ideal delivery points in tripura

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EDITED VERSION 1.1

Ideal Delivery Points in Tripura A Step towards improving Quality of Care in Government Hospitals

13th January 2015

National Health Mission State Health & Family Welfare Society, Tripura

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Table of Contents

1. Introduction ........................................................................................................................... 3

2. Background of the Initiative .................................................................................................. 4

3. Need of the Initiative ............................................................................................................. 4

4. How we Started ...................................................................................................................... 5

5. Procedures Adopted ............................................................................................................... 5

6. Likely Results and Impact of the Initiative ............................................................................ 6

7. Post Intervention Phase ......................................................................................................... 8

7.1 Post Evaluation Findings: Delivery Room ....................................................................................... 19

8. Scope for Providing Quality Services in other Fields .......................................................... 20

9. Need for Replication in other Health Care Facilities ........................................................... 20

Annexure GO on declaration of Delivery Points in Tripura

GO on roles & responsibilities assigned at State and at 24 Health facilities

GO on responsibilities assigned for implementation and monitoring of ‘Ideal Delivery Points’ at 24 Health facilities

GO on providing handholding support to Facility In-charges

GO on extension of the initiative at 6 more facilities

Facility-wise scoring on Key Indicators of 24 Health Facilities

GO on training of health service providers of delivery points on RBSK

Services delivered under AIDS Control Programme at the 30 Delivery Points

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Ideal Delivery Points in Tripura

A Step towards improving Quality of Care in Government Hospitals

1. Introduction

The National Rural Health Mission (NRHM) was launched in the year 2005 with the

major objectives to reduce Infant Mortality Rate (IMR) and Maternal Mortality Ratio

(MMR). Comparative analysis of achievement of Tripura in terms of key indicators

such as average institutional delivery have shown at 86.7% (HMIS 2014) from 49%

with respect to the National average which is also at 86.7% (HMIS 2014) from 41%

NFHS-3 during 2005-06. In terms of Maternal Mortality Ratio (MMR), the present

status is 160 (other State category) as compared to the National average of 212

(HMIS 2014). The National average of MMR as per NHFS-3 (2005-06) report which

coincides with the launch of NRHM was about 254 per 1,00,000 live births. The

Infant Mortality Rate (IMR) of Tripura is also on declining trend from 32 (SRS:

2006) to 26 (SRS: 2014) per 1,000 live births in comparison with the National

average of 58 (SRS: 2006) and 40 (SRS: 2014) respectively.

To achieve the objectives, there are numbers of schemes such as Janani Suraksha

Yojana (JSY), Janani Sishu Suraksha Karyakram (JSSK), Facility Based New Born

Care (FBNC) etc. and training programmes of health care personnels like Skilled

Birth Attendant (SBA), Navjaat Sishu Suraksha Karyakram (NSSK) etc. Although the

institutional delivery has increased, it has been observed that there are number of

weakness inside the Labour Room, New Born Care Corners (NBCC), PNC Wards. As

a result the institutional delivery rate is almost stagnant in the range of 84-86% since

last three years.

The ‘Mayer Ghar’ Initiative

National Health Mission (NHM), Tripura has created the facility ‘Mayer Ghar’ in difficult and hilly terrain areas where home delivery rate is high mostly due to lack of transportation facilities. The ‘Mayer Ghar’ initiative shall now enable pregnant women of difficult and hilly terrain areas to come at least 7-8 days in advance along with one family member near the facility. Presently, the Mayer Ghar has been set up at Kanchanpur SDH of North Tripura district and Chawmanu PHC of Dhalai district and became functional from the month of November 2014 where more than 75 (seventy-five) women have been benefitted respectively as on date.

With the success of ‘Mayer Ghar’ at these two places, the State is also planning to

start more such facilities in remote areas. It is envisaged to ensure in improving the

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accessibility to public health care services by the vulnerable population especially

belonging to tribal ethnic groups which accounts for delivering at homes.

2. Background of the Initiative

In Tripura, about 30% of institutional deliveries takes place in State Hospitals, while

remaining takes place in 70 (seventy) other Hospitals. While maternal mortality and

infant mortality helped us to understand the overall health care situation, improving

the capacity and preparedness to avert identified causes of maternal deaths namely

Hemorrhage, Hypertensive disorder, obstructed labour & sepsis and newborn/infant

death – sepsis, asphyxia, low birth weight (LBW) etc. was felt important at the

facility level by addressing gaps in the areas of availability of skilled human

resources, effective utilization of equipments, effective and efficient supply chain

management of drugs and consumables. Key observations and recommendations of

the 6th Common Review Mission (CRM) visit report to Tripura regarding saturation

of public health facilities with adequate skilled manpower, equipments drugs and

supplies to meet the case load for institutional delivery were thus taken into account.

Further, in response to the Ministry of Health & Family Welfare, Government of

India’s call for immediate implementation of specified range of services especially at

the identified Delivery Points (DPs) to improve performances in maternal and neo-

natal health (MNH), IPD, OPD and other services, a roadmap was developed through

a formal notification regarding declaration of designated DPs. (Relevant GO attached

as Annexure-1.1). Therefore, in an effort to improve health care at public health

facilities, a special intervention has been initiated at selected 30 nos. designated

Delivery Points (DPs) spread across all 8 districts of the State.

3. Need of the Initiative

As mentioned above, National Health Mission has identified 30 (thirty) health

facilities where almost 40% of the institutional deliveries of the rural areas were

being covered. In the first phase, need of launching the initiative in the hospitals, the

area or the wards where general people would least like to visit or enter in Labour

Room i.e. delivery room where deliveries are conducted. The reason is that most of

the labour rooms are not properly maintained. After visiting the labour rooms, it has

been observed that there are numbers of problems like poor quality of labour tables,

lack of cleanliness and proper sanitation in the labour rooms, shortage of equipments

e.g. if any facility conducts four deliveries per day, the available set of equipments is

only for one, non-availability of life saving medicines like Magnesium Sulphate, to

treat Hypertension in pregnancy. Poor bio-medical waste management practices,

unhygienic conditions of toilets, lack of privacy, record maintenance are not up to the

mark.

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4. How we started

Initially baseline assessment was carried out in only 10 (ten) designated Delivery

Points, where detailed gap analysis was carried out in terms of infrastructure, labour

room equipments, drugs and consumables, register, availability of trained human

resources and conditions of post-natal wards (PNC) where women stay after delivery.

A detailed Score Card was prepared having total score of 80. Very few health facilities

had a score above 50.

5. Procedure adopted

NHM administration had divided the responsibility at State level and facility level i.e.

with Rogi Kalyan Samitis (RKS) and Doctors. Relevant GO issued in this respect is

attached as Annexure-1.2. Amendments were also carried out in the RKS

guidelines to allow them procure all labour room equipments and medicines along

with greater support in terms of funds.

The sample scenario of baseline assessment at 10 (ten) designated Delivery Points

paved the way to accord priority activity and accordingly a team of officials under

State Programme Management Unit (SPMU) were constituted and distribution of

health facilities have been made amongst the officials to support towards assessment

and continuous handholding technical support to respective 30 (thirty) health

facilities. Relevant GO issued in this respect is attached at Annexure-1.3

Initially, Bishalghar SDH was able to be successfully upgraded as Ideal Delivery

Room NBCC and PNC Wards and equipped to provide the prescribed minimum

range of services as per MNH Took Kit. This model was shown to 24 (twenty-four)

Medical Officer-in-Charges of health facilities in a workshop conducted in the same

health facility to provide orientation about the processes followed for up-gradation,

location and local specific issues. Training Order issued is attached as Annexure-

1.4.

After thorough gap assessment of 30 Delivery Points, the health facilities have been

categorized in to three viz. facilities which have a score less than 30, facilities which

have a score ranging between 30-60 and facilities which are scoring more than 60.

The facilities which scored above 60 were chosen to be upgraded in the first phase as

separate strategies were required with greater effort for the facilities where the score

was <30. Presently, the intervention has been completed for 24 DPs and their

detailed scoring in key indicators of each health facilities has been detailed district-

wise at Annexure-2.

Special focus is given for training of the untrained human resources like Staff Nurses

on the skill side like SBA, NSSK. Almost 80% of the work is done through RKS by

motivating them so as to develop ownership in the initiative and to make it

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sustainable. Also the process of change is over period of 3 months to make it more

sustainable.

Special focus is also given to maintain and observing the Labour Room protocols by

the Staff Nurses on infection control to ensure frequent cleaning and improving the

corridors of the floor since cleanliness of the hospitals by and large were not up to the

mark.

6. Likely Results and Impact of the Initiative Few snapshots of the health facilities prior to implementation of the initiative:

Unhygienic Labour Table Unhygienic Floor Non-functional Suction Machine & Bulb

BIO MEDICAL WASTE MANAGEMENT DOES NOT EXISTS IN MOST OF THE HOSPITALS

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Unhygienic Curtain Shoes found instead of slippers, no slippers found in rest of the

facilities

Poor conditions of OT Lamps

Unhygienic Labour Table Misuse/Locally Managed NBCC

Locally managed foot steps Poor quality of Infection Management

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7. Post intervention phase

After the intervention period of about two months, lots of changes were observed in

the Labour Rooms, PNC Wards etc. In the Labour Rooms, all the equipments are

available; all necessary essential medicines are available, labour room protocols for

the treatment of complications during pregnancy as well as neo-natal resuscitation

are available at 30 health facilities. Sanitation and cleanliness has dramatically

improved. As a result of the interventions, the health facilities

Few snapshots showing marked improvement in Health Facilities through the

intervention:

BEFORE AFTER

Natunbazar CHC Scoring Before Intervention: 28 Scoring After Intervention: 65

Noticeable Changes: New Labour Table, Mackintosh Sheet, Curtains, Spot Light/Lamp & Color Coded Bins are in place. New Born Care Corner (NBCC)have been installed at the right place of Labour Room (LR).

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BEFORE AFTER

Nutanbazar CHC Scoring Before Intervention: 28 Scoring After Intervention: 65

Noticeable Changes: Well managed Drugs & Consumables, Dressing Drum & Trays, Accessories, Sterilizer, Bio-Medical Waste Management with 24*7 water connectivity have been ensured.

Jirania CHC Scoring Before Intervention: 43 Scoring After Intervention: 63

Noticeable Changes: One of the most crowded and unorganised CHC now converted into a well organized facility having quality Labour Room with all Equipments, Tray, Trolley, Spot Light, etc & Infection Control system.

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BEFORE AFTER

Jirania CHC Scoring Before Intervention: 43 Scoring After Intervention: 63

Noticeable Changes: A radical change inside the Labour Room with all Equipments & Accessories, NBCC, basin with a good Infection Control Management System.

Manubazar PHC Scoring Before Intervention: 47 Scoring After Intervention: 65

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BEFORE AFTER

Manubazar PHC Scoring Before Intervention: 47 Scoring After Intervention: 65

Noticeable Changes: New Labour Table, Mackintosh Sheet, Curtains, Spot Light/Lamp, necessary Equipments, Drugs & Consumables, Protocols are in place.

Noticeable Changes: Along with labour room changes have been made in ANC / PNC ward, color coded bins are in place, protocols are pasted inside of LR & ANC / PNC ward. Infection Control Management is in place.

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BEFORE AFTER

Gandacherra SDH Scoring Before Intervention: 26 Scoring After Intervention: 68

Noticeable Changes: One of the most challenging hospitals of the State, Labour Room (LR) was very much congested and conceptually there was no ANC/PNC Ward. However, whole LR & ANC/PNC ward has been shifted in the 1st Floor of the Facility’s building with new Labour Table, Curtains, Lights, Water Connectivity & Infection Control Management.

Noticeable Changes: The working atmosphere has drastically improved due to availability of all necessary resources & confidence of the service providers. The sanitation and cleanliness has improved a lot.

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BEFORE AFTER

Bishalghar SDH Scoring Before Intervention: 62 Scoring After Intervention: 70

Noticeable Changes: Curtains for privacy, Delivery Trolley with all Equipments, Spot Light, Cleanliness, Labour Room protocols, etc.

Noticeable Changes: NBCC in readiness, Protocols, etc.

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BEFORE AFTER

Sabroom SDH Scoring Before Intervention: 41 Scoring After Intervention: 67

Noticeable Changes: Efforts done through RKS of the health facility resulting well managed Labour Room (LR) with Labour Table, Essential Drugs & Consumables, Trays, Trolleys, Water & Power connectivity, Skilled man power along with Infection Control Management. ANC & PNC Ward & NBCC ensured with readiness.

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BEFORE AFTER

Belonia SDH Scoring Before Intervention: 51 Scoring After Intervention: 74

Noticeable Changes: Wooden Labour Table has been replaced and Dressing Drum, Tray, Trolley with all necessary Drugs & Consumables, Footsteps, Protocols, Privacy, Infection Control Management System ensured.

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BEFORE AFTER

Belonia SDH Scoring Before Intervention: 51 Scoring After Intervention: 74

Noticeable Changes: Well organized ANC, PNC & FBNC ward

Khowai SDH Scoring Before Intervention: 55 Scoring After Intervention: 70

Noticeable Changes: Khowai DH is an equipped facility now and may be referred as a well organized facility with all essential equipments, infection control management, drugs & logistics, registers & trained service providers along with NBSU.

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BEFORE AFTER

Chawmanu CHC Scoring Before Intervention: 32 Scoring After Intervention: 57

Noticeable Changes: The Labour Room have been shifted in new location within the facility’s building and Equipments like Labour Table, Drug Trays etc. have been replaced with new ones, Essential Drugs has been ensured and Infection Control Management is also ensured.

Kulai District Hospital Scoring Before Intervention: 57 Scoring After Intervention: 73

Noticeable Changes: Dhalai DH is a newly functional Hospital. With minimum effort maximum result has been achieved.

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BEFORE AFTER

Ompi CHC Scoring Before Intervention: 30 Scoring After Intervention: 55

Noticeable Changes: A radical change in Ceiling, Labour Table, Curtains, Infection Control Management, Protocols. NBCC in readiness with clean clothes ensured the improved working environment.

Noticeable Changes: Availability of Essential Drugs & Consumables, Neatness & Cleanliness etc.

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7.1 Post Evaluation Findings: Delivery Room

(i) The working atmosphere in the delivery rooms has drastically improved

due to availability of all necessary resources inside the labour room.

(ii) The sanitation and cleanliness has improved a lot.

(iii) The Infection preventive practices has improved as Clean table , Clean

hands, Clean Cord practices has been ensured by use of plastic aprons,

gloves, clean floor, disposal of the products of delivery by Biomedical

waste management etc. use of chappals.

(iv) The storage of the essential consumable items like sterile cotton,

antiseptics, and all essential medicines has improved.

(v) The equipments like Different trays e.g. Delivery tray, baby tray has

become proportionate to number of deliveries taking place per day. This

ensures adequate time for sterilization of these items prior to its next

use. This will help to reduce the infections in Delivery Room.

(vi) Privacy of the woman in Delivery room has been ensured with

use of curtains on windows, doors which is more important in

case of rural healthcare settings.

(vii) Various Labour Room Protocols like treatment of PIH, Postpartum

Hemorrhage, Hand washing, Third stage management of labour,

Neonatal Resuscitation etc almost 12 different varieties has been put up

in all 30 facilities for assistance of doctors ,staff nurses working in labour

room.

(viii) For management of prolonged labour and obstructed labour equipments

of assisted delivery like Ventouse Machine has been made available. This

will help to reduce the morbidity and mortality associated with

prolonged and obstructed delivery.

(ix) Focus has been given on ensuring the availability of necessary skills like

skilled birth attendance, Essential newborn care by training of nurses on

SBA, NSSK and ENC training.

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(x) In New born Care Corner all essential equipments like Radiant warmer,

Ambu Bag, Oxygen trolley, Baby weighing scale, Mucus extractor baby

towel etc. are made available.

(xi) Protocol for Neonatal resuscitation has been made available next to

warmer for assistance of the trained staff nurses.

(xii) These will ensure reduction in Neonatal morbidity and mortality due to

hypothermia, asphyxia, which are most important reasons of neonatal

death.

8. Scope for Providing Quality Services in other Fields Once the health facilities are sustainably upgraded with the help of ‘Ideal Delivery

Points’ initiative for quality Maternal care, then services in other fields like

Reproductive Health (including convergence with AIDS Control Programme),

Newborn and Child Health including Adolescent Health could also be improved in an

integrated manner.

Recently, respective Facility in-Charges and two Staff Nurses of 30 (thirty) selected

DPs covered under this initiative have been nominated for RBSK training to enable

them detect, register report and refer birth defects of children who are identified with

any form of 4Ds enlisted under Rashtriya Bal Swasthya Karyakram (RBSK). Relevant

GO for the said training is attached as Annexure-3. The trainees are being imparted

training by National Adviser (RBSK), Dr. Arun Singh who had taken personnel

attention to build the capacities for effective implementation of RBSK in the State.

Similarly, NHM-AIDS convergence could also find the initiative as enhancing factor

to deliver quality services. The package of services available in the 30 (thirty) selected

DPs under AIDS Control Programme include ICTC and STD clinics or both is as per

the mandatory requirement at the SDH and DH level (Level-3 facilities).

ICTC/FICTC which are required at the PHC/CHC level (Level-2 facilities) are

providing services related to early detection of HIV, basic information on modes of

transmission and prevention of HIV/AIDS and to link people with other HIV

prevention, care and treatment. Service delivered under AIDS Control Programme at

the 30 DPs is attached as Annexure-4.

9. Need for Replication in the Health Care Facilities Now the time has come to further improve the quality and services of health facilities

under NHM. This year onwards, NHM is going to focus on the Quality Assurance.

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All India figures of performance related to Maternal Health: Institutional

Deliveries for the period April to September for the year 2014-15 and 2013-14

State/UT/Agency

Need

Assessed

(2014-15)

Achievement during April to September

% Achvt. of

need

assessed

Total Institutional Deliveries (2014-15)

(2014-15) (2013-14) % change

(A) (B) (C) (D=((B-

C)/C)*100)

(E=(B/A)*10

0)

All India 27,016,300 8,335,640 8,369,544 -0.4 30.9

I. High Focus-

NE

Arunachal

Pradesh 27,800 7,272 7,182 1.3 26.2

Assam 729,100 244,288 230,283 6.1 33.5

Manipur 43,700 15,650 14,468 8.2 35.8

Meghalaya 73,800 21,590 20,653 4.5 29.3

Mizoram 18,400 9,737 9,160 6.3 52.9

Nagaland 31,700 8,444 7,324 15.3 26.6

Sikkim 10,900 3,838 3,640 5.4 35.2

Tripura 52,400 21,207 20,990 1.0 40.5

II. High Focus-

Non NE

Bihar 3,002,800 734,325 755,234 -2.8 24.5

Chhattisgarh 652,500 174,725 153,706 13.7 26.8

Himachal

Pradesh 113,300 38,436 39,323 -2.3 33.9

Jammu &

Kashmir 228,900 88,900 88,724 0.2 38.8

Jharkhand 850,500 250,652 239,864 4.5 29.5

Madhya Pradesh 2,015,400 590,995 567,835 4.1 29.3

Odisha 847,300 309,732 300,897 2.9 36.6

Rajasthan 1,849,000 673,079 662,642 1.6 36.4

Uttar Pradesh 5,764,600 1,122,655 1,120,029 0.2 19.5

Uttarakhand 192,600 61,186 58,283 5.0 31.8

III. Non High

Focus Large

Andhra Pradesh 885,400 179,401 186,265 -3.7 20.3

Goa 20,800 8,516 7,906 7.7 40.9

Gujarat 1,314,400 509,581 550,064 -7.4 38.8

Haryana 570,500 215,551 210,971 2.2 37.8

Karnataka 1,157,300 440,680 429,124 2.7 38.1

Kerala 502,500 242,989 251,259 -3.3 48.4

Maharashtra 1,940,700 800,018 834,189 -4.1 41.2

Punjab 451,800 179,297 173,535 3.3 39.7

Tamil Nadu 1,148,800 487,636 513,206 -5.0 42.4

Telangana 631,000 173,231 198,659 -12.8 27.5

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State/UT/Agency

Need

Assessed

(2014-15)

Achievement during April to September

% Achvt. of

need

assessed

Total Institutional Deliveries (2014-15)

(2014-15) (2013-14) % change

(A) (B) (C) (D=((B-

C)/C)*100)

(E=(B/A)*10

0)

West Bengal 1,506,500 547,411 551,157 -0.7 36.3

IV. Non High

Focus- Small &

UT

A & N Islands 6,100 2,370 2,411 -1.7 38.9

Chandigarh 18,200 12,632 12,194 3.6 69.4

Dadra & Nagar

Haveli 10,100 3,456 3,614 -4.4 34.2

Daman & Diu 5,000 1,810 1,763 2.7 36.2

Delhi 319,000 120,919 113,874 6.2 37.9

Lakshadweep 1,000 331 344 -3.8 33.1

Puducherry 22,500 21,624 20,893 3.5 96.1

V. OTHER

AGENCIES

M/O Defense . 7,972 5,063 57.5 .

M/O Railways . 3,504 2,816 24.4 .

(Source: HMIS Report)

If we can improve the quality of services through this intervention there would be

significant increase in the rate of institutional deliveries which will act as crucial

factor for reduction of MMR and IMR.

*****

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Annexure-1.1

No.F.3 (5-2596)-FWPM/SHFWS/2012 GOVERNMENT OF TRIPURA

HEALTH & FAMILY WELFARE DEPARTMENT

18th November 2013

M E M O R A N D U M

Subject: Declaration of Delivery Points for RMNCH+A Services

Provision of ‘continuum of care’ in the areas of Reproductive, Maternal,

Newborn, Child & Adolescent Health (RMNCH+A) services is deemed to address major

causes of mortality among women and children as well as the delays in accessing and

utilizing health care and services. It has been accordingly decided that such public health facilities which were categorized to have conducted deliveries above the minimum

benchmark specified for each level of facility based on actual average number of deliveries

being conducted per month, be formally declared as Delivery Points (DPs).

2. The list of public health facilities declared as DPs [Enclosed as Annexure-I] specifying its functional level is as per the State specific standard criteria described

hereunder:-

(i) Level-1 Facilities: Health Sub-Centres (HSCs) reporting >2 deliveries/month.

(ii) Level-2 Facilities: PHCs & Non FRU-CHCs & SDHs reporting >6

deliveries/month.

(iii) Level-3 Facilities: (a) First Referral Units (FRUs) at CHCs/ SDHs

reporting >20 deliveries/month including

management of complications & C-Sections.

(b) District Hospitals reporting >30 deliveries/

month including C-Sections, State Hospitals & Medical Colleges reporting >50 deliveries/month

including C-Sections

3. All concerned facility in-charges are, therefore, requested to sustain their

ongoing efforts to provide the specific range of services as communicated vide this Department’s Memorandum No.F.3 (5-302)-FWPM/SHFWS/2011 dated 15th November

2012 [Copy enclosed as Annexure-II] to fulfill the implementation of comprehensive

RMNCH+A services at their respective facility declared as DP.

4. Concerned Chief Medical Officers are also being requested to take necessary initiatives to identify and address facility specific gaps/needs [viz. infrastructure, human

resource, equipments, drugs supplies, logistics etc.] through regular analysis and review of

performances of all the designated DPs in the district to ensure its optimal functioning.

Further, concerted initiative to maintain its functional status would be pre-requisite for

subsequent updating/adding up DPs.

Enclo: As Stated.

Sd/-

07-11-2013

[Smt. B. Basfore]

Deputy Secretary (H) Govt. of Tripura

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No.F.3 (5-2596)-FWPM/SHFWS/2012 18th November 2013

To

1. The Chief Medical Officers,

West/ Khowai/ Sepahijala/ Gomati/ South/ Unakoti/ North/ Dhalai

2. The Medical Superintendent,

AGMC & GBP Hospital/ IGM Hospital/ Kulai District Hospital.

3. The Sub-divisional Medical Officers, Khowai, Bishalghar, Melagharh, Amarpur, Belonia, Sabroom, Tripura Sundari,

Kanchanpur, Dharmanagar, RGM, Gandacherra, Longtrai Valley & Kamalpur.

4. Concerned Medical Officer I/C ____________________________________ CHC/ PHC.

Copy to:-

1. The Member Secretary, SH&FWS, Tripura

2. The State Programme Officer, RCH, Govt. of Tripura.

3. The Deputy Director (Finance), SH&FWS, Tripura.

4. The Consultant, SH&FWS, Tripura. 5. The State Programme Manager, SH&FWS, Tripura.

6. The MIS Manager, SH&FWS, Tripura.

for information and follow-up action.

Copy also forwarded to:- 1. PS to the Hon’ble Minister of Health & Family Welfare, Govt. of Tripura for

information of Hon’ble Minister.

2. PS to the Secretary, H&FW Govt. of Tripura for information of Secretary.

3. PS to the District Magistrates & Collector, West/ Khowai/ Sepahijala/ Gomati/

South/ Unakoti/ North/ Dhalai for information of District Magistrate & Collector. 4. PS to the Mission Director, NRHM, Govt. of Tripura for information of DM &

Collector

5. PS to the Director of Health Services, Govt. of Tripura.

6. PS to the Director of Medical Education, Govt. of Tripura.

7. PS to the Director of Family Welfare & P.M., Govt. of Tripura.

8. The Website Section of NRHM for uploading in the website.

Sd/-

07-11-2013

Deputy Secretary (H)

Govt. of Tripura

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Annexure-I

List of Public Health Facilities Designated as Delivery Points (DPs)

Sl. Names of Public Health Facilities

Category

Level of Health Facilities Monthly Average

Delivery (Status of FY:

2012-13)

Type of Facility Level-1

(HSC: > 2 deliveries/

month)

Level-2 (PHC & Non-FRU

CHC/SDH: >6 deliveries/

month)

Level-3 (FRU CHC/SDH: >20;

DH: >30 & MC&SH:>50

deliveries/ month )

I WEST TRIPURA DISTRICT

1 GBP & AGMC State Hospital 491 MC & Hospital

2 Indira Gandhi Memorial State Hospital 576 FRU

3 Mohanpur CHC 11 24*7

4 Jirania CHC 22 24*7

5 Mandai PHC 56 24*7

6 Katlamara PHC 40 24*7

7 Anandanagar PHC 7 24*7

II SEPAHIJALA DISTRICT

1 Bishalghar SDH 46 24*7

2 Melaghar SDH 110 FRU

3 Kathalia CHC 23 24*7

4 Takarjala CHC 29 24*7

5 Madhupur PHC 10 24*7

6 Bishramganj PHC 40 24*7

III KHOWAI DISTRICT

1 Khowai SDH 102 24*7

2 Kalyanpur CHC 12 24*7

3 Teliamura CHC 99 24*7

4 Baijalbari PHC 10 24*7

5 Tulashikhar PHC 9 24*7

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Category



2012-13)



month)



month)


DH: >30 & MC&SH:>50

deliveries/ month )

IV GOMATI DISTRICT

1 Gomati DH 328 FRU

2 Tripura Sundari SDH 10 FRU

3 Amarpur SDH 44 24*7

4 Karbook CHC 13 24*7

5 Nutanbazar CHC 22 24*7

6 Ompi CHC 28 24*7

7 Killa PHC 17 24*7

V SOUTH TRIPURA DISTRICT

1 Belonia SDH 61 FRU

2 Sabroom SDH 55 FRU

3 Manubankul CHC 22 24*7

4 Hrishyamukh CHC 8 24*7

5 Jolaibari CHC 24 24*7

6 Manubazar CHC 10 24*7

7 Shantirbazar PHC 73 24*7

8 Kalachara PHC 26 24*7

9 Rajnagar PHC 18 24*7

10 Niharnagar PHC 8 24*7

11 Rupaichari PHC 7 24*7

12 Srinagar PHC 10 24*7

13 Muhuripur PHC 7 24*7

VI NORTH TRIPURA DISTRICT

1 Dharmanagar SDH 72 FRU

2 Kanchanpur SDH 45 24*7

3 Jalebasa PHC 15 24*7

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Category



2012-13)



month)



month)


DH: >30 & MC&SH:>50

deliveries/ month )

4 Kadamtala PHC 13 24*7

5 Dasda PHC 23 24*7

6 Damchara PHC 20 24*7

7 Anandabazar PHC 40 24*7

8 Tilthai PHC 11 24*7

VII UNAKOTI DISTRICT

1 Rajiv Gandhi Memorial SDH 63 FRU

2 Kumarghat CHC 44 24*7

3 Kanchanbari PHC 18 24*7

4 Pecharthal PHC 25 24*7

5 Fatikroy PHC 15 24*7

6 Machmara PHC 22 24*7

7 Kanika Memorial PHC 10 24*7

VIII DHALAI DISTRICT

1 Kulai DH 17 24*7

2 Gandacherra SDH 56 24*7

3 Bimal Sinha Memorial SDH 84 FRU

4 Chailengta SDH 11 24*7

5 Manu CHC 78 24*7

6 Chawmanu PHC 43 24*7

7 82-Mile PHC 43 24*7

8 Ganganagar PHC 7 24*7

9 Raishyabari PHC 10 24*7

10 Maracherra PHC 10 24*7

11 Nakashipara PHC 10 24*7

Page | 28

Annexure-II No.F.3 (5-302)-FWPM/SHFWS/2011

HEALTH & FAMILY WELFARE DEPARTMENT

GOVERNMENT OF TRIPURA

15th November 2012

MEMORANDUM

Subject: - Range of services for delivery points.

Under implementation framework for conditionalities and incentives detailed

in Records of Proceedings (ROP): 2012-13 of the National Programme Coordination

Committee (NPCC) meeting held by the Ministry of Health & Family Welfare,

Government of India, it has been decided to specify range of services required to be

delivered at public health facilities which have been categorized as delivery points in

RCH context. As a part of fulfillment for facility wise performance audit and taking corrective action based thereon, range of services has been accordingly specified and

enclosed at Annexure-I for reference and guidance.

2. Compliance to the range of services as has been determined in State’s

context is essential to ensure Incentivization up to 2½% of MFP (Mission Flexi pool) under National Rural Health Mission (NRHM). Non-compliance of the same would lead

to reduction up to 2½% of MFP. All concerned are, therefore, requested to ensure

delivering the specified range of services especially at the identified delivery points to

improve performance in maternal and neo-natal health (MNH), IPD, OPD and other

service.

Enclo: As Stated.

Sd/- 12-11-2012

Under Secretary to the

Government of Tripura

Copy to:-

1. State Programme Officers

[FW & RCH and NDCPs (RNTCP/NVBDCP/NLEP/NPCB/IDSP/NIDDCP)]

2. Chief Medical Officers

West Tripura/ Khowai/ Sepahijala/ Gomati/ South Tripura/ North Tripura/

Unakoti/ Dhalai

3. Medical Superintendents, GBP Hospital/ IGM Hospital/ TSD Hospital/ RGM District Hospital/ Kulai District Hospital.

for information and necessary action.

Copy also to:-

1. The Director of Health Services, Govt. of Tripura.

2. The Director of Family Welfare & P.M., Govt. of Tripura

with request to supervise implementation of the range of services as per the enclosed

guidelines and review the progress on monthly basis.

Copy also forwarded for favour of information to:-

1. PS to the Secretary, HFW, Govt. of Tripura.

2. APS to the Secretary & Mission Director, NRHM, Govt. of Tripura.

3. The District Magistrate & Collectors

West Tripura/ Khowai/ Sepahijala/ Gomati/ South Tripura/ North Tripura/

Unakoti/ Dhalai

Sd/-

12-11-2012

Under Secretary to the


Page | 29

Annexure-I

Guidelines on Range of Services Specified for Delivery Points in Tripura

Level of Delivery Point

Category of Health Facilities

Range of Services

Maternal Care Newborn Care Family Planning Services Adolescent Services Disease Control Curative Services

Level-1 Health Sub-centres (HSC)

Ante natal Care

Ensuring consumption of 100 IFA tablets

Intra natal care (Delivery by SBA: 64 HSC by using Partograph)

Post natal care

Referral linkage for complicated pregnancies.

Home visit on 3rd, 7th & 42nd day for mother & child both.

Care of LBW <2500gm.

Identification, Management & referral of Sick neonates, low birth weight (LBW).

Immunization

Emergency contraceptive pills.

Support to VHND.

Counseling on Hygiene, Nutrition, Birth preparedness, Safe abortion, Family planning, Institutional Delivery.

Adolescent Counseling

DOTS facility (Sputum collection)

Blood slide collection for Malaria Parasite.

Outreach services like VHND, Fixed day Immunization, FP services etc.

Level-2

Primary Heath Centres (PHCs) / Community Health Centres (CHCs) / Sub-divisional Hospitals (SDHs) operationalised as 24*7

All in Level 1+

Blood Grouping, Rh typing, Wel mount (saline / KOH) etc.

Linkage with nearest ICTC / PPTCT for testing of HIV / AIDS

Referral linkage with higher facility.

Cashless benefit to PW & Infant under JSSK.

Free drug, diet, blood, diagnostics, exemption of user charges for PW & Sick new born.

Post natal care (Basic obstetric care with 48 hr stay)

Stabilization of patients with Obstetric emergencies, e.g. eclampsia, PPH, sepsis, shock.

Management of severe anemia.

Janani Suraksha Yojana (JSY) & Janani Shishu Suraksha Karyakram (JSSK).

Care of LBW >1800 gm.

Referral services for newborn.

Neo natal care with resuscitation, warmth, infection prevention, screening of congenital anomalities, weighing of newborns.

Prevention of Respiratory Distress Syndrome (RDS)

Management of sepsis in 24*7 hr PHC, CHC & SDH

Immunization

MTP services.

Family Planning Services (sterilization services like: Spacing / limiting.

Referral linkage for sterilization.

Counseling on Nutrition & Hygiene.

Adolescent services through ARSH clinic & referred to higher institution.

DOTS facility

Blood slide collection for Malaria Parasite

AYUSH facility.

& IPD /OPD services

Page | 30

Level of Delivery Point

Category of Health Facilities

Range of Services

Maternal Care Newborn Care Family Planning Services Adolescent Services Disease Control Curative Services

Level-3

Sub-divisional Hospitals (SDHs), District Hospitals (DHs), State Hospitals (SHs) and Medical Colleges (MCs) designated as functional First Referral Units (FRUs)

All in Level 2+

C- section Delivery facility

Post natal care (Comprehensive obstetric care)

Blood cross matching.

Management of severe anaemia.

Comprehensive management of all Obstetric emergencies, e.g., eclampsia, PPH, sepsis, retained placenta, shock etc.

Management of complication referred from PHC / CHC / non FRU.

Blood bank / blood storage centre.

Surgical intervention.

Referral facility for PW & Infant

Cashless benefit to PW & Infant under JSSK

Free drug, diet, blood, diagnostics, exemption of user charges for PW & Sick new born.

Linkage with nearest ICTC / PPTCT for testing of HIV / AIDS

Janani Suraksha Yojana (JSY) & Janani Shishu Suraksha Karyakram (JSSK).

Management of Complication referred.

Care of newborns <1800 gm.

Sick newborn care unit / Newborn Stabilization Unit.

Vitamin ‘K’ for premature babies.

Management of Blood transfusion, Surgery.

Immunization.

MTP services.

Management of all post abortion complications.

Sterilization (Male & Female).

Nutrition & Hygiene Counseling.

Adolescent services through AR

ARSH clinic.

RTI / STI services through PPTCT.

Distribution of IFA tabs.

DOTS facility

Blood slide collection for Malaria Parasite

AYUSH facility.

Surgical intervention with ICU.

IPD / OPD services

Referral linkage, if necessary.

Page | 31

Annexure-1.2

OFFICE OF THE MISSION DIRECTOR NATIONAL HEALTH MISSION GOVERNMENT OF TRIPURA

No.F.3 (2937)-FWPM/SHFWS/Maternal Health/2014 Dated 17th September 2014

MEMORANDUM As a part of strengthening Delivery Points (DPs), 24 (twenty four) numbers of public health facilities were short-listed/pre-identified to conduct gap assessment/ baseline survey as per Maternal & Neo-natal Health Toolkit of MoHFW, GOI leading to implementation of ‘Ideal Delivery Room, ANC & PNC Ward’ initiative. List of the public health facilities is enclosed at Annexure-A.

2. Key findings in the said health facilities have been quantified (using score sheet), consolidated and analyzed to derive the existing gaps in terms of equipments, infrastructure, drugs & consumables, uniform records & registers and other aspects. Top priority shall have to be accorded in the aforesaid 24 (twenty four) numbers of public health facilities for fulfillment of the existing gaps enclosed at Annexure-B to result quality delivery with dignity.

3. All concerned are, therefore, requested for taking necessary actions.

Enclo: As Stated.

Sd/- 17-09-2014

(Dr. Sandeep N. Mahatme, IAS) Mission Director, NHM

Govt. of Tripura

Copy for information and necessary action to:- 1. The Director of Family Welfare & P.M., Govt. of Tripura. 2. The Medical Superintendent, Kulai DH, Ambassa. 3. The Chief Medical Officer, West Tripura/Khowai/Sepahijala/South Tripura/

Gomati/North Tripura/Unakoti/Dhalai. 4. The State Programme Officer, RCH, Govt. of Tripura. 5. The Branch Officer, NHM, Tripura 6. The Executive Engineer, Engineering Cell, O/o the Dte. of FW & PM. 7. The Public Relations Officer, O/o the Dte. of FW & PM. 8. The Sub-divisional Medical Officer, Gandacherra SDH/Bishalghar SDH/

Melaghar SDH/Amarpur SDH/Khowai SDH/Sabroom SDH/Belonia SDH/ Dharmanagar SDH/Kanchanpur SDH.

9. The Medical Officer I/C, Manu CHC/Chawmanu CHC/Kathalia CHC/Takarjala CHC/Ompi CHC/Nutanbazar CHC/Mohanpur CHC/Jirania CHC/Teliamura CHC/Kumarghat CHC/Bishramganj PHC/Manubazar PHC/Shantirbazar PHC/Pecharthal PHC.

Copy forwarded to:- 1. PS to the Addl. Secretary (H&FW) and Director of Health Services, Govt. of

Tripura for information. Sd/-

17-09-2014 (Dr. Sandeep N. Mahatme, IAS)

Mission Director, NHM

Govt. of Tripura

Page | 32

Annexure-A

LIST OF PUBLIC HEALTH FACILITIES

Sl. District Name of the Facilities

1

Dhalai

Manu CHC

2 Chawmanu CHC

3 Gandacherra SDH

4 Kulai DH

5

Sepahijala

Bishalghar SDH

6 Melaghar SDH

7 Kathalia CHC

8 Bishramganj PHC

9 Takarjala CHC

10

Gomati

Ompi CHC

11 Amarpur SDH

12 Nutanbazar CHC

13 West Tripura

Mohanpur CHC

14 Jirania CHC

15 Khowai

Khowai SDH

16 Teliamura CHC

17

South Tripura

Manubazar CHC

18 Sabroom SDH

19 Shantirbazar PHC

20 Belonia SDH

21 North Tripura

Dharmanagar SDH

22 Kanchanpur SDH

23 Unakoti

Kumarghat CHC

24 Pecharthal PHC

Page | 33

Annexure-B

LIST OF GAPS IDENTIFIED

Gaps Identified Responsibility Source of

Fund

Equipments: 1. Labour Table 24 nos. 2. High pressure sterilizer/Autoclave

12 nos. 3. Inverter 14 nos. 4. Oxygen Cylinder with regulator and

Mask 14 nos. 5. Electrical suction/suction bulb 13

sets. 6. Complete BMW Management in 12

facilities. 7. Color coded bin for 96 sets for 24

facilities @ 4 set each 8. Deep Burial Pits for 10 facilities.

Director Family Welfare & Preventive Medicine

IMR Grant

Infrastructure: 1. New construction/Renovation of

Attached Toilet in 14 facilities. 2. Flooring – for 24 facilities 3. Indoor/architectural correction for

Melaghar SDH. 4. Ensuring 24x7 running water (Over

Head tank/Basin) in 6 facilities. 5. Installation of elbow operated water

tape in all 24 facilities. 6. Privacy curtain 24 nos.

Engineering Cell, O/o the Dte. of FW&PM

ROP/Interest component.

Drugs & Consumables: 1. Essential medicines (Misoprostol,

Oxytocin, Antibiotics) as per case load as per JSSK-EDL as attached.

2. Medicine Tray with medicines as per the MNH toolkit (Each Medicine Tray contains Inj. Oxytocin (to be kept in fridge), Cap Ampicillin 500 mg, Tab Metronidazole 400 mg, Tab Paracetamol, Tab Ibuprofen, Tab B complex, IV fluids, Inj. Oxytocin 10 IU, Tab. Misoprostol 200 micrograms, Inj. Gentamycin, Vit K, Inj. Betamethason, Ringer lactate, Normal Saline, Inj. Hydrazaline, Nefidepin, Methyldopa, magnifying glass)

3. Delivery tray @ 3 sets with items as per MNH toolkit (Contents: Gloves, scissor, artery forceps, cord clamp, sponge holding forceps, urinary catheter, bowl for antiseptic lotion, gauze pieces and cotton swabs,

Medical Superintendent,

SDMOs & MOI/C of respective Institutions.

Untied Fund /JSSK fund

Page | 34

Gaps Identified Responsibility Source of

Fund

speculum, sanitary pads, Kidney tray)

4. Baby tray @ 2 sets each with items as per MNH toolkit (Two pre-warmed towels/sheets for wrapping the baby, cotton swabs, mucus extractor, bag & mask, sterilized thread for cord/cord clamp, nasogastric tube and gloves Inj. Vitamin K, needle and syringe. (Baby should be received in a pre-warmed towel. Do not use metallic tray.)

5. Episiotomy tray @ 1 set each with items as per MNH toolkit (Inj. Xylocaine 2%, 10 ml disposable syringe with needle, episiotomy scissor, kidney tray, artery forceps, Allis forceps, sponge holding forceps, toothed forceps, needle holder, needle (round body and cutting), chromic catgut no. 0, gauze pieces, cotton swabs, antiseptic lotion, thumb forceps, gloves.)

7. Dressing Drums 8. 2 Ambu Bag 9. 2 mucus extractor (500 & 250)

10. 1 paddle suction with Suction cannulas

Others: 11. Slippers 12. Dedicated Sweeping & Cleaning

Staff for ANC / PNC / LR / NBSU @ 1 for each.

13. LED TV for PNC ward

Uniform Record & Registers: 1. Partograph 2. Registers (ANC/PNC/Labour Room/

Safe Birth Check list). 3. Labour Room/BMW protocol.

Others/Training 4. IEC/BCC 5. Training for MO/SN

SPO, RCH, PRO & B.O. (NHM)

ROP/Interest component

_____________

Page | 35

Annexure-1.3

No.F.3 (5-2807)-FWPM/SHFWS/SPIP/2014-15/Sub-I Office of the Mission Director

National Health Mission Government of Tripura

14th October 2014

Office Order

In order to ensure the quality of services to be provided by the identified Ideal Delivery Points (IDP) functioning in different districts of Tripura, regular monitoring and supervision is indispensable. Therefore, the following officers are hereby requested to start visiting all those health institutions as mentioned below

and report to the undersigned with implementation status and issues of each health institution.

Sl. Name of the District

Name of the health

institution designated as Delivery Points

Officers for Monitoring &

Supervision of the” Ideal Delivery Points”

1 West & Khowai Districts

Khowai SDH Dr. Jyotirmoy Das, Member Secretary, SH&FWS, Tripura 2 Mohanpur CHC

3

Sepahijala District

Melaghar SDH Dr. M. S Chowdhury, State Immunization Officer, NHM Tripura

Dr. Supratim Biswas, Consultant Community Mobilization, RRC-NES, Tripura

4 Takarjala CHC

5 Kathalia CHC

6

Gomati & Dhalai Districts

Amarpur SDH

Dr. Kamal Reang, State Programme Officer, RCH

Sri. Arindam Saha, State Facilitator, RRC-NES

7 Natubazar CHC

8 Ompi CHC

9 Gandacherra SDH

10

South Tripura District

Belonia SDH

11 Sabroom SDH

12 Manubazar CHC

13 Santirbazar PHC

14

Unakoti & North Tripura Districts

Kumarghat CHC Dr. Pranadish Das, Branch Officer, NHM Tripura

Sri. Sudip Deb, State Programme Manager, NHM Tripura

15 Pecharthal CHC

16 Dharmanagar SDH

17 Kanchanpur SDH

18

West Tripura, Khowai, Sepahijala & Dhalai Districts

Jirania CHC Dr. Sandeep N. Mahatme,

IAS, Mission Director, NHM Tripura

Sri. Deepak Biswal, State RMNCHA Consultant, UNICEF

19 Teliamura CHC

20 Bishalgarh SDH

21 Bishramganj PHC

22 Dhalai DH

23 Manu CHC

24 Chawmanu CHC

Page | 36

2. Field visit report is to be submitted to the undersigned within two (2) days after finishing each visit. This order should be followed with immediate effect.

3. They should maintain continuous liaison with concerned SDMOs and MO I/Cs or in-charges. They should guide the MO I/Cs for establishment of Ideal Delivery Rooms, ANC & PNC.

Sd/- 14-10-2014

(Dr. Sandeep N. Mahatme, IAS) Mission Director, NHM Government of Tripura

To All Concerned Copy to:

1. The CMOs, West/ Sepahijala/ Khowai/ Gomati/ South/ Unakoti/ North Tripura/ Dhalai District, Government of Tripura for information and circulation the same with all MO I/Cs of the concerned health facilities.

Page | 37

Annexure-1.4

OFFICE OF THE MISSION DIRECTOR

NATIONAL HEALTH MISSION

GOVERNMENT OF TRIPURA

No.F.3 (2937)-FWPM/SHFWS/Maternal Health/2014 Dated 21st October 2014

MEMORANDUM

In order to showcase the model ‘Ideal Delivery Room, ANC & PNC Ward’ initiative,

a dissemination workshop to provide handholding support to the facility in charges is scheduled to be held on 24th October 2014 at 11:00 AM at the Hospital premises of

Bishalghar SDH. Accordingly, following SDMOs and MO I/Cs where this model are to be

replicated/implemented at their respective facilities are requested to attend the said

workshop positively.

Sl. District Name of the Facility for Ideal

Delivery Room, ANC & PNC Ward’ initiative

Category of Officers for attending

the Workshop

1 West Tripura Mohanpur CHC

Jirania CHC

Medical Officer I/C

Medical Officer I/C

2 Khowai Khowai SDH

Teliamura CHC

SDMO

Medical Officer I/C

3 Sepahijala

Melaghar SDH

Bishalghar SDH

Takarjala CHC

Kathalia CHC

Bishramganj PHC

SDMO

SDMO

Medical Officer I/C

Medical Officer I/C

Medical Officer I/C

4 Gomati

Amarpur SDH

Nutanbazar CHC

Ompi CHC

SDMO

Medical Officer I/C

Medical Officer I/C

5 Dhalai

Kulai DH

Gandacherra SDH

Manu CHC

Chawmanu CHC

Medical Superintendent

SDMO

Medical Officer I/C

Medical Officer I/C

6 South Tripura

Sabroom SDH

Belonia SDH

Manubazar CHC

Shantirbazar PHC

SDMO

SDMO

Medical Officer I/C

Medical Officer I/C

7 Unakoti Kumarghat CHC

Pecharthal PHC

Medical Officer I/C

Medical Officer I/C

8 North Tripura Dharmanagar SDH

Kanchanpur SDH

SDMO

SDMO

Sd/-

21-10-2014

(Dr. S.R. Debbarma)

Addl. Secretary (HFW) & DHS Government of Tripura

To

All Concerned

Copy for information to:-

1. All Chief Medical Officers

2. PS to the Mission Director, NHM, Government of Tripura

3. PS to the Director f FW & PM, Government of Tripura Sd/-

21-10-2014

Addl. Secretary (HFW) & DHS


Page | 38

Annexure-1.5


No.F.3 (2937)-FWPM/SHFWS/Maternal Health/2014 Dated 29th November 2014

MEMORANDUM As a part of strengthening Delivery Points (DPs), 24 (twenty four) numbers of

public health facilities were short-listed/pre-identified to conduct gap

assessment/baseline survey as per Maternal & Neo-natal Health Toolkit of MoHFW, GOI

leading to implementation of ‘Ideal Delivery Room, ANC & PNC Ward’ initiative. List of

the public health facilities is enclosed at Annexure-A.

2. On the next phase, 06 nos. of facilities have been identified (List of which is

enclosed) for the same purpose. The gap assessment of the said institutions for

strengthening ‘Ideal Delivery Room, ANC & PNC Ward’ will be done shortly. Gap

assessment format is enclosed for early information.

Enclo: As Stated.

Sd/- 22-11-2014


Govt. of Tripura

Copy for information and necessary action to:- 1. The Director of Family Welfare & P.M., Govt. of Tripura. 2. The Medical Superintendent, Gomati/Unakoti District Hospital. 3. The Chief Medical Officer, South Tripura/ Gomati/North Tripura/Unakoti/

Dhalai. 4. The State Programme Officer, RCH, Govt. of Tripura. 5. The Branch Officer, NHM, Tripura 6. The Executive Engineer, Engineering Cell, O/o the Dte. of FW & PM. 7. The Public Relations Officer, O/o the Dte. of FW & PM. 8. The Sub-divisional Medical Officer, Kamalpur SDH. 9. The Medical Officer I/C, Jolaibari CHC/ KIlla PHC/Rajnagar PHC.

Copy forwarded to:-

1. PS to the Addl. Secretary (H&FW) and Director of Health Services, Govt. of Tripura for information.

Sd/- 22-11-2014


Govt. of Tripura

Page | 39

Annexure-A

List of Health Facilities

Sl. District Name of the Facility for Ideal Delivery

Room, ANC & PNC Ward’ initiative

1 Gomati Gomati District Hospital

Killa PHC

2 Dhalai Kamalpur SDH

3 South Tripura Jolaibari CHC

Rajnagar PHC

4 Unakoti Rajiv Gandhi Memorial (RGM) Hospital

Page | 40

Annexure-2

Facility-wise Scoring on Key Indicators of 24 Health Facilities

District Name of the

Facilities Status

Building Status - New = 1 / Old =

0

Infrastructure up-gradation/

Renovation

Labour Room

Equipments

Drugs and Consumables

Records &

Registers

Human Resource

Training received

Others Total (80)#

Points Gained

Dhalai

Kulai DH Before 5 10 20 4 4 6 4 4 57

16 After 5 14 29 5 5 6 4 5 73

Gandacherra SDH

Before 0 4 7 2 4 5 3 1 26 42

After 5 13 27 3 5 5 5 5 68

Manu CHC Before 5 10 13 4 5 5 1 4 47

18 After 5 12 28 5 5 5 1 4 65

Chawmanu CHC

Before 5 7 3 3 5 5 0 4 32 25

After 5 8 23 4 5 5 3 4 57

Khowai

Khowai DH Before 0 12 26 3 6 5 1 2 55

25 After 0 13 29 5 7 5 7 4 70

Teliamura CHC

Before 0 6 17 3 5 5 1 2 39 -1

After 0 6 17 3 5 5 0 2 38

West Tripura

Jirania CHC Before 0 10 18 4 5 5 0 1 43

20 After 0 14 27 4 5 5 3 5 63

Mohanpur CHC

Before 0 10 21 4 6 6 2 1 50 10

After 0 11 25 5 7 6 3 3 60

Sepahijala

Bishalgarh SDH

Before 5 12 28 4 6 5 0 2 62 12

After 5 14 30 5 6 5 0 5 70

Melaghar SDH

Before 0 10 11 4 5 5 0 1 36 15

After 0 10 24 4 5 5 2 1 51

Kathalia CHC Before 0 5 18 3 5 4 0 1 36

10 After 0 9 20 4 6 5 0 2 46

Page | 41

District Name of the

Facilities Status

Building Status - New = 1 / Old =

0

Infrastructure up-gradation/

Renovation

Labour Room

Equipments

Drugs and Consumables

Records &

Registers

Human Resource

Training received

Others Total (80)#

Points Gained

Sepahijala

Bishramganj PHC

Before 0 6 20 3 5 5 1 1 41 0

After 0 6 20 3 5 5 1 1 41

Takarjala CHC

Before 0 7 21 3 6 5 0 1 43 13

After 0 14 25 4 6 5 0 2 56

Gomati

Ompi CHC Before 0 6 12 2 4 5 0 1 30

25 After 0 13 25 4 5 5 2 1 55

Amarpur SDH

Before 0 3 18 2 5 5 0 1 34 23

After 0 11 25 4 5 5 2 5 57

Nutanbazar CHC

Before 0 7 10 2 4 4 0 1 28 37

After 5 14 26 3 5 5 2 5 65

South Tripura

Manubazar CHC

Before 0 9 19 5 6 6 1 1 47 18

After 0 14 26 5 7 6 2 5 65

Sabroom SDH

Before 0 7 15 4 5 5 3 2 41 26

After 0 12 28 5 6 5 6 5 67

Shantirbazar PHC

Before 0 9 10 3 4 5 0 2 33 25

After 0 13 22 5 5 5 3 5 58

Belonia SDH Before 0 10 21 3 6 5 4 2 51

23 After 5 15 29 5 7 5 5 3 74

Unakoti

Kumarghat CHC

Before 0 3 10 3 3 5 0 2 26 19

After 0 11 13 4 4 5 3 5 45

Pecharthal PHC

Before 0 10 20 3 5 4 2 1 45 13

After 0 14 24 4 6 4 2 4 58

North Tripura

Kanchanpur SDH

Before 0 6 17 0 5 5 2 1 36 24

After 0 12 27 4 5 5 2 5 60

Dharmanagar SDH

Before 5 10 24 3 5 5 5 4 61 9

After 5 14 28 5 5 5 3 5 70

Page | 42

Baseline Assessment Score of 6 (six) Health Facilities

Name of the

Facilities

Building Status

(New = 1 / Old

= 0)

Infrastructure

up-gradation/

Renovation

Labour Room

Equipments

Drugs and

Consumables

Records &

Registers

Human

Resource

Training

received Others Total (80)

Gomati DH 5 11 26 3 4 4 7 3 63

Killa PHC 0 13 21 4 6 5 1 0 50

Jolaibari CHC 5 13 26 5 5 5 2 3 64

Rajnagar PHC 0 11 25 3 4 5 1 0 49

RGM Hospital 0 9 27 1 5 5 2 4 53

Kamalpur SDH 0 14 24 5 6 5 2 5 61

Legend: #Individual Value of Key Indicators to determine Scoring

Key Indicators Value

Facilities scoring < 40 after

intervention.

Building Status – (For New = 1 /Old = 0) 5

Facilities scoring 40 – 60 after

intervention.

Infrastructure up-gradation/ Renovation 15

Facilities scoring > 60 after

intervention.

Labour Room Equipments 30

Drugs and Consumables 5

Records & Registers 7

Human Resource 6

Training received 7

Others (Display of protocols, Dedicated ANC/PNC Wards

for mothers and their Flooring )

5

Page | 43

Annexure-3


No.F.3 (2754)-FWPM/SHFWS/2013 Dated 9th January 2015

MEMORANDUM

The Operational Guidelines for Rashtriya Bal Swasthya Karyakram (RBSK) provisions for facility based newborn screening at public health facilities, by existing health manpower. This includes screening of birth defects in institutional deliveries at public health facilities, especially at the designated delivery points.

2. Accordingly it has been decided to impart training to the existing health service providers i.e. respective Medical Officer I/C & 2 (two) Staff Nurses of the below mentioned designated delivery points to enable them detect, register report and refer birth defects on 13th January 2015 at 9:30 AM at Shahid Bhagat Singh Youth Hostel, Agartala.

Sl. District Names of the designated Delivery Points

A West Tripura 1. Mohanpur CHC

2. Jirania CHC

B Khowai 3. Khowai SDH

4. Teliamura CHC

C Sepahijala

5. Melaghar SDH

6. Bishalghar SDH

7. Takarjala CHC 8. Kathalia CHC

9. Bishramganj PHC

D Gomati

10. Amarpur SDH

11. Nutanbazar CHC

12. Ompi CHC

13. Gomati District Hospital

14. Killa PHC

E Dhalai

15. Kulai DH

16. Gandacherra SDH

17. Kamalpur SDH

18. Manu CHC

19. Chawmanu PHC

F South Tripura

20. Sabroom SDH

21. Belonia SDH 22. Jolaibari CHC

23. Rajnagar PHC

24. Manubazar PHC

25. Shantirbazar PHC

G Unakoti

26. Rajiv Gandhi Memorial Hospital

27. Kumarghat CHC 28. Pecharthal PHC

H North Tripura 29. Dharmanagar SDH

30. Kanchanpur SDH

Sd/- 09-01-2015


Page | 44

No.F.3 (2754)-FWPM/SHFWS/2013 Dated 9th January 2015 To All Concerned

Copy for information to:- 1. The Director of Health Services, Government of Tripura. 2. The Director of FW & PM, Government of Tripura. 3. All Chief Medical Officers with request to ensure participation of the trainees.

Copy forwarded to:- 1. PS to the Secretary, H&FW, Government of Tripura

Sd/- 09-01-2015


Page | 45

Annexure-4

Services delivered under AIDS Control Programme at the 30 Delivery Points

Sl. District

Name of the

Facilities/Delivery

Points

ICTC/ PPTCT F-ICTC/ PPTCT STD Clinic

1

Dhalai

Kulai DH ICTC

STD clinic

2 BSM SDH ICTC STD clinic

3 Gandacherra SDH ICTC STD clinic

4 Chawmanu CHC

F-ICTC

5 Manu CHC F-ICTC

6

Gomati

Gomati DH ICTC

STD clinic

7 Amarpur SDH ICTC STD clinic

8 Nutanbazar CHC

F-ICTC

9 Ompi CHC F-ICTC

10 Killa PHC F-ICTC

11 Khowai

Khowai SDH ICTC

STD clinic

12 Teliamura CHC ICTC

13

Sepahijala

Bishalghar SDH ICTC STD clinic

14 Melaghar SDH ICTC STD clinic

15 Takarjala CHC

F-ICTC

16 Kathalia CHC F-ICTC

17 Bishramganj PHC F-ICTC

18

South Tripura

Belonia SDH ICTC

STD clinic

19 Sabroom SDH ICTC STD clinic

20 Manubazar CHC

F-ICTC

21 Jolaibari CHC F-ICTC

22 Rajnagar PHC F-ICTC

23 Shantirbazar PHC F-ICTC

24 West Tripura

Jirania CHC F-ICTC

25 Mohanpur CHC F-ICTC

26. North Tripura

Kanchanpur SDH ICTC

STD clinic

27 Dharmanagar SDH ICTC STD clinic

28

Unakoti

RGM SDH ICTC STD Clinic

29 Kumarghat CHC ICTC

30 Pecharthal PHC

FICTC

ICTC: Integrated Counseling and Testing Centre

F-ICTC: Integrated Counseling & Testing Centre

STD: Sexually Transmitted Diseases

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ideal delivery points in tripura

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