MAHARASHTRA 1.District Akola Major observations of Regional Evaluation Team, Chennai about the Evaluation work in Akola District of Maharashtra 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 India, 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.