Chattisgarh 1. District:- Mahasamund 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 Mahasamund 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 Mahasamund CHC: Bagbahara & 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 Basna, 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, Saraipali 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.