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Tamil Nadu

1. District Theni Major observations of Regional Evaluation Team, Chennai about the Evaluation work in Theni District of Tamil Nadu states in the month of September, 2010 respectively.

I. Details of the visited Institutions: District Visited

GHs and PHCs visited HSCsMCH & Scan Centre visited

Theni GH: Bodi Nayakkanur PHCs:Rajadhani and Thevaram

HSCs : Kothuppatti, Pichampatti, Thambi Nayakkanpatti and Laxminayakkanpatti and Municipal Health Center – Bodi Banu Scan Centre of- Shanmugam Clinic, Bodi

II. Major observations:

1. Human Resources: i. 11 posts of medical officers against strength of 78 Medical Officers, 14 posts (out of

86 sanctioned) of MPW(M) and 5 posts of LHV (out of 33 sanctioned) were lying

vacant in district

ii. Except the post of Siddha Medical Officer, one staff nurse, two VHS and one Sanitary

worker, all the sanctioned posts were filled up in PHC Rajadhani.

iii. In PHC Thevaram all the sanctioned posts were filled up except the post of one

Pharmacist and one Staff Nurse.

2. Rogi Kalyan Samiti (RKS) and Village Health & Sanitation Committee (VHSC):

i. As reported, in 36 institutions RKS has been set up in the district and RKS meetings

were being held regularly at all level.

ii. The district has formed VHSCs in 215 villages. Most of the allotted funds of VHSC

were spent for the salary of the Mazdurs to clean the villages, check the water tanks

etc.

3. Untied Funds:

i. The PHCs and HSCs as visited by the team have utilized the whole funds provided to

them.

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ii. All PHCs & HSCs in the district were maintaining the financial records and voucher

in a proper way.

4. Services of JSY:

i. Janani Surakha Yojna was implemented in all the visited centres and functioning well

at all level.

ii. Beneficiaries were given cash assistance and no case pending was found by the

visited team.

5. Physical infrastructure and Stock Position:

(i) GH and PHC:

i. GH at Bodinayakkanur is well equipped 70 bedded hospital, but no waste bio-

medical system was found there. It was also reported that Ambulance facility is not

available in this Hospital.

ii. PHCs at Rajadhani (a 22 bedded hospital) and PHC Thevaram (a 30 bedded hospital)

were well maintained with good infrastructure and adequate medicines. Residential

quarters for staff were also available in the visited PHCs.

(iii) HSCs:

i. All four sub centres visited in the district were functioning in Govt. building. The

HSCs visited at Laxminaykkanpatti, Pichanpatti and Kothuppatty were having labour

room facility but delivery were not being conducted in these centres. In HSC

Kothuppatty, building was not maintained properly for clinic purpose. The team

observed that no attention was paid towards cleanliness. The ANM also was not

staying in the HSC.

ii. The Ambu bag /suction, Steam sterilizer, disposable syringes, Antiseptic solution,

chlorine solution/bleaching, Chlorine Tablets, Paracetamol tablets, metraonidazole,

were not available in some HSCs

iii. DDKs, Co-trimoxazole, Oxytocin tablets, Cap Ampicillin, Gentamycin Injection, Kit

‘A’ and Kit ‘B’ (for current year) were not available in any HSC.

6. Community Opinion and Satisfaction:

i. 20 mothers having child upto one year old were contacted in the district. They

informed that ANMs are available as and when needed. Their deliveries were

conducted by trained personnel and also their babies were weighed after birth.

ii. All the mothers were aware of the use of ORS.

iii. 10 (40%) mothers were aware of the symptoms of ARI. All contacted mothers were

aware about contraceptives but 11(44%) mothers did not know about its side effects.

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iv. Three PNC Check up was given to 15(60%) mothers.

v. The public expressed very good opinion about the functioning of the PHCs and their

staff. Similarly public opinion for Male Health Workers about their work was found

satisfactory.

7. Sample verification of F.W. acceptors:

i. The visited team selected a total of 87 FW cases out of which 57 (65.%) could be

contacted by them for sample verification.

ii. Minor discrepancies were noticed in the age of acceptor, spouse and in the number

and spilt up of children

iii. 5 (9%) IUD acceptors reported to have not received IUD insertion.

8. Maintenance of Registers and Records:

i. Maintenance of registers and records was not satisfactory in the visited centres.

ii. Eligible Couple Register, Sterilisation Register, IUD Register, OP and CC Registers

were not maintained properly in the visited centers.

iii. Due to absence of IUD register at PHC Rajdhani, reported figures under IUD could

not be verified.

iv. Case Cards for sterilizations were also not maintained at any of the visited PHC and

GH

9. Other Observations and Suggestions:

i. It was observed that CC service details were not at all maintained by the workers of

the visited HSCs in both the PHCs at Rajadhani and Thevaram but performance of

these services are reported.

ii. Reporting in HMIS was not implemented at HSC and PHC level. PHC Thevaram

started entering data in HMIS from this year onwards.

iii. In the whole district there was no stock of OP for the last six months. In the visited

HSCs, it was observed that they received some amount of OP in September 2009 and

July 10 but the stock was not sufficient.

iv. Dy Director (Medical Officer) post is vacant since 23.12.09. District EE post is

vacant since 1/8/10. Out of 7 block extension educators only 2 were in position. Out

of 7 block health statisticians only 3 were in position. Out of 7 store keepers only one

was in position. The vacancies may be filled urgently to improve performance in the

family welfare programmes

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2. District: Thirunelveli

Major observations of Regional Evaluation Team, Chennai about the Evaluation work in Thirunelveli District of Tamil Nadu states in the month of and October 2010 respectively.

I. Details of the visited Institutions: District Visited

GHs and PHCs visited HSCsMCH & Scan Centre visited

Thirunelveli GH: Melappalayam PHCs: Munirpallam, Kallur and Pathamadai

HSC Bharathiyar Nagar, Nadukallur, Karisulndhamangalam and Gandhinagar Scan Centre - Pushpalatha Nursing Home Scan Centre - Annai Velankanni Hospital.

II. Major observations:

1. Human Resources:

i. In the district large number of essential posts of health functionaries were vacant. 39

(36%) out of the sanctioned 108 posts of specialists, 38 (18%) of the 217 sanctioned posts

of MOs and 33 (43%) of the sanctioned 77 posts of LHVs were vacant in the district.

Moreover, 11 (85%) posts out of 13 block health statisticians, 16 (84.2%) posts of BEE and

18 (94.7%) posts of storekeeper at various centers in the district were lying vacant.

ii. In the visited center in GH at Melappalyam, there were sufficient number of doctors and

paramedical staff, however, no specialist in dermatology and ENT were available. The post

of FW Assistant was lying vacant in the Hospital.

iii. In PHC Pathamada, the post of Theater Assistant and one Post of MO was lying vacant.

All the three PHCs visited in the district were hiring the services of anesthetists and

gynecologists.

2. Functioning of Rogi Kalyan Samiti:

i. As reported, Rogi Kalyan Samiti was functioning in 66 institutions in the district. It

was observed to be functioning in all the centres visited. It also observed that the

government officials are only the members of RKS committee.

ii. All the visited centers were getting funds regularly under RKS.

iii. During 2009-10, all the PHCs were providing funds @ Rs.88,000 and Rs.1 lakh each

during the current year.

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iv. It was observed that RKS were utilizing funds for meeting requirements like

purchase of medicine, salary of contractual staff etc.

3. Village Health & Sanitation Committee (VHSCs) :

i. Out of total 485 villages, VHSCs were formed in 425 villages in the district.

ii. The visited team observed that the details of funds and vouchers were not

maintained properly in the visited centres. Each VHSC was given fund @ Rs.5,000

every year.

iii. Team found that the formation of VHSCs in the district was not uniform. In HSC

Bhartiyar nagar of Kallur PHC there was only one VHSC for a population of 9335

covering 7 villages. Whereas in HSC Gandhinagar of PHC Pathamadai had 3

VHSCs for a population of 6850.

iv. It was noticed by the team that in town Panchayat Pathamadai all the three VHSCs

had received Rs.10,000/- separately.

4. Services of JSY:

i. Janani Surakkshya Yojna programme is being implemented in all the PHCs and GH

visited in the district.

ii. All eligible mothers were given cash assistance to the tune of Rs.700 which includes

transportation charges under the scheme.

iii. During 2009-10, the district had released Rs.67.3 lakhs under JSY scheme, out of

which 56.3 lakhs were spent for 6413 beneficiaries. During the current year, out of

Rs. 34.12 lakhs, Rs. 1.07 lakhs were spent.

iv. No pending case for cash incentive to JSY beneficiary was found during 2009-10 in

the district.

v. In the district, the team selected 12 JSY beneficiaries Out of these 11 were

contracted. One could not be contracted due to temporarily leaving the place. All the

contracted mothers got the JSY amount and transportation charges.

5. Untied Fund:

i. There are two divisions for maintaining the programme wise funds and services in the

district. The details of untied funds from Ankarankoil HUD was made available

whereas this details were not made available by the second HUD, Thirunelveli.

ii. The record of funds received by the district and its distribution to the subordinate

institutions were not properly maintained at the district office. Moreover, funds

details were not systematically maintained at the PHCs and HSCs visited in the

district.

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6. 24 hours delivery care Services

i. In addition to 15 GHs there are 66 PHCs functioning as 24x7 hour delivery care services

in the district. All the 3 PHCs and GH visited have sufficient skilled manpower and

advanced equipments like USG, ECG etc., to provide round the clock quality health care

services.

ii. It was reported that 60 to 70% deliveries are conducted during night hours in the visited

24x7 hour centres in the district.

7. Physical infrastructure:

i) GH:

GH at Melappalayam is a very old hospital near to the district HQ; ambulance, blood storage

unit and residential quarters for doctors and staff were not available there.

ii) PHC:

i. Residential quarters for MO and staff were not available in PHC Kallur and PHC

Munirpallam.

ii. AYUSH wing was also not available in PHC Munirpallam.

iii. PHCs were hiring the services of Gynecologists and anesthetists.

iii) Sub Centres:

i. HSC Karisulthamangalam was not having Govt. building and furniture. Except Nadu

Kallur, ANM was not staying in any HSC.

ii. Supply of water, labour room, examination table, foot stool were not available in HSCs

Karisulndama and Munir Pallam. Benches for clients were also not available in HSCs

Karisulndama.

iii. Except Nadu Kallur, Mclntsh sheets, Ambu bag/such, Steam sterilizer and Delivery kits

were not available in any other HSCs. Thermometer was not available in HSC Gandhi

Nagar, Nadu Kallur and Bharthiyar Nagar.

iv. Equipments like Gloves, AD Syringes and Needles, disposable Syringes and drugs like

emergency contraceptive pills, OPs, Condoms, Antiseptic solution, chlorine

solution/bleaching, Chloroquine Tablets, Paracetamol tablets, Metraonidazole, Oxytocin

tablets, Cap Ampicillin, Gentamycin injection Kit ‘A’ and Kit ‘B’ ( for current year) were

not available in any HSC.

v. ORS packets were not available in Munir Pallam HSC. DDKs were not available in HSCs

Karisulndamagalam, Bharathiyar nagar and Munir pallam.

vi. SBA training was also not given to ANMs.

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vii. Posters for public awareness were not properly displayed on the wall of any visited HSC.

8. Knowledge & Opinion of the Community:

i. The team contacted 18 mothers having upto one year old child in the area of visited

HSCs, they told that ANMs were available as and when needed.

ii. All the contacted mothers informed that their deliveries were conducted by trained

personnel and in 13 (72%) cases child weighed after birth. Only 7 (40%) had given

breast feeding within half an hour of the delivery.

iii. All 18 contacted mothers were aware of the use of ORS and 11 (61%) mothers about

ARI and contraceptive.

iv. 21(54%) deliveries of the contacted mothers were conducted by trained personnel at

home without use of DDKs.

v. Three PNC check up services were received by 12 (40%) mothers.

9. Sample Verification of F.W. Acceptors:

i. The visited team selected a total of 104 FW cases out of which 100 (97 %) could be

contacted for sample verification.

ii. Minor discrepancies were notices in the age of spouse, in the number of total children,

Male children and last child.

10. Maintenance of Records and Registers:

i. The record and register maintenance need lot of improvement in the visited centres.

Eligible Couple Register, Sterilisation Register, IUD Register, MCH Register, CC and

OP Registers were either not maintained or not updated in the visited centres.

ii. Due to non maintainence of CC record, the team could not able to select the sample

for verification.

iii. Stock of OP was reported to be available but actually it was observed during the

visit that there was no OP stock.

iv. Mother Child tracking details were not updated at the PHC and HSC level.

v. Case Cards (Follow up cards) of Sterilization were not maintained in any visited

centres.

11. Miscellaneous observations & suggestions:

i. The district was not having a head to monitor and supervise the various health activities. In

the district, there was more than one DD Health to whom NRHM funds were directly given

by the State. More over senior officers like JD and DD medical having separate offices in

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the district have no control over the activities and there was no officers to co ordinate the

activities at the periphery level. Due to such condition at the district head quarter, the team

could not able to get the total district level actual data required for the evaluation work.

ii. The maintenance of FW service register and HSC untied and AMG funds registers are not

maintained as per guidelines. HMIS report is yet to start in GH Melappalayam.

iii. Citizen charter regarding availability of facilities, emergency phone numbers were not

available in the centers visited.

iv. None of the visited PHCs, panchayat member, NGO or village leader were included in the

RKS committee which is mandatory.

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3. District Pudukkottai: Major observations of Regional Evaluation Team, Chennai about the Evaluation work in Pudukkottai District of Tamil Nadu State in May 2010. I. Details of the visited Institutions: District Visited GH and PHC visited HSCs visited

1. Pudukkottai GH: Keeranur and Annavasal PHCs : Arimazham and Melaiyur

HSCs: Onamkudi, Keelapanaiyur, Athiran Vidudhi and Mankottai ii)Appollo Scan Centre iii)City Scan Centre

II. Major observations: 1. Human Resources: a. In the district, at PHCs level 35 posts of MOs out of 134 sanctioned, 37 LHVs out of 50 sanctioned and 71 Male Health worker out of 169 sanctioned were vacant. Further 3 posts of Block health statisticians were lying vacant out of 10 sanctioned. b. In GH, Keeranur and Annavasal the post of DGO was lying vacant. Out of 8 sanctioned post of staff nurses, 3 were appointed on contract basis. Anesthetist, Pediatrician and Pharmacist were also lying vacant in GH. c. In PHC Arimazham, out of 5 posts of staff nurse only 2 were filled up. 2. Functioning of Janani Suraksha Yojna (JSY): a. The Health services and cash assistance was being provided to the mothers regularly under JSY Scheme in the district. There was no funds scarcity in the district. b. In the visited GH Keeranur and GH Annavasal, JSY Services have been started since November 2009. c. In the PHCs visited at Arimazham and Malaiyrur, it was observed that the funds were sufficient and beneficiaries were happy with the services. d. Out of 29 JSY beneficiaries selected for sample verification, 21 could be contacted and it was found that all the contacted beneficiaries had received JSY incentives, follow up services and transportation help etc. 3. Untied Funds: a. There were 4 parallel health offices running in this district viz, JD, DD Medical and two separate DD health at Pudukkottai and at Aranthangi. Details of funds received, spent by the district as a whole was not available like other districts. There was no DPM, District account officer or any staff appointed for this purpose. In the district, though each and every office was spending funds nobody was taking the responsibility of keeping the details of funds received and spent which is serious matter and needs to be resolved.

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b. Untied funds were provided to PHCs and HSCs. c. Untied funds were not properly spent in HSCs of PHC Malaiyur. Both the visited HSCs had spent for solar lamp costing Rs.4000 which were not working and irreparable and PHC has spent Rs.25000 for solar heater that too was not working. d. There was irregularity in the distribution of PHC level untied funds from the HUD Aranthangi to PHC Arimazham. During 2006-07 the PHC received Rs.24240, in 2007-08 no fund was given, in 2008-09 an amount of Rs. 25000 and in 2009-10 funds to the tune Rs.79315 were given. No proper guidelines were followed, in distributing funds to the PHCs. Similarly PHC level distribution of AMG in PHC Malaiur was also found improper. During 2006-07, Rs.50000 was given by the DD Health, in 2007-08 and 2008-09 no funds were given but 2009-10 an amount of Rs.25000 was provided. 4. Functioning of Rogi Kalyan Samiti(RKS): a. RKSs (known as Patient Welfare Society PWS) in the state have been constituted in 66 institutions in the district. The details of meetings of PWS were not made available by the District Health Society in the district. During visit to the different Institutions, the team observed that there was no uniformity in the amount sanctioned to the PWSs in the district. b. There is no uniformity in the amount sanctioned for RKS in both the GHs and it vary from year to year. GH Annavasal, was given Rs.1 lakhs each for 07-08 and 08-09 but only Rs.75000 was given during the year 09-10. In GH Keeranur, an amount of Rs. 1 lakh each was provided during 07-08, 08-09 but Rs.1.80 lakh was given during the current year. This is also a serious matter. Yearly renewal of RKS registration is pending from the registration department of the district. Both the GHs had submitted the necessary papers some months ago but the renewal not yet done by the registration department. c. In PHC Arimazham, under RKS, an amount of Rs.50000 in 2006-2007, 1 lakh each in 2007-2008 and 2008-2009 and Rs.50000 in 09-10 were sanctioned. no guidelines are followed in the distribution of RKS funds to PHC Malaiyur. In 2006-07 an amount of Rs.50000, in 2007-08 Rs. 1.75 lakhs, in 2008-09 Rs. 80,000 and in 2009-10 Rs. 2.08 lakhs were received by the PHC. 5. Village Health and Sanitation Committee (VHSC): a. Out of total 755 villages in the district, the VHSCs were formed in 498 villages. b. In PHC Arimazham, there were 9 VHSCs and all had received the funds to the tune Rs.10,000 per year. c. In PHC Malaiyur, out of total funds of Rs.120635 received, only an amount Rs.78429 was spent by various VHSCs for sanitation work. 6. 24X7 hours services: As informed by the district authority all the 54 PHCs, 12 GHs and 4 block PHCs were working as 24 hours delivery care services. 7. Physical Infrastructure and Stock Position: (i) Government Hospital (G.H.) a. GH Annavasal is a 30 bedded hospital. The space is not sufficient for OPD and no separate wards available for male and female patients. Facilities of vehicle and blood storage were not available. Although residential quarters are available for all, the maintenance work was not done by the PWD for the past several years. In GH Keeranur, no separate building for emergency and infectious diseases was available. There was no blood storage, and only one residential quarter available that too was not properly maintained by the PWD. (ii) PHC a. PHC Arimazham is a 30 bedded pakka building with good facilities like 2 ambulances, USG, and X-ray.

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b. Stock of Oral pill was not available for more than a year and users of Oral Pills were only 200 in the current year in PHC Arimzham. c. PHC at Malaiyur is a 8 bedded hospital but most of the facilities like 2 vehicles, USG, Boyles apparatus are available. The blood storage facilities is under process. No separate space is available for siddha, dental and post operative ward. (iii) HSCs a. Water source at SC Arthiranvidudhi and labour room facility in the Sub centre Onam Kudi were not available. The building at SC Kizhapanaiyur was under repair as most of the prime facilities were in poor condition. b. Ambu bag/suction, AD Syringes and Needles, disposable Syringes, DDKs, Emergency Contraceptive Pills, Oral Pills, Chloroquine Tablets, Cap Ampicillin and Gentamycin injection were not available in any of the Sub Centre visited. It was reported that no medicine other than IFA tablets is available in the HSCs drug kits. 8. Knowledge and Opinions of Community on Health services: a. 37 mothers having child upto one year of age were contracted in the area of visited HSCs. All the mothers confirmed about the regular availability of the ANMs at their villages. All of them visited immunization sessions / AWs for nutritional diet and also their deliveries were conducted by trained persons. b. All the mothers informed that their babies were weighed at birth, they had also received the services of PNC and were well aware about the ORS use. c. Community of these area need health education through IEC as the mothers was not fully aware about symtoms of ARI, use of contraceptive and use of Calcium in proper time. 9. Sample verification of FW acceptors: The team selected a total of 113 FW acceptors and out of them 85 (75.2%) were contacted for sample verification. Minor discrepancies were noticed in the age of spouse of the acceptors and in the total number of children. Field staffs should be more careful while recording the demographic details in the service registers in this regard. 10. Maintenance of Registers and Records: a. The team found that the maintenance of registers and records was satisfactory in the centres visited. b. However, Case cards for sterilization operations were not maintained properly. 11. Observations and Suggestions: a. Oral Pills were not available throughout the district for more than four months. b. It is desirable to have a DPM, district accounts officer and other related staff in the district to co-ordinate the fund flow and NRHM programmes. c. Both male health workers of PHC Arimazham did not maintain any register and also not doing any work for the past several years. d. None of the HSCs visited have conducted any deliveries or any immunization session in their HSCs. e. Citizen charter indicating availability of facilities, emergency phone numbers was not seen exhibited in any of the GHs, PHCs and HSCs visited. f. During visit to the HSCs, the team has observed that the Government is spending much amount providing inverters, gas connections and solar lamps to the HSCs inspite of the major activities especially immunization services and deliveries are not conducted there at all. g. It was also observed that every HSC has spent about Rs.2500 for online feeding data, this can be minimized by appointing staff at PHC level on contract basis. h. Out of two PHCs visited, in PHC Arimazham, no members from panchayat SHG, Anganwadi worker, NGO etc. were included in the RKS as per guidelines.

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4. District Nilgiris Major observations of Regional Evaluation Team, Chennai about the Evaluation work in Nilgiris District of Tamil Nadu State in May 2010. I. Details of the visited Institutions: District Visited GH and PHC visited HSCs visited

2.Nilgiris

GH: Coonoor PHC:Nedugula and Sholur FPAI, Coonoor

HSCs: Nedgula, VOC Nagar and Sholur PNDT Centre Nedugula PNDT Centre, Namker Hospital PNDT Centre, Shivshakti N. Home

II. Major observations: 1. Human Resources: a. The staff position in health sector in respect to Medical officer & ANM was satisfactory in the district. However, 34 out of 90 posts of Staff Nurse contractual and 24 out of 34 SHN posts were lying vacant in different centres of the district. b. In the visited PHCs and GH most of the staff was in position except vacancy of DGO in GH, Coonoor. 2. Functioning of Janani Suraksha Yojna (JSY): a. JSY programme was implemented successfully in the District. There were 2865 beneficiaries in the year 2006-07, 2585 in 2007-08 and total 1035 in the year 2008-09 (upto September 2009). Details of beneficiaries for 2008-09 and current financial year were not available. b. In the visited centres, the beneficiaries were observed having services, there was no pending case for cash incentive under the scheme at GH Coonoor while in PHC Sholu 21 cases were pending for the payment. c. The team contacted 21 JSY beneficiaries and found that JSY incentive and transport charges were paid to all. 3. Untied Funds: a. In the visited Centres/Institutions, the team observed that the funds were provided regularly under different head i.e., Untied, RKS, AMG etc. In GH Coonoor, the utilization of untied funds as available was satisfactory. At PHC Nedugula, no details in respect of untied funds was made available to the team. b. In PHC Sholur maximum amount of the untied funds was utilized.

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c. In the visited HSCs at Nagar and Sholur, no uniformity in the distribution of untied fund was noticed. As per the details received, untied funds @ Rs.10,000 annually were not given to them regularly, for some years the amount provided was very less. 4. Implementation of Rogi Kalyan Samiti (RKS): a. RKSs have been formed in 37 institutions in the district but the details of the distribution of RKS funds in the district was not made available to the team even through the information was requested from the district authority more than one month ago. b. It was observed that only one meeting was held in the district on 26.3.2007 since its formation. The team contacted most of the governing body and executive body members of the district health society in this regard. They informed that no meeting was held in the district and they were not informed about any meeting whether it is executive or governing body. 5. Village Health and Sanitation Committee (VHSC): a. In the Nilgiri district, the VHSCs were formed in 98 villages. b. Provision of funds and its utilization etc. was not made available by the district office even though they were requested well in advance. 6. 24X7 hours services: As reported by the district, all PHCs and GHs were providing 24 hours delivery care services in the district. 7. Physical Infrastructure: (i) GH & PHCs Except USG, all other equipments and facilities were available in GH Coonoor, PHC Nedugula has no AYUSH Unit. PHC Sholur has all facility of Health Services and maintained the hospital hygienically and systematically. Residential quarters were under construction in this PHC. (ii) Health Subcentres: a. HSCs, visited at VOC Nagar and Sholur, were having own buildings with all primary facilities alongwith labour rooms but no delivery was conducted there during last three months. b. AD Syringes and Needles, disposable Syringes, DDKs, Emergency Contraceptive Pills, Cap Ampicillin and Gentamycin injection were not available on the day of visit in the centres. c. Vit. A solution and Paracetamol tablets were not found in HSC VOC Nagar and Steam sterilizer was not available in HSC Sholur. d. The ANMs of these centres were not provided SBA training. 8. Knowledge and opinions of community on Health services: a. The team contracted 18 mothers in the area of visited HSCs in the district to assess their knowledge and opinion about the services rendered by ANMs. All the mothers informed that ANMs were available when needed most. Their deliveries had been conducted by trained person and 17(94.4%) mothers informed that their babies were also weighed after birth. b. 11 (61.1%) mothers were not aware about the danger sign of ARI. c. All the contacted mothers were aware of the use of ORS and exclusive breast feeding. 9. Sample verification of FW acceptors: a. The team selected a total of 104 FW acceptors and out of them, 86 (82.7%) were contacted during sample verification. Discrepancy in the age of acceptor, spouse, total number of children and number of male children recorded in the service registers in respect of the acceptors were noticed during sample verification. 10. Maintenance of Registers and Records:

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a. The team found that the maintenance of registers and records was satisfactory in the centres visited. b. Case cards for sterilization acceptors were not maintained . 12. Observations and Suggestions: a. District level RKS (both executive and governing body) meeting should be conducted regularly and all the members should be invited and transparency in the sanctioning and allotment of funds should be made. b. Citizens charter was not exhibited in Nedugula PHC. c. It was informed by the DD Medical and DD TB that they are not getting sufficient funds for maintenance of vehicle and for conducting IEC activities. The allotment for maintenance of vehicle for the current year is only about Rs.800/- per vehicle which is insufficient. d. There is no common district officer for the district. There are separate officers for JD, DD Medical, DD Health, DD TB etc. without any co ordination.

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5. District Ariyalur:

Major observation of Regional Evaluation Team, Chennai about the Evaluation work in Ariyalur district of Tamil Nadu State in the month of January 2011 respectively.

I. Details of the Visited Institutions:

District

Visited

GH DH, HSP and PHCs Visited HSCs Visited

A. Ariyalur

GH : Jayamkondan

DH : Ariyalur

PHCs : Andimadam,

Kadugur and Vilangudi

A.S Hospital

Vilanthai,Olaiyur

Kallamkurichi,Vilangudi and

PNDT centre

II. Major observations:

1. Human Resources:

a. The staff position of the district was not satisfactory. Most of the posts were lying

vacant. Out of 83 sanctioned post of MO, 6 were filled up. 16 of the posts of 90 staff

nurses, 3 of the 19 sanctioned posts of lab Technician, 8 of 117 sanctioned posts of

ANMs, 96 of 108 sanctioned post of MPWs (M), 23 of 28 sanctioned post of LHV/HS

(F) and 14 of 28 sanctioned posts of Health supervisors (M) were lying vacant in the

district.

b. In the district HQ hospital, Ariyalur, there was no separate field staff for the urban area.

Out of 20 MO Posts of including 3 specialist are in position. All three specialists are

most often deputed to other centers of Ariyalur and Perambalur districts and with great

difficulty managing the average daily OPD of 1120 and IPD 1000 and large number of

surgeries. There was acute shortage of sweepers and basic hospital workers viz out of

32, only 15 are filled up.

c. In GH Jayamkondan out of 245 staff nurses 20 only are filled up. Out of them 6 were

appointed on contract basis.

d. In PHC Vilangudi Both male and female non medical supervisor posts were lying

vacant. In Andimadam PHC out of 18 male health workers only 3 were filled up and

one post of ANM was lying vacant out of total 18.

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e. Under Kadugur block PHC, only 3 MOs are filled up out of 5 MO posts. One post of

male health worker was only filled up out of total 5.

2. Functioning of Janani Suraksha yojana(JSY):

a. As per the district report there were 6169 JSY beneficiaries during 2009-10 and 2443

during 2010-11. The total JSY expenditure was Rs. 43.18 lakhs during 2009-2010 and

Rs. 17.1 lakhs during 2010-11.

b. In the visited GH Ariyalur. GH Jayamkondan , PHC Vilangudi, PHC Kadugur and

PHC Andimadam good number of deliveries were conducted under the ruled.

However, GH Jayamkondan 130 JSY beneficiaries observed to be waiting for their

cash incentives during 2010-11.

c. The team has contacted 27 JSY mothers in the district who have received the JSY

amount as per rule.

3. Untied funds

a. The DD (health) Perambalur was also incharge of Ariyalur district for the distribution

of funds. No details of untied funds were made available to the team from the district

office.

b. As has been reported at visited centres,there was no similarity in distribution of the

untied funds to PHCs and HSCs. PHC Vilangudi were given Rs. 25,000 for the year

2009-10 and only Rs 12,500 was given in 2010-11.

c. HSCs at Vilangudi and HSC Kallamkurichi untied funds Rs. 10000 was given for

2009-10 and no amount was given 2010-11. The HSC Vilanthai to the ten only

Rs. 6,898 was given in 2010-11 instead of Rs. 10000 HSC Olaiyur was given Rs.

12000 during 2009-10 and Ts. 500 during 2010-11 and HSC Vilagudi was not given

any funds during 2010-11.

4. Functioning of Rogi Kalyan Samiti (RKS):

a. RKs have been constituted in 32 institutions in the district.

b. There was no separate district Health society for the district and no representative from

the Ariyalur was included in the Perambalur cum Ariyalur district society. In all the

visited centers RKS were formed and some meetings were held. But no public leaders

were made as member in the RKS.

17

c. The details of funds distributed to the RKS of various centers were not made available

to the team from the district. As per details of RKS funds of various centers as per draft

there was no uniformity in the amount sanctioned for RKS. GH Ariyallur. was given

Rs. 1 lakh each for 2009-1010 and Rs.1.75 lakh was ginen in the year 2010-11. In GH

Jayamkondan , an amount amount of Rs. 1 lakh each was provided during 2009-10 and

2010-11. In PHC Vilankudi, under RKS, an amount of Rs. 152,170 in 2009-10 Rs.

138000 was given during the year 2010-2011. In PHC Andimadom in 2009-10 an

amount of Rs. 5 lakh and Rs.7.5 Lakh in 2010-11 was given during the current year.

5. Villge Health and Sanitalion Committe (VHSC):

a. 201 VHSCs formed in the district

b. In visited HSCs no Vouchers of expenditure incurred available though and records

of the VHSC meetings was available there.

6. 24 Hours Delivery cane services

Though all the 28 PHCs in the district said to have been working for 24 hour

deliveries, some were not functioning properly for want of sufficient manpower and

equipments. In PHC Kadugur, blood storage unit was long set up. In PHC

Vilangudi no residential quarters, OT and lab facility were available and also there

was only one MO.

7. Physical infrastructure and stock position :

i) FRU/PHC

a. In the head quarter of Government Hospital, Ariyalur, a new building was constructed

with modern facilities and necessary equipments funded by the Tamil Nadu Health

System Project. The hospital is 120 beded with all the facilities except residential

quarters and sufficient manpower.

b. In GH Jayamkondan, the maintenance of the hospitals and wards need improvement.

Most of the facilities are available except residential quarters. The availability of drugs

was not sufficient, ENT section, in the Hospital needed necessary items

18

c. PHCs at Andimadam and Kadugun were having all the facilities and supplies . In PHC

Vilangudi, facilities of power back up, microscope, lab facilities, OT, and residential

quarters were lacking.

ii) HSCs

a. Out of 4 sub centers selected in the district, two were functioning in rented premises.

Toilet facility was not available in one HSC. Labour room was available only in

vilangudi HSC.

b. Cupboard for drugs, examination table, benches, foot stool, Mcintosh sheets Ambu bag

, Steam sterilizer, delivery kit, torch light, stock of IUD, kit A & B were available only

in half of the sub centers.

c. Water, electricity, pregnancy kit, weighing scale, B. P. Apparatus Thermometer,

Vitamin A etc were available in all the HSCs.

d. None of the HSC visited have RDT Kit, AD syringes, Disposable Syringes,

contrimoxad, sanitary nepkins, EC Pills, Antiseptic solution, Chloroquine, Condoms,

Paracetamol, Metranidazole and Ampicillin Tab. and Gentamycin Injection

e. Out of 4 HSCs only one HSC had conducted deliveries during the past three months.

8. Knowledge and Opinions of Community on Health Services

a. The team has selected and contacted 27 mothers to know about the work of ANMs and

their knowledge on various health matters. All the contacted mothers informed that

ANMs were available when needed and all have visited the immunization site for IFA

& TT.

b. All contacted mothers had their delivery in institutions, and also they were aware of

exclusive breast feeding, ORS, contraception and about nearest government health

facilities.

c. 4 mothers (14.8%) had problem in the last pregnancy, first breast feeding within half an

hour was given by 18(66.6%) mothers.18 mothers (66.6%) had knowledge on ARI and

contraceptive side effects was only known to 16 (59.2%) mothers.

9. Sample Verification of F.W. acceptors

a. The team has selected totally 99 FW cases in the district, out of which 60 (60.6%)

could be contacted. Follow up services and compensation money since to the

sterilization cases found to be satisfactory.

19

b. Two OP users who were put for the services from December 2010 found to have denied

the services.

10. Maintenance of Records And Registers:

a. Sterilization registers were maintained in all the Visited PHCs & GHs. Consolidated

IUD registers were not maintained in all the PHCs visited.

b. All the workers of the visited HSCs maintained MCH & EC registers.

11. Observations and Suggestions (i) There was no separate district Health Society for Ariyalur. Perambalur district Health

Society also takes decision for the Ariyalur area. But no official representation from the

Ariyalur region and no public leader was included in the health society.

(ii) In the RKS, only government officials are included. No public representative is

involved in the functioning of RKS.

(iii) There was only one laparoscopic surgeon for the whole of Ariyalur and perambalor.

More doctors may be trained in laparoscopy.

(iv) Even though funds were said to have been given to the VHSCs, the team could not find

any committee functioning in the HSC areas visited. There was no list of committee

members and vouchers at the HSC level.

(v) The team has contacted public leaders like Ex - MLA of Perambalor. He has informed

that they are not involved in the implementation of any health programmes and

expressed displeasure in the functioning of health activities.

(vi) It was observed that all the visited HSCs were in a non functioning stage. There was no

basic medicines available in the HSCs. Immunization and delivery service are shifted

from HSCs to PHCs. ANMs were not interacting with the public in the field since they

have to be there in the PHC for immunization, ANC clinic, IUD insertion and School

health programmes etc. It was also observed that the implementation of family welfare

programmes (spacing methods) was totally neglected and there was no records

maintained for the spacing methods at HSC level. Most of the HSCs do not have male

health worker and so CC registers was not maintained at HSC level.

******

20

6. Salem district:

Major observation of Regional Evaluation Team, Chennai about the Evaluation work in Salem district of Tamil Nadu State in the month of January 2011 respectively.

1.Details of the Visited Institutions:

District Visited GH DH, HSP and PHCs Visited HSCs Visited

B. Salem

DHQ, GH :Yercaud, PHC: Nangavalli,

Tharamangalam, Panamarathupatti and

Thummalpatti

Nariyampatti,Kapparathampatti,

Thutampatti,Thasanaikkanpatti,

Gajanayakkanpatti, Kuttar Shri Hari

Hospital, Omalur, Ramana Nursing

Home , Omalur

II. Major observations:

1. Human Resources:

a. The staff position of the district was satisfactory except very few posts lying vacant

especially in the category of specialist, Lab Technician, Male Health worker Supervisor

and Block Health Statistician. Out of 58 Lab technicians. 41 only are filed up, BHS 15

in position out of total 20 and 3 vacancy in the Male Health Supervisor posts in the

district. There are totally 117 specialist posts sanctioned in various GHs out of which

only 69 are filled up.

b. In District Head quarter hospital Omalur, though all the MO posts are filled up, 2 were

an unauthorized absence for more than 6 months.

c. In GH Yercaud, out of 5 staff nurses posts, 2 were lying vacant and out of 7 MNA

posts, only 3 were filled up.

2. Functioning of Janani Suraksha yojana (JSY):

a. As per the statements reamed from the status of JSy is give below:

S.No Particulars 2009-10 2010-11

1 No. of JSY eligible mothers in the district 19499 17201

2 No. of mothers received JSY 19499 17201

3 JSY amount received in the district 1.04 crores 1.52 crores

21

4 JSY expenditure in the district 1.04 crores 90.41 lakhs

b. In the visited GHs and PHCs, JSY performance was good . In GH Omalur and Yercaud

JSY cases not reported during 2009-10.

S. No Name of the centers 2009-2010 2010-2011

1 GH Omalur - 108

2 PHC Nangavally 700 674

3 PHC Panamarathupatti 309 76

4 GH Yercaud - 3

c. The team has contacted 13 JSY mothers for an the field verification All have received

the JSy in centre as per rules and mostly delivered in Govt. Hospitals.

3. Untied funds

a. Untied funds to the extent of Rs.64,50,395 was available for the sub centres 2009-10 in

the district, Out of it Rs.49,30,514 was spent during the year. For the year 2010-11,

district had recieved Rs. 54,99,881 at their disposal and Rs. 13,35,083 was spent out of

the funds.

b. Untied funds to the tune of was Rs. 28,26,234, were available at PHC level during

2005-2010 out of which an expenditure of Rs. 21,11,222 was made during the year.

Similarly in the year 2010-11 an amount of Rs. 31,40,012 was available and out of it

Rs.12,65,546 was spent during the year.

c. Untied funds to the tune of Rs 50,000 and 2,00,000 were reamed during for 2009-10

and 2010-11 by the district hospital was received but no expenditure was reported.

d. Rs. 2,00,000 for the year 2009-10 and Rs. 8,00,000 for 2010-11 as untied funds were

released to Taluk and non Taluk Hospitals. An amount of Rs. 1,01,230 was spent during

2010-11.

e. At PHC Nangavalli an amount of Rs. 75000 had received and out of them spent Rs. 74861

in the year 2009-20010. Similarly, PHC Panamarathupatti received Rs. 54048 and incur

the expenditure of Rs. 537851 in the year 2009-10. During the current year 2010-2011

PHC Nagavalli and PHC Panamarathupatti have received Rs. 37639 and Rs. 22797

respectively out of which an expenditure of Rs. 19539 was made by Nagavalli and no

expenditure has been reported by PHC Panamarathupatti.

22

4. Functioning of Rogi Kalyan Samiti (RKS) and Villge Health and Sanitalion

Committe (VHSC):

a. RKS formed in all the 80 institutions in the district. Rs. 1.26 crores were distributed

to RKS during 2009-10 and Rs 88 lakhs during 2010-11 in the district. All the

visited centers have utilized the RKS funds for the welfare of the patients.

b. In Salem district 533 VHSCs formed. Out of it, 148 were in the town panchayat limit

and the rest 385 are in the village panchayat area.

c. Yearly Rs. 14.7 lakhs distributed to VHSCs for utilization in the district since 2008-09.

5. Services of ASHA.

In the district, totally 101 ASHAs were selected only for the hilly and tribal areas of

the district. They were helping the ANMs in immunizations, ANC, PNC, FW

motivation and conducting village health and nutrition day.

6. 24 Hours Delivery cane services

a. All the PHCs and GHs were functioning 24 hours for deliveries. All the PHCs are well

equipped with modern facilities. The GHs are getting funds only from Tamil Nadu

Health system project for building and equipments. The maintenance of PHCs are

found good.

b. The deliveries conducted by the visited centers during 2009-10 and 2010-11 are as

follows.

Sl. No Name of center Deliveries conducted in 2009-10 Deliveries conducted in

2010-11

1 DHQ Omalur 260 336

2 PHC Nagavall 712 516

3 PHC P.Patti 360 361

4 G.H Yercaud 11 3

7. Physical infrastructure

i) FRU / CHC Facility

23

a. In GH Yercaud, the facility was limited with no specialty services available. Only

normal deliveries were conducted in the tribal GH. Moreover, all the post of staff

nurses and nursing assistants were not filled up.

b. In DHQ Omalur, facilities and staff position were improved recently. The labuor ward

was very old for which replacement of floor tiles and minor repairs are due.

ii) PHC Facility

a. The facilities were excellent in all the 3 visited PHCs with most modern equipments of

USG, ECG, Separate toilet for patients and staff, newly purchased beds etc. In one

PHC Tharamangalam the building was recently constructed with 50 lakhs

contribution from the local public. Though facilities are very good, there is no

specialist doctor in the PHC.

b. In the PHC Nangavalli, there was no driver for the ambulances and the X- ray was

under repair. This PHC has only 2 clerical staff to do the accounts, establishment and

to upload the monthly reports. They no only do the pay bill for 74 PHC staff,

JSY payments and other official work also.

iii) HSC Facilities

a. The team has visited the HSCs at Thansanaikkanpatti, Kapparathan patti,

Thuthampatti, Nariyampatti, Kuttar and Gajanayakkanpatti. All the HSCs visited

have own buildings. ANM was not staying in one HSC. None of them have

conducted any deliveries or immunization and all these services are shifted to the

PHCs.

b. Facilities of Electricity, Delivery Table, McIntosh sheets, Delivery Kit, IUD kit, BP

appatratus, Weighing Scale , IFA items, Thermometer, vitamin- A, and OP stock

were no available in all the centers visited.

c. None of the HSCs had sanitary napkins, DDKs, ambubag.

d. All the HSC building maintained properly for clinic purpose. Facilities of conducting

delivery and cleanliness was found lacking in one center All the HSCs have

conducted VHNDs regularly.

8. Knowledge and Opinions of Community on Health Services

a. In Salem district, the team has selected and contacted 27 mothers to know about the

work of ANMs and their knowledge on various health activities. All the contacted

24

mothers informed that ANMs were available when needed and all have visited the

immunization site for IFA & TT. All contacted mothers had their delivery in

institutions and were aware of exclusive breast feeding, ORS knowledge, and

contraception.

b. First breast feeding within half an hour of delivery was given by 17(62.9%) mothers.

c. 19 mothers (70.3%) had knowledge on ARI and contraceptive side effects only known

to 17(62.0%) mothers.

9. Maintenance of Records And Registers:

Sterilization registers were maintained in all the Visited PHCs & GHs. Consolidated

IUD registers were not maintained in all the PHCs visited. All the workers of the

visited HSCs maintained MCH & EC registers.

10. Other Observations and Suggestions

a. Though, the number of maternal deaths has decreased absolutely over the years, the

present trend still remain alarming . In 2001-02, the maternal deaths were 84

decreased to 70 in 2004-05 , 50 in 2009-10 and 42 in 2010-11 (up to Feb. 2011).

b. There is only one Orthopedist in the accident and injury ward of G.H Omalur. If he

deputed to other institutions, the accident ward become no functional as there is no

other full time Orthopedist.

********

25

7. District Thiruvarur.

Major observation of Regional Evaluation Team, Chennai about the Evaluation

work inThiruvarur district of Tamil Nadu State in the month of March, 2011

respectively.

1.Details of the Visited Institutions:

District Visited GH DH, HSP and PHCs Visited HSCs Visited

Thiruvarur

GH: Nannilam, Mannarkudi and

Thiruthuraipoondi

PHCs:Ullikkottai,Thiruvizhimizhalai, and

Senganthiedaiyur,

HSC: Kandithampettal, Kunnalur,

Mahadevanpattinam, Manavanallur

and Sarabhojipuram

II. Major observations:

(Thiruvarur district do not have separate Joint director, DD Health and DD

Medical. All the work was managed and supervised by the Nagappattinam

district health officers.)

1. Human Resources

a. The problem of staff position was very acute in both Nagappattinam and Thiruvarur

district. In the combined district out of 21 blocks, the Posts of Health Statistician were

posted only in 4 blocks. District level offices also face hard ship in pertaining work due

to in sufficient statistical and data entry operators. Due to absence of the vital posts at

the block and district levels, register maintenance and report works were affected badly.

Moreover, block level supervisor and BEE was filled up only in 2 blocks out of 21

blocks.

b. All the district level posts of JD, DD Health, DD Medical were vacant.

c. In GH Nannilam, out of 14 specialists only one was in position. Only one lab technician

was available out 2 sanctioned and 3 staff nurses posts were lying vacant out of 16

sanctioned .

d. In GH Mannargudi, the staff position was somewhat better. Out of 18 post of

specialists 10 were filled up.

26

2. Functioning of Janani Suraksha Yojana (JSY):-

a. In the district there were 4620 JSY beneficiaries during 2009-10 and 3069 during 2010-

11, all the beneficiaries were reported to have been paid with the JSY cash assistance

during last two years.

b. During 2009-10, Rs. 56.66 Lakhs were received under JSY and amount of 32.34 lakhs

were spent. During 2010-11, Rs. 56.65 Lakhs were received and amount of 21.21 lakhs

was spent.

c. The team of contacted mothers in the district for field verification. All have received

the amount as per rules and most of their delivered in Govt. hospital.

3. Untied Funds

a. As per the district statement, untied fund was not properly monitored in the district.

Untied funds for sub-centres were not given in PHC Senganthiedaiyur and PHC

Thiruvizhimizhalai during 2009-10. There was no sufficient manpower to manage the

district level accounts.

b. In the visited PHCs at Senganthiedaiyur, Ullikkottai and Thiruvizhimizhalai, the funds

was sufficient during last two years and also utilized in these centers.

4. Rogi Kalyan Samithies (RKS)

a. In the district, RKS was formed in all the 4 institutions. Panchayath president or

peoples representatives were included in the RKS committee.

b. There was no separate district Health Society formed for Thiruvarur district.

c. In the visited centers RKS were functioning regularly. All the centers have utilized the

RKS funds for the welfare of the patients.

5. Services of ASHA and Village Health & Sanitalion Committe (VHSC):

a. ASHA scheme was not implacemented in the district.

a. In Thiruvarur district there were 430 VHSCs formed. Since ASHAs were not selected

in the district, they were not included as a member in the VHSCs.

b. All the VHSCs were regularly meeting with village leaders and they were helping in

improving the sanitation of the villages.

27

6. 24 Hours Delivery care services

a. All the 42 PHCs and 7 GHs were working as 24 hours centres for conducting delivery

in the district. As per the district statement, out of total 20,085 deliveries, 13736 were

conducted in the government sector.

b. Under the NRHM, the facilities were greatly improved in PHCs than in the GHs. All

the major PHCs having USG, X ray, ECG facility for caring mothers and new born

children, well equipped OTs, labour room and also well maintained wards.

7. Physical Infrastructure

i) FRU / CHC

a. In GH Mannarkudi, ambulance was available but no driver posted. There was

only one residential quarter in the GH which was not fit for stay. The maintenance of

the 198 beds, wards and premises found satistactory.

b. In GH Nannilam, the facilities were very limited. Surgical equipments available only

for P S and no facility for sick new born care. No residential accommodation for any

of the MOs and Staffs.

c. In GH Thiruthuraipoondi no separate space for specialty OP, and no residential

quarters. Ambulance and generator were under repair in this GH.

ii) PHC

a. PHC Thiruvizhimizhalai was a well maintained and well equipped PHC, the main

building was constructed make year age but nicely maintained with modern tiles, USG

ECG VCTC and a good garden. The PHC was also has a recently constructed 30

bedded ward with all facilities.

b. In PHC Ullikkottai, facilities are good. But the quarters were not fit to stay since the

maintenance is overdue. This PHC also has an additional 30 bedded newly constructed

building under NRHM.

c. In PHC Senganthiedaiyur, a recently constructed 30 bedded building with OT

developed major crack which was constructed by the PWD. Even the new tiles had to

be replaced in the OP and varanda. And in the ward, the tiles were broken and it has to

be replaced.

28

iii) HSC

a. The team has visited the HSCs of Mahadevanpattinam, Sarabhojirajapuram,

Kagithampetai, Manavalanllur and Kunnalur. All the five HSCs visited having own

building out of it ANMs were staying only in 4 . Facilities of water, electricity, toilet,

cupboard for drugs, IUD kit, adult weighing machine, BP apparatus, ORS, Gas, IFA

and vitamin- A were available in all the HSCs visited.

b. Facility of Kit A & B, Inje. Gentamycine , Ompicillin, Oxytoxin, Chloroquine, CC, EC

pills, DDKs, ambu bag and RDT Kit for Malaria, were not available in all the HSCs

visited.

c. Male health worker was not posted in any of the HSCs visited.

8. Knowledge and Opinions of Community on Health Services

a. The team has evaluated the work of 1 health inspector of PHC Thiruvizhimazhalai. He

was given the charge of all the HSCs of the PHC since male worker posts were vacant

in all the HSCs. He was doing only indoor work at the PHC and no field activities like

motivation of FW acceptors, collection of blood smears etc.

b. The team has selected and contacted 18 mothers to know about the work of ANMs and

their knowledge on various health services, all the contacted mothers informed that

ANMs were available when needed and all have visited the immunization site for IFA

& TT.

c. First breast feeding within half an hour up delivery were given by 8 (44.4%) mothers.

11 mothers (61.1%) had knowledge on ARI and side effects of contraceptive was only

known to 11 (61.1%) mothers.

d. The community leaders and the contacted public expressed satisfaction on the

functioning of PHCs and GHs visited.

9. Maintenance of Records and Registers.

a. Consolidated IUD registers are maintained in all the PHCs visited except PHC

Senganthiedaiyur.

b. Service register for spacing methods were not kept properly in the HSCs visited by the

team. CC register was not maintained in all the visited HSCs.

c. The registers for untied funds are maintained by the workers of the visited HSCs but the

Vouchers and pass books are with the PHCs.

29

10. Suggestions and Other Observations

a. Out of 10 blocks, the post of block Health Statistician was filled only in one block. The

post is very much essential in collection and compilation of reports and online reporting

of data.

b. There was no post of District Programme Manager, District Account Officer, Data

Entry Operator at the district, PHC & GH level. The district health society should think

of filling up some crucial posts like block health statistician and data entry operator on

contract basis till permanent candidates are posted.

c. In PHC Ullikkottail the residential quarters are not fit to stay. If minor repair for the

front wall of the old OT was done, the building can be use for years. Similarly, for the

OP section, minor repairs and painting was due. Residential quarters were insufficient

or nil in the GHs visited.

d. No posters of JSY and NRHM seen in the centers visited.

*********

-

30

8.District Cuddalore: Major observation of Regional Evaluation Team, Chennai about the Evaluation work carried out in Cuddalore District of Tamil Nadu State during June 2010.

I. Details of the visited institutions:

GH and PHCs Visited Scan Centres visited HSCs Visited GH – Panrutty PHCs – Thiruvendhipuram and Melpattampakkam

Krishna Hospital Scan Centre, Cuddalore Srinivasa Scan Centre, Cuddalore and Scan Centre, PHC Melpattampakkam

Pachayankuppam, Padhirikuppam, Melpattampakkam and A.C. Palayam

II.Major observations: Health Human Resources:

a) As reported, except MO, MPHW (M) and Block Health Statistician, the

staff position of other category of the posts was satisfactory in the district. b) Block Health Statistician posts in 5 blocks and 28 posts of MO were lying

vacant in the District. c) Out of 319HSCs, ANMs were posted in 309 HSCs and out of 156 posts

of MPHW (male) 106 were working in HSCs. d) The sanitation and hygiene condition of the GH Panruty was very poor

due to inadequate number of sanitary workers in the hospital. The condition can be improve by appointing required workers on contract basis.

2. Rogi Kalyan Samiti (RKS) and Village Health and Sanitation Committee

(VHSC): a) The Rogi Kalyan Samiti has been formed in 58 institutions in the district. b) The meetings of district Health Society and RKS of GH Panrutty were not

being conducted regularly; it was reported that only one meeting in 2008 and three meetings in 2009 were conducted in district Health Society. Only two meetings one each during 2008 and 2009 were reported to be held in GH Panrutty.

c) The RKS of both the visited PHCs were functioning smoothly. d) 659 VHSCs were formed in the district. In the visited PHC at

Thiruvedhipuram, the details of funds of VHSCs were not maintained.

3. Services of Janani Suraksha Yojna (JSY):

31

a) During 2008-09 there were 7639 JSY beneficiaries in the district. b) It was observed by the team that due to non availability of sufficient funds

under the Scheme 763 beneficiaries in PHC Thiruvedhipuram were waiting for their JSY cash incentive in 2008-09

c) The team contacted 35 JSY mothers in the district, all were having the ANC/PNC services in time and also received transportation amount.

d) It was reported that JSY Programme was implemented in GH Panrutty from 26.9.09.

4. Untied Funds:

a) Under different heads including untied funds the district had received

Rs.14.52 crores in 2008-09 and Rs.13.65 crores in 2009-10. Out of this, an amount of Rs.11.5 crores was utilized during 2008-09 and Rs.8.91 crores in 2009-10.

b) In PHC Melpattampakkam, untied funds were received 4 times viz, Rs.24744 on 28.3.08, Rs.25000 on 10.10.08. Rs.34510 on 10.09.09 and Rs.7250 on 30.3.10. In both the visited sub centre under this PHC, untied funds, Annual Maintenance grant and VHSC funds were properly utilized for benefits of the people.

c) The details of HSC level untied funds and AMG funds and funds for the VHSCs were not available at PHC & HSC level.

5. 24x7 Delivery Care Service: a) In this district 50 PHCs and all the GHs were functioning as 24 hours

delivery care hospitals. b) In the visited PHCs number of OPD and deliveries have increased due to

24 hours service . 6. Physical infrastructure:

i) GH a) GH Panruty was functioning in an old building without adequate maintenance. The hospital’s premises and wards were not maintained hygienically. b) The blood storage unit was just set up but without trained staff . c) Residential facilities to the doctors and the staff nurses were not available.

ii) PHCs a) Residential quarters for MOs and staff were lacking in PHC

Thiruventhipuram. Inadequate stock of CuT, OP and CC was observed on the day of visit.

b) In PHC Melpathampakkam, the space to provide 24 hour care services and residential quarters were also not there.

c) There was no AYUSH Unit in both the visited PHCs. iii) HSCs

a) Ambu bag/suction, Gloves, AD Syringes and Needles, disposable Syringes, DDKs, OPs, Condoms, Oxytocin tablets, Cap Ampicillin,

32

Gentamycin injection and Kit ‘A’ & ‘B’ were not available in any HSC visited in the district.

b) In HSC Pachayankuppam, regular water supply was not there. IEC material and stock of IUD also were not available.

7. Community satisfaction on overall health services: a) The team contacted 20 mothers having child upto one year of age in the area of the visited sub centres and they informed that ANMs are available as and when needed. All of them have visited either anganwadi centers or PHCs for service of immunization and ANC/PNC and also nutritional advice. b) 16 (80%) mothers were aware about danger sign ARI and side effect of contraceptive methods. c) All the contacted mothers were aware of the use of ORS and exclusive breast feeding. d) The public of both the visited PHCs areas have expressed good opinion about the functioning of the PHCs.

8. Maintenance of Registers and Records:

a) The record maintenance of the centers visited in the district was found satisfactory by the visited team. However, follow up cards for sterilization acceptors were not maintained. b) In district office, the person who is in charge of making HMIS entries in the computer was not given any training. The team observed some errors in HMIS data of the district and PHCs visited and they were asked to rectify. c) In the Krishna hospital scan center, none of the forms in the F and G register were having the name, address, signature and registration number of the doctor and some pages did not have the name and address and signature of the patient. 9. Other Observations and Suggestions: a) Regular meetings of governing and executive body of the DHS may be conducted at the district and periphery level. b) PNDT centers may be checked and monitored as per guidelines. c) The number of NSV cases done in the district is very few. There is a scope to increase the performance. d) The district has reported 14 maternal deaths in the current year. Swift action may be taken to reduce the same.

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