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									Workshop on Quality Services under
NRHM for Faculty of Medical Colleges
    of Good Performing States

       (2nd to 5th February, 2010)




         WORKSHOP REPORT




  National Institute of Health & Family Welfare
Baba Gangnath Marg, Munirka, New Delhi-110 067
Workshop on Quality Services under NRHM for Faculty
   of Medical Colleges of Good Performing States



                 (2nd to 5th February, 2010)




                Workshop Coordinating Team
   Workshop Director           :       Prof. Deoki Nandan
                                       (Director, NIHFW)

   Workshop Coordinator        :       Dr. S. Menon

   Workshop Co-coordinator :           Dr. Bindoo Sharma/ Dr. Vandana
                                       Bhatnagar




     National institute of Health & Family Welfare
     Baba Gangnath Marg, Munirka, New Delhi-110 067
          (Ph.: 011-26166441, 26165959, 26107773, 26185696,
                         Fax: 91-11-26101623)

                        E-Mail: director@nihfw.org
                             www.nihfw.org
INTRODUCTION
        National Rural Health Mission (NRHM) launched in April, 2005 envisages provision of
affordable, equitable and quality health care to the population of India, especially vulnerable
groups. National Rural Health Mission has given the guiding principles and has also listed the
deliverables and service guarantees required to be ensured by health care providers/institutions.
However this needs to be translated to actual good quality service delivery at various levels of
health care delivery system (from village to Tertiary health care institutions).

         There has been increasing public concern over the quality of health care in recent years both
because of increasing awareness amongst the population and mushrooming of health care
institutions particularly in the private sector. The quality of health care can be improved by
functional health facilities with skilled personnel providing effective and good quality of services.

        Medical Colleges are the intellectual and academic capital of the State. The faculty
members of medical colleges would be expected to provide the intellectual input on how to apply
any program to their state/region, in the context of the needs of their state / region and also
demonstrate how good quality health care services can be provided. They would have to therefore
understand the centre‟s program, have thorough knowledge about the health problems and available
infrastructure for health services in their states such that they can adapt the programs for effective
implementation through the existing infrastructure to meet the health needs of the population of the
state.

        Important role of medical college is pre-service teaching and training. The faculty members
of medical colleges would have to use not only the textbooks but also ensure that their students
both Under Graduates and Post Graduates do have the knowledge and the skills required for
provision of good quality heath care services and implementing the program for the state‟s needs.
Many of the students are likely to work in the private sector in the current situation. This
knowledge and skills would therefore help these future doctors to participate in public health
programs even while working in private or other sectors.

        Medical Colleges and their hospitals in addition to having highly academic faculty also have
a large case load which is a major advantage for providing skill up gradation training and enabling
the trainees not only to acquire the skills but also learn to diagnose and treat complications. Thus
Medical Colleges have a major role to play in knowledge and skill up gradation during in-service
training for various service providers. In this their roles may be:

    Training of district and below district level trainers
    Training of MO of PHC/CHC (if necessary).
    Training for specialised skills (as Lap. Sterilisation, MTP, Minilap, NSV etc.)

‘Workshop on Quality Services under NRHM for Faculty of Medical Colleges of good
performing States’ was conducted from 2nd to 5th Feb.2010 in NIHFW, Munirka, New Delhi.




                                                  1
Category of Participants
      The participants of the workshop were faculty from departments of Obstetrics &
Gynaecology, Paediatrics and PSM of medical colleges few trainees from SIHFWs, HFWTCs and
SHSRC.

General Objective
       To orient the faculty members of medical colleges about the provision of good quality
health care services under NRHM so as to enable them to incorporate aspects of quality
appropriately in all their teaching and training activities and collaborate with state/district officials
for improving services at primary and secondary levels of health care.

Specific Objectives:
At the end of the workshop the participants are able to:
      Discuss the key strategies and interventions under NRHM
      Explain the parameters for accreditation of hospitals
      Describe the critical issues relevant to quality of Health and Family Welfare services
      Evolve a mechanism to incorporate key quality aspects while teaching various components
       of health care services
      Orient about quality assurance cells at state and district levels

Workshop Contents:
      Overview of NRHM
      Accreditation of hospitals
      Role of Medical Colleges in quality services
      Critical issues relevant to Quality of Health and F.W. Services
      Infection Control and Biomedical waste management
      Integration and convergence of Health & Family Welfare Services at different levels of
       health care delivery system
      International Classification of Disease-X
      Quality Health and F.W services under NRHM

Duration       :       4 days (2nd to 5th February, 2010)

Number of Participants         : 37 (Annexure-I)

Methodology
      Lecture Discussion
      Group Work
      Participants Presentation
      Brain Storming

Evaluation: The workshop was evaluated based on participant‟s feedback on structured Performa.




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Salient Features of the Workshop
     The participants represented medical college faculty from deptt. of obstetrics and
      gynaecology, PSM and Paediatrics. There were a few trainers from HFWTC/SIHFW and
      SHRC. The break up is as follows:

     States       Obst. / Gyane        Paed.          PSM          HFWTC/              Total
                                                                SIHFW, SHSRC
Maharashtra              4               4              8            5                  21
Gujarat                  1               2              2            1                   6
West Bengal              3                                                               3
Punjab                   2               1              1                                4
Haryana                                                 1                                1
Chandigarh                               2                                               2
Total                   10               9             12               6               37

      Nominations were received from Govt. and private medical colleges from six states and the
       break up is as follows:
States                  Name & Address of Medical Colleges
Chandigarh              Govt. Medical College & Hospital, Sector-32, Chandigarh-160030
Gujarat                1) Medical College, Baroda-390001, Gujarat
                       2) Pramukh Swami Medical College, Karamsad-388325, District Anand,
                           Gujarat
Haryana                 Maharaja Agrasen Medical College, Agroha, Hisar-125047, Haryana
Punjab                 1) Christian Medical College & Hospital, Ludhiana-141008, Punjab
                       2) Govt. College Amritsar-143001, Punjab
Maharashtra            1) Govt. Medical College, Aurangabad-431001, Maharashtra
                       2) Indira Gandhi Government Medical College (IGGMC), Nagpur-
                           440012, Maharashtra
                       3) MGM Medical College, Kamothe, Navi Mumbari, Distt. Raigad-
                           410209, Maharashtra
                       4) N.K.P. Salve Institute of Medical Sciences & Lata Mangeshkar
                           Hospital, Digdon Hills, Hingna Road, Nagpur-440019, Maharashtra
                       5) LTM Medical College, Dr. B.A. Road, Sion, Mumbai (Urban Health
                           Centre, Dharavi) Mumbai-400022, Maharashtra
                       6) KEM Hospital & G.S. Medical College, Mumbai-400012, Maharashtra
                       7) B.J. Medical College, Pune Station Road, Pune-411001, Maharashtra
                       8) TN Medical College & BYL Nair Hospital, Mumbai-400008,
                           Maharashtra
West Bengal            1) Calcutta National Medical College (CNMC), 32, Gorachand Road, Park
                           Circus, Kolkara-700014, West Bengal
                       2) North Bengal Medical College, Sushrut Nagar, Distt. Darjeeling-
                           734012, West Bengal




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            Workshop on Quality Services under NRHM for Faculty of Medical Colleges of Good Performing States
                                                  (2nd to 5th February, 2010)
                                                                           Programme Schedule
                  9.00 AM -9.30 AM        9.30 AM- 10.30 AM 10.30 AM -11.15AM               11.30 AM -1.00 PM          2.00 PM – 4.00 PM*                   4.15 PM – 5.30PM
                        Registration         Introduction,           Participant‟s     Critical issues in quality of       Group work                      Overview of NRHM
                                           Expectations of         perception about     Health & F.W.Services          Quality services under
Tuesday                                       Participants.        quality services                                           NRHM                            (Dr. U. Dutta)
2.2.2010                                   Briefing about the       under NRHM                                              Facilitators:                   Lecture Discussion
                                                 course                                        (Dr. Bindoo)               (Dr. S. Menon,
                                            (Dr. Bindoo &           (Dr. S. Menon)            Brain Storming               Dr. Bindoo &
                                             Dr. Vandana)             Discussion                                          (Dr. Vandana)

                  9.00 AM – 9.30AM                  9.30 AM– 11.15 AM                     11.30 AM -1.00 PM             2.00 PM -3.30 PM                    3.45 PM-5.30 PM
                   Recap/experience                                                    Role of Medical college in         Monitoring and
                        sharing                  Inter-sectoral Convergence                  quality of care             evaluation under                 Orientation to ICD-X
Wednesday                                                                                (Prof. Deoki Nandan)                NRHM
3.2.2010                (Participant)            (Dr. Prema Ramachandran)                      Discussion                                                  (Dr. Ashok Kumar)
                                                      Lecture discussion                                                (Dr. Rattan Chand)                 Lecture Discussion
                                                                                                                        Lecture discussion
              9.00 AM – 09.30 AM                     9.30 AM – 11.15 AM                     11.30AM -1.00.PM            2.00 PM – 3.30 PM                 03.45 PM– 05.30 PM
                Recap/experience           Quality Issues in family welfare services                                   Infection control and       Accreditation of hospitals for quality
Thursday            sharing                              under NRHM                    Integrated service delivery       Biomedical waste                        Services
4.2.2010                                                                                                                   management
                                                    (Dr. Kiran Ambwani)                     (Dr .K.Kalaivani)                                                (Prof. J.K. Das)
                        (Participant)                    Discussion                         Lecture discussion            (Mrs. Renuka                         Discussion
                                                                                                                             Patnaik)
                                                                                                                        Lecture discussion
              9.00 AM – 9.30 AM                     9.30 AM – 10.00 AM                   10. 00AM – 11.15 AM                11.30AM – 1.00PM                     2.00 PM – 3.30PM
                                                                                          Group work (contd)            Group work presentation by               Concluding session
                  Recap/experience         Brief about National Health Information       Quality services under                 Participants
Friday                sharing                           Collaboration                           NRHM
5.2.2010                                                                                      Facilitators:                   (Dr. K. Kalaivani,
                        (Participant)             Dr. Mirambika Mahopatra                                                       Dr. S. Menon,
                                                                                              (Dr. Menon &                      Dr. Bindoo &
                                                                                               Dr. Bindoo)                      Dr. Vandana)

       Tea time     :           11.15 AM to 11.30 AM; 3.30PM to 3.45 PM                     *4.00 PM to 4.15 PM                                     Lunch :           1.00 – 2.00 PM



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Sessional Objectives:

1. Perception about quality services under NRHM:
     To list the various views of the participants regarding quality services.
     To identify the differences in perception of quality services.

2. Critical issues in quality of Health & F.W. services
       Discuss the critical issues relevant to provision of good quality of maternal & child
          health, Family planning and disease control services.

3. Quality services under NRHM: (Group Work):
    A. Reproductive health Services (Maternal, RTI/STI, contraception, Infertility etc.)

   B. Child health services including newborn care. (Preventive and curative Services).

   C. Communicable and non-communicable diseases health care services. (Preventive and
      curative Services)

   D. Development of supervisory checklist for quality services during Village Health and
      Nutrition day.

Terms of Reference (TOR) for Group Work:
      Enumerate the outdoor as well as inpatient services relevant to group work.
      List the quality issues relevant to the services.
      Explain a mechanism for addressing the quality issue.
      Discuss how Medical colleges can develop linkages or mechanism to improve the service
       delivery at all levels of health care delivery (from village level to district levels)

4. Overview of NRHM:
     Enumerate the key strategies under NRHM.
     Explain various interventions under NRHM.

5. Inter-sectoral Convergence:
     Describe the mechanism of inter-sectoral convergence under NRHM.
     Explain how inter-sectoral convergence improves quality of services.

6. Role of Medical College in quality of care:
     Explain what is quality of Care.
     Describe the role of medical college in quality of care.

7. Monitoring and evaluation under NRHM:
      Explain the mechanism of monitoring and evaluation under NRHM.
      Discuss importance of NFHS, DLHS data.

8. Orientation to ICD-X:
     Explain the rationale of ICD-X.
     Discuss the importance of ICD-X.



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9. Quality issues in family welfare services under NRHM:
     Explain quality of care for maternal ,child health and Family planning services
     Describe the mechanism of quality assurance for family welfare Services.

10. Integrated service delivery:
      Describe the mechanism of integrating the services at various levels of Health care delivery
       system

11. Infection control and Biomedical waste management:
     Discuss the Infection prevention and control measures.
     Explain the standard Precautions.
     Describe the procedures relevant to biomedical waste management.

12. Accreditation of hospitals for quality Services:
     Explain the importance of accreditation of hospitals.
     Describe the parameters/criteria for accreditation of hospitals under NRHM.




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                          WORKSHOP PROCEEDINGS

Day 1:        2/2/2010

The workshop started with the self introduction by participants and workshop coordinators. The
participants were asked to write down their expectations from the workshop. The expectations are
listed in Annexure-IV.

Most of participants had the following expectations:
  1. How to incorporate quality services in the medical college
  2. Newer interventions under NRHM


Participant’s Perception about Quality Services under NRHM
The session was conducted by Prof. S. Menon, who asked the participants to explain their
perception of quality. She explained that for everyone the perception may be different. The
participant‟s perceptions are given in Annexure-V.

The following issues were highlighted:
      Quality is quantifiable
      Perception depends on the interest of the participants.
      Benchmark standard should be set and once it is reached then a higher standard should be
       set.
 Highlights
     Most of the participants felt that client‟s satisfaction is the major parameter of quality.
     Only 4 participants felt that performance to standards is an important benchmark of quality


Critical issues in quality of Health & F.W. services
This session was taken by Dr. Bindoo by the brainstorming method. All the participants were
divided into three groups and were asked to identify critical issues in provision of:
     Maternal Health services
     Child Health Services.
     Service environment favorable for Good Quality Services.
    Each group was asked to discuss amongst themselves and present the observations which were
    discussed amongst all the participants. The presentation (s) is included as Annexure-VI.

   There were a few cross cutting issues like:
                       Issues                                    Strategies under NRHM
   Accessibility, Affordability & Accreditation       Architectural correction
   Behaviour of service providers                     Behaviour change communication
   Continuity of services                             Citizens charter
   Delays and equity                                  Differential strategy


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Group Work Quality Services under NRHM:
For group work the participants were divided into 4 groups by the facilitators. Each group consists
of representatives from different states and specialties viz maternal health, child health, community
medicine and from training centre. The presentations made by participants are given in Annexure-
VIII.

Overview of NRHM
During the session on Overview of NRHM Dr. U. Datta talked about the vision of NRHM. He
enumerated the goals of NRHM which includes providing universal access to equitable, affordable
and quality health care services, responsive to the needs of the people. He explained the expected
outcomes of NRHM at the community level. He talked of how to improve the Public Health
Delivery System. He explained how decentralization and convergence is being implemented in the
country.

He explained about the architectural corrections and the funding under NRHM. He discussed about
the new strategies under NRHM.

 Highlights
     Improving public health delivery system, convergence, decentralization and architectural
      corrections as per IPHS are some of the interventions under NRHM.
     For improving public health delivery system capacity building of PRIs, PMSUs and health
      professionals is one of the steps.


Day II: 3/2/2010

Experience Sharing (Annexure-VII)
Dr. Arun Humne
He shared the experience related to evaluation of mother NGOs and field NGOs under NRHM,
funded by State Health Systems Resource Centre, Pune. It was suggested that this could be
reproduced by others so that the medical college will be able to use their manpower for reaching
out to the public within the system.

Dr. R.R. Shinde spoke about
Establishing Integrated Disease Surveillance Programme (IDSP) in the hospital involving clinical
departments coordinated by PSM department.

IDSP is one of the flagship program of Government of India, promoting quality data management
in disease surveillance. The focus is on ensuring uniformity, standardization, reliability, accuracy,
consistency & diligency in disease data collection, compilation, analysis and public health
applications.

The faculty of PSM and resident doctors conduct a preventive OPD in KEM Hospital daily. All
new patients & patients on chronic management are first referred to preventive OPD. The


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preventive OPD undertakes screening, counseling, health education, treatment of uncomplicated
cases.

The Medicine & Paediatrics OPD is on the same floor and hence, where essential, immediate
escorted referral of cases is possible.

This has facilitated cooperation & active participation of clinical faculty in IDSP. At institutional
level, PSM department has assertively introduced role of PSM faculty as “Doctors of Health” and
role of clinical specialists as “Doctors of Disease”. In public health terms, clinicians are now
referred as specialists of secondary & tertiary prevention.


Inter-sectoral Convergence:
In this session Dr. Prema Ramachandran explained that there quantifiable determinants &
ingredients of quality which include infrastructure/manpower, processes for diagnosis & treatment,
safety & timeliness of interventions outcome and cost of care. She explained the pre-requisites of
good quality of services.

She explained that convergence will result in provision of quality services by ensuring better
coverage, content and timeliness. She further explained how synergy between AWW, ASHA &
ANM can help to ensure better safe abortion services, better Antenatal care, increased institutional
delivery and management of malnutrition. She talked of how the convergence between vertical
health programmes and RCH can help to achieve integrated services. She described the Antenatal
card developed by ICDS which was distributed to all the participants of the workshop. She
explained how to standardize the weighing machine for accurate measurement of the change in
weight and for estimation of BMI. She cautioned that most of the „weight for height cards‟ are
developed by the western world. She ended by informing the participants about the advantage of
estimating BMI for cards identification of both under & over nutrition.

 Highlights
     Intra- sectoral convergences between different health sector programmes Inter-sectoral
      coordination between health, nutrition, education, water supply sanitation and other
      related sectors has synergistic effect and improves performance in all the sectors. It is
      essential that efforts are made to ensure that coordination occurs at all levels especially
      during implementation at or below district level
     integrate the activities related to procurement, logistics of supply, training, IEC, HMIS
      under different vertical programmes;


Role of Medical College in Quality of Care:
In the session the Director explained to look into the need of the citizens of the country and work
for their benefit. He said that knowledge, analysis, planning etc. should be for the people‟s benefit
and not just of academic importance. He also said that some states like Bihar, UP, MP and West
Bengal need to have more Medical Colleges and the medical colleges should realize their
responsibilities towards the rural India.



                                                  9
He stated that Medical Colleges and the Medical College Hospitals given their vast and diverse
case load and the experienced expert faculty should be the best skill up - gradation training centres.
The Medical Colleges can ensure that their undergraduate and postgraduate students as well as
participants in training courses understand the rationale, components as well as strategies of all the
programs ,also ensure that they do have the knowledge and the skills required for implementing the
program for the state‟s needs.

The Medical College Hospitals should act as Apex Training Centres by practicing the program
components in National Training Strategy for In-service Training under National Rural Health
Mission and their routine service delivery, thereby, enabling the post graduate and under graduate
students to practice & achieve all the skills required pre-service.

He added that there should be paradigm shift in curriculum and issues like Mainstreaming AYUSH,
Telemedicine/ICT, Tobacco Control, Patients Rights in health, Standard treatment guidelines, ICD
-10 Classification, Revitalizing Primary Health Care and Stress Management should be included.

Some of the deficient areas like Counseling skills, Quality issues, Elementary Nursing practices &
Geriatric Care should be strengthened.

He concluded by giving an example how the first years may be posted in the wards, listen to
conversation of patients and relatives to learn social behaviour/concerns.

 Highlights
     Medical Colleges should not be viewed in isolation
     The Medical Colleges can ensure that their undergraduate and postgraduate students as
      well as participants in training courses understand the rationale, components as well as
      strategies of all the programs ,also ensure that they do have the knowledge and the skills
      required for implementing the program for the state‟s needs.
     Integrated/ multi-disciplinary teaching and enabling environment

Monitoring and Evaluation under NRHM
Dr. Rattan Chand talked about Monitoring and Evaluation. He described about DLHS and it is
concurrent evaluation of NRHM through independent agencies like IIPS.
      District wise indicators on CBR, CDR, IMR
      MMR for a group of districts

He informed that Indicators to be covered in Annual Health Surveys (AHS) finalized in meeting of
the Steering Committee held on 9th September, 2009. A Technical Advisory Group (TAG) has
been constituted under the chairmanship of Dr. N.S. Sastry, Ex-DG NSSO to finalize survey
instruments. The Annual Health Survey is expected to be launched by March 2010 and results
expected by early 2011. Regarding HMIS he stated that:
      Formats finalized in consultation with program divisions
      Separate facility level formats
      Information flow has changed from paper to electronic form
      HMIS portal has been launched and is functional.

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He cautioned about the need to validate data received from different sources like HMIS, surveys
etc. He said Expert Group needed to guide triangulation activities has been established and data
triangulation work on MCH and FP is under progress.

 Highlights
     Indicators to be covered in AHS finalized in meeting of the Steering Committee held on
      9th September, 2009
     Survey expected to be launched by March 2010 and results expected by early 2011
     Expert Group to guide triangulation activities established
     Data triangulation work on MCH and FP under progress.

Orientation to ICD-10
This session was conducted by Dr. Ashok Kumar. He explained the need of International
classification of Disease-10 (ICD-10) and enumerated some of the initiatives taken in the country to
promote the use of ICD-10. He informed that Central Bureau of Health Intelligence (CBHI) has
prepared and released the Module & Workshop-Orientation Training on ICD-10 for distribution to
the trainees as reference and self learning module. This module has been updated and reprinted in
2008. Certain initiatives taken by CHBI towards manpower development are:
       Request to Director General of (i) Armed Forces Medical Services, (ii) Railways Health
        Services and (iii) ESI, for appropriately ensuring the use of the ICD-10 in their respective
        medical and health care institutions and develop the trained manpower.
       In 2008, Based on the need, the orientation on International Classification of Functioning
        Disability & Health (ICF) in India was integrated with the orientation training on ICD-10 as
        devised by the experts during National Workshops, 18th November & o4 -05th December,
        2008 and updated to the “Orientation Training Course on FIC (ICD-10 &ICF)”, one week,
        separately, for Master Trainers and Non-Medical Functionaries.
       CBHI has already institutionalized orientation training on Functionaries of IRDA and
        Health Insurance Companies in India-FIC (ICD-10 & ICF) through its various training
        centers in different regions of the country

 Highlights
     ICD-10 coding system be implemented throughout the country for comparison at both,
      national and international levels and the use of ICD-10 be concurrently monitored by
      hospital administration for timely corrective measures at various levels, including meeting
      the ICD-10 trained manpower needs
     All the Government Allopathic Medical Colleges and Medical Council of India have been
      requested and being pursued to ensure appropriate teaching and skill on use of ICD-10 as
      part of the under- graduate and post- graduate degree curricula.

Day III: 4/2/2010

Experience Sharing
Dr. Dinesh Bhanderi shared his experience on “Evaluation of the government health care services
provided to women in reproductive age and children under three years age in Anand district. The


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observations included that in small & remote villages, the distribution of „Mamta card‟ is not
satisfactory, visits by FHW & supervisory staff were also very less than desired and Mamta card
was not used adequately for educating the women regarding nutrition, warning signs, self-care &
newborn care. The recommendations included that IEC activities to create awareness regarding
various government programmes and schemes need to be strengthened so as to maximize their
utilization by the beneficiaries and Mamta card should be extensively used for education &
counseling of pregnant women & mothers.

Quality Issues in Family Welfare Services under NRHM
The session was conducted by Dr. Kiran Ambwani who talked about the various dimensions of
quality services and the steps taken to improve RCH services. She elaborated on quality assurance
committee and quality circles. She informed how quality council of India is supporting GOI in
adapting quality standards at different levels and conducting awareness seminars. She shared
experiences of different state in improving quality. she summarized by reminding that quality
requires setting and achieving standards of service availability to all and that GOI support is
available for states to take initiatives.

 Highlights
     Dimensions of quality include perceptions of service provider, client (user) and the service
      environment
     Focus on Quality is essential for achieving National Health Goals & ensuring
      sustainability and credibility of Public Health Systems;
     Support of GOI available for States to take initiatives.


Integrated Service Delivery
The session was conducted by Prof. K. Kalaivani who described the current practices of service
provision with their disadvantages e.g. Immunisation and MCH services are provided on separate
days. This implies that the women needs to come twice for seeking services i.e. for immunisation,
contraception etc., which has direct implications on their time lost for work and wages. She
informed that the proposed strategy in NRHM to ensure provision of services at periphery in all
villages which is the village health and nutrition day. She enumerated the services to be provided at
the AWC during the VHND.


 Highlights
     The work schedule is not displayed in the sub-centre or PHCs or in the community, people
      remain unaware of the services being provided and also the availability MPHW (M&F) in
      the village on a particular day.
     There is lack of clarity in job responsibility of MPHW(M&F), which clearly leads to non
      performance of work as well as low quality of services provided.




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Infection Control & Biomedical Waste Management
The session was conducted by Mrs. Renuka Patnaik who informed that infection prevention means
prevention of occurrence of infection and minimization of risk of transmitted infection while
providing services for contraception, childbirth, newborn care, post natal care, etc. She pointed out
that all objects coming in contact with patients should be considered potentially contaminated. She
explained the difference between disinfection, decontamination, cleaning and asepsis. She gave
examples from her monitoring visits.

 Highlights
     Minimization of risks of transmitting infection while providing services for contraception,
      childbirth, newborn care, post-natal care, immunization, post-abortion care and
      management of RTIs/STIs.
     To address these issues, an Infection Management and Environment Plan (IMEP) has been
      formulated by the MOH&FW, GOI with the aid of DFID India
     Operational Guidelines designed for easy utilization by healthcare workers at CHCs,
      FRUs, PHCs and SCs with simple instructions and pictorial presentation of infection
      control and waste management procedures


Accreditation of Hospitals for Quality Services
Prof. J.K. Das informed that Accreditation is now a world trend in health care and that accreditation
benefits are patients, community and hospital as well as employees. Internationally the best-known
focused accreditation programmes are WHO/UNICEF‟s Baby Friendly and Mother Friendly
Hospital initiatives. Accreditation or other EQA programmes are most likely to successfully
improve quality if they are voluntary and exist in conjunction with enforced governmental licensure
that assures minimum standards.

The process of accreditation is includes initial application including self assessment as per the laid
down standards, screening of the application followed by assessment survey and accreditation
committee recommendations.

 Highlights
     Accreditation process encourages those that are doing the best work, and stimulates those
      of inferior standards to do better.
     The most effective means of providing long-term support for an accreditation / EQA
      programme is indirect, by establishing financial incentives for organizations to participate.


Day IV: 5/2/2010

Experience Sharing
   1. Dr. Gautam Mukhapadhyay talked about the role of injection magsulf in the treatment of
      ecclampsia. He said that gradual persuasion and use of low dose magsulf in the periphery
      has resulted in decreasing the morbidity of ecclampsia.

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   2. Dr. Seema Ananjaya shared her experience regarding provision of integrated teaching in the
      under graduate in the second year MBBS students. She explained how integration is being
      done between the departments of PSM, paediatrics, obstetric. She said that the study will be
      completed in April 2010 in order to evaluate the outcome of integrated teaching in the
      community. The topics covered include breastfeeding, PEM and malnutrition.

   3. Dr. A.P. Kulkarni spoke about his experience in finalization of the PIP for Maharashtra. He
      informed the group during his career at the Medical College there were lot of issues about
      which he was not aware. After joining SHRC, Pune he has realized the spectrum of issues
      which need to be addressed by Medical College faculty as well.

The participants gave suggestions for involvement of medical college faculty in NRHM (Annexure-
IX)

Dr. Mirambika, From NIHFW
She demonstrated the portal for National Health Information Collaboration (NHIC) to the
participants. The participants felt that there should be strict rules for including articles at the NHIC.
Some of the participants visited the computer centre of the institute for practicing the use of this
portal.

Presentation on Group Work
All the four groups presented their group work to Prof. Menon. All the group‟s presentations were
appreciated. However, the following issues were raised:
     Presentation on disease control addressed the issues of quality services in the tertiary centres
        predominantly.
     The checklist in the village health and nutrition day did not include any experience of the
        group.


Concluding Session
The valedictory session was chaired by Dr. M. Bhattacharya, Dean of Studies who asked the
participants to explain what were the additions in their knowledge following the workshop. Dr.
Sushma Malik (Pead) informed that there were so many interventions under NRHM about which
she was not aware and she was happy to learn about them. Similarly Dr. Bhosale (Obst./Gynae) felt
the experience sharing was another strong feature of the workshop. Suggestions to involve medical
colleges in NRHM were taken from the participants and is included as Annexure-IX.

Dr. Dinesh Bhanderi gave a brief on the sessional evaluation which is included as Annexure-X (A).
He clarified that most of the sessions were satisfactory but suggestions were given for improvement
in most of the sessions which are included.

The workshop evaluation was done by Dr. Shinde and the workshop evaluation is included as
Annexure-X (B) in which suggestion for improvement have been included as well. The participants
found the workshop to be democratic, informative and helpful.




                                                   14
     Workshop on Quality Services under NRHM for Faculty of Medical Colleges of
                 Good Performing States (2nd to 5th February, 2010)

                                   List of Resource Persons
S. Name                   Designation                   Ph/Fax No.         E-Mail ID
No.
External:
1. Dr. Ashok Kumar        Dy. Director General &        (O) 011-23062695 dircbhi@nic.in
                          Director,
                          Central Bureau of Health      23061529
                          Intelligence Dt. General of   (F) 011-23063175
                          Health Services, Room No.     (M) 9868891147
                          401 & 404-A Wing, Nirman
                          Bhawan, New Delhi-110 011

2.    Dr. Kiran Ambwani DC (F.P.)                       (O) 011-23062485 kambwani@rediffmail.c
                        Room No. 311-D, MOHFW,          Ext/ 2789/ 464   om
                        Nirman Bhawan, New Delhi        (F) 23062485

3.    Dr. Rattan Chand    CD (Statistics)/ CD (M&E), (O) 011-23062699 cdstat@nb.nic.in
                          Room No. 243-A, Nirman
                          Bhawan, Maulana Azad Marg,
                          New Delhi-110 011

4.    Dr. Prema           Director, NFI & Former         (M) 9891485605    premaramachandran@g
      Ramachandran        Advisor (Health) Planning                        mail.com
                          Commission
                          Nutrition Foundation of India
                          C-13, Qutab Institutional Area
                          New Delhi - 110 016, India

Internal :
1. Prof. Deoki Nandan Director, NIHFW, New          011-26165959           director@nihfw.org
                      Delhi                         Ext – 301, 302         dnandan51@yahoo.com
                                                    011-26101623 (Fax)     dnandan@nihfw.org
2.    Prof. K. Kalaivani  HOD, RBM and Nodal        011-26165959           rchtrg@gmail.com
                          Officer, NRHM/RCH ,       Ext – 330, 333         kalaivanikrishnamurthy
                          NIHFW                     011-26160158(Fax)      @gmail.com
3.    Dr. S. Menon        Professor ,Deptt. of RBM, 011-26165959           smenon30@gmail.com
                          Asst. Nodal Officer,      Ext – 125, 387         rchtrg@gmail.com
                          NRHM/RCH, NIHFW.          011-26160158 (Fax)
4.    Prof. J.K. Das      HOD, Epidemiology,        011-26165959           jkdas.nihfw@nic.in
                          NIHFW, New Delhi          Ext – 307
5.    Prof. U. Dutta      HOD E&T, NIHFW, New 011-2616595                  utsuk@rediffmail.com
                          Delhi                     Ext-314
6.    Dr. Bindoo Sharma Sr. Consultant – RCH,       011-26165959           rchtrg@gmail.com
                          NIHFW                     Ext – 376
7.    Mrs. Renuka Patnaik Consultant, RCH, NIHFW 011-26165959              rchtrg@gmail.com
                                                    Ext – 367
8.    Dr. Vandana         Consultant - RCH,         011-26165959           rchtrg@gmail.com
      Bhatnagar           NIHFW                     Ext – 238

                                                15
                                                                                               Annexure-I
      Workshop on Quality Services under NRHM for Faculty of Medical Colleges of
                  Good Performing States (2nd to 5th February, 2010)

                                           List of Participants
S.   Name & Designation       Department      Office Address       Phone Nos. / Fax         E-mail Address
No.
Chandigarh
1. Dr. Kana Ram Jat           Pediatrics   Govt. Medical           M: 9646121525       vishal_guglani@yahoo.com
    (M.D. Pediatric)                       College & Hospital,     Res : 9872308656        drkanaram@gmail.com
    Asst. Professor                        Sect.32, Chandigarh-
                                           160030
2.   Dr. Geetanjali Jindal    Pediatrics   Govt. Medical           M: 9646121595        vishal_guglani@yahoo.com
     (M.D. Pediatric)                      College & Hospital,     Res : 2624222       geetanjali_jindal@yahoo.co.
     Asst. Professor                       Sect.32, Chandigarh-                                                 in
                                           160030
Gujarat
3. Dr. Omprakash Shukla       Pediatrics   Medical      College,   Off : 0265-          opshukla101@yahoo.co.in
   (M.D. Pediatric)                        Baroda-390001,          2422883
   Asso. Professor                         Gujarat                 M : 9426370860
4.   Dr. Nitin Raithatha      Obst. &      Pramukh Swami           Off : 02692-          psmc@charutarhealth.org
     (M.D. Gynae)             Gynae.       Medical College,        222130              dr_nitin_raithatha@yahoo.c
     Asso. Professor                       Karamsad-388325,        M : 09825197277                             om
                                           District Anand,                              nitinsr@charutarhealth.org
                                           Gujarat
5.   Dr. Dipen Patel          Pediatrics   Pramukh Swami           Off : 02692-          psmc@charutarhealth.org
     (M.D. Pediatrics)                     Medical College,        222130
     Asst. Professor                       Karamsad-388325,        Res : 02764-
                                           District Anand,         265269
                                           Gujarat
6.   Dr. Dinesh Bhanderi      PSM          Pramukh Swami           Off : 02692-          psmc@charutarhealth.org
     (M.D. Community                       Medical College,        222130               bhanderi1963@gmail.com
     Medicine)                             Karamsad-388325,        Res : 02692-
     Asso. Professor                       District Anand,         231721
                                           Gujarat
7.   Dr. Navnit Padhiyar      PSM          Medical      College,   Off : 02651-        navneet_padhiyar@yahoo.c
     (M.D.)                                Baroda-390001,          2427545                                 o.in
     Asst. Professor                       Gujarat                 Res: 9228186060
                                                                   M: 9427226707
8.   Dr. Kiritkumar Ratilal   Epidemiolo   SIHFW, S.G.             Off : 079-                krshah22@gmail.com
     Shah                     gy           Highway, Sola Civil     27662811
     (MBBS)                                Hospital,               Res : 079-
     M.O. (Epidemiologist)                 Ahmedabad-380060,       26440809
                                           Gujarat                 Fax: 079-27665964
Haryana
9. Dr. Seema Choudhary        PSM          Maharaja Agrasen        Off : 01669-        profseemachoudhary@yaho
   (M.D., Community                        Medical College,        281193                                o.co.in
   Medicine)                               Agroha, Hisar-          Ext.: 264
   Asso. Professor                         125047, Haryana         Off : 01669-
   Community Medicine                                              281176
                                                                   M : 9896247710



                                                      16
S.   Name & Designation      Department      Office Address     Phone Nos. / Fax        E-mail Address
No.
Punjab
10. Dr. Geetika Dheer        Pediatrics   Christian Medical     Off : 0161-         drtenjinder@rediffmail.com
    (M.D. Pediatrics)                     College & Hospital,   2229010                    drgdheer@gmail.com
    Asst. Professor                       Ludhiana-141008,      M : 9872206670
                                          Punjab

11. Dr. Ashok Salwan         Obst. &      Govt. Medical         Res: 0183-3299760
    (M.D., MBBS, DGO)        Gynae.       College Amritsar-     M: 9915068181
    Asst. Professor                       143001, Punjab
12. Dr. Pratibha Dabas       PSM          Christian Medical     Off: 0161-6450829   doctorpratibha@gmail.com
    (M.D., MBBS)                          College & Hospital,   M: 9780243695
    Asst. Professor                       Ludhiana-141008,
    Community Medicine                    Punjab
13. Dr. Moneet Walia         Obst. &      Christian Medical     Off: 0161-             navmalwai@yahoo.com
    (M.D., MBBS)             Gynae.       College & Hospital,   22290101
    Asst. Professor                       Ludhiana-141008,      M: 9876020475
                                          Punjab
Maharashtra
14. Dr. Mohan K. Doibale     PSM          Govt. Medical         Off : 0240-                doibale@gmail.com
    (M.D. PSM)                            College, Aurangabad- 2402424
    Asso. Professor                       431001, Maharashtra Res : 0240-
                                                                2354393
                                                                Fax : 0240-
                                                                2402418
                                                                M: 09422203393
15. Dr. Anita Banerjee       Pediatrics   Indira Gandhi         M: 9881010321     dr.anitabanerjee@gmail.com
    (M.D. Pediatrics)                     Government Medical
    Lecturer                              College (IGGMC),
                                          Nagpur-440012,
                                          Maharashtra
16. Dr. Seema Anjenaya       PSM          MGM Medical           Off : 022-2742     drseema23@rediffmail.com
    Professor & Head                      College, Kamothe,     7997
                                          Navi Mumbari, Distt. Res : 0251-
                                          Raigad-410209,        2202170
                                          Maharashtra           M: 9821661558
17. Dr. Madhukar S. Pawar    PSM          Health & Family       Off : 0253-          hfwtcnsk@rediffmail.com
    (MBBS, DPH, MD)          (HFWTC)      welfare Training      2311201
    Principal                             Centre, Nashik, Civil Res : 0253-
                                          Hospital Campus,      2575108
                                          Nasik-422001,         Fax: 0253-2311201
                                          Mumbai
18. Dr. Sudhakar B. Kokane   HFWTC,       Health & Family       Off : 020-             hfwtcpune@yahoo.com
    (MBBS, DPH)              Pune         welfare Training      27281255                 sbk2015@yahoo.co.in
    Principal                             Centre, Aundh         Res : 020-
                                          Campus, Pune-         25453171
                                          411027, Mumbai        Fax: 020-27281255
                                                                M: 09422021581,
                                                                   09867218951
19. Dr. Vijay Kamale         Pediatrics   MGM Medical           Off : 022-         drvijaynkamale@yahoo.co.i
    Professor                             College, Kamothe,     27423404                                   n
                                          Navi Mumbari, Distt. Res : 022-
                                          Raigad-410209,        64217771
                                          Maharashtra           M: 9224475712
20. Dr. Pankaj Patil         Obst. &      MGM Medical           Off : 022-                Patilp68@yahoo.com
    (M.D.)                   Gynae.       College, Kamothe,     27427997                mgmmcnb@gmail.com

                                                     17
S.     Name & Designation      Department      Office Address        Phone Nos. / Fax       E-mail Address
No.
      Asst. Professor                       Navi Mumbari, Distt.     M: 9222177561
                                            Raigad-410209,
                                            Maharashtra
21. Dr. Anjali Edbor           Pediatrics   N.K.P. Salve Institute   Off : 07104-        nkpsims1@rediffmail.com
    (M.D. Pediatrics)                       of Medical Sciences      236201              dranjaliedbor@gmail.com
    Asso. Professor                         & Lata Mangeshkar        M: 09822470808
                                            Hospital, Digdon
                                            Hills, Hingna Road,
                                            Nagpur-440019,
                                            Maharashtra
22. Dr. Pallavi S. Shelke      PSM          Lokmanya Tilak           Off : 022-        psmltmmc@rediffmail.com
    (M.D., DPH, DNB,                        Municipal Medical        24038983,             drpallavis@gmail.com
    MPS)                                    College, Deptt. of             24063123
    Asso. Professor                         PSM, Dr. B.A. Road,      M : 9867003734
                                            Sion, Mumbai (Urban      Fax: 022-24038983
                                            Health Centre,
                                            Dharavi) Mumbai-
                                            400022, Maharashtra
23. Dr. Ratnendra Ramesh       PSM          G.S. Medical College,    Off : 022-                sanjayoak@kem.edu
    Shinde                                  Deptt. of PSM, 3rd       24107074            expertratnesh@yahoo.com
    (M.D.)                                  Floor, Library Bldg.     M : 9820097514             psmgsmc@kem.edu
    Prof.& Head                             Parel, Mumbai-           Fax: 022-24166006
                                            400012, Maharashtra
24. Dr. Rajan N. Kulkarni      PSM          G.S. Medical College,    Off : 022-        kulkarniteacher@hotmail.co
    (MBBS, DPH, M.D.)                       Deptt. of PSM, Parel,    24107484                                  m
    Asso. Professor                         Mumbai- 400012,          M : 9819960961
                                            Maharashtra              Fax: 022-24142503
25. Dr. Payal Laad             PSM          Lokmanya Tilak           Off : 022-                 slpayu@gmail.com
    (MBBS, M.D.)                            Municipal Medical        24038983,                 shpays@yahoo.com
    Asst. Professor                         College, Deptt. of             24063123
                                            PSM, Dr. B.A. Road,      M : 9699740416
                                            Sion, Mumbai (Urban      Fax: 022-24038983
                                            Health Centre,
                                            Dharavi) Mumbai-
                                            400022, Maharashtra
26. Dr. Ramesh A. Bhosale      Obst. &      B.J. Medical College,Off : 020-         staterchqa.cell@gmail.com
    (M.D.)                     Gynae.       Pune Station Road,   26128000          drrameshbhosale@yahoo.co
    Professor                               Pune-411001,         Res : 020-                                 m
                                            Maharashtra          26133367
                                                                 Fax: 020-26126868
                                                                 M: 9823037565
27. Dr. Shailesh Deshpande     PSM          State Health Systems Off : 020-         staterchqa.cell@gmail.com
    (M.D. PSM)                              Resource Centre, 1st 26615505                shsrc.gan@gmail.com
    Sr. Consultant (Research                Floor, Arogyabhavan, Res : 020-
    & Documentations)                       Parivartan Building, 25386821
                                            Alandi Road,         Fax: 020-26615505
                                            Yerawada, Pune-      M: 9890394334
                                            411036, Maharashtra
28. Dr. Deepak Phalgune        RCH, CTI-    KEM Hospital &       Off : 020-        staterchqa.cell@gmail.com
    (M.D. PSM, Ph.D)           PSM          Research Centre,     26135091               dphalgune@gmail.com
    Sr. Consultant                          Sardar Moodliar      Res : 020-                  kemunr@vsnl.net
                                            Road, Rasta Peth,    25440197
                                            Pune-411011,         Fax: 020-26125603
                                            Maharashtra          M: 9850434220


                                                       18
S.   Name & Designation      Department      Office Address       Phone Nos. / Fax         E-mail Address
No.
29. Dr. A.P. Kulkarni        Public       State Health Systems    Off : 020-        staterchqa.cell@gmail.com
    (BSc, MBBS, DPH,         health       Resource Centre, 1st    26612010          , drapkulkarni@gmail.com
    MD, Ph.D)                SHSRC,       Floor, Arogyabhavan,    Fax: 020-26610180
    Sr. Consultant           Pune-        Parivartan Building,    M: 9422701650
                             411006       Alandi Road,
                                          Yerawada, Pune-
                                          411036, Maharashtra
30. Dr. Jitendra K.          Obst. &      Govt. Medical           Res: 0712-2545296 drjkdeshmukh@gmail.com
    Deshmukh                 Gynae.       College, Nagpur-        Fax: 0712-2750145    vtalloo@rediffmail.com
     (M.D., DGO, DFP,                     440010, Maharashtra     M: 9822200820
    DICOG, FCTS, DNB)                                                9422164768
    Asso. Professor
31. Dr. Chinmay Pataki       Obst. &      Lokmanya Tilak          Off: 0222-4063152      drchinmay@gmail.com
    (M.D. Obst. & Gynae.)    Gynae.       Municipal Medical       M: 9769134005
    Asst. Professor                       College, Deptt. of
                                          PSM, Dr. B.A. Road,
                                          Sion, Mumbai (Urban
                                          Health Centre,
                                          Dharavi) Mumbai-
                                          400022, Maharashtra
32. Dr. (Mrs) Sushma Malik   Pediatrics   Deptt. of Pediatrics,   Off : 022-           sushmamalik@hotmail.co
    (M.D. Pediatrics)                     1st Floor, College      23027000                                 m
    Prof. Incharge NICU                   Building, TN Medical           Extn. 7139    sushmamalik@gmail.com
                                          College & BYL Nair      Fax: 022-23072663
                                          Hospital, Mumbai-       M: 9819065322
                                          400008, Maharashtra
33. Dr. Arun Humne           PSM          Govt. Medical         Off : 0712-       drarun_humne@yahoo.co.i
    M.D.( PSM) D.P.H.                     College Nagpur, Near  2701369                                 n
                                          Hanuman Nagar,        Res : 0712-
                                          Nagpur-440003,        2701711
                                          Maharashtra           Fax: 0712-2701369
                                                                M: 9422102844
                                                                   9921251441
34. Dr. Prakash Adhav        PSM          B.J. Medical College, Off : 020-            drpsadhav@yahoo.com
    (PGD, M.D., DIH)                      Pune Station Road,    25897563              drpsadhav@gmail.com
    Professor & HOD                       Pune-411001,          M: 9371010297
                                          Maharashtra
West Bengal
35. Dr. Bidyut Kumar Basu    Obst. &      Calcutta National       Off : 0332-          cnmcalumni.a@gmail.com
    (MBBS, M.D.)             Gynae.       Medical College         2897122,            drbdyutibasu@rediffmail.co
    Professor                             (CNMC), 32,                                                         m
                                          Gorachand Road,         2897123               basu.drbdyuti@gmail.com
                                          Park Circus, Kolkara-   Res: 0332-3374098
                                          700014, West Bengal     M: 09433847695
36. Dr. Gautam               Obst. &      N.B. Medical            Off: 0353-2585478   nbmc_slg@yahoo.com
    Mukhopadhyay             Gynae.       College, P.O Sushruta   M: 09434377088 gautam_in_66@yahoo.co.uk
    (M.D. DGO) DNB                        Nagar-734012,              09434377088
    Asso. Professor                       Siliguri, Dist.
                                          Darjeeling, West
                                          Bengal
37. Dr. (Mrs.) Sohini        Obst. &      N.B. Medical            Off: 0353-2585478      nbmc_slg@yahoo.com
    Bhattacharya             Gynae.       College, P.O Sushruta   M: 9832072309     drsohinibhattacharya@yaho
    (M.D.)                                Nagar-734012,                                                 o.co.in
                                          Siliguri, Dist.
                                          Darjeeling, W.B.

                                                     19
                                                                       Annexure-II

                                 CD Contents


1.   Presentations
2.   Group photograph
3.   Guidelines
        NFHS-3
        IPHS SC, PHC, CHC (Downloaded October 2007)
        Rogi Kalyan Samiti
        Standards for Male & Female sterilization
        Training of Trainers on Capacity Building of MC Faculty in RCH-
         IINRHM Strategies
        Four Years of NRHM 2005-2009
        Adolescent Health and Development (AHD) NPIP RCH Phase II[1]
        District Health Action (Downloaded October 2007)
        Manual for Family Planning Insurance Scheme (January 2008)
        FRU Guidelines 2004
        Guidelines for AWWs, ASHAs, ANMs, PRIs - VHND
        Guidelines for Operationalizing a Primary Health Centre for Providing 24-
         Hour Delivery and Newborn Care Under RCH-II
        Guidelines for Setting up Blood Storage at FRU (October 2007)
        IUCD Reference Manual for MO
        NRHM-Frame Work for Implementation
        NGO guidelines
        NRHM Mission Document (October 2007)
        NRHM Evaluation Report
        Quality Assurance Manual for Sterilization services
        SOP Book (FP)
        National Training Strategy
        IMEP guidelines




                                        20
                                                                   Annexure-III

                           Documents Distributed


1.   Reference Manual for Minilap Tubectomy
2.   Monthly     Village     Health    Nutrition       Day   (Guidelines    for
     AWWs/ASHAs/ANMs/PRIs
3.   Capacity Building of Medical College Faculty in RCH-II/NRHM (Background
     Document Vol. I National Rural Health Mission)
4.   Capacity Building of Medical College Faculty in RCH-II/NRHM (Background
     Document Vol. II Reproductive and Child Health)
5.   Capacity Building of Medical College Faculty in RCH-II/NRHM (Background
     Document Vol. III National Health Programme)
6.   Manual For Family Planning Insurance Scheme




                                      21
                                                                                     Annexure-IV

                 Expectation of Participants from the Course

1.    Skills & promotion
2.    Laparoscopy, Sterilization, NSV Training
3.    We will get guidelines & teachings to improve teaching to our students in rural areas. To
      know role of medical colleges.
4.    Gain knowledge and skills of the NRHM/RCH for the activities that we perform to improve
      the quality of training under RCH-II that in turn will improve services at primary &
      secondary levels of health care.
5.    To improve health care delivery system and it should reach at bottom level with quality.
6.    I want to go back with a direction in the form of an action plan with a continued link with
      the NIHFW, have a life long relationship with NIHFW.
7.    We will get guidelines and teachings from here to teach our students (budding doctors) to
      serve better in rural areas.
8.    I expect that the workshop will deal with the NRHM goal and activities in some detail &
      subsequently focus on how the quality of services in the health sector can be improved.
9.    To understand medical teachers role in teaching NRHM to medical students and patients
      care in teaching hospital.
10.   To brainstorm on causes of failure and ways to arrange for all those things needed to
      provide ideal care of education to patients/students.
11.   What will be the role of our medical college in adapting NRHM
12.   Enabling to improve the quality of teaching and health- management at medical college &
      state level and also general guidelines.
13.   I expect to know in depth different facts of NRHM and acquire skill to deliver quality
      services under NRHM and also to train my colleagues and junior in this aspect.
14.   Adequate knowledge regarding how to improve quality services at their medical colleges
      respectively.
15.   How best the medical college faculty be used for effective implementation of NRHM/RCH?
16.   To orient ourselves (medical faculty) about ensuring quality health services to the
      community & percolate it to our students.
17.   To gain information regarding newer policies of govt. for NRHM & RCH programme and
      implementation of these programmes through private medical college.
18.   - To learn feasible, practical affordable interventions to achieve quality health services to
          all stake holders.
      - How to introduce in medical education curriculum teach & evaluation?
19.   Developing skills to practice and teach (guide) quality care while delivering health care for
      families.
20.   The course should give practical insights in developing “checklists” for monitoring &
      “indicators” for evaluation of quality of services under NRHM/RCH & generate mechanism
      for linking medical colleges‟ expertise with state health services.
21.   To know the key strategies of NRHM, critical quality health issues and mechanism to
      incorporate quality in health care services.
22.   To enhance the knowledge and skill on NRHM, so as to improve the health care delivery
      system in rural health.
                                               22
23.   To provide quality services to patients at minimum cost so that we are able to increase our
      IPD and patients goes fully satisfied and sends other patients in multiplication.
24.   We will be trained in quality services so that we will train lower cadres (DHD, ADHO,
      Medical officer, paramedical etc.) appropriately.
25.   How to execute services under NRHM in proper way at all levels of health system.
26.   My main expectation of this workshop/course is to enable to know and give better services
      in health both at hospital and community level.
27.   As an incharge of rural health centre in a tribal village under medical college, I expect to
      learn innovative ways of launching existing health services under NRHM to deliver the
      quality.
28.   Knowing ways and means of improvement of quality of health care.
29.   How we can further improve quality of services given at government hospital
30.   To get practicable, applicable, affordable and cost effective and definitely suitable
      knowledge for 75% of Indian population for improvement of economic and social
      upliftment there by helping all of us.
31.   Improvement of the quality of obstetric care. To reduce the maternal mortality and
      morbidity keeping in mind the limited resources available at the medical institute.
32.   Quality indicators of NRHM/RCH
33.   To acquire in-depth understanding of NRHM and ways of quality induction in it.
      ̵ To help me in improving quality of health care at peripheral level.
34.    Funding for logistic & to prepare more human resources (capacity building) to
       maintain/establish quality services under NRHM.




                                               23
                                                                                       Annexure-V

Participant’s Perception about Quality Services under NRHM by Group-I are
as follows:

1.    Quality is all good constitutions of a thing which can bring good results.
2.    Quality is giving best out of available resources
3.    Satisfaction and something which should be achieved the community.
4.    A patient when comes to doctors at any level of care is 100% sure that it is the best which is
      given to him and the same is true regarding the doctor. Both are 100% sure and confident in
      the treatment.
5.    Quality improvement remains a constant process.
6.    Quality is maximum output with minimum input.
7.    Quality in health care is to provide standard of care to all equally as we have proposed to
      give.
8.    Quality is cream, essence or best part of something.
9.    Quality is achieving the objective with patient/people satisfaction and convenience and
      needs being the top most priority, services being updated with time.
10.   The final result of anything and everything in a practicable suitable manner presented
      beautifully and easily understandable and presentable.
11.   Quality is “How much percentage of expected out of it”.
12.   Quality is not measurable but which give satisfaction to customer.
13.   Quality strict adherence to standards of procedure (protocol).
14.   Satisfaction to service provider as well as consumer.
15.   Quality may be a set of objectively defined benchmarks for ensuring that a product/service
      is of good standards to benefit the end user and certainly not harm him/her, while also being
      perceived as of good standards by the end user.
16.   Quality means to me the most effective way delivering a service which gives maximum
      output which minimum input.
17.   Perfection or excellence


      Participant’s Perceptions by Group-II are as follows:
1.    Quality means a well accepted protocol strict adherence to it.
2.    Quality means optimal effective beauty of the event/parameter.
3.    Quality refers the content.
4.    Quality it is a relative term evaluated against attain in? /parameter.
5.    Pre-decided criteria at affordable price.
6.    Quality services can be defined as a “ services in which is scientifically proved to be result
      oriented with least advertising”
7.    Quality is that component in any service or activity which makes both recipient and
      provider satisfied and outcome is as per the expectations.
8.    Quality the level best in any field
9.    IPHS Indian public health standards
10.   Quality- mark of efficiency, mark of perfection, mark of assurance and a scientific gradation
11.   A tool to measure input and output.

                                                24
12.   The concept and proactive diagnosis and management of diseases has to be changed as per
      new concepts and methods of diagnosis under NRHM that is the quality of health
      management.
13.   Quality is appropriateness of content and way of delivery leading to best possible outcome.
14.   Quality with reference to health care Assessment of performance of an activity /program on
      the backdrop of expectations.
15.   Effective services given to needy people that is very helpful to them.
16.   Quality is: - Planning, implementation, coordination of an activity with accuracy, diligence,
      consistency, with optimal use of resources, and ensures that the desired objectives are
      achieved.
17.   Quality means scientifically sound technology used in a way that satisfies the user as well as
      gives good outcome at right time, for the right person, at reasonable cost.
18.   Quality of care? Role of the medical colleges in improving quality care in areas line family
      planning maternal and child health areas.




                                                25
                                                                                      Annexure-VI

         Critical issues in quality of Health & F.W. services




                                           GROUP – II
                     MATERNAL HEALTH & FAMILY WELFAE

Group Representative: - Dr. Chinmaya Pataki
  PROBLEMS                PROVIDER                       SYSTEM                   BENEFICIARY
MATERNAL
PROBLEM
1. Anaemia             Ignorance               Lack of                            Non compliance
                       Take for granted         protocol(implementation)           Ignorance
                                                Quality of iron preparation        Illiteracy
2. Bleeding in 1st     No counselling          Lack of diagnostic facilities      Non compliance
   trim                Lack of                 OTC Drugs available for            Ignorance
                        expertise/knowledge      termination of 1st trimester       Illiteracy
                                                 Pregnancy                          Gender
                                                                                     discrimination
3. ANC &               Lack of motivation      Lack of protocol
   Immunisation        Financial incentives
4. High Risk           Blood transfusion       Referral and transportation      Reluctance
   pregnancies          practices                facilities for patients and
   PIH/APH                                       Health provider.
5. Delivery            Lack of resources       Janani Suraksha yojna            Institutional

                                               26
      services                                                                     deliveries not
                                                                                   100%
6. Post partum                                  Lack of follow up protocol
   and lactational
7. Family               Lack of                 Lack of protocol              Unmet need of
   planning              counselling/motinati     implementation                 contraception
   unregulated           on                                                      ignorance.
   pregnancy            Tubectomy more
                         popular than
                         vasectomy.
8. Sociocultural        Maternal death audit
   and gender           Management of near
   issues.               “miss”
9. Capacity                                      EmOC
   Building                                      BEmOC



                                          GROUP - III
                      CRITICAL ISSUES OF HEALTH SYSTEM

Group Representative: - Dr. Payal Laad
1.       Non uniformity of the Health Services.
2.       Existence of the mixed pattern across the country.
3.       Inadequate budgetary provision in both – allocation and utilization.
4.       Development is not Health Centric.
5.        Non regulation of private sector.
6.       Lack of political will.
7.       Skewed doctor to patient ratio.
8.       Lack of emphasis on health impact of industrialization and urbanization.
9.       Lack of baseline health census.
10.      Lack of data management.
11.      Ill equipped community based health insurance.
12.      Ill focused role of media.
13.      Non existence of co-ordination between medical colleges and public health.
14.      Frequent change of man power.
15.      Bureaucratic red tapism over technical heads of health programmes and medical education.
16.      Management training.




                                                 27
                                                                                    Annexure- VII

                                    Experience Sharing

   1. DR. ARUN HUMNE
      Professor & Head, Community Medicine, Govt. Medical College, Nagpur-440003,
      Maharashtra

The experience sharing is related to evaluation of mother NGOs and field NGOs under NRHM,
funded by State Health Systems Resource Centre, Pune.

Expected investigators for this evaluation were medical social workers/interns. We utilized services
of post graduate students of community medicine, who did qualitative analysis alongwith structured
evaluation as per predesigned proforma.

The last unit to be evaluated by us was the village of FNGO, where we arranged meeting of project
coordinators of MNGO and FNGOs, ANM, AWW and PRI office bearers and local leaders.

The scenario prior to this meeting was that „There was lack of co-ordination between these agents
of health care delivery system.

With this joint meeting the whole village came to know all details of MNGO & FNGO scheme,
their job responsibilities. All the stake holders at periphery accepted that there would be profound
effect, of course beneficial to achieve the objectives of the MGNO scheme.

The baseline data about the beneficiaries is with us and our team of investigators is prepared to
perform the evaluation after 6 months, in those villages without asking for additional funds from
the sponsors. The PGs have donated the remuneration they received for the present evaluation, so
the same could be used for transportation during next voluntary evaluation planned after six
months.

This has been done for 3 districts. If this model of joint venture and coordinated efforts of health
personnel, FNGOs & PRIs works to improve the quality of health care, the same can be replicated
at other places.

Post graduates are thinking of using the money saved (remuneration after expenditure on voluntary
evaluation) for improvising the PG seminar rooms.

   2. Dr. R.R. Shinde
      Professor & Head Department of PSM, G.S. Medical College & KEM Hospital, Parel,
      Mumbai – 400012

Project title     :   Establishing Integrated Disease Surveillance Programme in the hospital
                      involving clinical departments coordinated by PSM department.

Task              :   Mainstreaming IDSP in the hospital


                                                 28
Introduction: IDSP is one of the flagship programme of Government of India, promoting quality
data management in disease surveillance. The focus is ensuring uniformity, standardization,
reliability, accuracy, consistency & diligency in disease data collection, compilation, analysis and
public health applications.

Clinical specialists are rarely proactive about preparing periodic morbidity / mortality reports and
generally dissociate themselves from this activity citing their main focus on technical case
management. Further, PSM department was viewed as non-clinical department and the clinical
specialist were inclined to place the entire responsibility on PSM Department and evade ownership
of the programme. The existing situation in the hospital indicated that the “Institutional” nature of
“IDSP” would be grossly overlooked and then, there was a possibility of the programme being
reduced to an “activity” of a department (PSM).
Hence, a strategic plan of action was necessary to meet this challenge effectively. This strategic
plan is being presented as “Good Practice” strategy.

Situation Prior to Establishment of IDSP
1.     Conventional case papers, indoor papers, report formats
2.     No emphasis on quality of generating case records
3.     No supervision or cross-check of case record contents
4.     Confirmed diagnosis often not mentioned clearly on indoor case papers.
5.     Case-history, treatment, procedures, recorded inadequately.
6.     Case definition and treatment protocols now followed uniformly in all medical units.
7.     No accountability of record maintenance.
8.     Medical Records Department Staff not trained regarding accuracy in recording patient data
       (very often address written inadequately)
9.     Clinicians / resident doctors were very reluctant & termed the progress as “clerical job”
10.    The staff nurses, matron, residents viewed it as additional burden.
11.    Laboratory staff expressed displeasure of writing “more” on paper.
12.    No mandate for submission of records or reports on a daily basis.
13.    Medical Supdt / AMO on call not involved in disease report preparation.
14.    No coordinating committee for disease surveillance reporting.
15.    Collaboration with public health department for follow-up surveillance action not
       formalized.
16.    Resident Medical Officers not sensitized regarding IDSP.

In view of the above circumstances, the Strategic Approach adopted as follows:-
1.     Promote the program as “Institutional” rather than PSM Department programme pro-
       actively.
2.     Team approach essential, so a coordination committee formed involving PSM, Medicine,
       Paediatrics, Microbiology & Medical Records Department with Principal as Chairperson &
       PSM as member secretary.
3.     The action plan for coordination was outlined.
4.     The “curative”, “preventive” components of surveillance were identified & departmental
       responsibilities were outlined, identified & departmental responsibilities were outlined and
       linkage with public health department was outlined.
5.     The Dean & Director was updated & emphasized about the “Institutional mandate” &
       meeting of concerned department convened in presence of Dean.

                                                 29
6.     The micro plan was explained and an IDSP unit was located in hospital near the casualty
       area. It was proposed that this IDSP unit will be converted into Disaster Management
       Control room, during disasters.
7.     The registration counter & emergency services were identified & geared for involvement in
       IDSP.
8.     Meeting of faculty staff of concerned department held.
9.     The above meeting lead to preparation of a case-definition & treatment protocol manual for
       clinicians.
10.    All RMOs were oriented in IDSP and their role in reporting. The need for clearly writing
       the confirmed diagnosis on indoor paper was stressed.
11.    The Medical Records department staff was sensitized on the need for accuracy in recording
       data.
12.    Additional equipment for rapid blood investigations was installed.
13.    Separate proformas for compiled reporting were devised to facilitate easy record of IDSP
       cases in the words (to used by clinical residents) and also for coordinating weekly &
       monthly compilation of reports (to be used by PSM Department)
14.    Meeting convened with Executive Health Officer, public health department, to outline
       responsibilities of Insecticidal officer, MOH I/c of wards, to work with PSM Department for
       surveillance actions.

Core function of IDSP in the hospital:-
1.     Identify – confirmed disease cases and document the same (clinicians)
2.     Epidemiological investigations of cases & deaths and prepare spot map off cases (PSM
       Department)
3.     Implement surveillance actions in the community from where the cases have been located in
       the spot map along with public health department.
4.     Reporting on daily basis; timely, accurate, diligent.


Strategic Interventions for Implementation
1.     A stamp of enlisted IDSP cases was prepared and all emergency case papers were stamped
       with it.
2.     If a patient reports to emergency services the RMO on duty examines & decides whether the
       case is an IDSP case or not based on his clinical acumen. It is an IDSP case, he / she will
       mark on the IDSP stamp.
3.     The patient then goes to registration counter. If the clerk, finds that case-paper is ticked as
       “IDSP” case, he records the case in a separate IDSP register and takes due care to write
       details of address of the patient. The patient then gets admitted in the indoor ward; clinical
       unit and his record is entered in ward register by the staff nurse.
4.     The RMOs on duty in wards receive all the emergency lab reports of this patient after about
       2-3 hours. He is then able to make a confirmed diagnosis. If not, he reports as “probable”
       diagnosis.
5.     The compiled report of all such cases is sent in the proforma devised for clinical wards to
       the control unit (IDSP). The interns posted assists in the same.
6.     The PSM department RMO, visits registration counter to note all IDSP cases of the day and
       also clarifies queries regarding data, with the RMO in the ward on phone.

                                                 30
7.     A team of PSM resident, AMO on call, Lecturer on call meet in the evening at 8 p.m. and
       again at 6 a.m. next day to update the compiled report of IDSP cases.
8.     The copy of complied report is sent to Deans residence for his information and media
       management in the morning at 7.30 a.m.
9.     The Dean sends the approved compiled report in his office at 8.30 a.m.
10.    This report is collected by the control unit through the AMO posted in Deans office
11.    The compiled report is finalized as reporting of “probable‟ and “confirmed” cases and faxed
       to IDSP Head Quarters for Mumbai City (Kasturba Hospital) which in turn faxes a
       combined report of Mumbai city to State IDSP unit.

Preventive component
1.     The cases are recorded on spot map of Mumbai from their address.
2.     A mobile van reports to the given address for initiating surveillance actions. (PSM residents
       intern, surveillance workers from public health department).
3.     Deaths of IDSP cases are investigated epidemiologically by PSM residents, to ascertain
       courses contributing to death.

USP of IDSP strategy
The faculty of PSM and residents conduct a preventive OPD in KEM Hospital daily. All new
patients & patients on chronic management are first referred to preventive OPD. The preventive
OPD undertakes screening, counseling, health education, treatment of uncomplicated cases. The
Medicine & Paediatrics OPD is on the same floor and hence, where essential, immediate escorted
referral of cases is possible.

         This has facilitated cooperation & active participation of clinical faculty in IDSP. At
institutional level, PSM department has assertively introduced role of PSM faculty as “Doctors of
Health” and role of clinical specialists as “Doctors of Disease”. In public health terms, clinicians
are now referred as specialists of secondary & tertiary prevention.

Collateral benefits
1.     PSM department involved by clinical departments in integrated teaching.
2.     AMOs from clinical departments consult PSM faculty to validate research designs of their
       dissertation.
3.     Psychiatry department / OBGY department / Paediatric / Medicine department are proactive
       in participating in community health camps in rural & urban areas.
4.     AMOs from clinical department are deputed to urban health centres from community
       orientation.
5.     Students from foreign universities seeking “observership” training in clinical departments
       are essentially sent to PSM department for orientation of community based health program.
6.     PSM faculty is represented in key positions on the committees viz AEFI, Epidemic control
       task force of Public health department and committees at the institution viz. patient
       education cell, ethics department, staff society, Research Society, Sexual harassment,
       redressal committee, Academic Committee and various enquiry committee.
7.     Post of contractual data entry operator sanctioned and provision for expenses made for
       IDSP unit. Further, the location for IDSP unit / control unit ensured in developmental plan
       of hospital.


                                                 31
8.      Team from NICD visited IDSP unit in 2008, reviewed and endorsed IDSP strategy in
        hospital PSM department was included for conducting TOTs in IDSP and the model was
        discussed at NICD.


     3. Dr. Dinesh Bhanderi
        Department of Community Medicine, P. S. Medical College, Karamsad

          Evaluation of the government health care services Anand District

Objectives of Survey:
To evaluate the government health care services provided to women in reproductive age and
children under three years age in Anand district.




Minimum 40 or more households were surveyed in each cluster.

The survey was continued in each cluster till:
      Total eight children in age group 12-23 months were found
      At least two antenatal mothers in last trimester were found
      At least five postnatal mothers who delivered in last trimester were studied.

Results
Total 1283 families were surveyed.




                                                 32
Distribution of children of age less than 3 years according to place of birth
 Place of birth     Children of Age (months)
                    0-11              12-23                  24-36               Total
                    No.(%)            No.(%)                 No.(%)              No.(%)
                    37(19.9)          75(28.5)               28(26.4)            140(25.2)
 Govt. health       52(28.0)          74(28.1)               35(33.0)            161(29.0)
 center(SC,
 PHC,CHC)
 Govt. District     3(1.6)               10(3.8)             3(2.8)              16(2.9)
 hospital
 Private hospital94(50.5)           104(39.5)            40(37.7)                238(42.9)
 Total           186                263                  106                     555
                 (100.0)            (100.0)              (100.0)                 (100.0)
 Maximum number of children (42.9%) were born in private hospital.

      Birth weight of 429(77.3%) children was measured.
      85(20.3%) were low birth weight i. e. less than 2.5 Kg.
      Mamta card was available for 304(54.8%) children.
      In case of 78(14.1%) children, though the card was provided, the mother lost it.




                                                   33
34
35
   •   Mamta card was available for 304(54.8%) children.
   •   In case of 78(14.1%) children, though the card was provided, the mother lost it.

Majority (63.5%) of the children were immunized at government health centers i. e. SC, PHC, CHC
or district hospitals

 Vaccine            % Vaccine Coverage
                                     NFHS-3
                    MICS             Gujarat                 India               India
                                                             Rural               Total
 BCG                97.0                 86.4                75.1                78.2
 DPT-1              97.3
 DPT-2              93.5
 DPT-3              89.7                 61.4                50.4                55.3
 OPV-1              97.0
 OPV-2              95.8
 OPV-3              93.5                 65.3                76.5                78.2
 Measles            88.2                 65.7                54.2                58.8
 Com immu           84.5                 45.2                38.6                43.5

Vaccine Coverage
 Vaccine                                              % Coverage
 DPT                                                  89.6
 (booster dose)
 OPV                                                  90.6
 (booster dose)


                                                36
  •   All the 555 children except two were ever breast-fed.
  •   Out of 553 children who were breast fed, 343(62.0%) received it within the first hour of life.
  •   502(90.5%) children of age less than 3 years were registered at Mamta diwas.
  •    However, only 295(53.2%) children were taken to Mamta Diwas Kendra regularly.
  •   64(11.5%) children were never taken to Mamta Diwas Kendra.
  •   Only 125(22.5%) children received Mamta card, and out of that, parents of only 44(7.9%)
      children were able to show this card to the survey team.
  •   Out of 42 children having Mamta card & being taken to Mamta Diwas Kendra, the weights
      of only 15(35.7%) were plotted on growth chart during the last visit to Mamta Diwas
      Kendra.
  •   Parents of 11(73.3%) out of these 15 children were explained regarding the weight of their
      child plotted on growth chart during the last visit to Mamta Diwas Kendra
  •   During the last visit to Mamta Diwas Kendra, parents of 396(80.7%) children were given
      advice regarding their feeding.
  •   Majority(63.8%) of the children were found to be registered at Anganwadi
  •   313(76.9%) children of age nine months or more had received vitamin A around Diwali
      time.
  •   Out of these 313 children, vitamin A supplementation was recorded in Mamta card of only
      107 children.
  •   Out of the 102 pregnant women, 87(85.3%) were registered at Mamta Diwas & 77(75.5%)
      had Mamta card.
  •   Weight of 83(95.4%) pregnant women was measured during their last visit to Mamta Divas
      Center, out of which, in 57(65.5%) women, it was found to be noted in Mamta card.
  •   Blood pressure of 71(81.6%) women was measured during the last antenatal check up.
  •   88(86.3%) pregnant women were immunized against Tetanus. It was recorded in Mamta
      card of 74(72.5%) women.
  •   Though 77(75.5%) pregnant women received Iron tablets, these tablets were actually seen
      only in case of 34(33.3%) women.
  •   61(79.2%) out of 77 pregnant women were swallowing these tablets daily

Distribution of pregnant women of age15-45 years according to their knowledge of
Chiranjivee Yojna
Knowledge of Chiranjivee Yojna                       Women No. (%)
Complete knowledge                                   1(1.0)
Incomplete knowledge                                 11(10.9)
No knowledge                                         89(88.1)
Total                                                101(100.0)

Distribution of pregnant women of age15-45 years according to their knowledge of
Janani Suraksha Yojna
Knowledge of Janani Suraksha Yojna                   Women No. (%)
Complete knowledge                                   1(1.0)
Incomplete knowledge                                 9(8.9)
No knowledge                                         91(90.1)
Total                                                101(100.0)




                                                37
Institutional delivery rate was 80.5%
Place of delivery                                    Women No. (%)
Home                                                 37(19.5)
Govt. health center                                  52(27.4)
District Govt. hospital                              4(2.1)
Private hospital                                     97(51.0)
Total                                                190(100.0)

LSCS rate was 15.3%
   •   Out of 64 eligible women, only 6(9.4%) women got the benefit of Chiranjeevi Yojna
   •   Out of 123 eligible women, only 25(20.3%) women got the benefit of JSY
   •   Duration of hospital stay was comparatively longer in women who delivered normally in
       private hospital (p<0.01).

Distribution of postnatal women (during last one year) of age15-45 years according to
the postpartum visits
Postpartum visits                                    Women No. (%)
First                                                79(41.6)
Second                                               11(5.8)
Third                                                18(9.5)
Nil                                                  82(43.2)
Total                                                190(100.0)

Distribution of postnatal women (during last one year) of age15-45 years according to
the worker who made the postpartum visits
Worker who made the postpartum visits                Women No. (%)
Anganwadi worker                                     82(75.9)
ANM/FHW                                              10(9.3)
Both                                                 16(14.8)
Total                                                108(100.0)

Comparison of some study results with NFHS 3 data
Variable studied     MICS                                        NFHS-III
                     2008                                      (2005-2006)
                     Anand District %   Gujarat %            India
                                                             Total %         Rural %
LBW                  20.2               22                   21.5            23
Institutional        80.5               54.6(42.2 in         40.7            28.9
Delivery                                rural area)
LSCS rate            15.3                                    8.5             5.6
Breast feeding       62.0               27.8(25.3 in rural   24.5            22.4
started within 1                        area)
hour of birth
Vitamin A            76.9               17.1                 25.1            24.5
supplementation                         (17.9 in rural
in last six months                      area)
Consumption of       94.6               72.1                 76.1            70.1
Iodated salt

                                                38
Some observations made during MICS
    •    In small & remote villages, the distribution of „Mamta card‟ is not satisfactory.
    •   Nearly half of mothers and children are not given the card even if they attend the sessions.
    •   Inadequate supply of these cards was one of the reasons for not issuing them to the
        beneficiaries.
    •   Visits by FHW & supervisory staff were also very less than desired.
    •   Documentation of the activities performed during Mamta Diwas in Mamta card was found
        to be poor, even when they were performed e.g. measurement of Blood Pressure and
        Vitamin A supplementation.
    •   A wide gap regarding utilization of health services was found across the different socio-
        economic strata of the villages.
    •   Mamta card was not used adequately for educating the women regarding nutrition, warning
        signs, self-care & newborn care.


Recommendations
    •   IEC activities to create awareness regarding various government programmes and schemes
        need to be strengthened so as to maximize their utilization by the beneficiaries.
    •   People should be made aware of the importance of BPL card & its benefit. This is
        particularly essential in remote and small villages where BPL families are in higher
        proportion.
    •   Quality of antenatal and postnatal care should be monitored and supervised by the medical
        officers.
    •   Antenatal care sessions should be made more interactive.
       Mamta card should be extensively used for education & counseling of pregnant women &
        mothers.
    •   Supervisory staff should ensure that at least one postpartum visit is made with in 24 hours
        after birth of the baby by the health worker
    •   Presentation of completely filled Mamta/immunization card of the child may be made
        compulsory at the time of school admission so as to ensure 100% vaccine coverage.
    •   Parents of the children will also force the health workers to enter all the given vaccines and
        examination findings like weight and feeding advice in the card.

It takes whole village to raise a child.
                                                                                     African proverb




                                                  39
                                                                                Annexure-VIII

                     Presentation of the Group Work
                                       Group- A
                         Reproductive Health Services
Dr. Ramesh Bhosale, Dr. Kana Ram Jat, Dr. Gautam Mukhopadhyay, Dr. Anita Banerjee,
Dr. Pratibha Dabas, Dr. R. R. Shinde, Dr. Sudhakar Kokane, Dr. Arun Humne, Dr. Dinesh
Bhandari, Dr. Sushma Malik

Service         Outdoor                                   Indoor
Maternal        Premarital counseling                     Abnormal pregnancy
                Pre-pregnancy counseling & care           Pregnancy complications
                ANC                                       Intranatal care
                -Counseling & Education                   Normal/abnormal labour
                -History & General, systemic,             Obstetric emergencies
                abdominal, gyn. examination               Postpartum complications
                -High Risk Identification                 Tertiary care to referrals
                -Screening-
                     Hb, Urine, Rh, Bld.Gr., VDRL,
                        HIV, HBsAg, Pap
                     RTI/STI
                     Medical disorders
                -Immunization
                -Advice & Nutrition
                - Aaemia prophylaxis
                -Delivery plan
                PNC
                -Anaemia prophylaxis
                -Nutrition
                -BF, Baby immunization
                -Contraception counseling
RTI/STI         Counseling, education, behaviour          Surgical treatment
                modification,                             Complications management
                Partner counseling/treatment
                Condoms
                HIV (ICTC Integration)
                Screening – VDRL, HPV, Pap
                Diagnosis
                Treatment
                Prevention, contact tracing
                (Easy access,
                Confidentiality
                Address barriers- socio-cultural, etc.)
Contraception   Adolescents‟ Reproductive Health          Tubal ligation
                Education (jeevan shiksha)                Laparoscopic Sterilization
                (Not to call “Sex Education”)             Complications management
                Counseling of both partners               MTP Complications
                Supply of expanded basket of              Tertiary care to referrals
                contraceptives

                                             40
                    MTP
                    NSV
                    Laparoscopic Sterilization
                    (Women’s Rights & Empowerment
                    Choice)
Infertility         Education                               Operative management
                    Counseling                              Endoscopy services
                    Investigations                          Artificial Reproductive
                    Diagnosis                                           Technology
                    Treatment                               Tertiary care to referrals
                    (Access & Affordability
                    Involving male partner from beginning
                    Confidentiality
                    Address barriers- social, etc.)
Gynaec. Care        Diagnosis, Treatment, Education on      Blood transfusion
etc.                Menstrual disorders, etc                Surgical procedures
                    Menopause
                        Care
                        Cancer screening
                    Cancer- screening, treatment
                        Cervix
                        Breast
                        Ovarian,Other


General Quality Issues:-
       Woman centered                              Access
       Women‟s rights/ empowerment                 Choice
       Barrier elimination- family, social,        Patient safety
        cultural, financial, etc.                   Promptness
       Equity                                      Technical competence
       Stigma, confidentiality                     Support- family, social, self help
       Gender issues                               Attention to nutrition


SPECIFIC QUALITY ISSUES
Maternal Health
–   Early registration of pregnancies.           –   Identification of severe cases of anaemia.
–   Registration of all pregnant women.          –   Identification of pregnant women who need
–   Lost to follow up ANC women- to be               hospitalization, with signs of complications
    tracked and provide services to them.            during pregnancy and those needing
–   Focused ANC.                                     emergency care.
                                                 –   Safe abortion / MTP




                                                41
Counseling on:
–   Care during pregnancy.                      –   Care of a newborn
–   Danger signs during pregnancy.              –   Contraception
–   Birth preparedness.                         –   Importance of institutional delivery and
–   Importance of nutrition.                        where to go for delivery (Delivery Planning)
–   Registration for the JSY                    –   Identification of transport in emergency
–   Availability of funds under the JSY for     –   Importance of seeking post-natal care
    referral transport.                         –   Counseling for better nutrition
–   Exclusive Breastfeeding, Weaning and        –   Information on RTIs, STIs, HIV and AIDS
    complementary feeding.                      –   Prevention of HIV/AIDS, STIs
–   Counseling on ENBC                          –   Personal hygiene
                                                –   Dangers of sex selection

CONTRACEPTION
–   Contraception counseling
–   Information on use of contraceptives.
–   To give condoms, OCPs and other contraceptive services as per their choice to all eligible
    couples.
–   Compensation for loss of wages resulting from sterilization and insurance scheme for family
    planning.

RTI / STI
–   Counseling on prevention of RTIs and STIs, including HIV/AIDS, and diagnosis and treatment.
–   Counseling for perimenopausal and post-menopausal problems
–   Information on causation, transmission, and prevention of HIV/
–   AIDS and distribution of condoms for dual protection.
–   VCTC and PPTCT services

GYNAEC CARE
–   Education of girls.
–   Awareness activities for prevention of pre-natal sex selection, illegality of pre-natal sex
    selection, and special alert for one daughter families.
–   Communication on the Prevention of Violence against Women, Domestic Violence Act, 2006.
–   Age at marriage, especially the importance of rising the age at marriage for girls.
–   Identification of problems of the old and the destitute.
–   Special attention to the vulnerable and weaker sections of society.

DATA MANAGEMENT:
– Audit of deaths of women.

Mechanisms For Addressing The Quality Issues
    1. Use of protocols
    2. Setting quality indicators
    3. Monitoring and Evaluation, Audits

                                               42
  4. Training HCPs in “Quality services”
  5. Start accreditation process
  6. Adequate health-man power and expertise
  7. „Adequate‟ Training and re-trainings and feedback
  8. Accurate estimate of clients/beneficiaries
  9. GIS mapping of maternal morbidities/mortalities
  10. Identify causes for home deliveries
  11. Seniors / experts to take lead role
  12. Use of Media
  13. Use of technology- PDA, mobile, computers, telemedicine
  14. Involve and train local leaders- social, religious, political
  15. Increase people‟s awareness- maternal care, RTI etc.
  16. Incentives to HCW
  17. Good practices- 6 Cs
  18. Increase financial allocation, creating special expenditure head
  19. Mobilize political will, utilizing part of budget of MPs/MLAs for health facility
  20. Integration with ICDS
  21. Involve Community Based Organizations viz. microfinance credit for empowerment
  22. Organizing camps- specialized, need based, screening oriented, educating
  23. Convergence with RTO for directives to transport pregnant women with priority.
  24. Linkages with National Rural Employment Guarantee Scheme
  25. Promotion of PPP schemes for medical or non-medical issues e.g. transport
  26. Contraception
          a. Access- anonymous supply
          b. Awareness
          c. Choice
          d. Women empowerment
          e. Education of adolescents
          f. Postnatal counseling
          g. Educating religious leaders
          h. Political reorientation towards population policy in context of economy


Role of Medical Colleges In Improving The Service Delivery
  1.  Tertiary level care and feedback to health service system
  2.  Motivation and training of faculty of all medical colleges and HCPs in “Quality services”
  3.  Development of protocols for all levels of health care delivery
  4.  Develop referral protocol
  5.  Maternal death audit, „near-miss‟/morbidity medical audit
  6.  Undertake research on relevant research question of priority areas e.g. operational,
      evaluational, etc.
  7. Dissertations of PGs focused on national health with special reference to rural area
  8. Monitoring/supportive supervision and evaluation through feasible mechanisms.
  9. Updating UG & PG syllabi, incorporating evidence based technical strategies of
      RCH/NRHM concepts and implementation framework
  10. Ongoing inclusion of emerging programmatic interventions in teaching e.g. PNDTA/sex
      selection, gender issues, male participation, etc.
  11. Integrated teaching of UG/PG students within college and with program managers
  12. Examinations to include questions relevant to NRHM/RCH
  13. Training activities- TOT, various HCPs at district/state/national levels
  14. CMEs
  15. Participation in policy making process / planning

                                             43
16. Develop partnership with state/district health/FW authorities to strengthen training and
    improve quality services.
17. Participating in developing PIP micro-planning at district/state level
18. Linkages with social groups, NGOs
19. Public education through media etc.
20. Liaison between medical education and public health (MoU)
21. Telemedicine resource center
22. To form advocacy consortium for administrative and technical reforms.
23. Collaborate with FOGSI, IAP, IAPSM




      Together We Succeed To Achieve Goal of India‟s Health NRHM




                                           44
                                           Group B
       Child Health Services Including Newborn Care Preventive &
                            Curative Services
Dr. Geetanjali Jindal, Dr. Geetika Dheer, Dr. Jitendra Deshmukh, Dr. Mohan K.D, Dr. M.S Pawar,
Dr. Nitin Raithatha, Dr. Navneet, Dr. R. N. Kulkarni, Dr. Sohini Bhattacharya

Objectives
      Enumeration of the outdoor & inpatient services
      Relevant quality issues
      Mechanism for addressing these issues
      Improvement of health care delivery at all levels

Outdoor services
              General pediatric OPD                           Immunization
              Well baby clinic                                Nutritional       assessment   and
              High risk neonatal clinic                        counseling
              Growth & development assessment                 Genetic counseling
              Breast feeding counseling                       Rehabilitation services
              Adolescent services                             Special clinics
                                                               Side lab services
Indoor services
              Neonatal resuscitation                          PICU
              NICU                                            Pediatric ward
              Nursery                                         Pediatric emergency services
              KMC                                             Isolation services
              Post natal ward                                 Side lab facilities

   Quality issues….
   How do we address them?




          Adequate manpower at all levels
          Medical, paramedical, supportive service staff




                                                45
                                                    Appropriate qualifications
                                                    Induction training
                                                    Inservice training
                                                    CME
                                                    Approximately 10% of newborns require
                                                     some assistance to begin breathing at birth.
                                                     About 1% require extensive resuscitative
                                                     measures
                                                    Neonatal resuscitation
                                                    All concerned with newborn care! Not only
                                                     pediatricians


        Pediatric advanced life support
             For pediatricians, emergency physicians, family physicians, physician assistants,
           nurses, nurse practitioners, paramedics, and other healthcare providers who initiate and
           direct advanced life support in pediatric emergencies.




Motivation, sense of responsibility, accountability, communication skills and human touch

Quality issues…
    Physical Infrastructure
         As per the standards
    Basic amenities
         As per the site standards
Patient friendly atmosphere




                                                46
                                         Role models
Quality issues…
     Adequate biomedical equipment and instruments and consumables (drugs,
      disposables etc.) of good quality

            
            Purchase
            
            Maintenance(AMC/CMC)
            
            Sensitization and knowledge regarding proper utilization of funds
            
            Training of the staff regarding proper handling,usage and maintenance of
            equipment
     Back up of Biomedical engineer

Funding
     Adequate funds from the concerned administration
     Sensitization regarding proper utilization of funds
     Proper biomedical waste disposal at all levels as per standard guidelines
     Reinforcement of infection control practices




Quality issues….
   Ensuring good quality services
        Strict adherence to standard protocols by concerned health care providers
        Periodic check of quality of services provided
        Supervision by senior faculty
        Review meetings /audit
        Exit interviews of beneficiaries


                                                     Record keeping

                                                         Accurate        and        complete
                                                          documentation and record keeping
                                                                   ICD -10 coding
                                                                   Medical certification of death
                                                                   Daily ward notes
                                                                   Data entry personnel
                                                                   Periodic statistical meetings




                                                47
Quality issues…
   Ensure follow up
        Counselling
        Follow up cards
        Tracking of the lost to follow up patients (correspondence via letter, phone, home visit)

Quality issues…
   Health education
            Counselling
            Audio-visual aids
            Use of mass media

Quality issues…
    Optimizing patient turn around time
        Adequate manpower
        Adequate equipment
        Sensitization of staff
        Patient feedback
        Regular monitoring of the turn around time

Referral
    Sensitization of the peripheral health organizations regarding the importance of a good
     referral
          What
          when
          Where
    Appropriate feedback to the referring authorities

Citizen charter
    Proper exhibit of the existing facilities available at appropriate places

Mobile units to carry sick patients to the hospitals
    Mobile health unit to visit underprivileged and marginalized pediatric population
        Foster homes/orphanages

Role of medical colleges in improvement of health care delivery at all levels
      Inservice training of the medical and paramedical staff from village levels to district levels
      Identifications of the various units to establish such linkages
      Monitoring of the impact of training at these peripheral health units
      Linkages to district hospitals for higher level of care via improved referral services
      Telemedicine facilities connecting to district and village level
      Research with orientation to rural areas
      Mobile health unit to visit underprivileged and marginalized pediatric population
            Foster homes/orphanages




                                                  48
                                              Group C
     Communicable And Non-Communicable Diseases (Preventive And
                        Curative Services)
Dr.A.P.Kulkarni- Chairman, Dr.Pallavi Shelke- Presenter, Dr.P.S. Adhav, Dr. Ashok Salwan, Dr.
Pankaj Patil, Dr.S.Deshpande, Dr. Omprakash Shukla, Dr.S.Choudhary

Outdoor services (OPD)
1.      Help desk                                  10. Store –general
2.      Registration                               11. Record section
3.      Waiting                                    12. Nursing station
4.      Examination-                               13. Ambulatory service-interdepartmental
        -dept OPDs, -speciality OPD                14. Minor OT
5. Investigations (lab, imaging)                   15. Physiotherapy
6. Education and counselling                       16. Immunization and ORT corner
7. Pharmacy                                        17. Ambulance
8. Notification                                    18. FP & BCC
9. Billing


Outdoor services (OPD)-other
         Casualty (with MLC section)
         Blood bank
         PRO
         Post-mortem and mortuary services

Indoor services
     1.   Registration                                 Anaesthesia service
     2.   Wards                                        7. Record section
     3.   Pharmacy                                     8. Follow up service
     4.   Non-medical store                            9. ICUs and ICCU
     5.   Operation theatres

Supportive services
     1.   House keeping                                 10. Security
     2.   Waste management                              11. Telephone(EPABX) service
     3.   Kitchen                                       12. Computer section (HMIS, IDSP)
     4.   Sterilization unit                            13. Administrative –ministerial staff e.g.
     5.   Laundry                                            accounts
     6.   Water supply                                  14. Public address system
     7.   Cold chain facility                           15. Out-reach activities
     8.   Utility services e.g. telephone, bank         16. RKS and others
     9.   Relatives accommodation (Dharmashala )        17. MSW services

Issues
      MCI norms as per no. of students not work load
      Norms for teaching not for hospital services provided for support staff
      Tertiary care hospitals compelled to primary care services
                                                 49
     Red tapism
     Lack of formal managerial training and Communication skills
     Lack of SOPs and protocol
     No updating and timely information regarding changing guidelines of health care

Tools for quality monitoring and evaluation
   MCI and nursing council norms                       Periodic reports and interim assessment
   Accreditation norms e.g. NABH, NABL                 Death audit
   TISS norms? Not yet accepted by GOI                 Performance budget
   Quality assurance committee                         Citizen charter
   Grievance redressal committee                       Various committees- HICC, purchase
   RTI                                                  committee
   Internal, external audit- financial,                Staff grievances redressal
    performance                                         Outsourcing
   MET cell, CME points                                G-OPD
   Ethical and research committee(Inst                 Operational research
    Research and Review board)                          Using existing norms and standards e.g.
                                                         ISO, Blood bank, FDA norms


Linkage mechanisms
     Liaison officer
     Inclusion of public health specialists in services provided by medical college
     Inclusion of medical college specialists in services provided by public health personnel
      referral feedback mechanism e.g. IMNCI, DOTS, ASHA
     Training and updating of para-medicals, medical officer and other public health officials
     Public-private partnership
     Collaborating with PRI at peripheral level
     Liaison with HFWTC
     RCH mela, out-reach camps e.g. prevention of blindness, cancer detection




                                               50
                                       GROUP - D
      Supervisory Check List For Quality Services During VHND
Dr. Deepak Phalgune, Dr. Vijay Kamale, Dr. Seema Anjenaya, Dr. K. R. Shah, Dr. Bidyut
Kumar Basu, Dr. Moneet Walia, Dr. Anjali Edbor, Dr. Chinmaya Pataki, Dr. Payal Laad

Village Health Nutrition Day (VHND)
      Once a month
      Hub of services in RCH II, NRHM
      Inter-sectoral convergence
      Platform for interfacing between community & the health system
      Roles of ASHA, AWW , ANM well redefined
      Outcomes should be measured and monitored

INTRODUCTORY INFORMATION
      Name of the Village                               Date of visit
      Name of the Sub centre                            Name of the Block
      Name of the PHC                                   Name of the District
                                                        Name of the State
INFORMATION ABOUT ASHA
      Name of the ASHA
      Qualification
      Years / Months of service
      Training received - Y/N
      Disbursement of incentives for mobilizing clients - Y/N

INFORMATION OF AWW
      Name of the AWW
      Qualification
      Years / months of service
      Training received - Y/N,
      If yes, Induction / IMNCI/any other
      Remuneration amount whether received regularly - Y/N

INFORMATION OF ANM
      Name of the ANM
      Years / months in service
      Training received
      If Yes (SAB / IMNCI any other ) - Y/N
      Married - Y/N
      From Govt. Setup / Contractual

VITAL INFORMATION
      No of deaths in last month                        No. of marriages
      – 0-2 months                                      No. of child marriages
      – 2m – 5yrs                                       No. of new births

                                              51
    – Maternal
    Causes of the death

MATERNAL HEALTH
    No. of families SC/ST
    No. of families of SC/ST ASHA visited
    No. of pregnant women registered ( List)
    No. of women registered before 12 wks of pregnancy (list)
    No. of women having high risk pregnancy (list)
    No. of pregnant women having two living children (list)
    No. of high risk pregnancy women referred to PHC for check up

MATERNAL HEALTH…
    No. of mother beneficiaries of JSY and amount given
    No. of pregnant women checked for
    – Blood pressure
    – Hb
    – Urine examination
    No. of women received TT - one dose & two doses
    No. of women received IFA and how many

MATERNAL HEALTH…
    No. of pregnant women received counseling for
    – Care during pregnancy.                        – Post-natal care.
    – Danger signs during pregnancy.                – Breastfeeding & complementary feeding.
    – Birth preparedness.                           – Care of a newborn.
    – Importance of nutrition.                      – Contraception
    – Institutional delivery.
    Identification of referral transport if needed
    Identification of nearest FRU/DH for referral ( Distance from the village)
    Availability of funds under JSY for referral transport and the amount given

POST NATAL CARE
    No. of visits to the house post delivery and days of visits
    No of visits to the house in cases where newborn was underweight and days of visit

FAMILY PLANNING
   No. of eligible couples in the village
   No. of eligible couples using contraception
   – spacing – condoms /OC pills / IUCDs
   – permanent methods - Tubectomy / vasectomy
   No. of condoms distributed in a month
   No. of OCPs distributed in a month
   No. of IUCDs inserted in a month
   No. of tubectomies and vasectomies performed in a month




                                            52
CHILD HEALTH
      No. of LBWs
      Counseling for care of newborns and feeding - Y/N
      No. of primary immunization given
           –    BCG                                  –      DPT- 1,2,3
           –    OPV-0,1,2,3                          –      MEASLES & Vit A

Infants up to 1 year:
      No. of infants completely immunized
      No. of infants regularly weighed
      No. of infants reporting AEFI
      No. of infants with malnourishment grade III & IV (list)

Children aged 1-3 years:
      No. of children who received Booster dose of DPT/OPV.
      No. of children who received Second to fifth dose of Vitamin A
      No. of children who received Tablet IFA - (small) to children with clinical anaemia.
      No. of children who were weighed regularly.
      No. of children who received supplementary food for grades of mild malnutrition
      No. of children who were referred for severe malnutrition (list).

All children below 5 years:
      No. of missed children tracked and vaccinated by ASHA and AWW.
      No. of Cases of diarrhea
      No. of Cases managed for diarrhea
      No. of ORS distributed
      No. of Cases of diarrhea referred to PHC / FRU
      No. of cases Acute Respiratory Infections.
      No. of Cases of ARI referred to PHC / FRU
      No. of mothers counseled on home management and where to go in event of complications.
      Organizing ORS depots at the session site - Y/N
      No. of mothers counseled on worm infestations

RTI & STIs
      No. of sessions on counseling on prevention of RTIs and STIs, including HIV/AIDS
      No. of cases referred for diagnosis and treatment of the same
      No. of women counseled for peri-menopausal & post-menopausal problems
      Referral for VCTC and PPTCT services to the appropriate institutions.

SANITATION
      No. of households having the sanitary latrines
      No. of households identified for the construction of sanitary latrines
      No. of households guided on Total Sanitation Campaign
       No. of breeding sites identified for mosquitoes
       No. of households mobilized for community action for safe disposal of household refuse
      and garbage



                                               53
WATER SUPPLY
     No. of households having the access to safe water supply
     No. of days chlorination of well is performed in a week

COMMUNICABLE DISEASES
     No. of group communication sessions held for raising awareness about signs & symptoms
     of leprosy, suspected cases, and referrals.
      No. of depots for collection of blood film for MP and presumptive treatment.
     No. of sessions on awareness generation about TB
     No. of symptomatic sent for sputum examination at the nearest health centre
     No. of patients provided with DOTS
     No. of unusual numbers of cases of any disease or disease outbreak reported in village

GENDER
     No. of sessions held for prevention of pre-natal sex selection
     No. of sessions held on prevention of violence against Women
     No. of sessions held on age at marriage
     No of women married before the age of 18yrs

HEALTH PROMOTION
     No. of sessions held on :
                        – Tobacco chewing                             –   Proper exercise
                        – Healthy lifestyle                           –   Food that can be grown
                        – Proper diet                                     locally

Check list of VHND
     No. of women came for the VHND
     No. of pregnant women came for the VHND
     No. of lactating mothers came for the VHND
     No. of women attended having under 5 children
     No. of women attended with malnourished children
     No. of malnourished children in need of supplementary nutrition
     No. of malnourished children availed supplementary nutrition
     No. of patients suffering from Tuberculosis
     No. of patients came to collect DOTS

Inspection of AW
     Cleanliness
     Ventilation
     Light
     Safe drinking water
     Place of privacy for ANC
     No. of MCH cards
     Toys and other things for NFPSE
     Charts, posters, photographs
     Vaccine supply available - Y/N
        – OPV - DPT             - Measles
     Storage of vaccine vials – Appropriate – Y/N
                                              54
      Cold chain maintained - Y/N
      Ice packs available - Y/N
      Place of giving vaccination – Satisfactory – Y/N

Inspection of VHND
      M.O. present – Y/N
      ANM present - Y/N
      MPW present - Y/N
      School teachers present - Y/N
      Sarpanch / PRI member present - Y/N
      Village Health and sanitation committee members present - Y/N
      SHG present - Y/N
      NGO ( If applicable) members present - Y/N

Instruments
      Examination table                                   BP instrument
      Bed screen/ Curtain                                 Checking calibration of BP instrument
      Weighing machine scale – Adult Child                Stethoscope
      Checking of weighing machine for                    Measuring tape
      accuracy
      Gloves availability                                 Kit for urine examination
      Syringes and needles , disposal of them             Laboratory consumables, eg. Stain,
      Foetoscope                                          Slides
      Hb meter                                            IEC material

Medicines
      Vit A                                               DOTS
      IFA tabs                                            Tab Paracetamol
      ORS                                                 Condoms
      Tab Cotrimaxazole                                   OCPs (ECPs)
      Antihelminthic drugs                                AYUSH
                                                          Home remedies for common ailments

Publicity
      VHND programme schedule displayed & disseminated - Y/N
      Timing of VHND programme
      Wall writing on local language
      Hoarding present - Y/N
      Handbills , pamphlets distributed - Y/N

Client satisfaction
    Exit interviews with 5 clients ( 1 pregnant mother, 1 lactating mother, 1 each Adolescent girl
    & boy, 1 Post menopausal woman)
      Focus Group Discussions
      Interviews regarding dates of repeat visits for immunization, birth preparedness and the
      institution identified for delivery.




                                                55
                                                                                       Annexure- IX

Suggestions given by Participants to involve Medical Colleges in
NRHM

A. Maharashtra
 Name of Participant        :   Dr. R.R. Shinde
   Department                :   Preventive and Social Medicine, Prof. / Head, G.S. Medical
                                 College, Mumbai

   1)  Involve faculty of PSM department in training programmes as (TOTs) resource persons at
       state and district and national levels.
   2) Recognize Rural Health Training Centres affiliated to PSM department – Medical College
       as a component of primary health care system and provide funds structural and functional
       upgradation. The staff can be utilized for evaluation and research.
   3) Medical Colleges located in metro cities (e.g Mumbai) serve as apex institute, catering to
       rural populations in the state. Hence, should receive funds, as per provision for a district
       hospital in NRHM.
   4) Faculty of PSM (Professors) to be involved as members of Quality Assurance Committees
       under NRHM.
   5) Faculty can undertake monitoring, evaluation and research activities to create evidence for
       strategic modifications.
   6) Faculty can be involved as planners to assist state/district, to develop PIPs
   7) Postgraduate students can be given “dissertation” assignments for M/D. / D.P.H. course
       on “NRHM “ issues and the same may be considered for financial support.
   8) “NRHM” newsletter can be developed at state level to include updates / progress of
       NRHM, involving PSM faculty as Editors / editorial team members.
   9) Promote formation of state level public health consortium, affiliated to National Public
       Health Consortium, of NIHFW to create advocacy platform for NRHM, thereby average
       as stakeholders in policy development.
   10) Document the role of medical colleges in NRHM (govt.) circulars, generated at National /
       State levels through health secretary / Mission Director. A letter indicating inclination or
       directives to the state to involve medical colleges (especially PSM faculty) at all levels for
       technical and managerial support in NRHM.
   11) Issue directives to universities to include NRHM in Medical syllabus for UG/PG courses
       in PSM, Gynaecology and Obstetrics, Pediatrics.

 Name of Participant        :   Dr. Mohan Doibale
   Department                :   PSM Department, Govt.           Medical    College,    Aurangabad,
                                 Maharashtra

   1)   NRHM – policy making at all levels.
   2)   Quality Assurance Committee – state and district level
   3)   Training and evaluation at district level
   4)   Rural Health Training Centres under PSM department of Medical Colleges should be
        treated as FRU/CHC under NRHM and funds should be made available.
   5)   PSM department as State Health Training Centre or Regional Training Centers should be
        supported under NRHM.
   6)   Convergence at district and state level in PIP and DLHAP.


                                                 56
 Name of Participant        :   Dr. A.P. Kulkarni
   Department                :   Sr. Consultant, State Health Systems Resource Centre, Pune

   1)   Inclusion of at least one senior faculty of PSM in preparation, monitoring of district PIP
        (although recommended, it is not practiced actually)
   2)   Inclusion of faculty of Medical College in third party evaluation of programme under
        NRHM with monetary incentives.
   3)   Sanction of grant in aid to M.D (Thesis) projects as is available under RNTCP
   4)   Inclusion of faculty in Medical Colleges in training programmes at HFWTCs, DTTs
   5)   Preparing PIPs for Medical Colleges and allotting grants for activities under NRHM.
   6)   Allotment of a district to a willing medical college with institute serving as “Guardian” for
        NRHM.
   7)   Currently the field practice areas of medical colleges are in „no-man‟s-land‟. They should
        be given budget from NRHM which will bring accountability and their participation.
   8)   Sensitization of Deans on NRHM.

 Name of Participant        :   Dr. D.S. Phalgune
   Department                :   PSM, KEM Hospital Research Centre, Pune

   1)   Involvement in various training programmes under RCH II
   2)   Formulate strategies to implement, monitor and evaluate NRHM.
   3)   Teaching UGs and PGs regarding various aspects of NRHM.

 Name of Participant        :   Dr. Sushma Malik
   Department                :   Professor (Paediatrics) Incharge – Neonatology, Nair Hospital,
                                 Mumbai
   The Medical Colleges should be involved firstly in the departments of Paed/ Obst./PSM
   (a) Preparation and planning of programmes at grassroot level
   (b) Preparation of SOP and making of protocols
   (c) Should be involved in the training of community health workers
   (d) Regular updates of all new things happening in NRHM should be conveyed to medical
        colleges, so that the knowledge can be given to all UG & PGs

 Name of Participant        :   Dr. R.A. Bhosale
   Department                :   Obstetrics & Gynaecology, B.J. Medical College, Pune Station
                                 Road, Pune-411001, Maharashtra
   1)   Medical College Professors may be involved in policy / programme making from drafting
        stage.
   2)   Medical Colleges can be involved as Resource Centre for Tele-medicine facility.
   3)   For training of various sort at district / State / National level, TOTs, CMEs.
   4)   Appropriate Technology development and utilization.
   5)   Involve in research in priority areas the faculty & large number of post graduate training
        & give funding.
   6)   Involve universities for updating syllabus.
   7)   Arrange conferences / seminars / symposium on Health Programme like NRHM with
        Medical colleges and fund it to inculcate in PG/UG students.
   8)   Use as Intellectual capital / „think tank‟.


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 Name of Participant       :    Dr Anita Banerjee
   Department               :   Pediatrics, Indira Gandhi Government          Medical    College
                                (IGGMC), Nagpur-440012, Maharashtra
   1)   Teachers to be involved in decision making.
   2)   Training of ANMs and MOs in Medical College (deputation) and organizing workshops,
        follow up.
   3)   Protocols for management of diseases to be ascertained by the Professors from time to
        time.
   4)   Protocols for referrals and further management of those patients when they arrive at
        tertiary hospital.
   5)   Streamlining of services at all levels of health care.

 Name of Participant       :   Dr. R.N. Kulkarni
   Department               :   PSM, G.S. Medical College, Deptt. of PSM, Parel, Mumbai-
                                400012, Maharashtra
   1)   Medical Colleges are given valuable inputs to State health department for quality
        improvement in program implementations including NRHM via Quality Assurance Cells.
   2)   Medical colleges can be involved in pre-service training to various health functionaries.
   3)   Medical college faculties can carry out monitoring and evaluation of health programme
        run by State health departments.
   4)   Medical colleges can admit and treat serious patients referred by peripheral health
        facilities running health services.
   5)   Medical college can develop Standard of Practices (SOP) or protocols to carry out various
        treatment modalities / procedures.
   6)   Medical colleges can offer hands on training for family welfare procedures such as lap
        sterilization, minilap, NSV etc.
   7)   Medical colleges can impart latest treatment modalities / new development in other
        aspects of health care delivery.

 Name of Participant       :   Dr. Adhav Prakash
   Department               :   PSM, B.J. Medical College, Pune Station Road, Pune-411001,
                                Maharashtra
   1)   Training faculty for various cadre.
   2)   Model service provider.
   3)   Bringing vital contents in the MBBS curriculum.
   4)   Allotting the topics related to NRHM to PG Dissertation so that P.G will have in-depth
        knowledge in these issues.
   5)   Chairman / member of group of committee evaluating the NRHM delivery in remote area.
   6)   To provide regular feedback (monthly or quarterly)

 Name of Participant       :   Dr. Shailesh R. Deshpande
   Department               :   PSM, State Health Systems Resource Centre, Pune
   1)   Dialogue between DHS & DMER of the States, facilitated by interventions at higher
        level. Subsequently meeting of Dean / Principal / Director may be arranged.
   2)   PSM departments, especially their field practice area may be given specific assignments
        and necessary budget through NRHM or through other appropriate budget.
   3)   Inclusion of NRHM issues in UG & PG curriculum after consultation with MCI,
        Universities and DMER.


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   4)   Budget provision to esp. Obst. / Gynae. & Paediatrics departments for purchase of
        necessary drugs and equipments.
   5)   District / State PIP should include contributions from Medical Colleges & proportionate
        budgetary provision.

 Name of Participant       :   Dr. Chinmay Pataki
   Department               :   Obst. & Gynae, LTMMC, Sion, Mumbai-22
   1)   Involved Medical colleges HODs in Policy making.
   2)   Revamp all Medical Colleges as it is NRHM‟s responsibility also if it expects fault from
        Medical Colleges to train the trainee.
   3)   Renovate the basis facilities in Medical Colleges
   4)   Make the training programmes. Reward based in terms of Infrastructure development.
   5)   Stop doing quick fix like 16 weeks training to perform cesarean, rather put faculty on
        deputation on monthly basis with good incentives.
   6)   Improve Library facilities which are poorer than periphery.
   7)   Keep track of obscene amount of money put blindly in health programmes without any
        practical change.

 Name of Participant       :   Dr. Payal Laad
   Department               :   Community Medicine (PSM), LTMMC, Sion, Mumbai-22

   1)   Rural health training centre can be given the funds under NRHM. This would help
        medical college function better. All medical colleges are required to have rural training
        centres under their administration, constraint faced is in form of funds to set up
        infrastructure.
   2)   Research done in rural field practice area should be funded by NRHM, Research and
        development committee. The way to obtain fund should be intimated well on website of
        NRHM.
   3)   The Quality Assurance Committee should be including technocrats from Community
        Medicines Dept. of Medical College.
   4)   Medical colleges can become facilitator for training or evaluation as a third party under
        NRHM.

 Name of Participant       :   Dr. Pallavi S. Shelke
   Department               :   PSM, LTMMC, Sion, Mumbai-22

   1)   Involving in preparing PIP.
   2)   Protocol preparation.
   3)   Involving them at planning, policy making level.
   4)   Covering Rural Health Centres attached to Medical Colleges under NRHM.
   5)   Communicating adequately and timely the changing strategies, so that it can be taught to
        UG & PG students.
   6)   Sponsoring relevant research work or model projects.

 Name of Participant       :   Dr. Madhukar S. Pawar
   Department               :   Principal, HFWTC Nasik

   1)   Involve of PSM, Obst. & Paediatric Dept. of medical college in preparation of Dist. PIP.
   2)   Involvement concerned departments of MC for preparing training modules of various
        trainings under NRHM.


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   3)   Research studies in impact evaluation/process evaluation of NRHM activities in Non
        NRHM Vs NRHM area or before and after NRHM.
   4)   Involving teachers of concerned dept. of MC as Master trainer /GOI for different
        trainings.
   5)   To get exposure to recent advances in health care delivery district /divisional level health
        authorities to be called as guest lecturer for training undergraduates.
   6)   Preparing SOPs, quality standards for different procedures/activities under NRHM.
   7)   Doing facility survey with help UGs/PGs
   8)   Supportive supervision of activities like IPHS, CHCs PHCs, SC etc.

 Name of Participant       :   Dr. Arun Humne
   Department               :   PSM, Govt. Medical College Nagpur, Near Hanuman Nagar,
                                Nagpur-440003, Maharashtra

   1)   Sensitization of Directors, medical Education and Research, and the Deans is required.
   2)   Professor and heads of Community Medicine can work as Regional Coordinator to
        supervise the work of dist. Program managers.
   3)   Regular evaluation of various schemes like ASHA, MNGO, JSY can be done by
        community Medicine preferably in the month of July/August.
   4)   Community medicine, Obst. and Paediatrics can impart training to all the workshop in
        NRHM.
   5)   Professors and Heads at least Community Medicine should be involved in all National
        Health Programs right from planning through implementation. So that the details of the
        program can be taught to medical students concurrently as it takes some years to appear
        the program in text books.
   6)   Professor and Heads, Community Medicine Obst. and paediatrics should be on mailing
        list and should be updated with recent advancements in NRHM.

 Name of Participant       :   Dr. Anjali Edbor
   Department               :   Pediatrics, N.K.P. Salve Institute of Medical Sciences & LMH,
                                Digdon Hills, Hingna Road, Nagpur-440019, Maharashtra
   1)   Involvement of Paediatrician at the PHC level.
   2)   Interaction of the ANM, AWW & ASHA with Medical Faculty.
   3)   Involvement of Private Medical Colleges situated in Rural Area for all concerns.

 Name of Participant       :   Dr. Vijay N Kamale
   Department               :   Pediatrics, MGM Medical College, Kamothe, Navi Mumbari,
                                Distt. Raigad-410209, Maharashtra
   1)   Orientation of Dean regarding NRHM Programmes & its importance in patient care
        (quality).
   2)   Orientation of teaching staff through emails or publication.
   3)   Making aware of teaching staff by sending publications to library at reasonable cost.
   4)   Displaying on NRHM website about research they wanted for improvement of quality
        care at community level.
   5)   To train ASHA/Anganwadi worker and make them aware of local accredited hospital as
        well as Medical College.
   6)   A visit to Anganwadi, sub-centre, PMC & FPV made compulsory for undergraduate
        student.
   7)   Communication skills & counseling – a practical assessment should be compulsory for
        both U.G & P.G students.


                                                60
 Name of Participant       : Dr. Jitendra K. Deshmukh
   Department               : Obstetrics & Gynaecology, Govt. Medical College, Nagpur-
                              440010, Maharashtra
   1)   As integrator between health services and NRHM.
   2)   Facilitator in Programmes.
   3)   Tutor for up-gradation of knowledge.
   4)   Monitoring of services
   5)   Accreditation of centre.
   6)   Feedback centre – on morbidity & mortality.

 Name of Participant       :   Dr. Seem Anjenaya
   Department               :   Prof. & HOD Dept. of PSM, MGM Medical College, Kamothe,
                                Navi Mumbari, Distt. Raigad-410209, Maharashtra

   1)   The medical colleges should be involved right from the stage of planning, policy and
        decision making.
   2)   Funds from NRHM should be provided to medical colleges, so that atleast the objectives
        of NRHM could be fulfilled in the field practice areas of medical colleges.
   3)   Training and retraining of faculties from dept. of PSM OBGY & Paediatrics.

 Name of Participant       :   Dr. Pankaj Patil
   Department               :   Obs/Gyne, MGM Medical College, Kamothe, Navi Mumbari,
                                Distt. Raigad-410209, Maharashtra

   1)   Immediate
   2)   Involve medical college administration
   3)   Provision for LSCS and remuneration
   4)   All family planning measures should be applied
   5)   Accreditation medical college hospital

 Name of Participant       :   Dr. Sudhakar Kokane
   Department               :   Public Health Deptt., Govt. of Maharashtra, Principal, Health &
                                Family Welfare Training Centre, Pune

   1)   Involvement of Medical College – Especially Deptt. of PSM Gynae, Obst., Paediatric,
        Microbiology to prepare annual PIP for district.
   2)   Separate PIP for each medical college or atleast concerned about RCH activities should be
        prepared.
   3)   Orientation about NRHM of all HOD of medical college alongwith Dean & DMER.
   4)   Medical college can be involved for preparation of Training material.
   5)   Quarterly meeting of Director of Health Services with Medical Education Director and all
        concerned Deans with specialists.
   6)   Convergence between ICDS, Medical, Education & Health Services, Social Welfare &
        Tribal Deptt. – Monthly Review by Chief Secretary of Govt.
   7)   Field visit arrangement to PHC, SC, CHC & District Hospital with medical College
        people to give suggestion to improve health delivery system and medical college people
        will also be oriented there by health service people.




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B. Gujarat
 Name of Participant       :   Dr. Dinesh Bhanderi
   Department               :   Community Medicine, Pramukh Swami Medical College,
                                Karamsad-388325, District Anand, Gujarat

   1)   One faculty from Community Medicine should be a member of District Health Mission.
   2)   Community Medicine department should be involved in PIP as well in process of
        monitoring and evaluation.
   3)   50% of Medical Colleges are private. Their role in NRHM should be clearly defined.
   4)   MBBS curriculum must include orientation about NRHM & some practical training.
   5)   Faculty may be trained in quality assurance so that they can act as Consultants in that
        field.

 Name of Participant       :   Dr. O.P. Shukla
   Department               :   Paediatrics, Medical College Baroda

   1)   Allocation of funds to Medical Colleges in N.R.HM.
   2)   A good Quality Services Training and Workshop such trained persons be designated as
        NRHM Quality Consultants.
   3)   Medical Colleges can be involved in training & teachings
        (a) EmNC training (Emergency Newborn Training) for Medical Officers – 4 months
              course – presently run by some Medical Colleges.
        (b) EmNC training for Nurses – 1 month training
   4)   Funds are allocated for Trainers / Trainees / One time Infrastructure Grants / Stationary
        and contingency. Some of these Grants can be utilized for upgradation of Department
   5)   Medical Colleges can be involved in
        – Policy making
        – Advocacy
        – Teaching / Training of MOs / Health Workers
        – Evaluation
        – Supervision
        And funds should be allocated for faculties / trainees plus extra funds for contingencies –
        so that this money is used for departmental activities. For all these activities, direct
        funding to the department should also go so as to enrich the department.
   6)   Proper services / job environment and job satisfaction including good payment vis-à-vis
        private Consultants so as to increase the already good motivation of Medical College
        teachers and a uniform policy for all Medical Colleges in the State as that of Centre
        including Time-bound promotion & pay-commissions.
   7)   For every training / teaching – funds should be allocated to Medical Colleges.

 Name of Participant       :   Dr. Nitin S. Raithatha
   Department               :   Obst. & Gynae, Pramukh Swami Medical College, Karamsad-
                                388325, District Anand, Gujarat
   1)   Improvement in Medical education: Content, techniques, assessments (curriculum exam)
   2)   Role model for different level services or create one PHC under authority of model unit
        for practical demonstration
        – Supportive supervision – in house, in field as a third party.
        – Operational Research.
        – Maintain the SOP for integration for skill practices.

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        –   Need provision of fund for basic infrastructure, operationalisation and research work.
        –   MCI should take the lead for all above mention suggestion so they can be percolate
            down to appropriate authority.
        –   Govt. vs private medical college – to define rights and responsibilities.

 Name of Participant       :   Dr. Dipan Patel
   Department               :   Paediatrics, Pramukh Swami Medical College, Karamsad-
                                388325, District Anand, Gujarat
   1)   Integrate and update the Medical Colleges about the recent activities and objective of
        NRHM.
   2)   Provision of funds to Medical Colleges to improve infrastructure of college hospitals.
   3)   Identification of leader in Medical College to coordinate with NRHM.
   4)   Integration of primary health care services with Medical College.
   5)   Training of peripheral health worker by faculties of Medical College and their activities to
        be supervised


C. Punjab
 Name of Participant       :   Dr. Moneet Walia
   Department               :   Obs/Gyne., Christian Medical College & Hospital, Ludhiana-
                                141008, Punjab
   1)   To prepare protocols for various high risk.
   2)   To have short term training courses of MO (Medical Officer) in medical college.
   3)   To organize rural camps in association with Medical College for various specialties.

 Name of Participant       :   Dr. Ashok Salwan
   Department               :   Gynae & Obstetric, Govt. Medical College Amritsar-143001,
                                Punjab
   1)   Teaching regarding NRHM should be made compulsory in P.G Course in all specialties
        because these students are our future Medical Officers and they will handle the things
        better.
   2)   Medical Faculties in Medical Colleges should be trained under NRHM, of all specialties
        to impart training to the PGs of their specialties.

 Name of Participant       :   Dr. Pratibha Dabas
   Department               :   Community Medicine, Christian Medical College & Hospital,
                                Ludhiana-141008, Punjab
   1)   Assign a Consultant from Medical Faculty for NRHM.
   2)   Coordination with Private Medical Colleges, peripheral health centres and their workers.




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D. West Bengal
 Name of Participant       :   Dr. Gautam Mukhopadhyay
   Department               :   Gyneaecology and obstetrics, N.B. Medical College, P.O
                                Sushruta Nagar-734012, Siliguri, Dist. Darjeeling, West Bengal
   1)   Involve faculties in Training, Evaluation and Supportive Supervision.
   2)   Provision of some untied funds to Medical Colleges. To make students, nurses aware of
        the mission, this when in service they are already updated about the mission.
        Communication between peripheral health service people for better service delivery.

 Name of Participant       :   Dr. Bidyut Kumar Basu
   Department               :   Obst. / Gynae, CNMC, 32, Gorachand Road, Park Circus,
                                Kolkara-700014, West Bengal

   1)   Coordination between Medical Colleges and Health Service section of the state is required
        first and national level helps for NRHM.
   2)   Medical Colleges can put suggestions, work and intellectual input - to any programme in
        the state on Medical Science/ and also for National level.
   3)   75% of our countries population resides in rural areas, so development of the rural sector
        is definitely needed (Health Sector).
   4)   NRHM – programme started in 2005 but incorporating Medical College is a late event. At
        last it came to Medical college better late than never for betterment of course.
   5)   To be incorporated in MCI academic course of MBBS and may be thought in Post
        graduation course.
   6)   A mandatory event (thing) one year rural service before giving registration by MCI or No.
        for doctors. MBBS rigorously to be followed probably MCI is trying.
   7)   The teachers of medical colleges joining NRHM project – should have some sort of
        directives – either promotion / monetary benefit for encouraging the teachers.
   8)   Let the attempt for integration of NRHM with Medical College to continue, let more
        teachers come to NRHM (NIHFW) programme here from other Medical Colleges


E. Haryana
 Name of Participant       :   Dr. Seema Choudhary
   Department               :   Community Medicine, Maharaja Agrasen Medical College,
                                Agroha, Hisar-125047, Haryana
   1)   The National Health Programmes existing under the umbrella of NRHM can be
        effectively implemented through Medical Colleges.
   2)   Important role in pre-service teaching and training of under-graduate and post-graduates
        to provide good quality health care services and implementing the programme for the
        State‟s needs.
   3)   Also providing skill upgradation training and enabling the trainees not only to acquire the
        skills but also learn to diagnose and treat complications.
   4)   Knowledge and skill upgradation during in-service training for various service providers.
   5)   Training of district and below district level trainers.
   6)   Training of MOs of PHC/CHC (if necessary)
   7)   Training of Specialized Skills.
   8)   Monitoring & evaluation of NRHM can be done effectively.
   9)   Overall involvement of Medical Colleges under NRHM will improve the quality of health
        care provider through NRHM.

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F. Chandigarh
 Name of Participant        :   Dr. Geetanjali Jindal
   Department                :   Pediatrics, Govt. Medical        College   &    Hospital,    Sect.32,
                                 Chandigarh-160030
   1)   Training to district and State level medical and paramedical staffs.
   2)   Monitoring activities at district and State level regarding importance of training.
   3)   Tele medicine services.
   4)   Rural bases research with funds through NRHM.

 Name of Participant        :   Dr. Kana Ram
   Department                :   Asst. Prof. Pediatrics, Govt. Medical College & Hospital, Sect.32,
                                 Chandigarh-160030

   1)   Training of peripheral workers through medical colleges
   2)   To make protocols to be used at peripheral centre
   3)   Funds to medical colleges also
   4)   To improve referral system – actually patients really needing tertiary care intervention
   5)   Medical colleges should be involved in planning methods of NRHM.




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