Mizoram 1.District- Serchhip Major Observations of Regional Evaluation Team, Kolkata About the Evaluation Work Carried out in Se
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Mizoram 1.District- Serchhip Major observations of Regional Evaluation Team, Kolkata about the Evaluation work carried out in Serchhip district of Mizoram during the month of September, 2011 I. Details of the visited Institutions: District visited DH., CHC and PHC visited SCs visited Serchhip DH.: Serchhip Serchhip, New Serchhip, CHC: Thenzawl Thenzawl and Chhingchhip PHC: Chhingchhip II. Major Observations: 1. Health Human Resources: a. No sanctioned strength of the staff was available at district office. At district headquarter no one was aware about the sanctioned strength of staff in the district. There were 3 Specialists, 9 Medical Officers, 28 Grade- A Nurse/ Staff Nurses, 19 ANMs, 17 MPWs (M), 5 MPS (F), 9 MPS (M), 1 Lab Technician and 6 Pharmacists in position in the district as a whole. b. 7 Medical officers, 6 Grade- A Nurse/ Staff Nurses, 23 ANMs, 8 MPWs (M), 15 Lab Technicians, 1 Pharmacists, 2 District Account Manager, one District Programme Manager and one District Data Manager were appointed on contract basis in the district. c. Information on sanctioned strength of the staff was also not available at visited institutions. 3 Specialists, 2 MOs and 27 Grade- A Nurse/Staff Nurses, 1 each of Lab Technician and Pharmacist were posted at District Hospital Serchhip. Only 1 MO and 8 Grade- A Nurse/Staff Nurse were available in CHC Thenzawl. d. Similarly, 1 Medical Officer, 3 Grade- A Nurse/ Staff Nurses, 8 ANMs, 4 MPWs (M), 1 MPS (F) and 1 Pharmacist were found in position in PHC Chhingchhip. 2. Functioning of Rogi Kalyan Samiti (RKS): The team observed that RKS have been constituted and registered in the visited DH, CHCs & PHCs in the district, but the meetings of RKS were not being held regularly on monthly basis. 3. Functioning of ASHA Scheme and Village Health Sanitation & Nutrition Committee (VHSNCs): a. As targeted, 54 ASHAs were selected for 40 villages of the district. All ASHAs have been trained up to 5th modules and provided with Drug kits. b. As reported, 40 VHSNCs have been constituted in the district and ASHA was working as a member in the VHSNCs. The team observed that meetings of VHSNCs were being conducted regularly in the Centres visited. c. VHSNC untied funds to the tune of Rs. 6,66,951 including opening balance of Rs. 2,66,951 were available during the year 2010-11 in the district and out of that, an amount of Rs. 3,44,993 was utilized by the VHSNCs in the year. Similarly, an amount of Rs. 1,58,578 was utilized by VHSNCs in the district against the available amount of Rs. 7,21,858 during current year (up to August, 2011). 4. Services of Janani Suraksha Yojana (JSY): a. During the year 2010-11, district spent funds to the tune of Rs. 9,29,200 out of allotted funds of Rs. 11,52,200 under the scheme. Similarly, an amount of Rs. 3,63,100 was utilised against the available amount of Rs. 8,23,000 during current year up to August, 2011. b. It was reported that 632 and 254 deliveries were identified for JSY payment under the scheme in the year 2010-11 and 2011-12, out of that 630 and 250 JSY beneficiaries were paid cash incentive under the scheme during last year and current year respectively. c. The budget provision and expenditure at the visited DH/CHC/PHC as reported is given below: Sr. Particulars For the year 2010-11 ( in Rs) No. DH Serchhip CHC Thenzawl PHC Chhingchhip 1 Total fund available 3,44,900 1,28,694 1,09,600 2 Total expenditure under JSY 3,43,700 1,21,300 1,01,900 3 Balance amount 1,200 7,294 7,700 4 No. of JSY mothers paid 350 66 66 incentive For the year 2011-12 ( in Rs) 1 Total fund available 1,52,100 62,320 37,700 2 Total expenditure under JSY 1,47,300 33,900 36,900 3 Balance amount 4,800 28,420 800 4 No. of JSY mothers paid 147 19 21 incentive d. 30 JSY beneficiaries were contacted for on the spot verification in the district and it was observed that MCH cards were issued to all of them. ASHAs involvement was satisfactory. Beneficiaries were paid incentive amount on date of discharge from the hospital. There was no provision for payment of transport money to the beneficiaries. e. Printed JSY registers were maintained properly with all details and checked by the concerned Medical Officer regularly. 5. Untied Fund: a. There is one CHC, 5 PHCs and 26 Sub Centres in the district. Though detail of the untied funds for CHC and PHCs were made available for the year 2010-11 and 2011- 12, an information Sub Centre level untied fund was not made available in the district. The details are as below: (In Rs.) For the year 2010-11 Sr. Particulars Opening Fund received Expenditure Balance No. Balance during the year 1 For CHCs 28,684 51,310 30,677 49,317 2 For PHCs 52,216 1,25,000 1,28,792 48,424 3 For Sub Centres Not made available For the year 2011-12 1 For CHCs 49,317 50,888 31,562 68,643 2 For PHCs 48,424 62,500 48,775 62,149 3 For Sub Centres Not made available b. The team observed that untied funds for CHC and VHSNCs were released in time but these were not provided timely to the SCs and PHCs in the district. c. Status of Untied Fund in the visited CHC, PHC and Sub Centres in the year 2010-11 & 2011-12 is as below: (in Rs) For the year 2010-11 Name of Institutions Opening Released Expenditure Balance Balance CHC Tenzawl 28,684 51,310 30,677 49,317 PHC Chhingchhip 12,760 25,000 30,525 7,235 SC: Chhingchhip 2,104 10,000 8,459 3,645 SC: New Serchhip 10,031 10,000 10,031 10,000 SC: Serchhip 4,565 10,000 7,705 6,860 SC: Tenzawl 5,513 10,278 9,716 6,075 For the year 2011-12 CHC Tenzawl 47,137 50,888 31,562 68,643 PHC Chhingchhip 7,235 12,500 7,055 12,680 SC: Chhingchhip 3,645 5,000 5,670 2,975 SC: New Serchhip 10,000 Nil 5,390 4,610 SC: Serchhip 6,860 Nil 674 6,106 SC: Tenzawl 6,075 10,112 2,372 13,815 d. There was no proper monitoring in the Centres. The district releases the fund without taking into account the opening balance. Though there was sufficient opening balance with some of the centres, still they were provided with amount entitled for untied fund or more than the entitled amount and that too could not be spent at the end of year. The team also observed that cash books of untied funds were not maintained properly at Sub Centre level. These registers were never checked by concerned Block Accountant/ Medical officer I/c of the institutions. 6. 24 Hours Delivery Care Services: a. 24 hours delivery care services are provided through District Hospital, CHC and 5 PHCs in the district. District Hospital Serchhip conducted 405 and 199 deliveries in the year 2010-11 and 2011-12 respectively and PHC Chhingchhip conducted 73 and 16 deliveries in the year 2010-11 and 2011-12 respectively. b. C- Section delivery and Blood storage facilities are only available at District Hospital. Though facility for caring mothers and new born baby were inadequate, availability of Doctors and Staff Nurse etc. was adequate in view of the deliveries being conducted in the visited institution. 7. Physical infrastructure (HSC/CHC/PHC) (i) Health Sub Centres: a. Labour room facility was not available in the visited Sub Centres at Serchhip, New Serchhip and Chhingchhip. b. ORS Packets, Sanitary Napkins, Condoms, Chlorine Solution/ Bleaching Powder, Oxitocine tablets, Ampicillin capsule and Gentamycin Injection were not available in the visited Sub Centres. c. Delivery Table and Mclntosh sheet in Sub Centres at Chhingchhip and New Serchhip, Paracetamol & Metronidazole tablets in Sub Centres at New Serchhip and Thenzawl were found not available. d. Delivery kits, RDT Kits, BP apparatus and DDKs at Sub Centre New Serchhip, DDKs at Sub Centre Serchhip and Heamoglobinometer at Sub Centre Thenzawl were not available. e. Skilled Birth Attendance training was not provided to the Auxiliary Nurse Midwives of the visited Sub centres. (ii) DH /CHC/ PHC: a. In the District Hospital, Sick New Born Care Unit was not available and Baby Warmer was not working since 2 months. Though Anesthesia equipment was available but Anesthetist was not posted. b. CHC Thenzawl and PHC at Chhingchhip were not as per IPHS. CHC Thenzawl was not functional as a CHC, as specialty services were not available. c. Jeep and Anesthesia equipment were not available in CHC Thenzawl. d. Residential accommodations for Para-Medical staff were inadequate at District Hospital Serchhip and CHC Thenzawl. e. Labour room table and CuT Insertion Kit were not available, Operation Theatre was not functional due to want of equipments in PHC Chhingchhip. f. No supply of Oral Pills & Nirodh was observed since 3 months and AYUSH Medical Officer was not posted in PHC Chhingchhip. 8. Opinion and awareness of the Community on the Health Services: (i). ANMs and MPWs Services: a. 20 mothers were interviewed for assessing their opinion and knowledge about the services provided by the concerned ANMs at visited Sub Centres at New Serchhip and Serchhip. b. Contacted mothers were dissatisfied on early discharge from the hospital and poor Post Natal services.