PIP 2013-14 Monitoring Report (MP)

Executive Summary
For action based PIP monitoring of NRHM for high priority districts proposed by MoHFW
(GOI) a field visit was made to Singrauli district in Madhya Pradesh in March, 2014. For
monitoring purpose District Hospital (DH) Singrauli, Community Health Centre (CHC)
Khutar, 24X7 Primary Health Centre (PHC) Morwa, and Sub-Centre (SC) Chaura health
facilities were visited. PIP monitoring included critical areas like maternal and child health,
immunization, family planning, adolescent health, human resources and programme
management, and qualitative interaction with beneficiaries to ascertain quality of services.

 Singrauli district provides public health services in urban areas through DH Singrauli. In the
periphery 06 CHCs, 14 PHCs and 157 SHCs are providing health services.
 In Singrauli, all the CHCs and PHCs in the -district are functioning from government
buildings and 142 out of 157 SHCs are functioning from government building.
 DH Singrauli is presently not functioning as a CeMONC facility. Caseload of cesarean section
and critical care is shared by PSU hospitals in the district.
 In Singrauli district only two- fifth specialists and MOs are in position against the sanctioned
posts. There are only two lady MOs in the district.
 Vacancies at district and block PMU are observed.
 The trainings on EmOC, LSAS, BEmOC, SBA, F-IMNCI, MTP, NSV, NSSK, IUCD and PPIUCD,
Mini- lap, BSU have been received by different category of staff including doctors, SNs and
para- medics.
 Singrauli district has limited availability of public health services beyond DH. Most of the
diagnostic tests are available at the DH. In the peripheral health institutions diagnostic
services are limited.
 Presently, there is no exclusive maternity hospital in Singrauli. Line listing of severely
anaemic pregnant women is not separately reported by any of the health facilities. Although
delivery points have been designated as L1, L2, L3, few are actually functional either due to
shortage of manpower, diagnostic facilities or specialists and infrastructure.
 District level committee is formed for maternal death review. Except for Singrauli DH which
has reported 05 deaths during April-February 2013-14 other health facilities have not
reported any maternal deaths. Under reporting of maternal deaths is observed.
 Free JSSK services are provided including free drugs and consumables, free diet, free
diagnostics, free blood transfusion and free transport to women with exemption of user
charges in visited DH Singrauli, CHC Khutar and PHC Morwa.
 Beneficiaries received JSY payments at the time of discharge through an account payee
cheque in the visited facilities. Beneficiaries face difficulty in opening new bank account.
 SNCU at DH is functional with trained doctors and nurses. Most of the SNCU equipments
were being installed, and separate diagnostic facilities are being created.

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 In Singrauli district there are 4 NRCs of which a 20 bedded NRC is functional at DH Singrauli.
Establishing more NRCs with all round facilities is urgently required to bring down the SAM
rates in the district.
 RBSK scheme is yet to be launched in the district.
 DH Singrauli has facilities for sterilization including post partum sterilization on daily basis.
CHC Khutar and PHC Morba has facilities for female sterilizations on fixed days. At SHC
Chaura IUD insertion services are on fixed days anddistribution of condom and oral pills is
done regularly. IUCD 375 is not yet introduced.
 An Adolescent Friendly Health Clinic previously functioning in DH Singrauli has become non-
functional due to non availability of the counsellor.
 General cleanliness, practices of health staff, protocols, disinfection, autoclave functioning
are being maintained at the visited facilities. Awareness of protocols among staff in
periphery is low.
 Display of IEC material for MCH, FP, different services available, hospital timings, phone
numbers are being maintained in the visited health facilities. Display of partographs, clinical
protocols, EDL with free drug distribution caption was observed in all the visited health
facilities.
 Clinical Establishment ACT is yet to be implemented in state for the registration and
regulation of clinical establishments.
 Referral transport services are being provided in Singrauli district through 12 ambulances
with staff and centralized call system '108'. Six MMUs are providing mobile health services
in the periphery.
 In the district 857 ASHA's are presently working and 681 VHSCs are formed with all VHSCs
having running accounts. All blocks have Block Community Mobiliser (BCM). Village level
meetings are few and community participation is low.
 Urban RCH is at an elementary stage. Forty one USHAs have been appointed in the urban
wards.
 The HMIS data uploading in health facilities is being carried out online. Data uploading is
being done online since July, 2013.
 MCTS data indicates gaps in tracking of child immunization services children and MCH ANC
services for pregnant women.

Action Points

1. None of the CHCs of district Singrauli are providing any specialist services. Other
services as per CHC norms are not provided properly. All the specialist posts should be
filled on priority.
2. Lack of supervision was noticed at all levels. Monitoring mechanisms through
supervisory visits need strengthening for corrective actions.
3. Reporting and reviewing of infant and maternal deaths needs stringent monitoring.

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PIP 2013-14 Monitoring Report (MP)

4. Staff quarters for Staff Nurse and other Para-Medical staff are not available at CHC
Khutar and PHC Morwa.
5. Lines listing of severely anemic pregnant women have not been prepared at SHC
Chaura.
6. ICTC/ PPTCT center is not available at CHC Khutar.
7. Proper facilities for Blood Bank and blood storage unit are lacking which needs
immediate attention.
8. There is no system in place for preventive maintenance of equipments.
9. There is no fixed day for insertion of IUD in any of the CHC, PHC visited.
10. There is no functional NBSU in CHC, PHC visited.
11. There is no ARSH Clinic established and no manpower has been trained in any of the
CHC, PHC visited.
12. Essential Drug List was not displayed in SHC Chaura.
13. IFA Blue, MifiPristone tablets, drugs for hypertension, Diabetes, Anti Allergy drugs are
not available in SHC Chaura.
14. Blood Sugar testing Kit, Colour coded bins, RBSK pictorial tool kit is not found available
in SHC Chaura.
15. There is no arrangement for Bio-Medical waste management. Even placenta is handed
over to the attendants to dispose off in SHC Chaura.
16. SHC Chaura which is a delivery point is in a pathetic state. Though it functioning from
two buildings both of them are in unauthorized occupation & clinic and delivery work
takes place in dirty surroundings and unhygienic conditions.

 Residential building of Sub Center Chaura is in unauthorized possession of

ANM of Sub Center Amaliya who lives with family and discourages patients
coming there for medical help.

 One ANM (regular ANM) lives/occupies in area meant for labour room and
second ANM (RCH, contractual) lives/occupies an area meant for clinic
purpose.

 If unauthorized possession cannot be removed, the center should be shifted

elsewhere, because institutional delivery in such a condition is unsafe, and is
worse than home delivery.

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PIP 2013-14 Monitoring Report (MP)

Qualitative Monitoring of PIP 2013-14: District Singrauli (M.P.)

1. Introduction
For action based PIP monitoring of NRHM for high priority districts proposed by MoHFW
(GOI) a field visit was made to Singrauli district in Madhya Pradesh in March, 2013. DH (DH)
Singrauli, Community Health Centre (CHC) Khutar, 24X7 Primary Health Centre (PHC)
Morwa, and Sub-Centre (SC) Chaura health facilities were visited by PRC Singrauli. PIP
monitoring included critical areas like maternal and child health, immunization, family
planning, adolescent health, human resources and programme management, and
qualitative interaction with beneficiaries to ascertain quality of services. Secondary data
was collected for the structured format from the state and district HMIS data format that
was already available at the respective Programme Management Unit. Primary data was
collected for the qualitative responses in the format through interactions with the health
staff during the visits to the health facilities. The reference point for examination of issues
and status was 1st April 2013 for all selected facilities. Checklists were used to assess the
availability of services.

2. State and District Profile

Madhya Pradesh located in central India has 50 districts and 342 blocks with a total
population of 7.2 crores (Census, 2011). Singrauli district is 50th district of Madhya Pradesh.
It was granted district status on 24th May 2008, with its headquarter at Waidhan.

Morena Bhind Madhya Pradesh

Sheopur
Gwalior
Datia
Districts
Shivpuri

Tikamgarh
Neemuch Chhatarpur
Guna Ashoknagar Rewa
Satna
Mandsaur Panna
Sidhi Singrauli
Rajgarh Vidisha
Sagar
Damoh
Ratlam Shajapur Katni Shahdol
Bhopal Umaria
Ujjain
Raisen Jabalpur
Jhabua
Sehore Anuppur
Indore Narsimhapur
Dewas Dindori
Dhar Hoshangabad
Alirajpur Mandla

Harda Seoni
East Nimar Chhindwara
West Nimar
Barwani Betul
Balaghat

Burhanpur

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PIP 2013-14 Monitoring Report (MP)

It has been formed after dividing it from Sidhi district. Singrauli district is located at a
distance of 712 kms from the state capital Bhopal. Singrauli has three tehsil namely
Singrauli, Deosar and Chitarangi. It has three development blocks by the same name.
Key Socio-Demographic Indicato
Sr. Indicator MP Singrauli
2001 2011 2001 2011
1 No. of Districts 45 50 -- --
2 No. of Blocks 333 342 -- 03
3 No. of Villages 55393 54903 744 744
4 No. of Towns 394 476 02 02
5 Population (Million) 60.34 72.52 0.22 1.17
6 Decadal Growth Rate 24.3 20.3 38.60 28.05
7 Population Density (per km2) 196 236 162 208
8 Literacy Rate (%) 63.7 70.6 49.2 62.4
9 Female Literacy Rate (%) 50.3 60.0 31.5 49.9
10 Sex Ratio 919 912 922 916
11 Sex Ratio (0-6 Age) 918 912 955 921
12 Urbanization (%) 26.5 27.6 20.9 19.3

The population density of Singrauli district is 208 persons per sq. km as compared to 236 of
M.P. The decadal growth rate of Singrauli has decreased from 38.60 to 28.05 percent during
2001-2011. Total literacy rate of Singrauli has increase from 49.2 to 62.4 during 2001-2011.
Female literacy rate has increased from 31.5 to 49.9 during 2001-2011. The male-female
sex ratio of Singrauli is 916 females per thousand males in comparison to 912 of M.P. The
sex ratio for 0-6 years of age group in Singrauli district has decreased from 955 in 2001 to
921in 2011 but is higher than the average sex ratio of M.P.
Singrauli is one of the 100 districts of Empowered Action Group (EAG) states of India
where IMR is very high. Singrauli district a part of erstwhile Sidhi district is among 100
districts of Empowered Action Group (EAG) states of India of leading in Infant Mortality Rate
(IMR), and belongs to top 25 administrative divisions in order of Maternal Mortality Ratio
(MMR).

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Key Health and Service Delivery Indicators

Sr. Indicator MP Singrauli Source

1 Infant Mortality Rate (per 1000 Live Births) 65 -- AHS, 2011-12
2 Neonatal Mortality Rate (Per 1000 Live Births) 43 -- AHS, 2011-12
3 Post Neonatal Mortality Rate (Per 1000 Live Births) 21 -- AHS, 2011-12
4 Maternal Mortality Ratio (Per 100,000 Live Births) 277 -- AHS, 2011-12
5 Sex Ratio at Birth 904 -- AHS, 2011-12
6 Expected number of Pregnancies for 2013-14 2071294 35856 CNAA, GoMP
7 ANC Registration Up to December’ 2013 1363022 24517 HMIS, 2013-14
8 1st Trimester ANC Registration (%) 52 45 HMIS, 2013-14
9 OPD cases per 10,000 population Up to Dec. 2013 2984 1668 HMIS, 2013-14
10 IPD cases per 10,000 population Up to Dec. 2013 320 164 HMIS, 2013-14
11 Estimated number of deliveries for 2013-14 1882992 32596 CNAA, GoMP
12 SBA Home Deliveries (%) Up to Dec. 2013 34 62 HMIS, 2013-14
13 Reported Institutional Deliveries (%) up to Dec. 2013 84 58 HMIS, 2013-14
14 Postnatal Care received within 48 Hrs. after delivery 74.2 -- AHS, 2010-11
15 Fully Immunized Children age 12-23 months (%) 54.9 -- AHS, 2010-11
16 Unmet Need for Family Planning (%) 22.4 -- AHS, 2010-11

3. Health Infrastructure in Singrauli District

Singrauli district provides health services in urban areas through DH Singrauli, and in
rural areas and peripheries through 06 CHCs, 14 PHCs and 157 SHCs. DH Singrauli, 06
CHCs and 14 PHCs are functioning from government buildings. Out of 157 SHCs 15 do
not have a building of their own.

Existing Health Facilities and Health Facilities Visited

Health Facility Number Health facility Visited
DH 1 DH Singrauli
Community Health Centers 6 CHC Kuthar
Primary Health Centers 11 PHC Morwa (24*7)
Sub Health Centers 151 SHC Chaura (Delivery Point)

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4. Human Resources
Madhya Pradesh has 68 percent of specialists' vacancy at CHC and 34 percent vacancy of
medical officers at PHCs as per RHS, 2012. In order to reduce the vacancy in rural areas the
state government in Madhya Pradesh has introduced compulsory rural service as pre-
requisite for admission to post graduation courses or bonds which insists on rural service
after the graduate medical course. In Madhya Pradesh, presently, MBBS pass-outs have to
serve one year bond for compulsory rural services. The in-service doctors must serve for two
years in rural area for eligibility for admissions in Post Graduate courses quota in
government medical colleges. Recently the state government in 2013-14 has proposed to
raise the salary of doctors to Rs. 1 lakh for serving in high focus /remote areas. Retention of
doctors is a major challenge in M.P.
In Singrauli district only two-fifth posts of specialists and MOs are in position against
the sanctioned posts. There is paucity of lady MOs in the district. Inspite of recent
appointments through MPPSC many doctors in the district have joined PG course. In DH
Singrauli 6 specialists are working against the 15 sanctioned posts, 10 MOs are in position
against 27 posts, 1 gynaecologist are in position against 2 posts, 2 paediatricians are in
position against 6 posts, and there is anesthetist in the DH inspite of 2 sanctioned posts.
There are 55 SNs working against 70 sanctioned posts and 10 ANMs working against their
sanctioned posts in DH Singrauli.
CHC Khutar does not have any specialists and is functioning with 2 MOs, 5 SNs and 2
ANMs. PHC Morwa is functioning with two MOs in position.

Training Status/skills: Capacity Building: Along with ensuring availability of the health staff
in the facilities NRHM focuses on build on the capacities of the existing staff and skill
upgradation for which there are provisions for trainings at all levels. It is found that in DH
various cadres of personnel are trained and skilled in EmoC, LSAS, BEmOC, SBA, MTP/MVA,
NSV, F-IMNCI/IMNCI, NSSK, Mini Lap Sterilizations, Leprosy Sterilization, IUCD, PPIUCD,
Blood Bank,/Storage, IMEP & Immunization & Cold Chain.
In CHC Khutar various cadres of personnel trained are skilled only in SBA, MTP, NSSK,
IUCD, Immunization & Cold Chain. In PHC Morwa that various cadres of personnel are
trained and skilled in SBA, MTP and Cold Chain.

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PIP 2013-14 Monitoring Report (MP)

5. Other Health Systems Inputs

Physical Infrastructure:-
DH Singruali, CHC Khutar, PHC Morba & Sub Center Chaura all are functioning in
government building and accessible to transport facility to reach there.In DH and CHC
Khutar, PHC Morba electricity supply with power backup and 24 hours running water facility
is found available. In Sub center there is no power back up and handpump facility is
available and no 24 hours continuous water supply. Wards were found clean in all the
visited health institutions but SC Chaura is occupied bv ANM for residential purpose.
Separate male and female wards are found available in DH, Singruoli, It is found that there
are no separate male and female wards in visited CHC and PHC. Blood Bank or Blood
Storage Unit is found non-existent in any of the visited institutions.
Availability of drugs:-
In all the health institutions visited it is found that according Essential Drug List all the drugs
are sufficiently available. The IFA (Blue) are not available in any of the visited health
institutions. Computerized Inventory Management System is functional in DH Singrauli and
CHC Khutar but not in the visited PHC and SC.
Diagnostic tests:-
The supplies of pregnancy testing kits, Urine albumin and sugar testing kit, OCPs, EC pills,
IUCDs, sanitory napkins, Gloves, Mckintosh, Pads, Bandages and gauze etc are found
available within expiry in DH, CHC, PHC & SC.
Essential Equipments:-
It is found that as per requirement in DH, CHC, PHC essential equipments are in position.
OT equipments:-
In DH all the equipments are available except multi para monitor, surgical diathermies, & C-
arm units. In CHC Khutar & PHC Morwa the prescribed OT equipments are not available.
Specialty care service:-
In DH speciality care services of surgery, medical, obstetrics and gynaecology, emergency
service, opthalmology and pathology are available but cardiology, trauma care ENT,
radiology are not available. Specialist care services are not provided in the visited CHC
Khutar.
AYUSH services:-
AYUSH services are not provided in the visited DH, CHC and PHC.

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PIP 2013-14 Monitoring Report (MP)

6. Maternal Health
In Singrauli city there is no separate maternity wing in DH.
6.1 ANC and PNC
Estimated pregnancies for 2013-14 for Singrauli district is 35856 of which 30206 (84
percent) pregnant women have been registered for ANC during April-2013-14. Forty seven
percent women were registered in the first trimester. In DH Singrauli 3821 women were
registered upto February 2014. In total 20 hypertensive cases were reported in DH
Singrauli. IFA was received by 617 women in DH Singrauli and 519 TT injections respectively.
Line listing of severely anaemic pregnant women is not separately done by any of the
institutions. In case of pregnant women with anaemia a separate column in' the register
was suggested. A total of 72 severely anaemic pregnant women were reported in DH upto
February 2014. It was observed that at DH Singrauli and CHC Khutar most mothers stayed
upto 48 hours after delivery but in SHC the mothers left within 24 hours raising questions
about quality of care and ensuing risk for 'mothers.
Service delivery in post natal wards: It is observed that all the mothers initiated breast
feeding within one hour of the normal delivery, at the visited health institutions. Zero doze
BCG, Hepatitis B and OPV & free diet given in district hospital, CHC & PHC but not in Sub
center. JSY payments are given before discharge.In Sub health center for mothers here is no
facility for accommodation for stay of 48 hours.

6.2 Institutional deliveries

DH Singrauli, CHC Khutar, PHC Morwa and SC Chourah have reported 2333, 510, 393
and 453 deliveries respectively during April, 2013 to February, 2014. Hospital records show
that during this period a total of 08 C-section deliveries are reported from DH Singrauli.
Although 40 health facilities are designate as, L1 (16 ), L2 (20), L3 (4) delivery points, very
few are actually functional, either due to lack of manpower, diagnostic facilities or
specialists and infrastructure. Also weak data reporting from different sources like paper
reports, register records, and HMIS reporting is observed.

6.3 Maternal death Review

District level committee has been formed for maternal death review except DH
Singrouli which has reported 05 deaths during April, 2013 to February, 2014. Other health

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facilities have not reported any deaths. Under reporting of maternal deaths is observed
indicating weak monitoring. Facility based Maternal Death review is not taking place at
peripheral level.

6.4 Janani Shishu Suraksha Karyakram (JSSK)

A total of 20 beneficiaries were interviewed through exit interviews at facility level
and at the household level visited in different villages visited. Out of these beneficiaries 10
received ANC care, 7 deliveries and 7 immunization cares. Most of the interviewed
beneficiaries had heard about JSSK and free services received. All of them were registered
with the ANM/ASHA. In the exit interviews beneficiaries reported to have received free JSSK
services including free drugs and consumables, free diet, free diagnostics, and free
transport with exemption of user charges in DH Singrauli CHC Khutar and PHC Morwa.
However at PHC Morwa and SHC-Chaura all the JSSK benefits like free food and diagnostic
facilities were not available. At village level the beneficiaries were not provided discharge
card after delivery. Some of the beneficiaries did not receive MCP cards from ANM or ASHA
and some beneficiaries did not receive JSY payments because bank accounts were not
operationalised.

6.5 JSY
In Singrauli district the JSY guidelines regarding payments to beneficiaries are being
followed by making payments through an account payee cheque at the time of discharge up
to January & February, 2013-14 at the visited facilities. The payment in this mode is
creating problems for beneficiaries who find it difficult to open bank accounts. It was
observed that most of the beneficiaries leave the health facility before 48 hours except DH.
This raises questions about the quality of care received at the institutions. District officials
like SDM, Tehsildar MOs, DPM monitor payments by doing physical verification of payments
in their respective areas. The direct transfer scheme is implemented since January, 2014.

7. Child Health
7.1 SNCU
The state has a functional SNCU unit in all 50 districts with 30931 inborn and 28799
out born Neonates treated during the year 2012-13. SNCU in Singrauli DH is functioning.

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There are 2 regular and 2 contractual Medical Officers, 2 regular & 13 contractual staff
nurse 15, 2 ANM, 1 Wardboy, 2 Ayas, 3 Security guard, 2 Sweepers, 1 Data Entry Operator, 1
Lab Technicains are in position. Most of the SNCU equipments are being installed, and
separate diagnostic facilities created. Medical officers and staff nurses are trained for SNCU.
During April, 2013 to February, 2014 total admissions of 113 inborn and 63 out born
children were reported. Out of these 88 children cured, 15 not cured and 9 children were
referred.

7.2 Nutritional Rehabilitation Centres

M.P. has 10.8 million children of 0-6 years (Census, 2011) out of which an estimated
l.3 million children are Severe Acute Malnourished (SAM) as per the SAM rate of the state.
The state has 280 functional NRCs. In Singrauli district presently 4 NRCs are functional of
which 1 is located at DH Singrauli, 1 each in three CHCs Sarai, Devsar and Chitrangi. NRC in
DH is 20 bedded and 10 beds each available the in three CHCs. In NRCs trained manpower
and necessary equipments are available. The visited NRC in DH Singrauli it is observed that
260 infants were admitted from April 2013 out of which only one child was referred. Rest of
the children recovered.

7.3 Immunization
The pockets of low immunization coverage in Singrauli district have been identified
and district and block level plans have been prepared for 2014-15. Micro plans have been
prepared for different blocks by DIO. The district has prepared a plan for intensification of RI
for low immunization coverage areas. Alternate vaccine delivery system is in place in the
district. The birth dose of immunization is being ensured for all newborns delivered before
discharge at DH, CHC & PHC. Immunization services are available on fixed days in the visited
health institutions. Due list of children generated through MCTS was not observed during
the field visit.

7.4 Rashtriya Baal Swasthya Karyakram (RBSK):

RBSK is yet to be initiated in the district.

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8. Family Planning
DH Singrauli has facilities for sterilization including post partum sterilization on daily basis.
At CHC Kuthar there is no Surgeon. The Surgeon is called from DH for performing
operations as per requirement. At PHC Morwah camps for sterilization are organized. IUCD
is sufficiently available in all the visited health institutions but in PHC Morwa IUCD is not
inserted as there is no trained personal available. PPIUCD services are available only at DH.
During April-February 2013 total coverage of sterilization in Singrauli district is 4296 (VT:71;
LTT:4222;CTT:3) thus accomplishing 0.1 percent sterilization to total institutional deliveries,
in comparison to 1.7 percent achieved by the state (CNNA, February, 2013). No death during
sterilization is reported. Ten post partum sterilizations were reported in the district. There
were 1467 IUD insertions and 843 IUD removal in the district upto February 2013. There
were 6293 OP users and 395 condom users in the district (CNNA Report, February, 2014).

9. Adolescent Reproductive and Sexual Health (ARSH)

ARSH clinic not existing in Singrauli district due to non availability of counselor.

10. Quality in Health Services

Infection Control: General cleanliness, practices of health staff, protocols, fumigation,
disinfection, autoclave functioning are observed in DH Singrauli, CHC Khutar and PHC
Morwa bur not in SHC Chaura. Although CHC Khutar is in adequate waiting space for
patients is lacking.
Biomedical Waste Management: Segregation of bio medical waste is being done at DH
Singrauli CHC Khutar and PHC Morwa but not in SC Chaura. Outsourcing for disposal of Bio-
medical waste management is found in DH, CHC & PHC. Awareness amongst staff on
cleanliness and hygiene practices is satisfactory in in DH Singrauli, CHC Khutar and PHC
Morwa but poor at SHC Chaura.
IEC: Display of list of services available, immunization schedule, clinical protocols EDL with
information on free drug distribution is available, timings of health facility and phone
numbers, awareness generation chart were displayed in visited institution.
11. Clinical Establishment Act
Clinical Establishment ACT is yet to be implemented in the state for the registration and
regulation of both private and public clinical establishments.

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12. Referral transport and MMUs

Singrauli district has 12 Janani Express and 01 ambulance operated with staff and
centralized call centre '108'. Janani Express call centre is established in DH providing round
the clock service. Dedicated register for in-bound (Home to facility) and out-bound (Facility
to Home) JE services are maintained. During April, 2013 to February, 2014 transport facility
by Janani express were provided to 5043mothers and drop back facility to 3496 mothers. A
total of 126 sick children were provided transport facility and 74 children received drop back
facility. A total 777 mothers and children received referral transport services.

13. Community processes

Accredited Health Social Activist: In the district 857 ASHA's are presently working and 681
VHSCs are formed with all VHSCs having running accounts. All blocks have Block Community
Mobiliser (BCM). Village level meetings are few and community participation is low. District
Community Mobiliser (DCM) who is overall incharge of ASHA programme has not been
appointed. All 3 blocks have Block Community Mobiliser (BCM).
Skill development: During the year 2013-14 in CHC Khutar out of 264 ASHAs 228 have
completed 6& 7 module training and out of 7 ASHAs under SHC Choura 6 have completed
this training. Different programme officers in Singrauli district are providing orientation to
ASHAs for National Health Programmes like TB, Malaria, Leperosy, etc. at the block level.
ASHA Resource Centre has been formed at the state level to monitor the progress of ASHAs.
Mentoring Group for community Action provides supportive services.
Functionality of the ASHAs: Drug kit replenishment is done based on demand and
availability of drugs. Payments to ASHAs have been regularized based on certification by the
concerned ANM. However, analysis of highest and lowest paid ASHA has been carried out
by the district although population norms and activeness of ASHA are the deciding factors.
Urban RCH: The urban RCH is at an elementary stage. Forty one USHAs have been
appointed in the urban wards of the district

14. Good Practices and Innovations

District has is yet not evolved any innovative health care delivery practices.

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15. MCTS and HMIS

In Singrauli district out of 182 health facilities, presently 177 health facilities (DH, 6 CHCs, 25
PHCs and 145 SHCs) are reporting online for HMIS from June, 2013. Earlier uploading was
taking place in R-HMIS for all the facilities and consolidated report was submitted. Data
entry operators are available in 4 blocks in the district. DH Singrauli does not have a regular
DEO for HMIS data entry and this task is carried out by computer operator of another
programme with no training about the data elements of HMIS. In Singrauli, district M&E
officer and three data entry officers have recently received training on HMIS at state level.
Gap in child immunization service for children with DOB in April, 2013 by different vaccination for MP and
Percent regitered children in MCTS with DOB in April, 2013

Singrauli, MCTS 2013-14 accessed on 26.05.2014

100.0

90.0

80.0

70.0

60.0

50.0

40.0

30.0

20.0

10.0

0.0
All
BCG OPV0 HEP0 DPT1 OPV1 HEP1 DPT2 OPV2 HEP2 DPT3 OPV3 HEP3 Measles Vit A Vaccinati
on
Madhya Pradesh 92.0 81.7 77.1 81.2 81.2 81.0 75.9 75.8 75.6 71.9 71.7 71.4 58.0 57.2 55.6
Singrauli 73.7 50.4 49.0 61.9 61.0 55.7 45.2 45.1 45.0 38.5 38.3 35.8 19.3 18.9 16.9

Total Number of Children with DOB in April, 2013: 158582 (MP) and 2304 (Singrauli)
MCTS accessed on 26.05.2014 indicates gaps in tracking of child immunization services for
children with DOB in April, 2013 varying between 70 percent for BCG to 17 percent for all
vaccinations, indicating poor data updation for all services provided. For all the vaccines
tracking of child immunization services is weak. Similarly, gaps in tracking of pregnant
women with LMP of June, 2013 is observed which varies between 100 percent for ANC 1 to
13 percent for TT2 booster provided. In Madhya Pradesh, delivery is reported for 23 percent
of registered women with LMP in June, 2013 while in singrauli it is only 5 percent. MCTS
updation of child immunization for all vaccines is lower in Singrauli district (17 percent) as
compared to the state average (56 percent). Similarly, for maternal health updation of full
ANC services is 24 percent for Singrauli district as compared to state average (32 percent).
MCTS data entry is outsourced in Singrauli district and lacks stringent monitoring follow up.

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PIP 2013-14 Monitoring Report (MP)

Gap in Maternal Health Services to the pregnant women with LMP in June,
2013 for MP and Singrauli, MCTS 2013-14 accessed on 26.05.2014
Services to pregnant women with LMP in June, 2013 (%)

100.0 100.0

84.0
76.775.5 76.1
70.1

59.6
56.1 56.4
50.0
42.9
39.6 38.6 39.5
31.6
29.3
24.2 23.9

12.3 13.3
5.7

ANC1 ANC2 ANC3 ANC4 3 ANC's Full ANC TT1 TT2 TTBooster IFA Deliveries
Reported
Madhya Pradesh Singrauli

Total Number of Pregnant Women with LMP in June, 2013: 127392 (MP) and 2079 (Singrauli)
16. Key Conclusions and Recommendations / Action Points
 Paucity of specialists and trained staff at all levels was observed. Specialists and Staff
vacancies in all categories must be filled up. Adequate recruitment of staff nurses to
suffice the requirements of PHCs and CHCs is essential.
 It is essential to increase the bed capacity of DH considering the high case load.
 All the vacancies at district and block PMU must be filled up immediately. PMU at district
and block level need orientation to ensure that processes of planning, organizing and
monitoring are carried out efficiently in the district.
 Orientation of data analyst at the DPMU and BPMU's is essential to ensure the quality of
data and regular updating. For HMIS and MCTS data special training of DEOs is essential
in the district.
 Provision of residential and amenities for medical officers for retention is necessary.
 Blood bank and blood storage unit facility is lacking which needs immediate attention.
 IMNCI trainings for senior ANMs should be taken up at the earliest.
 VHSC meetings need to be monitored and supervised and BCC through community
participation needs to be increased, because community participation is low.
 Monitoring mechanisms through supervisory visits are weak in the district. It is essential
to strengthen the monitoring chain to track the progress of the different health facilities.
 Line listing of severely anaemic pregnant women is not separately reported by any of the
institutions. In case of pregnant women with anaemia a separate column in the register
was suggested for tracking severely anaemic women.
 Reporting and reviewing of infant and maternal deaths needs stringent monitoring.

15
PIP 2013-14 Monitoring Report (MP)
Annexure

1 Health Infrastructure available in the district: As on March, 2014

No. of institutions Available Located in Felt need for No. of No of beds
government additional Health in each
buildings number of Facilities category*
health having
facilities inpatient
facility
DH 1 1 0 1 120
Exclusive MCH hospital 0 -- -- -- --
SDH
CHC 06 06 0 05 102
PHC 14 14 0 08 48
SHC (under PRIs) 0 0 0 0 0
SCs 157 142 0 0 0
AYUSH Ayurvedic -- -- -- -- --
AYUSH(Homoeopathic) -- -- -- -- --
AYUSH (Others) -- -- -- -- --
*: DH has sanctioned strength of 200 beds however, only 120 beds are functional

2 Physical Infrastructure
Infrastructure (Yes / No) DH CH CHC PHC SHC Remark
Health facility easily accessible from nearest Yes Yes Yes Yes
road head
Functioning in Govt. building Yes Yes Yes Yes
Building in good condition No Yes Yes Yes
Staff Quarters for MOs Yes-3 Yes Yes
Staff Quarters for SNs Yes-3 No No
Staff Quarters for other categories Yes-3 No No Yes
Electricity with power back up Yes Yes Yes Yes* *without
power backup
Running 24*7 water supply Yes Yes Yes Yes* *Hand pump
Clean Toilets separate for Male/Female Yes No Yes No
Functional and clean labour Room Yes Yes Yes Yes
Functional and clean toilet attached to labour Yes Yes Yes No* *Non
room functional,
poor condition
Clean wards Yes Yes Yes Yes* *ANM
Occupied for
residential
purpose
Separate Male and Female wards (at least by Yes No No
partitions)
Availability of Nutritional Rehabilitation Centre Yes No
Functional BB/BSU, specify No No
Separate room for ARSH clinic No No
Availability of complaint/suggestion box Yes No Yes No
Availability of mechanisms for Biomedical Yes Yes Yes No
waste management (BMW)at facility

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PIP 2013-14 Monitoring Report (MP)

Infrastructure (Yes / No) DH CH CHC PHC SHC Remark

BMW outsourced Yes Yes Yes No
Availability of ICTC/ PPTCT Centre Yes No
Availability of functional Help Desk Yes No No No

3 Human Resources
No. and types of HRH required vs Available, Postings.
Health Functionary Required (Sanctioned) Available
DH CH CHC PHC SC DH CH CHC PHC SC
Gynecologist 2 01 1 0
Pediatrician 6 01 2 0
Anesthetists 2 01 0 0
Cardiologist 1 - 0 -
General Surgeon 1 01 1 0
Medicine Specialist 1 01 1 0
ENT Specialist 1 0
Ophthalmologist 1 1
Ophthalmic Asst. 2 1
Radiologist 1 0
Radiographer 2 2
Pathologist 1 1
LTs 6 2 01
MOs 27 02 10 02 02
AYUSH MO 0 - 0 - -
LHV 1 01 1 01 -
ANM 10 02 2 10 02 02 2
MPHW (M) 0 1 0 - - 0
Pharmacist 6 01 2 01 01
Staff nurses 70 07 0 55 05 02 0
RMNCHA+ Counselor 0 0

No. of Trained Persons and skills of various cadres vis-à-vis service delivery (Yes, No)
Training programmes DH CHC PHC SC Remark
No. EmOC Yes-2 No
No. LSAS Yes-2 No
No. BEmOC Yes-2 No No
No. SBA Yes-1 Yes-5 Yes-3 Yes-2
No. MTP/MVA Yes-1 Yes-1 Yes-1
No. NSV Yes-2 No No
No. F-IMNCI/IMNCI Yes-1 No No
No. NSSK Yes-1 Yes No Yes
No. Mini Lap-Sterilizations Yes-2 No No
No. Laproscopy – Sterilizations Yes-1 No
No. IUCD Yes-1 Yes No Yes
No. PPIUCD Yes-1 No
No. Blood Bank / storage Yes-2 No
No. IMEP Yes-1 No
No. Immunization and cold chain Yes-1 Yes Yes Yes
No. Others (specify)-------- - - - -

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PIP 2013-14 Monitoring Report (MP)

4 Other health System inputs

Availability of drugs and diagnostics, Equipments (Mention Yes / No)
DH CH CHC PHC SC Remarks
Availability of EDL and Displayed Yes Yes Yes Yes* *but not
displayed
Availability of EDL drugs Yes Yes Yes Yes
No. and type of EDL drugs not available No -
(Collect Separate List)
Computerized inventory management Yes Yes No No
IFA tablets Yes Yes Yes Yes
IFA tablets (blue) No No No No
IFA syrup with dispenser Yes Yes Yes Yes
Vit -A syrup Yes Yes Yes Yes
ORS packets Yes Yes Yes Yes
Zinc tablets Yes Yes Yes Yes
Injection Magnesium Sulphate Yes Yes Yes Yes
Injection Oxytocin Yes Yes Yes Yes
Misoprostol tablets Yes Yes Yes Yes
Mifepristone tablets Yes Yes No No
Availability of antibiotics Yes Yes Yes Yes
Labeled emergency tray Yes Yes Yes Yes
Drugs for hypertension, Diabetes, Yes Yes Yes Partial* *Only PCM
common ailments e.g PCM, Available
metronidazole, anti-allergic drugs etc.
Adequate Vaccine Stock available Yes Yes Yes Yes
Supplies (Check Expiry Date during visit to the Facility)
Pregnancy testing kits Yes Yes Yes Yes
Urine albumin and sugar testing kit Yes Yes Yes Yes
OCPs Yes Yes Yes Yes
EC pills Yes Yes Yes Yes
IUCDs Yes Yes Yes Yes
Sanitary napkins Yes Yes Yes Yes
Gloves, Mckintosh, Pads, bandages, and Yes Yes Yes Yes
gauze etc.
Laboratory and Other Diagnostic tests
Haemoglobin Yes Yes Yes Yes
CBC Yes Yes Yes
Urine albumin and sugar Yes Yes Yes
Blood sugar Yes Yes Yes
RPR Yes Yes Yes
Malaria Yes Yes Yes Yes
T.B Yes Yes No
HIV Yes No No
Liver function tests (LFT) Yes Yes
Ultrasound scan (Ob.) Yes
Ultrasound Scan (General) No
X-ray Yes
ECG Yes
Endoscopy No
Others , pls specify

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PIP 2013-14 Monitoring Report (MP)

DH CH CHC PHC SC Remarks

Essential Equipments
Functional BP Instrument and Yes Yes Yes Yes
Stethoscope
Sterilized delivery sets Yes Yes Yes Yes
Functional Neonatal, Pediatric and Yes Yes Yes Yes
Adult Resuscitation kit
Functional Weighing Machine (Adult Yes Yes Yes Yes
and child)
Functional Needle Cutter Yes Yes Yes Yes
Functional Radiant Warmer Yes Yes Yes No* *Bulb only
Functional Suction apparatus Yes Yes Yes No
Functional Facility for Oxygen Yes Yes
Administration
Functional Foetal Doppler/CTG Yes
Functional Mobile light Yes
Delivery Tables Yes Yes Yes
Functional Autoclave Yes Yes Yes
Functional ILR and Deep Freezer Yes Yes Yes
Emergency Tray with emergency Yes Yes Yes
injections
MVA/ EVA Equipment Yes No No
Functional phototherapy unit Yes Yes No
OT Equipments
O.T Tables Yes No No
Functional O.T Lights, ceiling Yes No No
Functional O.T lights, mobile Yes No No
Functional Anesthesia machines Yes No No
Functional Ventilators No No No
Functional Pulse-oximeters Yes No No
Functional Multi-para monitors No No No
Functional Surgical Diathermies No No No
Functional Laparoscopes Yes No No
Functional C-arm units No No No
Functional Autoclaves (H or V) Yes Yes Yes
Blood Bank / Storage Unit
Functional blood bag refrigerators with No No
chart for temp. recording
Sufficient no. of blood bags available No No
Check register for number of blood No No
bags issued for BT in last quarter
Checklist for SHC
Haemoglobinometer Yes
Any other method for Hemoglobin Yes
Estimation
Blood sugar testing kits No
BP Instrument and Stethoscope Yes
Delivery equipment Yes
Neonatal ambu bag Yes

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PIP 2013-14 Monitoring Report (MP)

Adult weighing machine Yes

Infant/New born weighing machine Yes
Needle &Hub Cutter Yes
Color coded bins No
RBSK pictorial tool kit No

Specialty Care Services Available in the District

DH CHC Remarks
Separate Women’s Hospital No No
Surgery Yes No
Medicine Yes No
Ob&G Yes No
Cardiology No No
Emergency Service Yes No
Trauma Care Centre No No
Opthalmology Yes No
ENT No No
Radiology No No
Pathology Yes No

AYUSH services
DH CHC PHC Remarks
Whether AYUSH facilities available at the HF No No No
If yes, what type of facility available - - -
Ayurvedic - 1
Homoeopathic -2
Others (pl. specify)_________-3
Whether AYUSH MO is a member of RKS at facility NA NA NA
Whether OPDs integrated with main facility or NA NA NA
they are earmarked separately
Position of AYUSH medicine stock at the faculty NA NA NA

User Charges for Different Services (1-Free for Preg.Women, 2-Free for Children, 3-Free for Both
Preg. Women and Children, 4-Free for All)
Services DH CHC PHC SHC Remarks
Haemoglobin Hb test 4 4 4 4
Urine Pregnancy Test 1 4 4 4
Malaria PF/PV testing 4 4 4 4
Urine (Microscopy, Acetone) 4 4 4
Slide Collection for PBF & Sputum AFB 4 4 4
Blood Sugar 4 4 4
Serum Urea 4 4 4
Serum Cholesterol 4 4 4
Serum Bilirubin 4 4 4
Typhoid Card Test 4 4 4
Blood Typing 4 4 4
Stool Examination 4 4 4
ESR 4 4 4
Complete Blood Picture 4 4 4
Platelet Count 4

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PIP 2013-14 Monitoring Report (MP)

Services DH CHC PHC SHC Remarks

PBF for Malaria 4
Sputum AFB 4
SGOT liver function test 4
SGPT blood test 4
G-6 PD Deficiency Test 4 4 4
Serum Creatine / Protein 4 4 4
RA factor (Blood Grouping) 4 4 4
HBsAG 4 4 4
VDRL 4 4 4
Semen Analysis 4
X-ray 4 - -
ECG 4 - -
Liver Function Test 4 - -
RPR for syphilis 4 - -
RTI/STI Screening 4 4 4
HIV 4 4 4 4
Indoor Fees 4 4 4 4
OPD fees 4 1 1 4
Ambulance 4 - -
Food for Inpatients 4 4 4

5 Maternal health (Give Numbers since April'2013) up to February 2014

5.1 ANC and PNC

Services Delivered DH CHC PHC SC Remarks

Jun 2013 to Jun 2013
Feb. 2014 to Feb.
2014
ANC registered 3821 306 464 190
New ANC registered in 1st Trim 30 236 81
ANC 3 Coverage 110 195 99
ANC 4 Coverage 33 Ng
Line listing severely anemic 72 14 07 0
pregnant women
Identified hypertensive pregnant 20 NG NG Ng
women
No. of B-Sugar tests conducted
No. of U-Sugar tests conducted
No. of protein tests conducted
No. of pregnant women given TT - 519 67 119 114
2 & Booster
No. of pregnant women given 100 617 153 244 175
IFA
No. of women receiving PNC visits
Within 48 hours 178 376 157
Between 48 hours & 14 days 0 82 261
Whether the documentation and Yes Yes Yes Yes
follow-up satisfactory
If not, record reasons

21
PIP 2013-14 Monitoring Report (MP)

Services Delivered DH CHC PHC SC Remarks

Jun 2013 to Jun 2013
Feb. 2014 to Feb.
2014
No. of Pregnant women referred 500 86 5
No. of MTP before 12 weeks 134 0 0 NA
No. of MTPs after 12 weeks 46 0 0 NA

5.2 Institutional deliveries

DH CHC PHC SHC Remarks
(April 2013
to Feb.
2014)
Normal Deliveries conducted 2333 510 393 453
C- Section deliveries conducted 08 0 0 NA
No. of Assisted Deliveries (Ventouse / Forceps) 01 0 0 NA
Number of patients provided EmOC 0 0 0 NA
No. of Obstetric complications managed (Please 0 0 0 0
note type of complications during visit)
No. of Neonates initiated breastfeeding within 2180 481 373 467
one hour
No. of Still Births 105 11 10 04

5.3 Maternal death Review

DH CHC PHC Remarks
Total maternal deaths reported 5 0 0
Number of maternal death reviews during the quarter 0 0 0
Key causes of maternal deaths found Anemic, NA NA
Eclampcia,
PPH,
Home
Delivery

5.4 JSSK
DH CHC PHC Remarks
Free and zero expense delivery & caesarean section Yes Yes Yes
Free drugs and consumables Yes Yes Yes
Free diet up to 3 days during normal delivery and up Yes Yes
to 7 days for C-section,
Free essential and desirable diagnostics (Blood & Yes Yes Yes
urine tests, USG, etc) during Ante Natal Care,
Intra Natal Care and Post Natal care
Free provision of blood, however relatives to be Yes Yes
encouraged for blood donation for replacement.
Free transport – Yes Yes Yes
home to hospital, 5169
inter-hospital in case of referral 777
drop back to home 3570
Exemption of all kinds of user charges Yes Yes Yes

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PIP 2013-14 Monitoring Report (MP)

5.5 JSY
Status of implementation, payment to home deliveries, payment mode- direct transfer, acc. Payee
or bearer cheque, record keeping
DH CHC PHC SC Remarks
JSY payments are made as per Yes Yes Yes Yes
the eligibility criteria indicated
in JSY Guidelines
No delays in JSY payments to Yes Yes Yes Yes
the beneficiaries.
Full amount of financial Yes Yes Yes Yes
assistance to be given to the
beneficiary before being
discharged from the health
facility after delivery.
Payments mode Up to Jan.- Up to Up to Feb.- Up to
3 Feb.-3 3 Feb.-3
Cash-1 Since Feb - Since Since Since
Cheque bearer-2 4 March -4 March -4 March -4
Cheque a/c payee-3
Direct transfer-4
Others (specify____) -5
Physical (at least 5%) No No No No
verification of beneficiaries to
be done by district level health
authorities to check
malpractices.
Grievance redressal Yes Yes Yes Yes
mechanisms as stipulated
under JSY guidelines to be
activated in the district.
Proper record maintained for Yes Yes Yes Yes
beneficiaries receiving the
benefit

5.6 Service delivery in post natal wards

Parameters (Ask during visit to confirm the DH CHC PHC SHC Remark
status)
All mothers initiated breast feeding within one Yes Yes Yes Yes
hour of normal delivery
Zero dose BCG, Hepatitis B and OPV given Yes Yes Yes No
Counseling on IYCF done Yes Yes Yes Yes
Counseling on Family Planning done Yes Yes Yes Yes
Mothers asked to stay for 48 hrs Yes Yes Yes Yes* *No facility
for stay
JSY payment being given before discharge Yes Yes Yes Yes
Any expenditure incurred by Mothers on travel, No No No No
drugs or diagnostics(Please give details)
Diet being provided free of charge Yes Yes Yes No

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PIP 2013-14 Monitoring Report (MP)

6 Child health (Give Numbers Since April'2013)

6.1 SNCU / NBSU (Yes / No)
DH CHC PHC SC (NBCC) Remarks
Whether SNCU / NBSU exist. Yes No No No
Necessary equipment available Yes No No No
Availability of trained MO and staff nurses Yes No No -
No. of admissions - - -
Inborn 113
Out Born 63
No. of Children - - -
Cured 88
Not cured 15
Referred 09
Others (specify)

6.2 NRCs
DH CHC Remarks
Whether NRC exist at the facility Yes No
Whether necessary equipment available Yes No
Availability of trained manpower Yes No
If yes, number of admissions with SAM 260 -
No. of sick children referred 01 -
Average length of stay 45 -

6.3 Immunization (Give Numbers since April'2013) up to February 2014

DH CHC PHC SC Remarks
(Jun-2013 (Jun- (Jun- (April-
to Jan- 2013 to 2013 to 2013 to
2014) Feb.- Feb.- Feb.-
2014) 2014) 2014)
No. of Children given birth dose (Polio/Hap-B)
BCG 1712 501 384 447
DPT1/Penta1 506 40 211 192
DPT2/Penta2 408 27 177 178
DPT3/Penta3 373 20 139 168
Polio0 1667 488 384 170
Polio1 488 40 211 192
Poli02 408 27 177 178
Polio3 373 20 139 168
Hep 0 1098 404 352 118
Hep 1 449 40 211 192
Hep 2 403 27 177 178
Hep 3 376 20 139 168
Measles1 399 47 112 246
Measles2 55 0 0 21
DPT booster 260 4 85 112
Polio Booster 261 4 85 112
No. of fully vaccinated children Ng
ORS / Zinc Ng

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PIP 2013-14 Monitoring Report (MP)

DH CHC PHC SC Remarks

(Jun-2013 (Jun- (Jun- (April-
to Jan- 2013 to 2013 to 2013 to
2014) Feb.- Feb.- Feb.-
2014) 2014) 2014)
Vitamin - A Ng
No. of immunisation sessions planned 90
No. of immunisation sessions held 74
Maintenance of cold chain. Specify problems No No No -
(if any)
Whether micro plan prepared Yes Yes Yes Yes
Whether outreach prepared Yes Yes Yes Yes
Stock management hindrances (if any) No No No No
Is there an alternate vaccine delivery system Yes Yes Yes Yes

6.4 Number of Child Referral and Death

DH CHC PHC SHC Remarks
No. of Sick children referred 113 01 0 0
No. of Neonatal Deaths 05 0 0 0
No. of Infant Deaths 0 0 0

7 Family Planning
DH CHC PHC SC Remarks
June June April,2013
2013 – 2013 – to Feb,
Feb,2014 Feb,2014 2014

Whether FP services provided (Yes/No) Yes Yes Yes Yes* *Spacing

method only
Whether IEC material available Yes Yes Yes Yes
IEC activities during the quarter Yes Yes Yes No
IUCD type available Yes Yes Yes* Yes *available
375/380 but not in
use due to
no trained
person
available.
Whether PP IUCD services available at Yes No
the facility
Male Sterilization (VT+NSV) 40 0
Female Sterilization (CTT+LTT) 1906 21
Minilap sterilization 0 0
IUCD 25 0 11
PPIUCD 487 0 0
Condoms 8220 22 97 118
Oral Pills 731 0 24 119

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PIP 2013-14 Monitoring Report (MP)

8 Quality in health services

8.1 Infection Control
General cleanliness, practices of health staff, protocols, fumigation, disinfection, autoclave
DH CH CHC PHC SC Remarks
General cleanliness Good Good Good No
Condition of toilets Good Good Good Poor
Building condition Good Good Good Good
Adequate space for medical staff No No Yes Yes
Adequate waiting space for patients Yes No Yes Yes
Practices followed
Protocols followed Yes Yes Yes No
Last fumigation done Yes Yes No No
Use of disinfectants Yes Yes Yes No
Autoclave functioning Yes Yes Yes Yes

8.2 Biomedical Waste Management

DH CHC PHC SC Remarks
Whether bio-medical waste segregation done Yes Yes Yes No
Whether outsource Yes Yes Yes No
If not, alternative arrangement 4-packed &
Pits-1 return to
Incineration-2 attendant
Burned -3
Others (specify) --4

8.3 IEC (Observe during facility visit)

DH CHC PHC SC Remarks
Whether NRHM logo displayed in both languages Yes Yes Yes Yes
Approach road have direction to health facility Yes No Yes No
Citizen Charter Yes Yes Yes No
Timing of health facility Yes Yes Yes Yes
List of services available Yes Yes Yes Yes
Protocol poster Yes Yes Yes Yes
JSSK entitlements (displayed in ANC clinic/PNC Yes Yes Yes Yes
clinic/wards)
Immunization schedule Yes Yes Yes Yes
FP IEC Yes Yes Yes Yes
User charges No No No No
EDL Yes Yes Yes No
Phone number Yes Yes Yes Yes
Complaint/suggestion box No Yes No No
Awareness generation charts Yes Yes Yes Yes
Others (specify)

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PIP 2013-14 Monitoring Report (MP)

8.4 Quality Parameter of the facility (Through probing questions demonstration assess does the
staff know how to)
Essential Skill Set (Yes / No) DH CHC PHC SHC Remark
Manage high risk pregnancy Yes No No No
Provide essential newborn care Yes Yes Yes Yes
(thermoregulation, breastfeeding and asepsis)
Manage sick neonates and infants Yes No No No
Correctly uses partograph Yes Yes Yes No
Correctly insert IUCD Yes Yes * Yes *IUD not
inserted in PHC
Correctly administer vaccines Yes Yes Yes Yes
Segregation of waste in colour coded bins Yes Yes No No
Adherence to IMEP protocols Yes
Yes Out Out No
sour sou
ced rce
Bio medical waste management d
Updated Entry in the MCP Cards Yes Yes Yes Yes
Entry in MCTS Yes Yes Yes Yes
Action taken on MDR Yes No No No

9 Referral transport and MMUs

# of MMUs, Service utilization data, issues
DH CH CHC PHC Remarks
Number of ambulances of different types (give details) 13
Ambulance per lakh population
Availability of call centre Yes
Number of clients utilized ambulance services
Number of clients utilized ambulance services at night
Number of times the ambulance services could not be
provided
Average kms per day
Average kms per visit
Number of MMU 2
Micro plan prepared
GPS installed
Monthly Performance monitoring Yes
Number of patients served during the last quarter

10 Community processes
10.1 ASHA
CHC PHC SC Remarks
Number of ASHAs required 7
Number of ASHAs available 264 7
Number of ASHAs left during the quarter 12 0 0
Number of new ASHAs joined during the quarter 19 0 0
All ASHA workers trained in module 6&7 for 228 6
implementing home based newborn care schemes
Availability of ORS and Zinc to all ASHAs Yes Yes Yes
Availability of FP methods (condoms and oral pills) to all Yes Yes Yes

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PIP 2013-14 Monitoring Report (MP)

CHC PHC SC Remarks

ASHAs
Highest incentive to an ASHA during the quarter 13900 5000 13900
Lowest incentive to an ASHA during the quarter 150 1500 1500
Whether payments disbursed to ASHAs on time Yes Yes Yes
Whether drug kit replenishment provided to ASHAs Yes Yes Yes
ASHAs social marketing spacing methods of FP Yes Yes Yes

11 Disease control programmes

District DH CHC PHC SC Remarks
total
National Malaria control programme
Number of slides prepared 7178
Number of positive slides 149
Availability of Rapid Diagnostic kits (RDK) Yes
Availability of drugs Yes
Availability of staff Yes
Revised National Tuberculosis Programme
(RNTCP)
Number of sputum tests 7598
No. of positive tests 496
Availability of DOT medicines Yes
All key RNTCP contractual staff positions filled Yes
up
Timely payment of salaries to RNTCP staff Yes
Timely payment to DOT providers Yes
National Leprosy Eradication Programme
(NLEP)
Number of new cases detected 137
No. of new cases detected through ASHA 08
No. of patients under treatment 121

12 Non Communicable Diseases (Yes / No)

DH CHC PHC Remarks
NCD Yes No No
Establishment of NCD clinics No No
Type of special clinics (specify)_________
Availability of drugs Yes NA NA
Type of IEC material available for prevention of NCDs Yes NA NA

13 Record maintenance (Verify during facility visit)

1= Available and undated/ correctly filled; 2=Available but not updated; 3=Not available
Record DH CHC PHC SHS Remark
OPD Register 1 1 1 3
IPD Register 1 1 1 1
ANC Register 1 1 1 1
PNC Register 1 1 1 1

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PIP 2013-14 Monitoring Report (MP)

Record DH CHC PHC SHS Remark

Indoor bed head ticket 1 1 1 3
Line listing of severely anaemic pregnant 1 3 3 3
women
Labour room register 1 1 1 1
Partographs 1 1 1 2* Not filled
FP-Operation Register (OT) 1 1 * *Central register
maintained at block
level
OT Register 1 1 NA
FP Register 1 1 1 3
Immunization Register 1 1 1 1
Updated Micro plan 1 1 1 1
Blood Bank stock register NA NA
Referral Register (In and Out) 1 1 1 1
MDR Register 1 3 3 3
Infant Death Review and Neonatal Death 1 3 3
Review
Drug Stock Register 1 1 1 1
Payment under JSY 1 1 1 1
Untied funds expenditure (Check % 3
expenditure)
AMG expenditure (Check % expenditure) 3
RKS expenditure (Check % expenditure)

14 HMIS and MCTS (Verify during facility visit)

DH CHC PHC SC Remarks
Dedicated Staff available for HMIS and MCTS Yes Yes Yes Yes
Quality of data Yes Yes Yes Yes
Timeliness Yes Yes Yes Yes
Completeness Yes Yes Yes Yes
Consistent Yes Yes Yes Yes
Data validation checks (if applied) Yes Yes Yes Yes

15 Additional / support services

Services DH CHC PHC Remark
Regular Fogging (Check Records) No No No
Functional Laundry/washing services Yes Yes Yes
Availability of dietary services Yes Yes Yes
Appropriate drug storage facilities Yes Yes Yes
Equipment maintenance and repair mechanism Yes Yes Yes
Grievance Redressal mechanisms Yes No No
Tally Implemented Yes No No

29