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Health sub-centre evaluation

Dr. Rizwan S A, M.D.,

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Outline

• Definitions• Basic information about SC – Jawan• Evaluation

– Methodology– Input – Process– Output– Impact

• Conclusions• Recommendations

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What is evaluation?

• Process to determine as systematically & objectively as possible

the relevance, effectiveness and impact of activities in light of

their objectives (John M Last)

• Components involved -

– Input : The sum total of resources & energies purposefully engaged

– Process : Sequence of steps in executing the program

– Output: Immediate results of health care activities

– Outcome/Impact: All identified changes in health status arising as a

consequences of the intervention or program

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What is supportive supervision?

• A process that promotes quality at all levels of the health system – by strengthening relationships within the system – focusing on identification and resolution of

problems– optimizing the allocation of resources– promoting high standards, team work and better

two-way communications.

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Basic information

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Basic information

• Under PHC Chhainsa, CHC Kurali• Functioning as sub-centre since 1995• Distance from PHC – 12 km• Villages covered – Jawan, Ahmedpur• HW (M) – Mr. Roshan Lal • HW (F) – Mrs. Meena Solanki

Total

Male 3305

Female 2923

Total 6228

Sex ratio 884

Sex ratio at birth 1154

As on September 2011

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Location of Jawan

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Methodology

• Design – cross-sectional study• Reference period – Apr. 2011 to Mar. 2012• Input & process

– Using IPHS 2012– Sub centre visit– Record review– House visits– Interview of HW– Monthly report review

• Output and outcome– Record review

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Steps of evaluation

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Steps of evaluation

PROCESSINPUT OUTPUT IMPACT

• Manpower

• Infrastructure

• Equipments

• Drugs

• Furniture

• Services

• Record keeping

• Quality control

• Maternal Health

• Child Health

• Family planning

• Vital statistics

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1. Manpower2. Infrastructure3. Equipments4. Drugs5. Furniture6. Funds

Input

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Manpower – Type A HSC

Staff Essential Existing

Health Worker (Female) 1 / 2 (desirable) 1

Health Worker (Male) 1 1

Safai karmachari(contractual, part time)

1 1

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Sub-centre layout as per IPHS

• The original building of Jawan sub-centre is not being used• For the past 3 months the sub-centre is functioning in a single hall (16X20sq.ft)

of a govt. school under the instructions of Panchayat

××

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Infrastructure – 1/3

Location of sub centre

Location On the outskirts of Jawan village

Whether easily accessible? Yes, but not for Ahmedpur

Distance from the remotest place Ahmedpur is 5 Km from the SC

Travel time from the remotest place 1 hour (by walk)

Distance from the PHC 12 km

Distance from the CHC 16 km

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Infrastructure – 2/3Building ownership Panchayat

Construction Complete

Compound wall All around, no gates

Plaster on walls Intact everywhere

Ramp No

Floor Concrete

Separate toilets for males & females No

Cleanliness Satisfactory

Complaint box No

Prominent name board Yes

Labour room It is a Type A HSC

Clinic room Yes

Examination room Yes

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Infrastructure – 3/3

Residential facility for staff No

Does staff stay in SC village No

Water supply No

Waste disposal

Garbage – disposal at public dump, or burnt in the premises.Needles used in immunization session sent to PHC

Electricity No

Telephone No

Transport facilities No

Residential facility No

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Equipment – 1/3 N/AN/A

N/A

N/A1

N/A111

N/A1

N/A1

N/A1

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Equipment – 2/3 1

N/A

1

N/A

N/A

1 oral

1

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Equipment – 3/3

N/A1

N/A1

N/A

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Consumables – 1/2

YesYesNoNo NoNoNoYes

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Consumables – 2/2 YesYes

Yes

YesYes

Yes

YesNo

Yes

N/A

N/A

N/A

N/A

N/A

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Furniture

111

N/A

N/A

* For type B HSC only

N/A

4N/A

222

1N/A

1

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Sundry articles

1

1

1

* For type B HSC only

N/A

N/A

N/A

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Drugs – Kit A

Yes

Yes

Yes

Yes

No

YesYes

Yes

N/A

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Drugs – Kit B

Yes

Yes

N/A

N/A

N/A

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Other drugsName Availability

Syp. Cotrimoxazole Yes

Tab. Cotrimoxazole (Adult) Yes

Syp. Paracetamol Yes

Tab. Chloroquine Yes

Syp. Chlorquine No

Tab. Primaquine Yes

Tab. DEC No

Anti-leprosy drugs No

Anti-TB drugs Yes, PWB

Inj. Gentamicin No

Betadine ointment No

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Contraceptives

Name Availability

Condoms Yes

Oral pills Yes

Copper T Yes

Emergency contraceptive pills Yes

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IEC materials

• Display boards

Programme Status

JSSK Yes

JSY Yes

Routine Immunisation No

IMNCI No

Family Planning No

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Funds supplySource Availability Remarks

Untied funds for sub-centre

No,Not av. for study period

Shared with Naryala SC, no separate fund received

JSY Yes through PHC

Village Level Committee(Jawan, Ahmedpur)

Not available in Jawan, Fund received in 2011 from VLC of Ahmedpur

SMS group

Name board for immunization session site was made from SMS of Ahmedpur

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1. Services provided2. Record keeping3. Quality control

Process

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Services provided – 1/2Services   Availability

Visit by doctor (at least once a month)  Yes

Is the day and time of this visit fixed? Yes (every wed

afternoon)

Are the residents of the village aware of thetimings of the doctor's visit?

Yes

Visit by HA (at least once a week) Yes

Referral facilities for delivery cases (24 hr) No  

Escorting Delivery Cases by ANM No

Treatment of minor ailments Yes  

First aid (specify) No

Peripheral blood smear in case of fever Yes

Is it a DOTS centre? Yes

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Services provided – 2/2Services   Availability

Disease surveillance by IDSP format No

Control of local endemic diseases Yes

Promotion of sanitation No

Field visits and home care Yes

National Health Programmes Yes

Traditional birth attendants Yes (one)

ASHA Yes (5+1)

Coordinated services with AWWs, ASHA, VillageHealth and Sanitation Committee, PRIs

Yes

Village Health Plan / Sub Centre Plan No

Watch over unusual health events Yes

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Record keeping – 1/2

Registers maintained Registers not maintained

1. Birth register (includes immunization details)

2. Death register3. ANC register4. Family planning register 5. OPD register6. TB register7. Malaria register8. Visitors register9. Monthly report register10. ANC camp register11. Stock book (Drug register)12. Equipment , furniture and other

accessories register13. FRC14. JSY register

1. Eligible couple register including contraception

2. Epidemic, communicable, syndromic surveillance register

3. Register for water quality & sanitation

4. Under five growth monitoring register

5. Above 5 child immunization register6. Number of HIV/STI screening and

referral7. Fund register

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Record keeping – 2/2Name of register Whether

available?Remarks

ANC record Yes Complete

Eligible couple register No From work plan

Maternal death record Yes Maintained in death register

Infant and still birth Yes Maintained in birth and death register

IMNCI field visits Yes Since sep 2012

Maintenance of PNC visit records No From work plan

ANC + immunisation cards Yes Given to all

Referral transport voucher book Yes Not used since April

IBSY register Yes Since oct. 2012

List of severely anaemic children No -

Last month monthly report given to PHC Yes Complete

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Skills and training of ANM

Skill Whether proficient?

SBA trained Yes

IMNCI trained Yes

Measuring BP Yes

Use of Haemoglobinometer Yes

Use of Uristix Yes

Giving DPT vaccine Yes

Danger signs for referring sick child Yes

Identifying HRP Yes

Maintaining aseptic precautions during labour Yes

When not to use vaccine Yes

Treatment of anaemic pregnant women Yes

Some skills were observed directly

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Quality control

Particulars Availability

Citizen’s charter No

Internal monitoring Yes

External monitoring No

No. of visits by MO in the last month 2

No. of visits by LHV in the last month 3

No. of visits by CMO in last year 0

No. of visits by state official in last year 0

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Checking by house visits - 1House 1 House 2

Name of woman Latha Krishna

Husband Vedpal Krishnapal

First ANC 5th month 2th month

No. of ANC visits at HSC 4 4

Approx. no. of IFA 50 40

Was BP taken Yes Yes

Was weight taken Yes Yes

Was urine tested No No

Was Hb tested Yes Yes

Place of delivery PHC Chhainsa Home

Was JSY given Not eligible Not eligible

No. of PNC visits made by ANM 3 4

Houses in which a child between 1 and 2 months of age was selected for this purpose

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Checking by house visits - 2

House 1 House 2 House 3 House 4

Name of child Nanshi Krishna Prakash Manu

Age 6m 3m 7m 3m

Immunisation card? Yes Yes Yes Yes

Who informs about sessions? ASHA ASHA ASHA ASHA

Whether immunised appropriately for age

Yes Yes Yes Yes

Whether ANM gave ORS for diarrhoea

Yes NA NA NA

Whether ANM gave cotrimaxazole for ARI

NA NA Yes NA

Houses in which a child between 2 months and 1 year of age was selected for this purpose

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Output

1. Maternal health

2. Child health

3. Family welfare

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Maternal health – 1/2

Services Sub centre Expected

Population covered 6228 (mid year) 5000

New ANC registration 148 131

Registration <12 weeks 134 (90.5%) 100%

High Risk Pregnancy 34 13

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Maternal health – 2/2

Services Sub centre Expected Remarks

Institutional Deliveries

87/114 (76.3%) 100%80.2% MOHFW stats for 2010-11

Home Deliveries 27/114 (23.7%) 0T Dai is atleast partly responsible

Deliveries at sub centre

0 0 It’s a Type A HSC

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Child Health

*CES 2009

Services Achieved Expected Remarks

DPT3 (%) 99.2 100 Haryana (R) –73*

OPV3 (%) 99.2 100 Haryana (R) - 76*

BCG (%) 97.1 100 Haryana (R) –83.2*

Measles (%) 93.6 100Haryana (R) – 78.7*

No of under five children with malnutrition - - Not maintained

No of newborns whose birth weight recorded 104/108 (96.3%) 100

Home deliveries not measured

Newborns with low birth weight (< 2500 kg)

18/108(16.7%) 22% in NFHS 3

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Family welfare – 1/2

* As on march 2012

Services Achieved*

No. of eligible couples 1184

Tubectomy 523

Vasectomy 10

IUD 51

OCP 50

Condom 200

Total couples protected 634

Parameter India Jawan

Couple protection rate 56.0% (All India, NFHS 3) 53.5%

Contraception prevalence rate for modern methods

55.6% (Rural India , DLHS 3) 70.4%

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Family welfare – 2/2

* For March 2012

Formulae for calculating target:1. C = no. of eligible couples – couples who adopted sterilisation2. Target for IUCD = (C X 30)/4003. Target for sterilisation = (C X 20)/4004. Target for CC user = (C X 37.5)/4005. Target for OCP = (C X 12.5)/4006. To get Monthly target divide by 12.

ServicesMonthly target to be achieved

Achieved

Sterilisation 3 0

IUD 5 1

OCP 2 2

Condom 2 10

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Impact

1. Vital statistics

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Vital Statistics

Indicator Jawan HSC PHC Chhainsa Haryana (Rural)

CBR (per 1000 population) 18.3 23.7 22.9**

CDR (per 1000 population) 5.3 6.9 7.0**

IMR (per 1000 live birth) 26.3 52.8 48**

NNMR ( per 1000 live birth) 8.8 37.0 38*

U5MR (per 1000 live birth) 43.9 62.0 74.0#

MMR (per lakh live birth) No maternal death reported in the study period

212* (2007-09)

** SRS 2012, * SRS(2009), # NFHS 3

For the period 2011-12

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Conclusion

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Conclusion• Overall functioning of Sub-centre was satisfactory• Visibility of SC to the public needs to be improved, Location outside the

village seems to be a hindrance• Water supply and power are not available• Some items like Cu T insertion set, dressing materials, salter weighing

scale, uristix are not available but furniture is adequate• Most drugs are available in ample amounts, but signage inadequate• Inadequate funds supple to SC• Overall record keeping is satisfactory, however under 5 malnutrition status

is not recorded• ANM is well trained• Home deliveries conducted by village Dai seems to be a problem• Family welfare activities, immunization coverage are satisfactory

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Recommendations

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Recommendations

• Urgent repair of the building and provision of electricity and water supply

• Making the SC more prominent with signage

• More efforts for surveying under 5 children for nutritional status and

anemia

• Timely release of untied funds will help in procuring items which are not

available

• Village Health Plan and SC plan should be initiated

• More time is spent for records keeping and report preparing

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Thank you