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Chattisgarh

1.Korba district

Major observations of Field Survey Unit, Bhopal about the Evaluation work in district Korba of Chattisgarh in July, 2010. I. Details of the visited institutions:-

District Visited

DH, CHCs and PHCs visited SCs Visited

Korba

Distt. Hospital: Korba CHCs: Katghora and Pali PHCs:Chhurikala,Ranjna,Chetma

& Hardi Bazar

Salora, Hunkra, Ranjna, Dipka, Nanbaka, Rajkamma, Nunera & Tiwarta

II. Major Observations:-

1. Human resources:-

a) Acute shortage in the technical manpower was observed in the district. Most of the posts of specialist were lying vacant in the District. More than 50% posts of medical officer were lying vacant there. Overall in 463 posts of different categories were lying vacant as against 938 sanctioned posts in the district. Sanctioned strength & vacancy in key posts are given below:

Particulars Sanctioned Vacant Class- I Officers 37 26 Class -II Officers 105 53 Male Supervisor 49 22 Lab.Technician 32 23 Lady Health Visitor 55 20 MPW (M) 215 109 MPW (F) 251 115 Ophthalmic Assistant 37 33 Pharmacist Gr. II/Store Keeper 45 17

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Urgent necessary steps may be taken to fill up the vacant posts for providing smooth health

services in the District.

-1- b) At CHC Katghora, 2 of 7 sanctioned posts of Medical Officers were vacant. Against 5

specialists required for CHC there was only 1 in position. Similarly, 1 MO against sanctioned strength of 2 in each of the visited PHC was vacant.

2. Janani Suraksha Yojana (JSY):-

a) During visit to CHCs at Kathghora and Pali, it was observed that the funds are provided regularly in time and the beneficiaries were having facilities as well as incentive under the Scheme. JSY registers were maintained entering all relevant details of the beneficiaries in these CHCs. Concerned MOs were checking the registers regularly.

b) In CHC Kathghora, total numbers of pregnant women identified under JSY were 8105 for the last complete year and 1575 for the current year and incentive provided to 1473 and 567 JSY beneficiaries during 2009-10 and 2010-11 respectively. An amount of Rs. 19,42,500 was provided during 2009-10, against which expenditure incurred was to the tune of Rs. 18,16,700 and an amount of Rs. 10,00,000 was provided in the current financial year, out of it Rs. 8,32,700 was spent..

c) In CHC Pali total numbers of pregnant women identified under JSY were 4421 for the last complete year and 1376 for the current year. And the fund provided to 2442 and 591 for the last and current year respectively. The fund allotted to the CHC Pali,was Rs. 38,70,600 for the year 2009-10 and the expenditure incurred was Rs.26,99,600. An amount of Rs 10,00,000 was allotted to the CHC for the current year and out of it an expenditure of Rs.7,31,050 was incurred.

d) The team contacted 32 beneficiaries in the areas of the visited centres out of 40 selected for sample verification and observed that all of them received ANC services in time and also JSY amount as per the norms. Contacted beneficiaries were mostly satisfied with the services under the scheme,, but some of the mother had not received three post natal checkups.

e) Most of the beneficiaries were accompanied by ASHAs while going to the hospitals for deliveries.

3. Untied Funds:-

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a) Untied funds to the tune of Rs.5,00,000 was provided to the District Hospital and an expenditure of Rs. 5,26,968 was incurred and excess amount was met from other funds.

b) All 4 CHCs were given untied funds of Rs.2,00,000 during 2009-10 and 85% of the funds were utilised during the period. Similarly, for 37 PHCs, Rs. 9,25,000 @ 25,000 each PHC was provided during the year 2009-10 and funds utilised upto 92% during the period.

c) All 211 Sub-Centres were given @10,000/- per centre during 2009-10 and 2010-11. It was reported that 157 Sub-Centres out of 211 submitted their utilization certificate for both the years i.e., 2009-10 and 2010-11.

d) No untied fund has been provided to CHCs and PHCs for 2010-11 till the month of visit.

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4. Rogi Kalyan Samiti (RKS) and Village Health & Sanitation Committee (VHSC):-

a) It was reported that Rogi Kalyan Samitis have been constituted at DH, 4 CHCs and 37 PHCs in the district.

b) During 2009-10, 04 CHCs had received RKS funds @ Rs.1,00,000 for each CHC and utilized 85% of funds during the year.

c) In 2009-10, all the 37 PHCs had been provided RKS funds to the tune of Rs. 37,00,000 i.e., @ Rs.1,00,000 to each PHC and utilized about 92% of the funds.

d) RKS funds were not given to the institutions for the current year till the month of visit.

e) Block-wise report of the district shows that out of 795 villages, VHSCs have been formed in 716 villages in the district and all VHSCs were having ASHA as a member. Most of villages in the visited Sub Centres were having VHSCs.

f) VHSCs were reported to have opened bank accounts for handling funds.

5. Functioning of ASHA Scheme:-

a) 2274 ASHAs have been selected in the district and all ASHAs have been trained up to IV th module and provided with Drug Kit. In the visited centres, it was observed that ASHAs were trained up to IV th module, having drug kits and working properly.

b) As informed by the ANMs, JSY beneficiaries and villagers of the visited Sub- Centres, the role of ASHAs in the field was satisfactory.

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c) At the time of ANCs and immunization, ASHAs were helping ANMs and also motivating and accompanying mothers for Institutional deliveries.

6. 24 x 7 hour Delivery Care System:-

a) In the district there are 4 CHCs and 37 PHCs. All were functioning as 24 x 7 but delivery care service is reported to be available on call. At PHC level, staff Nurse is providing services for delivery on call.

b) The Sub-Centre Salora, under Chhuri PHC in Katghora CHC had been accredited for institutional delivery.

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7. Physical Infrastructure and position of supplies:-

i) CHC:

a) The Pali and Kathghora CHCs were functioning in government buildings. The premises of both the CHCs were found neat & clean. The Kathghora CHC was having 30 & CHC Pali was having 20 beds and all the beds were found to be in good condition during the visit. The Water supply was regular but the electric supply was irregular in both the visited CHCs.

b) Though the norms for infrastructure and equipments were not as per IPHS, necessary equipments like BP Apparatus, Weighing Machine (Adult & Infant), Microscope & Lab Equipments, Auto clave, Oxygen Cylinder, Resuscitation Equipment, Neo natal Resuscitation Equipment Labour room, Labour room table & Equipments, Examination table and IUD insertion kits were available at both the visited CHCs.

c) Anaesthesia equipments were not available in CHC Katghora and surgical equipments were not available in CHC Pali. The license for Blood storage unit is awaited at the visited CHCs.

d) Vital, Essential and desirable drugs were available in both the CHCs visited.

ii) PHC:

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a) PHCs viz., Chhurikala, Ranjna, Chetma & Hardi Bazar, visited in the district were functioning in Govt. Building. Electricity and water supply were available at all the PHCs. BP Apparatus, Weighing Machine (Adult & Infant), Auto clave, minor surgical equipments IUD insertions kit, Labour room with the table & Equipments etc. were available in the visited PHCs except PHC at Chetma.

b) Functional Operation Theatre with OT table was not available at visited PHCs. There was no vehicle in any of the 4 visited PHCs. The Cold Chain equipments were found only in 2 PHCs out of 4 visited PHCs.

c) AYUSH Medical Officers were not available at 3 out of 4 visited PHCs. There was no residential quarter at PHC Hardi Bazar.

iii) Sub-centre:

a) Out of 08 visited Sub-Centres, 05 were functioning in Govt. buildings and the sub centres at Nanbaka, Nunera and Tiwarta were functioning in rental building. The sub-centres Ranjana, Nanbaka, Nunera and Tiwarta were not having sufficient space for conducting deliveries and cleanliness was not up to the satisfactory level at Nunera and Tiwarta Sub-Centres.

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b) Essential furniture, weighing machine, IUD insertion kit and Ambu bag etc. were available in the SCs functioning under CHC Katghora i.e., Sub Centres at Salora, Hunkra, Ranjna and Dipka.

c) BP apparatus in working condition, steam sterilizer, blood slides, ORS and vitamin “A” etc. were lacking one or other visited centres.

d) Drugs like Tab. Chloroquine, Metronidazole, Paracetamole, Oxytocin and Ampicillin, lnj. Gentamicin and Antisaptic solution etc. were not available at most of the centres. Short Supply of Condom since Feb.2010 was observed in the centres visited.

8. Knowledge and opinion of the Community on health Services:-

a) To assess the knowledge and opinion on health services provided by the ANMs, 25 mothers having child up to one year old were interviewed in the areas of 8 visited sub centres and mothers reported that ANMs were available as and when needed.

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b) 10(40%) mothers replied that the ANM visited them within three days of the delivery. 13(52%) intimated the ANM visited on 7th day of delivery. In 2 cases there was no home visit. 19(76%) mothers put their babies to breast within 1 hour of delivery and only 10 (40%) mothers received three post natal checks up.

c) 14 (56%) mothers knew about danger sign of ARI. 17 (68%) mothers knew the use of ORS.

d) All the mothers knew the schedule of child immunization and use of contraceptive.

e) The posts of male workers found vacant at 4 out of 8 visited sub-centres. MPW was there at SCs Dipka, Nunera, Nanbaka and Rajkamma and they were collecting blood slides regularly and also looking after immunization programmes. The villagers were satisfied with the services and behaviour of the MPWs.

e) During the course of visit to PHCs, as intimated by the service acceptors and other villagers they were satisfied with the staff and the Health services provided by PHCs. Almost all the Medical Officers of the visited PHCs used to stay at Head Quarters and all the emergency medicine and drugs were available in the visited PHCs.

9. Sample verification of FW acceptors:-

a) Out of selected 214 acceptors of Family planning methods, 177 (82.7%) acceptors could be contacted for sample verification in the district. While examining the data of the selected acceptors from the service registers, it was noticed that age of acceptors, age of spouse, total number of children, number of male/female children and age of the youngest child were not recorded in 29 (14%), 62 (29%), 23 (11%), 29 (14%) and 98 (46%) cases respectively.

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b) Similarly, discrepancies in the age of accepters in 32 cases, in the age of spouse in 27 cases and in the number of male child in 19 cases were observed during sample check of the F.W acceptors.

c) There were 143 acceptors of spacing method and out of that 113 (79%) cases were found to the reported fake/false i.e., IUD 29, Oral Pills 38 and Nirodh 46.

d) 6 OP users and 2 Nirodh users were facing difficulty due to irregular supply.

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e) The follow-up services were confirmed by 55 (86%), out of 64 genuine contacted acceptors. All 34 contacted Sterilization cases got the incentive amount.

10. Maintenance of records and Registers:-

a) Maintenance of records and registers for F.W. services was found very poor in the visited sub-centres except in SCs at Hunkra, Dipka and Nanbaka.

b) EC registers were not maintained properly at most of the SCs.

c) Non-printed registers in respect of F.W. Services were being used at CHC, PHC and Sub Centres level.

d) Monthly progressive performance for F.W. Services for the Year 2009-10 and 2010-11 was not readily available at district office.

e) Due to absence of IUD record at CHC Head Quarter, the IUD figures could not be verified.

11. Observation and Suggestions:-

a) Due to lack of proper supervision by Block Medical Officers, the maintenance of records and registers was poor. The monitoring and supervision needs to be strengthened at periphery level.

b) During ANC/PNC surveillance, it was ascertained that 3 PNC, visits to mother were not being given at village level.

c) SC Salora which is under the jurisdiction of PHC Chhurikala & Katghora CHC was accredited for institutional deliveries from December, 2009 and only 3 deliveries were conducted upto the time of visit.

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2.Rajnandgaon district

Major observations of Regional Evaluation Team, Bhopal about the Evaluation work in District Rajnandgaon in Chattisgarh State in September , 2010

I. Details of the visited Institutions:

District Visited DH , CHCs and PHC s visited SCs Visited

Rajnand Gaon District Hospital Rajnandgaon, CHCs: Dongargaon, Chhuikhadan and Gumka. PHCs: Pendarwani, Badgaon, Charbhata, Gandai, Asra, and Dumardih.

Udaypur, Ghirgholi, Birutola, Tilai, Khujji, Atariyaroad, Gopalpur and Rudgaon.

II. Major Observations:-

1. Health Human Resource

a) The following table shows the vacancy position of key Health personnel against the sanctioned strength in the district.

Post Sanctioned Strength Vacant

Specialist 33 29

Medical Officer 97 56

Lab Technicians 28 27

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MPW (Male) 314 91

LHV 67 29

ANM 355 10

Apart from the above, 12 out of 48 sanctioned posts of Contractual Staff nurse (BE MOC) filled on contractual basis are also lying vacant.

a) 13 posts of Causality Doctors GDPO out of 24 sanctioned , all 2 posts of Anesthetist, all 2 posts of Medical specialists, and 1 out of 2 posts of OB & G, Pediatrics and 4 out of posts of Pharmacists were lying vacant in District Hospital, Rajnandgaon. There was only one post each of Psychiatrist and Dental Surgeon which were presently lying vacant in the Hospital.

b) In CHC visited at Chhuikhadan, Ghumka and Dongargaon, few posts of Specialists, BEE, Account Assiststs, Computers, Staff Nurse, MPWs and Radiographer ets are lying vacant .

c) . Necessary action is required to be taken to fill up these posts for providing proper health care delivery in the district..

2. Services of Janani Suraksha Yojana (JSY) :

a) To assess the client satisfaction and availability, of services under JSY as many as 28 JSY beneficiaries were contacted by the team in the district and all of them were found satisfied with the services provided under JSY.

b) All the mothers received TT and IFA tablets during ANC checkups and also had the checkups during the ANCs. Most of them were accompanied by ASHA/Dai/ ANM while going to the hospital for delivery.

c) However, Only 12 ( 42%) beneficiaries got three post natal checkup and 6 (21%) mothers received their cheques for JSY cash incentive within 3 days of the delivery.

d) Proper registers were being maintained containing list of beneficiaries to whom cheques were issued and the MOs of the visited centres were checking the registers on monthly basis.

3. Utilization of Untied Funds:

a) As reported CHCs @ Rs 50,000 each, PHCs @ Rs 25,000 each and HSCs @ Rs10,000 each were provided as united funds during 2009-10 in the district. Utilization certificate (UC) for the financial year 2009-10 was not submitted by the CHCs and PHCs and hence funds for 2010-11 were been released to them till the visit of the team. However, all the HSCs submitted UCs for the funds provided in 2009-10.

No. of centres provided Untied funds in 2009-10 Submitted UC in 2009-10

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Untied unds 9 CHCs (@ Rs. 50,000 9 CHCs NIL 39 PHCs @ Rs 25,000 39 PHCs NIL 305 HSCs @ 10,000 305 HSCs 305 HSCs

b) In the visited sub-centres, untied funds were found to have been provided and utilized as per norms.

4. Implementation of Rogi Kalyan Samiti (RKS)

a) Rogi Kalyan Samitis has been set up in District Hospital, 9 CHCs, and 39 PHCs . RKS at CHC level had been provided the funds @ Rs. 1,00,000 during 2009-10. In 9 CHCs which were provided funds, reported complete utilization but Utilization certificates were not submitted. Hence, these CHCs were not provided funds for 2010-11 till visit of the RET. During 2010-11 3 CHCs namely Chhuikhandan, chouki and Mohala incurred 100% expenditure and have submitted Utilization Certificates.

b) At PHC level, funds had been provided @ Rs. 1,00,000 during 2009-10. In 39 PHCs out of 43 PHCs which were provided funds, reported complete utilization but Utilisation certificates were not produced. Hence, these PHCs were not provided funds for 2010-11 till visit of the RET. During 2010-11 4 PHCs namely Salhewara, Udaipur, Tumdibod and Charbhata incurred 100% expenditure and have submitted Utilisation Certficate.

c) During 2008-09 and 2009-10 the RKS of the District Hospital Rajanandgaon, was provided funds @ Rs. 5 Lakhs per RKS. Though occasionally executive committee meetings were convened but general body meeting was not convened since last two years. The district collector wants the proposal for incurring expenditure to be submitted to in General Body meeting . Since, this was not done, expenditure was not incurred as there was no expenditure in previous year funds were not provided in 2010-11.

5. Village Health Sanitation Committee (VHSCs):

a) Village Heath & Sanitation Committees have been formed in all 1603 villages and VHSCs were having ASHA as a member. All the 1603 VHSCs have been reported to have opened joint Bank accounts as per norms for handling the funds.

b) As per the details available , the district was in reeipt of Rs. 37,40,000 as VHSC fund for 374 VHSC during 2010-11 and out which an amount of Rs. 15,12,279 was spent.

6. Functioning of ASHA Scheme:

a) As per the information received from DPMU, 3740 ASHAs were selected and trained and equipped with drug kits.

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b) During visit to the sub-centres, it was observed that most of the ASHAs were taking active part in providing the services of ANC, Immunization and other JSY activities, and also motivating cases for sterilisation.

7. 24 X 7 hours Delivery Care System:

a) 32 institutions i.e District hospital, 8 CHCs, and 23 PHCs were providing 24X7 delivery care in the district. Visited CHCs,and PHCs were providing 24X7 Delivery care services.

8. Physical Infrastructure:

i. CHCs:

a) CHC Dongargaon, Chhuikhada and Ghumka were functioning in Govt. buildings. . CHC Dongargaon and Chhuikhada were having 30 beded facility and CHC Ghumka had 10 beds. The premises of visited CHCs were found neat & clean.

b) Medical waste disposing system Incinerator and Blood storage facility were not available at any CHC visited.

c) X-Ray facility was available in all visited CHC, but it was non functional in CHC Ghumka as there was no x-ray technician posted there.. Anesthesia equipments were non –functional at Dongargaon CHC.

d) Infrastructure and equipments were in the CHCs were not as per IPHS standard.

ii. PHC:

a) PHCs at Badgaon Charbhata, Gandai, Dumardih and Asra were functioning in government building having capacity of 4,10,2,& 20 beds respectively. PHC Pandarvani, was running in rent free building and had no bed facility.

b) Most of the essential facility Like water supply electricity, toilet and telephone, etc. were found available in all the visited PHCs except PHC Pandarvani.

c) Microscops was found unused in Dumardhi and Asra PHC. d) Cold chain equipments were available in the visited PHCs expect at PHC Padarvani. The

same was was not in working condition in PHCs at Badgaon Charbhata.. e) Residential quarters for MO are avaliable in Badagaon, Charghata, Gandgi and Dumarih

PHCs but not in Asra and Pandarvani. f) AYUSH MO was not available in the visited PHCs.

iii. Sub-centre:

a) 8 visited Sub-Centres were Viz. Khuji, Raudgaon, Ataria road, Gopalpur, Udaipur, Ghirgholi, Birutola and Tilai . Except Bitrutola and Gopalpur SCs all were having Govt accommodations. ANMs of Bitrutola and Gopalpur sub centers were not residing in sub

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center villages. Deliveries were being conducted in the centers except SC Udaipur and Birutola. At Tilai SC, deliveries being conducted even though there was no labor room.

b) Examination table, Cup board, for drugs, Delivery kit, Gloves, weighing machines etc were found in all the sub-centres except one or two places. Ambu bag was available in 2 sub centers out of 8 SCs visited.

c) DDK, Emergency Contraceptive Pills, tab. Misofrostol, Injection Gentamicin and Oxitocin etc were not available at some of the visited sub centers, Cap. Ampicillin was not available at any of the SCs visited.

d) Torch, Stove, BP apparatus were available at some of the Centers and they were not in working conditions in a few other centers.

9. Knowledge and opinion of community on health services:

a) 44 mothers having child upto one-year age were interviewed for assessing the services being rendered by the ANM working in the visited sub-centres.

b) Only 39 mothers replied that the ANMs visited them within three days of their delivery.

c) 14 ( 32% ) mothers had three post natal checkups.

d) Of the 44 contacted, mothers15 mothers knew danger sign of ARI and 27 knew the schedule of child immunization.

e) 11(25%) mothers were aware about advantages and side effects of contraceptives use.

f) During the course of visit to PHCs at Asra, Badgaon Charbhata and Gandai, it was observed that the community was mostly satisfied with the services of PHC staffs.

g) Performance of MPW(M) for 2009-10 could not be assessed as the performance report and registers could not be produced by workers.

10. Sample Verification of Family Welfare Acceptors:

a) Out of selected 141 Family Planning acceptors (Sterilisation, IUD, OP and Nirodh) 87 (61%) could be contacted for sample verification in the district.

b) While examining records of selected acceptors from service registers, age of spouse was found not recorded in 10 (8%) cases and age of youngest child in 66 (47%) cases. 14 (21%) cases out of 87 contacted acceptors reported to have not been visited by the Health Personnel for follow up services.

c) Out of 57 contacted cases of spacing methods i,e., IUD, OP and Nirodh 21 (24%) found to be false reported in the in the district.

d) Out of selected 192 beneficiaries of child immunization, 167 (87%) children could be contacted and confirmed received the vaccination. It was also found that as many as 104 (62%) beneficiaries were not provided with the follow-up services.

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.11. Maintenance of records and Registers:

a) EC Register was neither maintained nor updated at most of the visited centers in the district. b) Service registers for OP and Nirodh were not maintained properly in most of the visited sub

centers. Some of these registers were lacking the required data of accepters. c) MCH service Registers were mostly updated. d) Service registers for Sterilization, was maintained properly at CHC Dongargaon and PHC

Chhuikhadan but not in CHC Ghumka. e) Lack of supervision and monitoring was noticed at all the centers at periphery level which

should be strengthened.

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3.Janjgir district

Major observations of Field Survey Unit (FSU) and Regional Evaluation Team (RET), Bhopal about the Evaluation work in district Janjgir of Chattisgarh State in the month of March, 2011. I. Details of the visited Institutions:

District

Visited

PHCs /CHCs/District

Hospital Visited

HSCs Visited

Janjgir

District Hospital: Janjgir CHCs: Sakti and Akaltara PHCs: Kurda, Baradwar, Kapan and Nariyara

Nagarda, Dhanpur, Deragarh, Lavsara, Parsahibana, Tilai, Pauna and Taraud

II. Major Observations :-

1. Human Resources:

a) There was acute shortage of manpower in the district against the sanctioned strength. 54 (83%) of

the sanctioned posts of Specialist, 78 (57%) of the sanctioned posts of Medical Officer, 15 (29%) of the

sanctioned posts of Staff Nurse, 25 (71%) of the sanctioned posts of Lab Technician, 22 (35%) of the

sanctioned posts of the LHV, 24 (44%) of the sanctioned posts of Multi Purpose Supervisor, 87 (26%) of

the sanctioned posts of ANM and 116 (43%) of the sanctioned posts of MPW (Male) were lying vacant

in the district.

b) As regards, contractual staff under RCH, all 12 posts of Staff Nurse CEmOC, 34 (77%) posts

out of 44 Staff Nurse BEmOC and 39 (65%) of the 60 posts of ANM were lying vacant.

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c) In the visited District Hospital, posts of Hospital Superintendent, Medical Specialist,

Psychiatrists, Ophthalmologist, Orthopedician and Radiologist were lying vacant. Further under

para-medical category, 6 out of 18 sanctioned posts of Staff Nurse, one post out of 02

Ophthalmic Assistant and post of Lab Technician were vacant in the hospital.

d) At the CHC level, 2 out of 4 posts of PGMOs each at CHC Sakti and and CHC Akaltara were

lying vacant. Post of Block Programme Manager, BEE and Computer were lying vacant at both

the CHCs. In CHC Akaltara, the only post of the AIDS Counselor and the Technician were

lying vacant.

e) In the visited PHC Kurda, one post each of the post of Staff Nurse, Lab. Technician and Ward

Boy and all 2 sanctioned posts of ANM were lying vacant. The post of Medical Officer, one of

the 2 sanctioned posts of Staff Nurse and only sanctioned post of Lab. Technician were lying

vacant at PHC- Paradwar. All the sanctioned posts were found filled up at Kapan PHC, except

one post of Staff Nurse. Each of the sanctioned post of Lab. Technician, Radiographer and ANM

and both sanctioned posts Staff Nurse were lying vacant at PHC, Nariyara.

2. Functioning of Rogi Kalyan Samiti (RKS) and Village Health & Sanitation

Committee (VHSC):

a) Rogi Kalyan Samiti known as Jeewan Deep Samiti (JDS) in the State was reported to be set

up at the PHCs, CHCs and District Hospital (DH) in the district. Jeewan Deep Samiti (JDS)

have been registered in DH, 8 CHCs and 37 PHCs.

b) JDS have been provided funds at CHC @ Rs.1,00,000 and at PHC @ Rs.50,000 in the year

2009-10. There were 11 PHCs out of 37 to whom RKS funds@ Rs. 1,00,000 had been provided

in the year 2009-10. It was observed that most of the amount was utilized at the CHC and PHC

level in the year 2009-10. No fund was released to PHC Tilai, Portha, Jarve and Lavsara in

financial year 2009-10 and PHC Baradwar in current year.

c) RKS funds for the CHCs were not received during 2010-11 by the district from the State till

the month of February, 2011 and RKS funds at PHCs were provided @ Rs.50,000 each.

d) As per the VHSC scheme, 898 villages out of total 915 villages in the district were covered

under the scheme and all 898 VHSCs were functioning with ASHA as a member in the district.

Block Dabhara is the only block in the district in which all 126 villages were having VHSC. It

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was reported that 886 of the 898 VHSCs have opened their bank account for handling the funds

for sanitation work.

3. 24X7 hour Delivery Care System:

a) Nine institutions including DH, Janjgir, Civil Hospital Champa, 6 CHCs and one PHC were providing 24

x7 hours delivery care service in the district. Mostly this service was being provided on telephonic call in

the institutions.

b) In this connection, the performance and other facilities were checked in some of the PHCs. It was

observed that 213 deliveries were conducted at Bardwar PHC in the year 2010-11, which showed

improvement in comparison to 161 deliveries in the year 2009-10. PHCs visited at Kurda, Kapan and

Nariyara could not achieve the stipulated minimum 10 deliveries per month. PHC Kapan conducted only

3 deliveries in 2009-10 and 2 deliveries in 2010-11. It was informed that PHCs were not improving their

performance because delivery of mother in the areas of PHCs Kurda, Kapan and Nariyara were also

being conducted in CHCs Sakti and Akaltar.

c) There was no Blood Storage Unit in the visited centres.

4. Janani Suraksha Yojana (JSY):

a) The district spent Rs.1,06,55,150 out of Rs.2,29,37,308 provided in the year 2009-10.

Similarly, An amount of Rs.90,41,850 was spent up to February, 2011 out of total funds of Rs.

2,35,26,253 allotted to the district during 2010-11 under the scheme.

b) Performance under JSY in the district as a whole and visited institutions is reported as under:

Sr.

No.

Particulars District DH Janjgir CHCs

Sakti Akaltara

2009-10 2010-11 upto Feb. 2011

2009-10 2010-11 2009-10 2010-11 2009-10 2010-11

1 Total no. of deliveries conducted

38481 32173 - - - - - -

2 Total no. of Instt. Delivery conducted

10246 11121 303 283 781 794 404 705

3 No. of beneficiaries to whom incentive was paid

10246 11121 303 283 781 784 404 705

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c) During visit to PHCs, it was observed that there were no separate funds provided to these

centres under JSY. All the expenditure earmarked under FLEXIPOOL (NRHM).The JSY funds

were received in time in all the four visited PHCs and the payment were made timely to all the

beneficiaries.

d) 50 (71%) JSY beneficiaries were contacted out of 64 selected in the area of 8 Sub Centres

for field verification. All beneficiaries were satisfied with the services. 46 (92%) beneficiaries

were accompanied by ASHA/Dai. 10 beneficiaries used Janani Express to go to hospital. All

beneficiaries got three Ante Natal Checkups (ANC) and 44 (88%) beneficiaries got three Post

Natal Checkups (PNC).

5. Implementation of ASHA Scheme:

a) Targeted no. of 3611 ASHAs were in position in the district, Of these, 3586 ASHAs reported to have

been provided with drug kits.

b) As informed, 3611 ASHAs were working in 915 villages in the district. Almost all blocks were having

more than two ASHAs in each village.

c) During visit to the villages, it was observed that ASHAs were accompanying the mothers for delivery

purpose and helping ANMs during immunization, assisting them in ANC/PNC. The ASHAs were also

motivating the cases for sterilization operations.

6. Untied Funds:

a) Untied funds were being given regularly to the CHCs, PHCs and HSCs in the district but its

utilization was observed to have not been done fully during last two years.

b) It was reported that no expenditure was incurred under this head out of the funds to Rs.

63,73,274 in the district during financial year 2009-10. The same amount carried forward to the

current financial year 2010-11, but only Rs.8,56,651 spent up to Feb. 2011during the current

year.

c) It was also observed that no amount under Untied Fund has been provided at CHC, PHC and

Sub Centre level in the year 2010-11 (up to Feb. 2011) in the district.

7. Physical infrastructure:

i) CHCs:

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a) CHCs visited at Sakti and Akaltara were functioning in govt. buildings having 30 beds each.

The premises of CHCs were found neat and clean. Water supply and electricity with power

back-up were available at all visited CHCs.

b) Anesthesia equipment was not available at Akaltara CHC. Blood storage unit and Waste

Disposal Management System were not available in both the CHCs. Infrastructure was not as per

IPHS in the CHCs.

c) Posts of Specialists and Gynecologist were not available in the CHCs. Neonatal resuscitation

suction machine and baby incubator were not available.

ii) PHCs:

a) Visited PHCs Kurda, Bardwar, Kapan and Nariyara were functioning in Government

building. Water supply was available in all the visited PHCs. Electricity connection was not

available in Kapan PHC and Power backup was not available at Nariyara PHC. Telephone

facilities were available in Kapan and Nariyara PHCs. Ambulance/Jeep was not available in all

the visited PHCs.

b) BP Apparatus and facility of Labour room was not available at Kapan PHC. The Microscope

was available only at Kurda PHC. Microscope was unused as post of Lab Technician was laying

vacant at Baradwar and Nariyara PHC. The Resuscitation equipments available only at Kurda

and Baradwar PHCs.

c) Operation Theatres were not in functional condition at the visited PHCs.

e) The Stock of IUD, OP and Nirodh pieces was not available in all the visited PHCs except

Kurda PHC. The stocks of vaccines (BCG, DPT, OPV, Measles, DT and TT) was available at

Kurda and Baradwar PHC. The Prophylactic drugs-IFA large were not available in all the

visited PHCs except Kapan PHC and IFA small was available at Baradwar PHC, IFA syrup and

Vitamin A Tab. were available in Baradwar and Nariyara PHC. Vitamin A syrup was available

in all PHCs except Kapan.

f) Medical Officers (AYUSH) was posted only at Kurda and Nariyara PHCs.

g) Residential quarters for Medical officers were available in all the PHCs except Baradwar.

iii) Sub Centres:

a) All the visited sub centers were functioning in Govt. building. ANMs of the sub centres

Nagarda, Dhanpur, Deragarh and Lavsara were residing in Sub-centre building. ANM of

19

Parsahibana and Tilai SC were residing in sub centre village and ANM of Taraud SC was not

residing at SC building or village.

b) Water supply facility was not available at Nagarda, Dhanpur, Deragarh and Taraud SCs.

Electricity connection was available in all the visited sub centres except Taraud SC. Labour

rooms was available and deliveries were not conducting in Dhanpur and Taraud SCs.

c) Examination table was available in all the visited sub centres except Dhanpur, Tiali and

Taraud SCs. Delivery table was available in all the visited sub canters except Dhanpur,

Parsahibana and Pauna SCs. McIntosh sheet was not available at Dhanpur, Deragarh,

Parsahibana and Pauna SCs. Ambubag /suction was available in all the visited sub centres except

Dhanpur, Parsahibana and Tilai SCs.

d) ORS packets and Tab. Paracetamole, Kits A and B were available in all the visited Sub

Centres except Deragarh SC. DDKs were not available in 4 SCs i.e. Nagar, Dhanpur,

Parsahibana and Tilai SCs. Kerosene oil/gas was not available in all the visited sub centres

except Nagarda and Dhanpur SCs. Vitamin A solution was available in all the visited sub

centres except Taraud SCs.

e) Sanitary Napkins, Emergency Contraceptive Pills, Tab. Oxytocin, Cap Ampicillin were not

available in all the visited Sub Centres. Antiseptic Solution was available in all the visited Sub

Centres except Deragarh, Tilai, Pauna and Taraud SCs. Chlorine Solution / Bleaching Powder

was not available in Taraud SC. Inj. Gentamycin was not available in all the visited Sub Centres

except Lavsara and Parsahibana SCs.

f) The posters for public awareness were not displayed at the sub-centres Nagarda, Dhanpur,

Parsahibana and Tilai SCs.

g) SBA training was not received by the ANMs at Dhanpur, Parsahibana, Tilai and Taraud SCs

visited.

h) ANMs of 7 Sub Centres did not receive training of Integrated Management of Neonatal and

childhood infection (IMNCI) except ANM at Pauna SC.

8. Opinion and Knowledge of Community on Health Services:

a) As many as 43 mothers having child up to one year of age were interviewed in the area of the visited

Sub Centres for assessing the work of ANM and Knowledge & Opinion of mothers.

b) 41 (95%) mothers informed that ANM is available when needed. 7 (16.3%) mothers knew the

danger sign of ARI. 22(51.2%) mothers received three post natal checkups. and 30(69.77%) mothers

20

knew about use of ORS packets during diarrhoea. 34 (79.1% ) mothers reported that immunization are

held regularly in the village. All the mothers were aware of contraceptive methods and All the mothers

were aware of the government facilities where they can get all health facilities.

c) During the course of visit to PHC Kurda, Baradwar, Kapan and Nariyara it was observed that the

community was satisfied with the services received from staff and Medical Officers of the PHCs.

However, Medical officers of PHC Kurda and Nariyara were not residing at their head quarter.

9. Sample Verification of F.W. beneficiaries:

a) 252 Family Welfare beneficiaries were selected in the visited Centres for sample verification and out

of them 179 (71.03%) could be contacted in the district. Minor discrepancies in the age of acceptors,

spouse, total no. of children and no. of Male children were found during field verification. In cases of 19

(10.6%) acceptors, proper age of youngest child was not recorded. Demographic data of the acceptors

should be recorded properly.

b) Out of contacted 128 of the selected 175 spacing methods acceptors, 26(20%) were found to be

reported false in the district.

c) 33 (21.6%) beneficiaries didn’t get follow up services.

d) All 128 contacted beneficiaries of child immunization confirmed receipt of proper doses of

vaccination and there was no complication after receiving the services.

10. Maintenance of Records and Registers:

a) EC, IUD, CC and OP registers were not maintained in all the visited CHCs.

b) MCH registers were not maintained in visited CHC, Akaltara but the ANC & PNC registers were

maintained in CHC, Sakti.

c) Stock registers were maintained in all the visited CHCs.

d) Printed registers for eligible couple were not available at visited sub centres Pauna and Taraud SC.

Printed register for family planning services were available at Nagarda, Dhanpur, Parsahibana and Tilai

SC. Printed stock register and formats for monthly reporting were not available at Sub Centres

Deragarh, Lavsara and Pauna SCs.

21

e) OP and Nirodh registers were not printed but the same was maintained in most of the Sub Centres.

f) ANC, PNC and Immunisation service registers were maintained in all the visited Sub Centres.

g) JSY register was maintained properly in most of the Sub-Centres, but JSY Registration Cards not

available at Dhanpur and Pauna SCs.

h) Mother and child tracking formats were not available at Sub Centres Deragarh and Lavsara SC.

11. Other Observations and Suggestions:

a) During the visit to the district, counselor on HIV/AIDS was not observed to be available in visited

CHCs Sakti, Akaltara and District Hospital.

b) Lack of supervision was noticed at all levels which need to be strengthened.

c). Not a single case was motivated at Dhanpur SC for sterilization during 2009-10 & 2010-11 till the

date of visit. EC Pills were not supplied in 04 Sub Centres, i.e. Dhanpur, Deragarh, Lavsara and Pauna

during 2009-10 & 2010-11.

*********

22

4. Kawardha District

Major observations of Field Survey Unit (FSU) and Regional Evaluation Team (RET), Bhopal about the Evaluation work in district Kawardha of Chattisgarh State in the month of March, 2011. I. Details of the visited Institutions:

District

Visited

PHCs /CHCs/District

Hospital Visited

HSCs Visited

Kawardha District Hospital: Kawardha. CHCs: Sahaspur Lohara, Bodla and Pipariya

PHCs: Bhimbhori, Indori, Rengakhar and Chilpi

Maharatola, Bamhantola, Singhanpuri Jangal, Udiyakala, Khairbankala, Rochan, Khairbankhurd, Bhonda, Rajanawagaon, Indori and Bamhani

II. Major Observations :-

1. Human resources:

a) The staff position in the district was not satisfactory. 22 (71%) of the sanctioned posts of Specialist,

39 (57%) of the sanctioned posts of Medical Officer, 18 (53%) of the sanctioned posts of Staff Nurse, 10

(77%) of the sanctioned posts of Lab Technician, 23 (72%) of the sanctioned posts of the LHV, 44 (26%)

of the sanctioned posts of ANM and 69 (46%) of the sanctioned posts of MPW (Male) were lying vacant

23

in the district. Urgent steps need to be taken to fill up the above vacant posts in the district for providing

effective health care delivery to the people.

b) In the visited District Hospital, one post each of Hospital Superintendent, OB & Gyne,

Anesthetist, Ophthalmologist, Dental Surgeon and 11 out of 15 sanctioned posts of Casualty

Doctors/GDMO were lying vacant. Under paramedical category, 4 of the 18 sanctioned posts of

Staff Nurse,1 out of 2 posts each of Lab Attendant, Radiographer and only post of Matron were

vacant.

2. Functioning of Rogi Kalyan Samiti( RKS) and Village Health & Sanitation

Committee(VHSC) :

a) Rogi Kalyan Samiti is known as Jeewan Deep Samitis (JDS) in the State were reported to

have been registered in DH, 4 CHCs and 9 PHCs. Meetings of JDS in the visited CHCs and

PHCs were being conducted, However, no information was available about JDS at PHCs Indori

and Chilpi.

c) It was reported that JDS funds for the years 2008-09 and 2009-10 were provided to the block

head quarters during January, 2010. There are 13 CHCs/PHCs located in 4 blocks in the district

and funds @ Rs.2,00,000 to each JDS at CHC/PHC level and @ Rs.10,00,000 to DH were

provided. During financial year 2010-11 funds were not provided to any JDS.

c) The VHSCs were constituted in all 956 villages and all the VHSCs were having ASHAs as a

member and also opened bank account for handling the funds.

3. 24X7 hour Delivery Care System:

a) All CHCs and 10 PHCs were identified to provide 24 X 7 hours services in the district. Most of the

PHCs were having Medical Officer except PHCs Indori, Ranveerpur and Kisungarh and three PHCs viz.

Rengakhar, Ranveerpur and Kisungarh did not have Staff Nurse.

b) Two PHCs were functioning in Sub Centre building.

c) In Visited 24x7 hours Health Institutions, no CHC/PHC was having Blood Storage facility.

d) Most of CHCs and PHCs were not having adequate facilities for caring Mothers and New born child

except at CHC Sahaspur Lohara.

4. Janani Suraksha Yojana (JSY):

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a) The district spent Rs.1,82,87,190 out of funds of Rs.2,67,11,780 provided in the year 2009-

10, but no figure was available for the current year.

b) JSY physical performance in the whole district and visited institutions is reported as under:

Sr.

No.

Particulars District CHCs

Pipariya Sakti Akaltara

2009-10 20010-11 up to Feb 2011

2009-10 2010-11 2009-10 2010-11 2009-10 2010-11

1 Total no. of deliveries conducted ( Home + Institutional)

20827 20306 6766 4882 4812 4443 2641 3694

2 Total no. of Instt. Deliveries conducted

4812 6660 1284 1141 688 1285 1318 1999

3 No. of beneficiaries to whom JSY incentive was paid

8860 7975 3273 1772 1111 1658 2152 2107

c) During visit to 11 HSCs, it was observed that all the HSCs were conducting deliveries, JSY

fund received in time and the payment were made timely to all the beneficiaries.

d) Registers were being maintained properly containing list of beneficiaries to whom cheques

were issued. Proper columns have been found filled up in that register in the visited institutions.

e) Total 38 (90%) JSY beneficiaries were contacted out of 42 selected in the area of 7 visited

sub centre for on the spot verification. All beneficiaries were accompanied by ASHA/Dai. 37

(97%) beneficiaries had received cheques within three days after delivery. 29 (76%)

beneficiaries got three Ante Natal Check (ANC) ups by ANM and 25 (66%) beneficiaries got

three Post Natal Check ( PNC) ups by ASHA and ANM.

5. Implementation of ASHA Scheme:

a) 1675 ASHAs were in position out of selected 1705 ASHAs in the district. All the ASHAs were trained

upto 5th module and also provided with drug kits.

b) During visit to the centres, it was observed that most of ASHAs were working, trained and

participating in the activities of VHSCs. It was also observed that ASHAs were accompanying the

mothers for delivery purpose to the hospital and helping ANMs during immunization and in ANC/PNC.

The ASHAs were also motivating the cases for sterilization operations.

25

c) ASHAs were receiving performance based remuneration on an average Rs. 800-1200 per month.

6. Untied Funds:

a) It was reported that in November, 2009 Untied Funds were provided to 04 CHCs and in

December, 2010 funds provided to 24 PHCs but the whole amount was taken back from CHCs

& PHCs and returned to State Health authorities. Till date, no untied funds provided to any of

the CHCs & PHCs in the district. No proper explanation in this regard was available from the

district.

7. Physical infrastructure and Stock Position:

i) CHCs:

a) CHCs visited at Sahaspur Lohara, Pipariya and Bodla were functioning in Govt. buildings.

The premises of CHCs were found neat & clean. Water supply and electricity were available at

all visited CHCs. Power backup was not available in the visited CHCs except Sahaspur Lohara

CHC.

b) X-ray facilities and Anesthesia equipment were not available at Pipariya CHC. Blood storage

unit, Incinerator and Sick new born care unit were not available in all the visited CHCs. Waste

Disposal Management System was not available in all the visited CHCs except Pipariya CHC.

Resuscitation equipments were not available at Sahaspur Lohara CHC. Neonatal Resuscitation

equipments were not available in all the visited CHCs except Bodla CHC. Quinine injections

and Arteether injections were not available in all the visited CHCs.

c) Residential quarters for para medical staff were available in all the visited CHCs except

Bodla CHC.

d) Norms for infrastructure and equipments were not as per IPHS.

ii) PHCs:

a) PHC Bhimbhori, Indori and Rengakhar were functioning in Government building and PHC

Chilpi was functioning in a school building. Regular water supply was available in all the visited

PHCs except Chilpi CHC. Power backup was not available in all the visited PHCs except in

Rengakhar PHC . Telephone facility was not available in Bhimbhori and Indori PHCs. Toilet

facility was available in all the visited PHCs except in Chilpi PHC.

b) Ambulance/Jeep was not available in all the visited PHCs except in Rengakhar PHC. The

cold chain equipments were not available at Bhimbhori and Indori PHCs.

26

c) Autoclave/Steam Sterilizer, Oxygen cylinder and Minor surgical equipments were available

in all the visited PHCs except in Chilpi PHC. Resuscitation equipments were available in all the

visited PHCs except in Indori PHC. Microscope was available only in Rengakhar PHC.

Functional Operation Theatre with OT table was available only in Rengakhar PHC.

d) AYUSH Medical Officers were not available in all the visited PHCs. Residential quarters

for Medical officers were not available at Indori and Chilpi PHCs.

iii) Sub Centres:

a) All the visited sub centers were functioning in Govt. buildings. Additional ANM under

NRHM was not posted at the visited SCs. Post of MPW(M) was vacant in all the visited SCs

except at Rochan and Bamhani SCs.Water facility was not available at Khairbankala Sub Centre.

b) DDKs, Kerosene oil/Gas cylinder, Sanitary Napkins, Emergency Contraceptive Pills, Tab

Oxytocin and Injection Gentamycin were not available in all the visited SCs. Nishchay

Pregnancy test kit was not available at Maharatola, Udiyakala and Khairbankal since 3-4

months. Rapid Diagnosis Kit for Malaria was not available at Bamantola, Rajanawagaon and

Indori SCs.

c) Though deliveries were being conducted by all the visited HSCs, Delivery table was not

available at Maharatola, Khairbankala, Rochan, Bhonda, Rajanawagaon, Indori and Bamhani

SCs. Ambubag/suction was available in all the visited SCs except the Indori SC. Kit A and Kit

B were not received by most of the visited SCs during the year 2010-11.

d) SBA training was not received by the ANM at Rochan SC.

.8. Opinion and Knowledge of Community on Health Services:

a) 60 mothers having child up to one year of age were interviewed in the area of the visited sub

centres for assessing the work of ANMs and knowledge & opinion of mothers.

b) 52 (86.7%) mothers replied that ANM is available when needed. 32 (53.3%) mothers knew the

danger sign of ARI. 34 (56.7%) mothers received three post natal checkups and 41(68.3%) mothers

knew about use of ORS during diarrhoea. All mother informed that immunization session for children

were being held regularly in their villages. 41(68.3%) mothers were aware of contraceptive methods.

59(98.3% ) mothers had been counselled for exclusive breast feeding and complementary feeds.

c) All the mothers were aware of the government health facilities where they can get health facilities.

27

d) 2 of 11 visited Sub Centres were having the post of health worker (M). The MPW (M) were not

present at their Sub Centre head quarter at Rochan and Bamhari. Though, villagers were apparently

observed satisfied with the services of MPW (M), their visit to the villages was irregular.

e) During the course of visit to PHCs Bhimbhori, Indori and Chilpi, it was observed that the community

was satisfied with the services received from staff and Medical Officers of the PHCs though M.Os was

not present regularly in the at PHCs Bhimbari and Chilpi as they were looking after the work of other

hospitals also.

9. Sample Verification of F.W. Acceptors:

a) Out of 201 Family Welfare acceptors selected for sample verification, 146 (73%) could be contacted

in the district. While examining records of selected acceptors from service registers, age of acceptors

was found not recorded in 9 (4%) cases, age of spouse was not recorded in 98 (48.76%) cases and age of

youngest child was not recorded in 153 (76%) cases. No. of Male/female children was found not

recorded in 100 (50%) cases.

b) 16 (19%) beneficiaries were not provided follow up services.

c) Out of contacted 102 of the selected 131 spacing methods acceptors, 63(48%) were found to be

false cases in the district.

d) All 70 contacted beneficiaries of child immunization confirmed receipt of proper doses of

the vaccinations and there was no case of complication after receiving the services.

10. Maintenance of records and registers:

a) EC, Sterilization, IUD, CC and OP registers were not maintained in all the visited CHCs.

b) Printed registers for eligible couple were neither maintained nor updated at most of the visited Sub

Centres.

c) MCH service Registers were mostly updated.

d) JSY registers were not printed but maintained properly in all the visited SCs.

e) Stock registers were not printed but were maintained and updated in all the visited SCs.

28

11. Other Observations and Suggestions:

a) Lack of supervision was noticed at all levels which need to be strengthened.

b) It was observed that the specialist services viz. Medicine, OBG, Paediatrics and Blood Storage facility

were not available in the visited CHCs at Bodla, Sahaspur Lohara and Pipariya.

******

29

No.Q-11015/1/2011-Stats (E.V.) Ministry of Health & Family Welfare

Statistics Division Nirman Bhawan,New Delhi,

Dated: To,

The Secretary / Commissioner (H& FW) Dept. of Health & Family Welfare, Government of Chhattisgarh, Room No. 164, D.K.S. Bhavan, Mantralaya, Raipur- 492001 Chhattisgarh

Subject: Major observations of sample verification conducted by Regional Evaluation Team

(RET) and Field Survey Unit (FSU), Bhopal.

Sir, The Regional Evaluation Team (RET) and the Field Survey Unit (FSU) located in the Regional Office of the Ministry of Health & Family Welfare at Bhopal had undertaken sample checks in Janjgir and Kawardha districts of Chhattisgarh State during the month of March, 2011.

The major observations of the team regarding the availability of man power, equipments etc., at health facilities, health care services etc. are annexed. You are requested to kindly examine the same and forward your valuable comments along with the action taken in this regard urgently.

Yours

faithfully,

(Biswajit Das)

Director (Stats) Phone: (011)23062647

E mail:jdstat2-mohfw@nic.in Copy for information and necessary action to : 1. The Mission Director (NRHM), D.K.S. Bhavan Campus, Old Nursing Hostel, Raipur,

Chhattisgarh. 2. The Sr. Regional Director (H & FW), Regional office for Health & Family Welfare, 32 Purzor

House Press Complex, Maharana Pratap Nagar, Zone-1, Bhopal 462011, Madhya Pradesh. 3. Regional Director I/C, RO for Health & Family Welfare, RLTRI P.O. Lalpur, Raipur – 492001,

Chhattisgarh. 4. DC(MH)/DC(FP)/DC(CH)/DC(TRG)/DC(Imm). 5. DDG (Dr. Dharmashaktu) Dte. GHS, Niman Bhawan, New Delhi.

Director (Stats) Copy to :- 1. PPS/PS to SS & MD (NRHM) 2. JS (P) / JS (PH) / JS (RCH) / DDG (Stats).