Yanam - PIP Report
PIP Monitoring of NRHM
Dr. J. Joseph Durai Selvam
Mr.V.Saravanakumar
POPULATION RESEARCH CENTRE, GANDHIGRAM
Executive Summary
The PIP monitoring visit was done at Yanam district of Puducherry in September 2013. This district is one of the four districts of Puducherry Union Teritory. This district is located in the coastal line of Andrapradesh.
This district has one district hospital and four health sub-centres. The hospital is functioning in a well constructed building which has three floors. There is a common lift operated for these three floors. In the third floor Office of the District hospital is running.
The hospital has shortage of Manpower both in medical and paramedical specialities. At least one more well built building is needed since all the services are given in one building only. The bed facility is minimum and at least 20 more bed is required in the hospital. Because of shortage of Manpower equipments like CT scan and Ventilators are not in use for a long time.
Due to non availability of good schools and colleges most of the medical persons do not prefer to work in this district hospital on regular basis hence helath personnel are working on contract basis.
There is no facility for blood bank and blood is collected from the near by Non Government Organization called Old Age Home. TB unit is functioning well and there is no space for ICTC in the hospital.
Hospital kitchen is functioning well, though there is in adequate number of cooks.
2. Introduction
The PIP monitoring of National Rural Health Mission was done at Yanam district of Pondicherry by the team consisting of Dr.J.Joseph Durai Selvam, R.I and Mr.Saravanakumar, R.I of PRC during 9-14 September 2013. After a brief introduction about the visit to the Deputy Director (i/c) Dr. Ravishankar the team collected data about the Yanam District Hospital and two sub centers namely Dariyalathippa and Kanakalpettai.
3. State profile and District Profile
The yanam district is one among the four district of union territory of Pondicherry. Apart from Yanam town the Yanam district has seven villages. This district occupies an area of 20 square kilometers. As per 2011 census the yanam district has a population of 55,616.The sex ratio is 1039 females for every thousand males and the literacy rate is 80.26%. Majority of the people speak Telugu language. The district has a population density of 3,272 per square kilometer.
4. Key health and service delivery indicators
The total unmet need for family planning is at 16 percent .The current use of family planning method is at 58% and female sterilization is the most used method(49.8%) followed by male sterilization (5.8%). Forty four percentage of mothers had at least 3 antenatal visit during last pregnancy. Fifty four percent of mother had at least one TT injection when they were pregnant last time. Mothers who received post natal care within 48 hours of delivery is at 71%. Children fully immunized is at 31.1% this when compared with DLHS-2 (95%) was at very low Children who received vitamin A was at 70%.
5. Health Infrastructure
The district has one District Hospital and four sub-centers. The bed strength of District Hospital is 80 beds. The district hospital is located at the centre of the Yanam town. The total in-patient for the year April 2012 to March 2013 is at 2810 and the total out-patient for the same period is at 139134.
Out of the four sub centers three are located nearby and one is located at a distance of 13 kilometers from the town. All the sub centre are having a good infrastructure and in two sub centres the ANMs are staying. The sub centre provides only some basic medicines to the patients and because of the district hospital which is located nearby all the patients with chronic conditions are referred to the District Hospital. One more PHC/CHC may be put in place of the sub centre that is located far away from the district hospital to meet emergency needs. The in-patient bed is 80 and the hospital authorities required an additional bed of 20. Only one operation theatre is available and there is no separate O.T for O& G section. The O&G section needs more bed facility. The space for the district hospital is inadequate and there is no blood bank facility in the hospital. The rooms for ICTC counseling is inadequate and there is no privacy.
6. Human Resources
There is no permanent position of pediatrician available and one person is appointed on contract post. The post of Specialist in Anesthesia is vacant. The post of specialist in O&G is vacant. The post of Specialist in T.B, Opthamology and Radiology is vacant. The vacant is the key position is causing problem to the hospital administration in delivering quality services to the patients. Due to this many a time the patients were referred to the Kakinada Government hospital of Andrapradesh. Some of the key positions are filled on contract basis so there is a frequent staff turnover with regard to medical personnel. Also because of inadequate educational institutions and other facilitites the Medical persons do not prefer to be posted in Yanam District Hospital.
In regard to paramedical personnel five staff nurse position is vacant. Statistical officer and all the four position of radiographer is vacant. Almost half of the ward attendant post is vacant.
With regard to training only one doctor got trained in New born care. Two doctors were trained on NVBDCP training. Most of the training will be conducted at Pondicherry and the doctors have to travel a lot to attend training and because of frequent turnover on medical persons the training attended by these doctors is very less.
With regard to training of paramedical personnel seven staff nurses and two ANM attended HIV/AIDS prevention care and support. Four staff nurses and five ANM trained on whole blood screening. One Health Inspector, one LHV and 14 ANM attended training on VBD (Dengue and Chikenguniya). Three staff nurses trained on Care in emergency -role of nurses. One N.S Gr.II trained on sensitization of state level nursing superintendent.
7 Other Health System inputs
Adequate drugs and equipments are available and a separate pharmacy store is available and out of five posts sanction four are regular and one is in contract. The drugs are procured from Pondichery, the U.T. headquarters this sometimes leads to temporary shortage of drugs, particularly IFA tablets.
In AYUSH three doctors were available in ayurvedic, one doctor for Homeopathic and one doctor for naturopathy and yoga therapist. All these doctors were recruited on contract basis.
8 Maternal Health
8.1 ANC and PNC
The total number of ANC registered for the last financial years was at 779 and the PNC was at 700. One hundred and sixteen women were severely anemic and five were identified as hypertensive. Number tested for Blood sugars was at 849, urine sugar at 803 and no protein test was conducted. Total number of women given TTI is 404 and TTII is 408. Total number of women given IFA was at 833. The records for ANC and PNC were kept in registers only.
8.2 Institutional deliveries
Total number of deliveries for the last financial year was at 376 out of which 367 were normal deliveries and the remaining 9 were caesarian deliveries.
8.3 Maternal death Review
No maternal death was reported at Yanam district Hospital for the last financial year.
8.5 JSY
Number of women paid JSY for the last financial year was at 114.
9 Child Health
The pediatric Out patient were 9180 female children and 11574 male children during last financial year. Children admitted during last financial year were 178.
9.1 SNCU
SNCU is available in the Hospital. One warmer is available and the other equipments like Incubator and Ventilator is available but not in working condition. No death is reported in SNCU. Human resource like regular pediatrician and equipments are not available and all the children were referred to the near by Kakinada district hospital. It is essential a need to have a full fledged SNCU with proper equipments in the district hospital.
9.2 NRCs
9.3 Immunization
The immunization is carried out regularly and a total of 250 immunization session were planned
10. Family Planning
A total of 20 sterilization were done in the last financial year and seven MTP were done. Total number of beds for O&G section alone is 11 and this is inadequate and they require at least 6 more beds.
12. Quality in Health Services
12.1 Infection control
In general the hospital was clean and staff practicing safety precautions.
12.2 Biomedical waste management
At present there is no proper bio-medical waste management is done. The contract period of the private player who usually disposes the biomedical waste is over so at present it is taken care by the local municipal people. Once the contract of private player is renewed it will be handed over to them.
12.3 IEC
The IEC materials were displayed at appropriate places . At the entrance details about the rooms were displayed and in the wards details about family planning methods and directions to various wards were clearly displayed. The whole hospital is functioning in single building so it is easy for the patients to locate the services. The phone numbers are not displayed.
13. Clinical Establishment Act.
14. Referral Transport and MMUs
A total of three ambulances, one jeep and two cars are available at General Hospital and all of them are in running condition. Two ambulances were available fro referral/drop back of delivery women. A system of 102 is used for calling ambulances for emergency services. One mobile medical unit is available at the hospital.
16 Disease control programmes
16.1 Malaria
A total of 5284 were screened for malaria and two were found positive. Four cases of leprosy were found and two were cured. Adequate staff are available to control malaria and Filaria in the hospital.
16.2 T.B
A fully developed T.B centre is in operation in the hospital. A total of 375 persons were tested for T.B and 32 were found positive and receiving medicine. Adequate staff is available in the T.B centre and they require a laminar flow for processing samples. .
17. Non Communicable Diseases
Every Tuesday and Friday screening for Diabetes and Hypertension is done at the Hospital and the people are aware of this and vountarly coming for diagnosis. But there is no separate staff for handling the Non-communicable diseases. There is no proper IEC display of NCD.
19. HMIS and MCTS
The data from subcenters were collected the Hospital and one data manager is posted for HMIS and MCTS. The data related to MCTS are entered at the hospital itself and the HMIS data is sent to Pondicherry for entry in the HMIS portal.
20. Key conclusions and Recommendations
Yanam district is situated on the coastal area of Andhra Pradesh, a remote place having inadequate educational institutions and other facilities. Medical or Para medical personnel do not prefer to be posted in Yanam District. Hence a special incentive scheme may be introduced to short out the problems or the medical or para medical staff may be diverted from Kakkinada government hospital of Andhra Pradesh for full time functioning at Yanam district hospital.
Vacant positions, especially the specialist namely, Pediatrician Anesthetist, O&G, Specialist in T.B, Ophthalmology and Radiology is to be posted on regular basis to deliver quality services to the patients. Health personnel who are appointed on contract basis will again create shortage of human resource after 1.00 p.m, as they are not available in the hospital 24 x 7.
Trainings for Medical and Para medical staff are inadequate, most of the training was conducted at Pondicherry and the doctors and staff have to travel a lot to attend training and so necessary training may be given at the Yanam district itself.
The space for the district hospital is inadequate. One more well built infrastructure is needed, since all the services are given in one building only. Bed facility is minimum and atleast 20 more bed is required in the hospital. Total number of beds for O&G section is 11 only and at least 6 more beds needed.
Health Sub Centre is well built with facilities. One more PHC/CHC may be put in place of the sub centre which is located far away (i.e 13 k.ms) from the district hospital to meet emergency needs.
Only one operation theatre is available and a separate O.T for O& G section is needed. There is no blood bank facility, as the blood bank was met with fire accident in the hospital and blood is collected from the nearby NGO called Old Age Home., A full fledged Blood Bank may be provided to the hospital. The room for ICTC counseling is inadequate and there is no privacy. Separate section for ICTC with all necessary facilities may be provided.
Adequate drugs and equipments are available and a separate pharmacy store is available. Shortage of medicine is happening lot of time since the medicines has to be arrived from Puducherry. Provision for purchase of essential drugs may be provided to meet out emergency purposes.
Because of shortage of Manpower, equipments like CT scan and Ventilators are not in use for a long time. Trained manpower to utilize the same is needed.
It is essential a need to have a full fledged SNCU with proper equipments in the district hospital.
The government hospital was clean and staff are practicing safety precautions. No proper bio-medical waste management is done at present. The contract with the private player has to be renewed.
The IEC materials were displayed at appropriate places and as the hospital is functioning in a single building, patients could locate the services easily.
Adequate referral transport and MMUs and ‘102’ ambulance was available for emergency services in the hospital.
Disease control programs for Malaria and TB is satisfactory. Every Tuesday and Friday screening for Diabetes and Hypertension is done at the Hospital and the people are aware of this and voluntarily coming for diagnosis. But there is no separate staff for handling the Non-communicable diseases. There is no proper IEC display of NCD. Separate staff for NCD and adequate display of IEC will be helpful in improving the services.
A separate data manager is appointed for HMIS and MCTS. The data related to MCTS are entered at the hospital itself and the HMIS data is sent to Pondicherry for entry in the HMIS portal. But they are to be trained for data validation, outlier, cross check and data quality.
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