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8/12/2019 Guidance Note for Block Monitoring Visits in High Priority Districts
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Guidance Note for Block Monitoring
Visits in High Priority Districts
Guidance Note for Block Monitoring
Visits in High Priority Districts
September 2013
8/12/2019 Guidance Note for Block Monitoring Visits in High Priority Districts
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8/12/2019 Guidance Note for Block Monitoring Visits in High Priority Districts
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3Guidance Note for Block Monitoring Visits in High Priority Districts
Block Monitoring Visits
I. Why Block Monitoring Visits?
The RMNCH+A strategic approach for improving maternal health and child survival envisages support
from Development Partners, State and District Programme Management Unit for integrated planning,
implementaon and monitoring of the RMNCH+A intervenons across high priority districts. In
order to ensure that districts get mely support to implement the most crical intervenons, the
Development Partners are expected to oerneedbaseddistrictlevelassistance and work alongside
district and block level stakeholders to idenfy key bolenecks and address themsystemically.
It has been observed from the eld visits that there exist interblock variaons within the districts in
terms of health infrastructure and service delivery. This could be due to clustering of vulnerable and
marginalized populaons, geographical inaccessibility, or security concerns (eg; LWE aected), on
account of which these blocks remain relavely underserved.
Under the District Intensicaon Plan, the block is envisaged as the primary unit for implementaon
and management of RMNCH+A intervenons, the capacies for which are to be developed locally
through mentoring support by the district and state management units and the development
partner.
II. Purpose of Block Monitoring Visits
The purpose of Block Monitoring Visitswill be to:
1. make a quick assessment of the infrastructure, human resources, and provision of services
(both at facility and community level) ;
2. assess service delivery (quality and coverage) at block level;
3. review progress of community outreach and community/home based intervenons;
4. validate the data reported into HMIS; and
5. gauge the client (beneciary) sasfacon level with RMNCH+A services.
III. Steps in Block Monitoring Visit
To achieve the above goals, constuon of appropriate mixed skills team is important. These
team members should be able to provide mentoring/handholding and supporve supervision. It
is proposed that District Monitors, assigned by various Development Partners, visit one block each
month in each high priority district. They will be joined on these visits by government representaves
from district and state, and where directed by the SPMU, experts, resource persons from mentoring
instuons and NGO representaves may also be part of the team. The dates for block monitoring
visits should be informed in advance to all team members. The schedule of visit for three or six
months may be drawn up so that the District Monitors can schedule it in their monthly work plans
and availability of all team members is ensured.
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4 Guidance Note for Block Monitoring Visits in High Priority Districts
The team should visits delivery points including DH & FRU (if present in the block), 24 x 7 PHC, CHC,
and sample of sub-centresdesignated and interact with the community. During the visit the focus
should be on:
1) Boleneck hampering quality / eecve coverage of essenal intervenons saving newbornand mother lives, at all level community, outreach, facility level throughout connuum of care
2) Implementaon of strategies overcoming the boleneck and addressing inequity and disparity
at block level (geographical, gender, social groups..)
3) Trends / progress of key indicators to follow
a. Eecve implementaon of strategy
b. reducon of boleneck
c. increase coverage of essenal intervenons
4) Real me feedback and report to adjust and accelerate implementaon and scale up from block
to district wide scale.
IV. Reporng format
Following the visit, the District Monitors, along with the team members are expected to prepare a
visit report that includes:
1) Major aconable points & level at which the acon is to be taken (i.e. facility, block, district or
State);
2) Stakeholders (Development Partner/s, DPMU, SPMU, other experts or resource persons, NGOs)responsible for providing technical support along with melines; and
3) Acons taken on previously idened bolenecks and visit reports.
The Reporng Formatbelow provides a broad guidance on the parameters to be assessedduring
monthly visits to the blocks and to be reported thereaer. Addional components may be included
by the District Monitors based on experiences from the eld visits so that most relevant and crical
issues are reported. It is important that not only is the progress captured but also the bolenecks
for delay are explored and recorded. The acons should focus on addressing these bolenecks.
The reports should be forwarded by the District Monitors to the concerned authories at Districtand State levelwithin one week of compleng the visit. The State Lead Partner Agency can compile
the reports from dierent block visited during the month , presenhe key ndings and proposed
acons to the SRU/SUT before forwarding it to the Naonal RMNCH+A Unit (NRU) in the following
month.
Note: Specic tools and checklists may be used to assess the various parameters included in the
reporng format. These can include facility assessment tools/monitoring checklist, community /
household visit tool, tools for assessment of labour rooms, newborn care facilies, hygiene and
sanitaon facilies, and so on.
The data may be accessed from District /Block Management Unit before or during the visit andvalidated in the eld/health facility.
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5Guidance Note for Block Monitoring Visits in High Priority Districts
Reporng Format
Name of the Block/s & District visited:
Dates of Visit:
Name of team leader & organizaon:
Names of team members & organizaons:
I. Block Prole
i. Demographic informaon Census 2011
Whether it has areas that are dicult to reach (due to
hilly or dicult terrain)
Name of the villages that are dicult to reach
Whether block has more than 50% Tribal Populaon Yes/No
Whether the block is LWE aected Yes/No
Total Populaon Male Female Total Urban Rural
ii. Infrastructure Sanconed Presently Funconal
Number of Sub-Health Centers
Number of 24x7 Primary Health Centers
Community-Health Centers
FRU (facility providing C secon/ EMONC)
Any adolescent health clinic/s
SNCU (Yes/No)
Any NBSU
Any NRCs
Any health facility with blood bank
Any facility with blood storage unit
Block covered by funconal MMUs (Mobile Medical Units) Yes/No
Detailed Observaons and comments
iii. Human resources Sanconed posts In posion
(contractual +regular)
BPMU sta
ASHAs
ASHA Supervisors
1st ANM
2nd ANM
Sta nurses
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6 Guidance Note for Block Monitoring Visits in High Priority Districts
FRU
24X7 PHCs
LHVs
MPWs (male)
Medical Ocers
FRU
24X7 PHCs
AYUSH MOs
Specialists (at any health facility in the block)
Obstetricians &Gynaecologist
Anaesthest
Paediatrician
Surgeons
Detailed Observaons and comments
iv. Health service provision # designated as
delivery point
against total no.
of facilies
# having SBA & NSSK
trained ANM/ SNs
against total no. of
delivery points
# having funconal
NBCC against total
no. of delivery points
Sub-Health Centers
24x7 Primary Health Centers
Other PHCs
Community-Health Center
Number of facilies in the block conducng
C-secon
CHC 24×7 PHCs SC
Number of facilies with xed day family
planning services
Number of facilies with RMNCH+A counsellors
Number of funconal Anganwadi centers
% villages with funconal VHSNC
No of Villages with NO Access to any public
health facility within 30 minutes walking
distance
Names of the villages
Detailed Observaons and comments
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7Guidance Note for Block Monitoring Visits in High Priority Districts
II. ASSESSMENT OF KEY RMNCH+A COMPONENTS AT BLOCK LEVEL
The following components shouldbe assessed during the eld visits and the related quantave
and qualitave informaon provided in the visit report.
Health facilies
1. Delivery points: (Assess on the following aspects as pe naonal guidelines- availability of
skilled human resources, raonal deployment, infrastructure, equipment , supplies (including
vaccines, contracepves); delivery of key RMNCAH service packages, hygiene & sanitaon,
waste management, funconing of blood banks/ blood storage units, data management,
maintenance of records)
2. Management of pregnant women with high risk pregnancies, including severe anaemia:
(Assess number and type of high risk pregnancies managed , referral mechanisms)
3. Newborn care facilies: (Assess as per naonal guidelines the status of NBCCs, NBSU(if any)in terms of skilled HR, infrastructure, ulisaon , data maintenance, adherence to protocols
including asepsis, iniaon of breaseeding& exclusive breaseeding promoted; hygiene &
sanitaon facilies,referral mechanisms)
4. Family Planning services: (Assess PP-IUCD programme, availability of RMNCH+A counsellors,
xed day services/sites for interval IUCD, training for IUCD inseron, status of sterilisaon
services)
5. Comprehensive Aboron services (Assess if services available, number of aborons performed,
methods used, training/skills of providers)
6. Adolescent Health services: (Assess if services available, clinics held regularly, service ulisaon)
Health Systems
7. JSSK scheme: (Assess if the scheme rolled out and number of entlements in place, number
of beneciaries, public grievancesredressal system, cizens’ charter, ambulances &call centre,
client feedback on sasfacon with services and out of pocket expenses, if any)
8. JSY scheme: (Assess the performance in terms of number of beneciaries, payments, mandatory
stay of 48 hours, client feedback, ASHA feedback)
9. Ulisaon of RKS funds (purpose for which funds have been ulised, frequency of RKS meengs,maintenance of books of account)
10. Training of health workers (Assess funconality of training instuons, progress on key trainings
–EMONC, BEMOC, SBA, NSSK, IMNCI, PP-IUCD, IUCD inseron etc. and raonal deployment)
Community level
11. Communisaon processes (formaon of VHSNC and their funconality, if social audits being
conducted, convergence with PRI & other sectors like water & sanitaon, rural development,
involvement of self-help groups/ women’s groups in health & nutrion acvies)
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8 Guidance Note for Block Monitoring Visits in High Priority Districts
12. VHNDs (Numbers held against planned, number of services provided, presence of community
workers and other stakeholders, availability of supplies, equipment, client feedback, record
keeping, MCP card, IFA supplementaon for adolescent girls and boys, line lisng of women
with severe anaemia/high risk pregnancy, convergence with women and child development
department)
13. HBNC scheme (Module 6 & 7 training ,ASHA kits, home visits, referrals made, line list of LBW/
preterm babies, detecon of congenital defects, MCP card, client feedback during home visits)
14. Immunisaon: (Assess availability of microplans, RI sessions held, coverage, dropouts, strategies
for reaching dropouts, vaccine availability at site, cold chain)
15. RBSK scheme (whether it has been launched, number of mobile health teams, progress on
DEIC, number of schools covered, preparedness of AWCs)
16. Doorstep delivery of contracepvesby ASHAs: status of implementaon, supplies, trends in
uptake of contracepves, feedback from ASHAs and clients
17. Menstrual Hygiene Scheme: supplies, uptake, acceptance of the product, ASHA and client
feedback
18. WIFS: Number of schools covered, supplies, monitoring mechanism, convergence with
department of educaon, handling of complaints following administraon of IFA tabs, feedback
from students & teachers
19. IEC/BCC on RMNCH+A (Strategies used for IPC, BCC, mass media , local innovaons, availability
of IEC materials in local language etc.)
20. Maternal Death Review: whether being conducted regularly, causes of maternal deaths, keyrecommendaons emerging from reports, regularity of reporng to state & naonal level
21. Any other pilots/ schemes /innovaons
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9Guidance Note for Block Monitoring Visits in High Priority Districts
III. VALIDATION OF KEY RMNCH+A INDICATORS REPORTED IN IN HMIS
AND MCTS
The team should validate the HMIS reporng of following indicators from the primary data source
( eg; registers) available at the facility/block management unit. Sample data from last two quarterscan be validated.
Pregnancy Care HMIS data Specify the
data source
Primary Data
recorded in the
data source
Comments (whether
the HMIS data
matches the data
recorded in primary
data source)
1st Trimester registraon to ANC
registraon
Pregnant women received 3 ANC check-
ups to total ANC registraonPregnant women given 100 IFA to total
ANC registraon
Cases of pregnant women with Obstetric
Complicaons and aended to reported
deliveries
Pregnant women receiving TT2 or Booster
to total number of ANC registered
Child Birth
SBA aended home deliveries to total
reported home deliveries
Instuonal deliveries to ANC registraon
C-Secon to reported deliveries
Post natal Mother& Child care
Newborns breast fed within 1 hour to
total live births
Women discharged in less than 48 hours
of delivery in public instuons to total
no. of deliveries in public instuons
Newborns weighing less than 2.5 kg to
newborns weighed at birth
Newborns visited within 24hrs of homedelivery to total reported home deliveries
Infants 0 to 11 months old who received
Measles vaccine to reported live births
Reproducve Age Group
Post-partum sterilizaon to total female
sterilizaon
Male sterilizaon to total sterilizaon
IUD inserons in public plus private
accredited instuon to all family
planning methods (IUD plus permanent)
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10 Guidance Note for Block Monitoring Visits in High Priority Districts
IV. Key Findings and Acons
5 major aconable points agreed upon for acon aer block monitoring visit &level at which the
acon is to be taken i.e. facility, block, district or State to be menoned
1
2
3
4
5
Acon taken on last visit report (Date of the last visit)
1
2
3
4
5
Date of preparaon of report:
Signatures of team members:
1.
2.
3.
4.
5.
6.