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Gujarat

1. District- Anand

Major observations of Regional Evaluation Team, Bangaluru on Evaluation work carried out in

Anand district of Gujarat State in August, 2011.

I. Details of the visited Institutions:

Districts Visited PHCs / CHCs visited SCs Visited

Anand PHCs: Vadod, Budhej and

Undel

Gopalpura, Vadod, Mahiyari, Budhej,

Sakkarpur and Undel

II. Major Observations:

1. Health Human Resources:

a) In the district, sanctioned post of Chief District Health Officer, Chief District Medical Officer,

Blood Bank Officer and Dental Medical Officer at district HQ, 7 out of the 57 sanctioned posts of

Medical Officer, 16 out of the 82 sanctioned posts of Staff Nurse, 8 out of the 46 sanctioned

posts of LHV, 30 out of the 59 sanctioned posts of MPH Supervisor (M), 8 out of the 58

sanctioned posts of Pharmacist, 38 out of the 274 sanctioned posts of Multi Purpose Health

Worker (M) and 46 out of the 274 sanctioned posts of Multi Purpose Health Worker (F) and 91

out of the 274 sanctioned posts of Helper ANM were vacant. Post each of Physician,

Pediatrician, Radiologist, Ophthalmologist and ENT Specialist was also lying vacant.

b) In the visited PHC Vadod, 4 out of 6 sanctioned posts of Helper ANM were lying vacant.

c) In the visited PHC Budhej, 2 out of the 6 sanctioned posts of Multi-Purpose Health Worker (F),

3 out of the 6 sanctioned posts of Multi-Purpose Health Worker (M), 4 out of the 6 sanctioned

posts of Helper ANM and post each of Health Supervisor (F) / LHV, Health Supervisor (M) and

Lab Technician were lying vacant.

d) In the visited PHC Undel, 2 out of the 5 sanctioned posts of Multi-Purpose Health Worker (F)/

ANM and one out of the 5 sanctioned posts of Helper ANM were lying vacant.

2. Janani Suraksha Yojna (JSY):-

a) Women belonging to BPL, SC/ST category family only are eligible to receive JSY cash

incentive. Upto the end of 2008-09, incentive was restricted for first 2 deliveries only, but from

April 2009 onwards incentive is paid for all deliveries in the state of Gujarat.

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b) In Gujarat, incentive of Rs. 500 is paid to pregnant mother in the 7th month of pregnancy, and

the remaining amount of Rs. 200 in rural areas and Rs. 100 in urban area is paid during the

time of delivery. For Caesarean delivery Rs. 1500 is paid to hired gynecologist. ASHA gets Rs.

200 per case for accompanying women to the hospital for delivery.

c) It was reported that 46,172 deliveries were conducted during 2010-11 in the district and JSY

payments were made to 14,252 beneficiaries. Similarly, 10,762 deliveries were conducted

during 2011-12 (up to June, 2011) in the district and JSY payments were made to 3,424

beneficiaries.

d) Total budget for JSY in the district was available to the tune of Rs.1, 20, 11,442 during 2010-11

and Rs. 1, 15, 21,000 during 2011-12 (up to June‟11). Expenditure to the tune of Rs. 85, 36,100

was incurred in 2010-11 and Rs. 15, 77,100 during 2011-12 (up to June‟11).

e) During Sample check, 22 out of 27 selected JSY beneficiaries could be contacted in the district.

As reported, they have received full JSY cash incentive, MCH cards were issued to all and

ANC/PNC visits were made by ANMs. 19 deliveries were normal and the remaining 3 was C-

Section.

g) All the JSY concerned registers were maintained with complete information in the district office

and CHCs/PHCs. Beneficiaries registers were maintained at Sub-Centres visited, registers were

checked by the concerned Medical Officers. JSY cards were issued to all the beneficiaries.

3. Untied Funds:-

a. CHCs @ Rs. 50,000, PHCs @ Rs. 25,000 and HSCs @ Rs. 10,000 are given as Untied Funds

per year in the district.

b. Provision and utilization of Untied Funds in the district are detailed as below:

(Amount in Rs)

* upto July, 2011.

Sl.

No

Particulars of

Untied Fund

for CHCs for PHCs for HSCs

2010-11 2011-12* 2010-11 2011-12* 2010-11 2011-12*

1. Total budget

available

5,31,177 82,529 11,00,000 11,00,000 27,40,000 27,40,000

2. Exp. incurred 4,48,648 35,870 6,12,291 67,379 13,89,447 0

3. Balance 82,529 46,659 4,87,709 10,32,621 13,50,553 27,40,000

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a) It was reported that the 138 SCs out of total 274 SCs in the district were functioning in Govt.

building and are being provided @ Rs. 10,000 as Untied Funds and @ Rs. 10,000 as AMG per

year in the district. During visit to the Sub Centres at Mahiyari & Sakkarpur, it was observed

that only Rs. 5,000 was released to each of these centres due to shortage of fund for the period

2010-11.Untied Fund was not released to the Sub Centres for 2011-12 till date of visit of the

district.

b) Untied Funds in the visited SCs was utilized to purchase the items such as plastic boxes to

keep Medicines, Buckets, Weighing Machines (adult and baby), Needle Cutter, Doppler, Drugs,

Gloves, Test Tubes and Stationery.

c) AMG in the visited SCs was utilized to purchase the items like Orient Pedal Fan, Steel

Utensils, Glass sets, Surgical items, Broom Sticks, Plastic Tub and Drugs. Also amount was

spent on IEC and conducting Mamata day celebrations.

4. Rogi Kalyan Samiti (RKS):

a) Every RKS was provided funds @ Rs. 2, 50,000 at CHC level and @ Rs. 1, 75,000 at PHC

level every year. These funds include corpus fund, AMG and Untied Funds. All these funds

are kept at the disposal of RKS and after taking the approval in its meeting, the funds are

utilized on developmental activities of institution.

b) Details of funds available and expenditure incurred at CHCs & PHCs in the District are given in the

following table:

(In Rs.)

Type/ head

of the

funds

For CHCs For PHCs

2010-11 2011-12* 2010-11 2011-12*

Budget Expdr. Budget Expdr. Budget Expdr. Budget Expdr.

Corpus fund

12,32,555

10,75,892

1,56,663

76,889

44,00,000 30,11,012

44,00,000 4,30,686

AMG Fund 14,93,315 9,92,307 5,01,008 2,79,225 22,00,000 11,10,363 22,00,000

0

Untied fund

5,31,177 4,48,648 82,529 35,870 11,00,000 6,12,291 11,00,000 67,379

* upto July, 2011.

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c) During visit to the PHCs at Bhudej and Undel, it was observed that sufficient funds were made

available during 2010-11 and 2011-12 (upto July, 2011) and at PHC Bhudej the funds were

spent on purchase of Post-Mortem kit, Stationery, Instruments for Operation Medicines and

camera. Expenditure was incurred towards Printing of formats, Internet wireless net payment

bills, audit fees of VHSNC accounts and other essential miscellaneous expenses.

d) In PHC Undel, RKS funds were spent on purchase of Medicine, Computer Printer, Hardware

and Spirit. Major expenditure of Rs. 54,876 was incurred on POL charges used for PHC

vehicle.

5. Services of ASHA:-

a) There were 1418 ASHAs selected upto 31.03.2011 against the total requirement of 1645

ASHAs in the district. All 1418 ASHAs were in position and also provided drug kits.

b) During 2010-11, an expenditure of Rs. 1, 40, 48, 649 and during 2011-12 (up to July 2011), Rs.

32, 34,547 was incurred in the district towards payment of performance based remuneration to

ASHA.

c) In the visited institutions, 13 ASHAs were contacted. As informed, all were trained and given

drug kits. Performance based remuneration was paid to the ASHAs regularly.

d) At the visited SCs Mahiyari & Sakkarpur, ASHAs were posted and trained. In the VHSCs

ASHAs were functioning as a member.

6. Functioning of Village Health Sanitation and Nutrition Committees (VHSNC):-

a) 353 VHSNCs were set up in all 353 revenue villages in the district. Every year Rs. 10,000 are

allotted to each VHSNC which was operated jointly by the MPHW (F) and Sarpanch of Village

Gram Panchyat.

b) Details of VHSNC budget in the district for 2010-11 and 2011-12 are as below:

SI.No Particulars 2010-11 2011-12

(upto June, 2011)

1. Total budget available 35,30,000 35,30,000

2. Expenditure incurred 17,22,815 12,946

3. Balance 18,07,185 35,17,054

c) VHSNC fund @ Rs. 10,000 was released to the VHNSCs of SC-Mahiyari and @ Rs. 5,000

was released to the VHSNC of SC-Sakkarpur for 2010-11 and during 2011-12, Rs. 1,000 was

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released as a 1st installment to VHSNC of SC- Sakkarpur, due to shortage of budget at the

district. Fund was not released for the year 2011-12 to the VHSNCs of SC- Mahiyari.

d) In the visited Sub Centres at Mahiyari and Sakkarpur, VHSNCs fund was spent on purchase of

Office Tables, Chairs, Drugs, Pedestal Fans, Baby Weighing Scales, Utensils, Stationary,

Cupboards, Doppler and Lancets etc. Besides this amount was spent for transporting the items

purchased to the SCs and for auditing fees of the VHSNC accounts. VHSNC fund was not

utilized for sanitary purpose according to the guidelines.

7. 24 x 7 hours Delivery Care System:-

a) In the district, 19 out of the 46 PHCs were functioning as 24X7 delivery care institutions. Only

one Medical Officer was posted in each PHC. Only 6 PHCs have 3 Staff Nurses posted and

remaining 13 have less than 3 Staff Nurses.

b) During 2010-11, 8 of the 19 PHCs and during April to July 2011, 13 of the 19 PHCs did not

achieve the stipulated minimum achievement of 10 deliveries per month. Thus the district

authorities need to revamp the 24X7 centres in the district according to delivery load.

c) In the visited PHC Undel, Baby radiant warmer was not available.

8. Physical Infrastructure and Stock Position:-

i) Sub Centres

a) SC Mahiyari was functioning in the Anganawadi building and the space to keep the medicines,

registers and equipments etc was not sufficient SC Sakkarpur was functioning in Govt. building.

Infrastructure was not as per IPHS at SC Sakkarpur.

b) Delivery table, McIntsh Sheets, Ambu bag/suction, IUD Insertion Kit and Stove were not

available in the visited SCs. Steam Sterilizer and RDT Test Kit were not available at SC

Mahiyari. Benches for clients, Heamoglobinometer and Torch were not available at SC

Sakkarpur.

c) DDKs, Sanitary napkins, EC pills, and Antiseptic Solution were not available at the visited Sub

Centres. Vit. A Solution, Chlorin Solution, Tab Oxitocin and Inj Gentamycin were not available

at the SC Mahiyari. Tab. Co trimoxazole, IFA Tablets (Big) / Syrup and Kits- A & B were not

available at SC Sakkarpur.

ii) PHCs

a) In the visited PHCs at Bhudej and Undel, it was observed that both the PHCs were functioning

in government building but their infrastructure was not as per IPHS.

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b) In the visited PHC Bhudej, Power backup and Microscope were not available. Labour room and

Operation Theatre were not functional resuscitation equipment was also not supplied in this

PHC.

c) Stock of Condom and Oral Pills Strips was nil since June 2011 in PHC Undel.

d) AYUSH, Medical Officer was posted in both the PHCs. Residential quarter for Medical Officer

was not available in PHC Bhudej.

9. Community Satisfaction and opinion on Health Services:-

i) Services of ANMs and MPW (M):

a) 20 mothers having child upto one year of age were interviewed in the area of two visited Sub

Centres to assess their knowledge and opinion on the services rendered by ANMs and found

that 19 mothers had their delivery by trained persons, weighed their baby after birth and also

received PNC services in time.

b) 17 (85.0%) mothers had no knowledge about danger signs of ARI and 6 (30%) mothers had no

knowledge about advantages and side effects of contraceptive methods. 18 (90.0%) deliveries

were institutional.

c) The team found that the opinion of the community about the services provided by the MPW (M)

was satisfactory at the visited centres.

ii) Services of PHCs:

Public opinion was good about the services being rendered by the PHCs visited by the team.

Village leader, ANC/ PNC beneficiaries and others expressed good opinion on the overall

functioning of PHCs.

10. Sample Verification of FW Acceptors:

a) Out of 63 FW acceptors (Sterilization, IUD, OP and Nirodh) selected, 49 (77.8%) could be

contacted for sample verification.

b) Minor discrepancy in the recorded age of acceptor, total no. of children, no. of male children

and age of last child was found during sample check.

c) Most of the contacted beneficiaries had received follow up services and sterilization acceptors

received full compensation money after having the services.

d) All contacted 25 child immunization beneficiaries had received doses of immunization and also

got follow up services. No complication was found after receiving the doses among the

contacted beneficiaries.

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11. Maintenance of records and registers:

Most of the printed service registers in respect of F.W. services were maintained. Stock

registers for the item purchased under NRHM funds and Cash book were not maintained in

SCs.

12. IT Infrastructure and Mother & Child (MCH) Tracking System:

a) One computers was installed at the district level. All the 5 blocks, all the 11 CHCs and 44 of 46

PHCs were having computer in the district.

b) Internet connectivity was provided to the system available at district, blocks and in all 11 CHCs

& 44 PHCs.

c) It was reported that under HMIS reporting system, facility based reporting has not yet started;

compilation of data is done at district level office and forwarded to state office on line. Under

named based Mother and Child Tracking System (MCTS), data entry was done at facility

(CHC/PHC) level on line directly in the MCTS web portal. All the staff at CHC/PHC/SC level

were trained and sensitized on MCTS.

13. Other Observations:

a) Special cash incentives are applicable to the staff working in 24X7 hours delivery care centres

if the number of deliveries exceeds more than 15 per month, from the 16th delivery onwards, for

every delivery, the staff conducting delivery are paid following rates: Medical Officer @ Rs.

100, Staff Nurse @ Rs. 50 and class-IV@ Rs. 25. Additional budget is allotted to Rogi Kalyan

Samiti of these centres @ Rs. 75 per case to meet delivery related expenses.

b) In the district, Annual Maintenance Grant (AMG) @ Rs, 10,000 given to the Sub Centres which

are having Govt. accommodation. AMG @ Rs. 5,000 only was released during 2010-11 to both

the SCs due to shortage of funds at district. Though, SC- Mahiyari is not having its own

government building and is functioning in Anganawadi School, AMG was released to this SC.

For the period 2011-12, AMG was not released to both the Sub Centres.

c) In other States (other than Gujarat), 2nd Multi-Purpose Health Worker (F) / ANMs were

appointed in the Sub Centre level whose qualification is same as that of 1st ANM. 2nd ANM is

posted for helping the 1st ANM, as the 1st ANM is burdened with handling Sub Centre Untied

Funds, Annual maintenance grant and Village Health Sanitation Committee funds apart from

doing the Sub Centre activities but in the state of Gujarat, instead of 2nd ANM, they have

appointed Helper to ANM for a fixed honorarium of Rs. 1500 per month who is not of 2nd ANM

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and cannot be considered as para-medical staff. Therefore, Helper to ANM would not be in a

position to handle ANC/PNC checkups and vaccination session, which is being done by the 2nd

ANM in other states. This system would not bring down the job related burden of the 1st ANM.

Gujarat model is the deviation of the guidelines under NRHM followed by other states. One

ASHA per1000 population is already positioned to help ANM. One more cadre or layer non-

technical personnel is created by appointing helper to ANM.

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2. District- Vadodara

Major observations of Regional Evaluation Team, Bangaluru on Evaluation work carried out

in Vadodara district of Gujarat State in August, 2011.


Districts Visited PHCs / CHCs visited SCs Visited

Vadodara

PHC: Sokhda & Chandod

CHC: Dabhoi

Vasana Katoriya, Sokhda, Chandod &

Shanor



a) In the district, post of Additional District Health Officer, 26 out of the 100 sanctioned posts of

Medical Officer, 19 out of the 180 sanctioned posts of Staff Nurse, 44 out of the 91 sanctioned

posts of LHV, 21 out of the 80 sanctioned posts of MPH Supervisor (M), 59 out of the 465

sanctioned posts of Multi Purpose Health Worker (M) and 16 out of the 465 sanctioned posts of

Multi Purpose Health Worker (F)/ANM were lying vacant.

b) 5 out of the 6 sanctioned posts of Helper ANMs and 2 out of the 6 sanctioned posts of Multi

Purpose Health Worker (M) were lying vacant in PHC Sokhada and all 3 sanctioned posts of

Staff Nurse and 7 posts of ANM, 3 of the 7 sanctioned posts of Helper ANM and post of each

AYUSH Medical Officer and Computer Operator were lying vacant in PHC Chandod.

c) In the visited CHC Dabhoi, Post each of Gynecologist, Pediatrician and AYUSH Medical Officer

was lying vacant.


a) Women belonging to BPL SC/ST category family only eligible to receive JSY cash incentive.

Upto the end of 2008-09, incentive was restricted to first 2 deliveries only but from April 2009

onwards incentive is paid for all deliveries in the state of Gujarat.


the remaining Rs. 200 in rural areas and Rs. 100 in urban area is paid during the time of

delivery. For Caesarean delivery Rs. 1500 is paid to hired gynecologist.


payments were made to 22,024 beneficiaries. Similarly, 3,802 deliveries were conducted

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during 2011-12 (upto June'11) in the district and JSY payments were made to 992

beneficiaries.

d) Total budget for JSY in the district was available to the tune of Rs.1, 00, 45,200 for 2010-11

and Rs. 97, 50,600 for 2011-12 (upto June‟11). Expenditure to the tune of Rs. 1, 19, 10,700

was incurred in 2010-11 and Rs. 5, 32,600 during 2011-12 (upto June‟11).

e) During Sample check, 12 out of 15 selected JSY beneficiaries could be contacted in the

district. As reported, they have received full JSY cash incentive, MCH cards were issued to all

and ANC/PNC visits were made by ANMs.

f) All the JSY concerned registers were maintained with complete information in the district office

and PHCs/SCs. Beneficiaries registers were maintained at Sub-Centres visited and the

registers were checked by the concerned Medical Officers.

3. Untied Fund:-

a) CHCs @ Rs. 50,000, PHCs @ Rs. 25,000 and HSCs @ Rs. 10,000 are given as Untied Fund


b) Provision and utilization of Untied Funds in the district are detailed as below:

(Amt in Rs)

* upto June, 2011.

c) It was reported that the 365 SCs out of total 465 SCs in the district were functioning in Govt.

building and are being provided @ Rs. 10,000 as Untied Funds and @ Rs. 10,000 as AMG per

year in the district. During visit, it was observed that Untied Funds of Rs. 9,300 and AMG of Rs.

5,000 for the period 2010-11 were released to SC Vasana Katoriya and out of it Untied Funds

of Rs. 8832 and AMG of Rs. 5,000 were spent during the year. In the visited SC Vasana

Katoriya, Untied/AMG Fund was not released for the period 2011-12 till date of visit of the

district. In the visited SC Shanor, Untied Funds/ AMG Funds @ Rs. 10,000 were released for

Sl. No Particulars of

Untied Fund

for CHCs for PHCs for HSCs

2010-11 2011- 12* 2010-11 2011-12* 2010-11 2011-12*

1. Total budget

available

13,60,820 3,29,256 54,22,472 56,57,953 1,65,35,326 1,71,29,611

2. Expenditure

incurred

10,31,564 84,612 16,64,519 30,712 40,55,715 10,557

3. Balance 3,29,256 2,44,644 37,57,953 56,27,241 1,24,79,611 1,71,19,054

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the period 2010-11 and out of it Untied Funds of Rs 9,700 and AMG of Rs. 9,500 were spent

during the year. During 2011-12, funds released by the block, was yet to be credited in SC‟s

account.

d) Untied Funds in the visited SCs were utilized to purchase items like as Hemoglobinmeter, Dust

Bin, Bio Medical Bags, PCM Kit, Seal Pad, Electical Items, Registers & Stationery, IEC Boards &

Banners, getting Xerox copies of reporting formats and for payment of Mobile Phone bills.



level every year. These funds includes corpus fund, AMG and Untied Funds. All these funds




following table:

(In Rs.)

Type/

head of

the funds

For CHCs For PHCs

2010-11 2011-12 * 2010-11 2011-12 *


Corpus

fund

33,13,099 12,19,465 20,93,634 4,30,064 1,29,78,427 75,16,974 1,34,61,453

8,11,746

AMG

Fund

38,78,469 6,30,459 32,48,010 1,81,822 57,43,487 36,96,081 56,47,406 0

Untied

fund

13,60,820 10,31,564 3,29,256 84,612 54,22,472 16,64,519 56,57,953 30,712

* Upto June, 2011

c) In both the PHCs visited at Chandod and Sokhda, it was observed that during the year 2011-12

( upto the end of July, 2011) only Corpus grant of Rs. 30,000 was released; AMG and Untied

Fund were not released.

d) In PHC Chandod, the RKS funds for the year 2010-11 was spent on purchase of Mamatha

New Born Baby Kits, Labour Room Instruments, Lancet, Lab. Equipment, Chemicals, School

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Health Medicines, Chlorine Tablets and Printer. Expenditure was incurred on Electrical Fittings,

Water Cooler and Computer repairs, Printing of OPD case papers, Gas Refilling, Vehicle

Repair, Flooring making charges of Dressing Room and Office Room, Geyser Fixing, Computer

maintenance, and Transport expenses to send water samples to district office, Payment of

salary of Sweeper & Aya and payment of CUG (Close User Group) mobile bills.

e) In PHC Sokhadal, the RKS funds for the year 2010-11 were spent on Construction of platform

in Post-Partum room and Aluminum partitions, making of road sign boards, purchase of

Stationery, Office Furniture, Public Address System, Electric Auto Clave, Labour Room

Instrument, Emergency Lamps, Washing Machine & Fans, Painting of Building and Compound

Wall, Printing of case papers etc.

f) In the CHC Dabhoi, Untied/AMG funds were not released upto July 2011 during the year 2011-

12. The funds provided for the year 2010-11 were spent on Repair of Ambulance, Computer,

Printer & Xerox Machine, Air conditioner and Electrical repairs. Purchase of Blood Pouches,

Linen, Medical Instruments, Medicines, Stationery, Visitor Chairs for OPD and Needle Cutter

and payment of salary of contract basis employees.


a) There were 2061 ASHAs selected as on upto 31.3.2011 against the total requirement of 2221

ASHAs in the district. All 2061 ASHAs were in position and also provided drug kits to all of

them. 1688 ASHAs were trained in all modules till 31.3.2011. 160 new ASHAs were proposed

to be inducted during 2011-12.

b) During 2010-11, expenditure to the tune of Rs. 2, 19, 56,603 and during 2011-12 up to June

2011, Rs. 36, 65,999 was incurred in the district towards payment of performance based

remuneration to ASHA. In the visited institutions, 14 ASHAs were contacted. As informed, all

were trained and given drug kits. Performance based remuneration was paid to the ASHAs

regularly.

c) At the visited SCs Vasana Katoriya and Shanor, ASHAs were posted and trained. In the

VHSNCs, ASHAs were functioning as a member

6. Functioning of Village Health Sanitation and Nutrition Committees (VHSNC):-

a) 1450 VHSNCs were set up against 1548 revenue villages in the district. Every year Rs. 10,000

are allotted to each VHSNC which was operated jointly by the MPHW (F) and Sarpanch of

Village Gram Panchyat.

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(Amount in Rs)

SI.No Particulars 2010-11 2011-12 (up to

June, 2011)

1. Total budget available 3,71,25,033 4,25,42,012

2. Expenditure incurred 1,00,63,021 43,315

3. Balance 2,70,62,012 4,24,98,697

c) VHSNC fund of Rs. 10,000 was released to the VHSNCs of SC-Shanor and Rs. 9,552 was

released to the VHSNC of SC-Vasana Katoriya for 2010-11. VHSNC fund was not released

during 2011-12.

d) In the visited Sub Centres at Shanor and Vasna Katoriya, VHSNCs fund was spent on

purchase of Mosquito nets, Dust Bins, Bio-Medical Waste Bags, Medicines, Laminated IEC

Boards, Weighing Machines, Immunization Charts, Plastic Containers for keeping drugs and for

Mamata day celebration.


a) In the district, 33 out of the 80 PHCs were functioning as 24X7 delivery care institutions. Only

15 PHCs of these 33 PHCs have 2 Medical Officers, including one MO from AYUSH segment.

3 Staff Nurses were available in only 9 of the 30 PHCs.

b) Baby Radiant Warmer was available in 25 out of 33 centres.

c) During 2010-11, 13 of the 33 PHCs did not achieve the stipulated minimum 10 deliveries per

month. During 2011-12 (upto 08/11), 18 PHCs did not performe minimum 10 deliveries per

month. Thus the district authorities need to revamp the 24X7 centres in the district according to

delivery loads.


i) Sub Centres

a) Both the SCs visited at Vasana Katoriya and Shanor were not having own buildings and

functioning in the Anganawadi centres not having sufficient space to keep stock of medicines,

registers and SC equipments etc.

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b) RDT Kit for Malaria, Delivery Table, McIntsh Sheets , Ambu bag/suction, Foot Stool, Steam

Sterilizer and Stove were not available in both the visited SCs. Benches for clients, were not

available at SC Vasana Katoriya.

c) DDKs, Kerosene oil/gas, EC pills, Tab. Metronidazole, Tab. Oxytocin, Cap. Ampicillin, Inj

Gentamycin and Kits- A & B were not available at the visited Sub Centers. Gloves and IUDs

were not available at SC Shanor.

ii) PHC/CHC

a) PHCs visited at Chandod & Sokhada were functioning in government building. Infrastructure of

PHC Chandod was not as per IPHS. Operation Theatre was not functional. AYUSH, Medical

Officer was not posted. Residential quarter for Medical Officer was not available.

b) CHC Dabhoi was functioning in Govt. building. Incinerator was not set-up, Bio-Medical waste is

handed over to the agency outsourced and listed by the district office.


i) Services of ANMs and MPW(M):



that 95% mothers had their delivery by trained persons, weighed their baby after birth and also

received PNC services in time.

b) 17 (85.0%) mothers had no knowledge on danger signs of ARI and 4 (20%) mothers had no

knowledge on advantages and side effects of contraceptive methods. 18 (90.0%) deliveries

were institutional.


was satisfactory at the visited centres. MPWs (M) were not staying at the SC HQs.


Public opinion was good about the services being rendered by the PHCs visited by the team.


functioning of PHCs


15

a) Out of 62 FW acceptors (Sterilization, IUD, OP and Nirodh) selected, 45(72.6%) could be


b) Minor discrepancy in the recorded total no. of children and no. of male children was found

during sample check.

c) Most of the contacted beneficiaries had follow up services and sterilization acceptors received

full compensation money after receiving the services.

d) All contacted 31 child immunization beneficiaries confirmed receiving the doses of immunization

and also got follow up services. No complication was found after receiving the doses among the


11. Maintenance of Records and Registers:

Most of the service registers in respect of F.W. services were found printed at all the centers

and were maintained. Stock registers for the item purchased under NRHM funds and Cash

book were not maintained in PHCs/SCs


a) One computer was installed at the district level. All the 11 blocks, all the 17 CHCs and 76 of 80

PHCs were having computer in the district.

b) Internet connectivity was provided to the system available at district, all blocks and in all 17

CHCs & 76 PHCs.


compilation of data is done at district level office and forwarded to state office on line. Under

name based Mother and Child Tracking System (MCTS), data entry was done at facility

(CHC/PHC) level on line in the MCTS web portal. All the staff at CHC/PHC/SC level were

trained and sensitized on MCTS.

13. Other Observations and Suggestion:

a) Special cash incentives are applicable to the staff working in 24X7 hours delivery care centres if

the number of deliveries exceeds more than 15 per month; from the 16th delivery onwards, for

every delivery, the staff conducting delivery are paid @ following rates; Medical Officer- Rs.

100, Staff Nurse Rs. 50 and class-IV- Rs. 25. Additional budget is allotted to Rogi Kalyan

Samithi of these centres @ Rs. 75 per case to meet delivery related expenses.

b) In the district, every year AMG @ Rs. 10,000 are given to the Sub Centres which are having

Govt. accommodation. Annual maintenance grants are meant for maintaining the government

16

sub centre building, and should not be released to those sub centres that are not functioning in

Govt. building. On the contrary, both the SCs visited at Vasana Katoriya and Shanor were given

AMG during 2010-11. AMG utilized to purchase the items such as- Child Growth Chart,

Stationery, Torch Cells, Uristics, Drugs, Brooms, Carpets, Marker Pens, Detergent Powder,

Plastic Cans, Bags, Bed, Chairs, Cupboard and the amount spent for Wall Paintings, Action Plan

Boards, E Mamatha survey and for nutrition.

c) In other States (other than Gujarat), 2nd Multi-Purpose Health Worker (F) / ANMs were appointed

in the Sub Centre level whose qualification is same as that of 1st ANM. 2nd ANM is posted for

helping the 1st ANM, as the 1st ANM is burdened with handling Sub Centre Untied Funds,

Annual maintenance grant and Village Health Sanitation Committee funds apart from doing the

Sub Centre activities but in the state of Gujarat, instead of 2nd ANM, they have appointed

Helper to ANM for a fixed honorarium of Rs. 1500 per month who is not technically qualified

ANM and cannot be considered as para-medical staff. Therefore, Helper to ANM would not be

in a position to handle ANC/PNC checkups and vaccination session, which is being done by the

2nd ANM in other states. This system would not bring down the job related burden of the 1st

ANM. Gujarat model is the deviation of the guidelines under NRHM followed by other states.

One ASHA per1000 population is already positioned to help ANM. One more cadre or layer

non-technical personnel is created by appointing helper to ANM.

17

3. District- Kheda

Major observations of Regional Evaluation Team, Bangaluru on Evaluation work carried

out in Kheda district of Gujarat State in September, 2011.


Districts

Visited

PHCs /CHCs visited SCs Visited

Kheda PHCs: Salun and Alindra

CHC: Dakor

Salun, Fathepur, Alindra and Sandhana



Post of Chief District Health Officer, District Tuberculosis Officer and District Leprosy Officer

were lying vacant. 2 out of 8 sanctioned posts of Block Health Officer, 20 of the 126

sanctioned posts of Medical Officer, 5 of the 51 sanctioned posts of Staff Nurse, 37 of the 52

sanctioned posts of LHV, 12 out of 68 sanctioned posts of Supervisor (M), 6 out of 53

sanctioned posts of Pharmacist, 3 out of 51 sanctioned posts of Lab. Technician, 167 out of

317 sanctioned posts of Multi Purpose Health Worker (M) and 10 out of 317 sanctioned posts

of Multi Purpose Health Worker (F)/ ANM and 137 out of 317 sanctioned posts of Helper ANM

(the post of helper ANM is sanctioned by state authority) were vacant in the district.

a) In the visited PHC Salun, post of AYUSH Medical Officer, 1 out of 7 sanctioned posts of ANM

and 3 out of 7 sanctioned posts of Helper ANM were lying vacant. Similarly, one post of LHV

and 2 out of 5 sanctioned posts of Helper ANM were lying vacant in PHC Alindra.

b) In the visited CHC Dakor, one post each of Pediatrician and Gynecologist was lying vacant.


a) Women belonging to BPL, SC/ST category family only are eligible to receive JSY cash

incentive. Up to the end of 2008-09, incentive was restricted to first 2 deliveries only. however,

from April, 2009 onwards incentive is paid for all deliveries in the state of Gujarat.


the remaining amount of Rs. 200 in rural areas and Rs. 100 in urban area is paid during the

time of delivery. For Caesarean delivery Rs. 1500 is paid to the hired gynecologist.

18


payments were made to 16,791 beneficiaries. Similarly, 9,946 deliveries were conducted during

2011-12 (upto June'11) in the district and JSY payments were made to 2,787 beneficiaries.

d) Total budget for JSY in the district was available to the tune of Rs.1, 13, 71,335 for 2010-11

and Rs. 18, 90,735 for 2011-12 (upto June‟11). Expenditure to the tune of Rs. 1, 02, 30,600

was incurred in 2010-11 and Rs. 16, 57,200 during 2011-12 (upto June‟11).

e) During visit to the SC at Fathepur, 7 pending cases for JSY payment for 2010-11 and 2 pending

cases for JSY payment for current year up to August 2011 were reported.

f) During Sample check, 21 out of 28 selected JSY beneficiaries could be contacted in the district.

As reported, they had received full JSY cash incentive, MCH cards were issued to all and

ANC/PNC visits were made by ASHAs/ ANMs. For institutional deliveries, ASHA accompanied

the beneficiaries to the hospitals.

g) All the JSY concerned registers were maintained with complete information in the district office

and CHCs/PHCs. Beneficiaries registers were maintained at Sub-Centres visited; registers were

checked by the concerned Medical Officers. JSY Cards were issued to all the beneficiaries.

3. Untied Fund:-

a) CHCs @ Rs. 50,000, PHCs @ Rs. 25,000 and HSCs @ Rs. 10,000 are given as Untied Funds



* upto June, 2011.

c) It was reported that 160 out of total 324 SCs in the district were functioning in Govt. building and

are being provided @ Rs. 10,000 as Untied Funds and @ Rs. 10,000 as AMG per year in the

Sl. No Particulars Budget for CHCs Budget for PHCs Budget for HSCs

2010-11 2011-12* 2010-11 2011-12* 2010-11 2011-12*

1. Total budget

available

9,64,149 5,00,050 8,56,851 68,980 16,60,000 1,53,332

2. Expenditure

incurred

7,00,058 1,01,279 7,87,600 40,994 15,06,668 2,750

3. Balance 2,64,091 3,98,771 69,251 27,986 1,53,332 1,50,582

19

district. During visit to the Sub Centres at Fathepur & Sandhana, it was observed that

Untied/AMG Fund was not released to the Sub Centres for the period 2011-12.

d) Untied Funds in the visited SCs were utilized to purchase the items such as – examination table,

bed sheets, pillows and registers. Besides this funds were also utilized for e-Mamta survey,

Installation of Water Purifier for drinking water, partition of examination room and electrical

repairs at the SCs.

e) AMG Funds in the visited SCs were utilized to purchase the items such as Motor Pump to the

Water Tank, Painting and Repairing of SC building, buying Syntax Tank and Pipe fittings at the

SC and Plumber Charges, Electrical Items, Stationery, Stamp & Pad and Toilet repair works at

the SC.

4. Rogi Kalyan Samiti (RKS):-


level every year. These funds includes corpus fund, AMG and Untied Funds. All these funds




following table:

(In Rs.)

Type of

funds

For CHCs For PHCs

2010-11 2011-12* 2010-11 2011-12*

Budget Expenditure Budget Expendit

ure

Budget Expenditu

re

Budget Expenditure

Corpus

fund

12,62,954 12,24,607 5,98,691 1,62,701 50,00,000 44,05,914 5,94,086 3,13,757

AMG Fund 18,21,132 14,95,199 7,65,124 1,07,618 25,00,000 17,89,506 7,10,494 2,65,396

Untied fund 9,64,149 7,00,058 5,00,050 1,01,279 ,56,851 7,87,600 68,980 40,994

* upto June, 2011.

c) In PHC Salun, it was observed that during the year 2011-12 ( upto the end of July‟11) only

Corpus grant of Rs. 25,000 was released, AMG and Untied Funds of PHC were not released.

The funds were spent by the RKS on purchase of Medicines, Bed Sheets/Linen, Laboratory

equipment, Stationery items, Diesel and Computer. Expenditure was incurred on Electrical

20

Repairs, Ambulance Maintenance, Contract Charges of Bio-Medical Waste, Painting of PHC

building, Construction of Cubicle for Injection Room, Parking Bay outside PHC, Garden

Cleaning and Composite Pit. No discrepancy was found.

d) In PHC Alindra, it was observed that during the year 2010-11, PHC Untied fund was not

released. During the year 2011-12 (upto the end August‟11), no RKS funds was not released.

The funds were spent on purchase of Computer anti-virus Software, Printer, TV with DVD, Gas

Geyser, Patient Gowns, Medicine, Blood-Lancet, Sign Boards, Cupboards, Linen, Stationery,

Digital Thermometer and S. Widal Kit. Expenditure was incurred on strengthening of Operation

Theatre and Labour Room, Electrical Work, Civil Construction Work, Maintenance of Garden

and Hospital Building, Plumbing Work, Ambulance Maintenance with POL charges and

payment of audit fees of NRHM accounts. No discrepancy was found.

e) In CHC Dakor, some of the major works undertaken by RKS were electrical rewiring and repair

of the building, minor civil work, laying of water and sanitation pipelines, painting, strengthening

of operation theatre and laboratory. Besides, expenditure as computer repair, ambulance

vehicle maintenance with POL charges, purchase of Instruments, stationery and medicine was

also incurred. Major expenditure was towards Petrol charges for Ambulance Vehicle and

maintenance of Ambulance.


a) There were 1627 ASHAs selected as on 30.3.2011 against the total requirement of 1675

ASHAs in the district. All 1627 ASHAs were in position also provided drug kits trained up to 5th

modules.

b) During 2010-11, an expenditure to the tune of Rs. 1,65,03,793 and during April to June 2011,

Rs. 21,05,790 was incurred in the district towards payment of performance based remuneration

to ASHA.

c) In the visited institutions, 19 ASHAs were contacted. As informed, all were trained and given

drug kits. Performance based remuneration was paid to the ASHAs regularly.

d) At the visited SCs Fathepur and Sandhana, ASHAs were posted and trained. In the VHSNCs,

ASHAs were functioning as a member.

6. Functioning of Village Health Sanitation and Nutrition Committees (VHSC):-

21

a) 618 VHSNCs were set up in all 618 revenue villages in the district. Every year, Rs. 10,000 are

allotted to each VHSNC which was operated jointly by the MPHW (F) and Sarpanch of Village

Gram Panchayat.


(In Rs)

SI.No Particulars 2010-11 2011-12 (upto June 2011)


2. Expenditure incurred 44,30,168 2,64,816

3. Balance 18,58,404 15,93,588

c) VHSNC funds @ Rs. 10,000 were released to the VHSNCs of both visited SCs Fathepur and

Sandhana during 2010-11. VHSNC fund was not released for the year 2011-12 up to the time of

team‟s visit. VHSNC meetings were conducted regularly in the visited SCs. ANMs were

maintaining the accounts of VHSNC funds.

d) In the visited Sub Centres at Fathepur and Sandhana, VHSNCs fund was spent on purchase of

Office Tables, Plastic Chairs, Drugs, Fans, File Folders, Registers & Stationary, Cupboards,

Protein Powder to Children, Slides, Electric Bulbs, Dust Bin, etc; Besides this amount was spent

for transport of high risk ANC cases to the hospitals.

e) It was observed that major part of VHSNC fund was utilized to purchase Furniture and Stationery

for SCs and not utilized for Health and Sanitation purpose as per the guidelines.


a) In the district, 17 out of the total 51 PHCs were functioning as 24X7 delivery care institutions. All

17 PHCs have 2 medical officers (1 MBBS + 1 AYUSH). In all PHCs, only 2 Staff Nurses were

available instead of 3 or more Staff Nurses.

b) During 2010-11, 4 of the 17 PHCs and during April to June 2011, 6 of the 17 PHCs could not

achieve the stipulated minimum 10 deliveries per month. The district authority should revamp the

24X7 centres in the district and also reclassify the PHCs as 24x7 centres according the work load.


i) Sub Centres

22

a) In the visited SCs at Fathepur and Sandhana, it was observed that both the SCs were

functioning in Govt. building and the infrastructure was not as per IPHS. ANM was not staying in

the SC areas. Labour Room was not functioning in both the SCs.

b) RDT Kit for Malaria, McIntsh Sheets and Ambu bag/suction, were not available in both the

visited SCs. Delivery Table and Nischay pregnancy test kit were not available at SC Fathepur.

c) DDKs, Kerosene oil/gas, Sanitary Napkins, Condoms, Tab. Oxytocin, Cap. Ampicillin, Inj

Gentamycin and Kits- A & B were not available at the visited Sub Centers. OP cycles and EC

Pills were not available at SC Sandhana.

ii) PHCs

a) In the visited PHCs at Salun and Alindra, it was observed that both the PHCs were functioning

in government building. In the visited PHC Salun, residential quarter for Medical Officers was

not available.

b) CHC Dakor, was functioning in Govt. building. Incinerator was not set-up, Bio-Medical waste

was being handed over to the agency outsourced and listed by the district office. Blood storage

unit was not functioning presently. One post of each Gynecologist and Pediatrician was lying

vacant. Injection Arteether and Quinine were not available.





that 17(85%) mothers had their delivery by trained persons, weighed their baby after birth and

also received PNC services in time.

b) 18 (90.0%) mothers had no knowledge on danger signs of ARI and 5 (25.0%) mothers had no

knowledge on advantages and side effects of contraceptive methods. 17 (85.0%) deliveries were

institutional.


was satisfactory at the visited centres though the MPWs (M) were not staying in the SC HQs.


23

Public opinion was good on the services being rendered by the PHCs/CHC visited by the team.


functioning of PHCs/CHCs.


a) Out of 70 FW acceptors (Sterilization, IUD, OP and Nirodh) selected, 57 (81.4%) could be


b) Minor discrepancy in the recorded age of acceptor, age of spouse, total No. of children, No. of

male children and age of last child was found during sample check. Most of the contacted

beneficiaries were provided with follow up services.

c) All contacted 28 child immunization beneficiaries confirmed receiving doses of immunization and

also the follow up services. No complication was found after receiving the doses among the


11. Reconciliation of Reported Performance:

For the period from i) 01-04-2010 to 31-03-2011 and ii) 01-04-2011 to 31-08-2011, reconciliation

of reported performance of FW cases were done at PHC and SC level. No discrepany was

observed in reported performance.


Most of the service registers in respect of F.W. services were found available in printed forms at

all the centers and maintained. Stock registers for the item purchased under NRHM funds were

not maintained at SC levels. Cash book for untied fund was not maintained in SC Sandhana.


a) One computer was installed at the district level. All the 8 blocks and 11 of the 12 CHCs were

having computer in the district.

b) Internet connectivity was provided to the system available at district, to all blocks and 50 of the 51

PHCs.


compilation of data is done at district level office and forwarded to state office online. Under

named based Mother and Child Tracking System (MCTS), data entry was being done at facility

(CHC/PHC) level directly in the MCTS web portal. All the staff at CHC/PHC/SC were trained and

sensitized on MCTS.

14. Other Observations and Suggestions:

24

a) Special cash incentives are applicable to the staff working in 24X7 hours delivery care centres if

the number of deliveries exceeds more than 15 per month; From the 16th delivery onwards, for

every delivery, the staff conducting delivery are paid incentive as: Medical Officer @Rs. 100, Staff

Nurse @ Rs. 50 and class-IV@ Rs. 25. Additional budget is allotted to Rogi Kalyan Samiti of these

centres @ Rs. 75 per case to meet delivery related expenses.

b) In the district, AMG @ Rs. 10,000 is given every year to the Sub Centres which were having Govt.

accommodation. Annual Maintenance Grant (AMG) of Rs. 10,000 per SC was released during

2010-11 to both the SCs at Fathepur and Sandhana, and the same was not released during 2011-

12 up to the time of team‟s visit in Sep, 2011.

c) In other States (other than Gujarat), 2nd Multi-Purpose Health Worker (F) / ANMs were appointed in

the Sub Centre level whose qualification is same as that of 1st ANM. 2nd ANM is posted for helping

the 1st ANM, as the 1st ANM is burdened with handling Sub Centre Untied Funds, Annual

maintenance grant and Village Health Sanitation Committee funds apart from doing the Sub Centre

activities but in the state of Gujarat, instead of 2nd ANM they have appointed Helper to ANM for a

fixed honorarium of Rs. 1500 per month who is not technically qualified like ANM and cannot be

considered as para-medical staff. Therefore, Helper to ANM would not be in a position to handle

ANC/PNC checkups and vaccination session, which is being done by the 2nd ANM in other states.

This system would not bring down the job related burden of the 1st ANM. Gujarat model is the

deviation of the guidelines under NRHM followed by other states. One ASHA per1000 population is

already positioned to help ANM. One more cadre or layer non-technical personnel is created by

appointing helper to ANM. The main purpose of strengthening the sub-centre by posting of

technically qualified 2nd ANM is not achieved here in the state.

25

4. District- Dohad

Major observations of Regional Evaluation Team, Bangaluru on Evaluation

work carried out in Dohad district of Gujarat State in September, 2011.


Districts

Visited

PHCs /CHCsvisited SCs Visited

Dohad PHCsPHCs: Agawada and Gangardi

CHC: Jhalod

Agawada, Dasala, Gangardi and Tukiwaju



a) In the district, sanctioned post of District Quality Assurance Medical Officer, one of 7

sanctioned posts of Block Health Officer and 1 of the 2 posts of Public Health Nurse,

11 out of 67 sanctioned posts of Medical Officer, 6 out of 21 sanctioned posts of Staff

Nurse, 26 out of 68 sanctioned posts of LHV, 5 out of 25 sanctioned posts of MPH

Supervisor (M), 22 out of 65 sanctioned posts of Pharmacist, 31 out of 65 sanctioned

posts of Lab. Technician, 37 out of 332 sanctioned posts of Health Worker, 5 out of

332 sanctioned posts of ANM and 39 out of 332 sanctioned posts of Helper ANM were

vacant.

b) Sanctioned post each of MBBS Medical Officer, LHV, Male Supervisor and Lab

Technician were lying vacant in PHC Agawada and the post of AYUSH Medical

Officer, one of the 3 sanctioned posts of Staff Nurse and 1 out of 5 posts of Helper

ANM / Male Worker were lying vacant in PHC Gangardil.

c) In the visited CHC Jhalod, post each of the Medical Superintendent, AYUSH Medical

Officer, Dental Surgeon, X-Ray Technician and Ophthalmic Assistant was lying

vacant. Specialist posts such as Pediatrician and Gynecologist were not sanctioned to

this CHC.


a) Women belonging to BPL, SC/ST category family only are eligible to receive JSY

cash incentive. Upto the end of 2008-09, incentive was restricted to first 2 deliveries

26

only but from April 2009 onwards incentive is paid for all deliveries in the state of

Gujarat.

b) In Gujarat, incentive of Rs. 500 is paid to pregnant mother in the 7th month of

pregnancy, and the remaining amount of Rs. 200 in rural areas and Rs. 100 in

urban area is paid during the time of delivery. For Caesarean delivery Rs. 1500 is

paid to hired gynecologist.

c) It was reported that 54,317 deliveries were conducted during 2010-11 in the district

and JSY payments were made to 28,625 beneficiaries. Similarly, 21,412 deliveries

were conducted during 2011-12 (upto July'11) in the district and JSY payments were

made to 2,876 beneficiaries.

d) Total budget for JSY in the district was available to the tune of Rs.1, 84, 65,438

during 2010-11 and Rs. 1, 96, 19,400 during 2011-12 (upto July‟11). Expenditure to

the tune of Rs. 1, 78, 13,700 was incurred in 2010-11 and Rs. 28, 82,600 during

2011-12 (upto July‟11).

e) During Sample check, 25 out of 29 selected JSY beneficiaries could be contacted in

the district. As reported, they had received full JSY cash incentive, MCH cards were

issued to all and ANC/PNC visits were made by ASHAs/ ANMs. For institutional

deliveries, ASHAs accompanied the beneficiaries to the hospitals.

f) All the JSY concerned registers were maintained with complete information in the

district office and CHCs/PHCs. Beneficiaries registers were maintained at visited Sub-

Centres and registers were checked by the concerned Medical Officers. JSY Cards were

issued to all the beneficiaries.

3. Untied Funds:-

a) CHCs @ Rs. 50,000, PHCs @ Rs. 25,000 and HSCs @ Rs. 10,000 are given as

Untied Funds per year in the district.


Sl. No Particulars Budget for CHCs Budget for PHCs Budget for HSCs

2010-11 2011-12

2010-11 2011-12

2010-11 2011-12

27

* upto July, 2011.

c) It was reported that the 200 SCs out of total 332 SCs in the district were functioning in

Govt. building and were being provided @ Rs. 10,000 as Untied Funds and @ Rs.

10,000 as AMG per year in the district. During visit to the Sub Centres at Tukiwaju, it

was observed that Untied Fund was not released to the Sub Centres for the period

2011-12 till date of visit of the district. In both the visited SCs Dasala & Tukiwaju, it

was observed that AMG Fund was not released for the period 2010-11 and 2011-12.

d) Untied Funds in the visited SCs were utilized to purchase the items such as – Table,

Chairs, Fan, Registers & Stationery items, for getting Xerox copies of Reporting

Formats, for repairing SC Doors & Windows, Electrical work at the SCs and for

payment of Electricity Bills.


a) Every RKS was provided funds @ Rs. 2, 50,000 at CHC level and @ Rs. 1, 75,000 at

PHC level every year. These funds includes corpus fund, AMG and Untied Funds. All

these funds are kept at the disposal of RKS and after taking the approval in its meeting,

the funds are utilized on developmental activities of institution.

b) Details of funds available and expenditure incurred at CHCs & PHCs in the District are

given in the following table:

(In Rs.)

Type/ head of

the funds

For CHCs for the year For PHCs for the year

2010-11 2011-12 2010-11 2011-12


Corpus fund 23,62,865 7,62,641 16,00,224 2,88,336 60,00,000 30,74,797 63,00,000 8,49,592

1. Total budget

available

10,32,147 6,67,328 15,00,000 15,75,000 33,20,000 33,20,000

2. Expenditure

incurred

3,64,819 92,058 13,61,953 4,70,123 14,75,438 82,300

3. Balance 6,67,328 5,75,270 1,38,047 11,04,877 18,44,562 32,37,700

28

AMG Fund 27,35,013 5,85,597 21,49,416 2,11,077 30,00,000 13,78,864 29,00,000 0

Untied fund 10,32,147 3,64,819 6,67,328 92,058 15,00,000 13,61,953 15,75,000 4,70,123

* upto July 2011-12

c) During visit up to July, 2011 to the PHC at Agawada, it was observed that during the

year 2010-11 and 2011-12, PHC AMG Fund was not released. The RKS funds were

spent on purchase of Medicines, Furniture, Stationer, Electrical Stabilizer, Preparation

of Signboards, Data-Entry Charges, Repair of Vehicle, Data Transport Charges to

Transport Vaccine from district stores, Payment of Telephone Bills, Electrical Bills,

Petrol/Diesel Bills, Minor Civil Works, Computer Services and Printer Refill Cartiges

etc.

d) During visit to the PHC Gangardi, it was observed that during the year 2010-11 and

2011-12, PHC AMG fund was not released. The RKS funds were spent on purchase

of Stationery, Blood-Lancets, Chlorination Cards, Plastic Buckets, Repair of Vehicle

and Servicing, Printing of Reporting Formats, Printer Refill Cartilages, Electrical

Fitting and Repairs, Repair of Computer, Windows Software Installation, Minor Civil

Works, Plumbing, Purchase of Medical & Lab Equipment, Baby Tray, Mattress &

Beds for Examination Table & Stretcher, Linen Bed Sheets, Pen-Drive, RO System

Water Purifier installation, Petrol & Diesel Bills, IEC equipment speakers & Mikes and

installation of Pump Motor etc.

e) In CHC Jhalod, RKS funds were utilized for payment of salary to night watchman &

sweeper, toilet repairs, POL for Ambulance, Ambulance repair, Purchase of Baby Kits

for new born babies, Installation of Internet, Diesel for Generator, Tubectomy Camp

expenses, Cholera Outbreak Food & Medicines, Hospital painting, Plumbing & Water

Pipe line installation, making of Aluminium Partitions, Electrical Fixtures and

purchases Stationery items etc.


a) There were 1586 ASHAs selected as on 30.3.2011 against the total requirement of

1633 ASHAs in the district. All 1586 ASHAs were in position and also provided drug

kits to all. ASHAs were trained upto 5th modules till 30.3.2011.

29

b) During 2010-11, an expenditure to the tune of Rs. 1, 40, 02,345 and during April to

June 2011, Rs. 1, 16,508 was incurred in the district towards payment of

performance based remuneration to ASHA.

c) In the visited institutions, 15 ASHAs were contacted. As informed, all were trained

and given drug kits. Performance based remuneration was paid to the ASHAs

regularly.

d) At the visited SCs Dasala and Tukiwaju, ASHAs were posted and trained. In the

VHSCs, ASHAs were functioning as a member.

6. Functioning of Village Health and Sanitation and Nutrition Committees

(VHSNC):-

a) 684 VHSNCs were set up against 693 revenue villages in the district. Every year Rs.

10,000 are allotted to each VHSNC which was operated jointly by the MPHW (F) and

Sarpanch of Village Gram Panchayat.


( Amount in Rs)

SI.No Particulars 2010-11 2011-12 ( upto July 2011)


2. Expenditure incurred 65,81,218 9,25,515

3. Balance 3,48,782 60,04,485

c) VHSNC fund of Rs. 10,000 was released to the VHSNCs of both visited SCs at

Dasala and Tukiwaju during 2010-11 and 2011-12. VHSNC meetings were

conducted regularly in the visited SCs. ANMs were maintaining the accounts of

VHSNC funds.

d) In the visited Sub Centres at Dasala and Tukiwaju, VHSNCs funds were spent on

purchase of Tables, Chairs, Dust Bin, Tray, Tea Cups, Syringes, Phenol, Registers,

Curtains, Soap and Uniform Sarees to ASHAs. Besides this amount was also spent

on Laminated IEC Posters, for transport the items purchased to the SCs, for getting

Xerox copies of reporting formats and for payment of SC Electrical Bills.

30

e) It was observed that major part of VHSNC fund was utilized for purchasing of

Furniture and Stationery for SCs and not utilized for Health and Sanitation purpose as

per the guidelines.


a) In the district, 7 PHCs out of the total 65 were functioning as 24X7 delivery care

institutions. All 7 PHCs have only 1 Medical Officer posted instead of 2 Medical

Officers and 2 Staff Nurses were available in 6 of the 7 PHCs instead of 3 Staff

Nurses.

b) During 2010-11, 4 of the 7 PHCs and during 2011-12 (upto July‟11), 3 PHCs could

not achieve the stipulated minimum achievement of 10 deliveries per month. Thus

the district authority needs to revamp the 24X7 centres in the district and also re-

classify 24x7 as per notified delivery loads.


i) Sub Centres:

a) Both the SCs visited at Dasala and Tukiwaju, were functioning in Govt. building and

the infrastructure was not as per IPHS. ANM was not staying in the SC areas. Labour

Room was not functioning in both the SCs.

b) RDT Kit for Malaria, Foot Stool and Ambu bag/suction, were not available in both the

visited SCs. Delivery Table, Mclntch Sheets, Torch and Stove were not available at

SC Dasala. In SC Tukiwaju, Benches for clients and Steam Sterilizer were not

available.

c) DDKs, Kerosene oil/gas, Sanitary Napkins, Condoms, Tab. Oxytocin, Inj Gentamycin

and Kits- A & B were not available at both the visited Sub Centers. Thermometer,

ORS packets, Tab. Co Trimoxazole, Vit.‟A‟ solution, IFA tablets (small/big and syrup),

Clorine solution, Tab. Metranidazole and Cap. Ampicillin were not available at SC

Tukiwaju.

ii) PHC/CHC:

a) PHCs visited at Agawada & Umrakh were functioning in government building. Power

back-up and Residential quarter for Medical Officer were not available in both the

PHCs.

31

b) In PHC Agawada, tap water, toilet and wash room for staff were not available.

Building accommodation was not fit for running any services except OPD; even

minor surgical procedures cannot be undertaken. Labour room and Operation

theatre cannot be set-up. Vehicle, Oxygen Cylinder, Minor Surgical Equipment,

Labour Room Table, other equipment for delivery purpose, Resuscitation Equipment,

Computer & Internet facilities and IUD Insertion Kits were not available in the PHC.

Post of Lab. Technician was not filled.

c) In PHC Umrakh, Operation Theatre was not functional. AYUSH Medical Officer was

not posted.

d) CHC Jhalod was functioning in Govt. building. It was observed that X-Ray facility not

working since April 2011. Bio-Medical waste is handed over to the agency

outsourced and listed by the district office. Allmost all the specialist posts such as

Pediatrician, Gynecologist, Anesthesiologist, Radiologist and Physician posts were

not sanctioned. Normal deliveries were conducted, caesarian deliveries were not

conducted.



a) 20 mothers having child upto one year of age were interviewed in the area of two

visited Sub Centres to assess their knowledge and opinion on the services rendered

by ANMs and found that 19 ( 95%) mothers had their delivery by trained persons,

weighed their baby after birth and also received PNC services in time.

b) 17 (85.0%) mothers had no knowledge of danger signs of ARI and 2 (10.0%) mothers

had no knowledge on advantages and side effects of contraceptive methods. 19

(95.0%) deliveries were institutional.

c) The team found that the opinion of the community about the services provided by the

MPW (M) was satisfactory at the visited centres.


Public opinion was good about the services being rendered by the PHCs/CHC visited

by the team. Village leader, ANC/ PNC beneficiaries and others expressed good

opinion on the overall functioning of PHCs/CHCs.


32

a) Out of 70 FW acceptors (Sterilization, IUD, OP and Nirodh) selected, 55 (78.6%) could

be contacted for sample verification.

b) Minor discrepancy in the recorded age of acceptor, age of spouse, total No. of

children, No. of male children and age of last child was found during sample check.

c) All contacted 30 child immunization beneficiaries confirmed with the doses of

immunization and also got follow up services. No complication was found after

receiving the doses among the contacted beneficiaries.


For the period from i) 01-04-2010 to 31-03-2011 and ii) 01-04-2011 to 31-08-2011,

reconciliation of reported performance of FW cases was done at PHC and SC level. No

discrepancy was observed in the reported performance.


Most of the printed service registers were maintained in respect of F.W. services at all

the centers. Stock registers for the item purchased under NRHM funds, Cash book for

untied fund and VHSNC fund were not maintained at SCs.


a) 2 computers were installed at the district level. All the 7 blocks and 11 CHCs were

having computer in the district.

b) Internet connectivity was provided to the system available at district, to all blocks. 63 of

the 65 PHCs were having computer systems and only 45 PHCs were having internet

facility.

c) It was reported that under HMIS, facility based reporting has not yet started;

compilation of data is done at district level office and forwarded to state office online.

Under named based Mother and Child Tracking System (MCTS), data entry was done

at facility (CHC/PHC level) on line directly in the MCTS web portal. All the staff at

CHC/PHC/SC level were trained and sensitized on MCTS.

14. Other Observations and Suggestion:

a) Special cash incentives are applicable to the staff working in 24X7 hours delivery care

centres if the number of deliveries exceeds more than 15 per month; from the 16 th

33

delivery onwards, for every delivery, the staff conducting delivery are paid as per

following rates.: Medical Officer @ Rs. 100, Staff Nurse@ Rs. 50 and class-IV@ Rs. 25.

Additional budget is allotted to Rogi Kalyan Samiti of these centres @ Rs. 75 per case

to meet delivery related expenses.

b) In the district, AMG @ Rs. 10,000 are given to the Sub Centres annually which are

having Govt. accommodation. Both the SCs at Dasala and Tukiwaju are functioning in

Govt. buildings, but AMG was not released to both the SCs for 2010-11 and 2011-12.

c) In other States (other than Gujarat), 2nd Multi-Purpose Health Worker (F) / ANMs were

appointed in the Sub Centre level whose qualification is same as that of 1st ANM. 2nd

ANM is posted for helping the 1st ANM, as the 1st ANM is burdened with handling Sub

Centre Untied Funds, Annual maintenance grant and Village Health Sanitation

Committee funds apart from doing the Sub Centre activities. This but in the state of

Gujarat, instead of 2nd ANM Helper to ANM has been appointed for a fixed honorarium of

Rs. 1500 per month who is not technically qualified as ANM and cannot be considered as

para-medical staff. Therefore, Helper to ANM would not be in a position to handle

ANC/PNC checkups and vaccination session, which is being done by the 2nd ANM in

other states. This system would not bring down the job related burden of the 1st ANM.

Gujarat model is the deviation of the guidelines under NRHM followed by other states.

One ASHA per1000 population is already positioned to help ANM. One more cadre of

layer non-technical personnel is created by appointing helper to ANM.

**********

34

5. District - Tapi:

Major observations of Regional Evaluation Team (RET), Patna on the evaluation

work carried out in Tapi District of Gujrat State in the month of February, 2012.


District visited DH/PHCs visited HSCs visited Tapi DH: Tapi

PHCs: Panchol, Jamkhadi and Algat Jamkhadi, Tokarwa, Antapur, Umarvavdur, Algat and Jammania


1. Human Resources:

As per the details available, the district was having vacancies in some key categories of

skilled personnel in the health sector. The details of some of the categories of staff in

the whole of the district are as reported below:

Particulars of Post

Sanctioned

In position status of Vacant

Regular Posts Contractual Posts

ANM 226 188 29 9

MPW (M) 203 28 112 63 LHV/HS(F) 28 4 - 24 Health Supervisor (M) 32 4 - 28 GNM 22 4 - 18

Lab Technician 30 8 18 4

There was no posts of Specialist sanctioned in the district. The vacancies against

regular posts could be filled by appointing contractual staff in the district.

2. Rogi Kalyan Samiti (RKS) and Village Health Sanitation and Nutrition

Committee (VHSNC):

a) Rogi Kalyan Samiti has been constituted at the DH / CHCs / PHCs in the district. 36

Rogi Kalyan Samiti (RKS) have been registered in 5 CHCs, 30 PHCs and District

Hospital in the district. Regular quarterly meetings of RKS were being conducted in the

visited centres.

b) An amount of Rs. 28,00,000 was available for RKS in the district for the year 2010-

11, out of which, an amount to the tune of Rs. 27,47,805 (98%) was spent. Similarly,

35

RKS funds of Rs. 30,00,000 were available in the district for the year 2011-12, out of

which, an amount to the tune of Rs. 10,62,385 (35%) was spent up to January, 2012.

c) 456 Village Health Sanitation & Nutrition Committees (VHSNCs) have been

constituted in the district.

d) An amount of Rs. 44,60,000 was available as untied fund for VHSNC in the district

for the year 2010-11, out of which, an amount to the tune of Rs.36,43,522 (82%) was

spent. Similarly, the funds to the tune of Rs. 44,60,000 were available for VHSNCs in the

district for the year 2011-12, out of which, an amount to the tune of Rs.9,57,103 (21%)

was spent up to January, 2012.

e) During visit to the centres, the team observed that the meetings were being

conducted regularly and VHSNCs were functioning smoothly in the district.

3. Service of Janani Suraksha Yojana (JSY):

a) The District received JSY funds of Rs. 97,75,300 for year 2010-11 and spent Rs.

61,68,300 (63%) during the year. An amount of Rs.1,04,93,200 was available during

2011-12 , out of which Rs. 41,69,800 (40%) was spent till January, 2012.

b) 18 JSY beneficiary out of 38 newly delivered mothers selected were interviewed for

on the spot verification. It was observed that MCH cards were issued to them and most

of them were registered in early stage of pregnancy and JSY payments were made in

time. Most of the mothers delivered at Government Hospital and ASHAs accompanied

them to the hospital.

c) It was observed that necessary information was not recorded in JSY cards, but

Immunization Cards were filled properly. ANC/PNC was not up to the mark. Supervisory

checks for regular monitoring at HSC level were lacking.

4. Functioning of ASHA Scheme:

a) 669 ASHAs were in position against the targeted no. of 710 ASHAs in the district.

665 ASHAs were trained upto 5th module but only 474 ASHAs have been provided drug

kits in the district.

b) For the implementation of ASHA scheme, budget to the tune of Rs. 69,47,500 was

provided in 2010-11 which was fully utilised during the year. The district also spent an

amount of Rs. 82,89,856 up to January, 2012 as against the available budget of Rs.

36

63,37,300 during 2011-12. The excess expenditure for the year 2011-12 was adjusted

from the flexi-pool fund.

5. Untied funds (UF) and Annual Maintenance Grant (AMG):

Provision and Utilization of funds in respect of UF and AMG at PHC and SC level

reported to

the team was as under:

(Amt in Rs.)

Type of Fund Centres 2010-11 2011-12 (up to January, 2012)

Fund available

Expenditure Fund available Expenditure

Untied Fund PHCs 7,00,000 9,67,934* 7,50,000 1,44,627 Sub Centres 22,80,000 22,66,442 22,80,000 5,11691

AMG PHCs 14,00,000 23,49,154* 12,00,000 3,12,267 Sub Centres 22,80,000 11,01,795 16,10,000 4,06,545

* The excess expenditure for the year 2010-11 was made from flexi-pool fund.

6. 24 x 7 Hours Delivery Care Services:

As reported, 16 institutions were providing 24x7 hours services in the district.

7. Physical Infrastructure and Stock Position:

i. DH:

District Hospital at Tapi was functioning in govt. building. There was no Blood Storage

Unit available in the Hospital.

ii. PHCs:

a) PHCs visited at Panchol, Jamkhadi and Algat have own buildings but the

maintenance of the hospital buildings was not up to the mark. The team found regular

water supply, electricity and telephone facility only in PHC at Algat.

b) Oxygen cylinder in the PHCs Panchol and Jamkhadi and OT table in the PHCs

Panchol and Algat was not available. Labour room table was not available at PHC

Algat.

37

c) Oral Pills were not available in any of the visited PHCs. Condom was in stock

available only at PHC Jamkhadi.

d) There was no residential accommodation available for AYUSH MO and Medical

Officer (PHC) at PHCs Jamkhadi and Algat.

iii. SCs:

a) Out of the 4 Sub Centres visited, 3 SCs namely Umaravavdur, Tokarwa and

Jammania were having their own building. The facilities at SC Jammania were better

than the other three SCs visited. None of the visited Sub Centres was having Labour

room. Electricity and Toilet facilities were not available at all the visited SCs except SC

Jammania.

b) Essential furnitures, equipments and also drugs were not mostly available at SC

Anantpur. Benches for clients, Cupboard for drugs, McIntsh Sheet, Steam Sterilizer,

RDT Kits, Thermometer, Gloves and DDKs etc. were not available in most of the

centres.

c) Short supply of Misofrostol, Magsulth tab., Oxitocine, Co-trimoxazole tablets,

Ampicillin Capsule, Gentamycine Injection, Kits A & B, EC pills and OP etc. was

available in the visited Sub Centres.

d) At HSCs Antapur and Tokarwa, no MPW (M) was posted.

e) None of the SCs was having facility for conducting delivery and the service registers

were not checked/verified by the PHC/District Officials.

f) In all visited SCs, ANMs had not received SBA and IMNCI training.

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

i. Towards ANM’s and MPW (M) services:

a) 10 mothers having child up to one year age were interviewed in the area of visited 4

Sub Centres in the district. Mothers informed that ANMs are available when needed and

also conduct immunization clinic in regular basis. ANMs had provided IFA and TT

injections to pregnant women. Home deliveries were being conducted by trained

persons in the area. It was observed that mothers had utilised DDK during home

delivery.

b) Most of the mothers had no knowledge about ARI. The ANC/PNC services need to

be strengthened in the Sub Centres areas.

38

c) It was observed that the HW was neither staying at SC village nor available when

needed.

ii. Towards PHC’s services:

a) Public opinion was good on the services being rendered by the PHCs visited by the

team. MO visited PHCs regularly and disbursement of drugs was satisfactory.

b) It was observed that the services and health education in respect of pregnant

women, recently delivered women, mother of two year old child, ASHA and village

leader was not up to the mark.

c) During visit, it was found that MOs of PHCs Jamkhedi and Algat did not visit their

villages regularly.

9. Sample Verification of Family Welfare Acceptors:

a) The team selected 150 FW acceptors out of which 92 (61%) could be contacted for

Sample verification in the district. Discrepancy in the age of spouse of the acceptors in

35 (38%) cases and in the age of last child in 66 (72%) cases was found during sample

check.

b) Follow-up services by FW Staff were provided to 54 (59%) acceptors. Full amount of

compensation was given to 36 acceptors of Sterilisation.

c) 13 (7 BCG and 6 Hepatitis “B”) beneficiaries of child immunization were contacted. All

beneficiaries confirmed receiving the doses and were satisfied with the services

rendered by the health staff. All beneficiaries received follow up services. No

complication was found among contacted beneficiaries.


There was no co-ordination between District Office and reporting centres in respect of

performance reported for the same figures in the year 2010-11 and 2011-12 (up to

January, 2011). The details are as below:

a) 117 and 97 Sterilization were reported by PHCs Panchol and Algat for the year 2010-

11 whereas these figures shown in the report of district office were 136 and 96

respectively. Similarly, 199 and 107 IUD acceptors were reported by PHCs Jamkhadi

and Panchol for the year 2010-11 whereas these figures shown in the report of district

office as 99 and 77 respectively.

39

b) 163 OP cycles/users reported by PHC Alghat and 233 Nirodh pieces/users reported

by PHC Panchol for the year 2010-11 whereas these figures shown in the report of

district office were 1598 and 594 respectively.

c) 96 OP cycles/users and 136 Nirodh pieces/users reported by PHC Panchol for the

year 2011-12 (up to January, 2012) whereas these figures shown in the report of district

office were 1380 and 5760 respectively.

d) IUD acceptors were recorded less than the reported number of acceptors for the

year 2010-11 in the PHCs Panchol and Algat.

11. Maintenance of Registers & Records:

a) Eligible Couple register was not maintained properly and was not up to date at Algat

PHC. This register was not made available at Jamkhedi and Panchol PHCs.

b) Sterilization Register was not maintained properly at District Hospital Vyara (Tapi).

c) Cu-T service register, Oral pills & Nirodh distribution register were not maintained

properly at PHC Algat and DH Vyara (Tapi).

d) ANC Register was maintained properly at the visited institutions.

e) Stock Register for IUD, OP and CC was not maintained properly at the visited

institutions except PHC Algat.

12. IT Infrastructure & Mother and Child Tracking (MCH) System:

Computers were available at the district headquarters, CHCs and PHCs in the district.

Internet connectivity was provided to the systems available in the district, CHC and PHC

level.


a) Monitoring and supervision in the district need to be enhanced especially for the

activities taken up at Sub Centre level.

b) During the visit, it was reported that the condition of Labour Room and Maternity

Wards at Panchol PHC was unhygienic and no restriction had been maintained to enter

Labour Room for general public.

c) With regard to utilization of Untied Fund and Annual Maintenance Grant, the

submission of Utilization Certificate and Statement of Expenditure was irregular and not

in accordance with the guidelines of the government.

40

d) The team observed that, the members of NRHM Management Supporting Units at

district as well as at PHC/CHC and the officials at district headquarter were not having

adequate knowledge about the latest Programme guidelines under NRHM. The entire

units need re-orientation training to improve the work.

*********

41

6. District - Sabhar Khantha

Major observations of Regional Evaluation Team (RET), Patna on the evaluation

work carried out in Sabhar Khantha District of Gujrat State in the month of

February, 2012.


District visited DH/PHCs visited HSCs visited B. Sabar Khantha

DH: Sabar Kantha PHCs: Gabat, Lusadia, Hadiyol and Jashvantpur

Gabat, Sarsoli, Lusadia, Baghpur, Gadhoda, Jasvantpur and Maniyar


1. Human Resources:-

Vacancy position of the skilled personnel was alarming in the district. The details of

some of the important posts in this regard are given below:

Particulars of Post Sanctioned In position Vacant

Specialists 18 11 7 Medical Officer 80 72 8

ANMs 413 313 100 MPW (M) 413 207 206 LHV/HS(F) 70 63 7 Health Supervisor (M) 68 18 50 Lab Technician 70 60 10

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

a) Rogi Kalyan Samiti (RKS) has been registered in 20 CHCs, 68 PHCs, Sub-

Divisional Hospital and District Hospital in the district. Regular quarterly meetings of

RKS were being conducted in the visited centres.

b) An amount of Rs. 61,00,000 was available for RKS in the district for the year 2010-

11, out of which, an amount to the tune of Rs. 60,45,410 (99%) was spent. Similarly,

funds of Rs. 68,00,000 were available for RKS in the district for the year 2011-12, out of

which, an amount to the tune of Rs. 44,20,184 (65%) was spent up to January, 2012.

c) 1362 Village Health Sanitation & Nutrition Committees (VHSNCs) have been

constituted in the district.

d) An amount of Rs. 30,15,882 was available as untied fund for VHSNC in the district for

the year 2010-11, out of which, an amount to the tune of Rs. 16,81,424 (95%) was

42

spent. Similarly, VHSNC funds of Rs. 1,37,20,000 were available in the district during

2011-12 out of which, an amount to the tune of Rs. 1,04,08,474 (76%) was spent up to

January, 2012.

e) During visit to the centres, the team observed that the meetings were being

conducted regularly and VHSNCs were functionally smoothly in the district.

3. Services under Janani Suraksha Yojana (JSY):

a) The District received JSY funds to the tune of Rs. 1,54,00,000 during 2010-11 and

an amount of Rs. 1,08,39,944 (70%) was spent during the year. Similarly, the district

received Rs. 1,49,00,000 during 2011-12 and out of it, Rs. 13,85,500 (46%) was spent

till January, 2012.

b) It was observed that necessary information was not recorded in JSY cards and

Immunization Cards were not filled up properly. Some of mothers did not receive three

consecutive checks up. The post natal visits by the ANM/ASHA need to be increased.

4. Functioning of ASHA scheme:

a) 2109 ASHAs were in position against the targeted no. of 2221 ASHAs in the district.

It was reported that all ASHAs were trained in all modules and provided with drug kits

in the district.

b) For the implementation of ASHA scheme, an amount of Rs. 1,83,25,000 was

provided to the district in 2010-11, out of it, an amount of Rs. 2,06,76,962 was spent

during the year. During the year 2011-12, Rs. 1,99,10,100 was available and district

spent Rs. 1,94,89,183. The excess exopenditure was adjusted from flexi-pool fund up.

5. Untied funds (UF) and Annual Maintenance Grant (AMG):

Utilization of funds in respect of UF and AMG at PHC and SC level reported by the

team was as under:

(Amount in Rs.)

Type of Fund Type of Centres

2010-11 2011-12 (up to January, 2012)

Fund available

Expenditure

Fund available

Expenditure

Untied Fund PHCs 15,25,000 14,99,304 17,00,000 12,51,677 Sub Centres 41,30,000 37,25,810* 41,30,000 26,14152

AMG PHCs 30,50,000 34,55,882 28,50,000 26,25,959 Sub Centres 41,30,000 24,46,294 28,20,000 2,16,524

43

* The excess expenditure for the year 2010-11was made from flexi-pool fund.

6. 24 x 7 Hours Delivery Care Services:

As reported, 11 institutions were providing 24x7 hours services in the district. 24 x 7

hour services were not provided at PHCs Gabat and Lusadia.

7. Physical Infrastructure and Stock Position:

i. DH:

a) The visited District Hospital, Saber Kantha was functioning in govt. building. b) All

surgical equipments, Oxygen cylinder, Labour room, Resuscitation equipment,

Anaesthesia equipment, Auto Clave and Blood Storage Unit were available at the

District Hospital, Saber Kantha.

ii. PHCs:

a) PHCs visited at Hadiyol, Gabat, Jasvant and Lusadia have own buildings but the

maintenance of the hospital buildings was not up to the mark. There was regular water

supply, electricity and Toilet facility in all the visited PHCs. Power backup facility was

not available in the PHCs Gabat and Lusadia. Telephone facility was available in all the

visited PHCs except PHC Lusadia.

b) All the visited PHCs were not having Functional Operation Table with OT Table.

Labour Room table, other equipments for delivery and Resuscitation equipment were

not available in Lusadia PHC.

c) During the visit, it was found that the Stock of Contraceptives viz. IUD, Oral Pills and

Condom was not available in all the visited PHCs except Hadiyol PHC. Stock of

Vaccines like BCG and DT was not available in the PHCs Gabat and Lusadia.

Similarly, Prophylactic Drug i.e. IFA Small (Tab) and Vit A (Syrup) was not available in

the PHCs Gabat and Jashvant. IFA (Syrup) was not available in any of the visited

PHCs.

d) There was no residential accommodation available for Medical Officer (PHC) at all

the visited PHCs except PHC Jashvant.

iii. SCs:

a) Baghpur and Maniyor SCs were having their own building except SC Sarsoli. Water,

Electricity and Toilet were available at the visited SCs except SC Sarsoli.

44

b) None of Sub Centres was having Labour room. All the visited SCs had no Delivery

table, Delivery Kit and McIntsh Sheet. SCs Baghpur and Sarsoli had no Rapid

Diagnosis Test (RDT) Kit for Malaria.

c) No supply of DDKs, Condoms, Metronidazol, Misofrostol, Magsulth, Oxitocine, Co-

trimoxazole tablets, Ampicillin Capsule, Gentamycine Injection and EC pills was

observed in the visited Sub Centres.

8. Knowledge and Opinion of the Community on Health Service:

i. Towards ANM’s and MPW (M) service:

a) 10 mothers having child up to one year age were interviewed in the area of visited 2

Sub Centres in the district. Mothers informed that ANMs are available when needed and

also conducted immunization clinic fairly on regular basis. ANMs provided IFA and TT

injections to pregnant women. Home deliveries were being conducted by trained

persons in the area. It was observed that mothers had utilised DDK during home

delivery.

b) Most of the mothers had no knowledge about ARI. The ANC/PNC services need to

be strengthened in the Sub Centres areas.

ii. Towards PHC’s service:

a) Public opinion was good on the services being rendered by the PHCs visited by the

team. The visit of the Medical Officer to the village during last 6 months was found poor

at the visited PHCs.

b) It was observed that the services and health education in respect of pregnant

women, recently delivered women, mother of two year old child, ASHA and village

leader was not satisfactory.

c) During the visit, it was found that MOs of PHCs Hadiyol, Jashvantpur and Pipardi

were not visiting their villages regularly.

9. Sample Verification of Family Welfare Acceptors:

a) The team selected 199 FW acceptors out of which 123 (62%) could be contacted for

Sample verification in the district. Discrepancy in the age of spouse of the acceptors in

90 (73%) cases and in the age of last child in 61(50%) cases was found during sample

check.

45

b) Follow-up services by FW Staff were provided to 84 (68%) acceptors and also

provided full amount of compensation to 22 acceptors of Sterilisation.

c) 13 (9 Cu „T‟ and 4 OP) beneficiaries of child immunization were contacted. All

beneficiaries confirmed receiving the doses and were satisfied with the services

rendered by the health staff. Nirodh users discontinued/Denied using these methods.

d) 29 (17 BCG, 6 Measles and 6 Vit. A) beneficiaries of child immunization were

contacted. All beneficiaries confirmed receiving the doses and were satisfied with the

services rendered by the health staff. All beneficiaries received follow up services. No

complication was found among contacted beneficiaries.


a) IUD figures reported at PHC Gabat for the years 2010-11 and 2011-12 did not tally

with the numbers of registered IUD cases in the PHC. There were 760 and 726 IUD

cases in the service registers as against 902 and 735 reported cases for the year 2010-

11 and 2011-12 up to January, 2012 respectively in PHC Gabat.

b) OP and Nirodh figures reported at PHC Hadiyol for the years 2010-11 and 2011-12

up to January, 2012 were much more in the report of District office. The district office

reported 2100 OP and 52850 Nirodh in the year 2010-11 against the figures of 169 and

830 respectively reported by PHC. Similarly, district office reported 1844 OPs and 8850

Nirodhs against the figures of 189 and 830 respectively reported by PHC Hadiyol in the

year 2011-12 up to January, 2012.

11. Maintenance of Registers & Records:

a) Eligible Couple & Children Register was not maintained at all the visited institutions

in the district.

b) Sterilization Service Register was not maintained properly at all visited PHCs except

PHC Jashvantpur in the district.

c) Service Register for Cu-T was not maintained properly in the PHCs Gabat and

Hadiyol.

d) Printed Oral pills & Nirodh distribution registers were available but not maintained at

all the visited PHCs in the district.

e) Stock register of Cu.T, OP and CC was not maintained properly at all the visited

PHCs in the district.

46

12. IT Infrastructure & Mother and Child Tracking (MCH) System:

a) Computers were available at the district headquarters, CHCs and PHCs in the

district.

b) Internet connectivity was provided to the systems available in the district, CHC and

PHC level.

c) It was reported that all Sub Centres were having MCH Tracking formats and Health

functionaries sensitised in MCH formats. Data Entry was in progress at CHC/PHC level

and online data entry in MCH tracking formats in the district was found up to date.


a) Monitoring and supervision in the district need to be enhanced. Supervisory staffs

need to check the overall activities of SCs including coordination between ASHAs &

AWWs and all the records and registers. Staff of DPMU/BPMU need immediate re-

orientation under NRHM.

b) Submission of utilization Certificate and Statement of Expenditure in respect of

various funds provided at the SCs, PHCs and CHCs was very irregular and whatever

submitted, it was without any details. In this connection, prescribed formats and

guidelines should be provided to SC, PHC, CHC and District Hospital and concerned

staff should be oriented for proper filling up of these formats /statements.

c) During visit to the different centres, the team, noticed lack of cleanliness in OPD,

Indoor, Labour Room and Maternity Wards. On enquiry, the concerned head of the

Centres informed about lack of manpower.

d) The computer room of the PHCs was dirty. Due to insufficient space at PHC

attached Sub Centre, ANC/PNC clinics were not being conducted properly.

******

gujarat 1. district- anand major observations of regional ... · g) all the jsy concerned registers...

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