PRC Udaipur –1st qtr PIP Report for Rajasthan – Distts covered - Rajasamand, Dungarpur
Strengths
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Programme Management Units are well functioning in the districts and blocks.
Meetings of District Health Society, RKS and VHNSC organised regularly; monthly
review meeting held at all the levels of health facility.
Funds released in time with NRHM guidelines.
RCHO and Dy CM & HO responsible for monitoring the activities at district level; they
prepare the evidence based district action plans and use HMIS/MCTS data for review of
performance at various levels.
Departments of Health, Family Welfare and AYUSH integrated.
Inter-departmental convergence available.
Job description and responsibility is well defined for various categories of staff under
NRHM.
Training to ASHA being imparted. Essential drugs, consumables and equipments being
procured through transparent bids. Rational deployment of procured equipment ensured
through audit of the equipment and redeployment of unused equipment.
Supply of essential drugs is streamlined at the health facilities; all the public health
facilities provide free generic medicines.
Facilities of free drugs and consumables, free essential diagnostics, free diet during stay,
free provision of blood, free transport etc provided to delivery and caesarean section
mothers.
Untied funds and AMG fund provided to all the facilities.
Nutrition Rehabilitation Centres established at high focus district hospitals.
All the newborns delivered at health facilities given birth doze of immunisation.
Payments made to JSY beneficiaries by cheque at the time of discharge.
Toll free number provided for redressal of grievances under JSSK.
MCTS has been made fully functional for regular and effective monitoring of service
delivery.
Weaknesses
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Health facilities constructed with NRHM funds do not display the Logo of NRHM.
Vacancies of Medical Officer, Specialists, GNM and AYUSH personnel exist at various
facilities.
IMNCI training for ANMs in the districts needs augmentation.
ARSH clinics are not functional in the districts.
Partly introduced Cu IUCD services in the districts may need augmentation
PRC Patna – 1st qtr PIP Report for Bihar – Distts covered - Nalanda and East Champaran
Strengths:
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In the State, there are 533 PHCs and 8858 Sub Centres. All the PHCS are reported to be
working 24x7.
Rogi Kalyan Samitis formed, registered and functional in all health facilities till PHC
level. Many health facilities have improved their infrastructure and logistics availability
die to proactive RKS.
The system for improving reporting of maternal deaths is now initiated.
A new programme called ‘MUSKAAN’ to track pregnant women and Newborn Child
has been launched in 2007. Under this programme ASHA, AWW and ANM hold
meeting with Mahila Mandals in AWCs.
Toll free number 102 was launched during 2006-07 and is running in all the six regional
headquarters successfully.
The state is implementing the PNDT Act at right earnest.
Ambulance for emergency transport is being provided in all the districts of Bihar.
Operationalisation of Mobile Medical Unit in the District (Nalanda) is in progress.
Trainings of personnel in IMNCI successfully completed. However there is inadequate
monitoring of this activity at field level.
Adolescent councilors are positioned in each district from State AIDS Control Society.
HMIS has been strengthened right up to the HSC level and daily reporting from nearly all
the blocks has been ensured through the Monitoring and Evaluation Officers.
VHNDs are being organized at every AWC all over the district every month.
The agencies for undertaking the task of Bio-Waste Management and Treatment have
been identified. The state has outsourced the Biomedical Waste Management system for
all the Government hospitals.
Weaknesses
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Most of the Sub Centres are not in good condition and require renovation / new
construction.
Shortage of medical officers, Specialists, Nurses and Paramedical Staff. Shortage of
essential equipment and consumables.
C-Section deliveries are not conducted in DH (East Champaran District)
Home deliveries by untrained traditional Dai is still prevalent (East Champaran District)
Weak referral network is existing for emergency medical and obstetric care services.
Lack of knowledge about antenatal, perinatal and post natal care among community
especially in rural Areas is very common. Knowledge of Basic child health care practices
among the community is lacking.
There is no strong public-private partnerships, social marketing to promote deliver family
planning services.
There is no improvement in awareness levels with regard to adolescent health issues.
The district hospital and the selected PHCs are adopting the method of burning the waste
material in the open space and bury some of the waste outside the campus of the health
centre. Proper supervision is lacking
PRC Patna – 1st qtr PIP Report for Jharkhand – Distts covered - Gumla and Dhanbad
Strengths:
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In the State, there are 330 PHCs and 3958 Sub Centres. About 180 PHCs are reported to
be working as 24x7.
The Jharkhand Rural Health Mission Society has been working for inter-sectoral and
intra-sectoral convergence.
Specific capacity building initiatives have been undertaken to orient the health providers
at various levels to specific necessities of the ARSH program like; adolescent
vulnerability to RTI/STI/HIV/AIDS, communication with adolescents, and gender related
issues etc. at the district level.
The State Co-ordination Committee has adopted the procedure for increasing the number
of couples adopting family planning measures.
There are mobile health care services for curative, preventive and rehabilitative in nature
at the district and PHC levels.
Training of personnel like; pre service IMNCI training, safe abortion methods, skill birth
attendant training and new born care unit have been completed at the district level.
The new born care corner is functioning in the district hospital (Gumla).
Weaknesses
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Out of 330 existing PHCs, 180 PHCs are reported to be working as 24x7. Most of the
HSCs are not in good condition and need renovation
Shortage of medical specialists (1369), Nurses (1830), ANM (1830) Male Health Worker
(1904) and other paramedical staff in the State. Shortage of gynecologists and
obstetricians to provide maternal health services at PHC level.
Shortage of essential equipment and consumables.
Inadequate skilled birth attendants to assist home based deliveries.
Inadequate supply of all essential drugs (at PHC - Karanj, PHC - Tudurma of Gumla
District) and non--availability of thermometer, Haemoglobinometer, IUD insertion kit
etc. at selected SCs reported.
Inadequate monitoring of the activity under “IMNCI” at field level. Inadequate training
imparted to ANMs / Doctors in operating baby warmer machines.
Family Planning achievements with respect to target is not satisfactory (Gumla District) .
ARSH clinics have been formulated in each of the blocks but need to be strengthened so
as to create awareness in sexual development and sexuality; HIV/AIDS; Unwanted and
unsafe pregnancies.
Tribal Health: There are no monthly camps for underserved areas.
There is no sensitization on safe and early abortion in the community by the front line
health workers.
Monitoring team constituted at district level as well as at block level to monitor the
implementation of the HMIS activities of the NRHM requires more training on the
HMIS activities
PRC PU Chandigarh – 1st qtr PIP Report for Haryana – Distts covered - Mewat and Ambala
.
Strengths:
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The State has developed a full fledged Programme Management Unit and also established
a separate directorate of AYUSH.
The State has implemented a rolling policy (outside the purview of Haryana Public
Service Commission) to fill up regular vacancies of doctors. By and large posts of
Doctors filled in both the districts.
Faculty of several medical colleges is roped in as trainers to provide skill based and
knowledge based training to health care providers.
Integrated policy for procurement of equipment is in place in the State.
Procurement of drugs is decentralized and purchase of drugs is done one quarter in
advance at the District.
In both the Districts, the total number of ASHAs is in place as per the sanctioned
strength. All ASHAs received training up to Module- 5.
The State has implemented the policy to provide free and uninterrupted supply of
medicines free of cost to all OPD patients / Causality and Delivery cases.
A strong referral transport system is existing in the State.
C-section deliveries and 1st and 2nd Trimester abortion facilities are available at 19
District Hospitals (except Mewat and Palwal).
Functional SNCU and NBSU facilities (with trained staff) are available at Ambala and
Mewat DHs.
Districts have implemented free entitlements under JSSK.
Both the districts have prepared a plan for intensification of RI for low immunization
coverage.
At state level a separate adolescent health cell has been set up and a nodal officer is in
position.
The State has adopted the GOI guidelines and students of Government schools and aided
schools are careened for health problems.
SKS has been constituted at DH, CHC and PHC level.
Weaknesses
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All the Ambulances are fitted with GPS but it is not functional in both the Districts.
The upkeep of toilets is poor and no clean linen is provided to the in-patients. CHC
Punhana of Mewat District had no water both in toilets and for drinking purposes.
Proper arrangements are not for providing free meals under JSSK at District Hospital
Mewat and all CHCs and PHCs visited by PRC. Alternative diet (Milk, bread, fruit and
dry fruit) is given at these facilities.
Quality of ANC services provided to the pregnant women in both the Districts is poor.
Information on facility-wise deployment of staff is not uploaded on NRHM website.
Brest feeding to the new born within one hour of delivery is not ensured.
Delay in JSY payments due to documentation process is prevalent in the districts.
PRC Sagar – 1st qtr PIP Report for Madhya Pradesh – Distt covered - Chhattarpur
Strengths
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HR policy being formulated for NRHM staff. Rational and equitable deployment of HR
in high focus areas planned and prioritised
JSSK is implemented in selected facilities (DH and FRUs) but with limitations.
Mandatory rural services for fresh MBBS pass-outs and PG aspirants.
NRCs providing effective services to malnourished children.
AYUSH doctors are co-located at health facilities to strengthen OPD facilities.
Timely disbursement of untied funds to SHCs and VHNSCs observed.
Construction of health facilities being prioritised with alternative sources like BRGF etc
in the periphery.
Weaknesses
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Details about MMUs and procurement (Drugs & Equipments) partially disclosed. But
details of building under construction/renovation, PTA/ERA are not disclosed under
mandatory disclosures
There is no mechanism for facility performance auditing due to non availability of
facility level HMIS/MCTS data for monitoring.
Diet, referral transport and drop back facility are weak elements in the JSSK. Stay for 4872 hours mothers and sick neonatal child care under JSSK needs to be strengthened.
Large number of positions of Specialists and MOs are vacant.
High attrition rate is prevalent among NRHM staff at PMUs.
Sustainability of trained staff in specialised services not ensured.
Monitoring links and supportive supervision at periphery are weak.
HMIS is not yet functional; use of CSCs not initiated.
No mechanism exists for facility performance appraisal.
Mapping of remote/difficult areas not yet finalised for providing incentives.
Reluctance for serving in remote/hard to reach areas is prevailing due to non availability
of basic amenities and security reasons.
PRC Sagar – 1st qtr PIP Report for Chhattisgarh – Distt covered - Rajnandgaon
Strengths
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Rational and equitable deployment of HR in high focus areas is planned and prioritised.
JSSK is fully implemented in selected facilities (DH & FRUs).
IT penetration is high, up to PHC level.
Alternative source of electricity (solar) being installed at remote areas to ensure efficient
service delivery 24x7.
Training is being given top priority. Detailed training calendar is under preparation
Infrastructure is being augmented.
Urban health programme is initiated under MMSSK in 11 major cities.
Appointment of AYUSH doctors is being prioritised in 24x7 PHCs.
Facility performance appraisal system is functional.
Weaknesses
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Mandatory disclosures made fully in respect of Human Resources. But it is partial in
respect of procurement, drugs & equipment, building construction/renovation, MMU, and
PTA/ERA
There is no mechanism for facility performance auditing due to non-use of facility level
of HMIS/MCTS data for monitoring.
Appointment of 2nd ANM needs to be expedited.
MCTS data not being monitored for planning of logistics.
SAM and LBW list not being maintained at facility level.
Support mechanism for NRHM contractual staff is limited; high attrition is observed.
Large number of positions of Specialists and MOs are vacant.
Sustainability of trained staff in specialised services like CT-SCAN, USG, SNCU, NBSU
etc is not ensured.
Conflict of job roles among RMA and MBBS MOs regarding practice of Allopathy.
Conflict of supervisory role to RMAs with the regular health staff.
Monitoring links are weak; corrective actions are not defined.
SNCU is not functioning at DH.
CT-SCAN/USG not operational due to non-availability of skilled personnel.
PRC Dharwad – 1st qtr PIP Report for Goa – Distt covered – North Goa
Strengths
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Quality assurance committee at district level have been established with respect to family
planning services
Department has good inter sectoral convergence
Recording of vital events is cent percent and are being triangulated with other data such
as DLHS, NFHS and HMS
Majority of the JSSK beneficiaries have received free entitlements.
State has a policy of free supply of generic medicines in all the public health facilities
Payment is being made to JSY beneficiaries within one month of delivery through cheque
VHNDs are being conducted regularly
Maternal death review (MDR) and Infant Death Review (IDR) is being done at facility
level
BeMOC services, RTI/STI services and essential newborn services are available at PHCs
Mammography Mobile Unit has been installed to screen for breast and cervical cancers.
Emphasis has given for filling up vacant posts especially specialist doctors and para
medical workers.
Response time of 108 ambulance is 12 minutes
Weaknesses
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PIP activities started late due to delay in obtaining approval
State NRHM website is not yet started, will be started by 15th Aug 2012
As per the road map, state has to identify high focus areas to improve coverage of
services. However, it is found that PIP has no mention about the high focus areas.
Second ANM is not in place in many HSCs as three-fourths of HSCs have only one
ANM
MCTS/HMIS is not being used as a base for calculation of vaccines
Physical verification of JSY cases by district authorities to check malpractices is not
done.
Milk bank at Goa medical college is not yet placed
VHSC and RKS meetings are not regular
District AEFI committees are not in existence and grievance re-addressal
mechanism/meetings have never taken place
Line listing of severely anaemic pregnant women and tracking them for services is not in
place in any of the sampled facilities
First trimester safe abortion facility is not available at PHCs
AYUSH is not integrated with Health & FW Directorate
PRC Thiruvananthapuram – 1st qtr PIP Report for Kerala– Distts covered – Alappuzha and
Thiruvananthapuram
Strengths:
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The state has taken initiatives to upload necessary mandatory information on strategic
areas on the NRHM website.
Planning at the State level is as per the guidelines provided in the State PIP 2012-13 with
regard to most of the components.
Marked improvement in infrastructure has taken place but maximizing the utilization of
services by way of providing necessary facilities both in terms of manpower and facilities
to carry out services in the PHCs where infrastructure developments have taken place
need to be emphasized.
Various categories of human resources have been added on contract basis under NRHM
but a clear demarcation and lack of coordination exists between the regular health staff
and contractual staff under NRHM at facility level.
The State is paying attention to disease surveillance programme.
Kerala is rightly giving impetus through the KASH initiative to the development of
hospitals both SDH and DH where majority of the population flow.
Weaknesses
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Delay in implementation of during the first quarter has occurred as the first tranche of
funds received in the month of June, 2012.
Monitoring mechanism is in place but monitoring of activities down to facility level is
reportedly inadequate mainly due to lack of manpower.
Coordination and convergence with other departments is lacking in the state.
Utilization of services in the PHCs is less. Only ANC and child immunization are the
major activities reported.
CHCs do not have delivery units (3 CHCs out of 4 selected for study), mainly due to lack
of specialist doctors on 24X7 basis. There is no delivery unit even in 24X7 PHCs inspite
of the infrastructural developments extended during the first phase of NRHM 2005-12.
This is a feature peculiar to Kerala where people tend to avail treatment in privates and
public hospitals.
FRUs are not operationalized strictly as per guidelines ( New born care units, NBSU are
not available)
Shortage of manpower in OPD and IPD.
Community monitoring activities needs to be strengthened.
Urban RCH in Thiruvananthapuram district is not working in a satisfactory manner.
Software and network problems are causing hindrance for the speedy uploading of
HMIS and MCTS data at the facility level.
PRC ISEC, Bangalore – 1st qtr PIP Report for Karnataka - Distts covered – Davangare, Mysore
Strengths
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Information on Human Resources in respect of contractual staff, patient transport data,
procurement and building details under NRHM are available and regularly updated, but
have not been publicly disclosed mandatorily.
Approval for total budget received by the State and item wise finalisation and reappropriation is under progress.
NRHM logo is posted on the vehicles procured in the state under NRHM funds.
Field verifications of the data furnished by the State have been done by the PRC and the
data found to be correct.
Actions under MCH and FP services are implemented for most of the strategies in
Karnataka and field districts, and study facilities in particular.
Primary healthcare delivery particularly MCH and FP services in the State as a whole is
adequately developed.
Procurement and maintenance of essential equipments has been systematised in the
facilities on functional and need basis.
State has developed a network of patient transport system which is operative in all the
districts.
District/general hospitals, FRUs, CHCs and PHCs are essentially providing diagnostic
services as per prescribed norms with involvement of private facilities.
Patients’ feedback is addressed through complaint and suggestion boxes kept in the
facilities.
RKS and VHSNCs have been established as per guidelines..
Intersectoral convergence in the state is achieved.
IEC activities are done with guidelines in the regional language.
PPP and NGO involvement is there in the programme.
Sound monitoring system is developed in the state with universal registration of births;
data compiled by HMIS and MCTS are being used in review exercises in the state.
Weaknesses
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Action plan for the current is year is not available for all the PHCs in the State.
Logo is not exhibited on the buildings constructed or under NRHM funds.
All the Mandatory information on NRHM website yet to be posted on the website.
Regional disparities have been noticed in the implementation of MCH and FP services in
the State.
Monitoring and review activities in the first quarter of the current year affected by nonsubmission of performance reports by the facilities due to MOs strike.
PRC CRRID, Chandigarh – 1st qtr PIP Report for Punjab - Distts covered – Faridkot, Rupnagar
Strengths
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Substantial infrastructure up-gradation and equipment addition has taken place in the
Districts.
Sizeable increase in service delivery including improvement in IPD/OPD care. Increase
in institutional deliveries combined with improvement in IMR.
Addition of para-medical staff, particularly to the existing pool of female MPHWs and
staff nurses has taken place.
Better enforcement of PC-PNDT and streamlining of activities under the Act is
prevailing.
Improvement in HMIS and MCTS statistics.
Improved IEC and BCC targeting and impact.
Weaknesses
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The State NRHM website is yet to contain required mandatory disclosures relating to
facility-wise deployment of contractual staff, availability and use of patient transport
ambulance and emergency response, details of procurement and buildings under
construction and renovation.
Key positions of full-time Director/Joint Director/Deputy Director (Finance) continue to
remain vacant.
No health facility has dietary provision in the State due to absence of kitchens, and this is
a major discouragement for indoor patients.
No mechanism is in place to enforce or incentivize rational prescription of drugs and
diagnostic procedures.
Prevalence of high infant mortality is a major concern. Infant Death Review (IDR)
mechanism not introduced.
Deliveries in remote and underserved areas are mostly conducted by staff nurses in the
absence of female Medical Officer. Even some 24X7 PHCs do not conduct regular
deliveries due to non-availability of adequate medical staff.
Shortage and irrational postings of specialists and Female Medical Officers and skilled
staff is affecting the service delivery particularly in remote and outreach areas.
The Sub-Centres usually remain open only for two hours daily in the morning, after
which they remain, closed.
Some potential beneficiaries are left out from the JSY as they fail to get certificates from
their respective Sarpanch /Ward member
BMI calculations are not part of school health card. No dedicated team for AWC health
check-up found in the survey areas.
PRC CRRID, Chandigarh – 1st qtr PIP Report for UT Chandigarh - Distt covered – Chandigarh
Strengths
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Effective Maternal Death Review format and procedures are in place.
PC-PNDT activities including notification and constitution of committees, medical audit,
meetings, submission of quarterly progress reports are regular and effective.
Micro-birth planning and services are encouraging leading to improvement in
institutional deliveries in slums and rehabilitation colonies.
IEC and BCC campaigns are regular and systematic.
Weaknesses
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The State NRHM website yet to contain required mandatory disclosures relating to
facility-wise deployment of contractual staff, availability and use of patient transport
ambulance and emergency response, details of procurement and buildings under
construction and renovation.
Quality assurance parameters are not properly defined at the delivery points. JSSK
entitlements not available in PGIMER and ESI Hospital.
No separate full time Mission Director in the UT. Posts of Joint Director/Deputy
Director (Finance) continue to remain vacant.
A separate public health cadre needs to be created in Chandigarh, and Public Health Act
not enacted.
No mechanism is in place to enforce or incentivize rational prescription of drugs and
diagnostic procedures. No prescription audit.
Essential Drug List is available at all levels of health facilities. Except for maternal health
services, non-availability of such drugs due to sluggish purchase procedure and reduced
financial allocations, etc. is a major handicap.
Shortage and irrational postings of specialists and Female Medical Officers and skilled
staff is affecting the service delivery particularly in remote and outreach areas
The Sub-Centres in outreach areas and slums are usually overburdened due to nonavailability of ASHA and large coverage load.
Some sub-centres also need urgent renovation and provision of basic amenities like
water, electricity and toilets.
Some potential beneficiaries are left out from the JSY as they fail to produce BPL
certificate.
The association of local community in health care planning and delivery is loose and
ineffective. Measures are needed to strengthen involvement of the civil society.
BMI calculations are not a part of school health card.
There is no provision of MMU in the Chandigarh.
No standard procedure for patient feedback exists in the UT.
PRC Vadodara – 1st qtr PIP Report for Gujarat - Distts covered – Narmada, Vadodara
Strengths
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A dedicated NRHM web site is available in the State.
JSSK being implemented in the selected districts in respected of limited activities.
It was noticed that free diagnostics, medicines, transport to higher facility, food etc are
provided from other funds/schemes at the studied facilities.
Pregnant women visiting health facilities are screened for anaemia and free treatment
provided, if necessary.
JSY guidelines are being followed in identifying beneficiaries and for making payments.
Adolescent health programme, the school health component is being implemented
according to guidelines.
Periodic meetings of RKS are held but not monthly.
AYUSH practitioners have been co-located in the CHCs/PHCs.
Weaknesses
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Mandatory disclosures not displayed on the State NRHM website.
Many activities under JSSK not available in the selected districts of Narmada and
Vadodara.
Under Child Health not all the service providers have received training in NSSK and
IMNCI at the studied facilities.
The MHS and WIFS components under adolescent health programme not being
implemented as per guidelines.
There is no separate cell for delivering health services to the adolescent girls.
All service delivery points especially those below district level are not yet operational in
terms of manpower or infrastructure/equipments for ensuring safe delivery and child
survival.
None of the delivery points including district hospital are fully operational to provide the
mandated service mainly due to lack of trained staff or essential infrastructure/equipment
(Narmada District).
Many Specialist posts are vacant in the District Hospitals; in the CHC-FRU also there are
no Specialists.
PRC Vadodara – 1st qtr PIP Report for UT Daman & Diu- Distts covered – Daman & Diu
Strengths
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The provision of 2 ANMs in a SC is noted in 2 out of 6 SCs at Diu and in 3 out 20 SCs at
Daman.
There is no problem of funds, equipments and essential drugs at all the facilities in both
the districts.
At Daman, the service provision especially at higher level facilities is relatively better
than at Diu.
The DH of Daman manages to provide all the services by appointing specialists on part
time basis.
Weaknesses
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The UT of Daman and Diu does not have its own NRHM website to display the relevant
information.
All the service delivery points are not yet fully operational as envisaged in the PIP. This
is mainly due to lack of specialized services and in-service training of the staff.
Service provision at DH in Diu is hampered due to paucity of trained HR while the FRUCHC is better able to provide the services with the help of contractual specialists.
JSY and JSSK are not yet implemented in the UT. Similar entitlements to pregnant
women are provided through two other schemes viz. Dikri Development Scheme (DDS)
and Matru Samruddhi Yojana (MSY).
The RKS is not functioning at either of these districts.
School Health Programme is functioning properly but not as a part of Adolescent Health
Programme.
The MHS and WIFS are not yet initiated in these districts.
At Daman, BSU/BB is available only at DH, whereas it is not available at any public
health facility at Diu.
Deliveries are not conducted at any of the SCs in the UT.
No PHC, out of 2 in Daman and 1 in Diu, is functioning as 24x7
PRC Shimla– 1st qtr PIP Report for Himachal Pradesh - Distts covered – Sirmour, Hamirpur
Strengths
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Public health programme is being strengthened through IEC activities.
Human resources are being strengthened along with infrastructure, ambulance and referral
transport.
Registration of deaths and births being carried out very well.
Atal Swasthya Sewa-108 is providing transport and emergency health care to all patients.
Suggestion box is kept in the health care facilities to get feedback and complaints.
Inter-sectoral convergence is developed with linkages with other departments.
NGOs also involved in the health care activities.
Block level training to VHNSC has been imparted; however, training of staff with reference
to the requirement of NRHM needs augmentation.
Under JSY deliveries are conducted in government facilities and payments released to the
beneficiaries.
JSSK has been implemented in the State; drugs, consumables, diagnostics, transport etc are
provided to the beneficiaries.
Registration for ANC has been excellent.
Pregnant women being provided good health care and supplied with IFA tablets.
87.4 per cent institutional deliveries reported in the State.
Medicine procurement has been streamlined and free medicines being provided to
BPL/IRDP families.
The State has formulated and developed a procedure for the procurement of equipments.
Disease control programme is well implemented in the State.
Good work being done on Ante Natal Care services and on immunisation coverage.
Weaknesses
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Details of facility-wise deployment of contractual staff engaged, MMU position, transport
services, procurement of equipment, cost and current position of construction of buildings
etc not disclosed even though it is mandatory.
At the State level there is no separate website for NRHM.
There is acute shortage of Specialists, Medical Officers, Pharmacists, Nurses,
Technicians and other category of staff.
Sufficient funds for construction of facilities not being released by the State
Government.
Huge funding made by NRHM does not translate into results in the State.
Second ANM not appointed during 2011-12.
Supply of generic medicines has not yet started due to non-functional Jan Aushadh
Centre.
PRC Srinagar– 1st qtr PIP Report for Jammu & Kashmir - Distts covered – Poonch and Budgam
Strengths
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The State is following a decentralized planning for implementation of NRHM activities.
PMUs at State, Divisional, District and Block level have been established.
The State has a full-time Mission Director and a Finance Officer under NRHM.
To attract doctors to work in far flung areas, the State Govt. is offering higher incentives.
Most of the AYUSH positions, 2nd ANM and other Paramedical staff are in position in both
the districts.
Generic medicines are available and provided free of cost.
Districts have been provided ambulances for referral transport.
Print and Electronic Media is used to propagate the facilities available under NRHM.
Maternal and Infant Deaths Review Committees have been established in all districts.
Mainstreaming of AYUSH is given importance in the State.
The State has implemented JSSK in all the districts. New born care corners have been
established at all functional delivery points.
The state is promoting use of IUCD and the number of trained IUCD providers has
increased.
Menstrual Hygiene Scheme has been operationalized in a few Districts.
The state has started MCTS in all districts but State level MCTS call centre has not yet been
made functional.
There is large scope for improvement in the quality of data reported for HMIS.
Weaknesses
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None of the mandatory disclosures are available on State NRHM website.
J&K has shortage of Specialists and Surgeons particularly in high focus districts.
DTCs do not have required manpower and none of the training institutions in the state is
accredited by any Accreditation Agency.
The State has not set up a dedicated corporation for procurement of drugs and equipment.
Guidelines for ensuring 100% registration of births and deaths have been issued but not
much has been to ensure 100% registration.
The number of ASHAs in both the districts outnumbers the sanctioned strength. ASHAs are
yet to be trained in Module 6-7 (IMNCI) in the districts.
Untied Funds are not utilized as per the guidelines in some SCs of Poonch District.
Diagnostics facilities for pregnant women in Poonch district are not entirely free under
JSSK. But women in Poonch have to pay an amount of Rs. 2000-3000 for C-section
delivery and Rs. 1000-2000 for normal delivery at both DH and CHC.
SNCUs in both the districts hospitals have not yet been made functional. NBSUs with
necessary infrastructure have been established in all FRUS in both the districts but they do
not have adequate trained manpower.
Pregnant women and expectant mothers are not counseled for early and exclusive breast
feeding.
Nutrition Rehabilitation Centres (NRC) has not been established in any of HFDs in the
State.
JSY cards in Poonch are prepared after the delivery. Payments are generally made after 1-3
months of delivery in both districts
PRC IEG, Delhi– 1st qtr PIP Report for Delhi - Distts covered – North District, N.E.District
Strengths
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The State has appointed a State Immunization Officer for monitoring the coverage of
immunization of all districts and also one District Immunization Officer for all the
nine districts
JSSK provisions are followed and financed through the state budget (State does not
utilize JSSK fund)
Regular review meetings are organized at State and District level.
Data collection on key performance indicators is carried out at the facility level and
communicated to the District and State level after validation.
Under Civil Registration System, births and deaths are registered to an extent of
100%.
The State has a highly skilled Nursing Cadre. Creation of a Public Health Cadre is in
process.
A grievance Redressal Cell is in place.
Weaknesses
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There is no separate website for NRHM activities but a web-link under the State
Governments’ Health and Family Welfare website is in place. This web-link does not
contain the prescribed mandatory disclosures.
There is no full-time Mission Director for NRHM at State and District level. The
Mission Director at the State and District level takes multiple responsibilities.
Transport facility is available only within the Municipal limits of Delhi. The
Centralized Accident Trauma (CAT) Ambulances are used to commute pregnant
women to health facility.
MCTS is not made fully operational for regular and effective monitoring of service
delivery. The work is assigned to ANMs (and ASHAs) in nine districts.
Human Resources: No new recruitment of personnel took place at State level for
different categories during the current financial year.
Ambulances, presently available, are not fitted with GPS equipment. However,
procurement of ambulances ordered recently, will be having GPS.
Unsatisfactory Treatment services (Observations based on beneficiary
interviews): In some facilities, beneficiaries are not treated with respect, not
encouraged to ask questions on health concerns and poor treatment services during
delivery period. In some cases, beneficiary was refused admission but had delivered
on the same day.
Patients are not supplied with feedback form.
Only 752 VHNDs were organized as against a monthly target of 4425.
Target for establishment of new NBSUs, NBCCs and IYCF (under child health)
centers not achieved for the current quarter.
As against a target of 50,000 IUD insertions (As per PIP of 2012-13), 8074 insertions
have been achieved during the quarter.
PRC IEG, Delhi– 1st qtr PIP Report for Uttarakhand - Distts covered – Dehradun, Haridwar
Strengths
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The state has developed a separate website for NRHM activities with all mandatory
disclosures. However, some document links are not functioning properly.
Project Management Unit is almost fully staffed at State, District and Block levels
respectively. Mapping of the facilities is done at both State and District level.
There are policies in place for provision of free drugs.
JSSK component is functioning well in the State. Transport and drop back for
pregnant women and new born is free and found effective.
The State undertakes facility-wise performance audit and corrective action, if
required.
The State has expert teams to visit delivery points and evaluate the quality of services.
However, it is not documented.
All the facilities have requisite equipments including NBCC and cold chains at CHC
and PHC level and SNCU at DH level.
NGO are filling the service delivery gap, particularly in Urban Slums of Dehradun
and Haridwar Districts.
HMIS and MCTS data capturing is functional. Data collection on key performance
indicators is carried out at the facility level and communicated to the District and
State level after validation
Regular review meeting are held at both State and District level.
Weaknesses
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Over 58 percent of the total approved posts (2319) of medical officers are lying
vacant.
27% of the approved ANMs and 35% of Staff Nurse Positions are yet to be filled
under RoP 2012-13.
Inadequate C-Section and Abortion Facility: 18 District Hospitals (12 Male and 6
Female) only 11 DHs have C-Section and 1st and 2nd trimester abortion facility. Out
of 55 CHCs only 6 provide C-Section and 1st and 2nd trimester abortion facility.
Inadequate diagnostics test facility: With the exception of District Hospitals,
pregnancy related diagnostics tests such as ultra sound and blood tests are referred to
private diagnostics centers and the beneficiaries have to pay for it.
CHCs have ultrasound facility but it not utilized due to lack of trained HR.
The HMIS and MCTS data are yet to be improvised for logistics planning and
effective monitoring of service delivery including tracking and monitoring of severely
anemic women, low birth weight babies and sick neonates.
Coordination between different levels of programme management viz. State, District
and Block is weak in some Districts.
Unsatisfactory Treatment services (Observations based on beneficiary
interviews): In some facilities, beneficiaries are not treated with respect, not
encouraged to ask questions on health concerns and poor treatment services during
delivery period.
No positive feedback is received for NHSC or the role of PRI, particularly from
slums.
Community audit is not practised.
AIIH&PH, Kolkata– 1st qtr PIP Report for West Bengal - Distts covered – Malda, Nadia
Strengths
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High focus areas are identified and mapped at all levels in all the districts of the State.
Inter-sectoral convergence being put in position with other Departments.
Institutions set up for procurement of medicines centrally.
Free drugs are given to BPL category and SC/ST category.
Transparency maintained through proper bidding process for procurement of
equipment.
Call Centre/control room set up by number 102 in each district to place requirement
for vehicle; entitlement of referral transport as per JSSK norm.
In-service training being conducted to all levels of personnel.
Mandatory rural postings (after MBBS and PG) after joining service introduced. .
CMOH offices, BPHC identified as training centres for ANM/GNM
HMIS/MCTS data being uploaded regularly from district/block level facility wise.
Performance of health indicators through HMIS monitored and reviewed quarterly.
ASHA training being organized in collaboration with NGOs.
Weaknesses
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Full time post of NRHM Mission Director is not available in the State.
Action to add manpower on war footing required; assessment of requirement of
manpower needed.
Labour room needs to be upgraded and privacy in delivery maintained.
Hygiene and cleanliness of wards, washrooms, passageway & periphery not upto the
mark.
Ratio of bed to patients for maternal wards too low; overcrowding of wards is noticed.
Supply of medicines at facility level and timely payment of JSY and JSSK benefits
needs to be ensured.
Infrastructural facilities at BPHC/PHC to be increased along with human resources.
All PHCs to be made delivery points to assure quality health services.
PRC Visakhapatnam – 1st qtr PIP Report for Andhra Pradesh - Distts covered – Srikakulam,
Nellore
Strengths
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In the State, there are 475 MMUs (known as Fixed Day Health Services -104)verification is not in public domain.
A total of 802 ambulances (patient transport ambulances -108) exist in the state while
752 are on road and remaining is in buffer- verification is not in public domain.
A quality Assurance Cell at State level is created.
JSSK is being implemented in the State and new guidelines were issued to districts in
July, 2012.
In 417 Sub Centres (out of 478 in Srikakulam District) the second ANMs are
available while in Nellore District, 399 Sub Centres (Out of 477) the second ANMs
are available
Weaknesses
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The State has not made any of the 5 mandatory disclosures available for public
consumption by putting the details on the State NRHM web-site in the first quarter.
The details of HR, MMUs, ambulances and construction of new buildings are at
present can only be accessed in-house with user ID and password. Also the details of
HR at district level are to be thoroughly updated.
The State has issued Office Orders / Guidelines for rationale and equitable
deployment of HR and JSSK to the Districts. However, at district level no action has
been taken.
Implementation of JSSK is restricted only to pregnant women and it is not being
implemented in all the public health facilities in the two districts. None of the
delivered women received diet or money as part of JSSK during the stay at PHC.
No review meetings on JSSK are held so far with SPHOs/MOs at district level.
Districts have not opened Grievance Redressal Cell for recording JSSK related
grievances from the public.
108 ambulances takes longer time: Most of the pregnant women (according to the
field interview) reached the facility by private vehicles as arrival of 108 ambulances
takes longer time.
According to the Field interviews, JSY payments were not made in the sampled
facilities at Srikakulam district from April, 2012. While in Nellore district payments
are made through cheques at the time of discharge or after a gap of 1-3 weeks after
delivery.
Payments of incentives to ASHAs are irregular.
Line listing of severe anemic pregnant women and low birth weight newborns are not
being done at district and sub-district level.
The trainings on MDR are done up to SPHO at CHNC level. But these are not
percolated down to MOs and other field level functionaries.
PRC Bhubaneswar – 1st qtr PIP Report for Odisha - Distts covered – Baleshwar, Bargath
Strengths
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The state has a Full time Mission Director for NRHM. PMUs have been established at
State, District and Block levels.
Two updated website are available (Janani Sishu Suraksha Karyakrama and Citizen
Charter for FRU & Non-FRU). Facility wise HR engaged under NRHM displayed on
the website.
The HR Policy has been formulated in the state which envisages incentives to
different categories of staff to be retained in High Focus and KBK+ districts.
JSSK has been implemented in the state since 1st November, 2011. Grievance
redressal for JSSK scheme is in place.
Process has been initiated by the state govt. for online registration of births and
deaths.
PPP strategy has been used especially for management of PHC(N) located in most
vulnerable, inaccessible, hard to reach areas, urban slum health project, RCH special
services for vulnerable communities and Janani Express etc.
Swasthya Kantha Campaign in all 30 districts to provide health related information to
rural population.
High focus areas have been identified and mapped at all levels.
Training & capacity building is given priority and being implemented through
SIHFW, RHWTC, and DTC & Medical Colleges.
Drug Management Policy is in place.
AYUSH MOs are members of respective RKS and supervise field and involved in of
National Health Programmes.
22853 ASHAs of High Focus Districts were trained on Module 6 & 7 (IMNCI).
Facility Performance Appraisal system is in place.
Work plan for the women tracked under MCTS are being generated for ANMs and
SMS alert is in place.
MIS coordinators have been appointed in urban area to capture data on urban
beneficiary including private.
Weaknesses
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MMUs – Not Disclosed. 240 Mobile Health Units (MHUs) are operational in the
state.
Patients Transport Ambulances and Emergency Response Ambulance etc. are not
available in the website.
Procurement details not disclosed. Drug Inventory Management System is in place in
SDMU and Districts.
There remains noticeable gap in implementation of different aspects of JSSK Facilities under JSSK are made available.
Second ANMs are not in place in most of the SCs.
SNCUs and NBSUs are not fully functional.
Policy decision has been taken but prescription audit is yet to be started.
No policy to procure equipments.
Distribution of Sanitary Napkins to school going adolescents is yet to be initiated in
the districts visited.
PRC Guwahati – 1st qtr PIP Report for Assam - Distts covered – Jorhat & Chirang
Strengths
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Details of all contractual staff engaged are available on website facility wise.
Mobile Medical Units are functional in all the 27 districts and 23 subdivisions of the
State.
List of service delivery data including clients served, Tenders for all procurements
are available on the website.
As per state guidelines the district has formulated and implemented a comprehensive
HR policy under NRHM.
Posting of staff including Doctors, incentives to be given to the staff, monitoring of
the programme etc. are followed in the district as per state NRHM guidelines.
The district has implemented JSSK in all public facilities and ensured free services of
Transport, Medicine, Diagnostic, Meals and Drop back to all pregnant women and
sick new born.
District health societies/ RKS/ VHSCs constituted and action initiated for training of
the members of RKS, VHSNCs.
Untied funds/ AMG funds are allocated and released to various health facilities.
JSY guidelines strictly followed by all the facilities for payment of JSY incentives etc.
All the pregnant as well as delivered women received ANC, JSY and Child
Immunization card. ASHAs doing good work.
HMIS/MCTS data used for reviewing the performance of the concerned facilities.
Weaknesses
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Details of functional MMUs like total number, their registration number, name of
operating agency, monthly schedule etc not available on the NRHM website.
Total number of building under construction/renovation, name of the facility, cost of
construction and name of the executing agency etc not available in the state website.
No nodal person for technical areas of RCH is available in Jorhat district.
No mechanism to redress the grievances under JSSK at facility level.
Details of Untied/AMG funds received by the facilities not displayed publicly.
No awards given to well performing ASHAs in the district during last 3 months i.e
April – June, 2012.
No fixed day for IUCD services at various facilities.
PRC Pune - 1st qtr PIP Report for Maharashtra - Distts covered – Satara and Nandurbar
Strengths
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Details of MMUs are given in the website. Monthly schedule of MMUs also is
provided.
Basic information related to Emergency Medical and Referral Services provided in
the website.
The state has differential planning for the districts and has identified the list of
facilities in difficult areas in 10 districts.
HR policies for doctors, nurses, paramedicals and programme management staff are
available.
State has developed a very good computer based online database by using ASHA
Software for maintaining their profiles, performance, training, contact details etc.
The state has formulated essential drug list for all types of health facilities; this
includes drugs for MCH, safe abortion, RTI/STI.
The state has established the infrastructure development wing for upgradation of
existing health institutions and new constructions.
Assured free transport for pregnant women and newborn infants is available under
JSSK.
Control room with call assistance, computer, and internet and toll free numbers is
established.
Funds of Untied funds/AMG/RKs are being allocated and used as per the NRHM
guidelines.
All the delivery facilities in the State have a functional New Born Care Corner with
essential equipments; SNCU established in all the district hospitals.
ANMs and GNMs trained in IMNCI.
State has prepared district plans for intensification of routine immunisation for
districts with low immunisation coverage.
All newborns delivered at health facilities get birth doze of immunisation in the
facility itself.
Weaknesses
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Facility-wise deployment of all contractual staff engaged under NRHM with name
and designation not provided in the NRHM website.
Procurement details of drugs, equipments and details of buildings under
construction/renovation not available on the website.
The State has not started the GPS fitted ambulances.
While Polio-0 is ensured to the newborns at the facility level before discharge, in a
few cases Hepatitis B-0 and BCG are given after the discharge due to delay in receipt
of supplies.
PRC Lucknow - 1st qtr PIP Report for Uttar Pradesh - Distts covered – Firozabad,
Kannauj, Kanpur Nagar & Varanasi
Strengths
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State has released Rs 612 Crore to the districts even though during the quarter AprJun 2012 no funds have been released to the state from the centre.
The state has full time Mission Director and Finance Person to look after state
NRHM.
Till now a total of 5806 Sub-Centres were constructed under NRHM. Of these 54
percent were in high focus districts.
Comprehensive IEC is in place for FP and RI programmes.
The NRHM website is updated frequently with recent government orders and
guidelines.
All the districts have facilities of functional Newborn Care corners (NBCC). SNCCUs
are functional in seven DHs and are to be made functional in another five DHs.
Weaknesses
\
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Under mandatory disclosures, information relating to only deployment of contractual
staff in 35 districts was displayed on website.
Public Health Act has not been enacted in the state.
Comprehensive HR policy has not been formulated in the state. There is acute
shortage of doctors in the state. Renewal of contractual staff under NRHM is delayed.
Posting of second ANM has not been done so far.
Defined measures of HR accountability are not in place in the state.
One-fourth beneficiaries had to pay for the services/ medical tests received by them at
government health facilities. Some beneficiaries also reported that they have to
purchase medicines.
A total of 133 MMUs were functional till Jan 2012 and later their services were
suspended.
All the districts still follow dual reporting system i.e. MPRs as well as reporting on
HMIS. However state has reported that dual reporting system is not being followed.
Uniforms and diaries have not been provided to ASHAs. Due to some issues related
to procurement the ASHA kits are not being replenished regularly.
Among the recently delivered women 41 percent got free transport to come to the
facility and half of them did not receive JSY incentives by the time of discharge.
Out of eight surveyed CHCs, five do not conduct Caesarean Sections and four do not
have provision of first and second trimester abortion services.
PRC Gandhigram, Dindigul - 1st qtr PIP Report for Tamil Nadu - Distts covered – Theni and
Kanyakumari
Strengths
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The State has a strong PMU at State level and is supported by well experienced technical
experts. There is a well developed three tier health delivery system managed by three
directorates – DPH, DMS and DME.
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The infrastructure for health delivery is good and well dispersed to meet the needs of the
population.
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Plan of monitoring exists and the programme officials regularly visit districts to monitor
programme implementation. Regular review meetings are held with DPMU by the State
Health Society officials.
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Under JSSK, pregnant women and children are transported to the health facilities by the
emergency transport system ‘108’ and referrals to next level are done with the referral
transport vehicles.
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Food is provided from the kitchen wherever it is available and arrangements with eateries are
made where kitchen is not available. Drugs and diagnosis are provided free of cost to all
those availing public health care facilities.
Weaknesses
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Data management at State level is poor. Absence of State Data Manager is a serious concern.
Data available in the national portals-HMIS & MCTS-is not complete & do not give a true
picture.
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Mechanism to track timeliness, validity and feedback does not exist. Data from the portal are
not utilized for either programme planning or monitoring programme implementation at the
district level and below.
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District programme management unit is weak. There is absence of coordination between the
three programme implementing directorates at district level.
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Locally available infrastructure, man power and related resources at the three directorates are
not analyzed for developing a holistic approach for effective programme delivery.
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DPMU under the DPH lacks support from the health institutions under other directorates.
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Though a strong procurement system (TNMSC) for procuring drugs and equipments exists,
of late there is shortage of drugs at all levels of health delivery under maternity benefit
scheme.
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Non-visible HR accountability, weak patient grievance redressal mechanism and absence of
community participation in planning and implementation.
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Mandatory disclosures are not visible in the web site and plans to update / upload the
mandatory information is not clear.