GAVI End Evaluation Report

District Matiari, Sindh.

(GAVI Project)

Strengthening & Enhancing Health Accessibility

Through community mobilization in District Matiari

(SEHAT)

2

GAVI End Evaluation Report District MATIARI [Pick the date] Submitted by: HEALTH AND NUTRITION DEVELOPMENT SOCIETY

Strengthening & Enhancing Health Accessibility

Through community mobilization in District Matiari

(SEHAT)

3

Table of Contents Page #

Abbreviation 04

Acknowledgement 05

Executive Summary 06

Chapter 01. Introduction

1.1 Introduction of the project 12

1.2 Goal of Project 12

1.3 Objectives 12

1.4 Expected Results 12

Chapter 02. End Evaluation

2.1 Objectives 13

2.2 Universe of the study 13

2.3 Methodology 13

Chapter 03 Results

3.1 Respondent’s characteristics 17

3.2 KAP (Knowledge Attitude &Practices) Survey with

Married Women

19

3.3 Strengthening and Enhancing Health Accessibility

through Community Mobilization

38

Chapter 04 Conclusion and Recommendations 43

Annexure

5.1 Questionnaire for Health Care Facility Information

45

5.2 Questionnaire for IDI-District Officials

53

5.3 Questionnaire for VHC Assessment

55

5.4 Questionnaire for KAP

58

5.5 Questionnaire for HMC 64

5.6 Questionnaire for Vaccinators 67

4

Abbreviations

GAVI Global Alliance for Vaccines & Immunization

HANDS Health and Nutrition Development Society

MER Monitoring, Evaluation & Research

NGOs Non Government Organizations

FGD Focus Group Discussion

MGDs Millennium Development Goal

SEHAT Strengthening & Enhancing Health Accessibility Through

PDHS Pakistan Demographic Health Survey

BHU Basic Health Unit

RHC Rural Health Centre

THQ Taluka Head Quarter

DHQ District Head Quarter

DTC District Technical Committee

VHC Village Health Committee

HMC Health Management Committee

EPI Expanded Program on Immunization

TT Tetanus Toxoid

UC Union Council

KAP Knowledge Attitude and Practice

LHW Lady Health Worker

FWW Family Welfare Worker

LHV Lady Health Visitor

TBA Traditional Birth Attendant

IUCD Intra Uterine Contraceptive Device

TL Tubal Ligation

OP Oral pill

Kg Kilo gram

BCG Bacillus Calmette-Guérin

DPT Diphtheria, pertussis and tetanus

HB Hepatitis B

TB Tuberculosis

MIS Management Information System

EDO Executive District Officer

DO District Officer

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Acknowledgement

Our first acknowledgement is for the Almighty Allah who has bestowed His blessing on us. We

are thankful to our donor GAVI Alliance for the providing funds for achievements of the project

activities and hence their contribution towards immense support for Pakistan’s development. I

would like to extend my gratitude to National EPI Manager and team for their cooperation &

support throughout the project implementation. Our whole hearted acknowledgement and

appreciation is for the overwhelming support of District Government Matiari especially EDO &

DOs Health Department.

I express my deep sense of appreciation to the efforts of all Health Management committees

(HMCs), Village Health Committees (VHCs), members of Community Based Organizations

(CBOs) Medical Superintendents, Medical staff, Lady Health Workers (LHWs), and vaccinators.

The entire staff of District Matiari and field workforce worked relentlessly with full devotion and

commitment. The efforts of Ms. Sajida, Mr. Sada Hussain, Ms. Shakila Memon, Ms. Sanober,

Ms. Rahila and Ms. Khadija were instrumental in organizing a disciplined training, dispatching

questionnaire to data collection teams, conducting IDIs, managing and providing completed

questionnaires to ME&R team, and supervising the whole survey on desk and in field. We

acknowledge the contribution of each one of them. I express my gratitude to Mrs. Azra Shakeel,

Senior District Executive Manager for her sincere leadership and professional approach for

creating an environment of team work, encouraging and facilitating the core team to put in their

best and completing the Evaluation study in time.

ME&R team including Mr. Noor Muhammad, Ms. Sahar Yameen, Ms. Shabana & Mr. Afzal

Hussain for assisting in tools development and Training of surveyors, data processing, analyzing,

developing, reviewing, editing, formatting and proofreading this report are highly appreciated.

I am very thankful to the senior management of HANDS for their active and valuable

participation during different phases of the survey. I am deeply indebted to Dr. Sheikh Tanveer

Ahmed (Chief Executive -HANDS), for his technical support, valuable input and encouragement

throughout the evaluation process.

Chief Investigator

Dr. Anjum Fatima

Senior General Manager

Monitoring, Evaluation & Research Program

HANDS

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Executive Summary

GAVI/SEHAT project was implemented in District Matiari from July 2009 to December 2010.

The goal of the project was to assist the District Government in achieving the targets of MDGs 4

& 5 i.e. maternal and child health focusing on enhancing the accessibility and quality of health

services through strengthening community monitoring and feedback system.

This report is based on the findings of Evaluation conducted at the end of the project. The end

evaluation aimed to assess awareness of target population about the available health services,

behaviors for seeking health care, and the accessibility, availability and quality of health services

in District Matiari after completion of the project. There are 3 Talukas and 19 UCs in Matiari

covering 655062 population. The study population will comprise of 04 groups i.e House hold

survey/Married women (15-49 years with 13-23 years child), Health Facility Assessment/Health

Management Committee, LHWs/Village Health Committees, Government Officials and

Vaccinators.

The respondents were the married women from each household with at least a child between the

ages of 13 to 23 months. A total of 210 households were selected for conducting midterm review

assessment. The mean age of respondents was 29.50 during End line evaluation while it was

28.64 in Baseline survey. Both in End line evaluation and Baseline 51.9% respondents were of

age 30 years and above. A little less than half (47.6%) of the women were below the age of 30

years with nearly 0.5% being under 19 years and during Baseline survey 45.2% were below the

age of 30 years and 2.8% were under the age of 19 years.

The mean of age at marriage was 20.64 and 40.4% of the respondents reported their age at

marriage in their teens during End line evaluation while in Baseline survey the mean of age at

marriage was 18.5 and 65.6% respondents reported to got married during teen ages. End line

evaluation results show that 56.6% of the respondents got married at age of 20 to 29 years and

few 2.8% at the age of 30 or above. While during Baseline 33.3% of the respondents were during

the age of 20 to 29 years at marriage and few 0.9% were of age 30 years or above.

A total of 872 pregnancies were reported by 210 women with an average of 4.15 pregnancies per

woman in End Evaluation and in Baseline survey total 951 pregnancies were reported with an

average of 4.5 pregnancies per woman. The number of pregnancies varied from 1- 12. Majority

of the women (48.5%) reported to have 1-3 pregnancies, 34.3% had 4-6 and 17.3% had 7

pregnancies or more than it in End line Evaluation. And we find the same trend in Baseline

survey where 42% respondents reported to have 1-3 pregnancies, 37% reported 4-6 and 21%

reported to have 7 or more pregnancies. A total of 749 live births were reported by 210 women

with an average of 3.57 per woman during End line Evaluation and in Base line Survey 810 live

births were reported by 210 women with an average of 3.8 per woman. Majority of women had

1-3 live births both in end line evaluation (56.2%) and in Base line (49%). While more than 36%

women had 4-6 live births during both End line Evaluation and Baseline Survey. More than 7

live births had occurred for 7% women during End line Evaluation and for 17% women during

Base line.

A total of 38 pregnancies ended up in still births in End Evaluation. Of those 38 women who had

still births, majority 57.8% had 1 stillbirth, 13.1% had 2 stillbirths, however 5.2% (02 women)

reported to have 3 stillbirths. No women reported to have 4 to 5 stillbirths.

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Almost 85 pregnancies ended up in abortions in End Evaluation while 93 were reported in Base

line survey. Majority of women reported 1 abortion both in End Evaluation (45.8%) and Baseline

(36.5%). A number of 02 abortions were reported by 11.7% women and 18.2 % women during

End Evaluation and Baseline survey respectively. However out of the 85 women 7 reported to

have 3-5 abortions during End Evaluation (8.1%) while in Baseline Survey 7 out of 93 women

(7.4%) reported 3-5 abortions

A total of 4 maternal deaths were reported by the women of 210 households and the causes of

deaths were reported to be High BP, Weakness, Heart fail and one reason was not mentioned.

Total 39 neonatal deaths were occurred out of which 25 were under the age of 1 month, 9 were

under the age of 2 years and 5 were under 5 years of age. The major reasons were Fever, fits,

Jaundice, Malnourish, Pneumonia and hole in heart.

2 infantile deaths were reported and the reasons were fits and TB. Nearly 90% of the women

reported to have checkups during antenatal period. Nearly 46% did more than four visits during

the whole gestational period and it was 39% in Baseline. Majority of the respondents 62.7%

consulted to Private Doctor for the antenatal care. Almost 76.7% women had received their

tetanus immunization during last pregnancy according End line Evaluation results while during

Baseline 80% women had reported to get it.

Out of the women who were immunized against TT vaccine, 45% women reported to have

TT 01 & TT 02 and 55% reported 05 TT & above. Most of the deliveries 75% were facility based

and only 25% remained Home based. 75.6% deliveries were assisted by Skilled birth Attendant

(Doctors, Nurses, Midwives and LHVs). Only 46.2% of the women reported to have a postnatal

check up after their last delivery while during Baseline 50% women had reported to avail post

natal check up. In this way in end line evaluation 53.8 % didn’t receive any post natal check up in

comparison of 50% during Baseline. A significant proportion of respondents 55% knew that

Anemia, 46.1% knew Bleeding and 41.4% knew that headache/vertigo are danger signs. Except it

During Antenatal period women also reported Black outs 16.8% and vomiting after first trimester

16.2% as danger sign while they had reported it during Baseline 7.6% and 12.9% Black outs and

vomiting after first trimester respectively. Women also indicated other danger signs as High fever

26.7%, Severe pain in lower abdomen 14.7%, Heavy Bleeding 6.8%, Palpitation/weakness 4.7%,

Foul smelling vaginal discharge 3.1% and Inflammation of breasts 1.0% during post natal period

while in Baseline these danger signs were reported as 26.2%, 9.5%, 6.2%, 5.2%, 4.3% and 3.3%

respectively. Some more danger signs of natal period were reported by women like Delay in

progress of labor 9.4%, Fetal malposition 5.2%, Dizziness/fainting 2.6% and Delay in expulsion of

placenta 2.1% and according to Baseline Survey these signs were reported by women as 4.8%,

3.3%, 3.8 and 2.9% respectively. 33.8% of the women reported to face any complications during

pregnancy, delivery and postnatal period while 66.2% did not report to face any complication,

According to Baseline results 8% women had confronted some complications and 92% had not

faced it. End line Evaluation shows that 80% (169/210) women reported to knew about family

planning while during Baseline survey 63.4% (133/210) women had knowledge about it. 23.3%

women had reported to be current users of Family Planning while during End line evaluation

44.3% current users were reported which indicates an increase of 21% in Family Planning users.

End line results show that currently 44.3% respondents are the current users of any contraceptive

method while during Baseline current users were 23.3%. among the total Current Users, the use of

Injection was 15.2% and it was 7.6% in Baseline. Use of Pills was 7.1% while it was3.3% in

Baseline. In End line evaluation use of Condom was 5.2% and in Baseline it was 6.2%. TL was

4.7% (3.3% in Baseline). The use of IUCD was 8.6% 2.4% in Baseline), and use of withdrawal

method was 8.0% while no use of it was reported during Baseline. While no use of Vasectomy and

Abstinence was reported from the respondents during both baseline survey and End line

evaluation.

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A little less than one third of women (29%) reported ever use of contraceptives during Baseline

while as shown in the figure during End line Evaluation 58.1% women were the ever users. In End

line Evaluation Out of total ever users 56% reported the use of Injections, 38% Oral Pills, followed

by 20% Condom, 14% Vasectomy, 10% IUCD and 5% TL. .

The mean birth weight of their last born child as reported by 110 women was 2.62 while during

baseline was 2.59. Around one quarter of babies were reported of low birth weight both in End

Evaluation and Baseline survey. Many women mentioned that they had given Pre lacteals to the

newborns. (These include water, Ghutti, honey, sugar, glucose, butter, formula milk and fresh

milk.) The most commonly reported Pre lacteal given to the new born was fresh milk 28.1%

followed by Honey 21.5%, Water 13.3%, Ghutti 11.1%, Sugar 1.5% and others 17.7% in

comparison of Baseline these pre lacteals were given by percentage of 10, 18.8, 7.1, 6.7, 3.7 and

others 2%. Overall 95.7% mothers reported to breast feed their youngest child. Those who

reported to breastfeed their child were asked about the time of initiation of breastfeeding.

According to End line evaluation nearly 39% mothers initiated breast feeding immediately after

birth while in Baseline it was reported 58.6%. Many mothers 45.5% reported to start breast

feeding within 24 hours in end evaluation and during Baseline it was reported to be 31%. While

some about 8.5% reported to initiate Breast feeding by next day and during Baseline it was 5.2%.

According to the End line evaluation results Colostrum was given by 86.7% mothers while in

Baseline 91.41% mothers reported to fed Colostrum to their babies. At the time of End line

evaluation 75.7% mothers were currently breast feeding to their babies in comparison of 77.6% in

Baseline. In response of ever bottled feeding given to babies about 33% mothers reported it while

during Baseline 30% mothers had given Bottled feeding to the babies.

Nearly 94% of mothers claimed that their last born children have been immunized. 93.5% of the

infants were immunized for BCG as reported in End Evaluation and almost same in Baseline

survey 93.8%. The rates of Polio 0 and Polio 1 were 95.3% and 93.9% respectively in end

evaluation while during Baseline it was 89.5% & 93.9%. However, Polio 2 and 3 were prevalent

among 92.5% and 88.8% of the infants respectively. While during Baseline the prevalence rate

was 81.9 and 79 for Polio 2 & 3 respectively. 93.9% children of the respondents received DPT1 and

HB1, 92.5% received DPT2 and HB2 while 88.8% received DPT3 and HB3. End line results

show that 85.5% children were immunized against Measles 9 while during Baseline it was found

that only 48.1% children were immunized against it. Graph shows that 58.9% children received

vaccine of Measles 12 while during Baseline 31.4% children had received it. Women were

assessed for their knowledge about the danger signs for the newborns. The main symptom

mentioned was high fever by 72.9% women while during Baseline 86.2% women reported it.

Stopped breastfeeding was notified by 27.6% women, it was reported by 41.4% during Baseline.

32.7% women indicated Fits as danger sign for new born while in Baseline indication about it

was 0%. Yellow discoloration of body was mentioned by 31.2% women while it was 13.2% in

Baseline. 25.1% women knew Low body temperature as danger sign for a child while in

Baseline 17.6% had knowledge about it. Blue discoloration of body was mentioned by 21.6%

women while during Baseline 9% indicated it. 18.1% the drowsiness was mentioned by women

but during Baseline 6.2% women indicated it. 85.7% women knew for initiating breast feeding

early while in Baseline 63.4% women had this knowledge. 76.1% women knew that it is

important to give bath to the baby just after birth while during Baseline 77.6% had indicated it.

35.6% of the women were aware about to clean and dry the cord of child in comparison of 36.6%

awareness regarding this. Knowledge regarding immunizing the new born against TB and Polio

was known by 25.9% according to End line Evaluation results while during Baseline 27.4%

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women had mentioned it. 17.6% women knew to weighing the new born and in Baseline 18.6%

women had indicated it. End line Evaluation results show that some women (3.9%) mentioned

some other indicators as essential care of new born while 4.9% women reported to have no

knowledge about it. During End line Evaluation multiple responses were noticed for the

availability of health care facilities, 47.4% women mentioned Private Hospital, 44.5% mentioned

Health Houses, 37.8% mentioned to Govt Hospitals and 18.2% indicated Basic Health Unit. The

availability of some other facilities was also mentioned like Rural Health Center, NGO’s

facilities and other by 13.9%, 5.7% and 1.0% women respectively.

Women were explored for the availability of various cadres of providers in their respective

villages. Multiple responses were given by women where the most commonly reported provider

available was LHW mentioned by 68.9% women while previously was reported 80%. For

Government physician 52.6% women mentioned, for Private physician 42.6%, for TBA 28.2%,

for vaccinator 23% and for midwife 15.8% women indicated. Some other providers were also

mentioned like Government Nurse by 11% women, LHV and Private Nurse by 10.5% for each,

followed by FWW by 3.3%. The mean time mentioned by women to reach the facility on foot

was 33.8 minutes while in Baseline it was reported 29 min. An average of 10.3 minutes was

reported to reach to the Health facility by a vehicle while according to Baseline result it was

mentioned as 13 min. Women were asked about the reasons for visiting a particular facility. The

main reasons mentioned were consultation for child illnesses (93.1%), Antenatal care (42.9%),

Child Immunization (36%) and for delivery (23.6%) followed by Pregnancy related problems

16.3%, consultation for family members 15.3%, TT immunization 14.8%, Family Planning

12.3% and for weighing child 5.9% were the reasons for visiting a facility. In end evaluation

60.2% women gave positive response for the availability of DPT and in Baseline it was

mentioned by 70.5% women. Availability of Measles was mentioned by 60.7% women while during

Baseline 62.9% had mentioned it. For Hepatitis 32.8% women respond for its availability while during

Baseline 52.4% had mentioned it. Availability of TT vaccination was mentioned by 53.7% women while

in Baseline survey 42.4% had mentioned it. 91.7% of the women were affirmative for their visit for

children’s immunization while in Baseline 70% women had witnessed it. For TT immunization

of pregnant women 40% had reported the visit of vaccinator while in Baseline it was reported by

61% women. 9% women reported to have no knowledge about such visits. and in Baseline 15%

were not aware. 13.8% denied for any visit made by a government vaccinator for any kind of

immunization while in Baseline it was reported by 12% women.

For the purpose of assessment of the Health Management Committees a total of 6 health

facilities were identified out of 10 health facilities where interventions of GAVI were intervened.

These 6 health facilities included 2 BHU’s, 2 RHC’s, 1 THQ and 1 DHQ. In Depth Interviews

were conducted with each member of the committee for the purpose of assessment. For the

assessment of Village Health Committees a total of 29 LHW’s were identified and interviewed

during survey. In the End line evaluation it was found that all the surveyed Health facilities was

found to be improved 100% in different areas like attendance of staff, Outlook and display,

Signboards and their direction, Boundary walls, Electricity, Water supply, Sewerage System and

Hospital waste disposal. While during Baseline surveys in all the 19 units surveyed attendance

was found to be 100%. In 11 of the BHU’s the outlook and the display looked good but for the

rest 8 units they required improvement. In 90% of the BHU’s the signboards and its direction

were found to be alright. Boundary walls for the 15 units were found to be in good condition but

for the rest of the BHU’s the boundary walls were found to be either incomplete or in depleted

condition.

Coming to the availability of the utilities; Electricity was found to be available and functional in

all BHU’s. Telephones were available in all the BHU’s except for the 2 units. Adequate water

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supply system was available and functioning in all the BHU’s except for in one unit where for

use salt water was present. Sewerage system was found to be working in all the BHU’s but 2 of

the BHU’s requires improvement in the sewerage system. All units were found to have good

arrangement for the disposal of hospital waste. Data was gathered for the no. of delivery

conducted at the intervened facilities. The figure shows that 90 deliveries conducted at DHQ, 25

deliveries at RHCs, 18 at THQ and 4 deliveries were conducted at BHUs. Services were given to

clients for Antenatal checkups at different facilities which were surveyed. Almost 320 clients

were recorded at THQ, 115 at BHUs, 67 clients at RHCs and 30 clients at DHQ. The figure

shows that for the postnatal check up 63 clients were recorded at BHUs, 41 clients at RHCs, 30

clients at THQ and same number at DHQ. During Endline Evaluation Family Planning clients

were also recorded as recieveing FP service from the facilities which were assessed. The figure

shows that 36 clients were recorded at RHCs, 21 at BHUs, 18 at THQ and a same number of

clients was recorded at DHQ. A total of 10 Health committees were assessed during End line

evaluation survey. There were total 284 health committee members, 139 were men and 145 were

women. Information was collected from 29 LHWs about their role in village health committees.

26 LHWs reported to be the resident of their workplace. The LHWs were affiliated with BHUs,

RHCs and THQs. The mean population covered by each LHW was reported to be 916 with 684

and 1232 as minimum and maximum population. All of them had a LHW kit. However, the kit

register was maintained by 25 LHWs. When asked if they face shortage of kits, 22 LHWs

reported about shortage of few medicines. In response to the question regarding their

responsibilities, all responded their role in mother and child immunization and care, visiting the

community and resolving their issues and polio vaccination. In response to the question if MIS of

health committees maintained, 76% reported it positively. Majority of LHWs assumed that the

village committees are there to mobilize communities, support to LHWs, plan for better health of

the communities, create awareness among the communities, and conduct health sessions.

Resolve the health issues related to vaccination, mother & child care and support during polio

vaccination. 96% of them reported that meetings of village committees are conducted monthly.

However, 83% of the responded said that meeting minutes are maintained properly. Though

100% of the LHWs reported to meet village committee members, only 10.3% agreed that health

improvement plans are prepared. In response to the question about common health issues of the

area, the answer varied from no issue reported by only 1 respondent. As shown in the table the

mainly issues of High fever/malaria, Hepatitis and Sanitation each by 5 respondents. Skin

diseases were also reported by 4 HC members while 2 members reported pneumonia and

unavailability of 24 hours health facility. 01 member reported the issue of unavailability of

vaccination for pregnant women and children. Interviews of EDO Health, DO Health

(Prevention) and DO Health (Administration) were also taken. All of them were well aware of

the project objectives and reported to have signed MoU for the project. They all reported to have

meetings with the project team. The usual agenda for the meetings were to work hard for EPI

coverage with support of each other, vaccination coverage achieved by regular visit in field of

vaccinator, to monitor vaccinators regularly, to organize training on VHC at different health

facilities. In response to the question regarding effectiveness of the project the officials

commented that HMCs have become strengthened to resolve health issues, EPI coverage has

increased specially in uncovered areas. The health status of district is better now in comparison

of previous performance.

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Introduction 1 The population of the world is increasing at an alarming rate and so are the health issues. There

are definite evidences of widening gaps in health worldwide. These issues are more so in the

developing and under developed countries of the world.

A major challenge faced by Pakistan’s Health Sector is the imbalance in the health workforce

characterized by a lack of sufficient number of health managers, nurses, paramedics and skilled

birth attendants. Concomitantly, the rapid increase in the number of medical colleges, mostly in

the private sector, has increased the number of doctors leading to a much better doctor. Problems

are compounded as fresh medical graduates tend to concentrate more in the major cities while a

large number of trained health personnel migrate to other countries, creating a vacuum in certain

critical areas. MoH and WHO are emphasizing on community oriented medical education

(COME) in order to produce more primary health care physicians in an effort to bridge the

current imbalance of trained human resource amongst the rural and urban areas. With the

induction of more than 70,000 Lady Health Workers (LHWs), however, the Government of

Pakistan is in the process of providing essential health care at the doorsteps of the community.

The number of LHWs is expected to reach 100,000 as announced by Prime Minister.

Since August 2001, the Government of Pakistan has implemented its plan to devolve financial

and administrative authority to the district level with an aim to upscale investment in social

sector and enhance rational utilization of services in pursuit of poverty reduction and attainment

of MDGs. As a result, currently the federal and provincial governments are responsible for the

overall policy formulation whereas implementation is largely the responsibility of the district

level. The projected benefits of devolution in strengthening the district health system are still in

the process of consolidation. The Zila Nazim, who is elected, is the executive head of a team of

district administrators including Executive District Officer (EDO) of Health who looks after both

the preventive and curative aspects of healthcare in the entire district. WHO is assisting MoH in

enhancing the capacity of District Managers in public health and health economics issues such as

epidemiology, biostatistics, communicable disease control, policy analysis tools such as burden

of disease estimation, national health accounts, and cost-effectiveness analysis.

Despite this elaborate network of health facilities in the district headquarters, tehsils, other major

towns, and union councils, the utilization of the public sector health care delivery system is low

with an estimated 24% of the population using these services (Ref. PDHS 2006-2007).

Furthermore, a substantial proportion of the population lacks regular access to essential

medicines, laboratory or diagnostic services particularly in the rural areas. The issue has been

outlined as a priority area in the National Health Policy.

To enhance the agreement of community participation each district has established District

Health Committees and Village Health Committees to oversee the health care services at all

levels, in their respective areas. The district health system needs to be strengthened during the

five-year period through provision of financial and technical assistance to provide quality health

care to the communities. The ability of the district government to actively manage and develop

the health facilities, will have a crucial bearing on public health.

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The key element is to strengthen District Health Systems in all the districts. This involves

transferring all recruitment, financial and management functions to district authorities. It also

involves integrating curative and preventive services and placing them under common

management.

Considering the importance of community participation HANDS proposed an strategy to

enhance the efficiency of District Health System through Capacity Building of community

groups responsible for monitor the Health Facilities and Health Workers.

1.1 Introduction of the project SEHAT project, in conjunction with the District Government, Department of Health, local

implementing partners and institutions and Health Committees started after signing an agreement

with the Global Alliance for Vaccines and Immunization (GAVI) in district Matiari.

1.2 Goal of Project The goal of the project was to assist the District Government in achieving the targets of MDGs 4

& 5 i.e. maternal and child health focusing on enhancing the accessibility and quality of health

services through strengthening community monitoring and feedback system.

1.3 Objectives The project objectives were to:

Strengthen the Health Committees at different levels of facilities (including BHUs,

RHCs, THQs, DHQ as well as at DTC and VHCs) to improve the rates of outreach

vaccination.

improve the coverage of antenatal and postnatal services for women of child bearing age

improve the proportion of deliveries conducted by skilled birth attendants

Facilitate to establish a help-line centre at the district level

1.4 Expected Results 56 HMC members and 994 VHC members trained and mobilized

30 % increase in EPI coverage (under 23 months children) from baseline

20 % increase in TT coverage (child bearing age women) from baseline

10 vaccinators recruited and trained

90 % outreach of vaccinators achieved

35 Community Midwives recruited and trained

10 % increase in antenatal coverage from baseline

10 % increase in postnatal coverage from baseline

20% decrease in low birth weight babies from baseline

20% decrease in children with moderate/severe malnutrition

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End Evaluation 2

The project completed its 18 months (July 2009-December 2010) duration. And as per planning of project’s Phase III, End Evaluation was conducted to assess the progress made against the bench marks set during the baseline survey for the objectives of the project. The End Evaluation study aimed to measure the impacts of the project on target beneficiaries regarding their awareness about the available health services, behaviors for seeking health care, and the accessibility, availability and quality of health services in District Matiari.

2.1 Objectives The objectives of the study were to obtain

Measurements of outcome indicators of the project Information on knowledge Attitude and Practices of married women in the target

population regarding maternal and child health Status of Health Committees at Facility Level (Health Management Committees -

HMC) and Community Level (Village Health Committee - VHC of Lady Health Worker)

2.2 Universe of the study There are 3 Talukas and 19 UCs in Matiari covering 655062 population. The study population comprised

of following groups;

1. Communities:

i. Married women (15-49 years with 13-23 years old child)

2. Health Facility Assessment 3. Health Management Committees

4. Village Health Committees

2.3 Methodology An Evaluative study was carried out involving both quantitative and qualitative method. The

survey involved assessment at household level both for information about the members of

household which was carried out on house to house basis and assessment of Knowledge Attitude

Practices which was carried out on random sampling. The health facilities in the District Matiari

were assessed for their functionality and services provided. The Health Management Committees

(HMCs) for facilities were assessed in the same context. The Lady Health Workers (LHWs) and

their Village Health Committees (VHCs) were also assessed in terms of the services provided in

their target areas. Assessment of vaccinators recruited for the project was also carried out.

Sample Design

The district Matiari has got more than 275 villages and for end evaluation 30 cluster method was

used and thus 30 villages were selected for the Evaluation and from each cluster/village 7 house

hold, 1LHW and its VHC were assessed. There were 27 Public Health Facilities in the target area

and their Health Management Committees so 06 of them were selected and assessed.

Survey Tools/ Techniques

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A combination of qualitative and quantitative survey techniques and tools were used which

included:

In Depth Interviews (IDIs)

• Member of Health Management Committees (01 member from each Health Management

Committee/ Facility = 06)

• Member of Village Health Committees (01 member each of male and female Village

Health Committee LHWs = 29)

• District Officials (01 EDO Health, 01 DO Health (Prevention) and 01 DO Health

(Administration)

Quantitative Questionnaire

• Household Survey of married CBAs for KAP (women with at least 01 child between the

age of 13-23 months).

• Health Facility assessment

Sample Size

Following were the sample of the different instruments that would be used in the survey;

Household Survey 210 Household (30 cluster method)

(Demographic vaccination and malnutrition status)

Household Survey Total 210 households for KAP (07 household/30 clusters)

IDIs 06 Health Management Committee members of Health Facilities

284 - 139 men (01 each) and 145(01each) women members of 06

29 members of Village Health Committees

03 Government Officials

Health facilities 06 Assessment of Health facility

Household Survey

The data regarding socio demography, EPI, TT was collected from 100% households of the 27

selected villages in the target area. Information about married CBAs was collected to assess the

Knowledge Attitude and Practices regarding maternal and child health. For this purpose 30

cluster method was used and the selected 27 villages were divided into 30 clusters, 07

households in each cluster were interviewed and thus total of 210 households were surveyed.

Health Management Committee

Total 27 public health facilities were identified for survey. In Depth interview were conducted

with 01 member of each health management committee for the baseline survey.

Category Number

BHUs 02

RHCs 02

THQs 01

DHQ 01

15

Village Health Committee

Total 30 LHWs were identified for the assessment of the village health committees in End

Evaluation study (data was gathered from 29 LHWs) i.e. 01 LHW from each selected village. In

Depth Interviews were conducted with 01 member of each village health committee.

Training of the Field Staff

Training of the field staff / surveyors was conducted on the survey tools.

Pre-testing & Finalization of Instruments

The instruments were pre-tested before the start of real field level data collection. Then the

questionnaires were examined with a view that the data collected were amenable to analysis. All

the survey tools were thus finalized for the survey after making any required changes as per the

findings of the pretesting process.

Field Survey Conduction

The field survey conduction started from February 2011 and carried till March 2010. The

number of tools and the sample size were quite extensive and travelling time to distant villages in

the rural areas was also time consuming.

Field Validation Plan

Validation of 10% of the data was done through the supervisors of the End Evaluation team. All

the data collected on the different tools was validated on this basis by the immediate supervisors,

mid and senior level management of the organization.

Analysis Plan

For data feeding and analysis Ms Excel and SPSS were used.

16

Results

17

Results 3

The respondents were the married women from each household with at least a child between the

ages of 13 to 23 months. A total of 210 households were selected for conducting midterm review

assessment.

3.1 Respondent’s Characteristics

This section includes the basic background characteristics of the respondents. This includes

information on age distribution, the age at marriage and pregnancy outcomes.

Age distribution

Distribution of respondents according to their Current Age & Age at marriage

Baseline End Evaluation

Variables Frequency

(n=210)

Percentage Frequency

(n=210)

Percentage

Current Age (years)

Mean Age 28.64(±5.7) 29.50 19 and < 6 2.8 1 0.5 20-29 95 45.2 100 47.6 30 and > 109 51.9 109 51.9

Age at Marriage Mean Age at

marriage

18.5 (±3.3)

20.64

19 and < 138 65.6 85 40.4 20-29 70 33.3 119 56.6 30 and > 2 0.9 6 2.8

The mean age of respondents was 29.50 during End line evaluation while it was 28.64 in

Baseline survey. Both in End line evaluation and Baseline 51.9% respondents were of age 30

years and above. A little less than half (47.6%) of the women were below the age of 30 years

with nearly 0.5% being under 19 years and during Baseline survey 45.2% were below the age of

30 years and 2.8% were under the age of 19 years.

According to the PDHS survey 2006-07 the median age at first marriage was 19.1. The mean of

age at marriage was 20.64 and 40.4% of the respondents reported their age at marriage in their

teens during End line evaluation while in Baseline survey the mean of age at marriage was 18.5

and 65.6% respondents reported to got married during teen ages. End line evaluation results

show that 56.6% of the respondents got married at age of 20 to 29 years and few 2.8% at the age

of 30 or above. While during Baseline 33.3% of the respondents were during the age of 20 to 29

years at marriage and a few 0.9% were of age 30 years or above.

18

KAP (Knowledge Attitude &Practices)

Survey with Married

Women

19

3.2 Knowledge Attitude & Practices

The respondents were the married women from each selected household with at least one child

between the ages of 13 to 23 months. 30 cluster method was used for the household survey and

from each cluster 7 house hold were selected randomly for the KAP of married women. Thus a

total of 210 households were selected for conducting midterm review assessment.

Fertility

A total of 872 pregnancies were reported by 210 women with an average of 4.15 pregnancies per

woman in End line Evaluation and in Baseline survey total 951 pregnancies were reported with

an average of 4.5 pregnancies per woman. According to PDHS survey 2006-07 the total fertility

rate was 4.1 children per woman.

The number of pregnancies varied from 1- 12. Majority of the women (48.5%) reported to have

1-3 pregnancies, 34.3% had 4-6 and 17.3% had 7 pregnancies or more than it in End line

Evaluation. And we find the same trend in Baseline survey where 42% respondents reported to

have 1-3 pregnancies, 37% reported 4-6 and 21% reported to have 7 or more pregnancies.

Women were asked about their pregnancy outcomes i.e. live births, still births and abortions. A

total of 749 live births were reported by 210 women with an average of 3.57 per woman during

End line Evaluation and in Base line Survey 810 live births were reported by 210 women with an

average of 3.8 per woman. Majority of women had 1-3 live births both in end line evaluation

(56.2%) and in Base line (49%). While more than 36% women had 4-6 live births during both

End line Evaluation and Baseline Survey. More than 7 live births had occurred for 7% women

during End line Evaluation and for 17% women during Base line.

Distribution of respondents according to their Fertility

Baseline End Evaluation

Variables Frequency Percentage Frequency Percentage

Pregnancies

Total Pregnancies reported by 210 women 951 872 Mean no. of Pregnancies per women 4.5 + 2.8 4.15 1-3 88 42.0 102 48.5 4-6 78 37.0 72 34.3 7 and > 44 21.0 36 17.3

Live births

Total live births reported by women 810 749 Mean number of live births per woman 3.8 + 2.4 3.57 1-3 106 49.0 118 56.2 4-6 77 36.6 77 36.7 7 and > 30 17.3 15 7.1

Still Births

Total still births reported by women 34 38 1 17 50 22 57.8 2 4 11.7 5 13.1 3 0 0 2 5.2

20

4 1 2.1 0 0 5 1 2.1 0 0

Abortions

Total Abortions reported by 210 women 93 85 1 34 36.5 39 45.8 2 17 18.2 10 11.7 3 4 4.3 3 3.5 4 2 2.1 3 3.5 5 1 1 1 1.1

A total of 38 pregnancies ended up in still births as reported in End Evaluation. Of those 38

women who had still births, majority 57.8% had 1 stillbirth, 13.1% had 2 stillbirths, however

5.2% (02 women) reported to have 3 stillbirths. No women reported to have 4 to 5 stillbirths.

While according to the results of Base line survey 34 pregnancies resulted in stillbirths. Out of

which majority of women 50% had 1 stillbirth like End line Evaluation finding. 11.7% women

had 2 stillbirths while no women reported to have 03 stillbirths but 02 women (4.5%) reported to

have 4 to 5 stillbirths.

Almost 85 pregnancies ended up in abortions as reported in End Evaluation while it was reported

as 93 during Baseline survey. Majority of women reported 1 abortion during both End line

Evaluation (45.8%) and Baseline (36.5%). A number of 02 abortions were reported by 11.7%

women and 18.2 % women during End Evaluation and Baseline survey respectively. However

out of the 85 women 7 reported to have 3-5 abortions during End Evaluation (8.1%) while in

Baseline Survey 7 out of 93 women (7.4%) reported 3-5 abortions .

Attitude towards Current Pregnancy

Distribution of Respondents according to their Pregnancy Status

Baseline End Evaluation

Variables Frequency Percentage Frequency Percentage

Currently Pregnant 15 7.1 27 12.8

Nearly 12.8% of the women were pregnant at the time of interview during End Evaluation while

during Baseline survey 6.7% women were pregnant. In end evaluation out of the 27 currently

pregnant women, 6 were in their second trimester and for 4 women, it was the third trimester.

The mean duration of pregnancy was 4.7 months.

21

Figure: showing Wanted and Unwanted Pregnancies.

The above figure shows that out of the total pregnancies Wanted Pregnancy was 53.3% during

Baseline and during End Evaluation this percentage has increased by 9.7% which means now

63% pregnancies were wanted or planned. Regarding Unwanted pregnancies in Baseline Survey

it was 46.7% and this has been decreased by 9.7%. But still 37% unwanted pregnancies, is an

indicator of existing unmet needs.

Maternal and Newborn Health

Women were asked about any maternal and infant death in the household during the last two

years and their perceptions about the causes of the deaths.

A total of 4 maternal deaths were reported by the women of 210 households and the causes of

deaths were reported to be High BP, Weakness, Heart fail and one reason was not mentioned.

Total 39 neonatal deaths were occurred out of which 25 were under the age of 1 month, 9 were

under the age of 2 years and 5 were under 5 years of age. The major reasons were Fever, fits,

Jaundice, Malnourish, Pneumonia and hole in heart.

While in baseline a total of 1 maternal death was reported by the women of 210 households and the

cause of death was reported to be bleeding. 2 infantile deaths were reported and the reasons were fits

and TB.

Maternal and Neonatal Care

The 210 women were asked about seeking care during last pregnancy, delivery and postpartum

period.

Wanted Unwanted

53.346.7

63

37

Baseline End Evaluation

22

Figure; showing A/N checkups status

Antenatal Period

The Ministry of Health recommends preferably 04 Antenatal Checkups. It includes the early detection of

dangers signs or complications and concurrent problems such as anemia, provision of proper counseling

about nutrition & care at home and postnatal care; and delivery by skilled birth attendant. Under the

National Health policy, the antenatal care should also include provision of iron & folic acid supplement,

two doses of Tetanus Toxoid and blood pressure measurement.

Nearly 90% of the women reported to have checkups during antenatal period while in Baseline

80% of the women reported to have antenatal checkups done and in result on the other hand as

20% Antenatal checkups had not done during baseline this has been reduced to 10%, as shown in

figure.

According to PDHS 2006-07, 65% mothers receive Antenatal care.

Table Distribution of respondents regarding Antenatal Care during Last Pregnancy

Baseline End Evaluation

Variables Frequency Percentage Frequency Percentage 4 and More A/N checkups 66 39 87 46 Less than 04 checkups 102 61 102 54

In our study the results show that nearly 46% did more than four visits during the whole

gestational period and it was 39% in Baseline. The women who did less than 04 visits in End line

were 51% while in Baseline these were 61%.

A/N checkups done No A/N checkup

80

20

90

10

Baseline End Evaluation

23

Table Distribution of respondents according to Service Provider mentioned for A/N

checkup

Variables End Evaluation

n End Evaluation

% Government Doctor 74 40.0 Government Nurse 7 3.8 Private Doctor 116 62.7 Private Nurse/Midwife 15 8.1 LHV 9 4.9 LHW 9 4.9 TBA 8 4.3 Other 2 1.1

The table shows that in End line Evaluation majority of the respondents 62.7% consulted to Private

Doctor for the antenatal care. Nearly 40% received care from Govt; Doctor, 8.1% from Private

Nurse/Midwife, and 3.8% from Govt; nurses. 4.9% Antenatal checkups were done by each LHV

and LHW while 4.3% by TBA. Remaining 1.1% Antenatal checkups were done by others.

In Baseline survey majority of the women (96%) consulted a physician for the antenatal

checkup. However, small proportion had their checkups by nurses, LHV or a LHW.

Table 6 Distribution of respondents according to TT vaccination Status at last Delivery

Baseline End Evaluation

Variables Frequency Percentage Frequency Percentage TT received 168 80 161 76.7 TT 01 & TT 02 35 21 94 45 05 TTs & above 133 79 67 55

Almost 76.7% women had received their tetanus immunization during last pregnancy according

End line Evaluation results while during Baseline 80% women had reported to get it.

Out of the women who were immunized against TT vaccine, 45% women reported to have TT 01

& TT 02 and 55% reported 05 TT & above. While in Baseline 21% and 79% reported to get TT 01 &

TT 02 and 05 TT & above respectively.

According to PDHS 2006-07, 60% women were protected against Tetanus, out of which 53% mothers

received 02 or more Tetanus injections.

Place of Delivery

Proper medical attention and hygienic conditions during delivery can reduce the risk of complications and

infections that may cause the death or serious illness of the mother and the baby or both. Hence, an

important component in the effort to reduce the health risks of mothers and children is to increase the

proportion of babies delivered in a safe and clean environment and under the

24

supervision of health professionals.

Most of the deliveries 75% were facility based and only 25% remained Home based. For 46.2% births

place of delivery were Private Hospitals / Clinics while it was 33% during Baseline. For 25.7% Govt

Hospitals were the place of delivery while in Baseline 40% deliveries had taken place in Govt Hospitals.

In end line evaluation 25.2% deliveries took place at Home while during base line 27.2% deliveries had

taken place at home. And 2.8% deliveries were reported to held in some NGO Hospital / Clinics and

others.

According to PDHS 2006-07 34% births take place at facility.

Assistance during delivery by medically trained birth attendants is considered to be effective in the

reduction of maternal and neonatal mortality. As presented in the above Figure 75.6% deliveries were

assisted by Skilled birth Attendant (Doctors, Nurses, Midwives and LHVs), while during Baseline 70%

deliveries had assisted by Skilled birth Attendants. 24.3% deliveries were assisted by TBAs in End

Evaluation while in Baseline Survey it was 30%.

25%

75%

Facility Based Delivery

Home Facility based

Home Govt Hospital

Private Hospital /

Clinic

NGO Hospital /

Clinic

Other

27

40

33

0 0

25.2 25.7

46.2

1.4 1.4

Place of Delivery

Baseline End Evaluation

TBA Skilled Birth Attendants

30

70

24.3

75.6

Assistance during delivery

Baseline End Evaluation

25

Post Natal Care

According to PDHS for the health of mothers and newborns, a newly delivered mother and baby should

be followed up for at least about 6 weeks after delivery. Safe motherhood programs emphasize the

importance of postnatal care, recommending that all women receive at least two postnatal checkups and iron supplementation for 45 days after a delivery

Distribution of Respondents according to Post natal check ups

Baseline End Evaluation

Variables Frequency Percentage Frequency Percentage Yes 105 50 97 46.2 No 105 50 113 53.8 Total 133 79 67 55

Only 46.2% of the women reported to have a postnatal check up after their last delivery while

during Baseline 50% women had reported to avail post natal check up. In this way in end line

evaluation 53.8 % didn’t receive any post natal check up in comparison of 50% in Base line.

According to PDHS 2006-07, 43% received Post natal care.

Knowledge about danger signs during Antenatal natal & Post natal period

Women were explored for their knowledge about the complications during antenatal, natal and

post-natal period. Women were asked about 8 danger signs i.e. anemia, bleeding, pain in and

swelling of legs, vomiting after first trimester, headache/vertigo, black outs, swelling of hands

and feet and fits.

A significant proportion of respondents 55% knew about anemia, 46.1% knew about bleeding

and 41.4% knew that headache/vertigo are danger signs. The baseline survey shows women’s

knowledge was only 43.4%, 42.9% and 24.3% for Anemia, Bleeding and headache/vertigo

respectively. Other signs reported by women were pain in and swelling of legs 37.7%, swelling

of hands and feet 29.8% and Fits 17.3% during Antenatal period while during Base line women

had reported 18.1% pain in and swelling of legs, 13.8% swelling of hands and feet, and Fits only

12.4%. Except it During Antenatal period women also reported Black outs 16.8% and vomiting

after first trimester 16.2% as danger sign while they had reported it during Baseline 7.6% and

12.9% Black outs and vomiting after first trimester respectively.

Knowledge about the danger signs during pregnancy, delivery and postpartum period

among women from selected UCs in District Matiari

Baseline End Evaluation

Variables Frequency n=210

Percentage Frequency n=210

Percentage

Antenatal Period Anemia 91 43.3 105 55.0 Bleeding 90 42.9 88 46.1 Pain in and swelling of legs 38 18.1 72 37.7 Vomiting after first trimester 27 12.9 31 16.2

26

Headache/vertigo 54 24.3 79 41.4 Black outs 16 7.6 32 16.8 Swelling of hands and feet 29 13.8 57 29.8 Fits 26 12.4 33 17.3 Natal Period Delay in progress of labor 10 4.8 18 9.4 Fetal mal position 7 3.3 10 5.2 Delay in expulsion of placenta 6 2.9 4 2.1 Dizziness/fainting 8 3.8 5 2.6 Postnatal Period High fever 55 26.2 51 26.7 Palpitation/weakness 11 5.2 9 4.7 Heavy Bleeding 13 6.2 13 6.8 Severe pain in lower abdomen 20 9.5 28 14.7 Foul smelling vaginal discharge 9 4.3 6 3.1 Inflammation of breasts 7 3.3 2 1.0

Women also indicated other danger signs as High fever 26.7%, Severe pain in lower abdomen

14.7%, Heavy Bleeding 6.8%, Palpitation/weakness 4.7%, Foul smelling vaginal discharge 3.1%

and Inflammation of breasts 1.0% during post natal period while in Baseline these danger signs

were reported as 26.2%, 9.5%, 6.2%, 5.2%, 4.3% and 3.3% respectively.

Some more danger signs of natal period were reported by women like Delay in progress of labor

9.4%, fetal malposition 5.2%, Dizziness/fainting 2.6% and Delay in expulsion of placenta 2.1%

and according to Baseline Survey these signs were reported by women as 4.8%, 3.3%, 3.8 and

2.9% respectively.

Distribution of Respondents according to Complication faced in Last Pregnancy

Baseline End Evaluation

Variables Frequency n=210

Percentage Frequency n=210

Percentage

Yes 17 8 71 33.8 No 193 92 139 66.2 Total 210 100 210 100

As shown in above table 33.8% of the women reported to face any complications during

pregnancy, delivery and postnatal period while 66.2% did not report to face any complication,

According to Baseline results 8% women had confronted some complications and 92% had not

faced it.

According to PDHS 2006-07, 57% reported any problem during delivery & Post natal period.

27

Family Planning

Figure showing Respondent’s knowledge about Family Planning

End line Evaluation shows that 80% (169/210) women reported to knew about family planning

while during Baseline survey 63.4% (133/210) women had knowledge about it.

According to PDHS 2006-07, 96% ever married & currently married know at least one method

of Family planning.

The above figure shows that 23.3% women had reported to be current users of Family Plannig

while during End line evaluation 44.3% current users were reported which indicates an increase

of 21% in Family Planning users.

Family Planning Practices

The respondents were asked about their practices for ever and current use of contraceptives.

63.4

80

Knowledge regarding Family Planning

Baseline End Evaluation

23.3

44.3

Current Users of Family Plannig

Baseline End Evaluation

28

Distribution of respondents according to Practices of Family Planning

Variables Ever Users Current Users Current

Users*PDHS

2006-07 Baseline End

Evaluation Baseline End

Evaluation Use of

contraceptive

methods

n %

n %

n %

n %

%

Oral Pills 11 5.2 38 31.1 7 3.3 15 7.1 2.0 IUCD 8 3.8 10 8.2 5 2.4 8 3.8 2.0 Injection 25 11.9 56 45.9 16 7.6 32 15.2 2.0 Condom 19 9.0 20 16.4 13 6.2 11 5.2 7.0 Tube-Ligation 6 2.9 5 4.1 7 3.3 10 4.7 8.0 Vasectomy 0 0.0

14 11.5 0 0.0 0 0.0 0.1

Abstinence 0 0.0 0 0.0 0 0.0 0 0.0 4.0 Withdrawal 0 0.0 0 0.0 0 0.0 17 8.0 4.0 Total 62 29.5 122 58.1 49 23.3 93 44.3 29

End line results show that currently 44.3% respondents are the current users of any contraceptive

method while during Baseline current users were 23.3%.

Above Table shows that among the total Current Users, the use of Injection was 15.2% and

it was 7.6% in Baseline. Use of Pills was 7.1% while it was3.3% in Baseline. In End line

evaluation use of Condom was 5.2% and in Baseline it was 6.2%. TL was 4.7% (3.3% in

Baseline). The use of IUCD was 8.6% 2.4% in Baseline), and use of withdrawal method was 8.0%

while no use of it was reported during Baseline. While no use of Vasectomy and Abstinence was

reported from the respondents during both baseline survey and End line evaluation.

A little less than one third of women (29%) reported ever use of contraceptives during Baseline

while as shown in the figure during End line Evaluation 58.1% women were the ever users. In End

line Evaluation Out of total ever users 56% reported the use of Injections, 38% Oral Pills, followed

by 20% Condom, 14% Vasectomy, 10% IUCD and 5% TL. .

While during Base line Survey the most commonly reported contraceptive by Ever Users was

Injection (25%) followed by Condoms (19%) and OPs (11%) then IUCD (8%) & TL (6%).

According to PDHS 2006-07, ever users of FP were 49% and current users of FP are 30%.

Information regarding Child Health Care status

The provision of appropriate care to a newborn is critical. Information was collected from the

women about the existing practices related to breast feeding, immunization and immediate

measures for new born care. The information was collected about the last new born child.

29

Figure; Distribution of respondents according to their perception for the size of their last

born infant

End Evaluation result as shown in above figure reveals that 74.8% reported their new born similar

to other newborns in comparison of 79.5% in Baseline. 12.9% women reported their new born to

be smaller than other new born in comparison of 3.8% in Baseline. 5.7% women reported their

new born were Bigger than others while it was 11% reported in Baseline. Another 5.7% women

reported their new born to be very small in comparison of 2.4% in Baseline. In case of very big

size 1% women claimed it while it was reported14% during Baseline survey.

Distribution of Respondents according to the reported Weight at Birth

Variables End Evaluation

Frequency percentage

Yes 110 52.4

No 100 47.6

Total 210 100.0

52.4% of the women reported that birth weight of their last newborn was taken. This was very

interesting to note as 75% of women had their delivery in a public or a private facility by a trained

birth attendant.

The mean birth weight of their last born child as reported by 110 women was 2.62 while during

baseline was 2.59. The minimum weight was reported as 1 kg and maximum was 10 kg during

End Evaluation while in Baseline the minimum weight was recorded as 2kg and maximum as 8

kg. Around one quarter of babies were reported of low birth weight both in End Evaluation and

Baseline survey.

Ver big size Bigger than other new

borns

Similar to other new borns

Smaller than other new

borns

Ver small

1.411

79.5

3.8 2.41 5.7

74.8

12.95.7

Mother's Perception for their last born child

Baseline End evaluation

30

Breast feeding and weaning practices

Pre lacteal

Many women mentioned that they had given Pre lacteals to the newborns. (These include water,

Ghutti, honey, sugar, glucose, butter, formula milk and fresh milk.) The most commonly

reported Pre lacteal given to the new born was fresh milk 28.1% followed by Honey 21.5%,

Water 13.3%, Ghutti 11.1%, Sugar 1.5% and others 17.7% in comparison of Baseline these pre

lacteals were given by percentage of 10, 18.8, 7.1, 6.7, 3.7 and others 2%.

Fig Percentage distribution of Prelacteals given to newborns as reported by women from selected

UCs in District Matiari

Distribution of respondents according to Breastfeeding practices to the newborn

Baseline End Evaluation

Variables Frequency Percentage Frequency

Percentage

Ever Breastfed 199 95.7 207 98.6 Initiation of Breastfeeding after birth Immediately 123 61.8 83 40 Few Hours 65 32.6 95 46 Next Day 11 5.6 29 14 Colostrums Given 192 91.4 182 86.7 Currently

Breastfeeding 163 77.6 159 75.7

Ever Bottle Feed 64 30 70 33.3

Overall 95.7% mothers reported to breast feed their youngest child. Those who reported to

breastfeed their child were asked about the time of initiation of breastfeeding. According to End

line evaluation nearly 39% mothers initiated breast feeding immediately after birth while in

Baseline it was reported 58.6%. Many mothers 45.5% reported to start breast feeding within 24

Water Ghutti Honey Sugar Fresh Milk Others

7.1 6.7

18.8

3.7

10

2

13.311.2

21.5

1.5

28.1

17.8

Prelacteals given to new born

Baseline End Evaluation

31

hours in end line evaluation and during Baseline it was reported to be 31%. While some about

8.5% reported to initiate Breast feeding by next day and during Baseline it was 5.2%.

According to the End evaluation results Colostrum was given by 86.7% mothers while in Baseline

91.41% mothers reported to fed Colostrum to their babies.

At the time of End evaluation 75.7% mothers were currently breast feeding to their babies in

comparison of 77.6% in Baseline. In response of ever bottled feeding given to babies about 33%

mothers reported it while during Baseline 30% mothers had given Bottled feeding to the babies.

Immunization of the children

Baseline End Evaluation

Variables Percentage Percentage BCG 93.8 93.5 Polio 0 89.5 95.3 Polio 1 88.6 93.9 Polio 2 81.9 92.5 Polio 3 79 88.8 DPT 1 77.1 93.9 DPT 2 67.1 92.5 DPT 3 67.1 88.8 HB 1 32.9 93.9 HB 2 33.3 92.5 HB 3 31.4 88.8 Measles 9 48.1 85.5 Measles 12 31.4 58.9

Nearly 94% of mothers claimed that their last born children have been immunized. 93.5% of the

infants were immunized for BCG as reported in End Evaluation and almost same in Baseline

survey 93.8%. The rates of Polio 0 and Polio 1 were 95.3% and 93.9% respectively in end

evaluation while during Baseline it was 89.5% & 93.9%. However, Polio 2 and 3 were prevalent

among 92.5% and 88.8% of the infants respectively. While during Baseline the prevalence rate

was 81.9 and 79 for Polio 2 & 3 respectively.

93.9% children of the respondents received DPT1 and HB1, 92.5% received DPT2 and HB2

while 88.8% received DPT3 and HB3.

End evaluation results show that 85.5% children were immunized against Measles 9 while in

Baseline it was found that only 48.1% children were immunized against it. Graph shows that

58.9% children received vaccine of Measles 12 while during Baseline 31.4% children had

received it.

Knowledge of mothers for Newborn Care

The mothers were asked selected question to assess their knowledge about newborn care. The

knowledge was assessed by asking questions about time for giving bath after birth, practice of

slapping for making the child cry, giving him/her bath right after birth, wrapping the newborn in

dry sheet and initiating the breastfeeding.

32

Danger Signs for newborns

Women were assessed for their knowledge about the danger signs for the newborns. The main

symptom mentioned was high fever by 72.9% women while during Baseline 86.2% women

reported it. Stopped breastfeeding was notified by 27.6% women, it was reported by 41.4%

during Baseline. 32.7% women indicated Fits as danger sign for new born while in Baseline it

was not mentioned at all. Yellow discoloration of body was mentioned by 31.2% women while it

was 13.8% in Baseline. 25.1% women knew Low body temperature as danger sign for a child

while in Baseline 17.6% had knowledge about it. Blue discoloration of body was mentioned by

21.6% women while during Baseline 9% indicated it. The drowsiness was mentioned by 18.1%

women but during Baseline 6.2% women indicated it.

Distribution of respondents according to their knowledge about the danger signs for

newborn

Knowledge of mothers for Newborn Care

The mothers were asked selected question to assess their knowledge about newborn essential

care just after birth like keeping new born clean, dry and warm, Cord care, initiating the

breastfeeding, weighing the child, and immunization against TB and Polio. The knowledge of the

mothers varied for various aspects of newborn care as shown in the figure.

Stopped breast

feeding

High fever Low body temperature

Blue discoloration of face/lips

Yellow discoloration

of body

Drowsiness Fits

41.4

86.2

17.69

13.86.2

0

27.6

72.9

25.1 21.631.2

18.1

32.7

Knowledge about danger signs for new born

Baseline End evaluation

33

The results have been shown in figure as 85.7% women knew for initiating breast feeding early

while in Baseline 63.4% women had this knowledge. 76.1% women knew that it is important to

give bath to the baby just after birth while during Baseline 77.6% had indicated it. 35.6% of the

women were aware about to clean and dry the cord of child in comparison of 36.6% awareness

regarding this in Baseline. Knowledge regarding immunizing the new born against TB and Polio

was known by 25.9% according to End line Evaluation results while during Baseline 27.4%

women had mentioned it. 17.6% women knew to weighing the new born and in Baseline 18.6%

women had indicated it. End line Evaluation results show that some women (3.9%) mentioned

some other indicators as essential care of new born while 4.9% women reported to have no

knowledge about it.

Availability of Health Care facilities

The women were asked about availability of health care services in their respective villages.

Questions were asked about facilities, providers, time needed to reach a facility and preferred

choice for a facility, and availability of vaccinations.

During End line Evaluation multiple responses were noticed for the availability of health care

facilities, 47.4% women mentioned Private Hospital, 44.5% mentioned Health Houses, 37.8%

mentioned to Govt Hospitals and 18.2% indicated Basic Health Unit. The availability of some other

facilities was also mentioned like Rural Health Center, NGO’s facilities and other by 13.9%, 5.7% and

1.0% women respectively.

While Baseline results showed that almost half of the women mentioned about a public sector

hospital and an equal proportion mentioned a private clinic /hospital.

Percentage distribution of knowledge of Health care facilities and the preferred choice for

their use among women from selected UCs in District Matiari

Baseline End Evaluation

Variables Frequency Percentage Frequency

Percentage

Availability of Health Care facility

Weighing newborn

Immunization Cord care Keeping newborn

clean, dry and warm

Early initiation for breast

feeding

Others Don’t Know

18.6 27.4

36.6

77.6 85.7

0 017.6

25.9 35.6

76.163.4

3.9 4.9

Knowledge regarding New born Care

Baseline End Evaluation

34

Govt: Hospital 98 46.7 79 37.8 Private Hospital 95 45.2 99 47.4 Basic Health Unit 30 14.3 38 18.2 Rural Health Center 2 1.2 29 13.9 NGO 4 1.9 12 5.7 Health Houses - - 93 44.5 Other 0 0 2 1.0 Preferred choice for a Health Care facility Govt; Hospital 131 62.4 116 55.5 Private Hospital 85 40.5 123 58.9 Basic Health Unit 19 9.0 26 12.4 Rural Health Center 6 2.9 16 7.7 NGO 1 0.5 2 1.0

Women talked about preferred choices of facilities for availing health care/healing services. There

were multiple responses from the women. 75.6% women preferred to Government facilities

including Govt Hospital, Basic Health Unit and Rural Health Center in comparison of 59.9% who

preferred Private Hospital/Clinics including 1% NGO’s facilities.

According to Baseline results for 62.4% of the women, it was a Government hospital, and 40.5%

women preferred for a private hospital. While other choices were Basic Health Unit by 9.0%, Rural

Health Center by 2.9% and NGO”s facilities by 0.5% women

Percentage distribution of knowledge for availability of various cadres of service providers

among women from selected UCs in District Matiari

Women were explored for the availability of various cadres of providers in their respective

villages. Multiple responses were given by women where the most commonly reported provider

available was LHW mentioned by 68.9% women in End evaluation while previously was

reported 80% by respondents in Baseline. For Govt physician 52.6% women mentioned, for

Private physician 42.6%, for TBA 28.2%, for vaccinator 23% and for midwife 15.8% women

Govt; Physician

Govt; Nurse

Private Physician

Private Nurse

LHV LHW FWW Midwife Vaccinator TBA

51

9

44.3

2.4

11

80

7.1 4.8

20.5

42.9

52.6

11

42.6

10.5 10.5

68.9

3.3

15.823

28.2

Availability of service providers mentioned by respondennts

Baseline End Evaluation

35

indicated. Some other providers were also mentioned like Govt Nurse by 11% women, LHV and

Private Nurse by 10.5% for each, followed by FWW by 3.3%

While the results of Baseline for preferred choices of women has been shown in the figure.

Time to reach a nearest health facility

The mean time mentioned by women to reach the facility on foot was 33.8 minutes while in

Baseline it was reported 29 min. An average of 10.3 minutes was reported to reach to the Health

facility by a vehicle while according to Baseline result it was mentioned as 13 min.

Reason for visiting a facility

Percentage distribution of reasons for visiting a facility reported by women from selected

UCs in District Matiari

Women were asked about the reasons for visiting a particular facility. The main reasons

mentioned were consultation for child illnesses (93.1%), Antenatal care (42.9%), Child

Immunization (36%) and for delivery (23.6%) followed by Pregnancy related problems 16.3%,

consultation for family members 15.3%, TT immunization 14.8%, Family Planning 12.3% and

for weighing child 5.9% were the reasons for visiting a facility.

According to Baseline result reasons for visiting a health facility were reported by women as

consultation for child illnesses (83.8%), Antenatal care (57.6%), delivery (45.7%), Child

Immunization (43.8%) and followed by Pregnancy related problems 26.2%, consultation for

family members 20.5%, Family Planning 16.7%, , TT immunization 14.8%, weighing child

15.7% and for TT immunization 13.3%, were the reasons for visiting a facility.

20.5

13.3

15.7

45.7

16.7

26.2

57.6

43.8

83.8

15.3

14.8

5.9

23.6

12.3

16.3

42.9

36

93.1

0 20 40 60 80 100

Consultation for other family members

TT immunization

Weighing the child

Delivery

Family Planning

Pregnancy related problems

Antenatal Care

Child immunization

Consultation for child illness

End Evaluation

Baseline

36

Immunization Services at the Govt. facilities in the area

Women were asked about the availability of the vaccines in the govt. facilities in their respective

villages.

Distribution of respondents according to availability of vaccines in the govt. facilities reported

Baseline End Evaluation

Variables Frequency Percentage Frequency

Percentage

Available vaccines for children BCG 173 83.4 137 68.2 DPT 169 70.5 121 60.2 Polio 146 69.5 145 72.1 Measles 132 62.9 122 60.7 Hepatitis 110 52.4 66 32.8 Available vaccines for Pregnant women TT 89 42.4 108 53.7

In response to the question that if the vaccines for children and women are available in

Government facility, for Polio 72.1% mentioned it while during Baseline 69.5% had witnessed it.

68.2% women indicated the availability of while in Baseline 83.4% had mentioned it. 60.2%

women gave positive response for the availability of DPT and it Baseline it was mentioned by 70.5% women.

Availability of Measles was mentioned by 60.7% women while during Baseline 62.9% had mentioned

it. For Hepatitis 32.8% women respond for its availability while during Baseline 52.4% had mentioned it.

Availability of TT vaccination was mentioned by 53.7% women while in Baseline survey 42.4% had

mentioned it.

Vaccinator’s visit from Government

In response to the question if the vaccinator from a govt. facility has visited them during the last

one year, multiple responses were reported by women. 91.7% of the women were affirmative for

their visit for children’s immunization while in Baseline 70% women had witnessed it. For TT

immunization of pregnant women 40% had reported the visit of vaccinator while in Baseline it

was reported by 61% women. 9% women reported to have no knowledge about such visits. and in

Baseline 15% were not aware.

13.8% denied for any visit made by a government vaccinator for any kind of immunization while

in Baseline it was reported by 12% women.

37

Strengthening and

Enhancing Health

Accessibility through

Community

Mobilization

38

3.3 Strengthening and Enhancing Health Accessibility

through Community Mobilization

The aim of this part of the study was to assess the status of all health management committees

and village health committees in the Matiari. For the purpose of assessment of the Health

Management Committees a total of 6 health facilities were identified out of 10 health facilities

where interventions of GAVI were intervened. These 6 health facilities included 2 BHU’s, 2

RHC’s, 1 THQ and 1 DHQ. In Depth Interviews were conducted with each member of the

committee for the purpose of assessment. For the assessment of Village Health Committees a

total of 29 LHW’s were identified and interviewed during survey.

Breakdown of Health Management Committees

During Baseline for the purpose of

assessment of the Health Management

Committees a total of 27 health

facilities were identified. These 27

health facilities included 19 BHU’s, 5

RHC’s, 2 THQ’s and 1 DHQ.

Some other descriptive data

In the End line evaluation it was found

that all the surveyed Health facilities

was found to be improved 100% in

different areas like attendance of staff, Outlook and display, Signboards and their direction,

Boundary walls, Electricity, Water supply, Sewerage System and Hospital waste disposal. While

during Baseline surveys in all the 19 units surveyed attendance was found to be 100%. In 11 of

the BHU’s the outlook and the display looked good but for the rest 8 units they required

improvement.

In 90% of the BHU’s

the signboards and its

direction were found to

be alright. Boundary

walls for the 15 units

were found to be in

good condition but for

the rest of the BHU’s

the boundary walls were

found to be either

incomplete or in

depleted condition.

Coming to the

availability of the

utilities; Electricity was

found to be available

and functional in all

Category Baseline End

Evaluation

BHUs 19 02

RHCs 05 02

THQs 02 01

DHQ 01 01

Descriptive Heading Conforming centers

Baseline

N=27

Conforming centers

End evaluation

Percentage

N=6

Attendance 100% 100

Outlook and display 11 100

Signboards and their

direction

90% 100

Boundary walls 15 100

Electricity 100% 100

Water supply 18 100

Sewerage System 17 100

Hospital waste disposal 100% 100

39

BHU RHC THQ DHQ

21

36

18 18

FP Clients at Facilities during last month

0

200

400

BHUs RHCs THQ DHQ

115

67

320

30

A/N patients during last month

BHU’s. Telephones were available in all the BHU’s except for the 2 units. Adequate water

supply system was available and functioning in all the BHU’s except for in one unit where for

use salt water was present. Sewerage system was found to be working in all the BHU’s but 2 of

the BHU’s requires improvement in the sewerage system. All units were found to have good

arrangement for the disposal of hospital waste.

Number of Deliveries held in

intervened

Facilities Data was gathered for the no. of delivery

conducted at the intervened facilities. The

figure shows that 90 deliveries conducted at

DHQ, 25 deliveries at RHCs, 18 at THQ and

4 deliveries were conducted at BHUs.

Antenatal clients at facilities during

last month

Services were given to clients for Antenatal

checkups at different facilities which were

surveyed. Almost 320 clients were recorded

at THQ, 115 at BHUs, 67 clients at RHCs

and 30 clients at DHQ.

Post natal clients at facilities during

last month

The figure shows that for the postnatal check

up 63 clients were recorded at BHUs, 41

clients at RHCs, 30 clients at THQ and same

number at DHQ.

Family Planning clients at facilities

during last month

During End Evaluation Family Planning

clients were also recorded as recieveing. FP

service from the facilities which were

assessed.

The figure shows that 36 clients were

recorded at RHCs, 21 at BHUs, 18 at THQ

0

20

40

60

80

BHUs RHCs THQ DHQ

63

4130 30

Postnatal patients during last month

DHQ THQ BHUs RHCs

90

184

25

Deliveries conducted during last month

40

and a same number of clients was recorded at DHQ.

Village Health Committee Assessment

A total of 29 Village Health committees were assessed during End evaluation survey

Village Health Committee members

There were total 284 health committee

members, 139 were men and 145 were

women.

LHWs

Information was collected from 29 LHWs about their role in village health committees. 26

LHWs reported to be the resident of their workplace. The LHWs were affiliated with BHUs,

RHCs and THQs. The mean population covered by each LHW was reported to be 916 with 684

and 1232 as minimum and maximum population.

LHW Kit All of them had a LHW kit. However, the kit register was maintained by 25 LHWs. When asked

if they face shortage of kits, 22 LHWs reported about shortage of few medicines.

LHWs responsibilities

In response to the question regarding their responsibilities, all responded their role in mother and

child immunization and care, visiting the community and resolving their issues and polio

vaccination.

Health Committees In response to the question if MIS of health committees maintained, 76% reported it positively.

Majority of LHWs assumed that the village committees are there to mobilize communities,

support to LHWs, plan for better health of the communities, create awareness among the

communities, and conduct health sessions. Resolve the health issues related to vaccination,

mother & child care and support during polio vaccination. 96% of them reported that meetings

of village committees are conducted monthly. However, 83% of the responded said that meeting

minutes are maintained properly. Though 100% of the LHWs reported to meet village committee

members, only 10.3% agreed that health improvement plans are prepared.

Total Health Committee Members

284

Total Health Committee Members Male

139

Total Health Committee Members Female

145

41

In response to the question about common health issues of the area, the answer varied from no

issue reported by only 1 respondent. As

shown in the table the mainly issues of

High fever/malaria, Hepatitis and

Sanitation

each by 5 respondents. Skin diseases

were also reported by 4 HC members

while 2 members reported pneumonia

and unavailability of 24 hours health

facility. 01 member reported the issue

of unavailability of vaccination for

pregnant women and children.

Government Officials

Interviews of EDO Health, DO Health (Prevention) and DO Health (Administration) were also

taken. All of them were well aware of the project objectives and reported to have signed MoU

for the project. They all reported to have meetings with the project team. The usual agenda for

the meetings were to work hard for EPI coverage with support of each other, vaccination

coverage achieved by regular visit in field of vaccinator, to monitor vaccinators regularly, to

organize training on VHC at different health facilities. In response to the question regarding

effectiveness of the project the officials commented that HMCs have become strengthened to

resolve health issues, EPI coverage has increased specially in uncovered areas. The health status

of district is better now in comparison of previous performance.

Government Vaccinators

Interview of 11 vaccinators was taken. All of them were working under government with service

duration ranging from 1 to 30 years. 04 of them reported to get training under GAVI project. Out

of 04 vaccinators 02 reported to have 0 training and the other two reported to have 02 trainings.

They discussed the training topics like VHC and Vaccination during training. Average 35.2

births per month ranging from 12 to 86 were reported by them in their respective working area.

Regarding the children in area aging 12 to 23 average 674 children were reported ranging 42 to

1972. Similarly vaccinators reported that average 2036 women of age 15 to 45 are there in their

working area ranging from 285 to 6412. Regarding the number of EPI vaccinations average 387

vaccines by per vaccinator were reported. They also reported that they also aware the clients

regarding EPI & TT vaccinations. Questions were asked regarding the Health problems of their

working areas. Multiple responses were record for the question which reveals that Phenomena is

the most commonly prevailing disease in their areas. Pneumonia was followed by another

problems like Hepatitis, Flu, cough & fever, Unhygienic condition of areas and far away health

facilities. Except unavailability of transport for the access of these areas for providing

vaccination is also a big issue. Other problems include Malaria, TB, unavailability of health

service at night, Unavailability of Laboratory/Ultra sound, Low literacy rate of population, and

less number of vaccinator in the areas where population is high. Reasons for possible maternal

Health issues

n

Skin diseases 4

High fever/malaria 5

Sanitation 5

Hepatitis 5

pneumonia 2

24 hours health facility not available 2

No vaccination for pregnant women and

children

1

42

deaths were also asked from the vaccinators and multiple answers were recorded. The most

commonly reported reason was Anemia followed by Malnourishment and other reasons were

High BP, Pneumonia, and avoidance of Preventive measures. Multiple responses were given by

the vaccinator for highlighting the possible reasons for child death in their respective areas. The

most commonly reported reason was Pneumonia followed by High fever & Malnourishment.

The other possible reported reasons were avoidance of Preventive measures and Hole in heart.

They all reported to have vaccination record including daily activity register and permanent

register.

43

Conclusion & Recommendations 4

The role of the district governments in general has been very supportive, but, the number of

visits of the EDO, the DO and the DDO depicts otherwise. The visits by the officials can bring

about a world of change in the performance of the centres and help resolve the issue pertaining to

the centres. Some other good developments which were noticed during the end evaluation were

as HANDS became part of District Technical Committee, good Public Private partnership to

increase immunization coverage, Development of Health Improvement Plans to improve Health

Facilities, Mobilization of VHCs to improve LHWs performance, Community Midwifery

trainings to improve antenatal and post natal complications and the regular participation of

HANDS in Dist. PPHI Monthly Meetings.

But at the same time there are some challenges which still needs to work on like

Poorly developed or Non functional HMCs / VHCs, lack of logistics, MIS and vaccinators in

District EPI program, nonresident LHWs, Lack of logistics for LHWs, Uncovered areas by

LHWs and Delay in fund release.

The study reveals that the centers have adequate attendance and general outlook along with the

visibility of the signboards, which is alright for most of the centres. Similarly, civil infrastructure

for which study of the boundary walls were made was found to be satisfactory for most of the

centres. The study further came to the conclusion that most centres have available facilities like

electricity, telephone, water supply, sewerage and hospital waste disposal. These are important

for the proper functioning of the centres. Availability of the medicines and other general store

items like beds and linen have been found to be satisfactory at most of the centres. Equipment

required for a proper functioning labor room and other requirement like disposable syringes,

syringe cutters and cold chain equipments are available at most of the centers. The fact that

various vaccines and medicines have been made available at the centre makes it ironic. The

outlook, displays, signboards, boundary walls, waiting areas etc. were found generally adequate

and satisfactory at most of the surveyed centres. Availability of the services like outdoor patients

service, indoor patient service, surgeries, emergencies, MCH, services of MCH staff, handling of

Antenatal cases, emergency obstetrical care services, services of the Labor room, operation

theatre for Obstetrics and Gynecology, handling of the deliveries and the Caesarean are

important for any health facility. Many of the above services are present at most of the centres.

Referrals to and from the health centres are an important function of the health facility. This

system is available at most of the centres. However, accurate data needs to be stored in order to

allow for accurate analysis. EPI services and EPI vaccines were available at most of the centres.

44

Annexure

45

Annexure 1

Health Care Facility Information

General Information

Date of Interview:_____________________

District:______________________________ Tehsil / Taluka:________________________

Type of Health Facility:

1. THQ/DHQ 2. RHC 3. BHU 4. RHC 5. Other (Name)………

Address of the facility ________________________________

Name of Interviewee: ________________________________

Designation: ________________________________________

Name of the {Interviewer}_____________________________

Catchment Area & Population

1. What is the total {area} in sq km that is covered by the health facility? ____________ 2. What is the total catchment {population} of this facility: _____________ (please check the

catchment population chart and if that is not available then check with the EPI Vaccinator). 3. Ask for List of {catchment} area villages with population and distance from facility

Section 1: Availability of Specific Health Services

1. Health Services:

1.1 Does this facility offer the following services? If yes, how many patients have visited during the

specified period? (ASK THE RESPONDENT EACH OF THE CATEGORIES)

Outpatient Services Number of patients attended during

last 1 month

General OPD

46

Female OPD

Antenatal Care

Deliveries

Postnatal Care

Growth Monitoring

EPI vaccine for children

TT vaccine for women

Family Planning

Services

General inpatient care

Surgical care

Pediatric Care

Infertility

STDS

HIV/AIDS

Hepatitis

Total Patients

1.2 How many days the facility was open for ambulatory care during last one month_______

1.3 During last 1 month for how many days Female HCP has attended the hospital ________

1.4 Note the average time (in hours) for last one month OPD remained open in the morning ____

47

Section 2: Health Facility Management

2.1 Staff position:

Type of Staff Filled posts Staff on job at time

of survey

Gynecologist

Anesthetist

Medical Officer

(Male)

Women Medical

Officer

Dental Surgeon

Medical Assistant

LHVs

Dais / Midwife

Dispenser

Lab. Technician

Theatre Technician

Dental Technician

Radiographer

Ward Boys

Vaccinator

FP Worker

Ayah

LHW (attached/

affiliated)

Other: (specify)

48

Total

2.2Staff available at night

Type of Staff Sanctioned posts Filled posts Staff on job at time of

survey

Women Medical

officer

Nurse

Midwife

LHV/FHT

Staff qualified to

conduct C-section

49

Section 03: Planning and Management

3.1. Management Information System (HMIS):

Type of HMIS activities undertaken: Yes=1

No=0

Has somebody from this facility been trained in HMIS reporting?

Did this facility send its HMIS report in time last month?

Did you receive any feedback on HMIS reports submitted during last three months?

Did any supervisor visited your facility and inspected the monthly/yearly HMIS report?

3.2 Referral System:

3.2.1 Do you keep the record for referral cases? 1. Yes 2. No 3.2.2 What types of patients were referred during the specific period?

Type of referred patients

Number of referred patients

During last 01 month

General Curative Care

Antenatal Care

Delivery Care

Postnatal Care

Expanded Program of Immunization (EPI)

Family Planning Services

Obstetric/Gynecologic Care

Pediatric Care

Trauma Orthopedic Care

Other (Specify)

50

Total patients referred

3.2.3 How many patients seen at the OPD were referred from another facility/ health care provider/

LHW within the last one month? ____________________________________.

3.2.4 How many inpatients in the last one month were referred from another facility/ health care

provider/ LHW? ___________________________________.

3.2.5 Where majority of patients were referred? _____________________________________.

3.4 Transport System:

Does the Health facility has the Ambulance service Yes / No

If yes then is the Ambulance functional Yes / No

51

Section 4: Health Facilities Coverage/ Activities

4.1 Immunization coverage:

4.1.1 is this facility a vaccination point?

1. Yes

2. No

3. Don’t Know

Interviewer’s Observations

(To be filled in after completing interview)

Comments about the functioning of Health Facility:

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

52

Comments on the patients present at the Facility:

__________________________________________________________________

__________________________________________________________________

Any Other Comments

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

Name of Interviewer:________________________________

53

Annexure 2

GAVI – Project End Evaluation

IDI for District Officials Date: ___________________ Name: ________________________

Designation: _____________

1. Knowledge/objectives of GAVI project: ________________________________________

________________________________________________________________________

2. MoU signed and available for GAVI: Yes No

3. Activities of GAVI project in district: __________________________________________

________________________________________________________________________

________________________________________________________________________

4. Trainings conducted under this project? Yes No

5. No. of trainings conducted under this project: ________

6. Title of trainings: __________________________________________________________

7. Topics of training: _________________________________________________________

8. Meetings conducted with GAVI (HANDS) team/HMCs in last 06 months? Yes No

9. No. of meetings conducted with GAVI (HANDS) team/HMCs in last 06 months: ________

10. Regularity of meetings_____________________________________________________

11. Availability of meeting minutes record? Yes No

12. Decisions taken in last 06 months ____________________________________________

________________________________________________________________________

________________________________________________________________________

13. Follow up of Decisions _____________________________________________________

________________________________________________________________________

14. Monitoring Cell establishment Date: _____________ Place: _______________________

15. Objectives/activities of monitoring cell: _______________________________________

________________________________________________________________________

16. Effectiveness of monitoring cell: _____________________________________________

________________________________________________________________________

17. Effectiveness of GAVI activities: ______________________________________________

54

_______________________________________________________________________

18. Sustainability issues of the project: ___________________________________________

55

Annexure 3

GAVI – Project

VILLAGE HEALTH COMMITTEE ASSESSMENT

1 Date__________________ 2. Assessment

by:_____________________________________________

3. Name of LHW/VHC __________________________ 4. Tel / Cell No

__________________________

5. Resident: Yes No

6. Name of Village: _____________________UC _______________ Taluka

________________________

7. LHS Name____________________________ 8. LHS last visit

date______________________

9. Report submitted to LHS: Yes No 10. Last report date:

_____________________

11. MoU with VHC signed and available: Yes No

12. Health Committee Members: Total _______ Men

____________Women_________

13. No. of VHC members trained: Total _______ Men ____________

Women_________

14. Population Covered by LHW______________

15. Is LHW Kit Available: Yes No 16. Any Shortage in

Kit______________________

17. Is LHW Kit Stock Register maintained: Yes No

18. What are the responsibilities of LHW

________________________________________________________________________

________________________________________________________________________

_______________________________________________________________________

56

19. No. of Home visits conducted by LHW in last

month_________________________________________

20. No. of deliveries in last month in target

population__________________________________________

21. No. of low birth weight births in last

month________________________________________________

22. No. of FP clients in last month___________ 23. No. of pregnant women in last

month__________

24. No. of children vaccinated in last month______ 25. No. of CBAs vaccinated against TT

last month_____

26. No. of awareness sessions conducted in last month _________

27. Referral Health strategy developed? Yes No

28. If yes name of Facility ______________________

29. No. of cases referred last month____________

30. Where are vaccinations carried out? _____________ 31. Last Polio team visit

date________________

32. Is MIS of Health Committee maintained? Yes No

33. What are the duties of Health Committee?

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

34. Is monthly Health Committee meeting held? Yes No

35. Date of last Health Committee Meeting Participants: Total___ Men___ Women____

36. Are meeting minutes/registers of Health Committee meeting maintained? Yes No

37. Does LHW meet the members of Health Committee? Yes No

38. Is Health Improvement Plan prepared? Yes No

39. Follow up of Health Improvement Plan did?

________________________________________________________________________

57

________________________________________________________________________

________________________________________________________________________

40. Main Health

Issues___________________________________________________________________

________________________________________________________________________

________________________________________________________________________

41. No. of meetings with GAVI (HANDS) team in last 06 months ___________

42. Meeting minutes/record available? Yes No

43. Commnets_______________________________________________________________

________________________________________________________________________

________________________________________________________________________

58

Annexure 4

59

60

61

62

63

64

Annexure 5

65

66

67

Annexure 6