State 3CRM Chhattisgarh by pLdevf2h


Issues and initiatives

National Rural Health Mission
          Issues and initiatives

• Human resources
• Facilities & services
• Monitoring
  – utilization of services
  – Coverage
  – utilization of funds
• Community aspects
      Issues and initiatives – Human resources

• Doctors -
  – 240 appointed (approximately 50 PHCs still without
  – Re-appropriation of specialists doctors done
     • Every district hospital now has all specialists
     • 28 CHCs now have 4 specialists – functional FRUs
     • Numbers will increase after certification of EmOCs and
       LSAS trained Mos.
• Rural Medical Assistants – 858 appointed, 1 in
  each PHC and CHC
      Issues and initiatives – Human resources

• Nurses – 251 appointed, ANMs – 500 appointed
• Training –                        Req
  – ANM capacity from 430 to 1270       5000
  – MPW capacity from 180 to 800        2500
  – GNT capacity from 240 to 600        3000
  – BSc Nursing from 100 to 1000
• Recruitment of all managerial and support staff
  (SPMU, DPMU & BPMU) completed.
             Issues and initiatives – Human resources
• Chhattisgarh Rural Medical Corps-
   • Implemented in 31 difficult and 67 most difficult blocks.
• Institutions-
   •   District hospitals -   5 Hardest ,         3 Hard
   •   CHCs          -        67 Hardest ,        31 Hard
   •   PHCs          -        472 Hardest         -

• Manpower                                                         …….. back
                                             Sanctioned                  CRMC
                       Name of Post                      In position
                                                Post                   Agreement
               Specialist + PGMO                     578            86         71
               MBBS                                1264          657         445
               Staff Nurse + Nursing               1008          409         326
               RMA                                  472          465         437
               TOTAL                               3322         1617        1279
         Issues and initiatives – Facilities & services
• RSBY in all districts – equity, resources for hospitals.
• Facility mapping done. New req 313 SHCs, 65 PHCs.
• Streamlining procurement and logistics
   – CGMSC to be created.
   – Ready for PROMIS
• Mahtari express – JSY referral transport.
• New born care –
   – TOT for Navjat shishu raksha karyakram completed
   – HBNC launched in 18 blocks on pilot basis
       Issues and initiatives - Monitoring
• Line Listing of beneficiaries -
   •   Village wise register - designed and distributed.
   •   Training to be completed by 31st Dec09
   •   Listing of beneficiaries from 1st January 2010
   •   Offline software at PHC level - developed.
   •   Data entry will start from 27th January 2010.
• Daily on-line reporting of all districts hospitals
  and CHCs started
• HMIS - Facility wise data entry at block level to
  be started in January 2010
• Traditional system of inspections revived
       Issues and initiatives – Community issues
• Swasth Panchayat Yojana (SPY)–
   – GP wise health status data compiled on 10 indicators
   – Data shared with RD, WCD and PHED, also hosted on
• Sensitization of PRIs – (Village registers)
   – Lists of beneficiaries to be read out in gram sabha
   – GP health reports to be made available (SPY)
• Restructuring of VHSC –
   – Convergence with VHSC in TSC
   – A lady panch to be president of VHSC
• 13th training of Mitanin – focus on BCC
• Mitanin divas and passbook to start in January 2010.

• National level Collector’s conference
• Awards for best districts at the national level
• Rope in positive energies of district collectors
       Thank you

National Rural Health Mission
    NRHM Chhattisgarh Special initiatives.
• Chhattisgarh Medical Services Corporations
• Emergency Medical Response Service
• Medical establishment protection Act.
• Chhattisgarh Clinical establishment and nursing
  home Act.
• Ayurved Gram
                                   3rd CRM Findings                               Action taken

                    1. Nobody knew how much mitanins are               1. Preparation of work book/ pass
                       earning – could have a passbook system;            book for mitanin under
Community aspects
                       non-functioning mitanins found in Naxal            process. Draft version
                       areas, and due to lack of monitoring.              prepared.

                    2. Monitoring mechanism is needed to find          2. Appointment of Block level
                       out how many Mitanins are working,                 programme managers
                       facilitating safe deliveries, etc.                 completed- which will
                                                                          improve the monitoring.
                    3. First and second referral to Govt. facilities   3. Mahatari type referral services
                       needs to be clarified and strengthened.            started in the state. Service
                                                                          delivery mapping is being
                    4. VHSCs have been set up but villagers               done.
                       don’t know about them; need capacity            4. Re-orientation about VHSC to
                       building and participation in decisions to         community through Gram
                       spend untied funds.                                sabha is planned to be held
                    5. Bcc activities need to be strengthened for         during January.( Republic day)
                                   3rd CRM Findings                                     Action taken

                          1. Almost 95% of patients are being            1. Reinforcement of free service
                             charged for diagnostics etc. – which           delivery has been taken care by
                             would include BPL; diet also being             issuing directives to institutions.
                          1. Raigarh - In general infrastructure is      1. RMA (854) and staff nurses (251)
                             good (except PHCs which are converted          appointed in the PHCs will
Facilities and Services

                             SHCs) and under-utilized; in Bastar –          definitely increase utilization of
                             some Block PHCs and CHCs also in poor
                             condition.                                  2. Rationalization of Specialist (35)
                          2. In Bastar, the only FRU was at the             completed there are 28 CHC
                             teaching hospital of medical college but       equipped with qualified and multi
                             of poor quality; other three FRUs not          skilled doctors ( OBG Anesthesia)
                             functioning                                    and started functioning as FRU.
                          3. CHCs need strengthening to provide full
                             range of services.                          3. Regular monitoring services by the
                                                                            Nodal officers initiated , which will
                          4. Full scale improvement of Distt Hospitals
                                                                            improve quality services at the
                             is highly necessary, incl. disposal of         centres.
                             condemned furniture/equipment and
                             vehicles which are spread everywhere.       4. Delegation of powers to CMOs for
                          5. Much equipment needs either repair or          condemn and dispose off unusable
                             replacement; AMCs not in place.                items;
                                3rd CRM Findings                                  Action taken

                          1. JDS are collecting money but not spending 1. Hospital administrator at
                             it on much needed improvements- need to         each District hospital and
Facilities and Services
                             be facilitated (e.g., fixed day meetings for    BPM at each CHC
                             decision making; auto-approved lists;           appointed which will
                             contracting out of non-clinical services ,      facilitate to enhance the
                             etc.)                                           functions of JDS.
                                                                          2. Re orientation of JDS/
                          2. Bastar – life-saving drugs and some others      Hospital management is
                             not available/poorly managed.                   planned.
                                                                          3. CGMSC Model is finalized
                          3. Large outside purchase prescriptions are        for effective drug
                             being written (e.g., for malaria and            procurement and logistics.
                             deliveries) even when drugs appear to be 4. Initiation of Emergency
                             available under NRHM.                           ambulance service by PPP is
                          4. Ambulances not functioning; recommend 5. Proper bio medical waste
                             emergency medical system.                       management is being
                                                                             planned. BMWD is being
                          5. Biomedical waste disposal not in place at       taken care by qualified
                             all.                                            Hospital administrator.
                                 3rd CRM Findings                                         Action taken

                      1. Cleanliness of facilities needs major emphasis,       1. Out sourcing of cleaning and
                         including toilets and running water (e.g., in labor      sanitation of hospital promoted
                         rooms)                                                   and JDS is being sensitized.

                      2. Clinical protocols (SOPs) (e.g., labour room,         2. Instructions issued for
                         LTT) need to be put in place                             maintaining clinical Protocol
Quality of Services

                      3. Also need Basic patient care inputs (e.g., bednets 3. Mandatory supply of bed net in
                         to prevent cross-infection given the high Pf rates)   hospital along with linen. Under
                                                                               NVBDCP programme.
                      4. Expensive equipment bought but not in use in
                         Bastar (e.g., phototherapy units, lead protection, 4. Reallocation of equipments as
                         electrophoresis, etc                                  per need has been instructed.,
                                                                               Training of technician is
                                                                               planned to operationalised the
                                           3rd CRM Findings                                        Action taken

                                 1. JSY functioning well in Raigarh – women stay      1. Regular JSY monitoring
                                    48 hours or more and receive payments; not so        initiated. Instructions issued to
                                    in Bastar – stay low, records poor, and backlog      read out beneficiaries list during
RCH: Maternal and Child Health
                                    of payments and no advances (improvements            Gramsabha and displayed at
                                    underway); good information display except           Panchayat
                                    lists of beneficiaries seen in only one case in
                                    each district.                                    2. Facility level amenities are being
                                                                                         ensured so that the 48 hour stay.
                                 2. Mothers not coming for other services – over
                                    60% of deliveries at home                         3.  Anm register has been devised
                                                                                         beneficiary wise village register
                                 3. Could track mothers on the basis of the              prepared  training on progress
                                    Mitanins’ info                                    4. SBA training started in the
                                                                                         districts. Accreditation of private
                                 4. SBA training.                                        facilities for SBA training
                                 5. Need to improve identification of maternal
                                    deaths at community level and do audits; large    5. Maternal death audit activities
                                    number of stillbirths being recorded.                initiated .
                                                                                      6. Navjaat Sishu surakshya
                                 6. Newborn care needs full improvement                  Karyakram TOT completed,
                                                                                         HBNC finalised and started in 18
                                                                                         district as pilot programme.
                                            3rd CRM Findings                                          Action taken

                                 •   FP – Laparoscopes being washed in hot water       •      Laparoscopic surgeons from
RCH: Maternal
                & Child Health       between patients sterlisation (Bastar mega camps)        private facilities are empanelled
                                                                                              to increase no. of camps with
                                 •   Lack of spacing methods                                  quality of care.

                                 •   Lack of safe abortion;                               •   Re enforcements of fixed day FP
                                                                                              service at CHC level and daily
                                 •   No VDRL tests                                            services at DH.
                                                                                          •   Instruction issued to follow all
                                 •   No Adolescent Health (NB. High maternal anemia.          clinical protocols at each level.

                                 •   Need to improve availability of diagnostics for      •   HR recruitment done.
                                     malaria, TB, etc. – RDKs, lab supplies,                  (NVBDCP)
Disease Control

                                     technicians, etc.; also need follow-up of detected   •   Drugs and supplies has been
                                     cases (mal, TB)                                          streamlined. (NVBDCP)

                                 •   Need environmental vector control – biological or    •   Empanelment with private
                                     IRS with timely procurement and distribution.            doctors. (NBCP)
                                 •   Weak disease surveillance system (IDSP).             •   Rationalization of existing
                                 •   Blindness – non-operating Ophthalmic Surgeons;           skilled doctors. (NBCP)
                                     backlog in payments to NGOs (Bastar).                •   IDSP action oriented instruction
                                 •   Only doing institutional-based screening for TB –        has to be followed as and when
                                     need to plan screening through outreach.                 epidemic reported immediately.
                               3rd CRM Findings                                            Action taken

                  1.   Shortage of all cadres, esp. in Bastar (MOs,          •Recruitment of all managerial and support
                       Specialists, POs, DPM, BPMs and other officers); no staff (SPMU, DPMU,BPMU) completed.
                       second ANMs posted
                                                                             •All required specialist appointed at 28
Human Resources
                  2.   Irrational deployment of doctors – need to improve    FRUs through rationalisation and ounseling
                       fit between Specialists posted and patient load,      process.
                       including Staff Nurses.
                  3.   No separate Public Health cadre at District and State •240 Medical officers recruted by CHC and
                       level.                                                appointed in PHC/CHC/ and District
                  4.   NRHM training scant - SBA done by Raigarh DH          hospital
                       already mentioned; state LSAS in Raigarh need
                       certification; must increase LSAS, EmoC, SBA,         •854 RMA appointed at PHC/ CHC
                       Multi-skilling etc.                                   •251 Staff nurse appointed at PHC
                  5.   Contracts for Lab and X-ray techs. made but not       •ANM seats increased from 430 to 1270
                       renewed in Bastar – decentralize appointment and      •MPW training capacity increased from 180
                       renewal of contracts.                                 to 800.
                  6.   Lack of HR planning - Recommend HR Mapping,
                       PMIS, and transparent transfer and promotion          •Certification of LSAS will be over by
                       policies.                                             January 2010.
                  7.   Recommend Performance Management System and
                       incentives; Doctor incentives could include PG seats. •Need based hr planning done by initiation
                  8.   Career development for Mitanins to ANMs or GNMs of training.
                       (rather than BSc Nursing); ANMs to LHVs/BSc Nurs; •Mitanin to BSC nursing- 37
                       retain edu requirements, etc.                         •Mitanin to GNM- planned
                  9.   ANMTC and GNMTC in Bastar: training good but          •Mitanin to ANM- Planned
                       infrastructure needs great improvement
                               3rd CRM Findings                                        Action taken

                     1. Distt-specific ROPs not shared with district       •   ROP sent to districts.
                        level and DHS approvals delayed or not done.
                                                                           •   DPMU and BPMU staff
Program Management
                     2. Bastar DPMU and BPMUs non-functional; only             recruited , they will be appointed
                        two of nine BPMUs in Raigarh .                         after code of conduct (urban
                     3. PWD response to requirements tardy –
                        recommend Health Dept has own construction •           JDs has been empowered for
                        wing for repairs, renovation and maintenance.          minor civil works and repair.
                     4. Drugs widely available in Raigarh, less so in          CGMSC will have a
                     5.     Bastar – but need proper inventory, storage        infrastructure construction and
                        and use/distribution everywhere                        maintenance cell.

                     6. In Bastar much duplication of drugs procured at •      Chhattisgarh Medical Service
                        state/district and local levels.                       Corporation ( CGMSC) will take
                                                                               care the procurement
                     7. Daily on-line data reporting system a welcome          management system.
                        step, but needs to be operationalized and data
                        quality monitored; computers in place but not in
                        use in PHCs
                     8. Innovations and PPPs not found – tie ups
                        possible with industries and others; mobile
                        health teams for outreach; etc.
                                      3rd CRM Findings                                       Action taken

                            •   Role of PRIs limited except for VHSCs             Under swasth panchayat activities
                                                                                  10 point Health and human
                            •   Lack of convergence with sanitation, water supply development index is being
Intra- and Inter-sectoral

                                storage and testing,                              accepted by different department to
                                                                                  ensure development of health and
                                                                                  other sectors. E.g Rural
                                                                                  development, Panchayat, education,


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