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Joint Review Mission - RCH-II Madhya Pradesh
Field visit report, January 14-19, 2007
A Joint Review Mission led by Ministry of Health and Family Welfare, Government of
India and development partners visited the state of Madhya Pradesh to review the
implementation of the RCH II programme.
The Mission members included the following:
Ministry of Health and Family Welfare, Government of India
1. Mr. PK Agarwal, Director Finance – Team leader
2. Dr. Manisha Malhotra, Assistant Commissioner Maternal Health
Department of Health & Family Welfare, Government of Gujarat
3. Mr. Amarjeet Singh, Principal Secretary DoHFW, GoG
Department of Public Health & Family Welfare, Government of Madhya Pradesh
4. Dr. AN Mittal, Jt Director Health Services
5. Dr. Jayashree Chandra, Jt. Director Maternal Health
6. Dr. DK Mangal, UNFPA representative
7. Dr. GC Sachdeva, ECTA representative
DFID
8. Mr. Billy Stewart, Health and AIDS Adviser
9. Dr. Jenny Amery, Senior Regional Health Adviser for Asia
10. Dr. Sushila Zetylin, Senior Social Development Adviser
GTZ
11. Dr. KB Singh, Health Adviser, Health Sector Support
UNFPA
12. Mr. Venkatesh Srinivasan, Assistant representative
PMSG, DC Division MOHFW, GOI
13. Pranav Priyadarshi, Consultant
On January 15, 2007, a briefing meeting chaired by Dr. Rajesh Rajora, Commissioner
Health GoMP was conducted. Progress of the state on RCH II was presented to the
JRM team followed by discussions on progress factors and key bottlenecks faced by the
state.
Districts for field visits were decided in consultation with the Directorate officials and it
was sought to include one good performing district, and one poor performing district on
RCH, being Dewas and Raisen districts respectively. Health facilities covered in these
districts is as follows:
Dewas – District hospital Dewas, CHC Bagli, CHC Sonkatch, PHC Bhouransa,
SHC Chapda
Raisen – District hospital Raisen, CHC Bareli, PHC Sanchi, PHC Salamatpur,
SHC Sarakia, SHC sadalatpur
A debriefing session chaired by Mr. MM Upadhyaya Principal Secretary DoHFW,
GoMP, and attended by Dr. R Rajoura Commissioner Health DoHFW, GoMP, Dr. YR
Sharma Director FW, GoMP, other key functionaries of GoMP and JRM team members
was conducted on January 19, 2007. Observations of the field visits including key areas
for improvement were presented by the JRM team.
The JRM team is thankful to the officials of GoMP for extending utmost cooperation
during the conduct of the mission.
PROGRESS ON RCH PROCESS AND INTERMEDIATE INDICATORS
The state’s progress on RCH II process indicators has been satisfactory for 8 of the 13
proposed indicators (refer Annex 1). On indicators such as % of sampled state and
district managers aware of their responsibilities, % sampled outreach session where
guidelines for AD syringe use and safe disposal are followed, % sampled FRUs
following agreed IP and health care waste disposal procedures, % CHCs upgrades as
FRUs offering 24 hr EmOC services, the state has reported below satisfactory
performance, while no data is provided for M&E triangulation.
Under intermediate indicators (refer Annex 2) the state has performed well on upgrading
PHCs for 24X7 (98% of target), making 95% SHCs functional. However, only 10% of
targeted CHCs converted to FRUs, that too without blood storage facilities, and only
26% FRUs/ CHCs, 24X7 PHCs offering RTI/STI services is a cause for concern.
Training generally has been quite slow in the state: for SBA only TOTs completed in 18
districts, only 4% ANMs trained in IUD insertion, only TOTs being completed for training
MOs in life saving anaesthesia skills, EmOC, and NSV.
SIGNIFICANT DEVELOPMENTS/ PROGRESS OVERVIEW SINCE LAST JRM
The state has done well on acting on most of the observations/ suggested actions of the
2nd JRM (observations and suggested actions vis a vis 2nd JRM is provided at annex 3),
as well as making progress in other areas of RCH II:
Positions of SPM, SFM, and 3 SDOs filled. SAM appointed.
10 other consultants in areas of HRD, NGO coordination, PNDT/legal, ARSH,
Gender, HMIS, etc. in position
47 DPMs, 38 DAMs and 37 DDAs in position
All 48 districts have formulated DHAP
District Health Societies constituted and actively monitoring RCH and other
health programmes in the districts
RKS formed upto PHC levels
(Some RKS using innovative ways of generating funds e.g. PHC Badi, in district
Raisen generated Rs. 68 lakhs through construction and leasing out of shops)
Financial and physical monitoring/reporting being strengthened, mainly through
development of software for physical and financial reporting, and training of staff
in using this.
Concurrent audit at districts being done. Rs. 33.11 crores refunded to GOI
against settlement of RCH I accounts
Directorate having 4 directors. One Director being specifically responsible for
RCH II/ NRHM
BMOs upgraded to Senior Doctors and given drawing and disbursing powers
7 regional directors of the rank of joint ditercors, essentially responsible for
monitoring
External agency contracted for concurrent evaluation. Annual surveys for
progress on goals, and outcomes planned.
All MOs posted in periphery to get refresher training at district hospitals once in
two months
Impressive increase in institutional deliveries in the state.
(29% in 2004/5 to 74% in 2006/7 in Dewas, and 20.3% in 2004-05 to 42.35% in
2005-06 in Raisen. The state has progressed from 22 - 29.7% from NFHS 2 to 3)
JSY (68% utilisation by 2nd quarter 2006-07)
Innovative schemes for encouraging institutional deliveries and safe motherhood
e.g. Janani Express, Vijayraje Janani Kalyan Bima Yojana
Contractual staff at PHCs.
Close monitoring by District Collectors
Immunisation coverage in both districts visited was above state average
(improved from 22.6 % to 40.3% from NFHS 2-3)
o Dewas 56%
o Raisen 42.4%
Innovative scheme, called Bal Shakti scheme being carried out in the state in
coordination with DWCD, for identification and treatment of grade 3 and 4
children.
State support for training nurses from SC/ST communities in private nursing
institutions through state sponsored Swalamban scheme. Almost 550 candidates
availed of this during the first year of this scheme.
QUALITY OF STATE AND DISTRICT PIPs
The state has undergone three cycles of district planning, in 2004-05, 2005-06 and in
2006-07. All districts have prepared integrated district action plans, including RCH II
mainly through DFID support. The district planning involved a fairly rigorous process of
block and district level consultations, which were presented at district level workshops
for arriving at district action plans. These plans were then appraised at state level
meetings and activities and required budgets were approved for all districts.
The detailed state RCH II PIP was prepared during 2005-06, including workplan and
proposed budget for a five-year period from 2005 to 2010, and subsequently in 2006 for
the year 2006-07. The state PIPs covered situation analysis, and strategies for various
programme areas including programme management, institutional arrangements and
technical areas of maternal health, child health, family planning, adolescent health,
urban RCH, and tribal RCH.
Internal consistency in the PIPs
The state has formulated quite comprehensive PIP, addressing all key areas of RCH II,
with workplan and budget allocation for these. However, there are some areas of
concern:
Annual goals for intermediate indicators in line with the proposed goals needs to
be stated clearly.
The state has identified lack of manpower especially in terms of MOs/ specialist
MOs, and as a key constraint for RCH II in the state. However, strategy for facility
mapping and rationalisation of existing resources, and manpower have not been
addressed. There is also no mention of a comprehensive training plan in the PIP.
Situation analysis as well as indicators show the state to be poorly performing on
child health. However, budget allocation for child health has been reduced from
11.9% in 2005-06 to 0.7% in 2006-07.
In the 2006-07 PIP, the state has reported progress on proposed strategies in the
previous year’s PIP, but it would be desirable that the state should also identify
key problems in implementation of RCH II during 2005-06, and try to address
these in the 2006-07, rather than merely continue with the original strategies,
even if desired progress was not made.
Monitoring system vis a vis the plan
The state is in the process of developing and implementing web enabled HMIS system
by integrating physical and financial progress. The Net based MIS is expected to be
developed in next three months. It is envisaged to use this for monitoring the progress
of the districts on day to day basis. It is also planned to integrate physical progress
indicators with disaggregated data. The web enabled MIS is planned to be implemented
at block level once all data entry operators are in position.
IMPLEMENTATION BOTTLENECKS
The state’s progress based on budget utilisation during 2005-06, and 2006-07 has been
quite tardy. During 2005-06 the reported utilisation was only 27% of allocation, while in
first half of 2006-07 it has been 19% of allocation. Some of the key bottlenecks as
identified by the state are:
Delay in approval of State RCH-II PIP (approved on 22nd July 05)
Vacant positions of RCH consultants
Placement of SPMU and DPMU staff delayed (completed in July 05). Positions at
districts level still vacant specially of DAM and DA
Staff took time to understand RCH and NRHM
Limited capacities on the development of concept note, ToR, QA, Monitoring and
Supervision
Delay in merger of different societies at State and District level
Delay in preparation & appraisal of Distt. RCH-II plans
Lack of availability of Private Sectors at district and sub district level
High vacancies of Specialists, MOs and ANMs
Less number of health institutions as per population norms
Key issues identified by the JRM team
Based on facility observations (checklist provided at Annex 4), discussions, and review
of reports, key issues and suggestions for further improvements for RCH II in the state
are:
More focus required on neonatal and child health
o Neonatal care facilities (e.g. for keeping the newborn warm) were not
present in all places visited. Good neonatal care practices need to be
emphasised, including in non-IMNCI districts. This is a missed opportunity
where districts are doing well on deliveries.
o Alternate vaccine delivery needs to be emphasised by bringing it under
RCH II flexi pool funding.
o In Dewas, vaccines were collected by the ANM on Tuesdays and being
stored in private refrigerator till Friday.
o Emphasis on growth monitoring of children, and management of
malnourished children needs to be re-emphasised. Coordination between
ICDS and health, with ANMs also keeping track of malnourished children
is required.
o Clarification of the content of post-natal visits.
In ASHA training, explore possibility of using NGOs for ensuring quality in the
training programmes. Select women carefully as ASHAs, and develop carrier
plan for those that are 10th passed, such as training them as ANMs.
Where private blood banks/blood storage facilities are present, these could be
used under PPP.
BCC/IEC need to be focussed on bringing transparency in implementation of
schemes, such as fees and charges to be paid by the patients and mechanisms
for monitoring and complaints addressal. Monitoring of JSY funds reaching actual
beneficiaries can be strengthened through taking a periodic random sample and
assessing as to whether the money actually was received by the intended
beneficiary. Increased IEC/BCC for Janani Express, JSY and Vijaya Raje Janani
Kalyan Bima Yojana could be made through explicit signage and hoardings,
messages on transport vehicles, through ASHAs, ANMs and AWWs, and
Women’s self help groups.
Referral transport is still a major challenge to increasing institutional deliveries in
Raisen. The Janani Express scheme could be well documented and evaluated in
order to replicate in the entire state. Documentation could include the process of
establishing the scheme, challenges faced and how it can work in sparsely
populated areas.
Malaria prevention and treatment during pregnancy and for children could be
strengthened, e.g. clarification of policy for treatment of malaria among pregnant
women, hospitals to be equipped with bed nets, and nets provided through
antenatal visits in high prevalence areas.
Human resources issues need urgent attention. Mapping of human resources
could be conducted for better allocation of these in the state:
o There is a shortage of doctors, including both specialists for CEmONC
facilities (gynecologists, anaesthetists). Rationalise staff, involve private
sector, and conduct multiskilling of MBBS doctors in EmOC through
FOGSI and in anaesthesia, considering also incentives for trained MBBS
doctors to stay in the public sector. In the interim, vacancies for MOs could
be filled up through ISM doctors.
o The number of sanctioned ANM posts was low. Focus on posting of ANMs
at vacant SHCs, before placing 2 ANMs.
o Focus on SBA training. ANMs could also be provided hands on training at
the BEmONC and CEmONC centres where sufficient delivery load is
there, since many are not confident of conducting even normal deliveries.
Waste management needs to be improved, with segregation and proper disposal
of biomedical waste, as per GOI guidelines.
Supervision mechanisms from bottom to top, i.e. supervision SHCs by LHVs and
PHC staff; of PHCs and CHCs by district authorities and of the districts by the
state programme managers, needs to be revived. For this purpose, it is
suggested that appropriate checklists for each level and facility may be
developed, and used during the visits by concerned staff, so as to assure
minimum services expected from them. Job charts of different functionaries
should also be displayed.
ANMs could be trained to be used as first point of contact at village level. All
public and private facilities in the district could be mapped, and the ANM could
provide required services, or refer cases to appropriate facilities depending on
requirements. Compliment this with innovative schemes such as janani express.
Develop public health cadre. BMOs and CMHOs should be chosen from the
public health cadre, and not being PGMOs/specialists, who could work in their
area of specialisation.
Simplified financial management. A district plan, once approved at the state level,
should not be subject to further delays. Capacity to utilise substantial funds
released to the district, especially at block level, needs to be strengthened.
o Sub-centre untied funds (20,000 Rs)
o Upgradation of CHC to IPHS (40 lakhs Rs)
o Annual maintenance grant for PHCs (50,000 Rs)
o Untied funds for PHC (25,000 Rs)
Overall, utilisation of the district is 32% in Dewas, and 19% in Raisen in nine
months during 2006-07, is very low.
Tribal plan and Urban health plans to be developed and implemented. Where
mobile medical clinics are being used, plansshould set out how these will deal
with emergencies.
There appeared to be limited data available on health and demographic
indicators, or on service gaps. Record systems were not able to link patient
encounters to, for example, show the care given over a whole pregnancy. The
state has plans for improving the data available on health through annual
household surveys.
Renewed emphasis on all aspects of the family planning programme is needed,
including spacing methods. More could be done to improve access to emergency
contraception, where training has been provided for medical officers but not for
other workers. Since it is an OTC drug in India, it should be possible to include in
the ASHA kit, and there may be opportunities for social marketing approaches to
increase awareness of availability.
Strengthened provision of RTI and STI services is needed.
Annex 1
RCH II PROCESS INDICATORS
Sr. RCH Level of Calculation of the indicator by the State& % as on Task to be performed
No. INDICATOR achievement methodology of data collection in JRM 31/12/06 in JRM Review
1 % of ANM 80% Source of Information: Programme Data/Financial Data 84.34% Analysis of data
positions filled on Salary disbursement presented by the State
Type: Secondary
Definition:
Number of ANMs positions filled till date
(1067+9017=10084) X 100
Number of vacant positions as on 1 April
2005(9756+2200=11956)
Vacant is defined as regular vacancies against
sanctioned plus those approved for contractual
appointments
2 a. % of 90% Source of Information: 100% A. Achieved.
districts FMIS (Release of salary in the previous month)
having full- Data to be captured through secondary source. The B. Executive Body of
time indicator has two parts to it. The first part can be State Health Society has
programme captured through secondary data while for the second already sub delegated
manager for part, the job functions of programme managers and any ‘Delegation of Power’ to
RCH other support documents related to administrative and State & district level
b. financial powers will have to be provided. state.
Administrative Type: Secondary:
and financial This data can be compiled from the finance section
powers through salary disbursement (district-wise)
delegated Definition:
Sr. RCH Level of Calculation of the indicator by the State& % as on Task to be performed
No. INDICATOR achievement methodology of data collection in JRM 31/12/06 in JRM Review
Number of districts having full-time programme
managers in position as on date (48)
X 100
Number of districts in the state(48)
3 % of sampled 80% Source of Information: Programme Data 67% Depending on the
state and Check out whether the state is capturing this scores, the JRM can
district information? If no, ask state to use proxy variable frame their questions
program and provide (Orientations
managers programme/workshops
aware of their Proxy: on awareness are
responsibilities Number of Program Managers underwent held)
induction/orientation programme (32)
X 100
Number of Program Managers(48)
4 % of sampled 60% Source of Information: 100% If the state has not
state and Programme Review Minutes conducted any
district Number of programme reviews done in the last six programme managers
programme months review, then they have
managers to be probed for
whose Type: Secondary reasons?
performance Number of programme managers whose -How have they then
was reviewed performance was reviewed in the past six months(48) X been monitoring their
during the 100 performance? How is
past six Number of programme managers(48) the information
months consolidated?
-Have they initiated any
Sr. RCH Level of Calculation of the indicator by the State& % as on Task to be performed
No. INDICATOR achievement methodology of data collection in JRM 31/12/06 in JRM Review
steps in this direction? If
so, what all steps have
been initiated?
5 % of district <10% Source of Information: a. 0% Examine data on
not having at Stock Register/MIS b. 0% logistics and discuss
least one c. 8% if any flaws are
month stock of Type: Secondary observed. Find out
a. Measles This information has to be compiled from stock registers the logistics
Vaccine
maintained at district level. Compile district-wise mechanism
b. OCP information for last six months by opening balance,
c. Gloves
(indenting,
received, distributed and balance (month-wise) procurement,
disbursement etc)
followed by the state
6 % of districts 80% Source of Information: FMIS –Collect for two quarters Analyze data by districts
th
reporting Ask when districts were supposed to report and A. Till 5 - and find out reasons for
quarterly when reported. 27% delay (if any). Examine
financial Type: Secondary B. Till 10th - by budget heads so that
performance 70% an idea of major
in time* Definition: C. Till 15th – expenditure can be
Number of districts reporting quarterly financial 3% gauged and
statement on time (48) subsequently areas of
X 100 (Not Having reviews and questions
Total Number of districts(48) 100% District could be framed for
Accounts district visits
Sr. RCH Level of Calculation of the indicator by the State& % as on Task to be performed
No. INDICATOR achievement methodology of data collection in JRM 31/12/06 in JRM Review
Manger )
7 % of district 80% Source of Information: 100% Examine census
plans with State consolidated summary matrix of interventions by distribution of SC/ST
specific districts (if available) population and analyze
activities to Type: Secondary: district vulnerable plans
reach State can be asked to look into PIPs and compile district- against it. For BPL and
vulnerable plan activities in matrix form if not available. other indicators, find out
communities the rating from state and
Definition:
undertake the review
Number of districts with specific vulnerable plans X 100
Total Number of districts
Definition of Vulnerable community: SC, ST, BPL, not
accessible/remote areas planning etc.
8 % of sampled 80% Source of information: AD sy. AD syringe logistics in
outreach Routine Immunization records Supply- 100% terms of supply and
sessions Safe disposal- distribution can be
Type: Secondary
where 23% verified at district level
guidelines for Definition: and few ANMs can be
AD syringe Number of sampled outreach sessions where AD syringe asked related questions
use and safe disposal guidelines are being followed
Sr. RCH Level of Calculation of the indicator by the State& % as on Task to be performed
No. INDICATOR achievement methodology of data collection in JRM 31/12/06 in JRM Review
use and safe X100
disposal Number of sampled outreach sessions
followed
9 % of sampled 80% Source of information: 44% (MIS doesn’t capture
FRUs -Correspondences between state and district and district this information)
following and FRU’s on IP and waste disposal protocols
agreed IP and -Training related to the above
health care -IP supplies during the year at district etc.
waste Type: Secondary
disposal If this activity has been initiated, then check with the state
procedures of what all activities have been done in this regard and
whether any sample check has been undertaken. If yes,
then ask the state to provide information by using the
following definition
Definition:
Number of sampled FRUs following agreed IP and
waste disposal protocols (75)
X100
Number of sampled FRUs 170
10 % of 24 hrs 50% Source of information: MIS 67% Examine institutional
PHCs Type: Secondary delivery trends of 24hr
conducting facility by districts and
Sr. RCH Level of Calculation of the indicator by the State& % as on Task to be performed
No. INDICATOR achievement methodology of data collection in JRM 31/12/06 in JRM Review
minimum of Definition: find out districts that are
10 deliveries Number of 24 hr PHCs conducting 10 deliveries/ month performing well and
per month 211(BEmONC) otherwise. Explore
X 100 reasons and steps
Total Number of 24 PHCs in the state (314) initiated for increase
uptake
11 % of CHCs 50% Source of information: 13.04% Check whether progress
upgraded as MIS/Programme is according to work plan
FRUs offering Type: Secondary or not
24 hr EmOC
services Definition:
Number of CHCs functioning as FRUs (6)
X 100
Total number of CHCs proposed during the year
Compile information for 6 months by districts(46)
12 % of sampled 60% Source of information: 80%
health MIS (partial)-Proxy
facilities Type: Secondary
offering Number of facilities providing RTI/STI services by districts
RTI/STI could be compiled
services as Number of facilities where lab-tech is posted and
per the available
agreed Number of lab-tech who have undergone RTI/STI training
protocols All facilities where lab-tech has undergone training or
having VCTC can be considered as Numerator
Sr. RCH Level of Calculation of the indicator by the State& % as on Task to be performed
No. INDICATOR achievement methodology of data collection in JRM 31/12/06 in JRM Review
Definition:
Number of health facilities providing RTI/STI services
as per protocols
X 100
Number of health facilities
13 M&E
Triangulation
left out
* State is having its own MIS for monthly physical & financial reporting of RCH-II programme activities
Annex 2
INTERMEDIATE INDICATORS
Name of State: Madhya Pradesh
Reporting period: October – December 2006
S. Indicator Target as Achievement Remarks Source
No. per PIP of data
(06-07)
Infrastructure
1. No. of PHCs upgraded to 214 211
provide 24X7 services 1
2. No. of health facilities upgraded to FRUs, fulfilling the minimal criteria as per the
FRU guidelines (at least the 3 critical criteria)
a. District Hospitals 1 46 35
b. Sub-Divisional Hospitals1 32 11 (blood storage
facilities is
c. CHCs 1 92 10
lacking even
then
performing
LSCS
d. Others (pl. specify) 1 -
3. % of functional Sub- 8835 95.57% (8453
Centres (ANM is available is functional
and working out of the with ANM)
facility)
4. Total Number of FRUs, 170 26.4%(45 with support of
CHCs and 24 hr PHCs facilities) NACO
offering RTI/STI services 1
Staffing
5. % of ANM positions filled 2 2200 48.5% contractual
under RCH
Programme Management
S. Indicator Target as Achievement Remarks Source
No. per PIP of data
(06-07)
6. SPMU in place with 100 % 4 75 %
staff
7. % DPMU staff in place 3 48 77.77%
Training
8. No. of personnel trained in IMNCI
MOs 1 144 54.1% (78)
ANMs 1 144 283 achievement
is cumulative
AWW 1 144 1353
since 2005
also include 2
UNICEF
supported
districts
also
Supervisors 114
9. No. of personnel trained in SBA
MOs 1 - (TOT
completed in
ANMs 1 100 36
18 districts )
Staff nurse 1 14
10. No. of personnel trained in IUD insertion
MOs 1 - Not included
in PIP
ANMs 1 3840 187
Staff nurse 1 - Not included
in PIP
11. No. of MOs trained in
Life-saving anaesthesia 16 - Tot held
skills 1
S. Indicator Target as Achievement Remarks Source
No. per PIP of data
(06-07)
EMOC 1 16 5 13 master
trainer trained
batch of 8
MOs to be
started at
Indore from
22nd Jan. 07
NSV 1 100 - training is
under process
during NSV
Mega camps
being held in
different
districts
Maternal Health
12. Proportion of ANC 1497051 45.7%
registrations in first
trimester of pregnancy
13. Proportion of registered 1497051 76.46%
pregnant women who
received at least 3 ANC
checks
14. Proportion of registered 1497051 92.92%
pregnant women who
received TT2 or booster
15. Proportion of registered 1333985 89.1%
pregnant women who
received 100 doses of IFA
tablets / syrup
16. Proportion of C-section 123960 6.42%
births at FRUs
S. Indicator Target as Achievement Remarks Source
No. per PIP of data
(06-07)
17. Proportion of Mothers and
newborn visited as within
2 days of home delivery System of reporting is being developed.
by a trained community
level health provider/AWW
or health staff (ANM/Nurse
/Doctor)
18. Proportion of JSY 335000 67.36%
beneficiaries who availed
services in the quarter out
of total identified
beneficiaries
19. % of planned RCH 613 55.13%
outreach sessions held
(RCH+DFID)
Child Health
20. % of planned 918840 Formats have
Immunization sessions been sent
held data not
received from
districts
21. Proportion of children 12- 1997519 67.1%
23 months who are fully
immunised 4
Family Planning
22. Male Sterilisation 40000 14.2 % (5685)
Acceptance Rate 5
23. Female Sterilisation 542942 41% (222583)
Acceptance Rate 5
24. IUD Acceptance Rate 6 663095 49.23%
(326500)
Adolescent Health
S. Indicator Target as Achievement Remarks Source
No. per PIP of data
(06-07)
25. Proportion of ANC
registrations in first
trimester of pregnancy for
women < 19 years of age System of Reporting is being developed
26. Proportion of registered
pregnant women < 19
years of age who received
at least 3 ANC checks
Annex 3
OBSERVATIONS AND SUGGESTED ACTIONS VIS A VIS FINDINGS OF 2ND
JRM
Financial progress (05-06 and till 3rd quarter of 2006-07)
April 1, 2006 to December
FY 2005-06 (Rs. Crores) 31, 2006 (Rs. Crores)
Allocation (NPCC) 93.50 121.86
Release 66.20 84.53
Expenditure 25.30 42.90
Expenditure/ Release 38 % 50%
Expenditure/ Allocation 27% 35%
Rs. 33.11 crores refunded to GOI towards settlement of RCH I accounts
Component wise observations and suggested action points:
Achievements/ Observations Recommendations of 2nd JRM Suggested action (if any)
GOVERNANCE
Full time Mission Director for Recruitment process to be Orientation/induction
NRHM in place. monitored closely / fast training of new
SPMU/DPMU staff largely tracked incumbents required to
recruited and trained. make them aware of job
However, there are still a (Recruitments largely requirements
number of vacancies. An carried out) In case of drop outs,
advertisement has been offers from reserve panel
recently released. to be issued so as to fill
up all vacant posts. Post
of state accounts manager
needs to be filled, as state
finance manager is
overburdened.
Pay package of
consultants needs to be re
looked/ enhanced so that
experienced and better-
qualified people join.
Formulated guidelines for Need for adequate Process of upgradation of
delegation of administrative delegation of administrative CHCs to IPHS needs to be
and financial powers at the and financial powers at expedited.
state. district, sub district levels For utilisation of SHC
including ANMs for untied funds, PRI
utilisation of untied funds at department needs to be
SHCs involved and a joint
strategy for this worked
(Sub center/ upgradation out
of CHCs to IPHS funds are
lying unutilised)
Achievements/ Observations Recommendations of 2nd JRM Suggested action (if any)
TECHNICAL INTERVENTIONS
Institutional deliveries JSY component of Based on Unicef study for
improved from 26% to institutional deliveries to be institutional deliveries in
40.58% reported. the state: key areas of
concern including low
(6.57 lakh inst. deliveries ANC, low awareness about
during April-Dec 2006. JSY inst. delivery schemes,
beneficiaries are 2.25 unavailability of transport
lakhs) in most cases needs to be
addressed.
44% ASHAs selected. 40% Procurement and distribution Distribution of ASHA kits
of selected ASHAs trained in of ASHA kits to be speeded expected by 31 Jan 2007.
1st module. TOT for 2nd and up Provision of supplies at
3rd modules completed. regular intervals for these
Procurement of ASHA kits (62% ASHAs selected. kits would also need to be
under progress 46% of selected ASHAs addressed.
trained in first module.
TOT for 2nd and 3rd module
planned in Feb-March
2007)
Recruitment of contract staff, Training should be Blood storage/linkage with
training and provision of coordinated with other blood banks at district
equipments for activities. Place trained level/ other needs to be
operationalising manpower in facilities, ensured
BemOC/CemOC in progress where their skills can be Training of MOs in EmOC
utilised. and anaesthetic skills
needs to be scaled up.
(56/170 CEmOC made
functional. 305/500
BemOC made functional)
Telephones functional at All new constructions/
BemOC/CemOC. Repair/ institutions to be eco
renovation of OTs, labour friendly. Provide adequate
rooms at CHCs/ BemOCs in toilets, waiting enclosures,
progress. etc.
Build a nursing cadre in the
state
(Swalamban scheme for
sponsoring SC/ST
candidates in private
institutions, and obtaining
a bond from them to serve
in Governemnt sector for 5
years is a good initiative)
Achievements/ Observations Recommendations of 2nd JRM Suggested action (if any)
TRAINING AND NGO INVOLVEMENT
MTP training for MOs in Provide quality MTP facilities 11 tribal districts mobile
progress at government institutions. medical units already
Make people aware of this functioning. 19 additional
through IEC. mobile units proposed
(MTP training for 50 MOs could be provided
in progress, 40 trained. emergency contraception
MVA training for 50 MOs in pills
progress 26 trained) State has conducted TOT
for MVA training and
entered into long term
aggreeemet with IPAS for
trainings. This needs to be
speeded up for ensuring
MTP services at 24x7
PHCs
IEC messages should focus
on the root cause of poor
health seeking behaviour.
Address socio cultural
problems such as child
marriages.
INNOVATIONS
Provision of 24 hr referral Need to evaluate this and Proposal for scaling it in
transport, with telephone other pilot schemes before all districts. However,
connectivity and mapping of scaling up. evaluation of this could
pregnant women being be considered before
piloted in 3 districts upscaling.
50 blocks being developed Identify CHCs/PHCs being
as model blocks with all used by large number of
essential health care people. Use intersectoral
facilities convergence for building
roads, water and sanitation
(Reported doubling of facilities, etc. at these
institutional deliveries in 1 institutions
year period in these
blocks. SC/ST and other
disaggregated data of
usage being obtained)
Achievements/ Observations Recommendations of 2nd JRM Suggested action (if any)
M&E AND TA REQUIREMENT
GOI MIES formats being State to develop system for Incorporate monitoring of
adopted collection of data from outcomes in the web
Financial monitoring and SHCs/ PHCs at monthly based HMIS
reporting software meetings. Feed data into
developed. Training for computer at PHCs/CHCs
PMUs planned and report electronically at
Data triangulation and next levels.
validation planned Donor partners to support
states in developing HMIS.
(2 days workshop being Develop current baseline,
organised during 15-16 and compile yearly outcome
january 2007, for data.
improving health Use ASHAs for collecting
statistics in the state) data on key indicators
including IMR, MMR.
Immunisation in urban slum Urban plans to be fast
areas to be monitored tracked
separately and
disaggregated data to be
reported.
OTHER ISSUES
Some key recommendations HRD aspects need to be
of Goa conference to be addressed on priority
actioned:
- Maintainance of panel
for recruitment
- Timely confirmation,
salary of contract staff
- Integrate regular and
contract staff
- Design career
progression for DPMU
staff
- CMHO to have power to
sign cheques for
expenditure approved by
District Health Society
Annex 4
FACILITY OBSERVATION CHECKLISTS
Facility Observation Checklist - District Raisen (Madhya Pradesh)
District PHC CHC Bareli
SHC Hospital Sanchi PHC SHC (Designate
Sadalatpur Raisen (BEmOC) Salamatpur Sarakia d CEmOC)
Parameters (17/1/07) (17/1/07) (17/1/07) (17/1/07) (18/1/07) (18/1/06)
Service Provision
- Routine Delivery Services
(24hrs) N Y Y N N Y
- Manage Obs. Complications N Y N N N Y
Only in Only in
- Female Sterlisation Services N camps N N N camps
Only in Only in
- NSV Services N camps N N N camps
- MTP N Y N N N N
Staff Availability
- Ob/Gyn or trained M.O N Y N N N Y
- Anaesthesiologist N Y N N N N
- Staff Nurses/ANM's (atleast 4) 1 Y 2 2 N Y
- Lab Technicians N Y Y Y N Y
Equipment and Supplies
- NSV Kit N N N N N N
- Gluteraldehyde Solution N Y N N N Y
- RPR Test Kits N N N N N N
- Injection Magnesium Sulphate N N N N N N
- Doxycycline N Y Y Y N Y
- Functioning BP Instrument Y Y Y Y Y Y
- Measles Vaccine N Y Y Y N Y
Facility Infrastructure
- Needs assessment done N Y N N N Y
- Plans for Bio-waste disposal N N N N N N
- Visual Privacy in Labor Room N Y Y N N N
- Visual Privacy in OPD N Y Y Y N Y
- Back-up power facility N Y N N N Y
Referral Services
- Ambulance availabilty N Y Y N N Y
Client Convenience
- Covered waiting area Y Y Y Y Y Y
- Toilets (separate, clean and
functional) N Y Y Y Y Y
- Signage to guide client N Y Y Y N Y
- Signage on rooms N Y Y Y N Y
Record Review
Average number of monthly
institutional deliveries in the last
quarter 0 350 NA 0 0 100
Facility Observation Checklist - District Dewas (Madhya Pradesh)
CHC PHC SHC District
Sonkatch Bhouransa CHC Bagli Chapda hospital
Parameters (17/1/07) (17/1/07) (18/1/07) (18/1/07) (18/1/07)
Service Provision
- Routine Delivery Services
(24hrs) Y Y Y N Y
- Manage Obs. Complications N Y N N Y
Only in
- Female Sterlisation Services camps N Periodic N Y
Only in
- NSV Services Regular camps Periodic N Y
- MTP N N Periodic N Y
Staff Availability
- Ob/Gyn or trained M.O N Y Y N Y
- Anaesthesiologist N N N N Y
- Staff Nurses/ANM's (atleast 4) Y 2 2 1 Y
- Lab Technicians Y Y Y N Y
Equipment and Supplies
- NSV Kit Y N Y N Y
- Gluteraldehyde Solution Y N N N Y
- RPR Test Kits Y N N N Y
- Injection Magnesium Sulphate N Y Y N Y
- Doxycycline Y Y N N Y
- Functioning BP Instrument N Y Y Y Y
- Measles Vaccine Y Y Y N Y
Facility Infrastructure
- Needs assessment done Y Y Y Y Y**
- Plans for Bio-waste disposal N N N N Y
- Visual Privacy in Labor Room Y Y Y N Y
- Visual Privacy in OPD Y Y Y Y Y
- Back-up power facility Y Y Y N Y
Referral Services
- Ambulance availabilty Y N* Y N Y
Client Convenience
- Covered waiting area Y Y Y Y Y
- Toilets (separate,clean and
functional) Y Y Y Y Y
- Signage to guide client Y Y Y Y Y
- Signage on rooms Y Y Y Y Y
Record Review
Average number of monthly
instituional deliveries in the last
quarter 150 44 83 0 1000
* Facility has referral arrangement under Janani Express
** Being a 300 bedded hospital, it may be converted into a medical college
