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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
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