Guidance Note for Block Monitoring Visits in High Priority Districts

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Guidance Note for Block Monitoring

Visits in High Priority Districts

Guidance Note for Block Monitoring

Visits in High Priority Districts

September 2013



3Guidance Note for Block Monitoring Visits in High Priority Districts

Block Monitoring Visits

I. Why Block Monitoring Visits?

The RMNCH+A strategic approach for improving maternal health and child survival envisages support

from Development Partners, State and District Programme Management Unit for integrated planning,

implementaon and monitoring of the RMNCH+A intervenons across high priority districts. In

order to ensure that districts get mely support to implement the most crical intervenons, the

Development Partners are expected to oerneedbaseddistrictlevelassistance and work alongside

district and block level stakeholders to idenfy key bolenecks and address themsystemically.

It has been observed from the eld visits that there exist interblock variaons within the districts in

terms of health infrastructure and service delivery. This could be due to clustering of vulnerable and

marginalized populaons, geographical inaccessibility, or security concerns (eg; LWE aected), on

account of which these blocks remain relavely underserved.

Under the District Intensicaon Plan, the block is envisaged as the primary unit for implementaon

and management of RMNCH+A intervenons, the capacies for which are to be developed locally

through mentoring support by the district and state management units and the development

partner.

II. Purpose of Block Monitoring Visits

The purpose of Block Monitoring Visitswill be to:

1. make a quick assessment of the infrastructure, human resources, and provision of services

(both at facility and community level) ;

2. assess service delivery (quality and coverage) at block level;

3. review progress of community outreach and community/home based intervenons;

4. validate the data reported into HMIS; and

5. gauge the client (beneciary) sasfacon level with RMNCH+A services.

III. Steps in Block Monitoring Visit

To achieve the above goals, constuon of appropriate mixed skills team is important. These

team members should be able to provide mentoring/handholding and supporve supervision. It

is proposed that District Monitors, assigned by various Development Partners, visit one block each

month in each high priority district. They will be joined on these visits by government representaves

from district and state, and where directed by the SPMU, experts, resource persons from mentoring

instuons and NGO representaves may also be part of the team. The dates for block monitoring

visits should be informed in advance to all team members. The schedule of visit for three or six

months may be drawn up so that the District Monitors can schedule it in their monthly work plans

and availability of all team members is ensured.



4 Guidance Note for Block Monitoring Visits in High Priority Districts

The team should visits delivery points including DH & FRU (if present in the block), 24 x 7 PHC, CHC,

and sample of sub-centresdesignated and interact with the community. During the visit the focus

should be on:

1) Boleneck hampering quality / eecve coverage of essenal intervenons saving newbornand mother lives, at all level community, outreach, facility level throughout connuum of care

2) Implementaon of strategies overcoming the boleneck and addressing inequity and disparity

at block level (geographical, gender, social groups..)

3) Trends / progress of key indicators to follow

a. Eecve implementaon of strategy

b. reducon of boleneck

c. increase coverage of essenal intervenons

4) Real me feedback and report to adjust and accelerate implementaon and scale up from block

to district wide scale.

IV. Reporng format

Following the visit, the District Monitors, along with the team members are expected to prepare a

visit report that includes:

1) Major aconable points & level at which the acon is to be taken (i.e. facility, block, district or

State);

2) Stakeholders (Development Partner/s, DPMU, SPMU, other experts or resource persons, NGOs)responsible for providing technical support along with melines; and

3) Acons taken on previously idened bolenecks and visit reports.

The Reporng Formatbelow provides a broad guidance on the parameters to be assessedduring

monthly visits to the blocks and to be reported thereaer. Addional components may be included

by the District Monitors based on experiences from the eld visits so that most relevant and crical

issues are reported. It is important that not only is the progress captured but also the bolenecks

for delay are explored and recorded. The acons should focus on addressing these bolenecks.

The reports should be forwarded by the District Monitors to the concerned authories at Districtand State levelwithin one week of compleng the visit. The State Lead Partner Agency can compile

the reports from dierent block visited during the month , presenhe key ndings and proposed

acons to the SRU/SUT before forwarding it to the Naonal RMNCH+A Unit (NRU) in the following

month.

Note: Specic tools and checklists may be used to assess the various parameters included in the

reporng format. These can include facility assessment tools/monitoring checklist, community /

household visit tool, tools for assessment of labour rooms, newborn care facilies, hygiene and

sanitaon facilies, and so on.

The data may be accessed from District /Block Management Unit before or during the visit andvalidated in the eld/health facility.




Reporng Format

Name of the Block/s & District visited:

Dates of Visit:

Name of team leader & organizaon:

Names of team members & organizaons:

I. Block Prole

i. Demographic informaon Census 2011

Whether it has areas that are dicult to reach (due to

hilly or dicult terrain)

Name of the villages that are dicult to reach

Whether block has more than 50% Tribal Populaon Yes/No

Whether the block is LWE aected Yes/No

Total Populaon Male Female Total Urban Rural

ii. Infrastructure Sanconed Presently Funconal

Number of Sub-Health Centers

Number of 24x7 Primary Health Centers

Community-Health Centers

FRU (facility providing C secon/ EMONC)

Any adolescent health clinic/s

SNCU (Yes/No)

Any NBSU

Any NRCs

Any health facility with blood bank

Any facility with blood storage unit

Block covered by funconal MMUs (Mobile Medical Units) Yes/No

Detailed Observaons and comments

iii. Human resources Sanconed posts In posion

(contractual +regular)

BPMU sta

ASHAs

ASHA Supervisors

1st ANM

2nd ANM

Sta nurses




FRU

24X7 PHCs

LHVs

MPWs (male)

Medical Ocers

FRU

24X7 PHCs

AYUSH MOs

Specialists (at any health facility in the block)

Obstetricians &Gynaecologist

Anaesthest

Paediatrician

Surgeons


iv. Health service provision # designated as

delivery point

against total no.

of facilies

# having SBA & NSSK

trained ANM/ SNs

against total no. of

delivery points

# having funconal

NBCC against total

no. of delivery points

Sub-Health Centers

24x7 Primary Health Centers

Other PHCs

Community-Health Center

Number of facilies in the block conducng

C-secon

CHC 24×7 PHCs SC

Number of facilies with xed day family

planning services

Number of facilies with RMNCH+A counsellors

Number of funconal Anganwadi centers

% villages with funconal VHSNC

No of Villages with NO Access to any public

health facility within 30 minutes walking

distance

Names of the villages





II. ASSESSMENT OF KEY RMNCH+A COMPONENTS AT BLOCK LEVEL

The following components shouldbe assessed during the eld visits and the related quantave

and qualitave informaon provided in the visit report.

Health facilies

1. Delivery points: (Assess on the following aspects as pe naonal guidelines- availability of

skilled human resources, raonal deployment, infrastructure, equipment , supplies (including

vaccines, contracepves); delivery of key RMNCAH service packages, hygiene & sanitaon,

waste management, funconing of blood banks/ blood storage units, data management,

maintenance of records)

2. Management of pregnant women with high risk pregnancies, including severe anaemia:

(Assess number and type of high risk pregnancies managed , referral mechanisms)

3. Newborn care facilies: (Assess as per naonal guidelines the status of NBCCs, NBSU(if any)in terms of skilled HR, infrastructure, ulisaon , data maintenance, adherence to protocols

including asepsis, iniaon of breaseeding& exclusive breaseeding promoted; hygiene &

sanitaon facilies,referral mechanisms)

4. Family Planning services: (Assess PP-IUCD programme, availability of RMNCH+A counsellors,

xed day services/sites for interval IUCD, training for IUCD inseron, status of sterilisaon

services)

5. Comprehensive Aboron services (Assess if services available, number of aborons performed,

methods used, training/skills of providers)

6. Adolescent Health services: (Assess if services available, clinics held regularly, service ulisaon)

Health Systems

7. JSSK scheme: (Assess if the scheme rolled out and number of entlements in place, number

of beneciaries, public grievancesredressal system, cizens’ charter, ambulances &call centre,

client feedback on sasfacon with services and out of pocket expenses, if any)

8. JSY scheme: (Assess the performance in terms of number of beneciaries, payments, mandatory

stay of 48 hours, client feedback, ASHA feedback)

9. Ulisaon of RKS funds (purpose for which funds have been ulised, frequency of RKS meengs,maintenance of books of account)

10. Training of health workers (Assess funconality of training instuons, progress on key trainings

–EMONC, BEMOC, SBA, NSSK, IMNCI, PP-IUCD, IUCD inseron etc. and raonal deployment)

Community level

11. Communisaon processes (formaon of VHSNC and their funconality, if social audits being

conducted, convergence with PRI & other sectors like water & sanitaon, rural development,

involvement of self-help groups/ women’s groups in health & nutrion acvies)




12. VHNDs (Numbers held against planned, number of services provided, presence of community

workers and other stakeholders, availability of supplies, equipment, client feedback, record

keeping, MCP card, IFA supplementaon for adolescent girls and boys, line lisng of women

with severe anaemia/high risk pregnancy, convergence with women and child development

department)

13. HBNC scheme (Module 6 & 7 training ,ASHA kits, home visits, referrals made, line list of LBW/

preterm babies, detecon of congenital defects, MCP card, client feedback during home visits)

14. Immunisaon: (Assess availability of microplans, RI sessions held, coverage, dropouts, strategies

for reaching dropouts, vaccine availability at site, cold chain)

15. RBSK scheme (whether it has been launched, number of mobile health teams, progress on

DEIC, number of schools covered, preparedness of AWCs)

16. Doorstep delivery of contracepvesby ASHAs: status of implementaon, supplies, trends in

uptake of contracepves, feedback from ASHAs and clients

17. Menstrual Hygiene Scheme: supplies, uptake, acceptance of the product, ASHA and client

feedback

18. WIFS: Number of schools covered, supplies, monitoring mechanism, convergence with

department of educaon, handling of complaints following administraon of IFA tabs, feedback

from students & teachers

19. IEC/BCC on RMNCH+A (Strategies used for IPC, BCC, mass media , local innovaons, availability

of IEC materials in local language etc.)

20. Maternal Death Review: whether being conducted regularly, causes of maternal deaths, keyrecommendaons emerging from reports, regularity of reporng to state & naonal level

21. Any other pilots/ schemes /innovaons




III. VALIDATION OF KEY RMNCH+A INDICATORS REPORTED IN IN HMIS

AND MCTS

The team should validate the HMIS reporng of following indicators from the primary data source

( eg; registers) available at the facility/block management unit. Sample data from last two quarterscan be validated.

Pregnancy Care HMIS data Specify the

data source

Primary Data

recorded in the

data source

Comments (whether

the HMIS data

matches the data

recorded in primary

data source)

1st Trimester registraon to ANC

registraon

Pregnant women received 3 ANC check-

ups to total ANC registraonPregnant women given 100 IFA to total

ANC registraon

Cases of pregnant women with Obstetric

Complicaons and aended to reported

deliveries

Pregnant women receiving TT2 or Booster

to total number of ANC registered

Child Birth

SBA aended home deliveries to total

reported home deliveries

Instuonal deliveries to ANC registraon

C-Secon to reported deliveries

Post natal Mother& Child care

Newborns breast fed within 1 hour to

total live births

Women discharged in less than 48 hours

of delivery in public instuons to total

no. of deliveries in public instuons

Newborns weighing less than 2.5 kg to

newborns weighed at birth

Newborns visited within 24hrs of homedelivery to total reported home deliveries

Infants 0 to 11 months old who received

Measles vaccine to reported live births

Reproducve Age Group

Post-partum sterilizaon to total female

sterilizaon

Male sterilizaon to total sterilizaon

IUD inserons in public plus private

accredited instuon to all family

planning methods (IUD plus permanent)




IV. Key Findings and Acons

5 major aconable points agreed upon for acon aer block monitoring visit &level at which the

acon is to be taken i.e. facility, block, district or State to be menoned

1

2

3

4

5

Acon taken on last visit report (Date of the last visit)

1

2

3

4

5

Date of preparaon of report:

Signatures of team members:

1.

2.

3.

4.

5.

6.

Guidance Note for Block Monitoring Visits in High Priority Districts

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