Health Subcentre evaluation

1. Health sub-centre evaluation Dr. Rizwan S A, M.D., 1

2. Outline Definitions Basic information about SC – Jawan Evaluation Methodology Input Process Output Impact Conclusions Recommendations 2

3. 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 3

4. 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. 4

5. Basic information 5

6. 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 6

7. Location of Jawan 7

8. 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 8

9. Steps of evaluation 9

10. Steps of evaluation PROCESS INPUT OUTPUT IMPACT Manpower Infrastructure Equipments Drugs Furniture Services Record keeping Quality control Maternal Health Child Health Family planning Vital statistics 10

11. Manpower Infrastructure Equipments Drugs Furniture Funds Input 11

12. 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 12

13. 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 × × 13

14. 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 14

15. Infrastructure – 2/3 Building 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 15

16. 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 16

17. Equipment – 1/3 N/A N/A N/A N/A 1 N/A 1 1 1 N/A 1 N/A 1 N/A 1 17

18. Equipment – 2/3 1 N/A 1 N/A N/A 1 oral 1 18

19. Equipment – 3/3 N/A 1 N/A 1 N/A 19

20. Consumables – 1/2 Yes Yes No No No No No Yes 20

21. Consumables – 2/2 Yes Yes Yes Yes Yes Yes Yes No Yes N/A N/A N/A N/A N/A 21

22. Furniture 1 1 1 N/A N/A * For type B HSC only N/A 4 N/A 2 2 2 1 N/A 1 22

23. Sundry articles 1 1 1 * For type B HSC only N/A N/A N/A 23

24. Drugs – Kit A Yes Yes Yes Yes No Yes Yes Yes N/A 24

25. Drugs – Kit B Yes Yes N/A N/A N/A 25

26. Other drugs Name 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 26

27. Contraceptives Name Availability Condoms Yes Oral pills Yes Copper T Yes Emergency contraceptive pills Yes 27

28. IEC materials Display boards Programme Status JSSK Yes JSY Yes Routine Immunisation No IMNCI No Family Planning No 28

29. Funds supply Source 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 29

30. Services provided Record keeping Quality control Process 30

31. Services provided – 1/2 Services   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 the timings 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 31

32. Services provided – 2/2 Services   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, Village Health and Sanitation Committee, PRIs Yes Village Health Plan / Sub Centre Plan No Watch over unusual health events Yes 32

33. Record keeping – 1/2 Registers maintained Registers not maintained Birth register (includes immunization details) Death register ANC register Family planning register OPD register TB register Malaria register Visitors register Monthly report register ANC camp register Stock book (Drug register) Equipment , furniture and other accessories register FRC JSY register Eligible couple register including contraception Epidemic, communicable, syndromic surveillance register Register for water quality & sanitation Under five growth monitoring register Above 5 child immunization register Number of HIV/STI screening and referral Fund register 33

34. Record keeping – 2/2 Name 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 m onthly report given to PHC Yes Complete 34

35. 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 35

36. 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 No. of visits by state official in last year 36

37. Checking by house visits - 1 House 1 House 2 Name of woman Latha Krishna Husband Vedpal Krishnapal First ANC 5 th 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 37

38. 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 38

39. Output Maternal health Child health Family welfare 39

40. 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 40

41. 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%) T Dai is atleast partly responsible Deliveries at sub centre It’s a Type A HSC 41

42. 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 (%) 93.6 100 Haryana (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 42

43. 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% 43

44. Family welfare – 2/2 * For March 2012 Formulae for calculating target: 1. C = no. of eligible couples – couples who adopted sterilisation 2. Target for IUCD = (C X 30)/400 3. Target for sterilisation = (C X 20)/400 4. Target for CC user = (C X 37.5)/400 5. Target for OCP = (C X 12.5)/400 6. To get Monthly target divide by 12. Services Monthly target to be achieved Achieved Sterilisation 3 IUD 5 1 OCP 2 2 Condom 2 10 44

45. Impact 1. Vital statistics 45

46. 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 46

47. Conclusion 47

48. 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 48

49. Recommendations 49

50. 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 50

51. Thank you 51