Chattisgarh 1.Korba district Major observations of Field Survey Unit, Bhopal about the Evaluation work in district Korba of Chattisgarh in July, 2010. I. Details of the visited institutions:- District DH, CHCs and PHCs visited SCs Visited Visited Korba Distt. Hospital: Korba Salora, Hunkra, Ranjna, CHCs: Katghora and Pali Dipka, Nanbaka, Rajkamma, PHCs:Chhurikala,Ranjna,Chetma Nunera & Tiwarta & Hardi Bazar II. Major Observations:- 1. Human resources:- a) Acute shortage in the technical manpower was observed in the district. Most of the posts of specialist were lying vacant in the District. More than 50% posts of medical officer were lying vacant there. Overall in 463 posts of different categories were lying vacant as against 938 sanctioned posts in the district. Sanctioned strength & vacancy in key posts are given below: Particulars Sanctioned Vacant Class- I Officers 37 26 Class -II Officers 105 53 Male Supervisor 49 22 Lab.Technician 32 23 Lady Health Visitor 55 20 MPW (M) 215 109 MPW (F) 251 115 Ophthalmic Assistant 37 33 Pharmacist Gr. II/Store Keeper 45 17 1 Urgent necessary steps may be taken to fill up the vacant posts for providing smooth health services in the District. -1- b) At CHC Katghora, 2 of 7 sanctioned posts of Medical Officers were vacant. Against 5 specialists required for CHC there was only 1 in position. Similarly, 1 MO against sanctioned strength of 2 in each of the visited PHC was vacant. 2. Janani Suraksha Yojana (JSY):- a) During visit to CHCs at Kathghora and Pali, it was observed that the funds are provided regularly in time and the beneficiaries were having facilities as well as incentive under the Scheme. JSY registers were maintained entering all relevant details of the beneficiaries in these CHCs. Concerned MOs were checking the registers regularly. b) In CHC Kathghora, total numbers of pregnant women identified under JSY were 8105 for the last complete year and 1575 for the current year and incentive provided to 1473 and 567 JSY beneficiaries during 2009-10 and 2010-11 respectively. An amount of Rs. 19,42,500 was provided during 2009-10, against which expenditure incurred was to the tune of Rs. 18,16,700 and an amount of Rs. 10,00,000 was provided in the current financial year, out of it Rs. 8,32,700 was spent.. c) In CHC Pali total numbers of pregnant women identified under JSY were 4421 for the last complete year and 1376 for the current year. And the fund provided to 2442 and 591 for the last and current year respectively. The fund allotted to the CHC Pali,was Rs. 38,70,600 for the year 2009-10 and the expenditure incurred was Rs.26,99,600. An amount of Rs 10,00,000 was allotted to the CHC for the current year and out of it an expenditure of Rs.7,31,050 was incurred. d) The team contacted 32 beneficiaries in the areas of the visited centres out of 40 selected for sample verification and observed that all of them received ANC services in time and also JSY amount as per the norms. Contacted beneficiaries were mostly satisfied with the services under the scheme,, but some of the mother had not received three post natal checkups. e) Most of the beneficiaries were accompanied by ASHAs while going to the hospitals for deliveries. 3. Untied Funds:- 2 a) Untied funds to the tune of Rs.5,00,000 was provided to the District Hospital and an expenditure of Rs. 5,26,968 was incurred and excess amount was met from other funds. b) All 4 CHCs were given untied funds of Rs.2,00,000 during 2009-10 and 85% of the funds were utilised during the period. Similarly, for 37 PHCs, Rs. 9,25,000 @ 25,000 each PHC was provided during the year 2009-10 and funds utilised upto 92% during the period. c) All 211 Sub-Centres were given @10,000/- per centre during 2009-10 and 2010-11. It was reported that 157 Sub-Centres out of 211 submitted their utilization certificate for both the years i.e., 2009-10 and 2010-11. d) No untied fund has been provided to CHCs and PHCs for 2010-11 till the month of visit. -2- 4. Rogi Kalyan Samiti (RKS) and Village Health & Sanitation Committee (VHSC):- a) It was reported that Rogi Kalyan Samitis have been constituted at DH, 4 CHCs and 37 PHCs in the district. b) During 2009-10, 04 CHCs had received RKS funds @ Rs.1,00,000 for each CHC and utilized 85% of funds during the year. c) In 2009-10, all the 37 PHCs had been provided RKS funds to the tune of Rs. 37,00,000 i.e., @ Rs.1,00,000 to each PHC and utilized about 92% of the funds. d) RKS funds were not given to the institutions for the current year till the month of visit. e) Block-wise report of the district shows that out of 795 villages, VHSCs have been formed in 716 villages in the district and all VHSCs were having ASHA as a member. Most of villages in the visited Sub Centres were having VHSCs. f) VHSCs were reported to have opened bank accounts for handling funds. 5. Functioning of ASHA Scheme:- a) 2274 ASHAs have been selected in the district and all ASHAs have been trained up to IV th module and provided with Drug Kit. In the visited centres, it was observed that ASHAs were trained up to IV th module, having drug kits and working properly. b) As informed by the ANMs, JSY beneficiaries and villagers of the visited Sub- Centres, the role of ASHAs in the field was satisfactory. 3 c) At the time of ANCs and immunization, ASHAs were helping ANMs and also motivating and accompanying mothers for Institutional deliveries. 6. 24 x 7 hour Delivery Care System:- a) In the district there are 4 CHCs and 37 PHCs. All were functioning as 24 x 7 but delivery care service is reported to be available on call. At PHC level, staff Nurse is providing services for delivery on call. b) The Sub-Centre Salora, under Chhuri PHC in Katghora CHC had been accredited for institutional delivery. -3- 7. Physical Infrastructure and position of supplies:- i) CHC: a) The Pali and Kathghora CHCs were functioning in government buildings. The premises of both the CHCs were found neat & clean. The Kathghora CHC was having 30 & CHC Pali was having 20 beds and all the beds were found to be in good condition during the visit. The Water supply was regular but the electric supply was irregular in both the visited CHCs. b) Though the norms for infrastructure and equipments were not as per IPHS, necessary equipments like BP Apparatus, Weighing Machine (Adult & Infant), Microscope & Lab Equipments, Auto clave, Oxygen Cylinder, Resuscitation Equipment, Neo natal Resuscitation Equipment Labour room, Labour room table & Equipments, Examination table and IUD insertion kits were available at both the visited CHCs. c) Anaesthesia equipments were not available in CHC Katghora and surgical equipments were not available in CHC Pali. The license for Blood storage unit is awaited at the visited CHCs. d) Vital, Essential and desirable drugs were available in both the CHCs visited. ii) PHC: 4 a) PHCs viz., Chhurikala, Ranjna, Chetma & Hardi Bazar, visited in the district were functioning in Govt. Building. Electricity and water supply were available at all the PHCs. BP Apparatus, Weighing Machine (Adult & Infant), Auto clave, minor surgical equipments IUD insertions kit, Labour room with the table & Equipments etc. were available in the visited PHCs except PHC at Chetma. b) Functional Operation Theatre with OT table was not available at visited PHCs. There was no vehicle in any of the 4 visited PHCs. The Cold Chain equipments were found only in 2 PHCs out of 4 visited PHCs. c) AYUSH Medical Officers were not available at 3 out of 4 visited PHCs. There was no residential quarter at PHC Hardi Bazar. iii) Sub-centre: a) Out of 08 visited Sub-Centres, 05 were functioning in Govt. buildings and the sub centres at Nanbaka, Nunera and Tiwarta were functioning in rental building. The sub-centres Ranjana, Nanbaka, Nunera and Tiwarta were not having sufficient space for conducting deliveries and cleanliness was not up to the satisfactory level at Nunera and Tiwarta Sub-Centres. -4- b) Essential furniture, weighing machine, IUD insertion kit and Ambu bag etc. were available in the SCs functioning under CHC Katghora i.e., Sub Centres at Salora, Hunkra, Ranjna and Dipka. c) BP apparatus in working condition, steam sterilizer, blood slides, ORS and vitamin “A” etc. were lacking one or other visited centres. d) Drugs like Tab. Chloroquine, Metronidazole, Paracetamole, Oxytocin and Ampicillin, lnj. Gentamicin and Antisaptic solution etc. were not available at most of the centres. Short Supply of Condom since Feb.2010 was observed in the centres visited. 8. Knowledge and opinion of the Community on health Services:- a) To assess the knowledge and opinion on health services provided by the ANMs, 25 mothers having child up to one year old were interviewed in the areas of 8 visited sub centres and mothers reported that ANMs were available as and when needed. 5 b) 10(40%) mothers replied that the ANM visited them within three days of the delivery. 13(52%) intimated the ANM visited on 7th day of delivery. In 2 cases there was no home visit. 19(76%) mothers put their babies to breast within 1 hour of delivery and only 10 (40%) mothers received three post natal checks up.