2 nd 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 • Anganwadicentres • 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

18. Monitoring • Monthly review by District Magistrates • Close monitoring immunisation sessions (VHND) • Regular ASHA meetings • Structured inspection forms and follow up system • Grievances redress system for hospital beneficiaries • Regular exit interviews and Focus Group Discussions to get feedback from the beneficiaries about the services in the health facilities

19. Recommendations • IEC policy for the state and active promotion BCC activities • Increased participation of VHSC • RKS funds may be devolved at new PHC • Electrical connection to HSCs using annual maintenance fund Protected water for all the OPD/IPD cases in the health facilities • Mobile phones for ANMs

20. Thank You