highlights from the reports of the regio · gynecologist, 14 of the 31 sanctioned posts of...

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********************************* Highlights from the reports of the

Regional Evaluation Teams During 2012-13

************************* Statistics Division

Ministry of Health & Family Welfare Government of India

2

Districts covered by RETs during 2012-13

Sr. No

Name of States Name of the Districts No. of Districts

Page No.

1 Andhra Pradesh East Godavari, Krishna, Vishakhapattanam and Chitoor,

Guntur, Khammam, Prakasham and Kadapa

8 3-67

2 Bihar Jamui, Lekhisarai, Darbhanga, Gaya, Arawal,

Gopalganj, Buxer, Bhojpur, West Champaran,

Madhubani, Katihar and Purniya

12 68-141

3 Chhattisgarh Jaspur, Raigarh 2 142-158

4 Goa North Goa and South Goa 2 159-167

5 Gujarat Panchamahal Bharuch, and Jamnagar 3 168-190

6 Haryana Palwal, Mewat, Kaithal, Jind, Rohtak and Bhiwani 6 191-226

7 Himachal Pradesh Una, Shimla and Kangra 3 227-247

8 Jammu & Kasmir Budgam and Poonch 2 248-258

9 Jharkhand Palamu and Dhanbad 2 259-271

10 Karnataka Gulbarga, Bidar, Kolar, Ram Nagar, Chikkaballapur,

Mandya Chamarajanagar, Hassan and Chikmagalur

9 272-342

11 Kerala Wayanad, Kozhikode, Kannur and Idukki 4 343-370

12 Madhya Pradesh Chindwara, Khandawa, Singrauli, and Neemuch 4 371-396

13 Maharashtra Thane and Ahmednagar 2 397-412

14 Orissa Bargarh, Ganjam, Gajapati, Sambalpur, Jharsuguda and

Keonjhar

6 413-460

15 Puducherry UT Mahe 1 461-465

16 Rajasthan Sri Ganga Nagar, Hanumangarh, Dhaulpur and

Bharatpur

4 466-491

17 Tamil Nadu Tanjore, Tuticorin, Thiruvallur, Nagappathinam, Erode,

Thiruppur, Trichy, Sivagangai, Ramanathapuram and

Madurai

10 492-568

18 Tripura Dhalai and North Tripura 2 569-583

19 Uttar Pradesh Banda, Ambedkarnagar, Sidharth Nagar, Maharajganj,

Firojabad and Bahraich

6 584-621

20 Uttrakhand Tehri Garhwal, Pauri Garhwal 2 622-633

21 West-Bangal South 24 Parganas, Nadia, Birbhom and West Medinipur 4 634-668

Total 94

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Andhra Pradesh

1. District:- East Godavari

Highlights from the Evaluation Report of East Godavari District (Andhra Pradesh).

The Regional Evaluation Team, located at Regional Office for Health and Family Welfare

(Bangalore), Ministry of Health and Family Welfare, Government of India carried out sample

checks of activities covered under NRHM / RCH in East Godavari District of Andhra Pradesh State during June, 2012.

I. Health Facilities Covered: As a part of evaluation, the team visited Community Health Centres (CHCs), Primary Health

Centres (PHCs) and Sub Centres (SCs) in both districts of East Godavari as per the details given below:

Districts Visited

PHCs / CHCs visited SCs Visited

East Godavari CHC: Thallarevu.

PHCs: Shankhavaram and Rayavaram.

Korangi, Thallarevu, Shringavaram, Shankhavaram, Vedurupaka and Rayavaram.

II. The Major Observations

1. Human Resources:-

a) Shortage of Medical Personnel was reported in the district. The Post of the District Medical & Health Officer and District Surveillance Officer, both sanctioned posts of Addl. DMHO, 62 of the

238 sanctioned posts of Medical Officer (Allopathic) / MBBS, 9 of the 38 sanctioned posts of

Physician, 4 of the 37 sanctioned posts of Surgeon, 17 of the 43 sanctioned posts of

Gynecologist, 14 of the 31 sanctioned posts of Pediatrician, 4 of the 35 sanctioned posts of

Anesthetists, 3 of the 8 sanctioned posts of Radiologists, 5 of the 18 sanctioned posts of

Pathologist, 3 of the 6 sanctioned posts of ENT Specialists and 2 of the 15 sanctioned posts of

Ophthalmologist were lying vacant in the district.

b) Similarly, in the category of Para-medical, 18 of the 552 sanctioned posts of Staff Nurse (Regular), 49 of the 66 sanctioned posts of Staff Nurse (contract basis under 24X7 PHCs), 28 of

the 175 sanctioned posts of MPH Supervisor (Female) / L.H.V, 13 of the 183 sanctioned posts of

MPH Supervisor (Male), 59 of the 169 sanctioned posts of Pharmacist, 50 of the 163 sanctioned

posts of Lab Technician, 546 of the 581 sanctioned posts of MPHW (Male), 259 of the 913

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sanctioned posts of MPHW (Female) and 23 of the 809 sanctioned posts of 2nd MPHW (Female)

were also lying vacant in the district.

c) Further, 19 of the 22 posts of AYUSH Medical Officers sanctioned in PHC / CHC under NRHM

were lying vacant. No staff was reported to have been posted at District level NRHM Programme

Management Unit in the district.

d) In the visited CHC Thallarevu, one post of AYUSH Medical Officer, 1 of the 17 sanctioned posts of 2nd ANM and all the 9 sanctioned posts of Male Worker were lying vacant.

e) In the visited PHC Shankavaram, 2 of the 3 sanctioned posts of Medical Officer, post of AYUSH Medical Officer, 2 of the 5 sanctioned posts of Staff Nurse, 1 of the 2 sanctioned posts of

Pharmacist and all 8 sanctioned posts of Male worker were lying vacant.

f) In the visited PHC Rayavaram, one post of AYUSH Medical Officer, 1 of the 5 sanctioned posts of

2nd ANM and all 3 sanctioned posts of Male Worker were lying vacant.

2. Janani Suraksha Yojna (JSY):-

a) Women belonging to BPL and SC/ ST category who deliver in the Govt. institution or in Home are

eligible for JSY payments for their first two deliveries. JSY mothers are given incentive @

Rs.700 per case for rural area and @ Rs. 600 per delivery in urban area in the state. Rs. 500 for

per delivery in case of home delivery are given in the state.

b) In the district 85,273 deliveries were conducted during 2010-11. Out of them 10,163 got JSY cash

incentive in the year. During 2011-12 payments were made to 7,522 beneficiaries out of 87,967

deliveries.

c) Total budget for JSY in the district was available to the tune of Rs. 1, 11, 64,657 for 2010-11 and

1, 49, 48,279 for 2011-12. Expenditure to the tune of Rs. 66, 67,978 was incurred in 2010-11 and

Rs. 67, 64,180 during 2011-12.

d) The team contacted 17 JSY beneficiaries in the field. As reported, all deliveries were institutional

and they received full JSY cash incentive in time. MCH and JSY cards were issued to all; ANC /

PNC visits were made by the ANMs. Transport facility was arranged by ASHAs / ANMs to 14

mothers for delivery purpose.

e) All the JSY registers were maintained with complete information in the district office and CHCs /

PHCs. In the visited Sub Centres, Beneficiaries registers were not maintained at Sub-Centres

visited.

3. Untied Funds:-

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a) Provision and utilization of Untied Funds in the district are as detailed below:

(Amount in Rs)

Sl. no

Particulars Budget for CHCs* Budget for PHCs* Budget for HSCs*

2010-11 2011-12 2010-11 2011-12 2010-11 2011-12

1. Total budget

available

2,62,246 12,91,376 7,01,485 43,03,240 77,83,829 1,12,47,621

2. Expenditure

incurred 1,70,870 6,08,864

4,48,245 12,33,497 57,42,277 72,56,205

3.

Balance 91,376 6,82,512 2,53,240 30,69,743 20,41,552 39,91,416

* Including opening balance etc.

b) There are 20 CHCs, 103 PHCs and 792 Sub Centres in the district. Rs. 25,000 to each PHC

and Rs. 50,000 to each CHC are given as untied funds per year in the district. SCs are

provided @ Rs. 10,000 as Untied Funds.

c) Untied Funds to the tune of Rs. 10,000 were released to each of the visited SCs at Korangi and

Shringavaram in the year 2011-12 and utilized by the centres but this fund was not given to

these centres during 2012-13 till the date of visit.

d) The visited Sub Centres spent untied funds for purchasing of SC Name Board, IEC charts,

MCTS tracking formats, BP apparatus, Stationery, Benches, Chairs and Calculator. For the

year 2012-13, SC Untied Fund was not released from district.

4. Rogi Kalyan Samiti (RKS):-

a) Rogi Kalyan Samiti (RKS) was constituted in District Hospital, 7 SDHs, 20 CHCs and 103

PHCs in the district.

b) Every RKS was being provided funds to the tune of Rs. 5, 00,000 at Distt. Hospital level,

Rs. 1, 00,000 at SDH level, Rs. 2, 50,000 at CHC level and Rs. 1, 75,000 at PHC level every

year. These funds includes corpus fund, Annual Maintenance Grant (AMG) and Untied

Funds. AMG and Untied Funds to the RKS at DH and SDH are not given in the district. All these funds are kept at the disposal of RKS and after taking approval, the funds were being

utilized on developmental activities of the Institution.

c) Details of RKS funds available and expenditure incurred for CHCs and PHCs in the District are

given in the following table:

(Amount in

Rs.)

6

Type/

head of

the funds

For CHCs for the year For PHCs for the year

2010-11 2011-12 2010-11 2011-12

Budget* Expdr. Budget* Expdr. Budget* Expdr. Budget* Expdr.

Corpus

fund

5,71,37

4

4,43,407 26,27,96

7

13,59,22

8

13,53,531 8,91,548 1,65,61,98

3

74,01,236

AMG Fund 1,48,25

5

1,36,125 27,12,13

0

11,99,52

2

8,96,251 6,29,892 83,16,359 25,28,349


Status of Untied Funds may be seen at point 3. d) RKS funds meant for the year 2012-13 were not released from the State Office to District

Office. It was observed that no budget was released during 2010-11, budget meant for 2010-

11 was released in the next financial year during May, 2011 and the budget of 2011-12 was

also released very late during February 2012.

e) In CHC Thallarevu, during 2010-11 the fund to the tune of Rs. 53,357 and during 2011-12 the

fund to the tune of Rs. 2, 94,000 including opening balance etc. was available with RKS. Out

of this, during 2010-11 an amount to the tune of Rs.11,940 and during 2011-12 an amount to

the tune of Rs. 2,21,250 was spent on payment of salary to contingent workers, Telephone

Bills, LPG gas Bills and Transport of Drugs. Funds were also spent on purchase of Bio-

Metric Electronic Attendance Machine, Emergency Medicines, Surgical Instruments,

Registers, Case Sheets, Mike Set, OT Light, Linen, Lab Equipment, Surgical Bins, Dental

Equipment, Saline Stands and Iron Racks. Repair works of electrical connections,

Refrigerator, Air-Conditioner Machine, Plumbing work and Printing of OPD slips etc.

f) In the visited PHCs, funds were utilized for purchasing of Electrical Materials, Surgical

Instruments, UPS, Linen, Emergency Medicines. Computer Services, Refilling of Computer

Toners, Repair of Fans & Computer, Premises Cleaning, Payment of BSNL land line, broad

band bills, filling of Oxygen Cylinder and purchase of Steel Bins, Medicines, Water Purifier,

Water Cans, payment of Transport charges to bring Medicines from District Office.

5. Services of ASHA:-

a) As targeted the district selected 3781 ASHAs and all ASHAs were trained in all modules as

on 31-01-2012. All ASHAs were provided with drug kits. 221 new ASHAs are proposed to be

inducted during 2012-13.

b) An expenditure to the tune of Rs. 1, 86, 35,021 during 2010-11 and Rs. 2, 65, 58,404 during

2011-12 was incurred towards performance based incentives to ASHAs.

c) In the visited institutions, 10 ASHAs were interviewed. As informed by them, all were trained

and given drug kits, and have been receiving performance based remuneration regularly;

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however from April 2012 onwards incentive to ASHA was observed to be pending. ASHAs

have expressed their dissatisfaction for meager performance based incentive.

d) At the visited SCs Korangi and Shringavaram, ASHAs were posted and trained. After

receiving training, some of the ASHAs have left. In the VHSNCs, ASHAs were functioning as

a member.

6. Functioning of Village Health Sanitation & Nutrition Committees (VHSNC):-

a) 1021 VHSNCs were set up against 1438 revenue villages in the district. Every year funds @

Rs. 10,000 are allotted to each VHSNC which is kept in a bank account operated jointly by the

Village Secretary of Govt. Revenue department and ANM of Sub-Centre. b) Details of VHSNC budget available and spent in the district during 2010-11 and 2011-12 are

given below: (Amount in Rs.)

SI.No Particulars 2010-11 2011-12

1. Total budget available 91,03,943 1,15,71,525

2. Expenditure incurred 73,67,118 79,45,777

3. Balance 17,36,825 36,25,748

c) In the visited Sub-Centres, it was observed that the VHSNCs are established, functioning and

the budget released were spent, but regular meetings were not conducted. In general, it was

observed that meeting was conducted only once when funds were received and the entire

amount spent within a span of 2-3 months; Ideally the budget should be divided into 4

quarters so that fund is available for all the four quarters with the VHSNC for taking up

sanitation work in any health eventuality that may arise in future quarters. Due to late receipt

of funds, some of the VHSNCs could not spent the amount within the financial year.

d) Rs. 10,000 was allotted to each VHSNC in the visited SCs for 2011-12. For 2012-13, VHSNC

fund was not released.

e) In SC Sringavaram, VHSNC fund could not be spent as the joint account was not opened in

the name of Village Secretary and ANM. Also, the fund was released at the end of the year

(i.e. during Feb. 2012). In SC Korangi, VHSNC fund was utilized for Fogging, purchasing of

Bleaching Powder, Melathian, Phenyl, Registers, payment of Labour charges for cleaning of

Overhead Tank.

7. 24 x 7 hours Delivery Care System:-

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a) In the district, 29 of the total 103 PHCs were functioning as 24X7 delivery care institutions.

Staff position of these centres was not readily available in the district office.

b) No additional budget was released to 24X7 hours Service Centres except the salary for the

contractual Staff Nurses.

c) During 2011-12, 21 PHCs and during 2012-13 (upto May, 2012), 22 PHCs of the total 29

PHCs could not perform stipulated minimum of 10 deliveries per month. District authorities

need to

re – classify the 24X7 centres according to work load.

d) In CHC Thallarevu, 5 Medical Officers and 6 Staff Nurses were posted. Caesarean deliveries

were not conducted as there was no anesthesia equipment available. Normal deliveries

performance was only 264 during the year 2011-12 and 65 during 2012-13 (upto May, 2012).

Baby care unit and Baby corner were not established. Delivery related equipment such as

Phototherapy and radiant warmer units were also not available.

e) Visited PHCs at Shankavaram and Rayavaram, were not 24X7 delivery care centres.

8. Physical Infrastructure and Stock Position:- i) Sub Centres

a) It was reported that SC Korangi was functioning in rent free building (donated by Village

Panchayath) and SC Shringavaram was functioning in rented building. Infrastructure was not

as per IPHS. In SC Korangi, ANM was staying at SC village and in SC Shringavaram ANM

was staying at other places than the SC head quarter. Electricity and toilet were not available

in the visited SC Korangi. Labour Room was not available in all the visited SCs.

b) Examination Table, Foot Stool, Delivery Table, McIntsh Sheet, Ambu bag/suction, Steam

Sterilizer, Delivery Kit, IUD Insertion Kit, RDT Kit for Malaria and Hemoglobino meter were not

available in the visited SCs. Weighing Machine (Infant) was not available in the visited SC

Korangi. Cupboard for drugs was not available in the visited SC Shringavaram.

c) DDK, Kerosene oil / Gas, Tab. Co Trimoxazole, Vitamin A Solution, IFA tablets (small / big /

syrup), OP cycles, Sanitary napkins, EC Pills, Condoms, Clorine Solution (Bleaching

Powder), Tab. Oxitocin, Cap. Ampicillin, Inj. Gentamycine and Kits – A & B were not available

in the visited SCs.

d) Gloves, IUDs, Antiseptic Solution, Tab. Cloroquine and Tab. Metronidazole were not available

in the visited SC Shringavaram.

e) Most of the furniture equipment and drugs were not available in the visited centres as a result

SCs cannot render delivery and other related service effectively.

ii) CHC / PHCs

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a) CHC Thallarevu was functioning in government building though infrastructure was not as per

IPHS. Power back-up was not available. Ambulance, X-Ray machine, neonatal resuscitation

equipment, Anesthesia equipment, Baby care unit, Baby radiant warmer, Phototherapy unit,

Injection Arteether & Quinine and colour coded bins for waste disposable were not available.

Caesarean deliveries were not conducted as there was no anesthesia equipment.

b) In the visited PHCs Shankavaram and Rayavaram, it was observed that the PHCs were

functioning in government building though infrastructure was not as per IPHS. No vehicle was

provided to the PHCs.

c) In the visited PHC Shankavaram, Lab technician post was vacant for the past 6 years.

AYUSH Medical Officer was not posted. Residential quarter for Medical Officer was not

available.

d) In the visited PHC Rayavaram, Oxygen Cylinder was not available and Labour Room was not

set up.

9. Community Satisfaction and opinion on Health Services:- a) 20 mothers having child upto one year of age were interviewed in the area of visited 2 Sub

Centres to assess their knowledge and opinion on the services rendered by ANMs and

observed that all the mothers had their delivery by trained persons; their babies were weighed

after birth and also received PNC services in time.

b) 14 (70%) mothers had no knowledge on danger signs of ARI and 3 (15.0%) mothers had no

knowledge on advantages and side effects of contraceptive methods. 19 (95.0%) deliveries

were institutional.

c) Post of MPWs (M) were vacant in all the visited SCs. ANMs were doing the work of MPWs (M)

in these SCs.

d) Public opinion was good on the services being rendered by the PHCs visited by the team.

Village leader, ANC/ PNC beneficiaries and others expressed good opinion on the overall

functioning of PHCs.

10. Sample Verification of FW Acceptors:- a) Out of 66 FW acceptors (Sterilization, IUD, OP and CC) selected, 53 (80.3%) could be

contacted for sample verification in the district. Minor discrepancies were found in age of

acceptors, age of spouse, total children, number of male children & age of last child.

b) 46 (86.8%) contacted beneficiaries got follow up services and 20 sterilization acceptors

received full compensation money after receiving the services and 6 sterilization beneficiaries

replied that they didn’t know about that.

c) All contacted 21 child immunization beneficiaries confirmed with the doses of immunization

and also on follow up services. No complication among the contacted beneficiaries was found

after receiving the doses.

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11. Maintenance of Records and Register:-

a) Sterilization and IUD central registers (Non Printed) were maintained at PHC levels in the

visited centres.

b) EC, Immunization & MCH, Stocks and cash books were maintained at PHC / SC levels.

c) JSY beneficiaries registers were not maintained at SC levels.

d) EC registers and Stock registers were not updated in the visited centres.

12. IT Infrastructure and Mother & Child (MCH) Tracking System:-

a) Two computers were installed with internet facility at the district headquarter. At CHC level, 11

CHCs of the total 20 CHCs have computer systems and internet facility. At the PHC level,

only 38 PHCs of the total 103 PHCs have computer systems with internet connectivity.

b) In place of blocks, in Andhra Pradesh state, there are Community Health and Nutrition

Clusters (CHNCs) headed by the Senior Public Health Officer with job responsibility to

supervise 4-7 PHCs. There are 23 such CHNCs to supervise 103 PHCs functioning in the

district. At CHNCs level, only 13 CHNCs of the total 23 CHNCs have computer systems and

internet facility. At all levels, in majority of the centres there was no trained manpower to feed

the HMIS and MCTS data.

c) Under HMIS, at PHC level, user IDs were not created. As the CHNC level user IDs were only

created, PHCs having internet connection also do not upload HMIS data at their facilities.

Uploading of PHC wise or CHC wise data was done at CHNC level; only one data entry

operator was posted at CHNC level and uploading of data was made partial.

d) Under MCTS, registration of mothers and children in the web portal is done at the CHNCs. In

the urban areas of the district, MCTS registration was not done as the CHNCs were not

covering urban areas.

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2. District:- Krishna

Highlights from the Evaluation Report of Krishna District (Andhra Pradesh).



checks of activities covered under NRHM / RCH in Krishna District of Andhra Pradesh State during June, 2012.


Centres (PHCs) and Sub Centres (SCs) in both districts of Krishna as per the details given below:

Districts Visited

PHCs / CHCs visited SCs Visited

Krishna CHC: Gudur

PHCs: Katur and Nagayalanka.

Pathanpeta, Gudur, Kaluvapamula, Katur,

Nagayalanka and Nangegadda.

II. The major observations


a) One Post of the District Immunization Officer, 4 of the 7 sanctioned posts of Gynecologist, 5 of the 7 sanctioned posts of Pediatrician, 4 of the 7 sanctioned posts of Anesthetist, 5 of the 9

sanctioned posts of Radiologist, 1 of the 16 sanctioned posts of Ophthalmologist at CHNC level

and 1 of the 9 sanctioned posts of Dental Medical Officer were lying vacant.

b) Similarly, in the category of Para-medical, 14 of the 142 sanctioned posts of Staff Nurse

(Regular), 3 of the 132 sanctioned posts of MPH Supervisor (Female) / L.H.V, 24 of the 162

sanctioned posts of MPH Supervisor (Male), 10 of the 72 sanctioned posts of Pharmacist, 15 of

the 59 sanctioned posts of Lab Technician, 120 of the 346 sanctioned posts of MPHW (Male),

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115 of the 535 sanctioned posts of MPHW (Female) and 60 of the 136 sanctioned posts of 2nd

MPHW (Female) were also lying vacant in the district.

c) No staff was reported to have been posted at District level NRHM Programme Management Unit

in the district.

d) In the visited CHC Gudur, one post each of the Paediatrician, Gynecologist and General duty MO, 2 of the 15 sanctioned posts of ANM and 6 of the 16 sanctioned posts of Male Worker were lying

vacant.

e) In the visited PHC Katur, 1 of the 2 sanctioned posts of contract Staff Nurse, post of Pharmacist, 1 of the 14 sanctioned posts of ANM, 2 of the 14 sanctioned posts of 2nd ANM and 2 of the 5

sanctioned posts of Male worker were lying vacant.

f) In the visited PHC Nagayalanka, post each of the AYUSH Medical Officer, Pharmacist, Lab.

Assistant, 2 of the 3 sanctioned posts of contract Staff Nurse, 1 of the 9 sanctioned posts of ANM

were lying vacant.



eligible for JSY payments for their first two deliveries. JSY mothers are given @ Rs.700 per case

for rural area and @ Rs. 600 per delivery in urban area in the state. Rs. 500 for per delivery in

case of home delivery are given in the state.



deliveries.

c) Total budget for JSY in the district was available to the tune of Rs. 1, 49, 74,629 for 2010-11 and

1, 75, 84,394 for 2011-12. Expenditure to the tune of Rs. 65, 72,235 was incurred in 2010-11 and

Rs. 59, 66,058 during 2011-12.


and they received full JSY cash incentive. MCH and JSY cards were issued to all; ANC / PNC

visits were made by the ANMs. Transport facility was arranged by ASHAs / ANMs to 17 mothers

for delivery purpose.


PHCs. In the visited Sub Centres, Beneficiaries registers were not maintained at Sub-Centres

visited.

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3. Untied Funds:-

a) Provision and utilization of Untied Funds in the district are as detailed below:

(Amount in Rs)

Sl. No


2010-11 2011-12 2010-11 2011-12 2010-11 2011-12

1. Total budget

available

1,00,006 1,00,006 4,04,507 3,52,579 68,55,297 1,01,07,059

2. Expenditure

incurred 0 0

2,28,091 0 33,68,238 68,68,655

3.

Balance

1,00,006 1,00,006 1,76,416 3,52,579 34,87,059 32,38,404


b) There are 9 CHCs, 80 PHCs and 620 Sub Centres in the district. Rs. 25,000 to each PHC and

Rs. 50,000 to each CHC are given as untied funds per year in the district. SCs were being

provided @ Rs. 10,000 as Untied Funds.

c) Untied Funds to the tune of Rs. 10,000 was released to the visited SCs at Pathanpeta and

Kaluvapamula in the year 2011-2012 (during Feb. 2012) but this fund was not given to these

centres during 2012-13 till the date of visit.

d) The funds were spent by these sub centres to buy Glucometer, Thermometer, Uristix, Height

Measuring Scale, Survey Books, Stationery, Table, Chairs, for getting Xerox copies of

reporting formats, Door and Window curtains etc . For the year 2012-13, SC Untied Fund was

not released from district.


a) Rogi Kalyan Samiti (RKS) was constituted in District Hospital, 5 SDHs, 9 CHCs and 80 PHCs

in the district.

b) Every RKS was being provided funds to the tune of Rs. 5, 00,000 at Distt. Hospital level,


year. These funds include corpus fund, Annual Maintenance Grant (AMG) and Untied Funds.

AMG and Untied Funds to the RKS at DH and SDH are not given in the district. All these funds are kept at the disposal of RKS and after taking approval, the funds were being utilized

on developmental activities of the Institution.

14



(Amount in Rs.)

Type/head

of the

funds


2010-11 2011-12 2010-11 2011-12

Budget* Expdr. Budget* Expdr. Budget* Expdr. Budget* Expdr.

Corpus

fund

5,32,73

3

2,32,506 21,00,22

7

5,18,280 42,12,301 27,14,81

6

1,73,97,48

5

43,11,66

8

AMG Fund 3,50,10

6

1,64,648 15,35,48

5

68,495 11,87,753 7,30,742 75,57,011 16,02,22

3


Status of Untied Funds may be seen at point 3.

d) In the visited CHC / PHCs, It was observed that no budget was released during 2012-13 to this

centre under RKS as the District Office did not receive any budget from the state. No budget

was released during 2010-11 budget meant for 2010-11, was released in next financial year

during May, 2011 and the budget for 2011-12 was also released during Feb.2012.

e) In CHC Gudur, RKS funds were kept in the joint bank account of Medical Officer of CHC and

Mandal Development Officer (MDO) of government revenue department. As the other joint

signatory was not available during 2011-12 no expenditure was incurred during 2011-12.

During 2010-11, an expenditure of Rs. 1, 48,465 was incurred on purchase of Payment of

Sweeper labour charges, Night Watchman honorarium, Labour charges for cleaning &

maintaining CHC premises & gardening, cleaning of Toilets for whole year, payment of

Telephone & Internet bills, transport of medicines from district office. Repairs work of Auto-

clave, Dental Chair, Electrical repairs, Air-conditioner repair and construction of water tank.

Besides this, Calorie meter, Laboratory Chemicals, Curtains, Electrical spares parts and

emergency medicines was also purchased from this fund..

f) In the visited PHCs, expenditure was made under this head for purchase of Electrical fittings,

Thermo Regulator for Fridge, Laser Printer, computer monitor, hard disc, printer, UPS, Power

Cable, Repair works of Computer, Electrical items, Iron Sterilizer elements, Printer Cartridge,

Medicines for Tub cases and Colour coded Bins. Toilet, Water Cooler, Water Pipelines, Water

Tank cleaning & repairs and Window repair, Refilling of Oxygen Cylinder, Water connection

laying for PHC, Painting charges of PHC building, Celebration of World Women’s day, Iron Cot

Welding, payment of Telephone Broad band bill, Lab materials, Optical Drum for eye check-up

and Glucose-strips, etc.

15

5. Services of ASHA:-

a) As targeted, the district had selected 2697 ASHAs and all ASHAs were trained in all modules

as on 31-01-2012. All ASHAs were provided with drug kits. 733 new ASHAs are proposed to

be inducted during 2012-13.

b) An expenditure to the tune of Rs. 1,24,26,277 during 2010-11 and Rs. 2,35,96,361 during

2011-12 was incurred towards performance based incentives to ASHAs.


and given drug kits, some newly selected ASHAs were trained for 3 days at PHC. ASHAs

have been receiving performance based remuneration regularly. Some ASHAs have

expressed their dissatisfaction for meager performance based incentive.

d) At the visited SCs Pathanpeta and Kaluvapamula, ASHAs were posted and trained. In the

VHSNCs, ASHAs were functioning as a member.



Rs. 10,000 are allotted to each VHSNC which was operated jointly by the Village Secretary of

Govt. Revenue department and ANM of Sub-Centre.

b) Details of VHSNC budget available and spent in the district during 2010-11 and 2011-12 are

as below: ( Amount in Rs.)

SI.No Particulars 2010-11 2011-12

1. Total budget available 91,03,943 1,15,71,525


3. Balance 17,36,825 36,25,748

c) In the visited Sub-Centres, it was observed that the VHSNCs are established, functioning and

the budget released were spent, but regular meetings were not conducted. In general, it was

observed that meeting was conducted only once when funds are receive and the entire

amount is spent within a span of 2-3 months; Ideally the budget should be divided into 4


sanitation work in any health eventuality that may arise in future quarters.

16

d) Rs. 10,000 was allotted to each VHSNC in the visited SCs for 2011-12. For 2012-13 (upto

May, 2012) VHSNC fund was not released. Some of the VHSNCs could not spend the amount

during the financial year.

e) VHSNC fund was utilized for buying Bleaching Powder, Registers and payments to Labor

charges for cleaning drainage in the villages.


a) In the district, 28 of the total 80 PHCs were functioning as 24X7 delivery care institutions.

Only 10 PHCs had 2 Medical Officers and the remaining 18 had only 1 Medical Officer posted.

All 28 centres have 3 Staff Nurses posted. As per the norm of staff pattern in 24X7 centres,

minimum 2 Medical Officers should be posted to run the 24X7 centres efficiently.

b) No additional budget was released to 24X7 hours Service Centres except the salary for the


c) During 2010-11, 23 PHCs and during 2011-12, 25 PHCs of the total 28 PHCs could not

perform stipulated minimum of 10 deliveries per month.

d) In CHC Gudur, Caesarean deliveries were not conducted as there was no anesthesia

equipment available and Gynecologist was not posted. Normal delivery performance was only

12 during the year 2010-11 and 13 during 2011-12. The performance was very low for the

CHC level institutions considering the availability 6 staff nurses in this hospital. Baby care unit

and Baby corner were not established. Delivery related equipment such as Phototherapy and

radiant warmer units were also not available.

e) In PHCs Katur and Nagayalanka, Baby radiant warmer, Phototherapy Unit & Suction

Apparatus were not supplied and Baby corner was not established in both the PHCs. One post

of contractual Staff Nurse was vacant in PHC Katur. During 2011-12, 103 deliveries and from

April, 2012 to May 2012, 23 deliveries were conducted in PHC Katur. In PHC Nagayalanka, 2

posts of contractual Staff Nurse were vacant. During 2011-12, 18 deliveries and from April,

2012 to May 2012, 4 deliveries were conducted in PHC Nagayalanka.

8. Physical Infrastructure and Stock Position:- i) Sub Centres

a) It was reported that SC Pathanpeta was functioning in rented building and SC Kaluvapamula

was functioning in rent free building (Panchayath). Wherever sub-centres were functioning in

the rented buildings, the ANM posted there has to be reimbursed the sub-centre clinic rent,

this was not done for the past 2-3 years. ANMs posted in such centres were spending money

on their own and paying sub-centre rent to run the sub-centres. Infrastructure was not as per

IPHS. ANM was staying at other places than the SC head quarter in all the visited SCs. Toilet

17

was not available in the visited SC Pathanpeta. Labour Room was not available in all the

visited SCs.

b) Foot Stool, Delivery Table, McIntsh Sheet, Ambu bag/suction, Steam Sterilizer, RDT test Kit

for Malaria, Torch and Hemoglobin meter were not available in the visited SCs. Delivery Kit,

Nischay pregnancy test kit, IUD insertion kit, Stove and Weighing Machine (Infant) were not

available in the visited SC Kaluvapamula.

c) Gloves, DDK, Kerosene oil / Gas, Sanitary napkins, Condoms, Tab. Oxitocin and Inj.

Gentamycine were not available in the visited SCs. Tab. Co trimoxazole, Vitamin A Solution

were not available in the visited SC Pathanpeta. OP cycles, EC Pills, Antiseptic Solution, Tab.

Chloroquine, Cap. Ampicillin and Kits – A & B were not available in the visited SC

Kaluvapamula.

d) Most of the furniture equipment and drugs were not available in the visited centres as a result


ii) PHCs

a) CHC Gudur was functioning in government building though infrastructure was not as per IPHS.

There was no regular water supply. Power back-up was available for OT only. Ambulance, X-

Ray machine, Blood storage facility, neonatal Anesthesia equipment, Adult Anesthesia

equipment, Baby radiant warmer, Phototherapy unit, Injection Arteether & Quinine and colour

coded bins for waste disposable were not available. Caesarean deliveries were not conducted

as there was no anesthesia equipment available and Gynecologist was not posted.

b) In the visited PHCs Katur and Nagayalanka, it was observed that the PHCs were functioning in

government building though infrastructure was not as per IPHS. No vehicle was provided to

the PHCs. AYUSH Medical Officer was not posted. Residential quarter for Medical Officer

was not provided. Both the PHCs were functioning as 24X7 delivery care centre.

9. Community Satisfaction and Opinion on Health Services:- a) 20 mothers having child upto one year of age were interviewed in the area of visited 2 Sub


observed that most of the mothers had their delivery by trained persons; their babies were

weighed after birth and also received PNC services in time.

b) 15 (75%) mothers had no knowledge on danger signs of ARI and 2 (10.0%) mothers had no


were institutional.

c) Posts of MPWs (M) were vacant in all the visited SCs. ANMs were doing the work of MPWs

(M) in these SCs.

18


Village leader, ANC/ PNC beneficiaries and others had expressed good opinion on the overall


10. Sample Verification of FW Acceptors:- a) Out of 70 FW acceptors (Sterilization, IUD, OP and CC) selected, 50 (71.4%) could be


acceptors, total children, number of male children & age of last child.

b) 41 (82%) contacted beneficiaries got follow up services and 17 sterilization acceptors received

full compensation money after receiving the services and 7 sterilization beneficiaries replied

that they didn’t know about compensation money .

c) All contacted 22 child immunization beneficiaries confirmed receiving the doses of

immunization and also follow up services. No complication among the contacted beneficiaries

was found after receiving the doses.

11. Maintenance of Records and Register:- a) Sterilization and IUD central registers (Non Printed) were maintained at PHC levels in the

visited centres.

b) EC, Immunization & MCH, Stocks and cash books were maintained at PHC / SC levels.

c) JSY beneficiaries register was not maintained at SC levels.

d) EC registers and Stock registers were not found updated in the visited centres.

12. IT Infrastructure and Mother & Child (MCH) Tracking System:- a) Two computers were installed with internet facility at the district headquarter. At CHC level,

there is no computer system available. At the PHC level, only 40 PHCs of the total 80 PHCs

have computer systems with internet connectivity.

b) In the place of blocks, in Andhra Pradesh state, there are Community Health and Nutrition



district. At CHNCs level, all the 14 CHNCs have computer systems and internet facility, but

there is no trained manpower to make data entry in many CHNCs.

c) Under HMIS, at PHC level user IDs were not created. Only at CHNC level user IDs were

created, therefore PHCs having internet connection also do not upload HMIS data at their

facilities. Uploading of PHC wise or CHC wise data was done at CHNC level and as only one

data entry operator was posted at CHNC level, uploading of data was partial.

d) Under MCTS, registration of mothers and children in the web portal is made at CHNC level.

For the year 2011-12, 59,057 mothers and 46,555 children were enrolled in the MCTS web

19

portal. These figures are not complete as 86,827 ANCs and 74,264 deliveries were reported

in the district for the same period. In the urban areas of the district, namely Vijayawada town

and other towns, MCTS registration was not done as the CHNCs were not covering urban

areas.

20

3. District:- Vishakhapattanam

Highlights from the Evaluation Report of Vishakhapattanam District (Andhra Pradesh)



checks of activities covered under NRHM / RCH in Vishakhapattanam District of Andhra Pradesh State during July, 2012.


Centres (PHCs) and Sub Centres (SCs) in both districts of Vishakhapattanam as per the details

given below:

Districts Visited PHCs / CHCs visited SCs Visited

Vishakhapattanam PHCs : Thallavalasa, Tumpala,

Gavaravaram.

CHC : Bhimunipattanam.

Thatikuru, Singanbandh, Thumpala-I,

Seethanagaram, Govada and

Khandepalli.

II. The Major Observations:


a) Shortage of Medical Personnel was reported in the district. 25 of the 168 sanctioned posts of Medical Officer (Allopathic / MBBS), 3 of the 7 sanctioned posts of Physician, 3 of the 7

sanctioned posts of Surgeon, 9 of the 19 sanctioned posts of Gynecologist, 3 of the 10

sanctioned posts of Pediatrician, 1 of the 9 sanctioned posts of Anesthetist, 1 of the 2 sanctioned

posts of Radiologist, one post of Pathologist, 2 of the 3 sanctioned posts of ENT Specialist, 2 of

the 3 sanctioned posts of Ophthalmologist and 2 of the 16 sanctioned posts of Dental Medical

Officer were lying vacant in the district.

b) Similarly, in the category of Para-medical staff, 12 of the 138 sanctioned posts of Staff Nurse (Regular), 17 of the 52 sanctioned posts of Staff Nurse (contract basis under 24X7 PHCs), 49 of

the 157 sanctioned posts of MPH Supervisor (Female) / L.H.V, 26 of the 103 sanctioned posts of

Pharmacist, 10 of the 80 sanctioned posts of Lab Technician, 175 of the 477 sanctioned posts of

MPHW (Male), 119 of the 611 sanctioned posts of MPHW (Female) and 94 of the 503 sanctioned

posts of 2nd MPHW (Female) were also lying vacant in the district.

c) Further, the post of District Project Manager under NRHM was lying vacant in DPMU. No staff

was reported to have been posted at Taluk level, Sub-district level or Block level NRHM

Programme Management Unit in the district.

21

d) In the visited CHC Bhiminipattanam, 2 of the 5 sanctioned posts of Medical Officer, two posts of AYUSH Medical Officer, one post each of the Pharmacist and ANM were lying vacant.

e) In the visited PHC R. Thallavalsa, one post each of the AYUSH Medical Officer & Pharmacist, 2 of the 10 sanctioned posts of ANMs, 5 of the 10 sanctioned posts of 2nd ANM and 5 of the 6

sanctioned posts of Male worker were lying vacant.

f) In the visited PHC Thumpala, one post each of the Medical Officer and Pharmacist and 2 of the 4

sanctioned posts of Male Worker were lying vacant.

g) In the visited PHC Gouravaram, one post each of the Medical Officer and Staff Nurse, 3 of the 13

sanctioned posts of ANM, 2 of the 12 sanctioned posts of 2nd ANM and 4 of the 9 sanctioned

posts of Male worker were lying vacant.



eligible for JSY payments for their first two deliveries. JSY mothers are given @ Rs.700 per

institutional delivery for rural area and @ Rs. 600 per delivery in urban area in the state. In case

of home delivery Rs. 500 is given in the state.

b) In the district, 73,306 deliveries were conducted during 2011-12. Out of them 14,501 got JSY

cash incentive during the year. During 2012-13 (upto June, 2012) payments were made to 3,426

beneficiaries out of 17,908 deliveries.

c) Total budget for JSY in the district was available to the tune of Rs. 1, 15, 89, 834 for 2011-12 and

Rs. 56,79,187 for 2012-13. Expenditure to the tune of Rs. 1, 01, 10,647 was incurred in 2011-12

and Rs. 24, 05,484 during 2012-13 (upto June, 2012).


and they received full JSY cash incentive. Out of them, 17 mothers received JSY cash incentive

in time. MCH and JSY cards were issued to all; ANC / PNC visits were made by the ANMs.

Transport facility was arranged by ASHAs / ANMs to 19 mothers for delivery purpose.


PHCs.

f) During visit to the Sub Centres, 2 pending cases for JSY payment were reported at Singanbandh

SC in the year 2011-12. Similarly, 3 in Thatikuru, 7 in SC Singanbandh, 7 in SC Thumpala-I and

8 pending cases for JSY payment in SC Seethanagaram were reported in the current year (upto

June, 2012).

3. Untied Funds:-

22

a) Rs. 50,000 to each CHC / TH, Rs. 25,000 to each PHC and Rs. 10,000 to each Sub Centre are

given per year as Untied Fund in the district.

b) There are 13 CHCs, 85 PHCs and 584 Sub Centres in the district. Status of availability and

utilization of Untied Funds in the district are as given below:

(Amount in Rs)

Sl no


2011-12 2012-13 # 2011-12 2012-13 # 2011-12 2012-13 #

1. Total budget

available

11,44,961 11,44,961 43,99,699 23,67,843 98,10,790 63,96,953

2. Expenditure

incurred 0 0

20,31,856 2,13,500 34,13,837 4,85,600

3.

Balance 11,44,961 11,44,961 23,67,843 21,54,343 63,96,953 59,11,353

* Including opening balance etc. # upto June’ 2012

c) It was observed that Untied Funds to the tune of Rs. 10,000 were released to each of the

visited SCs at Thatikuru, Singanbandh, Thumpala-I and Seethanagaram in the year 2011-12

and the same was utilized by the centres but this fund was not given to these centres during

2012-13 till the date of visit.

d) The visited Sub Centres spent untied funds for purchasing of Weighing machine, BP

apparatus, Hemoglobinometer, Height Measuring Scale, Lancets, Records and Registers,

Stationery, Chloro-scope, Thermometer and Measuring Tape. For the year 2012-13, SC

Untied Fund was not released from district.


a) Rogi Kalyan Samiti (RKS) was constituted in District Hospital, SDH, 13 CHCs and 85 PHCs in

the district.

b) Every RKS was being provided funds to the tune of Rs. 5, 00,000 at District Hospital level,


year. These funds includes corpus fund, Annual Maintenance Grant (AMG) and Untied Funds.

AMG and Untied Funds to the RKS at DH and SDH are not given in the district. All these funds are kept at the disposal of RKS and after taking approval, the funds were being utilized

on developmental activities of the Institution.

23



(Amount in Rs.)

Type/

head of

the funds


2011-12 2012-13 # 2011-12 2012-13 #

Budget* Expdr. Budget* Expdr

.

Budget* Expdr. Budget* Expdr.

Corpus

fund

25,42,379 8,93,938 16,48,44

1

0 1,70,65,89

4

63,71,19

2

1,06,94,70

2

9,36,000

AMG Fund 13,00,000 0 13,00,00

0

0 58,02,618 16,60,91

8

41,41,700 4,26,800

* Including opening balance etc. # upto June’ 2012.

Status of Untied Funds may be seen at point 3 above. d) RKS funds meant for the year 2012-13 were not released from the State Office to District

Office till the visiting month. It was observed that budget meant for 2010-11 was released in

the next financial year during May, 2011 and the budget of 2011-12 was also released very

late during March 2012.

e) In CHC Bhiminipattanam, during 2011-12 the fund to the tune of Rs. 3, 00,000 and during

2012-13 the fund to the tune of Rs. 1, 50,000 including opening balance was available with

RKS. Out of this, during 2011-12, an amount to the tune of Rs.1,50,000 was spent on painting

of CHC building, Carpenter work for fixing window mesh, Labour charges for premises &

garden cleaning, Electrical rewiring, purchase Electrical items and purchase of Laboratory

equipment etc.

f) In the visited PHCs, expenditure was incurred on Repair & maintenance work of Bore-well,

Fixing of Window Glass & Sanitary fittings, Repair of Air-Conditioner, payment of honorarium

to Contingent Worker & Night Watchman, Labour charges on OT, Deliver Room cleaning,

Laundry and Washing charges, Purchase of Electrical items, Voltage Stabilizer, UPS and

other Computer items, OT Lamps, Emergency Medicines, Office Furniture, Inverter, Lab

equipment, Haemoglobinometer and Steel Almariah, purchase of Patient Cots & Beds, OT

equipment, DDT Pump Spray machine, Surgical equipment, Oxygen Cylinder and Fumigator

machine. Besides, expenditure was also incurred on Plumbing charges, Cleaning of premises

charges to earth movers, Refilling of LPG gas and payment of Transport charges to bring

Medicines from District Office to centre etc.

5. Services of ASHA :-

a) In the district, 5734 ASHAs were appointed against the total requirement of 6188 ASHAs and

2070 ASHAs were trained upto 5th modules. 2365 ASHAs were provided with drug kits.

24

b) An expenditure to the tune of Rs. 3, 64, 57,248 during 2011-12 and Rs. 41, 25,000 during

2012-13 (upto June, 2012) was incurred towards performance based incentives to ASHAs.



however from April to June 2012 incentive to ASHA was observed to be pending in PHC

Gouravaram. ASHAs expressed their dissatisfaction for meager performance based

incentive.

d) At the visited SCs Thatikuru, Singanbandh, Thumpala-I and Seethanagaram ASHAs were

posted and trained. In the VHSNCs, ASHAs were functioning as a member.



Rs. 10,000 are allotted to each VHSNC which is kept in a bank account operated jointly by

the Village Secretary of Govt. Revenue Department and ANM of Sub-Centre.


given below:

(Amount in Rs.)

Srl no Particulars 2011-12 2012-13 (upto June’12)

1. Total budget available 1,71,06,303 1,02,18,489


3. Balance 1,02,18,489 89,24,489

c) In the visited Sub-Centres, it was observed that the VHSNCs were established, functioning

and the budget released were spent, but regular meetings were not conducted. In general, it

was observed that meeting was conducted only once when funds receive and the entire

amount is spent within a span of 2-3 months; ideally the budget should be divided so that the

fund is available for all the four quarters with the VHSNC for taking up sanitation work in any

health eventuality that may arise in future quarters.

d) For the year 2011-12, Rs. 10,000 was allotted to each VHSNC in the visited SCs during March

2012. VHSNC fund was utilized to buy Bleaching Powder, Lime Powder, Phenyl, Spraying

Machine, Dust Bins, Chairs, Table, Buckets, Mugs, Stamp Pad, Labour charges for Sanitation

work and cleaning Over head Tank. For the period 2012-13, VHSNC fund was not released

from district as there was no budget.


25

a) In the district, 35 of the total 85 PHCs were functioning as 24X7 delivery care institutions. Of

these, 25 PHCs have 2 Medical Officers posted and the remaining 10 have only one Medical

Officer; 16 PHCs have 3 Staff Nurses and the remaining 19 have less than 3 Staff Nurses

posted.

b) No additional budget was released to 24X7 Service Centres except the salary for the


c) During 2011-12, 16 PHCs and during 2012-13 (up to June, 2012), 19 PHCs of the total 35

PHCs could not perform stipulated minimum of 10 deliveries per month. District authorities

need to re-classify the 24X7 centres according to workload.

d) In CHC Bhiminipattanam, 2 of the 5 sanctioned posts of Medical Officers were lying vacant.

Blood storage facility, Neonatal Resuscitation & Anesthesia equipment, Baby Care Unit, Baby

Radiant Warmer and Phototherapy Unit were not available. Caesarean deliveries were not

conducted as there was no anesthesia equipment available. Normal delivery performance was

only 114 during the year 2011-12 and 10 during 2012-13 (upto June, 2012). Baby care unit

and Baby corner were not established.

e) In the visited PHC at Thumpala, one Medical Officer and 3 Staff Nurses were posted. Baby

Radiant Warmer and Phototherapy Unit were not available. Baby corner was not set up.

During 2010-11, 76 deliveries and during 2011-12, 65 deliveries were conducted, performance

was below the stipulated norm of minimum 10 deliveries per month.

8. Physical Infrastructure and Stock Position:- i) Sub Centres a) It was reported that SC Thatikuru was functioning in rent free building, SC Singanbandh was

functioning in Govt. building, SC Thumpala-I and SC Seethanagaram were functioning in

rented building. Infrastructure was not as per IPHS. In SCs Singanbandh and Seethanagaram,

ANM was staying at SC village and in SCs Thatikuru and Thumpala-I, ANM was staying at

other places than the SC head quarter. Electricity, toilet and main source of water were not

available in the visited SCs Thatikuru and Singanbandh. Labour Room was not available in all

the visited SCs.

b) Foot Stool, Delivery Table, Ambu bag/suction, RDT test Kit for Malaria were not available in the

visited SCs. Steam Sterilizer, Delivery kit and Stove were not available in the visited SCs

Thatikuru, Singanbandh and Thumpala-I. Weighing Machine (Infant) was not available in the

visited SCs Singanbandh and Seethanagaram. IUD Insertion Kit & Torch were not available in

the visited SCs Thatikuru and Singanbandh. Hemoglobinometer was not available in SC

Seethanagaram.

c) Gloves, DDK, Kerosene oil / Gas, Vitamin A Solution, IFA tablets (small / big / syrup), OP

cycles, Sanitary napkins, EC Pills, Condoms, Tab. Oxitocin, Inj. Gentamycine and Kits – A & B

26

were not available in the visited SCs. Tab. Co Trimoxazole was not available in the visited

SCs except SC Thumpala-I. Clorine Solution (Bleaching Powder) was not available in the

visited SCs Singanbandh and Seethanagaram. IUDs was not available in the visited SCs

Thumpala-I and Seethanagaram.

d) Antiseptic Solution, Cap. Ampicillin and Tab. Cloroquine were not available in the visited SC

Seethanagaram.

e) Most of the furniture equipment and drugs were not available in the visited centres as a result


ii) CHC / PHCs a) CHC Bhiminipattanam was functioning in government building though infrastructure was not

as per IPHS. Power back-up was under repair. X-Ray machine, Blood Storage facility,

Neonatal Resuscitation equipment, Anesthesia equipment, Baby care unit, Baby radiant

warmer, Phototherapy unit, Injection Arteether & Quinine and colour coded bins for waste

disposable were not available. Caesarean deliveries were not conducted as there was no

anesthesia equipment.

b) In the visited PHCs R. Thallavalsa and Thumpala, it was observed that the PHCs were

functioning in government building though infrastructure was not as per IPHS. No vehicle was

provided to the PHCs. AYUSH Medical Officer was not posted. Residential quarter for

Medical Officer was not available.

c) PHC R. Thallavalsa was not categorized to function as 24X7 delivery care centre.



observed that 38 mothers had their delivery by trained persons; All the mothers had their

babies weighed after birth and also received PNC services in time.

b) 23 (57.5%) mothers had no knowledge on danger signs of ARI and 5 (12.5%) mothers had no


were institutional.

c) Post of MPWs (M) was vacant in the visited SCs except SC at Thumpala-I. ANMs were doing

the work of MPW (M) in the SCs where MPWs (M) were not posted.

d) 10 persons were contacted and interviewed in the SC Villager Thumpala-I. It was observed

that MPW (M) was not staying in the SC HQ. His behavior, work towards attending health

clinics / immunization session, collection blood smears and giving proper advice / treatment of

fever cases was found satisfactory. Village leaders, School teacher and already motivated

person for male sterilization have expressed their satisfaction towards the work of MPW (M).

He has achieved his targets in collection of blood smears and motivated persons for FP

methods.

27

e) Public opinion was good on the services being rendered by the PHCs visited by the team.



10. Sample Verification of FW Acceptors:- b) Out of 84 FW acceptors (Sterilization, IUD, OP and Nirodh) selected, 63 (75.5%) could be


acceptors, age of spouse, total children & number of male children recorded in the service

registers of the acceptors.

b) 54 (85.7%) contacted beneficiaries got follow up services and 35 sterilization acceptors

informed receiving full compensation money.





a) IUD / OP / CC registers, Stocks and Cash Books (Non Printed) were maintained at PHC / SC

levels in the visited centres.

b) EC, ANC / PNC and Immunization registers were maintained at PHC levels.

c) JSY beneficiary register was not maintained at SC levels.

d) EC and Stock registers were not updated in the visited centres.

12. IT Infrastructure and Mother & Child (MCH) Tracking System:- a) Two computers were installed with internet facility at the district headquarter. At CHC / PHC

level, information on the availability of computers and internet facility was not readily available

at the district office.




district. At CHNCs level, all the 15 CHNCs having computer systems and internet facility, but

there was no trained manpower to make data entry in many CHNCs.

c) Under HMIS, user IDs for uploading data were created only at CHNC level, therefore PHCs

having internet connection do not upload HMIS data at their facilities, uploading of PHC wise

or CHC wise data was done at CHNC level; only one data entry operator was posted at CHNC

level and uploading of data was made partial.

28

4. District:- Chittoor

Highlights from the Evaluation Report of Chittoor District (Andhra Pradesh).



checks of activities covered under NRHM / RCH in Chittoor District of Andhra Pradesh State during July, 2012.


Centres (PHCs) and Sub Centres (SCs) in both districts of Chittoor as per the details given below:


Chittoor CHC: Gudur

PHCs : Katur and

Nagayalanka.

Pathanpeta, Gudur, Kaluvapamula, Katur,

Nagayalanka and Nangegadda.

II. The Major Observations:


a) One Post of District Surveillance Officer, 31 of the 197 sanctioned posts of Medical Officer (Allopathic / MBBS), 33 of the 165 specialists i.e. 17 of the 21 sanctioned posts of Physician, 7 of

the 19 sanctioned posts of Surgeon, 1 of the 2 sanctioned posts of Radiologist, all the 6

sanctioned posts of Pathologist, 1 of the 7 sanctioned posts of ENT Specialist and 1 of the 20

sanctioned posts of Dental Medical Officer were lying vacant in the district.

b) Similarly, in the category of Para-medical, 36 of the 74 sanctioned posts of Staff Nurse (contract basis for 24X7 PHCs), 29 of the 142 sanctioned posts of MPH Supervisor (Female) / L.H.V, 47

of the 94 sanctioned posts of MPH Supervisor (Male), 18 of the 114 sanctioned posts of


MPHW (Male), 103 of the 556 sanctioned posts of MPHW (Female) and 68 of the 625 sanctioned

posts of 2nd MPHW (Female) were also lying vacant in the district.

c) All the posts at District level NRHM Programme Management Unit (DPMU) were filled. No staff

was reported to be there at the Taluk level, Sub-District level and Block level NRHM Programme

Management Unit in the district.

d) In the visited CHC V. Kota, 5 of the 7 sanctioned posts of Medical Officer, one post each of the AYUSH Medical Officer and Pharmacist, 4 of the 15 sanctioned posts of ANM, 3 of the 15

29

sanctioned posts of 2nd ANMs and all the 2 sanctioned posts of Lab. Technician were lying

vacant.

e) In the visited PHC Madireddypalem, two sanctioned posts of Medical Officer and 2 of the 4 sanctioned posts of Male worker were lying vacant.



eligible for JSY payments for their first two deliveries. JSY mothers are given @ Rs.700 per case

for rural area and @ Rs. 600 per delivery in urban area in the state. Rs. 500 per delivery in case

of home delivery are given in the state.



deliveries upto June’ 2012.

c) Total budget for JSY in the district was available to the tune of Rs. 2,51,67,984 for 2011-12 and

Rs. 1,48,24,134 for 2012-13. Expenditure to the tune of Rs. 1, 48, 41,050 was incurred in 2011-

12 and Rs. 10, 53,255 during 2012-13 (upto June’ 12).


and they received full JSY cash incentive. Out of them, 14 mothers received JSY cash incentive

in time. MCH and JSY cards were issued to all; ANC / PNC visits were made by the ANMs.

Transport facility was arranged by ASHAs / ANMs to 14 mothers for delivery purpose.


PHCs.

f) During visit to the Sub Centres, 4 pending cases at SC P. Gollapally and 1 in SC Kumbaralapally

for JSY payment were reported in the year 2011-12. Similarly, 4 in P. Gollapally and 4 pending

cases for JSY payment in Kumbaralapally were reported in the year 2012-13 (upto June’12).

3. Untied Funds:-

a) Rs. 50,000 to each CHC / TH, Rs. 25,000 to each PHC and Rs. 10,000 to each Sub Centre are

given per year as Untied Fund in the district.

b) There are 9 CHCs, 94 PHCs and 644 Sub Centres in the district. Status of availability and

utilization of Untied Funds in the district are as detailed below:

(Amount in Rs)

Sl. No Particulars Budget for All Institutions* Budget for HSCs*

30

2011-12 2012-13 # 2011-12 2012-13 #

1. Total budget

available

56,67,392 38,23,854 1,28,04,416 70,42,530

2. Expenditure

incurred

5,74,538 72,701 57,61,886 0

3.

Balance 50,92,854 37,51,153 70,42,530 70,42,530

* Including opening balance etc. # upto June’ 12.

c) It was observed that Untied Funds @ Rs. 10,000 was released to the visited SCs at P.

Gollapally and Kumbaralapally in the year 2011-12 and the same was utilized by the centres

but this fund was not given to these centres during 2012-13 till the date of visit.

d) The visited Sub Centres spent untied funds for purchasing of Almeria, Benches, Phenyl,

Curtains, Records and Registers, Stationery, for HMIS / MCTS data uploading charges, for

getting Xerox copies of reporting formats, for Transport charges of items purchased to the SC

and for cleaning of SC building. For the year 2012-13, SC Untied Fund was not released from

district.


a) Rogi Kalyan Samiti (RKS) was constituted in District Hospital, 9 SDHs, 9 CHCs and 94 PHCs

in the district.

b) Every RKS was being provided funds to the tune of Rs. 5, 00,000 at District Hospital level,


year. These funds includes Corpus Fund, Annual Maintenance Grant (AMG) and Untied

Funds. AMG and Untied Funds to the RKS at DH and SDH are not given in the district. All these funds are kept at the disposal of RKS and after taking approval, the funds were being

utilized on developmental activities of the Institution.



(Amount in Rs.)

Type/ head

of the funds

For all Institutions for the year For all Institutions for the year

2011-12 2012-13 (upto June’12)

Budget* Expdr. Budget* Expdr.

31

Corpus fund 2,38,11,298 46,29,845 1,68,39,453 3,47,514

AMG Fund 1,70,67,315 14,22,392 1,12,90,923 3,48,485


Status of Untied Funds may be seen at point 3. d) RKS funds meant for the year 2012-13 were not released from the State Office to District

Office till the visiting month. It was observed that budget meant for 2010-11 was released in

the next financial year 2011-12 during June, 2011 and the budget of 2011-12 was also

released very late just before the closure of the year i.e., in February / March 2012.

e) In CHC V Kota, during 2011-12, the fund to the tune of Rs. 4, 26,016 and during 2012-13 the

fund to the tune of Rs. 1, 51,033 including opening balance was available with RKS. Out of

this, during 2011-12, an amount to the tune of Rs.2,74,983 was spent on purchase of

Electrical items, Fans, V- Guard Stabilizer, Invertor Battery, Linen, Pillows, Printing Refills,

Stationery, Registers, Antivirus Software. Other works done were, Sign Boards preparation,

Printing of OPD Slips, Electrical repairs, Tiling of Bathroom, Plumbing works, Toilet fittings,

Bore Motor repair, Pump Motor repair, cleaning of Premises, Civil works, fixing of Window

Mesh, Septic Tank cleaning, Payment of Sanitation workers Honorarium, Transport of

Medicine from district drug store and Computer repairs etc.

f) In the visited PHC Madireddypalem, an expenditure of Rs. 1,03,000 was incurred during 2011-

12 on Transportation cost of Drugs from District Office to PHC, purchase of Office Furniture

Chairs

& Tables, Iron Bureaus, Lenova Desktop, UPS, Printer, Computer Table, Iron Racks, Inverter

Battery, Elisa kits for detection of Hepatitis B, Glucose Meter for Blood Sugar check &

Emergency Medicines, Printing of Registers, Premises & Hospital cleaning, Repair &

purchases of Electrical items and White Washing of PHC building.

5. Services of ASHA :-

a) In the district, 2536 ASHAs were appointed against the total requirement of 3229 ASHAs and

all 2536 ASHAs were working as on 31.03.2012. 693 new ASHAs are proposed to be

inducted during 2012-13.

b) An expenditure to the tune of Rs. 1,25,47,607 during 2011-12 and Rs. 18,52,055 during

2012-13 (upto June’ 12) was incurred towards performance based incentives to ASHAs.



however from April to June 2012 incentive to ASHA was observed to be pending in CHC V.

Kota. ASHAs have expressed their dissatisfaction for meager performance based incentive.

32

d) At the visited SCs P. Gollapally and Kumbaralapally, ASHAs were posted and trained. In the

VHSNCs, ASHAs were functioning as a member.



Rs. 10,000 are allotted to each VHSNC which is kept in a bank account operated jointly by

the Village Secretary of Govt. Revenue Department and ANM of Sub-Centre.


given below:

(Amount in Rs.)

SI. No Particulars 2011-12 2012-13 (upto July’12)

1. Total budget available 2,69,37,128 1,37,94,882

2. Expenditure incurred 1,31,42,246 0

3. Balance 1,37,94,882 1,37,94,882

c) In the visited Sub-Centres, it was observed that the VHSNCs were established, functioning

and the budget released were spent, but regular meetings were not conducted. In general, it

was observed that meeting was conducted only once when funds receive and the entire

amount is spent within a span of 2-3 months. Ideally the budget should be divided into 4


sanitation work in any health eventuality that may arise in future quarters.

d) For the year 2011-12, Rs. 10,000 was allotted to each VHSNC in the visited SCs during March

2012. VHSNC fund was utilized to buy Bleaching Powder, Lime Powder, White Cement,

Melathian, Phenyl, disposal of Garbage and labour charges for Sanitation work and cleaning

Over head Tank. For the period 2012-13, VHSNC fund was not released from district as there

was no budget.


a) In the district, 36 of the total 94 PHCs were functioning as 24X7 delivery care institutions. Of

these, 16 PHCs have 2 Medical Officers posted and the remaining 20 have only one Medical

Officer; 10 PHCs have 3 Staff Nurses and the remaining 26 have less than 3 Staff Nurses

posted.

b) No additional budget was released to 24X7 Service Centres except the salary for the


33

c) During 2011-12, 18 PHCs of the total 36 PHCs could not perform stipulated minimum of 10

deliveries per month. District authorities need to re-classify the 24X7 centres according to

notified delivery points.

d) In CHC V Kota, 5 of the 7 sanctioned posts of Medical Officer, 8 of the 10 sanctioned posts of

Staff Nurses were lying vacant. Blood storage facility, Neonatal Resuscitation & Anesthesia

equipment, Baby Care Unit, Baby Radiant Warmer and Phototherapy Unit were not available.

Caesarean deliveries were not conducted, as there was no anesthesia equipment available.

Normal deliveries performance was 907 during the year 2011-12 and 222 during 2012-13

(upto June, 2012).

8. Physical Infrastructure and Stock Position:-

i) Sub Centres a) It was reported that SC P. Gollapally was functioning in rent free building (SC P. Gollapally was

not having its own building and working in a small room of primary school), SC Kumbaralapally

was functioning in Govt. building (SC Kumbaralapally was having government building, which

was fully condemned and presently functioning in the Anganawadi centre). Infrastructure was

not as per IPHS. In the visited SCs, ANM was staying at other places than the SC head

quarter. Electricity, toilet and main source of water were not available in the visited SC

Kumbaralapally. Labour Room was not available in the visited SCs.

b) Delivery Table, Ambu bag/suction, RDT test Kit for Malaria and Hemoglobinometer were not

available in the visited SCs. McIntsh Sheet, Steam Sterilizer, Stove and Weighing Machine

(Infant) were not available in the visited SC P. Gollapally. Delivery kit and Torch were not

available in the visited SC Kumbaralapally.

c) DDK, Kerosene oil / Gas, Condoms, Antiseptic Solution, Tab. Oxitocin, Cap. Ampicillin and Inj.

Gentamycine and Kits – A & B were not available in the visited SCs.

d) Tab. Co Trimoxazole, Vitamin A Solution, Sanitary napkins and EC Pills were not available in

the visited SC P. Gollapally.

e) Thermometer, Gloves, IFA tablets (small / big / syrup) and OP cycles were not available in the

visited SC Kumbaralapally.

f) Most of the furniture equipment and drugs were not available in the visited centres as a result


ii) CHC / PHCs a) CHC V Kota was functioning in government building though infrastructure was not as per

IPHS. Ambulance, X-Ray machine, Blood Storage facility, Neonatal Resuscitation equipment,

Anesthesia equipment, Baby care unit, Baby radiant warmer, Phototherapy unit and Injection

Arteether were not available. Caesarean delivery was not being conducted due to non

availability of anesthesia equipment.

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b) In the visited PHC Madireddypalem, it was observed that the centre was upgraded to PHC

level institution during May 2011 but continue to function in the same erstwhile government

dispensary building. No vehicle, telephone and resuscitation equipment was provided to the

PHCs. Operation theatre was not set-up because it was a dispensary building. AYUSH

Medical Officer was not posted. Residential quarter for Medical Officer was not available.

c) PHC Madireddypalem was not categorized to function as 24X7 delivery care centre.



observed that 19 mothers had their delivery by trained persons; All the mothers had their

babies weighed after birth and also received PNC services in time.

b) 11(55.0%) mothers had no knowledge on danger signs of ARI and 3 (15%) mothers had no


were institutional.

c) Post of MPWs (M) was vacant in all the visited SCs. ANMs were doing the work of MPWs (M)

in these SCs.




10. Sample Verification of FW Acceptors:- a) Out of 74 FW acceptors (Sterilization, IUD, OP and Nirodh) selected, 58 (78.4%) could be


acceptors, age of spouse, total children & number of male children recorded in the service

registers of the acceptors.

b) 54 (93.1%) contacted beneficiaries got follow up services and 15 sterilization acceptors replied

receiving full compensation money.





a) IUD / OP / CC registers, Stocks and Cash Books (Non Printed) were maintained at PHC / SC

levels in the visited centres.

b) EC, ANC / PNC and Immunization registers were maintained at PHC levels.

c) JSY beneficiary register was not maintained at SC levels.

35

d) EC and Stock registers were not found updated in the visited centres.

12. IT Infrastructure and Mother & Child (MCH) Tracking System:- a) 3 computers were installed with internet facility at the district headquarter. At CHC level, 3 of

the 9 CHCs have computer systems and internet facility. At the PHC level, 53 of the 94 PHCs

have computer systems and only 14 have internet facility.




district. At CHNCs level, all the 20 CHNCs having computer systems and internet facility, but

there was no trained manpower to make data entry in many CHNCs.

c) Under HMIS, user IDs for uploading data were created only at CHNC level, therefore PHCs

having internet connection also do not upload HMIS data at their facilities, uploading of PHC

wise or CHC wise data was done at CHNC level; only one data entry operator was posted at

CHNC level and uploading of data was made partial.

d) As per the data reporting status on 1st July 2012, out of the 644 sub-centres, data for 175, 226

and 402 sub-centres was not uploaded on the HMIs portal for the months of April, May and

June 2012 respectively. Similarly, out of the 94 PHCs, data for 41, 43 and 66 PHCs was not

uploaded for the month of April, May and June 2012 respectively. Since inception (April

2011) of facility wise on-line reporting of data on HMIS web portal, District Hospital did not

upload data on the portal.

e) Under Mother & Child Tracking System, of the total 88,644 ANCs reported during 2011-12 in

the district, only 70,582 mothers were registered in the MCTS web-portal. For the same year,

of the 76,148 deliveries reported, only 60,811 children were registered in MCTS web portal.

For the period April to June 2012, 13,243 mothers and 9,001 children were registered in the

web portal against 18,466 ANCs reported and 17,072 deliveries reported in the district.

Therefore, there was lack of complete information in MCTS web portal.

36

5. District:- Guntur

Highlights from the Evaluation Report of Guntur District (Andhra Pradesh).


Bangalore, Ministry of Health and Family Welfare, Government of India carried out sample

checks of activities covered under NRHM / RCH in Guntur District of Andhra Pradesh State during February, 2013.

I. Health Facilities Covered: As part of evaluation, the team visited Community Health Centres (CHCs), Primary Health

Centres (PHCs) and Sub Centres (SCs) in both district of Guntur as per the details given below:


Guntur PHCs: Thadepalli and Emani.

CHC : Vemuru.

Undavalli, Penumaka, Duggirala (West),

Morampudi and Vemuru.

II. Major Observations:


a) Only 2 of the 175 sanctioned posts of Medical Officer (Allopathic / MBBS), 9 of the 143

sanctioned posts of Staff Nurse (Regular), 22 of the 64 sanctioned posts of Staff Nurse (contract

basis under 24X7 PHCs), 7 of the 147 sanctioned posts of MPH Supervisor (Female) / L.H.V, 1

of the 176 sanctioned posts of MPH Supervisor (Male), 1 of the 88 sanctioned posts of


MPHW (Male), 164 of the 727 sanctioned posts of MPHW (Female) and 127 of the 679

sanctioned posts of 2nd MPHW (Female) were lying vacant in the district.

c) Further, the post of Computer Operator under NRHM in District Programme Management Unit

was also lying vacant in DPMU.

d) In CHC Vemur, the sanctioned post of Pediatrician, 1 of the 9 sanctioned posts of ANM, 3 of the 8 sanctioned posts of 2nd ANM and 3 of the 8 sanctioned posts of Male worker were lying vacant.

e) In PHC Tadepalli, post of Pharmacist, 2 of the 15 sanctioned posts of 1st ANM, 1 of the 15 sanctioned posts of 2nd ANM and 2 of the 8 sanctioned posts of Male worker were lying vacant.

f) In the visited PHC Emani, one post each of the Staff Nurse and Lab Technician, 2 of the 12

sanctioned posts of 2nd ANM were lying vacant.


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a) Pregnant Women belonging to BPL and SC/ ST category are eligible for JSY payments for their

first two deliveries. JSY mothers are given @ Rs.700/- per institutional del

highlights from the reports of the regio · gynecologist, 14 of the 31 sanctioned posts of...

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