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NATIONAL HEALTH MISSION

A REPORT ON

MONITORING OF IMPORTANT COMPONENTS OF NHM PROGRAMME

IMPLEMENTATION IN MAINPURI DISTRICT,

UTTAR PRADESH

MINISTRY OF HEALTH AND FAMILY WELFARE

GOVERNMENT OF INDIA

WILLIAM JOE

VIDYA SAGAR TRIGUN

NIRANJAN ROUT

POPULATION RESEARCH CENTRE

INSTITUTE OF ECONOMIC GROWTH

DELHI 110007

JANUARY 2016

NHM UP PIP 2015-16: M&E Report Mainpuri District PRC-IEG, Delhi

i JANUARY 2016

TABLE OF CONTENTS

Sr.No. TABLE OF CONTENTS Page No.

TABLE OF CONTENTS i

LISTS OF TABLES ii

LISTS OF FIGURES iii

ACKNOWLEDGEMENT iv

ACRONYMS AND ABBREVIATIONS v

EXECUTIVE SUMMARY vi

1. INTRODUCTION 1

1.1 BACKGROUND 1

2. STUDY APPROACH 1

3. DISTRICT PROFILE 2

4. SOCIO-ECONOMIC, DEMOGRAPHIC AND HEALTH CHARACTERISTICS 3

5. HEALTH INFRASTRUCTURE 6

6. HUMAN RESOURCES 7

7. MATERNAL HEALTH 8

7.1 JANANI SURAKSHA YOJANA (JSY) 10

7.2 JANANI SHISHU SURAKSHA KARYAKRAM 10

8. CHILD HEALTH 12

8.1 IMMUNIZATION 12

8.2 RASTRIYA BAL SURAKSHA KARYAKRAM (RBSK) 13

9. FAMILY PLANNING 13

10. QUALITY IN HEALTH CARE SERVICES 14

11. COMMUNITY PROCESS IN THE DISTRICT 14

12. DISEASE CONTROL PROGRAMME 14

13. AYURVEDA, YOGA AND NATUROPATHY, UNANI, SIDDHA AND HOMOEOPATHY

(AYUSH)

15

14. INFORMATION EDUCATION AND COMMUNICATION 15

15. HEALTH MANAGEMENT INFORMATION SYSTEM/ MOTHER AND CHILD TRACKING

SYSTEM (HMIS/MCTS)

15

16. FIELD OBSERVATIONS 16

16.1 DISTRICT WOMEN’S HOSPITAL, MAINPURI 16

16.2 COMMUNITY HEALTH CENTRE, KURAOLI 19

16.3 NEW PRIMARY HEALTH CENTRE, SAADATPUR 22

16.4 SUB CENTRE, PUNUPURA 24

17. CONCLUSIONS AND RECOMMENDATIONS 25

17.1 CONCLUSIONS 25

17.2 RECOMMENDATIONS 26

18. ANNEXURE 1

18.1 DH LEVEL MONITORING CHECKLIST

18.2 FRU LEVEL MONITORING CHECKLIST

18.3 PHC/CHC (NON FRU) LEVEL MONITORING CHECKLIST

18.4 SUB CENTRE LEVEL MONITORING CHECKLIST


ii JANUARY 2016

LIST OF TABLES Page No

TABLE 1:

NUMBER OF HEALTHCARE FACILITIES VISITED BY DELHI-PRC IN MAINPURI

DISTRICT, FOR NHM-PIP MONITORING AND EVALUATION 2015

2

TABLE 2: SOCIO-ECONOMIC, DEMOGRAPHIC AND HEALTH CHARACTERISTICS OF MAINPURI

DISTRICT, UTTAR PRADESH

4-5

TABLE 3: DEMOGRAPHIC INDICATORS, MAINPURI DISTRICT, UTTAR PRADESH 5

TABLE 4: HEALTH INDICATORS, MAINPURI DISTRICT, UTTAR PRADESH 6

TABLE 5: DETAIL OF HEALTH INFRASTRUCTURE 2014-15 6

TABLE 6: HUMAN RESOURCES UNDER NHM 2014-15 7

TABLE 7: TRAINING STATUS OF HUMAN RESOURCE 2014-15 7

TABLE 8: TRAINING STATUS OF HUMAN RESOURCE 2014-15 8

TABLE 9: BLOCK WISE SERVICE DELIVERY INDICATORS 2013-14 & 2014-15 (MATERNAL

HEALTH)

9

TABLE 10: BLOCK WISE SERVICE DELIVERY INDICATORS 2013-14 & 2014-15 (MATERNAL

HEALTH)

10

TABLE 11: STATUS OF JSY PAYMENTS IN DISTRICT 2014-15 10

TABLE 12: BLOCK WISE JSSK PROGRESS IN MAINPURI DISTRICT 2014-15 11

TABLE 13: CHILD HEALTH: DETAIL OF INFRASTRUCTURE AND SERVICES UNDER NEONATAL

HEALTH, 2014-15

12

TABLE 14: CHILD HEALTH: BLOCK WISE ANALYSIS OF IMMUNIZATION, 2014-15 12

TABLE 15: RASTRIYA BAL SURAKSHA KARYAKRAM (RBSK), PROGRESS REPORT MAINPURI

DISTRICT 2014-15

13

TABLE 16: FAMILY PLANNING ACHIEVEMENTS IN MAINPURI DISTRICT 2014-15 13

TABLE 17: BIO-MEDICAL WASTE MANAGEMENT AND INFECTION CONTROL IN THE

MAINPURI DISTRICT

14

TABLE 18: BACKGROUND STATUS OF ASHAS IN THE DISTRICT 14

TABLE 19: PROGRESS OF DISEASE CONTROL PROGRAMME IN THE DISTRICT 15


iii JANUARY 2016

LIST OF FIGURES PAGE NO.

FIGURE 1: MAP OF UTTAR PRADESH 3

FIGURE 2: MAP OF MAINPURI DISTRICT 3

FIGURE 3: DISTRICT WOMEN’S HOSPITAL, MAINPURI 16

FIGURE 4: PATIENTS QUEUE UP AT DWH MAINPURI 16

FIGURE 5: OBG DOCTOR WITH PATIENTS AT DWH 16

FIGURE 6: LABOR ROOM, DWH MAINPURI 16

FIGURE 7: STI UNIT IN DWH, MAINPURI 17

FIGURE 8: NRC UNIT IN DWH MAINPURI 17

FIGURE 9: RTI/STI CLINIC AT DWH 18

FIGURE 10: NHM POSTER DEPICTS NB CARE WEEK 18

FIGURE 11: NRC REGISTER FOR RECORD MAINTENANCE 18

FIGURE 12: INFANTOMETER AT DWH 18

FIGURE 13: IEC DISPLAY AT HOSPITAL WALL 19

FIGURE 14: IEC DISPLAY ABOUT JSSK 19

FIGURE 15: IEC DISPLAY ABOUT NRC 19

FIGURE 16: IEC DISPLAY ABOUT FACILITIES HELPLINE 19

FIGURE 17: BIKE IN FRONT OF OT DOOR 20

FIGURE 18: LIST OF STAFFS WORKING AT CHC 20

FIGURE 19: IMMUNIZATION MESSAGE AT CHC KURAOLI 20

FIGURE 20: RTI/STI CLINIC AT CHC KURAOLI 20

FIGURE 21: RADIANT WARMER AT CHC 21

FIGURE 22: MEDICAL SUPERINTENDENT OF CHC KURAOLI 21

FIGURE 23: ICTC ADVISORY WARD AT CHC KURAOLI 22

FIGURE 24: JSSK POSTER AT CHC KURAOLI 22

FIGURE 25: IEC DISPLAY ABOUT ASHA AND ESSENTIAL DRUG

LIST AT CHC KURAOLI

22

FIGURE 26: NEW PHC SAADATPUR BUILDING 23

FIGURE 27: STAFF QUARTERS, NEW PHC SAADATPUR 23

FIGURE 28: SUB CENTRE PUNUPURA 24

FIGURE 29: ANM WITH NHM PIP M &E TEAM LEADER 24

FIGURE 30: MOTHER AND CHILD HEALTH REGISTE 25

FIGURE 31: DRUGS AND OTHER EQUIPMENTS BAG AT THE

SUB CENTRE

25


iv JANUARY 2016

ACKNOWLEDGEMENTS

The Monitoring and Evaluation of NHM PIP in Mainpuri district of Uttar Pradesh has been

successfully completed with the help and cooperation received from District NHM Staff and

support extended by officials from State Medical, Health and Family Welfare Department.

This entire study is sponsored by Ministry of Health and Family Welfare (MoHFW), Government

of India. We are extremely thankful to Shri C.R.K. Nair, Additional Director General (Stats)

Ministry of Health and Family Welfare, Government of India for overall support and cooperation.

We are also thankful to Shri P. C. Cyriac, Deputy Director General (Stats), and Smt. Navanita

Gogoi, Director (Stats) Ministry of Health and Family Welfare, Government of India for their

support and encouragement.

We acknowledge the support from Dr. K.K.Sharma Chief Medical Officer of Mainpuri district. We

also appreciate the help extended by Dr. R.K.Singh Deputy CMO Mainpuri, Dr. Dalbir Singh

Additional CMO (NRHM) Mainpuri, Dr. Sarvesh Yadav MOIC CHC Kuraoli, and Mr. Sanjiv

Verma District Programme Manager Mainpuri. The M&E exercise heavily relies on the cooperation

and enthusiasm of the health facility staff and we thank them for their active involvement during the

monitoring visits in the districts.

Last but not the least, we are grateful towards ANMs, ASHAs and beneficiaries who spent their

time and responded to the questions with enthusiasm.

William Joe

Vidya Sagar Trigun

Niranjan Rout

January 2016

Population Research Centre (PRC-IEG)

Institute of Economic Growth

Delhi


v JANUARY 2016

ACRONYMS AND ABBREVIATIONS

AMG Annual Maintenance Grant

ANM Auxiliary Nurse Midwife

AYUSH Ayurveda, Yoga & Naturopathy, Unani, Siddha and

Homoeopathy BEMOC Basic Emergency Obstetric Care

BMW Biomedical waste

BSU Blood Storage Unit

CMO Chief Medical Officer

CHC Community Health Care Centre

DGD Delhi Government Dipensary

DH District Hospital

DPM District Programme Manager

ECG Electrocardiography

EMOC Emergency Obstetric Care

FRU First Referral Unit

HMIS Health Management Information System

IEC Information, Education and Communication

IPD In Patient Department

IUCD Intra Uterine Contraceptive Device

IYCF Infant and Young Child Feeding

JSSK JananiShishuSurakshaKaryakram

JSY JananiSurakshaYojana

LHV Lady Health Visitor

LSAS Life Saving Anaesthetic Skill

LT Laboratory Technician

MCTS Mother and Child Tracking System

M&CW Centres Maternal And Child Health Care Centres.

MH Maternity Home

MMU Mobile Medical Unit

MO Medical Officer

MoHFW Ministry of Health and Family Welfare

NBCC New Born Care Corner

NBSU New Born Stabilization Unit

OCP Oral Contraceptive Pill

OPD Out Patient Department

OPV Oral Polio Vaccines

PIP Programme Implementation Plan

PHC Primary Health Care Centres

PRC Population Research Centre

SBA Skilled Birth Attendant

SN Staff Nurse

SNCU Special Newborn Care Unit


vi JANUARY 2016

EXECUTIVE SUMMARY

NHM UTTAR PRADESH: MAINPURI DISTRICT

This report is based on the NHM PIP Monitoring visit to Mainpuri District of Uttar Pradesh. The

PRC Delhi team was assigned to this work. During entire work, the team has visited many Health

Care Facilities such as District Female Hospital Mainpuri, CHC Kuraoli, New PHC Sahadatpur, and

Sub Centre Punupura. Team thoroughly interacted with many officials viz. Chief Medical Officer

(CMO) Mainpuri, Medical Superintendent of CHC Kuraoli, Doctors, ANM, and ASHA of other

health care facilities along with many patients or beneficiaries of NHM. The major strengths and

weaknesses in the implementation of the NHM programmes in the district are as follows:

STRENGTHS

It has been observed that district Mainpuri’s overall performances were good in spite of

some shortcomings in terms of availability of required human resource base as well as

adequate supporting infrastructure at various levels of health facility centres.

Ambulance services like 108 and 102 were working as a milestone for ferry the patients or

beneficiaries to and fro journey from home to hospital and vice-versa. These facilities

enhanced the people’s accessibility towards acquiring health services. Maternal and child

health situation improved lots after launching of 102. People were fully utilizing these

services during emergency situations. According to CMO Mainpuri, 108 Emergency

Medical Transport Services (EMTS) has been launched initially from Mainpuri district.

As mentioned by the CMO Mainpuri, ASHA’s jobs are appreciable and introduction of

ASHA through NRHM has transformed the reproductive and child health utilities services at

grass root level. She motivates and raised the accessibility of health services among the

people. ASHA has been also playing important role in improvement of institutional delivery,

immunization and family planning etc. Programmes like JSY, JSSK, RBSK, and launch of

Ambulances (108 & 102) have benefitted lots to the rural population. ASHA has been

working as a connecting and bridging force between health facilities and beneficiaries in

spite of low incentives and various other challenges. ASHA’s incentives should be increased

to boosting their enthusiasm for work.

Reporting of maternal death was satisfactory in Mainpuri district. Almost every maternal

death reported and for this also credit goes to ASHA and ANM of that area.


vii JANUARY 2016

Nutritional Rehabilitation Centre (NRC) at District Hospital (DH) has been functioning and

managed properly by adequate number of staff. Infrastructure and services were found

satisfactory at the centre.

WEAKNESSES

It has been observed that number of doctors and other staff members (lab technicians) were

inadequate against required for proper functioning of health facilities.

District Women’s Hospital Mainpuri has been currently running by single lady doctor where

she works under overburden situations due to vacant position of other doctors and staffs.

The irony was that, the District Hospital already suffering from lack of human resources but

one newly 100 beds hospital beside the District Women’s Hospital was in verge of

completion. It would be big challenge for managing human resources to this newly

constructed hospital in near future.

According to the senior level district health official, doctors from other parts of the state do

not want to come to Mainpuri district due to political and other kinds of nuisances as well as

lack of proper working environment.

Hospital premises of women’s hospital have been not found clean and conditions of

washrooms were not in good conditions. The reason as reported by the official was lack of

cleaning staffs.

It was observed that more staffs required for the proper functioning of PNC ward.

Special Newborn Care Units (SNCU) is not functioning at the district hospital, it was still

under construction.

CHC Kuraoli has also issues of lack of human resources and due to this entire functioning of

hospital got affected.

MCTS facility at CHC Kuraoli has been found inadequate and should be properly managed.

Patient’s wards were available but sanitation was the big issue. Mosquito roaming around

CHC Kuraoli during day time. Patients generally prefer to go home after overnight stay in

emergency situation.

New PHC Saadatpur condition was not satisfactory. There was nothing in the name of

infrastructure as well as human resource base except mere presence of building which also

have no water supply or electricity cover. The entire centre runs by two staffs who just


viii JANUARY 2016

provide some medicines to the needy patients. It is also not situated near the residential

settlements. It had been told that Kuraoli CHC is very near to this centre, so people

generally prefer to go there for diagnosis and all. Monitoring and evaluation team of PRC

Delhi has just found one patient at the centre during the visit who also confirmed the poor

medical facilities at the centre.

Sub Centre (SC) Punpura condition was more dissatisfactory as nothing kept at the centre

due to theft issue. ANM also concerned about the safety and security while working at the

centre as theft has been occurred earlier at the centre.

Beneficiaries under JSY has some issues regarding cash transfer as the recipient do not own

bank accounts which create problem in transferring money . The main reasons were

illiteracy among people, miscommunication between the bank and hospital authority.


1 JANUARY 2016

1. INTRODUCTION

1.1. BACKGROUND

The ministry of Health and Family Welfare (MoHFW) has involved Population Research Centres

(PRCs) for quality monitoring of important components of NHM State Programme Implementation

Plan (PIP) 2015-16. It is expected that a timely and systematic assessment of the key components of

NHM is critical for further planning and resource allocation. While engaging with the task, PRCs

would identify critical concerns in implementation of NHM activities and also evolve suitable

quality parameters to monitor the various components. Specifically, as a part of the qualitative

reports, the PRCs are required to observe and comment on four broad areas described in the

Records of Proceedings (RoPs) as follows;

Mandatory disclosures on the state NHM website

Components of key conditionality and new innovations

Strategic areas identified in the roadmap for priority action

Strengths and weaknesses in implementation

PRC Delhi is engaged in quality monitoring of state PIPs in – Uttar Pradesh, Sikkim and Delhi. This

report discusses the M&E findings and observations for Mainpuri District in Uttar Pradesh. Before

visiting Mainpuri district in the December 2015, the M&E Team reviewed the Mainpuri PIP

document and prepared, semi-structured interview schedules for district programme managers

(DPM), facility staff and beneficiaries. The field visits to health facilities in the district were

planned in consultation with the district NHM officials which includes CMO Mainpuri, Deputy

CMO, DPM and other health officials and staffs.

2. STUDY APPROACH

The Ministry of Health and Family Welfare (MoHFW) has engaged PRC-IEG Delhi for monitoring

and evaluating the performance of NHM programme in Mainpuri district regarding providing the

health care needs. PRC Delhi Team visited the Mainpuri district during the period 2nd

December to

4th

December 2015. The Team has arrived first at CMO office Mainpuri and interacted and

discussed with Chief Medical Officer (CMO) and other nodal officials of Mainpuri district about


2 JANUARY 2016

health scenario in general and NHM programmes in particular. This discussion helped lots in the

direction of PIP monitoring visit of Mainpuri district. Further the team has visited the health care

facilities of the district to accomplish the objectives of NHM PIP monitoring visit. The healthcare

facilities visited in Mainpuri district has been given in below mentioned table 1.

Table 1: Number of Healthcare Facilities Visited by Delhi-PRC in Mainpuri District, for

NHM-PIP Monitoring and Evaluation 2015

FACILITY TYPE NAME OF THE FACILITY

DISTRICT HOSPITAL (DH) DISTRICT WOMEN’S HOSPITAL MAINPURI

COMMUNITY HEALTH CENTRE (CHC) COMMUNITY HEALTH CENTRE, KURAOLI

PRIMARY HEALTH CENTRE (PHC) NEW PRIMARY HEALTH CENTRE, SAADATPUR

SUB CENTRE (SC) SUB CENTRE, PUNPURA

Source: PRC Delhi NHM-PIP Monitoring Team Visit, December 2015.

The team has visited above mentioned health facilities ranging from District Women’s Hospital to

CHC, PHC and SC where team had interaction with MOs, BPM, ANM, other service providers and

beneficiaries. Apart from these things team also physically inspected the condition of health

infrastructure as well as outcome of NHM programmes and maintenance of records at the facilities

centre. The other areas of the focus were availability of human resources and training, availability

of drugs and equipments, functioning of service delivery quality parameter of facilities, provision of

IEC display and progress under NHM activities.

3. DISTRICT PROFILE

Mainpuri district is situated in the western part of Uttar Pradesh state of India also known as Harit

(Green) Pradesh. Geographically Mainpuri district located in Middle Ganga-Yamuna Doab. This

region has historical importance and culturally also known as Braj region where local people speak

this dialect. Mainpuri town is the district headquarters and Mainpuri district. It comes under

administrative jurisdiction of Agra division which is one of the eighteen (18) divisions of Uttar

Pradesh. It consist five tehsils, namely Mainpuri, Bhongaon, Karhal, Kishni and Ghiror. It

surrounded by districts Etah, Farrukkhabad and Kannauj, Etawah, Firozabad and Etah on the North,

East, South and West respectively. Census 2011 shows that Mainpuri district has population of

1,847,194. The district has a population density of 670 persons per square kilometer. Sex ratio of

the district is 876 females for every 1000 males, and its literacy rate is 78.26 percent.


3 JANUARY 2016

Figure: 1 Map of Uttar Pradesh Figure: 2 Map of Mainpuri District

Source: www.mapsofworld.com Source: www.mainpuri.nic.in

NHM (PIP) M&E District Mainpuri, Uttar Pradesh

4. SOCIO-ECONOMIC, DEMOGRAPHIC AND HEALTH CHARACTERISTICS

Table 2 reveals the socio-economic, demographic and health scenario in the Mainpuri district. The

district CBR and TFR comes to 23.5 and 3.4 respectively which is equivalent to state average. Only

23.2 percent currently married women in the district using modern contraceptive methods which are

below from state average of 37.6 percent.

http://www.mapsofworld.com/


4 JANUARY 2016

Table: 2 SOCIO-ECONOMIC, DEMOGRAPHIC AND HEALTH CHARACTERISTICS OF MAINPURI


Source: Annual Health Survey 2012-13 Fact Sheet, Uttar Pradesh, Office of the Registrar General and Census

Commissioner, India, MoHA, GOI, 2/A, Mansingh Road, New Delhi-11.

The data reveals that district has huge unmet need (22.5 percent) of modern contraceptive methods

both in terms of spacing as well as limiting. District has recorded 51 percent currently married

women (15-49 years of age) registered for ANC. There are only 51 percent institutional deliveries

recorded in the district which should be enhanced for the betterment of maternal and child health.

Maternal and child health particularly neonatal data shows that district has lot to do in near future to

overcome these prevailing situations. District mortality data in terms of CDR, IMR, Neonatal and

U5MR are still high which should be given proper attention to further improvement in the situation.

BACKGROUND CHARACTERISTICS MAINPURI

DISTRICT

UTTAR PRADESH

POPULATION BELOW AGE 15 YEARS (PERCENT) 35.3 34.9

DEPENDENCY RATIO 76.7 75.8

CURRENTLY MARRIED ILLITERATE WOMEN AGED 15-49 YEARS

(PERCENT)

30.4 47.5

SEX RATIO AT BIRTH 1056 921

SEX RATIO (0-4 YEARS) 908 919

SEX RATIO (ALL AGES) 885 946

EFFECTIVE LITERACY RATE TOTAL 83.9

92.1

75.3

74.3

83.8

64.4 MALE

FEMALE

MARRIAGES AMONG FEMALES BELOW LEGAL AGE (18 YEARS) (PERCENT) 2.4 5.4

MARRIAGES AMONG MALES BELOW AGE (21 YEARS) (PERCENT) 15.3 16.9

CURRENTLY MARRIED WOMEN AGED 20-24 YEARS MARRIED BEFORE

LEGAL AGE (18 YEARS) (PERCENT)

26.4 32.6

MEAN AGE AT MARRIAGE MALE 23.4

21.1

23.8

21.6 FEMALE

CHILDREN AGED 5-14 YEARS ENGAGED IN WORK (PERCENT) 1.3 3.2

WORK PARTICIPATION RATE (15 YEARS AND ABOVE) 40.6 41.6

CRUDE BIRTH RATE (CBR) 23.5 24.8

NATURAL GROWTH RATE 13.4 16.5

TOTAL FERTILITY RATE (TFR) 3.4 3.3

WOMEN AGED 20-24 REPORTING BIRTH OF ORDER 2 & ABOVE (PERCENT) 54.6 46.0

WOMEN REPORTING BIRTH OF ORDER 3 & ABOVE (PERCENT) 53.9 45.1

WOMEN WITH 2 CHILDREN WANTING NO MORE CHILDREN 73.2 66.2

WOMEN AGED 15-19 YEARS WHO WERE ALREADY MOTHERS OR PREGNANT

AT THE TIME OF SURVEY (PERCENT)

47.0 43.7

MEDIAN AGE AT FIRST LIVE BIRTH OF WOMEN AGED 15-49 YEARS 22.0 22.3

LIVE BIRTHS TAKING PLACE AFTER AN INTERVAL OF 36 MONTHS

(PERCENT)

39.1 43.7

FAMILY PLANNING PRACTICES

(CMW AGED 15-49 YEARS)

CURRENT USAGE

ANY METHOD (PERCENT) 62.0

23.2

9.3

59.0

37.6

18.4

ANY MODERN METHOD

(PERCENT)

FEMALE STERILIZATION

(PERCENT)


5 JANUARY 2016

Continue……. TABLE 2 SOCIO-ECONOMIC, DEMOGRAPHIC AND HEALTH CHARACTERISTICS OF MAINPURI


BACKGROUND CHARACTERISTICS MAINPURI DISTRICT UTTAR PRADESH

UNMET NEED

FOR FAMILY

PLANNING

SPACING (PERCENT) 12.6

9.9

22.5

11.2

9.5

20.7

LIMITING (PERCENT)

TOTAL UNMET NEED (PERCENT)

CURRENTLY MARRIED PREGNANT WOMEN AGED 15-49

YEARS REGISTERED FOR ANC (PERCENT)

51.1 61.9

MOTHERS WHO RECEIVED ANY ANTENATAL CHECK-UP

(PERCENT)

84.9 85.2

INSTITUTIONAL DELIVERY (PERCENT) 51.2 56.7

DELIVERY AT GOVERNMENT INSTITUTION (PERCENT) 34.3 39.0

DELIVERY AT PRIVATE INSTITUTION (PERCENT) 16.8 17.6

LESS THAN 24HRS. STAY IN INSTITUTION AFTER DELIVERY

(PERCENT)

52.3 56.0

MOTHERS WHO AVAILED FINANCIAL ASSISTANCE FOR

DELIVERY UNDER JSY (PERCENT)

34.8 36.4


INSTITUTIONAL DELIVERY UNDER JSY (PERCENT)

65.0 62.8


GOVERNMENT INSTITUTIONAL DELIVERY UNDER JSY

(PERCENT)

95.1 88.7

CHILDREN AGED 12-23 MONTHS FULLY IMMUNIZED

(PERCENT)

50.6 52.7

CHILDREN BREASTFED WITHIN ONE HOUR OF BIRTH

(PERCENT)

33.8 39.4

BIRTH REGISTERED (PERCENT) 55.6 58.9

CRUDE DEATH RATE (CDR) 10.1 8.3

INFANT MORTALITY RATE (IMR) 50 68

NEO- NATAL MORTALITY RATE 34 49

POST NEO-NATAL MORTALITY RATE 17 19

UNDER FIVE MORTALITY RATE (U5MR) 78 90

Source: Annual Health Survey 2012-13 Fact Sheet, Uttar Pradesh, Office of the Registrar General and Census

Commissioner, India, MoHA, GOI, 2/A, Mansingh Road, New Delhi-11.

Table: 3 Demographic Indicators, Mainpuri District, Uttar Pradesh

NUMBER OF BLOCKS 9

NUMBER OF VILLAGES 821

POPULATION (CENSUS 2011) 1868529

LITERACY RATE 78.26

OVERALL SEX RATIO 876

DENSITY OF POPULATION (PERSONS PER SQUARE KM) 669

Source: CMO Office, Mainpuri District, Uttar Pradesh.

Table 3 data depicts that Mainpuri district has 1,868,529 populations (Census 2011) which resides

among 9 blocks and 821 villages of the district. The literacy rate of the district is quite good (78.26

percent) and it is above than state average. Sex ratio of the district is 876 which is less in


6 JANUARY 2016

comparison to state as well as national figure. Population density of the Mainpuri district is 669

persons per square kilometer.

Table: 4 Health Indicators, Mainpuri District, Uttar Pradesh


Table 4 shows the data from CMO office that is provided to the team which also indicates that

MMR is quite high in the district. Proportion of fully immunized children is also not adequate along

with proportion of pregnant women receiving any ANC. The data reveals that full ANC coverage is

still very low in the district.

5. HEALTH INFRASTRUCTURE:

Table: 5 Detail of Health Infrastructure 2014-15

HEALTH FACILITY NUMBER AVAILABILITY GOVT. BUILDING RENTED BUILDING/UNDER

CONSTRUCTION

DISTRICT HOSPITAL 2 2 -

SUB DISTRICT HOSPITAL - - -

CHC FRUS 1 1 -

CHC 9 9 -

PHC 46 44 2

SUB CENTRE 198 198 -

MEDICAL COLLEGE - - -

DELIVERY POINTS - - -

108 AMBULANCES 11 - -

CATS - - -

102 AMBULANCES 22 - -

REFERRAL TRANSPORT - - -


Table 5 reveals the picture of health infrastructure statistics of Mainpuri district. The data shows

that two district hospitals are functioning in two separate government buildings in the district. There

are one CHC FRUs, 9 CHCs, 46 PHCs and 198 Sub Centres are functioning within own

HEALTH INDICATORS 2013-14 2014-15

NMR 32 32

IMR 54 54

U5MR 79 79

MMR 281 281

TFR 3.4 3.4

PROPORTION OF FULLY IMMUNIZED CHILDREN 38.3 38.3

PROPORTION OF PREGNANT RECEIVING ANY ANC 38.1 38.1

PROPORTION OF SAFE DELIVERY

INSTITUTIONAL DELIVERIES 14176 19585

PERCENTAGE OF WOMEN RECEIVED PNC CHECKUPS WITHIN 48 HOURS 45.4 45.4

FULL ANC (AT LEAST THREE ANC CHECKUPS) 10.8 10.8


7 JANUARY 2016

government buildings in the district. It is also noticeable that 11 ambulances of 108 mark and 22

ambulances of 102 marks are operating in the district for medical transportation.

6. HUMAN RESOURCES

Table: 6 Human Resources under NHM 2014-15 POSITION NAME SANCTIONED REGULAR CONTRACTUAL TOTAL VACANT VACANT PERCENT

2013-14 2014-15 2013-14 2014-15 2013-14 2014-15 2013-14 2014-15 2013-14 2014-15

MO’S INCLUDING

SPECIALISTS

3 4 2 1 1 3 33.33 75.00

GYNECOLOGISTS 0 5 0 2 0 3 0.00 60.00

PEDIATRICIAN 1 0 1 0 0 0 0.00 0.00

SURGEON 0 0 0 0 0 0 0.00 0.00

LHV 0 0 0 0 0 0 0.00 0.00

ANM 39 41 39 41 0 0 0.00 0.00

PHARMACIST 10 10 0 10 10 0 100.0 0.00

LAB TECHNICIANS 6 6 6 6 0 0 0.00 0.00

X-RAY

TECHNICIANS

2 2 2 2 0 0 0.00 0.00

STAFF NURSE AT

CHC

36 40 36 40 0 0 0.00 0.00

STAFF NURSE AT

PHC

5 3 5 3 0 0 0.00 0.00

ANM AT PHC

ANM AT SC


Table 6 shows the availability of human resources in the district in terms of NHM 2014-15. The

data shows that 75 percent post of MO’s and 60 percent gynecologists post are vacant in 2014-15.

There are 41 ANM working in the district but all are serving on contractual basis. It is good to see

that all the 10 sanctioned post of pharmacist have been filled in 2014-15 which was 100 percent

vacant during 2013-14. The number of posts sanctioned for Lab Technicians and X-Ray

Technicians have been filled in 2014-15. The district serves with total sanctioned 40 staff nurses

and 3 staff nurses at CHCs and PHCs respectively in 2014-15.

Table: 7 Training Status of Human Resource 2014-15

POSITION NAME SBA BEMOC MTP MINILAP/PPS NSV TOTAL

MEDICAL OFFICER 0 0 2 0 0 2

LADY MEDICAL OFFICERS 0 0 1 0 0 1

STAFF NURSES 6 0 0 0 0 6

ANM 27 0 0 0 0 27

LAB TECHNICIANS 0 0 0 0 0 0

PHARMACISTS 0 0 0 0 0 0

LHV/PHN 11 0 0 0 0 11

ASHA 0 0 0 0 0 0

OTHER 0 0 0 0 0 0



8 JANUARY 2016

Table 7 depicts the status of trained human resources in the district during 2014-15. Data shows that

2 Medical Officer and 1 Lady Medical Officer have received MTP training. The data further reveals

that 6 staff nurses, 27 ANMs and 11 LHV/PHN have trained in SBA in 2014-15.

Table: 8 Training Status of Human Resource 2014-15

POSITION NAME IUCD INSERTION RTI/STI/HIV

SCREENING

FIMNCI NSSK TOTAL

MEDICAL OFFICER 4 3 0 6 13

LADY MEDICAL OFFICERS 3 0 0 3 6

STAFF NURSES 24 2 0 9 35

ANM 61 2 0 13 76

LAB TECHNICIANS 0 0 0 0 0

PHARMACISTS 0 0 0 0 0

LHV/PHN 16 3 0 14 33

ASHA 0 0 0 0 0

OTHER 0 0 0 0 0


Table 8 also provides information about training status of human resources in 2014-15. The data

shows that 4 Medical Officer got IUCD insertion training, 3 got RTI/STI/HIV Screening training

while 6 trained for NSSK. There have been 6 Lady Medical officer also got training in which 3 of

them trained for IUCD insertion and 3 for NSSK. It could be also observed through the data that 24

staff nurse, 61 ANMs, and 16 LHV/PHN have trained for IUCD insertion. In case of RTI/STI/HIV

Screening training, 2 staff nurse, 2 ANMs and 3 LHV/PHN have been trained in 2014-15. The data

further shows that 9 staff nurse, 13 ANM and 14 LHV/PHN have been trained in NSSK.

7. MATERNAL HEALTH

Table 9 depicts the picture of block wise service delivery scenario in maternal health in 2013-14

and 2014-15. Data shows that Sultanganj Block registered maximum number of ANC followed by

Kishani, Kuchela, Ghiror, Mainpuri DH and Bewar blocks in 2014-15. The data further reveals that

Sultanganj is also ahead in terms of 3 ANCs registration followed by Ghiror, Kuraoli, Bewar and

Kuchela in 2014-15. Table 9 shows that maximum home deliveries cases have been occurred in

Kuchela followed by Ghiror, Kishani and Bewar in 2014-15. Home Deliveries cases were not found


9 JANUARY 2016

at Mainpuri D.H. in 2013-14 and 2014-15. The Barnahal block registered only 21 cases of home

delivery in 2014-15 which is least after Mainpuri D.H. In case of Institutional deliveries, Mainpuri

D.H. recorded maximum number of institutional deliveries followed by Sultanganj, Barnahal,

Kuraoli, and Kishani in 2014-15.

Table: 9 Block wise Service Delivery Indicators 2013-14 & 2014-15 (Maternal Health)

BLOCK ANC

REGISTERED

3 ANCS HOME

DELIVERIES

INSTITUTIONAL

DELIVERIES

PNC WITHIN

48 HRS AFTER

DELIVERY

PNC BETWEEN

48 HRS AND 14

DAYS AFTER

DELIVERY

2013-

14

2014-

15

2013-

14

2014-

15

2013-

14

2014-

15

2013-

14

2014-

15

2013-

14

2014-

15

2013-

14

2014-

15

BARNAHAL 2247 3214 2080 2751 146 21 1448 2015

BEWAR 4178 5743 3731 5138 1562 1864 1208 1565

GHIROR 3797 6015 3517 5673 1399 2895 1553 1778

SANGAMAI 2697 3801 1443 2335 444 478 761 894

KERHAL 3363 4816 3090 3646 717 945 884 1122

KISHANI 4758 6255 2920 3920 1535 1987 1099 2000

KUCHELA 4810 6057 3336 5045 1621 3520 633 770

KURAOLI 4312 5502 2857 5243 884 789 1427 2013

MAINPURI

D.H.

5750 5896 1673 3282 0 0 3476 4782

SULTANGANJ 4942 7527 4577 6588 1307 1884 1687 2646

Note: Please include the data for Medical College and DH


Table 10 reveals the block wise data of service delivery indicator regarding maternal health in 2014-

15. Data shows that maximum number of TT1 and TT2 has been delivered in Sultanganj block

while least was in Barnahal in 2014-15. Kuchela block have recorded highest number of home

deliveries which is assisted by SBA followed by Ghiror, Bewar and Kishani block in 2014-15. The

Kishani block recorded highest number of cases of home deliveries which are not assisted by SBA

followed by Sultanganj, Kuchela and Ghiror in 2014-15. Table 10 depicts that highest number of

live births occurred in Mainpuri D.H. followed by Sultanganj, Ghiror, Kuchela and Kishani blocks

in 2014-15. The lowest live births recorded in Sangamai block of the district in 2014-15. Sultanganj

block of the district recorded highest number of still births followed by Kishani, Barnahal, Kuraoli

and Mainpuri D.H. in 2014-15. Kuchela and Ghiror block have no still births cases recorded in

2014-15. The data further shows that 604 total births have been recorded in Mainpuri D.H.,


10 JANUARY 2016

followed by Ghiror, Sultanganj and Kuchela block in 2014-15. The least total births recorded in

Sangamai block of the district in 2014-15.

Table: 10 Block wise Service Delivery Indicators 2013-14 & 2014-15 (Maternal Health)

BLOCK

TT1

TT2 HOME DELIVERIES LIVE BIRTH STILL BIRTH TOTAL

BIRTHS SBA

ASSISTED

NON-SBA

2013-

14

2014-15 2013-

14

2014-

15

2013-

14

2014-

15

2013-

14

2014-

15

2013-

14

2014-

15

2013-

14

2014-

15

2013-

14

2014-

15

BARNAHAL 234 2531 210 3301 129 18 17 3 159 201 0 23 159 199

BEWAR 389 5602 380 5270 1401 1794 161 70 274 345 19 11 273 344

GHIROR 321 5334 307 4982 778 1872 621 102 295 467 0 0 295 497

SANGAMAI 151 2636 228 3564 444 478 0 0 120 137 3 1 120 137

KERHAL 298 3594 297 3306 508 734 209 211 163 206 9 9 162 205

KISHANI 294 3924 384 5011 1366 1609 167 338 260 395 24 37 258 392

KUCHELA 462 5423 434 5500 1238 2284 383 123 224 429 0 0 224 429

KURAOLI 407 5263 337 5041 884 789 0 0 231 280 4 18 230 278

MAINPURI

D.H.

279 4941 301 4566 0 0 0 0 340 617 46 13 336 604

SULTANGANJ 561 7391 499 6778 13 0 129 188 298 453 26 56 295 447


7.1 JANANI SURAKSHA YOJANA (JSY)

Table 11 shows the status of JSY payments in the district for the year 2014-15. The data reveals that

entire payments of JSY have been paid through cheque. The record of payments is available and

regularly updated in 2014-15.

Table: 11 Status of JSY Payments in District 2014-15

STATUS OF PAYMENTS MODE OF PAYMENTS RECORD MAINTENANCE

INSTITUTIONAL

DELIVERIES

HOME

DELIVERIES

ASHAS CASH CHEQUE A/C

TRANSFER

AVAILABLE UPDATED NON

UPDATED

19616 1 16373 NIL YES NIL YES YES NIL


7.2 JANANI SHISHU SURAKSHA KARYAKRAM (JSSK)

Table 12 depicts the picture of JSSK progress in Mainpuri district’s block in the year 2014-15. It is

clear from the data that District Women Hospital has maximum number of beneficiaries in Diet,

Drugs and Diagnostic under JSSK followed by Sultanganj, Kuraoli, Kishani, Barnahal and Ghiror

blocks in 2014-15. The total figure for Diet, Drugs, and Diagnostic in the district is 14431, 16232


11 JANUARY 2016

and 16232 respectively in 2014-15. The data reveals that 12784 beneficiaries availed transport

facilities from home to facility centre while 1307 availed referral benefits and 11980 were utilized

transport services from facility centre to home in the district during 2014-15. The maximum

numbers of transport beneficiaries are recorded from District Women Hospital Mainpuri followed

by Kuraoli and Karhal.

The District Mainpuri recorded 27 maternal deaths during 2014-15 in which 10 deaths occurred at

hospital, 3 at home and rest in transit.

Table: 12 Block wise JSSK Progress in Mainpuri District 2014-15

BLOCK NO. OF BENEFICIARIES UNDER JSSK

DIET DRUGS DIAGNOSTIC TRANSPORT

HOME TO

FACILITY

REFERRAL FACILITY TO HOME

KUCHELA 334 383 383 369 0 356

KISHNI 1349 1461 1461 1006 0 1009

GHIROR 1281 1385 1385 1081 79 1238

SULTANGANJ 1535 2176 2176 1392 9 1574

BARNAHAL 1329 1499 1499 501 127 893

SAGAMAI 652 748 748 620 0 597

BEWAR 771 893 893 294 12 552

KURAOLI 1560 1985 1985 2363 226 1369

KARHAL 838 920 920 1696 295 1163

DISTRICT WOMEN

HOSPITAL

4782 4782 4782 3462 559 3229

TOTAL 14431 16232 16232 12784 1307 11980



12 JANUARY 2016

8. CHILD HEALTH

Table 13 depicts the picture of child health infrastructure and services under neonatal health

during 2014-15 in the district. The data shows that neonatal health infrastructure in the district

are still not adequate and up to the mark. Lots of improvement required to overcome the

shortcomings in this regard. There are only one NBSU and 13 SNCU presently functional in the

district.

Table: 13 Child Health: Detail of Infrastructure and Services under Neonatal Health, 2014-15

TOTAL SNCU NIL

TOTAL NBSU 1

TOTAL NBCC 13

TOTAL STAFF IN SNCU NIL

TOTAL STAFF IN NBSU

TOTAL NRCS NIL

TOTAL ADMISSIONS IN NRCS NIL

TOTAL STAFF IN NRCS NIL

ANTICIPATED ADMISSIONS IN NRCS NIL

DISCHARGED FROM NRCS NIL

REFERRED FROM NRCS NIL

AVERAGE DURATION OF STAY IN NRCS NIL

Source: CMO Office, Mainpuri District, Uttar Pradesh. Note: NRC sanctioned in 2015-16.

8.1 IMMUNIZATION

Table 14 depicts the block wise child health immunization status of Mainpuri district during

2014-15. It is clear from the figure that none of the blocks have touched the targeted digit of

immunization, although most of the blocks in the district are very close to the target in terms

of full immunization. Sultanganj block has highest number of full immunization among other

blocks while Sangamai has the least immunization among other blocks in 2014-15.

Table: 14 Child Health: Block wise Analysis of Immunization, 2014-15

BLOCK TARGET BCG DPT OPV MEASLES FULL

IMMUNIZATION

1 2 3 0 1 2

BARNAHAL 3940 3130 3481 3538 3555 2029 3481 3538 3577 3577

BEWAR 6764 5118 5520 5274 5623 3500 5520 5274 5887 5887

GHIROR 4893 4868 517 4920 463 1748 5173 4920 4874 4874

SANGAMAI 3247 3097 3402 3202 3443 1344 3402 3202 3035 3035

KERHAL 5364 3310 4320 4038 4211 2021 4320 4038 3980 3980

KISHANI 6122 4833 6330 5799 5940 4281 6330 5799 5893 5893

KUCHELA 5874 5292 5930 5851 5709 963 5930 5857 5522 5522

KURAOLI 4950 4531 4995 4059 5099 2413 4995 4959 4264 4264

MAINPURI 3440 5975 4104 4556 3866 5207 4104 4556 3426 3426

SULTANGANJ 6516 6082 7041 7099 6497 4248 7041 7099 6059 6459



13 JANUARY 2016

8.2 RASTRIYA BAL SURAKSHA KARYAKRAM (RBSK)

Table 15 reveals the picture of Rastriya Bal Suraksha Karyakram (RBSK) progress report of

Mainpuri district during 2014-15. The data shows that 5287 number of schools have been

registered in which 3, 36,976 children have been registered and 2, 52,714 have been diagnosed

in the district during 2014-15 under RBSK.

Table: 15 Rastriya Bal Suraksha Karyakram (RBSK), Progress Report Mainpuri District 2014-15

YEARS NO. OF

SCHOOLS

NO. OF

CHILDREN

REGISTERED

CHILDREN

DIAGNOSED

EYE

DISEASE

EAR

DISEASE

HEART

DISEASE

PHYSICALLY

CHALLENGED

ANEMIC

2014-15 5287 336976 252714

2013-14 4007 295852 198516


9. FAMILY PLANNING

Table 16 depicts the family planning achievements in Mainpuri district during 2014-15. Data

shows that Bewar block has achieved highest number of female sterilization followed by

Sultanganj, Kuraoli, Kishani and Kuchela while Karhal block has achieved least female

sterilization in 2014-15. It is important to mention that Kuchela block achieved 9 male

sterilization which is highest among all other blocks while Barnahal and Kerhal has no

achievement regarding male sterilization. The leading blocks in family planning achievements

are Sultanganj, Kishani, Barnahal, Kuchela and Bewar in the district during 2014-15.

Table: 16 Family Planning Achievements in Mainpuri District 2014-15

NAME

BLOCK

TARGET STERILIZATION IUD OCP CC

MALE FEMALE TOTAL % ACH % ACH % ACH %

BARNAHAL 645 0 149 149 2496 384 1771

BEWAR 991 1 226 227 1800 630 1670

GHIROR 801 1 164 165 2603 292 741

SANGAMAI 536 3 149 152 509 137 603

KERHAL 878 0 148 148 2919 476 1735

KISHANI 1003 1 181 182 3442 499 1865

KUCHELA 962 9 166 175 2191 297 1544

KURAOLI 811 3 185 188 884 381 801

MAINPURI

SULTANGANJ 1067 6 202 208 3954 556 1688



14 JANUARY 2016

10. QUALITY IN HEALTH CARE SERVICES

Table 17 reveals the bio-medical waste management and infection control mechanism in the

Manipuri district. Data shows that 11 health facilities have bio-medical pits, 11 have color

coded bins. The district also outsources services for bio-medical waste management.

Table: 17 Bio-Medical Waste Management and Infection Control in the Mainpuri District

BIO-MEDICAL WASTE MANAGEMENT

NO OF FACILITIES HAVING BIO-MEDICAL PITS 11

TRAINING ON BIO-MEDICAL WASTE MANAGEMENT

NO. OF FACILITIES HAVING COLOR CODED BINS 11

OUTSOURCING FOR BIO-MEDICAL WASTE YES

INFECTION CONTROL

NO. OF TIMES FUMIGATION IS CONDUCTED IN A YEAR

TRAINING OF STAFF ON INFECTION CONTROL


11. COMMUNITY PROCESS IN THE DISTRICT

Table 18 reveals the status of ASHAs in the district. Presently 1453 ASHAs are working in the

district, although 109 positions of ASHAs are still vacant. Data shows that 1175 ASHAs have been

got skill development/refresher training and 108 meetings have been held with ASHAs in the year

2014-15.

Table: 18 Background Status of ASHAs in the District

CURRENT STATUS OF ASHAS (TOTAL NUMBER OF ASHAS)

ASHAS PRESENTLY WORKING 1453

POSITIONS VACANT 109

SKILL DEVELOPMENT/REFRESHER TRAINING OF ASHAS (LIST THE MODULE) 1175

TOTAL NUMBER OF MEETING WITH ASHA ( IN A YEAR) 108

TOTAL NUMBER OF ASHA RESOURCE CENTERS/ ASHA GHAR NIL

DRUG KIT REPLENISHMENT 1200


12. DISEASE CONTROL PROGRAMME

Table 19 provides data regarding progress of disease control programme in the district. Data shows

that 37 cases of RNTCP have been screened in which 19 cases have been detected and 13 have been


15 JANUARY 2016

treated. In other hand 132 and 107 cases of Leprosy and Malaria have been screened and detected

and finally 105 and 107 number of cases has been treated in the district.

Table 19 Progress of Disease Control Programme in the District

NAME OF THE PROGRAM NO. OF CASES SCREENED NO. OF DETECTED CASES NO. OF TREATED CASES

RNTCP 37 19 13

LEPROSY 132 132 105

MALARIA 107 107 107


13. AYURVEDA, YOGA AND NATUROPATHY, UNANI, SIDDHA AND

HOMOEOPATHY (AYUSH)

AYUSH facilities are working in Mainpuri district as result shows that 23 facilities among 9 blocks

of the district have functional AYUSH centres. There are 35 AYUSH doctors presently (2014-15)

working in the district. All the required medicines are available at AYUSH centres in the district.

14. INFORMATION EDUCATION AND COMMUNICATION

IEC is very effective tools for people mobilization because it directly strikes the people mind

through its visual effect in forms of slogan writings, diagrams and maps. Lots of useful information

about NHM schemes like JSY, JSSK, Immunizations/Vacinations, and Prevention from

Communicable disease, RTI/STI/HIV prevention messages including cleaning and sanitation etc

has been provided to the people through this medium. All the facilities where team has visited have

found IEC materials in terms of drugs list, doctors visiting hours, Staffs working details, Schemes

benefit, Transportation benefits, incentive money and document required for availing benefits have

been mentioned. In maternity ward, IEC messages about breast feeding with I hour, sanitation,

neonatal care were written on the walls.

15. HEALTH MANAGEMENT INFORMATION SYSTEM/ MOTHER AND CHILD

TRACKING SYSTEM (HMIS/MCTS)

HMIS and MCTS are working in the district. MCTS portal helped to track anaemic women and

child in the district. Service delivery data uploaded regularly and HMIS data analyzed and discussed

with concerned staff at state and district levels for necessary corrective action.


16 JANUARY 2016

16. FIELD OBSERVATIONS

16.1 District Women’s Hospital, Mainpuri

District women’s hospital discharging its duty with proper care of patients in spite of scarcity of

human resources and over burden of number of patients.

The District Women’s Hospital (DWH) has adequate availability of required physical

infrastructure support base for the smooth functioning of hospital with some exception. It has

been observed that New Born Care Corner (NBCC), New Born Stabilization Unit (NBSU), and

Special New Born Care Unit (SNCU) were non functional at the DWH. These all three units

were under process to be functional in near future.

Figure: 3 District Women’s Hospital, Mainpuri Figure: 4 Patients Queue up at DWH Mainpuri

The DWH Mainpuri has scarcity of human resources as there has been single Obstetrician

and Gynecologist (OBG) and anesthetist has working. The posts of Paediatrician, General

Surgeon, Medical Officers (MOs), and Radiographer were vacant. In case of other HRs, 6 Staff

Nurses (SNs), 2 ANM, 2 LTs, 3 Pharmacist, 1 LHV and 2 RMNCHA+Counsellors have been

presently working at the DWH.

Figure: 5 OBG Doctor with Patients at DWH Figure: 6 Labor Room, DWH Mainpuri

The DWH has provided training to its human resources like one HR has been trained for

Emergency Obstetric Care (EmOC), 6 for Skilled Birth Attendant (SBA), 1 for Medical


17 JANUARY 2016

Termination of Pregnancy/Manual Vacuum Aspiration (MTP/MVA), 6 for Navjat Shishu

Suraksha Karyakram (NSSK), 1 each for Mini Lap-Sterilisations, Laproscopy-Sterilisation, and

Intrauterine Contraceptive Device (IUCD) and 10 has been trained for Postpartum Intrauterine

Contraceptive Device (PPIUCD).

Figure: 7 STI unit in DWH, Mainpuri Figure: 8 NRC unit in DWH Mainpuri

It has been found that every equipment at the DWH Mainpuri are functional except few like

Neonatal, Paediatric and Adult Resuscitation kit, Foetal Doppler/CTG, Phototherapy unit, Semi

autoanalyzer, C.T scanner, X-ray unit and ECG machines.

In case of essential drugs and its supplies, District Women’s Hospital (DWH) Mainpuri has

been doing appreciable job. It has been found that only IFA blue tablets, IFA syrup with

dispenser and Mifepristone tablets are unavailable in drugs list. There are no problems at the

DWH as far as supplies of essential drugs are concern.

There has been certain lab services which are not functioning that include CBC, T.B. LFT, X-

Ray, ECG, and Endoscopy. It is also noticeable that blood bag refrigerators with chart for

temperature recording, availability of blood bags and check register for number of blood bags

issued for BT in last quarter are in the list of non-functional at DWH Mainpuri

Service delivery data in last two quarters as provided by DWH Mainpuri depicts that 22910 and

29018 patients have got benefitted in Quarter 1 (Q1) and Quarter 2 (Q2) from OPD Services

respectively. In case of IPD services figures were 29000 and 39068 for Q1 and Q2 respectively.

Total 1042 and 1004 deliveries have been conducted at DWH during Q1 and Q2 respectively.

There has been 3 and 1 ‘C’ section conducted in Q1 and Q2 respectively at the hospital. It has

been found that 1042 and 1004 neonates initiated breast feeding within one hour of their birth in

Q1 and Q2 respectively. 973 and 1169 cases of TRI/STI have been treated in Q1 and Q2

respectively. There have been 147 and 106 pregnant women referred from the hospital and 1304


18 JANUARY 2016

and 1576 have been registered for ANC1 in Q1 and Q2 respectively. There has been only one

tubectomy conducted in Q1 and 9 in Q2 at the hospital.

Figure: 9 RTI/STI Clinic at DWH Figure: 10 NHM Poster depicts NB Care Week

Postnatal delivery services at the DWH have been found properly functional. Payment for JSY

beneficiaries have been given through account transfer mode.

Quality parameter at the DWH has been found appropriate in terms of every essential skill

required for proper service delivery.

As per information provided, record has been maintained in the proper register specify for

particular events.

Referral services provided to patients through government assigned vehicles at free of cost.

Figure: 11NRC Register for Record Maintenance Figure: 12 Infantometer at DWH

Information, Education and Communication (IEC) display materials had been well placed in the

hospital premises for the benefit of people.

Additional support services like regular fogging, laundry/washing, dietary, drug storage,

equipment maintenance has been adequately maintained. But apart from these things, cleaning

of toilets and even the hospital premises were not found up to the mark


19 JANUARY 2016

Figure: 13 IEC Display at Hospital Wall Figure: 14 IEC Display about JSSK

Figure: 15 IEC Display about NRC Figure: 16 IEC Display about Facilities Helpline

16.2 Community Health Centre, Kuraoli

CHC Kuraoli situated 23 km faraway from district headquarters Mainpuri. It serves more than 2

lakh population residing in 97 villages in its catchment area.

Physical infrastructure at the centre has been found by and large in good conditions. There has

been cleaning issues prevailing at the centre specially toilets and patients ward where people

spits and spider net made the premises hostile to stay at night. Mosquitoes even found roaming

during day time. The entire things demand immediate attention to curb the prevailing cleaning

and sanitation issues.


20 JANUARY 2016

Figure: 17 Bike in front of OT Door Figure: 18 List of Staffs Working at CHC

CHC Kuraoli has no as such scarcity of human resources for smooth functioning of hospital

except cleaning staffs as revealed by Medical Superintendent. There are 4 MO, 2+3 SNs/GNMs,

3 ANM, 2 LTs, 2 Pharamacist, 4 LHV/PHN and 5 others staff are working at the centre.

CHC Kuraoli frequently engages its human resources (HR) for specific training, as 22 personnel

got Skilled Birth Attendant (SBA) and IUD training. It has been also mentioned that 4 and 2

personnel got RTI/STI and Immunization and cold chain training respectively.

Figure: 19 Immunization Message at CHC Kuraoli Figure: 20 RTI/STI Clinic at CHC Kuraoli

As data reveals that entire equipments including laboratory equipments at the CHC have been

functional which shows that CHC Kuraoli is prepared well for smooth functioning of the centre.

There has been nothing found problematic as far as essential drugs and its supplies are

concerned at the centre.

CHC Kuraoli also equipped with all kinds of lab services and tests except test of Complete

Blood Count (CBC) and Rapid Plasma Reagin (RPR).


21 JANUARY 2016

Figure: 21 Radiant Warmer at CHC Figure: 22 Medical Superintendent

The CHC Kuraoli provided data of last two Quarters (Q1 and Q2 of 2014-15) which reveals the

services delivered to the patients. It has been found that 21638 and 26378 number of patients

utilized OPD services in Q1 and Q2 respectively while 921 and 1201 patients have been utilized

IPD services during similar period. The Centre has provided IFA tablets to 325 and 459

pregnant women during Q1 and Q2. There had been 3 and 2 cases of obstetric complications

managed in Q1 and Q2 respectively. The centre also ensured 100 percent neonates breast

feeding within one hour in last two quarters. RTI/STI patients (90 in Q1 and 116 in Q2) have

been treated. The CHC has referred 6 and 11 sick children in Q1 and Q2 respectively while 18

and 13 pregnant women were referred during the same time respectively. The CHC has done

registration of 325 and 459 cases for ANC1 in last two quarters. It is also noticeable that 48 and

46 cases of IUCD insertions, 5 and 11 cases of tubectomy have been conducted in last two

quarters Q1 and Q2 respectively. The CHC data shows that adequate numbers of children

immunized and have been given vitamin A and ORS+Zinc in last two quarters. There were three

maternal and three still births have been recorded at the centre in last two quarters.

It was also good to see that postnatal services at the CHC Kuraoli have been delivered properly

in last two quarters.

Quality parameters for different cases have been given more importance at the centre except

managing high risk pregnancy.


22 JANUARY 2016

Figure: 23 ICTC Advisory ward at CHC Kuraoli Figure: 24 JSSK Poster at CHC Kuraoli

Referral linkages managed through government transportation with free of cost as 1899 and

1638 women transported during ANC/INC/PNC in last two quarters.

IEC display materials were found at the centre’s wall.

Additional support services properly maintained but Grievance Redressal Mechanisms were

missing at the CHC.

Figure: 25 IEC Display about ASHA and Essential Drug List at CHC Kuraoli

16.3 New Primary Health Centre, Saadatpur

New PHC Saadatpur is situated around 40 km from district headquarter Mainpuri. It is easily

accessible via road. But its location is isolated and far from habitation. The entire premises are

government property and have covered enough land area where every staff quarters have been

made but all seems deserted due to negligence. There were no electric and water supply at the

centre. It seems that no attention has been paid for acquiring necessary infrastructure required

for normal functioning of centre after once building constructed. There were nothing found

appropriate and adequate at the centre except building and its wall. Animal’s fodders were kept

inside the staff quarters and bushes were overgrown surrounding the quarters. Patients visit are


23 JANUARY 2016

also low at the centre and it is due to CHC Kuraoli is very near to the centre and situated on

same road. So people generally prefer to go to CHC Kuraoli. Therefore it seems that the

location of this PHC is not appropriate as far as service deliveries to the people are concerned. It

should be located somewhere else in the block where government health facilities are

inadequate and in more demand.

Figure: 26 New PHC Saadatpur Building Figure: 27 Staff Quarters, New PHC Saadatpur.

There are four staffs presently registered for working at the centre that includes 1 each MO,

ANM, LTs and pharmacist. Only two were present at the time of visit.

In case of training status, two HR has been trained that includes one skill birth attendant (SBA)

and one for IUD.

As far as availability of equipments are concern, there were many equipments which are not

available at the centre like Neonatal, Paediatric and Adult Resuscitation kit, Radiant Warmer,

Suction Apparatus, Oxygen, ILR and Deep Freezer.

Although, essential drugs and supplies are adequate at the centre except few like Magnesium

Sulphate Injection, Mifepristone tablets and other vaccines including Urine albumin and sugar

testing kit.

Lab Services provided at the centre were not adequate as there were no lab services available for

CBC, Serum Bilirubin test, Blood Sugar, RPR and HIV.

Data regarding service delivery in last two quarters reveals that there have been 2052 and 3456

numbers of patient utilized OPD services, and 12 and 16 of IPD services in Q1 and Q2

respectively. It should be appreciated that hundred percent entries of MCTS has been carried out

to percentage of women registered in the first trimester. 45 and 51 pregnant women have been

given IFA and registered for ANC1 in last two quarters. Total five deliveries have been


24 JANUARY 2016

conducted in last quarter. There had been 17 IUCD insertion carried out and more than 200

children fully immunized in last two quarters.

Service delivery in post natal wards and quality parameters at the centre were not found

adequate and up to the mark.

Records maintenance was carried appropriately with proper assigned register for every event.

Data also depicts that there has been 100 percent expenditure recorded in untied funds, AMG

and RKS at the centre.

There has been no referral linkages data in last two quarters.

IEC Display was up to mark and which had been marked on wall in form of painting and as well

as in poster.

There was nothing in the name of additional support services like regular fumigation,

laundry/washing services, dietary drug storage, equipment maintenance, grievance redressal

mechanism etc.

16.4 Sub Centre, Punupura

Sub centre Punupura is situated 7 km far from New PHC Saadatpur. It serves 5675 population

of 9 villages in its catchment area. Sub Centre is situated near main habitation and functioning

in government building. The entire infrastructure which required for smooth functioning of sub

centre was inadequate. The sub centre has no electricity supply, water supply, NBCC, and

compliant/suggestion box. There were nothing kept inside the sub centre due to theft and

security issues and ANM also does not reside at the centre. ANM carries all the equipments and

necessary register during the visit to the centre. Once upon a time this sub centre has been

robbed by the thieves.

Figure: 28 Sub Centre Punupura Figure: 29 ANM with NHM PIP M &E Team Leader


25 JANUARY 2016

The sub centre has 1 ANM, 1 MPW-male along with one each ASHA and Anganwadi worker as

a human resource.

Lots of equipments at the centre were not available like Haemoglobinometre, Blood sugar

testing kits, Neonatal ambu bag and RBSK pictorial kit etc.

As far as availability of essential drugs is concerned, centre has kept most of the essential drugs

except Injection Magnesium Sulphate and Oxytocin.

Essential medical supplies were also found proper except Urine albumin and sugar testing kit.

Figure: 30 Mother and Child Health Register Figure: 31 Drugs and other Equipments bag at the Sub Centre

Sub Centre has given IFA to 45 and 23 pregnant women in the last two quarters Q1 and Q2

respectively. Sub centre has registered 45 and 27 women for ANC1 and 38 and 34 children have

been fully immunized in Q1 and Q2 respectively. Data reveals that 412 children were given

Vitamin A and 3 got IFA syrup in first quarter. There has been 6 VHND and 6 VHNSC meeting

attended by the centre in last two quarters.

Records had been properly maintained by the sub centre including untied fund expenditure.

IEC display materials were written on walls at the centre.

20. CONCLUSIONS AND RECOMMENDATIONS

20.1 CONCLUSIONS

Population Research Centre Delhi has been assigned by The Ministry of Health and Family Welfare

(MoHFW), Government of India, for quality monitoring and evaluation of National Health Mission

(NHM) Programme Implementation Plans (PIPs) in various states. The team has carried out field

visits for quality checks and improvements of various components of NHM. This report explains the

monitoring and evaluation findings of the Mainpuri District of Uttar Pradesh. The team has visited

following healthcare facilities for monitoring and evaluation in Mainpuri District: District Women

Hospital (DWH) Mainpuri, CHC Kuraoli, New PHC Saadatpur, and SC Punupura.


26 JANUARY 2016

Mainpuri District’s overall performance is good despite of its limited infrastructure and human

resource base.

It has been found that District Women’s Hospital is working under more distress full conditions

due to lack of human resources. DWH Mainpuri immediate requirement is to fill vacant post of

Medical Officer/ Specialist and Gynecologist.

Maternal and child health still requires more focus as result shows that apart from enhancement

in institutional deliveries in 2014-15, the home deliveries cases also increased in the same

period.

Cleaning and sanitation are one of the big challenge for district’s different health facilities as it

has been found that these things requires more focus to overcome the problem.

It could be imagined that how New PHC Saadatpur and SC Punupura are functioning without

electricity and water supply which is basic and vital for the smooth functioning of the facilities.

Training of human resources also found inadequate as lots of training are not given to various

kinds of human resources. ASHAs like grassroots worker also incorporated with HR training.

JSY payments in the district going smoothly and maximum payments have been made through

cheques.

Ambulances like 108 and 102 playing as a life line for beneficiaries. People are utilizing these

transport facilities as per their requirements. It has played transformational role in rural health

accessibility.

SNCU and NBSU are not functioning in the district. RBSK data is missing in providing overall

picture of the district.

Immunization coverage in the district requires more focus for well performance.

Family planning needs more focus to reduce the prevailing unmet need in the district. It is also

not clear as far as ARSH Progress (2014-15) is concerned in the district.

20.2 RECOMMENDATIONS

SNCU should be established immediately in the district facilities for providing better care to the

neonates. Apart from this, NBSU ward should be well equipped with adequate infrastructures

and human resources.

Institutional deliveries should be given more focus in the district as remote areas still recorded

more cases of home deliveries.

It would be good to mobilize people through community participation as well as applying

holistic mechanism to boosting the level of institutional deliveries and immunization coverage.


27 JANUARY 2016

ASHA’s incentives should be enhanced and also given some specific training for better

approach to the beneficiaries.

Human resources particularly number of specialist doctors and gynecologist post should be

immediately filled for the smooth functioning of facilities in general and District Women’s

Hospital in particular.

Cleaning staffs should be recruited for improving the situation of toilets, labour rooms and

overall premises of the facilities.

Apart from availability of medical kits and equipments, PHC’s and SC’s Physical infrastructure

like electricity and water supply should be ensured for smooth functioning of the facilities.


28 JANUARY 2016

21. APPENDIX

APPENDIX 1:

NATIONAL RURAL HEALTH MISSION

MONITORING OF DISTRICT PIP

POPULATION RESEARCH CENTRE, INSTITUTE OF ECONOMIC GROWTH, DELHI

EVALUATION OF KEY INDICATORS OF THE DISTRICT

1. Detail of demographic & health indicators

No. of Blocks

No. of Villages

Population (2011)

SC-ST Population (%)

Literacy Rate

Overall Sex Ratio

Density of Population

Health Indicators

NMR

IMR

U5MR

MMR

TFR

Proportion of fully immunized children

Proportion of Pregnant receiving any ANC

Proportion of Safe Deliveries

Institutional Deliveries 10605

No of women received PNC checkups within 48 hours 9323

Full ANC ( At least three ANC checkups) 25979

2. Detail of health infrastructures 2014-15

Health Facility Number available Govt. building Rented building/ Under const.

District hospital

SDH


29 JANUARY 2016

3. Human Resources under NHM 2014-15

Position Name Sanctioned Regular Contractual Total Vacant Vacant %

13-14 14-15 13-14 14-15 13-14 14-15 13-14 14-15 13-14 14-15 MO’s including specialists

Gynecologists

Pediatrician

Surgeon

LHV

ANM

Pharmacist

Lab technicians

X-ray technicians

Staff Nurse at CHC

Staff Nurse at PHC

ANM at PHC

ANM at SC

4.1. Training status of human resource 2014-15

Position Name SBA BeMOC MTP Minilap/PP

S NSV

Total

Medical Officers

Lady Medical Officers

Staff Nurses

ANM

Lab Technicians

Pharmacist

LHV/PHN

ASHA

Other

CHC FRUs

CHC

PHC

Sub Centre

Medical College

Delivery Points

108 Ambulances

CATS

102 Ambulance

Referral Transport


30 JANUARY 2016

* Note- Fill number of officials received training

4.2. Training status of human resource 2014-15

Position Name IUCD

insertion

RTI/STI/HIV

screening FIMNCI

NSSK Total

MO

LMO

Staff Nurses

ANM

Lab Technicians

Pharmacist

LHV/PHN

ASHA

Other

5.1 Block wise service delivery indicators 2013-14 & 2014-15 (Maternal Health)

Block

ANC

Registered 3 ANCs

Home

Deliveries

Institutional

Deliveries

PNC within

48 hrs after

delivery

PNC between

48 hrs and 14

days after

delivery

13-14 14-15 13-14 14-15 13-14 14-15 13-

14

14-15 13-14 14-

15

13-14 14-15

37391 40683 29795 25979 2308 2056 8342 10605 9468 9523 9158 9522

Note- Please included the data for Medical College and DH

5.2 Block wise service delivery indicators 2013-14 & 2014-15 (maternal health)

Note- Please included the data for Medical college and DH

B

l

o

c

k

TT1 TT2

Home Deliveries

Live Birth Still

Birth Total Births SBA

assisted Non-SBA

13-14 14-15 13-14 14-15 13-

14 14-15 13-14 14-15 13-14 14-15 13

-

14-

15 13-14 14-15

14612 14687 12629 12775 701 568 1607 1488 12371 12729 89 93 12460 12822


31 JANUARY 2016

5.3. Status of JSY Payments in district 2014-15

5.4. Block wise JSSK Progress in district 2014-15

Block

No. of Beneficiaries under JSSK Total =

Diet Drugs Diagnostic

Transport

Home to Facility Referral Facility to Home

5.5. Maternal Death Review: 2014-15

Total

Maternal

Deaths

Place of Deaths Cause

of death

Month Of pregnancy ANC

Statu

s

Total

No of

childre

n Hospital Home Transit

During

pregnancy

During

Delivery

Post

Deliver

y

Status of payments Mode of Payments Record maintenance

Institutional

deliveries

Home

Deliveries ASHAs Cash Cheque

A/C

transfer Available Updated

Non

updated


32 JANUARY 2016

6.1. Child Health: Block wise Analysis of immunization, 2014-15

Block Target BCG DPT OPV Measle

s

Full

Immunizat

ion 1 2 3 0 1 2

South 14706 3358 3368 3442 11084 15222 15378 18946 16982

6.2. Child Health: Detail of infrastructure & Services under Neonatal Health, 2014-15

Total SNCU

Total NBSU

Total NBCC

Total Staff in SNCU

Total Staff in NBSU

Total NRCs

Total Admissions in NRCs

Total Staff in NRCs

Anticipated Admissions in NRCs

Discharged from NRCs

Referred from NRCs

Average duration of stay in NRCs

6.3. Neonatal Health: 2014-15 (SNCU, NRCS & CDR)

Total

neonates

admitted in

to SNCU

Treatment Outcome Total

neonates

admitted

in to

NBSU

Treatment Outcome

Discharge Referred Death LAMA*

Discharge Referred Death LAMA*

Note- * Leave against medical advise


33 JANUARY 2016

6.4. Neonatal Health: 2014-15 (SNCU, NRCS & CDR)

Total Deaths

Place of Deaths

Reason

Month/year in

which child has

died ANC

Status of

mother

Birth

order

Hospital Home Transit

6.5. Rashtriya Bal Suraksha Karyakram (RBSK), Progress Report 2014-15

Years No. of

Schools

No. of children registered

Children Diagnosed

Eye Disease

Ear Disease

Heart diseas

e

Physically challenged

Anemic

2014-15

2013-14

7. Family Planning Achievement in District 2014-15

Name Block Target Sterilization IUD OP CC

Male Female Total % Ach % Ach % Ach %

27 1033 0160 5734

12242 293262

8. ARSH Progress in District 2014-15

Block

No. of Counseling session

held No of Anemic Adolescents

Iron tablets given

deworming tablets given

Referred with severe health issues

No. of RTI/STI cases

Planned Conducted Severe Moderat

e Normal

7112


34 JANUARY 2016

9. Quality in health care services

Bio-Medical Waste Management

No of facilities having bio-medical pits

Training on bio-medical waste management

No. of facilities having color coded bins

Outsourcing for bio-medical waste

Infection Control

No. of times fumigation is conducted in a year

Training of staff on infection control

10. Community process in District 2014-15

Current status of ASHAs (Total number of ASHAs)

ASHAs presently working

Positions vacant

Skill development/refresher training of ASHAs (List the module)

Total number of meeting with ASHA ( in a Year)

Total number of ASHA resource centers/ ASHA Ghar

Drug kit replenishment

11. Disease control programme progress District 2014-15

Name of the Program No. of cases screened No. of detected cases No. of treated cases

RNTCP

Leprosy

Malaria

12. AYUSH progress District 2014-15

Block No. of facilities

with AYUSH

health centers

No. of

AYUSH

Doctors

No. of patients

received

treatment

Ayurveda

Medicines

availability

Unani/Siddha

Medicines

availability

Homeopathy

Medicines

availability

Yes No Yes No Yes No

13. HMIS/MCTS progress District 2014-15

HMIS/MCTS Remarks

Is HMIS /MCTS implemented at all the facilities Yes No Yes

Is HMIS data analyzed and discussed with concerned staff at state and

district levels for necessary corrective action to be taken in future?

Yes No yes

Do programme managers at all levels use HMIS data for monthly

reviews?

Yes No yes


35 JANUARY 2016

13. New Initiative and new innovations

Is MCTS made fully operational for regular and effective monitoring

of service delivery including tracking and monitoring of severely

anemic women, low birth weight babies and sick neonates

Yes No

yes

Is the service delivery data uploaded regularly Yes No

yes

Is the MCTS call centre set up at the District level to check the

veracity of data and service delivery?

Yes No yes

Is HMIS data analyzed and discussed with concerned staff at state

and district levels for necessary corrective action to be taken in future?

Yes No yes


36 JANUARY 2016

Appendix 2:

DH level Monitoring Checklist

Name of District: _______________ Name of Block: _______________ Name of DH: _________________

Catchment Population: __________ Total Villages: ________________

Date of last supervisory visit:__________

Date of visit: _____________ Name& designation of monitor:_____________________________

Names of staff not available on the day of visit and reason for

absence:____________________________________________

_______________________________________________________________________________________

Section I: Physical Infrastructure:

S.No Infrastructure Yes No Additional Remarks

1.1 Health facility easily accessible

from nearest road head

Y N

1.2 Functioning in Govt building Y N

1.3 Building in good condition Y N

1.4 Staff Quarters for MOs Y N

1.5 Staff Quarters for SNs Y N

1.6 Staff Quarters for other

categories Y N

1.7 Electricity with power back up Y N

1.9 Running 24*7 water supply Y N

1.10 Clean Toilets separate for

Male/Female Y N

1.11 Functional and clean labour

Room Y N

1.12 Functional and clean toilet

attached to labour room Y N

1.13 Functional New born care

corner(functional radiant

warmer with neo-natal ambu

bag)

Y N

1.14 Functional Newborn

Stabilization Unit Y N

1.16 Functional SNCU Y N

1.17 Clean wards Y N

1.18 Separate Male and Female wards

(at least by partitions) Y N

1.19 Availability of Nutritional

Rehabilitation Centre Y N


37 JANUARY 2016

1.20 Functional BB/BSU, specify Y N

1.21 Separate room for ARSH clinic Y N

1.22 Availability of

complaint/suggestion box Y N

Availability of mechanisms for

Biomedical waste management

(BMW)at facility

Y N

1.23 BMW outsourced Y N

1.24 Availability of ICTC/ PPTCT

Centre Y N

1.25 Availability of functional Help

Desk Y N

Section II: Human resource:

S. no Category Numbers Remarks if any

2.1 OBG

2.2 Anaesthetist

2.3 Paediatrician

2.4 General Surgeon

2.5 Other Specialists

2.6 MOs

2.7 SNs

2.8 ANMs

2.9 LTs

2.10 Pharmacist

2.11 LHV

2.12 Radiographer

2.13 RMNCHA+ counsellors

2.14 Others

Section III: Training Status of HR:

S. no Training No. trained Remarks if any

3.1 EmOC

3.2 LSAS

3.3 BeMOC

3.4 SBA

3.5 MTP/MVA

3.6 NSV

3.7 F-IMNCI

3.8 NSSK


38 JANUARY 2016

3.9 Mini Lap-Sterilisations

3.10 Laproscopy-Sterilisations

3.11 IUCD

3.12 PPIUCD

3.13 Blood storage

3.14 IMEP

3.16 Immunization and cold chain

3.15 Others

Section IV: Equipment:

S. No Equipment Yes No Remarks

4.1 Functional BP Instrument and Stethoscope Y N

4.2 Sterilised delivery sets Y N

4.3 Functional Neonatal, Paediatric and Adult

Resuscitation kit Y N

4.4 Functional Weighing Machine (Adult and

child) Y N

4.5 Functional Needle Cutter Y N

4.6 Functional Radiant Warmer Y N

4.7 Functional Suction apparatus Y N

4.8 Functional Facility for Oxygen

Administration Y N

4.9 Functional Foetal Doppler/CTG Y N

4.10 Functional Mobile light Y N

4.11 Delivery Tables Y N

4.12 Functional Autoclave Y N

4.13 Functional ILR and Deep Freezer Y N

4.14 Emergency Tray with emergency injections Y N

4.15 MVA/ EVA Equipment Y N

4.16 Functional phototherapy unit Y N

4.17 O.T Equipment

4.18 O.T Tables Y N

4.19 Functional O.T Lights, ceiling Y N

4.20 Functional O.T lights, mobile Y N

4.21 Functional Anesthesia machines Y N

4.22 Functional Ventilators Y N

4.23 Functional Pulse-oximeters Y N

4.24 Functional Multi-para monitors Y N

4.25 Functional Surgical Diathermies Y N

4.26 Functional Laparoscopes Y N

4.27 Functional C-arm units Y N


39 JANUARY 2016

4.28 Functional Autoclaves (H or V) Y N

Laboratory Equipment

4.1a Functional Microscope Y N

4.2a Functional Hemoglobinometer Y N

4.3a Functional Centrifuge Y N

4.4a Functional Semi autoanalyzer Y N

4.5a Reagents and Testing Kits Y N

4.6a Functional Ultrasound Scanners Y N

4.7a Functional C.T Scanner Y N

4.8a Functional X-ray units Y N

4.9a Functional ECG machines Y N

Section V: Essential Drugs and Supplies: S.No Drugs Yes No Remarks

5.1 EDL available and displayed Y N

5.2 Computerised inventory management Y N

5.3 IFA tablets Y N

5.4 IFA tablets (blue) Y N

5.5 IFA syrup with dispenser Y N

5.6 Vit A syrup Y N

5.7 ORS packets Y N

5.8 Zinc tablets Y N

5.9 Inj Magnesium Sulphate Y N

5.10 Inj Oxytocin Y N

5.11 Misoprostol tablets Y N

5.12 Mifepristone tablets Y N

5.13 Availability of antibiotics Y N

5.14 Labelled emergency tray Y N

5.15 Drugs for hypertension, Diabetes,

common ailments e.g PCM,

metronidazole, anti-allergic drugs etc.

Y

N

5.16 Adequate Vaccine Stock available Y N

S.No Supplies Yes No Remarks

5.17 Pregnancy testing kits Y N

5.18 Urine albumin and sugar testing kit Y N

5.19 OCPs Y N

5.20 EC pills Y N

5.21 IUCDs Y N

5.22 Sanitary napkins Y N

S.No Essential Consumables Yes No Remarks

5.23 Gloves, Mckintosh, Pads, bandages, and

gauze etc.

Y N


40 JANUARY 2016

Section VI: Other Services : S.no Lab Services Yes No Remarks

6.1 Haemoglobin Y N

6.2 CBC Y N

6.3 Urine albumin and sugar Y N

6.4 Blood sugar Y N

6.5 RPR Y N

6.6 Malaria Y N

6.7 T.B Y N

6.8 HIV Y N

6.9 Liver function tests(LFT) Y N

6.10 Ultrasound scan (Ob.)

6.11 Ultrasound Scan (General)

6.12 X-ray

6.13 ECG

6.14 Endoscopy

6.15 Others , pls specify Y N

S.No Blood bank / Blood Storage Unit Yes No Remarks

6.16 Functional blood bag refrigerators with chart

for temp. recording Y N

6.17 Sufficient no. of blood bags available Y N

6.18 Check register for number of blood bags

issued for BT in last quarter

Section VII: Service Delivery in last two quarters: S.No Service Utilization Parameter Q1 Q2 Remarks

7.1 OPD

7.2 IPD

7.3 Expected number of pregnancies

7.4 MCTS entry on percentage of women

registered in the first trimester

7.5 No. of pregnant women given IFA

7.6 Total deliveries conducted

7.7 No. of assisted deliveries( Ventouse/

Forceps)

7.8 No. of C section conducted

7.9 Number of obstetric complications

managed, pls specify type

7.10 No. of neonates initiated breast feeding

within one hour

7.11 Number of children screened for

Defects at birth under RBSK

7.12 RTI/STI Treated

7.13a No of admissions in NBSUs/ SNCU,


41 JANUARY 2016

whichever available

7.13b Inborn

7.13c Outborn

7.14 No. of children admitted with SAM

7.15 No. of sick children referred

7.16 No. of pregnant women referred

7.17 ANC1 registration

7.18 ANC 3 Coverage

7.19 ANC 4 Coverage

7.20 No. of IUCD Insertions

7.21 No. of Tubectomy

7.22 No. of Vasectomy

7.23 No. of Minilap

7.24 No. of children fully immunized

7.25 Measles coverage

7.26 No. of children given ORS + Zinc

7.27 No. of children given Vitamin A

7.28 No. of women who accepted post-partum

FP services

7.29 No. of MTPs conducted in first trimester

7.30 No. of MTPs conducted in second trimester

7.31 Number of Adolescents attending ARSH

clinic

7.32 Maternal deaths, if any

7.33 Still births, if any

7.34 Neonatal deaths, if any

7.35 Infant deaths, if any

Section VII a: Service delivery in post natal wards: S.No Parameters Yes No Remarks

7.1a All mothers initiated breast feeding

within one hour of normal delivery Y N

7.2a Zero dose BCG, Hepatitis B and

OPV given Y N

7.3a Counseling on IYCF done Y N

7.4a Counseling on Family Planning

done Y N

7.5a Mothers asked to stay for 48 hrs Y N

7.6a JSY payment being given before

discharge Y N

7.7a Mode of JSY payment (Cash/

bearer cheque/Account payee

cheque/Account Transfer)


42 JANUARY 2016

7.8a Any expenditure incurred by

Mothers on travel, drugs or

diagnostics(Please give details)

Y N

7.9a Diet being provided free of charge Y N

Section VIII: Quality parameter of the facility: Through probing questions and demonstrations assess does the staff know how to…

S.No Essential Skill Set Yes No Remarks

8.1 Manage high risk pregnancy Y N

8.2 Provide essential newborn

care(thermoregulation,

breastfeeding and asepsis)

Y N

8.3 Manage sick neonates and infants Y N

8.4 Correctly uses partograph Y N

8.5 Correctly insert IUCD Y N

8.6 Correctly administer vaccines Y N

8.7 Segregation of waste in colour

coded bins

Y N

8.8 Adherence to IMEP protocols Y N

8.9 Bio medical waste management Y N

8.10 Updated Entry in the MCP Cards Y N

8.11 Entry in MCTS Y N

8.12 Action taken on MDR Y N

Section IX: Record Maintenance:

S. no Record Available and

Updated and

correctly filled

Available but

Not maintained

Not

Available

Remarks/Ti

meline for

completion

9.1 OPD Register

9.2 IPD Register

9.3 ANC Register

9.4 PNC Register

9.5 Indoor bed head ticket

9.6 Line listing of severely anaemic

pregnant women

9.7 Labour room register

9.8 Partographs

9.9 FP-Operation Register (OT)

9.10 OT Register

9.11 FP Register

9.12 Immunisation Register

9.13 Updated Microplan


43 JANUARY 2016

9.14 Blood Bank stock register

9.15 Referral Register (In and Out)

9.16 MDR Register

9.17

Infant Death Review and

Neonatal Death Review

9.18 Drug Stock Register

9.19 Payment under JSY

9.20

Untied funds expenditure

(Check % expenditure)

9.21

AMG expenditure (Check %

expenditure)

9.22

RKS expenditure (Check %

expenditure)

Section X: Referral linkages in last two quarters:

S. no JSSK Mode of

Transport

(Specify

Govt./ pvt)

No. of women

transported

during

ANC/INC/PN

C

No. of sick

infants

transported

No. of

children 1-

6 years

Free/Paid

10.1 Home to facility

10.2 Inter facility

10.3

Facility to Home (drop

back)

Section XI: IEC Display: S.No Material Yes No Remarks

11.1

Approach roads have directions to

the health facility

Y N

11.2 Citizen Charter Y N

11.3 Timings of the health facility Y N

11.4 List of services available Y N

11.5 Essential Drug List Y N

11.6 Protocol Posters Y N

11.7

JSSK entitlements ( Displayed in ANC

Clinics/, PNC Clinics) Y N

11.8 Immunization Schedule Y N

11.9 JSY entitlements( Displayed in ANC

Clinics/, PNC Clinics) Y N

11.10 Other related IEC material Y N

Section XII: Additional/Support Services: Sl. no Services Yes No Remarks

12.1 Regular Fogging (Check Records) Y N


44 JANUARY 2016

12.2 Functional Laundry/washing services Y N

12.3 Availability of dietary services Y N

12.4 Appropriate drug storage facilities Y N

12.5 Equipment maintenance and repair

mechanism Y N

12.6 Grievance Redressal mechanisms Y N

12.7 Tally Implemented Y N


45 JANUARY 2016

Appendix 4:

PHC/CHC (NON FRU) level Monitoring Checklist

Name of District: _______________ Name of Block: _______________ Name of PHC/CHC: _________________

Catchment Population:

__________ Total Villages: ________________ Distance from Dist HQ: __________



Names of staff not available on the day of visit and reason for

absence:____________________________________________

_______________________________________________________________________________________


S.No Infrastructure Yes No Additional Remarks

1.1 Health facility easily accessible from nearest

road head

Y N


1.3 Building in good condition Y N

1.4 Staff Quarters for MOs available Y N

1.5 Staff Quarters for SNs available Y N

1.6 Staff Quarters for other categories Y N



1.10 Clean Toilets separate for Male/Female Y N

1.11 Functional and clean labour Room Y N

1.12 Functional and clean toilet attached to labour

room

Y N

1.13 Functional New born care corner(functional

radiant warmer with neo-natal ambu bag)

Y N

1.14 Functional Newborn Stabilization Unit Y N

1.15 Clean wards Y N

1.16 Separate Male and Female wards (at least by

Partitions)

Y N

1.17 Availability of complaint/suggestion box Y N

1.18 Availability of mechanisms for waste

management

Y N


46 JANUARY 2016

Section II: Human resource:

S. no Category Numbers Remarks if any

2.1 MO

2.2 SNs/ GNMs

2.3 ANM

2.4 LTs

2.5 Pharmacist

2.6 LHV/PHN

2.7 Others

Section III: Training Status of HR

S. no Training No. trained Remarks if any

3.1 BeMOC

3.2 SBA

3.3 MTP/MVA

3.4 NSV

3.5 IMNCI

3.6 F- IMNCI

3.7 NSSK

3.8 Mini Lap

3.9 IUD

3.10 RTI/STI

3.11 Immunization and cold chain

3.12 Others

Section IV: Equipment

S. No Equipment Yes No Remarks

4.1 Functional BP Instrument and

Stethoscope

Y N

4.2 Sterilised delivery sets Y N

4.3 Functional neonatal, Paediatric and

Adult Resuscitation kit

Y N

4.4 Functional Weighing Machine (Adult and

infant/newborn)

Y N

4.5 Functional Needle Cutter Y N

4.6 Functional Radiant Warmer Y N

4.7 Functional Suction apparatus Y N

4.8 Functional Facility for Oxygen Y N


47 JANUARY 2016

Administration

4.9 Functional Autoclave Y N

4.10 Functional ILR and Deep Freezer Y N

4.11 Functional Deep Freezer

4.12 Emergency Tray with emergency

injections

Y N

4.13 MVA/ EVA Equipment Y N

Laboratory Equipment Yes No Remarks

4.14 Functional Microscope Y N

4.15 Functional Hemoglobinometer Y N

4.16 Functional Centrifuge, Y N

4.17 Functional Semi autoanalyzer Y N

4.18 Reagents and Testing Kits Y N

Section V: Essential Drugs and Supplies

S.No Drugs Yes No Remarks

5.1 EDL available and displayed Y N

5.2 Computerised inventory management Y N

5.3 IFA tablets Y N

5.4 IFA tablets (blue) Y N


5.6 Vit A syrup Y N

5.7 ORS packets Y N





5.12 Mifepristone tablets Y N

5.13 Availability of antibiotics Y N

5.14 Labelled emergency tray Y N

5.15 Drugs for hypertension, Diabetes,


metronidazole, anti-allergic drugs etc.

Y

N

5.16 Adequate Vaccine Stock available Y N

S.No Supplies Yes No Remarks

5.17 Pregnancy testing kits Y N

5.18 Urine albumin and sugar testing kit Y N

5.19 OCPs Y N

5.20 EC pills Y N

5.21 IUCDs Y N



48 JANUARY 2016

S.No Essential Consumables Yes No Remarks

5.23 Gloves, Mckintosh, Pads, bandages,

and gauze etc.

Y N

Section VI: Other Services :

S.no Lab Services Yes No Remarks

6.1 Haemoglobin Y N

6.2 CBC Y N

6.3 Urine albumin and Sugar Y N

6.4 Serum Bilirubin test Y N

6.5 Blood Sugar Y N

6.6 RPR Y N

6.7 Malaria Y N

6.8 T.B Y N

6.9 HIV Y N

6.10 Others Y N

Section VII: Service Delivery in last two quarters:

S.No Service Utilization Parameter Q1 Q2 Remarks

7.1 OPD

7.2 IPD

7.3 Expected number of pregnancies

7.4 MCTS entry on percentage of women

registered in the first trimester

7.5 No. of pregnant women given IFA

7.6 Total deliveries conducted

7.7 Number of obstetric complications

managed, pls specify type

7.8 No. of neonates initiated breast

feeding within one hour

7.9 Number of children screened for

Defects at birth under RBSK

7.10 RTI/STI Treated

7.11 No of admissions in NBSUs, if available


7.13 No. of pregnant women referred


7.15 ANC3 Coverage

7.16 ANC4 Coverage

7.17 No. of IUCD Insertions

7.18 No. of Tubectomy


49 JANUARY 2016

7.19 No. of Vasectomy

7.20 No. of Minilap

7.21 No. of children fully immunized

7.22 Measles coverage

7.23 No. of children given ORS + Zinc


7.25 No. of women who accepted post partum

FP services

7.26 No. of MTPs conducted

7.27 Maternal deaths, if any

7.28 Still births, if any

7.29 Neonatal deaths, if any

7.30 Infant deaths, if any

Section VII a: Service delivery in post natal wards:

S.No Parameters Yes No Remarks

7.1a All mothers initiated breast

feeding within one hr of normal

delivery

Y N

7.2a Zero dose BCG, Hepatitis B and

OPV given

Y N

7.3a Counseling on IYCF done Y N

7.4a Counseling on Family Planning

done

Y N

7.5a Mothers asked to stay for 48 hrs Y N

7.6a JSY payment being given before

discharge

Y N

7.7a Mode of JSY payment (Cash/

bearer cheque/Account payee

cheque/Account Transfer)

7.8a Any expenditure incurred by

Mothers on travel, drugs or

diagnostics(Please give details)

Y N

7.9a Diet being provided free of

charge

Y N

Section VIII: Quality parameter of the facility Through probing questions and demonstrations assess does the staff know how to…

S.No Essential Skill Set Yes No Remarks

8.1 Manage high risk pregnancy Y N

8.2 Provide essential newborn Y N


50 JANUARY 2016

care(thermoregulation,

breastfeeding and asepsis)

8.3 Manage sick neonates and infants Y N

8.4 Correctly Uses Partograph Y N

8.5 Correctly insert IUCD Y N

8.6 Correctly administer vaccines Y N

8.7 Alternate Vaccine Delivery

(AVD) system functional

Y N

8.7 Segregation of waste in colour

coded bins

Y N

8.8 Adherence to IMEP protocols Y N

Section IX: Record Maintenance:

S. no Record Available,

Updated

and

correctly

filled

Available

but Not

maintain

ed

Not

Avai

lable

Remarks/Timeline

for completion

9.1 OPD Register

9.2 IPD Register

9.3 ANC Register

9.4 PNC Register

9.5 Indoor bed head ticket

9.6 Line listing of severely anaemic pregnant

women

9.7 Labour room register

9.8 Partographs

9.9 OT Register

9.10 FP Register

9.11 Immunisation Register


9.13 Drug Stock Register

9.14 Referral Registers (In and Out)

9.15 Payments under JSY

9.16 Untied funds expenditure (Check %

expenditure)

9.17 AMG expenditure (Check %

expenditure)

9.18 RKS expenditure (Check %

expenditure)

Section X: Referral linkages in last two quarters:


51 JANUARY 2016

S. no JSSK Mode of

Transport

(Specify

Govt./ pvt)

No. of

women

transpor

ted

during

ANC/INC

/PNC

No. of

sick

infants

transpor

ted

No.

of

chil

dren

1-6

year

s

Free/Paid

10.1 Home to facility

10.2 Inter facility

10.3

Facility to Home (drop

back)

Section XI: IEC Display:

S.No Material Yes No Remarks

11.1

Approach roads have directions to

the health facility

Y N


11.3 Timings of the Health Facility Y N

11.4 List of services available Y N

11.5 Essential Drug List Y N

11.6 Protocol Posters Y N

11.7 JSSK entitlements Y N

11.8 Immunization Schedule Y N 11.9 JSY entitlements Y N


Section XII: Additional/Support Services:

Sl. no Services Yes No Remarks

12.1 Regular fumigation (Check Records) Y N

12.2 Functional laundry/washing services Y N

12.3 Availability of dietary services Y N

12.4 Appropriate drug storage facilities Y N

12.5 Equipment maintenance and repair

mechanism

Y N

12.6 Grievance redressal mechanisms Y N

12.7 Tally Implemented Y N


52 JANUARY 2016

Appendix 5:

Sub Centre level Monitoring Checklist

Name of District: _______________ Name of Block: _______________ Name of SC: _________________

Catchment Population: __________ Total Villages: ________________ Distance from PHC: __________



Names of staff posted and available on the day of visit: ________________________________________________________

Names of staff not available on the day of visit and reason for absence : ____________________________________


S.No Infrastructure Yes No Remarks

1.1 Subcentre located near the main

habitation

Y N


1.3 Building in good physical

condition

Y N



1.6 ANM quarter available Y N

1.7 ANM residing at SC Y N

1.8 Functional labour room Y N

1.9 Functional and clean toilet

attached to labour room

Y N

1.10 Functional New Born Care Corner

(functional radiant warmer with neo-

natal ambu bag)

Y N

1.11 General cleanliness in the facility Y N

1.12 Availability of complaint/

suggestion box

Y N

1.13 Availability of deep burial pit for

biomedical waste management /

any other mechanism

Y N

Section II: Human Resource:

S.no Human resource Numbers Trainings received Remarks

2.1 ANM

2.2 2nd ANM

2.3 MPW - Male

2.4 Others, specify


53 JANUARY 2016

Section III: Equipment : S.N

o

Equipment Available

and

Functional

Available

but non-

functional

Not

Available

Remarks

3.1 Haemoglobinometer

3.2 Any other method for

Hemoglobin Estimation

3.3 Blood sugar testing kits

3.4 BP Instrument and

Stethoscope

3.5 Delivery equipment

3.6 Neonatal ambu bag

3.7 Adult weighing machine

3.8 Infant/New born weighing

machine

3.9 Needle &Hub Cutter

3.10 Color coded bins

3.11 RBSK pictorial tool kit

Section IV: Essential Drugs:

S.

No

Availability of sufficient

number of essential Drugs

Yes No Remarks

4.1 IFA tablets Y N


4.3 Vit A syrup Y N

4.4 ORS packets Y N





4.9 Antibiotics, if any, pls specify Y N

4.10 Availability of drugs for


metronidazole, anti-allergic

drugs etc.

Y N

Section V: Essential Supplies


54 JANUARY 2016

S.No Essential Medical Supplies Yes No Remarks

5.1 Pregnancy testing Kits Y N

5.2 Urine albumin and sugar

testing kit

Y N

5.3 OCPs Y N

5.4 EC pills Y N

5.5 IUCDs Y N


Section VI: Service Delivery in the last two quarters:

S.No Service Utilization

Parameter

Q1 Q2 Remarks

6.1 Number of estimated

pregnancies

6.3 No. of pregnant women given

IFA

6.4 Number of deliveries

conducted at SC

6.5 Number of deliveries

conducted at home


6.9 No. of pregnant women

referred


6.11 ANC3 coverage

6.12 ANC4 Coverage

6.13 No. of IUCD insertions

6.14 No. of children fully

immunized

6.14a Measles coverage

6.15 No. of children given ORS +

Zinc


6.17 No. of children given IFA Syrup

6.18 No. of Maternal deaths

recorded , if any

6.19 No. of still birth recorded, if

any

6.20 Neonatal deaths recorded, if

any

6.21 Number of VHNDs attended

6.22 Number of VHNSC meeting

attended


55 JANUARY 2016

Section VIII: Record Maintenance:

Sl. No Record Available

and

Upto-

date and

correctly

filled

Available

but non-

maintained

Not

Avail

able

Remarks

8.1 Untied funds expenditure

(Rs 10,000-Check %

expenditure)

8.2 Annual maintenance grant

(Rs 10,000-Check %

expenditure)

8.3 Payments under JSY

8.4 VHND plan

8.5 VHSNC meeting minutes

and action taken

8.6 Eligible couple register

8.7 MCH register ( as per GOI)

8.8 Delivery Register as per

GOI format

8.9 Stock register

8.10 Due lists

8.11 MCP cards

8.12 Village register

8.13 Referral Registers (In and

Out)

8.14 List of families with 0-6

years children under RBSK

8.15 Line listing of severely

anemic pregnant women


8.17 Vaccine supply for each

session day (check

availability of all vaccines )

8.18 Due list and work plan

received from MCTS Portal

through Mobile/

Physically

Section X: IEC display:


56 JANUARY 2016

S. no Material Yes No Remarks

10.1 Approach roads have

directions to the sub centre

Y N


10.3 Timings of the Sub Centre Y N

10.4 Visit schedule of ANMs Y N

10.5 Area distribution of the ANMs/

VHND plan

Y N

10.6 SBA Protocol Posters Y N

10.7 JSSK entitlements Y N

10.8 Immunization Schedule Y N

10.9 JSY entitlements Y N


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