Bihar 1. District- Begusarai Major observations of Regional Evaluation Team (RET), Patna on the evaluation work carried out in Begusarai District of Bihar State in the month of May, 2011. I. Details of the visited Institutions: District visited PHCs visited HSCs visited Begusarai PHCs: Matihani, Bakhari, Bagdav, Hanspur, Godargama, Ratar, Mohanpur, Bachchawara & Bhagawanpur Salauni, Chianjivipur, Chauth, Rasalpur & Maharauli II. Major Observations: 1. Human Resources: Though the detail information on the staff position was not made available in the district, some of the posts like 44 posts out of the 122 sanctioned posts of Specialists / Medical Officer and 4 posts out of the 28 sanctioned posts of Lab Technician were lying vacant in the district. 2. Rogi Kalyan Samiti (RKS) &Village Health Sanitation Committee (VHSC): a) Rogi Kalyan Samiti (RKS) was constituted at all visited institutions in the district but their meeting were not conducted regularly. b) 257 Village Health & Sanitation Committees (VHSCs) were constituted in the district. 3. Service of Janani Suraksha Yojana (JSY): a) During visit to the centres in the district, it was observed that most of the deliveries under JSY were recorded as institutional but in fact in the visiting areas large number of home deliveries were conducted by untrained persons. b) 11 (28%) JSY beneficiaries were contacted out of 40 newly delivered mother selected for interview. All beneficiaries were having MCH cards. It was found that timely payment of JSY packages were not made due to irregular allotment of funds. c) It was observed that necessary information was not recorded in JSY cards. Some mothers had not received three consecutive PNC checkups. d) JSY status in the visited PHCs Bakhari & Bachchawara as reported is given below: Sl. Particulars PHC Bakhari PHC Bachchawara No. 20010-11 2011-12 20010-11 2011-12 1. No. of deliveries eligible 3777 2910 1836 2253 for payment under JSY 2 No. of beneficiaries to 3777 2850 1836 2253 whom JSY fund were paid 3 Total fund received 1,24,94,500 81,12,400 63,31,400 49,04,500 4 Expenditure incurred 1,24,92,800 81,11,900 49,26,900 41,54,300 under JSY 1 4. Functioning of ASHA scheme: a) As against the target of 2629 ASHAs, 2325 ASHAs were in position in the district. All selected ASHAs were having drug kits. Training in all modules was not yet provided to the ASHAs. b) Role of ASHA in the activities under JSY to accompany the mother to hospital was observed to be not up to the mark. 5. Untied funds: a) The team could not assess the provision and expenditure of Untied Fund in the district as District Programme Management Unit did not provide the details of fund in this regard. b) Status of untied fund in the visited PHCs was reported as below: (in Rs.) Name of 2010-11 2011-12 PHCs Fund Expenditure Balance Fund Expenditure Balance available available Bakhari 80,000 80,000 Nil 50,000 Nil 50,000 Bachchawar 50,000 11,666 38,334 38,334 37,996 338 a 6. 24 Hours Delivery Care Services: 24x7 hours delivery service was implemented in the district. As reported 13 institutions were working as 24x7 hours service provider in the district. 7. Physical Infrastructure and Stock Position: I. PHCs: a) PHCs visited at Matihani, Bakhari and Bachchawara have own building but the maintenance of the hospital buildings was not up to the mark. There was regular water supply, electricity and also telephone facility in the PHCs. b) At visited PHCs, most of the equipments, supplies and furniture etc were available. However Vit ‘A’ (tab) in PHC Bachchawara and AYUSH-MO in PHC Bakhari was not available. III. HSCs: a) Mohanpur and Ratar HSCs were having their own building. Electricity/water supply, labour room etc. were not available at both the HSCs. These HSCs have no MPW (M) posted. b) Both the SCs had no examination table, Benches for Clients, Ambu bag, Torch, Stove and Weighing Machine (Adult and Infant). c) Short supply of Metronidazol, Misofrostol, Magsulth, Oxitocine, Co-trimoxazole tablets, Ampicillin Capsule, Gentamycine injection and EC pills was observed in the visited Sub Centres. 8. Knowledge and Opinion of the Community on Health Service: a) 18 mothers having child of upto one year age were interviewed in the area of visited HSCs Mohanpur and Ratar. Mothers informed that ANMs are available when needed and also conducted 2 immunization clinic in regular basis. ANMs provided IFA and TT injections to pregnant women. Home deliveries were being conducted by trained persons in the area. It was observed that mothers had utilised DDK during home delivery. b) Most of the mothers had no knowledge about ARI. The ANC/PNC services need to be strengthened. 9. Sample Verification of Family Welfare Acceptors: a) Out of 101 selected FW acceptors, 31 (30.6%) could be contacted for Sample verification in the district. Minor discrepancy in the recorded age of acceptors/spouse and total /male children was found during sample check. b) No follow up services were observed to be provided to the 16 (51.6%) acceptors. c) 25 (80.6%) acceptors were satisfied with the method, as they had not faced any major complication. Out of 13 selected acceptors IUD acceptors, 10 (77%) cases were contacted and out of them 9 were continuing the method without any complication till the date of interview. One acceptor discontinued the service due to bleeding. d) The team could not draw OP & CC user sample due to non maintenance of records. 10. Maintenance of Registers & Records: a) Eligible Couple register was not maintained properly and up to date at Bachhawara PHC. This register was not made available at Matihani, Bakhari and Bhagwanpur PHCs. b) Sterilization service cum payment Register was not maintained properly at Matihani and Bhakhari PHCs and the same register was not made available at Bachhawara PHC. c) Cu-T service register and Oral pills & Nirodh distribution register were not made available at all the visited institutions. Cu-T figures reported for the year 2009-10 and 2010-11 could not be verified for want of service register at PHC head quarters. d) ANC Register was not maintained properly at Matihani, Bakhari and Bachhawara PHCs and the same was not made available at Bagwanpur PHC. e) Stock Register of IUD, OP and CC was not maintained properly at Bakhari and Bhagwanpur PHCs. 11. Other Observations and Suggestions: a) Monitoring and supervision in the district need to be enhanced especially for the activities taken up at Sub Centre level. b) JSY records at the visited centres reflected that most of deliveries are conducted in the hospital. Services of ASHAs in this regard were poor. To improve the services, effective coordination should be developed between ASHAs & ANMs. 3 c) Budgetary provision and utilization under various activities i.e., Untied Fund, AMG, JSY, ASHA and VHSC etc. were not made available by the DPMU. The team observed that, the members of NRHM Management Supporting Units at district as well as at PHC/CHC and the officials at district headquarter were not having adequate knowledge about the latest guidelines of different Programme under NRHM. The entire units need re-orientation training to improve the work. ********* 4 2.District- Muzaffarpur Major observations of Regional Evaluation Team (RET), Patna on the evaluation work carried out in Muzaffarpur District of Bihar State in the month of May, 2011. I. Details of the visited Institutions: District visited PHCs visited HSCs visited Muzaffarpur PHCs: Minapur, Mushahari & Salaha Jalalpur, Madhopur, Narauli, Saraiya Paharpur, Nawada, Munza & Mustafapur II. Major Observations: 1. Human Resources: Though the information regarding the staff position was not made available in the district, some of the posts i.e., 87 out of the 233 sanctioned posts of Specialists / Medical Officer, 226 of the 1168 sanctioned posts of ANMs and 35 out of sanctioned 184 posts of GNMs were lying vacant in the district. 2. Rogi Kalyan Samiti (RKS) & Village Health and Sanitation Committee (VHSC): a) Rogi Kalyan Samiti (RKS) was constituted at the visited institutions in the district and its members meet quarterly. b) As per District profile, 374 Village Health & Sanitation Committees (VHSCs) were working in the district. All VHSCs have ASHA as a member. c) In the district VHSC funds to the tune of Rs. 1,21,14,639 were provided during the year 2009-10, but only Rs. 9,97,500 (8.2%) were spent till March, 2011. 3. Services under Janani Suraksha Yojana (JSY): a) JSY was functioning in the district. For this, the District received JSY funds to the tune of Rs. 8,34,69,052 during 2009-10 and an amount of Rs.6,50,57,716 (77.94%) was spent during the year. b) In the visited PHCs Minapur, Mushahari & Saraiya, JSY status as reported is given below: Sl. Particulars Distt. Hospital PHC Minapur PHC Mushahari No. 20010-11 2011-12 20010-11 2011-12 20010-11 2011-12 1. No. of deliveries eligible 43322 55180 1766 2078 1625 546 for payment under JSY 2 No. of beneficiaries to NA NA 1766 1438 NA NA whom JSY fund paid 4 Total fund received 7362218 NA 5696739 3188500 2845450 3386100 5 Expenditure incurred 65057716 NA 2802600 3173100 2169000 3371700 under JSY NA: Not available. 5 c) As many as 19 JSY beneficiaries were contacted in the district, MCH cards were issued and most of them were registered in the earliest stage of pregnancy. ANC/PNC checks up were completed in time. d) It was observed that most of the beneficiaries were not paid due to irregular allotment of funds under JSY.