108-Ambulance Service in the State of Rajasthan Ajmer tour 23-27 th October, 2013

1. Anuja AgarwalConsultant-108, NRHMDepartment of Medical, Health and Family WelfareGovernment of Rajasthan 108-Ambulance Service in the State of Rajasthan Ajmer tour 23-27th October, 2013

3. CHC Good practices Issues/ gaps No/ dirty stained sheets on the beds & Mackintosh was torn in all the centers % of male to female sterilization is very low Branding of delivery points was not observed at any center 49% of ANC within 12 wks against total ANC registration EMOC/ LSAS trained doctor was present at CHC Bijainagar and trained doctor from CHC Pisangan is on deputation for the last 6 months to CHC Pushkar. MTC- pediatrician not available/ trained staff but no equipments/ no facility available • Cleanliness of Toilets/Wards was good / satisfactory • Hot food was being given as per schedule after delivery. • JSY payments were being made on time and no gaps were identified. • Equipments/ medicines were available and functional • Disposal of Bio medical waste was being done as per norms.

4. PHC Good practices Issues/ gaps No/ dirty stained sheets on the beds & Mackintosh was torn in all the centers % of male to female sterilization is very low Branding of delivery points was not observed at any center 63% of ANC within 12 wks against total ANC registration 108 is being used for post delivery cases Funds not received/ not aware under cleanliness head Funds lying ideal but not being used as lack of knowledge about the guidelines and usage of funds. • Cleanliness of Toilets/Wards was good • Hot food was being given as per schedule after delivery. • JSY payments were being made on time and no gaps were identified. • Equipments/ medicines were available and functional

5. Sub Centre • Urine and blood sticks not available at any Sub centre • Cleanliness of Toilets/Wards was satisfactory. • At Lidi (upgraded PHC) metal beds in ward had no mattresses. Infrastructure is very good. It was informed that after Soma nurse left in April’13 no deliveries are taking place. This centre was upgraded and declared a delivery point due to the exceptional no of deliveries taking place at this centre. • At Lidi, nine ASHA cheques pending and VHSC fund still pending at sub centre Rs 45343/- (No expenditure in 2013-14) • At Sursura (upgraded PHC)name of the sub centre was not displayed, Doctor posted due to upgraded PHC which could not be identified as a sub centre also. Deliveries , outdoor etc every thing was being done in one room which was very dirty with no water and dirty toilets. • Availablility of family planning techniques (IUCD, oral contraceptives, condoms, Ipills, pregnancy testing kits) in short supply. • suction machine, amu bag, soap, partograph, attached toilet, new born corner not available

6. Anganwari kendra • 1) ROOPRA ANGANWADI KENDRA:- very bad • no name or sign of Anganwadi displayed. ASHA not in uniform Anganwadikaryakarta not present ,Sahika present .Out of 27 children only 8 present. instead of khichdi only bad quality rice was cooked. Open cooking which had insect. No displays, toys or any learning aids for children & nothing was being done at the centre. Children were very dirty • 2) SHRINAGAR ANGANWADI KENDRA:- • 8 children present. Khichdi was available but the quality was bad children were only sitting & no work was being done. ASHA not in uniform Anganwadikaryakarta present, Sahika present. Gud, chana, kheel had insects and were stale .

7. ASHA • Some ASHAs not trained in module 6/7 • ASHAs are encouraging women for spacing of children (copper T) home to home distribution of contraceptives (nirodh/oral pills but are in short supply). • ASHAs are holding VHSC meetings every month. Participants in VHSC meetings: Sarpanch/Wardpunch, ANM, AnganwadiKaryakarta, ASHA Samuhkisadasya, sathin, janmangaljoda. • Beneficiaries are being mobilized for MCHN days and ASHAs are being paid in the sector meetings under various heads like ASHA monthly meeting, JSY 3 ANC payment • ASHA is not getting paid in VHSC meeting, HBNC meeting, child death information, discharge children under FBNC/MTC • Yes cash payments are being made on MCHN days at all centres, subcentres • ASHAs were not found in uniform. Incentive upto September 13 has been paid to ASHAs. PHC wise no dues received from blocks and instructed also to complete the payments by end of month. • 6-7 module training target- 360 ASHAs.

8. Weekly Iron-Folic acid program • WIFS program is ongoing in all 3 schools visited. • No complaint of any kind except an odd case of stomach ache. • One school had stock of medicines whereas in 2 schools iron-folic acid was not given on last Monday as the medicine was in short supply. • In co-ed school the medicine was being given to both boys and girls. • De-worming done in all schools on 15/10/2013 (Albendazole syrup)

9. 108 • 108 staff working for 7 days continuously • all cases are being bought to Bijainagar instead of nearest government hospital • EMT/pilot not in uniform • spare tyre kept inside the ambulance, medicine cabinet doors were all broken,Seats were torn, lights/AC not working, Gloves were lying open, oxygen leaking from panel , vehicle body and flooring broken , water pump not working, suction machine not working, • ambulance dirty from inside and outside • RTO has refused to give fitness certificate looking at the condition of the ambulance (Mangliyawas: 9813) • blood stains on stretcher not cleaned after patient transported. • carrying only post delivery patients (both 104/ 108 are 12kms away) . • medicines received on 24/10/2013

10. MMV/ MMU • RJ14-pb-7630 (Roopangarh) • AC/Fans not working • MMU: RJ14-pb-2086 MMU was present at Pushkar where migratory camp was in progress. During the camp 107 HIV tests were done and none were found positive whereas at Jawaja out of 313 cases 3 were found positive (HIV)

11. Thanks:)