Rapid Appraisal of NRHM : 2008-2009

State: MADHYA PRADESH PRC: Sagar

A. Infrastructure Preparedness
A1. District Profile (Based on data reported by District Authorities)
Indicators Sidhi Anuppur Indore
o. of Total Facilities Existing in the District
Sub Centre 287 174 111
PHCs 41 16 26
CHCs 10 4 4
Sub Divisional Hospital 0 0 1
District Hospital 1 1 1
No. of Facilities where IPHS Facility Survey completed
Sub Centre 0 0 0
PHCs 0 16 0
CHCs 0 4 1
Sub Divisional Hospital 0 NA 0
District Hospital 1 1 1
No.of Facilities where IPHS Upgradation Completed
Sub Centre 0 0 0
PHCs 0 0 0
CHCs 0 0 0
Sub Divisional Hospital 0 NA 0
District Hospital 0 0 0
A2. Sub Centres
Indicators Sidhi Anuppur Indore
Number of Sub Centres covered in each district 12 12 12
Infrastructure
Functioning in own government building 33.3 75.0 58.3
IPHS Facility Survey Done 0.0 0.0 0.0
Sub Centres with ANM Quarter 66.7 58.3 33.3
% of Sub Centres
ANM Staying in Sub Centre 25.0 33.3 0.0
Labour Room available 41.7 25.0 33.3
Labour Room Currently in Use 0.0 0.0 0.0
Manpower
Health Worker Male in position 25.0 66.6 41.7
Health Worker Female in position 83.3 75.0 83.3
% of Sub Centres with
Additional ANM Contractual 0.0 33.3 83.3
No ANM 16.7
Services
Arrangement for Deliveries and Referral between 8 PM and 8
AM** 0.0 0.0 0.0
% of Sub Centres providing
specific service ANM been trained on the insertion/ Removal of IUD A380
41.7 50.0 70.0
IUCD insersions being carried out using IUD A380 25.0 41.6 70.0

** either conducted at Sub Centre and referred to higher facility, if required or not conducted at Sub Centre but referred to higher facility
Performance
Average ANC Registered 58.3 10.5 44.1
Performance based on last three Average Deliveries conducted by ANM at Sub Centre 1.0 0.0 10.8
months
Average JSY cases registered 58.3 10.5 44.1
Average JSY cases resulted in institutional deliveries 38.1 6.8 20.8
A3. Primary Health Centres (PHCs)
Indicators Sidhi Anuppur Indore
umber of PHCs covered in each district 4 44
Infrastructure
4-6 Beds 2 3 2
Labour Room available 4 3 4
o. of PHCs with New Born Care Corner 0 1 1
Names of JSY Baneficiaries maintained in record 3 3 3
IPHS Facility Survey done 0 3 0

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 Indicators Sidhi Anuppur Indore
Manpower
At least one Medical Officer 4 4 4
o. of PHCs with
MO Ayush 2 1 1
Services
Functioning 24x7 1 3 0
o. of PHCs providing service of Provide basic obstetric services 0 3 2
Labour Room currently in use 4 3 3
Performance
Average Monthly ANC Registered 6 8 11
Performance based on last three Average Monthly JSY Registered 5 8 11
months Average Monthly Institutional Deliveries 38 21 26
Average Monthly JSY Deliveries out of total 38 21 26
A4. Community Health Centres (CHCs)
Indicators Sidhi Anuppur Indore
umber of CHCs covered in each district 2 2 2
Infrastructure
30 or more beds 1 0 0
OT available 2 2 2
OT used for Gynae. 1 0 1
o. of CHCs with Labour Room available 2 2 2
Functioning on 24x7 basis 2 2 2
IPHS Facility Survey done 1 2 1
Names of JSY Baneficiaries maintained in record 2 2 2
Manpower
General Surgeon 1 0 1
Physician 2 0 0
Obst. & Gynae 0 1 0
o. of CHCs with Paediatrician 1 1 1
MO Trained in Obst. 0 0 0
MO Trained in Anaesthesia 0 0 0
Anaesthetist 1 0 1
Services
Surgery 1 0 0
o. of CHCs with specific Blood Storage Facility 0 0 0
facilities Emergency Care for Sick Children 0 0 0
Mobile Medical Unit 0 2 0
Performance
Bed Occupancy Rate in last 12 CHC 1 92 157.7 NA
Months CHC 2 NA 34.0 NA
Average Daily OPD Attendence CHC 1 42 80.0 66.5
(Based on last three months) CHC 2 NA 48.0 39.5
Average Monthly Institutional CHC 1 150 168.0 172
Deliveries CHC 2 855 149.0 102
CHC 1 0 38.3 2010
Average Monthly ANC
CHC 2 374 58.3 79
CHC 1 0 38.3 996
Average Monthly JSY Registered
CHC 2 428 58.3 97
Average Monthly JSY Deliveries CHC 1 150 168.0 967
out of total CHC 2 428 149.0 97
* : Figure for CHC, Sawer are for whole block and not for CHC alone.
Records for services are not maintained properly at CHC. This CHC is under construction and old building
B. RKS and Untied Funds
Indicators Sidhi Anuppur Indore

No. of Facilities where RKS Registered (Based on data reported by District Authorities)

Sub Centre
PHCs 41 16 25
CHCs 10 4 4
Sub Divisional Hospital 0 - 1
District Hospital 1 1 1

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 Indicators Sidhi Anuppur Indore
(Based on Facilities Covered)
RKS Registered 4 2 4
o. of PHCs with
RKS Generating Resources 2 4 4
RKS Registered 2 2 2
o. of CHCs with
RKS Generating Resources 2 2 2
Received Untied Grant 83.3 83.3 75.0
% of Sub Centres
Sub Centre reported expenditure from Untied Grant 66.7 83.3 75.0
ANM having a joint account with the Sarpanch/any other GP
functionary 83.3 83.3 50.0
C. JSY
Indicators Sidhi Anuppur Indore
SC 12.8 9.2 39.5
% of JSY Beneficiaries By Social ST 17.9 58.0 8.3
Category OBC 54.8 25.9 39.9
Other 14.5 6.9 12.4
Low 64.8 59.8 24.4
% of JSY Beneficiaries By SLI of
the Household
Medium 24.1 19.5 33.7
High 11.0 20.7 42.0
Registered for JSY within first Trimester 38.5 45.4 42.7
Received JSY Card 20.6 16.7 34.7
Place of Delivery
With delivery in public health facility (Sub Centre,
PHC, CHC, DH/SDH) 96.2 98.9 86.0
With delivery in private health facility 0.3 0.0 12.4
With Home Delivery 3.4 1.2 1.6
% of JSY Beneficiaries Type of Delivery
Normal 93.6 90.6 89.5
Assisted (Forceps, Vacuum) 5.0 5.3 8.4
Caesarean 1.4 4.1 2.1

With ASHA providing specific help during pregnancy 26.6 34.5 18.1
Received Cash Incentive 85.2 100.0 100
At the time of registration 0.0 0.0 0.0
At the time of antenatal checkups 0.0 0.0 0.0
% of JSY Beneficiaries By time of Before the Delivery 0.0 0.0 0.0
receipt of cash incentive by the Immediately after the delivery 13.0 24.6 31.0
beneficiary Within a week after delivery 24.7 22.6 32.2
Much later 54.7 51.2 32.7
Other/ Do not know/husband knows 7.7 1.2 4.1
Average number of days spent by the JSY beneficiary in the facility till discharge 2.3 NA NA
D. Village Level Impact
Indicators Sidhi Anuppur Indore
Number of Gram Panchayats covered in each district 16 17 19
% of Gram Panchayats Reporting
Regular availability of ANM 33.3 64.7 28.6
Existence of VHSC in the Gram Panchayat village 68.8 94.1 73.7
Regular meetings of VHSC 16.7 56.3 28.6
Village health Plan been prepared by VHSC 8.3 25.0 21.4
Awareness of the benefits under JSY scheme 100.0 100.0 100.0
AHSA in position 93.8 100.0 94.7
NRHM brought about any improvement in their area (yes) 31.3 50.0 57.9
Type of Improvements brought by RHM
Funds available for maintenance of Sub Centres 20.0 50.0 18.2
Community support is available as ASHA worker 0.0 16.7 9.1
Funds/facilities are available under JSY 100.0 100.0 81.8
Better facilities are available for CHCs/PHCs for referred patients 20.0 16.7 18.2
Transport facilities are available 40.0 16.7 9.1

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 Indicators Sidhi Anuppur Indore
Type of Difficulties faced in Implementation of RHM Interventions
Funds not available in time 12.5 58.8 10.5
Decision making with the community leaders is difficult 18.8 0.0 0
ASHA has not been adequately trained 12.5 11.8 0
Adequate facilities for institutional deliveries not available 12.5 41.2 10.5
Type of support required to implement programs more effectively
More funds required for maintenance / effective functioning 12.5 52.9 15.8
GP should be given direct control over funds 12.5 35.3 0
More training to be arranged for ASHA and community members 12.5 52.9 26.3
SC 12.3 5.5 24.6
% Distribution of Households ST 15.7 64.3 6.8
surveyed by Social Category OBC 54.3 21.4 48.0
Other 17.8 8.8 20.7

Availability of Health Workers when needed

33.1 37.8 20.2
% of Household Respondent Availability of Health facility at PHC when needed
6.6 0.0 19.8
surveyed reporting
Heard of NRHM 11.2 10.3 14.7
Heard about ASHA 62.6 64.9 47.3
Aware about JSY Scheme 88.7 84.1 87.5
Reporting awareness about JSY 100.0 100.0 100.0
Reporting increase in demand for Institutional delivery after
% of AMs implementation of JSY Scheme 100.0 100.0 100.0
Reporting Average time taken after birth for JSY payment to
beneficiary as less than one week 30.0 8.3 80.0

Note: NA: Not Available

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Key Emerging Issues Issue of Concern; Positive Trend

Infrastructure
In Sidhi 33%, in Anuppur 75% and in Indore only 58% of surveyed Sub Centres Functioning in Govt.
Buildings
In all the three districts, none of surveyed Sub Centres have done IPHS Facility Survey
In Sidhi 25%, in Anuppur33% and in Indore none of surveyed Sub Centres have ANM staying in Sub
Centres
In all the three districts, at least one of the surveyed PHC do not have 4-6 indoor beds
In both Anuppur and Indore 1of the 4 surveyed PHCs and in Sidhi none of the surveyed PHCs have
new borne care corner
In Sidhi all and in both Anuppur and Indore 3 out of 4 surveyed PHCs have a Functioning Labour Room
In Sidhi and Indore, none of surveyed PHCs have done IPHS Facility Survey
One of the surveyed CHCs have not done IPHS Facility Survey in Sidhi and Indore
None of the surveyed CHCs in Anuppur and Indore have 30 or more beds
In Sidhi 1 of the 2 surveyed CHCs have 30 or more beds
In Anuppur none and in both Sidhi and Indore 1 of the 2 surveyed CHCs have OT being used for
Gynae. Purpose

Manpower
In Anuppur 75% and in Sidhi and Indore 83% of surveyed Sub Centre have regular ANM in position
In Anuppur 33% and in Indore 83% of surveyed Sub Centre have additional ANM in position
None of the surveyed Sub Centres in Sidhi have additional ANM in position
In all the three districts, all of surveyed PHCs have at least one Medical Officer in position

Untied Funds and RKS

In all the three districts, more than 75% of the surveyed Sub Centres received Untied Funds
In all the three districts, all the surveyed CHCs have RKS registered and generating resources
In Anuppur 2 and In Sidhi and Indore all of 4 surveyed PHCs have RKS registered
In Sidhi 2 and in Anuppur and Indore all PHCs have RKS generating resources

JSY
In the three districts, 38%-45% of surveyed JSY beneficiaries only registered within first trimester
In Sidhi 85% and in Anuppur and Indore all of surveyed JSY beneficiaries received cash incentive
In Sidhi and Anuppur about 51-54%% and in Indore 32% of surveyed JSY beneficiaries received cash
incentive after a week of delivery or much later
In Sidhi 96%, in Anuppur 99% and in Indore 86% of surveyed JSY beneficiaries delivered at public
health facility

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