GAVI End Evaluation Report - hands.org.pk · 5.4 Questionnaire for KAP 58 5.5 Questionnaire for HMC...
Transcript of GAVI End Evaluation Report - hands.org.pk · 5.4 Questionnaire for KAP 58 5.5 Questionnaire for HMC...
GAVI End Evaluation Report
District Matiari, Sindh.
(GAVI Project)
Strengthening & Enhancing Health Accessibility
Through community mobilization in District Matiari
(SEHAT)
2
GAVI End Evaluation Report District MATIARI [Pick the date] Submitted by: HEALTH AND NUTRITION DEVELOPMENT SOCIETY
Strengthening & Enhancing Health Accessibility
Through community mobilization in District Matiari
(SEHAT)
3
Table of Contents Page #
Abbreviation 04
Acknowledgement 05
Executive Summary 06
Chapter 01. Introduction
1.1 Introduction of the project 12
1.2 Goal of Project 12
1.3 Objectives 12
1.4 Expected Results 12
Chapter 02. End Evaluation
2.1 Objectives 13
2.2 Universe of the study 13
2.3 Methodology 13
Chapter 03 Results
3.1 Respondent’s characteristics 17
3.2 KAP (Knowledge Attitude &Practices) Survey with
Married Women
19
3.3 Strengthening and Enhancing Health Accessibility
through Community Mobilization
38
Chapter 04 Conclusion and Recommendations 43
Annexure
5.1 Questionnaire for Health Care Facility Information
45
5.2 Questionnaire for IDI-District Officials
53
5.3 Questionnaire for VHC Assessment
55
5.4 Questionnaire for KAP
58
5.5 Questionnaire for HMC 64
5.6 Questionnaire for Vaccinators 67
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Abbreviations
GAVI Global Alliance for Vaccines & Immunization
HANDS Health and Nutrition Development Society
MER Monitoring, Evaluation & Research
NGOs Non Government Organizations
FGD Focus Group Discussion
MGDs Millennium Development Goal
SEHAT Strengthening & Enhancing Health Accessibility Through
PDHS Pakistan Demographic Health Survey
BHU Basic Health Unit
RHC Rural Health Centre
THQ Taluka Head Quarter
DHQ District Head Quarter
DTC District Technical Committee
VHC Village Health Committee
HMC Health Management Committee
EPI Expanded Program on Immunization
TT Tetanus Toxoid
UC Union Council
KAP Knowledge Attitude and Practice
LHW Lady Health Worker
FWW Family Welfare Worker
LHV Lady Health Visitor
TBA Traditional Birth Attendant
IUCD Intra Uterine Contraceptive Device
TL Tubal Ligation
OP Oral pill
Kg Kilo gram
BCG Bacillus Calmette-Guérin
DPT Diphtheria, pertussis and tetanus
HB Hepatitis B
TB Tuberculosis
MIS Management Information System
EDO Executive District Officer
DO District Officer
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Acknowledgement
Our first acknowledgement is for the Almighty Allah who has bestowed His blessing on us. We
are thankful to our donor GAVI Alliance for the providing funds for achievements of the project
activities and hence their contribution towards immense support for Pakistan’s development. I
would like to extend my gratitude to National EPI Manager and team for their cooperation &
support throughout the project implementation. Our whole hearted acknowledgement and
appreciation is for the overwhelming support of District Government Matiari especially EDO &
DOs Health Department.
I express my deep sense of appreciation to the efforts of all Health Management committees
(HMCs), Village Health Committees (VHCs), members of Community Based Organizations
(CBOs) Medical Superintendents, Medical staff, Lady Health Workers (LHWs), and vaccinators.
The entire staff of District Matiari and field workforce worked relentlessly with full devotion and
commitment. The efforts of Ms. Sajida, Mr. Sada Hussain, Ms. Shakila Memon, Ms. Sanober,
Ms. Rahila and Ms. Khadija were instrumental in organizing a disciplined training, dispatching
questionnaire to data collection teams, conducting IDIs, managing and providing completed
questionnaires to ME&R team, and supervising the whole survey on desk and in field. We
acknowledge the contribution of each one of them. I express my gratitude to Mrs. Azra Shakeel,
Senior District Executive Manager for her sincere leadership and professional approach for
creating an environment of team work, encouraging and facilitating the core team to put in their
best and completing the Evaluation study in time.
ME&R team including Mr. Noor Muhammad, Ms. Sahar Yameen, Ms. Shabana & Mr. Afzal
Hussain for assisting in tools development and Training of surveyors, data processing, analyzing,
developing, reviewing, editing, formatting and proofreading this report are highly appreciated.
I am very thankful to the senior management of HANDS for their active and valuable
participation during different phases of the survey. I am deeply indebted to Dr. Sheikh Tanveer
Ahmed (Chief Executive -HANDS), for his technical support, valuable input and encouragement
throughout the evaluation process.
Chief Investigator
Dr. Anjum Fatima
Senior General Manager
Monitoring, Evaluation & Research Program
HANDS
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Executive Summary
GAVI/SEHAT project was implemented in District Matiari from July 2009 to December 2010.
The goal of the project was to assist the District Government in achieving the targets of MDGs 4
& 5 i.e. maternal and child health focusing on enhancing the accessibility and quality of health
services through strengthening community monitoring and feedback system.
This report is based on the findings of Evaluation conducted at the end of the project. The end
evaluation aimed to assess awareness of target population about the available health services,
behaviors for seeking health care, and the accessibility, availability and quality of health services
in District Matiari after completion of the project. There are 3 Talukas and 19 UCs in Matiari
covering 655062 population. The study population will comprise of 04 groups i.e House hold
survey/Married women (15-49 years with 13-23 years child), Health Facility Assessment/Health
Management Committee, LHWs/Village Health Committees, Government Officials and
Vaccinators.
The respondents were the married women from each household with at least a child between the
ages of 13 to 23 months. A total of 210 households were selected for conducting midterm review
assessment. The mean age of respondents was 29.50 during End line evaluation while it was
28.64 in Baseline survey. Both in End line evaluation and Baseline 51.9% respondents were of
age 30 years and above. A little less than half (47.6%) of the women were below the age of 30
years with nearly 0.5% being under 19 years and during Baseline survey 45.2% were below the
age of 30 years and 2.8% were under the age of 19 years.
The mean of age at marriage was 20.64 and 40.4% of the respondents reported their age at
marriage in their teens during End line evaluation while in Baseline survey the mean of age at
marriage was 18.5 and 65.6% respondents reported to got married during teen ages. End line
evaluation results show that 56.6% of the respondents got married at age of 20 to 29 years and
few 2.8% at the age of 30 or above. While during Baseline 33.3% of the respondents were during
the age of 20 to 29 years at marriage and few 0.9% were of age 30 years or above.
A total of 872 pregnancies were reported by 210 women with an average of 4.15 pregnancies per
woman in End Evaluation and in Baseline survey total 951 pregnancies were reported with an
average of 4.5 pregnancies per woman. The number of pregnancies varied from 1- 12. Majority
of the women (48.5%) reported to have 1-3 pregnancies, 34.3% had 4-6 and 17.3% had 7
pregnancies or more than it in End line Evaluation. And we find the same trend in Baseline
survey where 42% respondents reported to have 1-3 pregnancies, 37% reported 4-6 and 21%
reported to have 7 or more pregnancies. A total of 749 live births were reported by 210 women
with an average of 3.57 per woman during End line Evaluation and in Base line Survey 810 live
births were reported by 210 women with an average of 3.8 per woman. Majority of women had
1-3 live births both in end line evaluation (56.2%) and in Base line (49%). While more than 36%
women had 4-6 live births during both End line Evaluation and Baseline Survey. More than 7
live births had occurred for 7% women during End line Evaluation and for 17% women during
Base line.
A total of 38 pregnancies ended up in still births in End Evaluation. Of those 38 women who had
still births, majority 57.8% had 1 stillbirth, 13.1% had 2 stillbirths, however 5.2% (02 women)
reported to have 3 stillbirths. No women reported to have 4 to 5 stillbirths.
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Almost 85 pregnancies ended up in abortions in End Evaluation while 93 were reported in Base
line survey. Majority of women reported 1 abortion both in End Evaluation (45.8%) and Baseline
(36.5%). A number of 02 abortions were reported by 11.7% women and 18.2 % women during
End Evaluation and Baseline survey respectively. However out of the 85 women 7 reported to
have 3-5 abortions during End Evaluation (8.1%) while in Baseline Survey 7 out of 93 women
(7.4%) reported 3-5 abortions
A total of 4 maternal deaths were reported by the women of 210 households and the causes of
deaths were reported to be High BP, Weakness, Heart fail and one reason was not mentioned.
Total 39 neonatal deaths were occurred out of which 25 were under the age of 1 month, 9 were
under the age of 2 years and 5 were under 5 years of age. The major reasons were Fever, fits,
Jaundice, Malnourish, Pneumonia and hole in heart.
2 infantile deaths were reported and the reasons were fits and TB. Nearly 90% of the women
reported to have checkups during antenatal period. Nearly 46% did more than four visits during
the whole gestational period and it was 39% in Baseline. Majority of the respondents 62.7%
consulted to Private Doctor for the antenatal care. Almost 76.7% women had received their
tetanus immunization during last pregnancy according End line Evaluation results while during
Baseline 80% women had reported to get it.
Out of the women who were immunized against TT vaccine, 45% women reported to have
TT 01 & TT 02 and 55% reported 05 TT & above. Most of the deliveries 75% were facility based
and only 25% remained Home based. 75.6% deliveries were assisted by Skilled birth Attendant
(Doctors, Nurses, Midwives and LHVs). Only 46.2% of the women reported to have a postnatal
check up after their last delivery while during Baseline 50% women had reported to avail post
natal check up. In this way in end line evaluation 53.8 % didn’t receive any post natal check up in
comparison of 50% during Baseline. A significant proportion of respondents 55% knew that
Anemia, 46.1% knew Bleeding and 41.4% knew that headache/vertigo are danger signs. Except it
During Antenatal period women also reported Black outs 16.8% and vomiting after first trimester
16.2% as danger sign while they had reported it during Baseline 7.6% and 12.9% Black outs and
vomiting after first trimester respectively. Women also indicated other danger signs as High fever
26.7%, Severe pain in lower abdomen 14.7%, Heavy Bleeding 6.8%, Palpitation/weakness 4.7%,
Foul smelling vaginal discharge 3.1% and Inflammation of breasts 1.0% during post natal period
while in Baseline these danger signs were reported as 26.2%, 9.5%, 6.2%, 5.2%, 4.3% and 3.3%
respectively. Some more danger signs of natal period were reported by women like Delay in
progress of labor 9.4%, Fetal malposition 5.2%, Dizziness/fainting 2.6% and Delay in expulsion of
placenta 2.1% and according to Baseline Survey these signs were reported by women as 4.8%,
3.3%, 3.8 and 2.9% respectively. 33.8% of the women reported to face any complications during
pregnancy, delivery and postnatal period while 66.2% did not report to face any complication,
According to Baseline results 8% women had confronted some complications and 92% had not
faced it. End line Evaluation shows that 80% (169/210) women reported to knew about family
planning while during Baseline survey 63.4% (133/210) women had knowledge about it. 23.3%
women had reported to be current users of Family Planning while during End line evaluation
44.3% current users were reported which indicates an increase of 21% in Family Planning users.
End line results show that currently 44.3% respondents are the current users of any contraceptive
method while during Baseline current users were 23.3%. among the total Current Users, the use of
Injection was 15.2% and it was 7.6% in Baseline. Use of Pills was 7.1% while it was3.3% in
Baseline. In End line evaluation use of Condom was 5.2% and in Baseline it was 6.2%. TL was
4.7% (3.3% in Baseline). The use of IUCD was 8.6% 2.4% in Baseline), and use of withdrawal
method was 8.0% while no use of it was reported during Baseline. While no use of Vasectomy and
Abstinence was reported from the respondents during both baseline survey and End line
evaluation.
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A little less than one third of women (29%) reported ever use of contraceptives during Baseline
while as shown in the figure during End line Evaluation 58.1% women were the ever users. In End
line Evaluation Out of total ever users 56% reported the use of Injections, 38% Oral Pills, followed
by 20% Condom, 14% Vasectomy, 10% IUCD and 5% TL. .
The mean birth weight of their last born child as reported by 110 women was 2.62 while during
baseline was 2.59. Around one quarter of babies were reported of low birth weight both in End
Evaluation and Baseline survey. Many women mentioned that they had given Pre lacteals to the
newborns. (These include water, Ghutti, honey, sugar, glucose, butter, formula milk and fresh
milk.) The most commonly reported Pre lacteal given to the new born was fresh milk 28.1%
followed by Honey 21.5%, Water 13.3%, Ghutti 11.1%, Sugar 1.5% and others 17.7% in
comparison of Baseline these pre lacteals were given by percentage of 10, 18.8, 7.1, 6.7, 3.7 and
others 2%. Overall 95.7% mothers reported to breast feed their youngest child. Those who
reported to breastfeed their child were asked about the time of initiation of breastfeeding.
According to End line evaluation nearly 39% mothers initiated breast feeding immediately after
birth while in Baseline it was reported 58.6%. Many mothers 45.5% reported to start breast
feeding within 24 hours in end evaluation and during Baseline it was reported to be 31%. While
some about 8.5% reported to initiate Breast feeding by next day and during Baseline it was 5.2%.
According to the End line evaluation results Colostrum was given by 86.7% mothers while in
Baseline 91.41% mothers reported to fed Colostrum to their babies. At the time of End line
evaluation 75.7% mothers were currently breast feeding to their babies in comparison of 77.6% in
Baseline. In response of ever bottled feeding given to babies about 33% mothers reported it while
during Baseline 30% mothers had given Bottled feeding to the babies.
Nearly 94% of mothers claimed that their last born children have been immunized. 93.5% of the
infants were immunized for BCG as reported in End Evaluation and almost same in Baseline
survey 93.8%. The rates of Polio 0 and Polio 1 were 95.3% and 93.9% respectively in end
evaluation while during Baseline it was 89.5% & 93.9%. However, Polio 2 and 3 were prevalent
among 92.5% and 88.8% of the infants respectively. While during Baseline the prevalence rate
was 81.9 and 79 for Polio 2 & 3 respectively. 93.9% children of the respondents received DPT1 and
HB1, 92.5% received DPT2 and HB2 while 88.8% received DPT3 and HB3. End line results
show that 85.5% children were immunized against Measles 9 while during Baseline it was found
that only 48.1% children were immunized against it. Graph shows that 58.9% children received
vaccine of Measles 12 while during Baseline 31.4% children had received it. Women were
assessed for their knowledge about the danger signs for the newborns. The main symptom
mentioned was high fever by 72.9% women while during Baseline 86.2% women reported it.
Stopped breastfeeding was notified by 27.6% women, it was reported by 41.4% during Baseline.
32.7% women indicated Fits as danger sign for new born while in Baseline indication about it
was 0%. Yellow discoloration of body was mentioned by 31.2% women while it was 13.2% in
Baseline. 25.1% women knew Low body temperature as danger sign for a child while in
Baseline 17.6% had knowledge about it. Blue discoloration of body was mentioned by 21.6%
women while during Baseline 9% indicated it. 18.1% the drowsiness was mentioned by women
but during Baseline 6.2% women indicated it. 85.7% women knew for initiating breast feeding
early while in Baseline 63.4% women had this knowledge. 76.1% women knew that it is
important to give bath to the baby just after birth while during Baseline 77.6% had indicated it.
35.6% of the women were aware about to clean and dry the cord of child in comparison of 36.6%
awareness regarding this. Knowledge regarding immunizing the new born against TB and Polio
was known by 25.9% according to End line Evaluation results while during Baseline 27.4%
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women had mentioned it. 17.6% women knew to weighing the new born and in Baseline 18.6%
women had indicated it. End line Evaluation results show that some women (3.9%) mentioned
some other indicators as essential care of new born while 4.9% women reported to have no
knowledge about it. During End line Evaluation multiple responses were noticed for the
availability of health care facilities, 47.4% women mentioned Private Hospital, 44.5% mentioned
Health Houses, 37.8% mentioned to Govt Hospitals and 18.2% indicated Basic Health Unit. The
availability of some other facilities was also mentioned like Rural Health Center, NGO’s
facilities and other by 13.9%, 5.7% and 1.0% women respectively.
Women were explored for the availability of various cadres of providers in their respective
villages. Multiple responses were given by women where the most commonly reported provider
available was LHW mentioned by 68.9% women while previously was reported 80%. For
Government physician 52.6% women mentioned, for Private physician 42.6%, for TBA 28.2%,
for vaccinator 23% and for midwife 15.8% women indicated. Some other providers were also
mentioned like Government Nurse by 11% women, LHV and Private Nurse by 10.5% for each,
followed by FWW by 3.3%. The mean time mentioned by women to reach the facility on foot
was 33.8 minutes while in Baseline it was reported 29 min. An average of 10.3 minutes was
reported to reach to the Health facility by a vehicle while according to Baseline result it was
mentioned as 13 min. Women were asked about the reasons for visiting a particular facility. The
main reasons mentioned were consultation for child illnesses (93.1%), Antenatal care (42.9%),
Child Immunization (36%) and for delivery (23.6%) followed by Pregnancy related problems
16.3%, consultation for family members 15.3%, TT immunization 14.8%, Family Planning
12.3% and for weighing child 5.9% were the reasons for visiting a facility. In end evaluation
60.2% women gave positive response for the availability of DPT and in Baseline it was
mentioned by 70.5% women. Availability of Measles was mentioned by 60.7% women while during
Baseline 62.9% had mentioned it. For Hepatitis 32.8% women respond for its availability while during
Baseline 52.4% had mentioned it. Availability of TT vaccination was mentioned by 53.7% women while
in Baseline survey 42.4% had mentioned it. 91.7% of the women were affirmative for their visit for
children’s immunization while in Baseline 70% women had witnessed it. For TT immunization
of pregnant women 40% had reported the visit of vaccinator while in Baseline it was reported by
61% women. 9% women reported to have no knowledge about such visits. and in Baseline 15%
were not aware. 13.8% denied for any visit made by a government vaccinator for any kind of
immunization while in Baseline it was reported by 12% women.
For the purpose of assessment of the Health Management Committees a total of 6 health
facilities were identified out of 10 health facilities where interventions of GAVI were intervened.
These 6 health facilities included 2 BHU’s, 2 RHC’s, 1 THQ and 1 DHQ. In Depth Interviews
were conducted with each member of the committee for the purpose of assessment. For the
assessment of Village Health Committees a total of 29 LHW’s were identified and interviewed
during survey. In the End line evaluation it was found that all the surveyed Health facilities was
found to be improved 100% in different areas like attendance of staff, Outlook and display,
Signboards and their direction, Boundary walls, Electricity, Water supply, Sewerage System and
Hospital waste disposal. While during Baseline surveys in all the 19 units surveyed attendance
was found to be 100%. In 11 of the BHU’s the outlook and the display looked good but for the
rest 8 units they required improvement. In 90% of the BHU’s the signboards and its direction
were found to be alright. Boundary walls for the 15 units were found to be in good condition but
for the rest of the BHU’s the boundary walls were found to be either incomplete or in depleted
condition.
Coming to the availability of the utilities; Electricity was found to be available and functional in
all BHU’s. Telephones were available in all the BHU’s except for the 2 units. Adequate water
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supply system was available and functioning in all the BHU’s except for in one unit where for
use salt water was present. Sewerage system was found to be working in all the BHU’s but 2 of
the BHU’s requires improvement in the sewerage system. All units were found to have good
arrangement for the disposal of hospital waste. Data was gathered for the no. of delivery
conducted at the intervened facilities. The figure shows that 90 deliveries conducted at DHQ, 25
deliveries at RHCs, 18 at THQ and 4 deliveries were conducted at BHUs. Services were given to
clients for Antenatal checkups at different facilities which were surveyed. Almost 320 clients
were recorded at THQ, 115 at BHUs, 67 clients at RHCs and 30 clients at DHQ. The figure
shows that for the postnatal check up 63 clients were recorded at BHUs, 41 clients at RHCs, 30
clients at THQ and same number at DHQ. During Endline Evaluation Family Planning clients
were also recorded as recieveing FP service from the facilities which were assessed. The figure
shows that 36 clients were recorded at RHCs, 21 at BHUs, 18 at THQ and a same number of
clients was recorded at DHQ. A total of 10 Health committees were assessed during End line
evaluation survey. There were total 284 health committee members, 139 were men and 145 were
women. Information was collected from 29 LHWs about their role in village health committees.
26 LHWs reported to be the resident of their workplace. The LHWs were affiliated with BHUs,
RHCs and THQs. The mean population covered by each LHW was reported to be 916 with 684
and 1232 as minimum and maximum population. All of them had a LHW kit. However, the kit
register was maintained by 25 LHWs. When asked if they face shortage of kits, 22 LHWs
reported about shortage of few medicines. In response to the question regarding their
responsibilities, all responded their role in mother and child immunization and care, visiting the
community and resolving their issues and polio vaccination. In response to the question if MIS of
health committees maintained, 76% reported it positively. Majority of LHWs assumed that the
village committees are there to mobilize communities, support to LHWs, plan for better health of
the communities, create awareness among the communities, and conduct health sessions.
Resolve the health issues related to vaccination, mother & child care and support during polio
vaccination. 96% of them reported that meetings of village committees are conducted monthly.
However, 83% of the responded said that meeting minutes are maintained properly. Though
100% of the LHWs reported to meet village committee members, only 10.3% agreed that health
improvement plans are prepared. In response to the question about common health issues of the
area, the answer varied from no issue reported by only 1 respondent. As shown in the table the
mainly issues of High fever/malaria, Hepatitis and Sanitation each by 5 respondents. Skin
diseases were also reported by 4 HC members while 2 members reported pneumonia and
unavailability of 24 hours health facility. 01 member reported the issue of unavailability of
vaccination for pregnant women and children. Interviews of EDO Health, DO Health
(Prevention) and DO Health (Administration) were also taken. All of them were well aware of
the project objectives and reported to have signed MoU for the project. They all reported to have
meetings with the project team. The usual agenda for the meetings were to work hard for EPI
coverage with support of each other, vaccination coverage achieved by regular visit in field of
vaccinator, to monitor vaccinators regularly, to organize training on VHC at different health
facilities. In response to the question regarding effectiveness of the project the officials
commented that HMCs have become strengthened to resolve health issues, EPI coverage has
increased specially in uncovered areas. The health status of district is better now in comparison
of previous performance.
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Introduction 1 The population of the world is increasing at an alarming rate and so are the health issues. There
are definite evidences of widening gaps in health worldwide. These issues are more so in the
developing and under developed countries of the world.
A major challenge faced by Pakistan’s Health Sector is the imbalance in the health workforce
characterized by a lack of sufficient number of health managers, nurses, paramedics and skilled
birth attendants. Concomitantly, the rapid increase in the number of medical colleges, mostly in
the private sector, has increased the number of doctors leading to a much better doctor. Problems
are compounded as fresh medical graduates tend to concentrate more in the major cities while a
large number of trained health personnel migrate to other countries, creating a vacuum in certain
critical areas. MoH and WHO are emphasizing on community oriented medical education
(COME) in order to produce more primary health care physicians in an effort to bridge the
current imbalance of trained human resource amongst the rural and urban areas. With the
induction of more than 70,000 Lady Health Workers (LHWs), however, the Government of
Pakistan is in the process of providing essential health care at the doorsteps of the community.
The number of LHWs is expected to reach 100,000 as announced by Prime Minister.
Since August 2001, the Government of Pakistan has implemented its plan to devolve financial
and administrative authority to the district level with an aim to upscale investment in social
sector and enhance rational utilization of services in pursuit of poverty reduction and attainment
of MDGs. As a result, currently the federal and provincial governments are responsible for the
overall policy formulation whereas implementation is largely the responsibility of the district
level. The projected benefits of devolution in strengthening the district health system are still in
the process of consolidation. The Zila Nazim, who is elected, is the executive head of a team of
district administrators including Executive District Officer (EDO) of Health who looks after both
the preventive and curative aspects of healthcare in the entire district. WHO is assisting MoH in
enhancing the capacity of District Managers in public health and health economics issues such as
epidemiology, biostatistics, communicable disease control, policy analysis tools such as burden
of disease estimation, national health accounts, and cost-effectiveness analysis.
Despite this elaborate network of health facilities in the district headquarters, tehsils, other major
towns, and union councils, the utilization of the public sector health care delivery system is low
with an estimated 24% of the population using these services (Ref. PDHS 2006-2007).
Furthermore, a substantial proportion of the population lacks regular access to essential
medicines, laboratory or diagnostic services particularly in the rural areas. The issue has been
outlined as a priority area in the National Health Policy.
To enhance the agreement of community participation each district has established District
Health Committees and Village Health Committees to oversee the health care services at all
levels, in their respective areas. The district health system needs to be strengthened during the
five-year period through provision of financial and technical assistance to provide quality health
care to the communities. The ability of the district government to actively manage and develop
the health facilities, will have a crucial bearing on public health.
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The key element is to strengthen District Health Systems in all the districts. This involves
transferring all recruitment, financial and management functions to district authorities. It also
involves integrating curative and preventive services and placing them under common
management.
Considering the importance of community participation HANDS proposed an strategy to
enhance the efficiency of District Health System through Capacity Building of community
groups responsible for monitor the Health Facilities and Health Workers.
1.1 Introduction of the project SEHAT project, in conjunction with the District Government, Department of Health, local
implementing partners and institutions and Health Committees started after signing an agreement
with the Global Alliance for Vaccines and Immunization (GAVI) in district Matiari.
1.2 Goal of Project The goal of the project was to assist the District Government in achieving the targets of MDGs 4
& 5 i.e. maternal and child health focusing on enhancing the accessibility and quality of health
services through strengthening community monitoring and feedback system.
1.3 Objectives The project objectives were to:
Strengthen the Health Committees at different levels of facilities (including BHUs,
RHCs, THQs, DHQ as well as at DTC and VHCs) to improve the rates of outreach
vaccination.
improve the coverage of antenatal and postnatal services for women of child bearing age
improve the proportion of deliveries conducted by skilled birth attendants
Facilitate to establish a help-line centre at the district level
1.4 Expected Results 56 HMC members and 994 VHC members trained and mobilized
30 % increase in EPI coverage (under 23 months children) from baseline
20 % increase in TT coverage (child bearing age women) from baseline
10 vaccinators recruited and trained
90 % outreach of vaccinators achieved
35 Community Midwives recruited and trained
10 % increase in antenatal coverage from baseline
10 % increase in postnatal coverage from baseline
20% decrease in low birth weight babies from baseline
20% decrease in children with moderate/severe malnutrition
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End Evaluation 2
The project completed its 18 months (July 2009-December 2010) duration. And as per planning of project’s Phase III, End Evaluation was conducted to assess the progress made against the bench marks set during the baseline survey for the objectives of the project. The End Evaluation study aimed to measure the impacts of the project on target beneficiaries regarding their awareness about the available health services, behaviors for seeking health care, and the accessibility, availability and quality of health services in District Matiari.
2.1 Objectives The objectives of the study were to obtain
Measurements of outcome indicators of the project Information on knowledge Attitude and Practices of married women in the target
population regarding maternal and child health Status of Health Committees at Facility Level (Health Management Committees -
HMC) and Community Level (Village Health Committee - VHC of Lady Health Worker)
2.2 Universe of the study There are 3 Talukas and 19 UCs in Matiari covering 655062 population. The study population comprised
of following groups;
1. Communities:
i. Married women (15-49 years with 13-23 years old child)
2. Health Facility Assessment 3. Health Management Committees
4. Village Health Committees
2.3 Methodology An Evaluative study was carried out involving both quantitative and qualitative method. The
survey involved assessment at household level both for information about the members of
household which was carried out on house to house basis and assessment of Knowledge Attitude
Practices which was carried out on random sampling. The health facilities in the District Matiari
were assessed for their functionality and services provided. The Health Management Committees
(HMCs) for facilities were assessed in the same context. The Lady Health Workers (LHWs) and
their Village Health Committees (VHCs) were also assessed in terms of the services provided in
their target areas. Assessment of vaccinators recruited for the project was also carried out.
Sample Design
The district Matiari has got more than 275 villages and for end evaluation 30 cluster method was
used and thus 30 villages were selected for the Evaluation and from each cluster/village 7 house
hold, 1LHW and its VHC were assessed. There were 27 Public Health Facilities in the target area
and their Health Management Committees so 06 of them were selected and assessed.
Survey Tools/ Techniques
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A combination of qualitative and quantitative survey techniques and tools were used which
included:
In Depth Interviews (IDIs)
• Member of Health Management Committees (01 member from each Health Management
Committee/ Facility = 06)
• Member of Village Health Committees (01 member each of male and female Village
Health Committee LHWs = 29)
• District Officials (01 EDO Health, 01 DO Health (Prevention) and 01 DO Health
(Administration)
Quantitative Questionnaire
• Household Survey of married CBAs for KAP (women with at least 01 child between the
age of 13-23 months).
• Health Facility assessment
Sample Size
Following were the sample of the different instruments that would be used in the survey;
Household Survey 210 Household (30 cluster method)
(Demographic vaccination and malnutrition status)
Household Survey Total 210 households for KAP (07 household/30 clusters)
IDIs 06 Health Management Committee members of Health Facilities
284 - 139 men (01 each) and 145(01each) women members of 06
29 members of Village Health Committees
03 Government Officials
Health facilities 06 Assessment of Health facility
Household Survey
The data regarding socio demography, EPI, TT was collected from 100% households of the 27
selected villages in the target area. Information about married CBAs was collected to assess the
Knowledge Attitude and Practices regarding maternal and child health. For this purpose 30
cluster method was used and the selected 27 villages were divided into 30 clusters, 07
households in each cluster were interviewed and thus total of 210 households were surveyed.
Health Management Committee
Total 27 public health facilities were identified for survey. In Depth interview were conducted
with 01 member of each health management committee for the baseline survey.
Category Number
BHUs 02
RHCs 02
THQs 01
DHQ 01
15
Village Health Committee
Total 30 LHWs were identified for the assessment of the village health committees in End
Evaluation study (data was gathered from 29 LHWs) i.e. 01 LHW from each selected village. In
Depth Interviews were conducted with 01 member of each village health committee.
Training of the Field Staff
Training of the field staff / surveyors was conducted on the survey tools.
Pre-testing & Finalization of Instruments
The instruments were pre-tested before the start of real field level data collection. Then the
questionnaires were examined with a view that the data collected were amenable to analysis. All
the survey tools were thus finalized for the survey after making any required changes as per the
findings of the pretesting process.
Field Survey Conduction
The field survey conduction started from February 2011 and carried till March 2010. The
number of tools and the sample size were quite extensive and travelling time to distant villages in
the rural areas was also time consuming.
Field Validation Plan
Validation of 10% of the data was done through the supervisors of the End Evaluation team. All
the data collected on the different tools was validated on this basis by the immediate supervisors,
mid and senior level management of the organization.
Analysis Plan
For data feeding and analysis Ms Excel and SPSS were used.
16
Results
17
Results 3
The respondents were the married women from each household with at least a child between the
ages of 13 to 23 months. A total of 210 households were selected for conducting midterm review
assessment.
3.1 Respondent’s Characteristics
This section includes the basic background characteristics of the respondents. This includes
information on age distribution, the age at marriage and pregnancy outcomes.
Age distribution
Distribution of respondents according to their Current Age & Age at marriage
Baseline End Evaluation
Variables Frequency
(n=210)
Percentage Frequency
(n=210)
Percentage
Current Age (years)
Mean Age 28.64(±5.7) 29.50 19 and < 6 2.8 1 0.5 20-29 95 45.2 100 47.6 30 and > 109 51.9 109 51.9
Age at Marriage Mean Age at
marriage
18.5 (±3.3)
20.64
19 and < 138 65.6 85 40.4 20-29 70 33.3 119 56.6 30 and > 2 0.9 6 2.8
The mean age of respondents was 29.50 during End line evaluation while it was 28.64 in
Baseline survey. Both in End line evaluation and Baseline 51.9% respondents were of age 30
years and above. A little less than half (47.6%) of the women were below the age of 30 years
with nearly 0.5% being under 19 years and during Baseline survey 45.2% were below the age of
30 years and 2.8% were under the age of 19 years.
According to the PDHS survey 2006-07 the median age at first marriage was 19.1. The mean of
age at marriage was 20.64 and 40.4% of the respondents reported their age at marriage in their
teens during End line evaluation while in Baseline survey the mean of age at marriage was 18.5
and 65.6% respondents reported to got married during teen ages. End line evaluation results
show that 56.6% of the respondents got married at age of 20 to 29 years and few 2.8% at the age
of 30 or above. While during Baseline 33.3% of the respondents were during the age of 20 to 29
years at marriage and a few 0.9% were of age 30 years or above.
18
KAP (Knowledge Attitude &Practices)
Survey with Married
Women
19
3.2 Knowledge Attitude & Practices
The respondents were the married women from each selected household with at least one child
between the ages of 13 to 23 months. 30 cluster method was used for the household survey and
from each cluster 7 house hold were selected randomly for the KAP of married women. Thus a
total of 210 households were selected for conducting midterm review assessment.
Fertility
A total of 872 pregnancies were reported by 210 women with an average of 4.15 pregnancies per
woman in End line Evaluation and in Baseline survey total 951 pregnancies were reported with
an average of 4.5 pregnancies per woman. According to PDHS survey 2006-07 the total fertility
rate was 4.1 children per woman.
The number of pregnancies varied from 1- 12. Majority of the women (48.5%) reported to have
1-3 pregnancies, 34.3% had 4-6 and 17.3% had 7 pregnancies or more than it in End line
Evaluation. And we find the same trend in Baseline survey where 42% respondents reported to
have 1-3 pregnancies, 37% reported 4-6 and 21% reported to have 7 or more pregnancies.
Women were asked about their pregnancy outcomes i.e. live births, still births and abortions. A
total of 749 live births were reported by 210 women with an average of 3.57 per woman during
End line Evaluation and in Base line Survey 810 live births were reported by 210 women with an
average of 3.8 per woman. Majority of women had 1-3 live births both in end line evaluation
(56.2%) and in Base line (49%). While more than 36% women had 4-6 live births during both
End line Evaluation and Baseline Survey. More than 7 live births had occurred for 7% women
during End line Evaluation and for 17% women during Base line.
Distribution of respondents according to their Fertility
Baseline End Evaluation
Variables Frequency Percentage Frequency Percentage
Pregnancies
Total Pregnancies reported by 210 women 951 872 Mean no. of Pregnancies per women 4.5 + 2.8 4.15 1-3 88 42.0 102 48.5 4-6 78 37.0 72 34.3 7 and > 44 21.0 36 17.3
Live births
Total live births reported by women 810 749 Mean number of live births per woman 3.8 + 2.4 3.57 1-3 106 49.0 118 56.2 4-6 77 36.6 77 36.7 7 and > 30 17.3 15 7.1
Still Births
Total still births reported by women 34 38 1 17 50 22 57.8 2 4 11.7 5 13.1 3 0 0 2 5.2
20
4 1 2.1 0 0 5 1 2.1 0 0
Abortions
Total Abortions reported by 210 women 93 85 1 34 36.5 39 45.8 2 17 18.2 10 11.7 3 4 4.3 3 3.5 4 2 2.1 3 3.5 5 1 1 1 1.1
A total of 38 pregnancies ended up in still births as reported in End Evaluation. Of those 38
women who had still births, majority 57.8% had 1 stillbirth, 13.1% had 2 stillbirths, however
5.2% (02 women) reported to have 3 stillbirths. No women reported to have 4 to 5 stillbirths.
While according to the results of Base line survey 34 pregnancies resulted in stillbirths. Out of
which majority of women 50% had 1 stillbirth like End line Evaluation finding. 11.7% women
had 2 stillbirths while no women reported to have 03 stillbirths but 02 women (4.5%) reported to
have 4 to 5 stillbirths.
Almost 85 pregnancies ended up in abortions as reported in End Evaluation while it was reported
as 93 during Baseline survey. Majority of women reported 1 abortion during both End line
Evaluation (45.8%) and Baseline (36.5%). A number of 02 abortions were reported by 11.7%
women and 18.2 % women during End Evaluation and Baseline survey respectively. However
out of the 85 women 7 reported to have 3-5 abortions during End Evaluation (8.1%) while in
Baseline Survey 7 out of 93 women (7.4%) reported 3-5 abortions .
Attitude towards Current Pregnancy
Distribution of Respondents according to their Pregnancy Status
Baseline End Evaluation
Variables Frequency Percentage Frequency Percentage
Currently Pregnant 15 7.1 27 12.8
Nearly 12.8% of the women were pregnant at the time of interview during End Evaluation while
during Baseline survey 6.7% women were pregnant. In end evaluation out of the 27 currently
pregnant women, 6 were in their second trimester and for 4 women, it was the third trimester.
The mean duration of pregnancy was 4.7 months.
21
Figure: showing Wanted and Unwanted Pregnancies.
The above figure shows that out of the total pregnancies Wanted Pregnancy was 53.3% during
Baseline and during End Evaluation this percentage has increased by 9.7% which means now
63% pregnancies were wanted or planned. Regarding Unwanted pregnancies in Baseline Survey
it was 46.7% and this has been decreased by 9.7%. But still 37% unwanted pregnancies, is an
indicator of existing unmet needs.
Maternal and Newborn Health
Women were asked about any maternal and infant death in the household during the last two
years and their perceptions about the causes of the deaths.
A total of 4 maternal deaths were reported by the women of 210 households and the causes of
deaths were reported to be High BP, Weakness, Heart fail and one reason was not mentioned.
Total 39 neonatal deaths were occurred out of which 25 were under the age of 1 month, 9 were
under the age of 2 years and 5 were under 5 years of age. The major reasons were Fever, fits,
Jaundice, Malnourish, Pneumonia and hole in heart.
While in baseline a total of 1 maternal death was reported by the women of 210 households and the
cause of death was reported to be bleeding. 2 infantile deaths were reported and the reasons were fits
and TB.
Maternal and Neonatal Care
The 210 women were asked about seeking care during last pregnancy, delivery and postpartum
period.
Wanted Unwanted
53.346.7
63
37
Baseline End Evaluation
22
Figure; showing A/N checkups status
Antenatal Period
The Ministry of Health recommends preferably 04 Antenatal Checkups. It includes the early detection of
dangers signs or complications and concurrent problems such as anemia, provision of proper counseling
about nutrition & care at home and postnatal care; and delivery by skilled birth attendant. Under the
National Health policy, the antenatal care should also include provision of iron & folic acid supplement,
two doses of Tetanus Toxoid and blood pressure measurement.
Nearly 90% of the women reported to have checkups during antenatal period while in Baseline
80% of the women reported to have antenatal checkups done and in result on the other hand as
20% Antenatal checkups had not done during baseline this has been reduced to 10%, as shown in
figure.
According to PDHS 2006-07, 65% mothers receive Antenatal care.
Table Distribution of respondents regarding Antenatal Care during Last Pregnancy
Baseline End Evaluation
Variables Frequency Percentage Frequency Percentage 4 and More A/N checkups 66 39 87 46 Less than 04 checkups 102 61 102 54
In our study the results show that nearly 46% did more than four visits during the whole
gestational period and it was 39% in Baseline. The women who did less than 04 visits in End line
were 51% while in Baseline these were 61%.
A/N checkups done No A/N checkup
80
20
90
10
Baseline End Evaluation
23
Table Distribution of respondents according to Service Provider mentioned for A/N
checkup
Variables End Evaluation
n End Evaluation
% Government Doctor 74 40.0 Government Nurse 7 3.8 Private Doctor 116 62.7 Private Nurse/Midwife 15 8.1 LHV 9 4.9 LHW 9 4.9 TBA 8 4.3 Other 2 1.1
The table shows that in End line Evaluation majority of the respondents 62.7% consulted to Private
Doctor for the antenatal care. Nearly 40% received care from Govt; Doctor, 8.1% from Private
Nurse/Midwife, and 3.8% from Govt; nurses. 4.9% Antenatal checkups were done by each LHV
and LHW while 4.3% by TBA. Remaining 1.1% Antenatal checkups were done by others.
In Baseline survey majority of the women (96%) consulted a physician for the antenatal
checkup. However, small proportion had their checkups by nurses, LHV or a LHW.
Table 6 Distribution of respondents according to TT vaccination Status at last Delivery
Baseline End Evaluation
Variables Frequency Percentage Frequency Percentage TT received 168 80 161 76.7 TT 01 & TT 02 35 21 94 45 05 TTs & above 133 79 67 55
Almost 76.7% women had received their tetanus immunization during last pregnancy according
End line Evaluation results while during Baseline 80% women had reported to get it.
Out of the women who were immunized against TT vaccine, 45% women reported to have TT 01
& TT 02 and 55% reported 05 TT & above. While in Baseline 21% and 79% reported to get TT 01 &
TT 02 and 05 TT & above respectively.
According to PDHS 2006-07, 60% women were protected against Tetanus, out of which 53% mothers
received 02 or more Tetanus injections.
Place of Delivery
Proper medical attention and hygienic conditions during delivery can reduce the risk of complications and
infections that may cause the death or serious illness of the mother and the baby or both. Hence, an
important component in the effort to reduce the health risks of mothers and children is to increase the
proportion of babies delivered in a safe and clean environment and under the
24
supervision of health professionals.
Most of the deliveries 75% were facility based and only 25% remained Home based. For 46.2% births
place of delivery were Private Hospitals / Clinics while it was 33% during Baseline. For 25.7% Govt
Hospitals were the place of delivery while in Baseline 40% deliveries had taken place in Govt Hospitals.
In end line evaluation 25.2% deliveries took place at Home while during base line 27.2% deliveries had
taken place at home. And 2.8% deliveries were reported to held in some NGO Hospital / Clinics and
others.
According to PDHS 2006-07 34% births take place at facility.
Assistance during delivery by medically trained birth attendants is considered to be effective in the
reduction of maternal and neonatal mortality. As presented in the above Figure 75.6% deliveries were
assisted by Skilled birth Attendant (Doctors, Nurses, Midwives and LHVs), while during Baseline 70%
deliveries had assisted by Skilled birth Attendants. 24.3% deliveries were assisted by TBAs in End
Evaluation while in Baseline Survey it was 30%.
25%
75%
Facility Based Delivery
Home Facility based
Home Govt Hospital
Private Hospital /
Clinic
NGO Hospital /
Clinic
Other
27
40
33
0 0
25.2 25.7
46.2
1.4 1.4
Place of Delivery
Baseline End Evaluation
TBA Skilled Birth Attendants
30
70
24.3
75.6
Assistance during delivery
Baseline End Evaluation
25
Post Natal Care
According to PDHS for the health of mothers and newborns, a newly delivered mother and baby should
be followed up for at least about 6 weeks after delivery. Safe motherhood programs emphasize the
importance of postnatal care, recommending that all women receive at least two postnatal checkups and iron supplementation for 45 days after a delivery
Distribution of Respondents according to Post natal check ups
Baseline End Evaluation
Variables Frequency Percentage Frequency Percentage Yes 105 50 97 46.2 No 105 50 113 53.8 Total 133 79 67 55
Only 46.2% of the women reported to have a postnatal check up after their last delivery while
during Baseline 50% women had reported to avail post natal check up. In this way in end line
evaluation 53.8 % didn’t receive any post natal check up in comparison of 50% in Base line.
According to PDHS 2006-07, 43% received Post natal care.
Knowledge about danger signs during Antenatal natal & Post natal period
Women were explored for their knowledge about the complications during antenatal, natal and
post-natal period. Women were asked about 8 danger signs i.e. anemia, bleeding, pain in and
swelling of legs, vomiting after first trimester, headache/vertigo, black outs, swelling of hands
and feet and fits.
A significant proportion of respondents 55% knew about anemia, 46.1% knew about bleeding
and 41.4% knew that headache/vertigo are danger signs. The baseline survey shows women’s
knowledge was only 43.4%, 42.9% and 24.3% for Anemia, Bleeding and headache/vertigo
respectively. Other signs reported by women were pain in and swelling of legs 37.7%, swelling
of hands and feet 29.8% and Fits 17.3% during Antenatal period while during Base line women
had reported 18.1% pain in and swelling of legs, 13.8% swelling of hands and feet, and Fits only
12.4%. Except it During Antenatal period women also reported Black outs 16.8% and vomiting
after first trimester 16.2% as danger sign while they had reported it during Baseline 7.6% and
12.9% Black outs and vomiting after first trimester respectively.
Knowledge about the danger signs during pregnancy, delivery and postpartum period
among women from selected UCs in District Matiari
Baseline End Evaluation
Variables Frequency n=210
Percentage Frequency n=210
Percentage
Antenatal Period Anemia 91 43.3 105 55.0 Bleeding 90 42.9 88 46.1 Pain in and swelling of legs 38 18.1 72 37.7 Vomiting after first trimester 27 12.9 31 16.2
26
Headache/vertigo 54 24.3 79 41.4 Black outs 16 7.6 32 16.8 Swelling of hands and feet 29 13.8 57 29.8 Fits 26 12.4 33 17.3 Natal Period Delay in progress of labor 10 4.8 18 9.4 Fetal mal position 7 3.3 10 5.2 Delay in expulsion of placenta 6 2.9 4 2.1 Dizziness/fainting 8 3.8 5 2.6 Postnatal Period High fever 55 26.2 51 26.7 Palpitation/weakness 11 5.2 9 4.7 Heavy Bleeding 13 6.2 13 6.8 Severe pain in lower abdomen 20 9.5 28 14.7 Foul smelling vaginal discharge 9 4.3 6 3.1 Inflammation of breasts 7 3.3 2 1.0
Women also indicated other danger signs as High fever 26.7%, Severe pain in lower abdomen
14.7%, Heavy Bleeding 6.8%, Palpitation/weakness 4.7%, Foul smelling vaginal discharge 3.1%
and Inflammation of breasts 1.0% during post natal period while in Baseline these danger signs
were reported as 26.2%, 9.5%, 6.2%, 5.2%, 4.3% and 3.3% respectively.
Some more danger signs of natal period were reported by women like Delay in progress of labor
9.4%, fetal malposition 5.2%, Dizziness/fainting 2.6% and Delay in expulsion of placenta 2.1%
and according to Baseline Survey these signs were reported by women as 4.8%, 3.3%, 3.8 and
2.9% respectively.
Distribution of Respondents according to Complication faced in Last Pregnancy
Baseline End Evaluation
Variables Frequency n=210
Percentage Frequency n=210
Percentage
Yes 17 8 71 33.8 No 193 92 139 66.2 Total 210 100 210 100
As shown in above table 33.8% of the women reported to face any complications during
pregnancy, delivery and postnatal period while 66.2% did not report to face any complication,
According to Baseline results 8% women had confronted some complications and 92% had not
faced it.
According to PDHS 2006-07, 57% reported any problem during delivery & Post natal period.
27
Family Planning
Figure showing Respondent’s knowledge about Family Planning
End line Evaluation shows that 80% (169/210) women reported to knew about family planning
while during Baseline survey 63.4% (133/210) women had knowledge about it.
According to PDHS 2006-07, 96% ever married & currently married know at least one method
of Family planning.
The above figure shows that 23.3% women had reported to be current users of Family Plannig
while during End line evaluation 44.3% current users were reported which indicates an increase
of 21% in Family Planning users.
Family Planning Practices
The respondents were asked about their practices for ever and current use of contraceptives.
63.4
80
Knowledge regarding Family Planning
Baseline End Evaluation
23.3
44.3
Current Users of Family Plannig
Baseline End Evaluation
28
Distribution of respondents according to Practices of Family Planning
Variables Ever Users Current Users Current
Users*PDHS
2006-07 Baseline End
Evaluation Baseline End
Evaluation Use of
contraceptive
methods
n %
n %
n %
n %
%
Oral Pills 11 5.2 38 31.1 7 3.3 15 7.1 2.0 IUCD 8 3.8 10 8.2 5 2.4 8 3.8 2.0 Injection 25 11.9 56 45.9 16 7.6 32 15.2 2.0 Condom 19 9.0 20 16.4 13 6.2 11 5.2 7.0 Tube-Ligation 6 2.9 5 4.1 7 3.3 10 4.7 8.0 Vasectomy 0 0.0
14 11.5 0 0.0 0 0.0 0.1
Abstinence 0 0.0 0 0.0 0 0.0 0 0.0 4.0 Withdrawal 0 0.0 0 0.0 0 0.0 17 8.0 4.0 Total 62 29.5 122 58.1 49 23.3 93 44.3 29
End line results show that currently 44.3% respondents are the current users of any contraceptive
method while during Baseline current users were 23.3%.
Above Table shows that among the total Current Users, the use of Injection was 15.2% and
it was 7.6% in Baseline. Use of Pills was 7.1% while it was3.3% in Baseline. In End line
evaluation use of Condom was 5.2% and in Baseline it was 6.2%. TL was 4.7% (3.3% in
Baseline). The use of IUCD was 8.6% 2.4% in Baseline), and use of withdrawal method was 8.0%
while no use of it was reported during Baseline. While no use of Vasectomy and Abstinence was
reported from the respondents during both baseline survey and End line evaluation.
A little less than one third of women (29%) reported ever use of contraceptives during Baseline
while as shown in the figure during End line Evaluation 58.1% women were the ever users. In End
line Evaluation Out of total ever users 56% reported the use of Injections, 38% Oral Pills, followed
by 20% Condom, 14% Vasectomy, 10% IUCD and 5% TL. .
While during Base line Survey the most commonly reported contraceptive by Ever Users was
Injection (25%) followed by Condoms (19%) and OPs (11%) then IUCD (8%) & TL (6%).
According to PDHS 2006-07, ever users of FP were 49% and current users of FP are 30%.
Information regarding Child Health Care status
The provision of appropriate care to a newborn is critical. Information was collected from the
women about the existing practices related to breast feeding, immunization and immediate
measures for new born care. The information was collected about the last new born child.
29
Figure; Distribution of respondents according to their perception for the size of their last
born infant
End Evaluation result as shown in above figure reveals that 74.8% reported their new born similar
to other newborns in comparison of 79.5% in Baseline. 12.9% women reported their new born to
be smaller than other new born in comparison of 3.8% in Baseline. 5.7% women reported their
new born were Bigger than others while it was 11% reported in Baseline. Another 5.7% women
reported their new born to be very small in comparison of 2.4% in Baseline. In case of very big
size 1% women claimed it while it was reported14% during Baseline survey.
Distribution of Respondents according to the reported Weight at Birth
Variables End Evaluation
Frequency percentage
Yes 110 52.4
No 100 47.6
Total 210 100.0
52.4% of the women reported that birth weight of their last newborn was taken. This was very
interesting to note as 75% of women had their delivery in a public or a private facility by a trained
birth attendant.
The mean birth weight of their last born child as reported by 110 women was 2.62 while during
baseline was 2.59. The minimum weight was reported as 1 kg and maximum was 10 kg during
End Evaluation while in Baseline the minimum weight was recorded as 2kg and maximum as 8
kg. Around one quarter of babies were reported of low birth weight both in End Evaluation and
Baseline survey.
Ver big size Bigger than other new
borns
Similar to other new borns
Smaller than other new
borns
Ver small
1.411
79.5
3.8 2.41 5.7
74.8
12.95.7
Mother's Perception for their last born child
Baseline End evaluation
30
Breast feeding and weaning practices
Pre lacteal
Many women mentioned that they had given Pre lacteals to the newborns. (These include water,
Ghutti, honey, sugar, glucose, butter, formula milk and fresh milk.) The most commonly
reported Pre lacteal given to the new born was fresh milk 28.1% followed by Honey 21.5%,
Water 13.3%, Ghutti 11.1%, Sugar 1.5% and others 17.7% in comparison of Baseline these pre
lacteals were given by percentage of 10, 18.8, 7.1, 6.7, 3.7 and others 2%.
Fig Percentage distribution of Prelacteals given to newborns as reported by women from selected
UCs in District Matiari
Distribution of respondents according to Breastfeeding practices to the newborn
Baseline End Evaluation
Variables Frequency Percentage Frequency
Percentage
Ever Breastfed 199 95.7 207 98.6 Initiation of Breastfeeding after birth Immediately 123 61.8 83 40 Few Hours 65 32.6 95 46 Next Day 11 5.6 29 14 Colostrums Given 192 91.4 182 86.7 Currently
Breastfeeding 163 77.6 159 75.7
Ever Bottle Feed 64 30 70 33.3
Overall 95.7% mothers reported to breast feed their youngest child. Those who reported to
breastfeed their child were asked about the time of initiation of breastfeeding. According to End
line evaluation nearly 39% mothers initiated breast feeding immediately after birth while in
Baseline it was reported 58.6%. Many mothers 45.5% reported to start breast feeding within 24
Water Ghutti Honey Sugar Fresh Milk Others
7.1 6.7
18.8
3.7
10
2
13.311.2
21.5
1.5
28.1
17.8
Prelacteals given to new born
Baseline End Evaluation
31
hours in end line evaluation and during Baseline it was reported to be 31%. While some about
8.5% reported to initiate Breast feeding by next day and during Baseline it was 5.2%.
According to the End evaluation results Colostrum was given by 86.7% mothers while in Baseline
91.41% mothers reported to fed Colostrum to their babies.
At the time of End evaluation 75.7% mothers were currently breast feeding to their babies in
comparison of 77.6% in Baseline. In response of ever bottled feeding given to babies about 33%
mothers reported it while during Baseline 30% mothers had given Bottled feeding to the babies.
Immunization of the children
Baseline End Evaluation
Variables Percentage Percentage BCG 93.8 93.5 Polio 0 89.5 95.3 Polio 1 88.6 93.9 Polio 2 81.9 92.5 Polio 3 79 88.8 DPT 1 77.1 93.9 DPT 2 67.1 92.5 DPT 3 67.1 88.8 HB 1 32.9 93.9 HB 2 33.3 92.5 HB 3 31.4 88.8 Measles 9 48.1 85.5 Measles 12 31.4 58.9
Nearly 94% of mothers claimed that their last born children have been immunized. 93.5% of the
infants were immunized for BCG as reported in End Evaluation and almost same in Baseline
survey 93.8%. The rates of Polio 0 and Polio 1 were 95.3% and 93.9% respectively in end
evaluation while during Baseline it was 89.5% & 93.9%. However, Polio 2 and 3 were prevalent
among 92.5% and 88.8% of the infants respectively. While during Baseline the prevalence rate
was 81.9 and 79 for Polio 2 & 3 respectively.
93.9% children of the respondents received DPT1 and HB1, 92.5% received DPT2 and HB2
while 88.8% received DPT3 and HB3.
End evaluation results show that 85.5% children were immunized against Measles 9 while in
Baseline it was found that only 48.1% children were immunized against it. Graph shows that
58.9% children received vaccine of Measles 12 while during Baseline 31.4% children had
received it.
Knowledge of mothers for Newborn Care
The mothers were asked selected question to assess their knowledge about newborn care. The
knowledge was assessed by asking questions about time for giving bath after birth, practice of
slapping for making the child cry, giving him/her bath right after birth, wrapping the newborn in
dry sheet and initiating the breastfeeding.
32
Danger Signs for newborns
Women were assessed for their knowledge about the danger signs for the newborns. The main
symptom mentioned was high fever by 72.9% women while during Baseline 86.2% women
reported it. Stopped breastfeeding was notified by 27.6% women, it was reported by 41.4%
during Baseline. 32.7% women indicated Fits as danger sign for new born while in Baseline it
was not mentioned at all. Yellow discoloration of body was mentioned by 31.2% women while it
was 13.8% in Baseline. 25.1% women knew Low body temperature as danger sign for a child
while in Baseline 17.6% had knowledge about it. Blue discoloration of body was mentioned by
21.6% women while during Baseline 9% indicated it. The drowsiness was mentioned by 18.1%
women but during Baseline 6.2% women indicated it.
Distribution of respondents according to their knowledge about the danger signs for
newborn
Knowledge of mothers for Newborn Care
The mothers were asked selected question to assess their knowledge about newborn essential
care just after birth like keeping new born clean, dry and warm, Cord care, initiating the
breastfeeding, weighing the child, and immunization against TB and Polio. The knowledge of the
mothers varied for various aspects of newborn care as shown in the figure.
Stopped breast
feeding
High fever Low body temperature
Blue discoloration of face/lips
Yellow discoloration
of body
Drowsiness Fits
41.4
86.2
17.69
13.86.2
0
27.6
72.9
25.1 21.631.2
18.1
32.7
Knowledge about danger signs for new born
Baseline End evaluation
33
The results have been shown in figure as 85.7% women knew for initiating breast feeding early
while in Baseline 63.4% women had this knowledge. 76.1% women knew that it is important to
give bath to the baby just after birth while during Baseline 77.6% had indicated it. 35.6% of the
women were aware about to clean and dry the cord of child in comparison of 36.6% awareness
regarding this in Baseline. Knowledge regarding immunizing the new born against TB and Polio
was known by 25.9% according to End line Evaluation results while during Baseline 27.4%
women had mentioned it. 17.6% women knew to weighing the new born and in Baseline 18.6%
women had indicated it. End line Evaluation results show that some women (3.9%) mentioned
some other indicators as essential care of new born while 4.9% women reported to have no
knowledge about it.
Availability of Health Care facilities
The women were asked about availability of health care services in their respective villages.
Questions were asked about facilities, providers, time needed to reach a facility and preferred
choice for a facility, and availability of vaccinations.
During End line Evaluation multiple responses were noticed for the availability of health care
facilities, 47.4% women mentioned Private Hospital, 44.5% mentioned Health Houses, 37.8%
mentioned to Govt Hospitals and 18.2% indicated Basic Health Unit. The availability of some other
facilities was also mentioned like Rural Health Center, NGO’s facilities and other by 13.9%, 5.7% and
1.0% women respectively.
While Baseline results showed that almost half of the women mentioned about a public sector
hospital and an equal proportion mentioned a private clinic /hospital.
Percentage distribution of knowledge of Health care facilities and the preferred choice for
their use among women from selected UCs in District Matiari
Baseline End Evaluation
Variables Frequency Percentage Frequency
Percentage
Availability of Health Care facility
Weighing newborn
Immunization Cord care Keeping newborn
clean, dry and warm
Early initiation for breast
feeding
Others Don’t Know
18.6 27.4
36.6
77.6 85.7
0 017.6
25.9 35.6
76.163.4
3.9 4.9
Knowledge regarding New born Care
Baseline End Evaluation
34
Govt: Hospital 98 46.7 79 37.8 Private Hospital 95 45.2 99 47.4 Basic Health Unit 30 14.3 38 18.2 Rural Health Center 2 1.2 29 13.9 NGO 4 1.9 12 5.7 Health Houses - - 93 44.5 Other 0 0 2 1.0 Preferred choice for a Health Care facility Govt; Hospital 131 62.4 116 55.5 Private Hospital 85 40.5 123 58.9 Basic Health Unit 19 9.0 26 12.4 Rural Health Center 6 2.9 16 7.7 NGO 1 0.5 2 1.0
Women talked about preferred choices of facilities for availing health care/healing services. There
were multiple responses from the women. 75.6% women preferred to Government facilities
including Govt Hospital, Basic Health Unit and Rural Health Center in comparison of 59.9% who
preferred Private Hospital/Clinics including 1% NGO’s facilities.
According to Baseline results for 62.4% of the women, it was a Government hospital, and 40.5%
women preferred for a private hospital. While other choices were Basic Health Unit by 9.0%, Rural
Health Center by 2.9% and NGO”s facilities by 0.5% women
Percentage distribution of knowledge for availability of various cadres of service providers
among women from selected UCs in District Matiari
Women were explored for the availability of various cadres of providers in their respective
villages. Multiple responses were given by women where the most commonly reported provider
available was LHW mentioned by 68.9% women in End evaluation while previously was
reported 80% by respondents in Baseline. For Govt physician 52.6% women mentioned, for
Private physician 42.6%, for TBA 28.2%, for vaccinator 23% and for midwife 15.8% women
Govt; Physician
Govt; Nurse
Private Physician
Private Nurse
LHV LHW FWW Midwife Vaccinator TBA
51
9
44.3
2.4
11
80
7.1 4.8
20.5
42.9
52.6
11
42.6
10.5 10.5
68.9
3.3
15.823
28.2
Availability of service providers mentioned by respondennts
Baseline End Evaluation
35
indicated. Some other providers were also mentioned like Govt Nurse by 11% women, LHV and
Private Nurse by 10.5% for each, followed by FWW by 3.3%
While the results of Baseline for preferred choices of women has been shown in the figure.
Time to reach a nearest health facility
The mean time mentioned by women to reach the facility on foot was 33.8 minutes while in
Baseline it was reported 29 min. An average of 10.3 minutes was reported to reach to the Health
facility by a vehicle while according to Baseline result it was mentioned as 13 min.
Reason for visiting a facility
Percentage distribution of reasons for visiting a facility reported by women from selected
UCs in District Matiari
Women were asked about the reasons for visiting a particular facility. The main reasons
mentioned were consultation for child illnesses (93.1%), Antenatal care (42.9%), Child
Immunization (36%) and for delivery (23.6%) followed by Pregnancy related problems 16.3%,
consultation for family members 15.3%, TT immunization 14.8%, Family Planning 12.3% and
for weighing child 5.9% were the reasons for visiting a facility.
According to Baseline result reasons for visiting a health facility were reported by women as
consultation for child illnesses (83.8%), Antenatal care (57.6%), delivery (45.7%), Child
Immunization (43.8%) and followed by Pregnancy related problems 26.2%, consultation for
family members 20.5%, Family Planning 16.7%, , TT immunization 14.8%, weighing child
15.7% and for TT immunization 13.3%, were the reasons for visiting a facility.
20.5
13.3
15.7
45.7
16.7
26.2
57.6
43.8
83.8
15.3
14.8
5.9
23.6
12.3
16.3
42.9
36
93.1
0 20 40 60 80 100
Consultation for other family members
TT immunization
Weighing the child
Delivery
Family Planning
Pregnancy related problems
Antenatal Care
Child immunization
Consultation for child illness
End Evaluation
Baseline
36
Immunization Services at the Govt. facilities in the area
Women were asked about the availability of the vaccines in the govt. facilities in their respective
villages.
Distribution of respondents according to availability of vaccines in the govt. facilities reported
Baseline End Evaluation
Variables Frequency Percentage Frequency
Percentage
Available vaccines for children BCG 173 83.4 137 68.2 DPT 169 70.5 121 60.2 Polio 146 69.5 145 72.1 Measles 132 62.9 122 60.7 Hepatitis 110 52.4 66 32.8 Available vaccines for Pregnant women TT 89 42.4 108 53.7
In response to the question that if the vaccines for children and women are available in
Government facility, for Polio 72.1% mentioned it while during Baseline 69.5% had witnessed it.
68.2% women indicated the availability of while in Baseline 83.4% had mentioned it. 60.2%
women gave positive response for the availability of DPT and it Baseline it was mentioned by 70.5% women.
Availability of Measles was mentioned by 60.7% women while during Baseline 62.9% had mentioned
it. For Hepatitis 32.8% women respond for its availability while during Baseline 52.4% had mentioned it.
Availability of TT vaccination was mentioned by 53.7% women while in Baseline survey 42.4% had
mentioned it.
Vaccinator’s visit from Government
In response to the question if the vaccinator from a govt. facility has visited them during the last
one year, multiple responses were reported by women. 91.7% of the women were affirmative for
their visit for children’s immunization while in Baseline 70% women had witnessed it. For TT
immunization of pregnant women 40% had reported the visit of vaccinator while in Baseline it
was reported by 61% women. 9% women reported to have no knowledge about such visits. and in
Baseline 15% were not aware.
13.8% denied for any visit made by a government vaccinator for any kind of immunization while
in Baseline it was reported by 12% women.
37
Strengthening and
Enhancing Health
Accessibility through
Community
Mobilization
38
3.3 Strengthening and Enhancing Health Accessibility
through Community Mobilization
The aim of this part of the study was to assess the status of all health management committees
and village health committees in the Matiari. For the purpose of assessment of the Health
Management Committees a total of 6 health facilities were identified out of 10 health facilities
where interventions of GAVI were intervened. These 6 health facilities included 2 BHU’s, 2
RHC’s, 1 THQ and 1 DHQ. In Depth Interviews were conducted with each member of the
committee for the purpose of assessment. For the assessment of Village Health Committees a
total of 29 LHW’s were identified and interviewed during survey.
Breakdown of Health Management Committees
During Baseline for the purpose of
assessment of the Health Management
Committees a total of 27 health
facilities were identified. These 27
health facilities included 19 BHU’s, 5
RHC’s, 2 THQ’s and 1 DHQ.
Some other descriptive data
In the End line evaluation it was found
that all the surveyed Health facilities
was found to be improved 100% in
different areas like attendance of staff, Outlook and display, Signboards and their direction,
Boundary walls, Electricity, Water supply, Sewerage System and Hospital waste disposal. While
during Baseline surveys in all the 19 units surveyed attendance was found to be 100%. In 11 of
the BHU’s the outlook and the display looked good but for the rest 8 units they required
improvement.
In 90% of the BHU’s
the signboards and its
direction were found to
be alright. Boundary
walls for the 15 units
were found to be in
good condition but for
the rest of the BHU’s
the boundary walls were
found to be either
incomplete or in
depleted condition.
Coming to the
availability of the
utilities; Electricity was
found to be available
and functional in all
Category Baseline End
Evaluation
BHUs 19 02
RHCs 05 02
THQs 02 01
DHQ 01 01
Descriptive Heading Conforming centers
Baseline
N=27
Conforming centers
End evaluation
Percentage
N=6
Attendance 100% 100
Outlook and display 11 100
Signboards and their
direction
90% 100
Boundary walls 15 100
Electricity 100% 100
Water supply 18 100
Sewerage System 17 100
Hospital waste disposal 100% 100
39
BHU RHC THQ DHQ
21
36
18 18
FP Clients at Facilities during last month
0
200
400
BHUs RHCs THQ DHQ
115
67
320
30
A/N patients during last month
BHU’s. Telephones were available in all the BHU’s except for the 2 units. Adequate water
supply system was available and functioning in all the BHU’s except for in one unit where for
use salt water was present. Sewerage system was found to be working in all the BHU’s but 2 of
the BHU’s requires improvement in the sewerage system. All units were found to have good
arrangement for the disposal of hospital waste.
Number of Deliveries held in
intervened
Facilities Data was gathered for the no. of delivery
conducted at the intervened facilities. The
figure shows that 90 deliveries conducted at
DHQ, 25 deliveries at RHCs, 18 at THQ and
4 deliveries were conducted at BHUs.
Antenatal clients at facilities during
last month
Services were given to clients for Antenatal
checkups at different facilities which were
surveyed. Almost 320 clients were recorded
at THQ, 115 at BHUs, 67 clients at RHCs
and 30 clients at DHQ.
Post natal clients at facilities during
last month
The figure shows that for the postnatal check
up 63 clients were recorded at BHUs, 41
clients at RHCs, 30 clients at THQ and same
number at DHQ.
Family Planning clients at facilities
during last month
During End Evaluation Family Planning
clients were also recorded as recieveing. FP
service from the facilities which were
assessed.
The figure shows that 36 clients were
recorded at RHCs, 21 at BHUs, 18 at THQ
0
20
40
60
80
BHUs RHCs THQ DHQ
63
4130 30
Postnatal patients during last month
DHQ THQ BHUs RHCs
90
184
25
Deliveries conducted during last month
40
and a same number of clients was recorded at DHQ.
Village Health Committee Assessment
A total of 29 Village Health committees were assessed during End evaluation survey
Village Health Committee members
There were total 284 health committee
members, 139 were men and 145 were
women.
LHWs
Information was collected from 29 LHWs about their role in village health committees. 26
LHWs reported to be the resident of their workplace. The LHWs were affiliated with BHUs,
RHCs and THQs. The mean population covered by each LHW was reported to be 916 with 684
and 1232 as minimum and maximum population.
LHW Kit All of them had a LHW kit. However, the kit register was maintained by 25 LHWs. When asked
if they face shortage of kits, 22 LHWs reported about shortage of few medicines.
LHWs responsibilities
In response to the question regarding their responsibilities, all responded their role in mother and
child immunization and care, visiting the community and resolving their issues and polio
vaccination.
Health Committees In response to the question if MIS of health committees maintained, 76% reported it positively.
Majority of LHWs assumed that the village committees are there to mobilize communities,
support to LHWs, plan for better health of the communities, create awareness among the
communities, and conduct health sessions. Resolve the health issues related to vaccination,
mother & child care and support during polio vaccination. 96% of them reported that meetings
of village committees are conducted monthly. However, 83% of the responded said that meeting
minutes are maintained properly. Though 100% of the LHWs reported to meet village committee
members, only 10.3% agreed that health improvement plans are prepared.
Total Health Committee Members
284
Total Health Committee Members Male
139
Total Health Committee Members Female
145
41
In response to the question about common health issues of the area, the answer varied from no
issue reported by only 1 respondent. As
shown in the table the mainly issues of
High fever/malaria, Hepatitis and
Sanitation
each by 5 respondents. Skin diseases
were also reported by 4 HC members
while 2 members reported pneumonia
and unavailability of 24 hours health
facility. 01 member reported the issue
of unavailability of vaccination for
pregnant women and children.
Government Officials
Interviews of EDO Health, DO Health (Prevention) and DO Health (Administration) were also
taken. All of them were well aware of the project objectives and reported to have signed MoU
for the project. They all reported to have meetings with the project team. The usual agenda for
the meetings were to work hard for EPI coverage with support of each other, vaccination
coverage achieved by regular visit in field of vaccinator, to monitor vaccinators regularly, to
organize training on VHC at different health facilities. In response to the question regarding
effectiveness of the project the officials commented that HMCs have become strengthened to
resolve health issues, EPI coverage has increased specially in uncovered areas. The health status
of district is better now in comparison of previous performance.
Government Vaccinators
Interview of 11 vaccinators was taken. All of them were working under government with service
duration ranging from 1 to 30 years. 04 of them reported to get training under GAVI project. Out
of 04 vaccinators 02 reported to have 0 training and the other two reported to have 02 trainings.
They discussed the training topics like VHC and Vaccination during training. Average 35.2
births per month ranging from 12 to 86 were reported by them in their respective working area.
Regarding the children in area aging 12 to 23 average 674 children were reported ranging 42 to
1972. Similarly vaccinators reported that average 2036 women of age 15 to 45 are there in their
working area ranging from 285 to 6412. Regarding the number of EPI vaccinations average 387
vaccines by per vaccinator were reported. They also reported that they also aware the clients
regarding EPI & TT vaccinations. Questions were asked regarding the Health problems of their
working areas. Multiple responses were record for the question which reveals that Phenomena is
the most commonly prevailing disease in their areas. Pneumonia was followed by another
problems like Hepatitis, Flu, cough & fever, Unhygienic condition of areas and far away health
facilities. Except unavailability of transport for the access of these areas for providing
vaccination is also a big issue. Other problems include Malaria, TB, unavailability of health
service at night, Unavailability of Laboratory/Ultra sound, Low literacy rate of population, and
less number of vaccinator in the areas where population is high. Reasons for possible maternal
Health issues
n
Skin diseases 4
High fever/malaria 5
Sanitation 5
Hepatitis 5
pneumonia 2
24 hours health facility not available 2
No vaccination for pregnant women and
children
1
42
deaths were also asked from the vaccinators and multiple answers were recorded. The most
commonly reported reason was Anemia followed by Malnourishment and other reasons were
High BP, Pneumonia, and avoidance of Preventive measures. Multiple responses were given by
the vaccinator for highlighting the possible reasons for child death in their respective areas. The
most commonly reported reason was Pneumonia followed by High fever & Malnourishment.
The other possible reported reasons were avoidance of Preventive measures and Hole in heart.
They all reported to have vaccination record including daily activity register and permanent
register.
43
Conclusion & Recommendations 4
The role of the district governments in general has been very supportive, but, the number of
visits of the EDO, the DO and the DDO depicts otherwise. The visits by the officials can bring
about a world of change in the performance of the centres and help resolve the issue pertaining to
the centres. Some other good developments which were noticed during the end evaluation were
as HANDS became part of District Technical Committee, good Public Private partnership to
increase immunization coverage, Development of Health Improvement Plans to improve Health
Facilities, Mobilization of VHCs to improve LHWs performance, Community Midwifery
trainings to improve antenatal and post natal complications and the regular participation of
HANDS in Dist. PPHI Monthly Meetings.
But at the same time there are some challenges which still needs to work on like
Poorly developed or Non functional HMCs / VHCs, lack of logistics, MIS and vaccinators in
District EPI program, nonresident LHWs, Lack of logistics for LHWs, Uncovered areas by
LHWs and Delay in fund release.
The study reveals that the centers have adequate attendance and general outlook along with the
visibility of the signboards, which is alright for most of the centres. Similarly, civil infrastructure
for which study of the boundary walls were made was found to be satisfactory for most of the
centres. The study further came to the conclusion that most centres have available facilities like
electricity, telephone, water supply, sewerage and hospital waste disposal. These are important
for the proper functioning of the centres. Availability of the medicines and other general store
items like beds and linen have been found to be satisfactory at most of the centres. Equipment
required for a proper functioning labor room and other requirement like disposable syringes,
syringe cutters and cold chain equipments are available at most of the centers. The fact that
various vaccines and medicines have been made available at the centre makes it ironic. The
outlook, displays, signboards, boundary walls, waiting areas etc. were found generally adequate
and satisfactory at most of the surveyed centres. Availability of the services like outdoor patients
service, indoor patient service, surgeries, emergencies, MCH, services of MCH staff, handling of
Antenatal cases, emergency obstetrical care services, services of the Labor room, operation
theatre for Obstetrics and Gynecology, handling of the deliveries and the Caesarean are
important for any health facility. Many of the above services are present at most of the centres.
Referrals to and from the health centres are an important function of the health facility. This
system is available at most of the centres. However, accurate data needs to be stored in order to
allow for accurate analysis. EPI services and EPI vaccines were available at most of the centres.
44
Annexure
45
Annexure 1
Health Care Facility Information
General Information
Date of Interview:_____________________
District:______________________________ Tehsil / Taluka:________________________
Type of Health Facility:
1. THQ/DHQ 2. RHC 3. BHU 4. RHC 5. Other (Name)………
Address of the facility ________________________________
Name of Interviewee: ________________________________
Designation: ________________________________________
Name of the {Interviewer}_____________________________
Catchment Area & Population
1. What is the total {area} in sq km that is covered by the health facility? ____________ 2. What is the total catchment {population} of this facility: _____________ (please check the
catchment population chart and if that is not available then check with the EPI Vaccinator). 3. Ask for List of {catchment} area villages with population and distance from facility
Section 1: Availability of Specific Health Services
1. Health Services:
1.1 Does this facility offer the following services? If yes, how many patients have visited during the
specified period? (ASK THE RESPONDENT EACH OF THE CATEGORIES)
Outpatient Services Number of patients attended during
last 1 month
General OPD
46
Female OPD
Antenatal Care
Deliveries
Postnatal Care
Growth Monitoring
EPI vaccine for children
TT vaccine for women
Family Planning
Services
General inpatient care
Surgical care
Pediatric Care
Infertility
STDS
HIV/AIDS
Hepatitis
Total Patients
1.2 How many days the facility was open for ambulatory care during last one month_______
1.3 During last 1 month for how many days Female HCP has attended the hospital ________
1.4 Note the average time (in hours) for last one month OPD remained open in the morning ____
47
Section 2: Health Facility Management
2.1 Staff position:
Type of Staff Filled posts Staff on job at time
of survey
Gynecologist
Anesthetist
Medical Officer
(Male)
Women Medical
Officer
Dental Surgeon
Medical Assistant
LHVs
Dais / Midwife
Dispenser
Lab. Technician
Theatre Technician
Dental Technician
Radiographer
Ward Boys
Vaccinator
FP Worker
Ayah
LHW (attached/
affiliated)
Other: (specify)
48
Total
2.2Staff available at night
Type of Staff Sanctioned posts Filled posts Staff on job at time of
survey
Women Medical
officer
Nurse
Midwife
LHV/FHT
Staff qualified to
conduct C-section
49
Section 03: Planning and Management
3.1. Management Information System (HMIS):
Type of HMIS activities undertaken: Yes=1
No=0
Has somebody from this facility been trained in HMIS reporting?
Did this facility send its HMIS report in time last month?
Did you receive any feedback on HMIS reports submitted during last three months?
Did any supervisor visited your facility and inspected the monthly/yearly HMIS report?
3.2 Referral System:
3.2.1 Do you keep the record for referral cases? 1. Yes 2. No 3.2.2 What types of patients were referred during the specific period?
Type of referred patients
Number of referred patients
During last 01 month
General Curative Care
Antenatal Care
Delivery Care
Postnatal Care
Expanded Program of Immunization (EPI)
Family Planning Services
Obstetric/Gynecologic Care
Pediatric Care
Trauma Orthopedic Care
Other (Specify)
50
Total patients referred
3.2.3 How many patients seen at the OPD were referred from another facility/ health care provider/
LHW within the last one month? ____________________________________.
3.2.4 How many inpatients in the last one month were referred from another facility/ health care
provider/ LHW? ___________________________________.
3.2.5 Where majority of patients were referred? _____________________________________.
3.4 Transport System:
Does the Health facility has the Ambulance service Yes / No
If yes then is the Ambulance functional Yes / No
51
Section 4: Health Facilities Coverage/ Activities
4.1 Immunization coverage:
4.1.1 is this facility a vaccination point?
1. Yes
2. No
3. Don’t Know
Interviewer’s Observations
(To be filled in after completing interview)
Comments about the functioning of Health Facility:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
52
Comments on the patients present at the Facility:
__________________________________________________________________
__________________________________________________________________
Any Other Comments
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Name of Interviewer:________________________________
53
Annexure 2
GAVI – Project End Evaluation
IDI for District Officials Date: ___________________ Name: ________________________
Designation: _____________
1. Knowledge/objectives of GAVI project: ________________________________________
________________________________________________________________________
2. MoU signed and available for GAVI: Yes No
3. Activities of GAVI project in district: __________________________________________
________________________________________________________________________
________________________________________________________________________
4. Trainings conducted under this project? Yes No
5. No. of trainings conducted under this project: ________
6. Title of trainings: __________________________________________________________
7. Topics of training: _________________________________________________________
8. Meetings conducted with GAVI (HANDS) team/HMCs in last 06 months? Yes No
9. No. of meetings conducted with GAVI (HANDS) team/HMCs in last 06 months: ________
10. Regularity of meetings_____________________________________________________
11. Availability of meeting minutes record? Yes No
12. Decisions taken in last 06 months ____________________________________________
________________________________________________________________________
________________________________________________________________________
13. Follow up of Decisions _____________________________________________________
________________________________________________________________________
14. Monitoring Cell establishment Date: _____________ Place: _______________________
15. Objectives/activities of monitoring cell: _______________________________________
________________________________________________________________________
16. Effectiveness of monitoring cell: _____________________________________________
________________________________________________________________________
17. Effectiveness of GAVI activities: ______________________________________________
54
_______________________________________________________________________
18. Sustainability issues of the project: ___________________________________________
55
Annexure 3
GAVI – Project
VILLAGE HEALTH COMMITTEE ASSESSMENT
1 Date__________________ 2. Assessment
by:_____________________________________________
3. Name of LHW/VHC __________________________ 4. Tel / Cell No
__________________________
5. Resident: Yes No
6. Name of Village: _____________________UC _______________ Taluka
________________________
7. LHS Name____________________________ 8. LHS last visit
date______________________
9. Report submitted to LHS: Yes No 10. Last report date:
_____________________
11. MoU with VHC signed and available: Yes No
12. Health Committee Members: Total _______ Men
____________Women_________
13. No. of VHC members trained: Total _______ Men ____________
Women_________
14. Population Covered by LHW______________
15. Is LHW Kit Available: Yes No 16. Any Shortage in
Kit______________________
17. Is LHW Kit Stock Register maintained: Yes No
18. What are the responsibilities of LHW
________________________________________________________________________
________________________________________________________________________
_______________________________________________________________________
56
19. No. of Home visits conducted by LHW in last
month_________________________________________
20. No. of deliveries in last month in target
population__________________________________________
21. No. of low birth weight births in last
month________________________________________________
22. No. of FP clients in last month___________ 23. No. of pregnant women in last
month__________
24. No. of children vaccinated in last month______ 25. No. of CBAs vaccinated against TT
last month_____
26. No. of awareness sessions conducted in last month _________
27. Referral Health strategy developed? Yes No
28. If yes name of Facility ______________________
29. No. of cases referred last month____________
30. Where are vaccinations carried out? _____________ 31. Last Polio team visit
date________________
32. Is MIS of Health Committee maintained? Yes No
33. What are the duties of Health Committee?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
34. Is monthly Health Committee meeting held? Yes No
35. Date of last Health Committee Meeting Participants: Total___ Men___ Women____
36. Are meeting minutes/registers of Health Committee meeting maintained? Yes No
37. Does LHW meet the members of Health Committee? Yes No
38. Is Health Improvement Plan prepared? Yes No
39. Follow up of Health Improvement Plan did?
________________________________________________________________________
57
________________________________________________________________________
________________________________________________________________________
40. Main Health
Issues___________________________________________________________________
________________________________________________________________________
________________________________________________________________________
41. No. of meetings with GAVI (HANDS) team in last 06 months ___________
42. Meeting minutes/record available? Yes No
43. Commnets_______________________________________________________________
________________________________________________________________________
________________________________________________________________________
58
Annexure 4
59
60
61
62
63
64
Annexure 5
65
66
67
Annexure 6