hfa district report - keich

7/23/2019 HFA District Report - Keich

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Health Facility Assessment Balochistan

District Keich


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Acknowledgement

TRF acknowledges the cooperation and support of Contech International Health

Consultants, Lahore who worked on the assignment and authored the report. The final

reports were quality assured by Jennifer Sanchos, HLSP Health Systems Consultants, and

Ms. Pamela Sequeria, M & E Specialist TRF.

Disclaimer

This document is issued for the party which commissioned it and for specific purposes

connected with the above-captioned project only. It should not be relied upon by any other

party or used for any other purpose.

We accept no responsibility for the consequences of this document being relied upon by any

other party, or being used for any other purpose, or containing any error or omission which is

due to an error or omission in data supplied to us by other parties.

June 2012


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Table of Contents

List of Tables ................................................................................................................ iv

List of Figures .............................................................................................................. vi

Acronyms .................................................................................................................... vii

Executive Summary ...................................................................................................... 1

Section 1: Introduction ................................................................................................. 3

Survey Objectives ...................................................................................................... 3

Assignment Duration .................................................................................................. 3

Scope Of Hfa ............................................................................................................. 3

Report Organisation ................................................................................................... 4

Section 2: District Information ..................................................................................... 5Geographical Location ............................................................................................... 5

Administrative Setup .................................................................................................. 6

Demographic Information ........................................................................................... 6

Socioeconomic And Health Indicators ........................................................................ 6

Section 3: Health Facility Assessment Survey Findings............................................ 8

MNCH Services ......................................................................................................... 8

8/6 Preventive MNCH Services At BHU ................................................................ 924/7 Basic EmONC Services At RHC .................................................................. 12

24/7 Comprehensive EmONC Services at SHC Hospital .................................... 15

24/7 Basic EmONC Services at THQ Hospital..................................................... 19

Management Basics ................................................................................................. 20

Human Resource ................................................................................................ 20

Work Coordination And Supervision .................................................................... 23

Management Information System ........................................................................ 24

Drugs And Supplies ............................................................................................ 26

Fee For Services ................................................................................................. 27

Infection Control .................................................................................................. 29

Death Review ...................................................................................................... 31

Facility Utilisation ..................................................................................................... 31

Well Baby Clinic ....................................................................................................... 34

Donor Contribution ................................................................................................... 34

Clients Perspective .................................................................................................. 35

Procurement Estimates ............................................................................................ 37


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Equipment ........................................................................................................... 37

Civil Works .......................................................................................................... 37

Section 4: Key Findings ............................................................................................. 39

Infrastructure ............................................................................................................ 39

Human Resource ..................................................................................................... 39

Equipment ................................................................................................................ 40

Drugs And Supplies ................................................................................................. 40

Support Services ...................................................................................................... 41

Management Basics ................................................................................................. 41

Donor Contribution ................................................................................................... 42

Clients Perspective .................................................................................................. 42

Annexes ....................................................................................................................... 43

Annex 1: District Health Department ......................................................................... 44

Annex 2: Input Criteria For MNCH Services .............................................................. 50

Annex 3 A: Status of Surveyed HF Against Minimal Level of Inputs .................... 63

Annex 3 B: List of Items Required .......................................................................... 69

Annex 4: Scope of Civil Works Required .................................................................. 79


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List of Tables

Table 1.1: Scope of HFA ................................................................................................ 4

Table 2.1:Demographic profile ....................................................................................... 6

Table 2.2: Population groups .......................................................................................... 6Table 2.3: Socio-economic and health indicators ............................................................ 7

Table 3.1: Status of assessed infrastructure in BHU ..................................................... 10

Table 3.2: Status of MNCH related staff in BHU ........................................................... 10

Table 3.3:Status of functional equipment in BHU ......................................................... 11

Table 3.4:Status of drugs and supplies in BHU............................................................ 11

Table 3.5: Status of support services in BHU................................................................ 11

Table 3.6:Status of assessed infrastructurein RHC...................................................... 12Table 3.7: Status of MNCH related staff in RHC ........................................................... 13

Table 3.8:Status of functional equipment in RHC ........................................................ 14

Table 3.9: Status of drugs and supplies in RHC ........................................................... 14

Table 3.10:Status of support services in RHC ............................................................. 15

Table 3.11:Status of assessed infrastructure in DHQ hospital .................................... 15

Table 3.12:Status of MNCH related staff in DHQ hospital ............................................ 18

Table 3.13:Status of functional equipment in SHC hospital.......................................... 18

Table 3.14:Status of drugs and supplies in SHC hospital ............................................ 19

Table 3.15:Status of support services in SHC hospital ................................................ 19

Table 3.16: Status of HR at SHC hospital ..................................................................... 20

Table 3.17: Status of HR at RHC .................................................................................. 20

Table 3.18:Status of HR at surveyed BHU ................................................................... 21

Table 3.19:Reasons of non-availability of HR at RHC.................................................. 22

Table 3.20: Reasons of non-availability of HR on 24/7 basis at SHC hospital ............... 22

Table 3.21:Capacity building of MNCH related staff .................................................... 22

Table 3.22: Status of coordination and supervision ...................................................... 23

Table 3. 25:Status of MIS ............................................................................................. 24

Table 3.24: Reasons for stock out reported by surveyed facilities................................. 26

Table 3.25: Status of fee for service ............................................................................. 28

Table 3.26: Mechanisms of social protection available ................................................. 29

Table 3.27: Status of infection control & waste management practices ........................ 30

Table 3.28:Status of death reviews .............................................................................. 31

Table 3.29: Status of services utilisation ....................................................................... 31


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Table 3.30: Average monthly MNCH services provided ................................................ 32

Table 3.31: Average monthly FP services provided ...................................................... 33

Table 3.32:Status of WBC established ........................................................................ 34

Table 3.33: Status of donor contribution ....................................................................... 34

Table 3.34:Clients perspective .................................................................................... 36

Table 3.35: Summary of estimated cost for procurement of equipments & civil works .. 38

Table 2.4: Number of public sector health facilities in the district .................................. 44

Table 2.5: Human resourse in office of DHO ................................................................ 44

Table 2.6:Availability of MNCH services staffing in district Keich ................................. 45

Table 2.7: Financial allocation in district Keich.............................................................. 46

Table 2.8:NMNCHP monitoring indicators (year 2010) ................................................ 47

Table 2.9: Number of facilities with staff provided by the NMNCHP .............................. 48

Table 2.10: Number of staff trained on delivering MNCH services ................................ 49

Table 2.11:Status of CMW training and deployment .................................................... 49

i. Status of assessed infrastructure in BHU ................................................................ 63

ii. Status of MNCH related staff in BHU ...................................................................... 63

iii. Status of functional equipment in BHU.................................................................... 63

iv. Status of drugs and supplies in BHU ...................................................................... 63

v. Status of support services in BHU ........................................................................... 64

i. Status of assessed infrastructure in RHC ................................................................ 64

ii. Status of MNCH related staff in RHC ..................................................................... 65

iii. Status of functional equipment in RHC ................................................................... 65

iv. Status of drugs and supplies in RHC ...................................................................... 66

v. Status of support services in RHC .......................................................................... 66

i. Status of assessed infrastructure in SHC hospital ................................................... 66

ii. Status of MNCH related staff in SHC hospital ........................................................ 67

iii. Status of functional equipment in SHC hospital ...................................................... 67

iv. Status of drugs and supplies in SHC hospital ......................................................... 68

v. Status of support services in SHC hospital ............................................................. 68


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List of Figures

Figure 1:Map of Keich ................................................................................................... 5

Figure 2:Range of services that signal fully functional MNCH services.......................... 8

Figure 3:Status of management basics ....................................................................... 21

Figure 4:Level of satisfaction with examination and attitude of staff ............................ 37

Figure 5:Availability of medicines and lab services ...................................................... 37


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ACRONYMS

ANC Antenatal Care

AVD Assisted Vaginal Deliveries

BB technician Blood Bank TechnicianBHU Basic Health Unit

CBA Child bearing age

CEI Client Exit Interview

CH Civil Hospital

CMW Community Midwives

CWAQ Civil Works Assessment Questionnaire

CDC Communicable Disease Control

DCO District Coordination Officer

DDCT District Data Collection TeamsDHO District Health Officer

DHDC District Health Development Centre

DHIS District Health Information System

DHQH District Headquarter Hospital

DLQ District Level Questionnaire

EDOs Executive District Officers

EmONC Emergency Obstetric and Newborn Care

ENC Emergency Newborn Care

EAQ Equipment Assessment QuestionnaireEPI Expanded Programme of Immunisation

FP & PHC Family Planning and Primary Health Care

HF Health Facilities

HFA Health Facility Assessments

HID Health Institution Database

HIV Human Immunodeficiency Virus

HMIS Health Management Information System

HR Human Resource

IDI EDOH In-depth Interview of EDO HealthIMNCI Integrated Management of Neonatal and Childhood Illnesses

IMPAC Integrated Management of Pregnancy and Childbirth

JD Job Description

LHS Lady Health Supervisor

LHV Lady Health Visitor

LHW Lady Health Worker

MDGs Millennium Development Goals

M&E Monitoring and Evaluation

MICS Multiple Indicator Cluster Survey

MIS Management Information System


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MNCH Maternal, Neonatal and Child Health

MO Medical Officer

NMNCHP National Maternal Newborn and Child Health Programme

NVD Normal Vaginal Deliveries

OBGYN Obstetrics and GynaecologyOPD Out Patient Department

OT Operation Theatre

PC-1 Planning Commission Proforma 1

PDHS Pakistan Demographic and Health Survey

PNC Post natal care

PPHI Peoples Primary Health care Initiative

PSLM Pakistan Social & Living Standards Measurement Survey

RHC Rural Health Centre

SBA Skilled Birth AttendantsSD&MB Service Delivery and Management Basics

SE Socioeconomic

SHC hospitals Secondary health care

SPSS Statistical Package for the Social Sciences

TA Technical Assistance

THQ Tehsil Headquarter hospital

TRF Technical Resource Facility

TT Tetanus Toxoid

WMO Women Medical OfficerWBC Well Baby Clinics


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District Report - Keich

1

Executive Summary

Health Facility Assessment 2011 (HFA) is aimed at assessing the availability, functioning,

and quality of health care services in public sector health facilities with a focus on maternal,

new-born and child health services. This report provides the findings of the HFA for eachsurveyed health facility in the district. It is baseline information for the district and the

National Maternal New-born and Child Health Programme (NMNCHP), to set performance

benchmarks and realign activities for bridging the gaps existing in Maternal New-born and

Child Health (MNCH) services for achieving the objectives of the programme.

The HFA started in October 2010 and completed in May 2011. Contech accomplished the

assignment in a participatory way by maintaining constant liaison with the entire key

stakeholder. Nineteen (19) health facilities were assessed in District Keich,

including 1 DHQhospital, 11 RHC and 7 BHU. The BHU were assessed for availability of 8/6 Preventive

MNCH services; RHC were assessed for availability of 24/7 Basic EmONC services; and

DHQ Hospital was assessed for availability of 24/7 Comprehensive EmONC services. An

assessment criterion was formulated to ascertain gaps in availability of inputs1, including

Infrastructure; Human Resource (HR); Drugs and Supplies; Equipment; and Level specific

support services. Summarised HFA findings (detailed findings are given in Section 4) of

HFA, are as follows:

In infrastructure, major gaps existed in availability of labour room at all BHU and 4 RHC,

female ward at RHC Gomazai, RHC Gower Koop and RHC Bal Nigor;LHV residence at

all BHU, 3 RHC

Regarding HR, required number of WMO were not available at all RHC except RHC

Dasht Khudan; required number of LHV were present at 6 RHC; and major gaps were

related to gynaecologist, anaesthetist, anesthesia technician and OT technician at

DHQH

Majority of the required equipment items were not available at the surveyed health

facilities, although complete range of items was not available at any of the facility

Drugs, Supplies, Vaccines and FP commodities were assessed using facility specific list

of tracer items for their availability on the day of survey and stock-out status during last

1

1 (1) ; ,

.

3 A 1


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2

one month. Majority of the items were available at the RHC and DHQ Hospital, but most

of the required items were not available at the surveyed BHU.The most common reason

for stockout of drugs was poor quantification and delayed supply

Level specific required items for delivery of support services were assessed at the

surveyed health facilities. In District Keich, both DHQH and RHC were provided with

majority of items for delivering support services, however, gaps existed at BHU.

Management basics assessed at the surveyed facilities included availability of job

description and service delivery protocols, work coordination and supervision, MIS, infection

control practices, death reviews of maternal and neonatal deaths, fee for services and

available mechanisms of social protection, and facility utilisation of MNCH services

Majority of the health facilities were conducting regular performance review meetings but

its record was not maintained

Health Management Information System (HMIS) was being practiced in the District Keich

and HMIS tools were available at all surveyed health facilities but not maintained

properly at the surveyed facilities

Major gaps existed in availability of materials for infection control measures

Review of maternal and neonatal deaths was not conducted as death review committee

was not available at any health facility

No Well Baby Clinic established in any of the facilities except at DHQH Keich.

In order to assess the perceptions of the clients, a total of 65 Client Exit Interviews were

conducted in the DHQH and RHC. Clients perspective on quality of care revealed that

majority of the clients were satisfied with the care provided at the public facilities.

Findings of the HFA at all levels revealed significant gaps in the required inputs for provision

of quality MNCH services. This warrants immediate need to bridge these gaps in order to

improve the MNCH services.


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Section 1: Introduction

This section includes survey objectives, its scope and duration, and organisation of the

District Report

Survey Objectives

The HFA was aimed at assessing the availability, functioning, and quality of health care

delivery system in the public sector facilities with a focus on maternal, new-born and child

health services.

Specific objectives of the HFA were:

To assess the health facility status and quality of MNCH services (Comprehensive and

Basic EmONC, Preventive MNCH and Family Planning) at district level

To assess clients satisfaction and perception of MNCH services

To provide information for systematic planning for procurement and supply of goods and

commodities (listing the medical equipment and instruments which needs to be replaced

or purchased); and

To update and assess the contributions made by the development partners for improving

MNCH and FP services in the selected districts

Assignment Duration

Estimated duration of the assignment was 7 months. The assignment started in October

2010 and completed in May 2011.

Scope of HFA

The survey included District Headquarter Hospital (DHQH), Tehsil Headquarter Hospital

(THQH), Rural Health Centres (RHC) and 20% of Basic Health Units (BHU) randomly

selected within the district. Selection of the BHU was through geographical stratification on

the basis of proportionate distribution. Client exit interviews were conducted at the surveyed

facilities (10 at DHQH, 5 at each THQH and RHC), excluding BHU. Table 1.1 shows the

number of health facilities in the district and health facilities surveyed.


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TABLE 1.1:SCOPEOF HFA

District KeichNumber of Health Facilities by type

DHQH THQH RHC BHU Total

Number of facilities listed by HID 1 0 11 36 48

Number of facilities surveyed 1 0 11 7 19

Report Organisation

HFA District Report has been structured in four sections. While the introduction to the

survey, its scope and methodology is described in Section 1, Section 2 District Information

contains information collected from the District Health Department using DLQ as well as the

secondary data sources and it comprises of demographic, economic and education relatedinformation of the district as well as the organisation of health care delivery system in the

district. This section also includes information about the monitoring indicators of National

MNCH Programme.

Details of the assessment are contained in Section 3 HFA Findings. This section presents

information about NMNCHP analytical framework indicators, status of the MNCH service

availability based on optimal level of inputs including infrastructure, human resource,

equipment, drugs and supplies and availability of support services. Information onmanagement basics like work coordination, MIS etc., is also contained in this section. The

information presented in this section gives snapshot in time of the surveyed health facilities.

At the end information about the satisfaction and perspective of the clients on the MNCH

services provided at the public sector health facilities. Section 4 comprises of key findings of

HFA at district level.


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.

Section 2: District Information

This section includes district brief, information on demographic, socioeconomic and health

indicators. It also contains information on health resources and NMNCHP indicator compiled

at district level. The data sources of the information are DHO office using District Level

Questionnaire (DLQ) and published documents. The information collected from DHO office

may not match with subsequent tables containing similar information collected from

respective health facilities included in survey.

Geographical Location

District Keich is in the northwest of province Balochistan having 22,539 km 2 areas. The

whole population has always been rural. A small portion of the population is residing in urban

areas. The main Baloch tribes in the district are the Gichki, Pogh, Naushervani, Buledai Mir,

Hoth, Khushk, Rais, Rind, Sangur, Lundi, Kattawar, Kalyar, Kaunda, Bizanjo and Darzada.

Tump is very famous tehsil of district Keich, there are so many villages and union council in

Tump after the Turbat tehsil; tump tehsil is beginning from Hothabad village and going end

last border of Iran called Mand. District Kech is connected to adjacent districts and the

provincial capital through a network of roads and rail.

FIGURE 1: MAPOF KEICH


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Administrative Setup

Like other districts in the province, district Keich is headed by Deputy Commissioner (DC)

assisting the Divisional Commissioner and is accountable to him. The DC is appointed by

the provincial government from the Federal or Provincial Civil Service.

Demographic Information

TABLE2.1:DEMOGRAPHICPROFILE

Indicators Value Indicators Value

Total Population (thousands) 432,569 Urban Population 17%

Population of Tehsil Turbat 205,753 Rural Population 83%

Population of Tehsil Buleda 79,250Population density (persons

per sq.km)19

Population of Tehsil Dashat 67,866Sex ratio (number of males

over 100 females) at birth108

Population of Tehsil Tump 91,304

SOURCE:HMISCELLDHOOFFICE

TABLE2.2:POPULATIONGROUPS

PopulationGroups

StandardDemographic

(%)

Estimatedpopulation

PopulationGroups

StandardDemographic

(%)

Estimatedpopulation

Under 1 year 2.7011,679

Women 15-49years

22.0095,165

Under 5 years 13.4057,964

Married WomenChild Bearing

Age (CBA)16.00

69,211Under 15

years 41.97 181,549 Pregnant women 3.40 14,707Expected Births 2.9 12,545

SOURCE:PDHS2006-07

Socioeconomic and Health Indicators

Selected Socio-Economic (SE) and health indicators are given in the table 2.3. The sources

include, Pakistan Demographic and Health Survey (PDHS) 2006-7, Pakistan Social and

Living standards Measurement Survey (PSLM) 2008-09, Immunisation Coverage Evaluation

Survey Pakistan (CES) 2006-7, District EPI Cell.


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TABLE 2.3:SOCIO-ECONOMIC ANDHEALTH INDICATORS

Indicators Value Indicators Value

District Specific figures PSLM 2008-09

Literacy rate 52%

Malnutrition*

Women

Children

- % children


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Section 3: Health Facility Assessment Survey

Findings

MNCH Services

The packages of MNCH services assessed include Preventive MNCH services at BHU,

Basic EmONC services at RHC and Comprehensive EmONC services at THQ and DHQ

hospitals2. The range of MNCH services are given below.

FIGURE 2: RANGEOF SERVICES THATSIGNAL FULLYFUNCTIONAL MNCHSERVICES

2 NMNCHP PC -1

BHU: Facility

available for

RHC: Facility

available for

DHQ/THQ

Hospitals: Facility

available for

8/6 Preventive

MNCH Services

Antenatal checkup

Lab (Anemia,

Malaria, pregnancy

test, urine test for

sugar & Protein)

Normal delivery

Family planning

services (at least 3

methods)

TT immunisation

EPI vaccination

Growth monitoring

Nutrition counseling

HR (at least oneLHV or Doctor)

24/7 Basic EmONC

Services

Parenteral

antibiotics

Parenteral oxytocic

drugs

Parenteral

anticonvulsants for

pregnancy induced

convulsions (due to

hypertension)

Manual removal of

placenta

Removal of

retained products

Assisted vaginal

delivery (vacuum

extraction, forceps)

Newborn

resuscitation+

Post abortion care

HR (skilled female

providers-WMO

and LHV), and

Preventive MNCH

24/7

Comprehensive

EmONC services

Surgery (C-section)

Blood transfusion

Newborn care

(resuscitation &

incubator)

+

Gynaecological

care

Comprehensive

family planning

services including

sterilisation

HR (skilled staff for

conducting, C-

section, blood

transfusion and

anaesthesia),

and

Preventive MNCH

and Basic EmONC


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Functional capacity of health facilities were assessed against 5 specified inputs, which

include:

1. Infrastructure

2. Human Resource

3. Drugs and Supplies

4. Equipment

5. Level specific support services

Health facilities assessment findings are presented against two levels of inputs including:

1. Optimal level of Inputs are those proposed in the PC-1 of the National MNCH

Programme, required to make a health facility fully functional for provision of level

specific package of MNCH services.

Optimal level of inputs provides a strategic norm upon which gaps are identified and

up-gradation are proposed for improving accessibility of quality MNCH services

through development and implementation of an integrated and sustainable MNCH

programme at all levels of the health care delivery system.

2. Minimal level of Inputs, which are bare minimum requirement of the inputs, required for

delivering the package specific MNCH services at the health facilities.Findings related

to minimal level of inputs are given as Annex 2.

Following tables present the status of assessed facilities for availability of the optimal

level of inputs

8/6 Preventive MNCH Services at BHU

BHU operating within District Keich were assessed for provision of Preventive MNCH

services available for 8 hours a day, 6 days a week (8/6). Seven BHU were assessed for

availability of optimal level of inputs as summarised in Tables 3.1 - 3.5 by individual BHU.


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TABLE 3.1:STATUS OF ASSESSED INFRASTRUCTURE IN BHU

*THEBHUDASHAT, ANDBHUKUNCHITY AREAFFECTED BY FLOOD.

Doctor or LHV is required for provision of Preventive MNCH Services.Status of assessed

BHU for availability of Human Resource (HR) (both regular posted and provided by

NMNCHP),against the required number mentioned in PC-1 of NMNCHP is presented below:

TABLE 3.2:STATUS OF MNCHRELATED STAFF IN BHU

Equipment items (general items, equipment for OPD and LHV room) for BHU are listed in

PC-1 of NMNCHP. Status of functional quantity of these items at assessed BHU is

presented below:

Infrastructure Status

Status of building components at Surveyed BHU

BHUDastuk*

BHUGawak

BHUKohad

BHUBalgather

BHUGokdan

BHUDrachkoo

BHUKunchity*

OPD1. Consultation

area

A Y Y Y Y Y Y Y

F N N Y N Y N N

2. Examinationarea

A N N N N N N N

F N N N N N N N

3. Hand washingA N N N N N N N

F N N N N N N N

LHV Room1. Consultation

area

A Y Y Y Y Y Y Y

F N N Y N Y N N2. Examination

area

A N N N N N N N

F N N N N N N N

3. Hand washingA N N N N N N N

F N N N N N N N

Labour room1. Delivery room

A N N N N N N N

F N N N N N N N

2. Scrub areaA N N N N N N N

F N N N N N N N

3. Patient washroom

A N N N N N N N

F N N N N N N N

ResidenceDoctor

A N N N N N N N

F N N N N N N N

ResidenceLHV

A N N N N N Y Y

F N N N N N N N

Staffcategories

Requirednumber

Number of MNCH related staff available at each BHUBHU

Dastuk

BHU

Gawak

BHU

Kohad

BHU

Balgather

BHU

Gokdan

BHU

Drachkoo

BHU

Kunchity

WMO 1 0 1 1 0 2 1 1

LHV 1 0 1 1 0 1 0 0


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TABLE 3.3:STATUS OF FUNCTIONAL EQUIPMENT IN BHU

List of essential drugs and supplies for MNCH services is contained in PC-1 of NMNCHP.

Tracer items were selected from the list (Annex 1) for assessing their availability at surveyed

facilities. Status of surveyed BHU regarding available quantity of tracer items is presented

below:

TABLE3.4:STATUS OF DRUGS ANDSUPPLIES IN BHU

Facility for basic laboratory tests (test strips and HR) was assessed at surveyed BHU and

their status is presented below

TABLE 3.5:STATUS OF SUPPORTSERVICES IN BHU

Equipment

TotalItems

required

at eachBHU

Number of functional equipment items available at each surveyedBHU

BHU

Dastuk

BHU

Gawak

BHU

Kohad

BHU

Balgather

BHU

Gokdan

BHU

Drachkoo

BHU

Kunchity

General items 3 0 0 0 0 0 0 0

OPD 14 1 2 2 2 6 6 5

LHV Room 12 5 9 3 0 8 0 0

Item groups

T

otalItems

r

equiredat

eachBHU Number of items available at each surveyed BHU

BHU

Dastuk

BHU

Gawak

BHU

Kohad

BHU

Balgather

BHU

Gokdan

BHU

Drachkoo

BHU

Kunchity

Supplies 6 4 2 5 4 3 3 3

Drugs 12 10 9 11 8 10 6 7

Vaccines 5 0 0 0 0 1 0 0

FPCommodities

6 0 0 4 0 0 0 0

Supportservices

TotalItems

required ateach BHU

Number of items available at each surveyed BHU

BHU

Dastuk

BHU

Gawak

BHU

Kohad

BHU

Balgather

BHU

Gokdan

BHU

Drachkoo

BHU

Kunchity

Basic labtests

2 0 1 1 0 1 1 1


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24/7 Basic EmONC Services at RHC

RHC operating within District Keich were assessed for provision of Basic EmONC services

available for 24 hours a day, 7 days a week (24/7). Eleven RHC were assessed for

availability of optimal level of inputs as summarised in Tables 3.6 - 3.10 by individual RHC.

Infrastructure of the RHC has been assessed for availability of OPD, indoor ward, LHV room,

labour room and clinical laboratory as service provision areas and residences for

accommodation of required staff. Service provision areas have been assessed as single

room having facilities like consultation, examination and hand washing etc., as contained in

table below. Findings are presented as status of building components available and

functional:

TABLE 3.6:STATUS OF ASSESSED INFRASTRUCTURE IN RHC


Status of building components at each RHC

RHCBuleda

RHCGomazai

RHCMand

RHCTump

RHCGower

Koop

RHCKalatak

RHC

Nasirabad

RHCPidark

RHCBal

Nigore*

RHC

Khudan

RHCZaring

Bag

OPD

1. Consultationarea

A Y Y Y Y Y Y Y Y Y Y Y

F Y Y Y Y Y Y Y Y Y Y Y

2. Examinationarea

A N N N N N N Y N N N N

F N N N N N N Y N N N N

3. Handwashing

A N N N N N N N N N N N

F N N N N N N N N N N N

Female ward1. Patient area

A Y N Y Y N Y Y Y N Y Y

F N N Y Y N N Y N N Y N

2. Patient washroom

A Y N Y Y N Y Y Y N Y Y

F N N N N N N N Y N N N

Labour room

1. Deliveryroom

A Y N Y Y N N Y Y N Y Y

F Y N Y N N N N N N Y N

2. Scrub areaA N N N N N N N N N N Y


3. Patient washroom

A Y N Y Y N N Y Y N Y Y

F N N N N N N Y Y N Y Y

Clinical lab.1. Laboratory

room

A Y Y Y Y N Y Y Y N Y Y

F Y Y N Y N Y Y N N N Y

2. Working areaA N N N N N N N N N N Y


3. Pt. washroom

A Y Y Y Y N Y Y Y N Y Y

F N N Y Y N Y Y Y N N Y

LHV Room1. Consultation

area

A Y Y Y Y Y N N N Y N Y

F Y N Y Y N N N N N N N


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Status of building components at each RHC

RHCB

uleda

RHCGo

mazai

RHCM

and

RHCT

ump

RHCG

ower

Koop

RHCKalatak

RH

C

Nasirabad

RHCP

idark

RHC

Bal

Nigo

re*

RHC

K

hudan

RHCZ

aring

Ba

g

2. Examinationarea

A Y N N N N N N N N N N

F Y N N N N N N N N N N

3. Handwashing

A N N N N N N N N N N N


ResidenceDoctor

A N N Y Y Y N Y N Y Y Y

F N N N N Y N N N N N N

ResidenceLHV

A N N Y Y N Y Y N Y Y Y

F N N Y N N N N N N N N

*THERHC BALNIGORE IS AFFECTED BY FLOOD

PC-1 of NMNCHP contains category and number of staff required for Basic EmONC

services. Status of RHC for availability of HR (both regular posted and provided by

NMNCHP), against required numbers is presented in table below:

TABLE 3.7:STATUS OF MNCHRELATED STAFFIN RHC

Equipment items for various service components at RHC are listed in PC-1 of NMNCHP.

Status of functional quantity of these items at RHC, is presented in the table below:

Staffcategories

Requirednumberat

eachRHC

Number of MNCH related staff available at each RHC

RHCBuleda

RHCGomazai

RHCMand

RHCTump

RHCGowerKoop

RHCKalatak

RHCNasirabad

RHCPidark

RHCBalNigore

RHC

Khudan

RHCZaringBag

WMO 2 0 0 0 0 0 0 0 0 0 2 0

LHV 2 7 0 2 1 1 2 4 3 1 0 0

Labtechnician

1 1 1 1 1 0 1 1 1 0 1 1

OTtechnician

1 1 1 1 1 0 1 0 1 0 0 0

Ambulancedriver

1 1 0 0 1 0 0 1 0 1 1 0


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14

TABLE 3.8:STATUS OF FUNCTIONAL EQUIPMENTIN RHC



facilities. Status of surveyed RHC regarding available quantity of tracer items is presented

below:

TABLE 3.9:STATUS OF DRUGS ANDSUPPLIES IN RHC

Facility for support services including basic laboratory tests (space, test strips and HR) and

ambulanceservices (functional vehicle and driver) was assessed at surveyed RHC.

Availability status of these services at RHC is presented below:

Equipment

TotalItems

requiredateach

RHC

Number of functional equipment items available at each RHC

RHCBuleda

RH

CGomazai

R

HCMand

R

HCTump

RHCGower

Koop

RH

CKalatak

RHC

N

asirabad

RHCPidark

RHCBal

Nigore

RH

CKhudan

RHCZaring

Bag

Generalitems

4 0 0 0 0 0 0 0 0 0 0 0

Femaleward

9 6 0 8 6 0 0 6 0 0 2 3

WMO OPD 15 10 8 10 2 0 0 10 0 0 10 9

Labourroom

19 12 0 10 8 0 0 0 0 0 5 16

LHV Room 10 7 0 7 7 6 5 6 6 0 0 7

Item groups

TotalItems

requiredateach

RHC

Number of items available at each RHC

RHCBuleda

RHCGomazai

RHCMand

RHCTump

RHCGower

Koop

RHCKalatak

RHCNasirabad

RHCPidark

RHCBalNigore

RHC

Khudan

RHCZaringBag

Supplies 6 2 4 6 5 3 4 6 2 3 6 4

Drugs 18 11 10 12 13 13 14 15 14 15 13 11

Vaccines 5 4 5 5 5 0 5 5 5 5 5 4

FPCommodities

6 4 0 3 4 0 3 2 0 2 2 1


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15

TABLE 3.10:STATUS OF SUPPORTSERVICES IN RHC

24/7 Comprehensive EmONC Services at SHC Hospital

DHQ Hospital operating within District Keich was assessed for provision of Comprehensive

EmONC services available for 24 hours a day, 7 days a week (24/7). DHQ Hospital was

assessed for availability of optimal level of inputs as summarised in Tables 3.11 - 3.15.

Infrastructure of the DHQ hospital has been assessed for availability of OPD, indoor wards,

LHV room, labour room, operation theatre, paediatric nursery, blood bank, ultrasound room

and clinical laboratory as service provision areas and residences for accommodation of

required staff. Service provision areas have been assessed for availability of essential space

in respective areas e.g., consultation area, examination area and hand washing in OPD;

patient area, nursing station, store rooms and attached washrooms in indoor wards, etc., as

contained in table below. Findings are presented as status of building components available

and functional:

TABLE 3.11:STATUS OF ASSESSED INFRASTRUCTURE IN DHQHOSPITAL

Supportservices

TotalItemsrequired

ateachRHC

Number of items available at each RHC

RHCBuleda

R

HCGomazai

RHCMand

RHCTump

RHCGowerKoop

R

HCKalatak

RHCNasirabad

RHCPidark

RH

CBalNigore

R

HC

Khudan

RH

CZaringBag

Basic labtests

8 4 4 4 5 4 6 6 5 4 3 7

Ambulanceservice

2 0 0 0 1 0 0 1 0 1 1 0

Infrastructure StatusAvailability of building components

DHQH Keich

OPD:

1. Consultation area

A Y

F Y

2. Examination areaA Y

F Y

3. Privacy of examination areaA N

F N

4. Hand washingA N

F N

Female ward:

1. Patient area

A Y

F Y

2. Nursing stationA Y

F Y


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16

3. Patient wash roomA Y

F Y

4. Store for general itemsA N

F N

5. Store for equipmentA N

F NLabour room:

1. Delivery room

A Y

F Y

2. Preparation /stage roomA Y

F Y

3. Scrub areaA Y

F Y

4. Staff duty roomA N

F N

5. Patient wash roomA Y

F Y

6. Staff wash roomA Y

F Y

7. Store for general itemsA N

F N

8. Store for equip.A N

F N

Operation theatre:

1. Patient preparation room

A N

F N

2. Operating roomA Y

F Y

3. Recovery roomA N

F N

4. Scrub areaA Y

F Y

5. Sterilisation areaA N

F N

6. Doctors roomA Y

F Y

7. Support staff duty roomA N

F N

8. Store for general items A N

F N

9. Store for equipmentA N

F N

10. Attached washroom for staffA N

F N

Paediatrics ward:

1. Patient area

A Y

F Y

2. Nursing stationA Y

F Y

3. Store for generalitems/drugs or equip.

A N

F N

4. Patient wash room A YF N

Paediatric nursery: A Y


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17

1. Patient area F Y

2. Nursing stationA N

F N

3. Store for generalitems/drugs or equip.

A N

F N

4. Change room/areaA NF N

Clinical lab.:

1. Laboratory room

A Y

F Y

2. Working areaA Y

F Y

3. Doctors duty roomA Y

F Y

4. Store for general reagents orequip.

A Y

F Y

5. Attached wash room A YF Y

Blood bank:

1. Blood collection room

A Y

F Y

2. Working areaA Y

F Y

3. Staff duty roomA N

F N

4. Store for general reagents orequip.

A N

F N

5. Attached wash room

A Y

F Y

LHV Room:

1. Consultation area

A Y

F Y

2. Examination areaA Y

F Y

3. Privacy for examinationA N

F N

4. Hand washing facilityA N

F N

Ultrasound room:

Examination area

A Y

FY

Residence:

Gynaecologist

A Y

F N

Residence:

Anaesthetist

A Y

F N

Residence:

Paediatrician

A Y

F N

Residence:

WMO

A Y

F N

Residence:

LHV

A Y

F N

Residence:

Nurses

A Y

F Y


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18

PC-1 of NMNCHP contains category and number of staff required for Comprehensive

EmONC services. Status of DHQ hospital for availability of HR (both regular posted and

provided by NMNCHP), against required numbers is presented in table below:

TABLE 3.12:STATUS OF MNCHRELATEDSTAFFIN DHQHOSPITAL

Equipment items for various service components at DHQ hospital are listed in PC-1 of

NMNCHP. Status of functional quantity of these items at SHC hospitals, is presented in the

table below:

TABLE3.13:STATUS OF FUNCTIONAL EQUIPMENTIN SHCHOSPITAL

Residence

Lab technician

A N

F N

Residence:

BB technician

A N

F N

Residence:Anaesthesia technician

A NF N

Staff categories

Availability of MNCH related staff at SHC Hospital

DHQH Keich

Required number Available number

Gynaecologist 2 1

Anaesthetist 2 1

Paediatrician 2 3

WMO 6 6

OT technician 4 0

BB technician 4 1

Lab technician 3 2

Anaesthesia technician 4 0

Nurses 20 0

LHV 4 3

Ambulance drivers 4 3

Staff categoriesNumber of functional equipment at

Total required Items DHQH Keich

General items 4 3

Female ward 19 14

OPD 12 9

Paediatric nursery 13 11


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19



facilities. Status of DHQ hospital regarding available quantity of tracer items is presented in

the table below:

TABLE 3.14:STATUS OF DRUGS ANDSUPPLIES IN SHCHOSPITAL

Facility for support services including laboratory tests (space, test strips and HR), blood

transfusion services (space, supplies and HR), ambulanceservices (functional vehicle and

driver), operation theatre (space, drugs and supplies, equipment items and HR) was

assessed at surveyed DHQ hospital. Availability status of these services at SHC hospitals ispresented below:

TABLE 3.15:STATUSOF SUPPORTSERVICES IN SHCHOSPITAL

24/7 Basic EmONC Services at THQ Hospital

There is no THQH in this District.

Paediatric ward 10 8

Labour room 24 18

Operation theatre 31 23

Clinical laboratory 5 2

Item groups Total ItemsNumber of items available at

DHQH Keich

Supplies 9 9

Drugs 21 14

Vaccines 5 5

FP Commodities 7 5

Item groups Total ItemsNumber of items available at

DHQH Keich

Basic laboratory tests 17 15

Blood transfusion 5 5

Ambulance services 2 2

Radiology services 3 2

Operation theatre 62 35


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20

Management Basics

Findings related to facility management basics are presented below:

Human ResourceInformation about sanctioned and filled posts of MNCH related staff was collected from the

surveyed facilities; and their status is presented in table 3.16 - 3.18. Filled status of staff

categories presented in following tables, include regular posting only, as reported by the

respective facility on the day of survey.

TABLE 3.16:STATUS OF HR AT SHCHOSPITAL

Staff Status of HR at SHC HospitalDHQH Keich

Sanctioned Filled

Gynaecologist 1 1

Anaesthetist1 1

Paediatrician 3 3

WMO 6 6

OT technician1 0

BB technician 1 1

Lab technician 2 2

Anaesthesia technician 0 0

Nurses 14 0

LHV2 2

Ambulance drivers 3 3

TABLE 3.17:STATUSOF HR AT RHC

Staff

Number of posts sanctioned and filled at each RHC

RHCBuleda

RHC

Gomazai

RHCMand

RHCTump

RHCGower

Koop

RHC

Kalatak

RHC

Nasirabad

RHCPidark

RHCBal

Nigore

RHC

Khudan

RHCZaring

Bag

S F S F S F S F S F S F S F S F S F S F S F

WMO 1 0 0 0 1 0 1 0 0 0 1 0 1 0 1 0 0 0 1 2 1 0

Lab

technician1 1 1 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 1 1 1 1


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Nurse 0 0 0 0

LHV 4 4 1 0

Ambulance

drivers1 1 1 0

TABLE

Staff BHUDashat G

S F S

WMO/MO 0 0 0

LHV 1 0 1

Availability of job description

assessed and their findings a

FIGU

Reasons for non-availability

3.19 and 3.20.

0

2

4

6

8

10

12

1

11

1

0 0 0

0 0 0 0 0 0 0 0 0 0 0 0

1 1 1 1 0 1 1 2 2 2 2 1

0 1 1 0 0 1 0 1 1 1 0 1

3.18:STATUS OF HR AT SURVEYED BHU

Number of posts filled at BHU

HU

wak

BHU

Kohad

BHU

Balgather

BHU

Gokdan

F S F S F S F

1 1 1 1 0 2 2

1 1 1 1 0 1 1

s, service delivery protocols and staff as p

re presented in the Figure 3.

E 3: STATUS OF MANAGEMENT BASICS

f staff on 24/7 basis at RHC and SHC ar

B

7

00

3

00

00

0

A

A

21

0 0 0 0 0

1 1 0 1 0

1 1 1 0 0

BHU

rachkoo

BHU

Kunchity

F S F

1 1 1 1

1 0 1 0

er duty roster was

provided in Table

()


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22

TABLE3.19:REASONS OF NON-AVAILABILITY OF HR AT RHC

Reasons of non-availabilityStatus in RHC

WMO LHV Ambulance Driver

Residence not available 0 5 0Residence damaged 0 1 0

Security reasons 0 0 0

Lack of basic amenities 0 0 0

TABLE 3.20:REASONS OF NON-AVAILABILITY OF HR ON 24/7BASISAT SHCHOSPITAL

Reasons of non-availability

Status of DHQ Hospital

G

ynaecologist

Anaesthetist

Paediatrician

BloodBank

Technician

Laboratory

Technician

WMO

LHV

Residence not available 0 0 0 0 0 0 0

Residence damaged 0 0 0 0 0 0 0

Security reasons 0 0 0 0 0 0 0

Lack of basic amenities 0 0 0 0 0 0 0

Health facilities having staffed trained for providing MNCH services is presented in the Table

3.21.

TABLE 3.21:CAPACITY BUILDING OF MNCHRELATED STAFF

Health

Facility

MNCH related training conducted

EmONC ENC IMNCI IMPACFP

surgicalFP

counsellingClient

centeredness

DHQH Keich Y N Y N Y Y N

RHC Buleda N N N N N Y

RHC Gomazai N N N N N Y

RHC Mand N N N N N Y

RHC Tump N N N N N Y

RHC Gower

KoopN N N N N Y

RHC Kalatak N N N N N Y

RHC

Nasirabad N N N N N Y

RHC Pidark N N N N N Y


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23

Health

Facility

MNCH related training conducted

EmONC ENC IMNCI IMPACFP

surgicalFP

counsellingClient

centeredness

RHC Bal

NigoreN N N N N Y

RHC DashtKhudan N N N N N Y

RHC Zaring

BagN N N N N Y

BHU Dashat N N N N N Y

BHU Gawak N N N N N Y

BHU Kohad N N N N N Y

BHU

BalgatherN N N N N Y

BHU Gokdan N N N Y N NBHU

DrachkooN N N N N Y

BHU Kunchity N N N N N Y

Work Coordination and Supervision

Health facilities in the district were assessed for work coordination and supervisory activities,

including facility staff meetings, participation of facility in charges in district level meetings

and conduction of supervisory visits and feedbacks by district health managers. Findings ofeach surveyed health facility are presented in Table 3.22.

TABLE 3.22:STATUS OF COORDINATION ANDSUPERVISION

Health Facility


Regular facility PRM*

Participation indistrict PRM*

Monthly Supervisory Visit

Meetingheld

Recordmaintained

Facilityvisited

Facility receivedvisit feedback

DHQH Keich Y N Y Y Y

RHC Buleda N N N Y Y

RHC Gomazai Y N N Y N

RHC Mand Y Y Y Y Y

RHC Tump Y Y Y Y N

RHC Gower Koop N N N Y N

RHC Kalatak N N Y Y Y

RHC Nasirabad Y Y Y Y Y

RHC Pidark N N N Y Y


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24

Health Facility


Regular facility PRM*

Participation indistrict PRM*

Monthly Supervisory Visit

Meetingheld

Recordmaintained

Facilityvisited

Facility receivedvisit feedback

RHC Bal Nigore Y Y Y Y Y

RHC Dasht Khudan N N N N N

RHC Zaring Bag N N N Y Y

BHU Dashat N N N N N

BHU Gawak N N N Y Y

BHU Kohad Y Y Y Y Y

BHU Balgather N N N N N

BHU Gokdan Y N Y Y Y

BHU Drachkoo N N N Y N

BHU Kunchity N N N Y Y

* PRM=Performance Review Meeting

Management Information System

District Keich was practicing Health Management Information System (HMIS). Surveyed

facilities were assessed for availability and maintenance of HMIS tools and their findings are

presented in Table 3.23.

TABLE 3. 1: STATUS OF MIS

HealthFacility

Status of MIS Tools

OPD

ticket

OPDr

egister

Motherhealthregister

Birthregister

Childhealthregister

FamilyPlanning

reg

ister

EPIregister

Meeting

register

MedicineStock

reg

ister

Dailyexpenseregister

HMISmon

thlyreport

TBre

gister

DiseaseEa

rlyWarning

Sys

tem

DEWSchart

GrowthM

onitoring

Reg

ister

MIS Tools Available

DHQH Keich Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y

RHC Buleda Y Y Y Y N Y Y Y Y Y Y N N N N

RHC

GomazaiY Y Y Y Y Y Y Y Y Y Y N N N N

RHC Mand Y Y Y Y N Y Y Y Y Y Y N N N N

RHC Tump Y Y Y Y N Y Y Y Y Y Y Y N N N


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25

HealthFacility

Status of MIS Tools

OPD

ticket

OPDr

egister


Birthregister

Childhealthregister

FamilyPlanning

reg

ister

EPIregister

Meeting

register

MedicineStock

reg

ister


HMISmon

thlyreport

TBre

gister

DiseaseEa

rlyWarning

Sys

tem

DEWSchart

GrowthM

onitoring

Reg

ister

RHC Gower

KoopY Y Y Y Y Y N Y Y Y Y N N N N

RHC Kalatak Y Y Y Y Y Y Y Y Y Y Y N N N N

RHC

NasirabadY Y Y Y Y Y Y Y Y Y Y Y Y Y N

RHC Pidark Y Y Y Y Y Y Y Y Y Y Y N N N N

RHC Bal

NigoreY Y Y Y Y Y Y Y Y Y Y N N Y N

RHC Dasht

KhudanN Y N N N N Y N Y Y Y N Y Y N

RHC Zaring

BagY Y Y Y Y Y Y Y Y Y Y Y Y N N

BHU Dashat Y Y N N N N N N Y Y N N N N N

BHU Gawak Y Y Y Y N Y N Y Y Y Y N N N N

BHU Kohad Y Y Y Y N Y N Y Y Y Y N N Y N

BHU

BalgatherY Y Y Y N Y N N Y Y Y N N N N

BHU Gokdan Y Y Y Y N N N Y Y Y Y N N Y N

BHU

DrachkooY Y N Y N N N Y Y Y Y N N N N

BHU Kunchity Y Y Y Y Y N N N Y Y Y N N N N

MIS Tools Maintained

DHQH Keich Y Y Y Y Y Y Y Y Y Y Y Y Y Y

RHC Buleda Y Y Y Y N Y Y N Y Y Y N N N

RHC

GomazaiY Y N N N N Y N Y Y Y N N N

RHC Mand Y Y Y Y N Y Y Y Y Y Y N N N

RHC Tump Y Y N Y N Y Y Y Y Y Y N N N

RHC Gower

KoopY Y N N N N N N N Y N N N N

RHC Kalatak Y Y N Y Y Y Y N Y Y Y N N N

RHC

Nasirabad Y Y N N N N Y Y Y Y Y N Y N

RHC Pidark Y Y N N N N Y N Y Y Y N N N


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26

HealthFacility

Status of MIS Tools

OPD

ticket

OPDr

egister


Birthregister

Childhealthregister

FamilyPlanning

reg

ister

EPIregister

Meeting

register

MedicineStock

reg

ister


HMISmon

thlyreport

TBre

gister

DiseaseEa

rlyWarning

Sys

tem

DEWSchart

GrowthM

onitoring

Reg

ister

RHC Bal

NigoreY Y N Y N N Y Y Y Y Y N N Y

RHC Dasht

KhudanN Y N N N N Y N Y Y Y N N Y

RHC Zaring

BagY Y N N N N N N Y Y N N N N

BHU Dashat Y Y N N N N N N Y Y N N N N

BHU Gawak Y Y N N N N N N Y Y Y N N N

BHU Kohad Y Y Y Y N Y N Y Y Y Y N N Y

BHU

BalgatherY Y N N N N N N Y Y N N N N

BHU Gokdan Y Y Y Y N N N Y Y Y N N N Y

BHU

DrachkooY Y N Y N N N N Y Y Y N N N

BHU Kunchity Y Y N N N N N N Y N Y N N N

Drugs and Supplies

Availability of drugs and supplies has been described under individual MNCH service

packages. The reasons of their non-availability were identified at the surveyed facilities and

presented in the Table 3.24.

TABLE 3.24:REASONS FORSTOCKOUTREPORTED BY SURVEYEDFACILITIES

Health facilities

citing stock out

Reasons for stock out

Poorquantification

Delayeddemand

submission

Unavailabilityof

bufferstock

Lackofstorage

capacity

Delayedsupply

Undersupply

Noprocurement

powers

Insufficientbudget

Lackofcold-chain

DHQH Keich N N N N Y N N N N

RHC Buleda Y N N N Y N N N N

RHC Gomazai Y N N N Y N N N N


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27

Health facilities

citing stock out

Reasons for stock out

Poorquan

tification

Delayeddemand

submission

Unavailabilityof

bufferstock

Lackofs

torage

capacity

Delayed

supply

Unders

upply

Noprocu

rement

powers

Insufficien

tbudget

Lackofco

ld-chain

RHC Mand N N N N Y N N N N

RHC Tump N N N N Y N N N N

RHC Gower Koop Y N N Y Y N N N N

RHC Kalatak N N N Y Y N N N N

RHC Nasirabad N N N N Y N N N N

RHC Pidark N N N N Y N N N N

RHC Bal Nigore N N N N Y N N N N

RHC Dasht Khudan Y N N N Y N N N N

RHC Zaring Bag N N N N Y N N N N

BHU Dashat N N N N Y N N N N

BHU Gawak Y N N N Y N N N N

BHU Kohad N Y N N N N N N N

BHU Balgather Y N N Y N N N N N

BHU Gokdan N N N N Y N N N N

BHU Drachkoo Y N N N Y N N N N

BHU Kunchity N N N N Y N N N N

Fee for Services

Fee for MNCH services and availability of social protection mechanisms for the poor wereassessed at surveyed facilities and their findings are presented in Table 3.25 and 3.26.


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28

TABLE3.25:STATUS OF FEEFORSERVICE

Health facilities

where service are

charged

Services provided free of cost

OPD IndoorAmbulanceservices

OPDTicket

OPDLaboratory

OPDUltrasound

OPDX-rays

OPDMedicines

Admissionfee

Wardbed

InpatientLaboratory

InpatientUltrasound

InpatientX-rays

Bloodgrouping&

crossmatching

Inpatientmedicines

DHQH Keich N N N N N N N N N N N N N

RHC Buleda Y Y N N Y Y Y Y N N Y Y

RHC Gomazai Y Y N N Y Y Y Y N N Y N

RHC Mand Y Y N N Y Y Y Y N N Y Y

RHC Tump Y Y N Y Y Y Y Y N N Y Y

RHC Gower Koop Y N N N Y N N N N N N N

RHC Kalatak Y Y N N Y Y Y Y N N Y N

RHC Nasirabad Y Y N N N Y Y Y N N Y Y

RHC Pidark Y N N N Y N N N N N N N

RHC Bal Nigore Y Y N N Y N N N N N N N

RHC Dasht

KhudanY Y N N Y Y Y Y N N Y Y

RHC Zaring Bag Y Y N N Y N N N N N N N

BHU Dashat Y N Y

BHU Gawak Y N Y

BHU Kohad Y N Y

BHU Balgather Y N Y

BHU Gokdan Y Y Y

BHU Drachkoo N N Y

BHU Kunchity Y N Y


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29

TABLE3.26:MECHANISMS OF SOCIAL PROTECTIONAVAILABLE

Health Facilities with available

Social Protection

Social Protection Mechanism

Bait-ul MaalZakat

Patient Welfare

Society

DHQH Keich Y N N

RHC Buleda N N N

RHC Gomazai N N N

RHC Mand N N N

RHC Tump N N N

RHC Gower Koop N N N

RHC Kalatak N N N

RHC Nasirabad N N N

RHC Pidark N N N

RHC Bal Nigore N N N

RHC Dasht Khudan N N N

RHC Zaring Bag N N N

BHU Dashat N N N

BHU Gawak N N N

BHU Kohad N N N

BHU Balgather N N N

BHU Gokdan N N N

BHU Drachkoo N N N

Infection Control

Health facilities were assessed for practices of infection control and waste management, and

availability of related material. Findings of individual surveyed facilities are presented in table

3.27.


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30

TABLE 3.27:STATUS OF INFECTIONCONTROL&WASTEMANAGEMENT PRACTICES

Health facilities

Availability of Materials Infection Control Practices

Wastemanagementplan

Wastecollectionmaterials

P

ersonalprotectionmaterials

Wastetreatmentequipment

FunctionalIncinerators

Handwashingpracticesof

HCP

Disinfectionofservice

provisionarea

HepBVaccinationofStaff

Wastesegregation

Disposalofwastethrough

burning

DisposalthroughThrowing-

away

DisposalthroughMunicipal

Arrangement

DHQH Keich Y N N N Y Y Y Y N N N Y

RHC Buleda Y N N N Y N N N N N

RHC Gomazai N N N N Y N Y N N N

RHC Mand N N N N Y Y Y N N N

RHC Tump N N N N Y Y Y N N N

RHC Gower

KoopN N N N Y N Y N N N

RHC Kalatak N N N N Y N Y N N N

RHC Nasirabad Y N N N Y N Y N N N

RHC Pidark N N N N Y N Y N N N

RHC Bal Nigore N N N N Y N Y N N N

RHC Dasht

KhudanN N N N Y N Y N N N

RHC Zaring Bag N N N N Y N Y N N N

BHU Dashat N N N N Y N N N N N

BHU Gawak N N N N Y N N N N N

BHU Kohad N N N N Y N Y N N N

BHU Balgather N N N N Y N N N N N

BHU Gokdan N N N N Y N Y N Y N

BHU Drachkoo N N N N Y N N N N N


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31

Death Review

Findings related to availability and functioning of death review committees are presented in

the Table 3.28.

TABLE 3.28:STATUS OF DEATHREVIEWS

Health Facility

Status of Death Review

DeathReview

CommitteeAvailable

Maternal Deaths Neonatal Deaths

AnnualNumber

Reviewed bycommittee

AnnualNumber

Reviewed bycommittee

DHQ Keich N 7 0 0 0

RHC Buleda N 0 0 0 0

RHC Gomazai N 0 0 0 0

RHC Mand N 0 0 0 0

RHC Tump N 0 0 0 0

RHC Gower Koop N 0 0 0 0

RHC Kalatak N 0 0 0 0

RHC Nasirabad N 0 0 0 0

RHC Pidark N 0 0 0 0

RHC Bal Nigore N 0 0 0 0

RHC Dasht Khudan N 0 0 0 0

Facility Utilisation

Findings of services utilisation at surveyed facilities are given as monthly aggregate from

July to December 2010, annual utilisation of year 2010 and facility-wise average monthly

utilisation are presented in Tables 3.29, 3.30 and 3.31.

TABLE 3.29:STATUS OF SERVICES UTILISATION

Type of serviceMonthly utilisation (July to December 2010) Annual

utilisation(2010)July Aug Sep Oct Nov Dec

1st Antenatal Care visits (ANC-1) 351 323 241 231 237 266 3,611

Normal vaginal deliveries 236 300 254 257 231 246 2,548

Assisted vaginal deliveries 0 0 0 0 0 0 0

C-sections 8 23 14 13 18 23 216


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Type of serviceMonthly utilisation (July to December 2010) Annual

utilisation(2010)July Aug Sep Oct Nov Dec

1st Postnatal Care visits (PNC-1) 106 146 149 192 99 105 1,320

Pregnant women given TT2

vaccine

563 524 532 542 484 441 6,802

FP services 208 165 167 197 92 172 1,829

Diarrhoea/Dysentery casestreated (< 5 years of age)

1,607 1,380 1,826 1,661 1,330 1,175 18,222

Pneumonia cases treated(< 5 years of age)

943 827 893 765 784 791 9,466

TABLE 3.30:AVERAGEMONTHLYMNCHSERVICES PROVIDED

HealthFacility

Average Monthly Utilisation

ANC -1

NVDAssisted

VDC

SectionPNC -

1TT2

Diarrhoea/

Dysentery(in


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BHU

Drachkoo0 0 0 0 0 23 63

BHU

Kunchity28 10 0 2 112 31 45

TABLE 3.31:AVERAGEMONTHLYFP SERVICES PROVIDED

HealthFacility

Average Monthly Utilisation of FP Services

COC POP DPMANet-en

Condoms IUCDs ImplantsSurgical (Tubal

Ligation Vasectomy)

DHQH

Keich0 39 64 14 0 0 0 1

RHC Buleda 1 0 8 0 0 0 0

RHCGomazai

0 0 0 0 0 0 0

RHC Mand 0 0 0 13 0 0 0

RHC Tump 0 3 0 11 0 0 0

RHC Gower

Koop8 10 0 0 0 0 0

RHC

Kalatak0 0 0 0 0 0 0

RHC

Nasirabad0 0 0 0 0 0 0

RHC Pidark 0 0 0 0 0 0 0

RHC Bal

Nigore0 0 0 0 0 0 0

RHC Dasht

Khudan0 0 0 0 0 0 0

RHC Zaring

Bag0 0 0 0 0 0 0

BHU Dashat 0 0 0 0 0 0 0

BHU Gawak 0 0 0 0 0 0 0

BHU Kohad 0 0 0 0 0 0 0

BHU

Balgather0 0 0 0 0 0 0

BHU

Gokdan0 0 0 0 0 0 0

BHU

Drachkoo0 0 0 0 0 0 0

BHU

Kunchity1 0 8 0 0 0 0

KEY: COC=Combined Oral Contraceptive, POP=Progesterone-Only Pills, DPMA=Depot

Medroxyprogesterone Acetate, Net-en=norethisterone enanthate, IUCDs=Intrauterine ContraceptiveDevices


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34

Well Baby Clinic

Surveyed health facilities were assessed for established Well Baby Clinic (WBC) and its

findings are presented in Table 3.32.

TABLE3.32:STATUS OF WBCESTABLISHED

Name of health facility WBC Established Name of health facility WBC Established

DHQ Keich Y RHC Dasht Khudan N

RHC Buleda N RHC Zaring Bag N

RHC Gomazai N BHU Dashat N

RHC Mand N BHU Gawak N

RHC Tump N BHU Kohad N

RHC Gower Koop N BHU Balgather N

RHC Kalatak N BHU Gokdan N

RHC Nasirabad N BHU Drachkoo N

RHC Pidark N BHU Kunchity N

RHC Bal Nigore N

Donor Contribution

Donor Contribution during last three years was assessed regarding human resource,

infrastructure, equipment including ambulances, and drugs and supplies and findings are

presented in Table 3.33.

TABLE 3.33:STATUS OF DONORCONTRIBUTION

Health Facilities

Donor Contribution

Human Resource Infrastructure EquipmentDrugs andSupplies

Provisionofke

y

staff

Capacitybuildin

g

StaffIncentive

Constructiono

f

newbuilding

Renovationof

existingbuildin

g

Provisionofne

w

equipment

Provisionofne

w

vehicle/

ambulance

Provisionof

Medicines

Provisionof

Consumables

DHQ Keich N N N N N N N N N


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Health Facilities

Donor Contribution

Human Resource Infrastructure EquipmentDrugs andSupplies

Pr

ovisionofkey

staff

Ca

pacitybuilding

S

taffIncentive

Constructionof

newbuilding

R

enovationof

ex

istingbuilding

Provisionofnew

equipment

Provisionofnew

vehicle/

ambulance

Provisionof

Medicines

Provisionof

C

onsumables

RHC Buleda N N N N N N N N N

RHC Gomazai N N N N N N N N N

RHC Mand N N N N N N N N N

RHC Tump N N N N N N N N N

RHC Gower Koop N N N N N N N N N

RHC Kalatak N N N N N N N N N

RHC Nasirabad N N N N N N N N N

RHC Pidark N N N N N N N N N

RHC Bal Nigore N N N N N N N N N

RHC Dasht Khudan N N N N N N N N N

RHC Zaring Bag N N N N N N N N N

BHU Dashat N N N N N N N N N

BHU Gawak N N N N N N N N N

BHU Kohad N N N N N N N N N

BHU Balgather N N N N N N N N N

BHU Gokdan N N N N N N N N N

BHU Drachkoo N N N N N N N N N

BHU Kunchity N N N N N N N N N

Clients Perspective

Client Exit Interviews (CEI) was conducted within the scope of the HFA Survey to assess

clients perspective on provided services. Findings of these interviews were analysed for

assessing their perspective on access, quality and preference for health care and are

presented in Table 3.34 and Figures 4 and 5.


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TABLE3.34:CLIENTS PERSPECTIVE

No of interviewed clients (Total: 65)

DHQH RHC

Time to reach facility

Less than 30 minutes 6 46

30 minutes to 1 hour 2 4

More than 1 hour2 5

Means of transport

Walk 0 6

Personal transport 1 42

Public transport 9 7

Waiting time at facility

Less than 10 minutes 2 16

10 minutes to 20 minutes 5 31

20 minutes to 30 minutes 05

More than 30 minutes 3 3

Fee for services

Paid fee for services 10 0

Health Education Material

Received Education Material0 0

Preference for healthcare

Public HF 10 54

Private sector 0 1

Reasons for visiting public HF

Close to home 1 29

Good quality 5 17

Staff attitude 0 1

Affordability 4 8

Lack of choice 0 5

Overall satisfaction

Very satisfied 3 20

Satisfied 7 34

Not satisfied 0 1


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FIGURE 4: LEVEL OF SA

FIGURE 5: A

Procurement Estim

EquipmentBased on the information col

have been identified for i

Summary of estimated cost

required equipment for each

cost estimates for individual f

Civil Works

A yardstick has been used f

building components (Anne

0%

A

A

0% 20%

ISFACTIONWITHEXAMINATIONANDATTITU

AILABILITYOF MEDICINES ANDLABSERVICE

ates

lected, procurement needs for provision of r

dividual surveyed facilities to strengthen

or procurement of required equipment is g

surveyed facility is presented as Annex 3

cilities is given in Annex 3 B.

r assessing the scope of civil works of vari

1). Identified scope of work to complet

35

39

39

40

65

61

61

55

20

5

20% 40% 60% 80% 100%

60

62

30

38

10

0

40% 60% 80% 100%

37

EOF STAFF

S

equired equipment

MNCH services.

iven below. List of

and details about

ous MNCH related

the infrastructure

()

()


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needs of the individual surveyed facilities is presented in Annex 4. Summary of estimated

cost for


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execution of civil works including repair and maintenance, renovation and new construction

of missing facilities; is given in table below and details about cost estimates for individual

facilities is given in Annex 4.

TABLE 3.35:SUMMARYOF ESTIMATED COST FORPROCUREMENT OF EQUIPMENTS&CIVILWORKS

ProcurementEstimated Cost (PKR in Millions)

DHQH RHC BHU Total

Equipment 8.4 71 4.5 84

Civil Works 20 124 37 181


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Section 4: Key Findings

In district Keich, total of 19 health facilities were assessed including 7 BHU, 11 RHC, and 1

DHQH. The BHU were assessed for availability of 8/6 Preventive MNCH services; RHC

were assessed for availability of 24/7 Basic EmONC services; and DHQ Hospital wasassessed for availability of 24/7 Comprehensive EmONC services.

The key findings have been presented based on the availability of specified inputs including,

Infrastructure, Human Resource, Equipment, Drugs and Supplies, and Support services.

Status of each input has been described at one place for all levels. This is followed by key

findings on Management basics, Donor contribution and Clients perspective on the quality of

MNCH services.

Infrastructure

At BHU, OPD was available at all the BHU while labour rooms were not available at all

BHU; LHV residences were available only at BHU Drachkoo and Kunchity but none of

these were in good condition

OPD was available at all eleven RHC while female ward was not present at 3 RHC i.e.,

RHC Gomazai, RHC Gower Koop and RHC Bal Nigore. Labour room was not availableat 4 RHC, clinical laboratory was not available at RHC Gower Koop and RHC Bal Nigore.

WMO residence was available at 7 RHC but was in good condition at RHC Gower Koop

OPD,female ward, Delivery room,Operating Theater,Paediatric ward and Paediatrc

Nursery,clinical laboratory and blood bankand also USG room were at

DHQH.Residences for gynaecologist,paediatrician and anaesthetist were available but

were not in good condition.

Human Resource

All required staff was available at all BHU except at BHU Dashat and BHU Balgather,

where no staff was available

Required number of WMO were available only at RHC Dasht Khudan out of 11 RHC;

while required number of LHV were available at 5 RHC; Laboratory technicians were

available at 9 RHC; while OT technicians were available at 6 RHC. Ambulance drivers

were available only at 5 RHC


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41

Required number of Paediatrician were present at DHQH. OTand Anaesthesia

techncians were not available at DHQH

Staff residence not being available was the most common reason for non-availability of

staff round the clock at RHC

Staff at DHQH received training on FP counselling, FP surgical, IMNCI and EmONC;staff

at BHU Gokdan received training on IMPAC while all RHC and BHU except BHU

Gokdan received training on client centredness only

Equipment

The complete set of required equipment items was not available at any of the surveyedfacilities

General equipment items were not available at any of the surveyed BHU. LHV room

equipment was not available atBHU Balgather, BHU Drachkoo and BHU Kunchity out of

7 BHU

General equipment items were not available at all RHC. All required female ward

equipment items were not available at 5 RHC. WMO equipment items were not available

at 4 RHC. Labour room equipment items was not available at 6 RHC; while LHV room

equipment items were not available at 3 RHC

Drugs and Supplies

The complete list of tracer drugs and family planning were not available at any of the

surveyed facilities

All the required vaccines were not available at any of the BHUexcept BHU Gokdan while

FP commodities were alsonot available at anyBHU except BHU Kohad

The complete range of vaccines was available at 8 RHC.FP commodities were absent at

3 RHC namely RHC Gomazai, RHC Gower Koop and RHC Pidark.The complete range

of supplies was available at 3 RHC namely RHC Mand, RHC Nasirabad and RHC

Khudan

Complete range of vaccines and supplies were available at DHQH

The most common reason for stockout of drugs was poor quantification and delayed

supply


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42

Support Services

The complete range of required inputs for delivery of support services was not available

at most of the surveyed facilities

Inputs required for provision of basic laboratory tests were not available at BHU Dastuk

and BHU Balgather

All required inputs for provision of ambulance services were not present at 7 RHC

Blood transfusion and ambulance services were available at DHQH Keich

Management Basics

Management basics assessed at the surveyed facilities included availability of job

description and service delivery protocols, work coordination and supervision, MIS, infection

control practices, death reviews of maternal and neonatal deaths, fee for services and

available mechanisms of social protection, and facility utilisation of MNCH services.

Eight out of nineteen health facilities were conducting regular performance review

meetings but its record was maintained at only 5 of the surveyed facilities. Eight facility

in-charges reported regular participation in district level performance review meetings

Majority of the facilities reported supervisory visits of district health managers and its

feedback was also received at most of the facilities

Health Management Information System (HMIS) was being practiced in district Keich.

Regarding HMIS tools, complete range of tools was not available except at DHQH,

specifically non-availability of TB Register,child health register and DEWS chart

Social protection mechanisms for the poor was found only at DHQH in the form of Bait ulMal

Complete range of inputs required for infection control practices were deficient at all the

surveyed facilities. Out of 19 facilities, 3 reported availability of waste management plan

but materials for waste collection, personal protection and waste treatment were not

available at any of the facility

Death review committee was not available for review of maternal and neonatal deaths at

any of the surveyed facilities.


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43

Donor Contribution

Donor contribution for supporting delivery of MNCH was assessed at the surveyed facilities

for provision of human resource, infrastructure, equipment, drugs and supplies. In the

district, no facility reported any such contribution.

Clients Perspective

Client exit interviews were conducted to assess clients perspective about their satisfaction

with the services utilised at the facility. Total of 65 interviews were conducted in the district

and findings concluded that 35% of the clients were very satisfied and 63% were satisfied

with the availed services.


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44

Annexes


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Annex 1: District Health Department

Public sector district health system consists of Secondary Health Care (DHQH) and Primary

Health Care (RHC, BHU) facilities. DHO acts as head of the district health department,

under supervision of DC.

Health Resources

Health facilities (Public sector)

Public sector facilities providing MNCH services are given in table below:

TABLE 2.4:NUMBEROF PUBLIC SECTORHEALTH FACILITIESIN THE DISTRICT

Type Number Bed strength

Teaching hospitals 0 0

DHQ Hospital 1 90

THQ Hospital 0 0

RHC 11 98

BHU 36 0

Govt. Rural Dispensaries 43

MNCH Centres 4

Sub Health Centres 0SOURCE:HMISCELL,DHOOFFICE

Human Resource DHO Office

Table 2.5 summarises the HR situation at the DHO Office.

TABLE 2.5:HUMANRESOURCE IN OFFICE OF DHO

Name of Post Sanctioned Filled % Filled

District Officer Health 1 1 100

Deputy District Officer Health 2 2 100

District Coordinator National Program for FP & PHC 1 1 100

District Coordinator EPI Surveillance 1 1 100

District Coordinator NMNCHP 1 1 100

District Sanitary Inspector 1 1 100

CDC Officer 1 1 100

CDC Inspector 0 0 0

Drug Inspector 2 2 100

District Superintendent Vaccination 1 1 100


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Name of Post Sanctioned Filled % Filled

Assistant Superintendent Vaccination 2 2 100

Tehsil Sanitary Inspector 0 0 0

Inspector Vaccination0 0 0

Total 100

SOURCE:DHOOFFICE

MNCH staff in District Keich

Table 2.6 summarises the status of MNCH staffing in health facilities including DHQH, RHC

and BHU in the district. The information was collected from DHO office during survey.

This information may not match with subsequent tables containing similar information on

human resource (HR) collected from respective surveyed health facilities (No. 3.7, 3.12,

3.16, 3.17, 3.18).

TABLE 2.6:AVAILABILITYOF MNCHSERVICES STAFFING IN DISTRICT KEICH

Posts

Sanctioned

Filled % Filled

Filled posts

R= Regular, C= On Contract

DHQH=1 THQH=0 RHC=11 BHU=36

R C R C R C R C

Gynaecologist 1 2 100 1 1

Paediatrician 1 1 100 0 1

Anaesthetist 1 0 0 0 0

Radiologist 1 0 0 0 0

Pathologist 1 0 0 0 0

Women MedicalOfficers (WMO)

5 3 60 2 0 1 0 0 0

Medical Officers

(MOs)12 9 75 7 0 1 0 1 0

Blood Transfusion

Officers0 0 0 0 0

Blood Bank

Technician0 0 0 0 0

O.T. Technician 6 2 33 2 0

Anaesthesia

Technician6 1 17 1 0

LHV 18 14 78 7 0 7 0 0 0

Nurses 0 0 0 0 0 0 0


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Posts

Sanctioned

Filled % Filled

Filled posts

R= Regular, C= On Contract

DHQH=1 THQH=0 RHC=11 BHU=36

R C R C R C R C

Lady Health

Workers (LHW)10* 10 100

Laboratory

Technician0 0 0 0 0 0 0

X-ray Technician 0 0 0 0 0 0 0

Dispenser 10 9 90 4 0 3 0 2 0

Vaccinators 10 5 50 2 0 3 0 0 0

Ambulance

Drivers2 2 100 1 0 1 0

*LHW ARE COMMUNITY BASED

SOURCE:HMISCELL,DHOOFFICE,

Financial Allocations

Budgetary allocations and expenditures over the last three years for the district (in PKR

Million) are presented in table 2.7; allocations mentioned below are lump sum as provided by

DHO office.

TABLE 2.7:FINANCIAL ALLOCATIONIN DISTRICTKEICH

DistrictHealthBudget

2007-08 2008-09 2009-10

Allocation Expenditure Allocation Expenditure Allocation Expenditure

Non-Development

93.1 92.7 14.2 12.4 139 134

Development 0 0 0 0 0 0

Total 93.1 92.7 14.2 12.4 139 134

SOURCE:DHOOFFICE

Donor Contribution

Information about donor contribution for MNCH services was asked from DHO office in terms

of financial input. It was reported that donor contribution was not provided to this district.

During survey, information about donor inputs on surveyed health facilities was also

collected, and findings were the same.


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48

NMNCH Programme Indicators

Information on NMNCHP indicators is being compiled at office of DHO and this information

has been gathered on the sets of indicators, which is reproduced as such in following

tables.It is important to note that services utilisation data reported by district office take into

account utilisation of all public sector facilities in the district.

This information may not match with subsequent tables containing information on drugs and

supplies (Table No. 3.4, 3.9, 3.14 and 3.24) and C-sections (No. 3.29) collected from

respective health facilities included in survey.

TABLE2.8:NMNCHP MONITORING INDICATORS (YEAR2010)

Services Management

Number of district monthly performance review meetings held during last year 4

Number of facilities with stock-out of FP commodities 60

Number of facilities stock outs of essential EmONC drugs 0

Support Services

Number of facilities with laboratory services available 11

Number of facilities with blood transfusion services available 5

Service UtilisationAntenatal care coverage 9371

Percentage of children


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hfa district report - keich

Documents