MONTHLY RMNCH+A PROGRESS REPORT OF 6 HPDs, J&K …

Monthly RMNCH+A Progress Report of 6 HPDs for the month of June’15 Page | 1

MONTHLY RMNCH+A PROGRESS REPORT OF 6 HPDs, J&K

MONTH OF JUNE’2015


Contents Objective Specific progress: .......................................................................................................................................... 3

Support Required from State Level: ............................................................................................................................. 4

Support Required from District Level: ......................................................................................................................... 4

Other Technical Support at State Level: ....................................................................................................................... 5

Activities plan for the month of July’15: ....................................................................................................................... 5

Supportive Supervision Status for the month of June’15 ............................................................................................. 6

VHND Monitoring Status for the Month of June’15 ...................................................................................................53

Model Delivery Point ....................................................................................................................................................56

Strengthening Review Mechanism ...............................................................................................................................58

Other Support Provided ...............................................................................................................................................60

Support Provided At State Level ..................................................................................................................................62

Some glimpses of district level advocacy done by the District Coordinators ..............................................................66

Recommendation ..........................................................................................................................................................68

Conclusion .....................................................................................................................................................................68


Objective Specific progress: Five major objectives were identified for the year 2015 to strengthen the RMNCH+A activities in Jammu & Kashmir. However technical support provided to state and district in other domain of RMNCH+A strategy. Objective wise a brief progress report has been discussed follows:

1. Supportive Supervision:

2. VHND Strengthening

3. Strengthening review mechanism

4. Strengthening delivery point as Model Delivery Point

5. Support in SPIP and DHAP

Supportive Supervision: As per the GoI mandate Supportive Supervision carried out in all HPDs. 18 facilities were covered in the month of June’15. Three level (L1/L2/L3) of facilities covered during supportive supervision. Availability of common drugs is the major issues at the facility level. In spite of having NBCC inside the labour room, management of ENBC is poor. During supportive supervision the labour room staff oriented on NBCC management. It is good that some facilities started the new standard labour room register and other register. A letter also issued from state level regarding the standardization of different register. Monthly data entry of supportive supervision shared with National RMNCH+A Unit, MoHFW on regular basis.

VHND Strengthening: VHND is a common platform to deliver maximum community outreach programme at doorstep. After regular monitoring and advocacy at district level VHND status has been strengthened but monitoring from block level is also very much essential for quality of service delivery at VHND session. During the month of June’15 a few number of VHND sessions were monitored. All the sites were reviewed as per the standard format and beneficiaries interview were taken to assess the service delivery at VHND session. District Coordinators are providing regular support to district in VHND implementation. It has been decided that VHND micro plan need to be rationalized to improve the service of VHND. Some major changes happened in VHND like ANC started in VHND after regular advocacy Strengthening Review mechanism: For strengthening the review mechanism District Coordinator regular submit their weekly feedback to CMO for their action. Each District Coordinator participate in District level monthly meeting and share their monitoring feedback to all officials. Block monthly meeting also attend by District Coordinator and all the monitoring findings also shared with ANM. District Coordinator sensitized the ANM at block level meeting in different topics. Strengthening Model Delivery Point: Total numbers of 12 delivery point identified from 6 HPDs to strengthen it as a model one. We have implemented the standard labour room register, NBCC register and referral register at 7 delivery points. Other quality parameter like labelling and availability of trays


as per MNH tool kit, duty roster of staff have been ensured. A detailed plan for MDP will be prepared within this month for strengthening the delivery points. Support in DHAP and SPIP: Follow up mechanism of 2015-16 fund released have been developed. Each DC-RMNCH+A will follow up the progress report of fund released. It has been fixed that every quarter a report will be submitted to state regarding the follow up and progress of fund released based on gap analysis.

Support Required from State Level: Timely and regular supply of essential drugs & consumable (IFA, Zinc, Misoprostol, Inj.

Magnesium Sulfate etc.) and equipment Man power planning and rational deployment of skilled manpower Engaged state officials to monitor the quality of district level training and develop a training

monitoring mechanism Special thrust on VHND

Support Required from District Level:

Ensure the quality of SBA, NSSK, IMNCI and other training Rational deployment of SBA trained manpower Ensure joint monitoring of DPM/DMEO/DAM and District Coordinator-RMNCH+A at District

Hospital. Ensure line listing of severe anemic mothers and regular follow up at all levels Orientation of labour room staff on Essential New Born Care Management Ensure 48 hours retention delivered women and compliance of JSSK services Ensure display of “Diet Chart” at prominent places in all delivery points Strengthen the review mechanism of maternal death and establish a standard review mechanism

for CDR at district and block level Ensure involvement District Coordinator in every NHM programme Standardized VHND reporting system and involve district and block ASHA Coordinator in

VHND monitoring Give importance of facility wise feedback shared by District Coordinator-RMNCH+A Programmatic data need to be shared with District Coordinator-RMNCH+A


Other Technical Support at State Level: All RMNCH+A consultant recruited by SHS, NHM oriented on Supportive supervision checklist.

Support in strengthening SNCU at State level. Month wise SNCU data analysis shared with concerned authority for further action and during filed visit special focus also given to SNCU.

Advocacy done at state level for standardization of different register as per MNH tool kit and as a result an order from MD, NHM issued to all district to implement the standard register as per MNH Tool kit.

Advocacy done at state level for specification of Labour Room Protocol poster and other standard protocol. A list of for standard protocol prepared and shared with state for implementation. Based on our advocacy a letter issued form MD, NHM to all district regarding to follow the standard protocol.

Support Provided to Strengthen the Child Death Review: After discussion with DNO, Kashmir, we have prepared the standard line listing and reporting format as per guideline of Child Death Review. The formats were shared with DNO, Kashmir for further action and implementation at district level.

An analytical report submitted to state on RI and Family planning.

Activities plan for the month of July’15:

Two district level RMNCH+A review meetings Preparation of district VHND micro plan at least in two districts Special focus on waste management at district level Supportive supervision in 2 HPDs Monitoring of Mission Indradhanush Support in SNCU strengthening Support in maternal death review and child death review


Supportive Supervision Status for the month of June’15 Total number of 18 facilities were visited for supportive supervision in the month of June’15. Three level (L1/L2/L3) of facilities covered during the supportive supervision visit.

Kishtwar Doda Rajouri Poonch Leh SHC Pochaal SDH Bhaderwah PHC Manjakote DH Poonch DH Leh SHC Sigdi CHC Gandoh CHC Kandi PHC Ajoate PHC Afti DH Doda SC Tatpani CHC Marwah PHC Gundana PHC Keruu SC Bhaja Charialla DH Kishtwar PHC Chatroo

District Wise Major Findings of different facilities:

DISTRICT KISHTWAR

SC Sigdi:

Brief profile of SHC-Sigdi: The facility SHC-Sigdi is approximately 70 Kms away from DH Qtrs.-Kishtwar. The catchment population of the facility is 6000 approximately.7 ASHAs catering the facility.

Service delivery status of District Hospital for the month of May’15:

Drugs/ supplies availability:

IUCD 380A is available. Inj. Oxytocin Tab.Misoprostol, anti-hypertensive, Inj. Magsulf are not available Sterile pads and IFA tablets are not available in the facility. Zinc tablets (10mg & 20mg) are not available in the facility. The toilet is not attached in the Labour Room instead the toilet is near and non-availability of

24x7 water supply. Mucous extractor and clean linen/towels for receiving new born are not available. Color coded bins and bags are not available in the facility, thus the segregation is not being done. MCP Cards are available.

Delivery Live birth Birth dose vaccination Referral IPD OPD IUCD

06 06 06 n/a 06 526 0


The stabilizer of the ILR available was non-functional and the ILR was connected directly to the power supply.

Status of ANC:

6 mothers were registered in the month of May and out of which only 3 are registered within 1st trimester. Only 3 mothers received 3 ANC during the month.

IFA tablets are not available Line listing of severely anemic PW’s is not maintained

LR status:

Standard protocols for cleaning are not being followed because of lack of availability of 24x7 water supply.

There is no designated hand washing area and soap. All registers like Standard Labour Room Register, referral out/in registers as per protocols are not

being followed. Protocol posters are not available in the Labour Room. Two trays were available but they were not properly filled with the essential drugs and supplies.

Newborn care management:

NBCC is not available in the Labour Room. Bag and mask is not available. Sterile cord cutting clamp is also not available.

INC status:

Partograph is not being maintained.

PNC Status:

All the Mothers are not staying 48 hours after delivery Counseling on Family planning, breast feeding are being followed

Referral system of the facility:

The referral is being done on call basis and referral is being provided from the Block head Quarter. Laboratory test of PW: No tests are being conducted in the facility for PW’s in the facility, not even the Hemoglobin.


PHC Afti:

PHC Afti is 24X7 PHC though there is no provision of institutional delivery covering near about 2500 population scattered in 5 villages. There are 3 SCs and 1 NTSC under this PHC. Nearest referral is PHC Larnoo which is 72 km away from the facility though CHC Marwah is only 42 kms but due to poor road condition no one prefer to go there. 15 ASHAs are working under this PHC.

Services provided: OPD, IPD, Vaccination and diagnostics

Infrastructure:

The PHC is functioning in old building though the new building already constructed but handover is pending.

There is no water supply facility at this PHC There is no provision of toilet as a result diagnostic tests specially urine test of PW is a major

problem PHC has no connection of electricity though they have 5 kb gen set for power supply Only 3 beds are currently functional There is no quarter for Medical officer and other staff

Manpower and Training:

HR Permissible In position Remarks

MO 4 1 (ISM) 2 Medical officer attached one at DH Kishtwar and another one at SHS, Sringara( recently detached)

Jr. SN 2 2 One attached to NTPHC Inshan

Pharmacist 2 1 Only ISM pharmacist from NHM is available where as another Supervisor pharmacist from regular side is attached to NTPHC Inshan

MFMPHW 1 1 Absconding from 15th May 2013. She is from regular side

LT 1 1 Health Educator 1 1 PTS (from HDF) - 1 NO 3 2 from regular side Safaiwala 2 1

Lab Technician, Jr.SN and ISM Pharmacist found absent on the date of visit


Labour room status:

Labour room is well equipped with required equipment One labor table is available with foot rest is available Suction machine is available and functional One phototherapy unit is kept inside the labour room but

there is no radiant Warmer All protocol posters were available

Major constrains for delivery: Water supply Electricity Non availability of SBA trained personnel Toilet availability Poor road connection

25000/- was given to Block Development Officer in 2013 for minor repairing of the community hall to make it a delivery point nearest to the community but the community hall is being used by the army people now.

Laboratory test:

Functional laboratory is available at the facility Lab Technician was absent at the time of visit None of the laboratory register was available at the time of

visit Urine test is a major problem at this facility due to non-

availability of water and toilet Basic tests are being conducted at this facility

Indoor:

3 functional beds are available at the facility Major cause of emergency admission at this facility are diarrhea, vomiting, RTI and UTI

Drug Store room:

Separate drug store room is available


Arrangement of the drugs are satisfactory though none of the record was available at the facility at the time of visit

BCG syringe found expired at drug store 39 cartons of sanitary napkins were available at the

PHC

ANC and Immunization Status:

As per the HMIS report 2015-16 only 4 women were registered for ANC and none of them registered with 1st trimester

None of the mother received 3 ANC 4 mother received 100 IFA There is no status of IUCD 12 infants received BCG up to May’15 Only 5 infants received Measles 1st dose There is no status of Vit-A

Record Keeping:

Non-availability of documents like MCTS Register, HMIS Reports, ANC Register and Immunization Registers.

Non-availability of financial Records like RKS cash Books, RKS Minutes of meeting, JSY, JSSK cash Books.

Non-availability of Stock Register, Drug Register, Asset/Dead stock Register.

Community visit:

Maximum number of home deliveries Interviewed 5 mothers regarding Immunization and ANC service Poor immunization status at the community None of the mother completed full ANC Community awareness is very poor regarding institutional delivery, immunization and family

planning No follow up drop out mother and child

Referral Mechanism:

One functional ambulance with driver is available at the facility Only one mother , namely-Ms.Afroza w/0 Mr.Shabir Ahmad R/O Margi have been referred to

PHC-Larnoo on dated : 23-08-14 and the amount of Rs.2500/= for the referral transport have been beard by Dr. Haqnawaz Kichloo MOIC ,from his own pocket and He didn’t got the money back.

Facility didn’t receive any fund for referral transport in 2014-15


Community people or mothers are not aware about the JSSK scheme

Recommendation:

Ensure the availability of attached staff to PHC Afti to make it a functional 24X7 PHC and functional delivery point.

Ensure availability of SBA trained SN One lady doctor is very much essential to ensure the institutional delivery Provision of toilet and water supply is very much essential to start delivery Regular monitoring from block and district level Strengthening of referral mechanism Immunization camp at the community to cover the dropout and left out Follow up and tracking mechanism for pregnant, postnatal mother and child Ensure all types of registers should available at facility ASHA need to be more proactive to create awareness among the community for institutional

delivery and Immunization Regular RKS meeting need to be conducted

Few glimpses of PHC Afti……………….


Major Findings of CHC Marwah

CHC Marwah is a designated FRU under the Dachhan block caters 14500 population scattered in 5 SCs, 2 Ads, 2 NTPHCs and 1 NTSC. The road connection is very poor at Marwah. There is no provision of electricity and network communication at this facility. During winter the road become block for 6 months.

Infrastructure:

CHC is functioning in old and very congested building and only 3 beds are there

Only one quarter is available at the facility 24*7 water facility is available at the facility There is no provision of electricity at the facility but under “Sat Bhavna Scheme” of army they

have provided generator set for this facility The road communication is very poor There is no such standard waste management mechanism for this facility

Manpower Status:

Manpower Status from Regular Side HR Sanctioned Posted Remarks Medical Officer 2 0 Dental Surgeon 1 0 CHO 1 0 Health Educator 1 0 Head Pharmacist 1 0 Sup. Pharmacist 1 1 Attached at PHC Dachhan Jr. Grade Nurse 1 0

FMPHW 2 2 0ne attached at PHC Atholi and one at PHC Dachhan and both are SBA trained

Jr. Dental Tech. 1 0 Sr. Assistant 2 1 Nursing Orderlies 4 2 One attached at PHC Dachhan LHV 1 1 Attached at PHC Dachhan


Manpower Status from NHM Side HR Sanctioned Posted Remarks

MO (MBBS) 2 2 one attached at DH Kishtwar Jr. SN 2 2 ( one available) 1 attached at PHC Dachhan LT 2 2 ( one available) 1 attached at PHC Dachhan

OT Tech 2 2 There is no status of 1 OT Tech since April'15

X-Ray 2 2

PTS 4

Maximum number of staff is attached to another facility and services are being hampered at CHC Marwah due to this reason. Delivery is being conducted by the Sr. Pharmacist. One MO from RBSK is doing OPD.

Labour Room:

Labour room found clean and well maintained One labour table is available in the labour room Attached toilet is available with labour room All protocol posters are available inside the labour room but not in specific place Eg. Breast

feeding protocol posters was displayed over the hand washing place and hand washing protocol displayed elsewhere

Medicine tray, emergency tray, delivery tray, baby trays were welly labelled NBCC is in place but not is use Basinet of the RW is not clean and RW is not properly

maintained One phototherapy unit is there but not in use. One oxygen concentrator provided by the army under

‘Sat Bhavna Scheme” available inside of the labour room

Designated hand washing place is available in the labour room

Color coded bins are available but only black plastic bag is available Inj. Oxytocin, Inj. Magsulph was available but oxytocin kept in trays. Foetal Doppler and autoclave is available Adult and newborn weighing machine both are available


Laboratory Test:

All diagnostic tests are free for pregnant women Outcome of laboratory test result not mentioned in the laboratory register

ANC Status:

ANC clinic has been established in X-ray room 36 mothers are registered up to May’15, out of which only 3 mothers have received 3ANC. ANM has poor knowledge on ANC and high risk pregnancy There is no list of high risk pregnancy with the ANM There is no tracking mechanism of PW Due list is neither prepared by ANM or by ASHA

Services April May Total ANC Registration 16 20 36 1st Trim. Registration 7 20 27 3 ANC 14 24 38 Number of pregnant women given 100 IFA tablets 16 20 36

Number of mother severe anemia (Hb<7) 0 0 0 Live Birth 14 22 36 Still Birth 2 2 4 IUCD 0 0 0

Immunization

ANM doesn’t have clear idea about birth dose vaccination. Hepatitis birth dose vaccination given after one month No follow up or tracking mechanism There is provision of due list preparation by ANM or ASHA

Equipment received under “Sath Bhavna Scheme” of Army:

1. Generator set 2. Oxygen Concentrator 3. X-Ray machine 4. ECG Machine


Immunization service delivery of Marwah CHC up to May’15

Vaccination April May Total BCG 12 22 34 Pentavalent 1 3 11 14 Pentavalent 2 1 8 9 Pentavalent 3 2 16 18 OPV 0 (Birth Dose) 12 22 34 OPV1 3 11 14 OPV2 1 8 9 OPV3 2 12 14 Hepatitis-B0 12 22 34 Measles 6 5 11

Family planning:

Family planning service is very poor There is no status of IUCD insertion since Aprill’15 Only OCP and condoms are distributed Community awareness is very poor

ASHA:

10 ASHAs were interviewed regarding their functionality and home based newborn care

None of the ASHAs are well aware about the assured incentives and other incentives None of the ASHA received HBNC kit ASHAs have not clear idea about the home based new born care Drop out list is not prepared by any ASHA Pending liabilities of ASHA Incentives. Last meeting with ASHA was conducted by BM&EO, Dachhan

MCTS

Incomplete MCTS Register, maintained up to 20-01-15 and non-availability of HMIS Reports.

JSSK: Diagnostic tests are free for pregnant women Las year (2014-15) an amount of Rs. 30000 was received with an opening balance of Rs. 13130. Balance as on 1st April was 1041. Whole fund was utilized in dietary provision of post mother. There is no diet chart at this facility Since April’15 none of the mother received diet under JSSK scheme


JSY:

In 2014-15 170 mothers were benefitted under JSY scheme Total amount of 2 lakhs was received in 2014-15 with an opening balance of Rs. 73890.0 Rs. 50400.0 was paid to ASHA under JSY scheme Balance as on 1st April was Rs 40738 None of the mother received JSY payment from April’15

Recommendation for better service delivery:

All attached staffs need to be detached for the benefit of the community and better service delivery Ensure that deliveries are being conducted by the SBA trained staff nurse. MO of RBSK should be in the field Training ANM on Immunization and cold chain management Block and district level follow up

Major Findings at PHC Keruu

PHC Keruu under Kishtwar block catering near about 15000 population with an average delivery load of 10-12 per month. Average OPD is near about 300 and IPD 20 per month.

Manpower:

HR In position Remarks MO 1 MBBS MO 2 ISM Dental Technician 1 Regular Jr.SN 2 NHM LT 2 ( 1NHM) Pharmacist 1 1 ISM/NHM Sr. Pharmacist 1 Regular FMPHW 1 Regular

During conversation with community it was came to know that none of the volunteer in IPPI 2nd round received the honorarium but acquaintance has been prepared at block level. As per the statement given by local people, the red account found was not having the Signatures of the booth workers and supervisors and their signatures were forgery done.


Staff Attendance:

The Attendance Register for the staff of NHM was maintained from May’15 instead of April’15. As per the attendance register one MO namely Dr. Anuradha-MBBS, is on Casual Leave with

effect from 01-05-2015 to 06-05-2015 and Absent from 07-05-2015 to 11-05-2015 , then again casual Leave from 12-05-15 to 14-05-15 , then on leave from 10-05-15 to 17-06-15 and then no attendance marked from 18-06-15 to 20-06-15.

Labour room:

Labour room was very unorganized and unclean One labour table is available Mackintosh of the labour table was full with blood strains Only two trays were available one is for drugs and another is for delivery set, but none of the trays

were labelled Oxygen cylinder was available but without key NBCC is there but none of SNs are well aware about the RW handling RW basinet was not clean One sterilizer was available Labour room floor was very dirty


A team work for labour room transformation:


Team work……………


Present Status of Labour Room………..


ANC:

28 mothers were registered for ANC up to May’15 and none of the mother registered within 1st trimester

28 mothers received 100 IFA, ANM giving 100 IFA at a time to all pregnant women but there is no follow up of pregnant women As per the register available with ANM none of the mother received 3 ANC but as per HMIS

report its shows that 9 mothers were received ANC 3. In spite of having Hb% testing facility ANM didn’t mention the Hb% status in ANC register There is no tracking mechanism of PW Line listing of high risk mothers not followed MCTS Register, HMIS report and village register were unavailable at the time of visit

Immunization and cold chain:

ANM kept lots of vaccine vial in vaccine carrier though she has not any due list of beneficiaries with her

Frozen Pentavalent vaccine found at vaccine carrier ANM has not clear idea about vaccination and cold chain

management There is drop out tracking mechanism One ILR and one DF available at the facility There is no practice of temperature recording None of the vaccines kept in ILR ANM kept all vaccines in domestic refrigerator available

inside the laboratory

Laboratory:

Functional laboratory available at the facility with 1 Lab Technician Lab register was unavailable at the time of visit and as per the MOIC it was send to block Kishtwar

for reporting Basic test like Hb%, urine, blood grouping are conducting here All diagnostic tests are free

Financial status:

As per the JSY Cash Book 2014-15, the funds available found were 15, 8980 up to 31-03-15, thus the cash book found was not maintained.

RKS funds found available up to 31-03-15 amount of Rs.43342 and cash book was not maintained for the year 2015-16.


Major Findings at District Hospital Kishtwar

Service delivery:

Service Delivery April May Total ANC Registration 23 31 54 ANC Registration within 1st trimester 5 7 12 Women registered under Janani Suraksha Yojana 23 31 54 3 ANC 56 30 86 TT1 21 25 46 TT2 or Booster 45 33 78 Deliveries conducted at the facility (Including C-Sections) 165 276 441 C -Section 50 67 117 Number discharged under 48 hours of delivery 115 209 324 Live Birth 164 261 425 Still Birth 5 15 20 Number of Newborns weighed at birth 169 276 445 Number of Newborns having weight less than 2.5 kg 3 2 5 Number of newborns breast fed within 1 hour of birth 164 261 425 Pregnant women with Obstetric Complications 67 67 134

Labour room:

Labour room has enough space but unorganized On an average 6-7 deliveries are being conducted 4 labour tables are available but none of the labour table has

mackintosh There is no partition in between the labour table, a curtain kept back

of the labour table 24*7 running water supply and attached toilet are available Color coded bins are available but the on duty staff has no clear idea

about the color coding of waste bins Partograph is not in practice Only two trays are available Standard labour room register is not being followed, existing OPD register is being used as delivery

register NBCC is in place, two RW is available inside the labour room and one is non functional SNs have not clear idea about the Essential New Born Care Management


Radiant Warmer basinet was not clean and bandage, gauze and medicine found below the bassinet towel

Post Natal Ward:

6 mothers were interviewed to assess the post natal care service

Diet is being provided to all mothers Counseling on early initiation of breastfeeding is poor JSSK is not implemented properly Some of the mothers purchased medicine and consumable from outside Referral is not being provided to all, some of the mothers came with their own vehicle or hired

vehicle Birth dose vaccination is provided

Referral Mechanism:

11 ambulances are functional but only 5 drivers are available As per the MS there is no such maintenance fund for the vehicle and it is very difficult to maintain

the ambulance. He received an amount of 10 lakhs from MLA and out of which 3.5 lakhs was utilized for replacement of tier. Generally maintenance cost is utilized from HDF.

Laboratory service:

All tests and diagnostics are free for pregnant women and senior citizen Test wise user fees are charged for general patient

USG, ECG, X-ray and CT scan facility:

Functional USG unit and CT Scan units are available at the facility User charge for general patients is 100 Rs On an average USG load per moth is 600 ECG and X-ray charge for general patient is Rs. 50, but there is a problem of supply of films.

HDF funds are utilized for purchasing the films

Blood Bank:

Functional blood bank is available with an storage limit of 40 units Renewal of license is pending 2 functional blood storage refrigerators are available with proper labelling of blood group Blood collection unit is clean and well maintained

RW Basinet at LR


During the month of May 31 mothers received blood and 1 infant

Waste Management:

There is no such standard waste management mechanism. As per the MS waste pits are full and they made a waste storage dump shade in the hospital premises. Every Sunday Municipal Corporation collect the waste from hospital. The cost of the P Oil borne by the hospital.

JSSK Status:

JSSK Status April-May'15 April May Total No. of Pregnant Women given Drugs and consumables for Normal Deliveries 108 184 292 C-Section 26 32 58 No. of Pregnant Women provided free Diagnostics 345 415 760 Blood transfusion 1 19 20 No.of Pregnant Women provided diet for during Normal Deliveries 108 184 292 C-Section 26 32 58 During stay of sick children 0 No. of Pregnant Women given free referral transport from Home to facility 0 Drop back facility 37 57 94 Referral to higher facility 3 5 8

No. of Sick Neonates provided Drugs and consumable 28 48 76

No. of Sick Neonates given free referral transport from Home to facility 0 Drop back facility 2 3 5 Referral to higher facility 3 3

Out of 350 deliveries only 94 mothers received drop back facilities 8 mothers were referred to higher facilities 3 infant referred to higher facility till date


JSSK Financial Status 2014-15

Janani Shishu Suraksha Karyakram(JSSK)

Opening Balance as on 1st

April'2014

Fund Received in 2014-

15

Total fund for the year 2014-15

Expenditure Balance

as on 1.04.15

Drugs and Consumables for Normal Deliveries including ANC,INC & PNC 555573 3194699 3750272 3719242 31030

Drugs and Consumables for Caesarean Deliveries including ANC,INC & PNC 0 0 0 0 0

Diagnostic including ANC,INC & PNC 45226 300000 345226 334274 10952 Blood Transfusion 5000 5000 0 5000 Diet (3 days for Normal Delivery) 87500 409600 497100 497100 0 Diet (7 days for Caesarean) 65550 285000 350550 350550 0 Referral Transport for Pregnant women Home to facility 229 110000 110229 110229 0 Drop Back facility 31917 210251 242168 242168 0 Facility to Higher Facility 17116 240000 257116 257116 0

Sub Total JSSK 803111 4754550 5557661 5510679 46982

JSSK Financial Status 2014-15

Janani Shishu Suraksha Karyakram (JSSK) - (for Sick neonates & infants up

to 1 yr.)

Opening Balance as

on 1st April'2014

Fund Received in 2014-

15

Total fund for the

year 2014-

15

Expenditure Balance

as on 1.04.15

Drugs & Consumables for Infants 8000 8000 8000 0 Diagnostics 5952 5000 10952 10724 228

Free Referral Transport for Pick up and Drop Back Home 39547 10000 49547 49547 0

Iron Sucrose intervention 5000 5000 5000 0 Total 45499 28000 73499 73271 228


JSY Status:

Janani Suraksha Yojana / JSY 2014-15

Opening Balance as

on 1st April'2014

Fund Received in 2014-15

Total fund for the year 2014-15

Expenditure Balance

as on 1.04.15

Incentives to Mothers (Institutional Delivery) Rural

450600 2401200 2851800 2851800 0

Incentives to Mothers (Institutional Delivery) Urban

30000 101000 131000 131000 0

Performance Related incentive to ASHAs under JSY

5096 17800 106210 129106 122793 6313

Total 485696 2520000 106210 3111906 3105593 6313

Financial Status:

No cash books of JSSK, JSY & RKS were produced for verification by the concerned staff. As the post for District Hospital Accounts Manager is vacant so the work has been given to

ARSH data entry operator. Drug register under JSSK found incomplete only MRD NO and contact no is mentioned there,

no other details for verification is given. Expenditure for current financial year is nil.


SNCU:

Functional 10 bedded SNCU is available at DH One pediatric, One SNCU in-Charge, 4 Medical Officers

and 5 SNs are designated for SNCU At the time of visit Paediatric and SNCU in charge was

present Basinet of the RW was not clean SNCU Sister in charge has not clear idea about RW handling There is no standard register for SNCU SNCU reporting system is poor, major portion like delivery, CS and birth weight are missing in

the report available with SNCU in Charge Maximum duration stay at SNCU is 1-2 days There is no systematic follow up system of SNCU discharge babies, those who are coming at their

own received the follow up

Service delivery:

Admissions in the unit

April May Total

Inborn Out born Inborn Out born Inborn Out born

Male 18 3 25 5 43 8

Female 6 1 14 4 20 5

Total 24 4 39 9 63 13

Since April’15 76 newborns are admitted in SNCU Out born admissions are very low

Cause of admission:

Sepsis Pneumonia Respiratory distress Hypothermia

RW basinet at SNCU


Outcome:

Outcomes April-May'15 April May Total

Discharge 25 43 68

Referral 1 3 4

Left against medical advice (LAMA) 0 1 1

Died 2 1 3

Other findings:

Basic requirements like shoe caps, head caps, hand sanitizer etc. are not available. Operational cost of an amount of 5 lakhs received in 2014-15 and as per the FMR 5 lakhs have

been utilized.

Major recommendation for better service delivery:

Staff need to be more cooperative, basic record need to be shared and discussed with the monitoring officials during their visit

Orientation of SNCU sister in charge on NSSK is very much essential Labour room staff nurse need to be oriented on ENBC

89.5

5.3

1.33.9

Outcomes of SNCU Admission Babies

Discharge Referral Left against medical advice (LAMA) Died


Proper cleanliness of labour room is very much essential Ensure availability of fund of different programme like JSY, JSSK etc. Basic supplies for need to be assured from MS level Standard labour room register need to be implemented for proper recording Labour room protocol need to be followed by the staff nurse Monthly monitoring of DPMU staff is very much essential to monitor the progress of ongoing

NHM scheme.

PHC Chatroo:

The facility PHC-Chatroo is approximately 35 Kms away from the DH Qtrs.-Kishtwar. The catchment population of the facility is 5050 .The bed capacity of this facility is 10. The number of ASHA’s catering the block are 56. Recently PHC-Chatroo got the Power Back up. There is no regular water supply in the facility however managed by the facility by storing it.


IUCD 380A is available. Sterile pads and IFA tablets are also short in Supply. Partograph is not being used. Zinc tablets (10mg & 20mg) are not available in the facility. There was no status of WIFS available in the facility. Color coded bins and bags are not available all around the facility or in different sections.

Status of ANC:

The total ANC Registration of the facility for the month is 29, out of which 11 have been registered within 12

IFA tablets are being provided to the mother. Line listing of severely anemic PW’s is being followed.

LR status:

All such registers like Standard Labour Room Register, referral out/in registers as per protocols are not being followed.

Protocol posters are very well displayed in the LR. Trays are not maintained as per the protocols. Hand washing area is designated but is without long handled tap.


NBCC is available but shoulder roll and thermometer are not available. RW base and probe is not clean.


INC status:


PNC Status:

All the Mothers are not staying for 48 hours after delivery Free diet is being provided according to the diet chart. Counseling on Family planning, breast feeding are being followed.


There are 2 Ambulances available which are providing referral services. Status of laboratory (especially lab test of PW): All essential tests are being done in the facility for PW’s. Separate documentation is done for ANC PW’s. Tests like Hepatitis B and HIV are not being done because of non-availability of Kits. In last month total of 169 tests have been done.

Vaccination and cold chain status:

ILR and Deep freezer is available at the facility. Temperature of vaccines are being monitored and maintained. The health worker who was handling the cold chain was well aware about the mechanism.

JSSK status (referral, drugs and diet):

As per the in charge free referral, free diet and free drugs are being provided by the facility but couldn’t check the registers.

JSY Status:

All the benefits under JSY Entitlements are being provided.

VHND status of the block:

As BMEO was not available in the facility, had gone for registration of disposal pit, so couldn’t get the micro plan of VHND, but as per the in charge VHNDs are going on.

Family planning status:

The family planning status in overall district is very poor and as per the last month HMIS data the facility has not done even a single IUD insertion, after enquiring the reason from the in charge, he


said people are not getting motivated but we are trying our level best and for that we are also planning to organize the camps very soon.

Family planning counselling is being done.

Maternal and child death review status of the facility:

As per the in charge no maternal and child death has occurred during the current year.

Status of different IEC:

IEC material is very well displayed around the facility.

Waste Management status:

The waste management disposal pit is now in place and they have also filed the requisition for the registration to the concerned department.

DISTRICT DODA

SDH Bhaderwah:

Reproductive Health:

Presently there is no stock of IUCD 380A at the facility. Hence the overall rate of IUCD insertion at SDH Bhaderwah is very low.

There is no PPIUCD insertion done at SDH Bhaderwah, because staff is not yet trained. There is no comprehensive abortion care and sterilization services available. The family planning counselling is done during ANC visits and after delivery.

Newborn Health:

The vitamin K1 injection is not available due to no funds. The Resuscitation kit is available but not functional although the staff of labour room has been

given NSSK training recently at DH Doda but still they are not able to do resuscitation. The clean and sterile towels are available in labour room. The NBCC is available inside labour room. The zero dose vaccine to all newborns in this facility and record is also maintained properly. The 340 HBNC kits are distributed to ASHAs.


Maternal Health:

There is stock out of essential commodities like oxytocin, IFA and other essential medicines. The Partograph is not being plotted. There is no Gynecologist posted hence no caesarian at SDH Bhaderwah nor the Blood storage is

functional.

Child Health:

The ORS is available in the stock. Zinc tablets are stock out from last 2 years. The Albendazole syrup is available but tablets are out of stock.

Adolescent Health:

There is no ARSH clinic in the CHC as yet where as it is sanctioned under NHM. The WIFS tablets are available. The Dicyclomine is out of stock. The Menstrual hygiene scheme is in functional and sanitary napkins under brand name “free

days” distributed among Adolescent girls. Antibiotics:

The Antibiotics as per RMNCH+A matrix are out of stock only Amoxicillin, Metronidazole is available

Vaccines:

All the vaccines are available and are stored as per cold chain protocols and temperature is also recorded twice in a day.

The zero dose vaccines are given to newborns. The MCP cards are available and card is given to pregnant women and counterfoil is kept in tickler

box at MCH section.

Other essential supplies and equipment’s:

The weighing machine, BP apparatus and stethoscope, Thermometer etc. are available and functional.

The hub cutter and needle destroyer is available and functional. There is no RTI and STI kit available. The Oxygen is available and functional. The boiler is available in labour room and after every delivery the instruments are sterilized. The color coded bins are available but bags are out of stock. The electricity backup is available in facility. The toilet is attached to labour room and is cleaned regularly.


ANC Care:

During ANC essential tests such as BP, HB, Blood glucose and urine albumin is measured. Beneficiaries are counselled on family planning, childcare, nutrition and personal hygiene.

Intra-partum and immediate postpartum care:

Fetal heart rate is measured by Medical officer in charge of labour room. Mothers BP and temperature is recorded at time of admission. The skin to skin contact is practiced also early initiation of breastfeeding are initiated at the facility

level. The privacy during delivery is maintained. The transport facility of drop back is not given as there are no JSSK fund available. No free diet is given to mothers because of no JSSK funds. During ANC checkups and after delivery mothers are counselled about exclusive breastfeeding.

During community assessment visits I interviewed mothers and they told me they are the exclusive breastfeeding and complementary feeding.

Misoprostol have not been started as yet.

ASHA:

There are 500 ASHAs in district Doda only 340 ASHA have been given Module 5 and 6 training and remaining 160 ASHAs will be given module 5 and 6 training shortly.

The ASHAs are distributing contraceptives door to door and they are maintaining record of contraceptives distributed.

The ASHAs also tell Adolescent girls how to use it and also how to dispose it.

VHNDs:

The VHNDs are done every week on a fixed day at AWC as per micro plan submitted by ANMs but no Vaccination is done on VHNDs. It is also observed that growth monitoring is also not maintained.

RBSK:

The RBSK is operational and there are two teams in every block.

Funds:

Funds are not available for all most 6 months for schemes like JSY and JSSK. Hence beneficiaries are neither paid not given free services under schemes.


Name of the Site: PHC Gundana Block: Ghat

The PHC gundana is around 50 km from DH Doda. The road connectivity is very bad and remains cut off from rest of district during winters and rains. The condition of building is not good and needs urgent attention. There is no electricity backup and the electricity of region is very sporadic. There is no 102 or any ambulance at PHC Gundana. The PHC caters almost 12000 population. There are 4 doctors, of which one female doctor is SBA and NSSK trained. IEC display in labour room is not as per the protocol. On an average 5-6 deliveries are conducted per month.


There are no stock of IUCD 380A at facility. In last month no IUCD inserted.

Newborn Health:

The vitamin K1 injection is not available as there are no JSSK and other funds to purchase medicines.

The Resuscitation kit is not available in labour room. There is no ENBC in labour room but it is proposed in supplementary PIP 2015. There is no zero dose vaccine because there is no ILR functional from last three years. Mucous extractor is not functional

Maternal Health:

There is stock out of essential commodities like oxytocin and other essential medicines. The partograph is not being plotted. There is no skilled obstetric care available. The condition of labour room is very bad. There is no boiler in labour room and equipment’s are not sterilized properly. There are no color

coded bins and drug store room attached to labor room. There is no toiler attached to labour room. The boiler is not available in labour room.

Child Health:

The ORS is available in the stock but zinc tablets are stock out from last 2 years. The Albendazole syrup is also out of stock

Adolescent Health:

The sanitary napkins are distributed to adolescent girls at SHCs but Albendazole and Dicyclomine is not available

Antibiotics

The Antibiotics as per RMNCH+A matrix are out of stock only Amoxicillin, Metronidazole is available


Vaccines:

There vaccination is done once in a month on fixed day 15 because there is no cold chain point.

Other essential supplies and equipment’s:

The weighing machine is available and functional and weight of every PWs is recorded. The hub cutter and needle destroyer is available and functional. There is no RTI and STI kit available. The Oxygen cylinder is not available. The BP apparatus and stethoscope is available and BP of every PWs is measured during ANCs

and before and after delivery. The Thermometer is available and temperature of every PWs is recorded. The counter foil of MCP card is not kept at Facility

ANC Care:

During ANC BP, HB, Blood glucose and urine albumin is measured. Family planning, personal hygiene, childcare & nutrition etc. counselling of beneficiaries,

mothers is not done.

Intrapartum and Immediate postpartum care:

Fetal heart rate is measured. Partograph is not being plotted. Oxytocin is given to mothers after delivery of baby. Early initiation of breastfeeding is practiced and breastfeeding is started within one hour. The practice of skin to skin contact is not practiced. The family planning counselling is not done. The zero dose vaccine is not given to newborns. The privacy during delivery is not maintained. The transport facility, free diet is not given as there are no JSSK fund available. During ANC checkups and after delivery mothers are not counselled about exclusive

breastfeeding. There are no curtains available in labour room.


CHC Gandoh

Gandoh is a designated FRU presently functional in old building having 20 beds and there is no moterable road up to the main gate of the facility. The present building is in two parts of which one building has LR, ultrasound, Female ward, Dental OPD, OT , laboratory, X –Ray , SNCU and Office Block, and second has general ward , meeting hall etc. however there is no direct approach in between the two buildings. However building is centrally located in the town.

Here to mention that new building having 100 bed capacity is under construction which may take another one to get complete.

New Building under construction Old Building

Supportive Supervision checklist was used to assess the status of the facility and some of the major findings are as follows –

Reproductive Health –

Spacing method items like IUCD 375 and ECP is not available in the facility. Also Mifepriston+Misoprostal (MMA) and MVA kit / EVA is not available.

Staff was requested to prepare a tray having OCP and Condom and keep it on the table so that beneficiaries would know the availability.

It is also observed that there is knowledge deficiency in the staff regarding Mala – N and its method of consumption which is vital during counselling.

There is no fixed day sterilization camps are planned. None of the staff are trained in PPIUCD. Postpartum Sterilization and postpartum IUCD insertion

services are not available.


Maternal Health -

Two essential drugs mentioned in the List of minimum Essential Commodities under 5x5 matrix namely Methyldopa/ labetalol or Nifedipine and Inj. Magnesium Sulfate is not available in the facility.

Partograph is neither in practice. HIV Screening kit is also not available in the facility. Privacy is maintained in LR as curtains are placed on the main gate and windows. BP and

statoscope are neither in the LR nor at ANC room. Toilet is not attached to the LR but mother ward only. There are two labour table placed in the LR however much more efforts are needed to maintain

cleanliness there. And does not have Kelley’s pad, Spot lamp, Additional delivery kit, BP instrument for LR.

Trays are not available as per the level of facility here at least 6 trays needs to be kept and maintained.

Protocols are displayed in the LR however not as per the mandate of FRU. Mgmt. of PPH, Eclampsia , Pre – Eclampsia , labour Room Sterilization are placed in the LR however Vaginal Bleeding , Antepartum Haemorrhage are kept in the maternal Ward and no protocols of Breastfeeding and kangaroo care in the mothers ward displayed.

So many tables (other than Labour Tables) and 4 Hub cutter were kept in the LR which are not required.

Oxygen Cylinder is available in the LR but Flow meter is not in adequate quantity, only one is available in the LR. And Cylinders are sent to Jammu for refilling by the Facility which is time consuming and very costly also. There is no provision of vehicle/ POL for the transportation of consumables hence Ambulance is used.

JSSK and JSY is not fully operational due to unavailability of funds. However food and some of the available drugs are provided to beneficiaries.

Stay after delivery for 48 hr is very low.

Protocols display Poor sanitary practices in labour table


Good Practices in LR Shoe rack with slippers are kept and SN resist entry with self-shoes. Some of the very essential medicines are made available through Donation. 3 of the SN are trained in the SBA and conducting deliveries. Ultra Sound is conducted in the facility by the Dr. Hamid BMO / Surgeon. PNC Register, Standardized Labour Room Register and NBCC register is maintained.

Major Concern Antibiotics such as Ampicillin, Gentamicin, and Metronidazole are not available from year 2010.

New Born Care and Child Health –

In terms of availability Inj. Vit. K1 is not available instead K3 is available, ORS, Zinc (10mg and 20mg), Vit. A , Syp. Salbutamol and albendazole is not available. Fetoscope / Doppler not available.

Radiant wormer is not functional as its sensor is not intact and one size Mask is also not available. SNCUs equipment’s are made available however it is not functional due to lack of dedicated staff. ILR and DF are functional and vaccines are kept however record of ILR is neither maintained in

the prescribed format (Break down time is not recorded) nor any protocol is displayed in there. Data of early initiation of breast feeding is quite discouraging. Out of 151 deliveries in the facility

in this year just 55 (36.4%) new born were early breast fad.

RW Sensor is not attached Cold Chain room and displays


Cold Chain (ILR) Break down time not captured

Adolescent Health –

There is no AFHC Sanctioned for the facility and BMO is not aware of WIFS program as it is directly implemented by the CMO office.

Bi Medical Waste Management and infection prevention practices –

Bleaching power is not available, Autoclave/ Boiler is kept only in OT. Color coded bins and bags are available however bags and bins are not of same size which is

supplied by the DHS- J. None of the staff is trained in the BMW however BMO provided in house training in monthly

meeting. Segregation at source, sterilization protocols are not followed, however open deep burial pit is

there but not as per the specific design. Sharp pit is not available at the facility. Only one colored bags are available and used.


Laboratory Bin has yellow bag All the bins has blue bags

Deep Burial pit having all the waste in to it

Blood Storage unit –

All though blood storage fridge is available but not functional and it is kept in the laboratory. Hence it is a non-Functional FRU presently. As post of Gynecologist, Pediatrician are also vacant. Hence no C- section also.

Moreover mother Blood Bank at District hospital Doda is also not having license since 2012.

Here to mention that due to its hard to reach location it is very essential to make blood storage unit functional.

Laboratory

Facility has functional laboratory and DMC also conducting basic tests. It has adequate staff available. However needs to be arranged properly.

Non-functional Blood storage fridge having no dedicated area, kept in the laboratory.


DMC and laboratory Inside arrangements of the lab.

Other –

Very nice display of scheme JSSK in the facility premises. Block has 3 GPS fitted functional ambulances for referral. General ward is very well maintained with attached functional toilet. Still needs to place curtains

on windows.


District Hospital Doda:

District hospital has new building and it is IPD block. It is properly planned and centrally located. MS chamber has layouts of all floor plans as well as displayed the comparative data of different departments.

Ground Floor Plan of Building Display of progress yr 14-15 &15-16

Supportive Supervision checklist was used to assess the status of the facility and some of the major findings are as follows –

Reproductive Health –

Spacing method items like IUCD 375 and ECP is not available in the facility. Also Mifepriston+Misoprostal (MMA) and MVA kit / EVA is not available.

As compared to previous year in the month of May MTP was 11 which increased to 36 this month, laparoscopic surgeries are 10 and 11 respectively and IUCD has seen fall from 5 to 1 this year, whereas condom distribution has seen dramatic increase from 222 to 1800 plus in the month of May this year.

Friday is fixed for laparoscopic operation at the facility. None of the staff are trained in PPIUCD. Whereas DH is conducting highest number of

deliveries in the district.

Maternal Health -

Two essential drugs mentioned in the List of minimum Essential Commodities under 5x5 matrix namely Methyldopa/ labetalol or Nifedipine and Inj. Magnesium Sulfate is not available in the facility.

Staff Nurse Wahida and Nahida are not SBA trained however posted in LR for last 3 months before that they were in Surgery department.

Partograph is not in practice.


HIV Screening kit is also not available in the facility. Privacy is maintained in LR as plastic curtains are placed on the main gate and windows. However

not placed in between the Labour Table. Toilet is attached to the LR and found clean. There are four labour tables placed in the LR but does not have Kelley’s pad, Spot lamp,

Additional delivery kit, BP instrument for LR. Trays are not available as per the level of facility here at least 6 trays needs to be kept and

maintained. Protocols are displayed in the LR however not as per the mandate of DH. Mgmt of PPH, Mgmt

of atonic PPH, Partograph, Pre – Eclampsia, Neonatal resuscitation, Antepartum hemorrhage and APH are displayed.

JSSK and JSY is not fully operational due to unavailability of funds. However some of the available drugs are provided to beneficiaries.

Stay after delivery for 48 hr is also approx. 64 % in last month which is low. Refrigerator is not kept in the LR but cold chain box is kept with oxytocin, that to without zipper

bag.

Trays needs to be kept properly Duty Roster initiated

Major Concern Outstanding liability of the DH under JSSK and JSY is huge and funds not released

for more than 6 months now. And a sum of Rs. 3245601/- has been demanded by MS on 24/4/15.

Facility has officially stopped the benefits provided under JSSK scheme due to non-availability of funds from 25.5.2015.


New Born Care and Child Health –

In terms of availability Inj. Vit. K1 is not available instead K3 is available, Zinc (10mg and 20mg), Vit. A , Syp. Salbutamol and albendazole is not available. Fetoscope / Doppler not available.

One of the Radiant wormer is not functional as it has display problem and Zero size Mask is also not available.

SNCUs is functional and has dedicated trained staff in FBNC. As per the discussion with the MS they are developing Step down unit, feeding corner and mothers ward for sick new born mothers to stay, adjoining to SNCU. Here curtains are of different shades.

ILR and DF are functional and vaccines are kept however record of ILR does not seems correct as no power failure reported since Dec.2013 and nor any protocol is displayed there.

There was no stand for ILR and DF and one stabilizer is used for both. Staff deputed in the Cold chain are not trained. As per the discussion with the Dy CMO, Post of

ILR/ DF technician post is vacant. No dedicated Data entry operator for MCTS at DH.

NBCC SNCU Set up

Only one Stablizer for ILR & DF Vaccination Room


Adolescent Health and DEIC–

There is AFHC Sanctioned and functional at DH. District early intervention center is also functional and records are maintained. And monthly there are approximately 300 referral to the DH.

As per the discussion with the DEIC manager 2 vehicles are provided however Medicine Kit is not available in the district. Post of MOs are vacant at Thatri and Gandoh.

Bi Medical Waste Management and infection prevention practices –

Incinerator has been supplied to the DH, which is not yet installed. As per the MS during site visit, they have submitted documents to the Pollution Control Board for approval.

Sewerage treatment Plant is to be installed in the premises which is a good initiative. Bleaching power is not available, Autoclave/ Boiler are kept only in OT. Color coded bins and bags are available however bags and bins are not as per the protocols. There is no structured training on BMW for Staff conducted till date. Segregation at source, sterilization protocols are not followed, however open deep burial pit is

there but not as per the specific design. Sharp pit is not available at the facility.

Incinerator parts Deep Burial Pit (Open Pit)

Blood Bank –

All though Blood Bank is functional however the license has expired in 2012. Having inadequate staff for it. Moreover some of the equipment’s are non-functional such as automatic blood mixer digital, one of the centrifuge machine, Elisa reader, Incubator and also one of the Blood storage refrigerator. All this has been shared with the DHS- J too through CMO.


Good Practices- Display of services of different department month on month basis with comparison to

previous year. Cleanliness in premises and inside the hospital building. Display of handmade message boards of “Save Girl Child”. And IEC at prominent areas

such as sitting area.


DISTRICT RAJOURI

Name of the Site: PHC Manjakote

PHC Manjakote is around 25 km away from district Rajouri having Bed capacity of 4 only. Service delivery status of PHC Manjakot for the month of June. Its reporting period is 15 to 14 every month.

There were 14 normal deliveries conducted having all 14 live births however 22 were referred. All the live births were given birth doze. In the reporting month IPD was 137, OPD was 1312 and 2 IUCD inserted and Sterilization is nil for the month of June.

No of client received CAC were 4. In the monthly report it is mentioned that IFA was not distributed and there is no high risk pregnancy whereas Laboratory Test register of JSSK has one lady with less than 7 HB.


Mifepristone + Misoprostol (MMA) and MVA/EVA Kit are short in Supply. Zinc short not available. Sy Salbutamol not available. Sanitary Pads not available. Tab Albandazol is available HIV screening and Partograph is not being done in the Facility Zinc tablets (10mg &20mg) are not available in the facility as per the in charge this is supplied

in the community by ASHA’s. Antibiotic as per RMNCH+A 5*5 matrix not available.

LR status:

Protocol posters were not displayed as per the MNH tool kit in the LR. Two Radiant Warmers were available only one was functional. Trays were not maintain inside the LR as per the MNH tool kit and some are locked. Fetoscope / Doppler was not available. Clean linen were not available. Color coded bins were not available inside the LR. Hand washing area is designated but elbow tap is not there.


NBCC is available. RW basinet is not clean.


INC status:


PNC Status:

Most of the delivered mothers prefer to leave facility within 48 hours of delivery. Free diet is not being provided since last 15 days due to financial issues. However BMO assured

that it will be started again in a day or two. Counseling on Family planning, breast feeding are being followed. As there was no client present in the IPD so client satisfaction assessment could not be done.

ANC Status:

Women and Child tracking register are maintain but there is no line listing of anemic women and ANM not aware about the incentive of it.


Ambulances are available to provide referral services under the scheme JSY/JSSK.

Laboratory test of PW: All basic tests are being done in the facility for PW except HIV screening. HbSAg kit was found Expire inside the Laboratory. Expiry and Manufacturing date were scratched from the box of Urine albumin kit so expiry date

could not be checked.

Action taken at the facility:

Shared all the gaps with BMO over phone and as he was not present at that time and also discussed to fix the date for further discussion once he back to PHC in a day or two.

Support required from District and State to achieve the proposed intervention:

Training on BMW and sterilization to all the officials and staff.

Training of SNs of LR on NSSK.


Name of the Site:CHC Kandi

Brief profile of CHC Kandi: the CHC Kandi is around 65 km away from district Rajouri. It has 12 Bedded L3 Delivery Point (FRU) facility caters around 80000 population. Currently there are two MO and one BDS and three staff nurses.

In the month of May 42 normal deliveries were conducted and all newborns received birth doze vaccination. Though it is a L3 level facility but there are no C section services. IPD is 310 and OPD is 4280 and IUCD is 6 in the month. 249 received IFA tablet and 9 PWs were identified as high risk pregnancy.



Mifepristone + Misoprostol (MMA) and MVA/VA Kit are not available.

Maternal Health:

Oxytocin available but not kept in freeze. Sanitary Pads are short in supply. HIV screening and Partograph is not being done in the Facility Labour room protocol posters are not displayed.

New Born Health:

Clean towels to receive the new born were not available.

Child Health:

ORS and Zinc are not Sy Salbutamol and Tab Albandazol are short in supply.

LR status:

Labor room is not maintained as per MNH tool kit. PTS Part time safai wala was cleaning the labor room with water without bleaching solution.

Privacy in labour room is not maintained, window is always open. Two labor table were there but there was no curtain in between two table. Staff nurses do not know about the proper use of color coded bins. Labor table condition was very poor, unclean and blood layer were around the mattresses and

table. Standard Labor room protocol poster were not display inside the LR. Standard register like Labor room, Referral in /out etc. are not in practice. Wall mount thermometer was not there. 24*7 running water is not there, water stored in bucket for toilet and hand washing.


Cloxacilin Inj was found expired inside the Labor Room Cleanness of labor room was poor as there is no bleaching powder available in the CHC for

Cleaning. Trays are not maintained properly. 24*7 water supply is not available and the power backup system is poor in the CHC, the

Solar system are sanctioned but it is not fixed till date though battery and other equipment’s are there since last one year.

Color coded bins was not available inside the LR. Hand washing area is designated but there is no long handled tap.

Newborn care:

Designated NBCC is there but it was not properly maintained and Oxygen cylinder key was missing.

Designated NBSU is there but not properly functional and it is observed that inverter battery are placed inside the NBSU. Same finding were noted in previous visit (April) that time also requested staff to shift it at other place as they have lot of space.

INC status:


PNC Status:

Bed Strength of the PNC is just 2, Interviewed one mother inside the PNC Ward and counseled her to stay for 48 hour

Counseling on Family planning, breast feeding are being followed.

ANC Status:

There is no practice of taking BP in ANC area, PWs are being sent to OPD for the BP. IFA tablet is not available Due list of beneficiaries is not maintained Date of opening was not written on open Pentavalent and DPT vial and designated ANM did not

aware about open vial policy Women and Child tracking register are maintain but there is no line listing of anemic women and

ANM did not aware about the incentive of it.


Ambulances are available to provide referral services under the scheme JSY/JSSK. One of patient’s attendant interviewed and it was found that driver asks for the fuel charge from

the patient while picking up from home.

Laboratory test of PW:


Under JSSK they are doing the test and maintaining the record as well. All essential tests are being done in the facility for PW except HIV screening and Hepatitis B. Hub Cutter is not available inside the Lab. Running tap water is not available inside the Lab.

Name of the Site:SC Tattapani, Block:Kalakote

Brief profile of SC Tattapani: The SC tattapani is around 53 km away from district Rajouri. It is L1 delivery Point and caters to around 1500 population. Currently there are two ANM posted. Average monthly OPD load of 290 per month.

Training Status:

One FMPHW is trained in SBA, NSSK, and IUCD and second one is NSSK trained.

Untied Fund Status:

They have utilized the untied fund amount of Rs 10000/- and purchased medicines , Registers, BP Apparatus, HB Meter and Weighing machine etc with that.


Sanitary Pads are short in supply. There is no provision of diagnostics services IFA tablet is not available

New Born Health:

Designated NBCC not available.

Child Health:

ORS and Zinc short in supply. Sy Salbutamol and Tab Albandazol are short in supply. Adolescent Health medicine was short in supply since long time. Antibiotic as per RMNCH+A 5*5 matrix not available.

LR status:

There are two rooms in the SC, Labor room and ANC runs in one room hence it is congested and not as per the protocols, however they are providing the services.

Standard Registers are maintained the record very nicely kept. They are not storing the oxytocin inside the Refrigerator sensitize them to store that in ILR.

PNC Status:


Free diet is provided to the delivered women from the facility and record is maintained. Counseling on Family planning, breast feeding are being followed.

ANC Status:

BP measurement during ANC is in practice. Due list of beneficiaries not maintained. Women and Child tracking register are maintain but there is no line listing of anemic women and

ANM did not aware about the incentive bound with that.

VHND Status:

4 VHND were organized out 4 planned VHND.

Other observation:

Hub cutter, running water and soup not available in SC. There is no cleaning staff attached to SC. ANM herself clean Labor room after delivery. There is no toilet available for the Patient.

DISTRICT LEH

Achievements at DH Leh for the months of upto May 2015

Normal Deliveries- 230 Assisted Vaginal Deliveries- 7 C-Section- 76 Live Births – 310 Number of Newborns immunized before discharged- 290 IPD Load- 1983 OPD Load- 24636 IUCD Insertions (interval)- 36 Female Sterilizations- 9 Male Sterilizations- 3 No. of clients received Comprehensive Abortion Care Services- 25 No. of clients with high risk conditions- 86

Posted Trained in SBA/BEmOC Trained in PPIUCD Medical Officers 21 0 ANM/Staff Nurses 54 NA 0


While doing Supportive Supervision at the Labour Room it was found that Out of 5 available Labour Tables, two needed repair as the foot rest was dysfunctional. Also, one of the two Radiant warmer was totally nonfunctional. The Staff nurse told us that it could not be repaired even after the engineer’s visit.

Also, the staff told us that they require Shoe covers and Good quality Aprons/Gown. There is no personal trained in PPIUCD insertions in the whole district.

VHND Monitoring Status for the Month of June’15

Leh: Place- Sub Centre Umla

The ANMs and ASHAs did not come prepared as per the VHND guidelines. There was no Immunization schedule, no Eligible couple register or any other IEC materials brought by them.

The community members were not informed by the ASHA about the VHND meet and as a result only 3 women appeared for the VHND session out of which only one was pregnant.

District - Doda

Name of the Site: AWC Barshalla (SC- Barshalla), Block: Thatri

Major Findings:

The VHND session was organized at AWC Barshalla which is around 2 km from SHC Barshalla.

As per the observation VHND was not conducted as per guideline. There was no BP apparatus, Hb meter, medicines, MCP cards, sanitary napkins and any register at session site.

There was only group of children’s, PWs and Adolescent girls at session site and they don’t know about VHND.

ANM and ASHA were sensitized about VHND guidelines and then told to bring medicines , equipment’s and other supplies from SHC to the VHND session site and also told them to ask pregnant mothers to bring their MCP cards and taking BP, weight, Hb , counselling to PWs and adolescent girls. AWW was asked to plot weight of children’s 0- 5 years on Growth Chart.

During VHND also checked the immunization card of children’s and status of vaccine given is good and there was no dropout or partially immunized.


District - Kishtwar

Name of the Site: AWC-CHAIRHAR (SC – Pochaal),Block: Kishtwar

Major Findings:

There was no Micro plan available with the ANM at the session site. ANM, ASHA and AWH was available at the session site and AWW was not available All beneficiaries were mobilized by ASHA. Logistics like BP Instrument , stethoscope , weighing scale adult , growth chart for boys and girls

, ORS Sachets , Zinc tablets , Anti helminthic tablets , Cotrimoxazole tablets , ,Hemoglobin testing kit , urine testing kits , red & black bag , materials for IPC,IEC material , Due list of beneficiaries , referral cards and were not available in the session site.

Charts for the Children’s used for teaching purpose were available and no other banner, wall writing, poster, flip charts, pamphlets were available.

Vaccines were wrapped up in simple polythene bag instead of the Zipper bag. ANC registration was done and only TT dose was given to mother. Growth monitoring was not done during the VHND session. No community growth chart is available. Counselling was done by the ANM on several topics.

Action taken at Session site and Block/District Level:

1. Sensitized ANM, ASHA & AWH on above mentioned findings and stressed on ensuring availability of Supply/Logistics which are very essential during VHND and RI session.

2. Sensitized on preparation of due list of beneficiaries and its benefits.

Support Required at District Level:

1. Monitoring of VHND by district level officials.

District - Poonch

Name of the Site: Baila Mohalla (PHC Chandak),Block: Mandi

During the VHND session 6 pregnant ladies, 7 adolescent girls, 7 children, 5 eligible couples were benefited.

One IUD and Two pregnancy tests were done, Sanitary napkins, Oral contraceptives, condoms and medicines were distributed among beneficiaries, Vaccination was provided to drop out children and nutrition to all.

ASHA has mobilized the community but did not prepared due list of beneficiaries. Except BCG all other vaccines were available.


BP apparatus, stethoscope, weighing machines adult, Haemoglobinmeter were available. Weighing machines baby/New born was not available.

IFA Tablets/IFA Syrup, Zn, ORS were not available Reproductive and child health IEC material was not displayed at the site. Mothers were not carrying MCP cards with them. Weight of children not taken and recorded. Group meetings were not conducted with any of the age groups. Group counselling was also not done.

District - Rajouri

Name of the Site: AWC Thuddi B ( Jwar Nag), Block: Manjakot

Last VHND organized at AWC Thuddi was in 2011 since then no VHND conducted at the center having population of approx. 700. Both the ANMs (regular and contractual- NHM) were present there.

The following activities took place at VHND site – Counseling on Hygiene and sanitation, balance diet. Distributed IFA to pregnant women and Adolescent Counseling session for pregnant women and adolescent were conducted The AWC did not have the child weighing machine since last two years hence no growth

monitoring and plotting is being conducted ANM did not prepare and carry the due list of beneficiaries. There is no ASHA attached to this session site therefore community mobilized by AWW/ helper. There was no IEC material at VHND site to display. Child Health issues such as breastfeeding and identifying danger sign were discussed and Family

planning services were also provided at VHND site. Action taken at Session site and Block/District Level:

Sensitized the ANM about Due list of beneficiaries. Group Counseling was not in practice so make the arrangement for that. Sensitize the ANM and AWW about the importance of VHND.


Model Delivery Point Two delivery points from each HPD have been identified to be strengthened as Model delivery Point (MDP) during the year 2015-16. The facilities have been selected based on the following criteria: 1) Delivery load 2) Accessibility and 3) Non-availability of nearest delivery point. The status of MDPs was assessed by using the MNH-toolkit as approved by the MoHFW, Government of India (GoI) guideline. Standard labour room register designed and shared with the HPDs. Till now standard labour room register started at Doda, Poonch, Kishtwar, PHC Manjakote (Rajouri District) and work in progress at Leh and Ramban. Implementation of other standard registers like New Born Care Corner (NBCC), NBSU (New Born Stabilization Unit) also started in Doda and Poonch. Different trays as per the MNH Tool kit has been ensured in delivery points. Displaying of labour room protocol supplied by state health society has been ensured. Regular monitoring report has been shared with district and state for further action.

Rajouri District: Name of the MDP: PHC Manjakote

Major Observation

Extra Radiant warmer still need to fix. Oxygen Cylinder not available Display some labor room protocol poster rest of them forwarded to print. Shoes rack are available Screen available in Labor room Long Hand Tap not available Wall Mount Thermometer not available

HPDs Facilities Identified

Doda DH Doda CHC Gandoh

Rajouri CHC Sundarbani PHC Manjakote

Poonch CHC Mendhar PHC Loran

Ramban CHC Banihal PHC Sangaldaan

Kishtwar CHC Marwah PHC Chatroo

Leh SDH Disket PHC Bogdang


Phototherapy not available Duty roster register not available Mattresses need to change Refrigerator required for labor room Partograph not being done Infection control practices need to strengthen

Action taken by the facility based on interventions/ activities identified from last visit:

Trays has been started few days back but not maintaining as two trays are theft from labor room Printed and Display some Labor room protocol poster Arranged the 4 trays Screen available Cleaning the Labor room Standard Labor room register started Duty roster register sent for printing White wash of labor room will start soon BMO ensure about some changes in coming days e.g, Long hand tap, Protocol poster, Register,

Refrigerator, white wash, duty roster

Intervention taken by District Coordinator:

Facilitate to arrange the Trays and Labelling them Fix the Screen around Labor table Facilitate to cleaning labor room Facilitate to arrange Radiant warmer and cleaning

Progress Report:

PHC Manjakote is one of the Health facility for Model Delivery point that need to strengthen and declare as MDP by interventions and advocacy, Trays is been arranged and ready for use inside the labor room, fetoscope/dopler need to be purchase. Curtains and Screen for labor room is placed and attached toilet is functioning well.


Strengthening Review Mechanism

A meeting with CMO Leh on 19th June 15 to discuss the following issues:

Status of WIFS Program in district Status of HBNC Kits availability: it was brought into the notice of the chair that HBNC kits are

not available with all ASHA workers. Hence it was decided that the office would request to the Mission Director NHM, J&K to issue the same on priority.

Shared the findings of Supportive Supervision visit conducted at the District Hospital. Such as there is an immediate need to repair two Labour tables. One of the two Radiant warmer is out of order form some time which needs to be repaired. The CMO Leh assured that he will talk to the Medical Superintendent about this matter for necessary action.

District – Rajouri,

1. Block monthly meeting – Kalakote,Dated – 24/06/2015

Discussion points:

Discussion on the monthly reporting of individual facility. Discussion on the ASHA Functionality and ASHA facilitator role and responsibilities. Pending Incentives were discussed. Discussion on the MCTS reporting. Mission Indradhanush Micro plan was also discussed. Availability of MCP card was discussed. Discussion of shortage of ANM in some facility like Kortcharwal and Kotbani Survey of the Facility area. Vacant Post at various facilities. Discussion upon the Home deliveries.

Action Point:

Zonal head instructed to schedule the monthly tour to all their area and submit the report. Every official/ supervisor to maintain a tour diary. Make the requirement of the MCP Card and submit to block. CHC Trehat advised to depute some ANM to improve the Immunization. Instructed all the facilities to conduct survey of their catchment area and submit the compiled

report to block 30th June. Letter to CMO Rajouri about Vacant post of Pharmacist in Saraano.


2. Mission Indradhanush – Fourth Round meeting of Block Coordinators and ASHA facilitators. Date:26/06/2015

Agenda:

Mission Indradhanush Coverage Increase Session Site

Action:

It is instructed to the Block Heads that the drop outs and left out children will be covered and proper micro plan need to be prepared. No. of sessions need to be increased in respective Blocks.

Micro Action Plan need to be submitted by 30th of June.

3. Meeting: District Monthly Review Meeting,Place:Rajouri CMO office, Date:30/06/2015

Monthly review meeting for the month of June held at 30/06/2015 under the chairmanship of Chief Medical officer Rajouri at Chief Medical office Rajouri.

Decision Taken and Action point:

Non Serious approach regarding monthly review meeting and other health related issues thereof. DPM Rajouri NHM was directed to give the warning notice to underperforming staff of NHM

and was directed to daily update MCTS/HMIS and also directed to regular visit in their falling institution.

Dy CMO, all BMO were directed for PowerPoint presentation from next meeting onwards Dy CMO Rajouri directed to furnish the micro plan of mission Indradhanush for next round along

with physical achievement. MS District Hospital Rajouri directed to Ensure the health facilities services and Fitness certificate

for Amarnath Yatries All DDO were directed not delay of the reply of the letter and Information ask/received from the

higher authorities. All DDO s were directed physical verification of all store/stock up to MAC level and submit the

report by 31 July 2015. Furnished the budget estimate for the year of 2015-16. MS of District Hospital and all BMO,s were directed to take the serious note of implementation

of instruction of the Hon’ble Health Minister for health medical education and ARI training e.g Dress code, Cleanliness , Labor room, emergency, sign board, Duty Roster.

Dy CMO Rajouri was directed to arrange a laparoscopic machine for district hospital to conduct fixed day LS


Dy CMO and all BMO,s were directed to ensure the proper use of MCP card and Safe mother hood booklets

MS and all BMO,s instructed conduct the facility based MDR/IDR and compile the report along with action taken.

Dy CMO and all BMO, s were directed to ensure the IFA distribution to PW at all facility level. All BMO.s instructed to submit the Biomedical Waste Management Status at facility. All DDO, s were directed to distribute the job responsibility of all supervisory staff to monitor the

all national program and Scheme. Discussion of ASHA Functionality and Cluster meeting as monthly bases. Unmarried ASHA remove from the Data base and services.

Discussion of Supportive supervision Findings:

Share the feedback on line listing of Severe Anemic women and incentives bound with that all BMO instructed to look after in matter.

Discussion on Labor room protocol for all delivery points Strengthening of VHND at all level

Other Support Provided

All District Coordinators were involved in monitoring of 3rd round Mission Indradhanush Programme in HPDs. Findings of MI monitoring reports also shared with all concerned. Mission Indradhanush Monitoring Report Date: 08.06.2015 District Poonch: Session site: AWC Kashmrimohalla under SC Kaniyan. Findings: Session held but not as per the micro plan. The location of MI session changed without

intimation to concerned authorities 5 children were provided immunization out of 8 in the micro plan Vaccination record not maintained on MCP cards, separate page maintained by ANM Due list was not available either with ANM or ASHA. Hub cutter was not available. Date and time was not marked on the open vial BCG and Hepatitis B was not available at the site.


Blank MCP cards , counter foils of MCP cards, AD (0.1ml) syringes , vitamin A solution, ORS packet, IFA tablet, Amoxicillin tab/syp, Zinc tab, red and black bags were not available at session site

IEC materials (e.g. Banners, poster's, hoardings wall paintings) were not available at session site or at community level.

MI poster with tagline “Bhool Na Jaana Teekakaran Zaroor Karna” was also not displayed anywhere. As per ANM they have not received any kind of Indradhanush specific IEC material.

District Doda: Session site: AWC Manyana Team: District Coordinator-RMNCH+A, APM NHM J&K and Consultant MOHFW. 2 children's were vaccinated Hub cutter and red bag was not available. No hoarding , banner , poster was found displayed in the community Four key messages were given to caregivers. The due list was not available ASHA was not present at session site The date and time of opened vials not written on open vial MI poster with tagline “Bhool Na Jaana Teekakaran Zaroor Karna” was also not displayed

anywhere. As per ANM they have not received any kind of Indradhanush specific IEC material.

District Kishtwar: Session Site: Pinjrari in Dacchan Block Some major Findings: 1. Session was organized as per the micro plan but somehow the proper planning as per the protocols was missing. 2. 8 Children’s were immunized and this was the first session in Pinjrari. 4. Session site located at high hilly area (the site has been selected for the new sub center which Govt has recently announced) 5. The vaccinator was male and he was not well aware of the mission Indradhanush. 6. Hub cutter was not available with the vaccinator. 7. One left out children of 2 years of age found and he never immunized before this session. 8. MCP Card was available with the beneficiaries. 9. There is no IEC or IPC at the area on MI.


10. IFA/ORS/Zinc tablets were not available in session site. 11. ASHA’s doesn’t have clear idea about the MI, 12. The people living near the vicinity were called for the session site for immunization as it is hard to reach area people are living on high altitudes and there are many such hamlets which need to be covered.

Support Provided At State Level

Orientation of District RMNCH+A Consultant:

All District RMNCH+A Consultant of Kashmir division oriented on NHM programme and Supportive Supervision checklist on 12th and 13th June’15 at state level. National Coordinator-RMNCH+A along with both State Coordinators oriented the RMNCH+A Consultant on different NHM programme and GoI. Supportive Supervision checklist.

Training schedule was designed as per the following:

Day – 1 Time Particulars Resource Person / Speaker

10.00AM Opening Remarks Mission Director 10.10 AM Objective of Training DNO Kashmir 10.20 AM Overview of NHM DNO Kashmir 10.40 AM Need of RMNCH+A and Intervention Dr. P Sahoo, NC-RMNCH+A 12.00 PM Introduction on Supportive Supervision State Coordinator 1.30 PM Break 2.00 PM Reproductive Health (IUCD, various

Sterilization methods and incentives) Director FW / Representative

3.30 PM Maternal Health ( Various Schemes and incentives)

PM (Maternal Health )

Day -2 10.00 AM Adolescent Health (RBSK) PM (RKSK) 11.00 AM Child Health and ( Various Programs) PM (Child Health) 12.00 AM VHND Session checklist State Coordinator 1.00 PM Break 1.30 PM Neo Natal Health ( SNCU, NBSU, NBCC)

and Visit to District Hospital APM (Child Health) & State Coordinator

5.30 PM Concluding Remarks and Vote of Thanks State Official


Some glimpses of training:

Supportive Supervision of 2 HPDs by State Coordinators and National Coordinator-RMNCH+A

2 HPDs( Doda and Kishtwar) were visited by National Coordinator-RMNCH+A and State Coordinator-RMNCH+A for supportive supervisions. 6 facilities were visited in two district along with two feedback sharing meeting with CMO and MS for further improvement. Monitoring report along with recommendation was submitted to state for further action.

Support in SNCU Reporting and SNCU Strengthening:

An analytical report of all SNCUs in the State submitted to DNO, Kashmir. Provide technical support to state in proper reporting and strengthening SNCUs. In the month of July’15 a plan will be prepared jointly for SNCU assessment in state.

Support in Maternal Death Review:

Line listing format as per the standard prepared and shared with the Programme Manager and Asst. Programme Manager, Maternal Health for implementation. Maternal death list shared by Asst. Programme Manager, Maternal Health discussed with concerned District Coordinator and after extensive effort of District Coordinator 3 maternal deaths reviewed as per CBMDR and FBMDR.


Support in implementation of Standard register as per MNH Tool Kit at all delivery point of state:

Advocacy done at state level for implementation of standard register at all delivery point so that the reporting mechanism can be strengthened. A letter for MD, NHM issued to all district based on our advocacy for implementation of standard register at state level

Letter issued by MD, NHM for standardization of different register


Support in specification of labour room and other protocol poster at delivery point:

Specification of all standard protocol prepared and share with state. Advocacy at state level done for issuing a letter to all district for proper displaying of different protocol. Based on our activities MD, NHM issued a letter to all CMOs for proper displaying of protocol poster along with their size and location.

Letter issued from MD, NHM based on the field visit findings and standard operating procedure for different protocol


Some glimpses of district level advocacy done by the District Coordinators

District Coordinator-RMNCH+A sharing their finding based on their filed visit to CMO and BMOs. But action need to be taken at both level.

Letter issued by CMO, Doda based on the RMNCH+A Indicator analysis

Letter of CMO, Poonch on Maternal Death Review

Letter of CMO, Poonch based on the findings of DC-RMNCH+A


Monitoring findings of District Coordinators also shared at level……….


Recommendation

Staff who is trained in the SBA, NSSK be kept in the Labor Room only. They are on roster duty and are placed in other wards / sections too presently.

Functional Toilet attached to the LR and gyne ward. Delivery Trays must be maintained as per MNH tool kit. Present practice of staff is to sterilize used instruments and generally kept there itself,

instead they must autoclave and keep them in trays, and these sets must be ready as per the delivery load.

Cleanliness of the Labor Table is one of the weak component observed, nursing staff and cleaning staff must be trained in infection prevention, BMW etc.

Standardized and printed labor register, reporting formats be kept at LR, NBCC, SNCU Protocols must be placed must be readable. Duty roster, numbers of ambulance driver, diet chart with all details must be displaced at

outside the nursing station, inside the nursing station and at prominent places respectively. Dedicated staff of cleaning for SNCU is required. Deep Burial Pit at Different level of facility and their authorization from JK pollution control

Board. Blood Bank Authorization. Strengthening of NBCC Give importance of monitoring findings of District Coordinator-RMNCH+A

Conclusion RMNCH+A strategy has been planned to provide a complete service throughout the life cycle. Increasingly, across the globe, there is emphasis on establishing the “Continuum of Care”, which includes integrated service delivery in various life stages including adolescent, pre-pregnancy, childbirth and postnatal period, childhood and through reproductive age. The field visits reveals that there is a need for improving awareness about the standards of performances among service providers. The 5x5 matrix helps us in giving focused attention on different program activities to ensure performance and quality aspects in service delivery. Availability of essential drugs and consumable and skilled manpower, are the crucial determinant to maintain the quality standards and overall performance at facility level. Quality of training is one of the importance part which should be given priority for better service delivery. District should more effective for rational deployment of skilled manpower. Progress of all 16 indicators need to be reviewed on the monthly basis at state, district as well as Block level. And necessary decisions must be taken based on the data and its analysis with follow up actions.


MONTHLY RMNCH+A PROGRESS REPORT

FOR THE MONTH OF JUNE’15

MONTHLY RMNCH+A PROGRESS REPORT OF 6 HPDs, J&K …

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Transcript of MONTHLY RMNCH+A PROGRESS REPORT OF 6 HPDs, J&K …