Uttarakhand 1.District:- Bageshwar Major Observations of Regional
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Uttarakhand 1.District:- Bageshwar Major observations of Regional Evaluation Team, Lucknow about the Evaluation work carried out in Bageshwar district of Uttarakhand in November, 2011 I. Details of the visited Institutions: District visited PHCs/CHCs visited SCs visited Bageshwar CHCs: Baijnath and Kapkot Bajyula, Laubaj, Saran, Bhanar, Kamedi PHC: Kanda and Dhapala Sheri II. Major Observations: 1. Health Human Resources: a. 109 of the 141 sanctioned posts of ANM, 4 of the 32 sanctioned posts of MPW (M), 9 of the 10 sanctioned posts of Health Supervisor (F), 4 of the 18 sanctioned posts of Health Supervisor (M) and 2 of the 6 sanctioned posts of Lab Technician were filled in the district. The latest position for the posts of Medical Officers, Specialists and Staff Nurses in the district as a the whole of was not made available at district office. b. All the posts in DPMU i.e. District Programme Manager, District Account Manager, Data Entry Operator and Block Level Accountant were filled except the post of District Community Mobilizer in the district. c. In CHC, Baijnath, 4 of the 36 sanctioned posts of ANM, 8 of the 14 sanctioned posts of MPW (M), 1 of the 7 sanctioned posts of Staff Nurse and 4 of the 6 sanctioned posts of Specialist were lying vacant. Similarly, 1 of the 38 sanctioned posts of ANM, all 9 sanctioned posts of MPW (M), 1 of the 4 sanctioned posts of Health Supervisor (F), all 7 sanctioned posts of Health Supervisor (M), 5 of the 9 sanctioned posts of Staff Nurse and all 5 sanctioned posts of Specialist in CHC Kapkot were lying vacant. d. In PHC Kanda, 1 of the 9 sanctioned posts of ANM, one sanctioned post of Health Supervisor (F) and 1 of the 2 sanctioned posts of Medical officer were lying unfilled. 2. Functioning of Chikitsa Prabandhan Samiti (CPS): a. Rogi Kalyan Samiti (called Chikitsa Prabandhan Samiti (CPS) in the state) has been constituted/ registered in all CHCs and PHCs in the district. It was reported that Chief Development Officer (CDO) is the President of executive body at CHC level and CMO is the President of executive body at PHC level. CPS account jointly operated by CDO/ CMO and concerned CHC/PHC Medical Officer. b. RKS corps fund, Untied Fund and Annual Maintenance Grant are kept at the disposal of Chikitsa Prabandhan Samiti. Meeting of executive body of RKS were being conducted twice in a year. c. Details of expenditure made for developmental activities in the visited CHCs/PHC and the approvals taken from the CPS in this regard were recorded in the registers. 3. Functioning of ASHA Scheme: a. As reported, 419 ASHAs were in position out of 500 targeted in the district during 2010-11. All of them were trained up to 5th module but were working without drug kits. No new ASHA was proposed to be inducted in the district during 2011-12. b. During visit to the Sub Centres at Bajyula, Laubaj, Saran, Bhanar, Kamedi and Dhapala Sheri, 6 ASHAs were interviewed and as reported, most of them were receiving performance based remuneration on an average Rs. 1600- 2500 yearly. c. ASHA is involved in VHSNC as a member. 4. Functioning of Village Health Sanitation & Nutrition Committee (VHSNCs): a. It has been reported that 861 VHSNCs were functioning in the district and joint bank account in the name of concerned Gram Vikas Adhikari (GVA) and Gram Pradhan has been opened in all 861 VHSNCs to handle the funds for undertaking sanitation work in the villages. Meetings of the VHSNCs were not being conducted regularly in the visited Sub Centres. b. As reported, VHSNC were given funds @ Rs. 10,000 every year for each revenue village under the scheme in the district. The total budget for the VHSNCs in the district was allotted to the tune of Rs. 86,10,000 for 861 revenue villages through CHCs / PHCs and out of that Rs. 85,50,000 spent by the VHSNCs during 2010-11. Similarly, the district had received Rs. 86,10,000 as VHSNC funds for the year 2011-12 and provided the same funds to VHSNC though PHC/CHC, but no details of expenditure were available at district office as well visited CHCs/ /PHC and SCs. c. During visit to the centres, team found that the district had released Rs. 18,50,000 to CHC Baijnath, Rs. 20,20,000 to CHC Kapkot and Rs. 46,80,000 to PHC Kanda as VHSNCs fund in 2010-11 and the amount was fully utilised during the year. Same amounts was also provided to these CHCs/ PHC in 2011-12 as VHSNC funds but no details of expenditure were available in the visited CHCs/ /PHC for the current year up to November, 2011. 5. Untied Funds: a. Untied Funds @ Rs. 10,000 to each Sub centre, @ Rs. 50,000 to each CHC and @ Rs. 25,000 to PHC were provided through block level CHCs and PHCs every year in the district. b. Details of the fund provision and expenditure incurred in the district for the year 2010-11 and 2011-12 are reported as under: (in Rs.) Srl.No Particulars of Untied In the year 2010-11 In the year 2011-12 Fund For For For For Sub centres CHCs/PHCs Sub centres CHCs/PHCs 1 Fund allotted 7,70,000 4,00,000 7,70,000 4,00,000 2 Expenditure incurred 7,70,000 4,00,000 3,64,351 65,081 3 Total Balance Nil Nil 4,05,649 3,34,919 c. It was observed that, ANMs were updating their Cashbook/ Passbook of Untied funds at Sub Centres level in the district. d. During visit to the centres, team found that the district had released Rs. 2,00,000 to CHC Baijnath, Rs. 2,90,000 to CHC Kapkot and Rs. 2,80,000 to PHC Kanda for the year 2010-11 for their Sub Centre as untied funds and the amount was fully utilised . Similarly, funds to the tune of Rs. 2,00,000 to CHC Baijnath and Rs. 2,90,000 to CHC Kapkot was provided and out of that Rs. 44,000 at CHC Baijnath & Rs. 1,47,000 at CHC Kapkot were utilised in current year up to October, 2011. Records regarding utilisation of funds was not made available to the team at PHC Kanda. e. The team reported that, Untied Funds were utilized for printing of OPD & Indoor slip, buying of stationary and PVC goods etc. in the centres visited. 6. Janani Suraksha Yojana (JSY): a. During the year 2010-11, district had spent funds to the tune of Rs. 43,58,791 out of allotted budget of Rs. 46,22,216 under the scheme. Similarly, an amount of Rs. 21,13,800 was utilised against the available amount of Rs. 39,07,989 during current year up to October, 2011. b. As per details received, as many as 2186 JSY beneficiaries in the year 2010-11 and 1211 JSY beneficiaries in current year up to October, 2011 have been paid cash incentive under the scheme. c. The budget provision and expenditure at the visited CHCs is reported as below: Sr. Particulars For the year 2010-11 ( in Rs) No. CHC Baijnath CHC Kapkot 1 Total fund available 10,72,156 9,70,000 2 Total expenditure under JSY 10,61,763 9,05,400 3 Total balance amount 10,393 64,600 4 Total beneficiaries 564 494 For the year 2011-12 up to October, 2011 ( in Rs) 1 Total fund available 7,10,393 4,00,000 2 Total expenditure under JSY 4,90,750 3,92,950 3 Total balance amount 2,19,643 7,050 4 Total beneficiaries 297 242 d. 39 JSY beneficiaries were contacted out of 45 selected in the area of visited Centres in the district. All the beneficiaries stated that they had received incentives through cheque from the concerned CHCs and PHCs within 1 to 2 month of the date of delivery. Most of the mothers were relieved from the hospital within 10 to 20 hours of delivery. JSY registers found to be maintained properly and checked by concerned MOs regularly. 7. 24x7 Delivery Care Services: a. 15 institutions were identified to provide 24x7 delivery care services in the district. During 2011- 12 additional incentive is released to these Centres for improvement of institutional delivery after fulfilling the normal target. b. Records regarding total number of institutional deliveries & night hours delivery conducted by 24x7 institutions/ FRUs were not made available in the district. c. In the visited CHC Baijnath, a total of 448 deliveries during 2010-11 and 274 deliveries during 2011-12 have been conducted during current year up to October, 2011. A, total 229 deliveries have been conducted during 2011-11 in CHC Kapkot. Facilities for caring mother and new born baby were found to be satisfactory in all the visited institutions under the scheme. 8. Physical infrastructure (HSC/PHC/CHC) (i) CHCs/ PHC: a. Visited CHCs at Baijnath and Kapkot were functioning in Govt. building but the maintenance of the hospitals was not up to the mark. Hospital buildings for FRU Baijnath was constructed but not functional till the time of visit by the team. b. Blood Storage unit was not set up in both visited CHCs. Incinerator was not available there but bio-medical waste pits were available. Injections Quinine and Arteether were not available in the visited CHCs. Jeep was not available in CHC Kapkot. c. Visited PHC at Kanda was functioning in Govt.