Madhya Pradesh 1.Alirajpur District Major observations of RET, Bhopal about the Evaluation work in District Alirajpur of Madhya Pradesh in July 2010.
Details of the visited Institutions:
District Visited DH/ PHCs/CHCs visited SCs Visited Alirajpur Distt. Hospital: Alirajpur Walpur, Ojhad, Lodhani, Madhupalavi, Silota, Malveli, CHCs: Sondwa and Bhabhra Chotikareti, Chhotakhutaja, Badakhutaja, Sejawada, PHCs:Bakhatgarh and Umarali. Dunganwani, Devali and Mahendra.
1. Human resources: a) 13(87%) out of 15 posts of Specialists, 35 (67%) posts of Medical Officers, 50 (68%) posts of Staff Nurse, 15 (54%) posts of LHV, 6 (50%) post of Multi Purpose Supervisor and 38 (46% ) posts of MPW(Male) were lying vacant in the District . b) 2 posts of Surgical Specialists, 50 posts of Staff Nurses, 3 posts of Nursing Sisters, 2 posts each of Opthalmic Assistants, Lab Technicians, Matrons & Store Keepers and 5 posts of Pharmacists were vacant in District hospital Alirajpur. c) It was observed that position of medical & para medical staff are inadequate in visited CHCs Sondwa and Bhabhra; vacant posts should be filled for providing better health care services.
2 Rogi Kalyan Samiti (RKS) and Village Health & Sanitation Committee (VHSC):
a) Rogi Kalyan Samitis have been constituted and funds are provided every year.
b) As per the information received from DPMU, CHC Bhabhra and Kattiwada did not incurr any expenditure from RKS funds during 2009-10. CHC, Sondwa has spent only 40% of allotted funds in the same year. Funds have been allotted for 2010-11 to all CHCs also but no expenditure was incurred by any CHC till the time of visit by the team.
c) It was informed that during 2009-10, PHCs at Ambua, Bakhatgarh, Khattali Umarali and barjhar have not incurred any expenditure from RKS funds. PHCs Bori, Nanapur and Jhiran have utilized allotted funds . Funds allotted in 2010-11 to all PHCs but no expenditure incurred by any PHC till the visiting month in the district.
d) Most of the Villages were covered with the VHSCs in the district as 521 VHSCs have been formed against 540 villages in the district.
e) It was reported that 307 Village Health & Sanitation Committees have ASHA as a member . Bank accounts were opened in 291 VHSCs. However, there were only 5 VHSCs with bank accounts out of 44 VHSCs in Sondwa block.
3. Services of Janani Suraksha Yojana (JSY): a) 46 JSY beneficiaries who were contacted during the field check in the area of 10 sub- centres were mostly satisfied with the services received under the scheme. b) Among the contacted mothers, only 59% got all three ANC checkups and 50 % got PNC checkups by ASHA and ANM. Only 6 (13%) mothers were accompanied by ASHA /DAI/AWW to the institutions for delivery. c) Updated registers were maintained by the visited centres and concerned Medical Officer checked the same regularly once in a month.
4. Services of ASHA Scheme: a) 473 ASHAs have been selected and 416 out of them were trained and equipped with drug kits in the district. b) In the visited sub centers at Medveli, Devali, Mahendra and Bada Khutaja, no ASHA was selected. ASHAs were working properly at the other places visited in the district.
5. 24 X 7 hours Delivery Care System:
11 (2CEmOC & 9 BEmOC ) institutions were providing 24 X 7 hours delivery care services in the district.
6. Untied funds: a) Rs 50,000 to CHC, Rs. 25000 to PHC and Rs 10,000 to each sub centre were provided as untied funds during 2009-10. b) As reported by DPMU, all 5 CHCs received allotment of funds and spent more than 80% of funds during 2009-10. CHC Bhabhra spent only Rs 3692 out of Rs 50,000 allotted in 2009-10. During 2010-11, all the above CHCs were allotted funds @ Rs.50,000 each and CHC Jorbat, Katthiwada and Udaigarh were utilizing the same and others not yet started spending. c) During the year 2009-10, all the PHCs received allotment of funds and also spent 80% or more funds, except PHC at Barjhar and Jhiran. During 2010-11, all the PHCs received untied funds but most of them have not yet spent anything. d) Sub centres at Walpur, Ojhad, Lodhani, Madhupalavi, Chotikareti, Chotakhataja, Badakhutaja, Sejawada Dungawani, Devali, Mahendra received funds and utilized the same properly. ANMs of Silota & Malveli has joined recently and did not receive any untied funds.
7 Physical Infrastructure:
7.1 CHCs
a) CHCs at Sondwa and Bhabhra visited in the district were functioning in Govt. buildings and the premises were found in neat and tidy condition. CHC Sondwa and CHC Bhabhra had only 4 & 6 beds respectively against 30 beds sanctioned to each CHC. b) Blood storage unit and incinerator facilities were not available in both the visited CHCs.
c) X-Ray facility is available at both the CHCs but in non-functional condition. Resuscitation equipment was not available at Bhabhra CHC. Anaesthesia equipment was also not available in both the CHCs.
7.2 PHCs
a) Both the visited PHCs at Bakhatgarh and Umarali were functioning in Govt. building and were having 4 beds each. Most of the equipments and facilities were available with them except telephone facility. b) OT was not available at Umrali PHC.
c) Microscopes are available at both visited the PHCs but Lab. Technician post was lying vacant at Bakhatgarh PHC.
d) AYUSH Medical Officer is not available at the both PHCs.
7.3 Sub-Centres
a) Sub-centres visited at Walpur, Ojhad, Lodhani, Madhupalavi, Chotikareti, Badakhutaja, Sejawada Dungawani, Mahendra & Silota were functioning in Govt. buildings. Malveli, Chotakhutja and Devli centres were functioning in Anganwadi centres. Hand pumps was the main source of water at most of the sun-centres. b) None of the visited sun-centers had pointed eligible couple registers c) Health workers (F) had received SBA training in the visited sub-centres. d) Labour rooms was available in sub-centre Sejawquda, Walpur, Ojhad, Silota, and Chhotikareti but deliveries were not conducted in the labour room. Rest of the sub- centres were not having labour rooms. e) Examination table, Delivery kit, Delivery table and BP apparatus were not available at some of the centres. f) DDKs, Emergency contraceptive pills, Tab. Misofrostol, Inj. Gentamicine, Tab. Oxitocin, Cap. Ampicillin etc were not available at any of the visited sub-centres. g) ANMs were not staying in the Sub-centre villages.
8) Community satisfaction & opinion on health services:
a) To assess the community satisfaction, 57 mothers having last child up to one year of age old were interviewed in the area of the visited sub-centre.
b) Almost all the mothers were aware of the Government health facilities where they can get all health services.
c) Less than half of the mothers replied that they were visited by the ANMs within three days of delivery, had three post natal checkup and aware about advantage and side effects of contraceptives. d) 39% mothers knew the symptoms of ARI, 44% mothers knew the schedule of child immunization and only 37% mothers were aware of contraceptive methods. e) During the course of visit to PHCs Bakhatgarh and Umarali, it was found that the beneficiaries and others health clients were satisfied with the services of PHC MO and the staff.
9) Sample verification of FW acceptors:
a) Out of selected 124 acceptors of Family Planning methods, for Sample verification, 95 cases (77%) could be contacted in the district. While examining records of selected cases from service registers, it was noticed that age of spouse in 55 (44%) cases and age of youngest child in 47 (38%) cases were not recorded.
b) Out of 60 contacted cases of IUD, OP and Nirodh users 46(76.7%) acceptors denied receipt of the services. Such false reporting is required to be rectified urgently.
10) Maintenance of registers:
a) Maintenance of records and registers was found very poor in most of the visited sub centres.
b) Most of the sub centres visited did not maintain and produce IUD, CC and OP service register. The records wherever maintained were of poor quality hence sample selection of the beneficiaries could not be done properly. c) The reported figures of IUD in the year 2009-10 and 2010-11 could not be verified due to absence of master Register at CHCs visited and Civil Hospital Alirajpur.
d) Lack of supervision was noticed at all the visited centres in up keeping of records.
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2.Indore District Major observations of Regional Evaluation Team, Bhopal about the Evaluation work in Indore District of Madhya Pradesh State in August, 2010
I. Details of the visited Institutions:
District PHCs/CHCs and DH visited SCs Visited Visited
Indore District Hospital: Indore, Chotabangarda, Gandhinagar, Civil Hospital: Mhow, Jambudihapsi, Khurdi, CHCs: Manpur and Depalpur Khedisihod, Rajpurakhati, Kelod, PHCs: - Hatod, Bhicholi, Hapsi, Kishanganj and Agra Kanadia and Hisalpur
II Major Observations
A) District Indore
1. Health Human Resource :
a) There was acute shortage of skilled man power in the district as may be seen from the following table. Particulars Sanctioned Posts Vacant
Specialist 43 21
Medical Officer 152 38
Staff Nurse 152 28
MPW Male 104 39
MPS 10 8
As may be seen from above, a large number of posts of Specialist, Staff nurse and MPW (M) are lying vacant. It is required to take necessary action to fill up these posts for providing health care delivery in the district may be taken urgently..
5 b) Contractual staff under RCH was also found to be inadequate. One post each of PGMO for Anesthetics, Pediatrics and Gynecologist was lying vacant. 2 posts of Medical officers, 13 posts of staff nurse (BE moc) and 18 posts of ANMs were also vacant. c) Six specialists including the post of hospital Superitendent and 11 posts of staff nurses (out of 53) were lying vacant in Distt. Hospital Indore. It was also observed that medical and para medical staff are inadequate in visited CHCs at Manpur & Depalpur.
2. Implementation of Janani Suraksha Yojana (JSY):
a. To assess the client satisfaction and service availability under JSY as many as 28 JSY beneficiaries contacted by the team in the district and found them to be satisfied with the services provided under JSY. b. All of them had TT and IFA during ANC checkups and also three ANC checkups. Most of them (about 93%) were accompanied by ASHA / Dai / ANM for going to the hospital for delivery. c. Transportation services / facilities were made available to all the contacted beneficiaries. d. Only 13 ( 46.4%) beneficiaries got three post natal checkup by ASHAs and ANMs and 8 mothers (28.6%) received their cheques for JSY cash incentive within 3 days of the delivery.
e) Proper registers were being maintained containing list of beneficiaries to whom cheques were issued and the MO in the visited centres were checking the registers on monthly basis.
3. Utilisation of Untied Funds: a) As reported by DPMU, Indore all CHC, PHCs, and sub-centres had been provided with the untied funds during 2009-10 and most of them utilized the funds. It was reported that except Khurdi Sub-centre, all visited sub-centres utilized their funds properly. b) No Untied funds for the year 2010-11 was provided to any of the centres till the month of visit.
4. Implementation of Rogi Kalyan Samiti (RKS): a) As per the information as has been received from DPMU, Rs. 23,00,000 to all 23 PHCs and Rs. 3,00,000 to all 3 CHCs were provided under RKS during both 2009-10 and 2010-11. b) It was reported that RKS at PHCs Dhanned, Palasiyapar, Jalodiyagvan, Palia, Harsola and Ataheda PHC did not incur any expenditure during 2009-10.
6. Village Health and Sanitation Committee (VHSCs):
a. The District has Village Heath & Sanitation Committees in 540 villages out of its total 645 villages and all VHSCs were having ASHA as a member.
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b. Only 425 VHSCs have been reported to have opened joint Bank accounts as per norms for handling the funds.
7. Functioning of ASHA Scheme:
a. It was reported that 735 ASHAs were selected and 710 of them were trained. All the 735 ASHAs are equipped with drug kits in the district.
b. During field verification, it was observed that ASHAs at village level were working satisfactorily. They were helping ANMs in ANC, Immunisation and other health activities and also motivating Institutional deliveries.
8. 24 X 7 hours Delivery Care System:
11 institutions were providing 24X7 delivery care system in the district.
9. Physical Infrastructure: i. CHC
a. CHCs Manpur and Depalpur were functioning in Govt. buildings and their premises were found neat & clean. Both the CHCs are 30 sanctioned beds but at present only 20 beds are available at Manpur and 10 beds at Depalpur
b) Though the Infrastructures was not as per IPHS in these CHCs most of the required equipments, drugs and other facilities were available there.
ii. PHC:
a) PHCs visited at Hatod Bhicholihapsi, Kanadiya and Hasalpur were having Govt. Buildings and having 6, 4, 2 and 5 beds respectively.
b) Cold Chain equipment was not available in Kannadiya and Hasalpur PHCs. Residential quarters for Medical officers were available at Hatod PHC only.
c) Electricity & water facility were available at all PHCs but electricity supply was irregular. Similarly, Jeep and Laboratory facilities were not available at any visited PHCs.
d. Contraceptives (IUD, OP and Nirodh) and Prophylactic drugs (IFA, Vitamin A) and Rescitation equipments were available in all the PHCs visited. AYUSH MO was available in all the PHCs.
iii.Sub-centre:
a) Visited Sub Centers were functioning in Government building except sub centres at Kinshanganj which was located in a Panchayat Bhavan. The ANM sof the most visited sub centers were not residing in sub center Villages.
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b) Electricity, Examination table, foot Delivery table and IUD insertion Kit were not available in one or other centers visited. Torch, stove and weighing medicine for adult etc. were not in working condition in few of the sub centers.
c) DDK, Kerosene oil, Emergency Contraceptive Pills, tab Misofrostol, tab Tablet Oxytocin is not available at any of the visited sub centers. Injection Gentamycin and Cap Ampicillin was available only at Gandhinagar sub center.
10 Knowledge and opinion of community on health services:
a. 41 mothers having child upto one-year of age were interviewed for assessing the services being rendered by the ANM working in the visited sub-centers in the district.
b. 24 (59%) mothers replied that the ANMs visited them within three days after delivery.
c 25 (61%) mothers received three post natal check ups. 20 (48.8%) mothers knew the danger sign of ARI. d. 29 (71%) mothers were aware about the use of ORS during diarrhoea and knew the schedule of child immunization. 61% mothers were aware of contraceptive methods.
e. All the mothers were aware of the government health facilities where they can get all health facilities.
F Performance of Health worker (M) of SC Chhota Bangarda was assessed for 2009-10 and 2010-11. After having elaborate discussions with Sarpanch, CC Users, ASHA and villagers it was observed that they were satisfied with their work though visit of the MPW(M) in the village were irregular.
g During the course of visit to PHC Bhichlihapsi, Kanadiya and Hasalpur it was found that the community was satisfied with the services received from staff and Medical Officers of PHCs.
11 Sample Verification of Family Welfare Acceptors:
a) Out of 155 FW acceptors (Sterilisation, IUD, OP and Nirodh) selected, 113 (72.90%) could be contacted for sample verification. b) While examining records of selected acceptors from service registers age of spouse was observed to be not recorded in 79 (51%) cases and age of youngest child in 18 (12%) cases. c) 41(51%) cases out of 82 genuine contacted acceptors reported to have not been visited by the Health Personnel for follow up services. d) It was also found that out of 83 contacted acceptors 31 (37%) acceptors of spacing method of Family Planning were reported false in the district. 14 (26.98%) acceptors were found to have discontinued services and out of that only 4 acceptors accepted other F.W .methods. Such data shows poor services of the spacing methods of FP and need close monitoring for improvement.
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e) Out of selected 139 beneficiaries of child immunization, 117 (84.2%) children could be contacted. As many as 49 (41.9%) beneficiaries weree not provided follow up services.
12. Reconciliation of reported performance:
a) Reported figures under IUD could not be verified for 2009-10 and 2009-11 for want of Master Registers at reporting units at CHCs Manpur, Depalpur, and PHC Hatod.
b) Figures reported by District Office for sterilization, IUD, OP and Nirodh for 2009-10 and 2010-11 for CHC Depalpur could not be checked with the report of CHC Depalpur because of non availability of progressive report. Such report for the current year was not made available for 2010-11 at PHC Hatod.
13. Maintenance of records and Registers:
a) EC Register was not maintained properly. The register was not produced before the team at some of the sub centers. b) Service registers for, OP and Nirodh were not maintained properly in most of the visited sub centers. c) MCH service Registers were mostly updated. d) Service registers for Sterilization, OP and Nirodh were not in printed form. e) Printed stock register is not available at entire visited sub-centres except at Kelod. Mothly reporting formats were not available at entire visted sub-centre except Chhotabangarda and Agra sub centres.
14. Other observation and Suggestions: -
a. Lack of supervision and monitoring was noticed at all levels which should be strengthened.
b The Bhicholihapsi and Kanadiya PHCs are 4-7 Km. away from District Hospital Indore and 4 Kms away from each other. In both PHCs there are 4 MOs and 3 staff nurses. Villagers in the surrounding area of these PHCs are generally utilizing the services at DH Indore which is near to all. Therefore, proper utilization of infrastructure and manpower of these PHCs need to be viewed.
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3. District Morena Major observations of Regional Evaluation Team, Bhopal about the Evaluation work in Morena District of Madhya Pradesh State in August, 2010
II. Details of the visited Institutions:
District PHCs/CHCs and DH visited SCs Visited Visited
Morena District Hospital: Morena Banmorgaon, Paroli, Rithorakalan, CHCs-Kailaras and Noorabad. Padavali, Sujarma, Madhogarh, PHCs- Sujarma and Banmore Kutrawali and Bharauli
II Major Observations
1. Health Human Resource a) The following table shows the vacancy position of skilled personnel against the sanctioned strength in the district.
Particulars Sanctioned Posts Vacant
Specialist 48 33
Medical Officer 94 11
Staff Nurse 159 127
MPW Male 202 60
LHV 55 18
As may be seen from above, a large number of posts of Specialist, Staff Nurses and MPW (M) are lying vacant. Necessary action is required to be taken to fill up these posts for providing proper health care delivery in the district. b) Contractual staff under RCH was also found to be inadequate. One Post of PGMO for Pediatrics and 2 posts of PGMO Gynecologist were lying vacant. 6 posts of Medical officers, 11 posts of staff nurse (BE moc), 4 posts of staff nurse (CE moc) and 51 posts of ANMs were lying unfilled. c) 16 posts of Specialists and 78 posts of staff Nurse were lying vacant in District Hospital, Morena. 10
2. Implementation of Janani Suraksha Yojana (JSY) :
a. To assess the client satisfaction and service availability under JSY as many as 20 JSY beneficiaries contacted by the team in the district and all of them were found satisfied with the services provided under JSY. b. All the mothers received TT and IFA tablets during ANC checkups and also three of ANCs. Most of them were accompanied by ASHA/Dai/ ANM while going to the hospital for delivery. c. Only 9 ( 45%) beneficiaries got three post natal checkup by ASHAs and ANMs and 3 mothers (15%) received their cheques for JSY cash incentive within 3 days of the delivery. d. Proper registers were being maintained containing list of beneficiaries to whom cheques were issued and the MOs of the visited centres were checking the registers on monthly basis. e.
3. Utilization of Untied Funds: a. As per information given by DPMU out of 8 CHCs 3 CHCs at Sabalgarh, Kailaras and Noorabad had received untied funds during 2009-10 and most of them utilized it fully; 05 CHCs were not provided funds during the year 2009-10 because they had not incurred expenditure during the financial year 2008-09. b. Out of 17 sector PHCs, only 3 PHCs Banmore, Devgarh,and Sumvali were provided with funds during 2009-10 and which was utilized. Other 14 PHCs did not get the grant because they had not spent the money allotted to them during 2008-09. c. Out of 199 sub centres in the district 169 Sub-centres were provided with untied funds during 2009-10 and the same was utilized the same properly. d. No Untied fund for the year 2010-11 has been allotted to any CHC, PHC and Sub Canter till the visiting month.
4. Implementation of Rogi Kalyan Samiti (RKS) a) Only two Rogi Kalyan Samitis at CHC level had been provided the funds @ Rs. 1,00,000 during 2009-10. The remaining 6 CHCs were not allotted funds because they did not incur any expenditure from the funds provided them during 2008-09. Only one RKS i.e. at CHC kailaras was provided the fund in the current year 2010- 11.
b) Out of 17 sector PHCs only PHCs at Banmore and Devgarh were provided with funds during 2009-10 and utilized properly. Other 15 PHCs did not get the grant because they had not spent the money allotted to them during 2008-09. For the year 2010-11 PHCs have not been allotted any fund till the month of visit.
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5. Village Health Sanitation Committee (VHSCs):
a. In the district out of 817 villages, VHSCs were formed in 478 Villages. Only in 10 Village Heath & Sanitation Committees, ASHA were working as its member.
b. 379 VHSCs have opened joint bank accounts for handling funds.
6. Functioning of ASHA Scheme:
a. As per the information received from DPMU, 1249 ASHAs were selected and out of that 1148 trained in first module. All 1249 ASHAs were equipped with drug kits.
b. In the visited 8 sub centers, most of the ASHAs were taking active part in providing the services of ANC, Immunization, Institutional deliveries and also preparation of blood slides of the febrile patients.
7. 24 X 7 hours Delivery Care System:
17 (4 CEmOC and 13 BEmOC) institutions were providing 24X7 delivery care system in the district.
8. Physical Infrastructure: i. CHC a. CHC Kailaras and Noorabad were functioning in Govt. buildings having 30 beded facility and their premises were found neat & clean. b. Anesthesia equipments and Blood storage facility were not available at CHC Noorabad. c. Bio-Medical wastage dispose system was not found in both CHCs.
iii. PHC:
a) Both the visited PHCs at Sujarma and Banmore were functioning in government building having capacity of 4 and 5 beds respectively. b) Microscope was unused as the post of due to Lab technician was lying vacant at PHC sujarma. c) Vehical and cold chain equipments were not available in the visited PHCs. d) AYUSH Medical Officer was not available at PHC Sujarma. e) Residential quarters for Medical officers were not available in both the visited PHC . f) The team reported that PHC at Sujarma is 2 Km away from village locality. No residential accommodation is seen around PHC. There is severe electricity supply problem. To and fro Public transport from PHC to village is available only one in 24 hours. Hence, accessibility to this PHC is very difficult and people were not availing the services regularly. ii. Sub-centre:
a. All visited Sub-Centres were having Govt accommodations except Sub Centers at Bharauli. Most ANMs of the visited sub centers were not residing in sub center
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villages. Deliveries were not being conducted in many centers even though there are lebour room facilities.
b. Examination table, Cup board, for drugs, Delivery kit, Torch, BP apparatus, Gloves, weighing machines etc were found in all the sub-centres except one or two places. Ambu bag was available in 4 sub centers out of 8 SCs visited.
c. DDK, Emergency contraceptive pills, kerosene oil, tab. Misofrosfol, and Oxtocin etc were not available at any of the visited sub centers.
d. Torch, Stove, BP apparatus were available at some of the Centers and they were not in working conditions in a few other centers.
e. SBA training was not provided to any of the ANMs working in the visited Sub Centers.
9. Knowledge and opinion of community on health services:
a. 39 mothers having child upto one-year age were interviewed for assessing the services being rendered by the ANM working in the visited sub-centres. b. Only 19 (49%) mothers replied that the ANMs visited them within three days of their delivery. c. 19 ( 48% ) mothers had three post natal checkups. d. 17 mothers (44) knew danger sign of ARI and the schedule of child immunization. e. (28.2%) mothers were aware about advantages and side effects of contraceptives use. f. During the course of visit to PHC at Ban More and at 5 villages of Sub Centers, it was observed that the community was mostly satisfied with the services of MO PHC and staffs.
10. Sample Verification of Family Welfare Acceptors:
a) Out of selected 117 Family Planning acceptors (Sterilisation, IUD, OP and Niodh) 82 (70%) could be contacted for sample verification in the district. b) While examining records of selected acceptors from service registers, age of spouse was found not recorded in 22 (19%) cases and age of youngest child in 36 (31%) cases. 37 (82%) cases out of 45 contacted acceptors reported to have not been visited by the Health Personnel for follow up services. c) The team found that out of 57 contacted cases of spacing methods i,e., IUD, OP and Nirodh 37 (65%) were reported false in the district. Such data shows poor service of the spacing methods of FP and need close monitoring and urgent action to discontinue such false reporting. d) Out of selected 174 beneficiaries of child immunization, 143 (82%) children could be contacted and confirmed with the doses. It was also found that as many as 75 (52.5%) beneficiaries were not provided with the follow-up services.
11. Maintenance of records and Registers:
13 a. EC Register was neither maintained nor updated at most of the visited centers in the district. b. Service registers for, OP and Nirodh were not maintained properly in most of the visited sub centers. Some of these registers were lacking the required data of the accepters. c. MCH service Registers were mostly updated. d. Service registers for Sterilization, was maintained properly at Distt. Hospital and CHC Kailaras but not in CHC Noorabad. e. IUD figures could not be verified for want of master register at the reporting units. f. Lack of supervision and monitoring noticed at all the centers at periphery level which should be strengthened.
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Major observations of Regional Evaluation Team, Bhopal about the Evaluation work in district Guna of Madhya Pradesh in April, 2010 1. Details of the visited institutions:- District DH, CHCs and PHCs visited SCs Visited Visited Guna Distt. Hospital: Guna Chhipon, Barkhedahat, Panwadi hat, CHCs: Aron and Myana Shahrok, Barod, Khutiawad, Dungasara PHCs: Bhadora (Block level) and Taknera Panwadihat and Bajaranggarh
2. Human resources:- a) Acute shortage in the technical manpower was observed in the district as given below: Particulars Sanctioned Vacant Specialist 68 50 Medical Officer 84 44 Staff Nurse 222 190 Lab.. Technician 28 12 Lady Health Visitor 51 21 MPW (M) 119 40
b) Under RCH, out of sanctioned 13 PGMOs contractual staff, only 8 posts were filled up. Against 12 staff nurses required for CEmOC & BEmOC there were only 4 in position. Similarly only 90 ANMs against 133 identified posts were in position. c) Most of the posts of specialist including Civil Surgeon were lying vacant in District Hospital, Guna. More than 50% posts of medical officer were also lying vacant there. The only post of Nursing Superintendent, all 9 post of Matrons, 6 out of 7 posts of Nursing Sister, 126 out of 150 posts of Staff Nurse, all (2) Ophthalmic Assistants, 11 out of 17 posts of PGMO, 4 out of 9 posts of Lab Technicians were also lying vacant there.
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3. Janani Suraksha Yojana (JSY) :- a) Beneficiaries under the scheme were receiving services in the visited area of the centres.
b) The team contacted 39 beneficiaries out of 45 selected for sample verification and found that all of them received ANC services in time and also JSY amount as per the norms.
c) Most of the beneficiaries were accompanied by ASHAs while going to the hospitals for deliveries. Only in 49% cases PNC services were provided and these services need to be enhanced by the health personnel.
d) In the visited centres JSY registers were maintained entering all relevant details of the beneficiaries. Concerned MOs in the visited institutions were checking the registers regularly once in a month.
4. Untied Funds :- a) As reported by DPMU, Guna every CHC, PHC and HSC in the district were being provided with untied fund @ Rs. 50,000, Rs. 25,000 and Rs. 10,000 per year respectively.
b) Out of 6 CHC, CHC Aron, CHC Raghogarh and CHC Beanaganj utilised untied funds during 2008-09 and 2009-10, CHC Bamori spent upto 50% of funds during last two year; CHC Kumbharaj did not spend funds during 2007-08 and 2009-10, though an amount of Rs. 50,000 was provided to the CHC during 2008-09.
c) PHCs at Chanchada, Mrigwas and Vijaypur did not incur expenditure from their untied funds in the year 2008-09, and PHCs at Maksudangarh, Mrigwas, Panwadihat, Vijaypur, Fatehgarh and Vishanwada did not spend the amount against the funds available during 2009-10.
d) All the visited sub-centers viz., Chhipon, Barkhedahat, Panwadihat, Shahrok, Barod Khutiawad, Dungasara and Taknera have received untied funds and also utilized the funds properly.
5. Rogi kalyan Samiti (RKS) and Village Health & Sanitation Committee (VHSC):- a) It was reported that Rogi Kalyan Samitis have been constituted at CHC and PHC level and all the PHCs and CHCs were provided with funds in the year 2008-09 and 2009-10. b) During 2008-09, PHC Chanchada and Mrigwas have not spent any amount out of the allotted RKS Funds. Similarly PHC Vijaypur & Vishanwada have not incurred any expenditure out of the allotted RKS funds during 2009-10.
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c) During 2008-09 CHCs Bamori, Beenaganj and Kumbharaj have not utilized RKS amount. During 2009-10 CHC Bamori has not yet utilized the allotted funds.
d) Block-wise report of the district shows that in 790 villages VHSCs have been formed against the 1260 villages in the district and all 790 VHSCs were having ASHA as a member. Most of villages in the visited sub centres were having VHSCs. e) Out of 790 VHSCS in the district only 687 were reported to have opened bank accounts for handling the funds.
6. Functioning of ASHA Scheme:- a) 1120 ASHAs have been selected in the district. Out of them , 1055 ASHAs have been trained and 957 of them provided with Drug Kit. In the visited centres, it was observed that ASHAs were trained, having drug kits and working properly. b) As informed by the ANMs, JSY beneficiaries and villagers of the visited sub centres the role of the ASHAs in the field was satisfactory. c) At the time of ANCs and immunization, ASHA’s were helping ANMs and also motivating and accompanying mothers for Institutional deliveries. 7. Physical Infrastructure and position of supplies:- i) CHC: a) CHCs visited at Aron and Myana were functioning in Govt. buildings. The premises of the visited CHCs were found neat and clean. 30 bedded facility was available at CHC Aron whereas only 6 beds were available at CHC Myana.
b) Infrastructure and equipment were not as per IPHS Standard. X-Ray facility, Resuscitation equipments and Anaesthesia equipments were not available at CHC Mayana. Anaesthesia equipment at CHC Aron but lying unused since long due to non availability of Anaesthesia specialist.
c) Blood storage unit and incinerator were not available in both the three visited CHCs. d) Operation Theatre was available at CHC Aron and the same was not available at CHC Myana. ii) PHC: a) PHCs Visited in the district were functioning in Govt. building having 6 bedded facility. Electricity connection was available at all the PHCs but power supply was irregular; Functional Operation Theatre with OT table was not available at all the three visited PHCs.
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b) Microscopes were available at all the visited PHCs but Lab. Technicians were not posted at PHC Panwadi hat. Jeep was not available in PHCs Bajranggarh and Panwadi hat.
c) AYUSH Medical officer was not available at the visited PHCs.
iii) Sub-centre: a) All the visited sub-centres were functioning in Govt. building except sub centre at Panwadihat which was running in PHC building . Electricity facility was not available in the visited sub-centre except Panwadihat and Dungasara sub-centres.
b) Though Delivery table was available at SCs Chippon, Shahrok, Panwadihat and Barod but Delivery kit was only available at sub-centre Barod. BP apparatus was available at all the visited sub-centre though it was found not in working condition at Barkhedahat sub- centre. Thermometer was available at all the visited sub-centre except at Chhipon, Khutiawad and Taknera sub-centre.
c) IUD and condoms were available at all visited sub-centre except Khutiawad, Dungasara and Taknera sub-centre. Oral pills were available at all the visited sub-centre except Durgasara and Taknera sub-centre.
8. Knowledge and opinion of the Community on health Services :- a) To assess the Knowledge and opinion on health Services provided by the ANMs, 38 mothers having child up to one year old were interviewed. Only 27 (57.9%) mothers reported that ANMs are available and as when needed.
b) Delivery of all the mothers was conducted by trained person and their babies were also weighed after birth.
c) 32 (84.2%) mothers put their babies to breast within 1-2 hours of delivery, 35 (92.1%) mothers were counselled for exclusive breast feeding and complimentary feeds. 14 mothers knew about danger sign of ARI.
d) Only 6 mothers were using any method of contraceptive and only 12 mothers were aware about contraceptive methods.
e) Some school teachers, CC users, Village Leaders, Social Workers and acceptors of family planning were interviewed in Shahrok, Barkhedahat and Chhipon sub-centres for
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assessing the services and their opinion about the work of MPW(M) working there. It was found that all the workers are performing their duties satisfactorily though they were not residing at their head quarters.
9. Sample verification of FW acceptors:- a) Out of selected 204 acceptors of Family planning methods, 134 (65.6%) acceptors could be contacted for sample verification. It was found that wrong / incomplete address was recorded for 26 acceptors. b) Minor discrepancy in the records of age of accepters, age of their spouse, age of their last child and total number of the children of the acceptors was also found during sample check. c) The incomplete information was also found in the record of F.W service registers in 116 (56.9%) cases with the age of spouse, 67 accepters (32.8%) with the age of youngest child and 15 cases (7.35%) with the age of accepters. d) It is also to be mentioned that during various sample check in the districts of M.P. many false cases of spacing methods of family planning were noticed this is being regularly reported to the State and Districts for taking appropriate necessary action so improve the quality of service but it seems that no action has been taken so far by the State. In this district also half of the contacted spacing method users (50/97) were found to be false reporting cases. 10. Reconciliation performance report:- The figures reported for IUD at district office for the year 2008-09 and 2009-10 did not tally with the same report at CHC Aron, PHC Bhadora and D.H. Guna. Similarly performance in respect of Sterilisation for D.H. Guna was shown as 946 by district office for the year 2008- 09 but the same was 626 as per the report at D.H. Guna. The matter may be treated as serious and looked into. 11. Maintenance of records and Registers:- a) Eligible Couple registers were either not maintained or not up dated at sub centre level. b) Most of OP and CC registers were not printed and, these registers were mostly found with incomplete information at the sub-centre. c) No sterilisation service register was maintained at CHC Aron. d) Consolidated IUD register was also not maintained at CHC Aron and PHC Bhodara.
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Major observations of Field Survey Unit, Bhopal about the Evaluation work in district Shahadol in September, 2010
I. Details of the visited institutions:-
Districts DH, CHCs and PHCs visited SCs Visited Visited Distt. Hospital: Shahdol Bakoha, Bahagarh, Kishwahi, Shahdol CHCs: Budhar and Singhpur Dhanoura, Pathra, Samatpur, & PHCs: Channoudi, Kishwahi, Chhirhati Amraha & Khaira
1. Human resources:- As reported, there was acute shortage in the technical manpower in the district for regular and the contractual staff as given below. a. Regular:
Particulars Sanctioned Vacant Officers (Class I & II) 126 72 Staff Nurse 199 145 Lab. Technician 30 18 Lady Health Visitor (LHV) 40 5 MPW (M) 166 58 MPW (F) 244 24
B.Contractual Staff under RCH:
Particulars Required Vacant PGMO(Pediatrics) 03 01 PGMO(Anesthetics)) 03 02 PGMO(Gynecologist) 03 02 Medical Officer 10 06 Staff Nurse BEmOC 10 10 ANMs 194 164 c) However, in the visited centers at Budhar, Singhpur, Keshwahi, Channaudi, Amaraha and Khaira most of the Specialists, MOs as well as Para-Medical staff were in position.
2. Janani Suraksha Yojana (JSY):-
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a) The team contacted 30 (77%) beneficiaries out of 39 selected JSY beneficiaries in the district, Most of the beneficiaries were satisfied with the services and other facilities received during ANC and PNC. b) It was also observed that only 10 (33%) beneficiaries had been paid with the cash incentives within three days after delivery. c) In the visited CHCS at Budhar and Singhpur, the status is as under.
Name of Funds allotted Expenditures incurred No of beneficiaries CHCs 2009-10 2010-11 2009-10 2010-11 2009-10 2010-11 Budhar 1,20,62,635 40,74,450 53,08,000 29,45,375 2899 1480 Singhpur 24,75,000 14,00,00017,03,276 64,14,50 973 299
3. Untied Funds:- a) As par the details received from the district, untied funds provided to all 8 CHCs, 28 PHCs and 194 sub centers during 2009-10 had been mostly utilized by these centers. b) It was also reported that the funds provided for the current year to the district have been distributed to the CHCs, PHCs and sub centers and an amount of Rs.1, 37,000 has been spent by the CHC/PHC but no expenditure was incurred by the SCs till the visit of the team to the district. c) It was reported that the sub centers in the district were given funds @ Rs 10,000 in the year 2009-10 but in the current year each of these centers was provided with funds @ Rs. 5000.
4. Rogi kalyan Samiti (RKS):- a) It was reported that 37 Rogi Kalyan Samitis have been constituted at DH, 8 CHCs and 28 PHCs in the district. No RKS fund were provided in the District during 2009- 10 However, out of the opening balance of Rs.87, 34,047 an amount of Rs. 85, 84,320 was spent during 2009-10 and the remaining amount to the tune of Rs. 1, 49,727 was carried forward for the year 2010-11. b) It was reported that only 6 CHCs out of 8 have been given RKS fund @ Rs 10, 0000 during the current year 2010-11 and no RKS funds was allotted to any PHC during 2009-10 and 2010-11. c) District Hospital, Shahdol was in receipt of RKS fund to the tune Rs 5,00,000 for the year 2010-11. 5. Functioning of ASHA Scheme:-
21 a) 871 ASHAs have been selected for 818 villages in the district. All ASHAs have been trained Up to IVth module and all of them provided with drug kit. b) In the visited CHCs Budhar and Singpur, 163 and 220 ASHAs were selected for197 and 156 villages respectively and all were given IV Module of training and drug kits. 6. Village Health Sanitation Committee (VHSCs):- a) Block-wise report of the district shows that VHSCs have been formed in 660 villages and all VHSCs were having ASHA as a member. b) All VHSCs were reported to have opened bank accounts for handling the funds. c) The funds provided to the VHSCs was Rs.64,66,000 during 2008-09 and Rs.66,00,000 in the year 2009-10. d) Most of villages in the visited Sub Centers were having VHSCs.
7. 24 x 7 hour Delivery Care System:- In the district there are 37 institutions viz., 01 DH, 08 CHCs and 28 PHCs; All were functioning as 24 x 7, but this service was available in all the visited CHCs and PHCs on call. At PHC level, staff nurse is providing services for delivery on call. 8. Physical Infrastructure and position of supplies:- i) CHC: a) The Budhar and Singhpur CHCs were functioning in government buildings. The premises of both the CHCs were found neat & clean. The Budhar CHC having 30 beds & CHC Singhpur having 6 beds and all the beds were found in good condition during the visit. The Water supply was regular and sufficient but the electric supply was irregular in both the visited CHCs. b) Though norms for infrastructure and equipments were not as per IPHS both the CHCs were having essential equipments. c) Medical waste disposable system was lacking in both the CHCs. Anesthesia equipments were not available at CHC Singhpur. d) There is no Blood storage unit at any of the visited CHCs. The residential quarters for medical officers and Paramedical staff were available at CHC Budhar but at CHC Singhpur the quarters were under construction. ii) PHC:
22 a) Visited PHCs at Channoudi, Kishwahi, Amraha & Khaira in the district were functioning in Govt. Building. Electricity and water supply were available at all the PHCs except Amraha. b) The vehicle was not available in any of the visited PHCs. IUD insertions kit, Auto Clave and steam sterilizer was not found in PHC Channoudi. Resuscitation equipment was not available in PHC Amraha. The functional OT with OT table was found only at PHC Khaira. c) Cold Chain equipments like ILR and Deep freezers were found in the visited PHCs except PHC at Channoudi. Stock of vaccine was found sufficient only at PHC Khaira. Except PHC Khaira the Oxygen cylinder was found in all visited PHCs. Microscope was not found in the PHCs at Channoudi and Amraha. d) The contraceptives like IUD, Oral Pills and Nirodh were not available at PHCs Channoudi and Amraha. The stock of IFA found in adequate in PHCs Keshwai and Amraha. e) AYUSH Medical Officers were not available at any of the visited PHCs. The residential quarters for Medical Officers were found in good condition in Keshwahi PHC. iii) Sub-centre: a) All (8) visited sub centers were functioning in Govt. Buildings, There was no electricity and toilet facility in Dhanoura and Pathra SCs. Labour room for delivery was not available at Dhaoura, Pathra and Samatpur. b) Delivery table, Mcintosh sheet, Ambu bag, steam sterilizer, Delivery Kit and IUD insertion Kit were not available in most of the sub centers visited. c) The posts of male workers were found vacant in five out of eight visited sub-centers. The MPW was avaliable in Bakoha, Kishwahi and Sarangpur sub-centers 9. Knowledge and opinion of the Community on health Services:- a) To assess the Knowledge and opinion on health Services provided by the ANMs, 36 mothers having one year old child were interviewed. 28 (78%) mothers reported that ANMs are available as and when needed. b) 04 (11%) mothers have problems during their last pregnancy but they received proper advice in health. All 36 mothers replied that their babies were weighed after birth, only 13(36%) mothers put their babies to breast within 1 hour of delivery.
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11(31%) mothers replied that the ANM visited within three days after delivery, and in 18(50%) cases visits were made within 7th day. c) 13 (36.1%) mothers knew about danger sign of ARI. 29 (80.6%) mothers were aware about the use of ORS. 26 (72.2%) mothers knew the schedule of child immunization; only. d) 22 persons were interviewed to take the opinion about the services provided by health services and behavior of the worker. The respondents were mostly satisfied with the services and behavior of the MPWs. The male worker of Bakoha and Kishwahi was collecting slides regularly and were looking after immunization programmes. e) During the course of visit to PHCs, Khaira, Keshwani, Channoudi and Amraha, it was found that the service holders, AWW/ASHA etc. were satisfied with the staff and the health services provided by PHCs. The 42 persons were interviewed who were found satisfied with the behaviour and the services of the PHC. Almost all the Medical Officers of the visited PHCs used to stay at Head Quarters and all the emergency medicine and drugs were available in all the visited PHCs. 10. Sample verification of Family Welfare (FW) beneficiaries:- a) Out of total 196 selected acceptors of family planning methods, 133(68%) were contacted for sample verification in the district. While examining the data of selected accepters from service registers, age of spouse in 66 (34%) cases, breakup of male / female children in 29 (15%) cases and age of youngest child in 56(29%) cases were not found recorded. b) The follow-up services were confirmed by 56(98%), out of contacted 57 genuine family Planning method acceptors. All the operated cases (Sterilization cases) got the full incentive and in time. c) Spacing method accepters reported in the district was found mostly false cases. Out of 150 selected acceptors of spacing methods (IUD, OP & CC), 109 were contacted, 76(70%) cases were found fake/false reporting i.e., IUD-13, Oral Pills-31 and Nirodh 32. d) 06 of 10 OP contacted genuine users were facing difficulty in getting regular supply of OP. 11. Maintenance of records and Registers:-
24 a) The registers of eligible couple were not found printed and properly maintained in any of the visited sub-centers. b) The registers of IUD, OP and Nirodh were not found printed and not properly maintained in some of the sub-centers. In SCs at Pathra, Dhanoura and Samatpur the age of youngest child was not recorded in OP registers. c) The stock registers and cash-book of untied funds were found properly maintained in most of the visited SCs. d) Block Medical Officers were not verifying the records regularly resulting in poor maintenance of records.
12. Observation and Suggestions:- a) It was observed that the service for PNC checkup is not up to the mark at sub centre level. b) Many of the Visited sub-centers were functioning in PHCs building and were not conducting deliveries due to lack proper toilet facility and regular water supply in the centers. Such accommodations should be renovated for utilizing delivery purpose.
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6.Sagar District Major observations of Field Survey Unit, Bhopal about the Evaluation work in districts Sagar of Madhya Pradesh in the month of October, 2010. I. Details of the visited institutions:- District Visited DH, CHCs and PHCs visited SCs Visited Sagar Distt. Hospital: Sagar Naryawali,Jaruakheda, CHC: Rahatgarh and Kesli Khakron, Sehora, Kesli, PHC: Naryawali, Sehora, Sahajpur and Kusmi, Ghana and Paloh Tada
II. Major findings 1. Human resources: - Acute shortage in the technical manpower was observed in the District. A large no. of posts of key functionaries were vacant as given below: - a. Regular: Health Human Resource A. Particulars Sanctioned In position Vacant
1 Specialists 50 27 13 2 Medical Officer 135 78 57 3 Staff Nurse 203 128 75 4 LHV 87 63 24 5 Lab. Technician 50 33 17 6 Male Supervisor 55 44 11 7 MPW (M) 214 137 77
b. Contractual Staff under RCH: Staff requirement under RCH was also not satisfactory. The details are as given below: B. Particulars Required In Position Vacant 1 PGMOs 10 02 08 2 Medical Officer 15 08 07 3 ANMs 80 48 32
c. In the visited CHCs at Kesli and Rahatgarh, Staff position was somewhat good even though the key posts as detailed below were lying vacant. Name of the posts CHC : Kesli PHC : Rahatgarh Sanctioned Vacant Sanctioned Vacant Medical Officers 05 03 06 02 Staff Nurse 04 03 06 03 Supervisor 04 06 - - LHV 06 02 1 1
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ANM 21 02 - - MPW(Male) 18 09 - - d. In other visited PHCs, staff strength was satisfactory. 2. Janani Suraksha Yojana(JSY):-
a) JSY in the district was functioning satisfactorily to provide services to the pregnant women. There was no scarcity of funds in the district.
b) The team contacted 41(69.5%) JSY beneficiaries for sample verification out of 59 selected in the district. Most of the beneficiaries were satisfied with the services received during ANC and PNC period.
c) 29 (70.7%) beneficiaries received cheque in time within three days after delivery. 65.9% mothers were accompanied by ASHA. 3. United Funds:- a) As per the information available from the district, untied funds were provided to all 11 CHCs, 27 PHCs and 245 Sub-Centres during 2009-10 and the funds had been mostly utilized by these centres. b) It was also reported that the funds provided to PHC Bhaisha have not been spent by the PHC during 2009-10. c) In the Year 2009-10 & 2010-11 all 245 Sub-Centres were provided untied funds and out of them 142 Sub-Centres submitted UCs in the year 2009-10 and only 09 sub centres have submitted utilization certificate in 2010-11.
4. Rogi Kalyan Samiti(RKS):- a) It was reported that Rogi Kalyan Samitis at the DH, 11 CHCs and 27 PHCs have been constituted in the district. b) Most of the CHCs and PHCs were provided with the funds to the tune of Rs 1,00,000 during 2009-10 and 2010-11. Funds have been utilised by the centres.
5. Functioning of ASHA Scheme:-
27 a) In the district, 1630 ASHAs have been selected for 1875 villages in the district till current year, out of which 1448 were trained up to IVth module. Drug kits were provided to all trained ASHAs. b) In the visited CHCs and PHCs, ASHAs were selected as per requirement and were functioning at the villages. 6. Village Health Sanitation Committee (VHSCs): - a) 1382 villages were having VHSCs out of 1875 villages in the district and 1324 VHSCs were having ASHA as a member. b) Joint Bank Accounts in 1184 VHSCs have been opened up to September 2010 for handling funds. c) It was reported that the funds @ Rs 5000 to each VHSC had been provided to 1184 VHSCs in the year 2009-10.
7. 24 x 7 hour Delivery Care System:- In the district, 24 Institutions were identified to provide 24 x 7 hours delivery care services, but this service was available in all the visited CHCs and PHCs only on call. 8. Physical Infrastructure and position of supplies:-
i) CHCs: a) The Rahatgarh and Kesli CHCs were functioning in government buildings. The premises of both the CHCs were found neat & clean. 30 beds were sanctioned for both the CHCs but there were only 22 beds in Rahatgarh & 24 beds functioning in CHC Kesli. The facilities like water, electricity, ambulance, jeep, X-ray, laboratory, labor room facilities and residential quarters for doctor and paramedical staff were available in both the CHCs.
b) Blood Storage Unit and Anesthesia equipment were not available in both the visited CHCs. Neonatal resuscitation was not available in CHC Kesli. c) Medical Waste Disposable system has not been set up in the visited CHCs. ii) PHCs:
28 a) All the four visited PHCs at Naryawali, Sahajpur, Tada and Sehora were functioning in Government building. Though 6 beds were sanctioned for all the PHCs but PHC Naryawali & Sahajpur were having 3 beds and PHC Tada and Sehora were having only 4 beds. Regular water, electricity supply with power back up and toilet facilities were available in all the PHCs visited. Telephone Facilities were available only in Sahajpur and Sehora. b) Cold chain equipments were available in all the visited PHCs except Sahajpur and temperature chart was found properly maintained. c) Vehicle was not available at any of the visited PHCs. d) Stock of Cu-T was not available in PHC Sahajpur. Oral Pills stock was available only in Naryawali & Sahajpur and condom stock found only in Naryawali. IFA syrup was found available in all PHCs except PHC Sehora. Vit- A was available only in Naryawali. e) The AYUSH Medical Officer was available only at PHC Sehora. iii) Sub- centres: - a) 08 sub centres of CHC Rahatgarh and Kesli were visited out of which 5 sub - centres at Naryawali, Khakron, Kesli, Paloh and Sehora were functioning in government building. All the visited sub centres were having water facilities except Jaruakheda and Paloh SCs. There is no electricity in Jaruakheda, Khakron and Paloh sub centres. Toilet facilities were available only at Naryawali, Kharkon, Kesli and paloh sub centres. b) Functional labor room was not available at any of the sub centres visited. c) Steam Sterilizer was available at Jaruakheda sub centres. d) IUD Insertion Kits, Delivery table and weighing machine for adult were not available at few of the visited Sub Centres. e) Stock of Oral pills was not available at sub centres Ghana and Condoms Stock at sub centre Jaruakheda & Ghana. Emergency Contraceptive pills were available only at SC Khakron and Antiseptic solution at sub-centre Kusmi, Kelsi and Sehora Sub-Centres.
9. Knowledge and opinion of the Community on health services:-
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a) To assess the knowledge and opinion on health services provided by the ANMs, 52 mothers having child up to one-year age were interviewed. 42 (80.8%) mothers reported that ANMs are available as and when needed.
b) Only 3 (5.8%) mothers were visited by the health workers within 24 hours of their delivery.
c) Only 11 mothers knew the danger sign of ARI. 15 (28.9%) mothers informed that they have been told about the side effect of contraceptive. 34 (65.4%) mothers were aware about the govt. facilities.
d) Total 24 persons were interviewed for assessing their opinion on overall services at PHCs, all the respondents were satisfied with the services. Almost all the Medical Officers of the visited PHC were staying at the Head Quarters of PHCs and all the emergency medicine and drugs were available in all four visited PHCs.
10. Sample verification of Family Welfare (FW) beneficiaries:- a) 240 beneficiaries of sterilization and other methods of family welfare were selected for sample verification,out of them 158 (63.2%) cases could be contacted. b) Discrepancy in the age of spouse, no. of males/female children and age of youngest child was found in 7(2.8%), 5(2%) and 17(6.8%) cases respectively during sample verification. c) 132 beneficiaries of spacing method (IUD, OP and CC) were selected out of these 116 (87.9%) could be contacted. As many as 44(37.9%) cases were found fake/false reporting i.e. IUD-8, oral pills-20 and CC-16. Steps may be taken, so that fake reporting of beneficiaries should not happen in future.
11. Maintenance of records and Registers: i) Most of all the service registers for FW services were not available in printed formats at CHC, PHC and SCs. ii) Oral Pills and Nirodh distribution registers were not maintained properly at the sub center level. Registers being maintained for Stock, JSY and cash of UT at Sub-Centres level need proper supervision of the higher authority. iii) Short supply of child immunization cards was reported in CHC Rahatgarh from April 2010.
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12. Observations and Suggestions:- (a) In the district there was shortage of the Doctor. Although 50 posts of Class-I Medical Officers and 135 posts of Class-II Medical Officers were sanctioned, but only 27 and 78 were in position respectively.
(b) 442 beds were available in district hospital out of which 61beds were in Gynaecologic ward. Due to shortage of maternity beds some patients were being to be kept in corridor. The numbers of patients were just double the number of available beds.
(c) Shadow lamp was found not working in district hospital OT.
(d) Block Medical Officers are not verifying the records regularly in any of the visited sub centres.
(e) OT was found non functional in CHC Rahatgarh.
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7. Tikamgarh Major observations of Field Survey Unit, Bhopal about the Evaluation work in districts Tikamgarh of Madhya Pradesh in the month of October 2010. I. Details of the visited institutions:- District Visited DH, CHCs and PHCs visited SCs Visited
Tikamgarh Distt. Hospital: Tikamgarh Digora, Vijrawan, CHCs: Jatara and Badagaon Ramgarh, Manchi, Dikoli, PHCs: Digora, Lithoura, Budera and Aston Lar, Kundeshwar and Khiriya
II. Major findings 1. Human resources:-
As reported, there was acute shortage in technical manpower in key posts as given below. a) Regular Staff:
S.No Particulars of the staff Sanctioned In Vacant position 1 Specialist 55 15 40 2 Medical Officer 63 43 20 3 Male Supervisor 36 12 24 4 Staff Nurse 108 34 74 b) Contractual Staff under RCH: None of the post of PGMOs i.e. Pediatrics, Anesthetics and Medical Officer Post was filled as against the identified requirement number of 3, 2 and 7posts respectively in the district. Similarly 6 posts of ANMs out of 35 were not filled in the category. c) In 200 bedded District Hospital Tikamgarh the following key posts under Medical and Para Medical cadre were reported to be unfilled: Designation Sanction Working Vacant Specialists 17 13 4 Medical Officers (Male & 18 10 8
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Female) Radiologist & Pathologist 3 1 2 Laboratory Technician (LT) 6 4 2 Staff Nurse 75 16 59 ANM 8 11 3 extra Computer Operator 4 0 4 Compounder/Pharmacist Gr. 2 8 4 4 d) In the visited CHCs at Badagaon and Jatara, posts of Specialists, Staff Nurse and ANMs were vacant. At PHCs, Staff position was somewhat satisfactory but posts of Medical Officer, Lab Technician and Compounder etc. were lying vacant.
2. Functioning of Janani Suraksha Yojana( JSY):- a) The team contacted 32 (82.0%) beneficiaries for sample verification out of 39 selected JSY beneficiaries in the district and it was observed that most of the beneficiaries were satisfied with the services and other facilities received during ANC and PNC period. b) It was also observed that 27 (84.4%) beneficiaries had been paid with the cash incentives within three days after delivery and only 14 (43.8%) beneficiaries got post natal checkups by the health personnel. c) The visited centres had sufficient funds for the scheme. 3. Utilisation of Untied Funds:- a) As per details received from the district, untied fund was being provided to all CHCs, PHCs and Sub-Centres in the district. b) As per the information received from the district, there are six blocks and block -wise untied funds for CHCs, PHCs and SHCs were provided in the year 2009-10 and 2010- 11. District hospital @ Rs 5,00,000, CHC @ Rs 50,000, PHC @ Rs 25,000 and SHC @ Rs 10,000 are given per year. c) Untied funds provided to the DH, CHCs, PHCs and HSCs were mostly utilized in the year 2009-10. The fund provided for the current year to the CHCs, PHCs and Sub Centres in the district was not fully utilised till the visiting month. 4. Functioning of Rogi Kalyan Samiti (RKS):-
33 a) It was reported that 28 Rogi Kalyan Samiti have been constituted at DH, 7 CHCs and 20 PHCs in the district. It was also reported that only 20 PHCs out of 35 PHCs in the district had registered RKS. b) The information as had been received from DPMU, CHCs and PHCs were provided @ Rs 1,00,000 each during the current year 2010-11 in the month of September 2010 and no expenditure incurred till the month of visit. c) District hospital, Tikamgarh was in receipt of RKS fund to the tune Rs 5, 00,000 for the year 2009-10 and 2010-11. 5. Functioning of ASHA Scheme:- a) A total of 816 ASHAs have been selected in the district, 433 were selected in 2009-10. All of them provided with drug kit. b) It was reported that all 816 ASHAs have been given Ist module training and 383 ASHAs have been trained up to IVth Module.
6. Village Health Sanitation Committee(VHSCs):- a) Block-wise district report shows that 527 VHSCs have been formed in 863 villages and all VHSCs were having ASHA as a member in the district. b) All VHSCs were reported to have opened bank accounts for handling the funds. c) VHSCs in the district were not given the funds in 2008-09 but Rs 86,30,000 were distributed to the VHSCs @ 10,000 each in the year 2009-10. d) Most of villages in each block except Jatara and Badagaon blocks were having VHSCs. There was no VHSC formed in the block Baldevgarh. e) The visited CHC Jatara received an amount of Rs 16,80,000 for VHSCs during year 2009-10 in the last month of financial year i.e. in March 2010, but it could not be utilized and returned. The same amount was released during the current year in the month of October, 2010.
7. 24 x 7 hour Delivery Care System:- In the district, 03 CEmoC and 11 BEmoC were providing 24x7 hour care centres. At PHC level, ANMs / LHVs were providing these services for delivery on call. 8. Physical Infrastructure and position of supplies:-
34 i) CHC: a) CHCs at Jatara and Badagaon were functioning in government buildings. The premises of both the CHCs were found neat & clean. At CHC Jatara, there were 30 beds & CHC at Badagaon was having only 06 beds. No Ambulance or jeep was available in CHC Badagaon. b) Bio- medical waste disposable system and Anesthesia equipments were not available at both the CHCs. Neonatal Resuscitation Equipments were not available in CHC Badagaon. Vital, Essential and desirable drugs were available in both the CHCs visited. Inj Arteether was not available in the CHC Jatara and Inj Quinine was not available in both the CHCs. c) Availability of Residential quarters was much less than the strength of the staff at CHC
Badagaon. There was no blood storage unit available at both of the visited CHCs. ii) PHC: a) All the visited 04 PHCs at Budhera, Aston, Digora and Lithoura were functioning in the Government buildings. There was no regular water supply in two PHCs i.e. Lithoura and Aston; telephone was not available in PHC Budhera and Aston. b) IUD insertion kit, Resuscitation equipment and cold chain equipments were not available in PHC Aston. Stock of Oral Pills and Nirodh was not available at the visited PHCs of Budhera, Aston and Lithoura. c) Oxygen cylinder was not available in PHCs Digora and Lithoura. There was no microscope in PHC Aston. Operation theater was not functional at Budhera and Aston PHCs. d) The AYUSH Medical Officers were not available in the visited PHCs except in PHC at Lithoura. Residential Quarters for Medical Officers were available at the PHCs except at PHC Aston. iii) Sub- centres:- a) 6 out of the 8 visited sub centres were functioning in Govt. Buildings. There was no electricity in 4 sub centres. There was no labor room in the 6 visited sub centres except in sub centres Vijrawan and Digora. The main source of water supply was hand pump. The toilet facility was available in 06 Sub Centres. The toilets in another 2 centres were in bad condition and not in use. b) Examination table was available in all the sub centres. Item like cupboard for drug storage, foot stool, delivery table, IUD insertion kit, torch, Weighing Machine for adult &
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infant, BP apparatus and thermometer were available in almost all the visited sub centres except in one or two sub centres. c) Oral pills are not available in sub centres Vijrawan and Ramgarh. Condoms were not available in 06 sub centres. d) Supplies like AD syringes, Gloves, Disposable syringes, slides for blood test and DDKs, ORS packets, DDKs, IUDs, Oral Pills were not available in few sub centres. e) The co-trimoxazole, EC Pills, tab Oxytocin, Cap Amplicin, Inj, Gentamycin, Tab. Centrimoxuzole and Anticeptic Solution etc. were not available at most of the Sub- Centres visited. 9. Knowledge and opinion of the Community on health services:- a) To assess the Knowledge and opinion on health services provided by the ANMs, 54 mothers having child of one year age were interviewed. 43 (79.6%) mothers reported that ANMs are available as and when needed. b) 3 (5.6%) mothers out of 54 had home delivery and DDKs were used. As regards Post- Natal follow up, only one mother visited by ANM within 7 days of her deliveries, and 20 (37.1%) mothers informed that no one had visited there home till the day of visit by the team. 17 (31.48%) mothers put their babies to breast within ½ hour, and 3 (5.6%) put their babies to breast between one or two days of their delivery. c) Total 56 villagers of the visited sub centres area were interviewed; most of them were satisfied with services of Male workers. The male workers of these sub centres were collecting blood slides regularly and also looking after immunizations programmes. d) During the course of visit to PHCs Budhera, Aston, Lithoura and Digora it was observed that all the necessary services were available in these PHCs. The Medical Officer of PHC Digora was not sitting regularly in the PHC because he has additional charge of BMO of CHC Badagaon. However,The team interviewed some of the local representatives and state holders, most of them were satisfied with the behaviour of the staff and the health services provided by PHCs. 10. Sample verification of Family Welfare (FW) beneficiaries:- a) Out of total 237 selected beneficiaries of sterilization and other methods of family planning, 174 (73.4%) could be contacted for sample verification in the district. While examining, the data of the selected cases in the service register, the age of spouse in 25 (10.6%) cases, total number of children in 9 (3.8%) cases, number of male/female
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children in 9 (3.8%) cases and the age of youngest child in 23 (9.7%) cases were not found recorded at all. b) The follow up services were not provided to 18 (19.4%) out of 93 (genuine) contacted family planning cases. c) 188 beneficiaries of spacing methods (IUD-60, OP-62 & CC-66) were selected out of which 143 (75.5%) could be contacted. During sample check it was found that there was 81fake/false reporting i.e. in IUD-19 (45.2%), Oral Pills-30 (63.8%) and CC -32 (59.3%) out of contacted cases of IUD-42, OP-47 and CC-54 respectively in the district. d) Due to short supply, OP and Nirodh users were facing difficulty in continuing the services .
11. Maintenance of records and Registers:- (a) Eligible Couples register were not properly maintained, these registers were not made available to the team for verification at some of the Sub Centres. (b) The registers for IUD, OP, and Sterilisations were not in printed forms but were maintained properly. (c) The Stock registers and cash book of untied funds were properly maintained in most of the visited SCs.
12. Other Observations and Suggestions:- a) In district hospital, there was only one fully equipped OT for performing all type of surgeries. The maternity wards had more patients than its capacity. Large number of pregnant women, who had labour pain was seen lying in the corridor of the Hospital. Necessary arrangement need to be taken for upgrading the hospital.. b) More than 300 villages in the district were not having VHSC. VHSCs may be formed in these villages for providing sanitary services to the village community. c) Printed register were not available for keeping records of temporary and permanent methods of F.W in most of the visited Sub Centres. The ANM was maintaining single register for all these methods. However, printed registers of Immunization were found in most of the visited Sub Centres.
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8. Damoh District Major observations of Field Survey Unit, Bhopal about the Evaluation work in districts Damoh of Madhya Pradesh in the month of November, 2010. I. Details of the visited institutions:- District Visited DH, CHCs and PHCs visited SCs Visited Damoh Distt. Hospital: Damoh Bandakpur, Palar, Luhara, CHCs: Tendukheda, Hatta & Hindoriya Gunji, Pipariya, Tikari, PHCs:Hinotakala, Abhana and Raneh Borikalan, Rasilpur, Raneh, Sakor, Samnapur and Taradehi
II. Major findings 1. Human resources:- a) Acute shortage in the technical manpower was observed in the district as given below: Regular: Particulars Sanctioned Vacant Specialists 76 65 Medical Officer 53 12 Staff Nurse 160 111 Lady Health Visitor (LHV) 35 06 Lab.. Technician 33 24 MPS 29 03 MPW (M) 168 64
Contratual Staff under RCH: Particulars Required Vacant PGMO 6 02 Medical Officer 9 07 Staff Nurse CEmOC 03 02 Staff Nurse BEmOC 09 01 ANMs 162 40 b) In the District Hospital Damoh, most of the posts of specialists i.e., 20 out of 27 sanctioned posts were lying vacant. 75 posts of Staff Nurse out of 100 and all the posts of Matron, SA and OA were vacant in the hospital c) In the visited CHCs at Hatta, Tendukheda and Hindoriya, posts of Specialists, Medical Officers and some of paramedical posts were vacant. PHC level staff position was some what good. 2. Janani Suraksha Yojana (JSY) :-
38 a) The district was performing the good number of institutional deliveries under this scheme. It was reported that there were 18715 institutional deliveries conducted out of total 27,861 deliveries during 2009-10 and these numbers were 11,532 and 16,475 during 2010-11 (upto Oct. 2010) in the district. b) During last two years funds have been spent from the total flexi pool for providing benefits to the mother under the scheme. In this respect an expenditure of Rs. 3,65,03,968 in the year 2009-10 and Rs. 1,94,20,920 during 2010-11 (upto October, 2010) was incurred in the district. In the visited CHCs and PHCs, funds were utilised and no pending cases for the payment were observed there.
c) The team contacted 42 (87.5%) beneficiaries out of 48 selected for sample verification and found that all of them received TT and IFA tablets during the pregnancy. Only 17 (40.5%) beneficiaries received cheques for their cash incentives within three days after delivery. 20 (48%) beneficiaries used the facility of Janani Express for going to hospital and 16 (38.1%) made self arrangement for going to hospital. Out of them 12 (75%) beneficiaries got money for transport. d) 32 (76%) beneficiaries were accompanied by ASHA/Dai/AWW while going to the hospitals for deliveries and 40 (95%) beneficiaries received ANC services in time. Only in 22 (52.4%) cases PNC services were provided and these services needed to be enhanced by the health personnel. In the visited centres JSY registers were maintained with all relevant details of the beneficiaries. Concerned MO had checked the records only at Tendukheda CHC.
3. Untied Funds :- a) All 7 CHCs were given untied fund @ Rs 50,000 each during the year 2009-10 and 2010- 11 and 99% of the fund was utilised by the CHCs during the year 2009-10 except the CHC Batiyagarh, which incurred 84% expenditure of allotted fund. It was observed that in the year 2010-11 CHC Jabera utilised 100% of the fund and CHC Tendukheda made 93% expenditure. Four CHCs Pathariya, Hatta, Patera and Hindiriya incurred 38% to 70% expenditure and only one CHC Batiyagarh did utilise any untied fund till the visiting month during the year 2010-11.
39 b) The untied fund were provided to each of the 14 PHCs @ Rs. 25,000 during the year 2009-10 and 20010-11. All the PHCs utilised their untied fund ranging between 78% to 100% during the year 2009-10. In 2010-11 PHCs at Abhana, Shajpura, Bandakpur, Sarra and Nohata utilised 4.6% to 79.2% of funds and nine PHCs did not utilise any funds. c) All the visited 11 sub-centres were given @ Rs.10,000 per centre for the year 2009-10. In 2009-10 all sub-centres utilised their untied fund fully except sub-centre Gunji, whose utilisation was 94%. In 2010-11 all the visited sub-centres except sub-centre Samanapur received untied fund and it was observed that SC Bandakpur incurred 100% expenditure towards untied fund whereas Pipariya Tikari sub-centre utilised only 25% of the fund and other sub-centres i.e., Palar, Luharra, Gunji, Borikala, Rasilpur, Sakor Raneh and Taradehi did not even start utilizing the untied funds till month month of visit.
4. Rogi kalyan Samiti (RKS):- a) It was reported that 17 Rogi Kalyan Samitis have been constituted at DH, 7 CHCs and 9 PHCs in the district and the meeting of RKS was being conducted regularly in the visiting centres except at PHC Abhana. b) During the year 2009-10 and 2010-11, all 7 CHCs had received RKS funds @ Rs.1,00,000 per CHC. The utilisation of RKS funds by all the CHCs was between 83% to 100% except CHC Patera whose utilisation was 55% of the allotted fund during the year 2009-10. In the year 2010-11 CHC Tendukheda used 100% of the RKS and other CHCs viz., Hatta, Pathariya, Hindoriya and Batiyagarh incurred 50% to 62% of the allotted funds. The CHC Patera’s utilisation was only 23% of the allotted RKS fund. c) In 2009-10 and 2010-11, all the 14 PHCs were provided RKS funds to the tune of Rs. 14,00,000 i.e., @ Rs.1,00,000 per PHC. During 2009-10, two PHCs Raneh, Abhana, Roand and Sarra made 98%-100% use of the fund whereas other PHCs could not utilise the RKS funds. It was observed that in 2010-11 all PHCs incurred 50%-100% expenditure of the RKS fund except PHC Hinouta which did not utilise any sort of RKS fund till the visiting month October, 2010. 5. Functioning of ASHA Scheme:- a) 999 ASHAs have been selected for 1158 villages in the district and out of these 907 ASHAs were trained and working with Drug Kits in the district.
40 b) As informed by the ANMs, JSY beneficiaries and villagers of the visited sub-centres, the role of ASHAs in the field was satisfactory. They were taking active part in MCH, FP and other health activities. 6. Village Health Sanitation Committee (VHSCs):- a) It was reported that in 915 villages out of 1158 villages, VHSCs were constituted in the district. All 915 VHSCs were having ASHAs as a member. b) Out of 915 VHSCS in the district, 758 VHSCs were reported to have opened bank accounts for handling the funds. c) Regular meeting of VHSC was being conducted at all visited sub-centres except Pipariya and Rasilpur sub-centre.
7. 24 x 7 hour Delivery Care System:- a) In the district, 12 institutions are identified for providing 24x7 hour services i.e., DH, 7 CHCs and 4PHCs. b) In the visited CHCs and PHCs, the required staff position i.e., atleast 2 M.Os. and 3 staff nurses were not available to provide the 24 x 7 hour services smoothly at some of the centres. Blood Storage Unit were mostly not setup in these centres. c) At PHCs viz., Sarra and Kumhari, the doctors and paramedical staff was not available and the posts of paramedical staff was lying vacant at PHC Madiadoh.
8. Physical Infrastructure and position of supplies:- i) CHC: a) CHCs visited at Hindoriya, Hatta and Tendukheda CHCs were functioning in government buildings. The premises of visited CHCs were found neat & clean. As against sanctioned strength of 30 beds, CHCs Hindoriya and Tendukhedi had 14 and 20 beds respectively. CHC
Hatta was having 60 sanctioned beds but there was only 30 beds at present. b) Anesthesia equipments were available only in Hatta CHC. At CHCs Hindoriya and Tendukheda Blood Storage Unit was not available but despite its availability at Hatta CHC, the Blood Storage Unit was not functioning. c) Residential quarters for paramedical staff were not available at CHC Hatta ii) PHC:
41 a) All PHCs visited in the district were functioning in Govt. Building and all the PHCs were having 6 beds. Electricity, water and toilet facility was available at all the PHCs. There was no telephone facility in the visited PHCs. b) Operation Theatre was found functional at visited PHCs Abhana and Raneh and non- functional in Hinotakala PHC. There was no vehicle in any of the visited PHCs. In spite of the availability of Microscopes in all the visited PHCs, all were non-functional due to non- availability of LTs. c) The Cold Chain System equipments were found only in 2 PHCs out of 4 PHCs visited. The stock of vaccines was not found at Raneh PHC. d) AYUSH Medical officer was not available at all visited PHCs.
iii) Sub-centre: a) All the 11 visited sub-centres except two sub-centres viz., Taradehi and Samnapur were functioning in Govt. Building. The ANMs of SCs Gunji, Palar, Luharra, Pipariya Tikari and Samnapur were not residing at their respective sub-centre/villages. Despite the availability of Labour Room at the SCs Bandakpur, Palar, Luharra, Tardehi and Rasilpur, deliveries were not conducted there except Taradehi sub-centre. b) Examination table was available at all visited sub-centres except SCs Pipariya Tikari, Raneh and Sakor. Nishchay Pregnancy Test Kit was available at all the visited sub-centres except sub-centre Luharra. c) It was observed that Rapid Diagnosis Test Kit (RDT Kit), DDKs, Kerosene Oil, Sanitary Napkins, Emergency contraceptive pills, Tab Oxytocin, Injection, Gentamycin and Cap Ampicilline were not available at any of the visited SCs. 9. Knowledge and opinion of the Community on health Services :- a) To assess the Knowledge and opinion on health Services provided by the ANMs, 66 mothers having child up to one year old were interviewed. 39 (59.1%) mothers reported that ANMs are available as and when needed. b) Most of the contacted mothers received services during ANC and PNCs. c) 64 (97%) mothers put their babies to breast within 1 hour of delivery, 60 (91%) mothers were counselled for exclusive breast feeding and complimentary feeds. 27 (41%) mothers knew about danger sign of ARI. 47 (71%) mothers knew the use of ORS. 62 (94%) mothers were informed by ANM/ASHA/AWW about the schedule of child immunization.
42 d) 19 (29%) mothers received one post natal checks up only. 34 (52%) mothers received two post natal checks up and 13 (20%) received three post natal checks up. 28 (42%) mothers were using contraceptives. e) Out of 11 visited sub-centres, male workers were found posted at 08 sub-centres. It was found that Male workers were not staying at their head quarters and most of them were not visiting their respective fields regularly. f) During the course of visit to three PHCs viz., Abhana, Raneh and Hinotakala, the people using the services of PHCs were interviewed, it was observed that they were satisfied with the staff and the health services provided by PHCs. The Medical Officer of the visited PHC Hinotakala was attached to District Hospital Damoh and used to visit OPD Hinotakala for 2 days in a week and likewise the M.O. of PHC Raneh was found attached to CHC Hatta for 2 days and used to attend OPD only for 2 days due to which patients were unable to avail medical facility in the remaining days. 10. Sample verification of FW acceptors:- a) Out of selected 150 acceptors of Family planning methods, 96 (64%) acceptors could be contacted for sample verification. b) While examining the data of selected cases ages of acceptors, age of spouse, total number of children, number of male/female children and age of youngest child was not recorded in the service registers were 18(12%), 78(52%), 18(12%), 28(19%) and 40(27%) respectively. c) The follow-up services confirmed by 32(48%), out of 66 genuine contacted family Planning method acceptors. All the 20 out of 22 operated cases (Sterilization cases) got the incentive amount in full. d) Out of selected 113 acceptors of specing methods (IUD, OP & CC), 74 (65%) were contacted and as much as 30 (27%) cases were found to be fake/false reporting ( IUD 14, Oral Pills 12 and CC 4). 11. Maintenance of records and Registers:- a) Maintenance of records and registers viz., EC, Sterilization, IUD register, OP, CC at CHC/PHC level was found very poor. b) The reported performance under IUD could not be verified for the year 2009-10 and 2010-11 (upto Oct. 10) due to absence of service registers at reporting Units. c) JSY records were being maintained at PHC/CHC level. This record was not available at sub-centres.
43 d) It was found that EC, IUD, OP, CC, ANC/PNC, immunization/immunization-card, stock register and maintenance of cash book & untied funds registers were not printed/maintained/updated properly at most of the SCs visited. 12. Observation and Suggestions:- a) It was noticed that there were 258, 257 and 253 infant deaths reported in the year 2008- 09, 2009-10 and 2010-11 (upto October, 2010) in the district. Similarly, the number of maternal deaths wee 13, 22 and 18 for the same period. In this connection maternal and child care services needed more attention to protect the new born babies and mothers in the district. b) Lack of supervision was found at all levels which should be strengthened to improve the RCH activities in periphery area of the district. c) At most CHCs, services like medicine, surgery, OBG and pediatric, caesarean sections/Emergency care of sick children were not being provided due to non-availability of the specialist. There are 4 Baby warmers in Hindariya CHCs and 3 PHCs under its jurisdiction but all these warmers are defected and due to electricity problem they are not in use.
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Major observations of Regional Evaluation Team, Bhopal about the Evaluation work in Mandsaur District of Madhya Pradesh State in October, 2010
III. Details of the visited Institutions: District PHCs/CHCs and DH visited SCs Visited Visited Mandsaur CHCs : Shamgarh and Sitamau. Kurawan, Baghuniya, Pichhala, PHCs: Dhundhadka, Digaonmali, Chandawasa, Rajakhedi, Amlawad, Amlawad and Melkheda Rewas Dewada Malayakherkhedi and Sedaramata .
1. Health Human Resource :
a) There was acute shortage of skilled man power in the district. Health Service delivery is affected badly due to vacancy of Specialists, Medical Officers, Staff Nurses and Vacancy of MPW(M) as may be seen from the following table. Post Sanctioned Vacant Strength Specialist 65 49 Medical Officer 88 48 Staff Nurse 245 191 MPW Male 170 76
Necessary steps to fill up the above posts should be taken up urgently. b) Contractual staff required under NRHM was also found to be inadequately available in the category of specialists, Medical Officers and ANMs. Two post each of PGMO of Anesthetics, Pediatrics and Gynecologist were lying vacant. 2 Staff Nurse (CE MOC), 14 Staff Nurse (BE MOC) and 25 ANMs who were identified to fill up on contractual basis were also lying vacant in the district. However as against the requirement of 3 contacted Medical officers 11 were in position. c) As many as 25 posts of specialists including Surgical Specialists, Anesthetics, Pediatrics, Gynecologist etc. and 168 posts of staff nurses (out of 200) were lying vacant in Distt. Hospital Mandsaur.
2. Services of Janani Suraksha Yojana (JSY):
a) During visit to CHCs and PHCs, it was observed that there was no separate funds under JSY provided to these centres. All the expenses were met from the flexi-pool (NRHM) Budget. b) In CHC Shamgarh more than 100 deliveries were being conducted. The CHC is getting 1,00,000 per month from block headquarters which is inadequate to make complete JSY payments.
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c) To assess the client satisfaction and service availability under JSY as many as 34 JSY beneficiaries were contacted by the team in the district and found them mostly satisfied with the services provided under JSY. d) All of them had received TT and IFA during ANC checkups. Transportation services / facilities were made available to all the contacted beneficiaries. While going to hospital for delivery, about 74% of them were accompanied by ASHA / Dai / ANM. e) 50% beneficiaries got three post natal checkups through ASHA and ANMs. f) Proper registers were being maintained containing list of beneficiaries to whom cheques were issued. However, except in PHC Melkheda, the MO in the visited centres were not checking the registers on monthly basis. g) In Melkheda PHC, due to shortage of cheques timely payments could not be made to the beneficiaries though funds were available.
3. Implementation of Rogi Kalyan Samiti (RKS): a) Rogi Kalyan Samitis have been set up in the District Hospital, 6 CHCs and 42 PHCs in the District b) As per the information received from DPMU, Rs. 27,00,000 to 27 PHCs and Rs. 4,00,000 to 4 CHCs were provided under RKS in the months of February & March during year 2009-10 . c) It was reported that the CHCs and PHCs in the blocks of Malhargarh, Melkheda, and Sandhara could not utilize their funds during the financial year 2009-10 due to late receipt of the funds. Many of the RKS have not been provided with RKS funds during 2010-11 because of outstanding balance of the previous year. d) In the visited CHCs, and PHCs, one or two meetings were conducted during 2009-10 . There was no regular meeting in the RKS.
4. Village Health and Sanitation Committee (VHSCs):
a) Out of 906 villages in the district, Village Heath & Sanitation Committees were formed in 645 villages and VHSCs were having ASHA as a member. 575 VHSCs have been reported to have opened joint Bank accounts as per norms for handling the funds.
b) As per the details available, the district was in receipt of Rs. 37,40,000 as VHSC fund for 374 VHSC during 2010-11 and out of which Rs. 15,12,279 was spent upto the time of visit.
5. Utilisation of Untied Funds:
a) As reported by DPMU, CHCs @ Rs. 50,000 and PHCs, @ Rs. 25,000 each had been provided with the untied funds during 2009-10 and CHC and PHCs in Dhundhadka and Sitamau Blocks utilized the funds. Others could not utilize the funds as the amount was released to them in the end of Feb or Middle of March 2010 only.
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b) All the SCs visited had received untied funds for 2009-2010 and utilized fully. The visited SCs received the funds and incurred expenditure except SCs at Rajakhedi, Amlawad and Rewas Dewada during 2010-11. c) PHC Amlawad was not using untied funds since 2008-09 & 2009-10.
6. Functioning of ASHA Scheme:
a) It was reported that 738 ASHAs were in position in the district. All the 738 ASHAs are reported to be trained and also equipped with drug kits in the district.
b) During visit to the sub-centres, it was observed that ASHAs at village level were working satisfactorily. They were helping ANMs in providing services to the mothers and children in JSY and immunisation activities but their involvement was almost nil in taking blood samples from febrile patients.
7. 24 X 7 hours Delivery Care System:
a) 14 Institutions including 5 CHCs, and 9 PHCs (all BE MOC) were identified as 24x7 delivery care centres in the district. CHCs Sitamua and Shamgarh, PHCs at Dhundhadka and Malkheda were visited. PHC Melkheda has only one MO and other 3 centres have 2 MOs; CHC Sitamua have 7 ANMs and 3 Staff Nurses and PHC Dhundhadka have 3 ANMs and one Staff nurse and other two centers have one ANM and one staff nurse respectively. There was no blood storage unit in the visited centres.
8. Physical Infrastructure: i. CHC
a) CHCs Shamgarh was functioning in own building and CHC Sitamau was functioning in donated building. Their premises were found neat & clean.
b) While Ambulance, Lab equipments and some other facilities were available, Anesthesia Equipment was not available in CHC Sitamau and at CHC Shamgarh it was lying unused. There was no medical waste disposal system & blood storage units were not available in both the CHCs.
c) Though the Infrastructures was not as per IPHS, most of the required equipments, Arteether injection, Drugs etc. were available there except injection quinine.
iv. PHC:
a) PHCs visited at Dhundhadka, Amlawad, Digaonmali and Malkheda were functioning in Govt. buildings, having water supply and also toilet facility. Vehicle was not available at PHCs at Amlawad and Digaonmeli.
b) Most of the equipments were found available except Cold Chain equipments in Amlawad and Digaonmeli. Residential quarters for Medical officers were available
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at Melkheda, Amlaawad, and Dhundhadaka but not in PHC Digaonmali. OT facility were lacking in the visited PHCs.
c) Contraceptives (IUD, OP and Nirodh) and Prophylactic drugs (IFA, Vitamin A) and Resucitation equipments were available in all the PHCs visited.
d) AYUSH MO was not available in all the PHCs visited.
iii. Sub-centre:
a) 9 Sub centres Viz Kurawan, Baghunia, Pchahala, Chandawasa, Rajakhedi, Amlawad, Rewasdewada, Malayarkhedi, and Sadramata were visited. All Sub Centers were functioning in Government building except sub centre at Rajakhedi. ANMs of 4 of the 9 visited sub centers were residing in sub center Villages.
b) 6 of the 9 visited the Sub-centres have labour rooms but delivery was being conducted only at Rewas dewda Sub-centres.
b) Electricity was available in all SCs except Pichhla, Kurawan and Bhaguniya SCs.
c) Examination Table, Bench, Ambu bag /Suction, steam sterilizer, Delivery kit, Gloves and stove etc were not available in some of the SCs visited. Thermometer DDKs, EC Pills, Injection Gentamycin Cap Ampicillin and, tab Tablet Oxytocin were not available in most of the centres in the district.
c) SBA training was not received by any of the ANMs at the visited centres.
9. Knowledge and opinion of community on health services:
a) 50 mothers having child of upto one-year age were interviewed for assessing the services being rendered by the ANM working in the visited sub-centers in the district.
b) 23 (56%) mothers replied that the ANMs visited them within three days after of their home delivery.
c) 22 (44%) mothers received three post natal check ups. 18 (36%) mothers knew the danger sign of ARI.
d) 29 (58%) mothers were aware about the use of ORS during diarrhea and 20 (40%) knew the schedule of child immunization. 27 (54%) mothers were aware of contraceptive methods.
d) All the mothers were aware of the government health facilities where they can get all health facilities.
f) 6 of 9 visited sub centres were having the post of health worker (M). The villagers were satisfied with their work.
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g) During the course of visit to PHC Dhundhadka, Amlawad amd Melkheda it was found that the community was satisfied with the services received from staff and Medical Officers of the PHCs.
10. Sample Verification of Family Welfare Acceptors:
f) Out of 138 FW acceptors (Sterilisation, IUD, OP and Nirodh) selected, 92 (66.7%) could be contacted for sample verification. g) While examining records of selected acceptors from service registers age of spouse was observed to be not recorded in 68(49.3% ) cases. In 98 (71%) cases age of youngest child was not recorded. h) It was also found that out of 92 contacted 68 were of Spacing method acceptors. 24 (27%) of spacing method acceptors were found to have been reported false in the district. i) Out of selected 98 beneficiaries of child immunization, 79 (80.61%) children could be contacted. As many as 50 (66.7%) beneficiaries were not provided follow up services.
11. Maintenance of records and Registers:
f) Printed EC registers were available but were not maintained properly. The register was not made available at sub-centre level. g) Reported figures under IUD could not be verified for 2008-09 and 2009-10 for want of Master Registers at reporting units at CHC Sitamau, PHC Melkheda and PHC Dhundhadka. h) MCH service Registers were mostly updated. i) OP and Nirodh distribution registers were not available in any SC visited. j) Printed stock register was not available at all the visited sub-centres
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10.Mandla District
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Major observations of Regional Evaluation Team (RET) and Field Survey Unit (FSU), Bhopal about the evaluation work in Mandla and Jhabua Districts of Madhya Pradesh State during the month of March, 2011.
I . Details of the visited Institutions:
District Visited DH, CHC and PHC Visited HSC Visited
Mandla DH : Mandla Ramnagar, Nakwal, Dhanitola, Ahamad- CHC: Bichhiya and Narayanganj pur, Rajomal, Bijegaon, Mand, Babaliya, PHC: Sijhora, Ramnagar and Sukhram, Kudamaili and Chauki. Babaliya
II. Major Observations 1. Human Resources:- a) Many of the key posts as shown in the following table were lying vacant in the District:- Post Post sanctioned In position Vacant Specialist 78 13 65 Medical Officer 89 46 43 Staff Nurse 142 82 60 LT 40 25 15 MPS 64 37 27 MPW(M) 238 155 83
b) In addition to above, contractual post of 8 PGMOs, 9 MOs, 4 staff Nurses and 31 ANMs against the requirement of 9, 14, 4 and 87 posts respectively were vacant. c) In visited District Hospital, 1 post of Medical Specialist out of 3 sanctioned, 2 posts of Surgical Specialist out of 3 sanctioned were vacant. All 4 sanctioned posts of OB & Gyn, only post each of Psychiatrists and Dermatologist/Venerologist, all 4 posts of Anaesthetist, all 2 posts of Orthopedician, only post of ECG Technician, all 4 posts of Lab Attendant, 7 posts of Matron, 1 out of 3 posts of Paediatrics, 1 out of 2 posts of Ophthalmologist, 2 out of 3 posts of Radiologist, 1 out of 2 posts of Pathologist, 44 out of 100 posts of Staff Nurse, 1 out of 2 posts of Ophthalmic Assistant, 4 out of 8 posts of Lab Technician and 5 out of 8 posts of Pharmacist were lying vacant. d) Similarly, in CHC Narayanganj, All 3 posts of Specialist and 6 posts of Staff Nurse, 4 out of 6 posts of Medical Officer, 1 out of 2 posts each of LT & Pharmacist, 3 out of 4 posts of Ward Boy were vacant. Only post each of BPM and Accountant under NRHM were also vacant in this CHC.
50 e) Additional ANMs were deployed only at Nakwal, Dhanitola, Rajomaland, Sukharam Sub Centres. MPW(M) post was vacant at Sub Centres Dhanitola, Mand, Kudamaili, and Chauki. 2. Rogi Kalyan Samiti &Village Health Sanitation Committee(VHSC) :- a) Rogi Kalyan Samiti (RKS) has been constituted in the visited CHCs and PHCs and meetings of RKS were being conducted on regular basis. b) In 2009-10, RKS funds were not provided at PHCs level due to non-registration of RKS. During 2010-11, RKS provided funds to the PHCs @ Rs.1,00,000 each but, no expenditure was incurred by any PHC till February, 2011. c) During 2009-10, DH and CHCs spent RKS funds fully except CHCs at Nainpur, Ghughari and Narayanganj. In the current year 2010-11, CHCs Nainpur and Bichhiya made 100% expenditure and DH incurred 50% expenditure. The rest of the CHCs did not incur any expenditure till February, 2011. d) VHSCs were functioning in 1154 villages out of 1223 villages in the district,. 1099 VHSCs were having ASHA as a member and in 927 VHSCs, bank account were opened for handling funds. e) It was also reported that out of 9 blocks, VHSCs were established in all the villages in 6 blocks. 3. Services of Janani Suraksha Yojana (JSY):- a) Janani Suraksha Yojana was being implemented properly in the district. Out of 18475 deliveries in the year 2009-10 and 17189 deliveries in the current year (up to February, 2011) conducted in the district, there were 12190 and 12213 institutional deliveries in the respective year. 11420 beneficiaries in the year 2009-10 and 10129 beneficiaries in the current year upto February, 2011 have been paid with incentive under the scheme. b) The district had spent Rs. 2,76,11,529 in 2009-10 out of funds of Rs.4,30,18,000 available in the year. Similarly, an amount of Rs. 2,18,18,800 was spent up to February, 2011 out of funds of Rs. 3,01,22,000 allotted to the district during current year. c) In the visited CHCs and PHCs, there was sufficient funds available and beneficiaries were provided with cash assistance and other services. d) 50 beneficiaries were contacted by team for sample verification and it was observed that beneficiaries were mostly satisfied with the services. 84% beneficiaries received help from ASHA/Dai while going to the hospital for delivery and 40% beneficiaries used Janani
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Express to go to hospital. 96% beneficiaries got three ANCs check up and 66% beneficiaries had three post natal check ups (PNCs). e) 48% beneficiaries made self arrangement to go to hospital and none of them got money for transport. 4. Services of ASHA:- a) During the year 2009-10, 1214 ASHAs have been selected in the district and all have been trained upto 4th Module and 143 of them provided 5th Module of training. b) In the visited 9 Blocks, it was reported that 1140 ASHAs were trained and 926 ASHAs were having drug kits and working properly. c) In all 11 visited Sub Centres, all ASHAs were trained and working properly. They were accompanying pregnant women for delivery, helping in immunizing, assisting for ANC/PNC and motivating for sterilization operation. Most of the ASHAs were involved in the functioning of VHSCs.
5. Untied funds: a. CHCs: As reported, 6 CHCs @ Rs.50,000 each and 3 CHCs @ Rs.25,000 each were provided as untied funds during 2009-10 in the district and the funds were spent by the CHCs. During the year 2010-11, 4 CHCs @ Rs. 50,000 each and 5 CHCs @ Rs.25,000 each were provided untied funds, Out of them, CHCs at Mawai, Niwas, Narayangang and Bijadandi did not incur any expenditure and CHCs at Bichhiya, Nainpur, Ghughari & Bamhni incurred 83%, 54%, 37%, & 100% expenditure respectively, till February, 2011. No specific information was given us to how the CHCs were divided into two categories for the purpose of providing untied funds. b. PHCs: All PHCs were provided Rs. 25,000 each as untied funds in the district for the financial year 2009-10 and 2010-11. All PHCs except Menari, Mehaniya, Patpara & Maharajpur spent funds fully and submitted Utilization certificate. During the financial year 2010-11, no PHC has incurred any expenditure till February, 2011. 6. 24 Hours delivery care services:- a) 10 CHCs and 5 PHCs were providing 24x7 delivery care service in the district. It was observed that total no. of deliveries in the visited CHC Bichhiya was 1671 in 2009-10 and
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1650 in 2010-11 (up to February, 2011). In another visited CHC Narayanganj, the no. of deliveries was 579 in 2009-10 and 484 in 2010-11 (upto Feb.2011) b) The facilities for caring Mother and Newborn baby were adequate in the CHC Bichhiya but not in CHC Narayanganj. c) The visited CHC Narayanganj was having Blood Storage facility though it was found non-functional. There was no Blood Storage facility available at CHC Bichhiya. 7. Physical infrastructure and stock position: I. CHCs: a) CHCs visited at Bichhiya and Narayangang have own building for functioning. Water supply, Electricity, Jeep and Residential quarter for doctors and Para medical staffs were available. Infrastructure and equipments of these CHCs were not as per IPHS. b) New CHC building at Narayanganj is completed but yet to be occupied. 30 beds, X- ray facility, Blood Storage and other facilities and equipments are available but non- functional due to non-possession of the building. c) Neonatal Resuscitation equipments are not available at CHC Narayangang. Blood Storage Unit and X-Ray facility was not available at CHC Bichhiya. Sick new born care unit was not set up in both CHCs. d) Vital Essential drug and Arteether injection were available in both CHCs but quinine injections were not available in both visited CHCs. e) Medical waste disposable system was not available in both CHCs. II. PHCs: a) PHCs visited at Sijora, Ramnagar and Babaliya were functioning in Govt. building. Electricity and toilet facility were available at the PHCs. Regular water supply is available in Ramnagar and Babaliya but not in PHC Sijora. b) Telephone facility was not available in Sijora and Babaliya. There is no vehicle in any of the visited PHCs. Residential quarter for Medical Officer was not available in PHCs Sijora and Babalia. c) Quantity of prophylactic drugs like IFA, Vitamin A, etc was inadequate in Ramnagar PHC. Vitamine - A was not available in Babaliya and IFA was not available in Sijora PHC. d) Functional Operation Theatres with OT table was not available in all visited PHCs. III. HSCs:
53 a) All 11 visited Sub Centres were functioning in Govt. building. Water facility was available at all visited HSCs except Rajomal Sub Centre. Electricity was available at all visited centre. b) Labour rooms were available in Sub Centre Dhanitola, Ahmadpur, Rajomal, Bijegaon, Mand, Babaliya and Kudamaili but deliveries were being conducted only in Sub Centres Dhanitola and Rajomal. Examination table is not available at Ahmadpur, Bijegaon, Mand, Kudamaili and Chauki Sub Centres. c) Mobile Phone was not provided to ANMs at visited centres. Additional ANM were posted at HSCs Dhanitola, Nakwal, Rajomal and Sukhram. MPW(M) post was vacant at Dhanitola, Mand, Kudamaili and chauki Sub Centre. SBA training was received by the worker of Bijegaon and Chauki Sub Centres. IMNCI training was received by the ANMs of Rajomal, Bijegaon and Chauki Sub Centres. d) DDKs, Kerosene Oil/Gas Cylinder, Sanitary Napkins, Emergency Contraceptive Pills and Oxytocin Tablets were not available at any of the visited Sub Centres. Delivery table and Mclntsh sheet were not available in Ramnagar, Nakwal, Sukhram, Babaliya and Kudamaili Sub Centres. Delivery kit was not available in Bijegaon, Sukhramand chauki Sub Centres. Rapid Diagnosis test kit for Malaria was not available at Rajomal HSC. e) Stock of IUDs at HSCs Dhanitola and Bijegaon, Oral Pills at Dhanitola and Sukhram and Condoms at Babaliya Sub Centre was not available. Injection Gentamycin was available only at Bijegaon Sub Centre . f) No supervision was done by the supervisory staff during last 3 months in most of the visited Sub Centre. 8. Community Satisfaction on Overall Services: i. ANMs’ Services at HSCs: a) 64 mothers having child of one year old were contacted in the visited 11 Sub Centres. Mostly, ANM was available as per need and mothers were satisfied with ANM’s work. All deliveries were institutional but only 37 (57.81%) mother received three post natal check up. b) 21 (32.81%) mothers knew about danger sign of ARI and 35 (54.69%) mothers were aware about contraceptive use. All the respondents were aware of government health facilities where they can get health services. ii. Services of MPW (M):
54 a) Out of 11 Sub Centre visited, MPW(M) were posted in only 7 Sub Centres. After elaborated discussions with teachers, Sarpanch, ASHA, CC users and Villagers, the team found that they all were satisfied with the services received from MPW (M). iii. Services at PHCs: b) Villagers and some of the service acceptors contacted in the area of visited PHCs were satisfied with services of PHCs. However, few mothers and some of the villagers were not aware about danger sign of pregnancy, danger sign of sick new born, contraceptive methods and STD/HIV-AIDS. ASHAs interviewed in the visited PHCs informed that EC Pills are not available in their Kits. 9. Sample Verification of Family Welfare Acceptor :- a) The team contacted 103 FW acceptors out of 134 selected in the visited centres. Discrepancy in the age of acceptor, in the age of spouse and in the age of youngest child, etc was observed. b) While examining records of selected acceptors from services registers, age of acceptors was not recorded in 7 (5%) cases, age of spouse in 12 acceptors, age of youngest child in 8 (6%) cases, total number of children in 22 (16%) acceptors and break up of male /female children in 14 (11%) acceptors out of the contacted cases. c) 11 F.W. acceptors ( 5 of OP users and 6 of Nirodh users) out of 58 spacing method acceptors were found to be false cases. d) All 45 contacted sterilization acceptors received full amount of compensation. e) The team also contacted 166 beneficiaries of child immunization and the beneficiaries confirmed with the doses. Only 54 (32.53%) beneficiaries received follow up services. No complication was reported by the contacted beneficiaries. 10. Reconciliation of Reported Performance : a) Performance under family planning was less than the targeted figures in 2009-10 and 2010-11 (upto February, 2011) in the district. The district had achieved 9004 sterilization operation, 2278 IUD insertions, 5530 OP users and 9640 CC users, and against the targeted figures of 10000, 3800, 7900 & 11700 respectively in the year 2009-10. Targets for the same for the year 2010-11(upto February, 2011) was 10200, 3800, 7900 & 11700 of which achievements were 9678, 1940, 7183 and 6904 respectively up to February 2011. While examining the block wise achievement under family planning, it was observed that 3 bolcks namely Mavai, Mohgaon and Narayanganj achieved more than targeted Sterilisation during 2010-11 (upto February, 2011).
55 b) Sterilisation and CuT performance reported by district office for CHCs Bichhiya & Narayanganj and District hospital Mandla for the year 2011-12 upto February,2011 did not tally with the reported figures of respective centres/institutions. 11. Maintenance of Registers & Records: a) EC Register was not maintained in district hospital and the same was not updated at HSCs Mand, Kudamaili and Chauki. b) In the visited CHCs, no IUD register was maintained for last two years. c) Maternal care services and child immunisation services were recorded in the printed registers and also maintained properly. 12. Other Important Observations and Suggestions:- a) For online data entry of MCH tracking formats, all the CHC were having computers with internet facility. Trained Data Entry Operators were posted. MCH tracking formats have also been provided to the Sub Centres in the district but online data entry was not started till February, 2011. b) Lack of supervision was noticed at all levels in the rural and urban centres.
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11. Jhabua District
Major observations of Regional Evaluation Team (RET) and Field Survey Unit (FSU), Bhopal about the evaluation work in Jhabua Districts of Madhya Pradesh State during the month of March, 2011. I . Details of the visited Institutions:
District Visited DH, CHC and PHC Visited HSC Visited
DH: Jhabua Ban, Bhurimati, Bhujkhedi, Kundapur, Jhabua CHC: Ranapur and Kalyanpur Amliphalia, Pipliya, Dhakalbadi and PHC: Keetol, Kunjawani, Bhagora. Rambhapur and Mordundiya
II. Major Observations 1. Human Resources:- a) The Staff position of the following key posts is as reported below:
Post Post sanction In position Vacant Specialist 33 10 23 Medical Officer 72 45 27 Staff Nurse 107 54 53 LHV 24 19 05 MPS 06 03 03 MPW(M) 107 72 35 b) Contractual posts under RCH: All 4 post of PGMO, 3 posts of staff nurse (CEmOC), 10 posts of staff nurse (BEmOC) and 2 out of 5 posts of MO were vacant in the district. c) Post of Hospital Superintendent, all 2 posts each of Paediatrics, Aanaesthetist and Pathologist, all 4 posts of Lab Attendant, post of Dark Room Assistant, all 3 posts of Matron, post of Electrician, 2 out of 3 posts of OB & Gyn, 19 out of 29 posts of Casualty Doctor/GDM, 41 out of 75 posts of Staff nurse, 6 out of 17 posts of Hospital Worker, 7 out of 11 posts of Sanitary Worker, 1 out of 7 posts of Lab technician, 1 out of 3 posts of Radiographer, and 46 out of 79 posts of class IV staffs were lying vacant in the district Hospital Jhabua. d) All 4 posts of Specialist, one sanctioned posts each of Lab Attendant and OT Attendant, 6 posts of Staff Nurse, 1 post of Radiographer, 1 post of Ophthalmic Assistant, 1 post of Accountant, 1 post of Compounder, 2 posts of Surveillance Investigator, 1 out of 2 posts of Medical Officer, 24 of the 36 posts of MPW(M), 1 out of 2 posts of LHV, 2 out of
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36 sanctioned posts of ANM, 3 of the 8 posts of Surveillance Worker were vacant in CHC Kalyanpur. e) 3 of the 4 sanctioned posts of Specialist, sanctioned post each of Computer, B.E.E, 4 of 5 sanctioned posts of Supervisor and 16 of the 24 sanctioned posts of MPW were lying vacant in CHC Ranapur. Post of BMP under RCH was also vacant. f) Each of the sanctioned posts of MPW(M), Health Supervisor, Lab Technician and Compounder was lying vacant in PHC Keetol. g) Each of the sanctioned post of ANM, LHV, Health supervisor, Lab Technician and Compounder was vacant in PHC Kunjawani. h) Each of the sanctioned post of Medical Officer, ANM, MPW(M), Health supervisor and Lab Technician was vacant in PHC Rambhapur. i) Each of the sanctioned post of ANM, one health supervisor and one Lab Technician was vacant in Mordundiya PHC. 2. Rogi Kalyan Samiti & Village Health Sanitation Committee (VHSC) :- a) RKS was set up in the visited CHCs & PHCs. As per the information provided, District Hospital, CHCs and PHCs in the district were provided @ Rs. 1,00,000 annually as RKS fund. Out of 7 CHCs, two CHCs i.e. Thanda and Meghnagar were allotted with RKS funds in the current year and other 5 CHCs were having previous funds or were upgraded from PHC to CHC. b) Similarly, most of the PHCs were not provided RKS funds for year 2009-10 as they had balance of previous funds which they utilized. RKS funds to the tune of Rs.1,00,000 provided to 10 PHCs out 19 PHCs in the district and other PHCs were having previous funds. c) VHSCs are constituted in all 786 villages in the district and all VHSCs were having ASHAs as a member. All VHSCs had opened their bank accounts. 3. Service of Janani suraksha Yojana (JSY):- a) Janani Suraksha Yojana was being implemented properly in the district. Out of 28,783 deliveries in the year 2009-10 and 29,480 deliveries in the current year (up to February, 2011) conducted in the district, there were 21453 and 22043 institutional deliveries in the respective years. 15,108 beneficiaries in the year 2009-10 and 23,863 beneficiaries in the current year upto February, 2011 have been paid with incentive under the scheme.
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b) The district had spent Rs. 311.90 lakhs in 2009-10 out of funds Rs. 492.00 lakhs available in the year. Likewise, Rs. 484.00 lacs were spent up to February, 2011 out of funds of Rs. 527.00 lakhs allotted to the district during current year. c) In the visited CHCs and PHCs, there were sufficient funds available and beneficiaries were provided cash assistance and other services. d) The JSY funds were received in time in all the visited 4 PHCs and the payments were made timely to all the beneficiaries. e) Registers have been maintained containing list of beneficiaries to whom cheques have been disbursed at visited DH, CHCs and PHCs. f) 38 beneficiaries out of 66 were contacted by team for sample verification were satisfied with the services rendered by ANMs/ASHA/Dai. 26 (68%) beneficiaries availed services of Janani Express to go to hospital for delivery g) 31 (81%) beneficiaries got three ANC check ups and 16 (42%) beneficiaries had three post natal check ups (PNCs). 4. Functioning of ASHA scheme: a) There are 786 ASHA selected for 786 villages in the district. All ASHAs were trained and provided with drug kit. b) In the visited Sub Centres, it was observed that most of the trained ASHAs were working properly. As reported by the interviewed JSY beneficiaries, ANMs and Villagers, ASHAs were accompanying beneficiaries for delivery, helping ANMs for immunization, assisting them in ANC/PNC and also motivating cases for Sterilization operation. 5. Untied funds: a. CHCs: a) As reported, 4 CHCs were provided untied funds @ Rs.50,000 each during 2009-10 and most of the funds were spent by the CHCs. During the year 2010-11, 3 PHCs were upgraded to CHCs and all CHCs were provided untied fund @ Rs.50000 each. All CHCs except Thandla utilized funds properly. CHC Thandla spent only Rs.7391 till the month of visit. b. PHCs: a) All 19 PHCs except PHCs Rambhapur and Pithanpur have been provided untied funds @ Rs.25,000 each for the year 2009-10 and all PHCs except PHC Bekalda spent the full fund during the year. PHC Bekalda did not spend any money.
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b) During 2010-11, all PHC except Bekalda, Kardavad, Umarkot and Pithanpur were provided untied funds @ Rs.25000 each, out of them only PHCs Rambhapur and Madrani spent Rs. 18100 each, rest of the PHCs did not spent any untied funds till the month of visit. c. HSCs: a) Untied funds were provided to all 190 Sub Centre during 2009-10. Out of these, 55 Sub Centres utilized the fund and submitted Utilization Certificate for the year. Similarly the funds were provided to all Sub Centre for the year 2010-11 and till the month of visit, only 60 Sub Centres started utilizing funds.
6. 24 Hours delivery care services:- a) In the district, 13 institutions including District Hospital, 7 CHCs and 5 PHCs were providing 24x7 services. Out of these, 2 CHCs and DH are CEmONC and rest are BEmONC. b) The facilities for caring mother and new born babies were adequate in visited CHCs Kalyanpura and Ranapura though Blood Storage Unit was not available in both the CHCs visited. 7. Physical infrastructure and stock position:- I. CHCs: a) Both visited CHCs at Ranapur and Kalyanpur were functioning in their own (new) building which were neat and clean. Water supply, electricity with power back up, and Residential quarter for doctor and para medical staff were available at both visited CHCs. Ambulance was available in CHC Ranapur but jeep was not available in both visited CHCs. b) Essential equipment and apparatus related to FRU were available in both CHCs but Anesthesia Equipment, Sick New Born Care Unit and Blood Storage Unit were not available in both CHCs. c) Medical waste disposable system was not set up in both the CHCs. d) Vital and Essential drugs were available in both visited CHCs, but quinine injections were not in stock in CHC Ranapur. II. PHC: a) All visited PHCs i.e., Keetol, Rambhapur, Mordunya and Kunjawani were functioning in their own building. Residntial quarter for Medical Officer, Electricity facility
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with power back up, toilet facility and telephone facility was available in all visited PHCs. Regular Water supply was not available in PHCs Keetol and Rambhapur. Ambulance/Jeep was available only at PHC Keetol and not available at other 3 PHCs visited. b) Oxygen cylinder was not available in PHCs Mordunya and Kunlawani. Minor surgical and delivery equipments were not available at PHC Rambhapur; Microscope was available only in Kunjawani PHC; Resuscitation equipment was found only at PHC Rambhapur; Operation theatre was found in functional condition at Morduniya PHC only. c) Stock of IUD, OP & CC were not available at Keetol PHC. Stock of OP & Nirodh at Morduniya and Cu-T at Rambhapur PHC was not available. Stock of BCG, DPT, OPV, DT, TT and Measles vaccines was not available at any of the visited PHCs. d) Post of AYUSH Medical Officer was not available in any of the visited PHCs. III. HSC: a) All 8 visited HSCs except Bhurim HSC were functioning in Government building. All HSCs except Dhakalbadi and Bhagore have regular supply of water. Electricity was available only at 4 out of 8 HSCs. Toilet facility was available at all visited HSCs except Bhujkhedi and Amliphalia. Labour room was not available in Bhujkedi, Amliphaliya and Baghora HSCs. b) Mobile Phone was not provided to any ANM in the district. ANMs of the Sub Centres Bhurimati, Bhujkhedi and Kundanpur were residing in Sub Centre head quarters. Additional ANM under NRHM was posted only in Dhkalbadi HSC. Out of, 8 only 4 ANMs received SBA training and only one ANM received IMNCI training. c) Condoms were not available in SC Bhurimati and Emergency contraceptive pills were not available at SCs Ban and Kundanpur. Oxytocins Tab, Ampicillin Cap, Gentamycin Inj. and Metronidazole tab were not available at any of the visited Sub Centres. Kerosene-oil/ gas cylinder was available only at Bhurimati and Bhagora Sub Centre. 8. Community Satisfaction on overall health service: i. ANMs’ Services at HSCs: a) 34 mothers having child of one year old were contacted in the visited 8 Sub Centres., ANM was mostly available as per need and mothers were satisfied with ANM’s work. All deliveries were institutional and only 11 (32.35%) mother received three post natal check up. b) 7 (16.28%) mothers knew about danger sign of ARI and all mothers were aware about contraceptive use. 31(91.18%) mothers were aware of government health facilities where they can get health services.
61 ii. Services of MPWs (M): Out of 8 visited Sub Centre , MPW(M) was posted in only Amliphalia Sub Centre. The work of MPW was found satisfactory. iii. Services of PHCs: a) Villagers and some of the service acceptors contacted in the area of visited PHCs were satisfied with service of PHCs. However, few mothers and some of the villagers were not aware about danger sign of pregnancy, danger sign of sick new born, contraceptive methods and STD/HIV-AIDS.
9. Sample Verification of Family Welfare Acceptor :- a) The team contacted 196 FW acceptors out of 262 selected in the visited centres in the district. Discrepancy in age of acceptor, age of spouse and age of youngest child was found during sample check of F.W. acceptors. b) While examining records of selected acceptors from services registers, it was found that age of youngest child in 63 (24.24%) cases was not recorded. c) 91 F.W. acceptors ( 24 of OP users, 37 of IUD users and 30 of Nirodh users) among the contacted 145 spacing method acceptors were found to be false in the district. d) All 51 contacted sterilization acceptors received full amount of compensation. e) The team had also contacted 46 beneficiaries of child immunization and they confirmed with the doses. Only 22(47.83%) beneficiaries had been provided with follow up service. No complication was found among the contacted beneficiaries. 10. Reconciliation of Reported Performance: a) Performance under family planning was less than the targeted figures in 2009-10 and 2010-11 (upto February, 2011) in the district. The district had achieved 4508 Sterilization Operation, 9528 IUD insertions, 6852 OP users and 30581 CC users figures against the targeted figures of 8000, 13000, 11150 & 23920 respectively in the year 2009-10. Targets for the same for the year 2010-11 (upto February, 2011) was 9253, 13100, 11100 & 23600 and the achievements were 9780, 6518, 6678 and 18232 respectively up to February 2011. While examining the block wise achievement under family planning, four blocks viz., (1) Petlawad, (2) Thandla, (3) Kalyanpura and (4) Rama observed to have achieved more than the targeted Sterilisation during 2010-11(upto February, 2011).
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11. Maintenance of Register & Record: a) No EC Register was produced at CHCs Kalyanpur and Ranapur. b) IUD, OP and Nirodh Register were not maintained in CHCs Kalyanpur and Ranapur. Sterilization Register and MCH, register were maintained in non printed form at both CHCs Kalyanpur and Ranapur. c) Most of the centres visited in the district had not updated OP and Nirodh distribution registers. d) Lack of supervision was observed at all the centres visited in the district. To improve the quality of services, supervision needs to be strengthened in the district. ******** .
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Major observations of Field Survey Unit (FSU) and Regional Evaluation Team (RET), Bhopal about the Evaluation work in districts of Ratlam of Madhya Pradesh State in the month of January, 2011.
I. Details of the visited Institutions: District Visited DH, CHCs and PHCs visited SCs visited Ratlam District Hospital: Ratlam Amargarh, Makodiyarundi, CHCs: Sailana and Namli Chavadakhedi, Kunda, Basindra, PHCs: Shivgarh, Sarvan, Shivgarh, Parnala, Bangrod, Sakrawada, Malwasa and Bibdod Berda and Bangrod
II. Major Findings 1. Human resources:- a) There was acute shortage of technical manpower in the district. 58 (77%) out of 75 posts Specialist and 42 (47%) out of 90 posts of Medical Officer were lying vacant in the District. In paramedical category, 139 (52%) out of 269 posts of Staff Nurse, 7 out of 30 posts of Lab Technician, 5 out of 32 posts of MPS and 75 (48%) out of 156 posts of MPW (M) were lying vacant.
b) During visit to District Hospital, it was observed that 3 of the 4 posts of Medical Specialist, 2 each out of 4 and 3 sanctioned posts of Pediatrician and Orthopedician were lying vacant. All 3 posts of Radiologist and 111 out of 212 posts of Staff Nurse, one of 2 sanctioned posts of Ophthalmic Assistant and 2 posts of Dietician and all 9 posts of Matrons were also lying vacant. c) In the visited CHCs at Namli and Sailana, Specialists were not provided. 2. Janani Suraksha Yojana (JSY):- a) As per the report received from visited CHCs and PHCs, the status of JSY scheme is given below: Sl. Particulars Year CHC CHC PHC PHC No. Sailana Namli Shivgarh Sarvar 1 Total no. of deliveries conducted 2009-10 885 749 1557 1828
(Home + Institutional) 2010-11 708 613 1080 1686 (up to Dec.2010) 2 No. of Institutional deliveries 2009-10 850 749 1545 1804
2010-11 691 613 1077 1667 (up to Dec.2010) 3 No. of beneficiaries paid with 2009-10 885 749 1557 1828
incentives 2010-11 690 613 1080 1686 (up to 64
Dec.2010) b) There was no scarcity of JSY fund in the visited centres during 2009-10 and 2010-11. It was observed that sufficient JSY fund was received in time by all the visited institutions and all beneficiaries were paid JSY incentives. c) The team contacted 35 beneficiaries out of 45 selected cases for on the spot verification and observed that all beneficiaries were satisfied with the services. d) 34 (97.11%) beneficiaries were accompanied by ASHAs /Dai while going to the hospital for deliveries. All beneficiaries received cheques within three days after delivery. e) Most of the beneficiaries used Janani Express and 5 (14.3%) beneficiaries made self arrangement to go to hospital and none of the beneficiaries got money for transport. 23 (65.7%) beneficiaries got three Anti natal checkups (ANC) and 10 ( 28.6%) beneficiaries got three post natal check ups (PNC) by ASHA and ANM. 3. Untied Funds:- a) Institution wise information given by BPMU of visited block Bilpank & Sailana for Untied Funds and Maintenance Grant is as under:- Name of the centres Total fund Total expenditure Balance as on available * 12/2010 2009-10 2010-11 2009-10 2010- 2009- 2010-11 11 10 Bilplank Block (Untied Funds and Maintenance Fund) CHC, Namli 1,50,000 75,000 1,50,000 0 0 75,000 PHC, Bangrod 87,525 87,525 0 0 87,525 87,525 PHC, Birmawal 1,00,000 25,000 75,000 0 25,000 25,000 PHC, Dhamnod 87,500 1,05,000 57,500 0 30,000 1,05,000 PHC, Dharad 88,000 88,000 0 0 88,000 88,000 Sailana Block(Untied Funds and Maintenance Fund) CHC, Sailana NA 50,000 NA 33,211 NA 16,789 PHC,Berda NA 12,500 NA 0 NA 694 PHC,Sakrawada NA 12,500 NA 0 NA 785 PHC, Sarwan NA 12,500 NA 0 NA 12,500 PHC, Shivgarh NA 12,500 NA 0 NA 12,500
* Including opening balance
b) All the visited Sub-Centres viz., Amargarh, Makodiyarundi, Chawadakhedi, Kunda, Basindra, Arnala, Shivgarh, Bangrod, Malwasa and Bibdod have received untied and maintenance funds during 2010-11and most of the funds were utilized. 4. Rogi Kalyan Samiti (RKS) and Village Health & Sanitation Committee (VHSC) :- a) 31 Rogi Kalyan Samitis at District Hospital, 6 at CHCs and 24 at PHCs were registered in the district. 65
b) RKS was constituted at visited CHCs Sailana and Namli and at PHCs i.e. Sarvan, Shivagarh, Sakrawada, Berda and Bangroad. No meetings of RKS were being conducted on regular basis except in CHC Namli and PHC Bangrod. c) As per the information given by the BPMU of the visited block Sailana and Bilpank, RKS Funds to the tune of Rs.50,000 each was available at CHCs and PHCs during 2010- 11 except PHCs at Dhamnod (Rs.1,60,000), Dharad (Rs.1,25,000) and Bangrod (Rs.1,00,000). No expenditure was reported by any of the centers till January, 2011. d) Out of total 1051 villages in the district VHSCs were constituted in 722 villages. All VHSCs were having ASHA as a member and they have opened bank accounts for handling funds. 5. Functioning of ASHA Scheme:- a) 1020 ASHAs have been selected in the district. Out of them, 953 ASHAs have been trained upto 4th module and 710 ASHAs trained up to 5th module and 300 of them have been provided with Drug Kits. b) In the visited Sub Centres, maximum villages have been covered under the scheme and all the ASHAs were carrying out the activities i.e. accompanying mothers for delivery purpose, helping child immunizing, assisting in ANC/PNC check up and motivating the cases for Sterilization operations etc. 6. 24x7 hours Delivery Care System:- a) There were 24 institutions provideing 24x7 hours services in the district. Out of them, 2 CHCs and 3PHCs were visited by the team. In CHC Namli and PHC Bangrod there were inadequate facility for cares of Mothers and New born babies. Only CHC Sailana had facilities along with staff. Shortage of staff nurse and ANMs was found in all the centres visited except CHC Sailana. There was no blood storage unit in the visited centres. b) Total number of deliveries conducted in the visited centres are reported as under:
Sl. Name of the centres No. of deliveries performed under the No. scheme 2009-10 2010-11 1 CHC Sailana 850 691 2 CHC Namli 749 571 3 PHC Sarvan 1804 1667 4 PHC Shivgarh 1545 1077 5 PHC Bangrod 132 77
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7. Physical Infrastructure and Stock Positions:- i. CHC: a) CHCs visited at Sailana and Namli were functioning in their own building. The premises of the visited CHCs were found neat & clean. b) 30 beds were sanctioned at the visited CHCs but 30 & 20 beds were found in good condition at CHCs Sailana and Namli respectively. c) The X-ray facility was available in CHC Sailana but not at Namli CHC. Anesthesia Equipment, Sick New Born Care Unit and Blood storage Unit were not available in both the CHCs visited. d) Quinine and Arteether injection were not available at both the visited CHCs. ii. PHC: a) PHCs visited at Shivagarh, Sarwan, Berda, and Sakrawad were functioning in Govt. building and Bangrod was functioning in rent free building. 6 bedded facility was available at Sarwan, Berda and Bangrod PHCs and 35 beds in Shivgarh PHC. b) The regular water supply was available in 4 PHCs out of 5 visited PHCs. The PHCs Shivgarh was using tanker water as there was no water supply. Electricity connection was available in all the PHCs but power back up was not available in PHCs Berda and Sakrawada. c) Telephone and Toilet facility were available in all the visited PHCs. The Cold Chain equipments, Autoclave, Steam Sterilizer and Resuscitation equipments were not available in Berda and Sakrawada PHCs. d) Labour room, equipments (for delivery purpose) and Minor surgical equipments were available at all the visited PHCs but Labour room Table was not available at PHC Berda. e) Microscopes were available at all the visited PHCs except PHCs Berda and Sakrawada but the Lab. Technician was not available at PHCs Bangrod and Shivgarh. f) Functional Operation Theatres was found available in Shivgarh and Sarvan PHCs. Vital drugs were available in all the visited PHCs. Contraceptives (IUD, OP, CC) were available in all the PHCs except Shivgarh and PHC Bangrod. iii. Sub-Centre: a) All the visited Sub Centres were functioning in Govt. building except Amargarh and Bibdod Sub Centres. Amargarh and Bibdod Sub Centres were running in rent free room. ANMs of 7 of the 10 visited Sub Centres were residing in Sub Centre Villages. Labour rooms were available in all the visited Sub Centres but delivery not conducted except at Amargarh, Bangroda, Malwasa and Bibdod SCs.
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b) Water supply facility was available in all SCs except Parnala and Malwasa SCs. Electricity supply was not available in the visited Sub Centres except Chawdakhedi, Basindra, Shivagarh, Bangroda and Malwasa SCs. The visited Sub Centreas were not as per IPHS. c) Thermometer was available in all the visited sub centres except Basindra and Bibdod Sub Centres. Delivery kit was not available at Amargarh, Chawdakhedi and Bangrod Sub Centres. Chloroquine tablets were available at all the visited Sub Centres except Amargarh. Antiseptic solution was not available at Amargarh, Makodiyarundi, Chawdakhedi and Parnala SCs. Chlorine solution / Bleaching powder were available at all of the visited SCs except Amargarh and Chawdakhedi. d) Delivery table was available at SCs Maakodiyarundi, Chawdakhedi, Kunda, Basindra, Parnala & Shivgarh. Ambu bag/suction was not available at Amargarh, Makodiyarundi, Chawdakhedi, Basindra and Malwasa SCs. DDKs, Sanitary Napkins, Tab Oxytocin, Injection Gentamycin and Cap Ampiciline were not available at visited SCs. Emergency contraceptive pills, Tab Paracetamole, Cotrimoxazole tablet and Tab. Metronidazolewere not available in some of the visited SCs. Kits A and B were received by all the Sub Centres in the year 2010-11 except Shivgarh Sub Centre. 8. Knowledge and Opinion of Community on Health Services: a) 57 mothers having child up to one-year of age were interviewed for assessing the work of ANM and knowledge & opinion of mothers. b) 24 (42%) mothers replied that ANM was available whenever needed. c) 20 (35%) mothers received three post natal check ups. 22 (39%) mothers knew the danger sign of ARI and 42 (74%) mothers knew the use of ORS. d) 28 (49%) mothers were aware of contraceptive method. 8 (14%) mothers replied that they had been told the advantage and side effects of contraceptives. e) Out of the visited 10 Sub Centres, male workers were posted in 5 Sub Centres. Community in their areas was satisfied with their work but they wanted regular visit by the workers in the villages. 9. Sample Verification of Family Welfare Acceptors: a) Out of selected 220 acceptors of Family planning methods, 172 (78% ) acceptors could be contacted for sample verification in the district. b) While examining the records of selected acceptors from service registers, age of spouse was found not recorded in 49 (22%) cases, total no. of children in 20 (9%) cases, no. of male/female children in 16 (7%) cases and age of youngest child in 28 (13%) cases. All these cases were reported for spacing methods (IUD, OP and Nirodh).
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c) There was high percentage of fake reporting under the spacing method. Out of the 90 IUD cases contacted, 72 (80%) cases found to be fake. Similarly, 6 (30%) out of 20 OP cases and 6 (27%) out of 22 Nirodh cases contacted were found to be fake. 10. Reconciliation of reported performance:- a) The figures reported for Sterilization, IUD, OP and CC at district office for the year 2009-10 and 2010-11 (up to December, 2010) did not tally with the same report at CHC Sailana, PHC Bilpank and D.H. Ratlam. 11. IT infrastructure & Mother & Child (MCH) Tracking System: a) Computer was available at CMO office, DPMU, 3 CHCs (block HQ) and 3 PHCs (Block HQ). In other 3 CHCs and 21 sector level PHCs, computers were not available. b) MCH tracking formats were available at all the Sub Centres in District. Health functionaries district level to Sub Centre level were sensitized in MCH tracking formats. Most of the workers of Sub Centres were submitting MCH tracking formats to their respective BPMU. Data entry at block level is under process. According to DPMU, due to some portal problem data entry was not accepted by portal sometimes. 12. Maintenance of records and Registers:- a) EC registers were either not maintained or not up dated at CHC, PHC and Sub Centre level. b) Most of the OP and Nirodh registers were not printed and these registers were mostly not updated at the Sub Centres. c) No sterilization service register was maintained at CHC Sailana. d) Consolidated IUD register was also not maintained at CHC Sailana and PHC Bilpank. e) Printed stock register was not updated in all the visited Sub Centres.
13. Other Observations and Suggestions:- a) Sarvan PHC was functioning in old building. The new building was under construction. In Sarvan PHC, electricity problem was there. Excess workload and shortage of manpower was found in PHC Sarvan. b) At CHC Sailana the toilet facility is not in convenient place. Seepage was found in the wards and there was no proper drainage system available in the CHC building. As stated, some of the instruments for use of delivery purpose were not available in CHC Sailana.
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13. Narsinghpur District Major observations of Field Survey Unit (FSU) and Regional Evaluation Team (RET), Bhopal about the Evaluation work in districts of Narsinghpur of Madhya Pradesh State in the month of January, 2011.
I. Details of the visited Institutions: District Visited DH, CHCs and PHCs visited SCs visited Narsinghpur District Hospital: Narsinghpur Barman, Manegaon, Piparia CHCs: Kareli and Gotegaon Balodia,Nayakhera, Shrinagar, PHCs: Barman, Amgaon, Umaria, Themi and Bauchhar. Shrinagar and Karakvel
II. Major Findings 1. Human resources: a) 53 (83%) out of the 64 sanctioned posts of Specialist, 25 (37%) out of the 68 sanctioned posts of Medical Officer, 72 (45%) out of the 159 sanctioned posts of Staff Nurse, 5 (9%) out of the 23 sanctioned posts of Lab Technician and 13 (9%) out of the 144 sanctioned posts of MPW (Male) were lying vacant in the District. b) As against the requirement of posts under contractual category, all 2 posts of PGMO Anesthetics, 9 ( 90%) posts of Staff Nurses CEmOC and all 21 posts of Staff Nurse BEmOC and 68 (53 %) posts of ANMs were lying vacant in the district. c) It was also observed that 2 out of the 3 posts of Medical Specialist and 19 out of the 75 posts of Staff Nurse were lying vacant in district hospital Narsinghpur. 2. Rogi Kalyan Samiti (RKS) and Village Health & Sanitation Committee (VHSC): a) Rogi Kalyan Samitis (RKS) have been registered in 5 CHCs, 19 PHCs and District Hospital in the district. b) Funds to the tune of Rs. 1,00,000 to each of 19 PHCs were provided under RKS during the year 2009-10 and 2010-11. c) It was reported that the expenditure incurred during last year was to the tune of Rs. 10,53,730 and Rs. 4,31,158 for current year ( upto November, 2010 ) in the district at PHCs level RKS.
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d) It was observed that 5 PHCs did not spend any funds during last year. Similarly the PHCs Khurpa, Singhpur Bada, Dhamna, Malah Piparia, Karakvel, Shrinagar, Bohani, Bhama and Shshpur did not spend RKS funds in the current year. e) The VHSCs were constituted in all 1040 villages and all the VHSCs were having ASHAs as a member. All the VHSCs have opened their bank accounts. 3. Services of Janani Suraksha Yojana (JSY): a) 23,518 deliveries in the year 2009-10 and 19,063 deliveries in 2010-11(up to Dec., 2010) were conducted in the district. The district had spent Rs. 2,39,38,158 for providing incentive to 14022 JSY beneficiaries against the provision of Rs. 310 Lakhs in the year 2009- 10 and Rs. 1,95,90,864 have been spent in the year 2010- 11 for 11207 JSY beneficiaries out of Rs. 353.63 Lakhs available during the year. b) There was sufficient fund available under JSY head in the visited district hospital. Fund for JSY was received to the tune of Rs. 77,60,630 in 2009 - 10 and Rs. 65,77,683 in 2010 - 11 and expenditure to the tune of Rs. 71,88,077 in 2009-10 and Rs. 58,75,436 in 2010 - 11 (up to Dec., 2010) was incurred under JSY. c) The team visited CHCs at Kareli and Gotegaon . CHC kareli received JSY fund to the tune of Rs. 32,00,000 in 2009 -10 and Rs. 30,00,000 in 2010 -11 and an expenditure to the tune of Rs. 34,26,507 in 2009 - 10 and Rs. 24,84,448 in 2010 - 11 (up to Dec., 2010) was incurred . CHC Gotegaon received Rs.35,00,000 in 2009 - 10 and Rs. 31,00,000 in 2010 - 11. An expenditure of Rs. 738,91,380 in 2009 - 10 and Rs. 30,02,850 was made respectively, in 2010-11 (up to December, 2010) under JSY. Excess amount of Rs.2,26,507 and Rs. 3,91,380 in both the CHCs were paid from the Mission Flexi Pool funds during the year 2009-10. d) The JSY fund were received in time in all the visited 04 PHCs and the payment were made timely to all the beneficiaries. Proper registers were being maintained containing list of beneficiaries alongwith other related details at most of the visited institutions. e) 70 JSY beneficiaries were selected and 50 (71%) contacted in the field. All the beneficiaries were satisfied with the services. About 34% of them were accompanied by ASHA / Dai for going to the hospital for delivery. All beneficiaries were received cheques within three days after delivery. Only 18% beneficiaries used Janani Express to go to hospital and 82% beneficiaries arranged self transport and all of them got money for transport. All beneficiaries got three Ante natal checkups through ASHA and ANM. 64% beneficiaries got three post natal checkups through ASHA and ANM. 4. Services of ASHA Scheme:
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a) DPMU reported that there were 1040 ASHAs in position as against the requirement of 1075 ASHAs in the district. All 1040 ASHAs were trained and provided with drug kits. b) In all 08 visited Sub Centres ASHAs were working properly. They were accompanying pregnant women for delivery purpose, immunization, assisting in ANC / PNC. ASHAs were also motivating the cases for Sterilization operations. 5. 24 X 7 hours Delivery Care System: a) 17 (3CEmONC & 14 BEmONC) institutions were providing 24 X 7 hours delivery care services in the district. Specialists were not posted in any of the visited PHCs. No Staff Nurse was posted in PHC Barman and PHC Shrinagar. b) In the visited PHCs it at Shrinagar and Karavel number of deliveries were observed to be less than the expected figure of 10 deliveries per month. c) There was no blood storage facility in the visited centres.
6. Untied funds: a) Untied fund was provided to each CHC @ Rs. 50,000, each PHC @ Rs. 25,000 and each Sub Centre @ Rs 10,000 every year. b) At CHC level in the district the expenditure incurred during the year 2009-10 was Rs. 2,79,801 and for the current year Rs. 1,26,105 were spent till the date of visit. c) All 19 PHCs were provided total funds of Rs. 4,75,000 and an amount of Rs. 3,87,066 was spent during 2009-10. Similarly an amount of Rs. 4,75,000 was allotted during 2010-11 but 8 PHCs did not report any expenditure. Only an expenditure of Rs. 1,19,649 was recorded in the remaining PHCs till the visit of the team. d) All 144 Sub Centres were provided untied fund @ Rs. 10,000 each for the year 2009-10 & 2010-11. All these Sub Centres fully utilized the fund during last year and for the current year the UCs of untied fund not submitted till the date of visit. 7. Physical Infrastructure and Stock Position: i) CHCs: a) CHCs Kareli and Gotegaon were functioning in Govt. buildings and their premises were found neat and clean. 30 beds each were available in the visited CHCs. b) Water facility and Electricity were available in both the visited CHCs. c) Blood storage unit and Incinerator facilities were not available in both the visited CHCs. d) Though the Infrastructures was not as per IPHS in these CHCs most of the required equipments, drugs and other facilities were available there. ii) PHCs: 72
a) PHCs visited at Barman, Amgaon, Shrinagar and Karakvel were functioning in Govt. buildings. 06 beds were sanctioned for each PHC but at present only 02 beds at Amgaon, 06 beds at Barmana, 04 beds at Shrinagar and 02 at Karakvel were available in visited PHCs. b) Electricity, Toilet & water facilities were available at all PHCs but supply of electricity was found irregular. c) Telephone and Ambulance / Jeep facilities were available in all the visited PHCs except at PHC Shrinagar. d) The daily temperature Chart was maintained properly in all the visited PHCs except at PHC Barman. e) The Microscope was not available at PHC Barman and post of Lab Technician was lying vacant in all the visited PHCs. f) Resuscitation equipment available only at Barman PAC and Functional OT with OT Table was not available at PHC Amgaon & Shrinagar. g) Vital, essential, desirable drugs were not available at Amgaon PHC. The Stock of OP, CC were not available at Shrinagar PHC and IUD was not available at Karakvel PHC. Stock of vaccines (BCG, DPT, OPV, Measles, DT and TT) were available PHC Karakvel only. Prophylactic drugs ( IFA, Vitamin A etc.) were available at Karakvel PHC only. h) AYUSH Medical Officers were not available in any of the visited PHCs. iii) Sub-Centres: a) All the visited 08 Sub Centres were functioning in Government building. ANMs of 3 of the 8 visited Sub Centres were residing in Sub Centre villages. SC buildings were not as per IPHS standards except SC & Barman & Baochhar. b) MPW (M) was not posted at SCs Umarin, Themi and Baochhar. c) Regular Source of water was not available at Piparia Balodia, Manega, Umaria & Themi SCs. Electricity Connection was available in all the visited SCs except Barman & Themi SCs. d) Labour rooms were available only in 2 Sub Centres at Barman and Baochhar but deliveries were not being conducted in these Sub Centres. e) Examination table was not available at Shrinagar, Umaria and Baochhar SCs. Delivery table was available only at Barman, Shrinagar and Themi SCs. McIntosh Sheet was available at SCs Shrinagar and Themi. Ambu bag / suction was not available in all the visited SCs except SCs Themi & Bauchhar. Steam sterilizer was available in all the visited SCs except Umaria SC. Delivery kit was not available at Umaria SC. RDT kit for Malaria was not available at Barman and Manegaon SCs. Hemoglobin meter was not available at Umaria, Themi and Bauchhar SCs. 73
f) Co-trimoxazole tablet and Vitamin A solution were not available at Shrinagar, Umaria, Themi and Bauchhar SCs. Tab Meronidazole was not available in all the visited SCs except Manegaon and Themi SCs. IFA Tab / Syrup was available at almost all the SCs except Manegaon SC. Sanitary Napkins, Tablet Oxytocin, Injection Gentamycin, Cap Ampicillin were not available at any of the visited SCs. Tab paracetamol was not available at Piparia Balodia and Barman SCs. Emergency Contraceptive Pills were not available in all the visited SCs except Shrinagar and Umaria SCs. Condoms and Oral Pills were available only at Piparia Balodia, Nayakhera and Barman SCs. 8) Community Satisfaction & Opinion on Health Services: a) 54 mothers having child upto one-year of age were interviewed for assessing the services being rendered by the ANM working in the visited Sub Centre in the district. b) 27 (50 %) mothers were visited for ANC, PNC, nutritional & immunization etc. c) 37 (69%) mothers received three post natal check ups. 11 (20%) mothers knew the danger sign of ARI. d) 45 (83%) mothers were aware about the use of ORS during diarrhaea and 50 (93%) mothers knew the schedule of child immunization. 51 (94%) mothers were aware of contraceptive methods. e) 53 (98%) mothers were aware of the government health facilities where they can get all health facilities. f) Performance of Health worker (M) of SCs Piparia Balodia, Nayakhera, Barman, Manegaon and Shrinagar were assessed for 2009-10 and 2010-11. After having elaborate discussions with teachers, Sarpanch, CC users, ASHA and villagers of visited sub centres it was observed that they were satisfied with their assigned work. Posts of MPW were lying vacant in visited Sub Centres at Umaria, Themi and Bauchhar. g) During the course of visit to PHC Amgaon, Baman, Shrinagar and Karkvel it was observed that the community was satisfied with the services of staff of PHCs. Medical officer and most of the other staff of Sub Centres Shrinagar and Karkvel PHC were not residing at their head quarters. 9) Sample verification of FW acceptors: a) Out of 258 FW acceptors selected, 188 (73%) cases could be contacted for Sample verification in the district. Minor discrepancy in the recorded age of acceptors, spouse and total /male children was found during sample check. Age of last child in 34 (18%) acceptors were not correctly recorded. b) No follow up services provided to the 34 (25%) cases.
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c) 50 ( 36.5%) acceptors out of 137 acceptors of spacing methods contacted were found to be fake. 10. Maintenance of registers: Printed registers for eligible couple were available in all the visited SCs except Barman, Manegaon and Umaria SCs. a) Service registers for IUD, OP and Nirodh users were not printed and maintained properly in most of the visited Sub Centres. b) MCH service registers were mostly updated. c) Printed stock register was not available at Nayakhera, Manegaon, Themi and Bauchhar SCs. d) Cash book for Untied Funds was available at all the visited sub centres except Bauchhar and Themi SCs and it was not made available at Themi SC. e) JSY register was not maintained in all the visited SCs except Barman SC.
11. Other observations:- a) Lack of supervision was noticed at all levels which should be strengthened b) Counseling facility on HIV/AIDS was not available in visited CHCs Kareli and Gotegaon.
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