apparatus was available in the OT. b. RH at Pathari was presently functioning in a guest house having 10 beds without facilities of ‘X’ ray, blood storage and boyels apparatus. Residential quarters for MOs were not available. A new RH building is under construction. (ii) PHCs: a. In PHC Jhari, AYUSH MO and post of (regular) driver was lying vacant. b. PHC Eldari, a 10 bedded centre had in sufficient space for conducting deliveries and sterilization. Boyels apparatus was also not found in the OT of PHC. c. In PHC Pratapgarh, facilities like Microsope, lab technician, vitamin-A and AYUSH MO were not available.

10 of 9 d. Water facility was not available at PHC Pedgaon. The posts of Lab technician and AYUSH MO were also found vacant in PHC. (iii) HSCs: a. HSCs at Banegaon, Kasapuri, Arvi, Kok, shelgaon and Pathergavan were visited to see the availability of infrastructure, facilities, stock position etc. and found that i. Kasapuri and Selgaon were not properly maintained for clinic purpose. ii. Regular Source of water was not available in HSC Banegaon. iii. ANMs in the centres of Kasapuri and Arvi were not staying in the centre even Govt. accommodation is available there. iv. Labour room and Examination Table were not available in HSC Kasapuri. v. BP apparatus, Gloves and Steam Sterilizer were not available in HSC Kasapuri. vi. Oral pills and Chlorine Solution were not available in some of the HSCs visited. vii. Emergency contraceptive pills were not available in any HSC. Except HSC Pathergavan, Cap Ampicillin and Gentamycin injection were not available at any visited HSC. b. None of the ANMs in the centres visited had received SBA training.

9. Knowledge and opinions of community on Health services: a. The public in the area of PHCs and RHs expressed good opinion about the work of the MOs and staff of the PHCs and RHs. b. The team interviewed 18 mothers having last child upto one year of age in the area of HSCs visited. Most of all the respondents had received the services during their AN and PN period. All the contacted mothers were aware of the use of ORS and breast feeding practices. However, awareness about the danger sign of ARI, use of any contraceptive menthods and knowledge about their side affets need to be increased.

10. Sample verification of FW acceptors: a. The team selected a total of 135 FW acceptors for Sample Verification and out of them 108 (80%) cases could be contacted. b. Minor discrepancies were noticed in the age of acceptor, spouse and in the number and spilt up of children. c. Out of 108 contacted acceptors 93 (90.7%) were satisfied with follow up services.

11. Miscellaneous Observations and Suggestions: 11 of 9 a. IEC posters, hoardings, wall paintings etc. were rarely observed in the centres visited by the team. b. 108 ambulance facilities’ may be introduced in the district. c. In the district six AYUSH dispensaries (4 Ayurvedic and 2 Unani) are functioning without building. d. There were more than 30% of the home deliveries conducted by unskilled Dais in the year 2008-09. The main reason for prevalence of home deliveries is said to be poor transportation facilities, in-accessible areas and scattered population of the district. 4. DISTRICT: RAIGARH

Major observations of Regional Evaluation Team, Chennai about the Evaluation work in Raigarh Districts of Maharashtra State in January, 2010.

II. Details of the visited Institutions:

Raigarh DH: Alibag PHCs : Kalamb, Kadav, Poshir(IPHS), SDH: Karjath and Nagothane and Pachad Gaurkamath, Posari Mangaon (IPHS), Kamp, Ainghar, Khandala (IPHS) of PHC Poynad

II. Major Observations:

1. Health Human Resources: a. The staff position at the visited centres was not found satisfactory. The District authorities reported that 67 posts of Medical specialists against 114 sanctioned, 24 posts of MBBS MO against 216 sanctioned, 154 posts of ANMs against 679 sanctionedand, 39 MPHW(male) posts against 158 sanctioned were lying vacant in the district. Besides, all 3 posts of ADHOs were lying vacant in the district. b. In the visited RH and PHCs, quality health care delivery to the people was being suffered due to non filling of the vacant posts of MOs, Specialists, ANMs and MPHWs .

2. Functioning of Janani Suraksha Yojna(JSY): a. Janani Surksha Yojna was implemented covering all centres in the district. There were enough funds and no cases was pending for payment in the centers visited by the team. 12 of 9 b. The team has contacted 16 JSY beneficiaries in the area visited and all followed that of them had received JSY amount, ANC Services consumed IFA and got TT injections.

3. Untied Funds: a. The district received a total of Rs.1128.99 lakhs under various NRHM heads including Untied Funds during 2009-10, out of which Rs.657.92 lakhs were spent. Besides, under the NRHM flexi pool, the district has received a total grant of Rs.340.72 lakhs in 2009-10 out of which Rs.117.12 lakhs were spent. 4. Implementation of Rogi Kalyan Samiti (RKS): RKS have been set up in all the 66 institutions in the district. The district health society and also governing and executive bodies were guiding these samities regularly in their functioning.

5. Services of ASHA: a. 1761 ASHAs were selected and out of them only 375 were given first module of training. Training for rest of the ASHAs was reported to be under progress. b. All modules of training and drug kits were given 130 ASHAs working in tribal areas. Drug kits reported to have not been provided to the ASHAs of the non-tribal areas in the district. c. This programme has been implemented under the PHC areas and not for the area under rural hospital and SDH.

6. Village Health and Sanitation Committee (VHSC): In the district, 1869 VHSCs have been functioning for last three years. In the tribal area, inclusion of ASHA in the VHSC was under process and would be completed with the completion of training of ASHA.

7. 24X7 hours services: a. 24 hours delivery care system was implemented in 27 PHCs in the district. b. Team observed that institutional deliveries in the district are progressing since the introduction of NRHM activities. It was 45% in 2005, increased to 68.8% in 2009 and in the current year has further gone up to 78.8%.

8. Physical Infrastructure: 13 of 9

(i) CHC/FRU: a. The team has visited the FRU centres of SDH Karjath, SDH Mangaon and District HQ hospital and found that facilities of USG and Blood storage unit were not available in SDH Karjath. The beds and drip stand in the hospital need urgent replacements. Perfomance of deliveries in the hospital has come down drastically from 916 in 2007-08 to 842 in 2008-09 and further down to 566 in 2009 . Only 5 staff nurse in postion out of the sanctioned strength of 12. b. In SDH Mangaon, the maintenance of beds needs improvement. Residential quarters were not available for all the staff. (ii) PHC: At PHCs Kalamb and Nagothane except USG, X ray, blood storage and Boyles apparatus almost all required routine facilities were available. The maintenance of PHCs was being done in systematic and hygienic manner. (iii) HSC: a. Examination Table, delivery table, DDKs, contraceptive like Oral Pills and Condoms were not available at a few of the HSCs visited. b. Mclntsh sheets and Ambu bag/suction were not available at most of the visited HSC. Emergency contraceptive pills, Cap Ampicillin and Gentamycin injection were not available at any HSC visited.

9. Assessment of Knowledge and Opinion of Community: a. The public expressed satisfaction about the functioning of the PHCs and RHs of their area. b. The MPHW’s(Male) work in the area of HSCs Poshir and Khandle was found satisfactory.The contacted people expressed good opinion about their skill in respect of F.W., Malaria and communicable diseases. c. The team interviewed 36 mothers having child upto one year old, out of them 33 (92%) informed that ANMs were available when they needed. 30 (83%) contacted mothers were aware of the use of ORS and 34 (94%) were aware of breast feeding. 32 (89%) mothers had contraceptive awareness and only 19 (53%) mothers had knowledge of its side effects. d. ARI awareness was found only in 9 (25%) mothers.

10. Sample verification FW acceptors: a. The team selected a total of 112 FW acceptors and out of them 91(81.3%) could be contacted for sample verification. Minor discrepancies were noticed in the age of acceptor 14 of 9

and the age of their spouse. The particulars of the acceptors should be recorded carefully in the service registers of Family Planning. b. 83 (91.3%) contacted acceptors were satisfied with the follow up services.

12. Mislleneous Observations and Suggestions: a. PHC Medical officer at Kalamb could not present the details of NRHM funds even he was informed well in advance. More over, none of the HSCs visited in the district keep the vouchers properly to reconcile the utilization of funds. b. In the Main PHC, R.H. and SDH level, most of the staff nurses posts were lying vacant. It was observed that ANMs and GNMs of the HSCs where no deliveries are conducted can be re-arranged or diverted to the main PHC or RH where their service is required. c. It was reported by the Superintendents of the RH and SDH hospitals of the districtthat even though funds were handed over to the PWD for construction and renovation of building, no work has yet started. d. In the district there are only 47 specialist doctors against the 114 sanctioned posts. Urgent action needed to fill up the vacant posts.

5. DISTRICT: SANGLI Major observations of Regional Evaluation Team, Chennai about the Evaluation work in Sangli Districts of Maharashtra State in December, 2009.

I. Details of the visited Institutions:

District DH / RH and PHCs visited HSCs visited Visited accredited Hospital visited Sangli RH: Atapadi, K.Mahankal PHCs :Desing, Sankh, Nagaj, Hingangaon Dr. Thambole Hospital Maneraj.Uri and Gavaon Navjivan Hospital, Sangli Kawalpul

II. Major Observations:

1. Health Human Resources:

15 of 9 a. Rural level centres (PHCs and Sub Centres) are functioning under the administrative control of DHO. It was reported that 19 sanctioned posts of MOs including Specialists are lying vacant under the DHO administration of the district. b. The District Civil Surgeon is supposed to monitor and supervise the work of the RHs and SDHs of the district under the overall supervision of Dean of the medical college hospital. It was informed by the civil surgeon that out of 14 institutions under him, only in five have medical Superintendents in position. In 5 RHs, there is not even a single specialist; only one physician, 3 general surgeons, 3 paediatricians, 5DGOs and 3 anaesthetists were in position in the RHs and SDHs under his control.

2. Functioning of Janani Suraksha Yojna (JSY): a. As per the report received from the district, JSY performance shows declining trend in the district. There were 6215 beneficiaries in 2007-08 and 5113 in the year 2008-09. During 2009-10,upto October, 2009 the figure was 2749. b. No pending cases for cash incentive were observed and sufficient funds were available in the centers visited by the team.

3. Untied Funds: Untied funds like other funds i.e. AMG, IPHS, RKS etc. are regularly being provided at all the centres functioning in the district. It was reported that the funds were utilised by most of the centres for upgradation the facilities during 2007-08, 08-09 & 09-10. 4. Implementation of Rogi Kalyan Samiti (RKS) and Village Health & Sanitation Ccommittees (VHSCs): a. RKSs have been constituted in 73 institutions in the district and the meetings were being conducted at regular intervals in all the centres visited. b. The funds under the scheme were being utilized for uplifting the facilities. c. 727 VHSCs have been formed in the district and the same were functioning well. d. During 2008-09, an amount of Rs.105.00 lakhs was sanctioned for the activity out of which only 75.05 lakhs were spent and an amount to the tune of Rs.72.68 lakhs sanctioned for 2009-10 and only Rs. 16.19 lakhs were spent upto Nov., 2009.

16 of 9 e. In all the HSC areas visited, the VHSCs were working properly with the full support of the village leaders and other members. All the visited committees were keeping the vouchers and expenditure details.

5. Service of ASHA: a. In the District, 1528 ASHAs were selected, out of them only 122 ASHAs were given the first module of training. Training for the rest is under progress. b. It was reported in all the visited centres that drug kits would be provided to the ASHSs after completion of the training.

6. 24X7 hours services: 10 PHCs, 21 RH and SDHs were functioning as 24X7 hours for conducting deliveries in the district. 7. Physical Infrastructure: (i) RH and SDH a. SDH K. Mahankal is an IPHS institution having 50 beds with all the facilities except USG & Blood storage. The hospital is systematically and hygienically well maintained. Residential quarters, OT, Resuscitation equipment and other equipments are well maintained with the co-operation and regular monitoring by the RKS. b. In RH Atapadi, facilities of transport were not available. Blood storage unit was being established. Bio medical wastes were disposed in deep pits. The hospital was neat and clean. All other basic facilities were available in the hospital.

(ii) PHC a. All the visited PHC, were founds to be well maintained b. PHC Desing is an IPHS PHC with 5 bedded modern look well maintained hospital functioning with 2 MOs. OT of the PHC found to be a minor one without boyles apparatus. c. Sufficient stock of oral pills and Nirodh was not found in PHC, Sankh. d. AYUSH Medical Officer was not posted at any PHC visited in the district. e. PHC Kawalpul did not have any stock of CU-T for last 3 months and ECP for last 1 year. f. Except vehicle and AYUSH MO, all the facilities were available in PHC Manerajuri.

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(iii) HSC a. Facilities checked for the sub centres at Nagaz, Hingangaon and Gavan and found that the centres were well equipped and having good stock of essential drugs. b. However, some of the drugs and items like bleaching powder, Ampicillin, Gentamycine, Kit A and Kit B were not available in the HSCs visited by the team. c. EC pills, OP and Nirodh were also not available in Hingangaon and Nagaz HSCs.

8. Knowledge and opinions of community on Health services: a. The team has interviewed as many as 18 mothers having child upto one years of age in the area of the visited sub centres and all of them informed that ANMs were available for services as and when required. However it was found that half of the mothers were not aware about ARI. b. PNC check up was given to 13 (72.2%) mothers. c. For assessing the work of MO and staff of the PHCs, the team contacted the village leaders, anganwadi workers & RKS members in the PHC areas. The public expressed very good opinion about the work of the MOs and staff of the PHCs.

9. Sample verification of FW acceptors: The team had selected a total of 124 FW acceptors and out of them 103 (83.1%) could be contacted for field verification and found minor discrepancy in the recorded data regarding age of acceptors, age of spouse and in the number and spilt up of children. 10. Maintenance of Registers and Records: Maintenance of registers and records was satisfactory in the visited centres.However, it was found that case cards for sterilization acceptors did was maintained at the performing centers. 12. Miscellaneous Observations and Suggestions: a. There is no supply of oral pills and CC at the district level during 2009-10. Hence the spacing methods programme is affected in the whole district. The district received only 5000 OP cycles and 30000 CC pieces during 2009-10 from the State HQ. b. The district civil surgeon at Sankh was facing hardship to provide quality health services due to shortage of the staff, driver and also non availability of vehicle.

18 of 9 c. Under NRHM, 58 posts of staff nurses and 59 posts of LHVs have been sanctioned for the PHCs; and these required to fill up urgently. 2 posts of ADHO also lying vacant in the district. d. It may be re-emphasised here that hygiene and sanitary condition in the centres visited was very good. visited IPHS PHCs have DOTS corner, emergency tray, baby warmer, garden, safe drinking water, well maintained labour room, OT, citizen charter etc. All the centres visited have solar energy lamps and all the RHS and PHCs visited have computer and internet facilities.

6. DISTRICT: SATARA Major observations of Regional Evaluation Team, Chennai about the Evaluation work in Satara Districts of Maharashtra State in December, 2009.

II. Details of the visited Institutions:

Satara DH: Satara PHCs : Parali, Karinje, Ozarde RH: Wai and Koregaon Kawathe and Chinlewadai Solanki Diagnostic Center, Kinhai Koregaon and District HQ Scan Centre

II. Major Observations:

1. Human Resources: a. Most of the posts sanctioned at the different level Institutions/centres functioning under DHO were filled up.

b. The team observed that in the HQ Hospital at least 2 Anaesthetists are needed, as 60-70 operations are conducted daily in the hospital.

c. In PHC Pareli, there was only one staff nurse to provide all the indoor services.

2. Rogi Kalyan Samiti (RKS) and Village Health Sanitation Committees (VHSCs):

19 of 9 a. Rogi Kalyan Samitis have been set up in 89 institutions in the district and their meetings were being held regularly. b. 1721 VHSCs have been formed against the requirement of 1739 in the district. It was observed that the funds were provided to the VHSCs in the area of visited PHCs for their functioning. c. ASHAs were not involved in the functioning of VHSCs since they were selected recently.

3. Functioning of Janani Suraksha Yojna (JSY): a. There were 6377 JSY beneficiaries in the year 2008-09 in the district and the figure was 3552 during 2009-10 upto November 2009.

b. No pending case for cash assistance was observed and sufficient funds were available in the centres visited.

c. All 12 beneficiaries contacted in the visited area were satisfied with the follow-up, cash assistance, ANC check up and IFA / TT services under JSY.

4. Services of ASHA: a. Out of selected 2458 ASHAs in the district only 419 ASHAs were given with first module of training. Efforts were being made to train all selected ASHAs in all modules. There were no supply of drug kits for providing the same to the ASHAs. b. ASHA scheme was not implemented in the area of RH and SDH in the district.

5. Untied Funds: a. For the rural level centres, the funds to the tune of Rs.1568.93 lakhs in 2007-08, Rs.1615.52 lakhs in 2008-09 and Rs.1027.44 lakhs during 2009-10 were provided under DHO, out of which Rs.59.50 lakhs (37.6%), Rs.1603.73 (99.3%) and Rs. 602.32 have been spent during 2007-08, 08-09 and 09-10 ( Upto Nov. 2009) respectively.

b. Similarly, a total of Rs. 350.00 lakhs was received during 2007-08 by the district Civil Surgeon for R.H.s, SDHs and HQ hospital, out of which Rs. 172 lakhs could only be spent. During 2008-09, Rs. 5488 lakhs received out of which Rs. 43

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lakhs were spent. During 2009-10 out of Rs. 271 lakhs , Rs. 113 lakhs were spent as on November 09.

c. It was observed that untied funds provided to the PHCs visited in the district during last three years were mostly spent and the centres were being strengthened to meet the community health requirements.

6. 24X7 hour delivery care services: a. In the district, all the PHCs were working 24 hours for delivery besides the RHs, SDHs and District HQ hospitals. There are 30 PHCs and 100 HSCs under IPHS in the district. Besides JSY accredited private hospitals were also involved in providing 24 hours service.

b. Institutional delivery is the main contribution under 24x7 hours services. During 2009-10 (up to Nov.09), out of total 30453 deliveries conducted in the district, 28430 were reported to be as institutional deliveries and out of it, 22432 were conducted by private organization whereas the contribution of 71 PHCs were 2547, HSCs 1276 and other Govt. hospitals 2175.

c. There is much scope to increase the govt. sector performance in the present scenario.

7. Physical Infrastructure: (i) RH a. Transportation facility like ambulance or jeep was not available at RHs visited at Koregaon. There was no facility of USG and blood storage unit was being set up in the centre.

b. RH Wai is located in a congested building with little space for OP, IP and ward etc. though a proposal for a new building had been sent by the RH but no action reported to be taken so far in this regard.

(ii) PHC PHCs at Pareli, PHC Kinhai and PHC Kawathe were well maintained having medical store, OT, Ward, Labor room, waiting room for patients and staff.

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(iii) HSC a. The team visited three HSCs in Satara District. Centres premises were neat and clean and most of the facilities found available in the HSCs visited. b. Water supply and electricity was lacking in HSC Karinje. c. Delivery Kit, Capsule Ampicillin, Gentamycin Injection, Kit A and Kit B (for current year) were not available in the visited HSCs. d. SBA training was provided to the ANM at HSC Karinje.

8. Knowledge and opinions of community on Health services: a. The team contacted 18 mothers in the area of the visited HSCs Satara district for evaluating their health awareness and opinion about the ANMs work and found they were happy with the availability of ANMs at the time of need. b. 12 mothers had given breast feeding within half an hour of their delivery whereas 4 within one hour and 2 more than one hour. c. The services and awareness about MCH and Family Planning was observed satisfactory amongst the respondents. d. The community members were satisfied with the work of the MPW(M) in the area of visited HSCs. e. The team contacted Anganwadi workers, local leaders, link leaders and the general public of the RHs and PHCs visited. They expressed full satisfaction on the functioning of the MOs and staff of the PHCs and RHs visited.

9. Maintenance of Registers and Records: The maintenance of registers and records was found satisfactory in the visited centres. However, Case cards for sterilization operations were not maintained at the performing centres. 10. Miscellaneous Observations and Suggestions a. Proper skill development of DPM and other NRHM staff may be made through training for strengthening quality & quantity of services under RCH Programme.

b. PHC level NRHM supervisors may be appointed.

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c. 108 Ambulance service may be implemented in the district by pooling together all the ambulances of the districts.

d. The facilities of blood bank was available only in the district hospital and blood storage only in 3 RHs. The facility of blood storage may be extended to all the Taluk level RHs of the district.

*******

7. District Bhandara

Major observations of Regional Evaluation Team, Bangalore about the Evaluation work in Bhandara Districts of Maharashtra in August, 2009

I.Details of the visited Institutions:

District Visited DH/PHCs/CHCs visited SCs Visited Bhandara Shahapur, Sangli and Kondha Parsodi,Kharbi,Shivanibandi, Savrabandh,Korsa andChichal.

II. Major Observations:

1. Human resources: a) Several Key posts at district headquarters like ADHO , DIO and other programme officers were vacant. . b) Similarly, 16 posts of MPW(Male) and 12 posts of MPW (Female and 26 posts of drivers were vacant in the district. 2. Implementation of Rogi Kalyan Samithi RKS)

a) Rogi kalian Samiti were set up in all 9 CHCs (called Rural Hosdpital in the state) and 32 PHCs and 1 Distt. And 2 Sub district level hospitals in the District.

b) Each RKS is funded regularly as per norms. For the year 2009-10, the district office has not yet realeased the grant under this level till the time of visit of the team.

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c) In the visited PHCs at Sangli and PHC Kondha, meetings of RKS were being held regularly and budget was utilized as per norms, after taking approval of the committee membres of the hospital development society.

3.. Village Health & Nutrition, Water Supply & Sanitation Committee (VHNWSC)

a) In the 4 sub-centres visited by the team , it was observed that VHSC accounts are maintained by Anganwadi workers. Use of VHSC funds were not satisfactory because of the non-co-operative Sarpanchs. (Joint signatories to operate the account) who took unilateral decision on the pattern of expenditure. Anganwadi worker has no voice in pattern and period of utilizing the fund . In practice, the VHSCs are not conducted regular meeting for passing resolution on sanitation etc. Sarpanchs are drawing the entire VHSC fund without doing any work actually. 4. Untied Funds: a) All the institutions were regularly provided Untied funds District office is yet to release untied fund for the year 2009-10 to the Sub-Centres at the time of visit.

5. 24 hours delivery care :

a) All the PHCs identified under IPHS standard are 24 hour service centres, there was n separate budget released under this head. The staff nurses and ANMs conduct delivery at these centres need to be trained in using new born care equipment such as Radient warmer and Phototherapy Unit.

6. Services of Janani Suraksha Yojana

a) Women belonging to BPL , SC/ST families are eligible for JSY cash incentive only for first two deliveries. b) Under the scheme the rates are for institutional deliveries –Rs. 700/- per case in rural area and Rs. 600 per case in urban area. For home delivery JSY benefits is Rs. 500 per case. c) The availability of budget was adequate and it was observed that beneficiaries got their payments under the scheme in time. 24 of 9

d) It was observed that all the 88 contacted beneficiaries were happy with the services received under the scheme. 7. Implementation of ASHA Scheme: a) District comprised of 870 villages, 1032 ASHAs were to be selected. 640 were selected upto the end of July 2009. It is stated by the district authorities that the target would be fulfilled and services of ASHAs would be made available in the district b the end of Sept. 2009. b) In the visited areas ASHAs were interviewed, it was found that the Scheme was yet to be functional. 8 Physical Infrastructure: 8.1 PHCs a) 4 PHCs, 7 CHCs and 37 Sub-centres ere not having own Building in the District. Most of the rural centres were having Govt. (Deptt) accommodation. b) PHCs visited at Sangadi, & Kondha were running in Govt. building. AYUSH MO was not posted in both the PHCs. 8.2 Sub-Centres

a) Sub centres visited at Shivanibandi, Savaraband, Kozra and Chichal.

b) Ambu bag/suction, benches for clients, steam sterilizer, weighing machine and delivery kit were not available in some of the centres visited.

c) Emergency contraceptive Pills, Disposable syringes, DDKs, IUDs anteceptic solution, Cap. Ampicillin, and injection Gentamicine were not in stock in most of the sub-centres at the time of visit.

9 ) Community satisfaction & opinion on health services;

a) To assess the community satisfaction 40 mothers of one year old child were interviewed in sub centre area at Shivanibandi,Kosra, and Chichal to assess the knowledge and opinion about the health services.

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b) 92.5% respondents were not aware about danger sign of ARI, and 42.5% mothers did not know the advantages and side effects of contraceptives. IEC activities need to be geared up. c) In addition 40 villagers of the selected area were also contacted to know the opinion about the work of male health workers and found that the behavior towards the villagers and work in respect of collecting blood smears, and giving proper advice /treatment of fever cases was satisfactory. d) Public opinion was good on the services rendered by the PHCs/CHCs visited by the team Village leaders and ANC/PNC beneficiaries and others have all expressed good opinion on the overall functioning of PHCs. 10) Maintenance of registers:

a) Printed registers for family planning services, immunization & MCH, Stock registers and Cash books were available at PHC /Sub centre level. Some o the registers were not maintained .

b) EC registers were not maintained at any of the sub-centre visited. Most of the registers maintained at SCs were printed. Wherever printed registers /reporting formats were not supplied ,Xerox copies of the same were maintained.

8.District Gondiya

Major observations of Regional Evaluation Team, Bangalore about the Evaluation work in Gondiya Districts of Maharashtra in August, 2009

I.Details of the visited Institutions:

Gondiya Kawarabandh,Indora,and Mulla Kawarabandh, Zhaliya,Indora,Paraswada,Mulla Davki.

II. Major Observations:

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1. Human resources: a) Staff required iin district level NRHM programme management Unit(DPMU) is filled. . b) Some of the technical posts as haealth workers and supervisors etc were found vacant in the CHC/PHC and SC level. c) Most of the sanctioned posts under IPHS in the district like X-ray Technician , Dermatologist, Orthodentist, Gynecologist, Pediatrician, ENT Specialist, Cardiologist and other Medical Specialists were found vacant.

2. I Implementation of Rogi Kalyan Samithi RKS)

a) Rogi kalian Samiti were set up in all 9 CHCs (called Rural Hosdpital in the state) and 39 PHCs and 1 Distt. And 1 Sub district level hospitals in the District.

b) In the visited centre PHCs at Indora and CHC at Pawarabandh , meetings of RKS were being held regularly and budget was utilized as per norms, after taking approval of the committee membres of the hospital development socity..

II. Village Health & Nutrition, Water Supply & Sanitation Committee (VHNWSC)

d) The fund is jointly operated by the village Sarpanch and the Anganwadi worker of the women & Child welfare deptt . ANM was only a member of the committee and Sarpanch took unilateral decision on the pattern of expenditure. Anganwadi worker has no voice in pattern and period of utilizing the fund . In practice, the VHSCs are not conducted regular meeting for passing resolution on sanitation etc. Sarpanchs are drawing the entire VHSC fund without doing any work actually. d) It was also observed that cash books are not properly maintained. Only vouchers are kept in loose sheets . It was observed that many times the village Sarpanch takes unilateral decisions without really conducting meetings of VHCs 3. Untied Funds: a) Untied funds was being provide to SCs, PHCs and CHCs in the district.

27 of 9 b) District office is yet to release untied fund for the year 2009-10 to the Sub-Centres at the time of visit to visited sub centres Jhalia and Paraswada. c) In the visited sub centres Jhalia and Paraswada it was observed that in the previous years also untied fund was not used as per norms. ANM worker has no voice in pattern and period of utilizing the fund . In practice, the VHSCs are not conducted regular meeting for passing resolution on sanitation etc. Sarpanchs were taking unilateral decision and demand part of the money without doing any work. ANMs being low cadre staff were having difficult time handling the non-cooperative Sarpanchs. actually.

4. 24 hours delivery care : a) All the PHCs identified under IPHS standard are 24 hour service centres, there was separate budget released under this head. The staff nurses and ANMs conduct delivery at these centres need to be trained in using new born care equipment such as Radient warmer and Phototherapy Unit. 5. Services of Janani Suraksha Yojana a) There was sufficient budget available in the district under the scheme. b) All the 58 contacted beneficiaries were happy with the services received under the scheme. 6. Implementation of ASHA Scheme: a) In the district upto the end of 2008-09, of the total 8 taluks (4 tribe taluks))were taken up for implementing ASHA Scheme. A total of 252 ASHAs were selected and 248 were trained. All were given drug Kits. b) In the visited areas ASHAs were interviewed, and they stated that they have received training and drug kits. 7 Physical Infrastructure: 7.1 District hospital at Gondia has equipment like multi monitors , defibrillators but physicisian’s post was lying vacant. There were no trained persons to handle these equipments. AYUSH Medical Officers were posted in under Ayurvedic,Unani and Homeopathy segments but they were not given separate cubicles to attend outpatients. They were sharing the room with Orthopedic surgeon and Physiotherapist. For Homeopathy drug dispensing bottles were not supplied. In the out patient wing chair were not provided for seating of patients.. 7.1 PHCs

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a) All 9 CHCs, 39 PHCs and 37 Sub-centres were functioning in Govt. (Deptt) accommodation. There are 335 sub-centres out of that only 9 were functioning in Private accommodation. b) In PHC Indona, it was observed that stock of condom was NIL since April 2009. 7.2 Sub-Centres a) Sub centres visited at Zhaliya and Paraswada. b) In the visited SCs at at Zhaliya and Paraswada examination table and Ambu bag/suction was not available at Zhaliya SC and, Ambu bag/suction and steam sterilizer were not available at Paraswada SC . c) Kerosin oil,/gas ,Emergency contraceptive Pills, Tab Metronidazole, were not in stock in the sub-centres at the time of visit. 8 ) Community satisfaction & opinion on health services; a) To assess the community satisfaction 20 mothers of one year old child were interviewed in sub centre area to assess the knowledge and opinion about the health services.

b) 95% respondents were not aware about danger sign of ARI, and more than 50% mothers did not know the advantages and side effects of contraceptives. IEC activities need to be geared up.

c) In addition 10 villagers of the selected area at Zhaliya and Paraswada were also contacted to know the opinion about the work of male health workers and found that the behavior towards the villagers and work in respect of collecting blood smears, and giving proper advice /treatment of fever cases was satisfactory.

d) Public opinion was good on the services rendered by the PHCs/CHCs visited by the team . Village leaders and ANC/PNC beneficiaries and others have all expressed good opinion on the overall functioning of PHCs. 9) Maintenance of registers: a) Printed registers for family planning services, immunization & MCH, Stock registers and Cash books were available at PHC /Sub centre level. b) The registers were not found updated in some sub centres. c) EC registers were not maintained at any of the sub-centre visited. Most of the registers maintained at SCs were printed. Wherever printed registers /reporting formats were not supplied ,Xerox copies of the same were maintained. 29 of 9

************* 9. District: Jalna

Major observations of Regional Evaluation Team, Banglore about the Evaluation work in Jalna Districts of Maharashtra in Sept- 2009 I. Details of the visited Institutions: District Hospitals PHCs visited SCs Visited Visited visited Jalna _ Jamked,D.Kalegaon Jamked, Bakshiwadi, Rajur. D.Kalegaon Revgaon, Raijur and Nalani.B.K.

II. Major Observations:

1. Human Resources: All the sanctioned posts under DPM and Block Programme Management units were in position.. At the district office one post of Programme Officer, 8 posts of MOs 14 posts of Staff nurse and 155 posts of contractual ANM were vacant. 2. Rogi Kalyan Samities (RKS) and VHNWSCs: a) Rogi Kalyan Samities have been set up in all the peripheral 38 PHCs, 8 CHCs and 2 Sub- district Hospitals District hospital in the district., b) It was observed that the meetings of RKS were being held regularly and funds were also are being utilized as per norms. c ) The team has reported that 904 Gram Panchayats out of existing 958 Gram Pachyats in the district VHNWSCs were having joint account to handle VHNWSC fund. d) In both the Sub-Centres visited by the team, it was observed that,VHSC accounts are maintained by Anganwadi workers. Use of VHSC funds are not satisfactory because of non-cooperative Sarpanchs.(Joint signatories to operate the account.) who take unilateral decisions. AWWs have no voice in the pattern and period of utilizing the fund. In practical the VHSCs are not conducting regular meetings for passing resolutions on sanitation etc; instead , Sarpanchs are drawing the entire VHSC fund without doing any actual work. 2 Services of Janani Suraksha Yojana:

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a) Women belonging to BPL,SC/ST category family is eligible for JSY payments for their fist two deliveries. The rates are Rs. 700 per case for rural area, Rs. 600 per delivery in Urban area and Rs. 500 for home delivery in the district.. b) It is found that JSY was functioning in proper way in the district and funds were being provided regularly. In the two SCs visited by the team at Nalani B.K. and Revgaon several cases were pending for JSY benefits. c) In all, 62 JSY beneficiaries were selected and 51 contacted in the field. All the beneficiaries stated that they received full JSY cash incentive, MCH cards were issued to all, ANC/PNC visits were made by the ANM. 24 hour delivery care system: a. In the district, all PHCs were functioning as 24 –hour delivery care institutions. There was no separate budget provided to the Centres. b. Staff nurses and ANMs who are particularly involved to conduct delivery need to be trained in using new born care equipments such as Radient warmer and Phototherapy . c. Among the PHC s visited PHC D.Kalegaon has not conducted 10 stipulated No of deliveries per month fixed for 24X7 institutions . Delivery performance was just 46 in 2008-09 and 6 during April to August 2009. 4. ASHA Scheme: During the current year 2009-10 upto the end ofJuly 674 ASHA were selected. Training of ASHA is yet to be taken up. 5. Physical Infrastructure and stock position: PHCs a) PHCs visited at Rajur and D.Kalegaon were having Govt. building b) In PHC D. Kalegaon the condition of the building is very poor. With dampness in the ceiling in all the rooms during rainy season. There is no regular water supply. c) AYUSH MO Is not posted in both the PHCs visited.

Sub-Centres a) The furniture ,equipments and drugs like Benches for clients, foot stool, Ambu bag/suction is not available in SC Revgaon.AD syringes, disposable syringes, IUDs, DDKs, EC pills, Tab, Metronidazole, Tab Oxytocin, Cap. Ampicillin,Inj. Gentamycin were not available at SC Revgaon 31 of 9 b) Similarly, Mclntsh sheet, Ambu bag/suction Delivery kit . EC pills, Tab, Metronidazole, Tab Oxytocin, Cap. Ampicillin,Inj. Gentamycinare not being supplied to Nalani B.K. 6. Knowledge and opinion of the community on Health Services: ANM Services a) As many as 20 mothers were interviewed in the coverage area of 2 sub-centres visited in the district for assessment of Knowledge and Opinion on services provided by ANMs . b ) All of the contacted mothers were happy ith the availability of ANMs when needed. c) Majority of the mothers were satisfied with maternal care services. d) 90% Mothers were found to be not aware of danger sign of ARI. e) 55% have no kbowledge on side effects of contraceptive methods MPW(male) Services: 10 persons from each village of the visited SC area were also contacted to know the opinion about the work of male health workers and found that the behavior towards the villagers and work in respect of collecting blood smears, and giving proper advice /treatment of fever cases was satisfactory.MPW(M) has not maintained register for Nirodh beneficiaries register. Villagers have expressed satisfaction towards work of MPW(M) . He has achieved his target in collection of blood smears and FP methods. 7. Reconciliation of reported performance: 225 Sterilization and 111 IUD cases were recorded in the service registers as against the reported figures are 283 and 179 respectively at PHC Jamkheda for 2008-09. 8. Maintenance of Registers on FW and MCH services: a) Registers for FW methods , mmunization & MCH , stocks and cash books are aintained at PHCs/SC level. Some of the registers are not updeated. b) EC registers,Stock register, cash book for SC funds, JSY registration cards were not found maintauind at SC Revgaon. c) Most of the registers maintained at Sub-centre level were Printed ones.

10. District:Gingili

Major observations of Regional Evaluation Team, Banglore about the Evaluation work in Hingoli Districts of Maharashtra in Sept- 2009 I. Details of the visited Institutions:

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Hingoli Sub-distt Masod,Akhodabalapur Masod,Akhodabalapur Hospital Basamath Jawlabazar,and Kurunda Krishnapur,Tapovan Distt.Hospital Hingoli ,Kauta and Jawlabazar.

II. Major Observations:

1. Human Resources: a) Posts of DHO/ADHO were vacant in the District. Most of the posts of Health Supervisors, Health Assistants (Male & Female) MPW (Male & Female/ANM, Pharmascists and Drivers were lying vacant in the district. 20 posts of Lab technician were also vacant. b) At District Hospital Hingoli, all sanctioned posts of specialists, were filled. Gynecologist, General Surgeon, Radiologist and Dermatologist were on contractual basis visiting hospital three days a week. 2.1. Rogi Kalyan Samities (RKS): a) Rogi Kalyan Samities were set up in all the peripheral 24 PHCs, 4 CHCs District hospital and one sub-district hospital in the district., b) It was observed that the meetings of RKS were being held regularly and funds are being utilized as per norms. 2.2 Village Health , Nutrition,Water Supply & Sanitation Committees: a ) All 711 villages have VHNWSCs and opened joint to handle the funds. Accounts are being maintained by Anganwadi workers. b) The funds has already been released to the VHSCs, but the manner it was being utilized is not satisfactory . c) VHSC accounts are maintained by Anganwadi workers. Use of VHSC funds are not satisfactory because of non-cooperative Sarpanchs.(Joint signatories to operate the account.) who take unilateral decisions. AWWs have no voice in the pattern and period of utilizing the fund. In practical the VHSCs are not conducting regular meetings for passing resolutions on sanitation etc; instead , Sarpanchs are drawing the entire VHSC fund without doing any actual work. 3 Services of Janani Suraksha Yojana:

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a) Women belonging tio BPL,SC/ST category family is eligible for JSY funds for their fist two deliveries. The rates are for Institutional deliveries Rs. 700 per case for rural area, Rs. 600 per delivery in Urban area and Rs. 500 for home delivery. b) It is found that JSY is functioning in proper way in the district and there was no scarcity of funds . In the two SCs visited by the team several cases are pending for JSY benefits. c) In all, 47 JSY beneficiaries were contacted in the field. All the beneficiaries stated that they received full JSY cash incentive. 4. 24 hour delivery care system: a. In the district, all 12 PHCs were identified under IPHS are functioning as 24 –hour delivery care institutions. b) Staff nurses and ANMs need training for infant care equipment such as Radiant warmer and Phototherapy. 5. Untied funds: In both the centres visited, viz. PHC Jawalabazar and PHC Kurundha this fund was utilized as per guidelines after taking approval o the committee members of the Rogi Kalyan Samithi, the fund is utilized for meeting the expenses of up-keep of the hospital. 5. Physical Infrastructure and stock position: PHCs a) Out of 24 PHCs functioning , 16 PHCs have other Department accommodation for services. (b) 12 PHCs, in the district were identified to provide facilities and services as per IPHS during 2008-09. c) PHCs visited at Kurundha and Jawala Bazar were functioning in Govt. building. d) In PHC Jawala Bazar Telephone facility and Microscope were available/not supplied. e) AYUSH MO Is not posted in both the PHCs visited. Sub-Centres a) Out of 132 HSCs functioning, 8 HSCs have other Departmental accommodation for the services. b) Sub-centres at SC. Tapovan and Kauta were verified for facility check list and found that essential furniture nd equipments like Machinth sheets, Ambu bag/suction,delivery kit,stove etc were not available in these centres. b) AD Gloves, syringes, disposable syringes, IUDs, DDKs, EC pills, Tab, Metronidazole, Cap. Ampicillin, and Inj. Gentamycin were not available in both the sub-centres.. 6. Knowledge and opinion of the community on Health Services: 34 of 9 a) As many as 20 mothers were interviewed in the coverage area of 2 sub-centres visited at Tapovan and Kauta for assessment of Knowledge and Opinion on services provided by ANMs b ) Majority of the mothers were satisfied with maternal care services. c) 90% Mothers were found to be not aware of danger sign of ARI. 55% respondents have knowledge of side effects of contraceptive methods. d) Public opinion was good on the services being rendered by PHC/CHC. ANC/PNC beneficiaries expressed good opinion on the overall functioning of PHCs. e) 10 persons from each village of the visited SC area were also contacted to know the community health service status on the work of male health workers and found they were satisfied with the services 7. Maintenance of Registers on FW and MCH services: a) Registers for FW methods, immunization & MCH , stocks and cash books are maintained at PHCs/SC level. Some of the registers were updated. b) Most of the registers maintained at Sub-centre level were Printed except Eligible Couple registers.

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