Assessment of Utilization of RCH Services and Client Satisfaction ...

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Assessment of Utilization of RCH Services and Client Satisfactionunder Different Level of Health Facilities in Varanasi District

Chief Investigator

Prof. Deoki NandanDirector

National Institute of Health and Family Welfare

Study Team

IMS, BHU, Varanasi

Prof. Ratan K. SrivastavaDr. Sangeeta Kansal

National Institute of Health and Family Welfare

Dr. V.K TiwariDr.L.Piang

Mr. Ramesh Chand

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CONTENTS

Preface

Acknowledgements

Abbreviations

List of Table

Executive Summary

Chapter 1 Introduction

Chapter 2 Methodology

Chapter 3 Findings and Discussion

Chapter 4 Conclusion and Recommendations

References

Facility Survey at Various Levels of Government Health Centres

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PREFACE

The National Rural Health Mission (NRHM) was launched by the Government of Indiaon 12th April 2005 to carry out necessary architectural correction in the basic health caredelivery system, with a p lan of action that includes a commitment to increase publicexpenditure on health. The Mission envisages an additionality of 30% over existingannual budgetary outlays every year to fulfill the mandate to raise the outlays for publichealth from 0.9% of GDP to 2-3% of GDP. Under the Mission, multifarious activitieshave been initiated to strengthen the rural health care delivery system for theimprovement of health of the rural population.

NRHM implementation framework does not envisage significant engagemn ent ofmedical colleges in delivery of Mission interventions. The role of medical colleges inRCH-II is largely limited to conduction of clinical skill -based trainings. In the absenceof any systematic engagement of medical colleges, faculty members of dep artments areclueless about the evidence -based technical strategies being pursued in theimplementation of various National Health Programmes. There is a huge potentialavailable in medical colleges of the country for undertaking innovations, facilitatingprogramme interventions and conducting health systems research, which largelyremains untapped.

The Rapid Assessment of Health Interventions (RAHI), a collaborative activity with theUnited Nations Fund for Population Activities (UNFPA), is a unique initiative takenunder the wider umbrella of the Public Health Education and Research Consortium(PHERC) of the National Institute of Health and Family Welfare (NIHFW) fordeveloping partnerships with different organisations working in the field of health andfamily welfare. The objective of the project is to accelerate NRHM delivery inidentified states by organising timely , quality and appropriate inputs through rapidassessments/reviews to address priority implementation problems. During the firstphase of the RAHI project, the UNFPA supported 12 health systems research projectsin five low performing states viz. Madhya Pradesh, Jharkhand, Chhattisgarh, UttarPradesh, and Orissa. During the second phase, another 12 health system researchprojects from 6 low performing states viz. Uttar Pradesh, Uttarakhand, Madhya Pradesh,Jharkhand, Bihar and Rajasthan were taken up.

The rationale for supporting such rapid assessments stems from the discussions duringthe periodic Joint Review Missions and Common Review Missions. An impressivenumber of innovations have been supported by the states to improve access and enhanceservice quality. Many innovations are currently underway in the states and districts todeliver health care services in an effective manner. The state and district programmemanagers wish to know how well these innovations are performing so that in case ofgaps corrective measures can be taken to achieve the stated objectives. There has been

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an increasing recognition for incremental improvemen ts in the programme delivery byundertaking quick and rapid health systems research and engineering the feedback intothe processes. As an institutional response to such demand an attempt has been madeto develop a network of institutions and strengthen their capacities on rapid appraisalmethodologies for generating programme -relevant information at local and regionallevels.

The rapid appraisal of some of the interventions taken up in the second phase of RAHI -project covered the issues of contribut ion of indigenous systems of medicine inoperationalisation of 24x7 services, interface of ASHAs with the community and serviceproviders, logistics and supply management system of drugs at different levels,functioning of mobile medical units, birth prep aredness and complication readiness as atools to reduce MMR, quality assessment of institutional deliveries, performance -basedincentives to ASHA Sahyogini, referral transport systems, functioning of programmemanagement units, functioning of RKS, utilisa tion of untied funds at various levels andutilisation and client satisfaction of RCH service. A draft report entitled Assessment ofUtilization of RCH Services and Client Satisfaction Under Different Level of HealthFacilities in Varanasi District ” by the IMS, BHU, Varanasi, was finalised by NIHFW inconsultation with UNFPA.

The findings and recommendations of these studies will trigger of a series of follow -upmeasures by programme managers in the state. We strongly feel availability of such aresource to the programme managers will provide necessary evidence-based inputsenabling them to make any mid -course corrections and also scaling up.

Dr. Dinesh Agarwal Prof. Deoki NandanNational Programme Officer, UNF PA Director, NIHFW

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Acknowledgements

At the outset we will like to express our deep sense of gratitude to Dr. Deoki Nandan, Director,National Institute of Health and Family Welfare, New Delhi to invite us to submit a researchproposal based on the need of the health department of district Varanasi. We were given all localtechnical assistance, guidance with excellent local hospitality in the campus of NIHFW, New Delhi.We are indebted to him as well as to UNFPA for providing fund to carry ou t this study.

It is very valuable to mention special appreciation for Dr. V. K. Tiwari, Dr. K. S. Nair and Mr.Ramesh Chand from NIHFW, New Delhi who were central coordinating team members who helpedus for the quality check of the data. They were alway s very helpful and provided all sort ofcooperation to us for successfully completion of this study. The members of NIHFW were alwaysavailable to help us and instan tly replied our all e-mails whe ever we had query.

We would like to put words of appreciat ion to Dr. Sunita Chandra, Deputy Registrar (Dev), BHUfor providing all sort of help and administrative co -operation whenever required by us at Universitylevel. We are thankful to the Registrar of BHU for allowing us to carry out this study. We arethankful to the Finance Officer, BHU and the Deputy Registrar (Finance), BHU and IMS forreleasing the money at time and guiding us in the matter of finance.

We are indebted to our respected Prof. Gajendra Singh, Director, Institute of Medical Sciences,BHU for all his administrative support to carry out this study. We are also obliged to Prof. P.Sharma, Dean, IMS, BHU for all her cooperation and support. We are very much thankful to Prof.S. C. Mohapatra, Community Medicine who always encouraged us to carry out such studies. We areespecially thankful to Prof. R. N. Mishra, Community Medicine who remained with us at the time ofconduction of FGD in the field. We are very much appreciative of Mrs. Prarthi Sharma and Mrs.Manushi Srivastava, Lecturers who super vised the data collection process as well as they helped inthe data analysis of FGDs. We are thankful to all my faculty members and staff of Department ofCommunity Medicine, BHU, Varanasi for sharing all the responsibility of the department during thephase of data collection without whom it was not possible. We are also thankful to the staff ofCPERE, Community Medicine, IMS, BHU who maintained the quality during the process of datacollection from the rural areas of Varanasi district.

We are very much gratified to CMO, Varanasi and his team of officers at the headquarter as theywere always very cooperative and supportive whenever we needed their help and support even at thenotice of short period. This study could be possible because of the support of the office of CMO,Varanasi. We are also appreciative of Medical Officers of CHC and PHC who could spare theirvaluable time during facility assessment exercise. The field staff (ANM, HV, AWW, ASHA) ofrural areas were very supporting to us and we cannot f orget their help and cooperation.

We are thankful to Mr. Anjani Singh and Mr. R. K. Mishra for entry of huge data as well as formanaging the data. We are thankful to all the respondents of rural Varanasi for their support to carryout in-depth interview as well as the participants of FGD for their cooperation and participation inthe study.

Prof. Ratan K. Srivastava Dr. Sangeeta KansalPrincipal Investigator and Prof. and Head Co-investigator and ReaderIMS, BHU, Varanasi IMS, BHU, Varanasi

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ABBREVIATIONS

RCH: Reproductive and Child Health

ANC: Ante-natal Care

PNC: Post-natal Care

OBC: Other Backward Classes

SC: Scheduled Castes or Sub-centre

IEC: Information, Education and Communication

IPHS: Indian Public Health Standard

CHC: Community Health Centre

PHC: Primary Health Centre

ANM: Auxiliary Nurse Midwife

ASHA: Accredited Social Health Activist

CMO: Chief Medical Officer

MO: Medical Officer

NRHM: National Rural Health Mission

RKS: Rogi Kalyan Samiti

UNFPA: United Nations Fund for Population Activities

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LIST OF TABLES

SlNo.

TableNo.

Title PageNo.

1 (a) General Profile of the Selected Two Blocks of Varanasi District(b) Tools used in the study and it’s relation to different objectives of

the study(1) Distribution of respondents according to their religion in two blocks

of Varanasi(2) Distribution of respondents according to their social category in two

blocks of Varanasi(3) Distribution of respondents according to their education in two

blocks of Varanasi(4) Distribution of Respondents According to their Monthly Income in

Two Blocks of Varanasi(5) Distribution of respondents according to their occupation in two

blocks of Varanasi(6) Distribution of respondents according to the age of their infant at

the time of interview and the association with caste in two blocks ofVaranasi

(6.1) Distribution of respondents according to the age of their infant atthe time of interview and the association with educational status andoccupation in two blocks of Varanasi

(7.1) The knowledge of respondents about the health facilities availablein two Blocks of Varanasi district according to their caste

(7.2) The knowledge of respondents about the health facilities availablein two blocks of Varanasi district according to their educationalstatus

(7.3) The knowledge of respondents about the health facilities availablein two blocks of Varanasi district according to their occupation

(8) The Level of Awareness of Type of Health Services A vailable atGovernment Health Centres of two Blocks of Varanasi districtaccording to level of caste

(8.1) The Level of Awareness of Type of Health Services Available atGovernment Health Centres of two Blocks of Varanasi Districtaccording to level of Education

(8.2) The type of health services available at Government health facilitiesof two Blocks of Varanasi district according to occupation

(9) Level of Utilisation of Government MCH Health Services byrespondents According to their Social Cate gory

(9.1) Level of Utilisation of Government MCH Health Services by theRespondents in Two Blocks of Varanasi District according to theirOccupation

(9.2) Level of various types of MCH Health Services Availed by theRespondents from Government Hea lth Centres according to theirLevel of Education

(10) The type of ANC services availed by respondents during pregnancyin two Blocks of Varanasi district according to social category

(10.1)The type of ANC Services Availed by Respondents duringPregnancy in two Blocks of Varanasi District according to Level ofEducation

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(10.2)The type of ANC Services Availed by Respondents duringPregnancy in two Blocks of Varanasi District according toOccupation

(10.3) Reasons for Not Availing Government Health Facilities byRespondents according to their Social Category

(11) Advice given to the Respondents during Antenatal period fromGovernment Health Centres by Social Category, occupation andéducation

(12) Place of Delivery of Youngest Child of Respondents according toSocial Category, Level of Education and Occupation in two blocksof Varanasi

(13) Services provided at the Time of Delivery (institutional) Accordingto Social Category, Level of Educationand Occupation in twoBlocks of Varanasi

(14) Status of the First Check-Up Carried out After the Delivery at theHealth Centre according to Social Category, level of Educationaland Occupation

(15) Number of Postnatal Check-ups of Respondents within 7 Days ofthe Delivery by Level of Education and Occupation in two Blocksof Varanasi

(16) Distribution of Respondents as per Vaccination given to theirChildren from Different Health Facilities by Social category ,Education and Occupation in two Blocks of Varanasi

(17) Level of satisfaction of respondents for various health servicesprovided by different government health centres and the associationwith caste, educational status and occupation in two blocks ofVaranasi (Q 16)

(18) Distribution of respondents whose child had epi sode of diarrhoea inthe last 2 weeks according to the place of treatment in two blocks ofVaranasi

(19) Distribution of respondents whose child had pneumonia in the last 2weeks according to the place of treatment in two blocks of Varanasi

(20) Proportion of respondents received RTI/STI treatment according tothe place of treatment in association with caste in two blocks ofVaranasi

(21) Distribution of respondents who adopted family planning methodsavailed from different health facilities in association with caste oftwo blocks of Varanasi

(23) Level of satisfaction of respondents for family planning servicesprovided by different government health services and theassociation with caste in Two blocks of Varanasi

(24) Distribution of respondents according to the time required to availthe facilities to evaluate the suitability of Government healthfacilities and its association with caste in Two blocks of Varanasi

(25) Distribution of responses according to the means of conveyance toreceived health services from Government health facilities and itsassociation with caste, occupation and educational status in twoblocks of Varanasi.

(26) Distribution of respondents according to the status of maintenanceof privacy by health providers and its association with caste in twoblocks of Varanasi

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(27) Distribution of respondents according to their level of satisfactionfor the behaviour of Medical Officer and Health Workers by SocialCategory in Two blocks of Varanasi

(28) Distribution of respondents according to their perception about thestatus of routine facilities (cleaning of toilet; availability of drinking water;cleanliness of health centres) available at government health centres bySocial Category

(29) Distribution of respondents according to their perception regardingadequacy of the government health services by social category

(30) Distribution of the respondents who have paid the charges otherthan routine Registration Fee at government health centres

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Executive Summary

Maternal and child health are critically important in a country that is experiencing highinfant mortality and maternal mortality. Realising the importance of maternal and childhealth services, the Ministry of Health took up step to strength en maternal and child healthservices in the first and second five years plans (1951-56 and 1956-61). In the fifth five yearplan (1974-79) it was merged with the family planning services and nutrition services. Sincethen the promotion of maternal and chi ld health have become the most important aspect offamily welfare programme. The MCH services are delivered mainly by government -runCHCs, PHCs, and sub-centres, government hospital and private hospital/clinic/nursinghome.

To improve the availability and access of quality health care, especially for those residing inrural areas, the government has recently launched the NRHM programme in 2005 for poorwomen and children. It aims to provide effective health care to rural population throughoutthe country by improving accessibility, enabling community ownership and demand forservices, strengthening public health systems for efficient service delivery, enhancing equityand accountability and promoting decentralisation. Its special focus is on 18 states that haveweak public health infrastructure and where the challenge for strengthening poor publichealth systems is tough. Uttar Pradesh is one of the 18 special -focus states.

In the district of Varanasi, out of total six CHCs two started functioning as FRU. 2 4x7facilities are introduced at the 6 block PHCs and 64 sub -centers (8 per block) wereidentified for institutional deliveries. 1942 ASHAs were selected and trained. IMNCItrainings of ASHAs are almost over in 2 blocks. Rogi Kalyan Samiti is formed in all CHCsand district hospitals. Saubhagyavati Yojna has been introduced in the district as PublicPrivate Partnership to promote institutional deliveries in the community.

According to DLHS-3 (2007-08) in rural areas of Varanasi women having 3 ANC check -ups was only 17.7%, one dose of TT was received by 84.4%, institutional deliveriesrecorded 47.4%, mothers received PNC within 48 h ours of child birth was 33.5%,contraceptive use was also low i.e. 54.6%. However, regarding services for childrenreceived ORS for diarrhoea was 25.9%, exclusively breast -fed children were only 3% andper cent of children received measles vaccine was 65.2%. The health officials of district arevery much concerned for the further improvement of the utilization of various services a tCHC, FRU, PHC and sub-centre.

Therefore, keeping this in view, this study was planned to analyze the determinants ofutilization, reasons of non-utilization of RCH services at different level i.e. CHC, PHC andsub-centre and also to find out the measu res to gear up the utilization. The followingobjectives were earmarked under this study :

General Objective

To assess the various factors influencing utilization and non -utilization of services ( ANC,INC, PNC, family planning practices, immunization, feeding practices of young infant andchild, and use of ORS in diarrhoea, treatment of ARI ) and extent of client satisfactionunder RCH-II.

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Specific Objectives

1. To study the utilization pattern and to identify factors influencing the utilizationand non-utilization of RCH services at various levels of health services in Varanasidistrict of Uttar Pradesh ;

2. To describe level of client satisfaction about the various RCH services provided bydifferent health facilities in Varanasi district of Uttar Pradesh; and

3. To suggest measures for the enhancement of utilization of services by thecommunity at various levels in Varanasi district of Uttar Pradesh so that similarefforts may be replicated in other districts of UP.

Methodology

This was a cross-sectional study using a multistage sampling technique within the twoblocks purposively selected on the recommendations of Department of Health, districtVaranasi. List of villages were prepared and divided into 3 categories: < 2 km s, 2-5 kms, >5kms from CHC in each block under study. From each category two villages werepurposively selected, one each on road side and one from interior area. A total of 509mothers, whose babies were less than 12 months old, from the two 2 blocks – Pindra andCholapur, were interviewed by using structured and semi -structured schedules. In-depthinterview was conducted to 1 Medical Officer/Health Worker each of the facility. 4 FGDs,from study areas (women of reproductive age group with baby less than one year old) werecarried out. These four FGDs were carried out to elicit factors responsible for utilization andnon-utilization of RCH services . Those who did not utilize any of the above governmentservices were defined as non-user. The study maintained all research ethics throughout. Al lin-depth interviews and FGDs were recorded after taking prior consent from therespondents and were transcribed. The ethical clearance of the project was obtained fromthe Institutional Review Board of NIHFW.

Salient Findings

About 87% of the respondents have the knowledge of facilities available in the sub-centrefollowed by PHC (70.2%) and private hospital (40.7%) in Pindra. In Cholapur about 93%have the knowledge of the facilities at sub-centre followed by CHC (83.1%), and privatehospital (46.7%). About 91 % illiterates have the knowledge of facilities available at sub -centre followed by CHC (64%) and then PHC (52%). Overall the knowledge of sub-centreis more followed by CHC and then PHC.

The utilisation of ANC services was the highest among th e respondents belonging to theSCs with 90.1% followed by OBC with 89.1% and lowest among the general category . Theutilisation of immunization has the same pattern. Utilisation of PNC and f amily planningservices have different pattern with OBCs the highe st users followed by SCs and generalcategory. The utilisation of ANC, PNC and immunisation were higher among theagriculturists and weavers and labourers than respondents who were in business and service.

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Utilisation of family planning was higher among business category (26.8%) and weaversand labourers (14.2%) than agriculture (5%) and service (5%), but they were much belowthe national level. The utilisation of ANC has an inverse relation with education as higherlevels of education avail health facili ties from the private hospital.

More than half of the mothers found using private hospital for blood pressure (56%) andhaemoglobin (51%). Most of the mother had received tetanus vaccine (98%) and IFAtablets (79%) from the sub-centre. More than one-half (56.6%) received abdominalexamination during pregnancy out of that more than one-third (68.4%) received at sub-centre.

79.1% of the mothers received nutritional advice from health workers at the sub-centres.About 29% of the respondents received post -natal check-up and a very small proportion ofrespondents around 14% received 3 or more times PNC check -up. The utilisation of PNCshows that is higher among the general category ( 41%) than OBCs (29%) and SCs (22%).Utilisation of PNC has a positive relation with level of education but it is still very low withgraduate and above (45 %) being the highest. The percentage of utilisation of PNC is lowamong the weavers and labourers than the other who are well off occupation.

Around 13% of the respondents did n ot availed health facilities provided by thegovernment. The main reason for not using is th e decision of ‘family members and others ’with 28% followed by ‘behaviours of the doctors/health staff/distance of health facilities’with about 25%. About 25% of the respondents belong to general category, 11% OBCs and12% SCs did not avail health services from the government health facilities.

Non-utilisation of government health services has a negative relation with level ofeducation. The percentage of non-utilisation of government health services were moreamong the agriculturists with 37% followed by services category with 25%.

Around 16% of the respondents, irrespective of social category, educational status andoccupation were not satisfied with the servic es provided by government health facilities.About 44% of the respondents said just satisfactory followed by 27% who said satisfactoryand only about 7% said most satisfactory. About 25% of the respondents belong to SCshave graded not satisfactory though they were the main users. Higher levels of educationhave graded the government health facilities as ‘not satisfactory’.

More than half (56%) of the respondents reported to wait for ‘lees than half an hour’ in boththe blocks where the study was done. In terms of percentage-wise the hour spent for waitingwere more less in the same ranges except in Cholapur block more than one -third (38%) ofthe respondents belong to general category reported to have waited for ‘more than 2 hours’ .

The percentage of the use of family planning is far below the national level with 35.4%.Their main sources of family planning services is PHCs with 38.3% followed by sub-centrewith 23% and then CHCs with 19%.

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The percentage of the respondents who found the behaviour of doct or and health worker notsatisfactory were highest among the SCs with 22.2% and 25% respectively. Overall about40% found it ‘satisfactory’, 36% ‘just satisfactory’, 12% ‘most satisfa ctory’ and 12% ‘notsatisfactory.

Key Recommendations

The study came out with the following recommendations: All the health facilities should be made functional according to IPHS i.e. adequate

staff especial specialists should be appointed/hired to provide emergency and qualityservices.

Inadequacy of logistics (equipments, m edicines, and vaccines) and infrastructureshould be met.

There is a need for providing health services for 24 hours to improve the utilizationof health services.

The cleanliness and maintenance of infrastructure of the health centres is also veryimportant factor to increase the utilisation of the government health services.

Free and sufficient medicines should be made available . Cleanliness of the health centres and hospitals should be ensured. No amount should be deducted in JSY scheme. IEC activities must be strengthened to create awareness among the community about

various health schemes. Availability of pathological services at rural centres . Health services providers should be given training to build their capacity to improve

in their dealing with the patients. Availability of female doctor should be ensured at CHC . No one should be charged for the case paper and injection . The PNC services needed to be strengthened and encourage mothers for the

utilisation of the services. Electricity should be made available at delivery places with a proper power backup . Sub-centre should be at secure place so ANM can stay there . Increase the OPD timings with proper arrangement for emergency at night.

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CHAPTER 1

INTRODUCTION

In most developing countries such as Ind ia, utilization of basic health services has remainedpoor though there has been an increase in the public and private expenditure on theprovision of advanced health care. Maternal health is important in itself and for the health ofthe children also appropriate care of mother is necessary, both before and after the delivery.In India over 50 per cent of the children born are reported to have low birth weight with alow probability of survival in the first year. The poor utilization of RCH services also po seserious threats to maternal and child health.

Maternal and child health are critically important in a country that is experiencing highinfant mortality and maternal mortality. Realising the importance of maternal and childhealth services, the Minist ry of Health took up step to strengthen maternal and child healthservices in the first and second five year plans (1951-56 and 1956-61). In the fifth five yearplan (1974-79) it was merged with the family planning services and nutrition services. Sincethen the promotion of maternal and child health have become the most important aspect offamily welfare programme. The MCH services are delivered mainly by government -runCHCs, PHCs, and sub-centres, government hospital s and private hospitals/clinics/nursinghomes.1

To improve the availability and access of quality health care, especially for those residing inrural areas, the government has recently launched the NRHM programme in 2005 for poorwomen and children. It aims to provide effective health care to rural population throughoutthe country by improving accessibility, enabling community ownership and demand forservices, strengthening public health systems for efficient service delivery, enhancing equityand accountability and promoting decentralisation. Its special focus is on 18 states that haveweak public health infrastructure and where the challenge for strengthening poor publichealth systems is tough. Uttar Pradesh is one of the 18 special -focus states.

The focus of the programme is on reducing the MMR, IMR, and TFR. It also aims toincrease CPR and the coverage of children through immunization. Implementation of IPHS(Indian Public Health Standards) in respect of CHC, PHC, SC, upgradation of CHC as FRUfor dealing with emergency obstetric care, 24 x7 delivery services at the PHCs, operationalskill of sub-centers, multi-skilling of doctors, contractual appointments of MOs, SkilledBirth Attendants (SBAs) permitting ANMs to administer certain drugs in emergency,ASHAs for community mobilization, Publ ic Private Partnership, IEC activities and IMNCIare the major interventions to reduce MMR, andIMR. Beside, government has provideduntied funds at different levels of health facilities and Rogi kalyan Samitis are established atdifferent levels of health facilities so that existing facilities may run efficiently.

This study is conducted at two blocks in Varanasi district of Uttar Pradesh state. Varanasi islocated between 82°56’ East 83°00’ East longitudes and 25°20’ North - 25° 23’ Northlatitudes in the middle Ganga valley. By railway route it is well connected from Delhi (797kms), Kolkata (696 kms) and Mumbai (1560 kms). The first reliable census taken in 1881showed a population of about 2,18,573 people. According to 2001 census records, it had apopulation of about 31, 38,000 people with sex ratio: 903 females per thousand males. Ithad been the twenty-second city of India in urban agglomerations with 40.16% urbanpopulation. Female literacy rate (7 years and above) was 53.04 % and male literacy rat e (7years and above) was 77.87 %.

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In district Varanasi out of total six CHCs two started functioning as FRU. 24x7 facilities areintroduced at the 6 block PHCs and 64 sub -centers (8 per block) were identified forinstitutional deliveries. 1942 ASHAs were selected and trained. IMNCI trainings of ASHAsis almost over in 2 blocks. Rogi Kalyan Samiti is formed in all the CHCs and districthospitals. Saubhagyavati Yojna has been introduced in the district as Public Priv atePartnership to promote institutional deliveries in the community.

The DLHS was initiated in 1997 with a view to assess the utilization of services providedby government health care facilities and peoples perception about the quality o f services.According to DLHS–3 (2007-08) in rural areas of Varanasi women having 3 ANC check -ups was only 17.7%, one dose of TT was received by 84.4%, institutional deliveriesrecorded 47.4%, mothers received PNC within 48 h ours of child birth was 33.5%,contraceptive use was also low i.e. 54.6%. How ever, regarding services for childrenreceived ORS for diarrhoea was 25.9%, exclusively breast -fed children were only 3% andper cent of children received measles vaccine was 65.2%. The health officials of district arevery much concerned for the further improvement of the utilization of various services atCHC, FRU, PHC and sub-centre.

Therefore, keeping this in view, this study was planned to analyze the determinants ofutilization, reasons of non-utilization of RCH services at different level s i.e. CHC, PHCand sub-centre and also to find out the measures to gear up the utilization. The followingobjectives were earmarked under this study.

1.1 General Objective

To assess the various factors influencing utilization and non -utilization of Services ( ANC,INC, PNC, family planning practices, immunization, feeding practices of young infant andchild, and use of ORS in diarrhoea, treatment of ARI ) and extent of client satisfactionunder RCH-II.

1.2 Specific Objectives

1. To study the utilization pattern and to identify fac tors influencing the utilization andnon-utilization of RCH services at various levels of health services in Varanasidistrict of Uttar Pradesh;

2. To describe level of client satisfaction about the various RCH services provided bydifferent health facilities in Varanasi district of Uttar Pradesh; and

3. To suggest measures for the enhancement of utilization of services by thecommunity at various levels in Varanasi district of Uttar Pradesh so that similarefforts may be replicated in other districts of UP.

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CHAPTER 2

METHODOLOGY

2.1 Study Design and Sampling

This was a cross-sectional study using a multistage sampling technique. This study wasconducted during October to December 2008 in Pindra and Cholapur blocks, out of the 8blocks of Varanasi distric t, which were selected by purposive sampling technique on therecommendations of department of health, district Varanasi. List of villages were preparedfor 3 categories (< 2 kms/2-5 kms/>5 kms from CHC in each block under study). From eachcategory two villages were sampled (purposive) one each on road side and one from interiorarea. A total of 360 mothers; 180 from each selected block were planned to interview, and 1medical officer and health workers. The study population includes Medical Officers/HealthWorkers of health facilities and community members (Users/non Users of governmenthealth services). In this study village is the sampling unit.

General profile of both the blocks is as follow: -

Table 1 : General Profile of the Selected Two Blocks of Varanasi Districts

Profile of blocks Pindra Block Cholapur BlockTotal area of the block 22859 sq.mts. 192.5 sq.mts.

Current population 252,946 2,40,000

No. of villages 192 148

No. of CHC 01 01

Mother PHC 01 01

No of additional PHC 01 03

No. of sub-centers 49 35

2.2 Study Area

Pindra and Cholapur block

2.3 Study Units

Mothers whose babies were less than 12 months old and Medical officers. The Stratificationat block level for selection of 360 mothers is give bel ow:

120 mothers who availed (ANC/PNC, FP services, treatment for the illness of theirchild) from less than 2 kms of CHC.

120 mothers who availed (ANC/PNC, FP services, treatment for the illness of theirchild) from 2-5 km away from CHC.

120 mothers who availed (ANC/PNC, FP services, treatment for the illness of theirchild) more than 5 kms away from CHC.

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Those who did not utilize any of the above government services were defined as non-user.Before asking from client, investigator also undertook facili ty survey (IPHS tools wereused) to find out status of services.

4 FGDs, from study areas (women of reproductive age group with baby less than one yearold) were carried out. These four FGDs were carried out to elicit factors responsible forutilization and non-utilization of RCH services. (Please refer tool of FGD , Annexure-2).

2.4 Data Collection Plan and Techniques

On receiving the assignment a detail schedule would be finalized to collect data from the 2blocks of Varanasi districts in 4 week time. Two teams of 3 persons (Investigator 2 +Supervisor 1 (lecturer in Department of Community Medicine) ). Thus there would be atotal number of 4 investigators + 2 supervisors for collection of information. Theinformation collected from the field would be checked and corrected every evening by thesupervisor before leaving the field. The data collected would be complete in all respects.The tools already discussed would be used in respectiv e situation. These 2 teams spentaround 30 days to collect data. PI and Co PI/medically trained person collected data fromMOs and facility assessment.

In order to ensure the quality of data collection, PI/Co-PIs also collected 10% of data andsupervised the data collection. Depending upon the availability of time, interviews weredivided between PI and Co-PIs. This took around 7-8 team days. A tape recorder /electronicdata recorder would be used along with th at of a note taker. Camera was used for takingphotograph. The decoding would be done same day as far as possible.

In this study the following tools were used for data collection: In-depth interview schedule (semi-structured) for the client satisfaction for RCH

services among users and also among non -users of government sector. (Annexure -1) FGD (as per thematic discussion : Annexure-2) Checklist for facility survey of CHC/PHC and sub-centre according to the guidelines

of IPHS.

Table 2 : Tools Used in the Study and its Relation to Different Objectives of the StudySl.No.

Objectives Variables Objective-wise Tools

Objective-wiseTechnique

Respondents

1 To studyutilizationpatterns,influencingfactors andclientsatisfactionfor RCHservices.

Information and awarenessAvailability of servicesLocation and distance of healthcentresSocio-economic factors

Semi -structuredinterviewscheduleDiscussionguide

Interview

FGDs

Women of reproductiveage group who arehaving child of <1 yearsage.

Women of reproductiveage group who werehaving child of <1 yearage. User and non-userof government services

2 Facilitysurvey

CHCsvariables

PHCsvariables

Sub-centrevariables

Checklist In-depth-interview

MOIC of PHCMed. Superintendent of

CHCHealth Worker of Sub-centers

17 | P a g e

The tools and the data collection procedure were pre -tested and validated in a block otherthan the study block. Pre-testing was undertaken in a small sample of 20 clients (it wasexcluded from the main study) . Data were collected using semi -structured questionnaire.The questionnaire had both open ended and close ended questions. (Anne xure1)

2.5 Data Management and Statistical Analysis

Data collected from the field would be verified, cross -checked the same day, before beingdispatched to the headquarters. Data would be entered into the computer on bi -weekly basisand would be checked for discrepancies. Once clean data is ready, it was processed andtabulated and used for writing report. Quantitative as well as Qualitative Techniques wasused for data analysis.

2.6 Quality Assurance

The field investigators were trained for carrying out the interviews. The use of pre-structured and pre-tested schedule ensured uniformity of the data

collected. 25% sample check was done by PI and co-PI. Visit of NIHFW faculty/TAG members during training, pre -testing of tools, data

collection, data analysis report writing etc

2.7 Expected Outcome of the Study

The study provided new insight for researchers and hospital managers to devote resourcesfor achieving the best possible quality of maternal and child health services as per the feltneed of community.

2.8 Ethical Clearance

The project structure was examined and cleared by ethical committee of the InstitutionalReview Board of NIHFW for ethical considerations.

18 | P a g e

Chapter 3FINDINGS AND DISCUSSION

FINDINGS

3.1 Social Background of the Respondents

In this study two blocks of Varanasi district were sampled as per the recommendation of the officeof the Chief Medical Officer, Health Services, Varanasi and these were Pindra and Cholapur block(please refer map for their geographical situation). In -depth interview was carried out of 509respondents and majority of them (97.4%) were Hindu as shown in Table ( 1). Respondents of boththe blocks were similar for their religion.

Table 1 : Distribution of respondents according to their religion in two b locks of Varanasi

Religion

PINDRABLOCK

CHOLAPURBLOCK

TOTAL

No. % No. % No. %Hindu 244 98.4 252 96.6 496 97.4Muslim 04 1.6 09 3.4 13 2.6Total 248 100.0 261 100.0 509 100.0

Table 2 : Distribution of respondents according to their social category in two blocks ofVaranasi

Caste

PINDRABLOCK

CHOLAPURBLOCK

TOTAL

No. % No. % No. %General 32 12.9 32 12.3 64 12.6OBC 147 59.3 146 55.9 293 57.6Scheduled Caste 69 27.8 83 31.8 152 29.9Total 248 100.0 261 100.0 509 100.0

More than half of the respondents in both the blocks belonged to OBC and then followed by aboutone-third scheduled castes (Table 2). Caste-wise there was no difference in the respondents of twoblocks.

Table 3 : Distribution of respondents according to their education in two blocks of Varanasi

Educational StatusPINDRABLOCK

CHOLAPURBLOCK

TOTAL

No. % No. % No. %Illiterate 82 33.1 94 36.0 176 34.61-8 years of schooling 52 21.0 73 28.0 125 24.69-12 years of schooling 69 27.8 63 24.1 132 25.9Graduate and above 45 18.1 31 11.9 76 14.9Total 248 100.0 261 100.0 509 100.0

One-third of the respondents of both the blocks were illiterate and one-fourth had schooling of 9-12years duration. Graduate and above were very few (14 to 18) and both the blocks had similareducational status (Table 3).

19 | P a g e

Table 4 : Distribution of Respondents According to their Monthly Income in Two Blocks ofVaranasi

MonthlyIncome

PINDRABLOCK

CHOLAPURBLOCK

TOTAL

No. % No. % No. %1000-5000 219 88.3 246 94.3 465 91.45000-10000 22 8.9 10 3.8 32 6.310000-15000 05 2.0 01 0.4 06 1.215000-20000 01 0.4 03 1.1 04 0.820000-25000 00 0.0 01 0.4 01 0.230000-35000 01 0.4 00 0.0 01 0.2Total 248 100.0 261 100.0 509 100.0

Most of the respondents (about 90%) of both the blocks belonged to very low monthly incomeranging from Rs.1000-5000 only. The distribution of the respondents of two blocks according totheir total monthly income was almost similar (Table 4).

Table 5 : Distribution of Respondents According to their Occupationin Two Blocks of Varanasi

Occupation PINDRA BLOCK CHOLAPUR BLOCK TOTALNo. % No. % No. %

Agriculture 29 11.7 36 13.8 65 12.8Service 22 8.9 18 6.9 40 7.9Business 19 7.7 22 8.4 41 8.1Others* 178 71.8 185 70.9 363 71.3Total 248 100.0 261 100.0 509 100.0

* Others = Labourers, weavers, rickshaw puller, and driver etc.

India is an agricultural country and one will find mostly people belonging to agricultural area.However in the current study most of the r espondents (about 70%) were labourer , weavers, rickshawpullers and auto drivers in both the blocks. Varanasi is known for its handicraft and ha nd wovenBanarasi saris, which is why most of the respondents belonged to this category. The distribution ofthe respondents of both the blocks was almost similar accordi ng to their occupation (Table 5).

Though the respondents of both the blocks were similar in their demography but the data of all theobservations have been presented separately for both the block s to help the district administrator tounderstand the reason of any difference if observed for the purpose of making necessaryarrangements to increase the utilisation of the services of the health by rural people. Most of thesocio-demographic variables were correlated in the following tables to understand the factorsaffecting utilization and non-utilization of RCH services by the respondents.

Table 6 : Distribution of Respondents According to the Age of their InfantAt the Time of Interview and the Association With Caste in Two Blocks of varanasi

Age ofinfant at

the time ofinterview

PINDRA BLOCK CHOLAPUR BLOCK

General(n=32)

OBC(n=147)

ScheduleCaste(n=69)

TOTAL(N=248)

General(n=32)

OBC(n=146)

ScheduleCaste

( n=83)TOTAL(n=261)

1-3 month 15 52 21 88 10 40 23 7346.9% 35.4% 30.4% 35.5% 31.3% 27.4% 27.7% 28.0%

3-6 month 8 27 13 48 5 42 24 71

25.0% 18.4% 18.8% 19.4% 15.6% 28.8% 28.9% 27.2%

6-9 month 3 27 14 44 8 22 11 41

9.4% 18.4% 20.3% 17.7% 25.0% 15.1% 13.3% 15.7%9-12 month 6 41 21 68 9 42 25 76

18.8% 27.9% 30.4% 27.4% 28.1% 28.8% 30.1% 29.1%

20 | P a g e

Table 6.1 : Distribution of Respondents According to the Age of their Infant at the Time ofInterview and the Association With Educational Status and Occupation in Two Blocks of

VaranasiAge of

infant at thetime of

interview

Agriculture (n=29)

Service(n=22)

Busin-ess

(n=19)

Others[Weavers

andLabourers]

(n=178)

Total(n=248)

Agriculture

(n=36)

Service(n=18)

Busin-ess

(n=22)

Others[Weavers

andLabourers

(n=185)

Total(n=261)

1-3 month 10 9 4 65 88 12 5 4 52 73

34.5% 40.9% 21.1% 36.5% 35.5% 33.3% 27.8% 18.2% 28.1% 28.0%

3-6 month 4 6 5 33 48 5 4 6 56 71

13.8% 27.3% 26.3% 18.5% 19.4% 13.9% 22.2% 27.3% 30.3% 27.2%

6-9 month 3 6 6 29 44 6 6 5 24 41

10.3% 27.3% 31.6% 16.3% 17.7% 16.7% 33.3% 22.7% 13.0% 15.7%

9-12 month 12 1 4 51 68 13 3 7 53 76

41.4% 4.5% 21.1% 28.7% 27.4% 36.1% 16.7% 31.8% 28.6% 29.1%

Age ofinfant at thetime ofinterview

Illiterate(N=82)

Schooling Graduateand

Above(N=45)

Total(n=248) Illiterate

(N=94)


Above(N=31)

Total(N=261)

1-8 years(N=52)

9-12years

(N=69)1-8 years(N=73)

9-12years

(N=63)

1-3 month 31 16 26 15 88 25 22 16 10 73

37.8% 30.8% 37.7% 33.3% 35.5% 26.6% 30.1% 25.4% 32.3% 28.0%

3-6 month 16 9 17 6 48 29 20 15 7 71

19.5% 17.3% 24.6% 13.3% 19.4% 30.9% 27.4% 23.8% 22.6% 27.2%

6-9 month 11 11 12 10 44 13 12 10 6 41

13.4% 21.2% 17.4% 22.2% 17.7% 13.8% 16.4% 15.9% 19.4% 15.7%

9-12 month 24 16 14 14 68 27 19 22 8 76

29.3% 30.8% 20.3% 31.1% 27.4% 28.7% 26.0% 34.9% 25.8% 29.1%

According to the methodology, the mothers of children (youngest one) whose age was less than 1year were interviewed. Table shows the distribution of respondents of two blocks . It was found thatmajority of the respondents who were interviewed were having the infant between 1-3 month of agein the Pindra block while 9-12 months in cholapur block (Table 6). However, the overall distributionpattern of mothers in both the block o f Varanasi was almost similar including the ir association withthe caste, educational status and occupation.

3.2 Knowledge of Respondents about Health Facilities

All the respondents were asked to assess their knowledge regarding availability of differen t healthfacilities in their area and the information was analysed to see the status according to their socialcategory.

Table 7.1 : The Knowledge of Respondents About the Health Facilities Available in TwoBlocks of Varanasi District According to their Caste


General(n=32)

OBC(n=147)

ScheduledCaste(n=69)

TOTAL(N=248)

General(n=32)

OBC(n=146)

ScheduledCaste

( n=83)TOTAL(n=261)

Primary Health Centre

24 118 32 174 21 56 36 113

75.0% 80.3% 46.4% 70.2% 65.6% 38.4% 43.4%43.3%

21 | P a g e

Community Health Centre

13 57 35 105 27 122 68 217

40.6% 38.8% 50.7% 42.3% 84.4% 83.6% 81.9% 83.1%

Sub-Centre

28 131 57 216 29 136 79 244

87.5% 89.1% 82.6% 87.1% 90.6% 93.2% 95.2% 93.5%

District Hospital

7 36 13 56 8 33 22 63

21.9% 24.5% 18.8% 22.6% 25.0% 22.6% 26.5% 24.1%

Private Hospital

15 63 23 101 21 65 36 122

46.9% 42.9% 33.3% 40.7% 65.6% 44.5% 43.4% 46.7%

Others (Traditional Healers)

0 5 0 5 1 1 1 3

0.0% 3.4% 0.0% 2.0% 3.1% 0.7% 1.2% 1.1%

The awareness about the sub-centre and the PHC was among the most of the respondents from boththe blocks. The pattern of knowledge was almost similar in both the blocks. 3.4% respondents ofOBC in Pindra block were also aware about the traditional healers while none from the scheduledcaste or the general caste (Table 7.1). However in the Cholapur blocks respondents from all thecastes were aware about the traditional healers though the number was less as compared to thePindra block.

Table 7.2 : The Knowledge of Respondents About the Health Facilities Available in TwoBlocks of Varanasi District According to their Educational Status


Illiterate(n=82)

1-8 yearsof

Schooling(n=52)

9-12 yearsof

Schooling(n=69)

Graduateand

Above(n=45)

Total(n=248)

Illiterate(n=94)

1-8 yearsof

Schooling(n=73)

9-12 yearsof

Schooling(n=63)

Graduateand

Above(n=31)

Total(n=261)

Primary Health Centre53 30 55 36 174 38 26 31 18 113

64.6% 57.7% 79.7% 80.0% 70.2% 40.4% 35.6% 49.2% 58.1% 43.3%Community Health Centre

32 23 28 22 105 81 62 49 25 21739.0% 44.2% 40.6% 48.9% 42.3% 86.2% 84.9% 77.8% 80.6% 83.1%

Sub-centre69 41 66 40 216 91 70 56 27 244

84.1% 78.8% 95.7% 88.9% 87.1% 96.8% 95.9% 88.9% 87.1% 93.5%District Hospital

9 16 14 17 56 21 18 16 8 6311.0% 30.8% 20.3% 37.8% 22.6% 22.3% 24.7% 25.4% 25.8% 24.1%

Private Hospital32 18 32 19 101 35 34 34 19 122

39.0% 34.6% 46.4% 42.2% 40.7% 37.2% 46.6% 54.0% 61.3% 46.7%Others (Traditional Healers)

1 1 1 2 5 0 1 1 1 31.2% 1.9% 1.4% 4.4% 2.0% .0% 1.4% 1.6% 3.2% 1.1%

The awareness about different health facilities among the respondents was further analyzed to seethe status according to their educational level. In Pindra block 4.4% of the respondents having highlevel of education (graduate and above) were aware of traditional healers but none of the illiterate

22 | P a g e

person from Cholapur block. This could be accidental information and needs to be explored furtherin the future. However, the overall distribution pattern in two blocks was similar (Table 7.2). Mostof the respondents from Cholapur block were aware of CHC as compared to the Pindra block. Thedistrict health authorities have informed that most of the health activities are managed by CHCCholapur whereas by the PHC of Pindra block. This i nformation corroborates with the currentobservation recorded by interviewing the respondents.

Table 7.3 : The Knowledge of Respondents About the Health Facilities Available in TwoBlocks of Varanasi District According to their Occupation


Occupation Occupation

Agriculture(n=29)

Service(n=22)

Business(n=19)

Others(Weavers

andLabourers)(n=178)

Total(n=248)

Agriculture(n=36)

Service(n=18)

Business(n=22)

Others*(Weavers

andLaboures)(n=185)

Total(n=261)

Primary Health Centre24 15 16 119 174 19 8 8 78 113

82.8% 68.2% 84.2% 66.9% 70.2% 52.8% 44.4% 36.4% 42.2% 43.3%

Community Health Centre12 7 9 77 105 27 15 19 156 217

41.4% 31.8% 47.4% 43.3% 42.3% 75.0% 83.3% 86.4% 84.3% 83.1%

Sub-centre25 18 18 155 216 35 17 19 173 244

86.2% 81.8% 94.7% 87.1% 87.1% 97.2% 94.4% 86.4% 93.5% 93.5%

District Hospital8 8 10 30 56 6 1 4 52 63

27.6% 36.4% 52.6% 16.9% 22.6% 16.7% 5.6% 18.2% 28.1% 24.1%

Private Hospital10 7 10 74 101 21 11 11 79 122

34.5% 31.8% 52.6% 41.6% 40.7% 58.3% 61.1% 50.0% 42.7% 46.7%

Others (Traditional Healers)1 0 2 2 5 0 0 1 2 3

3.4% .0% 10.5% 1.1% 2.0% .0% .0% 4.5% 1.1% 1.1%

Knowledge of respondents about health facilities was explored in view of their occupational statusand it was observed that in both the blocks of Varanasi district, majority of the weavers andlabourers (others) were aware of the PHC and SC for the availability of health facilities and somefarmers and land owners were also aware of the PHC and sub-centre where routine health facilitiesare available (Table 7.3). More than half (58.3%) of the farmers (agriculture workers) fromCholapur were aware of availability of Private hospitals while only one -third (34.5%) from Pindrablock.

.3.3 Level of Awareness about Type of Health Services at Government Health Centres

The level of awareness of the respondents about the type of health services available at governmenthealth centres by social category is shown in Table (8.1). It was observed that the respondentsbelonging to OBC (98 %) and Scheduled caste (100 %) were more aware of availability ofimmunization and natal care services at government health centres and they were also aware of theavailability of family planning services to some extent (46.9 %) but for diarrhoea (16 .3 %) and ARI(10.2 %) about one-tenth of respondents from Pindra block were aware about these services atgovernment health centres and the same proportion was very low i.e. 8.8% and 1.9% respectively inCholapur block.

23 | P a g e

Table 8.1 : The Level of Awareness of Type of Health Services Available at GovernmentHealth Centres of two Blocks of Varanasi District according to their Caste


General(n=32)

OBC(n=147)

ScheduleCaste(n=69)

TOTAL(N=248)

General(n=32)

OBC(n=146)

ScheduleCaste

( n=83)TOTAL(n=261)

Immunization

26 144 69 239 32 143 83 25881.2% 98.0% 100.0% 96.4% 100.0% 97.9% 100.0% 98.9%

ANC

28 130 57 215 31 138 74 24387.5% 88.4% 82.6% 86.7% 96.9% 94.5% 89.2% 93.1%

PNC

24 104 45 173 29 109 61 19975.0% 70.7% 65.2% 69.8% 90.6% 74.7% 73.5% 76.2%

INC

23 89 51 163 25 105 58 18871.9% 60.5% 73.9% 65.7% 78.1% 71.9% 69.9% 72.0%

Diarrhoea

7 24 10 41 4 14 5 2321.9% 16.3% 14.5% 16.5% 12.5% 9.6% 6.0% 8.8%

ARI

1 15 2 18 1 2 2 53.1% 10.2% 2.9% 7.3% 3.1% 1.4% 2.4% 1.9%

Family Planning15 69 28 112 18 75 45 138

46.9% 46.9% 40.6% 45.2% 56.2% 51.4% 54.2% 52.9%

Do Not Know1 4 3 8 1 3 2 6

3.1% 2.7% 4.3% 3.2% 3.1% 2.1% 2.4% 2.3%

Table 8.2 : The Level of Awareness of Type of Health Services Available at GovernmentHealth Centres of two Blocks of Varanasi District according to EducationPINDRA BLOCK CHOLAPUR BLOCK

Illit

erat

e(n

=82)

1-8

year

sof

Scho

olin

g(n

=52)

9-12

year

sof

Scho

olin

g(n

=69)

Gra

duat

ean

dA

bove

(n=4

5)

Tot

al(n

=248

)

Illit

erat

e(n

=94)

1-8

year

sof

Scho

olin

g(n

=73)

9-12

year

sof

Scho

olin

g(n

=63)

Gra

duat

ean

dA

bove

(n=3

1)

Tot

al(n

=261

)

Immunization80 52 66 41 239 92 72 63 31 258

97.6% 100.0% 95.7% 91.1% 96.4% 97.9% 98.6% 100.0% 100.0% 98.9%ANC

70 46 63 36 215 87 69 57 30 24385.4% 88.5% 91.3% 80.0% 86.7% 92.6% 94.5% 90.5% 96.8% 93.1%

PNC53 35 54 31 173 71 58 48 22 199

64.6% 67.3% 78.3% 68.9% 69.8% 75.5% 79.5% 76.2% 71.0% 76.2%INC

46 27 55 35 163 62 57 45 24 18856.1% 51.9% 79.7% 77.8% 65.7% 66.0% 78.1% 71.4% 77.4% 72.0%

Diarrhoea8 11 11 11 41 12 4 6 1 23

9.8% 21.2% 15.9% 24.4% 16.5% 12.8% 5.5% 9.5% 3.2% 8.8%

24 | P a g e

ARI6 4 3 5 18 3 0 0 2 5

7.3% 7.7% 4.3% 11.1% 7.3% 3.2% 0.0% 0.0% 6.5% 1.9%Family Planning

22 28 38 24 112 48 34 41 15 13826.8% 53.8% 55.1% 53.3% 45.2% 51.1% 46.6% 65.1% 48.4% 52.9%

Do Not Know2 2 2 2 8 3 0 2 1 6

2.4% 3.8% 2.9% 4.4% 3.2% 3.2% .0% 3.2% 3.2% 2.3%

Almost similar pattern about the availability of various services at government health centres wasobserved in both the blocks. Most of the illiterate and less educated (1-8 years of schooling)respondents informed about the availability of mainly immunization and natal care services ascompared to other services of government health centres. They were also aware about theavailability of family planning services at government health centres . (Table 8.2)

Table 8.3 : The type of health services available at Government health facilities of twoBlocks of Varanasi district according to occupation


Agr

icul

ture

(n=2

9)

Serv

ice

(n=2

2)

Bus

ines

s(n

=19)

Oth

ers

(Wea

vers

and

Lab

oure

rs)

(n=1

78)

Tot

al(n

=248

)

Agr

icul

ture

(n=3

6)

Serv

ice

(n=1

8)

Bus

ines

s(n

=22)

Oth

ers

(Wea

vers

and

Lab

oure

rs)

(n=1

85)

Tot

al(n

=261

)

Immunization27 20 17 175 239 36 18 22 182 258

93.1% 90.9% 89.5% 98.3% 96.4% 100.0% 100.0% 100.0% 98.4% 98.9%ANC

25 19 18 153 215 35 17 20 171 24386.2% 86.4% 94.7% 86.0% 86.7% 97.2% 94.4% 90.9% 92.4% 93.1%

PNC21 14 13 125 173 27 11 16 145 199

72.4% 63.6% 68.4% 70.2% 69.8% 75.0% 61.1% 72.7% 78.4% 76.2%INC

23 17 14 109 163 26 13 16 133 18879.3% 77.3% 73.7% 61.2% 65.7% 72.2% 72.2% 72.7% 71.9% 72.0%

Diarrhoea5 4 8 24 41 0 1 2 20 23

17.2% 18.2% 42.1% 13.5% 16.5% .0% 5.6% 9.1% 10.8% 8.8%ARI

3 0 4 11 18 1 0 0 4 510.3% .0% 21.1% 6.2% 7.3% 2.8% .0% .0% 2.2% 1.9%

Family Planning17 9 10 76 112 21 9 13 95 138

58.6% 40.9% 52.6% 42.7% 45.2% 58.3% 50.0% 59.1% 51.4% 52.9%Do Not Know

2 1 1 4 8 2 1 0 3 66.9% 4.5% 5.3% 2.2% 3.2% 5.6% 5.6% .0% 1.6% 2.3%

The table showed that majority of the respondents of other category (weavers, labourers, rickshawpullers and auto drivers) were aware of immunization and natal care services and some of them werealso aware about family planning services. Awareness of respondents about the availability of childcare services was very low. However service and business class people were also aware about theavailability of private health facilities for child care services because of their high socio-economicstatus. Almost similar utilization pattern was seen in Cholapur block (Table 8.3)

25 | P a g e

3.4 Level of Utilization of MCH Services at the Government Health Centres

It was observed that OBC and scheduled caste respondents were utilizing ANC, PNC andimmunization services more as compared to other services. In general category the pattern ofutilisation of services was almost similar to other cast es but was less. Similar pattern was observedin both the blocks as shown in Table (9.1).

Table 9.1 : Level of Utilisation of Government MCH Services by the RespondentsAccording to their Social Category


General(n=32)

OBC(n=147)


TOTAL(N=248)

General(n=32)

OBC(n=146)

ScheduledCaste

( n=83)TOTAL(n=261)

ANC27 132 59 218 28 129 78 235

84.4% 89.8% 85.5% 87.9% 87.5% 88.4% 94.0% 90.0%PNC

9 69 34 112 15 77 33 12528.1% 46.9% 49.3% 45.2% 46.9% 52.7% 39.8% 47.9%

RTI1 2 1 4 1 1 0 2

3.1% 1.4% 1.4% 1.6% 3.1% .7% .0% .8%STI

2 2 1 5 0 1 0 16.2% 1.4% 1.4% 2.0% .0% .7% .0% .4%

Diarrhoea4 13 4 21 0 7 3 10

12.5% 8.8% 5.8% 8.5% .0% 4.8% 3.6% 3.8%ARI

1 2 2 5 0 3 1 43.1% 1.4% 2.9% 2.0% .0% 2.1% 1.2% 1.5%

Immunization27 136 63 226 30 132 81 243

84.4% 92.5% 91.3% 91.1% 93.8% 90.4% 97.6% 93.1%Family Planning

4 15 9 28 2 22 12 3612.5% 10.2% 13.0% 11.3% 6.2% 15.1% 14.5% 13.8%

Others0 4 2 6 0 2 0 2

0.0% 2.7% 2.9% 2.4% 0.0% 1.4% 0.0% .8%

Table 9.2 : Level of Utilisation of Government MCH Health Services by the Respondentsin Two Blocks of Varanasi District according to their Occupation


Agr

icul

ture

(n=2

9)

Serv

ice

(n=2

2)

Bus

ines

s(n

=19)

Oth

ers*

(n=1

78)

Tot

al(n

=248

)

Agr

icul

ture

(n=3

6)

Serv

ice

(n=1

8)

Bus

ines

s(n

=22)

Oth

ers*

(n=1

85)

Tot

al(n

=261

)

ANC26 17 15 160 218 35 14 17 169 235

89.7% 77.3% 78.9% 89.9% 87.9% 97.2% 77.8% 77.3% 91.4% 90.0%PNC

15 5 6 86 112 15 8 13 89 12551.7% 22.7% 31.6% 48.3% 45.2% 41.7% 44.4% 59.1% 48.1% 47.9%

RTI0 2 1 1 4 0 0 0 2 2

.0% 9.1% 5.3% .6% 1.6% .0% .0% .0% 1.1% .8%STI

2 1 1 1 5 0 0 0 1 16.9% 4.5% 5.3% .6% 2.0% .0% .0% .0% .5% .4%

26 | P a g e

Diarrhoea3 2 5 11 21 0 0 1 9 10

10.3% 9.1% 26.3% 6.2% 8.5% 0.0% 0.0% 4.5% 4.9% 3.8%ARI

0 1 1 3 5 0 0 0 4 4.0% 4.5% 5.3% 1.7% 2.0% .0% .0% .0% 2.2% 1.5%

Immunization27 21 14 164 226 35 16 19 173 243

93.1% 95.5% 73.7% 92.1% 91.1% 97.2% 88.9% 86.4% 93.5% 93.1%Family Planning

1 3 6 18 28 5 2 5 24 363.4% 13.6% 31.6% 10.1% 11.3% 13.9% 11.1% 22.7% 13.0% 13.8%

Others0 2 1 3 6 0 1 1 0 2

0.0% 9.1% 5.3% 1.7% 2.4% 0.0% 5.6% 4.5% 0.0% .8%*others include weavers and labourers

As compared to others, most of the weavers and labourers were found utilizing ANC, PNC andimmunization services. Most of the businessmen were also being noted utilizing family planningservices. Immunization services were utilized by most of the respondents (91.1 %) belonging toalmost all categories of the job. The pattern was similar in both the blocks as shown in Table (9.2).

Table 9.3 : Level of Various Types of MCH Health Services Availed by the Respondentsfrom Government Health Centres according to their Education


Illit

erat

e(N

=82)

1-8

year

sof

Scho

olin

g(N

=52)

9-12

year

sof

Scho

olin

g(N

=69)

Gra

duat

ean

dA

bove

(N=4

5)

Tot

al(N

=248

)

Illit

erat

e(N

=94)

1-8

year

sof

Scho

olin

g(N

=73)

9-12

year

sof

Scho

olin

g(N

=63)

Gra

duat

ean

dA

bove

(N=3

1)

Tot

al(N

=261

)

ANC73 46 60 39 218 87 66 56 26 235

89.0% 88.5% 87.0% 86.7% 87.9%92.6%

90.4% 88.9% 83.9% 90.0%

PNC39 23 32 18 112 47 34 29 15 125

47.6% 44.2% 46.4% 40.0% 45.2%50.0%

46.6% 46.0% 48.4% 47.9%

RTI1 2 0 1 4 1 0 1 0 2

1.2% 3.8% .0% 2.2% 1.6%1.1%

.0% 1.6% .0% .8%

STI1 2 0 2 5 1 0 0 0 1

1.2% 3.8% .0% 4.4% 2.0%1.1%

.0% .0% .0% .4%

Diarrhoea4 7 5 5 21 2 5 3 0 10

4.9% 13.5% 7.2% 11.1% 8.5%2.1%

6.8% 4.8% .0% 3.8%

ARI0 3 2 0 5 3 1 0 0 4

.0% 5.8% 2.9% .0% 2.0%3.2%

1.4% .0% .0% 1.5%

Immunization77 47 63 39 226 89 68 58 28 243

93.9% 90.4% 91.3% 86.7% 91.1%94.7%

93.2% 92.1% 90.3% 93.1%

27 | P a g e

Family planning8 8 9 3 28 17 8 7 4 36

9.8% 15.4% 13.0% 6.7% 11.3%18.1%

11.0% 11.1% 12.9% 13.8%

Others0 2 4 0 6 1 0 1 0 2

.0% 3.8% 5.8% .0% 2.4%1.1%

.0% 1.6% .0% .8%

The utilization of immunization and ANC services w as higher than other services. I t was furtherrevealed that utilization was seen higher among illiterates for the government services . Almostsimilar utilization pattern was found in both the blocks (Table 9.3). It seems that there is need toincrease the utilization of family planning services in the future at different levels of the governmenthealth centres.

Table 10.1 : The type of ANC Services Availed by Respondents during Pregnancy in twoBlocks of Varanasi District According to Social Category

.

Services availed PINDRA BLOCK CHOLAPUR BLOCK

General(n=32)

OBC(n=147)


Total(N=248)

General(n=32)

OBC(n=146)

ScheduledCaste

( n=83)

Total(n=261)

Blood PressurePHC No.

%4 9 5 18 1 5 0 6

12.5 6.1 7.2 7.3 3.1 3.4 0.0 2.3CHC No.

%0 1 4 5 0 5 1 6

0.0 0.7 5.8 2.0 0.0 3.4 1.2 2.3Sub-centre No.

%2 13 3 18 0 2 0 2

6.3 8.8 4.3 7.3 0.0 1.4 0.0 0.8District No.Hospital %

0 2 2 4 2 4 0 60.0 1.4 2.9 1.6 6.3 2.7 0.0 2.3

Private No.Hospital %

9 14 4 27 9 14 6 2928.1 9.5 5.8 10.9 28.1 9.6 7.2 11.1

Haemoglobin

PHC No.%

5 9 5 19 1 3 0 415.6 6.1 7.2 7.7 3.1 2.1 0.0 1.5

CHC No.%

0 1 4 5 0 4 1 50.0 0.7 5.8 2.0 0.0 2.7 1.2 1.9

Sub-centre No.%

4 11 1 16 1 8 3 1212.5 7.5 1.4 6.5 3.1 5.5 3.6 4.6

District No.Hospital %

0 0 2 2 2 5 0 70.0 0.0 2.9 0.8 6.3 3.4 0.0 2.7


8 12 6 26 8 12 5 2525.0 8.2 8.7 10.5 25.0 8.2 6.0 9.6

IFA TabletPHC No.

%4 14 6 24 0 6 1 7

12.5 9.5 8.7 9.7 0.0 4.1 1.2 2.7CHC No.

%0 1 4 5 0 5 0 5

0.0 0.7 5.8 2.0 0.0 3.4 0.0 1.9Sub-centre No.

%18 95 44 157 26 92 73 191


1 0 1 2 0 7 0 73.1 0.0 1.4 0.8 0.0 4.8 0.0 2.7


6 6 4 16 5 3 1 918.8 4.1 5.8 6.5 15.6 2.1 1.2 3.4

For blood pressure and haemoglobin, more number of respondents was found using private healthservices irrespective of their caste. Perhaps the reach of ANM to the village people has shown

28 | P a g e

higher utilization of sub-centres for IFA tablets and that was good in both the blocks. Efforts arerequired to increase the blood pressure and haemoglobin measurement by sub-centre workers toimprove the quality of health services.

Table 10.1 Contd. : The Type of ANC Services Availed by Respondents during Pregnancy intwo Blocks of Varanasi district according to caste.

Servicesavailed


General(n=32)

OBC(n=147)


TOTAL(N=248)

General(n=32)

OBC(n=146)

ScheduledCaste

( n=83)Total

(n=261)Tetanus

PHC No.%

6 15 5 26 1 8 3 1218.8 10.2 7.2 10.5 3.1 5.5 3.6 4.6

CHC No.%

0 4 5 9 0 5 1 60.0 2.7 7.2 3.6 0.0 3.4 1.2 2.3

Sub-centre No.%

19 113 50 182 26 111 74 21159.4 76.9 72.5 73.4 81.3 76.0 89.2 80.8


1 1 2 4 0 6 0 63.1 0.7 2.9 1.6 0.0 4.1 0.0 2.3


1 1 2 4 0 6 0 63.1 0.7 2.9 1.6 0.0 4.1 0.0 2.3

Abdomen ExamPHC No.

%6 22 7 35 3 9 4 16

18.8 15.0 10.1 14.1 9.4 6.2 4.8 6.1CHC No.

%1 8 4 13 1 6 0 7

3.1 5.4 5.8 5.2 3.1 4.1 0.0 2.7Sub-centre No.

%12 55 23 90 15 57 35 107


1 0 2 3 2 4 0 63.1 0.0 2.9 1.2 6.3 2.7 0.0 2.3


7 13 6 26 5 16 4 2521.9 8.8 8.7 10.5 15.6 11.0 4.8 9.6

Nutritional AdvicePHC No.

%4 12 6 22 0 4 1 5

12.5 8.2 8.7 8.9 0.0 2.7 1.2 1.9CHC No.

%1 1 5 7 0 5 0 5

3.1 0.7 7.2 2.8 0.0 3.4 0.0 1.9Sub-centre No.

%18 74 29 121 23 77 52 152


0 0 2 2 0 6 0 60.0 0.0 2.9 0.8 0.0 4.1 0.0 2.3


6 9 5 20 4 9 2 1518.8 6.1 7.2 8.1 12.5 6.2 2.4 5.7

Most of the respondents had received tetanus vaccine from the sub-centre. Higher number of therespondents told about their abdomina l examination during pregnancy and that too by sub-centrestaff. Nutritional advice was also provided by health workers of sub-centres and availed by most ofthe general (56.3%) and OBC (50.3%) respondents in Pindra block (Table 10.1). It was noted higheramong the respondents of Cholapur block.

Table 10.2 : The Type of ANC Services Availed by Respondents during Pregnancy in TwoBlocks of Varanasi District according to Level of EducationPINDRA BLOCK CHOLAPUR BLOCK

Illit

erat

e(N

=82)

1-8

year

sof

Scho

olin

g(N

=52)

9-12

year

sof

Scho

olin

g(N

=69)

Gra

duat

ean

dA

bove

(N=4

5)

Tot

al(N

=248

)

Illit

erat

e(N

=94)

1-8

year

sof

Scho

olin

g(N

=73)

9-12

year

sof

Scho

olin

g(N

=63)

Gra

duat

ean

dA

bove

(N=3

1)

Tot

al(N

=261

)


%8 2 2 6 18 1 4 0 1 6

9.8 3.8 2.9 13.3 7.3 1.1 5.5 0.0 3.2 2.3

29 | P a g e

CHC No.%

4 0 1 0 5 2 3 1 0 64.9 0.0 1.4 0.0 2.0 2.1 4.1 1.6 0.0 2.3

Sub-centre No.%

6 4 3 5 18 2 0 0 0 27.3 7.7 4.3 11.1 7.3 2.1 0.0 0.0 0.0 0.8


0 4 0 0 4 1 4 0 1 60.0 7.7 0.0 0.0 1.6 1.1 5.5 0.0 3.2 2.3


4 2 9 12 27 3 5 8 13 294.9 3.8 13.0 26.7 10.9 3.2 6.8 12.7 41.9 11.1

Hb (gm%)PHC No.

%8 1 4 6 19 0 2 1 1 4

9.8 1.9 5.8 13.3 7.7 0.0 2.7 1.6 3.2 1.5CHC No.

%4 0 1 0 5 3 1 1 0 5

4.9 0.0 1.4 0.0 2.0 3.2 1.4 1.6 0.0 1.9Sub-centre No.

%3 1 9 3 16 5 2 2 3 12

3.7 1.9 13.0 6.7 6.5 5.3 2.7 3.2 9.7 4.6District No.Hospital %

0 2 0 0 2 1 5 0 1 70.0 3.8 0.0 0.0 0.8 1.1 6.8 0.0 3.2 2.7


4 2 8 12 26 2 6 7 10 254.9 3.8 11.6 26.7 10.5 2.1 8.2 11.1 32.3 9.6

IFA TabletPHC No.

%10 5 3 6 24 2 3 2 0 7

12.2 9.6 4.3 13.3 9.7 2.1 4.1 3.2 0.0 2.7CHC No.

%2 1 2 0 5 2 1 1 1 5

2.4 1.9 2.9 0.0 2.0 2.1 1.4 1.6 3.2 1.9Sub-centre No.

%57 28 51 21 157 75 51 48 17 191


0 1 0 1 2 1 3 0 3 7

0.0 1.9 0.0 2.2 0.8 1.1 4.1 0.0 9.7 2.7Private No.Hospital %

2 1 4 9 16 0 1 3 5 9

2.4 1.9 5.8 20.0 6.5 0.0 1.4 4.8 16.1 3.4

Most of the respondents (26.7% in Pindra and 41.9% in Cholapur block) with higher educationavailed ANC services from private hospitals. Less number of highly educated respondents (20%)had taken IFA tablets from sub-centres. Most of the respondents belonging to illiterate category(79.8%) or those completed only schooling (76.2%) had availed IFA tablets from sub-centres in theCholapur block (76.2%).

Table 10.2 Contd. : The Type of ANC Services Availed by Respondents during Pregnancy inTwo Blocks of Varanasi District According to Educational Status


Illit

erat

e(n

=82)

1-8

year

sof

Scho

olin

g(n

=52)

9-12

year

sof

Scho

olin

g(n

=69)

Gra

duat

ean

dA

bove

(n=4

5)

Tot

al(n

=248

)

Illit

erat

e(n

=94)

1-8

year

sof

Scho

olin

g(n

=73)

9-12

year

sof

Scho

olin

g(n

=63)

Gra

duat

ean

dA

bove

(n=3

1)

Tot

al(n

=261

)

TetanusPHC No.

%9 6 4 7 26 2 6 4 0 12

11.0 11.5 5.8 15.6 10.5 2.1 8.2 6.3 0.0 4.6CHC No.

%3 3 3 0 9 3 1 1 1 6

3.7 5.8 4.3 0.0 3.6 3.2 1.4 1.6 3.2 2.3Sub-centre No.

%60 41 56 25 182 82 59 51 19 211


2 1 0 1 4 1 2 0 3 62.4 1.9 0.0 2.2 1.6 1.1 2.7 0.0 9.7 2.3


7 1 6 11 25 3 2 4 7 168.5 1.9 8.7 24.4 10.1 3.2 2.7 6.3 22.6 6.1

Abdomen ExamPHC No.

%9 10 7 9 35 4 8 4 0 16

11.0 19.2 10.1 20.0 14.1 4.3 11.0 6.3 0.0 6.1CHC No.

%4 3 4 2 13 3 1 2 1 7

4.9 5.8 5.8 4.4 5.2 3.2 1.4 3.2 3.2 2.7Sub-centre No. 28 16 34 12 90 36 33 26 12 107

30 | P a g e

% 34.1 30.8 49.3 26.7 36.3 38.3 45.2 41.3 38.7 41.0District No.Hospital %

0 2 0 1 3 1 4 0 1 60.0 3.8 0.0 2.2 1.2 1.1 5.5 0.0 3.2 2.3


7 1 6 12 26 2 5 8 10 258.5 1.9 8.7 26.7 10.5 2.1 6.8 12.7 32.3 9.6


%7 6 3 6 22 1 2 2 0 5

8.5 11.5 4.3 13.3 8.9 1.1 2.7 3.2 0.0 1.9CHC No.

%2 0 5 0 7 1 2 1 1 5

2.4 0.0 7.2 0.0 2.8 1.1 2.7 1.6 3.2 1.9Sub-centre No.

%30 29 41 21 121 55 43 40 14 152


0 2 0 0 2 1 2 0 3 60.0 3.8 0.0 0.0 0.8 1.1 2.7 0.0 9.7 2.3


6 0 5 9 20 1 3 4 7 157.3 0.0 7.2 20.0 8.1 1.1 4.1 6.3 22.6 5.7

One-fourth (24.4%) of the respondents with higher education availed TT vaccine from privatehospitals. Half of the respondents (46.7%) took TT vaccine from sub-centres. About half of thehighly educated respondents (48.8%) were given nutritional advice by the staff of sub-centres inPindra block. Most of the ANC services were availed by the respondents from sub -centres exceptblood pressure measurement and haemoglobin estimation where private sector was used more andthat too by respondents who were educated to graduation or above.

Table 10.3 : The Type of ANC Services Availed by Respondents during Pregnancy in twoBlocks of Varanasi District according to Occupation


Agr

icul

ture

(n=2

9)

Serv

ice

(n=2

2)

Bus

ines

s(n

=19)

Oth

ers

(Wea

ver

and

Lab

oure

r)(n

=178

)

Tot

al(n

=248

)

Agr

icul

ture

(n=3

6)

Serv

ice

(n=1

8)

Bus

ines

s(n

=22)

Oth

ers

(Wea

ver

and

Lab

oure

r)(n

=185

)

Tot

al(n

=261

)


%2 4 1 11 18 2 1 1 2 6

6.9 18.2 5.3 6.2 7.3 5.6 5.6 4.5 1.1 2.3CHC No.

%0 0 0 5 5 2 0 0 4 6

0.0 0.0 0.0 2.8 2.0 5.6 0.0 0.0 2.2 2.3Sub No.Centre %

4 1 1 12 18 0 0 0 2 213.8 4.5 5.3 6.7 7.3 0.0 0.0 0.0 1.1 0.8


0 0 1 3 4 0 0 0 6 60.0 0.0 5.3 1.7 1.6 0.0 0.0 0.0 3.2 2.3


5 3 3 16 27 2 7 6 14 2917.2 13.6 15.8 9.0 10.9 5.6 38.9 27.3 7.6 11.1

Hb (gm%)PHC No.

%2 3 1 13 19 1 1 1 1 4

6.9 13.6 5.3 7.3 7.7 2.8 5.6 4.5 0.5 1.5CHC No.

%0 0 0 5 5 1 0 0 4 5

0.0 0.0 0.0 2.8 2.0 2.8 0.0 0.0 2.2 1.9Sub No.Centre %

2 1 0 13 16 6 0 0 6 126.9 4.5 0.0 7.3 6.5 16.7 0.0 0.0 3.2 4.6


0 0 0 2 2 0 0 0 7 70.0 0.0 0.0 1.1 0.8 0.0 0.0 0.0 3.8 2.7


4 3 3 16 26 2 6 3 14 25

13.8 13.6 15.8 9.0 10.5 5.6 33.3 13.6 7.6 9.6IFA Tablet

PHC No.%

3 4 3 14 24 2 0 1 4 710.3 18.2 15.8 7.9 9.7 5.6 0.0 4.5 2.2 2.7

CHC No.%

0 0 0 5 5 1 0 1 3 50.0 0.0 0.0 2.8 2.0 2.8 0.0 4.5 1.6 1.9

Sub No. 19 9 11 118 157 28 10 14 139 191

31 | P a g e

Centre % 65.5 40.9 57.9 66.3 63.3 77.8 55.6 63.6 75.1 73.2District No.Hospital %

0 0 0 2 2 0 1 0 6 7


3 2 2 9 16 1 2 4 2 9

10.3 9.1 10.5 5.1 6.5 2.8 11.1 18.2 1.1 3.4Tetanus

PHC No.%

3 5 3 15 26 2 3 3 4 1210.3 22.7 15.8 8.4 10.5 5.6 16.7 13.6 2.2 4.6

CHC No.%

0 0 1 8 9 1 0 1 4 60.0 0.0 5.3 4.5 3.6 2.8 0.0 4.5 2.2 2.3

Sub No.Centre %

22 13 13 134 182 28 12 13 158 21175.9 59.1 68.4 75.3 73.4 77.8 66.7 59.1 85.4 80.8


0 0 0 4 4 0 1 0 5 60.0 0.0 0.0 2.2 1.6 0.0 5.6 0.0 2.7 2.3


4 4 2 15 25 3 2 5 6 1613.8 18.2 10.5 8.4 10.1 8.3 11.1 22.7 3.2 6.1

Majority of the respondents received various ANC services during antenatal period from sub -centre(except for haemoglobin estimation and measurement of blood pressure), whereas some of therespondents also received ANC services from private sector.

Table 10.3 Contd. : The Type of ANC Services availed by Respondents during Pregnancy intwo Blocks of Varanasi District according to Occupation


Agr

icul

-tur

e(n

=29)

Serv

ice

(n=

22)

Bus

ines

s (n

=19)

Oth

ers

(Wea

ver

and

Lab

oure

r)

(n=1

78)

Tot

al (

n=24

8)

Agr

icul

ture

(n=3

6)

Serv

ice

(n=1

8)

Bus

ines

s (n

=22)

Oth

ers

(Wea

ver

and

Lab

oure

r)

(n=1

85)

Tot

al (

n=26

1)

Abdomen ExamPHC No.

%7 5 3 20 35 4 0 3 9 16

24.1 22.7 15.8 11.2 14.1 11.1 0.0 13.6 4.9 6.1CHC No.

%1 1 2 9 13 2 0 2 3 7

3.4 4.5 10.5 5.1 5.2 5.6 0.0 9.1 1.6 2.7Sub No.Centre %

11 7 9 63 90 16 7 9 75 107


0 0 0 3 3 0 0 0 6 6


3 3 3 17 26 3 5 4 13 25

10.3 13.6 15.8 9.6 10.5 8.3 27.8 18.2 7.0 9.6


%3 4 3 12 22 1 0 1 3 5

10.3 18.2 15.8 6.7 8.9 2.8 0.0 4.5 1.6 1.9

CHC No.%

0 1 1 5 7 1 0 2 2 5

0.0 4.5 5.3 2.8 2.8 2.8 0.0 9.1 1.1 1.9Sub No.Centre %

18 10 12 81 121 28 11 9 104 152

62.1 45.5 63.2 45.5 48.8 77.8 61.1 40.9 56.2 58.2


0 0 0 2 2 0 1 0 5 6


3 3 2 12 20 3 2 4 6 15

10.3 13.6 10.5 6.7 8.1 8.3 11.1 18.2 3.2 5.7

32 | P a g e

Illiterates were using more government facilities while private sector was mainly utilized byrespondents having graduate and above qualification (Table 10.3). Respondents who were workingin agriculture were also found using more private health facilities for blood pressure measureme ntand haemoglobin estimation. However, occupation-wise similar pattern was observed in both theblocks.

Very few respondents (34 from Pindra and 33 from Cholapur) replied when they were asked aboutthe reasons for not utilising the government health serv ices. Proportion has been calculated out of allthe respondents interviewed (Table 10.4).

3.5 Reasons for Not Availing of Government Health Facilities

The non-utilisation of government health facilities according to reasons is shown in Table(10.4). The study found that around 13% of the respondents did not availed health facilitiesprovided by the government. The decision of the family members and others was highestamong other reasons provided with 28% followed by ‘behaviours of the doctors/healthstaff/distance of health facilities from their residence’ with about 25%.

In relation to social category, 25% of the respondents from the general category did notavail health services from the government health facilities. About 11% and 12% of OBCSand SCs did not avail health services from the government health facilities.

The percentage of non-utilisation of government health services is highest among therespondents who were at the category of graduate and above with about 36% followed by 9 -12 years of schooling respondents with about 14%. The illiterate and 1 -8 years schoolingwere more or less the same with around 7%. The percentage of non -utilisation ofgovernment health services were more among the agriculturists with 37% followed byservices category with 25%.

Table 10.4 : Reasons for Not Availing Government Health Facilities byRespondents according to their Social Category

Reasons caste wise PINDRA BLOCK CHOLAPUR BLOCK

Gen

eral

(n=

32)

OB

C(n

=147

)

Sche

dule

dC

aste

(n=

69)

Tot

al(N

=24

8)

Gen

eral

(n=

32)

OB

C(n

=146

)

Sche

dule

dC

aste

( n=

83)

Tot

al(n

=26

1)Poor availability ofdoctors

3 5 1 9 2 1 0 3

9.4% 3.4% 1.4% 3.6% 6.3% 0.7% 0.0% 1.1%Facilities (services/drugs) not available

1 3 1 5 0 3 3 6

3.1% 2.0% 1.4% 2.0% 0.0% 2.1% 3.6% 2.3%Emergency services notavailable

0 3 1 4 0 3 1 40.0% 2.0% 1.4% 1.6% 0.0% 2.1% 1.2% 1.5%

Decision of familymembers and others

2 3 5 10 2 5 2 96.3% 2.0% 7.2% 4.0% 6.3% 3.4% 2.4% 3.4%

Others* 1 3 2 6 5 4 2 113.1% 2.0% 2.9% 2.4% 15.6% 2.7% 2.4% 4.2%

Reasonseducation-

wise


Illit

erat

e(N

=82)

Schooling

Gra

duat

ean

dA

bove

(N=4

5)

Total(N=248)

Illit

erat

e(N

=94)

Schooling

Gra

duat

ean

dA

bove

(N=3

1)

Total(N=261)

1-8

year

s(N

=52)

9-12

year

s(N

=69)

1-8

year

s(N

=73)

9-12

year

s(N

=63)

Poor availability 2 2 2 3 9 0 0 2 1 3

33 | P a g e

of doctors 2.4% 3.8% 2.9% 6.7% 3.6% 0.0% 0.0% 3.2% 3.2% 1.1%Facilities(services/ drugs)not available

2 1 1 1 5 1 2 2 1 6

2.4% 1.9% 1.4% 2.2% 2.0% 1.1% 2.7% 3.2% 3.2% 2.3%Emergencyservices notavailable

0 1 2 1 4 1 1 0 2 4

0.0% 1.9% 2.9% 2.2% 1.6% 1.1% 1.4% 0.0% 6.5% 1.5%Decision offamily membersand others

4 0 0 6 10 1 2 3 3 9

4.9% 0.0% 0.0% 13.3% 4.0% 1.1% 2.7% 4.8% 9.7% 3.4%Others* 0 0 3 3 6 2 0 3 6 11

0.0% 0.0% 4.3% 6.7% 2.4% 2.1% 0.0% 4.8% 19.4% 4.2%Reasons

occupation-wise


Agr

icul

ture

(n=

29)

Serv

ice

(n=

22)

Bus

ines

s(n

=19

)

Oth

ers

(n=

178)

Tot

al(n

=24

8)

Agr

icul

ture

(n=3

6)

Serv

ice

(n=

18)

Bus

ines

s(n

=22

)

Oth

ers

(n=1

85)

Tot

al(n

=26

1)

Poor availabilityof doctors

2 0 0 7 9 0 2 1 0 3

6.9 0.0 0.0 3.9 3.6 0.0 11.1 4.5 0.0 1.1Facilities(services/ drugs)not available

0 0 0 5 5 1 0 0 5 6

0.0 0.0 0.0 2.8 2.0 2.8 0.0 0.0 2.7 2.3Emergencyservices notavailable

1 0 0 3 4 1 0 1 2 4

3.4 0.0 0.0 1.7 1.6 2.8 0.0 4.5 1.1 1.5Decision offamily membersand others

1 1 1 7 10 1 3 1 4 9

3.4 4.5 5.3 3.9 4.0 2.8 16.7 4.5 2.2 3.4Others* 1 2 0 3 6 0 2 3 6 11

3.4 9.1 0.0 1.7 2.4 0.0 11.1 13.6 3.2 4.2* Others= (behaviour of doctors and health staff and the distance of health facilities from their residence)

3.6 Services Given by Government Health Centres

Table 11 : Advice given to the Respondents during Antenatal period from GovernmentHealth Centres by Social Category, occupation and education


General(n=32)

OBC(n=147)

ScheduledCaste (n=69)

TOTAL(N=248)

General(n=32)

OBC(n=146)


TOTAL(n=261)

Place ofdelivery

26 109 50 185 30 117 71 21881.3% 74.1% 72.5% 74.6% 93.8% 80.1% 85.5% 83.5$

Danger signs 18 76 36 130 24 69 54 14756.3% 51.7% 52.2% 52.4% 75.0% 47.3% 65.1% 56.3%

Familyplanning

15 62 31 108 14 62 47 12346.9% 42.2% 44.9% 43.5% 43.8% 42.5% 56.6% 47.1%

Immunization 25 113 58 196 29 114 75 21878.1% 76.9% 84.1% 79.0% 90.6% 78.1% 90.4% 83.5%

Agriculture

(n=29)Service(n=22)

Business(n=19)

Others(n=178)

Total(n=248)

Agriculture

(n=36)Service(n=18)

Business(n=22)

Others(n=185)

Total(n=261)

Place ofdelivery

24 12 17 132 185 31 14 17 156 21882.8% 54.5% 89.5% 74.2% 74.6% 86.1% 77.8% 77.3% 84.3% 83.5%

Danger signs 12 14 14 90 130 24 11 14 98 14741.4% 63.6% 73.7% 50.6% 52.4% 66.7% 61.1% 63.6% 53.0% 56.3%

Familyplanning

14 8 12 74 108 17 7 8 91 12348.3% 36.4% 63.2% 41.6% 43.5% 47.2% 38.9% 36.4% 49.2% 47.1%

Immunization 24 13 17 142 196 32 13 14 159 21882.8% 59.1% 89.5% 79.8% 79.0% 88.9% 72.2% 63.6% 85.9% 83.5%Illiterat

e(N=82)

Schooling Graduateand Above

(N=45)

Total(N=248)

Illiterate(N=94)

SchoolingGraduate andAbove (N=31)

Total(N=261)

1-8 years(N=52)

9-12years

(N=69)1-8 years(N=73)

9-12years

(N=63)

34 | P a g e

Place ofdelivery

56 39 56 34 185 77 62 53 26 21868.3% 75.0% 81.2% 75.6% 74.6% 81.9% 84.9% 84.1% 83.9% 83.5%

Danger signs 41 27 41 21 130 46 44 34 23 14750.0% 51.9% 59.4% 46.7% 52.4% 48.9% 60.3% 54.0% 74.2% 56.3%

Familyplanning

36 21 29 22 108 46 31 29 17 12343.9% 40.4% 42.0% 48.9% 43.5% 48.9% 42.5% 46.0% 54.8% 47.1%

Immunization 62 40 61 33 196 80 58 54 26 21875.6% 76.9% 88.4% 73.3% 79.0% 85.1% 79.5% 85.7% 83.9% 83.5%

The antenatal period is utilized to inform pregnant women for certain essential information. In thisstudy respondents were asked (Table 11) close ended question with 4 options . Three-fourth of therespondents were, told by the health staff about the place of delivery. Half of the mothers in both theblocks were also given advice about the danger signs of the pregnancy. This table shows itsrelationship with the caste, occupation and the educatio nal status of the respondents.

Table 12 : Place of Delivery of Youngest Child of Respondents according to SocialCategory, Level of Education and Occupation in two blocks of Varanasi

Place ofdelivery

PINDRA BLOCK CHOLAPUR BLOCKGeneral(n=32)

OBC(n=147)


TOTAL(N=248)

General(n=32)

OBC(n=146)

Scheduled Caste( n=83)

Total(n=261)

Home 4 43 25 72 4 46 33 8312.5% 29.3% 36.2% 29.0% 12.5% 31.5% 39.8% 31.8%

PHC 14 52 16 82 5 26 12 4343.8% 35.4% 23.2% 33.1% 15.6% 17.8% 14.5% 16.5%

CHC 3 6 5 14 8 35 24 679.4% 4.1% 7.2% 5.6% 25.0% 24.0% 28.9% 25.7%

Sub-centre

0 16 9 25 3 13 8 24.0% 10.9% 13.0% 10.1% 9.4% 8.9% 9.6% 9.2%

DistrictHospt

1 7 3 11 3 3 0 63.1% 4.8% 4.3% 4.4% 9.4% 2.1% .0% 2.3%

Pvt. Hospital 10 23 11 44 9 23 6 3831.3% 15.6% 15.9% 17.7% 28.1% 15.8% 7.2% 14.6%

Place ofdelivery

Agriculture

(n=29)

Service

(n=22)

Busin-ess

(n=19)

Others(n=178)

Total(n=248)

Agriculture

(n=36)

Service(n=18)

Busin-ess

(n=22)

Others(n=185)

Total(n=261)

Home 5 3 5 59 72 9 6 3 65 8317.2% 13.6% 26.3% 33.1% 29.0% 25.0% 33.3% 13.6% 35.1% 31.8%

PHC 14 11 10 47 82 6 4 6 27 4348.3% 50.0% 52.6% 26.4% 33.1% 16.7% 22.2% 27.3% 14.6% 16.5%

CHC 1 0 0 13 14 11 3 3 50 673.4% .0% .0% 7.3% 5.6% 30.6% 16.7% 13.6% 27.0% 25.7%

Sub-centre 5 2 0 18 25 6 1 2 15 2417.2% 9.1% .0% 10.1% 10.1% 16.7% 5.6% 9.1% 8.1% 9.2%

DistrictHospt

0 0 0 11 11 0 0 1 5 6.0% .0% .0% 6.2% 4.4% .0% .0% 4.5% 2.7% 2.3%

PrivateHospital

4 6 4 30 44 4 4 7 23 3813.8% 27.3% 21.1% 16.9% 17.7% 11.1% 22.2% 31.8% 12.4% 14.6%

Place ofdelivery

Schooling Schooling

Illiterate(N=82)

1-8years

(N=52)

9-12years

(N=69)

Graduateand

Above(N=45)

Total(N=248)

Illiterate(N=94)

1-8 years(N=73)

9-12years

(N=63)

Graduateand Above

(N=31)

Total(N=261)

- Home 27 20 18 7 72 39 26 15 3 8332.9% 38.5% 26.1% 15.6% 29.0% 41.5% 35.6% 23.8% 9.7% 31.8%

- PHC 29 11 23 19 82 15 14 10 4 4335.4% 21.2% 33.3% 42.2% 33.1% 16.0% 19.2% 15.9% 12.9% 16.5%

- CHC 3 5 6 0 14 26 17 16 8 673.7% 9.6% 8.7% .0% 5.6% 27.7% 23.3% 25.4% 25.8% 25.7%

- Sub-centre

9 3 9 4 25 7 8 7 2 2411.0% 5.8% 13.0% 8.9% 10.1% 7.4% 11.0% 11.1% 6.5% 9.2%

- DistrictHospt

4 6 0 1 11 0 1 1 4 64.9% 11.5% .0% 2.2% 4.4% .0% 1.4% 1.6% 12.9% 2.3%

- PrivateHospital

10 7 13 14 44 7 7 14 10 3812.2% 13.5% 18.8% 31.1% 17.7% 7.4% 9.6% 22.2% 32.3% 14.6%

35 | P a g e

The Table (12) shows that more than 70% of deliveries were institutional. Out of which 33.1% wereat PHC and 17.7% from private hospital. On further analysis it was observed that home deliveries(36.2%) were more in sub-centres and labourers and weavers (33.1%). Whereas respondents havinggraduate and above qualifications opted PHC ( 42.2%) and private health clinic (31.1%) in Pindrablock.

In Cholapur block home deliveries were more (31.8%) in comparison to Pindra block, rest 54.0%were institutional deliveries .17.7% institutional deliveries were from private sector in Pindra. Caste,occupation and educational status shows same pattern in both the blocks.

Table 13 : Services provided at the Time of Delivery (institutional) According toSocial Category, Level of Education and Occupation in two Blocks of Varanasi

Actiontaken after

delivery


General(n=32) OBC (n=147)


TOTAL(N=248)


ScheduledCaste

( n=83)Total

(n=261)

Measurementof birthweight

19 46 21 86 17 54 33 104

59.4% 31.3% 30.4% 34.7% 53.1% 37.0% 39.8% 39.8%

BCGvaccination

10 40 18 68 12 28 16 56

31.3% 27.2% 26.1% 27.4% 37.5% 19.2% 19.3% 21.5%

Poliovaccination

15 47 20 82 12 26 20 58

46.9% 32.0% 29.0% 33.1% 37.5% 17.8% 24.1% 22.2%

Actiontaken after

delivery

Agricul-ture

(n=29)

Service(n=22)

Busin-ess

(n=19)

Others(n=178)

Total(n=248)

Agricul-ture

(n=36)

Service(n=18)

Busin-ess

(n=22)

Others(n=185)

Total(n=261)


15 10 7 54 86 17 5 12 70 104

51.7% 45.5% 36.8% 30.3% 34.7% 47.2% 27.8% 54.5% 37.8% 39.8%

BCGvaccination

9 6 7 46 68 9 4 6 37 56

31.0% 27.3% 36.8% 25.8% 27.4% 25.0% 22.2% 27.3% 20.0% 21.5%

Poliovaccination

14 8 9 51 82 10 6 7 35 58

48.3% 36.4% 47.4% 28.7% 33.1% 27.8% 33.3% 31.8% 18.9% 22.2%

Actiontaken afterdelivery

Illiterate(N=82)


Above(N=45)

Illiterate(N=94)


Above(N=31)

Total(N=261)1-8 years

(N=52)

9-12years

(N=69)

Total(N=248) 1-8 years

(N=73)

9-12years

(N=63)


20 17 26 23 86 34 28 30 12 104

24.4% 32.7% 37.7% 51.1% 34.7% 36.2% 38.4% 47.6% 38.7% 39.8%

BCGvaccination

21 15 16 16 68 23 12 12 9 56

25.6% 28.8% 23.2% 35.6% 27.4% 24.5% 16.4% 19.0% 29.0% 21.5%

Poliovaccination

26 15 18 23 82 20 15 14 9 58

31.7% 28.8% 26.1% 51.1% 33.1% 21.3% 20.5% 22.2% 29.0% 22.2%

The Table (13) showed the services received by the respondents at the time of birth or after birth. Itwas very low as weight of the newborn baby was taken only in 34% cases, BCG and Poliovaccination was given to children of 27.4% and 21.5 respondents only. It was found to be mor e ingeneral (31.3%), business class (36.8%) and mother who were graduate and above 35.6% in Pindrablock. Almost similar pattern was observed in Cholapur block.

36 | P a g e

Table 14 : Status of the First Check-Up Carried out After the Delivery at the HealthCentre according to Social Category, Level of Educational and Occupation

Durationof 1st check

up afterdelivery


General(n=32)

OBC(n=147)


Total(N=248)

General(n=32)

OBC(n=146)


Total(n=261)

Within 24hrs

11 51 16 78 15 50 30 95

34.4% 34.7% 23.2% 31.5% 46.9 34.2% 36.1% 36.4

In 2-3 days 5 20 18 43 1 17 11 29

15.6% 13.6% 26.1% 17.3% 3.1% 11.6% 13.3% 11.1%

In 4-7 days 6 14 4 24 3 19 7 29

18.8% 9.5% 5.8% 9.7% 9.4% 13.0% 8.4% 11.1%

First checkup afterdelivery

Agriculture

(n=29)

Service(n=22)

Business (n=19)

Others(Weavers

andLaboures)(n=178)

Total(n=248)

Agriculture

(n=36)

Service(n=18)

Business (n=22)

Others(Weavers

andLaboures)(n=185)

Total(n=261)

Within 24hrs

11 9 7 51 78 15 3 7 70 95

37.9% 40.9% 36.8 28.7% 31.5% 41.7% 16.7% 31.8% 37.8% 36.4%

In 2-3 days 6 4 5 28 43 4 3 1 21 29

20.7% 18.2% 26.3 15.7% 17.3% 11.1% 16.7% 4.5% 11.4% 11.1%

In 4-7 days 3 2 2 17 24 6 3 3 17 29

10.3% 9.1% 10.5 9.6% 9.7% 16.7% 16.7% 13.6% 9.2% 11.1%

First checkup afterdelivery

Illiterate(N=82)


Above(N=45)

Illiterate(N=94)

SchoolingGraduateand Above

(N=31)

Total(N=261)

1-8years

(N=52)

9-12years

(N=69)1-8 years(N=73)

9-12years

(N=63)

Within 24hrs

23 15 22 18 78 33 27 24 11 95

28.0% 28.8% 31.9% 40.0% 31.5% 35.1% 37.0% 38.1% 35.5% 36.4%

In 2-3 days 16 6 12 9 43 9 5 12 3 29

19.5% 11.5% 17.4% 20.0% 17.3% 9.6% 6.8% 19.0% 9.7% 11.1%

In 4-7 days 8 4 8 4 24 10 9 5 5 29

9.8% 7.7% 11.6% 8.9% 9.7% 10.6% 12.3% 7.9% 16.1% 11.1%

The Table (14) shows that 103 (41.6%) respondents did not receive any post -natal check-up after theirmost recent birth. Majority of the respondents receive first post-natal check-up (31.5%) within 24hours. Ante-natal checkups within 24 hours were found to be more in OBCs and service class.Education-wise there was no specific pattern. In Cholapur block half of general class (46.9%) received1st PNC within 24 hours. However, it seems that there is need to improve coverage of all the women forPNC services.

Table 15 : Number of Postnatal Checkups of Respondents within 7 Days of the DeliveryBy Level of Education and Occupation in two Blocks of Varanasi

Number oftimes

checked


General(n=32)

OBC(n=147)


Total(N=248) General (n=32)

OBC(n=146)

ScheduledCaste (

n=83)

Total(n=261)

One Time 7 22 6 35 5 19 12 3621.9% 15.0% 8.7% 14.1% 15.6% 13.0% 14.5% 13.8%

2-3 Time 8 22 11 41 4 9 1 14

25.0% 15.0% 15.9% 16.5% 12.5% 6.2% 1.2% 5.4%

>3 Times 0 9 3 12 2 5 1 8

0.0% 6.1% 4.3% 4.8% 6.3% 3.4% 1.2% 3.1%

37 | P a g e

Not checkedup at all

17 94 49 160 21 113 69 203

53.1% 63.9% 71.0% 64.5% 65.6% 77.4% 83.1% 77.8%

Number oftimes

checked

Agriculture

(n=29)Service(n=22)

Business (n=19)

Others(Weavers and

Labourer)(n=178)

Total(n=248) Agriculture

(n=36)Service(n=18)

Business(n=22)

Others(Weavers and

Labourer)(n=185)

Total(n=261)

One Time 5 4 6 20 35 8 2 6 20 3617.2% 18.2% 31.6% 11.2% 14.1% 22.2% 11.1% 27.3% 10.8% 13.8%

2-3 Time 8 7 1 25 41 6 0 1 7 1427.6% 31.8% 5.3% 14.0% 16.5% 16.7% .0% 4.5% 3.8% 5.4%

>3 Times 1 3 5 3 12 1 0 4 3 83.4% 13.6% 26.3% 1.7% 4.8% 2.8% .0% 18.2% 1.6% 3.1%


15 8 7 130 160 21 16 11 155 20351.7% 36.4% 36.8% 73.0% 64.5% 58.3% 88.9% 50.0% 83.8% 77.8%

Number oftimeschecked

Illiterate(N=82)


Above(N=45)

Total(n=248

Illiterate(N=94)


Above(N=31)

Total(n=261)

1-8 years(N=52)

9-12years

(N=69)1-8 years(N=73)

Total(n=261)

One Time 15 2 12 6 35 13 12 6 5 3618.3% 3.8% 17.4% 13.3% 14.1% 13.8% 16.4% 9.5% 16.1% 13.8%

2-3 Time 9 6 11 15 41 2 6 5 1 1411.0% 11.5% 15.9% 33.3% 16.5% 2.1% 8.2% 7.9% 3.2% 5.4%

>3 Times 2 6 0 4 12 0 3 2 3 82.4% 11.5% .0% 8.9% 4.8% .0% 4.1% 3.2% 9.7% 3.1%


56 38 46 20 160 79 52 50 22 20368.3% 73.1% 66.7% 44.4% 64.5% 84.0% 71.2% 79.4% 71.0% 77.8%

One-third (35.5%) respondents (Table 15) in Pindra block and one-fourth (22.2%) in Cholapur blockreceived Post-natal check-up. A very small proportion of respondents (4.8%) had received 3 PNCcheck-up. The post-natal check-up need to be improved by Government health centres to reduceIMR and to improve the utilization of Gov ernment health services.

Table 16 : Distribution of Respondents as per Vaccination given to their Children fromDifferent Health Facilities by Social Category, Education and Occupation in two Blocks of

VaranasiPlace of

vaccinationPINDRA BLOCK CHOLAPUR BLOCK



Total(N=248)


ScheduledCaste

( n=83)Total

(n=261)PHC 3 6 2 11 0 6 1 7

9.4% 4.1% 2.9% 4.4% 0.0% 4.1% 1.2% 2.7%CHC 2 15 4 21 0 6 2 8

6.3% 10.2% 5.8% 8.5% 0.0% 4.1% 2.4% 3.1%Sub-centre 16 96 47 159 23 96 74 193

50.0% 65.3% 68.1% 64.1% 71.9% 65.8% 89.2% 73.9%DistrictHospital

2 5 3 10 1 6 0 76.3% 3.4% 4.3% 4.0% 3.1% 4.1% 0.0% 2.7%

PrivateHospital

4 3 3 10 4 6 1 1112.5% 2.0% 4.3% 4.0% 12.5% 4.1% 1.2% 4.2%

Agricul-ture

(n=29)Service(n=22)

Busin-ess

(n=19)Others(n=178)

Total(n=248)

Agricul-ture

(n=36)Service(n=18)

Busin-ess

(n=22)Others(n=185)

Total(n=261)

PHC 0 1 1 9 11 2 0 1 4 70.0% 4.5% 5.3% 5.1% 4.4% 5.6% 0.0% 4.5% 2.2% 2.7%

CHC 2 0 2 17 21 2 0 1 5 86.9% 0.0% 10.5% 9.6% 8.5% 5.6% 0.0% 4.5% 2.7% 3.1%

Sub-centre 24 11 10 114 159 22 15 14 142 19382.8% 50.0% 52.6% 64.0% 64.1% 61.1% 83.3% 63.6% 76.8% 73.9%

DistrictHospital

0 1 2 7 10 2 1 1 3 70.0% 4.5% 10.5% 3.9% 4.0% 5.6% 5.6% 4.5% 1.6% 2.7%

PrivateHospital

0 0 2 8 10 1 1 2 7 110.0% 0.0% 10.5% 4.5% 4.0% 2.8% 5.6% 9.1% 3.8% 4.2%

38 | P a g e

Illiterate(N=82)


(N=45)

Total(N=248)

Illiterate(N=94)


(N=31)

Total(N=261)

1-8years

9-12years

1-8years

(N=73)

9-12years

(N=63)PHC 2 4 4 1 11 2 2 2 1 7

2.4% 7.7% 5.8% 2.2% 4.4% 2.1% 2.7% 3.2% 3.2% 2.7%CHC 10 3 5 3 21 3 3 1 1 8

12.2% 5.8% 7.2% 6.7% 8.5% 3.2% 4.1% 1.6% 3.2 3.1%Sub-centre 49 30 50 30 159 72 50 51 20 193

59.8% 57.7% 72.5% 66.7% 64.1% 76.6% 68.5% 81.0% 64.5% 73.9DistrictHospital

6 1 3 0 10 3 1 2 1 77.3% 1.9% 4.3% 0.0% 4.0% 3.2% 1.4% 3.2% 3.2% 2.7%

PrivateHospital

2 2 0 6 10 3 2 3 3 112.4% 3.8% 0.0% 13.3% 4.0% 3.2% 2.7% 4.8% 9.7% 4.2%

3.7 Level of Satisfaction of the Respondents

Table 17 : Level of Satisfaction of Respondents for Various Health Services Provided ByDifferent Government Health Centres and the Association With Caste,Educational Status and Occupation in Two Blocks of Varanasi (Q 16)

Scale ofSatisfaction

(Coin scale outof 100 paise)


General(n=32)

OBC(n=147)


Total(N=248)

General(n=32)

OBC(n=146)


TOTAL(n=261)

10-25 paise(NotSatisfactory)

4 18 16 38 3 20 22 45

12.5% 12.2% 23.2% 15.3% 9.4% 13.7% 26.5% 17.2%25-50 paise(JustSatisfactory)

12 63 23 98 21 67 35 123

37.5% 42.9% 33.3% 39.5% 65.6% 45.9% 42.2% 47.1%50-75 paise(Satisfactory)

4 49 19 72 2 40 22 6412.5% 33.3% 27.5% 29.0% 6.3% 27.4% 26.5% 24.5%

75-100 paise(MostSatisfactory)

5 8 6 19 2 8 4 14

15.6% 5.4% 8.7% 7.7% 6.3% 5.5% 4.8% 5.4%Agricul-

ture(n=29)

Service(n=22)

Busin-ess

(n=19)Others(n=178)

Total(n=248)

Agricul-ture

(n=36)Service(n=18)

Busin-ess

(n=22)Others(n=185)

Total(n=261)

10-25 paise(NotSatisfactory)

2 8 3 25 38 5 4 4 32 45

6.9% 36.4% 15.8% 14.0% 15.3% 13.9% 22.2% 18.2% 17.3% 17.2%25-50 paise(JustSatisfactory)

14 6 6 72 98 18 9 10 86 123

48.3% 27.3% 31.6% 40.4% 39.5% 50.0% 50.0% 45.5% 46.5% 47.1%50-75 paise(Satisfactory)

10 3 6 53 72 11 3 2 48 6434.5% 13.6% 31.6% 29.8% 29.0% 30.6% 16.7% 9.1% 25.9% 24.5%


3 2 3 11 19 2 1 1 10 14

10.3% 9.1% 15.8% 6.2% 7.7% 5.6% 5.6% 4.5% 5.4% 5.4%

Illiterate(N=82)

Schooling Graduate andAbove(N=45)

Total(N=248)

Illiterate(N=94)

SchoolingGraduate

and Above(N=31)

Total(N=261)

1-8years

9-12years

1-8 years(N=73)

9-12years

(N=63)10-25 paise(NotSatisfactory)

13 9 11 5 38 15 7 14 9 45

15.9% 17.3% 15.9% 11.1% 15.3% 16.0% 9.6% 22.2% 29.0% 17.2%25-50 paise(JustSatisfactory)

36 17 30 15 98 48 34 31 10 123

43.9% 32.7% 43.5% 33.3% 39.5% 51.1% 46.6% 49.2% 32.3% 47.1%50-75 paise(Satisfactory)

21 20 19 12 72 20 23 14 7 6425.6% 38.5% 27.5% 26.7% 29.0% 21.3% 31.5% 22.2% 22.6% 24.5%


3 4 5 7 19 9 2 0 3 14

3.7% 7.7% 7.2% 15.6% 7.7% 9.6% 2.7% 0.0% 9.7% 5.4%

39 | P a g e

Only 39.5% of the respondents were just satisfied with the services provided by government healthfacilities. Irrespective of caste, educational status and occupation only 7.7% were most satisfiedwith the services that shows the quality of services. Almost same pattern was observed in Cholapurblock. This analysis was carried out on the basis of subjective assessment of the respondents aboutthe health services provided by government health centres.

Table 18 : Distribution of Respondents whose Child had Episode of Diarrhoea in the last 2Weeks According to the Place of Treatment in Two Blocks of Varanasi

DiarrhoeaPINDRA BLOCK CHOLAPUR BLOCK

General (n=32)OBC

(n=147)Scheduled

Caste (n=69)Total

(N=248) General (n=32)OBC

(n=146)

ScheduleCaste(n=83)

Total(n=261)

PHC --- --- --- --- --- --- --- ------ --- --- --- --- --- --- ---

CHC 0 0 1 1 0 3 0 3.0% .0% 1.4% 0.4% 0.0% 2.1% 0.0% 1.1%

Sub-centre --- --- --- --- 1 3 3 7--- --- --- --- 3.1% 2.1% 3.6% 2.7%

DistrictHospt.

--- --- --- --- 1 0 0 1--- --- --- --- 3.1% 0.0% 0.0% 0.4%

PrivateHealth Clinic

6 27 8 41 3 17 12 3218.8% 18.4% 11.6% 16.5% 9.4% 11.6% 14.5% 12.3%

Agriculture(n=29)

Service(n=22)

Business(n=19)

Others(n=178)

Total(n=248)

Agriculture(n=36)

Service(n=18)

Business(n=22)

Others(n=185)

Total(n=261)

PHC --- --- --- --- --- --- --- --- --- ------ --- --- --- --- --- --- --- --- ---

CHC 0 0 0 1 1 1 0 2 3.0% .0% .0% 1.9% 2.0% 1.3% --- 0.0% 2.8% 4.3%

Sub-centre --- --- --- --- --- 2 --- 0 5 7--- --- --- --- --- 5.6% --- 0.0% 2.7% 2.7%

DistrictHospt.

--- --- --- --- --- 0 --- 0 1 1--- --- --- --- --- .0% --- .0% 0.5% 0.4%


6 3 4 28 41 7 --- 5 20 32

20.7% 13.6% 21.1% 15.7% 16.5% 19.4% --- 22.7% 10.8% 12.3%

IlliterateSchooling Graduate

andAbove

Total IlliterateSchooling Gradu-

ate andAbove

Total1-8years

9-12years

1-8years

9-12years

PHC --- --- --- --- --- --- --- --- --- ------ --- --- --- --- --- --- --- --- ---

CHC 1 0 0 0 1 0 1 2 0 31.2% 0.0% 0.0% 0.0% 0.4% 0.0% 1.4% 3.2% 0.0% 1.1%

Sub-centre --- --- --- --- --- 3 1 2 1 7--- --- --- --- --- 3.2% 1.4% 3.2% 3.2% 2.7%

DistrictHospt.

--- --- --- --- --- 0 1 0 0 1--- --- --- --- --- 0.0% 0.0% 1.6% 0.0% 0.0%


11 7 11 12 41 11 11 7 3 32

13.4% 13.5% 15.9% 26.7% 16.5% 11.7% 15.1% 11.1% 9.7% 12.3%

This table shows that only 42 mothers (16.9 %) reporting diarrhoeal episode in past two weeks inPindra block. For treatment of diarrhoea almost all of them had consulted private sector irrespectiveof caste, literacy status and occupation (Table 18). The treatment seeking pattern was almost similarin both the blocks.

40 | P a g e

Table 19 : Distribution of Respondents whose Child had Pneumonia in the Last 2 WeeksAccording to the Place of Treatment in two Blocks of Varanasi

PneumoniaPINDRA BLOCK (N=248) CHOLAPUR BLOCK (N=261)

General(n=32)

OBC(n=147)


Total(N=248)

General(n=32)

OBC(n=146)

ScheduleCaste

( n=83)Total

(n=261)

PHC No.

%

1 1 1 3 0 3 0 3

3.1 0.7 1.4 1.2 0.0 2.1 0.0 1.1

CHC No.

%

0 1 0 1 1 0 2 3

0.0 0.7 0.0 0.4 3.1 0.0 2.4 1.1

Sub- No.

centre %

0 0 1 1 0 3 1 4

0.0 0.0 1.4 0.4 0.0 2.1 1.2 1.5

District No.Hospt. %

0 1 1 2 1 2 3 6

0.0 0.7 1.4 0.8 3.1 1.4 3.6 2.3

Private No.

Clinic %

1 10 9 20 1 12 8 21

3.1 6.8 13.0 8.1 3.1 8.2 9.6 8.0

It was observed that only 27 mothers (10.9 %) were reporting for pneumonia and 8.1 % had gone toprivate sector for treatment. Caste-wise distribution showed that those who were seeking it fromprivate sector belong to OBC (6.8%) and SC (13.0%). Almost similar pattern was observed inCholapur block (Table 19).

Table 20 : Proportion of Respondents Received RTI/STI Treatment According to the Place ofTreatment in Association with Caste in two Blocks of Varanasi

Presence ofRTI/ STI and

Treatment

PINDRA BLOCK (N=248) CHOLAPUR BLOCK (N=261)

General(n=32)

OBC(n=147)


Total(N=248)

General(n=32)

OBC(n=146)


Total(n=261)

PHC No.

%

1 1 1 3 0 3 0 3

3.1 0.7 1.4 1.2 0.0 2.1 0.0 1.1

CHC No.

%

0 1 0 1 1 0 2 3

0.0 0.7 0.0 0.4 3.1 0.0 2.4 1.1

Sub- No.

centre %

0 0 1 1 0 3 1 4

0.0 0.0 1.4 0.4 0.0 2.1 1.2 1.5

District No.

Hospt. %

0 1 1 2 1 2 3 6

0.0 0.7 1.4 0.8 3.1 1.4 3.6 2.3

Private No.

Clinic %

1 10 9 20 1 12 8 21

3.1 6.8 13.0 8.1 3.1 8.2 9.6 8.0

Only 27 respondents (10.9%) received treatment for STI/ RTI. Very few (8.1%) took treatment fromprivate sector. In Cholapur block (Table 20) reported prevalence of RTI/STI was slightly higher(14.2%) than Pindra block (10.9%).

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Table 21 : Proportion of Respondents Satisfied Who Received RTI/STI Treatment Related toRTI/STI Treatment in Two Blocks of Varanasi

Related RTI/STI


General(n=32)

OBC(n=147)


Total(N=248)

General (n=32)

OBC(n=146)


Total(n=261)

Satisfied withthe Healthworkers

0 3 4 7 2 4 2 8

0.0% 2.0% 5.8% 2.8% 6.3% 2.7% 2.4% 3.1%

Satisfied withHealth Facility

0 10 3 13 --- 0 1 1

0.0% 6.8% 4.3% 5.2% --- 0.0% 1.2% 0.4%

15 husbands of the respondents in Pin dra took RTI/STI treatment and nil in Cholapur. 6.0%respondents told that the confidentiality was maintained during the management of RTI/STItreatment. Small proportion of respondents was satisfied with the work of health workers and withhealth facility of the RTI/STI treatment.

Table 22 : Distribution of respondents who adopted family planning methods availed fromdifferent health facilities in association with caste of two blocks of Varanasi

Source ofFamily

PlanningServices


General(N=9) OBC (N=68)

ScheduledCaste

(N=35)Total

(N=112)General(N= 17)

OBC(N=64)

ScheduledCaste

(N=36 )Total

(N=117)

PHC 0 16 10 26 0 3 2 50.0% 20.3% 29.4% 23.2% 0.0% 3.7% 4.3% 4.3%

CHC 0 1 1 2 0 10 4 140.0% 1.3% 2.9% 1.8% 0.0% 12.2% 8.5% 12.0%

Sub-centre 2 5 3 10 0 6 3 98.7% 6.3% 8.8% 8.9% 0.0% 7.3% 6.4% 7.7%

District Hospt. 1 3 1 5 1 4 1 64.3% 3.8% 2.9% 4.5% 6.7% 4.9% 2.1% 5.1%

Private Hospt. 2 1 1 4 --- --- --- ---8.7% 1.3% 2.9% 3.6% --- --- --- ---

Number ofrespondentswho usedservices

5 26 16 47 1 23 10 34

21.7% 32.9% 47.1% 42.0% 6.7% 28.0% 21.3% 29.1%

Respondents were mothers of infants and mothers with baby less than 6 month old were excludedfrom this question. Therefore, 112 respondents from Pindr a and 117 from Cholapur wereinterviewed about temporary method of contraception used by them after delivery of the baby till thedate of interview. None from Cholapur took contraceptive from private hospital. One-fourth of therespondents (23.2%) received these services from primary health centre in Pindra block. Utilisationof PHC services was more in scheduled castes as compared to OBC. In Cholapur block morerespondents (12.0%) have adopted different family planning methods from CHC. (Table 22)

Table 23 : Level of Satisfaction of Respondents for Family Planning Services Provided byDifferent Government Health Services and the Association with Caste in

two Blocks of VaranasiLevel ofSatisfaction(Coin scalemethod, out of100 paise)


General(N=5)

OBC(N=26)

ScheduledCaste

(N=16)Total(N=47)

General(N= 1)

OBC(N=23)

ScheduledCaste

(N=10 )

Total(N=34)

10-25 Paise (Not 0 4 3 7 --- 4 4 8

42 | P a g e

Satisfactory) .0% 16.0% 25.0% 17.1% --- 21.1% 44.4% 28.6%

25-50 Paise (JustSatisfactory)

0 3 2 5 --- 10 4 14

.0% 12.0% 16.7% 12.2% --- 52.6% 44.4% 50.0%

50-75 Paise(Satisfactory)

3 14 4 21 --- 5 1 6

75.0% 56.0% 33.3% 51.2% --- 26.3% 11.1% 21.4%

75-100 Paise(MostSatisfactory)

1 4 3 8 --- --- --- ---

25.0% 16.0% 25.0% 19.5% ------ --- ---

Table (23) shows satisfaction level of the respondents for family planning services out of those whoavailed. Only 47 respondents of Pindra and 34 of Cholapur had availed these services. 17.1 % fromPindra and 28.6% from Cholapur were no t satisfied with the services provided by the healthfacilities. (Table 23)

Table 24 : Distribution of Respondents According to the Time Required to Avail the Facilitiesto Evaluate the Suitability of Government Health Facilities and its Association

with Caste in two Blocks of Varanasi

Time requiredto avail the

health facilities


General(N=32)

OBC(N=147)

ScheduledCaste

(N=69)

Total(N=248)

General(N= 32)

OBC(N=146)

ScheduledCaste

(N=83 )

Total(N=261)

Less than one hour 15 82 31 128 12 97 47 156

46.9% 55.8% 44.9% 51.6% 37.5% 66.4% 56.6% 59.8%

1 hour 8 25 17 50 6 31 20 57

25.0% 17.0% 24.6% 20.2% 18.8% 21.2% 24.1% 21.8%

1-2 hours 3 9 3 15 1 4 0 5

9.4% 6.1% 4.3% 6.0% 3.1% 2.7% 0.0% 1.9%

More than 2 hours 0 5 1 6 12 7 15 34

0.0% 3.4% 1.4% 2.4% 37.5% 4.8% 18.1% 13.0%

51.6% of the respondents agreed that timing of government health facilities at Pindra was suitablefor them and most of them were able to reach to the health facility in less than one hour. Similarpattern was reported by 59.8% of the respondents of Cholapur block (Table 24).

Table 25 : Distribution of Responses According to the Means of Conveyance to ReceivedHealth Services from Government Health Facilities and its Association with

Caste, Occupation and Educational Status in two blocks of Varanasi

Means ofconveyanceto receive

healthservices


General(n=32)

OBC(n=147) Scheduled

Caste (n=69)

TOTAL(N=248)

General(n=32)

OBC(n=146)


Total(n=261)

On Foot 10 76 37 123 24 99 58 18131.3% 51.7% 53.6% 49.6% 75.0% 67.8% 69.9% 69.3%

By Bus 0 12 1 13 2 8 2 120.0% 15.8% 2.7% 10.6% 8.3% 8.1% 3.4% 6.6%

By Cycle 5 19 13 37 2 14 15 3115.6% 12.9% 18.8% 14.9% 6.3% 9.6% 18.1% 11.9%

By Scooter 11 14 1 26 3 18 7 2834.4% 9.5% 1.4% 10.5% 9.4% 12.3% 8.4% 10.7%

Total 26 121 52 199 31 139 82 25281.3% 82.3% 75.4% 80.2% 96.9% 95.2% 98.8% 96.6%

Means ofconveyanceto receive

Agriculture(n=29)

Service(n=22)

Business(n=19)

Others(Weavers

andLaboures

Total(n=248)

Agricul-ture

(n=36)Service(n=18)

Busin-ess

(n=22)

Others(Weavers

andLaboures

Total(n=261)

43 | P a g e

healthservices

(n=178) (n=185)

On Foot 13 8 6 96 123 27 9 15 130 18144.8% 36.4% 31.6% 53.9% 49.6% 75.0% 50.0% 68.2% 70.3% 69.3%

By Bus 4 2 0 7 13 0 1 0 11 128.9% 5.5% 0.0% 13.0% 26.2% 0.0% 2.0% 0.0% 15.7% 17.3%

By Cycle 3 4 4 26 37 3 0 2 26 3110.3% 18.2% 21.1% 14.6% 14.9% 8.3% 0.0% 9.1% 14.1% 11.9%

By Scooter 6 2 3 15 26 6 7 4 11 2820.7% 9.1% 15.8% 8.4% 10.55 16.7% 38.9% 18.2% 5.9% 10.7%

Total 26 16 13 144 199 36 17 21 178 25289.7% 72.7% 68.4% 80.95 80.2% 100.0% 94.45 95.55 96.2% 96.6%

Means ofconveyanceto receivehealthservices

Illiterate(n=82)


Above(n=45)

Total(N=248)

Illiterate(n=94)

Schooling Gradu-ate andAbove(n=31)

Total(N=261)

1-8years

(n=52)

9-12years(n=69)

1-8years

(n=73)

9-12years

(n=63)On Foot 44 26 36 17 123 73 42 46 20 181

53.7% 50.0% 52.2% 37.8% 49.6% 77.7% 57.5% 73.0% 64.5% 69.3%By Bus 2 2 5 4 13 5 4 0 3 12

2.4% 3.8% 7.2% 8.9% 5.2% 5.3% 5.5% 0.0% 9.7% 4.6%By Cycle 12 8 9 8 37 12 11 6 2 31

14.6% 15.4% 13.0% 17.8% 14.9% 12.8% 15.1% 9.5% 6.5% 11.9%By Scooter 3 2 10 11 26 4 11 8 5 28

3.7% 3.8% 14.5% 24.4% 10.5% 4.3% 15.1% 12.7% 16.1% 10.7%Total 61 38 60 40 199 94 68 60 30 252

74.4% 73.1% 87.0% 88.9% 80.2% 100.0% 93.2% 95.2% 96.8% 96.6%

In both the blocks, majority (49.6% in Pindra and 69.3% in Cholapur) of respondents were going byfoot. Utilization of vehicle seems to be very less by each category viz. Caste wise, education wiseand occupation wise. (Table-25)

Table 26 : Distribution of respondents according to the status of maintenance of privacy byhealth providers and its association with caste in two blocks of Varanasi

Privacymaintainedby healthworkers


General(N=27)

OBC(N=133)

ScheduledCaste

(N=55)Total

(N=215)General(N= 31)

OBC(N=137)

ScheduledCaste

(N=83 )

Total(N=251)

Privacymaintained

13 52 19 84 10 74 32 11640.6 35.4 27.5 33.9 31.3 50.7 38.6 44.4

Privacynotmaintained

1 6 3 10 0 0 3 3

3.1 4.1 4.3 4.0 0.0 0.0 3.6 1.1Privacynot needed

11 62 30 103 21 65 47 13334.4 42.2 43.5 41.5 65.6 44.5 56.6 51.0

Those whoreplied

25 120 52 197 31 139 82 25278.1 81.6 75.4 79.4 96.9 95.2 98.8 96.6

More then 40% of the respondents in both the blocks did not felt for the need of privacy and 33.9 %from Pindra and 44.4 % from Cholapur replied that the privacy was maintained during hea lth check-up. (Table 26) It seems that most of the government health workers are already taking precautionsfor privacy of the respondents and the respondent did not perceive about the importance of this.However, efforts must be continued by government h ealth centres to further improve the facility toprovide privacy to the respondents while they are being examined for routine health check -ups. Sothe respondents perceive this as one of the important part of the medical check -up.

44 | P a g e

Table 27 : Distribution of Respondents According to their Level of Satisfaction for theBehaviour of Medical Officer and Health Workers by Social Category in two blocks of

VaranasiLevel of

Satisfaction (Coinscale method, out

of 100 paise)

PINDRA BLOCK (N=248) CHOLAPUR BLOCK (N=261)General(N=18)

OBC(N=83)

ScheduledCaste

(N=36)

Total(N=137)

General(N= 16)

OBC(N=91)

ScheduledCaste

(N=46 )

Total(N=153)

Satisfaction level about the behaviour of Medical Officer10-25 paise (NotSatisfactory)

2 6 8 16 2 16 13 3111.1% 7.2% 22.2% 11.7% 12.5% 17.6% 28.3% 20.3%

25-50 paise (JustSatisfactory)

4 33 12 49 6 34 14 5422.2% 39.8% 33.3% 35.8% 37.5% 37.4% 30.4% 35.3%

50-75 paise(Satisfactory)

9 35 11 55 7 33 17 5750.0% 42.2% 30.6% 40.1% 43.8% 36.3% 37.0% 37.3%

75-100 paise (MostSatisfactory)

3 9 5 17 1 8 2 1116.7% 10.8% 13.9% 12.4% 6.3% 8.8% 4.3% 7.2%

Satisfaction level about the behaviour of Health Worker10-25 paise (NotSatisfactory)

2 8 9 19 5 16 21 4211.1% 9.5% 25.0% 13.8% 31.3% 17.6% 45.6% 27.5%


10 56 22 88 10 58 28 9655.5% 66.7% 61.1% 63.7% 62.5% 63.7% 60.9% 62.7%


11 53 22 86 10 38 24 7261.1% 63.1% 61.1% 62.3% 62.5% 41.7% 52.1% 47.1%


4 8 6 18 2 10 4 1622.2% 9.5% 16.7% 13.0% 12.5% 10.9% 8.6% 10.5%

Same trend of client satisfaction was observed for the behaviour of Medical Officers and healthworkers in both the blocks. General category respondents were least satisfied with the behaviours ascompared to OBCs and scheduled castes. About 80% to 90% of the respondents from both theblocks were satisfied with the behaviour of doctors while 75% to 85% of the respondents weresatisfied with the behaviour of health workers of different government heath cent res.

3.8 Findings Related to the Quality of Services

Table 28 : Distribution of Respondents According to their Perception about the Status ofRoutine Facilities (cleaning of toilet; availability of drinking water; cleanliness ofhealth centres) Available at Government Health Centres by Social Category

Status of routinefacilities (Coin scalemethod, out of 100

paise


General(N=26)

OBC(N=119)

ScheduledCaste

(N=52)

Total(N=197)

General(N= 23)

OBC(N=113)

ScheduledCaste

(N=69 )

Total(N=205)

Status of Cleaning of Toilet10-25 paise (NotSatisfactory)

2 10 8 20 4 19 17 40

7.7% 8.4% 15.4% 10.2% 17.4% 16.8% 24.6% 19.5%25-50 paise (JustSatisfactory)

9 44 18 71 6 57 26 8934.6% 37.0% 34.6% 36.0% 26.1% 50.4% 37.7% 43.4%


8 50 21 79 11 32 21 6430.8% 42.0% 40.4% 40.1% 47.8% 28.3% 30.4% 31.2%

75-100 V(MostSatisfactory)

7 15 5 27 2 5 5 1226.9% 12.6% 9.6% 13.7% 8.7% 4.4% 7.2% 5.9%

Status of the Availability of Drinking Water10-25 paise (NotSatisfactory)

1 11 8 20 5 18 17 403.8% 9.2% 15.4% 10.2% 21.7% 15.9% 24.6% 19.5%


9 42 18 69 5 59 26 9034.6% 35.3% 34.6% 35.0% 21.7% 52.2% 37.7% 43.9%


9 49 20 78 11 30 20 6134.6% 41.2% 38.5% 39.6% 47.8% 26.5% 29.0% 29.8%

75-100 paise (Most 7 17 6 30 2 6 6 14

45 | P a g e

Satisfactory) 26.9% 14.3% 11.5% 15.2% 8.7% 5.3% 8.7% 6.8%

Status of Cleaning of Health Centres in General10-25 paise (NotSatisfactory)

3 14 7 24 4 22 16 4211.5% 11.8% 13.5% 12.2% 17.4% 19.5% 22.9% 20.4%


5 42 15 62 7 42 28 7719.2% 35.3% 28.8% 31.5% 30.4% 37.2% 40.0% 37.4%


14 50 26 90 12 45 24 8153.8% 42.0% 50.0% 45.7% 52.2% 39.8% 34.3% 39.3%


4 13 4 21 0 4 2 615.4% 10.9% 7.7% 10.7% .0% 3.5% 2.9% 2.9%

According to analysis OBCs and SCs were more satisfied by the regular process of toilet cleaning ofthe health centres as compared to general population but irrespective of their caste most of therespondents (Table 28) were satisfied with other routine facilities (like drinking water andcleanliness of hospitals).

Table 29 : Distribution of Respondents According to their Perception Regarding Adequacy ofthe Government Health Services by Social Category

Coin scalemethod,

out of 100paise


General(N=26)

OBC(N=119)

ScheduledCaste

(N=52)

Total(N=197)

General(N= 23)

OBC(N=113)

ScheduledCaste

(N=69 )TOTAL(N=205)

Adequacy of Government Health Services10-25 paise (NotAdequate)

5 19 10 34 5 23 25 5319.2% 16.0% 19.2% 17.3% 21.7% 20.2% 35.7% 25.6%

25-50 paise (JustAdequate)

5 59 23 87 10 61 27 9819.2% 49.6% 44.2% 44.2% 43.5% 53.5% 38.6% 47.3%

50-75 paise(Adequate)

12 35 15 62 8 28 14 5046.2% 29.4% 28.8% 31.5% 34.8% 24.6% 20.0% 24.2%

75-100 paise(Most Adequate)

4 6 4 14 0 2 4 6

15.4% 5.0% 7.7% 7.1% .0% 1.8% 5.7% 2.9%

On enquiry about the adequacy of government health services, about 79% respon dents of Pindra andCholapur block could reply (Table 29). However, 17.3% of the respondents of Pindra and 25.6% ofthe respondents of Cholapur did not perceive health services adequate.

Table 30 : Distribution of the respondents who have paid the ch arges other than routineRegistration Fee at government health centres

PINDRA BLOCK (N = 248) CHOLAPUR BLOCK (N=261)

General (n=32)OBC

(n=147)Scheduled

Caste (n=69)Total

(N=248) General (n=32)OBC

(n=146)


Total(n=261)

Yes 18 95 38 151 24 102 55 18156.3% 64.6% 55.1% 60.9% 75.0% 69.9% 66.3% 69.3%

Agriculture(n=29)

Service(n=22)

Business(n=19)

Others(n=178)

Total(n=248)

Agriculture(n=36)

Service(n=18)

Business(n=22)

Others(n=185)

Total(n=261)

Yes 20 12 13 106 151 26 11 12 132 18169.0% 54.5% 68.4% 59.6% 60.9% 72.2% 61.1% 54.5% 71.4% 69.3%

Illiterate(N=82)

SchoolingGraduate

andAbove(N=45)

Total(N=248)

Illiterate(N=94)

SchoolingGraduate

andAbove(N=31)

Total(N=261)

1-8years 9-12 years

1-8 years(N=73)

9-12years

(N=63)Yes 48 31 46 26 151 69 50 42 20 181

58.5% 59.6% 66.7% 57.8% 60.9% 73.4% 68.5% 66.7% 64.5% 69.3%

60% to 70% of the respondents informed about paying of charges in government healthcentres other than routine registration fee. Caste, education and occupation did not show anyspecific pattern.

46 | P a g e

DISCUSSION

Family Planning Services

In this study 4 Focussed Group Discussion (FGD) were conducted among users of familyplanning from government health centres and others using family planning from privatesources.

The level of knowledge about family planning methods among users was not very high.However, some of them can mention various methods like Mala-D, Copper-T, Nirodh,Saheli etc. They have a belief that the quality of contraception provided in governmenthealth centres was not good. A lady stated that, “people say that government product is notgood. We get good quality by paying more money to the shop” .

In the discussion the main issue arise w as about sanitation in the government facilities andthe behaviour of the doctors toward the clients. One of them stated that, " in governmentonly few doctors talk well but in private all doctors use to talk normally” . Another problemthat was highlighted was the privacy issue, as in government hospitals privacy was notproperly maintained that doctors talk openly in front of a large group of people but inprivate they understand problem and talk privately even during check -up they use curtainduring examination and check thoroughly. One participant says, “Only those who havemoney go to private. Everyone can’t go to private therefore if government doctor talks wellthen everyone will go” .

In relation to mother and child health they complained the inadequacy of th e governmentfacilities and the non-availability of health workers to guide them or to provide informationabout various services. For delivery they prefer to go to private hospital as the governmenthospital could not manage complication. However, they av ailed ANC services fromgovernment health centres. A participant stated that, "for serious cases we go to private as ingovernment hospital, there is no one to take care off” . Regarding the availability oftransportation facilities during emergency they have to arrange vehicle by their own source/means. In village, as one participant says, "conveyance are available in the village, we get iton demand”. In government hospital, "no one advised in government but when we went toprivate, we got calcium and iron”.

But some other stated that in government hospital also ANM told about breast -feeding butnormally after delivery they get discharged in few hours only, as stated by one of theparticipants that "if the patient is all right then they use to discharge within half or onehour”.

About immunization sessions it was conducted regularly or not then 90% response showedthat in Government centres immunization practices for both child and mother is very goodand very particular because almost every Wednesday AW W, ANM conductedimmunization sessions in their area . One stated that, “for vaccination we all go only to thegovernment”.

For the treatment for pneumonia or for severe diarrhoea they mostly opt for private, simplydue to lack of faith on government services and they did not want to take any risk butparallel some of them also admits that they usually got ORS packets from GovernmentHealth centres as per their requirements.

47 | P a g e

In spite of the good knowledge about natal and child care by both users and non-users,especially for complications and emergencies arises during pregnancy and child care(related to severe diarrhoea or pneumonia) they motivated to avoid private services.

So we can say that due to unavailability of emergency services and incompetence to managecomplications in Government hospitals as per their desire or requirement they sometimesforced to opt for private services.

RECOMMENDATIONS

The study came out with the following recommendations: All health facilities should be made functional according to IPHS i.e. adequate staff esp.

specialists should be appointed/hired to provide emergency and quality services. Inadequacy of logistics (equipments, medicine, and vaccine) and infrastructure should

be met. There is a need for providing health s ervices for 24 hours to improve the utilization of

health services. The cleanliness and maintenance of infrastructure of the health centres is also very

important factor to increase the utilisation of the government health services. Free and sufficient medicines should be made available . Cleanliness of the health centres and hospitals should be ensured. No amount should be deducted in JSY scheme IEC activities must be strengthened to create awareness among the community about

various health schemes. Availability of pathological services at rural centres . Health services providers should be given training to build their capacity to improve in

their dealing with the patients . Availability of female doctor should be ensured at CHC . No one should be charged for the case paper and injection. The PNC services needed to be strengthened and encourage mothers for the utilisation

of the services. Electricity should be made available at delivery places with a proper power backup . Sub-centre should be at secure place so ANM can stay there. Increase the OPD timings with proper arrangement for emergency at night.

48 | P a g e

CHAPTER 4

CONCLUSION AND RECOMMENDATIONS

This study was planned to analyze the determinants of utilization, reasons of non -utilizationandclient satisfaction about RCH services at different level of health facilities i.e. CHC,PHC and Sub-centre. In response to achieve these objectives the survey was conducted inPindra and Cholapur blocks out of the total 8 blocks in Varanasi district. These two blockswere selected purposively on the recommendations of department of health, districtVaranasi. From each block, on an average 6 villages were selected following the distancecriterion (<2 km, 2-5 km and >5 km) from CHC. FGDs and in-depth interviews of mothershaving less than 12 months old infants (user and non user of government health facility) wasused as tools to assess these parameters. In addition to this availability, working status andadequacy of the equipments (according to Indian Public Health Standard (IPH S) were alsoinvestigated at CHC, PHC and Sub-centres.

A total of the 509 mothers (248 in Cholapur and 261 in Pindra block) were interviewed.Socio-demographic profile of respondents of both the blocks was almost same. Majority(97.4 %) of the respondents were Hindus and belonged to OBC category (57.6%).One -third(34.6 %) of interviewed respondents were illiterate and only 14.9% were having graduateand above qualification. Most of the respondents (91.4 %) of both the blocks belonged tovery low monthly income ranging from Rs.1000-5000. Occupation-wise distributionshowed that majority of them (71.3%) were labourers, weavers, rickshaw pullers and autodrivers. Most of the socio-demographic variables were correlated with the factors affectingutilisation and non utilisation of RCH services. The mothers of children (youngest one)whose age was less than one year were interviewed. Respondents having children 1 -3 yearswere maximum 35.5 % in Pindra and 29.1 % were from Cholapur block.

The study found that level of knowledge among respondents about the availability of healthfacilities (both government and private) showed variation in two blocks . In Pindra block asignificant proportion knew about Sub-centre (87.1 %) followed by PHC (70.2%) amongstgovernment health facilities and 40.7 % knew private sector. In Cholapur block majority ofthe responses were for sub-centre (93.5%) followed by CHC (83.1%), and 46.7% wereusing private health facility.

Majority of them were utilising ANC (93.1 %), Immunisation (98.9 %) and PNC (76.2 %).The pattern of knowledge was almost similar in both the blocks. Family planning serviceswere utilised by only 11.3% respondents. Utilisation of services for child i.e. diarrhoea (3 -8%), ARI (about 2%) was considerably low, irrespecti ve of their caste, occupational andeducational status in both the blocks.

A significant proportion of the respondents received inj. TT and Tab IFA during antenatalperiod from sub-centre (60–70 %) except for haemoglobin estimation (6.5 %) andmeasurement of blood pressure (7.3 %), whereas, 2-11 % of respondents have received theservices during antenatal period from the private sector. Analysis regarding place of theirlast delivery showed that about 70% were the institutional deliveries. Where as 33.1 % wasat PHC and 17.7 % in private hospital in Pindra block. The respondents having higherqualifications opted PHC (42.2 %) and private health clinic (31.1%) for the deliveries inPindra block. In Cholapur block home deliveries were 31.8%. Institutional d eliveries were68.2 % and 14.6 % were from private sector in Cholapur block.

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41.6% of the respondents did not receive any post -natal check-ups after their most recentbirth. One-third of respondent (31 to 36 %) received first post -natal check-up with in 24hours. PNC check-up within 24 hours in the Pindra block was highest by caste amongOBC, by occupation among service class and by education among graduate and above.

Findings of in-depth interview regarding non -utilisation of government health facilitiesshowed that out of the total 248 respondents in Cholapur block, only 34 were using privatehealth facility and reasons for non utilisation were mainly family decision (4.0%) and pooravailability of doctors (3.6 %) followed by poor behaviour of doctors and health staff anddistance from health facility (2.4 %). While in Pindra block out of the total 261 respondentsonly 11 were using private facilities. According to them most important reason for not usingof government services was poor behaviour of do ctor and staff (1.1 %) and distance ofhealth facilities (4.2 %) followed by family decision (3.4%). No clear pattern was observedaccording to caste, occupation and educational status in both the blocks.

Regarding services for children the findings sugg est that only 17.3% mothers reporteddiarrhoeal episodes of their children in past two weeks and 16.5 % in Pindra and 12.3 % inCholapur block consulted private sector for treatment irrespective of their caste, literacystatus and occupation in both the bl ocks. It was observed that only 1.5% of the motherswere reporting for pneumonia and majority (about 8%) had gone to private sector fortreatment in both the blocks.

Self reported prevalence of RTI/STI was between 10 -14% in study blocks and majority (8.1% in Pindra and 8.0 % in Cholapur block) of them preferred private sector for the treatment.Very few of the respondents (3 to 6 %) had utilised government facility for the same.

Very few of the respondents (19 %) adopted temporary methods for family pla nning inPindra block, 10.5% of the respondents received these services from primary health centre.Utilisation was more in scheduled caste as compared to other castes. In Cholapur block only13% have adopted temporary family planning methods and 5.4 % of the respondentsreceived these services from CHC. In both the blocks 75 to 80% of the respondents agreedthat timing of the Government health facilities was suitable for them and 50 to 60 % of themwere able to reach to the health facility within less than one hour. As per the data more than40% of the respondents in both the blocks did not feel the need of privacy. However, 33 to44 % of the respondents replied that the privacy was maintained during health check up.

Client satisfaction was an important measure of the quality of health care and needs to beaddressed in order to improve the utilisation of services. In this study coin scale was used tomeasure respondent’s satisfaction about various RCH services, behaviour of doctor andhealth worker, cleanliness of toilets and drinking water facility. It was found that majorityof the respondents (75 %) were just satisfied (25 -50 paise) or satisfied (50-75 paise) withthe services provided by government health centre. About 40% of the respondents were justsatisfied (25-50 paise) with the adequacy of services at government health facilities. Abouttwo-third (60 to 69%) paid money other th an the registration fee at government healthcentres.

The FGD for family planning services put us on the conclusion that in spite of theirknowledge regarding family planning services still they were facing socio -cultural barrierslike culture of silence which inhibit to share their experience in front of large group ofpeople along with this they didn't have good faith on Government products and on their

50 | P a g e

dealing. So they motivated towards private where they got good level of privacy, suitabledealing and services. They also have faith on products provided by private sources.

For the treatment for pneumonia or for severe diarr hoea they mostly opted for private,simply due to lack of faith in Government services and they did not want to take any riskbut some of them also admitted that they usually got ORS packets from Government healthcentres as per their requirements.

In spite of the good knowledge about natal care and child care of both users and non -users,especially for complications and emergencies arising during pregnancy and child care(related to severe diarrhoea or pneumonia) they were motivated to avail private servi ces.

It is a known fact that any service in health care system is impossible to deliver withoutappropriate facilities. Assessing this aspect, different health facilities were surveyed .Facility survey was conducted in two block PHCs viz. Pindra and Danganj (CholapurBlock). Pindra PHC was working as 24 x 7 health facility. All the national healthprogrammes were implemented in the block through this PHC. Bed occupancy was veryhigh. JSY scheme was implemented and eight sub-centers were identified for RCH services(esp. deliveries). RCH camps were organized regularly. At present no LMO was posted atPHC. Essential newborn care was given by the medical officer, otherwise required facilitiesfor emergency newborn care was not available in this PHC. Laboratory services were notaccording to Indian Public Health Standard (IPHS). Pregnancy kit (Nischaya) wasintroduced in the community through ASHA for rapid diagnosis of pregnancy. Adequatefacilities for treatment of pneumonia and diarrhoea were available. Rogi kalyan samiti(RKS) was well formed and functional at various levels. On the contrary at Danganj PHCdelivery of RCH services were not according to the prescribed norms.

Pindra CHC was existed since 5 years but it became functional in 2007. At present it is notfunctioning according to IPHS (Esp. in terms of manpower, required equipments andcommunication facilities). Only the physical infrastructure was according to the norms.Though CHC Cholapur was identified as FRU, but there was no blood storage unit.Paediatrician and surgeon were also not posted in the CHC. Other services likeinvestigations, equipments in OT etc. were also not according to the norms. All nationalhealth programmes were implemented in the block through CHC only.

Two accredited sub-centres viz. Phulpur (Pindra Block), Rupchandpur ( Cholapur block)was visited and ANM was interviewed. The physical infrastructure of Rupchandpur sub-centre was according to the norms for the delivery of ANC, INC, FP services. ANM wasavailable for 24 hours at the centre. Phulpur sub-centre was in rented building but ANMwas staying there and providing ANC, INC, FP services round the clock.

So it could be said that due to unavailability of emergency services and incompetence tomanage complications in Government hospitals (as respondent perceived in the FGDs) asper their desire or requirement they sometimes forced to opt for private services. Nonutilisation of government health facilities was also due to non availability of emergency and24 hours services and poor cleanliness of most of the health facilities.

In the end it may be concluded that for the improvement of utilisation and quality ofservices through government health facilities there is a strong need to take actions at thedistrict as well as community level.

51 | P a g e

RECOMMENDATIONS

Keeping this in view the study came out with the following recommendations andsuggestions: All health facilities should be made functional according to IPHS i.e. adequate staff esp.

specialists should be appointed/ hired to provide emergency and quality services. Inadequacy of logistics (equipmen t, medicine, and vaccine) and infrastructure should be

met. There is a need for providing health services for 24 hours to improve the utilization of

health services. The cleanliness and maintenance of infrastructure of the health centres is also very

important factor to increase the utilisation of the government health services. Free and sufficient medicines should be made available Cleanliness of the health centres and hospitals should be ensured. No amount should be deducted in JSY scheme IEC activities must be strengthened to create awareness among the community about

various health schemes. Availability of pathological services at rural centres . Health services providers should be given training to build their capacity to improve in

their dealing with the patients . Availability of female doctor should be ensured at CHC No one should be charged for the case paper and injection . The PNC services needed to be strengthened and encourage mothers for the utilisation

of the services. Electricity should be made available at delivery places with a proper power back -up Sub-centre should be at secure place so ANM can stay there Increase the OPD timings with proper arrangement for emergency at night.

52 | P a g e

References

1 IIPS, NFHS-1(1992-93), MoHFW, Government of India, p. 227

2 Government of India, (2005), NRHM: Framework for Implementation , MoHFW,New Delhi.

3 DLHS–3 (2007-08), IIPS, Mumbai, India.

4 Carr-Hill RA. The Measurement of Patient Satisfaction. J Public Health Med 1992;14:236-49. PMID: 1419201.

5 Crow R, Gage H, Hampson S, Hart J, Kimber A, Storey L, et al. The Measurementof Satisfaction with Health Care: Implications for Practice from a SystematicReview of the Literature. Health Technol Assess 2002; 6:1-244. PMID:12925269

6 Hudak PL, Wright JG. The Characteristics of Patient Satisfaction Measures. Spine2000; 25:3167-77. PMID:11124733 doi:10.1097/00007632 -200012150-00012.

7 Ross CK, Stewart CA, Sinacore JM. A Comparative Study of Seven Measures ofPatient Satisfaction. Med Care 1995; 33 -392-406. PMID:7731280doi:10.1097/00005650-00006.

8 Sitzia J, Wood N. Patient Satisfaction: A Review of Issues and Concepts. Soc SciMed 1997; 45:1829-43. PMID:9447632 doi:10.1016/S0277 -9536(97)00128-7.

9 Sofaer S, Firminger K. Patient Perceptions of the Quality of Health Services. AnnuRev Public Health 2005; 26:513 -59. PMID: 15760300doi:10.1146/Anurev.publhealth.25.050503. 153958.

10 Jackson JL, Chamberlin J, Korenke K. Predictors of Patient Satisfaction. Soc SciMed 2001; 52:609-20. PMID:11206657 doi:10.1016/S0277 -9536(00)00164-7.

11 Kane RL, Maciejewski M, Finch M. The Relationship of Patient Satisfaction withCare and Clinical Outcomes. Med Care 1997;35:714 -30. PMID:9219498doi:10.1097/00005650-199707000-00005.

12 Linder-Petz S. Social Psychological Determinants of Patient Satisfaction: A Test ofLive Hypotheses. Soc Sci Med 1982; 16:583 -9. PMID:7100991 doi:10.1016/0277 -9536(82)90312-4.

13 Nguyen Thi PL, Briancon S, Empereur F, Guillemin F. Factors DeterminingInpatient Satisfaction with Care. Soc Sci Med 2002; 54:493-504. PMID:11848270doi: 10.1016/S0277-9536(01)00045-4.

14 Blendon RJ, Benson JM, DesRoches CM, Weldon KJ. Using Opinion Surveys toTract the Public’s Response to a Bioterrorist Attack. J Health Commun 2003; 8Suppl 1;83-92. PMID:14692573.

15 Blendon RJ, Leitman R, Morrison I, Donelan K. Satisfaction with Health Systems inTen Nations. Health Aff (Millwood) 1990; 9:185 -92. PMID: 2365256doi:10.1377/hlthaff.9.2.185.

16 European Commission, Directorate General Press and Com munication, PublicOpinion Analysis Sector. Candidate C ountries Eurobarometr 2002.2, September -October 2002 [Candidate Countries Eurobarometer Survey Series]. Ann Arbor, MI:

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Inter-University Consortium for Political and Social Research; 2007. Available fro m:http://www.icpsr.umich.edu/cocoon/ICPSR/STUDY/04062.xml [accessed on 26February 2009].

17 Stewart M, Roter D. Which facets of Communication have Strong Effects onOutcome : A Meta-analysis. In : Stewart M, Roter D. Communicating with MedicalPatients. Newbury Park, CA: Sage Publications; 1989. pp. 183 -96.

18 Blendon RJ, Schoen C, DesRoches C, Osborn R, Zapert K. Common Concerns andDivers System: Health Care Experiences in Five Countries. Health Aff (Millwood)2003;22: 206-21. PMID: 12757276 doi: 10.1377/ hth aff.22.3.106

17 Sara N Bleach, Emire Ozalin and Christopher JL Murray: How Does Satisfactionwith Health Care System Relate to Patient Experience?, Bull World Health Organ,2009, 87, 271-278.

http://www.icpsr.umich.edu/cocoon/ICPSR/STUDY/04062.xml

54 | P a g e

Observations of Facility Assessment of two CHC(as per IPHA guidelines)

Name of the State : UTTAR PRADESHDistrict : VARANASIHealth Facilities Recognized as FRU? : No

1. Services

S.No. PINDARABLOCK

CHOLAPURBLOCK

1.1 Population covered (in numbers) 252946 2400001.2 Specialist services available (Yes/No)

a. Medicine No Yesb. Surgery No Noc. OBG No Yesd. Paediatrics Yes Yese. National Health Programmes (Specify) Through

Pindra BlockPHC

Yes

f. Emergency services (24 hours) No Yesg. 24 - hour delivery services including normal and assisted d eliveries No Yesh. Emergency Obstetric Care including surgical interventions like Caesarean

Sections and other medical interventionsNo Yes

i. New born care No Yesj. Emergency care of sick children No Yesk. Full range of family planning services including L aparoscopic Services No Yesl. Safe abortion services No Yesm. Treatment of STI / RTI No Yesn. Essential Laboratory Services (Specify the

type of lab tests conducted)Sputum smearpreparationonly

Yes

o. Blood storage facility No Nop. Referral transport service No Ambulance

1.3 Bed Occupancy Rate in the last 12 months (1 - Less than 40%; 2 - 40-60%; 3 - More than 60%)

Only inepidemics

38% (Dec 08)

1.4 Average daily OPD Attendance 100 250a. Male 50% 50%b. Female 50% 50%

1.5 Types of Surgeries performed (specify) No Hydrocele,Hernia, CS

1.6 HIV/AIDS No Noa. Availability of Counseling facility on HIV/AIDS/STD etc. (Yes/No) No Nob. Is it a Voluntary Council and Testing Centre (VCTC)? No No

1.7 Service availabilityNumber of days in a month the servic es are available

No Yes

a. Ante-natal Clinics Yes Yesb. Post-natal Clinics No Yesc. Immunization Sessions No Yes

1.8 Number of cases of caesarian delivery (During last one year) No 1+21.9 Total number of paediatric beds No No

1.10 Is separate septic labour room available No No1.11 Availability of facilities for out -patient

department in Gynaecology/ obstetric(Yes / No)

Yes Yes

a. Board /Name plates to guide the clients No Yesb. Adequate working space Yes Yesc. Privacy during examination Yes Nod. Facility for counselling No Noe. Separate toilet with running water No Nof. Facility for sterilizing instruments No Nog. Male specialist No 02h. Female specialist Contractual 02

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2. ManpowerS.No. Personal PINDARA BLOCK CHOLAPUR BLOCK

IPHSNorm

CurrentAvailabilityat CHC(indicateNumber)

RemarksSuggestion/IdentifiedGaps

IPHSNorm

Current Availabilityat CHC (indicateNumber)


[A] Clinical Manpower2.1 General Surgeon 1 No 1 No

2.2 Physician 1 No 1 01

2.3 Obstet./Gynecologist 1 Contract 1 01

01 (Contractual)

2.4 Paediatric 1 No 1 No

2.5 Anaesthetist1 No On contractual

appointment orhiring ofservices fromprivate sectors oncase to casebasis

1 01 Oncontractualappointment orhiring ofservicesfromprivatesectorson caseto casebasis

2.6 Public HealthProgramme Manager

1 No Oncontractualappointment

1 01 Oncontractualappointment

2.7 Eye Surgeon1 1 For every 5 lac

popn. as pervision 2020approved PlanofAction

1 No Forevery 5lac pop.as pervision2020approved PlanofAction

2.8 Other specialists(if any)

NoNo

2.9 General Duty Officers(Medical Officer)

NoNo

[B] Support Manpower PINDARA BLOCK CHOLAPUR BLOCKIPHSNorm

CurrentAvailabilityat CHC(indicateNumber)


IPHSNorm

CurrentAvailability at CHC(indicateNumber)

RemarksSuggestion/Identified Gaps

2.10 Nursing Staff7 + 2 1 ANM and 1

Public HealthNurse forFamilyWelfare willbe appointedunder theASHAscheme

7 + 2 1 ANM and 1Public HealthNurse for FamilyWelfare will beappointed under theASHA scheme

a. Public Health Nurse 1 Nil 1 Nilb. ANM 1 Nil 1 01 HV-1c. Staff Nurse 7 03 7 03d. Nurse/Midwife Nil 02

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2.11 Dresser 1 Nil 1 02; 02 Chief2.12 Pharmacist/

Compounder1 01 1 01

2.13 Lab. Technician 1 01 1 012.14 Radiographer 1 01 12.15 Ophthalmic Assistant 1 Nil 1 Yes2.16 Ward boys/nursing

orderly2 01 2 02

2.17 Sweepers 3 attachment 3 032.18 Chowkidar 1 01 1 022.19 OPD Attendant 1 Nil 1 Nil2.20 Statistical Assistant /

Data Entry Operator1 Nil 1 Nil

2.21 OT Attendant 1 Nil 1 Nil2.22 Registration Clerk 1 Nil 1 Yes2.23 Any other staff

(specify)1 Nil 1 Nil

[C] Training of MOs during previous (full) yearS. No. Personnel PINDARA BLOCK CHOLAPUR BLOCK

No. of MOs trained No. of MOs trained

2.24 Available training in

a. Sterilization Nil Yes

b. IUD Insertions Nil Yes

c. Emergencycontraception

Nil Yes

d. RTI/STI, HIV/AIDS Nil Yes

e. Newborn care Nil Scheduled for next month

f. Emergency obstetriccare

Nil Yes

g. Other subjects (mention) Blood Bank, IMNCI

3. Investigative Facilities

S. No. IPHS NormPINDARA BLOCK CHOLAPUR BLOCK

CurrentAvailabilityat CHC

Remarks /Suggestions /Identified Gaps


Remarks /Suggestions /Identified Gaps

3.1 Availability of ECG facilities(Yes/ No)

No No

3.2 X-Ray facility (Yes /No)

Notfunctional

Yes

3.3 Ultrasound facility (Yes / No) No No3.4 Appropriate training to a

nursing staff on ECG (Yes /No)

No No

3.5 Lab test facilities (specifykind of tests done)

Sputum smearpreparation

DOTs, RTI /STI

3.6 Any lab test / diagnostic testoutsourced to private lab/hospital (please specify thetest)

No No

3.7 All necessary reagents,glassware and facilities forcollection and transportationof samples (Yes / No)

Only forDOTS

No

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4. Physical Infrastructure (As per specifications)S. No. PINDARA BLOCK CHOLAPUR BLOCK


Ifavailable,area inSq.mts.)

Remarks /Suggestions/IdentifiedGaps


Ifavailable,area inSq.mts.)

Remarks /Suggestions /IdentifiedGaps

4.1 Where is this CHClocated?

a. Within village locality Yes Yesb. Far from village

localityc. If far from locality

specify in km4.2 Building

a. Is a designatedGovernment buildingavailable for the CHC?

Yes Yes

b. If there is nodesignated Governmentbuilding, then wheredoes the CHC locatedRental premisesOther GovernmentbuildingAny other specify

c. Area of the building(Total area in sq. mts)

d. What is the presentstage of construction ofthe building

Constructioncomplete

Yes Yes

Constructionincomplete

e. Compound Wall/Fencing (1-All around;2-Partial; 3-None)

2 1

f. Condition of plaster onwalls (1- Wellplastered with plasterintact everywhere; 2-Plaster coming off insome places;3-Plaster coming off inmany places or noplaster)

1 Yes

g. Condition of floor: (1-Floor in goodcondition; 2- Floorcoming off in someplaces; 3- Floor comingoff in many places orno proper flooring)

1 Yes

h. Whether the cleanlinessis Good / Fair/Poor?(Observe)

Fair Fair

OPD

OT

Rooms

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Wards

Toilets

Premises(compound)

i. Are any of thefollowing close to thehospital? (Observe)(Yes/No)

Garbage dump No No

Cattle-shed No No

Stagnant pool Yes No

Pollution fromindustry

No No

4.3 Location

a. Whether located at lessthan 2 hours of traveldistance fromthe farthest village?(Yes/No)

Yes Rajwari 25 km 1 hr

b. Whether the districtheadquarter hospitallocated at a distanceof less than 4 hourstravel time? (Yes/No)

Yes Yes 20 km

c. Feasibility to hold theworkforce (e.g.availability of degreecollege, railway station,municipality,industrial/mining belt)(Yes/No) (specify)

Yes Yes

4.4 Availability of PrivateSector Health Facilityin the area

a. Privatelaboratory/hospital/Nursing Home(Yes/No)

Yes No

b. Charitable Hospital(Yes/No) (specify)

Yes No

c. Hospital run by NGO(Yes/No)

Yes

4.5 Prominent displayboards in locallanguage/Charter ofPatient Rights(Yes/No)

No

4.6 Registration Counter(Yes/ No)

No No

4.7 a. Pharmacy for drugdispensing and drugstorage (Yes/No)

Yes Yes

b. Counter near entranceof hospital to obtaincontraceptives, ORSpackets, Vitamin Aand Vaccination(Yes/No)

No Yes

4.8 Separate public utilitiesfor males and females(Yes/No)

Yes Yes

4.9 Suggestion/complaintbox (Yes/No)

No Yes

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4.10 OPD rooms/cubicles(Yes/No) (Givenumbers)

Yes Yes

4.11 Adequate no. ofwindows in the roomfor light and air in eachroom (Yes/No)

Yes Yes

4.12 Family Welfare Clinic(Yes/No)

No Yes

4.13 Waiting room forpatients (Yes/No)

Yes Yes

4.14 Emergency roomCausality (Yes/No)

Yes Yes

4.15 Separate ward forMale/Female(Yes/ No)

Yes Yes

4.16 No. of Bed Males 15 15

4.17 No. of Beds Females 15 15

4.18 Operation Theatre

a. Operation Theatreavailable (Yes/No)

Yes Yes

b. If operation theatre ispresent, are surgeriescarried out in theoperation theatre?Yes Yes

No No

Some times

c. If operation theatre ispresent, but surgeriesare not beingconducted there, thenwhat are the reasons forthe same?Non-availability ofdoctors/anaesthetist/staff

Yes

Lack of equipment/poor physical state ofthe operation

Yes

No power supply in theoperation theatre

Yes

Any other reason(specify)

d. Operation Theatre usedfor obstetric/gynaecological purpose(Yes/No)

No Yes

e. Has OT enough space(Yes/No)

Yes Yes

f. Is OT fitted with airconditioner?(Yes/No)

No Yes

g. Is the air-conditionerworking? (Yes/No)

Yes

h. Is generator availablefor OT? (Yes/No)

No Yes

i. Is emergency lightavailable in OT?(Yes/No)

No Yes

j. Is fumigation doneregularly? (Yes/No)

No No

k. Is the days ofsterilization in a week

No No

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displayed on the publicnotice on OT?(Yes/No)

4.19 Operation TheatreEquipmentBoyles apparatus No No

EMO Machine No No

Cardiac Monitor forOT

No No

Defibrillator for OT No No

Ventilator for OT No No

Horizontal HighPressure Sterilizer

No No

Vertical High Pressuresterilizer 2/3 drumcapacity

No No

Shadowless lampceiling trak mounted

No Yes

Shadowless lamppedestal for minor OT

Yes 02

OT care/fumigationapparatus

No No

Gloves and dustingmachines

No

Oxygen cylinder 660ltrs 10 cylinders for 1Boyles Apparatus

No

Nitrous Oxide Cylinder1780 ltr. 8 for oneBoyles Apparatus

No

Hydraulic OperationTable

No

4.20 Labour room Yes

a. Labour room available?(Yes/ No)

Yes

b. If labour room ispresent, are deliveriescarried out in thelabour room?Yes Yes

No No

Sometimes

c. If labour room ispresent, but deliveriesare not beingconducted there, thenwhat are the reasons forthe same?

Non-availability ofdoctors/staff

Yes

Seepage in the labourroomNo power supply in thelabour roomAny other reason(specify)

4.21 X-ray room with darkroom facility (Yes/No)

Notfunctional

Yes

4.22 Laboratory Yes

a. Laboratory (Yes/No) Yes

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b. Are adequateequipment andchemicals available?(Yes/No)

No

c. Is laboratorymaintained in orderlymanner? (Yes/No)

No

4.23 Cold Chain

a. Walk-in coolers(Yes/No)

No

b. Walk-in freezersavailable (Yes/No)

No

c. Icelined freezers(Yes/No)

No Yes,03

d. Deep freezers(Yes/No)

No Yes,02

e. Refrigerators(Yes / No)

No

4.24 Blood Storage Unit No

a. Blood Storage Unitavailable(Yes/No)

No No

b. Is the CHC havinglinkage with districtblood bank? (Yes/No)

No Yes

c. Is regular blood supplyavailable? (Yes/No)

No

4.25 Ancillary Rooms -Nurses rest room(Yes/No)

4.26 Water Supply Yes

a. Source of water (1-Piped; 2- Bore well/hand pump / tubewell; 3- Well; 4- Other(specify))

2 Yes

b. Whether overhead tankand pump exist(Yes/No)

Yes Yes

c. If overhead tank exist,whether its capacitysufficient?(Yes/No)

Yes

d. If pump exist, whetherit is in workingcondition? (Yes/No)

Yes Yes

4.27 Sewerage

Type of seweragesystem ( 1- Soak pit; 2-Connected toMunicipal Sewerage)

1

4.28 Waste disposal

a. Is there anyincinerator? (Yes/No)

No No

b. If yes, type (1- electric;2- Other (specify)

c. If no, how the medicalwaste disposed off?

Burialandburning

4.29 Electricity Yes

a. Is there electric line inall parts of thehospital? (1- In allparts;2- In some parts; 3-None)

2

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b. Regular Power Supply(1- Continuous PowerSupply; 2-Occasional powerfailure; 3- Power cutsin summer only; 4-Regular power cuts; 5-No power supply

4 (only 4 to 6hrs powersupply)

c. Standby facility(generator) available(Yes/No)

No Yes 1-2 hour

4.30 Laundry facilities:

a. Laundry facilityavailable (Yes/No)

No No

b. If no, is it outsourced? No Yes

4.31 Communicationfacilities

a. Telephone (Yes/No) No No

b. Number of differenttelephone linesavailable

c. Personal Computer(Yes/No)

d. NIC Terminal(Yes/No)

e. E-Mail (Yes / No)

f. Is CHC accessible by

i. Rail (Yes/No)

ii. All whether road(Yes/No)

Yes

iii. Others (specify)

4.32 Vehicles No

a. If running

Ambulance Yes

Jeep Yes

Car

b. If vehicle is notrunningAmbulance

Jeep

Car

4.33 Office Room (Yes/No) Yes Yes

4.34 Store Room (Yes/No) Yes Yes

4.35 Kitchen (Yes/No) No No

4.36 Diet:

a. Diet provided byhospital (Yes/No)

No

b. If no, how diet isprovided to the indoorpatients?

4.37 Residential facility forthe staff with livingcondition

Notsufficient

No

General Surgeon No

Physician No

63 | P a g e

Obstetrician /Gynaecologist

No

Paediatrics No

Anaesthetist No

General Duty MedicalOfficer

No

Public HealthProgramme Manager

No

Eye Surgeon Yes No

Public Health Nurse No No

ANM No Yes

Staff Nurse Yes

Nurse/Midwife No Yes

Dresser No

Pharmacist/compounder

No Yes

Lab. Technician Yes Yes

Radiographer Yes Yes

Ophthalmic Assistant Yes

Ward boys/nursingorderly

Yes Yes

Sweepers Yes Yes

Chowkidar Yes

OPD Attendant No No

Statistical Assistant/Data Entry Operator

No Yes

OT Attendant No No

Ambulance driver No Yes

Registration Clerk No No

4.38 Accommodationfacility for families ofadmitted patients

a. Facility for stayavailable (Yes/No)

No

b. Attached toiletavailable (Yes/No)

No

c. Cooking facilityavailable (Yes/No)

No

4.39

a. Is the CHC open foroutpatient services forthe stipulated OPDtime?

Yes Yes

Yes, on all daysexcepting designatedholidaysNo, it always closesbefore timeOnly on some days itfunctions for thestipulated time

b. If yes, specifystipulated OPD hours

( 8AM-2PM)summers,(10am-5pm) inwinters

( 8AM-2PM)summers,(10am-5pm) in

winters

64 | P a g e

4.40 In cases where a patientneeds to be admittedfor inpatientYes, patients who canbe managed at CHC arealways admitted

Yes

Some deservingpatients are notadmitted but arereferred toother facilities

Yes

Patients usually refusedadmission

4.41 Does the CHC providetreatment to emergencypatients/victims ofaccident medicalemergencies etc) at anytime of the day/ night?

Yes

Emergency patients aregiven treatment. Wherenecessary, they arereferred higher levelGovernment hospitalEmergency patients areoften not treated,referred to a publichealth care facility

Yes Yes

Emergency patients areoften not treated,referred to a privatehealth care facility

4.42 If referred to a higher-level health carefacility, how is thepatient taken there?

Yes

Free transport byhospital ambulanceBy hospital ambulance,but fuel and othercharges have to bepaid by the patientPrivate/personalconveyance

Yes

4.43 Behavioural Aspects

a. How is the behaviourof the CHC staff withthe patient ?Courteous Yes Yes

Casual/indifferent

Insulting/derogatory

b. Is there corruption interms of charging extramoney for any of theservice provided?(Yes/No)

No No

c. Is a receipt alwaysgiven for the moneycharged at the CHC?(Yes/No)

Yes Yes

d. Is there any incidence of anysexual advances oral or physicalabuse, sexual harassment by thedoctors or any otherparamedical? (Yes/No)

NoNo

65 | P a g e

e. Are woman patients interviewedin an environment thatensures privacy and dignity?(Yes/No)

Yes Yes

f. Are examinations on womanpatients conducted in presenceof a woman attendant, andprocedures conducted underconditions that ensure privacy?(Yes/No)

Yes Yes

g. Do patients with chronicillnesses receive adequate careand drugs for the entireduration? (Yes/No)

Yes Yes

h. If the health centre isunequipped to provide theservices needed, are patientstransferred immediately withoutdelay, with all the relevantpapers, to a site where thedesired service is available?(Yes/No)

Yes Yes

I. Is there a publicly displayedmechanism, whereby acomplaint/ grievance can beregistered? (Yes/No)

No RKS

5. Furniture

S. No

Item

PINDARA BLOCK CHOLAPUR BLOCKCurrent

availabilityat CHC

If availablenumber

Remarks/Suggestion/IdentifiedGaps

Currentavailability

at CHC

If availablenumber


5.1 Examination table Yes 05 Yes

5.2 Delivery table Yes 03 Yes

5.3 Footstep Yes 06 Yes

5.4 Bed side screen Yes 06 Yes

5.5 Stool for patients Yes 08 Yes

5.6 Arm bed for adultand child

No No

5.7 Saline stand Yes I3 Yes

5.8 Wheel chair No Yes

5.9 Stretcher on trolley Yes 01 Yes

5.10 Oxygen trolley Yes 08 Yes

5.11 Height measuringstand

No No

5.12 Iron bed Yes 27 Yes

5.13 Bed side locker Yes 30 Yes

5.14 Dressing trolley Yes No

5.15 Mayo trolley No No

5.16 Instrument trolley Yes 01 No

5.17 Instrument cabinet No Yes

5.18 Bucket Yes Yes

5.19 Attendant stool Yes 15 Yes

5.20 Instrument tray Yes 02 Yes

66 | P a g e

5.21 Chair Yes 38 Yes

5.22 Wooden table Yes 03 Yes

5.23 Almirah Yes O4 Yes

5.24 Swab rack Yes

5.25 Mattress Yes 27 Yes

5.26 Pilow Yes 27 Yes

5.27 Waiting bench forpatient/attendants

Yes 03 No

5.28 Medicine cabinet No Yes

5.29 Side rail No

5.30 Rack Yes No

5.31 Bed side attendantchair

No No

6. Quality Control

S. No.Particular

PINDARA BLOCK CHOLAPUR BLOCKWhether functional/available as pernorms

RemarksWhetherfunctional /available as pernorms

Remarks

6.1 Citizen's charter (Yes/No) No No6.2 Constitution of Rogi Kalyan

Samiti (Yes/No) (give a list ofoffice order notifying themembers)

Yes Yes

6.3 Internal monitoring (Social auditthrough Panchayati RajInstitution/Rogi Kalyan Samitis,Medical audit, Technical audit,Economic audit, Disasterpreparedness audit etc. (Specify)

Yes Yes

6.4 External monitoring (Gradationby PRI (Zila Parishad)/RogiKalyan Samitis

Yes Yes

6.5 Availability of StandardOperating Procedures(SOP)/Standard TreatmentProtocols (STP)/Guidelines(Please provide a list)

NoNo

67 | P a g e

OBSERVATIONS FOR TWO PHCs

Name of the State : UTTAR PRADESHDistrict : VARANASIIs the PHC providing 24 hours and 7 days delivery facilities

1. ServicesS.No. PINDARA PHC DANGANJ PHC

1.1 Population covered (in numbers) 252946

1.2 Assured services available (Yes/No)

q. OPD services Yes Yesr. Emergency services (24 hrs) Yess. Referral services Get referral Self or through CHC

vehiclet. In-patients services Yes Yes

1.3a. Number of beds available 4 2b. Bed Occupancy Rate in the last 12 months (1 -

Less than 40%; 2 - 40-60%; 3 - More than 60%)

3

1.4 Average daily OPD attendance 200 80 - 100

a. Male 35 % 50%b. Female 65% 50%

1.5 Treatment of specific cases (Yes/ No)

a. Is surgery for cataract done in the PHC? No No

b. Is the primary management of wounds done atthe PHC?

Yes Yes

c. Is the primary management of fracture done atthe PHC?

Yes Yes

d. Are minor surgeries like draining of abscess etcdone at the PHC?

Yes Yes

e. Is the primary management of cases of

poisoning/snake, insect or scorpion bite done atthe PHC?

Yes No

f. Is the primary management of burns done atPHC?

Yes No

1.6 MCH Care including family planning

1.6.1 Service availability (Yes / No)

a. Ante-natal care Yes Yes

b. Intranatal care (24 hours delivery services bothnormal and assisted)

Yes Yes

c. Post-natal care Yes Yes

d. New born Care No No

e. Child care including immunization Yes Yes

f. Family Planning Yes No

g. MTP No No

h. Management of RTI/STI Yes Yes

i. Facilities under Janani Suraksha Yojana Yes Yes

S.No. PINDARA PHC DANGANJ PHC1.6.2 1.6.2. Availability of specific services

(Yes/No)a. Are antenatal clinics organized by the PHC

regularly?Yes Yes

b. Is the facility for normal delivery available inthe PHC for 24 hours?

Yes Yes

68 | P a g e

c. Is the facility for tubectomy and vasectomyavailable at the PHC?

Yes No

d. Is the facility for internal examination forgynaecological conditions available at the PHC?

Yes Yes

e. Is the treatment for gynaecological disorders likeleucorrhoea, menstrual disorders available at thePHC?

Yes Yes

f. If women do not usually go to the PHC, thenwhat is the reason behind it?

g. Is the facility for MTP (abortion) available atthe PHC?

No No

h. Is there any precondition for doing MTP suchas enforced use of contraceptives after MTP orasking for husband's consent for MTP?

NA NA

i. Do women have to pay for MTP? NA NA

j. Is treatment for anaemia given to both pregnantas well as non-pregnant women?

Yes Yes

k. Are the low birth weight babies managed at thePHC?

No( referred) No

l. Is there a fixed immunization day? Yes Yesm. Is BCG and Measles vaccine given regularly at

the PHC?Yes Yes

n. How is the vaccine received at PHC anddistributed to sub-centres?

On every immunizationday

from CHC Cholapur on theday of immunizationvaccine box and distributedto sub-centres

o. Is the treatment of children with p neumoniaavailable at the PHC?

Yes Yes

p. Is the management of children suffering fromdiarrhoea with severe dehydration done at thePHC?

Yes Yes

1.7 Other functions and services performed(Yes/No)

a. Nutrition services Through ICDS through ICDS

b. School health programmes Yes Yes(13 school)primary+middle

c. Promotion of safe water supply and basicsanitation

India Mark-II No

d. Prevention and control of locally endemicdiseases

Filarial survey Yes

e. Disease surveillance and control of epidemics Yes Yes

f. Collection and reporting of vital statistics Yes No

g. Education about health/behaviour changecommunication

Sanitation, Hygiene,Epidemic control

No

h. National Health Programmes includingHIV/AIDS control programmes

Yes No (All through Cholapurblock)

i. AYUSH services as per local preference Ayurvedic No

j. Rehabilitation services (please specify) Referred to Districthospital

No

1.8 Monitoring and Supervision activities(Yes/No)

All activities are carriedout through CHC

a. Monitoring and supervision of activities of sub -centres through regular meetings/periodic visits,etc

Yes, monthly meeting onlast Saturday. Tuesdaymeeting sector Supervisor

b. Monitoring of National Health Programmes Yes No

c. Monitoring activities of ASHAs Yes Yes

d. Visits of Medical Officer to all sub -centres atleast once in a month

Yes Yes

e. Visits of Health Assistants (Male) and LHV tosub-centres once a week

Yes No LHV ( LHV Cholapurvisit)

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2. Manpower

S.No

PersonalPINDARA PHC DANGANJ PHC

ExistingPattern

RecommendedCurrentAvailabilityat CHC(indicateNumber)


ExistingPattern

RecommendedCurrentAvailabi-lity atCHC(indicateNumber)

RemarksSuggestion/ IdentifiedGaps

2.1 Medical Officer 1 2 (one may be

from AYUSH

and one otherMedical Officerpreferably a

Lady Doctor)

2MBBS,DCH

1 2 (one may be

from AYUSH

and one otherMedical Officerpreferably a

Lady Doctor)

1

2.2 Pharmacist 1 1 1 1 1 1

2.3 Nurse - Midwife(Staff Nurse)

1 3 (for 24 hour

PHCs; 2 maybecontractual))

2 1 3 (for 24 hour

PHCs; 2 may becontractual))

0

2.4 Health Worker(Female)

1 1 523 ANM + 1HV

1 1 1

2.5 Health Educator 1 1 1 1 1 0

2.6 Health Assistant(One male and Onefemale

2 2 3 (Male) 2 2 0

2.7 Clerks 2 2 1 2 2 0

2.8 LaboratoryTechnician

1 1 1 1 1 1

2.9 Driver 1 Optional;

vehicles may beoutsourced

1 1 Optional;

vehicles may beout-sourced

0

2.10 Class IV 4 4 6 4 4 2

Total 15 17/18 15 17/18

3. Training of MOs During Previous (full) Year

S. No. Available Training for PINDARA PHC DANGANJ PHCNo. trained No. trained

a. Traditional birth attendants NO

No

No

Yes

b. Health Worker (Female) Yes

c. Health Worker (Male) Yes

d. Medical Officer No Training in Leprosy

e. Initial and periodic training of paramedics intreatment of minor ailments

f. Training of ASHAs 221

g. Periodic training of doctors through continuing Medical Education,conferences, skill development training etc. on emergencyobstetric care

Leprosy at DistrictHospital

h. Training of Health Workers in ante -natal careand skilled birth attendance

52 Yes

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4. Essential Laboratory Services

S. No. PINDARA PHC DANGANJ PHCCurrentAvailabilityat

PHC


CurrentAvailabilityat

PHC


4.1 Routine urine, stool and blood tests yes No

4.2 Blood grouping No No

4.3 Bleeding time, clotting time yes No

4.4 Diagnosis of RTI/STI with wet mounting, gr ams stain , etc. No No

4.5 Sputum testing for TB Yes Yes

4.6 Blood smear examination for malaria parasite Yes Yes

4.7 Rapid tests for pregnancy Yes (Nischayakit)

No

4.8 RPR Test for Syphilis/YAWS surveillance No No

4.9 Rapid tests for HIV No No

4.10 Others (specify) No No

5. Physical Infrastructure (as per Specifications)

S. NoPINDARA PHC DANGANJ PHC

CurrentAvailability atPHC

Ifavailable, are inSq.mts.)

Remarks/Suggestions /IdentifiedGaps

CurrentAvailabilityat PHC

Ifavailable,are in Sq.mts.)

Remarks/Suggestions /IdentifiedGaps

5.1 Where is this PHC located?

a. Within village locality Roadside(with in11/2km)

Yes

b. Far from village locality

c. If far from locality specify in km ½ KM

5.2 Building

a. Is a designated government building availablefor the PHC?

Yes Yes

b. If there is no designated government building,then where does the PHC located- Rented premises

- Other governmentbuilding

- Any other (specify)

c. Area of the building (Total area in sq. mts.) 6 bissa

d. What is the present stage of construction of thebuildingsConstruction complete Yes Yes

Construction incomplete

e. Compound Wall/Fencing (1-All around; 2-Partial; 3-None)

1 3

f. Condition of plaster on walls (1 - Well plasteredwith plaster intact every where; 2 - Plaster

Yes

71 | P a g e

coming off in some places; 3-Plaster coming offin many places or no plaster)

g. Condition of floor (1- Floor in good condition;2- Floor coming off in some places; 3 - Floorcoming off in many places or no proper flooring)

1

h. Whether the cleanliness is Good/Fair/Poor?(Observe) OPD Fair Good

Rooms Fair Good

Wards Fair Fair

Toilets Poor Fair

Premises (compound) Fair Good

i. Are any of the following close to the PHC?(Observe) (Yes/No) Garbage dump No Yes

Cattle-shed No No

Stagnant pool No Yes

Pollution from industry No No

j. Is boundary wall with gate existing? (Yes/No) Yes No

5.3 Location

a. Whether located at an easily accessible area?(Yes/No)

Yes Yes

b. Distance of PHC (in Kms.) from the farthestvillage in coverage area

10 km 1 km

c. Travel time (in minutes) to reach the PHC fromfarthest village in coverage area

½ Hr. 1 hr bycycle

d. Distance of PHC (in Kms.) from the CHC 10 KM 6 km

e. Distance of PHC (in Kms.) from DistrictHospital

29 KM 26 km

5.4 Prominent display boards regarding serviceavailability in locallanguage (Yes/No)

No Yes

5.5 Registration counters (Yes/No) Yes Yes

5.6 Yes

a. Pharmacy for drug dispensing and drug storage(Yes/No)

Yes Yes

b. Counter near entrance of PHC to ob taincontraceptives, ORS packets, Vitamin A andVaccination (Yes/No)

Yes No

5.7 Separate public utilities for males and females(Yes/No)

No No

5.8 Suggestion / complaint box (Yes/No) Yes No

5.9 OPD rooms / cubicles (Yes/No) (Give numbers) Yes 6 rooms

5.10 Adequate no. of windows in the room for lightand air in eachroom (Yes/No)

Yes Yes

5.11 Family Welfare Clinic (Yes/No)

5.12 Waiting room for patients (Yes/No) Yes

5.13 Emergency Room / Casualty (Yes/No) No No

5.14 Separate wards for males and females (Yes/No) Yes No

5.15 No. of beds : Male 02 2 Beds

5.16 No. of beds : Female 02

5.17 Operation Theatre (if exists) Yes

72 | P a g e

a. Operation Theatre available (Yes/No) Yes Yes

b. If operation theatre is present, are surgeriescarried out in the operation theatre? Yes

No No No

Sometimes

c. If operation theatre is present, but surgeries arenot being conducted there, then what are thereasons for the sameNon-availability of doctors/staff Yes Yes

Lack of equipment/poor physical state of theoperation theatre

Yes

No power supply in operation theatre With inlimit

d. Operation theatre used forObstetric/Gynecological theatre

Yes No

e. Has OT enough space? (Yes/ No.) Yes Yes

5.18 Labour room

a. Labour room available (Yes/ No) Yes Yes

b. If labour room is present, are deliveries carried out inthe labour room?Yes Yes

No No

Sometimes

c. If operation theatre is present, but surgeries arenot being conducted there, then what are thereasons for the same?Non-availability of doctors/staff Yes Yes

Lack of equipment / poor physical state of theoperationNo power supply in the operation theatre

Any other reason (specify)

d. Is separate areas for septic and aseptic deliveriesavailable (Yes/No)

No

5.19 Laboratory

a. Laboratory (Yes/No) Yes

b. Are adequate equipment and chemicalsavailable? (Yes/No)

Yes Yes

c. Is laboratory maintained in orderly manner?(Yes/No)

Yes

5.20 Ancillary Rooms- Nurses rest room (Yes/ No) Yes Yes

5.21 Water supply

a. Source of water (1- Piped; 2- Borewell/handpump / tube well; 3- Well; 4- Other(specify))

1 1 and 2

b. Whether overhead tank and pump exist (Yes/No) Yes No

c. If overhead tank exist, whether its capacitysufficient?(Yes/No)

Yes Yes

d. If pump exist, whether it is in workingcondition? (Yes/No)

Yes Yes

5.22 Sewerage

Type of sewerage system (1- Soak pit; 2-Connected to Municipal Sewerage)

1(septictank)

1(septictank)

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5.23 Waste disposal

How the waste material is being disposed(please specify)

Burningandburial

Burningand burial---

5.24 Electricity

Is there electric line in all parts of the hospital?(1- In all parts; 2- In some parts; 3- None)

1 3

Regular power supply (1- continuous powerSupply; 2- Occasional power failure; 3- Powercuts in summer only; 4-Regular power cuts; 5-No power supply

4 2

Standby facility (generator) available (Yes/No) No Yes

5.25 Laundry facilities:

Laundry facility available(Yes/No) No No

If No, is it outsourced? No No

5.26 Communication facilities:

a. Telephone (Yes/No) Yes No

b. Number of different Telephone lines available No No

c. Personal Computer (Yes/No) No No

d. NIC Terminal (Yes/No) No No

e. E.Mail (Yes / No) No No

f. Is CHC accessible by No No

i. Rail (Yes/No) No No

ii. All whether road (Yes/No) Yes

iii. Others (specify)

5.27 Vehicles Yes No

a. If running Yes

Ambulance No

Jeep Yes(Bolero)

Car No

b. If vehicle is not running

Ambulance

Jeep

Car

5.28 Office Room (Yes/No) Yes Yes

5.29 Store Room (Yes/No) Yes Yes

5.30 Kitchen (Yes/No) No No

5.31 Diet:

a. Diet provided by hospital (Yes /No) No

b. If no, how diet is provided to the indoorpatients?

Self

5.32 Residential facility for the staff with living condition

Medical Officer Yes

Pharmacist Yes

Nurses Yes

Other staff Yes

74 | P a g e

5.33 Behavioural Aspects

a. How is the behaviour of the CHC staff with thepatient?Courteous Yes Yes

Casual/indifferent

Insulting/derogatory

b. Any fee for service is charged from the uses?(Yes/No) If Yes, specify

Yes forRegis-tration

Yes forRegis-tration

c. Is there corruption in terms of charging extramoney for any of the service provided?(Yes/No)

No No

d. Is a receipt always given for the money chargedat the CHC?(Yes/No)

No No

e. Is there any incidence of any sexual advances.oral or physical abuse, sexual harassment by thedoctors or any otherparamedical? (Yes/No)

No No

f. Are woman patients interviewed in anenvironment that ensures privacy and dignity ?(Yes/No)

Yes Yes

g. Are examinations on woman patients conductedin presence of a woman attendant, andprocedures conducted under conditions thatensure privacy? (Yes/No)

YesYes

h. Do patients with chronic illness receive adequatecare and drugs for the entire duration? (Yes/No)

No No

i. If the health centre is unequipped to provide theservices how and where the patient is referredand how patients transported?

SelfTransport

SelfTransport

j. Is there a publicity displayed mechanism,whereby a complaint/ grievance can beregistered (Yes/No)

Yes No

k. Is there an outbreak of any of the followingdiseases in the PHC in the last three years? Malaria No No

Measles No No

Gastroenteritis Yes Yes

Jaundice No No

l. If Yes. Did the PHC staff respondedimmediately to stop the further spread of theepidment

Yes Yes

m. Does the doctor do private practice during orafter the duty hours ? (Yes/No)

No No

n. Are there instances where patients fromparticular social background dalits, minorities,villagers) have faced derogatory ordiscriminatory behaviour or service of poorerquality (Yes/No)

No No

o. Have patients with specific health problems(HIV/AIDS, leprosy suffered discrimination inany form? (Yes/No)

No No

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6. Furniture

S. No

Item

PINDARA BLOCK CHOLAPUR BLOCKCurrent

availabilityat CHC

Ifavailablenumber


Currentavailability

at CHC

If availablenumber


6.1 Examination table Yes 1

6.2 Delivery table Yes 2

6.3 Footstep Yes

6.4 Bed side screen Yes

6.5 Stool for patients Yes 2

6.6 Arm bed for adult and child No No

6.7 Saline stand Yes 1

6.8 Wheel chair Yes 1

6.9 Stretcher on trolley Yes No

6.10 Oxygen trolley Yes 1

6.11 Height measuring stand Yes No

6.12 Iron bed Yes 2

6.13 Bed side locker Yes No

6.14 Dressing trolley Yes No

6.15 Mayo trolley Yes No

6.16 Instrument trolley No No

6.17 Instrument cabinet Yes No

6.18 Bucket Yes 3

6.19 Attendant stool Yes 2

6.20 Instrument tray Yes No

6.21 Chair Yes 22

6.22 Wooden table Yes 3

6.23 Almirah Yes 4

6.24 Swab rack Yes 1

6.25 Mattress Yes 2

6.26 Pillow Yes 1

6.27 Waiting Bench forpatient/attendants

Yes No

6.28 Medicine cabinet Yes 1

6.29 Side Rail No No

6.30 Rack Yes No

6.31 Bed side attendant chair Yes 1

632 Others -- ---

76 | P a g e

7. Quality Control

PINDARA BLOCK CHOLAPUR BLOCKSl.No.

Particular Whether functional/available as per norms

Remarks Whether functional /available as per norms

Remarks

7.1 Citizen's charter (Yes/No) No No7.2 Constitution of Rogi Kalyan Samiti

(Yes/No) (give a list of office ordernotifying the members)

Yes No

7.3 Internal monitoring (Social audit throughPanchayati Raj Institution/ Rogi KalyanSamitis, medical audit, technical audit,economic audit,disaster preparedness audit etc. (Specify)

No

RKS of Cholapur

7.4 External monitoring (Gradation by PRI(ZilaParishad)/Rogi Kalyan Samitis

DMPURKS of Cholapur

7.5 Availability of Standard OperatingProcedures(SOP)/Standard Treatment Protocols(STP)/ Guidelines (Please provide a list)

NoNo

77 | P a g e

OBSERVATIONS FOR TWO SUB-CENTRES

Name of the State : UTTAR PRADESHDistrict : VARANASI

1. Services

S.No. PINDARABLOCK

CHOLAPURBLOCK

Sub-Centre PHULPUR RUPCHANDPUR

1.1 Population covered (in numbers) 7000 4500

1.2 MCH Care including Family Planning

1.2.1 Service availability (Yes/No)u. Ante-natal care Yes Yesv. Intranatal care Yes Yesw. Post-natal care Yes Yesx. Newborn Care Yes Noy. Child care including immunization Yes Yesz. Family planning and contraception Yes Yesaa. Adolescent health care Yes Yesbb. Assistance to school health services Yes Yescc. Facilities under Janani Suraksha Yojana Yes Yesdd. Treatment of minor ailments Yes Yesee. First aid (specify) Yes Yes

1.2.2 Availability of specific services (Yes/No) Yesa. Does the doctor visit the sub-centre at least once in a month? Yes Yesb. Is the day and time of this visit fixed? No Noc. Are the residents of the village aware of the timings of the

doctor's visit?No No

d. Does the Health Assistant (male) or LHV visit the sub-centreat least once a week?

Once in amonth

Yes

e. Is the Antenatal care (Inj. T.T, IFA tablets, weight and BPcheck-up) provided by those in the Sub-centre?

Yes Yes

f. Is the facility for referral of complicated cases of pregnancy/delivery available at Sub-centre for 24 hours?

Yes Yes

g. Does the ANM/any trained personnel accompany the womanin labour to the referred

Yes Yes

h. Are the immunization services as per Government scheduleprovided by the sub-centre

Yes Yes

i. Is the ORS for prevention of diarrh oea and dehydrationavailable in the sub-centre?

Yes Yes

j. Is the treatment of minor illness like fever, cough, cold,worm disinfestations etc. available in the sub-centre

Yes Yes

k. Is the facility for taking peripheral blood smear in case offever for detection available in the sub-centre?

Yes No

l. Are the contraceptive services like insertion of Copper -T,distributing oral contraceptive pills or condoms provided bythe sub-centre?

Yes Yes

m. Is it a DOT centre? No Yes1.3 Other functions and services performed (Yes /No) Yes

a. Disease surveillance Yes Yesb. Control of local endemic diseases Yes Yesc. Promotion of sanitation Yes Yesd. Field visits and home care Yes Every Mondaye. National Health Programmes including HIV/AIDS control

programmesYes Yes

1.4 Monitoring and Supervision activities (Yes / No) Yes Yesa. Training of traditional birth attendants and ASHA Yes 02, 02b. Monitoring of water quality in the village No Yes

78 | P a g e

c. Watch over unusual health events Yes Yesd. Coordinated services with AWWs, ASHA, Village Health

and Sanitation Committee, PRIsYes Yes

e. Coordination and supervision of activities of ASHA Yes Yesf. Proper maintenance of records and register Yes Yesg. Is there a Village Health Plan/ sub-centre Plan? No Yesh. Is the scheme of ASHA implemented in sub-centre? Yes Yes

2. Manpower

S. No. Personal PINDARA BLOCK CHOLAPUR BLOCKPHULPUR Sub-Center RUPCHANDPUR Sub-Center

Existing CurrentAvailabilityat Sub-centre(indicateNumber)


Existing CurrentAvailability atSub-centre(indicateNumber)


2.1 Health Worker(Female)[Recommended 1 or 2 ]optional

1 1 01

2.2 Health Worker (Male)[Recommended 1 or 0Optional may bereplaced by femalehealth workers]

1 1 BSW

2.3 Voluntary worker tokeep the sub-centreclean and assistingANM. She is paid bythe ANM from hercontingency fund @Rs. 100 per month[Recommended 1optional]

1(optional)

NILYes

3. Physical Infrastructure (as per Specifications)

S. No. PINDARA BLOCK CHOLAPUR BLOCKPHULPUR Sub-Center RUPCHANDPUR Sub-Center

CurrentAvailabilityat sub-centre

IfAvailablearea in sqmt.)


CurrentAvailability at Sub-centre

IfAvailabilearea in sqmt.)

RemarksSuggestio/IdentifiedGaps

3.1 Locationa. Where is this sub-centre

located?Yes

Within village locality Yes YesFar from village locality YesIf far from locality specifyin km

Yes

b. Whether located at an easilyaccessible area? (Yes/No)

Yes

c. The distance of sub-centre (inkms.) from the remotestvillage in the coverage area.

2 km2 km

d. Travel time to reach the sub-centre from the remote placein the coverage area.

e. The distance of sub-centre (inkms.) from the PHC

5 km Danganj 6km

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f. The distance of Sub-centre (inkms.) from the CHC

10 km 12 km

3.2 Building Yes

a. Is a designated governmentbuilding available for the sub-centre? (Yes/No)

No

b. If there is no designatedGovernment building, thenwhere does the sub-centrelocatedRented premises Yes

Other Government building

Any other specifyc. Area of the building (Total

area in sq. mts.)Yes

d. What is the presentcondition of the existingbuilding

e. What is the present stage ofconstruction of the building YesConstruction complete

Construction incomplete Yes Yesf. Compound Wall / Fencing (1-

All around; 2-Partial; 3-None)g. Condition of plaster on walls

(1- Well plastered with plasterintact every where; 2- Plastercoming off in some places; 3-Plaster coming off in many placesor no plaster)

2

h. Condition of floor (1- Floor ingood condition; 2- Floor comingoff in some places; 3- Floorcoming off in many places or noproper flooring)

1 Yes

i. Whether the cleanliness isGood/Fair/Poor? (Observe)

Good

j. Are any of the following closeto the sub-centre? (Observe)(Yes/No)

Garbage dump No Cattleshed No Stagnant pool Yes No Pollution from industry Nok. Is boundary wall with gate

existing? (Yes/No)Yes No

3.3 Prominent display boards in locallanguage (Yes/No)

No No

3.4 Separate public utilities for males an dfemales (Yes/No)

No No

3.5 Suggestion/complaint box (Yes/No) No No3.6 Labour Room

a. Labour room available? (Yes/No)

Yes Yes

b. If labour room is present, aredeliveries carried out in thelabour room?

Yes

Yes YesNoSometimes

c. If labour room is present butdeliveries not being conductedthere, then what are thereasons for the same?

Staff not staying Yes

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Poor condition of the labourroom

No power supply in the labourroom

Any other specify3.7 Clinic Room Yes Yes3.8 Examination Room Yes Yes3.9 Water Supply Yes Yes

a. Source of water (1- Piped; 2-Bore well/ hand pump / tubewell; 3- Well; 4- Other(specify)

Hand pump/Tube well

Handpump/

Tube well

b. Whether overhead tank andpump exist (Yes / No)

No No

c. If overhead tank exist,whether its capacitysufficient? (Yes/No)

d. If pump exist, whether it isin working condition?(Yes/No)

3.10 Waste disposalHow the medical wastedisposed off (pleasespecify)?

Burningandburial

Burningand burial

3.11 ElectricityRegular electric supplyavailable? (Yes/No)

No No

3.12 Communication FacilitiesTelephone (Yes/No) No No

3.13 Transport facility formovement of staff(Yes/No)

No No

3.14 Residential facility for thestaff

No No

Health Workers (Female) No No3.15 Whether Health Worker

(Male) available in the Sub-centre?

Yes Yes

3.16 Is he staying at Sub-centreHeadQuarter village?(Yes/No)

Yes Yes

4. Equipment (As per List)

PINDARA BLOCK CHOLAPUR BLOCK

PHULPUR Sub-Center RUPCHANDPUR Sub-CenterEquipment Available Functional Remarks/

Suggestion/IdentifiedGaps

Available Functional Remarks/Suggestion/IdentifiedGaps

Weighing Machine Yes Yes

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5. Drugs (As per Essential Drug List)


PHULPUR Sub-Center RUPCHANDPUR Sub-CenterDrug Available Functional Remarks/

Suggestion/IdentifiedGaps

Available Functional Remarks/Suggestion/IdentifiedGaps

Colomix Yes Yes

Paracetamol Yes Yes

OCP Yes Yes

IFA Yes Yes

6. Furniture

S. No

Item


PHULPUR Sub-Center RUPCHANDPUR Sub-CenterCurrent

availabilityat sub-center

Ifavailablenumber

Remarks/Suggestion/ IdentifiedGaps

Currentavailability

at sub-center

If availablenumber


6.1 Examination table Yes 01 Yes

6.2 Writing table Yes 02 Yes

6.3 Armless chairs Yes Yes

6.4 Medicine chest Yes Yes

6.5 Delivery Table Yes Yes

6.6 Wooden screen Yes No

6.7 Foot step Yes Yes

6.8 Coat rack Yes No

6.9 Bed side table No No

6.10 Stool Yes No

6.11 Almirah Yes Yes

6.12 Lamp Yes Yes

6.13 Side wooden racks No No

6.14 Fans Yes No

6.15 Tube lights Yes No

6.16 Basin stand Yes Yes

6.17 Buckets Yes Yes

6.18 Mugs Yes Yes

6.19 Kerosene Stove/ Gas Yes Yes

6.20 Sauce pan with lid Yes Yes

6.21 Water receptacle Yes Yes

6.22 Rubber/ Plasticshutting

Yes Yes

6.23 Talquist Hb Scale No No

6.24 Drug with tap forstoring water

Yes Yes

6.25 Others (specify)

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7. Quality Control

Sl.No.


PHULPUR Sub-Center RUPCHANDPUR Sub-CenterParticular Whether functional /

available as per normsRemarks

Whether functional /available as per norms

Remarks

7.1 Citizen's charter (Yes/No) No No

7.3 Internal monitoring:supportive supervision andrecord checking at periodicintervals by the male andfemale health supervisors fromPHC (at least once aweek) and by MO (at leastonce in a month)

Yes

MO not fixedHV 08 to 10 AM

7.4 External monitoring: Villagehealth and sanitationcommittee, evaluation byindependent externalagency

Yes Yes

7.5 Availability of variousguidelines issued by GOI orState Government (specify)

Yes

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Summary findings of Facility Assessment Survey

1. CHC (facility survey form enclosed)

Pindra CHC existed for 5 years but it started functioning since 2007. At present it was notfunctioning according to IPHS (especially in terms of manpower, required equipments andcommunication facilities). Only the physical infrastructure was according to the norms.

Though CHC Cholapur is identified as FRU, but there was no blood storage unit at the timeof visit, Pediatrician and surgeon were also not posted in the CHC. Other services likeinvestigations, equipments in OT etc. were not according to the norms. All national healthprogrammes are implemented in the block through this CHC.

2. PHC ( facility survey form enclosed)

Facility survey was conducted in two block PHCs viz. Pind ara and Danganj (CholapurBlock). Pindara PHC was working as 24 x 7 he alth facility. All the national Healthprograms are implemented in the block through this PHC .Bed occupancy was very high.JSY scheme is implemented and eight sub-centers are identified for RCH services(especially deliveries). RCH camps are organized reg ularly.

At the time of visit no LMO was posted at PHC. Essential newborn care was given by themedical officer, otherwise required facilities for emergency newborn care was not availablein the PHC. Laboratory services were not according to Indian Public Health Standard(IPHS). Pregnancy kit (Nischaya) was introduced for rapid diagnosis of pregnancy.Adequate facilities for treatment of pneumonia and diarrhoea was available .Rogi KalyanSamiti (RKS) was well formed and functioning properly.

On the contrary at Danganj PHC delivery of RCH services were not according to IPHS.

3. SUB-CENTRE (Facility survey form enclosed)

Two accredited sub-centers viz. Phulpur (Pindara Block), Rupchandpur (Cholapur Block)was visited and ANM was interviewed. The physical i nfrastructure of Rupchandpur sub -centre was according to norms for the delivery of ANC, INC, FP services.and ANM wasavailable 24 hours for the deliveries.

Phulpur sub-centre was in rented building but ANM was staying there and providing ANC,INC, FP services.

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Annexure I

Department of Community Medicine, Institute of Medical Sciences, BHU, Varanasi.

Assessment of factors influencing utilization and non utilization of services and client satisfaction at CHC,PHC and Sub-centre under RCH-2 in Varanasi District

Utilization of Services(At CHC/PHC/SC level)

Name of Block Name of village

Name of client Religion/C aste

Educational Status Income (monthly)

Occupation of client Socio-economic status

1. What type of health services for mother and child care available in your area?PHCs/CHCs/Sub-centre/sarkari davakhana/priva te health centre/other (specify)

2. What type of health facilities are available at public health centres ?Immunization/ANC/PNC/INC/Diarrhoea treatment/ARI/Family Planning services/don’tknow/cant say.

3. Which services did you availed for mother and child c are? (Specify)............ANC/PNC/INC/RTI/STI/Diarrhoea treatment/ARI/ Immunization/Family Planning servicesother (specify)

4. As part of ante-natal care, which services did you receive?Services Yes No Public-Sector Private Why

(1/2/3)Satisfaction( COINSYSTEM )

PHC CHC SUB-CENTRE

GOVERNMENTHOSPITAL

BloodpressureHaemoglobin100 IFAtabletsTwo doses ofTetanusToxoidAbdominalexaminationNutritionaladvice

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5. Where were you counselled about the following ?

services YES NO PHC CHC Sub-centre

GOVERNMENTHOSPITAL

PRIVATE OTHER Satisfactionlevel(COINSYSTEM )

Place fordeliveryBreastfeedingFamilyplanningImmunization

6. Where did you go for last delivery

Home/PHCs/CHCs/Sub-Centre/sarkari davakhana/ private health centre/other (specify)

7. If institutional thenWas new born weighed after birth yes / no?

Did new born receive BCG Yes /No

and zero dose polio Yes /No

8. How many hours, days, after delivery did the first check -up take place

Hours…… Days……, Weeks……….. Don’t know

9. How long after birth did you first put to the breast?

Immediately/with in half an hour/after one hours/Days

10. Is child exclusively breast-fed? Yes / No

11. Are you still breast-feeding? Yes /No (If yes, for how long……..)

12. Have you started complementary food to the child ? Yes / NoIf yes, how many times in a day ……… (If the child is more than 6 months old)

13. How many times the child did eat solid, semi -solid food other than the milk/liquid …………..(If the child is more than 1 year old)

14. Did your child receive any vaccination …………. Yes/ No/ other (specify)

15. Where did the child receive vaccinations (mention doses as per age)?PHCs/CHCs/Sub-centre/sarkari davakhana/private health centre/other (specify)

16. Are you satisfied with the services given by health facility?(Coin system)

17. Has the child had diarrhoea in the last 2 weeks? Yes/No/other (specify)

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18. If yes, did you seek advice or treatment for the diarrhoea from any source ?

Yes/no/other (specify).

19. If yes, where did you seek advice or treatment?

Home/PHCs/CHCs/Sub-Centre/sarkari davakhana/private health centre/other (specify)

20. Whether ORS was prescribed to your child? Yes / no

21. Did you ever received treatment for RTI/STI ? Yes / No

22. Where did you go for RTI/STI treatment?Home/PHCs/CHCs/Sub-Centre/sarkari davakhana/private health centre/other (specify)

23. Have you received required medicines for the treatment of RTI/STI Yes/No?

24. Did the service provider give you any advice for the prevention of disease?

Yes (specify) /No

25. Did your partner received treatment for the same disease? Yes / No26. Was privacy maintained during and after treatment? Yes /No27. Are you satisfied with the services given by health facility?

Coin system

28. Have you ever used any thing or tried in any way to delay or avoid getting pregnant?Yes / No

29. If yes, which methods have you ever used ..............................

30. Where did you receive family planning services?PHCs/CHCs/Sub-centre/sarkari davakhana/ private health centre/other (specify)

31. Did the service provider explain advantages /disadvantages of each method ?Yes / No

32. Are you satisfied with the family planning services given by health facility?

Coin system

33. Do the timings of health facilities suit you? Yes / No34. How much time it takes to reach the health facility?

Less than one hour/ between one to two hour/more than two hour35. How do you reach to the health facility?

On foot/by bus/by cycle/by scooter/other (please specify -------------------------------------------------------------------)How long did you have to wait before you received the services you went for?Did not wait much/ about an hour / had to wait for hours/ did no t receive service

36. Did she/he respect your need for privacy if you needed it ?Yes/No/privacy not needed

37. How would you rate about the complete information about illness and treatment givenby the doctor/medical Officer?

Coin system

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38. How would you rate about the time given by the Doctor for the patient check up at thecentre?

Coin system

39. How would you rate about the behaviour of doctor at centre?Coin system

40. How would you rate about the behaviour of staff of centre?Coin system

41. How would you rate about the condition of toilets at the centre?Coin system

42. How would you rate about the availability of drinking water at the centre?Coin system

43. How would you rate about the cleanliness of the centre?Coin system

44. What is your opinion about the quality of services at the centre?Coin system

If you are not satisfied (if less than 25%) with the services of the hospital, please givereasons for the same.

****Please give suggestions for further improvement in the services.

**Note: We are grateful to you for your cooperation and time.

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Annexure II

Natal and Child Care

Discussion Guide for FGD

Introduction ( why we have come here)

Do you know about various Government health facilities in your area ?

Who are the workers providing health services in your area ?

Is ante-natal check-up ( care during delivery) necessary?

Do you know where these services are available?

Where are you going for check-up ?

If using private health facility, what are the reasons for not usinggovernment facilities ?

Where the deliveries takes place ?

Do you know about Janani Suraksha Yojna ?

Is transport facility easily available in case of any emergency duringdelivery ?

Is post-natal check-up ( care after delivery) takes place ?

Was advice given for breast-feeding immediately after delivery, exclusivebreast feeding and weaning ?

Are immunisation sessions conducted regularly in your area ?

What is the usual health care seeking pattern, if your child suffers fromdiarrhoea, pneumonia ?

Are ORS packets easily available?

Are health workers trained to diagnose signs of pneumonia ?

How much are you satisfied with the services ( coin system )

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Family Planning Services and Discussion Guide for FGD

Introduction (why we have come here) How many of you have heard about family planning methods.( discuss )

Given a choice which method would you like to use. Place/Source of family planning services. ( PHCs, CHCs, sub-centre and sarkari

davakhana)/private/any other).

Are you satisfied with family planning services available at health centres (availability of service provider/Sufficient time provided/Merits and demerits/general health problemattended or not)

Distance and location of health centre and conveyance available .

Was privacy maintained during discussion? Family planning methods available at health centres is satisfactory/not

satisfactory( in term of quality, quantity and accessibility)

If not satisfied then why?

Do you have any concrete suggestions to improve these services

If health services in government set -up are improved will you utilize themfully? If no (Give reason)

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Annexure III

Time line of the Project in Week (1st August to 31st December 2008)

Task 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20Finalization ofproposalandSubmission toNIHFWSigning of MOU

Sampling

Release of firsttranche by NIHFWResearch areavisitedandDHO/DC takeninto confidenceMonitoring visitsplan by principal/co-investigatormadeTeam placed infield and activitystartedSupervisory/monitoring visit asper scheduleField work on going

Field workcompletedData analysiscontinuedData analysiscompletedDraft reportprepared and sharedwith NIHFWFeedback fromNIHFW on draftreportFinalization ofreportMinutes ofdisseminationworkshop sharedwith NIHFWNationaldisseminationjointly by NIHFWand partnerInstitutionSubmission ofaudited SOE,UCand disseminationreports by partnerinstitutions

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