Madhya Pradesh 1.Alirajpur District Major observations of RET, Bhopal about the Evaluation work in District Alirajpur of Madhya Pradesh in July 2010. Details of the visited Institutions: District Visited DH/ PHCs/CHCs visited SCs Visited Alirajpur Distt. Hospital: Alirajpur Walpur, Ojhad, Lodhani, Madhupalavi, Silota, Malveli, CHCs: Sondwa and Bhabhra Chotikareti, Chhotakhutaja, Badakhutaja, Sejawada, PHCs:Bakhatgarh and Umarali. Dunganwani, Devali and Mahendra. 1. Human resources: a) 13(87%) out of 15 posts of Specialists, 35 (67%) posts of Medical Officers, 50 (68%) posts of Staff Nurse, 15 (54%) posts of LHV, 6 (50%) post of Multi Purpose Supervisor and 38 (46% ) posts of MPW(Male) were lying vacant in the District . b) 2 posts of Surgical Specialists, 50 posts of Staff Nurses, 3 posts of Nursing Sisters, 2 posts each of Opthalmic Assistants, Lab Technicians, Matrons & Store Keepers and 5 posts of Pharmacists were vacant in District hospital Alirajpur. c) It was observed that position of medical & para medical staff are inadequate in visited CHCs Sondwa and Bhabhra; vacant posts should be filled for providing better health care services. 2 Rogi Kalyan Samiti (RKS) and Village Health & Sanitation Committee (VHSC): a) Rogi Kalyan Samitis have been constituted and funds are provided every year. b) As per the information received from DPMU, CHC Bhabhra and Kattiwada did not incurr any expenditure from RKS funds during 2009-10. CHC, Sondwa has spent only 40% of allotted funds in the same year. Funds have been allotted for 2010-11 to all CHCs also but no expenditure was incurred by any CHC till the time of visit by the team. c) It was informed that during 2009-10, PHCs at Ambua, Bakhatgarh, Khattali Umarali and barjhar have not incurred any expenditure from RKS funds. PHCs Bori, Nanapur and Jhiran have utilized allotted funds . Funds allotted in 2010-11 to all PHCs but no expenditure incurred by any PHC till the visiting month in the district. d) Most of the Villages were covered with the VHSCs in the district as 521 VHSCs have been formed against 540 villages in the district. e) It was reported that 307 Village Health & Sanitation Committees have ASHA as a member . Bank accounts were opened in 291 VHSCs. However, there were only 5 VHSCs with bank accounts out of 44 VHSCs in Sondwa block. 3. Services of Janani Suraksha Yojana (JSY): a) 46 JSY beneficiaries who were contacted during the field check in the area of 10 sub- centres were mostly satisfied with the services received under the scheme. b) Among the contacted mothers, only 59% got all three ANC checkups and 50 % got PNC checkups by ASHA and ANM. Only 6 (13%) mothers were accompanied by ASHA /DAI/AWW to the institutions for delivery. c) Updated registers were maintained by the visited centres and concerned Medical Officer checked the same regularly once in a month. 4. Services of ASHA Scheme: a) 473 ASHAs have been selected and 416 out of them were trained and equipped with drug kits in the district. b) In the visited sub centers at Medveli, Devali, Mahendra and Bada Khutaja, no ASHA was selected. ASHAs were working properly at the other places visited in the district. 5. 24 X 7 hours Delivery Care System: 11 (2CEmOC & 9 BEmOC ) institutions were providing 24 X 7 hours delivery care services in the district. 6. Untied funds: a) Rs 50,000 to CHC, Rs. 25000 to PHC and Rs 10,000 to each sub centre were provided as untied funds during 2009-10. b) As reported by DPMU, all 5 CHCs received allotment of funds and spent more than 80% of funds during 2009-10. CHC Bhabhra spent only Rs 3692 out of Rs 50,000 allotted in 2009-10. During 2010-11, all the above CHCs were allotted funds @ Rs.50,000 each and CHC Jorbat, Katthiwada and Udaigarh were utilizing the same and others not yet started spending. c) During the year 2009-10, all the PHCs received allotment of funds and also spent 80% or more funds, except PHC at Barjhar and Jhiran. During 2010-11, all the PHCs received untied funds but most of them have not yet spent anything. d) Sub centres at Walpur, Ojhad, Lodhani, Madhupalavi, Chotikareti, Chotakhataja, Badakhutaja, Sejawada Dungawani, Devali, Mahendra received funds and utilized the same properly. ANMs of Silota & Malveli has joined recently and did not receive any untied funds. 7 Physical Infrastructure: 7.1 CHCs a) CHCs at Sondwa and Bhabhra visited in the district were functioning in Govt. buildings and the premises were found in neat and tidy condition. CHC Sondwa and CHC Bhabhra had only 4 & 6 beds respectively against 30 beds sanctioned to each CHC. b) Blood storage unit and incinerator facilities were not available in both the visited CHCs. c) X-Ray facility is available at both the CHCs but in non-functional condition. Resuscitation equipment was not available at Bhabhra CHC. Anaesthesia equipment was also not available in both the CHCs. 7.2 PHCs a) Both the visited PHCs at Bakhatgarh and Umarali were functioning in Govt. building and were having 4 beds each. Most of the equipments and facilities were available with them except telephone facility. b) OT was not available at Umrali PHC. c) Microscopes are available at both visited the PHCs but Lab. Technician post was lying vacant at Bakhatgarh PHC. d) AYUSH Medical Officer is not available at the both PHCs. 7.3 Sub-Centres a) Sub-centres visited at Walpur, Ojhad, Lodhani, Madhupalavi, Chotikareti, Badakhutaja, Sejawada Dungawani, Mahendra & Silota were functioning in Govt. buildings. Malveli, Chotakhutja and Devli centres were functioning in Anganwadi centres. Hand pumps was the main source of water at most of the sun-centres. b) None of the visited sun-centers had pointed eligible couple registers c) Health workers (F) had received SBA training in the visited sub-centres. d) Labour rooms was available in sub-centre Sejawquda, Walpur, Ojhad, Silota, and Chhotikareti but deliveries were not conducted in the labour room. Rest of the sub- centres were not having labour rooms. e) Examination table, Delivery kit, Delivery table and BP apparatus were not available at some of the centres. f) DDKs, Emergency contraceptive pills, Tab. Misofrostol, Inj. Gentamicine, Tab. Oxitocin, Cap. Ampicillin etc were not available at any of the visited sub-centres. g) ANMs were not staying in the Sub-centre villages. 8) Community satisfaction & opinion on health services: a) To assess the community satisfaction, 57 mothers having last child up to one year of age old were interviewed in the area of the visited sub-centre. b) Almost all the mothers were aware of the Government health facilities where they can get all health services. c) Less than half of the mothers replied that they were visited by the ANMs within three days of delivery, had three post natal checkup and aware about advantage and side effects of contraceptives. d) 39% mothers knew the symptoms of ARI, 44% mothers knew the schedule of child immunization and only 37% mothers were aware of contraceptive methods. e) During the course of visit to PHCs Bakhatgarh and Umarali, it was found that the beneficiaries and others health clients were satisfied with the services of PHC MO and the staff. 9) Sample verification of FW acceptors: a) Out of selected 124 acceptors of Family Planning methods, for Sample verification, 95 cases (77%) could be contacted in the district. While examining records of selected cases from service registers, it was noticed that age of spouse in 55 (44%) cases and age of youngest child in 47 (38%) cases were not recorded. b) Out of 60 contacted cases of IUD, OP and Nirodh users 46(76.7%) acceptors denied receipt of the services. Such false reporting is required to be rectified urgently. 10) Maintenance of registers: a) Maintenance of records and registers was found very poor in most of the visited sub centres. b) Most of the sub centres visited did not maintain and produce IUD, CC and OP service register. The records wherever maintained were of poor quality hence sample selection of the beneficiaries could not be done properly. c) The reported figures of IUD in the year 2009-10 and 2010-11 could not be verified due to absence of master Register at CHCs visited and Civil Hospital Alirajpur. d) Lack of supervision was noticed at all the visited centres in up keeping of records. **** 2.Indore District Major observations of Regional Evaluation Team, Bhopal about the Evaluation work in Indore District of Madhya Pradesh State in August, 2010 I. Details of the visited Institutions: District PHCs/CHCs and DH visited SCs Visited Visited Indore District Hospital: Indore, Chotabangarda, Gandhinagar, Civil Hospital: Mhow, Jambudihapsi, Khurdi, CHCs: Manpur and Depalpur Khedisihod, Rajpurakhati, Kelod, PHCs: - Hatod, Bhicholi, Hapsi, Kishanganj and Agra Kanadia and Hisalpur II Major Observations A) District Indore 1. Health Human Resource : a) There was acute shortage of skilled man power in the district as may be seen from the following table. Particulars Sanctioned Posts Vacant Specialist 43 21 Medical Officer 152 38 Staff Nurse 152 28 MPW Male 104 39 MPS 10 8 As may be seen from above, a large number of posts of Specialist, Staff nurse and MPW (M) are lying vacant. It is required to take necessary action to fill up these posts for providing health care delivery in the district may be taken urgently.. 5 b) Contractual staff under RCH was also found to be inadequate. One post each of PGMO for Anesthetics, Pediatrics and Gynecologist was lying vacant. 2 posts of Medical officers, 13 posts of staff nurse (BE moc) and 18 posts of ANMs were also vacant.