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1 ********************************* Highlights from the reports of the Regional Evaluation Teams During 2011-12 ************************* Statistics Division Ministry of Health & Family Welfare Government of India
Transcript

1

*********************************

Highlights from the reports of

the

Regional Evaluation Teams

During 2011-12

*************************

Statistics Division

Ministry of Health & Family Welfare

Government of India

2

Major Findings on the report of the RET for the Year 2011-12

S.No Name of the States

Name of the Districts No. of Districts

Page No.

1 Assam Barpeta, Bongaigaon, Dibrugarh, Karimganj, Cachar and Golaghat

6 3-35

2 Arunachal Pradesh

West Kemang and Tawang 2 36-46

3 Andhra Pradesh Srikakulam, Vizianagaram, Kurnool, Ananthapur, Nalgonda, Mehboob Nagar, Nizamabad, Adilabad, Ranga Reddy and Warangal.

10 47-112

4 Bihar Begusarai, Muzaffarpur, Patna, Nalanda, Madhpura, Bhagalpur, Navada, Shekhpura and Samastipur

9 113-159

5 Chhattisgarh Mahasamund and Surguja (Ambikapur) 2 160-174

6 Daman & Diu Daman & Diu 2 175-183

7 Gujarat Anand, Vadodara, Kheda , Dohad, Tapi and Sabar Kantha

6 184-222

8 Haryana Faridabad, Gurgaon, Fatehabad, Panipat and Jhajjar

5 223-240

9 J & K Reasi 1 241-246

10 Jharkhand Lohardaga, Garhwa, Chatra, Dumka and Kodarma 5 247-266

11 Karnataka Bangalore City, Bangalore Rural, Bangalore(Urban), Tumkur, Dharawad, Belgaum, Shivmoga, Uttara Kannada, Dakshina Kannada and Udupi

10 267-329

12 Kerala Pathanamthitta, Alapuzha, Kottayam, Ernakulam and Kasaragod

5 330-355

13 Maharashtra Gadchiroli, Chandrapur, Pune, Kolhapur, Nagpur, Jalgaon and Nasik,

7 356-388

14 Manipur Chandel and Thoubal 2 389-400

15 Mizoram Serchhip and Aizawl West 2 401-413

16 Madhya Pradesh Bhopal, Shajapur, Dewas, Sehore, Vidisha and Rajgarh

6 414-458

17 Orissa Baleshewar, Navrangpur, Mayurbhanj, Koraput, Nayagarh, Dhenkanal, Sundergarh and Kandhamal

8 459-506

18 Puducherry UT Puducherry and Yanam 2 507-515

19 Punjab Firozpur, Faridkot, Muktsar and Mohali 4 516-538

20 Tamil Nadu Virudhunagar , Thiruvannamalai and Coimbatore 3 539-558

21 Tripura South Tripura and West Tripura 2 559-570

22 Uttar Pradesh Kaushambi, Ballia, Kanpur Dehat, Hamirpur, Meerut, Mathura, Farrukhabad, Hardoi, Lucknow, Gonda and Rampur

11 571-630

23 Uttrakhand Bageshwar, Champawat, Haridwar and Deharadun 4 631-656

24 West Bengal Maldah, N. 24 Parganas, Barddhaman, Kochbehar and Jalpaiguri

5 657-682

Total

119

3

Assam

1. District- Barpeta

Major observations of Regional Evaluation Team, Kolkata about the Evaluation work

carried out in Barpeta district of Assam in May, 2011.

I. Details of the visited Institutions:

District

visited

CHC/BPHCs and MPC visited HSCs visited

Barpeta CHC: Barpeta Road

BPHCs: Barpeta Road, Chenga and

Mandiya

MPHC: Jania

Mouthpart, Barpeta Farm,

Subha, Gajia and Jania

II. Major Observations:

1. Health Human Resources:

a. 19 out of the 147 sanctioned posts of MO were lying vacant in the district.

b. Similarly, 18 ANMs against the sanctioned posts of 382, 33 MPW (M) out of the 145

sanctioned posts and 1 GNM against 34 sanctioned posts were lying vacant in the district.

c. Most of the visited Sub centres were functioning with 2 ANMs and post of MPW (M) at Sub

Centre level was vacant.

d. As reported, there was no post of specialist Doctor sanctioned in the Govt. health centres

in Assam State. GDMO (called as MO- 1) having postgraduate qualification are functioning

to the post of specialist in the district.

e. However, 297 additional ANMs and 51 MOs were also appointed on contractual basis

under NRHM in the district.

2. Functioning of Hospital Management Society:

It was observed that Hospital Management Society has been constituted at visited CHC and

PHCs, but their registration process was not completed. Regular meetings of Hospital

Management Society were not conducted at visited facilities.

3. Functioning of ASHA and Village Health & sanitation Committee (VHSC):

a. 1511 ASHAs have been selected for 908 villages in the district.

b. It was reported that 1472 ASHAs have been trained in 5th modules and were having drug

kits.

c. As reported, there were 1495 VHSCs functioning in the district and all were having ASHA

as a member of the committee.

4

d. VHSC Untied fund to the tune of Rs. 2,12,33,216 including opening balance of Rs.

62,13,216 was available in the year 2010-11 and out of that an amount of Rs. 91,04,218 was

utilized by the VHSCs within the period. No VHSC Untied fund was provided to the district

during current year i.e. in 2011-12 till the time of visit by the team.

4. Services of Janani Suraksha Yojana (JSY):

a. It was observed that sufficient budget provision available under the scheme in the district.

As per the information available, Rs. 4,16,16,911 were spent against the JSY funds

available to the tune of Rs. 8,28,15,083 in the year 2010-11 and balance amount carried

forward to the next year. Similarly, Rs. 17, 06,980 were spent in April, 2011 against the

available funds of Rs. 4, 11, 98,169 during the current year.

b. Institutional deliveries were conducted at CHCs, Block PHCs and some of the Mini PHCs.

C- Section delivery facility was found available at CHC level. Payment of JSY beneficiaries

were found updated at the visited facilities. Sufficient funds were provided in time at

the visited facilities. Registers for JSY were maintained properly containing the list of

beneficiaries to whom JSY incentives had been distributed, but these registers were not

checked properly by concerned Medical Officer.

c. 38 JSY beneficiaries were interviewed in the district for on the spot verification and it was

observed that MCH cards of contacted beneficiaries were filled up properly. 3 ANC,

arrangement of transport by ASHA, accompany and stay of ASHA to the health centre for

institutional delivery, payment of JSY money to beneficiaries and payment of transport

money were found cent percent. 36 (95%) deliveries were found normal, while 2 (5%)

delivery was complicated.

d. It was also observed that the beneficiaries had received JSY incentive packages as per

norms. State Government was paying Rs. 2000 to the beneficiaries of institutional

deliveries from the poor section of the community for promotion of safe delivery.

5. Untied Fund:

a. Details of Untied Fund provided to the district for strengthening the services at different

facilities and utilization of funds are given below:

(Amt in Rs.)

Sr.No. Particulars CHC level PHC level HSC level

2010-11 2011-12 2010-11 2011-12 2010-11 2011-12

1 Opening

balance

13,522 30,818 3,55,265 5,05,035 11,76,401 28,16,151

2 Fund received

3,50,000 Nil 9,00,000 Nil 25,70,000 Nil

3 Expenditure

incurred

3,32,704 Nil 7,50,230 Nil 9,30,250 Nil

4 Balance 30,818 30,818 5,05,035 5,05,035 28,16,151 28,16,151

5

b. Untied Fund released and expenditure incurred in the visited PHCs/CHC in the year 2010-

11 are as follow:

(Amt in Rs)

Name of Institutions Opening

Balance

Released Expenditure

Incurred

Balance

CHC Barpeta Road Nil 50,000 50,000 Nil

PHC Chenga Nil 25,000 23,000 2,000

PHC Mandia 10,135 25,000 27,135 8,000

PHC Jania 21 25,000 12,350 12,671

c. Flow and utilization of Sub Centre Untied Funds was not satisfactory at visited Sub

centres. The funds for the year 2009-10 were provided in the month of March, 2010.

Similarly for the year 2010-11, it was also provided during the month of March, 2011.

6. 24 hours Delivery Care Services:

a. 24 hours delivery care services implemented in 24 institutions i.e. 7 CHCs, 7 BPHCs and

10 Mini PHCs in the district.

b. Facility for caring mothers and new born babies were found adequate at CHC level, while

it was inadequate at PHC level. Blood storage facility was found available at CHC level

while it was not available at BPHCs and Mini PHCs.

c. Deployment of para-medical staff for conducting 24x7delivery care was adequate at all

visited facilities.

7. Physical infrastructure:

(i) Health Sub Centres:

a. The team visited Sub centres at Mouthpart, Barpeta Farm, Subha, Gajia and Jania for

assessment of sub centre facilities. Labour room was not available at sub centres

Mouthpart, Subha, Gajia and Jania.

b. Gentamycin injection was not available at all visited Sub Centres.

c. Delivery table, Mclntsh sheet, Delivery kit and Ampicillin capsule were not available at the

visited centres at Subha, Gajia and Jania.

d. Ambu bag / suction, RDT Kits, EC Pills, Magsulth and Oxitocine tablets were not available

at Sub centres Gajia and Jania.

e. Sanitary Napkins and Magsulth tablets were not available at Sub centres Mouthpart and

Barpeta Farm.

f. Mclntsh sheet and Ambu bag / suction at Sub centre Mouthpart, Ampicillin capsule at Sub

centre Barpeta Farm and Sanitary Napkins at Sub centre Subha were not available.

g. Skilled Birth Attendance training was not received by the Auxiliary Nurse Midwives of

visited Sub centres at Subha, Gajia and Jania.

(ii) PHC:

a. The visited PHCs at Chenga, Mandia and Janiya were functioning in Govt. buildings but

the maintenance of the hospital was not up to the mark.

6

b. Minor surgical equipments and OT table in Operation Theatre were not available in the

visited PHCs. Stock of DPT vaccine and Vitamin- A tablets was also not available in the

visited centres.

c. Auto Clave/ Steam Strilizer and IFA syrup were not available in the visited PHCs at

Mandia and Janiya. Jeep/ Ambulance was not provided at PHC Janiya and the post of

AYUSH Medical Officer was found vacant in the PHC.

(iii) CHC:

CHC, Barpeta Road was upgraded from PHC in the year 2005 without providing additional

space for the CHC. As a result, CHC was functioning in the old building of PHC with

inadequate space. Jeep was not available and residential quarter for MO and Para medical

staff was found inadequate in this CHC.

8. Opinion and awareness of the Community on the Health Services:

(i). ANMs Services:

a. 30 mothers having child up to one year of age were interviewed for assessing their opinion

and knowledge about the services provided by the concerned ANMs in the area of the

visited sub centres. They informed that the ANMs were available at village level as and

when needed.

b. Mothers were mostly unaware about danger signs of ARI, usage of ORS and contraceptive

methods in the areas of visited Subcentres Subha, Gajia and Jania. Visit for Post Natal

checkups were also not made to most of the mothers at Sub centres Subha and Jania.

(II) Services of PHC:

a. The team interviewed 22 persons from different target groups i.e. pregnant women, recently

delivered women, mothers upto two year old child, AWW, ASHA and Villagers in the area of

PHCs Chenga and Mandia. Interviewed people were mostly satisfied with the services.

However, awareness about danger sign of pregnancy during ANC and sick new born care

during ANC were not found satisfactory among the interviewed women.

b. Field visits to the villages in the PHCs area were not made regularly by the MO.

9. Sample Verification of F.W. acceptors:

a. The team selected a total of 101 F.W. acceptors for sample verification and out of that 88

(87%) could be contacted.

b. Among the contacted acceptors, 15 (17%) informed that they did not receive any follow up

services after having accepted the services.

c. 93 beneficiaries of BCG/ DPT/ Polio, Measles and Vitamin- A were contacted in the field. All

beneficiaries were confirmed with doses. Follow up services by health staff were found cent

percent among the contacted beneficiaries.

7

10. Reconciliation of the Reporting Performance:

a. Sterilisation operations mostly are being made in the camps organized by the District office.

There was no facility to conduct the sterilisation in the CHCs/ PHCs. Area wise sterilisation

acceptors are being reported and maintained the records by the CHCs/ PHCs. On

examining the reports and records in the visited PHCs, it was observed that reported

sterilisation cases for the year 2010-11 and 2011-12 (April, 2011) did not tally with the same

figures available at district office and PHC Barpeta Road. No sterilisation register was

maintained at PHCs Chenga and Mandia.

b. Similarly, reported figures for CuT, Oral Pills and Nirodh did not tally to each other. The

details are as below:

Name of the

Centres

During the year 2010-11

CuT Oral Pills in cycle Condoms in pieces

Distric

t

office

Reportin

g

Centres

Veri-

fied

Distric

t

office

Reportin

g

Centres

Veri-

fied

Distric

t

office

Reporting

Centres

Veri-

fied

BPHC

Barpeta

Road

91 73 73 5703

603 *

5335

487 *

NV 22346

1949

*

33600

3790 *

NV

BPHC

Chenga

371 371 145 - - - - - -

BPHC

Mandia

552 526 235 21128 20837 NV - - -

(*) Figures are for the year 2011-12 (April, 2011)

11. Registers, records and reports maintained at the visited centres:

a. Printed Eligible Couple register were maintained but not updated at visited facilities.

b. Service registers for Sterilization were not maintained in the visited PHCs at Chenga and

Mandia.

c. Oral Pills and Nirodh users registers and Stock register were maintained with the required

details of users at visited facilities.

12. IT Infrastructure:

Sufficient Computers were found available at District, CHC, Block PHC and Mini PHC

level. Internet connectivity was found available at District and Block headquarters level

only. Internet connectivity was not found available at Mini PHCs.

13. Miscellaneous Observation and Suggestions:

a. Performance of Family Planning methods i.e. sterilisation, CuT, OP and CC was found

very poor in the district. It can be improved by involving ASHA/ ANM and others

stakeholders of local community.

b. JSY activities were running smoothly in the district particularly in visited hospitals, but

beneficiaries were not getting incentive at the time of discharge because JSY cards along

with necessary papers were not being submitted in due time to the office of the hospital. In

8

visited PHC headquarter the team noticed that the A/C payee cheques in favour of

mothers were being drawn by some other persons/ ASHAs without complying office

procedure.

c. The Medical officer In charge of visited facilities reported that they could not keep

delivered mothers 48 hours for post delivery observation due to insufficient infrastructure,

space and beds. Most of the mothers were released 5-10 hours after delivery.

d. Monitoring and supervision need to be strengthened in the district.

e. Printed register for Family Planning, JSY payment and Stock book should be made

available at all facilities to maintain uniformity.

2. District- Bongaigaon

Major observations of Regional Evaluation Team, Kolkata about the Evaluation work

carried out in Bongaigaon district of Assam in May, 2011.

I. Details of the visited Institutions:

District visited CHC/BPHCs and MPHCs visited HSCs visited

Bongaigaon CHC: Abhayapuri

BPHCs: Boitamari, Srijangram,

Manikpur

MPHCs: Dhamtola, Patiladoha

Kakaijana, Dhamtola, North

Boitamari, Novapara and

Barbila

II. Major Observations:

1. Health Human Resources:

a. 22 out of the 85 sanctioned posts of MOs were lying vacant in the district.

b. Similarly, 5 against sanctioned posts of 95 ANMs, 1 MPW (M) out of the 16 sanctioned

posts and 8 GNM against 21 sanctioned posts were lying vacant in the district.

c. As reported, there was no post of specialist Doctor sanctioned for the Govt. health facilities

in Assam State. GDMO (called as MO- 1) having postgraduate qualification are functioning

to the post of specialist in the district.

d. However, 71 additional ANMs were appointed on contractual basis under NRHM in the

district. Most of the visited Sub centres were functioning with 2 ANMs and post of MPW

(M) at Sub Centre level was vacant.

2. Functioning of Rogi Kalyan Samiti (RKS):

RKS (called Hospital Management Society (HMS) in the state) has been constituted at visited

CHC and PHCs, but registration process was not completed. Regular meetings of Hospital

Management Society were not conducted at visited facilities.

9

3. Functioning of ASHA and Village Health & sanitation Committee (VHSC):

a. 699 ASHAs have been selected in 699 villages in the district and out of that 633 ASHAs

have been trained in all 5th modules and 600 ASHAs were having Drug kits.

b. As reported, there were 590 VHSCs functioning in the district and all were having ASHA

as a member of the committee.

c. VHSC Untied fund to the tune of Rs. 1,08,17,118 including opening balance of Rs.

49,17,118 was available in the district in the year 2010-11 and out of that an amount of

Rs. 36,86,036 was utilized within the period by the VHSCs. No VHSC Untied fund was

provided to the district during current year up to the time of visit by the team.

4. 24 hours delivery care services:

a. 24 hours delivery care system implemented in 24 institutions i.e. 4 CHCs, 4 BPHCs and

16 Mini PHCs in the district.

b. Facility for caring mothers and new born babies were found adequate at CHC level, while

it was inadequate at PHC level. Blood storage facility was not available at CHC and PHC

level.

c. Deployment of para-medical staff for conducting 24x7delivery care was adequate at all

visited facilities.

5. Untied Funds:

a. Details of Untied Fund provided to the district for strengthening the services and utilized at

different level of facilities are given below

( Amt in Rs.)

Sr.

No.

Particulars CHC level PHC level HSC level

2010-11 2011-

12

2010-11 2011-12 2010-11 2011-12

1 Opening balance

923 30,449 2,06,343 5,01,503 5,68,858 6,87,942

2 Fund received

1,00,000 Nil 6,75,000 Nil 5,70,000 Nil

3 Expenditure

incurred

70,474 5,107 3,79,840 19,040 4,50,916 Nil

4 Balance 30,449 25,342 5,01,503 4,82,463 6,87,942 6,87,942

b. Untied Fund released and expenditure incurred in the visited PHCs/CHC in the year 2010-11 is as

below:

(Amt in Rs)

Name of Institutions Opening

Balance

Released Expenditure

Incurred

Balance

CHC Abhayapur 74 50,000 20,474 29,600

PHC Boitamari 381 25,000 15,374 10,007

PHC Srijangram 13,499 25,000 32,102 6,397

PHC Manikpur 7,825 25,000 10,422 22,403

PHC Dhamtola Nil 25,000 25,000 Nil

PHC Patiladoha 3,917 25,000 25,622 3,295

10

c. Flow and utilization of Sub Centre Untied Fund was not satisfactory at visited Sub

centres. The fund for the year 2009-10 was provided in the month of March, 2010.

Similarly for the year 2010-11 the same was provided during the month of March, 2011.

6. Services of Janani Suraksha Yojana (JSY):

a. There was sufficient funds available under the scheme in the district. As per the

information available, Rs. 1,54,50,603 were spent against the JSY funds available to the

tune of Rs. 3,06,94,398 in the year 2010-11 and balance amount carried forward to the

next year. Similarly, Rs. 9,32,200 were spent against available funds of Rs. 1,52,43,795

during the current year (April, 2011).

b. Institutional deliveries were conducted at CHCs, Block PHCs and some of the Mini PHCs.

As reported, total number of deliveries eligible for payment were 8084 and 647 for the last

year and current year in the district and out of which 8084 and 586 beneficiaries were paid

in the respective years. JSY payment to 61 beneficiaries was yet to make at the time of

visit during the current year.

c. C- Section delivery facility was found available at CHC level. Payment of JSY beneficiaries

were updated at facilities. Sufficient funds were provided in time at the visited facilities.

Registers for JSY were maintained properly containing the list of beneficiaries to whom

cash had been distributed and registers were checked properly by concerned Medical

officer In charge.

d. 46 JSY beneficiaries were interviewed in the district for on the field verification and, it was

observed that they had received three consecutive ANCs in their nearest health care

centre and MCH cards were issued to mothers by the health personnel. ASHA was

accompanying with mothers for institutional delivery.

e. It was also observed that the beneficiaries had received JSY incentive packages as per

norms. Most of the beneficiaries from the poor section of the community were coming to

Govt. Hospital for institutional delivery and State Government was paying to mothers to

the tune of Rs. 2000 in each institutional delivery for promotion of safe delivery.

7. Physical infrastructure (HSC/BPHC/CHC)

(i) Health Sub Centres:

a. All the visited Sub centres were functioning in Govt. buildings but their maintenance was

not up to the mark. Labour room was not available at sub centres of Kakaijana, Dhamtola,

North Boitamari and Barbila.

b. Delivery table, Ambu bag/suction, Delivery kit, Magsulth, Oxitocine tablets, Ampicillin

capsule and Gentamycin injection etc. were not found available in all the visited centres.

c. Mclntsh sheet, Sanitary Napkins and EC Pills were not available in the visited sub centres

of Kakaijana and Novapara.

11

d. RDT Kit for Malaria, Sanitary Napkins and EC Pills at sub centre Barbila, Mclntsh sheet

and EC Pills at sub centre Dhamtala, Mclntsh sheet and Sanitary Napkins at Sub Centre

North Boitamari were not available.

e. Skilled Birth Attendance training was not given to the Auxiliary Nurse Midwives in all the

visited Sub centres.

(ii) PHCs:

a. The visited PHCs at Boitamari, Dhamtola, Srijangram, Manikpur and Patiladoha were

functioning in Govt. buildings but maintenance of the hospitals was not up to the mark.

b. Functional Operation Theatre with OT table was not available and no stock of DPT

vaccine and Vitamin- A tablets were found available at visited PHCs.

c. Telephone facility and IFA syrup were not available in the visited PHCs at Dhamtola,

Srijangram and Patiladoha. Jeep/ Ambulance of PHC Patiladoha and IFA syrup of PHC

Manikpur was not available.

d. AYUSH Medical Officer was not posted in the visited PHCs at Dhamtola and Patiladoha.

(iii) CHC:

CHC was functioning in Govt. building but the maintenance of the hospital was not up to

the mark. Sick New Born Care Unit was not available in this CHC.

8. Opinion of the Community on the Health Services:

(I). Services of ANM:

20 mothers having child of one year age were interviewed in the area of SCs Novapara and

Barbila for assessing their opinion and knowledge about the services provided by the

concerned ANMs. They informed that the ANMs were available at village level as and when

needed. Mothers were mostly satisfied with the services rendered by the concerned ANMs

in the areas of centres visited.

(II) Services of PHC:

a. team interviewed pregnant women, recently delivered women, mothers upto two year old

child, AWW, ASHA and other Villagers in the area of visited PHCs at Boitamari and

Dhamtola. Community was generally satisfied with the work of MO and staff of the visited

PHCs.

b. The Medical officer at PHC Boitamari was not visiting the villages under the PHC regularly.

Village leader of PHC Dhamtola complained about the non availability of MO and

inadequate availability of para-medical staff. There was no MO posted at PHC.

9. Sample Verification of F.W. acceptors:

a. The team selected a total of 157 F.W. acceptors and out of that 144 (92%) could be

contacted for sample verification.

12

b. Among the contacted acceptors, 8 (6%) informed that they did not receive any follow up

services after having accepted the services.

c. 99 beneficiaries of BCG/ DPT/ Polio, Measles and Vitamin- A was selected and out of that

96 (97%) beneficiaries were contacted. All contacted beneficiaries were confirmed with

doses. Follow up services by health staff were need to the contacted beneficiaries.

10. Reconciliation of the reporting performance under Sterilization:

a. Sterilisation operation mostly were being done in the camps organized by the District office.

There was no facility to conduct sterilisations in the CHCs/ PHCs. Area wise sterilisation

acceptors are being reported and records are maintained by the CHCs/ PHCs. On

examining the reports and records in the visited BPHCs at Boitamari and Manikpur, the

reported figures of sterilisation were found more than the recorded number of cases for the

year 2010-11.

b. Similarly, the reported figures of CuT for the year 2010-11 and 2011-12 (April, 2011) in the

visited BPHCs at Boitamari, Srijangram and Manikpur were much more than the recorded

cases in the same registers.

c. Figures reported by the district office for Oral Pills and Condom for the year 2010-11 did not

match with the same figures reported at BPHC Boitamari.

11. Registers, records and reports maintained at the visited centres:

a. Printed Eligible Couple register were maintained but not updated at visited facilities.

b. Service registers for Sterilization and CuT were not updated in all the visited facilities.

c. Oral Pills and Nirodh registers were not recorded with the required details at BPHCs

Boitamari and Srijangram.

12. IT Infrastructure:

Sufficient Computers were found available at District, CHC, Block PHC and Mini PHC level.

Internet connectivity was found available at District and Block headquarter level only.

Internet connectivity was not found available at Block PHC Srijangram, CHC Abhayapur and

Mini PHCs.

13. Miscellaneous observation and suggestions:

a. Performance of Family Planning was poor in the district.

b. JSY activities were running smoothly in the district particularly in visited hospitals, but

beneficiaries are not getting incentives on the date of discharge because JSY cards along

with necessary papers are not submitted in due time. In visited PHC headquarter the team

noticed that the A/C payee cheques in favor of mothers were drawn by some other persons/

ASHAs without complying office procedure.

c. It was reported that delivered mothers could not be kept 48 hours in hospital for post care

delivery observation due to insufficient infrastructure, space and beds. Most of the mothers

were released after 5-10 hours of delivery.

13

d. Monitoring and supervision was almost absent which need to be strengthened at facility

level.

e. Printed register for Family Planning, JSY payment and Stock book should be made

available at all facilities to maintain uniformity.

3. District- Dibrugarh

Major observations of Regional Evaluation Team, Kolkata about the Evaluation work

carried out in Dibrugarh district of Assam in June, 2011.

I. Details of the visited Institutions:

District visited CHC/BPHCs/MPHC visited SCs visited

Dibrugarh CHCs: Rajgarh, Naharani, Moran Tiloi

BPHCs: Tengakhat, Nahrani, Khowang

MPHC: Tingkhong

Kachuagaon, Walton Grant,

Subkait and Tilika Amguri

II. Major Observations:

1. Health Human Resources:

a. 16 out of the 272 sanctioned posts of ANM, 4 out of the 6 sanctioned posts of Health

Supervisor (BEE) were lying vacant.

b. All the sanctioned posts of LHV, MPW (M) and Lab Technician were filled up in the district.

191 additional ANMs and 27 MOs were also appointed on contract basis under NRHM in

the district.

c. During visit to the centres, it was observed that the details received from the district office

in respect of staff position given above are misleading. District had reported single

vacancy of regular Medical officer, while visit to CHC Rajgarh it was found that the CHC

was functioning with a single MO and other posts of Doctors were vacant. Similarly, posts

of ANM, MPW (M), GNM, LHV, Male Supervisors, Lab Technician etc. were found vacant

at visited centres. Most of the visited Sub centres were functioning with single ANM and

without MPW (M).

2. Functioning of Hospital Management Society:

It was observed that Hospital Management Society has been constituted at 5 CHCs, 6 PHCs

and 22 MPHCs, but registration process was not completed. Regular meetings of Hospital

Management Society were not conducted at visited facilities.

3. Functioning of ASHA and Village Health & sanitation Committee (VHSC):

a. Though the district has a target to select a ASHA in every village in the district presently,

1145 ASHAs have been selected for 1145 villages against the total no. of 1185 villages

available in the district.

14

b. It was reported that all selected ASHAs have been trained up to 5th modules and were

having Drug kits.

c. 1145 VHSCs were functioning in the district and all are having ASHA as a member of the

committee.

d. It was observed that, untied funds are being provided to VHSCs without looking at the

status of availability and utilization of funds. In spite of having huge unspent balance

amount of Rs. 1,26,30,000 lying with the district under the head of VHSC Untied funds as

on 1st August 2010 an amount of Rs. 98,70,000 was released to the district for 987 VHSC

in the year 2010-11. It was reported that full funds could not utilized by the VHSCs in the

district during 2010-11.

4. Services of Janani Suraksha Yojana (JSY):

a. There was sufficient budget provision available under the scheme in the district. As per the

information available, Rs. 3,56,90,577 were spent against the JSY fund available to the

tune of Rs. 4,52,86,375 in the year 2010-11 and balance amount Rs. 95,95,798 carried

forward to the next year and out of that Rs. 31,14,830 were spent during the current year

(up to May, 2011).

b. As per the district report total 22473 and 2967 mothers were eligible for JSY payment in

2010-11 and the current year 2011-12 respectively, out of that 16738 and 1948

beneficiaries in the respective year were paid with incentives.

c. 38 JSY beneficiaries were interviewed in the district for on the field verification and it was

observed that they had received three consecutive Ante Natal checks up in their nearest

health care centre and MCH cards were issued to mothers by the health personnel. ASHA

was accompanying with mothers for institutional delivery.

d. All deliveries were found normal. Transport money was not paid to any beneficiary, though

transport was self arranged by beneficiaries. 39.5% beneficiaries were paid JSY money at

the time of discharge while 60.53% were paid after one week of delivery.

e. JSY beneficiaries register were found maintained at visited facilities but all relevant details

were not recorded in the registers and also not found properly checked/ signed by

concerned Medical officers.

5. Untied Funds:

a. Details of Untied Fund provided to the district for strengthening the services at different

facilities and utilization of funds are given below

15

( Amt in Rs.)

Sr.No. Particulars CHC level PHC level HSC level

2010-11 2011-

12

2010-11 2011-12 2010-11 2011-12

1 Opening balance (-) 14,340 23,912 43,500 63,054 46,35,796 50,95,459

2 Fund received 2,50,000 Nil 1,25,000 Nil 22,10,000 Nil

3 Expenditure

incurred

2,11,748 Nil 1,05,446 Nil 17,50,337 Nil

4 Balance 23,912 23,912 63,054 63,054 50,95,459 50,95,459

b. Untied Funds released and expenditure incurred in the visited PHCs/CHC in the year 2010-11 are

as follow:

(Amt in Rs)

Name of

Institutions

Opening

Balance

Released Expenditure

Incurred

Balance

CHC Rajgarh 5,560 50,000 55,560 Nil

CHC Moran Tiloi 452 50,000 46,545 3,907

CHC Naharani 1,453 50,000 44,915 6,538

PHC Tengakhat 31,048 25,000 32,665 23,383

PHC Khowang 590 25,000 22,200 3,390

PHC Tingkhong 35,751 25,000 44,508 16,243

6. 24 hours Delivery Care Services:

a. 24 hours delivery care services were being provided in 27 institutions i.e. in 5 CHCs, 5

BPHCs, 10 Mini PHCs and 7 State Dispensaries in the district.

b. Required facilities for caring mothers and new born babies were inadequate at CHC

Rajgarh, BPHC Tengakhat and MPHC Tingkhong. Deployment of para-medical staff for

conducting deliveries in 24x7 centres was adequate at all the visited facilities.

c. Blood storage facility was found available at Moran Tiloi CHC but it was not available at

other centres.

7. Physical infrastructure:

(i) Health Sub Centres:

a. The team visited Sub centres at Kachuagaon, Walton Grant, Subkait and Tilika Amguri for

assessment of sub centre facility. Labour room was not available in all visited sub centres.

b. Delivery table, Mclntsh sheet, Sanitary Napkins and Ampicillin capsule were not available

at all the visited centres.

c. Electricity connection and Toilet facility were not provided to the Sub centres of

Kachuagaon, Walton Grant and Subkait.

d. Ambu bag/ suction, Nischay Pregnancy Test Kit and CuT at Sub Centre Kachugaon,

Ambu bag / suction, CuT Insertion Kit, RDT Kits, CuT and Oxitocine tablets at Sub Centre

Walton Grant, Nischay Pregnancy Test Kit and RDT Kits at Sub Centre Subkait, Ambu

bag/ suction and RDT Kits at Sub centre Tilika Amguri were not available.

16

e. Skilled Birth Attendance training was not provided to the Auxiliary Nurse Midwive at Sub

centre Kachuagaon.

(ii) PHCs:

a. The PHCs at Tengakhat, Tingkhong and Khowang were visited and found Operation

Theatre was not available. No stock of DPT vaccine, IFA syrup and Vitamin- A tablets was

observed at visited PHCs.

b. AYUSH Medical Officer was not posted at PHC Tingkhong and Residential quarter not

available for MO at PHC Tengakhat.

(iii) CHC:

a. Maintenance of the hospital building was not up to the mark at all visited CHCs and Jeep

was not provided there.

b. Blood storage unit was not functional in CHC Naharani and the same was not available in

CHC Rajgarh.

c. In Sick new born care unit, adequate facility was lacking in CHC Rajgarh and the same

was not functioning in CHC Moran Tiloi.

d. Residential quarter for MO and Para medical staff was not available at CHC Moran Tiloi

and it was inadequate in CHC Naharani.

8. Opinion and awareness of the Community on the Health Services:

(i). ANMs Services:

20 mothers having child up to one year of age were interviewed for assessing their opinion

and knowledge about the services provided by the concerned ANMs at sub centre level.

Mothers were mostly satisfied with the work of ANMs in the areas of centres visited.

However, Post Natal checkups need to be increased to cover all needy mothers.

(II). Services of PHC:

To assess the opinion on the services provided in PHCs Tengakhat, Tingkhong and

Khowang different community members i.e. pregnant women, recently delivered women,

mothers upto two year old child, AWW, ASHA and Villagers were contacted. It was

observed that community was generally satisfied with the services. However, awareness

about danger signs during ANC and sick new born babies and also about HIV/STD/AIDS

was found poor. Community members were dissatisfied for the adequate availability of

drugs in PHCs and for the regular visit to the remote villages by the MO.

9. Sample Verification of F.W. acceptors:

a. The team selected a total of 89 F.W. acceptors and out of that 84 (94%) could be contacted

for sample verification.

b. Among the contacted acceptors, 30 (37%) informed that they did not receive any follow up

service after having accepted the services.

17

c. 132 beneficiaries of BCG/ DPT/ Polio, Measles and Vitamin- A was selected and out of that

131 (99%) beneficiaries could be contacted. All contacted beneficiaries were confirmed with

doses. Cent percent follow up by health staff was made to contacted beneficiaries.

10. Reconciliation of the reporting performance under Sterilization:

a. Sterilisation figures reported by BPHCs at Tengakhat and Khowang for the year 2010-11

did not tally with the same figures reported by district office. Similarly, reported figures of

Sterilisation were more than the registers figures in BPHCs Tengakhat and Naharani for the

year 2010-11.

b. CuT figures reported by BPHCs at Tengakhat, Naharani and Khowang for the year 2010-11

and 2011-12 (up to May, 2011) were not matching with registered cases in BPHCs and with

the same figures reported by district office.

c. The details are given below:

Name of the

Centres

During the year 2010-11

Sterilizations reported by CuT reported by

District

office

Reporting

Centres

Recorded

in

registers

District

office

Reporting

Centres

Recorded

in registers

BPHC

Tengakhat

487 483 423 295 290 290

BPHC

Naharani

754 754 494 841 841 481

BPHC

Khowang

649 606 NV 521 421 207

Name of the

Centres

During the year 2011-12 ( up to May, 2011)

CuT reported by

District

office

Reporting

Centres

Recorded

in registers

BPHC Tengakhat 52 52 29

BPHC Naharani 173 201 31

BPHC Khowang 91 91 NV

_ Figures matched to each other

NV- Figures not verified due to absence of service register.

11. Registers, records and reports maintained at the visited centres:

a. Eligible Couple register which is one of the most important records for FW services were

not updated with all details at visited facilities.

b. Service registers for Sterilization were not updated with all details at visited facilities.

Consolidated CuT service registers were not found to be maintained except BPHC

Tengakhat.

18

c. Oral Pills and Nirodh users registers and Stock register were maintained without all

relevant details at visited facilities.

12. IT Infrastructure:

Computers were found available at District, CHC, Block PHC and Mini PHC level. Internet

connectivity was found available at visited facilities except CHC Rajgarh, BPHC Naharani

and MPHC Tingkhong.

13. Miscellaneous observation and suggestions:

a. It was observed that monitoring and regular supervision at periphery level was not effective.

Field visit of ANM may be enhanced keeping in mind of quality of services. They may keep

their records/ dairy of field duties while going on field visit. LHV, BEE and Health Educator

should conduct field work for supportive supervision in respective field area.

b. JSY activities were running smoothly in the district particularly in visited hospitals, but

payment to mother was not done on the date of discharge from the hospital as the JSY card

with necessary supporting papers were not submitted by the beneficiaries/ASHAs timely

and properly.

4. District- Golaghat

Major observations of Regional Evaluation Team, Kolkata about the Evaluation work

carried out in Golaghat district of Assam in June, 2011.

I. Details of the visited Institutions:

District visited CHC/BPHCs/MPHC visited SCs visited

Golaghat BPHCs: Kamarbandha Ali (K B

Ali), Missamora and Charigia

Napamua Kumargaon, Kacharihat,

Rangamati, Sital Pathar, Kakotigaon

and Adhar Satra

II. Major Observations:

1. Health Human Resources:

a. Details of the sanctioned strength of human resources in the district office as well in the

visited CHCs, BPHCs and Mini PHCs were not made available. However, as reported 174

ANMs, 25 MPWs (M), 17 LHVs, 56 MOs, 46 GNMs, 25 Lab Technicians and 49

Pharmacists were in position in the whole district.

b. In addition to the above regular posts, 177 additional ANMs, 26 MOs, 126 GNMs and 23

Lab Technicians were appointed on contact basis under NRHM in the different facilities in

the district.

c. In the visited PHCs, strength of ANM, MPW (M) and Supervisory staff was less in

comparison to the number of Sub centres.

19

2. Functioning of Hospital Management Society:

It was observed that Hospital Management Society has been constituted at visited CHC and

PHCs, and its registration was under process. Regular meetings of Hospital Management

Society were not conducted at visited facilities.

3. Functioning of ASHA and Village Health & sanitation Committee (VHSC):

a. district has fulfilled its targeted no. of ASHA by selecting 1002 ASHAs for 1159 villages in

the district.

b. It was reported that 993 ASHAs have been trained in 5 modules and 919 ASHAs were

provided with drug kits.

c. 960 VHSCs were constituted in the district having ASHA as a member.

4. 24 hours delivery care services:

a. 24 hours delivery care services were being provided in 23 institutions i.e. in 4 CHCs, 4

BPHCs, 13 Mini PHCs, 1 State Dispensary and 1 SHC in the district.

b. Facilities for caring mothers and new born babies were inadequate at BPHC Chargia,

though Deployment of para-medical staff for conducting deliveries in 24x7 centres was

adequate at all visited facilities.

c. Blood storage facility was not available in all the visited BPHCs.

5. Untied Funds:

a. The purpose of providing Untied fund was not fulfilled in the district. There was no proper

supervision and regular watch towards untied funds for improving the health services at

facilities. It was reported that the funds are being given to the Sub Centres and PHCs

without considering the previous opening balance and that too not in proper time.

b. During visit to PHCs and Sub Centres in the district, the status of availability and utilization

of funds observed is given below:

Untied Fund for the year 2010-11

( Amt in Rs)

Name of

Institutions

Opening

Balance

Released Expenditure

incurred

Balance

PHC K. B. Ali Nil 25,000 Nil 25,000

PHC Missamora 10,000 25,000 9,144 25,856

PHC Charigia 1,812 25,000 20,100 6,712

SC Napamua Kumargaon 19,509 10,000 6,687 22,922

SC Kacharihat 16,656 10,000 6,869 19,787

SC Rangamati 4,689 10,000 1,141 13,548

SC Sital Pathar 20,662 10,000 12,164 18,648

SC Adhar Satra 10,354 10,000 16,051 4,303

20

c. It was observed that Untied fund for the year 2010-11 was released to the sub centres

in the month of March, 2011 and to the PHCs in the month of January, 2011. No Untied

fund at periphery level was released by the district authority during the current year

2011-12 up to the visiting month.

6. Services of Janani Suraksha Yojana (JSY):

a. There was sufficient budget provision under the scheme in the district. As per the

information available, Rs. 2,71,47,314 were spent against the JSY fund available to the

tune of Rs. 4,42,85,636 in the year 2010-11 and balance amount Rs. 1,71,41,322 carried

forward to the next year and out of that Rs. 37,95,277 were spent during the current year

(up to May, 2011).

b. As per the district report total 14360 and 1779 mothers were eligible for JSY incentives for

the last year 2010-11 and the current year 2011-12 respectively, out of that 14079 and

1894 beneficiaries in the respective year were paid with JSY benefits.

c. 31 JSY beneficiaries were interviewed in the district and it was observed that they had

received three consecutive AN checks up in their nearest health care centre and MCH

cards were issued to mothers by the health personnel. ASHA was accompanying with

mothers for institutional delivery.

d. All deliveries were found normal at the visited centres. Transport money was not paid to

any beneficiary, though transport was self arranged by beneficiaries.

e. JSY beneficiaries register were found maintained at visited facility and were checked/

signed by concerned Medical officers.

7. Physical infrastructure (HSC/BPHC/CHC)

(i) Health Sub Centres:

a. Labour room, Delivery table, Ambu bag/suction, Steam sterilizer and CuT etc. were not

found available in almost all the visited centres.

b. EC Pills and Oxitocine tablets were not available in the Sub Centres of Napamua

Kumargaon, Kacharihat and Rangamati.

c. RDT Kit for Malaria and DDKs at Sub Centre Napamua Kumargaon, Electricity, RDT Kit for

Malaria and Ampicillin capsule at Sub Centre Kacharihat, Electricity and Ampicillin capsule

at Sub Centre Rangamati, EC Pills at Sub Centre Sital Pathar, DDKs, Oxitocine tablets

and Ampicillin capsule at Sub Centre Kakotigaon and RDT Kit for Malaria at Sub Centre

Adhar Satra were not found available.

d. Skilled Birth Attendance training was not given to the Auxiliary Nurse Midwives in the

visited Sub centres at Napamua Kumargaon, Rangamati and Kakotigaon.

21

(ii) BPHC:

a. The BPHCs at K.B. Ali, Missamora and Charingia were visited and found that Operation

Theatre is available there. No stock of DPT vaccine, IFA syrup and Vitamin- A tablets

available at visited PHCs.

b. Resuscitation equipment was not functional in BPHC of Missamora and it was not

available at BPHC Charingia.

c. AYUSH Medical Officer was not posted in the visited BPHCs at Missamora and

Charingia.

d. Residential quarter for MO was not available at BPHC Missamora and the same was

found inadequate at BPHC Charingia.

8. Opinion of the Community on the Health Services:

(I). Services of ANM:

20 mothers having child up to one year old were interviewed in the area of SCs

Kakotigaon and Adhar Satra for assessing their opinion and knowledge about the services

provided by the concerned ANMs. Mothers were mostly satisfied with the work of ANMs in

the areas of centres visited. However, health staff were not visiting to the mothers for

providing Post Natal services in these areas.

(II). Services of BPHC:

To assess the opinion on the services provided in PHCs K.B. Ali, Missamora and

Charingia different community members i.e. pregnant women, recently delivered women,

mothers upto two year old child, AWW, ASHA and Villagers were contacted. It was

observed that community was generally satisfied with the services. Awareness about

danger signs during ANC and sick new born babies and also about HIV/STD/AIDS was

poor. Community members were dissatisfied for inadequate availabilities of drugs in PHCs

and irregular visit by MOs to the remote villages.

9. Sample Verification of F.W. acceptors:

a. The team selected a total of 113 F.W. acceptors and out of that 109 (96%) could be

contacted for sample verification.

b. Among the contacted acceptors, 10 (9%) informed that they did not receive any follow up

service after having accepted the services.

c. 75 beneficiaries of BCG/ DPT/ Polio, Measles and Vitamin- A was selected and out of that

69 (92%) beneficiaries could be contacted. All contacted beneficiaries were confirmed with

doses. Follow up by health staff was found cent percent among contacted beneficiaries.

22

10. Reconciliation of the reporting performance under Sterilization:

a. Sterilisation operation mostly are done in the camps organized by the District office. There

was no facility to conduct the sterilisation in the CHCs/ PHCs. Area wise sterilisation

acceptors are being reported and maintained the records by the CHCs/ PHCs. On

examining the reports and records in the visited PHCs, reported sterilisation cases for the

year 2010-11 did not tally with the same at district office and BPHCs K.B. Ali, Missamora

and Charingia. No sterilisation cases were reported at BPHCs Missamora and Charingia

during current year (up to May, 2011).The details are as below:

Name of the Centres Sterilisation reported during 2010-11

District office Reporting Centres Verified

BPHC K.B. Ali 515 511 NV

BPHC Missamora 557 566 556

BPHC Charigia 433 457 NV

NV- Figures could not verify for want of service register maintained

b. Similarly, reported figures for CuT, Oral Pills and Nirodh did not tally to each other. The details are

as below:

Name of the

Centres

During the year 2010-11

CuT Oral Pills in cycle Condoms in pieces

Distric

t

office

Reportin

gCentr

es

Verifie

d

Distric

t

Office

Reportin

g

Centres

Verified District

Office

Reportin

g

Centres

Verified

BPHC K.B. Ali 815 814 127 17514 17506 NV 97467 112281 NV

BPHC

Missamora

157 173 NV 7073 6758 NV 30655 30358 NV

BPHC Charigia - - - - - - - - -

During the year 2011-12 (up to May, 2011)

BPHC K.B. Ali 59 58 11 - - - 18958 19343 NV

BPHC

Missamora

29 29 5 1047 1125 NV 5590 6522 NV

BPHC Charigia - - - - - - - - -

NV- Figures not verified due to absence of service register.

11. Registers, records and reports maintained at the visited centres:

a. Eligible Couple register which is one of the most important records for FW services was

not updated at visited facilities.

b. Stock record being maintained for spacing methods of Family Planning were not recorded

properly at the visited centres.

23

c. In all the visited centres, Oral Pills and Nirodh register was not maintained properly.

12. Miscellaneous observation and suggestions:

a. As reported there was no proper facility for conducting sterilisation operations in the field. It

is suggested that OT table, Bed with linen, Transport etc. may be made available to the

District Laparoscopic Team.

b. No ANM at Sub Centre level was trained for CuT insertion as a result insertion of CuT at SC

level was nil.

c. It was observed that monitoring and regular supervision at periphery level was not effective.

Field visit of ANM may be enhanced keeping in mind the quality of services. They may keep

their records/ dairy for field duties while making field visits. LHV, BEE and Health Educator

should conduct field work for supportive supervision in respective field area.

d. Printed register for Family Planning, JSY payment and Stock book may be supplied to all

facilities to maintain uniformity in maintaining records.

e. ANM and ASHAs may be encouraged to submit the necessary papers of JSY mothers in

time to enable Block Accounts Manager and SDMO to pay benefit to the mothers on the

date of discharge from the hospital.

5. District: Karimganj

Major observations of Regional Evaluation Team, Kolkata on the Evaluation work carried out in Karimganj district of Assam in February, 2012. I. Details of the visited Institutions:

District visited CHC/BPHCs/MPHC visited SCs visited Karimganj CHC: Srigouri

BPHCs: Nilambazar, R.K. Nagar, atharkandi & Kachuadam Mini PHCs: Chargola & Baraigram

Bazarghat, Baraigram and Moina

II. Major Observations:

1. Health Human Resources: a. Vacant position of regular posts in respect of skilled manpower are mostly filled by posting

contractual personnel under NRHM in the district. As observed 19 out of the 79 sanctioned

posts of MO were vacant but 31 posts of MOs were also posted under contractual basis in

the district. There was no Specialist post sanctioned at any CHC/ BPHC in the entire

district.

b. 64 out of the 272 sanctioned posts of ANM, 18 out of the 80 sanctioned posts of MPW (M),

3 out of the 23 sanctioned posts of MPS (F), 10 out of the 26 sanctioned posts of GNM/

Staff Nurse and 12 out of the 41 sanctioned posts of Pharmacist were lying vacant in the

24

district. But there were 181 ANMs, 44 GNM/ Staff Nurse and 5 Pharmacists posted on

contact basis in the district.

c. The post of Superintendent of Civil Hospital, Karimganj was vacant since last 3 years.

Similarly, 3 Posts of SDM & HO, in each BPHCs at Nilambazar, Kachuadam and Girishganj

were lying vacant since last 6 years. Post of Dy. Superintendent of CHC Srigauri was

vacant since long back; one lady SMO was the incharge of CHC at Srigauri and BPHC

Kachuadam.

d. It was reported that posts of MO, 3 at CHC Srigouri, 3 at PHC Nilambazar, 2 at PHC RK

Nagar and 1 at PHC Patharkandi were vacant out of 5 sanctioned posts at each centre. 1

out of the 2 sanctioned posts MO at MPHC, Chargola and all 2 sanctioned posts of MO at

MPHC Baraigram were lying vacant. No regular Medical officer was posted at BPHC

Kachuadam.

e. In PHC Nilambazar, 3 of the 42 sanctioned posts of ANMs and 1 MPS (F) out of the 5

sanctioned posts was lying vacant. However, 18 of the 51 sanctioned posts of ANMs, 3 of

the 5 sanctioned posts of MPS (F), all 9 sanctioned posts of MPS (M), 1 of the 4 sanctioned

posts of Lab Technician and 8 against 10 sanctioned posts of Pharmacist were lying vacant

in PHC RK Nagar. Likewise, 16 of the 64 sanctioned posts of ANMs and 2 out of the 5

sanctioned posts of MPS (F) were lying vacant in PHC Patharkandi.

f. Similarly, 1 post of Lab Technician at MPHC Chargola and 3 against 11 sanctioned posts of

ANMs at MPHC Baraigram were lying vacant.

2. Functioning of Rogi Kalyan Samiti: It was observed that Rogi Kalyan Samiti has been constituted at all visited facilities, but

registration process was not completed till the visit of the team in the district. Regular

meetings of Rogi Kalyan Samiti were not being conducted at visited facilities.

3. Functioning of ASHA and Village Health Sanitation & Nutrition Committee (VHSNC): a. The district targeted 1195 ASHAs for 1065 villages out of total 1213 villages in the district.

Presently, there were 1130 ASHAs in position in the district and out of that 1051 ASHAs

were trained up to 5th modules and provided with Drug kits.

b. 982 VHSCs were functioning in the district and all have ASHA as a member of the

committee.

c. It was observed that release of untied funds from the state headquarter to the district was

very irregular. The fund for VHSNC for the year 2010-11 was released to the district in the

month of September, 2010. Similarly, the VHSNC funds for the year 2011-12 were not

released to the district upto the month of January, 2012.

25

d. In spite of having huge opening balance of Rs. 67,33,998 lying with the district, the State

headquarter released an amount of Rs. 75,79,000 to the district for 982 VHSNCs in the year

2010-11. It was reported that only Rs. 66,18,455 (46.2%) out of total amounts of Rs.

1,43,12,998 available could be utilized by the VHSNCs in the district during 2010-11.

VHSNC fund to the tune of Rs. 76,94,543 as an opening balance was available in the

district in the year 2011-12 and out of that an amount of Rs. 10,45,604 (13.5%) was utilized

up to the visit of month.

4. Services of Janani Suraksha Yojana (JSY): a. There was sufficient budget provision available under the scheme in the district for both

the years in 2010-11 and 2011-12. The details are given below: (Amt in Rs)

Sr. No.

Particulars For the Year- 2010-11

For the Year- 2011-12

1 Total fund available 6,54,59,938 4,91,01,761

2 Total expenditure under JSY 2,45,82,077 4,27,51,230

3 Balance amount 4,08,87,861 63,50,531

4 Total no. of JSY beneficiaries 12090 10,976

5 No. of JSY mothers paid incentive

11279 9,584

b. JSY status at the visited BPHCs / MPHCs as reported is given below:

Sr. No.

Particulars For the year 2010-11 ( in Rs)

BPHC Nilambazar

BPHC RK Nagar

BPHC Patharkandi

BPHC Kachudam

MPHC Dalgram

MPHC Baraigram

1 Total fund available

39,00,000 60,00,000 50,00,000 30,00,000 12,00,000 1,87,000

2 Total expenditure under JSY

33,65,000

55,81,000 47,90,300 28,30,300 11,99,400 1,84,800

3 Balance amount 5,35,000 4,19,000 2,09,700 1,69,700 600 2,200

4 Total no. of JSY beneficiaries

1452 2655 2353 1185 509 132

5 No. of JSY mothers paid incentive

1452 2655 2241 1185 487 132

For the year 2011-12 ( in Rs)

1 Total fund available

32,72,093

56,08,915 45,91,737 36,69,700 12,00,600

5,03,600

2 Total expenditure under JSY

25,52,100 42,54,200 39,95,850 25,92,650 9,93,100 3,94,000

3 Balance amount 7,19,993 13,54,715 5,95,887 10,77,050 2,07,500 1,09,600

4 Total no. of JSY beneficiaries

1278 1995 2179 1258 484 175

5 No. of JSY mothers paid incentive

1214 1989 1974 1232 484 147

26

c. 26 JSY beneficiaries were interviewed in the district for on the field verification and it was

observed that they had received three consecutive Ante Natal checks up in their nearest

health care centre and MCH cards were issued to mothers by the health personnel. ASHA

was accompanying with mothers for institutional delivery. All deliveries were normal. Most

of the beneficiaries from weaker section were coming from public transport to the hospital

for institutional delivery.

d. It was also observed that most of the beneficiaries at rural areas had no Bank Accounts as

no bank branch exist in their areas. JSY mothers are paid their cash incentive by cheques

and it is very difficult to encash their Account Payee cheque in the bank.

e. JSY beneficiaries register were found maintained at visited facilities but all relevant details

were not recorded in the registers and it was not checked/ signed by concerned Medical

officers.

5. Untied Funds: a. Details of Untied Fund provided to the district for strengthening the services at different

facilities and utilization of funds are given below: (In Rs.)

Sr.No. Particulars CHC level PHC level HSC level

2010-11 2011-12 2010-11 2011-12 2010-11 2011-12

1 Opening balance

19,405 52,743 1,79,432 5,24,069 1,23,32,481 1,21,17,688

2 Fund received 50,000 50,000 5,50,000 5,50,000 21,50,000 16,90,000

3 Total available fund

69,405 1,02,743 7,29,432 10,74,069 1,44,82,481 1,38,07,688

4 Expenditure incurred

16,662 52,298 2,05,363 19,105 23,64,793 (16.3%)

5,42,000 (3.9%)

5 Balance 52,743 50,445 5,24,069 10,54,964 1,21,17,688 1,32,65,688

b. Untied Funds released and expenditure incurred in the visited BPHCs/CHC in the year 2010-11 and 2011-12 are as follow:

(in Rs.)

Name of Institutions Opening Balance

Released Total available fund

Expenditure incurred

Balance

CHC Srigouri

2010-11 19405 50,000 69,405 16,662 52,743

2011-12 52,743 50,000 1,02,743 52,298 50,445

BPHC Nilambazar

2010-11 1,02,737 25,000 1,27,737 95,668 32,068

2011-12 32,068 25,000 57,068 Nil 57,068

BPHC R. K. Nagar

2010-11 1,561 25,000 26,561 20,644 5,917

2011-12 5,917 25,000 30,917 5,000 25,917

BPHC Patharkandi

2010-11 35,784 25,000 60,784 22,014 38,770

2011-12 38,770 25,000 63,770 Nil 63,770

BPHC Kachuadam

2010-11 18,319 25,000 43,319 28,945 14,374

2011-12 14,374 25,000 39,374 14,105 25,269

MPHC Chargola

2010-11 33,139 25,000 58,139 57,200 939

2011-12 939 25,000 25,939 Nil 25,939

MPHC Baraigram

2010-11 18,742 25,000 43,742 27,056 16,686

2011-12 16,686 25,000 41,686 16,557 25,129

27

c. It was observed that untied fund for the year 2010-11 was released to the centres in the

month of September, 2010 and for the year 2011-12 in the month of January, 2012. So it

was not practically possible for the institutions to fully utilize the fund within the financial

year.

d. During visit to the Sub Centres at Bazarghat, Baraigram and Moina, no cash book for

untied fund for the year 2010-11 and 2011-12 was observed to be maintained.

6. 24 hours Delivery Care Services: a. 24 hours delivery care services were being provided in 15 institutions i.e. in one CHC, 4

BPHCs, 5 Mini PHCs, 3 State Dispensaries and 2 Subsidiary Health Centres in the district.

b. Availability of facilities for caring mothers and new born babies were inadequate in all the

visited institutions. Deployment of regular para-medical staff for conducting deliveries in

24x7 centres was also found inadequate at most of the visited facilities. These services

are managed by contractual staff in the visited Centres. Not a single post of Staff Nurses/

GNM was sanctioned at any BPHC/ MPHC in the district.

c. Blood storage facility was not available at all the visited facilities. The facility for C- Section

delivery was also not available at any visited Centres.

d. The following table shows the performance and staff position of the visited 24x7 hours

services centres:

Name of Institutions Total number of deliveries under 24x7

Number of deliveries conducted in the night hours

Number of Doctors/ specialist posted

Number of ANMs/ Staff Nurses posted

CHC Srigouri

2010-11 774 250 4 9

2011-12 780 260

BPHC Nilambazar

2010-11 517 280 3 3

2011-12 449 240

BPHC R. K. Nagar

2010-11 853 250 3 6

2011-12 569 178

BPHC Patharkandi

2010-11 2044 1170 4 4

2011-12 1671 930

MPHC Dalgram

2010-11 509 205 2 2

2011-12 484 189

MPHC Baraigram

2010-11 132 38 3 4

2011-12 175 46

7. Physical infrastructure:

(i) Health Sub Centres: a. The team visited Sub Centres at Bazarghat, Baraigram and Moina for assessment of Sub

Centre facility. Labour room was not available in Sub Centre at Moina.

b. DDKs, Sanitary Napkins and Bleaching Powder were not available at all the visited

Centres.

c. RDT Kits, Hemoglobinometer and EC Pills were not provided to the Sub Centre of Bazarghat.

28

(ii) BPHCs: a. The BPHCs at Nilambazar and RK Nagar were visited. Operation Theatre was not

available at both Centres. No stock of OPV vaccine was available at visited BPHCs. TT

vaccine was not available at BPHC RK Nagar. Oxygen Cylinder was not available at

BPHC Nilambazar.

b. Maintenance of hospital was not up to the mark at both BPHCs at Nilambazar and RK

Nagar.

(iii) CHC: a. Team visited CHC Srigouri and found that maintenance of the hospital building was not up

to the mark. Ambulance was not provided to the centre.

b. X-ray facility, Blood storage unit, surgical equipments, Anesthesia equipment, Incinerator

and Operation Theatre with OT table was not provided to the CHC.

c. Residential quarter for Para medical staff and availability of drugs was inadequate in CHC

Srigouri.

8. Opinion and awareness of the Community on the Health Services:

(i). ANMs Services:

a. 20 mothers having child up to one year of age were interviewed for assessing their opinion

and knowledge about the services provided by the concerned ANMs at sub centre level.

Mothers were mostly satisfied with the work of ANMs in the areas of visited Centres.

b. However, mothers were mostly unaware about danger signs of ARI, usage of ORS and

contraceptive methods in the areas of visited Subcentres at Baraigram and Moina. Post

Natal checkups were also not being provided to the mothers in the visited Sub centres.

(II). Services of PHC:

To assess the opinion on the services provided in PHCs Nilambazar and RK Nagar, 22

different community members‟ i.e. pregnant women, recently delivered women, mothers

upto two year old child, AWW, ASHA and Villagers were interviewed. It was observed that

community was generally satisfied with the services. However, awareness about danger

signs during ANC and sick new born babies and also about HIV/STD/AIDS was found poor.

Community members were dissatisfied due to irregular visit to the remote villages by the

MO.

9. Sample Verification of F.W. acceptors: a. The team selected a total of 73 F.W. acceptors and out of that 68 (94.4%) could be

contacted for sample verification.

b. Among the contacted acceptors, 38 (55.8%) informed that they did not receive any follow up

service after having accepted the services.

29

c. 88 beneficiaries of BCG/ DPT/ Polio, Measles and Vitamin- A were selected and contacted.

All contacted beneficiaries confirmed receiving the doses and follow up by health staff.

10. Reconciliation of the reporting performance of CuT: CuT figures reported by BPHCs at Nilambazar, R.K. Nagar, Patharkandi & Kachuadam for

the year 2010-11 and 2011-12 (up to January, 2012) did not match with the figures

recorded in the registers and figures reported by the district office for these Centres. The

details are given below:

Name of the Centres

During the year 2010-11 During the year 2011-12 ( up to Jan, 2012)

Reported by District office

Reported by Centres

Recorded in registers

Reported by District office

Reported By Centres

Recorded in registers

BPHC Nilambazar 340 335 NV 533 536 NV

BPHC R.K. Nagar 67 11 25 29 27 13

BPHC Patharkandi

324 324 NV 327 327 NV

BPHC Kachuadam

89 94 NV 123 119 NV

NV- Figures not verified due to absence of service register.

11. Registers, records and reports maintained at the visited centres: a. Eligible Couple register which is one of the most important records for FW services was

not updated with all necessary details at visited facilities.

b. Consolidated CuT service registers were not found to be maintained in the centres visited.

c. Oral Pills and Nirodh users‟ registers were maintained without full details at visited

facilities.

12. IT Infrastructure:

Computers were found available at District, CHC, Block PHC and Mini PHC level. Internet

connectivity was found available at visited facilities except MPHC Chargola.

13. Miscellaneous observations:

a. It was observed that monitoring and regular supervision at periphery level was not effective.

Regular Supervisory check by LHV, BEE and Health Educator could improve the quality of

services and record keeping.

b. All the BPHCs were having 6 beds from very beginning as per old pattern which do not fulfill

present requirement of community.

c. In the entire district there was no FRU in the periphery level, except District Civil Hospital,

Karimganj.

30

6. District: Cachar

Major observations of Regional Evaluation Team, Kolkata on the Evaluation work carried

out in Cachar district of Assam in February, 2012.

I. Details of the visited Institutions:

District visited FRU/BPHCs/PHC(N) visited SCs visited

Cachar FRU: Kalain

BPHCs: Bikrampur and Dholai

PHC (New): Chargola

Dholchera, Burunga, Poloi and

Kanakpur

II. Major Observations:

1. Health Human Resources:

a. 27 out of the 77 sanctioned posts of MO were vacant but 29 MOs were also posted under

contractual basis in the district. There was no Specialist post sanctioned at any CHC/ BPHC

in the entire district.

b. 14 out of the 318 sanctioned posts of ANM, 17 out of the 96 sanctioned posts of MPW (M),

11 out of the 23 sanctioned posts of MPS (F), 5 out of the 27 sanctioned posts of MPS (M),

9 out of the 23 sanctioned posts of GNM/ Staff Nurse and 5 out of the 62 sanctioned posts

of Pharmacist were lying vacant in the district. However, 265 ANMs, 132 GNM/ Staff Nurse,

20 Lab Technician, 10 Pharmacists and one post each of District Programme Manager,

Block Programme Manager, District Account Manager, Block Account Manager were

working on contact basis in the district.

c. The post of SDM & HO at BPHC Dholai was vacant since last 7 months. Post of Dy.

Superintendent at FRU Kalain was vacant since long back. It was reported that posts of

MO, 1 at FRU Kalain, 2 at BPHC Bikrampur and 3 at BPHC Dholai were vacant out of

sanctioned 5 posts at each centre. 1 out of 12 sanctioned posts of MO at NPHC

Narsinghpur was lying vacant. No regular ANM, MPW (M), MPS (F & M) of FRU Kalain,

GNM/ SN at BPHCs Bikrampur and Dholai and GNM/ SN, ANM, MPW (M), MPS (M) at

NPHC Narsinghpur was posted.

d. In BPHC Bikrampur, 5 of the 27 sanctioned posts of ANMs, 2 of the 5 sanctioned posts of

MPS (M), 1of the 2 sanctioned posts of MPS (F) and 2 Lab Technician out of the 3 posts

sanctioned were lying vacant. However, 1 of the 48 sanctioned posts of ANMs, 2 of the 3

sanctioned posts of MPS (F), 1 of the 6 sanctioned posts of MPS (M), 1 of the 2 sanctioned

posts of Lab Technicians and 1 against 9 sanctioned posts of Pharmacist were lying vacant

in BPHC Dholai. Likewise, 8 of the 10 sanctioned posts of GNM/ SN were lying vacant in

FRU Kalain.

31

2. Functioning of Rogi Kalyan Samiti:

a. It was observed that Rogi Kalyan Samiti has been constituted at all visited facilities, but

registration process was not completed at FRU Kalain and NPHC Narsinghpur till the visit

of the team in the district. Regular meetings of Rogi Kalyan Samiti were not being

conducted at visited facilities.

b. 3 Blocks i.e. Silchar, Bikrampur and Barkhola had a single post of Circle Officer (CO)

stationed at Silchar and he was the chairman of RKS of BPHCs Bikrampur and Barkhola

but he was not available as per requirement of respective RKS.

3. Functioning of ASHA and Village Health Sanitation & Nutrition Committee (VHSNC):

a. As against the target of 1578 ASHAs for 1328 villages out of total 1424 villages in the

district, presently, 1576 ASHAs were in position in the district and all of them were trained

up to 5th modules and provided with Drug kits.

b. 1478 VHSNCs were functioning in the district and all were having ASHA as a member of the

committee.

c. It was observed that, release of untied funds from the state headquarter to the district was

very irregular. The fund for VHSNC for the year 2010-11 was released to the district at the

end of 3rd quarter.

d. In spite of having huge opening balance of Rs. 1,19,57,587 lying with the district, the State

headquarter released an amount of Rs. 1,42,70,000 to the district for 1478 VHSNCs in the

year 2010-11. It was reported that only Rs. 67,13,547 (25%) out of total amounts of Rs.

2,62,27,587 available could be utilized by the VHSNCs in the district during 2010-11.

Similarly, funds to the tune of Rs. 3,37,54,040 including opening balance of Rs.

1,95,14,040 were available in the district for the year 2011-12 and out of that only an

amount of Rs. 34,10,075 was utilized by the VHSNCs upto the time of visit.

4. 24 hours delivery care services:

a. 24x7 hours delivery care services were being provided in 20 institutions i.e. in 1 FRU, 8

BPHCs, 9 Mini PHCs and 2 Subsidiary Health Centre in the district.

b. Availability of facilities for caring mothers and new born babies were inadequate in all the

visited institutions. Not a single post of Staff Nurses/ GNM was sanctioned at any BPHC/

MPHC in the district. These services were being managed by contractual staff in the

visited Centres.

c. Blood storage facility was not available at all the visited facilities. The facility for C- Section

delivery was also not available at any visited Centre.

d. The following table shows the performance and staff position of the visited 24x7 hours

services centres:

32

Name of Institutions Total number

of deliveries

under 24x7

Actual number

of deliveries

conducted in the

night hours

Number of

Doctors/

specialist

posted

Number of

ANMs/ Staff

Nurses

posted

FRU Kalain 2010-11 1599 680 4 7

2011-12 1414 568

BPHC

Bikrampur

2010-11 646 250 3 4

2011-12 537 210

BPHC

Dholai

2010-11 2531 1125 3 6

2011-12 1925 789

NPHC

Narsinghpur

2010-11 430 407 3 6

2011-12 165 160

5. Untied Funds:

a. Details of Untied Fund provided to the district for strengthening the services at different

facilities and utilization of funds are given below:

( Amt in Rs.)

Sr.No

.

Particulars CHC/FRU level PHC level HSC level

2010-11 2011-12 2010-11 2011-12 2010-11 2011-12

1 Opening

balance

1,00,000 1,50,000 4,52,324 3,94,422 24,23,171 35,94,533

2 Fund received 50,000 1,00,000 2,00,000 6,75,000 19,30,000 24,10,000

3 Total available

fund

1,50,000 2,50,000 6,52,324 10,69,422 43,53,171 60,04,533

4 Expenditure

incurred

Nil Nil 2,57,902 75,654 7,58,638 2,23,958

5 Balance 1,50,000 2,50,000 3,94,422 9,93,768 35,94,533 57,80,575

b. Untied Funds released and expenditure incurred in the visited BPHCs/CHC in the year

2010-11 and 2011-12 are as follow:

(in Rs.)

Name of Institutions Opening Balance

Released Total available fund

Expenditure incurred

Balance

CHC/FRU Kalain

2010-11 1,08,001 50,000 1,58,001 72,345 85,656

2011-12 85,656 50,000 1,35,656 Nil 1,35,656

BPHC Bikrampur

2010-11 49,926 25,000 74,926 Nil 74,926

2011-12 74,926 25,000 99,926 12,200 87,726

BPHC Dhalai

2010-11 31,943 25,000 56,943 35,290 21,653

2011-12 21,653 25,000 46,653 16,000 30,653

MPHC Narsinghpur

2010-11 13,028 25,000 38,028 28,518 9,500

2011-12 9,500 25,000 34,500 18,719 15,791

33

c. It was observed that untied fund for the year 2010-11 and 2011-12 was released to district

in the end of 3rd quarter. So it was not practically possible for any institution to fully utilize

the fund within the financial year. No Untied fund at periphery level was released by the

district authority during the current year 2011-12 up to the visiting month.

6. Services of Janani Suraksha Yojana (JSY):

a. As per details provided, cash incentive under the scheme have been paid to 25176 JSY

beneficiaries in the year 2010-11 and 20747 JSY beneficiaries in current year (up to

January, 2012) in the district.

b. JSY status in the district and at the visited BPHCs / MPHCs as reported is given below:

Sr. No.

Particulars For the year 2010-11 ( in Rs)

District

CHC/FRU Kalain

BPHC Bikrampur

BPHC Dholai

NPHC Narsinghpur

1 Total fund available 3,80,95,820 29,10,022 32,07,502 55,00,000 6,02,400

2 Total expenditure under JSY

4,71,30,738 22,38,600 21,55,950 58,42,470 60,200

3 Balance amount -9,18,619* 6,71,422 10,51,552 -3,42,470* 5,42,200

4 Total no. of JSY beneficiaries to whom incentive paid

25176 1599 851 2961 430

For the year 2011-12 ( in Rs)

1 Total fund available 3,39,47,100 21,71,422 30,51,552 50,77,093 6,02,000

2 Total expenditure under JSY

1,23,88,886 19,79,600 15,78,600 47,70,250 5,87,200

3 Balance amount 2,15,58,214 1,41,822 14,72,952 3,06,843 59,800

4 Total no. of JSY beneficiaries to whom incentive paid

20747 1414 672 2427 407

* Source of excess expenditure record was not made available to the team.

d. 26 JSY beneficiaries were interviewed in the district and it was observed that they had

received three consecutive Ante Natal checks up in their nearest health care centre and

MCH cards were issued to mothers by the health personnel. ASHA was accompanying

with mothers for institutional delivery. All deliveries were normal.

e. It was also observed that most of the beneficiaries in rural areas had no Bank Accounts as

no bank branch is available in their areas. JSY mothers are paid cash incentive by

cheques and it is very difficult to encash their Account Payee cheque in the bank.

f. JSY beneficiaries register were found maintained at visited facilities but all relevant details

were not recorded in the registers and also not found properly checked/ signed by

concerned Medical officers.

7. Physical infrastructure (HSC/BPHC/CHC)

(i) Health Sub Centres:

a. The team visited Sub Centres at Dholchera, Burunga, Poloi and Kanakpur for assessment

of sub centre facility and observed that Labour room, Delivery table, Mclntosh sheet, Ambu

34

bag/suction, DDKs, Sanitary Napkins, Magsulth, Oxitocine tablets, Ampicillin capsule and

Gentamycine injection were not available in the Centres.

b. No stock of Delivery Kit and Metronidazole tablets was observed in most of the visited Sub

Centres.

c. Skilled Birth Attendance and IMNCI training was not given to the Auxiliary Nurse Midwives

in the visited Sub Centres.

(ii) BPHC:

a. The BPHCs at Bikrampur and Dholai and NPHC Narsinghpur were visited and found that

Operation Theatre was not available there. Short supply of BCG, DPT, OPV, Measles and

TT vaccine was observed at BPHC Bikrampur. Inadequate stock of OPV vaccine was

found at BPHC Dholai and NPHC Narsinghpur.

b. Vehicle was not functional in BPHC Dholai and it was not available at NPHC Narsinghpur.

Auto Clave was not provided to BPHCs at Bikrampur and Dholai. Oxygen Cylinder was not

available at BPHC Bikrampur.

c. Maintenance of hospital building of all the visited institutions was not up to the mark.

(iii) FRU/CHC:

a. The post of specialist was not sanctioned at FRU Kalain.

b. Blood storage unit was not setup due to non availability of skilled person. Surgical

equipments related to FRU and incinerator were not provided and availability of drugs was

also found inadequate in FRU Kalain.

8. Opinion of the Community on the Health Services:

(I). Services of ANM:

a. 20 mothers having child up to one year of age were interviewed in the area of SCs

Dholchera and Burunga for assessing their opinion and knowledge about the services

provided by the concerned ANMs. Mothers were mostly satisfied with the work of ANMs in

the areas of centres visited.

b. However, mothers were mostly unaware about danger signs of ARI, usage of ORS and

contraceptive methods and its side effect in the areas of centres visited. Post Natal

checkups were also not made to the mothers in the visited Sub centres.

(II). Services of BPHC:

To assess the opinion about the services provided in BPHCs Bikrampur and Dholai, 22

different community members‟ i.e. pregnant women, recently delivered women, mothers

upto two year old child, AWW, ASHA and Villagers were contacted. It was observed that

community was generally satisfied with the services. Awareness about danger signs

35

during ANC and sick new born babies and also about HIV/STD/AIDS was poor.

Community members were dissatisfied for irregular visit by MOs to the remote villages.

9. Sample Verification of F.W. acceptors:

a. The team selected a total of 56 F.W. acceptors and out of that 54 (88.5%) could be

contacted for sample verification.

b. Among the contacted acceptors, 8 (14.8%) informed that they did not receive any follow up

service after having the services.

c. 57 beneficiaries of BCG/ DPT/ Polio, Measles, Vitamin- A and Hep. B were selected and

contacted. All contacted beneficiaries confirmed receiving the doses and follow up by health

staff.

10. Reconciliation of the reporting performance of CuT:

a. CuT figures reported by BPHC at Bikrampur for the year 2010-11 and 2011-12 (up to

January, 2012) respectively could not be verified for want of service register.

b. CuT figures of 581 and 443 reported by BPHC Dholai for the year 2010-11 and 2011-12 (up

to January, 2012) respectively did not match with the figures available in the service

register.

11. Registers, records and reports maintained at the visited centres:

a. Eligible Couple register which is one of the most important records for FW services was not

updated at visited facilities.

b. CuT service registers, Oral Pills and Nirodh users‟ registers were also not updated at visited

facilities.

12. IT Infrastructure:

Computers were found available at District, CHC, Block PHC and Mini PHC level. Internet

connectivity was found available at visited facilities except NPHC Narsinghpur.

13. Miscellaneous observations:

a. It was observed that monitoring and regular supervision at periphery level was not effective.

Regular Supervisory check by LHV, BEE and Health Educator could improve the quality of

services and record keeping.

b. All the BPHCs were having 6 beds from very beginning as per old pattern which need to be

increased.

c. In entire district there was a single FRU i.e. Kalain in the periphery level.

36

Arunachal Pradesh

1. District- West Kameng (Bomdila)

Major observations of Regional Evaluation Team, Kolkata on the Evaluation work carried out in West Kameng (Bomdila) district of Arunachal Pradesh in March, 2012.

I. Details of the visited Institutions:

District visited DH/CHC and PHCs visited SCs visited West Kameng (Bomdila)

District Hospital: Bomdila CHCs: Rupa & Dirang PHC: Sinchung

Wanghoo, Jameri, Salary & Jerigaon

II. Major Observations:

1. Health Human Resources:

a. At the district headquarter and visited facilities, no one was aware about the sanctioned

strength of human resources in the district and the visited facilities.

b. However as observed from the in position staff reported by the district office, there was a

single Specialist (O & G), working as Superintendent at District Hospital Bomdila; Further,

32 MOs, 15 GNMs, 26 ANMs, 14 MPWs (M), 2 each of MPS (M & F), 3 Lab Technicians

and 21 Pharmacists were also working in the district.

c. During visit to the centres, acute shortage of manpower in the key posts i.e. Specialist,

Medical Officer, Supervisor (M & F), Lab Technician, Pharmacist and MPW (M) etc. was

observed. In District Hospital Bomdila, 1 Specialist, 9 MOs, 5 GNMs, 4 ANMs and 2 MPS

(F); in CHC Rupa, 3 MOs, 5 ANMs, 1 MPW (M) and 1 Pharmacist and in CHC Dirang, 1

MO, 3 GNMs, 9 ANMs, 1 Lab Technician and 1 Pharmacist were working.

d. 1 MO, 2 ANMs and 1 MPW (M) were in position at PHC Sinchung.

e. 4 MOs, 4 Staff Nurse/ GNM, 2 Additional ANM and 8 Lab Technician were also appointed

on contractual basis under NRHM in the district.

2. Functioning of Rogi Kalyan Samiti: It was observed that Rogi Kalyan Samiti has been constituted and registered but regular

meetings of Rogi Kalyan Samiti were not being conducted at the visited facilities.

3. Functioning of ASHA and Village Health Sanitation & Nutrition Committee (VHSNC): a. District has fulfilled its target by selecting 215 ASHAs for its 215 villages in the district.

b. It was reported that all selected ASHAs have been trained up to 6 modules and also

provided with drug kits.

c. 215 VHSNCs were reportedly functioning in the district. These committees were having

ASHA as a member.

d. VHSNC Untied funds to the tune of Rs. 16, 35,700 including opening balance of Rs. 25,700

was available in 2010-11 and utilized fully during the year. Further, the district had spent an

37

amount of Rs. 7, 30,000 against the VHSNC allotted funds of Rs. 19, 80,000 during the year

2011-12.

4. Services of Janani Suraksha Yojana (JSY): a. As per details received, as many as 431 JSY beneficiaries in the year 2010-11 and 390

JSY beneficiaries in the year 2011-12 (up to February, 2012) were paid with cash incentive

under the scheme.

b. The budget provision & expenditure in the district and at the visited DH/ CHCs / PHC under

JSY as reported is given below:

(Amt in Rs)

Sr.No. Particulars For the year 2010-11

District Office

CHC Rupa

CHC Dirang

PHC Sinchung

1 Total fund available 8,52,900 1,45,500 86,100 88,800

2 Total expenditure under JSY 5,60,000 1,03,400 74,400 83,400

3 Balance amount 2,92,900 42,100 11,700 5,400

For the year 2011-12

1 Total fund available 5,90,000 1,17,100 81,700 80,400

2 Total expenditure under JSY 4,03,600 1,17,100 62,400 48,700

3 Balance amount 1,86,400 Nil 19,300 31,700

The details were not made available at DH, Bomdila. However, it was reported that Rs.

5,00,000 provided as corpus fund to this hospital were utilized to meet the expenditure under

JSSK.

c. During visit to DH and CHCs, the Incharge of these Institutions informed that they did not

receive any guidelines for disbursing cash incentive to the JSY eligible mothers from their

higher authorities.

d. The team contacted and interviewed 30 JSY mothers in the district and observed that 29

JSY beneficiaries were provided with cash incentives and 22 mothers had been

accompanied by ASHAs for institutional delivery. Post Natal visit was almost absent.

e. JSY registers were maintained at CHC Dirang and PHC Sinchung, while it was not

maintained properly at District Hospital Bomdila and CHC Rupa.

5. Untied Funds:

a. Details of Untied Fund provided to the district for strengthening the services at different

facilities and utilization of funds are given below:

(Amount in Rs.)

Sr.No. Particulars CHC level PHC level HSC level

2010-11 2011-12 2010-11 2011-12 2010-11 2011-12

1 Opening balance 2,419 807 1,25,700 39,070 Nil Nil

2 Fund received 1,50,000 2,00,000 1,00,000 50,000 2,00,000 2,40,000

3 Total available fund 1,52,419 2,00,808 2,25,700 89,070 2,00,000 2,40,000

4 Expenditure incurred

1,51,612 1,13,858 1,86,630 50,000 2,00,000 70,000

5 Balance 807 87,949 39,070 39,070 Nil 1,70,000

38

b. Untied Funds released and expenditure incurred in the visited CHCs and PHC in the year 2010-11 and 2011-12 are as follow:

(Amt in Rs.)

Name of Institutions Opening Balance

Released

Total available fund

Expenditure incurred

Balance

CHC Rupa*

2010-11 919 50,000 50,919 50,900 19

2011-12 19 50,000 50,019 49,958 61

CHC Dirang

2010-11 Nil 50,000 50,000 50,000 Nil

2011-12 Nil 50,000 50,000 50,000 Nil

PHC Sinchung**

2010-11 212 25,000 25,212 Nil 25,212

2011-12 25,212 25,000 50,212 Nil 50,212

* The untied funds for the year 2010-11 and 2011-12 were utilized by CHC Rupa for

purchase of medicines only.

** Untied Fund provided to PHC Sinchung for the year 2010-11 was released to the PHC

in the month of March, 2011. Similarly, fund for the year 2011-12 was released to this

PHC in the month of September, 2011. The total fund for both years was lying unutilized

at the PHC.

c. Untied Funds were provided to the visited Sub Centres for 2010-11 and 2011-12 in March,

2011 and in March, 2012 respectively.

6. 24 hours Delivery Care Services: a. District Hospital Bomdila and CHCs at Rupa & Dirang were providing 24x7 hours delivery

care services in the district. PHC visited at Sinchung was identified for providing 24x7

hours delivery care service institution but there was no indoor facility to take care of Post

Natal mothers and new born baby. Neo-natal stabilization Unit and Blood storage facility

was not available at all the visited facilities in the district.

b. Single Medical Officer was posted at CHC Dirang and also at PHC Sinchung for providing

24x7 hours delivery care services.

c. The following table shows availability of staff and performance during 2010-11, 2011-12 in

the visited CHCs and PHC under 24x7 hours delivery care services:-

Name of the visited CHCs and PHC

Total number of deliveries

conducted under 24x7 services

Number of Doctors posted

Number of ANMs/ Staff posted

CHC Rupa

2010-11 53 3 5

2011-12 63 3 5

CHC Dirang

2010-11 102 1 11

2011-12 120 1 11

PHC Sinchung

2010-11 62 1 2

2011-12 42 1 2

d. DH, Bomdila is a big Institution and there are good facilities for 24x7 hours delivery care

services. In the visited CHCs and PHC, actual figure of night hour deliveries was not made

available.

39

7. Physical infrastructure: (i) Health Sub Centres: a. The team visited Sub centres at Wanghoo, Jameri, Salary & Jerigaon for assessment of

sub centre facility. In the visited Sub Centres, maintenance of building was not up to the

mark. Labour room was not available there.

b. Maclntsh sheet, Ambu bag/suction, Nischay pregnancy test kit, Delivery kit, Sanitary

Napkins, Vitamin- A solution, DDKs, Oral Pills, CuT, EC Pills, Chloroquine, Oxytocin

tablets, Kits- A & B and Gentamycine injection were not available at all the visited centres.

c. Examination table, Delivery table, Steam sterilizer and Condoms were not available at Sub

Centres Jameri, Salary & Jerigaon.

d. RDT kit, Heamoglobinometer and Co-trimoxazole tablets were not available at Sub centres

Wanghoo, Jameri and Jerigaon.

e. No supply of ORS packets and IFA tablets at Sub Centres Wanghoo and Jerigaon was

observed

(ii) BPHCs: a. Auto clave, Microscope & Labour room table was not available and Operation Theater with

OT table was not functional in PHC Sinchung.

b. AYUSH Medical Officer was not posted and residential accommodation for Medical

Officers was not available in the PHC.

(iii) DH/CHCs: a. Team visited District Hospital Bomdila, CHCs at Rupa & Dirang and found that

maintenance of the hospital building was not up to the mark. Jeep, Blood storage unit,

surgical equipments and Anesthesia equipment were not available there. Ambulance was

not provided at District Hospital Bomdila.

b. X-ray facility was not setup due to want of Technicians and Auto clave was not provided at

CHC Rupa.

c. Residential quarter for MOs & Para medical staff was not available at DH Bomdila and

residential quarter for Para medical staff was found inadequate in CHCs Rupa and Dirang.

8. Opinion and awareness of the Community on the Health Services:

Services of PHC: To assess the opinion on the services provided in PHC Sinchung, 11 different community

members‟ i.e. pregnant women, recently delivered women, mothers upto two year old child,

AWW, ASHA and also Villagers were interviewed. It was observed that community was

generally satisfied with the services. However, proper attention to register the AN mothers

within the 16 weeks of pregnancy, awareness about danger sign in pregnancy, sick new

born care, breast feeding practices and also uses of contraceptive methods need to be

increased. Community was having poor knowledge about HIV/STD/AIDS. Community

members were dissatisfied due to irregular visit by the MO to the remote villages.

40

9. Sample Verification of F.W. acceptors: a. The team selected a total of 70 F.W. acceptors and out of that 66 (94.3%) could be

contacted for sample verification in the district. The contacted acceptors informed that they

did not receive any follow up service after having accepted the services.

b. During sample check, discrepant entries in age of spouse in 41 (62%) cases, total number

of children in 6 (9%) cases, number of male child in 11 (17%) cases and in age of youngest

child in 43 (65%) cases were found in the records.

c. 44 beneficiaries of BCG/ DPT/ Polio, Measles and Vitamin- A were selected and were

contacted. All contacted beneficiaries confirmed receiving the doses. Follow up service was

provided to all contacted beneficiaries.

10. Reconciliation of the reporting performance under Sterilization: CuT, Oral Pills and Nirodh figures reported by DH Bomdila, CHC at Rupa and PHC at

Sinchung for the year 2010-11 and 2011-12 (up to February, 2012) did not tally with the

figures shown in the report of district office for these Centres. CuT reported cases were also

found varying with the figures recorded in the service registers maintained at the reporting

centres in DH/CHC & PHC. The details are given below:

Name of the Centres

During the year 2010-11

CuT reported Oral Pills cycle reported

Condoms pieces reported

By District office

By the Centres As per service register

By District office

By the Centres

By District office

By the Centres

DH Bomdila 195 213 205 381 419 915 945

CHC Rupa 25 30 30 315 87 1359 76

PHC Sinchung 25 24 26 157 153 2288 2186

During the year 2011-12 (up to February, 2012)

DH Bomdila 177 208 210 279 336 2270 2600

CHC Rupa 18 27 27 146 232 589 64

PHC Sinchung 16 13 19 81 124 1229 1833

11. Registers, records and reports maintained at the visited centres: a. Eligible Couple register which is one of the most important records for FW services was

not maintained at the visited facilities.

b. Consolidated CuT service registers were maintained without all relevant details in the

centres visited.

c. Oral Pills, Nirodh users‟ and Stock registers were not maintained properly at visited

facilities.

d. Post Natal Care register was not found to be maintained in visited centres of CHC Rupa

and PHC Sinchung.

12. IT Infrastructure: Computers were found available at District and CHC level. Internet connectivity was found

available at district level only. MCH tracking was not implemented in the district upto the

visiting month.

41

13. Other observations: a. It was observed that monitoring and regular supervision at periphery level was not

effective. Medical Officers and MPS (M & F) should conduct field work for supportive

supervision in respective field area.

b. IEC activity in the district was not visible; the team did not find any wall painting/ hoarding/

banners and posters at the periphery centres and district level.

c. It is difficult to provide regular 3 Ante Natal checks up (2 doses of TT and 100 IFA tablets)

to all pregnant mothers in the area of 80% or more Sub Centres in the district as no ANM/

Addl. ANM was posted in such Sub Centres.

d. Immunization was done once in a month under outreach programme through EPI team

consisting of ANM and Health Assistant (M) etc in rural area of the district. Most of the time

outreach programme was not organized on regular basis due to non allocation/ lack of

fund. For example, immunization work was not performed in rural areas under outreach

since October, 2011 at the visited facilities, due to scarcity of fund under the scheme.

2. District: Tawang

Major observations of Regional Evaluation Team, Kolkata on the Evaluation work carried

out in Tawang district of Arunachal Pradesh in March, 2012.

I. Details of the visited Institutions:

District visited DH/CHC and PHCs visited SCs visited Tawang District Hospital: Tawang

CHC: Jang PHCs: Khou & Kitpi

Lemberdung

II. Major Observations:

1. Health Human Resources:

a. Sanctioned strength of the staff for the entire district was not available at district office as

well as in the visited Centres.

b. As observed from the status of in position provided by the district office, there was only

one Specialist (O & G), working as Superintendent at District Hospital Tawang. Further, 15

MOs, 5 GNMs, 10 ANMs, 8 MPS (M), 5 MPS (F) and 4 Pharmacists were also working in

the whole district.

c. During visit to the centres, acute shortage of manpower in the key posts i.e. Specialist,

Medical Officer, Supervisor (M & F), Lab Technician, Pharmacist and MPW (M) etc. was

observed. In District Hospital Tawang, 1 Specialist, 8 MOs, 3 GNMs, 9 ANMs, 3 MPS (F),

1 Lab Technician and 2 Pharmacists; in CHC Jang, 3 MOs, 1 GNM and 1 Pharmacist; in

42

PHC Lhou, 1 MO, 1 GNM, 2 ANMs, 1 MPW (M) and 1 Pharmacist and in PHC, Kitpi only 2

ANMs and 1 MPW (M) were working.

d. 3 MOs, 5 Staff Nurse/ GNM, 4 Additional ANM and 4 Lab Technicians were also appointed

on contractual basis under NRHM in the district.

2. Functioning of Rogi Kalyan Samiti: It was observed that Rogi Kalyan Samiti has been constituted and registered at all visited

facilities. Regular meetings of Rogi Kalyan Samiti were not being conducted at visited

facilities.

3. Functioning of ASHA and Village Health Sanitation & Nutrition Committee (VHSNC): a. District has selected 189 ASHAs for its 189 villages in the district.

b. It was reported that 179 ASHAs have been trained in all modules and all ASHAs were

having drug kits.

c. 189 VHSNCs were constituted in the district and all were having ASHA as a member.

d. VHSNC Untied fund to the tune of Rs. 14,00,000 including opening balance of Rs.

11,10,000 were available and out of that, an amount of Rs. 9,28,521 was utilized in the

year 2010-11 and the district spent an amount of Rs. 10,70,000 against the VHSNC funds

of Rs. 22,72,469 during the year 2011-12.

4. 24 hours delivery care services: a. District Hospital Tawang, CHCs at Jang & Lumla were providing 24x7 hours delivery care

services with inadequate facilities in the district.

b. Blood storage facility was not available at all the visited institutions.

c. The following table shows the performance and staff position in the visited 24x7 centres:

Name of Institutions

Total number of deliveries conducted under 24x7 services

Actual number of deliveries conducted in night hours

Number of Doctors/ specialist posted

Number of ANMs/ Staff Nurses posted

DH Tawang

2010-11 190 78 9 16

2011-12 240 107 9 16

CHC Jang

2010-11 22 9 1 3

2011-12 16 6 1 3

5. Untied Funds:

a. Details of Untied Fund provided to the district for strengthening the services at different facilities and utilization of funds are given below:

(Amt in Rs.)

Sr.No.

Particulars CHC/FRU level PHC level HSC level

2010-11 2011-12 2010-11 2011-12 2010-11 2011-12

1 Opening balance Nil 25,000 Nil Nil 62,753 10,000

2 Fund received 25,000 50,000 50,000 1,25,000 1,20,000 80,000

3 Total available fund 25,000 75,000 50,000 1,25,000 1,82,753 90,000

4 Expenditure incurred

Nil 75,000 50,000 Nil 1,72,753 80,000

5 Balance 25,000 Nil Nil 1,25,000 10,000 10,000

43

b. Untied Fund released and expenditure incurred in the visited PHCs/CHC in 2010-11 and 2011-12

is as follow: (Amt in Rs)

Name of Institutions Opening Balance

Released

Total available fund

Expenditure incurred

Balance

CHC Jang

2010-11 Nil 25,000 25,000 Nil 25,000

2011-12 25,000 50,000 75,000 75,000 Nil

PHC Lhou

2010-11 Nil Nil Nil Nil Nil

2011-12 Nil 25,000 25,000 24,203 797

PHC Kitpi

2010-11 Nil Nil Nil Nil Nil

2011-12 Nil 25,000 25,000 24,900 100

c. It was observed that CHC untied fund for the year 2010-11 and 2011-12 was utilized by CHC Jang for purchase of medicine only.

6. Services of Janani Suraksha Yojana (JSY): a. As per details received, as many as 287 JSY beneficiaries in the year 2010-11 and 146

JSY beneficiaries in current year (up to February, 2012) have been paid with cash

incentive under the scheme.

b. The budget provision and expenditure in the district and at the visited DH/ CHC as

reported is given below:

(Amt in Rs)

Sr. No.

Particulars For the year 2010-11

District office

DH Tawang CHC Jang

1 Total fund available NA 80,000 NA

2 Total expenditure under JSY NA 49,674 14,400

3 Balance amount NA 30,326 NA

4 Total no. of JSY beneficiaries 287 39 22

5 No. of JSY mothers paid incentive 287 39 22

For the year 2011-12

1 Total fund available 2,47,000 1,36,326 NA

2 Total expenditure under JSY 1,18,200 72,300 11,700

3 Balance amount 1,78,000 64,026 NA

4 Total no. of JSY beneficiaries 146 87 15

5 No. of JSY mothers paid incentive 146 87 15

NA- Statement of fund received was not made available to the team.

c. During visit to DH and CHCs, the In charge of these Institutions informed that they did not

receive any guidelines for disbursing cash incentive to the JSY eligible mothers from their

higher authorities.

d. 17 JSY beneficiaries were interviewed in the district for on the field verification and it was

observed that they had received JSY money. ASHA was accompanying with mothers for

institutional delivery. But Post Natal visit was almost absent in the visited centres.

e. JSY beneficiaries register was found maintained at District Hospital, Tawang while it was

not found maintained at CHC Jang.

44

7. Physical infrastructure (HSC/BPHC/CHC) (i) Health Sub Centres: a. The team visited Sub centre at Lemberdung and found that Benches for clients, Cupboard

for drugs, Ambu bag/suction, Steam sterilizer, Nischay pregnancy test kit, RDT kit,

Heamoglobinometer, Slide for blood test, CuT, Chloroquine, Oxytocin tablets and

Gentamycine injection etc were not available in the Centre.

b. Skilled Birth Attendance and IMNCI training was not given to the Auxiliary Nurse Midwives

there.

(ii) PHC: a. The visited PHCs at Lhou and Kitpi were upgraded to PHC from Sub Centre one year back.

Still both PHCs were functioning in the old Sub Centre building with inadequate space and

facilities.

b. Jeep/ Ambulance, Auto clave, Steam sterilizer, Microscope, Lab Technician, Oxygen

cylinder, Minor Surgical equipments, Labour room, Labour room table, Resuscitation

equipment and functional Operation Theater with OT table were not available in both visited

PHCs.

c. Residential quarter for MOs was not available in both the visited PHCs.

(iii) CHC: The team visited CHC at Jang and found that Jeep/vehicle, X-ray facility, Blood storage unit,

surgical equipments, Anesthesia equipments and functional Operation Theater with OT

table were not available. Specialist not posted and short supply of drug was also observed

there.

8. Opinion of the Community on the Health Services:

(I). Services of ANM: a. 20 mothers having child up to one year old were interviewed in the area of SC Lemberdung

for assessing their opinion and knowledge about the services provided by the concerned

ANM and found that mothers were mostly satisfied with the work of ANMs in the areas of

centres visited.

b. However, mothers were mostly unaware about danger signs of ARI and usage of ORS.

(II). Services of PHC: a. To assess the opinion on the services provided in PHCs Lhou and Kitpi, 22 different

community members‟ i.e. pregnant women, recently delivered women, mothers upto two

year old child, AWW, ASHA and Villagers were contacted. It was observed that community

was generally satisfied with the services. However, awareness about referral transport,

danger signs during ANC and sick new born babies and also about HIV/STD/AIDS was

poor.

b. Community members were dissatisfied with the irregular visit by MOs to the remote villages.

45

9. Sample Verification of F.W. acceptors: a. The team selected a total of 40 F.W. acceptors and out of that 34 (85%) could be contacted

for sample verification in the district. 20 (58.8%) contacted acceptors informed that they did

not receive any follow up service after having accepted the services.

b. During sample check, discrepant entries in age of spouse in 29 (85%) acceptors, total

number of children in 3 (9%) cases, male child in 3 (9%) cases and in age of youngest child

in 34 (100%) cases were found in the records.

c. 49 beneficiaries of BCG/ DPT/ Polio, Measles and Vitamin- A were selected and were

contacted. All contacted beneficiaries confirmed receiving the doses. Follow up by health

staff was found cent percent among the contacted beneficiaries.

10. Reconciliation of the reporting performance under Sterilization: CuT, Oral Pills and Nirodh figures reported by DH Tawang, CHC at Jang and PHC at Lhou

for the year 2010-11 and 2011-12 (up to February, 2012) did not match with the figures

showed in the report of district office for these Centres. CuT reported cases were also found

varying with the recorded figures in the service registers maintained at the reporting centres

in DH/CHC & PHC. The details are given below:

Name of the Centres

During the year 2010-11

CuT Oral Pills in cycle Condoms in pieces

By District office

By Centres

Verified

By District office

By Centres

By District office

By Centres

DH Tawang 94 111 150 365 426 393 755

CHC Jang 8 24 24 136 NA 84 NA

PHC Lhou 1 2 2 98 143 230 235

During the year 2011-12 (up to February, 2012)

DH Tawang 95 84 68 243 273 503 297

CHC Jang 12 11 11 109 NA 94 NA

PHC Lhou - - - 90 98 195 290

NA- Performance report not made available to the team. 11. Registers, records and reports maintained at the visited centres:

a. Eligible Couple register which is one of the most important records for FW service was

found maintained and updated at visited institution except District Hospital Tawang.

b. Consolidated CuT service registers were maintained without relevant details at District

Hospital Tawang and CHC Jang, and the register was not provided to the team at PHC

Lhou.

c. Oral Pills, Nirodh users‟ registers were maintained without all relevant details at District

Hospital Tawang and CHC Jang, and the same register was not found to maintain properly

in the areas of PHCs Lhou and Kitpi. Stock registers were also not maintained properly by

these centres.

46

d. Post Natal Care register was not found to be maintained in all the visited centres.

12. IT Infrastructure: Computers were found available at District and CHC level. Internet connectivity was found

available at district level only. MCH tracking was not implemented in the district upto the

visiting month.

13. Miscellaneous observation and suggestions: a. Routine immunization was provided at District Hospital, CHC and PHC level only.

b. IEC activity i.e. wall painting/ hoarding/ banners and posters was good in the periphery and

as well as at district level.

c. In the Sub Centre areas, immunization programme was done once in a month under

outreach programme through EPI team consisting of ANM, Health Assistant (M) with

vaccine carrier.

47

Andhra Pradesh 1. Kurnool District Major observations of Regional Evaluation Team (RET), Bangalore about the Evaluation work carried out in Kurnool District of Andhra Pradesh State in October, 2011. I. Details of the visited Institutions:

Districts Visited PHCs /CHCs visited SCs Visited

Kurnool PHC: Guduru, Gonegondla,

Hussainapuram

CHC: Done.

Julakal, Gudipadu, Kulumala,

Vemugodu, Somayajulapalli &

Brahmanapalli.

II. Major observations:

1. Human Resources:-

a) There was shortage of Medical and Paramedical Personnel in the district. Sanctioned post of

District Medical & Health Officer and District Malaria Officer, 37 of the 208 sanctioned posts of

Medical Officers, 22 of the 171 sanctioned posts of Staff Nurse (Regular), 32 of the 69

sanctioned posts of Staff Nurse ( contract basis the 24X7 PHCs ), 27 of the 100 sanctioned

posts of Health Supervisor (F), 61 of the 89 sanctioned posts of Health Supervisor (Male), 16

of the 107 sanctioned posts of Pharmacist, 3 of the 74 sanctioned posts of Lab Technician,

172 of the 403 sanctioned posts of MPHW (Male), 36 of the 449 sanctioned posts of ANMs/

MPHW (Female) and 222 of the 542 sanctioned posts of 2nd ANM / MPHW (Female) were

lying vacant in the district.

b) All the posts under NRHM Programme Management Unit were filled at district level.

c) In PHC Gudur, post of AYUSH Medical Officer, 2 posts of Contractual Staff Nurse and 4 of

the 6 sanctioned posts of Health Worker (Male) were lying vacant.

d) In the visited PHC Gonegondla, one of the 3 sanctioned posts of LHV, 2 posts of Health

Supervisor (Male), 5 of the 12 sanctioned posts of 2nd ANMs and 2 of the 6 sanctioned posts

of Health Worker (Male) were lying vacant.

e) In the visited PHC Hussainapuram, one each of the 2 sanctioned posts of Contractual Staff

Nurse & Health Supervisor (Male) and 3 of the 8 sanctioned posts of Health Worker (Male)

were lying vacant.

f) In visited CHC Dhone, one sanctioned post of Civil Surgeon Specialist and 1 of the 4

sanctioned posts of Civil Assistant Surgeon were lying vacant.

48

2. Janani Suraksha Yojna (JSY):-

a) Women belonging to BPL and SC/ ST category are eligible for JSY payments for their first two

deliveries @ Rs.700 per case for rural area and @ Rs. 600 per delivery in urban area in the

state. Further, JSY benefits are given for the deliveries conducted in Govt. institutions only.

b) In the district, 79,287 deliveries were conducted during 2010-11. Out of these, in 3,619 cases

of deliveries, mothers were paid JSY cash incentives in the year. During 2011-12 (upto August,

11) payments were made to 480 beneficiaries only whereas 34,061 deliveries were reported.

c) Total budget for JSY in the district was to the tune of Rs. 47,59,619 during 2010-11 and Rs.

76,62,419 during 2011-12 (upto August, 11) and expenditure to the tune of Rs. 25,20,200 was

incurred in 2010-11 and Rs. 3,36,000 during 2011-12 (upto August, 11).

d) During visit to the SCs at Julakal, Gudipadu, Kulumala and Vemugodu, few pending cases ( 2

in Julakal, 2 in Gudipadu, 7 in Kulumala and 5 in Vemugodu ) for JSY payment were reported

in the year 2010-11. Similarly, 4 in Julakal, 7 in Gudipadu, 10 in Kulumala and 9 in Vemugodu

for JSY payment were reported for year 2011-12.

e) The team contacted 20 JSY beneficiaries in the field. All contacted beneficiaries stated that

they received full JSY cash incentive. 18 of the 20 beneficiaries received full JSY cash

incentive in time. Cases for pending JSY payment due to insufficient budget were observed.

Follow up visits were made by the ASHA/ANM after delivery. All deliveries were institutional.

JSY registers were maintained in the district office and CHCs/PHCs. Beneficiary registers

were maintained at visited SCs. JSY cards were issued to all the beneficiaries.

3. Untied Funds:

a) Provision and utilization of Untied Funds in the district are as detailed below: (Amount in Rs)

* upto August, 2011. $ Grants for the year 2010-11 has been received in 2011-12 in April, 2011 from the state.

Most of the centres are yet to report expenditure statement up to Sept., 2011 in the year 2011-12.

Sl. No

Particulars for CHCs for PHCs for HSCs

2010-11 2011-12*

2010-11 2011-12*

2010-11

2011-12*

1. Total budget available

$ 3,50,000

5,36,424

22,29,965

50,84,266

34,46,215

2. Expenditure incurred

_ $ 1,81,459

$ 32,35,051

$

3. Balance _ 3,50,000

3,54,965

22,29,965

18,49,215

34,46,215

49

b) All the SCs were being provided Rs. 10,000 as Untied Funds and Rs. 10,000 as AMG per

year in the district. During visit to the SCs, it was observed that untied funds of Rs.10, 000

had been released to all the SCs during 2010-11 and full amount was utilized except SC

Kulumala. Annual Maintenance Grant was not released to any of the visited SCs for the

years 2010-11 and 2011-12 as all visited SCs were functioning in rented buildings.

c) In the visited SCs Untied Funds were utilized for purchasing of items such as – Tables,

Chairs, Electrical Bulbs, Weighing Machines, Examination Table, Stethoscope, Bleaching

Powder, BP Apparatus, Syringes, Registers, Window / Door Screens and Stationery items.

Besides this, fund was utilized for getting Xerox copies of reporting formats.

4. Rogi Kalyan Samiti (RKS)

a) Rogi Kalyan Samiti (RKS) have been constituted in District Hospital, all 18 CHCs and all 83

PHCs in the district.

b) Every RKS was being provided funds to the tune of Rs. 5, 00,000 at Distt. Hospital level,

Rs.2, 50,000 at CHC level and Rs. 1, 75,000 at PHC level every year. These funds includes

corpus fund, Annual Maintenance Grant (AMG) and Untied Funds. All these funds are kept at

the disposal of RKS and after taking the approval in its meeting, the funds were being utilized

on developmental activities of the Institution.

c) Details of Corpus funds and AMG funds available and expenditure incurred at CHCs & PHCs

in the District are given in the following table:

Type/ Head of the funds

For CHCs For PHCs

2010-11 2011-12 $ 2010-11 2011-12 $

Budget * Expdr. Budget* Expdr Budget* Expdr. Budget* Expdr.

Corpus fund

3,41,946 1,01,200 9,40,746 0 19,87,221 10,17,600 84,69,621 0

AMG Not Released 7 ,00,000 0 8,85,886 4,28,303 42,07,583 0

*Including opening balance $ upto August, 2011.

d) In the visited PHCs at Gudur, Gonegondla & Hussainapuram, it was observed that RKS

grants of the year 2010-11 were released in the year 2011-12 from district office to PHC

Gudur during June, 2011, to PHC Gonegondla during June – July, 2011 and to PHC

Hussainapuram during April - May, 2011, as the state office has released the grant late during

April, 2011 to the district office.

e) In the visited PHCs Gudur & Hussainapuram, no expenditure was incurred duirng June to

September 2011, because the joint account holders to operate this account has been

changed from Mandal Praja Parishid President to Mandal Development Officer as per the

directions of the directorate of Medical and Health Services, Andhra Pradesh; the other joint

account holder, the Medical Officer of the PHCs remains unchanged.

f) In the visited PHC Gonegondla, some of the major works undertaken by the RKS are:

50

i) During 2010-11, Rs. 30,000 transferred to AP Health Infrastructure and Drug Management

Corporation for construction of parking shed for Ambulance – 108.

ii) During 2011-12, expenditure was incurred on purchase of Stationery, Emergency Medicine,

Power back-up invertor, Electrical repairs and Civil Works like repair of compound wall etc.

g) In the visited CHC Dhone, RKS grants for 2010-11 was released in the year 2011-12 during

April – May 2011 from the district office, as the state office has released the grant late during

April 2011 to the district office. During 2011-12 (upto September, 2011), expenditure was

incurred on purchase of Lab. Equipments, payment of Laundry charges for washing Bed

Sheets, Ambulance repairs and Vehicle maintenance etc.

5. Services of ASHA:-

a) In the district, 2946 ASHAs were appointed till 31.03.2011. All were trained in all modules

and 2727 ASHAs were provided with drug kits. 833 New ASHAs were proposed to be

inducted during 2011-12.

b) An expenditure to the tune of Rs. 1,58,90,466 during 2010-11 and Rs. 1,36,16,885 during

2011-12 ( upto August 2011) was incurred towards work based incentives to ASHAs.

c) In the visited institutions, 23 ASHAs were interviewed. As informed, all were trained and

received performance based remuneration regularly.

d) At the visited SCs, ASHAs were posted and trained. In the VHSNCs, ASHAs were

functioning as a member.

6. Functioning of Village Health Sanitation and Nutrition Committees (VHSNC):-

a) 899 VHSNCs were set up against 927 revenue villages covered under 899 Gram Panchyaths;

3023 Anganawadi Centres were functioning in the district. Every year Rs. 10,000 are

allotted to each

VHSNC which was operated jointly by the Village Secretary of Revenue department and ANM

of Sub-Centre.

b) Details of VHSNC budget in the district for 2010-11 and 2011-12 are as below:

SI.No Particulars 2010-11 04/11 to 08/11

1. Total budget available *

1,02,28,977

48,73,340

2. Expenditure incurred

54,56,637

0

3. Balance

47,72,340

48,73,340

*Including opening balance:

c) In the visited Sub-Centres, it was observed that the VHSNCs are established, functioning and

the budget released were spent, but regular meetings were not conducted. In general, it was

51

observed that meeting was conducted only once when funds are provided and the entire money

was spent within a span of 2-3 months, Large part of the money was spent on bleaching

powder and labour charges. Ideally the budget should be divided into 4 quarters so that money

was available for all the four quarters with the VHSNC for taking up sanitation work. VHSNC

fund was utilized to buy Bleaching Powder, Lime Powder, Labour charges for cleaning sub

centre surroundings, cleaning of Drainage and Water Tanks at the villages.

d) VHSNC fund was released to the visited SCs during 2010-11. But no fund was released to the

committees for the current year.

7. 24 x 7 hours Delivery Care System:-

a) In the district, 45 of the total 83 PHCs were functioning as 24X7 delivery care institutions. 30

of these 45 PHCs have only two Medical Officers posted and the remaining 15 PHCs have

only one Medical Officer. 3 Staff Nurses were posted in 8 centres only.

b) In the 24X7 hours service centres, no additional budget was released except the salary for

the contractual basis Staff Nurses.

c) During 2009-10, 15 PHCs and during 2010-11, 17 PHCs of the total 45 PHCs have not performed minimum stipulated 10 deliveries per month.

8. Physical Infrastructure and Stock Position:-

i) Sub Centres

a) It was observed that all the visited SCs were functioning in rented building and infrastructure

was not as per IPHS. ANM was staying at other places than the SC head quarter. Labour

Room was not functioning in all the visited SCs. In the visited SCs Julakal & Vemugodu, toilet

was not available.

b) Delivery Table, McIntsh Sheets, Ambu bag / Suction, RDT Test Kit for Malaria, Weighing

Machine (Infant) and Hemoglobin meter were not available in the visited SCs. In the visited

SCs, Cup Board for drugs was not available except at Vemugodu SC. Steam Sterilizer & IUD

insertion Kit was not available in the visited SCs except Julakul SC. In the visited SCs Julakal

& Kulimala, Delivery Kit was not available.

c) DDK, Gloves, Kerosene oil / Gas, Sanitary Napkins, EC pills, Tab Oxitocin, Inj Gentamycin

and Kits – A & B were not available at the visited Sub Centers. In the visited SCs at Julakal &

Vemugodu, Condoms were not available. IUDs & OP cycles were not available at Julakal SC.

Antiseptic Solution, Cap. Ampicilin, were not available in the visited SCs except at Julakal. In

the visited SCs Gudipadu & Vemugodu, Tab. Metranidazole was not available.

ii) PHCs

a) It was observed that all PHCs were functioning in Govt. building though infrastructure was

not as per IPHS. Residential quarter for Medical Officer was not provided to the PHCs. No

vehicle provided to the PHCs. In the visited PHC Gonegondla, stocks of condoms, Hepatitis-

52

B vaccine and Vit-A were nil since June 2011. Stock of Iron tablets (small & big) was nil since

April 2011.

b) AYUSH Medical Officer was not posted in PHC Gudur.

c) It was observed that CHC Dhone was functioning in Govt. building and infrastructure was not

as per IPHS. Vehicle, Anesthesia Equipment, Injection Arteether & Quinine and Anti-Rabies

vaccine were not supplied. Only normal deliveries were conducted, caesarian deliveries were

not conducted because of lack of anesthesia equipment. Baby Radiant Warmer and

Phototherapy equipment for new born care were also not provided.

9. Community Satisfaction and opinion on Health Services:-

a) 40 mothers having child upto one year of age were interviewed in the area of 4 visited Sub

Centres to assess their knowledge and opinion on the services rendered by ANMs and

observed that 39 (97.5%) mothers had their delivery by trained persons, their babies were

weighed after birth and also received PNC services in time.

b) 31 (77.5%) mothers had no knowledge on danger signs of ARI, and 7 (17.5%) mothers had

no knowledge on advantages and side effects of contraceptive methods.

c) The team contacted different community persons to have their opinion about the services

provided by the MPW (M) of SCs Julakal & Vemugodu. Community expressed their

satisfaction towards the work of MPWs (M) though MPW (M) was not staying in the SC HQ.

d) Public opinion was good on the services being rendered by the PHCs visited by the team.

Village leader, ANC/ PNC beneficiaries and others expressed good opinion on the overall

functioning of PHCs.

10. Sample Verification of FW Acceptors:

a) Out of 93 FW acceptors (Sterilization, IUD, OP and CC) selected, 64 (68.8%) could be

contacted for sample verification in the district. Minor discrepancies were found in age of

acceptor, age of spouse, total children & number of male children and age of last child.

b) All contacted 40 child immunization beneficiaries confirmed receiving the doses of

immunization and also got follow up services. No complication among the contacted

beneficiaries was reported after receiving the doses.

11. Maintenance of Records and Register:

a) EC registers and Stock registers were not found updated in the visited centres.

b) Nirodh / Oral pills distribution registers were maintained (Non Printed) at SC levels.

c) Sterilization and IUD registers (Non Printed) were maintained at PHC levels in the visited centres.

12. IT Infrastructure and Mother & Child (MCH) Tracking System:

a) Two computers were installed at the district headquarter. At CHC level, 7 of the total 18

CHCs having computer systems, but none have internet facility and at PHC level, 36 of the 83

PHCs having computer systems, but internet connection was not there.

53

b) Under HMIS reporting system, facility based reporting had not yet started.

c) Under Mother and Child Tracking System, data entry was done at district level office for all

PHCs in the district, data entry was in process though not yet completed. All the staff at

CHCs/PHCs were trained and sensitized on MCTS.

2. Ananthapur District:

Major observations of Regional Evaluation Team (RET), Bangalore about the Evaluation work carried out in Ananthapur District of Andhra Pradesh State in October, 2011. I. Details of the visited Institutions:

Districts Visited PHCs /CHCs visited SCs Visited

Ananthapur PHCs: Rapthad,

Mudigubba &

Chilamattur.

Marrur, G.R.Pally, Malakavemula,

Sanevaripally, Demakothapalli &

Maravakothapalli.

II. Major observations:

1. Human Resources:-

a) There was shortage of Medical and Paramedical Personnel in the district. Post of District

Surveillance Officer, 75 of the 181 sanctioned posts of Allopathic Medical Officer, 23 of the 41

sanctioned posts of AYUSH Medical Officers, 2 of the 133 sanctioned posts of Staff Nurse

(Regular), 23 of the 69 sanctioned posts of Staff Nurse ( contract basis for 24X7 PHCs), 63 of

the 113 sanctioned posts of Health Supervisor (M), 18 of the 88 sanctioned posts of

Pharmacist, 10 of the 72 sanctioned posts of Lab Technician, 108 of the 411 sanctioned posts

of MPHW (Male), 98 of the 570 sanctioned posts of ANMs / MPHW (Female) and 138 of the

619 sanctioned posts of 2nd ANM / MPHW (Female) were lying vacant in the district.

b) In the visited PHC Rapthadu, one of the 7 sanctioned posts of ANM was lying vacant.

c) In the visited PHC Mudigobba, 2 of the 4 sanctioned posts of Medical Officer, 2 of the 3

sanctioned posts of Staff Nurse, 1of the 2 sanctioned posts of Supervisor (M), 1 of the 13

sanctioned posts of ANM, 3 of the 13 sanctioned posts of 2nd ANMs, were lying vacant.

d) In the visited PHC Chilamathur, post of AYUSH Medical Officer, 5 of the 10 sanctioned posts

of 2nd ANM and 5 of the 7 sanctioned posts of Health Worker (Male) were lying vacant.

2. Janani Suraksha Yojna (JSY):-

a) Women belonging to BPL and SC/ ST category are eligible for JSY payments for their first two

deliveries @ Rs.700 per case for rural area and @ Rs. 600 per delivery in urban area in the

state. Further, JSY benefits are given for the deliveries conducted in Govt. institutions only.

54

b) In the district 75,023 deliveries were conducted during 2010-11. Out of these, in 11,185 cases

of deliveries, mothers were paid JSY cash incentives in the year. During 2011-12 (upto August,

11) payments were made to 4,903 beneficiaries only whereas 39,924 deliveries were reported.

c) Total budget for JSY in the district was to the tune of Rs. 1,45,96,291 during 2010-11 and Rs.

1,25,88,560 during 2011-12 (upto August, 11) and expenditure to the tune of Rs. 84,32,731

was incurred in 2010-11 and Rs. 10,81,386 during 2011-12 (upto August, 11).

d) During visit to the SCs, 6 pending cases for JSY payment were reported at G.R. Pally SC for

2010-11. Similarly, 6 in Marrur, 25 in G.R. Pally, 5 in Malakavemula and 8 in Sanevaripally

pending cases for JSY payment were reported for 2011-12.

e) The team contacted 22 JSY beneficiaries in the field. All contacted beneficiaries stated that

they received full JSY cash incentive in time. Follow up visits were made by the ASHA/ANM

after delivery. 21 deliveries were institutional. JSY registers were maintained in the district

office and CHCs / PHCs. Beneficiary‟s registers were maintained at visited SCs. JSY cards

were issued to all the beneficiaries.

3. Untied Funds:

a) Provision and utilization of Untied Funds in the district are as detailed below: ( In Rs.)

* Upto August, 2011. $ Excess expenditure was drawn from flexi pool fund for the year 2010-11 for PHC. b) All the SCs were being provided Rs. 10,000 as Untied Funds and Rs. 10,000 as AMG per

year in the district. During visit to the SCs, it was observed that untied funds of Rs.10, 000

had been released to all the SCs during 2010-11 and full amount was not utilized. During

2011-12 fund was not released.

c) In the visited SCs, Untied Funds were utilized for purchasing of items such as – Tables,

Plastic Chairs, Benches, Weighing Machines, Stethoscope, Bleaching Powder, Medicines, BP

Apparatus, Registers and Stationery items. Besides this, fund was utilized for painting delivery

Table, for Waste Management at the SC, School Health programmes, and expenses for

Medical Camps conducted at the SC villages and getting Xerox copies of reporting formats.

Sl. No

Particulars for AHS and CHCs for PHCs for HSCs

2010-11 2011-12*

2010-11 2011-12*

2010-11 2011-12*

1. Total budget available

4,76,659 2,57,359 4,32,161 26,44,130 61,23,311 16,55,449

2. Expenditure incurred

2,19,300 0 4,38,031 5,00,000 52,28,762 1,50,000

3. Balance 2,57,359 2,57,359 -5,870$ 21,44, 130 8,94,549 15,05,449

55

4. Rogi Kalyan Samiti (RKS):

a) Rogi Kalyan Samiti (RKS) have been constituted in District Hospital, all (6 ) Area Hospitals, all

(11) CHCs and all (80) PHCs in the district.

b) Every RKS was being provided funds to the tune of Rs. 5, 00,000 at Distt. Hospital level, Rs.

1, 00,000 at Area Hospitals, Rs. 1, 00,000 at CHC level and Rs. 1, 00,000 at PHC level every

year. These funds includes corpus fund, Annual Maintenance Grant (AMG) and Untied

Funds. All these funds are kept at the disposal of RKS and after taking the approval in its

meeting, the funds were being utilized on developmental activities of the Institution.

c) Details of Corpus funds and AMG funds available and expenditure incurred at CHCs & PHCs

in the District are given in the following table:

Type/ head of the funds

For all Institutions in district for the year

2010-11 2011-12 $

Budget * Expdr. Budget* Expdr.

Corpus fund 27,50,764 18,66,248 1,04,13,220 10,00,000

AMG 11,16,342 8,41,079 73,55,296 10,00,000

*Including opening balance$ upto August, 2011.

Note: for the year 2010-11 for PHC, excess expenditure was drawn from flexi pool fund.

d) In the visited PHCs at Mudigobba & Chilamathur, it was observed that RKS grants of the year

2010-11 was released in the year 2011-12 from district office to PHC Mudigobba during June

– July, 2011 and to PHC Chilamathur during April - May, 2011, as the State Office has

released the grant late during April, 2011 to the district office.

e) During visit to the PHC at Rapthadu, it was observed that the expenditure was incurred for

purchasing of Medicine & Bleaching Powder during epidemic control, Medical & Lab

Equipment, Stationery, Repair of Computers, Cleaning of PHC Premises, Leveling of Earth

Surrounding PHC, Fixing of electrical items, Plumbing work such as fixing of Wash Basins,

Carpentry work such as Window & Door repairs and painting of PHC building. Payment of

labour charges hired for cleaning and washing of Delivery Room. Payment of transport hire

charges for carrying drugs from district stores to PHC, making of Xerox copies of reporting

formats etc.

f) In the visited PHCs Mudigobba, from June to September 2011, no expenditure was incurred,

because the joint account holders to operate this account has been changed from Mandal

Praja Parishid President to Mandal Development Officer as per the directions of the

Directorate of Medical and Health Services, Andhra Pradesh; the other joint account holder,

the Medical Officer of the PHCs remains unchanged.

56

g) During visit to the PHC at Chilamathurf, it was observed that major expenditure was towards

cost of transport to bring Medicines issued by District Office to PHC, cost of hiring of vehicle for

Arogya Mela, cleaning charges of Bathrooms & Lavatory, fixing of Electrical Fittings, purchase

of Auto-Clave equipment, Computer Printer, Carpentry Work, Leveling of Earth Surrounding

PHC premises, Refreshment charges during meetings and purchase of office Stationery

items, etc.

5. Services of ASHA:-

a) In the district 3057 ASHAs were appointed till 31.03.2011. All were trained in all modules and

2930 ASHAs were provided with drug kits.

b) An expenditure to the tune of Rs. 1,00,05,890 during 2010-11 and Rs. 1,37,34,250 during

2011-12 ( upto September 2011) was incurred towards work based incentives to ASHAs.

c) In the visited institutions, 21 ASHAs were interviewed. As informed, all were trained and

received performance based remuneration regularly.

d) At the visited SCs, ASHAs were posted and trained. In the VHSCs, ASHAs were functioning

as a member.

6. Functioning of Village Health Sanitation and Nutrition Committees (VHSC):-

a) 1001 VHSNCs were set up against 947 revenue villages covered under 1001 Gram

Panchyaths 3696 Anganawadi Centres were functioning in the district. Every year Rs. 10,000

are allotted to each VHSNC which was operated jointly by the Village Secretary of Revenue

department and ANM of Sub-Centre.

b) Details of VHSNC budget in the district for 2010-11 and 2011-12 are below:

SI.No Particulars 2010-11 04/11 to 08/11

1. Total budget available 1,03,72,311 21,35,170

2. Expenditure incurred 90,47,141 3,00,000

3. Balance 13,25,170 18,35,170

c) In the visited Sub-Centres, it was observed that the VHSNCs are established, functioning and

the budget released was spent, but regular meetings were not conducted. In general, it was

observed that meeting was conducted only once when funds received and the entire money

was spent within a span of 2-3 months, ideally the budget should be divided into 4 quarters so

that money is available for all the four quarters with the VHSNC for taking up sanitation work.

VHSNC fund was utilized to buy Bleaching Powder, Lime Powder, Labour charges for cleaning

sub centre surroundings, cleaning of Drainage and Water Tanks at the villages.

d) VHSNC fund was released to the visited SCs during 2010-11. But no fund was released to the

committees for the current year.

57

7. 24 x 7 hours Delivery Care System:-

a) In the district, 42 of the total 80 PHCs were functioning as 24X7 delivery care institutions. 17 of

these 42 PHCs have only two Medical Officers posted and the remaining 25 PHCs have only

one Medical Officer. Position on posting Staff Nurses was not readily available in the district

office.

b) In these centres no additional budget was released except the salary for the contractual Staff

Nurses.

c) During 2009-10, 10 PHCs and during 2010-11, 13 PHCs of the total 42 PHCs did not perform

minimum stipulated 10 deliveries per month.

d) In the visited PHCs Mudigobba & Chilamathur, Baby Radiant Warmer was not supplied.

8. Physical Infrastructure and Stock Position:-

i) Sub Centres

a) It was observed that all the visited SCs were functioning in rented building except SC G.R.

Pally and infrastructure was not as per IPHS. ANM was staying at other places than the SC

head quarter. Labour Room was not functioning in all the visited SCs. In all the visited SCs,

toilet was not available.

b) Examination Table, Foot Stool, Ambu bag / Suction, Steam Sterilizer, RDT Test Kit for Malaria,

IUD Insertion Kit, Stove and Weighing Machine (Infant) were not available in the visited SCs.

Benches for clients, Delivery Table and McIntsh Sheet were not available at visited SCs except

SC G.R.Pally. In all the visited SCs, Cup Board for drugs, Torch and Delivery Kit were not

available except SC Malakavemula. In the visited SCs G.R. Pally and Sanevaripally,

Hemoglobin Meter was not available.

c) DDK, Kerosene oil / Gas, Vit. A Solution, OP Cycles, Sanitary Napkins, EC pills, Condoms,

Clorine Solution (Bleaching Powder), Tab Oxitocin, Inj Gentamycin and Kits – A & B were not

available at the visited Sub Centers. In all the visited SCs, Gloves were not available except

SC Malakavemula. In all the visited SCs, Antiseptic Solution, Tab. Cotrimoxazole, IUDs and

IFA (small & big) / Syrup were not available except SC Marrur.

ii) PHCs

a) It was observed that all PHCs were functioning in Govt. building though infrastructure was

not as per IPHS. Residential quarter for Medical Officer was not provided to the PHCs. No

vehicle provided to the PHCs. In the visited PHC Rapthadu, stocks of Condoms was nil

since May 2009 and stock of Oral Pill was nil since February 2010.

b) AYUSH, Medical Officer was not posted in PHC Chilamathur.

9. Community Satisfaction and opinion on Health Services:-

a) 40 mothers having child upto one year of age were interviewed in the area of 4 visited Sub

Centres to assess their knowledge and opinion on the services rendered by ANMs and

58

observed that 95 % mothers had their delivery by trained persons; their babies were weighed

after birth and also received PNC services in time.

b) 33 (82.5%) mothers had no knowledge on danger signs of ARI, and 11 (27.5%) mothers had

no knowledge on advantages and side effects of contraceptive methods. 38 (95%) deliveries

were institutional.

c) The team contacted different community persons to have their opinion about the services

provided by the MPW (M) of SCs Marrur, G.R. Palli & Malakavemula. Community expressed

their satisfaction towards the work of MPWs (M) though MPW (M) was not staying in the SC

HQ.

d) Public opinion was good on the services being rendered by the PHCs visited by the team.

Village leader, ANC/ PNC beneficiaries and others had expressed good opinion on the overall

functioning of PHCs.

10. Sample Verification of FW Acceptors:

a) Out of 94 FW acceptors (Sterilization, IUD, OP and CC) selected, 64 (68.1%) could be

contacted for sample verification in the district. Minor discrepancies were found in age of

acceptor, age of spouse, total children & number of male children and age of last child.

b) All contacted 37 child immunization beneficiaries confirmed with the doses of immunization

and also got follow up services. No complication among the contacted beneficiaries was found

after receiving the doses.

11. Maintenance of Records and Register:

a) EC registers and Stock registers were not found updated in the visited centres.

b) In the visited centres, Sterilization and IUD registers were maintained (Non Printed) at PHC

levels.

c) Follow up entries was not in IUD/OP/CC registers. 12. IT Infrastructure and Mother & Child (MCH) Tracking System:

a) Two computers were installed at the district headquarter. At CHC level, 6 of the total 11

CHCs have computer systems, but out 4 have internet facility and at PHC level 60 of the 80

PHCs having computer systems, but internet connection was not there.

b) Under HMIS reporting system, facility based reporting had not yet started.

c) Under Mother and Child Tracking System, data entry was done at district level office for all

PHCs in the district and the data entry was in process though not yet completed. All the staff

at CHCs / PHCs were trained and sensitized on MCTS.

59

3. Nalgonda District: Highlights from the Evaluation Report of Nalgonda and Mehabubnagar District (Andhra Pradesh). The Regional Evaluation Team, located at Regional Office for Health and Family Welfare

(Bangalore), Ministry of Health and Family Welfare, Government of India carried out sample

checks of activities covered under NRHM / RCH in Nalgonda District of Andhra Pradesh

State during February, 2012.

I. Details of the visited Institutions:

Districts

Visited

PHCs / CHCs visited SCs Visited

Nalgonda PHCs: Thipparthy,

Nidamanoor & Varkatpalli.

CHC: Choutuppal.

Duppalapalli, Madugulapalli, Vempadu,

Thummadam & Choutuppalli.

II. Major observations: 1. Human Resources:-

a) Shortage of Medical Personnel was reported in the district. The Post each of the District

Immunization Officer, Dist TB Officer, Dist Leprosy Officer & Radiologist, 24 of the 137

sanctioned posts of Medical Officer (Allopathic) / MBBS, 6 of the 11 sanctioned posts of

Physician, 4 of the 19 sanctioned posts of Surgeon, 5 of the 24 sanctioned posts of

Gynecologist, 1 of the 18 sanctioned posts of Pediatrician, 2 of the 15 sanctioned posts of

Anesthetists, 4 of the 7 sanctioned posts of Pathologist were lying vacant in the district.

b) Similarly, 2 of the 94 sanctioned posts of Staff Nurse (Regular), 10 of the 69 sanctioned

posts of Staff Nurse (contract basis under 24X7), 15 of the 79 sanctioned posts of

Pharmacist, 31 of the 91 sanctioned posts of Lab Technician, 128 of the 365 sanctioned

posts of MPHW (Male), 107 of the 472 sanctioned posts of MPHW (Female) and 12 of the

565 sanctioned posts of 2nd MPHW (Female) were also lying vacant in the district.

c) Post of District Project Management Officer under District level NRHM Programme

Management Unit (DPMU) was lying vacant. No staff was reported to have been posted

at the Taluk level / sub-district level or Block level NRHM Programme Management Unit in

the district.

d) In the visited PHCs, 2 of the 9 sanctioned posts of ANM and 2 of the 7 sanctioned posts of

Male worker were lying vacant in PHC Thipparthy. 1 of the 2 sanctioned posts of Medical

Officer, 3 of the 10 sanctioned posts of ANM, 2 of the 5 sanctioned posts of Male Worker

and are sanctioned post each of the AYUSH Medical Officer & Lab-Technician were lying

vacant in PHC Nidamanur.

e) In the visited CHC Choutuppal, all the sanctioned posts were in position except one post

of Safaiwala.

60

2. Janani Suraksha Yojna (JSY):-

a) Women belonging to BPL and SC/ ST category who deliver in the Govt. institution or in

Home are eligible for JSY payments for their first two deliveries. JSY mothers are given @

Rs.700 per case for rural area and @ Rs. 600 per delivery in urban area in the state.

b) In the district 57,074 deliveries were conducted during 2010-11. Out of them 10,547 got

JSY cash incentive in the year. During 2011-12 (upto December) payments were made to

7,169 beneficiaries out of 42,237 deliveries.

c) Total budget for JSY in the district was available to the tune of Rs. 1,56,01,143 for 2010-

11 and Rs. 1,82,97,118 for 2011-12 (upto January, 2012). Expenditure to the tune of Rs.

69,02,525 was incurred in 2010-11 and Rs. 58,58,300 during 2011-12 upto January, 2012.

d) The team contacted 21 JSY beneficiaries in the field. As reported, all deliveries were

institutional and they received full JSY cash incentive. MCH and JSY cards were issued to

all; ANC / PNC visits were made by the ANMs. Transport facility was arranged by ASHAs /

ANMs to all 21 mothers for delivery purpose.

e) All the JSY registers were maintained with complete information in the district office and

CHCs / PHCs. In the visited Sub Centres, Beneficiaries registers were maintained and

checked by the concerned Medical Officer.

3. Untied Funds:-

a) Provision and utilization of Untied Funds in the district are as detailed below:

(Amount in Rs)

Sl. no Particulars Budget for CHCs Budget for PHCs Budget for HSCs

2010-11 2011-12* 2010-11 2011-12* 2010-11 2011-12 *

1. Total budget

available

4,03,500 5,53,500

24,17,173 41,14,170 51,99,209 51,19,258

2. Expenditure

incurred

50,000

0

78,003 3,25,000 57,29,951 30,000

3.

Balance 3,53,500 5,53,500 23,39,170 37,89,170 - 5,30,742 $ 50,89,258

* upto January, 2012. $ excess expenditure was met from flexi pool funds.

b) There are 7 CHCs, 72 PHCs and 565 Sub Centres in the district. Rs. 25,000 to each

PHC and Rs. 50,000 to each CHC are given as untied funds per year in the district. SCs

were being provided @ Rs. 10,000 as Untied Funds.

c) Untied Funds to the tune of Rs. 10,000 was released to each of the visited SCs in the

year 2010-11 and funds were spent by these centres to buy Stationery, Table Fan,

Bulb, Registers, BP Apparatus and Stethoscope for getting Xerox copies of reporting

formats, Wall Writings, Immunization flexi boards, Banners and Organizing rallies on

swine flu etc

d) Untied Funds provided to the visited SCs during 2011-12 were not spent up to the

month of visit.

4. Rogi Kalyan Samiti (RKS):-

a) Rogi Kalyan Samiti (RKS) was constituted in District Hospital, 7 SDHs, 7 CHCs and 72

PHCs in the district.

b) Every RKS was being provided funds to the tune of Rs. 5, 00,000 at Distt. Hospital

level,

61

Rs. 2, 00,000 at SDH level, Rs. 2, 50,000 at CHC level and Rs. 1, 75,000 at PHC level

every year. These funds includes corpus fund, Annual Maintenance Grant (AMG) and

Untied Funds. AMG to the RKS at District Hospital and Untied Funds to the RKS at

DH and SDH are not given in the district. All these funds are kept at the disposal of

RKS and after taking approval, the funds were being utilized on developmental

activities of the Institution.

c) Details of RKS funds available and expenditure incurred at in the District as a whole

are given in the following table:

Type/ head of the funds

For CHCs for the year

For PHCs for the year

2010-11 2011-12 $ 2010-11 2011-12 $

Budget* Expdr. Budget* Expdr. Budget* Expdr. Budget* Expdr.

Corpus fund

9,79,588 2,29,804 11,49,784 0 1,04,91,795 17,60,778 1,58,31,017 28,89,412

AMG Fund

7,00,000 0 11,00,000 0 37,44,724 91,368 92,43,306 29,12,000

* Including opening balance. $ upto January, 2012.

Status of Untied Funds may be seen at point 3.

d) Delay in the release of RKS funds was observed. RKS funds meant for the year 2010-11

were released from State Office to district office on the last day of the financial year of

2010-11 i.e., on 31.03.2011. The district office released these funds to the peripheral

institutions (DH/ CHCs/PHCs) in May, 2011.

e) Similarly RKS funds meant for the year 2011-12 were released from the State Office to

district office very late in December, 2011, The district office has not yet disbursed these

funds to the peripheral institutions (DH / CHCs / PHCs) up to the visiting month i.e.,

February 2012.

f) In the visited PHCs at Thipparthy and Nidamanur, it was observed that no budget was

released during 2010-11, budget meant for 2010-11 was released in the next financial

year during June 2011. In PHC Thipparthy, the budget meant for the 2011-12 was

released in February 2012 and in PHC Nidamanur, the budget meant for the year 2011-12

was released in January 2012.

g) In PHC Thipparthy, the funds were spent on Digging of bore-well, Construction of new

water tank, Materials and labour charges of painting of PHC building, Electricity repairs,

JCB charges for cleaning of PHC premises, Purchase of stationery, Payment of bills of

pollution control board, expenses towards celebration of world population day and

independence day etc.

h) In PHC Nidamanur, upto January 2012, no expenditure was incurred. There was change

in the joint account holders of RKS bank account from Mandal Praja President to Mandal

Development Officer (MDO). Now the RKS bank account was jointly handled by the

Medical Officer of the PHC and MDO. Because of this reason there was delay in executing

works upto January, 2012.

i) In CHC Choutuppal, during 2010-11 the fund to the tune of Rs. 2,60,000 including opening

balance etc. was available with RKS, Out of this, an amount to the tune of Rs. 2,30,721

was spent on purchase of Drugs, Surgical equipment, Computer, Printer and UPS, Table,

Chair, filling of Oxygen Cylinders, Lab & Diagnostic materials, Transportation of drugs

62

from district HQ, Water supply, Aprons and Gowns, Dental Chair repair, Replacements

and repairs of beds, Plumbing work, materials required for sanitation such as Soap, Dettol,

Phenol, Bucket, Jugs and Electrical repairs. No budget was released during 2011-12.

5. Services of ASHA :-

a) As targeted the district had selected 3517 ASHAs as on 31.3. 2011. 3215 ASHAs were

working as on 31-12-2011 and 2963 ASHAs were provided with drug kits.

b) An expenditure to the tune of Rs. 1,36,67,226 during 2010-11 and Rs. 2,31,23,400 during

2011-12 upto January 2012 was incurred towards performance based incentives to

ASHAs.

c) In the visited institutions, 15 ASHAs were interviewed. As informed by them, all were

trained and given drug kits, and have been receiving performance based remuneration

regularly. Some ASHAs have expressed their dissatisfaction for meager performance

based incentive.

d) At the visited SCs Duppalapalli, Madugulapalli, Vempadu and Thummadam, ASHAs were

posted and trained. In the VHSNCs, ASHAs were functioning as a member.

6. Functioning of Village Health Sanitation & Nutrition Committees (VHSNC):-

a) 1178 VHSNCs were set up against 1178 revenue villages in the district. Every year funds

@ Rs. 10,000 are allotted to each VHSNC which was operated jointly by the Village

Secretary of Revenue department and ANM of Sub-Centre.

b) Details of VHSNC budget available and spent in the district during 2010-11 and 2011-12

(upto Jan, 12) are below:

SI.No Particulars 2010-11 2011-12 (upto Jan, 12)

1. Total budget available 1,18,40,489 1,12,71,084

2. Expenditure incurred 1,26,79,405 76,50,000

3. Balance -8,38,916 36,21,084

Note: For 2010-11, excess expenditure was met from flexi pool funds.

f) In the visited Sub-Centres, it was observed that the VHSNCs are established, functioning

and the budget released were spent, but regular meetings were not conducted. In

general, it was

observed that meeting was conducted only once when funds receive and the entire

amount is spent within a span of 2-3 months; Ideally the budget should be divided into 4

quarters so that fund is available for all the four quarters with the VHSNC for taking up

sanitation work. VHSNC fund was utilized to buy Bleaching powder, Registers, labour

charges for cleaning Sub Centre surroundings, cleaning of drainage & drinking water tanks

and repair of water pipelines at the villages.

d) It was reported that VHSNC funds had been released to the visited SCs at Duppalapalli

& Vempadu to @ Rs. 40,000, SC at Madugulapalli to @ Rs. 30,000 and SC at

Thummadam to @ Rs. 10,000 during 2010-11 & 2011-12 (upto Jan‟ 2011).

7. 24 x 7 hours Delivery Care System:-

a) In the district, 37 of the total 72 PHCs were functioning as 24X7 delivery care institutions.

Of these 37 centres, only 26 PHCs have 2 Medical Officers posted and the remaining 11

have only 1 Medical Officer. 24 PHCs have 3 Staff Nurses and remaining 13 have less

than 3 Staff Nurses.

63

b) No additional budget was released to 24X7 hours Service Centres except the salary for

the contractual Staff Nurses.

c) During 2010-11, 35 PHCs and during 2011-12, all 37 PHCs could not perform stipulated

minimum of 10 deliveries per month and therefore, it is required to reclassify the 24X7

centres based on their performance.

d) In the visited PHCs Thipparthy & Nidamanur, Baby Radiant Warmer was not supplied and

Baby corner was not established.

8. Physical Infrastructure and Stock Position:-

i) Sub Centres

a)It was reported that SCs visited at Duppalapalli, Madugulapalli, Vempadu and Thummadam

were functioning in rented building and infrastructure was not as per IPHS. ANM was

staying at other places than the SC head quarter at Duppalapalli, Madugulapalli. Electricity

was not available in the visited SC Thummadam. Labour Room was not available in all

the visited SCs. In the visited SCs Duppalapalli and Thummadam toilet was not available.

b) Benches for clients were not available in the visited SCs Madugulapalli and Vempadu.

Weighing Machine (Infant), Steam Sterilizer, OP Cycles and Clorine Solution (Bleaching

Powder) were not available in the visited SCs except SC Duppalapalli. IUD Insertion Kit

was not available in the visited SCs Madugulapalli and Thummadam. Cupboard for drugs

and Stove were not available in the visited SC Vempadu. Dlivery Kit and Tab.

Cotrimoxazole were not available in the visited SCs Vempadu and Thummadam. Foot

Stool was not available in all the visited SCs except SC Thummadam.

c) Delivery Table, McIntsh Sheets, Ambu bag/suction, RDT test Kit for Malaria and

Hemoglobinmeter were not available in the visited SCs.

d) DDK, Kerosene oil / Gas, Vitamin A Solution, Sanitary napkins, Tab. Oxitocin and Kits – A

& B were not available in the visited SCs.

f) EC Pills & Antiseptic Solution were not available in all the visited SCs except SC

Vempadu. Gloves, IUDs and Tab. Paracetamol were not available in the visited SC

Thummadam.

g) More than 80 % of furniture equipment and drugs were not available in the visited centres

as a result SCs cannot render delivery and other related service effectively.

ii) PHCs

a) In the visited PHCs Thipparthy and Nidamanur, it was observed that the PHCs were

functioning in government building though infrastructure was not as per IPHS. No vehicle

provided to the PHCs.

b) In the visited PHC, Thipparthy, Oxygen Cylinder, Auto-clave and sterilizer drum were not

available. Under AYUSH one lady Medical Officer was posted since 3 years, but her

salary has not been paid for the past 1 year since February, 2011. Delivery room was not

well maintained.

c) In the visited PHC Nidamanur, Lab technician post was vacant since 6 months. Operation

theatre was not functional. AYUSH Medical Officer was not posted. Residential quarter

for Medical Officer was not provided.

d) CHC Choutuppal was functioning in government building though infrastructure was not as

per IPHS. No vehicle provided to the CHC. Blood storage unit was not set – up. Sick

new born care unit was not established. There was no neonatal resuscitation equipment.

Injection Arteether and Quinine were not supplied but same were purchased as and when

required. Caesarian deliveries were not conducted due to non availability of Boyles

apparatus, Anesthetic equipment and non availability of blood storage unit.

64

9. Community Satisfaction and opinion on Health Services:-

a) 40 mothers having child upto one year of age were interviewed in the area of four visited

Sub Centres to assess their knowledge and opinion on the services rendered by ANMs

and observed that most of the mothers had their delivery by trained persons; their babies

were weighed after birth and also received PNC services in time.

b) 22 (55.0%) mothers had no knowledge on danger signs of ARI and 6 (15.0%) mothers had

no knowledge on advantages and side effects of contraceptive methods.

c) Public opinion was good on the services being rendered by the PHCs visited by the team.

Village leader, ANC/ PNC beneficiaries and others had expressed good opinion on the

overall functioning of PHCs.

10. Sample Verification of FW Acceptors:-

a) Out of 94 FW acceptors (Sterilization, IUD, OP and CC) selected, 67 (71.3%) could be

contacted for sample verification in the district. Minor discrepancies were found in age of

acceptors, age of spouse, total children & number of male children.

b) All contacted 41 child immunization beneficiaries confirmed with the doses of

immunization and also on follow up services. No complication among the contacted

beneficiaries was found after receiving the doses.

11. Maintenance of Records and Register:-

a) Sterilization and IUD central registers (Non Printed) were maintained at PHC levels in the

visited centres.

b) Immunization & MCH, Stocks and cash books were maintained at PHC / SC levels.

c) EC registers and Stock registers were not found updated in the visited centres.

12. IT Infrastructure and Mother & Child (MCH) Tracking System:-

a) Two computers were installed with internet facility at the district headquarter. At CHC

level, all 7 CHCs have no computer systems. At the PHC level, only 20 PHCs of the total

72 PHCs having computer systems without internet connectivity.

b) In the place of blocks, in Andhra Pradesh state, there are Community Health and Nutrition

Clusters (CHNCs) headed by the Senior Public Health Officer with job responsibility to

supervise 4-7 PHCs. There are 15 such CHNCs to supervise 72 PHCs functioning in the

district. All the 15 CHNCs have computer systems and internet facility, but there was no

trained manpower to make data entry in many CHNCs. Therefore, data feeding or

compilation work under HMIS was not done at this CHNC level.

c) Under HMIS reporting system, facility based reporting had started partially at PHC and

Sub centre level since April 2011, but the data feeding was very poor and negligible. Out

of the total 72 PHCs, during November and December 2011, only 1 PHC had fed data in

the HMIS web portal for September and October 2011, 20 PHC fed data for August 2011

only, 12 PHC uploaded data for April to July 2011 and the remaining PHCs did not upload

any data. All PHCs and SCs send HMIS paper report to district office and at the district

office 6 data entry operators feed Sub Centre and PHC wise data; the work load for these

data entry operator was so huge that they could not complete the month wise data for all

565 SCs an 72 PHCs, 7CHCs, 7 SDHs and 1 DH for the past months from April to

January 2012. The district office was not able to generate the web portal system

generated district level report. The district total performances reports were being prepared

on excel sheets by manually feeding data received from all peripheral institutions.

d) Under Mother and Child Tracking System, of the total 56,000 Antenatal cases registered

in the district during April to January 2012, data for 50,666 pregnant women were entered

in the MCTS web portal.

65

4. Mehabubnagar District: Highlights from the Evaluation Report of Mehabubnagar District (Andhra Pradesh). The Regional Evaluation Team, located at Regional Office for Health and Family Welfare

(Bangalore), Ministry of Health and Family Welfare, Government of India carried out sample

checks of activities covered under NRHM / RCH in Mehabubnagar District of Andhra

Pradesh State during February, 2012.

I. Details of the visited Institutions:

Districts

Visited

PHCs / CHCs visited SCs Visited

Mehabubnaga

r

PHCs: Manikonda, Kotakonda

& Balanagar.

CHC: Athmakur.

Serilingampalli, Kotakonda,

Ammireddipalli, Balanagar &

Motiganapur.

II. Major observations:

1. Human Resources:-

a) There was acute shortage of Medical and Paramedical Personnel in the district.

Sanctioned post each of the Addl. DMHO & Dist TB Officer, 27 of the 186 sanctioned

posts of Medical Officer (Allopathic) / MBBS, 12 of the 13 sanctioned posts of Physician,

10 of the 45 sanctioned posts of Surgeon, 18 of the 26 sanctioned posts of Gynecologist,

3 of the 14 sanctioned posts of Pediatrician, 9 of the 17 sanctioned posts of Anesthetists,

1 of the 2 sanctioned pots of Radiologist, 4 of the 13 sanctioned posts of Pathologist, 2 of

the 6 sanctioned posts of ENT Specialist and 1 of the 4 sanctioned posts of

Ophthalmologist were lying vacant in the district.

b) Similarly, 3 of the 141 sanctioned posts of Staff Nurse (Regular), 18 of the 81 sanctioned

posts of Staff Nurse (contract basis under 24X7), 8 of the 127 sanctioned posts of MPH

Supervisor (Female) L.H.V, 20 of the 155 sanctioned posts of MPH Supervisor (Male), 26

of the 135 sanctioned posts of Pharmacist, 2 of the 79 sanctioned posts of Lab

Technician, 113 of the 299 sanctioned posts of MPHW (Male), 48 of the 539 sanctioned

posts of MPHW (Female) and 88 of the 672 sanctioned posts of 2nd MPHW (Female) were

lying vacant in the district.

c) Sanctioned post each of the District Project Management Officer and Management

Information System Officer under District level NRHM Programme Management Unit

(DPMU) was lying vacant. No staff was posted at the Taluk level or sub-district level or

Block level NRHM Programme Management Unit.

d) In the visited PHC Kotakonda, 6 of the 10 sanctioned posts of ANM (Regular), 1 of the 10

sanctioned posts of 2nd ANM, 6 of the 8 sanctioned posts of MPW(M) and one post of

PHN were lying vacant.

e) In the visited CHC Atmakur, all Specialists posts except Dental were lying vacant.

66

2. Janani Suraksha Yojna (JSY):-

a) Women belonging to BPL and SC/ ST category who deliver in the Govt. institutions are

eligible for JSY payments for their first two deliveries. JSY mothers @ Rs.700 per case for

rural area and @ Rs. 600 per delivery are given in urban area in the state.

b) In the district 71,822 deliveries were conducted during 2010-11. Out of them 5,020 got

JSY cash incentive in the year. During 2011-12 (upto December) payments were made to

4,258 beneficiaries whereas 59,321 deliveries were reported.

c) Total budget for JSY in the district was available to the tune of Rs. 1,31,51,200 for 2010-

11 and Rs. 1,96,08,100 for 2011-12 (upto December). Expenditure to the tune of Rs. 36,

61,000 was incurred in 2010-11 and Rs. 63,95,169 during 2011-12 upto December, 2011.

d) The team contacted 17 JSY beneficiaries in the field. As informed, All deliveries were

institutional and they received full JSY cash incentive. MCH and JSY cards were issued to

all; ANC / PNC visits were made by the ANMs. Transport facility was arranged by ASHAs /

ANMs to all contacted mothers for delivery purpose.

e) All the JSY registers were maintained with complete information in the district office and

CHCs / PHCs. In the visited Sub Centres, Beneficiaries registers were maintained and

checked by the concerned Medical Officers.

3. Untied Funds:-

a) Provision and utilization of Untied Funds in the district are as detailed below:

(Amount in Rs)

Sl. no

Particulars Budget for CHCs Budget for PHCs Budget for HSCs

2010-11 2011-12*

2010-11 2011-12* 2010-11 2011-12 *

1. Total budget available

1,81,428 8,81,428 25,90,752 47,51,090 67,99,552 1,05,37,995

2. Expenditure incurred

0

0

1,13,662 2,50,000 49,98,557 1,00,000

3.

Balance 1,81,428 8,81,428 24,77,090 45,01,090 18,00,995 1,04,37,995

*CHC & HSCs upto December, 2011. *PHC upto January, 2012.

b) There are 14 CHCs, 85 PHCs and 675 Sub Centres in the district. @ Rs. 25,000 to

each PHC and @ Rs. 50,000 to each CHC are given as untied funds per year in the

district. SCs were being provided @ Rs. 10,000 as Untied Funds.

c) For the year 2010-11, Untied Fund of Rs. 10,000 each was released to the visited

SCs. Funds were utilised by the SCs to buy Chairs, Stationery, Registers, for getting

Xerox copies of reporting formats, Wall Writings and for Cleaning the SC

Surroundings etc. During 2011-12, it was observed that as per the new guidelines

issued by the Andhra Pradesh state government, joint account for SC Untied Fund

has to be opened with PHN or MO of the PHC but the account was not yet opened.

Hence, SC Untied Fund was not released to the visited SCs.

4. Rogi Kalyan Samiti (RKS):-

a) Rogi Kalyan Samiti (RKS) was constituted in District Hospital, 4 SDHs, 14 CHCs and

85 PHCs in the district.

b) Every RKS was being provided funds to the tune of Rs. 5, 00,000 at Distt. Hospital

level, Rs. 2, 00,000 at SDH level, Rs. 2, 50,000 at CHC level and Rs. 1, 75,000

at PHC level every year. These funds includes corpus fund, Annual Maintenance

Grant (AMG) and Untied Funds. All these funds are kept at the disposal of RKS and

67

after taking the approval in its meeting, the funds were being utilized on

developmental activities of the Institution.

c) Details of RKS funds available and expenditure incurred at in the District as a whole

are given in the following table:

Type/ head of the

funds

2010-11 2011-12 $

Budget* Expdr. Budget* Expdr.

Corpus fund

1,06,36,

672

21,73,23

0

2,39,65,4

24

8,53,000

AMG Fund

56,72,29

5

6,45,279

1,07,86,0

35

5,10,700

* including opening balance $ upto January, 2012.

Status of Untied Funds may be seen at point 3.

d) In the visited PHCs at Kotakonda and Balanagar, it was observed that no budget was

released during 2010-11; budget i.e. Rs. 1,75,000 meant for 2010-11 was released in the

next financial year (on 30.05.2011). Again Rs. 1,75,000 was released on 09.02.2012. No

expenditure was incurred upto February 2012. In PHC Kotakonda, the RKS meeting was

not held as the chairman was not co-operating.

e) In PHC Balanagar, during 2010-11 with the opening balance and interest, a total fund of

Rs. 1,50,000 was available with RKS. Out of this, Rs. 1,46,500 was spent on purchase of

Electrical motor and Plumber work, Electrical repairs. Purchase of Medicines, Lab

equipment, BP Apparatus and Weighing Machines. Expenditure was incurred towards

laundry charges and premises cleaning charges.

f) In CHC Atmakur, no budget was released during 2010-11, budget meant for 2010-11 was

released in the next financial year during 28.09.2011. During 2011-12, Rs. 2,75,000 was

released, out of this, Rs. 48,000 was spent on purchase of Power inverter, Drugs

transportation, Sanitation work and for Stationery. The RKS meeting was not held as the

Chairman was not co- operating.

5. Services of ASHA:-

a) The district had selected 4500 ASHAs as on 31.12. 2011 against the total requirement of

4530 ASHAs in the district. 3740 ASHAs were working as on 31-01-2012. 800 new

ASHAs were proposed to be inducted during 2011-12.

b) An expenditure to the tune of Rs. 1,45,26,344 during 2010-11 and Rs. 2,14,75,771 during

2011-12 (upto December 2011) was incurred towards performance based incentives to

ASHAs.

c) In the visited institutions, 10 ASHAs were interviewed. As informed by them, all were

trained and given drug kits, and have been receiving performance based remuneration

regularly.

d) At the visited SCs Ammireddipalli and Motiganapur, ASHAs were posted and trained. In

the VHSNCs, ASHAs were functioning as a member.

6. Functioning of Village Health Sanitation & Nutrition Committees (VHSNC):-

a) 1348 VHSNCs were set up against 1553 revenue villages located under 1348 Gram

Panchyaths in the district. Every year Rs. 10,000 are allotted to each VHSNC which was

operated jointly by the Village Secretary of Revenue department and ANM of Sub-Centre.

68

b) Details of VHSNC budget available and spent in the district during 2010-11 and 2011-12

are below:

Sl. No Particulars 2010-11 2011-12 (upto Dec, 11)

1. Total budget available 1,70,16,675 2,20,53,491

2. Expenditure incurred 1,21,93,184 1,49,700

3. Balance 48,23,491 2,19,03,791

c) In the visited Sub-Centres, it was observed that the VHSNCs are established, functioning

and the budget released were spent, but regular meetings were not conducted. In

general, it was observed that meeting was conducted only once when funds receive and

the entire amount is spent within a span of 2-3 months; Ideally the budget should be

divided into 4 quarters so that fund is available for all the four quarters with the VHSNC for

taking up sanitation work in any health eventuality that may arise in future quarters.

d) It was reported that VHSNC funds of Rs. 30,000 had been released to the visited SCs at

Ammireddipalli & Motiganapur during 2010-11. During 2011-12 (upto Jan‟ 2011) VHSNC

funds was not released to the visited SCs.

e) VHSNC fund was utilized to buy Phenol, Bleaching powder, Registers for ASHAs, for

getting Xerox copies of reporting formats, Labor charges for cleaning of drainage and

drinking water tanks at the villages.

7. 24 x 7 hours Delivery Care System:-

a) In the district, 62 of the total 85 PHCs were functioning as 24X7 delivery care institutions.

Of these 62 centres, only 49 PHCs have 2 Medical Officers posted and the remaining 13

have only 1 Medical Officer. Position on posting Staff Nurses was not readily available in

the district office.

b) No additional budget was released to 24X7 hours Service Centres except salary for the

contractual Staff Nurses.

c) During 2010-11, 46 PHCs and during 2011-12 (upto Dec, 2011) 45 PHCs of the total 62

PHCs could not perform stipulated minimum of 10 deliveries per month and therefore, it is

required to reclassify the 24X7 centres based on their performance.

d) In the visited PHC Balanagar, Blood storage facility was not available. Facilities were

adequate to run 24X7 delivery services: However, Baby Radiant Warmer was not

supplied and Baby corner was not set up. Visited PHC Kotakonda was not a 24X7

centre.

e) In the visited CHC Atmakur, Blood storage facility was not available. Facilities were

adequate to run 24X7 delivery services.

8. Physical Infrastructure and Stock Position:-

i) Sub Centres

a) It was reported that SCs visited at Ammireddipalli and Motiganapur were functioning in

Govt. building and infrastructure was not as per IPHS. ANM was staying at other places

than the SC head quarter at Motiganapur. Main source of water and electricity was not

available in the visited SCs. Labour Room was not functioning in all the visited SCs. In

the visited SC Motiganagpur toilet was not available.

b) Benches for Clients, Nischay Pregnancy Test Kit, Stove, Weighing Machine (Infant) and

BP Apparatus were not available in the visited SC Ammireddipalli.

c) Examination Table, Foot Stool, Delivery Kit, McIntsh Sheets, Ambu bag/suction, Sieam

Sterilizer, IUD insertion kit, RDT test Kit for Malaria, Torch and Hemoglobinmeter were not

69

available in the visited SCs. DDK, Kerosene oil / Gas, Sanitary Napkins, EC Pills, Clorine

solution (Bleaching powder) and Kits – A & B were also not available in the visited SCs.

d) Gloves, IUDs, OP cycles, Condoms and Tab. Paracetamol were not available in the

visited SC Ammireddipalli. Thermometer, Antiseptic Solution and Cap. Ampicillin were not

available in the visited SC Motiganapur.

e) Most of the furniture, equipments and drugs were not available in the visited centres as a

result SCs could not conduct delivery and other related service effectively.

ii) PHCs

a) In the visited PHCs Kotakonda and Balanagar, it was observed that the PHCs were

functioning in government building though infrastructure was not as per IPHS. No

telephone, vehicle, oxygen cylinder and residential quarter for Medical Officer were

provided to the PHC

b) In the visited PHC Kotakonda, Power back up, Auto-clave, Minor surgical equipments and

IUD insertion kit were not available. AYUSH Medical Officer was not posted. Stock of Cu-

T, OP cycles, Condoms, DT vaccine, IFA (large), IFA syrup and Vit. Syrup were not

available on the day of team visit. This PHC was not designated to work as 24X7 delivery

care centre.

c) In the visited PHC Balanagar, Stock of Vaccine- BCG, Polio, DT, IFA (small) and IFA syrup

were not available on the day of team visit,

d) CHC Atmaskur was functioning in government building though infrastructure was not as

per IPHS. No Ambulance, X-Ray facility, Blood storage facility, Sick new born care unit,

Anesthesia equipment and IUD Insertion Kit were provided. All specialist posts except

dental were vacant. All 4 doctors were not having privacy for conducting patient‟s

examination. No separate room was available for dentist to conduct OP. Roof of labor

room was leaking even after repairs done by spending funds of Rs. 1,00,000 during

2009-10. Residential quarters for Medical Officer was occupied by CHNC office (cluster).

Though, residential quarters for para Medical Personnel were available but the same

was not occupied due to non availability of water and power supply.

9. Community Satisfaction and opinion on Health Services:-

a) 20 mothers having child upto one year of age were interviewed in the area of two visited

Sub Centres to assess their knowledge and opinion on the services rendered by ANMs

and observed that most of the mothers had their delivery by trained persons; their babies

were weighed after birth and also received PNC services in time.

b) 11 (55.0%) mothers had no knowledge on danger signs of ARI and 2 (10.0%) mothers

had no knowledge on advantages and side effects of contraceptive methods.

c) Posts of MPW (M) were vacant in the visited SCs Ammireddipalli & Motiganapur. ANMs

were carrying out the work of MPW (M) in these SCs.

d) Public opinion was good on the services being rendered by the PHCs visited by the team.

Village leader, ANC/ PNC beneficiaries and others had expressed good opinion on the

overall functioning of PHCs.

10. Sample Verification of FW Acceptors:-

a) Out of 94 FW acceptors (Sterilization, IUD, OP and CC) selected, 67 (71.3%) could be

contacted for sample verification in the district. Minor discrepancies were found in age of

acceptors, age of spouse, total children & number of male children.

b) All contacted 41 child immunization beneficiaries confirmed with the doses of

immunization and also on follow up services. No complication among the contacted

beneficiaries was found after receiving the doses.

70

11. Maintenance of Records and Register:-

a) Sterilization and IUD central registers (Non Printed) were maintained at PHC levels and

printed registers for the same at SC levels in the visited centres.

b) Immunization & MCH, Stocks and cash books were maintained at PHC / SC levels.

c) EC registers and Stock registers were not found updated in the visited centres.

12. IT Infrastructure and Mother & Child (MCH) Tracking System:-

a) 4 computers were installed with internet facility at the district headquarter. At CHC level,

all the 14 CHCs have no computer systems. At the PHC level, none of the PHCs was

having computer systems with internet connectivity.

b) In the place of blocks, in Andhra Pradesh state, there are Community Health and Nutrition

Clusters (CHNCs) headed by the Senior Public Health Officer with job responsibility to

supervise 4-7 PHCs. There are 19 such CHNCs to supervise 85 PHCs functioning in

c) the district. All the 19 CHNCs have computer systems and internet facility, but there was

no trained manpower to make data entry in many CHNCs. Therefore, data feeding or

compilation work under HMIS and MCTS was not done at this CHNC level.

d) Under HMIS reporting system, facility based reporting had started partially at PHC and

Sub centre level since April 2011, but the data feeding was very poor and negligible.

HIMS district total compilation was done at district level office and forwarded to state

office on line. Facility based reporting has not yet started.

5. Ranga Reddy District: Highlights from the Evaluation Report of Ranga Reddy District (Andhra Pradesh).

The Regional Evaluation Team, located at Regional Office for Health and Family Welfare

(Bangalore), Ministry of Health and Family Welfare, Government of India carried out sample

checks of activities covered under NRHM / RCH in Ranga Reddy District of Andhra Pradesh

State during January, 2012.

I. Details of the visited Institutions:

Districts Visited PHCs /CHCs visited SCs Visited

Ranga Reddy PHCs: Serilingampalli, Uppal,

Moinabad, Saroor Nagar and

Kandukur.

SCs: Serilingampalli, Uppal, Kothapet,

Chilakuru, Peddamangalaram, Balapur,

Batasingaram, Guduru and Nedunur.

II. Major observations:

1. Human Resources:-

a) There was acute shortage of Medical and Paramedical Personnel in the district. 7 of the

86 sanctioned posts of Medical Officer (Allopathic), 14 of the 25 sanctioned posts of

Physician, 3 of the 9 sanctioned posts of Surgeon, 12 of the 31 sanctioned posts of

Gynecologist, 14 of the 25 sanctioned posts of Pediatricians, 14 of the 23 sanctioned

posts of Anesthetists, 1 of the 7 sanctioned posts of Dental Medical Officer were lying

vacant in the district. Post of Radiologist & Pathologist was also lying vacant.

71

b) Similarly, 8 of the 208 sanctioned posts of Staff Nurse (Regular), 3 of the 28 sanctioned

posts of Staff Nurse (contract basis under 24X7), 14 of the 44 sanctioned posts of

AYUSH Medical Officers, 4 of the 98 sanctioned posts of LHV, 77 of the 152 sanctioned

posts of Supervisor (Male), 9 of the 69 sanctioned posts of Pharmacist, 9 of the 59

sanctioned posts of Lab Technician, 80 of the 399 sanctioned posts of ANMs/ MPHW

(Female) and 123 of the 399 sanctioned posts of 2nd ANM / MPHW (Female) were lying

vacant in the district.

c) In the visited PHCs, post of Pharmacist was lying vacant in PHCs Serilingampalli &

Saroornagar. 6 of the 10 sanctioned posts of ANM and 4 of the 10 sanctioned posts of 2nd

ANM were lying vacant in PHC Kandakur. 1 of the 9 sanctioned posts of ANM, one post

of Male Worker and one post of Staff Nurse was lying vacant in PHC Moinabad.

2. Janani Suraksha Yojna (JSY):-

a) Women belonging to BPL and SC/ ST category are eligible for JSY payments for their first

two deliveries @ Rs.700 per case for rural area and @ Rs. 600 per delivery in urban area

in the state. Further, mothers delivering in the Govt. institutions are only entitled for JSY

incentives.

b) In the district 1, 03,195 deliveries were conducted during 2010-11. Out of them 4,432, got

JSY cash incentive in the year. During 2011-12 (upto December) payments were made to

2,861 beneficiaries whereas 67,024 deliveries were reported.

c) Total budget for JSY in the district was available to the tune of Rs. 73,66,236 for 2010-11

and Rs. 1,58,43,182 for 2011-12 (upto December). Expenditure to the tune of Rs. 35,

83,954 was incurred in 2010-11 and Rs. 16, 65,193 during 2011-12 upto December, 2011.

d) During visit to the SC at Guduru, 6 pending cases for JSY payment were reported for the

year 2010-11. During 2011-12 (upto December, 2011), 6 pending cases were reported at

SC Balapur.

e) The team contacted 26 JSY beneficiaries in the field. 25 (96.2%) deliveries were

institutional and they received full JSY cash incentive. MCH and JSY cards were issued to

all; ANC / PNC visits were made by the ANMs. Transport facility was arranged by ASHAs /

ANMs to 21 (84%) mothers for delivery purpose. All the JSY registers were maintained

with complete information in the district office and CHCs / PHCs.

3. Untied Funds:-

a) Provision and utilization of Untied Funds in the district are as detailed below:

72

(Amount in Rs)

Sl. No

Particulars Budget for CHCs Budget for PHCs Budget for HSCs

2010-11 2011-12*

2010-11 2011-12* 2010-11 2011-12 *

1. Total budget available

4,36,802 4,36,802

14,81,716 32,64,454 22,76,828 28,27,757

2. Expenditure incurred

0

0

6,03,262 1,01,250 20,24,071 1,17,579

3.

Balance 4,36,802 4,36,802 8,78,454 31,63,204 2,52,757 27,10,178

* upto December, 2011.

b) There are 8 CHCs, 48 PHCs and 399 Sub Centres in the district. Rs. 25,000 to each

PHC and Rs. 50,000 to each CHC are given as untied funds per year in the district. SCs

were being provided @ Rs. 10,000 as Untied Funds.

c) It was reported that 5 PHCs in the district are located in Urban areas and therefore no

Untied Funds were given to them. During visit to the SCs, it was observed that Rs. 10,000

had been released to SC Batasingaram during 2010-11 but no expenditure incurred during

the year. Other three visited SCs namely Balapur, Guduru and Nedunur had not been

provided Untied Fund in the year 2010-11. During 2011-12, @ Rs. 10,000 were given to

the visited SCs but none of the SCs had spent the same upto of visit month.

4. Rogi Kalyan Samiti (RKS)

a) Rogi Kalyan Samiti (RKS) was constituted in District Hospital, 4 SDHs, 8 CHCs and 43

PHCs in the district. Of the total 48 PHCs in the district, 5 PHCs at Urban areas were

reported to be not eligible for RKS grants.

b) Every RKS was being provided funds to the tune of Rs. 5, 00,000 at Distt. Hospital level,

Rs. 2, 00,000 at SDH level, Rs. 2, 50,000 at CHC level and Rs. 1, 75,000 at PHC level

every year. These funds includes corpus fund, Annual Maintenance Grant (AMG) and

Untied Funds. AMG to the RKS at District Hospital and Untied Funds to the RKS at DH

and SDH are not given in the district. All these funds are kept at the disposal of RKS and

after taking the approval in its meeting, the funds were being utilized on developmental

activities of the Institution.

c) Details of RKS funds available and expenditure incurred at in the District as a whole are

given in the following table:

Type/ head of the funds

2010-11 2011-12 $

Budget * Expdr. Budget* Expdr.

Corpus fund 63,33,691

27,24,451 44,25,594 2,42,620

AMG 41,47,783 6,51,136 45,09,049 1,20,924

Status of Untied Funds may be seen at point 3. *Including opening balance.

73

$ upto December, 2011.

d) Delay in the release of RKS funds was observed. RKS funds meant for the year 2010-11

were released from State Office to district office on the last day of the financial year of

2010-11 i.e., on 31.03.2011. The district office released these funds to the peripheral

institutions (DH/ CHCs/PHCs) in July, 2011.

e) Similarly RKS funds meant for the year 2011-12 were released from the State Office to

district office in December, 2011, the district office has not yet disbersed these funds to the

peripheral institutions (DH / CHCs / PHCs) till 17.01.2012, as majority of the CHCs / PHCs

did not submit their expenditure statement for the year 2010-11.

f) In the visited PHCs at Serilingampalli, Saroornagar & Kandukur, it was observed that no

budget was released during 2010-11, budget meant for 2010-11 was released in the next

financial year during July 2011.

g) In the PHC Serilingampalli, upto December 2011, no expenditure was incurred. The RKS

meeting was held during Nov-Dec, 2011 and the process of executing work orders and

purchase orders were under process.

h) In PHC Saroornagar, during 2010-11, with the opening balance and interest a total fund of

Rs. 1,05,473 was available with RKS, out of this, Rs.98,996 was spent. During 2011-12

upto Dec. 2011, no expenditure was incurred. Funds for 2010-11 were utilized for Wall

Painting of PHC building, Partition of Pharmacy Cubicle, Civil works such as construction of

compound wall and electrical repairs. Purchasing of Medicines, Lab equipment, BP

Apparatus and weighing machines. Expenditure was incurred towards laundry charges and

premises cleaning charges.

i) In PHC Kandukur, during 2010-11 fund to the tune of Rs. 1,45,377 including opening

balance etc. was available with RKS, out of this Rs. 1,45,349 was spent. During 2011-12

upto Dec. 2011 no expenditure was incurred. During 2010-11, the expenditure was incurred

towards painting of exterior and interior of PHC building with doors, windows and

compound wall. Purchase of Blood grouping kit, Glucometer, Office Stationery, Linen,

Table Cloth, Electrical items such as fans and bulbs. Expenditure was also incurred

towards transport cost of medicines from district store to PHC at Rs. 1200 PM and

purchase of toilet cleaning detergents, plastic buckets, broomsticks, cleaning of deep burial

pit, soak pit and repair of electrical pump motor etc.

5. Services of ASHA :

a) The district had selected 1572 ASHAs as on 31.3. 2011 against the total requirement of

1837 ASHAs in the district. All 1572 ASHAs were working and provided with drug kits. It

has been reported that 265 new ASHAs proposed for the year 2011-12.

74

b) An expenditure to the tune of Rs. 62, 00,781 during 2010-11 and Rs. 62, 89,544 during

2011-12 upto December 2011 was incurred towards performance based incentives to

ASHAs.

c) In the visited institutions, 19 ASHAs were interviewed. As informed by them, all were

trained and given drug kits, and have been receiving performance based remuneration

regularly.

d) At the visited SCs Balapur, Batasingaram, Guduru and Nedunur, ASHAs were posted and

trained. In the VHSNCs, ASHAs were functioning as a member

6. Functioning of Village Health Sanitation & Nutrition Committees (VHSNC):-

c) 705 VHSNCs were set up against 948 revenue villages located under 705 Gram

Panchyaths in the district. Every year Rs. 10,000 are allotted to each VHSNC which was

operated jointly by the Village Secretary of Revenue department and ANM of Sub-Centre.

d) Details of VHSNC budget available and spent in the district during 2010-11 and 2011-12

(upto Dec, 11) are below:

SI.No Particulars 2010-11 2011-12 (upto Dec, 11)

1. Total budget available * 1,31,27,580 96,36,550

2. Expenditure incurred 72,65,030 13,103

3. Balance 58,62,550 96,23,447

*Including opening balance: e) In the visited Sub-Centres, it was observed that the VHSNCs are established, functioning

and the budget released was spent, but regular meetings were not conducted. In

general, it was observed that meeting was conducted only once when funds receive and

the entire amount is spent within a span of 2-3 months; Ideally the budget should be

divided into 4 quarters so that fund is available for all the four quarters with the VHSNC

for taking up sanitation work. VHSNC fund was utilized to buy Phenol, Bleaching powder,

Registers, for getting Xerox copies of reporting formats, labor charges for cleaning sub

centre surroundings, cleaning of drainage and drinking water tanks at the villages.

d) It was reported that VHSNC funds of Rs. 10,000 had been released to the visited SCs at

Balapur, Batasingaram, Guduru and Nedunur during 2010-11 & 2011-12 (upto Dec.‟

2011).

7. 24 x 7 hours Delivery Care System:-

a) In the district, 28 of the total 48 PHCs were functioning as 24X7 delivery care institutions.

Of these 28 centres, only 9 PHCs have 2 Medical Officers posted and the remaining 19

have only 1 Medical Officer. Status on posting of Staff Nurses in these centres was not

readily available in the district office.

75

b) No additional budget was released to 24X7 hours Service Centres except the salary for

the contractual Staff Nurses.

c) During 2009-10, 13 PHCs and during 2010-11, 16 PHCs of the total 28 PHCs did not

perform stipulated minimum of 10 deliveries per month and therefore, it is required to

revamp the 24X7 centres based on their performance.

d) In the visited PHC Kandakur, Baby Radiant Warmer was not supplied.

8. Physical Infrastructure and Stock Position:-

i) Sub Centres

a) It was reported that SCs visited at Batasingaram and Nedunur was functioning in Govt.

building and infrastructure was not as per IPHS. ANM was staying at other places than

the SC head quarter. Electricity was not available in the visited SCs. Labour Room and

toilet was not available in both the centres at Guduru & Nedunur.

b) Examination Table, Benches for clients, Weighing Machine (Infant) and Foot stool were

not available in the visited SCs except SC Batasingaram.

c) Delivery Table, McIntsh Sheets, Ambu bag/suction, Steam Sterilizer and RDT test Kit for

Malaria were not available in the visited SCs.

d) Hemoglobinometer was not available in the visited SCs Balapur & Batasingaram. IUD

Insertion Kit, Torch, Cap. Ampicillin and IFA (small & big) were not available in the visited

SCs Batasingaram & Nedunur. Delivery Kit, Stove and Inj. Gentamycine were not

available in the visited SCs except SC Balapur.

e) DDK, Kerosene oil / Gas, Vitamin. A Solution, Sanitary napkins, EC Pills, Tab. Oxitocin

and Kits – A & B were not available in the visited SCs.

f) Clorine Solution (Bleaching Powder) and Antiseptic Solution were not available in the

visited SCs except SC Guduru. IUDs and Condoms were not available in the visited SC

Batasingaram. Tab. Chloroquine was not available in SC Guduru.

g) More than 80 % of furniture equipment and drugs were not available in the visited centres

as a result SCs cannot render delivery and other related service effectively.

ii) PHCs

a) In the visited PHCs Serilingampalli, Saroornagar and Kandaukur, it was observed that the

PHCs were functioning in government building though infrastructure was not as per IPHS.

No vehicle provided to the PHCs.

b) Residential quarter for Medical Officer was not available in the visited PHCs at

Saroornagar and Kandaukur.

c) It was observed that PHCs Serilingampalli and Saroornagar were not categorized to work

as 24X7 delivery care centre.

76

9. Community Satisfaction and opinion on Health Services:-

a) 40 mothers having child upto one year of age were interviewed in the area of four visited

Sub Centres to assess their knowledge and opinion on the services rendered by ANMs

and observed that all mothers had their delivery by trained persons, their babies were

weighed after birth and also received PNC services in time.

b) 20 (50.0%) mothers had no knowledge on danger signs of ARI and 9 (22.5%) mothers

had no knowledge on advantages and side effects of contraceptive methods.

c) Posts of MPW (M) were vacant in all the visited SCs. ANMs were carrying out the work of

MPW (M) in these SCs.

d) Public opinion was good on the services being rendered by the PHCs visited by the team.

Village leader, ANC/ PNC beneficiaries and others had expressed good opinion on the

overall functioning of PHCs.

10. Sample Verification of FW Acceptors:

c) Out of 98 FW acceptors (Sterilization, IUD, OP and CC) selected, 71 (72.4%) could be

contacted for sample verification in the district. Minor discrepancies were found in age of

acceptors, age of spouse, total children & number of male children and age of last child.

d) All contacted 56 child immunization beneficiaries confirmed with the doses of

immunization and also on follow up services. No complication among the contacted

beneficiaries was found after receiving the doses.

11. Maintenance of Records and Register:

a) Sterilization and IUD central registers (Non Printed) were maintained at PHC levels in the

visited centres.

b) Immunization & MCH, Stocks and cash books were maintained at PHC / SC levels.

c) EC registers and Stock registers were not found updated in the visited centres.

d) Follow up entries were not made in IUD / OP / CC registers.

12. IT Infrastructure and Mother & Child (MCH) Tracking System:

a) Two computers were installed with internet facility at the district headquarter. At CHC

level, all the 8 CHCs have no computer systems. At the PHC level, only 6 PHCs of the

total 48 PHCs having computer systems with internet connectivity.

b) In the place of blocks, in Andhra Pradesh state, there are Community Health and Nutrition

Clusters (CHNCs) headed by the Senior Public Health Officer with job responsibility to

supervise 4-7 PHCs. There are 11 such CHNCs to supervise 48 PHCs functioning in

the district. All the 11 CHNCs have computer systems and internet facility, but there was

no trained manpower to make data entry. Therefore, data feeding or compilation work

under HMIS was not done at this CHNC level.

77

c) Under HMIS reporting system, facility based reporting had started partially at PHC and

Sub centre level since April 2011, but the data feeding was very poor and negligible. 5 of

the 48 PHCs during April, 2 PHCs each in May, June and July fed the data in the HMIS

web portal and none of the PHCs have fed data from August to December, 2011. 65 of

the 399 SCs during April, 75 SCs during May, 62 SCs during June, 61 SCs during July

and 38 SCs during August fed the data in web portal and none of the SCs have fed the

data from September to December, 2011. Of the total 48 PHCs in the district, 5 urban

PHCs have not yet been mapped in the HMIS web portal, therefore data entry was not at

all possible for these 5 urban PHCs.

d) Under Mother and Child Tracking System, of the total 76,766 Antenatal cases registered

in the district during April to December 2011, data for 24,241 pregnant women were

entered in the MCTS web portal. Data entry was in process. All the staff at CHCs/PHCs

were trained and sensitized on MCTS.

6. Warangal District:

Highlights from the Evaluation Report of Warangal District (Andhra Pradesh).

The Regional Evaluation Team, located at Regional Office for Health and Family Welfare

(Bangalore), Ministry of Health and Family Welfare, Government of India carried out sample

checks of activities covered under NRHM / RCH in Warangal District of Andhra Pradesh

State during January, 2012.

I. Details of the visited Institutions:

Districts Visited PHCs /CHCs visited SCs Visited

Warangal PHCs: Thorrur, Dharmasagar,

Kadipikonda.

CHC: Station Ghanpur.

Gurthur, Cherlapalem, Unikicherla,

Rampur. Kadipikonda

II. Major observations:

1. Human Resources:-

a) Post of District Leprosy Officer, 1 of the 142 sanctioned posts of Medical Officer

(Allopathic), 2 of the 24 sanctioned posts of Physician, one post each of the sanctioned

strength of 24 Surgeon, 32 Gynecologist, 28 Pediatricians and of the 2 Radiologist were

lying vacant in the district.

b) Similarly, 7 of the 106 sanctioned posts of Staff Nurse (Regular), 19 of the 72 sanctioned

posts of Staff Nurse (contract basis under 24X7), 16 of the 40 sanctioned posts of

AYUSH Medical Officers, 7 of the 74 sanctioned posts of Pharmacist, 10 of the 63

sanctioned posts of Lab Technician, 169 of the 327 sanctioned posts of MPHW (Male),

78

110 of the 543 sanctioned posts of ANMs / MPHW (Female) and 16 of the 605 sanctioned

posts of 2nd ANM / MPHW (Female) were lying vacant in the district.

c) In the visited PHCs, one of the 2 sanctioned posts of contractual Staff Nurse under 24X7

delivery section and 4 of the 5 sanctioned posts of Male worker were lying vacant in PHC

Thorrur. One post of Pharmacist and 1 of the 8 sanctioned posts of 2nd ANM were lying

vacant in PHC Dharmasagar.

d) 2 of the 3 sanctioned posts of Male Worker were lying vacant in CHC Stn. Ghanpur.

2. Janani Suraksha Yojna (JSY):-

a) Women belonging to BPL and SC/ ST category are eligible for JSY payments for their first

two deliveries @ Rs.700 per case for rural area and @ Rs. 600 per delivery in urban area

in the state. Further, mothers delivering in the Govt. institutions are only entitled for JSY

incentives.

b) In the district 64,182 deliveries were conducted during 2010-11. Out of them 2,183 paid

with JSY cash incentive in the year. During 2011-12 (upto December) payments were

made to 5,664 beneficiaries whereas 47,031 deliveries were reported.

c) Total budget for JSY in the district was available to the tune of Rs. 1,11,20,417 for 2010-

11 and Rs. 1,51,00,214 for 2011-12 (upto December). Expenditure to the tune of Rs.

26,46,103 was incurred in 2010-11 and Rs. 55,02,800 during 2011-12 upto December,

2011.

d) The team contacted 15 JSY beneficiaries in the field. All contacted beneficiaries stated

that they received full JSY cash incentive. MCH and JSY cards were issued to all; ANC /

PNC visits were made by the ANMs. 14 (93.3%) deliveries were institutional. Transport

facility was arranged by ASHAs / ANMs to 14 (100%) mothers for delivery purpose.

3. Untied Funds:-

a) There are 12 CHCs, 70 PHCs and 590 Sub Centres in the district. Rs. 25,000 to each

PHC and Rs. 50,000 to each CHC are given as untied funds per year in the district. SCs

were being provided @ Rs. 10,000 as Untied Funds.

b) Provision and utilization of Untied Funds in the district are as detailed below: (Amount in Rs)

Sl. No

Particulars Budget for CHCs Budget for PHCs Budget for HSCs

2010-11 2011-12*

2010-11 2011-12* 2010-11 2011-12 *

1. Total budget available

3,50,000 10,50,000 50,32,832 62,74,755 1,43,96,000 1,85,01,808

2. Expenditure incurred

0

0

3,58,077 0 19,44,192 2,00,000

3.

Balance 3,50,000 10,50,000 46,74,755 62,74,755 1,24,51,808 1,83,01,808

* upto December, 2011.

79

c) During visit to the SCs it was observed that no Untied Fund had been released to these

Sub Centres in the year 2010-11. During 2011-12 (upto Dec. 2011), Rs. 10,000 had been

released to the visited SCs at Unikicherla & Rampur. Out of this, full amount utilized in the

SC Unikicherla whereas only Rs. 5,000 could be spent at Rampur SC upto December

2011..

d) Untied Fund in the visited SCs was utilized to purchase items such as Examination Table,

Foot Stool, Fan, Stamp & Pad, Plastic Chairs, Bleaching Powder, Medicines,

Thermometer, BP apparatus, Registers and Stationery items. Besides, this fund was

utilized for getting Xerox copies of reporting formats.

4. Rogi Kalyan Samiti (RKS)

a) Rogi Kalyan Samiti (RKS) was constituted in District Hospital, 4 SDHs, 12 CHCs and 70

PHCs in the district.

b) Every RKS were being provided funds to the tune of Rs. 5, 00,000 at Distt. Hospital level,

Rs. 2, 00,000 at SDH level, Rs. 2, 50,000 at CHC level and Rs. 1, 75,000 at PHC level

every year. These funds include Corpus Fund, Annual Maintenance Grant (AMG) and

Untied Funds. AMG to the RKS at District Hospital and Untied Funds to the RKS at DH

and SDH are not given in the district. All these funds are kept at the disposal of RKS and

after taking the approval in its meeting, the funds were being utilized on developmental

activities of the Institution.

c) Details of RKS funds available and expenditure incurred at CHCs + SDH & PHCs in the

District are given in the following table:

Type/

head of

the

funds

For CHCs + SDH for the year For PHCs for the year

2010-11 2011-12 $ 2010-11 2011-12 $

Budget* Expdr. Budget* Expdr Budget* Expdr. Budget* Expdr.

Corpus

fund

8,00,000

0

22,00,000 0 1,17,18,726 29,93,630 1,51,25,096 5,14,588

AMG

Fund

8,00,000

0

22,00,000

0 38,90,903 6,56,402 57,34,401 52,483

Untied

fund

3,50,000 0

10,50,000

0 50,32,832 3,58,077 62,74,755 0

* Including opening balance. $ upto December, 2011.

d) RKS funds meant for the year 2010-11 were released from State Office to district office on

the last day of the financial year of 2010-11 i.e., on 31.03.2011. The district office

released these funds to the peripheral institutions (DH/ CHCs/PHCs) in May, 2011.

e) In the visited PHCs at Thorrur & Dharmasagar, it was observed that no budget was

released during 2010-11, budget meant for 2010-11 was released in the next financial

year during June 2011. Upto December 2011, no expenditure was incurred.

80

f) In the PHC Thorrur, RKS meeting was not held from April to December, 2011; plan of

action was also not prepared for executing works to be taken for developmental activities

of the hospital.

g) In PHC Dharmasagar, there was change in the joint account holders of RKS bank

account from Mandal Praja President to Mandal Development Officer (MDO), now the

RKS bank account was jointly handled by the Medical Officer of the PHC and MDO.

Because of this reason, there was delay in executing works upto December 2011 in the

present financial year 2011-12. During 2010-11, with the opening balance and interest

earned, total fund of

Rs. 1,14,804 was available with RKS, out of this Rs.40,200 was spent. Funds for 2010-11

were utilized for Motor Winding of Water Pump, Premises Cleaning, Routine maintenance

of PHC building, purchase of Office Stationery and expenses incurred towards awarding

best worker medal of the PHC etc.

h) In CHC Stn. Ghanpur, there was no budget releases in 2010-11. Budget meant for 2010-

11 was released in the next financial year 2011-12 during June, 2011. During 2010-11

with the opening balance and interest, total fund of Rs. 17,787 was available with RKS

and full amount was utilized. During 2011-12 upto Dec. 2011, total fund of Rs. 1,75,000

was available with RKS and out of this Rs. 1,49,844 was spent. RKS Funds for 2011-12

was utilized to purchase of Iron 3-seater Chairs of outpatient seating, Foetal Doppler,

Ultrasound scans jelly, Vision Drum, Ophthalmic Trial sets, Stethoscope, BP Apparatus,

Lab Regent and Lab. Equipment, Philips Charging Light, materials required for sanitation

such as Dettol, Phenol, Bucket and Jugs, Printing of case sheet, Discharge Cards,

Outpatient Cards, Water Purifier installation, Electrical repairs, Pluming work, Tank

Washing and Tap connection and painting of part of CHC building.

5. Services of ASHA:

a) The district had selected 3316 ASHAs as on 01.3.2011 against the total requirement of

3477 ASHAs in the district. All 3316 ASHAs were working as on 31/3/2011. It has been

reported that 161 new ASHAs were proposed to be inducted during 2011-12.

b) An expenditure to the tune of Rs. 1, 40, 24,141 during 2010-11 and Rs. 91,87,521 during

2011-12 upto December, 2011 was incurred towards performance based incentives to

ASHAs.

c) In the visited institutions, 24 ASHAs were interviewed. As informed by them, all were

trained and given drug kits. In PHC Dharmasagar, disbursement of performance based

ASHA incentive was pending from October to December 2011 and in PHC Thorrur from

April to December, 2011. Incentives were never paid monthly and regularly. Every time

payment was done once in 3-4 months with arrears for past months. The district office

81

need to release sufficient funds to PHCs in time and monitor regular disbursement of

incentives. Some ASHAs have expressed their dissatisfaction for meager performance

based incentive.

d) At the visited SCs Gurthur, Cherlapalem, Unikicherla and Rampur, ASHAs were posted

and trained. In the VHSCs, ASHAs were functioning as a member.

6. Functioning of Village Health Sanitation & Nutrition Committees (VHSNC):-

a) 1014 VHSNCs were set up against 1098 revenue villages located under 1014 Gram

Panchyaths in the district. Every year Rs. 10,000 are allotted to each VHSNC which was

operated jointly by the Village Secretary of Govt. Revenue department and ANM of Sub-

Centre.

b) Details of VHSNC budget available and spent in the district during 2010-11 and 2011-12

(upto Dec, 11) are below:

SI.No Particulars 2010-11 2011-12 (upto Dec, 11)

1. Total budget available *

1,76,84,534 2,09,38,874

2. Expenditure incurred 55,95,660 7,36,489

3. Balance 1,20,88,874 2,02,02,385

*Including opening balance: c) In the visited Sub-Centres, it was observed that the VHSNCs are established, functioning

and the budget released were spent, but regular meetings were not conducted. In

general, it was observed that meeting was conducted only once when funds were received

and the entire amount is spent within a span of one month without actually executing the

claimed work. Ideally the budget should be divided into 4 quarters so that fund is available

for all the four quarters with the VHSNC for taking up sanitation work. VHSNC fund was

utilized to buy bleaching powder, Labor charges for cleaning of drainage and water tanks

at the villages.

d) It was reported that VHSNC funds was not released to the visited SCs Gurthur and

Cherlapalem for the year 2010-11 and 2011-12.

7. 24 x 7 hours Delivery Care System:-

a) In the district, 36 of the total 70 PHCs were functioning as 24X7 delivery care institutions.

Of these 36 centres, only 21 PHCs have 2 Medical Officers posted and the remaining 15

have only 1 Medical Officer. 14 PHCs have 3 Staff Nurses and remaining 22 have less

than 3 Staff Nurses.

b) In these centres no additional budget was released except the salary for the contractual

Staff Nurses.

c) During 2010-11, 32 PHCs and during 2011-12, all 36 PHCs have not performed minimum

stipulated 10 deliveries per month and therefore, it is required to revamp the 24X7 centres

based on their performance.

82

d) In the visited PHCs Thorrur and Dharmasagar, Baby Radiant Warmer and Suction

Apparatus were not supplied. Baby care corner was not established in both the visited

PHCs. In the PHC Thorrur, caesarean deliveries were not conducted.

e) In the visited CHC Stn. Ghanpur, all the specialists were posted since one and half year

without creating any infrastructure, equipment and accommodation facilities. All

Specialists, one post each of Gynecologist, Pediatrician and Anesthetist besides one

general duty Medical Officer sit in one room sharing one examination table. Anesthetist

has no Boyles apparatus. The skills of the highly specialized doctors were not utilized

because of non-availability of necessary equipment and material support. Baby care unit

not established, Phototherapy unit was not available. During 2011-12 upto December

2011, only 45 normal deliveries were conducted; caesarian deliveries are not conducted.

8. Physical Infrastructure and Stock Position:-

i) Sub Centres

a) It was reported that SCs visited at Gurthur, Cherlapalem, Unikicherla and Rampur were

functioning in rented building and infrastructure was not as per IPHS. ANM was staying

at other places than the SC head quarter except Rampur. Labour Room was not available

in the visited SCs. Toilet was not available in SC Cherlapalam.

b) Examination Table was not available in the visited SCs Cherlapalem and Rampur.

Benches for clients, Mclntsh sheet and Delivery table were not available in the visited

SCs except SC Gurthur. Weighing Machine (Infant), IUD Insertion Kit, Thermometre and

Stove were not available in the visited SCs except SC Rampur. Nischay Pregnancy test

Kit was not available in SC Cherlapalem.

c) Ambu bag/suction, Steam Sterilizer, Delivery Kit, RDT test Kit for Malaria, Torch and

Hemoglobinometer were not available in the visited SCs.

d) DDK, Gloves, Kerosene oil / Gas, Vitamin. A Solution, Sanitary Napkins, EC Pills,

Antiseptic Solution, Tab. Oxitocin, Cap. Ampicillin and Kits – A & B were not available in

the visited SCs.

e) Clorine Solution (Bleaching Powder) was not available in the visited SCs except SC

Unikicherla. Cotrimoxazole Tablets were not available in the visited SCs Gurthur and

Cherlapalem. IUDs and Tab. Paracetamol were not available in the visited SCs

Cherlapalem and Unikicherla. IFA (small & big) / Syrup and Tab. Metranidazole were not

available in the visited SC Cherlapalem.

f) More than 80 % of essential furniture equipment and drugs were not available in the

visited centres, as a result SCs cannot render delivery and other related service

effectively.

83

ii) PHCs

a) In the visited PHCs Thorrur and Dharmasagar, it was observed that the PHCs were

functioning in government building though infrastructure was not as per IPHS. Power

backup was not installed in both the visited PHCs. No vehicle was provided to the PHCs.

b) In the visited CHC Stn Ghanpur, it was observed that the CHC was functioning in Govt.

building though infrastructure was not as per IPHS. Vehicle was not supplied. X-Ray plant

was non-functional since 2 months. Blood storage unit was not set-up. Delivery room was

not well equipped; there was no Neonatal resuscitation equipment. Injection Arteether and

Quinine were not supplied. Gynecologist and Anesthetist were posted but caesarian

deliveries were not conducted due non-availability of Boyles Anesthetic equipment and

non-availability of blood storage unit,

9. Community Satisfaction and opinion on Health Services:-

a) 40 mothers having child upto one year of age were interviewed in the area of four visited

Sub Centres to assess their knowledge and opinion on the services rendered by ANMs

and observed that 90% mothers had their delivery by trained persons; their babies were

weighed after birth and also received PNC services in time.

b) 20 (50.0%) mothers had no knowledge on danger signs of ARI and 8 (20%) mothers had

no knowledge on advantages and side effects of contraceptive methods. 87.5% deliveries

were institutional.

c) Posts of MPW (M) were vacant in all the visited SCs. ANMs were carrying out the work of

MPW (M) in these SCs.

d) Public opinion was good on the services being rendered by the PHCs visited by the team.

Village leader, ANC/ PNC beneficiaries and others had expressed good opinion on the

overall functioning of PHCs.

10. Sample Verification of FW Acceptors:

a) Out of 64 FW acceptors (Sterilization, IUD, OP and CC) selected, 50 (78.1%) could be

contacted for sample verification in the district. Minor discrepancies were found in total

children & number of male children.

b) All contacted 40 child immunization beneficiaries confirmed with the doses of

immunization and also got follow up services. No complication among the contacted

beneficiaries was found after receiving the doses.

11. Reconciliation of Reported Performance:

Some discrepancies were found during verification of performance figures reported at

district office and the visited centres for the year 2010-11 & 2011-12 as given below.

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a) Sterilisation cases reported as 568 and 474 for PHCs Thorrur and Kadipikonda

respectively by the district office for 2010-11, these figures were reported by the particular

PHCs as 549 and 424 for the same year.

b) Oral Pills figures reported 1448 for PHC Dharmasagar for the year 2010-11 but these

figures were reported as 1248 in the PHC report. Similarly Oral Pills figures reported by

district office for the PHC Kadipikonda were 1910 for the year 2011-12 but PHC report

showed the same as 1880 Oral Pills.

c) Condom Pieces reported for the PHC Kadipikonda by district office were 42400 for the

year 2010-11 and 19684 for the year 2011-12 but these figures in the PHC report

showed 2100 and 1575 respectively.

d) IUD figures reported at district office and PHC head quarters did not tally each other as

given below.

Name of the centres Year IUD

DFWB* PHC

PHC: Thorrur 2010-11 336 12

2011-12 143 Nil

PHC: Dharmasagar 2010-11 143 132

2011-12 68 16

PHC: Kadipikonda 2010-11 186 174

2011-12 110 42

* District Family Welfare Bureau / District Health Office.

12. Maintenance of Records and Register:

a) Sterilization and IUD Service registers (Non Printed) were maintained at PHC levels in the

visited centres.

b) Immunization & MCH, Stocks and cash books were maintained at PHC / SC levels.

c) EC registers and Stock registers were not found updated in the visited centres.

d) Follow up entries were not made in IUD / OP / CC registers.

13. IT Infrastructure and Mother & Child (MCH) Tracking System:

a) Two computers were installed with internet facility at the district headquarter. At CHC

level, there is no computer systems available. At the PHC level, only 2 PHCs of the total

70 PHCs were having computer systems with internet connectivity.

b) In Andhra Pradesh state, there are Community Health and Nutrition Clusters (CHNCs) at

block level headed by the Senior Public Health Officer with job responsibility to supervise

4-7 PHCs. There are 16 such CHNCs to supervise totally 70 PHCs functioning in the

district. All the 11 CHNCs have computer systems and internet facility, but there was no

trained manpower to make data entry. Therefore, data feeding or compilation work under

HMIS was not done at this CHNC level.

85

c) Under HMIS reporting system, facility based reporting had started partially at PHC and

Sub centre level since April 2011, but the data feeding was very poor and negligible. 18

of the 70 PHCs in the district, during September 2011 had fed the data in the HMIS web

portal and none of the PHCs have fed data from October to December, 2011. 9 of the

590 SCs had fed the data in web portal for November 2011 and none of the SCs have

fed the data for October and December, 2011. Ever since April 2011, there was never

100% feeding of data in the HMIS web portal. HMIS district total compilation was done

on excel sheet at district level office and forwarded to state office by e-mail. Facility

based reporting has not yet started.

There are no computer-trained manpower at the CHNC level. All the CHCs and 97% of

PHCs do not have computer systems.

d) Under Mother and Child Tracking System, of the total 56,180 Antenatal cases registered

in the district during April to December 2011, only 26,240 pregnant women were entered

in the MCTS web portal.

7. Nizamabad District:

Highlights from the Evaluation Report of Nizamabad District (Andhra Pradesh).

The Regional Evaluation Team, located at Regional Office for Health and Family Welfare

(Bangalore), Ministry of Health and Family Welfare, Government of India carried out sample

checks of activities covered under NRHM / RCH in Nizamabad District of Andhra Pradesh

State during March, 2012.

I. Details of the visited Institutions:

Districts

Visited

PHCs /CHCs visited SCs Visited

Nizamabad

PHCs: Saloora, Mendora &

Dichpalli.

CHC: Armoor.

Erajpalli, Amadapur, Doodhgaon, Savel,

Dharmaram and Bardhipur.

II. Major observations:

1. Human Resources:-

a) Shortage of Medical Personnel was reported in the district. One post each of the Addl.

DMHO, District RCH Officer, Dist TB Officer, Dist Leprosy Officer & District Surveillance

Officer, 31 of the 116 sanctioned posts of Medical Officer (Allopathic) and 17 of the 34

sanctioned posts of AYUSH Medical Officers, were lying vacant in the district.

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b) Similarly, 31 of the 114 sanctioned posts of Staff Nurse (Regular), 28 of the 58 sanctioned

posts of Staff Nurse (contract basis for 24X7 PHCs)), 15 of the 88 sanctioned posts of

Female Supervisor (LHV), 5 of the 126 sanctioned posts of Male Supervisor, 10 of the 59

sanctioned posts of Pharmacist, 48 of the 64 sanctioned posts of Lab Technician, 139 of

the 228 sanctioned posts of Male Workers, 79 of the 449 sanctioned posts of ANMs/

MPHW (Female) and 28 of the 396 sanctioned posts of 2nd ANMs / MPHW (Female) were

lying vacant in the district.

c) Post of District Project Management Officer under District level NRHM Programme

Management Unit (DPMU) was lying vacant. No staff was reported to have been posted

at the Taluk level or Sub-District level or Block level NRHM Programme Management Unit

in the district.

d) In the visited PHCs, 1 of the 2 sanctioned posts of LHV, 1 of the 12 sanctioned posts of 2nd

ANM and one post of first division Assistant were lying vacant in PHC Salora. 1 of the 2

sanctioned posts of Medical Officer, 3 of the 13 sanctioned posts of 2nd ANM, 2 of the 3

sanctioned posts of Male Worker and the post of Lab-Technician were lying vacant in PHC

Mendora.

e) In the upgraded PHC-Ditchapally, Medical Officer has to manage the upgraded PHC. 1 of

the 6 sanctioned posts of Male Worker and one sanctioned post each of the Pharmacist

and Lab Technician were lying vacant in the PHC.

2. Janani Suraksha Yojna (JSY):-

a) Women belonging to BPL and SC/ ST category who delivers in the Govt. institution or in

Home are eligible for JSY payments for their first two deliveries. JSY mothers are given @

Rs.700 per case for rural area and @ Rs. 600 per delivery in urban area in the state.

b) In the district 46,535 deliveries were conducted during 2010-11. Out of them 6,812 got

JSY incentive in the year. During 2011-12 (upto January) payments were made to 2,127

beneficiaries as against 43,702 deliveries reported.

c) Total budget for JSY in the district was available to the tune of Rs. 76, 15,704 for 2010-11

and Rs. 83, 51,784 for 2011-12 (upto January, 2012). Expenditure to the tune of Rs. 46,

84,720 was incurred in 2010-11 and Rs. 18, 51,500 during 2011-12 upto January, 2012.

d) The team contacted 26 JSY beneficiaries in the field. All deliveries were institutional and

they received full JSY cash incentive. MCH and JSY cards were issued to all. ANC / PNC

visits were made by the ANMs. Transport facility was arranged by ASHAs / ANMs to 22

mothers for delivery purpose.

e) All the JSY registers were maintained with complete information in the district office and

CHCs / PHCs. In the visited Sub Centres, Beneficiaries registers were maintained and

checked by the concerned Medical Officer.

87

3. Untied Funds:-

a) Provision and utilization of Untied Funds in the district are as detailed below: (Amount in Rs)

Sl. No Particulars Centres at the level of PHC and

above.

Sub Centres

2010-11 2011-12* 2010-11 2011-12*

1. Total funds available 7,81,018 75,36,439 40,67,804 12,79,119

2. Expenditure incurred 2,04,579 75,000 31,71,685 1,10,975

3. Balance 5,76,439 74,61,439 8,96,119 11,68,144

* Up to January, 2012.

b) There are 14 CHCs, 41 PHCs and 396 Sub Centres in the district. Rs. 25,000 to each

PHC and Rs. 50,000 to each CHC are given as untied funds per year in the district.

Further an amount @ Rs. 10,000 is given to Sub Centres as Untied Funds annually.

c) Untied Funds to the tune of Rs. 10,000 was released to each of the visited SCs in the

year 2010-11 and funds were spent by these centres to buy Stationery, SC Name Board,

Painting of Sub Centre, Examination Table, Almairah, Table, Mat, Buckets, Seal and

Stamp Pad, Towel, Calculator, Wooden Benches, Steel Chairs, Phenol, Stethoscope,

Registers, BP Apparatus, Weighing Machine, Fetus-scope, Curtains, for getting Xerox

copies of reporting formats and Labor charges for cleaning SC. Etc at various centre.

During 2011-12, Untied Funds was not released to the visited SCs.

d) Annual Maintenance Grant to the SCs which are functioning in Govt. building were not

released for the year 2010-11 and 2011-12.

4. Rogi Kalyan Samiti (RKS):-

a) Rogi Kalyan Samiti (RKS) was constituted in District Hospital, 3 SDHs, 14 CHCs and 41

PHCs in the district.

b) Every RKS were being provided funds to the tune of Rs. 5, 00,000 at Distt. Hospital level,

Rs. 2, 00,000 at SDH level, Rs. 2, 50,000 at CHC level and Rs. 1, 75,000 at PHC level

every year. These funds includes corpus fund, Annual Maintenance Grant (AMG) and

Untied Funds. AMG to District Hospital and Untied Funds to District Hospital and Sub –

District Hospital are not given in the district. All these funds are kept at the disposal of

RKS and after taking approval, the funds were being utilized on the developmental

activities of the Institution.

c) Details of RKS funds available and expenditure incurred at in the District as a whole are

given in the following table:

88

Type/ head of the funds 2010-11 2011-12 *

Budget Expdr. Budget II Expdr.

Corpus fund 56,93,840 23,86,548 1,46,07,099 6,14,237

AMG Fund 36,98,680 7,60,184 1,08,38,989 1,61,650

Untied Funds which are included in RKS budget may be seen at point 3.

* Upto January, 2012. II - including previous balance

d) No budget was released in 2010-11; but released in the next financial year 2011-12 during

May, 2011.

e) Similarly RKS funds meant for the year 2011-12 were not released to PHCs / CHCs ( upto

14.03.2012 the day of visit of Evaluation Team to the district) as the district office itself

received budget from the State Office very late in December, 2011. The district office has

yet to release these budget to PHCs / CHCs , the delay was because of non- submission of

statement of expenditure (SOE) form all peripheral institutions.

f) In the visited PHCs at Salora Mendora and upgraded PHC Ditchapally, it was observed

that no budget was released during 2010-11, budget meant for 2010-11 was released in

the next financial year in May 2011. In PHCs, the budget meant for the 2011-12 were

released in February 2012.

g) In PHC Salore, the funds were spent on purchase of Face Masks, Surgical Equipment, HP

laser Jet Printer, Electrical items like Tubes & Bulbs, Stationery, Carpets, Plastic Chairs

and Curtains. Expenditure was also incurred on repair of motor winding of bore well pump

machine, Dot Matrix Printer, Electrical Repairs, Plumbing Works, Premises cleaning and

installation of computer antivirus software.

h) In PHC Mendora, upto Feb, 2012, no expenditure was incurred. Present Medical Officer is

the in-charge MO in the PHC who comes from the other PHC for 3 days in a week. The

earlier Medical Officer in whose name was the joint account of Hospital Development

Society (RKS) wasmaintained remains the signatory for drawing amounts of HDS funds;

the joint account name was not transferred to the name of Present MO though he is

working in the PHC on deputation basis since 8 months. Thus, due to the administrative

lapses, funds could not be utilized. The district office has to monitor the expenditure by

calling SOE from the peripheral institutions every month, which was not being done at

present.

i) In upgraded PHC Ditchalpally, the funds were spent on purchase of Soaps & Detergents,

Cleaning Acids, Slippers for OT & Delivery Room, Broom Sticks, Mop Materials, Electrical

Bulb & Tubes, Switch Boards, Patients Iron Cots, Mattress, BP Apparatus, Stethoscope,

Iron Patients Seating Stools, Patients Seating Benches, Wheelchair, Kent Water Purifier,

Inverter with Battery, Panel Board, Gas Cylinder Filling, Emergency Lamps, Painting of iron

cots and Emergency Medicines for delivery patients. Expenditure was also incurred on

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Transport of Medicines from district to PHC, Repair of Bore Well & MCTS tracking data

feeding charges and premises cleaning.

j) In CHC Armurl, during 2010-11 no budget was released; budget meant for 2010-11 was

released in the next financial year 2011-12 during May, 2011 and the funds were spent on

purchase of Water Purifier, Chair luxury type & Plastic type, Xylocaine Injection and other

Medicines. Expenditure was also incurred on Electricity repair, Plumbing works and

Sanitary fittings.

5. Services of ASHA :

a) As targeted the district had selected 1909 ASHAs as on 31.3. 2011. All ASHAs were

trained in all modules till 31.01.2011 and all were working as on 31-12-2011.

b) An expenditure to the tune of Rs. 79,21,137 during 2010-11 and Rs. 1,18,84,000 during

2011-12 upto January 2012 was incurred towards performance based incentives to ASHAs.

c) In the visited institutions, 19 ASHAs were interviewed. As informed by them, all were

trained and given drug kits, and have been receiving performance based remuneration

regularly. Some ASHAs have expressed their dissatisfaction for meager performance

based incentive.

d) At the visited SCs Erajpalli, Amadapur, Doodhgaon and Savel, ASHAs were posted and

trained. In the VHSNCs, ASHAs were functioning as a member.

6. Functioning of Village Health Sanitation & Nutrition Committees (VHSNC):-

f) 718 VHSNCs were set up for 922 revenue villages in the district. Every year @ Rs.

10,000 are allotted to each VHSNC which was operated jointly by the Village Secretary of

Revenue department and ANM of Sub-Centre.

g) Details of VHSNC budget available and spent in the district during 2010-11 and 2011-12

(upto Jan, 12) are below:

SI.No Particulars 2010-11 2011-12 (upto Jan, 12)

1. Total budget available 72,56,679

89,91,273

2. Expenditure incurred 61,57,406

1,68,990

3. Balance 10,99,273

88,22,283

c) In the visited Sub-Centres, it was observed that the VHSNCs are established, functioning

and the budget released were spent, but regular meetings were not conducted. In

general, it was observed that meeting was conducted only once when funds receive and

the entire amount is spent within a span of 2-3 months; Ideally the budget should be

divided into 4 quarters so that fund is available for all the four quarters with the VHSNC

for taking up sanitation work. VHSNC fund was utilized to buy Bleaching powder,

90

Registers, labour charges for cleaning Sub Centre surroundings, cleaning of drainage &

drinking water tanks, sanitation work and repair of water pipelines at the villages.

d) It was reported that VHSNC funds had been released in the visited SCs @ Rs. 10,000 for

1 VHSNC during 2010-11 & 2011-12 (upto Jan‟ 2011).

7. 24 x 7 hours Delivery Care System:-

a) In the district, 29 of the total 41 PHCs were functioning as 24X7 delivery care institutions.

Of these 29 centres, only 7 PHCs have 3 Staff Nurses posted and the remaining 22 have

less than 3 Staff Nurses. Position on posting of Medical Officers to these centres was not

readily available in the district office.

b) No additional budget was released to 24X7 hours Service Centres except the salary for

the contractual Staff Nurses.

c) During 2010-11, 24 PHCs and during 2011-12, all 25 PHCs of the total 29 PHCs could not

perform stipulated minimum of 10 deliveries per month and therefore, it is required to

revamp the 24X7 centres based on their performance.

d) In the visited PHCs Saloora & Mendoora, Baby corner was not established. In PHC

Saloora Suction Apparatus was not supplied.

8. Physical Infrastructure and Stock Position:-

i) Sub Centres

a) It was reported that SCs visited at Amadapur, Doodhgaon and Savel were functioning in

rented building and SC Erajpalli was functioning in Govt. building. Infrastructure was not

as per IPHS. ANM was staying at other places than the SC head quarter except SC

Doodhgaon. Electricity was not available in the visited SCs Amadapur and Savel. Labour

Room was not available in all the visited SCs. In the visited SCs Erapalli and

Doodhgaon toilet was not available. Wherever rented SC buildings were functioning, the

SC clinic rent was not paid to the ANMs for the past 2-3 years; and every month ANMs

were spending from their salaries for paying sub-centre clinic rent.

b) McIntsh sheet was not available in the visited SCs Erajpalli, Amadapur and Doodhgaon.

Delivery Table, Ambu bag / suction, RDT test kit for Malaria and Stove were not available

in all the visited SCs. Weighing Machine (Infant) was not available in the visited SC

Erajpalli. Steam Sterilizer was not available in SCs Erajpalli and Savel. IUD Insertion Kit,

Hemoglobin meter and Cap. Ampicillin were not available in the visited SCs Amadapur

and Savel. Nischay Pregnancy test kit was not available in the visited SC Doodhgaon.

c) Gloves, DDK, Kerosene oil / Gas, Vitamin. A Solution, Sanitary napkins, OP cycles, Tab.

Oxitocin and Kits – A & B were not available in all the visited SCs.

d) Condoms and Antiseptic Solution were not available in the visited SCs Erajpalli,

Amadapur and Savel. Inj. Gentamycine was not available in the visited SCs Erajpalli,

91

Doodhgaon and Savel. EC pills were not available in the visited SC Amadapur. IFA

(big/small/syrup) was not available in the visited SCs Doodhgaon and Savel.

e) Most of the furniture equipment and drugs were not available in the visited centres as a

result SCs cannot render delivery and other related service effectively.

ii) PHCs

a) In the visited PHCs Saloora, Mendora and Upgraded PHC Ditchapally, it was observed

that the PHCs were functioning in government building though infrastructure was not as

per IPHS. No vehicle was provided to the PHCs Saloora & Mendora and Operation

Theatre was also not functional in both the PHCs.

b) Oxygen Cylinder was not functional in the visited PHC Saloora and Upgraded PHC

Ditchapally.

c) In the visited PHC Saloora, AYUSH Medical Officer was not posted. Residential quarter

for Medical Officer was not provided.

d) CHC Armur was functioning in government building though infrastructure was not as per

IPHS. No vehicle was provided to the CHC. Blood storage unit was not setup. Sick new

born care unit was not established. There was no neonatal resuscitation equipment.

Injection Arteether and Quinine were not supplied. Waste disposal management was

outsourced, but colour coding was not followed. No residential quarter was found

available for both Medical and Paramedical staff.

9. Community Satisfaction and opinion on Health Services:-

a) 40 mothers having child upto one year of age were interviewed in the area of four visited

Sub Centres to assess their knowledge and opinion on the services rendered by ANMs

and observed that most of the mothers had their delivery by trained persons; their babies

were weighed after birth and also received PNC services in time.

b) 19 (47.5%) mothers had no knowledge on danger signs of ARI and 7 (17.5%) mothers had

no knowledge on advantages and side effects of contraceptive methods.

c) Public opinion was good on the services being rendered by the PHCs visited by the team.

Village leader, ANC/ PNC beneficiaries and others had expressed good opinion on the

overall functioning of PHCs.

10. Sample Verification of FW Acceptors:

a) Out of 81 FW acceptors (Sterilization, IUD, OP and CC) selected, 61 (75.3%) could be

contacted for sample verification in the district. Minor discrepancies were found in age of

acceptors, age of spouse & number of male children.

b) 52 (85%) contacted beneficiaries got follow up services and 19 sterilization acceptors

received full compensation money after receiving the services and 7 sterilization

beneficiaries replied that they didn‟t know about.

92

c) All contacted 40 child immunization beneficiaries confirmed receiving the doses of

immunization and also the follow up services. No complication among the contacted

beneficiaries was found after receiving the doses.

11. Maintenance of Records and Register:

a) Sterilization and IUD central registers (Non Printed) were maintained at PHC levels in the

visited centres.

b) Immunization & MCH, Stocks and cash books were maintained at PHC / SC levels.

c) EC registers and Stock registers were not updated in the visited centres.

12. IT Infrastructure and Mother & Child (MCH) Tracking System:

a) Two computers were installed with internet facility at the district headquarter. At CHC

level, all the 14 CHCs have no computer systems. At the PHC level, no computer system

is available; these institions go to nearby CHNC or district office for data

feeding/uploading.

b) In the place of blocks, in Andhra Pradesh state, there are Community Health and Nutrition

Clusters (CHNCs) headed by the Senior Public Health Officer with job responsibility to

supervise 4-7 PHCs. There are 14 such CHNCs to supervise 41 PHCs functioning in the

district. At CHNCs leve,l 5 of the 14 have computer systems had internet facility, but

there was no trained manpower to make data entry in many CHNCs. Therefore, data

feeding or compilation work under HMIS was not done at this CHNC level.

c) Under HMIS reporting system, facility based reporting had started partially at PHC and

Sub centre level since April 2011, but the data uploading was not complete. As on March

2012, none of the District Hospital, 3 sub-district hospitals and 14 CHCs have uploaded

data for April 2011 to February, 2012, only sub-centre and PHC level uploading was

being done. District level report was also not generated in the web-portal.

d) Of the total 51,468 Antenatal cases registered in the district during April to January 2012,

data for 31,117 pregnant women were entered in the MCTS web portal. There was under

reporting of live births; as against the total of 43,702 births, 28,286 were reported on the

HMIS portal.

93

8. Adilabad District: Highlights from the Evaluation Report of Adilabad District (Andhra Pradesh).

The Regional Evaluation Team, located at Regional Office for Health and Family Welfare

(Bangalore), Ministry of Health and Family Welfare, Government of India carried out sample

checks of activities covered under NRHM / RCH in Adilabad District of Andhra Pradesh State

during March, 2012.

I. Details of the visited Institutions:

Districts

Visited

PHCs /CHCs visited SCs Visited

Adilabad PHCs: Gudihatnoor, Ichoda &

Jainoor.

Seethagondi, Mannur, Boregaon,

Kokasamannur, Jamini & Marlavai.

II. Major observations:

1. Human Resources:-

a) Shortage of Medical Personnel was reported in the district. One post each of the District

Surveillance Officer and Dist TB Officer, 14 of the 166 sanctioned posts of Medical Officer

(Allopathic) and 6 of the 45 sanctioned posts of AYUSH Medical Officers were lying

vacant in the district.

b) Similarly, 60 of the 131 sanctioned posts of Staff Nurse (Regular), 21 of the 78 sanctioned

posts of Staff Nurse (contract basis for 24X7 PHCs), 15 of the 97 sanctioned posts of

Female Supervisor (LHV), 30 of the 88 sanctioned posts of Male Supervisor, 8 of the 85

sanctioned posts of Pharmacist, 20 of the 77 sanctioned posts of Lab Technician, 115 of

the 304 sanctioned posts of Male Workers, 47 of the 518 sanctioned posts of ANMs/

MPHW (Female) and 56 of the 469 sanctioned posts of 2nd ANMs / MPHW (Female) were

lying vacant in the district.

c) Post of Computer Operator under District Programme Management Unit (DPMU) was lying

vacant. No staff was reported to have been posted at the Taluk level or sub-district level

or Block level NRHM Programme Management Unit in the district.

d) In the visited PHCs, one post each of the Staff Nurse (Regular) and LHV, 1 of the 6

sanctioned posts of 2nd ANM and 2 of the 5 sanctioned posts of Male Worker were lying

vacant in PHC Gudihathnur. One post each of the Staff Nurse (Regular) and LHV, 1 of

the 6 sanctioned posts of ANM were lying vacant in PHC Ichoda.

94

e) In the upgraded PHC- Jainoor, 3 of the 7 sanctioned posts of Medical Officer, 2 of the 7

sanctioned posts of ANM, 1 of the 6 sanctioned posts of Male Worker and one post of

Pharmacist were lying vacant.

2. Janani Suraksha Yojna (JSY):-

a) Women belonging to BPL and SC/ ST category who delivers in the Govt. institution or in

Home are eligible for JSY payments for their first two deliveries. JSY mothers are given @

Rs.700 per case for rural area and @ Rs. 600 per delivery in urban area in the state.

b) In the district 55,042 deliveries were conducted during 2010-11. Out of them 3,444 got

JSY cash incentive in the year. During 2011-12 (upto January) payments were made to

2,439 beneficiaries whereas 44,594 deliveries were reported.

c) Total budget for JSY in the district was available to the tune of Rs. 10, 93,900 for 2010-11

and Rs. 95, 40,568 for 2011-12 (upto January, 2012). Expenditure to the tune of Rs. 40,

50,432 was incurred in 2010-11 an excess expenditure incurred is drawn from flexi pool

funds, therefore, closing balance is of minus value for this fund during the year and Rs.

68,91,000 was incurred during 2011-12 upto January, 2012.

d) The team contacted 24 JSY beneficiaries in the field. All deliveries were institutional and

they received full JSY cash incentive. MCH and JSY cards were issued to all. ANC / PNC

visits were made by the ANMs. Transport facility was arranged by ASHAs / ANMs to 22

mothers for delivery purpose.

e) All the JSY registers were maintained with complete information in the district office and

CHCs / PHCs. In the visited Sub Centres, Beneficiaries registers were maintained and

checked by the concerned Medical Officer.

3. Untied Funds:-

a) Provision and utilization of Untied Funds in the district are as detailed below: (Amount in Rs)

Sl. No

Particulars Budget for CHCs Budget for PHCs Budget for HSCs $

2010-11 2011-12*

2010-11 2011-12* 2010-11 2011-12 *

1. Total budget available

3,00,000 3,00,000 20,48,000 44,48,000 44,82,000 46,82,000

2. Expenditure incurred

0 3,00,000 0 14,47,658 45,30,000 $ 44,80,000

* upto January, 2012 $ For 2010-11, excess expenditure was met from flexi pool funds.

b) There are 10 CHCs, 72 PHCs and 469 Sub Centres in the district. Rs. 25,000 to each

PHC and Rs. 50,000 to each CHC are given as untied funds per year in the district. SCs

were being provided @ Rs. 10,000 as Untied Funds.

95

c) Untied Fund to the tune of Rs. 10,000 was released to each of the visited SCs in the year

2010-11 and funds were spent by these centres to buy Stationery, Table Fan, Bulb,

Medicines, Registers, Stethoscope, BP Apparatus, Adult Weighing Machine, Door &

Window Curtains, for getting Xerox copies of reporting formats, Locks, Mother & Child

Tracking formats, Vehicle hiring charges for ANC high risk cases to the hospital, Banners

& Pamphlets, Biotex Spray and SC Building Painting etc.

d) During 2011-12, Untied Fund was not released to the visited SCs.

e) AMG to the SCs which are functioning in Govt. building were not released for the year

2010-11 and 2011-12.

4. Rogi Kalyan Samiti (RKS):-

a) Rogi Kalyan Samiti (RKS) was constituted in District Hospital, 10 CHCs and 72 PHCs in

the district.

b) Every RKS was being provided funds to the tune of Rs. 5, 00,000 at Distt. Hospital level,

Rs. 2, 00,000 at SDH level, Rs. 2, 50,000 at CHC level and Rs. 1, 75,000 at PHC level

every year. These funds includes corpus fund, Annual Maintenance Grant (AMG) and

Untied Funds. AMG to District Hospital and Untied Funds to District Hospital and Sub –

District Hospital are not given in the district. All these funds are kept at the disposal of

RKS and after taking approval, the funds were being utilized on developmental activities of

the Institution.

c) An amount of Rs. 60,00,000 in the year 2010-11 and Rs. 60,00,000 in the year 2011-12

(up to January,2012) was available as corpus fund at CHCs level in the district out of

which no amount was utilized in the year 2010-11 and full amount was utilized in the year

2011-12.

d) An amount of Rs. 76,66,757 in the year 2010-11 and Rs. 1,68,00,000 in the year 2011-12

(up to January, 2012) was available as corpus fund at PHCs level in the district out of

which no amount was utilized in the year 2010-11 and an amount of Rs. 57,95,185 was

utilized in the year 2011-12.

e) AMG Fund at the CHCs level was not released during 2010-11 and 2011-12 in the district.

f) AMG to the tune of Rs. 38, 12,708 in the year 2010-11 was released at the PHCs level

and no amount was utilized. Similarly, during 2011-12 AMG to the tune of Rs. 86,63,000

was released to PHCs out of which Rs. 34,50,000 was utilized.

g) Details of Untied Fund may be seen at point 3.

h) In the visited PHC at Gudihathnur, it was observed that no budget was released during

2010-11. During 2011-12, an expenditure of Rs. 15,000 was incurred towards repair of

Doors & Windows, Fixing of Window Glasses and labour charges for carpenter.

96

i) In the visited PHC at Ichoda, it was observed that budget meant for 2009-10 was

released in March, 2010 and the same could not be utilized before closure of that year and

was therefore carried forward as opening balance for the year 2010-11, expenditure was

incurred between July to October, 2010 by the previous Medical Officer but no records

were handed over to the present Medical Officer, therefore details could not be checked

for the expenditure incurred in this year. During 2011-12 upto February, 2012,

expenditure was incurred on cleaning of delivery Room @ Rs. 50 each time for 315 times

after delivery, Vehicle hiring charges for conducting survey of rapid fever cases, purchase

of Emergency Medicines for treating rapid fever cases, Repair of Bore-Well Motor,

purchase of Electrical Materials and Electrical repairs.

j) In PHC at Jainoor, it was observed that no budget was released during 2010-11, budget

of this year was released in the next financial year 2011-12 during August, 2011. During

the year 2011-12 upto February, 2012 expenditure was incurred on purchase of Laser

Printer, Cannon Scanner, Invertor for Power back-up, Blue Star Water Purifier with Cold

and Hot Water Dispenser, purchase of Emergency Medicines for treating rapid fever cases

and POL charges for conducting survey of rapid fever cases.

5. Services of ASHA :

a) As targeted, the district had selected 2781 ASHAs as on 31.3. 2011. 2778 ASHAs were

trained in all modules till 31.01.2011 and provided with drug kits. 2778 ASHAs were

working as on 31-01-2012

b) An expenditure to the tune of Rs. 1,12,18,781 during 2010-11 and Rs. 2,05,51,226 during

2011-12 upto January 2012 was incurred towards performance based incentives to ASHAs.

c) In the visited institutions, 17 ASHAs were interviewed. As informed by them, all were

trained. Some newly selected ASHAs were trained for 3 days at PHC. ASHAs have been

receiving performance based remuneration regularly. Some ASHAs expressed their

dissatisfaction for receipt of meager performance based incentive.

d) At the visited SCs Seethagondi, Mannur, Boregaon and Kokasamannur, ASHAs were

posted and trained. In the VHSNCs, ASHAs were functioning as a member.

6. Functioning of Village Health Sanitation & Nutrition Committees (VHSNC):-

h) 866 VHSNCs were set up against 1748 revenue villages in the district. Every year @ Rs.

10,000 are allotted to each VHSNC and kept in a bank account which was operated

jointly by the Village Secretary of Revenue department and ANM of Sub-Centre.

i) Details of VHSNC budget available and spent in the district during 2010-11 and 2011-12

(upto Jan, 12) are below:

97

SI.No Particulars 2010-11 2011-12 (upto Jan, 12)

1. Total budget available 81,21,290 60,31,710

2. Expenditure incurred 86,60,000 65,50,000

Note: for both years, excess expenditure was incurred from flexi pool budget

c) In the visited Sub-Centres, it was observed that the VHSNCs are established, functioning

and the budget released were spent, but regular meetings were not conducted. In

general, it was observed that meeting was conducted only once when funds are receive

and the entire amount is spent within a span of 2-3 months; Ideally the budget should be

divided into 4 quarters so that fund is available for all the four quarters with the VHSNC

for taking up sanitation work. VHSNC fund was utilized to buy Bleaching powder,

Registers, labour charges for cleaning Sub Centre surroundings, cleaning of drainage &

drinking water tanks and repair of water pipelines at the villages. Besides this, each

VHSNC has spent for Biotex Spray under epidemic control as per the instructions of

district authorities.

d) It was reported that VHSNC funds had been released to the visited SCs @ Rs. 10,000 per

VHSNC during 2010-11 & 2011-12 (upto Feb‟ 2011).

7. 24 x 7 hours Delivery Care System:-

a) In the district, 39 of the total 72 PHCs were functioning as 24X7 delivery care institutions.

Of these 39 centres, only 20 PHCs have 2 Medical Officers and remaining 19 have only

1 Medical Officer posted and 20 have 3 Staff Nurses posted and the remaining 19 have

less than 3 Staff Nurses.

b) No additional budget was released to 24X7 hours service centres except the salary for

the contractual Staff Nurses.

c) During 2010-11, 34 PHCs and during 2011-12, upto Jan. 2012, 36 PHCs of the total 39

PHCs could not perform stipulated minimum of 10 deliveries per month and therefore, it is

required to revamp the 24X7 centres based on their performance.

d) In the visited PHCs Gudihathnur & Ichoda , Baby radiant warmer was not supplied & Baby

corner was not set up.

e) In the visited upgraded PHC Jainoor, Baby radiant warmer & Phototherapy units were

not available and Baby corner was not set up.

8. Physical Infrastructure and Stock Position:-

i) Sub Centres

a) It was reported that SCs visited at Seethagondi was functioning in Anganawadi centre, SC

Mannur was functioning in Govt. building and SC Boregaon was functioning in rented

building. Though new building was constructed two years ago for SC Kokasamannur but

98

it was not handed over to the ANM and the ANM was staying at other place than the SC

head quarter. Electricity was available in the visited SCs Mannur and Boregaon. Labour

Room was not available in all the visited SCs. In the visited SCs Boregaon toilet was not

available. Wherever rented SC buildings were functioning, the SC clinic rent was not paid

to the ANMs for the past 2-3 years; and every month ANMs were spending from their

salaries for paying sub-centre clinic rent.

b) McIntsh sheet, Stove & Hemoglobin meter were not available in the visited SCs

Seethagondi, Mannur & Kokasamannur . Delivery Kit, Ambu bag / suction, Steam

Sterilizer, Nischay pregnancy test kit, RDT test kit for Malaria and Torch were not

available in all the visited SCs. Weighing Machine (Infant) and Cap. Ampicillin were not

available in the visited SC Kokasamannur. IUD Insertion Kit was not available in the

visited SCs Mannur, Boregaon and Kokasamannur. BP Apparatus was not available in

the visited SC Mannur.

c) Gloves, DDK, Kerosene oil / Gas, Vitamin. A Solution, Sanitary napkins, OP cycles, EC

Pills, Tab. Oxitocin and Kits – A & B were not available in all the visited SCs.

d) Condoms and Antiseptic Solution, IUDs, Clorine Solution (Bleaching Powder) and Inj.

Gentamycine were not available in the visited SCs Mannur, Boregaon and

Kokasamannur. IFA (big/small/syrup) was not available in the visited SCs Mannur and

Boregaon. Tab. Paracetamol was not available in the visited SCs Boregaon and

Kokasamannur.

e) Most of the furniture equipment and drugs were not available in the visited centres as a

result SCs cannot deliver services effectively.

ii) PHCs

a) In the visited PHCs Gudihathnur, Ichoda and Upgraded PHC Jainoor, it was observed that

the PHCs were functioning in government building though infrastructure was not as per

IPHS. Power backup was not available and Telephone was not functional in PHC

Gudihathnur.

b) Operation Theatre was not functional and Oxygen Cylinder was not filled in the PHC

Ichoda.

c) In the visited PHCs Gudihathnur and Ichoda, Residential quarter for Medical Officer was

not provided.

d) In the visited Upgraded PHC Jainoor, Pressure Gauze of Oxygen Cylinder was not

functioning.

9. Community Satisfaction and opinion on Health Services:-

a) 40 mothers having child upto one year of age were interviewed in the area of four visited

Sub Centres to assess their knowledge and opinion on the services rendered by ANMs

99

and observed that most of the mothers had their delivery by trained persons; their babies

were weighed after birth and also received PNC services in time.

b) 17 (42.5%) mothers had no knowledge on danger signs of ARI and 4 (10.0%) mothers had

no knowledge on advantages and side effects of contraceptive methods.

c) Public opinion was good on the services being rendered by the PHCs visited by the team.

Village leader, ANC/ PNC beneficiaries and others expressed good opinion on the overall

functioning of PHCs.

10. Sample Verification of FW Acceptors:

e) Out of 89 FW acceptors (Sterilization, IUD, OP and CC) selected, 67 (75.3%) could be

contacted for sample verification in the district. Minor discrepancies were found in

number of male children.

f) 59 (88%) contacted beneficiaries got follow up services and 20 sterilization acceptors

received full compensation money after receiving the services and 7 sterilization

beneficiaries intimated that they do not know about compensation money.

g) All contacted 34 child immunization beneficiaries confirmed with the doses of

immunization and also on follow up services. No complication among the contacted

beneficiaries was found after receiving the doses.

11. Maintenance of Records and Register:

a) Sterilization and IUD central registers (Non Printed) were maintained at PHC levels in the

visited centres.

b) Immunization & MCH, Stocks and cash books were maintained at PHC / SC levels.

c) EC registers and Stock registers were not found updated in the visited centres.

12. IT Infrastructure and Mother & Child (MCH) Tracking System:

a) Two computers were installed with internet facility at the district headquarter. At CHC

level, computer is not available; same is the case for PHCs, these intuitions go to the

district office for data feeding/uploading.

b) In the place of blocks, in Andhra Pradesh state, there are Community Health and Nutrition

Clusters (CHNCs) headed by the Senior Public Health Officer with job responsibility to

supervise 4-7 PHCs. There are 17 such CHNCs to supervise 72 PHCs functioning in the

district. All the 17 CHNCs have computer systems and internet facility, but there was no

trained manpower to make data entry in many CHNCs. Therefore, data feeding or

compilation work under HMIS was not being done at this CHNC level.

c) Under HMIS reporting system, facility based reporting had started partially at PHC and

Sub centre level since April 2011, but the data uploading was not complete.

*******

100

9. Srikakulam District

Major observations of Regional Evaluation T.eam (RET), Bangalore about the

Evaluation work carried out in Srikakulam District of Andhra Pradesh State in July,

2011.

I. Details of the visited Institutions:-

Districts Visited PHCs / CHCs Visited SCs Visited

Srikakulam Kanchili, Achuthapuram

and Kinthali.

Kanchili, Kathivaram,

Achuthapuram, Srimukhalingam &

Kinthali.

II. Major observations: 1. Human Resources:- a) There was acute shortage of Medical and Paramedical Personnel in the district. 40 of the

142 sanctioned posts of Medical Officer, one of the 2 sanctioned posts of Physician, 4 of

the 6 sanctioned posts of Surgeon, 13 of the 25 sanctioned posts of Gynecologist, 12 of

the 20 sanctioned posts of Pediatricians, 16 of the 18 sanctioned posts of Anesthetists,

One of the 2 sanctioned post of Ophthalmologist and 9 of the 11 sanctioned posts of

Dental Medical Officer were lying vacant in the district. Post of District TB Officer was also

lying vacant.

b) Similarly, 25 of the 103 sanctioned posts of Staff Nurse, 47 of the 108 sanctioned posts of

Supervisor (Female), 9 of the 107 sanctioned posts of Supervisor (Male), 12 of the 84

sanctioned posts of Pharmacist, 8 of the 67 sanctioned posts of Lab Technician, 129 of

the 336 sanctioned posts of MPHW (Male), 4 of the 478 sanctioned posts of ANMs/

MPHW (Female) and 50 of the 478 sanctioned posts of 2nd ANM / MPHW (Female) were

lying vacant in the district.

c) In the visited PHCs, One post of LHV, One of the 5 sanctioned posts of 2nd ANM and One

of the 5 sanctioned posts of Health worker (Male) was lying vacant in PHC Kanchili. One

post of Medical Officer, one of the 2 sanctioned posts of LHV, 2 of the 4 sanctioned posts

of Health worker (Male) and one post of Lab-Technician were vacant in PHC

Achuthapuram. The Medical Officer in charge of this PHC attends duty thrice in a week.

One post of Lab Technician was lying vacant in PHC Kinthali.

2. Janani Suraksha Yojna (JSY):- a) Women belonging to BPL and SC/ ST category are eligible for JSY payments for their first

two deliveries @ RS.700 per case for rural area and @ Rs. 600 per delivery in urban area

101

in the state. Further, mothers deliver in the Govt. institutions are only entitled for JSY

incentives.

b) In the district 46,348 deliveries were conducted during 2010-11. Out of them 5,143 was

paid JSY cash incentive in the year. During 2011-12 (upto June) payments were made to

453 beneficiaries only whereas 11,583 deliveries were reported.

c) Total budget for JSY in the district was available to the tune of Rs. 62, 50,728 for 2010-11

and Rs. 65,90,533 for 2011-12 (upto June). Expenditure to the tune of Rs. 38,48,605 was

incurred in 2010-11 and Rs. 7,29,630 during 2011-12 upto June 2011.

d) During visit to the SCs at Kathivaram & Srimukhalingam, few pending cases (4 in

Kathivaram and 9 in Srimukhalingam) for JSY payment were reported for the year 2010-

11.

e) The team contacted 15 JSY beneficiaries in the field. All contacted beneficiaries stated

that they received full JSY cash incentive in time. MCH and JSY cards were issued to all;

ANC / PNC visits were made by the ANMs. 14 (93.3%) deliveries were institutional.

3. Untied Funds:- a) Provision and utilization of Untied Funds in the district are as detailed below:-

(Amount in Rs)

S.

No

Particulars Budget for CHCs Budget for PHCs Budget for HSCs

2010-11 2011-

12*

2010-11 2011-12* 2010-11 2011-12*

1 Total budget

available

Not Released

8,26,168 25,69,568 54,17,700 41,38,373

2 Expenditure

incurred

6,56,600 80,000 17,46,325 2,77,085

3 Balance 1,69,568 24,89,568 36,71,373 38,61,288

*upto June 2011

b) There are 9 CHCs, 76 PHCs and 478 Sub Centres in the district. Rs. 10,000 to each HSC,

Rs. 25,000 to each PHC and Rs. 50,000 to each CHC are' given as untied funds per year

in the district. During visit to the SCs it was observed that Rs. 8530 had been released to

SC Kathivaram during 2010-11 and out of that Rs. 8400 was spent. Similarly, Rs. 8289

had been released to SC Srimukhalingam in 2010-11 and spent Rs. 7578 during the same

year. No fund has been released for the current year up to the month of visit.

102

c) In the visited SCs Untied Funds were utilized to purchase the items such as Tables,

Chairs, Weighing, Machines, Stethoscope. Bleaching Powder, Fan, Medicines. BP

Apparatus, Fetoscope. Syringes. Registers. Partition Screens. White Cement and

Stationery items. Besides. this fund was also utilized for repairing Toilet. Doors and Floor

of the SCs building.

4. Rogi Kalyan Samiti (RKS):-

a) Rogi Kalyan Samiti (RKS) have been constituted in District Hospital, all (9) CHCs and all

(76) PHCs in the district.

b) Every RKS were being provided funds to the tune of Rs. 5,00,000 at Distt. Hospital level,

Rs. 2,50,000 at CHC level and Rs. 1,75,000 at PHC level every year. These funds

includes corpus fund, Annual Maintenance Grant (AMG) and Untied Funds. No AMG and

Untied Funds are given at District Hospital. All these funds are kept at the disposal of RKS

and after taking the approval in its meeting, the funds were being utilized on

developmental activities of the Institution.

c) Details of Corpus funds and AMG funds available and expenditure incurred at CHCs &

PHCs in the District are given in the following table:

Type/ head of the funds

For CHCs for the year For PHCs for the year

2010-11 2011-12 (June,11)

20 I 0-11 2011-12 (June, 11)

Budget * Expdr. Budget* Expdr. Budget* Expdr. Budget* Expdr.

Corpus fund 10,24,904 5,64,182 4,60,722 98,762 46,72,202 28,52,226 1, 11,19,976 6,30,494

AMG Not Released 21,53,779 16,45,237 66,58,542 1,31,580

Untied Funds

Not Released 8,26,168 6,56,600 25,69,568 80,000

*Including opening balance

d) In both the visited PHCs at Achuthapuram & Kanchili, it was observed that Corpus grant of

Rs.30, 000 was released instead of eligibility amount of Rs. 1, 00,000; AMG of Rs. 50,000

and Untied Funds of Rs. 25,000 were not released due to non availability of funds. No

expenditure was incurred in both the visited PHCs during April to June, 2011. Funds for

2010-11 were utilized by PHC at Achuthapuram for purchasing of medicines for the

medical camp organized in PHC, payment towards labour charges for cleaning PHC

premises.

103

5. Services of ASHA:-

a) In the district 2875 ASHAs were appointed till 01.03.2011. All were trained in all modules

and have been provided with drug kits.

b) An expenditure to the tune of Rs. 57, 63,370 during 2010-11 and Rs. 38,55,110 during

2011-12 up to June 2011 was incurred towards performance based incentives to ASHAs.

c) In the visited institutions, 19 ASHAs were interviewed. As informed by them, all were

trained and given drug kits, and have been receiving performance based remuneration

regularly.

d) At the visited SCs Kathivaram & Srimukhalingam, ASHAs were posted and trained. In the

VHSCs, ASHAs were functioning as a member.

6. Functioning of Village Health Sanitation Committees (VHSC):-

a) 1101 VHSCs were set up against 1870 revenue villages located under 1101 Gram

Panchyaths. 3152 Anganawadi Centres were functioning in the district. Every year Rs.

10,000 are allotted to each VHSC which was operated jointly by the Village Secretary of

Revenue department and ANM of Sub-Centre.

b) Details of VHSC budget available and spent in the district during 2010-11 and 2011-12

(upto June, 11) are below:

S. No Particulars 2010-11 2011-12 (upto June, 11)

1. Total budget available * 1,04,27,981 96,05,175

2. Expenditure incurred 36,82,806 4,22,539

3. Balance 67,45,175 91,82,636

*Including opening balance:

c) In the visited Sub-Centres, it was observed that the VHSCs are established, functioning

and the budget released were spent, but regular meetings were not conducted. In general,

it was observed that meeting was conducted only once when funds receive and the entire

amount is spent within a span of 2-3 months; large part of the money is spent on

bleaching powder and labour charges. Ideally the budget should be divided into 4 quarters

so that fund is available for all the four quarters with the VHSC for taking up sanitation

work.

d) It was reported that VHSC fund released to the visited SCs at Kathivaram &

Srimukhalingam during 2010-11. It was observed that the funds to the tune of Rs. 16,120

104

had been provided for three VHSCs of SC Kathivaram for the year 2010-11. But no fund

was released to these committees for the current year till the month of visit.

7. 24 x 7 hours Delivery Care System:-

a) In the district, 26 of the total 76 PHCs were functioning as 24X7 delivery care institutions.

Status on posting of Medical Officer and Staff Nurses in these centres was not readily

available in the district office.

b) Funds to the tune of Rs. 38,36,174 were available to district during 2010-11 and an

amount of Rs. 35,41,846 was spent during the year. For the year 2011-12 a budget of Rs.

2, 94,328 was available to the district and an amount of Rs. 29,432 was spent upto June,

2011 during the year.

c) Expenditure incurred mainly towards payment of salaries to contract staff like Staff Nurse,

ANMs. Contingent workers and night duty allowances to staff.

d) During 2011-12, upto June 2011, 17 PHCs of the total 26 PHCs did not perform stipulated

minimum of 10 deliveries per month and therefore, it is required to revamp the 24X7

centres based on their performance.

8. Physical Infrastructure and Stock Position:-

i) Sub Centres a) It was reported that the SC at Kathivaram was functioning in rented building and SC

visited at Srimukhalingam was functioning in Govt. building which was recommended for

condemnation. ANM was staying in the SC Srimukhalingam. Labour Room was not

functioning in both the centres at Kathivaram & Srimukhalingam.

b) Foot stool, Delivery Table, McIntsh Sheets & Ambu bag/suction, RD Test Kit for Malaria,

Weighing Machine (Infant) and Hemoglobinometer, IUD Insertion Kit, DDK, Gloves,

Vitamin. A Solution and Sanitary napkins were not available in the visited SCs.

c) Benches for clients, Steam Sterilizer, Thermometre & Torch were not available at SC

Srimukhalingam. Nischay Pregnancy kit, Tab. Paracetamol and Tab. Metranidazole were

not available at SC Kathivaram.

d) Tab. Cotrimoxazole, EC pills, OP cycles, IUDs, Antiseptic Solution, Tab Oxitocin, Cap.

Ampicillin, Inj Gentamycin and Kits - A & B etc. were not available at the visited Sub

Centers. AD Syringes, ORS packets and IFA (small & big) were not available at SC

Kathivaram.

ii) PHCs

105

a) In the visited PHCs Achuthapuram & Kanchili, it was observed that both the PHCs were

functioning in government building though infrastructure was not as per IPHS. No vehicle

provided to the PHCs.

b) Under AYUSH, Medical Officer was not posted in both the visited PHCs. Residential

quarter for Medical Officer was not available in both the visited PHCs. Labour room was

not functional at PHC Achuthapuram.

c) Stocks of IUD, Oral Pill Strips and condoms was nil since April 2011 in PHC Kanchili.

9. Community Satisfaction and opinion on Health Services:-

a) 20 mothers having child upto one year of age were interviewed in the area of two visited

Sub Centres to assess their knowledge and opinion on the services rendered by ANMs

and observed that 95% mothers had their delivery by trained persons, their babies were

weighed after birth and also received PNC services in time.

b) 13 (65.0%) mothers had no knowledge on danger signs of ARI and 4 (20%) mothers had

no knowledge on advantages and side effects of contraceptive methods.

c) The team contacted different community persons to have their opinion about the services

provided by the MPW (M) of SC Kathivaram. Community has expressed their satisfaction

towards the work of MPWs (M) though MPW (M) was not staying in the SC HQ.

d) Public opinion was good on the services being rendered by the PHCs visited by the team.

Village leader, AI C/ PNC beneficiaries and others had expressed good opinion on the

overall functioning of PHCs.

10. Sample Verification of FW Acceptors:-

a) Out of 70 FW acceptors (Sterilization, IUD, OP and CC) selected, 55(78.6%) could be

contacted for sample verification in the district. Minor discrepancies were found in total

children & number of male children.

b) All contacted 31 child immunization beneficiaries confirmed with the doses of

immunization and also got follow up services. No complication among the contacted

beneficiaries was found after receiving the doses.

11. Maintenance of Records and Register: a) EC registers and Stock registers were not found updated in the visited centres.

b) Nirodh. I Oral pills distribution registers were maintained properly at SC level.

c) Services registers for Family Planning were not in printed form at the visited centres.

106

12. IT Infrastructure and Mother & Child (MCH) Tracking System:-

a) Two computers were installed at the district headquarter. At CHC level, 8 of the total 9

CHCs having computer systems, but only 5 have internet facility and at PHC level, 14 of

the 76 PHCs having computer systems, but internet connection was not there.

b) Under HMIS reporting system, facility based reporting had not yet started.

c) Under Mother and Child Tracking System, data entry was done at district level office for all

PHCs in the district, data entry was in process though not yet completed. All the staff at

CHCs/PHCs were trained and sensitized on MCTS.

*******

10. Vizianagaram District

Major observations of Regional Evaluation T.eam (RET), Bangalore about the Evaluation work carried out in Vizianagaram District of Andhra Pradesh State in July, 2011. I. Details of the visited Institutions:

Districts Visited PHCs / CHCs Visited SCs Visited

Vizianagaram Nellimarla, Polipally &

Vepada.

Saripally, Nellimarla, Polipally, Gudivada

(under PHC Vepada) & Gudivada (under

PHC Polipally).

II. Major observations:

1. Human Resources:-

a) There was acute shortage of Medical and Paramedical Personnel in the district. 29 of the

129 sanctioned posts of Medical Officers. 6 of the 9 sanctioned posts of Physicians, 6 of

the 14 sanctioned posts of Pediatricians, 2 of the 13 sanctioned posts of Anesthetists and

One of the 2 sanctioned posts of Radiologists were lying vacant in the district. Post of

Addl. District Medical & Health Officer and District Malaria Officer was also vacant.

107

b) Similarly, 8 of the 211 sanctioned posts of Staff Nurses, 14 of the 93 sanctioned posts of

Supervisors (Female), 16 of the 129 sanctioned posts of Supervisors (Male), 22 of the 93

sanctioned posts of Pharmacists, 12 of the 75 sanctioned posts of Lab Technicians, 40 of

the 245 sanctioned posts of MPHW (Male), 66 of the 444 sanctioned posts of ANMs /

MPHWs (Female) and 27 of the 443 sanctioned posts of 2nd ANM / MPHW (Female)

were lying vacant in the district

c) One of the 5 sanctioned posts of General Duty Medical Officers was lying vacant in the

visited CHC Nellimarlai.

d) 2 of the 3 sanctioned posts of MPHW(M) were lying vacant in PHC Polipalli. Post each of

AYUSH Medical Officer and LHV was lying vacant in PHC Vepadu.

2. Janani Suraksha Yojna (JSY):-

a) Women belonging to BPL and SC/ ST category are eligible for JSY payments for their first

two deliveries @ Rs.700 per case for rural area and @ Rs. 600 per delivery in urban area

in the state. Further, JSY benefits are given for the deliveries conducted in Govt.

institutions only.

b) In the district 42160 deliveries were conducted during 2010-11. Out of these, in 8727cases

of deliveries, mothers were paid JSY cash incentives in the year. During 2011-12 (upto

June) payments were made to 105 beneficiaries only whereas 10161 deliveries were

reported.

c) Total budget for JSY in the district was to the tune of Rs. 65, 95,257 during 2010-11 and

Rs. 35, 78,977 during 2011-12 ( upto June) and expenditure to the tune of Rs. 59, 93,280

was incurred in 2010-11 and Rs. 71,200 during 2011-12 (upto June).

d) During visit to the SCs at Gudivada ( The SCs selected in both the PHCs for NRHM

inspection were having the identical names, i.e. Gudivada), few pending cases ( 1 in

Gudivada at PHC Polipally and 5 in Gudivada at PHC Vepada) for JSY payment were

reported in the year 2010-11.

e) The team contacted 22 JSY beneficiaries in the field. All contacted beneficiaries stated

that they received full JSY cash incentive in time. Cases for pending JSY payment due to

insufficient budget were observed. Follow up visits were made by the ASHAI ANMs after

delivery. All deliveries were institutional. JSY registers were maintained in the district office

and CHCs/Pt!Cs. Beneficiary's registers were maintained at visited SCs.

3. Untied Funds:-

a) Provision and utilization of Untied Funds in the district are as detailed below:

108

Sl. No

Particulars

for CHCs for PHCs for HSCs

2010-11 2011-12 (upto June,11)

2010-11 2011-12 (upto June,11)

2010-11 2011-12 (upto June, 11)

1. Total budget available $

2,04,932 3,50,182 1,68,894 17,02,574 43,10,000 4,84,494

2. Expenditure incurred

2,04,750 0 76,320 0 38,25,506 1,50,000

3. Balance 182 3,50,182 92,574 17,02,574 4,84,494 3,34,494

* upto June, 2011. $ including opening balance.

b) There are 10 CHCs, 66 PHCs and 431 Sub Centres in the district. Rs. 25,000 to each

PHC and Rs. 50,000 to each CHC was given as Untied Fund per year in the district.

During visit to the SCs, it was observed that Rs.10, 000 had been released to both SCs

during 2010-11 and full amount was utilized.

c) In the visited SCs Untied Funds were utilized for purchasing of items such as Bleaching

Powder, Lime powder, Bed Sheets, BP Apparatus, Stethoscope, Baby Weighing Machine,

Registers and Stationery items.

d) Untied funds is actually meant for the up-keep of sub-centre building and for purchasing of

essential items required for the Centre, but it was observed that, this fund is also divided

into number of Gram Panchayats that come under SC area and allotted to joint account,

as a result the ANM has to approach 2-3 Sarpanches even to incur essential expenditure

for the SC.

4. Rogi Kalyan Samiti (RKS):-

a) Rogi Kalyan Samiti (RKS) have been constituted in District Hospital, 10 CHCs and 66

PHCs in the district.

b) Every RKS were being provided funds to the tune of Rs. 5, 00,000 at Distt. Hospital level,

Rs. 2, 50,000 at CHC level and Rs. 1,75,000 at PHC level every year. These funds include

corpus fund, AMG and Untied Funds. No AMG and Untied Fund are given at District

Hospital. All these funds are kept at the disposal of RKS and after taking the approval in

its meeting, the fund was being utilized on developmental activities in the Institution.

c) Details of funds Corpus fund and AMG available and expenditure incurred at CHCs &

PHCs in the District are given in the following table.

109

Type/ head

of the funds

For CHCs for the year For PHCs for the year

2010-11 2011-12 $ 2010-11 2011-12 $

Budget* Expdr. Budget* Expdr. Budget* Expdr. Budget* Expdr.

Corpus fund 0 0 7,00,000 0 5,74,375 3,40,659 65,14,035 25,088

AMG Fund 182 0 7,00,182 0 1,88,443 1,15,763 37,31,685 0

Untied fund 2,04,932 2,04,750 3,50,182 0 1,68,894 76,320 17,02,574 0

$ upto June, 2011. * including opening balance.

d) In both the visited PHCs at Polipalli & Vepadu, it was observed that the sufficient funds

were made available during 2010-11 and 2011-12 (up to June). During visit to the PHC at

Polipalli, it was observed that the funds were spent towards payment of contingent

workers, transport of medicine from district stores to PHC, printing of OPD slips and family

planning registers, purchase of medicines, stationery items, typhoid kits and office

furniture. Rs.30, 000 was transferred APHMDC for construction of parking shed for 108

ambulances.

e) During visit to the PHC at Vepadu, it was observed that the expenditure was incurred for

purchasing of Surgical items, Computer software and Printer, Office Stationery & Drugs

and Broad band connection. Expenditure was also incurred on Electrical works,

Construction of shelter for 108 ambulance, Transport charges of drugs form central stores

to PHC, Computer repairs, payment of honorarium to computer operator and night

watchman, Clearing of land line telephone bills and laundry charges.

5. Services of ASHA:-

a) In the district 2596 ASHAs were appointed till 01.03.2011. 2462 were trained in all

modules and 2538 ASHAs were provided with drug kits. 88 New ASHAs were proposed to

be inducted during 2011-12.

b) An expenditure to the time of Rs. 73, 74,598 during 2010-11 and Rs. 45, 48,125 during

2011-12 (upto June 2011) was incurred towards work based incentives to ASHAs.

c) In the visited institutions, 15 ASHAs were interviewed. As informed, all were trained and

given drug kits. Work based incentive to ASHA was pending from April 2011 onwards.

Normally incentive was paid once in 3 months (including arrears for past 2 months) and

not regularly every month in the centres visited.

d) At the visited SCs Gudivada, ASHAs were posted and trained. In the VHSCs, ASHAs

were functioning as a member.

110

6. Functioning of Village Health Sanitation Committees (VHSC):-

a) 931 VHSCs were set up against 1551 revenue villages covered under 931 Gram

Panchyaths, 2765 Anganawadi Centres were functioning in the district. Every year Rs.

10,000 are allotted to each VHSC which was operated jointly by the Village Secretary of

Revenue department and ANM of Sub-Centre.

b) Details of VHSC budget in the district for 2010-11 and 2011-12 are below:

SI.No Particulars 2010-11 04/11 to 06/11

1 Total budget available* 94,58,492 20,75,792

2 Expenditure 73,82,700 2,92,682

3 Balance 20,75,792 17,83,110

*Including opening balance:

c) In the visited Sub-Centres, it was observed that the VHSCs are established, functioning

and the budget released were spent, but regular meetings were not conducted. In general,

it was observed that meeting was conducted only once when funds provided and the

entire money was spent within a span of 2-3 months, Large part of the money was spent

on bleaching powder and labour charges, Ideally the budget should be divided into 4

quarters so that money is available for all the four quarters with the VHSC for taking up

sanitation work.

d) VHSC fund was released to the visited SCs at Gudivada during 2010-11. But no fund was

released to the committees for the current year.

7. 24 x 7 hours Delivery Care System:-

a) In the district, 32 of the total 66 PHCs were functioning as 24X7 delivery care institutions.

24 of these 32 PHCs have only one Medical Officer posted. Status of posting of Staff

Nurses in these centres was not made available by the district office.

b) Funds to the tune of Rs. 42, 84,096 was available to district and an amount of Rs.

40,53,526 was spent during the year 2010-11. For the year 2011-12 (April to June, 2011)

a budget of Rs. 2,30,570 was available to district and an amount of Rs. 1,00,117 was

spent up to June 2011 during the year.

c) Expenditure incurred mainly towards payment of salaries to contract staff like, Staff Nurse,

ANMs, Contingent workers and night duty allowances to staff.

d) During 2009-10, 8 PHCs of the total 32 PHCs and during 2010-11, 7 PHCs have not

performed minimum stipulated 10 deliveries per month.

111

8. Physical Infrastructure and Stock Position:-

i) Sub Centres a) SC Gudivada at PHC Polipally have no building and SC Gudivada at PHC Vepada was

functioning in rented building. Infrastructure was not as per IPHS at visited SCs. ANM was

staying other than the SC head quarter.

b) Benches for clients, Delivery table, McIntsh sheets, Ambu bag / Suction, Steam Sterilizer,

Delivery Kit, RDT test kit for Malaria, IUD insertion kit and Torch and Haemoglobino meter

were not available in the visited SCs. Nischay Pregnancy Kit and Stove were not available

at SC Gudivada in PHC Vepada.

c) DDK, Gloves, Sanitary Napkins, EC pills, OP cycles, Condoms, Antiseptic Solution, Clorin

Solution (bleeching powder), Tab Oxitocin, Inj Gentamycin and Kits - A & B etc. were not

available at the visited Sub Centers. IFA Tablets (Small & Big) / Syrup and Cap. Ampicilin

were not available at SC Gudivada in PHC Polapally. AD Syringes, Disposable Syringe

and IUDs were not available at SC Gudivada in PHC Vepada.

ii) PHCs

a) It was observed that PHC Polapally was functioning in rented building and PHC Vepada

was functioning in government building but their infrastructure was not as per IPHS. No

vehicle provided to the PHCs. Regular water supply and power backup was not available

in PHC Polapally.

b) AYUSH, Medical Officer was not posted in PHC Vepada. Residential quarter for Medical

Officer was not available in both the PHCs.

9. Community Satisfaction and opinion on Health Services:-

a) 20 mothers having child upto one year of age were interviewed in the area of two visited

Sub Centres to assess their knowledge and opinion on the services rendered by ANMs

and found that 100% mothers had their delivery conducted by trained persons, weighed

their baby after birth and also received PNC services in time.

b) 15 (75.0%) mothers had no knowledge on danger signs of ARI and 5 (25%) mothers had

no knowledge on advantages and side effects of contraceptive methods.

c) The team contacted different community persons to have the opinion about the services

provided by the MPW (M) of SC Gudivada. Community has expressed their satisfaction

towards the work of MPW (M). MPW (M) post was vacant in other visited SC Gudivada of

PHC Vepada. Therefore review of the knowledge and opinion of the community about the

MPW (M) could not be done.

112

d) Public opinion was good on the services being rendered by the PHCs /CHC visited by the

team. Village leader, ANC/ PNC beneficiaries and others had expressed good opinion on

the overall functioning of PHCs / CHC.

10. Sample Verification of FW Acceptors:-

a) Out of 60 FW acceptors (Sterilization, IUD, OP and CC) selected, 47(78.3%) could be

contacted for sample verification in the district. Discrepancy was found in the total children

& number of male children in a few cases.

b) All contacted 28 child immunization beneficiaries confirmed with the doses of

immunization and also got follow up services. No complication was found after receiving

th~ doses among the contacted beneficiaries.

11. Maintenance of Records and Register:-

a) IUD central registers were not maintained at all the visited PHCs.

b) EC registers and Stock Registers were not updated in visited SCs. Follow up entries in the

FW registers were not made. Stock registers were not maintained for the equipment and

drugs purchased under NRHM funds at the SCs. JSY registration cards were not available

at SC level.

12. IT Infrastructure and Mother & Child (MCH) Tracking System:-

a) 2 computer systems at the district office and one computer system at block level were

available with internet facility. Information on the availability of computer systems and

internet facility at the CHC and PHC level was not readily available in the district office.

b) Under Mother and Child Tracking System, data entry was done at district office for all

PHCs.

c) All the staff at district office, CHCs, PHCs and at Sub Centres were trained and sensitized

on MCH formats.

113

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,

Bachchawara &Bhagawanpur Bagdav, Hanspur, Godargama, Ratar, Mohanpur, 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. No.

Particulars PHC Bakhari PHC Bachchawara 20010-11 2011-12 20010-11 2011-12

1. No. of deliveries eligible for payment under JSY

3777

2910 1836 2253

2 No. of beneficiaries to whom JSY fund were paid

3777

2850 1836 2253

3 Total fund received 1,24,94,500 81,12,400 63,31,400 49,04,500 4 Expenditure incurred

under JSY 1,24,92,800

81,11,900

49,26,900 41,54,300

114

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 PHCs

2010-11 2011-12

Fund available

Expenditure Balance Fund available

Expenditure Balance

Bakhari 80,000 80,000 Nil 50,000 Nil 50,000 Bachchawara 50,000 11,666 38,334 38,334 37,996 338

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.

II. 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.

115

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 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.

116

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.

*********

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 & Saraiya

Salaha Jalalpur, Madhopur, Narauli, 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.

117

b) In the visited PHCs Minapur, Mushahari & Saraiya, JSY status as reported is given below: Sl.

No.

Particulars Distt. Hospital PHC Minapur PHC Mushahari

20010-11 2011-12 20010-11 2011-12 20010-11 2011-12

1. No. of deliveries eligible for payment under JSY

43322

55180

1766

2078 1625 546

2 No. of beneficiaries to whom JSY fund paid

NA

NA 1766

1438 NA NA

4 Total fund received 7362218 NA 5696739 3188500 2845450 3386100 5 Expenditure incurred

under JSY 65057716

NA 2802600

3173100

2169000 3371700

NA: Not available.

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.

e) It was found that necessary information was not recorded in JSY cards but immunization

cards were filled up properly by the concerned ANMs.

4. Functioning of ASHA scheme:

a) There were 3504 ASHAs as against the requirement of 3984 ASHAs in the district. It was

reported that 2787 ASHAs out of total no. of 3504 were trained in 4th modules.

b) It was also reported that as many as 3298 ASHAs (more than trained ASHAs) were having

drug Kit in the district.

5. Untied Funds: Details of untied fund are reported as below:

(in Rs.)

Type of Institution

2009-10

Fund available

Expenditure Balance % of funds Utilized

APHCs/PHCs 12,36,307 5,61,585 6,74,722 45.4%

Sub centre 43,78,300 21,29,400 22,48,900 48.6%

Total fund for whole district 56,14,607 26,90,985 29,23,622 59.8%

a) The district had received untied funds to the tune of Rs. 45,01,907 during 2009-10 and

out of that Rs. 26,90,985 was spent.

b) Apart from above, Rs. 1288159 as Annual Maintenance Grant for the year 2009-10 were

provided to the district, out of which Rs. 4,71,193 were spent.

c) The details of Untied Funds and Annual Maintenance Grant (AMG) for the year 2010-11

were not made available by District Programme Management Unit (DPMU), Muzaffarpur.

118

6. 24 x 7 Hours Delivery Care Services:-

a) 24x7 hours delivery care services for promotion of institutional deliveries in rural areas

were set up in 16 institutions in the district.

b) Total number of deliveries conducted in Mushahari PHC were 1481 and 1625 during

2010-11 & 2011-12 respectively. The actual no. deliveries conducted in the night hours were

766 and 843 during 2010-11 & 2011-12 respectively in Mushahari PHC.

7. Physical Infrastructure and Stock Position:

I. PHCs:

a) The visited institutions viz. Minapur, Mushari and Saraiya PHCs had own building having

regular water supply, electricity connection and telephone facility.

b) Most of the required Equipments, Apparatus and Vital/Essential drugs etc were available

in the visited PHCs.

II. HSCs:

a) Paharpur and Mustafaganj HSCs were having their own building. Electricity, water supply

and labour room etc. were not available at both the HSCs. Paharpur HSC has no post of

MPW (M).

b) Ambu bag/Suction, Steam Sterilizer, Stove and Kerosene Oil were not available at

Paharpur and Mustafaganj HSCs. Similarly, Foot Stool and Delivery Table were not available

at Paharpur HSC. Examination table, benches for clients, Torch, Weighing machine,

Thermometer and Gloves were not available at Mustafaganj HSC. Magsulth, Oxitocine and

Co-trimoxazole tablets, Ampicillin Capsule, Gentamycine injection and EC pills were not

available at both of visited Sub

Centre. Nischay Pregnancy Test Kit, Haemoglobinometer, IUD, Oral Pills, Kits -A & B were

not available at Paharpur HSC. IFA tablet/syrup, condom, Metronidazole and Misofrostol

tablets were not available at Mustfaganj HSC.

c) ANMs of the visited centres had not received SBA training.

8. Knowledge and opinion of Community on health service:

i. Towards PHC’s service:

a) In the area of the visited PHCs, villager, AWWs, ASHAs and ANC/PNC mothers were

interviewed to assess their opinion regarding the quality of services provided at PHC level.

Public opinion was good on the services being rendered by the PHCs visited by the team.

b) It was observed that the services and health education in respect of Ante Natal Care

(ANC),

ARI & ORT and about AIDS and HIV needed to be improved.

ii. Towards ANM’s service:

119

a) 18 mothers having child upto one year of age were interviewed in the area of both HSCs

Paharpur and Mustafaganj. Mothers replied that ANMs are available when needed and also

conducted immunization clinic on regular basis. ANMs provided IFA and TT to pregnant

women. Home deliveries were 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 and ORT.

9. Sample Verification of Family Welfare Acceptor:

a) 19 FW acceptors were contacted for sample verification in the selected area of the

centres. Some discrepancies were found in the age of spouse and in the age of last child of

the acceptors.

b) Follow up services were provided to 13 (68.5%) acceptors. c) All contacted acceptors were satisfied with the method, as they had not faced any major complication. e) Some beneficiaries of child immunization were contacted by the team and found that

services provided were satisfactory.

10. Reconciliation of Reported Performance:

a) The Sterilization and IUD reported at district office and concerned PHCs are given below:

S. No.

Name of the Centre

2009-10 2010-11 Sterilization

Figure IUD Figure Sterilization Figure IUD Figure

Reported by Distt. Off.

Reported by the PHC

Reported by Distt. Off.

Reported by the PHC

Reported by Distt. Off.

Reported by the PHC

Reported by Distt. Off.

Reported by the PHC

1 Minapur PHC

734 765 149 66 1402 1470 343 312

2 Mushahari PHC

4932 234 144 144 4442 4067 459 643

3 Saraiya PHC

542 528 140 135 697 559 82 175

b) Nirodh performance reported by district office for the PHC Mushahari for 2009-10 was

3517 but as per the PHC records the figures were 7976.

c) Service register for IUD at the headquarters of PHCs were not maintained with complete

details for both the years 2009-10 and 2010-11.

11. Maintenance of Registers & Records:

a) Eligible Couple Register was not maintained at all the visited institutions in the district.

b) Sterilization Service cum Payment Register was not maintained properly at all visited

institutions in the district.

c) Printed Service Register for Cu-T, was not available in the visited institutions.

d) Printed Oral pills & Nirodh distribution registers were maintained but essential columns

were missing at Mushahari PHC.

120

e) ANC Register was printed but not maintained properly at Minapur PHC. Stock Register of

FW items were not maintained properly at Minapur and Mushahari PHCs.

f) Printed JSY beneficiaries register was available but not maintained properly at all visited

centres.

12. Other Observations and Suggestions:

a) Monitoring and supervision in the district need to be enhanced. Supervisory staffs need to

check the overall activities of SCs including coordination between ASHAs & AWWs and all

the records and registers. Staff of DPMU/BPMU be need immediate re-orientation under

NRHM.

d) Submission of utilization Certificate and Statement of Expenditure in respect of various

funds provided at the SCs, PHCs and CHCs was very irregular and whatever submitted, it

was without any details. In this connection, prescribed formats and guidelines should be

provided to SC, PHC, CHC and District Hospital and concerned staff should be oriented for

proper filling up of these formats /statements.

e) During visit to the different centres the team, noticed lack of cleanliness in OPD, IPD,

Labour Room and Maternity Wards. On enquiry, the concerned head of the centres informed

about lack of manpower. The computer room was full of dust. Due to insufficient space,

ANC/PNC clinics were not being conducted properly in the SC which is attached with the

BPHCs.

*****

121

3. District- Samastipur

Major observations of Regional Evaluation Team (RET), Patna on the evaluation work

carried out in Samastipur District of Bihar State in the month of June, 2011.

I. Details of the visited Institutions: District visited PHCs visited HSCs visited Samastipur PHCs: Samastipur, Bibhutipur

Kalyanpur & Ujiyarpur Sub centres were not visited by team as All the ANMs were engaged continuously in pulse polio activities in their areas during the

period of visit to the district. II. Major Observations:

1. Human Resources:

a) The details about the health human resources were not made available fully in the district.

As reported, 190 Medical Officers and Specialists were working in the district against the

sanctioned strength of 187. However, some posts i.e. 177 out of 962 sanctioned posts of

ANM both regular and contactual, 60 of 170 sanctioned posts of GNM (regular and

contractual) and 45 of 60 sanctioned posts of Lab Technician were lying vacant in the district.

b) The sanctioned strength of MO was filled by the posting contractual MO in the district.

2. Rogi Kalyan Samiti (RKS) & Village Health Sanitation Committee (VHSC):

a) As reported by the district office, Rogi Kalyan Samiti (RKS) has been constituted at PHC,

BPHC, RH and District Hospital functioning in the District. Meetings of RKS were being

convened on required basis.

b) Only 370 Village Health & Sanitation Committees (VHSCs) were formed against the 1239

villages in the district.

3. Service of Janani Suraksha Yojana (JSY):

a) The team has visited PHCs Ujiyarpur, Bibhutipur and Kalyanpur in the district. In PHC

Ujiyarpur, status of availability and utilisation of JSY fund and performance was no made

available for previous years. But this PHC has received Rs. 9,76,500 for the current year

2011-12 under the scheme and the whole amount was lying unspent at the time of visit

made by the team. In PHC Bibhutipur, there were 1100 beneficiaries waiting for their cash

assistance in 2010-11 out of total 5306 beneficiaries in the year; the PHC had spent Rs.

91,54,050 out of the fund available to the tune of Rs. 1,24,07,500 during 2010-11.

However, it was observed that all 626 beneficiaries were provided with the cash assistance

in the year 2011-12 in this PHC. In PHC Kalyanpur, there were 4146 and 444 JSY

beneficiaries in the year 2010-11 and 2011-12 respectively and the PHC has spent Rs.

64,31,400 and Rs. 15,88,800 out of available funds of Rs. 90,18,597 in the year 2010-11

and Rs. 2,58,97,197 in the current year 2011-12.

122

b) As per the records available in the visited centres, most of the deliveries were institutional.

But while visiting some villages, the team found that most of the mothers delivered at their

homes with the help of untrained person.

c) 13 recently delivered women who were JSY beneficiaries were contacted in the area

selected for sample check. All respondents reported that they had received TT & IFA (L)

during AN period. Most of them attended three checks up in their nearest service centre and

necessary advice like Breast feeding & child nutrition were provided to them. Most of them

were delivered in the hospital and also received JSY cash incentive. However post natal

visits by the field workers need to be increased.

4. Functioning of ASHA scheme:

a) As against the requirement of 3835 ASHAs for 1239 villages, 2442 ASHAs were in

position in the district. Training to the ASHAs was not provided in the district, but Drug Kits

provided to all ASHAs.

b) It was observed by the team that the involvement of ASHA in assisting mothers for

institutional delivery was very poor.

c) Status of ASHAs scheme in the visited PHCs is as under:

Sl. No.

Particulars

PHC Ujiyarpur

PHC Samastipur

PHC Bibhutipur

PHC Kalyanpur

1 No. of villages taken up for ASHA

64 95 41 116

2 Required no. of ASHA 267 261 324 301

3 No. of ASHA in position 241 213 250 247

4 No. of trained ASHA Nil Nil 248 211

5 Untied Funds:

a) As reported, District Health Society distributed Untied Funds to the SCs, PHCs, CHCs

and District Hospital but submission of utilization Certificate and Statement of Expenditure

from these Institutions was very irregular and not up to the mark.

b) During visit to the PHCs, it was observed that PHC Bibhutipur received Untied Funds to

the tune of Rs. 2,63,290 and spent Rs. 2,40,000. No other PHCs had been given United

Funds in the year 2010-11. Untied Fund for the current year 2011-12 was not distributed to

the periphery level centres till the visiting month.

6. 24 x 7 Hours Delivery Care Services:

As reported, 25 Institutions were working as 24 x7 hours service provider in the district. No

further details available in the report.

7. Physical Infrastructure and Stock Position:

i. PHCs:

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a) The visited PHCs at Samastipur and Ujiyarpur had own building with regular water supply,

electricity connection, power back-up and Toilet facility but maintenance of the hospital

building was poor. Telephone facility, Vehicle and Microscope were also not available at both

the PHCs.

b) Auto Clave/Steam-Sterilizer, Oxygen Cylinder, Minor Surgical Equipments with other

appliances for delivery purpose were not available at Samastipur PHC.

c) Stock of Contraceptive in PHC Samastipur was nil on the day of visit. Prophylactic drugs

i.e. IFA (small) a large/syrup and Vitamin „A‟ were also not were available at Samastipur

PHC.

d) There was no residential accommodation available at both the visited PHCs.

8. Community Satisfaction about overall PHC Services:

a) The team interviewed 10 community members including ANC, PNC and mothers having

up to two year‟s child, AWW, ASHAs etc. in the area of the PHCs visited at Ujiyarpur and

Samastipur. It was found that the mother and child care services provided to the

beneficiaries.

b) Mothers did not have enough knowledge about ARI & ORT. The children were not taken

for routine immunization in right time to the hospital. Community was not aware about AIDS

and HIV.

c) All the respondents were generally satisfied with the services provided at PHC level by the

PHC staff and Medical Officers.

9. Sample Verification of Family Welfare Acceptors:

a) The team selected 39 F.W. cases, out of which 20 (51%) cases could be contacted for

sample verification in the district. Discrepancy in the age of spouse, number of total children

and age of last child was found in all contacted (18) sterilisation cases.

b) Follow up services were not provided to 12 acceptors.

c) The team also interviewed 13 child immunisation beneficiaries out of 20 selected in the

district. All of them confirmed receiving the doses and no discrepancy was found in the

recorded data.

10. Reconciliation of Reported Performance:

a) There were 824 and 24 Sterilisation cases reported for the year 2010-11 and 2011-12

(upto May) repctively by the PHC Ujiyarpur. Similarly, this PHC reported 110 and 6 IUD

acceptors during same period. But the Service register for Sterilisation and IUD acceptors

for the year 2010-11 and 2011-12 (upto May, 2011) was not made available at the PHC

Ujiyarpur for checking the figures.

b) Due to incomplete service registers of IUD acceptors, the reported figures for the year

2010-11 could not be verified at PHCs Samastipur, Bibhutipur and Kalyanpur.

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11. Maintenance of Register & record:

a) Eligible Couple register was not made available to the team at all the visited institutions.

b) ANC, PNC and JSY beneficiary register were maintained properly at Samastipur and

Kalyanpur PHCs but not at Bibhutipur and Ujiyarpur PHCs.

c) Stock Register of Cu-T, OP and CC were not maintained at Kalyanpur PHC and its Sub

Centres and the same were not made available to the team at Samastipur, Bibhutipur and

Ujiyarpur PHCs.

12. Other Important Observations and Suggestions:

a) The team observed that due to absence of supervision at periphery level, maintenance of

records and registers in respect of various health schemes was poor in whole of the district.

Monitoring and supervision in the district needs to be enhanced. Cash book for untied funds,

JSY, FW & MCH registers were not reviewed by supervisor. Registers and records whatever

maintained by concerned worker for payment of JSY mothers were also not checked by

concerned Medical Officers.

b) Co-ordination between ASHAs and ANMs must be reviewed regularly so that institutional

deliveries could be promoted further in rural areas.

*****

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4. District- Patna

Major observations of Regional Evaluation Team (RET), Patna on the evaluation work carried

out in Patna District of Bihar State in the month of November, 2011.

I. Details of the visited Institutions:

District visited PHCs visited HSCs visited

Patna Bakhtiyarpur, Paliganj, Sampatchack & Mokama

Bakhtiyarpur, Paliganj, Elahibagh, Bahuara, Baireya & Mokama

II. Major Observations:

1. Human Resources:-

The Staff position of the technical categories in the district was as follow:

Particulars of Post Post sanctioned In position Vacant

Specialist 92 78 14

MO 423 265 158

LHV/HS(F) 60 34 26

Lab Technician 76 65 11

ANMs 527 506 21

MPW(M) 63 52 11

The above table showed that the district was facing acute shortage of Medical Officers,

Specialists and supervisory posts.

2. Rogi Kalyan Samiti (RKS) & Village Health Sanitation Committee (VHSNC):-

a) 26 Rogi Kalyan Samitis were reported to have been set up in the district. RKS were

registered in 3 SDH/FRU and 23 PHCs. Regular meetings of RKS were not being conducted

in the visited institutions.

b) As reported, Sufficient RKS Fund was available during financial year 2010-11 and 2011-

12 in the District. The District utilized Rs. 22,89,165 and Rs. 2,84,856 during the year 2010-

11 and 2011-12 (up to Oct, 11) respectively.

c) It was reported that 331 VHSNCs and 3937 Anganwadi Centres were functioning in the

district.

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3. Service of Janani Suraksha Yojana (JSY):-

a) Janani Suraksha Yojana was being implemented in the district. The District spent Rs.

3,81,88,728 during 2010-11 and Rs. 8,99,03,817 during 2011-12 up to October, 2011 from

the fund provided under flexi-pool budget.

b) The team found that the services under JSY at visited PHCs were satisfactory. But cash

incentive to JSY beneficiaries in the visited centres areas was not released in time.

c) 15 JSY beneficiaries were contacted by the team in the area of the visited centres. All

beneficiaries were satisfied with the services. All beneficiaries were provided TT & IFA (L)

during A.N period and most of them received three Checks-up in their nearest service centre.

Necessary advices like Breast feeding and child nutrition were also provided to them. Most of

contacted mothers were delivered at Hospital and received monetary benefit under JSY

scheme. However, post natal visit of field workers is required to be increased.

d) JSY Cards and Immunization Cards were not filled with the complete information by

concerned ANMs in the visited area. It was also observed that some of the mothers had not

received the three consecutive checks up during ANC.

b. 4. Functioning of ASHA:-

a) 2981 ASHAs were working as against target set for 3233 in the district. 1695 ASHAs were

trained in all modules but Drug Kit was provided to all 2981 ASHAs.

b) ASHAs were receiving incentive money per month in the district.

5. Untied Funds and Annual Maintenance Grant:- a) It was reported that sufficient fund was available in the district. District spent Rs. 14,08,501

during 2010-11 and Rs. 51,232 during 2011-12 up to October, 2011as untied fund from the

fund provided under flexi-pool budget.

b) In addition to Untied Fund, the district spent Rs. 17,49,424 during 2010-11 and Rs.

6,49,960 during 2011-12 up to October, 2011 as Annual Maintenance Grant from the flexi-

pool fund received by the district.

c. 6. 24 x 7 Hours Delivery Care Services:-

As reported, 24x7 hours delivery care service was being provided in 30 institutions in the

district.

d. 7. Physical infrastructure Stock Position:-

e. i. Health Sub Centres:

a) The team visited Sub centres at Bahuara and Bairiya under PHC Sampatchak and

observed that both were functioning in Govt. building but water, Electricity and toilet facility

was not available at both the Sub Centres. Labour room was also not available at both the

Sub Centres.

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b) ANMs of the visited Sub centers were not residing in their head quarter. Also, mobile

phone was not provided to ANM. Additional ANM (2nd ANM) was available at both Sub

Centers.

c) Most of the equipment, drugs and other supplies were not available at Bairiya Sub Centre.

Only B.P. Apparatus, Vit.A solution, IFA Tab/Syrup and paracetamole tablet were available

there.

d) Bench for clients, Cupboard for drugs, Foot stool, Ambu bag/suction, Delivery kits, RDT

Kit, Weighing Machine, Thermometer, ORS Packet, DDKs, IFA Tab/Syrup, EC Pills,

Misofrostol tab, Oxitocine tablets, Ampicillin capsule, Gentamycin injection and Kits- A & B

were not available at Bahuara sub centre.

e) SBA training was not received by the ANMs of visited Sub Centres. The posters for public

awareness were not displayed on the wall of Sub Centres.

f) Post of MPW (M) was lying vacant since more than 5 years in both visited Sub Centres.

ii. PHC:

a) Bakhtiyarpur, Paliganj, Sampatchack and Mokama PHCs were visited to assess the

availability of infrastructure, services etc.. All visited PHCs were functioning in Govt. building

with regular water supply, electricity with power back up, Telephone and Toilet facility.

Vehicle was not available at Sampatchack PHC.

b) Stock of Contraceptive, Vaccines and Prophylactic Drugs were available at all visited

PHCs. IFA (syrup) and Vit. A tab were not available at the PHCs visited.

8. Community Satisfaction on overall Service:-

i. Towards HSCs service:

a) 20 mothers were contacted in both SCs Bairiya and Bahuara. Contacted mothers replied

that ANMs were not available as per their need. Field visit was not made by the ANMs during

last month. But they conducted ANC and Immunization clinic regularly. They provided IFA

and TT to A.N mothers.

b) ANC and PNC services needed to enhance and to conduct regular basis in prescribed

time. Most of the contacted mothers were aware about the use of contraceptive methods,

ORT and symptoms of ARI.

c) Home deliveries were conducted by untrained persons.

d) All contacted mothers were aware of government health facilities where they can get all

health facilities.

ii. Towards PHC Servicees:

Villagers interviewed in the area of the PHCs informed that the services at PHCs are

satisfactory. MOs and staff are regularly available at the PHCs, they spend sufficient time in

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examining the patients and made available medicine & drugs satisfactory. It was found that

M.O of Bakhtiyarpur PHC visits his villages on regular basis but M.O of Mokama,

Sampatchack and Paliganj PHCs do not visit their villages regularly.

9. Sample Verification of Family Welfare Acceptors:-

a) The team selected 86 Family Welfare acceptors (Sterilization, IUD, OP and Nirodh) out of

which 35 (41%) acceptors could be contacted for sample verification in the district. It is a very

serious matter that as many as 40 (47%) acceptors could not be contacted due to

wrong/incomplete addresses. During sample check, age of spouse of the acceptors of all 35

contacted cases was found to be wrongly recorded.

b) 25 (71%) acceptors found to have not been provided with follow-up services where as 5

(14%) acceptors replied as not known. 22 (92%) sterilization acceptors received full amount

of compensation money whereas 2 (8%) acceptors replied that they do not know about the

compensation amount.

c) 14 Beneficiaries of child immunization were contacted in which all confirmed receiving the

doses and also received follow up services. No complication was found among contacted

beneficiaries and were satisfied with the services.

10. Reconciliation of Reported Performance:-

There was no coordination between District office and reporting centres in respect of

performance reported in the year 2010-11 and 2011-12 (up to October, 2011) The details

are as follows:

i) 500 Sterilization and 49 IUD cases were reported by PHC Bakhtiyarpur for the year 2010-

11 whereas the figures showed in the report of district office were 211 and 45 respectively for

the same period. Performance report for OP and Nirodh was not made available at this PHC.

ii) 848 IUD cases, 4741 OP cycles/user and 11764 Nirodh were reported by PHC Paliganj for

the year 2010-11 whereas the figures shown in the report of district office were 682, 490 and

490 respectively for the same period.

iii) 1628 Sterilization, 246 IUD cases, 578 OP cycles/user and 816 Nirodh were reported by

PHC Sampatchack for the year 2010-11 whereas the figures shown in the report of district

office were 597, 596, 95 and 376 respectively for the same period.

iv) 99 Sterilizations, 81 IUD cases, 602 OP cycles/user and 4390 Nirodh were reported by

PHC Mokama for the year 2010-11 whereas the figures shown in the report of district office

were NIL, 37, 380 and 317 respectively for the same period.

v) IUD figures reported by the visited PHCs for the year 2010-11 and 2011-12 could not be

verified for want of IUD register maintained at the reporting centres. Incomplete IUD registers

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were found at PHCs Bakhtiyarpur and Paliganj whereas no register was maintained at PHCs

Sampatchack and Mokama.

vi) Similarly, mismatch in the performance was observed in figures reported by the district

offices for the centres and reported by the centres for 2011-12. 426 IUD cases, 1361 OP

cycles/user and 11167 Nirodh were reported by PHC Paliganj for the year 2011-12 (up to

October, 2011) whereas same figures shown in the report of district office were 499, 1819

and 9188 respectively for the same period.

vii) 567 sterilization, 178 IUD cases, 381 OP cycles/user and 412 Nirodh were reported by

PHC Sampatchack for the year 2011-12 (up to October, 2011) whereas the figures shown in

the report of district office were 596, 95, 376 and 520 respectively for the same period.

viii) 28 IUD acceptors, 573 OP cycles/user and 1300 Nirodh were reported by PHC Mokama

for the year 2011-12 (up to October, 2011) whereas the figures shown in the report of district

office were 380, 317 and 600 respectively for the same period.

11. Information on IT Infrastructure and MCH Tracking System:-

a) Computer with Internet connection was available at District Office, 1 BPHC and 9 PHCs.

b) MCH tracking formats was available at Sub Centre level. Health functionaries of District

Office, BPHC and PHC were sensitized in MCH formats, but the same was not done at Sub

Centre level. Data entry was being made at District, BPHC and PHC level.

12. Maintenance of Registers & Records:-

a) Eligible Couple & Child Register was maintained properly and up to date at Mokama PHC

but the same was not maintained at Sampatchack PHC. This Register could not be verified

at Bakhtiyarpur and Paliganj PHCs due to non availability of the register.

b) Eligible Couple Register, Family planning service register, Stock register, Cash book of

untied fund and JSY card were not available at both visited Sub Centresat Bahuara and

Bairiya. Formats for Monthly Reporting were also not available at Bairiya Sub Centre.

c) Sterilization Register was maintained properly and up to date at Bakhtiyarpur and Paliganj

PHCs but the same was not maintained properly and up to date at Sampatchack and

Mokama PHCs.

d) IUD Register was maintained properly and up to date at Paliganj PHC, but not updated at

Sampatchack and Bakhtiyarpur PHCs and not maintained at Mokama PHC.

e) PNC, PNC & Immunization Register were maintained properly at all visited PHCs.

f) OP & CC Registers were not maintained at Mokama PHC, not maintained properly and up

to date at Paliganj and Sampatchack PHC but maintained properly at Bakhtiyarpur PHC.

g) Stock Register was not maintained properly and up to date at all visited PHCs except

Sampatchack PHC.

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h) Sterilization Case Card was not available at the visited PHCs.

13. Other Observations:-

i) Supervision with necessary guidance at grass root level centres was lacking in the district.

Regular meeting on HMIS should be conducted for improving reporting system in the district.

ii) The condition of Labour Rooms and Maternity Wards at Paliganj and Mokama PHCs was

found to be very poor and unhygienic. It was observed that there was no restriction for

general public facility members to enter Labour Rooms which is important for delivery of

quality services and privacy of mothers.

*********

5. District- Nalanda

Major observations of Regional Evaluation Team (RET), Patna on the evaluation work carried

out in Nalanda District of Bihar State in the month of November, 2011.

I. Details of the visited Institutions:

District visited PHCs visited HSCs visited

Nalanda

Harnout, Sermera, Noorsarai & Hilasa

Harnout, Gopalbad, Ahiyarpur, Merinagar, Tora, Daruwara & Lahanda

II. Major Observations: 1. Human Resources:-

There was acute shortage of man power in some category of posts. 42 of the 150 sanctioned

posts of Medical Officer, 74 out of the 766 sanctioned posts of ANM, 25 out of the 41

sanctioned posts of Lab Technician and 14 out of the 32 sanctioned posts of LHV/HS(F)

were lying vacant in the district.

2. Rogi Kalyan Samiti (RKS) & Village Health, Sanitation and Nutrition Committee

(VHSNC):-

a) 26 Rogi Kalyan Samitis were set up at the DH, CHC and PHC level in the district. It was

registered in DH, in 2 SDH, in 3 CHCs and in 20 PHCs. Regular meetings of RKS were not

being conducted in the visited institutions.

b) The District received RKS fund to the tune of Rs. 44,53,520 for the year 2011-12 out of

which Rs.10,00,188 (22%) was spent up to October, 2011.

c) It was reported that 249 VHSNCs and 2319 Anganwadi Centres were functioning in the

district. Regular meetings of VHSNCs were not conducted as per prescribed Govt. guidelines

in the visited institutions.

d) The District received VHSNC fund to the tune of Rs.63,87,500 for the year 2011-12 out of

which Rs. 45,90,000 (72%) were spent up to October, 2011.

131

3. Service of Janani Suraksha Yojana (JSY):-

a) Janani Suraksha Yojana was being implemented in the district. The District spent Rs.

61,33,180 out of the available fund of Rs. 5,43,63,595 during 2011-12 (up to October, 2011).

b) It was reported that sufficient fund was available in the district, but cash incentive to JSY

beneficiaries in the visited centres was not being released in time.

c) JSY Cards and Immunization Cards were not filled with the complete information by

concerned ANMs in the visited area. It was also observed that some of the mother had not

received the three consecutive checks up during ANC while, post natal visits need to be

increased.

d) Prescribed reporting format related to physical performance and expenditure of JSY

scheme was not properly maintained. As a result it was not possible to determine the actual

status of programmes implementation in the district.

e) 8 beneficiaries were contacted by the team and all beneficiaries reported satisfaction with

the services. All beneficiaries were provided with TT & IFA (L) during A.N period and most of

them received three Checks-up in their nearest service centre. Necessary advice like Breast

feeding and child nutrition were also provided to them. Most of contacted mothers were

delivered at Hospital and received monetary benefit under JSY scheme. However, post natal

visits by field workers need to be increased.

4. Functioning of ASHA:-

a) 2340 ASHAs were working as against target of 2365 ASHAs for the district. 2317 ASHAs

were trained in all modules but Drug Kit was provided to 2314 ASHAs.

b) ASHAs were receiving incentive money per month in the district.

5. Untied Funds and annual Maintenance Grant:-

a) It was reported that sufficient funds were available in the district. The District received

untied funds to the tune of Rs. 41,86,751 for CHCs, PHCs and Sub Centres for the year

2011-12 out of which Rs. 11,39,285 (27%) were spent up to October, 2011.

b) The team observed that the ANM/MPW (M) were not so clear about guidelines of

utilization of Untied Funds as well as submission of utilization certificate to their higher

authorities in prescribed formats.

c) In addition to Untied Fund, district received Annual Maintenance Grant to the tune of

Rs.16,50,833 for CHCs, PHCs and Sub Centres for the year 2011-12 out of which an amount

of Rs. 9,35,247 (57%) was spent up to October, 2011.

6. 24 Hours Delivery Care Services:-

As reported, total 20 institutions were working as 24x7 hours delivery care service providers

in the district.

7. Physical Infrastructure Stock Position:-

i. Health Sub Centres:

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a) Sub centres at Ahiyapur and Gopalbad of Sarmera PHC were visited for physical

verification. Gopalbad Sub Centre was functioning in Govt. building but Ahiyapur Sub Centre

was functioning in a private building. Water and Electricity facility was not available at both

the Sub Centres. Toilet facility was not available at Ahiyapur SC. Labour room was available

at Gopalbad Sub Centre but deliveries were not being conducted there.

b) ANMs of the visited Sub Centres were not residing in their head quarter. Also, mobile

Phone was not provided to ANM. Additional ANM (2nd ANM ) was not available at Ahiyapur

Sub Centre.

c) Examination table, Delivery table, McIntsh Sheet, Ambu bag/suction, Steam Sterilizer,

Delivery kits, RDT Kit and Heamoglobinometer were not available at both Sub Centres viz.

Ahiyarpur and Gopalbad. IUD Insertion Kit was not available at Ahiyapur SC whereas

Nischay Pregnancy Test Kit and Weighing Machine were not available at Gopalbad Sub

Centre.

d) Gloves, Slides for blood test, ORS Packet, DDKs, Co-trimoxazole tab, IFA Tab/Syrup, EC

Pills, Bleaching powder, Chloroquine tab, Metronidazole tab, Misofrostol tab, Magsulth tab,

Oxitocine tablets, Ampicillin capsule, Gentamycin injection and Kits- A & B were not

available at Ahiyarpur and Gopalbad Sub Centres. AD Syringes, Vit. A solution and

Paracetamole tab, were not available at Ahiyapur Sub Centre whereas Thermometer, Oral

Pills Cycles, Condom and Antiseptic Solution were not available at Gopalbad Sub Centre.

e) SBA training was not received by the ANM of visited Sub Centres. The posters for public

awareness were not displayed on the wall of Sub Centres.

f) Posts of MPW (M) were lying vacant for more than 5 years in both the visited Sub Centres

at Ahiyarpur and Gopalbad.

ii. PHC:

a) Harnaut, Sermera and Noorsarai PHCs were visited to observe the availability of facilities.

All visited PHCs were functioning in Govt. building with regular water supply, electricity with

power back up, Telephone and Toilet facility. Vehicle was not available at Sermera and

Noorsarai PHCs.

b) Stock of Contraceptive, Vaccines and prophylactic Drugs was available at Sermera and

Noorsarai PHCs but IFA (syrup) and Vit.A tab were not available at both PHCs. However,

Stock position could not be verified by the team at Harnaut PHC.

8. Community Satisfaction on Overall Service:-

i. Towards HSCs Service:

a) Contacted mothers in the area of Ahiyarpur and Gopalbad Sub Centres replied that ANMs

were not available as per their need, but they conducted Immunization Clinic regularly. They

provided IFA and TT to A.N. mothers.

133

b) ANC and PNC services need to be enhanced and provided on regular basis in prescribed

time. Most of the contacted mothers were aware about the use of contraceptive methods,

ORT and symptoms of ARI.

c) Home deliveries were conducted by untrained person.

d) All contacted mothers were aware of the government health facilities where they can get

all health facilities.

ii. Towards PHC Service:

a) Villagers interviewed in the area of PHCs informed that the services at PHCs were

satisfactory. MOs and staff were regularly available in the PHC, services and drugs were

being provided satisfactory. It was found that M.O of Sermera PHC was visiting his villages

on regular basis but M.O of Harnout and Noorsarai PHCs was visiting their villages regularly.

b) The team interviewed some mothers, AWW, ASHAs, and village leaders in the area of

each institutions and found that ANC services were given to pregnant women but early

registration was very poor in the district. The newly delivered women did not have much

knowledge about ARI & ORT. Mothers were not aware about AIDS and HIV. Some

Institutionally delivered mothers did not receive their incentive in due time.

c) Most of the mothers had no knowledge about the benefit for institutional delivery.

d) The children were not being taken in right time to hospital for routine Immunization.

9. Sample Verification of Family Welfare Acceptors:-

a) The team selected 148 Family Welfare acceptors (Sterilization, IUD, OP and Nirodh) out of

which 92 (62%) acceptors could be contacted for sample verification in the district. 30

acceptors left their house temporarily and 20 were not traceable due to wrong/incomplete

addresses whereas 3 recorded FW acceptors were not living that area. During sample check

discrepant entries in some case were found about age of last child and total number of

children.

b) 29 (46%) acceptors were not provided follow-up service where as 7 (11%) acceptors

replied as not known. 36 (84%) sterilization acceptors received full amount of compensation

money where as 7(16%) acceptors replied that they don‟t know about the compensation. 54

(86%) acceptors were satisfied with the methods.

c) Out of the 70 selected acceptor of spacing methods (Cu-T -51, OP-7 and Nirodh-12), 49

(Cu-T-39, OP-5 and Nirodh-5) acceptors were contacted. Out of contacted 39 Cu-T users,

29 denied using the method. Rest all users were continuing the method without any

complication.

d) Out of the 20 selected Beneficiaries of child immunization, 14 were contacted and all

confirmed receiving doses and follow up services. No complication was found among

contacted beneficiaries. All were satisfied with the service.

134

10. Reconciliation of Reported Performance:-

There was no coordination between District office and reporting centres in respect of

performance reported in the year 2010-11 and 2011-12 (up to October, 2011). The details

are as follows:

i) 746, 374, 741 and 339 Sterilizations were reported by PHC Harnout, Sermera, Noorsarai

and Hilsa for the year 2010-11 whereas the figures shown in the report of district office were

759, 577, 755 and 345 respectively for the same period.

ii) 275, 180, 292 and 23 Sterilizations were reported by PHCs Harnout, Sermera, Noorsarai

and Hilsa for the year 2011-12 (up to October, 2011) whereas same figures showed in the

report of district office were 287, 179, 294 and 32 respectively for the same period.

iii) Service registers in some of the centres were not complete. Steilization register had 330

cases against 339 cases reported by Hilsa PHC. 160 IUD acceptors were reported by PHC

Sermera for the year 2010-11 whereas the team verified the total acceptors 28 in the service

register. 440 IUD acceptors were reported by PHC Noorsarai for the year 2011-12 (up to

October, 2011) whereas the team verified 65 IUD acceptors in the service register only.

11. Information on IT Infrastructure and MCH Tracking System:-

a) Computer with Internet connection was available at District Office, BPHC, CHC and

PHCs.

b) MCH tracking formats was available at Sub Centre level. Health functionaries of District

Office, BPHC, CHC, PHC and Sub Centres were sensitized about MCH formats. Data entry

was being made at District, BPHC, CHC and PHC level.

12. Maintenance of Register & Record:-

a) Eligible Couple & Child Register was maintained properly at Hatnout PHC, not maintained

at Noorsarai PHC and not made available at Sermera and Hilsa PHCs.

b) Sterilization Register was not maintained properly and updated at all visited PHCs, through

particulars of acceptors along with payment documents were maintained in the same

register, but the register was not timely updated.

c) IUD, OP and CC Registers were not maintained properly and up to date at all visited

PHCs.

d) ANC, PNC & Immunization Register were maintained properly at Harnout and Hilsa PHCs

but the same were not maintained properly at Sermera and Noorsarai PHCs.

e) Stock Register was not maintained properly at Harnout and Noorsarai PHCs whereas the

same was not made available at Sermera and Hilsa PHCs.

f) Sterilization Case Card was not found at the visited centres.

g) Family Planning Service Register, Stock Register and Formats for Monthly Reporting was

not available at both visited Sub Centres i.e., Ahiypur and Gopalbad. MCH Register and

135

Immunization & ANC Cards were not available at Ahiyapur Sub Centre whereas Eligible

Couple Register and Cash book of untied fund were not available at Gopalbad Sub Centre.

13. Other Observations:-

i) Supervision with necessary guidance at grass root level centres was lacking in the district.

Regular meeting on HMIS should be conducted for improving reporting system in the district.

ii) The condition of Labour Rooms and Maternity Wards at Harnout and Sermera PHCs was

found very poor and unhygienic. There is no privacy of mother as any one can enter labour

room at any time.

iii) Orientation Training to the staff of District Programme Management Unit and to the Block

Accountant at PHCs may improve their performance.

136

6. District:- Madhepura Highlight from the Regional Evaluation Team Report of Madhepura District of Bihar. The Regional Evaluation Team, located at Regional Office for Health and Family Welfare

Patna, Ministry of Health and Family Welfare, Government of India carried out sample checks

of activities covered under NRHM / RCH in Madhepura District of Bihar State during January,

2012.

I . Details of the visited Institutions:

District Visited SDH/PHCs Visited SCs Visited

Madhepura PHCs: Chausa, Madhepura ( Murho), Alamnagar and Singheswar.

Chausa, Murho, Murowaha, Bhelawa, Alamnagar, Ratwara and Narthea.

II. Major Observations:

1. Human Resources:-

a) As reported Staff position of the district in the key categories was as follows:

Post Post sanctioned In position Vacant

M.O 177 66 111

Specialists 165 7 158

ANMs 349 134 215

LHV/HS(F) 32 2 30

Health supervisor(M) 92 25 67

Nurse Grade- A 67 17 50

Lab Technician 56 6 50

The above table shows that the district was facing acute shortage of skilled personnel in the

health sector for providing health services in the district.

b) In PHC Chausa, 8 out of the 13 sanctioned posts of Medical Officer, all 6 sanctioned

posts of Pharmacist, 5 out of the 6 posts of Lab. Technician, 2 posts of LHV, 41 out of 52

posts of ANM/HW(F) and all 6 sanctioned posts of Nurse grade-A were lying vacant.

c) In PHC Alamnagar, 3 out of 5 sanctioned posts of Medical Officer, all 3 post of LHV, 41

out of 45 sanctioned posts of ANM/HW (F), all 3 posts of Health Worker and 1 post of

Nurse grade-A were lying vacant.

d) In PHC Madhepura, 1 out of the 7 sanctioned posts of Medical Officer, all 5 sanctioned

posts each of Pharmacist and Lab. Technician, 39 out of the 54 sanctioned posts of

ANM/HW(F), 53 out of the 54 sanctioned posts of Health Worker and all 5 sanctioned posts

of Nurse grade-A were lying vacant.

137

e) In PHC Singheswer, 1 out of the 3 sanctioned posts of Medical Officer, sanctioned post of

S.I., all 3 sanctioned posts of LHV, 20 out of 27 sanctioned posts of ANM/HW (F), all 3

sanctioned posts of MPW(M) and 4 sanctioned post of Nurse grade-A were lying vacant.

f) 3 out of 4 the posts of MO, 4 out of the 39 posts of ANM and 3 out of the 4 posts of Nurse

grade-A were filled up on contract basis in the Alamnagar PHC. Similarly, 1 out of the 5 posts

of MO and 5 of the 19 posts of ANM were available on contractual basis in PHC Singheswer.

All 4 identified posts of Nurse grade-A for contractual appointment were not filled in this PHC.

g) It was observed that one ANM is there to look after 5-6 Sub Centres who is overloaded

with the clinical and field work in her respective areas.

2. Rogi Kalyan Samiti (RKS) & Village Health Sanitation and Nutrition Committee

(VHSNC):-

a) Rogi Kalyan Samiti was reported to be set up in 14 institutions (13 in PHCs and 1 in

District Hospital) in the district. It was observed that the meeting of RKS was being conducted

in the visited institutions.

b) The budget provision and expenditure of the RKS in the entire District and in the visited

PHCs are as under:

(Amount in Rs.)

Name of Institution

2010-11 2011-12 ( Up to Dec.2011 )

Fund available

Expenditure Balance Fund available

Expenditure Balance

District

22,11,847 18,14,669 (82%) 3,97,178 21,64,948 15,75,411 (73%) 5,89,537

PHC Chausa 2,09,631 1,76,452 (84%) 33,179 1,33,179 1,33,164 (100%) 15 PHC Madhepura (Murho)

1,03,928 95,132 (92%) 8,796 53,489 27,900 (52%) 25,589

PHC Alamnagar 2,03,825 2,01,464 (99%) 2,361 1,02,361 78,834 (77%) 23,527 PHC Singheswer

2,36,249 1,82,649 (77%) 53,600 1,01,306 1,00,098 (99%) 1,208

c) The team reported that the funds are mostly spent for purchasing the medicines and also

in the activity of the cleanliness in the Hospital.

d) As reported, 170 VHSNCs were constituted in the district. It was observed that utilization

of funds by VHSNCs was very poor in the district. Details of the fund of VHSNCs in the

District as well as visited PHCs is as under:

(Amount in Rs.) Name of Institution Fund Available

for 2010-11 Fund Available for 2011-12

Expenditure Up to Dec. 2011 *

District 42,20,000 33,40,000 28,500

PHC Chausa 4,30,000 3,70,000 19,500

PHC Madhepura (Murho)

4,90,000 4,70,000 NIL

PHC Alamnagar 2,90,000 2,80,000 NIL

PHC Singheswer 2,70,000 2,80,000 NIL

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* Expenditure for both the years.

a) JSY beneficiaries were being provided services as well as cash incentives in the district. It

was reported that Rs. 1000 in urban area and Rs. 1400 in rural areas are being given to the

beneficiaries for institutional delivery. It was also reported that Rs. 500 are being given to the

BPL beneficiary in rural and urban areas for home delivery.

b) The District spent Rs. 5,50,02,042 out of available JSY fund of Rs. 6,40,93,377 during

financial year 2010-11 and Rs. 4,69,99,256 out of available fund of Rs.5,55,42,422 during

financial year 2011-12 under JSY. Utilization certificate was also submitted to higher

Authority for both years.

c) Utilization of JSY Fund at the visited PHCs

(Amount in Rs.)

Name of PHCs

2010-11 2011-12 ( Up to Dec. 11 ) Fund available

Expenditure

Balance Fund available

Expenditure

Balance

PHC Chausa 61,88,376 55,47,778 6,40,598 38,80,289 35,47,100 3,33,189 PHC Madhepura (Murho)

NIL NIL NIL 8,00,000 2,27,000 5,73,000

PHC Alamnagar 41,61,050 41,61,000 50 42,00,050 38,93,100 3,06,950 PHC Singheswer 53,27,349 40,94,400 12,32,949 44,32,949 42,02,400 2,30,549

d) 6 out of 17 selected beneficiaries were contacted by the team and found that MCH Cards

issued to all of them and most of them were registered in earlier stage of ANC. Three

consecutive checks up were completed in time. JSY package to the beneficiaries was paid in

prescribed time.

e)Post natal services should be increased in the visited areas. Efforts may also be made to

enhance the Institutional Delivery and Family welfare services in these areas. During field

verification, the team observed that most of home deliveries were conducted by untrained

persons at the home.

f) The condition of Labour Rooms and Maternity Wards at Jainagar and Satgawa CHCs was

found very poor and unhygienic. Moreover, no restriction for general public was there to enter

Labour Room. This matter is deep concern for keeping of privacy of mothers and quality of

services.

g) It was observed that necessary information was not recorded in JSY Card. Immunization

Card were also not filled up by the concerned ANM. Concerned Medical Officer and

Supervisor did not visit frequently to visited institutions for effective monitoring.

4. Functioning of ASHA:-

As reported by the team, 1540 ASHAs out of requirement of 1711 ASHAs for 452 villages

were in position in the district. 1459 ASHAs were trained in 5 modules but drug kits were

provided to only 1165 ASHAs.

139

5. Untied funds:-

a) Untied funds to the tune of Rs.19,75,000 and Rs. 28,35,000 for APHCs & HSCs were

available in the District during financial year 2010-11 and 2011-12 respectively. Out of

available fund of Rs. 48,10,000 for both years, Rs.1,14,100 at APHCs level and Rs. 4,07,605

at HSCs level were spent up to December, 2011.

b) Submission of Utilization Certificate and statement of Expenditure was also found irregular

at HSC level. For this purpose prescribed formats were not provided to the HSCs.

c) Utilization of Untied Fund at visited PHCs was also not satisfactory which can be seen

from the following table:

(Amount in Rs.)

Name of PHCs

Fund Available for 2010-11

Fund Available for 2011-12

Expenditure Up to Dec. 2011 *

For APHC

For HSCs

For APHC

For HSCs

APHCs level

HSCs level

PHC Chausa 75,000 2,40,000 75,000 2,50,000 24,000 36,500

PHC Madhepura (Murho)

50,000 2,10,000 50,000 1,90,000 24,000 37,000

PHC Alamnagar NIL 2,20,000 50,000 3,50,000 NIL 56,500

PHC Singheswer

25,000 1,80,000 25,000 1,90,000 NIL NIL

* Expenditure for both the years.

6) Annual Maintenance Grant:-

a) As reported, Annual Maintenance Grant (AMG) to the tune of Rs. 5,00,000 for Sadar

Hospital and Rs. 13,00,000 for PHCs was available in the District for financial year 2010-11,

out of which an amount of Rs.4,99,906 at Sadar Hospital and Rs. 8,77,282 at PHCs was

spent during the year. Similarly, Rs. 6,75,845 have been spent at PHCs out of available AMG

of Rs. 10,72,720 during the year 2011-12 (up to December, 2011). No fund was given to

Sadar Hospital in the year 2011-12 up to the date of visit.

b) AMG @ 1,00,000 each for the year 2010-11 was provided to PHCs visited at Chausa,

Madhepura, Alamnagar and Singheshwer; out of which an amount of Rs. 80,674, 30,869,

99,810, and 98,335 was spent. During 2011-12, AMG of Rs. 69,328, Rs. 1,19,131, Rs.

50,190 and Rs. 51,665 was available at PHCs visited at Chausa, Madhepura, Alamnagar and

Singheshwer respectively; Out of which Rs. 68,301, Rs. 76,150, Rs. 37,972 and Rs. 3,000

was spent up to December, 2011.

140

7. Physical Infrastructure and Stock Position:

I. PHCs:

a) Visited PHCs at Chausa, Madhepura, Alamnagar and Singheshwer were functioning in

Govt. building with Regular water supply, Electricity facility with power back up, Toilet facility

and Telephone facility. Maintenance of the Hospital Building was found satisfactory.

Ambulance/Jeep was available at all visited PHCs.

b) Most of the equipments and apparatus were available at the visited PHCs

c) Stock of contraceptive, Vaccines vials and Prophylactic drugs were available at all visited

PHCs except Madhepura PHC. DT Vaccines vials and Vit. A Tab were not available at all the

visited PHCs where as IFA Syrup was available only at Singheshwer PHC.

d) Cleanliness in Operation Theatre and Labour Room was not up to mark at PHCs.

II. HSCs:

a) Out of three visited Sub Centres at Ratwara, Narthwa and Maruwaha, only Maruwaha

Sub Centre has Govt. building. ANMs of all visited Sub Centres were not residing in Sub

Centre or Sub Centre area. Additional ANM and MPW (M) were not posted at visited Sub

Centres under NRHM.

b) Mobile phone was not provided to ANM of visited sub centres. Facilities like water,

Electricity connection and Toilet facility were not available at all visited SCs.

c) Required Furniture and Equipments were not available at visited Sub Centres.

d) Co-trimoxazole tablet and Vit. A solution were available in all visited SCs, IUD,

Paracetamole and Metronidazole tab. were available in Ratwara and Narthwa SCs. No other

Drugs/Medicines were available at visited Sub Centre.

e) The posters for public awareness were not displayed at any of the visited Sub Centre.

f) SBA training was not received by the ANM of any of the visited Sub Centre.

g) Overall supervision during last three month was not done in any of the visited Sub

Centres.

8. Community Satisfaction on Overall Service:

i) Services of ANMs:

a) During field check in the sub centre area, it was stated by some of the mothers that ANM

was available as per their need. Services of ANC and PNC were satisfactory but check up of

ANC and PNC mothers need to be increased for covering all the mothers in the area.

b) Home delivery was conducted by trained personnel by using DDK. Mothers did not know

sufficiently about danger sign of ARI.

c) MPW (M) was not posted at any visited Sub Centres.

ii) Service of PHC:

a) Public opinion regarding behaviour and presence of staff at PHCs, treatment to the

patients and availability of drugs was found satisfactory. It was found that M.O of Madhepura

141

and Chausa PHC visited their villages in regular basis but MOs of Alamnagar and

Singheshwer did not visit their villages regularly.

9. Sample Verification of Family Welfare Acceptors:

a) Out of 120 selected family welfare acceptors (Sterilization-87 and IUD-33), 56 (47%)

(Sterilization-44 and IUD-12) acceptors could be contacted for sample verification in the

district. While examining the details of the contacted cases, discrepancy in age of spouse

and age of youngest child were found in all contacted cases.

b) 41(73%) acceptors found to have not been provided follow-up service. 37(84%)

sterilization acceptors received full amount of compensation money whereas 7(16%) persons

did not reply about compensation money as the acceptors themselves were not present at

the time of interview.

c) Out of 12 contacted Cu-T users, all were continuing the method without any complication.

d) Out of 26 selected beneficiaries of child immunization, 20 were contacted. All contacted

beneficiaries confirmed receiving doses but, only 8 (40%) beneficiaries received follow up

services. No complication was found among contacted beneficiaries. All were satisfied with

the services.

10. Reconciliation of Reported Performance of Family Planning:

A) There was no coordination between District office and reporting centres in respect of

reporting of performance of family planning. The details are given below:

i) Performance report for the year 2010-11:

a) The district office reported Sterilizations figures 821 and 915 as against the figures 823

and 908 reported by PHCs Alamgarh and Singhaswer respectively.

b) The district office reported IUD figures 344, 342, and 59 as against the figures 319, 269,

and 108 reported by PHCs Chausa, Alamgarh and Singhaswer respectively.

c) The district office reported OP figures 2788 and Nirodh 1295 as against the figures 136

and 10696 reported by PHCs Singhaswer and Chausa respectively.

ii) Performance report for the year 2011-12 ( up to Dec. 2011):

a) The district office reported Sterilizations figures 393 and 291 as against the figures 391

and 298 reported by PHCs Alamgarh and Singhaswer respectively.

b) The district office reported IUD figures 20 and Nirodh 14186 as against the figures 33 and

12756 reported by PHCs Singhaswer and Chausa respectively.

c) The district office reported OP figures 1331 and 884 as against the figures 1204 and 875

reported by PHCs Chausa and Singhaswer respectively

B) Also, the figures reported by PHCs did not match with the number of cases recorded in

the service registers in the PHCs.

142

a) There were 641 and 217 Sterilizations cases reported in the service register at PHC

Chausa for the year 2010-11 and at PHC Singhaswer for the year 2011-12 ( up to Dec.2011)

as against the reporting of 650 and 298 Sterilisation respectively.

b) Due to not maintenance of IUD register at the PHC, reporting figures could not be verified

for the year 2010-11 and 2011-12. Without service register reporting of IUD cases create

doubt on the figures.

11. Information on IT Infrastructure and MCH Tracking System:-

a) Computer with Internet connection was available at District Office, BPHCs and PHCs.

b) MCH tracking formats were available at Sub Centre level. Health functionaries of District

Office, BPHCs, PHCs and Sub Centres were sensitized in MCH formats.

c) Data was being captured in MCH formats and found to be completed during visit of the

team.

d) Data entry was being made by District office, BPHCs and PHCs in the district.

12. Maintenance of Register & Records:-

a) Sterilization Register was maintained properly and up to date at PHC Alamnagar but the

same was not maintained properly at PHCs Chausa, Singhaswer and Madhepura.

b) OP and Nirodh registers were not maintained properly at PHC Chausa, Singhaswer and

Alamnagar.

c) MCH Register was maintained properly and up to date at the visited institutions except

Chausa PHC.

d) Stock Registers with essential information like date of Manufacturing & Expiry, Batch No.

and Model No. of Cu-T etc were not recorded at the visited PHCs.

13. Other Important Observations and Suggestions:-

a) District Health plan for 2010-11 was prepared and submitted to higher Authority in proper

time, but the same was not prepared by visited BPHCs in the district.

b) The condition of Labour Rooms and Maternity Wards at visited PHCs at Madhepura,

Chausa and Alamnagar was found to be very poor and unhygienic. It was observed that

there was no restriction for to entering Labour Room for general public/family members. It

was a matter of deep concern about keeping the privacy of mothers and quality of services

c) Distribution of OP and Nirodh under F.W programme at SC level was very poor. The team

could not select the OP/Nirodh samples for field verification due to non availability of the

cases at the visited centres.

d) The team observed that Sub Centres attached to PHC were not having sufficient space for

their routine ANC/PNC clinics.

e) Orientation Training to the staff of DPMU and at CHC/PHC can improve the quality of

services in respect of proper maintenance of Records, Registers, SOE/Cash Book and

proper implementation of the schemes under NRHM.

143

f) ANMs and Medical Officers were noticed having not submitted their monthly performance

report in HIMS format in time. This may be regularised.

**********

7. District:- Bhagalpur Highlight from the Regional Evaluation Team Report of Bhagalpur District of Bihar The Regional Evaluation Team, located at Regional Office for Health and Family Welfare

Patna, Ministry of Health and Family Welfare, Government of India carried out sample checks

of activities covered under NRHM / RCH in Bhagalpur District of Bihar State during January,

2012.

I . Details of the visited Institutions:

District Visited SDH/PHCs Visited SCs Visited

Bhagalpur S.D.H: Navgachhiya. PHCs: Navgachhiya, Kahalgaon and Pirpainti

Bhawanipur, Pakara, Tetari, Anti Chack, Ghogha, Janidih, Kahalgaon, Simanpur, Laxmipur and Sadikpur.

II. Major Observations: 1. Human Resources;

144

a) 206 out of the 263 sanctioned posts of Medical Officer, 43 out of the 397 sanctioned posts

of ANM and 50 out of the 65 sanctioned posts of LHV/HS (F) were lying vacant in the District.

Staff position of other Officers and Staff was not made available to the team

b) It was also reported that 63 Medical Officers and 320 Additional ANM were posted on

contract basis in the district.

c) In PHC Navgachia, 5 out of the 6 sanctioned posts of Medical Officer, sanctioned post

each of Pharmacist and Sanitary Inspector, all 3 sanctioned posts of Lab. Technician and all

2 sanctioned posts of LHV were lying vacant.

d) In PHC Pirpaiti, 11 out of 13 sanctioned posts of M.O, all 6 sanctioned posts of

Pharmacist, 1 sanctioned post of S.I., 5 out of the 6 sanctioned posts of LHV, 8 out of the 47

sanctioned posts of ANM/HW (F) and 1 out of the 4 sanctioned post of Nurse Gr.-A were

lying vacant.

e) In PHC Kahalgaon, sanctioned post each of Pharmacist, S.I. and Lab Technician, 2 out of

the 3 sanctioned posts of LHV and 1 out of 36 sanctioned posts of ANM/HW were lying

vacant.

f) Contractual Staff position as reported in the visited PHC is as given below:

2. Rogi Kalyan Samiti (RKS) & Village Health Sanitation and Nutrition Committee

(VHSNC):-

a) Rogi Kalyan Samiti was constituted in District Hospital, SD Hospital, 3 CHCs/FRUs and 16

in PHCs in the district. Meeting of RKS was being conducted quarterly in visited centres.

b) An expenditure of Rs.14,73,498 under RKS was incurred from Flexi-pool fund during

2010-11 and Rs.12,79,202 were utilised from Flexi-pool fund during 2011-12 (up to

December, 11) in the district. It was reported that most of RKS budget had been utilised for

purchasing the Medicine and maintenance of cleanliness in the hospitals.

c) District spent funds from Flexi-pool fund for VHSNCs. Rs. 1473498 in the year 2010-11

and Rs.10, 000 in the year 2011-12 (up to December, 11) were utilised in the district in this

regard.

Name of the post

Naugachia PHC Pirpaiti PHC Kahalgaon PHC

Sanctioned

Posted

Vacant Sanctioned Posted Vacant Sanctioned Posted Vacant

Medical Officer

7 2 5 13 4 9 4 4 0

Lab.Tec. - - - 4 1 3 1 1 0

L.H.V. - - - 6 0 6 - - -

A.N.M. / H.W.(Female)

16 13 3 47 38 9 8 8 0

Nurse Grade-A

3 3 0 8 7 1 5 5 0

145

3. Service of Janani Suraksha Yojana (JSY):-

a) i) JSY beneficiaries were being provided the services as well cash incentives in the district.

It was reported that Rs. 1000 in urban area and Rs. 1400 in rural areas are being given to the

beneficiaries. It was also reported that Rs. 500 are being given to the beneficiary in rural and

urban areas for home delivery.

ii) For providing the transportation to the JSY beneficiaries, ASHAs/AWWs are given Rs. 200

per cases. Likewise, ASHA/AWW is given RS. 200 in urban areas and 400 in rural areas in

per case for coordinating all the activities as per JSY provision.

b) The District spent funds for JSY from Flexi-pool fund. Rs. 7,01,03,430 in the year 2010-11

and Rs.4,96,46,093 in the year 2011-12 (up to December, 11) were utilised in the district.

c) 10 out of 37 selected JSY beneficiaries were contacted by the team and found that MCH

Cards were issued to all of them and most of them were registered for ANC in early stage of

pregnancy. Three consecutive checks up were completed in time. JSY package to the

beneficiaries was paid in prescribed time.

d) It was observed that post natal services should be increased in the visited areas. Efforts

may also be taken to enhance the Institutional Delivery and Family welfare Services in these

areas. During field verification the team observed that most of home deliveries were

conducted by untrained persons.

e) It was observed that necessary information was not recorded in JSY Card. Immunization

Card were also not filled up by the concerned ANM. Concerned Medical Officer and

Supervisor did not frequently visit the institutions for effective monitoring.

f) The condition of Labour Rooms and Maternity Wards at Naugachia CHC and Pirpainti PHC

was found poor and unhygienic. Moreover, there was no restriction for general public to

enter Labour Rooms.

4. Functioning of ASHA:_

As reported by the team, 2209 ASHAs out of requirement of 2311 ASHAs for 1520 villages

were in position in the district. All ASHAs were provided with drug kit but only 1770 ASHAs

were trained up to 5th module in the district.

5. Untied funds and Annual Maintenance Grant:- a) It was reported that district utilised an amount of Rs. 9,92,634 in the year 2010-11 and Rs.

7,582 in the year 2011-12(up to Dec.11) as untied fund at PHCs from Flexi-Pool funds.

Similarly an amount of Rs. 13,66,661 in the year 2010-11 and Rs. 20945 in the year 2011-12

(up to Dec.11) was utilised as Annual Maintenance Grant at PHCs level from Flexi-Pool fund.

6. Physical infrastructure and Stock Position:-

146

I. Sub- Divisional Hospital:

a) Sub Divisional Hospital Navgachiya was functioning in Govt. building with Regular water

supply and Electricity facility with power back up. Maintenance of the Hospital Building was

found satisfactory. Ambulance & Jeep were available there.

b) Oxygen Cylinder, Neonatal Resuscitation equipment, Anesthesia equipment, Arteether

injection and quinine injection etc were not available in the hospital.

c) Out of 16 sanction posts, not a single Specialist was posted at the Hospital.

II. PHCs:

a) Visited PHCs at Naugachiya, Pirpainti and Kahalgaon were functioning in Govt. building

with Regular water supply, Electric facility with power back up, Toilet facility and Telephone

facility. Maintenance of the Hospital Building was found satisfactory. Ambulance/Jeep was

available at all visited PHCs.

b) Microscope, Oxygen Cylinder, Minor surgical equipment, Labour Room, Appliances for

delivery, Resuscitation equipment and IUD Insertion Kit were not available at PHC

Navgachiya.

c) Cleanliness in Operation Room and Labour Room was not satisfactory at all the visited

PHCs.

d) Stock of contraceptive, Vaccines vials and Prophylactic drugs was available at all visited

PHCs, but DT/DDT Vaccine vials and Vit. A Tab were not available at all the visited PHCs.

IFA Syrup was not available at Naugachiya and pirpainti PHCs.

e) AYUSH Medical Officer was available at all visited PHCs.

f) Residential Accommodation for Medical Officer was not available at Naugachiya and

Pirpainti PHCs.

III. HSCs:

a) Out of three visited Sub Centres, Antichack and Sadipur Sub Centres have Govt. building.

ANMs of all visited Sub Centres were not residing in Sub Centre or Sub Centre villages.

Additional ANM under NRHM was not posted at the visited Sub Centres. MPW (M) was

posted only at Antichack Sub Centre.

b) Mobile phone was not provided to ANMs of visited Sub Centres. Water and Electricity

connection were not available at all visited SCs whereas Toilet facility was available only at

Antichack Sub Centre.

c) Nischay Pregnancy Test kit, RDT, Weighing Machine and Haemoglobinometer were not

available at Antichack Sub Centre. Essential Furnitures and Equipments were lacking at

Ghogha and Sadipur Sub Centres.

d) DDKs, Sanitary Napkin, Clorin Solulution, Misofrostol, Magsulth and Oxitocine tablets,

Ampicillin Capsule, Gentamycine injection and Kit-A & Kit-B were not available at all the

147

visited HSCs. Thermometer, Gloves, Slides for blood test, ORS packet, IFA Tablet/Syrup,

Oral Pills Cycle, E.C.Pills, Condom, Antiseptic solution and Chloroquine tab were not

available at Ghogha and Sadipur HSCs. Co-trimoxazole tab and Vit.A solution was not

available available at Antichack Sub Centre, whereas Disposal syringes, IUD, Paracetamole

tab and Metronidazol tab were not available at Sadipur HSC.

e) Poster for public awareness was not displayed at any visited Sub Centre.

f) SBA training was not received by the ANM of all visited Sub Centres.

g) No supervision was dpne during last three month in any of the visited Sub Centres.

8. Community Satisfaction and Opinion on Health Services:-

I. Towards HSCs services

a) The interviewed mothers of visited HSCs informed that ANMs were available when needed

and also conducted immunisation clinics in the villages. ANMs also provided IFA and TT to

pregnant women in time.

b) It was reported to the team that home deliveries were being conducted by trained person

using DDK but service quality of ANC & PNC should be increased.

c) Most of Mothers had no idea about ARI.

II. Towards Medical officer:

Interviewed villagers informed that the services at visited PHCs are satisfactory. PHC MOs

and staff are regularly available in the centre for treatment of patients and drugs are provided

to them in the PHCs. It was found that MO of Navgachhiya and Kahalgaon PHCs visit their

villages on regular basis but MO of Pirpaiti PHCs and Navgachhiya SDH do not visit their

villages regularly.

9. Sample Verification of Family Welfare Acceptors:

a) The team selected 150 Family Welfare acceptors (Sterilization, IUD, OP and Nirodh) out of

which 48 (32%) acceptors could be contacted for sample verification in the district. It is a

matter of concern that as many as 70 (47%) acceptors could not be contacted due to

wrong/incomplete addresses. During sample check, age of spouse of the acceptors in 20 and

age of last child in 21 contacted cases was found to be wrongly recorded.

b) Out of 22 genuine cases, 10 (45%) acceptors were not provided follow-up services. 19

(96%) sterilization accepters were received full amount of compensation money where as 1

(4%) acceptor showed ignorance about the compensation amount.

c) It was also found that of the 28 contacted acceptors of spacing methods (Cu-T-15 and OP-

13) as many as 26 (15 Cu-T acceptors and 11 OP users) did not receive any service in this

regard.

d) Out of selected 25 beneficiaries of child immunization, not a single beneficiary could be

contacted due to wrong/incomplete address.

10. Reconciliation of Reported Performance:-

148

There was no coordination between District office and reporting centres in respect of

performance reported for the same figures in the year 2010-11 and 2011-12 (up to Dec,

2011) The details are as follows:

i) 374 Sterilization, 454 IUDs, 1073 OPs and 7916 Nirodhs were reported by PHC

Naugachhiya for the year 2010-11 whereas these figures shown in the report of district office

was 556, 434, 644 and 1645 respectively for the same period.

ii) 437 Sterilization cases were reported by SDH Naugachhiya for the year 2010-11 whereas

these figures shown in the report of district office as 421 for the same period.

iii) 1068 Sterilization, 177 IUDs, 910 OPs and 2105 Nirodhs were reported by PHC

Kahalgaon for the year 2010-11 whereas these figures shown in the report of district office as

2767, 339, 1567 and 12180 respectively for the same period.

iv) 1526 Sterilization and 293 IUD cases were reported by PHC Pirpaiti for the year 2010-11

whereas these figures shownin the report of district office as 1838 and 403 respectively for

the same period.

v) 9, 241, 265 and 595 sterilization cases were reported by PHC Navgachhiya, SDH

Navgachhiya, PHC Kahalgaon and PHC Pirpaiti for the year 2011-12 (Up to Dec, 11)

whereas these figures shown in the report of district office as 318, 245, 455 and 307

respectively for the same period.

vi) 306 and 462 IUD cases were reported by PHC Kahalgaon and PHC Pirpaiti for the year

2011-12 (Up to Dec, 11) whereas these figures shown in the report of district office as 344

and 505 respectively for the same period.

vii) 615 and 2300 OP cycles/user were reported by PHC Kahalgaon and Pirpaiti for the year

2011-12 (up to Decr, 2011) whereas these figure shown in the report of district office as 4779

and 3402 respectively for the same period.

viii) 1720 and 26140 Nirodh pieces/users were reported by PHC Kahalgaon and Pirpaiti for

the year 2011-12 (up to Decr, 2011) whereas these figure shown in the report of district office

as 10782 and 25158 respectively for the same period.

11. Information on IT Infrastructure and MCH Tracking System:-

a) Computer with Internet connection was available at District Office, BPHCs and PHCs.

b) MCH tracking formats was available at Sub Centre level. Health functionaries of District

Office, BPHCs, PHCs and Sub Centres were sensitized in MCH formats.

c) Data was being capturing in MCH formats and found to be completed during visit of the

team.

d) Data entry was being made by District office, BPHCs and PHCs and also through NIC.

12. Maintenance of Register & Records:-

a) Eligible Couple & Child Register could not be verified at the selected institution as the

registers were not maintained by the centres.

149

b) No register was available at Ghogha and Sadipur SCs whereas Family planning service

register, Stock register, Cash book of untied fund and mother & child tracking formats

/registers were not available at Antichack Sub Centre.

c) Sterilization Register was maintained properly at Kahalgaon and Pirpaiti PHCs but the

same was not maintained properly and up to date at Navgachhiya PHC and SDH

Navgachhiya.

d) IUD Register was not maintained properly at Navgachhiya and Pirpaiti PHCs and the

same was not made available at Kahalgaon PHC and SDH Navgachhiya.

e) OP & CC distribution registers were not maintained properly at Navgachhiya, Pirpaiti and

Kahalgaon PHCs.

f) No prescribed Performa was maintained in respect of Cu-T, OP & Nirodh services and also

for ANC/PNC registers in the visited institutions in the district.

g) ANC, PNC & Child Immunization Registers were maintained properly at Pirpaiti PHC but

not maintained at SDH Naugachhiya. ANC & PNC register were not maintained properly at

Naugachhiya PHC whereas this register was not available at Kahalgaon PHC but

Immunization Register was maintained properly at both PHCs.

h) Stock Register was not maintained properly at Kahalgaon and Pirpaiti PHCs whereas the

same was not available at Naugachhiya PHC and Navgachhiya SDH.

13. Other Observations:-

a) The financial and physical progress report under various components of NRHM such as

RKS, Untied Fund, Annual Maintenance grant, VHSNCs, JSY and ASHA for Sub Centre,

PHCs and CHCs was not given by the District Programme Management Unit of the district for

2010-11 and 2011-12 (up to Dec,11) to the team.

b) The condition of Labour Rooms and Maternity Wards of SDH Naugachhiya and Pirpaiti

PHC was found to be very poor and unhygienic. It was observed that there was no restriction

for general public/family members to enter Labour Rooms which is a matter of deep concern.

c) Distribution of OP and Nirodh under F.W programme at SC level was very poor. The team

could not select the OP/Nirodh samples for field verification due to non availability of records

of FW acceptors at the visited centres.

d) ANMs and Medical Officers were found to have not submitted their monthly performance

report in HIMS format in time. This may be regularised.

.

************

150

8. District:- Shekhpura

Major observations of Regional Evaluation Team (RET), Patna on the evaluation work carried

out in Shekhpura District of Bihar State in the month of March, 2012.

I. Details of the visited Institutions:

District visited PHCs visited HSCs visited

Shekhpura Chewara, Ghatkusumbha, Ariyari and Shekhpura

Andaulo, Ghatkusumbha(HQ), Panwar, Chorwar Hasangarh and Dilkusumba

II. Major Observations: 1. Human Resources:-

The Staff position in the key categories in the district was as follow:

Names of the Posts Post sanctioned In position Vacant

Medical Officer 43 25 18

LHV/HS(F) 16 5 11

Lab Technician 8 6 2

ANMs 112 104 8

MPW(M) 7 3 4

GNM 6 1 5

The district may fill up the vacant post urgently.

2. Rogi Kalyan Samiti (RKS) & Village Health Sanitation and Nutrition Committee

(VHSNC):-

a) Rogi Kalyan Samitis have been constituted in 7 institutions in the district. RKS were

registered in 1 DH and 6 PHCs. Regular meetings of the RKS were not being conducted in

the visited institutions.

b) As reported, sufficient RKS Fund was available in the district and Rs.7, 99,897 in the year

2010-11 and Rs.1, 82, 20,881 during 2011-12 had been utilized under this head.

c) It was reported that 54 VHSNCs were functioning in the district. The district had utilised the

VHSNC fund to the tune of Rs.24, 03,750 in the year 2010-11 and Rs. 23, 14,000 during the

year 2011-12.

3. Services under Janani Suraksha Yojana (JSY):-

a) Mothers in rural and urban areas were being covered under Janani Suraksha Yojana in

the district. It was reported that the district had sufficient budget to meet the total expenditure

under this head.

b) 16 JSY beneficiaries during field verification could be contacted by the team in the area of

the visited centres. All beneficiaries were found to be satisfied with the services. Beneficiaries

151

were mostly accompanied by ASHAs to the hospitals and JSY Packages were provided

timely to the beneficiaries.

c) JSY Cards and Immunization Cards were not completed by the concerned ANMs in the

visited area. It was also observed that some of the mothers had not received three

consecutive checks up during AN period. Post Natal visit was also poor.

d) Records and registers of JSY were not being checked frequently by concerned MOs and

Supervisory staff.

f. 4. Functioning of ASHA:-

a) It was reported that 361 ASHAs were working out of 363 ASHAs selected, through the

target set was 409 in the district. The ASHAs were not adequately trained but Drug Kit was

provided to all 361 ASHAs.

b) The district had spent Rs. 20, 86, 378 in the year 2010-11 and Rs.7, 49,814 in the year

2011-12 under this head.

5. Untied Funds and Annual Maintenance Grant:- a) It was reported that the district had spent Rs. 5, 05,717 in the year 2010-11 and Rs. 8,

61,000 during 2011-12 as untied fund at SDH, CHCs, PHCs and Sub Centres.

b) In addition to Untied Fund, the district also utilized Rs. 2, 79,754 during 2010-11 and Rs. 2,

56, 993 during 2011-12 as Annual Maintenance Grant at CHCs, PHCs and Sub Centre level.

6. 24 x 7 Hours Delivery Care Services:-

It was reported that 6 institutions were providing 24x7 hours delivery care services in

the district.

7. Physical infrastructure Stock Position:-

i. Health Sub Centres (HSCs):-

a) The team visited Sub centres at Panwar and Dihkusumba. Both centres were

functioning in non-Govt. building .Supply of water, electricity and toilet facility was not

available at both the Sub Centres. Labour room was also not available at both of these

Sub Centres.

b) ANMs of the visited Sub centers were not residing in their head quarter. Also, mobile

phone was not provided to ANMs. Additional ANM and MPW (M) were not posted at both the

centres. Post of MPW (M) was lying vacant since more than 3 years in the visited Sub

Centres.

c) Bench for clients, Examination-table, Cupboard for drugs, Foot stool, Ambu bag/suction,

Delivery table, RDT Kit, Weighing Machine, Thermometer, ORS Packet, DDKs, Misofrostol

tab, Oxitocine tablets, Ampicillin capsule, Gentamycin injection ,Kits- A & B and Condoms

were not available at both the visited sub centres.

. ii. Primary Health Centre (PHC):

152

a) Chewara, Ghat Kusumbha, Ariyari and Shekhpura PHCs were visited to assess the

availability of infrastructure and services etc. All visited PHCs were functioning in Govt.

building with regular water supply (except Ghat Kusumbha), electricity with power back up,

Telephone (except Ghat Kusumbha and Shekhpura) and Toilet facility. Vehicle was available

, is running and regular driver was available only at Chewara and Ariyari PHCs.

b) Stock of Contraceptive, Vaccines vials was generally available at all visited PHCs. IFA

(small Tab/syrup) and Vit. A (tab/syrup) were not available at most of the PHCs visited.

c) Residential accommodation for MO at PHC Ghat Kusmbha was not available.

8. Community Satisfaction on overall Service:-

i. Towards HSCs service:

a) 20 mothers having child up to one year age were contacted in the area of SCs Panwar

and Dhikusumba. Most of contacted mothers replied that ANMs were available as and when

needed. ANC services to the mothers were satisfactory.

b) Use of DDK while conducting home deliveries was found satisfactory. Knowledge about

ARI and check up of mothers during AN and PN periods needed to be enhanced.

ii. Towards PHC Services :-

During field verification, some of the villagers were interviewed. They informed that MO of

PHCs and staffs are regularly available. They spend sufficient time in examining the patients

and they made available medicines .It was observed that Medical Officers of PHCs at

Shekhpura, Chewara, Ghat Kusumbha and Ariyari were not visiting their villages on regular

basis.

9. Sample Verification of Family Welfare Acceptors:-

a) The team selected 102 Family Welfare acceptors (Sterilization, Cu T and OP) out of which

74 (72.6%) acceptors could be contacted for sample verification in the district. Discrepancy

of age of spouse in 68 (91.8%) acceptors and age of last child in 44 (59.4%) cases were

found.

b) A very few Nirodh users were observed in the visited centres.

c) Only 35(48%) contacted acceptors were provided follow up services.

d) 2(18.2%) beneficiaries of child immunization were contacted out of 11 beneficiaries

selected for sample verification. 9 (82%) beneficiaries could not be contacted due to incorrect

address.

10. Reconciliation of Reported Performance:-

a) There was no proper coordination between District office and reporting centres in respect

of performance reported needs to be improved as may be seen for the year 2010-11 and

2011-12.The details are as follows:

153

i)

Name of

PHC

Methods For the year

2010-11 reported

by

For the year

2011-

12 reported by

District

Office

The

Centre

District

Office

The

Centre

1. PHC

Chewara

Sterilisation 244 255 235 193

Cu T 174 564 675 613

2.PHCAriyari Cu T 547 426 528 504

ii)

For the year 2010-11 figures reported differently in

Name of PHC Methods District Office The Centre

Ghat Kusumbha Sterilisation 264 230

For the year 2011-12 figures reported differently.

1. Chewara OP 955 940

Nirodh 11000 2574

2. Ghat

Kusumbha

Cu T 280 272

OP 872 682

b) Performance reported for IUD at visited centres for the year 2010-11 and 2011-12 did not

tally with the figures recorded in service registers, IUD Service Register was not made

available at PHC Ariyari and Sadar PHC Shekhpura against IUD performance reported for

the year 2010-11.

11. Information on IT Infrastructure and MCH Tracking System:-

a) It was reported that the data entry was being done at District Office, BPHC and PHCs by

outsourcing.

b) MCH tracking formats was available at Sub Centre level. Health functionaries of District

Office, BPHC and PHC were sensitized in MCH formats. Data entry was being made at

District, BPHC and PHC level.

12. Maintenance of Registers & Records:-

a) Eligible Couple register was not maintained at all visited institutions.

b) Sterilization register was maintained properly at all visited institutions.

c) IUD Registers were mostly incomplete at all visited PHCs.

d) Immunization register & cards were maintained at all visited PHCs but addresses were not

correct as observed during sample verification.

e) ANC & PNC service register were provided but not maintained at PHCs Chewara and

Shekhpura.

154

f) OP & CC Registers were not maintained at PHCs Chewara and Ghatkusumbha whereas

the same was not updated at Shekpura PHC. OP &CC Register was not available at PHC

Ariyari.

g) Stock Register of IUD and OP were maintained properly at PHC Chewara but not

maintained at PHCs Ghatkusumbha and Ariyari.

13. Other Observations:-

a) Regular supervision at grass root level centres was lacking in the district. Regular meeting

on HMIS should be conducted for improving reporting system in the district. The team

observed that ANMs and Medical Officers were not submitting monthly performances report

timely in HIMS formats.

b) The condition of Labour rooms and Maternity Wards at all PHCs was found very poor and

unhygienic. It was also observed that there was no restriction for general public /staff

members to enter labour rooms, which is important to maintain privacy of mothers and new

born care.

c) The details on the expenditure under UF, VHSNC, ASHA, AMG, JSY and RKS were not

made available to the team as such proper assessment could not be done in the utilisation of

fund in these schemes under NRHM.

*******

9. District:- Nawada

Major observations of Regional Evaluation Team (RET), Patna on the evaluation work carried

out in Nawada District of Bihar State in the month of March, 2012.

I. Details of the visited Institutions:

District visited PHCs visited HSCs visited

Nawada Akberpur, Rajauli, Kasichack

and Kawakol

Pachrukha, Baksanda, Mahinar, Dhomani, Amawar, Patrang, Dhanwar, Purwati, Bhawanibigha, Kawakol(HQ), Bisanpur and Nawadih

II. Major Observations: 1. Human Resources:-

The Staff position of the key technical categories in the district was as follow:

155

Name of the Post Post sanctioned In position Vacant

Medical Officer 249 74 175

LHV/HS(F) 25 14 11

ANMs 433 345 88

MPW(M) 30 19 11

GNM 257 65 192

Lab Technician 54 14 40

The above table shows that the district is facing acute shortage of Medical Officers, LHVs

GNMs, Lab technicians etc..

2. Rogi Kalyan Samiti (RKS) & Village Health Sanitation and Nutrition Committee

(VHSNC):-

a) Rogi Kalyan Samitis have been constituted in 17 institutions in the district .RKS were

registered in 1 DH, 2 SDH and 14 PHCs. Regular meetings of the RKS were not being

conducted in the visited institutions.

b) An amount of Rs. 8, 25, 000 was available for RKS in the district for the year 2010-11, but

no amount was spent up to March, 2011. Similarly, fund to the tune of Rs. 48,58, 333 was

available in the district for the year 2011-12 out of which an amount of Rs. 26,84,669

(55.25%)was spent.

c) 967 Village Health, Sanitation & Nutrition Committees (VHSNCs) have been constituted in

the district.

d) The VHSNC fund to the tune of Rs. 4, 70,000 for the year 2010-11 and Rs. 87, 63,333 was

available for the year 2011-12 in the district. It was reported that the district had spent an

amount of Rs. 85, 80,000 in the year 2010-11 and Rs. 1, 71, 00,000 during 2011-12. The

excess amount of 81, 10,000 in the year 2010-11 and Rs. 83, 36,667 in year 2011-12 were

adjusted from flexi pool fund.

e) During visit to the centres, the team observed that the meetings in the VHSNCs were

being conducted regularly.

3. Service of Janani Suraksha Yojana (JSY):-

a) Janani Suraksha Yojana was being implemented and the district spent Rs. 40,00,000

(95%) out of the available fund of Rs. 42,77,289 during 2010-11.The expenditure was Rs.

2,76,653 (11%) out of available amount of Rs. 35,22,000 during 2011-12 in the district.

b) 11(55%) JSY beneficiaries out of 20 selected could be contacted by the team in the area

of the visited centres during field verification. All beneficiaries were found to be satisfied with

the services. Beneficiaries were mostly accompanied by ASHAs to the hospitals and JSY

Packages were provided timely.

156

c) MCH cards were completed by the concerned ANMs in the visited area. Mostly mothers

received three consecutive checks up during ANC and PNC visits. Records and registers

were not being checked frequently by concerned MOs and supervisory staffs.

4. Functioning of ASHA:-

a) 1774 ASHAs were working out of 1,936 selected ASHAsthrough the district target was

2,001 ASHAs. The number of trained ASHAs in all modules in the district was NIL but Drug

Kits were provided to all 1774 ASHAs.

b) The district had spent Rs.1, 42,719 in the year 2010-11 and 2467881 in the year 2011-12

under this head.

5. Untied Funds and Annual Maintenance Grant:- a) It was reported that no amount was spent out of available Untied Fund of Rs. 2, 34,467 in

the year 2010-11 and only Rs. 4, 13,029 were spent out of available amount of Rs.45,

32,916.66 during 2011-12 from the Flexible Pool Fund in the district.

b) In addition to Untied Fund, the district utilised Rs. 1,29,531(3%) out of its available AMG

of Rs.43,22,120 during 2010-11 but no amount has been spent out of available Amount AMG

of Rs.72,32,500 during 2011-12.

6. 24 x 7 Hours Delivery Care Services:-

As reported, 24x7 hours delivery care service was being provided in 14 institutions in

the district.

7. Physical infrastructure Stock Position:-

i. Health Sub Centres (HSCs):

a) The team visited Sub Centres at Dhomani and Amawar. Both were functioning in Govt.

building but Electricity and toilet facility was not available at both the Sub Centres. Labour

room was also not available at both the Sub Centres. Water facility was only available at

Amawar Sub Centre.

b) ANMs of the visited Sub centers were residing in their head quarter. Mobile phone was not

provided to ANM. Additional ANM and MPW (M) were not available at both the visited Sub

Centers.

c) Delivery table, McIntosh sheet ,Ambu bag/suction, NP test Kit, Delivery Kit,

Haemoglobinometer, DDKs, Sanitary Napkin, Bleaching Powder, Chloroquine

Tab..Mosofrostol Tab., Magsulth Tab., Oxitocine Tab., Ampicilline Capsule, Gentamycin Inj.

Kits-A and B were not available at both the Sub-Centres.

d) PHC or district level officials hardly inspect their SCs for reviewing performances and

availability of equipments and drugs.

ii. Primary Health Centres (PHC):

157

a) Kawakol, Rajauli and Akberpur PHCs were visited to assess the availability of

infrastructure and services etc. All visited PHCs were functioning in Govt. building with

regular water supply, electricity with power back up, Telephone and Toilet facility. Vehicle

along with regular duty driver was available at all PHCs but vehicle was functioning only at

PHC Akberpur. Provision of Petrol/Diesel was insufficient to run the vehicle as stated by the

MOs PHCs.

b) Cold Chain equipments, Weighing machine, Microscope & lab equipment, Oxygen

cylinder, B.P. apparatus, Labour room table& Resuscitation equipment etc. were available at

all visited PHCs. Stock of Contraceptive, Vaccine vials and Prophylactic Drugs was also

available at all the visited PHCs.

c) Stock of IUD, IFA (small) and Vit A was not available on the day of visit at PHCs Rajauli

and Akbarpur.

8. Community Satisfaction on overall Service:-

i. Towards HSCs Services:

a) The team interviewed the villagers of both Dhammi and Amawan SCs. They told that

ANMs were available when needed and conducted immunization session regularly. They

also conducted ANC and Immunization clinics regularly.

b) Use of DDK while conducting home deliveries was found satisfactory. Knowledge about

ARI and check up of mothers during AN and PN periods need to be enhance in the area

visited.

ii. Towards PHC Services:

During field verification, some villagers were interviewed .They informed that MO of PHCs

and staffs are regularly available and they spend sufficient time in the examining of patient

and made medicines are available. It was observed that MOs of visited PHCs were not

visiting their villages on regular basis.

9. Sample Verification of Family Welfare Acceptors:-

a) The team selected 106 Family Welfare acceptors (Sterilization, IUD, OP and Nirodh) out of

which 73 (68.8%) acceptors could be contacted for sample verification in the district

b) 43 (59%) acceptors were found to have not been provided with follow-up services.

Sterilization acceptors mostly confirmed receiving compensation amount.

c) 18 (81.8%) beneficiaries of child immunization were contacted in which all confirmed

receiving the doses and also received follow up services. No complication was found among

contacted beneficiaries and they were satisfied with the services.

10. Reconciliation of Reported Performance:-

There was no proper coordination between district office and reporting centres in respect of

performance reported in the year 2010-11 and 2011-12. The details are as follows:

158

Name of Centre Methods For the year 2010-11 reported by For the year 2011-12 reported by

District Office The Centre District Office The Centre 1. PHC, Akberpur

Sterilization Cu T OP Nirodh

430 434 5536 16547

534 564 4719 31120

207 835 1204 14300

326 1095 1390 19000

2.PHC, Rajauli

Sterilization Cu T OP Nirodh

685 408 608 20002

618 711 337 4027

482 147 1491 4138

609 175 3444 17978

3. PHC Kashichak

Sterilization Cu T OP Nirodh

189 213 1470 3113

Report was not made available at PHC

105 190 1316 2822

159 270 1403 8501

4. PHC Kawakol

Sterilization Cu T OP Nirodh

498 927 3023 15889

Report was not made available at PHC

304 290 3478 14562

515 283 2646 20369

b) Performance reported for all methods at visited centres for the year 2010-11 and 2011-12

did not tally when compared with the figures recorded in registers.

11. Information on IT Infrastructure and MCH Tracking System:-

a) Computer with Internet connection was available at District Office and BPHC only.

b) MCH tracking formats were available at Sub Centre level but not all places. Health

functionaries of District Office and BPHC were sensitized in MCH formats, but the same was

not being done at PHC& Sub Centre level. As observed, data entry was not

completed/updated at District, BPHCs and PHCs.

12. Maintenance of Registers & Records:-

a) Eligible Couple register was not made available at all visited PHCs. This register was not

maintained at Sub Centre level.

b) Sterilization Register was maintained properly and up to date at all visited PHCs except

Kawakol whereas it was not made available.

d) IUD Register was not maintained& updated at all visited PHCs.

e) ANC Register was not maintained & updated at PHCs Kawakol and Akberpur but

maintained & updated at Kasichack PHC, whereas ANC register was not available at PHC

Rajauli. PNC register was not maintained at all visited PHCs & Immunization Register was

maintained properly at all visited PHCs.

f) OP & CC Registers were not maintained at all visited PHCs.

g) Stock Register was not maintained properly and up to date at all visited PHCs except

Kasichack PHC.

h) Immunization Cards and the register were available at the visited PHCs.

159

13. Other Observations:-

a) Supervision with necessary guidance at grass root level centres was lacking in the district.

Regular meeting and monitoring should be improved in the district.

b) The condition of Labour Rooms and Maternity Wards at all visited PHCs was found very

poor and unhygienic. It was also observed that there was no restriction for general

public/staff members to enter Labour Rooms which is important to maintain privacy of

mothers and born care.

c) PHC or district level officials hardly inspect their SCs for reviewing performances and

facilities for providing guidance to the field functionaries.

*********

160

Chattisgarh

1. District:- Mahasamund The Regional Evaluation Team, located at Regional Office for Health and Family Welfare

(Bhopal), Ministry of Health and Family Welfare, Government of India carried out sample

checks of activities covered under NRHM / RCH in Mahasamund district of Chhattisgarh

during May, 2011. The findings / observations of the team which are based on the sample

checks are detailed below:

I. Details of the visited Institutions:

District CHCs/PHCs visited HSCs visited

Mahasamund

CHC: Bagbahara & Basana. PHC: Kallari, Komakhan & Baroli

Pandaripani, Narra, Bindrawan, Khuteri, Khallari, Badetemari, Singh-anpur, Garhphuljgar & Bade-dhaba.

II. Major Observations: 1. Human Resources:

Staff position in the key posts was not satisfactory in the district. In this connection status of human resources at various level as reported is given below:

a)

Particulars of Post Post sanctioned In position Vacant

Specialist 28 11 17

MO 86 49 37

Staff Nurse 34 18 16

Lab Technician 34 8 26

LHTV 44 19 25

MPS 40 17 23

ANMs 251 222 29

MPW(M) 223 113 110

b) In District Hospital, 2 sanctioned posts of Surgical Specialist and Anaesthetist were

vacant. 10 out of 22 sanctioned posts of Casualty Doctors/GDM, 14 out of 22 sanctioned post

of Staff Nurse and post of Radiographer and Pharmacist were also lying vacant.

c) At visited CHCs Baghbara and Basna, posts of Surgeon, Gynaecologist, paediatrician,

BMO & Anaesthesia (PGMO) were lying vacant. Posts of Medical Specialist was vacant in

CHC Bagbahara.

161

d) In PHC Baroli, post of Lab. Tech., Ophthalmic Asstt. and one of the 2 sanctioned posts of

Medical Officer were lying vacant. Likewise, the post of Lab. Technician and Ophthalmic

Asstt were vacant in the Khallari PHC.

2. Rogi Kalyan Samiti (RKS) and Village Health Sanitation and Nutrition Committee (VHSNC): a) Rogi Kalyan Samiti, known as Jeewan Deep Samitis (JDS) in the State are reported to be

constituted at the DH / CHCs / PHCs in the district. 32 Jeewan Deep Samitis (JDS) have

been registered in 4 CHCs, 27 PHCs and District Hospital in the district.

b) As reported, funds to the tune of @ Rs. 5, 00,000 to DH and @ Rs. 1, 00,000 to each

CHC & PHC were provided as JDS fund in the district in the year 2010-11.

c) It was observed that unspent balances were not taken into account while allocating funds

and proper monitoring was not being made for utilisation of funds. Though huge amount of

unspent balance was lying with 26 JDS at DH, CHCs and PHCs as on 1-4-2010, full eligible

amount was provided to every JDS during 2010-11. 29 JDS did not spend most of the

amount during the year. 20 JDS were having balance in between Rs. 1,00,000 to 2,00,000, 4

JDS more than Rs. 2,00,000, 2 JDS more than Rs. 3,00,000 and JDS at DH has an unspent

balance of Rs. 5,00,000 at the end of the year. It was also reported that 7 PHCs did not incur

any expenditure during the period. The State/District authority should take urgent step to

improve the situation.

d) 1078 VHSNCs were functioning in 1142 villages with ASHA as a member in the district.

Block Basana is the only block in the district in which all 226 villages were having VHSNCs.

All VHSNCs had opened their bank account for handling the funds.

3. 24 x7 Hours Delivery Care System: a) It was reported that 11 PHCs have been identified for providing 24 x7 hours delivery care

service in the district, but all of them were non functional.

b) During visit, it was observed that PHCs at Khalari, Komakhan and Baroli are providing the

24 x 7 hours services but there was no new born care facility available at PHC Komakhan.

PHC Baroli provides this service on call.

4. Janani Suraksha Yojana (JSY): a) The district had spent funds to the tune of Rs.1,85,50,900 out of funds of Rs. 2,95,54,083

provided in the year 2009-10 under JSY head. Similarly, an amount of Rs. 2,05,68,763 was

spent out of total allotted funds of Rs. 3,35,94,183 during 2010-11.

b) JSY status in the district and visited CHCs as reported is as under:

162

(Amount in Rs.)

Particulars

District as a whole CHCs

Bagbahara Basana 2009-10 2010-11 2009-10 2010-11 2009-10 2010-11

Total no. of Institutional deliveries conducted

11411

13401

520 566 430 330

Total no. of delivery eligible for JSY

10095

12109

520 566 430 330

Total no. of beneficiaries to whom incentive was paid

10095

11919

520 566 430 330

Total fund received for JSY

29554083 33594183 33,00,000 42,00,000 Information not available

Expenditure incurred Under JSY

1,85,50,900

20568763

24,50,500 37,75,200

d) JSY status in the visited PHCs is given below: (Amount in Rs.)

Particulars

PHCs Khallari Komakhan Baroli

2009-10 2010-11 2011-12 April’11

2009-10 2010-11 2011-12 April’11

2010-11 2011-12 April’11

Total no. of Institutional deliveries conducted

35 61 7 206 207 11 209 16

Total no. of beneficiaries to whom incentive was paid

35 61 6 206 207 11 206 15

Total fund received for JSY

NA 1,55,000 30,000 8,60,000 9,84,000 Information not available

Expenditure incurred under JSY

NA 1,04,900 9,650 8,03,500 9,35,502

c) In the visited Sub Centres, ANMs receive advance cash in respect of JSY mothers from

their respective PHCs and distribute same to the eligible JSY beneficiaries in their areas.

d) Total 45 (90%) beneficiaries were contacted out of 50 selected for sample verification. All

beneficiaries were satisfied with the services. 42 (93%) JSY beneficiaries were accompanied

by ASHA/Dai for delivery. 42 (93%) beneficiaries got three Ante natal checkups (ANC) and

30 (66.7%) beneficiaries got three Post natal checkups (PNC).

5. Implementation of ASHA Scheme: a) As reported, 2007 ASHAs were working in total 1142 villages in the district. All 2007

ASHAs were trained in 5th module and also having drug kits in the district.

b) During visit to the CHCs and Sub Centres, it was observed that every village was having 1

to 3 ASHAs in their areas and all were in position. ASHAs were accompanying the mothers

for delivery purpose, helping ANMs during immunization sessions, assisting in ANC/PNC and

also motivating the eligible couple for sterilization operations.

c) The following observations in respect of ASHAs reported by the team: In SC Narra, ASHA was not working and most of the time not residing in village.

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In SC Khuteri, Smt. Sarojbai, ASHA of Dumarpada village was not working at all and

also not interested to work. Smt. Manabai, ASHA of Dumarpada was not residing in

Dumarpada village. Most of the time she is residing at Mahasamund which is away

from Dumarpada. It is found that she is not working but forcefully taking motivation

amount. Smt. Triveni, ASHA of Ghuchpali village was not working.

In SC Khallari, Smt. Yadbai, ASHA of Kanharpuri went for Bricks Bhatta work since 6-

7 months. Smt. Kejabai, ASHA of Kanharpuri village is 67 years old and found not

working. Smt. Devika Thakur, ASHA of Khallari village was not working because she

engages herself in other work.

6. Untied funds: a) There was no proper planning observed to utilise the fund under this head at different

institutions in the district. Situation was similar, as in the case of utilization of JDS funds in the

district. It was reported that there was huge unspent balance as on 1/04/2010 due to non

utilisation of untied funds at CHCs, PHCs and Sub Centres level in the year 2009-10. All 4

CHCs were having balance of the amount in between Rs. 30,000 and 55,000, all 27 PHCs in

between Rs. 22,000 and 45,000 and visited 9 Sub Centres in between Rs. 18,000 and Rs.

35,000 as on 1/04/2010.

b) Though the district authority did not provide untied funds to the CHCs, PHCs and Sub

Centres during the year 2010-11 as sufficient unspent (previous) balance was there at almost

all the institutions, but there was no proper planning to utilise the amount during the year

2010-11. It was observed that CHC, Saraipali had balance of Rs. 44, 000, 10 PHCs had

balance in the range of Rs. 15,000 to Rs. 40,000 and visited 6 Sub Centres had balances

between Rs. 24,000 to Rs. 27,000 as on 1/4/2011. It is notable that there are 3 PHCs with 0

(zero) balance whereas another 3 PHCs had not utilised any amount during the year against

the amount of previous balance shown as on 1/4/2010. Similarly, Sub Centre Badetemari had

also not utilised any amount during the year 2010-11 from the previous unspent balance of

Rs. 27,868 available as on 1/4/2010. The State/District authority may take urgent step to

improve and monitor the situation in this regard regularly.

c) No untied funds have been released to the CHCs, PHCs and Sub Centres in the district

for the year 2011-12 till the month of visit.

7. Physical infrastructure: i) CHCs: a) Both visited CHCs Basana and Bagbahara were functioning in govt. buildings having 30

beds each. The premises of CHCs were found clean and tidy. Water supply and electricity

with power back-up were available at both visited CHCs.

b) Anaesthesia equipment, Resuscitation equipment and neonatal Resuscitation equipment

were not available at Basana CHC. Incinerator was not available at both CHCs.

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c) Blood Storage Unit was not available at Basana CHC but the same was available in non

functional condition at Bagbahara CHC. The Sick New Born Care Unit was not available at

Bagbahara CHC, only one warmer was available there. Arteether injection was not available

at both CHC whereas Quinine injection was not available at Bagbahara CHC.

ii) PHCs:

a) Visited PHCs at Khallari, Komakhan and Baroli were functioning in Government building.

Water supply and Electricity connection was available in the PHCs. Power backup was not

available at Khallari PHC. Telephone facilities were available only at Baroli PHC but that also

was out of working condition. Ambulance/Jeep was not available in all the visited PHCs.

b) Cold Chain equipment, Microscope and Resuscitation equipment was not available at

Baroli PHC. Autoclave/Steam Sterilizer was not available at Khallari PHC. Oxygen Cylinder

was not available at Khallari and Baroli PHCs. Operation Theatre was not functional at

Khallari and Komakhan PHCs.

c) The Stock of Contraceptives (IUD, OP and Nirodh) was not available in Khallari and

Komakhan PHCs. The stocks of vaccines (BCG, DPT, OPV, Measles, DT, and TT) were not

available at Khallari and Baroli PHCs; The Prophylactic drugs-IFA tab large were not

available in all the visited PHCs; IFA small and IFA syrup was not available at Komakhan

and Baroli PHCs, Vitamin A Tab and Vitamin A syrup were not available in Khallari and Baroli

PHCs.

d) Medical Officer (AYUSH) was not posted in any of the visited PHCs.

e) Residential quarters for Medical officers were not available at Komakhan PHCs.

iii) Sub Centres: a) All the visited Sub Centres were functioning in Govt. buildings. ANMs of all visited Sub

Centres except Badetemari HSC were residing either in Sub Centre building or in the Sub

Centre villages. Mobile was not provided to any ANM of the visited Sub Centres.

b) Additional ANM were available only at Bindrawan, Badedhaba and Khuteri Sub Centres

whereas MPW (M) was available at the visited Sub Centres except Pandripani and

Singanpur Sub Centre.

c) Water supply facility was not available at Badetemari, Badedhaba and Khuteri SCs.

Electricity connection was available in all the visited Sub Centres. Labour rooms were

available and deliveries were conducted in all visited Sub Centres except Badetemari SC.

d) Examination table was not available at Bindrawan, Badetemari, Badedhaba and Khallari

SCs. McIntosh sheet was not available at Pandripani and Singhanpur SCs. Ambubag

/suction was available in all the visited Sub Centres except Singhanpur and Khuteri SCs.

Nishchay Pregnancy Test Kit was not available at all visited Sub Centres except Khallari SC.

Delivery kit was not available at Bindrawan, Badetemari Badedhaba and Khallari Sub Centre.

IUD Insertion Kit was not available at Badedhaba HSC. Rapid Diagnosis Test kit for Malaria

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was not available at all the visited HSCs. Torch was not available in Badetemari, Khuteri and

Khallari SCs. Hemoglobinmeter was not available at Badetemari and Singhanpur HSC.

e) Gloves were not available at most of the visited Sub Centres, it was available only at

Singhanpur and Badedhaba Sub Centres. DDKs, Kerosene Oil, Sanitary Napkins,

Emergency Contraceptive Pills, Tab. Oxytocin, Cap Ampicillin (except Bindrawan HSC), Inj.

Gentamicin and Kits A & B for the year 2011-12 were not available in all the visited Sub

Centres. Tab Co-trimoxazole was not available at Pandripani HSC. IFA tab / syrup was

available only at HSCs Pandripani and Badedhaba. Oral Pills were not available at

Badetemari, Singhanpur, Khuteri and Khallari SCs. Condoms was not available at

Bindrawan, Badetemari, Singhanpur, Badedhaba, Khallari and Garhphuljhar HSC. Antiseptic

Solution was available only at Narra, Singhanpur and Badedhaba HSC. Chlorine solution

was not available at Narra, Badetemari and Khallari HSCs. Tab Metronidazole was not

available at Pandripani, Narra and Bindrawan HSCs.

f) Printed register for family planning service was not available at the visited Sub Centres.

Stock register was not available at Narra, Badedhaba, Khallari and Garhphuljhar HSCs.

Printed cash book of untied fund was available only at Badedhaba HSC.

g) The posters for public awareness were not displayed at the Sub Centres Pandripani,

Narra, Khuteri, Khallari and Garhphuljhar HSCs.

h) SBA training was not received by the ANMs of Narra, Bindrawan, Badetemari, Singhanpur,

Badedhaba and Garhphuljhar HSC.

i) ANMs of all 9 visited Sub Centres did not receive the training of Integrated Management of

Neonatal and child infection (IMNCI).

8. Opinion and Knowledge of Community on Health Services: a) As many as 57 mothers having child up to one year old were interviewed in the area of

the visited Sub Centres for assessing the work of ANM and Knowledge & Opinion of mothers.

b) 35 (61.4%) mothers informed that ANM is available when needed. 55 (96.5%) mothers

were counselled for exclusive breast feeding and complementary feeds. 26 (45.6%) mothers

received three post natal checkups. 30 (52.6%) mothers knew the danger sign of ARI. 44

(77.2%) mothers knew the use of ORS packets during diarrhoea. 35 (61.4%) mothers were

aware of contraceptive methods.

c) Out of 9 visited Sub Centres, MPW (M) was posted in 7 Sub Centres. After having

elaborate discussions with teacher, sarpanch, CC users, ASHA and villagers, it was learnt

that most of the male workers do not take rounds to the villages for field work regularly, but

behaviour of most of them towards the villagers was good. All workers attended the health

clinic/immunization/VHNDS session and all were available when health programmes were

organized in the villages.

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d) During the course of visit to PHC Khallari, Komakhan and Baroli, it was observed that the

community was satisfied with the services received from staff and Medical Officers of the

PHCs. Some of the villagers confirmed the availability of MO at HQ.

9. Sample Verification of F.W. Beneficiaries: a) 232 Family Welfare beneficiaries were selected in the visited Centres for sample

verification and out of them 173 (74.6%) could be contacted in the district. Minor

discrepancies were found in the age of children, age of spouse, no. of Male/female children

and age of youngest child were not recorded.

b) 32 (23.4%) beneficiaries of FW acceptors did not receive follow up services.

c) Out of contacted 126 spacing methods acceptors, 36 (28.6%) acceptors were found to be false in the district. d) All 129 contacted beneficiaries of child immunization confirmed receiving the vaccination

and there was no complications after receiving the services; however follow up services were

provided only to 72 (55.81%) beneficiaries.

10. IT Infrastructure & MCH Tracking: a) Computers were available at the district headquarters, CHCs and 10 out of 28 PHCs in

the district.

b) Internet connectivity was provided to the systems available in the district and at all CHCs

but the same is not available at PHC level.

c) It was reported that in the visited CHCs Bagbahara and Basana, all Sub Centres were

having MCH Tracking formats. Data Entry was in progress at CHC/PHC level and online data

entry of MCH tracking formats in the district was up-to-date till the visiting month.

11. Maintenance of Records and Registers: a) Service Register for IUD was not maintained in both the visited CHCs at Baghbahara &

Basana. PNC registers was not maintained in CHC Baghbahara.

b) OP and CC registers were not maintained properly in Baghbahara CHC.

c) Printed registers for eligible couple were not available at Badetemri Sub Centre whereas

this register was not updated in Badedhaba Sub Centre.

d) IUD register for the year 2008-09, OP register for the year 2008-10 and CC register for the

year 2008 to 2011 were not maintained at Pandripani HSC. OP register for the year 2010-11

was not maintained at Khutheri HSC. Name of the users except other details were given in

OP registers at Singhanpur HSC. Some of the visited HSCs, OP & CC registers were

maintained but some information like age of spouse, age of last child and no. of

male/female child was not mentioned in the service registers.

e) ANC, PNC and Immunisation service register were maintained in all the visited Sub

Centres.

f) JSY register was maintained properly in all visited Sub-Centres except Badetemri HSC

where information was recorded in delivery register.

g) Cash book for untied funds was not maintained properly at Bindrawan HSC.

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2. District:- Sarguja (Ambikapur)

The Regional Evaluation Team, located at Regional Office for Health and Family Welfare

(Bhopal), Ministry of Health and Family Welfare, Government of India carried out sample

checks of activities covered under NRHM / RCH in Surguja( Ambikapur) district of

Chhattisgarh during May, 2011. The findings / observations of the team which are based on

the sample checks are detailed below:

I. Details of the visited Institutions:

District CHCs/PHCs visited HSCs visited Surguja ( Ambikapur)

CHC: Sitapur, Rajpur, Pratappur & Balrampur.

PHC: Barion, Dharampur, Pratapgarh, Guturma & Pasta.

Soor, Guturma, Ulakiya, Narsinghpur, Okara, BoodhaBagicha, Badwar, Parsaguda, Ramkola, Mayapur & Kewara.

II. Major Observations: 1. Human Resources;

a. The Staff position of the key posts in the district was reported as follow:

Particulars of Post Post sanction

In position Vacant

Specialist 97 9 88

M.O 225 73 152

Staff Nurse 57 52 05

Lab Technician 103 47 56

LHV 123 87 36

ANMs 696 640 56 MPW(M) 612 447 165

b) In the District Hospital, sanctioned post each of Orthopaedic and Dental Surgeon and 3

out of 4 sanctioned post of Lab Attendant were lying vacant.

c) At CHC level, the sanctioned post of Block Medical Officer, Medical Specialist, Nursing

Sister, BEE, 1 out of 4 Staff Nurse and 1 out of 2 Pharmacist grade -II cum Store Keeper

were laying vacant at Sitapur CHC. Post of Block Medical Officer, BEE, MPW (M) and 1 out

of 2 Assistant Surgeon grade -II were vacant at Rajpur CHC. Post of Block Medical Officer,

Medical Specialist, Surgical Specialist, O B & G, Anaesthetist PGMO, Assistant Surgeon,

Nursing Sister, BEE, Accountant / Assistant, MPS and Pharmacist grade -II cum Store

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Keeper were vacant at Pratappur CHC. Post of Medical Specialist, Surgical Specialist, OB &

G, Anesthetist PGMO, BEE, MPS and MPW (M) were vacant at Balrampur CHC.

d) At PHC level, the sanctioned posts of Medical Officer and LT were vacant at Barion PHC.

Post of Medical Officer was vacant at Dharampur PHC. Post of Staff Nurse was vacant at

Pratapgarh PHC and post of Staff Nurse was vacant at Guturma PHC. Post of Pharmacist

was vacant in Pasta PHC.

2. Functioning of Rogi Kalyan Samiti (RKS) and Village Health Sanitation & Nutrition Committee (VHSNC):

a) Rogi Kalyan Samiti, known as Jeewan Deep Samiti (JDS) in the State has reported to be

constituted at the DH / CHCs / PHCs in the district. 96 Jeewan Deep Samitis (JDS) have

been registered in 19 CHCs, 76 PHCs and District Hospital in the district.

b) As per the details available from DPMU, CHCs visited at Sitapur, Balrampur, Pratappur

and Rajpur have been provided @ Rs.1,00,000 each respectively as JDS funds. Similarly,

PHCs visited at Barion, Dharampur, Pratapgarh, Guturma & Pasta were provided

Rs.1,00,000 each for the year 2009-10 as JDS fund. No JDS fund for the year 2010-11 have

been released to the PHCs till the visit of the team.

c) Information on expenditure of JDS funds was not provided by the DPMU, BMO and

concerned Medical Officer.

d) As per the reports received from the district, 1758 villages out of total 1779 villages in the

district were covered under the scheme and all 1758 VHSNCs were functioning with ASHA

as a member in the district. All VHSNCs had opened their bank account for handling the

funds.

3. 24 x 7 hours Delivery Care System: Total 39 institutions were providing 24 x 7 hours delivery care service in the district. Adequate

facilities for caring mother and new born baby were available at CHC Rajpur and Sitapur.

But these facilities were not available at CHC Balrampur, CHC Pratappur, PHC Bariyon and

PHC Guturma.

4. Janani Suraksha Yojana (JSY): a) The district had spent funds to the tune of Rs. 3, 75, 93,050 out of funds of Rs. 6, 55,

21,145 provided in the year 2009-10 under JSY head. Similarly, an amount of Rs. 6, 75,

35,301 was spent out of total allotted funds of Rs. 4, 00, 00,000 during 2010-11. During the

year 2009-10 and 2010-11, there were 27,366 and 39,756 JSY beneficiaries respectively.

b) JSY status in the District Hospital is as under.

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(Amount in Rs.)

Items 2009-10 2010-11

Total No. of Delivery 64,342 65,995

Total No. of inst. Delivery 22,776 33,697

Total No. of beneficiaries to whom JSY money paid

27,366 39,756

Total JSY funds received 6,55,21,145 4,00,00,000

Expenditure incurred under JSY 3,75,93,050 6,75,35,301

c) JSY status in the visited CHCs is reported as follow: (Amount in Rs.)

Items CHC Sitapur CHC Rajpur CHC Balrampur

2009-10 2010-11 2009-10 2010-11 2009-10 2010-11

Total No. of Delivery 1298 1499 2737 2762 1724 2169

Total No. of inst. Delivery 1161 1368 1032 1637 796 1200

Total No. of beneficiaries to

whom JSY money paid

1161 1368 1032 1369 796 1200

Total JSY funds received 2836400 2676900 2617900 3122900 1952500 2834500

Expenditure incurred under

JSY

2247300 2642200 2446000 3037050 1592000 2400000

d) JSY status in the visited PHCs is reported as under:

Items Name of the PHCs visited

Barion Dharampur Pratapgarh Guturma Pasta

2010-11 2011-12 2010-11

2011-12 2010-11

2011-12 2010-11 2011-12 2010-11 2011-12

Total No. of inst. delivery

121 10 78 4 40 3 69 4 60 3

Total No. of beneficiaries to

whom JSY

money paid

121 7 78 3 36 0 64 0 60 3

Financial details were not made available at the visited PHCs

e) Total 21 (80.8%) beneficiaries were contacted out of 26 selected cases for JSY. All

beneficiaries were satisfied with the services. All beneficiaries received T.T & IFA tablet

during pregnancy. 19 (90.5%) beneficiaries were accompanied by ASHA / Dai. 15 (71.4%)

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beneficiaries got three Ante natal checkups (ANC) and 13 (61.9%) beneficiaries got three

Post natal checkups (PNC).

5. Implementation of ASHA Scheme: a) As reported 8259 ASHAs were working in total 1779 villages in the district. All 8259

ASHAs were trained in 5th module and also having drug kits in the district.

b) During visit to the CHCs and Sub Centres, it was observed that every village was having 2

or more ASHAs according to the population size and all were in position in their jurisdiction.

ASHAs were accompanying the mothers for delivery purpose, helping ANMs during

immunization, assisting in ANC/PNC and also motivating the eligible couples for sterilization

operations.

6. Untied funds: a) There was no uniformity in providing untied funds to CHCs / PHCs in the district. During

2009-10 Rs. 50,000 was provided to CHCs Rajpur and Sitapur whereas Rs.1,00,000 to CHC

Balrampur. PHCs under Rajpur and Sitapur CHCs were provided @ Rs. 25,000 but PHCs

under Balrampur CHC were given @ Rs. 50,000.

b) Most of all visited CHCs and PHCs except CHC Sitapur spent their whole fund during

2009-10. CHC Sitapur did not incur any expenditure during the year.

c) Untied Fund for the years 2010-11 and 2011-12 was not provided to any CHC and PHC

in the district till the visiting month.

7. Physical infrastructure:

i) CHCs: a) All four visited CHCs (Sitapur, Pratappur, Rajpur and Balrampur) were functioning in govt.

buildings with regular water supply and electricity with power back-up. Out of 30 sanctioned

beds, 30, 10, 15 & 10 beds were available in good condition at Sitapur, Pratappur, Rajpur

and Balrampur CHCs respectively.

b) Blood Storage Unit and Anaesthesia equipment was not available at Pratappur and

Balrampur CHCs. Neonatal Resuscitation equipment was not available at Pratappur CHC.

The Sick New Born Care Unit was not available at Sitapur and Pratappur CHCs whereas only

one warmer was available at Balrampur CHC. Arteether injection was not available at any of

the visited CHCs. Quinine injection was not available at Balrampur CHC. Infrastructure and

equipment was not as per IPHS standard in the CHCs.

c) Posts of Specialist were vacant in Pratappur and Balrampur CHCs whereas out of 5

sanctioned posts 3 Specialists were posted at Sitapur CHC.

ii) PHCs: a) Visited PHCs Barion, Dharampur, Guturma and Pratapgarh were functioning in

Government building but PHC Pasta was working in Panchayat building. Water supply was

available at Barion and Dharampur PHCs but not at Pasta, Guturma and Pratapgarh PHCs.

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Power backup was not in working condition at Guturma and Pratapgarh PHCs. Telephone

was not working at Guturma PHCs. Ambulance/Jeep was not available at all the visited

PHCs.

b) Cold Chain equipment was not available at Dharampur, Guturma and Pratapgarh PHCs.

Weighing machine for Infant and Auto clave/Steam Sterilizer were not available at Guturma

PHC. Microscope was not available at Barion PHC. Oxygen cylinder was not available at

Guturma and Pratapgarh PHC. Resuscitation equipment was not available at Dharampur,

Pasta and Guturma PHCs. Post of Lab Technician was laying vacant at Barion PHC.

Functional Operation theatres were not available at all the visited PHCs except Barion PHC

where Minor OT was available.

c) The Stock of Contraceptives (IUD, OP and Nirodh) were not available in Pratapgarh PHC.

The stocks of vaccines (BCG, DPT, OPV, Measles, DT and TT) were not available at

Dharampur, Guturma and Pratapgarh PHCs. The Prophylactic drugs were available only at

Barion and Pasta PHCs whereas only IFA tab (Large & Small) was available in Dharampur

PHC and only IFA syrup was available in Guturma PHC

d) Medical Officers (AYUSH) was not posted in Pratapgarh PHC.

e) Residential quarters for Medical officers were not available at Dharampur and Guturma

PHCs.

iii) Sub Centres: a) Visited Sub Centres Soor, Guturma, Narsinghpur, Bodha Bagicha, Badwar, Parsaguda,

and Kewara were functioning in Govt. building and Sub Centres Ulakiya, Okara, Ramkola

and Mayapur were functioning in rented buildings. ANMs of all visited Sub Centres except

Okara, Mayapur and Kewara HSCs, were residing in Sub Centre building / Sub-centre

village. Mobile was not provided to any ANM of visited Sub Centres.

b) Additional ANM were not available at all visited Sub Centres except Padwar HSC,

whereas MPW (M) was not available at Guturma, Bodha Bagicha, Badwar and Ramkola Sub

Centres.

c) Water supply facility was not available at Okara and Kewara SCs whereas Electricity

connection was not available Guturma, Budha Bagicha and Badwar Sub Centres.

d) Examination table was not available at Soor and Parsaguda SCs. Delivery table was not

available at Narsinghpur, Parsaguda, Ramkola and Mayapur Sub Centres. McIntosh sheet

was not available at Narsinghpur, Ramkola and Mayapur Sub Centres. Ambu bag/suction

was not available Soor and Ulakiya Sub Centres. Nishchay Pregnancy Test Kit was not

available Ramkola and Mayapur Sub Centres. Delivery kit was not available at Guturma and

Ulakiya Sub Centres. IUD insertion kit was not available at Ulakiya, Badwar, Ramkola and

Kewara HSC. Rapid Diagnosis Test kit for malaria was not available at Guturma, Ulakiya,

Badwar, Ramkola and Kewara HSCs. Weighing machine for adult and infant was not

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available at Ramkola SC and the machine for adult was in not working condition at Soor and

Ulakiya HSC.

e) Gloves were not available at Soor, Ulakiya and Mayapur Sub Centres. DDKs, Sanitary

Napkins, Inj Gentamicin and Cap Ampicillin were not available at any visited Sub Centre.

Emergency contraceptive pills and Oxytocin Tab. was not available at entire visited SC

except Soor and Guturma HSC. Kits A & B for the year 2011-12 were not provided to any of

the visited HSC till May, 2011. Tab Co-trimoxazole was not available at Mayapur HSC.

Vitamin „A‟ solution was not available at Ulakiya and Badwar HSCs. IFA tab/syrup was not

available at most of the visited Sub Centres since 2 to 4 months. Oral pills were not available

at Ramkola, Mayapur and Kewara HSCs. Condoms was not available at Mayapur and

Kewara HSCs. Antiseptic solution was not available only at Soor, Narsinghpur, Badwar and

Mayapur HSC. Chlorine solution was available only at Soor, Guturma and Ulakiya HSCs. Tab

Pareacetamole was not available at Mayapur and Kewara HSCs.

f) Printed register for eligible couple was not available at Guturma and Ulakiya Sub Centres,

Printed register for family planning service was not available at the visited Sub Centres and

Monthly reporting format was not available at Soor, Ulakiya, Guturma Ramkola, Mayapur and

Kewara HSC. Separate JSY registration cards were not available at Sub Centre level.

g) The posters for public awareness were not displayed at the Sub Centres Narsinghpur and

Okara

h) SBA training was received only by the worker of Guturma and Okara Sub Centres.

i) Integrated Management of Neonatal and child infection (IMNCI) training was received by

the worker of Guturma, Okara, Bodha bagicha, Badwar and Ramkola Sub Centres.

8. Opinion and Knowledge of Community on Health Services: a) Total 56 mothers having child up to one year old were interviewed in the area of the visited

Sub Centres for assessing the work of ANM and Knowledge & Opinion of mothers.

b) 30 (53.6%) mothers informed that ANM is available when needed. All mothers were

delivered by trained persons. 49 (87.5%) replied that their last delivery was institutional one.

All 56 mothers were counselled for exclusive breast feeding and complementary feeds.

27(48.2%) mothers received three post natal checkups. 19(33.9%) mothers knew the danger

sign of ARI. 35 (62.5%) mothers knew about use of ORS packets during diarrhoea. All

mothers replied that immunization session are held regularly in the village. 32 (57.1%)

mothers were aware of contraceptive methods and all the mothers were aware of the

government health facilities where they can get all health facilities.

c) Out of 11 visited Sub Centres, MPW (M) was posted in 7 Sub Centres. After having

elaborated discussions with Teacher, Sarpanch, CC users, ASHA and villagers, it was learnt

that most of the male workers take rounds of the village for field work regularly and behaviour

of most of them towards the villagers was good. All workers attended the health

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clinic/immunization/VHNDS session regularly and were available when health programmes

were organized in the villages.

d) During the course of visit to PHC Barion, Dharampur and Pasta, it was observed that the

community was generally satisfied with the services received from staff and Medical Officers

of the PHCs. However Mothers were not aware about AIDS and HIV ; Stay at HQ and Visit of

the village by Medical officers was not satisfactory at Dharampur PHC.

9. Sample Verification of F.W. Beneficiaries: a) 118 Family Welfare beneficiaries were selected in the visited Centres for sample

verification and out of them 87 (73.7%) could be contacted in the district. out of contacted

beneficiaries age of spouse in 90 (76.3%), total no. of children in 16 (13.6%), no. of

Male/female children in 34 (28.8%) and age of youngest child in 45 (38.3%) cases were not

recorded.

b) 33 (64.7%) beneficiaries of FW acceptor were provided with follow up services and all 22

(68.8%) beneficiaries of Sterilisation told that they received full amount of compensation

money.

c) Out of contacted 55 spacing methods acceptors, 36 (65.5%) acceptors were found to be false reported cases in the district. d) All 70 contacted beneficiaries of child immunization confirmed to receiving the vaccination

and were satisfied with the services as there was no any complication after receiving the

services. However, follow up services were provided to only 26 (37.1%) beneficiaries.

10. IT Infrastructure & MCH Tracking: a) Computers were available at the district headquarters, CHCs and 48 out of 84 PHCs.

b) Internet connectivity was provided to the systems available in the district and at all CHCs

but not in PHCs.

c) It was reported that in the visited 4 CHCs Sitapur, Rajpur, Balrzmpur and Pratappur, all

Sub Centres are having MCH Tracking formats, though the work for want of internet

connectivity suffered due to the problem of power supply in Balrampur CHC. Data Entry was

in operation at CHC/PHC level and online data entry of MCH tracking formats in the district

was found updated till the visiting month.

11. Maintenance of Records and Registers: a) Sterilization Register was not maintained since December, 2009 at Rajpur CHC.

b) IUD Register was not maintained at the visited CHCs.

c) OP and CC Registers were not maintained properly in Sitapur CHC and these registers

were not produced at Rajpur and Pratappur CHCs.

d) ANC & PNC Registers were not maintained in CHC Rajpur. PNC and Stock Registers

were not produced at Pratappur CHC.

174

e) Eligible Couple Register was not maintained in Soor and Budhabagicha, not updated at

Ulakiya, Badwar, Ramkola and Mayapur and not produced at Guturma, Narsinghpur, Okara

and Parsagudi Sub Centres.

f) OP Register was not maintained at Okara, Budhabagicha and Ramkola HSCs and not

produced at Narsinghpur, Badwar and Parsagudi Sub Centres.

g) CC Register was not maintained at Okara, Budhabagicha, Badwar and Ramkola HSCs

and not produced at Narsinghpur and Parsagudi Sub Centres and PNC Register was not

maintained properly at Soor and Guturma Sub Centres.

h) Stock Register was not updated at Soor, Ramkola and Mayapur, and not produced at

Guturma, Narsinghpur, Okara, Budhabagicha, Badwar and Parsagudi Sub Centres.

i) JSY register was not produced at Guturma, Narsinghpur and Okara Sub-Centres.

j) Cash book for untied funds was not maintained properly at Guturma,Ulakiya, not updated

at Ramkola, not maintained at Soor and not produced at Narsinghpur, Okara,

Budhabagicha and Badwar Sub-Centres.

175

Daman and Diu

District- Daman

Major observations of Field Survey Unit (FSU), Bhopal about the Evaluation work

carried out in the Union Territory of Daman in the month of April, 2011.

I. Details of the visited Institutions:

District Visited PHCs/CHCs and DH visited SCs Visited

Daman DH: Daman

CHC: Moti Daman

PHC: Kachigam

Bhimpore, Dolar, Pariyari,

Magarwada, Patlara, Zari, Kund

Phalia & Kadaiya

II. Major Observations:

1. Human resources:

a) There was acute shortage of the health personnel in Medical category in the district. 10

of the 14 sanctioned posts of Specialist and 10 of the 18 sanctioned posts of Medical Officer

were lying vacant in the District. In paramedical category, 19 out of 45 sanctioned posts of

Staff Nurse, 3 out of 6 posts of Lab Technician, 6 out of 25 posts of ANMs and 5 out of the 16

sanctioned posts of MPW (M) were lying vacant.

b) During visit to District Hospital, it was observed that 9 of the 12 sanctioned posts of

Casualty Doctors/General Duty Medical Officer (GDMO) were lying vacant. Similarly, one

post of each of Medical Specialist, Pediatrics and Anesthetist was lying vacant. Under

paramedical, 16 out of 46 posts of Staff Nurses, 5 out of 27 posts of Hospital Workers and

one post each of Lab Technician, Radiographer, Pharmacist and Physiotherapist were lying

vacant, which need to be filled up.

c) In the visited CHC/PHC, Most of the posts were filled up except at PHC Kachigam where 1

post of Staff Nurse and one post of Female Health Worker was lying vacant.

2. Matru Samrudhi Yojana (MSY):

a) Under MSY, women resident of Daman & Diu in the age of 18 or above are eligible for

incentive of Rs. 5,000 upto two live birth if are delivered in Govt. or registered Private

Hospital of UT.

b) It was reported that the budget to the tune of Rs. 7,40,000 and Rs. 5,50,000 was available

in the district in 2009-10 and 2010-11 respectively. The entire amount in the year 2009-10

was spent. No expenditure has been incurred in the year 2010-11upto the month of visits. It

was also reported that 148 beneficiaries had been benefitted with the cash assistance in the

year 2009-10 and 110 beneficiaries eligible for cash assistance in the year 2010-11.

c) MSY status in the visited District Hospital and CHC Moti Daman:

176

Sl. No.

Items

District Hospital,

Daman

CHC: Moti Daman

2009-10 2010-11* 2009-10 2010-11*

1 No. of deliveries done 52 45 96 114

2 No. of beneficiaries to whom

MSY fund paid

52 0 96 0

3 No. of beneficiaries yet to be

paid MSY fund

Nil 45 Nil 65

* Upto Feb. 2011.

d) The team contacted 26 MSY beneficiaries in the district and all beneficiaries expressed

satisfaction towards the RCH services received.

e) All beneficiaries were accompanied by Link Worker while going to the hospital for

deliveries. None of the beneficiaries used Janani Express/transport arranged by Link Worker.

All the beneficiaries made self arrangement to go to hospital and none of the beneficiaries

got money for transport.

3. Untied Funds:

a) As reported, untied funds to the tune of Rs. 2,65,000 for the year 2009-10 and Rs.

3,06,963 (including opening balance) for the year 2010-11 were available with the district.

Out of that an expenditure of Rs. 2,33,037 in the year 2009-10 and Rs. 49,486 in 2010-11

was incurred expenditure for strengthening the services in the institutions.

b) It was observed that there are only one CHC, one PHC and twenty Sub Centres in the

district and as per the information available. CHC @ Rs. 50,000, PHC @ Rs. 25,000 and

every Sub Centre @ Rs. 10,000 are given as untied funds every year in the year. The details

of untied funds are as below:

Name of the centres Total fund available Total expenditure

2009-10 2010-11 2009-10 2010-11

For CHC, Moti Daman 50,000 54963* 45,037 49900

For PHC, Kachigam 25000 25000 24688 24953

For SCs ( all 19) 190000 190000 N.A. N.A.

* Including opening balance.

4. Rogi Kalyan Samiti (RKS) and Village Health & Sanitation Committee (VHSC) :

a) It was reported that RKS funds @ Rs. 1,00,000 per year have been allotted to CHC Moti

Daman during last three years i.e., 2008-09, 2009-10 and 2010-11, but the entire amount of

Rs. 3,00,000 was lying unutilized with the centre.

177

b) Likewise, RKS fund to the tune of Rs. 1,00,000 and Rs. 50,000 were provided to PHC

Kachigam in 2009-10 and 2010-11 respectively. Expenditure incurred during 2009-10 was

Rs. 99,845 but no fund was spent during 2010-11.

c) VHSC has been formed in all 24 villages and every VHSC was having Link worker as its

member in the district. All 24 VHSCs have opened bank accounts for handling funds for

sanitation related activities..

5. Link Workers Scheme:

a) Link Workers Schemes is functioning in the UT on the same pattern of ASHA scheme

functioning in other states.

b) 59 Link workers have been selected but none of them were trained and provided with Drug

Kits.

6. 24x7 hours Delivery Care System:

a) There were 2 institutions viz. CHC Moti Daman and Govt. Hospital Marwad providing

24x7 hours delivery care services in the district.

b) The PHC was not providing 24 x 7 hours delivery services.

7. Physical Infrastructure and Stock Positions:

i. CHC Moti Daman

a) CHC visited at Moti Daman was functioning in Govt. building with 30 beds having regular

water supply and electricity.

b) Blood Storage Unit was not available at the CHC.

c) Anesthesia Equipment, Resuscitation equipments, Weighing Machine (adult & Infant),

Autoclave, Oxygen Cylinder and Surgical Equipments were available in the CHC visited.

ii. PHC Kachigam:

a) PHC visited at Kachigam was functioning in Govt. building with regular water and

electricity.

b) At PHC Kachigam, Cold Chain equipment was not available.

c) Labour room and equipments used for delivery purpose were not available at the PHC.

d) Resuscitation Equipments, Functional Operation Theatre and other Surgical Equipments

were also not available at PHC Kachigam.

e) Residential quarters for Medical Officers were not available in the visited PHC.

iii. Sub-Centre:

a) All the visited Sub Centres were functioning in Govt. building. ANMs of the visited Sub

Centres were not residing in Sub Centre buildings. The additional ANMs were available only

in 2 Sub Centres namely Bhimpore and Magarwada out of 8 visited Sub Centres.

b) Labour room was available only at Sub Centres Pariyari and Magarwada, but deliveries

were not being conducted there.

178

c) Kits B for 2010-11 was not provided to the visited Sub Centres Dholar, Patlara, Zari and

Kund Phalia,

d) Delivery table was available only at SC Pariyari.

e) SBA training was provided to the ANM of 2 visited Sub Centres.

8. Knowledge and Opinion of Community on Health Services:

a) 37 mothers having child up to one-year of age were interviewed for assessing the work of

ANM and knowledge & opinion of mothers. All mothers replied that ANM was available

whenever needed.

b) 28 (76%) mothers received three post natal check ups (PNC). 24 (65%) mothers knew the

danger sign of ARI and all mothers knew the use of ORS.

c) All the mothers were aware of contraceptive method; 11 (30%) mothers were using

contraceptives and 10 (27%) mothers replied that they had been told about the advantages

and side effects of contraceptives.

d) MPW (Male) (called Basic Health Worker (BHW) in the district) was posted in 05 Sub

Centres viz. Bhimpore, Dholar, Magarwada, Kund Phalia and Kadaiya out of visited 8 Sub

Centres. It was observed that the villagers were satisfied with the services of MPWs.

9. Sample Verification of Family Welfare Acceptors:

a) Out of selected 233 acceptors of Family planning methods, 136 (58% ) acceptors could be

contacted for sample verification in the district. Follow up services were given to all contacted

beneficiaries. Compensation money was provided to the all contacted sterilization

beneficiaries.

b) Out of selected 70 beneficiaries of child immunization, 39 (56%) children could be

contacted for field verification. All beneficiaries confirmed the doses of vaccines and follow up

services.

10. Maintenance of records and Registers:

a) Printed Eligible Couple Register, Service register for family planning and MCH and Stock

maintenance registers were not provided to the centres, though the registers were

maintained properly at CHC Moti Daman.

b) OP and Nirodh distribution registers, F.P. records, ANC, PNC and Child Immunization

registers were not provided in printed form at the Sub Centres visited, though most of the

registers were maintained at Sub Centre level. Printed Stock register was available only at

SC Dholar.

c) MSY register was not available at any of the visited SCs. Mother and Child tracking

formats were not available at the Sub Centres Bhimpore and Kund Phaliya.

179

11. Other Observation:

Despite, the availability of the facilities at Sub Centres, delivery was not being conducted.

There was general feeling that the delivery should be done by Doctor and not by any other

Health Worker and mothers prefer to go to Private Hospitals in this regard.

District- Diu

Major observations of Field Survey Unit (FSU), Bhopal about the Evaluation work

carried out in the Union Territory of Diu in the month of April, 2011.

I. Details of the visited Institutions:

District Visited PHCs/CHCs and DH visited SCs Visited

Diu DH: Diu

CHC: Ghoghla Diu

PHC: Vanakbara

Banmorgaon, Paroli, Rithorakalan,

Padavali, Sujarma, Madhogarh,

Kutrawali and Bharauli

II. Major Observations:

1. Human Resource:

a) The district was facing shortage of skilled technical staff for providing quality services for

its population of 52056. As reported, 4 (80%) of the 5 sanctioned posts of Specialist, 10

(62.5%) of the 16 sanctioned posts of Medical Officer, 20 (80%) of the 25 sanctioned posts of

Staff Nurse and 4 (80%) of the 5 sanctioned posts of Lab Technician were lying vacant in the

entire district.

b) In district hospital only 2 (one Surgical Specialist and one Anesthetics) of the 13

sanctioned posts of Specialist were filled up. Similarly, 12 out of 17 sanctioned posts of Staff

Nurse were lying vacant in hospital.

c) At CHC Ghoghla, sanctioned post of the Gynecologist and the post of Pediatric were lying

vacant. Among para-medical staff, all sanctioned 5 posts of Staff Nurses and one post each

of X-ray Technician and Lab Technician was lying vacant.

2. Matru Samrudhi Yojana (MSY):

a) Under MSY, women resident of Daman & Diu, in the age of 18 or above were getting

incentive of Rs. 5,000 upto two live births if they delivered in Govt. or registered Private

Hospital of UT.

180

b) It was reported that the budget to the tune of Rs. 3,00,000 and Rs. 9,00,000 was available

in the district in 2009-10 and 2010-11 respectively. Most of the allotted was spent in 2009-10

and 2010-11.

c) MSY status in the visited District Hospital, CHC Ghoghla and PHC Vanakbara:

Sl. No. Items District Hospital CHC: Ghoghla PHC: Vanakbara

2009-10 2010-11 2009-10 2010-11 2009-10 2010-11

1 Total No. of deliveries 12 9 11 10 54 75

2 MSY beneficiaries to

whom MSY incentive

paid

3 4 3 10 12 43

3 Fund received for

MSY

- - 90,000 2,85,000 - -

4 Expenditure incurred

under MSY

* * 15,000 50,000 * *

* Budget for MSY was not given to DH and PHC. The expenditure of Rs. 15,000 in the year

2009-10 and Rs. 20,000 in the year 2010-11 under the MSY at DH were managed from the

fund of CHC Ghoghla. Similarly, the expenditure under the MSY at the visited PHC Rs.

60,000 in the year 2009-10 and Rs. 2,15,000 in the year 2010-11 were incurred from the

funds of CHC Ghoghla

d) The team contacted 24 beneficiaries in the district and observed that all beneficiaries are

satisfied with the RCH services received by them.

e) All beneficiaries were accompanied by Link Worker while going to the hospital for

deliveries. None of the beneficiaries used Janani Express / transport arranged by Link

Worker. All the beneficiaries made self arrangement to go to hospital and none of the

beneficiaries got money for transport.

3. Untied Funds:

a) As per the information available, CHC @50,000, PHC @ Rs. 25,000 and Sub Centre @

Rs. 10,000 are provided every year as untied funds in the district.

b) There were two PHCs in the district and these were provided funds to the tune of Rs.

25,000 each. All 6 Sub Centres were provided funds to the tune of Rs. 10,000 each in the

year 2009-10. PHC Vanakbara spent Rs. 30,585 and PHC Ghoghla could not spent any

funds in the year 2009-10. More than 80% Untied Funds had been utilized at Sub Centre

level during the period.

c) PHC Ghioghla has been upgraded from PHC to CHC and given Rs. 50,000 as an Untied

Funds during 2010-11. PHC Vanakbara spent Rs. 37122 against the allotted fund of Rs.

25,000 in 2010-11. All 6 Sub Centres spent their entire amount in the year 2010-11.

4. Rogi Kalyan Samiti (RKS) and Village Health & Sanitation Committee (VHSC):

a) There were three RKS ( District Hospital, CHC and PHC) registered in the district.

181

b) RKS fund amounting Rs. 5,00,000 to the District Hospital and Rs. 1,00,000 to CHC and

PHC was allotted on 25th March 2011 for the year 2010-11 in the district. Due to late receipt

of the same could not be spent during the yeasr. During the current year 2011-12, RKS

fund was not allotted to any institution.

c) In 4 villages in the district VHSCs were constituted. None of VHSC was having ASHA as a

member. All VHSCs have opened bank accounts for handling funds.

5. Link Workers Scheme:

a) Link Worker Scheme was functioning in the UT on the same pattern of ASHA Scheme

functioning in other states.

b) There is one Block having 4 villages in the district. At present 19 Link Workers out of

selected 20 were working on contract basis i.e., Rs. 1500 per month.

c) All 19 Link Workers were trained and provided drug kit.

d) During visit to the Sub Centres, it was observed that most of the trained Link Workers were

working and accompanying MSY beneficiaries for conducting delivery. They were helping

ANMs during immunization, ANC/PNC visits and motivating the cases for Sterilization

operations.

6. 24x7 hours Delivery Care System:

a) There were 3 institutions viz. District Hospital, CHC Ghoghla and PHC Vanakbara

providing 24x7 hours services in the district.

b) Total number of deliveries conducted in the visited centres was reported below:

Sl.

No.

Name of the Centres 2009-10 2010-11

Total

Delivery

Night Hour

Delivery

Total

Delivery

Night Hour

Delivery

1 District Hospital 12 2 9 5

2 CHC Ghoghla 11 5 10 7

3 PHC Vanakbara 54 31 75 37

c) It was observed that 360 deliveries in the year 2009-10 and 353 deliveries in 2010-11 were

conducted by private institutions in the district. If the facilities of Specialists, new born care

unit and incubator etc. are provided to the govt. institutions, the no. of deliveries can

increase.

7. Physical Infrastructure and Stock Positions:

i. CHC Ghoghla:

a) CHC was functioning in its own building. The premises of the visited CHCs was found neat

& clean. 30 bedded CHC was having regular water and electric supply.

b) X-ray facility was available but Blood Storage Unit was not available at the CHC.

182

c) BP apparatus, Resuscitation equipments, Weighing Machine (adult & Infant), Autoclave,

Oxygen Cylinder and Surgical Equipments were available in the CHC visited.

d) Residential quarter for doctors and staff were not available at the CHC.

ii. PHC Vanakbara:

a) PHC was functioning in Govt. building with regular water and electricity. Cold chain

equipments and Labour room & related equipments were available at the PHC.

b) Resuscitation equipments, functional Operation Theatre and other surgical equipments

were not available.

iii. Sub-Centres:

a) All the visited 6 Sub Centres were functioning in Govt. building and maintained properly for

clinic purpose. ANMs of the visited Sub Centres were not residing in Sub Centre buildings.

b) Labour room was available only at two Sub Centres Ghoghla-I and Ghoghla-II, but

deliveries were not conducted in these SCs.

c) Kit A and Kit B were not available at Vanakbara, Dagachi and Bucharwara SCs for both

the years. i.e. 2009-10 & 2010-11. Kit B was not found at Ghoghla SC in 2010-11.

d) Delivery table was available only at Dagachi and Bucharwara Sub Centres.

8. Knowledge and Opinion of Community on Health Services:

a) 28 mothers having child up to one-year of age were interviewed for assessing the work of

ANM and knowledge & opinion of mothers. All mothers replied that ANM was available

whenever needed.

b) All mothers received three PNC. 15 (54%) mothers knew the danger sign of ARI and all

mothers knew the usage of ORS.

c) All mothers were aware of contraceptive method and 13 (46%) mothers were using

contraceptives.

9. Sample Verification of Family Welfare Acceptors:

a) Out of selected 211 acceptors of Family planning methods, 120 (57%) acceptors could be

contacted for sample verification in the district.

b) All the Sterilization beneficiaries received full compensation amount in full and timely.

c) Out of selected 67 beneficiaries of child immunization, 39 (58%) children could be

contacted. All beneficiaries confirmed doses of vaccines along with follow up services.

10. Maintenance of records and Registers:

a) Printed EC, Sterilization, IUD, MCH, CC, OP, Stock Registers and Case Card of

sterilization were not provided to the centres but hand-written registers were maintained

properly at CHC Ghoghla and PHC Vanakbara for these services.

183

b) OP, Nirodh and Sterilization registers were maintained properly at all visited Sub Centres

except SC Dagachi.

c) Child Immunization Card was maintained at SCs Vanakbara, Bucharwara and Fudam.

d) MSY register was not maintained at 4 out of 6 SCs.

e) The stock of IUD, OP and CC were not maintained at PHC Vanakbara.

******

184

Gujarat

1. District- Anand

Major observations of Regional Evaluation Team, Bangaluru on Evaluation work

carried out in Anand district of Gujarat State in August, 2011.

I. Details of the visited Institutions:

Districts Visited PHCs / CHCs visited SCs Visited

Anand PHCs: Vadod, Budhej and

Undel

Gopalpura, Vadod, Mahiyari, Budhej,

Sakkarpur and Undel

II. Major Observations:

1. Health Human Resources:

a) In the district, sanctioned post of Chief District Health Officer, Chief District Medical

Officer, Blood Bank Officer and Dental Medical Officer at district HQ, 7 out of the 57

sanctioned posts of Medical Officer, 16 out of the 82 sanctioned posts of Staff Nurse,

8 out of the 46 sanctioned posts of LHV, 30 out of the 59 sanctioned posts of MPH

Supervisor (M), 8 out of the 58 sanctioned posts of Pharmacist, 38 out of the 274

sanctioned posts of Multi Purpose Health Worker (M) and 46 out of the 274

sanctioned posts of Multi Purpose Health Worker (F) and 91 out of the 274

sanctioned posts of Helper ANM were vacant. Post each of Physician, Pediatrician,

Radiologist, Ophthalmologist and ENT Specialist was also lying vacant.

b) In the visited PHC Vadod, 4 out of 6 sanctioned posts of Helper ANM were lying

vacant.

c) In the visited PHC Budhej, 2 out of the 6 sanctioned posts of Multi-Purpose Health

Worker (F), 3 out of the 6 sanctioned posts of Multi-Purpose Health Worker (M), 4 out

of the 6 sanctioned posts of Helper ANM and post each of Health Supervisor (F) /

LHV, Health Supervisor (M) and Lab Technician were lying vacant.

d) In the visited PHC Undel, 2 out of the 5 sanctioned posts of Multi-Purpose Health

Worker (F)/ ANM and one out of the 5 sanctioned posts of Helper ANM were lying

vacant.

2. Janani Suraksha Yojna (JSY):-

a) Women belonging to BPL, SC/ST category family only are eligible to receive JSY

cash incentive. Upto the end of 2008-09, incentive was restricted for first 2 deliveries

only, but from April 2009 onwards incentive is paid for all deliveries in the state of

Gujarat.

185

b) In Gujarat, incentive of Rs. 500 is paid to pregnant mother in the 7th month of

pregnancy, and the remaining amount of Rs. 200 in rural areas and Rs. 100 in urban

area is paid during the time of delivery. For Caesarean delivery Rs. 1500 is paid to

hired gynecologist. ASHA gets Rs. 200 per case for accompanying women to the

hospital for delivery.

c) It was reported that 46,172 deliveries were conducted during 2010-11 in the district

and JSY payments were made to 14,252 beneficiaries. Similarly, 10,762 deliveries

were conducted during 2011-12 (up to June, 2011) in the district and JSY payments

were made to 3,424 beneficiaries.

d) Total budget for JSY in the district was available to the tune of Rs.1, 20, 11,442 during

2010-11 and Rs. 1, 15, 21,000 during 2011-12 (up to June‟11). Expenditure to the

tune of Rs. 85, 36,100 was incurred in 2010-11 and Rs. 15, 77,100 during 2011-12 (up

to June‟11).

e) During Sample check, 22 out of 27 selected JSY beneficiaries could be contacted in

the district. As reported, they have received full JSY cash incentive, MCH cards were

issued to all and ANC/PNC visits were made by ANMs. 19 deliveries were normal and

the remaining 3 was C- Section.

g) All the JSY concerned registers were maintained with complete information in the

district office and CHCs/PHCs. Beneficiaries registers were maintained at Sub-Centres

visited, registers were checked by the concerned Medical Officers. JSY cards were

issued to all the beneficiaries.

3. Untied Funds:-

a. CHCs @ Rs. 50,000, PHCs @ Rs. 25,000 and HSCs @ Rs. 10,000 are given as

Untied Funds per year in the district.

b. Provision and utilization of Untied Funds in the district are detailed as below:

(Amount in Rs)

* upto July, 2011.

a) It was reported that the 138 SCs out of total 274 SCs in the district were functioning in

Govt. building and are being provided @ Rs. 10,000 as Untied Funds and @ Rs.

10,000 as AMG per year in the district. During visit to the Sub Centres at Mahiyari &

Sakkarpur, it was observed that only Rs. 5,000 was released to each of these centres

Sl.

No

Particulars of

Untied Fund

for CHCs for PHCs for HSCs

2010-11 2011-12* 2010-11 2011-12* 2010-11 2011-12*

1. Total budget

available

5,31,177 82,529 11,00,00

0

11,00,000 27,40,000 27,40,000

2. Exp. incurred 4,48,648 35,870 6,12,291 67,379 13,89,447 0

3. Balance 82,529 46,659 4,87,709 10,32,621 13,50,553 27,40,000

186

due to shortage of fund for the period 2010-11.Untied Fund was not released to the

Sub Centres for 2011-12 till date of visit of the district.

b) Untied Funds in the visited SCs was utilized to purchase the items such as plastic

boxes to keep Medicines, Buckets, Weighing Machines (adult and baby), Needle

Cutter, Doppler, Drugs, Gloves, Test Tubes and Stationery.

c) AMG in the visited SCs was utilized to purchase the items like Orient Pedal Fan, Steel

Utensils, Glass sets, Surgical items, Broom Sticks, Plastic Tub and Drugs. Also

amount was spent on IEC and conducting Mamata day celebrations.

4. Rogi Kalyan Samiti (RKS):

a) Every RKS was provided funds @ Rs. 2, 50,000 at CHC level and @ Rs. 1, 75,000 at

PHC level every year. These funds include corpus fund, AMG and Untied Funds. All

these funds are kept at the disposal of RKS and after taking the approval in its

meeting, the funds are utilized on developmental activities of institution.

b) Details of funds available and expenditure incurred at CHCs & PHCs in the District

are given in the following table:

(In Rs.)

Type/ head of the funds

For CHCs For PHCs

2010-11 2011-12* 2010-11 2011-12*

Budget Expdr. Budget Expdr. Budget Expdr. Budget Expdr.

Corpus fund

12,32,555

10,75,892

1,56,663

76,889

44,00,000 30,11,012

44,00,000 4,30,686

AMG Fund 14,93,315 9,92,307 5,01,008 2,79,225 22,00,000 11,10,363 22,00,000 0

Untied fund

5,31,177 4,48,648 82,529 35,870 11,00,000 6,12,291 11,00,000 67,379

* upto July, 2011.

c) During visit to the PHCs at Bhudej and Undel, it was observed that sufficient funds

were made available during 2010-11 and 2011-12 (upto July, 2011) and at PHC

Bhudej the funds were spent on purchase of Post-Mortem kit, Stationery, Instruments

for Operation Medicines and camera. Expenditure was incurred towards Printing of

formats, Internet wireless net payment bills, audit fees of VHSNC accounts and other

essential miscellaneous expenses.

d) In PHC Undel, RKS funds were spent on purchase of Medicine, Computer Printer,

Hardware and Spirit. Major expenditure of Rs. 54,876 was incurred on POL charges

used for PHC vehicle.

5. Services of ASHA:-

187

a) There were 1418 ASHAs selected upto 31.03.2011 against the total requirement of

1645 ASHAs in the district. All 1418 ASHAs were in position and also provided drug

kits.

b) During 2010-11, an expenditure of Rs. 1, 40, 48, 649 and during 2011-12 (up to July

2011), Rs. 32, 34,547 was incurred in the district towards payment of performance

based remuneration to ASHA.

c) In the visited institutions, 13 ASHAs were contacted. As informed, all were trained and

given drug kits. Performance based remuneration was paid to the ASHAs regularly.

d) At the visited SCs Mahiyari & Sakkarpur, ASHAs were posted and trained. In the

VHSCs ASHAs were functioning as a member.

6. Functioning of Village Health Sanitation and Nutrition Committees (VHSNC):-

a) 353 VHSNCs were set up in all 353 revenue villages in the district. Every year Rs.

10,000 are allotted to each VHSNC which was operated jointly by the MPHW (F) and

Sarpanch of Village Gram Panchyat.

b) Details of VHSNC budget in the district for 2010-11 and 2011-12 are as below:

SI.No Particulars 2010-11 2011-12

(upto June, 2011)

1. Total budget available 35,30,000 35,30,000

2. Expenditure incurred 17,22,815 12,946

3. Balance 18,07,185 35,17,054

c) VHSNC fund @ Rs. 10,000 was released to the VHNSCs of SC-Mahiyari and @ Rs.

5,000 was released to the VHSNC of SC-Sakkarpur for 2010-11 and during 2011-12,

Rs. 1,000 was released as a 1st installment to VHSNC of SC- Sakkarpur, due to

shortage of budget at the district. Fund was not released for the year 2011-12 to the

VHSNCs of SC- Mahiyari.

d) In the visited Sub Centres at Mahiyari and Sakkarpur, VHSNCs fund was spent on

purchase of Office Tables, Chairs, Drugs, Pedestal Fans, Baby Weighing Scales,

Utensils, Stationary, Cupboards, Doppler and Lancets etc. Besides this amount was

spent for transporting the items purchased to the SCs and for auditing fees of the

VHSNC accounts. VHSNC fund was not utilized for sanitary purpose according to the

guidelines.

7. 24 x 7 hours Delivery Care System:-

a) In the district, 19 out of the 46 PHCs were functioning as 24X7 delivery care

institutions. Only one Medical Officer was posted in each PHC. Only 6 PHCs have 3

Staff Nurses posted and remaining 13 have less than 3 Staff Nurses.

188

b) During 2010-11, 8 of the 19 PHCs and during April to July 2011, 13 of the 19 PHCs

did not achieve the stipulated minimum achievement of 10 deliveries per month. Thus

the district authorities need to revamp the 24X7 centres in the district according to

delivery load.

c) In the visited PHC Undel, Baby radiant warmer was not available.

8. Physical Infrastructure and Stock Position:-

i) Sub Centres

a) SC Mahiyari was functioning in the Anganawadi building and the space to keep the

medicines, registers and equipments etc was not sufficient SC Sakkarpur was

functioning in Govt. building. Infrastructure was not as per IPHS at SC Sakkarpur.

b) Delivery table, McIntsh Sheets, Ambu bag/suction, IUD Insertion Kit and Stove were

not available in the visited SCs. Steam Sterilizer and RDT Test Kit were not available

at SC Mahiyari. Benches for clients, Heamoglobinometer and Torch were not

available at SC Sakkarpur.

c) DDKs, Sanitary napkins, EC pills, and Antiseptic Solution were not available at the

visited Sub Centres. Vit. A Solution, Chlorin Solution, Tab Oxitocin and Inj Gentamycin

were not available at the SC Mahiyari. Tab. Co trimoxazole, IFA Tablets (Big) / Syrup

and Kits- A & B were not available at SC Sakkarpur.

ii) PHCs

a) In the visited PHCs at Bhudej and Undel, it was observed that both the PHCs were

functioning in government building but their infrastructure was not as per IPHS.

b) In the visited PHC Bhudej, Power backup and Microscope were not available. Labour

room and Operation Theatre were not functional resuscitation equipment was also not

supplied in this PHC.

c) Stock of Condom and Oral Pills Strips was nil since June 2011 in PHC Undel.

d) AYUSH, Medical Officer was posted in both the PHCs. Residential quarter for Medical

Officer was not available in PHC Bhudej.

9. Community Satisfaction and opinion on Health Services:-

i) Services of ANMs and MPW (M):

a) 20 mothers having child upto one year of age were interviewed in the area of two

visited Sub Centres to assess their knowledge and opinion on the services rendered

by ANMs and found that 19 mothers had their delivery by trained persons, weighed

their baby after birth and also received PNC services in time.

b) 17 (85.0%) mothers had no knowledge about danger signs of ARI and 6 (30%) mothers

had no knowledge about advantages and side effects of contraceptive methods. 18

(90.0%) deliveries were institutional.

189

c) The team found that the opinion of the community about the services provided by the

MPW (M) was satisfactory at the visited centres.

ii) Services of PHCs:

Public opinion was good about the services being rendered by the PHCs visited by

the team. Village leader, ANC/ PNC beneficiaries and others expressed good opinion

on the overall functioning of PHCs.

10. Sample Verification of FW Acceptors:

a) Out of 63 FW acceptors (Sterilization, IUD, OP and Nirodh) selected, 49 (77.8%) could

be contacted for sample verification.

b) Minor discrepancy in the recorded age of acceptor, total no. of children, no. of male

children and age of last child was found during sample check.

c) Most of the contacted beneficiaries had received follow up services and sterilization

acceptors received full compensation money after having the services.

d) All contacted 25 child immunization beneficiaries had received doses of immunization

and also got follow up services. No complication was found after receiving the doses

among the contacted beneficiaries.

11. Maintenance of records and registers:

Most of the printed service registers in respect of F.W. services were maintained.

Stock registers for the item purchased under NRHM funds and Cash book were not

maintained in SCs.

12. IT Infrastructure and Mother & Child (MCH) Tracking System:

a) One computers was installed at the district level. All the 5 blocks, all the 11 CHCs and

44 of 46 PHCs were having computer in the district.

b) Internet connectivity was provided to the system available at district, blocks and in all

11 CHCs & 44 PHCs.

c) It was reported that under HMIS reporting system, facility based reporting has not yet

started; compilation of data is done at district level office and forwarded to state office

on line. Under named based Mother and Child Tracking System (MCTS), data entry

was done at facility (CHC/PHC) level on line directly in the MCTS web portal. All the

staff at CHC/PHC/SC level were trained and sensitized on MCTS.

13. Other Observations:

a) Special cash incentives are applicable to the staff working in 24X7 hours delivery care

centres if the number of deliveries exceeds more than 15 per month, from the 16th

delivery onwards, for every delivery, the staff conducting delivery are paid following

rates: Medical Officer @ Rs. 100, Staff Nurse @ Rs. 50 and class-IV@ Rs. 25.

Additional budget is allotted to Rogi Kalyan Samiti of these centres @ Rs. 75 per case

to meet delivery related expenses.

190

b) In the district, Annual Maintenance Grant (AMG) @ Rs, 10,000 given to the Sub

Centres which are having Govt. accommodation. AMG @ Rs. 5,000 only was

released during 2010-11 to both the SCs due to shortage of funds at district. Though,

SC- Mahiyari is not having its own government building and is functioning in

Anganawadi School, AMG was released to this SC. For the period 2011-12, AMG

was not released to both the Sub Centres.

c) In other States (other than Gujarat), 2nd Multi-Purpose Health Worker (F) / ANMs

were appointed in the Sub Centre level whose qualification is same as that of 1st ANM.

2nd ANM is posted for helping the 1st ANM, as the 1st ANM is burdened with handling

Sub Centre Untied Funds, Annual maintenance grant and Village Health Sanitation

Committee funds apart from doing the Sub Centre activities but in the state of Gujarat,

instead of 2nd ANM, they have appointed Helper to ANM for a fixed honorarium of Rs.

1500 per month who is not of 2nd ANM and cannot be considered as para-medical

staff. Therefore, Helper to ANM would not be in a position to handle ANC/PNC

checkups and vaccination session, which is being done by the 2nd ANM in other

states. This system would not bring down the job related burden of the 1st ANM.

Gujarat model is the deviation of the guidelines under NRHM followed by other states.

One ASHA per1000 population is already positioned to help ANM. One more cadre or

layer non-technical personnel is created by appointing helper to ANM.

191

2. District- Vadodara

Major observations of Regional Evaluation Team, Bangaluru on Evaluation work

carried out in Vadodara district of Gujarat State in August, 2011.

I. Details of the visited Institutions:

Districts Visited PHCs / CHCs visited SCs Visited

Vadodara

PHC: Sokhda & Chandod

CHC: Dabhoi

Vasana Katoriya, Sokhda, Chandod &

Shanor

II. Major Observations:

1. Health Human Resources:

a) In the district, post of Additional District Health Officer, 26 out of the 100 sanctioned

posts of Medical Officer, 19 out of the 180 sanctioned posts of Staff Nurse, 44 out of

the 91 sanctioned posts of LHV, 21 out of the 80 sanctioned posts of MPH Supervisor

(M), 59 out of the 465 sanctioned posts of Multi Purpose Health Worker (M) and 16 out

of the 465 sanctioned posts of Multi Purpose Health Worker (F)/ANM were lying

vacant.

b) 5 out of the 6 sanctioned posts of Helper ANMs and 2 out of the 6 sanctioned posts of

Multi Purpose Health Worker (M) were lying vacant in PHC Sokhada and all 3

sanctioned posts of Staff Nurse and 7 posts of ANM, 3 of the 7 sanctioned posts of

Helper ANM and post of each AYUSH Medical Officer and Computer Operator were

lying vacant in PHC Chandod.

c) In the visited CHC Dabhoi, Post each of Gynecologist, Pediatrician and AYUSH

Medical Officer was lying vacant.

2. Janani Suraksha Yojna (JSY):-

a) Women belonging to BPL SC/ST category family only eligible to receive JSY cash

incentive. Upto the end of 2008-09, incentive was restricted to first 2 deliveries only

but from April 2009 onwards incentive is paid for all deliveries in the state of Gujarat.

b) In Gujarat, incentive of Rs. 500 is paid to pregnant mother in the 7th month of

pregnancy, and the remaining Rs. 200 in rural areas and Rs. 100 in urban area is

paid during the time of delivery. For Caesarean delivery Rs. 1500 is paid to hired

gynecologist.

c) It was reported that 52,112 deliveries were conducted during 2010-11 in the district

and JSY payments were made to 22,024 beneficiaries. Similarly, 3,802 deliveries

were conducted during 2011-12 (upto June'11) in the district and JSY payments

were made to 992 beneficiaries.

192

d) Total budget for JSY in the district was available to the tune of Rs.1, 00, 45,200 for

2010-11 and Rs. 97, 50,600 for 2011-12 (upto June‟11). Expenditure to the tune of

Rs. 1, 19, 10,700 was incurred in 2010-11 and Rs. 5, 32,600 during 2011-12 (upto

June‟11).

e) During Sample check, 12 out of 15 selected JSY beneficiaries could be contacted in

the district. As reported, they have received full JSY cash incentive, MCH cards were

issued to all and ANC/PNC visits were made by ANMs.

f) All the JSY concerned registers were maintained with complete information in the

district office and PHCs/SCs. Beneficiaries registers were maintained at Sub-Centres

visited and the registers were checked by the concerned Medical Officers.

3. Untied Fund:-

a) CHCs @ Rs. 50,000, PHCs @ Rs. 25,000 and HSCs @ Rs. 10,000 are given as

Untied Fund per year in the district.

b) Provision and utilization of Untied Funds in the district are detailed as below:

(Amt in

Rs)

* upto June, 2011.

c) It was reported that the 365 SCs out of total 465 SCs in the district were functioning in

Govt. building and are being provided @ Rs. 10,000 as Untied Funds and @ Rs.

10,000 as AMG per year in the district. During visit, it was observed that Untied Funds

of Rs. 9,300 and AMG of Rs. 5,000 for the period 2010-11 were released to SC

Vasana Katoriya and out of it Untied Funds of Rs. 8832 and AMG of Rs. 5,000 were

spent during the year. In the visited SC Vasana Katoriya, Untied/AMG Fund was not

released for the period 2011-12 till date of visit of the district. In the visited SC Shanor,

Untied Funds/ AMG Funds @ Rs. 10,000 were released for the period 2010-11 and

out of it Untied Funds of Rs 9,700 and AMG of Rs. 9,500 were spent during the year.

During 2011-12, funds released by the block, was yet to be credited in SC‟s account.

d) Untied Funds in the visited SCs were utilized to purchase items like as

Hemoglobinmeter, Dust Bin, Bio Medical Bags, PCM Kit, Seal Pad, Electical Items,

Sl.

No

Particulars of

Untied Fund

for CHCs for PHCs for HSCs

2010-11 2011-

12*

2010-11 2011-12* 2010-11 2011-12*

1

.

Total budget

available

13,60,820 3,29,256 54,22,472 56,57,953 1,65,35,326 1,71,29,611

2

.

Expenditure

incurred

10,31,564 84,612 16,64,519 30,712 40,55,715 10,557

3

.

Balance 3,29,256 2,44,644 37,57,953 56,27,241 1,24,79,611 1,71,19,054

193

Registers & Stationery, IEC Boards & Banners, getting Xerox copies of reporting

formats and for payment of Mobile Phone bills.

4. Rogi Kalyan Samiti (RKS):

a) Every RKS was provided funds @ Rs. 2, 50,000 at CHC level and @ Rs. 1, 75,000 at

PHC level every year. These funds includes corpus fund, AMG and Untied Funds. All

these funds are kept at the disposal of RKS and after taking the approval in its

meeting, the funds are utilized on developmental activities of institution.

b) Details of funds available and expenditure incurred at CHCs & PHCs in the District

are given in the following table:

(In Rs.)

Type/ head of the funds

For CHCs For PHCs

2010-11 2011-12 * 2010-11 2011-12 *

Budget Expdr. Budget Expdr. Budget Expdr. Budget Expdr.

Corpus fund

33,13,099 12,19,465 20,93,634 4,30,064 1,29,78,427 75,16,974 1,34,61,453

8,11,746

AMG Fund 38,78,469 6,30,459 32,48,010 1,81,822 57,43,487 36,96,081 56,47,406 0

Untied fund 13,60,820 10,31,564 3,29,256 84,612 54,22,472 16,64,519 56,57,953 30,712

* Upto June, 2011

c) In both the PHCs visited at Chandod and Sokhda, it was observed that during the year

2011-12 ( upto the end of July, 2011) only Corpus grant of Rs. 30,000 was released;

AMG and Untied Fund were not released.

d) In PHC Chandod, the RKS funds for the year 2010-11 was spent on purchase of

Mamatha New Born Baby Kits, Labour Room Instruments, Lancet, Lab. Equipment,

Chemicals, School Health Medicines, Chlorine Tablets and Printer. Expenditure was

incurred on Electrical Fittings, Water Cooler and Computer repairs, Printing of OPD

case papers, Gas Refilling, Vehicle Repair, Flooring making charges of Dressing

Room and Office Room, Geyser Fixing, Computer maintenance, and Transport

expenses to send water samples to district office, Payment of salary of Sweeper &

Aya and payment of CUG (Close User Group) mobile bills.

e) In PHC Sokhadal, the RKS funds for the year 2010-11 were spent on Construction of

platform in Post-Partum room and Aluminum partitions, making of road sign boards,

purchase of Stationery, Office Furniture, Public Address System, Electric Auto Clave,

Labour Room Instrument, Emergency Lamps, Washing Machine & Fans, Painting of

Building and Compound Wall, Printing of case papers etc.

194

f) In the CHC Dabhoi, Untied/AMG funds were not released upto July 2011 during the

year 2011-12. The funds provided for the year 2010-11 were spent on Repair of

Ambulance, Computer, Printer & Xerox Machine, Air conditioner and Electrical repairs.

Purchase of Blood Pouches, Linen, Medical Instruments, Medicines, Stationery, Visitor

Chairs for OPD and Needle Cutter and payment of salary of contract basis employees.

5. Services of ASHA:-

a) There were 2061 ASHAs selected as on upto 31.3.2011 against the total requirement

of 2221 ASHAs in the district. All 2061 ASHAs were in position and also provided

drug kits to all of them. 1688 ASHAs were trained in all modules till 31.3.2011. 160

new ASHAs were proposed to be inducted during 2011-12.

b) During 2010-11, expenditure to the tune of Rs. 2, 19, 56,603 and during 2011-12 up to

June 2011, Rs. 36, 65,999 was incurred in the district towards payment of

performance based remuneration to ASHA. In the visited institutions, 14 ASHAs were

contacted. As informed, all were trained and given drug kits. Performance based

remuneration was paid to the ASHAs regularly.

c) At the visited SCs Vasana Katoriya and Shanor, ASHAs were posted and trained. In

the VHSNCs, ASHAs were functioning as a member

6. Functioning of Village Health Sanitation and Nutrition Committees (VHSNC):-

a) 1450 VHSNCs were set up against 1548 revenue villages in the district. Every year

Rs. 10,000 are allotted to each VHSNC which was operated jointly by the MPHW (F)

and Sarpanch of Village Gram Panchyat.

b) Details of VHSNC budget in the district for 2010-11 and 2011-12 are as below:

(Amount in Rs)

SI.No Particulars 2010-11 2011-12 (up to

June, 2011)

1. Total budget available 3,71,25,033 4,25,42,012

2. Expenditure incurred 1,00,63,021 43,315

3. Balance 2,70,62,012 4,24,98,697

c) VHSNC fund of Rs. 10,000 was released to the VHSNCs of SC-Shanor and Rs. 9,552

was released to the VHSNC of SC-Vasana Katoriya for 2010-11. VHSNC fund was

not released during 2011-12.

d) In the visited Sub Centres at Shanor and Vasna Katoriya, VHSNCs fund was spent

on purchase of Mosquito nets, Dust Bins, Bio-Medical Waste Bags, Medicines,

Laminated IEC Boards, Weighing Machines, Immunization Charts, Plastic Containers

for keeping drugs and for Mamata day celebration.

7. 24 x 7 hours Delivery Care System:-

195

a) In the district, 33 out of the 80 PHCs were functioning as 24X7 delivery care

institutions. Only 15 PHCs of these 33 PHCs have 2 Medical Officers, including one

MO from AYUSH segment. 3 Staff Nurses were available in only 9 of the 30 PHCs.

b) Baby Radiant Warmer was available in 25 out of 33 centres.

c) During 2010-11, 13 of the 33 PHCs did not achieve the stipulated minimum 10

deliveries per month. During 2011-12 (upto 08/11), 18 PHCs did not performe

minimum 10 deliveries per month. Thus the district authorities need to revamp the

24X7 centres in the district according to delivery loads.

8. Physical Infrastructure and Stock Position:-

i) Sub Centres

a) Both the SCs visited at Vasana Katoriya and Shanor were not having own buildings

and functioning in the Anganawadi centres not having sufficient space to keep stock of

medicines, registers and SC equipments etc.

b) RDT Kit for Malaria, Delivery Table, McIntsh Sheets , Ambu bag/suction, Foot Stool,

Steam Sterilizer and Stove were not available in both the visited SCs. Benches for

clients, were not available at SC Vasana Katoriya.

c) DDKs, Kerosene oil/gas, EC pills, Tab. Metronidazole, Tab. Oxytocin, Cap. Ampicillin,

Inj Gentamycin and Kits- A & B were not available at the visited Sub Centers. Gloves

and IUDs were not available at SC Shanor.

ii) PHC/CHC

a) PHCs visited at Chandod & Sokhada were functioning in government building.

Infrastructure of PHC Chandod was not as per IPHS. Operation Theatre was not

functional. AYUSH, Medical Officer was not posted. Residential quarter for Medical

Officer was not available.

b) CHC Dabhoi was functioning in Govt. building. Incinerator was not set-up, Bio-

Medical waste is handed over to the agency outsourced and listed by the district office.

9. Community Satisfaction and opinion on Health Services:-

i) Services of ANMs and MPW(M):

a) 20 mothers having child upto one year of age were interviewed in the area of two

visited Sub Centres to assess their knowledge and opinion on the services rendered

by ANMs and found that 95% mothers had their delivery by trained persons, weighed

their baby after birth and also received PNC services in time.

b) 17 (85.0%) mothers had no knowledge on danger signs of ARI and 4 (20%) mothers

had no knowledge on advantages and side effects of contraceptive methods. 18

(90.0%) deliveries were institutional.

196

c) The team found that the opinion of the community about the services provided by the

MPW (M) was satisfactory at the visited centres. MPWs (M) were not staying at the

SC HQs.

ii) Services of PHCs:

Public opinion was good about the services being rendered by the PHCs visited by

the team. Village leader, ANC/ PNC beneficiaries and others expressed good opinion

on the overall functioning of PHCs

10. Sample Verification of FW Acceptors:

a) Out of 62 FW acceptors (Sterilization, IUD, OP and Nirodh) selected, 45(72.6%) could

be contacted for sample verification.

b) Minor discrepancy in the recorded total no. of children and no. of male children was

found during sample check.

c) Most of the contacted beneficiaries had follow up services and sterilization acceptors

received full compensation money after receiving the services.

d) All contacted 31 child immunization beneficiaries confirmed receiving the doses of

immunization and also got follow up services. No complication was found after

receiving the doses among the contacted beneficiaries.

11. Maintenance of Records and Registers:

Most of the service registers in respect of F.W. services were found printed at all the

centers and were maintained. Stock registers for the item purchased under NRHM

funds and Cash book were not maintained in PHCs/SCs

12. IT Infrastructure and Mother & Child (MCH) Tracking System:

a) One computer was installed at the district level. All the 11 blocks, all the 17 CHCs and

76 of 80 PHCs were having computer in the district.

b) Internet connectivity was provided to the system available at district, all blocks and in

all 17 CHCs & 76 PHCs.

c) It was reported that under HMIS reporting system, facility based reporting has not yet

started; compilation of data is done at district level office and forwarded to state office

on line. Under name based Mother and Child Tracking System (MCTS), data entry

was done at facility (CHC/PHC) level on line in the MCTS web portal. All the staff at

CHC/PHC/SC level were trained and sensitized on MCTS.

13. Other Observations and Suggestion:

a) Special cash incentives are applicable to the staff working in 24X7 hours delivery care

centres if the number of deliveries exceeds more than 15 per month; from the 16th

delivery onwards, for every delivery, the staff conducting delivery are paid @ following

rates; Medical Officer- Rs. 100, Staff Nurse Rs. 50 and class-IV- Rs. 25. Additional

197

budget is allotted to Rogi Kalyan Samithi of these centres @ Rs. 75 per case to meet

delivery related expenses.

b) In the district, every year AMG @ Rs. 10,000 are given to the Sub Centres which are

having Govt. accommodation. Annual maintenance grants are meant for maintaining

the government sub centre building, and should not be released to those sub centres

that are not functioning in Govt. building. On the contrary, both the SCs visited at

Vasana Katoriya and Shanor were given AMG during 2010-11. AMG utilized to

purchase the items such as- Child Growth Chart, Stationery, Torch Cells, Uristics,

Drugs, Brooms, Carpets, Marker Pens, Detergent Powder, Plastic Cans, Bags, Bed,

Chairs, Cupboard and the amount spent for Wall Paintings, Action Plan Boards, E

Mamatha survey and for nutrition.

c) In other States (other than Gujarat), 2nd Multi-Purpose Health Worker (F) / ANMs were

appointed in the Sub Centre level whose qualification is same as that of 1st ANM. 2nd

ANM is posted for helping the 1st ANM, as the 1st ANM is burdened with handling Sub

Centre Untied Funds, Annual maintenance grant and Village Health Sanitation

Committee funds apart from doing the Sub Centre activities but in the state of Gujarat,

instead of 2nd ANM, they have appointed Helper to ANM for a fixed honorarium of Rs.

1500 per month who is not technically qualified ANM and cannot be considered as

para-medical staff. Therefore, Helper to ANM would not be in a position to handle

ANC/PNC checkups and vaccination session, which is being done by the 2nd ANM in

other states. This system would not bring down the job related burden of the 1st ANM.

Gujarat model is the deviation of the guidelines under NRHM followed by other states.

One ASHA per1000 population is already positioned to help ANM. One more cadre or

layer non-technical personnel is created by appointing helper to ANM.

198

3. District- Kheda

Major observations of Regional Evaluation Team, Bangaluru on Evaluation work

carried out in Kheda district of Gujarat State in September, 2011.

I. Details of the visited Institutions:

Districts

Visited

PHCs /CHCs visited SCs Visited

Kheda PHCs: Salun and Alindra

CHC: Dakor

Salun, Fathepur, Alindra and Sandhana

II. Major Observations:

1. Health Human Resources:

Post of Chief District Health Officer, District Tuberculosis Officer and District Leprosy

Officer were lying vacant. 2 out of 8 sanctioned posts of Block Health Officer, 20 of

the 126 sanctioned posts of Medical Officer, 5 of the 51 sanctioned posts of Staff

Nurse, 37 of the 52 sanctioned posts of LHV, 12 out of 68 sanctioned posts of

Supervisor (M), 6 out of 53 sanctioned posts of Pharmacist, 3 out of 51 sanctioned

posts of Lab. Technician, 167 out of 317 sanctioned posts of Multi Purpose Health

Worker (M) and 10 out of 317 sanctioned posts of Multi Purpose Health Worker (F)/

ANM and 137 out of 317 sanctioned posts of Helper ANM (the post of helper ANM is

sanctioned by state authority) were vacant in the district.

a) In the visited PHC Salun, post of AYUSH Medical Officer, 1 out of 7 sanctioned posts

of ANM and 3 out of 7 sanctioned posts of Helper ANM were lying vacant. Similarly,

one post of LHV and 2 out of 5 sanctioned posts of Helper ANM were lying vacant in

PHC Alindra.

b) In the visited CHC Dakor, one post each of Pediatrician and Gynecologist was lying

vacant.

2. Janani Suraksha Yojna (JSY):-

a) Women belonging to BPL, SC/ST category family only are eligible to receive JSY cash

incentive. Up to the end of 2008-09, incentive was restricted to first 2 deliveries only.

however, from April, 2009 onwards incentive is paid for all deliveries in the state of

Gujarat.

b) In Gujarat, incentive of Rs. 500 is paid to pregnant mother in the 7th month of

pregnancy, and the remaining amount of Rs. 200 in rural areas and Rs. 100 in urban

area is paid during the time of delivery. For Caesarean delivery Rs. 1500 is paid to

the hired gynecologist.

199

c) It was reported that 52,792 deliveries were conducted during 2010-11 in the district

and JSY payments were made to 16,791 beneficiaries. Similarly, 9,946 deliveries were

conducted during 2011-12 (upto June'11) in the district and JSY payments were made

to 2,787 beneficiaries.

d) Total budget for JSY in the district was available to the tune of Rs.1, 13, 71,335 for

2010-11 and Rs. 18, 90,735 for 2011-12 (upto June‟11). Expenditure to the tune of Rs.

1, 02, 30,600 was incurred in 2010-11 and Rs. 16, 57,200 during 2011-12 (upto

June‟11).

e) During visit to the SC at Fathepur, 7 pending cases for JSY payment for 2010-11 and

2 pending cases for JSY payment for current year up to August 2011 were reported.

f) During Sample check, 21 out of 28 selected JSY beneficiaries could be contacted in

the district. As reported, they had received full JSY cash incentive, MCH cards were

issued to all and ANC/PNC visits were made by ASHAs/ ANMs. For institutional

deliveries, ASHA accompanied the beneficiaries to the hospitals.

g) All the JSY concerned registers were maintained with complete information in the

district office and CHCs/PHCs. Beneficiaries registers were maintained at Sub-Centres

visited; registers were checked by the concerned Medical Officers. JSY Cards were

issued to all the beneficiaries.

3. Untied Fund:-

a) CHCs @ Rs. 50,000, PHCs @ Rs. 25,000 and HSCs @ Rs. 10,000 are given as

Untied Funds per year in the district.

b) Provision and utilization of Untied Funds in the district are detailed as below:

* upto June, 2011.

c) It was reported that 160 out of total 324 SCs in the district were functioning in Govt.

building and are being provided @ Rs. 10,000 as Untied Funds and @ Rs. 10,000 as

AMG per year in the district. During visit to the Sub Centres at Fathepur & Sandhana,

it was observed that Untied/AMG Fund was not released to the Sub Centres for the

period 2011-12.

Sl.

No

Particulars Budget for CHCs Budget for PHCs Budget for HSCs

2010-11 2011-12* 2010-11 2011-12* 2010-11 2011-12*

1. Total budget

available

9,64,149 5,00,050 8,56,851 68,980 16,60,000 1,53,332

2. Expenditure

incurred

7,00,058 1,01,279 7,87,600 40,994 15,06,668 2,750

3. Balance 2,64,091 3,98,771 69,251 27,986 1,53,332 1,50,582

200

d) Untied Funds in the visited SCs were utilized to purchase the items such as –

examination table, bed sheets, pillows and registers. Besides this funds were also

utilized for e-Mamta survey, Installation of Water Purifier for drinking water, partition of

examination room and electrical repairs at the SCs.

e) AMG Funds in the visited SCs were utilized to purchase the items such as Motor Pump

to the Water Tank, Painting and Repairing of SC building, buying Syntax Tank and Pipe

fittings at the SC and Plumber Charges, Electrical Items, Stationery, Stamp & Pad and

Toilet repair works at the SC.

4. Rogi Kalyan Samiti (RKS):-

a) Every RKS was provided funds @ Rs. 2, 50,000 at CHC level and @ Rs. 1, 75,000 at

PHC level every year. These funds includes corpus fund, AMG and Untied Funds. All

these funds are kept at the disposal of RKS and after taking the approval in its

meeting, the funds are utilized on developmental activities of institution.

b) Details of funds available and expenditure incurred at CHCs & PHCs in the District

are given in the following table:

(In

Rs.)

Type of funds

For CHCs For PHCs

2010-11 2011-12* 2010-11 2011-12*

Budget Expenditure

Budget Expenditure

Budget Expenditure

Budget Expenditure

Corpus fund 12,62,954 12,24,607 5,98,691 1,62,701 50,00,000 44,05,914 5,94,086 3,13,757

AMG Fund 18,21,132 14,95,199 7,65,124 1,07,618 25,00,000 17,89,506 7,10,494 2,65,396

Untied fund 9,64,149 7,00,058 5,00,050 1,01,279 ,56,851 7,87,600 68,980 40,994

* upto June, 2011.

c) In PHC Salun, it was observed that during the year 2011-12 ( upto the end of July‟11)

only Corpus grant of Rs. 25,000 was released, AMG and Untied Funds of PHC were

not released. The funds were spent by the RKS on purchase of Medicines, Bed

Sheets/Linen, Laboratory equipment, Stationery items, Diesel and Computer.

Expenditure was incurred on Electrical Repairs, Ambulance Maintenance, Contract

Charges of Bio-Medical Waste, Painting of PHC building, Construction of Cubicle for

Injection Room, Parking Bay outside PHC, Garden Cleaning and Composite Pit. No

discrepancy was found.

d) In PHC Alindra, it was observed that during the year 2010-11, PHC Untied fund was

not released. During the year 2011-12 (upto the end August‟11), no RKS funds was

not released. The funds were spent on purchase of Computer anti-virus Software,

Printer, TV with DVD, Gas Geyser, Patient Gowns, Medicine, Blood-Lancet, Sign

Boards, Cupboards, Linen, Stationery, Digital Thermometer and S. Widal Kit.

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Expenditure was incurred on strengthening of Operation Theatre and Labour Room,

Electrical Work, Civil Construction Work, Maintenance of Garden and Hospital

Building, Plumbing Work, Ambulance Maintenance with POL charges and payment of

audit fees of NRHM accounts. No discrepancy was found.

e) In CHC Dakor, some of the major works undertaken by RKS were electrical rewiring

and repair of the building, minor civil work, laying of water and sanitation pipelines,

painting, strengthening of operation theatre and laboratory. Besides, expenditure as

computer repair, ambulance vehicle maintenance with POL charges, purchase of

Instruments, stationery and medicine was also incurred. Major expenditure was

towards Petrol charges for Ambulance Vehicle and maintenance of Ambulance.

5. Services of ASHA:-

a) There were 1627 ASHAs selected as on 30.3.2011 against the total requirement of

1675 ASHAs in the district. All 1627 ASHAs were in position also provided drug kits

trained up to 5th modules.

b) During 2010-11, an expenditure to the tune of Rs. 1,65,03,793 and during April to June

2011, Rs. 21,05,790 was incurred in the district towards payment of performance

based remuneration to ASHA.

c) In the visited institutions, 19 ASHAs were contacted. As informed, all were trained

and given drug kits. Performance based remuneration was paid to the ASHAs

regularly.

d) At the visited SCs Fathepur and Sandhana, ASHAs were posted and trained. In the

VHSNCs, ASHAs were functioning as a member.

6. Functioning of Village Health Sanitation and Nutrition Committees (VHSC):-

a) 618 VHSNCs were set up in all 618 revenue villages in the district. Every year, Rs.

10,000 are allotted to each VHSNC which was operated jointly by the MPHW (F) and

Sarpanch of Village Gram Panchayat.

b) Details of VHSNC budget in the district for 2010-11 and 2011-12 are as below:

(In Rs)

SI.No Particulars 2010-11 2011-12 (upto June

2011)

1. Total budget available 62,88,572 18,58,404

2. Expenditure incurred 44,30,168 2,64,816

3. Balance 18,58,404 15,93,588

c) VHSNC funds @ Rs. 10,000 were released to the VHSNCs of both visited SCs Fathepur

and Sandhana during 2010-11. VHSNC fund was not released for the year 2011-12 up

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to the time of team‟s visit. VHSNC meetings were conducted regularly in the visited SCs.

ANMs were maintaining the accounts of VHSNC funds.

d) In the visited Sub Centres at Fathepur and Sandhana, VHSNCs fund was spent on

purchase of Office Tables, Plastic Chairs, Drugs, Fans, File Folders, Registers &

Stationary, Cupboards, Protein Powder to Children, Slides, Electric Bulbs, Dust Bin, etc;

Besides this amount was spent for transport of high risk ANC cases to the hospitals.

e) It was observed that major part of VHSNC fund was utilized to purchase Furniture and

Stationery for SCs and not utilized for Health and Sanitation purpose as per the

guidelines.

7. 24 x 7 hours Delivery Care System:-

a) In the district, 17 out of the total 51 PHCs were functioning as 24X7 delivery care

institutions. All 17 PHCs have 2 medical officers (1 MBBS + 1 AYUSH). In all PHCs,

only 2 Staff Nurses were available instead of 3 or more Staff Nurses.

b) During 2010-11, 4 of the 17 PHCs and during April to June 2011, 6 of the 17 PHCs could

not achieve the stipulated minimum 10 deliveries per month. The district authority should

revamp the 24X7 centres in the district and also reclassify the PHCs as 24x7 centres

according the work load.

8. Physical Infrastructure and Stock Position:-

i) Sub Centres

a) In the visited SCs at Fathepur and Sandhana, it was observed that both the SCs were

functioning in Govt. building and the infrastructure was not as per IPHS. ANM was not

staying in the SC areas. Labour Room was not functioning in both the SCs.

b) RDT Kit for Malaria, McIntsh Sheets and Ambu bag/suction, were not available in both

the visited SCs. Delivery Table and Nischay pregnancy test kit were not available at SC

Fathepur.

c) DDKs, Kerosene oil/gas, Sanitary Napkins, Condoms, Tab. Oxytocin, Cap. Ampicillin,

Inj Gentamycin and Kits- A & B were not available at the visited Sub Centers. OP

cycles and EC Pills were not available at SC Sandhana.

ii) PHCs

a) In the visited PHCs at Salun and Alindra, it was observed that both the PHCs were

functioning in government building. In the visited PHC Salun, residential quarter for

Medical Officers was not available.

b) CHC Dakor, was functioning in Govt. building. Incinerator was not set-up, Bio-Medical

waste was being handed over to the agency outsourced and listed by the district

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office. Blood storage unit was not functioning presently. One post of each Gynecologist

and Pediatrician was lying vacant. Injection Arteether and Quinine were not available.

9. Community Satisfaction and opinion on Health Services:-

i) Services of ANMs and MPW(M):

a) 20 mothers having child upto one year of age were interviewed in the area of two

visited Sub Centres to assess their knowledge and opinion on the services rendered by

ANMs and found that 17(85%) mothers had their delivery by trained persons, weighed

their baby after birth and also received PNC services in time.

b) 18 (90.0%) mothers had no knowledge on danger signs of ARI and 5 (25.0%) mothers

had no knowledge on advantages and side effects of contraceptive methods. 17

(85.0%) deliveries were institutional.

c) The team found that the opinion of the community about the services provided by the

MPW (M) was satisfactory at the visited centres though the MPWs (M) were not

staying in the SC HQs.

ii) Services of PHCs:

Public opinion was good on the services being rendered by the PHCs/CHC visited by

the team. Village leader, ANC/ PNC beneficiaries and others expressed good opinion

on the overall functioning of PHCs/CHCs.

10. Sample Verification of FW Acceptors:

a) Out of 70 FW acceptors (Sterilization, IUD, OP and Nirodh) selected, 57 (81.4%) could

be contacted for sample verification.

b) Minor discrepancy in the recorded age of acceptor, age of spouse, total No. of children,

No. of male children and age of last child was found during sample check. Most of the

contacted beneficiaries were provided with follow up services.

c) All contacted 28 child immunization beneficiaries confirmed receiving doses of

immunization and also the follow up services. No complication was found after receiving

the doses among the contacted beneficiaries.

11. Reconciliation of Reported Performance:

For the period from i) 01-04-2010 to 31-03-2011 and ii) 01-04-2011 to 31-08-2011,

reconciliation of reported performance of FW cases were done at PHC and SC level. No

discrepany was observed in reported performance.

204

12. Maintenance of records and registers:

Most of the service registers in respect of F.W. services were found available in printed

forms at all the centers and maintained. Stock registers for the item purchased under

NRHM funds were not maintained at SC levels. Cash book for untied fund was not

maintained in SC Sandhana.

13. IT Infrastructure and Mother & Child (MCH) Tracking System:

a) One computer was installed at the district level. All the 8 blocks and 11 of the 12 CHCs

were having computer in the district.

b) Internet connectivity was provided to the system available at district, to all blocks and 50

of the 51 PHCs.

c) It was reported that under HMIS reporting system, facility based reporting has not yet

started; compilation of data is done at district level office and forwarded to state office

online. Under named based Mother and Child Tracking System (MCTS), data entry was

being done at facility (CHC/PHC) level directly in the MCTS web portal. All the staff at

CHC/PHC/SC were trained and sensitized on MCTS.

14. Other Observations and Suggestions:

a) Special cash incentives are applicable to the staff working in 24X7 hours delivery care

centres if the number of deliveries exceeds more than 15 per month; From the 16 th

delivery onwards, for every delivery, the staff conducting delivery are paid incentive as:

Medical Officer @Rs. 100, Staff Nurse @ Rs. 50 and class-IV@ Rs. 25. Additional

budget is allotted to Rogi Kalyan Samiti of these centres @ Rs. 75 per case to meet

delivery related expenses.

b) In the district, AMG @ Rs. 10,000 is given every year to the Sub Centres which were

having Govt. accommodation. Annual Maintenance Grant (AMG) of Rs. 10,000 per SC

was released during 2010-11 to both the SCs at Fathepur and Sandhana, and the same

was not released during 2011-12 up to the time of team‟s visit in Sep, 2011.

c) In other States (other than Gujarat), 2nd Multi-Purpose Health Worker (F) / ANMs were

appointed in the Sub Centre level whose qualification is same as that of 1st ANM. 2nd ANM

is posted for helping the 1st ANM, as the 1st ANM is burdened with handling Sub Centre

Untied Funds, Annual maintenance grant and Village Health Sanitation Committee funds

apart from doing the Sub Centre activities but in the state of Gujarat, instead of 2nd ANM

they have appointed Helper to ANM for a fixed honorarium of Rs. 1500 per month who is

not technically qualified like ANM and cannot be considered as para-medical staff.

Therefore, Helper to ANM would not be in a position to handle ANC/PNC checkups and

vaccination session, which is being done by the 2nd ANM in other states. This system

would not bring down the job related burden of the 1st ANM. Gujarat model is the deviation

205

of the guidelines under NRHM followed by other states. One ASHA per1000 population is

already positioned to help ANM. One more cadre or layer non-technical personnel is

created by appointing helper to ANM. The main purpose of strengthening the sub-centre

by posting of technically qualified 2nd ANM is not achieved here in the state.

206

4. District- Dohad

Major observations of Regional Evaluation Team, Bangaluru on Evaluation work

carried out in Dohad district of Gujarat State in September, 2011.

I. Details of the visited Institutions:

District

s

Visited

PHCs /CHCsvisited SCs Visited

Dohad PHCs: Agawada andGangardi

CHC: Jhalod

Agawada, Dasala, Gangardi and Tukiwaju

II. Major Observations:

1. Health Human Resources:

a) In the district, sanctioned post of District Quality Assurance Medical Officer, one of 7

sanctioned posts of Block Health Officer and 1 of the 2 posts of Public Health Nurse, 11

out of 67 sanctioned posts of Medical Officer, 6 out of 21 sanctioned posts of Staff Nurse,

26 out of 68 sanctioned posts of LHV, 5 out of 25 sanctioned posts of MPH Supervisor

(M), 22 out of 65 sanctioned posts of Pharmacist, 31 out of 65 sanctioned posts of Lab.

Technician, 37 out of 332 sanctioned posts of Health Worker, 5 out of 332 sanctioned

posts of ANM and 39 out of 332 sanctioned posts of Helper ANM were vacant.

b) Sanctioned post each of MBBS Medical Officer, LHV, Male Supervisor and Lab

Technician were lying vacant in PHC Agawada and the post of AYUSH Medical Officer,

one of the 3 sanctioned posts of Staff Nurse and 1 out of 5 posts of Helper ANM / Male

Worker were lying vacant in PHC Gangardil.

c) In the visited CHC Jhalod, post each of the Medical Superintendent, AYUSH Medical

Officer, Dental Surgeon, X-Ray Technician and Ophthalmic Assistant was lying vacant.

Specialist posts such as Pediatrician and Gynecologist were not sanctioned to this CHC.

2. Janani Suraksha Yojna (JSY):-

a) Women belonging to BPL, SC/ST category family only are eligible to receive JSY cash

incentive. Upto the end of 2008-09, incentive was restricted to first 2 deliveries only but

from April 2009 onwards incentive is paid for all deliveries in the state of Gujarat.

b) In Gujarat, incentive of Rs. 500 is paid to pregnant mother in the 7th month of

pregnancy, and the remaining amount of Rs. 200 in rural areas and Rs. 100 in urban

area is paid during the time of delivery. For Caesarean delivery Rs. 1500 is paid to hired

gynecologist.

207

c) It was reported that 54,317 deliveries were conducted during 2010-11 in the district and

JSY payments were made to 28,625 beneficiaries. Similarly, 21,412 deliveries were

conducted during 2011-12 (upto July'11) in the district and JSY payments were made to

2,876 beneficiaries.

d) Total budget for JSY in the district was available to the tune of Rs.1, 84, 65,438 during

2010-11 and Rs. 1, 96, 19,400 during 2011-12 (upto July‟11). Expenditure to the tune

of Rs. 1, 78, 13,700 was incurred in 2010-11 and Rs. 28, 82,600 during 2011-12 (upto

July‟11).

e) During Sample check, 25 out of 29 selected JSY beneficiaries could be contacted in the

district. As reported, they had received full JSY cash incentive, MCH cards were issued

to all and ANC/PNC visits were made by ASHAs/ ANMs. For institutional deliveries,

ASHAs accompanied the beneficiaries to the hospitals.

f) All the JSY concerned registers were maintained with complete information in the

district office and CHCs/PHCs. Beneficiaries registers were maintained at visited Sub-

Centres and registers were checked by the concerned Medical Officers. JSY Cards

were issued to all the beneficiaries.

3. Untied Funds:-

a) CHCs @ Rs. 50,000, PHCs @ Rs. 25,000 and HSCs @ Rs. 10,000 are given as Untied

Funds per year in the district.

b) Provision and utilization of Untied Funds in the district are detailed as below:

* upto July, 2011.

c) It was reported that the 200 SCs out of total 332 SCs in the district were functioning in

Govt. building and were being provided @ Rs. 10,000 as Untied Funds and @ Rs.

10,000 as AMG per year in the district. During visit to the Sub Centres at Tukiwaju, it

was observed that Untied Fund was not released to the Sub Centres for the period

2011-12 till date of visit of the district. In both the visited SCs Dasala & Tukiwaju, it was

observed that AMG Fund was not released for the period 2010-11 and 2011-12.

d) Untied Funds in the visited SCs were utilized to purchase the items such as – Table,

Chairs, Fan, Registers & Stationery items, for getting Xerox copies of Reporting Formats,

Sl. No Particulars Budget for CHCs Budget for PHCs Budget for HSCs

2010-11 2011-12

2010-11 2011-12

2010-11 2011-12

1. Total budget

available

10,32,147 6,67,328 15,00,000 15,75,000 33,20,000 33,20,000

2. Expenditure

incurred

3,64,819 92,058 13,61,953 4,70,123 14,75,438 82,300

3. Balance 6,67,328 5,75,270 1,38,047 11,04,877 18,44,562 32,37,700

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for repairing SC Doors & Windows, Electrical work at the SCs and for payment of

Electricity Bills.

4. Rogi Kalyan Samiti (RKS):

a) Every RKS was provided funds @ Rs. 2, 50,000 at CHC level and @ Rs. 1, 75,000 at PHC

level every year. These funds includes corpus fund, AMG and Untied Funds. All these

funds are kept at the disposal of RKS and after taking the approval in its meeting, the funds

are utilized on developmental activities of institution.

b) Details of funds available and expenditure incurred at CHCs & PHCs in the District are

given in the following table:

(In Rs.)

Type/ head of

the funds

For CHCs for the year For PHCs for the year

2010-11 2011-12 2010-11 2011-12

Budget Expdr. Budget Expdr. Budget Expdr. Budget Expdr.

Corpus fund 23,62,865 7,62,641 16,00,224 2,88,336 60,00,000 30,74,797 63,00,000 8,49,592

AMG Fund 27,35,013 5,85,597 21,49,416 2,11,077 30,00,000 13,78,864 29,00,000 0

Untied fund 10,32,147 3,64,819 6,67,328 92,058 15,00,000 13,61,953 15,75,000 4,70,123

* upto July 2011-12

c) During visit up to July, 2011 to the PHC at Agawada, it was observed that during the

year 2010-11 and 2011-12, PHC AMG Fund was not released. The RKS funds were

spent on purchase of Medicines, Furniture, Stationer, Electrical Stabilizer, Preparation of

Signboards, Data-Entry Charges, Repair of Vehicle, Data Transport Charges to

Transport Vaccine from district stores, Payment of Telephone Bills, Electrical Bills,

Petrol/Diesel Bills, Minor Civil Works, Computer Services and Printer Refill Cartiges etc.

d) During visit to the PHC Gangardi, it was observed that during the year 2010-11 and

2011-12, PHC AMG fund was not released. The RKS funds were spent on purchase of

Stationery, Blood-Lancets, Chlorination Cards, Plastic Buckets, Repair of Vehicle and

Servicing, Printing of Reporting Formats, Printer Refill Cartilages, Electrical Fitting and

Repairs, Repair of Computer, Windows Software Installation, Minor Civil Works,

Plumbing, Purchase of Medical & Lab Equipment, Baby Tray, Mattress & Beds for

Examination Table & Stretcher, Linen Bed Sheets, Pen-Drive, RO System Water Purifier

installation, Petrol & Diesel Bills, IEC equipment speakers & Mikes and installation of

Pump Motor etc.

e) In CHC Jhalod, RKS funds were utilized for payment of salary to night watchman &

sweeper, toilet repairs, POL for Ambulance, Ambulance repair, Purchase of Baby Kits for

new born babies, Installation of Internet, Diesel for Generator, Tubectomy Camp

expenses, Cholera Outbreak Food & Medicines, Hospital painting, Plumbing & Water

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Pipe line installation, making of Aluminium Partitions, Electrical Fixtures and purchases

Stationery items etc.

5. Services of ASHA:-

a) There were 1586 ASHAs selected as on 30.3.2011 against the total requirement of

1633 ASHAs in the district. All 1586 ASHAs were in position and also provided drug

kits to all. ASHAs were trained upto 5th modules till 30.3.2011.

b) During 2010-11, an expenditure to the tune of Rs. 1, 40, 02,345 and during April to

June 2011, Rs. 1, 16,508 was incurred in the district towards payment of performance

based remuneration to ASHA.

c) In the visited institutions, 15 ASHAs were contacted. As informed, all were trained and

given drug kits. Performance based remuneration was paid to the ASHAs regularly.

d) At the visited SCs Dasala and Tukiwaju, ASHAs were posted and trained. In the

VHSCs, ASHAs were functioning as a member.

6. Functioning of Village Health and Sanitation and Nutrition Committees (VHSNC):-

a) 684 VHSNCs were set up against 693 revenue villages in the district. Every year Rs.

10,000 are allotted to each VHSNC which was operated jointly by the MPHW (F) and

Sarpanch of Village Gram Panchayat.

b) Details of VHSNC budget in the district for 2010-11 and 2011-12 are as below:

( Amount in Rs)

SI.No Particulars 2010-11 2011-12 ( upto July

2011)

1. Total budget available 69,30,000 69,30,000

2. Expenditure incurred 65,81,218 9,25,515

3. Balance 3,48,782 60,04,485

c) VHSNC fund of Rs. 10,000 was released to the VHSNCs of both visited SCs at Dasala

and Tukiwaju during 2010-11 and 2011-12. VHSNC meetings were conducted regularly

in the visited SCs. ANMs were maintaining the accounts of VHSNC funds.

d) In the visited Sub Centres at Dasala and Tukiwaju, VHSNCs funds were spent on

purchase of Tables, Chairs, Dust Bin, Tray, Tea Cups, Syringes, Phenol, Registers,

Curtains, Soap and Uniform Sarees to ASHAs. Besides this amount was also spent on

Laminated IEC Posters, for transport the items purchased to the SCs, for getting Xerox

copies of reporting formats and for payment of SC Electrical Bills.

e) It was observed that major part of VHSNC fund was utilized for purchasing of Furniture

and Stationery for SCs and not utilized for Health and Sanitation purpose as per the

guidelines.

7. 24 x 7 hours Delivery Care System:-

210

a) In the district, 7 PHCs out of the total 65 were functioning as 24X7 delivery care

institutions. All 7 PHCs have only 1 Medical Officer posted instead of 2 Medical Officers

and 2 Staff Nurses were available in 6 of the 7 PHCs instead of 3 Staff Nurses.

b) During 2010-11, 4 of the 7 PHCs and during 2011-12 (upto July‟11), 3 PHCs could not

achieve the stipulated minimum achievement of 10 deliveries per month. Thus the

district authority needs to revamp the 24X7 centres in the district and also re- classify

24x7 as per notified delivery loads.

8. Physical Infrastructure and Stock Position:-

i) Sub Centres:

a) Both the SCs visited at Dasala and Tukiwaju, were functioning in Govt. building and the

infrastructure was not as per IPHS. ANM was not staying in the SC areas. Labour Room

was not functioning in both the SCs.

b) RDT Kit for Malaria, Foot Stool and Ambu bag/suction, were not available in both the

visited SCs. Delivery Table, Mclntch Sheets, Torch and Stove were not available at SC

Dasala. In SC Tukiwaju, Benches for clients and Steam Sterilizer were not available.

c) DDKs, Kerosene oil/gas, Sanitary Napkins, Condoms, Tab. Oxytocin, Inj Gentamycin and

Kits- A & B were not available at both the visited Sub Centers. Thermometer, ORS

packets, Tab. Co Trimoxazole, Vit.‟A‟ solution, IFA tablets (small/big and syrup), Clorine

solution, Tab. Metranidazole and Cap. Ampicillin were not available at SC Tukiwaju.

ii) PHC/CHC:

a) PHCs visited at Agawada & Umrakh were functioning in government building. Power

back-up and Residential quarter for Medical Officer were not available in both the

PHCs.

b) In PHC Agawada, tap water, toilet and wash room for staff were not available. Building

accommodation was not fit for running any services except OPD; even minor surgical

procedures cannot be undertaken. Labour room and Operation theatre cannot be set-

up. Vehicle, Oxygen Cylinder, Minor Surgical Equipment, Labour Room Table, other

equipment for delivery purpose, Resuscitation Equipment, Computer & Internet facilities

and IUD Insertion Kits were not available in the PHC. Post of Lab. Technician was not

filled.

c) In PHC Umrakh, Operation Theatre was not functional. AYUSH Medical Officer was not

posted.

d) CHC Jhalod was functioning in Govt. building. It was observed that X-Ray facility not

working since April 2011. Bio-Medical waste is handed over to the agency outsourced

and listed by the district office. Allmost all the specialist posts such as Pediatrician,

Gynecologist, Anesthesiologist, Radiologist and Physician posts were not sanctioned.

Normal deliveries were conducted, caesarian deliveries were not conducted.

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9. Community Satisfaction and opinion on Health Services:-

i) Services of ANMs and MPW(M):

a) 20 mothers having child upto one year of age were interviewed in the area of two visited

Sub Centres to assess their knowledge and opinion on the services rendered by ANMs

and found that 19 ( 95%) mothers had their delivery by trained persons, weighed their

baby after birth and also received PNC services in time.

b) 17 (85.0%) mothers had no knowledge of danger signs of ARI and 2 (10.0%) mothers

had no knowledge on advantages and side effects of contraceptive methods. 19 (95.0%)

deliveries were institutional.

c) The team found that the opinion of the community about the services provided by the

MPW (M) was satisfactory at the visited centres.

ii) Services of PHCs:

Public opinion was good about the services being rendered by the PHCs/CHC visited by

the team. Village leader, ANC/ PNC beneficiaries and others expressed good opinion on

the overall functioning of PHCs/CHCs.

10. Sample Verification of FW Acceptors:

a) Out of 70 FW acceptors (Sterilization, IUD, OP and Nirodh) selected, 55 (78.6%) could be

contacted for sample verification.

b) Minor discrepancy in the recorded age of acceptor, age of spouse, total No. of children,

No. of male children and age of last child was found during sample check.

c) All contacted 30 child immunization beneficiaries confirmed with the doses of

immunization and also got follow up services. No complication was found after receiving

the doses among the contacted beneficiaries.

11. Reconciliation of Reported Performance:

For the period from i) 01-04-2010 to 31-03-2011 and ii) 01-04-2011 to 31-08-2011,

reconciliation of reported performance of FW cases was done at PHC and SC level. No

discrepancy was observed in the reported performance.

12. Maintenance of records and registers:

Most of the printed service registers were maintained in respect of F.W. services at all the

centers. Stock registers for the item purchased under NRHM funds, Cash book for untied

fund and VHSNC fund were not maintained at SCs.

13. IT Infrastructure and Mother & Child (MCH) Tracking System:

a) 2 computers were installed at the district level. All the 7 blocks and 11 CHCs were having

computer in the district.

b) Internet connectivity was provided to the system available at district, to all blocks. 63 of

the 65 PHCs were having computer systems and only 45 PHCs were having internet

facility.

212

c) It was reported that under HMIS, facility based reporting has not yet started; compilation of

data is done at district level office and forwarded to state office online. Under named

based Mother and Child Tracking System (MCTS), data entry was done at facility

(CHC/PHC level) on line directly in the MCTS web portal. All the staff at CHC/PHC/SC

level were trained and sensitized on MCTS.

14. Other Observations and Suggestion:

a) Special cash incentives are applicable to the staff working in 24X7 hours delivery care

centres if the number of deliveries exceeds more than 15 per month; from the 16th delivery

onwards, for every delivery, the staff conducting delivery are paid as per following rates.:

Medical Officer @ Rs. 100, Staff Nurse@ Rs. 50 and class-IV@ Rs. 25. Additional budget

is allotted to Rogi Kalyan Samiti of these centres @ Rs. 75 per case to meet delivery

related expenses.

b) In the district, AMG @ Rs. 10,000 are given to the Sub Centres annually which are having

Govt. accommodation. Both the SCs at Dasala and Tukiwaju are functioning in Govt.

buildings, but AMG was not released to both the SCs for 2010-11 and 2011-12.

c) In other States (other than Gujarat), 2nd Multi-Purpose Health Worker (F) / ANMs were

appointed in the Sub Centre level whose qualification is same as that of 1st ANM. 2nd ANM

is posted for helping the 1st ANM, as the 1st ANM is burdened with handling Sub Centre

Untied Funds, Annual maintenance grant and Village Health Sanitation Committee funds

apart from doing the Sub Centre activities. This but in the state of Gujarat, instead of 2nd

ANM Helper to ANM has been appointed for a fixed honorarium of Rs. 1500 per month who

is not technically qualified as ANM and cannot be considered as para-medical staff.

Therefore, Helper to ANM would not be in a position to handle ANC/PNC checkups and

vaccination session, which is being done by the 2nd ANM in other states. This system would

not bring down the job related burden of the 1st ANM. Gujarat model is the deviation of the

guidelines under NRHM followed by other states. One ASHA per1000 population is already

positioned to help ANM. One more cadre of layer non-technical personnel is created by

appointing helper to ANM.

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5. District - Tapi:

Major observations of Regional Evaluation Team (RET), Patna on the evaluation work

carried out in Tapi District of Gujrat State in the month of February, 2012.

I. Details of the visited Institutions:

District visited DH/PHCs visited HSCs visited Tapi DH: Tapi

PHCs: Panchol, Jamkhadi and Algat Jamkhadi, Tokarwa, Antapur, Umarvavdur, Algat and Jammania

II. Major Observations:

1. Human Resources:

As per the details available, the district was having vacancies in some key categories of skilled

personnel in the health sector. The details of some of the categories of staff in the whole of the

district are as reported below:

Particulars of Post

Sanctioned

In position status of Vacant

Regular Posts Contractual Posts

ANM 226 188 29 9

MPW (M) 203 28 112 63 LHV/HS(F) 28 4 - 24 Health Supervisor (M) 32 4 - 28 GNM 22 4 - 18

Lab Technician 30 8 18 4

There was no posts of Specialist sanctioned in the district. The vacancies against regular

posts could be filled by appointing contractual staff in the district.

2. Rogi Kalyan Samiti (RKS) and Village Health Sanitation and Nutrition Committee

(VHSNC):

a) Rogi Kalyan Samiti has been constituted at the DH / CHCs / PHCs in the district. 36 Rogi

Kalyan Samiti (RKS) have been registered in 5 CHCs, 30 PHCs and District Hospital in the

district. Regular quarterly meetings of RKS were being conducted in the visited centres.

b) An amount of Rs. 28,00,000 was available for RKS in the district for the year 2010-11, out

of which, an amount to the tune of Rs. 27,47,805 (98%) was spent. Similarly, RKS funds of

Rs. 30,00,000 were available in the district for the year 2011-12, out of which, an amount to

the tune of Rs. 10,62,385 (35%) was spent up to January, 2012.

c) 456 Village Health Sanitation & Nutrition Committees (VHSNCs) have been constituted in

the district.

d) An amount of Rs. 44,60,000 was available as untied fund for VHSNC in the district for the

year 2010-11, out of which, an amount to the tune of Rs.36,43,522 (82%) was spent.

Similarly, the funds to the tune of Rs. 44,60,000 were available for VHSNCs in the district for

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the year 2011-12, out of which, an amount to the tune of Rs.9,57,103 (21%) was spent up to

January, 2012.

e) During visit to the centres, the team observed that the meetings were being conducted

regularly and VHSNCs were functioning smoothly in the district.

3. Service of Janani Suraksha Yojana (JSY):

a) The District received JSY funds of Rs. 97,75,300 for year 2010-11 and spent Rs. 61,68,300

(63%) during the year. An amount of Rs.1,04,93,200 was available during 2011-12 , out of

which Rs. 41,69,800 (40%) was spent till January, 2012.

b) 18 JSY beneficiary out of 38 newly delivered mothers selected were interviewed for on the

spot verification. It was observed that MCH cards were issued to them and most of them were

registered in early stage of pregnancy and JSY payments were made in time. Most of the

mothers delivered at Government Hospital and ASHAs accompanied them to the hospital.

c) It was observed that necessary information was not recorded in JSY cards, but

Immunization Cards were filled properly. ANC/PNC was not up to the mark. Supervisory

checks for regular monitoring at HSC level were lacking.

4. Functioning of ASHA Scheme:

a) 669 ASHAs were in position against the targeted no. of 710 ASHAs in the district. 665

ASHAs were trained upto 5th module but only 474 ASHAs have been provided drug kits in the

district.

b) For the implementation of ASHA scheme, budget to the tune of Rs. 69,47,500 was provided

in 2010-11 which was fully utilised during the year. The district also spent an amount of Rs.

82,89,856 up to January, 2012 as against the available budget of Rs. 63,37,300 during 2011-

12. The excess expenditure for the year 2011-12 was adjusted from the flexi-pool fund.

5. Untied funds (UF) and Annual Maintenance Grant (AMG):

Provision and Utilization of funds in respect of UF and AMG at PHC and SC level reported to

the team was as under:

(Amt in Rs.)

Type of Fund

Centres 2010-11 2011-12 (up to January, 2012)

Fund available

Expenditure

Fund available

Expenditure

Untied Fund PHCs 7,00,000 9,67,934* 7,50,000 1,44,627 Sub Centres 22,80,000 22,66,442 22,80,000 5,11691

AMG PHCs 14,00,000 23,49,154* 12,00,000 3,12,267 Sub Centres 22,80,000 11,01,795 16,10,000 4,06,545

* The excess expenditure for the year 2010-11 was made from flexi-pool fund.

6. 24 x 7 Hours Delivery Care Services:

As reported, 16 institutions were providing 24x7 hours services in the district.

7. Physical Infrastructure and Stock Position:

215

i. DH:

District Hospital at Tapi was functioning in govt. building. There was no Blood Storage Unit

available in the Hospital.

ii. PHCs:

a) PHCs visited at Panchol, Jamkhadi and Algat have own buildings but the maintenance of

the hospital buildings was not up to the mark. The team found regular water supply, electricity

and telephone facility only in PHC at Algat.

b) Oxygen cylinder in the PHCs Panchol and Jamkhadi and OT table in the PHCs Panchol and

Algat was not available. Labour room table was not available at PHC Algat.

c) Oral Pills were not available in any of the visited PHCs. Condom was in stock available only

at PHC Jamkhadi.

d) There was no residential accommodation available for AYUSH MO and Medical Officer

(PHC) at PHCs Jamkhadi and Algat.

iii. SCs:

a) Out of the 4 Sub Centres visited, 3 SCs namely Umaravavdur, Tokarwa and Jammania

were having their own building. The facilities at SC Jammania were better than the other three

SCs visited. None of the visited Sub Centres was having Labour room. Electricity and Toilet

facilities were not available at all the visited SCs except SC Jammania.

b) Essential furnitures, equipments and also drugs were not mostly available at SC Anantpur.

Benches for clients, Cupboard for drugs, McIntsh Sheet, Steam Sterilizer, RDT Kits,

Thermometer, Gloves and DDKs etc. were not available in most of the centres.

c) Short supply of Misofrostol, Magsulth tab., Oxitocine, Co-trimoxazole tablets, Ampicillin

Capsule, Gentamycine Injection, Kits A & B, EC pills and OP etc. was available in the visited

Sub Centres.

d) At HSCs Antapur and Tokarwa, no MPW (M) was posted.

e) None of the SCs was having facility for conducting delivery and the service registers were

not checked/verified by the PHC/District Officials.

f) In all visited SCs, ANMs had not received SBA and IMNCI training.

8. Knowledge and Opinion of the Community on Health Services:

i. Towards ANM’s and MPW (M) services:

a) 10 mothers having child up to one year age were interviewed in the area of visited 4 Sub

Centres in the district. Mothers informed that ANMs are available when needed and also

conduct immunization clinic in regular basis. ANMs had 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 in the Sub Centres areas.

216

c) It was observed that the HW was neither staying at SC village nor available when needed.

ii. Towards PHC’s services:

a) Public opinion was good on the services being rendered by the PHCs visited by the team.

MO visited PHCs regularly and disbursement of drugs was satisfactory.

b) It was observed that the services and health education in respect of pregnant women,

recently delivered women, mother of two year old child, ASHA and village leader was not up to

the mark.

c) During visit, it was found that MOs of PHCs Jamkhedi and Algat did not visit their villages

regularly.

9. Sample Verification of Family Welfare Acceptors:

a) The team selected 150 FW acceptors out of which 92 (61%) could be contacted for Sample

verification in the district. Discrepancy in the age of spouse of the acceptors in 35 (38%) cases

and in the age of last child in 66 (72%) cases was found during sample check.

b) Follow-up services by FW Staff were provided to 54 (59%) acceptors. Full amount of

compensation was given to 36 acceptors of Sterilisation.

c) 13 (7 BCG and 6 Hepatitis “B”) beneficiaries of child immunization were contacted. All

beneficiaries confirmed receiving the doses and were satisfied with the services rendered by

the health staff. All beneficiaries received follow up services. No complication was found

among contacted beneficiaries.

10. Reconciliation of Reported Performance:

There was no co-ordination between District Office and reporting centres in respect of

performance reported for the same figures in the year 2010-11 and 2011-12 (up to January,

2011). The details are as below:

a) 117 and 97 Sterilization were reported by PHCs Panchol and Algat for the year 2010-11

whereas these figures shown in the report of district office were 136 and 96 respectively.

Similarly, 199 and 107 IUD acceptors were reported by PHCs Jamkhadi and Panchol for the

year 2010-11 whereas these figures shown in the report of district office as 99 and 77

respectively.

b) 163 OP cycles/users reported by PHC Alghat and 233 Nirodh pieces/users reported by

PHC Panchol for the year 2010-11 whereas these figures shown in the report of district office

were 1598 and 594 respectively.

c) 96 OP cycles/users and 136 Nirodh pieces/users reported by PHC Panchol for the year

2011-12 (up to January, 2012) whereas these figures shown in the report of district office were

1380 and 5760 respectively.

d) IUD acceptors were recorded less than the reported number of acceptors for the year

2010-11 in the PHCs Panchol and Algat.

217

11. Maintenance of Registers & Records:

a) Eligible Couple register was not maintained properly and was not up to date at Algat PHC.

This register was not made available at Jamkhedi and Panchol PHCs.

b) Sterilization Register was not maintained properly at District Hospital Vyara (Tapi).

c) Cu-T service register, Oral pills & Nirodh distribution register were not maintained properly

at PHC Algat and DH Vyara (Tapi).

d) ANC Register was maintained properly at the visited institutions.

e) Stock Register for IUD, OP and CC was not maintained properly at the visited institutions

except PHC Algat.

12. IT Infrastructure & Mother and Child Tracking (MCH) System:

Computers were available at the district headquarters, CHCs and PHCs in the district. Internet

connectivity was provided to the systems available in the district, CHC and PHC level.

13. 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) During the visit, it was reported that the condition of Labour Room and Maternity Wards at

Panchol PHC was unhygienic and no restriction had been maintained to enter Labour Room

for general public.

c) With regard to utilization of Untied Fund and Annual Maintenance Grant, the submission of

Utilization Certificate and Statement of Expenditure was irregular and not in accordance with

the guidelines of the government.

d) 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 Programme guidelines under NRHM. The entire units need re-

orientation training to improve the work.

********

6. District - Sabhar Khantha

Major observations of Regional Evaluation Team (RET), Patna on the evaluation work

carried out in Sabhar Khantha District of Gujrat State in the month of February, 2012.

I. Details of the visited Institutions:

District visited DH/PHCs visited HSCs visited B. Sabar

Khantha

DH: Sabar Kantha PHCs: Gabat, Lusadia, Hadiyol and Jashvantpur

Gabat, Sarsoli, Lusadia, Baghpur, Gadhoda, Jasvantpur and Maniyar

II. Major Observations: 1. Human Resources:-

218

Vacancy position of the skilled personnel was alarming in the district. The details of some of

the important posts in this regard are given below:

Particulars of Post Sanctioned In position Vacant

Specialists 18 11 7 Medical Officer 80 72 8 ANMs 413 313 100 MPW (M) 413 207 206 LHV/HS(F) 70 63 7 Health Supervisor (M) 68 18 50 Lab Technician 70 60 10

2. Rogi Kalyan Samiti (RKS) & Village Health and Sanitation Committee (VHSC):-

a) Rogi Kalyan Samiti (RKS) has been registered in 20 CHCs, 68 PHCs, Sub-Divisional

Hospital and District Hospital in the district. Regular quarterly meetings of RKS were being

conducted in the visited centres.

b) An amount of Rs. 61,00,000 was available for RKS in the district for the year 2010-11, out

of which, an amount to the tune of Rs. 60,45,410 (99%) was spent. Similarly, funds of Rs.

68,00,000 were available for RKS in the district for the year 2011-12, out of which, an amount

to the tune of Rs. 44,20,184 (65%) was spent up to January, 2012.

c) 1362 Village Health Sanitation & Nutrition Committees (VHSNCs) have been constituted in

the district.

d) An amount of Rs. 30,15,882 was available as untied fund for VHSNC in the district for the

year 2010-11, out of which, an amount to the tune of Rs. 16,81,424 (95%) was spent.

Similarly, VHSNC funds of Rs. 1,37,20,000 were available in the district during 2011-12 out of

which, an amount to the tune of Rs. 1,04,08,474 (76%) was spent up to January, 2012.

e) During visit to the centres, the team observed that the meetings were being conducted

regularly and VHSNCs were functionally smoothly in the district.

3. Services under Janani Suraksha Yojana (JSY):

a) The District received JSY funds to the tune of Rs. 1,54,00,000 during 2010-11 and an

amount of Rs. 1,08,39,944 (70%) was spent during the year. Similarly, the district received Rs.

1,49,00,000 during 2011-12 and out of it, Rs. 13,85,500 (46%) was spent till January, 2012.

b) It was observed that necessary information was not recorded in JSY cards and

Immunization Cards were not filled up properly. Some of mothers did not receive three

consecutive checks up. The post natal visits by the ANM/ASHA need to be increased.

4. Functioning of ASHA scheme:

a) 2109 ASHAs were in position against the targeted no. of 2221 ASHAs in the district. It was

reported that all ASHAs were trained in all modules and provided with drug kits in the district.

b) For the implementation of ASHA scheme, an amount of Rs. 1,83,25,000 was provided to

the district in 2010-11, out of it, an amount of Rs. 2,06,76,962 was spent during the year.

During the year 2011-12, Rs. 1,99,10,100 was available and district spent Rs. 1,94,89,183.

The excess exopenditure was adjusted from flexi-pool fund up.

219

5. Untied funds (UF) and Annual Maintenance Grant (AMG):

Utilization of funds in respect of UF and AMG at PHC and SC level reported by the team was

as under:

(Amount in Rs.)

Type of Fund

Type of Centres

2010-11 2011-12 (up to January, 2012)

Fund available

Expenditure

Fund available

Expenditure

Untied Fund PHCs 15,25,000 14,99,304 17,00,000 12,51,677 Sub Centres 41,30,000 37,25,810* 41,30,000 26,14152

AMG PHCs 30,50,000 34,55,882 28,50,000 26,25,959 Sub Centres 41,30,000 24,46,294 28,20,000 2,16,524

* The excess expenditure for the year 2010-11was made from flexi-pool fund.

6. 24 x 7 Hours Delivery Care Services:

As reported, 11 institutions were providing 24x7 hours services in the district. 24 x 7 hour

services were not provided at PHCs Gabat and Lusadia.

7. Physical Infrastructure and Stock Position:

i. DH:

a) The visited District Hospital, Saber Kantha was functioning in govt. building. b) All surgical

equipments, Oxygen cylinder, Labour room, Resuscitation equipment, Anaesthesia equipment,

Auto Clave and Blood Storage Unit were available at the District Hospital, Saber Kantha.

ii. PHCs:

a) PHCs visited at Hadiyol, Gabat, Jasvant and Lusadia have own buildings but the

maintenance of the hospital buildings was not up to the mark. There was regular water supply,

electricity and Toilet facility in all the visited PHCs. Power backup facility was not available in

the PHCs Gabat and Lusadia. Telephone facility was available in all the visited PHCs except

PHC Lusadia.

b) All the visited PHCs were not having Functional Operation Table with OT Table. Labour

Room table, other equipments for delivery and Resuscitation equipment were not available in

Lusadia PHC.

c) During the visit, it was found that the Stock of Contraceptives viz. IUD, Oral Pills and

Condom was not available in all the visited PHCs except Hadiyol PHC. Stock of Vaccines like

BCG and DT was not available in the PHCs Gabat and Lusadia. Similarly, Prophylactic Drug

i.e. IFA Small (Tab) and Vit A (Syrup) was not available in the PHCs Gabat and Jashvant. IFA

(Syrup) was not available in any of the visited PHCs.

d) There was no residential accommodation available for Medical Officer (PHC) at all the

visited PHCs except PHC Jashvant.

iii. SCs:

220

a) Baghpur and Maniyor SCs were having their own building except SC Sarsoli. Water,

Electricity and Toilet were available at the visited SCs except SC Sarsoli.

b) None of Sub Centres was having Labour room. All the visited SCs had no Delivery table,

Delivery Kit and McIntsh Sheet. SCs Baghpur and Sarsoli had no Rapid Diagnosis Test (RDT)

Kit for Malaria.

c) No supply of DDKs, Condoms, 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:

i. Towards ANM’s and MPW (M) service:

a) 10 mothers having child up to one year age were interviewed in the area of visited 2 Sub

Centres in the district. Mothers informed that ANMs are available when needed and also

conducted immunization clinic fairly on 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 in the Sub Centres areas.

ii. Towards PHC’s service:

a) Public opinion was good on the services being rendered by the PHCs visited by the team.

The visit of the Medical Officer to the village during last 6 months was found poor at the visited

PHCs.

b) It was observed that the services and health education in respect of pregnant women,

recently delivered women, mother of two year old child, ASHA and village leader was not

satisfactory.

c) During the visit, it was found that MOs of PHCs Hadiyol, Jashvantpur and Pipardi were not

visiting their villages regularly.

9. Sample Verification of Family Welfare Acceptors:

a) The team selected 199 FW acceptors out of which 123 (62%) could be contacted for

Sample verification in the district. Discrepancy in the age of spouse of the acceptors in 90

(73%) cases and in the age of last child in 61(50%) cases was found during sample check.

b) Follow-up services by FW Staff were provided to 84 (68%) acceptors and also provided full

amount of compensation to 22 acceptors of Sterilisation.

c) 13 (9 Cu „T‟ and 4 OP) beneficiaries of child immunization were contacted. All beneficiaries

confirmed receiving the doses and were satisfied with the services rendered by the health

staff. Nirodh users discontinued/Denied using these methods.

d) 29 (17 BCG, 6 Measles and 6 Vit. A) beneficiaries of child immunization were contacted. All

beneficiaries confirmed receiving the doses and were satisfied with the services rendered by

221

the health staff. All beneficiaries received follow up services. No complication was found

among contacted beneficiaries.

10. Reconciliation of Reported Performance:

a) IUD figures reported at PHC Gabat for the years 2010-11 and 2011-12 did not tally with the

numbers of registered IUD cases in the PHC. There were 760 and 726 IUD cases in the

service registers as against 902 and 735 reported cases for the year 2010-11 and 2011-12 up

to January, 2012 respectively in PHC Gabat.

b) OP and Nirodh figures reported at PHC Hadiyol for the years 2010-11 and 2011-12 up to

January, 2012 were much more in the report of District office. The district office reported 2100

OP and 52850 Nirodh in the year 2010-11 against the figures of 169 and 830 respectively

reported by PHC. Similarly, district office reported 1844 OPs and 8850 Nirodhs against the

figures of 189 and 830 respectively reported by PHC Hadiyol in the year 2011-12 up to

January, 2012.

11. Maintenance of Registers & Records:

a) Eligible Couple & Children Register was not maintained at all the visited institutions in the

district.

b) Sterilization Service Register was not maintained properly at all visited PHCs except PHC

Jashvantpur in the district.

c) Service Register for Cu-T was not maintained properly in the PHCs Gabat and Hadiyol.

d) Printed Oral pills & Nirodh distribution registers were available but not maintained at all the

visited PHCs in the district.

e) Stock register of Cu.T, OP and CC was not maintained properly at all the visited PHCs in

the district.

12. IT Infrastructure & Mother and Child Tracking (MCH) System:

a) Computers were available at the district headquarters, CHCs and PHCs in the district.

b) Internet connectivity was provided to the systems available in the district, CHC and PHC

level.

c) It was reported that all Sub Centres were having MCH Tracking formats and Health

functionaries sensitised in MCH formats. Data Entry was in progress at CHC/PHC level and

online data entry in MCH tracking formats in the district was found up to date.

13. Other Observations and Suggestions:

a) Monitoring and supervision in the district need to be enhanced. Supervisory staffs need to

check the overall activities of SCs including coordination between ASHAs & AWWs and all the

records and registers. Staff of DPMU/BPMU need immediate re-orientation under NRHM.

b) Submission of utilization Certificate and Statement of Expenditure in respect of various

funds provided at the SCs, PHCs and CHCs was very irregular and whatever submitted, it was

without any details. In this connection, prescribed formats and guidelines should be provided

222

to SC, PHC, CHC and District Hospital and concerned staff should be oriented for proper filling

up of these formats /statements.

c) During visit to the different centres, the team, noticed lack of cleanliness in OPD, Indoor,

Labour Room and Maternity Wards. On enquiry, the concerned head of the Centres informed

about lack of manpower.

d) The computer room of the PHCs was dirty. Due to insufficient space at PHC attached Sub

Centre, ANC/PNC clinics were not being conducted properly.

******

223

Haryana

1. District- Barpeta

Major observations of Field Survey Unit (FSU), Lucknow on the Evaluation work carried

out in Panipat district of Haryana during the month of August, 2011.

I. Detail of the visited Institutions:

District visited PHCs/CHCs visited SCs visited

Panipat CHC: Samlakha

PHC: Chulkana

Pavati, Jaurasi, Saharmalpur and Peholi

II. Major Observations:

1. District Health Profile and Human Resources:

a. District Panipat came into existence in 1992. Panipat is a small compact district of

Haryana situated on the National Highway north of the National capital Territory. The

district, there was One General Hospital, one ESI Hospital, 3 CHCs, 13 PHCs, 90 SCs and

7 Urban RCH Centres to cater the health requirement of its 1,20,288 population.

b. The staff position as a whole in the district is reported to be good as only 35 (8%) posts of

different category out of 452 sanctioned posts were lying vacant. As reported, one post of

Sr. Medical Officer and 4 posts of Staff Nurse are surplus in the district.

c. In the visited CHC at Samalkha, 2 out of 7 sanctioned posts of Medical Officer and the

post Dental Surgeon, Computor and Sweeper were found to be vacant.

2. Swasthya Kalyan Samiti (SKS) & Village Health Sanitation & Nutrition Committee

(VHSNC):

a. Swasthya Kalyan Samiti has been constituted and functioning in the visited CHC at

Samalkha and PHC Chulkana.

b. The last meeting of the samiti at CHC Samalkha was held on 4.7.2011.

c. It was reported that 170 VHSNCs in district were formed in the villages and ASHA was a

member in each VHSNC.

3. Services of ASHA:

a. It has been reported that 518 ASHAs have been selected and out of that 442 ASHAs were

trained in all modules in the district. Drug kits have not been provided to any ASHA in the

district.

b. During visit to the facilities, it was reported that 101 ASHAs in CHC Samalkha and 31

ASHAs in PHC Chulkana were selected and all of them were trained up to 5th modules.

c. Drug kits were not provided to the ASHAs in the visited CHC at Samalkha and at PHC

Chulkana.

224

4. 24x7 hours delivery care services:

a. As reported, out of total 2322 deliveries conducted by the 24x7 centres in the district,

1752 deliveries had been conducted in night hours during 2010-11. There were 22

Doctors, 187 ANMs and 109 Staff Nurses posted for conducting 24x7 hours delivery

services in the district.

b. 24x7 hours delivery care services were being provided at visited CHC Samalkha and PHC

Chulkana.

5. Untied Funds:

a. PHCs/ CHC and sub centres functioning in the district were being provided with untied

funds for strengthening the services. The district had spent Rs. 28,97,696 out of untied

funds Rs. 31,25,000 allotted in the year 2010-11.

b. During the year 2010-11 an amount of Rs. 50,000 for CHC at Samalkha and Rs. 72,040

including opening balance of Rs. 47,042 for PHC at Chulkana was allotted and out of it an

amount of Rs. 19,135 at CHC Samalkha and Rs. 636 at PHC Chulkana, was utilized.

Similarly, Rs. 30,865 was allotted to CHC at Samalkha and out of that Rs. 7,588 was

utilized in the current year 2011-12 up to July, 2011. However, in PHC Chulkana Rs.

25,023 was utilized in the current year against available balance amount of Rs. 71,406 of

previous year carried forward.

6. Janani Suraksha Yojana (JSY):

a. The district spent Rs. 7,16,000 under the scheme out of allotted funds of Rs. 25,69,657

during 2010-11.

b. An amount of Rs. 1,74,800 was allotted to CHC at Samalkha and Rs. 1,54,000 to PHC at

Chulkana under JSY and out of that Rs. 20,200 at CHC Samalkha and Rs. 82,700 at PHC

Chulkana was utilized during 2010-11. Similarly, Rs. 1,54,600 was allotted to CHC at

Samalkha and an amount of Rs. 71,300 was available for PHC at Chulkana under the

scheme and out of that Rs. 18,200 at CHC, Samalkha and Rs. 8,700 at PHC Chulkana

were utilized in the current year 2011-12 up to July, 2011.

c. 33 mothers in the year 2010-11 and 32 mothers during current year up to July, 2011 were

given benefit under the scheme in CHC Samalkha.

d. 125 mothers in the year 2010-11 and 13 mothers during current year up to July, 2011 were

given benefit under the scheme in PHC Chulkana.

e. JSY register was properly maintained and checked by concerned Medical Officer in PHC

Chulkana but the same was neither properly maintained nor checked by Medical Officer in

CHC Samalkha.

7. Physical infrastructure (HSC/PHC/CHC)

(i) Health Sub Centres:

225

a. Sub centres visited at Pavati, Jaurasi, and Peholi were running in rent free buildings and

Sub centre Saharmalpur was functioning in Govt. building. Maintenance of building and

cleanliness was found good. Most of the supplies and equipments at sub centre level were

available on the day of visit.

b. Toilet facility was not available at Sub Centre Jaurasi and no Electricity was available at

sub centre Pavati.

c. In the visited SCs at Pavati and Jaurasi, ANMs were staying at Sub Centre villages.

(ii) CHC and PHC:

a. Visited CHC at Samalkha was functioning in Govt. building and PHC at Chulkana

functioning in a donated building.

b. There was no proper arrangement for conducting delivery in CHC Samalkha; Labour room

was functioning in a general room and no drainage system was available in the room.

Blood Storage unit was not available in the CHC.

c. In PHC Chulkana, Vehicle was not available but the same was available on call. Cold

Chain equipment and functional OT were not available there.

d. AYUSH Medical Officer was not posted and residential accommodation for MO of PHC

Chulkana was not available.

8. Assessment and opinion of the Community on Health Services:

a. 23 mothers having child up to one year of age from the area of 4 visited sub centres were

interviewed by the team to assess their opinion about the services rendered by the ANMs.

b. 22 (96%) contacted mothers informed that they had no problem in their last pregnancy.

c. Almost all contacted mothers were well aware about symptoms of ARI and use of ORS. It

was also observed that 8 (35%) of the contacted mothers were not utilising any methods of

(contraceptive) Family Planning. 3 (13%) each of the contacted mothers were not aware of

possible side effect of contraceptive methods and regarding health services provided to

the institutions.

9. Registers, Records and Reports Maintained at the Visited Centres:

a. Maintenance of record / reports regarding MPR of various programmes, delivery register,

indoor and outdoor registers were found up to date in the district.

b. It was observed that, the details of deliveries for last 3 years were maintained in a single

register at CHC Samalkha. The register was not signed by dealing hand and also I/c of

CHC.

c. At all the visited Sub centres, printed records/ registers were found available and properly

maintained by health personnel.

226

2.District- Gurgaon

Major observations of Regional Evaluation Team, Lucknow about the Evaluation work

carried out in Gurgaon district of Haryana in October, 2011

I. Details of the visited Institutions:

District visited PHCs/CHCs visited SCs visited

Gurgaon CHCs: Pataudi and

Ghangola

Sherpur, Nanhukhera, Lalakhedali

and Mahmoodpur

II. Major Observations:

1. Health Human Resources:

a. 19 of the 60 sanctioned posts of Medical Officer, 41 of the 173 sanctioned posts of ANM, 44

of the 92 sanctioned posts of MPW (M), 4 of the 22 sanctioned posts of Health Supervisor

(M), 36 of the 115 sanctioned posts of Staff Nurse/GNM and 14 of the 33 sanctioned posts

of Lab Technician were lying vacant in the district. 1 post each of the 5 posts each of

Computer Operator and Computer Assistant was vacant in District/ Block PMU in the

district.

b. In CHC, Pataudi, 1 of the 68 sanctioned posts of ANM, 25 of the 34 sanctioned posts of

MPW (M), 1 of the 6 sanctioned posts of Health Supervisor (M), 6 of the 22 sanctioned

posts of Medical officer and 12 of the 16 posts of Staff Nurse were lying vacant. Similarly,

11 of the 24 sanctioned posts of ANM, 9 of the 14 sanctioned posts of MPW (M), 1 post

each of the 5 sanctioned posts each of Medical officer Health, Supervisor (M) & and 5

posts of Staff Nurse in CHC Ghangola were lying vacant. No specialist was available at

CHC level.

2. Functioning of Rogi Kalyan Samiti (RKS):

a. RKS known as Swasthya Kalyan Samiti (SKS) was registered in each Block level PHCs and

CHCs in the district. SKS Funds including Untied Fund and Annual Maintenance Grant etc.

are kept at the disposal of Samiti. Meeting of SKS executive body was being conducted

every month but necessary approvals for incurring the expenditure were not observed to

have not been taken.

b. It was also observed that meeting of advisory body of SKS was not being conducted in the

visited centres.

3. Functioning of ASHA Scheme:

a. As reported, 569 ASHAs have been selected in the district during 2010-11 and out of that

480 ASHAs were trained but drug kits were not given to them. No new ASHA was proposed

to be inducted in 2011-12.

b. In the area of visited Sub centres at Sherpur, Nanhukhera, Lalakhedali and Mahmoodpur,

18 ASHAs were interviewed and observed that they were working without drug kits. ASHAs

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were receiving performance based remuneration on an average Rs. 2,500- 3,000 yearly.

ASHA is involved in VHSNC as a member.

4. Functioning of Village Health Sanitation & Nutrition Committee (VHSNCs):

a. It was reported that 205 VHSNCs have been formed covering 289 villages and funds were

being operated through a joint bank accounts in the name of concerned AWW and

Sarpanch. In the year 2010-11, funds @ Rs. 10,000 were provided to VHSNCS for each

revenue village for undertaking sanitation work in the villages.

b. It was reported that though there were only 205 VHSNCs in the district, thus funds were

received for 235 VHSNCs from state headquarter. The total budget for the VHSNCs in the

district was allotted to the tune of Rs. 23,50,000 in 2010-11 and out of that an amount of Rs.

20,20,000 was spent by the VHSNCs during 2010-11. No funds to the VHSNCs have been

provided during current year up to Sep. 2011.

c. It was also reported that there was no direct involvement of health centres in respect of

VHSNC fund. The amount is released through District Panchayati Raj Officer (DPRO) and

utilised by Sarpanch and AWW, so records of expenditure is not maintained at District/

CHC/ PHC/ Sub Centres level.

5. Untied Funds:

a. During the year 2010-11 district had allotted untied funds to the tune of Rs. 4,75,000 for

CHCs and out of that Rs. 3,30,775 were utilised. Similarly, an amount of Rs. 79,935 was

spent out of allotted funds of Rs. 1,87,500 as CHCs level untied funds during the year 2011-

12 up to September, 2011.

b. No details were made available about the untied fund to the DH, SDH, PHCs etc. in the

district. The district had allotted untied funds to the tune of Rs. 7,10,000 for Sub Centres

and out of that funds Rs. 6,74,696 was utilised during the year 2010-11 for strengthening

the services of Sub centres.

c. In the visited CHCs at Pataudi and Ghangola, Rs. 1,50,000 and Rs. 75,000 respectively

were provided in the year 2010-11, out of that Rs. 1,46,197 in CHC Pataudi and Rs. 64,099

in CHC Ghangola were spent. The Untied funds were utilized as per norms in contingency

and development work like repair of hospital building in CHC Pataudi and refreshment of

Civil Surgeon, refreshment of ASHA meeting, repair of electrical equipments and computer

transportation etc. in CHC Ghangola.

6. Janani Suraksha Yojana (JSY):

a. As per details received, as many as 1659 JSY beneficiaries in the year 2010-11 and 832

JSY beneficiaries in current year up to September, 2011 have been paid cash incentive

under the scheme. It was reported that, 238 JSY beneficiaries in the year 2010-11 and 751

JSY beneficiaries during current year (up to September, 2011) were waiting for their

incentive money in the district.

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b. During the year 2010-11, district had spent funds to the tune of Rs. 14,21,505 out of allotted

budget of Rs. 40,46,635. Similarly, an amount of Rs. 5,94,300 was utilised against the

available amount of Rs. 7,50,000 during current year up to September, 2011 under JSY.

c. The budget provision and expenditure as reported at the visited CHCs is given below:

(Amount in Rs.)

Sr.

No.

Particulars CHC Pataudi for the year CHC Pataudi for the year

2010-11 2011-12 2010-11 2011-12

1 Total fund available 9,91,800 2,00,000 6,00,000 2,00,000

2 Total expenditure under JSY 6,58,000 2,20,700 3,34,000 1,55,200

3 Balance amount 3,33,800 -20,700 2,66,000 44,800

4 No. of JSY mothers benefited 1032 325 509 235

d. 26 JSY beneficiaries were contacted in the area of visited Centres in the district. All the beneficiaries

stated that they had received cash incentives through cheque from the concerned CHCs and PHCs.

Most of the mothers informed that they were discharged within 6 to 15 hours after delivery from the

hospital.

e. The team observed that beneficiaries were receiving their amount after 30 to 45 days of delivery.

JSY registers were found maintained properly except date of discharge from the hospitals.

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. As reported, in the visited CHC at Pataudi, 243 deliveries in the year 2010-11 and 188 deliveries

during current year (up to September, 2011) were conducted under 24x7 delivery care services.

8. Physical infrastructure (HSC/PHC/CHC)

(i) CHC/ PHCs:

a. Visited CHCs at Pataudi and Ghangola were functioning in Govt. building but the maintenance of the

hospitals was not up to the mark, CHC Ghangola was declared to be condemned.

b. Blood Storage unit, Anesthesia equipment, OT facility, Injections Quinine and Arteether were not

available in CHC Pataudi. CHC Pataudi was presently having 6 beds, 30 bedded wards could not be

constructed due to non-availability of adequate land area.

c. Visited CHC at Ghangola was functioning in two rooms only. Ambulance/ Jeep, X- ray facility, Blood

Storage unit, Resuscitation equipment, Neonatal Resuscitation equipment, Anesthesia equipment,

OT facility, Injections Quinine and Arteether were not available in CHC Ghangola. Residential

accommodation for MOs and para-medical staff was not provided there.

d. Incinerator was not available but bio-medical waste is handed over to the agency outsourced and

listed by the district office in both the visited CHCs.

(ii) Health Sub Centres:

a. Visited Sub centres i.e. Sherpur, Nanhukhera, Lalakhedali and Mahmoodpur were functioning in

Govt. buildings. At Sub Centres Nanhukhera and Lalakhedali, ANMs were not staying at their Sub

Centre head quarters.

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b. RDT kit, DD Kits and Condoms were not available in the visited Sub centres.

c. Oxytocin tablets, Ampicillin capsules and Gentamycine injection were not available at Sub centres

Nanhukhera, Lalakhedali and Mahmoodpur.

d. Nischay pregnancy test kit, Heamoglobinometer and Sanitary Napkins at Sub Centre Sherpur;

Ambu bag, Foot stool, ORS packets, Cloroquine and Metronidazole tablets at Sub Centre

Nanhukhera; Water and Toilet facility, Kerosene oil, CuT, Oral Pills, EC Pills and Bleaching powder

at Sub Centre Lalakhedali and Examination table, Foot stool, CuT insertion kit, Thermometer,

Kerosene oil, Co-trimoxazole and Cloroquine tablets at Sub Centre Mahmoodpur were not available.

9. Assessment and opinion of the Community on Health Services:

(i) Services of ANM-

a. 36 mothers having child up to one year of age from the area of 4 visited sub centres were

interviewed by the team to assess their opinion about the services rendered by the ANMs.

b. 16 (44%) Mothers were not aware about danger sign of ARI, 4 (11%) were not aware about use of

ORS and 5 (14%) replied that their babies were not weighed at the time of birth. 3 (8%) mothers did

not receive three Post Natal checkups.

c. It was also observed that 5 (14%) mothers were not sufficiently aware about side effect of

contraceptive methods.

(ii) HW (M) Services:

Villagers in area of Nanhukala Sub Centre were satisfied generally with the services of MPW (M) in

respect of his staying at sub centre headquarters, collecting blood smears and giving proper advices

to fever cases and also the services relating to environmental sanitation and group meeting on

health topic etc.

(iii) Services of PHC-

a. 45 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 PHC/CHCs.

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 in the PHC/ CHC areas. Mostly

people were satisfied with the services provided at PHC and CHCs.

10. IT Infrastructure and Mother & Child Tracking System:

a. Team found that 18 computers were available at district, CHCs and PHCs level but only 3

computers were functioning at the time of visit. Internet connectivity was available at district and

CHC level only.

b. MCH Tracking formats were available in the Sub centres.

c. Health functionaries were sensitized in MCH formats at PHC/ CHC level. They are capturing data in

the formats and making data entry at PHC/ CHC level.

11. Registers, records and reports maintained at the visited centres:

a. Performance reported under CuT at CHCs Pataudi and Ghangola could not be verified due to want

of service registers. Oral Pills and Nirodh distribution registers were also not maintained properly in

the centres visited.

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b. Printed registers for Family Planning services, Eligible Couple, Stock book, Monthly Reporting

format and Immunisation card were maintained properly at most of the visited centres.

c. Cash book for untied fund and JSY card were not maintained at Nanhukheda Sub Centre.

3.District- Fatehabad

Major observations of Regional Evaluation Team, Lucknow about the Evaluation work carried

out in Fatehabad district of Haryana in October, 2011

I. Details of the visited Institutions:

District visited PHCs/CHCs visited SCs visited

Fatehabad CHCs: Bhuna and Jakhal

PHC: Badopal

Chinder, Dhangera, Lahariyan,

Bhuwan, Hindalwala and

Chelewala

II. Major Observations:

1. Health Human Resources:

a. 30 of the 110 sanctioned posts of Medical Officer, all sanctioned posts of specialist, 28 of

the 208 sanctioned posts of ANM, 27 of the 79 sanctioned posts of MPW (M), 11 of the 18

sanctioned posts of LHV/Health Supervisor (F), 1 of the 17 sanctioned posts of Health

Supervisor (M), 6 of the 83 sanctioned posts of Staff Nurse/GNM and 9 of the 29 sanctioned

posts of Lab Technician were lying vacant in the district.

b. In the visited CHC Jakhan, 11 of the 46 sanctioned posts of ANM, 2 of the 18 sanctioned

posts of MPW (M), 4 of the 5 sanctioned posts of LHV/ Health Supervisor (F), 6 of the 16

sanctioned posts of Medical Officer, 2 of the 5 sanctioned posts of Lab Technician and 1 of

the 2 sanctioned posts of Information Assistant were vacant. Similarly, 3 of the 56

sanctioned posts of ANM, 5 of the 16 sanctioned posts of MPW (M), 4 of the 5 sanctioned

posts of LHVs/Health Supervisor (F), 1 of the 5 sanctioned posts of Health Supervisor (M), 5

of the 16 sanctioned posts of Medical Officer and 2 of the 8 sanctioned posts of Lab

Technician in CHC Bhuna were lying unfilled.

c. In the visited PHC Badopal, 2 of the 12 sanctioned posts of ANM, 3 of the 12 sanctioned

posts of MPW (M), one sanctioned post each of LHV/ Health Supervisor (F) and Lab

Technician was vacant.

2. Functioning of Swasthya Kalyan Samiti (SKS):

a. RKS known as Swasthya Kalyan Samiti (SKS) was registered in each Block level PHCs and

CHCs in the district. SKS Funds including Untied Fund and Annual Maintenance Grant etc.

are kept at the disposal of Samiti. Meeting of SKS executive body was being conducted

two/three times in a year but necessary approvals for incurring the expenditure in the

hospitals were not taken from the SKS as observed by the team.

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b. It was also observed that meeting of advisory body of SKS was not being conducted in the

visited centres.

3. Functioning of ASHA Scheme:

a. As reported, 592 ASHAs have been selected in the district during 2010-11 and out of that

503 ASHAs were trained but drug kits were not given to them. No new ASHA was proposed

to be inducted in 2011-12.

b. In the area of visited Sub centres at Chinder, Dhangera, Lahariyan, Bhuwan, Hindalwala

and Chelewala, 12 ASHAs were interviewed and observed that they were working without

drug kits. ASHAs were receiving performance based remuneration on an average Rs.

3,800- 4,000 yearly. ASHA is involved in each VHSNC as a member.

4. Functioning of Village Health Sanitation & Nutrition Committee (VHSNCs):

a. It was reported that, 240 VHSNCs have been formed for covering 270 villages and funds

were being operated by opening joint bank accounts in the name of concerned AWW and

Sarpanch. In the year 2010-11, funds @ Rs. 10,000 were provided to VHSNC for each

village for undertaking sanitation work in the villages.

b. It was reported that, VHSNC fund are allotted to District Panchayat Raj Officer (DPRO) by

district authority and funds are utilised by Sarpanch and AWW, so records of expenditure is

not maintained at District/ CHC/ PHC/ Sub Centres level.

5. Untied Funds:

a. Every CHC, PHC and Sub Centre was being provided funds @ Rs. 50,000, Rs. 25,000 and

Rs. 10,000 per year respectively as Untied funds in the district. The position of Untied funds

for the year 2010-11 is given below:

Sr.

No

Particulars of Untied

Fund

In the year 2010-11 ( in Rs)

For Sub centres For CHCs/PHCs

1 Fund allotted 10,30,000 5,40,000

2 Total Expenditure 7,79,685 5,57,863

3 Total Balance 2,50,315 -17,863

b. Untied Fund released to the visited PHCs/CHC and utilized by them in the year 2010-11 in the

district are given below:

(In Rs)

Name of

Institutions

Released Expenditure Balance

CHC Jakhal 50,000 50,000 Nil

CHC Bhuna 50,000 29,575 20,425

PHC Badopal 25,000 23,335 1,665

No Untied Fund was released to the institutions in the district during the year 2011-12.

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c. Untied Funds were utilized mainly for activities like buying of Invertor battery, repairing of

electrical equipments, servicing X-ray machine, Sanitation work, office Stamp and Toner

refilling by CHC Bhuna. Similarly, fund has been utilised for transportation of medicine,

computer and for giving incentive to site supervisor for report collection from Sub Centres

and sending to district headquarter in CHC Jakhal. Funds were utilised for purchasing

instruments and Almirah by PHC Badopal.

6. Janani Suraksha Yojana (JSY):

a. As per details received, as many as 3011 JSY beneficiaries in the year 2010-11 and 1148

JSY beneficiaries in current year up to September, 2011 have been paid cash incentive

under the scheme.

b. During the year 2010-11, district had spent funds to the tune of Rs. 15, 37,776 out of

allotted budget of Rs. 20, 42, 600. Similarly, an amount of Rs. 7, 05,000 was utilised against

the available amount of Rs. 10, 50,000 during current year up to September, 2011 under

JSY.

c. The budget provision and expenditure at the visited PHC/CHCs is as reported given below:

(in Rs.)

Sr.No. Particulars CHC Jakhal

for the year

CHC Bhuna

for the year

PHC Badopal

for the year

2010-11 2011-12 2010-11 2011-12 2010-11 2011-12

1 Total fund available 5,85,000 3,00,000 4,00,000 3,00,000 3,28,000 2,00,000

2 Total expenditure

under JSY

5,59,700 1,67,200 4,64,600 1,48,200 3,49,200 1,03,000

3 Balance amount 25,300 1,32,800 -64,600 1,51,800 -21,200 97,000

4 No. of JSY mothers

benefited

837 244 724 224 499 148

d. 50 JSY beneficiaries were contacted in the area of visited Centres in the district. All the

beneficiaries stated that they had received cash incentives through cheque from the

concerned CHCs and PHCs.

e. The team has observed that beneficiaries were receiving incentives after 30 to 45 days of

delivery. JSY registers were found maintained properly except date of discharge from the

hospitals.

7. 24x7 Delivery Care Services:

a. 14 institutions were identified to provide 24x7 delivery care services in the district. No

additional budget for these services was released to these Centres.

b. As reported, in the district, 3635 deliveries in the year 2010-11 and 2154 deliveries during

current year (up to September, 2011) were conducted under 24x7 delivery care services.

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However, 471, 531 and 38 deliveries in CHCs Jakhal, Bhuna and PHC Badopal were

respectively reported in the year 2010-11. Similarly, 401, 257 and 41 deliveries in CHCs

Jakhal & Bhuna and PHC Badopal respectively were conducted during current year (up to

September, 2011) under 24x7 delivery care services.

8. Physical infrastructure (HSC/CHC/PHC):

(i) CHCs/PHC:

a. Visited CHCs at Jakhal and Bhuna were functioning in Govt. building, but in CHC Jakhal

maintenance of the hospitals was not up to the mark.

b. Jeep, X- ray facility, Blood Storage unit, Neonatal Resuscitation equipment, Anesthesia

equipment, Injections Quinine and Arteether were not available in CHC Jakhal. Blood

Storage unit, Neonatal Resuscitation equipment, Injections Quinine and Arteether were not

available in CHC Bhuna. As against the sanctioned strength of 30 beds, 16 beds are

available in the CHC Bhuna.

c. Incinerator was not available but bio-medical waste is handed over to the agency

outsourced and listed by the district office in both visited CHCs.

d. Visited PHC at Badopal was functioning in Govt. building but maintenance of the hospitals

was not up to the mark. Jeep was not provided, OT room was not functional and AYUSH

MO was not posted in PHC. Residential accommodation for MOs needs repair.

(ii) Health Sub Centres:

a. Sub centres visited at Chinder, Bhuwan, Hindalwala and Chelewala were functioning in

Govt. buildings. However, Sub Centres Dhangera and Lahariyan were not having Govt.

accommodation. Labour room facility was not available in the Sub Centres of Dhangera,

Lahariyan, Bhuwan and Chelewala.

b. Ambu bag/suction, RDT kit and DD kits were not available in the visited Sub centres.

c. Oxytocin tablets, Ampicillin capsules and Gentamycine injection were not available at Sub

centres Chinder, Dhangera, Lahariyan, Hindalwala and Chelewala.

d. ORS packets and Bleaching powder were not available at Sub centres Chinder, Lahariyan,

Bhuwan, Hindalwala and Chelewala.

e. EC Pills, Metronidazole tablets and Kits- A & B were not available at Sub centres Lahariyan

and Hindalwala.

f. Delivery table, Steam Sterilizer, Nischay Pregnancy Test Kits, CuT insertion kit,

Heamoglobinometer, Sanitary Napkins, Stove and Condoms at Sub centre Chindar; Mclntsh

Sheet, Weighing machine (Adult/ Infant), Stove and BP apparatus at Sub centre Dhangera;

Cupboard for drugs, Delivery table, Mclntsh Sheet, Delivery kit, Torch, Weighing machine

(Infant), Gloves, Disposable syringes, Co-trimoxazole, Cloroquine, Paracetamol tablets,

Antiseptic solution and Condoms at Sub centre Lahariyan; Electricity, Water, Toilet facilities,

Delivery table, Mclntsh Sheet, Co-trimoxazole, Paracetamol tablets, Condoms and Kits- A &

234

B at Sub Centre Bhuwan; Kerosene oil and IFA tablets at Sub Centre Hindalwala; Steam

Sterilizer, Weighing machine (Infant), Kerosene oil, IFA tablets, EC Pills, Condoms and Kits-

A & B at Sub centre Chelewala 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. 21 (39%) mothers were not aware about danger sign of ARI, 10 (19%) about use of ORS

and 4 (7%) replied that their babies were not weighed at the time of birth. 3 (5%) mothers

did not receive three Post Natal checkups.

c. It was also observed that 17 (31%) mothers were not sufficiently aware about contraceptive

methods and 10 (19%) about side effects of contraceptive uses.

(ii) Services of PHC-

45 Persons who were generally utilising the services at visited PHCs were interviewed and

it was found that most of them were satisfied with the services provided by the Medical

officers and others staff of PHCs.

10. IT Infrastructure and Mother & Child Tracking System:

a. Team found that 29 computers were available at district, CHCs and PHCs level but only 3

computers were functioning at the time of visit. Internet connectivity was available at district

and CHC level only.

b. MCH Tracking formats were available in the Sub centres.

c. Health functionaries were sensitized in MCH formats at PHC/ CHC level. They were

capturing data in the formats and making data entry at PHC/ CHC level.

11. Registers, records and reports maintained at the visited centres:

a. Service registers for CuT, Oral Pills and Nirodh cases were not being maintained at any of

the CHCs/PHCs head quarters. Performance reported under CuT could not be verified due

to want of service registers in the visited CHCs/ PHC.

b. Printed materials for Monthly reporting formats, Cash book for untied fund, JSY and

Immunisation & ANC cards at Sub Centre Lahariyan, Family Planning services and Monthly

reporting formats at Sub Centre Hindalwala were not supplied.

*********

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4.District- Jhajjar

Major observations of Field Survey Unit (FSU), Lucknow on the Evaluation work carried

out in Jhajjar district of Haryana during the month of August, 2011.

I. Detail of the visited Institutions:

District visited PHCs/CHCs visited SCs visited

Jhajjar CHC: Dhakla

PHC: Maachhrauli

Danapur, Patauda and

Subana

II. Major Observations:

1. District Health Profile and Human Resources:

a. There was One Sub Divisional Hospital, 2 Referral Hospital, 6 CHCs, 21 PHCs and 123

SCs to cater the health requirement of its 10,00,574 population in Jhajjar district.

b. As reported, 44 of the 160 sanctioned post of Doctors, 20 of the 36 sanctioned posts of

Laboratory Technician, 5 of the 41 sanctioned posts of Pharmacist/ Dresser and 12 of the

93 sanctioned posts of Nurse Grade-A were lying vacant in the district. The team observed

that there were 3 posts in each specialisation of Gynaecologist, Paediatrician,

Ophthalmologist and Ortho Surgeon, 1 post in each Anaesthesiologist & ENT and 2 posts

in each specialist of Surgeon and Pathologist in position in the district.

c. In the visited CHC at Dhakla, 3 out of 13 sanctioned posts of Medical Officer and one

sanctioned posts of Laboratory Technician were found to be vacant. Similarly, one post

each of Medical Officer, Laboratory Technician and Grade- D was vacant in PHC

Maachhrauli.

2. Swasthya Kalyan Samiti (SKS) & Village Health Sanitation & Nutrition Committee

(VHSNC):

a. Swasthya Kalyan Samiti has been constituted and functioning in the visited CHC at Dhakla

and PHC Maachhrauli. As reported, the last meeting of the samiti at CHC Dhakla was held

on 23.5.2011.

b. 243 VHSNCs were formed in district and ASHA was a member in each VHSNC.

3. Janani Suraksha Yojana (JSY):

a. The district had spent Rs. 16,60,600 under the scheme, out of allotted funds of Rs.

23,98,565 during 2010-11.

b. In the visited CHC Dhakla, an amount of Rs. 3,70,000 was allotted and Rs. 3,95,000

utilized during 2010-11 under the scheme. It is informed that the excess amount was met

out from AMG in this CHC. In PHC Maachhrauli, the expenditure of Rs. 1,03,000 in the

year 2010-11 and Rs. 22,700 have been provided during the current year 2011-12 up to

July, 2011 by CHC Dhakla to meet the expenditure under JSY because of DDO power is

236

not delegated at the level of PHC Maachhrauli and hence the disbursement is made by

CHC Dhakla for JSY.

c. 139 JSY beneficiaries in the year 2010-11 and 24 beneficiaries during current year up to

July, 2011 received the cash incentive under the scheme in CHC Dhakla. Similarly, 160

JSY beneficiaries in the year 2010-11 and 35 beneficiaries during current year up to July,

2011 received cash incentive under the scheme in PHC Maachhrauli.

d. JSY register was properly maintained and checked by concerned Medical Officer in the

visited institutions.

4. Services of ASHA:

a. As against required 700 ASHAs, 640 have been selected and all ASHAs were trained in all

modules in the district. Drug kits have not been provided to any ASHA in the district.

b. During visit to the facilities, it was reported that 111 ASHAs in CHC Dhakla and 30 ASHAs

in PHC Maachhrauli were selected and received training in all modules but no drug kit was

distributed to the ASHAs in these centres.

5. Untied Funds:

a. PHCs/ CHC and sub centres functioning in the district were being provided with untied

funds for strengthening the services. The district had spent Rs. 75,95,120 out of untied

funds Rs. 69,60,394 allotted. It was reported that excess amount was met from AMG &

other Additional fund under NRHM head in the year 2010-11.

b. During the year 2010-11, an amount of Rs. 50,000 to CHC at Dhakla and Rs. 24,673 to

PHC at Maachhrauli was allotted and out of it, an amount of Rs. 1,63,931 at CHC Dhakla

and Rs. 21,012 at PHC Maachhrauli, was utilized. However, in CHC Dhakla excess

amount was utilized from AMG & other Additional fund under NRHM head in the year

2010-11.

c. No Untied Fund was released to the institutions in the district during the year 2011-12 up to

the time of visit.

6. 24x7 hours delivery care services:

a. 2590 deliveries out of total 4685 deliveries had been conducted in night hours by the 24x7

hours functioning centres in the district during 2010-11. There were 92 Doctors, 26 ANMs

and 78 Staff Nurses posted at various centres for conducting 24x7 hours delivery in the

district.

b. 24x7 hours delivery care services were being provided at visited CHC Dhakla and PHC

Maachhrauli. Doctors and para-medical staff were being provided services on call basis at

CHC Dhakla. 41 night hours deliveries were conducted during current year in the CHC and

67 deliveries in PHC Maachhrauli in last year.

7. Physical infrastructure (HSC/PHC/CHC)

(i) Health Sub Centres:

237

a. Sub centres visited at Danapur and Subana were functioning in Govt. building and Sub

centre Patauda was running in rented building. Maintenance of building and cleanliness

was found good. Most of the supplies and equipments at sub centre level were available

on the day of visit.

b. Basic facilities like Water, Electricity and Toilet was available at Sub Centres visited.

c. Labour room, Delivery table, CuT insertion kit and Weighing machine (Infant) at Sub

Centre Patauda, Delivery table, Delivery kit, Weighing machine (Infant) Gloves,

Disposable syringes, DDKs and Co-trimoxazole tablets at Sub Centre Subana were not

available.

d. In the visited SCs at Danapur, Patauda and Subana, ANMs were staying at Sub Centre

villages.

(ii) CHC and PHC:

a. Visited CHC at Dhakla and PHC at Maachhrauli were functioning in Govt. buildings. But

building of CHC Dhakla has been condemned by the Department.

b. Blood Storage unit was not set up and residential accommodation for MO and para-

medical staff of CHC Dhakla was not available.

c. In PHC Maachhrauli, Cold Chain equipment and functional OT were not available there.

Residential accommodation for MO of PHC was not available.

8. Assessment and opinion of the Community on Health Services:

a. 13 mothers having child up to one year of age from the area of 3 visited sub centres were

interviewed by the team to assess their opinion about the services rendered by the ANMs.

b. All contacted mothers informed that their baby was weighted after delivery.

c. Almost all contacted mothers were well aware about symptoms of ARI and use of ORS. It

was also observed that 6 (46%) of the contacted mothers were not utilising any methods of

(contraceptive) Family Planning.

9. Registers, Records and Reports Maintained at the Visited Centres:

a. Maintenance of record/ reports regarding MPR of various programmes, delivery register,

indoor and outdoor registers were found up to date in the district.

b. At all the visited Sub centres, printed records/ registers were found available and properly

maintained by health personnel.

5.District Faridabad

Major observations of Field Survey Unit (FSU), Patna about evaluation work carried out

in Faridabad District of Haryana State in the month of May, 2011.

238

I. Details of the visited Institutions:

District Visited PHC Visited HSC Visited

Faridabad PHCs: Tigaon, Mohna & Kurali

Tigaon-A, Tigaon-B, Neemka,

Deeg, Hirapur, Mohana, Chandpur,

Kurali

& Fajjupur

II. Major Observations:

1. Rogi Kalyan Samiti (RKS) & Village Health Sanitation Committee(VHSC):

a) 12 RKS were constituted in the district at the different institutions and regular meetings of

RKS were being conducted in the visited centres.

b) VHSCs were functioning in all 183 villages and 154 VHSCs were having ASHA as a

member.

c) As reported, the VHSC budget to the tune of Rs. 5,00,000 was available in the district

during 2010-11 out of which Rs. 4,90,000 was spent during the period. During 2011-12, no

fund was provided to VHSCs.

2. Service of Janani Suraksha Yojana (JSY):

a) JSY was functioning in the district. It was also reported that 1916 JSY beneficiaries had

been identified in the district during 2010-11 and all beneficiaries provided cash assistance in

the same year.

b) It was observed that district could utilize only Rs. 11,80,550 out of its available budget of

Rs. 46,92,647 in the year 2010-11.

c) JSY status in the visited PHCs is as under:

Sl. No. Particulars PHC Tigaon PHC Mohna PHC Kurali

2010-

11

2011-

12

2010-

11

2011-

12

2010-11 2011-

12

1. No. of deliveries eligible for payment

under JSY

868 29 413 22 100 Nil

2 No. of beneficiaries to whom JSY

incentive provided

868 29 413 22 100 Nil

3 Total fund received 13150

0

Nil 4,07,00

0

82,00

0

1,06,30

0

85,00

0

4 Expenditure incurred under JSY 13150

0

Nil 3,56,90

0

19,50

0

67,300 Nil

239

d) During sample verification, as many as 36 JSY beneficiaries were contacted by the team

and all of them had received JSY incentive. In the PHCs, JSY registers needed proper

attention to record all details of the beneficiaries.

3. Functioning of ASHA scheme:

a) Out of requirement of 345 ASHAs in the district, 342 ASHAs were in position in the district.

325 ASHAs were trained in all modules in the district .

b) None of ASHA was provided drug kit and DDK.

4. Untied funds:

a) Provision and expenditure of Untied Fund at CHC, PHCs and HSCs for the year 2010-11 in

the district reported as below: (in Rs.)

Name of Fund For CHC funds For PHCs funds For HSCs funds

Untied funds Received 50,000 2,75,000 4,70,000

Expenditure incurred 50,000 2,75,000 4,29,479

Balance Nil Nil 40,521

b) No untied fund for the year 2011-12 was released at CHC, PHC and HSC level till the visit

of the team.

c) It was reported that PHCs Tigaon, Kurali and Mohana were having Rs. 25,000, Rs.

1,13,099 and Rs. 25,040 as untied funds respectively for the year 2010-11. PHCs Tigaon and

Kurali spent whole amount of untied funds and PHC Mohana spent excess funds of Rs. 2346

during the same period.

5. 24 x 7 Hours Delivery Care Services:

a) 10 institutions (CHC/PHC/FRU) were providing 24x7 hours delivery care service in the

district. All the centres except PHC Dhey were having two MOs and 4 or more SN/ANMs in

each centres. There was no specialist in any Institution.

b) Blood storage facility was not available in the visited 24 x 7 hours delivery care centres.

6. Physical Infrastructure and Stock Position:

i. PHCs:

a) PHCs visited at Tigaon, Mohna and Kurali were functioning in Govt. building with electricity

and telephone facilities.

b) Vehicle and Resuscitation equipment were not available at PHC Kurali, while functional

Operation Theatre was not available at Tigaon PHC.

c)Oral Pills, EC Pills, Condoms and Vitamin-„A‟ Tablets were not available at Tigaon PHC.

BCG vaccines vials, IFA syrup and Vitamin „A‟ (Tablet & Syrup) were not available at PHC

Mohna.

ii. HSCs:

a) All visited Sub Centres were functioning in Govt. building having hand pump, Electricity,

Toilet and Labour Room.

240

b) Delivery table, Mcintsh sheets, Ambu bag/ suction, Steam Sterilizer, IUD Insertion kit,

Torch, Stove, Kerosene Oil, Slide for Blood Test and DDKs were not available at the visited

Sub Centres.

7. Community Satisfaction on overall Service:

Some of Mothers having one year old child were contacted in the area of visiting centres and

found that they were mostly satisfied with the services of ANMs. Similarly, villagers in the area

of PHCs expressed their satisfaction towards the services provided at PHCs.

8. Sample Verification of Family Welfare Acceptor:

a) Out of selected 139 acceptors of Family planning methods, 83 (60% ) acceptors could be

contacted for sample verification in the district. All acceptors were satisfied with the followup

services.

b) Out of selected 49 beneficiaries of child immunization, 32 (65%) children could be contacted

during field verification. All beneficiaries confirmed the doses of vaccines alongwith follow up

services.

9. Reconciliation of Sterilisation Figures:

The team verified the district level Sterilization figures reported for PHC Mohna for the year

2010-11 and found that as per District office, 148 Sterilization operations were conducted by

the PHC whereas the PHC Mohna reported 109 operations for the same period.

10. Maintenance of Register & Record:

a) Eligible Couple Register (EC) was not maintained at all in the visited institutions in the

district.

b) Sterilization register, IUD service register and child Immunization register were not

maintained properly at PHC Tigaon whereas it was not produced at PHC Mohana and Kurali.

c) Oral Pills, Condoms, ANC, PNC and Stock register were not produced at all the visited

institutions.

d) Sterilization case card was not issued to any of the visited institution.

e) Printed Eligible Couple Register, Register for family planning service, Stock register, Cash

book of Untied Funds and JSY Registration Card were not available at visited Sub Centre.

********

241

Jammu & Kashmir

District- Reasi

Major observation of Field Survey Unit (FSU) of Regional office for Health & Family

Welfare, Jaipur about evaluation work in Reasi district of J & K State in the month of

May, 2011.

I. Details of the visited Institutions:

District Visited CHC and PHC Visited HSC Visited

Reasi CHC: Katara

PHC:Dharmari & Pouni

Kanthi, Maslote,

Kheral-A & Kund-

Khanari

II. Major Observations:

1. Human Resources:

a) Acute shortage of technical manpower was observed in the district. One post each of

Surgeon, Radiologist, Anesthetic, Gynaecologist, Paediatrician, Ophthalmic, two posts

of Physicians of the 18 sanctioned posts of B-Grade Specialist, 10 post out of the 17

sanctioned posts of Dental Surgeons and 41 out of 72 sanctioned posts of Assistant

Surgeon were lying vacant in the district.

b) Similarly, 17 out of the 34 sanctioned posts of Jr. Staff Nurse, 34 out of 111 sanctioned

posts of Pharmacist, 6 out of the 7 sanctioned posts of MMPW, 19 out of the 99

sanctioned posts of FMPW and 6 out of the 10 sanctioned posts of LHV were also lying

vacant.

c) In the visited CHC Katara, one of three sanctioned posts of MO and only one

sanctioned posts of Assistant Radiographer was vacant.

d) Most of the posts of Specialists/Medical Officer and paramedical staff were filled up in

both the visited PHCs at Dharmari and Pouni. However, post of AYUSH Doctor

and LHV were vacant in PHC Dharmari.

242

2. Rogi Kalyan Samiti (RKS) &Village Health Sanitation Committee (VHSC):

a) As reported, 14 RKS were constituted in the district. In the visited CHC and PHCs, RKS

has been formed but its meeting was not being held on regular basis.

b) During visit to PHC Dharmari, it was observed that Rs. 2,075 was generated through

RKS in 2009-10, but no expenditure was incurred during the year and Rs.13274 was

spent, out of Rs. 23011 was generated till April, 2011 through RKS. Likewise, PHC

Pouni generated revenue of Rs.1,40,788 through RKS in 2009-10 and Rs.1,04,723 was

spent whereas, Rs. 2,08,130 was generated in year 2010-11and Rs. 96,498 was spent

till April, 2011.

c) 271 VHSCs were constituted in the district, out of which 173 VHSCs opened their bank

account. It was also observed that no fund was allotted to any VHSC in the district.

d) All VHSCs had ASHA as a member. No printed register was provided for recording the

proceeding of VHSCs.

3. Service of Janani Suraksha Yojana (JSY):

a) The beneficiaries were increasing due to JSY implementation in the district. Total 899,

1488 and 2321 institutional deliveries were reported in 2008-09, 2009-10 and 2010-11

respectively, showing an increasing trend.

b) Visited CHC Katara, PHCs Dharmari and Pouni were provided sufficient funds for

proper functioning of JSY. No fund was released to visited PHCs for current year 2011-

12 till the date of visit.

c) It was observed that JSY amount to beneficiaries was not being made at the time of

discharge from the Hospital at CHC Katara. Transportation amount to all those

beneficiaries who were not accompanied by ASHA was not paid by M.O.

4. Functioning of ASHA scheme:

a) 304 ASHAs out of required 943 ASHAs were functioning in the district and out of these

225 ASHAs had received 5th module training and provided drug kit.

b) ASHAs of all visited Sub Centres were not maintaining the record book/diary for their

routine activities. Neither did they prepare the Micro-Birth Plan of their area nor did they

prepare the list of adolescent girls. In Sub Centre Kund Khanari, PNC visit was not

being carried out by the ASHA.

5. Untied funds:

a) As observed, CHC @ Rs. 50,000, PHC @ Rs. 25000 and HSC @ Rs. 10,000 are given

untied fund every year in the district.

b) During visit to the different Health Centres in the district, the following status about

untied funds was observed.

243

(In Rupees)

Sl.No. Name of the Health

Centres

Year 2009-10

Year 2010-11

OB Fund

released

Exp. OB Fund

released

Exp.

1 CHC Katara 27784 50000 66934 10850 - -

2 PHC Dharmari 50000 25000 75000 - 25000 25000

3 PHC Pouni 3830 25000 25835 2995 25000 24776

4 HSC Moslote 21500 10000 205000 11000 NR Nil

5 HSC Kenthi 1058 10000 10000 1058 10000 10000

6 HSC Kheral 8965 10000 15543 3422 10000 12924

7 HSC Kund- Khanari 16294 10000 7729 18565 10000 27487

OB: Opening balance

c) Though there was sufficient opening balance during 2009-10 with CHC, Katara, PHC

Dharmari and HSCs at Maslote, Kheral and Kund-Khanari, full funds were released to

these centres during 2010-11.

d) Most of the HSCs spent their untied funds during 2009-10 and 2010-11. No fund was

spent at HSC Maslote during 2010-11.

6. 24 x 7 hours Delivery Care Services:-

a) It was reported that both CHCs and 3 out of 12 PHCs were functioning as 24x7 hours

delivery care services in the district. CHCs declared as functional FRU but there were

no functional Blood Storage Unit in the Centres.

b) At CHC Katara, Gynaecologist, Paediatrician, Anaesthetics and Surgeon were posted.

Labour room and OT were well equipped and also baby care room was available there.

c) At PHC Dharmari one MO and one AYUSH doctor was posted. New born care counter

was not established there. 65 deliveries were conducted in 2010-11 in the PHCs. At

PHC Pouri two AYUSH doctors were looking after the services. 132 and 165 deliveries

were conducted in the PHC during 2009-10 and 2010-11 respectively.

7. Physical Infrastructure and Stock Position:

i. CHC:

a) CHC visited at Katara was functioning in Govt. building having regular water &

electricity supply. The premises of the visited CHC were found neat & clean. There

were 30 beds. It had Labour room, well equipped OT and ICU.

b) Residential quarters for MOs and para-medical staff were not available at the CHC.

c) The Blood Storage Unit was not functional.

II. PHCs:

244

a) PHCs at Darmari and Pouni were functioning in Govt. building with having regular water

& electricity supply. The labour room was available at both visited PHCs Darmari and

Pouni but, telephone facility was not available at both the PHCs.

b) Condom, IFA tab (Large & Small) and Vitamin-A tab were not available in both PHCs.

BCG Vaccine vials was not available in Dharmadi PHC whereas, Polio Vaccine vials

and Vitamin-A Syrup were not available in Pouni PHC.

c) In PHC Dharmmari, the citizen charter was not displayed. There was no counter for

condom and oral polls. The available generic medicine board was not displayed at the

PHC. The complain and suggestion box were also not available at the PHC.

d) There were shortage of room in the PHC Pauni. The Citizen Charter was displayed in

the PHC. There was shortage of quarters for staff. This also affects the functioning of

PHC as 24 x 7 hour services. The available generic medicine board was not displayed

at the PHC.

III. HSCs:

a) Sub Centres Maslote and Kund Khanari were functioning in Govt. building, while Sub

Centre Kenthi was running in the rented house and Sub Centre Kheral was in ISM

building.

b) Cleanliness of all visited HSCs was good. Labour room, Hemoglobinometer, IUD, EC

Pills, Co-Trimoxazole, Chlorine Solution, Oxytocins tab and Gentamycine Inj. were not

available at all visited Sub Centres.

c) Electricity, Steam Sterilizer, Antiseptic Solution, Chloroquine and Ampacillin, Ambu bag,

Nischay Pregnancy Test Kit, IUD insertion Kit, RDT Kit, Torch, Gloves, Disposable

Syringes, DDKs and Sanitary Napkins were lacking in most of the Sub Centres.

d) Rapid diagnostic test kit, Infant weighing machine, Thermometer, Vit-A Solution, Oral

Pills Cycle, Condom , Paracetamol Tab, Metronidazole Tab were not available at

Maslote Sub Centre.

e) Toilet, Cupboard for drug, Foot Stool, Mclintsh Sheets, Delivery kit, Torch,

Thermometer, Glove, AD Syringes and Needles, ORS packet were not available at

Kenthi Sub Centre. Toilet facility and Ambu bag were not available at Kheral Sub

Centre.

f) Likewise, at Kund Khanari Sub Centre, Delivery kit, IUD insertion kit, IFA Tablet &

Syrup were not available.

8. Community Satisfaction on Overall Service:

a) The team contacted 21 mothers to know about the work of ANMs and their knowledge

on various health services. More then 50% contacted mothers informed that ANMs

were available when they needed most.

245

b) 14 (67%) deliveries of the contacted mothers were conducted by the trained persons

and 4 (19%) mother were visited at their home by the health personnel within 24 hour of

delivery, 7 (33%) mothers were visited within 3 days, 4 (19%) mother were visited

within 7 days of delivery and 5 (24%) mothers after 7 days of delivery.

c) 7 (33%) out of 21 contacted mothers had given breast feeding within half an hour of

delivery and rest 14 (67%) mothers started breast feeding within one or more hour. All

mothers were aware of exclusive breast feeding and complementary feeds.

d) It was reported that only 8 (38%) mothers received 3 PNC checkups. ARI awareness

was found in 6 (29%) mothers. 9 (43%) mothers knew the use of ORS. 19 (90%)

mothers were aware of usage of Contraceptive, but the knowledge of its side effects

was not known to 3 (14%) mothers.

ii. Towards the service of PHC:

a) The team visited Dharmari and Pouni PHC and found that the public of the area of both

the PHCs were satisfied with the services. X-Ray facility was not available in PHC

Dharmari.

b) No female staff was available in the the night duty at both the PHCs.

9. Maintenance of Register & record:

a) Maintenance of records was found to be poor at all visited facilities. Most of the

information was not filled in by ANM in Service Delivery Register. Due to non

availability of printed register ANMs were not maintaining the F.W. acceptors

records and thus team could not make sample verification.

b) No supervisory staff visited these facilities to check their Service Delivery Register

(SDR) in last three month. Printed stock register was not available at all visited facilities.

c) Case - cards for Cu-T were not supplied to all the institutions. No record of Nirodh user,

OP user, and Cu-T user was maintained by the ANM of the visited facilities.

d) The ANM of the visited facilities did not produce the EC register at the time of visit of the

team and no EC survey was conducted by the ANM of Sub Centre area. The

State/District authority should provide the printed register to all the ANM for Eligible

Couple Survey.

e) The printed labour room register was not available at the visited PHCs and CHC and

the essential information not recorded. The printed labour room register should be

provided to all the visited facilities containing all the required the column of information.

10. Other Observations and Suggestions:

a) Ward facility may be developed at PHCs Dharmari & Pouni.

b) The citizen charter should be displayed in Hindi or local language at PHCs and CHCs.

Complain & Suggestion box, Separate Counter for Condom and OP needs to be set up

at all the facilities.

246

c) The Hemoglobinometer may be procured for all the MPW (F) and the training may be

provided to them.

d) The district authority may ensure that all the staff should stay at the HQ particularly at

24x7 hour institutions and one female staff should be in PHCs in the night duty.

e) OP /Condom and IFA tab. be provided at Maslote and Khanari HSCs.

f) The ANM of visited HSCs do not insert CU-T. The training should be organised for them

for this work.

g) RKS meeting was not called regularly at visited PHC & CHC.

h) The AYUSH Doctor posted at PHC Dharmadi & Pouni has to perform the post mortem

in the absence of MBBS doctor and they were also conducting deliveries. The state /

district authority should organise training for the AYUSH doctors in this regard.

i) Transport charges was not being reimbursed to JSY beneficiaries who were not

escorted by ASHA or TBA/UTBA.

j) It was observed that Untied funds, AMG & VHSC funds were not utilised by the in-

charges of visited facilities during the corresponding year for which the funds were

allotted.

k) Most of the ASHAs of visited health facilities reported that they did not receive any

incentive from the Medical Superintendent for escorting of the pregnant women to

Jammu Hospital attached with medical college on demand of the relatives of the

pregnant women. The State/District authority should issue the instructions to the

Medical Superintendent of the Jammu Medical college & hospital that either give the

incentive to ASHA at the time of discharge of the JSY beneficiaries or issue the

attendance certificate to her, so that she may claim her incentive from the concerned

PHC/CHC of her working place.

******

247

Jharkhand

1.District:- Lohardaga

Major observations of Regional Evaluation Team, Patna about the Evaluation work in

Lohardaga district of Jharkhand State in April, 2011.

I. Details of the visited inspection:

District PHCs visited Sub-centres/ Areas visited

Lohardaga Lohardaga, Senha and

Kuru

Lohardaga (HQ), Chitri, Barahi, Shithiya,

Lawagaie and Hejala

II. Major Observations:

1. Human Resource:

Out of 46 sanctioned posts of ANMs there were only 35 but district get 111 more posts of

ANMs on contractual basis. Similarly, as against the sanctioned strength of 48 posts of MO/

Specialist,7 posts of GNM and 18 posts of LT there were 42, 6 and 1 post respectively but

district had also appointed additional 11 MOs/ SPe, 20 GNMs and 6 LTs on contractual basis.

However, many posts like 35 of 65 posts of MPW (M), 8 of 10 posts of LHV/HS and 22 of the

84 sanctioned posts of Gr. D Staff were still lying vacant in the district.

2. Functioning of Rogi Kalyan Samiti(RKS) and Village Health Sanitation Committee

(VHSC) :

a) As reported Rogi Kalyan Samiti (RKS) have been constituted in the district. Visited PHCs

were having RKS and the members of RKS meet quarterly.

b) VHSC at village level are constituted in the district.

c) As per the detail available, Rs.8,22,017 were spent out of Rs.41,40,000 available under

VHSC head for the year 2009-10. It appears that the activities were not conducted

satisfactorily as there was only 20% funds utilisation in 2009-10.

d) Rs. 36,99,370 were utilised in the district from the allotted funds of Rs. 1,67,97,983 for

VHSC for the year 2010-11(up to Feb.11).

3. Services of ASHA:

a) It has been reported that 476 ASHAs were in position and trained up to 4th modules.

b) Drug Kit was provided to only 334 ASHAs in the district. ASHAs are reported to be getting

performance based incentive regularly.

4. Untied Funds:

248

a) United funds were distributed at CHC, PHC and Sub Centre level in the district. There are 4

CHCs, 10 PHCs and 73 Sub- Centres in the district.

b) The district received Untied Fund of Rs.1,47,94,405 but spent only Rs. 92,801 in the year

2009-10. The reported expenditure for the year of 2010-11 was Rs.15,98,013 against the

available amount of Rs. 23,91,639/-

c) The CHC, PHC and Sub-Centre wise allotment and expenditure of untied fund for 2009-10

and 2010-11 is as given below .

Sl. No. Type of Institutions 2009-10 2010-11(up to Feb.11)

Fund

Available

Rs.

Expenditure

Rs.

Fund

Available

Rs.

Expenditure

Rs.

1 CHCs 2,50,000 63,300 4,36,700 2,89,819

2 PHCs 4,03,258 28,024 4,00,234 3,97,137

3 Sub-Centres 8,26,182 1,477 15,54,705 9,11,057

Total 1,47,94,40 92,801 23,91,639 15,98,013

5. Services under Janani Suraksha Yojana (JSY):

a) The district had utilised JSY funds to the tune of Rs. 47,64,157 in 2009-10 and Rs.

1,04,39,206 during 2010-11 (up to Feb.11 ) against the provision of Rs. 81,26,089 and Rs.

1,54,61,922 respectively.

b) During Sample verification, it has been observed that JSY cards and Imm. Cards were filled

properly. Some of mothers did not receive three consecutive cheeks up properly. The post

natal visits by the ANM/ASHA may be increased.

c) 25 JSY beneficiaries were selected for interview and 17 (64%) were contracted. Most of

them were registered for ANC in early stage of pregnancy. JSY packages was received by

them in time.

d) Supervisory checks for regular monitoring at HSC level was lacking.

6. Physical Infrastructure :

i. HSCs:

a) To check Infrastructuree status of availability of equipments, other supplies and drugs,

HSCs at Barahi and Lawagaie were visited and found that ANMs were staying at their Sub-

Centre head quarter. Electricity, water supply and labour room were not available there. Due

to the non availability of facilities, ANMs were not in a position to conduct delivery at the SC.

b) Benches, Ambubag/section, steam sterilizer were not available at the Centres . Cupboard,

Stove, Weighing Machine (Adult and infant ), Gloves and DDKs were not available in two of

three centres visited.

249

c) Drugs like Co-trimoxazole tab., OP cycles, E.C. pills, Metronidazole tab., Oxytocine tab.,

Ampicillin cap. and Gentamycin Inj. were not available at two of three places visited.

ii. PHCs:

a) Both the visited PHCs Senha and Kuru are functioning in Govt. Accommodation and the

maintenance of the building was satisfactory during visit.

b) Most of the items i.e., supplies and equipments were available in the centres visited.

Contraceptives (IUD, OP&CC), Stock of vaccines vials (BCG, DPT, OPV, MEASLES etc.)

were available but prophylactic drugs were not available at the visited PHCs.

c) Residential accommodation for MOs of PHC Kuru was not available.

7. Knowledge and Opinion of Community on Health Services:

i. ANM SERVICES:

30 mothers in the area of HSCs at Barahi, Shethiya and Lawagaie were interviewed. Most of

the mothers were not aware of ARI. It is felt that ANC and PNC services need to be geared up

to provide to all the mothers.

ii. MPW (M) Services:

Male worker at Sethiya was available but in other two SCs the post was vacant. Male worker

at HSC Shethiya participating in some programme relating to public health, immunization

camp and collecting of blood smear of fever patients. He visits also nearby primary school for

school health programme.

iii. PHC Level Services:

Villagers and some of the beneficiaries contacted under area of the PHCs Kuru and Shethiya

were happy with the services provided at PHCs. They were satisfied with the drugs availability

and visit to the remote area of the PHCs.

8. Sample Verification of Family Welfare Acceptors:

a) The team selected 72 F.W. acceptors out of which 46 (64%) acceptors could be contacted

in the district. Minor discrepancies were found in the age of spouse in 18 (39%) cases and in

the age of last child in 4 (9%) cases. Follow up services to the 31 (67%) acceptors were

observed to have not been provided by the Health Personnel.

b) Similarly, 33 beneficiaries of child immunization (BCG, Polio, DPT, Measles and Vitamin-A)

were selected and out of these 28 (84%) beneficiaries could be contacted. All the beneficiaries

confirmed to have received the doses as per record and no complication after providing the

doses was reported in the area visited.

9. Reconciliation of Reported Performances:

a) Reported figures for family planning for the year 2009-10 and 2010-11 could not be verified

with the service registers at visited PHCs Lohardaga and Senha due to non availability of

registers. There was no report for 2009-10 available to cheek the figure at above said PHCs to

250

confirm the achievement under various schemes. The reported figures under Oral Pills and

Nirodh scheme were not available at district office also.

b) Sterilisation and IUD figures reported by district office for the PHCs Lohardaga, Senha and

Kuru for the year 2010-11 did not tally when compare with the same figures available at

respective PHC H.Q.

Sl. No.

Name of the PHC

For the year 2010-11

Sterilization IUD

Reported

by DFWB

Reported

by Centres

Reported

by DFWB

Reported

by Centres

1 Lohardaga 29 92 39 100

2 Senha 115 157 120 88

3 Kuru 253 334 222 363

10. Maintenance of Records & Registers:

a) Register maintained for MCH Services were in printed form.

b) Family Planning registers maintained for Ste. Cu T, OP and Nirodh were not in printed form.

The registers were not maintained properly.

c) JSY payment register was also not maintained properly at the visited centres.

d) It was observed that the information was not properly collected by the visited centres on

mother and child tracking. The workers and concerned officers needed training in this regard.

11. Other Observations:

a) During field visit, some of the rural areas were still inaccessible for providing institutional

delivery services. In that area, home deliveries were conducted by untrained persons.

b) Performance under NSV was poor in the district.

c) Supervision at the visited centres was almost nil.

*******

2.District:- Garhwa

Major observations of Regional Evaluation Team, Patna about the Evaluation work in

Garhwa district of Jharkhand State in April, 2011.

I. Details of the visited inspection:

District PHCs visited Sub-centres/ Areas visited

Garhwa Garhwa, Meral, Majhiyao

and Ranka

Garhwa (HQ), Kalyanpur, Okhalgara,

Kushaha, Khajuri and Khardiha

251

II. Major Observations:

1. Human resource :

It was observed that there was acute shortage of manpower in the district. As reported 126 of

the 195 sanctioned posts of Medical Officer/ Specialists, 19 of the 27sanctioned posts of Lab

Technician, 21 of the 85 sanctioned posts of MPW (M) and 162 of the 343 sanctioned posts of

ANM were lying vacant.

2. Functioning of Rogi Kalyan Samiti (RKS) and Village Health Sanitation Committee

(VHSC):

a) As reported most of all the centres/institutions constituted have Rogi Kalyan Samiti (RKS) in

the district and the visited PHCs were having RKS. However, regular meetings of all RKS

were not being conducted in the district.

b) VHSC at village level are constituted in the district.

c) As per the details available, Rs. 50,561 (2.3%) were spent out of total fund of Rs. 21,66,881

available for this scheme for the year 2009-10. It is appears that the VHSC activities were not

being conducted satisfactorily as only 2% funds were utilised during 2009-10.

d) Rs. 19,03,214 have been utilised in the district out of available fund of Rs. 21,16,320 for

VHSC for the year 2010-11(up to March, 2011).

3. Services of ASHA:

a) It was reported that 1127 ASHAs were selected and 1125 ASHAs were trained up to 5 th

modules.

b) Drug Kits were not provided to ASHAs in the district.

4. Untied Funds:

a) The district received Untied Fund of Rs. 43,11,130 and spent only Rs. 14,16,436 (32.8%) in

the year 2009-10. Out of Rs.39,19,555 available with the district, Rs.37,42,207 (95.5%) were

spent during the year 2010-11(upto February, 2011).

b) The CHC, PHC and Sub-Centre wise allotment and expenditure of untied fund for 2009-10

and 2010-11 (upto February, 2011) is as given below.

Sl.

No.

Type of

Institutions

2009-10 2010-11(up to Feb.11)

Fund Available

Rs.

Expenditure

Rs.

Fund Available

Rs.

Expenditure

Rs.

1 CHCs 5,20,538 1,78,475 8,76,924 8,25,294

2 PHCs 5,59,200 9,0178 3,69,022 3,61,400

3 Sub-Centres 32,31,392 11,47,783 26,73,609 25,55,513

Total 43,11,130 14,16,436 39,19,555 37,42,207

252

5. Services of JSY:

a) The district had utilised its JSY fund Rs. 1,51,26,894 (76.9%) in the year 2009-10 and Rs.

3,49,81,689 (86.8%) during 2010-11 (up to Feb.11 ) against the allotment of Rs. 1,96,62,603

and Rs. 4,02,84,859 respectively.

b) During Sample verification, it was observed that JSY cards and incentive was not received

by some of the mothers. Further, three consecutive checks up and post natal visits need to be

increased.

6. Physical Infrastructure :

i. HSCs:

a) To check the status of equipments and other supplies at visits were made to 4 HSCs at

Kusha, Okhalargara, Kalyanpur and Khajuri and it was observed that Electricity, water supply

and labour room were not available there. Due to the insufficient facilities, the ANMs were not

in a position to conduct delivery at these SC.

b) Ambu bag/section, Steam Sterilizer, Stove, Gloves, DDKs and Vitamin-A solution were not

available in most of the centres visited.

c) Drugs like IFA Tablets/ Syrup, OP cycles, Ampicillin cap. and Gentamycin Inj. were not

available at two of four SCs visited. ii.

PHCs:

a) PHCs Manjhiyao and Moral visited. Both PHCs were functioning in Govt. accommodation

and the maintenance was satisfactory.

b) Maximum items i.e., supplies and equipments were available at the places visited.

Contraceptives (IUD, OP & CC), Stock of vaccines vials (BCG, DPT, OPV, Measles etc.) were

available but prophylactic drugs were not available at the visited PHCs.

7. Knowledge and Opinion of Community on Health Services:

i. ANM Services:

a) During the visit, 12 mothers in each SCs i.e. Kusha, Khajuri Okhalargara and Kalyanpur

were interviewed and found that all ANMs of the selected 4 SCs were available when needed.

Home deliveries were conducted by trained persons using DDK.

b) Most of the mothers were not aware of ARI. It was also observed that ANC and PNC

services need to be geared up to cover all the mothers.

8. Sample Verification of Family Welfare Acceptors:

a) During visit to the district, the team contacted 59 (57.2%) F.W. acceptors out of total 103

selected. Discrepancies were found in the age of spouse in 22 (48%) cases. Follow up

services to the 21 (46%) acceptors were observed to have not been provided by the Health

Personnel.

b) 16 beneficiaries of child immunization were also contacted in the district. All the

beneficiaries confirmed receiving the doses but did not receive follow up services..

253

9. Reconciliation of Reported Performances:

a) There was no Service register maintained for Sterilization acceptors for the year 2009-10 at

PHC Moral , Majhiyao and Ranka and hence, reported figures could not be verified.

b) Reported figures for IUD for 2009-10 and 2010-11 did not tally with each other at reporting

centres and at district office. Similarly, OP and Nirodh figures reported by District office for the

year 2008-09 and 2009-10 did not tally with those available at the visited centres.

c) The Sterilization and IUD acceptors reported by DFWB and by the visited centres for the

year 2010-11 are as reported below:

Sl.

No.

Name of the PHC

For the year 2010-11

Sterilization IUD

Reported

by DFWB

Reported

By Centres

Reported

by DFWB

Reported

by Centres

1 Garhwa 585 583 55 264

2 Moral 193 197 185 67

3 Majhiyao 507 510 210 209

4 Ranka 484 484 79 95

10. Maintenance of Records & Registers:

a) Family Planning registers maintained for Sterilization, Cu T, OP and Nirodh were not in

printed form. These registers were not maintained properly.

b) JSY payment register was also not maintained properly at the visited centres.

c) The team observed that the information is not being properly collected in the visited centres

on mother and child tracking. The workers and concerned officers needed training in this

regard.

11. Other Observations:

a) It was observed that performance of Family Planning was poor in the district.

b) It was found that no prescribed Proforma was maintained in respect of Cu.T, OP/Nirodh

distribution and ANC/PNC in selected institutions in the district.

c) It was also observed that the members of NRHM Management Supporting Units at

District/CHC/PHC level were not having adequate knowledge about latest guidelines of

different programmes under NRHM. Therefore, re-orientation training was highly required.

d) Performance of NSV was found very poor in the district.

*****

254

3.District:- Chatra

Major observations of Field Survey Unit (FSU), Patna on the Evaluation work carried

out in Chatra district of Jharkhand State in the month of August, 2011.

I. Details of the visited Institutions:

District Visited PHCs visited SCs Visited

Chatra PHCs: Simaria and Hunterganj Bagra, Belgada, Pandeypura &

Orugerua

II.Major Observations:

1. Human Resources:

a) As reported there was shortage of health personnel in some of the key categories. 33 out of 54

sanctioned posts of Medical Officer, 37 out of 164 sanctioned posts of ANMs, 27 out of 50

sanctioned posts of GNMs and 19 out of 70 sanctioned posts of MPW (M) were lying vacant in

the district. The status of other categories of staff was not made available to the team.

b) 2 out of 4 sanctioned posts of Medical Officer, 11 out of 18 sanctioned posts of ANMs, the

only sanctioned post of Pharmacist and 2 sanctioned posts of LHV were vacant in the visited

PHC, Hunterganj. Similarly, 4 out of 8 sanctioned posts of Medical Officer, one out of 2

sanctioned post of ANM and the sanctioned post of LHV was vacant in PHC Simaria.

2. Rogi Kalyan Samiti (RKS) & Village Health Sanitation and Nutrition Committee

(VHSNC):

a) 12 RKS (in Referral Hospital, 5 CHCs and 6 PHCs) were constituted in the district and

regular meetings of RKS were being conducted in visited PHCs.

b) It was reported that 1425 VHSCs have been constituted in the district and all VHSCs were

having ASHA as a member. In the visited HSCs, ASHA was one of the member of the

committee.

c) An amount of Rs. 1,03,80,000 was available as VHSC fund with the district in the year 2010-

11 and district had spent Rs. 72,90,497 during the year. The balance amount of Rs. 30,89,503

was carried forward to the year 2011-12 and only Rs. 11,30,000 could be spent till the visit of

the team.

3. Service of Janani Suraksha Yojana (JSY):

a) 9940 deliveries in the year 2010-11 and 2966 deliveries in 2011-12 upto visiting month were

identified for getting JSY benefit in the district and all the beneficiaries in both the years were

provided with JSY incentives.

b) It was reported that the budget to the tune of Rs. 1, 23, 87,737 and Rs. 87, 24,772 was

available under JSY during 2010-11 and 2011-12 respectively in the district. The expenditure

255

to the tune of Rs. 77,84,937 in 2010-11 and Rs. 32,11,775 in 2011-12 was incurred under

JSY.

c) In the visited PHCs Simaria and Hunterganj JSY status as reported is given below:

Sl. No. Particulars PHC Simaria PHC Hunterganj

2009-10 2010-11 2009-10 2010-11

1. No. of deliveries eligible for payment

under JSY

1864 895 1800 575

2 No. of beneficiaries to whom JSY fund

paid

1864 895 1800 575

4 Total fund received 36,15,00

0

13,00,00

0

36,00,00

0

13,00,000

5 Expenditure incurred under JSY 32,11,77

5

12,99,89

5

36,00,00

0

11,50,000

d) 18 JSY beneficiaries were contacted for sample verification in the visited area of the centres

and it was found that all contacted beneficiaries received JSY incentives.

e) All beneficiaries were provided three Ante Natal Checkups (ANC) and MCH cards. All of them

were provided with transport facilities by ANM/ASHA and they were accompanied by ASHAs

to Health Centes at the time of delivery.

4. Functioning of ASHA Scheme:

a) It was reported that there were 1609 ASHAs in position in the district. Out of them, 1432

ASHAs trained up to 5th modules and also provided drug kits to them.

b) 210 and 287 ASHAs were in position in the visited PHCs Simaria and Hunterganj respectively.

All ASHAs were trained up to 5th modules and were having drug kit as well in the PHCs.

c) Performance of ASHA under NRHM was satisfactory. Incentive money was paid in time to

ASHAs under JSY scheme.

5. Untied Funds:

a) Provision and expenditure of Untied Fund in the district is as reported below:

(in Rs.)

Particulars

for CHCs for PHCs for HSCs

2010-

11

2011-12 2010-11 2011-

12

2010-11 2011-12

Untied funds Received 579227 1,807* 3,56,000 33,628* 27,73,236 2,70,491*

Expenditure incurred 577420 Nil 3,22,372 3,200 25,02,745 7,716

Balance 1807 1,807 33,628 30,428 2,70,491 2,62,775

* Opening balance.

256

b) In visited PHCs at Simaria and Hunterganj, no Untied Fund for the year 2011-12 has been

released till the visit of team. Both the PHCs utilized their full allotment of Untied Funds for last

year 2010-11.

6. 24 x 7 Hours Delivery Care Services:

a) There were one Sadar Hospital, Chatra and 5 CHCs viz. Simariya, Ithkhori, Hunterganj,

Tandawa and Partapur providing 24x7 delivery care service in the district but no Specialist was

posted at any institution except CHC Simariya.

b) Total number of deliveries conducted in CHC Simaria and PHC Hunterganj were 1864 and

1800 during 2010-11 respectively and in 2011-12 the number of deliveries were 895 in CHC

Simaria and 575 in PHC Hunterganj.

7. Physical Infrastructure and Stock Position:

i. PHCs

a) PHCs visited at Simaria and Hunterganj were functioning in Govt. building with the facilities

of Electricity and Telephone, Drinking water and also Public Utility (Toilet).

b) 24x7 hour service are given at the visited PHCs.

c) Shortage of IFA large tablet and Vitamin „A‟ tablets was observed in the PHCs.

d) Post of AYUSH Medical Officers was not filled in the PHCs.

ii. HSCs:

a) All visited Sub Centres viz. Bagra, Belgeda and Pandeypura were working in Govt. building

except SC Orugerua which was functioning in rented building. Almost all visited HSCs were

having hand pump for drinking water. Electricity, Toilet and Labour room facility found

available in the visited HSCs.

b) Delivery table, Mcintsh sheets, Ambu bag/suction, Steam Sterilizer, IUD Insertion kit and

Stove & Kerosene Oil was not available at the visited Sub Centres.

8. Community Satisfaction on Overall Health Services:

Public opinion in the area of Sub Centres and PHCs visited was observed to be good towards

the services rendered by ANMs and PHC MOs/Staff.

9. Sample Verification of Family Welfare Acceptors:

a) The team selected 38 FW acceptors and contacted 21 acceptors for sample check. All the

acceptors had received FW services and also payment for Sterilization was made to

contacted beneficiaries as per norms.

b) Besides above 21 beneficiaries out of 31 selected child immunization were contacted, all

beneficiaries confirmed the doses and expressed satisfaction. Follow up services were

provided to all of them. No complication was found among them.

10. Reconciliation of Reported Performance:

a) Achievement under Family Planning was not made available at District Office for the year

2010-11 and 2011-12.

257

b) Reported figures for Sterilization for the year 2010-11 and 2011-12 (upto July, 2011) by the

district office did not match with the figures available at PHCs head quarters at Simaria and

Hunterganj.

11. Maintenance of Registers & Records:

a) Eligible Couple Register (EC) and Sterilization Register were not maintained at both the

visited PHCs Simaria and Hunterganj in the district.

b) IUCD Service Register, Child Immunization Register, Oral pills, Condom, ANC, PNC and

Stock register were not made available at all the visited institutions.

c) Sterilization case card was not issued to any visited institution.

d) Printed Eligible Couple Register, Register for Family Planning Service, Stock Register,

Cash Book of untied funds and JSY registration Card were not available at visited Sub

Centres.

4.District:- Dumka

Major observations of Field Survey Unit (FSU), Patna on the Evaluation work carried

out in Dumka district of Jharkhand State in the month of August, 2011.

I. Details of the visited Institutions:

District Visited PHCs Visited HSCs Visited

Dumka Saraiya hat, Jama &

Jarmundi

Berhat-1, Chorbatiya, Chikaniya, Silanda,

Dhanadih, Sahara, Jamna & Basukinath

II. Major Observations:

1. Human Resources:

a) Acute shortage of the staff was observed in the district. As informed there were totally

1519 class III and class IV categories of the posts sanctioned and out of those 528 posts were

lying vacant in the district. A large no. of posts of key functionaries in the different health

centres/institutions was also vacant as given below:

S. No. Particulars Sanctioned In position Vacant

1 M.O 107 95 12

2 ANMs 328 290 38

3 ANM(Contractual) 240 174 66

4 Nirikshak 20 5 15

5 Nigrani karykarta 69 10 59

6 LHV/HS(F) 39 19 20

7 Health Worker 112 84 28

258

8 Health educator 28 17 11

9 Pharmacist 38 3 35

10 BCG Technician 5 0 5

District/State authority needs urgent step to fill up the vacancy.

b) Staff position in CHC Saraiyahat was satisfactory in comparison to the sanctioned

strength.

2. Rogi Kalyan Samiti (RKS) &Village Health Sanitation and Nutrition Committee

(VHSNC):

a) As reported, Rogi Kalyan Samiti (RKS) was constituted and got registered at different

health centres in the district. Regular meeting of RKS was observed to be conducted in visited

PHCs.

b) It was reported that 2260 of the total 2722 villages in the district have been covered under

Village Health Sanitation and Nutrition Committee and all VHSNCs having ASHA as a

member.

c) An amount of Rs. 2,29,12,748 was available as untied funds for VHSNCs with the district in

the year 2010-11 out of which an expenditure to the tune of Rs. 1,57,86,347 were made. The

balance amount was carried forward to the next year 2011-12 and no regular fund was

provided for current year to the district till the time of visit by team.

3. Service of Janani Suraksha Yojana (JSY):

a) Janani Suraksha Yojana was being implemented properly in the visited institution.

Institutional deliveries were being conducted at PHCs level and JSY fund was provided to the

visited PHCs in time.

b) It was reported that the budget to the tune of Rs. 1,34,54,312 including opening balance

was available in the district in 2011-12 and Rs. 72,23,376 was spent.

c) JSY status in the visited PHCs was as reported below:

Sl.

No

.

Particulars PHC Saraiya hat PHC Jama PHC Jarmundi

20010-11 2011-12 20010-11 2011-12 20010-11 2011-12

1. No. of deliveries eligible

for payment under JSY

1455

725 709 257 1840 630

2 No. of beneficiaries to

whom JSY fund paid

1455

725 700 221 1668 558

3 No. of beneficiaries yet

to be paid JSY fund

-

-

9 36 172 72

4 Expenditure incurred

under JSY (in Rs.)

33,53,600

16,03,

810

17,11,38

0

4,85,850 37,15,95

0

12,95,

250

259

d) It was observed that funds were utilised but JSY payment Register was not being

maintained properly. During field visit, 38 JSY beneficiaries were contacted in the area visited

and observed that all beneficiaries have received cash incentive under the scheme.

4. Functioning of ASHA scheme:

a) It was reported that there were 2583 ASHAs selected as against the target of 2722 in the

district. Out of them, 2316 ASHAs were trained in all modules, but drug-kits provided to 2449

ASHAs.

b) During visit to the PHCs, it was observed that these PHCs were having ASHAs and

activities under taken by the ASHAs under NRHM were found satisfactory. They are getting

incentives in time.

5. Untied funds:

a) CHC @ Rs. 50,000, PHC @ Rs. 25,000 and every Sub Centre @ Rs. 10,000 are given as

untied funds every year in the district. The status of Untied Funds at CHC, PHC and SC level

are given below:

(in Rs.)

Sl. No. Name of the centres Total fund available * Total expenditure

2010-11 2011-12 2010-11 2011-12

1 For CHC 8,06,475 5,02,239 8,04,236 13,827

2 For PHC

17,35,401

1,22,347 16,13,054 17,460

3 For SCs 67,16,785 7,01,938 60,14,847

.

2,04,999

* Including opening balance.

b) In the visited PHCs, it was observed that untied fund was provided to them and most of the

funds were utilised during last two years.

6. 24 x 7 Hours Delivery Care Services:

a) 24x7 hour delivery care services are being provided by 8 CHCs in the district.

b) It was reported that most of the CHCs were having 2 or more Doctors and 6 to 8 SN/ANMs.

There was no Specialist available at CHC level.

7. Physical Infrastructure and Stock Position:

i. PHC:

a) In the district, 50% of the PHCs (out of total 34) were functioning in Govt. building.

b) All visited PHCs (Saraiya hat, Jama & Jarmundi) were functioning in Govt. building with the

facility of electricity and telephone. Drinking water facility was available within the campus.

Toilet facility for staff and patient was available, but sanitation was not maintained properly.

c) Residential quarter for Medical Officer was available.

d) 24x7 hours services were being provided at the visited PHCs, but labour room and

maternity wards were unhealthy for delivered mothers and new born babies.

260

e) Specialists and AYUSH Medical Officer were not posted in these PHCs.

f) Stock of contraceptive and vaccines vials was available but IFA (Large) were not available

at visited institutions.

ii. HSCs:

a) In the district out of the total 249 HSCs, only 86 were functioning in Govt. building.

b) HSC Berhat-1, Chikaniya and Basukinath were functioning in Govt building. HSC Sahara

was functioning in a rented building. HSC Chorbatiya and Dhanadih were functioning in rent-

free building, HSC Silanda was functioning in AWC building and HSC Jamna was functioning

in school building.

c) Almost all HSCs use hand pump for drinking water. Electricity was available at all visited

Sub Centres except Jamna. Toilet facility and labour room was not available at visited HSC

except Basukinath.

d) ANMs in charge of the visited Sub Centre was not staying at their Sub Centres.

e) Mcintsh sheets, Ambu bag/ suction, steam sterilizer, IUD Insertion kit and Kits-A & B were

not available at the visited Sub Centres.

f) Printed Stock register, cash book for untied funds and JSY registration cards were not

available at visited Sub Centres.

8. Community Satisfaction on Overall Services:

i. Towards HSC’s service:

Mother having child up to one year old interviewed at visited Sub Centre and they were found

to be satisfied with the services rendered by the ANMs. Mothers were aware and also

satisfied having MCH and JSY services under NRHM.

ii. Towards PHC’s service:

a) The team interviewed some Mothers (ANC, PNC and with 2 years old child), AWW,

ASHAs, and village leaders in the PHC areas and found that MCH services were being given

properly in these areas. Women were also being advised for adoption of F.W methods.

b) Villages were mostly happy with the services provided at PHC head quarters.

9. Sample Verification of Family Welfare Acceptors:

a) The team selected 92 F.W. cases, out of which 66 (72%) cases could be contacted. While

examining the data in the service registers, it was observed that age of Spouse of the

acceptors was not recorded.

b) Follow up services was provided to all contacted cases and also payment for sterilization

was made to the beneficiaries as per norms.

c) Out of 26 selected, 23 beneficiaries of child immunization were contacted, all beneficiaries

confirmed the doses and expressed their satisfaction towards the services. Follow up services

were provided to all of them. No complication was found among them.

261

10. Reconciliation of Reported Performance:

Reported figures for Sterilization, Cu.T, Oral Pills and Condom for the year 2010-11 and 2011-

12 (upto May, 2011) could not be verified with the service registers at visited PHCs Saraiya

hat, Jama and Jarmundi as the reports were not made available by District Office.

11. Maintenance of Register & Records:

a) Eligible Couple Survey Register and Sterilization registers were not maintained properly at

the visited institutions in the district.

b) IUCD Service Register, Oral Pills Service Register and Condom Service Register were not

produced in the visited institutions.

c) MCH Service Register and Child Immunization registers were not maintained properly.

d) Stock Register of IUCD, Oral pills and Condom was not produced in the visited institutions.

e) Sterilization case card was not issued to any visited institutions.

12. Other Important Observations and Suggestions:

1) Eligible Couple Survey was not being conducted for a long time at PHC/ HSC level and due

to this ECR was not being maintained by the concerned HSCs.

2) Lack of supervision was observed in the district.

5.District:- Koderma

Major observations of Regional Evaluation Team, Patna about the Evaluation work

carried out in Koderma District of Jharkhand State in the month of October 2011.

I. Details of the visited Institutions:

District CHC Sub Centres

Koderma Satgawa, Koderma & Jainagar Dhab, Maranchi, Ramdih, Jhanjhideh.

Chhatarwar, Chachi, Gonal, Behradin

& Bogodiha.

II. Major Observations:

1. Human Resources:

a) Latest status of staff position in the health Sector was not made available to the team at

District office. However, as reported 26 of the 67 sanctioned posts of Medical

Officer/Specialists and 45 out of 150 sanctioned posts of ANMs were vacant in the district.

b) 6 sanctioned posts of Specialists were vacant at CHCs Jainager and Satgawa.

2. Rogi Kalyan Samiti (RKS) &Village Health Sanitation and Nutrition Committee

(VHSNC):

262

a) It was reported that Rogi Kalyan Samiti (RKS) was constituted in different health facilities in

the district. Regular meetings of RKS were not being conducted in the visited centres.

b) 555 Village Health Sanitation & Nutrition Committees (VHSNCs) have been constituted in

the district.

c) Though, funds were being provided regularly, utilization of VHSNC funds was poor in the

district. An amount of Rs. 37,50,000 was available as untied fund for VHSNC in the district for

the year 2010-11, out of which, an amount to the tune of Rs.16,01,649 (43%) was spent. No

untied fund for the year 2011-12 was provided to the district up to the time of visit. The district

has spent Rs. 1,10,000 up to September, 2011 from the last year unspent amount of Rs.

21,48,351.

d) Availability and utilisation of VHSNC funds in the visited CHCs as reported is given below:

(Amt. in Rs.)

Type of

institution

2010-11 2011-12 (up to September 11)

Fund

available

Expend

iture

Balance

% of

fund

Utilized

Fund

availabl

e

Expendi

ture

Balanc

e

% of

fund

Utilized

CHC Sadar,

Kodarma

6,50,000 NIL 6,50,000 0 6,50,000 40,000 6,10,00

0

6.15

CHC

Jainagar

3,50,000 1,57,85

4

1,92,146 45.10 1,92,146 10,000 1,82,14

6

5.2

CHC

Satgawa

8,70,000 4,37,65

2

4,32,348 50 6,92,348 NIL 6,92,34

8

0

3. Service of Janani Suraksha Yojana (JSY):

a) To benefit the JSY mothers and for proper implementation of the scheme, budget to the

tune of Rs. 1,21,95,343 during 2010-11 and Rs.1,51,24,342 during 2011-12 was provided to

the district. The utilization was Rs. 1,08,51,501 (88.98%) in 2010-11 and Rs. 56,27,185

(37.21%) during 2011-12 (till Sept. 2011).

b) Details of utilization of JSY funds at visited CHCs are as under:

Type of

institutio

n

2010-11 2011-12 (up to September 11)

Fund

availabl

e

Expenditure

Balance

% of

fund

Utilized

Fund

availabl

e

Expenditu

re

Balanc

e

% of fund

Utilized

CHC

Sadar

Kodarma

12,56,9

50

5,47,900 7,09,050 43.6 7,09,05

0

7,01,050 8,000 98.8

263

CHC

Jainagar

8,85,92

0

6,80,000 2,05,920 76.8 5,05,92

0

3,06,750 1,99,17

0

60.6

CHC

Satgawa

23,27,7

00

23,27,700 NIL 100 15,00,0

00

5,25,100 9,74,90

0

35

c) 6 JSY beneficiaries were contacted in the visited centres and it was found that MCH cards

were issued to all of them. Three consecutive ANC check ups were given in time. Payment of

JSY package to beneficiaries was also made in prescribed time. Most of the mothers were

delivered at government hospital and involvement of ASHA to accompany the mother to

hospital was satisfactory in the district.

d) It was observed that more attention should be given to fill up JSY cards and immunization

cards with all the information by the ANMs.

4. Functioning of ASHA scheme:

a) Instead of requirement of 763 ASHA for 653 villages, 619 ASHAs were in position in the

district; all ASHAs were trained in all modules. However, only 58 ASHAs have been provided

with drug kits in the district.

b) ASHAs in the district were being provided performance based incentive. As per the details

received from the district, only Rs. 5,000 were said to ASHAs in the year 2010-11 and Rs.

16,500 during 2011-12 (up to Sept. 2011) against the total allotment of Rs. 29,000 and Rs.

1,86,000 respectively.

5. Untied funds:

a) The total untied funds to the tune of Rs. 18,69,321 during 2010-11 and Rs. 13,64,735

during 2011-12 ((up to September, 2011) were available in the district. Out of available funds,

an amount of Rs. 13,54,586 (72%) in the year 2010-11 and Rs. 85,986 (6%) in the current

year up to September, 2011 was spent in the district.

b) Utilization of untied funds at CHCs, PHCs and SCs level is as follows:

(Amount in Rs.)

Type of

institutions

2010-11 2011-12 (up to June,2011)

Fund Available

Expenditure

Balance

Fund

Available

Expendit

ure

Balance

CHCs 2,75,462 2,53,708 21,754 2,21,754 21,915 1,99,839

PHCs 3,00,000 67,350 2,32,650 2,32,650 36,095 1,96,555

Sub centres 12,93,859 10,33,528 2,60,331 9,10,331 27,976 8,82,355

c) During visit to SCs, it was found that the untied funds were being utilised and cash books

were maintained properly.

264

6. Utilization of Referral Transport funds:

Utilization of Referral Transport funds was very poor in the district. An amount of Rs.1,77,744

was available for the year 2010-11 out of which, Rs. 22,261 (12.5%) was utilised. Further,

against the available fund to the tune of Rs. 2,25,477 for the year 2011-12, only an amount of

Rs.15,600 (0.7%) was utilised till September, 2011.

7. Annual Maintenance Grant (AMG):

Total Annual Maintenance Grant (AMG) for CHCs, PHCs and Sub Centre in the district was

received to the tune of Rs. 21,88,103 for the year 2010-11, out of which Rs. 12,12,809

(55.4%) was spent during the year. An amount of Rs. 13,75,294 was available for the year

2011-12 out of which Rs. 50,105 (3.6%) was utilized till September, 2011.

8. 24 Hours Delivery Care Services:-

The scheme, 24x7 delivery service was not introduced for rural centres in the district.

9. Physical Infrastructure and Stock Position:

i. CHC:

a) Most of the PHCs have been upgraded as CHCs in the State of Jharkhand and the district.

It was found that visited CHCs were functioning in their own building, but maintenance of

hospital building was not up to the mark. Water supply and electricity with power back-up were

available at CHCs Jainager and Satgawa. Condition of beds in CHCs Jainager and Satgawa

was poor.

b) X-Ray facility, Blood storage unit, Anesthesia equipment, Arteether injection and Quinine

injections were not available at CHCs Jainager and Satgawa. Neonatal Resuscitation

equipments and Sick New born care unit was not available at Jainagar CHC whereas

Resuscitation equipment was not available Satgawa CHC.

ii. HSCs:

a) HSC Chachi was running in Govt building and HSC Chhatarwar was running in private

building, Drinking water, Electricity and Toilet facility was not available at both visited HSCs

Chachi & Chhatarwar. Building of Chachi SC required major renovation.

b) ANMs of the visited Sub Centres were not staying at their H.Q. or jurisdiction villages.

Mobile phone was provided to ANM at Chachi HSC but not to ANM of Chhatarwar HSC.

Labour Room was not available at both HSCs Chachi & Chhatarwar.

c) Ambu bag / suction, Steam Sterilizer, Nischay Pregnancy Test Kit, Delivery Kit, RDT Kit for

Malaria was not available at both HSCs Chachi & Chhatarwar, whereas Examination Table,

Foot Stool and Stove were not available at Chhatatwar HSC and Mcintsh sheets, IUD

Insertion kit and Torch were not available at Chachi HSC.

d) DDKs, IFA Tablet/Syrup, Misofrostol, Magsulth and Oxitocine tablets, Ampicillin Capsule,

Gentamycine injection and Kit-A & Kit-B (for current year) were not available at both visited

HSC, whereas Co-trimoxazole tab, E.C.Pills, Paracetamole tab were not available at

265

Chhatarwar HSC, Antiseptic solution, Chloroquine tab and Metronidazol tab were not

available at Chachi HSC.

e) Eligible Couple Register, Family planning Service register and JSY Card was not available

at both HSCs Chachi & Chhatarwar whereas Stock register, Formats for monthly reporting and

Cash book of Untied funds were not available at Chachi HSC.

f) Building of both Sub Centres Chachi & Chhatarwar was not maintained properly for clinic

purpose. Posters for public awareness were not properly displayed on the wall of the centre.

There was lack of checking/verification of service register by PHC/District officials/

supervisor/DPHN/BEE etc.

g) The post of Heath Worker (Male) was lying vacant since more than 5 years in both SCs.

10. Community Satisfaction on overall service:

i. HSC’s Service:

a) 20 mothers were interviewed to assess their opinion regarding quality of services rendered

by ANMs in the visited centres. The interviewed mothers of both visited HSCs Chachi &

Chhatarwar replied that ANM were not available when needed, but they provided IFA and TT

to pregnant women if available at the time.

b) Home deliveries were conducted by trained person with using DDK. Most of Mothers told

that they had no idea about ARI sufficiently. Performance of family planning was very poor.

Necessary information need to be given to mother by the concerned ANM and ASHAs.

ii. PHC Staff and Medical Officer:

The knowledge and opinion of the community regarding the behaviour and stay at PHC of

PHC staff, regular visit of MO at CHCs, utilizing sufficient time in examine the patient and

disbursing drugs were found satisfactory. It was observed that the services under MCH

Scheme to pregnant women, recently delivered women and to the children needed more

attention to improve the quality. However, MO of Satgawa CHC visited his villages in regular

basis.

11. Sample Verification of Family Welfare Acceptors:

a) Out of 115 selected Family planning acceptors, 59 (51.3%) could be contacted in the

district. During sample verification of sterilisation and IUD acceptors. It was found that age of

spouse of 43 acceptors and age of last child in 22 acceptors were wrongly recorded.

b) 35 (70%) acceptors replied that they had received follow up services by the health

personnel.

c) 2 OP users were contacted and both users denied receiving the service. Similarly, all 7

contacted Nirodh users denied receiving the services.

d) Most of the contacted sterilization acceptors received full compensation money.

e) 6 contacted child immunisation beneficiaries confirmed receiving the doses.

12. Maintenance of Registers & Records:

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a) ANC / PNC and Children immunization Register were maintained properly. But Sterilization,

Cu-T, OP & Nirodh distribution registers were not maintained properly at the visited centres.

b) JSY payment register was also not maintained properly. Complete addresses of the

beneficiaries were not recorded and in some cases, no address was recorded.

c) Stock Register in respect of family welfare items were not maintained properly. Date of

Manufacturing & Expiry, Batch No., Model No. of Cu-T etc were not recorded.

13. Other Observations:

a) The condition of labour room and maternity ward was very poor and unhygienic at both

CHCs Jainagar and Satgawa. No privacy of mother was maintained as there was no restriction

to enter labour room for general public.

b) OP & Nirodh distribution at most of the SC was very poor.

c) The team observed that there was no regular supervision or cross checking in the activities

carried out under NRHM at PHC and SC level. As a result, a lot of discrepancies were found in

the records and registers in respect of financial matter as well as physical performance.

d) The team has also observed that the performance reports were not being prepared at Sub

Centres and PHCs as per HIMS formats.

***********

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Karnataka

1. District- Bangalore City

Major observations of Regional Evaluation Team (RET), Bangalore about the

Evaluation work in Bangalore City District of Karnataka State in Aprill, 2011.

I. Details of the visited Institutions:

Districts Visited PHCs / UFWC visited Area Covered / SCs Visited

Bangalore City UFWCs: Hosahalli,

Goripalya &

Banashankari.

Chowdarapalya, Mariyanahalli,

Goripalya, Padarayanapura,

Kadirrenahalli Park & Kanakapura

Road.

II. Major Observations:

1. Human resources: .

a) There was acute shortage of specialists/Para-medical staff in the district. Post of Chief

Health Officer, 50 of the 91 sanctioned posts of Astt. Surgeons, 4 of the 9 sanctioned posts

of Pediatrician, 7 of the 17 sanctioned posts of Gynacologist, all 2 sanctioned posts of

Anesthetist and the sanctioned post of Unani Physician was lying vacant in the district.

b) Similarly, 105 of the 120 sanctioned posts of Staff Nurse, 105 of the 224 sanctioned posts

of ANM, both sanctioned posts of Astt. Chemist, 24 of the 130 sanctioned posts of Senior

Inspector, 21 of the 27 sanctioned posts of the Food Inspector, 14 of the 32 sanctioned

posts of LHVs, 38 of the 77 sanctioned posts of Sub Registrar and 12 of the 22 sanctioned

posts of Lab Technician were vacant in the district.

c) However, in all the visited 3 UFWCs, no post was reported to be vacant.

2. Janani Suraksha Yojna (JSY):

a) Women belonging to BPL and SC / ST category family are eligible for JSY payments for

their first two deliveries. The mothers are entitled for incentives @ Rs. 600 for institutional

deliveries and Rs. 500 for home deliveries.

b) 35461 deliveries in the year 2009-10 and 37907 deliveries in 2010-11 were conducted in

the district. It was reported that 1553 beneficiaries in 2009-10 and 916 in the year 2010-11

were provided cash assistance under the scheme. Expenditure to the tune of Rs 9,31,800

was incurred in 2009-10 and Rs. 5,49,600 was incurred in 2010-11 in this regard.

268

c) 35 JSY beneficiaries were selected for sample verification and 21 were contacted in the

field. All the beneficiaries stated that they received full JSY cash incentive in time.

d) All the JSY concerned registers were maintained with complete information in the district

office and visited centres. Beneficiary‟s registers were maintained at the centres visited.

MOs were giving the JSY amount directly to the beneficiaries.

3. 24 x 7 hours delivery care System:

In the district, 30 institutions, i.e., all the 24 existing Maternity Centres and 6 referral

hospitals were functioning as 24X7 delivery care institutions.

4. Physical Infrastructure:

All visited UFWCs / UHPs were functioning in Government building with minor OT,

delivery room, OPD, waiting hall for patients, injection room, stores etc. Most of the

buildings were built under IPP-IX scheme with well laid building plans that can cater to

the service needs of the people under RCH programme.

5) Community Satisfaction and opinion on Health Services

Public opinion was good on the services being rendered by the UHCs / UFWCs visited

by the team. ANC/PNC beneficiaries and others expressed good opinion on the overall

functioning of these centres.

6) Sample Verification of FW Acceptors :

a) Out of 90 FW acceptors (Sterilization, IUD,OP and Nirodh) selected, 63(70 %) could

be contacted for sample verification.

b) Minor discrepancy in the recorded age of acceptor, total no. of children, no. of male

children and age of last child was found during sample check.

c) Out of 63 contacted beneficiaries only 31 (49%) reported that they got follow up

services after accepting the F.W. methods.

7) Reconciliation of Reported Performance:

During sample check it was observed that Sterilizations done in other states such as

Tamil Nadu and Andhra Pradesh were reported in performance of visited UFWCs. Such

reporting might have caused double reporting at National level thus needed proper

monitoring.

8) Maintenance of Records and Registers :

Printed registers for Eligible Couple, Immunization, Sterilization, IUD, OP, CC

acceptors and ANC / PNC were maintained at the visited UFWCs.

9) Compensation money to sterilization acceptors:

a) Payment of incentive money to the sterilization acceptors was found delayed at RH

Hosahalli as the adequate budget was not released in time from the City Bureau Head

quarters.

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b) Team also reported that due to late release of budget, many acceptors did not

receive sterilization incentive amount since 2008.

10) Untied Fund, Rogi Kalyan Samiti (RKS), ASHA Scheme and VHSC Scheme is not

applicable in this district as it is purely urban district and no funds are released under

this head.

11) IT Infrastructure and Mother and Child (MCH) Tracking.

a) One computers was installed at the district headquarters. All 6 blocks head quarters and

35 PHCs were having computer in the district.

b) Internet connectivity was provided to the systems available at district, in all blocks and

35 PHCs.

c) It was reported that the complete MCT data was available in hard copies at PHC/Block

level. MCH tracking software was being developed by NIC.

*******

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2. District- Bangalore Rural

Major observations of Regional Evaluation Team (RET), Bangalore about the

Evaluation work in Bangalore Rural District of Karnataka State in Aprill, 2011.

I. Details of the visited Institutions:

Districts Visited PHCs / UFWC visited Area Covered / SCs Visited

Bangalore Rural PHCs. Anugondanahalli,

Dabaspet &

Kanasawadi.

SCs: Anugondananhalli, Harohalli,

Tattekere, Dabaspet, Isturu &

Kanaswadi.

II. Major Observations:

1. Human resources:-

a) 7 of the 24 sanctioned posts of Lady Health Visitor (LHV), 49 of the 107 sanctioned

posts of MPHW (Male) and 18 of the 207 sanctioned posts of MPHW (Female) / ANM

were vacant in the district.

b) In the visited PHC Anugondanahalli, one of the two sanctioned posts of MPW (M) were

lying vacant.

c) In the visited PHC Dabaspet, 1 of the 5 sanctioned posts of ANM and 1 of the 3

sanctioned posts of MPW(M) were lying vacant.

d) In the visited PHC Kanaswadi, only sanctioned post of LHV, 2 of the 4 sanctioned posts

of MPW(M), one of the 6 sanctioned posts of ANM and both the sanctioned posts of

Group-D were lying vacant.

2. Janani Suraksha Yojna (JSY) :-

a) Women belonging to BPL and SC/ ST category family are eligible for JSY payments for

their first two deliveries. The rates for normal institutional delivery are: Rs. 700 per case

for rural area, Rs. 600 per delivery in urban area. Rs. 1500 per case for caesarean

delivery in private institutions and Rs. 700 in Govt. institutions are also provided. For

home delivery, Rs. 500 per case are given.

b) ASHA gets Rs. 200 per case for accompanying women to hospital for delivery.

c) It has been reported that 21180 ANC were registered during 2009-10 and 23926 during

April, 2010 to February, 2011. 13160 deliveries were conducted during 2009-10 and

10952 during April, 2010 to February, 2011 and JSY cash incentive could be made

available to 6892 beneficiaries during 2009-10 and 6558 beneficiaries during April, 2010

to February, 2011.

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d) In the visited SCs, no pending cases of JSY beneficiaries were found. JSY beneficiary

registers were maintained in printed registers. JSY cards were issued to all the

beneficiaries.

e) 35 JSY beneficiaries were selected and 27 were contacted in the field for sample

verification. All JSY beneficiaries stated that they received full JSY cash incentive in

time. Follow up visits were made by the ASHA/ANM after delivery.

3) Untied Fund:-

a) It was reported that the 4 SCs functioning in Govt. building are being provided @ Rs.

10,000 as Untied Funds and @ Rs. 10,000 as AMG per year in the district. During visit to

the Sub Centres at Harohalli and Tattekere, it was observed that Rs. 10,000 were

released to each of these centres during 2009-10 and 2010-11 and Rs. 10,000 and Rs.

8605 respectively were utilized by the centres in 2009-10.

b) Untied Fund in the visited HSCs was utilized to purchase the items such as – registers

/records, digital BP apparatus, labor cot, weighing machine (adult), medicines, racks,

chairs, benches, foot stool, water filter, bleaching powder and stationery. Besides this, the

amount was spent on transportation of high risk delivery cases, for taking Xerox copies of

reporting formats and for conducting village health & nutrition day, etc.

4. Arogya Raksha Samithi (ARS):

a) Rogi Kalyan Samiti (RKS) is named as Arogya Raksha Samithi (ARS) in Karnataka state.

It was constituted in 2 CHCs and 43 PHCs in the district.

b) Every ARS were provided funds @ Rs. 2, 50,000 at CHC level and @ Rs. 1,75,000 at

PHC level every year. These funds includes corpus fund, AMG and Untied Funds. All

these funds are kept at the disposal of ARS and after taking the approval in its meeting,

the funds were utilized on developmental activities in the Institution.

c) During visit to the PHCs at Anugondanahalli and Dabaspet, it was observed that the

sufficient funds were made available during 2009-10 and 2010-11 and the expenditure

was incurred on purchase of surgical equipments, flex boards, TV/ DVD, stabilizer,

refrigerator and stand, water purifier, repair of electrical connections and for payment of

night Dai incentives etc.

5. Services of AHSA :-

a) In the district 672 ASHAs were appointed till 31.3.2011. All were trained and provided

with drug kits. 160 new ASHAs were proposed to be inducted during 2011-12.

b) In the visited institutions, 15 ASHAs were contacted. As informed, all were trained

and given drug kits. Performance based remuneration was paid regularly to them.

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c) c) At the visited SCs Harohalli and Tattekere, ASHAs were posted and trained. In

the VHSCs, ASHAs were functioning as a member.

6. Functioning of Village Health Sanitation Committees (VHSC):-

a) 763 VHSCs were setup against 951 revenue villages covered under 98 Gram

Panchayat in the district. Every year Rs. 10,000 is allotted to each VHSC which was

being kept in the bank account operated jointly by the Aanganwadi worker and

Sarpanch of Village Gram Panchayat upto the end of 2009-10. From the current year

2010-11 funds were jointly operated by village Sarpanch and ASHA. In some of the

VHSCs, transferring the accounts form Anganwadi worker to ASHAs was still under

process.

b) Rs. 10,000 was allotted to each VHSC in the visited SCs during 2009-10 and 2010-11.

In SC Harohalli, allotted amount was fully utilized during 2009-10. In SC Tattekere,

only 70% of the allotted amount was spent. During 2010-11, SC Harohalli spent Rs.

5628 and SC Tattekere did not utilize any fund upto the month of visit.

c) VHSC fund mainly utilized for purchasing of bleaching powder, phenol, chairs and

weighing machines to anganwadi centres, school medicine kits, water filter and

stationery. Besides this, fund was spent for cleaning of village drinking water tanks

and drains, cleaning of anganwadi & school building surroundings and repairing bore

wells. Amount was also utilized for purchasing of mobile phone sets and uniforms to

ASHAs.

7. 24 x 7 hours Delivery Care System:-

a) In the district, 17 of the total 43 PHCs were identified for providing 24X7 delivery care

services. Of these 17 centres, only 8 PHCs have 2 Medical Officers, and 8 PHCs

have 3 Staff Nurses posted.

b) No separate budget was released to these centres, except the salary budget to the

contractual staff nurses.

c) During 2010-11, 7 of the 17 PHCs functioning as 24 X 7 hour services did not achieve

the stipulated minimum 10 deliveries per month.

8. Physical Infrastructure and Stock Position:-

i) PHC

a) Visited PHCs, Anugondanahalli and Dabaspet were functioning in Govt. buildings.

PHC building at Dabaspet was as per IPHS but was not having functional OT. Vehicle

was not available in PHC, Anugondanahalli.

b) Stock of condoms was not available since 6 months in PHC, Anugondanahalli. Stock

of IFA (big & small/syrup) and Vitamin A tablets were not available in both the PHCs.

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c) Medical officer under AYUSH was not posted in PHC Dabaspet. Residential quarter

for Medical Officer was not available in both the PHCs.

ii) Sub Centres:

a) Sub centres visited at Harohalli and Tattekere were functioning in rented building.

ANM of Tattekere SC was not staying at the SC village. There was no facility for

water supply at Tattekere SC. Labour Room facility in the rented building was not

available in both the visited SCs.

b) Benches for clients, cup board for drugs, Ambu bag/suction, steam sterilizer and

RDT kit for malaria were not available in both the visited SCs. Delivery table and

Haemoglobinometer were not available at Harohalli SC. McIntsh sheets, Nischay

pregnancy test kit, IUD insertion kit, Stove and Weighing machine (Infant) were not

available at Tattekere SC

c) DDK, Gloves, Sanitary napkins, Kerosene oil/gas, IFA tablets (Big & small/syrup)

and Tab. Oxitocin Cap. Ampicillin, Inj. Gentamycin and kits A&B were not available

in both the visited SCs. OP cycles, EC pills, Clorin Solution (bleaching powder) and

Tab. Metranidazole were not available at Tattekere SC.

9) Community Satisfaction and opinion on Health Services:-

a. 20 mothers having child upto one year of age were interviewed to assess their

knowledge and opinion on the services rendered by ANMs and found that most of

them were satisfied having PNC services in time in the area of visited two SCs.

b. 15(75%) mothers had no knowledge on danger signs of ARI and 3 (15.0%)

mothers had no knowledge on advantages and side effects of contraceptive

methods.19 out of 20 deliveries were institutional.

c. The team found that the opinion of the community about the services provided by

the MPW (M) was satisfactory at the visited centres. The villagers reported that

MPW (M)s were not staying at their head quarters.

d. Public opinion was good on the services being rendered by the PHCs visited by

the team. Village leader, ANC/ PNC beneficiaries and others expressed good

opinion on the overall functioning of PHCs.

10) Sample Verification of FW Acceptors:

a) Out of 85 FW acceptors (Sterilization, IUD, OP and Nirodh) selected, 67(78.8 %)

could be contacted. Minor discrepancy in the recorded age of acceptor, total No. of

children, No. of male children and age of last child was found during sample check.

b) Out of 67 contacted beneficiaries 58 (86.6.%) reported that they got follow up

services after having accepted the F.W. methods.

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c) All contacted 32 children confirmed with the doses of immunization and got follow

up services. No complication among the contacted beneficiaries was found after

receiving the doses.

11) Maintenance of Records and Register:

a) Printed registers for Eligible Couple, ANC/PNC were maintained at the visited

PHCs / SCs.

b) For Family Planning beneficiaries and maintenance of stock, non printed registers

were maintained.

c) Stock registers for the items purchased under NRHM funds were not maintained at

PHCs/SCs.

12) IT Infrastructure and Mother and Child (MCH) Tracking.

a. 3 computers was installed at the district headquarters. All 4 blocks head quarters

and 34 of 45 PHCs were having computer in the district.

b. Internet connectivity was provided to the 2 systems available at district, to all

blocks and to 25 of the 45 PHCs.

c. It was reported that the complete MCT data was available in hard copies at

PHC/Block level. MCH tracking software was under development by NIC.

******

3. District- Bangalore (Urban)

Major observations of Regional Evaluation Team (RET), Bangalore about the

Evaluation work in Bangalore (Urban) District of Karnataka State in May, 2011.

I. Details of the visited Institutions:

Districts Visited PHCs Visited SCs Visited

Bangalore (Urban) Abbig Abbiger,Dommasandra &

Begur

Vadeyara halli, Somashetti halli,

Yemare, Muttanalluru, Chik Yemare, Muttanalluru, Chikkabeguru

Chikkabeguru kabegur & Yelenahalli

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II. Major Observations:

1. Human Resources:-

a) 11 of the 114 sanctioned posts of Medical Officer, 11 of the 85 sanctioned posts of

Staff Nurse, 12 of the 33 sanctioned posts of Male Supervisor, 56 of the 170

sanctioned posts of MPHW (Male) and 5 of the 270 sanctioned posts of MPHW

(Female)/ANM were lying vacant. Among the specialists, 2 posts each out of the 4

each sanctioned posts of Physician and Gynecologist, One post of Surgeon, One

post of Pediatricians & One post of Anesthetists out of 4 each sanctioned were also

lying vacant.

b) In the visited PHC Abbigere, 1 of the 2 sanctioned posts of Medical Officer was

vacant. Further, 1 ANM out of the 6 sanctioned posts of ANM was reported to be

unauthorized absent.

c) In the visited PHC Dommasandra, 1of the 3 sanctioned posts of Medical Officer and 2

of the 3 sanctioned posts of Male Worker were lying vacant.

d) In the visited PHC Begur, 1 of the 4 sanctioned posts of Male Worker was lying

vacant.

2. Janani Suraksha Yojna (JSY) :-

a) Women belonging to BPL and SC/ ST category families are eligible for JSY payments

for their first two deliveries. For normal institutional delivery, the rate is Rs. 700 per

case for rural area and Rs. 600 per delivery in urban area. Rs. 1500 per case for

caesarean delivery in private institutions and Rs. 700 in Govt. institutions are also

provided. For home delivery, Rs. 500 per case are given.

b) ASHA gets Rs. 200 per case for accompanying the women for delivery to hospital.

c) It has been reported that 53,700 were registered for ANC during 2009-10 and 57,058

were registered during 2010 -11. 40,553 deliveries were conducted during 2009-10

and 43,872 during 2010-11 JSY cash incentive were paid to 15,046 beneficiaries

during 2009-10 and to 12,344 beneficiaries during 2010 -11.

d) In the visited SCs, no pending cases for JSY payment were observed. JSY

beneficiaries registers were maintained in printed forms and JSY cards issued to all

the beneficiaries.

e) 24 JSY beneficiaries were contacted in the field. About 96% of sample beneficiaries

informed that their delivery was institutional and they received full JSY cash incentive

in time. For 18 ( 78% ) beneficiaries transport was arranged by ASHA/ANM for

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their institutional delivery and in cases of 23 ( 96%) beneficiaries follow up services

were given by ASHA/ANM.

3. Untied Funds:-

a) Provision and utilization of Untied Funds in the district is as below:

(Amount in Rs. lakhs)

Sl.No Particulars 2009-10 2010-11

1. Total budget available * 18.06 21.0

2. Expenditure incurred 15.50 17.89

3. Balance 3.1 3.11

* including opening balance.

b) It was observed that Untied Funds @ Rs. 10,000 to each HSC, @ Rs. 25,000 to each

PHC, @ Rs. 50,000 to each CHC and SDH were given per year in the district. During

visit to the Sub Centres at Somashettihalli, Yemare & Muttanalluru, it was observed

that Rs. 10,000 have been released to each of these centres during 2010-11. During

visited to SC Vaderahalli, it was observed that untied funds were not released to this

SC since 2009-10.

c) Untied Funds in the visited SCs were utilized to purchase items such as Labour Cot,

Cupboard, Table, Registers /records, BP apparatus, Stethoscope, Hub Cutter, Digital

Thermometer, Medicines, Chairs and Stationery. Besides this, the amount was also

spent on transportation of high risk delivery cases & HIV positive cases to hospitals,

SC building painting & electrical repairs, for taking Xerox copies of reporting formats

and for conducting village health & nutrition day, etc.

d) AMG of Rs. 10,000 was released to the visited SC Muttanalluru of PHC Dommasandra

and the amount was utilized for purchasing overhead tank, for fixing compound gate to

the SC, for payment of electricity bill, repairing and painting of SC building etc. As

there was no Govt. building for the SC Somashettihalli, SC Vadeyarahalli of PHC

Abbigere and SC Yemare of PHC Dommasandra, AMG was not released to these

SCs.

4. Rogi Kalyan Samiti (RKS):

a) 81 Rogi Kalyan Samiti (RKS) were registered in the District. It was constituted in 3 Sub

District Hospitals, 3 CHCs and 75 PHCs in the district.

b) Every RKS was provided funds @ Rs. 2, 50,000 at Sub Distt. Hospital / CHC level and

@ Rs. 1,75,000 at PHC level every year. These funds includes corpus fund, AMG and

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Untied Funds. All these funds are kept at the disposal of RKS and after taking the

approval in its meeting, the funds are utilized on developmental activities in the facility.

c) Details of funds available and expenditure incurred at CHCs & PHCs in the District are

given in the following table:

(Rs. In lakhs)

Type/ head

of the funds

For CHCs for the year For PHCs for the year

2009-10 2010-11 2009-10 2010-11

Budget * Expdr. Budget * Expdr

.

Budget * Expdr. Budget * Expdr.

Corpus fund NA NA 3.0 3.0 46.08 33.99 74.41 69.64

AMG Fund 4.5 3.09 2.41 2.41 37.1 37.1 26.5 26.5

Untied fund 3.0 3.0 1.5 1.5 17.75 17.75 17.5 17.01

* including opening balance.

a) As reported, AMG and Untied Funds for the past 3 years were released to the CHCs

at Chandrappa Circle and Kaggalipura as per entitlement of CHC by the district office.

At CHC Chandrappa Circle, through new CHC building was built but not yet handed

over, and at CHC Kaggalipura the centre is functioning in old PHC pattern building.

The district office should therefore release funds to these CHC as per the rates of

PHC level institutions.

b) During visit to the PHCs at Abbigere and Dommasandra, it was observed that

sufficient funds were made available during 2009-10 and 2010-11 and at PHC

Abbigere the funds were spent on purchase of Oxygen Cylinder & Trolley, Furniture,

Dish-net of TV, BSNL Modem Net-work, Curtains with rod, UPS 2.5 KV, Sanitary

items, Chairs for OPD, Surgical equipment, Water motor pump etc. Besides,

activities/ works relating to providing glass window fitting, painting for PHC, Erection of

glow sign boards, 24X7 flex banners, maintenance of UPS and batteries, Oxygen

cylinder refilling, electricity work for hospital, payment of TA and DA to ICTC staff and

payment of night watchman @ Rs. 1000 per month etc. were undertaken. In visited

PHC Dommasandra, the expenditure was incurred on maintenance of PHC building

including laying of vitrified tiles, Window curtain, purchase of drugs and medical

equipment, Water purifier, Fire extinguisher, repair of microscope, payment to solid

and liquid waste management agency, payments to night watchman and ICTC

counsellor.

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5. Services of ASHA :-

a) In the district, 867 ASHAs were appointed till 01.3.2011. 751 ASHAs were trained in all

modules till 01.3.2011 and provided with drug kits. 116 new ASHAs are proposed to be

inducted during 2011-12.

b) During 2009-10, an expenditure of Rs. 2.52 lakhs and during 2010-11, funds to the

tune of Rs. 52.95 lakhs were incurred in the district towards payment of performance

based remuneration to ASHA.

c) In the visited institutions, 25 ASHAs were contacted. As informed, all were trained and

given drug kits. Performance based remuneration was paid to them regularly. VHSC

accounts were maintained by ASHAs.

d) At the visited SCs Vadeyarahalli, Somashettihalli, Yemare and Muttanalluru ASHAs

were posted and trained. Drug kit was not provided to any of the ASHAs in SC

Muttanalluru. In the VHSCs , ASHAs were functioning as a member.

6. Functioning of Village Health Sanitation Committees (VHSC):-

a) VHSC has been setup in all 589 revenue village in the district. Every year Rs. 10,000

are allotted to each VHSC which is kept in the bank account operated jointly by the

Aanganwadi worker and Sarpanch of Village Gram Panchyat. From the current year

2010-11, this fund was jointly operated by village Sarpanch and ASHA.

b) Rs. 10,000 was allotted to each VHSC in the visited SCs for 2010-11. For the year

2011-12, fund was not released.

c) VHSC fund was mainly utilized for purchasing medicines, bleaching powder, chappals

to ANC cases, chairs, cupboard and weighing machines to anganwadi centres and

stationery. Besides this, fund was spent for cleaning of village drinking water tanks,

IEC activities under pulse polio, drainage cleaning, cleaning of Anganwadi & School

building surroundings.

d) Details of VHSC budget and expenditure in the district for 2009-10 and 2010-11 are

below:

SI.No Particulars 2009-10 2010-11

1. Total budget available 60.17 61.71

2. Expenditure incurred 56.86 34.43

3. Balance 3.31 27.28

7. 24 x 7 hours Delivery Care System:-

279

a. In the district, 22 out of the total 75 PHCs were identified for providing 24X7 delivery

care services. Of these centres, only 17 PHCs had 2 Medical Officers, and 16 PHCs

had 3 Staff Nurses posted.

b. No separate budget was released to these centres, except the salary budget to the

contractual staff nurses.

c. During 2009-10, 3 of the 22 PHCs could not achieve the stipulated minimum 10

deliveries per month. However during 2010–11, all PHCs achieved minimum 10

deliveries per month. In the visited PHC Abbigere, it was observed that number of

institutional deliveries was increase during last two years while in PHC Dommasandra

the number of deliveries decreased. Baby Radiant Warmer was not available in both

the visited PHCs.

8. Physical Infrastructure and Stock Position:-

i) Sub Centres

a) Sub Centres visited at Vadeyarahalli, Somashettihalli and Yemare were not having

any accommodations and ANM was staying in the SC village and operating from her

residence. SC Muttanalluru was functioning in Govt. building. ANM was not staying in

the SC areas and there was no regular water supply arrangement in the centre..

b) Examination table, Benches for clients, Foot Stool, Delivery Table, McIntch sheets,

Ambu bag / Suction tube, Steam sterilizer, RDT kit for malaria and Delivery kit etc.

were not available at most of the visited SCs.

c) DDK, Sanitary napkins, EC pills, Tab. Metranidazole, Tab Oxitocin, Cap. Ampicillin, Inj

Gentamycin and kits – A & B etc. were not available in the visited Sub Centers.

ii) PHCs

a) In the visited PHCs at Abbigere & Dommasandra, it was observed that both the PHCs

were functioning in government building and the infrastructure was not as per IPHS.

All the materials and equipment were available except vehicle. No AYUSH medical

officer was posted in this 24X7 PHC. Operation theatre was not functional.

Residential quarter for Medical Officers was not provided.

9. Community Satisfaction and Opinion on Health Services:-

a) 40 mothers having child up to one year of age were interviewed to assess their

knowledge and opinion on the services rendered by ANMs and found that most of

them were satisfied having PNC services in time in the area of visited 4 SCs.

b) 31 (77.5%) mothers had no knowledge on danger signs of ARI and 6 (15.0%) mothers

had no knowledge on advantages and side effects of contraceptive methods. 39

(97.5%) deliveries were institutional.

280

c) The team contacted different community persons to have their opinion about the

services

Provided by the MPW (M) of SC Vadeyarahalli. Mostly community expressed their

satisfaction towards the work of MPW (M). Posts of MPWs (M) were vacant in the SCs

Somashettihalli, Yemare and Muttanalluru. ANMs were doing the work of MPWs (M) in

these SCs.

d) Public opinion was good on the services being rendered by the PHCs /CHCs visited

by the team. Village leader, ANC/ PNC beneficiaries and others had expressed good

opinion on the overall functioning of PHCs/CHCs.

10. Reconciliation of Reported Performance:

a) Incomplete service registers pose the question on reported performance of

sterilizations in the visited centres. There was difference in the number of sterilization

between reported and recorded cases as given below.

Name of the

centres

Sterilization cases for the year

2010-2011 2011-2012 (April-2011)

Reported Verified in the

register

Reported Verified in the

register

PHC: Abbigere 504 124 41 18

PHC: Dommasandra 295 287 25 25

PHC: Beguru 419 391 37 37

d) The reported performance under IUD could not be verified at PHCs Abbigere and Beguru

for want of service registers for the year 2010-11 and 2011-12 (April-2011).

11. Maintenance of Records and Register:

a) Printed registers for Eligible Couple, Sterilization and ANC/PNC were maintained at the

visited PHCs/SCs. No printed registers for the services provided under IUD, OP & CC

and also Stock registers for the items purchased under NRHM funds were maintained at

PHCs/SCs.

12. IT Infrastructure and Mother & Child (MCH) Tracking System:

a) 1 computers was installed at the district headquarter. All 4 blocks head quarters and 22

of 75 PHCs were having computers in the district.

b) Internet connectivity was provided to the 1 system available at district, to all blocks and

to 6 out of the 22 PHCs.

c) It was reported that the complete MCT data was available in hard copies at PHC/Block

level. MCH tracking software was under development by NIC.

281

4. District- Tumkur

Major observations of Regional Evaluation Team (RET), Bangalore about the

Evaluation work in Tumkur District of Karnataka State in May, 2011.

I. Details of the visited Institutions:

Districts Visited PHCs Visited SCs Visited

Tumkur

Urudig Urudigere,

Chelur &

Ramagondanahalli

Seethkal, Here Doddawadi,

Sathenahalli, Bidre (R),

Hiregundagal & C.T.Kere.

II. Major Observations:

1. Human resources:-

a) 14 of the 147 sanctioned posts of Medical Officer, 12 of the 57 posts of AYUSH Medical

Officer, 13 of the 160 sanctioned posts of Staff Nurse, 10 of the 72 sanctioned posts of

LHV, 31 of the 65 sanctioned posts of Male Supervisor, 13 of the 160 sanctioned posts

of Pharmacist, 12 of the 117 sanctioned posts of Lab technician, 113 of the 319

sanctioned posts of MPHW (Male) and 70 of the 555 sanctioned posts of MPHW

(Female)/ANM were lying vacant. 28 of the 100 sanctioned posts of specialist and 8 of

the 17 sanctioned posts of Dental Medical Officer were also lying vacant.

b) In the visited PHC Urdigere, 1 of the 2 sanctioned posts of Medical Officer was vacant

since 1 month and 2 of the 5 sanctioned posts of MPHA(M) were also lying vacant.

c) In the visited PHC Chelur, one post of AYUSH Medical Officer and 2 of the 5 sanctioned

posts of Male Worker were lying vacant. The only Pharmacist of PHC was on deputation

to General Hospital Tumkur.

2. Janani Suraksha Yojna (JSY) :-

a) Women belonging to BPL and SC/ ST category family are eligible for JSY payments for

their first two deliveries. For normal institutional delivery, the rate is Rs. 700 per case

for rural area and Rs. 600 per delivery in urban area; Rs. 1500 per case for caesarean

delivery in private institutions and Rs. 700 in Govt. institutions are also provided. For

home delivery Rs. 500 per case are given.

b) ASHA gets Rs. 200 per case for accompanying the women for delivery to hospital.

c) It has been reported that 57,479 ANC were registered during 2009-10 and 52,682 ANC

were registered during 2010 -11. 40,664 deliveries were conducted during 2009-10 and

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38,796 during 2010 – 11. JSY cash incentive was paid to 19,045 beneficiaries during

2009-10 and 20,060 beneficiaries during 2010 -11.

d) In the visited SCs, no pending cases for JSY payment were found. JSY beneficiaries

registers were in printed forms and JSY cards issued to all the beneficiaries.

e) 30 JSY beneficiaries were contacted in the field. About 90% cases, the delivery was

institutional and they received full JSY cash incentive in time. For 25(93%) beneficiaries,

transport arranged by ASHA/ANM for their institutional delivery and 28(93%)

beneficiaries received follow up services through ASHA/ANM.

3) Untied Funds:-

a) Provision and utilization of Untied Funds in the district are detailed as below:

(Amount in Rs)

Sl.No Particulars 2009-10 2010-11

1. Total budget available * 47,70,000 44,69,711

2. Expenditure incurred 3,00,289 44,69,711

3. Balance 44,69,711 0

* including opening balance.

b) It was observed that Untied Funds @ Rs. 10,000 to each HSC, @ Rs. 25,000 to each

PHC, @ Rs. 50,000 to each CHC and SDH were given per year in the district. During

visit to the Sub Centres, it was observed that Rs. 10,000 has been released to SC Bidare

only during 2010-11.

c) Untied Fund in the visited SCs was utilized to purchase the items such as Registers

/records, BP apparatus, Racks, Chairs, Table, Stove, IUD insertion set, Delivery cot,

Cupboard, Water filter and Stationery. Besides this, the amount was spent on

transportation of high risk delivery cases, for taking Xerox copies of reporting formats,

Biomedical waste management and for conducting village health & nutrition day, etc.

d) AMG of Rs. 10,000 was released to the SC Bidare (R) of PHC Cheluru and the amount

was utilized for repairing and painting of SC buildings, cleaning SC surroundings, SC

board, wall writings, water and electrical works at the SC. SCs Heredoddawadi and

Seethkal of PHC Urudigere were not having accommodations. SC Sathenahalli is

functioning in rented building. Therefore AMG was not released to these three SCs.

4) Rogi Kalyan Samiti (RKS):

a) 145 Rogi Kalyan Samiti (RKS) were registered in the District. It was constituted in 1

District Hospital, 9 Taluk Hospitals, 4 CHCs and 131 PHCs in the district.

b) RKS was provided funds @ Rs.5,00,000 at Distt. Hospital level, @ Rs. 2, 50,000 at

Taluk Hospital /CHC level and @ Rs. 1, 75,000 at PHC level every year. These funds

283

includes corpus fund, AMG and Untied Funds. All these funds are kept at the disposal of

RKS and after taking the approval in its meeting, the funds are utilized on developmental

activities in the Institution.

c) Details of funds available and spent at CHCs & PHCs in the District are given in the

following table:

Type/ head of the funds

For CHCs & TH for the year For PHCs for the year

2009-10 2010-11 2009-10 2010-11

Budget * Expdr. Budget * Expdr. Budget * Expdr. Budget *

Expdr.

Corpus fund

16,11,678

1,241,751

18,82,067

12,92,662

1,19,54,492 1,09,26,694

1,29,00,000

1,23,98,077

AMG Fund

895,270

7,52,826

4,40,209

4,30,196

36,26,637

31,98,445

55,61,842

54,66,882

Untied fund

4,53,327

3,20,690

3,08,200

5,90,064 @

30,38,919

26,82,081

32,75,850

32,20,850

* including opening balance.

@ Excess expenditure met from flexi pool funds.

d) During visit to the PHCs at Urdigere and Chelur, it was observed that the sufficient funds

were made available during 2009-10 and 2010-11 and at PHC Urdigere the funds were

utilised for purchasing of Furnitures, Glow Sign Board, UPS inverter of 2 KV, Biometric

Attendance Machine, Delivery cots, Office Furniture, Refrigerator, BP apparatus, Water

filter, Chairs for seating of patients, Glucomeeter, Nebulizer, Sterilizer drum, Cord

clamps, BSNL data card, Foot Operated Suction Overeater, Office stationery etc. No

discrepancy was observed in the records.

e) In the visited PHC Chelur, funds were spent on purchase of Pulse Oximeeter, Oxygen

cylinder with regulator, Foot Operated Suction Apparatus, Water Filter, Almeria, Delivery

kit, Hand Gloves, Ceiling Fan, Office Tables, Fiber Chairs for meeting hall, 24X7 Glow

Sign Board, Malaria Insecticides and Stationery etc. No discrepancy was observed while

examining the records/registers.

5. Services of AHSA :-

a) In the district, 1947 ASHAs were appointed till 01.3.2011. 1872 ASHAs were trained

in all modules till 01.3.2011 and 1781 ASHAs were provided drug kits. 440 new

ASHAs are proposed to be inducted during 2011-12.

b) During 2009-10, an expenditure of Rs. 25, 33,996 and during 2010-11, Rs.

1,38,30,375 was incurred in the district towards payment of performance based

remuneration to ASHA.

284

c) In the visited institutions, 32 ASHAs were contacted. As informed, all were trained

and given drug kits. Performance based remuneration was paid regularly to them.

d) At the visited SCs Seethkal, Doddawadi, Sathenahalli and Bidare (R) ASHAs were

posted and trained. In the VHSCs, ASHAs were functioning as a member.

6. Functioning of Village Health Sanitation Committees (VHSC):-

b) 1967 VHSCs were setup against 2574 revenue villages, 321 Gram Panchyaths, 3345

Anganwadi centres functioning in the district. Funds were released to 708 VHSC

during 2010-11.

c) As per the details available, the district had received Rs. 75, 40,000 for the year 2009-

10 as VHSC funds, out of which no expenditure was incurred during the year. For the

year 2010-11 Rs. 1, 60, 39,060 was available including last year funds and the same

was fully utilized during the year.

d) In the visited VHSC Bidare (R), VHSC fund was received during 2010-11. Fund was

used to buy bleaching powder, phenol and stationery. Besides this, fund was spent for

cleaning of village drinking water tanks, drainage and cleaning of Anganawadi

surroundings. VHSC Sathenahalli (PHC Cheluru) and VHSC Seethkal (PHC

Urudigere), VHSC fund was released only once during 2008-09 (i.e. on 27/08/2008)

and no fund received thereafter. In VHSC Heredoddawadi, account could not be

verified as the ASHA was not available at the time of visit the team.

7. 24 x 7 hours Delivery Care System:-

a) In the district, 49 of the total 131 PHCs were identified for providing 24X7 Delivery Care

institutions. Of these 49 centres, 45 PHCs had 2 Medical Officers, and all PHCs had 3

Staff Nurses posted.

b) No separate budget was released to these centres, except the salary budget to the

contractual staff nurses.

c) During 2009-10, 24 of the 49 PHCs did not achieved the stipulated minimum 10

deliveries per month. During 2010–11, 11 of the 49 PHCs could not achieve minimum 10

deliveries per month. .

8. Physical Infrastructure and Stock Position:-

i) Sub Centres

a) Sub Centres visited at Seethkal & Doddawadi had no building, SC Sathenahalli was

functioning in rented building and SC Bidare (R) was functioning in Govt. building.

Infrastructure was not as per IPHS at visited SCs Sathenahalli and Bidare (R). ANM was

not staying in the SC areas and there was no regular water supply arrangement in the

centre. Labour Room was not functioning in SCs Sathenahalli & Bidare (R).

285

b) Examination table, Benches for clients, Delivery Table, McIntch sheets, Ambu bag /

Suction tube, Steam sterilizer, RDT kit for Malaria, Delivery kit, Weighing machine(Infant)

and Haemoglobinometer etc. were not available at most of the visited SCs.

c) DDK, Sanitary napkins, EC pills, Tab. Metranidazole, IFA tablets(small & big), Clorine

solution (bleaching powder), Tab Oxitocin, Cap. Ampicillin, Inj Gentamycin and Kits – A

& B etc. were not available at most of the visited Sub Centers.

ii) PHCs

a) In the visited PHCs Urdigere & Chelur, it was observed that both the PHCs were

functioning in government building though the infrastructure was not as per IPHS. All the

materials and equipment were available except Vehicle. Under AYUSH, Medical Officer

was not posted in PHC Urdigere. Residential quarter for Medical Officer was condemned

in both the visited PHCs. In PHC Urdigere, stock of Oral Pills and Condoms were not

available since November 2010.

9. Community Satisfaction and Opinion on Health Services:-

a) 40 mothers having child upto one year of age were interviewed to assess their knowledge

and opinion on the services rendered by ANMs and found that most of them were

satisfied having PNC services in time in the area of visited SCs.

b) 30 (75.0%) mothers had no knowledge on danger signs of ARI and 8 (20.0%) mothers

had no knowledge on advantages and side effects of contraceptive methods. 37 (92.5%)

deliveries were institutional and 38 (95.0%) deliveries were conducted by trained

personal.

c) The team contacted different community persons to have their opinion about the services

provided by the MPW (M) of SCs Seethkal & Sathenahalli. The community expressed

their satisfaction towards the work of MPWs(M). MPWs (M) were not staying in the SC

HQs. ANMs were doing the work of MPW(M)s in these SCs.

d) Public opinion was good on the services being rendered by the PHCs /CHCs visited by

the team. Village leader, ANC/ PNC beneficiaries and others expressed good opinion on

the overall functioning of PHCs/CHCs.

10. Sample Verification of FW Acceptors:

a) Out of 95 FW acceptors (Sterilization, IUD, OP and CC) selected, 77 (81%) could be

contacted in the district. Minor discrepancies were found in the number of total children

& male children.

b) All contacted 33 children confirmed receiving doses of immunization and follow up

services. No complication among the contacted beneficiaries was observed after

receiving the doses.

286

11. Reconciliation of Reported Performance:

For the period from i) 01-04-2010 to 31-03-2011 and ii) 01-04-2011 to 30-04-2011,

reconciliation of reported performance of FW cases were done at PHC and SC level. IUD

central register was not maintained at all the visited PHCs and sterilization central

registers were not maintained at the PHCs Urudigere and Ramagondanahalli, therefore

reconciliation for the same could not be done at these PHCs.

12. Maintenance of Records and Registers:

Printed registers for Eligible Couple were maintained at the visited PHCs/SCs. IUD

central register was not maintained at all the visited PHCs and sterilization central

registers were not maintained at PHCs Urudigere and Ramagondanahalli. Stock

registers for the items purchased under NRHM funds were not maintained at PHCs/SCs.

Follow up entries were not made for some of the Sterilization/IUD cases.

13. IT Infrastructure and Mother & Child (MCH) Tracking System:

a) 1 computers was installed at the district headquarter. All 10 blocks head quarters and

82 out of 131 PHCs were having computer in the district.

b) Internet connectivity was provided to the system available at district, to all blocks and in

all CHCs & 82 PHCs.

c) It was reported that the complete MCT data was available in hard copies at PHC/Block

level. MCTS tracking software was under development by NIC.

287

5. District- Dharwad

Major observations of Regional Evaluation Team (RET), Bangalore about the Evaluation

work carried out in Dharwad District of Karnataka State in June, 2011.

I. Details of the visited Institutions:

Districts Visited PHCs SCs Visited

Dharawad Abbig Shiraguppi, Mukkal, & Alnavar Bandiwada, Mantur, Dastikoppa,

T. Honnalli, Aravatigi & Dori

II. Major Observations:

1. Human resources:-

a) 8 of the 50 sanctioned posts of Medical Officer, 2 of the 77 sanctioned posts of Staff Nurse, 1

of the 24 sanctioned posts of LHV, 2 of the 37 sanctioned posts of Lab Technician, 23 of the

124 sanctioned posts of MPHW (Male) and 17 of the 218 sanctioned posts of MPHW

(Female)/ANM were lying vacant in the district.

b) Among the specialists, all 3 posts of Physician, 2 of the 3 sanctioned posts of Surgeon, 2 of

the 3 sanctioned posts of Gynecologist, 2 of the 3 sanctioned posts of Anesthetist and 2 of the

3 sanctioned posts of ENT specialist were also lying vacant.

c) 1 of the 6 sanctioned posts of ANM and one post of Male worker was lying vacant in the visited

PHC at Shiraguppi.

d) In the visited PHC Mukkal, one post of Health Supervisor (Male) and 1 of the 3 sanctioned

posts of Male worker were vacant and 1 of the 4 sanctioned posts of Health Worker (Male)

was lying vacant in PHC Alnavar.

2. Janani Suraksha Yojna (JSY):-

a) Women belonging to BPL and SC/ ST category family is eligible for JSY incentives for their

first two deliveries. The rates for normal institutional delivery are Rs. 700 per case for rural

area and Rs. 600 per delivery in urban area. Rs. 1500 per case for caesarean delivery in

private institutions and Rs. 700 in Govt. institutions are also provided. For home delivery Rs.

500 per case is given.

b) ASHA gets Rs. 200 per case for accompanying pregnant women to hospital for delivery.

288

c) It was reported that 31207 ANC were registered during 2009-10 and 41646 during 2010 -11.

29817 deliveries were conducted during 2009-10 and 32475 during 2010- 11 and JSY cash

incentive could be paid to 13623 beneficiaries during 2009-10 and 13406 beneficiaries during

2010 -11.

d) In the visited SCs, no pending cases of JSY beneficiaries were found in 2010-11 and during

2011-12 (upto 06/11), 4 cases of JSY payments were found pending in SC Bandiwada & 5

cases were found pending in SC Dastikoppa. JSY beneficiary registers were maintained in

printed registers in the visited SCs. JSY cards were issued to all the beneficiaries.

e) 31 JSY beneficiaries were selected and 25 of them could be contacted in the field for sample

verification. All JSY beneficiaries stated that they received full JSY cash incentive in time.

23(92%) deliveries were institutional and 22 (88%) deliveries were normal. Follow up visits

were made to 24 ( 96%) mothers by the ASHA/ANM after delivery.

3. Untied Funds:-

a) Provision and utilization of Untied Funds in the district are as detailed below:

( in Rs)

Sl. No Particulars 2009-10 2010-11

1. Total budget available * 32,18,703 31,19,152

2. Expenditure incurred 19,48,198 22,83,950

3. Balance 12,70,505 8,35,202

* including opening balance and interest earned.

b) Rs. 25,000 to each PHC and Rs. 50,000 to each CHC/TH are given each year as Untied

Funds in the district. All the SCs were also being provided Rs. 10,000 as Untied Funds and

Rs. 10,000 as AMG per year in the district. During visit to the Sub Centres, it was observed

that Rs. 10,000 have been released to all the SCs during 2010-11. AMG fund was not

released by district office though 97 SCs were functioning in Govt. building and were eligible

for AMG funds. In the visited SCs, untied funds for the current year was not released till the

date of visit by the team

c) Untied Fund in the visited SCs was utilized to purchase items such as Registers /Records, BP

apparatus, Medicines, Baby/adult weighing machines, Chairs, Table, Delivery Table, Delivery

kit, Foot stool, Torch and Stationery. Besides this, the amount was spent on transportation of

high risk delivery cases, SC building repairs, painting, cleaning & electrical work, for taking

Xerox copies of reporting formats and for conducting village health & nutrition day, etc.

.4) Rogi Kalyan Samiti (RKS):

289

a) Rogi Kalyan Samiti (RKS) was constituted in District Hospitals, 3 CHCs / THs and 30 PHCs in

the district.

b) Every RKS were provided funds @ Rs. 5,00,000 at Distt. Hospital level, @ Rs. 2,50,000 at

Taluk Hospital /CHC level and @ Rs. 1,75,000 at PHC level every year. These funds include

corpus fund, AMG and Untied Funds. All these funds are kept at the disposal of RKS and after

taking the approval in its meeting, the funds were being utilized on developmental activities in

the Institution.

c) Details of RKS funds available and expenditure incurred at CHCs /THs & PHCs in the District

are given in the following table:

*Including opening balance

d) During visit to the PHC at Shiraguppi, it was observed that the sufficient funds were made available

during 2009-10 and 2010-11. The funds were incurred on purchase of UPS, Laparoscopic Table,

Computer Chair & Table, Electrical Fittings, Window Curtains, OT/ labour room Mats, Surgical

Instruments, Oxygen Cylinder and Labour Instruments. Also painting of PHC building, replacement of

window glasses, repair of drainage and fixing of floor tiles was undertaken.

e) In visited PHC Mukkal the expenditure was incurred on purchase of OT ceiling fan, Table & Chair, Bore

starter, Standing fan, surgical instruments, Inventor, Meeting chairs, Water purifier. Also, works such

as getting 24X7 sign board, Bore repair, Plumbing works, Electrical repairs, Fixing of aluminum window

tinted glasses, Solar water heater fixing, Printing of documents and payment of night

watchman salaries was undertaken.

5. Services of ASHA :-

a) In the district 692 ASHAs were appointed till 31.03.2011. All ASHAs were trained in all

modules by 01.3.2011 and 642 ASHAs were provided with drug kits. 50 new ASHAs were

proposed to be inducted during 2011-12.

b) During 2009-10, an expenditure of Rs. 56,74,631 and during 2010-11, Rs. 22,96,113 was

incurred in the district towards payment of performance based remuneration to ASHAs.

Type/ head of the funds

For CHC/TH

For PHCs

2009-10 2010-11 2009-10 2010-11

Budget *

Expdr. Budget * Expdr. Budget * Expdr. Budget * Expdr.

Corpus fund

3,02,228 1,99,393 4,02,835 3,05,718 30,00,000

11,74,175 30,29,363

27,11,269

AMG Fund

3,00,000 2,25,204 3,80,659 2,95,028 19,44,566

13,44,105 15,45,149

11,96,521

Untied fund

1,50,000 58,352 2,00,000 1,55,225 11,49,407

6,76,494 8,02,817

6,04,450

290

c) In the visited institutions, 30 ASHAs were contacted. As informed, all were trained and

given drug kits. Performance based remuneration was paid regularly to them.

d) At the visited SCs Bandiwada, Mantur, Dastikoppa and T.Honnalli ASHAs were posted and

trained. In the VHSCs, ASHAs were functioning as a member.

6. Functioning of Village Health Sanitation Committees (VHSC):-

a) VHSCs setup in all 359 revenue village in the district. Every year Rs. 10,000 are allotted to

each VHSC which was being kept in the bank account operated jointly by the village Gram

Panchyath Surpanch and ASHA.

b) Rs. 10,000 was allotted to each VHSC in the visited SCs for 2010-11. For the year 2011-12,

fund was not released.

c) VHSC fund mainly utilized for purchasing of Uniform Sarees to ASHAs, Bleaching powder,

Phenol, Melathian, Water filter and Stationery. Besides this, fund was spent for cleaning of

village drinking water tanks, under Arogyasree programme, drainage cleaning and cleaning of

Anganwadi surroundings.

d) Details of VHSC budget and utilization in the district for 2009-10 and 2010-11 are below:

SI.No Particulars 2009-10 2010-11

1. Total budget available 57,52,050 61,01,060

2. Expenditure incurred 32,51,601 50,03,727

3. Balance 25,00,449 10,97,333

Note: For the year 2009-10, total expenditure of Rs. 32,51,601 includes Rs. 1,20,000 remitted

back to state by the district office, as stated by district officials.

7. 24 x 7 hours Delivery Care System:-

b) In the district, 20 of the total 30 PHCs were identified for providing 24X7 delivery care

institutions. Of these 20 centres, only 8 PHCs had 2 Medical Officers, and 16 PHCs had 3

Staff Nurses posted. Baby radiant warmer was not available in 16 of the total 20 PHCs.

c) Centre wise performance on delivery conducted by these centres was not readily available in

the district office. No separate budget was released to these centres, except the salary budget

to the contractual staff nurses.

c) During 2010-11, 22 deliveries and during April, 2011 to May, 2011, 4 deliveries were conducted

in PHC Shiraguppi, achievement was far below the expected minimum 10 deliveries per month.

d) In the visited PHCs Mukkal, during 2009–10, 194 deliveries and during 2010-11, 246 deliveries

were conducted. Baby Radiant Warmer was not available.

8. Physical Infrastructure and Stock Position:-

i) Sub Centres:

291

a) In the district it was reported that the 97 SCs were functioning in Govt. buildings, 33 SCs were

functioning in rented building and 55 SCs functioning without any building. Sub Centres visited

at Bandiwada was functioning in rented building and SCs Mantur, Dastikoppa & T. Honnalli

were functioning in Govt. building. Infrastructure was not as per IPHS at the visited SCs. ANM

was not staying in the SC areas at Bandiwada and Mantur. There was no regular water supply

arrangement in SC Bandiwada. Labour Room was not functioning in SCs Bandiwada and

Mantur.

b) Examination table was available in all the visited SCs except SC Bandiwada. McIntch sheets

were not available in SCs Bandiwada & Mantur. Ambu bag / Suction was not available in all the

visited SCs. Steam sterilizer was available in all the visited SCs except SC Bandiwada.

Nischay Pregnancy Test Kit was not available in SCs Bandiwada & Mantur. IUD insertion kit &

RDT kit for Malaria were not available in SCs Bandiwada & Dastikoppa.

c) DDK, Stove, Weighing Machine(Infant), Haemoglobinometer, Sanitary napkins, EC pills, IFA

tablets, Tab Oxitocin, Cap. Ampicillin, Inj Gentamycin and Kits – A & B etc. were not available

at most of the visited Sub Centers.

ii) PHCs

In the visited PHCs Shiraguppi & Mukkal, it was observed that both the PHCs were

functioning in government building and the infrastructure was not as per IPHS. There was no

vehicle in the PHCs. AYUSH, Medical Officer was not posted in PHC Shiraguppi. Residential

quarter for Medical Officer was not available in PHC Shiraguppi.

9. Community Satisfaction and opinion on Health Services:-

a) 40 mothers having child upto one year of age were interviewed to assess their knowledge and

opinion on the services rendered by ANMs and found that most of them were satisfied having

PNC services in time in the area of visited 4 SCs.

b) 30 (75.0%) mothers had no knowledge on danger signs of ARI and 10 (25.0%) mothers had

no knowledge on advantages and side effects of contraceptive methods. 32 (80%) deliveries

were institutional and 34 (8 5.0%) deliveries were conducted by trained persons.

c) The team contacted different community persons to have their opinion about the services

provided by the MPW (M) of SC Manturu. Community expressed their satisfaction towards the

work of MPWs (M). MPWs (M) were not staying in the SC HQs. ANMs / Sr Health Inspectors

were doing the work of MPW (M)s in these SCs.

d) Public opinion was good on the services being rendered by the PHCs /CHCs visited by the

team. Village leader, ANC/ PNC beneficiaries and others had expressed good opinion on the

overall functioning of PHCs/CHCs.

292

10. Sample Verification of FW Acceptors:

a) Out of 97 FW acceptors (Sterilization, IUD, OP and CC) selected, 77 (79.4%) could be

contacted for sample verification in the district. Minor discrepancies were found in the number

of total children & no. male children.

b) All contacted 37 child immunization beneficiaries confirmed with the doses of immunization

and also got follow up services. No complication among the contacted beneficiaries was found

after receiving the doses.

11. Maintenance of Records and Register:

Printed registers for Eligible Couple were maintained at the visited PHCs/SCs. Stock

registers for the items purchased under NRHM funds were not maintained at PHCs/SCs.

Sterilization/ IUD registers were not printed at PHCs. Nirodh distribution/ Oral pills distribution

registers were maintained at SC level but not in printed form.

12. IT Infrastructure and Mother & Child (MCH) Tracking System:

a) Computers installed at the district headquarter. All 4 blocks head quarters, 27 of 30 PHCs

were also having computer in the district.

b) Internet connectivity was provided to the system available at district office and to all blocks

and in 10 of 27 PHCs.

c) It was reported that the complete MCT data was available in hard copies at PHC/Block level

and data entry was in process.

**********

6. District- Belgaum

Major observations of Regional Evaluation Team (RET), Bangalore about the Evaluation

work carried out in Belgaum District of Karnataka State in June, 2011.

I. Details of the visited Institutions:

Districts Visited PHCs SCs Visited

Belgaum Urudig Chachadi, Noginahala & Kinaye Tadasanoora, Yerajhavi, Elimunnalli,

Madihalli, Peeranawadi & Mache-II

II. Major Observations:

293

1. Human resources:-

a) 15 of the 157 sanctioned posts of Medical Officer, 48 of the 175 sanctioned posts of Staff

Nurse, 3 of the 105 sanctioned posts of LHV, 33 of the 84 sanctioned posts of Male Supervisor,

4 of the 149 sanctioned posts of Pharmacist, 101 of the 425 sanctioned posts of MPHW (Male)

and 139 of the 657 sanctioned posts of MPHW (Female) /ANM were lying vacant in the district.

b) Among the specialists, 10 of the 16 sanctioned posts of Physician, 3 of the 14 sanctioned posts

of Surgeon, 1 of the 18 sanctioned posts of Gynecologist, 4 of the 12 sanctioned posts of

Pediatrician, 4 of the 11 sanctioned posts of Anesthetist, 7 of the 10 sanctioned posts of ENT

specialist and 5 of the 11 sanctioned posts of Ophthalmologist were also lying vacant.

c) In the visited PHC Neginahala, one post of first division Assistant, and 2 of the 5 sanctioned

posts of Male worker were lying vacant.

.2. Janani Suraksha Yojna (JSY):-

a) Women belonging to BPL and SC/ ST category family is eligible for JSY payments for their

first two deliveries. The rates for normal institutional delivery are Rs. 700 per case for rural

area, Rs. 600 per delivery in urban area. Rs. 1500 per case for caesarean delivery in private

institutions and Rs. 700 in Govt. institutions are also provided. For home delivery Rs. 500 per

case are given.

b) ASHA gets Rs. 200 per case for accompanying the women for delivery to hospital.

c) As reported, 1,01,717 ANC were registered during 2009-10 and 1,08,106 cases during 2010 -

11. 91,579 deliveries were conducted during 2009-10 and 91,169 during 2010- 11 and JSY

cash incentive could be made available to 48969 beneficiaries during 2009-10 and 29643

beneficiaries during 2010 -11. Total budget for JSY in the district was Rs. 4,06,75,734 for

2009-10 and Rs. 2,26,09,477 for 2010-11. Expenditure to the tune of Rs. 3, 49.90,500 was

made in 2009-10 and Rs. 2, 13, 91,200 during 2010-11.

d) It was observed that payment of JSY incentive to 35 beneficiaries at SC Elimunnalli, 51 at SC

Madihalli, 24 at SC Peeranawadi and 50 at SC Mache-II was pending for 2010-11. Similarly,

payment to 21 JSY beneficiaries at SC Elimunnalli, 51 at SC Madihalli, 28 at SC Peeranawadi

and 36 at SC Mache-II was found pending in 2011-12 (up to 06/11). JSY beneficiaries‟

registers were maintained in printed registers. JSY cards were issued to all the beneficiaries.

e) 33 JSY beneficiaries were selected and 25 could be contacted in the field for sample

verification. All JSY beneficiaries stated that they received full JSY cash incentive in time.

23(92%) deliveries were institutional and 24(96%) deliveries were normal. Follow up visits

were made in 23(100%) cases by the ASHA/ANM after delivery.

294

3. Untied Fund:-

a) Provision and utilization of Untied Funds in the district are detailed as below:

(Amount in lakhs)

Sl. No Particulars 2009-10 2010-11

1. Total budget available * 1,02,59,874 60,03,423

2. Expenditure incurred 96,46,451 58,90,000

3. Balance 6,13,423 1,13,423

* including opening balance and interest earned.

b) Rs. 25,000 to each PHC and Rs. 50,000 to each CHC/TH are given per year as Untied Funds

in the district. All the SCs were being provided Rs. 10,000 as Untied Funds and Rs. 10,000 as

AMG per year in the district. During visit to the Sub Centres it was observed that Rs. 10,000

have been released to all the SCs during 2010-11. AMG fund was not released by district office

though 319 SCs were functioning in Govt. building and were eligible for AMG funds. In the

visited SCs, untied funds for the current year were not released till the time of visit by the team.

c) Untied Funds in the visited SCs were utilized to purchase the items such as Ambu bag, Mucus

sucker, Chloroscope, BP apparatus, Medicines, Hub cutter, Registers/ stationery items,

Buckets, Mug, baby/adult weighing machines, Chairs, Table, Torch light, Water filter,

Pregnancy test kit. Besides this, the amount was spent on transportation of high risk delivery

cases, SC building repairs & painting for taking Xerox copies of reporting formats and for

conducting village health & nutrition day, etc.

4. Rogi Kalyan Samithi (RKS):

a) Rogi Kalyan Samiti (RKS) was constituted in District Hospitals, 26 CHCs / THs and 132 PHCs

in the district.

b) Each RKS was provided funds @ Rs. 5, 00,000 at Distt. Hospital level, @ Rs. 2, 50,000 at

Taluk Hospital /CHC level and @ Rs. 1, 75,000 at PHC level every year. These funds include

corpus fund, AMG and Untied Funds. All these funds are kept at the disposal of RKS and after

taking the approval in its meetings, the funds were being utilized on developmental activities in

the Institution.

c) Details of funds available and expenditure incurred at CHCs & PHCs in the District are given in

the following table:

295

Type/ head of the funds

For CHCs for the year For PHCs for the year

2009-10 2010-11 2009-10 2010-11

Budget* Expdr. Budget * Expdr. Budget * Expdr. Budget * Expdr.

Corpus fund

2,90,000 65,000 19,25,000

17,50,000

1,49,00,000

12,29,488

2,66,70,512

26,41,452

AMG Fund

17,47,607

16,97,607 17,50,000

17,22,000

1,14,78,945

1,12,91,488

66,37,457 63,74,457

Untied fund

12,85,842

11,75,566 8,60,276 8,39,916 60,34,391 5,91,204 34,72,337 3,4l,59,437

* including opening balance

d) During visit to the PHC at Noginahali, it was observed that the sufficient funds were made

available during 2009-10 and 2010-11. The funds spent for purchasing of Medicine,

Chloroscope, Mercury bulbs for OT, H1N1-mask, Surgical equipment, Wall mounted fans,

Water filter, Window curtains, Furniture, Rexene covers, Torch, Chairs for out patients,

Executive chairs, Saline stand, Digital foetal Doppler, Office table, Racks, Suction machine,

Examination stool/table, Foot step, Stethoscope, Aqua-guard water filter, Cot, Refrigerator,

Delivery table, Almariah, Carpets, Nebuliser, Auto clave, OT lamp, Oxygen flow meter, Baby

tray and Table glasses. Construction of pharmacy cubicles, Flag post. Electrical repair work

was also undertaken.

e) In visited PHC Kinaye the expenditure incurred for purchase of Colour TV, DVD, Furniture,

Medical instrument, Oxygen Cylinder, Surgical equipment, V-guard stabilizer, Stationery items

for ASHA workers, Drugs, Submersible pump sets, Chairs for OPD and Curtain cloth. Beside

works such as construction of Ambulance shed, Aluminium partitions for OPD room was

undertaken. Expenditure was incurred to organize school health check-up camps also.

5. Services of ASHA :-

a) In the district 3397 ASHAs were appointed till 31.03.2011. All were trained in all modules and

provided with drug kits.

b) During 2009-10, expenditure of Rs. 1, 29, 77,738 and during 2010-11, Rs. 1, 69, 02,000 was

incurred in the district towards payment of performance based remuneration to ASHAs.

c) In the visited institutions, 25 ASHAs were contacted. As informed, all were trained and given

drug kits.

d) In the visited PHC Noginahal, it was observed that ASHA‟s performance based incentive was

not paid for the last 8 months i.e. from October, 2010 to May, 2011. ASHA‟s drug kits were not

refilled since December 2010.

e) In PHC Kenaye, it was observed that performance based remuneration to ASHA was not paid

for the last 5 months i.e. from January, 2011 to May, 2011.

296

f) At the visited SCs Elimunnalli, Madihalli, Peeranawadi & Mache-II, ASHAs were posted and

trained. In the VHSCs, ASHAs were functioning as a member.

6. Functioning of Village Health Sanitation Committees (VHSC):-

a) 1157 VHSCs were set up against 1270 revenue villages covered under 485 Gram Panchyaths.

5296 Anganawadi Centres were also functioning in the district. Every year Rs. 10,000 are

allotted to each VHSC which was being kept in the bank account operated jointly by the village

Gram Panchyath Surpanch and ASHA.

b) VHSC funds to the tune of Rs. 10,000 was released during 2010-11 to the VHSCs, Elimunnalli

and Madihalli and funds were not released to the VHSCs, Peeranawadi and Mache-II as they

were functioning in the urban areas. VHSC accounts were maintained by the ASHAs. For the

year 2011-12 fund was not released.

C) VHSC funds mainly utilized for purchasing of Sarees (uniform) to ASHAs, Chairs and Tables,

Water filter, Mattress and Weighing machines to Anganawadi Centres, School Medicine kit,

Chappals to ANCs, Drugs and Stationery. Besides this, fund was spent for transporting

delivery cases to the Institutiions, for conducting village health and nutrition day, wall writings

and Anganawadi boards, IEC activities, Drainage cleaning, cleaning of Anganswadi & school

building surroundings and repairing bore wells.

d) Details of VHSC budget in the district for 2009-10 and 2010-11 are below:

SI.No Particulars 2009-10 2010-11

1. Total budget available 33,70,000 1,19,42,227

2. Expenditure incurred 29,97,773 1,08,09,209

3. Balance 3,72,227 11,33,018

7. 24 x 7 hours Delivery Care System:-

a) In the district, 88 of the total 134 PHCs were identified for providing 24X7 delivery care

institutions. Of these 88 centres, only 8 PHCs have 2 Medical Officers, and in all PHCs 3 Staff

Nurses were posted. These centres should have minimum 2 Medical Officers posted in order

to give 24X7 delivery care services efficiently.

b) Centre wise performance on delivery conducted by these centres was not readily available in

the district office.

c) No separate budget was released to these centres, except the salary budget to the contractual

staff nurses.

8. Physical Infrastructure and Stock Position:-

i) Sub Centres

297

a) It was reported that the 319 SCs were functioning in Govt. buildings, 220 SCs were functioning

in rented building. Sub Centres visited at SC Mache-II was functioning in rented building and

SC Elimunnalli, SC Madihalli & SC Peeranawadi were functioning in Govt. building.

Infrastructure was not as per IPHS at the visited SCs. ANM was staying in the SC areas.

Labour Room was not functioning in the visited SCs Madihalli & Mache-II.

b) Foot stool, Delivery table , McIntsh sheets & Ambu bag/suction were not available in most of

the visited SCs. Steam Sterilizer & RDT kit were not available at SCs Elimunnalli &

Peeranawadi. Benches for clients were not available at SCs Peeranawadi & Mache-II. Stove

and Haemoglobinometer was not available at SC Elimunnalli. Cup board for drugs, Nischay

pregnancy test kit, IUD insertion kit and stove were not available at SC Mache-II.

c) DDK, Sanitary napkins, Tab. Cotrimoxazole, EC pills, OP cycles, Tab. Cloroquine, Tab.

Metronidazole, Tab Oxitocin, Cap. Ampicillin, Inj Gentamycin and Kits – A & B etc. were not

available at the visited Sub Centers. Vitamin A solution was not available at most of the visited

SCs.

ii) PHCs

In the visited PHCs Noginahal & Kinaye, it was observed that both the PHCs were functioning

in government building and the infrastructure was not as per IPHS. No vehicle was provided to

the PHCs. Under AYUSH, Medical Officer was not posted in both the visited PHCs.

Residential quarter for Medical Officer was not available in PHC Noginahal. PHC works was

not categorized for 24X7 delivery services care centre in both the visited PHCs.

9. Community Satisfaction and opinion on Health Services:-

a) 40 mothers having child upto one year of age were interviewed to assess their knowledge and

opinion on the services rendered by ANMs and found that most of them were satisfied having

PNC services in time in the area of visited 4 SCs.

b) 30 (75.0%) mothers had no knowledge on danger signs of ARI and 11 (27.5%) mothers had no

knowledge on advantages and side effects of contraceptive methods. 36 (90%) deliveries were

institutional and 37 (92.5%) deliveries were conducted by trained persons.

c) The team contacted different community persons to have their opinion about the services

provided by the MPW (M) of SC Manturu. Community mostly expressed their satisfaction

towards the work of MPWs(M).

d) Public opinion was good on the services being rendered by the PHCs /CHCs visited by the

team. Village leader, ANC/ PNC beneficiaries and others had expressed good opinion on the

overall functioning of PHCs/CHCs.

10. Sample Verification of FW Acceptors:

298

a) Out of 89 FW acceptors (Sterilization, IUD, OP and CC) selected, 72 (80.9%) could be

contacted for sample verification in the district. Minor discrepancies were found in the number

of total children & no. male children.

b) All contacted 28 child immunization beneficiaries confirmed with the doses of immunization

and also got follow up services. No complication among the contacted beneficiaries was found

after receiving the doses.

11. Reconciliation of Reported Performance:

Some discrepancies were found during verification of performance figures reported at district

office and the visited centres for the year 2010-11 & 2011-12 as given below.

a) There were only 262 Sterilization cases in Service Register against the reported 306 cases in

PHC Noginahala for the year 2010-11.

b) Reported number of IUD accepters found more than the registered number of IUD accepters.

139 IUD cases recorded in the Service register against total 148 IUD cases reported in PHC

Chachadi and 62 in the Service register against total 163 IUD cases reported in PHC

Noginahala for the year 2010-11. No Service register was maintained for IUD cases against

the reported cases of 210 in PHC Kinaye for the year 2010-11.

c) During the year 2011-12, 20 of the total 26 IUD cases were recorded in the Service register at

PHC Noginahala. No Service register maintained for IUD cases against the reported cases of

20 in PHC Kinaye for 2011-12.

12. Maintenance of Records and Register:

Printed registers for Eligible Couple, ANC/PNC were maintained at the visited PHCs/SCs.

Stock registers for the items purchased under NRHM funds were not maintained at PHCs/SCs.

Nirodh / Oral pills distribution registers were maintained at SC level but not in printed form.

13. IT Infrastructure and Mother & Child (MCH) Tracking System:

a) One computer was installed at the district headquarter. All 10 block head quarters, all 17

CHCs and 72 of 134 PHCs were also having computers in the district.

b) Internet connectivity was provided to the system available at district office and to all blocks and

in 15 0f 17 CHCs & 68 of 72 PHCs.

c) It was reported that the complete MCT data was available in hard copies at PHC/Block level.

Data entry was in process.

*

299

7. District- Shivmoga

Major observations of Regional Evaluation Team (RET), Bangalore about the

Evaluation work carried out in Shivmoga District of Karnataka State in November,

2011.

I. Details of the visited Institutions:

Districts Visited CHC/ PHCs SCs Visited

Shivmoga CHC: Ayanuru.

PHCs: Haramaghatta & Antharagange.

Holebenavalli, Abbalagere,

Mavinakere, Ts Taskent Nagara and Ayanuru.

II. Major Observations:

1. Human resources:-

a) Sanctioned post of District Surveillance Officer and 15 of the 124 sanctioned posts of

Medical Officer were lying vacant in the district. 32 posts of Specialists i.e. Surgeon,

Gynecologist, Pediatricians, Anesthetist, Radiologist & Pathologist, ENT specialist,

Ophthalmologist and Dental Medical Officer were also lying vacant in the district.

b) Further, 91 of the 225 sanctioned posts of Staff Nurse, 11 of the 69 sanctioned posts of

LHV, 10 of the 49 sanctioned posts of Male Supervisor, 31 of the 121 sanctioned posts of

Pharmacist, 15 of the 81 sanctioned posts of Lab Technician, 105 of the 207 sanctioned

posts of MPHW (Male) and 83 of the 348 sanctioned posts of MPHW (Female) / ANM

were also lying vacant in the district.

c) One post each of the 4 sanctioned posts of General Duty Medical Officer and 3

sanctioned posts of Medical Officer with Diploma in Child Health was lying vacant in the

visited CHC at Ayanur. Post of the Gynecologist and the Anesthetist were not available

in the CHC.

d) In the visited PHC Antharagange, 3 of the 6 sanctioned posts of Health Worker (Male)

were lying vacant.

e) One post of Health Supervisor (Male) and 2 of the 5 sanctioned posts of Health Worker

(Male) were lying vacant in PHC Haramaghatta

300

2. Janani Suraksha Yojna (JSY):-

a) Women belonging to BPL and SC/ ST category are eligible for JSY incentives for their

first two deliveries. The rates for normal institutional delivery are: Rs. 700 per case for

rural area and Rs. 600 per delivery in urban area. Rs. 1500 per case for caesarean

delivery in private institutions and Rs. 700 in Govt. institutions are also provided. For

home delivery Rs. 500 per case is given.

b) ASHA gets Rs. 200 per case for accompanying pregnant women to hospital for delivery.

c) It was reported that 32503 ANCs were registered during 2010-11 and 14900 during 2011-

12

( upto September 2011). Further 28837 deliveries were conducted during 2010-11 and

14665 during 2011- 12 (upto September 2011) and JSY cash incentive could be paid to

14319 beneficiaries during 2010-11 and 5206 beneficiaries during 2011 -12 (upto

September 2011).

d) Total budget for JSY in the district was available to the tune of Rs. 1, 79, 25,386 for 2010-

11 and Rs. 1,62,12,651 for 2011-12. Expenditure to the tune of Rs. 1, 02, 51,735 was

incurred in 2010-11 and Rs. 38, 83,757 during 2011-12 (upto September 2011).

e) 18 pending cases of JSY payment in SC Abbalagere, 4 cases in Mavinakere and one

JSYcase in Taskent Nagara were found for the current year. It was observed that JSY

beneficiary registers were maintained properly and JSY cards were issued to all the

beneficiaries in the visited centres.

f) 22 JSY beneficiaries were contacted for sample verification out of these 21(95.5%)

deliveries were institutional. All JSY beneficiaries stated that they received full JSY cash

incentive. Follow up visits were made to 21(95.5%) mothers by the ASHA/ANM after

delivery.

3. Rogi Kalyan Samiti (RKS):

a) Rogi Kalyan Samiti (RKS) was constituted in District Hospitals, 12 SDH/ CHCs / THs and

89 PHCs in the district.

b) RKS funds @ Rs. 5, 00,000 at Distt. Hospital level, @ Rs. 2, 50,000 at Sub Divisional

Hospital / Taluk Hospital / CHC level and @ Rs. 1, 75,000 at PHC level were being

provided every year in the district. These funds include corpus fund, AMG and Untied

Funds. All these funds are kept at the disposal of RKS and after taking approval in its

meeting, the funds were being utilized on developmental activities in the Institution.

c) Details of RKS funds available and expenditure incurred at CHCs /THs & PHCs in the

District are given in the following table.

301

*Including opening balance. # up to September, 2011.

d) During visit to the PHC at Antharagange, it was observed that only 50% of the amount of

RKS fund was released up to the end of October, 2011 and there was a total amount of

Rs. 87,037 available for the year 2011-12 out of which Rs. 40,364 were spent.

Expenditure was incurred on purchase of Chemicals, Lab Materials, Electrical Items,

Plumbing Items, Table Glass, Name Boards, Syringe and Needles, Fibre Board Wall

Hangings, Computer Printer, Refills and Toner in the PHC besides, Repair of Lab

equipment. Funds were also used for payment of remuneration to night Dais, driver

engaged for pulse polio programme and Close User Group

(CUG) telephone bills of BSNL. Construction of pit used for dumping bio-medical waste,

Electrical and plumbing work for PHC building were also undertaken.

e) In PHC Haramaghatta, expenditure incurred on purchase of Medicines for general use

and for TB patients, Bleaching Powder, Stationery Items, Stamps Seals Pad, Flexi

Banners, BP Apparatus, Stethoscope, Lab equipment, Fire Extinguisher Machine, Drip

Stand, Syringes, UPS Battery, fixing of name boards, Table Glass and Window Glasses.

Expenses incurred also towards celebration of Community Health Day, Mobile

Telephone bills of CUG Sim Cards, repair of Water Filter, electrical repair in PHC

building, cleaning of PHC premises etc from this fund.

f) The funds in CHC Ayunur were utilized for purchase of Lab Blood Grouping Kits, Boyle‟s

Apparatus and related materials, Water Purifier with Installation, Fridge and ILR repair,

TV, Fridge & Stabilizer, Surgical Equipments, Fans & Tube Fittings, Emergency Drugs.

Expenditure was also incurred on printing of OPD Slips, Construction of Liquid/Solid

Waste management Pits and Fittings, payment of Electrical Bills and making of Sign

Display Boards. Plumbing & Electrical works in maternity ward and Trauma Care Unit.

Type/ head

of

the funds

For CHC For PHCs

2010-11 2011-12 2010-11 2011-12

Budget Expdr. Budget* Expdr.# Budget Expdr. Budget* Expdr.#

Corpus fund

5,00,000 4,95,678 1,45,322 37,339 88,00,00

0

87,50,35

2

49,27,125 19,64,985

AMG Fund

5,00,000 4,96,772 2,03,228 70,000 32,50,00

0

27,22,61

1

23,33,389 5,84,012

Untied fund

2,50,000 2,29,456 1,20,544 18,348 22,00,00

0

21,09,29

1

12,12,709 4,33,229

302

4. Untied Funds:-

a) Rs. 25,000 to each PHC and Rs. 50,000 to each SDH/CHC/TH is given per year as

Untied Funds in the district. SCs were being provided @ Rs. 10,000 as Untied Funds and

Rs. 10,000 as AMG per year in the district. Position of utilized funds for CHCs, PHCs has

been already described under RKS.

b) As reported, an amount of Rs. 30,70,000 during 2010-11 and Rs. 16,75,818 in 2011-12

which includes opening balance was available as Unspent Balance for strengthening the

services of health Sub Centres and out of it, an amount of Rs. 28,69,182 and Rs. 2,04,499

was spent in 2010-11 and 2011-12 ( up to September 2011) respectively.

c) During visit to the Sub Centres, it was observed that Rs. 10,000 have been released to all

the SCs as Untied Funds during 2010-11 and full amount was utilized by the centres

except SCs Holebenavalli and Mavinakere. AMG fund was released to the SCs except SC

Holebenavalli not having Govt. building.

d) Untied Fund in the visited SCs was utilized to purchase items such as Registers /Records,

BP apparatus, Medicines, Baby/adult weighing machines, Chairs, Table, Fan and

Stationery. Besides this, the amount was spent on transportation of high risk delivery

cases, electrical materials and work, for taking Xerox copies of reporting formats and for

conducting village health & nutrition day, etc.

5. Services of ASHA:-

a) In the district 1003 ASHAs were sleeted till 31.03.2011. All ASHAs were reported to be

trained in all modules by 31.10.2011 and 974 ASHAs were provided with drug kits.

b) Expenditure to the tune of Rs. 47,76,090 in the year 2010-11 and Rs. 20, 10,033 during

2011-12 (up to Oct, 2011) was incurred in the district towards payment of performance

based remuneration to ASHAs.

c) In the visited institutions, 24 ASHAs were interviewed, all were trained and given drug

kits. Performance based remuneration was also paid regularly to them.

d) At the visited SCs Holebenavalli, Abbalagere, Mavinakere and Taskent Nagara, ASHAs

were posted and trained. In the VHSNCs, ASHAs were functioning as a member.

6. Functioning of Village Health Sanitation & Nutrition Committees (VHSNC):-

a) VHSNCs have been set up in 1141 revenue village in the district. Every year, Rs. 10,000

were allotted to each VHSNC which was being kept in the bank account and operated

jointly by the village Gram Panchyath Surpanch and ASHA.

b) Details of VHSNC budget and utilization in the district for 2010-11 and 2011-12 in the

district are below:

303

SI.No Particulars 2010-11 2011-12

(upto Sept‟11)

1. Total budget available 80,50,000 48,73,813

2. Expenditure incurred 73,66,187 6,57,639

3. Balance 6,83,813 42,16,174

c) Rs. 10,000 was allotted to each VHSNC in the visited SCs for 2010-11. Up to the year

2009-10, accounts were maintained by Anganawadi Workers. During the year 2010-11,

these accounts have been transferred and maintained by ASHAs. For the year 2011-12,

1st installment up to a maximum of Rs.5, 000 was released to all the visited SCs under

this head.

d) VHSNC funds were mainly utilized for purchasing of Uniform Sarees to ASHAs,

Bleaching powder, Phenol, Chappals & nutrition for BPL ANC caseas, Medicines, Water

Filter & Mats to Anganawadis, First Aid Kits to schools and Stationery. Besides this, fund

was spent for cleaning of village drinking water tanks and Larva survey. Expenditure on

transportation of AN mothers to the hospital for delivery was also reported under this

head.

7. 24 x 7 hours Delivery Care System:-

a) As reported, 24 of the total 89 PHCs were identified for providing 24X7 delivery care

institutions in the district. It was observed that 6 PHCs have 2 Medical Officers, and 15

PHCs have 3 Staff Nurses posted.

b) The team reported that 20 PHCs in the year 2010-11 and 21 PHCs during 2011-12 (upto

October 2011) could not achieve the minimum stipulated 10 deliveries per month. The

district authorities need to revamp the 24X7 delivery care services in the notified delivery

points. No separate budget was released to these centres, except the salary to the

contractual Staff Nurses.

c) In the visited CHC Ayanur, only normal deliveries were conducted, caesarian deliveries

were not conducted because of non availability of Anesthetist and Gynecologist. Though

all the 8 sanctioned posts of Staff Nurses were filled up, its performance was not up to the

mark i.e. 51 deliveries in the year 2010-11 and 37 deliveries during the current year up to

Oct, 2011.

8. Physical Infrastructure and Stock Position:-

i) Sub Centres:

a) Visited SCs were functioning in Govt. buildings except SC Holebenavalli. ANM of these

centres except SC Taskent Nagara were not staying at the SC head quarters. Labour

Room was not functioning in SC Mavinakere.

304

b) Examination Table and Benches for clients were not available in SCs Holebenavalli and

Abbalagere. Delivery Table, Hemoglobin Meter and McIntch sheet were not available in

all the visited SCs except SC Mavinakere. Ambu bag / Suction and RDT Kit for Malaria

were not available in all the visited SCs. Steam Sterilizer and Delivery Kit were not

available in all the visited SCs except SC Taskent Nagara. Cup Board was not available in

SCs Holebenavalli & Mavinakere. IUD Insertion Kit was available in all the SCs except SC

Holebenavalli. Weighing Machine (infant) was not available in SCs Holebenavalli &

Mavinakere. BP Apparatus was not available in SCs Holebenavalli & Taskent Nagar.

c) ORS packets were available in all the visited SCs except SC Abbalagere. DDK, Kerosene

oil/gas, Sanitary Napkins, EC pills, Tab Metranidazole, Tab Oxitocin, Cap. Ampicillin, Inj

Gentamycin and Kits – A & B were not available in the visited Sub Centers. IFA Tablets,

Antiseptic Solution & OP Cycles were available in all the visited SCs except SC

Holebenavalli. Condoms were not available in SCs Holebenavalli & Abbalagere. Clorin

Solution (bleaching powder) and Tab. Paracetamol were not available in the visited SCs

Holebenavalli & Mavinakere. Co trimoxazole Tablets were not available in SCs

Mavinakere & Taskent Nagar. Vitamin A Solution was available in all the visited SCs

except SC Taskent Nagara.

ii) PHCs:

In the visited PHCs Antharagange & Haramghatta, it was observed that both the PHCs

were functioning in government building and the infrastructure was not as per IPHS.

There was no vehicle available in the PHCs. Operation Theatre was not functional in

both the PHCs. AYUSH, Medical Officer was not posted in the PHCs. Residential quarter

for Medical Officer was not available in the PHCs.

iii) CHC:

CHC Ayanur was functioning in Govt. building and the infrastructure was not as per

IPHS. Only normal deliveries were being due to non availability of Anesthetist and

Gynecologist.

9. Community Satisfaction and opinion on Health Services:-

a) 40 mothers having child upto one year of age were interviewed in the area of visited 4

SCs to assess their knowledge and opinion on the services rendered by ANMs and found

that most of them were satisfied and had PNC services in time.

b) 32 (80.0%) mothers had no knowledge on danger signs of ARI and 9 (22.5%) mothers

had no knowledge on advantages and side effects of contraceptive methods. 37 (92.5%)

deliveries were institutional.

305

c) The team contacted different community persons to have their opinion about the services

provided by the MPW (M) at SC Holebenavalli. Though MPW (M) was not staying in the

SC HQs, community expressed their satisfaction towards the work of MPWs (M). Posts

of MPWs (M) were vacant in the SC Mavinakere, SC Taskent Nagara. At SC

Abbalagere, MPW (M) was deputed to Shivamoga Municipally. ANMs / Sr. Health

Inspectors were doing the work of MPWs (M) in these SCs.

d) Public opinion was good on the services being rendered by the PHCs / CHCs visited by

the team. Village leader, ANC / PNC beneficiaries and others expressed good opinion on

the overall functioning of PHCs / CHCs.

10. Sample Verification of FW Acceptors:

a) Out of 104 FW acceptors ( Sterilization, IUD, OP and CC ) selected, 75 (72.1%) could be

contacted for sample verification in the district. Minor discrepancies were observed in

the age of acceptor, number of total children & no. male children.

b) Most of the contacted beneficiaries got follow up services and sterilization acceptors

received full compensation money after receiving the services.

c) All contacted 34 child immunization beneficiaries confirmed receiving the doses of

immunization and also got follow up services. No complication among the contacted

beneficiaries was found after receiving the doses.

11. Maintenance of Records and Registers:

a) Printed registers for Eligible Couple, ANC/PNC and Immunization were maintained at the

visited PHCs/SCs. For Family Planning beneficiaries and maintenance of stock, non –

printed registers were maintained.

b) Stock registers for the items purchased under NRHM funds were not maintained at

PHCs/SCs.

12. IT Infrastructure and Mother & Child (MCH) Tracking System:

a) One Computer system at the district office and a computer system at each block in all

the 7 blocks were available with internet connection in the district. All the 7 CHCs had

no computer systems. 20 of 89 PHCs were having computer systems with internet

connection in the district. The centres which were having internet connection were

uploading HMIS/MCTS data online in the Govt. of India web portal at their head quarter

themselves; other centres use this facility at block level.

b) Staff at all levels were trained and sensitized on MCTS.

c) It has been observed that the web portal of Karnataka for MCTS is designed to record

messages sent by mobile phones for updating data on subsequent services provided to

306

the already registered pregnant women. All the field level, staffs such as ANMs and

ASHAs were instructed to send messages from their mobiles phones to the central

server of the MCTS web portal. Thereby, updating of subsequent services rendered to

the pregnant women becomes easy.

d) It was also reported that Karnataka state has already switched over to facility based

HMIS reporting from the sub centre level and PHC/CHC/TH/DH level since August 2010.

307

8. District- Uttara Kannada

Major observations of Regional Evaluation Team (RET), Bangalore about the

Evaluation work carried out in Uttara Kannada District of Karnataka State in

November, 2011.

I. Details of the visited Institutions:

Districts Visited CHC/ PHCs SCs Visited

Uttara Kannada Urudig PHCs: Siddarabetta, Hiregutti and Nandolli. Kinnera, Shirwada, Mirjana,

Bargi, Balagimane and

Yellapur-II.

II. Major Observations:

1. Human Resources:-

a) One post each of District TB Officer, District Surveillance Officer and District Immunization

Officer, 51 of the 102 sanctioned posts of Medical Officer, 10 of the 16 sanctioned posts

of AYUSH Medical Officer were lying vacant in the district. Among the specialists, 11 of

the 16 sanctioned posts of Physician, 10 of the 17 sanctioned posts of Surgeon, 9 of the

20 sanctioned posts of Gynecologist, 7 of the 12 sanctioned posts of Pediatricians, 7 of

the 13 sanctioned posts Anesthetist, one of the 2 sanctioned posts of Radiologist, 2 posts

of Pathologist, 9 of the 12 sanctioned posts of ENT specialist, 9 of the 13 sanctioned

posts of Ophthalmologist and 3 of the 15 sanctioned posts of Dental Medical Officer were

also lying vacant in the district.

b) 37 of the 239 sanctioned posts of Staff Nurse, 23 of the 66 sanctioned posts of LHV, 37 of

the 61 sanctioned posts of Male Supervisor, 29 of the 98 sanctioned posts of Jr.

Pharmacist, 12 of the 15 sanctioned posts of Sr. Pharmacist, 16 of the 22 sanctioned

posts of Sr. Lab Technician, 22 of the 76 sanctioned posts of Jr. Lab Technician, 82 of the

205 sanctioned posts of MPHW (Male) and 23 of the 365 sanctioned posts of MPHW

(Female) / ANM were lying unfilled in the district.

c) In the visited PHCs at Siddharabetta, Hireguthi & Nandolli, AYUSH MO was working in

place of MBBS Medical Officer and the sanctioned post of Health Supervisor was lying

vacant. 2 of the 4 sanctioned posts of Health Worker (Male) and the sanctioned post of

Lab-Technician were vacant in PHC Hireguthi. Similarly, sanctioned post of LHV and 2 of

the 3 sanctioned posts of Health Worker (Male) were vacant in PHC Nandolli.

308

2. Janani Suraksha Yojna (JSY):

a) A woman belonging to BPL and SC/ ST category family is eligible for JSY incentives for

their first two deliveries. The rates for normal institutional delivery are: Rs. 700 per case

for rural area and Rs. 600 per delivery in urban area. Rs. 1500 per case for caesarean

delivery in private institutions and Rs. 700 in Govt. institutions are also provided. For

home delivery, Rs. 500 per case is given.

b) ASHA gets Rs. 200 per case for accompanying pregnant women to hospital for delivery.

c) It was reported that 23278 ANC during 2010-11 and 11555 during 2011 -12 ( upto

September 2011) were registered. 21242 deliveries during 2010-11 and 10358 during

2011- 12 (upto September 2011) were conducted and JSY cash incentive could be paid to

10933 beneficiaries during 2010-11 and 5619 beneficiaries during 2011 -12 (upto

September 2011).

d) Total budget for JSY in the district was available to the tune of Rs. 1, 14, 09,311 for 2010-

11 and Rs. 90, 95,061 for 2011-12. Expenditure to the tune of Rs. 80, 66,250 was

incurred in 2010-11 and Rs. 41,57,000 during 2011-12 (upto September 2011).

e) In the visited SCs, 5 JSY beneficiaries in Bargi and 8 beneficiaries in Yellapur-II were

found waiting for their cash incentive under the scheme during current year 2011-12. It

was observed that Printed JSY beneficiary registers were maintained in the visited SCs

and JSY cards issued to all the beneficiaries.

f) 28 JSY beneficiaries were selected and 20 of them could be contacted in the field for

sample verification. 18 (90.0%) deliveries of the contacted beneficiaries were institutional.

All JSY beneficiaries stated that they received full JSY cash incentive and 95% of the

beneficiaries received the amount in time. Follow up visits were made to 18 (90.0%)

mothers by the ASHA/ANM after delivery.

3) Rogi Kalyan Samiti (RKS):

a) Rogi Kalyan Samiti (RKS) was constituted in District Hospitals, 11 SDH/ CHCs / THs and

79 PHCs in the district.

b) Every RKS was provided funds @ Rs. 5, 00,000 at Distt. Hospital level, @ Rs. 2, 50,000

at Sub Divisional Hospital/Taluk Hospital /CHC level and @ Rs. 1, 75,000 at PHC

annually in the district. These funds include corpus fund, AMG and Untied Funds. All

these funds are kept at the disposal of RKS and after taking approval in its meeting, the

funds were being utilized on developmental activities in the Institution.

c) Details of RKS funds available and expenditure incurred at CHCs /THs & PHCs in the

District are given in the following table:

309

*Including opening balance. # upto September, 2011.

d) In the visited PHCs at Siddharbhetta, Hiregugthi and Nandolli, it was observed that for

the year 2011-12, only about 50% of the RKS funds were released upto the end of

October, 2011.

e) In PHC Siddharbhetta, the funds were spent on purchase of Surgical equipment, Flexi-

Board, Glow Sign Board and Medicine. Expenditure was also incurred on construction of

solid waste management pit and liquid waste management equipment, repairs of road

approaching PHC and cleaning charges etc.

f) In PHC Hiregugthi, the Untied Funds were utilized for purchasing of Laboratory

equipment, Surgical equipment, Retina-Scope, Thermometer, Furniture, Computer,

Electrical Fittings, Indane Cooking Gas Cylinder and Sign Board. Expenditure was also

incurred on Waste Management equipment for solid and liquid wastes, Deep Burial pit

Construction, Payment to Night AYA, Display Hospital Glowing Sign Board erected on

pole on road leading to hospital with pole charges, Pulse Polio remuneration to driver,

Fixel board for displaying performance statements kept inside PHC, payment of travelling

allowance bill to ICTC counselors and referral transport charges to AIDS patients etc.

g) Funds were spent in the PHC Nandolli on purchase of Medicine, Furniture and Fixograph

board. Expenditure was also incurred on referral transport charges to AIDS patient,

Construction of solid waste pit and erecting of glow sign board etc.

h) Deviation of purchase procedures and purchase of overpriced materials.

The team observed that expenditure of Rs. 17542/- per board measuring 2‟ X 4‟ was

incurred placing purchase order centrally by the District office for 27 PHCs in the district.

The market cost of this board could be roughly around Rs. 3000 to Rs. 5000 per board.

Expenditure on waste management is also over priced at Rs. 5000 per unit consisting of

Type/ head of

the funds

For CHC

For PHCs

2010-11 2011-12 2010-11 2011-12

Budget

*

Expdr. Budget * Expdr

.#

Budget * Expdr. Budget * Expdr.#

Corpus fund 12,04,7

21

9,76,02

1

3,10,70

0

39,09

0

71,53,469 60,46,77

4

40,25,69

5

7,27,44

6

AMG Fund 12,08,3

76

8,62,89

4

5,50,000 47,73

2

29,46,292 28,05,766 19,74,52

6

2,77,99

4

Untied fund 7,07,93

3

6,02,04

4

2,74,889 29,55

2

25,94,582 18,10,518 9,89,064 2,02,45

2

310

two fiber / plastic cans measuring around 5 liters and 50 liters. The basic purpose for

providing RKS funds to the CHC / PHC is that the institute can procure essential

drugs, equipments etc. at the local level due to non-availability of the same in time

from the HQ for the smooth functioning of the institute and the institute is to take

approval for its purchases so that RKS can keep a tab on it.

4. Untied Funds:

a) Rs. 25,000 to each PHC and Rs. 50,000 to each SDH/CHC/TH are given per year as

Untied Funds in the district. All the SCs were being provided Rs. 10,000 as Untied Funds

and Rs. 10,000 as AMG per year in the district.

b) During visit to the Sub Centres, it was observed that Rs. 10,000 have been released to

each SCs as Untied Funds during 2010-11 but no sub centre has utilized whole amount as

there was balance in each centre. AMG fund was not released to any of the visited SCs

during 2010-11 and 2011-12 in the district, as in the district PIP budget, AMG fund release

was approved for the total of 46 SCs in 2010-11 and for 77 SCs during 2011-12.

c) Untied Fund in the visited SCs was utilized to purchase items such as Registers /Records,

BP Apparatus, Stethoscope, Digital Thermometer, Benches, Chairs, Tables, Medicines,

Water Filter, Door & Window curtains and Stationery. Besides this, the amount was spent

on transportation of high risk delivery cases, electrical materials and work, for taking Xerox

copies of reporting formats and for conducting village health & nutrition day, etc.

. 5. Services of ASHA:

a) The district had selected 1372 ASHAs as targeted for all 1246 villages in the district by

end of the year 2010-11. Out of them, 1330 ASHAs were working as on 31/10/2011. All

1372 ASHAs were trained in all modules and 1330 ASHAs were given drug kits. It has

been reported that 42 ASHAs proposed for the year 2011-12 as only 1330 ASHAs were

working in the district as against 1372.

b) An expenditure to the tune of Rs. 23,09,557 in the year 2010-11 and Rs. 22,59,787 during

2011-12 (upto Oct, 2012) was incurred in the district towards payment of performance

based remuneration to ASHAs.

c) 27 ASHAs contacted during field visit were trained and given drug kits. Performance

based remuneration was paid regularly to them.

d) At the visited SCs Mirjana, Bargi, Balagimane and Yellapur-II, ASHAs were posted and

trained. In the VHSNCs, ASHAs were functioning as a member.

6. Functioning of Village Health Sanitation & Nutrition Committees (VHSNC):

a) 1226 VHSNCs have been set up in the district. Every year Rs. 10,000 are allotted to

each VHSNC which were being kept in the bank account operated jointly by the village

Gram Panchyath Surpanch and ASHA.

311

b) Details of VHSNC budget and utilization in the district for 2010-11 and 2011-12 are given

below:

(in Rs.)

SI.No Particulars 2010-11 2011-12

(upto Sept‟ 2011)

1. Total budget available 1,06,85,000 62,30,538

2. Expenditure incurred 70,16,462 7,80,668

3. Balance 36,68,53 54,49,870

c) Rs. 10,000 was allotted to each VHSNC in the visited SCs for 2010-11. Up to the year

2009-10 accounts were maintained by Anganawadi Workers. During the year 2010-11,

these accounts have been transferred and maintained by ASHAs. For the year 2011-12,

1st installment was released to the SC Mirjana but it was not released to the SC Bargi.

District Office has collected Rs. 2,000 to 3,000 from each VHSNC for bulk purchase of

Medicines. The amount was collected through DD drawn in favour of „Medico Remedies,

Bangalore.‟

d) VHSNC fund was mainly utilized for purchasing of Uniform Sarees to ASHAs, Chappals to

BPL ANC cases, Sanitary Napkins, Medicines, Protein Powder to Leprosy patients, First

Aid Kits to Schools, Water Filter and Stationery. Besides this, fund was spent for cleaning

of Village drinking water tanks, Larva survey, Transportation of women to the hospital for

delivery and for conducting Village Health and Nutrition day.

7. 24 x 7 hours Delivery Care System:

a) In the district, 15 of the total 79 PHCs were identified for providing 24X7 delivery care

institutions. Of these 15 centres, only 1 PHC had 2 Medical Officers, and 8 PHCs had 3

Staff Nurses posted.

b) During 2010-11 and during April to October 2011, none of the 15 PHCs could achieve the

minimum stipulated 10 deliveries per month. The district authorities need to reclassify the

24X7 delivery services care centres according to notified delivery points. No separate

budget was released to these centres, except the salary to the contractual staff nurses.

c) Visited PHCs were not functioning as 24X7 delivery care centres

8. Physical Infrastructure and Stock Position:

i) Sub Centres:

a) Visited SCs did not have own buildings except SC Mirjana, which was functioning in Govt.

building, but its infrastructure was not as per IPHS and the labour Room was also not

functioning.

312

b) Examination Table and Benches for clients were not available in the visited SCs except SC

Mirjana. Foot Stool, Delivery Table, Mcintch Sheet, Ambu bag/Suction, Stove and

Hemoglobinometer were not available in the visited SCs. Steam Sterilizer and Delivery

Kit was not available in the visited SCs except SC Bargi. Nischay Pregnancy Test Kit,

Weighing Machine (infant) and Cup Board were not available in SCs Mirjana &

Balagimane. RDT Kit for Malaria was not available in SCs Mirjana & Balagimane. Torch

and BP Apparatus were not available in SCs Mirjana & Bargi. IUD Insertion Kit was not

available in SCs Balagimane & Yellapur-II.

c) DDK, Kerosene oil/gas, Sanitary Napkins, Tab. Cloroquine, Tab Oxitocin, Cap. Ampicillin,

Inj Gentamycin and Kits – A & B were not available in the visited Sub Centers. Tab.

Cotrimoxazole, Clorin Solution (bleaching powder) and IFA Tablets were not available in

the visited SCs except Balagimane. Tab. Metranidazole was not available in SCs Mirjana

& Bargi. EC Pills Antiseptic Solution was available in all the visited SCs except SC

Mirjana.

ii) PHCs:

a) It was observed that all the PHCs were functioning in government building but

infrastructure was not as per IPHS. There was no vehicle and Resuscitation Equipment

in the PHCs at Siddharbetta & Nandolli. Oxygen Cylinder was not available in PHC

Siddharbetta. Power back was also not available in PHCs Hireguthi & Nandolli.

b) Operation Theatre and Labour Room were not functional in all the PHCs. Residential

quarter for Medical Officer was not available in all the visited PHCs.

c) In the visited 3 PHCs, no MBBS Medical Officer is posted and AYUSH Medical Officer

was working there.

9. Community Satisfaction and opinion on Health Services:

a) 40 mothers having child up to one year of age were interviewed in the area of visited 4

SCs to assess their knowledge and opinion on the services rendered by ANMs and

found that most of them were satisfied having PNC services in time.

b) 29 (72.5%) mothers had no knowledge about danger signs of ARI and 8 (20%) mothers

had no knowledge about advantages and side effects of contraceptive methods. 36

(90%) deliveries were institutional.

c) Posts of MPWs (M) were vacant in all the visited SCs. ANMs / Sr. Health Inspector /

Male Health Supervisors were doing the work of MPW (M)s in these SCs.

d) Public opinion was good about the services being rendered by the PHCs /CHCs visited

by the team. Village leader, ANC/ PNC beneficiaries and others had expressed good

opinion on the overall functioning of PHCs/CHCs.

313

10. Sample Verification of FW Acceptors:

a) Out of 97 FW acceptors (Sterilization, IUD, OP and CC) selected, 76 (78.4 %) could be

contacted for sample verification in the district. Minor discrepancies were found in the

age of acceptor, age of spouse, number of total children & no. male children. No case of

denial, double entry of fake case was found during sample check.

b) All contacted 32 child immunization beneficiaries confirmed receiving the doses of

immunization and also got follow up services. No complication among the contacted

beneficiaries was found after receiving the doses.

11. Maintenance of Records and Register:

a) Printed registers for Eligible Couple, ANC/PNC and Immunization were maintained at the

visited PHCs/SCs. For Family Planning beneficiaries and maintenance of stock, non –

printed registers were maintained.

b) Stock registers for the items purchased under NRHM funds were not maintained at

PHCs/SCs.

12. IT Infrastructure and Mother & Child (MCH) Tracking System:

a) One Computer system at the district office and a computer system at each block in all

the 11 blocks, at Taluk Hospital and CHC level were available with internet connection

in the district. 29 of 79 PHCs were having computer systems and modem were supplied

recently but not yet installed. The centres which were having internet connection were

feeding HMIS/MCTS data online in the Govt. of India web portal at their head quarter

themselves; other centres use this facility at block level.

b) Staff at all levels were trained and sensitized on MCTS.

c) It has been observed that the web portal of Karnataka for MCTS is designed to record

messages sent by mobile phones for updating data on subsequent services provided to

the already registered pregnant women. All the field level staffs such as ANMs and

ASHAs are instructed to send messages from their mobiles phones to the central server

of the MCTS web portal. Thereby, updating of subsequent services rendered to the

pregnant women has become easy.

d) It was also reported that Karnataka state has already switched over to facility based

HMIS reporting from the sub centre level and PHC/CHC/TH/DH level since August 2010.

************

314

9. District- Dakshina Kannada

Highlights from the Evaluation Report of Dakshina Kannada District (Karnataka)

The Regional Evaluation Team, located at Regional Office for Health and Family

Welfare (Bangalore), Ministry of Health and Family Welfare, Government of India carried out

sample checks of activities covered under NRHM / RCH in Dakshina Kannada District of

Karnataka State during December, 2011.

I. Health Facilities Covered:

As a part of the evaluation, the team visited Community Health Centres (CHCs), Primary

Health Centres (PHCs) and Sub Centres (SCs) in both districts of Dakshina Kannada and

Udupi as per the details given below:

Districts PHCs/ CHC SCs Visited

Dakshina

Kannada

PHCs: Mani and Kateel.

CHC : Mulky.

Kadeshivalaya, Barimaru, Badaga Ekkar and

Kateel Kateel and Mulky. Kateel.

The major findings / observations of the team which are based on the sample checks

are detailed below:

II. Major Observations:

1. Human resources:-

a) Sanctioned post of Asst. District Health and FW Officer, 16 of the 91 sanctioned posts of

Medical Officer and 11 of the 24 sanctioned posts of Specialists were lying vacant in the

district. As reported, among the posts of Specialist, 4 of the 5 sanctioned posts of

Physician, sanctioned post each of Surgeon & Radiologist, 1 of the 5 sanctioned posts of

Gynecologist, 1 of the 2 sanctioned posts of Pediatrician and 3 of the 5 sanctioned posts

of Dental Medical Officer were lying vacant.

b) In the category of Para-medical staff, 8 of the 62 sanctioned posts of LHV, 41 of the 64

sanctioned posts of Male Supervisor, 38 of the 74 sanctioned posts of Pharmacist, 3 of

the 78 sanctioned posts of Lab Technician, 165 of the 225 sanctioned posts of MPHW

(Male) and 31 of the 444 sanctioned posts of MPHW (Female) / ANM were lying vacant

in the district.

315

c) One sanctioned post each of Physician and Pharmacist was lying vacant in the visited

CHC at Mulki.

d) Post of Pharmacist & Health Supervisor (Male) and 4 of the 6 sanctioned posts of Health

Worker

(Male) were lying vacant in PHC Mani.

e) Post of Pharmacist, Health Supervisor (Male), LHV, Block Health Educator and 5 of the 6

sanctioned posts of Health Worker (Male) were lying vacant in PHC Kateel.

2. Janani Suraksha Yojna (JSY):-

a) Women belonging to BPL and SC / ST category are eligible for JSY incentives for their

first two deliveries. The rates for normal institutional delivery are: Rs. 700 per case for

rural area and Rs. 600 per delivery in urban area. Rs. 1500 per case for caesarean

delivery in private institutions and Rs. 700 in Govt. institutions are also provided. For

home delivery, Rs. 500 per case is given.

b) ASHA gets Rs. 200 per case for accompanying pregnant women to hospital for delivery.

c) It was reported that 26315 ANCs were registered during 2010-11 and 13880 during 2011

-12 ( upto Sep‟ 11) . 22948 deliveries were conducted during 2010-11 and 12638 during

2011- 12 (upto Sep‟11) and JSY cash incentive could be paid to 7098 beneficiaries during

2010-11 and 3770 beneficiaries during 2011 -12 (upto Sep‟11).

d) Total budget for JSY in the district was available to the tune of Rs. 77, 33,044 for 2010-11

and Rs. 58, 71,994 for 2011-12 (upto Sep‟11). Expenditure to the tune of Rs. 54, 99,050

was incurred in 2010-11 and Rs. 29, 69,394 during 2011-12 (upto Sep‟11).

e) 4 JSY cases during 2010-11 and 6 JSY cases in 2011-12 (upto Oct‟11) were found

pending for their incentives amount in SC Kateel. JSY beneficiary registers were

maintained properly and JSY cards were issued to all the beneficiaries in the visited

centres.

f) 21 JSY beneficiaries were contacted for sample verification and out of these 20 (95.2%)

deliveries were institutional. All JSY beneficiaries stated that they received full JSY cash

incentive. Follow up visits were made to 21(100%) mothers by the ASHA/ANM after

delivery.

3. Untied Funds:-

a) Rs. 25,000 to each PHC and Rs. 50,000 to each CHC/TH are given per year as Untied

Funds in the district. All SCs were being provided @ Rs. 10,000 as Untied Funds and

Rs. 10,000 as Annual Maintenance Grant ( AMG ) per year in the district.

b) Provision and utilization of Untied Funds in the district are as detailed below:

316

(In Rs)

* upto Sept, 2011.

c) During visit to the SCs, it was observed that Rs.10, 000 had been released to all the SCs

during 2010- 11 and full amount was utilized by the SCs except Kadeshivalaya. AMG was

not released to the visited SCs Kadeshivalaya and Kateel for the years 2010-11. During

the year 2011-12 (upto Nov., 2011) it was reported that Rs. 5,000 as Untied Funds have

been released to the visited SCs and most of amount was spent by the Sub Centres

except SC Barimaru. Similarly, AMG to the tune of Rs. 10,000 was released to the SCs

Barimaru and Badaga Ekkar in 2010-11 whereas all four sub centres were given AMG

during current year except SC Barimaru, which was received Rs. 5,000 during the year.

d) In the visited SCs Untied Funds were utilized for purchasing of items such as –

Registers/Records, BP Apparatus, Medicines, Cupboard, Benches, Table, Chairs and

Stationery. Besides this, the amount was spent on transportation of high risk delivery

cases to the institution, plumbing work at the SC, for taking Xerox copies of reporting

formats, cleaning the SC surroundings and conducting Village Health & Nutrition days, etc.

4) Rogi Kalyan Samiti (RKS):

a) Rogi Kalyan Samiti (RKS) was constituted in District Hospitals, 11 CHCs / THs and 63

PHCs in the district.

b) Every RKS was being provided funds to the tune of Rs. 5, 00,000 at Distt. Hospital level,

@ Rs.

2, 50,000 at Taluk Hospital /CHC level and @ Rs. 1, 75,000 at PHC level every year in

the district. These funds include RKS corpus fund, AMG and Untied Funds. All these

funds are kept at the disposal of RKS and after taking approval in its meeting, the funds

were being utilized on developmental activities in the Institution.

Sl. No

Particulars for CHCs for PHCs for HSCs

2010-11 2011-12* 2010-11 201112*

2010-11 2011-12*

1. Total budget

available

5,69,35

3

2,74,679 17,04,492

7,87,480

48,63,767

21,50,494

2. Expenditure

incurred

5,66,67

4

91,689 16,90,012

4,49,782

46,51,273

9,12,195

3. Balance

2,679

1,82,990 14,480

3,37,698

2,12,494

12,38,299

317

c) Details of RKS funds available and expenditure incurred at CHCs /THs & PHCs in the

District are given in the following table:

*Including opening balance. # upto September, 2011.

d) During visit to the PHC at Mani, it was observed that for the year 2011-12, only 50% of

the untied fund, Corpus funds were released upto the end of November, 2011. Funds

were utilized for purchase of AIDS kit, Aluminium Rack for pharmacy room, Baby Radiant

Warmer, Curtains for doors and windows, Electrical Items, Printer & Scanner,

Emergency drugs, Lab Regents & Equipment, Wall Hanging Board for display of

available drugs list. Expenditure was also incurred on civil works like Lab renovation,

Corridor, Passage, Electrical repairs, Painting of corridor & ward, Water Tank and Well

cleaning. The funds were also utilized on payment of bills to outsourced agency for solid

waste management @ Rs. 1,150 per month for payment of night watchman @ Rs. 1,000

per month and for meeting referral transport provided to pregnant women and TB

patients.

e) In PHC Kateel, the expenditure was incurred on purchase of Oxygen cylinder, Voltage

guard, UPS battery, furniture and electrical items. Expenditure was also incurred on civil

work such as construction of fish hatchers, making of partitions in PHC building, fixing of

window frames, wooden door, name boards, electrical repairs and wiring, plumbing and

payment of bills to outsourced agency for solid waste management @ Rs. 1,150 per

month.

f) The expenditure in CHC Mulki was incurred on purchase of Printer, Lab equipment, Steel

Cupboard, Emergency Medicines, Shadow-less lamp for operation theatre, Ceiling fans,

Solar water heater, Surgical equipment, X-ray film, Microscope, Bed Sheets, Rexene

covers to beds, Fetal heart Doppler and submersible pump for bore-well. Expenditure

was also incurred on repairs of pump sets, power backup generator, Computer systems

and air condition machine repairs. Civil works in toilets, cleaning of hospital premises and

water tank etc.

Type/ head of the

funds

For CHC For PHCs

2010-11 2011-12# 2010-11 2011-12#

Budget Expdr. Budget* Expdr. Budget Expdr. Budget* Expdr.

Corpus fund

7,09,825 7,07,5

2

7

3,50,298 65,198 61,64,504 60,02,8

99

31,49,605 13,36,7

73

AMG Fund

9,91,841 9,86,6

59

5,50,000 1,09,46

6

33,62,722 33,05,8

70

15,74,852 5,64,60

4

Untied fund

5,69,353 5,66,6

74

2,74,679 91,689 17,04,492 16,90,0

12

7,87,480 4,49,78

2

318

5. Services of ASHA :-

e) In the district, 1072 ASHAs were appointed till 31.03.2011. All ASHAs were trained by

31.03.2011 and 1050 ASHAs were provided with drug kits. 22 New ASHAs were

proposed to be inducted during 2011-12.

f) Expenditure to the tune of Rs. 28,06,649 in the year 2010-11 and Rs. 44,57,246 during

2011-12 (upto Oct, 2011) was incurred in the district towards payment of performance

based remuneration to ASHAs.

g) In the visited institutions, 21 ASHAs were contacted, all were trained and given drug kits.

Performance based remuneration was also paid regularly to them.

h) At the visited SCs Kadeshivalaya, Barimaru, Badaga Ekkar and Kateel, ASHAs were

posted and trained. In the VHSNCs, ASHAs were functioning as a member.

6. Functioning of Village Health Sanitation & Nutrition Committees (VHSNC):-

b) VHSNCs were set up in 368 revenue villages in the district. Every year Rs. 10,000 are

allotted to each VHSNC which are kept in the bank account and operated jointly by the

village Gram Panchyath Surpanch and ASHA.

b) Details of VHSNC budget and utilization in the district for 2010-11 and 2011-12 (up to

Sept‟ 2011) in the district are given below:

c) Rs. 10,000 was allotted to each VHSNC in the visited SCs for 2010-11. Up to the year

2009-10, accounts were maintained by Anganawadi Workers. During the year 2010-11,

these accounts have been transferred and maintained by ASHAs. For the year 2011-12,

1st installment up to a maximum of Rs. 5, 000 was released to all the visited SCs under

this head.

d) VHSNC funds were mainly utilized for purchasing Uniform Sarees to ASHAs, Registers, File

Covers Stationery, Bleaching powder, Phenol, Egg & Milk to the TB patients, Protein food to the

Anganawadi children, Water Filter to Anganawadi schools and Medicines. Besides this, fund was

spent for conducting Larva survey, Health day celebration, Wall writings about RCH programmes.

Transportation of ANCs to the hospital for delivery was also reported under this head.

7. 24 x 7 hours Delivery Care System:-

c) As reported, 10 of the total 63 PHCs were identified for providing 24X7 delivery care

institutions in the district. It was observed that of these 10 PHCs, none of the PHCs has 2

Medical Officers, and in all 10 PHCs have 3 Staff Nurses posted.

SI.No Particulars 2010-11 2011-12

(upto 09/11)

1. Total budget available 41,34,773 18,39,928

2. Expenditure incurred 37,48,845 9,28,404

3. Balance 3,85,928 9,11,524

319

d) The team reported that 6 PHCs in the year 2010-11 and 8 PHCs during April to

November, 2011 could not achieve the minimum stipulated 10 deliveries per month. The

district authorities need to revamp the 24X7 delivery care Services Centres where

performance is not up to the mark. No separate budget was released to these centres,

except the salary budget to the contractual Staff Nurses.

e) In the visited PHC Mani, facilities were adequate to run 24X7 delivery care unit, except

the posting of Medical Officers. During the year 2010-11, 80 deliveries and during April to

November‟ 2011, 64 deliveries were conducted. Delivery performance was below marks

of minimum stipulated 10 deliveries per month.

d) In the visited CHC Mulki, caesarian deliveries were being conducted in addition to normal

deliveries. During 2010-11, 147 normal and 20 caesarean deliveries and during April to

November‟ 2011, 189 normal and 30 caesarean deliveries were conducted. Facilities for

the new born child care were created with 2 Radiant Warmers and one Phototherapy

units but Incubator was not supplied.

8. Physical Infrastructure and Stock Position:-

i) Sub Centres:

a) Visited SCs were functioning in Govt. buildings and infrastructure was not as per IPHS.

Labour Room was not functioning in the visited SCs.

b) Delivery Table, Hemoglobinometer was not available in all the visited SCs except SC

Badaga Ekkar. McIntch sheet, Ambu bag / Suction, Delivery Kit and RDT Kit for Malaria

were not available in all the visited SCs. Steam Sterilizer was not available in all the

visited SCs except SC Kateel. Nischay Pregnancy Test Kit was not available in SCs

Kadeshivalaya & Badaga Ekkar. Weighing Machine (infant) was not available in SCs

Kadeshivalaya & Barimaru.

c) ORS packets were not available in all the visited SCs except SC Badaga Ekkar. DDK,

Kerosene oil/gas, Sanitary Napkins, Tab Metranidazole, Tab Oxitocin, Cap. Ampicillin, Inj

Gentamycin and Kits – A & B were not available in all the visited Sub Centers. IFA Tablets

and Antiseptic Solution were not available in SC Kadeshivalaya. OP Cycles & Condoms

were not available in SCs Kadeshivalaya and Barimaru. EC Pills were not available in all

the visited SCs except SC Badaga Ekkar. Clorin Solution (bleaching powder) was not

available in SC Badaga Ekkar. Tab. Paracetamol and IUDs were not available in the

visited SC Barimaru. Vit. A Solution was not available in SC Kateel. Gloves were not

available in SC Kadeshivalaya.

320

ii) PHCs:

a) In the visited PHCs Mani & Kateel, it was observed that both the PHCs were functioning

in government building and the infrastructure was not as per IPHS. There was no vehicle,

Operation Theatre and AYUSH Medical Officer posted in the PHCs.

b) Power backup, Residential quarter for Medical Officer was not available in PHC Mani.

Oral Pills & Condom Stocks were nil for 9 months from January to September‟2011 in

PHC Mani.

iii) CHC:

CHC, Mulki was functioning in Govt. building and the infrastructure was not as per IPHS.

Blood storage unit was not functional in the CHC. Waste disposable was outsourced. In

operation theatre shadow-less lamp was not installed.

9. Community Satisfaction and opinion on Health Services:-

e) 40 mothers having child upto one year of age were interviewed to assess their

knowledge and opinion on the services rendered by ANMs and found that most of them

were satisfied having PNC services in time in the area of visited 4 SCs.

f) 29 (72.5%) mothers had no knowledge about danger signs of ARI and 8 (20.0%) mothers

had no knowledge on advantages and side effects of contraceptive methods. 36 (90.0%)

deliveries were institutional and 38 (95.0%) deliveries were conducted by trained

persons.

g) The team contacted different community persons to have their opinion about the services

provided by the MPW (M) at SC Kateel. Though MPW (M) was not staying in the SC

HQs, community expressed satisfaction towards the work of MPWs (M).

h) Public opinion was good on the services being rendered by the PHCs /CHCs visited by

the team. Village leader, ANC/ PNC beneficiaries and others expressed good opinion on

the overall functioning of PHCs/CHCs.

10. Sample Verification of FW Acceptors:

d) Out of 98 FW acceptors (Sterilization, IUD, OP and CC) selected, 77 (78.6%) could be

contacted for sample verification in the district.

e) Minor discrepancies in the recorded age of last child, number of total children & no.

male children was found during sample check. Most of the contacted beneficiaries were

provided with follow up services.

f) All contacted 32 child immunization beneficiaries confirmed with the doses of

immunization and also got follow up services. No complication among the contacted

beneficiaries was found after receiving the doses.

321

11. Maintenance of Records and Register:

a) Printed registers for Eligible Couple, ANC/PNC and Immunization registers were

maintained at the visited PHCs/SCs. For Family Planning beneficiaries non – printed

registers were maintained.

b) Stock registers for the items purchased under NRHM funds were not maintained at the

visited centres.

c) Follow up entries were not made for some of the sterilization and IUD beneficiaries in the

registers. LMP date not recorded in the IUD register at the visited PHCs Mani & Kateel

and CHC Mulky.

12. IT Infrastructure and Mother & Child (MCH) Tracking System:

a) One Computer system at the district office and a computer system at each block in all

the 5 blocks and at CHC level in all the 7 CHCs with internet modem connection were

avaliable in the district. 23 of 63 PHCs were having computer systems with internet

connection in the district. In the remaining 40 PHCs computer systems were supplied

during September‟ 2011, installation process was going on. The centres which are

having internet connection were feeding HMIS/MCTS data online in the Govt. of India

web portal at their head quarter themselves; other centres use this facility at block level.

b) Staff at all levels were trained and sensitized on MCTS.

c) It has been observed that the web portal software of Karnataka MCTS is designed to

send messages from mobile phones for updating data on subsequent services provided

to the already registered pregnant women. All the field level, staffs such as ANMs and

ASHAs are instructed to send messages from their mobiles phones to the central server

of the MCTS web portal. Thereby, updating of subsequent services rendered to the

pregnant women becomes easy.

d) It was also reported that Karnataka state has already switched over to facility based

HMIS reporting from the sub centre level and PHC/CHC/TH/DH level since August 2010.

****

322

10. District- Udupi

Highlights from the Evaluation Report of Udupi District (Karnataka)

The Regional Evaluation Team, located at Regional Office for Health and Family

Welfare (Bangalore), Ministry of Health and Family Welfare, Government of India carried out

sample checks of activities covered under NRHM / RCH in Udupi Districts of Karnataka State

during December, 2011.

I. Health Facilities Covered:

As a part of the evaluation, the team visited Community Health Centres (CHCs), Primary

Health Centres (PHCs) and Sub Centres (SCs) in both districts of Dakshina Kannada and

Udupi as per the details given below:

Districts PHCs/ CHC SCs Visited

Udupi Urudig PHCs: Ajekar and Padubidri.

CHC: Shirva.

Muniyala, Andar, Hejamadi-A,Hejamadi-B

And Shirva.

The major findings / observations of the team which are based on the sample checks are

detailed below:

II. Major Observations:

1. Human resources:-

a) 10 of the 68 sanctioned posts of Allopathic Medical Officer, 16 of the 37 sanctioned posts

of AYUSH Medical Officer, 5 posts each of the 8 sanctioned posts each of Physician,

Surgeon, Gynecologist & Pediatricians were lying vacant in the district.

b) 14 of the 39 sanctioned posts of LHV, 38 of the 53 sanctioned posts of Male Supervisor,

26 of the 69 sanctioned posts of Pharmacist, 3 of the 65 sanctioned posts of Lab

Technician, 103 of the 191 sanctioned posts of MPHW (Male) and 65 of the 325

sanctioned posts of MPHW (Female) / ANM and 6 of the 18 sanctioned posts of 2nd ANM

were also lying vacant in the district.

c) Sanctioned post each of Physician, Pediatrician and Gynecologist was lying vacant for

the past 4 years in the visited CHC at Shirva. One post of Pharmacist was vacant for the

past 1 year, one post of Superintendent and 9 of the 10 sanctioned posts of Group – D

were also lying vacant in the CHC.

d) Post of Pharmacist was vacant as the incumbent was on unauthorized absence for the

past 4 years in PHC Ajkar.

e) One post of LHV was lying vacant in PHC Padubidri.

323

2. Janani Suraksha Yojna (JSY):-

a) Women belonging to BPL and SC/ ST category are eligible for JSY incentives for their

first two deliveries. The rates for normal institutional delivery are: Rs. 700 per case for

rural area and Rs. 600 per delivery in urban area. Rs. 1500 per case for caesarean

delivery in private institutions and Rs. 700 in Govt. institutions are also provided. For

home delivery, Rs. 500 per case is given.

b) ASHA gets Rs. 200 per case for accompanying pregnant women to hospital for delivery.

c) It was reported that 16356 ANCs were registered during 2010-11 and 9609 during 2011 -

12 ( upto Sep‟11). 14600 deliveries were conducted during 2010-11 and 9280 during

2011- 12 (upto Sep‟11) and JSY cash incentive could be paid to 8201 beneficiaries during

2010-11 and 4765 beneficiaries during 2011 -12 (upto Sep‟11).

d) Total budget for JSY in the district was available to the tune of Rs. 99,11,558 for 2010-11

and Rs. 42,14,958 for 2011-12 (upto Sep‟11). Expenditure to the tune of Rs. 69,10,600

was incurred in 2010-11 and Rs. 35,30,700 during 2011-12 (upto Sep‟11).

e) 4 JSY cases in 2011-12 (upto Nov‟11) were found pending for their incentives amount in

SC Hejamadi - A. JSY beneficiary register was maintained properly and JSY cards were

issued to all the beneficiaries in the visited centres.

f) 29 JSY beneficiaries were contacted for sample verification; As reported 28 (96.6%)

deliveries were institutional. All JSY beneficiaries stated that they received full JSY cash

incentive. Follow up visits were made to 27 (93.1%) mothers by the ASHA/ANM after

delivery.

3. Untied Funds:-

a) Rs. 25,000 to each PHC and Rs. 50,000 to each CHC/TH are given per year as Untied

Funds in the district. All SCs were being provided funds @ Rs. 10,000 as Untied Funds

and Rs. 10,000 as AMG per year in the district.

b) Provision and utilization of Untied Funds in the district are as detailed below:

(In Rs)

* upto Sept, 2011.

Sl. No

Particulars for CHCs for PHCs for HSCs

2010-11 2011-12*

2010-11 2011-12*

2010-11 2011-12*

1. Total budget available

2,99,095 2,00,440 14,47,179 7,50,011 17,47,924 14,60,000

2. Expenditure incurred

2,91,655 50,546 13,34,168 3,98,783 17,47,924 2,75,188

3. Balance 7,440 1,49,894 1,13,01 3,51,228 0 11,84,812

324

c) During visit to the SCs, it was observed that Rs.10, 000 had been released to all the SCs

during 2010-11 except to SCs Andar & Hejamadi-B. The amount was not utilized by the

SCs except SC Hejamadi-A. Annual Maintenance Grant was not released to all the visited

SCs for 2010-11. During the year 2011-12 (upto Nov., 2011), it was reported that Rs.

5,000 as Untied Funds had been released to the visited SCs and most of the amount was

spent by the Sub Centres . Similarly, Annual Maintenance Grant of Rs. 5,000 was

released to all the visited SCs during 2011-12 and the amount was utilized by the SCs

mostly except SC Andar.

c) In the visited SCs, Untied Funds were utilized for purchasing of items such as – Registers /

Records, BP Apparatus, Stethoscope, Medicines, Re-chargeable Light, Seal and Seal

Pad, Thermometer, Cupboard, Baby Weighing Machines, Table, Chairs, Fan and

Stationery. Besides this, the amount was spent on transportation of high risk delivery

cases to the institution, for taking Xerox copies of reporting formats and conducting Village

Health & Nutrition days, etc.

d) Rs. 25,000 to each PHC and Rs. 50,000 to each CHC/TH are given per year as Untied

Funds in the district. All SCs were being provided Rs. 10,000 as Untied Funds and Rs.

10,000 as AMG per year in the district.

4) Rogi Kalyan Samiti (RKS):

a) Rogi Kalyan Samiti (RKS) was constituted in District Hospital, 3 SDHs / THs, 6 CHCs and

59 PHCs in the district.

b) Every RKS was being provided funds to the tune of Rs. 5, 00,000 at Distt. Hospital level,

@ Rs.

2, 50,000 at Taluk Hospital / SDH level, @ Rs. 2, 50,000 at CHC level and @ Rs. 1,

75,000 at PHC level every year in the district. These funds include corpus fund, AMG

and Untied Funds. All these funds are kept at the disposal of RKS and after taking

approval in its meeting, the funds were being utilized on developmental activities in the

Institution.

c) Details of RKS funds available and expenditure incurred at CHCs, SDHs /THs & PHCs in

the District are given in the following table:

Type/ head of

the funds

For CHC For PHCs

2010-11 2011-12# 2010-11 2011-12#

Budget Expdr. Budget* Expdr. Budget Expdr. Budget* Expdr.

Corpus fund

5,82,333 5,68,1

1

7

3,00,216 1,42,3

24

48,71,95

3

45,14,5

55

30,00,398 12,15,7

13

325

*Including opening balance. # upto September, 2011.

d) During visit to the PHC at Ajkar, it was observed that a total amount of Rs. 2,65,411 was

available for 2010-11 including private party donation of Rs. 99,749, out of which Rs.

1,60,454 were spent. During 2011-12, a total amount of Rs. 2,65,475 available out of

which Rs. 1,97,301 were spent. Expenditure incurred on repairs of Computer, BP

Apparatus, Furniture repair, Expenses towards conducting of Community Health Day,

ARS meetings, Plumbing works, Post Mortem Shed repair, Vehicle Shed repair, Painting

of Almirah, Construction of Deep Burial Pit, Cleaning of Premises, Payment of Travelling

allowance to ICTC counselors under AIDS programme, Salary to night Dai @ Rs. 1,000

PM, Bills payments to Biomedical outsourced agency @ Rs. 1,150 PM. Purchase of

fans, Flexi Board, Sign Boards, Weighing Machine, Emergency Lamps and Anti- Rabies

injections.

e) In the visited PHC Padubidri, it was observed that there was a total amount of Rs. 1,

54,520 available for the year 2010-11 out of which Rs. 1, 15,350 were spent. Similarly for

the year 2011-12, total amount of Rs. 1, 62,497 available and out of which Rs. 87,076

were spent. Expenditure was incurred on repairs of Invertor, Water Filter, Electrical

repair of LT room, Building repairs and Ground Tiles installation, purchase of Medicines,

Suction Apparatus, CDs, Office Stationery, Eye Screen for Cataract patients, Computer

Printer Toner Refill, Microscope Bulb, Hemoglobin Meter, Binocular for Microscope, Lab

Regents, Ceiling Fans, BP Apparatus, Anti-Rabies Rabipur injection. Expenditure was

also incurred on laundry charges of lining. Salary payment night Dai @ RS. 1,000 PM,

conducting World Health Day, Xerox copies, Premises cleaning, printing of OPD slips,

providing of food for PNC mothers, upto 2 days after delivery in the PHC.

f) The expenditure in CHC Shirva was incurred on purchase of Visitors Sofa, Chairs,

Computer Tables, Desk, Steel Almirahs, Office Tables, Book Case, Godrej Refrigerators,

Plastic Chairs, Pedestal Fan, Voltage Guards, V Guard Stabiliser, V Guard Invertors,

Battery and UPS, Anti-Rabies vaccines-100 vials, Calorimeter, Micro pipet-100 tips, 5 ML

test tube, Lab equipment, Oxygen Cylinder, Mucous Sucker, Torch big small, Urinary

Tray, Forceps, Auto Clave, Bandage cutting Scissors, Electrical suction apparatus,

Single bin auto clave, Pediatric Ambu bag, Needle Holders, Focus Light for labor room

and tooth extraction and related equipment. Expenditure was also incurred on tile fixing,

window and door fixing civil works, Aluminum windows and grills, Floor tiles fixing,

AMG Fund

6,12,752 6,00,2

19

4,00,000 1,62,9

16

28,99,99

9

26,45,3

31

14,24,668 4,19,52

6

Untied fund

2,99,095 2,91,6

55

2,00,440 50,54

6

14,47,17

9

13,34,1

68

7,50,011 3,98,78

3

326

charges for waste management to out sourced agency @ RS. 2,500 PM and conducting

school health camps.

5. Services of ASHA :-

a) In the district, 715 ASHAs were appointed till 31.03.2011. All ASHAs trained in all

modules by 31.03.2011 and 642 ASHAs were provided with drug kits.

b) Expenditure to the tune of Rs. 62,89,486 in the year 2010-11 and Rs. 34,32,081during

2011-12 (upto Sept, 2011) was incurred in the district towards payment of performance

based remuneration to ASHAs.

c) In the visited institutions, 20 ASHAs were contacted; all were trained and given drug kits.

Performance based remuneration was also paid regularly to them.

d) At the visited SCs Muniyala, Andar, Hejamadi-A and Hejamadi-B ASHAs were posted and

trained. In the VHSNCs, ASHAs were functioning as a member. SCs Hejamadi-A and

Hejamadi-B are located in one village and only one VHSNC comes under these two SCs.

6. Functioning of Village Health Sanitation & Nutrition Committees (VHSNC)

a) VHSNCs have been set up in 248 revenue village in the district. Every year @ Rs. 10,000

are allotted to each VHSNC which are being kept in the bank account which is operated

jointly by the village Gram Panchyath Surpanch and ASHA.

b) Details of VHSNC budget and utilization in the district for 2010-11 and 2011-12 ( up to

09/11) in the district are below:

(In Rs.)

SI.No Particulars 2010-11 2011-12

(upto 09/11)

1. Total budget available 4,73,327 12,40,000

2. Expenditure incurred 4,73,327 2,32,088

3. Balance 0 10,07,912

c) VHSNC fund was not released to any of the visited SCs during 2010-11. For the period

2011-12, Rs. 5,000 was released to all VHSNCs; these accounts have been maintained

by ASHAs.

d) VHSNC funds were mainly utilized for purchasing of Uniform Sarees to ASHAs, Water

Filter, Registers and Stationery to ASHAs and first aid kits to schools, Besides this, fund

was also spent for conducting eye camp and vehicle hiring charges for AN mother to the

hospital for delivery.

7. 24 x 7 hours Delivery Care System:-

327

a) As reported, 10 of the total 59 PHCs were identified for providing 24X7 delivery care

institutions in the district. It was observed that out of these 10 PHCs, 7 PHC had 2

Medical Officers, and 5 PHCs had 3 Staff Nurses posted.

The team reported that during 2010-11 and 2011-12 upto November, 2011 none of

these 10 PHCs achieve the minimum stipulated 10 deliveries per month. The district

authorities need to revamp the 24X7 delivery care services according to notified

delivery points. No separate budget was released to these centres, except the salary

budget to the contractual Staff Nurses.

c) In the visited PHC Ajkar, facilities were adequate to run 24X7 delivery care unit with 2

Medical Officers and 3 Staff Nurses posted. However, performance of the facility is not

satisfactory as 8 deliveries during the year 2010-11 and only 3 deliveries during April to

November‟ 2011, were conducted.

d) In the visited PHC Padubidri, facilities were adequate to run 24X7 delivery care unit with 2

Medical Officers and 3 Staff Nurses posted. During the year 2010-11, 39 deliveries and

during April to November‟ 2011, 31 deliveries were conducted. Delivery performance was

below then marks of minimum stipulated 10 deliveries per month.

e) In the visited CHC Shirva, caesarian deliveries were not conducted, as the post of

Anesthetist was not sanctioned and the post of Gynecologist was vacant for the past 4

years. During 2010-11, only 1 normal delivery and during April to November‟ 2011, only 2

normal deliveries were conducted. Facilities for the new born child care were not created.

8. Physical Infrastructure and Stock Position:-

i) Sub Centres:

a) Visited SCs were functioning in Govt. buildings and infrastructure was not as per IPHS.

Labour Room was not functioning in all the visited SCs. In SC Muniyala, ANM was not

staying at the SC head quarter.

b) Delivery Table and Foot Stool were not available in all the visited SCs except SC

Hejamadi – B. Mcintch sheet, Ambu bag / Suction and RDT Kit for Malaria were not

available in all the visited SCs. Steam Sterilizer was not available in all the visited SCs

except SC Andar. Weighing Machine (infant) was not available in SC Muniyala. Torch was

not available in SC Andar. Benches for clients were not available in SCs Andar and

Hejamadi - A. Hemoglobinometer was not available in SC Hejamadi – B.

c) ORS packets were available in all the visited SCs except SC Hejamadi - B. DDK,

Kerosene oil/gas, Sanitary Napkins, Co Trimoxazole Tablets, IFA Tablets, EC Pills, Tab

Oxitocin, Cap. Ampicillin, Inj Gentamycin and Kits – A & B were not available in all the

visited Sub Centers. Tab Metranidazole was not available in the visited SCs Muniyala and

Andar. Tab Chloroquine was not available in the visited SC Muniyala. IUDs were not

328

available in SCs Andar and Hejamadi - B. OP Cycles, Vit.A Solution and Condoms were

not available in SC Hejamadi - B. AD Syringes were not available in SC Hejamadi – A.

ii) PHCs:

In the visited PHCs Ajkar & Padubidri, it was observed that both the PHCs were

functioning in government building and the infrastructure was not as per IPHS. There

was no vehicle in the PHCs. Operation Theatre was not functional in both the PHCs.

Power backup was not available in PHC Ajkar and AYUSH, Medical Officer was not

posted in PHC Padubidri.

iii) CHC:

CHC Mulki was functioning in Govt. building and the infrastructure was not as per IPHS.

There was no Vehicle, Injection Arteether and Quinine in the CHC. Blood storage unit

and Operation Theatre were not functional in the CHC. Waste disposal was outsourced.

9. Community Satisfaction and opinion on Health Services:-

a) 40 mothers having child upto one year of age were interviewed to assess their knowledge

and opinion on the services rendered by ANMs and found that most of them were

satisfied with the PNC services provided to them in time in the area of visited 4 SCs.

b) 29 (72.5%) mothers had no knowledge on danger signs of ARI and 10 (25.0%) mothers

had no knowledge on advantages and side effects of contraceptive methods. 39 (97.5%)

deliveries were institutional and 39 (97.5%) deliveries were conducted by trained persons.

c) Posts of MPWs (M) were vacant in all the visited SCs in the district. ANMs/Sr. Health

Inspectors and Health Supervisors were doing the work of MPWs (M) in these SCs.

d) Public opinion was good on the services being rendered by the PHCs /CHCs visited by the

team. Village leader, ANC/ PNC beneficiaries and others expressed good opinion on the

overall functioning of PHCs/CHCs.

10. Sample Verification of FW Acceptors:

a) Out of 99 FW acceptors (Sterilization, IUD, OP and CC) selected, 80 (80.8%) could be

contacted for sample verification in the district.

b) Minor discrepancies in the age of acceptor, age of spouse, recorded age of last child,

number of total children & no. male children was found during sample check. Most of the

contacted beneficiaries were provided with follow up services.

c) All contacted 38 child immunization beneficiaries confirmed with the doses of immunization

and also got follow up services. No complication among the contacted beneficiaries was

found after receiving the doses.

11. Maintenance of Records and Register:

a) Printed registers for Eligible Couple were maintained at the visited PHCs/SCs. Non

printed registers were maintained for ANC/PNC, Immunization, Family Planning

329

beneficiaries and maintenance of Stock. OP/CC registers were maintained at SC levels

only.

b) Stock registers for the items purchased under NRHM funds were not maintained at the

visited centres.

12. IT Infrastructure and Mother & Child (MCH) Tracking System:

a) Computer was available in District Office, blocks and CHCs with internet conectivity. 23

of 59 PHCs were having computer systems with internet connection in the district. The

centres which are having internet connection were feeding HMIS/MCTS data online in

the Govt. of India web portal at their head quarter themselves; other centres use this

facility at block level.

b) Staff at all levels were trained and sensitized on MCTS.

c) It has been observed that the MCTS web portal of Karnataka is designed to record

messages receive through mobile phones for updating data on subsequent services

provided to the already registered pregnant women. All the field level, staffs such as

ANMs and ASHAs are instructed to send messages from their mobiles phones to the

central server of the MCTS web portal. Thereby, updating of subsequent services

rendered to the pregnant women becomes easy.

d) It was also reported that Karnataka state has already switched over to facility based

HMIS reporting from the sub centre level and PHC/CHC/TH/DH level since August 2010.

330

Kerala

1. District- Kasargod

Major observations of Regional Evaluation Team, Chennai about evaluation work

carried out in Kasargod district of Kerala State in May 2011.

I Details of the visited Institutions:

CHC / PHCs and Pvt. Scan Centers HSCs Visited

GOVT Hospital: Kasargode

CHC: Muliyar

PHCs: Ajanur and Anandasramam

Dr.Kamath Scan Centre, Kasargode

CT Scan Center, Kasargode

Kanathur, Kottur, Madugan and

Kolavayil

II. Major Observations:

1. Health Human Resources

a. Many posts of the Medical and Para Medical categories were lying vacant in the district.

36 of the 123 sanctioned posts of Medical Officers, 26 of the 63 sanctioned posts of

Specialist, 28 of the 188 sanctioned posts of GNM (Staff Nurse), 17 of the 45

sanctioned posts of LHVs, 9 of the 24 sanctioned posts of Lab Technician and 13 of the

144 sanctioned posts of Nursing Assistant were lying vacant in the district.

b. In GH Kasargode, out of 28 posts of specialist sanctioned, only 15 were filled up. There

were 78 Staff Nurses including contractual Staff working in the GH though sanctioned

strength is only 55.

2. Services of Janani Surakha Yojna (JSY):

a. As reported, 4409 JSY beneficiaries in 2009-10 and 3593 beneficiaries in 2010-11 were

there in the district.

b. While examining, no. of JSY beneficiaries in the visited centers, it was observed that

reported performance did not tally with district level report. CHC Muliyar had given the

figures of 142 and 610 for 2009-10 and 2010-11 respectively but as per the district

report it was 102 and 31 for the respective years. In PHC Anandasramam figure for

JSY was 360 and 377 for 2009-10 and 2010-11. As per the district figure it was only 59

and 35 for the respective years.

331

3. Untied Funds:

a. The district has received Untied Funds to the tune of Rs. 81,25,000 during 2010-11 and

incurred and expenditure of Rs.32.7 lakhs. An amount of Rs. 94.6 lakhs was spent

during 2009-10, as reported.

b. Some of the visited centers did not receive Untied Funds for 2010-11 in the district. MO

of CHC, Muliyar informed that Untied Funds and AMG for CHC and its HSCs and funds

for VHSCs for 2010-11 were not given.

4. Rogi Kalyan Samiti (RKS) and Village Health and Sanitation Committees (VHSCs):

a. As reported, 53 RKS were registered in the district and most of the RKSs, were not

functioning properly due to delay in inclusion of newly elected local body members to

RKS committees and lack of coordination between MOs and local members for the past

several months.

b. It was reported that in Kasargode GH, no RKS meeting was conducted after 7-12-2010

and in CHC Muliyar no meeting took place after 8-3-2011. In PHC, Ajanur only two

meetings were conducted in 2010 and only one in 2011 viz, on 8-2-2011. It was

informed by the DMO that executive body meeting of the District Health Society was not

held since 2010. The block Medical Officers were the members of the District Executive

Body and they were non-attending the meeting.

5. Services of ASHA:

a. In the district, totally 960 ASHAs were selected against the requirement of 1377. 817

have completed first module, 808 second module, 786 third modules and 147 fourth

module of the training.

b. Out of total 960 ASHAs, only 350 were supplied with drug kits. EC Pills were not in the

kits supplied to ASHAs in a few centers visited.

6. Village Health and Sanitation Committees (VHSC):-

a. 721, VHSCs had been set up in 2009-10 and the figure increased to 776 during 2010-

11 in the district.

b. Joint accounts for VHSCs were maintained by the ANMs with the local body members.

Local body members were satisfied about the NRHM and Untied Funds. ASHAs were

included as a member in the VHSCs visited by the team.

7. 24 Hours Delivery Care Systema.

a. There were 40 PHCs, 3 GHs, 9 CHCs, and 249 HSCs in the district and only two

institutions namely GH, Kasargode and GH, Kanhangad were conducting deliveries.

Though the district has declared 10 PHCs for providing 24x7 services, none were

conducting deliveries. It was observed that out of 40 PHCs only one was having Operation

Theatre.

332

a. In the GH, Kasargode facilities for conducting deliveries were good. CHC Muliyar did

not have proper facility for conducting deliveries. Moreover USG facilities were available

only in two institutions in the district.

8. Physical Infrastructures and Stock Position:

Adequate health infrastructure was not there in the district in spite of having sufficient

NRHM fund. Out of 40 PHCs only one has operation theatre that too not functioning at

present. Out of total 249 HSCs only 170 have Govt. buildings, 40 were attached to main

centre PHCs and the rest 39 have no building. The district has a vast stretch of National

Highway but there is no Trauma care centre for the accident victims. Similarly, there were

only 2 USGs in the govt. sector and most of the common people are exploited by the

private scan centres. Though 10 PHCs were declared for 24x7 deliveries care services, no

deliveries were conducted and no centre was upgraded as per IPHS.

i) FRU / CHC

a. In GH Kasargode, sufficient facilities were created with NRHM funds but residential

quarters were not available for MOs and staff.

b. In CHC Muliyar no separate toilet facility for patients, Microscope, Oxyzen cylinder,

Resuscitation equipment and Surgical equipments were available. The OT was not

functioning for the past several years. Labour room was without proper table and

cleanliness was totally lacking.

ii) PHC

a. In PHC Ajanur, Auto clave, Microscope, Oxygen cylinder, OT, Surgical equipments,

Labor room and equipments, Resuscitation equipments and Residential quarters were

lacking. There was only one bed available in the PHC.

b. In PHC Ananadasramam there was no O.T, Labor room and Residential quarters

iii) HSCs

a. The team visited HSCs Kanathur, Kottur, Madugan and Kolavayil. Labor room not

available in any of the HSCs visited and no deliveries were conducted there. Delivery

table, McIntosh sheets, Torch, RDK, DDK, IFA (small and large) Kerosene and kits

A&B were not available in any of the centers visited.

b. In HSC Madugan, stock of Sanitary napkin, ECP, Condoms, Antiseptic solution,

Bleaching powder, Chloroquine tablets, Paracetamol and Metranidazole tab. etc. were

not available.

333

c. In HSC Kanathur, Oxytoxin and Ampicilline and Gentamycin inj. were not available.

Oral pills, ECP, Sanitary napkins and all Medicinal items were not available in HSC

Kolavayal. In HSC Kottur Torch, Stove, Metranidazole, Oxytoxin, Ampicilline and

Gentamycin inj. were not available.

d. In HSC Kanathur no visit was done by either the PHC or district level supervisor. Details

of cash book of untied funds for 2010-11 were not maintained in HSC Madugan.

9. Community Satisfaction on Overall Services:-

a. PHC Services

The community members of the area of the visited PHCs and GH opined for improving the

services and infrastructure of the centers .None of the PHCs were functioning for Indoor

Patients and emergency services. The Panchayath committee members of Ajanur and

Muliyar PHCs were not satisfied with the present functioning of the centers. Ajanur

panchayath members and public emphasised the team for filling up the vacant post of

Medical Officer and starting of Indoor Patients facilities.

b. Services of MPW (M)

During assessment of the work of three Male Health Workers, it was observed that they

had motivated some cases of NSV, collected blood smear for malaria suspected cases

and followed up TB cases. They had helped the school health programme, chlorination

and conducting the VHND.

c. Services of ANM:

i) The team contacted 9 mothers to know about the work of ANMs and their knowledge on

various health services matters. All the contacted mothers informed that ANMs were

available when needed.

ii) All contacted mothers had their delivery in hospital / institutions; they were aware of

exclusive breast feeding, ORS knowledge and contraception awareness and

nearest government health facilities.

iii) First breast feeding within half an hour of delivery was initiated by 8(89%) mothers. Six

mothers (67%) had knowledge on ARI, three PNC check up were only given to 7 (78%)

mothers.

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10. Sample Verification of Family Welfare Beneficiaries:-

a. 63 Family Welfare acceptors out of selected 85 acceptors in the visited centers could

be contacted by the team in the district. During verification, discrepancies were found

in a few cases in the recorded data for the age of accepters, spouse and number of

male child.

b. It was observed that 59 (93.7%) acceptors were provided follow up services by the

health Personnel.

11. Reconciliation of Reported Performance:-

In the district, there was no system of keeping the record for FW figures for individual PHCs. The

District figures of sterilization for GH Kasargode was 381 but as per register and monthly report

verified at GH for the year 2010-11 up to Dec.10 it was observed to be 292. The figures of IUD, OP

and CC were not available from the district office.

12. Maintenance of Records/Registers:-

Sterilization registers and Consolidated IUD registers were maintained in all the Visited

PHCs & GHs. Register for Untied Funds was not maintained in one HSC visited. Case

cards for FW methods not maintained in the centers visited.

13. IT infrastructure & Mother and child tracking

a. Computer and internet connections were provided at district and peripheral centres.

But, very few centres have updated the report and statements under NRHM.

b. Mother and Child tracking training at the district level was conducted for 139

supervisory staff but the training at Block and PHC level could not be conducted.

14. Other Observations

a. Contribution in the Institutional deliveries in the district by Govt. Sector is very low. Only

two Institutions i.e. - GH Kasargode and GH, Kanhangad were conducting 24 hours

deliveries. Out of total 20518 deliveries conducted in the district, the Govt. institutions

have contributed only 2789 deliveries in the district.

b. The district and peripheral level reports were incomplete since December 2010

because of lack of coordination between MOs and field staffs of the peripheral centers.

The HMIS reports also found incomplete in the centers visited.

******

335

2. District- Kottayam

Major observations of Regional Evaluation Team, Chennai about evaluation work

carried out in Kottayam district of Kerala State in the month of July, 2011.

I. Details of the visited Institutions:

Districts Visited CHC / PHCs and Pvt. Scan Centers HSCs Visited

Kottayam

District HQ Hospital: Kottayam

GH: Changenessery

CHC: Paika

PHC: Nattakom

Scan Centre: Dianowork

Anikkad, Muttam and Pakkil

II. Major Observations:

1. Health Human Resources:

The position of human resources in the district was satisfactory except in the category

of specialists and Medical Officers. Out of 166 sanctioned posts of Specialists, 138 were

filled up and out of 94 MO posts, 75 were filled up. Staff position was found satisfactory in

all the centers visited by the team.

2. Services of Janani Surakha Yojna (JSY):

a. The details of JSY beneficiaries, JSY amount received and spent for the year 2009-10

and 2010-11 are as follows

*Expenditure was more than the fund available in the district.

b. It was observed that there was large number of pending cases of JSY payments due to

insufficient availability of fund during 2009-10 and 2010-11

S.No Particulars 2009-10 2010-11

1 No. of JSY eligible beneficiaries 11521 9729

2 No. of mothers received JSY incentives 6075 5257

3 No. of pending JSY cases 5446 4472

4 JSY fund received in the district (Rs in

Lakhs)

58 58

5 Expenditure under JSY head (Rs in Lakhs) *59.03 *63.84

336

c. At the visited PHC Nattkom, 12 beneficiaries did not get JSY assistance during 2009-

10. Similarly, at CHC Paika 13 and 27 beneficiaries did not get JSY incentive during

2009-10 and 2010-2011 respectively.

3. Untied Funds:

a. The district had received untied funds to the tune of Rs.182.6 lakhs under NRHM during

2009-10 and Rs. 185.15 lakhs during 2010-11. Full funds during 2009 -10 and funds to

the tune of Rs. 162.6 lakhs during 2010-11were utilized in the district.

b. In the centers visited, efforts were taken to utilise the funds as per guidelines for the

welfare of the patients and community. In the HSCs, joint bank account in the name of

village leader and ANM was maintained for the utilization of untied funds.

4. Rogi Kalyan Samiti (RKS):

79 RKS formed in the district and all are reported to have been functioning regularly with

the co operation of the MOs and public leaders.

5. Functioning of ASHA:

a. In the district, totally 2031 ASHAs were selected out of them 1177 were given drug kit

during 2010-11. The fourth module of training to the ASHAs was almost completed in

the district. All the ASHAs were getting the incentives according to their work. ASHAs

are included in the VHSCs of the centers visited.

b. The details of the number of ASHAs selected in the centers visited are as follows.

6. Village Health & Sanitation Committee (VHSCs):

a. In the district totally 1321 VHSCs have been formed and functioning properly. In the

VHSCs, ASHAs are included as committee members. The VHSC accounts are jointly

maintained by ward member with JHI /JPHN of the area.

b. The visited VHSCs, received funds regularly and the accounts and vouchers were kept

as per guidelines. The utilization of funds was almost 100%.

7. 24 Hours Delivery Care Services:

a. Out of 78 government institutions only 6 were conducting deliveries in the district.

Though there were 18 CHCs and 54 PHCs, none were conducting deliveries.

b. In the institutions visited, the facilities were sufficient for conducting deliveries.

S.NO Name of the Centers No. of ASHAs selected

1 PHC Nattakom 42

2 GH Changanessery 40

3 CHC Paika 42

4 District HQ Hospital 61

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c. In CHC Paika , there were 5 MOs including some specialists but no delivery was being

conducted there.

8. Physical Infrastructures

(i) FRU / CHC

a. The district HQ Hospital is situated in a very old building with lot of leaking and

damages. Only recently, the hospital Development committee has initiated action for

the maintenance of the building and for constructing a new multi storeyed building.

b. GH, Changanaserry is also like the District hospital, more than 100 years old building.

Both the Hospitals were not maintained as per IPHS.

c. There was no sick new born care centre and residential quarters in GH Changanaserry.

The condition of the beds needs improvement in both the hospitals.

ii) PHC

In visited PHC Nattakom, there was no drinking water facility, power back up, separate

toilet facility for patients, vehicle, Microscope & Lab Technician, OT, Resuscitation

equipment, Oral Pills and also IFA Tab. Residential quarters were not available for the

staff of PHC.

iii) HSC

The team visited the HSCs at Anikkad, Muttam and Pakkil in the district.

a. In HSC Pakkil, there was no HSC building and the ANM was not staying at the HQs.

Regular water supply, Toilet, Labour room, Examination Table, Benches, Delivery table,

Mclntsch sheets, Delivery table, Ambu - bag, Delivery kit, DDK, Kerosene,

Cotrimaxazole,-Tab. IFA Tab., OP,Nirodh, Chloroquine tablets and kits A & B etc. were

lacking there.

b. In HSC Anikkad, Delivery table, Ambu - bag, Steam sterilizer, IUD insertion kit, DDK,

Chloroquine, and kits A&B were not available.

c. In HSC Muttom, facilities of labour room, Ambu bag, DDK, IFA, ECP, OP and A & B kit

were not available.

d. Skilled Birth Attendants training was not provided to the ANMs of visited centres.

9. Opinion of Community Health Services:

i) Services in CHC/PHC

The community belongs to the area of the visited CHC and PHCs expressed

satisfaction on the functioning of the centers and services of the staff. The local body

leaders also actively involved in the functioning of the centers visited. In Paika CHC, the

public and local leaders have contributed for the development of the institution. In

338

Nattakom PHC there was no supply of drinking water to the patients and people need

urgent solution.

ii) Services of MPW(M)

As assessed the work of MPWs, they motivated the couples for Female sterilization, IUD, OP

& use of Nirodh. They also have actively involved in the collection of blood smear,

identification of fever cases, and prevention of epidemics, chlorination and follow up for TB

cases. In their areas, they have involved in the school health programme and conduction of

VHND activities.

iii) Services of ANMs

a. The team has contacted 8 mothers to know about the work of ANMs and their

knowledge on various health services. The mothers informed that ANM was available

when needed, had institutional delivery, weighed their new born child immediately after

delivery and were aware of contraceptives and ORS.

b. 3 PNC check up was given only to 7(87.5%) mothers. ARI awareness was observed in

only for 5(62.5%) cases and side effects of contraceptives known only to 6 (75%)

mothers.

10. Sample verification of Acceptors

a. The team selected totally 53 FW cases out of which 42 (79.2%) could be contacted for

sample verification Miner discrepancy was noticed in the age of spouse, acceptors

and in the number of male children.

b. Insufficient stock of oral pills and Nirodh was observed in the district.

11. Reconciliation of Reported Performance

a. The team has noticed discrepancies in the reported figures of sterilization and IUD.

There was no similarity in the same figures reported for the year 2010-11 by the district

office and the centres visited. The details are as under

Sr.

No

Name of the

Centre

Sterilization

IUD

Reported

by DFWB

Reported

by PHC

Verified in

the registry

Reported by

DFWB

Reported

by PHC

Verified

in the

registry

1 GH Kottayam 659 933 414 140 187 172

2 CHC Paika 36 31 5 109 134 78

3 PHC Nathakom NMA 157 226 NMA 84 84

4 GH Chengan

Achery

356 422 379 131 172 172

339

b. No Performance figures for OP users and Nirodh users was made available for the year

2010-11 to the team by district office.

12. Maintenance of Records and Registers:

a. E.C. registers were in printed forms but were not maintenance property at visited

centers.

b. Service Registers for sterilization , IUD, OP and Nirodh were maintained properly at

visited centres.

c. Case cares were not maintained for sterilization cases in the Institutions visited.

3. District- Ernakulam

Major observations of Regional Evaluation Team, Chennai about evaluation work

carried out in Ernakulam district of Kerala State in the month of August 2011.

I. Details of the visited Institutions:

Districts Visited CHC / PHCs and Pvt. Scan

Centers

HSCs Visited

Ernakulam

Govt. District Hospital: Aluva

W&C: Mattanchery

CHC: Chengamanadu

CHC: Angamali

DDTC Scan Centre, Aluva

Ammu Scan Centre, Aluva

Desam, Elanthikkara

Thavalapara & Chandrapura

II. Major Observations:

1. Health Human Resources:

b. The staff position was satisfactory in the district except few categories like Specialist

doctors, MPW (M) and Technician. 18 of the 265 sanctioned posts of MPW (M), 31 of

the 180 sanctioned post of Specialists and 22 of the 60 sanctioned posts of Lab

Technician were lying vacant in the district.

c. The posts of Staff Nurse and Medical Officer were more than the sanctioned strength

due to appointment of the contractual staff in the district. The number of sanctioned post

of MOs were 257 where as the MOs in positions were 297 and Staff Nurses in position

were 727 against the posts of 685 sanctioned.

d. In the District Hospital, out of total 188 sanctioned staff of various categories, only 23

were filled up. In W&C, Mattanchery, staff position was satisfactory. Out of 12 ANMs

340

sanctioned 6 were regular and another 6 were contractual. Out of 8 Specialists 7 were

filled up and out of 36 Staff Nurses 31 were filled up.

2. Services of Janani Surakha Yojna (JSY):

a. In the district there were 9038 JSY beneficiaries during 2009-10 and 7605 during 2010-

11. The expenditure incurred for the respective years was reported to be Rs. 89,82,200

and Rs. 59,18,700.

b. The details of JSY beneficiaries of the centers visited are as follows.

Sl.No Name of the centers No. of JSY Beneficiaries

2009-10 2010-11

1 CHC Chengamanad 274 367

2 W & C Mattanchery NMA 236

3 GH Angamali 387 253

4 District Hospital Aluva 337 435

5 HSC Desam 15 9

6 HSC Elavanthipuram 16 21

7 HSC Thavalapara 24 7

8 HSC Chandrapura 18 19

In addition to the GH, JSY amount is paid to the delivered mothers of 75 JSY

accredited private hospitals in the district.

3. Untied Funds:

a. The district has received Untied Funds to the tune of Rs.81.15 lakhs and 76.65 lakhs for

the financial year 2010-11 and 2011-12. Out of which Rs. 65.1 lakhs and 5.8 lakhs

spent for the respective periods. The main reasons for the low percent of expenditure

are due to the strike of the Medical officers for several months and also due to the

election of new local body members in the district.

b. In CHC Chengamanadu, untied funds @Rs. 50000 received yearly. The current year

fund of Rs. 50000 received in the month of July, 2011 and was lying unspent. In all the

visited HSCs, the available untied fund was almost utilized.

4. Rogi Kalyan Samiti and Village Health and Sanitation Committees (VHSCs):

a. As reported, 111 RKS formed in the district and all are reported to have been

functioning properly with co operation of the MOs and the local public leaders.

b. 1365 Ward Health Sanitation Committees are (rename of VHSC) formed in the village

panchayats, 369 in the Municipal areas and 74 in the Corporation areas.

341

c. ASHAS are included in all the committees except in Angamaly and Mattanchaery GH.

Joint bank account of the committee was operated by the ward member and the

ANM/Male Health Assistant.

5. Services of ASHA:

a. ASHA scheme was implemented in urban and rural areas of the district. As reported,

2186 ASHAs selected in the district out of which 2048 got training and of 1790 ASHAs

received drug kits.

b. In the visited CHC Chengamanad, out of 31 ASHAs selected 25 were trained in all

modules and were given drug kit.

c. In W&C Mattanchery, urban area, only recently 28 ASHAs were selected and they were

yet to get training and drug kits. In GH Angamaly also 10 ASHAs were recently

selected, out of 30 required. But none of them was trained and given drug kits. They

were also not included in the Ward Health, Nutrition and Sanitation Committee in

angamaly and Mattanchery. In GH Aluva urban area only one ASHA was selected for 26

wards area.

6. 24 Hours Delivery Care System:

a. In the district, there are totally 65 government institutions, out of which only 9

institutions were conducting deliveries. The contributions by the government sector for

the deliveries were very few compared to the total deliveries in the district. Out of total

40732 deliveries in the district during 2010-11, private hospital deliveries were 31341,

30 were domiciliary and only 9161(22.5%) deliveries were conducted in government

hospitals. Moreover, the numbers of government sector deliveries are decreasing year

after year. It was 8690 in 2008-09, 9161 in 2009-10 and further reduced to 7605 in

2010-11.

b. In CHC Chengamanadu, there were 4 MOs. There was no separate facilities for new

born. In GH Mattancherry there were totally 9 MOs out of which 5 were DGOs. There

was no blood storage unit and residential quarters for the staff to make it functional

properly. In the DH Aluva, the present labour ward needed white washing. Toilet and

Bath rooms were also not in good condition. There was no Sonologist in the USG

section.

c. In the district all the PHCs, CHCs and HSCs were not conducting deliveries in the

recent years.

7. Physical Infrastructures:

342

Ernakulam district is having a population of 32.7 lakhs with 49 PHCs, 5 GHs and 11

CHCs. Out of 316 HSCs only 4 did not have building . Computer & internet facilities

available in all the center and the MCTS was implemented in the district. Out of total 290

PNDT centers only 4 in the Government sector and the rest 286 are in the private sector.

The services in the government sector will improve if more USGs are installed in the

government sector.

i) DISTRICT HOSPITAL ALUVA:

a. Recently upgraded district hospital, Aluva with 227 beds is a cluster of about 15

buildings and scattered in a big compound. There are two vehicles in the hospital , one

is ambulance in the dialysis unit and another is a jeep in NRHM wing. Both have

contract drivers and could not be used round the clock.

b. Residential accommodation was almost nil in the hospital. There was one RMO

quarters which is not fit to stay.

c. There were 3 Lab Technicians out of which one belongs to RNTCP. Lab facilities are

minimal and up to 2 pm only. The post of pathologist was also not filled up. The posts of

Forensic Surgeon, Sonologist and dermatologist were lying vacant.

ii) In W&C Mattancherry, facilities of X-ray, blood storage were not available and residential

quarters were lacking. Even the one sanctioned post of Lab Technician was lying

vacant and filled with a contractual staff.

iii) CHCs

a. In CHC Chenagamanad, facilities of Ambulance, X –ray, USG, blood storage, OT,

Surgical equipment, Separate labor room, Sick new born care unit, Boyles apparatus

etc were not available.

b. CHC Angamali recently up graded as taluk hospital with a bed strength of 41 . Facilities

of Auto analyzer, X ray, USG and blood storage were not available. New building for

OP services was constructed. The stock of Ayurvedic medicines was insufficient in the

hospital.

iv) HSCs

a. The team has visited the HSCs of Desam, Elanthikkara, Thalvaapara and

Chandrapura. Out of 4 HSCs visited, 3 have Govt. building for functioning. ANMs were

staying only in 2 HSCs. Water and toilet facilities were not available in one HSC. Out of

4, 3 have no labour rooms.

343

b. Benches were not available in HSC Chandrapura. Delivery table, McIntsch sheet, Ambu

bag, Delivery kit, IUD kit, RDT kit for malaria, Torch light, Gloves, DDK, ECPs,

Keroscene /gas, IFA(small & large), OP, Sanitary napkins, Chloroquine tablets,

Metranidazole, Oxytoxin, Cap Ampicillin, Gentamycine injection, Kits A & B were not

available in all the HSCs visited. Paracetamol, Antiseptic solution, Cotrimoxazole,

Vitamin A, Hemoglobinometer, Steam sterilizer, Pregnancy test kit etc also not available

in some of the HSCs visited.

8. Community Satisfaction on Overall Services:

a. Services of GH, CHC, PHC

The contacted public of the visited centers expressed satisfaction on the services of

the GHs, CHCs & PHCs and staff in general. They opined for improving the facilities like

installation of USG, blood storage, fully fledged lab facility and posting of sufficient

specialists etc.

b. Services of MPW (M)

The team has assessed the work of 2 Male Health Assistants of HSCs Thavalappara

and Desam areas. The work at Thavalappara found satisfactory. Male Worker at HSC

Desam area was not involved in any of the activities like conducting of VHND session,

collection of blood smear, chlorination, motivating FW cases and School Health

Programme etc. The school principal of JSB school Desam and VHSC local leader

expressed complete dissatisfaction the activities of male health assistant.

c. Services of ANM:

a. The team contacted 10 mothers to know about the work of ANMs and their knowledge

on various health activities. All the contacted mothers informed that ANM was available

when needed, They were aware of exclusive breastfeeding, ORS and about the

immunization schedule.

b. All new born babies were weighed immediately after delivery. ARI awareness found in

7(70%) mothers. Contraceptives were using 6 (60%) mothers and side effects of

contraceptives were known to 7(70%) mothers.

9. Sample Verification of Family Welfare Beneficiaries:-

The team has selected totally 92 FW cases in the district out of which 70(76.1%) could

be contacted. for sample verification. Minor discrepancy was noticed in the age of

acceptors, in the age of spouse and in the number of total and male children.

10. Reconciliation of Reported Performance:-

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a. Sterilization and IUD performance cases should be matched with the reports and

service registers maintained at performing units and at the district office. But on

examination, it was not maintained properly to count the actual no. of the performance

figures. Details of the performance report for the year 2010-11 are as below.

S.No Name

Of the

Centre

Sterilization IUD

Reported

by

District

Office

Reported

by the

Centres

Registered

Figures

Reported

by

District

Office

Reported

by the

Centres

Registered

Figures

1 2 3 4 5 6 7 8

1 GH Aluva 434 533

NIL 242 316 212

2 CHC

Chengamanad

68 523 NIL 154 224 59

3 GH

Mattancherry

320 521 340 140 142 142

4 THQ

Angamaly

30 472 NIL 111 180 47

b. Performance report for OP users and condom for the year 2010-11 was not made

available to the team at District Office.

11. Other Observations

a) There was no separate Mission Director for NRHM. The present director was holding

the additional charge of 4 state government departments.

b) No state level governing body meetings under the chairmanship of the health minister

was convened in recent months. The state level executive body was convened by the

state health secretary only once during the past 4 months.

c) 108 ambulance services are not introduced in the district.

d) In both the private scans visited Viz., DDTC and Amma scan center Aluva, F& G

registers were not maintained. DDTC scan center is not sending any report to the DMO

office. Patients‟ full address also not available in their records.

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4. District- Pathananthitta

Major observations of Regional Evaluation Team, Chennai on evaluation work carried

out in Pathananthitta district of Kerala State in the month of October 2011.

I. Details of the visited Institutions:

Districts Visited DH/GH/CHC / PHCs

Visited

HSCs/Scan Centre/Diagnostic Center Visited

Pathananthitta

DH: Kozhencherry

GH: Adoor

CHC: Kalluppara

PHC: Pandalam and

Kaviyoor

HSC: Mangaram, Muttar, Kaviyoor North,

Kaviyoor South

Microtech Lab Scan Centre, Kozhencherry

Techilethu Diagnostic Center: Kozhencherry

II. Major Observations:

1. Health Human Resources:

a) 21 of the 140 sanctioned posts of Medical Officer, 22 of the 266 sanctioned posts of

ANM/JPHN, 7 of the 26 sanctioned posts of Lab. Technicians were lying vacant in the

district. Position of specialists was not made available to the team.

b) In GH Adoor, out of 25 specialist posts sanctioned, 8 were vacant and in DH

Kozhencherry, out of 28 specialists posts 4 were vacant. In PHC Pandalam and CHC

Kallooppara though 2 MOs are available in each institution, only OPD facilities were

being provided.

c) In the District Programme Management Unit under NRHM all the required posts are

filled up and functioning.

2. Services of Janani Surakha Yojna (JSY):

a) It was observed that no. of JSY eligible beneficiaries are decreasing. There were 4197

beneficiaries in 2009-10, 3163 in 2010-11 and 1061 in 2011-12 upto visit in the district.

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As reported, the district made an expenditure of Rs. 41,70,100 in 2009-10, Rs.

24,31,300 in 2010-11 and Rs. 7,39,100 in the year 2011-12, for providing incentives to

the beneficiaries.

b) In the District Hospital, Kozhencherry, there were 840 JSY beneficiaries during 2009-

10, 582 beneficiaries during 2010-11, and 182 during the current year up to August

2011. The expenditure incurred under JSY for the above periods was Rs. 589000, Rs.

407400 and Rs. 127400 respectively.

c) In the GH Adoor, the JSY achievement for 2009-10, & 2010-11 was 649 and 656 and

the expenditure incurred was Rs. 647900 and Rs. 554000 respectively.

d) The JSY mothers contacted in the district received JSY incentives as per the provision.

3. Untied Funds:

a) Status of Untied Funds at CHC Kallooppara was not made available to the team. The

MO of PHC Pandalam told that the PHC got untied funds @ Rs. 25000 regularly, but

details of expenditure of funds were not made available. Similarly, no detail in this

regard was provided in the PHC Kaviyoor.

b) HSC Kaviyoor South and Kaviyoor North received untied funds regularly @ Rs. 10000

per year, but the no funds in the current year was spent. HSC Mutter under PHC

Pandalam has spent Rs. 3000 during the current year out of total Rs. 10000 received;

HSC Mangaram was allotted untied funds of Rs 5000 during the current year out of

which Rs. 3000 were spent till the time of visit by the team.

c) In all the visited centers, untied funds was used for the purchase of essential items like

medicines, equipments, payment to ASHA. etc.

4. Functioning of Rogi Kalyan Samiti (RKS):

a) Though RKS has been formed in 61 institutions in the district their meetings were not

being conducted regularly. In PHC Kaviyoor, no meetings were held during 2010 and in

CHC Kallooppara only one meeting was conducted in 2010.

b) RKS funds details were made available only in the DH Kozhencherry and GH Adoor.

DH Kozhencherry got RKS funds @ Rs. 5 lakhs per year and fully utilized. Funds

Details were not made available at CHC Kallooppara and PHC Pandalam.

5. Functioning of ASHA:

It was reported that 1340 ASHAs were selected in the district and out of them 1229 were

provided with drug kits. ASHA is a member of VHSC. Public in the area visited was in contact

with ASHA regularly for their needs.

6. Village Health Nutrition Sanitation Committee (VHNSC):

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a. There are 930 Ward Health Sanitation and Nutrition Committees formed in the district.

VHNSCs are functioning regularly in the areas visited by the team. Joint bank accounts

in the name of the village leader and ANMs / Male Health Assistants were opened in all

the committees.

b. It was observed by the team that there was no uniform distribution of VHSNC funds in

the visited centers. In HSCs Kaviyoor south and Kaviyoor north only Rs. 5000 were

given to each VHSCs during 2010-11. In the current year, VHSCs of these areas were

given funds @ Rs. 10000; Under PHC Pandalam, 2 VHSCs of HSC Muttar were given

funds @Rs. 5000 during 2010-11 and only Rs. 6500 to each during 2011-12.

c. The details of expenditure by the VHSCs were not made available to the team by any of

the centers visited.

7. 24 Hours Delivery Care Services:

a. In the district, only 6 institutions (FRUs / GHs) were conducting deliveries. No CHC,

PHC and HSC was conducting deliveries. During 2010-11 out of total 14311, only 3497

deliveries (24.4%) were performed in government institutions.

b. The team visited district hospital Kozhencherry and GH Adoor which were conducting

majority of the deliveries. In these two hospitals, the available facilities were not

properly utilized and the maintenance of the maternity ward was found poor. Cots and

drip stands were rusted and bed linen was not sufficient. Window panes in the wards

were broken and ceiling fans were not repaired since long.

c. In District hospital Kozhencherry, though USG is available, it is very rarely used.

Instead, the common people are pushed to the scan centers in front of the hospital

which are either not approved or without having any qualified doctor and not

maintaining any PNDT registers.

d. Team reported that in the district hospital, the majority of the patient and mothers are

admitted for delivery and indoor services routed through the private clinics where

doctors of the District hospital are working privately.

e. It was observed that 108 Ambulance systems are not introduced and the insufficient

facilities of the centers compel the common man to utilize the services at private

hospitals.

8. Physical Infrastructures

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(ii) GH / DH:

a) In GH Adoor, a new multistoried building was constructed recently which can

accommodate all the specialties, wards, etc. USG and X-ray were not working.

Residential quarters for the hospital personnel were insufficient.

b) In the district hospital condition of the beds and wards was poor. There was no

directions or reception counters to guide the patients for easy services. USG though

installed very rarely used for the patients.

(ii) CHC:

In CHC Kallooppara, though 2 MOs were available, the public has to wait long for

treatment. Both the doctors come from very far off place. There was no ward services, OT,

Surgical equipments, Power back up. Vehicle, Microscope, Lab, Blood storage, Autoclave,

Oxygen Cylinder, Labour Room and other required equipments, New born care unit,

Resuscitation equipment, Boyles apparatus, staff quarters etc.

(iii) PHCs:

a) Pandalam PHC was functioning with 2 MOs but with no IP facilities. Even the single

bed available was not maintained clean and tidy. Resuscitation equipment and

Residential quarters were not available. The ambulance provided was under repair.

b) In PHC Kaviyoor, Examination table, Vehicle, Infant weighing machine, Autoclave,

Microscope, Lab technician, Oxygen cylinder, Resuscitation equipment, IFA (L),

Residential quarters and IUD insertion Kit were not available, There was insufficient

stock of Oral Pills and Nirodh in the PHC.

(iv) HSCs:

a) The team visited HSCs at Kaviyoor North, South Kaviyoor, Mangaram and Muttar in

Pathanamthitta district. Out of these centres, HSC Muttar did not have own building. In

3 HSCs ANMs were not saying at the HQ. Water facility is available only in one Sub

Center, None of the HSCs have facility of labor room. Ambubag, RDT kit for Malaria,

Oral Pills, Sanitary napkins, Oxytoxin, Ampicilline, Gentamycin and kit A and B were not

available in any of these HSCs.

b) Some of the HSCs did not have Toilet, Examination table, Benches, Mclntsh sheet,

Steam sterilizer, Pregnancy test kit, IUD kit, Hemoglobin meter, Gloves, ORS, DDK,

Kerosene/gas, vitamin A solution, IFA (L) & (S), Paracetamol etc.

c) IEC posters were not seen exhibited in 3 HSCs.

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d) None of the ANMs received training in SBA and IMNCI in the visited HSCs.

9. Opinion of Community Health Services:

iv) Services in GH/CHC:

a) The team reported that public who generally utilize the services in GH, Adoor and

District Hospital Kozhencherry are not satisfied with the services. Those who consult

MOs either in their private clinics or homes only are sure of getting admitted for delivery

or for emergency services. Moreover, all the specialists are not available in the OPD of

the hospital. They can be seen only in their private clinics and see their patients only at

the ward. Lab, USG are not free for all.

b) There was no reception counter and proper arrangement for the services of OPD and

IPD. Behavior of lower staff of the hospital is not at all satisfactory.

c) Public of CHC Kallooppara expressed dissatisfaction about the lack of services

available. Both the doctors of the CHC were not staying at the HQs. They come late

and leave the hospital after 1 or 2 hours.

ii) Services of PHC:

Contacted public of PHC Pandalam informed that other than the OPD no services are

available at the PHC. Even though lots of communicable diseases like chickenpox,

dengue, and fever are prevalent in the district, no field level staffs were visiting the PHC

areas.

iii) Services of MPW (M) / ANMs:

a) The team observed that the work of Male worker of HSC Mangaram under PHC

Pandalam was poor. His field activities need lot of improvement.

b) The team contacted 18 mothers to know the work of ANMs and their health awareness.

Out of 18 contacted mothers, 9(50%) mothers informed that ANMs were not available

when they needed most.

c) All the contacted mothers had institutional deliveries and their babies were weighted

immediately after delivery. Exclusive breast feeding, ORS & immunization were known

to all.

d) 16 (88.9%) were given PNC Check up by the field staff. Danger sign of ARI was known

only to 7 (38.9%) mothers, side effect of contraceptives was known only to 6 (33.3%)

mothers and use of contraceptives by 9(50%) mothers. Necessary action may be taken

to improve awareness and the services among the beneficiaries.

350

10. Sample verification of Acceptors

In Pathanamthitha district, the team selected a total of 91 FW cases out of which 76

could be contacted for sample verification. Minor discrepancy was noticed in the recorded

age of acceptors, age of spouse, and total children of the acceptors.

11. Other Observations

a) Field visit of the MOs and field staff was found poor in kadakkad area under PHC

Pandalam.

b) Meetings of District Health Society and RKS should be conducted regularly.

c) In the government sector only 3 USGs are available. Out of it one is under repair and

another one is not fully utilized. USG facilities may be provided to all the CHCs and

GHs.

d) OPD, IPD and specialist services should be regularized through computerization and

should not be based on private clinics of doctors.

e) Suggestion cum complaint box must be kept in the premises of all government hospitals

with phone number of the district and state officers.

f) District and state level supervision should be strengthened.

g) The district is in the grip of various epidemics. During 10-11 there were 144 dengue, 13

leptospirosis and several cases of hepatitis, chicken pox etc. This year itself 2 death of

dengue and 3 deaths of hepatitis were reported from the district. Field supervision

should be increased and staff availability at the peripheral centers and their work

monitoring should be ensured.

351

5. District- Alapuzha

Major observations of Regional Evaluation Team, Chennai on evaluation work

carried out in Alapuzha district of Kerala State in the month of October 2011.

I. Details of the visited Institutions:

Districts Visited DH/GH/CHC / PHCs

Visited

HSCs/Scan Centre/Diagnostic Center Visited

Alapuzha

GH: Chengannur

PHC: Perimbalam,

CHC: Chambakulam

HSC: Perimbalam North, Perimbalam South,

Nazarath, Chemmampuram, Attuathila.

Travancore Scans, Medical College, JN.

Alapuzha

Muthooth Diagnostic Center, Alapuzha

II. Major Observations:

1. Health Human Resources:

a) The staff position was satisfactory in the district except few categories like Specialist

and Medical Officer. 44 of the 186 sanctioned posts of Medical Officer and 45 of the 158

sanctioned posts of Specialist were lying vacant in the district.

b) In CHC Perimbalam, staff position was found satisfactory except the vacant post of Lab

Technician. In CHC Chambakkulam and in GH Chengannur all the sanctioned posts are

filled up except a few vacant posts.

2. Services of Janani Surakha Yojna (JSY):

a. As reported, there were 6966 JSY beneficiaries in 2009-10 and 7965 beneficiaries

during the year 2010-11 in the district.

b. Since no delivery is being conducted in the visited CHCs, Perimbalam and

Chambakualm, no JSY beneficiaries were reported there. In GH Chengannur, there

were 218 JSY beneficiaries during 2010-11 and 152 beneficiaries during the current

year 2010-11.

c. The details of funds allotted and spent for JSY was not available at the district office. In

the, Annual Statement of JSY for 2009-10 and 2010-11, all the items were shown as

zero.

3. Untied Funds:

352

There is no separate year wise financial report at the district level for NRHM funds.

The statements given are for the cumulative funds since 2005-06. As per the 2009-10

cumulative report, the district has spent an amount of Rs. 34.2 crores and closing

balance is Rs. 46.8 lakhs. Year wise allotment to different programmes was not

provided to the team. Programme management and financial management need lot of

improvement in the district.

a. Rs. 5000 given to CHC Perimbalam as untied funds for the year 2011-12 and no such

funds were provided to this CHC during 2010-11.

b. Out of 3 HSCs of PHC Perimbalam, the ANM of the HSC, perimbalam got only one time

untied fund in 2006. For other 2 HSCs at North Perimbalam and South Perimbalam, no

untied fund was given after 2006. Basic facilities and equipments were not available in

these HSCs, since no fund was provided.

c. In CHC Chambakulam, untied funds @ Rs 50000 was given in the year 2009-10 and

2010-11. But no fund was given during the year 2011-12.

d. 2 HSCs visited under CHC, Chammampuram viz, Nazarath and Attuvathala did not

receive any AMG or Untied fund for 2010-11 and 2011-12

4. Rogi Kalyan Samiti (RKS):

a. RKS were formed in all the centers visited. Details of the RKS funds were not provided

either at district office or at peripheral centers visited. Meeting of executive and

governing body of RKS were not held regularly. The team contacted the RKS

representatives and they expressed dis-satisfaction of the functioning of the centers,

Infrastructure and manpower.

b. The present Panchayath and other Local Body members in the RKS were not given any

orientation training on NRHM functioning.

5. Services of ASHA:

a. It was informed that 2300 ASHAs were selected in the district out of which 1600 were

given 5th module training. Drug kit was given to 1585 ASHAs.

b. In the district, no amount was spent for ASHA scheme during 2009-10 as per the district

statement. During 2010-11, the cumulative expenditure for training on ASHAs was 1.8

crores and performance based incentives for ASHAs was Rs. 1.3 crores. Details for the

current year were not made available.

6. Village Health and Sanitation Committees (VHSCs):

1372 Ward Health Sanitation & Nutrition Committees have been formed in the district. The

committees were functioning regularly in all the centers visited.

353

7. 24 Hours Delivery Care System:

d. There are only 7 government institutions conducting deliveries in the district. No CHC,

PHC or HSC is conducting delivery.

e. In the GH Chengannur only 197 deliveries were conducted in the current year 2011-12.

There are 23 specialist doctors in the GH.

8. Physical Infrastructures:

i) FRU

In GH Chengannur Residential quarters, Blood storage, USG, and cleanliness of wards

beds etc were lacking.

ii) CHCs

a. In CHC Chambakulam there are 5 MOs. Even though OP & IP facilities were available,

basic facilities for conducting deliveries were not available. There was no facility like

labour room and equipments, Ambulance, Weighing scale for adult and infants, Lab

facilities, X ray, ECG, USG Blood storage unit, Sick new born care unit, Neonatal

resuscitation Boyles apparatus, Waste disposal system and also, residential quarter for

MOs and Staff.

b. CHC Perimabalam was functioning in very old building with 51 beds. Microscope, Lab

equipments, USG, Labour room and its equipments, OT, Sick new born care unit,

Examination table, Boyles apparatus, and Residential quarters were not to available in

this CHC.

iii) HSCs

a. The team visited the HSCs at Nazarat, Attuvathala, Perimbalam North and Perimbalam

South. Out of four HSCs, 2 were functioning in government building and other 2 in

rented premises. Basic facilities are found poor in all the centers visited.

b. HSCs did not have Delivery table, Mclntsh sheets, Ambubag, Steam Sterilize, RDT Kit,

Antiseptic solution, Metronidazole tablet, Oxytoxin, Ampicilline, Gentamycin and kits A

& B. Some of the HSCs did not have facilities of Toilet, Labor room, Examination table,

Benches, Delivery kit, IUD kit, Stove, Haemoglobinometer, Slides for blood test, Stock

of IUD, OP and also Sanitary Napkins.

c. All the HSCs were maintained properly for clinic purpose but no delivery was being

conducted there.

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d. None of the ANMs have received any training on SBA and IMNCI.

9. Community Satisfaction on Overall health Services:

i) Services of GH, CHC,

a. The public opinion was not good on the functioning of GH Chengannur. The

superintendent is the administrative incharge of the hospital but he was not coming to

the hospital in time. The maintenance of the hospital, wards, reception counter etc were

poor. White washing, electrical and civil repair are over due. The postmortem activities

were stopped long before in this hospital. Though the Municipal Chairman and other

public had brought to the notice of the DMO about the problem, no action was taken so

far.

b. The Ex- chairman of the block panchayath of CHC Chambakulam area informed the

team that there is no facilities for emergency, labor room, lab etc. Similar problems are

pointed out by the public of the CHC Perimbalam. There was no labour room, lab, staff

quarters etc in the CHC.

ii) Services of ANM:

a. The team contacts 20 mothers to know the work of ANMs and about health awareness.

Mother informed that the ANMs were available when needed; they had visited the

HSCs / Anganwadi for ANC/PNC.

b. 10 (50%) mother were aware of ARI danger sign. 19 (95%) were aware of various

contraceptive methods and 14 (70%) about contraceptives users.

10. Sample Verification of Family Welfare Beneficiaries:-

a. The team selected 85 FW acceptors out of which 69 (81.2%) could be contacted for

sample verification. Out of 69 contacted, 62 (89.9%) acceptor were interviewed and

they had received follow up services from the field staff. Some discrepancies in the

recorded age of acceptors, age of spouse in split of children were noticed.

11. Other Observations

a. There was no list of PNDT centers in the district and all were not registered. On

verification, it was observed that Travancore scan near W & C, Aleppuzha Hospital has

not renewed its registration for the past more than 5 years and is said to have been

owned by a DMO of a nearby district.

b. Details of funds provided under NRHM and programmes activities were not properly

maintained at the district and peripheral levels.

c. “Rural Doctor Scheme” may be implemented in the district since the doctors are not

willing to work in rural areas under the CRS (compulsory rural service) scheme. In the

355

district 88 CRS doctors are posted by the government. Out of them only 43 are working

and others are absconding. Neither the district nor officer or PHC/CHC MO has any

control over these junior CRS doctors.

d. Supervision at periphery level needs to be strengthened.

e. The district is suffering from leptospirosis, degue, malaria and water borne diseases. In

2010-11 there were 68 Dengu, 130 Leptospirosis and 3 Chickungunea reported cases.

Since 2006-07, more than 200 lives have been taken away by these epidemics in

Alepppuzha and adjoining districts of Pathanamthitta and Kottayam. Mosquito control

activities need to be strengthened in the municipal area of Chengannur and Alappuzha.

f. RKS member and Chengannur Municipal Chairman Smt. Suja John informed the team

that in spite of her effort and local MLAs initiative, the superintendent and other staffs

are not coming regularly to the GH. The Superintendent in charge did not turn up even

during the team visit.

*************

356

Maharashtra

1. District Chitradurga:

Major observations of Regional Evaluation Team, Chennai about evaluation work

carried out in Gadchiroli district of Maharastra State in the month of November

2011.

I. Details of the visited Institutions:

Districts

Visited

DH/SDH/RH and PHCs Visited HSCs Visited

Gadchiroli

DH: Gadchiroli

SDH: Armorie

RH: Dhanora

PHCs: Delanwadi and Amirza

Kulkuli, Manapur, Gilgaon and

Khursa

II. Major Observations:

Gadchiroli is a backward tribal district with a population of about 11 lakhs. The district

has one DH, 4 SDHs, 12 RHs and 45PHCs. Out of 15 PNDT centers, 3 are owned by

government. There is one MNGO and one trauma care unit.

10. Health Human Resources:

a) Staff Position in the key posts was somewhat good in the district. 29 of the 421

sanctioned posts of ANM, 20 of the 264 sanctioned posts of MPW (male) and 12 of the

93 sanctioned posts of supervisors (male) were lying vacant in the district. However, it

was reported that the vacancy in the category of specialists, LHV / LHS and staff nurses

has been filled by posting of the respective staff on contact basis.

b) The Staff position In the DH Gadchiroli, was not satisfactory. Out of the post of 16

specialists only 6 were filled up. 2 posts of MO MBBS, out of 30 sanctioned, 41 posts of

staff nurses (113 sanctioned) and 30 posts of class IV (146 sanctioned) were lying

vacant.

c) SDH Armorie was having 9 staff nurse in position out of 16 posts sanctioned. In RH

Dhanora, there were totally 9 MOs, out of them only 2 were regular Doctors.

d) Staff position In PHC Dalenwadi was satisfactory. There were 2 MOs, 2 staff nurses, 6

ANMs, 6 Male Health Workers, 2 Lab Technicians and 5 class IV staffs for the PHC

having population of 9220.

357

2. Services of Janani Surakha Yojna (JSY):

a) During 2009-10, there were 7669 JSY beneficiaries and in 2010-11, there were 7335

JSY beneficiaries in the district.

b) JSY scheme is functioning well in the district. Rs 50.03 lakhs were spent under JSY, out

of available funds of Rs 55.85 lakhs in the year 2009-10. An amount of Rs 46.12 lakhs

was spent out of the funds of Rs 56.09 lakhs available during 2010-11.

c) JSY Performance collected from the visited centers is as follows.

S.No Name of the centers No of JSY

beneficiaries

during 2009-10

No of JSY beneficiaries

during 2010-11

1 S.D.H Armorie 217 30

2 RH Dhanora 69 13

3 PHC Amirza 194 43

4 PHC Delanwadi 68 88

In PHC Amirza, it was informed by the Medical Officer that only 58 mothers could be

paid JSY incentives during the current year and 96 cases are pending since there was

no fund available in the PHC.

3. Untied Funds:

a) The details of untied fund at HSC, PHC, RH and SDH level in the district as reported

are given below:

(Rs in Lakhs)

Sl. No Particulars Funds

Available

2010-11

%Expenditure Funds Available

2011-12 (up to

Oct-11)

%Expenditure

1 HSC Untied Fund 37.75 87.4 4.58 15.9

2 PHC Untied Fund 11.54 91.8 2.99 57.9

3 RH Untied Fund 4.5 90.0 1.1 98.2

4 SDH Untied Fund 1.5 99.3 0.38 100.0

b) It was reported that more than 90% of untied funds are spent at PHCs, RHs and SDH

level in the year 2010-11 in the district. The team reported that in some of the PHCs,

the untied funds for the current year were not provided. In PHC Amirza and PHC

Delanvadi the HSCs untied funds and AMG are not released for 2011-12 till visiting

month.

358

4. Rogi Kalyan Samiti (RKS) and Village Health Sanitation and Nutrition Committees

(VHSNCs):

a) 58 RKS have been formed in the district and RKS in the visited centres was functioning

properly.

b) There were 1224 VHSNCs formed in the district. All the VHSNCs are functioning

regularly in the centers visited.

c) The accounts of VHSNCs are jointly operated by the anganwadi workers and the village

leaders. The details of funds are not maintained properly in the centers visited.

d) No VHSNC fund was released to the HSCs of the PHC Dalenwadi during 2011-12.

5. Services of ASHA:

a) In the district, 768 ASHAs were selected. Out of them 740 were given training upto 3

modules and also provided drug kits. They are also members in the VHSNCs. They

motivate the mothers for ANC, PNC, institutional delivery, child immunization. ASHAS

also refer fever cases and diagnosing sickle cell anemia etc. The public during visit to

the field in the centres expressed satisfaction on the working of ASHAs.

b) In the visited HSC Manapur, no ASHA was selected.

6. 24 Hours Delivery Care System:

a) The team reported 17 FRUs, 23 PHCs and most of HSCs were engaged in conducting

deliveries round the clocks in the district. It was reported that out of total 18082

deliveries in the district, 12424 are institutional during 2010-11 and about 50% are

conducted at HSCs level.

b) In the DH Gadchiroli, 3062 deliveries were conducted in the year 2010-11 and 2056

deliveries during 2011-12 up to Oct 2011. The Bed occupancy rate is very high as total

bed strength is only 250.

c) SDH, Armorie conducted 264 deliveries during 2011-12 up to Oct 2011.

7. Physical Infrastructures and Stock Position:

i) DH/SDH

a) District Hospital, Gadchiroli is a well maintained and equipped hospital. But the space

for OPD and Ayurvedic unit was insufficient. There are facilities of USG, CT scan, X-

ray, ECG and 4 OTs with trauma care.

b) In SDH Armorie, facilities were good like X-ray, ECG, USG and Telemedicine unit. The

bed strength was only 50. Maintenance of the hospital was found good.

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ii) PHCs

a) PHC Delanwdi was having good facilities with 2 MOs, OT, IP, OP, deliveries and

sterilization services. There was no stock of Prophylactic Drugs for the past several

months in this PHC.

b) PHC Amirza is a 6 bedded PHC with 2 MOs. Facilities of resuscitation, IFA, Vitamin A

and Ayurvedic drugs were either not available or inadequate. Maintenance of the ward

and beds needs improvement.

iii) RH Dhanora:

Facilities are good in this RH. There was USG, well equipped OT, Lab etc. but

availability of beds and manpower were inadequate. The maintenance of the hospitals

and wards was excellent in all respects.

iv) HSCs

a) The team has visited HSCs at Gilgaon, Khursa, Kulkuli and Manapur; the ANMs were

staying at the HSCs HQs and the facilities in the HSCs were satisfactory.

b) Sterilizer, Ambu bag/suction, Stove, DDKs, Kerosene/Gas, Vit A solution, IFA tablets

(big/small) & syrup, IUDs chlorine solution OP Cycle, IC Pills, Oxytocin, contrimoxazole,

Cap Ampicillin, and Gentamycin injection, were not available in most of the HSCs.

c) Kit “A” and “B” at HSC, Khusra, Labour room at HSC manpur, sanitary napkins at HSC

Gilgaon and metranidazole tab. In manpur HSC were not available.

d) Mobile phone and SBA & IMNCI training was not provided to the ANMs except at HSC

Kulkuli.

e) IEC materials and posters were not displayed on the wall of HSCs except at HSC,

Gilgaon. No blood slide collection target completed at all the visited centres during last

three months.

8. Opinion of Community on the Health Services:

i) PHC Services

ii) The contacted public in the area of the PHCs visited expressed their satisfaction

towards services at PHC HQs. The villagers expressed satisfaction on the behavior of

the MOs and Staff of the PHCs.

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iii) MPW Male Services

As observed by the team, the work of Male Workers in HSC Manapur and HSC Gilgaon

in respect of FW, Malaria and Chlorination work etc was satisfactory.

iv) ANMs Services.

a) 18 mothers having child up to one year of age were contacted to assess their

knowledge and opinion on various health services rendered by the ANMs. They

informed, ANMs were available when needed. ANMs visited the HSC for

ANC/PNC/VHND: Mothers were aware of exclusive breast feeding, ORS,

Contraceptives and have their children immunized.

b) All the contacted mothers told that their babies were weighed immediately after

delivery.

c) PNC check up was given only to 13 (72.2%) mothers and 6 (33.3%) were aware about

danger signs of ARI.

9. Sample verification of FW Acceptors:

a) The team selected totally 74 FW cases out of which 63 (85.1%) could be contacted;

minor discrepancy was noticed in the number of male children and number of total

children of the acceptors recorded in the registers.

All 62 (98.4%) contacted FW acceptors were given follow up services by the field staff.

Compensation money was paid to all contacted sterilization cases.

10. Maintenance of Records and Registers:

The maintenance of registers and records in the visited centers were found to be

satisfactory. Consolidated registers for sterilization and IUD was maintained at the

reporting centers. The workers of the visited HSCs also maintained the registers in a

satisfactory way.

11. Other Observations:

a) It is appreciated that the district has conducted a total 1013 NSV cases during the last

year.

b) The increase in malaria cases is alarming in the district. In PHC Delanwadi with 9270

population, there were 76 malaria positive cases during 2010-11 out of which 60 are PF

and in 2011-12 there were 18 PF cases. In the RH Dhanora, there were 127 malaria

positive cases last year out of which 85 were PF. The supervision from the HQs is

essential in this respect.

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c) As reported, the sickle cell anaemia is highly prevalent in the district. Malaria together

with sickle cell contributes for about 50% of the maternal deaths in the district. Central

and state level supervision is required in the district. In the RH Dhanora, last year, out

of 719 tested, 102 were positive, sickle cell cases out of which 95 are elertrophites.

Besides the center have 44 sputum positive cases of TB during the period.

d) The team could not cross cheek the F.W. figures at different centres since the district

office had not made the required reports available to the team.

*********

2. District Chitradurga:

Major observations of Regional Evaluation Team, Chennai about evaluation

work carried out in Chandrapur district of Maharastra State in the month of November

2011.

I. Details of the visited Institutions:

Districts

Visited

DH/SDH/RH and PHCs Visited HSCs Visited

Chandrapur

DH: Chandrapur

RH: Ballarshaha

PHC: Chithpalli and Durgapur

PNDT Centre Christ Hospital:

Chandrapur

Junera, Lohara, Nagala and

Durgapur

II. Major Observations:

The district is a backward one with more than 50% tribal population. There are 2 USGs and 1

trauma care center in the district. Besides, there are 14 urban centers 58 PHCs and 339

HSCs in the district.

3. Health Human Resources:

a) Most posts of the skilled personnel against the sanctioned strength were filled up in the

district. In the district, 5 of the 124 sanctioned posts of Medical Officer, 4 of the 396

sanctioned posts of ANMs, 34 of the 200 sanctioned posts of MPW (male), 7 of the 77

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sanctioned posts of male health supervisor and 6 of the 58 sanctioned posts of staff

Nurse were lying vacant.

b) In the DH Chandrapur, 14 class-1 Doctor of the 20 sanctioned, 4 of the 39 class 11

Doctors, 29 of the 145 sanctioned posts of staff nurse, 28 posts of class IV out of

sanctioned 176, posts, were lying vacant.

c) In RH Ballarshsha, there were 6 ANMs, 2 Male Health Assistants (out of 3), 3 MOs, 6

staff Nurses (out of 7), 2 Lab Technicians, and 15 class IV staff. No specialist was

posted in the hospital.

d) In PHC Chithpalli, the staff position was satisfactory. There were 5 additional ANMs in

the Sub centres .

2. Services of Janani Surakha Yojna (JSY):

a) As reported, 12442 JSY beneficiaries in the year 2009-10 and 10,640 JSY beneficiaries

in the year 2010-11 had been provided with cash incentive under the scheme in the

district.

b) Expenditure incurred under JSY for the years 2009-10 and 2010-11 was Rs. 84,03,113

and Rs. 89,86,328 respectably. During the current year, the budget sanctioned for JSY

was 99.08 lakhs out which Rs. 65.57 were spent.

c) The number of JSY beneficiaries, for the year 2010-11 and 2011-12 in the visited

centers were as given bellow.

S.No Name of the centers No of JSY beneficiaries

during 2010-11

No of JSY beneficiaries

during 2011-12

1 PUC Durgapur 110 45

2 RH Ballarshaha 201 128

3 PHC Chithpalli 105 47

4 DH Chandrapur * 1193

* Not Made Available.

3. Untied Funds:

a) During 2010-11, the untied fund allotment to the district was Rs. 193.87 lakhs. But the

expenditure for the year was more than the allotment i.e. Rs. 199.15 lakhs. During the

current year 2011-12 (upto OCT 11), out of 121.68 lakhs, 68.60 lakhs were spent so far.

b) In PHC Chithpalli, the untied fund of Rs. 25,000 was fully utilized last year and in the

current year the amount of Rs. 10,000 was received & utilized. 6 HSCs of the PHC

received a total of Rs. 60,000 @ Rs. 10,000 per HSC during 2010-11 and the amount

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was fully utilized. During 2011-12 only Rs. 4,000 was allotted to each HSCs and the

balance of Rs. 6,000 will be issued later in the current year.

c) In PHC Ballarshaha, untied funds of Rs. 25,000 allotted for the year 2010-11 and Rs.

10,000 allotted for the current year were spent.

d) In GH Ballarshaha 99.9% of untied funds was utilized during 2010-11. In the current

financial year out of Rs. 15,000 received more than 98% was spent.

4. Rogi Kalyan Samiti (RKS) and Village Health Sanitation and Nutrition Committee

(VHSNCs):

a) In the district, there are 72 RKS formed. All the RKS were functioning properly in the

centers visited. During 2011-12, 13 RHS/SDHs under the district civil surgeon got RKS

funds amounting to Rs. 14.99 lakhs, out of which Rs. 87.96 lakhs were spent. District

hospital has spent more than 99% of the total funds during the above period.

b) Out of total 1461 villages in the district VHSNCs were formed in 1408 villages.

c) In the visited PHC Durgapur, 21 VHSNCs were formed for which joint bank accounts

were opened in the name of ANM and Anganwadi workers. In RH Ballarshaha urban

area, 9 link workers were appointed under NRHM to do similar work of ASHAs. In PHC

Chithpalli, 28 VHSNCs were formed.

5. Services of ASHA:

a) In the district, totally, 1761 ASHAs were selected, trained in 3 modules and given drug

kit. They are also included in the VHSNCs as member. It has been reported that

Rs.14,88,500 were spent on ASHA incentives During 2010-11.

b) Strength of ASHAs functioning in the visited centres was given below:

Sl. No Name of the center No. of ASHAs

1 PHC Durgapur 22

2 PHC Chithpalli 28

3 RH Ballarshaha 9

6. 24 Hours Delivery Care System:

a) In addition to the DH, and 13 RHs/ SDHs, there were 37 PHCs and most of the HSCs

were functioning as 24 hours for conducting delivery in the district.

b) In the district, out of total 35,226 deliveries conducted last year, 17,626 were in the

government sector.

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c) In RH Ballarshaha, there were no specialists and also found poor infrastructure. No

proper facilitied labour room, ward, OT, and in the new born care center in the RH. In

PHC Durgapur, even with inadequate infrastructure, 100 deliveries were being

conducted per year.

7. Physical Infrastructures and Stock Position:

i) Dh Chandrapur:

It is a 300 bedded well equipped hospital. There were 3 quarters for MOs but not in

good condition. The hospital is very much crowded with very high bed occupancy rate.

ii) RH Ballarshaha

a) This is a 30 bedded hospital recently constructed after demolishing the old building. Out

of 30 beds, 10 we earmarked for gynecology. By considering the OP & IP strength of

the hospital, it requires more beds and ward facilities. Available beds and cots were

mostly broken and rusted.

b) There was no facility of USG, X-ray, ECG, pulse oxio meter, shadow less lamp and

Boyles apparatus. Residential quarters for MOs and Staff and Sick new born care unit

were not available. The equipments in the OT and labour room in the hospital were very

old.

iii) PHCs

a) The PHC building at Chithpalli has developed cracks since it is located in the coal

mining area. PHC was equipped with the facility of USG, X-ray and Boyle‟s apparatus,

Some of the Cots in the PHC were rusted and need painting.

b) Building of PHC Durgapur was renovated with 15 beds. But the facilities are not

sufficient in this IPHS PHC. Stock of IUD, OP, CC, IFA (S) & (L), were not available in

the PHC for the past one year. There was inadequate supply of medicines from the

district medical stores depot and about 80% of the PHC funds utilized for purchasing

necessary medicines. There was also no stock of ORS, septran, syringes, Paracetamol,

bandage, formalin, and vaccine carriers for pulse polio programme.

iv) HSCs

a) In all the visited HSCs at Nagala, Junona, Padmapur, and Lohara, the ANMs were

staying at the HQs with additional ANMs in 2 HSCs. One of the HSC was maintained as

per IPHS. Male health worker post was not filled up in one HSC. Generally, the basic

facilities and equipments were available in all the HSCs except few items.

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b) Ambu bag, RDT kit for malaria, DDK, Kerosene / gas and Sanitary napkins, were not

available in all the visited HSCs.

c) In some HSCs, facilities of pregnancy test kit, Stove and chloroquine tab. were not

available.

d) In 2 HSCs, IEC materials were insufficient and ANMs have not received training on

SBA.

8. Opinion of Community on the Health Services:

i) PHC Services

In all the visited centers the public expressed satisfaction on the work of the MO and

staff of the visited centers, They expressed the view of increasing the infrastructure,

supply of adequate medicines etc to the centers.

ii) MPW Male Services

The team has evaluated the work of two male workers who were working in HSC

Junera and HSC Negala. The public of these villages expressed satisfaction on the

work of these staff.

iii) ANMs Services.

a) The team selected and contacted 25 mothers to know about the work of ANMs and

their knowledge on various health matters.

All the 25 contacted mothers informed that ANMs were available when needed. Mother

visited the HSC for ANC/PNC/VHND, had institutional delivery, aware of exclusive

breast feeding, ORS, contraceptives and have immunized their children.

b) All the contacted mothers told that their babies were weighed immediately after

delivery. PNC check up was given to 20 (80%) mothers and ARI danger sign

awareness was fond in 10 (40%) mother. Awareness on immunization site was known

to all the mothers and side effects of contraceptives were known only to 15 (60%)

mothers.

9. Sample verification of FW acceptors:

a) The team selected 87 FW cases out of which 71 (81.6%) could be contacted for sample

verification, Minor discrepancy was noticed in the number of total children, male

children age of youngest child of the acceptors and in the age of spouse.

b) Follow up services by the field staff to the F.W. acceptors and compensation money to

the sterilization acceptors was found to be satisfactory.

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c) Three oral pills users (4.2%) denied having the services.

10. Maintenance of Records and Registers:

a) The maintenance of registers and records was found to be satisfactory in the visited

centers.

b) The workers of the visited HSCs were also maintaining the registers as per guidelines.

11. Other Observations and Suggestions:

a) Supervisors from the State head quarter should visit the district regularly. It was

observed that there was inadequate stock of medicines in the district medical stores

depot.

b) Out the 5477 deliveries conducted in the DH, 271 were still births, 2369 babies were

about 2.5 kgs, and 2207 between 2 to 2.5 kgs, 454 between 1.5 kgs to 2 kgs and 194

below 1.5 kgs. Necessary action may be taken for the improvement of nutritional status

and birth weight of the newly born babies.

3. District Jalgaon:

Major Observations of Regional Evaluation Team, Chennai about evaluation

work carried out in Jalgaon district of Maharastra State in April 2011.

I Details of the visited Institutions:

Districts

Visited

DH / CH / SDH /RH / PHCs and

PVT Hospitals visited

HSCs Visited

Jalgaon

District Hospital: Jalgaon

SDH: Chopda and Jamner

RH: Pachora

PHCs: Wakod, Janave, Vaijapur,

Nandra, Mhasawad and Deku

PNDT centre: Anand Hospital,

Pachora

Kondakhed, Jalagke and

Ghandale

II. Major Observations:

1. Health Human Resources:

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a. Details of the different categories of staff in the district in some of the key posts are

given below.

S. No Categories of Human resources Sanctioned vacant

1 ANMs 519 26

2 MPW(M) 296 24

3 LHV /HS (F) 107 24

4 Health Supervisor (M) 114 32

5 Medical Officer 264 23

6 GNM/ Staff Nurses 291 50

b. In the visited RH Pachora, all the sanctioned posts were filled up except the posts of

2 Specialist doctors. In PHC Janeva, PHC Nandra, PHC Wakod and PHC Vaijaput all

the posts were filled up except the posts of Staff Nurse. None of the sanctioned posts

of Staff Nurses are filled up in these PHCs. Deliveries are assisted by LHVs in these

PHCs. In GH Chopda, out of the posts of 27 Staff Nurses only 19 were filled up and

out of 46 cleaning staff, only 34 were working there.

2. Services of Janani Surakha Yojna (JSY):

a. JSY amount of 106.78 lakhs during 2009-10 and Rs. 90.05 lakhs in 2010-11 was

received in the district. An expenditure of Rs. 96.15 Lakhs and Rs. 83.73 Lakhs was

made during 2009-10 and 2010-11 respectively in the district.

b. During 2009-10, 14679 beneficiaries and during 2010-11, 12141 beneficiaries

provided with cash assistance under JSY in the district.

c. The team has contacted 15 JSY mothers in the visiting areas and all have received

the amount as per rules and services under JSY.

3. Untied Funds:

a. The District received untied funds to the tune of Rs. 77.95 lakhs during 2009-10 and

Rs. 77.95 lakhs during 2010-11. And expenditure during 2009-10 and 2010-11 were

Rs. 66.19 lakhs and Rs. 54.78 lakhs respectively. SDH and RH were given funds @

Rs 50,000 and PHCs were given @ Rs. 25000 per year as untied funds.

b. In the centers visited, most of allotted amount of Untied Funds have been utilized.

All the records for untied funds were properly maintained in the visited PHCs, RHs and

SDHs in Jalgaon district.

4. Rogi Kalyan Samiti (RKS) and Village Health and Sanitation Committees

(VHSCs):

a. As reported, RKS was functioning in 98 centres in the district. All the centers have

utilized the RKS funds for the welfare of the patients in the district.

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b. 1498 VHSCs formed in the district. All the VHSCs in the visited areas were conducted

their meetings regularly. The ANMs and ASHAs were regularly liasoning with village

leaders in improving the sanitation of the villages.

5. Services of ASHA:

2594 ASHAs selected in the district. All of them have received 7 days of induction training

and provided with drug kit.

6. 24 Hours Delivery Care System

In Jalgaon district, out of 77 PHCs, 32 were working for 24 hours for delivery care

services. It has been observed that there was decreasing numbers in home deliveries

compared to last year, due to implementation of 24 hours delivery scheme. There is a further

scope to increase institutional deliveries in rural areas if more PHCs are designated for 24

hours delivers care services.

7. Physical Infrastructures and Stock Position

(i) District Hospital

District Hospital, Jalgaon having 354 beds providing the services of almost all

specialties like, Medicine, Surgery, Obstetrics & Gynecology, Pediatrics, neonatology,

emergency, critical care, Anesthesiology, Ophthalmology, Radiology, Dental and

Psychiatry Besides, all diagnostic and clinical services like Laboratory services,

Imaging services, CT Scan services, Sonography, ECG, EEG, Echo Cardiogram,

Endoscopy, Blood Bank, Physiotherapy, Dental service, Pharmacy and Dialysis wing.

This is the only government hospital in the district having dialysis unit which was

funded from the NRHM.

(ii) SDH

a. SDH Chopda is located in a tribal area with 100 beds. The hospital is well maintained

with facilities of Casualty, ICU Maternity Nard, NICU, OT, X-ray, ECG, Central

Pathology Lab, USG, 4 Male wards, 4 Female wards and 8 Special Rooms. In addition

Specialist Doctors, AYUSH wing with 2 Ayurvedic Doctors, One Unani Doctor and one

Homeopathy Doctor were available.

b. SDH has also a telemedicine branch working effectively in consultation with highly

Specialized Hospitals of the state.

c. SDH, Jamner is a 50 bedded hospital having good infrastructure facilities, 5

Specialists posted. Residential quarters are also available there.

(iii) GH

a. GH, Pachora is a 30 bedded hospital; the space available is insufficient for conducting

OP and IP. Setting up of a new born care unit was under process. There were no

Residential Quarters for MOs and Para -Medics for the Hospital.

369

(iv) PHC

a. The infrastructure facilities were good in Wakod, Nandra and Janeva PHCs. In PHC

Vaijapur OT & Surgical Equipment were not available and Residential Quarters were

not fit for residing.

(v) HSC

a. About 50% of the HSCs did not have any buildings. Out of total 442 HSCs, 225 only

have buildings. In the district, the team has visited the HSCs of Gandakhed of PHC

Wakod, HSC Ghandali of PHC Deku and HSC Jalakhe of PHC Masawan. All three

visited HSCs have own building, and all the ANMs were staying at the HSC HQ. The

availability of Equipments, supplies and Medicines etc. were satisfactory in all the

centers visited.

b. HSC Gandakhed does not have ambu bag/ suction apparatus. None of the ANMs

received any training on SBA and IMNCI. In HSC Ghandhali no additional ANM under

NRHM was posted and the items like Stove, Gentamycine Tab. and AD Syringes were

not available there.

c. None of the ANMs were provided mobile phone. DDK and kerosene were not

available in any of the visited HSCs.

8. Community Satisfaction on Health Services.

a. The team has selected and contacted 20 Mothers in the district to know about the

work of ANMs and their knowledge on various health services. All the contacted

Mothers informed that ANMs were available when needed.

b. All contacted Mothers were aware of exclusive breast feeding, usage of ORS

contraceptives methods and nearest Government Health facilities.

c. First breast feeding within half an hour of delivery was given by 16(80%) Mothers. 12

Mothers (60%) had knowledge on ARI and contraceptive side effects were known to

12 (60%) mothers.

d. 18 (90%) Mothers had their delivery in institutions and 2 (10%) were in their homes.

e. The team has evaluated the work of 3 MPHWs Male in the visited HSCs. All the three

have achieved the target of collection of blood slides, sterilization and CC cases. They

were regularly doing chlorination programme with the help of Village Health and

Sanitation Committees. They need to concentrate more on motivating men for NSV.

9. Maintenance of Records and Registers:

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a. Register maintenance found satisfactory in the centers visited. Consolidated service

register for IUD maintained in all the centers visited by the team.

b. Register of EC, ANC, PNC, Immunization, Untied funds and other activities were

maintained in all the centers visited by the team.

c. Figures for OP, CC and IUD were not made available by the district office for

verification.

*********

4. District Nasik:

Major Observations of Regional Evaluation Team, Chennai about evaluation

work carried out in Nasik district of Maharastra State in April 2011.

I Details of the visited Institutions:

Districts

Visited

DH / CH / SDH /RH / PHCs and

PVT Hospitals visited

HSCs Visited

Nasik Civil Hospital: Nasik,

RHs: Trimbak and Igatpuri

PHCs: Wavi, Mohadi, Geopur and

Amboli

Korati, Ambe Dindori, Datalai

and Anjaneri

II. Major Observations:

1. Health Human Resources:

a. The staff position of the district is satisfactory except very few posts lying vacant

especially in catergory of Medical Officer, GNM and Male Health Workers. 118 MO

posts were filled up against 128 posts sanctioned and 322 MPW (Male) posts were

filled up against 357 sanctioned posts in the district.

b. In addition to above, 454 posts of ANMs, 56 posts of LHVs & 44 posts of Specialists

were filled in the district on contract basis.

2. Services of Janani Surakha Yojna (JSY):

a. JSY amount of Rs.344.56 lakhs was received during 2009-10 and 2010-11 in the

district and incurred an expenditure to the tune of Rs. 335.49 Lakhs during the period.

b. There were 17,325 JSY eligible beneficiaries during 2009-10 and 2010-11 out of

which 14,147 mothers received the JSY incentive.

c. JSY performance of the visited centers are given below for 2009-10 and 2010-11

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S.No Name of the

centers

2009-2010 2010-2011

1 RH Igatpuri 39 58

2 RH Triambakeswar 223 234

3 PHC Wavi 153 146

4 PHC Mohali 264 220

d. The team contacted 9 JSY Mothers who have received the JSY amount. All have

received the amount as per rules and mostly Mothers delivered in Govt. Institutions.

3. Untied Funds:

a. The District received untied funds of Rs. 103.45 lakhs during 2009-10 and Rs. 102.7

lakhs during 2010-11. The expenditure was Rs. 94.13 lakhs during 2009-10 and Rs.

73.02 lakhs during 2010-11.

b. There was full utilization of the untied fund and the AMG fund in the visited RHs and

PHCs. RH, Triambak received funds @Rs.50, 000 annually during 2008-09, 2009-10,

& 10-11 and has a closing balance of Rs. 111 on the day of visit. PHC Wavi received

Rs. 25000 as untied fund and Rs. 25000 as AMG every year and spent the entire

amount. PHC Mohadi received a total of Rs. 50 000 as untied funds for the past two

years i.e. 2009-2010 & 2010-2011 and spent the funds.

4. Rogi Kalyan Samithi (RKS) and village Health & Sanitation Communities (VHSCs):

a. There are totally 133 RKS registered in the district. RKS meetings were being

conducted regularly in all the centers visited with due participation of local body

members.

b. RKS were allotted Rs. 141 lakhs during 2010-11 out of which 97 lakhs were spent up

to Feb 2011.

c. In Nashik district, out of 1931 revenue villages, VHSCs formed in 1922 villages. The

functioning of the VHSCs was found satisfactory in the area visited by the team.

Accounts and vouchers were kept properly in all the committees evaluated by the

team.

5. Services of ASHA:

372

a. In the district, totally 3532 ASHAs were selected. Out of them 3495 received 7 days

induction training, 3303 received training on II module, 2070 in III module, 1313

ASHAs trained in IV module and 1276 ASHAs received training in all the modules.

b. Out of 3532 ASHAs, 2787 were provided with the drug kit and issue of the drug kit for

remaining ASHAs were under process.

6. 24 Hours Delivery Care System:

a. In the district, 64 (IPHS) centers were functioning for 24 hours deliveries Services. All

the visited PHCs were well equipped with modern facilities. The maintenance of PHCs

was found good in all respects.

b. The details of the deliveries conducted by the visited centers during 2009-10 and

2010-11 are as follows.

S.No Name of center Deliveries conducted

in 2009-2010

Deliveries conducted

in 2010-2011

1 RH Igatpuri 140 174

2 RH Triambakeswar 449 437

3 PHC Wavi - 78

4 PHC Mohali 213 224

7. Physical Infrastructures and Stock Position:

i) RH /CHC

a. In RH Trigambak, the facilities were very limited. There was no water supply and

maintenance of beds needs improvement.

b. There was no blood storage unit.

c. There were 3 residential quarters for Medical Officers and 12 for Para medics.

d. In RH Igatpuri the facilities were good and maintained as per IPHS standards. 4

Specialists were hired on contract basis and other facilities were satisfactory except

residential quarters for MOs and paramedical staffs.

ii) PHC

a. All the PHCs visited viz; PHC Wavi, PHC Mohadi, PHC Gopore and PHC Amboli have

maintained the premises clean and tidy with seating arrangements for patients and

necessary equipments.

b. PHC Modadi is a Tribal PHC and has all the facilities and equipments except the stock

of Oral Pills during the visit of the team.

373

c. There was shortage of IFA items for the past 6 months and no stock of oral pills was

available in PHC Mohadi.

iii) HSC

a. The team has visited the HSCs at Ambe Dindori, Datalai Anjaneri and Korate, all the 4

ANMs were staying at the HQs and have conducted good number of deliveries.

b. Oxytoxin Injection was not available in one HSC and Cap Ampicillin was not available

in 2 HSCs. IEC materials were not available in one center.

c. All the HSC building maintained properly for clinic purpose. Facilities of conducting

delivery and cleanliness were found good. All the HSCs have conducted VHNDs

regularly.

d. RDT kit for malaria was not available at any visited centre.

8. Knowledge and Opinion of Community on Health Services:

a. The team contacted 18 mothers having child up to one year old to know about the

work of ANMs and their knowledge on various Health Services. All the contacted

mothers informed that ANMs were available when needed.

b. Breast feeding within half an hour of the delivery was initiated by 15 (83%) mothers.

10 mothers (56%) had knowledge on ARI and contraceptive side effects.

c. The community was satisfied with work of Staff of the PHCs and FRUs visited. The

team has also evaluated the work of 2 Health Workers. They motivated some cases

of NSV, collected blood smear for malaria suspected cases and also follow up done

for TB cases. They helped the School health programme, chlorination and conducting

the VHNDs.

9. Maintenance of Records and Registers:

a. Sterilization and IUD registers were maintained in all the visited PHCs & GHs.

b. Service Register for spacing methods of Family Planning was maintained properly in

the HSCs visited by the team.

10. Other Observations and Suggestions:-

a. Total number of USG in the government sector is only 6 in the district. The district is

having more than 50 lakh population with 26 RH & SDHs and 103 PHCs, this facility of

USGs should make available in all RHs and SDHs. There was also only one trauma

care center in the district. The district is more prone to accidents due to pilgrimage

center and commercial vehicles in the National Highway.

b. The team felt that 108 ambulance facility may be implemented in order to increase

institutional deliveries. The maintenance of Ayurvedic Garden at RH Igatpuri is

appreciable.

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c. The wards at RH Tiambakeswar need improvement. Residential quarters to the MOs

and paramedics in the RHs were lacking.

d. Out of 577 HSCs, 97 did not have Govt. building. The district is covering vast area

with more than 50 lakhs population. It is desirable to have more PHCs in the district.

e. Though there are Ayurveda and Unani Clinics, very few AYUSH medicines were

available.

f. District authorities did not provide institution-wise figures of IUD, OP and Nirodh for

further verification of the reporting system in the district.

*******

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5. District Kolhapur:

Major observations of Regional Evaluation Team, Chennai about evolution work

carried out in Kolhapur District of Maharastra State in June 2011.

I Details of the visited Institutions:

Districts

Visited

PHC /CHC/GH Visited HSCs Visited

Kolhapur SDHs: Gadhinglaj and Kodali

PHCs: Kasaba Sangaon and

Jayasinghpur

PNDT Centre, Dr. Patki Hospital

Buva Chiwathak and

Belewadimasa

II. Major Observations:

1. Human Resources:

a. The staff position of the district was satisfactory as reported: The details of human

resources under the DHO in some of key categories are given below.

S.No Categories of Human resources Sanctioned Vacant

1 ANMs/ JPHNs 505 20

2 HEALTH SUPERVISOR (M) 115 3

3 MEDICAL OFFICER 166 11

2. Services of Janani Surakha Yojna (JSY):

a. The JSY states and fund received and spent for the year 2009-10 and 2010-11 in the

district are as follows

Sl

No

Particulars 2009-10 2010-11

1 No. of JSY eligible beneficiaries 7613 7891

2 No. of mothers received JSY assistance 7613 7891

3 JSY amount received in the district (Rs in

lakhs )

71.47 74.68

4 JSY expenditure in the district (Rs in lakhs) 61.64 74.57

b. The JSY performance in the visited centers is as follows.

376

Sl.no Name of the center No. of JSY Beneficiaries

2009-10 2010-11

1 PHC Kasabasangaon 125 158

2 SDH Gandhinglaj 144 130

3 PHC Jayasinghpur 76 70

4 SDH Kodali 39 68

In all the visited centers, no pending cash for cash assistance to the JSY beneficiaries

was observed.

3. Untied Funds:

a. The district had received Untied Fund to the tune of Rs. 2373.16 lakhs under NRHM

during 2009-10 out of which 2265.84 (93.42%) were spent. The district spent more than

allotted fund in the year 2010-11. Out of Rs. 3149.87 lakhs received in the year 2010-11,

Rs. 3151.70 lakhs (99.72%) were spent.

b. In the visited centers, the funds were utilized as per guidelines. In the HSC level, joint

bank account in the name of village leader and the ANM was maintained for the

utilization of untied funds.

4. Rogi Kalyan Samiti (RKS) and Village Health Sanitation Committees (VHSCs):

a. There were totally 92 RKS formed in the district and all are reported to have been

functioning with the co operation of the MOs and public leaders.

b. 1206 VHSCs were formed in the district. In the VHSCs, ASHAs is committee members.

The VHSCs accounts are jointly maintained by the Anganwadi workers and the village

leaders for handling the funds. VHSCs were receiving funds regularly for their

functioning.

5. Functioning ASHA of Scheme:

a. In the district, totally 2773 ASHAs were selected and out of them 2458 were given drug kit

during 2010-11. In the visited centers ASHAs were given only 3 modules of training.

6. 24 Hours Delivery Care Services:

a. In the district, in additions to the 28 SDHs & RHs, there were 44 PHCs functioning under

24x7 hours services. The number of PHCs conducting deliveries was only 36 during

2009-10. Besides, some HSCs also were up graded as per IPHS standards and delivery

services are conducted round the clock.

377

b. During visit to the centers, PHC Kasabasangaon was observed to the conducted only 25

deliveries in 2009-10 Similarly HSC Belwadimasa conducted only 23 deliveries in 2009-

10 and 19 deliveries in 2010-11, HSC Bumchivethian conducted only 10 deliveries in

2009-10 and 12 deliveries in 2010-11.

7. Physical Infrastructures & Stock Position:

i) SDH

SDH Gandhingilaj is a 100 bedded hospital well maintained with all facilities except

residential quarters for MO & Staff. SDH Kodali is also a well maintained hospital with 50

beds. Facility of blood storage required in this hospitals. Both the SDHs were maintained

as per IPHS and contractual services provided for security, driver, electricity, cleaning and

laundry. Both SDHs have improved the services of OPD, IPD, delivery, JSY and female

sterilization in the recent years after introduction of NRHM.

ii) PHC

a. PHC Kasabasangaon is a 27 year old building renovated with floor tiles and maintained

as per IPHS standards. Stock of oral pills and EC Pills was not available in the PHC.

AYUSH wing was also not available in the PHC.

b. In PHC Jayasingnapur, AYUSH Medical Officer not posted. Facilities were available

mostly available.

c. Both the PHCs visited had necessary equipments and medicines and wards were

maintained clean.

iii) HSC

a. In both the HSCs visited at Belewadimasa and Buvachiwathak, the facilities were

excellent in all respects except lack of very few items. In HSC Belewadimasa, facilities of

Stove, DDK, Kerosene, Rapid Diagnostic kit for Malaria, kits A & B and Sanitary napkins

were not available.

b. Mobile phones were not provided to ANMs. However, a specified amount / recharge

mobile coupons are provided so that they can use their own mobiles in this regard. EC

posters and vital statistics were exhibited in the centres.

c. ANMs contacted did not get training on SBA and training in Integrated Management of

Neonatal and Child Infections (IMNCI).

8. Knowledge and Opinion of Community About Health Services:

a. The community belongs to the area of the visited SDHs, PHCs and HSCs expressed

satisfaction on the functioning of the centers and services of the staff. The local body

leaders actively involved in the functioning of the centers visited. In Bhuvachithak HSC,

the public had renovated the HSC building and provided a laptop to the ANM.

378

b. In the district the team has evaluated the work of two Male MPHWs. It was observed that

they have motivated cases of female sterilization, IUD, OP and Nirodh. They also actively

collected blood smears, participated in chlorination work and provided follow up services

by the workers. T.B cases. In the area, School Health Programme and VHND, activities

were also done.

c. The team has selected and contacted 12 mothers to know about the work of ANMs and

their knowledge on various health activities Health awareness among the contacted

mothers was good relating to institutional delivery, breast feeding practices, JSY, ORS

and schedule of immunization. All the contacted mothers informed that ANMs visits their

villages regularly.

d. 3 PNC check up, contraceptive awareness & ARI awareness were more or less

satisfactory among the contacted mothers.

9. Other Observations:

a. It was observed that some innovative steps have been taken in the district to control the

adverse sex ratio viz.,

a) A software has been developed by Dr. Patki Scan Centre, Kolhapur which can be

attached with the USG can records. This can be connected online to the district office

so that the district office can monitor the activities of PNDT centers.

b) Collecting the bi-weekly male female birth details from the PHCs and HSCs after

delivery.

c) Exhibit male / female birth details in the district, PHCs, HSCs and FRUs and

monitoring the same regularly.

d) The district has filed cases against 2 PNDT centers who violated the rules.

b. Innovative schemes to encourage breast feeding viz.,

a) Educate the mothers through ASHAs and Anganwadi workers regarding the benefits

of exclusive breastfeeding

b) A separate private room for breast feeding mother in all PHCs and HSCs.

c. The following innovative scheme inducted for female Child, mother

a) Incentives for 1st and 2nd female children from 1st October 2010 (Rs. 8000/- for one

female child and Rs. 10000/- for 1st and 2nd female child together

b) Free diet for all PNC mothers in IPD.

c) Free transport service for referring complicated cases.

d. In the district, there were only 5 USGs in the government sector. If more USGs can be

installed in the government facilities, the poor mothers will be benefited and private

PNDT centers can be controlled.

379

e. The district has done only few cases of NSV. There is scope for doing more male

sterilization cases.

**********

6. District Nagpur:

Major observations of Regional Evaluation Team, Chennai about evolution work

carried out in Nagpur District of Maharastra State in August 2011.

I Details of the visited Institutions:

Districts

Visited

PHC /CHC/GH Visited HSCs Visited

Nagpur Daga Women and Children

Hospital,

RH: Kadmeshwar, Bhivapur,

PHC: Makardokda,

Kacharislawanga,

Lata Mangeshkar hospital

Fetri, Navegaon, Dawa, and

Gharatwada

II. Major Observations:

1. Human Resources:

a. The staff position of the district was satisfactory except in the category of Male Health

Assistant, LHV and Staff Nurses. Details of staff sanctioned and in position in key

categories are given below.

Sl. No Categories of Human resources Sanctioned Vacant

1 ANMs/JPHNs 453 18

2 MPW(M) 224 36

3 LHV /HS (F) 50 11

4 HEALTH SUPERVISOR (M) 79 12

b. In the visited RH Bhivapur, there were only 3 MOs, out of them 2 MOs including a

Gynecologist were appointed on contract basis. The posts of specialists were not

sanctioned in this hospital. All the 7 GNM posts sanctioned were filled up. In addition to the

post of lab Assistant, one more Lab Technician was appointed on contract basis. In PHC

Katcharislawanga, in addition to 7 ANMs, there were 9 additional ANMs posted under

380

NRHM. Out of 10 Male Health Assistants sanctioned 7 were filled up. Out of 2 posts of

MO one was filled up. There was no permanent Lab Technician and only a contractual Lab

Assistant was available.

c. In PHC Makardhokda, all the sanctioned posts were filled up.

d. In the Daga Memorial Women and Children Hospital, Nagpur, there are 5 DGOs and 2

Anaesthetists and one specialist each in Pediatrics, ophthalmology, ENT and Dental.

There were 82 staff nurses in position out of 85 posts sanctioned.

2. Services of Janani Surakha Yojna (JSY):

a. In 2010-11, out of 13589 eligible mothers, only 8900 were paid JSY benefits and during

the current year out of 11155 JSY mothers only 6721 were paid incentives. Moreover in

the current year, there was no sufficient amount for payment to JSY mother in the district.

The details of JSY beneficiaries, JSY amount received and spent for the year 2010-11

and 2011-12 are as follows:

*an

excess amount of Rs. 12.71 lakhs was made in 2011-12.

b. In the visited centres, the beneficiaries were mostly provided with cash assistance except

some pending cases in PHC Makardhokda and HSC Fetri during 2009-10 and 2010-11.

3. Untied Funds:

a. The district had received Untied Funds to the tune of Rs. 56.61 lakhs in the year 2010-11

and 65.1 lakhs in 2011-12. Out of which Rs. 53.4 lakhs and 62.43 lakhs were spent during

respective periods.

b. It was reported that Untied Fund was distributed during 2009-10 and 2010-11 to all the

centres; In 2011-12, till the time of visit, 50 percent of untied funds were given to the

centers as first installment.

c. Untied fund was utilized in all the visited centers.

SlNo particulars 2010-11 2011-12

1 No. of JSY eligible beneficiaries 13589 11155

2 No. of mothers received JSY 8900 6721

3 No. of JSY pending cases 4689 4434

4 JSY amount received (Rs in Lakhs) 75.59 49.63

5 Expenditure under JSY (Rs in Lakhs) 66.34 62.34

381

4. Rogi Kalyan Samiti (RKS):

There were totally 62 RKS formed in the district and all are reported to have been

functioning regularly with the co-operation of the MOs and public leaders.

5. Functioning of ASHA and Village Health Sanitation Committees (VHSCs):

a. In the district, totally 1687 ASHAs were selected and all were given 3 modules of training.

Drug kit was supplied to 1569 ASHAs. ASHA is included as a member in the VHSCs.

b. The numbers of ASHAs selected in the visited centers are as follows.

Sl.No Name of the Centers No. of ASHAs selected

1 RH Bhivapur 27

2 PHC Kacharislavanga 33

3 RH Kadameshwar NIL

4 DAGA Women Hospital NIL

5 PHC Makardhokda 29

C. In the district, 1557 VHSCs were setup. VHSC accounts are jointly operated by the ANM

and Sarpanch of the village. The VHSCs were functioning regularly with the help of village

leaders and Anganwadi workers. The Funds are received regularly by the VHSCs for

carrying out their mandated work in the villages.

6. 24 Hours Delivery Care Services:

a. In the district, 29 PHCs and 16 RHs/SDHs were functioning 24 hours for conducting

deliveries. In the DAGA, W&C hospital, Nagpur the facilities are good and more than

11000 deliveries were being conducted per year. Funds are not received by this hospital

regularly from the corporation.

b. In RH Bhivapur, facilities were not sufficient to provide 24 hour service for conducting

deliveries. It is a 30 bedded hospital with no facilities of blood storage, boyles apparatus,

residential quarters for MOs and paramedics. There was shortage of medicines in the

hospital.

c. The PHCs visited were also conducting deliveries round the clock. RC roof of both the

visited PHCs was leaking.

7. Physical Infrastructure and Stock Position:

Nagpur is a big district with about 53 lakh population, but it has only limited health

infrastructure. The urban area is covered by the corporation commissioner and the rural

population has District Health Officer. In the district, there are 49 PHCs, out of which 5 did

not have any building. The number of PHCs available is very less compared to the vast

382

area and population of the district. The number of PNDT centers in the government sector

are only 5 out of the total of 290 in the district. Similarly, AYUSH units are only 7 and no

trauma care center available in the government sector. Computer and internet facilities are

provided to all the centers in last year. ANC and Child tracking system just started in the

district.

i) DAGA, W & C hospital, Nagpur

Since there are 2 Medical Colleges in Nagpur, there is no separate district hospital. The

DAGA Women and Children Hospital, Nagpur having 335 beds which is mainly providing

facilities for conducting deliveries. The hospital is conducting on an average of 11000

deliveries per year. Maintenance, equipments, facilities and patient care are good in all

respects. There are 13 specialists available out of 21 posts sanctioned.

ii) RHs

RH Bhivapur has no of blood storage and Boyles apparatus. Residential quarters were

not available. RH Kadmeshwar has all the facilities except residential quarter, blood

storage & USG.

iii) PHCs

a. In PHC Makhardhokda, the building was constructed in 1971, its ceiling was leaking.

Some portion of the building needed urgent renovation; still the PHC was maintained

nicely with floor tiles and proper white washing of walls. Bed maintenance needs some

improvement in this hospital. Stock of only few AYUSH medicine was available. Oral pills

and Nirodh packets were not available in the hospital for about 6 months.

b. PHC Kacharislavanga was functioning in a 45 year old building which was fully leaking and

need proper renovation immediately. There was a short stock of IFA syrup observed in the

centre.

iv) HSCs:

a. All the four visited HSCs at Gharathwada, Naveagaonsada, Dawa and Fetri have Govt.

buildings and necessary equipments for functioning. However, DDK, FST, ECP, Bleaching

powder, Oxytocin, Ampicillin, Gentamycine Inj. and Kits A & B were not available.

b. Register maintenance found satisfactory in all the HSCs visited. All the HSCs maintained

properly for clinic purpose and cleanliness maintained.

c. VHSC meetings are conducted regularly in the visited HSC areas and VHNDs are

celebrated regularly in the villages.

8. Knowledge and Opinion of Community about Health Services:

a) Services of RH & PHC

383

Public contacted in the visited centers expressed satisfaction towards the services of the

RHs, PHCs and staff in general. Some of the local leaders of the area expressed the

opinion of improving the building and infrastructure of the centres.

b) Services of MPW (male)

The team has interviewed some of the villages to assess the work of 4 Male Health

Assistants at, HSCs Dawa, Naveagaonsada, Fetri and Gharathwada. MPW at

Gharathwada who was working for 12 years did not maintain any register, not staying at

the HQs and his contribution to FW was not up to the mark.

c) Services of ANM

a. The team selected and contacted 20 mothers having child up to one year age to in the

area of visited centres to know about the work of ANMs and their knowledge on various

health services. All the contacted mothers informed that ANM was available when needed.

b. Mothers were aware of exclusive breastfeeding, ORS and knowledge about the child

immunization schedule 18 (90%) babies were weighed immediately after delivery.

c. ARI awareness found only in 8 (40%) mothers. Contraceptives used by 16 (80%) mothers

and side effects of contraceptives were known only to 10 (50%) mothers.

9. Sample Verification of FW Acceptors:

a. The team selected 75 FW cases out of which 62 (82.7%) acceptors could be contacted for

sample verification. Discrepancy was noticed in a few cases in the age of acceptors, age

of spouse and in the number of total and male children.

b. Out of 62 contacted cases, 59(95.2%) were given follow up services by the field staff.

Compensation money was paid to all sterilization cases.

c. Stock of Oral Pills and CC found insufficient in most of the centers visited. In PHC

Makardhokda, stock of only few AYUSH medicines was available.

**********

384

7. District Pune:

Major Observations of Regional Evaluation Team, Chennai on evaluation work carried

out in Pune district of Maharastra State in the month of Sept., 2011.

I. Details of the visited Institutions:

Districts

Visited

PH / PHCs and Pvt. Hosp. Visited HSCs Visited

Pune

RH: Manchar

PHCs: Khadkala, Peth and Kunjirwadi

PNDT, Centre, Pranchal Hospital, Manchar

Goyatri, Kunjirwadi and Thevur

II. Major Observations:

1. Health Human Resources:

As reported by the district office, 37 Specialists, 203 MOs, 639 ANMs, 96 MPW Male, 110

Staff Nurses, 96 Lab Assistants and 96 Male Health Supervisors are in position in the

district and there is no vacancy available in the district. But during visit to the centres, the

team found some vacancies in the centres. In PHC Khadkala, out of 5 class IV employees

4 were filled up. In addition to 4 ANMs sanctioned, 2 more ANMs were working in the PHC

on contact basis under NRHM. In PHC Peth, 2 of the 5 MPW (M) sanctioned and 3 of the

5 peons sanctioned were filled up. In PHC Kunjirwadi, out of sanctioned 3 posts of Staff

Nurse only 1 was filled up. 3 cleaning staff ware filled up out of sanctioned 4 Posts. All the

4 visited HSCs have additional ANMs posted.

2. Services of Janani Surakha Yojna (JSY):

d) JSY scheme is functioning in the district. During 2010-11, there were 3078 JSY

beneficiaries in the district and an amount of Rs 26.93 lakhs was spent under JSY, out of

available funds of Rs 101.91 lakhs.

e) As reported, JSY Performance in the visited centers is as follows.

S.No Name of the centers No of JSY beneficiaries

during 2009-10

No of JSY beneficiaries

during 2010-11

1 PHC Khadkala 157 153

2 RH Manchar Not made available 26

3 PHC Peth 42 44

4 PHC Kunjirwadi 86 95

385

3. Rogi Kalyan Samiti (RKS) and Village Health Sanitation and Nutrition Committees

(VHSNCs):

a) No details about formation of RKS in Rural Hospitals (RHs) and Sub Divisional Hospitals

(SDHs) were made available by the Office of District Civil Surgeon (DCS) as these

institutes are directly controlled by the office of DCS. However, 96 RKS were reported to

have been formed.

b) All the PHCs are functioning under the administrative control of District Health Officer in

the district. It was also reported that RKS meetings were conducted at PHC level as and

when required.

c) Details of the VHSNCs (whole of the district) were not made available to the team from the

district office. However, VHSNCs in the visited centers are given below.

S.No Name of the center No of VHSNCs formed

1 PHC Khadkala 37

2 RH Manchar Nil

3 PHC Peth 8

4 PHC Kunjirwadi 8

d) The details of VHSC funds and functioning were not made available to the team at the

PHCs visited. However, it was observed that Joint Bank Account in the names of ANM and

village leader was opened for handling the funds.

4. Services of ASHA:

As reported, 3293 ASHAs were in position in the district. The team reported that budget

provision status of ASHA training, availability of Drug kits to ASHAs and Service activities

undertaken by the ASHAs were not made available by the district office. No. of ASHAs

selected in the visited centers are given below.

S.No Name of the centers No of ASHAs selected

1 PHC Khadkala 40

2 RH Manchar Nil

3 PHC Peth 23

4 PHC Kunjirwadi 24

386

5. 24 Hours Delivery Care System:

It was informed that out of 96 PHCs in the district, 54 PHCs were functioning for 24

hours delivery care services in addition to 24 RHs and 12 SDHs in the district. All the

visited centers were conducting deliveries and having required facilities for the purpose.

6. Physical Infrastructures and Stock Position:

i) RH:

Manachar, is a 30 bedded hospital proposed to be upgraded as per IPHS. There is no

blood storage unit, separate new born care unit, residential quarters for MO and

paramedics. The beds need improvement in the hospital.

ii) PHCs:

a) In PHC Peth, the RC roof of the building was leaking and there was no provision for round

the clock services since the MO was not staying at the HQ. More over AYUSH wing was

not available in PHC.

b) In PHC Kunjirwadi all the facilities are available except post of AYUSH MO. The

maintenance of ward in Khadkala PHC needs improvement.

iii) HSC

a) The team visited the HSCs at Goyatri, Thevur and Kunjirwadi. In HSC Goyatri, Steam

Sterilizer, Rapid Diagnostic Kit for Malaria, DDK, Kerosene/ Gas, ECP, Oxytocin,

Ampicilline and Gentamycin Injection were not available. Deliveries were not taking place

in these HSCs.

b) In HSC Thevur, RDT kit, Stove, ORS, DDK, Kerosene, Cotrimoxazole, Sanitary Napkins,

Bleaching powder, Oxytoxin, Ampicilline Cab, Gentamycin Ink and Kits A & B were not

available. In HSC Kunjirwadi RDT kit, DDK, Bleaching powder and Gentamycin Injection

were not available.

7. Opinion of Community on the Health Services:

v) PHC Services

The contacted public in the area of PHC Peth opined that the regular stay of MO at PHC

HQ can improve services. The public in other PHCs area had expressed satisfaction

towards the services of the MOs and Staff.

vi) MPW Male Services

387

As observed by the team, the work of Male Workers in HSC Kunjirwadi and HSC Goyatri

in respect of FW, Malaria and Chlorination etc was satisfactory.

vii) ANMs Services.

d) 16 mothers having child up to one year of age were contacted to assess their knowledge

and opinion on various health activities rendered by the ANMs. As informed, ANMs were

available when needed. ANMs visited the HSC for ANC/PNC/VHND; they had institutional

deliveries and they were aware of exclusive breast feeding, ORS, Contraceptives and

have their children immunized.

e) 4 (25%) mothers told that their babies were not weighed immediately after delivery. ANC

check up was given only to 13 (81.3%) mothers and 7 (43.8%) mothers were aware about

danger sign of ARI. Possible Side effects of contraceptives were known to 5 (31.3%)

mothers.

8. Sample verification of FW Acceptors:

b) The team selected 73 FW cases out of which 58 (79.5%) could be contacted, minor

discrepancy was noticed in the number of male children.

c) All the 58 contacted FW acceptors were given follow up services by the field staff.

Compensation money was paid to all contacted sterilization.

9. Maintenance of Records and Registers:

i) In HSC Goyatri of PHC Khadkala, the registers for Immunization, OP and Nirodh were not

maintained for the past 2 years and also no monthly reports were available in the HSC. In

RH Manchar, the IUD register was maintained but it was not in printed form. Register

maintenance and regular supervision need improvement.

ii) In HSC Thevur, IEC posters were not available in sufficient number and no supervision

from district and PHC was done.

iii) All visited HSCs buildings were maintained properly for clinic purpose and VHNDs were

also conducted there regularly.

10. Other Observations:

a) Even after advance intimation of more than a month the required details were not provided

to the team by the district office. The team could not get the details in respect of JSY,

availability and utilization of various funds under NRHM, RKS, performance of institutional

388

deliveries, meetings of DHS etc. as the information was stated to be not readily available

in the district office.

b) Detail status of MCTS, and IT infrastructure were also not provided in the district.

c) There was no proper supervision from state to the district and from district to peripheral

centers.

d) HSC level details of Untied Fund, AMG and VHSC funds were not available in the PHCs

visited.

e) The contribution of the government sector for the deliveries was too meager. There were

totally 749 government institutions (12 SDHs, 24 RHs, 96 PHCs 78 Municipal Corporation

Centers and 539 HSCs) in the government sector. But the percentages of government

sector deliveries are 21.1 % in 2010-11 and only 20.8% (in 2011-12 up to August 11). Out

of total 63026 deliveries in 2010-11 only 13317 deliveries conducted by the government

health centers and during the current year out of 23604 deliveries only 4928 delivery were

conducted by government health centers.

**********

389

Manipur

1.District:- Chandel

Major observations of Regional Evaluation Team, Kolkata on the Evaluation work

carried out in Chandel district of Manipur during the month of August, 2011.

I. Details of the visited Institutions:

District visited D.H., CHC and PHCs visited SCs visited

Chandel DH: Chandel

CHC: More

PHCs: Chakpikarong, Tengnoupal and More

Aimol Thampak, Komla

Thambi, Unopat and

Saivom

II. Major Observations:

1. Health Human Resources:

a. No sanctioned strength of the staff was available at district office. At district headquarter

no one was aware about the sanctioned strength of staff in the district.

b. Acute shortage of Specialists and Medical officers was observed in the visited institutions.

5 posts of Specialist, 4 posts of MO and 4 posts of GNM/Staff Nurse were lying vacant at

District Hospital. 3 posts of Specialist, 13 posts of MO, 15 posts of GNM/Staff Nurse were

vacant in the Centres of CHC Moreh.

c. The PHC Chakpikarong was functioning with single AYUSH, MO.

d. Under District Programme Management Unit (DPMU), one post each of District

Programme Manager, District Data Manager, Block Account Manager, Block Data

Manager and 2 posts of Block Programme Manager were lying vacant since long in the

district.

2. Functioning of Rogi Kalyan Samiti (RKS):

It was reported that RKS has been constituted and registered in the visited CHC and

PHCs in the district, but the meetings of RKS were not being held regularly.

3. Functioning of ASHA and Village Health Sanitation & Nutrition Committee (VHSNCs):

a. As targeted, 550 ASHAs have been selected in the district and provided training up to 6th

module. 550 ASHAs had been provided drug kits during 2010-11 but no drug kit has been

provided to them during the year 2011-12 till the visiting month.

b. As reported 542 VHSNCs were functioning in the district and all are having ASHA as a

member of the committee.

c. Untied funds for VHSNC to the tune of Rs. 67,00,399 including opening balance of Rs.

35,00,399 were available for the year 2010-11 and out of that the amount of Rs. 39,76,150

390

was utilized by the VHSNCs within the period in the district. Opening balance amounting to

Rs. 27,24,249 available in the year 2011-12 was lying unspent till the time visit of the

team in the district and no VHSNC Untied fund was provided to the district during current

year 2011-12.

4. Services of Janani Suraksha Yojana (JSY):

a. Rs. 12,65,800 was spent in the district under the scheme out of an amount of Rs.

13,36,600 available during the year. No fund was released to the district during current

year 2011-12 up to the date of visit.

b. It was reported that, 1986 and 312 deliveries were identified for JSY payment under the

scheme in the year 2010-11 and 2011-12, out of that 1876 and 151 JSY beneficiaries were

paid with JSY incentive during last year and current year respectively.

c. C - Section delivery facility was not available in the district as a whole. During visit to the

centres, it was observed that sufficient funds were not provided in time to the visited

facilities. Registers for JSY were maintained properly containing the list of beneficiaries to

whom cash had been distributed and registers were checked properly by concerned

Medical officer In charge.

d. 36 JSY beneficiaries contacted for on the spot verification in the district and it was

observed that MCH cards were issued to all of them. Three consecutive ANC checkups

was not given to all the beneficiaries. Beneficiaries were not getting incentive amount on

the date of discharge due to delay in submitting the cards along with necessary papers to

the office of the hospital.

5. 24 hours delivery care services:

a. 24 hours delivery care system implemented in 4 institutions i.e. in District Hospital, 1 CHC

and 2 PHCs in the district.

b. Facility for caring mothers and new born care were found inadequate at most of the visited

centres. Blood storage facility was not available at CHC and PHCs visited. Required

number of para-medical staff for conducting 24x7 delivery was also not there at the visited

facilities.

6. Untied Funds:

a. Every CHC, PHC and Sub Centre was being provided funds @ Rs. 50,000, Rs. 25,000

and Rs. 10,000 per year respectively as Untied funds in the district. The position of

Untied funds for the year 2010-11 is given below:

391

(In Rs.)

Sr.

No.

Particulars Opening

Balance

Fund

Received

Expenditure Balance

1 For CHCs Nil 50,000 Nil 50,000

2 For PHCs 2,22,040 75,000 2,71,540 25,500

3 For Sub Centres 25,47,495 3,60,000 3,35,747 25,71,748

b. Untied Fund released to the visited PHCs/CHC and utilized by them in the year 2010-

11 in the district are given below:

(in Rupees)

Name of Institutions Opening

Balance

Released Expenditure Balance

CHC Moreh Nil 50,000 Nil 50,000

PHC Chakpikarong 25,000 25,000 50,000 Nil

PHC Moreh Nil Fund not provided

PHC Tengnoupal Record not made available

c. No untied fund has been provided to the district for the year 2011-12.

d. It was observed that fund was utilized for purchase of Generator, printer, Laboratory items,

gas box, stationary and expenditure on Photocopy etc. by the visited PHCs.

7. Physical infrastructure (HSC/PHC/RH)

(i) Health Sub Centres:

a. The Sub centres visited at Aimol Thampak, Komla Thambi, Unopat and Saivom were not

as per IPHS. Labour room facility was available only at Sub Centres Unopat and Saivom.

Electricity supply was irregular. No mobile phone has been provided to the ANMs.

b. Ambu bag/suction, Steam sterilizer, RDT kits, Heamoglobinometer, DDKs, Santary

Napkins, Oxitocine tablets, Kits- A & B and Gentamycin injection were not available at all

the visited centres.

c. Delivery table, Mclntosh sheet and CuT insertion kit were not available at the Sub Centres

Unopat and Saivom.

d. ORS packets, Co-trimoxazole tablets, EC Pills and Condoms were not available at Sub

Centres Aimol Thampak, Unopat and Saivom.

e. Vitamin- A solution and Oral Pills at Sub Centre Aimol Thampak, Delivery kit and

Chloroquine tablets at Sub Centre Komla Thambi, CuT and Chloroquine tablets at Sub

Centre Unopat and Delivery kit, Vitamin- A solution, Oral Pills and Chloroquine tablets at

Sub Centre Saivom were not available on the day of visit.

(ii) PHCs/CHC/DH:

392

a. District Hospital at Chandel, CHC at Moreh and PHCs at Chakpikarong, Tengnoupal and

Moreh were visited by the team in the district. New building for DH was under construction.

Electricity supply in these institutions was irregular. Labour room was not functional at

PHCs Tengnoupal and Moreh.

b. Blood storage unit, Sick New born Care Unit and Anesthesia equipment were not

available at District Hospital Chandel and CHC at Moreh.

c. Ambulance, Auto clave and Operation Theatre at District Hospital Chandel and X-ray

facility, Resuscitation equipment, Neonatal Resuscitation equipment and CuT insertion kit

at CHC Moreh were not available.

d. The building of PHC Tengnoupal was in bad condition, entire roof and wall of the building

was damaged. Rest of the building was leaking during rain. There was no safe OPD room,

ward, labour room, office room, store room, dressing room etc. as a result records,

registers, medicine and the equipments were getting damaged.

e. Functional Operation Theatre was lacking in the visited PHCs. There was also no

Ambulance/ Jeep in these PHCs.

f. Telephone facility was not provided to PHCs Chakpikarong and Tengnoupal. Cold chain

equipments at PHCs Chakpikarong and Moreh were not available. Oxygen cylinder was

not available at PHC Tengnoupal.

g. PHC Moreh had a very nice labour room, but deliveries were not conducted there for want

of equipments/ instruments. Presently labour room was used for store.

8. Opinion and awareness of the Community on the Health Services:

(i). ANMs Services:

a. 20 mothers having child up to one year age were interviewed for assessing their opinion

and knowledge about the services provided by the concerned ANMs at Sub Centre level.

Mothers were satisfied with the services.

b. Most of the interviewed mothers were not aware about use of contraceptive and its side

effects. Post natal services were also poor in the area of Sub Centres Kamala Thabi and

Unopat.

(ii). HW (M) Services:

Though the villagers in area of Kamala Thabi Sub Centre were satisfied generally with the

services of MPW (M), their dissatisfaction was mainly towards not staying of MPW (M) at

sub centre headquarters, his irregular visit to the villages and also the services relating to

environmental sanitation, group meeting on health topic and STD / HIV/AIDS etc.

(iii). Services of PHC:

393

a. In the area of visited PHCs at Chakpikarong and Tengnoupal, the RCH beneficiaries i.e.

pregnant women, recently delivered mothers, mothers with two years old child etc. and

local persons who generally use the services at PHCs were contacted to know the overall

functioning of PHCs. It was observed that the services in respect of early registration of

ANC, 3 Ante Natal checkups, referral transport, awareness of sick new born care and

motivation about uses of contraceptive etc. needed improvement in the areas of both the

visited PHCs.

b. The Medical officers at PHCs Chakpikarong and Tengnoupal were not visiting villages

regularly.

9. Sample Verification of F.W. acceptors:

a. The team selected a total of 22 acceptors of spacing methods of family planning and out of

that 16 (73%) could be contacted for sample verification.

b. Among the contacted acceptors, 9 (56%) informed that they did not receive any follow up

service.

c. 91 beneficiaries of BCG/ DPT/ Polio and Measles were also selected and out of that 79

(87%) beneficiaries were contacted in the area of visited centres. All contacted

beneficiaries confirmed the services and 48 (61%) beneficiaries were provided Follow up

services by the health staff.

d. No sterilisation operations have been performed in the whole district due to absence of

Surgeons and Anesthetists. This situation is very serious and state authority should take

an early corrective action to improve it.

10. Reconciliation of the reporting performance:

Institution wise reported figures reported by the district office for CuT, Oral Pills and Nirodh

did not tally with the reports available at some of the visited centres. Reporting system was

also very poor in the district. It was observed that the post of District Data Manager is

vacant since long in the district headquarter.

11. Registers, records and reports maintained at the visited centres:

a. In the visited Sub centres and PHC/CHC, service registers in respect of Eligible Couple

survey, Family Planning, ANC & PNC and Stock register of family welfare were not

maintained properly.

b. Annual District Health Plan (ADHP) for the current year 2011-12 have been prepared at

District, CHCs and PHCs level and transmitted to higher authority in time but the same

was not prepared by visited Sub centres.

394

c. Printed register for Family Planning, Eligible Couple survey, ANC, PNC, Child

immunisation, JSY, Untied Fund, Cashbook and Stock book etc. were supplied to all

facility level, but maintenance of these registers was found very poor. Only JSY register

was maintained properly. Child Immunisation registers were maintained, but not in

properly. Doses were not given in proper time as per the records.

d. Monthly performance report in HMIS format was sent through web based system at district

level only. Visited PHCs were not sending their on line reports, because internet facility

was not provided there.

12. IT Infrastructure and Mother & Child Tracking System:

a. Team found that computers were available at district level and all CHC/ PHCs level (one in

each). Internet connectivity was found available at district and PHC Moreh only. But the

same facility was not provided to other CHC and PHCs.

b. MCH Tracking system was not implemented in the district.

13. Miscellaneous observations and suggestions:

a. Monitoring and supervision required to be increased by the concerned officers and staff in

the district.

b. Routine Immunisation programme was conducted on regular basis. But Records/ registers

reflected that most of the children were not fully immunized and doses were not given in

proper time. It was observed that involvement of ASHAs and ANMs was poor in this

regard.

c. During visit to PHC Tengnoupal, It was observed that the Medical Officer,

Pharmacist, Block Programme Manager, Block Data Manager, Block Account

Manager and Cleark were not present even in the working hour at PHC. OPD of the

PHC was totally absent on the day of visit.

2. District:- Thoubal

Major observations of Regional Evaluation Team, Kolkata on the Evaluation work

carried out in Thoubal district of Manipur during the month of August, 2011.

I. Details of the visited Institutions:

District visited D.H., CHC and PHCs visited SCs visited

Thoubal CHC: Yairipok

PHCs: Khoiram, Pallel and Lilong

Khoiram Kikru, Sora,

Irengband and Waithou

II. Major Observations:

1. Health Human Resources:

395

a. Position of human resource was satisfactory. However, some posts were vacant. 2 posts

of Specialist (out of 10 sanctioned), 3 posts of MOs (out of 69 sanctioned) and 2 posts of

MOs (Contractual) out of 18 sanctioned were vacant in the district.

b. In the category of para-medical, 6 posts of ANMs/MPW (out of 90 sanctioned), 3 posts of

MPW (M) out of 34 sanctioned, 2 posts of GNM/Staff Nurse (out of 85 sanctioned), 2 posts

of Lab Technician (out of 18 sanctioned) and 3 posts of Pharmacist (out of 40 sanctioned)

were lying vacant there.

c. Under District Programme Management Unit (DPMU), one post each of District Account

Manager and Block Programme Manager and 3 posts of PHC Accountant were lying

vacant in the district as a whole.

2. Functioning of Rogi Kalyan Samiti (RKS):

It was reported that RKS has been constituted and registered in the visited CHC and

PHCs in the district, but the meetings of RKS were not being held regularly.

3. Functioning of ASHA and Village Health Sanitation & Nutrition Committee (VHSNCs):

a. Against the target of 525 ASHAs, for 525 villages in the district, 365 ASHAs have been

selected in the district and provided training up to 6th module. All 365 ASHAs had been

provided drug kits during 2010-11.

b. As reported 525 VHSNCs were functioning in the district and all are having ASHA as a

member of the committee.

c. Untied funds for VHSNC to the tune of Rs. 1,14,69,486 including opening balance of Rs.

62,19,486 were available for the year 2010-11 and out of that an amount of Rs. 74,71,326

was utilized during the period in the district. Similarly, funds to the tune of Rs. 76,48,160

including opening balance of Rs. 39,98,160 was available in the district and out of that Rs.

9,53,743 could be utilized during current year 2011-12 (up to July, 2011).

4. Services of Janani Suraksha Yojana (JSY):

a. As reported, funds amounting to Rs. 34,92,093 were available under the scheme for the

year 2010-11 in the district and out of that Rs. 26,65,198 were spent. Similarly, Rs.

3,45,100 have been spent against available amount of Rs. 19,81,895 during current year

2011-12 under the scheme.

b. 3700 and 487 deliveries were eligible under JSY scheme in the year 2010-11 and 2011-12

respectively in the district and all eligible beneficiaries were paid with JSY incentives.

c. During visit to the facilities in the district, it was observed that records/ registers were not

maintained properly to check the status of funds, beneficiaries and related details.

396

d. 23 JSY beneficiaries contacted in the district for on the spot verification and it was

observed that MCH cards were issued to all of them. Beneficiaries mostly didn‟t have

receive three consecutive ANC checkups in the visited area.

e. Beneficiaries were not paid incentive amount on the date of discharge due to delay in

submitting the cards along with necessary papers to the office of the hospital.

5. 24 hours delivery care services:

a. 24 hours delivery care system implemented in 5 institutions i.e. 4 CHCs and 1 PHC in the

district.

b. Facility for caring mothers and new born care were found inadequate at most of the visited

centres. Blood storage facility was not available at CHC and PHC visited. Required

number of para-medical staff for conducting 24x7delivery was also not there at the visited

facilities. C- Section delivery facility was not available at CHC Yairipok.

6. Untied Fund:

a. Every CHC, PHC and Sub Centre were being provided untied funds @ Rs. 50,000, Rs.

25,000 and Rs. 10,000 per year respectively in the district. The position of Untied funds

for the year 2010-11 and 2011-12 as given below-

(In Rs.)

For the year 2010-11

Sr.

No.

Particulars Opening

Balance

Fund

Received

Expenditure Balance

1 For CHCs 3,09,180 2,50,000 4,59,591 99,589

2 For PHCs 3,03,027 3,00,000 4,07,136 1,95,891

3 For Sub

Centres

7,36,328 5,00,000 7,28,461 5,07,867

For the year 2011-12

1 For CHCs 99,589 2,50,000 74,987 2,74,602

2 For PHCs 1,95,891 3,00,000 1,39,526 3,66,365

3 For Sub

Centres

5,07,867 5,10,000 1,36,741 88,126

b. Untied Fund released to the visited PHCs/CHC and Utilized by them in the year

2010-11 in the district is as given below

(in Rupees)

Name of Institutions Opening

Balance

Released Expenditure Balance

CHC Yairipok 1,00,000 25,000 1,05,982 44,018

397

PHC Khoiram 25,089 25,000 39,048 11,041

PHC Pallel 41,800 25,000 39,552 37,248

PHC Lilong 25,000 25,000 25,000 Nil

c. No untied fund has been provided to the institutions by district office for the year 2011-12.

d. It was observed that fund was utilized for purchase of petrol for generator, medicine,

furniture, sign board, payment of transportation, campus cleaning, organization of camps

in remote area, printing and Laboratory items etc. by the visited PHCs.

7. Physical infrastructure (HSC/PHC/RH)

(i) Health Sub Centres:

a. The Sub centres visited at Khoiram Kikru, Sora, Irengband and Waithou were not

maintained as per IPHS. Electricity supply and Labour room facility was available only at

Sub Centre Waithou. ANMs were not staying at Sub centre headquarters in the visited

centres.

b. Delivery table, Mclntosh sheet, Heamoglobinometer, Santary Napkins, Kits- A & B and

Gentamycin injection were not available in the visited centres.

c. Ambu bag/suction, EC Pills, Oxitocine tablets, Nischay pregnancy test kit and RDT kit were

not available in most of the visited Sub centres.

d. Delivery kit, CuT insertion kit, Co-trimoxazole tablets and CuT at Sub Centre Khoiram,

Toilet facility, Steam sterilizer and DDKs at Sub Centre Sora, Toilet facility, Steam sterilizer

and Oral Pills at Sub Centre Irengband and Co-trimoxazole tablets and CuT at Sub Centre

Waithou were not available as observed by the team during the visit.

(ii) CHC/ PHCs:

a. The visited CHC at Yairipok and PHCs at Khoiram, Pallel and Lilong were not maintained

as per IPHS.

b. The visited CHC at Yairipok was upgraded in the year 1996. CHC was functioning in the

old PHC building with inadequate space, facility, equipments and human resources. CHC

building was being constructed since last 12 years but still incomplete.

c. Ambulance/Jeep, Functional Operation Theatre, Residential quarter for Medical Officer

and 24x7 service facility was not available in the visited PHCs.

d. Telephone facility, Labour room table and IFA (L & S) tablets/ Syrup were not available at

PHCs Khoiram and Pallel. Residential quarter for Medical Officer was not avaliable there.

In PHC Lilong, residential quarters were constructed but not yet handed over.

e. Due to want of equipment and other facilities, Labour room was not functional in PHCs at

Khoiram and Lilong, and the same was not available PHC Pallel.

398

f. Oxygen cylinder and Resuscitation equipment in PHCs at Khoiram and Lilong were not

available. There was no supply of Oral Pills since 2 years in PHC Khoiram and Vitamin- A

syrup in PHC Pallel.

8. Opinion and awareness of the Community on the Health Services:

(i). ANMs Services:

a. 20 mothers having child up to one year age were interviewed for assessing their opinion

and knowledge about the services provided by the concerned ANMs at Sub Centre level.

Mothers were satisfied with the services.

b. Most of the interviewed mothers were not aware about danger signs of ARI, use of ORS

and use of contraceptive and its side effects. Post natal services were also found poor in

the area of Sub Centres Sora and Irengband.

(ii). HW (M) Services:

Though the villagers in area of Sora and Irengband Sub Centres were satisfied generally

with the services of MPW (M), their dissatisfaction was mainly towards not staying at sub

centre headquarters, irregular visiting the villages and also the services relating to

environmental sanitation, group meeting on health topic and STD / HIV/AIDS etc.

(iii). Services of PHC:

a. In the area of visited PHC at Khoiram, the RCH beneficiaries i.e. pregnant women,

recently delivered mothers, mothers with two years old child etc. and local persons who

generally use the services at PHC were contacted to know the overall function of PHC. It

was observed that the services in respect of early registration of ANC, 3 Ante Natal

checkups, referral transport, awareness of sick new born care and motivation about uses

of contraceptive etc. needed to improve in the areas of PHC visited.

b. The Medical officer at PHC Khoiram was not visiting villages regularly.

9. Sample Verification of F.W. acceptors:

a. The team selected a total of 22 F.W. acceptors for sample verification and all cases were

contacted.

b. Among the contacted acceptors, 20 (80%) informed that they did not receive any follow up

service.

c. 59 beneficiaries of BCG/ DPT/ Polio, Measles and Vitamin- A was selected and out of that

46 (71%) beneficiaries were contacted. All contacted beneficiaries had received doses.

Only 12 (26%) beneficiaries were provided follow up services by health staff.

399

d. No sterilisation operations have been performed in the whole district due to absence of

Surgeons and Anesthetists. This situation is very serious and early action may be taken to

improve the situation.

10. Reconciliation of the reporting performance:

a. Figures reported by the district and those at the individual centres for Oral Pills and Nirodh

did not tally with each other. The details are given below:

Name of the

Centres

During the year 2010-11

Oral Pills distributed in cycle Condoms distributed in pieces

District

office

Reporting

Centres

District

office

Reporting

Centres

CHC Yairipok 288 NA 3210 NA

PHC Khoiram 150 35 130 47

PHC Pallel 34 37 121 138

PHC Lilong 51 61 1470 157

During the year 2011-12

CHC Yairipok 70 NA 760 NA

PHC Khoiram 27 27 33 63

PHC Pallel 13 14 70 80

PHC Lilong 17 50 440 1016

b. Further, the Institution wise reported figures by district office for CuT did not tally with the

reports available at CHC Yaripok and PHC at Lilong for the year 2010-11 & 2011-12 and

PHC Pallel for 2011-12.

11. Registers, records and reports maintained at the visited Centres:

a. In the visited Sub centres and PHCs/CHC, service registers in respect of Eligible Couple

survey, Family Planning, ANC & PNC and Stock register of family welfare were not

maintained properly.

b. Annual District Health Plan (ADHP) for the current year 2011-12 have been prepared at

district level only and transmitted to higher authority in proper time but the same was not

prepared by visited CHC, PHCs and Sub centres.

c. Printed register for Family Planning, ANC, PNC and Child immunisation etc. were supplied

to all facility level, but maintenance of these registers was found very poor.

d. Monthly performance report in HMIS format was sent through web based system at district

level only. However, visited PHCs were not sending their on line reports, because internet

facility was not provided there.

400

12. Miscellaneous Observation and Suggestions:

a. Routine Immunisation programme was conducted on regular basis. But Records/ registers

reflected that most of the children were not fully immunized and doses were not given in

proper time. It was observed that involvement of ASHAs and ANMs is poor.

b. The team observed that coordination between existing regular officials and contractual

officials was absent which is affecting performance of the programmes. For example, in

some of the of Sub centres regular ANMs was not serious about their work while the

contractual ANM has to carry out all responsibilities.

401

Mizoram

1.District- Serchhip

Major observations of Regional Evaluation Team, Kolkata about the Evaluation work

carried out in Serchhip district of Mizoram during the month of September, 2011

I. Details of the visited Institutions:

District visited DH., CHC and PHC visited SCs visited

Serchhip DH.: Serchhip

CHC: Thenzawl

PHC: Chhingchhip

Serchhip, New Serchhip,

Thenzawl and

Chhingchhip

II. Major Observations:

1. Health Human Resources:

a. No sanctioned strength of the staff was available at district office. At district headquarter

no one was aware about the sanctioned strength of staff in the district. There were 3

Specialists, 9 Medical Officers, 28 Grade- A Nurse/ Staff Nurses, 19 ANMs, 17 MPWs (M),

5 MPS (F), 9 MPS (M), 1 Lab Technician and 6 Pharmacists in position in the district as a

whole.

b. 7 Medical officers, 6 Grade- A Nurse/ Staff Nurses, 23 ANMs, 8 MPWs (M), 15 Lab

Technicians, 1 Pharmacists, 2 District Account Manager, one District Programme Manager

and one District Data Manager were appointed on contract basis in the district.

c. Information on sanctioned strength of the staff was also not available at visited institutions.

3 Specialists, 2 MOs and 27 Grade- A Nurse/Staff Nurses, 1 each of Lab Technician and

Pharmacist were posted at District Hospital Serchhip. Only 1 MO and 8 Grade- A

Nurse/Staff Nurse were available in CHC Thenzawl.

d. Similarly, 1 Medical Officer, 3 Grade- A Nurse/ Staff Nurses, 8 ANMs, 4 MPWs (M), 1 MPS

(F) and 1 Pharmacist were found in position in PHC Chhingchhip.

2. Functioning of Rogi Kalyan Samiti (RKS):

The team observed that RKS have been constituted and registered in the visited DH,

CHCs & PHCs in the district, but the meetings of RKS were not being held regularly on

monthly basis.

3. Functioning of ASHA Scheme and Village Health Sanitation & Nutrition Committee

(VHSNCs):

402

a. As targeted, 54 ASHAs were selected for 40 villages of the district. All ASHAs have been

trained up to 5th modules and provided with Drug kits.

b. As reported, 40 VHSNCs have been constituted in the district and ASHA was working as a

member in the VHSNCs. The team observed that meetings of VHSNCs were being

conducted regularly in the Centres visited.

c. VHSNC untied funds to the tune of Rs. 6,66,951 including opening balance of Rs. 2,66,951

were available during the year 2010-11 in the district and out of that, an amount of Rs.

3,44,993 was utilized by the VHSNCs in the year. Similarly, an amount of Rs. 1,58,578

was utilized by VHSNCs in the district against the available amount of Rs. 7,21,858 during

current year (up to August, 2011).

4. Services of Janani Suraksha Yojana (JSY):

a. During the year 2010-11, district spent funds to the tune of Rs. 9,29,200 out of allotted

funds of Rs. 11,52,200 under the scheme. Similarly, an amount of Rs. 3,63,100 was

utilised against the available amount of Rs. 8,23,000 during current year up to August,

2011.

b. It was reported that 632 and 254 deliveries were identified for JSY payment under the

scheme in the year 2010-11 and 2011-12, out of that 630 and 250 JSY beneficiaries were

paid cash incentive under the scheme during last year and current year respectively.

c. The budget provision and expenditure at the visited DH/CHC/PHC as reported is given

below:

Sr.

No.

Particulars For the year 2010-11 ( in Rs)

DH Serchhip CHC Thenzawl PHC Chhingchhip

1 Total fund available 3,44,900 1,28,694 1,09,600

2 Total expenditure under

JSY

3,43,700 1,21,300 1,01,900

3 Balance amount 1,200 7,294 7,700

4 No. of JSY mothers paid

incentive

350 66 66

For the year 2011-12 ( in Rs)

1 Total fund available 1,52,100 62,320 37,700

2 Total expenditure under

JSY

1,47,300 33,900 36,900

3 Balance amount 4,800 28,420 800

4 No. of JSY mothers paid

incentive

147 19 21

403

d. 30 JSY beneficiaries were contacted for on the spot verification in the district and it was

observed that MCH cards were issued to all of them. ASHAs involvement was satisfactory.

Beneficiaries were paid incentive amount on date of discharge from the hospital. There

was no provision for payment of transport money to the beneficiaries.

e. Printed JSY registers were maintained properly with all details and checked by the

concerned Medical Officer regularly.

5. Untied Fund:

a. There is one CHC, 5 PHCs and 26 Sub Centres in the district. Though detail of the untied

funds for CHC and PHCs were made available for the year 2010-11 and 2011-12, an

information Sub Centre level untied fund was not made available in the district. The details

are as below:

(In Rs.)

For the year 2010-11

Sr.

No.

Particulars Opening

Balance

Fund received

during the

year

Expenditure Balance

1 For CHCs 28,684 51,310 30,677 49,317

2 For PHCs 52,216 1,25,000 1,28,792 48,424

3 For Sub Centres Not made available

For the year 2011-12

1 For CHCs 49,317 50,888 31,562 68,643

2 For PHCs 48,424 62,500 48,775 62,149

3 For Sub Centres Not made available

b. The team observed that untied funds for CHC and VHSNCs were released in time but

these were not provided timely to the SCs and PHCs in the district.

c. Status of Untied Fund in the visited CHC, PHC and Sub Centres in the year 2010-11 &

2011-12 is as below:

404

(in Rs)

For the year 2010-11

Name of

Institutions

Opening

Balance

Released Expenditure Balance

CHC Tenzawl 28,684 51,310 30,677 49,317

PHC Chhingchhip 12,760 25,000 30,525 7,235

SC: Chhingchhip 2,104 10,000 8,459 3,645

SC: New Serchhip 10,031 10,000 10,031 10,000

SC: Serchhip 4,565 10,000 7,705 6,860

SC: Tenzawl 5,513 10,278 9,716 6,075

For the year 2011-12

CHC Tenzawl 47,137 50,888 31,562 68,643

PHC Chhingchhip 7,235 12,500 7,055 12,680

SC: Chhingchhip 3,645 5,000 5,670 2,975

SC: New Serchhip 10,000 Nil 5,390 4,610

SC: Serchhip 6,860 Nil 674 6,106

SC: Tenzawl 6,075 10,112 2,372 13,815

d. There was no proper monitoring in the Centres. The district releases the fund without

taking into account the opening balance. Though there was sufficient opening balance with

some of the centres, still they were provided with amount entitled for untied fund or more

than the entitled amount and that too could not be spent at the end of year. The team also

observed that cash books of untied funds were not maintained properly at Sub Centre

level. These registers were never checked by concerned Block Accountant/ Medical officer

I/c of the institutions.

6. 24 Hours Delivery Care Services:

a. 24 hours delivery care services are provided through District Hospital, CHC and 5 PHCs in

the district. District Hospital Serchhip conducted 405 and 199 deliveries in the year 2010-

11 and 2011-12 respectively and PHC Chhingchhip conducted 73 and 16 deliveries in the

year 2010-11 and 2011-12 respectively.

b. C- Section delivery and Blood storage facilities are only available at District Hospital.

Though facility for caring mothers and new born baby were inadequate, availability of

Doctors and Staff Nurse etc. was adequate in view of the deliveries being conducted in the

visited institution.

7. Physical infrastructure (HSC/CHC/PHC)

(i) Health Sub Centres:

405

a. Labour room facility was not available in the visited Sub Centres at Serchhip, New

Serchhip and Chhingchhip.

b. ORS Packets, Sanitary Napkins, Condoms, Chlorine Solution/ Bleaching Powder,

Oxitocine tablets, Ampicillin capsule and Gentamycin Injection were not available in the

visited Sub Centres.

c. Delivery Table and Mclntosh sheet in Sub Centres at Chhingchhip and New Serchhip,

Paracetamol & Metronidazole tablets in Sub Centres at New Serchhip and Thenzawl were

found not available.

d. Delivery kits, RDT Kits, BP apparatus and DDKs at Sub Centre New Serchhip, DDKs at

Sub Centre Serchhip and Heamoglobinometer at Sub Centre Thenzawl were not available.

e. Skilled Birth Attendance training was not provided to the Auxiliary Nurse Midwives of the

visited Sub centres.

(ii) DH /CHC/ PHC:

g. In the District Hospital, Sick New Born Care Unit was not available and Baby Warmer was

not working since 2 months. Though Anesthesia equipment was available but Anesthetist

was not posted.

h. CHC Thenzawl and PHC at Chhingchhip were not as per IPHS. CHC Thenzawl was not

functional as a CHC, as specialty services were not available.

i. Jeep and Anesthesia equipment were not available in CHC Thenzawl.

j. Residential accommodations for Para-Medical staff were inadequate at District Hospital

Serchhip and CHC Thenzawl.

k. Labour room table and CuT Insertion Kit were not available, Operation Theatre was not

functional due to want of equipments in PHC Chhingchhip.

l. No supply of Oral Pills & Nirodh was observed since 3 months and AYUSH Medical

Officer was not posted in PHC Chhingchhip.

8. Opinion and awareness of the Community on the Health Services:

(i). ANMs and MPWs Services:

a. 20 mothers were interviewed for assessing their opinion and knowledge about the services

provided by the concerned ANMs at visited Sub Centres at New Serchhip and Serchhip.

b. Contacted mothers were dissatisfied on early discharge from the hospital and poor Post

Natal services. Mothers were not aware about advantage and its side effects of

contraceptives.

c. 30 persons were interviewed in the area of visited Sub Centres at New Serchhip and

Serchhip to assess the opinion on the services rendered by MPW (M). Though MPWs

406

were doing their work, community wants their involvement more in group discussion on

health activities, follow up services and motivation for NSV sterilisation.

(II). Services of PHC/CHC/FRU:

a. The team interviewed 11 community members including pregnant women, recently

delivered women and mothers having upto two year old child ASHAs. The respondents

were not sufficiently aware about danger sign for mothers during ANC, Symptoms of sick

new born baby and referral transport. They were also not much aware about

HIV/STD/AIDS.

b. Medical Officer of PHC Chhingchhip was not visiting villages under the PHC area

regularly.

9. Reconciliation of the reporting performance under Sterilization:

a. Sterilization figures reported for DH Serchhip by the district office for the year 2010-11 did

not tally with the same figures reported by DH Serchhip itself. District office reported 28

sterilizations for 2010-11 whereas the same figures were 25 in the DH Serchhip.

b. The performance of CuT also shown variation as given below:

During 2010-11

Name of the Centres Beneficiaries of CuT

District

office

Reported by

Centre HQ

In the centres

register

District Hospital Serchhip Nil Nil 34

CHC Thenzawl Nil 27 28

PHC Chhingchhip 69 11 11

During 2011-12 (up to August, 2011)

District Hospital Serchhip 40 40 13

CHC Thenzawl 177 14 13

PHC Chhingchhip 30 11 7

10. IT Infrastructure and Mother & Child Tracking System:

a. Team found that computers were available at district level and at CHC/ PHC level (one in

each) but internet connectivity was not available in any visited CHC/ PHC.

b. MCH Tracking formats were available in each Sub centres.

c. Health functionaries were sensitized in MCH formats at PHC/ CHC level.

11. Registers, records and reports maintained at the visited centres:

407

a. Eligible Couple register which is one of the most important record for FW services was not

maintained at District Hospital, Serchhip. This register was also not maintain/ updated

properly at CHC Thenzawl and PHC Chhingchhip.

b. Register for CuT acceptors was not maintained/ updated properly at District Hospital

Serchhip, CHC Thenzawl and PHC Chhingchhip.

c. Oral Pills and Nirodh users register was not maintained properly / updated in the Centres

visited.

d. PNC registers were not maintained at District Hospital Serchhip and CHC Thenzawl and

not updated at PHC Chhingchhip.

12. Other observations:

a. Monitoring and supervision required to be increased by the concerned Supervisory officers

and staff in the district to improve the quality of maintenance of records and registers

especially ECRs at Sub Centres level.

b. There was no supply of Printed register for Family Planning services at periphery level.

c. Periphery level centres were facing hardship to prepare huge numbers of reporting formats

of different programmes imposed upon facility level by the state authority in addition to

HIMS report. It was reported that required information already available in HIMS report but

no nodal officer of different programmes want to go through HIMS reports.

d. Cash book of different programme under NRHM was not maintained properly at PHC and

Sub Centre level

2.District- Aizawl (West)

Major observations of Regional Evaluation Team, Kolkata about the Evaluation work

carried out in Aizawl (West) district of Mizoram during the month of September, 2011

I. Details of the visited Institutions:

District visited DH., CHC and PHC visited SCs visited

Aizawl (West) Main Centre Aizawl (West)

PHCs: Aibawk and Lengpui

Dinthar, Vaikawn,

Lengpui, Tachhip and

Muallungthu

II. Major Observations:

1. Health Human Resources:

408

a. Sanctioned strength of the staff was not available at district office. At headquarter no one

was aware about the sanctioned strength of in the district. 10 Medical Officers, 20 Grade-

A Nurse / Staff Nurses, 57 ANMs, 43 MPS (M) and 5 Pharmacists were posted in whole of

the district.

b. 11 Medical Officers, 58 Grade- A Nurse/ Staff Nurses, 41 ANMs, 10 Lab Technicians, 2

Pharmacists, 11 MPWs (M) and District Programme Manager, District Account Manager

and District Data Manager were also appointed on contractual basis in the district.

c. No sanctioned strength of the staff was made available in the visited institutions. As per the

statement provided, 24 ANMs, 15 MPWs (M), 2 MPS (F), 3 MPS (M) and 2 Lab Technician

were working presently in Main Centre Aizawl West.

d. In PHC Aibawk, 1 Medical Officer, 3 Grade- A Nurse/ Staff Nurses, 6 ANMs, 1 MPWs (M),

1 each MPS (M & F) were posted. Similarly, 2 Medical Officer, 3 Grade- A Nurse/ Staff

Nurses, 1 ANM, 3 MPWs (M), 1 each MPS (M & F) and Pharmacist were found in position

in PHC Lengpui.

2. Functioning of Rogi Kalyan Samiti (RKS):

It was reported that RKS has been constituted in the Main Centre Aizawl and visited PHCs

in the district but the meetings of RKS were not being held regularly.

3. Functioning of ASHA Scheme and Village Health Sanitation & Nutrition Committee

(VHSNCs):

a. As targeted, 119 ASHAs were selected for 28 villages of the district. All ASHAs had been

trained up to 5th modules and provided with Drug kits.

b. There were 86 VHSNCs having ASHA as a member constituted in the district. The team

observed that meetings of VHSNCs were conducted regularly in the visited Centres.

c. The district received an amount of Rs. 8,60,000 as VHSNC untied funds during 2010-11

and the amount was fully utilized under the scheme during the year. In the current year

2011-12, the budget amounting Rs. 8,60,000 was received by district office but not

distributed to the VHSNCs at the time of visit by the team.

4. Untied Funds:

a. There is 5 PHCs and 37 Sub Centres in the district. Though detail of the untied funds for

PHCs and SCs made available for the year 2010-11 and 2011-12 in the district but

utilization of untied funds was found to be very poor. The detail is as below:

409

(In Rs.)

For the year 2010-11

Sr.

No.

Particulars Opening

Balance

Fund

Received

Expenditure Balance

1 For PHCs Nil 1,50,000 1,50,000 Nil

2 For Sub Centres 25,000 4,00,000 4,25,000 Nil

For the year 2011-12 (up to August, 2011)

1 For PHCs Nil 75,000 75,000 Nil

2 For Sub Centres Nil 2,00,000 90,000 1,10,000

b. The team observed that while the state headquarter provides full CHC and VHSNC untied

funds to the district but PHC and SC untied funds are provided in installments.

c. Status of Untied Fund in the visited PHCs and Sub Centres in the year 2010-11 & 2011-12

is as below:

(in Rs)

For the year 2010-11

Name of

Institutions

Opening

Balance

Released Expenditure Balance

PHC Aibawk 21,254 25,000 9,700 36,554

PHC Lengpui 27,453 25,000 31,646 20,807

SC: Dinthar 8,213 15,000 9,210 14,003

SC: Vaikawn 4,174 15,000 13,974 5,200

SC: Lengpui 840 10,000 10,840 Nil

SC: Tachhip 5,000 10,000 11,260 3,740

SC: Muallungthu 2,508 10,000 7,678 4,830

For the year 2011-12 (up to August, 2011)

PHC Aibawk 36,554 12,500 8,267 40,787

PHC Lengpui 20,807 12,500 12,149 21,158

SC: Dinthar 14,003 Nil 1,252 12,751

SC: Vaikawn 5,200 Nil Nil 5,200

SC: Lengpui Nil Nil Nil Nil

SC: Tachhip 3,740 5,000 1,020 7,720

SC: Muallungthu 4,830 5,000 Nil 9,830

d. It was observed that the district releases the untied funds without taking into account the

opening balance. There was sufficient amount of opening balance available with some of

the centres even they were provided with annual entitled funds or more than the eligible

410

amount and that too have not spent at the end of year. Moreover the team reported that

Cash books of untied fund were not maintained properly at Sub Centre level. These

registers were never checked by concerned Block Accountant/ Medical officer I/c of the

institutions.

5. Services of Janani Suraksha Yojana (JSY):

a. During the year 2010-11, district had spent funds to the tune of Rs. 9,08,100 out of allotted

funds of Rs. 10,50,000 under the scheme. Similarly, an amount of Rs. 4,13,800 was

utilised against the available amount of Rs. 7,91,900 during current year up to August,

2011.

b. As many as 925 JSY beneficiaries in the year 2010-11 and 200 JSY beneficiaries in

current year up to August, 2011 have been paid with cash incentive under the scheme.

c. The budget provision and expenditure at the visited PHCs as reported is given below:

Sr.

No.

Particulars For the year 2010-11 ( in

Rs)

PHC

Aibawk

PHC Lengpui

1 Total fund available 40,480 95,600

2 Total expenditure under JSY 22,100 71,900

3 Balance amount 18,330 23,700

4 No. of JSY mothers paid incentive 6 60

For the year 2011-12 ( in Rs)

1 Total fund available 38,380 53,700

2 Total expenditure under JSY 37,800 30,100

3 Balance amount 580 23,600

4 No. of JSY mothers paid incentive 11 24

d. 15 JSY beneficiaries were contacted for on the spot verification in the district. Most of the

beneficiaries were satisfied with the services received under JSY. Mothers were satisfied

with the services provided during ANC, PNC period. Mothers were also satisfied with

ASHAs. JSY Cards were issued to all mothers. Beneficiaries were paid incentive amount

on date of discharge from the hospital.

e. There was no provision for payment of transport money to the beneficiaries.

f. Printed JSY registers maintained properly with all details and checked by the concerned

Medical Officer regularly.

6. 24 Hours Delivery Care Services:

411

a. 24 hours delivery care services are provided through District Hospital and 6 PHCs in the

district. PHC Aibawk conducted 18 and 12 deliveries in the year 2010-11 and 2011-12

respectively and PHC Lengpui conducted 74 and 30 deliveries in the year 2010-11 and

2011-12 respectively.

b. C- Section delivery and Blood storage facilities are only available at District Hospital.

Though facility for caring mothers and new born baby was found inadequate, availability of

Doctors and Staff Nurse etc. was adequate in view of the number of deliveries taking place

in each visited institution.

7. Physical infrastructure (HSC/PHC)

(i) Health Sub Centres:

a. The Sub centres visited at Dinthar, Vaikawn, Lengpui, Tachhip and Muallungthu were not

as per IPHS. Labour room facility was not provided there.

b. Delivery Table, Mclntosh sheet, Delivery kits, Sanitary Napkins, Condoms, Paracetamol &

Oxitocine tablets, Ampicillin capsule and Gentamycin Injection were not available in the

visited Sub Centres.

c. No supply of ORS Packets and DDKs were found at Sub Centres at Vaikawn, Lengpui,

Tachhip and Muallungthu.

d. Steam sterilizer of Sub Centres at Vaikawn, Tachhip, Muallungthu and Chlorine Solution/

Bleaching Powder of Sub Centres at Dinthar, Vaikawn and Muallungthu were not

available.

e. SBA and IMNCI training was not provided to the Auxiliary Nurse Midwives of Sub centres

visited in the district.

(ii) PHCs:

a. The visited PHCs at Aibawk and Lengpui were visited in the district. Most of the facilities

were available there.

b. Functional Operation Theatre with OT table had not been provided at Aibawk PHC.

c. AYUSH Medical officer was not posted in both visited PHCs.

8. Opinion of the Community on the Health Services:

(i). ANMs and MPWs Services:

a. 20 mothers were interviewed for assessing their opinion and knowledge about the services

provided by the concerned ANMs at visited Sub Centres at Tachhip and Muallungthu.

412

b. Contacted mothers were dissatisfied on early discharge from the hospital after delivery

and poor Post Natal services. Mothers were not aware about advantage and its side

effects of contraceptives.

c. 18 persons were interviewed in the area of visited Sub Centre at Muallungthu to assess

the opinion on the services rendered by MPW (M). Though MPW were doing their work,

villagers want them to involve more in Group discussion on health activities, follow up

services and motivation for NSV sterilisation by the MPW.

(II). Services of PHC:

a. The team interviewed 22 community members including pregnant women, recently

delivered women and mothers upto two year old child in the area of PHC visited. The

respondents were not sufficiently aware about danger sign for mothers during ANC,

Symptoms of sick new born baby and supply of adequate drugs. They were also not much

aware about HIV/STD/AIDS.

b. Medical Officers of PHCs Aibawk and Lengpui were not visiting villages under their PHC

area regularly.

9. Reconciliation of the reporting performance under Sterilization:

a. Sterilization figures reported for PHCs Aibawk and Lengpui by the district office for the

year 2010-11 & 2011-12 (up to August, 2011) did not tally with the same figures reported

by PHCs Aibawk and Lengpui itself. District office reported Nil sterilizations for 2010-11

whereas it was 1 in the PHC Aibawk and 11 in the PHC Lengpui. Similarly, in the year

2011-12 (up to August, 2011), district office reported Nil sterilizations for PHC Aibawk and

1 for PHC Lengpui whereas the same figures were 1 in the PHC Aibawk and 5 in the PHC

Lengpui.

b. The same performance of CuT shown variation as given below

During 2010-11

Name of the Centres Beneficiaries of CuT

District

office

Reported by

Centre HQ

In the centres

register

Main Centre Aizawl West 36 36 9

PHC Aibawk 14 13 8

PHC Lengpui 7 8 8

During 2011-12 (up to August, 2011)

Main Centre Aizawl West NA 16 8

PHC Aibawk 10 18 8

413

10. IT Infrastructure and Mother & Child Tracking System:

a. Team found that computers were available at district level and at CHC/ PHC level (one in

each) but internet connectivity was not available in any of the visited PHCs.

b. MCH Tracking formats were available in each Sub centres.

c. Health functionaries were sensitized in MCH formats at PHC level.

11. Registers, records and reports maintained at the visited centres:

a. Eligible Couple Survey register which is one of the most important records for FW services

was not maintained/ updated properly in any of the visited Centres.

b. Register for CuT acceptors, Oral Pills and Nirodh users were not updated in the centres

visited.

c. Stock register for family planning items i.e. CuT, Oral Pills and Nirodh were not updated in

any of the Centres visited.

12. Other observations:

a. Monitoring and supervision required to be increased by the concerned Supervisory officers

and staff in the district to improve the quality of maintenance of records and registers

especially ECRs at Sub Centres level.

b. There was no supply of printed register for Family Planning services at periphery level.

c. Periphery level centres were facing hardship to prepare huge numbers of reporting formats

of different programmes imposed upon facility level by the state authority in addition to

HIMS report. It was reported that required information is already covered in the HIMS

report but no nodal officer of different programmes want to go through HIMS reports.

d. Cash book of different programme under NRHM was not maintained properly at PHC and

Sub Centre level.

e. Sterilisation operations conducted in the visited centres were almost nil during the last two

years.

414

Madhya Pradesh

1. District Bhopal:

Major observations of Field Survey Unit (FSU), Bhopal about the evaluation work carried

out in Bhopal District of Madhya Pradesh State during April, 2011.

Details of the visited Institutions:

District CHC and PHC Visited HSC visited

Bhopal CHC: Kolar & Gandhinagar

PHC: Misrod, Ratibarh,

Phanda

& Tumda

Golgaon, Ratanpur Sadak, Amrawatkala,

Mundla, Deepadi, Bagroda, Mugaliya

Chhap, Khamkheda, Kuthar, Itakhedi,

Mugaliya Hat, Khajuri Sadak, Arawaliya,

Tilakhedi, Rasuliya Pathar & Kurana

II. Major Observations:

1. Human Resources:

a) 27 of the 78 sanctioned posts of Specialist, 03 out of the 193 sanctioned posts of Staff

Nurse and 3 out of 21 sanctioned posts of MPS, 5 out of the 31 sanctioned posts of LHV

and 17 out of 114 sanctioned posts of MPW (M) were lying vacant in the district.

b) 59 Doctors/Specialists were in position out of 67 posts sanctioned in District Hospital.

Among the paramedical staff, 6 out of 100 sanctioned posts of Staff Nurse, 4 out of 5

sanctioned posts of Matron and 11 out of 30 sanctioned posts of Pharmacist were lying

vacant at the District Hospital.

c) In visited CHC Gandhinagar, 2 out of 4 sanctioned posts of Specialist, 1 out of the 6

sanctioned posts of Medical Officer and 1 out of the 8 sanctioned posts of Staff Nurse

were vacant. Likewise, in CHC Kolar, 2 out of 4 sanctioned posts of Specialists and 1

post each of Radiographer, Ophthalmic assistant and OT Attendant were vacant.

2. Rogi Kalyan Samiti (RKS):

a) 13 Rogi Kalyan Samitis at District Hospital, 3 at CHCs and 9 at PHCs were constituted in

the district. All of them except at PHC Tumda, were conducting their meetings regularly.

b) All CHCs were provided Rs.1, 00,000 each as RKS funds during the year 2009-10 and

2010-11. CHCs Berasiya and Gandhi Nagar spent the full funds and CHC Kolar incurred

70% expenditure during 2009-10. During 2010-11, CHCs Kolar and Gandhi Nagar

415

incurred 100% expenditure where as CHC Berasiya did not submit its expenditure status

till visit date.

c) All PHCs were provided with Rs. 1,00,000 as RKS funds for both financial year 2009-10

& 2010-11 out of which PHCs Damarra & Tumda did not spend any expenditure during

2009-10 and PHCs Gunga & Runha did not incur any expenditure during both the year

2009-10 & 2010-11. PHCs Najirabad, Ratibad, Phanda and Damarra spent 80-100%

funds in 2010-11 whereas PHCs Misrod and Tumda spent 58% and 46% funds

respectively.

3. Village Health Sanitation Committee (VHSC) :

a) In 488 out of 531 villages in the district, Village Health & Sanitation Committees were

constituted. VHSCs were having ASHA as a member.

b). As reported , 411 VHSCs were having bank account for handling their funds. However,

VHSCs in Kolar Block of the district did not open bank accounts.

c). In the visited Sub Centre Area, VHSCs were formed in 106 villages out of 121 villages

and in 104 VHSCs, ASHA was a member. 105 VHSCs have opened their bank accounts.

4. Service of Janani Suraksha Yojana (JSY):

a) As per the report received from visited CHCs and PHCs, the status of JSY scheme is

given below:-

Sl. No.

Particulars Year CHC Kolar

CHC Gandhi nagar

PHC Ratibarh

PHC Misrod

PHC Phanda

PHC Tumda

1 No. of Institutional deliveries conducted

20010-11

28 ( *)

614

87

115

13

13

2011-12 II

9

37 4 12 3 -

2

No. of beneficiaries Paid with incentives

20010-11 28 (*) 614 87 115 13 13

2011-12 II

9 37 4 7 1 -

3 Total fund recd. for JSY

20010-11

3,50,000 (*)

1400172 (@)

NG

50,000

15,500

NG

2011-12 II

0 - NG 20,000

20,150

-

4 Exp. Incurred under JSY

20010-11

3,21,700 (*)

9,07,964

NG

50,000

15,350

NG

2011-12 II

NG NG NG - 8,750 -

(*) - Figures for the period December, 2010 to March, 2011.

416

NG - Not Given

(@) - Amount including previous balance

II - For April, 2011

@ - Including previous balance of Rs. 6,00,172.

b) The team contacted 50 JSY beneficiaries for on the spot sample verification and

observed that all beneficiaries were satisfied with the services. 45 (90%) beneficiaries

were accompanied by ASHAs /Dai while going to the hospital for deliveries. 48 (96%)

beneficiaries received incentive by cheque within three days after delivery. 34 (68%)

beneficiaries used Janani Express to go to hospital and 12 (24%) beneficiaries made self

arrangement to go to hospital and out of them 7 (58%) beneficiaries got money for

transport. 42 (84%) beneficiaries got three Ante natal check ups (ANC) and 33 ( 66%)

beneficiaries got three post natal check ups (PNC).

5. Functioning of ASHA Scheme:-

a) It was reported that 502 ASHAs were selected against 531 villages in the district. In

Gandhinagar block, there were 168 ASHAs against 105 villages.

b) It has also been reported that 472 ASHAs have been trained in the district. Further, 480

ASHAs were provided with drug kits.

c) During visit to the Sub Centres in the district it was observed that most of the ASHAs

were working properly. They were accompanying the mothers for institutional deliveries,

helping in immunisation services and also assisting in ANC/PNC and sterilisation relating

services.

6. Untied Funds:-

CHCs @ Rs. 50,000 and PHCs @ Rs. 25000 are allotted every year as untied fund in the

district. 3 CHCs and 8 PHCs had been provided with the untied fund in the year 2009-10

and 2010-11 and most of the amount was spent under this head by the CHCs and PHCs

during the year 2009-10 & 2010-11.

7. 24 Hours Delivery Care Services:-

a) District Hospital, 02 Civil Hospitals, 3 CHCs and 3 PHCs were providing 24x7 hours

delivery care service in the district.

b) CHCs at Gandhi Nagar and Kolar were visited by the team. There were sufficient no. of

Doctors and other Paramedical staff to perform the 24x7 hours services in the CHCs.

Blood Storage Facility was not available there.

8. Physical Infrastructure and Stock Position:

I. CHCs:

417

a) CHC Kolar was functioning in rented building having 10 bedded facility. CHC Gandhi

Nagar was functioning in Govt. building having 30 beds, but only 20 beds were being

utilization. Water and electricity with power back up was available at both the CHCs.

b) Anaesthesia Equipments and Blood Storage Unit were not available at both the CHCs at

Gandhinagar and Kolar.

c) Residential quarters for doctors and Para medical staff were not available at both the

CHCs.

d) X-Ray facility was available only at CHC Gandhinagar.

e) Vital and Essential drugs were available in both the CHCs, but Quinine Injections and

Arteether Injection were not available in both visited CHCs.

II. PHCs:

a) PHCs visited at Misrod, Ratibarh, Phanda and Tumda were functioning in Govt.

buildings with regular water supply, electricity with power back up and also toilet facility.

Telephone facility was not available in Ratibarh and Phanda PHCs.

b) Residential quarter for Medical Officer was available only in Tumda PHC. There was no

vehicle in any of the visited PHCs. Functional Operation Theatre was not available at the

visited PHCs.

c) Autoclave/Steam sterilizer was not available at Ratibad and Tumda PHCs. Minor Surgical

Equipment was not available at Tumda PHC and Microscope was not available at

Ratibad and Phanda PHCs.

III. HSCs:

a) All 16 visited Sub Centres were functioning in Govt. building. Water facility was not

available at Khamkheda, Kuthar, Khajuri Sadak and Rasuliya Pathar HSCs. Electricity

was not available at Golgaon, Amrawatkala, Deepadi, Bagroda and Mugaliya Chhap Sub

Centres. Toilet facility was not available at Bagroda, Mugaliya Chhap and Arvaliya HSCs.

Labour rooms were available only in Ratanpur Sadak, Amrawatkala, Khamkheda, Khajuri

Sadak and Tilakhedi Sub Centres but delivery was not conducted there as these centres

are nearer to Bhopal city areas.

b) MPW (M) post was vacant at Ratanpur Sadak, Mundla, Bagroda and Mugaliya Hat Sub

Centres.

c) Examination table was not available at Kuthar, Mugaliya Hat, Rasuliya pathar, Golgaon,

Deepadi and Mugaliya Chhap HSCs. Delivery table was not available in Golgaon,

Mundla, Bagaroda, Kuthar, Mugaliya Hat, Khajuri Sadak, Aravaliya, Rasulia Pathar and

Kurana Sub Centres. Steam Sterilizer was not available at Golgaon, Mundla, Kuthar,

Aravaliya and Tilakhedi HSCs. Nischay pregnancy test kit was not available at Golgaon,

418

Deepadi, Bagroda and Aravaliya HSCs. Delivery kit was not available in Golgaon,

Deepadi, Bagroda, mugaliya Chhap, Kuthar, Tilakhedi, Rasuliya pathar and Kurana Sub

Centres. IUD insertion kit was not available at Golgaon HSC. Rapid Diagnosis test kit for

malaria was not available at Golgaon, Ratanpur ,Amrawatkala, Mundla, Mugaliya Chhap,

Khajuri Sadak, Arvaliya, Tilakhedi and Rasuliya Pathar HSCs. Hemoglobin meter was not

available at Golgaon, Mundla and Kurana Sub centres.

d) DDKs, Kerosene oil/gas cylinder, Sanitary Napkins, Emergency Contraceptive Pills,

Gentamycin and Oxytocin Tablets were not available at any of the visited Sub Centres.

Gloves, Vit-A, IUDs, Oral Pills, Condoms, Antiseptic Solution, Bleaching powder and

Ampicillin cap were not available at some of the visited Sub Centres. Kit-A & Kit-B were

not available at Golgaon, Deepadi, Bagroda, Mugaliya Chhap, Kuthar and Kurana SCs.

Kit-A was not provided to SC Tilakhedi and Kit-B was not provided to Mugaliya Hat SC

during 2010-11.

9. Community Satisfaction on overall health Service:

i. ANM and MPW (M) Services:

a) 65 mothers having child of one year old were contacted. 19 (39.6%) mothers reported

that ANM was available when needed. 34 (52.3%) mothers received three post natal

check up (PNC). 32 (49.2%) mothers knew about danger sign of ARI. 51 (78.5%)

mothers were aware about contraceptive methods. Only 14 (21.5%) mothers have been

told about the advantage and side effect of contraceptive methods. All mothers replied

that the immunization session are being held regularly in their villages and all of them

were aware of government health facilities.

b) Out of 16 visited Sub Centres, MPW(M) were posted in 12 Sub Centres. After elaborated

discussions with Teachers, Sarpanch, ASHA, CC users and villagers, the team found

that most of the male workers were not staying at the Sub Centre headquarters and not

visiting to the villages for field work regularly. Though, behaviour of most of the male

workers towards the villagers was found good. All workers attended health

clinic/immunization/VHNDS session regularly and were available when health

programmes were organized in the villages.

ii. PHC level Services:

a) Villagers in the area of PHCs were satisfied with the services of PHCs. However, some of

the women were not sufficiently aware about danger sign in pregnancy, danger sign of

sick new born, contraceptive methods, Family Welfare methods and STD/HIV- AIDS.

b) 7 ASHAs were interviewed in 4 visited PHCs and none of them had Kits containing EC

pills.

419

c) MOs of visited PHCs did not stay at PHC HQ. Regular presence of M.O at PHC Phanda

was not satisfactory. Visit to the villages of PHCs was not done during last six month by

MO.

10. Sample verification of Family Welfare Acceptors:

a) The team selected 275 FW cases, out of which 202 (73%) FW acceptors could be

contacted. Minor discrepancy was observed in age of acceptor, in age of spouse and in

the age of last child.

b) While examining the service registers of selected cases, it was found that age of

acceptors in 26 cases and age of spouse in 127 cases was not recorded. Total No. of

children and number of male/female children was not recorded in each 14 cases

respectively. Age of the youngest child was also not recorded in 78 cases.

c) 83 (41%) cases (31-IUD, 29-OP and 22-condom) were found to be false reported during

sample verification in the district.

d) 145 (30 DPT, 30 POLIO, 32 BCG, 17Vit-A and 36 MEASLES) beneficiaries of child

immunization were contacted in which all beneficiaries confirmed the doses. 94 (65%)

beneficiaries were not contacted by the health workers for follow up services after

vaccination.

11. Maintenance of Registers & Records:

a) Sterilization Register, MCH Register, Stock Register, OP Register, CC register and Case

Card Sterilization Register were maintained properly in both visited CHCs Kolar and

Gandhi Nagar.

b) EC Register was not maintained by most of the workers of visited Sub Centres in both

CHCs. Master Register of IUD was not maintained in both the CHCs.

c) None of the Sub Centres maintained Stock Register.

d) District performance report of F.W. cases were not produced to the team.

*******

420

2. District Shajapur:

Major observations of Regional Evaluation Team (RET), Bhopal on the evaluation work

carried out in Shajapur District of Madhya Pradesh State in the month of September, 2011

respectively.

i) Details of the visited Institutions:

District DH/CHC/ PHC Visited HSC visited

Shajapur DH: Shajapur

CHC: Mohan Barodiya & Susner

PHC: Berchha, Soyatkala, Mohana,

Gulana & Bolai

Dongargaon, Gulana, Bolai, Nipaniya,

Salsalai, Choma Abhaypur, Sunera,

Gopipur and Panwadi.

ii. Major Observations:

1. Human Resources:

a) In the visited district acute shortage of health manpower was observed. 60 of the 74

sanctioned posts of Specialist, 30 of the 83 sanctioned posts of Medical Officer, 157 out of the

193 sanctioned posts of Staff Nurse, 4 of the 25 sanctioned posts of Lab Technician (LT), 5 of

the 37 sanctioned posts of LHV and 89 out of 174 sanctioned posts of MPW (M) were lying

vacant in the district.

b) Similarly, in case of contractual staff under NRHM, 5 of the 13 posts of Medical Officer, one

of the 13 posts of Staff Nurse (CEmOC) and 57 of the 117 posts of ANMs, required in the

district were lying vacant.

c) 13 Doctors/Specialists were in position out of 24 posts sanctioned in District Hospital. Among

the paramedical staff, 70 out of 80 sanctioned posts of Staff Nurse, one out of 2 sanctioned

posts of Ophthalmic Assistant, 2 out of 6 sanctioned posts of LT, 2 out of 3 sanctioned posts of

Radiographer, 3 out of 5 sanctioned posts of Pharmacist and all four sanctioned posts of Lab

Attendant were lying vacant at the District Hospital.

d) In visited CHC Susner, one post each of Paediatrician, Medical Specialist, Gynaecologist,

Surgical Specialist and Anaesthetist was lying vacant. 2 posts each of the Nurse and ANM

against 3 sanctioned posts were vacant in CHC Susner. Likewise, in CHC Mohan Barodiya, one

post each of Medical Specialist, Gynaecologist and Surgical Specialist was lying vacant. All 6

sanctioned posts of Staff Nurse were also vacant in the CHC.

2. Rogi Kalyan Samiti (RKS) & Village Health Sanitation and Nutrition Committee

(VHSNC):

421

a) There are 27 Rogi Kalyan Samitis registered in 7 CHCs, 19 PHCs and at the District Hospital

in the district. The team has observed that the meetings of RKS were being conducted regularly

at visited CHCs and PHCs except at PHC Mohana.

b) Every CHC and PHC are given Rs. 1,00,000 as RKS fund per year in the district. It was also

reported that the authorities take into account the opening balance while providing the elegible

amount of Rs. 1,00,000 to each RKS. Every RKS at CHC and PHC was having sufficient fund in

the year 2010-11 and 2011-12 as per provision made above but CHC, Barod have been given

full eligible amount of Rs. 1,00,000 during the year 2011-12 in spite of having opening balance

of more than Rs. 68,000.

c) Out of 7 RKS at CHCs, 100% fund had been spent by 5 RKS, 32% fund spent by CHC Barod

and no fund utilised by CHC Sundarsi in the year 2010-11. Similarly, out of 19 RKS at PHCs no

fund had been utilised by 10 PHCs, 2 PHCs spent 100% fund, 2 about 5-9% and rest of the

PHCs utilised the amount in the range of 50 - 90% during 2010-11. Also it was observed that

there were 4 PHCs having about 1 to 2 lakhs amount but none of them spent any amount

during the year 2010-11.

d) No RKS fund was utilised during 2011-12 by the CHCs/PHCs up to visiting month.

e) Totally 846 VHSNCs are formed against 1065 villages in the district. All 846 Village Health

Sanitation and Nutrition Committees were having ASHA as a member and 781 VHSNCs

opened their bank account for handling the funds.

3. Janani Suraksha Yojana (JSY):

a) JSY status in the district and visited CHCs as reported is as under:

(Amount in Rs.)

Particulars

District as a

whole

CHCs

Susner M. Barodiya

2010-

11

2011-

12 #

2010-11 2011-12 # 2010-11 2011-12

#

Total no. of deliveries 28,315 10,300 2,551 1,066 1,108 503

Total no. of Institutional deliveries

conducted

27,245 9,996 2,172 724 1,094 499

Total no. of delivery eligible for JSY and

paid incentive

27,556 10,015 2,225 738 1,108 503

Total fund received for JSY NA NA 72,00,000 26,00,000 53,00,000 22,00,000

Expenditure incurred under JSY NA NA 49,66,440 15,78,846 26,72,290 10,63,300

NA: Not Available

#: upto Aug.‟ 2011

c) JSY status in the visited PHCs as reported is as under:

422

(Amount in Rs.)

Particulars

Name of PHCs

Berchha Bolai Gulana Soyatkalan

2010-11 2011-12 #

2010-11 2011-12 #

2010-11 2011-12 #

2010-11 2011-12 #

Total no. of Institutional deliveries eligible for JSY

479 226 172 46 233 137 723 269

No. of beneficiaries to whom incentive was paid

479 226 172 46 233 137 723 257*

Total fund received for JSY

10,00,000

4,72,000

2,50,000 40,100 4,60,000 2,86,961 12,75,000

5,77,375

Expenditure incurred under JSY

9,68,000 454000 2,49,900 28,000 4,53,049 2,12,350

12,47,625

5,31,375

# upto Aug.‟ 2011.

* 12 JSY beneficiaries are reported to be residing in remote area. They went to their homes

after delivery and discharged from the hospital without JSY money. Due to inaccessible area the

beneficiaries could not turn up to collect the JSY incentive from the institutions.

c) Out of 51 selected cases, 43 JSY beneficiaries were contacted in the area of visited Sub

Centres and found that all beneficiaries received monetary benefit under JSY. All beneficiaries

accompanied by ASHA/Dai for delivery were satisfied with the services. 38 (88%) beneficiaries

got three Ante natal checkups (ANC) and also 28 (65%) beneficiaries got three Post natal

checkups (PNC). 29 (67%) beneficiaries used Janani Express to go to hospital for delivery

purpose.

4. Functioning of ASHA Scheme:

a) It was reported that 1045 ASHAs have been selected against 1065 villages in the district.

1035 ASHAs were trained but drug kits were provided to 1011 ASHAs.

b) Status of ASHA scheme in the visited CHCs:

Particulars CHCs

Susner M. Barodiya

Total No. of ASHA required 125 164

No. of ASHA in position 116 133

No. of ASHA trained 116 133

No. of ASHA provided with drug kit 92 133

No. of VHSCs functioning 96 120

No. of VHSCs having ASHA as a member 96 120

423

c) 9 ASHAs were interviewed in 5 visited PHCs and none of them was observed to be having Kits

containing EC pills.

d) During visit to the PHCs at Berchha, Soyatkala, Gulana, Mohana and Bolai, it was observed

that ASHAs were receiving performance based remuneration on an average Rs. 800-1600 per

month

5. Untied Funds:

a) The team looked into the status of untied funds and Annual Maintenence Grant provided to

the CHCs and PHCs in the district. CHC @ Rs. 1,50,000 and PHC @ Rs. 75,000 was given as

untied fund and AMG jointly during the year 2010-11 and 2011-12 (upto August, 2011) in the

district. As per the statement received from the DPMU, the district authority take into account

of the opening balance while providing the funds to each CHC and PHC. Though there was a

balance to the tune of Rs. 45,900 at CHC Nalkheda and Rs. 549 at CHC Kalapipal, the full

amount Rs. 1,50,000 was given to them in the year 2010-11. Similarly, though the PHC at

Burchha was having huge balance, full amount of Rs. 75,000 was given to this PHC during the

year 2010-11 and 2011-12.

b) No CHCs and PHCs spent full amount except CHC Sundersi and PHCs at Bolai, Tilwad

Maina and Khokra Kalan in the year 2010-11.

c) During current year 2011-12 no expenditure was incurred by any CHC and PHC.

6. 24 x 7 Hours Delivery Care Services:

a) There are 17 institutions ( 4 in CEmONC and 17 in BEmONC) functioning as 24x7 hours

service in the district.

b) The team has observed that the services are being provided by 6 visited institutions (District

Hospital Shajapur, 2 CHCs at Susner and M. Barodia and 3 PHCs viz. Soyatkala, Berchha and

Bolai) in the district. There were sufficient no. of Doctors and Paramedical staff to perform the

24x7 hours services in the visited CHCs Mohan Barodia & Susner. There was only one MO at

visited PHCs Soyatkala and Bolai. Only one ANM was in position at PHC Soyatkala.

c) Blood Storage Facility was not available at the visited CHCs/PHCs. Mother and New born

baby care facilities were available at CHC Susner and PHC Soyatkala.

7. Physical Infrastructure and Stock Position:

i. CHCs:

a) CHCs Susner and M. Barodia were functioning in their own building with neat and clean

premises. Water and electricity with power back up was available at both the CHCs. Both

CHCs were having 30 bedded facility. Presently, 20 and 50 beds were found in good condition

at the Susner and M. Barodia respectively.

b) Anaesthesia Equipments and Incinerator facility were not available at both the CHCs.

424

c) Blood Storage Unit was non functional at CHC Susner and was not setup at CHC M.

Barodia.

d) Residential quarters for doctors and Para medical staff were not available at both the visited

CHCs.

e) Vital, Essential drugs and Quinine Injections were available in both the CHCs, but Arteether

Injection was available only at CHC Susner.

f) No post of Specialists was in position in M. Badodiya, only one Specialist was in position in

Susner CHC.

ii. PHCs:

a) PHCs visited at Berchha, Gulana, Bolai and Soyat kalan were functioning in Govt. buildings

with regular water supply, electricity with power back up and also toilet facility. Telephone facility

was available only at Berchha and Soyatkala PHCs.

b) Residential quarter for Medical Officer was available at all PHCs except PHC Mohana. There

was no vehicle available in any of the visited PHCs except Berchha.

c) Functional Operation Theatre with OT table was available only at two visited PHCs (Berchha

and Soyatkala).

d) Autoclave/Steam sterilizer, Minor Surgical Equipment, Labour room Resuscitation Equipment

was available at all PHCs except Mohana. Microscope was available at Berchha and Soyat kala

PHCs. Lab Technician was available in only Berchha PHC.

e) The stock of contraceptive items (IUD, OP and CC) was not available in sufficient quantity

except in Berchha and Bolai PHCs. Stock of vaccines (BCG, DPT, Polio, Measles, DT & TT)

was found only in PHCs Mohana and Bolai.

iii. HSCs:

a) All the visited Sub Centres were functioning in Govt. building except HSCs Gulana, Nipaniya

and Panwadi. Though main source of water supply was handpump in most of the visited HSCs.

Such facility was not available at Gulana, Nipaniya and Panwadi HSCs. Labour rooms were

available only in Dongargaon Sub Centre.

b) MPW (M) was not available at Gulana, Nipaniya, Salsalai, Choma and Sunera Sub Centres.

c) Rapid Diagnosis test kit for malaria was not available at Dongargaon, Nipaniya, Salsalai and

Abhyarpur HSCs.

d) DDKs, Kerosene oil/gas cylinder, Sanitary Napkins, Emergency Contraceptive Pills,

Gentamycin and Oxytocin Tablets were not available at any of the visited Sub Centres. Gloves,

Vit-A, IUDs, Oral Pills, Condoms, Antiseptic Solution, Bleaching powder and Ampicillin cap were

not available at some of the visited Sub Centres. Kit-A & Kit-B were not provided for current

year in any of the visited SCs.

425

e) It was observed that none of the service registers was regularly checked/verified by the

PHC/CHC/district officials. Only MCH registers were found checked in the visited Sub Centres.

f) The SBA and IMNCI training was not provided to the ANMs in the visited SCs. Only ANM at

the SC Dongargaon received both SBA and IMNCI training.

g) During last three months supervision was not done in any of the visited SCs.

8. Community Satisfaction on overall health Service:

i. ANM and MPW (M) Services:

a) 60 mothers having child up to one year old were contacted in the area of visited centres. 37

(62%) mothers reported that ANM was available when needed. 11 (18%) mothers received all

three required post natal check ups. 26 (43%) mothers knew about danger sign of ARI. 39

(65%) mothers were aware about contraceptive methods. Only 17 (28%) mothers have been

told about the advantage and side effects of contraceptive methods. All mothers replied that the

immunization session were being held regularly in their villages and all of them were aware of

government health facilities.

b) Out of 9 visited Sub Centres, MPW(M) were posted in 4 Sub Centres. After discussions with

Teachers, Sarpanch, ASHA, Nirodh users and villagers, the team found that most of the Male

Workers were not staying at the Sub Centre headquarters and not visiting the villages, though,

behaviour of most of the male workers towards the villagers was found good. All workers

attended health clinic/immunization/VHNDS session regularly and were available when health

programmes were organized in the villages.

ii. PHC level Services:

a) Villagers in the area of PHCs were satisfied with the services of PHCs. However, some of

the women were not sufficiently aware about danger signs in pregnancy, danger sign of sick

new born, contraceptive methods, Family Welfare methods and STD/HIV- AIDS.

b) MOs at none of the visited PHCs were staying at the PHC HQs except Berchha PHC.

Regular presence of M.O at PHCs was satisfactory except two PHCs Gulana and Mohana.

Likewise, visit to the villages of PHCs was done during last six month by the MOs in PHCs

Gulana and Mohana only.

9. Sample verification of Family Welfare Acceptors:

a) The team selected 226 FW acceptors for sample verification, out of them 82 (36%) could be

contacted. While examining the service registers of the FW acceptors, it was observed that 117

cases were not recorded with the age of spouse.

b) Out of contacted 39 cases of IUD 21 (54%) acceptors were found to be reported false.

c) It was also found that 46 OP users and 40 Nirodh users selected from the visited Sub

Centres for verification were false. These cases created and recorded in the registers by

426

the ANMs without providing the OP cycles and Nirodh pieces to them. There was no stock

of OP/Nirodh in these centres since last one year for which period users were falsely reported.

d) Follow-up services by FW Staff were provided to all acceptors and also provided full amount

of compensation to all the Sterilisation cases.

e) 72 (18 BCG, 18 DPT, 18 POLIO, 13 MEASLES and 5 Vit-A) beneficiaries of child

immunization were contacted. All beneficiaries confirmed receiving the doses and were satisfied

with the services rendered by the health staff. 46 (64%) beneficiaries were found not to had

been contacted by the health workers for follow up services.

10. Reconciliation of Reported Performance:

a) While examining the Sterilization performance for the year 2010-11 in CHC Susner, it was

observed that 19 Sterilizations belonging to the area of the CHC had been operated upon by the

another State/Centre were also included in the performance of Sterilization of CHC Susner.

b) Sterilization figures reported by District office for CHC M. Barodia were 1760 for the year

2010-11 but there figures reported by CHC itself were 1718. In the service register of

Sterilization in CHC M. Barodia, the cases recorded in the register were 1679.

c) There were 1946 IUD performance figures reported for the year 2010-11 by district office for

PHC Berchha as against the 2201cases reported by PHC Berchha for the same year.

d) Due to non maintenance of IUD register at the reporting centres, reported figures could not

be verified for the year 2010-11 in the visited centres.

11. IT Infrastructure & MCH Tracking:

a) 8 Computers were available at the district headquarters. 6 CHCs and 2 PHCs were also

having computers in the district.

b) Internet connectivity was provided to the systems available in the district and at all CHCs

and PHCs.

c) It was reported by the district authorities that all Sub Centres have MCH Tracking formats.

The health functionaries of Block level, CHC, PHC and SCs are sensitized in MCH formats.

Data entry is done at CHC level only.

12. Maintenance of Registers & Records:

a) Non printed Sterilization Register was maintained properly in CHCs Susner and M. Barodiya,

PHC Berchha and DH Shajapur. IUD register was not maintained in the CHCs/PHC/DH level.

b) Under MCH register, ANC/ PNC/ Immunisation register/ Immunisation card were printed and

maintained properly at most of the centres visited.

c) Stock register, JSY register and Sterilisation case cards were printed and maintained

properly at CHC, PHC and DH.

d) None of the visited Sub Centres maintained Cash Book & untied fund registers.

427

13. Other Important Observations :

a) In district Shajapur, there was short supply of OP and Nirodh. The reporting was made by the

Sub Centres workers on the basis of old users of OP and Nirodh in spite of no distribution of

OP and Nirodh to the beneficiaries.

b) Most of the staff in the visited CHCs, PHCs & HSCs were not residing in their headquarters.

c) Post natal care services were found poor in the villages.

d) The team observed that the supervision at the peripheral centres was totally lacking resulting

in poor maintenance of records and registers.

e) In the visited institutions, it was noticed that villagers prefer Dais to ASHAs as Dais are

available more conveniently any time at their homes. ASHAs reported not receiving motivation

payments.

*******

3. District Rajgarh:

Major observations of Regional Evaluation Team (RET), Bhopal on the evaluation work

carried out in Rajgarh District of Madhya Pradesh State in the month of January, 2012 .

i) Details of the visited Institutions:

Rajgarh DH: Rajgarh

CHC: Jeerapur, Khilchipur & Boda

PHC: Goghatpur, Machalpur,

Pipalyakulmi, Chhapiheda &

Kurawar

Kumda, Pipalyakulmi, Goghatpur, Ranara,

Kundibeh, Bairasiya, Ganiyari and

Amalyahat.

II. Major Observations:

1. Human Resources:

a) In the visited district, acute shortage of manpower was observed. 69 of the 80 sanctioned

posts of Specialist, 42 of the 107 sanctioned posts of Medical Officer, 166 out of the 210

sanctioned posts of Staff Nurse, 16 of the 30 sanctioned posts of Lab Technicians, 11 of the 40

sanctioned posts of LHV, 9 of the 28 sanctioned posts of Multipurpose Supervisor (MPS) and 46

out of 127 sanctioned posts of MPW (M) were lying vacant in the district.

428

b) Similarly, among the contractual staff under NRHM, post of PGMO (Gynaecologist), 2 of the

8 posts of Medical Officer, 17 of the 31 posts of Staff Nurse (CEmOC), 22 of the 22 posts of

Staff Nurse (BEmOC) and 51 of the 105 posts of ANMs required in the district were lying

vacant.

c) Only 19 Doctors/Specialists were in position out of 62 posts sanctioned in District Hospital.

Among the paramedical staff, 84 out of 100 sanctioned posts of Staff Nurse, 4 out of 8

sanctioned posts of Lab Technician and one post each of Ophthalmic Assistant, Lab Assistant

and Radiographer were lying vacant at the District Hospital.

d) At visited CHCs Jeerapur, Khilchipur and Boda, posts of Medical Specialist, Surgical

Specialist and Ayush Medical Officer were lying vacant. Posts of Medical Officer was vacant in

CHC Jeerapur.

e) In PHC Machalpur, post of Medical Officer was lying vacant. Likewise, the post of

Compounder was vacant in the Machalpur and Kurawar PHCs. The post of Staff Nurse was

vacant in Pipalyakiulmi and Chhapiheda PHCs.

2. Rogi Kalyan Samiti (RKS) & Village Health Sanitation Nutrition Committee

(VHSNC):

a) There are 31 Rogi Kalyan Samitis registered in 5 CHCs, 22 PHCs, 3 Civil Hospital and at

District Hospital in the district. The team observed that the meetings of RKS were being

conducted regularly at visited CHCs and PHCs except at PHC Pipalyakulmi.

b) Every CHC and PHC are given Rs. 1,00,000 as RKS fund per year in the district. It was also

reported that the authorities take into account the opening balance while providing the eligible

amount to each RKS. Every RKS at CHC and PHC was having sufficient fund in the year 2010-

11 and 2011-12 as per provision made above. During 2011-12 (up to January, 2012), none of

CHCs incurred expenditure except CHC Boda which had spent 98% of the allotted funds. No

fund was allotted to PHCs Kotara, Kunwar Kotari, Dhabala, Bhagora and in the year 2010-11

and during 2011-12 (up to January, 2012), PHCs Bhaisana, Kunwar Kotari, Chhapiheda,

Bhojapur and Somwariya did not receive RKS funds. PHCs Bhaisana, Kunwar Kotari,

Chhapiheda, Bhojapur and Somwariya did not spend any amount during the year 2010-11.

During 2011-12 (up to January, 2012) no PHCs had spent any expenditure except PHCs Iklera

and Goghatpur.

c) Totally 1434 VHSNCs are formed against 1727 villages in the district. 938 Village Health

Sanitation and Nutrition Committees were having ASHA as a member and all 1434 VHSNCs

opened their bank account for handling the funds.

3. Service of Janani Suraksha Yojana (JSY):

429

a) As per the report received from visited District, CHCs and PHCs, the status of JSY scheme is

given below:-

Sl.

No.

Particulars Year District

level

CHC

Jeerapu

r

CHC

Khilchp

ur

CHC

Boda

PHC

Machalp

ur

PHC

Chhapihe

da

1 No. of Institutional

deliveries conducted

20010-

11

26903

3448

3409

3580

357

475

2011-12

II

18580

2575 2658 2185 277 456

2

No. of beneficiaries

Paid with incentives

20010-

11

26681 3448 3471 3652 357 475

2011-12

II

18356 2575 2715 2233 277 456

3 Total fund recd. for

JSY

20010-

11

*

6950000

*

*

NR

NR

2011-12

II

*

4700000

*

*

NR NR

4 Exp. Incurred under

JSY

20010-

11

426.32 5514268

5556826

4

59635

00

- -

2011-12

II

282.64 3683718 411032

2

35842

95

- -

i) NR - Not Received

ii) II - For up to Jan. 2012.

iii) * - Amount spent from RCH Flexi Pool budget as per expenditure made.

b) 27 JSY beneficiaries were contacted at the visited Sub Centres area and found that all

beneficiaries had received monetary benefit under JSY. 22 beneficiaries accompanied by

ASHA/Dai for delivery were satisfied with the services. 26 (96%) beneficiaries got three Ante

natal checkups (ANC) and also 13 (48%) beneficiaries got three Post natal checkups (PNC). 20

(74%) beneficiaries used Janani Express to go to hospital for delivery purpose.

4. Functioning of ASHA Scheme:

a) It was reported that 1023 ASHAs were selected for 1727 villages in the district.

430

b) It has also been reported that 938 ASHAs have been trained in the district and provided with

drug kits.

c) During visit to the Sub Centres in the district it was observed that most of the ASHAs were

working properly and all of them had Kits. They were accompanying the mothers for institutional

deliveries, helping in immunisation services and also assisting ANMs in providing ANC/PNC and

sterilisation relating services.

5. Untied Funds:

a) CHCs @ Rs. 50,000 and PHCs @ Rs. 25000 were being provided as untied fund during the

year 2010-11 and 2011-12 (up to January, 2012) in the district. As per the statement received

from the district, 2 out of 5 CHCs spent 100% untied fund during the year 2010-11. Most of all

PHCs in the block Boda and Zirapur spent their available funds during 2010-11. CHCs and

PHCs in the block of Boda and Zirapur have not started to utilise the untied fund during 2011-12

up to January, 2012.

b) All the visited Sub Centres had received Untied funds of Rs. 10,000 except Goghatpur SC

both for the year 2010-11 and 2011-12 (up to January, 2012). The details are as under:

(Amount in Rs.)

Sub Centres 2010-11 2011-12 (up to January, 2012)

Allotment Expenditure Balance Allotment Expenditure Balance

Kumda 10,000 10,000 0 10,000 10,000 0

Pipalyakulmi 10,000 10,000 0 10,000 0 10,000***

Goghatpur The post of ANM is vacant for 2 yrs. MPW (Male) of another SC attached to

Goghatpur on temp. basis. Thus, no Untied fund provided to this SC.

Ranara 10,000 10,000 0 10,000 5,000 5,000

Kundibeh 10,000 10,000 0 10,000 10,000 0

Bairasiya 9,500 9,500 0 9,500 7,500 2,000

Ganiyari 10,000 10,000 0 10,000** 0 10,000

Amalyahat 10,000 10,000 0 10,000 10,000 0

** Untied funds was received in the month of January, 2012 and no expenditure incurred till the

month of visit by the team.

*** The fund could not be withdrawn as new Sarpanch did not complete the Bank requirements

as joint account holder with ANM.

6. 24 Hours Delivery Care Services:-

a) There were 16 institutions ( 2 in MCH level 3 and 14 in MCH level 2) functioning as 24x7

hours services in the district.

431

b) The team observed that the services are provided in 6 visited institutions (District Hospital

RaJgarh, 3 CHCs Jeerapur, Khilchipur and Boda and 2 PHCs viz. Machalpur and Chhapiheda)

in the district. There were sufficient no. of Doctors and Paramedical staff to perform the 24x7

hours services in the visited CHCs Narsinghgarh, Jeerapur, Khilchipur and Boda. There was

one MO at PHC Machalpur and 2 MOs at PHC Chhapiheda. Only one ANM was available in

PHCs Machalpur and Chhapiheda.

c) Blood Storage Facility was not available at the visited CHCs/PHCs. Mother and New born

baby care facilities were available at CHCs Narsinghgarh and Jeerapur and PHC

Chhapiheda.

7. Physical Infrastructure and Stock Position:

i. CHCs:

a) CHCs Susner and M. Barodia were functioning in own building with neat and clean premises.

Water and electricity with power back up was available at the visited CHCs. The CHCs were

having 30 bedded facility except CHC Boda, which had 20 beds.

b) Blood Storage Unit and Sick Newborn Care Unit were not available at all the visited CHCs.

c) X-Ray facility at CHC Jeerapur was not functional due to improper electric fittings.

d) Vital and Essential drugs were available in all the CHCs, but Quinine Injections was not

available at CHC Jeerapur. Arteether Injection was not available in CHCs Jeerapur and

Khilchpur.

e) It was reported that no Specialist was in position in visited CHCs.

ii. PHCs:

a) PHCs visited at Goghatpur, Machalpur, Pipalyakulmi, Chhapiheda and Kurawar were

functioning in Govt. buildings with regular water supply and electricity with power back up

except PHC Pipalyakulmi. Telephone facility was not available in Goghatpur and Pipalyakulmi

PHCs.

b) Residential quarter for Medical Officer was available only in Machalpur PHC. Functional

Operation Theatre with OT table was available at the visited PHCs except PHC Pipalyakulmi.

c) Microscope and Lab Technician were not available at Goghatpur PHC. The stock of

Prophylactic Drugs (IFA and Vitamin A etc.) was not available in Pipalyakulmi and Kurawar

PHCs.

d) The stock of OP and CC was not available in Pipalyakulmi, Chhapiheda and Kurawar PHCs.

iii. HSCs:

a) Visited Sub Centres were functioning in Govt. building except Pipalyakulmi, Bairasiya and

Ganiyari. Water facility was not available at Kumda, Goghatpur and Bairasiya HSCs. Electricity

was not available at Kumda, Goghatpur, Ranara and Kundibeh Sub Centres. Labour rooms

432

were available only in Kundibeh and Amalyahat Sub Centres but delivery was conducted in

Amalyghat but not in Kundibeh SCs.

b) Examination table, Cupboard for drugs, Weighing machine for adults and infants,

Haemoglobinometer. BP apparatus, AD Syrings, Disposal Syrings, Slides for blood test, ORS,

IFA tablets, Paracetomol tablets and Chloroquine tablets were available at all the visited Sub

Centres.

c) Delivery table was available at all the visited Sub Centres except Kundibeh and Bairasiya

Sub Centres.

d) DDKs, Kerosene oil/gas cylinder, Sanitary Napkins, Kit-A & Kit-B, Ampicillin cap, Injection

Gentamycin and Oxytocin Tablets were not available at any of the visited Sub Centres. Steam

Sterilizer was available at all the visited Sub Centres except Kumda SC. Nischay Pregnancy

Test Kit, Gloves and Vitmine A Solution were available at all the visited Sub Centres except

Bairasiya SC. Delivery kit was not available in Pipalyakulmi and Ganiyari Sub Centres. IUD

insertion kit was not available at Goghatpur SC. Rapid Diagnosis Test Kit for malaria was not

available at Kumda, Ranara, Kundibeh, Bairasiya and Ganiyariu SCs.

e) Oral Pills were not available in Kundibeh, Birasiya and Amalyahat Sub Centres since

October, 2011. Condoms were not available in Pipalyakulmi, Ranara, Kundibeh, Birasiya,

Ganiyari and Amalyahat Sub Centres since October, 2011.

8. Community Satisfaction on overall health Service:

i. ANM and MPW (M) Services:

a) 43 mothers having one year old child were contacted. 21 (48.8%) mothers reported that ANM

was available when needed. 9 (20.9%) mothers received three post natal check up (PNC). 16

(37%) mothers knew about danger sign of ARI. 25 (58%) mothers were aware about

contraceptive methods. Only 10 (23%) mothers have been told about the advantage and side

effect of contraceptive methods. All mothers replied that the immunization session are being

held regularly in their villages and all of them were aware of government health facilities.

b) Out of 8 visited Sub Centres, MPW(M) were posted in 2 Sub Centres. Contacted Teachers,

Sarpanch, ASHA, CC users and villagers, opined that behaviour of most of the male workers

towards the villagers was good. All workers attended health clinic/immunization/VHNDS session

regularly and were available when health programmes were organized in the villages.

ii. PHC level Services:

a) 10 pregnant women, 8 recently delivered women, 10 mothers of 2 year old child, 8

Anganwadi workers and 4 village leaders were interviewed by RET in 4 visited PHCs

Goghatpur, Machalpur, Pipalyakulmi and Chhapiheda. Village leaders in the area of PHCs were

satisfied with the services of PHCs. However, some of the women were not sufficiently aware

433

about danger sign in pregnancy, Danger sign of Sick New Born Child, Contraceptive methods,

Family Welfare methods and STD/HIV & AIDS.

b) 50 persons utilizing the services of PHCs were interviewed in 4 PHCs. MOs of visited PHCs

did not stay at PHC HQ except PHC Chhapiheda. Post of MO is vacant in Pipalyakulmi PHC. 41

persons answered positively about MO‟s regular presence in 4 visited PHCs. Regular MO of

PHC Machalpur had gone for PG course for 18 months and MO from PHC Bhagora was

attached to PHC Machalpur.

9. Sample Verification of Family Welfare Acceptors:

a) Out of 92 selected samples of family planning acceptors, 74 (80%) acceptors could be

contacted for sample verification in the district.

b) While examining the service registers of selected cases, it was found that age of acceptors in

17 (18%) cases and age of spouse in 32 (34.8%) cases was not recorded. Age of the youngest

child was also not recorded in 2 (2%) cases.

c) During sample verification, 13 (55%) out of 24 contacted acceptors of IUD were found to be

false.

d) Follow up service was provided to 40 (65.6%) acceptors.

e) 90 beneficiaries of BCG/ DPT/ Polio, Measles, Vitamin- A and Hepatitis –B were contacted

out of 122 selected in the field and all contacted beneficiaries were satisfied with services and

no complication had been reported after receiving the doses. Follow up services by health staff

were provided to 36 (40%) contacted beneficiaries and rest of the 54 (60%) beneficiaries

informed that they did not receive any follow up services.

f) No sample verification of OP and Nirodh users could be done by the team as the concerned

record was not produced before the team for the year 2010-11 and 2011-12 at the Sub Centres

visited.

10. Reconciliation of Reported Performance:

a) The district office reported 548 IUD acceptors against the reported cases of 561 by CHC

Jeerapur for the year 2010-11.

b) Incomplete IUD register was found in CHC Jirapur for the year 2010-11 and 2011-12. There

were only 140 and 41 IUD cases recorded in the register against the reported figures of 561 and

416 for 2010-11 and 2011-12 up to January, 2012 respectively in CHC Jirapur.

c) Due to non maintenance of IUD register at CHCs Khilchipur and Boda, reported figures could

not be verified for both the years 2010-11 and 2011-12 (up to January, 2012).

11. IT Infrastructure and Mother & Child Tracking System:

a) 11 Computers & 5 Laptops were available at the district headquarters. 13 CHCs and 4 PHCs

were also having computers in the district.

434

b) Internet connectivity was provided to the systems available in the district and at all CHCs but

not in the PHCs.

c) It was reported that the in the visited district, all Sub Centres are having MCH Tracking

formats. The health functionaries of Block level, CHC, PHC and SCs are sensitized in MCH

formats. Data entry is done at CHC level only.

12. Maintenance of Registers & Records:

a) Non printed Sterilization Register was maintained properly in CHCs Khilchipur and Boda

except CHC Jeerapur. IUD register was not maintained in the CHCs/SCs level.

b) OP and Nirodh distribution registers were maintained workerwise at SC level but were not

maintained at CHCs Jeerapur, Khilchipur and Boda.

b) Under MCH register, ANC/ PNC/ Immunisation register/ Immunisation card were not printed

and maintained properly at most of the centres visited.

c) Stock register, JSY register and Sterilisation case cards were printed and maintained

properly at CHC and SC level.

d) None of the visited Sub Centres maintained Cash Book & untied fund registers.

13. Other Observations:

a) Lack of supervision was noticed at DH/CHC/PHC/SC levels during the visit. Most of the staff

in the visited CHCs/PHCs and Sub Centres were not residing in their head quarters.

b) In spite of the availability of X-ray machine, it was not functional in Zeerapur CHC due to

faulty electric connection.

c) EC Pills, Condoms and OP were not provided to ANMs & MPW (Male) since October, 2011.

d) The team observed that Data Entry in respect of different health activities was not done at

CHC Khilchipur, as the Computer Operator was attached to Civil Surgeon Office, Rajgarh since

last three years.

e) Post natal care services were found poor in the villages.

f) JSY payment were made by Account Payee Cheque for both Institutional and Home

deliveries to the beneficiaries. It is learnt that villagers and illiterate beneficiaries are facing a lot

of difficulties for opening of account in the bank as per the procedure and in some areas banks

are also not available. Hence, the home delivered beneficiaries are lacking interest in taking

their cheques for deposit in banks.

*******

435

4. District Sehore :

Highlights of Evaluation Report

Sehore and Dewas Districts of Madhya Pradesh State

The Regional Evaluation Team, located in the Regional Office for Health and Family Welfare

Bhopal, Ministry of Health and Family Welfare, Government of India carried out sample checks

of activities covered under NRHM / RCH in Sehore District of Madhya Pradesh State in the

month of July 2011.

i) Details of the visited Institutions:-

District Visited DH/ CHCs/PHCs Visited HSCs Visited

Sehore DH: Sehore

CHCs: Aashta and Ichchawar.

PHCs: Kotari and Amlaha

Mugali, Harnawada, Kothari

Pathar, Borkheda, Bordi Kala,

Amlaha, Brijesh Nagar, Golu

Khedi and Damanda

ii. Major Observations:

1. Health Human Resources:-

a) The post of the Administrative Officer, ASO, Steward and Chief Clerk was vacant. Further, 5

out of 22 sanctioned posts of Specialist, 42 out of 75 sanctioned posts of Staff Nurse, 1 out of 5

sanctioned posts of Nursing Sister, 10 out of 12 sanctioned posts of Compounder and all 3

sanctioned posts of Matron were lying vacant.

b) In CHC Ichchwar, all 2 sanctioned posts of Specialist, one out of 3 sanctioned posts of

Medical Officer, post of Nursing Sister and 3 (1 regular and 2 contractual) out of 6 (4 regular and

2 contractual) sanctioned posts of Staff Nurse were lying vacant.

c) Sanctioned Posts of compounder and LHV was lying vacant in PHC Amlaha.

d) Additional ANM was not posted at Kothari Pathar, Borekheda and Amlaha Sub Centres.

MPW (M) post was vacant at Dhamanda and Bordikala Sub Centres.

2. Rogi Kalyan Samiti (RKS) & Village Health Sanitation and Nutrition Committee

(VHSNC):-

a) Rogi Kalyan Samiti was reported to be set up at the visited CHCs Aashta and Ichchwar and

PHC Kotari but it was not constituted at visited PHC Amlaha.

b) Details of the availability and utilisation of RKS funds in the CHCs and PHCs of Blocks

Aashta and Ichhawar are as under:

436

(Amount in Rs.)

Name of CHC/

PHC

2010-11 2011-12

Opening

Balance

Allotment Expenditure Opening

Balance

Allotment

Expenditur

e

CHC Ashta 100140 100000 100152 99988 100000 99988

CHC Jawar 93735 50000 93735 50000 100000 49230

CHC Ichchwar 0 100000 100000 0 100000 Nil

PHC Maina 59927 50000 58915 51012 0 Nil

PHC Siddiganj 100000 100000 100000 100000 100000 100000

PHC Kothari 21095 50000 Nil 71095 100000 71095

PHC Ram Nagar 0 100000 Nil 100000 0 Nil

PHC Divadia 0 100000 100000 0 100000 Nil

c) It is observed from the above table that there was no proper RKS allotment system in the

district. Many of the institution were given full amount during both year even huge opening

balance was lying with them.

d) The team visited two blocks Ichchwar and Aastha. VHSNC was constituted in 103 villages

out of 145 villages in Ichchwar block. All VHSNCs had bank account, but only 85 VHSNCs were

having ASHA as a member. In Aashta Block, VHSNC was constituted in 172 villages out of 283

villages. All VHSNC had bank account and also ASHA is a member of VHSNC.

3. Service of Janani Suraksha Yojana (JSY):-

a) JSY status in the visited CHCs is as reported under:

(Amount in Rs.)

Items CHC Aashta CHC Ichchwar

2010-11 2011-12 2010-11 2011-12

Number of institutional

Delivery conducted at the

centres

5312 1095 2336 521

Number of beneficiaries to

Whom JSY money was paid

5312 1095 2336+132

(Home Delivery)

521+16

(Home Delivery)

Total fund received under

JSY

94,36,052 19,58,352 41,80,248 8,68,150

Expenditure incurred under

JSY

93,93,750 18,44,500 41,80,248 8,68,150

Balance amount 42,302 1,13,852 Nil Nil

437

b) 24 beneficiaries were contacted by the team in the area of 6 Sub Centres and found that all

beneficiaries were satisfied with the services. 23 (96%) deliveries were institutional and all 24

mothers received the services during ANC period. All the contacted mothers received monetary

benefit under JSY.

c) About 20 (83%) beneficiaries were accompanied by ASHA/Dai while going to the hospital for

delivery. Further, 10 (42%) mothers arranged transportation by themselves and none of them

got money for transportation.

d) Only 3 (13%) mothers got three post natal checks up by ASHAs and ANMs.

e) Registers in respect of JSY were being maintained properly containing list of beneficiaries to

whom cheques / Cash were given at visited District Hospital, CHCs and PHCs. Registers were

also being checked every month regularly by Medical Officer in the visited institutions.

4. Functioning of ASHA:-

a) As reported by the team, 209 & 140 ASHAs were in position in visited Blocks Aashta and

Ichchawar respectively in the district. All ASHAs in both the blocks were trained and had drug

kits.

b) In the visited Sub Centres of the blocks Aashta and Ichchawar, the existing ASHAs were

found to be trained and working properly.

5. Untied funds:-

i) CHCs Untied Fund:

a) As reported, CHCs Aashta and Ichchawar were provided @Rs. 50,000 each as Untied Funds

during the year 2010-11 and the same was utilised by the centres.

b) CHC Jawar incurred only 45.6% expenditure out of Rs. 64,498 Untied Fund available during

2010-11.

c) Untied funds for the year 2011-12 was provided to CHCs Aashta and Ichchawar @ Rs.

50,000 each but not to CHC Jawar as unspent balance to the tune of Rs. 35,105 was lying with

the centre. During the year 2011-12, CHC Aashta and Jawar spent full amount whereas CHC

Ichchawar incurred only 2,700 (5%) expenditure till the visit by the team.

ii) PHCs Untied Funds:

a) PHCs visited at Maina, Siddi Gung, Kotari, Ram Nagar and Divadia were provided @ Rs.

25,000 each as Untied Fund during 2010-11, but utilisation of the funds during the year was not

satisfactory. PHCs Maina and Ram Nagar did not incur any expenditure; PHC Siddi Gung

incurred 50% and PHC Kotari incurred 38% expenditure during that year.

b) PHC Amlaha did not receive any untied fund during 2010-11.

c) Untied funds for the year 2011-12 was provided only to PHCs Divadia and Amlaha @Rs.

25000 each; No funds allotted to other PHCs as they had sufficient opening balance. During the

438

year 2011-12, PHCs Siddi Gung and Kotari spent full funds whereas other PHCs did not incur

any expenditure till the visit of the team.

iii) HSCs Untied Funds:

a) In Block Aashta, total 11 Sub Centres were provided with Untied Funds during 2010-11 and

2011-12, but it was observed that 3 Sub Centres did not utilize the fund during 2011-12 till the

visit of the team.

b) In Block Ichchawar, total 30 Sub Centres were provided with untied funds during 2010-11

and 2011-12, out of which, 29 Sub Centres utilized the funds during year 2010-11 and only 3

Sub Centres utilized the funds during year 2011-12, till the visit of the team.

c) Utilization certificate was submitted by the Sub Centres for both the year.

6. 24 x 7 Hours Delivery Care Services:-

a) These services were being provided in the visited CHCs Aashta, Ichchwar and PHC Kotari.

5321, 2336 & 50 deliveries in 2010-11 and 1095, 521 & 8 deliveries in 2011-12 (up to June,

2011) have been conducted at visited CHC Ashtha, CHC Ichchawar and PHC Kothari

respectively.

b) Though at the visited CHCs facilities were adequate but PHC, Kothari was not having

adequate facility for caring mother and new born baby.

c) CHC Ashtha was functioning with 6 MOs, one specialist, 16 ANMs and 6 Staff Nurses. CHC

Ichchwar was having 3 MOs, 6 ANMs and 3 Staff Nurses. PHC Kothari was functioning with one

MO and 2ANMs. Blood Storage facility was not available at CHC Ichchwar and PHC Kotari.

7. Physical Infrastructure and Stock Position:-

i) CHCs:

a) Both visited CHCs Ichchawar and Aashta were functioning in their own building which were

neat and clean. Water, Electricity with power back up and Residential quarters for Doctor and

Para Medical Staff were available at both visited CHCs. Ambulance was available at CHC

Aashta but it was not available at CHC Ichchawar. 30 & 100 Beds were available and were

maintained in good condition at Ichchawar and Aashta CHCs respectively.

b) Essential equipment and apparatus were available in both CHCs but Anesthesia Equipment,

Blood storage unit and Surgical equipments as per FRU requirement were not available at CHC

Ichchawar. Sick New Born care unit was not set up in both the visited CHCs.

c) Vital, Essential and desirable drugs were available in both visited CHCs, but Arteether and

quinine injections were not available in Ichchawar CHC.

ii) PHCs:

439

a) PHCs Amlaha and Kotari were visited. Both the PHCs were not providing 24 x 7 hour delivery

services but not maintained as per IPHS. PHC Kotari was functioning in own building and PHC

Amlaha was functioning in Sub Centre‟s building. Regular water supply, Electricity facility with

power back up and Toilet facility were available in both visited PHCs.

b) Microscope and minor surgical equipments and functional OT were not available at both

PHCs Amlaha and Kotari. Cold Chain Equipment, Auto Clave/Steam Sterilizer, Oxygen cylinder,

Labour Room, Equipment for delivery purpose and Resuscitation equipment were not available

in Amlaha PHC.

c) Stock of contraceptives and Vaccines was not available at Amlaha PHC and the Prophylactic

drugs were not available at both PHC.

d) AYUSH Medical Officer was not available at Kotari PHC.

iii) HSCs:

a) All the visited Sub Centres were functioning in Govt. building except Kothari Pathar HSC

where Doctor was staying in Sub Centre building and Sub Centre was running in PHC Kothari‟s

building. ANM of Kotari Pathar, Borekheda, Brijish Nagar and Bordikala Sub Centre were not

residing in Sub Centre or Sub Centre area. Additional ANM under NRHM was not available at

Kothari Pathar, Borekheda and Amlaha HSCs. MPW(M) was available at all visited HSC except

Dhamanda and Bordikala HSC.

b) Mobile phone was provided to ANM of Harnawada, Borekheda, and Bordikala Sub Centres.

Electricity was not available at Brijish Nagar and Bordikala Sub Centres whereas Tiolet facility

was not available at Borekheda and Brijish Nagar HSCs.

c) Examination table was not available at Brijish Nagar and Golu Khedi SCs; Delivery table was

not available at Borekheda, Brijish Nagar, Golu Khedi and Bordikala SCs; Nishchay Pregnancy

Test Kit was not available at Harnawada and Bordikala SCs; Delivery Kit was not available at

Borekheda and Golu Khedi SCs; Rapid Diagnosis Test Kit for Malaria was not available at

Mugali, Amlaha, Brijish Nagarand Dhamanda SCs. Macantosh, Ambu bag was not available at

most of the visited Sub Centres.

d) DDKs, Sanitary Napkins, Emergency contraceptive pills, Tab Oxytocin, Injection Gentamycin

and Cap Ampicillin were not available in all the visited SCs. Co-trimoxazole tab was not

available at Kothari Pathar, Amlaha, Brijish Nagar, Golu Khedi and Bordikala SCs; Condoms

was not available at Kothari Pathar, Borekheda, Amlaha, and Brijish Nagar SCs; Anticeptic

solution was not available at Kothari Pathar, Borekheda, Brijish Nagar and Bordikala SCs; Kit-A

& Kit-B was not provided to all visited SCs for the year 2011-12. Delivery was not conducted at

the visited SCs.

440

e) The posters for public awareness were not displayed at Kothari Pathar, Borkheda and

Bordikala Sub Centres.

f) SBA training was not provided to the ANM of all visited Sub Centres except ANM of

Dhamanda sub centre.

8. Community Satisfaction on Overall Services:-

i) Towards HSCs service:

a) 58 mothers having one year old child were contacted, out of them 32 (55%) mothers told that

ANM was available as per need. All mother replied that their last delivery was institutional and

they visited AWC for ANC, PNC, Nutrition & immunization etc.

b) 16 (28%) mothers received three post natal check-up. 57 (98%) mothers were counselled for

exclusive breast feeding and complementary feeds, 27 (47%) mothers knew about danger sign

of ARI in the child, 41(71%) mothers knew the use of ORS, 36 (62%) mothers were aware about

contraceptive methods and 13 (22.41%) mothers have been told about the advantage and side

effect of contraceptive methods.

c) All contacted mothers ware aware of government health facilities where they can get all

health facilities. All mothers told that immunization session are held regularly in their village.

d) Out of 9 visited Sub Centre, MPW (M) was posted at 6 Sub Centres. After discussions with

teachers, sarpanch, ASHA, CC users and villagers it was found that they all were satisfied with

the work of MPW (M). Their behaviour towards the villagers was also found good. They

attended Health Clinic/Immunization/ VHNDs session regularly and available when Health

Programmes were organized in villages.

ii) Towards the service of PHC:

a) Public opinion was good as the services being rendered by the PHCs. However, proper

awareness among ANC and lactating mothers about danger sign in pregnancy, danger sign of

sick new born, acceptance of Family Welfare methods and also awareness of STD/HIV-AIDS

needed to be improved.

b) 27 persons who utilized the services at PHCs were interviewed and all of them were satisfied

with behaviour and services of staff of PHCs. All persons confirmed the regular presence of

Staff and Medical Officers in PHC. At Amlaha PHC half of the contacted persons told that drugs

are available in PHC.

9. Sample Verification of Family Welfare Acceptors:-

a) Out of selected 213 family welfare acceptors (Sterilization, IUD, OP and Nirodh), 149 (70%)

acceptors could be contacted for sample verification in the district. While examining the details

of the selected cases, age of spouse in 28 cases and age of youngest child in 14 cases of

family welfare acceptors were found to be not recorded in the service registers.

441

b) 56 (54%) acceptors were found to have not been provided follow-up services. 25 (62%)

sterilization acceptors received full amount of compensation money whereas, 15 (37%) persons

replied that they do not have any idea about compensation.

c) Quality of service for spacing method was very poor as many false cases found in the

district. 34 (65%) of 52 IUD acceptors, 7 (26%) of the 27 OP users, and 4 (13%) of the 30

contacted Nirodh users were not using these methods. Altogether 45 (41%) of the 109

contacted spacing method acceptors were found fake in the district.

d) 109 Beneficiaries of child immunization were contacted in which all confirmed receiving

doses but only 41(37.61%) beneficiaries received follow up services. No complication was found

among contacted beneficiaries.

10. Reconciliation Of Reported performance:-

Figures reported at CHC Aashta did not tally with the figures shown at District office, Sehore.

CHC Aashta reported 5610 IUD acceptors, 9850 OP users and 7309 Nirodh users for the year

2010-11 whereas, these figures were shown in district office for the CHC were 5482, 8120 and

8090 respectively. Similarly, CHC Aashta reported 2657 OP users/cycles and 2207 Nirodh

pieces/users up to June, 2011 for the year 2011-12 but the figure available in the District were

8713 and 3765 respectively for the facility.

11. Maintenance of Registers & Records:-

a) EC Register was maintained worker wise at visited CHCs but it was not up-dated at District

Hospital. This Register was not maintained properly at most of the visited Sub Centres.

b) Sterilization Register was maintained properly and up to date at visited CHCs Aashta and

Ichchawar and also at District Hospital Sehore.

c) IUD Register was not maintained at CHC level but the same was maintained at District

Hospital Sehore.

d) PNC Register was not maintained at visited CHCs and District Hospital but it was maintained

properly at visited Sub Centres

e) OP & CC Registers were not maintained properly at both the visited CHC and District

Hospital but it was maintained properly at visited Sub Centres.

f) ANC Register, Immunization Register, Stock Register and Sterilization Case Card were

maintained properly and up to date at all visited institutions.

g) Service Registers were not checked/ verified by the PHC/CHC/District official on regular

basis at visited Sub Centre.

12. Other Observations:-

442

a) During field visit, it was noticed that Untied Funds are misused by the sarpanch. At SHC

Brijesh Nagar, Untied Fund of Rs. 5000 was provided during the year 2010-11. ANM of HSC

Brijesh Nagar informed to the team that Sarpanch took Rs. 2500 forcibly from her and did not

provide any receipt of expenditure. Untied Fund was not given to the SC during 2011-12.

b) MCH Tracking data entry was not being made fully in blocks Aashta and Ichchawar. The data

captured at the Sub Centres are not provided to the higher level agency in these areas.

c) No supply of Kit A & B was found in the district for 2011-12

**********

5. District Dewas :

Highlights of Evaluation Report

Sehore and Dewas Districts of Madhya Pradesh State

The Regional Evaluation Team, located in the Regional Office for Health and Family Welfare

Bhopal, Ministry of Health and Family Welfare, Government of India carried out sample checks

of activities covered under NRHM / RCH in Dewas District of Madhya Pradesh State in the

month of December, 2011.

i) Details of the visited Institutions:-

Dewas DH: Dewas

CHC: Bagli

PHCs: Barotha(Block level), Double

Choki and Hat Pipaliya

Bhangarh, Kelod, Tigariya Goga,

Rajoda, Chapda, Dhawdiya and

Bijukheda

ii. Major Observations:

1. Human Resources:-

a) The district was facing acute shortage of Medical Officers, Specialists and nursing staff.

Out of 6 CHCs, only 2 CHCs were functioning with the post of Specialist in the District.

Out of 23 PHCs, only 14 PHCs were functioning with MO and rest 9 PHCs were

functioning without MO in the District

No PHC was having with three Staff Nurse in the district.

443

Only 13 additional ANMs were appointed against the total 179 Sub Centres in the

district.

post of PGMO, 12 out of 14 post of M.O, all 8 post of Staff Nurse and 23 out of 24 post of

ANM (Contractual) under RCH were lying vacant in the district

b) In visited District Hospital Dewas, 17 out of 39 posts of Specialist, 5 out of 25 posts of

Medical Officer (PG), 1 out of 9 post of M.O (General), 78 out of 150 posts of Staff Nurse, 8 out

of 15 posts of Nursing Sister, 8 out of 9 posts of Matron, 6 out of 10 posts of Compounder, all 6

posts of Computer Operator, 14 out of 40 sanctioned posts of Ward boy and 6 out of 10

sanctioned posts of OT Attendant were laying vacant.

c) Additional ANMs under NRHM was not posted at Bhangarh, Kelod, Tigariya Goga,

Dhawadiya, and Bijukhedi Sub Centres. MPW (M) post was vacant at Dhawadiya and Bijukhedi

Sub Centres.

2. Rogi Kalyan Samiti (RKS) & Village Health Sanitation Committee (VHSNC):-

a) 30 Rogi Kalyan Samitis were reported to be set up at the PHCs, CHCs and district Hospital

in the district. It was observd that RKS were constituted in the visited CHCs and PHCs but

regular meetings were not being conducted there.

b) RKS fund to the tune of Rs.1,00,000 was given to each CHC and PHC every year in the

district. It was reported that district authority provides the RKS fund to each centre considering

the opening balance of year. But PHCs Double Chowki, Panigaon and Satwas were provided

funds of Rs.99,700, Rs.91,520 and Rs.1,00,000 respectively despite previous balance of Rs.

1,00,000 lying with each of them.

c) Utilisation of RKS funds was very poor in the district.

During financial year 2010-11, 2 of the 5 CHCs, namely, CHC Bagali and CHC

Tonkkhurd spent only 43% and 31% of the allotted amount and no expenditure was

incurred by other CHCs. Similarly 5 of the 23 PHCs i.e., PHCs Baijakwada, Barotha,

Bhorasa, Pipalwala and Choubaradhira spent 100%, 32%, 47%, 4%, & 5% of the

allotted funds respectively. NO other PHC had incurred any expenditure.

During financial year 2011-12, up to November, 2011 only CHC Kannod and PHC

Baijakwada spent 100% fund whereas PHC Double Chowki spent Rs.99,700 out of

available fund of Rs. 1,99,700 and PHC Panigaon spent Rs. 91,520 out of available fund

of Rs. 1,91,520. No other CHC and PHC incurred any expenditure.

d) As per the reports received from the district, 1052 villages out of total 1058 villages in the

district were covered under the scheme and all VHSNCs were functioning with ASHA as a

member. It was reported that 836 of the 1052 VHSNCs have opened their bank account for

handling the funds.

444

3. Services under Janani Suraksha Yojana (JSY):-

a) Janani Suraksha Yojana was being implemented in the district. District spent Rs. 420.34

lakhs in 2010-11 and Rs. 278.21 lakhs in 2011-12 out of funds @ Rs.496.49 lakhs approved for

JSY under RCH Flexi-pool appeared during 2010-11 and Rs. 278.21. It was also reported that

as many as 25144 JSY beneficiaries in the year 2010-11 and 15345 during the year 2011-12

(up to November, 2011) were provided with cash incentives under the scheme. No other

particular of the expenditure under the scheme has been reported to the team.

b) JSY status in the District Hospital and CHC Bagli is as reported below:

(Amount in Rs.)

Items District Hospital CHC Bagli

2010-11 2011-12(up

to 14-12-11

2010-11 2011-12( up to

November, 11

Number of institutional

Delivery

6485 4774 1333 947

Number of beneficiaries to

Whom JSY money paid

6486

4781

1500*

1018 *

Total fund received under

JSY

10200000 7400000 2510377 1851115

Expenditure incurred

under

JSY

9851121 6915001 2497050 1688310

* includes last year‟s pending cases.

c) JSY status in the visited PHCs is as reported under:

(Amount in Rs.)

Items Hatpipaliya Barotha Double Choki

2010-

11

2011-12

#

2010-

11

2011-12 # 2010-

11

2011-12 II

Number of institutional

Delivery

1378 1011 405 297 32 29

Number of beneficiaries to

whom JSY money paid

841 1076*

416

300

32 29

Total fund received under

JSY

1550100 1872775 1600000 800000 Information not

provided

Expenditure incurred

under JSY

1377350 1841000 312150 Not provided

445

# up to November, 2011. * includes pending cases for previous year.

d) It was reported that sufficient funds were provided to all visited institutions and Payment was

made to almost all beneficiaries but there were some JSY beneficiaries in the visited centres‟

areas waiting for their incentive; 200 mothers were observed to be waiting their cash incentive

due to shortage of funds at CHC Bagli and PHC Hatpipaliya.

e) JSY Registers were being maintained properly containing list of beneficiaries to whom

cheques / cash were issued. It was also found that registers were being checked by the

concerned MOs in visited centres except PHC Barotha.

f) 40 beneficiaries were contacted by team for sample verification. 33 (83%) beneficiaries were

accompanied by ASHA/Dai. All contacted beneficiaries received monetary benefit under JSY

scheme. 37(93%) beneficiaries used Janani express to go to hospital for delivery. 3 (8%)

beneficiaries made self arrangement to go to hospital and none of them got money for

transport. 34 (85%) beneficiaries got three Ante Natal Checks up by ANM and 17 (46%) got

three Post Natal Checks up by ASHA and ANM.

4. Functioning of ASHA:-

a) AS reported, 1021 ASHAs were working in 1058 villages in the district. As per block wise

details received from the district, every block had selected ASHA more than total village i.e.

1249 ASHAs against 1058 villages of the 6 blocks but 1021 ASHAs were working as on 20-12-

2011.

b) 1195 ASHAs were trained and 681 ASHAs were provided with drug kit in the district.

c) 9 ASHAs were interviewed in 3 visited PHCs. none of them had Kits containing EC pills.

5. Untied Funds:-

a) CHC and PHC in the district are given eligible amount of Rs. 50,000 and Rs. 25,000 every

year as untied funds.

b) While providing yearly funds to CHCs and PHCs, the authority takes into account the opening

balance available with the centre.

c) As reported, Untied Fund of Rs. 50, 000 including previous balance was available at all 5

CHCs except CHC Kannod for both the year 2010-11 and 2011-12.

d) CHC Kannod did not get any additional allotment other than the opening balance of Rs.

38,289 available in the year 2010-11. However, full amount could not be spent in the year

2010-11and carry forward to the next year 2011-12.

e) CHCs Kategaon, Tonkkhurd, and Bagli incurred expenditure as per requirement but CHCs

Kanod and Sonkachh did not incur any expenditure during financial year 2010-11. In current

446

year 2011-12, (up to November, 2011) CHCs Bagali, Kategaon and Sonkachh did not incur any

expenditure whereas CHCs Kannod and Tonkkhurd spent very little funds.

f) Untied Fund to the tune of Rs. 25,000 was available including previous balance in all 23 PHCs

except PHC Uday Nagar in the financial years 2010-11 and 2011-12. PHCs Vijayganjmandi,

Baijakwada, Dokakui and Kusmania incurred 100% expenditure and PHCs Bhorasa, Pipalrawa

and Choubaladhira incurred 26.1%, 33.6%, and 80% expenditure respectively whereas rest of

the PHCs did not incur any expenditure during financial year 2010-11.

g) In the year 2011-12, PHC Baijakwada and Panigaon incurred 100% expenditure and PHCs

Doublechoki, Satwas and Choubaradhira incurred 98.7%, 37.7% and 19.8% expenditure

respectively, the rest of PHCs did not incur any expenditure up to November, 2011.

6. 24 Hours Delivery Care Services:-

Total 18 institutions (District Hospital, 5 CHCs and 12 PHCs) were providing 24x7 services in

the district. The team visited CHC at Bagli, PHCs at Hatpipaliya, Barotha and Double Choki and

found that :

Facilities for caring mothers and new born babies were inadequate at all visited

institution except Bagli CHC.

Blood storage facility was not available at all visited institutions.

No specialist was posted at all visited institution except Bagli CHC.

No staff Nurse was posted in the visited institution except Bagli CHC. Only one ANM was

posted at Double choki PHC.

7. Physical Infrastructure Stock Position:-

i) CHCs:

a) Visited CHC Bagli was functioning in Govt. building with regular water supply and electricity

with power back up. Vehicle was not available. The premise of the visited CHC was neat and

clean.

b) All equipment and apparatus as per CHC requirement were available at Bagli CHC, but

Blood Storage Unit, Anesthesia equipment and Sick new born care unit and quinine injection

were not available there.

c) Out of 3 posts sanctioned, only 1 Specialist was in position in Bagli CHC.

ii) PHCs:

a) All three visited PHCs were functioning in Govt. building with regular water supply and

electricity with power back up, but vehicle was not available at all visited PHC whereas

Telephone was available only at Barotha PHC.

b) Microscope and Lab Technician was not available at Double Choki PHC.

447

c) OP and Condom were not available at Double Choki since last 18 month and at Hatpipaliya

PHC since last 3-5 months.

iii) Health Sub Centres:

a) Sub centres visited (at Bhangarh, Kelod, TigariyaGoga, Rajoda, Chapda, Dhawadiya and

Bijukhedi) were not conforming to IPHS.

b) Sub Centre Dhawadiya was functioning in ANM‟s rented room. Source of water was not

available at Dhawadiya and Rajodha Sub Centre. Electricity was not available at Bhangarh,

Kelod, Tigariya Goga and Rajoda Sub Centres.

c) ANMs of the visited Sub centers were not residing in their head quarter. Also, mobile phone

was not provided to any ANM. Additional ANM was available only at 2 out of 7 visited Sub

Centers.

d) RDT Kit, DDKs, Sanitary Napkins, EC Pills, Oxitocine tablets, Ampicillin capsule and

Gentamycin injection and Kits- A & B were not available at all visited Sub Centres.

e) Ambu bag/suction, steam sterilizer, Delivery kits, IFA tab/syrup, IUDs, Oral pills, Condom

were not available in most of the Centres visited.

f) Family planning service register, Stock register and Cash book of untied fund was not

available at most of the visited centre whereas JSY registration card was not available at the

visited Sub Centres.

g) There was lack of checking/verification of service register by PHC/District Hospital and

overall supervision by supervisor/DPHN/BEE in SCs. SBA and IMNCI training was not received

by the ANM of visited Sub Centres.

8. Community Satisfaction on overall service:-

i) Towards HSC’s Service:

a) Total 46 mothers having one year old child were interviewed in the area of 7 HSCs to collect

knowledge & opinion of mother and assessing the work of ANM.

21 (47%) interviewed mother replied that ANM were available when needed.

All the contacted mother replied that their last delivery was institutional.

All the contacted mother were counselled for exclusive breast feeding and

complementary feeds.

44 (96%) mothers put the baby to breast within 1-2 hours.

Only 11(24%) mothers received three post natal checks up.

18 (39%) mothers knew about the danger sign of ARI.

25 (54%) mothers knew about the use of ORS.

24 (52%) mothers were aware of contraceptives methods.

448

All contacted mother replied that immunization session were being held regularly in their

village and their children were fully immunized.

All contacted Mothers were aware of government health facilities where they can get

health facilities.

b) Out of 07 visited Sub Centres, MPWs (M) were posted in 5 Sub Centre. After elaborated

discussions with teachers, sarpanch, ASHA, CC users and villagers, the team found that most

of the male workers were not taking rounds of the village for field work regularly. But behaviour

of most of the male workers towards the villagers was found good. All workers attended health

clinic/immunization/VHNDs session regularly and were available when health programmes were

organized in the villages.

ii) Towards PHCs Service:

a) 43 villagers including pregnant women, PNC cases, ASHAs, AWWs and village

representatives etc were interviewed about the services at PHCs; It was observed that they

were satisfied with services of PHCs. However, information about danger sign in pregnancy,

danger sign of sick new born, contraceptive methods, acceptance of family welfare methods

and knowledge of STD/HIV-AIDS were poor among the contacted villagers.

b) MO of visited PHCs did not stay at PHC HQ. Regular M.O of Hatpipaliya PHC attended OPD

only in morning hours whereas MO of Doublechoki attended OPD only once in a week.

9. Sample Verification of Family Welfare Acceptors:-

a) Out of selected 145 family welfare acceptors (Sterilization, IUD, OP and Nirodh), 114 (79%)

acceptors could be contacted for sample verification in the district. While examining the details

of the selected cases, age of acceptors in 5 cases, age of spouse in 112 cases and age of

youngest child in 51 cases of family welfare acceptors was found to be not recorded. Total No.

of children and total No of Male/female children was not recorded in 21 cases.

b) 37 (41%) acceptors were found to have not been provided follow-up services. 40 (87%)

sterilization acceptors had received full amount of compensation money.

c) Quality of services under spacing method acceptors was very poor as many false

reported cases were found in the district. As observed by the team, 4 of 18 IUD

acceptors, 10 of the 20 OP users, and 10 of the 30 Nirodh users contacted were not using

those methods. Altogether 24 (35%) of the 68 spacing method acceptors were found fake

in the district.

d) Out of contacted genuine cases of 14 Cu-T, 10 OP and 20 Condom users, 6 (60%) Cu-T

users discontinued the method due to physical problem and 3 (30%) discontinued the method

449

due to unknown reason whereas 100% OP and condom user discontinued the method due to

short supply.

e) 102 (28 DPT, 28 POLIO, 19 BCG, 10 Vit-A and 17 MEASLES) Beneficiaries of child

immunization were contacted in which all confirmed receiving the doses, but only 37 (36.27%)

beneficiaries received follow up service of child immunization. All were satisfied with the

services. No complication was found among contacted beneficiaries.

10. Reconciliation of Reported Performance:-

a) There was no coordination between District office and reporting centres in respect of

reported performance for 2010-11 and 2011-12 (up to November, 2011). The details are as

follows:

i) 1921 IUD cases, 14381 OP cycles/user and 256980 Nirodh pieces/users were reported by

CHC Bagli for the year 2010-11 whereas figures maintained in the report of district office were

2119, 16281 and 2,46,571 respectively for the CHC for the same period.

ii) 12851 OP cycles/user and 95040 Nirodh pieces/users were reported by PHC Barotha for the

year 2010-11 whereas the figures shown in the report of district office were 13841 and 174809

respectively for the same period.

iii) 3583 sterilization were reported by DH, Dewas for the year 2010-11 whereas the figure

shown in the report of district office was 4251 for the same period.

iv) 1060 IUD cases, 3035 OP cycles/user and 14636 Nirodh pieces/users were reported by

CHC Bagli for the year 2011-12 (up to November 2011) whereas the figures shown in the report

of district office were 922, 5236 and 51056 respectively for the same period.

v) 745 sterilization and Nirodh pieces/users were reported by PHC Barotha for the year 2011-12

(up to November 2011) whereas the figures shown in the report of district office were 504 and

99141 for the same period.

vi) 507 IUD acceptors were reported by DH, Dewas for the year 2011-12 (up to November

2011) whereas the figure shown in the report of district office was 574 for the same period.

b) In District Hospital, Dewas, 574 IUD acceptors were reported against registered IUD cases of

456 for the year 2011-12 (up to November, 2011).

c) Reported IUD cases could not be verified at CHC Bagali and PHC Barotha for the year 2010-

11and 2011-12 (up to November, 2011) for want of service register at the centres head

quarters. Similarly, IUD performance report by DH, Dewas for the year 2010-11 could not be

verified for the want of service register.

11. Maintenance of Registers & Records:-

a) Sterilization Register was maintained properly and up to date at CHC Bagli and PHC Barotha

but the same was not produced before the team at District Hospital Dewas.

450

b) Cu-T service register, OP register and Nirodh registers were not maintained at District

Hospital, Dewas for the year 2010-11.

c) MCH Register was maintained properly and up to date at all visited institutions, However

PNC Register was not maintained at CHC Bagali and PHC Barotha.

d) Stock Register, JSY register and Sterilization case cards were maintained properly and up to

date at all visited institution in the district.

e) OP and Nirodh distribution registers for the year 2010-11 at the visited Sub Centres at

Dhawadhiya, Bijukhedi, Tigariya Goga, Kelod and Bhangarh were not produced before the

team. These registers were properly maintained at Sub Centres Rajoda and Chapda.

f) ANC register, Immunisation register and cards were printed and maintained properly at the

visited Sub Centres.

g) PNC register was not mostly maintained at Sub Centres.

h) Cash book was not produced before the team at Sub Centres Kelod, Rajoda and

Dhawadhiya.

i) Eligible Couple register was updated only at Kelod, Bhangarh and Rajoda Sub Centres.

j) Stock register was maintained at all Sub Centres visited except at Kelod, Dhawadhiya and

Chapda.

12. Other Important Observations and Suggestions:-

a) IFA & Oral Pills were not available at District Hospital since four month. Likewise in Block

Barotha, IFA was not available. During last four months, only 200 Copper-T, 100 packets of OP,

500 pieces of CC were received by block Barotha.

b) It has been observed that Untied funds and RKS funds are not being utilised at PHCs

Ratanpur, Punjapura, and Amlataj of of block Bagli because no MO PHC was posted at the

centre eventhough these funds were given to these centres by the higher authority.

c) During visit to PHC Hatpipaliya, it was observed that PHC was not being managed properly.

There was a shortage of mattress and bed sheets. It was observed that delivered women were

lying on the floor using their own bed sheet. Medical officer of the PHC resides other district and

attends only OPD in morning hours. It was also observed that MO of PHC is not taking proper

step to improve the PHC condition. Untied fund and RKS fund are mostly lying unutilized in the

PHC.

d) Most of the staff of visited CHCs, PHCs and SCs in the district was not residing at their

headquarters.

e) Lack of supervision was noticed in all levels.

451

6. District Vidisha:

Major observations of Regional Evaluation Team (RET), Bhopal on the evaluation work

carried out in Vidisha District of Madhya Pradesh State in the month of February, 2012.

i. Details of the visited Institutions:

District DH/CHCs/PHCs Visited HSCs visited

Vidisha

DH: Vidisha

CHCs: Nateran, Gyaraspur and

Pipalkheda

PHCs: Gulabganj and Barro

Devkhajuri, Chhirkheda, Chatoli,

Barrighat, Mungwara, Wardha and

Pipaldhar

ii. Major Observations:

1. Human Resources:-

a) There was acute shortage of man power in some category of posts. 51 of the 66

sanctioned posts of Specialist, 89 out of the 153 sanctioned posts of Staff Nurse, 11 out

of the 36 sanctioned posts of MPS, 61 out of the 146 sanctioned posts of MPW (M) and 9

out of the 37 sanctioned posts of LHV were lying vacant in the district.

b) More than 40% of the contractual posts under RCH were vacant in the district. One each

out of 4 PGMO Paediatrics and 3 Gynaecologists was lying vacant. 3 out of 12 posts of

Medical officers, one post out of 2 staff nurse (CE mOC) and 32 out of 58 posts of ANMs

were vacant.

c) Though, sanctioned position of HR in DH, Vidisha was not made available but it was

observed that 22 Doctors/Specialists, 37 posts of Staff Nurse, 6 posts of Lab Technicians

and 2 posts of Pharmacist were in position at the District Hospital. The team observed

that as per norms and requirement of District Hospital, the position of staff is found to be

inadequate.

d) In CHC Nateran, all 3 sanctioned posts of Specialist, 4 out of the 5 sanctioned posts of

Medical Officer and 2 out of the 4 sanctioned posts of Staff Nurse were vacant. In CHC

Gyaraspur, 2 out of the 4 sanctioned posts of Medical Officer and 1 out of the 4

sanctioned posts of Staff Nurse were vacant. Likewise, in CHC Pipalkheda, all 3

sanctioned posts of Specialist and 4 posts of Staff Nurse were lying vacant.

e) In visited PHCs of Gulabganj and Barro, MO including Ayush, LHV and ANM etc. were in

position.

452

2. Rogi Kalyan Samiti (RKS) and Village Health Sanitation and Nutrition Committee

(VHSNC):-

a) Rogi Kalyan Samitis in the visited 2 CHCs and 3 PHCs were constituted and their

meetings were being conducted regularly.

b) As per the detail of RKS fund provided by District, all 7 CHCs, 17 of the 21 PHCs and DH

were receiving RKS fund @ Rs. 1,00,000 at CHC/PHC level and @ Rs. 5,00,000 at DH

level per year regularly.

c) District Hospital was provided funds @ Rs. 5,00,000 each year during 2010-11 and 2011-

12 and full amount was utilized during both the years.

d) All 7 CHCs and 17 PHCs were having RKS fund @ Rs. 1,00,000 each annually during

2010-11 and 2011-12. Two CHCs viz. Gyaraspur and Shamsabad and 7 PHCs viz.

Gulabganj, Haiderganj, Mohammadgarh, Mahow, Barkhedajangir, Kasbatal and

Gamakhar did not spend any RKS fund during 2010-11. 10 PHCs viz. Gulabganj,

Haiderganj, Mohammadgarh, Rusallisahu, Mahow, Barkhedajangir, Balabarkheda,

Barron, Gamakhar and Kullhar did not spend any RKS fund during the year 2011-12.

e) RKS at CHC and PHC level was not supposed to get yearly allotment of funds if there is

previous balance lying with the centre but CHC Peepalkheda was given full eligible

amount even as there was unspent amount of Rs. 53,884 lying with the CHC in the year

2010-11. Similarly, CHCs at Nateran, Peepalkheda and Shamshabad were given full

eligible amount even though there was opening balance of Rs. 49899, 53884 and Rs.

100000 respectively lying with the centres in the year 2011-12.

f) PHC Garetha was provided full elegible RKS fund even as there was unspent amount of

Rs. 56,216 available with the centre in the year 2010-11. During the year 2011-12, 5

PHCs Mahow, Barkhedajangir, Kasbatal, Garetha and Gamakhar have been provided full

RKS fund even though there was opening balance of Rs. 1,00,000, 1,00,000, 100,000,

1,32,131 and 1,25,000 respectively available with the centres..

g) 1604 villages and 7 blocks are reported to be available in the district. Only 939 villages

have been identified for the formation of VHSNC. All 939 VHSNCs were having ASHA as

a member.

h) During visit to the Sub Centres, the team has observed that VHSNCs are constituted at

villages but their regular meetings were not conducted in Barrighat, Chatoli and Wardha

Sub Centres.

3. Service of Janani Suraksha Yojana (JSY):-

453

a) JSY status in the District and CHCs visited is as given below:

(Amount in Rs.)

Items District CHC

Pipalkheda

CHC Nateran CHC Gyaraspur

2010-11 2011-

12*

2010-

11

2011-

12*

2010-

11

2011-

12*

2010-

11

2011-12*

Number of institutional

Delivery conducted

26,297 20,540 151 136 3,184 2,435 2,234 1,911

Total No. of Home

delivery

81 82 59 34 0 0 0 0

Number of

beneficiaries to

Whom JSY money paid

(Institutional + Home)

26,378

20,622

210 170

3,184 2,435 2,234 1,911

Total fund received

under

JSY

5,06,40,000 43,82,70

00

27,00,0

00

18,51,1

15

NR NR 2,51,788 17,85,538

Expenditure incurred

under JSY

4,49,51,558 3,18,27,

908

2,95,75

0

16,88,3

10

55,82,8

89

41,63,0

40

21,96,25

0

16,23,850

b) JSY status in the visited PHCs:

(Amount in Rs.)

Items PHC Gulabganj PHC Barro

2010-11 2011-12

*

2010-11 2011-12*

Number of institutional Delivery 585 544 10 8

Number of beneficiaries to whom JSY

money paid

585 544 10 8

Total fund available under JSY 1,73,407

8,01,75

7

#

Expenditure incurred under JSY 10,06,650

6,83,30

0

* Figures up to February, 2012. # Expenditure done by CHC Peepalkheda. NR - Not Received.

c) The team contacted 30 out of 33 JSY beneficiaries selected for on the spot sample

verification and observed that all beneficiaries were satisfied with the services under JSY.

454

21 (70%) beneficiaries were accompanied by ASHAs /Dai while going to the hospital for

delivery. 12 (40%) beneficiaries received incentive by cheque within three days after

delivery. 19 (63%) beneficiaries used Janani Express to go to hospital and 11 (37%)

beneficiaries made self arrangement to go to hospital and none of them got transport

money from health authority.

d) All beneficiaries got three Ante natal check ups (ANC) and 9 (30%) beneficiaries got

three post natal check ups (PNC).

4. Functioning of ASHA Scheme:-

a) It was reported that 1316 ASHAs have been selected against 1604 villages in the district.

There were 1202 ASHAs trained and only 1194 ASHAs were provided with drug kits.

b) During visit to the Sub Centres in the district it was observed that all the existing ASHAs

were trained and provided with drug kits. It was also observed that one ASHA in the area

of Sub Centre Peepalkheda was not carrying out the work.

5. Untied Funds:-

a) Rs. 50,000 to each CHC, Rs. 25,000 to each PHC and Rs. 10,000 to each Sub Centre

are given per year as untied fund in the district.

b) It was observed that PHCs at Kasbatal, Garetha and Gamakhar were provided with full

eligible untied fund in 2011-12, though there was opening balance of Rs. 27838, 16410

and Rs. 25000 respectively lying with the centres.

c) There were two PHCs Kasbatal and Gamakhar which had not spent any amount of

untied fund in the year 2010-11. Similarly, three PHCs Barron, Gamakhar and Kulhar did

not spend any funds in the year 2011-12 up to January, 2012.

d) During visit to Sub Centres, it was observed that Untied Funds @ Rs. 10,000 were

provided to each during 2010-11 and 2011-12 except SC Mungwara. Utilisation of funds

at Sub Centre level was very poor. Out of 7 Sub Centres visited only SC at Devkhajuri

spent available funds in 2010-11 and 3 Sub Centres in 2011-12 up to January, 2012.

e) It was also observed that the Sub Centres who could not utilise its funds in the year

2010-11, are not provided with the untied funds during 2011-12.

6. 24 Hours Delivery Care Services:-

a) The team visited 3 CHCs at Gyaraspur, Nateran and Peepalkheda and 2 PHCs at Barro

and Gulabganj which were providing 24x7 hours delivery care service in the district.

b) Performance of the visited 24 x 7 centres:

Name of institutions Year No. of deliveries

CHC Gyaraspur 2010-11 1237

2011-12* 1069

455

CHC Nateran 2010-11 1274

2011-12* 1063

CHC Pipalkheda 2010-11 141

2011-12* 128

PHC Barro 2010-11 10

2011-12* 8

PHC Gulabganj 2010-11 585

2011-12* 544

* Up to February, 2012.

c) There were sufficient no. of Doctors and other Paramedical staff available to perform the

24 x 7 hours services in the visited CHCs and PHCs except CHC Nateran where only

one MO is posted.

d) None of visited CHC/PHC was having Blood storage facility and facilities for caring

Mother and New born baby in the hospital.

e) PHC Barro was providing 24 x 7 hours delivery services on call basis.

7. Physical Infrastructure and Stock Position:-

i. CHCs:

a) CHCs Gyaraspur and Nateran were functioning in their own building while, CHC

Pipalkheda was functioning in old PHC building; Premises of the visited CHCs were

found neat and clean. 30, 15 and 4 beds were found at CHCs Nateran, Gyaraspur and

Pipalkheda respectively. Water and electricity with power back up was available at all the

visited CHCs.

b) Quinine and Arteether Inj., Anaesthesia Equipments, Blood Storage Unit and Sick

Newborn Care Units were not available at all the visited CHCs.

c) Resuscitation Equipments were not available at CHCs Gyaraspur and Nateran. Auto

Clave was available at all the CHCs visited but at CHC Gyaraspur it was not in working

condition. Likewise, X-Ray facility was available at all the CHCs visited but at CHC

Pipalkheda it was not in working condition due to vacant post of Radiographer.

d) The post of Specialists was not in any of the visited CHCs.

ii. PHCs:

d) PHCs visited at Gulabganj and Barro were functioning in Govt. buildings with regular

water supply, electricity with power back up and also toilet facility. Telephone facility was

not available in both the visited PHCs.

e) There was no vehicle found in any of the visited PHCs. Functional Operation Theatre

was not available at the visited PHCs.

456

f) The Stock of Contraceptive IUD, OP and CC were not found in sufficient quantity in both

the PHCs visited.

iii. HSCs:

a) 3 out of 7 visited Sub Centres namely, Wardha, Pipaldhar and Devkhajuri were

functioning in Govt. building whereas SC Barrighat was functioning in Panchayat

Bhawan.

b) Labour rooms were available only in Wardha and Devkhajuri Sub Centres but deliveries

were not conducted there.

c) ANMs were not residing at the headquarter except the ANMs of SCs Wardha and

Pipaldhar whereas the ANM of Devkhajuri was residing in Sub Centre village.

d) Examination table was available only at Pipaldhar and Devkhajuri Sub Centres.

Kerosene, DDKs, Sanitary napkins, Cap. Ampicilline, Inj. Gentamycin, Tab. Oxytocyn

were not available in any of the Sub Centres visited.

e) Delivery Table, Benches for clients, McIntosh sheet, Ambu Bag/Suction, Rapid

Diagnostic Kit for Maleria were not available in the visited Sub Centres except SC

Devkhajuri.

f) IUDs were not available in Sub Centres Chatholi, Barrighat, Wardha and Chhirkheda,

while Oral Pills were available at the visited Sub Centres except Wardha SC. Condoms

were not available in the visited Sub Centres except Devkhajuri SC.

g) The SBA training was not provided to any of the workers in the visited SCs. However,

ANM of the visited SCs received IMNCI training.

h) During last three months supervision was not observed to be done in Barrighat SC.

8. Community Satisfaction on overall health Service:-

i. ANM and MPW (M) Services:

a) 41 mothers having child up to one year old were contacted. 17 (41.5%) mothers reported

that ANM was available when needed. 6 (14.6%) mothers received three post natal

check up (PNC). 13 (31.7%) mothers knew about danger sign of ARI. 21 (51.2%)

mothers were aware about contraceptive methods. Only 10 (24.4%) mothers have been

told about the advantage and side effect of contraceptive methods. All mothers replied

that the immunization session are being held regularly in their villages and all of them

were aware of government health facilities.

b) Out of 7 visited Sub Centres, MPW(M) were posted in 4 Sub Centres i.e. Chatholi,

Mungwara, Barrighat and Chhirkheda. After discussions with Teachers, Sarpanch,

ASHA, CC users and villagers, the team found that behaviour of the Male Workers for

providing the services to the villagers was good. All workers attended health

457

clinic/immunization/VHNDS session regularly and were available when health

programmes were organized in the villages.

ii. PHC level Services:

a) Villagers in the area of PHCs were satisfied with the services of PHCs. However, some of

the women were not sufficiently aware about danger sign in pregnancy, danger sign of

sick new born and contraceptive methods.

b) 6 ASHAs were interviewed in 2 visited PHCs and none of them had Kits containing EC

pills.

c) MOs of visited PHCs were staying at PHC HQ. Regular presence of M.O at PHC Phanda

was satisfactory. Visit to the villages of PHCs was done during last six months by MO.

9. Sample verification of Family Welfare Acceptors:-

a) The team selected 150 FW cases, out of which 105 (70%) FW acceptors could be

contacted. During sample verification, discrepancy was observed in the number of

children, age of last child and age of spouse recorded in the service registers.

b) 7 (38%) of the 71 contacted spacing method acceptors were found to be reported false in

the district.

c) 106 (22 DPT, 22 POLIO, 22 BCG, 20Vit-A and 20 MEASLES) beneficiaries of child

immunization were contacted in which all beneficiaries confirmed the doses. 24 (22.6%)

beneficiaries were not contacted by the health workers for follow up services after

vaccination.

10. IT Infrastructure & MCH Tracking:-

a) Computers were available at CMHO office/DPMU and CHCs except PHCs in the district.

b) Internet connectivity was provided to the systems available in the district and at all CHCs.

c) It was reported by the district authorities that all CHCs have MCH Tracking formats. The

health functionaries of CHC, PHC and SCs are sensitized in MCH formats. The Data

entry of all visited CHCs is done at district head-quarter only.

11. Maintenance of Registers & Records:-

a) Sterilization Register was maintained properly at visited CHCs Pipalkheda, Gyaraspur

and Nateran and but printed register was only available in CHC Pipalkheda.

c) IUD Register was not maintained at the visited CHCs. However, OP and CC Registers

were maintained worker wise properly.

d) PNC Register was not maintained at visited CHCs and HSCs. ANC register was up to

date and maintained at CHC level. ANC register was not in printed format but maintained

properly at visited Sub Centres.

458

e) Immunization Register was also not in printed format but maintained properly at all visited

institutions.

f) IUD, OP and CC registers and ANC & Immunization Service Registers were not printed

but were maintained properly at HSC level. However, PNC register is not maintained.

12. Other Observations:-

a) Lack of supervision was noticed at DH/CHC/PHC/SC levels during the visit. Most of

the staff in the visited CHCs/PHCs and Sub Centres were not residing at their head

quarters.

b) Post natal care services were found poor in the visited institutions and the registers/

records were not available in this regard.

c) JSY payment was made by Account Payee Cheque for both Institutional and Home

deliveries to the beneficiaries. It is learnt that villagers and illiterate beneficiaries are

facing a lot of difficulties for opening of account in the bank for encashing cheque and in

some areas banks are also not available.

d) Performance report for the F.P. acceptors was not made available to the team from

district office for the year 2010-11. Performance of IUD scheme could not be verified at

visited centres due to non availability of centralised IUD registers for both the years 2010-

11 and 2011-12.

*******

459

Orissa

1.District:- Mayurbhanj

Major observations of Field Survey Unit (FSU), Bhubaneswar about the Evaluation work

in district of Mayurbhanj of Orissa State during the month of June, 2011.

I. Details of the visited Institutions:

District

visited

PHCs/ CHCs/PPC visited SCs/Ward visited

Mayurbhanj CHCs Dukura and Badasahi

PPC Rairangapur (Ward No. 3 & 4)

Tadki, Bahanada, Chhelia- B and

Manatri

II. Major Observations:

1. Health Human Resources:

a. Key posts of health functionaries like 17 out of the 161 sanctioned posts of MOs

(Assistant Surgeons), 15 out of the 111 sanctioned posts of Specialists, 59 out of the 666

sanctioned posts of ANM, 203 out of the 264 sanctioned posts of MPW (M), 11 out of the

85 sanctioned posts of LHV, 18 out of the 130 sanctioned posts of GNM/ Staff Nurse and

9 out of the 66 sanctioned posts of Lab Technicians were lying vacant in the district.

b. In the visited CHC at Dukura, all 11 sanctioned posts of MPW (M), 1 out of the 3

sanctioned posts of LHV, 1 out of the 6 sanctioned posts of MOs (Assistant Surgeons),

both the sanctioned posts of Specialists were lying vacant. Similarly, in CHC Badasahi 3

out of the 40 sanctioned posts of ANM, 9 out of the 12 sanctioned posts of MPW (M), 1

out of the 5 sanctioned posts of HS (M) and 2 out of the 4 sanctioned posts of Specialists

were lying vacant. One sanctioned posts each of MPW (M) and Lab Technicians were

lying vacant in the visited PPC at Rairangapur.

2. Functioning of Rogi Kalyan Samiti (RKS):

a. It was reported that 89 (in DH- 1, SDH-3, CHC/PHC-28 and in PHC (New) - 57) Rogi

Kalyan Samitis have been constituted in the district. The regular meetings of Rogi Kalyan

Samitis were being conducted as per norms.

b. It has been reported that during the year 2009-10, district spent Rs. 44,74,822 (57%) out

of total fund of Rs. 77,47, 684 including opening balance of Rs. 31,47,684. Similarly, Rs

77,26,351 (95%) were spent against the available fund of Rs. 81,22,862 including

opening balance of Rs. 32,22,862 during 2010-11. During 2009-10, total receipt of the

460

user charges collected from the patients in the hospitals was Rs. 47,98,294 and during

the year 2010-11 it was Rs. 53,98,294. The funds earned under this were spent mainly

towards purchase of Lab Chemical, repair and renovation of hospital, repair of hospital

instrument, Equipment, stationary, electrical repair work, generator DOL, wages & other

developmental work.

c. During visit to CHCs Dukura, Badasahi and PPC Rairangpur, it was observed that most

of the alloted funds had been utilized during last two years under this head.

d. The major expenditure under this head was incurred for maintenance of medical

instrument & equipments, repair & renovation related to Civil/ electrical work, cleaning,

security, laundry, engagement of Sweeper for Labour Room, beautification, denting and

painting of hospital and procurement & provision of different amenities relating to patient

welfare etc.

3. Services of Janani Suraksha Yojana (JSY):

a. JSY scheme was being implemented properly in the district. As reported by the district,

all the eligible delivery cases were being paid incentives under the scheme by cheques in

time and most of the pregnant mothers were accompanied by ASHAs for institutional

deliveries.

b. During 2009-10 and 2010-11 a total of 42,657 & 36,894 deliveries were conducted under

JSY and out of which as reported by the district 41671 and 36887 were institutional

deliveries under the scheme.

c. The district spent Rs. 6,90,07,970 against the provision of Rs. 7,55,82,547 under the

scheme in the year 2009-10 and Rs. 7,36,18,964 were spent against the alloted amount

of Rs. 7,86,66,577 including opening balance of Rs. 65,74,577 during 2010-11.

d. As reported 26 Janani Express were on road and providing the referral transport services

to JSY beneficiaries in 26 CHC in the district. During 2009-10, facility was available in 6

CHCs and during 2010-11 it was extended to 20 more CHCs in the district. In SDH

Rainagpur, Janani Express Services (JES) is not yet functional. In the visited CHCs at

Dukura and Badasahi, these services were observed to be provided to the beneficiaries.

e. The team contacted 42 JSY mothers in the area of the visited centres in the district. As

confirmed by the respondents, JSY cards were issued to the mothers. Most of the

contacted beneficiaries were assisted by ASHA. All contacted mothers received JSY

package, 3 antenatal checkups and also had IFA tablets. 9 (21%) mothers discontinued

the consumption of IFA during their ANC. 13 (30%) mothers did not receive 3

consecutive postnatal checkups by the health staff.

4. Services of ASHA:

461

a. It was reported that 3294 ASHAs were selected up to the current year in the district. 3238

ASHAs have under gone 5th modules training as well as induction and thematic training

and First aid training.

b. During the field visit, 5 ASHAs were interviewed to ascertain the average monthly

incentive received by them and it was observed that they were getting @ Rs. 1300 to Rs.

1400 for JSY delivery/ immunization/ VHND and sector meeting etc.

c. It was also reported that 8 ASHA Gruha are functional in 8 FRUs against the target of 9

ASHA Gruha in the district.

5. Village Health & Sanitation Committee (VHSC)

a. Totally, 3666 VHSCs (called GKS in the district) were functioning against the targeted

number of 3748 VHSC in 26 blocks of the district. ASHA is a committee member in each

GKS.

b. 3640 GKS have opened their joint accounts to handle the funds.

c. The district had released Rs. 7,58,32,681 to all PHCs and CHCs for the GKS including

opening balance of Rs. 3,92,72,681 during 2010-11, out of which Rs. 4,02,80,087 was

utilized.

d. In the district, 520 GKS have prepared village health plan during 2009-10 and 3625 in

the year 2010-11. 1078 GKS were involved in Jalachatra activities during 2009-10 and

1362 in the year 2010-11. In addition to this, no. of GKS involved in Indoor Residual

Spray (IRS under Malaria) activities was 1003 on 2009-10 and 1832 during 2010-11.

e. During visit to the CHCs at Dukura and Badasahi it was observed that the funds was

received and utilised in the activities of GKS.

6. Untied Funds:

a. Untied funds are provided to the SCs, PHCs and CHCs regularly in the district. In 2009-

10 an amount of Rs. 22,64,794 including opening balance of Rs. 9,64,794 was released

to the CHCs/ PHCs and expenditure to the tune of Rs. 11,46,522 was incurred. Similarly,

untied fund of Rs. 23,78,272 including opening balance of Rs. 11,18,272 was given to all

CHCs/ PHCs and incurred expenditure to the tune of Rs. 21,82,457 during 2010-11.

b. Untied fund to the tune of Rs. 1,50,64,635 including opening balance of Rs. 34,54,535

were given though PHC/CHC for strengthing the services of Sub centres and out of that

amount only 51% expenditure was incurred during 2009-10. Similarly, fund to the tune of

Rs. 1,14,80,843 including opening balance of Rs. 73,57,843 was provided and out of that

76% was spent during 2010-11.

462

c. As reported by visited CHC Dukura, an amount of Rs. 3,99,649 including opening

balance of Rs. 19,649 was transferred to SC untied fund accounts and out of that

amount, Rs. 3,64,294 were utilized by the SCs during 2009-10. Similarly, Rs. 1,68,355

including opening balance of Rs. 35,355 was transferred to SCs under the scheme and

out of that Rs. 1,59,937 were utilized during 2010-11. At CHC Badasahi, Rs. 3,68,386

were spent under untied fund out of Rs. 7,93,355 including opening balance of Rs.

33,355 during 2009-10. Similarly, Rs. 5,81,713 were spent in the year 2010-11 by the

SCs against available amount of Rs. 6,90,969 including opening balance of Rs. 4,24,969.

d. In the visited Sub centres, most of the expenditure under untied fund was made on the

items like referral transport to needy cases, strengthening immunization & VHND site,

repair and renovation of Sub Centre, drinking water, labour cost for sanitation activities,

purchase of medical consumable if required and Mamata Diwas activities etc. Joint Bank

account was opened in all the visited Sub centers‟ areas.

7. 24 hours delivery Scheme:

a. 37 Institutions were reported to have been setup for 24x7 services at rural areas in the

district. 4 Blood Bank were functioning in the district as a whole.

b. In the visited CHC at Badasahi, 2 specialists and 4 Staff Nurses were providing the

services but blood storage facility was not available. At Dukura CHC, there were no

specialists posted however 4 Staff Nurse were in position.

8. Physical infrastructure (HSC/PPC/CHC)

(i) Health Sub Centres:

a. The team visited 4 Sub centres in the district. Out of these 2 sub centres i.e. Tadki and

Manatri were functioning in rented building. The ANMs of Sub Centres at Tadki and

Bahananda were not staying in the sub centre headquarter village.

b. Labour room and Delivery table was available but deliveries were not being conducted by

ANMs in Sub centres at Bahananda and Chhelia.

c. Mclntsh sheet, Ambu bag/suction, DDKs, Kerosene oil, Sanitary Napkins, Metronidazole,

Oxytocin tablets, Kits- A & B, Ampiciline capsule and Gentamycin Injection were not

available in almost all the visited Sub entres.

d. Delivery table, Gloves and Antiseptic solution at Sub Centre Tadki; Disposable syringes,

Oral Pills, Chlorine solution/bleaching powder, Chloroquine and Paracetamol tablets in

Sub centre at Bahanada; EC pills, Nirodh, Antiseptic solution, Co-trimoxazole and

Paracetamol tablets in Sub centre at Chhelia- B; Examination table, Benches for clients,

Delivery table, Thermometer, Gloves, Co-trimoxazole tablets, IFA tablets/ Syrup, Nirodh

and Chlorine solution/bleaching powder in Sub centre at Manatri were not available.

463

e. Skilled Birth Attendance training had not been received by the Auxiliary Nurse Midwives

of visited Sub centres at Bahanada, Chhelia and Manatri. However all the visited Sub

centre ANMs have been received training on IMNCI.

(ii) PPC:

a. Visited PPC attached to SDH Rairangpur. Separate labour room is not available, as such

no delivery was being conducted at PPC Rairangpur. Jeep/ Ambulance, Weighing

machine (Infant), Oral Pills, Condoms, IFA tablets (L & S)/ Syrup and Vitamin – A tablets

were not available at PPC Rairangpur.

b. Residential accommodation for MO and AYUSH Medical officer was also not available at

PPC Rairangpur.

(iii) CHC:

Except X-ray facility, Blood storage unit, Anesthesia equipments, DPT vaccine and

Vitamin – A tablets, all facilities were available at CHCs visited at Dukura and Badasahi.

Resuscitation equipment and supply of Condom were not available at Badasahi CHC.

9. Opinion of the Community on the Health Services:

a. 42 Mothers having child upto one year of age were interviewed to assess their opinion

about the services provided by the ANMs in the area of Sub centres at Tadki, Bahanada,

Chhelia, Manatri and PPC Rairangapur (Ward No. 3 & 4).

b. Most of the respondents were satisfied with the activities of the ANMs in respect of health

services as well as regular availability of the staff at SCs.

c. However, 11 (26%) mothers did not receive Post Natal Checkups from the health

personal. 18 (43%) mothers were not aware about danger sign of ARI, 6 (14%) about use

of ORS and 12 (29%) did not have any knowledge of side effects of contraceptive

methods. 27 (64%) contacted mothers were not adopting FP (contraceptive) methods.

10. Family Planning services and Sample Verification of F.W. acceptors:

a. All the sterilisation cases are done in camp approach. The achievement of FP methods in

the district as a whole against the target is reported to be 84%, 86%, 64% and 57% for

sterilisation, CuT, Nirodh and OP users during 2009-10 respectively. Similarly,

achievement of 101%, 97%, 57% and 86% for targets of sterilisation, CuT, Nirodh and

OP users respectively was also reported during 2010-11.

b. During the field visit, the team selected 40 acceptors of sterilisation, 40 of IUD, 46 of Oral

Pills and 39 of Nirodh users and out of these 35 acceptors of sterilisation, 35 IUD

acceptors, 37 acceptors of OP and 33 Nirodh users were contacted. It was observed that

12 IUD acceptors, 5 Oral Pills and 7 Nirodh users did not receive follow up services after

accepting the methods.

464

c. The acceptors of 5 (15%) IUD, 2 (5%) Oral Pills and 4 (12%) Nirodh denied having the

services.

d. Out of the total 42 cases of child immunization contacted, 39 (93%) of the beneficiaries

received all doses of DPT, Polio, BCG, Measles and Vitamin- A and the remaining 3 (7%)

received the doses partially. All contacted beneficiaries were satisfied with the services.

11. Maintenance of Registers, records and reports:

a. Eligible Couple registers were not maintained at visited CHCs. CuT service register was

maintained in a non printed register in PPC Rairangpur and CHC Badasahi. The same

register was not maintained at visited CHC Dukura.

b. Oral Pills distribution register was maintained in the visited sub centres in non printed

forms, where the details like EC number, age of the last children etc. were not recorded.

c. ANC/PNC and Child immunization register were not maintained at CHCs but the same

was maintained in a printed register at PPC level.

d. Stock registers were maintained and up to date at all the visited Centres.

12. Miscellaneous observation and suggestions:

a. Monitoring and supervision of both visited CHCs and PPC by the supervisory personnel

was found to be very poor, it required to be strengthened.

b. During verification of the case card of sterilisation, it was observed that, case card were

not signed by the surgeon who had done the operation at Dukura CHC.

c. Janani Express may be provided to PPC Rairangpur for providing transport to the

beneficiary.

d. Printed register for Family Planning, JSY payment and Stock book may be supplied to all

facilities to maintain quality of record.

e. In none of the visited Sub Centre additional ANM is posted.

f. There is no stock of Metronidazole, Oxytocin, Ampicillin capsules and Gentamycin

Injection in visited 4 Sub Centres.

465

2.District:- Koraput

Major observations of Field Survey Unit (FSU), Bhubaneswar on the Evaluation work

carried out in the Koraput district of Orissa during August, 2011.

I. Details of the visited Institutions:

District

visited

PHCs/ CHCs/PPC visited SCs/Ward visited

Koraput

CHCs: Rabanaguda & Pottangi

PPC: SDH Jeypore

SCs: Kanga, Umeri, Rallegada, Maliput

Wards: Sambaritota, Kumbharsahi,

Kelanagar and Bank Colony of Jeypore

Urban

II. Major Observations:

1. Health Human Resources:

a. Key posts of health functionaries like 30 out of the 97 sanctioned posts of MO (Assistant

Surgeons), 34 out of the 71 sanctioned posts of Specialist, 9 out of the 359 sanctioned

posts of ANM, 56 out of the 190 sanctioned posts of MPW (M), 8 out of the 44 sanctioned

posts of LHV, 3 out of 66 sanctioned posts of Health Supervisor (M), 25 out of 95

sanctioned posts of GNM/ Staff Nurse and 18 out of 43 sanctioned posts of Lab

Technician were lying vacant in the district.

b. In the visited CHC at Rabanaguda, 4 out of the 13 sanctioned posts of MPW (M), 1 out of

the 3 sanctioned posts of LHV, 1 out of the 2 sanctioned posts of MO (Assistant

Surgeons), 3 out of the 5 sanctioned posts of GNM/ Staff Nurse and 1 out of the 2

sanctioned posts of Lab Technician were lying vacant. Similarly, in CHC Pottangi, 1 out

of the 22 sanctioned posts of ANM, 2 out of the 13 sanctioned posts of MPW (M), 3 out of

the 4 sanctioned posts of LHV, 2 posts of the 5 sanctioned posts each of MOs (Assistant

Surgeons) and GNM/ Staff Nurse were lying vacant.

2. Functioning of Rogi Kalyan Samiti (RKS):

a. Rogi Kalyan Samitis have been constituted in 18 institutions in the district. The regular

meetings of Rogi Kalyan Samitis were being conducted as per norms.

b. As per the district report, total expenditure under the RKS was Rs. 47,32,909 in the year

2009-10 and Rs. 22,65,502 during 2010-11 in the district. The fund spent mainly towards

purchase of Equipment, minor repair/ modification and maintenance of building, water

466

purifiers, generator, emergency lights/ inverters, water coolers, wages to sweepers out

sourcing of cleaning and laundry services and security services etc.

c. During visit to CHCs Rabanaguda and Pottangi, it was observed that utilization of funds

during last two years was satisfactory. The Governing body meeting of RKS is being held

on a quarterly basis and Executive committee meeting is also being held once in a month

in both Pottangi and Rabanaguda CHCs.

3. Services of ASHA:

a. 1438 ASHAs have been selected against the targeted 1488 ASHA in the district and

1183 ASHAs have been trained in 5 modules and 1342 ASHAs were provided with Drug

kits.

b. During the field visit, 5 ASHAs were interviewed in the area of each CHC i.e.

Rabanaguda and Pottangi and as informed they are getting monthly incentives of about

Rs. 1500 on an average for JSY delivery/ immunization/ VHND and sector meeting etc.

4. Village Health & Sanitation Committee (VHSC):

a. Totally, 1698 VHSCs (called GKS in the district) were functioning against the targeted

number of 1922 VHSC in the district. There are 1922 villages in the district and 1698

villages have been covered under the scheme.

b. The district released an amount of Rs. 16,67,00,000 during 2009-10 for the GKSs and out

of which Rs. 3,44,52,400 was utilized during the year. Similarly, district spent Rs.

1,66,70,000 out of an available amount of Rs. 1,92,20,000 during 2010-11 under the

scheme.

c. In the visited CHC Rabanaguda, expenditure incurred to the tune of Rs. 4,05,575 (39.4%)

out of available fund of Rs. 10,30,000 during 2009-10 and Rs. 12,08,793 (an excess

amount) was utilized against available amount of Rs. 10,90,000 in 2010-11. Similarly, in

CHC Pottangi, Rs. 4,08,300 (38.1%) were utilized in 2009-10 out of funds of Rs.

10,71,000 received during the year and Rs. 10,65,660 were utilized in 2010-11 out of

funds of Rs. 18,70,000 received in the year 2010-11.

5. Services of Janani Suraksha Yojana (JSY):

a. There were sufficient funds available under the scheme in the district. As per the

information available, Rs. 2,50,39,436 were spent against the JSY fund available to the

tune of Rs. 2,99,60,100 in the year 2009-10. Similarly, Rs. 2,08,35,927 were spent in

2010-11 against available fund of Rs. 2,68,20,900 in the year 2010-11. The district

reported 16456 JSY beneficiaries during 2009-10 and 13047 beneficiaries during 2010-

11 in the district.

467

b. In CHC Rabanaguda, expenditure was Rs. 19,57,580 against the provision of JSY funds

of Rs. 19,00,000 in the year 2009-10 and Rs. 15,66,205 were spent against the alloted

amount of Rs. 23,50,000 during 2010-11. In CHC Pottangi total funds of Rs. 24,00,000

received in 2009-10 and out of that Rs. 21,76,000 were utilized during the year.

Similarly, Rs. 9,49,450 were spent in the CHC against available amount of Rs. 11,71,000

in the year 2010-11. It was observed that number of JSY beneficiaries in 2010-11 were

less than the number of beneficiaries in 2009-10 in the whole district and also in the

visited CHCs.

c. 12 Janani Express are providing referral transport services to JSY beneficiaries in the

district but during the field visit, it was observed that these services was utilized by very

few mothers during their delivery. About 85% of beneficiaries have arranged transport

from their own pocket to reach the hospital for delivery.

d. The team contacted 52 JSY mothers in the area of visited centres in the district. In cases

of 98% mothers, JSY cards were issued. More than 94% contacted beneficiaries were

assisted by ASHAs for institutional delivery. About 14 mothers delivered at their home.

Only 6 beneficiaries have availed the facility of Janani Express. More than 98%

beneficiaries have received 3 Ante-natal checkups in time. About 12% mothers were

found to have partially consumed IFA tablets during their ANC period.

6. Untied Funds:

a. In 2009-10, an amount of Rs. 17,16,20,000 was released to the district by state

headquarter and out of that expenditure to the tune of Rs. 4,70,37,614 (27.4%) was

incurred. Similarly, untied funds amounting to Rs. 2,24,83,000 were given during 2010-11

to the district and expenditure incurred to the tune of Rs. 1,94,19,00.

b. In CHC Rabanaguda, untied funds to the tune of Rs. 17,77,200 including opening

balance of Rs. 12,17,200 was given in 2009-10 and out of that an amount of Rs.

12,03,489 was incurred during the year. The untied funds to the tune of Rs. 3,57,000

were also provided in 2010-11 and out of that an expenditure to the tune of Rs. 2,02,554

was incurred during the year.

c. In CHC Pottangi, out of Rs. 11,04,062 (including opening balance of Rs. 7,49,062)

available for the year 2009-10 Rs. 6,47,758 incurred expenditure during . Similarly, each

of the fund Rs. 3,01,000 under the scheme Rs. 4,24,537 were utilized during 2010-11 in

the CHC.

7. 24 hours delivery Scheme:

18 Institutions were reported to have been providing 24x7 services in the district.

However, large numbers of home delivery are taking place in the district. As against the

468

institutional deliveries of 13036, 11734 and 3509 during 2009-10, 2010-11 and 2011-12

(up to June, 2011) respectively there were 16965, 12589 and 3249 home deliveries

conducted in the district for the respective period of year.

8. Physical infrastructure (HSC/PPC/CHC):

(i) Health Sub Centres:

a. The team visited 4 Sub centres in the district. Except Sub centre Rallegada all were

functioning in Govt. building.

b. Foot stool, Mclntsh sheet, Ambu bag/suction, Steam sterilizer, Niachay Pregnancy Test

kit, Delivery kit, Kerosene oil, Sanitary Napkins, Antiseptic solution, Oxytocin tablets, Kits-

A & B, Ampiciline capsule and Gentamycin injection were not available in the visited Sub

centres.

c. Labour room, Benches for clients, Delivery table and Stove were not available in Sub

centres at Kanga, Umeri and Rallegada.

d. CuT insertion kit, RDT kit, Memoglobinometer, BP apparatus, Gloves and DDKs were not

available in Sub centres at Kanga and Umeri.

e. Cupboard for drugs, Torch, Thermometer, Nirodh and Chlorine solution/bleaching

powder at Sub Centre Kanga, Co-trimoxazole, Chloroquine tablets, CuT and EC pills at

Sub Centre Umeri, Examination table, Toilet facility, Cupboard for drugs, Torch,

Weighing machine (Adult & Infant), AD syringes, Co-trimoxazole, Metronidazole tablets

and Chlorine solution/bleaching powder at Sub Centre Rallegada, CuT insertion kit,

Weighing machine (Adult & Infant), Memoglobinometer, DDKs, Co-trimoxazole,

Chloroquine tablets and Chlorine solution/bleaching powder at Sub Centre Maliput were

not available.

f. Skilled Birth Attendance training was not received by the Auxiliary Nurse Midwives in the

visited Sub centres except ANM of Sub centre Umeri.

(ii) PPC:

a. Visited PPC attached to SDH Jeypore was functioning in Govt. building. Shortage of

Vitamin- A tablets and Arteether & Quinine injections were observed in PPC.

b. AYUSH Medical officer was not posted at PPC Jeypore.

(iii) CHC:

a. Visited CHCs at Rabanaguda and Pottangi were functioning in Govt. building. Operation

Theatre with OT table and IFA tablets (Large) at CHC Rabanaguda and Jeep in CHC

Pottangi were not available.

b. X-ray facility, Blood storage unit, Anesthesia equipments, Vitamin- A tablets and

Arteether injection were not available in both the visited CHCs.

469

9. Opinion of the Community on the Health Services:

a. 52 Mothers having child upto one year of age were interviewed to assess their opinion

about the services provided by the ANMs in the area of Sub centres at Kanga, Umeri,

Rallegada, Maliput and Jeypore Urban area.

b. Most of the respondents were satisfied with the activities covered by the ANMs in respect

of health services as well as regular availability of the staff at the centres.

c. However, 11 (21%) mothers did not receive Post Natal Checkups from the health

personnel. About 77% mothers told that ANM visited their home within 24 hours to 3 days

of the delivery. 90% of beneficiaries had reported initiation of breast feeding to their new

born child within 12 to 24 hours after delivery and rest 10% of beneficiaries given breast

feeding after one and two days.

d. 33 (64%) mothers were not aware about danger sign of ARI, 12 (23%) about use of ORS

and 20 (38%) did not have any knowledge of side effects of contraceptive methods. 34

(65%) contacted mothers were not adopting FP (contraceptive) methods.

10. Sample Verification of F.W. acceptors:

a. The team selected 146 F.W. cases (51 acceptors of sterilisation, 37 of IUD, 35 of Oral

Pills and 23 of Nirodh users) out of which 115 cases (44 acceptors of sterilisation, 29 IUD

acceptors, 27 acceptors of OP and 15 Nirodh users) could be contacted. Minor

discrepancy was observed in the age of acceptors, age of spouse, no. of total children

and in the age of last child. All 44 cases of sterilisation received full incentives payment.

b. 4 (3%) acceptors (3 Oral Pills and 1 Nirodh) denied the services.

c. Besides, 52 beneficiaries out of selected 56 child immunization contacted in the district.

Of these 48 (93%) beneficiaries received all doses of DPT, Polio, BCG, Measles and

Vitamin- A and the remaining 4 (7%) have received the doses partially. All contacted

beneficiaries were satisfied with service and no complication had been reported after

receiving the doses.

11. Reconciliation of the reporting performance:

Reported figures for Sterilisation, CuT, Oral Pills and Nirodh by the CHCs at Rabanaguda

& Pottangi and PPC at Jeypore for the year 2009-10, 2010-11 and 2011-12 (up to June,

2011) did not tally with the same figures provided by district office.

The details are as below:

470

Name of the

Centres

During the year 2009-10

Sterilizations

reported by

CuT reported by Oral Pills reported

by

Nirodh reported

by

District

office

Reporting

Centres

District

office

Reporting

Centres

District

office

Reporting

Centres

District

office

Reportin

g

Centres

CHC

Rabanaguda

700 670 335 335 20 233 121 96

CHC Pottangi 352 352 308 308 278 278 658 655

PPC Jeypore 583 278 236 155 343 408 499 166

During the year 2010-11

CHC

Rabanaguda

377 680 243 243 454 454 392 316

CHC Pottangi 319 294 411 400 305 305 658 658

PPC Jeypore 197 216 193 201 73 402 13 13

During the year 2011-12 (up to June, 2011)

CHC

Rabanaguda

180 285 71 192 130 198 101 179

CHC Pottangi 123 195 10 237 80 109 103 243

PPC Jeypore 0 62 23 98 85 194 0 75

12. Maintenance of Registers, records and reports:

a. Eligible Couple registers were maintained and updated properly in the visited centres but

this register was not checked by supervisory staff regularly.

b. CuT service register was maintained in a non printed form in CHC Rabanaguda. The

same register was not maintained at visited CHC Pottangi.

c. Oral Pills distribution register was maintained in the visited sub centres in non printed

forms, where the details like EC number, age of the last children etc. were not recorded.

d. ANC/PNC and Child immunization services were being recorded in the printed register at

PPC and Sub centres.

e. Stock registers were not maintained properly and up to date at all the visited Centres.

13. Miscellaneous observations and suggestions:

a. Monitoring and supervision of both visited CHCs and PPC by the supervisory personnel

was found to be very poor, it requires to be geared up.

b. In spite of the AMG and Untied funds, the Sub centre have not maintained their standard

to provide minimum services to the people. At Sub centre level supply of medicine and

471

availability of contraceptive was irregular. BP checkups, routine examination and

checkups of Hb % were not done in ANC cases.

c. Institutional deliveries are not increasing as per the desired target in spite of

implementation of JSY in the district as well as in both the visited CHCs. JSY scheme

was implemented in the visited district and paying the incentive money to mothers, but

most of the JSY mothers reportedly spend more amount than the JSY money received

during their delivery.

d. All CHCs, PHCs and SCs were allocated Untied Fund and Annual Maintenance Grant

and utilized the money but most of the staff did not keep necessary register along with

voucher/ receipt of expenditure in proper way. Pass books and untied expenditure

registers were not updated in some of the visited Sub centres.

e. The supply of Oral Pills and Condom to the CHCs was irregular in the district since April

2011.

f. Availability of field staff in PPC Jeypore is very poor urban ASHA may be approved for

the PPC area to cater to the needs of people.

3.District:- Sundergarh

Major observations of Field Survey Unit (FSU), Bhubaneswar on the Evaluation work

carried out in the Sundergarh district of Orissa during November, 2011.

I. Details of the visited Institutions:

District visited CHCs/PPC visited SCs/Ward visited

Sundergarh CHCs: Birkera & Kinjirkela

PPC: DHH Sundergarh

SCs: Birda, Zadakudar, Kinkibandh,

Birkaldihi, Rangadhipa & Sunaripada

II. Major Observations:

1. Health Human Resources:

a. Key posts of health functionaries like 10 out of the 123 sanctioned posts of MO (Assistant

Surgeons), 36 out of the 78 sanctioned posts of Specialist, 86 out of the 461 sanctioned

posts of ANM, 21 out of the 216 sanctioned posts of MPW (M), 8 out of the 57 sanctioned

posts of LHV, 10 out of 90 sanctioned posts of Health Supervisor (M), 19 out of 198

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sanctioned posts of GNM/ Staff Nurse and 10 out of 62 sanctioned posts of Lab Technician

were lying vacant in the district.

b. In the visited CHC at Birkera, 2 out of the 36 sanctioned posts of ANM, one each of the 4

sanctioned posts of LHV, 6 sanctioned posts of MO (Assistant Surgeons) and 3 sanctioned

posts of GNM/ Staff Nurse were lying vacant. Similarly, in CHC Kinjirkela, 4 out of the 30

sanctioned posts of ANM, 2 out of the 13 sanctioned posts of MPW (M), all 2 sanctioned,

posts of Specialist, one of the 6 sanctioned posts of MO (Assistant Surgeons) and post of

Lab Technician were lying vacant. Only post of MO (Assistant Surgeon) was found vacant in

PPC Sundergarh.

2. Functioning of Rogi Kalyan Samiti (RKS):

a. Rogi Kalyan Samitis have been constituted in 79 institutions i.e. District Hospitals- 2, Sub

Divisional Hospital-2, PPC Rajgangpur-1, PHCs/CHCs-18 and PHCs (New)-56 in the district.

In the visited Institutions, RKS was constituted and the regular meetings of Rogi Kalyan

Samitis were being conducted as per norms.

b. RKS fund to the tune of Rs. 73,68,771 including opening balance of Rs. 14,32,704 was

available in the district during 2009-10 and an amount of Rs. 52,16,723 about 71% of the

total fund was utilized during the year. Similarly, an amount of Rs. 44,66,534 (97.3%) was

spent during 2010-11 against the available RKS funds of Rs. 54,52,048 including opening

balance of Rs. 21,52,048 in the district during the year.

c. In the visited CHCs at Birkera and Kinjirkela, it was observed that Rs. 2,00,000 in the year

2009-10 and Rs. 1,00,000 during 2010-11 were provided to each of them as RKS funds and

most of the alloted funds were utilized during last two years under this head. The funds were

spent mainly towards purchase of inverter, cooler, fans, delivery table, almirah and white

washing at the CHC Birkera. Similarly, the funds were spent on purchase of Water cooler,

almirah, Inverter, campus lighting, OPD, IPD registers & tickets and indoor partition in CHC

Kinjirkela during last two years.

d. In the District Hospital Sundergarh, the total users fees collected were to the tune of Rs.

60,51,169 in the year 2009-10 and Rs. 73,78,226 in 2010-11. The funds earned under this

were spent mainly towards purchase of Lab Chemical, repair and renovation of hospital,

repair of hospital instrument, Equipment, stationary, electrical repair work, generator POL,

wages & other developmental work in DHH Sundergarh.

3. Services of ASHA:

a. It was reported that 2383 ASHAs were in position and 2085 ASHAs have undergone 5th

modules training. Totally 2262 ASHAs have been provided with Drug kits in the district.

473

b. It was also reported that for 2263 ASHAs, bank account have been opened and uniform/

saree provided to these ASHAs. Out of total ASHAs in position, 932 ASHAs have been

provided with cycle in 1st phase in the district.

c. As reported by the district, average incentive received by ASHA per month was calculated to

be Rs. 8341 (calculated from payment records from April to August, 2011). During the field

visit, 5 ASHAs were interviewed to ascertain the average monthly incentive received by them

and it was observed that they were getting about Rs. 1160 per month for JSY delivery/

immunization/ VHND and sector meeting etc.

4. Village Health Sanitation & Nutrition Committee (VHSNC):

a. Totally, 1655 VHSNCs (called GKS in the district) were functioning till September, 2011

against the targeted number of 1723 VHSNCs in the district. Bank accounts have been

opened by these VHSNCs in the district under the scheme for handling funds.

b. The district released an amount of Rs. 3,47,26,000 including opening balance of Rs.

1,74,17,000 for the GKSs through PHCs/ CHCs in the year 2009-10 and out of which Rs.

3,17,07,818 was utilized during the year. Similarly, district spent Rs. 1,62,74,000 out of an

available amount of Rs. 1,80,58,182 including opening balance of Rs. 30,18,182 during

2010-11 under the scheme.

c. Visited CHC Birkera, incurred expenditure to the tune of Rs. 17,60,000 out of available fund

of Rs. 18,51,000 during 2009-10. An amount of Rs. 9,00,000 was spent against available

fund of Rs. 9,51,000 in the year 2010-11. Similarly, in CHC Kinjirkela, Rs. 15,70,600 were

utilized in 2009-10 out of allotted amount Rs. 15,91,000 during the year and Rs. 6,90,400

were utilized against available fund of Rs. 7,50,400 in the year 2010-11.

d. The major activities undertaken by GKS include preparation of village health plan, sanitation

campaign, jalachatra activities, Swasthya kantha, well chandini repair, facilitation in IRS

campaign and wages. In district, 1664 GKS prepared village action plan, 1611 GKS has done

Swasthya kantha and 1275 GKS have taken new initiatives so far out of 1655 GKS formed

during the year 2010-11.

5. Services of Janani Suraksha Yojana (JSY):

a. In Sundergarh district, the delivery conducted in private nursing home/ hospital are not

entitled for JSY benefit since none of the Private Hospital is accredited under JSY as

reported by the district authority. Delivery conducted in the Govt. Institutions is eligible for

JSY assistance.

b. The district reported that, 25361 of the 32063 total deliveries in 2009-10, 27051 of the 32258

total deliveries in 2010-11 and 14749 of the 17167 total deliveries conducted during 2011-12

(up to September, 2011) were institutional deliveries in the district. As reported by the district,

474

out of the total birth/ deliveries, the number of infant death was 1010 & 938 and maternal

death was 79 & 75 during 2009-10 & 2010-11 respectively. After introduction of JSY, the

institutional delivery is showing an increasing trend & number of infant & maternal death is

showing a downward trend in the district. However more motivation for institutional delivery is

needed to increase it further.

c. As far as the budget and expenditure is concerned during the year 2009-10, total JSY fund

available in the district was Rs. 4,23,88,597 out of which the total expenditure during the

period was Rs. 3,46,48,677 (81.7%). Similarly during 2010-11, total fund available was Rs.

3,48,89,920 out of which the total expenditure was Rs. 3,59,83,445 (103.1%). The excess

expenditure was managed from other head temporarily. During 2011-12 (after adjusting the

excess expenditure for Rs. 10,93,525 during 2010-11) total fund available was Rs.

3,28,00,975 under this head and expenditure up to September, 2011 was reported to be Rs.

1,75,65,194 (53.6%). As reported, majority of JSY beneficiaries were accompanied by ASHA

for delivery. All the eligible delivery cases are paid the JSY money by cheque in time and no

pending case of JSY payment.

d. During visit to CHCs at Birkera and Kinjirkela, JSY beneficiaries have been paid the dues in

time in 2010-11 and only 52 beneficiaries in the current year were to be paid in CHC

Kinjirkela. In PPC, most of all beneficiaries have been already paid the dues under the

scheme. It has also been observed that the delivery register, payment register and cash book

is properly maintained and the same is very rarely checked by the supervisory staff.

e. The team contacted 46 JSY mothers in the area of visited 4 Sub Centres and villages/ wards

under PPC in the district. All contacted mothers stated that, JSY cards were issued to them

and received 3 Ante-natal checkups and JSY package by cheque in time. More than 91%

contacted beneficiaries were assisted by ASHAs for institutional delivery and were provided

transport facility. More than 76% beneficiaries have received 3 Post-natal checkups in time.

About 13% mothers were found to have partially consumed IFA tablets during their ANC

period.

f. As reported by the DPM Unit, a total of 21 Janani Express were sanctioned for the district. At

present 16 Janani Express facilities were on road in the district and another 5 Janani Express

is yet to be operated. In the visited centres Janani Express was operational and mothers

have availed the benefit of Janani Express.

6. Untied Funds:

a. In 2009-10, an amount of Rs. 20,47,799 including opening balance of Rs. 10,47,799 was

released to the CHC as untied fund from the district headquarter and out of that, expenditure

to the tune of Rs. 12,23,670 (59.8%) was incurred. Similarly, untied funds amounting to Rs.

475

12,12,876 were given to the CHC/PHC during the year 2010-11 and expenditure incurred

was to the tune of Rs. 8,15,403.

b. As reported, in CHCs Birkera and Kinjirkela, major head of expenditure under this head was

mainly towards purchase of Torch, water bottle, umbrella for ASHA, POL of Genset, cleaning

of hospital and whitewashing during last year and the year 2010-11. Similarly, the

expenditure of untied fund at PHCs (New) under this head was incurred mainly towards

purchase of stationery and cleaning of hospital during the same tenure.

c. Total expenditure of untied fund at Sub Centres in the district was mainly towards purchase

of table & chairs, stationery, medical consumable if required, referral transport to needy

cases, minor repair and renovation of Sub Centres during 2009-10 and 2010-11.

7. 24x7 Hours Delivery Care Services:

a. 20 Institutions in the rural area of the district were reported to have been providing 24x7

hours delivery care services in the district.

b. In the visited CHCs at Birkera and Kinjirkela, there was no blood storage facility. It has been

observed that both the CHCs were having adequate Staff Nurses but posts of specialist were

vacant at CHC Kinjirkela.

c. The authorities need to take effective steps to minimize the home deliveries in the district.

Large numbers of home delivery are taking place in the district. As against the total deliveries

of 32063, 32258 and 17167 during 2009-10, 2010-11 and 2011-12 (up to Sep, 2011)

respectively, there were 6712, 5207 and 2418 home deliveries conducted in the district

during the respective year.

8. Physical infrastructure and Stock Position:

(i) Health Sub Centres:

a. Out of 4 Sub centres visited in the district, two at Birda and Zadakudar were functioning in

rented house, ANM of these centres are not staying at Sub Centre headquarters. Labour

room was not available in Sub Centre of Kinkibandh.

b. RDT kit for malaria in all visited Sub Centres and Mclntsh sheet in Sub Centres at Birda,

Zadakudar and Kinkibandh were not available.

c. Examination table, Ambu bag/suction and IFA tablets (Small & Big)/ Syrup were not available

in Sub Centres at Birda and Zadakudar.

d. Foot stool in Sub Centres Zadakudar and Kinkibandh, DDKs and Kerosene oil in Sub Centres

Zadakudar and Birkaldihi were not available.

e. Delivery table, Steam sterilizer, Thermometer, ORS packets and Co-trimoxazole tablets at

Sub Centre Zadakudar and Gloves at Sub Centre Kinkibandh were not available.

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f. Skilled Birth Attendance training was not received by the Auxiliary Nurse Midwife of Sub

centre Zadakudar however, ANMs at the visited Sub centres had training on IMNCI.

(ii) PPC:

a. Visited PPC attached to DH building at Sundergarh has labour room separately, deliveries

are conducted in DH labour room. PPC was using all facilities available at DHH Sundergarh.

b. Shortage of IFA tablets (L & S)/ Syrup, Vitamin- A tablets and Arteether & Quinine injections

were observed in PPC.

c. Residential accommodation for MO & para-medical staff was not available.

d. AYUSH Medical officer was not posted in PPC.

(iii) CHC:

a. Visited CHCs at CHCs Birkera and Kinjirkela were functioning in Govt. building. Resuscitation

equipment, Neonatal Resuscitation equipment, IFA syrup, Vital & Essential drugs were not

available and AYUSH Medical officer was not posted at CHC Birkera.

b. X-ray facility, Blood storage unit, Anesthesia equipments, IFA tablets (L & S) and Vitamin- A

tablets were not available in both the visited CHCs.

9. Opinion of the Community on the Health Services:

a. 45 Mothers having child upto one year of age were interviewed to assess their opinion about

the services provided by the ANMs in the area of Sub Centres at Birda, Zadakudar,

Kinkibandh, Birkaldihi, Rangadhipa & Sunaripada.

b. Most of the respondents were satisfied with the activities covered by the ANMs in respect of

health services as well as regular availability of the staff at the centres.

c. 8 (17.8%) mothers did not receive Post Natal Checkups from the health personnel. About

53% mothers told that ANM visited their home within 24 hours to 3 days of the delivery.

About 95% of beneficiaries had reported initiation of breast feeding to their new born child

within half to 2 hours after delivery and rest 5% of beneficiaries breastfed their child after one

and two days of delivery.

d. 20 (44%) mothers were not aware about danger sign of ARI, 7 (15%) about use of ORS and

16 (36%) did not have any knowledge of side effects of contraceptive methods. 27 (60%)

contacted mothers were not adopting FP (contraceptive) methods.

10. Sample Verification of F.W. acceptors:

a. The team selected 179 F.W. cases (44 acceptors of sterilisation, 47 of IUD, 50 of Oral Pills

and 38 of Nirodh users) out of which 155 cases (39 acceptors of sterilisation, 42 IUD

acceptors, 41 acceptors of OP and 33 Nirodh users) could be contacted. All 39 cases of

sterilisation received follow up services by health personnel and full incentives payment.

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b. 5 (3%) acceptors (3 CuT, 1 each of Oral Pills and Nirodh) denied having the services.

c. Besides, 47 beneficiaries out of selected 52 child immunization were contacted in the district.

Of these 44 (94%) beneficiaries received all doses of DPT, Polio, BCG, Measles and

Vitamin- A and the remaining 3 (6%) have received the doses partially. All contacted

beneficiaries were satisfied with services and no complication had been reported after

receiving the doses.

11. Maintenance of Registers, records and reports:

a. Eligible Couple registers were maintained and updated properly in the visited centres but this

register was not checked by supervisory staff regularly.

b. CuT service register was maintained in a non printed form in CHC Kinjirkela. The same

register was not maintained at visited CHC Birkera.

c. Oral Pills distribution register was maintained in the visited sub centres in non printed forms,

where the details like EC number, age of the last children etc. were not recorded.

d. ANC/PNC and Child immunization services were being recorded in the printed register at

PPC and Sub centres.

e. Stock registers were maintained properly in the visited CHC Birkera and PPC Sundergarh but

same register was not updated Since March, 2011 by Kinjirkela CHC.

12. IT Infrastructure and Mother & Child Tracking System:

a. Team found that computers were available at district level and at CHC level and internet

connectivity was also available in these institutions but same was not provided to PHCs and

PPC level.

b. MCH Tracking formats were available in each Sub centres.

c. Health functionaries were sensitized in MCH formats at PHC/ CHC level. They are capturing

data in the formats and making data entry at PHC/ CHC level through outsourcing.

13. Miscellaneous observations and suggestions:

a. Monitoring and supervision of visited CHCs and PPC by the supervisory personnel was found

to be very poor, it requires to be geared up.

b. Printed register for Family Planning, JSY payment and Stock book may be supplied to all

facilities to maintain quality of record.

c. Eligible Couple number is not given in the Sterilisation, CuT, Nirodh and OP register of PPC

Sundergarh. Nirodh users were recorded without name and age of the wife of the beneficiary

at Sub Centres in the registers.

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4. District:- Nayagarh

The Regional Evaluation Team, located at Regional Office for Health and Family Welfare

(Kolkata), Ministry of Health and Family Welfare, Government of India carried out sample

checks of activities covered under NRHM / RCH in Nayagarh District of Odisha State during

July, 2011. The findings / observations of the team which are based on the sample checks are

detailed below:

I. Details of Health facilities visited:

District

visited

CHC / PHC SCs

Nayagarh CHCs: Mahipur, Rajasunakhala

and Badapandusar

PHC: Darpnarayanpur

Sampada, Chahali,Darpnarayanpur,

Brindabanpur, Badapandusar and

Gamharidih

II. Major Observations:

1. Health Human Resources:

a. The district was facing acute shortage of Medical Officers, Specialists and nursing staff. .

32 (58%) posts of Specialist, 37 (52%) posts of Medical Officer were vacant in the

District.

12 (13%) posts of ANM, 52 (38%) posts of MPW (M), 1 (25%) post of PHN and 16

(20%) posts of LHV were vacant in the district.

b. Medical Officer / Specialist and Nursing posts sanctioned were inadequate

Out of 12 CHCs functioning in the District only 5 posts of MOs/Specialists were

sanctioned. (1 CHC without MO/Specialist, 2 CHCs with only MO in-charge/Specialist,

5 CHCs with 2 MOs in-charge/Specialist).

2 CHCs without Staff Nurse, 2 CHCs with single Staff Nurse, 3 CHCs with 2 Staff

Nurse and 1 CHC with 3 Staff Nurse were providing 24x7 services in the district.

c. Visited CHC at Badapandusar was functioning without regular post of Medical Officer,

Specialist and Staff Nurse.

d. The PHC visited at Darpnarayanpur, was functioning with MO (AYUSH-Homeopathy),

Pharmacists, ANM and a Class- IV employee.

e. Most of the Sub centres were having single post of ANM.

f. Only 32 additional ANMs were selected against the total 166 Sub Centres in the district.

479

2. Rogi Kalyan Samiti (RKS) and Village Health Sanitation & Nutrition Committee

(VHSNC):

a. RKS meetings were held regularly at visited facility centres.

b. 1374 VHSNCs were constituted in the district and ASHA was not given due representation

in most of the committees.

3. Functioning of ASHA:

Out of a target of 885 to be in place, 884 ASHAs were selected, trained up to 5th module

and also provided drug kits.

4. Services of Janani Suraksha Yojana (JSY):

The team observed that:

a. Sufficient funds were provided for implementation of JSY.

b. Proper accounting procedure was not followed at CHC Rajasunakhala. The following

inconsistencies were noticed in recording of entries.

(Amount in Rs.)

Particulars

Statement for the year 2010-11 Statement for the year 2011-12

As per

cashboo

k

As per fund

received and

expenditure

As per

register

As per

cashbook

As per fund

received and

expenditure

As per

register

Opening balance 1,50,187 -3,50,013 3,47,867 7,21,567

Fund received 37,52,500 52,00,000 42,00,000 23,10,600 20,00,000 20,00,000

Total fund

available

39,02,687 48,49,987 26,58,467 27,21,567

Total expenditure 35,54,820 41,28,420 27,24,035 27,23,205

Balance amount 3,47,867 7,21,567 -65,568 -1,638

c. Register containing details of JSY beneficiaries, incentives made were maintained properly

at CHCs and PHCs visited but these registers were not checked by concerned Medical

Officers regularly.

d. MCH cards were provided to 30 out of 32 JSY beneficiaries selected for spot verification in

the district.

e. All deliveries were normal and ASHAs accompanied pregnant women to the hospital for

deliveries.

f. Mother and child were discharged from the hospital after keeping them under observation

for 3 to 5 hours.

5. Untied Funds:

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a. The team reported that the utilization of untied funds released to CHCs/ PHCs/ SCs and

VHSNCs in the district was very poor.

14.1% of untied fund at CHC level, 22.1% at PHC level, 19.8% at Sub Centre level

were utilized during 2010-11 whereas it was 18.1% in the case of CHCs, 12.7% for

PHCs, and 9.7% in the case of SCs during 2011-12 (up to October, 2011)

VHSNCs utilized only 32.6% of untied funds released to them during 2010-11

whereas it was 5.8% in 2011-12 (up to October, 2011)

Huge amount of funds (AMG and Untied Fund) were lying unutilized at visited Sub

Centres viz. Chahali (Rs. 50,313) and Brindabanpur (Rs. 31,647) due to non co-

operation of the concerned Sarpanch

b. Accounting procedure not followed at the facilities evaluated by the team.

Separate cashbook for the funds received under different schemes were not

maintained at any of the visited CHCs and Sub Centres..

At visited CHCs, a common cashbook maintained for RKS fund, AMG, Untied Fund

and salary fund for contractual staff (AYUSH MO & Additional ANMs).

At Sub Centres visited, a common cash book was found to account untied fund and

AMG.

6. 24 Hours Delivery Care Services:

All the 12 CHCs were providing 24x7 services. Inadequate infrastructure and clinical staff

was common at visited facilities.

Facilities for caring mothers and new born babies were inadequate.

Blood storage facility was not available.

A hut with inadequate clinical infrastructure (with one bed) was functioning as labour

room (at CHC Badapandusar) to provide pre and post delivery care. The facility was

functioning without a regular MO.

7. Physical infrastructure Stock Position:

(i) Health Sub Centres:

a. Sub centres visited (at Sampada, Chahali, Darpnarayanpur, Brindabanpur, Badapandusar

and Gamharidih) were not conforming to IPHS.

b. Source of water, Labour room, Delivery table, Mclntsh sheet, Ambu bag/suction, Delivery

kits, Sanitary Napkins, Slide for blood test, DDKs, EC Pills, Oxitocine tablets, Ampicillin

capsule and Gentamycin injection etc. were not available in most of the Centres visited.

c. Short supply of Kits- A & B was observed (at the centres visited) for the last one year.

d. Sub Centre Badapandusar was functioning from ANM‟s residence.

(ii). CHC/PHC:

481

a. The visited CHCs at Mahipur, Rajasunakhala and Badapandusar were not in conformity

with IPHS.

b. All old PHCs were upgraded to CHC but their infrastructure remains unchanged, only

higher rate of RKS, AMG and Untied Funds were provided as per eligibility of CHC.

c. Adequate number of Medical Officer, Para-medical staff, residential accommodation and

sufficient drugs were also not found.

d. X-ray facility, Blood Storage Unit, Surgical equipment and Anesthesia equipment were not

available at CHCs viz. Mahipur, Rajasunakhala and Badapandusar.

e. PHC Darpanarayanpur.is functioning without Regular water supply, Power backup

arrangement, Telephone facility, Ambulance/Jeep, Weighing machine (Infant), Autoclave/

Steam sterilizer drum, Microscope, Oxygen Cylinder, Labour room and equipments,

Resuscitation equipment, CuT Insertion Kit, stock of contraceptive items. The Centre was

also not having the post of Lab Technician.

f. During visit to the CHC Rajasunakhala, it was observed that most of the space of the

building was used for the purpose of parking and storage of waste material. Unwanted /

damaged hospital equipment, dust full doormats were kept on a new stretcher just in front

of the OT room. Labour room was very small and unhygienic

g. Maternity cum Female ward was located just next to the labour room. There were 5 beds

having with very old mattress without bed sheet & pillow. (The team provided the

photographs describing Maternity cum Female ward in the CHC was very unsafe

and under unhygienic condition. One of the photograph depicts the picture of one

matured pregnant mother lying on one bed and just to that next bed a street dog

was resting in the presence of CHC staff).

8. Opinion of the Community on the Health Services:

a. 20 mothers of young children (up to one year age) were interviewed in the area of Sub

Centres located at Chahali and Sampada to assess their opinion and knowledge about the

services provided by the concerned ANMs. Most of the interviewed mothers were aware of

the RCH services and found satisfied with the services received through ANMs.

b. 20 community members (of different target group) were also interviewed in the area of Sub

Centre located at Chahali to assess their opinion and knowledge about the services

provided by the concerned MPW (M). Most of the community members expressed their

satisfaction towards the services provided by MPW (M).

c. 11 community members of different target group (i.e. pregnant women, Recently delivered

women, Mothers of young children up to two years of age, AWW, ASHA and Village

482

leaders etc) were contacted to know overall functioning of the visited PHC. Some of the

mothers found unaware of danger sign of pregnancy during ANC. They were also not

much aware about contraceptive and HIV/STD/AIDS.

9. Sample verification of FW acceptors:

a. The team selected a total of 80 F.P acceptors for sample verification and contacted 77

(96%). It was found that:

Age of spouse in respect of 10 cases was wrongly noted.

Number of male children in 10 (13%) cases and age of last child in 8 (10%) cases

were wrongly noted.

31 accepters (40%) informed that they did not receive any follow up services.

b. 99 beneficiaries of BCG/ DPT/ Polio, Measles, Vitamin- A and Hepatitis –B were contacted

in the field.

All contacted beneficiaries were satisfied with service and no complication had been

reported after receiving the doses.

Follow up services by health staff were provided for 81 (82%) contacted

beneficiaries and rest of the 18 (18%) beneficiaries informed that they did not

receive any follow up services.

10. IT Infrastructure and Mother & Child Tracking System:

Team found that:

Computers with internet connectivity were available at district level and at CHC level.

MCH Tracking formats were available in each Sub centres.

Health functionaries were sensitized in filling-up MCH formats and they were making

data entry at CHC level.

11. Maintenance of records and registers:

a. Sterilisation, ANC, PNC and child immunization registers were found to be maintained

properly at all visited facilities.

b. Registers for Eligible Couple Survey, CuT acceptors, Oral Pills and Nirodh users were not

maintained properly at Sub centre level.

c. Minor discrepancies were observed in the reported figures of CuT, Oral Pills and Nirodh in

between reports of district office and visited CHCs was found.

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5.District:- Dhenkanal

The Regional Evaluation Team, located at Regional Office for Health and Family Welfare

(Kolkata), Ministry of Health and Family Welfare, Government of India carried out sample

checks of activities covered under NRHM / RCH in Dhenkanal District of Odisha State during

July, 2011. The findings / observations of the team which are based on the sample checks are

detailed below:

I. Details of Health facilities visited:

District

visited

CHC / PHC SCs

Dhenkanal CHCs:: Sri Ram Chandrapur,

Beltikiri, Odapada and Analabereni

PHCs: Dhirapatana, Nimidha &

Kalanga

Talaborkot, Beltikiri, Odapada,

Bangursing and Analabereni

II. Major Observations:

1. Health Human Resources:

a. The district was facing acute shortage of Medical Officers, Specialists and nursing staff. .

28 (45%) posts of Specialist, 24 (27%) posts of Medical Officer were vacant in the

District.

14 (89%) posts of MPW (M), 15 (56%) post of Staff Nurse and 19 (40%) posts of ANM

(contractual) were vacant in the district.

b. Medical Officer / Specialist and Nursing posts sanctioned were inadequate

10 CHCs were providing 24x7 services in the district without adequate clinical Staff (1

CHC without MO/Specialist, 3 CHCs without Staff Nurse)

c. Visited CHC at Odapada was functioning without a regular post of Medical Officer,

Assistant Surgeon and AYUSH Medical Officer.

d. The PHC visited at Dhirapatana, was functioning without regular post of Medical Officer.

e. PHCs Nimidha and Kalanga, were functioning without MO I/c (regular or contractual).

f. Most of the Sub centres were having single post of ANM.

g. Only 29 additional ANMs were selected against a total of 167 Sub Centres in the district.

2. Functioning of Rogi Kalyan Samiti (RKS):

a. Rogi Kalyan Samitis was constituted in the district but . RKS meetings were not held

regularly at visited facility centres.

b. RKS funds were provided to facilities as per the norms (@ Rs. 5,00,000 to DH, @ Rs.

1,00,000 to SDH/ CHC and @ Rs. 75,000 to PHC (N) were being provided per year).

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3. Functioning of ASHA:

As against a target of 1122 ASHAs, 1117 were selected and trained up to 5th module. Drug

Kits, First AID Kit, Apporon and Bicycle were given to all of them. ASHA meeting on 3rd

Saturday and ASHA Divas 1st Monday of every month was being observed in the district.

4. Functioning of Village Health Sanitation & Nutrition Committee (VHSNC):

a. 988 VHSNCs were constituted in the district and ASHA was a representative in all the

committees.

VHSNC is called as Gaon Kalyan Samiti (GKS) in the district and NGOs, PRIs, SHG

group members, Youth groups and Health staff were participating in the activities of

GKS.

Village Health Nutrition day was being organized in Anganwadi Centres.

b. Utilization of untied fund in GKS/VHSNC was not satisfactory.

There was unspent amount of Rs. 1, 72, 00,000 lying under this head in the district up

to September, 2011.

5. Services of Janani Suraksha Yojana (JSY):

The team observed that:

a. Sufficient funds were provided for implementation of JSY.

b. At CHC Analabereni, the number of institutional deliveries (including C Section deliveries)

has gone up during last 4 years as given below:

During the

year

Total Number of

Normal deliveries

Total Number of C

Section deliveries

Total Number of

Institutional deliveries

2007-08 798 65 863

2008-09 1341 174 1515

2009-10 1376 242 1618

2010-11 1666 368 2034

c. Register containing details of JSY beneficiaries, incentives made were maintained properly

at CHCs and PHCs visited but these registers were not checked by concerned Medical

Officers regularly.

d. MCH cards were provided to all 50 JSY beneficiaries selected for spot verification in the

district.

All the 50 deliveries were normal and ASHAs accompanied pregnant women to the

hospital for deliveries.

Mother and child were discharged from the hospital after keeping them under

observation for 3 to 5 hours.

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6. Untied Funds:

a. The team reported that the utilization of untied funds released to CHCs/ PHCs/ SCs and

VHSNCs in the district was very poor.

59.3% of untied fund at CHC level, 36.9% at PHC level, 46.1% at Sub Centre level

were utilized during 2010-11 whereas it was 24.9% in the case of CHCs, 12.9% for

PHCs, and 25.8% in the case of SCs during 2011-12 (up to October, 2011)

VHSNCs not utilized untied funds released to them during 2010-11 whereas the

utilization was 16.6% in 2011-12 (up to October, 2011)

Allocation of fund for Sub Centres was less than Rs. 10,000 during last year and

current year.

Untied Fund to the PHCs and Annual Maintenance Grant (AMG) to the CHCs &

SCs have not been provided in the year 2011-12 (up to October, 2011)

b. Accounting procedure not followed at the facilities evaluated by the team.

Separate cashbook for the funds received under different schemes was not

maintained at any of the visited CHCs and Sub Centres.

At visited CHCs, a common cashbook maintained for RKS fund, AMG and Untied

Fund.

At Sub Centres visited, a common cash book was found to account Untied Fund

and AMG.

7. 24 Hours Delivery Care Services:

All the 10 CHCs were providing 24x7 services. Inadequate availability of infrastructure

and clinical staff was common at visited facilities.

Facilities provided for caring mothers and new born babies were inadequate.

Blood storage facility was not available.

The CHC at Odapada, was functioning without a regular MO, Specialist and Staff

Nurse. .

8. Physical infrastructure Stock Position:

(i) Health Sub Centres:

a. Sub centres visited (at Talaborkot, Beltikiri, Odapada, Bangursing and Analabereni) were

not conforming to IPHS.

b. Electricity, Labour room, Examination table, Delivery table, Mclntsh sheet, Ambu

bag/suction, Delivery kits, Sanitary Napkins, Bleaching powder, Slide for blood test,

Oxitocine tablets, Ampicillin capsule and Gentamycin injection etc. were not available in

most of the Centres visited.

c. Short supply of Kits- A & B was observed (at the centres visited) for the last one year.

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d. Sub Centres at Odapada, Bangursing and Analabereni was functioning from ANM‟s

residence.

(ii). CHCs/PHC:

a. The visited CHCs at Sri Ram Chandrapur, Beltikiri, Odapada and Analabereni were not in

conformity with IPHS. All old PHCs were upgraded to CHC level but their infrastructure

remains unchanged. However, higher rate of RKS, AMG and Untied Funds were

provided as per eligibility of CHC.

b. Adequate residential accommodation for Medical Officer, Para-medical staff was not

provided.

c. Sufficient drugs were also not found.

d. Ambulance, X-ray facility, Blood Storage Unit, Surgical equipment, Anaesthesia equipment

and Sick New Born Care Unit were not available in the visited CHCs at Sri Ram

Chandrapur, Beltikiri, Odapada and Analabereni.

e. During the visit to CHC Analaberni, it was found that there were very good number of

institutional deliveries including C Section delivery performed by the O & G Specialist with

dedication.

f. PHC - Dhirapatana is functioning without Power backup arrangement. Ambulance/Jeep,

Weighting machine (Infant), Microscope, Oxygen Cylinder and Resuscitation equipment.

Were also not available at the facility.

The Centre was also not having the posts of regular MO and Lab Technician.

AYUSH MO posted at the facility was conducting a numbers of institutional

deliveries, though facilities were found very inadequate in PHC.

9. Opinion of the Community on the Health Services:

a. 20 mothers of young children (up to one year age) were interviewed in the area of Sub

Centres located at Talaborkot and Beltikiri to assess their opinion and knowledge about

the services provided by the concerned ANMs. Most of the interviewed mothers were

aware of the RCH services and found satisfied with the services received through ANMs.

b. 20 community members (of different target group) were also interviewed in the area of Sub

Centre located at Talaborkot to assess their opinion and knowledge about the services

provided by the concerned MPW (M). Most of the community members expressed their

satisfaction towards the services provided by MPW (M).

c. 11 community members of different target group (i.e. pregnant women, Recently delivered

women, Mothers of young children up to two years of age, AWW, ASHA and Village

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leaders etc) were contacted to know overall functioning of the visited PHC. Some of the

mothers found unaware of danger sign of pregnancy during ANC. They were also not

much aware about contraceptive and HIV/STD/AIDS.

10. IT Infrastructure and Mother & Child Tracking System:

Team found that:

Computers with internet connectivity were available at district level and at CHC level.

MCH Tracking formats were available in each Sub centres.

Health functionaries were sensitized in filling-up MCH formats and they were making

data entry at CHC level.

11. Sample verification of FW acceptors:

a. The team selected a total of 55 F.P acceptors for sample verification and contacted 54

(98%). It was found that:

Age of spouse in respect of 15 cases was wrongly noted.

Number of male children in 2 (4%) cases and age of last child in 24 (44%) cases were

wrongly noted.

29 accepters (54%) informed that they did not receive any follow up services.

b. 81 beneficiaries of BCG/ DPT/ Polio, Measles, Vitamin- A and Hepatitis –B were contacted

in the field.

All contacted beneficiaries were satisfied with service and no complication had been

reported after receiving the doses.

Follow up services by health staff were provided for 66 (82%) contacted beneficiaries

and rest of the 15 (18%) beneficiaries informed that they did not receive any follow up

services.

12. Registers, records and reports maintained at the visited centres:

a. Sterilisation, ANC, PNC and child immunization registers were found to be maintained

properly at all visited facilities.

b. Registers for Eligible Couple Survey, CuT acceptors, Oral Pills and Nirodh users were not

maintained properly at Sub centre level.

c. Minor discrepancies were observed in the reported figures of CuT, Oral Pills and Nirodh in

between reports of district office and visited CHCs was found.

6.District:- Kandhamal

Major observations of Field Survey Unit (FSU), Bhubaneswar on the Evaluation work

carried out in the Kandhamal district of Orissa during November, 2011.

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I. Details of the visited Institutions:

District visited CHCs/PPC visited SCs/Ward visited

Kandhamal CHCs: K. Nuagaon & Phiringia

PPC: Phulbani

SCs: Badiketa, Mahasingh, Ratanga

and Rabingia

Wards: Masterpada, Jiringpada and

Peonpada of Phulbani Urban

II. Major Observations:

1. Health Human Resources:

a. Key posts of health functionaries like 25 out of the 65 sanctioned posts of Medical Officer/

Specialist, 8 out of the 187 sanctioned posts of ANM, 20 out of the 142 sanctioned posts of

MPW (M), 7 out of the 29 sanctioned posts of LHV, 10 out of 44 sanctioned posts of Health

Supervisor (M), 15 out of 71 sanctioned posts of GNM/ Staff Nurse, 8 out of 32 sanctioned

posts of Lab Technician, 9 out of 67 sanctioned posts of Pharmacist and 10 out of 46

sanctioned posts of AYUSH Medical Officer were lying vacant in the district.

b. In the visited CHC at K. Nuagaon, 2 out of the 16 sanctioned posts of ANM, 10 out of the 13

sanctioned posts of MPW (M), one out of the 2 sanctioned posts of LHV, 3 out of the 6

sanctioned posts of MO (Assistant Surgeons), both the sanctioned posts of Specialist, 1 out

of 2 sanctioned posts of Lab Technician, 2 out of 5 sanctioned posts of Pharmacist and 1 out

of 3 sanctioned posts of AYUSH Medical Officer were lying vacant.

c. Similarly, in CHC Phiringia, 3 out of the 24 sanctioned posts of ANM, 8 out of the 14

sanctioned posts of MPW (M), one out of the 3 sanctioned posts of LHV, 1 out of 4

sanctioned posts of Health Supervisor (M), 8 of the 12 sanctioned posts of MO (Assistant

Surgeons), all 4 sanctioned, posts of Specialist, only post of Lab Technician, 3 out of 6

sanctioned posts of Pharmacist and 2 out of 5 sanctioned posts of AYUSH Medical Officer

were lying vacant.

2. Functioning of Rogi Kalyan Samiti (RKS):

a. Rogi Kalyan Samitis have been constituted and functional in all institutions in the district.

Regular meetings of Rogi Kalyan Samitis were being conducted as per norms.

b. RKS fund to the tune of Rs. 67,50,000 including users fees was available in the district during

2009-10 and an amount of Rs. 58,92,000 was utilized during the year. Similarly, an amount

of Rs. 67,05,000 was spent during 2010-11 against the available RKS funds of Rs.

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67,50,000. However, district had spent Rs. 21,86,000 against the available amount of Rs.

76,50,000 during current year up to September, 2011.

c. In the visited CHC K. Nuagaon, it was observed that @ Rs. 1,00,000 have been provided

annually as RKS funds in every year during 2009-10, 2010-11 and 2011-12 and more than

alloted funds i.e. Rs. 1,27,969 in 2009-10 and Rs. 1,00,751 in 2010-11 were utilized under

this head. It was reported that the excess amount from the unspent balance of previous

year‟s was managed by the CHC authority. Further, an amount of Rs. 20,490 was utilised

during current year up to July, 2011. Similarly, in CHC Phiringia, an amount of Rs. 3,34,891,

Rs. 3,60,287 and Rs. 8,92,068 were provided during the year 2009-10, 2010-11 and 2011-12

respectively and out of that Rs. 2,24,604, Rs. 1,18,219 and Rs. 1,70,424 were utilised in the

respective years.

d. In the visited Institutions, meetings of Governing body of Rogi Kalyan Samitis were being

conducted on a quarterly basis and meeting of Executive body reportedly held once in a

month. The funds were spent mainly towards purchase of equipments, minor repair/

modification and maintenance of building, wages of sweeper, water purifiers, generator,

emergency lights/ inverter, water cooler, out sourcing of cleaning & laundry services and

security services etc. in the visited institutions.

3. Services of ASHA:

a. It was reported that 1087 ASHAs have undergone 5th modules training out of 1232 ASHAs in

the district. All 1232 ASHAs have been provided with Drug kits and pregnant mothers are

assisted by ASHA for institutional delivery in the district.

b. In the visited CHC K. Nuagaon, 93 ASHAs were in position, 81 ASHAs have been provided

with Drug kits and 74 undergone 5th modules training. Similarly, in CHC Phiringia, 120

ASHAs were working with Drug kits and 110 ASHAs had completed all modules training.

c. During the field visit, 5 ASHAs were interviewed to ascertain the average monthly incentive

received by each ASHA. As reported, they were getting approximately Rs. 1400 per month

for JSY delivery/motivation for sterilisation operation, immunization/ VHND and school health

programme.

4. Village Health Sanitation & Nutrition Committee (VHSNC):

a. Totally, 2241 VHSNCs (called GKS in the district) were functioning against the targeted

number of 2379 VHSNCs in the district. Bank accounts have been opened in 2232 VHSNCs

for handling funds.

b. The district released an amount of Rs. 2,37,90,000 in each year 2009-10 & 2010-11 for the

GKSs out of which more than the alloted amount i.e. Rs. 4,05,50,000 was spent during 2009-

10. The concerned District Account Manager (DAM) reported that the excess funds spent

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from the unspent balance of the previous year‟s. However, Rs. 2,31,13,000 were utilized

during 2010-11. It was also reported that the district has spent Rs. 2,73,000 during current

year up to September, 2011 out of the total fund Rs. 2,35,90,000 provided for the current

year 2011-12.

c. Similarly, CHC K. Nuagon, received the amount of Rs.8,70,000 under GKS and had spent

Rs. 26,69,204 during the year 2010-11. It is also spent from the previous year‟s balance i.e.

during 2008-09 fund received was Rs. 27,00,000 and no amount was spent during that same

year. During 2009-10, the CHC received Rs. 17,40,000, and only spent Rs. 5,42,850. For the

current year, the CHC incurred expenditure to the tune of Rs. 3,31,655 out of available fund

of Rs.4,95,000 during 2011-12. Similarly, in CHC Phiringia, Rs. 28,22,901 in 2009-10, Rs.

28,75,475 in 2010-11 and Rs. 8,85,177 during current year up to September, 2011 were

utilized out of allotted amount of Rs. 39,45,000, Rs. 45,31,599 and Rs. 27,24,124 during

2009-10, 2010-11 and 2011-12 respectively.

5. Services of Janani Suraksha Yojana (JSY):

a. It was reported that, 9328 beneficiaries in 2009-10, 9970 beneficiaries in 2010-11 and 6058

beneficiaries during 2011-12 (up to September, 2011) benefitted with cash incentive under

the scheme in the district.

b. As far as the budget and expenditure is concerned, the district had incurred more than the

alloted budget. Rs. 1,93,44,000 spent against alloted budget of Rs. 1,85,46,000 in 2009-10

and Rs. 1,94,95,000 spent against provision of Rs. 1,89,74,000 during the year 2010-11.

c. During visit to CHC K. Nuagon, it was reported that 426, 586 and 352 mothers in the year

2009-10, 2010-11and 2011-12 respectively have been paid with JSY benefits. Similarly, in

CHC Phiringia, 841, 1168 and 655 mothers in the year 2009-10, 2010-11and 2011-12

respectively received JSY benefits.

d. The team contacted 51 JSY mothers in the area of visited 4 Sub Centres and PPC in the

district. All contacted mothers stated that, JSY cards were issued to them and received 3

Ante-natal checkups in time. More than 96% contacted beneficiaries were assisted by

ASHAs for institutional delivery. More than 78% beneficiaries have received 3 Post-natal

checkups in time. About 16% mothers were found to have consumed IFA tablets partially

during their ANC period.

e. As reported, a total of 14 Janani Express were sanctioned out of that at present 12 Janani

Express were on road in the district. In spite of the availability of Janani Express, about 70%

of beneficiaries have arranged self transport to reach the hospital for delivery. As reported,

majority of the JSY beneficiaries were accompanied by ASHA for institutional delivery.

6. Untied Funds:

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a. The district had spent excess amount of the alloted budget for untied fund during 2009-10 &

2010-11. An expenditure of Rs. 43,08,000 and Rs.29,50,000 was incurred against alloted

untied fund to the tune of Rs. 32,20,000 and Rs. 22,12,000 during the years 2009-10 & 2010-

11, it is also spend from the previous year balance as reported by the district. Similarly,

untied funds amounting to Rs. 22,45,000 were received in the year 2011-12 and expenditure

incurred was to the tune of Rs. 99,000 up to September, 2011.

b. Untied funds to the tune of Rs. 2,30,000 and Rs. 1,53,800 in 2009-10 and 2010-11

respectively was allotted to CHC K. Nuagaon, out of that an amount of Rs. 1,80,498 and Rs.

2,21,175 were incurred during the respective years. During 2010-11, the excess amount was

utilized from the previous years balance of Rs. 2,90,302 lying unspent from 2006-07, 2007-08

and 2008-09 in the CHC. Similarly, the untied funds to the tune of Rs. 1,40,000 was provided

in 2011-12 and out of that an expenditure to the tune of Rs. 43,914 was incurred during the

year up to September,2011.

c. Untied funds to the tune of Rs. 3,70,000 and Rs. 2,54,000 in 2009-10 and 2010-11

respectively were allotted to in CHC Phiringia. Out of this an amount of Rs. 2,35,870 and Rs.

85,098 were incurred during the respective years. Similarly, the untied funds to the tune of

Rs. 4,13,032 (including opening balance of Rs. 3,03,032) was provided in 2011-12 but till

September,2011 no amount was spent.

7. 24x7 Hours Delivery Care Services:

a. 14 Institutions were reported to have been providing 24x7 hours delivery care services in the

district. All the posts of specialist were lying vacant in the visited CHC and 24x7 services

were managed by existing staff in the centres visited.

b. However, against the total deliveries of 15589, 15700 and 8763 during 2009-10, 2010-11 and

2011-12 (up to Sep, 2011) respectively, there were 5786, 4639 and 2362 home deliveries in

the district during the respective year.

8. Physical infrastructure and Stock Position:

(i) Health Sub Centres:

a. Visited Sub centres at Badiketa, Mahasingh, Ratanga and Rabingia were functioning in

Government accommodation but there maintenance was not up to the mark. Labour room

was not available there.

b. Bench, Mclntsh sheet, Ambu bag/suction, Steam sterilizer, Kerosene oil, Sanitary Napkins,

Oxitocine tablets and Gentamycin injection were not available in the Centres visited.

c. Examination table, Delivery table and Antiseptic solution were not available in Sub Centres at

Badiketa and Mahasingh.

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d. RDT kit for Malaria and Ampicillin capsule were not available in Sub Centres at Mahasingh

and Ratanga.

e. Stove and Metrondazole tablets at Sub Centre Badiketa, Co-trimoxazole tablets at Sub

Centre Mahasingh, Weighing machine (Adult), Bleaching powder and Ampicillin capsule at

Sub Centre Rabingia were not available.

f. Skilled Birth Attendance training was not received by the Auxiliary Nurse Midwife of Sub

centre Ratanga however, ANMs at the visited Sub centres had training on IMNCI.

(ii) PPC:

a. Visited PPC Phulbani, attached to DH building at Kandhamal did not have any separate beds

however, the beds of Gynecology ward of DH are used by PPC. PPC was using all facilities

available at DHH Kandhamal.

b. Irregular supply of IFA tablets (L & S), Oral Pills, Nirodh, Vitamin- A tablets and Arteether &

Quinine injections were observed in PPC.

c. AYUSH Medical officer was not posted in PPC.

(iii) CHC:

a. Visited CHCs at K. Nuagaon and Phiringia were functioning in Govt. building but the

maintenance of the hospital was not up to the mark. X-ray facility was not available at CHC

K. Nuagaon.

b. Blood storage unit, Anesthesia equipments, IFA tablets (L), Vitamin- A tablets and Arteether

injections were not available in both the visited CHCs.

9. Opinion of the Community on the Health Services:

a. 51 Mothers having child upto one year of age were interviewed to assess their opinion about

the services provided by the ANMs in the area of Sub Centres at Badiketa, Mahasingh,

Ratanga and Rabingia.

b. Most of the respondents were satisfied with the activities covered by the ANMs in respect of

health services as well as regular availability of the staff at the centres.

c. 15 (29.4%) mothers did not receive Post Natal Checkups from the health personnel. About

84% mothers told that ANM visited their home within 24 hours to 3 days of the delivery. 100%

beneficiaries had reported initiation of breast feeding to their new born child within half to 2

hours after delivery.

d. 22 (43%) mothers were not aware about danger sign of ARI, 16 (31%) about usage of ORS

and 6 (12%) did not have any knowledge of side effects of contraceptive methods. 41 (80%)

contacted mothers were not adopting FP (contraceptive) methods.

10. Sample Verification of F.W. acceptors:

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a. The team selected 132 F.W. cases (41 acceptors of sterilisation, 41 of IUD, 23 of Oral Pills

and 27 of Nirodh users) out of which 100 cases (33 acceptors of sterilisation, 32 IUD

acceptors, 18 acceptors of OP and 17 Nirodh users) could be contacted. 31 out of 33

contacted cases of sterilisation received follow up services by health personnel. All acceptors

of of sterilisation received full incentives payment.

b. During sample verification of F.W. acceptors, 3 CuT, 5 Oral Pills and 1 Nirodh acceptor

denied to have received the services.

c. Besides, 42 beneficiaries of child immunization were contacted in the district out of them 36

(86%) beneficiaries received all doses of DPT, Polio, BCG, Measles and Vitamin- A and the

remaining 6 (14%) have received the doses partially. All contacted beneficiaries were

satisfied with services and no complication had been reported after receiving the doses.11.

IT Infrastructure and Mother & Child Tracking System:

a. Team found that computers were available at district level and at BPHCs/CHCs level and

internet connectivity was available only at district and CHC level institutions.

b. MCH Tracking formats were available in each Sub centres.

c. Health functionaries were sensitized in MCH formats and they are capturing data in the

formats and making data entry at CHC level.

12. Maintenance of Registers, records and reports:

a. Eligible Couple registers were maintained and updated properly in the visited centres.

b. Child registers were maintained and updated properly in the visited centres but this register

was not checked by supervisory staff regularly.

c. CuT service register was maintained in a non printed form in the centres visited.

d. Oral Pills and Nirodh distribution register was maintained in the visited sub centres in non

printed forms, where the details like EC number, age of the last children etc. were not

recorded.

e. ANC/PNC and Child immunization services were being recorded in the printed register at

visited Sub centres.

f. Stock registers were maintained properly and updated in CHCs/ PPC and also Sub Centres

visited.

13. Other observations and suggestions:

a. Monitoring and supervision of visited CHCs and PPC by the supervisory personnel was found

to be very poor, it requires to be geared up.

b. Printed register for Family Planning, JSY payment and Stock book may be supplied to all

facilities to maintain quality of record.

c. Eligible Couple number is not given in the CuT, Nirodh and OP register in the centres visited.

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d. The supply of Oral Pills and Nirodh to the CHCs was irregular in the district from April to June

2011.

7. District:- Baleshwar

Major observations of Regional Evaluation Team, Patna about the Evaluation work

carried out in Baleshwar District of Odisha State in the month of August, 2011.

i . Details of the visited Institutions:

District CHC Visited Sub Centre Visited

Baleshwar

Basta, Jaleshwerpur, Rupsa & Remuna

Baleswer, Mukulish, Chunka/Chowki, Sultanpur, Kasipada, OL. Saragan, Somnathpur & Nuapada

II. Major Observations:

1. Human Resources: The details on human resources provided by the district revealed somewhat good position in the

category of the posts of Specialist, Supervisor (M/F) and GNM in the district. As reported, 30

Specialists, 107 Supervisors (M/F) and 139 GNMs were working in the district against the

sanctioned strength of 31, 117 and 139 respectively. However, 39 of the 183 sanctioned post of

Medical Officers, 80 of the 203 sanctioned posts of MPW(M) and 73 of the 426 posts of

ANMs/Addl ANMs (Regular and contractual) were lying vacant in the district.

2. Rogi Kalyan Samiti (RKS) and Village Health Sanitation & Nutrition Committee

(VHSNC):

a) Rogi Kalyan Samiti has reported to be constituted at 5 CHCs, 12 PHCs, 2 Sub Divisional

Hospitals and District Hospital in the district.

b) Quarterly meetings of RKS were being conducted in the visited PHCs.

c) 2687 Village Health Sanitation & Nutrition Committees (VHSNCs) have been constituted in

the district and the members of VHSNCs meet quarterly.

d) The exact fund provision and its utilization in the RKS and VHSNCs was not made available

to the team.

3. Service of Janani Suraksha Yojana (JSY):

a) JSY implemented in the district and the funds in the various component of the scheme have

been utilized as per requirement. Though the exact amount of allocation of fund was not

provided, the expenditure to the tune of Rs.6,73,53,884 and Rs. 2,18,51,692 during 2010-11

and 2011-12 (up to July, 2011) respectively was reported by the district. It was also reported

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that the entire amount was spent under flexi pool budget as instructed by State Health Society

(SHS).

b) During field visit, 14 JSY beneficiaries were contacted in the district. All contacted mothers

received TT & IFA (L) during A.N. period. Most of them attended three PNC in their nearest

service centre.

c) It was observed that necessary information was not recorded in JSY cards but immunization

cards were filled up properly by the concerned ANM.

4. Functioning of ASHA scheme:

a) It was reported to the team that out of a target of 1923 ASHAs for the district, 1902 were

working. All ASHAs were trained in all the modules and provided with drug kits.

b) It has been reported that ASHAs were receiving incentive money on monthly basis.

5. Untied funds:

a) During financial year 2011-12, the State Health Society provided flexi-pool fund to the

districts in the state. Previously, funds were allotted head-wise like JSY, Untied fund, Referral

Transport etc. to the district. Under this head the expenditure incurred from the flexi pool fund

was to the tune of Rs.39,12,432 during 2010-11 and Rs. 2,21,518 during 2011-12 ((up to July,

2011) in the district.

b) Utilization of untied funds at CHCs, PHCs and SCs level was as follows: (Amount in Rs.)

Type of institutions

2010-11 2011-12 (up to July, 2011)

Expenditure Expenditure

PHCs (N) 17,60,935 46,087

PHCs/CHCs 3,10,497 1,75,431

Sub Centres 18,41,000 -

Total 39,12,432 2,21,518

c) During visit to SCs, it was found that the untied funds were not utilised properly. Though their

cash Book was verified and found correct except some minor discrepancies.

6. Annual Maintenance Grant (AMG):

a) The Annual Maintenance Grant (AMG) funds to the tune of Rs.64,63,483 for the year 2010-

11 and Rs. 3,43,030 for the year 2011-12 ((up to July, 2011) were spent in the district from flexi-

pool budget . The sufficient fund was available during the period.

b) Utilization of Annual Maintenance Grant (AMG) at CHCs, PHCs and SCs level was as

follows: (Amount in Rs.)

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Type of institutions

2010-11 2011-12 (up to July, 2011)

Expenditure

Expenditure

PHCs (New created)

49,46,491 1,36,578

PHCs/CHCs 9,30,467 58,606

Sub Centres 5,86,525 1,47,846

Total 64,63,483 3,43,030

7. 24 Hours delivery care services:-

As reported by the district, 24 x 7 hours service delivery system was being implemented in 23

institutions in the district.

8. Physical Infrastructure and Stock Position:

i. CHC:

a) Visited CHCs Basta, Jaleshwarpur, Rupsa and Ramuna were functioning in govt. building

but maintenance of the Hospital was not satisfactory. Water supply and electricity with power

back-up were available at all the visited CHCs.

b) Resuscitation equipment and neonatal Resuscitation equipment were not available at

Jaleshwarpur and Rupsa CHCs. Anesthesia Equipment was not at available at Basta and

Remuna CHCs. Incinerator was available at all the visited CHCs except Remuna CHC.

c) Blood storage unit was not available at all the visited CHCs except Basta CHC. The Sick

New Born Care Unit was not available at all the visited CHCs. Arteether injection was not

available at both CHCs Basta and Jaleshwarpur whereas Quinine injection was not available at

Jaleshwarpur and Remuna CHCs. X-Ray facility was not available at Rupsa and Ramuna

CHCs.

ii. HSCs:

a) Visited Sub Centres at Sultanpur, Chowki and Somnath have its own government building

with regular water supply, electricity connection and toilet facility. MPW (M) was not available at

all the visited SCs except Somnathpur SC (Additional ANM was available at Chowki and

Somnathpur SCs).

b) Delivery was not being conducted at all the visited Sub Centres.

c) Examination table, Delivery table and Mcintsh sheets were not available at Sultanpur &

Chowki SCs. Cupboard for drugs, Foot stool, Delivery table, Mcintsh sheets, Ambu bag/ suction,

RDT Kit for Malaria and Heamoglobinometer were not available at Somnathpur SC whereas no

furniture & equipments were available at Kasipara SC.

d) DDKs, IFA Tablet/syrup, Antiseptic solution (except Kasipara SC), Chlorin solution (bleaching

powder), Metronidazole tablets (except Kasipara SC), Misofrostol tab, Magsulth tab, Oxitocine

497

tablet, Ampicillin Capsule, Gentamycine injection and Kit-A & Kit-B were not available at the

visited Sub Centres. Apart from these, Oral Pills and Condom were not available at Sultanpur

and Chowki SCs; ORS Packet, IUD and Chloroquine tablets were not available at Chowki SC;

Vitamin-A solution, EC pills, Chloroquine tablets was not available at Kasipara SC and Vitamin-

A solution were not available at Somnathpur SC. ANMs were regularly organizing VHND at

AWC with support of ASHAs and AWWs in Chowki and Somnathpur SCs.

e) SBA training was not provided to the ANMs in the district till the time of visit.

f) Posters for public awareness were not displayed on the wall of centres. Service registers were

not checked/verified by PHC/District officials regularly.

9. Community Satisfaction on Overall Service:

i. Towards HSC’s service:

a) Interviewed mothers were satisfied with ANM‟s work. Deliveries of these mothers were

conducted by trained persons.

b) They were satisfied with immunisation services. Though mothers were aware of exclusive

breast feeding and complementary feeds yet awareness about ARI & Oral Rehydration Therapy

(ORT) was very low.

c) Health Worker (M) of Chowki SC was not present during visit of team. The post of HW (M) at

Sultanpur, Kasipara and Somnathpur SC was lying vacant for long time.

ii. Towards CHC’s service/Medical officer:

a) The team interviewed villagers including some recently delivered mothers, AWW, ASHAs,

and village leaders in visited CHCs and it was found that they are getting services at the

hospitals.

b) Mothers were not aware about AIDS /HIV and also ARI & Oral Rehydration Therapy (ORT).

c) It was observed that the children were not being taken in right time to hospital for routine

Immunization.

d) Medical officer of the CHCs visited at Basta, Jaleshwarpur, Rupsa and Remuna did not pay

regular visits at the villages.

10. Sample Verification of Family Welfare Acceptors:

a) Out of 125 selected samples of family planning acceptors in the district, 86 (68.8%) acceptors

could be contacted. It was found that out of 86 contacted cases, discrepancy was found in the

recorded age of last child in 39 (45%) cases.

b) Follow up service was provided to 48 (55.8%) acceptors.

c) Out of 59 spacing method (CuT-32, OP-14 and Nirodh-13) acceptors, 32 (Cu T-24 and OP-

8) users kept continuing the services without any complications while 27 (45.7%) acceptors

discontinued the services for different reasons.

498

d) Out of 36 selected samples of child immunization, 28 beneficiaries were contacted in which

all beneficiaries confirmed the doses and expressed their satisfaction.

11. Reconciliation of Reported Performance:

a) There was much variation in the same figures of CuT, OP and Nirodh reported at district

office and reporting centres for the year 2010-11 and 2011-12 (up to July, 2011). The details are

as reported below:

Sl. No.

Name of the CHC

For the year 2010-11

IUD OP Nirodh

Reported by

DFWB

Reported

by Centres

Reported by

DFWB

Reported by Centres

Reported by

DFWB

Reported

by Centres

1 Basta 863 601 6,697 6,787 40,998 41,000

2 Jaleshwar

989 989 13,197 1,015 35,328 5,888

3 Rupsa 759 596 15,190 20,201 53,941 29,796

4 Remuna 651 754 12,759 1,141 29,382 752

Sl. No.

Name of the CHC

For the year 2011-12 (up to July, 2011)

IUD OP Nirodh

Reported by

DFWB

Reported by

Centres

Reported by

DFWB

Reported by

Centres

Reported by

DFWB

Reported

by Centres

1 Basta 214 137 340 2,156 7,981 6,631

2 Jaleshwar

169 301 3,524 333 22,616 3,126

3 Rupsa 148 362 3,370 5,902 18,571 13,591

4 Remuna 202 244 4,555 322 5,319 380

b) Sterilization figures were also not maintained in the proper way. The following variation

shows negligence of the concerned officials:

i) The figures reported by the CHCs for the year 2010-11 and 2011-12 (up to July, 2011) was

not found matching with the figure reported by the district office for individual CHCs as given

below:

Sl. No.

Name of the CHC

2010-11 2011-12 (up to July, 2011)

Reported by Distt. Office

Reported by the centre

Reported by Distt. Office

Reported by the centre

1 Basta 507 484 47 281

2 Jaleshwar 829 829 9 145

3 Rupsa 639 611 5 114

4 Remuna 611 640 0 104

499

ii) The figures reported by the CHCs for the year 2011-12 (up to July, 2011) did not tally with

the Sterilization acceptors recorded in the service register in the CHC head quarter. During

2010-11, CHC Basta reported 484 cases of Sterilization whereas in service register 517 cases

were recorded. Likewise, the number of cases of Sterilization reported as 281 whereas the

cases in service register were only 261 in 2011-12 (up to July, 2011) in the CHC Basta.

Similarly, number of Sterilization acceptors reported as 145 whereas the service register

recorded only 45 cases in the year 2011-12 (up to July, 2011) at the CHC Jaleshwar.

12. Maintenance of Registers & Records:

a) Eligible Couple and Child Registers were maintained properly and up to date at

Jaleshwarpur CHC but the same were not maintained at Rupsa CHC and were not made

available at Basta CHC.

b) Sterilization service register was maintained properly and up to date at Rupsa and Remuna

CHCs but the same was not maintained properly at Basta and Jaleshwar CHCs.

c) Incomplete Cu-T service register was found at all the visited CHCs.

d) ANC, PNC and JSY Registers were printed and maintained properly at Jaleshwarpur and

Rupsa CHCs. These registers were not recorded with the all required information at some of the

visited Sub Centres.

e) Stock Registers of Cu-T, OP and CC were not maintained with the information like date of

manufacturing & expiry, Batch No.& model No. of Cu-T etc. at Jaleshwerpur and Rupsa CHCs.

f) The reporting format for tracking of pregnant woman and child immunization was not

maintained properly in the district.

g) Printed Family Planning service register and Stock register were not available at Sultanpur

SC. Eligible couple Register and formats for monthly reporting were not available at Chowki SC.

Eligible couple Register, MCH Register, Family planning service register, Stock register, formats

for monthly reporting, JSY Card, Immunization & ANC Card and mother child tracking register

were not available at Kasipara SC. Family planning service register, Stock register and formats

for monthly reporting were not available at Somnathpur SC.

13. IT Infrastructure & MCH Tracking:

a) Computers were available at the district headquarters, CHCs and PHCs in the district.

b) Internet connectivity was provided to the systems available in the district and at all CHCs

but the same was not available at PHC level.

c) It was reported that MCH Tracking formats were available in all the health Sub Centres in the

district. Data Entry was in progress at all the health facilities in the district.

d) Sensitisation of the officials about MCH formats was almost completed.

500

14. Other Observations:

1) Supervision at gross root level centres in the district need to be enhanced. Supervisors need

to see the overall activities at Sub Centres regularly and streamline the coordination between

ASHAs and AWWs to improve the services. Monthly progress reports need to be checked step

by step from Sub Centre level to District office for proper reporting. Monthly Review Meeting at

CHC level could also give effective results.

2) Monitoring and Evaluation by the DPMU members can give the qualilative improvement in

respect of community based services at village level.

3) It was observed that most of the space of Sub Centre building was being utilised by the ANM

for personal utility.

4) In distribution of OP, no check list had been maintained for regular users. Nirodh distribution

done through Condom corner by ASHAs without maintaining any records. Also supply of CuT,

OP & CC was found irregular.

5) The team has observed re-orientation is essential to the staff who are directly involved in the

implementation of the various scheme launched under NRHM at CHC/PHC and District level.

8. District:- Navrangpur

Major observations of Regional Evaluation Team, Patna about the Evaluation work

carried out in Navrangpur District of Odisha State in the month of August, 2011.

I . Details of the visited Institutions:

District CHC Visited Sub Centre Visited

Navrangpur Tentulikhunti, Jhorigam & Papadahandi

Lamatagudi, Kaligam, Iachhapur, Kusumi, Patraguda & Makar

II. Major Observations:

1. Human Resources: a) Staff position in the key posts was not satisfactory in the district. 36 of the 64 sanctioned post

of Medical Officers, 23 of the 29 sanctioned post of Specialists and 41 of the 147 sanctioned

post of MPW (M) were lying vacant in the district.

b) The details received from the district revealed somewhat good position in the category of the

posts of ANMs & Addl. ANMs, LHV/HS (F) and Lab Technicians in the district. As reported, 311

ANMs including Addl. ANMs, 35 LHV/HS (F) and 9 Lab Technicians were working in the district

against the sanctioned strength of 315, 37 and 11 respectively.

501

2. Rogi Kalyan Samiti (RKS) & Village Health Sanitation Nutrition Committee

(VHSNC):

a) 46 Rogi Kalyan Samiti have been reported to be constituted at 11 CHCs, 34 PHCs and one

in District Hospital in the district.

b) Quarterly meetings of RKS were being conducted in the visited Block/PHCs.

c) 861 Village Health Sanitation & Nutrition Committees (VHSNCs) have been constituted in the

district and the members of VHSNCs meet quarterly.

d) An amount of Rs. 86,60,000 was available for VHSNC in the district for the year 2011-12, out

of which, an expenditure to the tune of Rs.5,23,000 was made during the year up to June,

2011.

3. Service of Janani Suraksha Yojana (JSY):

a) JSY has been implemented in the district and the funds are being utilised under various

component of the scheme. The expenditure to the tune of Rs. 3,02,56,697 and Rs. 2,47,000

was incurred during 2010-11 and 2011-12 (up to June, 2011) respectively in the district. It was

reported that the entire amount was spent from flexi pool fund as instructed by State Health

Society.

b) During JSY field visit, 20 beneficiaries were contacted in the district. All contacted mothers

received TT & IFA (L) during A.N. period. Most of them attended three PNC in their nearest

service centre.

c) It was observed that necessary information was not recorded in JSY cards but immunization

cards were filled up properly by the concerned ANMs in the visited centres.

4. Functioning of ASHA scheme:

a) It was reported that as against the target of 1552 ASHAs, 1541 ASHAs were working in the

district and they were trained in all the modules. Drug kits have been provided to all the ASHAs.

b) It has also reported the ASHAs were receiving incentive money on monthly basis.

5. Untied funds:

a) During financial year 2011-12, the State Health Society provided flexi-pool funds to the

districts in the State. Previously, funds were allotted head-wise like JSY, Untied fund, Referral

Transport fund etc. to the district. Under the head of untied fund an expenditure to the tune of

Rs. 21,07,652 during 2010-11 and Rs. 3,63,000 during 2011-12 (up to July, 2011) has been

incurred from the flexi pool budget.

b) Utilization of untied funds at CHCs, PHCs and SCs level is as follows:

502

(Amt. in Rs.)

Type of institutions

2010-11 2011-12 (up to June, 2011)

Expenditure

Expenditure

CHCs 7,00,352 86,000

PHCs 1,61,542 -

Sub centre 12,45,758 2,77,000

Total 21,07,652 3,63,000

c) During visit to SCs, it was found that the untied funds were not utilised properly. Though their

cash Book was verified and found correct except some minor discrepancies.

6. Annual Maintenance Grant (AMG):

a) The Annual Maintenance Grant (AMG) fund to the tune of Rs. 22,59,417 for the year 2010-11

and Rs. 1,67,000 for the year 2011-12 (up to June, 2011) was spent in the district from flexi-

pool. The sufficient fund was available during the period.

b) Utilization of Annual Maintenance Grant (AMG) at CHCs, PHCs and SCs level is as follows: (Amt. in Rs.)

Type of institutions

2010-11 2011-12 (up to July, 2011)

Expenditure

Expenditure

CHCs 10,03,414 16,000

PHCs 10,85,662 1,06,000

Sub centre 1,70,341 46,000

Total 22,59,417 1,67,000

7. 24 Hours delivery care services:-

As reported by the district authority, 24 x 7 hours delivery care service was being implemented

in 10 institutions in the district.

8. Physical Infrastructure and Stock Position:

i. CHCs:

a) It was found that visited CHCs Tentulikhunti, Jharigam and Papadahandi were functioning in

govt. building and maintenance of the Hospital was satisfactory. Water supply and electricity

with power back-up were available at all the visited CHCs.

b) Labour Room, Labour Room Table and other equipments, Resuscitation Equipment and

Neonatal Resuscitation equipment were available at all the visited CHCs. Anesthesia

Equipment was not available at Jharigam and Papadahandi CHCs. Incinerator was available at

the visited CHCs except Papadahandi CHC.

c) Blood storage unit and X-Ray Facility were not available at all the visited CHCs. The Sick

New Born Care Unit was not available at Jharigam and Papadahandi CHCs. Arteether injection

503

and Quinine injection were available at Jharigam and Papadahandi CHCs except Tentulikhunti

CHC.

d) Out of six sanctioned post of Specialist, not a single Specialist was posted at the visited

CHCs.

ii. HSCs:

a) Visited Sub Centres at Kaligam and Kusumi have government building with toilet facility.

Water and electricity connection were available only at Kaligam Sub Centre. Additional ANM

and MPW (M) were not available at both the visited HSCs Kaligam and Kusumi.

b) Delivery Table and Foot Stool were not available at Kaligam HSC.

c) Mcintsh sheets and Ambu bag/ suction were not available at both the visited HSCs ie.,

Kaligam and Kusumi. RDT Kit for Malaria, Steam Sterilizer, Nischay Pregnancy Test Kit and

IUD Insertion Kit were available at Kaligam SC only. Heamoglobinometer was available at both

the HSCs.

d) DDKs and ORS Packets were available at Kaligam HSC. Antiseptic solution, Chlorin solution

(bleaching powder), Metronidazole tablets, Chloroquine and Paracetamole tablets tab available

at all visited Sub Centres. Magsulth tab, Oxitocine tablet, Ampicillin Capsule, Gentamycine

injection and Kit-A & Kit-B were not available at the visited Sub Centres.

e) SBA training was not given to the ANM in the district till the time of visit. ANMs organized

VHND at AWC regularly with support of ASHA and AWWs.

f) Posters for public awareness were not displayed on the wall of HSCs. Service registers were

not checked/verified by PHC/District officials.

9. Community Satisfaction on Overall Service:

i. Towards HSCs Service:

a) Interviewed mothers informed that ANMs were not available as and when required need as

they did not stay in HSC village. Mothers normally visit nearest SC for necessary service and

received IFA (L) and T.T. doses. Mothers counselling to the on exclusive breast feeding and

complementary feeds was satisfactory.

b) It was reported that no mother faced any problem during their deliveries and all were aware

about child immunization and use of contraceptives.

ii. Towards CHCs Services:

a) The team interviewed the villagers including some recently delivered mothers AWW, ASHAs,

and village leaders in visited CHCs and it was found that the services given at the hospitals was

up to the mark.

b) Mothers were not aware about AIDS /HIV and also ARI & ORT.

504

c) The children were not being taken in right time to hospital for routine Immunization.

d) Medical officer of Tentulikhunti, Jharigam and Papahandi CHCs did not visit some villages

regularly.

10. Sample Verification of Family Welfare Acceptors:

a) Out of 86 selected samples of family planning acceptors, 55 (64%) could be contacted in the

district. Discrepancy was found in the age of last child in 22 (40%) cases and in age of spouse

in 2 (3.6%) cases.

b) Follow up service was provided to 34 (62%) acceptors.

c) Out of 45 spacing method (CuT-25, OP-11 and Nirodh-9) acceptors, 33 (Cu T-19 and OP-11

and Nirodh-3) users were continuing the services without any complication while, 12 (26.7%)

acceptors discontinued the services for different reasons.

d) Out of 27 selected samples of child immunization, 24 beneficiaries were contacted in which

all beneficiaries confirmed the doses and expressed their satisfaction.

11. Reconciliation of Reported performance:

a) While examining the performance report of IUD in the visited CHCs, the reported cases of

IUD did not tally with the numbers of cases recorded in the service register for both the years

2010-11 and 2011-12 (up to July, 2011). The details are as given below:

Sl. No.

Name of the CHC

IUD cases

2010-11 2011-12 (up to July, 2011

Reported cases

Verified in the register

Reported cases

Verified in the register

1 Tentulikhunti 301 55 165 30

2 Jharigam 236 36 27 16

3 Papadahandi

613 21 58 30

b) It was also noticed that District office has reported zero (0) Sterilization and 41 IUD cases for

CHC Tentulikhunti for the year 2011-12 (up to July, 2011) whereas CHC itself reported these

figures as 114 and 165 respectively for the same period.

c) There was much variation in the figures of Oral Pills and Nirodh reported at District office for

the CHCs and the figures reported by CHCs for the year 2010-11 and 201-12 (up to July. 2011).

The details are as below:

505

Sl. No.

Name of the CHCs

2010-11 2011-12 (up to July, 2011

OP Reported by

Nirodh Reported by

OP Reported by

Nirodh Reported by

Distt. office

CHCs Distt. office

CHCs Distt.

office

CHCs Distt. offic

e

CHCs

1 Tentulikhunti

365 365 473 473 99 2113 39 3512

2 Jharigam 472 6139 469 34752

139 NA 226 NA

3 Papadahandi

562 7305 1297 93436

150 5586 424 35720

NA- Not available 12. Maintenance of Registers & Records:

a) Eligible Couple and Child Registers were printed but not maintained properly and updated at

Jharigam and Papahandi CHCs and were not made available at Tentulikhunti CHC.

b) Sterilization service Register was maintained properly and up to date at all the visited

institutions.

c) Cu-T service register was maintained but found incomplete at all the visited CHCs.

d) Oral pills & Nirodh distribution registers were not maintained properly at all the visited Sub

Centres.

e) ANC & PNC including JSY beneficiaries Register were maintained at all the visited Sub

centres. Child immunization register were also maintained properly at all the visited Sub

centres.

f) Stock Register of Cu-T, OP and CC were not maintained properly at Jharigam and Papahandi

CHC. Some essential information, like date of manufacturing & Expiry, Batch No. & model No.

of Cu-T etc were not recorded.

g) Printed Family Planning service register and Stock register was not available at Sultanpur

SC. Eligible couple Register and formats for monthly reporting was not available at Chowki SC.

Eligible couple Register, MCH Register, Family planning service register, Stock register, formats

for monthly reporting, JSY Card, Immunization & ANC Card and mother child tracking register

was not available at Kasipara SC. Family planning service register, Stock register and formats

for monthly reporting was not available at Somnathpur SC.

13. IT Infrastructure & MCH Tracking:

a) Computers were available at the district headquarters, Block/BPHC and CHCs in the district.

b) Internet connectivity was provided to the systems available in the district and at all 3 CHCs.

c) It was reported that MCH Tracking formats were available in all the health centres in the

district. Data Entry was in progress at district level except Block/BPHC/CHC/PHC level.

506

d) The officials have been sensitized about MCH formats.

14. Other Observations:

i) The reporting format for tracking of pregnant woman and child immunization was not properly

maintained in the district.

ii) Monitoring and supervision in the district need to be enhanced. The health supervisors need

to see the overall activities of SC including coordination with ASHAs and AWWs. Information

gathered in HIMS format for monthly progressive report of Sub Centres need to be checked by

the supervisor carefully and compile it correctly so that concerned data operator at CHCs can

prepare their report properly. Similarly, Monthly review meeting at CHCs may be effectively

used and for understanding the problem of grass root level worker.

iii) Monitoring and Evaluation by the DPMU members can result in qualitative improvement in

community based services at village level.

iv) The Sub Centre building was being utilised by the ANMs for personal purpose at Sub

Centres Kaligam and Kusumi as observed by the .

***********

507

Puducherry

1. District Puducherry:

Major observations of Regional Evaluation Team, Chennai about evaluation work

conducted in Puducherry district of the UT in May 2011.

I. Details of the visited Institutions:

GH / PHCs and PVT Hospitals visited

HSCs Visited

GH Puducherry

CHC: Karikalambakkam,

PHC: Bahur and Villayanur,

Sono Scan Centre and Aruna Scan Centre

Seliamedu and Karkadu Maneli

II. Major Observations:

1. Health Human Resources:

a. Some of the key posts were reported to be lying vacant in the district. 13 posts of ANM

against 231 sanctioned, 5 posts of LHV against 29 sanctioned, 8 posts of Male

Supervisor against 29 sanctioned, 79 posts of MO against 337 sanctioned, 39 posts of

Specialist against 119 sanctioned and 23 posts of Lab Technician against 88 sanctioned

were lying vacant in the district.

b. In GH, Puducherry, out of 27 posts of Staff Nurses, 8 were vacant and out of 46 Posts of

Cleaning Staff, 12 were vacant. Further, 3 posts of Specialist Doctor, 5 posts of Medical

Officer, 4 Head Nurses, 6 Staff Nurses, 2 Technical Assistant, 3 Senior Lab Technician,

55 group „D‟ Staff, 5 Group „C‟ Ministerial Staff and 4 group „D‟ Ministerial Staff were also

vacant.

2. Services of Janani Surakha Yojna (JSY):

a. Details of JSY beneficiaries and amount received and spent for the period 2009-10 and

2010-11 in the district are given below.

S.NO PARTICULARS 2009-10 2010-11

1 No. of JSY beneficiaries in the district 3951 3627

2 No. of mothers received JSY 3951 3627

508

incentive

3 Expenditure incurred under JSY 25,91,400 23,77,000

b. The contacted 3 JSY mothers informed that they had received the JSY amount as per

rules.

3. Untied Funds:

a. Status of availability and utilization of Untied Funds during 2010-11 is given as follows:

Amount in Rs.

Sl.No States of Centres Untied Fund 2010-2011

Opening

balance

Received

In the year

Expenditure

1 Primary Health Centres 37,202 6,88,072 7,10,843(98%)

2 Community Health Centres 213 1,02,008 1,02,221(100%)

3 Health Sub Centres 71,298 5,43,225 5,89,930(96%)

b. All the records of Untied Funds were properly maintained in the visited centres in

Puducherry district.

4. Rogi Kalyan Samiti (RKS) and Village Health & Sanitation Communities

(VHSCs)

a. In GH Puducherry, Patient Welfare Committee was functioning with Governing Body and

Executive Body. Likewise PHCs / CHCs were also having Patient Welfare Society with

only Governing Body constituted in the district.

b. In the district, there were 92 VHSCs formed. All the VHSCs in the visited areas

conducted their meeting but not in regular basis in the visited centers.

5. 24 Hours Delivery Care System:

15 PHCs were working as 24 hours delivery care service centers. As per the district statement,

institutional deliveries were increasing gradually in the district.

6. Physical Infrastructures and Stock Position:

i) Government District HQ Hospital:

509

District hospital Puducherry with 738 beds provides the services of all specialties.

Anesthetists and Surgeons were available for 24 hours. Acute trauma care wards and

separated wards for male and female patients were available. Blood bank was functioning

round the clock; blood is collected from voluntary donors and supplies to all Government

Institutions.

ii) CHC Karikalambakkam

a. CHC Karikalambakkam is a 36 bedded hospital. There were seven Medical

Officersbut Specialists posts were vacant and blood storage unit was not available.

residential quarters for MOs and 23 quarters for paramedical staff were available.

iii) PHC

a. The facilities were good in Villianur PHC which is a 7 beded PHC. having seven MOs.

There was no AYUSH MO and also no residential quarters for MO. Around 6 deliveries

are conducted in a month and 500 OPD are attended daily.

b. In PHC Baghour there was no autoclave and OT facility.

iii) HSCs

a. The team visited the HSCs at Korkadu, Manaveli and Seliamed. All the three HSCs had

building and the ANMs were staying at the HSC HQ.

b. HSC Korkadu was having Hemoglobinometer but not in a working condition. Disposable

syringes, Thermometer, Gas cylinder were not available. IFA tablets (small) were not

available for the last one and half year.

c. None of the visited HSCs had Ambu bag suction apparatus, RDT kit, Thermometer,

Oxytocin, Ampicillin and Gentamycine - inj.

d. None of the ANMs received training for SBA and IMNCI.

e. Kit A and Kit B were not issued by the HSCs for the current year.

7. Opinion of Community on the Health Services:-

a. The team selected and contacted 9 mothers to know about the work of ANMs and their

knowledge on various health related issues. All the contacted mothers informed that

ANMs were available when needed.

b. All contacted mothers were aware of exclusive breast feeding, use of ORS and

Contraception. Mothers were aware of nearest government health facilities.

510

c. First breast feeding within half an hour of delivery was initiated by 6 (67%) mothers. 6

mothers (67%) had knowledge on ARI and contraceptive side effects was known to

7(78%) mothers only.

8. Maintenance of Records/Registers:-

a. Register maintenance was found satisfactory in the centers visited. Consolidated service

register for IUD was not maintained in the PHCs and CHCs visited. Register for EC,

ANC, PNC, Immunization and other activities were seen maintained in all the centers

visited by the team.

9. Other observations:

1. IUD performance in Bahur PHC was poor. During 2010-11 only nine cases were

reported. The PHC was having four HSCs. In view of this there was tremendous scope

for improvement in IUD performance.

2. The District of Puducherry 79% of total Institutional deliveries in government institutions.

3. Puducherry District was having a very good internet network. HMIS was sent through

internet and printed forms of ANC and Child tracking were available at all HSCs.

****

511

2. District Yanam:

Major observations of Regional Evaluation Team, Chennai about evolution work

conducted in Yanam district of Puducherry August 2011.

I Details of the visited Institutions:

GH visited

HSCs Visited

GH Yanam HSC Farampetta, Gueriampetta, Dariyalarthippa and Kamakalpetta

II. Major Observations:

1. Health Human Resources:

In the Yanam district, there are 254 total sanctioned posts under various categories.

Out of these 33 are group „A‟, 5 in group „B‟, 137 in Group „C‟, 78 in Group „D‟ and 1 of

part time staff. Out of 254 posts, sanctioned under various categories 170 post were

filled up and 84 posts were lying vacant.

a. Out of 20 General Duty Medical Officers, (Group „A‟), 3 post each of General surgeon,

ENT and Dentist were only filled up. The post of Anesthetist, DGO, and Medical

specialist, T.B, Ophthalmologist and Radiologist were lying vacant.

b. Out of 5 posts sanctioned under Group „B‟, 4 posts were lying vacant; only 1 of 2

sanctioned posts of office superintendent was filled.

c. There were 39 vacancies of Group „C‟ posts against the sanctioned strength of 137 in

the district. There was major vacancy in the sanctioned strength of Staff Nurse; only 53

out of 62 posts were filled in. Similarly all 4 sanctioned posts of radiographer, 5 of the 6

sanctioned posts of Head Nurse, all 2 sanctioned posts of X-ray Technician, one

sanctioned post of SO, all 2 sanctioned posts of Store keeper (Gr.III) and 3 of 5

sanctioned posts of Driver, were lying vacant.

d. Out of 78 sanctioned Group „D‟ category posts, 14 posts were vacant in the district.

Mainly each one of the sanctioned post of Boiler Attend, Theatre Assistant, Peon and

Inset Collector was lying vacant.

e. There was no post of DPM under NRHM in Yanam district.

f. In all the visited 4 HSCs, in addition to the regular ANMs, there was an additional ANM

posted.

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2. Services of Janani Surakha Yojna (JSY):

a. In the district, 200 JSY mothers benefitted with the cash assistance in the year 2009-

10 and 201 mothers during 2010-11. Most of the deliveries were conducted in Kakinada

of Andhra Pradesh. Rs. 600/- are given to each JSY mother for institutional delivery.

b. In Yanam, none of the HSCs have conducted any delivery. The number of deliveries

conducted in GH Yanam is also very few for want of sufficient manpower especially

DGO and Anesthetist.

c. The team interviewed 15 JSY beneficiaries in the field. All have reportedly received

JSY incentive.

3. The district has received a total of Rs. 52.77 lakhs under various heads during

2009-10. Out of which Rs. 27.96 lakhs were spent. During 2010-11, a total of Rs.

59.38 lakhs received out of which 53.85 lakhs were spent under various heads.

The observations of the team regarding funds are as follows.

a. No AMG and VHSC fund given to any of the HSCs visited.

b. Full details of funds received and spent in GH Yanam not made available.

c. All 4 HSCs had received untied funds from the GH Yanam when ever required instead

of getting untied funds @ Rs. 10000 per year. For example HSC Kanakalpathu

received Rs. 4000 during 2009-10 and Rs.6483 during 2010-11 instead of Rs.10000

per year. HSC Gueriampet received only Rs. 5620 and Rs.7539 for the same period.

HSC Dariyalitippa received Rs. 2760 and Rs.2960 and HSC Farampeta received

Rs.7000 and Rs. 3487 for the above period.

d. It was informed that PWD was entrusted with the maintenance work of 4 HSCs @ Rs.

49000 per HSC. It was observed by the team that out of 4 HSCs, buildings are fully

leaking in 3 HSCs. Only some white wash was done at the leaking side of the building.

e. No untied fund was given to any HSCs during 2011-12 up to the date of visit.

4. Rogi Kalyan Samiti (RKS):

It was informed that Rogi Kalyan Samiti was formed in GH Yanam in the district and

some meetings were held recently.

5. 24 Hours Delivery Care System:

a. In the whole of Yanam district only GH was conducting deliveries. GH has conducted

444 deliveries in 2009-10, 432 in the year 2010-11 and 189 delivers in 2011-12 (up to

July 2011).

b. In GH Yanam lack of infrastructure and qualified manpower has created bottleneck in

conducting more deliveries. Out of 13 posts of specialist only 4 were filled up. That too

the post of DGO, and anesthetists were lying vacant. Out of 20 General Duty MOs only

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3 are filled up. None of the Lab Technicians available are permanent. The post of

pathologist was vacant and Lab. Facilities are poor. Blood bank was not functioning

due to the fire accident occurred some months before. There is only one OT and 2 OT

tables. Because of the above deficiencies, majority of the Yanam mothers are going to

Kakinada in Andhra Pradesh for deliveries.

6. Physical Infrastructures:

iv) G H Yanam:

GH Yanam is the only institution conducting delivery and IPD activities in the district.

The hospital having a sanctioned capacity of 100 beds, with minimal lab facilities,

limited residential quarters, one OT, no blood bank , few specialists and general duty

MOs.

v) HSCs:

a. All the four HSC ANMs having additional ANMs, but none of them have conducted

deliveries. Out of them only three were staying at the Head quarters and 3 HSC

buildings were completely leaking

b. Benches, cupboards for drugs, foot stool & delivery table were available in all the

HSCs. Steam sterilizer , Nischey pregnancy kit, torch light, stove, RDT kit for malaria

were not available in any of the HSCs visited. McIntsh sheets, IUD insertion kit, adult

weighing machine and BP apparatus were neither available nor working in 2 HSCs.

Ambubag, delivery kit and infant baby weighing machine were not available in 3 HSCs.

c. Thermometer, AD syringes, disposable syringes slides for blood test, gas/ kerosene,

DDK, FST, bleaching powder, chloroquine, Oxytoxin & gentamycine injection were not

available in Gueriampetta and Ferampetta HSCs. Kits A and B were not available in all

the centers visited.

In Kamakalpetta HSC, supply of syringes, slides for blood test, DDK, kerosene, anti

septic solution, chloroquine, bleaching powder and gentamycine, ampicilline and

Oxytoxin were not available.

7. Opinion of Community Health Services:

a. The community leader of Kamakalpetta informed that the service of GH Yanam has

deteriorated for the past 10 years and most of the public are going to places like

Kakinada of Andhra Pradesh State for medical need. He suggested to improve the

facilities by providing sufficient number of specialists.

b. In the 4 HSC areas there were 3 Male Health Assistants. But none of them were

present on the day as visit to the HSCs even after prior intimation. In the field area, the

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public informed that they are not aware of any male staff who are for collecting blood

smear, issuing CC, giving health education, chlorination work or controlling mosquito

menace.

c. The team contacted 7 mothers to assess their health awareness and opinion about the

pervious rendered by the ANM. All the 7 contacted mothers informed that ANM was

available when needed; they had institutional delivery, aware of contraceptive methods

and ORS.

d. 5(71.4%) mothers informed that their babies are weighed immediately after delivery, 3

PNC check up was given only to 4 (57.1%). ARI awareness only for 2(28.6%), and side

effects of contraceptives were known to only 2 (28.6%) mothers.

8. Sample verification of f.w. accepters:

a. There was no female sterilizations done in Yanam since 2009-10 and only 4 cases of

NSV done in the whole area during the past three years. 64 IUDs inserted in Yanam

during 2009-10 and OP & CC performance for the period was 165 and 243

respectively. During 2010-11, the IUD performance has again decreased to 31 cases

and further to 3 cases of IUD during 2011-12 upto the period of visit.

b. Due to want of female sterilization, samples of GH Yanam, the team has verified the

Yanam area cases done in Kakinada. Out of 25 FW cases selected, 20 could be

contacted. Minor discrepency in the age of accepter, in the age of spouse, total no. of

children and no of male children was observed.

c. 13 MCH beneficiaries were for interviewed in the field sample verification, out of these

6 were fully immunised and all have received BCG, DPT and Polio.

9. Maintenance of Records/Registers:

a. In HSC Kamakalpetta, EC register was not maintained up to date.

b. Cash book for untied funds was not maintained in any of the centers visited. Mother

and child tracking formats were not available in 3 HSCs.

c. None of the ANMs received any training in SBA. Constitution of VHSC and celebration

of VHND not done in any of the HSCs visited. IEC posters found not available

sufficiently in all the HSCs. In HSC Kamakalpetta, the sub center building was not

maintained properly for clinic purpose.

10. Other Suggestions and Observations:

a. During the past 3 years no female sterilization cases conducted in GH. Total male

sterilization cases were only 4 for the above period. Stock of Oral pills and CC were not

available in the current year in Yanam district.

515

b. ASHA scheme, VHSC and VHND not implemented in Yanam district.

c. The basic facilities of HSCs not improved even though funds are available. Most of the

necessary equipments, furniture and medicines were not available.

d. The district NRHM wing (viz., District Account Manager, Data Manager, computer and

Data entry operator) not received any training on basic concepts and implementation of

the programme. The Pondicherry HQ supervisors are rarely visiting the district.

e. Fully fledged Lab facility with pathologist required at GH Yanam.

f. General sanitation of the Yanam area is very poor. Steps may be taken to control the

mosquito menace and open drainage system.

**********

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Panjab 1. District- Firozpur Evaluation Report of Firozpur District (Punjab)

The Regional Evaluation Team, located at Regional Office for Health and Family Welfare

(Patna), Ministry of Health and Family Welfare, Government of India carried out sample

checks of activities covered under NRHM / RCH in Firozpur District of Punjab State during

July, 2011. The findings / observations of the team which are based on the sample checks

are detailed below:

I. Details of the visited Institutions: As part of evaluation, the team visited Sub District Hospitals (SDH), Community Health

Centres (CHCs), Primary Health Centres (PHCs) and Sub Centres (SCs) in both Districts of

Firojpur and Faridkot as per the details given below:

Districts S.D.H./CHC/PHC Sub Centres

Firojpur

S.D. Hospital: Fazilka

CHC: Jandwala, Mandot &

Guruharsahai

PHC: Jandwala Bhim Shah

Saraiah, Khuranj, Karma,

Chhanga-khurd, Prabjb &

Sohangarh

II. Major Observations: 1. Human Resources:

Shortage is a common phenomenon across all categories of clinical staff. More than 30%

Posts of Medical Officers and about 24 % posts of Specialists were lying vacant in the

District. The details of posts sanctioned, in position and vacancies are as given below:

Post Post sanctioned In position Vacant

M.O 159 111 48

Specialists 80 61 19

GNM 266 213 53

Lab Technician 75 41 34

2. Rogi Kalyan Samiti (RKS) and Village Health Sanitation & Nutrition

Committee (VHSNC):

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a) Rogi Kalyan Samitis (RKS) were constituted in all the PHC and above level Health

facilities covered in the evaluations study but their meetings were not being conducted

regularly.

b) Details of funds allocated / available, expenditure incurred during 2010-11 in different

institutes are as given below:

(in Rs.)

Type of Institution 2010-11

Fund Available Expenditure Balance

D.H 5,00,000 4,96,481 3,519

S.D.H & Others 3,00,488 2,93,305 7,183

CHCs 8,00,000 7,94,500 5,500

PHCs 54,20,125 52,73,538 1,46,587

c) No funds were released up to July, 2011 to any health facilities during 2011-12.

d) It was reported to the team that a total of 1217 Village Health Sanitation & Nutrition

Committees were functioning in the district and out of the total budget allocation of Rs.

1,29, 85,544, an amount of Rs. 1, 22, 92,031 was utilized by these VHSNCs during 2010-

11.

e) The budget allocation for the current year (2011-12) was reported as Rs. 6,93,515 and

the utilization up to June, 2011 was only Rs. 1,03,746.

3. Services of Janani Suraksha Yojana (JSY):

a) During the field visit, the team observed that necessary information was not recorded in

JSY cards and JSY registers were not maintained properly at the facilities covered in the

evaluation.

b) Mothers of young children (13 Nos.) contacted by the team reported to have received 3

consecutive post natal check-ups after delivery.

c) The team was provided details of allocation and utilization funds during evaluation. It

was reported that an amount of Rs. 65,60,580 was spent out of the budget allocation of

Rs.65,90,480 under JSY. However, during the year 2011-12, funds are not allocated to the

district under JSY; an expenditure of Rs.7, 65, 625 has been incurred up to June, 2011.

d) It was also reported that the district had spent full amount of Rs.13,69,000 that was

provided for Referral Transport for the year 2010-11 under JSY scheme. No allocation for

the current year (2011-12) has been made to the district but Rs.2,16,800 spent up to June,

2011.

4. Functioning of ASHA Scheme:

a) It was reported to the team that out of a target 1393 ASHAs for the district, 1337 were in

position and 1278 were trained in all modules and provided drug kits.

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b) It was also reported that ASHAs were receiving incentive money on monthly basis.

5 Untied funds:

a) It was observed that the untied funds allocated to the SCs were utilised and cash books

maintained properly.

b) The fund utilization position was quite encouraging during 2010-11 but not so in 2011-

12.The details of utilization of untied funds at CHCs, PHCs and SCs level for both the years

reveals the position.

Type of Institution

2010-11 2011-12 (up to June,2011)

Fund Available

Expenditure

Balance

Fund Available

Expenditure

Balance

CHCs 4,00,573 4,01,227 (100%)

348 4,00,346 NIL (0%) 4,00,346

PHCs 8,52,620 8,40,247 (99%)

12,373 8,62,373 11,000 (1%)

8,62,373

Sub Centre

25,59,942 22,77,491(89%)

2,82,451 25,92,451 10,000 (0%)

25,82,451

6. 24 x 7 hours Delivery Care Services:

It was reported that there were 16 institutions providing 24 x 7 hours delivery services in

the district.

7. Physical Infrastructure and Stock Position:

i. CHCs and SDH:

a) Blood storage unit was not established at the CHCs at Mandot and Guruharsahai.

b) Some of the surgical equipments, Anaesthesia equipment and Inj. Quinine were not

available at CHC Mandot.

c) Sick New Born Care Unit was not established in CHC Mandot and SDH, Fazilka.

ii. PHCs:

a) PHC, Jandwala Bhimshah had its own building with Regular water supply, electricity

connection and Toilet facility. Maintenance of the hospital building was satisfactory.

Telephone facility was also available.

b) Most of the essential equipments and supplies were available in the PHC. Stock of

OPV, DT. Vit. „A‟ solution etc. was not available on the day of visit.

c) There was no residential accommodation at PHC for MO.

iii. HSCs:

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It was observed that the availability of medicines, clinical consumables, equipment etc. was

poor at HSCs visited, the details are:

a) Sub Centres at Saraiah and Khuranj were having own government building with regular

water supply, electricity connection and toilet facility.

b) Labour room, Delivery table, McIntosh sheets, Ambu bag / suction, Delivery Kit and RDT

Kit for malaria were not available at both the above visited Sub Centres.

c) Steam sterilizer, Nischay pregnancy test kit, Torch and stove were not available at

Sarrian Sub Centre.

c) EC pills, Co-trimoxazole, Misofrostol, Magsulth and Oxitocine tablet, Ampicillin Capsule

and Gentamycine injection were not available at both the Sub Centres.

d) Slides for blood test, IFA Tablet/syrup, chloroquine tablets and Metronidazole tablets

was not available at Khuranj S/C whereas Kit-A and Kit-B was not available at Sarrian S/C.

d) Printed Eligible couple Registers were not available at Khurang Sub Centre.

e) SBA training was not given to the ANMs.

8. Community Satisfaction on overall service:

i. Services of ANMs:

a) Mothers (18) of young children (up to one year of age), who had institutional deliveries,

expressed their satisfaction with the services provided by ANMs.

b) Though 40% of the contacted mothers were not aware of ARI & ORT, all of them were

aware of the benefits of exclusive breast feeding, complementary feeds and the services

available at Government Health Facilities.

ii. Services of MPW (Male):

a) Work of MPW (Male) was assessed at SC Saraich and his service delivery was up to the

mark.

b) Popularization and distribution of Nirodh by MPW needs further boost.

iii. Services of PHC/CHC:

a) It was reported that Medical officer of Mandot CHC, Guruharsahai CHC and PHC

Jandwala Bhim Shah did not pay regular visits to villages on regular basis.

b) Though the community was satisfied with the services provided at CHC/PHC

headquarters, some of the contacted mothers were not aware about the ANC, ARI, ORT

and AIDS/HIV.

9. Sample Verification of Family Welfare Acceptors:

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a) Out of 113 acceptors of family planning selected, 63 (55.8%) could be contacted for

sample verification in the district. Eleven FP accepters (18.0%) reported that they did not

receive any follow-up services.

b) Out of 23 selected samples of child immunization, 20 (87%) were contacted in which all

beneficiaries confirmed the receipt of immunization doses and expressed their satisfaction.

10. Reconciliation of Reported performance:

a) The team observed variations in the performance (Sterilizations) between the figures

reported by the District authorities compared with data available at the CHCs for the years

2010-11 and 2011-12 (Table).

Sr. No.

Name of centres Sterilization performance reported at

2010-11 2011-12 (upto June, 2011)

District office Centres District office Centres

1. Guruharsahai CHC 452 450 39 57

2. Jandwala CHC 618 NA 75 NA

3. Fazilka CHC 206 204 57 57

4. Mandot CHC 681 676 73 106

b) While conducting verification of the performance of family planning acceptors, there

was no reports and registers available for the year 2010-11 and 2011-12 at CHC Jandwala.

It was also observed that CHCs located at Guruharsahai and Mandot did not prepare

similar registers for sterilization for the year 2011-12 till visit of the team.

c) There were only 192 sterilization cases recorded in the services register at CHC Mandot

as against the reported figure of 676 for the year 2010-11.

11. Maintenance of Register & Record:

The team observed that:

a) Eligible Couple and Child Register were not maintained / not made available at Fazilka

CHC, Fazilka and Jandwala CHC.

b) Service Registers were not made available at most of the visited centres.

c) Stock Register of Cu-T, OP and CC were not maintained properly and not up to date at

all visited PHC/CHC and HSC.

d) JSY beneficiaries Register was not maintained properly and up to date at all the visited

centres.

12. Other Important Observations :

a) SBA Training for Staff Nurse & HW(F) and NSV training for MOs was not provided. Also

the concerned staff and officers were not trained in MCH tracking.

b) The condition of labour room and maternity wards at S.D.Hospital Fazilka was very poor

and unhygienic. It was observed that entry restriction for general public / party members

was not maintained at the entrance of labour room

521

c) The team observed that the supervision at the centres was totally lacking as a result

records and registers found not maintained properly.

d) It was observed that the staff working at DPMU and BPMU was not having adequate

knowledge about the different programme under NRHM. Re-orientation Training is

essential to these units for proper implementation of the programmes.

************

2. District- Faridkot . Evaluation Report of Faridkot District (Punjab)

The Regional Evaluation Team, located at Regional Office for Health and Family Welfare

(Patna), Ministry of Health and Family Welfare, Government of India carried out sample

checks of activities covered under NRHM / RCH in Faridkot District of Punjab State during

July, 2011. The findings / observations of the team which are based on the sample checks

are detailed below:

I. Details of the visited Institutions: As part of evaluation, the team visited Sub District Hospitals (SDH), Community Health

Centres (CHCs), Primary Health Centres (PHCs) and Sub Centres (SCs) in both Districts of

Firojpur and Faridkot as per the details given below:

Districts S.D.H./CHC/PHC Sub Centres

Faridkot

CHC: Bajakhana & Jaitu

PHC: Golewala

Rumana Ajit Singh, Jaitu &

Ghughiyana

II. Major Observations: 1. Human Resources:

The team observed that large number of vacancies across all categories of clinical staff

exist in the district notably the Medical Officers and MPW(M). The details of vacancies are

given below:

Post Post sanctioned In position Vacant

M.O 41 19 22

Specialists 36 30 6

ANMs 79 67 12

GNM 74 54 20

MPW(M) 69 18 51

Lab Technician

23 20 3

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2. Rogi Kalyan Samiti (RKS) & Village Health Sanitation Committee (VHSC):

a) It was observed that Rogi Kalyan Samiti (RKS) was constituted in the district and also at

the visited centres but their meetings were not being conducted as per norms.

b) Fund utilization position is quite alarming though RKS funds were provided to the

institutions viz. DH, SD /CHCs/PHCs in the district during the year 2010-11. The entire

amount allocated for the year 2010-11 had been carried forward to 2011-12.

Out of the carried forward funds, during 2011-12 (Up to June, 2011)

SDH and other centres utilized only Rs. 18,500 out of Rs. 1, 00,000,

At CHC level, out of Rs. 4,00,000 RKS fund available, Rs. 70,925 had been spent.

At PHC level only Rs.1,22,454 out of RKS fund Rs. 8,96,256 had been utilized

No expenditure was incurred by the district hospital out of RKS funds available (Rs.

5,00,000) during the current year.

d) It was reported to the team that 187 Village Health & Sanitation Committees have been

constituted in the district and the entire budget allocation of Rs. 18, 70,000 during last year

(2010-11) had been fully utilized. However, during 2011-12 (till June, 2011), no fund

utilization had been made (Allocation Rs.18, 70,000) by the VHSCs.

3. Service of Janani Suraksha Yojana (JSY):

a) The team observed that necessary information was not recorded in JSY cards. JSY

registers were also not maintained properly at the visited centres.

b) Some of the mothers (out of 9 contacted in the area of visited centres) of young children

did not receive three consecutive check-up in time.

c) It was observed that the fund utilization position is not encouraging.

During the year 2010-11, funds to the tune of Rs.22,96,675 were spent out of

Rs.26,34,175 (Allocation) under JSY head.

During the year 2011-12, out of Rs. 20, 83,288 (Allocation) the utilization was only

Rs.5, 34,282 (up to June, 2011).

Under the Referral Transport Head, an amount of Rs. 7, 46,400 out of Rs. 10,

19,175 allocated was spent during 2010-11.

During 2011-12 (Up to June, 2011), out of Rs. 7 73,000 allotted to the district,

Rs.2,61,200 had been spent.

4. Functioning of ASHA scheme:

a) It was reported that 396 ASHAs were in position as against the targeted of 407 in the

district and 360 ASHAs trained in all modules and 396 ASHAs were provided drug kits.

b) It was also reported that ASHAs were regularly receiving incentive money per month.

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5. Untied funds:

a) The total untied fund to the tune of Rs.28,90,000 was received for the year 2010-11 and

the whole amount was spent during the year. Out of available fund Rs. 28,90,000 in the

year 2011-12 and Rs. 1,18,705 in the current year up to June, 2011was spent in the district.

b) Utilization of untied funds at CHCs, PHCs and SCs level is as follows:

Type of institutions

2010-11 2011-12 (up to June, 2011)

Fund Available

Expenditure

Balance

Fund Available

Expenditure

Balance

CHCs 2,00,000 2,00,000 (100%)

NIL 2,00,000 54,761(27%)

1,45,239

PHCs 2,00,000 2,00,000 (100%)

NIL 2,00,000 59,944 (30%)

1,40,056

Sub centre

6,20,000 6,20,000 (100%)

NIL 6,20,000 4000 (0.6%)

6,16,000

c) During the visit to SCs, it was found that the untied funds were utilised and the cash

books were maintained properly

6. 24 Hours delivery care services:-

As reported, there were 5 institutions providing 24 x 7 hours delivery services in the district.

7. Physical infrastructure and stock position:

CHCs:

a) Most of the equipments, drugs and supplies were available at CHCs Bajakhana and

Jaitu.

b) X-ray, Anaesthesia equipment and Inj. Quinine were not available at CHC Bajakhana.

c) Sick New Born Care Unit was not established in CHC Bajakhana.

d) Arteerther & Quinine inj were not available at Jaitu CHC.

e) Out of six sanctioned posts, only one specialist was posted at Bajakhana CHC where as

not a single specialist was posted at Jaitu CHC.

PHC:

a) PHC, Golewala had own building with Regular water supply, electricity connection and

Toilet facility. Maintenance of the hospital building was satisfactory. Telephone facility was

also available there.

b) Most of the essential equipments and supplies were available in the PHCs. Stock of DT

and. Vit. „A‟ tab. etc. was not available on the day of visit.

c) There was no residential accommodation for PHC MO.

d) There was no functional Operation Table.

HSCs:

524

a) Sub Centre visited at Ghughiyana was having own government building with regular

water supply, electricity connection and toilet facility.

b) Labour room was available at Ghughiyana SC. Labour room was not available at SC

Remuna, but delivieries were not conducted there.

c) Ambu bag/suction, Foot Stool, Mcintsh sheets, Delivery Kit and Steam Sterilizer were not

available at the Sub Centre Remuna whereas Nischay pregnancy test kit, Torch and stove

were available at both the Sub Centres.

e) EC pills, Antiseptic solution, Bleaching powder, Metronidazole tablets, Misofrostol tablets

was not available at Remuna HSC and DDKs, Kerosene oil, Chloroquine Tab was not

available at Ghughiyana SC.

f) SBA training was not given to the ANMs.

8. Community Satisfaction on overall service:

i. Services of ANMs:

a) The team contacted 10 mothers (5 in each SC visited at Remuna and Ghughiyana SCs))

having child up to one year of age and interviewed them to assess their knowledge and

opinion of the services rendered by the ANMs. Mothers replied that:

The ANMs stay in HSC villages.

They were satisfied with ANMs‟ services.

Their deliveries were institutional. All mothers were aware of the benefits of

exclusive breast feeding and complementary feeding.

Immunisation sessions were conducted on regular basis in their village.

b) 3 (40%) of the contacted mothers were not aware about ARI & ORT.

c) All mothers were aware of Government Health Facilities where they can get all health

facilities.

ii. Services of CHCs/PHC:

a) The team interviewed some beneficiaries, AWW, ASHAs and village leaders in the area

of visited CHCs and PHC. It was found that:

ANC and PNC services were provided in time to the mothers but they did not have

knowledge about ARI & ORT.

It was also found that mostly mothers were not aware about AIDS and HIV.

There is a need for popularizing the benefits of institutional deliveries through

ASHAs to the expectant mothers regularly.

b) The team also observed that mothers of young children should be educated for bringing

their children to hospital in right time for Immunization.

c) Medical officer of visited CHCs and PHC were not visiting the villages on regular basis.

525

9. Sample Verification of Family Welfare Acceptors:

a) Out of 97 acceptors of family planning selected, 55 (57%) could be contacted for

sample verification in the district. 39 (71%) FW acceptors found to have not received

follow-up services after accepting the FP methods.

b) Out of selected 45 beneficiaries of child immunization, 31 (69%) beneficiaries could

be contacted and confirmed the doses.

c) Follow up service was not provided to 22 (71%) beneficiaries.

10. Reconciliation of Reported performance:

a) It was observed that Sterilization and IUD figures reported at CHC Bajakhana for the

year 2010-11 and 2011-12 (up to June, 2011) did not tally with the figures of service

registers:

There were 313 Sterilization acceptors and 103 IUD acceptors recorded in the

service registers as against the reported figures 937 and 1807 for the year 2010-

11.

Similarly, 134 Sterilization and 43 IUD acceptors were recorded in the service

registers as against the reported figures of 307 and 466 respectively up to June,

2011 for the current year.

b) There were under reporting of sterilization figures at CHC Jaitu :

For the year 2011-12 (up to June, 2011), the actual acceptors of sterilization as per

the service register were 129 whereas reported number was 120.

11. Maintenance of Registers & Records:

a) Eligible Couple and Child Registers were maintained properly at Bajakhana CHC and

Jaitu CHC but the registers were not maintained properly at Golewala PHC.

b) Sterilization service register was not maintained properly at Golewala PHC.

c) Cu-T service register was maintained properly at Bajakhana & Jaitu CHCs but it was not

maintained properly at Golewala PHC.

d) ANC Register was maintained properly at Jaitu & Bajakhana CHCs but the same was

not maintained properly at Golewala PHC.

e) Stock Registers of Cu-T, OP and CC were not maintained properly at all visited CHCs/

PHC/ HSCs.

12. Other Important Observations and Suggestions:

a) Training on MCH tracking was given neither to district officials nor to peripheral officials

in the district.

526

b) OP & Nirodh distribution under F.W programme was not up to the mark at SC level and

also no prescribed Performa was available for maintaining stock and distribution of Cu-T,

OP & Nirodh. ANC/PNC registers were also not available.

c) It was observed that the staff working in HQ and CHCs/PHC was not having adequate

knowledge about the different programmes under implementation under NRHM. Re-

orientation Training is essential at these units.

d) Out of six sanctioned post, only one post of Specialist was filled in at CHC Bajakhana.

**********

3. District:- Muktsar Major observations of Regional Evaluation Team (RET), Patna on the evaluation work

carried out in Muktsar District of Punjab State during the month of May, 2011.

I. Details of the visited Institutions:

District visited SDH/CHCs/PHCs visited HSCs visited

A. Muktsar CHCs: Chack Serawalia, Dodai & Lambi.

Rupana, Asha Butter, Doda -II, Warring Khera & Killian Wali.

II. Major Observations: 1. Human Resources:-

As reported,the status of staff position in the district was as follow:

Particulars of Post Post sanctioned In position Vacant

Specialist 72 30 42

MO 12 7 5

Nurse (Grade “A”) 86 32 54

LHV/HS(F) 22 14 8

Lab Technician 34 13 21

ANMs 113 68 45

527

MPW(M) 91 46 45

In addition to above, 150 posts of 2nd ANM, 3 posts of MPW (M) and 70 posts of Nurses

(Gr. “A”) were provided in the different health facilities on contractual basis in the district.

This shows that the district was facing acute shortage of Medical Officers, Specialists and

supervisory posts which is a hindrance in providing effective health care delivery to the

people.

2. Rogi Kalyan Samiti (RKS) & Village Health, Sanitation and Nutrition Committee

(VHSNC):-

a) 25 Rogi Kalyan Samitis were set up at the DH, 2 SDHs, 5 CHCs and 17 PHCs in the

district. Regular meetings of RKS were being conducted quarterly in the visited institutions

but proceeding registers were not maintained properly.

b) Details of RKS funds available and expenditure incurred at DH, SDH, CHCs and PHCs

in the District are given in the following table:

(Amount in Rs.)

Type of Insti- tutions

2010-11 2011-12 (upto August, 2011)

OB Recd. Total Fund

Exp. Bal. % of fund utiised

OB Recd. Total Fund

Exp. Bal. % of fund utiised

DH 0 5,00,000

5,00,000

4,65,699

34,301 93% 34,301 5,00,000

5,34,301

0 5,34,301

0%

SDH 0 2,00,000

2,00,000

1,20,780

79,220 60% 79,220 1,00,000

1,79,220

98,459

807,61

55%

CHCs

0 5,00,000

5,00,000

5,75,801

(-)75,801

115% (-)75,801 6,00,000

52,4,199

80,170

4,44,029

15%

PHCs

8,81,461

17,00,000

25,81,461

18,75,018

7,06,443 73% 7,06,443 17,00,000

24,06,443

1,94,693

22,11,750

8%

Total 8,81,461

29,00,000

37,81,461

30,37,298

7,44,161 80% 74,4,161 29,00,000

36,44,161

3,73,332

34,70,829

10%

OB- Openning Balance

c) 264 VHSNCs were functioning in the district. The meetings of VHSNCs were being

conducted regularly in the visited institutions.

d) As per the details received from the district, Rs. 26,40,000 [@ Rs. 10,000 to each

VHSNC] were given as VHSNC to the district each year 2010-11 and 2011-12 without

taking account of huge amount of opening balance in the year. Only Rs. 1334458 (56%) in

528

the year 2010-11 and Rs. 35,63,313 (10%) in the year 2011-12 (up to August, 2011) were

spent out of available total fund of Rs. 30,15,882 and Rs. 39,74,458 in the respective year.

3. Service of Janani Suraksha Yojana (JSY):

a) For the implementation of Janani Suraksha Yojana the district spent Rs. 21,10,200

(121%) against allotted fund out of the available fund of Rs. 17,41,200 during 2010-11. No

information about the source of excess expenditure was provided by the District. Rs.

9,73,000 (67%) was spent out of the available fund to the tune of Rs. 15,31,000 in the year

2011-12 (up to August, 2011).

b) 17 JSY beneficiaries were interviewed by the team for on the spot verification. All

beneficiaries were satisfied with the services and had received MCH cards and three

Checks-up during AN and PN period. Most of the deliveries of contacted mothers were

institutional and mothers received monetary benefit as per JSY scheme.

c) The team observed that JSY amount was utilised properly at SC level but available fund

was insufficient as reported by the ANMs. JSY Cards had also not been supplied to the

SCs.

4. Functioning of ASHA scheme:

573 ASHAs were working as against the target of 633 in the district. 529 ASHAs were

trained up to 5th modules and 573 ASHAs were provided with drug kits in the district.

5. Untied Funds and Annual Maintenance Grant (AMG):-

Utilisation of Untied Fund and Annual Maintenance Grant at CHCs, PHCs and Sub Centres

in the district was not satisfactory during last two years in the district. The details are as

given below:

(Amount in Rs.)

Type of Fund

2010-11 2011-12 (upto August, 2011)

CHCs PHCs Sub Centres

CHCs

PHCs Sub Centres

Untied Fund Available*

2,52,123

4,91,85

4

11,40,767

3,50,7

71

5,06,64

3

11,78,809

Expenditure

1,51,352 4,10,211 9,81,960 23,705 52,182 86,183

Balance

1,00,771 81,613 1,58,807 3,27,066

4,54,461

10,92,626

AMG Fund Available*

501888

102212

2

1247733

70206

3

128274

9

1255252

Expenditure

299825 589373 1012481 20191 92318 119760

Balance

202063 432749 235252 681872

1190431

1135492

* Including opening balance.

529

6. Physical Infrastructure and Stock Position:

i. CHCs:

a) CHCs visited at Chack Serawali, Dodai and Lambi were functioning in Govt. buildings.

Cleanliness in the delivery room was not maintained properly at the CHCs. Water supply

and electricity with power back-up were available at all visited CHCs. Condition of beds was

found poor in CHC Lambi.

b) All surgical equipments for CHC expertise, Ambulance, Oxygen cylinder, Labour room,

labour room table & equipment, Operation theatre and OT table were available at visited

CHCs, but Blood storage unit, Resuscitation equipments, Neonatal Resuscitation

equipments, Sick New born care unit, Quinine injections and Arteether injection were not

available in the visited CHCs.

c) X-Ray facility was not available at Lambi CHC and Anesthesia equipment was not

available at Chack Serawali and Lambi CHC.

d) No Specialist doctor was posted at CHC Chack Serawali.

ii. HSCs:

a) HSCs at Asha Butter and Rupana were functioning in Govt building and HSC Doda-II

was functioning in rented building. Drinking water, Electricity and toilet facility were

available at Asha Butter and Rupana HSCs.

b) ANMs in charge of the visited Sub Centres were staying at their Sub Centre village.

Additional ANM was available only at Asha Butter and Rupana HSCs, whereas MPW(M)

was not available at all the visited Sub Centres. Labour room was available at Asha Butter

and Rupana HSCs, but delivery was not conducted at the visited Sub Centres.

c) Water supply, electricity, toilet, labour room and examination table were not available at

SC Doda-II there. The post of 2nd ANM and MPW (M) was also not posted there.

d) Steam Sterilizer and B.P Apparatus were not available at Doda-II HSC, Delivery kit at

Asha Butter HSC and Ambu bag/ suction, steam sterilizer and Heamoglobinometer at the

Rupana Sub Centre were not available.

e) Condom, Misofrostol, Magsulth and Oxitocine tablets and Ampicillin Capsule and stock

of condom was not available at the visited Sub Centre. Besides, Vitamine A solution,

IFATable/Syrup, Oral pills, EC Pills, Antiseptic Solution, Clorin Solution, Metronidazol

tablets and Gentamycine Injection were not available at Doda-II HSC.

f) DDKs, Vitamine A solution, IFATablet/Syrup, Chloroquine tab and Gentamycine injection

were not available at Asha Butter HSC and DDKs, Co-trimoxazole tablets, and ECPills

were not available at Rupana SC.

530

g) Family planning Service register was not available at Doda-II SC, Formats for monthly

reporting and Mother- child Tracking formats/ register were not available at Asha Butter

HSC and Stock register was not available at Rupana Sub Centre.

h) Buildings of Doda-II and Rupana Sub Centres were not maintained properly for clinic

purpose and cleanliness.

i) SBA training to ANMs was not given in the district till the visit of the team.

7. Opinion and awareness of the Community on the Health Services:

Services of ANMs and MPW (M):

a) 70 mothers having child of up to one year of age were interviewed in the visited area of

the Sub Centres to assess opinion regarding quality of services of ANMs and HWs (M). The

interviewed mothers of the visited HSCs replied that ANMs were available when needed

and conducted immunization session in regular basis. They provided IFA and TT to

pregnant women. Home deliveries were conducted by trained persons by using DDK.

Mothers had no idea about ARI.

b) The post of Health Worker (Male) had been lying vacant for more than 3 years at Doda-

II and Asha butter SCs. HW(M) of Rupna SC did not stay in SC village and was not

available when needed. But he participated in some programme relating to Public health

immunization camp and also collected blood smear of the patients.

8. Sample Verification of Family Welfare Acceptors:

a) The team selected 132 FW acceptors out of which 81 (61%) could be contacted for

sample verification in the district. Discrepancies in the age of spouse in 7 (9%) cases and in

the age of youngest child in 12 (15%) cases was found in the recorded details of the

acceptors.

b) Follow up services were provided to 56 (69%) acceptors and all the contacted

sterilisation acceptors received full amount of compensation.

c) Out of 45 contacted Cu-T acceptors 4 discontinued the use of Cu T method, 4 for

accepting other family welfare methods and 12 acceptors discontinued due to bleeding,

backache and pain.

e) 19 of the 25 beneficiaries of child immunisation could be contacted for sample

verification and 17 beneficiaries confirmed receiving doses. All of them received follow up

services by the worker/ASHA.

9. Reconciliation of Reported Performance:

a) The consistency between figures reported by District office and reporting centres was not

there in respect of performance reported in the year 2010-11 and 2011-12 (up to August,

2011). The details are as below:

531

Name of Centres For the Year 2010-11 For the Year 2011-12

Reported by Distt. Office

Reported by Centres

Reported by Distt. Office

Reported by Centres

i) CHC, Chak Sherawala Sterilisation IUD Nirodh

780 2117

171576

781 2223 172376

289 1028 69696

290 1006 69637

ii) CHC, Lambi: IUD 1326 1342 729 833 iii) CHC Doda-II: IUD OP

934 5850

927 5852

454 689

553 845

b) There was also discrepancy in the reported figures at CHCs for Sterilisation and IUD

when compared to the figures of service registers at same CHCs for the year 2010-11 and

2011-12 (up to August, 2011). The details are given below:

Name of Centres For the Year 2010-11 For the Year 2011-12

Reported by the centre

Recorded in the service register

Reported by the centre

Recorded in the service register

i) CHC, Chak Sherawala Sterilisation IUD

781

2223

775 46

290

1028

133 1006

ii) CHC, Lambi: Sterilisation

IUD

576

1342

511 179

282 729

277 833

iii) CHC Doda-II: IUD

927 37 553 32

10. Maintenance of Registers & Records:

a) Eligible Couple and Child Registers were maintained properly and up to date at Chack

Sherawali and Dodai CHCs but the same were not maintained properly and updated at

Lambi CHC.

b) There was Sterilization service cum payment Register maintained at Chack Sherawali

CHC but the same was not properly updated.

c) Cu-T service register was maintained properly and up to date at Dodai and Lambi CHCs

but the same was not maintained properly at Chack Sherawali CHC.

d) Oral pills & Nirodh distribution registers were maintained properly and up to date at

Lambi CHC but the same were not maintained properly at Chack Sherawali and Dodai

CHCs.

532

e) MCH Register was not maintained properly and up to date at all visited CHC. PNC

Register was not maintained at Dodai and Lambi CHCs.

f) Stock Register of Cu-T, OP and CC were not maintained properly and were not up to

date at all visited institution in the district.

g) JSY beneficiaries Register was not maintained properly and was not up to date at all the

visited centre.

11. IT Infrastructure and MCH Tracking System:-

a) Computer with Internet connection was available at District Office, BPHC and CHCs.

b) MCH tracking formats was available at Sub Centre level. Staff of District Office, BPHCs,

PHCs and Sub Centres were sensitized in MCH formats. Data entry was being made at

District, BPHC and CHC level.

12. Other Important Observations and Suggestions

a) Supervision with necessary guidance at grass root level centres was lacking in the

district. It was observed that ANMs were not maintaining the records properly and also

were not conducting the field visits according to the community requirement.

b) Orientation Training to the staff of District Programme Management Unit and to staff at

PHC/CHC may improve their performance.

c) In view of the poor performance in respect of OP and Nirodh, staff of the CHCs needed

special attention to locate the regular users to improve distribution of OP & Nirodh at SC

level.

*******

4. District:- Mohali Major observations of Regional Evaluation Team (RET), Patna on the evaluation work

carried out in Mohali District of Punjab State during the month of May, 2011.

I. Details of the visited Institutions:

District visited SDH/CHCs/PHCs visited HSCs visited

Mohali

SDH: Kharar. CHCs: Derabassi & Kurali PHC: Boothgarh.

Paragpur, Mubarakpur & Salempur.

II. Major Observations: 1. Human Resources:

During visit to the District Office as well as different health facilities, staff position was not

made available to the team. However, as reported, 18 of the 79 posts of MPW (M) and 4 of

533

the 89 total sanctioned posts of MO and Specialist doctors were lying vacant in the district.

There was no vacancy of the Supervisor (M and F) in the district.

2. Rogi Kalyan Samiti (RKS) & Village Health, Sanitation and Nutrition Committee

(VHSNC):-

a) 19 Rogi Kalyan Samitis were set up at the DH, SDH, 4 CHCs and 13 PHCs in the

district. Regular meetings of RKS were being conducted quarterly in the visited institutions.

b) Details of RKS funds available and expenditure incurred at DH, SDH, CHCs and PHCs

in the District are given in the following table: (Amount in

Rs.)

Type of Insti- tutions

2010-11 2011-12 (upto August, 2011)

OB Recd. Total Fund

Exp. Bal. % of fund utiised

OB Recd. Total Fund

Exp. Bal. % of fund utiised

DH 3,18,057

5,00,000

8,18,057

8,18,057

0 100%

0 5,00,000

5,00,000

3,500

4,96,500

2%

SDH 0 1,00,000

1,00,000

1,00,000

0 100%

0 1,00,000

1,00,000

0 1,00,000

0%

CHCs 2,484

4,00,000

4,02,484

3,95,373

7,111 98%

7,111 3,00,000

3,07,111

42,391

2,64,720

34%

PHCs 4,83,739

12,00,000

16,83,739

10,37,948

6,45,791

62%

6,45,791

12,00,000

18,45,791

3,20,920

15,24,871

17%

Total 8,04,280

22,00,000

30,04,280

23,51,378

6,52,902

80%

6,52,902

21,00,000

27,52,902

3,66,811

23,86,091

13%

c) 426 VHSNCs were functioning in the district. The team reported that meetings of

VHSNCs were being conducted regularly in the visited institutions.

d) As per details received from the district, Rs. 36,44,774 out of available fund Rs.

52,00,000 in 2010-11 and Rs. 4,11,145 (10%) out of available fund Rs. 39,74,458 was

spent till August, 2011during the year 2011-12 by the VHSNCs.

3. Service of Janani Suraksha Yojana (JSY):-

a) In the implementation of Janani Suraksha Yojana though Rs. 31,48,878 during 2010-

11was available under the scheme an amount of Rs. 3419852(108%) was spent. No

information from the district about source of excess expenditure was made available. Rs.

8,76,300 (130%) were spent against the available fund of Rs. 6,73,026 in the year 2011-

12 (up to August, 2011).

534

b) 17 JSY beneficiaries were interviewed by the team. All beneficiaries were satisfied with

the services. All beneficiaries were provided MCH cards and also received three Checks-up

during ANC and PNC. Most of the deliveries of contacted mothers were institutional and

they received monetary benefit as per JSY scheme.

4. Functioning of ASHA Scheme:-

Total 532 ASHAs were working in 464 villages in the district and all ASHAs were trained up

to 5th modules. Drug Kit was provided to all ASHAs.

5. Untied Funds and Annual Maintenance Grant (AMG):

Full utilisation of Untied Fund and Annual Maintenance Grant at CHCs, PHCs and Sub

Centres in the district was not fulfilled during last two years. The details are as given below:

(Amount in Rs.)

Type of Fund 2010-11 2011-12 (upto August, 2011)

CHCs PHCs Sub Centres

CHCs

PHCs Sub Centres

Untied Fund Available*

1,50,336

3,90,53

8

6,81,629

23344

3

560501

647225

Expenditure

66,893 1,80,037 7,74,404 66330 84660 112608

Balance

83,443 2,10,501

(-) 92 775 167104

475841 534617

AMG Fund Available*

208554

631133

870673

31190

3

940958

880538

Expenditure

196651 390175 710135 39281 50154 87641

Balance

11903 240958 160538 272622

890804 792897

* Including opening balance.

6. Physical infrastructure and Stock Position:

i. CHCs:

a) Visited CHCs Derabassi and Kurali and S.D.Hospital Kharar were functioning in govt.

buildings. Maintenance of Hospital building was not satisfactory. The OT room is required

to be maintained properly and cleanness of delivery room need to be improved.

Water supply and electricity with power back-up were available at all visited CHCs.

Condition of beds was poor at S.D.Hospital Kharar.

b) All CHC level surgical equipment, Ambulance, Oxygen cylinder, Labour room, labour

room table & equipment, Resuscitation equipments, Neonatal Resuscitation equipments,

Anesthesia equipment, Operation theatre and OT table were available at visited CHC, but

Blood storage unit was not available at Derabassi and Kurali CHC, Sick New born care unit

535

not available in all the visited CHCs, Arteether injection was not available at Derabassi and

Kurali CHCs and Quinine injections were not available in all the visited CHCs.

ii) PHCs:

a) Visited PHC Boothgarh was functioning in Govt building with Regular water supply,

electricity connection and toilet facility. Telephone facility was also available.

b) All equipment & apparatus to PHC expertises, Stock of medicine/drugs, vaccines vials &

contraceptives were available. AYUSH medical officer was available and 24x7 service was

provided in the PHC.

ii. HSCs:

a) HSC Paragpur and Salempur were running in Govt building and HSC Mubarakpur was

finctioning in private building. Water and electricity were available at all the visited Sub

Centres.

b) Additional ANM was available only at Mubarakpur HSC, whereas MPW(M) was not

available at Mubarakpur Sub Centre. Labour room was not available at Paragpur HSC.

Delivery was not conducted at all visited Sub Centres.

c) Foot stool, Delivery table, Mcintsh sheets and Nischay pregnancy test kit were not

available at Paragpur HSC. Foot stool, Delivery table, Mcintsh sheets, Delivery kit,

weighing machine (Infant) and Heamoglobinometer were not available at Salempur HSC.

Ambu bag/ suction was not available at all the visited Sub Centres.

d) Oral pills cycles and Chlorine solution were not available at Paragpur HSC. Condom,

Chlorine solution and Chloroquine tab were not available at Mubarakpur HSC. DDKs, Co-

trimoxazole tablets, E.C.Pills, Condom and Metronidazol tab were not available at

Salempur HSC. Misofrostol tab, Magsulth tab, Oxitocine tab, Ampicillin Capsule and

Gentamycine injection were not available at all visited Sub Centres.

e) Eligible couple Register, Formats for monthly reporting, JSY registration card and

Mother- Child Tracking Formats/ Register was not available at Mubarakpur and Salempur

SCs. Stock register was not available at Paragpur and Salempur Sub Centres and Family

planning Service register was not available at Salempur Sub Centre,

f) SBA training to ANMs was not organized in the district till visit of the team. There was

lack of checking/verification of service register by PHC/District Hospital.

7. Opinion and awareness of the Community on the Health Services:

Towards HSCs service:

a) 11 mothers having child up to one year age were interviewed to collect opinion of service

rendered by ANMs and HWs (M) in the district. The interviewed mothers of all visited HSCs

replied that ANM were available when needed and conducted immunization clinic in regular

536

basis. They received IFA and TT and Home deliveries were conducted by trained person

with using DDKs.

b) Mothers was not sufficiently aware about ARI.

c) It was observed that HW(M) of Parargpur SC was not staying at Sub Centre area and

also he was not available when locality needed. As informed by the villagers, he was

participated in the activities of public health, Immunization camps and collection of blood

smear in the villages. He also visited nearby primary school for school health check up

activities.

d) The post of Heath Worker (Male) was lying vacant for more than 3 years at Mubarakpur

SC.

8. Sample Verification of Family Welfare Acceptors:

a) Out of 73 selected acceptors, 27 could be contacted, no discrepancy in the demographic

data of the acceptors was found during sample check in the district.

b) Follow up service was provided to only 11 (40.7%) acceptors.

c) Out of 16 selected, only 6 immunization beneficiaries could be contacted for verification

and all beneficiaries were found fully immunized. None of the contacted beneficiary faced

any complication after availing the services. But they did not receive follow up services by

the workers /ASHA.

9. Reconciliation of Reported Performance:

a) The performance reported in the year 2010-11 and 2011-12 (up to August, 2011) by the

Distt. Office and reporting centres was not consistent. The details are as below:

Name of Centres For the Year 2010-11 For the Year 2011-12

Reported by the centre

Reported by Centres

Reported by the centre

Reported by Centres

i)CHC, Derabassi Sterilisation IUD OP Nirodh

820 1004 941 2881

622 480 6953 159230

67 405 449

1247

188 405

5823 88836

ii) CHC, Kurali:

Sterilisation

174

133

18

40

iii) CHC Boothgarh: IUD OP Sterilisation

1174 305 1665

223 773

119834

528 137 861

528 773

62040

537

b) There was also discrepancy in the reported figures at CHCs for Sterilisation and IUD

when compared to the figures of service registers at same CHCs for the year 2010-11 and

2011-12 (up to August, 2011). The details are given below:

Name of Centres For the Year 2010-11 For the Year 2011-12

Reported by Distt. Office

Recorded in the service register

Reported by Distt. Office

Recorded in the service register

i) CHC, Derabassi Sterilisation IUD

622 480

618 64

188 405

177 58

ii) CHC, Kurali: Sterilisation

133

123

40

38

iii) CHC Boothgarh: IUD

1223

31

528

20

10. Maintenance of Registers & Records:

a) Eligible Couple Register was maintained and updated at Derabassi CHC, but not

maintained properly at S.D. Hospital Kharar. EC register was not made available at Kurali

CHC and Boothgarh PHC.

b) Sterilization service cum payment Register was not maintained properly at CHCs

Derabassi and Kurali and Boothgarh PHC.

c) Cu-T service register was maintained properly at Derabassi and Kurali CHCs and S.D.

Hospital Kharar but the same was not maintained properly and up to date at Boothgarh

PHC.

d) Oral pills & Nirodh distribution registers were not maintained properly at Derabassi and

Kurali CHCs and Boothgarh PHC.

e) Stock Register of Cu-T, OP and CC were not maintained properly at Derabassi CHC,

S.D. Hospital Kharar and Boothgarh PHC. Some essential information like date of

manufacturing & Expiry, Batch No., Model No. etc were not recorded.

f) JSY beneficiaries Register was not maintained properly at all the visited centres.

11. Information on IT Infrastructure and MCH Tracking System:-

a) Computer with Internet connection was available at District Office, BPHC and CHCs.

b) MCH tracking formats was available at Sub Centre level. Staff of District Office, CHCs

and, PHC were sensitized in MCH formats. Data entry was being made at District, BPHC

and CHC level.

12. Other Observations:-

538

a) The selected CHCs MO and other Paramedical staff were not taking proper attention in

respect of distribution of Nirodh under FW programme at SC level.

b) Orientation Training to the staff of District Programme Management Unit and to

staff at PHC/CHC may improve their performance.

d) It was observed that ANMs and MOs were not submitting monthly performance

reports in HIMS format in time.

539

Tamil Nadu

1. District:- Coimbatore

Major observations of Regional Evaluation Team, Chennai on Evaluation work

carried out in Coimbatore District of Tamil Nadu State in the month of March, 2012.

I. Details of the visited institutions:

District

Visited

GH / CHC & PHCs / PNDT Centers

Visited

HSCs Visited

Coimbatore

GH: Periya Nayakkam Palayam

PHCs: Pooluvapatti and Nallattipalayam

PNDT Centers: SRL Diagnostic Center,

Coimbatore and Best Scan Center,

Coimbatore

Pooluvappatti, Chadivayal,

Booluvampatti, Sengalpalayam and

Kovilpalayam

II. Major Observations:

1. Health Human Resources:

a) Status of consolidated staff position was not available in the district office. In the District,

three controlling authorities i.e. Joint Director for the staff of GHs/FRUs, DD Medical for

the FW staff and DD Health for the staff of the PHCs are responsible for maintaining the

details separately.

b) It was reported that under the Joint Director there were totally 128 posts lying vacant out

of 458 sanctioned posts in various categories in different FRUs and GHs in the district.

Under the DD Medical, there were totally 25 sanctioned posts out of these 12 posts are

vacant including the post of DD Medical. Similarly, under the DD Health, 5 and 10 posts

of B.E.Es and Block Health Statisticians were filled up as against the sanctioned posts of

14 each. Further, 4 Store keeper posts were filled up out of 14 sanctioned posts.

c) It was also reported that out of total 79 sanctioned posts of ANMs, 71 were filled up. 68

Posts of Female Health Supervisors were filled up out of the 80 sanctioned posts. 6

posts of Male Health Supervisor out of 12 sanctioned were vacant in the district.

Specialist posts are available only in GHs and FRUs. Out of 91 specialist posts 79 were

filled up in the district.

d) It was informed that most of the vacant posts of Staff Nurses were filled up through

contract in the PHCs. Out of 141 sanctioned posts of Staff Nurse only 6 were filled up

540

and 150 additional posts of staff nurse were filled up through contract. In the FRUs, out

of 88 posts of Staff Nurse, 85 were regular. Further, 17 were filled through contract.

e) 41 Lab. Technicians were available as against 51 sanctioned posts in the district.

f) In G.H Periyanayakkan Palayam, out of 6 specialist doctors, only 3 were filled up. 5 Staff

Nurses were posted against 7 sanctioned. There was no sanctioned post of Lab.

Technician in GH other than one appointed under RNTCP. There were only 2 cleaning

staffs which were not sufficient for this hospital.

g) In PHC Pooluvampatty, all the sanctioned posts of ANMs, Male and Female Supervisors,

Staff Nurses and Lab Technician were filled up. All the 4 sanctioned posts of cleaning

staffs were vacant but 3 contractual personnel appointed for the purpose.

h) In PHC Nallattipalayam, out of 7 ANMs, 6 were filled up. The post of Male Health

Supervisor was vacant. All the 3 Staff Nurses were on contract and no regular posts

filled up In the PHC. There were 3 Medical Officers and 2 Male Health Assistants in this

PHC.

2. Services of Janani Suraksha Yojna (JSY)

a) The district incurred an expenditure of Rs. 64,06,800 out of available budget of Rs.

1,27,34,400 for during 2010-11. Similarly, an amount of Rs. 62,65,000 was utilized

against the available amount of Rs. 63,27,600 (opening balance) in the year 2011-12 up

to the time of visit by the team.

b) As per details received, as many as 5917 JSY beneficiaries in the year 2010-11 and

7139 JSY beneficiaries in the year 2011-12 have been paid with incentives under the

scheme.

c) In PHC Nallattipalayam, the number of who mothers received JSY during 2010-11 and

2011-12 were 111 and 66 and the expenditure for the respective periods was Rs. 77,700

and Rs. 47,000 respectively. In PHC Pooluvapatty, the JSY performance for the above

periods was 262 and 249 respectively. The expenditure incurred was Rs. 39,200 and Rs.

1,92,500 for the above period. In GHs Periyanayakkan Palayam, the number of mothers

who received JSY were 33 and 37 respectively. In both the PHCs visited at

Nallattipalayam and Pooluvampatty, the JSY performance has come down in the current

year compared to previous year.

d) The team selected 41 JSY Beneficiaries in the field, out of which 38 were contacted. In

the GH, some of the mothers were paid the amount after a month of their delivery due to

delay of submitting JSY form by the mothers. In the PHCs, mothers paid incentive in

time. All the eligible cases were given Rs. 700 in the PHCs, Rs. 600 in GH and Rs. 500

for home deliveries.

541

3. Untied Funds:

a) Untied Funds to the tune of Rs 12,00,000 in the year 2010-11 and Rs. 13,25,000 during

2011-12 were given to the PHCs. Similarly, Rs 26,70,000 in the year 2010-11 and Rs.

29,75,000 in the year 2011-12 given to the HSCs in the district. The funds were spent by

the PHCs and HSCs

b) Untied Fund for Taluks and GHs was received by the district to the tune of Rs. 4,25,000

out of which Rs. 2,00,000 were distributed in the year 2010-11. Similarly Rs. 4,00,000

were received by the district in the year 2011-12 and distributed an amount Rs. 6,25,000

(including last year balance of Rs. 2,25,000) to these institution during the year.

c) Untied fund for the Head Quarter Hospital was approved to the tune of Rs. 1,00,000 for

2010-11 but only Rs. 50,000 was given to the hospital during 2010-11 and the balance

amount was lying with district office.

d) In GH, P.N. Palayam first time untied fund was given to the tune Rs. 75,000 during 2010-

11 for the year 2009-10 and Rs. 1,50,000 during 2011-12. The expenditure for the

respective periods were Rs. 23,406 and Rs. 24,246. Expenditure of untied funds in the

GH was made for purchasing of induction stove, medicines, contingency items and also

for sanitation charges etc. The GH had an unspent balance of Rs. 1,77,348 as on the

date of visit.

e) In PHC Nallattipalayam, untied funds to the tune of Rs. 50,000 were allotted during each

year in 2010-11 and 2011-12 and almost all the funds were utilized by the PHC in both

the years. Major

expenditure was on wages for Gardener, cable operator, lab items, TV repair, Oxygen

cylinder filling, generator repair, furniture purchase, water purifier purchase, fridge

purchase, ANC diet etc.

f) PHC Pooluvampatty spent the funds mostly every year.

g) HSCs visited at Pooluvampatty, Chadivayal and Kovilpalayam received @ Rs. 10,000 as

untied fund. The main items of expenditure were HSC cleaning, Mobile recharge, Gas

cylinder filling, White washing. IEC materials, purchase of weighing machine, Still Rack,

Stethoscope etc. in HSC Pooluvapatty.

4. Rogi Kalyan Samiti (RKS):

a) A total of 62 RKS (called Patient Welfare Society in the district) have been formed with

district. Out of these, 47 are in PHCs, 11 in GHs 1 in medical college and 3 are in the

municipalities in the district.

b) In all the visited centers, RKS meetings were conducted regularly and expenditure were

incurred based on the decision taken by the PWS.

542

c) Total amount earmarked for the PWS in the district was Rs. 50 lakhs during 2010-11 and

Rs. 55.5 lakhs during 2011-12 in the district.

d) PHC Pooluvapatty received PWS fund during 2010-11 and spent on the items which

include diet charges for ANC, sweeper salary, medicine bills, AMC for computer etc.

e) In PHC Nallattipalayam, the PWS amount of Rs. 1 Lakh was received in each year

during 2010-11 and 2011-12 and expenditure was incurred on R.O system repair,

purchase of Almirah, Dhobi charges, Lab items, BP apparatus etc.

f) In GH P.N Palayam, the PWS had received funds to the tune of Rs. 50,000 during 2010-

11 eventhough there was an opening balance of Rs. 1,83,267 as on 1.4.2010. The GH

has purchased generator, ECG machine and water purifier during that year Still there

was unspent amount of Rs. 68,012 at the end of year. In addition to the amount of

previous year, the GH received another Rs. 50,000 during the current year which could

not be spent due to some administrative problem.

5. Services of ASHA:

a) Only 62 ASHAs were selected in the district, mostly in the tribal areas.

b) Out of the Rs. 12.1 Lakhs allotted, Rs. 10.4 Lakhs were spent under the scheme in

2010-11 and out of Rs. 12.1 Lakhs, Rs. 13,800 were spent in 2011-12.

c) There were no ASHAs found in the visited centers.

6. Village Health Sanitation and Nutrition Committees (VHSNCs):

a) In the district there are 435 VHSNCs formed out of which 226 are in the town

panchayath area and 209 in the village panchayath area. As per the statement received

from the DD health of the district, the allotment and distribution of VHSNC funds are

given below for 2010-11 and 2011-12.

S. No Year Opening balance Allotment to the

district

Distributed to

VHSNCs

1 2010-11 60,000 50,40,000 48,85,000

2 2010-12 2,21,000 38,87,500 3,87,000

Expenditure incurred by the VHSNCs was not available in the district office.

b) Funds are given to the VHSNCs @ Rs. 10,000 per year in the district. It was observed

that some of the committees did not utilize the amount.

c) The accounts are jointly maintained by the ANM and the village leader. The amount is

spent for clearing of garbages, bleaching powder purchase, etc.

d) VHSNCs under HSC Pooluvampatty had an unspent balance of Rs. 7,157 at the end of

last financial year.

7. 24x7 Delivery Care Services:

543

a) In the district, the infrastructure is very good in the private and govt. sector for conducting

deliveries. Out of total 43,919 deliveries conducted in the district during 2010-11 only 30

deliveries were reported to be home deliveries.

b) In the district, all the 8 GHs and all the 47 PHCs are conducting deliveries

c) GH at Perianaicken Palayam was facing lot of problems in conducting deliveries round

the clock. There are only 10 beds at present. Construction of the new NRHM building

was started 3 years ago by the PWD not completed the date of visit. Basic facility like

Ambulance, Blood Storage Unit, New born care unit and also sufficient manpower for

providing 24 hour delivery services were not available in this hospital. The number of

deliveries conducted has also come down from 72 to 63 in the current year compared to

the previous year. It was informed that though 108 ambulance services is available in the

district, it is not providing services for shifting emergency patients to the district hospital.

d) In both the visited PHCs, the facilities are relatively good. In PHC Nallattipalayam, 142

deliveries in 2010-11 and 95 deliveries in 2011-12, conducted. These services are

managed by 3 MOs and 3 contract Staff Nurses in the PHC. In PHC Pooluvapatty,

deliveries conducted during the period were 288 and 260 and 4 MOs, 4 Staff Nurses and

3 indoor ANMs were posted for these services.

8. Physical infrastructure:

a) GHs Periyanaikkanpalayam:

i) In the GH, 24 hour services are difficult to manage properly due to lack of basic

facilities explained as above and also existing high bed occupancy rate.

ii) The hospital did not have Electricity connection and also Jeep, X Ray facility. Only 3

specialists out of 6 posts were posted in the hospital.

b) PHCs:

In PHCs at Nallattipalayam and Pooluvampatty facilities of water, Electricity, Toilets,

Vehicle, Auto clave, Lab equipments, Vaccine Vials, stock of contraceptives, residential

quarters for the PHC officials and Ayush wing etc were available.

c) HSCs:

i) The team visited five HSCs VIZ, Booluvampatty, Kovilpalayam, Pooluvampatty,

Chadivayal and Sengotuplayam. In all the HSCs, facilities of Toilet, Examination table,

Benches, Cupboard for drugs, Foot stool, Delivery table, Delivery kit, Weighing scale,

Hemoglobinometer, B.P apparatus. Thermometer, Gloves, slide for blood test, ORS,

Vitamin A, IFA, Antiseptic solution and Bleaching powder etc. were available.

544

ii) All the HSCs buildings are maintained properly for clinic purpose with adequate space.

Cleanliness maintained and IEC materials displayed in all the centers. Mother and child

tracking system was implemented in all the centers visited by the team.

iii) Deliveries were not conducted in any of the HSCs visited.

iv) RDT kit, Sanitary Napkin, DDK, Oral pills, Oxytoxin, Ampicilin, Gentamycin and Kits A &

B were not available in stock in all the Sub Centres visited.

v) Water supply, Ambubag, Gloves, Steam Sterliser and Disposable syringes were not

available in few centres visited.

vi) The ANM was not staying in HSC Head Quarter at Kovilpalayam. Weighing machine

and Haemoglobinometer were not working in HSC Chadivayal.

9. Opinion of Community on the Health Services:

i) ANMs Services

a) The team contacted 31 mothers to assess the work of ANMs and the health awareness

of mothers and observed that health awareness of the mothers in the visited villages was

satisfactory.

b) All of them were aware about ORS and contraceptive immunization session held in their

villages.

c) All the mothers told that their deliveries were institutional and their babies weighed after

birth.

d) Three PNC Check up was given to 26(83.9%) mothers and awareness on ARI found in

19 (61.2%) mothers. Usage and awareness about side effect of contraceptive methods

among the contacted mothers was not upto the mark.

ii) PHC Services

The contacted public and the patients were satisfied with the work of the MOs and staff

of the visited PHCs.

10. Sample verification of FW Acceptors:

a) Out of 123 family planning accepters selected for sample verification of the accepters,

minor discrepancies were found in the recorded age of acceptors, age of spouse, no. of

the children and also in male child. 85 (69.1%) accepters could be contacted in the

district.

b) 76(89.4%) accepters were given follow up services by the field staff and all sterilization

acceptors had received compensation money.

11. Maintenance of Records and Registers:

545

a) The consolidated scheme wise details were not properly maintained at the district office.

Basic information of the district, funds and other relating information was not readily

available at district office.

b) The maintenance of registers and records was found satisfactory in the peripheral

centers visited by the team.

c) ANMs at visited HSCs maintained reports and records properly.

12. Other Observation:

a) The district has 3 district level officers with separate offices viz; Joint Director of health

services in charge of GHs, DD Health for PHC level Staff and DD Medical for FW staff.

There was no person at the district level to coordinate programmes under NRHM. There

was no district programme management unit at the district level.

b) District funds are distributed by the DD health to all the peripheral centers in the district.

But, no expenditure details are available for the NRHM activities for any of the years.

c) There is no uniformity or guidelines followed in the distribution of funds to peripheral

centers. Allotments of funds vary from center to center and across periods. Details of the

eligible mothers for JSY were not also available at the district or peripheral level.

2. District:- Virudhunagar

Major observations of Regional Evaluation Team, Chennai on Evaluation work

carried out in Virudhunagar District of Tamil Nadu State in the month of January,

2012.

I. Details of the visited institutions:

District visited GH / CHC & PHCs Visited HSCs/ PNDT Centers Visited

Virudhunagar

GH: Aruppukkottai and

Rajapalayam

CHC: Pandalkudi

PHC: Kannisery and

Narikudi

GKS Hospital (NGO),

Krishnankiol

HSCs: Sankaralingapuram, O.Kovilpatti,

Nathakulam, Udaiyanservaikaranpatti,

Chidamparapuram and

Kanchanayakkanpatti

PNDT Centers: Sugasthalasriramhospital,

Aruppukottai vani Hospital, Aruppukottai

City Scan Centre, Aruppukottai Bharathi

Hospital, Rajapalayam Shri Krishna

Clinic, Rajapalayam and Krishna

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Hospital, Krishnankoil.

II. Major Observations:

1. Health Human Resources:

i) Staff position of key posts was somewhat satisfactory in the district. However, some

sanctioned posts were lying unfilled. 5 of each 50 sanctioned posts of LHV/HS (F) and

182 sanctioned posts of MPW (m), 8 of the 56 sanctioned posts of Medical Officer were

lying vacant in the district.

j) In GH Aruppukkotai, the following posts were lying vacant.

S. No Name of the post Sanctioned Vacant

1 Senior Civil Surgeon 6 2

2 Senior Assistant Surgeon 6 2

3 Assistant 5 2

4 Maternity Assistant 2 1

5 Radiographer 3 1

6 Sanitary Worker 8 5

7 ANM 2 2

8 Hospital Worker(DW) 4 4

9 Sanitary Worker (NRHM) 4 3

Besides, posts of Office Superintendent, Dark Room Assistant, X-Ray

Attendant, Physiotherapy Technician, Theater Assistant, Plaster Technician and

Assistant Surgeon (SIDDHA) were also lying vacant in the hospital.

c) Staff position in GH Rajapalayam was not upto the mark 8 of the 13 posts of Medical

Officer, 9 of the 16 sanctioned posts of Hospital Worker and 8 of the 11 sanctioned

posts of Sweepers were lying vacant.

d) Staff position in PHC Narikudi and CHC Pandalkudi was mostly satisfactory.

2. Rogi Kalyan Samiti (RKS):

Rogi Kalyan Samiti was constituted in the visited centers. The funds received and spent

in those centers are reported as given below:

(Amount in Rs.)

Sr.no. Name of the institutes Year 2010-11 Year 2011-12

Total Fund* Expenditure Total

Fund*

Expenditure

1 GH, Rajapalayam 282898 202564 205334 188578

2 GH, Aruppukkottai 213026 102991 611133 178578

3 PHC, Kanniseripudur 101089 97898 103191 78938

4 PHC, Narikudi 101231 100004 101227 57435

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5 CHC, Pandalkudi 122217 118297 103920 47000

* including opening balance

3. Services of Janani Suraksha Yojna (JSY)

a) JSY was implemented in the district and beneficiaries are being benefited with the

services and cash in cantres. In the visited centres, the no. of beneficiaries and

expenditure incurred was as reported below:

(Amount in Rs.)

Name of the

centres

Year 2011-12 Year 2011-12

No of beneficiaries

provided cash

assistance

Total

expenditure

No of beneficiaries

provided cash

assistance

Total

expenditure

GH Rajapalayam 1557 1037600 1259 843100

GH Aruppukkottai 762 456000 439 272981

PHC Kanniseripudur 257 179900 201 140700

PHC Narikudi 260 182000 190 133000

CHC Pandalkudi 152 105700 135 124900

4. Untied Funds:

g) It has been observed that an expenditure to the tune of Rs. 42253 was incurred out of

total fund available of Rs. 60058 in the PHC Kanniseripudur. In PHC Narikudi a

expenditure of Rs. 238000 was incurred out of the total available fund of Rs. 380000/-

h) An expenditure to the tune of Rs. 81509 out of total untied funds of Rs. 87805 has been

reported in PHC Kanniseripudur. In PHC Narikudi, Rs. 100000 were spent out of the

untied fund Rs. 154000 during the current year.

i) Expenditure of Rs. 37982 and Rs. 45387 was incurred out of the total untied funds of Rs.

70528 and 82546 available during the year 2010-11 and 2011-12 respectively in CHC

Pandalkudi.

j) In Chidambarapuram HSC, Untied funds and AMG wad not utilized till date and the HSC

had a balance of Rs. 25653 as AMG, and Rs. 11253 as untied fund. It was also

observed that the amount of untied fund and AMG was not used for the last two years in

HSC Udayanservaikaranpatti. HSC Nathakulam had Rs. 5694 as closing balance for

untied fund, Rs. 10224 as AMG and Rs. 16356 as VHSNC at the time of the team‟s visit.

5. Village Health Sanitation and Nutrition Committees (VHSNCs):

a) Provision and expenditure of VHSNC funds in the visited PHCs and CHC have been

reported by the team as under:

548

(Amount in Rs.)

S.No Name of the institutions Years Fund

Received

Total Fund* Expenditure

1 PHC Kanniseripudur 2010-11 580000 2002141 857841

2011-12 580000 1724300 531611

2 PHC Narikudi 2010-11 440000 974984 517443

2011-12 220000 677541 340973

3 CHC Pandalkudi 2010-11 320000 965680 372085

2011-12 320000 913595 215818

*including opening balance

b) The team reported that the records in respect of VHSNC were found satisfactory. In the

visited village Karaipundi, villagers were dissatisfied as proper treatment of drinking

water since last one year.

c) HSC Chidambarampuram has 7987 population spread over 13 hamlets and has four

VHSNCs. HSC Udayanservaikaranpatti has 2583 population spread in six villages and

three VHSNCs were functioning in the area of the HSC. HSC Nathakulam has 2584

scattered population in nine villages. There were three VHSNCs functioning in the HSC.

HSC Sankaralingapuram has 4252 population spread over three villages. Three

VHSNCs were functioning in the HSC. VHSNC fund was unutilized and has the closing

balance of Rs. 22904 during the visit. HSC O.Kovilpatti has 5227 population in 7 villages

and has three VHSCs functioning in the HSC.

6. 24x7 Delivery Care Services:

In the visited PHCs and CHC, 24 hours delivery care services were being provided. 401

deliveries in 2010-11 and 276 deliveries during 2011-12 (up to Nov.11) in PHC

Narikkudi, 427 deliveries in 2010-11 and 235 deliveries during 2011-12 (upto Nov.11) in

PHC Kanniseripudur and 185 deliveries in 2010-11 and 135 delivering during current

year upto Nov.2011 in CHC Pandalkudi were conducted under the scheme.

7. ASHA scheme is not available in the district, it was reported.

8. Physical infrastructure:

d) GHs:

GH Aruppukkotai has all the required facilities and equipments. The records for National

Health Activities were maintained well. GH Rajapalam had also adequate facilities,

equipments and medicines. The registers and records were well maintained in the GH.

549

e) CHC Pandalkudi:

It is a 30 bedded hospital functioning in Govt. building. The CHC had all the required

facilities, equipments and medicines. Residential quarters for Medical officers were

available in CHC.

f) PHCs Narikudi and Kanniseripudur:

a) PHC Narikudi is a 30 bedded hospital having all the required facilities and equipments.

No regular post of Lab technician was filled in the PHC and the technician was giving the

ICTC division.

b) PHC Kanniseripudur was having 6 beds covering 53440 population. All the required

facilities were available in the PHC.

g) HSCs:

a) The team visited six HSCs at Kanjanayakkanpatti, Chidambarapuram,

Udayanservaikaranpatti, Nathakulam, Sangaralingapuram and O.Kovilpatti. All the

centres were having Govt. building and basic facilities i.e. electricity, water supply, labour

room and toilet etc. but ANM was staying only at Nathakulam and Sangaralingapuram

subsenters.

b) All the HSCs were having essential furniture like Examination Table, Benches, Cupboard

for drugs, Foot stool, Delivery table, McIntosh sheets and Ambu bag/suction etc. Most of

the service registers i.e. Eligible couple register, Child immu. & MCH register, Registers

for family planning services, Stock Register, Formats for monthly reports, Cash book of

Untied Funds were maintained at all HSCs.

c) RDT kit for malaria, DDKs, Oxytoxin, Cap Ampicillin, Gentamycin injection, Kits “A” and

“B” (for current year), steam sterilizer, sanitary napkins, chloroquine tab. were not

available in most of the centres.

d) Posts of MPW(m) was not filled in all the HSCs visited. Deliveries were not conducted in

the centres. ANC tracking system is implemented; tracking cards are available with the

HSCs and also with the beneficiaries. Haemoglobinometer was working and there was

no stock of OP for the last one year in HSC Kanjanayakkanpatti.

9. Opinion of Community on the Health Services:

viii) PHC Services

The contacted public in the area of PHCs Narikudi and Kanniseripudur expressed

satisfaction towards the services of the MOs and Staff.

ix) ANMs Services.

550

f) 25 mothers having child up to one year of age were contacted to assess their knowledge

and opinion on various health activities rendered by the ANMs. As informed by the

mothers, ANM was available when needed.

g) It is appreciated that all deliveries of the mothers were conducted by a trained personnel,

all new born babies were weigh and breast feeding initiated within half an hour and ORS

awareness, Contraceptive awareness and awareness about JSY facility was there in

almost all cases.

h) 20 (80%) mother had received 3 PNC checkup, 19 (76%) mothers were aware about

danger sign of ARI and only 15 (60%) mothers used contraceptives.

10. Sample verification of FW Acceptors:

d) In the district, the team could select 186 FW cases out of which 136 (73.1%) could be

contacted. 114(83.8%) accepters were given follow up services by the field staff and all

44 sterilization accepter had received the compensation many.

11. Maintenance of Records and Registers:

iv) The maintenance of registers and records were found satisfactory in the centers visited

by the team. PHC Kanniseripudur and CHC Pandalkudi were not maintaining the

consolidated register for IUD.

v) At sub center level, the workers of the visited HSCs maintained all the registers in a

proper way except the Eligible couple register which was not updated in time by the

workers of the visited HSCs under PHC Kanniseripudur.

vi) In all the visited HSCs, the workers were maintaining the ANC tracking Performa in a

proper way and up-date, the records through online reporting.

3. District:- Thiruvannamalai

Major observations of Regional Evaluation Team, Chennai on Evaluation work

carried out in Thiruvannamalai District of Tamil Nadu State in the month of

December, 2011.

I. Details of the visited institutions:

District Visited GH s / PHCs / PNDT Centre

Visited

HSCs Visited

551

Thiruvannamalai

GH: Arani and Polur

PHCs: Kommanandal, Chetpet,

Vazhur and Thachhur

PNDT Centre: Thiruvannamali

Karaipoondi, Mattapirayur,

Indiravanam, Pazhampettai,

Vazhur, Vinnamangalam,

Thatchur,

Maharishi Clinic

II. Major Observations:

1. Health Human Resources:

The Health services function under 3 health Directorates in every district in the Tamil

Nadu state. No consolidated staff position is maintained at the district level since the

district office is under several directorates. However, the details of the main

categories of staff received from the district are given below.

a) Out of 229 posts of Medical Officers sanctioned, 223 were filled up in the district. There

were 10 regular staff nurses and 135 additional staff nurses appointed on contact. Out

of 410 field level ANM (VHNs) posts sanctioned, 401 were filled up. 133 of the 275

sanctioned posts of Male Health Worker, 49 of the 96 sanctioned posts of Lab.

technician, 37 of the 48 sanctioned posts of Female Health Supervisor and 12 out of 18

sanctioned posts of Male Health Supervisor were filled up in the district.

b) The staff position under the District Family Welfare Bureau was not satisfactory. Post of

Block Extension Educator (BEE) in all 19 blocks and the post of Block Health

Statistician were vacant in 12 blocks in the district.

c) In GH Arani, out of total 89 sanctioned posts, 24 are vacant. The key posts like Chief

Civil Surgeon, 2 Senior Civil Surgeons, 2 Senior Assistant Surgeons, one Radiographer

and 1 post of BEE were lying vacant. Out of 10 sanctioned posts of Sanitary Workers,

only 3 were filled up. The staff position in GH Polur was satisfactory as only one post of

Male Health Assistant was vacant there.

d) In Thatchur PHC, out of total 39 sanctioned posts, 12 were vacant. In block PHC

Vazhur out of 107 sanctioned posts, 40 were lying vacant. 3 of the 12 sanctioned posts

of Assistant Surgeons, the post of Radiographer and the post of Dark Room Assistant,

all 3 sanctioned posts of Sweepers and also 5 SHNs and 8 of 10 sanctioned posts of

Health Inspector were also vacant in this PHC. Out of 29 sanctioned posts, only 18

were filled up in PHC Kommanandal; post of BEE and 3 out of the 4 sanctioned posts

of Male Health Worker were vacant in this PHC.

2. Services of Janani Suraksha Yojna (JSY) :-

a) As per the district statement, there were totally 8,519 JSY eligible mothers during 2010-

11, out of which 8,130 were given JSY benefit and the rest of the eligible mothers did

552

not submit JSY applications. In 2011-12, out of 14,333 eligible mother, 13,733 applied

for JSY incentive. Total expenditure incurred for JSY in both the periods were Rs.

1,14,42,933 and 96,22,650 respectively.

b) In the visited centers, there was sufficient allotment of JSY fund and no pending case of

JSY payment was found. In all the visited centers there were no home deliveries and all

the institutional delivered mother were being paid @ Rs. 700 as cash incentive under

JSY.

c) The details of funds received and spent in the centers visited are given in the statement

below.

(Amount in Rs.)

S.

No

Name of the

Institutions

Year Opening

Balance

Funds

received

Interest

earned

Total

funds

aval.

Expenditure

incurred

Closing

Balance

1 PHC, Chetpet 2010-

11

39,399 1,73,400 1,175 2,13,974 1,29,425 84,549

2011-

12

84,549 30,600 733 1,15,882 60,180 55,702

2 PHC,

Kummanandal

2010-

11

4,36,323 1,73,400 15,429 6,25,152 65,520 5,59,632

2011-

12

5,59,632 30,600 9,210 5,99,442 25,925 5,73,517

3 PHC, Vazhur 2010-

11

1,19,979 55,000 - 1,74,979 92,200 82,779

2011-

12

82,779 0 - 82,779 60,900 21,879

4 PHC,

Thatchur

2010-

11

28 1,35,000 - 1,35,028 1,16,525 18,503

2011-

12

18,503 10,000 253 28,756 27,460 1,296

5 GH, Arani 2010-

11

22,865 1,30,000 1,543 1,54,411 1,15,669 38,742

2011-

12

38,742 1,60,305 - 1,99,047 65,405 1,27,709

6 GH, Polur 2010-

11

51,447 96,900 277 1,48,624 86,800 61,824

553

2011-

12

61,824 71,400 909 1,34,133 52,439 81,694

d) In the district, the team has selected and contacted 37 JSY beneficiaries and all

reported to have received the JSY amount in time.

3. Untied Funds:-

h) Untied Funds allotted and expenditure incurred in respect of HSCs, PHCs, District

Hospital and Taluk / non-Taluk hospitals for the year 2010-11 and 2011-12 are as given

below:

(Amount in Rs.)

S.

No

Untied

Funds for

Year Opening

Balance

Received

from

RCHP

Total Expenditure

incurred

Closing

Balance

1 HSCs 2010-

11

22,92,376 41,00,000 63,92,376 37,88,045 26,04,331

2011-

12

26,04,331 41,00,000 67,04,331 34,26,336 32,77,995

2 PHCs

(BEmONC)

2010-

11

3,42,481 0 3,42,481 3,42,481 0

2011-

12

- 5,25,000 5,25,000 2,77,491 2,47,509

3 110 new

PHCs

2010-

11

75,000 0 75,000 75,000 0

2011-

12

0 0 0 0 0

4 Dist.HQ.

Hospital

2010-

11

50,000 1,50,000 2,00,000 0 2,00,000

2011-

12

20,000 1,50,000 3,50,000 0 3,50,000

5 Taluk & Non

Taluk

Hospitals

2010-

11

1,50,000 4,50,000 600000 0 600000

2011-

12

60,000 1,50,000 750000 150000 600000

554

i) It was observed by the team that there was no uniformity in the allotment of untied funds

to the PHCs. It varies in different years. PHC Chetpet received Rs. 50,000 in 2010-11

and Rs. 34,394 in 2011-12. PHC Kummanandal received Rs. 12,500 in 2010-11 and Rs.

25,000 in the year 2011-12. PHC Vazhoor received Rs. 25,000 in 2010-11 and Rs.

37,500 in the year 2011-12.

j) There was no DPMU to co-ordinate the funds and programmes in the district.

k) The main items of expenditure under untied funds in the visited centres were purchase of

medicines, lab. Items, cleaning of PHC premises, wages for contract workers, purchase

of stethoscope, filling of cylinders and electric repair etc.

4. Rogi Kalyan Samiti (RKS): -

k) 93 Rogi Kalyana Samithis have been formed in the district. The team has not received

the details of executive and general body meeting conducted by the district health

society. However, as observed regular meetings of RKS was not conducted in all the

centers visited.

l) The budget provision & expenditure of RKS in different institutions are as below:

(Amount in Rs.)

S. No Type of RKS

Funds

Year Opening

Balance

Received

from

RCHP

Total Expenditure

incurred

Closing

Balance

1 RKS at PHC

level

2010-11 12,14,50

7

86,00,00

0

98,14,5

07

90,42,123(92.1

%)

7,72,38

4

2011-12 7,72,384 86,00,00

0

93,72,3

84

81,03,633(86.5

%)

12,68,7

51

2 RKS at Dist.

Hospital

2010-11 11,77,21

4

5,00,000 16,77,2

14

0 16,77,2

14

2011-12 16,77,21

4

5,00,000 21,77,2

14

0 21,77,2

14

3 RKS at 6

Govt.

Hospitals

2010-11 14,74,69

5

6,00,000 20,74,6

95

0 20,74,6

95

2011-12 20,74,69

5

6,00,000 26,74,6

95

8,74,549(32.7%

)

18,00,1

46

4 RKS at 110

new PHCs

2010-11 1,50,000 0 1,50,00

0

1,50,000 0

2011-12 0 0 0 0 0

555

As per the above statement, old PHCs have spent 86.55% of the RKS funds during

2011-12, where as the RKS at new PHCs have not spent any amount during 2010-11

and 2011-12. RKS of 6 GHs didn‟t spend any amount during 2010-11 and only 32.7%

fund was spent during 2011-12.

m) In the visited PHCs, RKS expenditure was not upto the mark. In PHC Chetpet, the

percentage of RKS expenditure was 99% in 2010-11 and only 21.6% in 2011-12. In PHC

Vazhoor, expenditure for 2011-12 was only 66.5%. Utilization of funds in other centers

was satisfactory. In PHC Thatchur, the details of RKS expenditure for 2011-12 was not

made available.

n) Registration of RKS in GH Arni expired in November 2011. GH didn‟t apply for renewal

upto the time of visit.

5. Services of ASHA:-

In the district, 139 ASHAs were selected. No selected ASHA was trained and drug kits

supplied to them.

6. Village Health Sanitation and Nutrition Committees (VHSNCs) :-

e) It was reported that 679 VHNSCs were formed in the district, out of which 426 were

formed in Thiruvannamalai health division and 253 in Cheyyar health division. As per the

financial statement of the district, details of allotment of funds to VHNSC and expenditure

incurred by them are given below:-

(Amount in Rs.)

S. No VHSNCs

for

Year Opening

Balance

Funds

received

Total funds

available

Expenditur

e incurred

Closing

Balance

1 Village

Panchayats

2010-11 6,075,708 86,00,000 1,46,75,708 1,13,58,94

0

33,16,76

8

2011-12 33,16,768 88,61,000 1,21,77,768 41,57,246 80,20,52

2

2 Town

Panchayath

s

2010-11 3,71,785 4,40,000 8,11,785 5,13,151 2,98,634

2011-12 2,98,634 4,40,000 7,38,634 4,22,374 3,16,260

f) In the village Karaipoondi, the public informed that the drinking water sources are not

properly chlorinated since last one year, though as per record all the funds were spent

for chlorination work. ANM was facing problem with the previous (2010-2011)

556

panchayath leader in sanctioning the amount for chlorination. It was informed that the

leader regularly took Rs. 600 per month towards the payment of wages to chlorinate the

water tanks but no chlorination work was done as informed by the villagers.

7. 24x7 Delivery Care Services:-

91 PHCs and all the GHs are providing 24 hours delivery services in this district. All the

visited centers have facility for conducting safe deliveries. Details of delivery conducted

in the centers visited are as follows.

S.

No

Name of the institute Number of Deliveries conducted

2010- 11 2011-12 (up to Nov-11)

1 PHC, Chetpet 479 281

2 PHC, Kummanandal 240 151

3 PHC, Vazhur NA 155

4 PHC, Thatchur 224 199

5 GH, Arani 530 526

6 GH, Polur 382 289

*NA – Figures not available

8. Physical Infrastructure:-

h) GHs:

a) GH Arani is a 115 bedded well maintained hospital with a good garden in the front side.

There are no residential quarters for the MO and paramedical staff. The facility of jeep

and sufficient BP apparatus was lacking in GH. Bio-medical waste is removed on

alternate day in the Hospital.

b) GH is a 78 bedded hospital having one Ambulance and no other vehicle. Blood storage

unit is yet to start in the GH for want of equipments and trained staffs. Boyles apparatus

and residential quarters for MO and paramedicals are not available in the hospital. Bio-

medical waste is removed on alternate day in the hospital.

i) PHCs:

a) The team visited PHCs at Thatchur, Vazhur, Kommanandal and Chetpet. PHC Thatchur

was well maintained center. All required facilities were available including 7 residential

quarters for MOs and paramedicals. PHC Vazhur is a 30 bedded hospital which was

providing 24 X 7 services. Residential quarters not available for the MO.

b) PHC Kommanandal was not having vehicle. Every Wednesday Tubectomy Sterilisation

camp is done. All 9 residential quarters were condemned in the hospital. PHC Chetpet

was having 5 MOs and every Saturday Tubectomy Sterilisation camps are conducted

there. Facilities of residential quarters and functional autoclave were lacking.

557

j) HSCs:

vii) The team visited HSCs at parampettai, Indiravanam Karaipoondi, Vazhur,

Vinnamangalam, Mattappirayur and Thatchur. HSC building at Parampettai was in the

stage of condemnation, still VHN was staying there. VHN was not staying in the HSC

building at Thatchur and Karaipoondi. Second ANM was not posted any of the visited

center and MPW (M) post was not filled up in 4 sub centres visited.

viii) Ambu bag / suction, RDT kit for malaria, DDKs, Co-trimoxazole, Chloroquine Tablets,

Metranidazole, Oxytoxin, Cap Ampicillin, Gentamycin injection, Kit “A”, Kit “B” were not

available in the all centers visited.

ix) Vit A solution, IFA tablets (big / small & syrup), IUDs and OP Cycle were not available at

Thatchur centre.

x) labour room, Examination Table, Cupboard for drugs, Torch light, Stove, Bp apparatus,

ORS packets, Antiseptic solution, were not available in one or two centres and Sanitary

napkins, emergency contraceptive pills were not in stock in most of the visited centres.

xi) SBA and IMNCI training was not received by most of the ANMs in the visited centers.

9. Opinion of Community on the Health Services:-

i) MPW (M) services:

e) The contacted public and the patients were satisfied with the work of MOs and other staff

of the visited PHCs. The team could contact only one Male Worker in the HSC

Mattapirayur of PHC Kommanandal. Villagers were satisfied with the work of the Male

Health Worker. He is the only Male Worker in PHC Kommanandal who was covering the

whole PHC area for field work.

ii) ANM Services:

a) The team contacted 30 mothers to know the work of ANMs and their health awareness.

The health awareness of the mothers in the visited villages was satisfactory. All of them

were aware of the services of the HSCs. They were aware about ORS, contraceptive

methods and also immunization sessions. All the contacted mothers told that their

deliveries were institutional and their babies were weighed immediately after birth.

b) 25(83.3%) mothers received three PNC Check up. 20(66.7%) mother had awareness on

ARI and only 15(50%) mothers had knowledge on the side effect of contraceptive

methods.

10. Sample verification of FW Acceptors:-

558

a) The team selected 127 FW accepters out of which 110(86.6%) could be contacted for

sample verification in the district. Out of them 81(73.6%) acceptors received follow up

services by the field staff after accepting the F.P. methods.

b) Discrepancies in the age of acceptors in 3(2.7%) cases, in the age of spouse in 4 cases

(3.6%), total children in 3(2.7%) cases and in the no. of male children in 3(2.7%) cases

were noticed.

c) The team came across 4(3.6%) denial cases of IUD acceptors also during sample check.

11. Maintenance of Records and Registers:-

a) The maintenance of registers and records were found not satisfactory in the centers

visited by the team. At sub center level the workers of the visited HSCs did not update

the Eligible Couple register. None of the workers of the visited HSCs maintained the CC

register and Oral Pills register.

b) All the visited HSCs maintained the ANC tracking proformae in a proper way and

updated the records through online reporting.

c) The field staff of Vazhur and Karaipoondi HSCs did not show their registers during the

visit of the team.

12. Other Observations:-

a) It was observed that in Arani GH, immediate payment was not given to sterilization

acceptors even for those who come from far off places.

b) Regular monitoring for the provision & utilization of different funds to the centres in the

district was lacking.

c) PNDT centers need to be supervised at regular intervals by concerned authorities. It was

observed that most essential forms prescribed by the Govt. were not being filled properly

in this regard.

Tripura

559

Tripura

1. District:- South Tripura

Major observations of Regional Evaluation Team, Kolkata on the Evaluation work

carried out in South Tripura district of Tripura in July, 2011.

II. Details of the visited Institutions:

District

visited

CHCs and PHCs visited SCs visited

South

Tripura

CHC: Nutan Bazar

PHCs: Maharani, Santir

Bazar, Kakaraban and Raj

Nagar

Kunjaban, Jatanbari, R. K.

Ganj, Subhash Colony,

Palatana and East Mirza

II. Major Observations:

Health Human Resources:

The team reported that 151 (Regular) and 27 (Additional) ANMs, 104 MPWs (M), 12

LHVs, 77 (Regular) and 34 (Contractual) Medical officers, 22 Specialists, 267 GNMs

and 30 Lab Technicians were in position in the district as a whole. The team has also

observed that 65 SCs were functioning without MPW (M) out of 169 SCs in the

district. The team could not asses the requirement of human resources as the

sanctioned strength of staff was not made available to team.

2. Functioning of Rogi Kalyan Samiti:

It was observed that Rogi Kalyan Samiti has been constituted and registered at all the

visited CHCs and PHCs in the district. Meetings of Rogi Kalyan Samiti were being

conducted as per requirements.

3. Functioning of ASHA and Village Health & Sanitation Committee (VHSC):

a. 1904 ASHAs have been selected in the district against the required no. of 1986

ASHAs. There are 319 villages in the district.

b. It was reported that 1830 ASHAs have been trained up to 5th modules and provided

with Drug kits.

c. As reported, 319 VHSCs were functioning in the district. Every VHSC was having

ASHA as a member.

560

d. VHSC Untied funds to the tune of Rs. 35,53,000 including opening balance of Rs.

3,53,000 was available in the district and out of that funds to the tune of Rs.

32,10,791 were utilized by the VHSCs for strengthening their services in the year

2010-11 and balance amount carried forward to the next year. Untied funds were not

provided to the district during current year 2011-12.

4. Services of Janani Suraksha Yojana (JSY):

a. There was no scarcity of fund under the scheme in the district. Sufficient fund

provided under the head of RCH Flexi Pool. The district had spent Rs. 66,56,300 the

year 2010-11 and Rs. 11,39,750 utilized during current year 2011-12 (up to June,

2011) under the scheme.

b. As per the information available from the district as many as 5056 JSY mothers in

the year 2010-11 and 985 mother during the current year 2011-12 (up to June, 2011)

got benefit under the scheme.

c. During visit to the centres, it was observed that sufficient funds were available and

JSY beneficiaries were provided with cash incentives. JSY beneficiary register was

maintained but not checked by concerned Medical officer/ In charge.

d. During sample check, 23 JSY beneficiaries were interviewed in the district. Three

ANC check-ups and MCH cards were provided to them. JSY incentive were also

received by the beneficiaries and ASHA accompanied the mothers for institutional

delivery.

e. It was also observed that JSY incentive to the beneficiaries was not paid in time due

to non production of requisite documents at the time of discharge after delivery.

There was no provision for payment of transport money to the beneficiaries.

5. Untied Fund:

a. CHC, PHC and Sub Centres were being provided untied funds @ Rs. 50,000, Rs.

25,000 and Rs. 10,000 each per year respectively in the district. The position of

Untied funds for the year 2010-11 is given below:

(In Rs.)

Sr.

No.

Particulars Opening

Balance

Fund

Received

Expenditure Balance

1 For CHCs 14,466 1,50,000 1,11,847 52,619

2 For PHCs 1,16,389 6,25,000 5,63,812 1,77,577

3 For Sub Centres 2,13,557 17,30,000 15,90,292 3,53,265

561

b. Untied Fund released to the visited PHCs/CHC and utilized funds by them in the

year 2010-11 in the district are given below:

(in Rupees)

Name of

Institutions

Opening

Balance

Released Expenditure Balance

CHC Nutanbazar 12,500 37,500 49,960 40

PHC Maharani 9,000 25,000 20,000 14,000

PHC Santirbazar Nil 25,000 25,000 Nil

PHC Kakaraban 1,987 25,000 25,635 1,352

PHC Rajnagar 100 25,000 25,100 Nil

e. No untied fund has been provided to the district for the year 2011-12.

f. It was observed that funds were utilized for printing of OPD, IPD, Laboratory slip

and Bed head ticket, expenditure on Photocopy, washing of Bed sheets and

expenditure for conducting meetings etc. by the visited PHCs.

6. 24 hours delivery care services:

a. 20 institutions i.e, 3 CHCs and 17 PHCs were identified for 24 hours delivery care

services in the district.

b. In the visited CHC at Nutanbazar and PHCs at Maharani, Santirbazar, Kakaraban

and Rajnagar, good number of deliveries were conducted in the year 2010-11 and

the performance was maintained during the current year. Though the facilities for

caring mothers and new born baby were inadequate at visited institutions, Medical

and para-medical staff for conducting delivery was sufficient in the institutions.

7. Physical infrastructure:

(i) Health Sub Centres:

a. The team visited Sub Centres at Kunjaban, Jatanbari, R. K. Ganj, Subhash Colony,

Palatana and East Mirza and found Labour room was not available at Sub Centres

Kunjaban, Jatanbari, Subhash Colony, Palatana and East Mirza.

b. Mclntsh sheet, Ambu bag / suction, Delivery kit, CuT insertion kit, DDKs, CuT,

Oxitocine tablets, Gentamycin injection and Kits- A & B were not available in the

visited Centres.

c. Delivery table, Hemoglobinometer and Gloves were not available at Sub Centres

Kunjaban, Jatanbari, R. K. Ganj and Subhash Colony.

562

d. Steam sterilizer, Sanitary Napkins and EC Pills were not available at Sub Centres

Kunjaban, R. K. Ganj, Subhash Colony and Palatana.

e. Vitamin- A solution and Oral Pills were not available at a few of the visited Sub

Centres.

f. Skilled Birth Attendance training was not given to the Auxiliary Nurse Midwives in the

visited Sub Centres.

(ii) PHC:

d. PHCs at Maharani, Shantirbazar and Kakaraban were functioning in Govt. buildings

but the maintenance of the hospitals was not up to the mark.

e. Operation Theatre (Functional), Oxygen Cylinder and stock of DPT vaccine, IFA

syrup & Vitamin- A tablets were not found available at the visited PHCs.

f. Jeep/ Ambulance were not available at PHC Maharani and vehicle was out of order

in PHC Shantirbazar.

(iii) CHC:

a. CHC, Nutanbazar had inadequate space for functioning. Residential quarters for

MOs and Para medical staff were not available in this CHC.

b. Jeep, Blood Storage Unit, Auto Clave, Oxygen Cylinder, Labour Room, Sick New

Born Care Unit, Neo-Natal Resuscitation equipment, Anesthesia equipment,

Operation Theatre with OT table, CuT insertion kit were not available in the visited

CHC at Nutanbazar.

8. Opinion and awareness of the Community on the Health Services:

(i). ANMs Services:

a. 20 mothers were interviewed for assessing their opinion and knowledge about the

services provided by the concerned ANMs at sub centre level. They informed that the

ANMs were available at village level as and when needed.

b. Contacted mothers mostly were not aware about danger signs of ARI, use of

contraceptives in the areas of visited centres. Post Natal checkups by health workers

was found poor in the area visited.

c. Community opinion on the services rendered by MPW (M) at R.K. Ganj Sub centre

was found good. But villagers were not satisfied with some of the services i.e.

irregular visit of MPW (M) in the village, maintenance of environmental

sanitation, group meeting on health topic, motivation for NSV and school health

activities etc.

(II). Services of PHC:

563

c. 22 RCH beneficiaries i.e. pregnant women, recently delivered women, mothers upto

two year old Child and AWW, ASHA and Village leaders etc. were contacted to know

overall functioning of the visited PHCs. Some of the mothers were unaware of danger

sign of pregnancy during ANC and sick new born baby. They were also not much

aware about contraceptives and HIV/STD/AIDS.

d. Medical officer of PHCs Maharani and Kakaraban was not visiting villages under the

PHC area since last 4 to 6 months.

9. Sample Verification of F.W. acceptors:

a. The team selected a total of 80 F.W. acceptors for sample verification and out of that

62 (75%) could be contacted. 16 (26%) acceptors informed that they did not receive

any follow up services.

b. Also 59 beneficiaries of BCG/ DPT/ Polio, Measles and Vitamin- A selected and out of

that 57 (97%) beneficiaries could be contacted for sample verification. All contacted

beneficiaries were confirming with doses. 49 (86%) beneficiaries received follow up

services from health staff.

c. It was observed that sterilizations were being done by the district level team by

organizing camps in the PHCs/ CHCs. There was no sterilisation case reported in

CHC Nutanbazar and PHCs Maharani and Shantirbazar for the year 2010-11 and

2011-12 (up to June 2011).

10. Reconciliation of the reporting performance under Sterilization:

a. The figures reported for IUD, Oral Pills and Nirodh by the district office for the year

2010-11 and 2011-12 (up to June 2011) did not tally with the figures reported by

visited CHC, PHCs.

The details are as below-

Name of the

Centres

Years CuT reported by OP reported by Nirodh reported

by

District

office

Centre District

office

Centre District

office

Centre

CHC Nutanbazar 2010-11 51 80 319 180 5845 4311

2011-12 - - 24 42 1469 1909

PHC Maharani 2010-11 3 5 390 645 4951 4630

2011-12 - - 50 93 1024 674

PHC Shantirbazar 2010-11 - - - - 16442 15284

2011-12 - - 990 1035 3913 3217

564

PHC Kakaraban 2010-11 165 228 5587 57 39918 28538

2011-12 - - - - 3415 4240

b. Sterilisation acceptors reported (78) by the PHC Kakarban for the year 2010-11 did

not tally with the cases (64) recorded in the register.

c. CuT register at CHC and PHC were found incomplete.

11. Registers, records and reports maintained at the visited centres:

a. Eligible Couple register which is one of the most important records for FW services

was not being updated and maintained properly at the visited facilities.

b. Oral Pills and Nirodh users register was not made available at PHC Shantirbazar.

c. ANC and PNC registers were not maintained properly at CHC Nutanbazar and PHC

at Maharani but same was not made available at PHC Shantirbazar. Stock register

were maintained without all details at visited facilities.

12. Other observations:

a. Performance of Family Planning services was poor in the district.

b. Payment of cash incentive to the mothers under JSY was delayed as the JSY card

with necessary supporting papers are not being submitted in time by the

beneficiaries/ASHAs. Proper guidance may be provided to the beneficiaries and

ASHAs in this regard.

c. Supply of Immunization Card to the centres was very poor. Therefore, most of the

time workers had to supply Xerox copy of Immunization Card to beneficiaries.

d. All CuT insertion done by Medical officer only. No ANM in the entire district was

trained for CuT insertion.

e. There was no printed register for maintaining the services of Family Planning, MCH,

JSY payment and also Stock book at the centres visited in the district.

2. District:- West Tripura

Major observations of Regional Evaluation Team, Kolkata on the Evaluation work

carried out in West Tripura district of Tripura in July, 2011.

I. Details of the visited Institutions:

565

District

visited

CHCs and PHCs visited SCs visited

West Tripura CHC: Takarjala

PHCs: Bamutia, Anand

Nagar and Baijalbari

Laxmilunga, South Rangutia,

Srinagar, Anand Nagar, South

Padmabil and Gayamani

II. Major Observations:

1. Health Human Resources:

a. Sanctioned strength of the staff in whole of the district and at PHC / CHC level was not

available at district office as well as the visited CHC/PHCs. As per the report available,

there were 298 (Regular) and 28 (Additional) posts of ANM, 183 posts of MPW (M), 16

posts of Health Supervisor (M), 125 (Regular) and 71 (Contractual) posts of Medical

officer, 4 posts of Specialist, 234 posts of GNM and 22 posts of Lab Technician filled

up in whole of the district.

b. It was observed that most of the SCs were functioning with only single ANM (Regular or

Contractual) in the district. 103 of the 286 SCs in the district were functioning without

MPW (M).

c. In CHC Takarjala, 7 out of 15 Sub Centres were functioning without ANM though MPW

(M) was available. In PHC Baijalbari, out of 9 Sub Centres 2 Sub centres were

functioning without ANM/MPW (M) and 3 Sub-Centres were functioning with ANM only.

2. Functioning of Rogi Kalyan Samiti (RKS) and Village Health & Sanitation Committee

(VHSC):

a. Rogi Kalyan Samiti had been constituted and registered at visited CHC and PHCs but

regular meetings of Rogi Kalyan Samiti were not being conducted.

b. 407 VHSCs were functioning in the district and all were having ASHA as a member of

the committee.

c. Untied funds to the tune of Rs. 1,07,65,405 including opening balance of Rs. 66,85,405

was available in the district during 2010-11 and an amount of Rs. 70,12,320 was

utilized by the VHSCs for strengthing their services within the period. Similarly, Rs.

2,67,258 was spent against available amount of Rs. 37,53,085 during the current year

up to June, 2011. No VHSC fund was provided to the district during current year 2011-

12.

3. Functioning of ASHA and

566

a. 2978 ASHAs have been selected for all 407 villages in the district against the required

no. of 3038 ASHAs.

b. It was reported that 2978 ASHAs have been trained up to 5th modules and provided

with Drug kits.

4. 24 hours delivery care services:

a. 24 institutions (6 CHCs and 18 PHCs) were providing 24 hours delivery care services in

the district.

b. In the visited CHC at Takarjala and PHCs at Bamutia, Anandnagar and Baijalbari good

number of deliveries were conducted in the year 2010-11 and the performance was

maintained during current year also. Though the facilities for caring mothers and new

born baby were inadequate at visited institutions, Medical and para-medical staffs for

conducting delivery were there in the institutions.

5. Untied Funds:

a. Every CHC, PHC and Sub Centre was being provided untied funds @ Rs. 50,000, Rs.

25,000 and Rs. 10,000 per year respectively in the district. Provision and Expenditure

of Untied Fund to the district for strengthening the services at different facilities are

given below:

(In Rs.)

Sr.No. Particulars CHC level fund PHC level fund HSC level fund

2010-11 2011-

12

2010-11 2011-

12

2010-11 2011-12

1 Opening

balance

34,053 49,390 1,68,115 81,129 13,41,006 17,05,983

2 Fund

received

3,00,000 Nil 5,75,000 Nil 28,10,000 Nil

3 Expenditure

incurred

2,84,663 400 6,61,986 65,013 24,45,023 2,45,450

4 Balance 49,390 48,990 81,129 16,116 17,05,983 14,60,533

b. Untied Funds released and expenditure incurred in the visited PHCs/CHC in the year

2010-11 are given below:

567

Untied Fund for visited PHCs/CHC

(in Rupees)

Name of

Institutions

Opening

Balance

Released Expenditure Balance

CHC Takarjala Nil 50,000 50,000 Nil

PHC Bamutia 9,112 25,000 33,161 971

PHC Anandnagar Nil 25,000 25,000 Nil

PHC Baijalbari Nil 25,000 25,000 Nil

c. No untied fund has been provided to the district for the year 2011-12.

d. It was observed that fund was utilized for printing of OPD, IPD, Laboratory slip and Bed

head ticket, expenditure on Photocopy, washing of Bed sheets and incurring

expenditure for organizing meeting etc. by the visited PHCs.

6. Services of Janani Suraksha Yojana (JSY):

a. There was no scarcity of fund under the scheme in the district. Sufficient fund provided

under the head of RCH Flexi Pool. The district had spent Rs. 47,45,400 the year 2010-

11 and Rs. 10,32,800 utilized during current year 2011-12 (up to June, 2011) under the

scheme.

b. As per the information available from the district as many as 7420 JSY mothers in the

year 2010-11 and 1563 mother during the current year 2011-12 (up to June, 2011)

were benefited with the cash incentives.

c. During visit to the centres, it was observed that there was sufficient fund available and

JSY beneficiaries were provided with cash incentives. JSY beneficiary register was

maintained there but these registers were not checked by concerned Medical officer/ In

charge.

d. During sample check 23 JSY beneficiaries were contacted by the team and found that

three ANC check-ups were provided to them. JSY incentive were also received by the

beneficiaries and ASHA accompanied the mothers for institutional delivery.

e. It was also observed that JSY incentive to the beneficiaries was not paid in time due to

non submission of requisite documents at the time of discharge after delivery. There

was no provision for payment of transport money to the beneficiaries.

7. Physical infrastructure (HSC/BPHC/CHC)

(i) Health Sub Centres:

568

a. All the visited Sub Centres i.e. Laxmilunga, South Rangutia, Srinagar, Anand Nagar,

South Padmabil and Gayamani were functioning in Govt. buildings but their

maintenance was not up to the mark.

b. Labour room, Delivery table, Mclntsh sheet, Ambu bag/suction, Steam sterilizer,

Delivery kit, CuT insertion kit, DDKs, Vitamin- A solution, CuT, Sanitary Napkins, Kits-

A & B, Oxitocine tablets and Gentamycin injection etc. were not found available in all

the visited Centres.

c. Electricity facility was not available in the visited Sub Centres at Laxmilunga, Srinagar,

South Padmabil and Gayamani were not available.

d. No stock of EC Pills was available in Sub Centres of Laxmilunga, South Rangutia,

South Padmabil and Gayamani and Bleaching powder at Sub Centre at Laxmilunga,

South Rangutia, Anand Nagar and Gayamani was not available.

e. Hemoglobinometer, ORS packets, IFA large tablets and Oral Pills cycle were not

available in a few of the Sub Centres visited.

f. Skilled Birth Attendance training was not given to the Auxiliary Nurse Midwives in

almost all the visited Sub Centres.

(ii) BPHC:

a. The visited PHCs at Bamutia, Anandnagar and Baijalbari were functioning in Govt.

buildings but the maintenance of the hospital was not up to the mark.

b. Oxygen cylinder, Functional Operation Theatre with OT table, IFA syrup and Vitamin- A

tablets were available at visited PHCs.

c. Jeep/ Ambulance was out of order, IFA large tablets and Vitamin- A syrup were not

available in PHC Anandnagar. Microscope and the post of Laboratory Technician was

not available in PHC Baijalbari.

d. Residential quarter for Medical Officer was not provided in the visited PHCs at Bamutia

and Anandnagar.

(iii) CHC:

a. CHC was functioning in Govt. building but the maintenance of the hospital was not up

to the mark.

b. Ambulance was off road and X-ray facility was not setup; Jeep, Blood storage unit,

surgical equipment, Anesthesia equipment, Sick New Born Care Unit and Operation

Theatre with OT table were not available in this CHC.

c. Availability of Specialist and residential quarter for Medical Officer and Para-medical

staff was inadequate.

569

8. Opinion of the Community on the Health Services:

(I). Services of ANM:

a. 20 mothers having child up to one year age were interviewed in the area of SCs

Srinagar and Anandnagar for assessing their opinion and knowledge about the services

provided by the concerned ANMs. They informed that the ANMs were available at

village level as and when needed. Mothers were mostly satisfied with the work of ANMs

in the areas of centres visited.

b. Contacted mothers mostly were not aware about danger signs of ARI, use of

contraceptives in the areas of visited centres. Post Natal checkups by health workers

found poor in the area visited.

(II). Services of BPHC:

a. 21 RCH beneficiaries i.e. pregnant women, recently delivered women, mothers upto

two year old Child and AWW, ASHA and Village leaders etc. were contacted to know

overall functioning of PHCs visited. Some of the mothers were unaware of danger sign

of pregnancy during ANC and sick new born baby. They were also not much

knowledgeable about contraceptive and HIV/STD/AIDS.

b. Medical officer of PHCs Bamutia and Anandnagar was not visiting the villages under

the PHC area since last 4 to 6 months.

9. Sample Verification of F.W. acceptors:

a. The team selected a total of 60 F.W. acceptors for sample verification and out of that

43 (72%) could be contacted.

b. Among the contacted acceptors, 22 (51%) informed that they did not receive any follow

up services.

c. 37 beneficiaries of BCG/ DPT/ Polio, Measles and Vitamin- A was selected and all

selected beneficiaries were contacted. All beneficiaries confirmed receiving the doses.

Follow up visits were not by health staff.

10. Registers, records and reports maintained at the visited centres:

a. Printed Eligible Couple register were maintained but not updated at visited facilities.

b. All Sterilisation operations were done by organising camps and visited facilities were

only reporting the figures. Service registers for Sterilization cases were not maintained

at PHC/CHC level, only vouchers and case cards were maintained there.

c. CuT, Oral Pills/ Nirodh and Stock registers were maintained without all details at visited

institutions.

570

11. Other observations:

a. Performance of Family Planning services was poor in the district..

b. No ANM was inserting CuT in the Sub Centres in the entire district because they were

not trained.

c. There was no printed register available for maintaining the services of Family Planning,

MCH, JSY payment and also Stock Book at the centres visited in the district.

d. It was observed that monitoring and regular supervision at periphery level was not

effective.

571

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

PHC: Chayal

Itaila, Mayhar, Anetha,

Malaksaddi, 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):

572

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 Fund

In the year 2010-11 ( in

Rs)

For Sub

centres

For CHCs/PHCs

573

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 JSY

47,76,650 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:

574

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.

575

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.

b. MCH Tracking formats were available in each Sub centres.

c. Health functionaries were sensitized in MCH formats at PHC/ CHC level. They are

capturing data in the formats and making data entry at PHC/ CHC level through cyber

cafe.

576

11. Registers, records and reports maintained at the visited centres:

a. Service registers for IUD, Oral Pills and Nirodh cases were not being maintained at

any of the PHC/CHC head quarter. Performance reported under CuT at CHCs Kanaili,

Sirathu and PHC at Chayal could not be verified due to want of consolidated registers.

b. Eligible Couple register, Cash book for untied fund and VHSC proceeding registers

were not being maintained at any of the visited centres.

c. Registers for Family Planning services, Stock book, Monthly Reporting format and

Cash book for untied fund were not supplied in printed forms to Sub Centres by higher

authority.

2. District: Ballia

Major observations of Regional Evaluation Team, Lucknow about the Evaluation

work in Ballia district of Uttar Pradesh in May, 2011

I.Details of the visited Institutions:

District

visited

PHCs/CHCs visited SCs visited

Ballia CHC: Sonvani

PHCs: Bansdih and

Beruabari

Haldi, Bigahi, Halpur,

Mudiyari, Sukhpura and

Sultanpur

II Major Observations

1. Health Human Resources:

a. 20 posts of MO out of 100 sanctioned and 44 posts of specialists out of 60 sanctioned

were lying vacant in the district.

b. Similarly, skilled personnel under Para Medical category like 10 ANMs (out of 426

sanctioned), 94 MPWs (M) (out of 136 sanctioned), 41 Health Supervisors (M) (out of

147 sanctioned), 11 HEOs (out of 18 sanctioned posts) and one each sanctioned

posts of District Program Manager, District Account Manager and District Community

Immobilizer were also lying vacant in the district.

c. In the visited CHC, Sonvani, 4 of the 20 sanctioned posts of ANM, all 9 sanctioned

posts of MPW (M), 4 of the 7 sanctioned posts of Health Supervisor (M), 5 of the 7

577

sanctioned posts of Medical Officer, 4 of the 5 sanctioned posts of specialist and 1 of

the 3 sanctioned posts of Staff Nurse were vacant.

d. 3 of the 31 sanctioned posts of ANM, all 8 sanctioned posts of MPW (M), 2 of the 4

sanctioned posts of LHV, 1 of the 6 sanctioned posts of Health Supervisor (M), all 3

sanctioned posts of Staff Nurse and 2 of the 7 sanctioned posts of Medical Officer in

PHC, Bansdih and 1 of the 16 sanctioned posts of ANM, 5 of the 8 sanctioned posts

of MPW (M), 1 of the 6 sanctioned posts of Health Supervisor (M) and 1 of the 8

sanctioned posts of Medical Officer in PHC Beruabari were lying unfilled.

2. Functioning of Rogi Kalyan Samiti (RKS):

a. Rogi Kalyan Samiti (RKS) was registered in each of the Block level PHC/CHC in the

district. Meeting of executive body of RKS was not being conducted every month.

b. RKS fund including Untied Fund and Annual Maintenance Grant etc. are kept at the

disposal of Rogi Kalyan Samiti and utilised on the development activities such as

repairing of vehicle, electricity and purchasing of equipments etc. It was observed that

expenditure incurred at CHC/PHCs was not approved by the RKS. The concerned

record was not made available to the team in visited CHC at Sonvani and PHC at

Bansdih.

c. It was also observed that meetings of advisory body of RKS were not being conducted

in the visited centres.

3. Functioning of ASHA Scheme:

a. 2567 ASHAs have been selected in the district under the scheme. Out of these 2456

ASHAs were trained and working in the field without having drug kits during 2010-11.

No new ASHA was proposed to be inducted during 2011-12 in the district.

b. During field visit, 12 ASHAs were interviewed, all were trained and receiving

performance based remuneration on an average Rs. 30,000- 35,000 yearly. ASHAs

were not given drug kits.

4. Functioning of Village Health & Sanitation Committee (VHSCs):

a. It was observed that 833 VHSCs were formed and joint bank account in the name of

concerned ANM and Gram Panchayat Pradhan has been opened only in 609 VHSCs

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. It was reported that every revenue village is provided funds @ Rs. 10,000 under the

scheme in the district. The total budget to the tune of Rs. 1,83,10,000 for 1831

revenue villages for the VHSCs in the district was allotted during 2010-11. Records of

expenditure were not available at the visited PHC/CHCs/SCs.

578

c. It was reported that Rs. 4,50,000 to CHC Sonvani, Rs. 15,90,000 to PHC Bansdih and

Rs. 8,90,000 to PHC Beruabari were released as VHSC fund.

d. VHSCs fund was not released to the district during current year 2011-12 up to the

month of visit.

5. Untied Funds:

a. During the year 2010-11 district had allotted untied funds to the tune of Rs. 36,60,000

for 366 Sub Centres and Rs. 11,50,000 for 10 CHCs and 13 PHCs @ Rs. 10,000 to

each Sub Centre and @ Rs. 50,000 to each PHC/CHCs.

b. During visit to the centres it was observed that most of the Untied Funds were utilised

on maintenance/ beautification of building.

c. It was also noticed that Sub Centre level Untied Fund are given to the concerned

PHC/ CHC and the Sub Centres who have bank accounts receive funds from

PHC/CHC. Every year PHC Bansdih received Untied Fund for its 20 Sub Centres but

released the funds to only 14 Sub Centres who have opened their bank accounts.

Balance of Rs. 60,000 for 6 Sub Centres is lying unspent at PHC Bansdih every year.

d. In the year 2011-12 untied fund was not received from State headquarter till the

month of visit by the team.

6. Janani Suraksha Yojana (JSY):

a. The district spent Rs. 7,63,83,873 out of funds of Rs. 7,63,88,573 allotted for the year

2010-11.

b. As per details received as many as 37454 beneficiaries were provided cash

assistance and there were 5610 beneficiaries waiting for their payments under the

scheme during 2010-11 in the district.

c. During visit to the centres it was observed that all the registers relating to JSY were

maintained properly with relevant details at PHC/ CHC level and also checked by

concerned MOs regularly. Cheques to the beneficiaries are provided by the

concerned CHC/ PHC directly within a week from date of delivery. Team found that

most of the delivered mothers are relieved from the institution within 20 to 24 hours

after delivery.

d. 65 JSY beneficiaries were contacted in the area of the visited centres in the district.

All the beneficiaries stated that they had received cash incentives and services in

time.

7. 24x7 delivery care services:

a. 23 institutions were identified to provide 24x7 delivery care services in the district.

579

b. As reported, total 31755 deliveries were conducted in the year 2010-11 by 23

institutions (PHC/ FRU) in the district. Facilities for caring mothers and new born

babies were not adequate in all the visited institutions under the scheme.

c. Baby warmer and Photo therapy machine was not functioning in PHC Bansdih.

8. Physical infrastructure (HSC/PHC/CHC)

(i) CHC/ PHCs:

a. During visit to the CHC Sonvani, team found that the CHC was functioning in Govt.

building but their maintenance was not up to the mark.

b. Blood Storage unit, Quinine and Artether injections were not available in CHC

Sonvani.

c. Visited PHCs at Bansdih and Beruabari were functioning in Govt. buildings.

Telephone facility and stock of contraceptive items were not available in the visited

PHCs.

d. AYUSH Medical Officer was posted in the visited PHCs, but Unani/ Ayurvedic and

Homeopathic medicines under this segment were lacking there. 24x7 services are

available in the PHCs.

(ii) Health Sub Centres:

a. Except Sub centre Bigahi all visited Sub centres i.e., centres at Haldi, Halpur,

Mudiyari, Sukhpura and Sultanpur were functioning in Govt. buildings.

b. It was observed that no delivery was being conducted in the visited Sub centre at

Sultanpur.

c. RDT kit, Nischay Pregnancy Test Kits, DDKs, Oxytocin tablets, Ampicillin capsules

and Gentamycine injection were not available in the visited Sub centres.

d. Foot stool, Delivery table, Maclntsh sheet, Ambu bag/suction, Weighing machine

(Infant), ORS packets, EC Pills and Paracetamol tablets were not available at Sub

centres Haldi and Sultanpur.

e. CuT, Oral Pills, Nirodh, Chlorin solution, Co-trimoxazole, Chloroquine, Metronidazole

and Paracetamol tablets were not available at Sub centres Haldi, Bigahi and Halpur.

f. Antiseptic solution, Chlorin solution, EC Pills, Paracetamol and Metronidazole tablets

were not available at Sub centre Sukhpura.

g. Electricity, Benches, Delivery kit, BP apparatus, Sanitary Napkins, Vitamin- A and IFA

were not available at Sub centre Haldi.

h. Foot stool, Ambu bag/suction, ORS packets, DDKs, Vitamin- A and IFA at Sub centre

Bigahi, Electricity, Toilet facility, Ambu bag/suction and Steam Sterilizer at Sub centre

580

Halpur, Ambu bag/suction, Steam Sterilizer, Oral Pills and Paracetamol tablets at Sub

centre Mudiyari and Antiseptic solution at Sub centre Sultanpur 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. 12 (22%) mothers were not aware about danger sign of ARI and use of ORS and 10

(18%) replied that their babies were not weighed at the time of birth. 14 (26%)

mothers did not receive three Post Natal checkups.

c. It was also observed that 37 (68%) mothers were not aware of contraceptive methods

and 34 (63%) regarding side effects of contraceptive use.

(ii) Services of PHC-

a. 30 Persons who were generally utilising the services at visited PHC/CHCs were

interviewed and it was found that most of them were satisfied with the services

provided by the Medical officers and others staff of PHCs/CHC.

b. The team also contacted different target groups like pregnant women, recently

delivered women, mother of 2 year old child and village leaders. Team found that

about 17% pregnant women are not registered within the 16 weeks of pregnancy and

recently delivered women have no knowledge of referral mechanisms. 33% mothers

were not aware of the danger sign of sick new born.

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) though internet connectivity was not available in any visited CHC/ PHC.

b. MCH Tracking formats were available in each Sub centres.

c. Health functionaries were sensitized in MCH formats at PHC/ CHC level. They are

capturing data in the formats and making data entry at PHC/ CHC level through cyber

cafe.

11. Registers, records and reports maintained at the visited centres:

a. Service registers for IUD, Oral Pills and Nirodh cases were not being maintained at

any of the PHC/CHC head quarter. Performance reported under CuT at CHC

Sonvani, PHCs at Bansdih and Beruabari could not be verified due to want of

consolidated registers.

581

b. Eligible Couple register which is one of the most important records for FW services

had not been maintained in the Sub centres at Haldi and Halpur. Monthly Reporting

format and Cash book for untied fund were also not maintained in these centres.

c. Family Planning services and Stock registers for FW items was not maintained in the

visited sub centres at Haldi, Halpur and Sukhpura.

d. JSY beneficiary card, ANC and Immunization cards were not found to be maintained

at sub centre Halpur.

3. District: Kanpur Dehat

Major observations of Regional Evaluation Team, Lucknow about the Evaluation

work in Kanpur Dehat district of Uttar Pradesh in June, 2011

I. Details of the visited Institutions:

District

visited

PHCs/CHCs visited SCs visited

Kanpur

Dehat

CHCs: Rasulabad & Akabarpur

PHC: Maitha

Pahadipur, Kahi Jiri,

Nariha, Muktapur, Bairi

Sawai and Sivali

II. Major observations

1. Health Human Resources:

a. In the Medical category, 15 posts of MO out of 115 sanctioned and 18 posts of

specialist out of 40 sanctioned were lying vacant in the district.

b. In the Para-medical category, 77 posts of ANM (out of 285 sanctioned), 91 posts of

MPW (M) (out of 100 sanctioned), 56 posts of Health Supervisor (M) (out of 70

sanctioned), 5 posts of Staff Nurse/GNM (out of 34 sanctioned) and 2 posts of Lab

Technician (out of 29 sanctioned) were lying vacant.

c. In the visited CHC, Rasulabad, 10 of the 34 sanctioned posts of ANM, 13 of the 14

sanctioned posts of MPW (M), 2 of the 4 sanctioned posts of Health Supervisor (F), 2

of the 4 sanctioned posts of Staff Nurse and 4 of the 6 sanctioned posts of specialist

were lying vacant. In CHC, Akabarpur, all 3 sanctioned posts of MPW (M), 4 of the 6

582

sanctioned posts of Health Supervisor (M) and all sanctioned posts of specialist were

lying unfilled.

d. 5 of the 29 sanctioned posts of ANM, 2 of the 8 sanctioned posts of MPW (M), all 6

sanctioned posts of Health Supervisor (M) and 1 of the 3 sanctioned posts of Staff

Nurse in PHC Maitha 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, 1663 ASHAs were in position out of 1700 selected in the district during

2010-11. 1303 ASHAs were reported to have been trained but working without drug

kits.

b. In the visited Sub Centres at Pahadipur, Kahi Jiri, Nariha, Muktapur, Bairi Sawai and

Sivali, required number of ASHAs were working in the field and trained up to 5th

module.

c. 8 ASHAs were interviewed and as informed all were trained and receiving an annual

average performance based remuneration of about Rs. 3500- 4500.

4. Functioning of Village Health & Sanitation Committee (VHSCs):

a. It was reported that 612 VHSCs were formed in 1032 villages 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 to the tune of Rs. 1,03,20,000 for

1032 revenue villages during 2010-11. Though the funds were reported to be utilized

fully, no details of expenditure were available at district office and also at visited

SCs/PHC/CHCs.

c. Meetings of the VHSCs were not being conducted regularly in the visited Sub

Centres.

583

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 Fund

In the year 2010-11 (

in Rs)

For Sub

centres

For

CHCs/PHCs

1 Fund allotted 22,60,000 12,61,500

2 Total Expenditure 22,60,000 12,61,500

b. Funds @ Rs. 10,000 to each Sub centre and @ Rs. 50,000 to each CHC/PHC per

year are released by district to block level CHCs/PHCs. But it has been observed that

in the jurisdiction of CHC Akabarpur & PHC Maitha Untied Funds @ Rs. 5,000 to each

Sub centre were allotted during 2010-11. Fund was not released in the year 2011-12.

c. Funds were utilized in contingency and development work like buying of stationary

and PVC Goods, printing of OPD and Indoor slip 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. Almost all JSY beneficiaries paid with the cash assistance during last two years in the

district and no case was pending for the payment in the district during this period. It is

reported that 23068 beneficiaries in the year 2010-11 and 2328 beneficiaries during

2011-12 were provided with JSY incentive.

b. The district had spent more amount than the allotted budget for the year 2010-11. Out

of funds of Rs. 4,25,92,000 allotted to the district for the year 2010-11, the

expenditure reported was to the tune of Rs. 4,57,71,062. The excess amount of

expenditure Rs. 31,79,062 was met from flexi pool fund. However, in the year 2011-

12, the district spent an amount of Rs. 42,96,350 out of alloted fund of Rs.

1,03,00,000 under the scheme.

c. The budget provision and expenditure at the visited PHC/CHC is reported as given

below:

Sr. Particulars For the year 2010-11 ( in RS)

584

No. CHC

Rasulabad

CHC

Akabarpur

PHC Maitha

1 Total fund available 75,61,000 18,89,200 27,68,700

2 Total expenditure

under

JSY

75,19,000 23,25,900 31,40,300

3 Total balance amount 42,000 (-) 4,36,700 (-)3,71,600

For the year 2011-12 ( in RS)

1 Total fund available 20,00,000 5,00,000 8,00,000

2 Total expenditure

under JSY

1,89,300 1,83,400 2,92,400

3 Total balance amount 18,10,700 3,16,600 5,07,600

d. 49 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 from the concerned CHCs and PHCs. JSY register was

maintained properly and that register was regularly checked by the concerned Medical

officer.

7. 24x7 delivery care services:

a. 12 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. 3735 deliveries in CHC Rasulabad, 688 in CHC Akabarpur and

1389 deliveries in PHC Maitha 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 Rasulabad and Akbarpur, team found that both the CHC

were functioning in Govt. building but their maintenance was not up to the mark.

b. Blood Storage unit, Injections Quinine and Arteether were not available in both visited

CHCs.

c. Visited PHC at Maitha was functioning in Govt. buildings. Jeep was not available at

PHC Maitha.

d. AYUSH Medical Officer was posted but Pharmacist and medicines under this

segment were lacking in the PHC.

585

(ii) Health Sub Centres:

a. Visited Sub centres at Pahadipur, Kahi Jiri, Nariha, Muktapur, Bairi Sawai and Maitha

were functioning in Govt. buildings. At Sub Centres Nariha and Bairi Sawai, ANMs

were not staying at their sub centre head quarters. Electricity was not available at

Pahadipur, Kahi Jiri, Nariha and Muktapur sub centres.

b. It was observed that delivery was being conducted in the visited Sub centres except at

Kahi Jiri, Nariha and Bairi Sawai Sub centres.

c. Nischay pregnancy test kit, RDT kit, Heamoglobinometer and Sanitary Napkins were

not available in the visited Sub centres.

d. ORS packets, DDKs, EC Pills, Oxytocin tablets, Ampicillin capsules and Gentamycine

injection were not available at Sub centres Rasulabad, Nariha, Muktapur, Bairi Sawai

and Siwali.

e. Examination table, Delivery table, Maclntsh sheet, Ambu bag/suction, Steam sterilizer,

Stove, Weighing machine (Infant), BP apparatus, Gloves, IFA tablets, Cloroquine,

Paracetamol, Metronidazole and Co-trimoxazole tablets were not available at Sub

centre Nariha.

f. Steam sterilizer, ORS packets and EC Pills at Sub Centre Pahadipur, Ambu

bag/suction and BP apparatus in Sub Centre at Rasulabad, DDK, Gloves and ORS

packets at Sub Centre Muktapur, Ambu bag/suction, Steam sterilizer, Delivery kit,

Stove, Vitamin- A, IFA and Co-trimoxazole tablets at Sub Centre Bairi Sawai and

Steam sterilizer, IFA, Cloroquine and Co-trimoxazole tablets at Sub Centre Siwali

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. 24 (44%) Mothers were not aware about danger sign of ARI, 17 (31%) were not aware

about use of ORS and 5 (9%) replied that their babies were not weighed at the time of

birth. 6 (11%) mothers did not receive three Post Natal checkups.

c. It was also observed that 27 (50%) mothers did not know about side effects of

contraceptive methods.

(ii) Services of PHC-

586

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 all pregnant women are registered within the 16 weeks of pregnancy and also

aware about danger sign in pregnancy, breast feeding practices and referral

mechanisms.

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.

b. MCH Tracking formats were available in each Sub centres.

c. Health functionaries were sensitized in MCH formats at PHC/ CHC level. They are

capturing data in the formats and making data entry at PHC/ CHC level through cyber

cafe.

11. Registers, records and reports maintained at the visited centres:

a. Performance reported under CuT at CHCs Rasulabad, Akbarpur and PHC at Maitha

could not be verified due to want of consolidated registers. Oral Pills and Nirodh

distribution registers were not maintained properly in the centres visited.

b. Eligible Couple register, Cash book for untied fund and VHSC proceeding registers

were not being maintained at any of the visited centres.

c. Registers for Family Planning services, Stock book, Monthly Reporting format and

Cash book for untied fund were not supplied in printed form to Sub Centres by higher

authority.

4. District: Hamirpur

Major observations of Regional Evaluation Team, Lucknow about the Evaluation

work in Hamirpur district of Uttar Pradesh in June, 2011

II. Details of the visited Institutions:

District

visited

PHCs/CHCs visited SCs visited

587

Hamirpur CHC: Maudaha

PHCs: Bharua Sumerpur &

Muskara

Makaraw, Maudaha

(Dehat), Lalpur, Chandra

Purawa, Niwada and Chili

II. Major observations

1. Health Human Resources:

a. 28 posts of MO out of 58 sanctioned and 18 posts of specialists out of 28 sanctioned

were lying vacant in the district.

b. Similarly, skilled personnel under Para Medical category like 66 ANMs (out of 249

sanctioned), 78 MPWs (M) (out of 81 sanctioned), 9 LHV/ Health Supervisors (F) (out

of 41 sanctioned) and one sanctioned post each of District Account Manager & District

Data Account Assistant, 7 Staff Nurse/ GNM (out of 13 sanctioned) and 3 Lab

Technician (out of 14 sanctioned) were also lying vacant in the district.

c. In the visited CHC, Maudaha, 29 of the 40 sanctioned posts of ANM, all 18 sanctioned

posts of MPW (M), all 6 sanctioned posts of specialist and 1 of the 3 sanctioned posts

of Staff Nurse were vacant.

d. One sanctioned post each of Lab Technician, ICC and UDC in PHC, B. Sumerpur, 7

of the 29 sanctioned posts of ANM, 14 of the 16 sanctioned posts of MPW (M) and 1

of the 4 sanctioned posts of Health Supervisor (F) in PHC Muskara were lying vacant.

2. Functioning of Rogi Kalyan Samiti (RKS):

a. Rogi Kalyan Samiti (RKS) was registered in each of the Block level PHC/CHC in the

district.

b. RKS fund including Untied Fund and Annual Maintenance Grant etc. are kept at the

disposal of Rogi Kalyan Samiti. Meeting of executive body of RKS were being

conducted for the approval of incurring expenditure on the development activities.

c. It was also observed that meetings of advisory body of RKS were not being conducted

in the visited centres.

3. Functioning of ASHA Scheme:

a. 866 ASHAs have been selected in the district under the scheme. Out of these 803

ASHAs were trained and working in the field without having drug kits during 2010-11.

No new ASHA was proposed to be inducted during 2011-12 in the district.

b. During field visit, 15 ASHAs were interviewed, all were trained and receiving

performance based remuneration on an average Rs. 40,000- 45,000 yearly. ASHAs

were not given drug kits.

588

4. Functioning of Village Health & Sanitation Committee (VHSCs):

a. It was observed that 506 VHSCs were formed and joint bank account in the name of

concerned ANM and Gram Panchayat Pradhan has been opened in all VHSCs to

handle the funds.

b. It was reported that every revenue village is provided funds @ Rs. 10,000 under the

scheme in the district. The total budget to the tune of Rs. 50,60,000 for 506 revenue

villages for the VHSCs in the district was allotted during 2010-11. Funds were mostly

utilised for conducting activities of sanitation & repairing of drains, spray, sanitation

and filling up of pits, fogging & bleaching work etc.

c. It was reported that Rs. 9,10,000 to CHC Maudaha, Rs. 8,70,000 to PHC B. Sumerpur

and Rs. 6,10,000 to PHC Muskara were released as VHSC fund.

d. VHSCs fund was not released to the district during current year 2011-12 up to the

month of visit.

5. Untied Funds:

a. During the year 2010-11, district had allotted untied funds to the tune of Rs. 21,50,000

for 214 Sub Centres and out of that funds Rs. 21,20,000 was utilised for strengthing of

sub centre services.

b. During the year 2010-11 district had allotted untied funds to the tune of Rs. 13,00,000

for 3 CHCs, @ Rs. 50,000 for 5 PHCs and @ Rs. 25,000 for 36 Addl. PHCs. It was

observed that the maximum fund were utilised on the development activities such as

repairing of vehicle, electricity, repairing of window glass, purchasing of chair, bench,

invertors and battery etc.

c. In the year 2011-12 untied fund was not received from State headquarter till the

month of visit by the team.

6. Janani Suraksha Yojana (JSY):

a. During the year 2010-11, district had spent to the tune of Rs. 3,41,64,000 out of

allotted funds of Rs. 3,67,66,880. Similarly, an amount of Rs. 27,40,950 was utilised

against the available amount of Rs. 67,02,880 during current year.

b. As per details received as many as 18946 beneficiaries in the year 2010-11 and 1585

beneficiaries of current year were paid incentive under the scheme.

c. 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 PHC B. PHC

589

Maudaha Sumerpur Muskara

1 Total fund available 73,03,880 69,33,050 47,17,750

2 Total expenditure

under JSY

70,27,300 67,01,900 44,86,450

3 Total balance amount 2,76,580 2,31,150 1,31,300

For the year 2011-12 ( in RS)

1 Total fund available 12,76,580 12,31,150 3,31,300

2 Total expenditure

under JSY

58,500 5,76,550 3,08,850

3 Total balance amount 6,96,580 6,54,600 22,450

d. During visit to the centres, it was observed that all the registers relating to JSY were

maintained properly with relevant details at PHC/ CHC level and also checked by

concerned MOs regularly. Cheques to the beneficiaries are provided by the

concerned CHC/ PHC directly within a week from date of delivery. Team found that

most of the delivered mothers are discharged from the institution within 20 to 24 hours

after delivery.

e. 53 JSY beneficiaries were contacted in the area of the visited centres in the district.

All the beneficiaries stated that they had received cash incentives and services in

time.

7. 24x7 delivery care services:

a. 8 institutions were identified to provide 24x7 delivery care services in the district.

b. As reported, total 18946 deliveries were conducted in the year 2010-11 by 8

institutions (PHC/ FRU) in the district. Facilities for caring mothers and new born

babies were not adequate in all the visited institutions under the scheme.

8. Physical infrastructure (HSC/PHC/CHC)

(i) CHC/ PHCs:

a. During visit to the CHC Maudaha, team found that the CHC was functioning in Govt.

building but their maintenance was not up to the mark.

b. Blood Storage unit and Incinerator were not available in CHC Maudaha.

c. Visited PHCs at B. Sumerpur and Muskara were functioning in Govt. buildings but

their maintenance was not up to the mark.

590

d. AYUSH Medical Officer was posted in the visited PHCs, but Unani/ Ayurvedic and

Homeopathic medicines under this segment were lacking there. 24x7 services are

available in the PHCs.

(ii) Health Sub Centres:

a. All visited Sub centres i.e., centre at Makaraw, Maudaha (Dehat), Lalpur, Chandra

Purawa, Niwada and Chili were functioning in Govt. buildings.

b. It was observed that no delivery was being conducted in the visited Sub centre at

Maudaha (Dehat).

c. RDT kit, Nischay Pregnancy Test Kits, DDKs, Oxytocin tablets, Ampicillin capsules

and Gentamycine injection were not available in the visited Sub centres.

d. Co-trimoxazole and Metronidazole tablets were not available at Sub centres Makaraw

and Lalpur.

e. Thermometer, Gloves, ORS packets, Examination table, Steam Sterilizer, BP

apparatus, Metronidazole and Paracetamol tablets were not available at Sub centre

Maudaha Dehat.

f. ORS packets, EC Pills, Vitamin- A, Chlorin solution and Sanitary Napkins at Sub

centre Makaraw, Chloroquine and Paracetamol tablets at Sub centre Lalpur, Ambu

bag/suction at Sub centre Chandra Purawa, Steam Sterilizer, CuT insertion kit, ORS

packets, Chloroquine and Co-trimoxazole tablets at Sub centre Niwada, ORS packets

and Kerosene oil at Sub centre Chili 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 (33%) mothers were not aware about danger sign of ARI, 7 (13%) use of ORS and

100% replied that their babies were not weighed at the time of birth. 2 (4%) mothers

did not receive three Post Natal checkups.

c. It was also observed that 13 (24%) mothers were not aware of contraceptive methods

and 9 (17%) regarding side effects of contraceptive use.

(ii) Services of PHC-

30 Persons who were generally utilising the services at visited PHC/CHCs were

interviewed and it was found that most of them were satisfied with the services

provided by the Medical officers and others staff of PHCs/CHC.

10. IT Infrastructure and Mother & Child Tracking System:

591

a. Team found that computers were available at district level and at Block level (one in

each Block) though internet connectivity was not available in any visited CHC/ PHC.

b. MCH Tracking formats were available in each Sub centres.

c. Health functionaries were sensitized in MCH formats at PHC/ CHC level. They are

capturing data in the formats and making data entry at PHC/ CHC level through cyber

cafe.

11. Registers, records and reports maintained at the visited centres:

a. Service registers for IUD, Oral Pills and Nirodh cases were not being maintained at

any of the PHC/CHC head quarter. Performance reported under CuT at CHC

Maudaha, PHCs at B.Sumerpur and Muskara could not be verified due to want of

consolidated registers.

b. Eligible Couple register which is one of the most important records for FW services

had not been maintained in the Sub centres at Makaraw and Niwada.

c. Family Planning services, Monthly Reporting format and Cash book for untied fund

were not maintained at all the visited centres.

d. Stock registers for FW items was not maintained in the visited sub centres at

Makaraw, Maudaha (Dehat), Lalpur, Chandra Purawa and Chili.

e. JSY beneficiary card, ANC and Immunization cards were not found to be maintained

at sub centres Lalpur and Chili.

5. District: Meerut

Major observations of Regional Evaluation Team, Lucknow about the Evaluation

work in Meerut and Mathura district of Uttar Pradesh in July, 2011

I. Details of the visited Institutions:

District

visited

PHCs/CHCs visited SCs visited

Meerut CHC: Sardhana

PHCs: Kharakauda and

Hastinapur

Kusawali, Salva, Bijauli,

Pipli Khera, Makhan

Nagar, Ganeshpur and

More Khurd

592

II. Major observations

1. Health Human Resources:

a. 63 posts of ANM (out of 377 sanctioned), 119 posts of MPW (M) (out of 142

sanctioned), 4 posts of LHV/HS (F) (out of 86 sanctioned), 30 posts of Health

Supervisor (M) (out of 89 sanctioned), 5 posts of Staff Nurse/GNM (out of 43

sanctioned) and 7 posts of Lab Technician (out of 24 sanctioned) were lying vacant in

the district. Position of Medical Officer and Specialist was not readily available in the

district office.

b. In the visited CHC, Sardhana, 4 of the 29 sanctioned posts of ANM, all 10 sanctioned

posts of MPW (M), 2 of the 7 sanctioned posts of Health Supervisor (M), 3 of the 8

sanctioned posts of Medical officer and 1 of the 6 sanctioned posts of specialist were

lying vacant.

c. In PHC, Hastinapur, 8 of the 25 sanctioned posts of ANM, all 14 sanctioned posts of

MPW (M), 1 of the 5 sanctioned posts of LHV, 5 of the 8 sanctioned posts of Health

Supervisor (M) and 5 of the 12 sanctioned posts of Medical officer were lying unfilled.

4 of the 23 sanctioned posts of ANM, 11 of the 12 sanctioned posts of MPW (M) and 2

of the 8 sanctioned posts of Health Supervisor (M) were lying vacant in PHC

Kharkhoda.

2. Functioning of Rogi Kalyan Samiti (RKS):

a. It was reported that Rogi Kalyan Samiti (RKS) was registered in each Block level

PHC/CHC and also in the District (Male & Female) Hospitals. Meeting of executive

body was conducted every month during the year 2010-11.

b. Funds including Untied Fund and 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 observed that meeting of advisory body of RKS was not being conducted in the

visited centres.

3. Functioning of ASHA Scheme:

a. As reported, 1375 ASHAs were in position out of 1431 selected in the district during

2010-11. 1110 ASHAs were reported to have been trained but are working without

drug kits in the district.

593

b. In the visited Sub Centres at Kusawali, Salva, Bijauli, Pipli Khera, Makhan Nagar,

Ganeshpur and More Khurd, required number of ASHAs were working in the field and

they were observed to be trained up to 4th module.

c. 20 ASHAs were interviewed in the area of 7 HSCs visited. All were trained and

receiving an annual average performance based remuneration of about Rs. 3500-

4500. ASHA is a member of VHSC.

4. Functioning of Village Health & Sanitation Committee (VHSCs):

a. It was reported that 460 VHSCs have been formed and funds were being operated by

opening joint bank accounts in the name of concerned ANM and Gram Panchayat

Pradhan. In the year 2010-11 funds @ Rs. 10,000 were provided to the VHSCs for

each revenue village for undertaking sanitation work in the villages.

b. The total budget for the VHSCs in the district was allotted to the tune of Rs. 67,40,000

for 674 revenue villages through CHCs/ PHCs and out of that Rs. 59,95,000 spent by

the VHSCs during 2010-11.

c. It was observed that, entire amount of Rs. 67,40,000 provided by the district was not

released by CHCs/ PHCs to the VHSC for the revenue villages during 2010-11 due to

non-opening of joint accounts by some of the VHSCs and about Rs. 1,80,000 were

kept in the account of different CHCs/PHCs. The team reported that in PHC

Hastinapur account opened only for 18 VHSCs out of 23 VHSCs. Similarly, in PHC

Kharkhonda the fund received for 34 VHSCs but accounts are operated only in 29

VHSCs.

d. During visit to the centres, it was observed that the funds are being utilized, but no

details of expenditure were available at district office and also visited SCs/PHCs/CHC.

Meetings of the VHSCs were not being conducted regularly in the visited Sub

Centres.

5. Untied Funds:

a. Untied Fund @ Rs. 10,000 to each Sub centre, @ Rs. 50,000 to each CHC/PHC and

Rs. 25,000 to Addl. PHC is provided through block level CHCs and PHCs in every

year in the district. No untied fund was released to the institutions during the year

2011-12. Details of the fund provision and expenditure incurred in the district for the

year 2010-11 are reported as under:

Sr.No Particulars of

Untied Fund

In the year 2010-11 ( in

Rs)

For Sub

centres

For CHCs/PHCs

594

1 Fund allotted 31,90,000 13,75,000

2 Total Expenditure 29,74,906 13,27,477

3 Total Balance 2,15,094 47,523

b. It was also observed that CHCs and PHCs provided Untied Funds to the Sub centres

where bank accounts are opened. In CHC Sardhana, 26 SCs opened accounts out of

28, in PHC Hastinapur, 18 SCs opened accounts out of 23 and in PHC Kharkhoda, 17

SCs opened accounts out of 22. The amount received from district office meant for

the SCs with no bank account has kept in the respective CHC/ PHC account.

c. Team visited 7 Sub centres and found that ANMs are not updated their Cashbook/

Passbook of untied fund. Out of 7 Sub centres, 5 Sub centres utilised funds for

purchasing BP apparatus digital, Hubcutter, Weighing scale, ANM bag lock etc. In

Sub Centre Piplikhera funds were not utilised due to non cooperation of village

Pradhan and in Sub Centre Makhanpur record was not made available to the team.

d. At the CHC/ PHC level, Untied Fund utilized as per norms in contingency and

development work like buying of stationary and banner of Sub centre, Weighing

Machine, Examination table, BP apparatus, Hubcutter lock, Invertor with battery,

repairing of ILR X-ray film, printing of Immunisation card, OPD and Indoor slip etc.

after getting approval from RKS.

e. Statement of expenditure regarding untied fund at Sub centres was not maintained at

CHCs/PHCs or at Sub centres.

6. Janani Suraksha Yojana (JSY):

a. During the year 2010-11, district had spent funds to the tune of Rs. 3,13,65,250 out of

allotted funds of Rs. 3,37,98,000. Similarly, an amount of Rs. 53,55,000 was utilised

against the available amount of Rs. 1,14,07,750 during current year up to June, 2011.

b. As per details received as many as 18141 JSY beneficiaries in the year 2010-11 and

3311 JSY beneficiaries in current year up to June, 2011 have been paid with cash

incentive under the scheme.

c. The budget provision and expenditure at the visited PHC/CHC as reported is given

below:

Sr.

No.

Particulars For the year 2010-11 ( in RS)

CHC

Sardhana

PHC

Hastinapur

PHC Kharkhoda

595

1 Total fund available 46,66,700 15,89,850 13,88,400

2 Total expenditure

under JSY

45,76,450 13,92,200 13,93,100

3 Total balance amount 90,250 1,97,650 (-) 4,700

For the year 2011-12 ( in RS)

1 Total fund available 10,90,250 1,97,650 2,95,300

2 Total expenditure

under JSY

8,61,800 2,20,500 2,75,300

3 Total balance amount 2,28,450 (-) 22,850 20,000

d. 47 JSY beneficiaries were contacted in the area of visited Centres in the district. All

the beneficiaries stated that they had received incentives through cheque from the

concerned CHCs/ PHCs within a week from the date of delivery. JSY registers found

maintained but was not being checked by the concerned Medical Officer regularly.

7. 24x7 delivery care services:

a. 13 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. 1154 deliveries in CHC Sardhana, 130 in PHC Hastinapur and

215 deliveries in PHC Kharkhoda 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. CHC Sardhana was functioning in Govt. building. New building was under

construction.

b. Seting up of Blood Storage unit was under process in the CHC. Jeep, Injections

Quinine and Arteether were not available in CHC Sardhana.

c. Visited PHCs at Hastinapur and Kharkhoda were functioning in Govt. buildings. Both

the PHCs were having required equipments and other supplies.

d. AYUSH Pharmacist and relating medicines were not available in the visited PHCs.

(ii) Health Sub Centres:

a. Visited Sub centres at Kusawali, Salva, Bijauli, Pipli Khera, Makhan Nagar,

Ganeshpur and More Khurd were functioning in Govt. buildings. At Sub Centres

Kusawali, Salva, Bijauli and Makhan Nagar, ANMs were not staying at their Sub

Centre head quarters.

596

b. It was observed that labour room was available but no delivery was being conducted

in the visited Sub Centres except at Sub Centre Makhan Nagar.

c. Nischay Pregnancy Test Kit, RDT Kit, Heamoglobinometer, Sanitary Napkins,

Oxytocin Tablets, Ampicillin Capsules and Gentamycine Injection were not available

in the visited Sub Centres.

d. Ambu bag/suction and Steam sterilizer were not available at Sub centres Bijauli, Pipli

Khera and Makhan Nagar.

e. ORS packets, DDKs and EC Pills were not available at Sub Centres Kusawali, Salva

and Pipli Khera.

f. Delivery Kit, Bleaching Powder, Cloroquine and Metronidazole tablets at Sub Centre;

Kusawali, Ambu bag/suction and Disposable syringes at Sub Centre Salva;

Examination table, DDKs, Nirodh, Co-trimoxazole and Cloroquine tablets at Sub

Centre Bijauli; Foot stool, Delivery table, Delivery kit, Gloves, ORS packets, Vitamin-

A and Co-trimoxazole tablets at Sub Centre Pipli Khera; EC Pills, Cloroquine and

Metronidazole tablets at Sub Centre Ganeshpur and DD kits at Sub Centre More

Khurd were not available.

9. Assessment and opinion of the Community on Health Services:

(i) Services of ANM-

a. 63 mothers having child up to one year of age from the area of 7 visited sub centres

were interviewed by the team to assess their opinion about the services rendered by

the ANMs.

b. 37 (59%) Mothers were not aware about danger sign of ARI, 12 (19%) were not aware

about use of ORS and 4 (6%) replied that their babies were not weighed at the time of

birth. 13 (21%) mothers did not receive three Post Natal checkups.

c. It was also observed that 28 (44%) mothers were not sufficiently aware of

contraceptive methods.

(ii) Services of PHC-

a. 35 Persons who were generally utilising the services at visited PHCs/CHC 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 in the PHCs/

CHC areas. Mostly people were satisfied with the services provided at PHCs and

CHC.

597

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 the visited CHC/ PHCs.

b. MCH Tracking formats were available in each Sub centre.

c. Health functionaries were sensitized in MCH formats at PHC/ CHC level. They are

capturing data in the formats and making data entry at PHC/ CHC level through cyber

cafe.

11. Registers, records and reports maintained at the visited centres:

a. Performance reported under CuT at CHC Sardhana and PHCs at Hastinapur and

Kharkhoda could not be verified due to want of service registers. Oral Pills and Nirodh

distribution registers were also not maintained properly in the centres visited.

b. Eligible Couple register, Cash book for untied fund and VHSC proceeding registers

were not being maintained at any of the visited centres.

c. Registers for Family Planning services, Stock book, Monthly Reporting format and

Cash book for untied fund were not supplied in printed forms to Sub Centres by higher

authority.

6. District: Mathura

Major observations of Regional Evaluation Team, Lucknow about the Evaluation

work in Mathura district of Uttar Pradesh in July, 2011

II. Details of the visited Institutions:

District

visited

PHCs/CHCs visited SCs visited

Mathura CHCs: Gobardhan and Farah

Adig, Radha Khurd and

Oal

II. Major observations

1. Health Human Resources:

a. 15 posts of MO out of 108 sanctioned and 6 posts of specialists out of 14 sanctioned

were lying vacant in the district.

b. Similarly, skilled personnel under Para Medical category like 56 ANMs (out of 256

sanctioned), 100 MPWs (M) (out of 107 sanctioned), 16 Staff Nurse/ GNM (out of 24

598

sanctioned) and 4 Lab Technician (out of 14 sanctioned) posts were also lying vacant

in the district.

c. In the visited CHC, Gobardhan, 5 of the 26 sanctioned posts of ANM, 6 of the 7

sanctioned posts of MPW (M), 3 of the 7 sanctioned posts of Health Supervisors (M)

and 2 of the 6 sanctioned posts of Staff Nurse were vacant. Similarly, 1 of the 20

sanctioned posts of ANM, 6 of the 7 sanctioned posts of MPW (M) and 1 of the 3

sanctioned posts of LHVs/Health Supervisor (F), 3 of the 10 sanctioned posts of

Health Supervisor (M) and 2 of the 6 sanctioned posts of Staff Nurse were lying

vacant in CHC Farah.

2. Functioning of Rogi Kalyan Samiti (RKS):

Rogi Kalyan Samiti (RKS) was registered in 11 Block level PHC/CHC and 2 District

level hospitals in the district. Registers and records which are required for assessing

the functioning of RKSs were not made available to the team in the visited CHCs.

3. Functioning of ASHA Scheme:

a. As reported, 1341 ASHAs were in position out of 1544 selected in the district during

2010-11. 1110 ASHAs were reported to have been trained but were working without

drug kits. 81 new ASHAs were proposed to be inducted during 2011-12 in the district.

b. During visit to the Sub Centres areas, 7 ASHAs were interviewed, and they were

trained and receiving performance based remuneration on an average Rs. 3,000-

4,000 yearly. ASHA was not a member in any VHSC in the district.

4. Functioning of Village Health & Sanitation Committee (VHSCs):

a. It was observed that 479 VHSCs were formed but joint bank account in the name of

concerned ANM and Gram Panchayat Pradhan has been opened in 476 VHSCs to

handle the funds.

b. It was reported that every revenue village is provided funds @ Rs. 10,000 under the

scheme in the district. The total budget to the tune of Rs. 87,50,000 for 875 revenue

villages in the district was allotted during 2010-11. Though, the funds were reported to

be utilized fully, but no details of expenditure were available at district office and also

in the visited SCs/PHC/CHCs.

c. Meetings of the VHSCs were not being conducted regularly in the visited Sub

Centres.

d. VHSCs fund was not released to the district during current year 2011-12 up to the

month of visit.

5. Untied Funds:

599

a. During the year 2010-11 district had allotted untied funds to the tune of Rs. 21,50,000

for 215 Sub Centres and the amount was utilised fully for strengthing the services of

the Sub Centre. But it was observed that expenditure incurred on untied fund at the

Sub Centres are not maintained at district level and also at the Sub Centre level. Also,

no alloted fund was utilised in the visited Sub centres at Adig and Radhakund.

b. Apart from the above, district had allotted untied funds to the tune of Rs. 12,00,000 for

CHCs/PHCs during the year 2010-11 and Rs. 1,07,207 utilised on the development

activities i.e. Street light with fitting and sodium light, glass window, purchasing of

Chair and Notice Board etc.

c. In the year 2011-12 untied fund was not received in the district from State headquarter

till the month of visit by the team.

6. Janani Suraksha Yojana (JSY):

a. 21236 JSY mothers in the year 2010-11 and 4759 mothers in current the year up to

June, 2011 benefited with cash incentive under the scheme in the district. The district

had spent Rs. 3,99,50,950 out of allotted funds of Rs. 4,58,00,000 in the year 2010-

11. There was an expenditure of Rs. 85,95,250 against the available fund of Rs.

84,49,050 during current year up to June 2011 in the district.

b. During visit to the centres, it was observed that all the registers relating to JSY were

maintained properly with relevant details except date of relieving from institution at

PHC/ CHC level. Register was not checked by concerned MOs regularly.

c. 17 JSY beneficiaries were contacted in the area of the visited centres in the district.

All the beneficiaries stated that they had received cash incentives and services in

time. Cheques to the beneficiaries are provided by the concerned CHC/ PHC directly

within a week from date of delivery. Team found that most of the delivered mothers

are relieved from the institution within 10 to 20 hours after delivery.

7. 24x7 Delivery Care Services:

a. 11 institutions were providing 24x7 delivery care services in the district. No additional

budget was released to these Centres.

b. As reported, total 21236 deliveries were conducted in the year 2010-11 by 11

institutions (PHC/ FRU) in the district. It was reported that facilities for caring mothers

and new born babies were adequate in all the visited institutions under the scheme.

8. Physical infrastructure (HSC/PHC/CHC)

(i) CHC/ PHCs:

a. CHCs Gobardhan and Farah were functioning in Govt. buildings. CHC Gobardhan is

situated out of locality and maintenance of the hospital was not up to the mark.

600

b. Facility for Ambulance/ Jeep, Blood Storage unit and bio-medical waste disposal etc.

were not available in the visited CHCs.

c. Short supply of Injections Quinine and Artether was observed in the CHCs.

(ii) Health Sub Centres:

a. Sub centres visited at Adig, Radha Kund and Oal were functioning in Govt. buildings.

At Sub Centres Adig and Radha Kund, ANMs were not staying at their sub centre

head quarters.

b. It was observed that no delivery was being conducted in all the visited Sub Centres.

c. Ambu bag/suction, Steam Sterilizer, BP apparatus, Heamoglobinometer, RDT kit,

Nischay Pregnancy Test Kits, Sanitary Napkins, EC Pills, Thermometer, DDKs,

Bleaching powder, Cloroquine, Oxytocin tablets, Ampicillin capsules and Gentamycine

injection were not available in the visited Sub Centres.

d. Delivery kit, Weighing machine (Adult & Infant), Gloves, Stove, Kerosene oil and CuT

were not available at Sub Centres Adig and Radha Kund.

e. Oral Pills and Metronidazole tablets at Sub Centre Adig, Electricity, Toilet,

Examination table, Delivery table, Disposable syringes and CuT insertion kit at Sub

centre Radha Kund and Torch, Stove, AD and Disposable syringes at Sub Centre Oal

were not available.

9. Assessment and opinion of the Community on Health Services:

(i) Services of ANM-

a. 27 mothers having child up to one year of age from the area of 3 visited Sub Centres

were interviewed by the team to assess their opinion about the services rendered by

the ANMs.

b. 16 (59%) mothers were not aware about danger sign of ARI, 10 (37%) did not know

about the use of ORS and 6 (22%) mothers did not receive three Post Natal

checkups.

c. It was also observed that 19 (70%) mothers were not sufficiently aware of

contraceptive methods.

(ii) Services of PHC-

35 Persons who were generally utilising the services at visited CHCs were interviewed

and it was found that most of them were satisfied with the services provided by the

Medical Officers and others staff of the CHCs. In the visiting area, proper attention to

register the AN mothers within 16 weeks of pregnancy and improve the awareness

about danger sign of sick new born need to be increased.

10. IT Infrastructure and Mother & Child Tracking System:

601

a. Team found that computers were available at district level and at Block level (one in

each Block) though internet connectivity was not available in any visited CHC/ PHC.

b. MCH Tracking formats were available in each Sub centres.

c. Health functionaries were sensitized in MCH formats at PHC/ CHC level. They are

capturing data in the formats and making data entry at PHC/ CHC level through cyber

cafe.

11. Registers, records and reports maintained at the visited centres:

a. Service registers for IUD, Oral Pills and Nirodh cases were not being maintained at

any of the PHC/CHC head quarter. Performance reported under CuT at CHCs

Gobardhan and Farah could not be verified due to want of service registers.

b. Eligible Couple register which is one of the most important records for FW services

had not been maintained in any of the visited Sub centres.

c. Cash book for untied fund and VHSC proceeding registers were not being maintained

at any of the visited centres.

d. Registers for Family Planning services, Stock book, Monthly Reporting format and

Cash book for untied fund were not supplied in printed forms to Sub Centres by higher

authority.

7.District: Farrukhabad

Major observations of Regional Evaluation Team, Lucknow about the Evaluation

work carried out in Farrukhabad district of Uttar Pradesh in August, 2011

III. Details of the visited Institutions:

District

visited

PHCs/CHCs visited SCs visited

Farrukhabad CHCs: Kayamganj and

Nawabganj

PHC: Faijbag

Raipur, Kampil, Pahadpur,

Bhatasa, Kainmini,

Rajendra Nagar and Mohd.

Pur Dhani

II. Major observations

1. Health Human Resources:

602

a. 34 posts of Specialist (out of 36 sanctioned), 17 posts of ANM (out of 229 sanctioned),

74 posts of MPW (M) (out of 77 sanctioned), 5 posts of LHV/HS (F) (out of 38

sanctioned), 34 posts of Health Supervisor (M) (out of 46 sanctioned), 8 posts of Staff

Nurse/GNM (out of 24 sanctioned) and 9 posts of Lab Technician (out of 24

sanctioned) were lying vacant in the district.

b. In CHC, Kayamganj, 7 of the 33 sanctioned posts of ANM, 8 of the 9 sanctioned posts

of MPW (M), all 4 sanctioned posts of Health Supervisor (M), 3 of the 4 sanctioned

posts of Medical officer, 5 of the 7 sanctioned posts of specialist and 1 of the 2

sanctioned posts of Lab Technician were lying vacant. Similarly, 4 of the 26

sanctioned posts of ANM, all 5 sanctioned posts of MPW (M), 2 of the 5 sanctioned

posts of LHV, all 5 sanctioned posts of Health Supervisor (M), 2 of the 4 sanctioned

posts of Medical officer, all 6 sanctioned posts of specialist and 1 of the 3 sanctioned

posts of Staff Nurse in CHC Nawabganj were lying vacant.

c. In PHC, Faizbag, 3 of the 29 sanctioned posts of ANM, 5 of the 6 sanctioned posts of

MPW (M), 4 of the 6 sanctioned posts of LHV, all 6 sanctioned posts of Health

Supervisor (M), 1 of the 6 sanctioned posts of Medical officer, 2 sanctioned posts

each of Staff Nurse and Lab Technician were lying unfilled.

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 (Male & Female) Hospital. Meeting of

executive body was conducted every month during the year 2010-11.

b. Funds including Untied Fund and 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, 1449 ASHAs were in position out of 1497 selected in the district during

2010-11. 1147 ASHAs were reported to have been trained but are working without

drug kits in the district.

b. In the visited Sub Centres at Raipur, Pahadpur, Bhatasa, Kainmini, Rajendra Nagar

and Mohd. Pur Dhani, required numbers of ASHAs were working in the field and

trained up to 4th module. No ASHA is posted in Sub Centre at Kampil.

603

c. 7 ASHAs were interviewed in the area of 7 HSCs visited. All were trained and

receiving an annual average performance based remuneration of about Rs. 3500-

4500. ASHA is involved in each VHSNC as a member.

4. Functioning of Village Health Sanitation & Nutrition Committee (VHSNCs):

a. It was reported that 917 VHSNCs have been formed covering 1008 villages and funds

were being operated by opening joint bank accounts in the name of concerned ANM

and Gram Panchayat Pradhan. In the year 2010-11, funds @ Rs. 10,000 were

provided to each revenue village for undertaking sanitation work in the villages.

b. The total budget for the VHSNCs in the district was allotted to the tune of Rs.

1,00,80,000 for 1008 revenue villages through CHCs / PHCs and out of that Rs.

91,70,000 spent by the VHSNCs during 2010-11.

c. During visit to the centres, the funds reported to be utilized, but no details of

expenditure were available at visited SCs. Meetings of the VHSNCs were not being

conducted regularly in the visited Sub Centres.

5. Untied Funds:

a. Untied Fund @ Rs. 10,000 to each Sub centre, @ Rs. 50,000 to each CHC/PHC and

@ Rs. 25,000 to Addl. PHC are provided through block level CHCs and PHCs in

every year in the district. No untied fund was released to the institutions during the

year 2011-12. Details of the fund provision and expenditure incurred in the district for

the year 2010-11 are reported as under:

Sr.

No

Particulars of

Untied Fund

In the year 2010-11 ( in

Rs)

For Sub centres For CHCs/PHCs

1 Fund allotted 18,50,000 9,00,000

2 Total Expenditure 18,50,000 6,06,201

3 Total Balance Nil 2,93,799

b. Team visited 7 Sub centres and found that ANMs had not updated their Cashbook/

Passbook of untied funds. Out of 7 Sub centres, 3 Sub centres utilised the fund for

purchasing chair, gas cylinder, bed sheet, table cloth, bucket, jug and stationary etc.

Funds were not provided to the Sub centre Khinmini.

c. At the CHC/ PHC level, Untied Funds were utilized as per norms in contingency and

development work like buying of Inverter with battery, stationary, construction of

Generator-set shadow and white wash in CHC Kayamganj, white wash in CHC

Nawabganj and printing of OPD and Indoor slip, purchasing of stationary, LCD &

604

DVD, Inverter with battery, gen set & cold chain equipment and electricity fitting in

PHC Faizbag etc. after getting approval of RKS.

d. Statement of expenditure regarding untied funds was not updated/ maintained in the

visited Sub centres.

6. Janani Suraksha Yojana (JSY):

a. During the year 2010-11, district had spent funds to the tune of Rs. 2,96,92,700 out of

allotted budget of Rs. 3,42,37,450. Similarly, an amount of Rs. 87,00,700 was utilised

against the available amount of Rs. 2,43,96,750 during current year up to July, 2011.

b. As per details received, as many as 16,446 JSY beneficiaries in the year 2010-11 and

4,864 JSY beneficiaries in current year up to July, 2011 have been paid with cash

incentive under the scheme.

c. The budget provision and expenditure at the visited PHC/CHCs is as reported given

below:

Sr.

No.

Particulars For the year 2010-11 ( in Rs)

CHC

Kayamganj

CHC

Nawabganj

PHC

Faizbag

1 Total fund available 59,00,500 35,94,580 29,35,427

2 Total expenditure

under JSY

55,88,100 37,33,950 27,51,450

3 Total balance

amount

3,12,400 8,64,630 1,83,977

For the year 2011-12 up to July, 2011 ( in

Rs)

1 Total fund available 23,24,800 8,64,630 8,65,100

2 Total expenditure

under JSY

19,53,750 6,51,150 7,12,500

3 Total balance

amount

3,71,050 2,13,480 1,52,600

d. 29 JSY beneficiaries were contacted in the area of visited Centres in the district. All

the beneficiaries stated that they had received incentives through cheque from the

concerned CHCs and PHCs within a week of the date of delivery. Most of the mothers

informed that they were discharge within 10 to 15 hours from the hospital after

605

delivery. JSY registers were found maintained properly except date of relieving from

the hospital.

7. 24x7 delivery Care Services:

a. 7 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. 806 out of total 1407 deliveries in CHC Nawabganj and 452 out

of total 1035 deliveries in PHC Faizbag were reported to have been conducted in

night hours during 2010-11.

c. Facilities for caring mother and new born baby were adequate in all the visited

institutions under the scheme.

8. Physical infrastructure (HSC/PHC/CHC)

(i) CHC/ PHCs:

a. Visited CHCs at Kayamganj and Nawabganj were functioning in Govt. building but the

maintenance of the hospitals was not up to the mark.

b. Blood Storage unit was not set up in both the visited CHCs. Incinerator was not

available there but bio-medical waste is handed over to the agency outsourced and

listed by the district office but that service is not provided since last 6 months.

Injections Quinine and Arteether were not available in the visited CHCs.

c. Visited PHC at Faizbag was functioning in Govt. building. Except Jeep most of the

required equipments and other supplies were found available in the PHC.

d. AYUSH Medical Officer was not posted in this PHC.

(ii) Health Sub Centres:

a. Out of 7 visited Sub centres, 6 Sub centres i.e. Raipur, Kampil, Bhatasa, Kainmini,

Rajendra Nagar and Mohd. Pur Dhani were functioning in Govt. buildings and Sub

Centre Pahadpur was functioning in a rented accommodation. At Sub Centres

Kinmini, Rajendra Nagar and Mohd. Pur Dhani, ANMs were not staying at their Sub

Centre head quarters.

b. It was observed that labour room was available in 6 Sub Centres but delivery was not

being conducted in the visited Sub centres.

c. Ambu bag/suction, Nischay pregnancy test kit, RDT kit, Heamoglobinometer, Sanitary

Napkins, DDKs, Oxytocin tablets, Ampicillin capsules and Gentamycine injection were

not available in the visited Sub centres.

d. Co-trimoxazole, Cloroquine tablets and Bleaching powder were not available at Sub

centres Pahadpur, Bhatasa and Khainmini.

606

e. Co-trimoxazole, Cloroquine, IFA tablets and EC Pills at Sub Centre Raipur, Antiseptic

solution, Bleaching powder, Disposable syringes, EC Pills and Nirodh at Sub Centre

Kampil, Examination table, Foot stool, Weighing machine (Infant), Metronidazole

tablets and Nirodh at Sub Centre Pahadpur, Foot stool, Gloves, ORS packets,

Vitamin- A, EC Pills and Nirodh at Sub Centre Bhatasa, Weighing machine (Infant),

Antiseptic solution and Metronidazole tablets at Sub Centre Khinmini, Weighing

machine (Infant), Steam sterilizer, ORS packets, Cloroquine, Metronidazole tablets,

EC Pills and Nirodh at Sub Centre Rajendra Nagar, Delivery kit, Gloves, ORS

packets, Co-trimoxazole tablets and Bleaching powder at Sub Centre Mohd. Pur

Dhani were not available.

9. Assessment and opinion of the Community on Health Services:

(i) Services of ANM-

a. 63 mothers having child up to one year of age from the area of 7 visited sub centres

were interviewed by the team to assess their opinion about the services rendered by

the ANMs.

b. 21 (33%) Mothers were not aware about danger sign of ARI, 16 (25%) were not aware

about use of ORS and 20 (32%) replied that their babies were not weighed at the time

of birth. 14 (22%) mothers did not receive three Post Natal checkups.

c. It was also observed that 24 (38%) mothers were not sufficiently aware of

contraceptive methods.

(ii) Services of PHC-

a. 35 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 PHC/CHCs.

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 in the PHC/

CHC areas. Mostly people were satisfied with the services provided at PHC and

CHCs. In the visiting area, proper attention to register the AN mothers within the 16

weeks of pregnancy and improve the awareness about danger sign of sick new born

need to be increased.

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). Internet connectivity was available at district and CHC level only.

b. MCH Tracking formats were available in each Sub centres.

607

c. Health functionaries were sensitized in MCH formats at PHC/ CHC level. They are

capturing data in the formats and making data entry at PHC/ CHC level through cyber

cafe.

11. Registers, records and reports maintained at the visited centres:

a. Performance reported under CuT at CHCs Kayamganj, Nababganj and PHC at

Faijbag could not be verified due to want of service registers. Oral Pills and Nirodh

distribution registers were also not maintained properly in the centres visited.

b. Eligible Couple register, Cash book for untied fund and VHSC proceeding registers

were not being maintained at any of the visited centres.

c. Printed registers for Family Planning services, Stock book, Monthly Reporting format

and Cash book for untied fund were not supplied to Sub Centres.

8.District: Hardoi

Major observations of Regional Evaluation Team, Lucknow about the Evaluation

work carried out in Hardoi district of Uttar Pradesh in August, 2011

IV. Details of the visited Institutions:

District

visited

PHCs/CHCs visited SCs visited

Hardoi District Women Hospital Hardoi

PHCs: Kothawa and Bhawan

Jaraua, Harriya and Gokul

Behata

II. Major observations

1. Health Human Resources:

a. Though the staff position for the posts of MO, specialist, Staff Nurse/ GNM and Lab

Technician was not made available to the team, Some of skilled personnel under Para

Medical category like 30 ANMs (out of 488 sanctioned), 23 MPWs (M) (out of 76

sanctioned), 26 LHVs/Health Supervisor (F) (out of 81 sanctioned) and 71 posts of

Health Supervisors (M) (out of 128 sanctioned) were reported to be lying vacant in the

district.

b. Under district Programme Management Unit of NRHM, posts of the District

Programme Manager and the District Account Manager were lying vacant in the

district.

608

c. In the visited PHC, Kothawan, 5 of the 23 sanctioned posts of ANM, 7 of the 8

sanctioned posts of MPW (M), 1 each of the 4 each sanctioned posts of LHV and

Health Supervisor (M), both sanctioned posts of Staff Nurse and 2 of the 9 sanctioned

posts of Medical Officer were vacant. Similarly, 4 of the 30 sanctioned posts of ANM,

all 10 sanctioned posts of MPW (M), 2 of the 4 sanctioned posts of LHVs/Health

Supervisor (F) and all 7 sanctioned posts of Health Supervisor (M) in PHC Bawan

were lying unfilled.

2. Functioning of Rogi Kalyan Samiti (RKS):

a. Rogi Kalyan Samiti (RKS) was registered in 11 Block level PHC/CHC and 2 District

level hospitals in the district.

b. Registers and records which required for assessing the functioning of RKS were not

made available to the team in the visited PHCs.

3. Functioning of ASHA Scheme:

c. As reported, 2747 ASHAs were in position out of 2865 selected in the district during

2010-11. 2608 ASHAs trained up to 5th module but were working without drug kits in

the district.

b. During visit to the Sub centres at Jaraua, Harriya and Gokul Behata, it was observed

that ASHAs were trained up to 4th module and drug kits were given in two places. 4

ASHAs were interviewed, all were receiving performance based remuneration on an

average Rs. 3,000- 4,000 yearly. ASHA is involved in each VHSNC as a member.

4. Functioning of Village Health Sanitation & Nutrition Committee (VHSNCs):

a. As reported, 1101 VHSNCs were functioning in 1901 revenue villages in the district

and joint bank account in the name of concerned ANM and Gram Panchayat Pradhan

has been opened in the all 1101 VHSNCs to handle the funds.

b. As reported, every revenue village is given Rs. 10,000 every year as VHSNC fund

under the scheme in the district. Though there was unspent amount of Rs. 10,56,000,

the district had provided Rs. 1,81,24,000 for the year 2010-11. No details of

expenditure were available at district office as well as in the visited SCs/PHCs.

c. Meetings of the VHSNCs were not being conducted regularly in the visited Sub

Centres.

d. VHSNCs fund was not released to the district during current year 2011-12 up to the

month of visit.

5. Untied Funds:

a. Provision of Untied Fund and expenditure at Sub centre and PHC level during 2010-

11 in the district are reported as under:

609

Sr.

No

Particulars of

Untied Fund

In the year 2010-11 ( in

Rs)

For Sub

centres

For CHCs/PHCs

1 Fund allotted 57,80,000 17,75,920

2 Total Expenditure 55,77,296 16,77,389

3 Total Balance 2,02,704 98,531

No Untied Fund was released to the institutions in the district during the year 2011-12.

b. In the visited 3 Sub Centres, the team observed that ANMs had not updated their

Cashbook/ Passbook of untied funds. Out of 3 Sub Centres, 2 Sub Centres i.e. Jaraua

and Behatagokul utilised funds for purchasing of BP apparatus, Hub cutter, Uristix,

Phenyl, Dari, Bed sheet, Chair and Table etc. In Sub Centre Harriya fund was not

utilised.

c. Untied Funds were utilized as per norms in contingency and development work like

repairing of vehicle, buying of Diesel, plantation and pits for waste disposal by PHC

Kothawan. Record regarding utilisation of untied fund was not made available to the

team in PHC Bawan.

6. Janani Suraksha Yojana (JSY):

a. 55,776 JSY mothers in the year 2010-11 and 11,213 mothers in the current year up to

June, 2011 benefited with cash incentive under the scheme in the district.

b. The district had spent funds to the tune of Rs. 10,71,71,410 out of allotted funds of Rs.

10,92,99,916 in the year 2010-11. Similarly, there was an expenditure of Rs.

1,98,31,650 against the available fund of Rs. 2,57,32,000 during the current year up

to June, 2011 under JSY in the district.

c. During visit to the centres it was observed that JSY fund was sufficiently available

there and all the registers relating to JSY services were maintained properly. In

District Female Hospital, Hardoi, yearly number, date of admission and date of

discharge from institution were not recorded in the register.

d. 27 JSY beneficiaries were contacted out of 29 selected in the area of the visited

centres in the district for on the spot verification. All the beneficiaries stated that they

had received cash incentives and services in time. Cheques to the beneficiaries are

provided by the concerned DH/ PHC directly within a week from date of delivery.

610

Team found that most of the delivered mothers are relieved from the institution within

10 to 12 hours of delivery due to insufficient availability of beds/ space.

7. 24x7 Delivery Care Services:

a. 18 institutions were providing 24x7 delivery care services in the district. No additional

budget for these services was released to these Centres.

b. As reported, 55776 deliveries in the year 2010-11 were conducted in the district. It

was reported that facilities for caring mothers and new born babies were adequate in

the visited PHC Kothawan. As many as 674 deliveries in the night hours out of total

3408 deliveries conducted in PHC Kothawan were reported during 2010-11.

8. Physical infrastructure (HSC/PHC/DH):

(i) District Women Hospital, Hardoi:

a. Blood Storage unit is available at District Male Hospital, Hardoi and services are being

taken from DMH Hardoi. Bio-medical waste disposal system is being provided by

NGO in the Hospital.

b. As against the sanctioned strength of 64 beds, 82 beds are available in the DWH,

Hardoi. Moreover some of the existing beds needed repair or condemnation. There

was short supply of Injections Quinine and Artether observed in the hospital.

(ii) PHCs:

a. PHCs Kothawan and Bawan were functioning in Govt. buildings. PHC Bawan is

situated out of locality and maintenance of the hospital was not up to the mark.

Ambulance/ Jeep were not provided there. In PHC Kothawan, Jeep was found off

road and Cold Chain Equipments were kept in district headquarter, Hardoi.

b. Short supply of Oral Pills was observed in both visited PHCs.

(ii) Health Sub Centres:

a. Sub centres visited at Harriya and Gokul Behata were functioning in Govt. buildings.

However, Sub Centres Jaraua was not having Govt. accommodation. ANMs were not

staying at their Sub Centre head quarters.

b. It was observed that no delivery was being conducted in Sub centres at Jaraua and

Harriya in spite of having labour room facility.

c. Electricity, RDT kit, Nischay Pregnancy Test Kits, Sanitary Napkins,

Heamoglobinometer, ORS packets, EC Pills, DDKs, Paracetamol, Oxytocin tablets,

Ampicillin capsules and Gentamycine injection were not available in the visited Sub

centres.

d. Delivery table, Ambu bag/suction, Torch and Stove were not available at Sub centres

Jaraua and Harriya.

611

e. Foot stool, Thermometer, IFA and Metronidazole tablets were not available at Sub

centres Jaraua and Gokul Behata.

f. Examination table, Delivery kit, Steam Sterilizer, Weighing machine (Adult),Oral Pills,

Bleaching powder and Cloroquine tablets at Sub centres Jaraua, Kerosene oil and

Disposable syringes at Sub centre Harriya were not available.

9. Assessment and opinion of the Community on Health Services:

(i) Services of ANM-

a. 27 mothers having child up to one year of age from the area of 3 visited sub centres

were interviewed by the team to assess their opinion about the services rendered by

the ANMs.

b. 6 (22%) mothers were not aware about danger sign of ARI, 1 (4%) about use of ORS

and 3 (11%) replied that their babies were not weighed at the time of birth. 3 (11%)

mothers did not receive three Post Natal checkups.

c. It was also observed that 15 (56%) mothers were not sufficiently aware about

contraceptive methods.

(ii) Services of PHC-

15 Persons who were generally utilising the services at visited PHCs were interviewed

and it was found that most of them were satisfied with the services provided by the

Medical officers and others staff of PHCs.

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) though internet connectivity was not available in any visited PHCs.

b. MCH Tracking formats were available in each Sub centre.

c. Health functionaries were sensitized in MCH formats at PHC/ CHC level. They are

capturing data in the formats and making data entry at PHC/ CHC level through cyber

cafe.

11. Registers, records and reports maintained at the visited centres:

a. Service registers for IUD; Oral Pills and Nirodh cases were not being maintained at

any of the PHC head quarters. Performance reported under CuT at PHCs Kothawan

and Bawan could not be verified due to want of service registers.

b. Eligible Couple register which is one of the most important records for FW services

had not been maintained in any of the visited Sub centres.

c. Cash book for untied fund and VHSC proceeding registers were not being maintained

at any of the visited centres.

612

d. Printed registers for Family Planning services, Stock book and Cash book for untied

fund were not supplied to Sub Centres.

9. District: Lucknow

Major observations of Regional Evaluation Team, Lucknow about the Evaluation work

carried out in Lucknow district of Uttar Pradesh in September, 2011

I. Details of the visited Institutions:

District

visited

PHCs/CHCs visited SCs visited

Lucknow CHCs: Bakhsi Ka Talab,

Mohanlal Ganj and

Mall

Shivpuri, Madiyaw, Sonawa, Tikara,

Nigoha, Lalpur, Ranipara and

Narainpur

II. Major observations

1. Health Human Resources:

a. The sanctioned staff strength as a whole in the district was not available at district

office. Therefore, the team couldn‟t assess the staff position vis-à-vis sanctioned

strength. However, as observed Contractual staff required in the district was mostly

filled in. There were 7 Specialists, 11 Medical officers, 15 Staff Nurses and 30 ANMs

posted in the district on contractual basis.

b. All the posts in DPMU i.e. District Programme Manager, District Account Manager,

District Community Mobilizer and Data Entry Operator were filled in.

c. In CHC, Bakhsi Ka Talab, 2 of the 32 sanctioned posts of ANM, 26 of the 32 sanctioned

posts of MPW (M), 2 each of 6 sanctioned posts each of Health Supervisor (M) and

Health Supervisor (F) and 3 of the 6 sanctioned posts of Staff Nurse were lying vacant.

Similarly, 4 of the 52 sanctioned posts of ANM, 10 of the 14 sanctioned posts of MPW

(M), 2 of the 8 sanctioned posts of Health Supervisor (F), 3 of the 9 sanctioned posts of

Health Supervisor (M), 2 of the 6 sanctioned posts of Staff Nurse, 3 of the 8 sanctioned

posts of Medical officer and 5 of the 8 sanctioned posts of Specialist were lying vacant

in CHC Mohanlal Ganj.

613

d. In PHC Mall, 21 of the 36 sanctioned posts of ANM, 8 of the 12 sanctioned posts of

MPW (M), 5 of the 6 sanctioned posts of each of Health Supervisor (M) and Health

Supervisor (F), 2 of the 3 sanctioned posts of Staff Nurse, 1 of the 6 sanctioned posts

of Medical officer and 2 of the 6 sanctioned posts of Specialist 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 (Male & Female) Hospitals. Meeting of executive

body was conducted every month during the year 2010-11.

b. The grant received under this head in every year is kept at the disposal of Rogi Kalyan

Samiti as RKS fund. Details of expenditure made for developmental activities 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, 1454 ASHAs were selected and in position in the district during 2010-11.

1214 ASHAs were reported to have been trained but were working without drug kits in

the district. No new ASHA proposed to be inducted in the district.

b. In the visited Sub Centres at Shivpuri, Sonawa, Tikara, Nigoha, Lalpur, Ranipara and

Narainpur, required numbers of ASHAs were working in the field and trained up to 4th

module.

c. 8 ASHAs were contacted in the area of HSCs visited; as informed they were trained

and receiving an annual average performance based remuneration of about Rs. 5000-

6000. ASHA is involved in each VHSNC as a member.

4. Functioning of Village Health Sanitation & Nutrition Committee (VHSNCs):

a. It has been reported that 511 VHSNCs were functioning in all 835 revenue villages in

the district and joint bank account in the name of concerned ANM and Gram Panchayat

Pradhan has been opened in all 511 VHSNCs to handle funds. In the year 2010-11,

funds @ Rs. 10,000 were provided to each revenue village for undertaking sanitation

work in the villages.

b. The total budget for the VHSNCs in the district was allotted to the tune of Rs 83,40,000

for 835 revenue villages through CHCs/ PHCs, but no details of expenditure were

614

available at visited CHCs/ PHCs/SCs and also district headquarter office for the 2010-

11.

c. During visit to the centres, team found that the district had released Rs. 11,60,000 as

VHSNCs fund to CHC Mohanlal Ganj, but CHC had shown an amount of Rs. 4,10,000

in the record and also no details of expenditure were made available to the team.

District had allotted Rs. 9,50,000 to CHC Bakhsi Ka Talab as VHSNCs fund for 95

revenue villages though 19 revenue villages of this CHC were already covered under

the same scheme by Nagar Panchayat fund.

d. During visit to the centres, the funds reported to be utilized, but no details of

expenditure were available at visited SCs. ANMs of visited SC stated that funds were

utilised by Village Pradhan and they didn‟t receive the vouchers and records, so

records was not maintained at Sub Centre level. This put a question mark on proper

utilisation of funds.

e. it was observed that meetings of the VHSNCs were not being conducted regularly in

the visited Sub Centres.

5. Untied Funds:

a. Untied Funds @ Rs. 10,000 to each Sub centre, @ Rs. 50,000 to each CHC/PHC and

@ Rs. 25,000 to Addl. PHC were provided through block level PHCs and CHCs in

every year in the district.

b. Details of the fund provided and expenditure incurred in the district for the year 2010-11

are reported as under:

Sr.

No

Particulars of Untied

Fund

In the year 2010-11 ( in

Rs)

For Sub

centres

For CHCs/PHCs

1 Fund allotted 34,30,000 11,25,000

2 Expenditure incurred 6,10,000 3,96,818

3 Balance 28,20,000 24,97,861

c. No untied fund was released to the institutions during the year 2011-12.

d. It was observed that, ANMs have not updated their Untied funds, Cashbook/ Passbook

as untied fund for Sub Centres in the year 2010-11 was released in the month of

March/ April 2011 by CHCs.

e. During visit to the centres, team found that the district had released Rs. 3,60,000 to

PHC Mall and Rs. 4,00,000 to CHC Mohanlal Ganj for the year 2010-11 for their Sub

Centre as untied funds but PHC Mall showed only an amount of Rs. 1,80,000 in the

615

record and CHC Mohanlal Ganj showed Rs. 5,00,000 in its record. The record of

expenditure was not made available to the team at visited institutions at PHC Mall,

CHCs Mohanlal Ganj and Bakhsi Ka Talab regarding utilization of untied funds.

f. As reported to the team, Untied Funds were utilized for buying of Inverter with battery,

stationary, POL of vehicle, electrical equipments and printing of OPD and discharge slip

in PHC Mall. Similarly, this funds were also utilised for making arrangement of drinking

water and civil work in CHC Bakhsi Ka Talab and purchased Inverter with battery,

stationary, POL of vehicle, electrical equipments and printing of OPD and discharge slip

etc. in CHC Mohanlal Ganj.

6. Janani Suraksha Yojana (JSY):

a. During the year 2010-11, district had spent funds to the tune of Rs. 6,60,91,808 out of

allotted budget of Rs. 7,16,38,802 under the scheme. Similarly, an amount of Rs.

2,34,65,437 was utilised against the available amount of Rs. 4,21,30,000 during current

year (up to August, 2011).

b. As per details received, as many as 45,532 JSY beneficiaries in the year 2010-11 and

16,798 JSY beneficiaries in current year up to August, 2011 have been paid with cash

incentive under the scheme.

c. The budget provision and expenditure at the visited PHC/CHCs is reported as below:

Sr.

No.

Particulars For the year 2010-11 ( in Rs)

CHC Bakhsi

Ka Talab

CHC Mohanlal

Ganj

CHC Mall

1 Total fund available 22,31,530 54,87,790 54,50,000

2 Total expenditure under

JSY

18,44,400 51,40,800 54,49,549

3 Total balance amount 3,87,130 3,46,990 451

For the year 2011-12 up to August, 2011 ( in

Rs)

1 Total fund available 1,50,000 17,00,000 23,00,000

2 Total expenditure under

JSY

1,20,370 16,33,300 NA

3 Total balance amount 29,630 66,700 NA

d. 41 JSY beneficiaries were contacted in the area of visited Centres in the district. All the

beneficiaries stated that they had received incentives through cheque from the

concerned CHCs / PHCs within a week of the date of delivery. Most of the mothers

616

were relieved from the hospital within 10 to 20 hours of delivery. JSY registers found to

be maintained properly and checked by concerned MOs regularly.

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 given to these Centres.

b. It was reported that out of 18,274 institutional deliveries conducted by 24x7 institutions/

FRUs in the year 2010-11, 9323 deliveries were conducted in the night hours.

c. In the visited CHC Mohanlalganj, 765 deliveries were reported to were conducted in

night hours during 2010-11. Such records were not maintained at CHC Bakhsi Ka

Talab and PHC Mall. Facilities for caring mother and new born baby were found to be

satisfactory in all the visited institutions under the scheme.

8. Physical infrastructure (HSC/PHC/CHC)

(i) CHCs/ PHC:

a. Visited CHCs at Bakhsi Ka Talab and Mall were functioning in Govt. building but the

maintenance of the hospitals was not up to the mark.

b. Jeep, Blood Storage unit was not available in both visited CHCs. Incinerator was not

available there but bio-medical waste is handed over to the agency outsourced and

listed by the district office. Injections Quinine and Arteether were not available in the

visited CHCs.

c. Visited FRU at Mohanlalganj was functioning in Govt. buildings but the maintenance of

the hospital was not up to the mark. Blood Storage unit was non functional in the CHC.

Incinerator was not available there but bio-medical waste is handed over to the agency

outsourced and listed by the district office. Injections Quinine and Arteether were not

available there.

(ii) Health Sub Centres:

a. Out of 8 visited Sub centres 7 Sub centres i.e. Shivpuri, Madiyaw, Sonawa, Tikara,

Nigoha, Lalpur and Narainpur were functioning in Govt. buildings and Sub Centre

Ranipara was functioning in Panchayat building. ANMs were not staying at their Sub

Centre head quarters at Sub Centres Shivpuri, Tikara and Ranipara.

b. It was observed that labour room was available in 6 Sub Centres i.e. Shivpuri, Sonawa,

Tikara, Nigoha, Lalpur and Narainpur but deliveries were being conducted in the Sub

centres at Nigoha and Lalpur only.

c. Ambu bag/suction, Nischay pregnancy test kit, RDT kit, Heamoglobinometer, Sanitary

Napkins, DDKs and EC Pills were not available in the visited Sub centres. No supply of

617

Kits- A & B was observed in the visited Sub centres at Shivpuri, Madiyaw, Nigoha,

Lalpur, Ranipara and Narainpur

d. Oxytocin tablets, Ampicillin capsules and Gentamycine injection were not available at

Sub centres Shivpuri, Madiyaw, Sonawa, Tikara, Nigoha, Lalpur and Ranipara.

e. Some of the equipments Mclntsh sheet, Delivery kits, Steam Sterilizer, IUD insertion kit,

Delivery table and Steam Sterilizer were not mostly available at the centres visited.

f. ORS packets, Co-trimoxazole and IFA tablets need to be made available at the Sub

Centres.

g. CuT, Oral Pills, Nirodh, Cloroquine and Bleaching powder were not available at Sub

centres Madiyaw and Sonawa. Cloroquine, Bleaching powder and Metronidazole

tablets were not available at Sub centres Tikara and Ranipara.

h. Weighing machine (Adult/Infant), BP apparatus, Nirodh and Antiseptic solution at Sub

Centre Shivpuri, Gloves and Metronidazole tablets at Sub Centre Madiyaw,

Examination table at Sub Centre Sonawa, Thermometer, Oral Pills, Antiseptic solution

and Paracetamol tablets at Sub Centre Tikara, CuT, Oral Pills and Cloroquine at Sub

Centre Nigoha, Vitamin- A and Cloroquine at Sub Centre Lalpur, Examination table,

Gloves and Nirodh at Sub Centre Ranipara were not available.

9. Assessment and opinion of the Community on Health Services:

(i) Services of ANM-

a. 72 mothers having child up to one year of age from the area of 8 visited sub centres

were interviewed by the team to assess their opinion about the services rendered by

the ANMs.

b. 40 (56%) mothers were not aware about danger sign of ARI, 21 (29%) were not aware

about use of ORS and 5 (7%) replied that their babies were not weighed at the time of

birth. 27 (38%) mothers did not receive three Post Natal checkups.

c. It was also observed that 43 (60%) mothers were not sufficiently aware of contraceptive

methods and 37 (51%) mothers about its side effects.

(ii) Services of PHC-

a. 40 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 in the PHC/

CHC areas. Mostly people were mostly satisfied with the services provided at PHCs

and CHC. However, proper attention to register the AN mothers within the 16 weeks of

618

pregnancy and improve the awareness about danger sign of pregnancy, sick new born

care and breast feeding practices need to be increased.

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). However, Internet connectivity was available at district and CHC level

only.

b. MCH Tracking formats were available in each Sub centres.

c. Health functionaries were sensitized in MCH formats at PHC/ CHC level. They are

capturing data in the formats and making data entry at PHC/ CHC level through cyber

cafe.

11. Registers, records and reports maintained at the visited centres:

a. Performance reported under CuT at CHCs Bakhsi Ka Talab, Mohanlal Ganj and Mall

could not be verified due to want of service registers. Oral Pills and Nirodh distribution

registers were also not maintained in the centres visited.

b. Eligible Couple register, Cash book for untied funds and VHNSC proceeding registers

were not being maintained at any of the visited centres.

c. Printed Registers for Family Planning services, Stock book, Monthly Reporting format

and Cash book for untied fund were not supplied to Sub Centres by higher authority.

10. District: Rampur

Major observations of Regional Evaluation Team, Lucknow about the Evaluation work

carried out in Rampur district of Uttar Pradesh in September, 2011

II. Details of the visited Institutions:

District

visited

PHCs/CHCs visited SCs visited

Rampur CHCs: Swar and Milak

PHC: Rajpura

Kumariya Kala, Milak Khanam,

Keorar and Loha Bhola Hata

II. Major observations

1. Health Human Resources:

619

a. Some of the skilled personnel under Medical and Para Medical category like 63 posts

of ANM (out of 244 sanctioned), 5 posts of LHVs/Health Supervisor (F) (out of 40

sanctioned), 14 posts of Medical Officer (out of 107 sanctioned), 15 posts of Specialist

(out of 25 sanctioned) and 3 Staff Nurse/ GNM (out of 15 sanctioned) were reported to

be lying vacant in the district as a whole.

b. Under Programme Management Units of NRHM, posts of the District Programme

Manager and 1 post of Block Data Entry Operator was lying vacant in the district.

c. In the visited CHC Swar, 15 of the 34 sanctioned posts of ANM, 3 each of the 6

sanctioned posts each of LHVs and Health Supervisors (M) and 5 of the 6 sanctioned

posts of specialists were vacant. As per the records provided, 2 of the 7 sanctioned

posts of specialists were laying vacant in CHC Milak.

d. 5 of the 43 sanctioned posts of ANM, all 5 sanctioned posts of MPW (M), one each of

the 5 sanctioned posts of each LHV and Health Supervisor (M) and only sanctioned

post of Staff Nurse was lying vacant in PHC Rajpura.

2. Functioning of Rogi Kalyan Samiti (RKS):

a. Rogi Kalyan Samiti (RKS) was registered in each Block level PHC/CHC in the district.

Meeting of executive body was conducted every month in a year.

b. Funds including Untied Fund and Annual Maintenance Grant etc. are kept at the

disposal of Rogi Kalyan Samiti as RKS fund. It was observed that expenditure was

incurred in the visited CHC/PHCs for development activities without taking prior

approval from the RKS.

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, 1500 ASHAs were in position out of 1535 selected in the district during

2010-11. All of them were trained up to 5th module but working without drug kits in the

district. No new ASHA was proposed to be inducted during 2011-12.

b. During visit to the Sub centres at Kumariya Kala, Milak Khanam, Keorar and Loha

Bhola Hata, 12 ASHAs were interviewed and as intimated most of them were receiving

performance based remuneration on an average Rs. 30,000- 35,000 yearly.

4. Functioning of Village Health Sanitation & Nutrition Committee (VHSNCs):

a. It was reported that 580 VHSNCs were functioning for 1089 revenue villages in the

district and joint bank account in the name of concerned ANM and Gram Panchayat

Pradhan has been opened in 580 all VHSNCs to handle the funds.

620

b. As reported, every revenue village is given Rs. 10,000 every year as VHSNC fund

under the scheme in the district. The district had received Rs. 1,08,90,000 as VHSNC

funds for the year 2010-11 and allotted funds to VHSNC though PHC/CHC, but no

details of expenditure were available at district office as well visited SCs/PHCs.

5. Untied Funds:

a. Untied Funds @ Rs. 10,000 to each Sub centre, @ Rs. 50,000 to each CHC/PHC and

@ Rs. 25,000 to Addl. PHC are provided through block level CHCs and PHCs in every

year in the district.

b. Details of the fund provision and expenditure incurred in the district for the year 2010-

11 are reported as under:

Sr.

No

Particulars of Untied

Fund

In the year 2010-11 ( in

Rs)

For Sub

centres

For

CHCs/PHCs

1 Fund allotted 21,10,000 10,50,000

2 Total Expenditure 21,10,000 NA

c. In the year 2010-11 district had released Rs. 10,50,000 to CHCs/PHCs as untied funds,

but record regarding utilisation of fund were not made available during visit of team. No

Untied Fund was released to the institutions in the district during the year 2011-12.

d. ANM of Sub Centre Kumariya Kala reported that she couldn‟t withdraw Sub Centre

untied fund due to non cooperation of Gram Pradhan of respective villages. It was

observed that ANMs were not updating their Cashbook/ Passbook of untied funds.

e. As reported, Untied Funds were utilized for buying of Inverter with battery, stationary,

wring of cold chain equipment, electrical equipments and water cooler in PHC Rajpura.

Similarly, this funds also utilised for purchased of Inverter with battery, stationary, POL

of vehicle, electrical equipments and printing of OPD and discharge slip etc. in CHC

Swar.

6. Janani Suraksha Yojana (JSY):

a. During the year 2010-11, district had spent funds to the tune of Rs. 2,70,93,210 more

than allotted budget of Rs. 2,70,11,900. Similarly, an amount of Rs. 99,93,700 was

utilised against the available amount of Rs. 1,88,13,000 during current year up to

August, 2011.

621

b. As per details received, as many as 15,120 JSY beneficiaries in the year 2010-11 and

5,869 JSY beneficiaries in current year up to August, 2011 have been paid with cash

incentive under the scheme.

c. The budget provision and expenditure at the visited PHC/CHCs is a reported given

below:

Sr.

No.

Particulars For the year 2010-11 ( in

Rs)

CHC Swar PHC

Rajpura

FRU

Milak

1 Total fund available 23,14,200 23,00,000 NA

2 Total expenditure under JSY 25,63,000 25,36,300 45,75,10

0

3 No. of JSY mothers paid

incentive

1394 282 3282

For the year 2011-12 up to August, 2011 ( in Rs)

1 Total fund available 16,00,000 4,50,000 24,00,00

0

2 Total expenditure under JSY 14,45,000 7,69,169 16,90,60

0

3 No. of JSY mothers paid

incentive

780 123 1227

d. 28 JSY beneficiaries were contacted out of 47 selected in the area of visited Centres in

the district. All the beneficiaries stated that they had received incentives through

cheque by the concerned CHCs and PHCs within a week from the date of delivery.

Most of the mothers were relieved from the hospital within 10 to 20 hours of delivery.

JSY registers were maintained properly and checked by concerned MOs regularly.

e. During visit to the CHC at Swar and PHC at Rajpura, it was observed that most of the

funds were utilised against the allotted budget under the scheme during 2010-11 and in

the year 2011-12 up to August 2011.

7. 24x7 Delivery Care Services:

a. 24x7 delivery care services was implemented in the district.

b. During visit to the district, the report regarding institutional/ night hours delivery

conducted by institutions was not made available to the team by the district office.

622

c. In the visited centres, all 915 deliveries in CHC Swar and 915 out of 3282 deliveries in

FRU Milak were reported to have been conducted in night hours during 2010-11.

Number of deliveries conducted at night hours was not maintained at PHC Rajpura.

Facilities for caring mother and new born baby found to be satisfactory in all the visited

institutions under the scheme.

8. Physical infrastructure (HSC/PHC/CHC/FRU):

(i) CHC/FRU:

a. During visit to the CHC Swar and FRU Milak, it was observed that, Blood Storage unit,

Jeep and Anesthesia equipment and Bio-medical waste disposal system were not

available at CHC Swar.

b. FRU Milak was functioning in CHC building but their maintenance was not up to the

mark. Blood Storage unit was available there but the same was not functional till the

time visit of team. As against the sanctioned strength of 30 beds, 40 beds were

available in the FRU Milak.

c. Short supply of Injections Quinine and Artether was observed in CHC Swar and FRU

Milak.

(ii) PHCs:

a. PHC Rajpura is functioning in Govt. building but maintenance of the hospital was not up

to the mark. PHC is situated 2.5 KM away from main road. Telephone facility not

available there. Most of the PHC staff and Doctor are were available in the PHC but

sitting at another CHC building at Milak.

b. AYUSH Medical Officer was posted in this PHC, but Ayurvedic medicines under this

segment were lacking there. Without Medical Officer, 24x7 services were being

provided in the PHC.

(ii) Health Sub Centres:

a. Sub Centres visited at Milak Khanam, Keorar and Loha Bhola Hata were functioning in

Govt. buildings. However, Sub Centres Kumariya Kala was not having Govt.

accommodation.

b. RDT kit, Nischay Pregnancy Test Kits, DDKs, Oxytocin tablets, Ampicillin capsules and

Gentamycine injection were not available in the visited Sub centres.

c. Electricity, Labour room, Delivery table, Mclntsh sheet, Ambu bag/suction, Steam

Sterilizer and Weighing machine were not available at Sub Centres Kumariya Kala and

Loha Bhola Hata.

623

d. Short supply of Co-trimoxazole and Metronidazole tablets was observed at Sub Centres

Kumariya Kala and Milak Khanam.

e. Source of Water, Toilet, Delivery kit, BP apparatus, Thermometer, Gloves, EC Pills,

Chlorine solution, Chloroquine tablets, Antiseptic solution and Sanitary Napkins at Sub

Centre Kumariya Kala, Weighing machine (Infant), ORS packets, Paracetamol tablets

and Antiseptic solution at Sub Centre Milak Khanam, Ambu bag/suction and

Chloroquine tablets at Sub Centre Keorar, Foot Stool, ORS packets and Kerosene oil

at Sub Centre Loha Bhola Hata were not available.

9. Assessment and opinion of the Community on Health Services:

(i) Services of ANM-

a. 36 mothers having child up to one year of age from the area of 4 visited sub centres

were interviewed by the team to assess their opinion about the services rendered by

the ANMs. 9 (25%) mothers replied that ANMs were not available when needed most

b. 17 (47%) mothers were not aware about danger sign of ARI, 5 (14%) about use of

ORS. 4 (11%) mothers did not receive three Post Natal checkups.

c. It was also observed that 22 (61%) mothers were not sufficiently aware about

contraceptive methods and 26 (72%) about side effects of contraceptive uses.

(ii) Services of PHC-

a. 20 Persons who were generally utilising the services at visited PHC/CHC were

interviewed and it was found that most of the house holds were not satisfied regarding

regular availability of Medical officers and others staff of PHC headquarter of PHC

Rajpura.

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 in the PHC/

CHC areas.

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) though internet connectivity was not available in any visited PHC/ CHCs.

b. MCH Tracking formats were available in each Sub centre.

c. Health functionaries were sensitized in MCH formats at PHC/ CHC level. They are

capturing data in the formats and making data entry at PHC / CHC level through cyber

cafe.

11. Registers, records and reports maintained at the visited centres:

624

a. Service registers for IUD, Oral Pills and Nirodh cases were not being maintained at any

of the PHC/CHC head quarter. Performance reported under CuT at CHC Swar, FRU

Milak and PHC Rajpura could not be verified due to want of service registers.

b. Eligible Couple register were not been maintained in the visited Sub centres of

Kumariya Kala and Loha Bhola Hata.

c. Cash book for untied fund was not being maintained in the visited centres of Kumariya

Kala and Milak Khanam.

d. Registers for Family Planning services i.e. Sterilisation cases, CuT acceptors, Oral Pills

and Nirodh users were not maintained in the centres visited.

e. Stock register for family planning items i.e. CuT, Oral Pills and Nirodh were not

maintained in the Centres of Kumariya Kala, Keorar and Loha Bhola Hata.

11.District Gonda

Major observations of Regional Evaluation Team, Lucknow on the Evaluation work

carried out in Gonda district of Uttar Pradesh in January, 2012

I. Details of the visited Institutions:

District

visited

PHCs/CHCs visited SCs visited

Gonda CHC: Colonel Ganj

PHCs: Itiyathok &

Maskanawa

Nachani, Chakraut, Bisunpur Tewari

at Sangam, Babaganj, Mahraj Ganj

Grant and Babhnan

II Major observations

1. Health Human Resources:

a. Skilled personnel under Medical and Para Medical categories like 48 posts of ANM out

of 381 sanctioned, 138 posts of MPW (M) out of 151 sanctioned, 60 posts of Health

Supervisor (M) out of 102 sanctioned, 26 posts of Medical Officer out of 105

sanctioned, 2 posts of Specialist out of 15 sanctioned, 9 posts of Staff Nurse/ GNM out

of 24 sanctioned and 3 posts Lab Technician out of 27 sanctioned were reported to be

lying vacant in the district.

b. Under Programme Management Units of NRHM, one post each of the District Account

Manager and District Community Mobilizer was lying vacant in the district.

625

c. In CHC, Colonel Ganj, 6 of the 26 sanctioned posts of ANM, 6 of the 8 sanctioned

posts of MPW (M), 1 of the 3 sanctioned posts of LHV/ Health Supervisor (F), 2 of the 6

sanctioned posts of Health Supervisor (M), 2 of the 6 sanctioned posts of Specialist and

2 of the 6 sanctioned posts of Staff Nurse were lying vacant.

d. In PHC Itiyathok, 5 of the 21 sanctioned posts of ANM, 7 of the 8 sanctioned posts of

MPW (M), 1 of the 4 sanctioned posts of Health Supervisor (M) and 3 of the 10

sanctioned posts of Medical officer were lying vacant. However, record of the

sanctioned staff strength was not available at PHC Maskanawa.

2. Functioning of ASHA Scheme:

a. As reported, there were 1370 ASHAs functioning out of 1600 ASHAs selected in the

district during 2010-11. 1303 ASHAs were reported to have been trained but no drug

kits provided to them.

b. In the visited Sub Centres at Nachani, Chakraut, Bisunpur Tewari at Sangam,

Babaganj, Mahraj Ganj Grant and Babhnan, required numbers of ASHAs were working

in the field and trained up to 4th module.

c. 8 ASHAs were contacted in the area of HSCs visited; as informed they were trained

and receiving an annual average performance based remuneration of about Rs. 5000-

6000. ASHA is functioning in each VHSNC as a member.

3. Functioning of Village Health Sanitation & Nutrition Committee (VHSNCs):

a. It has been reported that 1054 VHSNCs were functioning in all 1726 revenue villages in

the district and joint bank account in the name of concerned ANM and Gram Panchayat

Pradhan has been opened in all VHSNCs to handle funds. In the year 2010-11, funds

@ Rs. 10,000 were provided to VHSNCs for each revenue village for undertaking

sanitation work in the villages under the scheme.

b. The total budget for the VHSNCs in the district was allotted to the tune of Rs

1,72,60,000 for 1726 revenue villages through CHCs/ PHCs, but no details of

expenditure were available at visited CHCs/ PHCs/SCs and also district headquarter

office for the 2010-11.

c. It was observed that VHSNCs are constituted but their meetings were not being

conducted in the visited Sub centres areas.

4. Untied Funds:

a. Untied Funds @ Rs. 10,000 to each Sub centre, @ Rs. 50,000 to each CHC/PHC were

provided in every year in the district.

626

b. An amount of Rs. 32,20,000 at Sub Centre level and Rs. 20,50,000 at CHC/ PHC level

was provided as untied funds during 2010-11 and the amount was utilised fully by the

Centres.

c. No untied funds were released to the institutions during the year 2011-12 up to the

month of visit.

d. The records for Cashbook/ Passbook, Vouchers and other registers were not made

available in the visited Sub Centres to the team.

e. During field check, the team observed that the district had released Rs. 2,30,000 to

CHC Colonelganj in the year 2010-11 as Sub Centre level untied funds in CHC area.

CHC Colenganj returned the whole amount to CMO (FW) for central purchasing the

equipments i.e. Haemoglobinometer, Weighing machine, BP apparatus, Haemoglobin

Scale, Pregnancy Test Kits, Stethoscope and Uristix etc. for use of 20 SCs.

f. In the area of PHC Itiyathok, no record of expenditure of Untied Fund was available at

PHC as well as SCs. This PHC had released Rs. 1,90,000 to its Sub Centres as untied

fund for the year 2010-11. The record of expenditure was also not made available to

the team at PHC Maskanwa regarding utilization of untied funds.

g. As reported to the team, Untied Funds were utilized for repairing of building, chairs,

almirah, table and hand pump etc. in PHC Itiyathok.

5. Janani Suraksha Yojana (JSY):

a. As per details received, as many as 34,856 JSY beneficiaries in the year 2010-11 and

25,149 JSY beneficiaries in the current year up to December, 2011 have been paid

cash incentive under the scheme in the district.

b. As reported by the District office, an amount of Rs. 6,51,40,000 was available during

2010-11 under the scheme which was fully utilised. Similarly, an amount of Rs.

4,50,39,000 was utilised against the available amount of Rs. 4,64,11,000 during current

year (up to December, 2011) under the scheme.

c. The budget provision and expenditure at the visited PHC/CHCs is reported as below:

Sr.

No.

Particulars For the year 2010-11 ( in Rs)

CHC

Colonelganj

PHC

Itiyathok

1 Total fund available 57,13,681 40,67,500

2 Total expenditure under JSY 57,13,300 38,44,000

3 Total balance amount 381 2,23,500

For the year 2011-12 up to August, 2011 ( in Rs)

1 Total fund available *35,50,381 *33,23,500

627

2 Total expenditure under JSY 32,60,000 33,21,200

3 Total balance amount 2,90,381 2,300

* including previous balance for the year 2010-11

Detail of fund provision and expenditure was not made available to the team at visited

PHC Maskanwa.

d. 22 JSY beneficiaries were contacted in the area of visited Centres in the district. Almost

all contacted beneficiaries stated that they had received incentives through cheque

from the concerned CHCs / PHCs. Most of the mothers were relieved from the hospital

within 5 to 10 hours of delivery. JSY registers were found to be maintained properly and

checked by concerned MOs regularly.

e. The team observed that new born babies were having dirty clothes in the hospital.

There was also no system of displaying the names of JSY beneficiaries in health

facilities and there was no grievance redressal for JSY.

6. 24x7 Delivery Care Services:

a. 16 institutions were identified to provide 24x7 delivery care services in the district. No

additional budget was given to these Centres for these services.

b. It was reported that total 34,856 and 30,529 institutional deliveries conducted

collectively by 24x7 institutions/ FRUs and District hospital in the year 2010-11 and

2011-12 (up to December, 2012) respectively.

c. In the visited CHC Colonelganj, 797 deliveries out of total 2140 were reported to be

conducted in night hours during 2010-11 and 1114 deliveries out of total 2827 were

reported to be conducted in night hours during 2011-12 (up to December, 2012). Such

records were not maintained at PHCs Itiyathok & Maskanawa.

d. Facilities for caring mother and new born baby were found to be inadequate in the

visited PHCs under the scheme.

7. Physical infrastructure (HSC/PHC/CHC)

(i) CHC/ PHCs:

a. Visited CHC at Colonelganj was functioning in Govt. building but the maintenance of

the hospital was not up to the mark.

b. Blood Storage unit was non functional in the CHC. Incinerator was not available there

but bio-medical waste is handed over to the agency outsourced and listed by the district

office. Injections Quinine and Arteether were not available in the CHC.

c. Visited PHCs at Itiyathok & Maskanawa were functioning in Govt. buildings.

Maintenance of the hospital was not up to the mark in PHC Itiyathok. Record regarding

stock of contraceptive items & Prophylactic drugs like IFA and Vitamin- A were not

628

made available to the team at PHC Itiyathok. However, AYUSH Medical Officer was

posted in PHC Maskanawa, but AYUSH Pharmacist and Ayurvedic medicines were

lacking there.

(ii) Health Sub Centres:

a. Out of 6 visited Sub centres 3 Sub centres i.e. Chakraut, Babaganj and Babhnan were

functioning in Govt. buildings. ANMs in visited Sub Centers were not staying at their

head quarters.

b. It was reported that, the Sub Centre Nachani was functioning in one rented dark room

in the village and rent was dues since last two years. Sub Centre Bisunpur Tewari has

no accommodation and operated the activities of the centre from village Sangam where

only one house is situated. Under jurisdiction of this sub centre Seven villages are

situated two- three km. from village Sangam which is not approachable by vehicle.

Similarly, Sub Centre Mahraj Ganj Grant was not having proper accommodation and

there was also no sitting arrangement.

c. It was found that Electricity connection and labour room was available in the Sub

Centre at Babhnan only.

d. Ambu bag/suction, Nischay pregnancy test kit, RDT kit, Heamoglobinometer, Sanitary

Napkins, DDKs, Kerosene oil, Cloroquine, Paracetamol, Metronidazole, Oxitocine

tablets, Ampiciline capsules and Gentamycine injection were not available in the visited

Sub centres.

e. Bench, Cupbord for drugs, Delivery table, Mclntsh sheet, Co-trimoxazole, IFA tablets

and Bleaching powder were not available at Sub centres Nachani, Bisunpur Tewari at

Sangam and Mahraj Ganj Grant.

f. No supply of Kits- A & B, ORS packets and Antiseptic solution was observed in the

visited Sub centres at Nachani, Chakraut and Mahraj Ganj Grant.

g. Thermometer, Gloves, Oral Pills, Nirodh and EC Pills should be made available at the

Sub Centres Mahraj Ganj Grant and Babhnan.

h. Examination table, Steam Sterilizer and Torch at Sub Centre Nachini; Examination

table, Mclntsh sheet, Torch, Weighing machine, Steam Sterilizer, Thermometer, Gloves

and CuT at Sub Centre Chakaraut; Examination table, IUD insertion kit, Delivery kit,

Torch, Stove, CuT, EC Pills and Nirodh at Sub Centre Bisunpur Tewari at Sangam;

ORS packets, Bleaching powder and Kits- A & B at Sub Centre Babaganj, Delivery kit,

Stove, Weighing machine (Adult/Infant) and CuT at Sub Centre Mahraj Ganj Grant;

Delivery table, Steam Sterilizer, Stove, Weighing machine (Adult/Infant), ORS packets,

629

Co-trimoxazole tablets, Antiseptic solution and Bleaching powder at Sub Centre

Babhanan were not available.

8. 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. 31 (57%) mothers were not aware about danger sign of ARI, 25 (46%) were not aware

about use of ORS and 36 (67%) replied that their babies were not weighed at the time

of birth. 29 (54%) mothers did not receive three Post Natal checkups.

c. It was also observed that 38 (70%) mothers were not sufficiently aware of contraceptive

methods and 37 (69%) mothers about its side effects.

(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 in the PHC/

CHC areas. People were mostly satisfied with the services provided at PHCs and CHC.

However, proper attention to register the AN mothers within the 16 weeks of pregnancy

and improve the awareness about danger sign in pregnancy, sick new born care and

breast feeding practices need to be increased.

9. IT Infrastructure and Mother & Child Tracking System:

a. Team found that computers were available at district level and at Block level

PHCs/CHCs (one in each Block). However, Internet connectivity was available at

district level only.

b. MCH Tracking formats were available in each Sub centres.

c. Health functionaries were sensitized in MCH formats at PHC/ CHC level. They are

capturing data in the formats and making data entry at PHC/ CHC level through cyber

cafe.

10. Registers, records and reports maintained at the visited centres:

a. Performance reported under CuT at CHC Colonel Ganj and at PHCs Itiyathok &

Maskanawa could not be verified due to want of service registers. Oral Pills and Nirodh

distribution registers were also not maintained in the centres visited.

630

b. Eligible Couple register which is one of the most important records for FW services had

not been maintained in most of the visited Sub centres.

c. Printed Registers for Family Planning services, Immunisation register, Stock book and

Cash book for untied fund were not supplied to Sub Centres.

d. Cash book for untied funds and VHNSC proceeding registers were not being

maintained at any of the visited centres.

e. Team reported that, proceeding register of Rogi Kalyan Samiti (RKS) was not made

available to the team in all the visited institutions in the District.

631

Uttarakhand

1.District:- Bageshwar

Major observations of Regional Evaluation Team, Lucknow about the Evaluation

work carried out in Bageshwar district of Uttarakhand in November, 2011

III. Details of the visited Institutions:

District

visited

PHCs/CHCs visited SCs visited

Bageshwar CHCs: Baijnath and

Kapkot

PHC: Kanda

Bajyula, Laubaj, Saran, Bhanar,

Kamedi and Dhapala Sheri

IV. Major Observations:

1. Health Human Resources:

a. 109 of the 141 sanctioned posts of ANM, 4 of the 32 sanctioned posts of MPW (M), 9 of

the 10 sanctioned posts of Health Supervisor (F), 4 of the 18 sanctioned posts of

Health Supervisor (M) and 2 of the 6 sanctioned posts of Lab Technician were filled in

the district. The latest position for the posts of Medical Officers, Specialists and Staff

Nurses in the district as a the whole of was not made available at district office.

b. All the posts in DPMU i.e. District Programme Manager, District Account Manager, Data

Entry Operator and Block Level Accountant were filled except the post of District

Community Mobilizer in the district.

c. In CHC, Baijnath, 4 of the 36 sanctioned posts of ANM, 8 of the 14 sanctioned posts of

MPW (M), 1 of the 7 sanctioned posts of Staff Nurse and 4 of the 6 sanctioned posts of

Specialist were lying vacant. Similarly, 1 of the 38 sanctioned posts of ANM, all 9

sanctioned posts of MPW (M), 1 of the 4 sanctioned posts of Health Supervisor (F), all

7 sanctioned posts of Health Supervisor (M), 5 of the 9 sanctioned posts of Staff Nurse

and all 5 sanctioned posts of Specialist in CHC Kapkot were lying vacant.

d. In PHC Kanda, 1 of the 9 sanctioned posts of ANM, one sanctioned post of Health

Supervisor (F) and 1 of the 2 sanctioned posts of Medical officer were lying unfilled.

2. Functioning of Chikitsa Prabandhan Samiti (CPS):

a. Rogi Kalyan Samiti (called Chikitsa Prabandhan Samiti (CPS) in the state) has been

constituted/ registered in all CHCs and PHCs in the district. It was reported that Chief

632

Development Officer (CDO) is the President of executive body at CHC level and CMO

is the President of executive body at PHC level. CPS account jointly operated by CDO/

CMO and concerned CHC/PHC Medical Officer.

b. RKS corps fund, Untied Fund and Annual Maintenance Grant are kept at the disposal

of Chikitsa Prabandhan Samiti. Meeting of executive body of RKS were being

conducted twice in a year.

c. Details of expenditure made for developmental activities in the visited CHCs/PHC and

the approvals taken from the CPS in this regard were recorded in the registers.

3. Functioning of ASHA Scheme:

a. As reported, 419 ASHAs were in position out of 500 targeted in the district during 2010-

11. All of them were trained up to 5th module but were working without drug kits. No

new ASHA was proposed to be inducted in the district during 2011-12.

b. During visit to the Sub Centres at Bajyula, Laubaj, Saran, Bhanar, Kamedi and Dhapala

Sheri, 6 ASHAs were interviewed and as reported, most of them were receiving

performance based remuneration on an average Rs. 1600- 2500 yearly.

c. ASHA is involved in VHSNC as a member.

4. Functioning of Village Health Sanitation & Nutrition Committee (VHSNCs):

a. It has been reported that 861 VHSNCs were functioning in the district and joint bank

account in the name of concerned Gram Vikas Adhikari (GVA) and Gram Pradhan has

been opened in all 861 VHSNCs to handle the funds for undertaking sanitation work in

the villages. Meetings of the VHSNCs were not being conducted regularly in the visited

Sub Centres.

b. As reported, VHSNC were given funds @ Rs. 10,000 every year for each revenue

village under the scheme in the district. The total budget for the VHSNCs in the district

was allotted to the tune of Rs. 86,10,000 for 861 revenue villages through CHCs /

PHCs and out of that Rs. 85,50,000 spent by the VHSNCs during 2010-11. Similarly,

the district had received Rs. 86,10,000 as VHSNC funds for the year 2011-12 and

provided the same funds to VHSNC though PHC/CHC, but no details of expenditure

were available at district office as well visited CHCs/ /PHC and SCs.

c. During visit to the centres, team found that the district had released Rs. 18,50,000 to

CHC Baijnath, Rs. 20,20,000 to CHC Kapkot and Rs. 46,80,000 to PHC Kanda as

VHSNCs fund in 2010-11 and the amount was fully utilised during the year. Same

amounts was also provided to these CHCs/ PHC in 2011-12 as VHSNC funds but no

details of expenditure were available in the visited CHCs/ /PHC for the current year up

to November, 2011.

633

5. Untied Funds:

a. Untied Funds @ Rs. 10,000 to each Sub centre, @ Rs. 50,000 to each CHC and @ Rs.

25,000 to PHC were provided through block level CHCs and PHCs every year in the

district.

b. Details of the fund provision and expenditure incurred in the district for the year 2010-

11 and 2011-12 are reported as under:

(in Rs.)

Srl.No Particulars of

Untied Fund

In the year 2010-11 In the year 2011-12

For

Sub

centres

For

CHCs/PHCs

For

Sub

centres

For

CHCs/PHCs

1 Fund allotted 7,70,000 4,00,000 7,70,000 4,00,000

2 Expenditure

incurred

7,70,000 4,00,000 3,64,351 65,081

3 Total Balance Nil Nil 4,05,649 3,34,919

c. It was observed that, ANMs were updating their Cashbook/ Passbook of Untied funds at

Sub Centres level in the district.

d. During visit to the centres, team found that the district had released Rs. 2,00,000 to

CHC Baijnath, Rs. 2,90,000 to CHC Kapkot and Rs. 2,80,000 to PHC Kanda for the

year 2010-11 for their Sub Centre as untied funds and the amount was fully utilised .

Similarly, funds to the tune of Rs. 2,00,000 to CHC Baijnath and Rs. 2,90,000 to CHC

Kapkot was provided and out of that Rs. 44,000 at CHC Baijnath & Rs. 1,47,000 at

CHC Kapkot were utilised in current year up to October, 2011. Records regarding

utilisation of funds was not made available to the team at PHC Kanda.

e. The team reported that, Untied Funds were utilized for printing of OPD & Indoor slip,

buying of stationary and PVC goods etc. in the centres visited.

6. Janani Suraksha Yojana (JSY):

a. During the year 2010-11, district had spent funds to the tune of Rs. 43,58,791 out of

allotted budget of Rs. 46,22,216 under the scheme. Similarly, an amount of Rs.

21,13,800 was utilised against the available amount of Rs. 39,07,989 during current

year up to October, 2011.

634

b. As per details received, as many as 2186 JSY beneficiaries in the year 2010-11 and

1211 JSY beneficiaries in current year up to October, 2011 have been paid cash

incentive under the scheme.

c. The budget provision and expenditure at the visited CHCs is reported as below:

Sr.

No.

Particulars For the year 2010-11 ( in Rs)

CHC Baijnath CHC Kapkot

1 Total fund available 10,72,156 9,70,000

2 Total expenditure under

JSY

10,61,763 9,05,400

3 Total balance amount 10,393 64,600

4 Total beneficiaries 564 494

For the year 2011-12 up to October, 2011 ( in Rs)

1 Total fund available 7,10,393 4,00,000

2 Total expenditure under

JSY

4,90,750 3,92,950

3 Total balance amount 2,19,643 7,050

4 Total beneficiaries 297 242

d. 39 JSY beneficiaries were contacted out of 45 selected in the area of visited Centres in

the district. All the beneficiaries stated that they had received incentives through

cheque from the concerned CHCs and PHCs within 1 to 2 month of the date of delivery.

Most of the mothers were relieved from the hospital within 10 to 20 hours of delivery.

JSY registers found to be maintained properly and checked by concerned MOs

regularly.

7. 24x7 Delivery Care Services:

a. 15 institutions were identified to provide 24x7 delivery care services in the district.

During 2011-12 additional incentive is released to these Centres for improvement of

institutional delivery after fulfilling the normal target.

b. Records regarding total number of institutional deliveries & night hours delivery

conducted by 24x7 institutions/ FRUs were not made available in the district.

c. In the visited CHC Baijnath, a total of 448 deliveries during 2010-11 and 274 deliveries

during 2011-12 have been conducted during current year up to October, 2011. A, total

229 deliveries have been conducted during 2011-11 in CHC Kapkot. Facilities for

635

caring mother and new born baby were found to be satisfactory in all the visited

institutions under the scheme.

8. Physical infrastructure (HSC/PHC/CHC)

(i) CHCs/ PHC:

a. Visited CHCs at Baijnath and Kapkot were functioning in Govt. building but the

maintenance of the hospitals was not up to the mark. Hospital buildings for FRU

Baijnath was constructed but not functional till the time of visit by the team.

b. Blood Storage unit was not set up in both visited CHCs. Incinerator was not available

there but bio-medical waste pits were available. Injections Quinine and Arteether were

not available in the visited CHCs. Jeep was not available in CHC Kapkot.

c. Visited PHC at Kanda was functioning in Govt. buildings. Though Cold Chain

equipment is available but vaccines are kept in CHC Bageshwar considering the

suitability of proper distribution. Jeep and driver was not provided. No supply of IFA (L

& S) tablets/ syrup and Vitamin- A tablets was found in PHC Kanda.

d. AYUSH Medical Officer was posted but Pharmacist and medicines under this segment

were lacking in the PHC.

(ii) Health Sub Centres:

a. All visited Sub centres i.e. Bajyula, Laubaj, Saran, Bhanar, Kamedi and Dhapala Sheri

were functioning in Govt. buildings.

b. It was observed that labour room was available in all visited Sub Centres but delivery

was being conducted only in the Sub centre at Vajula.

c. Nischay pregnancy test kit, RDT kit, Hemoglobinometer and Sanitary Napkins were not

available in the visited Sub centres. No supply of Kits- A & B was observed in the

visited Sub centres at Bajyula, Laubaj, Saran and Kamedi.

d. Oxytocin tablets, Ampicillin capsules and Gentamycine injection were not available at

Laubaj, Saran, Bhanar, Kamedi and Dhapala Sheri.

e. Availability of DDKs, Co-trimoxazole, IFA tablets and Vitamin- A needs to be

maintained at Sub Centres Bajyula, Saran, Kamedi and Dhapala Sheri.

f. Bleaching powder, Chloroquine, Paracetamol and Metronidazole tablets were not

available at Sub centres Bajyula, Kamedi and Dhapala Sheri.

g. Torch and ORS packets at Sub Centre Baijula, Electricity, Delivery table, Mclntsh

sheet, Ambu bag/suction, BP apparatus and DDK at Sub Centre Laubaj, Electricity,

Delivery kit and Ambu bag/suction at Sub Centre Saran, Ambu bag/suction and

Vitamin- A at Sub Centre Bhanar, ORS packets, Kerosene oil and EC Pills at Sub

636

Centre Kamedi, Ambu bag/suction, Torch and Kerosene oil at Sub Centre Dhabalaseri

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. 14 (26%) mothers were not aware about danger sign of ARI, 5 (9%) were not aware

about use of ORS and 10 (19%) mothers replied that their babies were not weighed at

the time of birth and did not receive three Post Natal checkups.

c. It was also observed that 14 (26%) mothers were not sufficiently aware of contraceptive

methods and 20 (37%) mothers about their side effects.

(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 in the PHC/

CHC areas. Mostly people were satisfied with the services provided at PHCs and CHC.

In the visiting area, proper attention to register the AN mothers within the 16 weeks of

pregnancy and improve the awareness about danger sign of pregnancy, referral

mechanisms and breast feeding practices need to be increased.

10. IT Infrastructure and Mother & Child Tracking System:

a. Team found that computers were available at district level and at Block level PHC/CHC

(one in each Block). However, Internet connectivity was available at district level only.

b. MCH Tracking formats were available in the Sub centres.

c. Health functionaries were sensitized in MCH formats at PHC/ CHC level. They are

capturing data in the formats and making data entry at PHC/ CHC level through cyber

cafe.

11. Registers, records and reports maintained at the visited centres:

a. Performance reported under CuT at CHCs Baijnath, Kapkot and at PHC Kanda could

not be verified due to want of service registers. Oral Pills and Nirodh distribution

registers were also not maintained in the centres visited.

b. Eligible Couple register, Cash book for untied funds and VHSNC proceeding registers

were not being maintained at any of the visited centres.

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c. Printed Registers for Family Planning services, Stock book, Monthly Reporting format

and Cash book for untied fund were not supplied to Sub Centres by higher authority.

2.District:- Champawat

Major observations of Regional Evaluation Team, Lucknow about the Evaluation

work carried out in Champawat district of Uttarakhand in November, 2011

I. Details of the visited Institutions:

District

visited

PHCs/CHCs visited SCs visited

Champawat CHC: Champawat

PHCs: Pati and Barakot

Narsingh Danda, Sipty, Kheti Khan,

Pati, Naumana and Bardha Khan

II. Major Observations:

1. Health Human Resources:

a. The staff position in the district was not up to the mark. 12 of the 84 sanctioned posts of

ANM, all 18 sanctioned posts of MPW (M), 2 of the 8 sanctioned posts of Health

Supervisor (F), 6 of the 14 sanctioned posts of Medical Officers, 18 of the 26

sanctioned posts of Specialist, 15 of the 25 sanctioned posts of Staff Nurse and all 5

sanctioned posts of Lab Technician were lying unfilled in the district.

b. All the posts in DPMU i.e. District Programme Manager, District Account Manager,

District Data Account Assistant, Block Programme Manager and Block Level

Accountant were filled in the district.

638

c. In CHC, Champawat, 5 of the 35 sanctioned posts of ANM, all 4 sanctioned posts of

MPW (M), 5 of the 6 sanctioned posts of Specialist, 3 of the 7 sanctioned posts of Staff

Nurse and all 2 sanctioned posts of Lab Technician were lying vacant.

d. In PHC Pati, 3 of the 19 sanctioned posts of ANM, one sanctioned post of MPW (M),

1of the 2 each sanctioned post of Health Supervisor (F) & Health Supervisor (M), 4 of

the 7 sanctioned posts of Medical officer, 1 of the 2 sanctioned posts of Staff Nurse and

the sanctioned post of Lab Technician were lying unfilled. Similarly, 3 of the 15

sanctioned posts of ANM, one sanctioned post of MPW (M), all 2 sanctioned posts

each of Health Supervisor (M) and Staff Nurse, 1 of the 4 sanctioned posts of Medical

officer and sanctioned post of Lab Technician in PHC Barakot were lying vacant.

2. Functioning of Chikitsa Prabandhan Samiti (CPS):

a. Rogi Kalyan Samiti (called Chikitsa Prabandhan Samiti (CPS) in the state) has been

constituted/ registered in all CHC and PHC in the district. It was reported that Chief

Development Officer (CDO) is a President of executive body at CHC level and CMO is

a President of executive body at PHC level. CPS account jointly operated by CDO/

CMO and concerned CHC/PHC Medical Officer.

b. RKS fund including Untied Fund and Annual Maintenance Grant etc. are kept at the

disposal of Chikitsa Prabandhan Samiti. Meeting of executive body of CPS were being

conducted once in a year.

c. Details of expenditure made for developmental activities in the visited CHCs/PHC and

the approvals taken from the CPS in this regard were being recorded in the registers.

3. Functioning of ASHA Scheme:

a. As reported, 312 ASHAs were selected for covering 687 villages in the district during

2010-11. Out of that, 277 ASHAs were trained in all modules. Drug kits were not

provided to the ASHAs up to visiting month in the district.

b. During visit to the Sub Centres at Narsingh Danda, Sipty, Kheti Khan, Pati, Naumana

and Bardha Khan, 8 ASHAs were interviewed and most of them were receiving

performance based remuneration on an average Rs. 10000- 15000 yearly.

c. ASHA is involved in VHSNC as a member.

4. Functioning of Village Health Sanitation & Nutrition Committee (VHSNCs):

a. It has been reported that 653 VHSNCs were functioning in the district and joint bank

account in the name of concerned Gram Vikas Adhikari (GVA) and Gram Pradhan has

been opened in all VHSNCs to handle the funds for undertaking sanitation work in the

villages.

639

b. As reported, every revenue village is given Rs. 10,000 every year as VHSNC fund

under the scheme in the district. The total budget for the VHSNCs in the district was

allotted to the tune of Rs. 65,30,000 for 653 revenue villages through CHCs / PHCs in

the year 2010-11.

c. During visit to the centres, team found that the district had released Rs. 21,70,000 to

CHC Champawat, Rs. 15,50,000 to PHC Pati and Rs. 10,10,000 to PHC Barakot as

VHSNCs fund during 2010-11 but the expenditure details were not taken from the

concerned GVA/ Pradhans.

d. During visit to the Sub centres, the team observed that VHSNCs fund is being

operated by Gram Vikas Adhikari (GVA) and Gram Pradhan. The details of expenditure

were not made available to the ANMs by GVA/ Gram Pradhan.

5. Untied Funds:

a. Untied Funds @ Rs. 10,000 to each Sub centre, @ Rs. 50,000 to each CHC and @ Rs.

25,000 to PHC were provided through block level CHCs and PHCs in every year in the

district.

b. Details of the fund provision and expenditure incurred in the district for the year 2010-

11 and 2011-12 are reported as under:

(in Rs.)

Sr.

No

Particulars of

Untied Fund

In the year 2010-11 In the year 2011-12

For

Sub

centres

For

CHCs/PHCs

For

Sub

centres

For

CHCs/PHCs

1 Fund allotted 6,60,000 2,50,000 Nil 2,50,000

2 Expenditure

incurred

6,41,225 2,50,000 Nil Nil

3 Total Balance 18,775 Nil Nil 2,50,000

c. It was reported that, Sub Centres level untied funds were utilised for buying of Heater,

Ambubag, Cooler, Emergency light, Almirah, Gloves, Fan, Chair, Bench & Chauki, Tea

tray, Photo copy, Pen Paper, Nischay Pregnancy Test kit, repairing of electrical wiring,

Floor & Window etc.

d. During visit to the centres, the team found that the district had released Rs. @ 1,90,000

at CHC Champawat and PHC Pati for 19 Sub Centres each and Rs. 1,00,000 to PHC

Barakot for 10 Sub Centres as untied funds and out of that Rs. 1,94,013 of CHC

Champawat, Rs. 1,71,225 at PHC Pati and Rs. 1,00,000 at PHC Barakot were utilised

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in the year 2010-11. Similarly, an amount @ Rs. 1,90,000 to CHC Champawat and

PHC Pati was provided and out of that Rs. 149,167 at CHC Champawat and Rs.

1,05,000 at PHC Pati were utilised in current year up to October, 2011. Allotted fund

was not utilised by PHC Barakot.

e. Untied Funds were utilized for purchasing of computer in both visited PHCs. Similarly,

funds were utilised for payment of telephone bill, water bill and hospital contingency,

stationary and printer cartridge etc. in CHC Champawat.

6. Janani Suraksha Yojana (JSY):

a. During the year 2010-11, district had spent funds to the tune of Rs. 57,42,050 out of

allotted budget of Rs. 59,33,700 under the scheme. Similarly, an amount of Rs.

16,08,500 was utilised against the available amount of Rs. 21,65,000 during current

year up to October, 2011.

b. As per details received, as many as 2929 JSY beneficiaries in the year 2010-11 and

1312 JSY beneficiaries in current year up to October, 2011 have been paid cash

incentive under the scheme.

c. The budget provision and expenditure at the visited PHC/CHCs is reported as below:

Sr.

No.

Particulars For the year 2010-11 ( in Rs)

CHC

Champawat

PHC Pati PHC

Barakot

1 Total fund available 11,00,000 10,00,000 1,00,000

2 Total expenditure under JSY 10,99,600 9,44,200 56,000

3 Total balance amount 400 55,800 44,000

4 Total beneficiaries 837 587 91

For the year 2011-12 up to October, 2011 ( in Rs)

1 Total fund available 5,97,500 4,62,500 1,00,000

2 Total expenditure under JSY 4,79,200 2,86,500 79,200

3 Total balance amount 1,18,300 1,76,000 20,800

4 Total beneficiaries 371 217 88

d. 38 JSY beneficiaries were contacted out of 42 selected in the area of visited Centres in

the district. All contacted beneficiaries stated that they had received incentives through

cheque from the concerned CHCs and PHCs within 10 to 15 days of the date of

delivery. Most of the mothers were relieved from the hospital within 10 to 14 hours of

delivery. JSY registers were maintained properly and checked by concerned MOs

regularly.

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7. 24x7 Delivery Care Services:

a. As reported, district had conducted total 2929 deliveries during 2010-11 and 1312

deliveries during current year up to October, 2011. Figures of night hours delivery

conducted by 24x7 institutions/ were not made available in the district.

b. In the visited centres, 464 deliveries at CHC Champawat, 270 at PHC Pati and 12

deliveries at PHC Barakot were conducted under 24x7 during 2010-11 Facilities for

caring mother and new born baby were found to be satisfactory in all the visited

institutions under the scheme.

8. Physical infrastructure (HSC/PHC/CHC)

(i) CHC/ PHCs:

a. CHC Champawat was functioning in Govt. building but the maintenance of the hospital

was not up to the mark. Blood Storage unit was not set up and Incinerator was not

available there.

b. Visited PHCs at Pati and Barakot was functioning in Govt. buildings but maintenance of

the hospitals was not up to the mark. Except IFA tablets/ syrup and Vitamin- A tablets/

syrup all medicine and equipments were available in both visited PHCs.

(ii) Health Sub Centres:

a. All visited Sub centres i.e. Narsingh Danda, Sipty, Kheti Khan, Pati, Naumana and

Bardha Khan were functioning in Govt. buildings. Additional ANM was not posted in the

centres visited.

b. It was observed that labour room was available in all visited Sub Centres except Sub

Centre Bardha Khan but delivery was being conducted only in the Sub centre at Kheti

Khan.

c. Nischay pregnancy test kit, RDT kit, DD kits, Oxitocine tablets, IFA tablets, Vitamin- A,

Ampicillin capsules and Gentamycine injection were not available in the visited Sub

centres.

d. No supply of Kits- A & B was observed in the visited Sub centres at Narsingh Danda,

Sipty, Kheti Khan, Pati and Bardha Khan.

e. Delivery table, Ambu bag/suction and Mclntsh sheet were not available at Sipty, Kheti

Khan and Bardha Khan.

f. Co-trimoxazole, Chloroquine, Paracetamol, Metronidazole tablets and CuT insertion kit

were not available at Sub centres Narsingh Danda, Pati and Naumana.

g. Bench, Ambu bag/suction, Delivery kit, Gloves, Kerosene oil, Chlorin solution, Sanitary

Napkins, CuT and Oral Pills at Sub Centre Narsingh Danda; BP apparatus, ORS

packets, Antiseptic solution, Kerosene oil, Chloroquine and Metronidazole tablets at

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Sub Centre Shipti; Weight machine (Infant), ORS packets, EC Pills, Co-trimoxazole and

Metronidazole tablets at Sub Centre Kheti Khan, Ambu bag/suction, Kerosene oil and

Chlorin solution at Sub Centre Pati; ORS packets at Sub Centre Naumana, Foot Stool,

Steam sterilizer, CuT insertion kit, ORS packets, Kerosene oil and Chloroquine tablets

at Sub Centre Bardha Khan 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. 28 (52%) mothers were not aware about danger sign of ARI, 3 (6%) were not aware

about use of ORS, 6 (11%) mothers replied that their babies were not weighed at the

time of birth and 18 (33%) did not receive three Post Natal checkups.

c. It was also observed that 12 (22%) mothers were not sufficiently aware of contraceptive

methods and 20 (37%) mothers about its side effects.

(ii) Services of PHC-

a. 30 Persons who were generally utilising the services at visited PHC/CHCs were

interviewed and it was found that about 30% community were not 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 in the PHC/

CHC areas. Mostly people were satisfied with the services provided at PHCs and CHC.

In the visiting area, proper attention to register the AN mothers within the 16 weeks of

pregnancy and improve the awareness about danger sign of pregnancy, referral

mechanisms and breast feeding practices need to be increased.

10. IT Infrastructure and Mother & Child Tracking System:

a. Team found that 3 computers were available at district level and one each Block level

PHCs. However, Internet connectivity was available at district level only.

b. MCH Tracking formats were available in the Sub centres.

c. Health functionaries were sensitized in MCH formats at PHC/ CHC level. They are

capturing data in the formats and making data entry at PHC/ CHC level through cyber

cafe.

11. Registers, records and reports maintained at the visited centres:

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a. Performance reported under CuT at CHC Champawat and at PHCs Pati & Barakot

could not be verified due to want of service registers. Oral Pills and Nirodh distribution

registers were also not maintained in the centres visited.

b. Registers for Family Planning services and Stock book for FP items were not being

maintained at Narsingh Danda, Kheti Khan and Naumana. Cash book for untied funds

was not maintained at Sub centre Naumana.

3.District: Haridwar

Major observations of Regional Evaluation Team, Lucknow about the Evaluation work

carried out in Haridwar district of Uttarakhand in December, 2011

I. Details of the visited Institutions:

District visited CHCs/ FRU/ PHC

visited

SCs visited

Haridwar CHCs: Laksar, Narsan

and Bhagwanpur

PHC: Imalikhera

Bhogpur, Rampur Raigati, Mundawali,

Libbar Hedi, Mohamedpur, Thansipur

and Saliyar

II. Major Observations:

1. Health Human Resources:

a. As reported, 52 of the 94 sanctioned posts of Medical Officer, 18 of the 184 sanctioned

posts of ANM, all 72 sanctioned posts of MPW (M), 4 of the 42 sanctioned posts of

Health Supervisor (M), 1 of the 18 sanctioned posts of Staff Nurse/ GNM and 2 of the

12 sanctioned posts of Lab Technician were lying vacant in the district. The latest

position for the posts of Specialist in whole of the district was not made available at

district office.

b. All the posts in DPMU i.e. District Programme Manager, District Account Manager,

DDAA, BPM and Block Level Accountant were filled in the district.

c. In CHC Laksar, 1 of the 4 sanctioned posts of Health Supervisor (M ), all 14 sanctioned

posts of MPW (M) and 6 sanctioned posts of Specialist were lying vacant. Similarly, 2

of the 30 sanctioned posts of ANM, 15 sanctioned posts of MPW (M), 4 of the 10

sanctioned posts of Health Supervisor (M) and all 6 sanctioned posts of Specialist in

CHC Narsan were lying vacant. In CHC/FRU Bhagwanpur, 9 of the 30 sanctioned

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posts of ANM, all 11 sanctioned posts of MPW (M), 2 of the 9 sanctioned posts of

Health Supervisor (M), 8 of the 10 sanctioned posts of Medical Officer and 4 of the 5

sanctioned posts of Specialist were lying vacant.

d. In PHC Imalikhera, 1 of the 30 sanctioned posts of ANM, all 12 sanctioned posts of

MPW (M), 2 of the 6 sanctioned post of Staff Nurse/ GNM and 2 of the 7 sanctioned

posts of Medical officer were lying unfilled.

2. Functioning of Chikitsa Prabandhan Samiti (CPS):

a. Rogi Kalyan Samiti (called Chikitsa Prabandhan Samiti (CPS) in the state) has been

constituted/ registered in all CHCs and PHCs in the district. It was reported that Chief

Development Officer (CDO) is the President of executive body of RKS at CHC level

and CMO at PHC level. CPS account jointly operated by CDO/ CMO and concerned

CHC/PHC Medical Officer.

b. RKS fund including Untied Fund, Annual Maintenance Grant and Seed Money etc. are

kept at the disposal of Chikitsa Prabandhan Samiti.

c. Meeting of executive body of CPS was conducted once in 2010-11 and twice in 2011-

12 for giving approval to incur expenditure on the development activities at CHC Laksar

and once in each year at PHC Imaliakhera during 2010-11 and 2011-12.

d. However, proceeding register was not made available to the team at CHCs Narsan and

Bhagwanpur.

3. Functioning of ASHA Scheme:

a. As reported, the district has fullfiled its target by selecting 1439 ASHAs in the district

during 2010-11. All selected ASHAs trained up to 5th modules and working with drug

kits in 505 villages in the district. It was also reported that no drug kits have been

distributed to the ASHAs during current year up to visiting month in the district. No new

ASHA proposed to be inducted in the district during 2011-12.

b. During visit to the Sub Centres at Bhogpur, Rampur Raigati, Mundawali, Libbar Hedi,

Mohamedpur, Thansipur and Saliyar, 8 ASHAs were interviewed and as informed most

of them were receiving performance based remuneration on an average Rs. 1600-

2500 yearly.

c. ASHA is involved in each VHSNC as a member.

4. Functioning of Village Health Sanitation & Nutrition Committee (VHSNCs):

a. It has been reported that 451 VHSNCs were functioning in the district and joint bank

account in the name of concerned Gram Vikas Adhikari (GVA) and Gram Pradhan has

been opened in all the VHSNCs to handle the funds for undertaking sanitation work in

645

the villages. Meetings of the VHSNCs were not being conducted in the visited Sub

Centres.

b. As reported, every revenue village is given Rs. 10,000 every year as VHSNC fund

under the scheme in the district. The total budget for the VHSNCs in the district was

allotted to the tune of Rs. 45,10,000 for 451 revenue villages through CHCs / PHCs and

full amount was spent by the VHSNCs during 2010-11. Similarly, the district had

received Rs. 45,10,000 as VHSNC funds for the year 2011-12 which was released

directly to Panchayat Raj Officer (PRO) by CMO of the district. No details of

expenditure were available at district office as well visited CHCs/ /PHC.

c. During visit to the centres, team found that an amount of Rs. 8,20,000 to CHC Laksar,

Rs. 8,50,000 to CHC Narsan, Rs. 7,80,000 to CHC Bhagwanpur and Rs. 5,40,000 to

PHC Imaliakhera have been released as VHSNCs fund for the year 2010-11 but no

details of expenditure were available in the visited CHCs and PHC.

5. Untied Funds:

a. Untied Funds @ Rs. 10,000 to each Sub centre, @ Rs. 50,000 to each CHC and @ Rs.

25,000 to PHC were provided through block level CHCs/ PHCs every year in the

district.

b. Details of the fund provision and expenditure incurred in the district for the year 2010-

11 and 2011-12 are reported as under:

(in Rs.)

Sr.

No

Particulars of

Untied Fund

In the year 2010-11 In the year 2011-12

For

Sub centres

For

CHCs/PHCs

For

Sub centres

For

CHCs/PHCs

1 Fund allotted 15,90,000 3,25,000 15,90,000 3,25,000

2 Expenditure incurred 15,90,000 3,24,851 10,73,394 2,88,373

3 Total Balance Nil 149 5,16,606 36,627

c. It was observed that, ANMs were updating their Cashbook/ Passbook maintained for

untied fund at Sub Centres level in the district.

d. During visit to the centres, team found that the district had released Rs. 2,50,000 to

CHC Laksar, Rs. 3,00,000 to CHC Narsan, Rs. 2,80,000 to CHC Bhagwanpur and Rs.

2,70,000 to PHC Imaliakhera for the year 2010-11 for their Sub Centre as untied funds

and out of that except CHC Laksar, Rs. 3,00,000 at CHC Narsan, Rs. 48,000 at CHC

Bhagwanpur and Rs. 2,87,900 at PHC Imaliakhera were utilised by the Sub centres.

Detail of expenditure at CHC Laksar was not made available to the team. Similarly,

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amount to the tune of Rs. 2,50,000 to CHC Laksar, Rs. 3,00,000 to CHC Narsan, Rs.

2,80,000 to CHC Bhagwanpur and Rs. 2,70,000 to PHC Imaliakhera were provided and

out of that Rs. 1,20,000 at CHC Laksar, Rs. 70,000 at CHC Narsan, Rs. 1,36,000 at

CHC Bhagwanpur and Rs. 2,28,000 at PHC Imaliakhera were utilised by their Sub

centres in the current year up to December, 2011.

e. During visit it was observed that, CHCs @ Rs. 50,000 and PHCs @ Rs. 25,000 are

given untied funds regularly. Meeting of CPS was conducted at block level PHC/ CHC

and minutes were recorded, Ledger and cash book of untied fund was maintained and

fund was utilised as per approval of the CPS meeting on the development activities of

the PHC/ CHC.

f. It was reported that, Sub Centres level untied funds were utilised for buying of

Medicine, Hemoglobinometer and Curtain at Sub Centre Bhogpur; BP apparatus and

Hemoglobinometer at Sub Centre Rampur Raigati; BP apparatus, Chair, Curtain and

Mobile charging at Sub Centre Libbar Hedi; Table, Chair, Curtain and Bed sheets at

Sub Centre Mohamedpur; Towel, Banket, Register, Pen, Sanitation, Chair, BP

apparatus, HB kits and Mobile charging at Sub Centre Thansipur, Examination table,

BP apparatus and Curtain at Sub Centre Saliyar.

6. Janani Suraksha Yojana (JSY):

a. During the year 2010-11, district had spent funds to the tune of Rs. 1,36,31,028 out of

allotted budget of Rs. 1,68,41,828 under the scheme. Similarly, an amount of Rs.

69,89,423 was utilised against the available amount of Rs. 1,35,12,447 during current

year up to November, 2011.

b. As per details received, as many as 7540 JSY beneficiaries in the year 2010-11 and

4680 JSY beneficiaries in current year up to November, 2011 have been paid with cash

incentive under the scheme.

c. The budget provision and expenditure at the visited PHC/CHCs is reported as below:

Sr.

No.

Particulars For the year 2010-11 ( in Rs)

CHC Laksar CHC Narsan CHC

Bhagwanpur

PHC

Imaliakhera

1 Total fund available 26,27,650 9,24,000 15,00,000 6,00,000

2 Total expenditure

under JSY

23,16,900 7,33,800 10,96,600 4,80,700

3 Total balance

amount

3,10,750 1,90,200 4,03,400 1,19,300

4 Total beneficiaries 1246 423 576 215

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For the year 2011-12 up to November, 2011 ( in Rs)

1 Total fund available 20,15,700 7,88,900 8,49,250 6,49,250

2 Total expenditure

under JSY

12,22,350 4,11,550 3,89,900 3,32,900

3 Total balance

amount

7,93,350 3,77,350 4,59,350 3,16,350

4 Total beneficiaries NA 135 209 154

NA- Figures were not made available

d. 39 JSY beneficiaries were contacted for sample verification out of 53 selected in the

area of visited Centres in the district. All the beneficiaries stated that they had received

incentives through cheque from the concerned CHCs and PHCs within a week of date

of delivery. JSY registers were found to be maintained properly and also checked by

concerned MOs regularly.

7. 24x7 Delivery Care Services:

a. 7 institutions were identified to provide 24x7 delivery care services in the district. It was

reported that these 7 institutions fulfilled their targeted achievement during 2011-12 and

State Mission Director (NRHM) rewarded them providing additional incentives. Actual

numbers of deliveries conducted by 24x7 institutions/ FRUs were not made available to

the team in the district office.

b. In the visited centres, it was observed that in CHC Laksar, 1024 deliveries have been

conducted during 2010-11 and 618 deliveries during current year up to November,

2011. Similarly, total 231 deliveries during 2010-11 and 135 deliveries during current

year up to November, 2011 were conducted in CHC Narsan. 576 deliveries during

2010-11 and 209 deliveries during current year up to November, 2011 were conducted

in CHC Bhagwanpur. Facilities for caring mother and new born baby were found to be

satisfactory in all the visited institutions.

8. Physical infrastructure (HSC/PHC/CHC)

(i) CHCs/ PHC:

a. Visited CHCs at Laksar, Narsan and Bhagwanpur were functioning in Govt. building but

the maintenance of the hospitals was not up to the mark.

b. Blood Storage unit was not set up in both visited CHCs. Incinerator was not available

there but bio-medical waste pits were available. Injections Quinine and Arteether were

not available in the visited CHCs. All 6 sanctioned posts of Specialist each at CHCs

Laksar & Narsan and 3 of the 5 sanctioned posts of Specialist in CHC Bhagwanpur

were lying vacant.

648

c. Visited PHC at Imaliakheda was functioning in Govt. buildings. Though Cold Chain

equipment was available but vaccines are kept in Dy. CMO office, Roorkee for proper

distribution to the facilities. No supply of IFA (L & S) tablets/ syrup and Vitamin- A

tablets was observed in PHC Imaliakheda.

d. AYUSH Medical Officer was posted but Pharmacist and medicines under this segment

were lacking in the PHC.

(ii) Health Sub Centres:

a. All visited Sub centres i.e. Bhogpur, Rampur Raigati, Mundawali, Libbar Hedi,

Mohamedpur, Thansipur and Saliyar were functioning in Govt. buildings. At Sub Centres

Thansipur and Saliyar, ANMs were not staying at their Sub Centre head quarters.

b. It was observed that labour room was available in Sub Centres at Bhogpur, Rampur

Raigati, Mundawali, Thansipur and Saliyar but delivery was being conducted only in the

Sub Centre at Bhogpur.

c. Nischay Pregnancy Test Kit, RDT Kit, Heamoglobinometer, Sanitary Napkins, Oxytocin

Tablets, Ampicillin Capsules and Gentamycine Injection were not available in the

visited Sub Centres. No supply of Kits- A & B was observed in the visited Sub centres

at Bhogpur, Rampur Raigati, Mundawali, Libbar Hedi and Mohamedpur.

d. Availability of ORS packets, DDKs, Co-trimoxazole, Paracetamol and Metronidazole,

IFA tablets and Vitamin- A needed to be maintained at Sub Centres Bhogpur,

Mundawali and Saliyar.

e. DDKs, Keosene oil, Vitamin- A and Paracetamol tablets were not available at Rampur

Raigati and Libbar Hedi sub centres.

f. ORS packets, IFA tablets, EC Pills, Condoms and Antiseptic solution at Sub Centre

Rampur Raighati, Steam Sterilizer, Torch, CuT, Oral Pills, EC Pills and Antiseptic

solution at Sub Centre Mundawali, Ambu bag/suction, Chloroquine and Metronidazole

tablets at Sub Centre Libbar Hedi; Ambu bag/suction, DDK, Keosene oil, Paracetamol

and Metronidazole tablets at Sub Centre Mohamedpur; ORS packets, Co-trimoxazole,

Metronidazole, IFA tablets, Vitamin- A and EC Pills at Sub Centre Thansipur, Keosene

oil, CuT, EC Pills, Bleaching powder, Chloroquine tablets and Antiseptic solution at Sub

Centre Saliyar were not available.

9. Assessment and opinion of the Community on Health Services:

(i) Services of ANM-

a. 63 mothers having child up to one year of age from the area of 7 visited sub centres

were interviewed by the team to assess their opinion about the services rendered by

the ANMs.

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b. 25 (40%) mothers were not aware about danger sign of ARI, 7 (11%) were not aware

about use of ORS and 15 (24%) mothers replied that their babies were not weighed at

the time of birth and also ANM is not available when needed. 11 (17%) contacted

mothers did not receive three Post Natal checkups.

c. It was also observed that 35 (56%) mothers were not sufficiently aware about

contraceptive methods and 32 (51%) mothers about its side effects.

(ii) Services of PHC-

a. 35 Persons who were generally utilising the services at visited PHC/CHCs were

interviewed and it was found that about 37% community members needed

improvement of services at PHC/CHCs and 15 (43%) villagers replied that MOs were

not staying at PHC/CHC headquarter regularly.

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 in the PHC/

CHC areas. The team observed that health services in the area should be improved by

capturing the registration of 100% AN mothers and improving the awareness about

danger sign of pregnancy, referral mechanisms and breast feeding practices among

ANC and PNC.

10. IT Infrastructure and Mother & Child Tracking System:

a. Team found that computers were available at district level and at Block level

PHCs/CHCs (one in each Block). However, Internet connectivity was available at

district level only.

b. MCH Tracking formats were available in each Sub centres.

c. Health functionaries were sensitized in MCH formats at PHC/ CHC level. They are

capturing data in the formats and making data entry at PHC/ CHC level through cyber

cafe.

11. Registers, records and reports maintained at the visited centres:

a. Performance reported under CuT at CHCs Laksar, Narsan, Bhagwanpur and at PHC

Imaliakheda could not be verified due to want of service registers. Oral Pills and Nirodh

distribution registers were also not maintained in the centres visited.

b. Printed Eligible Couple register were not being maintained at any of the visited centres.

c. Printed Registers for Family Planning services, Stock book, Monthly Reporting format

and Cash book for untied fund were not supplied to Sub Centre in Mundawali. Similarly,

registers for Family Planning services and Stock book at Sub Centre Bhogpur and

Family Planning services register at Sub Centre Thansipur were also not supplied.

650

4.District: Deharadun

Major observations of Regional Evaluation Team, Lucknow about the Evaluation

work carried out in Dehradun district of Uttarakhand in December, 2011

I. Details of the visited Institutions:

District visited CHCs/ FRU/ PHC

visited

SCs visited

Dehradun CHCs: Raipur,

Sahaspur and

Doiwala

PHC: Kalsi

Saurasaroli, Nanukhera, Charaba,

Shelakuyi, Kanherwala, Jahuri and

Haiya

II. Major Observations:

1. Health Human Resources:

a. 58 of the 167 sanctioned posts of Medical Officer, 16 of the 48 sanctioned posts of

Specialist, 7 of the 212 sanctioned posts of ANM, 52 of the 64 sanctioned posts of

MPW (M), 4 of the 34 sanctioned posts of Health Supervisor (M) and 3 of the 17

sanctioned posts of Lab Technician were vacant in the district.

b. All the posts in DPMU i.e. District Programme Manager, District Account Manager,

DDAA, BPM and Block Level Accountant were filled in the district.

c. In CHC Raipur, 2 of the 4 sanctioned posts of MPW (M), 1of the 4 each sanctioned

posts of Health Supervisor (M) & Health Supervisor (F) and 4 of the 6 sanctioned posts

of Specialist were lying vacant. Similarly, 9 of the 12 sanctioned posts of MPW (M), 4 of

the 6 sanctioned posts of Health Supervisor (M), 1 of the 5 sanctioned posts of Medical

Officer and 2 of the 6 sanctioned posts of Specialist in CHC Sahaspur were lying

vacant. In CHC/FRU Doiwala, all sanctioned posts were filled up.

d. In PHC Kalsi, 2 of the 29 sanctioned posts of ANM, 6 of the 7 sanctioned posts of MPW

(M), 3 of the 4 sanctioned posts of Health Supervisor (F) and 3 of the 5 sanctioned

posts of Health Supervisor (M) were lying unfilled.

2. Functioning of Chikitsa Prabandhan Samiti (CPS):

a. Rogi Kalyan Samiti (called Chikitsa Prabandhan Samiti (CPS) in the state) has been

constituted/ registered in all CHCs and PHCs in the district. It was reported that Chief

Development Officer (CDO) is the President of executive body of CPS at CHC level

651

and CMO at PHC level. CPS account jointly operated by CDO/ CMO and concern

CHC/PHC Medical Officer.

b. RKS fund including Untied Fund, Annual Maintenance Grant and Seed Money etc. are

kept at the disposal of Chikitsa Prabandhan Samiti.

c. Meeting of executive body of CPS was conducted once in a year in 2010-11& 2011-12

at CHCs Raipur and Sahaspur, twice in a year in 2010-11 and once in a year in 2011-

12 at CHC Doiwala for taking approval to incur expenditure on the development

activities. Expenditure made for developmental activities in the visited CHCs at Raipur,

Sahaspur & Doiwala was reportedly in accordance to the approval taken from the

concerned CPS.

d. However, proceeding register was not made available to the team at PHC Kalsi.

3. Functioning of ASHA Scheme:

a. As reported, 1280 ASHAs were selected for covering 738 villages in the district during

2010-11. All selected ASHAs were trained up to 5th modules and totally 1000 ASHAs

have been provided with drug kits. No new ASHA is proposed to be inducted in the

district during 2011-12.

b. During visit to the Sub Centres at Saurasaroli, Nanukhera, Charaba, Shelakuyi,

Kanherwala, Jahuri and Haiya, 8 ASHAs were interviewed and most of them were

receiving performance based remuneration in the range of Rs. 2000- 2500 yearly on an

average.

c. ASHA is involved each VHSNC as a member.

4. Functioning of Village Health Sanitation & Nutrition Committee (VHSNCs):

a. It was reported that 1427 VHSNCs were functioning in the district and joint bank

account in the name of concerned Gram Vikas Adhikari (GVA) and Gram Pradhan has

been opened in all 1427 VHSNCs to handle funds for undertaking sanitation work in the

villages. Meetings of the VHSNCs were not being conducted in the visited Sub Centres.

b. As reported, every revenue village is given Rs. 10,000 every year as VHSNC fund

under the scheme in the district. The total budget for the VHSNCs in the district was

allotted to the tune of Rs. 1,42,70,000 for 1427 revenue villages through CHCs / PHCs

and full amount was spent by the VHSNCs during 2010-11, but no details of

expenditure were made available at district office as well visited CHCs/ /PHC. Similarly,

the district had received Rs. 71,40,000 as VHSNC funds during 2011-12 and out of that

Rs. 22,38,000 were utilised upto the time of visit.

c. During visit to the centres, team found that an amount of Rs. 20,50,000 to CHC

Sahaspur, Rs. 5,40,000 to CHC Doiwala and Rs. 20,40,000 to PHC Kalsi had been

652

released as VHSNC fund during 2010-11 but no details of expenditure were available in

the visited CHCs/ /PHC.

5. Untied Funds:

a. Untied Funds @ Rs. 10,000 to each Sub centre, @ Rs. 50,000 to each CHC and @ Rs.

25,000 to each PHC were provided through block level CHCs and PHCs every year in

the district.

b. Details of the fund provision and expenditure incurred in the district for the year 2010-

11 and 2011-12 are reported as under:

(in Rs.)

Sr.

No

Particulars of

Untied Fund

In the year 2010-11 In the year 2011-12

For

Sub centres

For

CHCs/PHCs

For

Sub centres

For

CHCs/PHCs

1 Fund allotted 16,40,500 7,75,000 16,89,065 7,75,017

2 Expenditure incurred 16,31,435 7,74,983 14,09,896 6,49,168

3 Total Balance 9,065 17 2,79,169 1,25,849

c. It was observed that, ANMs were updating their Cashbook/ Passbook operated for

untied fund at Sub Centres level in the district.

d. During visit to the centres, team found that the district had released Rs. 1,20,000 to

CHC Raipur, Rs. 60,500 to CHC Sahaspur, Rs. 2,30,000 to CHC Doiwala and Rs.

2,90,000 to PHC Kalsi for the year 2010-11 for their Sub Centres as untied fund and

out of that Rs. 1,17,300 at CHC Raipur, Rs. 60,500 at CHC Sahaspur, Rs. 2,28,465 at

CHC Doiwala and Rs. 2,90,000 at PHC Kalsi were utilised by the Sub centres.

Similarly, amount to the tune of Rs. 1,20,000 to CHC Raipur, Rs. 60,000 to CHC

Sahaspur, Rs. 2,30,000 to CHC Doiwala and Rs. 2,90,000 to PHC Kalsi have been

provided and out of that Rs. 1,20,000 at CHC Raipur, Rs. 59,930 at CHC Sahaspur,

Rs. 2,17,000 at CHC Doiwala and Rs. 2,62,000 at PHC Kalsi were utilised by the Sub

centres in the current year up to December, 2011.

e. As reported, the untied funds were utilized for purchasing Medicine index board, User

charges board, Computer sticker for RTI, Dental medicine, Dustbin (Big/Small), Gum

boot, Door mat, Wooden couch for Ultrasound, Dunlop mattress, Repairing of Auto

clave, making arrangement of Transportation, Emergency duty chart, Name plate etc.

in CHC Raipur. Similarly, funds were utilised for purchased Ultrasound role, Regent of

pathology, BP instrument with stand, Kailish pad, Dopler, Oxygen flow meter with

mask, Surgical equipments, Emergency light, Delivery Kits, IB stand, OT lamp, Drugs,

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repairing of Ambulance, Benches and Stools in CHC Sahaspur and funds were used in

making arrangement of Biomedical waste, Bed sheets, BP instrument with stand, Towel

and Mattress in CHC Doiwala. However, details regarding statement of expenditure

were not made available to the team at PHC Kalsi.

6. Janani Suraksha Yojana (JSY):

a. During the year 2010-11, district spent funds to the tune of Rs. 2,32,28,300 out of

allotted budget of Rs. 2,38,48,688 under the scheme. Similarly, an amount of Rs.

14,78,700 was utilised against the available amount of Rs. 1,65,25,388 during current

year up to November, 2011.

b. As per details received, as many as 13910 JSY beneficiaries in the year 2010-11 and

9495 JSY beneficiaries in current year up to November, 2011 have been paid with cash

incentive under the scheme.

c. The budget provision and expenditure at the visited PHC/CHCs is reported as below:

Sr.

No.

Particulars For the year 2010-11 ( in Rs)

CHC

Raipur

CHC

Sahaspur

CHC

Doiwala

PHC Kalsi

1 Total fund available 6,14,318 14,89,440 15,59,500 3,45,355

2 Total expenditure

under JSY

6,08,400 14,77,500 15,20,000 3,30,800

3 Total balance

amount

5,918 11,940 39,500 14,555

4 Total beneficiaries 318 741 760 190

For the year 2011-12 up to November, 2011 ( in

Rs)

1 Total fund available 2,55,918 10,25,000 8,50,000 2,39,555

2 Total expenditure

under JSY

2,21,100 9,87,750 5,38,300 2,02,350

3 Total balance

amount

33,818 37,250 3,11,700 37,205

4 Total beneficiaries 117 585 338 183

d. 29 JSY beneficiaries were contacted out of 35 selected in the area of visited Centres in

the district. All the beneficiaries stated that they had received incentives through

cheque from the concerned CHCs and PHCs within a week after date of delivery. JSY

654

registers were found to be maintained properly and checked by concerned MOs

regularly.

7. 24x7 Delivery Care Services:

a. 7 institutions were identified to provide 24x7 delivery care services in the district. It was

reported that these 7 institutions fulfilled their targeted achievement during 2011-12 and

State Mission Director (NRHM) rewarded them providing additional incentives.

However actual numbers of deliveries conducted by 24x7 institutions/ FRUs were not

made available to the team in the district office.

b. In the visited centres, 284 deliveries at CHC Raipur, 359 at CHC Sahaspur, 664 at CHC

Doiwala and 83 deliveries at PHC Kalsi were conducted under 24x7 during 2010-11.

Similarly, 100 deliveries at CHC Raipur, 244 at CHC Sahaspur and 299 at CHC

Doiwala deliveries have been conducted during current year up to November, 2011.

c. Facilities for caring mother and new born baby found to be satisfactory in the visited

CHCs at Raipur and Doiwala. However, baby warmer was not available in CHC

Sahaspur.

8. Physical infrastructure (HSC/PHC/CHC)

(i) CHCs/ PHC:

a. Visited CHCs at Raipur, Sahaspur and Doiwala were functioning in Govt. building but

the maintenance of the hospitals was not up to the mark.

b. Incinerator was not available but bio-medical waste pits were available in the visited

CHCs. Short supply of Injections Quinine and Arteether was observed. Blood Storage

unit was not set up in CHCs at Raipur and Sahaspur. Facilities like Neonatal

Resuscitation equipment and Anesthesia equipment at CHC Raipur and Jeep in CHC

Doiwal were not available.

c. 4 of the 6 sanctioned posts of Specialist at CHC Raipur, 3 of the 6 sanctioned posts of

Specialist at CHC Sahaspur and 2 of the 6 sanctioned posts of Specialist in CHC/FRU

Doiwala were lying vacant.

d. Visited PHC at Kalsi was functioning in Govt. buildings. No supply of IFA (L & S)

tablets/ syrup, Vitamin- A tablets and Oral Pills was found there and Residential

quarters of Medical Officer were demolished for construction of CHC building.

(ii) Health Sub Centres:

a. All visited Sub centres i.e. Saurasaroli, Nanukhera, Charaba, Shelakuyi, Kanherwala,

Jahuri and Haiya were functioning in Govt. buildings. Labour room was not available in

Sub Centres at Charaba and Kanherwala.

655

b. It was observed that labour room was available in Sub Centres at Saurasaroli,

Nanukhera, Jahuri, Haiya and Shelakuyi but delivery was being conducted only in the

Sub Centres at Jahuri and Haiya.

c. Nischay Pregnancy Test Kit, RDT Kit, Hemoglobinometer, Sanitary Napkins, Vitamin-

A, IFA Tablets, Co-trimoxazole, Oxytocin Tablets, Ampicillin Capsules and

Gentamycine Injection were not available in the visited Sub Centres. No supply of Kits-

A & B was observed in the visited Sub Centres at Saurasaroli, Nanukhera, Jahuri,

Haiya and Charaba.

d. ORS packets, Chloroquine, Paracetamol and Metronidazole tablets are needed to be

provided at Sub Centres Nanukhera, Jahuri, Haiya and Kanherwala.

e. DDKs, Keosene oil and EC Pills were not available at Sub Centres Nanukhera, Haiya

and Kanherwala.

f. Paracetamol, Metronidazole tablets and EC Pills at Sub Centre Saurasaroli; Gloves,

DDKs, Keosene oil, EC Pills and Bleaching powder at Sub Centre Nanukhera; Stove,

CuT, Oral Pills and Bleaching powder at Sub Centre Jahuri; Delivery table, DDKs,

Keosene oil, Chloroquine, Paracetamol and Metronidazole tablets at Sub Centre

Charaba; Condoms, Bleaching powder, IFA tablets and Antiseptic solution at Sub

Centre Kanherwala were not available.

9. Assessment and opinion of the Community on Health Services:

(i) Services of ANM-

a. 63 mothers having child up to one year of age from the area of 7 visited sub centres

were interviewed by the team to assess their opinion about the services rendered by

the ANMs.

b. 15(24%) mothers were not aware about danger sign of ARI, 6 (10%) were not aware

about use of ORS, 8 (13%) mothers replied that their babies were not weighed at the

time of birth and 11 (17%) mothers stated that ANM was not available when needed. 15

(24%) contacted mothers did not receive three Post Natal checkups.

c. It was also observed that 20 (32%) mothers were not sufficiently aware of contraceptive

methods and 19 (30%) mothers about its side effects.

(ii) Services of PHC-

a. 35 Persons who were generally utilising the services at visited PHC/CHCs were

interviewed and it was found that about 13 community members needed improvement

at PHCs/CHC and 15 villagers replied that MOs were not staying at PHC/CHC

headquarter regularly.

656

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 in the PHC/

CHC areas. The team observed that services should be improved by capturing the

registration of 100% AN mothers and improve the awareness about danger sign of

pregnancy, referral mechanisms and breast feeding practices among ANC and PNC.

10. IT Infrastructure and Mother & Child Tracking System:

a. Team found that computers were available at district level and at Block level

PHCs/CHCs (one in each Block). However, Internet connectivity was available at

district level only.

b. MCH Tracking formats were available in each Sub centres.

c. Health functionaries were sensitized in MCH formats at PHC/ CHC level. They are

capturing data in the formats and making data entry at PHC/ CHC level through cyber

cafe.

11. Registers, records and reports maintained at the visited centres:

a. Performance reported under CuT at CHCs at Raipur, Sahaspur and Doiwala and at

PHC Kalsi could not be verified due to want of service registers. Oral Pills and Nirodh

distribution registers were also not maintained in the centres visited.

b. Printed Eligible Couple register were not being maintained at any of the visited centres.

c. Printed Registers for Family Planning services and Stock book to Sub centres at

Saurasaroli, Nanukhera, Jahuri and Haiya, registers for Family Planning services to

Sub centre Charaba and Cash book for untied fund were not supplied to Sub Centres in

Haiya and Kanherwala.

657

West Bengal

1.District Maldah

Major observations of Regional Evaluation Team, Kolkata about the Evaluation

work carried out in Maldah district of West Bengal in September, 2011

II. Details of the visited Institutions:

District visited DH, PPC, BPHCs and PHC

visited

SCs visited

Maldah BPHCs: Hatimari and Silampur

PHC: Sujapur

PPC:District Hospital, Maldah

Hatimari, Arajideharul,

Silampur, Maruabadi and

Alipur

II. Major observations

1. Health Human Resources:

a. Acute shortages of Human Resources in the key posts i.e. Specialist, Medical

Officer, Staff Nurse, MPW (M), Malaria Inspector etc. was observed in the district.

25 posts of MO out of 134 sanctioned and 55 posts of specialists out of 58

sanctioned were lying unfilled. Similarly, under the category of para-medical, 110

posts (out of 517 sanctioned) of Grade- A Nurse/ Staff Nurse, 22 posts (out of 511

sanctioned) of ANMs/ MPW (F), 258 posts (out of 425 sanctioned) of MPW (M), 14

posts (out of 15 sanctioned) MPS (M), 19 posts (out of 37 sanctioned) of Lab

Technician and 31 posts (out of 65 sanctioned) of Pharmacist were lying vacant in

various institutions/ centres in the district.

b. In the visited PHC Hatimari, 4 of the 7 sanctioned posts of Medical Officer, 7 of the

11 sanctioned posts of Grade- A Nurse/ Staff Nurse, 3 of the 60 sanctioned posts

of ANM, 46 of the 60 sanctioned posts of MPW (M), 2 of the 3 sanctioned posts of

Lab Technician and 1 of the 2 sanctioned posts of Pharmacist were lying vacant. In

PHC Silampur, 3 of the 7 sanctioned posts of Medical Officer, 2 of the 3 sanctioned

posts of Lab Technician and 1 of the 2 sanctioned posts of Pharmacist were lying

unfilled.

658

c. 29 posts of Specialists and Medical Officers, 2 posts of Dy. Nursing

Superintendent, 76 Nursing Staff Grade- II, 7 ward Sister and 5 posts of Pharmacist

under the technical staff strength were lying vacant in District Hospital Maldah. It

was also reported that 7 posts of Ward Sister, 4 posts of MT (ECG), 2 posts of MT

(X-ray), 2 posts of MT (Lab), 5 posts of Clerical staff, 4 posts of SWO, 5 posts of

Linen Keeper and about 94 posts of Group- D staff were also vacant in this

hospital.

d. The District / state authority need to take urgent step for filling up of the vacancy in

the health sector for providing effective health care services in the district.

2. Functioning of Rogi Kalyan Samiti (RKS):

Rogi Kalyan Samiti has been constituted and registered in the visited BPHCs, PHC

and DH in the district but meeting of RKS was not being held regularly in the visited

institutes.

3. Functioning of ASHA:

As reported, the district has a requirement of 3222 ASHAs for all 3594 villages. As

against it, 2560 ASHAs were selected and out of them 2438 ASHAs have been

provided with drug kits and training up to 5th modules in the district.

4. Functioning of Village Health Sanitation & Nutrition Committee (VHSNC):

a. As informed to the team, 1132 VHSNCs have been constituted in the district and

ASHA is a member in every committee.

b. During field visit, it was observed that all the contacted ANMs and ASHAs were not

aware of the constitution of Village Health Sanitation & Nutrition Committee and its

functioning. ASHAs were unknown about their membership in the VHSNCs.

c. As informed by the district office, there was a budget of Rs. 1,79,81,203 including

opening balance of Rs. 33,01,203 during 2010-11 in the district for the VHSNCs;

out of that, Rs. 81,30,000 were utilized by the VHSNCs in the year and balance

amount carried forward to the next year 2011-12. No untied funds for VHSNCs

were provided to the district during current year 2011-12.

d. The local health SC staff was aware about the functioning of the VHSNCs though

regular funds were being utilized through the VHSNCs. The guidelines were not

being followed by the VHSNC while taking up their activities and need proper

supervision from the district /state level.

5. Services of Janani Suraksha Yojana (JSY):

a. During the year 2010-11, district had spent funds to the tune of Rs. 3,34,63,299 out

of allotted funds of Rs. 3,95,17,329. Similarly, an amount of Rs. 66,44,900 was

659

utilised against the available amount of Rs. 1,77,30,762 during the current year up

to August, 2011.

b. As per details received, as many as 21408 JSY beneficiaries in the year 2010-11

and 5760 JSY beneficiaries in current year (up to August, 2011) have been paid

cash incentive under the scheme.

c. The budget provision and expenditure at the visited DH/PHCs as reported is given

below:

Sr.

No.

Particulars For the year 2010-11 ( in Rs)

DH Maldah PHC Hatimari PHC Silampur

1 Total fund available 23,19,300 25,11,200 47,01,100

2 Total expenditure under JSY 22,66,700 18,00,000 39,65,500

3 Balance amount 82,600 7,11,200 7,38,600

4 Total no. of JSY beneficiaries 6418 1265 4053

5 No. of JSY mothers paid

incentive

4473 1265 3753

For the year 2011-12 ( in Rs)

1 Total fund available 9,11,200 14,81,200 7,38,600

2 Total expenditure under JSY 7,06,900 7,58,000 8,71,500

3 Balance amount 2,04,300 7,23,200 (-) 1,32,900

4 Total no. of JSY beneficiaries 1547 476 1703

5 No. of JSY mothers paid

incentive

1470 476 1193

d. 17 JSY beneficiaries were contacted for on the spot verification in the district and it

was observed that MCH cards were issued to all of them. Three consecutive ANC

checkups to the mothers were not up the mark. Beneficiaries were not getting JSY

incentive on the date of discharge from the hospital due to delay in submission of

the necessary papers to the office of the hospital and non availability of funds in

time. JSY register was maintained but was not being checked by the concerned

Medical Officer regularly.

6. Untied Funds:

a. Provision and utilization of untied funds in the district are as under:

(In Rs)

Sr. No

.

Particulars of Untied fund

Budget for BPHCs Budget for PHCs Budget for SCs

2010-11 2011-12 2010-11 2011-12 2010-11 2011-12

660

1 Opening Balance

8,50,000 12,55,926

8,50,000 15,50,946 27,52,233 19,01,519

2 Fund Received during the year

8,50,000 Nil 8,50,000 Nil 51,10,000 Nil

3 Total Funds available

17,00,000

12,55,926

17,00,000

5,50,946 78,62,233 19,01,519

4 Expenditure 4,44,074 2,16,111 1,49,054 3,44,480 59,57,681 16,62,816

5 Balance 12,55,926

10,39,815

15,50,946

12,06,466 19,01,519 2,11,733

c. The team observed that BPHC @ Rs. 50,000, PHC @ Rs. 25,000 and Sub Centre

@ Rs. 15,000 are given per year as untied funds in the district. The details of untied

funds in the visited centres are as below:

For the year 2010-11 (in Rs.)

Name of

Institutions

Opening

Balance

Released Expenditur

e

Balanc

e

BPHC: Hatimari 46,680 50,000 47,631 49,019

BPHC: Silampur Nil 3,50,000* 2,53,951 96,049

PHC: Sujapur Nil 25,000 25,000 Nil

SC: Hatimari Record not made available

SC: Arajideharul Record not made available

SC: Silampur Nil 45,000** 39,222 5,778

SC: Maruabadi 2,210 15,000 16,852 358

SC: Alipur 4,144 15,000 12,267 6,877

For the year 2011-12 (in Rs.)

BPHC: Hatimari 49,019 $ 15,191 33,828

BPHC: Silampur 96,049 $ 95,549 500

PHC: Sujapur Nil $ - -

SC: Hatimari Record not made available

SC: Arajideharul Record not made available

SC: Silampur 5,778 $ 5,058 720

SC: Maruabadi 358 $ 99 259

SC: Alipur 6,877 $ 6,000 877

* It was observed that unspent Untied Funds amounting of Rs. 3,00,000 of Sub

Centres of BPHC Silampur for the year 2009-10 had been diverted to BPHC

Silampur during 2010-11 even though Untied fund to the tune of Rs. 50,000 was

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provided to the BPHC which is violation of the norms/ guidelines prescribed for

untied funds.

** in addition to regular amount of Rs 15,000, an additional amount of Rs 30,000 was

provided to the Sub Centre Silampur during 2010-11 and Rs. 39,222 was spent by

the SC during the year.

$ No untied fund has been provided for the year 2011-12 till visit of the district.

7. 24 Hours Delivery Care Services:

a. 24 hours delivery care system implemented in 26 institutions i.e. in District Hospital,

5 Rural Hospitals, 9 BPHCs and 11 PHCs in the district.

b. There were adequate numbers of MOs and Staff Nurses in the visited institutions

for 24x7 hours services.

c. Facilities at RH, BPHC and PHC level were not upgraded for conducting C- Section

delivery. Facility for caring mothers and new born baby was found inadequate at

the visited centres. Blood storage facility was also not available in the visited

centres.

8. Physical infrastructure Stock Position:

(i) Health Sub Centres:

a. Sub centres visited at Arajideharul, Silampur, Maruabadi and Alipur were not as per

IPHS. Labour room facility was not available at all visited Sub Centres. Toilet facility

was available only at Sub Centre Maruabadi.

b. Delivery table, Mclntsh sheet, Ambu bag/suction, Nischay Pregnancy Test Kit,

DDKs, Sanitary Napkins, Oxitocine tablets, Kits- A & B, Ampicillin capsule and

Gentamycin injection etc. were not available in the Centres visited.

c. Delivery Kit was not available in the Sub Centres at Arajideharul, Silampur and

Maruabadi. Short supply of Nirodh was found in the Sub Centres at Arajideharul,

Maruabadi and Alipur.

d. Skilled Birth Attendance training was not provided to the Auxiliary Nurse Midwives

of visited Sub centres.

(ii) BPHC/PHC:

a. The visited BPHCs at Hatimari and Silampur were not maintained as per IPHS.

Upgradation of BPHCs to CHC seem to be on paper only.

b. Jeep, Blood Storage Unit, Surgical equipment, Sick New Born Care Unit,

Anesthesia equipment and Operation Theatre were not available in the visited

BPHCs at Hatimari and Silampur.

662

c. Telephone facility, Ambulance/Jeep, Microscope, Oxygen Cylinder, Functional

Operation Theatre, CuT Insertion Kit and the post of AYUSH Medical Officer was

not available in the visited PHC at Sujapur.

9. Opinion of the Community on the Health Services:

a. 20 mothers having child upto one year old were interviewed in the area of Sub

Centres at Silampur and Maruabadi to assess their opinion and knowledge about

the services provided by the concerned ANMs.

b. Most of the interviewed mothers were not aware about use of contraceptive and its

side effects. Acceptance of contraceptive was also poor in the area of Sub Centres

Silampur and Maruabadi.

c. ANM of the both visited Centres attends delivery on call.

d. 20 RCH beneficiaries i.e. pregnant women, recently delivered women, mothers

upto two year old Child and AWW, ASHA and Village leaders etc. were contacted

to know overall functioning of the visited PHCs. Some of the mothers were unaware

of danger sign of pregnancy during ANC and sick new born baby. They were also

not much aware about contraceptive and HIV/STD/AIDS.

e. Medical Officer of BPHC Hatimari and PHC at Sujapur not visiting the villages

under the PHC area regularly.

10. Reconciliation of reported Performance:

a. Sterilization figures reported at PPC Maldah for the year 2010-11 and 2011-12

(upto August, 2011) did not tally with the total numbers of registered sterilisation

cases in the service register. The reported figures at PPC, Maldah for the year

2011-12 (upto August, 2011) were also not matching with the same figures shown

by the district office in its report.

b. Due to absence of Sterilization register for the year 2010-11 and 2011-12 at BPHC

Hatimari, the reported figures for the same year could not be verified. Similarly,

CuT figures were also not verified at BPHC Hatimari and Silampur for both years.

c. CuT figures reported at PPC Maldah for the year 2011-12 (up to August, 2011) did

not tally each other with the figures of service register and the reported figures at

district office.

11. Registers, records and reports maintained at the visited centres:

a. Eligible Couple register which is one of the most important records for FW services

was not maintained at PPC Maldah and the same register was not updated at

BPHC Silampur. Eligible Couple Survey had not been conducted after 2009-10 in

BPHC Hatimari.

663

b. Service register for Sterilization cases was not found to be maintained at Hatimari

BPHC. Register for CuT acceptors were not maintained at BPHC Silampur and the

same register was not maintained/ updated properly at Hatimari BPHC.

c. Oral Pills and Nirodh users register was not maintained in the Centres visited.

d. ANC registers were not maintained properly at PPC Maldah and not updated at

BPHC Hatimari.

e. PNC registers were not maintained properly at BPHCs Hatimari and Silampur but

same was not made available at PPC Maldah. Child Immunisation register was not

maintained at PPC Maldah and not updated at BPHC Hatimari.

f. Stock register was not maintained properly at BPHCs Hatimari and Silampur.

12. Other Observation and suggestions:

a. Monitoring and supervision was almost absent at all level. Nodal officers of different

programme and members of DPM Unit (NRHM) were not visiting the periphery

level centres for proper implementation of different programme and proper record

keeping. Medical officers and MPS (M & F) should conduct their supervisory visit

effectively for smooth functioning & different programme and proper record

keeping.

b. Routine Immunisation programme was being conducted on regular basis. But

concerned Records/ registers were not maintained accordingly; most of the children

were not fully immunized and doses were not given in proper time as per registers.

c. It was observed that PHC at Sujapur has conducted the highest number

Institutional deliveries in the district but Labour Room and Maternity ward were

unhygienic and also found combined it with Female Ward in the PHC.

2. District:- North 24 Pargana

Major observations of Regional Evaluation Team, Kolkata about the Evaluation work

carried out in North 24 Parganas district of West Bengal in October, 2011

I. Details of the visited Institutions:

District visited RH, BPHC and PHC visited SCs visited

North 24

Parganas

Rural Hospitals: Taki and

Minakhan

BPHC: Rekjowani

Makhalgachha, Minakhan,

Bamonpukhur, Rekjowani

and Nababpur

664

PHC: Ghola

II. Major observations

1. Health Human Resources:

a. No sanctioned strength of the staff was available at district office. At district

headquarter no one was aware about the sanctioned strength of staff in the district.

However, during visit to the centres, acute shortage of manpower in the key posts i.e.

Specialist, Medical Officer, Supervisor (M & F), Lab Technician, Pharmacist and MPW

(M) etc. was observed in the district.

b. In the visited RH at Taki, 2 posts of Medical Officer, 4 posts of Supervisors (M & F), 4

posts of GNM/ Staff Nurse, 1 post of Lab Technician, 2 posts of Pharmacists and 27

posts of MPW (M) were lying vacant. Similarly, 4 posts of Medical Officer, 6 posts of

Supervisors (M & F), 2 posts each of Lab Technicians and Pharmacists and 19 posts

of MPW (M) were lying vacant in RH Minakhan.

c. 3 posts of Medical Officer, 7 posts of Supervisors (M & F), 2 posts of GNM/ Staff

Nurse, 2 posts each of Lab Technician and Pharmacists and 20 posts of MPW (M)

were lying unfilled in BPHC Rekjowani.

d. All visited Sub Centres were functioning with two ANMs.

e. The District/ State authority needs to take urgent step to fill up of the vacant post in

the health sector.

2. Functioning of Rogi Kalyan Samiti (RKS) and Village Health Sanitation & Nutrition

Committee (VHSNC):

a. Rogi Kalyan Samiti has been constituted and registered in the visited BPHC and Rural

Hospitals in the district. Funds were received but meeting of RKS was not being held

regularly in the visited institutes.

b. 102 VHSNCs have been constituted in the district and ASHA is a member of every

committee.

3. Functioning of ASHA:

a. 163 ASHAs against the target of 178 ASHAs for 102 villages have been selected in

the district. Training up to 4th module to all 163 ASHAs had been provided but they

were working without drug kits.

b. The team observed that ASHAs were participating for providing services of

immunization as well MCH activities in the areas of centres visited.

4. Services of Janani Suraksha Yojana (JSY):

665

a. It was reported that the scheme was properly functioning in the district. Sufficient

funds were being provided to the facilities and eligible mothers were being paid JSY

benefits either by Sub Centre ANM or by concerned Medical Officer I/c of PHC.

b. 24 JSY beneficiaries were contacted for on the spot sample verification in the district

and it was observed that all deliveries were normal and MCH cards issued to all of

them. Role of ASHA in the context of conducting institutional delivery was satisfactory.

Three consecutive ANC checkups were given to the mothers.

c. JSY registers were maintained properly containing the list of beneficiaries to whom

cash had been distributed.

5. Untied Funds:

a. It was observed that CHCs, PHCs and SCs were being provided untied funds every

year in the district.

b. The actual amount of untied fund to these centres was not made available but 95.3%

funds at CHC level, 69,9% at PHC level and 72.6% at Sub Centre level reported to

have been spent in the year 2010-11. Further, about 3.7% of funds at PHC level and

30.8% funds at SC level have been utilized during 2011-12 up to visit of month.

c. The team reported that allotment of untied funds at Sub Centre level in the district is

irregular. Generally, the Sub centre untied funds are released in two installments. First

installment i.e. 50% is released at the end of the second quarter and the second

installment is released at the end of financial year.

6. 24x7 Hours Delivery Care Services:

a. 24x7 hours delivery care system implemented in 22 institutions (Rural Hospitals and

BPHCs) in the district. The team reported that these centres were facing shortage of

skilled personnel i.e. MOs, Specialist and Staff Nurses in the district. During visit to

the institutions, there was no adequate facility observed for caring mothers and new

born baby.

b. Blood storage unit were not setup in the visited centres.

7. Physical infrastructure and Stock Position:

(i) Health Sub Centres:

a. Facilities at the Sub centres visited at Makhalgachha, Minakhan, Bamonpukhur,

Rekjowani and Nababpur were not as per IPHS.

b. Labour room, Delivery table, Mclntsh sheet, Ambu bag/suction, RDT kits, DDKs,

Sanitary Napkins, EC Pills, Oxitocine tablets, Ampicillin capsule and Gentamycin

injection etc. were not available in the Centres visited.

666

c. Short supply of Vitamin- A solution since June, 2011 was observed in the visited

Centres.

d. Skilled Birth Attendance and IMNCI training was not provided to the Auxiliary Nurse

Midwives of visited Sub centres.

(ii). RH/ BPHC/PHC:

a. The visited RHs/BPHC at Taki, Minakhan and Rekjowani were not maintained as per

IPHS. All BPHC and Rural Hospitals were upgraded to the level of CHC without

providing necessary infrastructure for CHC. However, only higher rate of RKS, AMG

and Untied Funds were provided there. Adequate number of Medical Officer, Para-

medical staff, residential accommodation and sufficient drugs were not found there.

b. Jeep, Blood Storage Unit, Surgical equipment, Sick New Born Care Unit and

Anesthesia equipment were not available in the visited RHs at Taki, Minakhan and

BPHC at Rekjowani.

c. Telephone facility, Ambulance/Jeep, Autoclave/ Steam sterilizer drum, Microscope,

Oxygen Cylinder, Labour room and equipments, Functional Operation Theatre, CuT

Insertion Kit, Condoms and the posts of Lab Technician and AYUSH Medical Officer

was not available in the visit of PHC Ghola.

8. Opinion of the Community on the Health Services:

a. 20 mothers having child upto one year old were interviewed in the area of Sub

Centres at Rekjowani and Nababpur to assess their opinion and knowledge about the

services provided by the concerned ANMs.

b. Most of the interviewed mothers were not aware about use of contraceptive and its

side effects. Contacted mothers reported that, ANMs were not attending home

delivery on call.

c. 21 community members of different target group i.e. pregnant women, recently

delivered women, mothers upto two year old Child were contacted to know overall

functioning of the visited PHC. Some of the mothers were unaware about danger sign

of pregnancy during AN period and sick new born baby. They were also not much

aware about contraceptive and HIV/STD/AIDS.

9. Performance of Family Planning:

As reported, there were total 22 F.W. performance reporting institutions in the district.

Out of these, 8 institutions performed less than 100 sterilizations during 2010-11 and

10 institutions performed less than 50 sterilizations during 2011-12 (upto August,

2011).

10. Sample verification of FW acceptors:

667

a. The team selected a total of 61 F.W. acceptors for sample verification and out of that

50 (82%) could be contacted. Discrepant entries in the registers were observed about

the contacted acceptors i.e., age of spouse in 35 (70%) cases, number of Male child

in 30 (60%) cases and age of last children in 18 (36%) cases.

b. Among the contacted acceptors, 17 (34%) informed that they did not receive any

follow up services after having accepted the services.

c. 68 beneficiaries of BCG/ DPT/ Polio, Measles, Vitamin- A and Hepatitis –B were

contacted in the field. All beneficiaries confirmed receiving the doses. No complication

was reported after receiving the doses. Follow up services by health staff were

provided to 44 (65%) contacted beneficiaries and rest of the contacted beneficiaries

did not receive any follow up services.

11. Registers, records and reports maintained at the visited centres:

a. Eligible Couple Survey register which is one of the most important records for FW

services was not maintained properly in the Centres visited. During visit to the

centres, Health Workers and Supervisors reported that, the newly supplied printed

ECR is less convenient than the previous register, as there is no provision to record

necessary information at a glance about the couples and their children immunized.

b. Service register for Sterilization cases was not found to be maintained at RH

Minakhan.

c. CuT figures reported for RHs at Taki, Minakhan and BPHC at Rekjowani by the

district office for the year 2010-11 and 2011-12 were not verified due to absence of

service registers.

d. ANC, PNC, Child Immunisation, Oral Pills and Nirodh users registers were not

maintained properly in the Centres visited.

e. There was no printed register available for maintaining the services of Family

Planning, MCH, JSY payment and also Stock Book at the centres visited in the

district.

f. Stock register for F.W. items was not maintained properly in all the centres visited in

the district.

12. Other observations:

a. Untied Funds to the VHSNCs in the district are released directly from the State Health

Society to the Department of Panchayat and further Department of Panchayat

distributes funds to the concerned village Panchayat. It was observed that District

Health Society, RKS of BPHCs and also Health officials were not involved in

668

monitoring or supervision of the activities and utilization of the untied fund in the

district.

b. Computers and internet connectivity were available at District, RH and CHC level.

Newly pregnant mothers were registered in MCH Tracking register by HA (F)/

Additional ANM, but all required information was not recorded. Full data of Tracking

registers was not up loaded on computer/ Net. Involvement of ASHAs was also

observed in MCH Tracking, though they were newly selected.

3.District: Barddhaman

Major observations of Regional Evaluation Team, Kolkata about the Evaluation work

carried out in Bardhaman district of West Bengal in October, 2011

I.Details of the visited Institutions:

District visited RH, BPHC and PHC visited SCs visited

Bardhaman Rural Hospital: Memari

BPHCs: Pursha and Mangalkot

Pursha, Mangalkot, Memari,

Nutanhat and Duttapada

II. Major observations

1. Health Human Resources:

a. Though the staff position of whole of the district was not made available at district

office, the team observed large number of vacancies in different category of regular

posts i.e. Specialist, Medical Officer, ANM, MPW (M), Supervisors (F), GNM/ Staff

Nurse, Lab Technician and Pharmacists in the district.

b. In the visited BPHCs at Pursha and Mangalkot, there was no post of Specialist.

c. The team has also observed that more than 50% of the sanctioned posts of

Supervisors (M & F) were lying vacant in the visited centres.

2. Functioning of Rogi Kalyan Samiti (RKS) and Village Health Sanitation & Nutrition

Committee (VHSNC):

a. Rogi Kalyan Samiti has been constituted and registered in the visited BPHC and Rural

Hospitals in the district. Funds were received but meeting of RKS was not being held

regularly in the visited institutes.

b. There was no information of Village Health Sanitation & Nutrition Committee (VHSNC)

at district office as well as at visited facilities in the district. The activities seem to be

669

undertaken without following proper guidelines and need proper supervision from the

state level.

3. Functioning of ASHA:

a. ASHA scheme was implemented recently in the district and as against the target of

4347 ASHAs, there were 3320 ASHAs selected in the district. As reported, 1794

ASHAs trained in 1st module, 1619 ASHAs up to 2nd module, 886 up to 3rd module,

567 up to 4th module and 563 ASHAs have been trained up to 5th module. No ASHA

has been given drug kits in the district.

b. The team observed ASHAs were participating for providing services of immunization

as well MCH activities in the areas of centres visited.

4. Services of Janani Suraksha Yojana (JSY):

a. It was reported that the scheme was properly functioning in the district. Sufficient

funds were being provided to the facilities and eligible mothers were being paid JSY

benefits either by Sub Centre ANM or by concerned Medical Officer I/c of PHC.

b. 42 JSY beneficiaries were contacted for on the spot verification in the district and it

was observed that all deliveries were normal and MCH cards issued to all of them.

Role of ASHA in the context of conducting institutional delivery was satisfactory.

Three consecutive ANC checkups were given to the mothers.

c. JSY registers were maintained properly containing the list of beneficiaries to whom

cash had been distributed.

5. Untied Funds:

a. As informed, CHC, PHC and SCs are being provided untied funds in the district. It

was observed that full amount had not been spent by these centres during the year

2010-11.

b. The team reported that allotment of untied fund at Sub Centres in the district is

irregular. Generally, the Sub centre untied funds are released in two installments. First

installments i.e., 50% of funds are released at the end of the second quarter and the

second installment released at the end of financial year.

6. 24 Hours Delivery Care Services:

a. 24x7 hours delivery care system is implemented in 34 institutions (Rural Hospitals and

BPHCs) in the district. The team reported that these centers were having shortage of

skilled personnel i.e. MOs, Specialist and Staff Nurses in the district. During visit to

the institutions it was found that there was inadequate facility for caring mothers and

new born baby.

b. Blood storage unit were not setup in the visited centres.

670

7. Physical infrastructure and Stock Position:

(i) Health Sub Centres:

a. Facilities at the Sub centres of Pursha, Mangalkot, Memari, Nutanhat and Duttapada

were not as per IPHS. Most of the visited Sub Centre ANMs were not staying at their

Sub Centre villages.

b. Delivery table, Mclntsh sheet, Ambu bag/suction, Delivery kits, Sanitary Napkins, EC

Pills, Oxitocine tablets, Ampicillin capsule and Gentamycin injection etc. were not

available in the Centres visited.

c. Short supply of Kits- A & B for one year and Vitamin- A solution since June, 2011 was

observed in the visited Centres.

d. Skilled Birth Attendance and IMNCI training was not provided to the Auxiliary Nurse

Midwives of visited Sub Centres.

(ii). RH/ BPHC:

a. The visited RH at Memari, BPHCs at Pursha and Mangalkot were not maintained as

per IPHS. All old BPHC and Rural Hospitals were upgraded to the level of CHC but

their infrastructure was at the same level. However, only higher rate of RKS, AMG and

Untied Funds were provided to these centres. Adequate number of Medical Officers,

Para-medical staff, residential accommodation and sufficient drugs were also not

available.

b. Jeep, Blood Storage Unit, Surgical equipment, Sick New Born Care Unit, X-ray facility

and Anesthesia equipment were not available in the visited RHs at Memari, BPHCs at

Pursha and Mangalkot.

8. Opinion of the Community on the Health Services:

a. 20 mothers having child upto one year old were interviewed in the area of Sub

Centres at Memari and Duttapada to assess their opinion and knowledge about the

services provided by the concerned ANMs.

b. Most of the interviewed mothers were not aware about use of contraceptive and its

side effects. Contacted mothers reported that, ANMs were not attending home

delivery on call.

c. 16 community members of different target group were interviewed in the area of Sub

Centre at Memari to assess their opinion and knowledge about the services provided

by the MPW (M). Community members were not satisfied towards not staying of MPW

(M) at sub centre headquarters, his irregular visit to the villages and also the services

relating to group meeting on health topic etc.

671

d. 20 community members of different target group i.e. pregnant women, recently

delivered women, mothers upto two year old Child were contacted to know overall

functioning of the visited PHC. Some of the mothers found unaware of danger sign of

pregnancy during ANC, breast feeding practice and sick new born baby. They were

also not much aware about contraceptive and HIV/STD/AIDS.

9. Sample verification of FW acceptors:

a. The team selected a total of 58 F.W. acceptors for sample verification and out of that

50 (86%) could be contacted. Discrepant entries were observed the age of spouse of

the acceptors in 22 (44%) cases and age of last child in 18 (36%) cases.

b. Among the contacted acceptors, 26 (52%) informed that they did not receive any

follow up services after having accepted the services.

c. 70 beneficiaries of BCG/ DPT/ Polio, Measles, Vitamin- A and Hepatitis –B were

selected for sample verification and out of them 66 (94%) could be contacted in the

field. All contacted beneficiaries confirmed receiving doses and were satisfied with the

services and no complication had been reported after receiving the doses. Follow up

services by health staff were provided to 46 (70%) contacted beneficiaries only.

10. Reconciliation of reported Performance:

a. Sterilization figures at BPHCs Pursha & Mangalkot and RH Memari reported for the

year 2010-11 were not matched with the same figures available on the registers for

the same period. These figures at BPHC Mangalkot for the year 2011-12 (up to

September, 2011) were also found varying. The details are given below:

Name of the Centres

Sterilisation cases for the year 2010-11

Sterilisation cases for the year 2011-12 (up to September, 2011)

Reported by Centres

Verified from the registers

Reported by Centres

Verified from the registers

BPHC: Pursha 600 593 18 18

BPHC: Mangalkot

2157 1764 381 374

RH:Memari 960 950 120 120

b. District office reported 26 sterilizations for BPHC, Pursha while as per the BPHC

records only 18 sterilizations were conducted during 2011-12 (up to September,

2011).

c. CuT figures in the reports of district office and in the visited facilities were mostly

tallied for both years 2010-11 & 2011-12 but could not be verified with the service

672

registers due to non / incomplete maintenance of service registers at the visited

facilities.

11. Registers, records and reports maintained at the visited centres:

a. Eligible Couple Survey register which is one of the most important records for FW

services was not maintained properly in the Centres visited.

b. PNC register in BPHC Mangalkot, Oral Pills users register at BPHCs Pursha and

Mangalkot and Nirodh users registers at RH Memari, BPHCs Pursha and Mangalkot

were not maintained properly.

c. No printed register was available for maintaining records for Family Planning, MCH

and JSY payment of the centres visited in the district.

12. Other observations:

a. As informed by the district office, VHSNC untied funds were directly released from the

State Health Society to the Department of Panchayat and further, Department of

Panchayat distributed fund to the concerned village Panchayat. So, District Health

Society and RKS of BPHCs were not aware about the releases and utilization of the

VHSNC untied funds.

b. Computers and internet connectivity were available at District, RH and CHC level.

Newly pregnant mothers were registered in MCH Tracking register by HA (F)/

Additional ANM, but all required information was not recorded. Full data of tracking

registers was not up loaded on computer/ Net.

c. Performance of Family Planning of different methods is required to be enhanced both

in terms of quantity and quality in the district, especially the performance of spacing

methods. ASHAs should motivate the eligible couple in their areas of jurisdiction to

accept the Family Planning methods. Concerned Health Assistant (M & F) at Sub

Centre level may co-ordinate with ASHA in this regard.

4.District: Kochbehar

Major observations of Regional Evaluation Team, Kolkata about the Evaluation work

carried out in Kochbehar district of West Bengal in December, 2011.

I. Details of the visited Institutions:

673

District

visited

BPHC and PHC visited SCs visited

Kochbehar BPHCs: Ghokshadanga, Dewanhat

and Boxirhat

PHC: Nishhiganj

Chhoto Simulguri, Chakiyar

Chhada, Dewanhat,

Kolakata, Boxirhat and

Atara

II. Major observations

1. Health Human Resources:

a. The district was facing shortage of health human resources. As reported, 34 (34.3%)

of the sanctioned posts of Specialist, 83 (31.9%) of the sanctioned posts of Medical

Officer, 230 (65.5%) posts of MPW (M)/ Health Assistant, 13 (34.2%) post of

Supervisor (M & F), 19 (25.8%) posts of Lab Technician and 29 (32.9%) of the

sanctioned posts of Pharmacist were vacant in the district.

b. Though the figures of vacant posts were not made available in the visited BPHCs,

most of the Specialists and the posts of Medical Officer & MPW (M) were observed to

be lying vacant. However, filled up positions of Health Assistant (F) and GNM/ Staff

Nurse were found satisfactory in the visited centres.

c. All the posts in DPMU and BPMU under NRHM were filled up in the district.

d. Most of the Sub Centres were functioning with 2nd ANM. The posts were filled up on

contractual basis.

2. Rogi Kalyan Samiti (RKS) and Village Health Sanitation & Nutrition Committee

(VHSNC):

a. Rogi Kalyan Samiti has been constituted and registered in the visited BPHCs and

PHC in the district. Meetings of RKS were being held regularly in the visited institutes.

b. As reported, 1346 VHSNCs have been constituted in the district. The team observed

that PHC MOs, Health Assistant (F) and ASHAs were not sufficiently aware about

VHSNC in these areas.

3. Functioning of ASHA:

a. It has been reported that 1948 ASHAs against the target of 2351 ASHAs for 1202

villages have been selected in the district.

b. ASHAs completed their training up to 5th module except 527 ASHAs who were trained

up to 1st module in the district. ASHAs were working with drug kits in the district.

4. Services of Janani Suraksha Yojana (JSY):

674

a. It was reported that the scheme was functioning properly in the district. Sufficient

funds were being provided to the facilities and eligible mothers were being paid JSY

benefits by Sub Centre ANM and by concerned Block Account Manager of PHC.

b. JSY benefits were provided to the eligible mothers in two instalments; first payment @

Rs. 500 is made by ANMs to eligible mothers after completion of three ANC and

second instalments @ Rs. 500 is made by Block Account Manager to eligible mothers

after institutional delivery. Most of the mothers informed that they were discharge

within 4 to 6 hours after delivery from the hospital.

c. 24 JSY beneficiaries were contacted for on the spot sample verification in the district

and it was observed that all deliveries were normal and MCH cards issued to all of

them. 2 doses of TT and 100 IFA tablets were provided to the mothers. Role of ASHA

in the context of conducting institutional delivery was not satisfactory. Three

consecutive ANC checkups were given to the mothers.

d. JSY registers were maintained properly with name of beneficiaries to whom cash had

been distributed.

5. Untied Funds:

a. Untied funds are being provided at all facilities in the district but it was not utilized fully

by the centres in last two years. As reported, 65.2% Untied fund at CHC level, 20.8%

at PHC level and 65.4% Untied fund at Sub Centre level was reported to have been

spent in the year 2010-11 and about 66.5% Untied fund at CHC level, 7.2% at PHC

level and 34.7% Untied fund at SC level have been utilized during 2011-12 up to the

time visit of month. Untied fund at CHC/ BPHC/ RH was not released for the year

2011-12 up to visiting month in the district. Utilisation of fund at CHC level during

2011-12 has been made from the last year‟s balance.

b. Untied fund to VHSNC in the district was provided through Department of Panchayat

directly by the State Health Society. There is no involvement of district health officials

at district or periphery level at all.

6. 24x7 Hours Delivery Care Services:

a. 24x7 hours delivery care services were implemented in all Rural Hospitals, BPHCs

and PHCs in the district.

b. Facilities at RH, BPHC and PHC level were not upgraded for conducting C- Section

delivery. These services were available only at DH and SDH level in the district.

Facility for caring mothers and new born baby was found inadequate at the visited

BPHCs and PHCs. Blood storage facility was also not available in the visited centres.

675

c. There were adequate numbers of MOs in the visited institutions for 24x7 hours

services.

7. Physical infrastructure and Stock Position:

(i) Health Sub Centres:

a. Sub centres visited at Chhoto Simulguri, Chakiyar Chhada, Dewanhat, Kolakata,

Boxirhat and Atara were not up graded as per IPHS. ANMs were not staying at their

Sub Centre villages in most of the visited Sub Centres.

b. Labour room, Delivery table, Mclntsh sheet, Ambu bag/suction, Delivery kits, DDKs,

Sanitary Napkins, EC Pills, Oxitocine tablets, Ampicillin capsule and Gentamycin

injection etc. were not available in the Centres visited.

c. Short supply of Kits- A & B since one year was observed in the visited Centres.

d. Skilled Birth Attendance training was not provided to the Auxiliary Nurse Midwives of

visited Sub centres.

(ii). BPHC/PHC:

a. Infrastructure in the visited BPHCs at Ghokshadanga, Dewanhat and Boxirhat was not

upgraded as per IPHS. BPHC and Rural Hospitals were declared as CHC without

upgrading necessary infrastructure for CHC. However, only higher rate of RKS, AMG

and Untied Funds were provided to these centres. Adequate number of Specialist and

residential accommodation for MO and para-medical staff was not found there.

b. Ambulance/Jeep, X-ray facility, Blood Storage Unit, Surgical equipment, Sick New

Born Care Unit, Anesthesia equipment and Operation Theatre were not available in

the visited BPHCs. There was no facility for conducting C- Section delivery.

c. Power back up arrangement, Telephone facility, Ambulance/Jeep, Oxygen Cylinder,

Labour room equipments, Functional Operation Theatre and the posts of Lab

Technician and residential accommodation for MO was not available in the visit of

PHC Nishiganj.

8. Opinion of the Community on the Health Services:

a. 20 mothers having child upto one year old were interviewed in the area of Sub

Centres at Dewanhat and Kolakata to assess their opinion and knowledge about the

services provided by the concerned ANMs.

b. Interviewed mothers were satisfied with the services provided by ANMs. Contacted

mothers reported that, ANMs were not available as and when needed by community

and Post Natal Care services to the mothers was also not provided.

c. 36 community members of different target group were interviewed in the area of Sub

Centres at Dewanhat and Kolakata to assess their opinion and knowledge about the

676

services provided by the MPW (M). Community members were not satisfied with the

MPW (M) for not staying at Sub Centre headquarters, his irregular visit to the villages

for follow up services and also for the services relating to group meetings on health

topics etc.

d. 11 community members of different target groups i.e. pregnant women, recently

delivered women, mothers having upto two year old Child were contacted to know

overall functioning of the visited PHC. Some of the mothers were unaware about

danger sign of pregnancy during AN period, sick new born baby and breastfeeding

practice. They were also not much aware about contraceptive and HIV/STD/AIDS.

e. Community members were not satisfied regarding regular visit to the villages by PHC

MO and distribution of adequate drugs in the PHC.

9. Sample verification of FW acceptors:

a. The team selected a total of 89 F.W. acceptors for sample verification and out of that

58 (65.2%) could be contacted. Discrepant entries in the registers were observed

about the contacted acceptors i.e., age of acceptors in 7 (12.1%) cases, age of

spouse in 39 (67.2%) cases, number of Male children in 23 (39.7%) cases and age of

last child in 25 (43.1%) cases.

b. Among the contacted acceptors, 26 (44.8%) informed that they did not receive any

follow up services after having accepted the services.

c. 90 beneficiaries of BCG/ DPT/ Polio, Measles, Vitamin- A and Hepatitis –B were

contacted in the field. All beneficiaries confirmed receiving the doses. No complication

was reported after receiving the doses. Follow up services by health staff were

provided to 82 (91%) contacted beneficiaries and rest of the contacted beneficiaries

did not receive any follow up services.

10. IT Infrastructure and Mother & Child Tracking System:

a. Team found that, computers were available at district, and BPHCs level in the district

with Internet connectivity.

b. MCH Tracking formats were available in each Sub centres.

c. Health functionaries were sensitized in MCH tracking register but all required

information was not recorded. Updated data of tracking registers was not uploaded on

computer/ Net.

11. Registers, records and reports maintained at the visited centres:

a. Eligible Couple registers were maintained and updated properly in the visited centres

except Sub centre of Chakiyarchhara.

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b. No consolidated CuT service register was maintained at visited BPHCs and hence no

reported figures for CuT for the year 2010-11 and 2011-12 could be verified in these

centres.

c. Oral Pills distribution register was maintained in the visited sub centres in non printed

forms, where the details like EC number, age of the last children etc. were not

recorded.

d. ANC/PNC, Child immunization services and Oral Pills distribution register were

maintained properly with all details in the visited Sub centres.

e. Stock registers were maintained properly but not updated in the visited BPHCs at

Ghokshadanga, Dewanhat and Boxirhat.

12. Other observations:

a. Effective monitoring and supervision is needed at periphery level centres for

improving the services and also record keeping.

b. Lack of co-ordination among the Health personal and staff of District Management

Unit/ Block Management Unit was observed in the district. The district authority needs

to take proper step to improve the situation.

c. Service register for Sterilization cases was not maintained properly at BPHC

Dewanhat. Sterilisation payment register and consent form were not countersigned by

the concerned officers. During verification it was noticed that the payment register for

the year 2010-11 was not containing the name and address of the 225 acceptors and

incomplete addresses were recorded in 840 cases. Similarly, 668 sterilisation

acceptors were not recorded with their complete addresses during the year 2011-12.

d. Sterilisation payment register at BPHC Boxirhat was also not maintained properly and

also not countersigned by the concerned officers.

5.District: Jalpaiguri

Major observations of Regional Evaluation Team, Kolkata about the Evaluation work

carried out in Jalpaiguri district of West Bengal in December, 2011.

I.Details of the visited Institutions:

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District

visited

BPHC and PHC visited SCs visited

Jalpaiguri Rural Hospitals: Dhupguri and

Falakata

BPHC: Nagarakata

PHC: Jateshwar

Sakoajhora, Purv Altagram,

Bagatpur, Sulkapara and

Jateshwar- I & II

II. Major observations

1. Health Human Resources:

a. The district was facing shortage of health human resources. As reported, 42 (36.8%)

of the sanctioned posts of Specialist, 72 (42.9%) of the sanctioned posts of Medical

Officer, 329 (61.2%) posts of MPW (M)/ Health Assistant, 36 (51.4%)posts of Lab

Technician and 18 (22%) of the sanctioned posts of Pharmacist were vacant in the

district.

b. Though the figures of vacant posts were not made available in the visited BPHCs. It

was observed that most of the Specialists and the posts of Medical Officer & MPW

(M) were lying vacant. However, the position in respect of Health Assistant (F) and

GNM/ Staff Nurse was observed to be satisfactory in the visited centres.

c. All the posts in DPMU and BPMU under NRHM were filled up in the district.

d. Most of the Sub Centres were functioning with additional ANM. The post was filled up

on contractual basis.

2. Rogi Kalyan Samiti (RKS) and Village Health Sanitation & Nutrition Committee

(VHSNC):

a. Rogi Kalyan Samiti has been constituted and registered in the visited RHs, BPHCs

and PHC in the district. Meeting of RKS was being held regularly in the visited

institutes. RKS fund for the year 2011-12 was not released to any of the RKSs Samiti.

b. As reported, 1659 VHSNCs have been constituted in the district and ASHA is a

member in 1420 VHSNCs.

3. Functioning of ASHA:

a. It has been reported that 1926 ASHAs against the target of 2794 ASHAs for 736

villages have been selected in the district.

b. 1301 ASHAs have completed their training up to 5th module in the district. ASHAs

were working without drug kits in the district.

4. Services of Janani Suraksha Yojana (JSY):

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a. It was reported that the scheme was properly functioning in the district. Sufficient

funds were being provided to the facilities and eligible mothers were being paid JSY

benefits by Sub Centre ANM and by concerned Block Account Manager of PHC.

b. JSY benefits were provided to the eligible mothers in two instalments, first payment @

Rs. 500 is made by ANMs to eligible mothers after completion of three ANC and

second instalments payment @ Rs. 500 is made by Block Account Manager to eligible

mothers after institutional delivery. Most of the mothers informed that they were

discharge within 4 to 6 hours after delivery from the hospital.

c. 37 JSY beneficiaries were contacted out of 40 selected for on the spot sample

verification in the district and it was observed that all deliveries were normal and MCH

cards issued to all of them. 2 doses of TT and IFA tablets were provided to the

mothers. Role of ASHA in the context of conducting institutional delivery was not

satisfactory.

d. JSY registers were maintained properly containing the list of beneficiaries to whom

cash had been distributed.

5. Untied Funds:

a. The team reported that allotment of untied funds at different level in the district is very

irregular. Untied Funds are being provided at all facilities in the district but it was not

utilized fully by the centres in last two years. As reported, 89.9%Untied fund at CHC

level, 73.9% at PHC level and 87.8% Untied fund at Sub Centre level was reported to

have been spent in the year 2010-11; Untied fund at CHC/ BPHC/ RH level were not

released for the year 2011-12 up to visiting month in the district.

b. Untied fund to VHSNC in the district was provided through Department of Panchayat

directly by the State Health Society. There is no involvement of district health officials

at district or periphery level at all.

6. 24x7 Hours Delivery Care Services:

a. 24x7 hours delivery care services were implemented in all Rural Hospitals, BPHCs

and PHCs in the district.

b. Facilities at RH, BPHC and PHC level were not upgraded for conducting C- Section

delivery. These services were available only at DH and SDH level in the district.

Facility for caring mothers and new born baby was found inadequate at the visited

BPHCs and PHCs. Blood storage facility was also not available in the visited centres.

c. There were adequate numbers of MOs and GNM/ Staff Nurse in the visited institutions

for 24x7 hours services.

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7. Physical infrastructure and Stock Position:

(i) Health Sub Centres:

a. Sub centre visited at Sakoajhora was locked and ANM/ Health Assistant (F) of Sub

Centre Bhagatpur was not present during visit of team. Others visited Sub Centres at

Purv Altagram, Sulkapara and Jateshwar- I & II were not upgraded as per IPHS.

ANMs were not staying at their Sub Centre villages in most of the visited Sub Centre.

b. Labour room, Delivery table, Mclntsh sheet, Ambu bag/suction, Delivery kits, DDKs,

Sanitary Napkins, EC Pills, Oxitocine tablets, Ampicillin capsule and Gentamycin

injection etc. were not available in the Centres visited.

c. Short supply of Kits- A & B since one year was observed in the visited Centres.

d. Skilled Birth Attendance training was not provided to the Auxiliary Nurse Midwives of

visited Sub Centres.

(ii). RH/ BPHC/PHC:

a. Infrastructure in the visited RHs at Dhupguri & Falakata and BPHC at Nagarakata was

not upgraded as per IPHS. BPHC and Rural Hospitals were declared as CHC without

upgrading necessary infrastructure for CHC. However, only higher rate of RKS, AMG

and Untied Funds were provided there. Adequate number of Doctors and para-

medical staff was not found there.

b. Blood Storage Unit, Surgical equipment, Sick New Born Care Unit and Anesthesia

equipment were not available in the visited RHs/BPHC. There was no facility for

conducting C- Section delivery.

c. Ambulance/Jeep, Auto clave/ Steam sterilizer Drum, Oxygen Cylinder, Labour room

equipments, Functional Operation Theatre were not available in the visit of PHC

Jateshwar. AYUSH Medical officer was not available in the PHC.

8. Opinion of the Community on the Health Services:

a. 20 mothers having child upto one year old were interviewed in the area of Sub

Centres at Jateshwar- I and II to assess their opinion and knowledge about the

services provided by the concerned ANMs.

b. Interviewed mothers were satisfied with the services provided by ANMs. Contacted

mothers reported that, Post Natal Care services to the mothers were not provided by

ANMs.

c. 11 community members of different target group i.e. pregnant women, recently

delivered women, mothers having upto two year old Child were contacted to know

overall functioning of the visited PHC. Some of the mothers were unaware about

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danger sign of pregnancy during AN period, sick new born baby and proper

breastfeeding practice. They were also not much aware about contraceptives and

HIV/STD/AIDS.

d. Community members were not satisfied regarding regular visit to the villages by PHC

MO.

9. Sample verification of FW acceptors:

a. The team selected a total of 78 F.W. acceptors for sample verification and out of that,

76 (97.4%) could be contacted. Discrepant entries in the registers were observed

about the contacted acceptors i.e., age of acceptors in 5 (6.7%) cases, age of spouse

in 37 (48.7%) cases, number of Male children in 19 (25%) cases and age of last child

in 54 (71.1%) cases.

b. Among the contacted acceptors, 40 (52.6%) informed that they did not receive any

follow up services after having accepted the services.

c. 88 beneficiaries of BCG/ DPT/ Polio, Measles, Vitamin- A and Hepatitis –B were

contacted in the field. All beneficiaries confirmed receiving the doses. No complication

was reported after receiving the doses. Follow up services by health staff was

provided to all of them.

10. IT Infrastructure and Mother & Child Tracking System:

a. Team found that, computers were available at district, and BPHCs level in the district

with Internet connectivity.

b. MCH Tracking formats were available in each Sub centres.

c. Health functionaries were sensitized in MCH tracking register but all required

information was not recorded. Updated data of tracking registers was not up loaded

on computer/ Net.

11. Registers, records and reports maintained at the visited centres:

a. Eligible Couple Survey and Sterilisation registers were maintained and updated

properly in the visited centres.

b. Consolidated CuT service register was not maintained at visited BPHCs and hence no

reported figures for CuT for the year 2010-11 and 2011-12 could be verified in these

centres.

c. Oral Pills and Nirodh distribution register were not maintained/ updated properly in the

visited sub centres.

d. ANC/PNC and Child immunization service registers were maintained properly with all

details in the visited Sub centres.

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e. Stock registers were maintained properly but all required details were not recorded in

the register in the visited RHs at Dhupguri & Falakata and BPHC at Nagarakata.

12. Other observations:

a. Lack of co-ordination among the Health personal and staff of District Management

Unit/ Block Management Unit was observed in the district. The district authority should

take proper steps to improve the situation.

b. It was reported by the team that the officials like BAM, BDEO, DEO, 2nd ANM etc. at

Nagarakata block were waiting their remuneration for the period April 2011 to June

2011. It was also informed that the amounts are released by District Health Society

Jalpaiguri for all the blocks but no such amount was given to Block Health and Family

Welfare Society Nagarakata up to the month of visit by the team.


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