Wel-Come

To
SRM Bilaspur Debriefing
State Review Mission -NRHM
-Vision -
Review of Progress in Health status and Health Delivery System
Assessment of Impact on Accessiility ! "#uity! affordaility and
#uality of health services #uality of health services
Identify the $est practices !succes stories and innovations
Identify the %onstrains and issues
Strategies to solve the prolems within availale resources
&eam Memers
State-
Dr' ('R' Sonwani Deputy Director )NRHM*
Dr' (haparde )+H,*
Dr' A'(' $harti )Ayush M, Dantewada*
Dr' Satyasandipani Pradhan )SHR%*
District
Dr' -iwani! DI,
.t/arsh &iwari! DPM
0ilson! DAM
Mo' &ahir Shei/h! DD,
Dr' Satyasandipani Pradhan )SHR%*
Neelu 1hritalhre )DPM /ondagaon*
0irendra Singh &ha/ur )DAM /an/er*
Neera2 0erma )DD, Raipur*
.day $hanu )D&% Narayanpur*
0i/ramra2 sahu )S" Sargu2a*
Nilesh )H% $alrampur*
0andana 1upta )SHR% -an2gir*
Mo' &ahir Shei/h! DD,
Pradeep Roy! D&%
3acility 0isited
DH CHC PHC SHC VHND VHSC
$I4HA
%HA(RA$HA&A
&A(HA&P.R
$"4PAN $"4PAN $I-A
DAI-A
MAS&.RI
MA4HAR 4IM&ARA RA(
PA%HP"DI MANI(%H,RI RA(
$I4ASP.R
PA%HP"DI MANI(%H,RI RA(
(,&A
(AR1I(A4A N"0RA
SHI0&ARAI SHI0&ARAI
1A0R"4A
("0%HI ("0%HI
P"NDRA
DANI (.NDI
MAR0AHI
DH,$HAR
SHI0NI
District Hospital
+ell estalished NR%!$lood $an/!
5' "stalished %all %entre
Peripheral Health acilit!
5' %ommitted 4eadership and Management .nit
6' insured Service delivery at %H% and PH% identified
7' "nsured Referral &ransport mechanism at %H%s and some
Positi"es
7' "nsured Referral &ransport mechanism at %H%s and some
PH%s
8' Some RMAs are doing well
9' 1ood Infrastructure and road connectivity !"lectrical supply!
Solar system
:' 1ood Initiatives for Infrastructure development
;' +ell estalished 3inancial system up %H%s level
<' .se of Health $oo/ satisfactory In 0isited 3acility =Pendra
>' Sharing of wea/ness and %onstrains at all level
Some good practices
Well maintaine# $mergenc! tra!%&orella' Well labelle# me#icine containers in nursing
station
Facilities in LR
?
5
6
7
8
9
:
;
%H%s PH%s
;
7
?
8
()*+ ,ater suppl!
Present
Asent
?
5
6
7
8
9
Present Asent not at proper
location
7 7
5
6
9
?
NBCC in -R
%H%s
PH%s
?
5
6
7
8
9
:
%H%s PH%s
:
5 5
:
$lectricit! Bac.up
Present
Asent
?
5
6
7
8
9
:
;
%H%s PH%s
;
8
?
7
$mergenc! Tra!
Present
Asent
6'9
7
7'9
8
7
6
8
6
Drugs in -R
%H%s
?
?'9
5
5'9
6
only ,@ytocin only Misoprostol $oth Present $oth not Present
5 5 5
?
%H%s
PH%s
Infrastructure Progress
59?
6??
69?
7??
6;5
55;
Sanctioned
%ompleted
.nder construction
PH% SH% Residential A
Sanctioned %ompleted
.nder
%onstructio
n
Sanctio
ned %ompleted
.nder
%onstruct
ion
Sanctio
ned
.nder
%onstructio
n
9: 7: 9 6;5 55; 95 66 5;
?
9?
5??
PH% SH% Res A
9:
66
7:
?
9
95
5;
HMIS
/0Monthl! facilit! reporting status
HMIS
Reporting status in the Sept2012
Total Facility
Total Facility
filled
%
District Facility
SC 268 268
100.00
55
Bilaspur
PHC 56 56
100.00
CHC 7 7
100.00
SDH
DH 1 1
100.00
Total
332 332 100.00
MCTS - Registration of pregnant ,omen an# chil#
)Apr- Sept 6?56*
___
_____ __ __
___
Mother Details Child Details
Total
Registrat
ion
______
_______
___
___ _____
______
______
________
______ __
_______
______
______ __
___
___ ______
______
______
______ ___
_ _____
_______
1 13572 4973 36.64 11504 2349 20.42 28.53
56
1 13572 4973 36.64 11504 2349 20.42 28.53
2 12956 4699 36.27 11318 2542 22.46 29.36
3 8330 2970 35.65 7258 2095 28.86 32.26
4 11080 3493 31.53 9693 2003 20.67 26.10
5 2935 782 26.65 2583 756 29.27 27.96
6 4295 1087 25.31 3746 767 20.48 22.89
7 5534 1562 28.23 4799 1318 27.47 27.85

58700 19566 33.33 50900 11830 23.24 28.29

/0MCTS- Number of #eli"eries entr! against e*pecte# #eli"eries as
on Sept /(
______ _____ ___
_______

visf{kr
izlo
dqy izlo
dqy izlo izfr'kr
1
fcYgk 4212 2141 51
2
eLrwjh 4248 2369 56
57
3
dksk 2!14 18"6 6!
4
r#kriqj 2893 166" 5!
5 is$%&k 812 !19 89
6 'k(jsyk 1231 !55 61
dqy 1!53" 1"588 6"
S.N
o
Name of
training
Target Group
Tar
get
Achie
veme
nt
% of
Achieveme
nt
1 MTP MO 3 2 66.67
2 Bemoc MO 5 5 100.00
3 Bemoc RMA 7 10 142.86
4 SBA SN, LHV, ANM 18 12 66.67
HR - &raining

5 RTI STI LT, RMA, SN 60 56 93.33

6 IUCD
MO, SN,LHV, RMA,
ANM
165 140 84.85
7 NSSK ANM 150 57 38.00
8
Quality
ANC
ANM 180 28 15.56
Post training Monitoring and 3ollow-up = 0ery wea/
.se of Partograph =Not satisfactory
%hild Health
NR% at 1ourela -Progress Not Satisfactory
SN%. =Not Started
N$S.-Pendra well functioning
N$%%- 0isited 3acility Not Proper N$%%- 0isited 3acility Not Proper
School Health %hec/-up---Satisfactory
School Health
Block Examined Sick % Reffered %
Takhatpur 10576 2919 27.60 188 6.44
Bilha 2784 1905 68.43 23 1.21
Marwahi 8831 1811 20.51 769 42.46
Masturi 30355 8129 26.78 246 3.03
Kota 16133 2982 18.48 40 1.34
endra 2881 478 16.59 41 8.58
!aurela 18826 3773 20.04 100 2.65
Total 90386 21997 24.34 1407 6.40
RN&%P
$asic Services
Performance 7A56
&uerculosis .nit
Suspects "@aminationBlac
population
AnnualiCed %ase
Detection Rate for NSP
%target 1/2/3lac' %target 1 +45'
D&% $ilaspur 57< 99D
$ilha :8 78D
1aurela 5<5 :8D
Marwahi 66: ><D
%ase Detection Rate for NSP &$ cases )7A5? to7A56*
5??
56?
58?
5:?
7?
7;
95
79
79
85
88
8?
78
?
6?
8?
:?
<?
7#5? 8#5? 5#55 6#55 7#55 8#55 5#56 6#56 7#56
D&% $ilaspur $ilha 1aurela Marwahi
&arget = ;?D
3ocussed $loc/ in the district =
$ilha! Masturi E &a/hatpur
Possible Solution to impro"e case #etection
rate6
Instruction )target ased* to all the MP+Fs to
identify E refer &$ suspects from the field identify E refer &$ suspects from the field
&arget oriented'
Referral slips for monitoring of the referrals
SensitiCation of MitaninFs for referral of &$
suspects to the nearest microscopy centre
3indings of SRM E Possile Solutions
Directly ,served &reatment )D,&* is very
wea/ in the district =
field visit reported Mitanin has given whole P+$
to the patient to the patient
Mitanin not aware of D,& provision E treatment
card mar/ings
Poor supervision E monitoring y the contractual
staff
3indings of SRM E Possile Solutions
No medicines )P+$* at PH% level
P+$ to e made availale at PH% level with
pharmacist
Monthly report not eing sumitted y the PH%Fs Monthly report not eing sumitted y the PH%Fs
All PH%Fs to sumit monthly reports on time
It needs to e incorporated in HMIS
Poor supervision E monitoring activities in the
district
No contractual staff availale at the time of visit
3indings of SRM E Possile Solutions
Poor visiility )I"%* of the programme
No postersBwall paintings at S%s E PH%s
.tiliCation of untied funds
&reatment card entry at NI(SHAG software
)online entry of &$ treatment cards* is very
slow
&raining of PADA E $ADA is pending
&$-HI0 %oordination
&$-HI0
+hole $lood finger
&esting )+$3&*
All DM% 4&s should
&uerculosis .nit
D of &$ patients
tested for HI0
)target - 5??D*
All DM% 4&s should
perform +$3&'
)target - 5??D*
D&% $ilaspur 68D
$ilha 99D
1aurela 5;D
Marwahi ?D
Programmatic Management of Drug Resistant &$
)PMD&*
Implementing from Dec 6?55
PMD&
None of the 4&s at %H%BDM% (ota are trained
in PMD&
4&s needs to e trained at the earliest! as they play
a crucial role in triggering identification of MDR a crucial role in triggering identification of MDR
suspects
Sputum transportation o@ were not availale
in the 4aBDM%
Mitanin Programme
5' Mitanin Help des/ visile in facility visited
6' Incentive payment are regular'
7' Mitanin Dawa Peti Reffiling Irregular'
8' Information to -SG $eneficiary satisfactory'
Issues
1. Out of Pocket Expenditure in some facilities.
2. Patients being charged for Normal eli!er"
#. $% expenditures against the Norms.
Areas of Improvements
5' Reduction of wor/load of District Hospital and %H%s y operationaliCation of PH% and
SH%
6' Regular Monitoring and guidance for waste disposal Management ! %leanliness within
4aour room
7' ,rganiCation of "#uipments! Drugs!and %onsumales within 4aour
8' Identification of High ris/ AN% detection at SH% and PH%s with regular support to staff
9' %hec/ing of ANMs records and monitoring of their s/ills -M,!RMA! Management 9' %hec/ing of ANMs records and monitoring of their s/ills -M,!RMA! Management
.nits
:' ,rientation to ANMs aout Nearest Delivery points and % S Point
;' Display of &a@i and 0ehicle with %ontact Numer of Drivers
<' Display aout -SG $eneficiaries 4ist
5' Monitoring of functional status of Traine# HR
6' "nsure the Staying of Staff at their Head#uarter =$oth Paramedical and Management
7' Provision and maintenance of Proper Duty room B %ain for Doctors and Nursing Staff
at all Delivery Points
8' Records /eeping =$oth 3inancial and Programme reporting at PH%s and SH%s
Areas of Improvements )%ont'*
8' Records /eeping =$oth 3inancial and Programme reporting at PH%s and SH%s
9' "nsure regular supply system of Drugs and %onsumales
:' Monitoring of Awareness aout 1uideline and their use y %H%s! PH%s and SH%s
;' DecentraliCation of &he D,&s supply system
<' %ommunication aout 3unctional Delivery point to 5?< call centre
>' .se of availale anti- malarial Drugs to treat poor People
Suggestions for PIP 6?57 - 58
5' Separate ,& and 4aour room at 1aurella Sanitorium
6' Staff Auarter for Paramedics At 1aurella
7' Special Proposal for Renovation of %H%s Marwahi- 7' Special Proposal for Renovation of %H%s Marwahi-
8' Display of Protocol at 4aour Rooms
Suggestions for 4aor Room
1& Emergenc" tra".
2& N'(( Resuscitation e)uipments to be located at
proper place
#& Partograph to be maintained and stored for
retrie!al. retrie!al.
*& Running +ater facilit" +ith proper hand+ashing
resources. Pictorial hand+ashing instructions
should be displa"ed at all strategic locations.
,& (urtains for pri!ac" bet+een deli!er" tables
-& Proper segragation and transportation of './
should be done.
%uggestions for rug storage
5* Medicines and other supplies should e
stored in order = alphaet wiseB disease wise
6* 3I3, should e followed
7* Near "@piry drug list should e prepared
Suggestions for 4aoratory
5* .se of PP" )gloves and aprons*
6* Segregation of $M+ at point of generation
7* Different Cones for different activities =
%ollection area! testing area! report
generation as per space availale' generation as per space availale'
"@cellent
"@ecutionH-
5
R,P 6?56-57 approved y District Health
Society'
3inancial Management
Society'
6
Approved $loc/wise R,P 3'G' 6?56-57
forwarded to all the loc/ '
7
&ally "RP >'7 version - DHS Ball loc/ tally
generated 3MR reporting to State Health
Society! Raipur'
3inancial Management
3indingsH-
5 4ac/ of Accounting Policies e@ecution in PH%! SH% levels'
6
Proper illing procedure was not followed in $ilha
%ha/rahata! Masturi! Malhar'
7
During the 0isit of DH team oserved that cashoo/
maintained against 1,I Norms' maintained against 1,I Norms'
Suggestions for financial ManagementH-
5 District Authorities have to ta/e more attention and
initiatives towards $M,IS )%H%BPH% 4evel* for
implementation of Accounting Policies'
6
"@penditure to e monitored as per -DS guidelines' "@penditure to e monitored as per -DS guidelines'
Action &a/en $y SRM
Identify the 1aps
Discussed issues with All staff
%orrected the minor issues on spot li/e re-arrangment of 4aour room
Demonstrated the gaps and aware the concerned staff
Action ta/en $y District
%MH, have circulated instruction to $M,s
$M,s have een circulated the instruction to Mos and RMAs
%orrective measure at Some 3acilities