9 Rapid September, PHC Balsmand 12-13 6 f. PHC Chaudhriwas 13 6 g. PHC Gawar 13-14 6 h. PHC Satrod...

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Transcript of 9 Rapid September, PHC Balsmand 12-13 6 f. PHC Chaudhriwas 13 6 g. PHC Gawar 13-14 6 h. PHC Satrod...

  • Child Health Division, NRHM, Haryana

    in technical collaboration with

    Rapid

    Assessment

    9th September, 2013 to 19th

    September, 2013

    District Hisar

    Facility Readiness Assessment for Essential

    Newborn Care and Resuscitation

  • 1 | P a g e

    Table of Contents

    Sr. No. Content Page No.

    1. Objectives 2

    2. Materials and Methods 2

    3. List of facilities visited 2-3

    4. General findings of District 3-4

    4a. Overall Training Status 4

    4b. Status of Newborn Corners 4

    4c. Availability of equipment and instruments in NBCC 4

    4d. Status of NBSUs 5

    5. Quantitative findings of facilities 6-10

    6. Qualitative findings of facilities

    6 a. General Hospital, Hisar 10

    6 b. General Hospital, Hansi 11

    6 c. General Hospital, Adampur 11

    6 d. CHC Aryanagar 12

    6 e. PHC Balsmand 12-13

    6 f. PHC Chaudhriwas 13

    6 g. PHC Gawar 13-14

    6 h. PHC Satrod Kalan 14

    6 i. CHC Barwala 14

    6 j. PHC Agroha 14

    6 k. PHC Dhansu 15

    6 l. PHC Landri 15

    6 m. CHC Mangali 15-16

    6 n. PHC Kaimri 16

    6 o. PHC Ladwa 16

    6 p. PHC Nalwa 16

    6 q. PHC Talwandi Rukka 16-17

    6 r. CHC Narnaund 17

    6 s. PHC Khanda kheri 17

    6 t. PHC Mirchpur 17

    6 u. PHC Thurana 17

    6 v. CHC Siswal 17

    6 w. PHC Chuli Bagarian 17-18

    6 x. PHC Dobhi 18

    6 y. PHC Kajlan 18

    6 z. PHC Neoli Kalan 18

    6 aa. CHC Sisai 19

    6 ab. PHC Data 19

    6 ac. PHC Gurana 19-20

    6 ad. PHC Umra 20

    6 ae. CHC Sorkhi 21

    6 af. PHC Baas 21

    6 ag. PHC Puthi Saimain 21

    6 ah. PHC Puthi Mangal Khan 21

    6 ai. CHC Uklana 22

    6 aj. PHC Daulatpur 22

    6 ak. PHC Hasangarh 22-23

    6 al. PHC Pabra 23

    6 am. URCH Azadnagar 23

  • 2 | P a g e

    1. Objectives:

    1. Qualitative and quantitative assessment of readiness of our health facilities for essential

    newborn care and resuscitation.

    2. To assess the quality of essential newborn care provided to each and every neonate

    immediately after birth.

    3. To understand the existing knowledge, skills, attitudes and practices of the health service

    providers.

    4. On the job trainings to the service providers on novelties in essential newborn care and

    resuscitation.

    2. Materials and Methods

    1. A structured and tested assessment tool has been used to assess the facilities on 8

    parameters viz. facility identification and infrastructure, availability of services, human

    resource, Equipment and supplies, Register and client case records, protocols and

    guidelines, individual case records, knowledge and practices.

    2. Knowledge and skill assessment has been done on the newborn simulators (mannequins).

    3. The current and ideal practices in essential newborn care and resuscitation have been

    demonstrated to the service providers on the mannequins.

    Our teams visited 39 facilities in the district, from 9th September, 2013 to 19th September,

    2013, including General Hospitals, all CHCs and PHCs and the delivery huts with monthly

    delivery load of 3 or more. Following is the list of facilities visited:

    Sr. No. Name of Facility

    1. General Hospital, Hisar

    2. General Hospital, Hansi

    3. General Hospital, Adampur

    4. CHC Aryanagar

    5. PHC Balsmand

    6. PHC Chaudhriwas

    7. PHC Gawar

    8. PHC Satrod Kalan

    9. CHC Barwala

    10. PHC Agroha

    11. PHC Dhansu

    12. PHC Landhri

    13. CHC Mangali

    14. PHC Kaimri

    15. PHC Ladwa

    16. PHC Nalwa

    17. PHC Talwandi Rukka

    18. CHC Narnaund

    19. PHC Khanda kheri

    20. PHC Mirchpur

    21. PHC Thurana

    22. CHC Siswal

  • 3 | P a g e

    23. PHC Neoli Kalan

    24. PHC Kajlan

    25. PHC Dobhi

    26. PHC Chuli Bagarian

    27. CHC Sisai

    28. PHC Data

    29. PHC Gurana

    30. PHC Umra

    31. CHC Sorkhi

    32. PHC Puthi Saimain

    33. PHC Puthi Mangal Khan

    34. PHC Baas

    35. CHC Uklana

    36. PHC Daulatpur

    37. PHC Hasangarh

    38. PHC Pabra

    39. URCH Azadnagar

    3. The findings of district Hisar in general are as follows:

    • Well established referral linkages at the time of delivery (Higher centers are

    catering mainly high risk deliveries).

    • Availability of staff (including medical officers) and attendants (Nursing staff) in

    most of the facilities.

    • New born care corners (NBCC) established in almost all the labour rooms.

    • Availability of reasonable number of trained staff in NSSK and IMNCI.

    • At birth immunization in many facilities.

    • Availability of resuscitation equipment in many facilities.

    • PHCs with availability of generators and 24*7 backup supply.

    • Availability of running water and toilets in the facilities.

    • Registers and records maintained in most of the facilities (Case sheets with

    uniformly printed formats).

    • Availability of Gynecologists in SDHs and CHCs.

    • Many birth attendants not trained in SBA.

    • Hand washing stations not appropriate for effective hand washing. Effective hand

    washing before delivery not followed.

    • Simplified Partographs not available in many facilities.

    • Partographs maintained in many facilities but method is not correct and in most

    cases these are filled after delivery for record completion.

    • Autoclave available but not used in some facilities.

    • Home deliveries in some areas of the district due to unavailability of 24*7

    services in some PHCs.

    • Birth preparedness before delivery not done in some facilities.

    • Labour room protocols for infection prevention not followed in routine.

  • 4 | P a g e

    • Case sheets do not have records of essential newborn care.

    • Suction of every new born in practice despite good cry.

    • Immediate cord cutting in practice.

    • Infection prevention and hygiene protocols for labour room and NBCC are not

    followed in majority of the facilities.

    • Bag and Mask used for resuscitation. Chronology of resuscitation is not clear

    (PSSR not followed). Steps are not in chronological order (Resuscitation

    equipment are not available)

    • Use of Bag and Mask not appropriate.

    • Regular refresher trainings needed for resuscitation.

    • AMTSL practices are not followed in some facilities.

    • Skin to skin contact not in practice.

    • Use of Radiant Warmer and separation of every newborn from mother is in

    practice.

    • Skills of essential newborn care lacking.

    • Immediate drying not followed in many facilities

    • Management of low birth weight babies not done as per protocols

    4 a. Overall Training Status

    Sr. No. No. of Birth attendants SBA NSSK IMNCI

    1. 204 113 167 135

    4 b. Status of Newborn Corners

    Newborn Corners

    with Radiant

    Warmer

    Newborn

    Corners with

    200 W bulb

    Total NBCCs

    Established

    NBCCs still not

    established

    36 (39) (No labour

    room in Mirchpur)

    19 37 (18 with both

    Bulb and warmer)

    One (Recently shifted to

    new building URCH

    Azadnagar)

    4 c. Availability of equipment and instruments in NBCCs (n=39)

    Sr. No. Equipment/Instrument Available (No. of

    Facilities)

    Not available (No.

    of Facilities)

    1. Self-Inflating Bag 39 0

    2. Mask Size ‘1’ 38 1(Gawar)

  • 5 | P a g e

    3. Mask Size ‘0’ 35 (4) Choudhriwas GH Hisar (LR)

    Talwandi rukka

    Daulatpur

    4. Shoulder Roll 38 1

    5. Suction Catheter 37 2 (Pabra and Sisai)

    6. Disposable Mucus Extractors 37 2 (Puthi Samain, Suryanagar)

    7. Suction Machine 39 0

    8. Oxygen Cyinder 37 2 (URCH Azadnagar and Suryanagar)

    9. Baby Sheets 38 1 (Balsamand)

    10. NBCC at appropriate place 33 6 (changes suggested on site)

    4 d. Status of Designated Newborn Stabilization Units (NBSUs)

    Sr. No. Name of

    Institution

    Status Functionality No. of Radiant

    Warmers

    No. of

    Phototherapy

    Units

    1. SDH Hansi Established Not Functional 1 1

    2. CHC Barwala Not Established

    NA Only in NBCC 0

    3. CHC Mangali Not Established

    NA Only in NBCC 1

    4. CHC Uklana Not Established

    NA Only in NBCC 1

    5. CHC Aryanagar Not Established

    NA Only in NBCC 1

  • 6 | P a g e

    4. Quantita