2nd Common Review Mission

1. 2nd Common Review Mission Uttar Pradesh

2. Methodology 5 member team visited the state Briefed by Mission Director The team split into two One team of 2 members visited Bahraich Other team of 3 members visited Unnao Each team visited all types of health care facilities and interacted with PRI and community

3. List of facilities visited District Hospitals (Men & Women) Office of the CMO Community Health Centers/FRU Block PHCs New PHCs/Addl. PHCs Health Sub Centers Anganwadi centres CCSP ( IMNCI) and ASHA training sites Village Health and Nutrition day sites

4. Interactions CMO, Addl CMO Chief Med Supdt. Supdt/Medical Officers I/C Specialists and medical officers Paramedical and field staff ANMs ASHAs AWW Village leaders Community

5. Infrastructure Mostly clean, green and well maintained dist. hospitals and CHCs and committed team Committed District Magistrate Excellent improvement during the last one year Very spacious HSC buildings .Lack electricity supply in some HSCs SHCs and PHCs need more maintenance Power supply is erratic. Generators and inverters are available in most places Bio Medical Waste management needs attention Mobile medical Units not operationalised Accreditation of Bahraich DH for NABH is in process but not in Unnao Transport constraints for field workers and patients

6. Human Resources Shortage of Human resources at all levels Those in position work hard to deliver health care Acute shortage of MPW (M) Training process slow: IMNCI, IDSP, SBA training, ASHA training Limited promotional avenues for doctors and paramedicals multi skill training of doctors – slow progress

7. Service gaps Post delivery stay in the facilities is very short New Born care services need strengthening Shortage of space leads to compromise with quality Passive screening for communicable diseases needs to be strengthened Active screening for communicable diseases ( Malaria) needs more attention Postpartum care and follow up of FW operated cases in the field.

8. Service gaps Integrated vector control measures and surveillance of diseases - weak Basic non communicable disease screening fixed day services needed at District Hospital level/ FRU – Diabetes , Hypertension clinic, cancer cervix screening RTI/STI clinics Integrated counseling and Testing Centres needed in all 24 x 7 facilities Poor voluntary blood donation – insisting on relative donor

9. Assured Services Institutional deliveries improved Awareness on MCH services very high in the community Adequate drug supply but no ISM drugs Poor availability of MTP/ MVA services Inadequate FP services Convergence needs more attention Lab services at peripheral centers poorly equipped – Lack of reagents and consumables

10. Community Participation ANMs and ASHAs are well accepted and respected in the community RKS formed up to Block PHC level. RKS funds for new PHCs held at block level PRIs not uniformly involved for VHSC VHSC recently instituted but not yet active Steps taken to activate VHSCs – 2nd October- good initiative

11. Finances Clear Guidelines for the use of funds Electronic transfer of funds up to block level Timely payment to JSY beneficiaries Inadequate utilization of funds in some health facilities (RKS, Untied and maintenance funds)- Dental clinic in Kaisarganj hospital

12. Recommendations – Human Resources Mapping the human resources and need based redistribution Recruitment of Human resources – ANM and nurses training schools Training programme for MPW(M) & Recruitment Diploma courses for nurses in Maternal and newborn care and career progression for nurses Better working conditions and compensation for hardships – Performance based incentives at least for those working in difficult areas. Rational transfer policy thro counseling Capacity building in health management Sharing of best practices – Visits to better performing facilities

13. Recommendations- Human Resources DNB course in Family Medicine in district hospitals Use of General Surgeons in the provision of EMOC Career progression for the paramedicals Non functional ASHAs may be replaced by new ASHAs ASHA career progression Interest free moped loan for health functionaries – ANMs and HVs

14. Strengthening Services Neonatal referral units in all the district hospitals with good lab support Basic newborn care units in all the CHCs and in all 24x7 facilities Blood storage facilities and caesarean services atleast 2-3 FRUs in each district Safe abortion services - MTP/MVA services Postpartum care need to be strengthened and closely monitored Strengthen referral services and documentation Mortuary and postmortem facilities to be provided in more facilities in a phased manner

15. Strengthening of services Mobile RCH services with fixed day clinics in the villages with daily reporting thro email. Community monitoring of the clinics. Fixed day antenatal clinics need to be strengthened Fixed day Voluntary blood donation drive Establish modern blood bank with blood component separation units Establish more blood storage units in the FRUs and organise training programme Ensure availability of Antenatal and immunization cards Home based newborn and postpartum care thro ASHAs Rapid implementation of IDSP Integrated vector control programme

16. Strengthening Services Nutrition supplementation programme for pregnant women with community support – Andhra Pradesh model Nutrition rehabilitation centres IFA capsule form for pregnant women need to be scaled up . Adolescent weekly supplementation with IFA capsule Food provision for delivered mothers and mothers undergone tubectomy in all the health facilities Creation of facilities in the institutions to encourage the mothers to stay after delivery – TV , Provision of food etc.

17. Quality of care NABH accreditation of district hospitals and CHCs in a phased manner Community based maternal audit system to be scaled up Institutional based maternal death audit system to be launched Formation of Quality control audit cell in the district hospitals and CHCs Standard treatment protocol usage in the maternal and newborn care complications in the health facilities Implementation of infection control protocols