VISIT OF DISTRICT BHILWARA ( 23.10.13 TO 26.1013)

1. VISIT OF DISTRICT BHILWARA(23.10.13 TO 26.1013) A RAPID FEEDBACK

2. Major Observations at CHC Aasind (L3 DP) • Only 02 doctors – JS Medicine and JS surgery • BSU not functional for last 02 months due to accident of LT • MTP / C-section not conducted due to non availability of Gync. or trained MO • No Gync / Pediatrician / Anesthetist • No EmOC / LSAS trained MO • Recently, 01 Gync. is retired but she is ready to join on contractual basis but due to procedural formalities hiring is delayed if she joined MTP and C-section may start • Sanitary condition of labour room is satisfactory • Sanitary condition of ward is satisfactory • Sanitary condition of toilet is satisfactory • Presently, all vaccines are available but earlier there were shortage of BCG and Measles • Partograph chart not available but format available • Radiant warmer at LR not functional, 200 watt bulb taken in work • At OT radiant warmer and weighing machine not available • ARSH clinic not functional but clinic is there • NBSU not established yet. Training of staff is required • Cleanliness work not started

3. Major Observations at CHC Jahajpur (L3 DP) • 01 SMO, 01 MO, 01 lady MO • BSU not functional for last 02 months • MTP / C-section not conducted due to non availability of Gync. or trained MO • No Gync / Pediatrician / Anesthetist • No EmOC / LSAS trained MO • MTP services not available • Sanitary condition of toilets of maternal ward was very bad • Sanitary condition of ward is satisfactory • Sanitary conditon of toilet is satisfactory • Labour table in poor condition and it is urgently required • UF, AMG, CG not a single paisa is utilized due to internal conflict • Presently, all vaccines are available but earlier there were shortage of BCG and Measles • Partograph chart available and format available not fill up for each case • ARSH clinic not functional but clinic is there • NBSU not established but not functional. 01 nursing staff already trained. • Cleanliness work not started

4. Major Observations at CHC Suwana • Deliveries only 3-5 per month • Sanitary condition of labour room is satisfctory • Sanitary condition of ward is satisfactory • Sanitary condition of toilet is satisfactory • Tablet misoprostol not available • MTP services not available • Radiant warmer not available only 200 watt bulb is taken in use • Presently, all vaccines are available but earlier there were shortage of BCG and Measles • Partograph chart not available and only format available. • ARSH clinic not functional but clinic is there • Cleanliness work not started

5. Major Observations at CHC Gulabpur (L3 DP) • 01 Gync, 01 Physician, 01 MO (01 MO on deputation) • BSU not functional due to non functional DG set • C-section not conducted due to non availability of Anesthetist • No Pediatrician • No EmOC / LSAS trained MO • Sanitary condition of toilet and ward adjacent to labour room was not good • Sanitary condition of ward was not good • Branding work incomplete only front of the CHC is coloured • Presently, all vaccines are available but earlier there were shortage of BCG and Measles • Partograph chart available and format available • CTF connectivity is there but service is not regular • ARSH clinic not functional but clinic is there • Raiant warmer and weighing machine not available at OT room • Cleanliness work not started

6. Major Observations at SH Shahpura(L3 DP) • 01 Gync, 01 Pediatrician and 03 MO out of 08 sanction post are working • BSU functional but shortage of blood, personally met PMO for supply of blood • C-section conducted – Upto September 24 • No Anesthetist / LSAS trained MO. Services hired. • EmOC and LSAS trg. required • Sanitary condition of toilet and ward was good • L 3 level all the services are available, work order issued for branding work. It can be identified as model DP. • Presently, all vaccines are available but earlier there were shortage of BCG and Measles • Partograph chart available and format available, maitained • ARSH clinic not functional but clinic is there • Cleanliness work started • More UF / AMG / CG are required. All the funds are utilized.

7. Major Observations of PHCs • Visited 04 PHCs out of which 03 are delivery points (Phooliyankalan, Sawaipur and Rayla) and another NDP (Badnor) • At PHC Badnor condition of LR required to be improved • Radiant warmer not available at any PHC. 200 watt bulb is used • At sector Sawaipurdue to shortage contraceptives not supplied to ASHA • ARSH clinics are not functional • Almost 80% VHSC accounts are opened but funds are not transferred • Sometimes there are shortage of BCG / Measles vaccines • At PHC Rayla (Block – Banera) average 70 deliveries conducted per month but no MO is there. Charge given to a MO posted at nearby DP PHC Rupalikhurd. He also look after the work of another PHC. • Sanitary condition of all the PHCs are satisfactory • Cleanliness work not initiated

8. Initiations Taken by District- Organization sector wise camp for rectification in SDR and maintaining quality data entry, accounts record- Line listing near about 80%- SH Shahpura is well maintained inspite of shortage of doctors- Regular block meetings are organized- Special focus given on ASHA payment during ASHA monthly meeting between 25 to 30th of the month Major Gaps Identified • Under JSY, payment for ensuring institutional deliveries not given to ASHA. Only payment given if ASHA escorted the case. • Under HBNC payment not given to ASHA. Though ASHA who are already get trained in IMNCI they are conduction regular home visit as per guideline

9. Major Gaps Continues….. • At district level ASHA work and payment related data not compiled? • VHSC meetings are conducted but other members not participated • Children of Grade 3 or 4 are identified but referral are not done for MTCs • ASHA are totally unaware about the work / package regarding follow up of MTC / FBNC discharge cases • At school level IFA tablets are distributed every Monday and at AWC tablets are distributed on every Thursday but reporting is irregular from schools. • Sanitary napkins are supplied to ASHA but it is under utilized due to lack of acceptance among the community • At block level vehicles are under utilized. No supervision plan is there especially at Block Jahajpur

10. Major Gaps Continues….. • Out of 12 allotted JE 01 is non-functional (Koshithol) due unavailability of driver, 05 JE have only 01 driver and remaining 06 JEs only have 02 drivers • JE generally covers only 01 PHC area where it is allotted • NGO / Agency not final, drivers hired only from SaineekKalyan Board • Out of 22 ‘108’ ambulance 06 are off road due to repair work. • 01 ambulance visited at DH. Collapsible stretcher broken, suction apparatus not functional, foot operated suction pump not working, pulse oxymeter not available, surgical items not available, medicines not available

11. Thanks