CPHC in Urban Areas

1. CPHC in Urban Areas Group 3

2. Human Resources at AB-HWCs • Punjab, Chhattisgarh, MP, J&K and Haryana – adequate number of HR in-position. Punjab - ANMs on strike for last two months, MAS not present. ASHAs were on strike in Haryana. • J&K – lack of support staff and Lab Technicians. • Rajasthan – there was no rationale deployment of HR in position. Attrition rate of Medical Officers was very high • Chandigarh –No ASHA and MAS in the UT. Dental MO is present in the facilities visisted. • Chhattisgarh - Civil dispensaries were upgraded as UPHCs with HR by NUHM and infrastructure by ULBs. Ophthalmic Assistants are present in some of the UPHCs. In Raipur, specialists from Medical College are deputed. • Uttarakhand – UPHC in PPP model. Staff in position. • Madhya Pradesh – Medical Officers are attached from the District Hospitals hence inconsistent HR availability in some facilities. Walk-in interviews every Wednesday to fill the vacant MO positions. To fill the LT gap – exam to be held in November.

3. Essential medicines availability • Haryana – Availability of around 120-150 drugs at the UPHCs. Essential Medicine List was displayed. Online drug indenting was done through Online Drug Inventory and Supply Chain Management System (State specific portal) at UPHC level. • Chandigarh – EML not displayed. Indenting was done manually. Anti-epileptic drug was not available. Buffer stock not maintained. • Rajasthan – Free Drug Initiatives is well run model. Daily indenting is done through e-Aushadhi software. Strong supply chain management however stock maintenance is an issue at the facility level. • Punjab – Manual indenting. 70 drugs available but quantity of medicines is less. Dispensing is for 10 days only. No buffer stock. EML was not displayed. • MP – availability of drugs as per EML. Indenting through E-aushadhi however due to lack of computers/internet, indenting is done at cyber café. • Chhattisgarh – All drugs available, epileptic drugs not there. EML not displayed with incorporation of NCD related drugs. State specific software DPDMIS is in the state. • Uttarakhand – 19 out of 103 drugs available in the facility. EML not displayed. • J &K – 71 drugs available. EML not displayed. Drugs procured through Jan Aushadhi.

4. Essential diagnostics • Haryana: 11-20 in-house tests being done. Sputum collection is only done at the UPHC and referred to nearby PHC (rural) or Civil hospital. • Punjab – 11 tests in house. • Rajasthan – 15 tests in-house. Some of the UPHCs have procured semi auto-anaylzers • Chandigarh – no LTs deputed in some of the facilities so patients are referred to nearby laboratories. No monitoring mechanism if the patient is being getting tested. • MP – 8 tests done in house (RDK) rest in outsourced. • Chhattisgarh – well equipped labs, 13-17 lab tests in-house. Huge load for laboratory tests (150-160/day). All UPHCs are DMCs. • Uttarakhand – dedicated LT available – 15 tests in-house. • J &K – 17 tests in-house where LTs are available. 7 tests are being done where LTs not available.

5. Population Based NCD Screening/ IT • Family folders and CBAC maintained in Chhattisgarh, Haryana. VIA training for Staff Nurses done in Haryana and Chandigarh. • Training on ANMs and ASHAs is an issue in all the States visited except Chhattisgarh and Chandigarh • Haryana - issues with software hence issues in data entry. Also ANMs have been recently trained in Haryana so data entry was slow. • Punjab: CBAC forms filled by ASHAs however the quality of filling the CBAC forms to be checked by ANMs. NCD training for ANMs and ASHAs was for one day. Tablet issue in Punjab. • Chandigarh – CBAC forms filled by ANMs as no ASHAs. NCD app has been provided to ANMs. Only one tablet was available. UT is in a process of procurement. • Rajasthan – CBAC forms not properly filled by ASHAs. Males are Screened for cervical cancers. No tablets procured. • Uttarakhand – no CBAC forms available in the facilities. • MP – CBAC forms filled by ASHAs supervised by ANMs • J & K – PBS initiated but CBAC not filled due to lack of ASHAs. Tablets in process of procurement.

6. AB-HWC Portal reporting mechanism • Haryana – Information Assistant cum Accountant was available at UPHC level for doing the daily data entry. • Punjab – Daily reporting is an area of concern in AB-HWC portal. State specific software for OPD data entry. • Chandigarh – desktops not available in the facilities. MOs sending data to DEO positioned in State HQs to upload the data on the portal. • Rajasthan and Chhattisgarh– daily and monthly data entry is being done – Good practice. • MP – daily reporting is an issue due to internet connectivity. • Uttarakhand – User id and password shared to the DEO but he is not aware how to do the daily data entry. • J & K – not started.

7. Branding • Branding of AB-HWCs is observed in all the health facilities visited, however state specific name ‘Arogyam’ was observed in Madhya Pradesh

8. Wellness Activities • Yoga Sessions are performed at least once a week in Haryana and Punjab in the visited facilities (UPHC Chauma, UPHC Bharago camp). • MP, Rajasthan – no wellness activities, tender floated to recruit yoga instructors in MP. • Structured wellness activities required in Chhattisgarh • Chandigarh – regular yoga sessions are being happened. Yoga instructors from Govt Yoga college. Help Age India awareness programmes being conducted. • J & K – Health promotions and modifications of food habits are being held.

9. RCH activities and Community Process • RMNCH+A services delivered is mainly ANC/PNC services, Immunization, Adolescent Health. No nutritional counselling happening. IUD insertions are happening in most of the facilities visited. Deliveries are being conducted in the UPHCs. • 100% institutional delivery in Chandigarh. • Smart Phones not procured for ASHAs in Haryana and Punjab. • Punjab – Services through bordering areas through MMUs. Outreach sessions are being affected as ANMs are on strike however RI sessions are happening. • Haryana – Special outreach sessions are conducted twice a month. • Chandigarh – outreach happening once a month and in some vulnerable pockets. • Chhattisgarh – MMUs are involved in conducting outreach sessions. Special Outreach camps are also being held.

10. Provision of Expanded range of services • Chandigarh – Dental OPD and ophthalmic services being provided at the UPHCs. • Chhattisgarh – Special day OPD for mental health (staff trained and refer cases to NIMHANS) • MP – skin specialists provide services once a week. • J&K – Dental and ophthalmic services provided in some of the facilities.

11. Best Practices • Punjab – State specific OPD software is being implemented in Amritsar. • Chhattisgarh - PoshanMah is being implemented. Specialists services being provided at the UPHCs through Govt Medical Colleges. SSK (Swasthya Suvidha Kendra – for providing primary health care services in slum areas). NCD Mah was initiated by the State in the months of 15 May- 15 June 2019. • MP – Tender floated for Telemedicine to cover all 245 UPHCs. • Chandigarh – Tareyzameen par – night vigil activity to increase the immunization coverage for left out children. ASHA Jyoti – mobile health care for cancer screening for vulnerable population – screen for breast and cervix cancer. Engagement of Yoga colleges for hiring yoga instructors. Restructuring of RBSK teams.

12. Key Recommendations • Continuum of care linkages to be strengthened • States to expedite the rollout of Population based NCD screening in urban areas. • Need more focus on wellness and health promotion activities • Engagement with MAS needs to be strengthened – focus on capacity building of MAS and opening of bank accounts to be expedited. • Reaching out to urban population in non-slum/ peri-urban areas.

13. Thank you