Jharkhand

1.District:- Lohardaga

Major observations of Regional Evaluation Team, Patna about the Evaluation work in

Lohardaga district of Jharkhand State in April, 2011.

I. Details of the visited inspection:

District PHCs visited Sub-centres/ Areas visited

Lohardaga Lohardaga, Senha and Kuru Lohardaga (HQ), Chitri, Barahi, Shithiya,

Lawagaie and Hejala

II. Major Observations:

1. Human Resource:

Out of 46 sanctioned posts of ANMs there were only 35 but district get 111 more posts of

ANMs on contractual basis. Similarly, as against the sanctioned strength of 48 posts of MO/

Specialist,7 posts of GNM and 18 posts of LT there were 42, 6 and 1 post respectively but

district had also appointed additional 11 MOs/ SPe, 20 GNMs and 6 LTs on contractual

basis. However, many posts like 35 of 65 posts of MPW (M), 8 of 10 posts of LHV/HS and

22 of the 84 sanctioned posts of Gr. D Staff were still lying vacant in the district.

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

(VHSC) :

a) As reported Rogi Kalyan Samiti (RKS) have been constituted in the district. Visited PHCs

were having RKS and the members of RKS meet quarterly.

b) VHSC at village level are constituted in the district.

c) As per the detail available, Rs.8,22,017 were spent out of Rs.41,40,000 available under

VHSC head for the year 2009-10. It appears that the activities were not conducted

satisfactorily as there was only 20% funds utilisation in 2009-10.

d) Rs. 36,99,370 were utilised in the district from the allotted funds of Rs. 1,67,97,983 for

VHSC for the year 2010-11(up to Feb.11).

3. Services of ASHA:

a) It has been reported that 476 ASHAs were in position and trained up to 4th modules.

b) Drug Kit was provided to only 334 ASHAs in the district. ASHAs are reported to be

getting performance based incentive regularly.

4. Untied Funds:

a) United funds were distributed at CHC, PHC and Sub Centre level in the district. There

are 4 CHCs, 10 PHCs and 73 Sub- Centres in the district.

b) The district received Untied Fund of Rs.1,47,94,405 but spent only Rs. 92,801 in the year

2009-10. The reported expenditure for the year of 2010-11 was Rs.15,98,013 against the

available amount of Rs. 23,91,639/-

c) The CHC, PHC and Sub-Centre wise allotment and expenditure of untied fund for 2009-

10 and 2010-11 is as given below .

Sl. No. Type of Institutions 2009-10 2010-11(up to Feb.11)

Fund

Available Rs.

Expenditure

Rs.

Fund

Available Rs.

Expenditure

Rs.

1 CHCs 2,50,000 63,300 4,36,700 2,89,819

2 PHCs 4,03,258 28,024 4,00,234 3,97,137

3 Sub-Centres 8,26,182 1,477 15,54,705 9,11,057

Total 1,47,94,40 92,801 23,91,639 15,98,013

5. Services under Janani Suraksha Yojana (JSY):

a) The district had utilised JSY funds to the tune of Rs. 47,64,157 in 2009-10 and Rs.

1,04,39,206 during 2010-11 (up to Feb.11 ) against the provision of Rs. 81,26,089 and Rs.

1,54,61,922 respectively.

b) During Sample verification, it has been observed that JSY cards and Imm. Cards were

filled properly. Some of mothers did not receive three consecutive cheeks up properly. The

post natal visits by the ANM/ASHA may be increased.

c) 25 JSY beneficiaries were selected for interview and 17 (64%) were contracted. Most of

them were registered for ANC in early stage of pregnancy. JSY packages was received by

them in time.

d) Supervisory checks for regular monitoring at HSC level was lacking.

6. Physical Infrastructure :

i. HSCs:

a) To check Infrastructuree status of availability of equipments, other supplies and drugs,

HSCs at Barahi and Lawagaie were visited and found that ANMs were staying at their Sub-

Centre head quarter. Electricity, water supply and labour room were not available there.

Due to the non availability of facilities, ANMs were not in a position to conduct delivery at

the SC.

b) Benches, Ambubag/section, steam sterilizer were not available at the Centres .

Cupboard, Stove, Weighing Machine (Adult and infant ), Gloves and DDKs were not

available in two of three centres visited.

c) Drugs like Co-trimoxazole tab., OP cycles, E.C. pills, Metronidazole tab., Oxytocine tab.,

Ampicillin cap. and Gentamycin Inj. were not available at two of three places visited.

ii. PHCs:

a) Both the visited PHCs Senha and Kuru are functioning in Govt. Accommodation and the

maintenance of the building was satisfactory during visit.

b) Most of the items i.e., supplies and equipments were available in the centres visited.

Contraceptives (IUD, OP&CC), Stock of vaccines vials (BCG, DPT, OPV, MEASLES etc.)

were available but prophylactic drugs were not available at the visited PHCs.

c) Residential accommodation for MOs of PHC Kuru was not available.

7. Knowledge and Opinion of Community on Health Services:

i. ANM SERVICES:

30 mothers in the area of HSCs at Barahi, Shethiya and Lawagaie were interviewed. Most

of the mothers were not aware of ARI. It is felt that ANC and PNC services need to be

geared up to provide to all the mothers.

ii. MPW (M) Services:

Male worker at Sethiya was available but in other two SCs the post was vacant. Male

worker at HSC Shethiya participating in some programme relating to public health,

immunization camp and collecting of blood smear of fever patients. He visits also nearby

primary school for school health programme.

iii. PHC Level Services:

Villagers and some of the beneficiaries contacted under area of the PHCs Kuru and

Shethiya were happy with the services provided at PHCs. They were satisfied with the

drugs availability and visit to the remote area of the PHCs.

8. Sample Verification of Family Welfare Acceptors:

a) The team selected 72 F.W. acceptors out of which 46 (64%) acceptors could be

contacted in the district. Minor discrepancies were found in the age of spouse in 18 (39%)

cases and in the age of last child in 4 (9%) cases. Follow up services to the 31 (67%)

acceptors were observed to have not been provided by the Health Personnel.

b) Similarly, 33 beneficiaries of child immunization (BCG, Polio, DPT, Measles and Vitamin-

A) were selected and out of these 28 (84%) beneficiaries could be contacted. All the

beneficiaries confirmed to have received the doses as per record and no complication after

providing the doses was reported in the area visited.

9. Reconciliation of Reported Performances:

a) Reported figures for family planning for the year 2009-10 and 2010-11 could not be

verified with the service registers at visited PHCs Lohardaga and Senha due to non

availability of registers. There was no report for 2009-10 available to cheek the figure at

above said PHCs to confirm the achievement under various schemes. The reported figures

under Oral Pills and Nirodh scheme were not available at district office also.

b) Sterilisation and IUD figures reported by district office for the PHCs Lohardaga, Senha

and Kuru for the year 2010-11 did not tally when compare with the same figures available at

respective PHC H.Q.

Sl. No.

Name of the PHC

For the year 2010-11

Sterilization IUD

Reported by

DFWB

Reported

by Centres

Reported

by DFWB

Reported

by Centres

1 Lohardaga 29 92 39 100

2 Senha 115 157 120 88

3 Kuru 253 334 222 363

10. Maintenance of Records & Registers:

a) Register maintained for MCH Services were in printed form.

b) Family Planning registers maintained for Ste. Cu T, OP and Nirodh were not in printed

form. The registers were not maintained properly.

c) JSY payment register was also not maintained properly at the visited centres.

d) It was observed that the information was not properly collected by the visited centres on

mother and child tracking. The workers and concerned officers needed training in this

regard.

11. Other Observations:

a) During field visit, some of the rural areas were still inaccessible for providing institutional

delivery services. In that area, home deliveries were conducted by untrained persons.

b) Performance under NSV was poor in the district.

c) Supervision at the visited centres was almost nil.

*******

2.District:- Garhwa

Major observations of Regional Evaluation Team, Patna about the Evaluation work in

Garhwa district of Jharkhand State in April, 2011.

I. Details of the visited inspection:

District PHCs visited Sub-centres/ Areas visited

Garhwa Garhwa, Meral, Majhiyao

and Ranka

Garhwa (HQ), Kalyanpur, Okhalgara,

Kushaha, Khajuri and Khardiha

II. Major Observations:

1. Human resource :

It was observed that there was acute shortage of manpower in the district. As reported 126

of the 195 sanctioned posts of Medical Officer/ Specialists, 19 of the 27sanctioned posts of

Lab Technician, 21 of the 85 sanctioned posts of MPW (M) and 162 of the 343 sanctioned

posts of ANM were lying vacant.

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

(VHSC):

a) As reported most of all the centres/institutions constituted have Rogi Kalyan Samiti

(RKS) in the district and the visited PHCs were having RKS. However, regular meetings of

all RKS were not being conducted in the district.

b) VHSC at village level are constituted in the district.

c) As per the details available, Rs. 50,561 (2.3%) were spent out of total fund of Rs.

21,66,881 available for this scheme for the year 2009-10. It is appears that the VHSC

activities were not being conducted satisfactorily as only 2% funds were utilised during

2009-10.

d) Rs. 19,03,214 have been utilised in the district out of available fund of Rs. 21,16,320 for

VHSC for the year 2010-11(up to March, 2011).

3. Services of ASHA:

a) It was reported that 1127 ASHAs were selected and 1125 ASHAs were trained up to 5 th

modules.

b) Drug Kits were not provided to ASHAs in the district.

4. Untied Funds:

a) The district received Untied Fund of Rs. 43,11,130 and spent only Rs. 14,16,436 (32.8%)

in the year 2009-10. Out of Rs.39,19,555 available with the district, Rs.37,42,207 (95.5%)

were spent during the year 2010-11(upto February, 2011).

b) The CHC, PHC and Sub-Centre wise allotment and expenditure of untied fund for 2009-

10 and 2010-11 (upto February, 2011) is as given below.

Sl. No. Type of

Institutions

2009-10 2010-11(up to Feb.11)

Fund Available

Rs.

Expenditure

Rs.

Fund Available

Rs.

Expenditure

Rs.

1 CHCs 5,20,538 1,78,475 8,76,924 8,25,294

2 PHCs 5,59,200 9,0178 3,69,022 3,61,400

3 Sub-Centres 32,31,392 11,47,783 26,73,609 25,55,513

Total 43,11,130 14,16,436 39,19,555 37,42,207

5. Services of JSY:

a) The district had utilised its JSY fund Rs. 1,51,26,894 (76.9%) in the year 2009-10 and

Rs. 3,49,81,689 (86.8%) during 2010-11 (up to Feb.11 ) against the allotment of Rs.

1,96,62,603 and Rs. 4,02,84,859 respectively.

b) During Sample verification, it was observed that JSY cards and incentive was not

received by some of the mothers. Further, three consecutive checks up and post natal visits

need to be increased.

6. Physical Infrastructure :

i. HSCs:

a) To check the status of equipments and other supplies at visits were made to 4 HSCs at

Kusha, Okhalargara, Kalyanpur and Khajuri and it was observed that Electricity, water

supply and labour room were not available there. Due to the insufficient facilities, the ANMs

were not in a position to conduct delivery at these SC.

b) Ambu bag/section, Steam Sterilizer, Stove, Gloves, DDKs and Vitamin-A solution were

not available in most of the centres visited.

c) Drugs like IFA Tablets/ Syrup, OP cycles, Ampicillin cap. and Gentamycin Inj. were not

available at two of four SCs visited.

ii. PHCs:

a) PHCs Manjhiyao and Moral visited. Both PHCs were functioning in Govt. accommodation

and the maintenance was satisfactory.

b) Maximum items i.e., supplies and equipments were available at the places visited.

Contraceptives (IUD, OP & CC), Stock of vaccines vials (BCG, DPT, OPV, Measles etc.)

were available but prophylactic drugs were not available at the visited PHCs.

7. Knowledge and Opinion of Community on Health Services:

i. ANM Services:

a) During the visit, 12 mothers in each SCs i.e. Kusha, Khajuri Okhalargara and Kalyanpur

were interviewed and found that all ANMs of the selected 4 SCs were available when

needed. Home deliveries were conducted by trained persons using DDK.

b) Most of the mothers were not aware of ARI. It was also observed that ANC and PNC

services need to be geared up to cover all the mothers.

8. Sample Verification of Family Welfare Acceptors:

a) During visit to the district, the team contacted 59 (57.2%) F.W. acceptors out of total 103

selected. Discrepancies were found in the age of spouse in 22 (48%) cases. Follow up

services to the 21 (46%) acceptors were observed to have not been provided by the Health

Personnel.

b) 16 beneficiaries of child immunization were also contacted in the district. All the

beneficiaries confirmed receiving the doses but did not receive follow up services..

9. Reconciliation of Reported Performances:

a) There was no Service register maintained for Sterilization acceptors for the year 2009-10

at PHC Moral , Majhiyao and Ranka and hence, reported figures could not be verified.

b) Reported figures for IUD for 2009-10 and 2010-11 did not tally with each other at

reporting centres and at district office. Similarly, OP and Nirodh figures reported by District

office for the year 2008-09 and 2009-10 did not tally with those available at the visited

centres.

c) The Sterilization and IUD acceptors reported by DFWB and by the visited centres for the

year 2010-11 are as reported below:

Sl. No.

Name of the PHC

For the year 2010-11

Sterilization IUD

Reported by

DFWB

Reported

By Centres

Reported

by DFWB

Reported

by Centres

1 Garhwa 585 583 55 264

2 Moral 193 197 185 67

3 Majhiyao 507 510 210 209

4 Ranka 484 484 79 95

10. Maintenance of Records & Registers:

a) Family Planning registers maintained for Sterilization, Cu T, OP and Nirodh were not in

printed form. These registers were not maintained properly.

b) JSY payment register was also not maintained properly at the visited centres.

c) The team observed that the information is not being properly collected in the visited

centres on mother and child tracking. The workers and concerned officers needed training

in this regard.

11. Other Observations:

a) It was observed that performance of Family Planning was poor in the district.

b) It was found that no prescribed Proforma was maintained in respect of Cu.T, OP/Nirodh

distribution and ANC/PNC in selected institutions in the district.

c) It was also observed that the members of NRHM Management Supporting Units at

District/CHC/PHC level were not having adequate knowledge about latest guidelines of

different programmes under NRHM. Therefore, re-orientation training was highly required.

d) Performance of NSV was found very poor in the district.

*****

3.District:- Chatra

Major observations of Field Survey Unit (FSU), Patna on the Evaluation work carried

out in Chatra district of Jharkhand State in the month of August, 2011.

I. Details of the visited Institutions:

District Visited PHCs visited SCs Visited

Chatra PHCs: Simaria and Hunterganj Bagra, Belgada, Pandeypura & Orugerua

II.Major Observations:

1. Human Resources:

a) As reported there was shortage of health personnel in some of the key categories. 33 out of

54 sanctioned posts of Medical Officer, 37 out of 164 sanctioned posts of ANMs, 27 out of

50 sanctioned posts of GNMs and 19 out of 70 sanctioned posts of MPW (M) were lying

vacant in the district. The status of other categories of staff was not made available to the

team.

b) 2 out of 4 sanctioned posts of Medical Officer, 11 out of 18 sanctioned posts of ANMs, the

only sanctioned post of Pharmacist and 2 sanctioned posts of LHV were vacant in the

visited PHC, Hunterganj. Similarly, 4 out of 8 sanctioned posts of Medical Officer, one out

of 2 sanctioned post of ANM and the sanctioned post of LHV was vacant in PHC Simaria.

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

(VHSNC):

a) 12 RKS (in Referral Hospital, 5 CHCs and 6 PHCs) were constituted in the district and

regular meetings of RKS were being conducted in visited PHCs.

b) It was reported that 1425 VHSCs have been constituted in the district and all VHSCs were

having ASHA as a member. In the visited HSCs, ASHA was one of the member of the

committee.

c) An amount of Rs. 1,03,80,000 was available as VHSC fund with the district in the year

2010-11 and district had spent Rs. 72,90,497 during the year. The balance amount of Rs.

30,89,503 was carried forward to the year 2011-12 and only Rs. 11,30,000 could be spent

till the visit of the team.

3. Service of Janani Suraksha Yojana (JSY):

a) 9940 deliveries in the year 2010-11 and 2966 deliveries in 2011-12 upto visiting month

were identified for getting JSY benefit in the district and all the beneficiaries in both the

years were provided with JSY incentives.

b) It was reported that the budget to the tune of Rs. 1, 23, 87,737 and Rs. 87, 24,772 was

available under JSY during 2010-11 and 2011-12 respectively in the district. The

expenditure to the tune of Rs. 77,84,937 in 2010-11 and Rs. 32,11,775 in 2011-12 was

incurred under JSY.

c) In the visited PHCs Simaria and Hunterganj JSY status as reported is given below:

Sl. No. Particulars PHC Simaria PHC Hunterganj

2009-10 2010-11 2009-10 2010-11

1. No. of deliveries eligible for payment under

JSY

1864 895 1800 575

2 No. of beneficiaries to whom JSY fund paid 1864 895 1800 575

4 Total fund received 36,15,000 13,00,000 36,00,000 13,00,000

5 Expenditure incurred under JSY 32,11,775 12,99,895 36,00,000 11,50,000

d) 18 JSY beneficiaries were contacted for sample verification in the visited area of the

centres and it was found that all contacted beneficiaries received JSY incentives.

e) All beneficiaries were provided three Ante Natal Checkups (ANC) and MCH cards. All of

them were provided with transport facilities by ANM/ASHA and they were accompanied by

ASHAs to Health Centes at the time of delivery.

4. Functioning of ASHA Scheme:

a) It was reported that there were 1609 ASHAs in position in the district. Out of them, 1432

ASHAs trained up to 5th modules and also provided drug kits to them.

b) 210 and 287 ASHAs were in position in the visited PHCs Simaria and Hunterganj

respectively. All ASHAs were trained up to 5th modules and were having drug kit as well in

the PHCs.

c) Performance of ASHA under NRHM was satisfactory. Incentive money was paid in time to

ASHAs under JSY scheme.

5. Untied Funds:

a) Provision and expenditure of Untied Fund in the district is as reported below:

(in Rs.)

Particulars

for CHCs for PHCs for HSCs

2010-11 2011-12 2010-11 2011-12 2010-11 2011-12

Untied funds Received 579227 1,807* 3,56,000 33,628* 27,73,236 2,70,491*

Expenditure incurred 577420 Nil 3,22,372 3,200 25,02,745 7,716

Balance 1807 1,807 33,628 30,428 2,70,491 2,62,775

* Opening balance.

b) In visited PHCs at Simaria and Hunterganj, no Untied Fund for the year 2011-12 has been

released till the visit of team. Both the PHCs utilized their full allotment of Untied Funds for

last year 2010-11.

6. 24 x 7 Hours Delivery Care Services:

a) There were one Sadar Hospital, Chatra and 5 CHCs viz. Simariya, Ithkhori, Hunterganj,

Tandawa and Partapur providing 24x7 delivery care service in the district but no Specialist

was posted at any institution except CHC Simariya.

b) Total number of deliveries conducted in CHC Simaria and PHC Hunterganj were 1864 and

1800 during 2010-11 respectively and in 2011-12 the number of deliveries were 895 in CHC

Simaria and 575 in PHC Hunterganj.

7. Physical Infrastructure and Stock Position:

i. PHCs

a) PHCs visited at Simaria and Hunterganj were functioning in Govt. building with the

facilities of Electricity and Telephone, Drinking water and also Public Utility (Toilet).

b) 24x7 hour service are given at the visited PHCs.

c) Shortage of IFA large tablet and Vitamin ‘A’ tablets was observed in the PHCs.

d) Post of AYUSH Medical Officers was not filled in the PHCs.

ii. HSCs:

a) All visited Sub Centres viz. Bagra, Belgeda and Pandeypura were working in Govt.

building except SC Orugerua which was functioning in rented building. Almost all visited

HSCs were having hand pump for drinking water. Electricity, Toilet and Labour room facility

found available in the visited HSCs.

b) Delivery table, Mcintsh sheets, Ambu bag/suction, Steam Sterilizer, IUD Insertion kit and

Stove & Kerosene Oil was not available at the visited Sub Centres.

8. Community Satisfaction on Overall Health Services:

Public opinion in the area of Sub Centres and PHCs visited was observed to be good

towards the services rendered by ANMs and PHC MOs/Staff.

9. Sample Verification of Family Welfare Acceptors:

a) The team selected 38 FW acceptors and contacted 21 acceptors for sample check. All

the acceptors had received FW services and also payment for Sterilization was made to

contacted beneficiaries as per norms.

b) Besides above 21 beneficiaries out of 31 selected child immunization were contacted, all

beneficiaries confirmed the doses and expressed satisfaction. Follow up services were

provided to all of them. No complication was found among them.

10. Reconciliation of Reported Performance:

a) Achievement under Family Planning was not made available at District Office for the year

2010-11 and 2011-12.

b) Reported figures for Sterilization for the year 2010-11 and 2011-12 (upto July, 2011) by

the district office did not match with the figures available at PHCs head quarters at Simaria

and Hunterganj.

11. Maintenance of Registers & Records:

a) Eligible Couple Register (EC) and Sterilization Register were not maintained at both the

visited PHCs Simaria and Hunterganj in the district.

b) IUCD Service Register, Child Immunization Register, Oral pills, Condom, ANC, PNC and

Stock register were not made available at all the visited institutions.

c) Sterilization case card was not issued to any visited institution.

d) Printed Eligible Couple Register, Register for Family Planning Service, Stock Register,

Cash Book of untied funds and JSY registration Card were not available at visited Sub

Centres.

4.District:- Dumka

Major observations of Field Survey Unit (FSU), Patna on the Evaluation work carried

out in Dumka district of Jharkhand State in the month of August, 2011.

I. Details of the visited Institutions:

District Visited PHCs Visited HSCs Visited

Dumka Saraiya hat, Jama & Jarmundi

Berhat-1, Chorbatiya, Chikaniya, Silanda,

Dhanadih, Sahara, Jamna & Basukinath

II. Major Observations:

1. Human Resources:

a) Acute shortage of the staff was observed in the district. As informed there were totally

1519 class III and class IV categories of the posts sanctioned and out of those 528 posts

were lying vacant in the district. A large no. of posts of key functionaries in the different

health centres/institutions was also vacant as given below:

S. No. Particulars Sanctioned In position Vacant

1 M.O 107 95 12

2 ANMs 328 290 38

3 ANM(Contractual) 240 174 66

4 Nirikshak 20 5 15

5 Nigrani karykarta 69 10 59

6 LHV/HS(F) 39 19 20

7 Health Worker 112 84 28

8 Health educator 28 17 11

9 Pharmacist 38 3 35

10 BCG Technician 5 0 5

District/State authority needs urgent step to fill up the vacancy.

b) Staff position in CHC Saraiyahat was satisfactory in comparison to the sanctioned

strength.

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

(VHSNC):

a) As reported, Rogi Kalyan Samiti (RKS) was constituted and got registered at different

health centres in the district. Regular meeting of RKS was observed to be conducted in

visited PHCs.

b) It was reported that 2260 of the total 2722 villages in the district have been covered

under Village Health Sanitation and Nutrition Committee and all VHSNCs having ASHA as

a member.

c) An amount of Rs. 2,29,12,748 was available as untied funds for VHSNCs with the

district in the year 2010-11 out of which an expenditure to the tune of Rs. 1,57,86,347 were

made. The balance amount was carried forward to the next year 2011-12 and no regular

fund was provided for current year to the district till the time of visit by team.

3. Service of Janani Suraksha Yojana (JSY):

a) Janani Suraksha Yojana was being implemented properly in the visited institution.

Institutional deliveries were being conducted at PHCs level and JSY fund was provided to

the visited PHCs in time.

b) It was reported that the budget to the tune of Rs. 1,34,54,312 including opening balance

was available in the district in 2011-12 and Rs. 72,23,376 was spent.

c) JSY status in the visited PHCs was as reported below:

Sl.

No.

Particulars PHC Saraiya hat PHC Jama PHC Jarmundi

20010-11 2011-12 20010-11 2011-12 20010-11 2011-12

1. No. of deliveries eligible for

payment under JSY

1455

725 709 257 1840 630

2 No. of beneficiaries to

whom JSY fund paid

1455

725 700 221 1668 558

3 No. of beneficiaries yet

to be paid JSY fund

-

-

9 36 172 72

4 Expenditure incurred

under JSY (in Rs.)

33,53,600

16,03,810

17,11,380 4,85,850 37,15,950 12,95,250

d) It was observed that funds were utilised but JSY payment Register was not being

maintained properly. During field visit, 38 JSY beneficiaries were contacted in the area

visited and observed that all beneficiaries have received cash incentive under the scheme.

4. Functioning of ASHA scheme:

a) It was reported that there were 2583 ASHAs selected as against the target of 2722 in

the district. Out of them, 2316 ASHAs were trained in all modules, but drug-kits provided to

2449 ASHAs.

b) During visit to the PHCs, it was observed that these PHCs were having ASHAs and

activities under taken by the ASHAs under NRHM were found satisfactory. They are getting

incentives in time.

5. Untied funds:

a) CHC @ Rs. 50,000, PHC @ Rs. 25,000 and every Sub Centre @ Rs. 10,000 are given

as untied funds every year in the district. The status of Untied Funds at CHC, PHC and SC

level are given below:

(in Rs.)

Sl. No. Name of the centres Total fund available * Total expenditure

2010-11 2011-12 2010-11 2011-12

1 For CHC 8,06,475 5,02,239 8,04,236 13,827

2 For PHC 17,35,401 1,22,347 16,13,054 17,460

3 For SCs 67,16,785 7,01,938 60,14,847. 2,04,999

* Including opening balance.

b) In the visited PHCs, it was observed that untied fund was provided to them and most of

the funds were utilised during last two years.

6. 24 x 7 Hours Delivery Care Services:

a) 24x7 hour delivery care services are being provided by 8 CHCs in the district.

b) It was reported that most of the CHCs were having 2 or more Doctors and 6 to 8

SN/ANMs. There was no Specialist available at CHC level.

7. Physical Infrastructure and Stock Position:

i. PHC:

a) In the district, 50% of the PHCs (out of total 34) were functioning in Govt. building.

b) All visited PHCs (Saraiya hat, Jama & Jarmundi) were functioning in Govt. building with

the facility of electricity and telephone. Drinking water facility was available within the

campus. Toilet facility for staff and patient was available, but sanitation was not maintained

properly.

c) Residential quarter for Medical Officer was available.

d) 24x7 hours services were being provided at the visited PHCs, but labour room and

maternity wards were unhealthy for delivered mothers and new born babies.

e) Specialists and AYUSH Medical Officer were not posted in these PHCs.

f) Stock of contraceptive and vaccines vials was available but IFA (Large) were not

available at visited institutions.

ii. HSCs:

a) In the district out of the total 249 HSCs, only 86 were functioning in Govt. building.

b) HSC Berhat-1, Chikaniya and Basukinath were functioning in Govt building. HSC

Sahara was functioning in a rented building. HSC Chorbatiya and Dhanadih were

functioning in rent-free building, HSC Silanda was functioning in AWC building and HSC

Jamna was functioning in school building.

c) Almost all HSCs use hand pump for drinking water. Electricity was available at all visited

Sub Centres except Jamna. Toilet facility and labour room was not available at visited HSC

except Basukinath.

d) ANMs in charge of the visited Sub Centre was not staying at their Sub Centres.

e) Mcintsh sheets, Ambu bag/ suction, steam sterilizer, IUD Insertion kit and Kits-A & B

were not available at the visited Sub Centres.

f) Printed Stock register, cash book for untied funds and JSY registration cards were not

available at visited Sub Centres.

8. Community Satisfaction on Overall Services:

i. Towards HSC’s service:

Mother having child up to one year old interviewed at visited Sub Centre and they were

found to be satisfied with the services rendered by the ANMs. Mothers were aware and

also satisfied having MCH and JSY services under NRHM.

ii. Towards PHC’s service:

a) The team interviewed some Mothers (ANC, PNC and with 2 years old child), AWW,

ASHAs, and village leaders in the PHC areas and found that MCH services were being

given properly in these areas. Women were also being advised for adoption of F.W

methods.

b) Villages were mostly happy with the services provided at PHC head quarters.

9. Sample Verification of Family Welfare Acceptors:

a) The team selected 92 F.W. cases, out of which 66 (72%) cases could be contacted.

While examining the data in the service registers, it was observed that age of Spouse of

the acceptors was not recorded.

b) Follow up services was provided to all contacted cases and also payment for sterilization

was made to the beneficiaries as per norms.

c) Out of 26 selected, 23 beneficiaries of child immunization were contacted, all

beneficiaries confirmed the doses and expressed their satisfaction towards the services.

Follow up services were provided to all of them. No complication was found among them.

10. Reconciliation of Reported Performance:

Reported figures for Sterilization, Cu.T, Oral Pills and Condom for the year 2010-11 and

2011-12 (upto May, 2011) could not be verified with the service registers at visited PHCs

Saraiya hat, Jama and Jarmundi as the reports were not made available by District Office.

11. Maintenance of Register & Records:

a) Eligible Couple Survey Register and Sterilization registers were not maintained properly

at the visited institutions in the district.

b) IUCD Service Register, Oral Pills Service Register and Condom Service Register were

not produced in the visited institutions.

c) MCH Service Register and Child Immunization registers were not maintained properly.

d) Stock Register of IUCD, Oral pills and Condom was not produced in the visited

institutions.

e) Sterilization case card was not issued to any visited institutions.

12. Other Important Observations and Suggestions:

1) Eligible Couple Survey was not being conducted for a long time at PHC/ HSC level and

due to this ECR was not being maintained by the concerned HSCs.

2) Lack of supervision was observed in the district.

5.District:- Koderma

Major observations of Regional Evaluation Team, Patna about the Evaluation work

carried out in Koderma District of Jharkhand State in the month of October 2011.

I. Details of the visited Institutions:

District CHC Sub Centres

Koderma Satgawa, Koderma & Jainagar Dhab, Maranchi, Ramdih, Jhanjhideh.

Chhatarwar, Chachi, Gonal, Behradin &

Bogodiha.

II. Major Observations:

1. Human Resources:

a) Latest status of staff position in the health Sector was not made available to the team at

District office. However, as reported 26 of the 67 sanctioned posts of Medical

Officer/Specialists and 45 out of 150 sanctioned posts of ANMs were vacant in the district.

b) 6 sanctioned posts of Specialists were vacant at CHCs Jainager and Satgawa.

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

(VHSNC):

a) It was reported that Rogi Kalyan Samiti (RKS) was constituted in different health

facilities in the district. Regular meetings of RKS were not being conducted in the visited

centres.

b) 555 Village Health Sanitation & Nutrition Committees (VHSNCs) have been constituted

in the district.

c) Though, funds were being provided regularly, utilization of VHSNC funds was poor in the

district. An amount of Rs. 37,50,000 was available as untied fund for VHSNC in the district

for the year 2010-11, out of which, an amount to the tune of Rs.16,01,649 (43%) was

spent. No untied fund for the year 2011-12 was provided to the district up to the time of

visit. The district has spent Rs. 1,10,000 up to September, 2011 from the last year unspent

amount of Rs. 21,48,351.

d) Availability and utilisation of VHSNC funds in the visited CHCs as reported is given

below:

(Amt. in Rs.)

Type of

institution

2010-11 2011-12 (up to September 11)

Fund

available

Expenditure

Balance

% of fund

Utilized

Fund

available

Expendi

ture

Balance

% of fund

Utilized

CHC Sadar,

Kodarma

6,50,000 NIL 6,50,000 0 6,50,000 40,000 6,10,000 6.15

CHC

Jainagar

3,50,000 1,57,854 1,92,146 45.10 1,92,146 10,000 1,82,146 5.2

CHC

Satgawa

8,70,000 4,37,652 4,32,348 50 6,92,348 NIL 6,92,348 0

3. Service of Janani Suraksha Yojana (JSY):

a) To benefit the JSY mothers and for proper implementation of the scheme, budget to the

tune of Rs. 1,21,95,343 during 2010-11 and Rs.1,51,24,342 during 2011-12 was provided

to the district. The utilization was Rs. 1,08,51,501 (88.98%) in 2010-11 and Rs. 56,27,185

(37.21%) during 2011-12 (till Sept. 2011).

b) Details of utilization of JSY funds at visited CHCs are as under:

Type of

institution

2010-11 2011-12 (up to September 11)

Fund

available

Expenditure

Balance

% of fund

Utilized

Fund

available

Expenditure

Balance

% of fund

Utilized

CHC Sadar

Kodarma

12,56,950 5,47,900 7,09,050 43.6 7,09,050 7,01,050 8,000 98.8

CHC Jainagar 8,85,920 6,80,000 2,05,920 76.8 5,05,920 3,06,750 1,99,170 60.6

CHC Satgawa 23,27,700 23,27,700 NIL 100 15,00,000 5,25,100 9,74,900

35

c) 6 JSY beneficiaries were contacted in the visited centres and it was found that MCH

cards were issued to all of them. Three consecutive ANC check ups were given in time.

Payment of JSY package to beneficiaries was also made in prescribed time. Most of the

mothers were delivered at government hospital and involvement of ASHA to accompany

the mother to hospital was satisfactory in the district.

d) It was observed that more attention should be given to fill up JSY cards and

immunization cards with all the information by the ANMs.

4. Functioning of ASHA scheme:

a) Instead of requirement of 763 ASHA for 653 villages, 619 ASHAs were in position in the

district; all ASHAs were trained in all modules. However, only 58 ASHAs have been

provided with drug kits in the district.

b) ASHAs in the district were being provided performance based incentive. As per the

details received from the district, only Rs. 5,000 were said to ASHAs in the year 2010-11

and Rs. 16,500 during 2011-12 (up to Sept. 2011) against the total allotment of Rs. 29,000

and Rs. 1,86,000 respectively.

5. Untied funds:

a) The total untied funds to the tune of Rs. 18,69,321 during 2010-11 and Rs. 13,64,735

during 2011-12 ((up to September, 2011) were available in the district. Out of available

funds, an amount of Rs. 13,54,586 (72%) in the year 2010-11 and Rs. 85,986 (6%) in the

current year up to September, 2011 was spent in the district.

b) Utilization of untied funds at CHCs, PHCs and SCs level is as follows:

(Amount in Rs.)

Type of

institutions

2010-11 2011-12 (up to June,2011)

Fund Available

Expenditure

Balance

Fund Available

Expenditure

Balance

CHCs 2,75,462 2,53,708 21,754 2,21,754 21,915 1,99,839

PHCs 3,00,000 67,350 2,32,650 2,32,650 36,095 1,96,555

Sub centres 12,93,859 10,33,528 2,60,331 9,10,331 27,976 8,82,355

c) During visit to SCs, it was found that the untied funds were being utilised and cash books

were maintained properly.

6. Utilization of Referral Transport funds:

Utilization of Referral Transport funds was very poor in the district. An amount of

Rs.1,77,744 was available for the year 2010-11 out of which, Rs. 22,261 (12.5%) was

utilised. Further, against the available fund to the tune of Rs. 2,25,477 for the year 2011-12,

only an amount of Rs.15,600 (0.7%) was utilised till September, 2011.

7. Annual Maintenance Grant (AMG):

Total Annual Maintenance Grant (AMG) for CHCs, PHCs and Sub Centre in the district

was received to the tune of Rs. 21,88,103 for the year 2010-11, out of which Rs. 12,12,809

(55.4%) was spent during the year. An amount of Rs. 13,75,294 was available for the year

2011-12 out of which Rs. 50,105 (3.6%) was utilized till September, 2011.

8. 24 Hours Delivery Care Services:-

The scheme, 24x7 delivery service was not introduced for rural centres in the district.

9. Physical Infrastructure and Stock Position:

i. CHC:

a) Most of the PHCs have been upgraded as CHCs in the State of Jharkhand and the

district. It was found that visited CHCs were functioning in their own building, but

maintenance of hospital building was not up to the mark. Water supply and electricity with

power back-up were available at CHCs Jainager and Satgawa. Condition of beds in CHCs

Jainager and Satgawa was poor.

b) X-Ray facility, Blood storage unit, Anesthesia equipment, Arteether injection and

Quinine injections were not available at CHCs Jainager and Satgawa. Neonatal

Resuscitation equipments and Sick New born care unit was not available at Jainagar CHC

whereas Resuscitation equipment was not available Satgawa CHC.

ii. HSCs:

a) HSC Chachi was running in Govt building and HSC Chhatarwar was running in private

building, Drinking water, Electricity and Toilet facility was not available at both visited HSCs

Chachi & Chhatarwar. Building of Chachi SC required major renovation.

b) ANMs of the visited Sub Centres were not staying at their H.Q. or jurisdiction villages.

Mobile phone was provided to ANM at Chachi HSC but not to ANM of Chhatarwar HSC.

Labour Room was not available at both HSCs Chachi & Chhatarwar.

c) Ambu bag / suction, Steam Sterilizer, Nischay Pregnancy Test Kit, Delivery Kit, RDT Kit

for Malaria was not available at both HSCs Chachi & Chhatarwar, whereas Examination

Table, Foot Stool and Stove were not available at Chhatatwar HSC and Mcintsh sheets,

IUD Insertion kit and Torch were not available at Chachi HSC.

d) DDKs, IFA Tablet/Syrup, Misofrostol, Magsulth and Oxitocine tablets, Ampicillin Capsule,

Gentamycine injection and Kit-A & Kit-B (for current year) were not available at both visited

HSC, whereas Co-trimoxazole tab, E.C.Pills, Paracetamole tab were not available at

Chhatarwar HSC, Antiseptic solution, Chloroquine tab and Metronidazol tab were not

available at Chachi HSC.

e) Eligible Couple Register, Family planning Service register and JSY Card was not

available at both HSCs Chachi & Chhatarwar whereas Stock register, Formats for monthly

reporting and Cash book of Untied funds were not available at Chachi HSC.

f) Building of both Sub Centres Chachi & Chhatarwar was not maintained properly for clinic

purpose. Posters for public awareness were not properly displayed on the wall of the

centre. There was lack of checking/verification of service register by PHC/District officials/

supervisor/DPHN/BEE etc.

g) The post of Heath Worker (Male) was lying vacant since more than 5 years in both SCs.

10. Community Satisfaction on overall service:

i. HSC’s Service:

a) 20 mothers were interviewed to assess their opinion regarding quality of services

rendered by ANMs in the visited centres. The interviewed mothers of both visited HSCs

Chachi & Chhatarwar replied that ANM were not available when needed, but they provided

IFA and TT to pregnant women if available at the time.

b) Home deliveries were conducted by trained person with using DDK. Most of Mothers told

that they had no idea about ARI sufficiently. Performance of family planning was very poor.

Necessary information need to be given to mother by the concerned ANM and ASHAs.

ii. PHC Staff and Medical Officer:

The knowledge and opinion of the community regarding the behaviour and stay at PHC of

PHC staff, regular visit of MO at CHCs, utilizing sufficient time in examine the patient and

disbursing drugs were found satisfactory. It was observed that the services under MCH

Scheme to pregnant women, recently delivered women and to the children needed more

attention to improve the quality. However, MO of Satgawa CHC visited his villages in

regular basis.

11. Sample Verification of Family Welfare Acceptors:

a) Out of 115 selected Family planning acceptors, 59 (51.3%) could be contacted in the

district. During sample verification of sterilisation and IUD acceptors. It was found that age

of spouse of 43 acceptors and age of last child in 22 acceptors were wrongly recorded.

b) 35 (70%) acceptors replied that they had received follow up services by the health

personnel.

c) 2 OP users were contacted and both users denied receiving the service. Similarly, all 7

contacted Nirodh users denied receiving the services.

d) Most of the contacted sterilization acceptors received full compensation money.

e) 6 contacted child immunisation beneficiaries confirmed receiving the doses.

12. Maintenance of Registers & Records:

a) ANC / PNC and Children immunization Register were maintained properly. But

Sterilization, Cu-T, OP & Nirodh distribution registers were not maintained properly at the

visited centres.

b) JSY payment register was also not maintained properly. Complete addresses of the

beneficiaries were not recorded and in some cases, no address was recorded.

c) Stock Register in respect of family welfare items were not maintained properly. Date of

Manufacturing & Expiry, Batch No., Model No. of Cu-T etc were not recorded.

13. Other Observations:

a) The condition of labour room and maternity ward was very poor and unhygienic at both

CHCs Jainagar and Satgawa. No privacy of mother was maintained as there was no

restriction to enter labour room for general public.

b) OP & Nirodh distribution at most of the SC was very poor.

c) The team observed that there was no regular supervision or cross checking in the

activities carried out under NRHM at PHC and SC level. As a result, a lot of discrepancies

were found in the records and registers in respect of financial matter as well as physical

performance.

d) The team has also observed that the performance reports were not being prepared at

Sub Centres and PHCs as per HIMS formats.

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