national health missionnhm up pip 2015-16: m&e report etawah district prc-ieg, delhi iii | p a g...

National Health Mission

A REPORT ON

MONITORING OF IMPORTANT COMPONENTS OF

NHM PROGRAMME IMPLEMENTATION PLAN

IN ETAWAH DISTRICT, UTTAR PRADESH

MINISTRY OF HEALTH AND FAMILY WELFARE

GOVERNMENT OF INDIA

RUBY A. SINGH

NIRANJAN ROUT & VIDYA SAGAR TRIGUN

RENU SAIN

POPULATION RESEARCH CENTRE,

INSTITUTE OF ECONOMIC GROWTH,

DELHI 110007

JANUARY 2016

NHM UP PIP 2015-16: M&E Report Etawah District PRC-IEG, Delhi

i | P a g e

JANUARY 2016

CONTENTS PAGE NO.

TABLE OF CONTENTS ................................................................................................................................................................................................................................I

LIST OF TABLES ........................................................................................................................................................................................................................................ II

LIST OF FIGURES ...................................................................................................................................................................................................................................... II

ACKNOWLEDGEMENTS .........................................................................................................................................................................................................................III

ACRONYMS AND ABBREVIATIONS ..................................................................................................................................................................................................... IV

EXECUTIVE SUMMARY ........................................................................................................................................................................................................................... V

1. INTRODUCTION.....................................................................................................................................................................................................................................1

1.1.BACKGROUND .....................................................................................................................................................................................................................................1

2. OBJECTIVES OF THE STUDY ..............................................................................................................................................................................................................2

3. SOCIO-ECONOMIC AND DEMOGRAPHIC PROFILE OF ETAWAH DISTRICT ........................................................................................................................3

4. KEY FINDINGS & OBSERVATIONS ....................................................................................................................................................................................................7

4.1. HEALTH INFRASTRUCTURES.........................................................................................................................................................................................................7

5. HUMAN RESOURCES: STATUS & TRAINING .................................................................................................................................................................................8

6. MATERNAL HEALTH .............................................................................................................................................................................................................................9

7. JANANI SURKSHA YOJANA ................................................................................................................................................................................................................ 11

8. JANANI SHISHU SURAKSHA KARYAKRAM .................................................................................................................................................................................. 12

9. MATERNAL DEATH ............................................................................................................................................................................................................................ 13

10. CHILD HEALTH ................................................................................................................................................................................................................................. 13

10.1. INFRASTRUCTURES AND SERVICES......................................................................................................................................................................................13

10.2. CHILD IMMUNISATION ...................................................................................................................................................................................................................... 14

10.3. NEONATAL HEALTH...................................................................................................................................................................................................................14

11. RASHTRIYA BAL SWASTHYA KARYAKRAM ............................................................................................................................................................................ 15

12. FAMILY PLANNING .......................................................................................................................................................................................................................... 15

13. ADOLESCENT REPRODUCTIVE AND SEXUAL HEALTH........................................................................................................................................................16

14. QUALITY IN HEALTH CARE SERVICES ......................................................................................................................................................................................... 17

15. COMMUNITY PROCESS IN THE DISTRICT ................................................................................................................................................................................. 17

16. DISEASE CONTROL PROGRAMS .................................................................................................................................................................................................. 18

17. AYUSH ................................................................................................................................................................................................................................................. 19

18. INFORMATION, EDUCATION AND COMMUNICATION.......................................................................................................................................................... 19

19. HMIS & MCTS .................................................................................................................................................................................................................................... 20

20. OBSERVATION FROM THE FIELD ................................................................................................................................................................................................ 20

20.1: DISTRICT FEMALE HOSPITA, ETAWAH. ............................................................................................................................................................................. 20

20.2: COMMUNITY HEALTH CENTRE, JASWANT NAGAR..................................................................................................................................... .................. 23

20.3. PRIMARY HEALTH CENTRE, BIJAULI................................................................................................................................................................................... 24

20.4. SUB-CENTRE, ASADPUR........................................................................................................................................................................................................... 25

20.5. SUB-CENTRE, LAKHANA........................................................................................................................................................................................................... 26

21. CONCLUSIONS AND RECOMMENDATIONS ............................................................................................................................................................................... 27

22. APPENDIX .......................................................................................................................................................................................................................................... 30


ii | P a g e

JANUARY 2016

LIST OF TABLES PAGE NO.

TABLE 1 VISITED HEALTH CARE FACILITIES IN ETAWAH , UTTAR PRADESH, 2016............................................................................. 3

TABLE 2 KEY SOCIO-ECONOMIC AND DEMOGRAPHIC INDICATORS OF ETAWAH DISTRICT........................................................... 4

TABLE 3 KEY DEMOGRAPHIC AND HEALTH INDICATORS OF ETAWAH DISTRICT....................................................................... 6

TABLE 4 HEALTH CARE FACILITIES AVAILABLE IN ETAWAH DISTRICT.............................................................................. 7

TABLE 5 STATUS OF HUMAN RESOURCES UNDER NHM IN ETAWAH DISTRICT......................................................................... 8

TABLE 6 TRAINING STATUS OF HUMAN RESOURCES, ETAWAH, UTTAR PRADESH, 2014-15................................... 9

TABLE 7 BLOCK-WISE PERFORMANCE IN ANTENATAL AND POST-NATAL CARE, ETAWAH, UTTAR PRADESH, ........................ 10

TABLE 8 PLACE OF DELIVERY AND STATUS OF CHILD BIRTH, ETAWAH, UTTAR PRADESH, ..................................................... 11

TABLE 9 STATUS OF JSY PAYMENTS IN ETAWAH, UTTAR PRADESH 2014-15........................................................................... 11

TABLE 10 BENEFICIARIES FROM JSSK , ETAWAH, UTTAR PRADESH 2014-15............................................................................ 12

TABLE 11 MATERNAL DEATH STATUS OF ETAWAH DISTRICT, 2014-15.................................................................................. 13

TABLE 12 INFRASTRUCTURE AND SERVICES UNDER NEONATAL AND CHILD HEATH, ETAWAH, UTTAR PRADESH, 2014-15.............. 13

TABLE 13 STATUS OF IMMUNISATION IN VARIOUS BLOCKS OF ETAWAH, UTTAR PRADESH 2014-15.............................................. 14

TABLE 14 STATUS OF NEONATAL HEALTH, ETAWAH, UTTAR PRADESH, 2014-15...................................................................... 15

TABLE 15 RBSK PROGRESS IN ETAWAH, UTTAR PRADESH 2014-15....................................................................................... 15

TABLE 16 BLOCK-WISE ACHIEVEMENTS OF FAMILY PLANNING, ETAWAH, UTTAR PRADESH, 2014-15.......................................... 16

TABLE 17 ARSH PROGRESS IN ETAWAH, UTTAR PRADESH, 2014-15..................................................................................... 17

TABLE 18 QUALITY IN HEALTH CARE SERVICES, ETAWAH, UTTAR PRADESH,2014-15.............................................................. 17

TABLE 19 COMMUNITY PROCESS IN ETAWAH, UTTAR PRADESH, 2014-15.............................................................................. 18

TABLE 20 FUNCTIONING OF DISEASE CONTROL PROGRAMS IN ETAWAH, UTTAR PRADESH,2014-15......................................... 18

TABLE 21 STATUS OF AYUSH IN ETAWAH DISTRICT, UTTAR PRADESH,2014-15...................................................................... 19

LIST OF FIGURES PAGE NO.

FIGURE 1: MONITORING DISTRICT, ETAWAH, UTTAR PRADESH.................................................................................................................................. .... 2

FIGURE 2: FULL IMMUNISATION AMONG THE CHILDREN IN VARIOUS BLOCKS OF ETAWAH AGAINST THE SET TARGETS, 2014-15.. 14

FIGURE 3: ACHIEVEMENTS OF STERILISATION AGAINST THE TARGET IN VARIOUS BLOCKS, ETAWAH, UTTAR PRADESH 2014-15.............16

FIGURE 4: DETECTION AND TREATMENT OF VARIOUS DISEASES, 2014-15.......................................................................................................................18

FIGURE 5: IEC DISPLAYS AT VARIOUS HEALTH FACILITIES, ETAWAH, UTTAR PRADESH...........................................................................................................................20

FIGURE 6: DIFFERENT WINGS OF DISTRICT HOSPITAL, ETAWAH, UTTAR PRADESH.................................................................................................... 21

FIGURE 7: BLOOD BANK FACILITIES AT DISTRICT HOSPITAL................................................................................................................................................22

FIGURE 8: DIFFERENT WINGS OF COMMUNITY HEALTH CENTRE, JASWANT NAGAR, ETAWAH, UTTAR PRADESH.............................................23

FIGURE 9: PRIMARY HEALH CENTRE, BIJAULI, ETAWAH, UTTAR PRADESH.......................................................................................................................24

FIGURE 10: SUB-CENRE, ASADPUR, ETAWAH, UTTAR PRADESH..........................................................................................................................................26

FIGURE 11: SUB-CENTRE, LAKHANA, ETAWAH, UTTAR PRADESH........................................................................................................................................27


iii | P a g e

JANUARY 2016

ACKNOWLEDGEMENTS

First of all the PRC team of IEG, Delhi expresses deep sense of gratitude to C.R.K. Nair, Additional

Director General (Statistics) Ministry of Health and Family Welfare, Government of India for assigning the

work of monitoring of the important components of NHM Programme Implementation Plan. We are also

thankful to Shri P. C. Cyriac, Deputy Director General (Stats), and Smt. Navanita Gogoi, Director

(Stats) Ministry of Health and Family Welfare, Government of India for their support and

cooperation. The monitoring of Etawah district won’t have got completed without the support of NHM

officials of the district. We would like to thank all the staffs of visiting health facilities for the co-operation

they extended during our visit. We are very grateful to CMO of Etawah Dr. R.K. Naiyyer, CMS of District

Women Hospital Dr. Ashok Kumar, CMS of District Hospital Dr. A.K. Paliwal, DPM Sandip Dixit and

DCPM Anup Srivastav for giving their valuable time to complete the Monitoring process. Also thank to

ASHAs and ANMs who supported the team in many ways making the monitoring successful.

Ruby A. Singh

Niranjan Rout & Vidya Sagar Trigun

Renu Sain

January 2016

Population Research Centre (PRC-IEG)

Institute of Economic Growth

Delhi


iv | P a g e

JANUARY 2016

ACRONYMS AND ABBREVIATION

AMG Annual Maintenance Grant

ANM Auxiliary Nurse Midwife

ARSH Adolescent Reproductive and Sexual Health

AYUSH Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy

BEMOC Basic Emergency Obstetric Care

BMW Biomedical waste

BPM Block Programme Manager

BSU Blood Storage Unit

CMO Chief Medical Officer

DH District Hospital

DPM District Programme Manager

ECG Electrocardiography

EmOC Emergency Obstetric Care

FMNCI Facility based Integrated Management of Neonatal Illness

FRU First Referral Unit

HMIS Health Management Information System

IEC Information, Education and Communication

IPD In Patient Department

IUCD Intra Uterine Contraceptive Device

IYCF Infant and Young Child Feeding

JSSK Janani Shishu Suraksha Karyakram

JSY Janani Suraksha Yojana

LHV Lady Health Visitor

LSAS Life Saving Anaesthetic Skill

LT Laboratory Technician

MCTS Mother and Child Tracking System

Minilap/ PPS Minilap/Post-Partum Sterilization

MMU Mobile Medical Unit

MO Medical Officer

MoHFW Ministry of Health and Family Welfare

NBCC New Born Care Corner

NBSU New Born Stabilization Unit

NRC Nutritional Rehabilitation Centre

NSSK Navjaat Shishu Suraksha Karyakram

OCP Oral Contraceptive Pill

OPD Out Patient Department

OPV Oral Polio Vaccines

PIP Programme Implementation Plan

PPIUCD Postpartum Intrauterine Contraceptive Devices

PRC Population Research Centre

RNTCP Revised National Tuberculosis Control Program

SBA Skilled Birth Attendant

SN Staff Nurse

SNCU Special New Born Care Unit


v | P a g e

JANUARY 2016

EXECUTIVE SUMMARY

ETAWAH DISTRICT: STRENGTHS AND WEAKNESSES

The report is based on the NHM PIP monitoring visit by the PRC team Delhi to various health

facilities in Etawah district, Uttar Pradesh (2015-16). It is prepared by the Population Research

Centre, Delhi on the basis of the observations and check list during the Monitoring and Evaluation

of the key components of NHM. The status of NHM in the district is highlighted in this report.

The major strengths and weaknesses of the district are listed below:

STRENGTHS:

The major strengths regarding health service delivery of the district are summarised below.

• All the visited health care facilities such as District Hospitals (DHs), Community Health

Centres (CHCs), Primary Health Centres (PHCs) and Sub-Centres (SCs) are running in

government buildings.

• Besides a functional District Hospital, there is a District Women Hospital for the females

only which is attached to the District Hospital.

• Except the Newborn Stabilisation Unit, the District Hospital is having all the functional

departments related to the care of newborns and children which include SNCU, NBCC and

NRC.

• The AYUSH and ARSH wing of the district is found functional. Blood bank is available.

• Rashtriya Bal Swasthya Karyakram (RBSK) as well as other disease control programs like

RNTCP, Leprosy and Malaria are running in the district.

• Specific family planning targets have been set by PHC and CHCs in the district.

• Almost all the equipments in the visited health facilities found functional in the district

• Kitchen of the NRC ward was well maintained and hygienic.

WEAKNESSES:

Despite the positive points mentioned above, the district has many irregularities in health care

delivery as noticed during the visits which are mentioned below.

� A co-ordination gap noticed among the higher order officials at district hospital.


vi | P a g e

JANUARY 2016

� Funds released under NHM lacking proper instructions regarding the utilisation creating

hurdle in the district for allocating funds in different heads as reported by the Chief Medical

Superintendent.

� Shortage of doctors in the anaesthesia wing of the district hospital. Fourth class employees

are less than the requirement. Scarcity of staffs in the Blood Bank. Filled HR positions are

less than sanctioned post.

� Release of funds is not in a timely manner. Funds released for NRC wing is not sufficient.

� Scarcity of cough syrups and other drugs reported at the PHC Level.

� Though there is adequate availability of staff quarters at the PHC level, Irregularities in

water supply and electricity reported. Also frequent cases of robbery reported at the visited

Primary Health Centre and Sub-Centre.

� The IEC displays at the District hospital and sub-centre were in a depleted condition lacking

proper clarity of the materials. The materials of IEC not found properly placed at the

Community Health Centre and were lying on the floor.

� The provision of toilets in the NRC ward is not adequate. No separate toilets/wash rooms for

the females.

� The ARSH wing lacking adequate space and congested. Poor visibility inside the room

noticed due to the lack of proper lightening.

� Though Ambulance services are functioning well in the district, the GPS found non

functional.

� Irregularities in training of various health workers as well as poor training reported at the

CHC level. Question over the timing of training and quality also raised.

� Despite the parking space, people found parking their vehicles near the entry point of the

District Hospital.

� No Biomedical pit at the Primary Health Centre. Bio-medical wastes have been disposed

openly near the sub-centres.

� The sub-centre ‘Asadpur’ running in a building with depleted condition. Doors are broken,

no provision of water, irregularly in electricity and also the condition of the ANM quarter is

very poor.

� Though Inverter is available at the visited PHC, it is found non-functional.

� Though premises of visited facilities were noticed clean, the condition inside the facilities

was not satisfactory. The area of drinking water facilities at the district hospital was water


vii | P a g e

JANUARY 2016

logged. Toilets were not clean and hygienic. Also the labour room and PNC wards of the

District Hospital were not hygienically good. Waste materials noticed lying in several places

inside the Jashwant Nagar CHC.

� Scarcity of space for abandoned infrastructures at the District Hospital. Some rooms found

occupied with these infrastructures.


1 | P a g e

JANUARY 2016

1. INTRODUCTION

1.1. BACKGROUND

National Health Mission (NHM) earlier known as National Rural Health Mission was launched to

make health care more accessible and affordable to all especially who are vulnerable and

underserved. Provision of good quality health services is the priority of this mission. Initially the

program was implemented in 18 states having weak public health indicators. The Empowered

Action Group States as well as the North eastern states, Jammu and Kashmir and Himachal Pradesh

are the high focus states under NHM program. The programme has been modified over years in

order to make the health system more accessible and affordable since the implementation of NHM.

Timely assessment of key components of NHM state Programme Implementation Plan is vital for

key changes in the programme and strengthening it further. Apart from this, a clear picture on the

functioning of NHM will prove helpful for further planning and resource allocation. The monitoring

work of the important aspects under NHM has been assigned to various research organizations by

the Ministry of Health and Family Welfare (MoHFW). The Population Research Centres (PRCs)

established by the Ministry have been directed for quality monitoring of important components of

NHM state Programme Implementation Plan. As a part of quality assessment, the PRCs are

required to look into four broad areas described in the Record of Proceedings (RoP) as mentioned

below:

a. Mandatory disclosures on the state NHM website

b. Components of key conditionality and new innovations

c. Strategic areas identified in the roadmap for priority action

d. Strengths and weaknesses in implementation

An effective policy requires an effective feedback on the functioning of the NHM activities carried

out in a state. In this context, the Ministry of Health and Family Welfare has asked Population

Research Centre, Delhi to conduct quality monitoring of the important components of NHM. As a

part of this, our Delhi PRC has been assigned to conduct monitoring of essential components of

NHM in Etawah district of Uttar Pradesh. Overall, the need of the whole monitoring and evaluation

process is to reveal a clear picture of the functioning of the district public health system. Apart

from this, the monitoring aims to create awareness about the need of better service delivery with

well equipped health infrastructures, well trained health personnel etc.


2 | P a g e

JANUARY 2016

Figure 1: Monitoring District, Etawah , Uttar Pradesh

Etawah

2. OBJECTIVES OF THE STUDY

The overall objective of this study is to monitor the functioning of National Health Mission in

Etawah district of Uttar Pradesh. Especially the study aims to look into the coverage of the mission,

constraints during service delivery and utilization of health services by the population of rural and

underserved areas at large. Further it seeks to examine the status of utilization of health care

services under NHM by the underserved section of the population. The quality monitoring of

Programme Implementation Plan (PIP) and some other aspects of the programme have been

evaluated in this study which will help the planners and Policy makers to modify the existing

policies for better service delivery under the mission. Apart from assessing the availability and

adequacy of health services in the study area, the monitoring process intends to assess the

performance of the health facilities. The specific objectives of the study are mentioned below

To assess the adequacy of physical infrastructures like buildings, hospital beds, Ambulances,

medical equipments and essential drugs needed for better service delivery at the DH, CHC, PHC

and SC level.

• To assess the availability of human resources and specialists along with their training status

working under National Health Mission.

• To obtain Block-wise reports on the status of Institutional deliveries, antenatal care, post natal

care, maternal deaths and immunization, family planning in the district

• To obtain information about the coverage of beneficiaries under JSSK and JSY of NHM.

• To assess the availability of infrastructures and other facilities under Neonatal Health.

• To obtain the achievements of family planning and immunization against the set targets in the

district.


3 | P a g e

JANUARY 2016

• To obtain the progress of different programs like RBSK, AYUSH and ARSH functioning

under NHM.

• To assess the quality in health care services like bio-medical waste management and infection

control; community progress like status and activities related to ASHAs; functioning of disease

control programs etc.

• To obtain information regarding the maintenance of health related registers at CHC, PHC and

SC level.

• To obtain information on IEC displays at DH, CHC, PHC and SC level.

The health facilities those were covered for monitoring are listed below.

Table 1: Visited Health Care Facilities in Etawah District, Uttar Pradesh, 2016

Facility Type Name of the Facility

District Hospital Dr. Bhim Rao Ambedkar District Hospital, Etawah

Community Health Centre CHC, Jaswant Nagar, Etawah

Primary Health Centre PHC, Bijauli, Etawah

Sub-Centre SC, Lakhana, Etawah

Sub-Centre SC, Asadpur, Etawah

3. SOCIO-ECONOMIC AND DEMOGRAPHIC PROFILE OF ETAWAH

Etawah district is located in the south-west part of Uttar Pradesh and is bounded by the districts of

Mainpuri on the North, Agra district on the west, Auraia in the East and Jalaun on the south. The

district covers an area of 2311 square kilometres. The district comes under Kanpur Division and

headquarter is Etawah town. The total population of the district is 15, 81,810 which ranks 61th in

terms of size among the districts of Uttar Pradesh (census, 2011). The people living in urban area

are one percentage point high (23.2%) in Etawah district as compared to the state averages of 22.3

(Table 2). With regard to literacy rate, the district has a high literacy rate in comparison to state

averages. The percentage share of scheduled caste population is also high in the district as against

the state averages. Though the percentage of scheduled tribe population is low in both the state and

district, the percentage is comparatively less in the district. The proportion of child population is

less in the district than the state. The decadal growth rate is 18.1 for the district which is 2

percentage points less than the state decadal growth rate of 20.2.


4 | P a g e

JANUARY 2016

Table 2: Key Socio-Economic and Demographic Indicators of Etawah District

Source: RGI, 2011

With regard to density, the persons living per square kilometre is significantly less in the district as

compared to the state (Table 2). The overall sex ratio of the district is 870 while the state average is

912. On the other hand sex ratio was seen high in the urban areas of the district while it was high in

the rural areas of the state. The district follows the same trend for child sex ratio where the district

Indicators

Etawah Uttar Pradesh

Number Percentage to Total

Population Number

Percentage

to Total

Population

Population Total Persons 15,81,810 19,98,12,341 Males 8,45,856 53.4 10,44,80,510 52.3 Females 7,35,954 46.6 9,53,31,831 47.7 Urban Persons 3,66,299 23.2 4,44,95,063 22.3 Males 1,93,116 22.8 2,34,87,515 22.5 Females 1,73,183 23.5 2,10,07,548 22.0 Rural Persons 12,15,511 76.8 15,53,17,278 77.7 Males 6,52,740 77.2 8,09,92,995 77.5 Females 5,62,771 76.5 7,43,24,283 78.0

Literates Persons 1,062,003 78.4 11,43,97,555 67.7 Males 6,23,583 86.1 6,82,34,964 77.3 Females 4,38420 69.6 4,61,62,591 57.2

Scheduled Castes Persons 3,88,283 24.5 4,13,57,08 20.7 Males 2,08,731 24.7 2,16,76,975 20.7 Females 1,79,552 24.4 1,96,80,633 20.6

Scheduled Tribes Persons 169 0.0 11,34,273 0.6 Males 89 0.0 5,81,083 0.6 Females 80 0.0 5,53,190 0.6

Child Population(0-6 year age) Total Persons 2,27,470 14.4 3,07,91,331 15.4 Males 1,21,295 14.3 1,61,85,581 15.5 Females 1,06,175 14.4 1,46,05,750 15.3

Decadal Growth 2,42,939 18.1 3,36,14,420 20.2

Density of Population(Persons

per square Kms) 685 829

Sex Ratio Total 870 912

Rural 862 918 Urban 897 894

Child Sex Ratio Total 875 902 Rural 876 906 Urban 874 885

Total Workers Persons 5,06,072 32.0 6,58,14,715 32.9 Males 4,13,713 48.9 4,98,46,762 47.7 Females 92,359 12.5 1,59,67,953 16.7


5 | P a g e

JANUARY 2016

has 875 female children as against 902 in the state per thousand male children. The share of

working population in the district is almost same with the state.

An investigation into the demographic and health aspects reveals a clear picture of the district’s

performance in comparison to the state. The district has a good record in certain indicators in

comparison to the states. The mean number of children ever born is 2.9 for the district while 3.3 for

the state which is significantly higher than the district (Table 3). The proportion of pregnancies

which resulted in abortion is comparatively less in the district than the state averages. With respect

to the use of family planning methods, the district performs better than the state. More than 67

percent couple use family planning methods in Etawah district as compared to 59 percent in the

state. Except the case of male sterilisation, the proportion using any modern method, traditional

method and female sterilisation is high in the district than the state in overall. Regarding the

indicators of antenatal care, the performance of the district is below the state averages. In specific,

the proportion of married women registered for ANC, those received any ANC, ANC received in

first Trimester, three or more antenatal care and women received full antenatal check-ups are less in

the district than the state averages. Moreover institutional deliveries were seen high in the district as

compared to the state. Also the proportion of home deliveries by skilled health personnel is high in

the district. The percentage of women with safe deliveries was seen comparatively high in the

district. On the matters of post-natal care the district registers a poor record as compared to the state.

The proportion of newborn received breastfeeding is significantly high in the district as compared

the state. Meanwhile the children being breastfed exclusively for at least six months is also high in

the district than the state. The district has an advantage over the state regarding the indicators of

child immunisation where the proportion of children having immunisation card, who received BCG,

3 doses of Polio, Polio doses at birth and Vitamin A are higher as compared to the state averages.

Children having full immunisation are comparatively high for the district as compared to the state..


6 | P a g e

JANUARY 2016

Table 3: Key Demographic and Health Indicators of Etawah District

Source: RGI , 2012-13

Indicators Etawah Uttar Pradesh

Fertility Particulars Mean Children Ever born 2.9 3.3

Pregnancy resulted in abortion 4.1 7.1

Family Planning Practices Use of family planning methods 67.8 59.0

Any modern method 41.9 37.6

Any traditional method 25.9 21.3

Female sterilisation 19.4 18.4

Male sterilisation 0.1 0.3

Antenatal Care Currently Married women registered for

Antenatal Care

56.7 61.9

Mothers received any ANC 70.4 85.2

Antenatal Check-up in first Trimester 49.4 50.5

Mothers who received 3 or more antenatal care 24.7 37.8

Mothers who had full Antenatal check-up 2.3 6.8

Delivery Particulars Institutional delivery 61.2 56.7

Delivery at home checked by skilled health

personnel 40.6 28.9

Safe Delivery 76.6 68.3

Postnatal care Less than 24 hours staying at hospital after

delivery 36.4 56.0

Mothers who received post-natal check up within

48 hours of delivery 63.3 77.6

Within one week of delivery 69.9 81.1

Newborns who were checked up within 24 hours

of birth

60.2 77.7

Breastfeeding practices Breastfeeding within one hour of birth 59.3 39.4

Exclusive breastfeeding for at least six months 24.8 20.8

Child Immunization Children aged 12-23 months having

immunization card 92.1 71.7

Children who received BCG 91.3 85.7

Children received 3 doses of Polio 72.7 64.1

Children received Polio doses at birth 78.6 70.7

Children who received at least one vitamin A

dose during last 6 months 43.0 40.8

Children fully immunised (12-23 months) 58.0 52.7

Prevalence of Childhood

Morbidities

Children suffering from diarrhoea 10.1 10.8

Children received treatment during diarrhoea 98.5 85.1

Children suffering from Acute Respiratory

Infections 7.4 27.9

Fever 13.1 24.5

Mortality Indicators Crude Death Rate 7.9 8.3

Infant Mortality Rate 56 68

Under-five mortality rate 85 90


7 | P a g e

JANUARY 2016

With respect to childhood morbidities, the prevalence of diseases like like diarrhoea, Fever and

Acute Respiratory Diseases is less in the district in comparison to the state (Table 3). Crude Death

Rate (CDR), Infant Mortality Rate (IMR) and Under-Five mortality rate is also less in the district

than the state

4. KEY FINDINGS AND OBSERVATIONS

4. 1. HEALTH INFRASTRUCTURES

One of the most important requisites for the effective rendering of health services is the adequacy of

health infrastructure. Availability of health facilities affects health services to a larger extent. In the

hierarchy of rural health care system in India, Sub-Centre found at the village level and

subsequently Primary Health Centre and Community Health Centre at the Block Level. Meanwhile

District Hospital situated at the District level is considered as the apex health institution in a district.

District hospital comprises of all the adequate health equipments with specialists in different

departments which cover the whole population of the district and records all the health activities of

the district as a whole. Table 4 presents the number of existing health facilities along with their

mode of establishment in Etawah district, Uttar Pradesh.

Table 4: Health Care facilities available in Etawah District

Type of Health Facility Total Govt. Building Rented District Hospital (DH) 1 - All - -

Sub-District Hospital (SDH) 0 - -

Community Health Centre FRUs 2 - All - -

Community Health Centres (CHCs) 6 - All - -

Primary Health Centres (PHCs) 27 - All - -

Sub-Centres (SCs) 162 -All- -

Medical College 1 -All-

Delivery Points 95 -All-

108 Ambulances 15

102 Ambulances 22 - -

Source: NHM, 2015

The district consists of 1 district hospital, 2 Community Health Centres FRUS, 6 Community

Health Centres (CHCs), 27 Primary Health Centres and 162 Sub-Centres and 1 Medical College.

Apart from these the district has 95 delivery points, 15 108 Ambulances and 22 102 Ambulances.

All the health facilities are functioning on government buildings in the district (Table 4).


8 | P a g e

JANUARY 2016

5. HUMAN RESOURCE: STATUS AND TRAINING

Human resources have large role to play in order to make the health care services accessible to all

and to improve the quality of services. Adequate number of health personnel is the basic

requirement of a health facility for better health service delivery. Table 5 presents the status of

human resources in Etawah where the sanctioned posts for both the time period are same. With

regard to MOs, only 2 posts found filled as against the 6 sanctioned posts in both the time periods

(2013-14 and 2014-15). All Gynaecologist posts found vacant. One paediatrician post for the year

2014-15 is still vacant. The positions of Surgeon, LHV, Staff nurse at PHC and ANM at PHC have

not been sanctioned for the district. All the 40 sanctioned posts of ANM have been filled. Three

posts of Pharmacists are still vacant from the 19 sanctioned posts for the year 2014-15 while for the

year 2013-14 8 posts found vacant than the sanctioned posts of 19. All the 19 sanctioned posts of

Lab technicians found occupied for the year 2014-15 while 10 found vacant out the 19 sanctioned

posts in 2013-14. All the sanctioned X-ray technician posts and Staff Nurse at PHC and ANM at SC

are filled in both the years.

Table 5: Status of Human Resources under NHM in Etawah District, Uttar Pradesh

Position Name Sanctioned Regular Contractual Total Vacant

13-14 14-15 13-14 14-15 13-14 14-15 13-14 14-15

MO’s including specialists 6 6 NA NA 2 2 4 4

Gynecologists 7 7 NA NA 0 0 7 7

Pediatrician 1 1 NA NA 1 0 0 0

Surgeon 0 0 NA NA 0 0 0 0

LHV 0 0 NA NA 0 0 0 0

ANM 40 40 NA NA 40 40 0 0

Pharmacist 19 19 NA NA 11 16 8 3

Lab technicians 19 19 NA NA 9 19 10 0

X-ray technicians 2 2 NA NA 2 2 0 0

Staff Nurse at CHC 35 35 NA NA 35 35 0 0

Staff Nurse at PHC 0 0 NA NA 0 0 0 0

ANM at PHC 0 0 NA NA 0 0 0 0

ANM at SC 40 40 NA NA 40 40 0 0

Source: CMO Office, Etawah,

Table 6 depicts the Training status of human resources for the year 2014-15. It can be seen that 5

Medical Officers are trained with SBA while one with NSV, 6 with IUCD insertion, 6 with

RTI/STI/HIV screening, 4 with FIMNCI and 6 with NSSK in Etawah district. Regarding Lady


9 | P a g e

JANUARY 2016

Medical Officers, 1 found trained with SBA, 1 with IUCD insertion and 1 with FMINCI and 2 with

NSSK. Among the staff nurses 40 of them are trained with SBA, 15 with IUCD insertion, 14 with

FIMNCI and 14 with NSSK. In case of ANM, 16 are trained with SBA, 185 with IUCD insertion,

21 with FIMNCI and 21 with NSSK (Table 6).

Table 6: Training Status of Human Resources, Etawah, Uttar Pradesh, 2014-15

Position Name SBA BeMOC MTP Minilap/PPS NSV IUCD

insertion

RTI/STI/HIV

screening FIMNCI NSSK

Medical

Officers 5 0 0 0 1 6 6 4 6

Lady Medical

Officers 1 0 0 0 0 1 0 1 2

Staff Nurses 40 NA NA NA NA 15 0 14 14

ANM 16 NA NA NA NA 185 NA 21 21

Lab NA NA NA NA NA NA NA NA NA

Pharmacist NA NA NA NA NA NA NA NA NA

LHV/PHN 0 NA NA NA NA NA NA NA NA

ASHA NA NA NA NA NA NA NA NA NA

Other - - - -

Source: CMO Office, Etawah,

6. MATERNAL HEALTH

India is one of the countries of high MMR in the world. Therefore focus on maternal health has

been remaining an integral part of different policies and programmes of India. In this context the

government of India launched National Rural Health Mission in the year 2005 to improve the

quality of health care delivery especially for those residing in rural areas, the poor, women and the

children. Improvement of maternal health by providing better antenatal care, incentives for

institutional deliveries and better post-natal care remaining an integral part of NHM. With regard to

ANC registration, 3 antenatal visits, postnatal care within 48 hours of delivery, TT1 and TT2 after

delivery, the district sees an improvement for the year 2014-15 as compared to 2013-14 (Table 7).

The Block-wise data show that for the year 2013-14 Basrehar block has the highest ANC

registration while Udi block has lowest ANC registration. In the year 2014-15, Mahewa Block has

the highest number of ANC registration while Rajpur has the lowest number of ANC registration.

Moreover, number of women received 3 ANC is highest in Basrehar and lowest in Udi in 2013-14

while in 2014-15 Mahewa has the highest and Rajpur has the lowest. Women receiving PNC within

48 hours and 48 hours to 14 days is highest in Basrehar Block while lowest in Udi Block in both

2013-14 and 2014-15. Women received TT1 and TT2 is highest in Basrehar Block in 2013-14. Udi


10 | P a g e

JANUARY 2016

has the lowest number of women received TT1 in the year 2013-14 while for TT2 it is lowest in

Takha. Women received TT1 for the year 2014-15 is highest in Mahewa and lowest in Rajpur while

TT2 is highest in Bhrathana and lowest in Rajpur. It can be concluded that, among different Blocks,

the overall performance of Basrehar block in maternal health care indicators is well while Udi

block’s performance is poor (Table 7).

Table 7: Block-Wise Performance in Antenatal and Postnatal Care, Etawah, Uttar Pradesh

Blocks

Maternal Health care Indicators

Women

Registered for

ANC

Women received 3

ANCs

Women received

PNC within 48

hours after

delivery

Received PNC

between 48 hours

and 14 days after

delivery

Women Received

TT1

Women Received

TT2

Year

2013-14 2014-15 2013-14 2014-15 2013-14 2014-15 2013-14 2014-15 2013-14 2014-15 2013-14 2014-15

Basrehar 7618

7074

5433

7074

2455

3030

2228

2586

7478

6084

9257

5820

Bharthana 3673

5895

2577

5895

1929

2951

938

1686

3132

5709

3363

5960

Takha 2242

3908

1613

3908

879

1528

598

1029

2183

3761

2656

3586

Mahewa 6631

9098

4623

9098

2061

2819

1478

633

6504

7553

6582

5915

Udi 2054

3651

1146

3651

438

572

372

402

2013

3443

2883

3599

Jaswant Nagar 3952

7036

3073

7036

2294

2772

868

621

3876

6879

4696

7802

Rajpur 2881

2205

1927

2205

1189

1117

481

1011

2826

2199

3041

1978

Urban 8097

8097

4138

8097

4797

5847

139

1748

1978

3094

1647

2931

Total

37148

46964

24530

46964

16042

20636

7102

9716

29990

38722

34125

37591

Source: CMO Office, Etawah

Women opting institutional deliveries is shown increasing which is due to the appointment of

ASHAs under NHM as reported by the Health officials in the district (Table 8). The provision of

600 rupees per delivery under JSSK encourages the ASHAs to motivate the mothers for institutional

deliveries. It can be seen that institutional deliveries for the year 2014-15 in total has increased

substantially in Etawah district as compared to the year 2013-14. Also a significant declining in

home deliveries noticed. The Block-wise data reveals that except Udi and Mahewa institutional

deliveries has increased in all the blocks in 2014-15 as compared to 2013-14. Institutional deliveries

were seen highest in Basrehar block and lowest in Udi in the year 2014-15. Meanwhile the district

sees a drastic decline in home deliveries in the year 2014-15. Surprisingly home deliveries by

Skilled Birth attendants (SBAs) were seen declining in 2014-15 in comparison to 2013-14. Still

birth cases reportedly high in 2014-15 as compared to 2013-14 (Table 8).


11 | P a g e

JANUARY 2016

Table 8: Place of Delivery and Status of Child Birth, Etawah, Uttar Pradesh

Blocks

Place of delivery and status of Births

Institutional

Deliveries Home Deliveries

Home deliveries

by SBAs Live Births Still Births Total Births

Year

2013-

14

2014-

15

2013-

14

2014-

15

2013-

14

2014-

15

2013-

14

2014-

15 2013-14

2014-

15

2013-

14 14-15

Basrehar 2502

3680

368

141

267

113

3797

3762

23

60

3820 3822

Bharthana 2270

3208

468

79

377

73

2997

3261

49

20

3046 3281

Takha 1500

1857

303

97

127

44

2048

1939

26

19

2074 1958

Mahewa 3430

3200

299

86

215

65

3891

3235

9

22

3900 3257

Udi 731

625

389

127

319

93

1244

757

9

5

1253 762

Jaswant Nagar 3247

3424

88

134

67

13

3819

3526

45

42

3864 3568

Rajpur 1205

1267

362

87

331

85

1597

1352

0 2

1597 1354

Urban 5010

9861

0 0 0 0 4797

9786

76

90

4873 9876

Total 19895

27122

2277

751

1703

486

24190

27618

237

260

24427 27878


7. JANANI SURAKSHA YOJNA (JSY)

One of the important components of NHM is Janani Suraksha Yojna (JSY) which targets to reduce

maternal mortality ratio and neonatal deaths by promoting institutional deliveries. Under JSY

ASHAs as well as the mothers receive incentives for promoting institutional deliveries. ASHA

receives a cash incentive of Rs 600 per delivery while the mother receives 700. The status of JSY

payments in Etawah district is discussed in Table 9.

Table 9: Status of JSY Payments in Etawah, Uttar Pradesh, 2014-15

Blocks

Status of Payments Mode of Payments Record Maintenance

Institutional

Deliveries

Home

Deliveries ASHAs Cash Cheque

A/C

transfer Available Updated

Basrehar 5152000 0 2355300

� � �

Bharthana 4389000 0 1695000

� � �

Takha 2592800 0 1091100

� � �

Mahewa 4480000 0 2066400

� � �

Udi 875000 0 802800

� � �

Jaswant

Nagar 4704000 0 2155800

� � �

Rajpur 1775200 0 765000

� � �

Urban 90400 0 0

� � �

DWH 6349600 0 0

� � �

RIMS 4874800 0 42000

� � �

Total 35282800 0 10973400

� � �



12 | P a g e

JANUARY 2016

Payment has been given to institutional deliveries only (Table 9). The total payment for

institutional deliveries is 35282800 while the payment is highest in institutional deliveries occurred

in District Women Hospital. Among different Blocks payment for institutional deliveries is highest

in Basrehar Block and lowest in Udi. The mode of payments is cash transfer. Also the records were

found available and updated.

8. JANANI SHISHU SURAKSHA KARYAKRAM (JSSK)

JSSK makes provisions of free transport to government hospitals from home, referral transport and

also drops back home safely after 48 hours of delivery. The mother receives free diet, drugs and

treatment under this scheme. Also the children under one year of age are the beneficiaries of this

scheme. In Etawah 22512 women received diet, 43700 diagnosed and received drugs. The Block

level data shows that diet recipients are highest in Bharthana block and lowest in Udi block (Table

10). Drugs recipients are highest in Jaswant Nagar and lowest in Rajpur Block. Regarding

diagnostic the number of women diagnosed is same as received drugs. A total of 14174 cases

transported from home to facility, 1261 referral transport and 16270 from facility to home in the

district. At Block level, home to facility transport, referral transport and facility to home transport is

highest in Jaswant Nagar block. Udi block has the lowest home to facility and facility to home

transport cases and Takha block has the lowest cases of referral transport.

Table 10: Beneficiaries from JSSK, Etawah, Uttar Pradesh, 2014-15

Blocks

BENEFICIARIES UNDER JSSK Total =22512

Diet Drugs Diagnostic Transport

Home to Facility Referral Facility to Home

Basrehar 2035 5849 5849 1832 231 1818

Bharthana 2356 6701 6701 1521 127 1852

Takha 1343 3902 3902 1314 62 1245

Mahewa 2322 7600 7600 2207 166 1780

Udi 788 4509 4509 535 162 528

Jaswant

Nagar 2981 8012 8012 2873 362 2649

Rajpur 834 2245 2245 816 50 697

DWH 5052 4882 4882 1525 101 3354

RIMS 4801 0 0 1551 0 2347

Total 22512 43700 43700 14174 1261 16270



13 | P a g e

JANUARY 2016

9. MATERNAL DEATH

The district has 90 maternal deaths for the year 2014-15 (Table 11). With regard to place of death,

37 found in hospitals, 7 in home and 6 in transit. Meanwhile maternal deaths are high during

delivery as 37 deaths reported during delivery while only 13 deaths in post delivery.

Table 11: Maternal Death Status of Etawah, Uttar Pradesh, 2014-15

Total

Maternal

Deaths

Place of Deaths

Cause of

death

Month Of pregnancy

ANC

Status

Total

No of

children

women

had Hospital Home Transit

During

pregnancy

During

Delivery

Post

Delivery

50 37 7 6 Anamic 0 37 13 50 63


10. CHILD HEALTH

10.1 INFRASTRUCTURES AND SERVICES

With regard to the Child Health, the district has 1 SNCU, 8 Newborn Care Corners (NBCCs) and 1

Nutritional Rehabilitation Centre (NRC) (Table 12). Regarding staffs, 9 staffs are in SNCU and 7

staffs are in the NRC. The number of admissions in NRC is 12, anticipated admission is 1,

discharge from NRC is 11, referral is 1 and average duration of stay is 13 days.

Table 12: Infrastructure and Services Under Neonatal and Child Health, Etawah, Uttar

Pradesh, 2014-15

Total SNCU 1

Total NBSU -

Total NBCC 8

Total Staff in SNCU 9

Total Staff in NBSU -

Total NRCs 1

Total Admissions in NRCs 12

Total Staff in NRCs 7

Anticipated Admissions in NRCs 1

Discharged from NRCs 11

Referred from NRCs 1

Average duration of stay in NRCs 13 Days



14 | P a g e

JANUARY 2016

10.2 CHILD IMMUNISATION

Immunization among children has been carried out against six vaccine preventable diseases in order

to reduced infant and child deaths. Table 13 presents the detailed picture of immunization in the

district. The total target of immunization in the district is 43693 while the coverage of full

immunization is 38501. The block level picture shows that the achieved percentage of full

immunisation against the set target is highest in Rajpur block while it is lowest in Udi block. In

overall the district has achieved 88 percent full immunisation against the set target (Table 13).

Table 13: Status of Child Immunization in Various Blocks of Etawah, Uttar Pradesh, 2014-15

Blocks Target BCG DPT OPV

Measles Full

Immunization

% target

Achieved 1 2 3 0 1 2 Basrehar 5696 4765 5465 5465 5465 5465 5465 5465 5342 5342 93.8

94.6

93.2

90.2

82.0

88.6

96.1

74.3

88.1

93.8

94.6

93.2

90.2

82.0

88.6

96.1

74.3

88.1

93.8

94.6

93.2

90.2

82.0

88.6

96.1

74.3

88.1

94.6

93.2

90.2

82.0

88.6

96.1

Bharthana

aa 6008 5729 5706 5706 5706 5706 5706 5706 5681 5681 94.6

Takha 3629 3439 3391 3391 3391 3391 3391 3391 3384 3384 93.2

Mahewa 6825 6256 6193 6193 6193 6193 6193 6193 6158 6158 90.2

Udi 4596 3686 3990 3990 3990 3990 3990 3990 3768 3768 82.0

Jaswant

Nagar 7531 6010 7041 7041 7041 7041 7041 7041 6675 6675

88.6

Rajpur 2309 2225 2396 2396 2396 2396 2396 2396 2218 2218 96.1

Urban 7099 11928 4732 4732 4732 4732 4732 4732 5275 5275 74.3

Total 43693 44038 3891

4 98914 38914 38914 38914 38914 38501 38501 88.1


Fig 2: Full Immunisation among the Children in Various Blocks of Etawah against the Set targets, 2014-15

10.3 NEONATAL HEALTH

A total of neonates admitted in the SNCU are 573 and all were discharged after recovery. No

referred and death cases reported (Table 14).


15 | P a g e

JANUARY 2016

Table 14: Status of Neonatal Health, Etawah, Uttar Pradesh, 2014-15

Total

neonates

admitted in

to SNCU

Treatment Outcome Total

neonates

admitted

in to

NBSU

Treatment Outcome

Discharge Referred Death LAMA*

Discharge Referred Death LAMA

*

573 573 0 0 0 - - - - -


11. RASHTRIYA BAL SWASTHYA KARYAKRAM (RBSK)

Rashtriya Bal Swasthya Karyakram is an initiative taken by NHM to identify 4 Ds (Defects at birth,

deficiencies, diseases, development delays including disability) for the children from birth to 18

years of age. The service aims to cover 0-6 years of age in rural areas and urban slums in addition to

children enrolled in classes 1st to 12

th in government and government aided schools. In Etawah, out

of 216087 registered children from 4786 schools, 164697 children diagnosed (Table 15). Eye

disease found in 1342 cases, ear disease 201 cases, heart disease 4 cases, 1711 physically

challenged and 2117 anaemic.

Table 15: RBSK Progress in Etawah, Uttar Pradesh, 2014-15

Years No. of

Schools

No. of children

registered

Children

Diagnosed

Eye

Disease

Ear

Disease

Heart

disease

Physically

challenged Anemic

2014-15 4786 216087 164697 1342 201 4 1711 2117

2013-14 3411 123727 114213 1271 113 1 1104 1444


12. FAMILY PLANNING

Uttar Pradesh is the most populous state in the country while district Etawah ranks 61st in terms of

the size of population. The Total Fertility rate of Uttar Pradesh as well as Etawah is more than

replacement level of 2.1, so the need of assessing the progress of family planning is vital to check

the fertility rates. The figures show that the district Etawah is performing below than the set target

of family planning (Table 16). With regard to Sterilization, it was found that the achieved

percentage of sterilization is far short than the set target. Only 62 percentage of the target have been


16 | P a g e

JANUARY 2016

achieved in the district. At block level, the achieved percentage is highest in Mahewa (79.49 %)

while lowest in Udi block (44.09%).

Table 16: Block-Wise Achievements of Family Planning, Etawah, Uttar Pradesh, 2014-15

Name Block Target Sterilization IUD OP CC

Male Female Total % Ach % Ach % Ach %

Basrehar 480 0 368 368 76.67 3857 129.17 1256 109.79 3679 151.90

Bharthana 546 0 222 222 40.66 2405 73.93 558 45.07 1426 55.02

Takha 297 0 227 227 76.43 1571 84.37 418 58.54 3098 206.53

Mahewa 585 0 465 465 79.49 3388 93.31 955 68.80 1983 67.73

Udi 372 0 164 164 44.09 1521 66.48 633 72.59 1360 73.75

Jaswant Nagar 571 1 423 424 74.08 3309 93.26 661 48.57 3799 132.74

Rajpur 241 0 169 169 70.12 986 66.58 675 120.11 1497 124.54

Urban 428 0 162 162 37.85 2301 86.41 621 61.85 1161 55.31

Total 3520 1 2200 2201 62.50 19338 89.07 5777 69.75 18003 103.17


Fig 3: Achievements of Sterilisation against the target in Various Blocks, Etawah, Uttar Pradesh, 2014-15

13. ADOLESCENT REPRODUCTIVE AND SEXUAL HEALTH (ARSH)

The ARSH wing is functional in the District hospital and women hospital. The number of

counselling sessions planned is 24 while 22 have been conducted in both the hospitals (Table 17).

Among the anaemic adolescents in the district women hospital, 34 are in severe category while 51

and 170 are in moderate and normal category respectively. In the district hospital, 45 are in severe


17 | P a g e

JANUARY 2016

category, 76 in moderate and 286 in normal category. With respect to treatment, 102 adolescents

given iron tablets, 102 deworming tablets and 17 referred with severe health issues in the district

women hospital. In the district hospital 198 adolescents given iron and deworming tablets and 18

referred with severe health issues. The number of RTI/STI cases is 28 and 42 in the district women

hospital and district hospital respectively (Table 17).

Table 17: ARSH Progress in Etawah, Uttar Pradesh, 2014-15

Block

No. of Counseling

session held No of Anemic Adolescents

Iron

tablets

given

deworming

tablets

given

Referred

with

severe

health

issues

No. of

RTI/ST

I cases Planned Conducted Severe Moderate Normal

DWH 24 22 34 51 170 102 102 17 28

DH 24 22 45 76 286 198 198 18 42


14. QUALITY IN HEALTH CARE SERVICES

Maintenance of hygiene and sanitation is one of the integral parts of a health facility. Clean and

hygienic premises have an impact on health. There are 10 facilities having bio-medical pits in the

district (Table 18). Colour coded bins available in 10 health facilities. Moreover fumigation drive

was have been conducted regularly once in a month and training have been provided to staffs

regarding infection control.

Table 18: Quality in Health Care Services, Etawah, Uttar Pradesh, 2014-15

Bio-Medical Waste Management

No of facilities having bio-medical pits 10

Training on bio-medical waste management No

No. of facilities having color coded bins 10

Outsourcing for bio-medical waste Yes

Infection Control

No. of times fumigation is conducted in a year Once in a month-

Training of staff on infection control yes


15. COMMUNITY PROCESS

The Community level health workers such as ASHAs play an important role in promoting

institutional deliveries which has a big impact on the health of the mother and newborn. Currently


18 | P a g e

JANUARY 2016

1127 ASHAs are working in the district (Table 19). Still 213 positions are vacant. In a year 336

meetings have been conducted with ASHAs. No ASHA resource centres are available in the district.

Drug kit replenishment provision is available.

Table 19: Community Process in Etawah, Uttar Pradesh, 2014-15

Current status of ASHAs (Total number of ASHAs)

ASHAs presently working 1127

Positions vacant 213

Skill development/refresher training of ASHAs (List the module) No refresher

Total number of meeting with ASHA ( in a Year) 336

Total number of ASHA resource centers/ ASHA Ghar 0

Drug kit replenishment Yes (1116)


16. DISEASE CONTROL PROGRAMS

Programs to control various diseases like Tuberculosis, Leprosy and Malaria are functioning in the

district. A total of 17050 screened for tuberculosis while 9 percentages detected and treated (Table

20). With respect to Leprosy, all were detected of those screened and 79 percentage detected cases

were treated. All screened cases detected malaria and treatment provided to all.

Table 20: Functioning of Disease Control Programs in Etawah, Uttar Pradesh, 2014-15

Name of the

Program

No. of cases

screened

No. of

detected

cases

% detected

of total

screened

No. of treated cases

% treated of total detected

cases

RNTCP 17050 1545 9.06 1545 100

Leprosy 93 93 100 71 76.34

Malaria 9 9 100 9 100

Source: CMO Office, Etawa

Fig 4: Detection and Treatment of Various Diseses , Etawah, Uttar Pradesh, 2014-15


19 | P a g e

JANUARY 2016

17. AYUSH

Treatment through Ayurveda, Yunani/Sidhha and Homeopathy (AYUSH) is functional in the

district. All the Blocks have AYUSH health centres in the district (Table 21). A total of 9 AYUSH

health centres running in the district with 21 AYUSH doctors. Basrehar and Udi block have 4

AYUSH doctors each as the highest among blocks. Patients received AYUSH treatment is highest

in Basrehar block and lowest in Takha. All the blocks having Ayurvedic and homeopathic

medicines while Unani / Sidha medicines available only in the district women hospital and district

hospital.

Table 21: Status of AYUSH in Etawah District, Uttar Pradesh, 2014-15

Block

No. of facilities

with AYUSH

health centers

No. of

AYUSH

Doctors

No. of patients

received

treatment

Ayurveda

Medicines

availability

Unani/Siddha

Medicines

availability

Homeopathy

Medicines

availability

Yes No Yes No Yes No

Basrehar 1 4 32624 Yes - - - Yes -

Bharthana 1 1 5270 Yes - - - Yes -

Takha 1 2 4773 Yes - - - Yes -

Mahewa 1 2 15771 Yes - - - Yes -

Udi 1 4 22789 Yes - - - Yes -

Jaswant

Nagar 1 3 19221 Yes - - - Yes -

Rajpur 1 2 13351 Yes - - - Yes -

DWH 1 1 8086 Yes - Yes - Yes -

DH 1 2 46365 Yes - Yes - Yes -

Total 9 21 168250 Yes - - - Yes -


18. INFORMATION, EDUCATION AND COMMUNICATION (IEC)

IEC displays were noticed in the visited health centres in the district. Information on Family

Planning, institutional delivery, breastfeeding and immunization, diseases like TB, Malaria, Leprosy

and HIV were observed in the facilities.


20 | P a g e

JANUARY 2016

Fig 5: IEC Displays at Various Health Facilities, Etawah, Uttar Pradesh

19. HMIS AND MCTS

HMIS and MCTS are functioning in the district. HMIS have been implemented in all the facilities

of the district. Records have been maintained properly. Programme managers use data for monthly

reviews at all levels. Service delivery data have been uploaded regularly in the district. Overall,

HMIS and MCTS are functioning smoothly in the district.

20. OBSERVATIONS FROM THE FIELD

20.1 DISTRICT FEMALE HOSPITAL, ETAWAH

The district hospital is situated at the heart of the city. It has two wards one is for female and the

other one is for the male. Both male and female wards are attached to each other. The provision of

female wards makes the women easier to get adequate health care facilities. Though there is

adequacy of facilities in certain wings, some wings have certain deficiencies reported.


21 | P a g e

JANUARY 2016

Fig 6: Different Wings of District Hospital, Etawah, Uttar Pradesh

� With regard to infrastructure and equipments, the district hospital is running in government

buildings. The hospital buildings well maintained. Staff quarters are available. Water supply

running for 24 hours and having electricity with power back-up. The DH has all equipments

available including BP instruments, Stethoscope, sterilized delivery sets, weighing machine

(functional), radiant warmer, foetal droppler, functional mobile light, delivery tables, functional

autoclave, functional ILR and deep Freezer, MVA/EVA equipments etc. All O.T. Equipments

like O.T. Tables, Lights, ceiling, mobile, anaesthesia machines, ventilators, pulse-oximeters

ventilators, surgical diathermies and c-arm units etc. are available and functional in the hospital.

The Laboratory equipments such as functional microscope, hemoglobinometer, Centrifuge

Reagents are available while semi autoanalyzer, ultrasound scanners, C.T. scanner, X-ray units,

ECG machines are functional in the male ward. With regard to Human resource, the women

wing has four OBGs, 2 Anaesthetists, 1 paediatrician, 6 MOs, 13 SNs, 4 ANMs, 1 LT, 4

Pharmacist, 1 LHV, 2 RMNCHA and 2 D.E.O. Training status shows that one HR is trained is

trained with EmOC, 4 with MTP/MVA, 4 with Mini- lap sterilisations, 16 with IUCD, and one

with immunisation and cold chain.


22 | P a g e

JANUARY 2016

� There is sufficient availability of drugs reported in the District Hospital. Also the supplies like

pregnancy testing kits, OCPs, sanitary napkins, EC pills and IUCDs are available. Essentials

consumables are available.

� The DWH doesn’t have all the facilities of testing in the Lab. Facilities like tests for CBC, blood

sugar, Malaria and HIV tests are not available. Also the facilities of ultrasound scan, X-ray,

ECG and Endoscopy are available in male ward. One blood bank is available for both the

hospitals.

Fig 7: Blood Bank Facilities at the District Hospital

� Proper recording of OPD, IPD, ANC, PNC and other registers noticed in the DWH. Apart from

these, proper displays of IEC marked in the district hospital

� The referral linkage data under JSSK in the last two quarter shows that, government vehicle is

the mode of transport from home to facility, inter facility and drop back. The number of women

transported during ANC/INC/PNC from home to facility is 1634 and women dropped back are

1365. Service provided under JSSK are free of cost.

� With regard to sanitary practices, though the hospital premises noticed hygienically well, the

washrooms and toilets were found dirty and unmanaged. Also the labor rooms were not

hygienically well.


23 | P a g e

JANUARY 2016

20.2 COMMUNITY HEALTH CENTRE, JASWANT NAGAR

CHC Jaswant Nagar covers 311 villages with a catchment population of 332,000. It is located

at a distance of 17 kilometres from the district headquarter.

� The CHC is running in government building and the staff quarters for MOs and SNs are

available. Female ward of the CHC is found separate from the male ward. Provision of

complaint and suggestions box noticed in the CHC. Also mechanisms for waste management

keep the premises of the CHC clean and hygienic.

� With respect to human resources, the CHC run by 10 MOs , 1 Anaesthetist, 1 general surgeon,,

7 SNs, 35 ANMs, 3 LTs, 3 Pharmacists, 4 LHVs, 1 RMNCHA and 7 other staffs. There is no

paediatrician, OBG and Radiographer in the CHC.

Fig 8: Different Wings of Community Health Centre, Jaswant Nagar, Etawah, Uttar Pradesh

� Training status of the staffs show that 1 is trained with LSAS, 1 with BeMOC, 3 with SBA, 1

with NSV, 1 with F-IMNCI, 3 with NSSK, 1 with Laproscopy sterilisation, 38 with IUCD, 9

with PPIUCD and 1 in immunisation and cold chain. .

� The laboratory equipments and other equipments in the CHC observed available and functional.

Except Misoprostol and Mifepristone tablets, all essential drugs, supplies and essential

consumables were found available. Lab service conducts almost all the tests except liver


24 | P a g e

JANUARY 2016

function tests and CBC. Blood bank storage unit is not available in the CHC. All the registers

have been maintained properly while partographs available but not maintained. Quarterly data

have been maintained in the registers regularly. Mothers received proper counselling regarding

breastfeeding, immunization and duration of staying at hospital after delivery.

� The cleanliness of the maternity ward was not satisfactory. The floor was noticed wet and also

the ward was not getting light sufficiently.

� Though the premises of the CHC were hygienically well, the conditions of the washrooms and

toilets were not satisfactory.

� The display of IEC was not found at prominent places. Some displays were found lying on the

floor though they were new.

20.3 PRIMARY HEALTH CENTRE, BIJAULI

PHC, Bijauli is situated at a distance of 17 kilometres from the district headquarter. It covers more

than 37,000 population from 5 villages.

Fig 9: Primary Health Centre, Biajuli, Etawah, Uttar Pradesh


25 | P a g e

JANUARY 2016

� The PHC is functioning on a government building with good condition. Staffs quarters are

available.

� Regarding human resources, the PHC run by 1 MO, 1 ANM, 1 Pharmacist, one LHV/PHN and

1 LH. Training status show that 1 staff is trained with BeMOC, 1 with SBA and 1 with IUD

� Electricity with power back up was available but inverter found non functional.

� Some laboratory equipments like BP instrument, Stethoscope, sterilised delivery sets, weighing

machine etc were available while the others like neonatal, paediatric and adult resuscitation,

autoclave, deep freezer, microscope, hamoglobinometer, centrifuge, semi autoanalyzer and

reagents and testing kits were not available. Drugs and other essentials are available in the PHC.

Lab is functional with the facilities of few tests. Only it has the provision of blood sugar and

Malaria tests.

� Proper counselling has been offered to the mothers regarding breastfeeding, immunization,

diets, JSY payments etc. Registers like OPD, IPD, ANC and others were seen maintained.

� IEC displays at the PHC were not satisfactory. Though some display materials noticed, these

were old and lacking clarity.

� No drug storage facilities and grievance redressal mechanisms is available at the PHC. Also

fumigation drive has not been conducted regularly.

20.4 SUB-CENTRE, ASADPUR

Asadpur sub-centre is located at a distance of 3 kilometres from the nearest PHC and it covers a

population of 11683 from 9 villages.

� The sub-centre is functioning in government building with a depleted good condition. Though

ANM quarter is attached to the sub-centre the facilities available is very poor. Labour room of

the sub-centre found functional but the condition inside the room was pathetic. Toilet facilities

were not available.


26 | P a g e

JANUARY 2016

Fig 10: Sub-Centre Asadpur, Etawah, Uttar Pradesh

� All equipments reported functional. Essential drugs and supplies were found available.

Various registers have been maintained properly at the sub-centre.

� No provision of drinking water at the sub-centre. ANM fetches drinking water from the

nearest villages. Also irregularities noticed regarding supply of electricity. Few IEC

materials noticed but were lacking clarity. No IEC materials noticed on outside wall of the

sub-centre.

20.5 SUB-CENTRE, LAKHANA

Asadpur sub-centre is located close to the PHC and it covers a population of 11343 from 9 villages.

The PHC and sub-centre located in the same premise.

� The sub-centre is running in a government building. The physical condition of the building

is not so good.


27 | P a g e

JANUARY 2016

� The ANM posted at the sub-centre is on heavy work load as she delivers duty for both the

sub-centre and the nearest PHC.

Fig 11: Sub-Centre, Lakhana, Etawah, Uttar Pradesh

� The condition of the ANM quarter is very poor. Irregularities in electricity and water supply

reported.

� Cleanliness inside the sub-centre is not satisfactory. No provision of pits for the disposal of

bio-medical waste.

� Though labour room is functional, it was not in a good condition. Sufficient light was not

coming inside the room.

� Except few, all equipments and drugs found available. There were proper maintenance of

records and were updated.

� Sufficient IEC materials did not found inside the sub-centre. The noticed display materials

were very poor in quality.

21: CONCLUSIONS AND RECOMMENDATIONS

A clear picture of the functioning of the various health facilities revealed from the monitoring and

the findings and observations will definitely strengthen the health service delivery system further.

The findings and observations from the monitoring discussed below.


28 | P a g e

JANUARY 2016

� As the availability of physical infrastructure is one of the basic components of a health

facility for providing better health care services it was observed that all the visited health

facilities running by government buildings. Though the district hospital, CHC and PHC are

well maintained, the Sub-Centre buildings are old and not properly maintained.

� The district hospital has two wards, one for male and another for female which makes the

women easier to access the health services. Staff quarters are also available. Except NBSU,

it is having all the functional departments related to the newborn and child care such as

SNCU, NBCC and NRC. Apart from these, AYUSH and ARSH wing of the hospital

functioning well.

� Shortage of staffs in certain wings like Anaethesia and Blood banks reported. Also district

hospital sees a shortage of fourth class employees. Gynaecologist posts

� Lack of co-ordination among the staffs reported in the district hospital. Staffs do not follow

the rules.

� Funds released under NHM lack proper instruction on their utilisation.

� NRC ward is having a common toilet and there is no provision of separate toilets for males

and females.

� ARSH wing lacking sufficient space and congested. Visibility inside the wing is very poor.

� Despite the availability of parking space, people noticed parking their vehicles near the entry

point making it congested.

� Irregularities in water supply and electricity at the visited PHC and SCs. The inverter is non-

functional.

� The conditions IEC materials are very poor at the PHC and SC level. At CHC, the materials

not found in proper places and were lying on the floor.

� Lack of bio-medical pits at the PHC and SC level. Though the surroundings of the visited

health facilities were clean, the conditions inside the facilities were not hygienic. Toilets are

at worst and unmanaged.

� District women Hospital doesn’t have all the lab-testing facilities.


29 | P a g e

JANUARY 2016

RECOMMENDATIONS

� The Sub-Centre buildings need to be renovated.

� Proper co-ordination should be maintained among the staffs for better service delivery.

� Proper guidelines should be provided regarding the utilisation of funds released under NHM.

� Vacant positions in the district hospital need to be filled.

� More focus should be given towards achieving the targets of family planning and child

Immunisation.

� Facilities like electricity and water supply need to be improved at the PHC and Sub-Centre

level.

� All types of lab facilities should be provided at the district hospital.

� Disciplinary action should be taken who park their vehicles at the entry point of the district

hospital.

� Facility of bio-medical pits should be provided to the Sub-Centres.

� Sanitation and hygienic conditions inside the health facility need to be improved.

� IEC materials should be properly placed with better clarity at the health facilities.


30 | P a g e

JANUARY 2016

22. APPENDIX

APPENDIX 1:

NATIONAL RURAL HEALTH MISSION

MONITORING OF DISTRICT PIP

POPULATION RESEARCH CENTRE, INSTITUTE OF ECONOMIC GROWTH, DELHI

EVALUATION OF KEY INDICATORS OF THE DISTRICT

1. Detail of demographic & health indicators

No. of Blocks

No. of Villages

Population (2011)

SC-ST Population (%)

Literacy Rate

Overall Sex Ratio

Density of Population

Health Indicators

NMR

IMR

U5MR

MMR

TFR

Proportion of fully immunized children

Proportion of Pregnant receiving any ANC

Proportion of Safe Deliveries

Institutional Deliveries 10605

No of women received PNC checkups within 48 hours 9323

Full ANC ( At least three ANC checkups) 25979

2. Detail of health infrastructures 2014-15

Health Facility Number available Govt. building Rented building/ Under const.

District hospital

SDH

CHC FRUs


31 | P a g e

JANUARY 2016

3. Human Resources under NHM 2014-15

Position Name Sanctioned Regular Contractual Total Vacant Vacant %

13-14 14-15 13-14 14-15 13-14 14-15 13-14 14-15 13-14 14-15

MO’s including specialists

Gynecologists

Pediatrician

Surgeon

LHV

ANM

Pharmacist

Lab technicians

X-ray technicians

Staff Nurse at CHC

Staff Nurse at PHC

ANM at PHC

ANM at SC

4.1. Training status of human resource 2014-15

Position Name SBA BeMOC MTP Minilap/PP

S NSV

Total

Medical Officers

Lady Medical Officers

Staff Nurses

ANM

Lab Technicians

Pharmacist

LHV/PHN

ASHA

Other

* Note- Fill number of officials received training

CHC

PHC

Sub Centre

Medical College

Delivery Points

108 Ambulances

CATS

102 Ambulance

Referral Transport


32 | P a g e

JANUARY 2016

4.2. Training status of human resource 2014-15

Position Name IUCD

insertion

RTI/STI/HIV

screening FIMNCI

NSSK Total

MO

LMO

Staff Nurses

ANM

Lab Technicians

Pharmacist

LHV/PHN

ASHA

Other

5.1 Block wise service delivery indicators 2013-14 & 2014-15 (Maternal Health)

Block

ANC

Registered 3 ANCs

Home

Deliveries

Institutional

Deliveries

PNC within

48 hrs after

delivery

PNC between

48 hrs and 14

days after

delivery

13-14 14-15 13-14 14-15 13-14 14-15 13-

14

14-15 13-14 14-

15

13-14 14-15

37391 40683 29795 25979 2308 2056 8342 10605 9468 9523 9158 9522

Note- Please included the data for Medical College and DH

5.2 Block wise service delivery indicators 2013-14 & 2014-15 (maternal health)

Note- Please included the data for Medical college and DH

5.3. Status of JSY Payments in district 2014-15

B

l

o

c

k

TT1 TT2

Home Deliveries

Live Birth Still

Birth Total Births SBA

assisted Non-SBA

13-14 14-15 13-14 14-15 13-

14 14-15 13-14 14-15 13-14 14-15 13

-

14-

15 13-14 14-15

14612 14687 12629 12775 701 568 1607 1488 12371 12729 89 93 12460 12822

Status of payments Mode of Payments Record maintenance


33 | P a g e

JANUARY 2016

5.4. Block wise JSSK Progress in district 2014-15

Block

No. of Beneficiaries under JSSK Total =

Diet Drugs Diagnostic

Transport

Home to Facility Referral Facility to Home

5.5. Maternal Death Review: 2014-15

Total

Maternal

Deaths

Place of Deaths Cause

of death

Month Of pregnancy ANC

Statu

s

Total

No of

childre

n Hospital Home Transit

During

pregnancy

During

Delivery

Post

Deliver

y

6.1. Child Health: Block wise Analysis of immunization, 2014-15

Block Target BCG DPT OPV Measle Full

Institutional

deliveries

Home

Deliveries ASHAs Cash Cheque

A/C

transfer Available Updated

Non

updated


34 | P a g e

JANUARY 2016

1 2 3 0 1 2 s Immunizat

ion South 14706 3358 3368 3442 11084 15222 15378 18946 16982

6.2. Child Health: Detail of infrastructure & Services under Neonatal Health, 2014-15

Total SNCU

Total NBSU

Total NBCC

Total Staff in SNCU

Total Staff in NBSU

Total NRCs

Total Admissions in NRCs

Total Staff in NRCs

Anticipated Admissions in NRCs

Discharged from NRCs

Referred from NRCs

Average duration of stay in NRCs

6.3. Neonatal Health: 2014-15 (SNCU, NRCS & CDR)

Total

neonates

admitted in

to SNCU

Treatment Outcome Total

neonates

admitted

in to

NBSU

Treatment Outcome



Note- * Leave against medical advise

6.4. Neonatal Health: 2014-15 (SNCU, NRCS & CDR)

Total Deaths Place of Deaths Reason

Month/year in

which child has

died

ANC

Status of

mother

Birth

order


35 | P a g e

JANUARY 2016

Hospital Home Transit

6.5. Rashtriya Bal Suraksha Karyakram (RBSK), Progress Report 2014-15

Years No. of

Schools

No. of children registered

Children Diagnosed

Eye Disease

Ear Disease

Heart diseas

e

Physically challenged

Anemic

2014-15

2013-14

7. Family Planning Achievement in District 2014-15

Name Block Target Sterilization IUD OP CC

Male Female Total % Ach % Ach % Ach %

27 1033 0160 5734

12242 293262

8. ARSH Progress in District 2014-15

Block

No. of Counseling session

held No of Anemic Adolescents

Iron tablets given

deworming tablets given

Referred with severe health issues

No. of RTI/STI cases

Planned Conducted Severe Moderat

e Normal

7112

9. Quality in health care services

Bio-Medical Waste Management

No of facilities having bio-medical pits

Training on bio-medical waste management


36 | P a g e

JANUARY 2016

No. of facilities having color coded bins

Outsourcing for bio-medical waste

Infection Control

No. of times fumigation is conducted in a year

Training of staff on infection control

10. Community process in District 2014-15

Current status of ASHAs (Total number of ASHAs)

ASHAs presently working

Positions vacant

Skill development/refresher training of ASHAs (List the module)

Total number of meeting with ASHA ( in a Year)

Total number of ASHA resource centers/ ASHA Ghar

Drug kit replenishment

11. Disease control programme progress District 2014-15

Name of the Program No. of cases screened No. of detected cases No. of treated cases

RNTCP

Leprosy

Malaria

12. AYUSH progress District 2014-15

Block No. of facilities

with AYUSH

health centers

No. of

AYUSH

Doctors

No. of patients

received

treatment

Ayurveda

Medicines

availability

Unani/Siddha

Medicines

availability

Homeopathy

Medicines

availability

Yes No Yes No Yes No

13. HMIS/MCTS progress District 2014-15

HMIS/MCTS Remarks

Is HMIS /MCTS implemented at all the facilities Yes No Yes

Is HMIS data analyzed and discussed with concerned staff at state and

district levels for necessary corrective action to be taken in future?

Yes No yes

Do programme managers at all levels use HMIS data for monthly

reviews?

Yes No yes

Is MCTS made fully operational for regular and effective monitoring

of service delivery including tracking and monitoring of severely

anemic women, low birth weight babies and sick neonates

Yes No

yes


37 | P a g e

JANUARY 2016

13. New Initiative and new innovations

Is the service delivery data uploaded regularly Yes No

yes

Is the MCTS call centre set up at the District level to check the

veracity of data and service delivery?

Yes No yes

Is HMIS data analyzed and discussed with concerned staff at state

and district levels for necessary corrective action to be taken in future?

Yes No yes


38 | P a g e

JANUARY 2016

Appendix 2:

DH level Monitoring Checklist

Name of District: _______________ Name of Block: _______________ Name of DH: _________________

Catchment Population: __________ Total Villages: ________________

Date of last supervisory visit:__________

Date of visit: _____________ Name& designation of monitor:_____________________________

Names of staff not available on the day of visit and reason for

absence:____________________________________________

_______________________________________________________________________________________

Section I: Physical Infrastructure:

S.No Infrastructure Yes No Additional Remarks

1.1 Health facility easily accessible

from nearest road head

Y N

1.2 Functioning in Govt building Y N

1.3 Building in good condition Y N

1.4 Staff Quarters for MOs Y N

1.5 Staff Quarters for SNs Y N

1.6 Staff Quarters for other

categories Y N

1.7 Electricity with power back up Y N

1.9 Running 24*7 water supply Y N

1.10 Clean Toilets separate for

Male/Female Y N

1.11 Functional and clean labour

Room Y N

1.12 Functional and clean toilet

attached to labour room Y N

1.13 Functional New born care

corner(functional radiant

warmer with neo-natal ambu

bag)

Y N

1.14 Functional Newborn

Stabilization Unit Y N

1.16 Functional SNCU Y N

1.17 Clean wards Y N

1.18 Separate Male and Female wards

(at least by partitions) Y N

1.19 Availability of Nutritional

Rehabilitation Centre Y N

1.20 Functional BB/BSU, specify Y N

1.21 Separate room for ARSH clinic Y N


39 | P a g e

JANUARY 2016

1.22 Availability of

complaint/suggestion box Y N

Availability of mechanisms for

Biomedical waste management

(BMW)at facility

Y N

1.23 BMW outsourced Y N

1.24 Availability of ICTC/ PPTCT

Centre Y N

1.25 Availability of functional Help

Desk Y N

Section II: Human resource:

S. no Category Numbers Remarks if any

2.1 OBG

2.2 Anaesthetist

2.3 Paediatrician

2.4 General Surgeon

2.5 Other Specialists

2.6 MOs

2.7 SNs

2.8 ANMs

2.9 LTs

2.10 Pharmacist

2.11 LHV

2.12 Radiographer

2.13 RMNCHA+ counsellors

2.14 Others

Section III: Training Status of HR:

S. no Training No. trained Remarks if any

3.1 EmOC

3.2 LSAS

3.3 BeMOC

3.4 SBA

3.5 MTP/MVA

3.6 NSV

3.7 F-IMNCI

3.8 NSSK

3.9 Mini Lap-Sterilisations

3.10 Laproscopy-Sterilisations


40 | P a g e

JANUARY 2016

3.11 IUCD

3.12 PPIUCD

3.13 Blood storage

3.14 IMEP

3.16 Immunization and cold chain

3.15 Others

Section IV: Equipment:

S. No Equipment Yes No Remarks

4.1 Functional BP Instrument and Stethoscope Y N

4.2 Sterilised delivery sets Y N

4.3 Functional Neonatal, Paediatric and Adult

Resuscitation kit Y N

4.4 Functional Weighing Machine (Adult and

child) Y N

4.5 Functional Needle Cutter Y N

4.6 Functional Radiant Warmer Y N

4.7 Functional Suction apparatus Y N

4.8 Functional Facility for Oxygen

Administration Y N

4.9 Functional Foetal Doppler/CTG Y N

4.10 Functional Mobile light Y N

4.11 Delivery Tables Y N

4.12 Functional Autoclave Y N

4.13 Functional ILR and Deep Freezer Y N

4.14 Emergency Tray with emergency injections Y N

4.15 MVA/ EVA Equipment Y N

4.16 Functional phototherapy unit Y N

4.17 O.T Equipment

4.18 O.T Tables Y N

4.19 Functional O.T Lights, ceiling Y N

4.20 Functional O.T lights, mobile Y N

4.21 Functional Anesthesia machines Y N

4.22 Functional Ventilators Y N

4.23 Functional Pulse-oximeters Y N

4.24 Functional Multi-para monitors Y N

4.25 Functional Surgical Diathermies Y N

4.26 Functional Laparoscopes Y N

4.27 Functional C-arm units Y N

4.28 Functional Autoclaves (H or V) Y N

Laboratory Equipment


41 | P a g e

JANUARY 2016

4.1a Functional Microscope Y N

4.2a Functional Hemoglobinometer Y N

4.3a Functional Centrifuge Y N

4.4a Functional Semi autoanalyzer Y N

4.5a Reagents and Testing Kits Y N

4.6a Functional Ultrasound Scanners Y N

4.7a Functional C.T Scanner Y N

4.8a Functional X-ray units Y N

4.9a Functional ECG machines Y N

Section V: Essential Drugs and Supplies: S.No Drugs Yes No Remarks

5.1 EDL available and displayed Y N

5.2 Computerised inventory management Y N

5.3 IFA tablets Y N

5.4 IFA tablets (blue) Y N

5.5 IFA syrup with dispenser Y N

5.6 Vit A syrup Y N

5.7 ORS packets Y N

5.8 Zinc tablets Y N

5.9 Inj Magnesium Sulphate Y N

5.10 Inj Oxytocin Y N

5.11 Misoprostol tablets Y N

5.12 Mifepristone tablets Y N

5.13 Availability of antibiotics Y N

5.14 Labelled emergency tray Y N

5.15 Drugs for hypertension, Diabetes,

common ailments e.g PCM,

metronidazole, anti-allergic drugs etc.

Y

N

5.16 Adequate Vaccine Stock available Y N

S.No Supplies Yes No Remarks

5.17 Pregnancy testing kits Y N

5.18 Urine albumin and sugar testing kit Y N

5.19 OCPs Y N

5.20 EC pills Y N

5.21 IUCDs Y N

5.22 Sanitary napkins Y N

S.No Essential Consumables Yes No Remarks

5.23 Gloves, Mckintosh, Pads, bandages, and

gauze etc.

Y N

Section VI: Other Services : S.no Lab Services Yes No Remarks


42 | P a g e

JANUARY 2016

6.1 Haemoglobin Y N

6.2 CBC Y N

6.3 Urine albumin and sugar Y N

6.4 Blood sugar Y N

6.5 RPR Y N

6.6 Malaria Y N

6.7 T.B Y N

6.8 HIV Y N

6.9 Liver function tests(LFT) Y N

6.10 Ultrasound scan (Ob.)

6.11 Ultrasound Scan (General)

6.12 X-ray

6.13 ECG

6.14 Endoscopy

6.15 Others , pls specify Y N

S.No Blood bank / Blood Storage Unit Yes No Remarks

6.16 Functional blood bag refrigerators with chart

for temp. recording Y N

6.17 Sufficient no. of blood bags available Y N

6.18 Check register for number of blood bags

issued for BT in last quarter

Section VII: Service Delivery in last two quarters: S.No Service Utilization Parameter Q1 Q2 Remarks

7.1 OPD

7.2 IPD

7.3 Expected number of pregnancies

7.4 MCTS entry on percentage of women

registered in the first trimester

7.5 No. of pregnant women given IFA

7.6 Total deliveries conducted

7.7 No. of assisted deliveries( Ventouse/

Forceps)

7.8 No. of C section conducted

7.9 Number of obstetric complications

managed, pls specify type

7.10 No. of neonates initiated breast feeding

within one hour

7.11 Number of children screened for

Defects at birth under RBSK

7.12 RTI/STI Treated

7.13a No of admissions in NBSUs/ SNCU,

whichever available

7.13b Inborn


43 | P a g e

JANUARY 2016

7.13c Outborn

7.14 No. of children admitted with SAM

7.15 No. of sick children referred

7.16 No. of pregnant women referred

7.17 ANC1 registration

7.18 ANC 3 Coverage

7.19 ANC 4 Coverage

7.20 No. of IUCD Insertions

7.21 No. of Tubectomy

7.22 No. of Vasectomy

7.23 No. of Minilap

7.24 No. of children fully immunized

7.25 Measles coverage

7.26 No. of children given ORS + Zinc

7.27 No. of children given Vitamin A

7.28 No. of women who accepted post-partum

FP services

7.29 No. of MTPs conducted in first trimester

7.30 No. of MTPs conducted in second trimester

7.31 Number of Adolescents attending ARSH

clinic

7.32 Maternal deaths, if any

7.33 Still births, if any

7.34 Neonatal deaths, if any

7.35 Infant deaths, if any

Section VII a: Service delivery in post natal wards: S.No Parameters Yes No Remarks

7.1a All mothers initiated breast feeding

within one hour of normal delivery Y N

7.2a Zero dose BCG, Hepatitis B and

OPV given Y N

7.3a Counseling on IYCF done Y N

7.4a Counseling on Family Planning

done Y N

7.5a Mothers asked to stay for 48 hrs Y N

7.6a JSY payment being given before

discharge Y N

7.7a Mode of JSY payment (Cash/

bearer cheque/Account payee

cheque/Account Transfer)

7.8a Any expenditure incurred by

Mothers on travel, drugs or Y N


44 | P a g e

JANUARY 2016

diagnostics(Please give details)

7.9a Diet being provided free of charge Y N

Section VIII: Quality parameter of the facility: Through probing questions and demonstrations assess does the staff know how to…

S.No Essential Skill Set Yes No Remarks

8.1 Manage high risk pregnancy Y N

8.2 Provide essential newborn

care(thermoregulation,

breastfeeding and asepsis)

Y N

8.3 Manage sick neonates and infants Y N

8.4 Correctly uses partograph Y N

8.5 Correctly insert IUCD Y N

8.6 Correctly administer vaccines Y N

8.7 Segregation of waste in colour

coded bins

Y N

8.8 Adherence to IMEP protocols Y N

8.9 Bio medical waste management Y N

8.10 Updated Entry in the MCP Cards Y N

8.11 Entry in MCTS Y N

8.12 Action taken on MDR Y N

Section IX: Record Maintenance:

S. no Record Available and

Updated and

correctly filled

Available but

Not maintained

Not

Available

Remarks/Ti

meline for

completion

9.1 OPD Register

9.2 IPD Register

9.3 ANC Register

9.4 PNC Register

9.5 Indoor bed head ticket

9.6 Line listing of severely anaemic

pregnant women

9.7 Labour room register

9.8 Partographs

9.9 FP-Operation Register (OT)

9.10 OT Register

9.11 FP Register

9.12 Immunisation Register

9.13 Updated Microplan

9.14 Blood Bank stock register


45 | P a g e

JANUARY 2016

9.15 Referral Register (In and Out)

9.16 MDR Register

9.17

Infant Death Review and

Neonatal Death Review

9.18 Drug Stock Register

9.19 Payment under JSY

9.20

Untied funds expenditure

(Check % expenditure)

9.21

AMG expenditure (Check %

expenditure)

9.22

RKS expenditure (Check %

expenditure)

Section X: Referral linkages in last two quarters:

S. no JSSK Mode of

Transport

(Specify

Govt./ pvt)

No. of women

transported

during

ANC/INC/PN

C

No. of sick

infants

transported

No. of

children 1-

6 years

Free/Paid

10.1 Home to facility

10.2 Inter facility

10.3

Facility to Home (drop

back)

Section XI: IEC Display:

S.No Material Yes No Remarks

11.1

Approach roads have directions to

the health facility

Y N

11.2 Citizen Charter Y N

11.3 Timings of the health facility Y N

11.4 List of services available Y N

11.5 Essential Drug List Y N

11.6 Protocol Posters Y N

11.7

JSSK entitlements ( Displayed in ANC

Clinics/, PNC Clinics) Y N

11.8 Immunization Schedule Y N

11.9 JSY entitlements( Displayed in ANC

Clinics/, PNC Clinics) Y N

11.10 Other related IEC material Y N

Section XII: Additional/Support Services: Sl. no Services Yes No Remarks

12.1 Regular Fogging (Check Records) Y N

12.2 Functional Laundry/washing services Y N


46 | P a g e

JANUARY 2016

12.3 Availability of dietary services Y N

12.4 Appropriate drug storage facilities Y N

12.5 Equipment maintenance and repair

mechanism Y N

12.6 Grievance Redressal mechanisms Y N

12.7 Tally Implemented Y N


47 | P a g e

JANUARY 2016

Appendix 4:

PHC/CHC (NON FRU) level Monitoring Checklist

Name of District: _______________ Name of Block: _______________ Name of PHC/CHC: _________________

Catchment Population:

__________ Total Villages: ________________ Distance from Dist HQ: __________



Names of staff not available on the day of visit and reason for

absence:____________________________________________

_______________________________________________________________________________________


S.No Infrastructure Yes No Additional Remarks

1.1 Health facility easily accessible from nearest

road head

Y N


1.3 Building in good condition Y N

1.4 Staff Quarters for MOs available Y N

1.5 Staff Quarters for SNs available Y N

1.6 Staff Quarters for other categories Y N



1.10 Clean Toilets separate for Male/Female Y N

1.11 Functional and clean labour Room Y N

1.12 Functional and clean toilet attached to labour

room

Y N

1.13 Functional New born care corner(functional

radiant warmer with neo-natal ambu bag)

Y N

1.14 Functional Newborn Stabilization Unit Y N

1.15 Clean wards Y N

1.16 Separate Male and Female wards (at least by

Partitions)

Y N

1.17 Availability of complaint/suggestion box Y N

1.18 Availability of mechanisms for waste

management

Y N


48 | P a g e

JANUARY 2016

Section II: Human resource:

S. no Category Numbers Remarks if any

2.1 MO

2.2 SNs/ GNMs

2.3 ANM

2.4 LTs

2.5 Pharmacist

2.6 LHV/PHN

2.7 Others

Section III: Training Status of HR

S. no Training No. trained Remarks if any

3.1 BeMOC

3.2 SBA

3.3 MTP/MVA

3.4 NSV

3.5 IMNCI

3.6 F- IMNCI

3.7 NSSK

3.8 Mini Lap

3.9 IUD

3.10 RTI/STI

3.11 Immunization and cold chain

3.12 Others

Section IV: Equipment

S. No Equipment Yes No Remarks

4.1 Functional BP Instrument and

Stethoscope

Y N

4.2 Sterilised delivery sets Y N

4.3 Functional neonatal, Paediatric and

Adult Resuscitation kit

Y N

4.4 Functional Weighing Machine (Adult and

infant/newborn)

Y N

4.5 Functional Needle Cutter Y N

4.6 Functional Radiant Warmer Y N

4.7 Functional Suction apparatus Y N

4.8 Functional Facility for Oxygen Y N


49 | P a g e

JANUARY 2016

Administration

4.9 Functional Autoclave Y N

4.10 Functional ILR and Deep Freezer Y N

4.11 Functional Deep Freezer

4.12 Emergency Tray with emergency

injections

Y N

4.13 MVA/ EVA Equipment Y N

Laboratory Equipment Yes No Remarks

4.14 Functional Microscope Y N

4.15 Functional Hemoglobinometer Y N

4.16 Functional Centrifuge, Y N

4.17 Functional Semi autoanalyzer Y N

4.18 Reagents and Testing Kits Y N

Section V: Essential Drugs and Supplies

S.No Drugs Yes No Remarks

5.1 EDL available and displayed Y N

5.2 Computerised inventory management Y N

5.3 IFA tablets Y N

5.4 IFA tablets (blue) Y N


5.6 Vit A syrup Y N

5.7 ORS packets Y N





5.12 Mifepristone tablets Y N

5.13 Availability of antibiotics Y N

5.14 Labelled emergency tray Y N

5.15 Drugs for hypertension, Diabetes,


metronidazole, anti-allergic drugs etc.

Y

N

5.16 Adequate Vaccine Stock available Y N

S.No Supplies Yes No Remarks

5.17 Pregnancy testing kits Y N

5.18 Urine albumin and sugar testing kit Y N

5.19 OCPs Y N

5.20 EC pills Y N

5.21 IUCDs Y N



50 | P a g e

JANUARY 2016

S.No Essential Consumables Yes No Remarks

5.23 Gloves, Mckintosh, Pads, bandages,

and gauze etc.

Y N

Section VI: Other Services :

S.no Lab Services Yes No Remarks

6.1 Haemoglobin Y N

6.2 CBC Y N

6.3 Urine albumin and Sugar Y N

6.4 Serum Bilirubin test Y N

6.5 Blood Sugar Y N

6.6 RPR Y N

6.7 Malaria Y N

6.8 T.B Y N

6.9 HIV Y N

6.10 Others Y N

Section VII: Service Delivery in last two quarters:

S.No Service Utilization Parameter Q1 Q2 Remarks

7.1 OPD

7.2 IPD

7.3 Expected number of pregnancies

7.4 MCTS entry on percentage of women

registered in the first trimester

7.5 No. of pregnant women given IFA

7.6 Total deliveries conducted

7.7 Number of obstetric complications

managed, pls specify type

7.8 No. of neonates initiated breast

feeding within one hour

7.9 Number of children screened for

Defects at birth under RBSK

7.10 RTI/STI Treated

7.11 No of admissions in NBSUs, if available


7.13 No. of pregnant women referred


7.15 ANC3 Coverage

7.16 ANC4 Coverage

7.17 No. of IUCD Insertions

7.18 No. of Tubectomy


51 | P a g e

JANUARY 2016

7.19 No. of Vasectomy

7.20 No. of Minilap

7.21 No. of children fully immunized

7.22 Measles coverage

7.23 No. of children given ORS + Zinc


7.25 No. of women who accepted post partum

FP services

7.26 No. of MTPs conducted

7.27 Maternal deaths, if any

7.28 Still births, if any

7.29 Neonatal deaths, if any

7.30 Infant deaths, if any

Section VII a: Service delivery in post natal wards:

S.No Parameters Yes No Remarks

7.1a All mothers initiated breast

feeding within one hr of normal

delivery

Y N

7.2a Zero dose BCG, Hepatitis B and

OPV given

Y N

7.3a Counseling on IYCF done Y N

7.4a Counseling on Family Planning

done

Y N

7.5a Mothers asked to stay for 48 hrs Y N

7.6a JSY payment being given before

discharge

Y N

7.7a Mode of JSY payment (Cash/

bearer cheque/Account payee

cheque/Account Transfer)

7.8a Any expenditure incurred by

Mothers on travel, drugs or

diagnostics(Please give details)

Y N

7.9a Diet being provided free of

charge

Y N

Section VIII: Quality parameter of the facility Through probing questions and demonstrations assess does the staff know how to…

S.No Essential Skill Set Yes No Remarks

8.1 Manage high risk pregnancy Y N

8.2 Provide essential newborn Y N


52 | P a g e

JANUARY 2016

care(thermoregulation,

breastfeeding and asepsis)

8.3 Manage sick neonates and infants Y N

8.4 Correctly Uses Partograph Y N

8.5 Correctly insert IUCD Y N

8.6 Correctly administer vaccines Y N

8.7 Alternate Vaccine Delivery

(AVD) system functional

Y N

8.7 Segregation of waste in colour

coded bins

Y N

8.8 Adherence to IMEP protocols Y N

Section IX: Record Maintenance:

S. no Record Available,

Updated

and

correctly

filled

Available

but Not

maintain

ed

Not

Avai

lable

Remarks/Timeline

for completion

9.1 OPD Register

9.2 IPD Register

9.3 ANC Register

9.4 PNC Register

9.5 Indoor bed head ticket

9.6 Line listing of severely anaemic pregnant

women

9.7 Labour room register

9.8 Partographs

9.9 OT Register

9.10 FP Register

9.11 Immunisation Register


9.13 Drug Stock Register

9.14 Referral Registers (In and Out)

9.15 Payments under JSY

9.16 Untied funds expenditure (Check %

expenditure)

9.17 AMG expenditure (Check %

expenditure)

9.18 RKS expenditure (Check %

expenditure)


53 | P a g e

JANUARY 2016

Section X: Referral linkages in last two quarters:

S. no JSSK Mode of

Transport

(Specify

Govt./ pvt)

No. of

women

transpor

ted

during

ANC/INC

/PNC

No. of

sick

infants

transpor

ted

No.

of

chil

dren

1-6

year

s

Free/Paid

10.1 Home to facility

10.2 Inter facility

10.3

Facility to Home (drop

back)

Section XI: IEC Display:

S.No Material Yes No Remarks

11.1

Approach roads have directions to

the health facility

Y N


11.3 Timings of the Health Facility Y N

11.4 List of services available Y N

11.5 Essential Drug List Y N

11.6 Protocol Posters Y N

11.7 JSSK entitlements Y N

11.8 Immunization Schedule Y N 11.9 JSY entitlements Y N


Section XII: Additional/Support Services:

Sl. no Services Yes No Remarks

12.1 Regular fumigation (Check Records) Y N

12.2 Functional laundry/washing services Y N

12.3 Availability of dietary services Y N

12.4 Appropriate drug storage facilities Y N

12.5 Equipment maintenance and repair

mechanism

Y N

12.6 Grievance redressal mechanisms Y N

12.7 Tally Implemented Y N


54 | P a g e

JANUARY 2016

Appendix 5:

Sub Centre level Monitoring Checklist

Name of District: _______________ Name of Block: _______________ Name of SC: _________________

Catchment Population: __________ Total Villages: ________________ Distance from PHC: __________



Names of staff posted and available on the day of visit: ________________________________________________________

Names of staff not available on the day of visit and reason for absence : ____________________________________


S.No Infrastructure Yes No Remarks

1.1 Subcentre located near the main

habitation

Y N


1.3 Building in good physical

condition

Y N



1.6 ANM quarter available Y N

1.7 ANM residing at SC Y N

1.8 Functional labour room Y N

1.9 Functional and clean toilet

attached to labour room

Y N

1.10 Functional New Born Care Corner

(functional radiant warmer with neo-

natal ambu bag)

Y N

1.11 General cleanliness in the facility Y N

1.12 Availability of complaint/

suggestion box

Y N

1.13 Availability of deep burial pit for

biomedical waste management /

any other mechanism

Y N

Section II: Human Resource:

S.no Human resource Numbers Trainings received Remarks

2.1 ANM

2.2 2nd ANM

2.3 MPW - Male

2.4 Others, specify


55 | P a g e

JANUARY 2016

Section III: Equipment : S.N

o

Equipment Available

and

Functional

Available

but non-

functional

Not

Available

Remarks

3.1 Haemoglobinometer

3.2 Any other method for

Hemoglobin Estimation

3.3 Blood sugar testing kits

3.4 BP Instrument and

Stethoscope

3.5 Delivery equipment

3.6 Neonatal ambu bag

3.7 Adult weighing machine

3.8 Infant/New born weighing

machine

3.9 Needle &Hub Cutter

3.10 Color coded bins

3.11 RBSK pictorial tool kit

Section IV: Essential Drugs:

S.

No

Availability of sufficient

number of essential Drugs

Yes No Remarks

4.1 IFA tablets Y N


4.3 Vit A syrup Y N

4.4 ORS packets Y N





4.9 Antibiotics, if any, pls specify Y N

4.10 Availability of drugs for


metronidazole, anti-allergic

drugs etc.

Y N


56 | P a g e

JANUARY 2016

Section V: Essential Supplies

S.No Essential Medical Supplies Yes No Remarks

5.1 Pregnancy testing Kits Y N

5.2 Urine albumin and sugar

testing kit

Y N

5.3 OCPs Y N

5.4 EC pills Y N

5.5 IUCDs Y N


Section VI: Service Delivery in the last two quarters:

S.No Service Utilization

Parameter

Q1 Q2 Remarks

6.1 Number of estimated

pregnancies

6.3 No. of pregnant women given

IFA

6.4 Number of deliveries

conducted at SC

6.5 Number of deliveries

conducted at home


6.9 No. of pregnant women

referred


6.11 ANC3 coverage

6.12 ANC4 Coverage

6.13 No. of IUCD insertions

6.14 No. of children fully

immunized

6.14a Measles coverage

6.15 No. of children given ORS +

Zinc


6.17 No. of children given IFA Syrup

6.18 No. of Maternal deaths

recorded , if any

6.19 No. of still birth recorded, if

any

6.20 Neonatal deaths recorded, if

any

6.21 Number of VHNDs attended


57 | P a g e

JANUARY 2016

6.22 Number of VHNSC meeting

attended

Section VIII: Record Maintenance:

Sl. No Record Available

and

Upto-

date and

correctly

filled

Available

but non-

maintained

Not

Avail

able

Remarks

8.1 Untied funds expenditure

(Rs 10,000-Check %

expenditure)

8.2 Annual maintenance grant

(Rs 10,000-Check %

expenditure)

8.3 Payments under JSY

8.4 VHND plan

8.5 VHSNC meeting minutes

and action taken

8.6 Eligible couple register

8.7 MCH register ( as per GOI)

8.8 Delivery Register as per

GOI format

8.9 Stock register

8.10 Due lists

8.11 MCP cards

8.12 Village register

8.13 Referral Registers (In and

Out)

8.14 List of families with 0-6

years children under RBSK

8.15 Line listing of severely

anemic pregnant women


8.17 Vaccine supply for each

session day (check

availability of all vaccines )

8.18 Due list and work plan

received from MCTS Portal

through Mobile/

Physically


58 | P a g e

JANUARY 2016

Section X: IEC display:

S. no Material Yes No Remarks

10.1 Approach roads have

directions to the sub centre

Y N


10.3 Timings of the Sub Centre Y N

10.4 Visit schedule of “ANMs” Y N

10.5 Area distribution of the ANMs/

VHND plan

Y N

10.6 SBA Protocol Posters Y N

10.7 JSSK entitlements Y N

10.8 Immunization Schedule Y N

10.9 JSY entitlements Y N


national health missionnhm up pip 2015-16: m&e report etawah district prc-ieg, delhi iii | p a g...

Documents