Chattisgarh

1. District:- The Regional Evaluation Team, located at Regional Office for Health and Family Welfare (), Ministry of Health and Family Welfare, Government of carried out sample checks of activities covered under NRHM / RCH in of during May, 2011. The findings / observations of the team which are based on the sample checks are detailed below:

I. Details of the visited Institutions: District CHCs/PHCs visited HSCs visited Mahasamund CHC: & Basana. Pandaripani, Narra, Bindrawan, PHC: Kallari, Komakhan & Baroli Khuteri, Khallari, Badetemari, Singh- anpur, Garhphuljgar & Bade-dhaba.

II. Major Observations: 1. Human Resources: Staff position in the key posts was not satisfactory in the district. In this connection status of human resources at various level as reported is given below: a) Particulars of Post Post sanctioned In position Vacant Specialist 28 11 17

MO 86 49 37 Staff Nurse 34 18 16 Lab Technician 34 8 26 LHTV 44 19 25 MPS 40 17 23 ANMs 251 222 29 MPW(M) 223 113 110

b) In District Hospital, 2 sanctioned posts of Surgical Specialist and Anaesthetist were vacant. 10 out of 22 sanctioned posts of Casualty Doctors/GDM, 14 out of 22 sanctioned post of Staff Nurse and post of Radiographer and Pharmacist were also lying vacant. c) At visited CHCs Baghbara and , posts of Surgeon, Gynaecologist, paediatrician, BMO & Anaesthesia (PGMO) were lying vacant. Posts of Medical Specialist was vacant in CHC Bagbahara. d) In PHC Baroli, post of Lab. Tech., Ophthalmic Asstt. and one of the 2 sanctioned posts of Medical Officer were lying vacant. Likewise, the post of Lab. Technician and Ophthalmic Asstt were vacant in the Khallari PHC. 2. Rogi Kalyan Samiti (RKS) and Village Health Sanitation and Nutrition Committee (VHSNC): a) Rogi Kalyan Samiti, known as Jeewan Deep Samitis (JDS) in the State are reported to be constituted at the DH / CHCs / PHCs in the district. 32 Jeewan Deep Samitis (JDS) have been registered in 4 CHCs, 27 PHCs and District Hospital in the district. b) As reported, funds to the tune of @ Rs. 5, 00,000 to DH and @ Rs. 1, 00,000 to each CHC & PHC were provided as JDS fund in the district in the year 2010-11. c) It was observed that unspent balances were not taken into account while allocating funds and proper monitoring was not being made for utilisation of funds. Though huge amount of unspent balance was lying with 26 JDS at DH, CHCs and PHCs as on 1-4- 2010, full eligible amount was provided to every JDS during 2010-11. 29 JDS did not spend most of the amount during the year. 20 JDS were having balance in between Rs. 1,00,000 to 2,00,000, 4 JDS more than Rs. 2,00,000, 2 JDS more than Rs. 3,00,000 and JDS at DH has an unspent balance of Rs. 5,00,000 at the end of the year. It was also reported that 7 PHCs did not incur any expenditure during the period. The State/District authority should take urgent step to improve the situation. d) 1078 VHSNCs were functioning in 1142 villages with ASHA as a member in the district. Block Basana is the only block in the district in which all 226 villages were having VHSNCs. All VHSNCs had opened their bank account for handling the funds. 3. 24 x7 Hours Delivery Care System: a) It was reported that 11 PHCs have been identified for providing 24 x7 hours delivery care service in the district, but all of them were non functional. b) During visit, it was observed that PHCs at Khalari, Komakhan and Baroli are providing the 24 x 7 hours services but there was no new born care facility available at PHC Komakhan. PHC Baroli provides this service on call. 4. Janani Suraksha Yojana (JSY): a) The district had spent funds to the tune of Rs.1,85,50,900 out of funds of Rs. 2,95,54,083 provided in the year 2009-10 under JSY head. Similarly, an amount of Rs. 2,05,68,763 was spent out of total allotted funds of Rs. 3,35,94,183 during 2010-11. b) JSY status in the district and visited CHCs as reported is as under:

(Amount in Rs.) District as a whole CHCs Particulars Bagbahara Basana 2009-10 2010-11 2009-10 2010-11 2009-10 2010-11 Total no. of Institutional 11411 13401 520 566 430 330 deliveries conducted Total no. of delivery 10095 12109 520 566 430 330 eligible for JSY Total no. of beneficiaries 10095 11919 520 566 430 330 to whom incentive was paid Total fund received for 29554083 33594183 33,00,000 42,00,000 JSY Information not available Expenditure incurred 1,85,50,90020568763 24,50,500 37,75,200 Under JSY

d) JSY status in the visited PHCs is given below: (Amount in Rs.) PHCs Particulars Khallari Komakhan Baroli 2009-10 2010-11 2011-12 2009-10 2010-11 2011-12 2010-11 2011-12 April’11 April’11 April’11 Total no. of Institutional 35 61 7 206 207 11 209 16 deliveries conducted Total no. of beneficiaries to35 61 6 206 207 11 206 15 whom incentive was paid Total fund received for NA 1,55,000 30,000 8,60,000 9,84,000 JSY Information not available Expenditure incurred underNA 1,04,900 9,650 8,03,500 9,35,502 JSY c) In the visited Sub Centres, ANMs receive advance cash in respect of JSY mothers from their respective PHCs and distribute same to the eligible JSY beneficiaries in their areas. d) Total 45 (90%) beneficiaries were contacted out of 50 selected for sample verification. All beneficiaries were satisfied with the services. 42 (93%) JSY beneficiaries were accompanied by ASHA/Dai for delivery. 42 (93%) beneficiaries got three Ante natal checkups (ANC) and 30 (66.7%) beneficiaries got three Post natal checkups (PNC). 5. Implementation of ASHA Scheme: a) As reported, 2007 ASHAs were working in total 1142 villages in the district. All 2007 ASHAs were trained in 5th module and also having drug kits in the district. b) During visit to the CHCs and Sub Centres, it was observed that every village was having 1 to 3 ASHAs in their areas and all were in position. ASHAs were accompanying the mothers for delivery purpose, helping ANMs during immunization sessions, assisting in ANC/PNC and also motivating the eligible couple for sterilization operations. c) The following observations in respect of ASHAs reported by the team:  In SC Narra, ASHA was not working and most of the time not residing in village.  In SC Khuteri, Smt. Sarojbai, ASHA of Dumarpada village was not working at all and also not interested to work. Smt. Manabai, ASHA of Dumarpada was not residing in Dumarpada village. Most of the time she is residing at Mahasamund which is away from Dumarpada. It is found that she is not working but forcefully taking motivation amount. Smt. Triveni, ASHA of Ghuchpali village was not working.  In SC Khallari, Smt. Yadbai, ASHA of Kanharpuri went for Bricks Bhatta work since 6-7 months. Smt. Kejabai, ASHA of Kanharpuri village is 67 years old and found not working. Smt. Devika Thakur, ASHA of Khallari village was not working because she engages herself in other work. 6. Untied funds: a) There was no proper planning observed to utilise the fund under this head at different institutions in the district. Situation was similar, as in the case of utilization of JDS funds in the district. It was reported that there was huge unspent balance as on 1/04/2010 due to non utilisation of untied funds at CHCs, PHCs and Sub Centres level in the year 2009-10. All 4 CHCs were having balance of the amount in between Rs. 30,000 and 55,000, all 27 PHCs in between Rs. 22,000 and 45,000 and visited 9 Sub Centres in between Rs. 18,000 and Rs. 35,000 as on 1/04/2010. b) Though the district authority did not provide untied funds to the CHCs, PHCs and Sub Centres during the year 2010-11 as sufficient unspent (previous) balance was there at almost all the institutions, but there was no proper planning to utilise the amount during the year 2010-11. It was observed that CHC, had balance of Rs. 44, 000, 10 PHCs had balance in the range of Rs. 15,000 to Rs. 40,000 and visited 6 Sub Centres had balances between Rs. 24,000 to Rs. 27,000 as on 1/4/2011. It is notable that there are 3 PHCs with 0 (zero) balance whereas another 3 PHCs had not utilised any amount during the year against the amount of previous balance shown as on 1/4/2010. Similarly, Sub Centre Badetemari had also not utilised any amount during the year 2010-11 from the previous unspent balance of Rs. 27,868 available as on 1/4/2010. The State/District authority may take urgent step to improve and monitor the situation in this regard regularly. c) No untied funds have been released to the CHCs, PHCs and Sub Centres in the district for the year 2011-12 till the month of visit. 7. Physical infrastructure: i) CHCs: a) Both visited CHCs Basana and Bagbahara were functioning in govt. buildings having 30 beds each. The premises of CHCs were found clean and tidy. Water supply and electricity with power back-up were available at both visited CHCs. b) Anaesthesia equipment, Resuscitation equipment and neonatal Resuscitation equipment were not available at Basana CHC. Incinerator was not available at both CHCs. c) Blood Storage Unit was not available at Basana CHC but the same was available in non functional condition at Bagbahara CHC. The Sick New Born Care Unit was not available at Bagbahara CHC, only one warmer was available there. Arteether injection was not available at both CHC whereas Quinine injection was not available at Bagbahara CHC. ii) PHCs: a) Visited PHCs at Khallari, Komakhan and Baroli were functioning in Government building. Water supply and Electricity connection was available in the PHCs. Power backup was not available at Khallari PHC. Telephone facilities were available only at Baroli PHC but that also was out of working condition. Ambulance/Jeep was not available in all the visited PHCs. b) Cold Chain equipment, Microscope and Resuscitation equipment was not available at Baroli PHC. Autoclave/Steam Sterilizer was not available at Khallari PHC. Oxygen Cylinder was not available at Khallari and Baroli PHCs. Operation Theatre was not functional at Khallari and Komakhan PHCs. c) The Stock of Contraceptives (IUD, OP and Nirodh) was not available in Khallari and Komakhan PHCs. The stocks of vaccines (BCG, DPT, OPV, Measles, DT, and TT) were not available at Khallari and Baroli PHCs; The Prophylactic drugs-IFA tab large were not available in all the visited PHCs; IFA small and IFA syrup was not available at Komakhan and Baroli PHCs, Vitamin A Tab and Vitamin A syrup were not available in Khallari and Baroli PHCs. d) Medical Officer (AYUSH) was not posted in any of the visited PHCs. e) Residential quarters for Medical officers were not available at Komakhan PHCs. iii) Sub Centres: a) All the visited Sub Centres were functioning in Govt. buildings. ANMs of all visited Sub Centres except Badetemari HSC were residing either in Sub Centre building or in the Sub Centre villages. Mobile was not provided to any ANM of the visited Sub Centres. b) Additional ANM were available only at Bindrawan, Badedhaba and Khuteri Sub Centres whereas MPW (M) was available at the visited Sub Centres except Pandripani and Singanpur Sub Centre. c) Water supply facility was not available at Badetemari, Badedhaba and Khuteri SCs. Electricity connection was available in all the visited Sub Centres. Labour rooms were available and deliveries were conducted in all visited Sub Centres except Badetemari SC. d) Examination table was not available at Bindrawan, Badetemari, Badedhaba and Khallari SCs. McIntosh sheet was not available at Pandripani and Singhanpur SCs. Ambubag /suction was available in all the visited Sub Centres except Singhanpur and Khuteri SCs. Nishchay Pregnancy Test Kit was not available at all visited Sub Centres except Khallari SC. Delivery kit was not available at Bindrawan, Badetemari Badedhaba and Khallari Sub Centre. IUD Insertion Kit was not available at Badedhaba HSC. Rapid Diagnosis Test kit for Malaria was not available at all the visited HSCs. Torch was not available in Badetemari, Khuteri and Khallari SCs. Hemoglobinmeter was not available at Badetemari and Singhanpur HSC. e) Gloves were not available at most of the visited Sub Centres, it was available only at Singhanpur and Badedhaba Sub Centres. DDKs, Kerosene Oil, Sanitary Napkins, Emergency Contraceptive Pills, Tab. Oxytocin, Cap Ampicillin (except Bindrawan HSC), Inj. Gentamicin and Kits A & B for the year 2011-12 were not available in all the visited Sub Centres. Tab Co-trimoxazole was not available at Pandripani HSC. IFA tab / syrup was available only at HSCs Pandripani and Badedhaba. Oral Pills were not available at Badetemari, Singhanpur, Khuteri and Khallari SCs. Condoms was not available at Bindrawan, Badetemari, Singhanpur, Badedhaba, Khallari and Garhphuljhar HSC. Antiseptic Solution was available only at Narra, Singhanpur and Badedhaba HSC. Chlorine solution was not available at Narra, Badetemari and Khallari HSCs. Tab Metronidazole was not available at Pandripani, Narra and Bindrawan HSCs. f) Printed register for family planning service was not available at the visited Sub Centres. Stock register was not available at Narra, Badedhaba, Khallari and Garhphuljhar HSCs. Printed cash book of untied fund was available only at Badedhaba HSC. g) The posters for public awareness were not displayed at the Sub Centres Pandripani, Narra, Khuteri, Khallari and Garhphuljhar HSCs. h) SBA training was not received by the ANMs of Narra, Bindrawan, Badetemari, Singhanpur, Badedhaba and Garhphuljhar HSC. i) ANMs of all 9 visited Sub Centres did not receive the training of Integrated Management of Neonatal and child infection (IMNCI). 8. Opinion and Knowledge of Community on Health Services: a) As many as 57 mothers having child up to one year old were interviewed in the area of the visited Sub Centres for assessing the work of ANM and Knowledge & Opinion of mothers. b) 35 (61.4%) mothers informed that ANM is available when needed. 55 (96.5%) mothers were counselled for exclusive breast feeding and complementary feeds. 26 (45.6%) mothers received three post natal checkups. 30 (52.6%) mothers knew the danger sign of ARI. 44 (77.2%) mothers knew the use of ORS packets during diarrhoea. 35 (61.4%) mothers were aware of contraceptive methods. c) Out of 9 visited Sub Centres, MPW (M) was posted in 7 Sub Centres. After having elaborate discussions with teacher, sarpanch, CC users, ASHA and villagers, it was learnt that most of the male workers do not take rounds to the villages for field work regularly, but behaviour of most of them towards the villagers was good. All workers attended the health clinic/immunization/VHNDS session and all were available when health programmes were organized in the villages. d) During the course of visit to PHC Khallari, Komakhan and Baroli, it was observed that the community was satisfied with the services received from staff and Medical Officers of the PHCs. Some of the villagers confirmed the availability of MO at HQ. 9. Sample Verification of F.W. Beneficiaries: a) 232 Family Welfare beneficiaries were selected in the visited Centres for sample verification and out of them 173 (74.6%) could be contacted in the district. Minor discrepancies were found in the age of children, age of spouse, no. of Male/female children and age of youngest child were not recorded. b) 32 (23.4%) beneficiaries of FW acceptors did not receive follow up services. c) Out of contacted 126 spacing methods acceptors, 36 (28.6%) acceptors were found to be false in the district. d) All 129 contacted beneficiaries of child immunization confirmed receiving the vaccination and there was no complications after receiving the services; however follow up services were provided only to 72 (55.81%) beneficiaries. 10. IT Infrastructure & MCH Tracking: a) Computers were available at the district headquarters, CHCs and 10 out of 28 PHCs in the district. b) Internet connectivity was provided to the systems available in the district and at all CHCs but the same is not available at PHC level. c) It was reported that in the visited CHCs Bagbahara and Basana, all Sub Centres were having MCH Tracking formats. Data Entry was in progress at CHC/PHC level and online data entry of MCH tracking formats in the district was up-to-date till the visiting month. 11. Maintenance of Records and Registers: a) Service Register for IUD was not maintained in both the visited CHCs at Baghbahara & Basana. PNC registers was not maintained in CHC Baghbahara. b) OP and CC registers were not maintained properly in Baghbahara CHC. c) Printed registers for eligible couple were not available at Badetemri Sub Centre whereas this register was not updated in Badedhaba Sub Centre. d) IUD register for the year 2008-09, OP register for the year 2008-10 and CC register for the year 2008 to 2011 were not maintained at Pandripani HSC. OP register for the year 2010-11 was not maintained at Khutheri HSC. Name of the users except other details were given in OP registers at Singhanpur HSC. Some of the visited HSCs, OP & CC registers were maintained but some information like age of spouse, age of last child and no. of male/female child was not mentioned in the service registers. e) ANC, PNC and Immunisation service register were maintained in all the visited Sub Centres. f) JSY register was maintained properly in all visited Sub-Centres except Badetemri HSC where information was recorded in delivery register. g) Cash book for untied funds was not maintained properly at Bindrawan HSC.

2. District:- Sarguja (Ambikapur) The Regional Evaluation Team, located at Regional Office for Health and Family Welfare (Bhopal), Ministry of Health and Family Welfare, Government of India carried out sample checks of activities covered under NRHM / RCH in Surguja( Ambikapur) district of Chhattisgarh during May, 2011. The findings / observations of the team which are based on the sample checks are detailed below:

I. Details of the visited Institutions: District CHCs/PHCs visited HSCs visited Surguja CHC: Sitapur, Rajpur, Pratappur & Soor, Guturma, Ulakiya, Narsinghpur, ( Ambikapur) Balrampur. Okara, BoodhaBagicha, Badwar, PHC: Barion, Dharampur, Pratapgarh,Parsaguda, Ramkola, Mayapur & Guturma & Pasta. Kewara.

II. Major Observations: 1. Human Resources; a. The Staff position of the key posts in the district was reported as follow: Particulars of Post Post sanction In position Vacant

Specialist 97 9 88 M.O 225 73 152 Staff Nurse 57 52 05 Lab Technician 103 47 56 LHV 123 87 36 ANMs 696 640 56 MPW(M) 612 447 165

b) In the District Hospital, sanctioned post each of Orthopaedic and Dental Surgeon and 3 out of 4 sanctioned post of Lab Attendant were lying vacant. c) At CHC level, the sanctioned post of Block Medical Officer, Medical Specialist, Nursing Sister, BEE, 1 out of 4 Staff Nurse and 1 out of 2 Pharmacist grade -II cum Store Keeper were laying vacant at Sitapur CHC. Post of Block Medical Officer, BEE, MPW (M) and 1 out of 2 Assistant Surgeon grade -II were vacant at Rajpur CHC. Post of Block Medical Officer, Medical Specialist, Surgical Specialist, O B & G, Anaesthetist PGMO, Assistant Surgeon, Nursing Sister, BEE, Accountant / Assistant, MPS and Pharmacist grade -II cum Store Keeper were vacant at Pratappur CHC. Post of Medical Specialist, Surgical Specialist, OB & G, Anesthetist PGMO, BEE, MPS and MPW (M) were vacant at Balrampur CHC. d) At PHC level, the sanctioned posts of Medical Officer and LT were vacant at Barion PHC. Post of Medical Officer was vacant at Dharampur PHC. Post of Staff Nurse was vacant at Pratapgarh PHC and post of Staff Nurse was vacant at Guturma PHC. Post of Pharmacist was vacant in Pasta PHC. 2. Functioning of Rogi Kalyan Samiti (RKS) and Village Health Sanitation & Nutrition Committee (VHSNC): a) Rogi Kalyan Samiti, known as Jeewan Deep Samiti (JDS) in the State has reported to be constituted at the DH / CHCs / PHCs in the district. 96 Jeewan Deep Samitis (JDS) have been registered in 19 CHCs, 76 PHCs and District Hospital in the district. b) As per the details available from DPMU, CHCs visited at Sitapur, Balrampur, Pratappur and Rajpur have been provided @ Rs.1,00,000 each respectively as JDS funds. Similarly, PHCs visited at Barion, Dharampur, Pratapgarh, Guturma & Pasta were provided Rs.1,00,000 each for the year 2009-10 as JDS fund. No JDS fund for the year 2010-11 have been released to the PHCs till the visit of the team. c) Information on expenditure of JDS funds was not provided by the DPMU, BMO and concerned Medical Officer. d) As per the reports received from the district, 1758 villages out of total 1779 villages in the district were covered under the scheme and all 1758 VHSNCs were functioning with ASHA as a member in the district. All VHSNCs had opened their bank account for handling the funds. 3. 24 x 7 hours Delivery Care System: Total 39 institutions were providing 24 x 7 hours delivery care service in the district. Adequate facilities for caring mother and new born baby were available at CHC Rajpur and Sitapur. But these facilities were not available at CHC Balrampur, CHC Pratappur, PHC Bariyon and PHC Guturma. 4. Janani Suraksha Yojana (JSY): a) The district had spent funds to the tune of Rs. 3, 75, 93,050 out of funds of Rs. 6, 55, 21,145 provided in the year 2009-10 under JSY head. Similarly, an amount of Rs. 6, 75, 35,301 was spent out of total allotted funds of Rs. 4, 00, 00,000 during 2010-11. During the year 2009-10 and 2010-11, there were 27,366 and 39,756 JSY beneficiaries respectively. b) JSY status in the District Hospital is as under. (Amount in Rs.) Items 2009-10 2010-11

Total No. of Delivery 64,342 65,995

Total No. of inst. Delivery 22,776 33,697

Total No. of beneficiaries to whom 27,366 39,756 JSY money paid

Total JSY funds received 6,55,21,145 4,00,00,000

Expenditure incurred under 3,75,93,050 6,75,35,301 JSY

c) JSY status in the visited CHCs is reported as follow: (Amount in Rs.) Items CHC Sitapur CHC Rajpur CHC Balrampur

2009-10 2010-11 2009-10 2010-11 2009-10 2010-11

Total No. of Delivery 1298 1499 2737 2762 1724 2169

Total No. of inst. Delivery 1161 1368 1032 1637 796 1200

Total No. of beneficiaries to 1161 1368 1032 1369 796 1200 whom JSY money paid

Total JSY funds received 2836400 2676900 2617900 3122900 1952500 2834500

Expenditure incurred under 2247300 2642200 2446000 3037050 1592000 2400000 JSY

d) JSY status in the visited PHCs is reported as under: Items Name of the PHCs visited

Barion Dharampur Pratapgarh Guturma Pasta

2010-11 2011-12 2010-11 2011-12 2010-11 2011-12 2010-11 2011-12 2010-11 2011-12 Total No. of inst. 121 10 78 4 40 3 69 4 60 3 delivery

Total No. of 121 7 78 3 36 0 64 0 60 3 beneficiaries to whom JSY money paid

Financial details were not made available at the visited PHCs e) Total 21 (80.8%) beneficiaries were contacted out of 26 selected cases for JSY. All beneficiaries were satisfied with the services. All beneficiaries received T.T & IFA tablet during pregnancy. 19 (90.5%) beneficiaries were accompanied by ASHA / Dai. 15 (71.4%) beneficiaries got three Ante natal checkups (ANC) and 13 (61.9%) beneficiaries got three Post natal checkups (PNC). 5. Implementation of ASHA Scheme: a) As reported 8259 ASHAs were working in total 1779 villages in the district. All 8259 ASHAs were trained in 5th module and also having drug kits in the district. b) During visit to the CHCs and Sub Centres, it was observed that every village was having 2 or more ASHAs according to the population size and all were in position in their jurisdiction. ASHAs were accompanying the mothers for delivery purpose, helping ANMs during immunization, assisting in ANC/PNC and also motivating the eligible couples for sterilization operations. 6. Untied funds: a) There was no uniformity in providing untied funds to CHCs / PHCs in the district. During 2009-10 Rs. 50,000 was provided to CHCs Rajpur and Sitapur whereas Rs.1,00,000 to CHC Balrampur. PHCs under Rajpur and Sitapur CHCs were provided @ Rs. 25,000 but PHCs under Balrampur CHC were given @ Rs. 50,000. b) Most of all visited CHCs and PHCs except CHC Sitapur spent their whole fund during 2009-10. CHC Sitapur did not incur any expenditure during the year. c) Untied Fund for the years 2010-11 and 2011-12 was not provided to any CHC and PHC in the district till the visiting month. 7. Physical infrastructure: i) CHCs: a) All four visited CHCs (Sitapur, Pratappur, Rajpur and Balrampur) were functioning in govt. buildings with regular water supply and electricity with power back-up. Out of 30 sanctioned beds, 30, 10, 15 & 10 beds were available in good condition at Sitapur, Pratappur, Rajpur and Balrampur CHCs respectively. b) Blood Storage Unit and Anaesthesia equipment was not available at Pratappur and Balrampur CHCs. Neonatal Resuscitation equipment was not available at Pratappur CHC. The Sick New Born Care Unit was not available at Sitapur and Pratappur CHCs whereas only one warmer was available at Balrampur CHC. Arteether injection was not available at any of the visited CHCs. Quinine injection was not available at Balrampur CHC. Infrastructure and equipment was not as per IPHS standard in the CHCs. c) Posts of Specialist were vacant in Pratappur and Balrampur CHCs whereas out of 5 sanctioned posts 3 Specialists were posted at Sitapur CHC.

ii) PHCs: a) Visited PHCs Barion, Dharampur, Guturma and Pratapgarh were functioning in Government building but PHC Pasta was working in Panchayat building. Water supply was available at Barion and Dharampur PHCs but not at Pasta, Guturma and Pratapgarh PHCs. Power backup was not in working condition at Guturma and Pratapgarh PHCs. Telephone was not working at Guturma PHCs. Ambulance/Jeep was not available at all the visited PHCs. b) Cold Chain equipment was not available at Dharampur, Guturma and Pratapgarh PHCs. Weighing machine for Infant and Auto clave/Steam Sterilizer were not available at Guturma PHC. Microscope was not available at Barion PHC. Oxygen cylinder was not available at Guturma and Pratapgarh PHC. Resuscitation equipment was not available at Dharampur, Pasta and Guturma PHCs. Post of Lab Technician was laying vacant at Barion PHC. Functional Operation theatres were not available at all the visited PHCs except Barion PHC where Minor OT was available. c) The Stock of Contraceptives (IUD, OP and Nirodh) were not available in Pratapgarh PHC. The stocks of vaccines (BCG, DPT, OPV, Measles, DT and TT) were not available at Dharampur, Guturma and Pratapgarh PHCs. The Prophylactic drugs were available only at Barion and Pasta PHCs whereas only IFA tab (Large & Small) was available in Dharampur PHC and only IFA syrup was available in Guturma PHC d) Medical Officers (AYUSH) was not posted in Pratapgarh PHC. e) Residential quarters for Medical officers were not available at Dharampur and Guturma PHCs. iii) Sub Centres: a) Visited Sub Centres Soor, Guturma, Narsinghpur, Bodha Bagicha, Badwar, Parsaguda, and Kewara were functioning in Govt. building and Sub Centres Ulakiya, Okara, Ramkola and Mayapur were functioning in rented buildings. ANMs of all visited Sub Centres except Okara, Mayapur and Kewara HSCs, were residing in Sub Centre building / Sub-centre village. Mobile was not provided to any ANM of visited Sub Centres. b) Additional ANM were not available at all visited Sub Centres except Padwar HSC, whereas MPW (M) was not available at Guturma, Bodha Bagicha, Badwar and Ramkola Sub Centres. c) Water supply facility was not available at Okara and Kewara SCs whereas Electricity connection was not available Guturma, Budha Bagicha and Badwar Sub Centres. d) Examination table was not available at Soor and Parsaguda SCs. Delivery table was not available at Narsinghpur, Parsaguda, Ramkola and Mayapur Sub Centres. McIntosh sheet was not available at Narsinghpur, Ramkola and Mayapur Sub Centres. Ambu bag/suction was not available Soor and Ulakiya Sub Centres. Nishchay Pregnancy Test Kit was not available Ramkola and Mayapur Sub Centres. Delivery kit was not available at Guturma and Ulakiya Sub Centres. IUD insertion kit was not available at Ulakiya, Badwar, Ramkola and Kewara HSC. Rapid Diagnosis Test kit for malaria was not available at Guturma, Ulakiya, Badwar, Ramkola and Kewara HSCs. Weighing machine for adult and infant was not available at Ramkola SC and the machine for adult was in not working condition at Soor and Ulakiya HSC. e) Gloves were not available at Soor, Ulakiya and Mayapur Sub Centres. DDKs, Sanitary Napkins, Inj Gentamicin and Cap Ampicillin were not available at any visited Sub Centre. Emergency contraceptive pills and Oxytocin Tab. was not available at entire visited SC except Soor and Guturma HSC. Kits A & B for the year 2011-12 were not provided to any of the visited HSC till May, 2011. Tab Co-trimoxazole was not available at Mayapur HSC. Vitamin ‘A’ solution was not available at Ulakiya and Badwar HSCs. IFA tab/syrup was not available at most of the visited Sub Centres since 2 to 4 months. Oral pills were not available at Ramkola, Mayapur and Kewara HSCs. Condoms was not available at Mayapur and Kewara HSCs. Antiseptic solution was not available only at Soor, Narsinghpur, Badwar and Mayapur HSC. Chlorine solution was available only at Soor, Guturma and Ulakiya HSCs. Tab Pareacetamole was not available at Mayapur and Kewara HSCs. f) Printed register for eligible couple was not available at Guturma and Ulakiya Sub Centres, Printed register for family planning service was not available at the visited Sub Centres and Monthly reporting format was not available at Soor, Ulakiya, Guturma Ramkola, Mayapur and Kewara HSC. Separate JSY registration cards were not available at Sub Centre level. g) The posters for public awareness were not displayed at the Sub Centres Narsinghpur and Okara h) SBA training was received only by the worker of Guturma and Okara Sub Centres. i) Integrated Management of Neonatal and child infection (IMNCI) training was received by the worker of Guturma, Okara, Bodha bagicha, Badwar and Ramkola Sub Centres. 8. Opinion and Knowledge of Community on Health Services: a) Total 56 mothers having child up to one year old were interviewed in the area of the visited Sub Centres for assessing the work of ANM and Knowledge & Opinion of mothers. b) 30 (53.6%) mothers informed that ANM is available when needed. All mothers were delivered by trained persons. 49 (87.5%) replied that their last delivery was institutional one. All 56 mothers were counselled for exclusive breast feeding and complementary feeds. 27(48.2%) mothers received three post natal checkups. 19(33.9%) mothers knew the danger sign of ARI. 35 (62.5%) mothers knew about use of ORS packets during diarrhoea. All mothers replied that immunization session are held regularly in the village. 32 (57.1%) mothers were aware of contraceptive methods and all the mothers were aware of the government health facilities where they can get all health facilities. c) Out of 11 visited Sub Centres, MPW (M) was posted in 7 Sub Centres. After having elaborated discussions with Teacher, Sarpanch, CC users, ASHA and villagers, it was learnt that most of the male workers take rounds of the village for field work regularly and behaviour of most of them towards the villagers was good. All workers attended the health clinic/immunization/VHNDS session regularly and were available when health programmes were organized in the villages. d) During the course of visit to PHC Barion, Dharampur and Pasta, it was observed that the community was generally satisfied with the services received from staff and Medical Officers of the PHCs. However Mothers were not aware about AIDS and HIV ; Stay at HQ and Visit of the village by Medical officers was not satisfactory at Dharampur PHC. 9. Sample Verification of F.W. Beneficiaries: a) 118 Family Welfare beneficiaries were selected in the visited Centres for sample verification and out of them 87 (73.7%) could be contacted in the district. out of contacted beneficiaries age of spouse in 90 (76.3%), total no. of children in 16 (13.6%), no. of Male/female children in 34 (28.8%) and age of youngest child in 45 (38.3%) cases were not recorded. b) 33 (64.7%) beneficiaries of FW acceptor were provided with follow up services and all 22 (68.8%) beneficiaries of Sterilisation told that they received full amount of compensation money. c) Out of contacted 55 spacing methods acceptors, 36 (65.5%) acceptors were found to be false reported cases in the district. d) All 70 contacted beneficiaries of child immunization confirmed to receiving the vaccination and were satisfied with the services as there was no any complication after receiving the services. However, follow up services were provided to only 26 (37.1%) beneficiaries. 10. IT Infrastructure & MCH Tracking: a) Computers were available at the district headquarters, CHCs and 48 out of 84 PHCs. b) Internet connectivity was provided to the systems available in the district and at all CHCs but not in PHCs. c) It was reported that in the visited 4 CHCs Sitapur, Rajpur, Balrzmpur and Pratappur, all Sub Centres are having MCH Tracking formats, though the work for want of internet connectivity suffered due to the problem of power supply in Balrampur CHC. Data Entry was in operation at CHC/PHC level and online data entry of MCH tracking formats in the district was found updated till the visiting month.

11. Maintenance of Records and Registers: a) Sterilization Register was not maintained since December, 2009 at Rajpur CHC. b) IUD Register was not maintained at the visited CHCs. c) OP and CC Registers were not maintained properly in Sitapur CHC and these registers were not produced at Rajpur and Pratappur CHCs. d) ANC & PNC Registers were not maintained in CHC Rajpur. PNC and Stock Registers were not produced at Pratappur CHC. e) Eligible Couple Register was not maintained in Soor and Budhabagicha, not updated at Ulakiya, Badwar, Ramkola and Mayapur and not produced at Guturma, Narsinghpur, Okara and Parsagudi Sub Centres. f) OP Register was not maintained at Okara, Budhabagicha and Ramkola HSCs and not produced at Narsinghpur, Badwar and Parsagudi Sub Centres. g) CC Register was not maintained at Okara, Budhabagicha, Badwar and Ramkola HSCs and not produced at Narsinghpur and Parsagudi Sub Centres and PNC Register was not maintained properly at Soor and Guturma Sub Centres. h) Stock Register was not updated at Soor, Ramkola and Mayapur, and not produced at Guturma, Narsinghpur, Okara, Budhabagicha, Badwar and Parsagudi Sub Centres. i) JSY register was not produced at Guturma, Narsinghpur and Okara Sub-Centres. j) Cash book for untied funds was not maintained properly at Guturma,Ulakiya, not updated at Ramkola, not maintained at Soor and not produced at Narsinghpur, Okara, Budhabagicha and Badwar Sub-Centres.

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