Jammu & Kashmir District- Reasi Major observation of Field Survey Unit (FSU) of Regional office for Health & Family Welfare, Jaipur about evaluation work in Reasi district of J & K State in the month of May, 2011. I. Details of the visited Institutions: District Visited CHC and PHC Visited HSC Visited Reasi CHC: Katara Kanthi, Maslote, Kheral-A & Kund-Khanari PHC:Dharmari & Pouni II. Major Observations: 1. Human Resources: a) Acute shortage of technical manpower was observed in the district. One post each of Surgeon, Radiologist, Anesthetic, Gynaecologist, Paediatrician, Ophthalmic, two posts of Physicians of the 18 sanctioned posts of B-Grade Specialist, 10 post out of the 17 sanctioned posts of Dental Surgeons and 41 out of 72 sanctioned posts of Assistant Surgeon were lying vacant in the district. b) Similarly, 17 out of the 34 sanctioned posts of Jr. Staff Nurse, 34 out of 111 sanctioned posts of Pharmacist, 6 out of the 7 sanctioned posts of MMPW, 19 out of the 99 sanctioned posts of FMPW and 6 out of the 10 sanctioned posts of LHV were also lying vacant. c) In the visited CHC Katara, one of three sanctioned posts of MO and only one sanctioned posts of Assistant Radiographer was vacant. d) Most of the posts of Specialists/Medical Officer and paramedical staff were filled up in both the visited PHCs at Dharmari and Pouni. However, post of AYUSH Doctor and LHV were vacant in PHC Dharmari. 2. Rogi Kalyan Samiti (RKS) &Village Health Sanitation Committee (VHSC): a) As reported, 14 RKS were constituted in the district. In the visited CHC and PHCs, RKS has been formed but its meeting was not being held on regular basis. b) During visit to PHC Dharmari, it was observed that Rs. 2,075 was generated through RKS in 2009-10, but no expenditure was incurred during the year and Rs.13274 was spent, out of Rs. 23011 was generated till April, 2011 through RKS. Likewise, PHC Pouni generated revenue of Rs.1,40,788 through RKS in 2009-10 and Rs.1,04,723 was spent whereas, Rs. 2,08,130 was generated in year 2010-11and Rs. 96,498 was spent till April, 2011. c) 271 VHSCs were constituted in the district, out of which 173 VHSCs opened their bank account. It was also observed that no fund was allotted to any VHSC in the district. d) All VHSCs had ASHA as a member. No printed register was provided for recording the proceeding of VHSCs. 3. Service of Janani Suraksha Yojana (JSY): a) The beneficiaries were increasing due to JSY implementation in the district. Total 899, 1488 and 2321 institutional deliveries were reported in 2008-09, 2009-10 and 2010-11 respectively, showing an increasing trend. b) Visited CHC Katara, PHCs Dharmari and Pouni were provided sufficient funds for proper functioning of JSY. No fund was released to visited PHCs for current year 2011-12 till the date of visit. c) It was observed that JSY amount to beneficiaries was not being made at the time of discharge from the Hospital at CHC Katara. Transportation amount to all those beneficiaries who were not accompanied by ASHA was not paid by M.O. 4. Functioning of ASHA scheme: a) 304 ASHAs out of required 943 ASHAs were functioning in the district and out of these 225 ASHAs had received 5th module training and provided drug kit. b) ASHAs of all visited Sub Centres were not maintaining the record book/diary for their routine activities. Neither did they prepare the Micro-Birth Plan of their area nor did they prepare the list of adolescent girls. In Sub Centre Kund Khanari, PNC visit was not being carried out by the ASHA. 5. Untied funds: a) As observed, CHC @ Rs. 50,000, PHC @ Rs. 25000 and HSC @ Rs. 10,000 are given untied fund every year in the district. b) During visit to the different Health Centres in the district, the following status about untied funds was observed. (In Rupees) Sl.No. Name of the Health Year 2009-10 Year 2010-11 Centres OB Fund Exp. OB Fund Exp. released released 1 CHC Katara 27784 50000 66934 10850 - - 2 PHC Dharmari 50000 25000 75000 - 25000 25000 3 PHC Pouni 3830 25000 25835 2995 25000 24776 4 HSC Moslote 21500 10000 205000 11000 NR Nil 5 HSC Kenthi 1058 10000 10000 1058 10000 10000 6 HSC Kheral 8965 10000 15543 3422 10000 12924 7 HSC Kund- Khanari 16294 10000 7729 18565 10000 27487 OB: Opening balance c) Though there was sufficient opening balance during 2009-10 with CHC, Katara, PHC Dharmari and HSCs at Maslote, Kheral and Kund-Khanari, full funds were released to these centres during 2010-11. d) Most of the HSCs spent their untied funds during 2009-10 and 2010-11. No fund was spent at HSC Maslote during 2010-11. 6. 24 x 7 hours Delivery Care Services:- a) It was reported that both CHCs and 3 out of 12 PHCs were functioning as 24x7 hours delivery care services in the district. CHCs declared as functional FRU but there were no functional Blood Storage Unit in the Centres. b) At CHC Katara, Gynaecologist, Paediatrician, Anaesthetics and Surgeon were posted. Labour room and OT were well equipped and also baby care room was available there. c) At PHC Dharmari one MO and one AYUSH doctor was posted. New born care counter was not established there. 65 deliveries were conducted in 2010-11 in the PHCs. At PHC Pouri two AYUSH doctors were looking after the services. 132 and 165 deliveries were conducted in the PHC during 2009-10 and 2010-11 respectively. 7. Physical Infrastructure and Stock Position: i. CHC: a) CHC visited at Katara was functioning in Govt. building having regular water & electricity supply. The premises of the visited CHC were found neat & clean. There were 30 beds. It had Labour room, well equipped OT and ICU. b) Residential quarters for MOs and para-medical staff were not available at the CHC. c) The Blood Storage Unit was not functional. II. PHCs: a) PHCs at Darmari and Pouni were functioning in Govt. building with having regular water & electricity supply. The labour room was available at both visited PHCs Darmari and Pouni but, telephone facility was not available at both the PHCs. b) Condom, IFA tab (Large & Small) and Vitamin-A tab were not available in both PHCs. BCG Vaccine vials was not available in Dharmadi PHC whereas, Polio Vaccine vials and Vitamin-A Syrup were not available in Pouni PHC. c) In PHC Dharmmari, the citizen charter was not displayed. There was no counter for condom and oral polls. The available generic medicine board was not displayed at the PHC. The complain and suggestion box were also not available at the PHC. d) There were shortage of room in the PHC Pauni. The Citizen Charter was displayed in the PHC. There was shortage of quarters for staff. This also affects the functioning of PHC as 24 x 7 hour services. The available generic medicine board was not displayed at the PHC. III. HSCs: a) Sub Centres Maslote and Kund Khanari were functioning in Govt. building, while Sub Centre Kenthi was running in the rented house and Sub Centre Kheral was in ISM building. b) Cleanliness of all visited HSCs was good. Labour room, Hemoglobinometer, IUD, EC Pills, Co-Trimoxazole, Chlorine Solution, Oxytocins tab and Gentamycine Inj. were not available at all visited Sub Centres. c) Electricity, Steam Sterilizer, Antiseptic Solution, Chloroquine and Ampacillin, Ambu bag, Nischay Pregnancy Test Kit, IUD insertion Kit, RDT Kit, Torch, Gloves, Disposable Syringes, DDKs and Sanitary Napkins were lacking in most of the Sub Centres. d) Rapid diagnostic test kit, Infant weighing machine, Thermometer, Vit-A Solution, Oral Pills Cycle, Condom , Paracetamol Tab, Metronidazole Tab were not available at Maslote Sub Centre. e) Toilet, Cupboard for drug, Foot Stool, Mclintsh Sheets, Delivery kit, Torch, Thermometer, Glove, AD Syringes and Needles, ORS packet were not available at Kenthi Sub Centre. Toilet facility and Ambu bag were not available at Kheral Sub Centre. f) Likewise, at Kund Khanari Sub Centre, Delivery kit, IUD insertion kit, IFA Tablet & Syrup were not available. 8. Community Satisfaction on Overall Service: a) The team contacted 21 mothers to know about the work of ANMs and their knowledge on various health services. More then 50% contacted mothers informed that ANMs were available when they needed most. b) 14 (67%) deliveries of the contacted mothers were conducted by the trained persons and 4 (19%) mother were visited at their home by the health personnel within 24 hour of delivery, 7 (33%) mothers were visited within 3 days, 4 (19%) mother were visited within 7 days of delivery and 5 (24%) mothers after 7 days of delivery. c) 7 (33%) out of 21 contacted mothers had given breast feeding within half an hour of delivery and rest 14 (67%) mothers started breast feeding within one or more hour. All mothers were aware of exclusive breast feeding and complementary feeds. d) It was reported that only 8 (38%) mothers received 3 PNC checkups. ARI awareness was found in 6 (29%) mothers. 9 (43%) mothers knew the use of ORS. 19 (90%) mothers were aware of usage of Contraceptive, but the knowledge of its side effects was not known to 3 (14%) mothers. ii. Towards the service of PHC: a) The team visited Dharmari and Pouni PHC and found that the public of the area of both the PHCs were satisfied with the services. X-Ray facility was not available in PHC Dharmari. b) No female staff was available in the the night duty at both the PHCs.