form-iv regional offices of health & family welfare …
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FORM-IV
REGIONAL OFFICES OF HEALTH & FAMILY WELFARE
DATA COLLECTION FORMATS FOR REVIEW OF PERIPHERAL INSTITUTES
Name of the Regional Office: Raipur
Report for the Month of: June 2010
1. ASSURED SERVICES:
Sl. No. Assured Services District Bastar(Jagdalpur)
I Formation of Programme Management
Unit (PMU) Yes
ii Plan and execute Health Related Activities
Yes
iii Formation of Health Planning & Health
Monitoring Committees No, separate
iv Release and account the funds to
subordinate Offices under NRHM Yes
v Development/Upgrade the peripheral
institute as per IPHS Yes
vi Arrange for procurement of the logistics required for the implementation of the
planned activities.
Yes
vii Implementation of National Health
programme
NRHM Yes
NVDDCP Yes
RNTCP Yes
NLEP Yes
NBCP Yes
HIV/AIDS Yes
NIDDCP Yes
IDSP Yes
viii Non Communicable Diseases
Tobacco control No
Injuries and Trauma No
CVD No
Mental Health No
NOHP No
Diabetes control No
2
ix IEC activities related to National Health
programmers Yes
x
Develop training institutes for providing
appropriate training to strengthen the
skills of the staff.
Yes but integrated setup
xi Work towards achievements of Set Mile
stones Yes
xii Generate Performance related indicators Yes
xiii Generate Indicators under Millennium Development Goals (MDGs)
Not available at time of district visit
xiv Monitoring and quality control Yes (Quality control)
Total Activities undertaken 18
% of activities undertaken 67%
2.1. Accessory services District Bastar(Jagdalpur)
Citizen's charter Yes
Electricity supply Yes
Emergency Lights Yes
Civil engineering Yes
Fire protection No
Water supply Yes
Waste disposal Yes
Total 6
%age 85%
Sl. No. Particulars District Bastar(Jagdalpur)
I Whether PMU formed Yes
ii Adequate Official Accommodation
available No
iii Planning unit Yes (Not sepate PU, as per programme)
iv Financial Management unit Yes ( as per programme )
v IEC management unit Yes
vi Training Unit Yes
vii Management Information System Unit Yes
viii Other (Specify) -
ix Other (specify) -
Total Units formed
% Units formed 85%
3
Sl. No. Manpower category-wise District Bastar(Jagdalpur)
I Programme managers DPM-1, BADA-7 (12), BPM-03 (12)
ii Technical Officers DDO,NVBD officers,RNTCP,NLEP ,IDSP officers
iii IT personnel Not available
iv Statistical personnel Not available
v Other Support staff Account Manager-1, Immunisation camp at 01
vi Other
Total Staff
% of staff available
Sl. No. Logistics District Bastar(Jagdalpur)
Office logistics (Specify)
I Necessary Furniture Yes
ii Computers Yes
iii Printers Yes
iv Telephones Yes
vi Faxes Yes
vii Storages Yes
viii Vehicle for Mobility (specify) No (PMU)
Total 6/7
%age 86%
I Whether HP&MC are constituted No (As per program NHP)
ii Whether the composition is as the
guidelines. Yes
iii Whether HP&MC convening meeting
regularly Yes
iv If Yes, at what interval Monthly
v Whether Discussion as agenda are
undertaken. Yes
vi Whether the Minutes prepared &
circulated Yes
vii Whether feed back on minutes is
received. Yes
Total 5/7
%age 71%
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3(a). HEALTH INFRASTRUCTURE IN THE VISITED STATE/DISTRICT
3.5. Health Infrastructure available in the Stat/Districts
Sl. No. Particulars District Bastar(Jagdalpur)
I # Districts Bastar
Ii # District Hospitals ONE
iii # Sub-Divisional Hospitals TWO
Iv # CHCs TEN
V # PHCs FIFTY-SIX
vi # SHCs 316
vii # Health NGOs 4 + 1 (M)
viii # instts. providing disability care services 1
Ix # CHC/PHC strengthened for BEmoNC
facilities 1
X # CHC/PHC strengthened for CEmoNC
facilities -
xi # CHC/District Hospital Strengthened for FRUs
03
xii # SHCs Strengthened with 2 ANMs NO
xiii # ASHAs functioning Yes(5002 (including Narayanpur)
xiv # AWWs Functioning Yes(4636)
Total Number of Units 11
% units Strengthened 79%
3.6 Staff Strength available against the sanctioned strength in the entire state/district visited
Sl. No. Particulars District Bastar(Jagdalpur)
I # Programme Officers Yes-1
Ii # Medical Specialists Yes at district hospital only
iii # Surgical Specialist Yes at district hospital only
Iv # Pediatricians Yes at district hospital only
v # O&G Specialists Yes at district hospital only
vi # Anesthetics Yes at district hospital only
vii # Eye Surgeons Yes at district hospital only
viii # Dental Surgeons Yes at district hospital only
ix # Medical Officers Yes
x # Ayush Medical Officers No
xi # Health Supervisors Yes
5
xii # LHVs Yes
xiii # Key Technical staff Yes
xiv # Paramedical staff Yes
xv # Ministerial Staff
Total Staffs
% staff available
4. Budget Allocation
Sl. No. Particulars District Bastar(Jagdalpur)
1 Balance from the previous Years -
2 Funds received under NRHM( current year)
36356533
3 Funds utilized under NRHM
32382689
4 Balance at the end 3973844
5 % Utilization funds 10.93%
5. Job Satisfaction
Sl. No. Particulars District Bastar(Jagdalpur)
PMU
District staff
6. Quality Monitoring
Sl. No. Particulars District Bastar(Jagdalpur)
i HIS Established
Diseases are classified as per ICD-10 pattern NO
MPR Format Developed Yes
QPR format developed
Half yearly report format developed
Annual Report Format developed
Monitoring Indicators Identified
All Necessary Records Registers maintained Yes
a NRHM Yes
b RNTCP Yes
c NLEP Yes
d NBCP Yes
e NVBDCP Yes
ii Admin Monitoring
Monthly Reports submitted Yes
Quarterly Reports submitted No
6
Half yearly Reports submitted No
Annual Reports Prepared Yes
Monitoring indicators developed No
If prepared , provide a copy of the Report for
the last Month/Quarter/year? Not available
iii Int. Audit
Monthly Review meeting organized Yes
Quarterly meeting organized Yes
Half Yearly Review meeting Organized Yes
Annual Meeting Organized Yes
National Review meeting organized Yes
If yes, provide a copy of ATR on the minutes -
iv Patient care (# Developed complications)
Ante-natal cases 24 (April 2010,HIMS data)
Post natal complication
New born/Infants Not available
IOL cases under NBCP Not available
TB cases Not available
Leprosy cases Not available
other cases Not available
If yes, provide a copy of the ATR
v Medical Audit (# Deaths reported
&reviewed)
Maternal Deaths Medical audit report are not available
Child deaths Medical audit report are not available
Malaria deaths No death
Tuberculosis Deaths 20 (district level ,ist quarter of 2009/10)
Others (specify)
If undertaken, provide a copy of the ATR ATR and audit report not available
vi Supervisory visits by State/National Prog.
Manager
what was checked Reports copy was not available
7
what gaps were found
what instructions were given Reports copy was not available
what administrative directions given Reports copy was not available
Provide a copy of the follow up action taken Reports copy was not available
vii External Audit
Independent Review Reports copy was not available
Review by Expert Groups Reports copy was not available
If undertaken, provide a copy of the ATR Reports copy was not available
Sl. No. Action points District Bastar(Jagdalpur)
I Whether district Rural Health Mission has been set up?
Yes
ii Whether HFW societies have been merged into one society?
Yes
iii Whether State and District Plans are prepared for implementation
of the identified activities. Yes
iv Whether Project Management Teams are in place and provided the necessary training. Yes
v Whether mobile medical units are sanctioned and functionalized.
No
vi Whether main streaming of AYUSH ha been undertaken. No
vii Whether networking with NGOs has been made. Yes
viii Whether Public Private Partnership has been established for
referring the BPL cases and out sourcing of some of the activities No
ix Whether JSY scheme is launched and practice of reporting every
maternal death to DM is followed. Yes
x Whether Quality Assurance Committee is Operational zed.
Yes
xi
Whether BEmONC facilities (including Civil hospitals, CHCs
and PHCs) are strengthened with 03 staff nurse to provide service guarantee as per IPHS.
Yes-1
xii
whether CEmONC institutions ( PHCs & CHCs) strengthened
with 7 Specialists with 9 Staff nurses to provide service guarantee
as per IPHS. No
8
xiii
Whether Sub-Centers Strengthened by providing 2 ANMs and
UNTIED funds of Rs. 10000/+ are given No
xiv
Whether Rogi Kalyan Samiti (RKS) at District/CHC/PHC are
formed and one time support to RKS are provided Yes
xv Whether streamlining of provisions for drug logistics at CHC, PHC and SHC for common ailments has been made under
mission.
Yes
xvi Whether access to Universal Immunization through introduction of Autosyrings, alternate delivery of vaccine is ensured.
Yes
xvii
Whether involvement of PRIs is ensured in the implementations
of Health Schemes at the village level (i.e. immunization, JSY,
sanitation, drinking water, etc.)
Yes
xviii Whether strengthening of Anganwadi through involvement of
AWW in MCH programme is done. Yes
xix Whether selection and training of ASHA @ 1 ASHA per 1000 population is done and ASHA Kit is given.
Yes
xx Whether Village Health & Sanitation Committee are constituted
and UNTIED grant is provided. Yes
xxi Whether SHC/PHC/CHC/DH are fully equipped to develop intra-Health sector convergence, coordination & services guarantees
for FW, NVBDCP, RNTCP, HIV/AIDS, etc.
Yes
xxii Annual need for FW and RCH services has been calculated in the district as per operation manual and monitoring of state
programme implementation plans? Yes
xxiii Whether performance report is submitted by the district in revised
MIES Formats Yes
xxiv whether Annual State and District Specific Public Reports on Health are Published Yes
xxv Whether institute wise assessment of performance against assured
services guarantee carried out. Inspection carried out for Yes
Total Number of activities completed
% miles stones completed
9
Sl. No. Particulars District Bastar(Jagdalpur)
13 Under Five mortality rate Not Available at time of Visit
14 infant mortality rate Not Available at time of Visit
15 proportion of 1 year-old children immunized
against measles
Not Available at time of Visit
Target 6 - Reduce three quarters, between 1990
and 2015, the maternal mortality ratio
Not Available at time of Visit
16 Maternal Mortality ratio Not Available at time of Visit
17 Proportion of births attended by skilled health personnel
Not Available at time of Visit
18 HIV prevalence among women aged 15-24
years
Not Available at time of Visit
19 Condom use rate of the contraceptive
prevalence rate
Not Available at time of Visit
19A Condome use of last high risk sex Not Available at time of Visit
19B percentage of population of aged 15-24 years with comprehensive correct knowledge of
HIV/AIDS
Not Available at time of Visit
19C Contraceptive prevalence rate Not Available at time of Visit
20 Ratio of school attendance of orphans to school attendance of no-orphans aged 10-14 years
Not Available at time of Visit
21 prevalence and death rate associated with
malaria
Not Available at time of Visit
22
Proportion of population in malaria risk areas
using effective malaria prevention and treatment measures
Not Available at time of Visit
23 Prevalence and death rates associated with
Tuberculosis ( 2009)
20
24 Proportion of tuberculosis cases detected and
cured under DOTS ( first quarter of 2010)
New smear positive cases -187, New smear
Negative P TB-141, New extra PTB-54,
Relapse-18
No. of Indicators Developed
%age
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FORM-IV
REGIONAL OFFICES OF HEALTH & FAMILY WELFARE
DATA COLLECTION FORMATS FOR REVIEW OF NATIONAL HEALTH PROGRAMME
Name of the Regional Office:
Report for the Month of:
REVIEW OF NATIONAL HEALTH PROGRAMMES AT THE DISTRICT HQ LEVEL
Sl. No. Assured services under NHP NRHM NVBDCP RNTCP NLEP NBCP NACP NIDDCP IDSP NCD
I ASSURED SERVICES
1.1 NHPs implemented in the District
I Human Control
I Diagnostic Services Yes Yes Yes Clinical Yes Yes Yes Yes Yes
ii Treatment Yes Yes Yes yes Yes yes Yes yes yes
iii Disability management Not visible
II Vector Control
I Interval Residual Spray Not Applicable Yes as per API
Not Appl- Not Appl Not Appl Not Appl
ii Space spray Not Applicable No Not Appl Not Appl Not Appl Not Appl
iii Impregnated Bed Net Provision Not Applicable Yes Not Appl Not Appl Not Appl Not Appl
III Biological Control
I Maintenance of Hatcheries Not Applicable No Not Appl Not Appl Not Appl Not Appl
ii Release of Anti-larval Fishes Not Applicable No Not Appl Not Appl Not Appl Not Appl
iii Others Not Applicable Not Appl Not Appl Not Appl Not Appl
IV Chemical Control
I Oil spray on water surface Not Applicable No Not Appl Not Appl Not Appl Not Appl
ii Others Not Applicable No Not Appl Not Appl Not Appl Not Appl
iii Others Not Applicable No Not Appl Not Appl Not Appl Not Appl
V Others Activities
I Health Education Yes Yes Yes Yes Yes Yes Yes Yes Yes
ii Training Yes Yes Yes Yes Yes Yes Yes Yes Yes
iii Conversance Yes Yes Yes Yes Yes Yes Yes Yes Yes
Total Services provided
% services provided
11
1.2. NRHM
1 Ante-natal Care Services Yes
I Intra-natal care services Yes
ii Post natal care services Yes
iii JSY care Services Yes
iv Immunization of Children Yes
v Full Range of FP Services Yes
vi Health Education Yes
vii Training Yes
Total Services provided All
% services provided 100%
2 Essential Services Expand
2.1 Support services
2.1.1 Health Education
I Individual - HE Material Yes
ii Group - HE Material Yes
iii Mass media - HE Material NA
2.1.2 Training
I Training Material Yes
ii Training Insstts No
separate
iii TOT Yes
iv Training Equipments
Details not
available
2.1.3 Conversance
I Allied Departments NA
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ii NGOs NA
iii Pvt. Institutes NA
iv Others NA
Total No. of support services 5
% support services
3
ESSENTIAL
INFRASTRUCTURE
NRHM NVBDCP RNTCP NLEP NBCP NACP NIDDCP IDSP NCD
3.1 Physical Structures
3.1.1
Infrastructure of Diagnostic
Services
I # Facilities undertaking active
surveillance Yes
ii # Facilities undertaking passive
surveillance Yes
iii # Programme dedicated facilities NA
iv # Treatment proving centers Yes
v # Residual Spray teams employed Yes
vi # Space spray teams Yes
vii # Oil spray teams No
viii # Bed-net Impregnation teams Through
PDS
ix # hatcheries maintained No
x # water bodies released ant larval
fishes
Not
available
3.1.2 Laboratory Services
I Pathology (Clinical Laboratory) Yes
ii Bacteriology Laboratory Yes(MC)
iii Hematological laboratory Yes
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iv Serological Laboratory Yes
v Biochemistry Laboratory Yes
vi Ophthalmologic Laboratory
vii Imaging/Radiological Laboratory Yes
3.1.3 Disability prevention services
I Physical Rehabilitation NA
ii Medical Rehabilitation NA
iii Surgical Rehabilitation NA
iv Vocational Rehabilitation NA
v Social Rehabilitation NA
Total I/S Items available 0
% I/S Items available 0%
3.2 Manpower
I Specialists
ii Doctors
iii Technicians
iv Others
Total Health staff in place
available
% staff in place
3.3 Logistics
3.3.1 Equipments (Specify)
I OPD equipment Available
ii Laboratory equipment Available
iii Vector control equipments Available
iv Chemical control equipments Available
v Biological control Appliances NA
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3.3.2 Drugs, chemicals and others
I Availability of adequate quantity
of Routine Programme Drugs Yes
ii
Availability of drugs for
management of complicated,
resistant, relapsed cases, etc.
Yes
iii Availability other supportive drugs required under programme.
Yes
iv
Availability of Chemicals &
insecticides Yes
v Bed nets LLIN
vi Biological (anti-larval fishes) No
3.3.3 Referral & Mobility
I Vehicle/s Ambulance
ii other modes of transport Own vehicle
Total Logistic items available
% Logistic Items available
4 Funds utilization NRHM NVBDCP RNTCP NLEP NBCP NACP NIDDCP IDSP NCD
I Funds allocated 36356533 4381668 1237424 Not available
Not available
Not available 200219
ii Funds Utilized 32382689 4158000 336688
Not
available
Not
available Not available
1708
iii % Utilization 10.93% 94.90% 27.21% 0%
Not
available
Not
available Not available
0.85% Not
available
5 Cross-checking
I Laboratories Yes
ii Blood/sputum slides of Malaria
Send to RD
and central lab
15
6 Satisfaction studies
I Staff
ii Beneficiaries
iii Therapeutic efficacy studies
iv Entomological studies
7 SUPERVISION, M&E
Sl. No. Particulars
i MIS Established
Diseases are classified on ICD-10 pattern
Not visible
MPR Format Developed
HIMS is established
at District
QPR format developed
Half yearly report format
developed
Annual Report Format developed
All Necessary Records Registers
maintained
Monitoring Indicators Identified
If MIS is functional, provide a
copy of the consolidated Report of last month
ii(a)
Necessary Registers &Records
maintained
A All necessary files and records as per programme at different programme manager of current national
Programmes at district levels.
B
C
D
E
16
F
17
ii Admin Monitoring
Monthly Reports submitted Yes
Quarterly Reports submitted Yes
Half yearly Reports submitted Yes
Annual Reports Prepared Yes
Monitoring indicators developed Yes
If prepared , provide a copy of the
Report for the last year? Yes
iii Int. Audit
Monthly Review meeting
organized
Yes-programme
meeting
Quarterly meeting organized
Half Yearly Review meeting
Organized
Not
available
Annual Meeting Organized
Not available
National Review meeting
organized
Not
available
If yes, provide a copy of ATR on
the minutes
Not
available
iv Patient care (# Developed
complications)
Ante-natal cases
Post natal complication
New born/Infants
IOL cases under NBCP
TB cases
Leprosy cases
other cases
If yes, provide a copy of the ATR
18
v Medical Audit (# Deaths
reported &reviewed)
NRHM NVBDCP RNTCP NLEP NBCP NACP NIDDCP IDSP NCD
Maternal Deaths
Child deaths
Malaria deaths
Tuberculosis Deaths
Others (specify)
If undertaken, provide a copy of the ATR
vi Supervisory visits by
State/National Prog. manager
what was checked
Not
available
what gaps were found
Not
available
what instructions were given Not available
what administrative directions
given
Not
available
If provided, a copy of the follow up action taken
vii External Audit
Independent Review
Not
available
Review by Expert Groups
Not
available
If undertaken, provide a copy of the ATR
Not available
Total No. of Monitoring items
% Monitoring Items
19
8
PERFORMANCE OF
INDICATORS
Sl. No. Particulars
8.1 Current Status
1 NCDR (NLEP) 19.99
2 PR 1.85
3 Proportion of Sever cases NA
4 Proportion of Child cases 15.23%
5 Proportion of Female cases 33.44%
6 Proportion of Deformity cases 11.25%
7 # Put on treatment among NCD Not available
8 # Relapsed & Resistant cases Not available
9 # completed the treatment Not available
10 # Under treatment at the end Not available
11 # Deaths Not available
12 IMR Not available
13 MMR Not available
14 Under Five Mortality rate Not available
8.2 Trends of New Cases
I NRHM
IMR Not available
MMR Not available
ii NVDDCP Downtrend
iii RNTCP Not available
iv NLEP Downtrend
v NBCP Not available
vi HIV/AIDS Not available
vii NIDDCP Not available
viii IDSP Not available
ix NCD Not available
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FORM-IV
REGIONAL OFFICES OF HEALTH & FAMILY WELFARE
DATA COLLECTION FORMATS FOR REVIEW OF PERIPHERAL INSTITUTES
Name of the Regional Office: REGIONAL OFFICE FOR HEALTH AND FAMILY WELFARE, RAIPUR
Report for the Month of: JUNE 2010
1. ASSURED SERVICES
Sl. No. Services CHC 1 CHC 2 CHC 3 CHC 4 Total
Lohandiguda Bakawand Tokapal Pharasgaon 4
i Specialists medical Care services available No No No No 0/4
ii Care of routine & emergency cases of surgery No No No No 0/4
iii Care of routine & emergency cases of Medicine No No No No 0/4
iv Care of routine & emergency cases of Obstetrics No No No No 0/4
v
Care of routine & emergency cases of Sick
Children No No No No 0/4
vi 24 Hrs Delivery Services Yes Yes Yes Yes 4/4 (100%)
vii Safe abortion services No No No No 0/4
viii New Born Care Services No No No No 0/4
ix Full Range of Family Planning Services Yes Yes Yes Yes 4/4 (100%)
x Other Medical care for management of nasal
packing, Snake bite, dog bite, etc.
Yes Yes Yes Yes 4/4 (100%)
xi Blood Storage Unit No No No No 0/4
xii Implementation of NHP activities
NRHM Yes Yes Yes Yes 4/4 (100%)
NVDDCP Yes Yes Yes Yes 4/4 (100%)
RNTCP Yes Yes Yes Yes 4/4 (100%)
NLEP Yes Yes Yes Yes 4/4 (100%)
NBCP Yes Yes Yes Yes 4/4 (100%)
HIV/AIDS No No No No 0/4
NIDDCP Yes Yes Yes Yes 4/4 (100%)
IDSP Yes Yes Yes Yes 4/4 (100%)
xiii Non Communicable Diseases
Tobaccos control No No No No 0/4
Injuries and Trauma Yes Yes Yes Yes 4/4 (100%)
CVD No No No No 0/4
Mental Health No No No No 0/4
NOHP No No No No 0/4
Diabetes control No No No No 0/4
Total Assured Services 11/25 11/25 11/25 11/25 44/100
% Assured Services 44% 44% 44% 44% 44%
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2. Other Services
Sl. No. Services CHC 1 CHC 2 CHC 3 CHC 4 Total
Lohandiguda Bakawand Tokapal Pharasgaon 4
2.1 Support Services
i Standards Treatment protocols No No No No 0/4
ii IEC Material Yes Yes Yes Yes 4/4 (100%)
iii Training manuals Yes No No No ¼ (25%)
iv Skill Strengthening Training of staff Yes No Yes Yes ¾ (75%)
v Diet to patients No No No No 0/4
vi Sterilization room Yes No No No ¼ (25%)
vii Central Sterilization storage Depot. (CSSD) No No No No 0/4
viii Laundry No No No No 0/4
ix Storage Yes Yes No Yes ¾ (75%)
5/9 (56%) 2/9 (22%) 2/9 (22%) 3/9 (33%) 12/36 (33%)
2.2. Accessory Services
i Citizen's charter Yes Yes Yes Yes 4/4 (100%)
ii Electricity supply Yes Yes Yes Yes 4/4 (100%)
iii Emergency Lights No No Yes No 1/4 (25%)
iv Telephone Yes Yes Yes Yes 4/4 (100%)
v Civil engineering Yes No No No 1/4(25%)
vi Fire protection No No Yes No 1/4(25%)
vii Water supply Yes Yes Yes Yes 4/4 (100%)
viii Waste disposal No No No No 0/4
ix Mortuary Yes Yes No Yes ¾(75%)
2.3. Diagnostic Laboratory) (180 Sq. Mts)
i Pathology (Clinical Laboratory) Yes Yes Yes Yes 4/4 (100%)
ii Bacteriology Laboratory No No No No 0/4
iii Hematological laboratory Yes Yes Yes Yes 4/4 (100%)
iv Serological Laboratory No No No No 0/4
v Biochemistry Laboratory Yes No No No ¼(25%)
vi Cardiac laboratory (ECG) No No No No 0/4
vii Ophthalmologic Laboratory No No No No 0/4
viii Imaging/Radiological Laboratory Yes Yes Yes Yes 4/4 (100%)
4/8 (50%) 3/8 (38%) 3/8 (38%) 3/8 (38%) 13/32 (41%)
2.4. Activities of NHP
I Human Control
i Diagnostic Services Yes Yes Yes Yes 4/4 (100%)
ii Treatment Yes Yes Yes Yes 4/4 (100%)
iii Disability management Yes No No Yes 2/4 (50%)
3/3 (100%) 2/3 (67%) 2/3 (67%) 3/3 (100%) 10/12 (83%)
22
II Vector Control Lohandiguda Bakawand Tokapal Pharasgaon Total
I Interval Residual Spray Yes Yes Yes Yes 4/4 (100%)
ii Space spray No No No No 0/4(0%)
iii Impregnated Bed Net Provision No Yes Yes
III Biological Control
I Maintenance of Hatcheries No No No No 0/4(0%)
ii Release of Anti-larval Fishes No No No No 0/4(0%)
iii others No No No No 0/4(0%)
IV Chemical Control
I Oil spray on water surface No No No No 0/4(0%)
ii Others No No No No 0/4(0%)
V Others Activities
I Health Education Yes Yes Yes Yes 4/4 (100%)
ii Training No Yes Yes Yes ¾ (75%)
iii Conversance No No Yes Yes 2/4 (50%)
2.5 NRHM
1 Ante-natal Care Services Yes Yes Yes Yes 4/4 (100%)
I Intra-natal care services Yes Yes Yes Yes 4/4 (100%)
ii Post natal care services Yes Yes Yes Yes 4/4 (100%)
iii JSY care Services Yes Yes Yes Yes 4/4 (100%)
iv Immunization of Children Yes Yes Yes Yes 4/4 (100%)
v Full Range of FP Services (Camps) Yes Yes Yes Yes 4/4 (100%)
vi Health Education Yes Yes Yes Yes 4/4 (100%)
vii Training Yes Yes Yes Yes 4/4 (100%)
Total Services provided 8/8 8/8 8/8 8/8
% services provided 100% 100% 100% 100%
3. INFRASTRUCTURE AVAILABLE
3.1. Physical Infrastructure (1503.32 Sq Mts)
Sl. No. Services Lohandiguda Bakawand Tokapal Pharasgaon Total
I Review by VH&SC
i Whether VH&SC are constituted Yes Yes Yes Yes 4/4 (100%)
ii Whether the composition of the VH&SC is as the
guidelines.
Yes Yes Yes Yes 4/4 (100%)
iii Whether VH&SC are convening the meeting
regularly No No No No
(0/4)
iv If Yes, at what interval N.A. N.A. N.A. N.A.
23
v Whether Discussion as agenda are undertaken. N.A. N.A. N.A. N.A.
vi Whether the Minutes of the meeting are prepared
and circulated to all the concerned N.A. N.A. N.A. N.A.
vii Whether the feed back on the minutes is received. N.A. N.A. N.A. N.A.
viii Village Health day & Health camps are organized N.A. N.A. N.A. N.A.
ii Entrance Zone: (72 Sq. Mts)
Location & Floor Area Good N.A. N.A. N.A.
Registration & Records Yes Yes Yes Yes 4/4 (100%)
Pharmacy Yes Yes Yes Yes 4/4 (100%)
Drugs Storage Yes Yes Yes Yes 4/4 (100%)
Public Utility Yes No No No ¼ (25%)
Circulation space Yes Yes Yes Yes 4/4 (100%)
iii Ambulatory Zone (OPD) (321.4 Sq. Mts)
Causality/Emergency No Yes No Yes 2/4 (50%)
GDMO Room Yes Yes Yes Yes 4/4 (100%)
AYUSH MO Room No No No No 0/4
8 Specialists Room No No No No 0/4
Treatment Room No Yes Yes Yes 3/4 (75%)
Refraction Room Yes Yes Yes Yes 4/4 (100%)
Nursing station Yes Yes Yes Yes 4/4 (100%)
Causality/Emergency No Yes Yes Yes ¾ (75%)
Dress Room Yes Yes Yes Yes 4/4 (100%)
Injection Room Yes Yes Yes Yes 4/4 (100%)
Female Injection Room No No No No 0/4
Public Utilities Yes No No No ¼ (25%)
Waiting Room No No No No 0/4
iv In-Patient Zone (313.76 Sq. Mts) Lohandiguda Bakawand Tokapal Pharasgaon Total
Male Wards No Yes Yes Yes
Female wards No Yes Yes Yes
Private Room No No No No
Isolation Room No No No No
Nursing station No Yes Yes Yes
Patient areas No No N.A. N.A.
Ancillary areas N.A. No N.A. N.A.
Rest Rooms N.A. No N.A. N.A.
24
v Critical Zone (Operation Room/Labour Room)-(240 Sq. Mts)
Patient Area N.A. No N.A. N.A.
Staff Area N.A. N.A. N.A. N.A.
Supply areas N.A. N.A. N.A. N.A.
OT/LR area N.A. N.A. N.A. N.A.
Public Utility N.A. N.A. N.A. N.A.
Circulation area N.A. N.A. N.A. N.A.
vi Administration Zone ( 60 Sq. Mts)
General administration Yes Yes Yes Yes
Establishment - No N.A. N.A.
Accounts - No N.A. N.A.
General Store - Yes Yes Yes
Total No. I/S items Present
% of I/S items Present
3.2. Manpower available in the CHCs as per IPHS
Sl. No. Categories of staff Lohandiguda Bakawand Tokapal Pharasgaon Total
Specialist Staff
I General Surgeon No No No No 0/4
ii Physician No No No No 0/4
iii O&G No No No No 0/4
iv Pediatrics No No No No 0/4
v Anesthetist No No No No 0/4
vi Public Health manager No Yes Yes No 2/4(50%)
vii Eye Surgeon (1for every 5 CHC) No No No No 0/4
viii Dental Surgeon No No No No 0/4
Total # Staff 0/8 1/8 1/8 0/8 2/32 (6%)
% staff against sanctioned
Key Essential Staff
ix GDMOs with at least 2 female MO) No No No No 0/4
(50%)
x Specialist of AYUSH No No No No 0/4
xi GDMO (AYUSH ) No No 1 No ¼ (25%)
xii Staff Nurse 1 3 3 3
xiii PHN No No No No 0/4
xiv ANM 1 1 1 1 4/4 (100%)
xv Pharmacist/Compounder 2 1 1 2
xvi Pharmacist – AYUSH No NO No No 0/4
xvii Lab. Technician 1 1 1 1 4/4 (100%)
xviii Radiographer 1 1 1 1 4/4 (100%)
xix Ophthalmic Assistant 1 1 1 1 4/4 (100%)
xx Dresser 1 3 1 2
Total # Staff 9 12 11 12
% staff against sanctioned 58% 58% 67% 58% 60%
25
Other staff Lohandiguda Bakawand Tokapal Pharasgaon Total
xxi Ward boy /Nursing orderly 2 6 2 1 11
xxii Sweeper 3 1 1 1 6
xxiii Chowkidar 1 1 1 0 3
xxiv Dhobi No No No No
xxv Mali No No No No
xxvi Aya 1 1 1 1 4
xxvii Peon ` 2 1 4 3 10
xxviii OPD attendant No No No No
xxix Registration Clerk No No No No
xxx Statistical Assistant /Data entry operator 1 1 1 1 4
xxxi Accountant/Administrative Assistant NO No 1 No 1
xxxii OT Technician No 1 1 1 3
Total 10 12 12 8 42
% staff against sanctioned 50% 42% 67% 42% 50%
Grand Total # Staff
% staff against sanctioned
3.3. Logistic Support
Sl. No. Logistics Lohandiguda Bakawand Tokapal Pharasgaon Total
3.3.1 Logistics - Vehicle/Referral transport Model
i Bicycles/ Moped No No No No
ii Ambulances 3 2 3 3
iii Call vehicles - - 1 -
iv Out sourced vehicles No No No
3.3.2 Logistic Equipments Lohandiguda Bakawand Tokapal Pharasgaon
i Surgical Instruments Set I No No No No 0/4
ii Surgical Instruments Set II No No No No 0/4
iii Surgical Instruments Set III No No No No 0/4
iv Surgical Instruments Set IV No No No No 0/4
26
v Surgical Instruments Set V No No No No 0/4
vi Surgical Instruments Set VI No No No No 0/4
vii IUD insertion Equipment Kit Yes Yes Yes Yes 4/4 (100%)
viii Normal Delivery Kit Yes Yes Yes Yes 4/4 (100%)
ix Equipment for Anesthetic No No No No 0/4
x Equipment for Neonatal Resuscitation Yes Yes Yes Yes 4/4 (100%)
xi Material Kit for Blood transfusion No No No No 0/4
xii Equipment for OT Yes Yes No No 2/4 (50%)
xiii Equipment for LR Yes Yes No No 2/4 (50%)
xiv Equipments for Radiology Yes Yes Yes Yes 4/4 (100%)
3.3.3 Logistics- Drugs Lohandiguda Bakawand Tokapal Pharasgaon
i Routine Drugs Yes Yes Yes Yes 4/4 (100%)
ii Tablets Yes Yes Yes Yes 4/4 (100%)
iii Capsules Yes Yes Yes Yes 4/4 (100%)
iv Injections Yes Yes Yes Yes 4/4 (100%)
v Vaccines & Antiserum Yes Yes Yes Yes 4/4 (100%)
vi Ayurvedic drugs No No No No 0/4
vii Unani drugs No No No No 0/4
viii Sidha Drugs No No No No 0/4
ix Homeopathic drugs No No No No 0/4
x Programme related drugs
Programme related drugs
NRHM Yes Yes Yes Yes 4/4 (100%)
NVDDCP Yes Yes Yes Yes 4/4 (100%)
RNTCP Yes Yes Yes Yes 4/4 (100%)
NLEP Yes Yes Yes Yes 4/4 (100%)
NBCP Yes Yes Yes Yes 4/4 (100%)
HIV/AIDS No No No No 0/4
NIDDCP Yes Yes Yes Yes 4/4 (100%)
IDSP Yes Yes Yes Yes 4/4 (100%)
NCD No No No No 0/4
Total No. of Logistic Items Present 7/9 7/9 7/9 7/9 28/36
% logistic items present 78% 78% 78% 78% 78%
27
4 Funds allocation & Utilization Lohandiguda Bakawand Tokapal Pharasgaon Total
i Funds allocated N.A. 1 lac 13 lac
6 lack
96775
ii Funds utilized N.A. 1 lac 7 lac 3 lack 46 426
iii % funds utilized N.A. 100% 52% 46% 66%
5 CROSS-VERIFICATION/FIELD VERIFICATION
I Malaria Slides Lohandiguda Bakawand Tokapal Pharasgaon Total
# +ve slides cross examined 1 5 0 NA
# Discrepancies found 0 0 0 NA
# -ve blood slides cross-examined 4 5 15 NA
# Discrepancies found 0 0 0 NA
Total Slides cross-examined 5 10 15 NA
Total discrepancies found 0 0 0 NA
% discrepancies found 0 0 0 NA
ii Peripheral Laboratories
Adequacy of Infrastructure of the laboratories NO YES NO NO ¼ (25%)
Trained Technician in-position 1 2 1 1
Adequate testing equipments in place No Yes No Yes 2/4 (50%)
adequate chemicals in place Yes Yes No Yes ¾ (75%)
Average no. of tests undertaken per day 30 15-17 20-30 40-100
Is it overburdened Yes No No Yes
Adequacy of records maintained No Yes Yes No 2/4 (50%)
Validity of results by cross checking No No No No 0/4
Quality of slides and tests No No No No 0/4
SOP/ Guidelines in place No No No No 0/4
Test results are given on the same day. No No No No 0/4
% of quality items present
6 SATISFACTION STUDIES Lohandiguda Bakawand Tokapal Pharasgaon Total
I Job Satisfaction (as per format) 1 1 2 2
ii Patient's Satisfaction (as per format) 1 1 1 2
28
7. SPERVISION & MONITORING
Sl. No. Particulars Lohandigu
da
Bakawan
d Tokapal Pharasgaon
Total
i MIS Established
Diseases are classified as per ICD-10 pattern No No No No 0/4
MPR Format Developed Yes Yes Yes Yes 4/4 (100%)
QPR format developed Yes Yes Yes Yes 4/4 (100%)
Half yearly report format developed Yes Yes Yes Yes 4/4 (100%)
Annual Report Format developed Yes Yes Yes Yes 4/4 (100%)
Monitoring Indicators Identified No Yes Yes Yes 3/4 (75%)
If MIS is functional, provide a copy of the
consolidated Report of last month
Yes Yes Yes Yes 4/4 (100%)
All Necessary Records Registers maintained
a HIMS Yes Yes Yes Yes 4/4 (100%)
b JSY Yes Yes Yes Yes 4/4 (100%)
c ANC, PNC Yes Yes Yes Yes 4/4 (100%)
d Immunization Yes Yes Yes Yes 4/4 (100%)
e ODDI IOD Yes Yes Yes Yes 4/4 (100%)
f NLEP Yes Yes Yes Yes 4/4 (100%)
g RNTCP Yes Yes Yes Yes 4/4 (100%)
h NVBDCP Yes Yes Yes Yes 4/4 (100%)
i JDS Yes Yes Yes Yes 4/4 (100%)
j F.P. Register Yes Yes Yes Yes 4/4 (100%)
k MCH Register Yes Yes Yes Yes 4/4 (100%)
l Death Register Yes Yes Yes Yes 4/4 (100%)
m Contraceptive Register Yes Yes Yes Yes 4/4 (100%)
ii Admin Monitoring Lohandigu
da
Bakawan
d Tokapal Pharasgaon
Total
Monthly Reports submitted Yes Yes Yes Yes 4/4 (100%)
Quarterly Reports submitted Yes Yes Yes Yes 4/4 (100%)
Half yearly Reports submitted Yes Yes Yes Yes 4/4 (100%)
Annual Reports Prepared Yes Yes Yes Yes 4/4 (100%)
Monitoring indicators developed No No No No 0/4
If prepared, provide a copy of the Report for the
last year?
iii Int. Audit
Monthly Review meeting organized Yes Yes No No 2/4 (50%)
Quarterly meeting organized Yes Yes Yes Yes 4/4 (100%)
29
Half Yearly Review meeting Organized Yes Yes Yes Yes 4/4 (100%)
Annual Meeting Organized Yes Yes No No 2/4 (50%)
National Review meeting organized Yes Yes No No 2/4 (50%)
If yes, provide a copy of ATR on the minutes - - - -
iv Patient care (# Developed complications) Lohandigu
da
Bakawan
d Tokapal Pharasgaon
Total
Ante-natal cases 42 N.A. 513 212
Post natal complication NIL N.A. 519 159
New born/Infants - N.A. - 77
IOL cases under NBCP - N.A. - 0
TB cases 36 N.A. - 0
Leprosy cases 3 N.A. - 0
other case - - - 0
If yes, provide a copy of the ATR - - - 0
v Medical Audit (# Deaths reported &reviewed)
Maternal Deaths 0 0 0 2
Child deaths 0 0 21 47
Malaria deaths 0 0 0 NIL
Tuberculosis Deaths 0 0 0 -
Others (specify) 0 0 0 -
If undertaken, provide a copy of the ATR - - - -
vi Supervisory visits by State/National Prog.
manager
what was checked Yes Yes Yes No
what gaps were found Yes - No No
what instructions were given Yes - N.A. No
what administrative directions given Yes - N.A. N.A.
Provide a copy of the follow up action taken
vii External Audit
Independent Review No No No No
Review by Expert Groups Yes No No No
If undertaken, provide a copy of the ATR No No - -
vii Whether the feed back on the minutes is received. No No N.A. N.A.
viii Village Health day & Health camps are organized Yes Yes Yes Yes
Total No. of Monitoring Items present
% Monitoring Items Present
30
8 Performance of services Lohandigu
da
Bakawan
d Tokapal Pharasgaon
Total
8.1 Hospital performance
# patients reported in OPD in last one year 21352 16668 15911 23863
# days hospital OPD operated 362 362 362 362
# Patient days in Hospitals N.A. 90 N.A. N.A.
# Patients admitted in Hospital 2160 3347 1409 9036
# of Bed days - N.A. N.A. N.A.
# patients died in hospital 4 NIL NIL N.A.
# Patients Discharged 2156 3347 1409 9036
# Live births occurred in hospital during reference
period 393 407 199 286
# of infant deaths 0 0 88
# of Maternal Death 0 0 0 0
# of abortions 10 0 0 0
8.2 Hospital Performance Indicators
Average daily Attendance in OPD in last one year 45 3347 80 80-85
Average duration stay in hospital N.A. N.A. N.A. N.A.
Bed Occupancy Ratio N.A. N.A. N.A. N.A.
Bed Turn over rate N.A. N.A. N.A. N.A.
Death rate N.A. N.A. 8/100 N.A.
IMR N.A. N.A. N.A. N.A.
MMR N.A. N.A. N.A. N.A.
8.3 NHP (Leprosy) NLEP
Prevalence rate N.A. 0.4/1000 N.A. 0.4/10,000
New cases detection rate N.A. N.A. N.A. 0.8/10,000
Prop. Of Sever cases N.A. - N.A. N.A.
Prop. Of Child cases N.A. 10% N.A. N.A.
Prop. Of female cases N.A. 30% N.A. 0%
Prop. Of Deformity cases N.A. 0% N.A. -
Prop. Of cases put on treatment among the new
cases N.A. No N.A. N.A.
Number of cases completed treatment among those
put on treatment N.A. 7 N.A. N.A.
Number of Prevalent cases on record at the end of
report month N.A. 33 N.A. N.A.
Number of resistant/relapse cases N.A. NIL N.A. N.A.
# of CHCs developed Indicators
31
FORM-IV
REGIONAL OFFICES OF HEALTH & FAMILY WELFARE
DATA COLLECTION FORMATS FOR REVIEW OF PRIMARY HEALTH CENTERS
Name of the Regional Office: Regional Office for Health & Family Welfare
Report for the Month of: June 2010
1 ASSURED SERVICES:
Sl. No. Assured Services Under
PHCs PHC1
(Nagar nar)
PHBAKAWA
ND
(Kachnar)
PHC 3
(Lajonda)
PHC 4
(Belar)
PHC 5
(Kalepal)
1.1 Medical Care Services
I OPD services Yes yes Yes Yes Yes
ii Emergency Services (24 Hrs) Yes no Yes Yes Yes
iii Referral services Yes no Yes Yes Yes
iv In-patient Services Yes yes Yes Yes Yes
1.2 Treatment of Specific cases
I Cataract surgeries No no No No No
ii Primary management of
Wounds Yes no Yes
Yes Yes
iii Primary management of
Fractures No no Yes
No No
iv Minor Surgeries Yes no No No Yes
v Primary management of Poisoning, snake bite, dog bite,
etc.
No no No No No
vi Primary management of Burns No no No No No
1.3 MCH & FP Services PHC1
(Nagar nar)
PHBAKAWA
ND
(Kachnar)
PHC 3
(Lajonda)
PHC 4
(Belar)
PHC 5
(Kalepal)
I ANC Yes yes Yes Yes Yes
ii INC (24x7 Hrs services) Yes yes No No Yes
iii PNC Yes yes Yes Yes Yes
iv JSY Yes yes No No Yes
v Immunization No no No No No
vi MTP services No no No No No
vii RTI/STD management No no Yes Yes Yes
viii FP methods Yes yes Yes Yes Yes
ix New Born care No no No No No
x Sick child care No no No No No
1.4 Other Services
I Nutritional Services No no No No No
ii School Health Services Yes yes Yes Yes Yes
iii Safe drinking water Yes na No No No
iv Control of locally endemic
diseases Yes yes Yes
Yes Yes
v Surveillance & control of epidemic diseases
Yes yes Yes Yes Yes
vi Collection of vital Statistics Yes yes Yes Yes Yes
vii Health Education Yes yes Yes Yes Yes
32
viii AYUSH services Yes no No No No
ix Rehabilitation services
No no No
No No
1.5 National Health programme PHC1
(Nagar nar)
PHBAKAWA
ND
(Kachnar)
PHC 3
(Lajonda)
PHC 4
(Belar)
PHC 5
(Kalepal)
I NRHM Yes yes yes Yes Yes
ii HIV/AIDS No no No No No
iii NVBDCP Yes yes yes Yes Yes
iv RNTCP Yes yes yes Yes Yes
v NLEP Yes yes yes Yes Yes
vi NBCP Yes no No No No
vii NIIDCP No no No No No
viii IDSP Yes yes yes Yes Yes
iv NCD-Newer initiatives No no No No No
1.6 Field Activities
Monitor activities of the SHCs Na na Na Na Na
Activities of the ASHAs Na na Na Na Na
MO to visit all SHC once in a month
Na na Na Na Na
HS/LHV to visit once a week Na na Na Na Na
Total activities undertaken
% of activities against total
2 Other Services PHC1
(Nagar nar)
PHBAKAWA
ND
(Kachnar)
PHC 3
(Lajonda)
PHC 4
(Belar)
PHC 5
(Kalepal)
2.1 Basic Laboratory Services
I Routine -Urine, stool & blood Hb only Hb only NA NA NA
ii BT&CT No no Na NA NA
iii Bacteriology-RTI, Sputum AFB only no Na NA No
iv Blood smear for malaria parasite
Yes yes NA NA No
v Rapid test for pregnancy No yes No Yes Yes
vi RPR test Syphilis/yaws No no No NA No
vii Rapid Diagnostic test for
Typhoid No no No
NA No
viii Rapid test kit for fecal
contamination of water No no No
NA No
2.2 Support Services
i Standards Treatment protocols NA NA NA NA NA
ii IEC Material Yes NA yes No Yes
iii Training Manuals NA NA na NA No
iv
Skill Strengthening Training of
staff No no no
No No
v Diet to patients No no no No No
vi Sterilization room No no no No No
vii
Central Sterilization storage
Depot. (CSSD) No no no
No No
33
viii Laundry No no no No No
ix Storage Yes yes no Yes No
2.3 Amenities/Accessory Services PHC1
(Nagar nar)
PHBAKAWA
ND
(Kachnar)
PHC 3
(Lajonda)
PHC 4
(Belar)
PHC 5
(Kalepal)
Citizen's charter NA NA NO NA NA
Adequate Residential
Accommodation with all amenities
NA NA NO
NA NO
Lecture Hall for training NA NA NO NA NO
Electricity with adequate back-
up NO NA NO
NA NO
Adequate water supply YES NA NO NA NO
Telephone NA NA NO NA YES
Garden NA NA NO NA NO
Waste disposal facilities NA NA NO NA NO
2.4. Activities of NHP
PHC1
(Nagar nar)
PHBAKAWA
ND
(Kachnar)
PHC 3
(Lajonda)
PHC 4
(Belar)
PHC 5
(Kalepal)
I Human Control
I Diagnostic Services YES YES YES YES YES
ii Treatment YES YES YES YES YES
iii Disability management NO NO NO NO NO
II Vector Control
I Interval Residual Spray YES YES YES YES YES
ii Space spray NO NO NO NO NO
iii Impregnated Bed Net Provision YES YES YES YES YES
III Biological Control
I Maintenance of Hatcheries NO NO NO NO NO
ii Release of Anti-larval Fishes NO NO NO NO NO
iii others
IV Chemical Control
I Oil spray on water surface NO NO NO NO NO
ii Others
iii Others
V Others Activities PHC1
(Nagar nar)
PHBAKAWA
ND
(Kachnar)
PHC 3
(Lajonda)
PHC 4
(Belar)
PHC 5
(Kalepal)
I Health Education YES YES YES YES YES
ii Training NO NO NO NO NO
iii Conversance NA NA NA NA NA
34
2.5 NRHM
1 Ante-natal Care Services YES NO YES YES YES
I Intra-natal care services YES YES NO NO YES
ii Post natal care services YES NO YES YES YES
iii JSY care Services YES YES NO
NO
YES
iv Immunization of Children NO NO NO NO NO
v Full Range of FP Services NA NA NA NA NO
vi Health Education YES YES YES YES YES
vii Training NO NO NO NO NO
Total activities undertaken
% of activities against total
Sl. No. Infrastructure
PHC1
(Nagar nar)
PHBAKAWA
ND
(Kachnar)
PHC 3
(Lajonda)
PHC 4
(Belar)
PHC 5
(Kalepal)
3.1 Review by HP&HM
Committee/RKS
i Whether VH&SC are
constituted YES YES YES
YES YES
ii Whether the composition of the
VH&SC is as the guidelines. NOT KNOWN NA NA
NA NA
iii Whether VH&SC are
convening the meeting regularly NO NO NO
NA NO
iv If Ye, at what interval
v Whether Discussion as agenda
are undertaken. NA NA NA
NA NA
vi Whether the Minutes opf the
meeting are prepared and circulated to all the concerned NA NA NA
NA NA
vii Whether the feed back on the
minutes is received. NO NO NO
NO NO
viii Village Health day & Health
camps are organized NOT KNOWN NO NO
NA NA
3.2 Physical Infrastructure PHC1
(Nagar nar)
PHBAKAWA
ND
(Kachnar)
PHC 3
(Lajonda)
PHC 4
(Belar)
PHC 5
(Kalepal)
I PHC Building
Easily accessible within locality YES YES YES YES YES
Building government or rented GOVT GOVT GOVT GOVT GOVT
Wheel chair friendly NO NO NO NO NO
Well Lit & Ventilated YES YES YES YES YES
Plinth Area 375 to 450 Sq. mtrs YES YES NO YES NO
Boundary wall/fence NO NO NO NO NO
ii Entrance
Registration and Record Room NA NO NO NO NO
Drug dispensing room NA NO NO YES NO
Waiting area for patients YES YES NO YES YES
Ramps at the doorways NO NO NO NO NO
35
iii Waiting area
Adequate seating YES NO NO YES NO
Display of HE Material YES NO YES NO YES
Separate Public utility NO NA NO YES NO
Facility for drinking water NO NO NO NO NO
Proper sign boards YES NO NO NO NO
Complaint box NO NO NO NO NO
clean surrounding, no water
logging YES YES YES
YES NO
36
iv Outpatient Department PHC1
(Nagar nar)
PHBAKAWA
ND (Kachnar)
PHC 3
(Lajonda)
PHC 4
(Belar)
PHC 5
(Kalepal)
Separate consultation &
examination room NO NO NO
NO NO
Privacy for physical examination NO NO YES NO YES
Public utility NO YES NO NO NO
v In-patient Wards
4-6 beds separate wards for Male
& females NO NO NO
NO NO
Facility for drinking water NA NO NO NO NO
clean toilet NO NO NO NO NO
separate nursing duty room NO NO NO NO NO
Nursing station NO NO NO NO NO
clean linen NO NO NO NO NO
provisions of Diet NO NO NO NO NO
Cleaning of wards FAIR FAIR POOR FAIR POOR
vi Operation Theater
change room NA NA NA NA NO
Separate storing sterile & other material NA NA NA
NO NO
Adequate Equipments NA NA NA NO NO
Simple Surgical Procedures YES YES YES NO NO
vii Labour Room
Separate septic & aseptic deliveries NA NO NO NO NO
well lit & ventilated YES YES NO NO NO
Toilet YES YES NO NO NO
Drinking water NO NO NO NO NO
separate storing of dirty & clean linen NO NO NO
NO NO
Baby care room NA NO NO NO NO
viii Minor OT
Minor surgeries YES YES YES NO NO
Emergencies/causality
management YES YES YES
NO NO
well equipped to handle
emergencies NO NO NO
NO NO
ix Laboratory
Sufficient space YES YES NO NO NO
Separate areas for collection &
Screening NO NO NA
NO NO
should have marble /stone tables & bash basins NO YES NA
NO NO
x General Stores
Separate sterile & common linen,
drugs etc. NO NO NO
NO NO
well lit & ventilated YES YES YES YES NO
Sufficient space YES NO NO YES NO
dispensing cum store NO NO NO YES NO
Vaccine & antiserum NO YES NO NO NO
Grand total Infrastructure Facilities
% of physical infrastructure Facilities
37
3.3. MANPOER IN PHC
Sl. No. Action points PHC1
(Nagar nar)
PHBAKAWA
ND (Kachnar)
PHC 3
(Lajonda)
PHC 4
(Belar)
PHC 5
(Kalepal)
I Medical officer
(Exiting-1, Recommended -3) 01 01 02 AMO
2 2
AYUSH Practioner
(Exiting-0, Recommended -1) 01 00 00
0 0
Account Manager
(Exiting-0, Recommended -1) 00 00 00
0 0
ii Pharmacist
(Exiting-1, Recommended -2) 01 00 01
1 1
iii Nurse – Midwife/Staff Nurse
(Exiting-1, Recommended -5) 01 01 00
0 0
iv Health Worker (female)
(Exiting-1, Recommended -1) 01 02 01
1 1
v Health Educator
(Exiting-1, Recommended -1) 00 00 00
0 0
vi Health Assistant (1 (M), 1 (F)
(Exiting-2, Recommended -2) 00 00 00
0 0
vii Clerks
(Exiting-2, Recommended -2) 00 00 00
0 0
viii Laboratory technician (Exiting-1, Recommended -2)
02 01 00 0 0
ix Driver
(Exiting-1, Recommended -0) 00 00 00
0 0
x Class IV (Exiting-4, Recommended -4)
01 02 01 2 3
TOTAL
(Exiting-15, Recommended -
24/25)
08 07 05
6 7
RMA 0 1 1 1 1
3.4. LOGISTICS SUPPORT IN PHC
Sl. No. Logistics PHC1
(Nagar nar)
PHBAKA
WAND
(Kachnar)
PHC 3
(Lajonda)
PHC 4
(Belar)
PHC 5
(Kalepal)
I Equipment:
Physical Examination in OPD YES YES YES NO NO
Ophthalmologic examination & Eye
care YES NO NO
NO NO
Equipment required under NHP NA NA NO NO NO
Set for Labour Room for Normal/assisted delivery NO NO NO
NO NO
Equipment for IUD NA NO NO NO NO
Equipment for pap smear NA NO NO NO NO
Equipment for laboratory NA NO NO NO NO
Necessary Furniture YES YES NA NO YES
ii Drugs
General Drugs AVL AVL AVL AVL AVL
Ayush drugs NA NO NO NO NO
Drugs for RCH programme NA NO NO NO NO
Drugs for RTI/STI NA NO NO YES YES
38
Ayurvedic Drugs NA NA NO NO NO
Unani medicines NA NA NO NO NO
Sidha Medicines NA NA NO NO NO
Homeopathy medicines NA NA NO NO NO
iii Transport Facilities
Referral facilities for emergency
patients NA NA NO
NO NO
Supervision & other out reach activities NA NA NO NO NO
4
FUNDS ALLOCATION &
UTILIZATION
I Funds allocated 175000 APRX 400000 NIL
175000 NA
ii Funds Utilized NIL 91000 NIL NIL NA
iii % utilization 00 NIL 0
5 CROSS-VERIFICATION/FIELD VERIFICATION
I Malaria Slides
PHC1
(Nagar nar)
PHBAKA
WAND
(Kachnar)
PHC 3
(Lajonda)
PHC 4
(Belar)
PHC 5
(Kalepal)
# +ve slides cross examined NA NA NA NA NA
# discrepancies found NA NA NA NA NA
# -ve blood slides cross-examined NA NA NA NA NA
# Discrepancies found NA NA NA NA NA
Total Slides cross-examined NA NA NA NA NA
Total discrepancies found NA NA NA NA NA
% discrepancies found NA NA NA NA NA
ii Peripheral Laboratories
Adequacy of Infrastructure of the laboratories POOR YES NA
NA NA
Trained Technician in-position 02 01 00 0 0
Adequate testing equipments in place NO NO NO NA NA
adequate chemicals in place NO NO NO NA NA
Average no. of tests undertaken per day 60 10 00 0 0
Is it overburdened NO NO NA NA NA
Adequacy of records maintained YES POOR YES POOR NA NA NA
Validity of results by cross checking NA NA NA NA NA
Quality of slides and tests POOR POOR NA NA NA
SOP/ Guidelines in place NA NA NA NA NA
Test results are given on the same day. YES NO NO NA NA
% of quality items present
6 SATISFACTION STUDIES
I Job Satisfaction (as per format)
ii Patient's Satisfaction (as per format)
39
7. SPERVISION & MONITORING
Sl. No. Particulars PHC1
(Nagar nar)
PHBAKA
WAND
(Kachnar)
PHC 3
(Lajonda)
PHC 4
(Belar)
PHC 5
(Kalepal)
i MIS Established
Diseases are classified as ICD-10 Pattern
NO NO NA NA NA
MPR Format Developed YES YES YES YES YES
QPR format developed NA NA NO NA NA
Half yearly report format
developed NA NA NA
NA NA
Annual Report Format developed NA NA NA NA NA
Monitoring Indicators Identified
If MIS is functional, provide a
copy of the consolidated Report of
last month
All Necessary Records Registers maintained
YES YES NO POOR POOR
a NLEP AVL AVL NA AVL NA
b RNTCP AVL AVL NA AVL NA
c NVBDCP AVL AVL NA AVL NA
d
e
ii Admin Monitoring
Monthly Reports submitted YES YES YES YES YES
Quarterly Reports submitted NA NA NA NA NA
Half yearly Reports submitted NA NA NA NA NA
Annual Reports Prepared YES YES NA NA NA
Monitoring indicators developed
If prepared , provide a copy of the
Report for the last year?
iii Int. Audit
Monthly Review meeting organized
YES YES YES YES YES
Quarterly meeting organized NA NA NA NA NA
Half Yearly Review meeting
Organized NA NA NA
NA NA
Annual Meeting Organized NA NA NA NA NA
National Review meeting organized
NA NA NA NA NA
If yes, provide a copy of ATR on
the minutes
40
iv Patient care (# Developed
complications)
PHC1
(Nagar nar)
PHBAKA
WAND
(Kachnar)
PHC 3
(Lajonda)
PHC 4
(Belar)
PHC 5
(Kalepal)
Ante-natal cases NA NA NA NA NA
Post natal complication NA NA NA NA NA
New born/Infants NA NA NA NA NA
IOL cases under NBCP NA NA NA NA NA
TB cases NA NA NA NA NA
Leprosy cases NA NA NA NA NA
other cases
If yes, provide a copy of the ATR
v Medical Audit (# Deaths
reported &reviewed)
Maternal Deaths NA NA NA NA NA
Child deaths NA NA NA NA NA
Malaria deaths NA NA NA NA NA
Tuberculosis Deaths NA NA NA NA NA
Others (specify)
If undertaken, provide a copy of the ATR
vi Supervisory visits by
State/National Prog. manager
what was checked NA NA NA NA NA
what gaps were found NA NA NA NA NA
what instructions were given NA NA NA NA NA
what administrative directions given
NA NA NA NA NA
Provide a copy of the follow up
action taken
vii External Audit
Independent Review NA NA NA NA NA
Review by Expert Groups NA NA NA NA NA
If undertaken, provide a copy of the ATR
Total No. of Monitoring Items
present
% Monitoring Items Present
41
8 Performance of services
PHC1
(Nagar nar)
PHBAKA
WAND
(Kachnar)
PHC 3
(Lajonda)
PHC 4
(Belar)
PHC 5
(Kalepal)
8.1 Hospital performance
# patients reported in OPD in last
one year NA NA NA
3500 NA
# days hospital OPD operated NA NA NA NA NA
# Patient days in Hospitals NA NA NA NA NA
# Patients admitted in Hospital NA NA NA NA NA
# of Bed days NA NA NA NA NA
# patients died in hospital NA NA NA NA NA
# Patients Discharged NA NA NA NA NA
# Live births occurred in hospital
during reference period NA NA NA
NA NA
# of infant deaths NA NA NA NA NA
# of Maternal Death NA NA NA NA NA
# of abortions NA NA NA NA NA
8.2 Hospital Performance Indicators
Average daily Attendance in OPD in last one year 25 10 12
10 18
Average duration stay in hospital NA NA NA 6 HRS NA
Bed Occupancy Ratio NA NA NA NA NA
Bed Turn over rate NA NA NA NA NA
Death rate NA NA NA NA NA
IMR NA NA NA NA NA
MMR NA NA NA NA NA
8.3 NHP
Prevalence rate NA NA NA NA NA
New cases detection rate NA NA NA NA NA
Prop. Of Sever cases NA NA NA NA NA
Prop. Of Child cases NA NA NA NA NA
Prop. Of female cases NA NA NA NA NA
Prop. Of Deformity cases NA NA NA NA NA
Prop. Of cases put on treatment among the new cases NA NA NA
NA NA
Number of cases completed
treatment among those put on
treatment NA NA NA
NA NA
Number of Prevalent cases on
record at the end of report month NA NA NA
NA NA
Number of resistant/relapse cases NA NA NA NA NA
42
FORM-IV
REGIONAL OFFICES OF HEALTH & FAMILY WELFARE
DATA COLLECTION FORMATS FOR REVIEW OF SUB-HEALTH CENTERS
Name of the Regional Office:
Report for the Month of:
1. ASSURED SERVICES BY HSC:
Sl. No. Services Badanjee Kinjoly Dimarapal Alore
1.1 Maternal Health
Antenatal Care Yes Yes Yes Yes
Intranasal care Yes Yes Yes Yes
Postnatal Care Yes Yes Yes Yes
JSY Scheme Yes Yes Yes Yes
1.2 Child Health:
Newborn Care Services Yes Yes Yes Yes
Promotion of exclusive breast feeding Yes Yes Yes Yes
Full Immunization of Children Yes Yes Yes Yes
Vitamin A prophylaxis Yes Yes Yes Yes
Assistance to school health services Yes Yes Yes Yes
Prevention & control of Childhood diseases Yes Yes Yes Yes
1.3 Family planning & Contraceptive:
IEC to ECs for adopting FP methods Yes Yes Yes Yes
Provision of contraceptives Yes Yes Yes Yes
Follow up services to Ecs adopting CCs Yes Yes Yes Yes
1.4 Counseling for safe abortion (MTP) & proper referral
Yes Yes Yes Yes
1.5 Assistance for School Health Services Yes Yes Yes Yes
1.6 Control of locally endemic diseases Yes Yes Yes Yes
1.7 Disease Surveillance & Control:
Surveillance of abnormal increase of cases No No Yes Yes
Weekly reporting of information on syndromes
surveillance
Yes Yes Yes Yes
High level of alertness for unusual events & action
No No No No
1.8 Water Quality Monitoring No No No No
Disinfections of water No No No No
testing of water quality No No No No
1.9 Promotion of sanitation & disposal of garbage Yes Yes No No
1.1 Curative Services
Treatment of minor ailments Yes Yes Yes Yes
Proper referral Yes Yes Yes Yes
Organizing Health days Yes Yes Yes Yes
Provide treatment as per AYUSH No No No No
Total
%age
43
2 Other Services Badanjee Kinjoly Dimarapal Alore
2.1 Support services
Availability of the Guidelines Yes Yes Yes Yes
Laboratory -Routine tests No No No No
Regular Skill development training/CME No No No No
IEC material No No No No
Waste disposal Yes Yes No No
2.2 Accessory Services
Availability of Regular Electricity Yes Yes Yes Yes
Availability of safe drinking Water Yes No No No
Telephone Yes Yes Yes Yes
Transport No No No No
Citizen's Charter Yes Yes Yes No
2.3 Others field activities Badanjee Kinjoly Dimarapal Alore
field visits Yes Yes Yes Yes
Community need assessment Yes Yes Yes Yes
Training No No No No
Records of vital events Yes Yes Yes Yes
2.40 National Health programme Badanjee Kinjoly Dimarapal Alore
NRHM Yes Yes Yes Yes
HIV/AIDS No No No No
NVBDCP Yes Yes Yes Yes
RNTCP Yes Yes Yes Yes
NLEP Yes Yes Yes Yes
NBCP Yes Yes Yes Yes
IDSP Yes Yes Yes Yes
NCD & Cancer Control No No No No
Total
%age
3 INFRASTRUCTURE
REQUIREMENTS: Badanjee Kinjoly Dimarapal Alore
3.1 Review by VH&SC
i Whether VH&SC are constituted Yes Yes Yes Yes
ii Whether the composition of the VH&SC is as the guidelines.
Yes Yes Yes Yes
iii Whether VH&SC are convening the
meeting regularly No No No No
iv If Yes, at what interval No No No No
v Whether Discussion as agenda are undertaken.
No No No No
vi Whether the Minutes of the meeting are
prepared and circulated to all the
concerned
No No No No
vii Whether the feed back on the minutes is
received. No No No No
viii Village Health day & Health camps are
organized
Yes Yes Yes Yes
44
3.2 Physical Infrastructure Badanjee Kinjoly Dimarapal Alore
I Building
SHCs located within locality Center Center Center Center
Government building for SHCs Yes Yes Yes Yes
Compound wall / Fencing gate Yes No No No
Residential facility for HW (F)? Yes Yes Yes Yes
Separate public utilities for M&F 1 1 Yes No
Plinth area (73.50 to 100.20 Mtrs) - 1200 sq. ft. Old 1500 sq. ft
Present condition of building. Good Good Good Good
Condition of plaster on walls Good Good Good Good
Condition of floor. Good Good Good Good
Whether the cleanliness is maintained Good Good Good Good
ii Waiting Area Badanjee Kinjoly Dimarapal Alore
Prominent display boards in local language Yes No Yes No
Visit Schedule of ANM Yes Yes Yes Yes
Suggestion / complaints box No No No No
Display of IEC material Yes Yes Yes Yes
Seating arrangements Yes Yes Yes Yes
iii Clinical Room Badanjee Kinjoly Dimarapal Alore
Examination table Yes Yes Condemn No
OPD Equipment (stethoscope, BP
apparatus, Weight Machine, etc) Yes Yes Yes Yes
Necessary furniture Yes No Yes Yes
iv Labour room available Badanjee Kinjoly Dimarapal Alore
Labour room available Yes Yes Yes Yes
Lithotomy table Yes Yes Yes Yes
Equipment trolly Yes Yes No No
Linen No No No No
Delivery Set No Yes Yes Yes
Suction apparatus Yes Yes Yes No
Newborn case set Yes Yes No No
v Residential Accommodation Badanjee Kinjoly Dimarapal Alore
Living Room - 2 1 1 1 2
Kitchen 1 1 1 1
W.C. 1 1 1 1
Bath Room 1 1 1 1
ANM Stays at Sub-center Yes Yes Yes Yes
HW(M) stays at Sub-center No No No No
3.3 Man power Badanjee Kinjoly Dimarapal Alore
ANM 1 1 1 1
Additional ANM N N N N
HW (Male) 1 1 1 1
AWW Yes No No No
ASHA Yes Yes Yes Yes
Volunteer Worker Yes No No No
Total
%age
LOGISTIC SUPPORT Badanjee Kinjoly Dimarapal Alore
45
3.4
I Equipments
OPD set Yes Yes Yes Yes
Delivery Set Yes Yes Yes Yes
IUD set Yes Yes Yes Yes
First Aid set Yes Yes Yes Yes
DDKs Yes Yes Yes Yes
Furniture Yes No Yes No
ii Drugs
Drug Kit-A (ORS, IFA, Vit.A,Co-tri) Yes Yes Yes Yes
Drug kit-B (Drugs related to delivery) Yes Yes Yes Yes
Additional drugs (used for sever infection) Yes Yes Yes Yes
Other Drugs & vaccine (UIP Vaccine) Yes Yes Yes Yes
NHP drugs (Malaria, MDT, DOT Yes Yes Yes Yes
Contraceptive supplies (Nirodh, OP, Cu.T) Yes Yes Yes Yes
AWW drug Kit No No No No
ASHA drug Kit No No No No
iii Referral Services
Provisions of referral Yes Yes Yes Yes
Total
%age
4 Funds allocated & Utilization
Un-Tied Funds of Rs. 10000/annum Yes Yes Yes Yes
Funds allocated & Utilization 500 3261 7072 4664
Funds utilized 9500 6739 2928 5336
% utilization 95% 67% 29% 53%
4 Field verifications
4.1 Field Verification CC Users
Sterilization Yes Yes Yes Yes
IUD Yes Yes Yes Yes
Oral Pill Yes Yes Yes Yes
Nirodh Yes Yes Yes Yes
4.2 Field verification of the Mothers
ANC Yes Yes Yes Yes
PNC Yes Yes Yes Yes
JSY mothers Yes Yes Yes Yes
4.3 Field Verification of the Children
5 Satisfaction studies
5.1 Client satisfaction Badanjee Kinjoly Dimarapal Alore
Client satisfaction towards ANM Yes Yes Yes Yes
Client satisfaction towards ASHA Yes Yes Yes No
Satisfaction of PRI
5.2 Job Satisfaction
SHC staff 2 2 2 1+1
PHC staff - - - -
CHC staff - - - -
6 Record Maintenance
Sl. No. Registers Maintained Badanjee Kinjoly Dimarapal Alore
46
I Eligible Couples Register Yes Yes Yes Yes
ii Maternal & Child Health Register Yes Yes Yes Yes
a Antenatal, Intra-natal, postnatal Yes Yes Yes Yes
b Under five Register - Immunization Yes Yes Yes Yes
c Under five Register - Growth Monitoring No No No No
iii Birth & Death Register Yes Yes Yes Yes
iv Drug Register Yes Yes Yes Yes
v Equipment/Furniture Register Yes Yes Yes Yes
vi Communicable diseases/ Epidemic Register Yes Yes Yes Yes
vii Passive surveillance register for malaria
cases Yes Yes Yes Yes
viii Register for record pertaining to JSY Yes No No No
ix Register for maintenance of account
including untied funds Yes Yes No -
x Register for water quality and sanitation No No Yes
xi Minor ailments Register OPD-Reg. OPD-Reg. OPD-Reg. OPD-Reg.
xii Records/registers as per various National
Health Programme guidelines Yes Yes Yes Yes
No of Register Maintained properly
% of Maintained properly
7 SPERVISION & MONITORING
Sl. No. Particulars
i HIS Established Badanjee Kinjoly Dimarapal Alore
Diseases are classified as per ICD-10
Pattern No No No Yes
Monthly Progress Report Format used Yes Yes No Yes
MPR received from all reporting units Yes Yes Yes Yes
MPR Summarized & Reviewed Yes Yes Yes Yes
Feedback on MPR given Yes Yes No Yes
ii Admin Monitoring
Monthly Reports submitted Yes Yes Yes Yes
Quarterly Reports submitted No No No Yes
Half yearly Reports submitted No No No No
Annual Reports Prepared Yes Yes Yes Yes
iii Int. Audit
Monthly Review meeting organized Yes Yes Yes Yes
Quarterly meeting organized No No No No
Half Yearly Review meeting Organized No No No No
Annual Meeting Organized Yes Yes Yes Yes
iv Medical Audit (# Deaths/complications
reported and reviewed iro)
Maternal Deaths No No No No
Child deaths No No No No
Malaria deaths No No No No
Tuberculosis Deaths No No No Yes
Others (specify) No No No No
v Supervisory visits by State/National
Prog. Manager Badanjee Kinjoly Dimarapal Alore
what was checked
47
what gaps were found
what instructions were given
what administrative directions given
what follow up action taken
vi External Audit
Independent Review
Review by Expert Groups
8 Performance Indicators Badanjee Kinjoly Dimarapal Alore
I
# ECs using CCs methods for more than 6 months continuously. 10 4 5 7
ii # ANC mothers Registered 34 10 22 24
iii # Mothers gone through the delivery 16 13 17 20
iv # mothers have hospital deliveries 9 8 7 14
v # Children upto 23 months immunized 5 5 3 4
vi # Infant deaths - - - -
vii # Maternal Deaths - - - -
viii # Malaria cases treated 500/35 N.A. 23 + 5 267
ix # TB cases under treatment 1 Yes 1 5
x # Leprosy cases under treatment No No No No
xi
# cases blindness & refractive errors
treated No No No No
xii # HIV/AIDS cases under treatment No No No No
MONTHLY PERFORMANCE REPORT ON TECHNICAL ACTIVITIES FOR ROH&FW
INFORMATION ON SHCs
48
Name of the ROH&FW:
Report for the Month of:
5.1. Field verification Children for fully immunization at SHCs
. Action points Badanjee Kinjoly Dimarapal Alore
1 Total beneficiaries selected 03 02 06 02
2 Total beneficiaries contacted 01 01 01 01
3 Beneficiaries could not be contacted due to
A) No such person living in the area.
B) Left the place temporarily.
C) Left the place permanently
D) Dead
E) Wrong /Incomplete address
F) Others
Total 01 01 01 01
4 No. of beneficiaries confirmed with full doses 01 01 01 01
5 No. of beneficiaries not confirmed with dose - - - -
6 Discrepancies in entries in the age of beneficiaries No No No No
7 Children have Complication after receiving the
services
No No No No
8 Satisfied with the services Yes Yes Yes Yes
5.2. Field verification of ANC and PNC mothers at SHCs
Sl. No. Action points Badanjee Kinjoly Dimarapal Alore
1 Total No of beneficiaries selected 02 02 02 02
2 Total beneficiaries contacted 02 02 02 02
3
Beneficiaries could not be contacted due to
A) No such person living in the area.
B) Left the place temporarily.
C) Left the place permanently
D) Dead
E) Wrong/Incomplete address
F) Others
Total 02 02 02 02
4 Discrepancy in age of beneficiaries No No No No
5 TT received during the pregnancy No No No No
6 IFA tablet received during the pregnancy No No No No
7 IFA consumed as per instruction No No No No
8 Received three Ante natal check up No No No No
9 No of women have gone through delivery No No No No
9.1. No. of Instts Deliveries 01 01 01 01
10 DDK used during delivery Yes Yes Yes Yes
11 Child fed within 30 minute of delivery Yes Yes Yes No
12 Used colostrums as per advise No No No No
13 Exclusive Breast feeding Yes Yes Yes Yes
14 Three post natal check up No Yes Yes Yes
5.3. Field verification of JSY beneficiaries at SHCs
Sl. No. Action points Badanjee Kinjoly Dimarapal Alore
1 Total No of beneficiaries selected 02 02 02 02
49
2 Total beneficiaries contacted 01 01 01 01
3
Beneficiaries could not be contacted due to - - - -
A) No such person living in the area.
B) Left the place temporarily.
C) Left the place permanently
D) Dead
E) Wrong/Incomplete address
F) Others
Total
4 Discrepancy in reporting of beneficiaries No No No No
5 TT received during the pregnancy Yes Yes Yes Yes
6 IFA tablet received during the pregnancy Yes Yes Yes Yes
7 IFA consumed as per instruction Yes Yes Yes Yes
8 Received three Ante natal check up Yes Yes Yes Yes
9 Three post natal check up Yes Yes Yes Yes
10 Monetary benefit under JSY Yes Yes Yes Yes
11 Satisfied with services Yes Yes Yes Yes
50
5.4. Field verification of Clients practicing Contraceptive methods – Sterilization
Sl. No. Action points Badanjee Kinjoly Dimarapal Alore
1 # of selected cases 01 01 01 01
2 # of contacted cases 01 01 01 01
3 Cases not contacted due to
a NSP
b IA/WA
h PO
d TO
e Others
Total
4 Discrepancy
a Age of acceptors No No No
b Age of spouse No No No
d No. of Total child No No No
e No.of Male child No No No
Total 0 0 0
5 Ineligible Cases No No No
6 Denial/ Fake No No No
a Denial cases No No No
b Fake cases No No No
c Double reported cases No No No
Total 0 0 0
7 Follow up by Staff out of found genuine cases yes yes yes
8 Pregnancy during the use of method out of found
genuine cases No No No
9 Complaints if any out of found genuine cases No No No
10 Satisfied with method out of found genuine cases yes yes yes
51
52
5.4. Field verification of Clients practicing Contraceptive methods – IUDs
Sl. No. Action points Badanjee Kinjoly
Dimarap
al Alore
1 # of selected cases 01 01 01 01
2 # of contacted cases 01 01 01 01
3 Cases not contacted due to
A NSP
B IA/WA
H PO
D TO
E Others
Total
4 Discrepancy
A Age of acceptors No No No
B Age of spouse No No No
D No. of Total child No No No
E No.of Male child No No No
Total
5 Ineligible Cases No No No
6 Denial/ Fake No No No
A Denial cases No No No
B Fake cases No No No
C Double reported cases No No No
Total
7 Follow up by Staff out of found genuine cases Yes yes Yes
8 Pregnancy during the use of method out of found
genuine cases
No No No
9 Complaints if any out of found genuine cases No No No
10 Satisfied with method out of found genuine cases Yes yes yes
53
5.4. Field verification of Clients practicing Contraceptive methods - Oral Pills
Sl. No. Action points Badanjee Kinjoly Dimarapal Alore
1 # of selected cases 01 01 01 01
2 # of contacted cases 01 01 01 01
3 Cases not contacted due to
a NSP
b IA/WA
h PO
d TO
e Others
Total
4 Discrepancy
a Age of acceptors No No No
b Age of spouse No No No
d No. of Total child No No No
e No.of Male child No No No
Total
5 Ineligible Cases No No No
6 Denial/ Fake No No No
a Denial cases No No No
b Fake cases No No No
c Double reported cases No No No
Total
7 Follow up by Staff out of found genuine cases Yes yes Yes
8 Pregnancy during the use of method out of found
genuine cases
No No No
9 Complaints if any out of found genuine cases No No No
10 Satisfied with method out of found genuine cases Yes yes yes
54
5.4. Field verification of Clients practicing Contraceptive methods – Condom
Sl. No. Action points Badanjee Kinjoly Dimarapal Alore
1 # of selected cases 01 01 01 01
2 # of contacted cases 01 01 01 01
3 Cases not contacted due to
a NSP
b IA/WA
h PO
d TO
e Others
Total
4 Discrepancy
a Age of acceptors No No No
b Age of spouse No No No
d No. of Total child No No No
e No.of Male child No No No
Total
5 Ineligible Cases No No No
6 Denial/ Fake No No No
a Denial cases No No No
b Fake cases No No No
c Double reported cases No No No
Total
7 Follow up by Staff out of found genuine cases Yes yes Yes
8 Pregnancy during the use of method out of found
genuine cases
No No No
9 Complaints if any out of found genuine cases No No No
10 Satisfied with method out of found genuine cases Yes yes yes
55
56
6.1. Community satisfaction of Mother for Work of ASHAs
Sl. No. Action points Badanjee Kinjoly Dimarapal Alore
1 ASHA visited mothers during period from pregnancy to
delivery yes
yes yes yes
2 Mothers Received three ANC yes yes yes yes
3 Mothers had some problem in last pregnancy
4 Mothers received timely advices for getting treatment yes yes yes yes
5 Institutional deliveries Home Inst Inst Inst
6 Babies weighed after birth
7 Mothers received three PNC yes yes yes yes
8 Mothers get information about proper breast feeding Yes yes Yes yes
9 Mothers have knowledge about the dangerous sign of
ARI.
No No No No
10 Mothers have knowledge about fluid that is to be given
during diarrhea
No No No No
11 Mothers have knowledge about the immunization given to
their child
yes yes yes No
12 Mothers nave knowledge about that the immunization
against measles given in the ninth month
No No No No
57
MONTHLY PERFORMANCE REPORT ON TECHNICAL ACTIVITIES FOR ROH&FW
INFORMATION ON community satisfaction
Name of the ROH&FW:
Report for the Month of:
Sl. No. Action points Badanjee Kinjoly Dimarapal Alore
1 ANMs visited village regularly Yes Yes Yes Yes
2 Mothers had some problem in last pregnancy No No No No
3 Mothers received timely advices for getting treatment Yes Yes Yes Yes
4 Institutional deliveries House House Institute Institute
5 Babies weighed after birth NA NA NA NA
6 Mothers aware about JSY No No yes No
7 Mothers received three PNC Yes No Yes Yes
8 Mothers advised regarding colostrums No No Yes No
9 Mothers get information about proper breast feeding Yes Yes Yes Yes
10 Mothers have knowledge about the dangerous sign of
ARI- No No No No
11 Mothers have knowledge about fluid that is to be given
during diarrhea Yes Yes Yes Yes
12 Mothers have knowledge about schedule of Child
immunization No No No No
13 Mothers aware about the disease for which immunization
given to their child - No No No No
14 Mothers aware about the immunization against measles to be given in the 9th month No No Yes No
15 Awareness of mothers about the contraceptive method - Oral Oral Yes Oral
16 Mothers aware about the side effect of the contraceptive. No No Yes No
17 Awareness about the ideal gap between two children 2 to 3 Years yes Yes 2 to 3 Years
58
Sl. No. 6.1. Community satisfaction of Mother for Work of
ASHAs Action points Badanjee Kinjoly Dimarapal Alore
1 ASHA visited mothers during period from pregnancy to
delivery No Yes Yes No
2 Mothers Received three ANC Yes Yes Yes Yes
3 Mothers had some problem in last pregnancy No No No No
4 Mothers received timely advices for getting treatment Yes Yes Yes Yes
5 Institutional deliveries Yes Yes Yes Yes
6 Babies weighed after birth Yes Yes Yes Yes
7 Mothers received three PNC Yes Yes Yes Yes
8 Mothers get information about proper breast feeding No No No No
9 Mothers have knowledge about the dangerous sign of
ARI.
No No No No
10 Mothers have knowledge about fluid that is to be given during diarrhea
No No No No
11 Mothers have knowledge about the immunization given to
their child
No No No No
12 Mothers nave knowledge about that the immunization
against measles given in the ninth month
No No No No
59
60
6.1. Key Information from sarpanchs on the work of ANMs
Sl. No. Action points Badanjee Kinjoly
Dimara
pal Alore
No. of Pancvhayat Members contacted
1 Do you know about NRHM?
2 Activities of NRHM are smoothly functioning ?
3 Whether the JSY benefited to all the villagers?
4 Do you know about untied funds?
5 Do you have a Joint account with ANM in bank for
untied funds?
6 Is there proper utilization of untied funds?
7 Are the Villagers are benefited out of the untied funds?
8 In your village when and where the health camps are
organized?
9 Who is ASHA in your Village?
10 You know about the functioning of ASHA?
11 Know about the how many Link Worker are working in
your Village?
12 In your village whether the cases of Institutional
deliveries are increased?
13 Any Polio case found in your Village?
14 Is there regular immunization of children from time to
time in your Village?
61