Uttar Pradesh 1.District: Kaushambi Major observations of Regional Evaluation Team, Lucknow about the Evaluation work in Kaushambi district of Uttar Pradesh in May, 2011 I. Details of the visited Institutions: District visited PHCs/CHCs visited SCs visited Kaushambi CHCs: Kanaili and Sirathu Itaila, Mayhar, Anetha, Malaksaddi, PHC: Chayal Salahpur and Manauri II.Major observations 1. Health Human Resources: a. In the Medical category, 20 posts of MO out of 73 sanctioned and 2 posts of specialist out of 15 sanctioned were lying vacant in the district. b. In the Para-medical category, 35 posts of ANM (out of 204 sanctioned), 63 posts of MPW (M) (out of 83 sanctioned), 23 posts of Health Supervisor (M) (out of 32 sanctioned) and 23 posts of Staff Nurse/GNM (out of 33 sanctioned) were also lying vacant. c. In the visited CHC, Kanaili, 5 of the 23 sanctioned posts of ANM, 8 of the 9 sanctioned posts of MPW (M), 4 of the 6 sanctioned posts of Health Supervisor (M), 1 of the 3 sanctioned posts of Staff Nurse and 1 of the 5 sanctioned posts of specialist were lying vacant. In CHC, Sirathu 2 of the 25 sanctioned posts of ANM, 9 of the 12 sanctioned posts of MPW (M), 5 of the 7 sanctioned posts of Health Supervisor (M), 3 of the 5 sanctioned posts of Staff Nurse, 4 of the 12 sanctioned posts of Medical Officer and 1 of the 5 sanctioned posts of specialist were lying unfilled. d. 2 of the 27 sanctioned posts of ANM, 11 of the 13 sanctioned posts of MPW (M), 5 of the 7 sanctioned posts of Health Supervisor (M) and 2 of the 8 sanctioned posts of Medical Officer in PHC Chayal were lying vacant. 2. Functioning of Rogi Kalyan Samiti (RKS): a. It was reported that Rogi Kalyan Samiti (RKS) was registered in each of the Block level PHCs/CHCs and also in the District Hospital. Meeting of executive body was conducted every month during the year 2010-11. b. Funds including Untied Fund, Annual Maintenance Grant etc. are kept at the disposal of Rogi Kalyan Samiti as RKS fund. Details of expenditure, equipments purchased etc. in the visited CHC/PHCs and the approvals taken from the RKS in this regard were not recorded in the registers. c. It was also observed that meeting of advisory body of RKS was not being conducted in the visited centres. 3. Functioning of ASHA Scheme: a. As reported, 1370 ASHAs were in position out of 1600 selected in the district during 2010-11. 1303 ASHAs were reported to have been trained but are working without drug kits. b. In the visited Sub Centres at Italia, Mayhar, Anetha, Malaksadi, Slahpur and Manauri, required number of ASHAs were working in the field and trained up to 4th module. c. 8 ASHAs were interviewed and as informed all were trained and receiving an annual average performance based remuneration of about Rs. 5000- 6000. 4. Functioning of Village Health & Sanitation Committee (VHSCs): a. It was reported that 440 VHSCs were formed and joint bank accounts in the name of concerned ANM and Gram Panchayat Pradhan have also been opened to handle the funds. In the year 2010-11 funds Rs. 10,000 were provided to each VHSC for undertaking sanitation work in the villages. b. The total budget for the VHSCs in the district was allotted to the tune of Rs. 86,10,000 for 861 revenue villages during 2010-11, but no details of expenditure were available at district office and also visited PHC/CHCs. c. Meetings of the VHSCs were not being conducted regularly in the visited Sub Centres. 5. Untied Funds: a. Details of the budget provision and expenditure incurred in the district for the year 2010-11 are reported as under: Sr.No Particulars of Untied In the year 2010-11 ( in Rs) Fund For Sub centres For CHCs/PHCs 1 Fund allotted 17,60,000 4,50,000 2 Total Expenditure 17,40,000 4,48,071 3 Balance amount 20,000 1,929 b. Funds @ Rs. 10,000 to each Sub centres and @ Rs. 50,000 to each CHCs/PHCs per year are released by district to block level CHCs/PHCs. It has been observed that in the visited CHCs at Kanaili, Sirathu and PHC at Chayal funds @ Rs. 50,000 were allotted during 2010- 11. c. Funds were utilized in contingency and development work like buying of stationary, POL of vehicle, electrical equipments and battery of inverter etc. after getting approval in the meeting of RKS. d. Statement of expenditure regarding untied fund at Sub centres was not maintained at CHCs/PHCs or Sub centre level. 6. Janani Suraksha Yojana (JSY): a. The district had spent more amount than the allotted budget for the year 2010-11. Out of funds of Rs. 5,68,84,000 allotted to the district for the year 2010-11, the expenditure reported was to the tune of Rs. 6,01,85,980. The excess amount of expenditure Rs. 33,01,980 was met from flexi pool fund. b. The budget provision and expenditure at the visited PHC/CHC is reported as given below: Sr. No. Particulars For the year 2010-11 ( in RS) CHC Kanaili CHC Sirathu PHC Chail 1 Total fund available 48,69,100 58,63,800 94,50,000 2 Total expenditure under JSY47,76,650 58,41,450 94,17,550 3 Total balance amount 92,450 22,350 32,450 c. 45 JSY beneficiaries were contacted in the visited area of the Centres in the district for on the field verification. All the beneficiaries stated that they had received incentives through cheque by the concerned CHCs and PHCs. 7. 24x7 delivery care services: a. 9 institutions were identified to provide 24x7 delivery care services in the district. No additional budget for these services was released to these Centres. b. During visit to the Centres, the performance under institutional delivery was found good during 2010-11. 2282 deliveries in CHC Kanaili, 2583 in CHC Sirathu and 1718 deliveries in PHC Chail were conducted during 2010-11. Facilities for caring mother and new born baby were there in all the visited institutions under the scheme. 8. Physical infrastructure (HSC/PHC/CHC) (i) CHC/ PHCs: a. During visit to the CHCs Kanaili and Sirathu, team found that both the CHC were functioning in Govt. building but their maintenance was not up to the mark. b. Jeep, Blood Storage unit, Injections Quinine and Arteether were not available in both visited CHCs. c. Visited PHC at Chail was functioning in Govt. buildings. Jeep was not available at PHC Chail. d. AYUSH Medical Officer was posted but Pharmacist and medicines under this segment were lacking in the PHC. (ii) Health Sub Centres: a. Visited Sub centres at Itaila, Mayhar, Anetha, Malaksaddi, Salahpur and Manauri were functioning in Govt. buildings. ANMs were not staying at their sub centre head quarters. Electricity was not available at Itaila, Mayhar, Anetha, Malaksaddi and Manauri sub centres. b. It was observed that no delivery was being conducted in the visited Sub centres except at Sub Centre Salahpur. c. Ambu bag/suction, Nischay pregnancy test kit, RDT kit, Heamoglobinometer, Sanitary Napkins and Paracetamol tablets were not available in the visited Sub centres. d. Delivery table, Maclntsh sheet, ORS packets, DDKs, Nirodh, Oral Pills and EC Pills were not available at Sub centres Itaila, Anetha and Manauri. e. Gloves, CuT, Co-trimoxazole and Paracetamol tablets were not available at Sub centres Itaila, Malaksaddi and Salahpur. f. Foot stool, Chloroquine, Paracetamol, Metronidazole, Oxytocin tablets, Ampicillin capsules and Gentamycine injection were not available at Sub centres Mayhar, Anetha, Malaksaddi and Manauri. g. IFA tablets, Oral Pills, Nirodh, EC Pills, Antiseptic solution, Bleaching powder, Chloroquine, Metronidazole, Oxytocin tablets, Ampicillin capsules and Gentamycine injection were not available at Sub centre Salahpur. h. Antiseptic solution in Sub Centre at Itaila, BP apparatus, Co-trimoxazole tablets, CuT, Oral Pills and Sanitary Napkins at Sub Centre Mayhar, Weighing machine (Infant), CuT and Sanitary Napkins at Sub Centre Anetha, Delivery table, DDK, Gloves, ORS packets, Vitamin- A, Oral Pills, Nirodh, EC Pills and Bleaching powder at Sub Centre Malaksadi, Co-trimoxazole tablets, Antiseptic solution and Bleaching powder at Sub centre Manauri were not available. 9. Assessment and opinion of the Community on Health Services: (i) Services of ANM- a. 54 mothers having child up to one year of age from the area of 6 visited sub centres were interviewed by the team to assess their opinion about the services rendered by the ANMs. b. 15 (28%) Mothers were not aware about danger sign of ARI, 17 (31%) were not aware about use of ORS and 8 (15%) replied that their babies were not weighed at the time of birth. 19 (35%) mothers did not receive three Post Natal checkups. c. It was also observed that 26 (48%) mothers did not aware about contraceptive methods. (ii) Services of PHC- a. 30 Persons who were generally utilising the services at visited PHC/CHCs were interviewed and it was found that they were satisfied with the services provided by the Medical officers and others staff of PHCs/CHC. b. The team also contacted persons from different target groups like pregnant women, recently delivered women, mother of 2 year old child and village leaders. Team found that some pregnant women are not registered within the 16 weeks of pregnancy. Futhrer, mothers were aware about danger sign in pregnancy breast feeding practices. 10. IT Infrastructure and Mother & Child Tracking System: a. Team found that computers were available at district level and at Block level (one in each Block) but internet connectivity was not available in any visited CHC/ PHC.