Rajasthan State Jhunjhunu District Major observation of

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Rajasthan State

1. Jhunjhunu District

Major observation of field Survey unit (FSU) of Regional office for Health & Family welfare, Jaipur about Evaluation work in Jhunjhunu and Banswara Districts of Rajasthan State in the month of April and May 2010 respectively.

I. Details of the visited Institutions

District visited

PHC/CHC visited

H SCs visited

Jhunjhunu

PHC- Ardawata and Kajara. CHC- Surajgarh

Gidaniya, Ojatu, Farahat and Jhini

II. Major Observations

1) Human Resources :

a) Out of 41 sanctioned post of specialists in the district only 19 were filled. The Vacancies

included 9 posts (out of 13 sanctioned) of junior specialists, 3 posts (out of 7 sanctioned)

of Gynaecologist and 2 posts (of the 3 sanctioned) Ophthalmologist.

b) It was reported that 53 AYUSH Doctors, 14 AYUSH compounders, 186 GHM-II and 113

ANMs are posted under NRHM in the district.

c) Staff position in the visited CHCs, PHCs and sub Centres was somewhat good. Two posts

of Junior Specialist at Surajgarh CHC and the post of Lab Technician at Kajara PHC were

lying vacant. MPW (M) was not posted at all the visited sub centres.

2) Functioning of Janani Suraksha Yojana (JSY):

a) JSY has been implemented in the district since 2005-06 and 9646 deliveries were

conducted under the scheme in the year 2006-07 and increased by 56.8% in 2007-08,

20.4% in 2008-09 and 67.7% in the year 2009-10 respectively over the preceding years.

Thus, the quantum of beneficiaries of JSY has gone up over the period of the NRHM since

its inception.

b) In 2008-09, a amount of Rs. 2,83,72,000 was spent under the scheme, the expenditure

was Rs. 3,45,75,000 during 2009-10 under the scheme.

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c) In the visited CHC and PHCs, it was observed that there was no shortage of fund under

JSY. The cash book was properly maintained at both the PHCs visited.

3) Untied Funds:

a) Rs. 66, 90,000 and 50, 00,000 were received in the district during 2008-09 and 2009-10

respectively as untied funds.

b) In the visited CHC at Surajgarh, the untied funds to the tune of Rs. 1,00,000 was received

in 2008-09 and only Rs. 15,942 was spent. In 2009-10, no amount was received in this

head and during this period only an amount of Rs. 12,576 was spent. Hence the

expenditure from untied fund has been very poor.

c) In the year 2008-09, untied funds to the tune of Rs 25,000 was received by the Ardawata

PHC, opening balance was Rs 30,852 and expenditure to the tune of Rs.57,698 was made

under this head. In the year 2009-10, an amount of Rs. 50,000 was received as AMG and

an over expenditure of Rs. 39,230 was incurred from this head by the end of March 2010.

d) In the year 2008-09, untied fund and annual maintenance grant to the tune of Rs. 25,000

and Rs.50,000 respectively were received by the PHC Kajada.

e) In the sub-centre visited at Ojatu, Gidaniya, Jhini and Farahat funds provided in 2008-09

and 2009-10 were spent except at SC Gidaniya.

4) Rogi Kalyan Sammiti (RKS)- :

a) Total 85 RKS( known as Medical Relief Society ( MRS) in the state) has been constituted

in the district and all were functioning as reported by the district.

b) In the year 2008-09, a total of 388 RKS meetings were held and 492 during 2009-10,

meetings were held.

c) Under the scheme, CHC at Surajgarh, PHC at Ardawata and Kajada were reviewed and

found that RKS were formed there. The medical officer In-charge of CHC reported they

called the meeting of RKS as and when required. However it was observed that the regular

meetings RKS are not being held at Ardawata PHC.

5) Service of ASHA Scheme:

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a) As against the target of 1379 ASHAs, 1350 have been selected and out of that 1309

ASHAs have been trained up to 3rd module.

b) All selected ASHAs were not equipped with drug kits.

c) In sub-centre Ojatu and Gidaniya, it was observed that ASHAs have received three module

of training. The drug kit was given to them and they accompanied with the pregnant

women for institutional delivery.

6) Village Health and Sanitation Committee.

a) In the district, 893 village Health Sanitation Committees have been formed and all have

also opened bank Accounts to handle the funds.

b) It was reported that 657 and 8152 VHSC meetings held in 2008-09 and 2009-10

respectively. Documentation of the VHSC meetings was poor and at some of visited sub-

centre it was not even available.

7) 24 hours delivery system :-

a) In the district there are 13 CHCs and 71 PHCs. All the CHCs were functioning as 24 x 7,

out of which 8 are FRUs while 20 PHCs are functioning as 24 x 7.

b) It was observed that not a single FRU was having functional Blood storage unit and also

there was no specialist in the CHC or PHC.

8) Physical Infrastructure:

i) CHC:

a) CHC Surajgarh is located in Govt. Building, having regular water and electricity supply.

There were 3 medical officers and none of them was trained in Emergency Obstructive

Care. There was no blood storage unit.

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b) The residential quarters were available for MOs & other Staffs. The drug position was

found satisfactory. Neonatal Resuscitation Equipments, Anesthesia Equipments and

Incinerator were not available at CHC.

ii) PHCs

a) At PHC Aradawata, there was no proper labour room and deliveries were being conducted

in a big hall. No residential quarters were available for Medical officer & other staff.

b) In PHC Kajada only one quarter is available and it was occupied by the staff Nurse and no

quarters were available for MO & other staff.

iii) Sub Centre

a) In sub-centre Gidaniya and Farahat labour room was not available. Gloves and Emergency

pills were not available.

b) Mclntosh sheet, Steam Sterilizer, Delivery kit were not available at Farahat sub- centre.

c) Cap. Ampicillin was not available at all the visited sub-centres.

9) Community Satisfaction/ Opinion:

a) The team contacted 38 mothers to assess their awareness about the health services. 34

(89.5%) of them informed that ANM was available when they needed most. All mothers

visited ANM/AWW for nutritional diet.

b) Only 4 (10.5%) mothers were visited by the health personnel within 24 hours after

delivery. 9 (23.7%) mothers have breast fed these child within half an hour and the rest i.e.

29 (71.3%) within an hour or more.

c) ARI awareness was found in 15 (39.5%) mothers and contraceptive awareness and

knowledge of its side effects was known to 6 (15.8%) mothers. It was also found that only

8 mothers (21.1%) were motivated for using contraceptives.

d) The public of Ardawata PHC was very much satisfied with the functioning and working of

MBBS medical officer and AYUSH doctor.

10) Sample verification of FW Acceptors:

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a) Out of selected 129 FW cases in the district, 98 (75.9%) could be contacted and the

discrepancy in the age of acceptors was found in 9 (9.8%) cases and in the age of last child

in 10 (10.2%) cases.

b) Out of 98 contacted cases, 13 (13.3%) were found to be reported false. All these cases

were reported for spacing method of Family Planning.

c) One case each for NSV & LT was reported as failure case in the visited area.

11) Maintenance of Registered and Records.

a) The registers like EC register, Sterilization, IUD, OP, CC stock registers need

improvement as details are not recorded.

b) The ANM of Ojatu sub-centre did not maintain any records of the services rendered in

year 2009-10.

c) Case cards for any FW method were not maintained at all the visited centres.

12) Main observation:

a) Citizen charter was not exhibited in some of the visited centres. It should be displayed in

all the facilities.

b) The proper mobility support was not provided to DPMU and BPMU which affected

monitoring under NRHM.

c) Supervision in PHCs and HSCs needs to be improved as well as maintenance of registers

and records.

d) At many visited facilities, the expenditure incurred was more than the allotted amount

particularly under united fund & AMG which should be avoided.

e) To reduce the false reporting of FW acceptors and improving the quality of reported cases

the sample verification of FW cases may be done at the district level.

******

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2) Banswara District

Major observation of field Survey unit (FSU) of Regional office for Health & Family welfare, Jaipur about Evaluation work in Banswara District of Rajasthan State in the month of May 2010.

I.Details of the visited Institutions

District visited

PHC/CHC visited

H SCs visited

Banswara PHC-Badarel and Nogama CHC-Partapur

Nalda, Boriya, Pindrama and Bodigama

II.Major Observations

1) Human Resources:-

a) Out of 34 sanctioned posts of specialist in the district, 25 were vacant.

b) Out of 14 sanctioned posts of Sr. Medical Officer / Medical Officer 8 were vacant.

c) 75 posts of rural medical officer were sanctioned out of which 34 posts were vacant.

3) Functioning of Janani Suraksha Yojana (JSY) :-

a) JSY has been Implemented in the district since 2005-06 and 5,972, 25,732, 4,336,

38,722 and 37,984 institutional deliveries were conducted during 2005-06, 2006-07, 2007-

08, 2008-09, 2009-10 respectively.

b) There was no scarcity of fund, the district authority received sufficient amount in JSY

head in the year 2008-09 & 2009-10.

c) During visit to PHCs Badarel and Nogama, it was observed that PHCs got sufficient

fund during 2009-10, but in the current financial year fund was not released by the district

authority to PHCs and the JSY payment could not be given to the beneficiaries since May,

2010.

4) Untied Fund:-

a) Untied Fund was being provided to the district every year and centres were receiving

funds as per norms. Untied funds to the tune of Rs. 2, 38, 60,000 were received in 2008-09

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and an expenditure of Rs. 2, 12, 67,609 was increased. In 2009-10, an amount of Rs.2, 32,

31620 was spent in this regard.

b) During visit to the PHCs and HSCs in the district, it was observed that most of the

centres have the untied funds and utilised mostly.

5) Rogi Kalyan Sammiti(RKS):-

a) Total 56 RKS were constituted in the district and all are functioning. It was reported

that in 2008-2009, 437 RKS meetings were held wereas in 2009-10, 478 meetings were held.

b) RKS (Known as Medical Relief Society) in the state was formed in the visited CHC at

Partapur and PHCs at Badrel & Nogama. The formal documentation of the MRS meeting

was lacking at all the visited facilities.

6) Service of ASHA :-

a) There are 1569 villages in the district. It was reported that 1611 ASHAs have been

selected against the target of 1792 ASHAs in the district.

b) Only 606 ASHAs received 3 module of training and 1180 ASHAs were equipped with

the drug kit.

c) During visit to the sub-centres, the work of most of the ASHAs was found appreciable,

they prepared micro birth plan of their areas. They were motivating mothers for institutional

delivery and also accompanied with some of the pregnant woman for institutional delivery.

7) Village Health and Sanitation Committees (VHSCs) :-

a) In the District, 1425 village Health Sanitation committees have been formed.

b) There were 12132 meetings held in the year 2009-10. Documentation of the VHSC

meetings was very poor, at some of the visited Sub-centres, it was not even available.

8) 24 Hours delivery care system:-

In the district, there are 13 CHCs & 41 PHCs. All the CHCs were functioning as 24 x 7. out

of 9 are FRUs. Out of the 41 PHCs, 20 are functioning as 24 x 7. Not a single FRU has the

functional blood storage unit. Gynaecologist was available only in two FRUs.

9) Physical Infrastructure:-

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a) CHC Partapur is located in Govt. Building, having regular water and Electricity

supply. There was no blood storage unit. Neonatal Resuscitation and Anaesthesia equipment

was not available there.

b) At PHC Badrel, there was no labour room and the deliveries were being conducted in

a big hall. The PHC was lacking facilities for new born care. The Medical officer room was

not of appropriate size. The toilet for staff was not available in the PHC. The curtain for

privacy for the patients was not available. The citizen charter was not put on display in the

PHC. The complaint and suggestion box was not available at the PHC.

c) In PHC Nogama, there was no proper labour room. The curtain for privacy for the

patients was not available. There was no quarters available for MOs and other staff.

d) Sub centres at Nalda, Boriya, Pindarma and Bodigama were selected for sample

verification. Examination table was not available at Boriya and Pindarma. DDK and

Emergency Pills were not available at Boriya, Pindarma and Bodigama sub-centres. IUD

was not available at Pindarma and Nalda sub-centre. AD syringes were not available at

Bodigama and Nalda sub-centre. Steam sterilizer was not available at Pindarma sub-centre.

10) Community Satisfaction/opinion on Health Services:-

(i) ANM Work

a) The Team contacted 34 mothers to assess their awareness about the availability of

various health services etc. Out of the contacted mothers, 25 (73.5%) informed that ANM

was available as and when needed.

b) 30 (88.2%) were aware of exclusive Brest feeding and complementary feeds. ARI

awareness was found in 14 (41.2%) mother. 21 (61.8%) mothers knew the use of ORS. 27

(79.4%) mothers had contraceptive awareness and knowledge of side effect was known to

only 19 (55.9%) mothers.

(ii) PHC Services

The team visited the PHC of Badrel & Nogama and evaluated the opinion of the public on

their functioning. The public of Badrel is very much satisfied with the functioning of the PHC

and working of MBBS Medical officer and AYUSH doctor.

11) Sample verification of F.W. acceptors:-

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a) In the district, the team conducted 89 FW acceptors, out of 139 selected for sample

verification and found that,

i) Age of the acceptors was not recorded in 21 (23.6%) cases.

ii) Age of youngest child was not recorded in 18 (20.2%) cases.

iii) Total no. of children was not recorded in 9 (13.6%) cases

b) Out of 34 immunization cases selected, 25 were contacted, All of them were

immunized as per schedule and no discrepancy was found.

12) Records & Registers:-

Proper maintenance of records was lacking at all the visited centres. The register like EC

reregister, Sterilization, IUD, OP, CC stock register need improvement as details were

missing.

12) Other Observations:-

a) Most of the post of specialist and medical officer were lying vacant in the district.

b) For proper functioning of 24 x 7 Institutions in the district, the residential facilities for

medical officer & all staff nurse are very much required.

c) As PHC Badrel conducting good number of deliveries, the facility for new born care

may alsobe developed. Ward facility may also be improved (attendant, benches, clean bed

sheets, proper mattress & beds). Infrastructure of the PHC needs further upgradation.

d) It was reported by the villagers that ANM is not available after evening and they are

not able to get health services in the emergency during night. Residential facility for MO &

staff need to be provided at the facilities.

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3.Dungar District

Major observation of Field Survey Unit (FSU) of Regional office for Health & Family Welfare, Jaipur about evaluation work in Dungarpur District of Rajasthan State in the month of August 2010. i. Details of the visited Institutions:

District visited PHC /CHC visited HSCs visited

Dungarpur PHC: Pohari Khaturat and Kanba CHC: Simalwara and Paratapur

Jhotari,Paladi Gujeshawar, Bhehana and Thana

ii. Major Observations

1) Human Resources:

a) Position of Specialists in the district is not at all satisfactory. Out of 19 posts of specialist sanctioned in the district 16 posts were vacant.

b) Staff position in the visited CHCs, PHCs and Sub-Centres was somewhat good. However, all 5 posts of Junior Specialist were lying vacant in CHC Simalwara.

2) Functioning of Janani Suraksha Yojana (JSY):-

a) JSY has been implemented in the district since 2005-06. 10195 deliveries were conducted under JSY in the year 2005-06 & this number went up to 13773, 19750, 20000, and 21300 during 2006-07, 2007-08, 2008-09 & 2009-10 respectively. Thus the number of JSY beneficiaries has increased over the period of the NRHM.

b) The district received sufficient amount under JSY head in the year 2008-09 and 2009-10. In the visited CHC and PHCs, fund provision under JSY was sufficient. It was observed that the cash books were properly maintained at CHC Simalwara and PHC Pohari Khaturat.

3) Untied Fund:-

a) Untied fund to the tune of Rs. 31,74,800 & 20,21,852 were spent during 2008-09 and 2009-10 respectively.

b) In the visited CHC, PHC and sub-centres, the untied funds were provided during 2008-09 and 2009-10 and also the same were being spent.

4) Functioning of Rogi Kalyan Samiti (RKS) :-

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a) Total 46 RKS (known as Medical Relief Society in the State) are constituted in the district and all are functioning. It was reported that totally 552 meetings of MRS were held in 2008-09 and 2009-10 respectively. The formal documentation of MRS meetings was lacking at all the visited facilities.

b) During visit to CHC and PHC, it was observed that the proceedings of MRS meetings were not maintained at CHC Simalwara. The Medical officer In-charge of CHC reported that they call the meeting of MRS as & when it is required. In PHC Pohari Khaturat & Kanba regular meetings of MRS were not held.

5) Functioning of ASHA Scheme:-

a) There are 859 villages in the district and as against the target of 1272, 1236 ASHAs have been selected and they were equipped with the drug kit.

b) In the visited sub centres it was observed that All ASHAs have received three module of training.

6) Village Health Sanitation Committees (VHSCs) :-

a) In the district, 859 Village Health Sanitation Committees (VHSC) have been formed and all have opened bank account for handling funds.

b) Though 12132 meetings of VHSCs were held in 2009-10, documentation of the VHSC meetings was very poor and at some of visited areas as it was not even available.

c) ASHA was functioning as a member in the VHSCs.

7) 24 hour delivery care system:-

a)In the district, there are 7 CHCs and 39 PHCs. All are functioning as 24 x 7, out of which 4 are FRU.

b)There was no Gynaecologist available at any FRU.

8) Physical infrastructure:-

i) CHC:

a) Visited CHC at Simalwara is functioning in Govt. Building, having regular water and electricity supply. In this CHC there was one SMO and 2 MOs. Overall maintenance of the CHC was good however cleanliness can further be improved as observed by the team.

b) Not a single FRU (there are 4 FRU in the district) is having functional Blood Storage blood Storage unit. This CHC is FRU having no blood Storage Unit.

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c)Gynaecologist, Paediatrician, Surgeon and Anaesthetic were not available. There is a heavy load of deliveries at this CHC. Residential quarters are available for MOs and other staffs but not in good condition.

ii) PHC:

a)The PHC at Pohari Khaturat was headed by the AYUSH doctor (Ayurveda). The benches were not available in the ward for the attendant. The Bed sheets & Pillow covers were found to be very dirty. The curtain for the privacy of the patients was not available. There is no regular water facility available in the PHC. The citizen charter & list of available generic medicine in the PHC were displayed in the PHC. There is no counter for condom. The complaint & suggestion box was not available at the PHC.

b) At Kanba PHC one MBBS doctor got 6 month contractual appointment for screening of Swine flu and was posted at this PHC. The curtain for privacy for the patients was not available. Residential quarters for the staff was available at Kanba PHC.

iii) Sub-Centres:

a)Visited Sub centers were functioning in Govt building. Electricity was not available except at SC Jhotari. Labour room was available in the visited SCs except SC Paladi Gajeswari. Deliveries were conducted only in SCs at Jhotari and Bhehana.

b)EC Pills, DDKs, Oxytocin Tab, Ampicin Capsule and Gentamycin Injection were not available in any of the visited sub centres. Kit A & Kit B for current year was only available at SC Bhehana.

c) SBA training was provided to the ANMs of visited Sub Centers at Jhotari and Bhehana.

9) Community Satisfaction/ Opinion:-

a) The team contacted 35 mothers to know their opinion about the various health services rendered by the ANM. 28 (80.0%) mothers informed that ANM was available when they needed. All mothers visited ANM / AWW for nutritional diet.

b) In 29 (83%) cases deliveries were conducted by the trained persons. 6 (17%) deliveries were conducted at home. 13 (37.1%) mother were visited by the health personnel with in 24 hour after delivery in 12 (34. %) cases visits were made within 3 days , 9 (26%) were visited within 7 days of delivery.

c) ARI awareness was found in 20(57%) mothers. 23(66%) mothers did not know the use of ORS. 32(91%) mothers had Contraceptive awareness and knowledge of its side effects was known to only 16(46%) mothers.

d)The team visited the PHC of Pohari Khaturat & Kanba and evaluated the opinion of the public on their functioning. The Public of Pohari Khaturat & Kanba PHCs was very much satisfied with the functioning of the PHC.

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10) Sample Verification of FW Acceptors:-

a) The team selected 151 F.W. cases, out of which 95 (62.9%) cases could be contacted. Out of 95 contacted cases, the discrepancy in the age of acceptors was found in 17 (17.9%) cases and in the age of last child in 12 (12.7%) cases.

b)All sterilization cases received full payment and follow up was also made with all the contacted cases.

c) Out of 95 cases of Family Planning contacted for field verification, 19 (20%) were found to have been registered without providing the services. All these 19 acceptors were reported under the performance of spacing method of Family Planning and need close monitoring to improve the quality of reporting.

d)34 immunization cases were selected and 25 contacted and all of them were immunized as per schedule and no discrepancy was found.

11) Maintenance of Records and Registers:-

a) There are 6 sub centres under CHC and ANM posted at CHC (Hq) did not maintain Service Delivery Registers for Specing methods of Family Planning and therefore, the team could not cross check their performance.

b) The registers like EC register, Service delivery register and Stock register need improvement as many details are missing.

c)Case cards for Cu-T were not maintained at all the visited centres by the team.

12) Observations and Suggestions:-

a) Sub-Centres conducting deliveries did not have proper space & infrastructure, their infrastructure needs up gradation.

b) Sample verification of FW cases may be done at the district level by the State in order to reduce the fake cases and improving the quality of reported cases.

c)The AYUSH doctors the managing PHCs should also be sensitized on national health programme & record maintenance.

d) IEC material display on most of the facilities particularly in sub-centres was very poor. Proper IEC display needs to be ensured by highlighting priority areas.

e) Most of the institutions were not utilizing the Untied Fund and AMG (where ever granted). District authority should closely monitor the utilization of funds in these heads for proper utilization of these funds. Institutions may also be assisted/guided through MRS/VHSC in need base utilization of the fund.

f) No. of deliveries escorted by ASHA is very low. ASHAs involvement in other health activities like in DOTS provider, Malaria treatment was also missing.

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4. Chittor Garh

Major observation of Field Survey Unit (FSU) of Regional office for Health & Family Welfare, Jaipur about evaluation work in Chittor Garh District of Rajasthan State in the month of August 2010. i. Details of the visited Institutions:

District visited PHC /CHC visited HSCs visited

Chittor Garh PHC: Kankarwa, Mangalwar CHC: Nimbaheda

Pari, Patolia, Nangawali and Arned.

ii. Major Observations

1) Human Resources:-

a) There are 46 sanctioned posts of specialist in the district out of which 25 were lying vacant. 6 out of 20 posts of Sr. Medical Officer and 23 out of 75 posts of Medical Officer were also vacant in the district.

b) 13 of the 53 sanctioned posts of Lab Technician were lying vacant in the district.


a) JSY has been implemented in the district since 2005-06. 189, 5346, 27427, 21562 and 21816 deliveries were conducted under the scheme during 2005-06, 2006-07, 2007-08, 2008-09 and 2009-10 respectively. The quantum of beneficiaries of JSY has gone up in the beginning years of NRHM and came down in 2008-09.

b) The district received sufficient amount under JSY head in the year 2008-09 and 2009-10.

3) Untied Funds:-

a) In the visited CHC and PHCs it was found that the funds were sufficient during 2008-09 and 2009-10. Performance of institutional deliveries in the visited CHC, PHCs and sub-centres needs to be increased.

b) CHCs, PHCs and Sub-Centres are being provided with untied funds regularly and the same were being utilised in the visited Sub centres.

c) At Patolia Sub-Centre at the end of the financial year 2009-10, most of the fund was utilized. In Nangawali Sub-Centre the fund was not received in 2010-11 but an expenditure of Rs. 9643/- was incurred up to August 2010 from the carried forward balance.

4) Rogi Kalyan Samiti (RKS) :-

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a) It was reported that 53 RKS (called Medical Relief Society (MRS) in the State ) have been constituted in the district and all are functioning.

b) MRS was formed at visited Nimbaheda CHC and PHCs. The regular meeting of MRS was being held at CHC Nimbaheda. Though conduct of regular meetings of MRS at PHCs Kankarwa and Mangalwar was not found satisfactory.

5) Functioning of ASHA:-

a) There are 1541 villages in the district and against the target of 1346, 1086 ASHAs have been selected.

b) It was reported that 1027 ASHAs received training up to 3rd module in the district.

c) In sub centres ASHAs did not prepare Micro birth plan of her area.

6) Village Health Sanitation Committees (VHSCs):-

a) In the district, 1531 Village Health Sanitation Committees (VHSC) have been formed and all have opened bank account for handling funds.

b) ASHA is a member of the VHSCs. The Printed register for maintaining VHSC meeting proceeding was given to ASHA. Documentation of the VHSC meetings was properly maintained at visited sub-centres.


a) In the district there are 14 CHCs and 38 PHCs. All were functioning as 24 x 7and out of which 10 are First Referral Units (FRU).

b) Only one FRU was having the functional Blood Storage unit. Gynaecologist was available at two FRUs.

c) At Kankarwa PHC, on an average 8 deliveries were conducted. In 2009-10, total 97 deliveries were conducted at the PHC out of these 42 (43.3%) deliveries were conducted in night hours. The PHC was lacking facilities for new born care. In the current year 2010-11, 40 deliveries were conducted up to August, 2010 and out of these, 25(62.5%) deliveries were conducted in night hours.

d) At Mangalwar PHC, 11 deliveries were conducted every month. In 2009-10, total 127 deliveries were conducted at the PHC, Out of these 50 (39.4%) deliveries were conducted in night hours. In the current year 2010-11, 51 deliveries were conducted up to August, 2010 out of these 27 (62.5%) deliveries were conducted in night hours.

8) Physical infrastructure:-

i) CHC:

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a) CHC Nimbaheda is located in Govt. Building, having regular water and electricity supply. Overall maintenance of the CHC was good. The Blood storage unit was functional. The drug position was found satisfactory. Neonatal Resuscitation Equipments, Anaesthesia Equipments were available at CHC.

b) Residential quarters were available for MOs and other staffs of the CHC but there was shortage of quarters.

ii) PHC:

Labour room in PHCs at Kankarwa and Mangalwar needs improvement. The Medical officer room was not of appropriate size. The toilet for staff and curtain for privacy for the patients were not available. There was shortage of rooms in the PHC. The citizen charter was on display in the PHC. There is no counter for dispensing Condoms. Complaint & suggestion box was not available at the PHC. Due to leakages of roof of ward three beds were shifted to another room. AYUSH (Ayurvedic) compounder was posted at this PHC and AYUSH medicines were available. Separate two rooms were newly constructed for AYUSH doctor in the PHC premises. Average 2 to 3 patients are registered in AYUSH OPD. The cleanliness of ward was not satisfactory.

iii) Sub-Centres:

a) The cleanliness of sub-centre Pari and Nangawali was found to be good

b) Ambu Bag, Emergency contraceptive pills, Tablets Oxytocine, Cap Ampaciline and Inj. Gentamycine were not available at all the visited sub-centres.

c) Steam sterilizer was not available at Nangawali sub-centre. The infant weighing machine was not found functional at Pari sub-centre.

d) The roof of Pari sub-centre building was leaking.


a) The team contacted 40 mothers to know their knowledge and opinion about the services rendered by the ANMs. All of them informed that ANM/AWW was available when they needed most.

b) Most of the mothers were aware of exclusive breast feeding and complementary feeds.

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c) ARI awareness was found in 19 (47.5%) mothers. 23 (57.5%) mothers knew the use of ORS. 35 (87.5%) mothers had Contraceptive awareness and knowledge of its side effects was known to 5 ( 12.5%) mothers.

d) The team has visited the PHC of Kankarwa & Mangalwar and evaluated the opinion of the public on their functioning. The Public of Kankarwa and Mangalwar was satisfied with the functioning of the PHC and working of MBBS Medical Officer and AYUSH doctor/AYUSH compounded.

10) Sample verification of FW Acceptors:-

a) The team selected 164 F.W. cases, out of which 131 (79.9%) cases could be contacted. All the 33 (20.1%) non contacted persons left the place temporarily.

b) Out of 131 contacted cases, the discrepancy in the age of acceptors was found in 19 (14.5%) cases and in the age of last child in 20 (15.3%) cases.

c) There were 32 (24.4%) fake cases of spacing methods of Family Planning. All sterilization cases received full incentives.

d) 29 immunization cases were also selected and 27 were contacted, Out of these, 1 child was found not immunized in the Nangawali sub-centre but the concerned ANM reported for BCG and DPT/Polio I & II doses.


a) Proper maintenance of records was lacking at all the visited facilities.

b) EC register, Sterilization, IUD, OP, CC and Stock registers were not properly maintained at all the visited sub-centres Case cards for Cu-T were not maintained at all the visited centres.

12) Other Observations and Suggestions:-

a) During visit to the sub-centres, accredited for conducting deliveries, it was observed that some essential equipment were not available there.

b) Lots of fake cases of the FP acceptors reported during the verification. It was suggested that sample verification of FW cases may be done at the district level by the State in order to reduce the fake cases and improving the quality of data.

c) Supervision for PHC and HSC is needed to be improved for better maintenance of registers and records.

d) IEC activities on most of the facilities particularly in sub-centre was very poor. Proper display of IEC material needs to be ensured by highlighting priority areas.

18

e) ASHA’s involvement need further stimulus. ASHA‘s role as a DOTs Provider, motivation for FP method, counselling on health, cleanliness & hygiene should geared up. Capacity building of ASHA should also be addressed to desired level.

f) Some sub-centres accredited for conducting deliveries under JSY were not making JSY payment to beneficiaries and it was done by the concern PHC I/c. It was suggested that all sub-centre(s) accredited for conducting deliveries should be allotted fund to meet JSY payment to avoid delay/inconvenience to JSY beneficiaries.

g) At some of the visited facilities it was observed that expenditure from untied fund/AMG was not incurred in time. In a year there was no expenditure where as in other year fund carry forwarded from previous years were fully utilized. District authority should ensure that fund allotted for a year should be optimally utilized in that year only.

*******

19

5.Sikar district

Major observations of Field Survey Unit (FSU) of Regional office for Health & Family Welfare, Jaipur about evaluation work in Sikar district of Rajasthan in the month of October, 2010. I. Details of the visited Institutions: District visited

PHC /CHC visited HSCs visited

Sikar CHC: Fatehpur PHC: Nechhawa and Dansroli

Jhajhar, Sevarada, Surera and Karad


1) Human Resources:

a) Position of health manpower of the district is given below:

Sl. No. Particulars

Sanctioned In position Vacant

1 Specialists 50 38 122 Sr. Medical Officer 23 19 43 Medical Officer 122 110 124 Radiographer 5 4 15 Assistant

Radiographer 13 11 2

6 Dental Technician 2 0 27 Lab Technician 93 85 88 Pharmacist 2 1 1

b) Staff position in the visited CHCs, PHCs and sub-centres was satisfactory.


a) JSY has been implemented in the visited district since 2005-06. 25807, 45287, 43818, 55172 and 32314 deliveries were respectively conducted under JSY during 2006-07, 2007-08, 2008-09, 2009-10 and 2010-11 (upto Oct.2010). Thus the quantum of beneficiaries of JSY has gone up over the period of the NRHM in the district.

b) The district received sufficient amount in JSY head in the year 2008-09 and 2009-10 and current financial year.

20

c) In the visited CHC at Fatehpur and PHCs at Nechhawa and Dansroli, the services under JSY was being provided to the beneficiaries satisfactorily. There was sufficient fund for proper functioning of JSY. The Cash book was properly maintained at the CHC and PHC Nechhawa. But at the PHC Dansroli the Cash book was not properly maintained.

e) The visited Sub-Centres at Jhajhar, Sevarada, Surera and Karad were accredited for JSY and all were having Labour room. The JSY beneficiaries got payment from SCs. Deliveries were conducted by the ANMs at these SCs except in SC Surera, because the labour room was not handed over to sub-centre by the Panchayat.

3) Untied Fund:-

a) CHCs, PHCs and sub-centres have been receiving untied funds regularly and utilising it.

b) In the visited CHC Fatehpur and PHCs at Nechhwa and Dansroli Rs. 50000/- and @ Rs. 25000/- were given to each in the year 2009-10 and in the current year 2010-11. There was no expenditure was reported during the current financial year up to September, 2010 in the centres.

c) During the years 2009-10 and 2010-11 the SCs Jhajhar, Sevarada, Surera and Karad received the untied fund @ Rs. 10,000 and the fund was fully utilised in the year 2009-10 and the funds were being utilised during the current year.

4) Functioning of Rogi Kalyan Samitis (RKS) :-

a) Total 86 RKS (RKS known as Medical Relief Society in the State) were constituted in the district and all were functioning. The information related to RKS meetings held was not available at district level.

b) During visit to CHC, it was observed that the MRS was formed at CHC Fatehpur and it’s meetings was held regularly. Expenditure statement regarding untied fund and AMG etc. were maintained properly at CHC Fatehpur.

c) The MRS was formed at the PHCs Nechhawa and Dansroli, but the MRS meetings were not being held regularly in these PHCs.

5) Functioning of ASHA Scheme:-

a) There are 1161 villages in the district and as against the target of 1944 ASHAs, 1720 ASHAs have been selected and all were equipped with the drug kit. Out of these, 1629 received 3rd module training. None of the ASHA was a DOTS provider.

b) In the visited sub centres it was noticed that all ASHAs received three module training. In all sub-centres ASHA did not prepare Micro birth plan of her area. Institutional deliveries were conducted in these SCs and ASHA accompanied the mothers for hospitalisation.

21

6) Village Health Sanitation Committees (VHSCs) :-

a) In the district 12561 Village Health Sanitation Committees (VHSC) were formed and all opened bank account for handling the funds.

b) It was reported that documentation of the VHSC meeting was not properly maintained at visited sub-centres.

c) At SCs Jhajhar, Sevadara, Surera and Karad 3, 2, 1 and 4 VHSCs were formed respectively and ASHA was a member in VHSCs in the visited sub-centres. ASHA was not a member in 2 VHSCs of Jhajhar sub-centre.


a) In the district there were 17 CHCs and 68 PHCs. All the CHCs were functioning as 24 x 7, out of which 10 were declared FRUs. Out of them 3 were functional and only 2 were having the functional Blood Storage Unit. 27 out of 68 PHCs were functioning as 24 x 7.

b) At the PHC Nechhawa on an average 19 deliveries were conducted every month. Total 274 deliveries were conducted at the PHC in 2009-10 and out of these 160 (56.3%) deliveries were conducted in night hours. In the current year 2010-11 (up to September, 2010), 172 deliveries were conducted and out of these 114 (66.3%) were conducted in night hours. The PHC was having some infra-structural facilities viz., shortages of rooms, toilets for staff, curtains for privacy for the patients and benches etc.

8) Physical infrastructure :-

i) CHC:

a) Visited CHC at Fatehpur was located in Govt. Building and was having regular water and electricity supply. It was a 50 bedded CHC on record. The physical infrastructure of the CHC was good. The cleanliness and IEC display was good at the CHC. The residential quarters were available for MOs and other staffs.

b) The Blood storage unit and child care equipments etc. were functional at the CHC. Essential drugs were in stock.

ii) PHC:

a) The PHCs at Nechhawa and Dansroli was having Labour room. The delivery load at PHC Nechhawa was good and was poor at PHC Dansroli.

b) Both the PHCs were not fulfilling the requirement of 24x7 regarding infrastructure & human resources. There was shortage of quarters for MO and other staff.

c) There was no condom distribution counter in both of the PHCs visited.

22

iii) Sub-Centres:

a) It was observed that the cleanliness at sub-centre viz. Jhajhar, Surera, Sevarada and Karad level was good.

b) The labour room was available at all the visited SCs. But deliveries were conducted at Jhajhar, Sevarada and Karad. Cupboard for drug and anticeptic solution were not available at the SCs Karad and Sevarada.

c) At Surera sub-centre Nishchy kit and condom was not available. IUD was not available at Karad sub-centre. Steam sterilizer was not available at Karad, Jhajhar and Surera sub-centre. DDK was not available at all the visited sub-centre. The infant weighing machine was not functional at Jhajhar sub-centre. Cap Ampiciline and Inj. Gentamycine was not available at Devarada, Karad and Surera sub-centres.


a) The team contacted 40 mothers to know the awareness of various health parameters and out of 40 contacted mothers, all informed that ANM was available when they needed.

b) All the deliveries were conducted by the trained persons. 6 (17.14%) deliveries were conducted at home. 3 (7.5%) mother were visited by the health personnel with in 24 hour after delivery, 15 (37.5%) were visited with in 3 days, 20 (50.0%) were visited within 7 days of delivery and 2(5.0%) after 7 days.

c) 14 (35.0%) out of 40 contacted mothers had given breast feeding within half an hour and rest 26 (65%) within one hour or more. 38 (95.0%) mothers were aware of exclusive breast feeding and complementary feeds.

c) ARI awareness was found in 20(50.0%) mothers. 30(75.0%) mothers were know the use of ORS. All the mothers were having Contraceptive awareness, but the knowledge of its side effects was not known to all mothers.

d) The team visited the PHC of Nechhawa and Dansroli and evaluated the opinion of the public on their functioning. The Public of Nechhawa and Dansroli PHCs was very much satisfied with the functioning of the PHC. There was opinion of the people that the post of MO and other vacant posts should be filled at the earliest.

10) Sample verification of Family Welfare (FW) Acceptors:-

a) The team selected 154 F.W. acceptors, out of which 124 (80.5%) cases could be contacted. During sample verification discrepancy in the age of acceptors was found in 24 (19.4%) cases and in the age of last child in 21(16.9%) cases.

b) The high percentage of fake reporting was observed in the specing method of Family Planning, 10(66%) of the 33 IUD acceptors, 9(77%) of the 30 OP users and 7 (63%) of the 29 condom users contacted in the district fund to be false. Such reporting needs remedial action to improve the quality.

23

c) All sterilization cases received full payment and follow up was also made with all the contacted acceptors.

d) 32 immunization cases were selected and 29 contacted and all of them were found immunized as per schedule and no discrepancy was reported.


a) The record maintenance needed further improvement at all the visited CHC/PHCs/SCs. The register like EC register, Sterilization, IUD, OP, CC Stock register was not properly maintained at visited sub-centres.

b) All the available registers were not regularly checked by the supervisory officers.

c) Case cards for Cu-T were not maintained at all the visited centres or at the reporting units.

12) Observations and Suggestions:-

a) For quality control in the services, the essential delivery equipments should be available at the JSY accredited sub-centres. The ward facilities at PHCs Nechhawa and Dansroli need to be improved.

b) The fake cases of the Cu-T, OP and Condom acceptors were observed during the verification. It was suggested that Sample verification of FW cases might be done by the State at the district level in order to reduce the fake cases and improving the quality of reported cases.

c) Supervision for PHC and HSC was needed to improve the maintenance of registers and records. Supervisory officer should put his remark on maintained records/ service register.

d) All the FRUs should be made functional. IEC display on most of the facilities particularly in sub-centres was very poor. Proper IEC display needed to be ensured by highlighting priority areas.

e) The daily work diary was not maintained by the MPW. So clear instructions on maintenance of daily work diary was required to be given. The citizen charter was not displayed at the visited PHCs Nechhawa and Dansroli. The complain & suggestion box, separate counter for Condom and OP was not available at all the visited PHCs.

f) ASHA involvement needs further improvement. ASHA’s role as a DOTs provider, motivation for FP method, counselling on health, cleanliness & hygiene should take up.

***********

24

6. Kota District.

Major observations of Field Survey Unit (FSU) of Regional office for

Health & Family Welfare, Jaipur about evaluation work in Kota District of

Rajasthan State in the months of December, 2010

I . Details of the visited Institutions:

District Visited CHC and PHC Visited HSC Visited

A. Kota CHC: Modak PHC: Suket & Kanwas

Hiriya Khedi, Khimach, Dara and Hingoniya


1. Human Resources:

a) The Staff position in the district was somewhat satisfactory except in the categories like

Gynaecologists, Radiographer, Dental Technician and Pharmacist. As reported, the following

table shows the details of staff position in some key posts.

Post Post sanctioned In position Vacant

JS Medicine 10 9 1

JS Surgery 10 8 2Gynaecologist 6 1 5Medical Officer 87 77 10

AYUSH Doctor 29 25 4

Radiographer 1 0 1

Assistant Radiographer 10 9 1

Dental Technician 1 0 1

Pharmacist 3 0 3 b) In visited CHC Modak, all 4 posts of specialist and one post of Dental Technician was vacant.

c) One post each of GNM (under NRHM) and ANM was vacant in PHC Suket and one post of LHV

was vacant in PHC Kanwas.

d) MPW (M) post was vacant at all visited Sub Centres but Additional ANM was not deployed at

Hiriya Khedi Sub Centre.

25

2. Rogi Kalyan Samiti (RKS) & Village Health Sanitation Committee

(VHSC):

a) There were 41 RKS in the district and meetings of RKS were being conducted as reported.

b) RKS was constituted in visited CHC Modak, PHCs Suket and Kanwas. But, it was found that

regular meeting of RKS was not being conducted there.

c) At visited PHC Suket, the revenue generated through RKS was Rs. 45,517 during 2009-10 and

expenditure was Rs.34,299. In 2010-11, the revenue and expenditure were Rs.39,181 and Rs.

49,068. Likewise, the visited PHC Kanwas was having revenue of Rs. 23164 from RKS with

opening balance of Rs. 7,572 and it spent Rs. 23,167 during 2009-10. In the current year 2010-11,

against the revenue of Rs.23,366, the expenditure was Rs.21,022.

d) 802 VHSCs have been formed in the district. All VHSCs were having ASHA as a member. The

printed register was provided to ASHA for recording the proceeding of VHSC in every month.

f) Regular meeting of VHSC was being organized in visited Sub Centres. However, the ASHA and

ANM of visited Sub Centres were observed to be unaware about the activities and responsibility of

VHSC.

3. Service of Janani suraksha Yojana(JSY)

a) Janani Suraksha Yojana was being implemented properly in the district and Institutional deliveries

were being conducted at CHCs and PHCs level.

b) There was a increasing trend in institutional deliveries in the district due to JSY. 23761, 29783,

30989, 31003 and 20717 deliveries reported to be conducted in the year 2006-07, 2007-08, 2008-

09, 2009-10 and 2010-11(up to Nov 2010) respectively. The district received sufficient amount of

funds in JSY head during last three years.

c) It was observed that JSY money was not paid at the time of discharge to all beneficiaries in most

of cases in the district and the payment is reported to be delayed for more than one month. Cash

book and other relating records were observed to be maintained properly.

4. Functioning of ASHA scheme:

a) 868 ASHAs were selected against the target no. of 1121 ASHAs for 853 villages for the district.

All 868 selected ASHA received 3rd module of training and all of them received drug kit. Most of

ASHAs were accompanying the beneficiaries for delivery.

b) During visit to the Sub Centres, it was noticed that ASHA prepared the list of adolescent girls of

her area, recorded the proceeding of the VHSC and informed the beneficiaries for VHND and also

accompanying the mothers to the hospitals.

5. Untied funds:

a) It was reported that untied fund was given to the every CHC, PHC, Sub Centre and VHSC in the

district.

26

b) Both visited PHCs were provided @ Rs. 25,000 each as untied fund for financial year 2009-10 and

2010-11 out of which balance amount available at the time of visit till was Rs. 25,471 in Suket

PHC and Rs. 840 in Kanwas PHC. Suket PHC did not incur any expenditure till November, 2010.

c) HSCs received untied fund during current year (2010-11) and last year (2009-10). Sub Centre

Hiriya Khedi spent an amount of Rs. 8,000 in 2009-10 but there was no expenditure in the current

year. In Khimach Sub Centre, cash book was not maintained properly and record was not made

available by the ANM. Rest two visited Sub Centres Hingoniya and Dara had utilized the fund

properly.

6. 24 Hours Delivery Care Services:

a) 9 CHCs were functioning on 24x7 basis. Out of these, 6 were declared as FRU but Blood Storage

Unit was not available there. Out of 29 PHCs, 18 PHCs were also declared as 24x7 service

provider, but both visited PHCs were not functioning as per guidelines of 24x7 as there was no

staff and other infrastructure as per 24 x7 services.

b) Modak CHC was a FRU without functional blood storage unit. Gynecologist and Surgeon were

posted at CHC through posts of Paediatrician & Anaesthetist were vacant. The labour room was

well equipped.

c) PHCs visited at Suket and Kanwas were providing services with one. MO and one AYUSH

doctor. There was a good no. of deliveries in last two years. Some of the essential facilities i.e. new

norn care unit in PHC Suket and curtain and also toilet facility for the patients in PHC Kanwas was

lacking.

7. Physical Infrastructure and Stock Position:

I. CHCs:

Physical infrastructure and availability of space in the visited CHC Modak was very good. It was

located in govt. building with regular water and electric supply. It had 30 beds and all other

necessary infrastructure, but Blood Storage Unit was not functional. Residential quarters for MOs

and other PHC staff were available.

II PHCs:

a) PHCs visited at Suket and Kanwas have no infrastructure relating 24x7 services. Though labour

room was available at both PHCs but need renovation. Residential quarter for medical officer and

other staff was not available at both PHCs.

b) The citizen charter was not display in the PHCs. There was counter for condom. The complaint

and suggestion box was not available at the PHCs. The availability of generic medicine was not

displayed at the PHC.

III.HSCs:

a) All visited Sub Centres were functioning in the Govt. building with water, toilet and electricity

facility. Mobile was not provided to ANM. SBA training was not given to ANMs at Hiriya Khedi

27

and Khimach Sub Centres. Only Khimach Sub Centre didn’t have electricity. Hiriya Khedi HSC

had no labour room. DDKs, Kerosene oil, Sanitary napkins, Condom, EC Pills, Oxytocins tab,

Ampicilline cap and Gentamycine inj. were not available in the visited Sub Centre.

b) Nischay pregnancy test kit, Delivery kit, Chlorine solution/bleaching and Kits & A&B for the

current year were not available in Hiriya Khedi HSC.

c) Delivery table, Mclintsh sheets, Ambu bag/suction, steam sterilizer, RDT kit for malaria were not

available in Khimach and Hiriya Khedi centres..

d) Nischay pregnancy test kit, Gloves, Disposable syringes, Co-trimoxazole and Oral pills cycle etc.

were not available in Hingoniya and Dara Sub Centres.

e) Ambu bag/suction and Kit-A&B for current year were not available in HSC Dara.

8. Community Satisfaction on overall Health Service:

i. Services of ANMs:

a) The team contacted 36 mothers to know the awareness of various health related items. Most of the

contacted mothers informed that ANM was available at their villages and they were satisfied with

ANM’s work.

b) All deliveries were conducted by trained persons but only 23 (64%) mother received three post

natal check ups. 19 (53%) mothers knew about danger sign of ARI, 24 (67%) mothers were aware

of ORS.

c) All mothers were aware about contraceptive methods and Government Health Facilities where

they can get all health services.

d) 18 (50%) mothers had given breast feeding within half an hour of delivery and 16 (44%) within

one hour and rest i.e. 3 (5%) beyond one hour.

ii. Services of PHC:

The community was some what satisfied with the services received from the PHCs at Suket and

Kanwas PHCs. Most of the people were of the opinion that the vacant posts should be filled up at

the PHCs.

9. Sample Verification of Family Welfare Acceptor:

a) Out of 146 F.W. acceptors selected 128 (87.7%) acceptors could be contacted for sample

verification in the district. Discrepant entries in the age of acceptor in 5 (6%) cases and in the age

of last child in 7 (4%) cases were found.

b) Follow-up service to the all contacted acceptors and compensation amount to all sterilization

were provided.

c) High percent of fake reporting was observed during sample check of the spacing method

acceptors. 13 (45%) of the 29 IUD cases, 14 (41%) of the 34 OP users and 15 (48%) of the 31

condom users contacted were false.

28

d) 21 Beneficiaries of child immunization were contacted in which all contacted were satisfied with

doses & methods and the beneficiaries received follow up service. No complication was found

among contacted beneficiaries.

10. Maintenance of Registers & Records:

a) Eligible couple register, MCH Register and Stock register was being maintained in both visited

PHCs Suket & Kanwas and CHC Modak.

b) Consolidated Sterilization register was maintained in all visited CHC & PHCs, but case cards of

Sterilization register was not maintained in any visited PHC & CHC.

c) IUD Register is not maintained in PHC Suket and CHC Modak but consolidated register was

maintained in PHC Kanwas.

d) Nirodh and OP Registers were maintained in CHC Modak and PHC Kanwas but it was not

maintained in PHC Suket.

11. Other Important Observations and Suggestions:

a) Record keeping of all visited sub centre was found very poor. MO I/c may pay attention on this

aspect and all records may be kept up to date.

b) Cleanliness in the ward may be improved at the visited facilities.

c) It was observed that allotted fund was not utilized by the visited institutions in the respective years.

The district authority may ensure that the allotted fund like UF/AMG/VHSC may be utilized in the

same financial year.

d) It was observed that Cash book maintained by ANM at sub centre is not checked & verified.

e) Residential facilities must be available for MO & other staff at CHC & PHC for proper functioning

of 24 hour delivery service and staff of these institutions should stay at Hq. particularly at 24x7

service provider institution.

f) Serious attention must be given to remove the false reporting cases in spacing method.

g) The ASHA may keep all the service record and the concerned PHC I/c should review the record of

ASHA from time to time. The PHC I/c may ensure that beneficiaries should get the transport

amount form ASHA and the PHC I/c should also bring this in the knowledge of beneficiaries.

h) IEC display on most of the facilities particularly in Sub Centre was poor. Proper IEC display needs

to be ensured by highlighting priority areas.

*******

7. Nagaur District


Health & Family Welfare, Jaipur about evaluation work in Nagaur District

of Rajasthan State in the months of February, 2011.

29



Nagaur CHC: Jayal PHC: Rol & Basani.

Ratanga, Bugarda, Didiya Kalan, Surjaniyawas, Sadokan and Tausar.


1. Human Resources:

a) About 24% posts were vacant in the district. There are many categories of posts having vacancy

of more than 30% of the sanctioned strength. Details are as below:


Junior Specialist 60 42 18Gen. Surgeon 18 7 11Gynaecologist 9 5 4Paediatrician 8 5 3Anaesthesia 5 2 3Sr. medical Officer 31 22 9Medical Officer 135 128 7

Lab Technician 100 76 24

Pharmacist 7 1 6Staff nurse 41 33 8 LHV 116 76 40MPW(M) 76 59 17MPW(F) 797 608 189

b) In visited CHC Jayal, Post of SMO, 2 Male Nurse-I, one post each of Staff nurse and Ward boy

were vacant.

c) One post of GNM (under NRHM), one of each post of LHV, ANM and ward boy was vacant in

PHC Rol. In PHC Basani, only post of MO, AYUSH Doctor and 1 out of 3 sanctioned posts of

GNM (under NRHM) and Ward boy were vacant.

d) MPW (M) post was vacant at all visited sub centre.

2. Rogi Kalyan Samiti (RKS) &Village Health Sanitation Committee

(VHSC):

a) 107 RKS khown as Medical Relief Society (MRS) were constituted in the district and all were

functioning in visited facilities. Details regarding the meeting of MRS conducted in the district

was not made available to the team.

30

b) MRS was constituted at visited CHC, Jayal and PHCs at Rol and Basani. The meetings of MRS

were not conducted in these centres regularly.

c) In PHC Rol out of Rs. 25,626 available with MRS, Rs. 26,873 were spent in 2009-10. In the

current year out of Rs. 29,286, Rs. 15,726 were spent up to Jan. 2011. In 2009-10, Rs. 1,29,645

was available at by PHC Basani through MRS and Rs. 1,09,971 was spent. In the current year

2010-11, Rs. 1,51,010 were available at this PHC with MRS and Rs. 1,28,129 was spent up to Jan.

2011.

d) 1676 VHSC had been formed in the district, bank accounts opened by these VHSCs to handle the

funds.

e) The printed register for VHSC meetings proceedings was given to ASHA. ASHA noted the

proceeding of VHSC every month. Documentation of VHSC meetings was being maintained

properly at visited Sub Centre.

f) In the visited Sub Centres, ASHAs was functioning as a member of committee.

3. Service of Janani Suraksha Yojana (JSY):

a) Janani Suraksha Yojana was implemented in the district. Institutional deliveries were being

conducted at CHCs and PHCs level.

b) 19303, 38147, 39420, 41607 and 36426 institutional deliveries were reported to be conducted in

the year 2006-07, 2007-08, 2008-09, 2009-10 and 2010-11 (up to Jan, 2011) respectively which

shows increasing trend of institutional deliveries since inception of the scheme in the district.

c) During visit to CHC, PHC and Sub Centres in the district, it was observed that there was good

nos. of deliveries and the cash books were properly maintained at CHC/PHC. Proper cleanliness

was maintained at the Sub Centres and no pending JSY care for payment of this cash incentive

was found.

4. Functioning of ASHA scheme:

a) 2293 ASHAs have been selected against the target no. of 2684 for 1518 villages in the district.

1675 ASHAs received 4th module of training and 1333 equipped with drug kit.

b) During visit to the Sub Centre, ASHAs were observed to be accompanying with beneficiaries to

the hospital for delivery. They were preparing the list of adolescent girl of her area, recorded the

proceeding of the VHSC and informed the beneficiaries for VHND. ASHA did not prepare a

micro birth plan of her area.

c) It was noticed that no ASHA has been selected for the area of Sub Centre Sadokan

5. Untied funds:

31

a) In the visited Health centres, provision of untied fund and its expenditure are given below:-

Sl.No. Name of the visited centres

For the year 2009-10 For the year 2010-11

Amt. available

Expenditure Amt. available

Expenditure (upto Jan. 2011)

1 CHC Jayal 50,000 50,000 50,000 nil

2 PHC Rol 34,040 34,040 22,500 15,354

3 PHC Basani 30,374 30,374 22,500 12,776

4 SC Ratanga 27,574 27,489 10,000 4,764

5 SC Bugarda 28600 5000 33600 26100

6 SC Didiya Kalan 20443 13649 6243 94

7 SC Surjaniyawas 20496 16414 7856 6447

8 SC Sadokan 18492 13870 4622 2527

b) CHC Jayal was also provided Annual Maintenance Grant of Rs.1.0 lakh in 2009-10 and also there

was an opening balance of Rs. 83,831. Out of the available funds Rs.1,38,351 were spent and Rs.

49,980 were carried forward to current year. Rs.50,000 was provided in the current year and

Rs.52,946 was spent during current year (up to Jan. 2011).

c) PHCs at Basani and Rol also received Annual Maintenance Grant of Rs.50,000 per year during

financial year 2009-10 and 2010-11 and they had also balance funds of previous year. An amount

of Rs. 94,555 & Rs. 1600 was spent by PHC Rol in last year and current year. PHC Basani spent

Rs. 71,047 & 28,500 of AMG during last year and current year respectively.

6. 24 Hours Delivery Care Services:-

a) All 17 CHCs were functioning as 24x7 service providers in the district, out of which 10 were

declared as FRU. Similarly, out of 89 PHC, 54 were functioning as 24x7.

b) 50 and 60 percent of the total institutional deliveries were conducted in night hours at visited CHC

Jayal during year 2009-10 and 2010-11.There was shortage of Specialist and supportive staff in

this CHC. Similarly, more than 65 percent of the total institutional deliveries were conducted in

night hours at visited PHC Rol during year 2009-10 & 2010-11 and 50 and 64 percent of the total

deliveries were conducted in night hours at PHC Basani during 2009-10 and 2010-11.

7. Physical Infrastructure and Stock Position:

i. CHC Jayal:

32

a) It is 20 bedded CHC located in Govt. building with the facilities of regular water and electric

supply.

b) Blood Storage Unit was not available there.

c) Drugs position was found satisfactory. Neonatal Resuscitation equipment and Anaesthesia

equipments were available but Inj. Arteether and Quinine were not available.

ii. PHCs:

a) PHC Rol was lacking facility for New born care. There was no counter for condom at both the

visited PHCs Rol and Basani. The labour room needs improvement. Residential quarters for the

staff were not available in the PHCs.

b) At the visited PHCs Rol & Basani, the curtain for privacy for the patient and the complaint and

suggestion box were not available.

iii. HSCs:

a) Infrastructure of visited HSCs was satisfactory. Labour room was not available at Surjaniyawas,

Sadocan and Tausar Sub Centres.

b) Delivery table and Steam Sterilizer was available only at Bugarda Sub Centre.

c) Delivery kit was not available at Bugarda, Surjaniyawas and Tausar Sub Centres. IUD kit was not

available at Didiya Kalan.

d) Rapid diagnostics kit was not available at Ratanga, Bugarda, Tausar and Didiya Kalan Sub

Centres. Oral pills was not available at Sub Centres Ratanga, Surjaniyawas, Tausar and Sadocan.

Foot stool, Ambu bag, Bleeching powder and Condom were not available at the visited Sub

Centres. Kit-A & Kit-B were not available at Surjaniyawas, and Bugarda HSCs.

e) Items like Torch, Weighing Machine for Infant, Gloves, Disposable Syringe, Condom, Antiseptic

Solution, Bleaching Powder and Kits-A and B were not available in one or two Sub Centres

visited.

f) Additional ANM was not deployed at Sadokan, and Diviya Kalan Sub Centre. Mobile was

provided to all ANM. SBA training was not given to any ANM of the visited Sub Centres.

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

i. Services of ANM:

a) The team contacted 51 mothers having child up to one year of age in the area of visited centres.

All the mothers informed that ANM was available as per their need. Mothers were satisfied with

ANM work and their deliveries were conducted by trained persons.

b) 24 (47%) mother received three PNCs. 22 (43%) mothers knew about danger sign of ARI.

c) 29 (57%) mothers were aware about usage of ORS.

d) All contacted mothers were aware about contraceptive methods but only 11 (22%) mothers knew

about the advantage and side- effects of contraceptives.

33

e) All contacted mothers were aware of Government Health Facilities.

ii. Towards the service of PHCs:

The team contacted and interviewed some community members who generally utilised the services

at PHCs Rol and Basani. The people of these PHCs were not much satisfied with the services.

Respondent of both PHCs told that present human resources was not sufficient to make the PHC

functional as 24x7 hour service provider. Most of the people of Basani PHC were of the opinion

that Gynaecologist & Paediatrician may be appointed because the delivery load was very high in

this PHC.


a) The team selected 190 F.W. cases, out of which 142 (75%) F.W. acceptors could be contacted.

Discrepancy was observed in age of acceptors in 21 (15%) cases and in age of last child in 20

(14%) cases during field check.

b) 26 (Cu-T-11, OP-9 and Condom-6) told that F.W. services were not provided to them.

c) All 40 contacted sterilization acceptors received full amount of compensation.

d) 68 beneficiaries of child immunization were contacted out of them 8 beneficiaries did not confirm

receipt of Measles vaccine. No complication was found among the contacted beneficiaries.

10. Maintenance of Registers & records:

a) Eligible couple register, MCH Register and Stock registers were being maintained in the visited

PHCs Rol & Basani and CHC Jayal.

b) Consolidated Sterilization register was maintained, but case cards of Sterilization acceptors were

not maintained in visited PHC & CHC.

c) Nirodh and OP Registers were maintained in CHC Jayal and PHC Basani but it was not

maintained in PHC Rol.

d) It was observed from the Service Delivery Register (SDR) of the ANM of the visited HSCs that

most of the columns viz., Eligible Couple No. date of delivery, Place of delivery, Date of starting

of spacing methods, No. of IFA given, EDD and LMP etc were not filled. The authority should

issue the instructions to all HSCs to fill all the columns given in the SDR.


a) At CHC Jayal, in most of the cases the JSY payment was not made at the time of discharge. In

some cases the delay in JSY payment was more than 2 months. If the all formalities of JSY card

completed 7 to 10 days before expected date of delivery by the concerned ANMs/ASHAs, this

would help to issue the JSY cheque to the beneficiary at the time of discharge from the hospital.

b) It was observed that vaccination date mentioned in the immunization card was not matching with

the date mentioned for the same in the service register by ANM. It should be checked and

rectified.

34

c) Speedy action may be taken by the district authority to make the Blood Storage Unit functional at

CHC Jayal.

d) The supply of drugs from the district HQ to visited PHCs and CHC was found inadequate as per

their OPD & IPD requirement.

e) The information related to AYUSH treatment facility may be displayed in the premises of

institution so that it is known to the people and they can use it. List of available medicines should

also be displayed .

f) Cash book and Ledger maintained for expenditure of untied fund, VHSC fund and AMG at the

visited HSC were not checked by Accountant since, 2006.

g) Fake cases of the Cu-T, OP and Condom acceptors were observed reported during the verification.

It is suggested that sample verification of FW cases may be done monthly by State/District

authorities in order to reduce the fake cases and improving the quality of reported cases.

h) IEC material display on most of the facilities was very poor and it needs to be improved.

******

8. Barmer District


Health & Family Welfare, Jaipur about evaluation work in District of

Rajasthan State in the months of March, 2011.



C. Barmer CHC: Dhori Manna Alamsar, Konara, Kanasar & Chochara

35

PHC: Dhanau & Bhiyad


1. Human Resources:

a) The sanctioned in position and vacancy position of key posts is given below:-


JS Medicine 14 3 11

JS Surgery 14 1 13Paediatrician 4 1 3JS Ophthalmic 2 1 1Sr.Medical Officer 9 4 5

Medical Officer 110 84 26

Assistant Radiographer 9 2 7

Lab Technician 81 67 14

Sr. Lab Technician 1 0 1

Optholmic Assistant 9 4 5

MPW 95 62 33SMPW 18 5 13Male Nurse-I 21 17 4Male Nurse-II 225 200 25

Further, all the 4 sanctioned post of Gynaecologists, one post each of JS TB, Dentist and Dental

Technician and 2 sanctioned posts of Pharmacist were lying vacant in the district. District

authority should take urgent necessary steps to fillup these posts

b) In visited CHC Dhori Manna, 1 post of MO out of 3 and the post of Assistant Radiographer

were lying vacant.

c) Only post each of AYUSH Doctor, LHV, Ward boy and Sweeper were vacant in PHC Dhanau.

All sanctioned posts were filled up in PHC Bhiyad.

d) One ANM and one additional ANM were deployed in all visited Sub Centres.

2. Rogi Kalyan Samiti (RKS) &Village Health Sanitation Committee

(VHSC):

a) 84 RKS were constituted in the district. Details of the RKS meeting conducted were not available

in district office.

b) RKS was formed in visited CHC Dhori Manna, PHCs Dhanau and Bhiyad. But, it was found that

regular meetings of RKS were not being conducted.

36

c) Provision of RKS fund and its utilisation at CHC Dhori Manna was maintained properly.

However, PHC Dhanau did not use RKS fund properly. Rs.1,07,786 were provided in the year

2009-10, but no expenditure was incurred in the year. Rs 57,058 were provided in current year

2010-11 also and out of total available fund (including the unspent amount of 2009-10) Rs.

86,483 were spent till February, 2011.

d) 2319 VHSCs have been formed in the district. All VHSCs have ASHA as a member. The printed

register was provided to ASHA for recording the proceeding of VHSC in every month.

e) During visit to the Sub Centres, it was observed that VHSCs in the villages were formed but their

role in respect of sanitation activities was not satisfactory.

3. Services under Janani Suraksha Yojana (JSY):

a) Janani Suraksha Yojana was implemented properly in the district. Institutional deliveries were

being conducted at CHCs and PHCs level.

b) 7558, 12326, 24789, 35617 and 33454 institutional deliveries were conducted in the year 2006-07,

2007-08, 2008-09, 2009-10 and 2010-11 (up to February, 2011) respectively. This

shows increasing trend of institutional deliveries since inception of the scheme in the district.

c) During visit to CHC, PHC and Sub Centres in the district, it was observed that there were good

nos. of deliveries conducted in these institutes.

d) District authority received sufficient amount in JSY head in the year 2009-10 &2010-11 and

payment of JSY money was made to all beneficiaries though after more than a month. The cash

books were properly maintained at CHC Dhori Manna but not in PHCs Dhanau and Bhiyad.

4. Functioning of ASHA Scheme:

a) Against the target of 3025 ASHAs for 2464 villages in the district, there were 1660 ASHAs

selected. 1332 ASHAs received 5 module of training and had drug kits.

b) During visit to the Sub Centres, It was observed that ASHAs were accompanying with the

beneficiaries to the hospital for delivery. They did not prepare the list of adolescent girl of her area

except SC at Kanasar, recorded the proceeding of the VHSC and informed the beneficiaries about

VHND.

5. Untied Funds: a) In the visited Health centres, provision of untied fund and expenditure is given below:

37

Sl. No.

Name of the visited centres

For the year 2009-10 For the year 2010-11

Amt. available Expenditure Amt. available Expenditure (upto Feb.

2011) 1 CHC Dhori Manna 1,86,993 1,77,786 9207 53873*

2 PHC Dhanau 50,784 nil 50,784 1,30,972

3 PHC Bhiyad 25,000 8,657 16,343 11,735

4 SC Alamsar 11,578 11,130 10,448 379

5 SC Konara 11,240 10,000 11,240 4,532

6 SC Chochara 14,722 8,174 16,548 nil

7 SC Kanasar 20,700 7,560 23,140 7,650

* The excess amount of expenditure by the CHC Dhori Manna was not explained to the team.

b) CHC Dhori Manna was also provided Annual Maintenance Grant of Rs.1.0 lakh in 2009-10 and

out of which an amount of Rs. 36,039 was spent. No AMG was released for the current year

2010-11 and its opening balance was Rs. 63,961 out of which Rs.74,216* were spent during

current year (up to Feb. 2011).

c) PHCs at Dhanau and Bhiyad received Annual Maintenance Grant of Rs.50,000 per year during

financial year 2009-10 and 2010-11and they also had balance amount from last year. Out of total

available amount of Rs.1,00,000, an expenditure of Rs.36,039 was incurred by PHC Dhanau in

2009-10 and an expenditure of Rs.1,20,181 was incurred till Feb, 2010. During 2009-10 no AMG

was utilised by PHC Bhiyad and in current year 2010-11, AMG was not received and out of

opening balance an expenditure of Rs. 49489 was incurred up to Feb, 2011.

6. 24 x 7 Hours Delivery Care Services:-

a) 14 CHCs are functioning as 24x7 service centres in the district. Out of these, 7 CHCs were

declared FRU but functional blood storage unit was not available there. Similarly, out of 61 PHCs,

14 PHCs were declared as 24x7 service provider.

b) Visited CHC Dhori Manna was a FRU but it had no functional blood storage unit. The post of

Gynaecologist, Paediatrician, Anaesthetics and surgeon were vacant. Only Physician post was

filled up. In visited PHCs, infrastructure was not developed to operate them for 24x7 hours.

Doctors and other staff position was not as per norms of IPHS.

38

c) In the year 2009-10, 920 deliveries were conducted at the PHC Dhanau. In the current year, 982

deliveries were conducted at the PHC. The PHC was lacking facilities for new born care, the ward

facility was also not good at the PHC.

d) 320 deliveries were conducted at PHC Bhiyad in 2009-10. In the current year, 62 deliveries were

conducted at the PHC up to March, 2011.

7. Physical infrastructure and stock position:

i. CHC Dhori Manna:

a) It is a 30 bedded CHC located in Govt. building with the facilities of regular water and electric

supply.

b) Blood Storage Unit was not functional. There was shortage of residential quarters for the doctor

and Paramedical staff.

c) Drug availability was satisfactory. Anesthesia equipments and Inj. Arteether were not available

there. X-ray machine was available but the post of Radiographer was vacant.

d) The sick new born care unit was not available in the CHC.

ii. PHCs:

a) There was no water supply at PHC Dhanau. Oxygeon Cylinder and autoclave/steam sterilizer

were not available at PHC Dhanau. The labour room needed improvement at Dhanau and Bhiyad.

Residential quarters for the staff were not available in the PHCs.

b) The delivery load at both the PHCs was high. Both the PHCs were not fulfilling the requirement of 24

x 7 hour service regarding infrastructure and human resources. The duty chart was not available at

both the PHCs.

iii. HSCs:

a) All the visited Sub Centres were functioning in Govt. building. Labour room was not available at

Chochara and Konara Sub Centres.

b) Steam Sterilizer, Disposable Syringe and Infant Weighing Machine were not available at all Sub

Centres except HSC Kanasar.

c) Similarly, Ambu bag and Rapid Diagnostic Test Kit were not available at all the visited HSCs.

d) Delivery Kit & AD syringe were not available at Alamsar Sub Centre.

e) Thermometer was not available at Konara Sub Centre.

f) Kit-A and Kit-B were not available at Kanasar and Almasar Sub Centres.

Opinion and Knowledge of Community on overall Health Service:

i. Services of ANM:

a) The team contacted 31 mothers having child up to one year of age in the area of centres visited. 29

(94%) mothers informed that ANM was available when they needed most. Mothers were satisfied

with ANM work and their deliveries were conducted by trained persons.

b) 17 (55%) mothers received three PNCs. 18 (58%) mothers knew about danger sign of ARI.

39

c) 21 (68%) mothers were aware about usage of ORS.

d) 26 (83%) mothers were aware about contraceptive methods but only 6 (19%) mothers knew about

the advantage and side- effects of contraceptives.

e) All contacted mothers were aware of Government Health Facilities.

ii. Towards the service of PHCs:

The team contacted and interviewed some community members who generally utilise the services

at PHCs Danau and Bhiyan. The people of Bhiyan PHC were satisfied with service of the PHC

but the people of Dhanau PHC were not much satisfied with the services. Most of the people of

PHCs Danau and Bhiyan were of the opinion that vacant posts of Specialists/Paramedical staff

may be filled up for the improvement of services.


a) The team selected 123 F.W. cases, out of which 110 (89%) F.W. acceptors could be contacted.

Discrepancy was observed in age of acceptor in 11 (10%) cases and in age of last child in 8 (7%)

cases.

b) 16 (Cu-T-5, OP-6 and Condom-5) told that F.W. services were not provided to them.

c) All 31 contacted sterilization acceptors received full amount of compensation.

d) 34 Beneficiaries of child immunization were contacted and out of them 3 beneficiaries had not

received Measles vaccines. No complication was found among the contacted beneficiaries.

10. Maintenance of Register & Record:

a) Maintenance of records was found to be poor at all visited facilities. Most information was not

filled in by ANM in Service Delivery Registers (SDRs). No supervisory staff visited these

facilities to check their SDR in last three year.

b) Printed stock register was not available at all visited facilities.

c) Eligible couple register, MCH Register and Stock register was being maintained in both visited

PHCs Dhanau & Bhiyad and CHC Dhori manna.

d) Consolidated Sterilizationregister was maintained in all visited CHC & PHCs, but case cards for

Sterilization were not maintained in the visited PHC/ CHC.

e) IUD Register was not maintained in PHC Dhanau and CHC Dhori Manna but consolidated

register for IUD was maintained in PHC Bhiyad.

f) It was observed from the labour room register of the Dhanau PHC that most of the information of

pregnant women like time of admission, date & time of discharge were not filled.

g) Nirodh and OP distribution Registers were maintained in CHC Dhori Manna and PHC Bhiyad but

it was not maintained in PHC Dhanau.


a) Cash book of the visited facilities was not checked by the accountant posted under NRHM.

40

b) Major cause of delay in making JSY payment to beneficiaries was that the beneficiaries did not

bring the JSY card with complete formalities at the time of admission to the facility because the

ANM /ASHA not handed over the JSY card with complete formalities to the pregnant women

before 15 days of expected date of their delivery. The authority may issue instructions to all the

ANM/ASHA in this regard to avoid delay in JSY payment.

c) Separate Female ward facility was not available at the visited PHCs.

d) The X-ray facility was available at the CHC but the post of Radiographer was lying vacant for the

last 2 years.

(e) The verification of users of spacing method may be done every month by the LHV or the

supervisory officer to reduce the fake cases.

*******

Documents

Rajasthan State Jhunjhunu District Major observation of