Study of Civil Dispensaries & Urban-Primary Health Centers ...

Study of Civil Dispensaries &

Urban-Primary Health Centers in

Madhya Pradesh

Project Report

Atal Bihari Vajpayee Institute of Good

Governance & Policy Analysis

FINAL REPORT

Study of Civil Dispensaries &

Urban-Primary Health Centres in

Madhya Pradesh

September 2018

STATE HEALTH RESOURCE CENTER (SHRC)

ATAL BIHARI VAJPAYEE INSTITUTE OF GOOD GOVERNANCE

AND POLICY ANALYSIS

A Study of Civil Dispensaries & Urban Primary Health Centres in Madhya Pradesh 2018

Atal Bihari Vajpayee Institute of Good Governance and Policy Analysis

Page 2 of 84

About the Report

This study report is an attempt to bridge the information gap on current situation of

urban health initiatives undertaken by the Urban Health Mission Madhya Pradesh. The

State Health Resource Centre is the technical support unit for Department of Health

and Family Welfare, Government of Madhya Pradesh. Based on their request to

conduct study and develop report reflecting current situation of Civil Dispensaries and

Urban Primary Health Centre’s. The basis of the current report is analysis of

department records, Health Portal HMIS and facility survey data. It is part of a series

of SHRC Reports for strengthening the Public Health System of Madhya Pradesh.

Ms. Preeti Upadhyay Advisor- SHRC prepared the report under the guidance of Mr.

Madan Mohan Upadhyay, Principal Advisor- Social Sector Development and Mr.

Akhilesh Argal, Director AIGGPA.

Study Team

Mr. Madan Mohan Upadhyay Principal Advisor

Ms. Preeti Upadhyay Advisor

Dr. Konika Jain Research Associate

Dr. Sapna Anchal Research Associate

Dr. Sumit Chouhan Research Associate

Dr. Karan Dandotiya Research Associate

Ms. Leena Singh Research Associate



Page 3 of 84

Abbreviation

ANC Antenatal Care

ANM Auxiliary Nurse Midwife

CD Civil Dispensary

DHFW Department of Health and Family Welfare

HCF Health Care Facility

IEC Information Education Communication

IUD Intra Uterine Device

JNNURM Jawaharlal Nehru National Urban Renewal Mission

MCH Maternal and Child Health

MoHFW Ministry of Health and Family Welfare

MP Madhya Pradesh

MPW Multi-Purpose Worker

NUHM National Urban Health Mission

UPHC Urban Primary Health Centre



Page 4 of 84

Executive Summary

Background:

With the introduction of the NUHM, the state systematically addresses the issues of

primary health care services in urban areas in year 2013. Similar to the rural PHC, the

urban PHCs envisaged as the nodal point for delivery of health care services under the

NUHM. Government of India has recognised that urban areas are shrinking due to

increased population and have congested especially slum and slum like habitations,

and with poor or no proper sanitation, water supply, garbage disposal mechanism

there is resurgence in urban infectious diseases in these areas. It is expected that

Urban PHC’s shall be responsible for health needs/vulnerability assessment, facility

based service provision, outreach services, referral services, disease surveillance and

epidemic control and convergence with other national programs.

This study conducted to get an overview of the current situation of civil dispensaries

and urban primary health centers in the state. The special focus is to understand the

availability of health facilities, physical infrastructure and human resource and services

provisions.

Quantitative and qualitative data collected and analyzed to meet the study objectives.

The In-depth discussion and observation tools were prepared for facility survey. The

staff and OPD related HMIS records collected from health department. Detailed report

based on the primary and secondary data has tried to capture the following:

Geo location of the Civil Dispensary and Urban Primary Health Centers in MP.

Status of human resource and out patient load as per the records of the HMIS

portal.

Availability and accesses to infrastructure, services and management of the

selected urban primary health centers for the study.

Major Findings: Service Records

The urban health centers were Geo-mapped as per HMIS records of the existing

health facilities. The geo mapping of the health facilities reveal that urban health

Centres are prominently present in the densely populated urban areas. Data from

Gwalior, Bhopal, Indore, Jabalpur and Sagar regions show high density of urban

health facilities. However, substantial non-functional health facilities are also located in

the same regions.

The study highlights that there is great shortage of manpower at UPHC. In total 125

UPHC, only 537 persons posted which is about 30.7 percent of the recommended staff

strength. The study finds that staff is very limited as compared to the responsibility

and workload assigned to the UPHC and Civil Dispensaries. There are only 54 Medical

officers and 9 contractual Medical officers in total 109 Civil Dispensaries covered that



Page 5 of 84

means the functional status of CDs are doubtful. The proportion of non-functional Civil

Dispensaries are large than Urban-PHC in Madhya Pradesh.

The HMIS OPD record of last year reveals about the types of health related reasons

for which patients visited the urban health facilities. As per the OPD records people

visited health facility for general health reasons, treatment of hypertension, diabetes,

ophthalmic care, dental care and general illness including psychological and emotional

ones. About 170 health centers inclusive of Urban PHCs and Civil Dispensaries provide

services related to maternal health, child health & nutrition and Vector borne disease.

The essential services confined to general consultation and they mostly referred to

nearby government health facility.

Major Findings: Facility Survey

All the surveyed Urban-PHCs are situated within the prescribed limit of distance and

they either are situated within slum or are adjacent to them. However, it was difficult

to locate some of the facilities due to incorrect location address and absence of

direction signs. Facilities like separate dressing room, seating arrangement and

appropriate waiting space were not available in all the facilities. The provision of safe

drinking water for staff and patients was not found in a portion of the health facilities.

It is important to mention here that internet facility was also not available at any

facility. Facilities follow the practice of manual registration of OPD cases. The facilities

do not have separate arrangement for examination of patients related to RCH and this

highlights the fact that there is no emphasis on arrangements for privacy and

confidentiality. The government has attempted to establish UPHCs and other health

facilities in the urban areas. At present majority of the facilities are being run from the

rented buildings that were not constructed for running health facilities and that is the

reason of shortage of space for almost all the activities.

Majority of the Urban-PHCs follow the GOI pattern for operating the OPD services and

are providing service from12 noon to 8 pm. Few UPHCs depend on the staff attached

to the facility and due to this reason, the facilities are forced to operate for a lesser

period of time that is 4 hours in a day. Civil Dispensaries have a different practice and

the either provide OPD services in the morning or in morning or evening both.

At present, most of the health staff working in urban health facilities has very limited

exposure and knowledge about their wider role of UPHC and other urban health

institutions. Data also highlights the fact that limited efforts taken to protect the staff

from health risks.

At present, the health facilities lack basic infrastructure to offer basic lab services. This

forces the doctors and health staff either to refer the cases to district hospital or to get

tests done through private pathology. Moreover, almost all the facilities face the

problem of limited or non-availability of necessary equipment.



Page 6 of 84

The situation of availability of basic drugs is much better than other indicators. Health

staff informed that basic drugs are always available in the facility. In case of shortage

or requirement of any particular drug, demand of drugs to the district authorities that

is send and these drugs are available to the facility within 7-10 days.

Study also identified key barriers vis-à-vis access to basic services provided by urban

health facilities and the barriers are linked to the lack of basic physical amenities in the

buildings in terms of adequate space for different service, provision for privacy and

confidentiality, separate toilets, safe drinking water. Lack of sufficient staff also

increases the workload on the existing staff and pending decisions demotivates them

from taking initiatives.

The status of managing and disposing biomedical waste is very poor due to shortage

of staff, proper orientation of existing staff, and lack of necessary facilities. Proper

segregation of the biomedical waste was not in place. The sharp edge waste items

were mixed with the other waste items. In some facilities, infectious and noninfectious

waste was observed in the same bins. The study also found that the Medical Officers

posted in Urban-PHC were also not aware about fund status.

Conclusion

Government has attempted to establish UPHC and equip other urban Civil Dispensaries

so that they are able to cater health services to most vulnerable population of urban

areas of the state. At present the Urban Health facilities are in their nascent stage and

lack basic orientation, infrastructure and equipment necessary run an UPHC. All these

urban health facilities require proper attention and support from the existing health

management system. Identifying proper and specious building, posting proper and

sufficient staff and appropriate training and orientation is necessary to run the UPHC

as per the expectations of National Health Mission. Government need to mainstream

the process of planning for extending health services to urban poor. It becomes more

important when the shift from rural to urban areas is very rapid and majority of the

distressed rural population is migrating and coming as vulnerable and deprived

population of the urban slums.



Page 7 of 84

Recommendations

Based on study findings, the suggested recommendations are as below:

1. Administration: During the process of verification, some of the facilities found

relocated or closed. It is very important to verify all the functional Civil Dispensaries

and Urban PHCs in the state. It revealed that staff posted in the Urban PHCs and Civil

Dispensaries are not full time staff and thus are under multiple administrative control.

It is worth recommending here to have only one administrative control at district level

to avoid multiple instructions.

2. Access and Infrastructure: Study recommends that UPHC and CDs to have separate

and proper room for consultation, dressing, pharmacy and lab with seating

arrangements for the patients. Ramp or hand railing, proper light and ventilation in

the facility must be ensure before finalization of the Structure. Regular maintenance of

the government buildings (majority of Civil Dispensaries) is highly recommended as it

creates a bad visual and environmental impact on the staff and patient apart from

other problem.

3. Human Resource/Health Staff: In order to improve the health care services provided

by the Civil Dispensaries and Urban-PHCs, recruitment and posting of staff as per

norms and capacity building needs to be done on priority basis.

4. Service Provision: Basic laboratory and required equipment’s must be provided to all

the facilities for timely identification, diagnosis and treatment to avoid undue pressure

in district hospitals. National health programme guidelines need to be followed for

implementation at the urban centers. To avoid delays and non-availability of drugs and

equipment at the centers, the provision of advance planning and demand should be

made.

5. Convergence and Partnership: This is one of the significant areas that needs to be

explored by the department. It is recommended to explore potential partnerships

available at district level. It could be in primary diagnostic area like basic pathological

tests and digital X-ray. It would help by nominating/appointing the state and district

level nodal officers.

6. Fund: Comprehensive mapping of activities and financial planning should be done in

coordination with NUHM i.e. multiple PIP of national programme, NHM, UHM should be

avoided. Electronic transfers of funds must be brought in practice.



Page 8 of 84

Contents

1. Background ................................................................................................... 9

2. Study - Present Situation of Civil Dispensary and Urban-PHC .................. 11

2.1 Study Objectives ....................................................................................... 11

2.2. Methodology ............................................................................................ 12

2.2.1 Service Records .................................................................................. 12

2.2.2 Facility Survey ..................................................................................... 12

2.2.3 Execution Steps .................................................................................. 13

3. Findings - Service Records ......................................................................... 15

3.1 Geo-mapping of Civil Dispensaries and Urban-PHCs ...................................... 15

3.2 Status of Human Resource ......................................................................... 17

3.3 Service Provision ....................................................................................... 22

4. Findings - Facility Survey ........................................................................... 25

4.1 Infrastructure ............................................................................................ 25

4.2 Human Resource ....................................................................................... 30

4.3 Service Provision ....................................................................................... 32

4.5 Referral Services ....................................................................................... 45

4.6 Management ............................................................................................. 46

4.7 Convergence and Partnership ..................................................................... 52

5. Conclusion ................................................................................................... 53

6. Recommendations ...................................................................................... 55

7. Limitations .................................................................................................. 57

8. References .................................................................................................. 58

Annexure ......................................................................................................... 59



Page 9 of 84

1. Background

The Bhore Committee, in 1946, introduced the Primary Health Centres in India to

provide an integrated curative and preventive health care to rural population. In urban

areas there have not been any coordinated efforts for primary health care. Urban

India have had many versions of the PHC, varying from state to state under various

projects, providing a range of services such as urban health posts, urban health and

family welfare centres, urban health centres and civil hospitals. It is important to

mention here that all such health services in urban areas have been sporadic and

unsystematic in their population coverage, service package and locations.

Urbanization is one of the most significant demographic trends of the 21st century.

Unplanned and rapid urbanization has led to massive growth in the number of urban

poor population, especially those living in slum areas. However, most of the Indian

towns, lack the necessary infrastructure in terms of proper housing, water and

sanitation, basic services such as health care and education to accommodate and

meet the needs of poor migrants. The poor living conditions have implications for

health, wellbeing and productivity. While on one hand the cities are considered full of

opportunities and affluence, paradoxically they become hubs of marginalization,

poverty and disease.

The urban poor not only suffer from poor health status with higher burdens of

mortality, morbidity and under-nutrition compared to rest of the urban population but

also the incidence of vector borne diseases, tuberculosis and respiratory infections are

significantly higher (WHO, 2009). Despite the supposed proximity of the urban poor to

health facilities, their access to these is severely restricted. Social exclusion, lack of

information, unavailability of assistance at the secondary and tertiary hospitals further

restricts their access to health care services. Ineffective outreach and weak referral

system inhibits them from accessing the available healthcare facilities. The lack of

economic resources limits their access to the available private facilities. Keeping this in

view, Government of India approved the Urban Health Mission as a sub-mission of

National Health Mission (NHM) on 1st May 2013. The objective of the National

Urban Health Mission is to address the primary health care needs of the urban

poor and marginalized population.

It is clear from NUHM guidelines that the U-PHC may cater to a slum population

ranging from 25,000 to 30,000. The guidelines also specify that depending on the

spatial distribution of the slum population, the population covered by a U-PHC may

vary from 50,000 for cities with sparse slum population to 75,000 for highly

concentrated slums. Centre, through NUHM has made it clear that the UPHC must be

located within a distance of not more than ½ a kilometre from a slum or slum-like

habitation, to ensure easy access by the most vulnerable of the urban population.



Page 10 of 84

The guidelines strictly clarify that the hours of operation of the UPHC must enable the

urban working population to conveniently access the UPHC. With this precondition the

NUHM has given liberty to state for providing 8 hours of service, which is convenient

to the community it caters to. NUHM has recommended that the U-PHC should

preferably operate from 12 noon to 8 pm. If states opt for dual shifts, this shall entail

employing additional staff. High caseloads may be a criterion for allocating additional

staff to UPHCs. NUHM has also suggested staff pattern for U-PHC. As per the

suggestion of NUHM there should be One MO I/C, one part time MO, One LHV, Nurse,

Lab Technician, Pharmacist, Public Health Manager/ Mobilization Officer, M & E Unit, 3

Support Staff and 3 to 5 ANMs.

National Urban Health Mission envisages to cater the health care needs of the

population with special focus on urban poor, by making available essential primary

health care services. This will be achieved by strengthening the existing health care

service delivery system, targeting the people living in slums and converging with

various schemes relating to wider determinants of health like drinking water,

sanitation, school education, etc. programme implemented by the Ministries of Urban

Development, Housing & Urban Poverty Alleviation, Human Resource Development

and Women & Child Development.

The framework of the National Urban Health Mission visualizes provision of primary

healthcare to the slum dwellers and vulnerable groups through targeted outreach

services. Unlike in rural areas, sub-centers are not being set up in the urban areas as

distances are relatively small and transportation facilities are easily available. While

routine health services at the Urban-PHCs, package of certain identified services would

be provided through targeted outreach services in non-accessible clusters. ANM would

provide the outreach services to these vulnerable populations in slum areas. In

addition, special outreach services would also be organized for these identified slum &

vulnerable population pockets periodically as per the specific local healthcare needs.

The National Health Mission (NHM) has identified following segments of population as

high focus clusters that are in line with National Health Policy 2017:

Urban Poor Population living in listed and unlisted slums

All other vulnerable population such as homeless, rag-pickers, street

children, rickshaw pullers, construction and brick and lime kiln workers, sex

workers, and other temporary migrants.

Public health thrust on sanitation, clean drinking water, vector control, etc.

Strengthening public health capacity of urban local bodies.

Given the large presence of private sector in urban areas, national Health Policy 2017

also recommends exploring the possibilities of developing sustainable models of

partnership with for profit and not for profit sector for urban health care delivery.



Page 11 of 84

2. Study - Present Situation of Civil Dispensary and Urban-PHC

The aim of National Urban Health Mission is to provide comprehensive preventive,

promotive and no domiciliary curative care services to urban poor population. It is

expected from urban primary health centers to provide health services like OPD

(consultation), basic diagnosis services, drug /contraceptive dispensing and delivery of

Reproductive & Child Health (RCH) care services including preventive and promotive

care for communicable and non-communicable diseases.

In Madhya Pradesh, Urban Health Mission began its operation since its inception in

year 2013. Prior to urban health mission, the Civil Dispensaries were already

established in urban areas for providing primary health care services. Under urban

health mission, new Urban Primary Health Centres were created in addition to Civil

Dispensaries to address the health needs of slum population. In order to understand

the current situation of Civil Dispensaries and urban primary health centers in Madhya

Pradesh, this study was conceptualized.

The present report is the outcome of the study conducted by AIGGPA for Department

of Health and Family Welfare Madhya Pradesh to get an overview of the current

situation of civil dispensaries and urban primary health centers. The special focus of

the study is to understand the availability of health facilities, physical infrastructure,

human resources and service provisions.

2.1 Study Objectives

The main purpose of the study is to undertake situation analysis of Civil Dispensaries

and Urban Primary Health Centers in Madhya Pradesh.

The specific objectives of the study were:

1. To Geo-map all the Civil Dispensaries and Urban-PHCs in Madhya Pradesh.

2. To assess the human resource gaps (against NUHM norms) in all Civil

Dispensaries and Urban-PHCs in the state.

3. To study the OPD records of all Civil Dispensaries and Urban-PHCs in last

one year from MP Health Management Information System database.

4. To study the services related barriers faced by staff of Civil Dispensaries and

Urban-PHCs in the state.

5. To identify the potential stakeholders, service collaborates (Public Private

Partner) and referral points of selected Civil Dispensaries and Urban-PHCs in

the state.



Page 12 of 84

2.2. Methodology

The current study is primarily a cross section study, a mix of primary and secondary

data analysis. In study, quantitative and qualitative data collected and analyzed to

meet the study objectives.

2.2.1 Service Records

The records related to Human Resource of Civil Dispensaries and urban primary health

centers from Department of Health and Family Welfare Madhya Pradesh and National

Health Mission MP collected and analyzed. In addition, Health Management

Information System (HMIS) database of last one year (April 2017 to March 2018)

collected to understand the OPD profile of patients who visited Civil Dispensaries and

Urban-PHCs. The discrepancies related to number of Civil Dispensaries and Urban-

PHCs were observed during data analysis. Subsequently, district wise data

triangulation exercise was performed to verify the facility name from HMIS and HR

records to ensure the actual number of Civil Dispensaries and Urban-PHCs reported in

records.

2.2.2 Facility Survey

In addition to service records, a survey of urban health facilities was also conducted in

the state. Considering the representation of all the 10 divisions, 11 districts were

selected randomly. Further, within the selected districts, 1 Civil Dispensary and 1

Urban-PHC were chosen randomly. The facility survey was conducted at the following

locations in May 2018:

Table 1: List of facility survey locations

Sl.

No.

Division Survey Locations

District Civil Dispensary Urban-PHC

1 Bhopal Bhopal 1. CD Anand Nagar 1. Sai baba Nagar

2 Chambal Bhind 2. CD Bhind 2. B.T.I. Road

3 Gwalior Gwalior 3. CD Palka Bazar -

4. CD Gol Pahariya -

4 Indore Indore 5. CD Bhanwarkuan -

Dhar 6. CD Branch 2 3. Ganji Khana

5 Jabalpur Jabalpur 7. CD Gohalpur Ward 4. Ghamapur

6 Narmadapuram Harda - 5. Harda

7 Rewa Rewa 8. CD Univ Rewa 6. Bodabag

8 Sagar Sagar 9. CD Bhagwanganj 7. Bina

9 Shahdol Umaria - 8. Loharganj

10 Ujjain Ujjain 10. CD Madhavnagar 9. Pawasa

Note: Civil Dispensary is not available in any of the districts in Narmadapuram & Shahdol Divisions.

One Civil Dispensary from Indore was selected randomly considering the size of the town.

https://simple.wikipedia.org/w/index.php?title=Narmadapuram_division&action=edit&redlink=1

https://simple.wikipedia.org/w/index.php?title=Rewa_division&action=edit&redlink=1

https://simple.wikipedia.org/w/index.php?title=Sagar_division&action=edit&redlink=1

https://simple.wikipedia.org/w/index.php?title=Shahdol_division&action=edit&redlink=1

https://simple.wikipedia.org/w/index.php?title=Ujjain_division&action=edit&redlink=1



Page 13 of 84

2.2.3 Execution Steps

2.2.3.1 Development of tool and testing:

The study tools i.e. In-depth Interview guideline consisting of structured, semi-

structured and open-ended questions were developed for collection of primary data.

The In-depth interview guideline developed by AIGGPA in consultation with National

Health Systems Resource Centre (NHSRC) New Delhi and R.D. Gardi Medical Collage

Ujjain. The draft study tool was shared with Urban Health Mission Government of

Madhya Pradesh for their inputs. The study tool was finalized after incorporating all

the inputs. The AIGGPA team also visited Sehore district to test the study tool before

commencement of survey.

2.2.3.2 Training of study team:

A team of four members having community medicine educational background was

constitutes to conduct the field operation. In May 2018, one day orientation for study

team was conducted at AIGGPA wherein representative from Urban Health Mission

GoMP was also present. The training included classroom training for understanding the

Urban Health Mission operations, study objectives and data collection procedure. The

detail discussion on in-depth-guideline (study tool) was done in participatory way.

Eventually, study team made a field visit at Civil Dispensary Bhopal to have an idea

about working of Civil Dispensary and its operations.

2.2.3.3 Data collection:

Primary data were collected by the study team in the month of May 2018. The AIGGPA

representative also visited the field during the survey period to ensure the quality of

data and hand holding of the study team.

From secondary sources, Civil Dispensary and Urban-PHC wise health staff status, OPD

records from Health Management Information System (HMIS), Directorate of Health

and Family Welfare and National Health Mission Madhya Pradesh offices were

collected. Following records were referred for secondary data analysis:

i. Directorate of Health and Family Welfare Madhya Pradesh: List of Medical

officers working in Civil Dispensaries in Madhya Pradesh

ii. Health Management Information System (HMIS): List of Civil Dispensary and

Urban PHC

iii. Health Management Information System (HMIS): Civil Dispensary and Urban

PHC wise OPD summary of last one year 2017-18

iv. HR Department NHM Madhya Pradesh: List of health staff posted in Civil

Dispensaries and Urban PHCs



Page 14 of 84

2.2.3.4 Data processing and Report development:

After collection of primary and secondary data from various sources, electronic

transfer of primary data and data compilation was done by the study team. The

Primary tables were generated as per the analysis plan. The primary data analysis was

limited to information available through interaction with the health staff presents at

the time of facility survey. The frequency tables with respect to infrastructure, human

resource, health services, management of facility and partnership were generated.

The analysis plan developed based on the study objectives and further discussed with

the Department of Urban Health. Accordingly, primary and secondary data analyses

were done. The presentation of data in the form of summary tables, detail tables with

appropriate illustration was developed. Subsequently, the detailed study report was

prepared as per the chapter plan of the study.



Page 15 of 84

3. Findings - Service Records

3.1 Geo-mapping of Civil Dispensaries and Urban-PHCs

The first objective of the study is to geo-map all the Civil Dispensaries and Urban-

PHCs in Madhya Pradesh. The map below shows the presence of Civil Dispensary and

Urban-PHC across the state. The map below indicates the functional and non-

functional status of Civil Dispensaries and urban-PHCs which is based on the HMIS and

HR records. It is evident from the map that the presence of urban health centres is

prominent in the densely populated urban area. Data from the Gwalior, Bhopal,

Indore, Jabalpur and Sagar regions show the high density of urban health facilities.

However, substantial non-functional health facilities are also located in the same

regions.

Figure 3.1(a): Distribution of Civil Dispensary and Urban-PHCs in Madhya Pradesh



Page 16 of 84

Figure 3.1(b): Distribution of all functional Civil Dispensaries and Urban-PHCs in

Madhya Pradesh

Figure 3.1(c): Distribution of all the non-functional Civil Dispensaries and Urban-PHCs

in Madhya Pradesh



Page 17 of 84

62

111

36 14

68

244

2 9 6 1 2

40 38

Medical

Officer

Staff Nurse Lab

Technician

Pharmacist LDC/MIS ANM Other

Urban-PHC Civil Dispensary

3.2 Status of Human Resource

One of the main objectives of the study was to understand the human resource gaps

in Civil Dispensary and Urban-PHC across state. The HR data received from NHM

about health staff was analysed in line with NUHM guidelines. The guideline1 suggests

that the health facility should have Medical Officer, Pharmacist, Lab Technician, LHV,

Account keeping & MIS, Public Health Manager, Community Mobiliser, Staff Nurse,

ANM and support staff. The figure below shows the current position of health staff of

Urban-PHCs and Civil Dispensaries in Madhya Pradesh.

Figure 3.2 (a) Who Provides health services in Urban-PHCs and Civil Dispensaries?

No of health staff posted in 125 Urban PHC and 25 Civil Dispensaries according to NHM records

According to NHM, total 633 health staff posted in 125 Urban-PHCs and 25 Civil

Dispensaries in 46 districts in Madhya Pradesh. The figure above shows the category

wise health staff posted in Urban-PHCs and Civil Dispensaries.

In case of Urban-PHC, total 537 health staff posted in 125 centres. The number of

ANM and staff nurse is higher than other health staff posted in Urban-PHC. However,

number of Lab Technician, Pharmacist is less than Medical Office and MIS in Urban-

PHCs. The figure above revels that there is a huge gap for the position of medical

officer, lab technician and Pharmacist. The number of health staff posted in urban

health centres shows the demand of the health staff.

According to NHM-HR records, total 96 health staff is posted in 25 Civil Dispensaries in

Madhya Pradesh. The posting of other staff category includes Orthopedic Specialist,

Ophthalmic & Assistant, Dental Attendant, Dresser, Female Health Supervisor,

Multipurpose Worker Male MPW, and Support Staff, non-Medical Assistant, Peon &

Sweeper, Ward boy, Mess Servant and Aaya & Dai show area of concern. In HR

records, lot of ambiguity related to designation of paramedical health staff also

noticed.

1 Quality Standards for Urban Primary Health Centre, October 2015http://nhm.gov.in/images/pdf/NUHM/



Page 18 of 84

1

1

1

2

1

2

3

5

8

11

19

1

1

1

1

1

1

1

2

2

3

5

1

1

1

2

2

3

7

10

13

15

18

Badwani

Bhind

Chhindwara

Ratlam

Satna

Sehore

Tikamgarh

Khargone

Rewa

Dhar

Ujjain

Aliragpur

Chhatarpur

Guna

Datia

Rajgarh

Morena

Sagar

Jabalpur

Indore

Gwalior

Bhopal

No of Civil Dispensary No of MO Posted

According to the reports from directorate of health, total 92 Civil Dispensaries exists in

22 districts. The figure below shows that in 11 districts, the post of medical officer is

vacant. Four districts namely Alirajpur, Chhatarpur, Guna and Datia are having one

Medical Officer for each of the Civil Dispensary. In 6 districts, there is no medical

officer posted. It is interesting to note that Bhopal has 18 Civil Dispensaries with

posting of 19 medical officers.

Figure 3.2 (b) Is Medical Officer posted in all the Civil Dispensaries?

District wise number of Civil Dispensaries and number of medical officers posted



Page 19 of 84

An attempt has been made in the study to understand the current status of medical

officer and other staff posted in Civil Dispensaries using administrative records of

directorate of health services and office of national health mission. According to the

health department and NHM records, total 106 Civil Dispensaries exist in 22 districts.

Out of total 22 districts, 10 districts did not show any health staffs posted in 18 Civil

Dispensaries.

Table 2: District wise number of Medical Officer (MO) posted in Civil Dispensary

according to health department and NHM

Sl.

No.

Districts No of Civil

Dispensary

MO

(Regular)

MO

(NHM)

Other Staff

(NHM)

1 Alirajpur 1 1 0 0

2 Badwani 1 0 0 0

3 Bhind 1 0 0 0

4 Bhopal 21 19 0 19

5 Chhatarpur 1 1 0 0

6 Chhindwara 1 0 0 0

7 Datia 2 2 0 0

8 Dhar 3 0 0 0

9 Guna 1 1 0 0

10 Gwalior 19 11 4 14

11 Indore 19 8 5 51

12 Jabalpur 10 5 0 0

13 Khargone 2 0 0 0

14 Morena 3 2 0 0

15 Rajgarh 2 1 0 0

16 Ratlam 1 0 0 0

17 Rewa 2 0 0 0

18 Sagar 7 3 0 0

19 Satna 2 0 0 3

20 Sehore 1 0 0 0

21 Tikamgarh 1 0 0 0

22 Ujjain 5 0 0 0

Total 106 54 9 87

In order to understand the human resource gap in Urban-PHC, the HR reports of NHM

were analyzed. Urban Health Mission has suggested minimum number of staff in

different categories to run an Urban PHC. The finding suggests that the many Urban-

PHCs do not have sufficient staff like Medical Officer, Staff Nurse, Lab Technician,

Pharmacist, LDC/MIS and ANM. Figure 3.2 (c) shows the availability of staff with

Urban PHC.



Page 20 of 84

Figure 3.2 (c) Whether Urban-PHCs are equipped with minimum required health staff?

Number of Urban-PHC with minimum required against existing health staff

According to NHM HR-Report, total 125 Urban-PHCs reported availability of at least

one health staff in the facility. The figure above shows the gap of health staff

according to different category. The figure 3.2 (c) above explains the status of existing

staff against required minimum staff as per the norms of the urban health mission. It

is evident from the above figure that there is a shortage of the staff category in all the

125 Urban PHCs. The human resource gap is three fold in case of Lab technician, half

of the Urban-PHC does not have Medical Officers and 35 Urban-PHC with non-

availability of ANM is a matter of concern.

125

250

375

125 125 125

375

125 125

62

2

111

0

36 14

244

0

68

MO (FT) MO(PT) Nurse LHV LabTechnician

Pharmacist ANM PHM/CM M & E

Minimum Required Staff Existing Staff



Page 21 of 84

Figure 3.2 (d) Type of health staff posted at Urban-PHCs and Civil dispensaries

Number and type of health staff with nature of appointment

The figure 3.2 (d) above explains the status of existing staff according to JD (National

Urban Mission) Office NHM. According to JD Office records, total 1037 heath staff

posted in 245 civil dispensaries and Urban PHCs in Madhya Pradesh. Out of total 1037

health staff 479 staff members are regular and 558 staff members are in contractual.

The figure 3.2 (d) shows the designation wise health staff with regular post and

contractual post.

It is evident from the above figure that the contractual staff in terms of medical

officer, staff nurse and ANM is higher than regular position. However, other staff in

regular scale is higher than contractual in civil dispensaries and Urban PHCs.

4 15 10

51

105

67

36 14

177

0

51

1

105

235

17 30

0

119

Specialist MO PHM Staff Nurse ANM Pharmasist LabTechnician

LHV Other staff

Regular Contractual



Page 22 of 84

Update in HMIS 69%

No Update in HMIS 31%

Figure 3.3 (a): whether all the facilities are functional?

3.3 Service Provision

The Health Management

Information System (HMIS)

data from Department of

Health and Family Welfare

Government of Madhya

Pradesh collected and

analyzed to understand the

service provision in Civil

Dispensaries and urban-

PHCs through outpatient

records. The last one year

(April 2017 to March 2018)

data shows in Figure 3.3 (a)

that out of total 245 health

facilities, 75 (31%) facilities

were not registered any

outpatient record in HMIS whereas, 170 (69%) facilities were functional and engaged

in outpatient services (OPD) with regular update records in HMIS.

The table below shows that the proportion of non-functional Civil Dispensaries are

large than Urban-PHC in Madhya Pradesh. Out of total 109, only 71 Civil Dispensaries

are functional and register outpatient records in HMIS whereas, only 4 Urban-PHCs

have not updated outpatient records in last year HMIS.

Table 3: Status of HMIS Update health facility

Facility Type Update in HMIS

No. (Percent)

No Update in HMIS

No. (Percent)

Total

Civil Dispensary 38 (35%) 71 (65%) 109

Urban-PHC 132 (97%) 4 (3%) 136

Total 170 (69%) 75 (31%) 245

The table 4 shows that volume of OPD in 170 facilities. The HMIS outpatient records

show that more than 18 lakh patients visited urban health facilities to avail primary

health care services in Madhya Pradesh. However, more than 50 thousand patient

benefited through Ayush facilities.



Page 23 of 84

Table 4: Status of OPD in HMIS Update Health facility

Facility Type Outpatient registered in HMIS

(Year 2017-18)

Allopathic facility Ayush facility

No. of Facility No. of Patients No. of facility No. of Patients

Civil Dispensary 38 125,614 5 23,663

Urban-PHC 132 1,678,742 12 30,985

Total 170 1,804,356 17 54,648

Although, provision of detail outpatient registration is available in HMIS but the details

was not registered by all the Civil Dispensary and Urban-PHCs. Out of total 170

functional health facilities only 99 (11 Civil Dispensaries and 88 Urban-PHCs) facilities

updated OPD detail in last year HMIS. Out of total 132 Urban-PHCs only 88 Urban-

PHCs updated detail outpatient records in HMIS. However, number of Civil

Dispensaries which update HMIS is not very encouraging and only 11 Civil

Dispensaries registered details of outpatient records in HMIS during last year.

Table 5: Status of OPD detail

Facility Type Number of health facilities (Percent)

Update OPD detail in

HMIS

Not Update OPD detail in

HMIS

Total

Civil Dispensary 11 (10%) 98 (90%) 109

Urban-PHC 88 (65%) 48 (35%) 136

Total 99 (40%) 146 (60%) 245

The report of Health Management Information System also shows the outpatient cases

registered in Civil Dispensaries and Urban-PHCs.



Page 24 of 84

27,099

20,890 18,141

12,573

1,588 1,392 596 283

Hypertension Diabetes OphthalmicRelated

Dental Mental illness Acute HeartDiseases

Epilepsy Stroke(Paralysis)

Diabetes 2%

Hypertension 2%

Ophthalmic Related

1%

Dental 1%

Other 94%

Figure 3.3 (b): Various reasons to visit Urban-PHCs

The classification of OPD records is mentioned the figure 3.3 (b) below.

The Figure revels that

the detail of outpatient

records of HMIS from 99

health facilities. In 99

facilities out of total 13

Lakh outpatient records

94% patients visited

health facility for general

health reasons in last

one year. The percent of

diabetes (2%),

hypertension (2%),

ophthalmic (1%) and

dental reason (1%)

cannot be ignored.

The volume of OPD records shows that from 1st April 2017 to 31st March 2018 more

than 27 thousand outpatients visited Urban- PHC for hypertension related reason. The

other health reasons registered were diabetes, ophthalmic and dental. It is important

to notice that substantial outpatient records were found in relation to Mental illness

related followed by Acute Heart Diseases, Epilepsy and Stroke (Paralysis).

Figure 3.3 (c): Why patient visits Urban Primary Health Care Centres?

Disease wise outpatient number registered in HMIS (April'17- March'18)

Urban-PHCs are the nearest health centre so people visit there for all types of health

challenges initial which includes mental illness, acute heart disease, Epilepsy and

stroke. Data presented in the graph 3.3 (c) also highlights this fact.



Page 25 of 84

4. Findings - Facility Survey

Facility survey tried to observe the field level situation in the selected urban health

facilities in the sample area. The focus of the field survey was to observe the physical

infrastructure, human resource, services provided and managed by the facilities.

During discussions opinion were also taken on the difficulties faced and ways to

improve health care services. The current section of the study tries to highlight the

findings of the facility survey.

4.1 Infrastructure

A. Accessibility

An attempt has been made to find out whether the slum population can access health

facilities with suitable timings

conveniently? As per National guideline the

Urban-PHC (Structure) must be located

within a distance not more than ½

kilometers from the slum or similar

habitation to ensure easy access by the

most vulnerable urban population. In

survey, study team observed that all the

Urban-PHCs situated adjacent to the slum

areas and are connected with all-weather

approach road.

In most of the facilities, display boards with

facility name noticed. However, it was

difficult to locate the facility due to incorrect

location address and absence of direction

signs. In Dhar district, the Urban-PHC

GanjiKhana was difficult to locate by study

team

as

there

was

no sign board in front of the building. The

team realized that there is need to put proper

sign boards with directions to identify, locate

facility without hassle. It was mentioned by the

facility providers that in most of the places, the

slum dwellers are not aware of the location of

the facility in their area.



Page 26 of 84

8 9

2

Urban-PHC Civil Dispensary

Figure 4.1 (a): Type of ownership

Govt Building Rented Building

B. OPD Timings

The OPD timing of Urban-PHC should enable the slum population to avail health

services to their convenience. The NUHM guidelines suggest that the OPD timing could

be of 8 hours availability of health services. The recommended OPD timing is 12.00

noon to 8.00 pm.

In the survey, out of total 9 Urban-PHCs, 8 Urban-PHCs follow the fixed timings from

12 noon to 8 pm. Only 1 Urban-

PHC Sagar provides OPD services

from 4 pm to 8 pm because

Medical Officer was attached to

Bina Community Health Center

(CHC) at the time of survey. In

total 10 Civil Dispensaries visited

by the study team, 3 Civil

Dispensaries follow only morning

session i.e. 8 am to 1 pm whereas

7 Civil Dispensaries follow timings

from 8 am to 1 pm and 5 pm to 6 pm.

Thus the morning OPD facilities were found to give 3 hours which is less than the

prescribed 8 hours.

C. Physical Infrastructure

Proper physical infrastructure is significant for health facility to provide health care

services. The study team during the facility survey observed current infrastructure

facilities of selected Urban-PHC and Civil Dispensaries and recorded primarily condition

of building, space arrangement for OPD and other necessary facilities.

All the 9 Urban-PHCs were reported to

have rented building whereas out of 10

Civil Dispensaries only 2 Civil

Dispensaries, (Jabalpur and Sagar

districts) reported rental buildings and

rest 8 Civil Dispensaries have

government building.

In survey, 3 health facilities namely

Civil Dispensary Bhagwanganj in Sagar,

Urban-PHC in Jabalpur and Civil

Dispensary Golpharia in Gwalior run in a double story building wherein the OPD was

located on the first floor. The absence of hassle free entrance and ramps denied easy

access for old and physically challenged patients.

OPD Timing 12 noon to 8.00 pm: 8 Urban-PHCs 4.00 pm to 8.00 pm: 1 Urban-PHC 8.00 am to 1.00 pm: 10 Civil Dispensaries 5.00 pm to 6.00 pm: 7 Civil Dispensaries



Page 27 of 84

19 19 19 19 17 16 15

12 9

2 3 4 7

10

OPDConsultation

room

PharmacyMedicine room

Regular watersupply

Regularelectricity

supply

Dressing room Seatingarrangement

Waitaingspace

Privacy andconfidentiality

Separatetoilets

Yes No

In survey, basic infrastructure facilities were recorded. The figure below shows the

infrastructure of the Urban-PHC and Civil Dispensaries recorded during the survey.

Figure 4.1 (b) Whether health facilities equipped enough in terms of infrastructure?

Number of surveyed health facilities with basic facilities

The key facilities like OPD cum consultation room, pharmacy room found in all the

facility visited. Separate dressing room, seating arrangement and appropriate waiting

space were not found in all the facilities. The health staff posted in all the health

facilities confirmed that facilities have regular water and electricity supply.

In Civil Dispensary Dhar, facility does not have water supply within the premises and

health staff reported that they bring water from nearby hand pump as per their

requirement. The provision of safe drinking water for staff as well as patients was not

found in most of the health facilities. In survey, no separate toilet for men and women

in the facility was one of the major observations in all the facilities.

The absence of separate toilet for male and female is a matter of concern, as patients

have to face difficulty using single toilet. The staff reported that absence of separate

toilet facility for them dismay their long hours of work. The study team also recorded

other supplementary facilities.



Page 28 of 84

18

14

10 9 6 5

3 1

1

5

9 10 13 14

16 18

RegistrationSystem

IEC/BCCmaterial

Citizen Charter Complaint box Suggesation box Internet Computer &accessories

Telephone

Yes No

The figure 4.1 (c) below shows that computer; internet is not available where as IEC

and BCC material found adequately in centers. Manual registration process is followed

in all the facility.

Figure 4.1 (c) Whether health facilities equipped with supplementary facilities?

Number of Health facilitates equipped with supplementary facilities

Key issues related to basic infrastructure reported by health staff were:

1. Dangerous Structure in Jabalpur: In Jabalpur district, the Civil Dispensary building

was found in very bad condition as the building can fall anytime. After enquiry,

health staff responded that formal notice is issued by the local authority to vacate

the building but facility is still operational

in the same building due to local political

influence.

2. Need for Systematic Rent Payment:

There is need for systematic and regular

rent payment provision.

3. Lack of Proper Spaces: In most of the

Urban-PHC buildings, availability of

appropriate space for essential services

was found to be a major issue. Lack of

space leads compromised services as

congested arrangements and

overcrowding of patients. In such

situation, patients and care taker keep

stand for long, major discomfort.



Page 29 of 84

4. Lack of Privacy for Pregnant Women: The reproductive and child health care

services are one of the main health service provisions with maintaining dignity and

privacy of patient. Unfortunate, no emphasis on arrangements for privacy and

confidentiality of the patients found in any of the visited Urban-PHCs.

5. Availability of Safe Drinking Water: Regular water availability was found in all the

facilities visited except Dhar Civil

Dispensary. However, safe drinking water

was absent in almost all the facilities. In

such situation patients forced to drink

unsafe water available in the premises.

The availability of safe drinking water is

possible as it was notice in only one Urban

PHC Pawasa Ujjain.

6. Lack of Separate Male and Female Toilet: One of the essential facility i.e. separate

toilet for male and female was missing in most of the facility visited. Only one

toilet in the premises was found in 11 facilities and it became a common toilet for

all. This is not good for health staff and patients. In Dhar Civil Dispensary, there is

no toilet facility available. The health staff and patients uses the Sulabh Jan

Suvadhaye situated nearby the facility.

Inappropriate constructed toilets, soiled and damaged toilets are wearisome for the

health staff and patients. Importantly, NO

HAND WASH facility arrangements found

in most of the facilities.

7. Unhygienic Environment: Practices

related to hygiene and sanitation were

almost absence in most of the facilities

visited. There is need to make check



Page 30 of 84

13

3

8 7 5

7

14

1 2

15

6

16

11 12 14

12

5

18 17

4

MO (FT) MO (PT) Staff Nurse Pharmacist LabTechnician

LHV ANM PHM/ CM LCD/MIS SupportStaff

Available Not Available

for cleanliness and maintenance of the buildings and its premises. Although most

of the facilities need immediate action to improve cleanliness as maintained by

Ujjain Civil Dispensary Chhatri Chowk.

8. Lack of Telephone and internet Facilities: Some essential facilities like telephone,

internet and computer with accessories are either not available or were not

functional.

4.2 Human Resource

a. Health Staff

According to national indicative norms for Urban-PHCs, a set of health staff was

proposed. In survey, category wise health staff availability was recorded.

Figure 4.2 (a) Whether survey facilities having appropriate health staff?

Number of health facility with and without health staff

The primary data reveals that out of total 19 facilities visited only 13 facilities had full

time medical officers and 3 facilities had part time medical officers. The study team

learnt that 2 Urban-PHCs (Harda and Dhar), 4 Civil Dispensaries (Dhar, Ujjain, Bhind,

Jabalpur) did not have any full time medical officers. These urban health facilities are

managed by paramedical health staff in the facility. However, 6 Civil Dispensaries

reported full time medical officers. In Bhopal Civil Dispensary, medical officer is there

but he has not resumed his service after long leave at the time of survey. One public

health manager/community mobiliser posted in Bhopal Urban-PHC with additional

charge of MIS.



Page 31 of 84

In the total 19 facilities, total 103 health staff recorded. There were 15 fulltime and 7

part time medical officers, 30 ANM, 18 support staff and 11 staff nurse were reported

by the health staff. The table below highlights the position of paramedic staff and

medical officers in the survey facilities. Lack of health staff with specific skill

overburdens the existing staff with multiple tasks and affects quality of service.

Table 6: District wise number of health staff according to category in survey facilities

Sl.

No. District

Facility

type

MO

(FT)

MO

(PT) SN Pharma LT LHV ANM

PHM/

CM MIS

Support

Staff

1 Bhopal

CD 1 - 1 1 - 1 2 - - -

2 UPHC 1 - - - - - 1 1 - 1

3 Harda UPHC - 1 1 - - - 1 - - 1

4 Sagar

CD 1 - - 1 1 - - - - 1

5 UPHC 1 - - - - 1 - - 1 1

6 Indore CD 1 - 1 - 1 - 2 - - 1

7 Dhar

CD - - - - - 1 1 - - -

8 UPHC - - - - - - 2 - - 1

9 Ujjain

CD - 4 1 1 1 1 5 - - 2

10 UPHC 1 - - 1 1 1 2 - - 1

11 Bhind

CD - - - - - - 2 - - 2

12 UPHC 1 1 2 - - - 2 - - -

13 Gwalior

CD 3 - - - - 1 2 - - 1

14 CD 1 - - - - - 2 - - 2

15 Jabalpur

CD - - - 1 - - - - - 1

16 UPHC 1 - 3 - 1 1 3 - 1 1

17 Umaria UPHC 1 - 1 1 - - 3 - - 1

18 Rewa

CD 1 - - 1 - - - - - 1

19 UPHC 1 1 1 - - - - - - -

Total 15 7 11 7 5 7 30 1 2 18

b. Health staff - Trainings and orientation

The training and orientation is one of the key aspects to ensure the quality of health

care services. During facility visit a question was asked about training of health staff.

Most of the health facility reported that the basic induction and orientation has not

been conducted. The health staff starts routine services soon after posting.

c. Health staff - Health Risk Protection

The health care providers are in regular contact with the patients and are likely to

acquire infections in the facility setting. In survey, a question was asked to know

whether vaccines like Hepatitis B and Tetanus Toxoid (TT) protected staffs. The

information related to immunization statue of health staff was collected for 103 health

personnel (48 Urban PHC; 55 Civil Dispensaries).



Page 32 of 84

Table 7: facility wise details of protection of health staff

Sl.

No.

Districts Hepatitis B Tetanus Toxoid (TT) Health Insurance

Urban

-PHC

Civil

Dispensary

Urban-

PHC

Civil

Dispensary

Urban-

PHC

Civil

Dispensary

1 Bhopal 1/4 3/6 4/4 6/6 1/4 0/6

2 Harda 1/4 NA 1/4 NA 1/4 NA

3 Sagar 1/4 0/4 2/4 3/4 1/4 1/4

4 Indore NA 1/6 NA 4/6 NA 1/6

5 Dhar 0/3 0/2 2/3 1/2 3 1/2

6 Ujjain 0/7 1/15 3/7 8/15 0/7 1/15

7 Bhind 2/5 0/5 4/5 9/5 0/5 0/5

8 Gwalior NA 7/12 NA 7/12 NA 3/12

9 Jabalpur 4/11 0/2 5/11 1/2 2/11 0/2

10 Umaria 1/7 NA 3/7 NA 1/7 NA

11 Rewa 2/3 1/3 2/3 2/3 0/3 1/3

Total 12/48 13/55 26/48 35/55 8/48 8/55

Note: (1) There were 48 total staff available in total 9 Urban-PHC and 55 staff in Civil

Dispensaries at the time of survey. (2) Numerator – no of staff covered with specific

risk/denominator total staff available in the facility

The table 7 above shows the availability of mechanism for protecting health workers

from the risk that is associated with various kinds of diseases. There are about 48

health staff in 9 urban PHCs and 55 health staff in 10 Civil Dispensaries, selected for

the study. The data reveals that only 12 staff members in Urban-PHC and 13 staff in

Civil Dispensaries immunized with hepatitis B vaccine. However, 26 staff members in

Urban-PHC and 35 from Civil Dispensaries were immunized to Tetanus Toxoid. It was

interesting to note that only 16 out of total 103 staff have been covered under health

insurance scheme.

4.3 Service Provision

The main purpose of urban-PHCs and Civil Dispensaries is to provide comprehensive

preventive, promotive and non-domiciliary curative care among urban poor. According

to UHM guidelines, the Urban-PHC health services include OPD-consultation, basic

diagnosis services, and Reproductive & Child Health (RCH) services, prevention of

communicable and non-communicable diseases. The services also include drugs

prescription and timely referral.



Page 33 of 84

a. Essential health services

The status of service, at facility, service provision in all the 19 health facilities visited

are compiled and analysed with reference to the essential health services suggested

under NUHM guidelines. The table below shows the availability of services in 19

facilities.

Table 8: Status of Essential health services available in the facilities surveyed

Sl.

No.

Essential Health Service Available Civil

Dispensary

(N-10)

Urban-PHC

(N-9)

Total

facility

(N-19)

1 Maternal health 7 7 14

2 Family welfare 7 8 15

3 Child health and nutrition 8 9 17

4 RTI/STI 8 9 17

5 Nutritional deficiency disorders 8 8 16

6 Vector borne diseases 7 8 15

7 Chest infections -TB/Asthma

(Diagnosis/treatment/referral)

6 8 14

8 Cardiovascular diseases

(Diagnosis/treatment/referral)

6 7 13

9 Trauma care (burns & injuries) 5 6 11

10 Oral Health (Diagnosis/referral) 2 6 8

11 Diabetes (Diagnosis/treatment/referral) 4 6 10

12 Cancer (Identification/referral/follow-up) 1 4 5

13 Mental Health (Initial screening/referral) 2 4 6

14 Other surgical interventions

(Identification/referral)

0 0 0

Data presented in the table-8 suggests that provision of 13 essential services were

available. The services related to maternal health, child health & nutrition, RTI/STI

and Vector borne disease provided by large number of Urban PHCs and Civil

Dispensaries. The essential services are confined general consultation and mostly

referred to nearby government health facility.

Table 9: Provision of Health Services in Civil Dispensary and Urban-PHC: Summary

Sl.

No.

Essential Health

Service

Civil Dispensary Urban-PHC Remark

1 Maternal health

(ANC/PNC/referral)

If MO is not available

ANM/LHV manage

most of the cases,

except complicated

cases

If MO is not

available ANM

/LHV handles

maternal service

except

complicated cases

Most of the facilities

do not provide all

required services due

to lack of staff;

Need for EmOC

training

2 Family welfare

(OCP/CC/IUD

insertion/referral

for sterilization/)

ANM/LHV/Staff Nurse

provide services

ANM/Staff Nurse

provides services

Only Condom

distribution; staff is

not trained in IUCD

insertion and removal

3 Child health and

nutrition

1. Diagnosis/

treatment/ referral

of acute/chronic

illness

2. Identification/

referral of

neonatal sickness

Medical officer provides

services , if not than

ANM provide services

In Rewa MO &

Pharmacist

Medical Officer

provides services

if not than staff

nurse /ANM

Ensure availability of

Medical Officer

Staff

Nurse/ANM/Pharmacis

t provide services

4 RTI/STI

(Symptomatic

Diagnosis/primary

treatment/referral)

Medical Officer Medical Officer Treatment is based

on sign and

symptoms; lack of lab

test facility

5 Nutrition

deficiency

disorders

(Diagnosis/

treatment/referral)

MO provides service if

not than ANM/Staff

Nurse provides

Medical officer

provides service if

not than

ANM/staff nurse

provides

Mostly referred to NRC

of District Hospital in

case of malnourished

6 Vector borne

diseases

MO provides the

service if not than

ANM/ staff nurse

provides

MO provides the

service

Most of the facility

test for Malaria is

carried out;

Non availability of

Laboratory facility

limits diagnose and

other investigation

7 Mental Health

(Initial

screening/referral)

Not Available MO provides the

Service

Referral on the basis

of symptoms



Page 35 of 84

Sl.

No.

Essential Health

Service

Civil Dispensary Urban-PHC Remark

8 Oral Health

(Diagnosis and

referral)

Mostly service is not

available, if available it

is provided by Medical

Officer only in Sagar,

Indore and Gwalior

Service is

provided by

Medical Officer if

available

Need of Dental

specialist needs to be

posted at CD and

UPHC

9 Chest infections -

TB/Asthma

(Diagnosis/

treatment/referral)

Service provided by

Medical Officer

Service provided

by Medical Officer

Urban-PHC and CD

needs to be linked TB

Cell at district for

treatment/follow-up;

Medicine for

registered patient can

be provided at Urban-

PHC and CD

10 Cardiovascular

diseases

(Diagnosis/

treatment/referral)

Service provided by

Medical Officer

Service provided

by Medical Officer

11 Diabetes

(Diagnosis/

treatment/referral)

Service provided by

Medical Officer

Service provided

by Medical Officer

Well-equipped lab and

technician would help

on time diagnose and

hassle free treatment;

Basic equipment -

glucometer not

available in the facility

12 Cancer

(Identification/

referral/

follow-up)

Service provided by

Medical Officer

Service provided

by Medical Officer

Patient are referred to

district hospital or

higher center for

further investigation

and treatment

13 Trauma care -

burns & injuries

Service provided by

Medical Officer for

injuries and trauma

Service provided

by Medical Officer

for injuries and

trauma; Not all

medical

emergencies are

treated

Training to manage

medical emergency

required; Most of the

facilities lack practice

of aseptic technique of

dressing;

No medico legal

certificate and

documentation is

done; referred to DH

14 Other surgical

interventions

No Service No service



Page 36 of 84

b. Other support services

Besides essential health care services, the provision of prevention of communicable

and non-communicable disease is one of the focus areas of urban PHC and Civil

Dispensary. It was observed, during the visit to health facilities, that IEC (information

education and communication) materials and materials related to BCC (Behavior

Change Communication) was displayed here and there on the walls of facilities. The

materials were not displayed on strategic locations ensuring proper information

dissemination and spread of messages among the masses.



Page 37 of 84

c. Basic Lab services

Diagnosis is one of the essential services required for the health care and treatment.

According to national Urban health care guideline for primary care, provision of basic

lab infrastructure with trained staff need to be placed in Urban-PHC. In this survey,

the basic lab services like Urine Microscopy Acetone Bile Salt and Bile Pigments Serum,

Cholesterols, Stool Exam LBR, ESR were not available in all the Urban-PHC. Moreover,

non-availability of necessary equipment’s and lab technicians were main reasons

reported. It is seen that blood and urine test facilities are available at very few

facilities and that too only a few tests are conducted. Lab tests services are affected

due to the shortage of lab technicians and necessary items required to conduct various

tests.

Figure 4.3 (a): Diagnosis services in place in all Urban-PHCs and Civil Dispensaries?

Number of facilities according to various lab test proposed by Urban Health Mission

The purpose of basic lab services in Urban-PHC and Civil Dispensary is primarily to

diagnoses communicable and non-communicable disease and help in providing quick

and appropriate treatment. There is need for improving the basic lab facilities with

availability of lab technician. The availability of lab services in urban-PHC would

certainly reduce the pressure on district hospital. In addition, effective lab services

would reduce the financial burden on the slum dwellers and build trust among

community.

1

1

1

1

2

2

2

2

4

6

7

8

9

10

12

18

18

18

18

17

17

17

17

15

13

12

11

10

9

7

Urine Microscopy

Serum Cholesterols

Stool Exam

LBR

Serum Urea

Serum Bilirubin

ESR

BTCT

Typhoid Card Test

HB(Sahli)method

Slide Collection for pVivex and P Falciparum

Urine Sugar Albumin leucocyte Esterase

Blood Sugar

HB Scale

Urine Pregnancy Test

Yes No



Page 38 of 84

Table 10: Essential Laboratory services recommended as per NHM guidelines

Essential Laboratory

services

Routine Test: Urine, stool and blood tests (Hb%, platelets

count, total RBC, WBC, bleeding and clotting time).

Diagnosis: RTI/STDs with wet mounting, Grams stain, etc.

Sputum testing for mycobacterium (as per guidelines of

RNTCP).

Blood smear examination malarial

Blood for grouping and Rh typing

RDK for Plasmodium falciparum malaria in endemic districts.

Rapid tests for pregnancy.

RPR test for Syphilis/YAWS surveillance (endemic districts).

Rapid test kit for fecal contamination of water.

Estimation of chlorine level of water using ortho-toludine

reagent.

Blood Sugar

Desirable

Blood Cholesterol

ECG

Validation of

reports

Periodic validation of lab reports needs to be done by DH for

Quality Assurance.

Periodic calibration of Laboratory and PHC equipment’s

It is important to note that none of the 19 urban health facilities had all the essential

tests facility available at the centre.



Page 39 of 84

d. Drug Supply

At the time of survey, the study team observed stock registers. Question related to

drug and its availability was also asked to the health staff. Health staff reported that

around 56 to 75 listed drugs, under essential drug list, were available. The health staff

reported that the basic drugs are always available in the facility. Further, they said

that at the time of particular drug requirement or in case of any drug falls short,

demand request is forwarded to the district authorities. The staff further informed that

demanded drugs are made available to the facility within 7-10 working days.

Table 11: Availability of Essential Drugs List at Facility

Essential Drugs (ED) and

Essential Drugs List (EDL)

Civil Dispensary Urban PHC

Available

at the time

of survey

Not

Available at

the time of

survey

Available

at the time

of survey

Not

Available at

the time of

survey

Essential Drugs available at

facility

9 1 8 1

EDL displayed in the facility 5 5 5 4

Table 11 shows that the essentials drugs were available in most of the facilities except

for Civil Dispensary situated at Anand Nagar in Bhopal and Urban-PHC of Sagar. The

display of essential drug list was found in 5 Urban-PHCs and 5 Civil Dispensaries. In

most of the facilities, the phamarcy was maintained properly with systematice

arrangment of drugs.

Availability and arrangement of drugs



Page 40 of 84

e. Availability of Medical Care Equipment

In survey, availability of basic equipment was also observed by the study team. List of

equipment were categorized in three differed categories that are (1) List of equipment

required for OPD; (2) list of equipment required for lab test; and (3) list of equipment

required for other/general purposes. Data presented in the table 12 shows the

availability of basic equipment in Urban-PHCs and Civil Dispensaries.

Table 12: List of equipment required at OPD services and its availability in Civil

Dispensaries and Urban-PHCs at the time of visit

Sl.

No.

OPD Equipment

Civil

Dispensary

(N-10)

Urban-

PHC

(N-9)

1 Adult weighing scale 9 9

2 Baby weighing scale 3 6

3 Bowl for antiseptic solution for soaking cotton swabs 7 3

4 Chairs, Stool 10 9

5 Examination couch, steps 10 6

6 Height measuring Scale 2 2

7 IUCD insertion kit 4 2

8 Measuring tape 4 3

9 Minor OT instruments 3 1

10 Spot light 2 1

11 Standard Surgical Set 1 1

12 Stethoscope 7 8

13 Thermometers Alcohol (stem) 4 7

14 Torch without batteries – 2 4 4

Data presented in the table 12 reveals that the basic equipment like adult weighing

scale was not available in 7 Civil Dispensaries and 3 UPHCs. During the study the team

visited Civil Dispensary Bhind and observed that adult weighing scale was not available

at the facility. The standard surgical set found in only one Civil Dispensary and one

Urban-PHC. The basic equipment required for OPD like Baby weighing scale, Bowl for

antiseptic solution for soaking cotton swabs, Height measuring Scale, IUCD insertion

kit, Measuring tape, Minor OT instruments, Spot light, Thermometers Alcohol (stem)

and Torch without batteries were not available in many facilities.

The set of equipment required for laboratory test mentioned in the table 13 shows

that many of the equipment are not available in many of the facilities selected for the

study.



Page 41 of 84

Table 13: List of equipment required for lab test and its availability in Civil

Dispensaries and Urban-PHCs at the time of visit

Sl.

No.

Lab Equipment Civil Dispensary

(N-10)

Urban-PHC

(N-9)

1 Refrigerator 3 5

2 Battery dry cells 1.5 volt

(large size) – 4

3 4

3 Binocular microscope 4 1

4 Domestic refrigerator 2 3

5 Equipment/reagents for essential lab

investigations

4 4

6 H2 S Strip test bottles 1

7 Kits for testing residual chlorine in

drinking water

2 2

More than 4 Civil Dispensaries and Urban-PHCs not reported to have Refrigerator,

Battery dry cells 1.5 volt (large size), Binocular microscope, Equipment/reagents for

essential lab investigations, H2 S Strip test bottles, Kits for testing residual chlorine in

drinking water at the time of survey.

Further, list of equipment according to general purposes were reviewed in terms of

availability at Civil Dispensaries and Urban-PHCs. The table 14 below specifies that 18

equipments were used for general purposes in Civil Dispensaries and Urban-PHCs

were not available in all the facility at the timer of survey. The data revels that

equipment like Autoclave, Cold Boxes (Small & Large), ECG machine, Equipment for

National Programmes, Fire extinguisher, Freeze Tag: 2 per ILR bimonthly, Hand

washing facilities & Alcohol based hand-rub, Ice box, ILR (Small) and DF (Small) with

Voltage Stabilizer, ice pack boxes per vaccine carrier, Standard Surgical Set ,

Stretcher, Suction machine, Tray containing chlorine solution for keeping soiled

instruments, Trolley, Vaccine Carriers with 4 Icepacks, Waste disposal twin bucket,

hypochlorite solution/ bleach less than 5 facilities were equipped to provide services.



Page 42 of 84

Table 14: List of equipment required for other/general purposes and its availability in

Civil Dispensaries and Urban-PHCs at the time of visit

Sl.

No.

Other/General purpose Civil

Dispensary

(N-10)

Urban-

PHC

(N-9)

1 Autoclave 2 1

2 Cold Boxes (Small & Large): Small- one, Large – two 6 4

3 ECG machine

4 Equipment for National Programmes 3 3

5 Fire extinguisher 1 3

6 Freeze Tag: 2 per ILR bimonthly 4 2

7 Hand washing facilities & Alcohol based hand-rub 6 7

8 Ice box 4 5

9 ILR (Small) and DF (Small) with Voltage Stabilizer 5 5

10 Spare ice pack box: 8, 25 & 60 ice pack boxes per

vaccine carrier,

5 4

11 Stretcher 3

12 Tray containing chlorine solution for keeping soiled

instruments

5 2

13 Trolley 2

14 Vaccine Carriers with 4 Icepacks: 5 6

15 Waste disposal twin bucket, hypochlorite solution/

bleach

4 5



Page 43 of 84

f. Barrier of Service Provision

One of the study objectives was to ascertain services related challenges as perceived

by service providers. In this regard, a set of question were asked to available health

staff at the time of visit. The reported barriers were classified in three categories and

are sited in table 15.

Table 15: Barriers of Service Provision

Category Key Barriers

Infrastructure Lack of maintenance of Physical Infrastructure

Unhygienic condition of toilets and no separate toilet for men

and women

Poor equipped lab/Lab services for name sake

Poorly located and facilities with inadequate spaces and poor

status of water supply

Human Resource Lack of trained personnel and adequate staff

In the absence equipped centers and MOs ,staff lose confidence

Non availability/irregularity of medical officer

Delayed decision/ignorance from higher authority

Health Services Facility Level

No transport facility for referral cases

Gap in follow up services

Facility not equipped to manage emergency services

No monitoring

Community Level

Nuisance created by alcoholic persons in late evening

Patients do not follow prescriptions

Environment Facilities are surrounded by unhygienic and dirty environment;

Description of key barriers reported by the service providers:

i. Physical Amenities: Basic physical amenities in the buildings in terms of

adequate space for different service, provision for privacy and confidentiality,

separate toilets, safe drinking water.

ii. Facilities Related to Computer and Internet: Facilities related to computer

and internet interrupts smooth administrative work and updating the HMIS

reports.

iii. Transportation Facilities: Lack of transportation facilities such as ambulance

services etc.

iv. Coordination, Roles Clarity and Work Pressure

The health staff not aware about their roles and responsibility in the

implementation of national health programmes.



Page 44 of 84

Staff is unable to take any initiative in the absence of timely instructions and

guidelines.

The senior staff is attached to the other health facility that affects the functioning

of Civil Dispensary and Urban-PHC.

Existing staff has to perform additional activities; conduct multitasks and keeps

working for long hours in the absence of sufficient of staff at facility.

Lack of coordination among staff affects the performance of the facility.

4.4 Outreach services

Outreach services are an integral part of public health services. It facilitates improving

health behaviors among community. The outreach services create trust and

confidence within community. As per guideline, Outreach, services would be provided

through Female Health Workers (FHWs)/ANMs at Urban-PHC and then move to their

respective areas for outreach services (including school health) on designated days.

In survey, a question was asked to understand to what extend the outreach services

being provided by the facility. The table below shows that three forth of the total

Urban-PHC and Civil Dispensary were providing regular outreach services through

Urban Health and Nutrition Day (UHND) and special outreach camps.

Table 16: Outreach Activity in the Facilities Surveyed

Outreach activity Civil Dispensary

(N-10)

Urban-PHC

(N-9)

Total

(N-19)

Urban Health & Nutrition Day Calendar

developed

6 6 12

Urban Health & Nutrition Day conducted 6 7 13

Special Outreach Camp conducted 6 8 14

During field visit, the study team noticed that in the absence of the medical officers

and sufficient number of ANM the outreach services are affected. Lack of confidence

among ANM on counseling techniques discourages them to initiate communication

with target group.



Page 45 of 84

4.5 Referral Services

Response related to referral services presented in the table 17. In the absence of lab

facilities and lab technician, patients are referred to the nearby district hospitals. The

patients who require specialized services were often referred to the district hospital.

Table 17: Referral Services at the Facility

Major reasons for referral Civil

Dispensary

(N-10)

Urban-

PHC

(N-9)

Total

(N-19)

1. Medical officer not posted in the facility

2. Patient refer for lab test

3 3 6

1. No lab technician at facility

2. No lab equipment

6 5 11

1. Chronic/major illness & specialist opinion

2. Advance investigation/need special care and

treatment

1 1 2



Page 46 of 84

4.6 Management

4.6.1 Biomedical Waste Management

Management of waste generated in the

health facilities causes a direct health

impact on health staff but also on the

surroundings. It is mandatory and

prime responsibility of the health

facility administrators to manage waste

in most safe and eco-friendly manner.

According to the Bio Medical Waste

Management Rules (2016), the bio-

medical waste can be categorized in

following steps.

1. Waste Segregation (at source of

generation);

2. Pre-treat Laboratory and Highly

infectious waste [Yellow (h) waste;

3. Collection and Storage of

segregated waste in color coded

bags/ containers/ bins;

4. Intra-mural transportation from

generation site to central storage

area;

5. Storage;

6. Treatment (within 48 hours of waste

generation)

7. Disposal

First five steps (Segregation,

Collection, pre-treatment Intramural

Transportation and Storage) are

exclusive responsibility of the Health

Care Facility while next two Treatment

and Disposal are primarily

responsibility of CBWTF (Common

Biomedical Waste Treatment Facility)

operator except for lab and highly

infectious waste requires pre-treatment

by the HCF. The the study team at the

time of visit observed biomedical waste management practices of Civil Dispensary and

Urban-PHCs were.

BIO MEDICAL WASTE COLLECTION

Bio-medical waste should be collected on

daily basis from each ward of the hospital

at a fixed interval of time. There can be

multiple collections from wards during the

day.

HCF should ensure collection,

transportation, treatment and disposal of

bio-medical waste within 48 hours.

Collection times should be fixed and

appropriate to the quantity of waste

produced in each area of the health-care

facility.

General waste should not be collected at

the same time or in the same trolley in

which biomedical waste is collected.

Collection should be daily for most

wastes, with collection timed to match

the pattern of waste generation during

the day. For example, in An IPD ward

where the morning routine begins with

the changing of dressings, infectious

waste could be collected mid-morning to

prevent soiled bandages remaining in the

area for longer than necessary.

Collect general waste immediately after

the visiting hours of the HCFs, as visitors

coming to facility generate a lot of

general waste. The collection timings

must enable the HCF to minimize or

nullify the use of interim storage of waste

in the departments.

Bio-medical waste collected by the staff,

should be provided with PPE (Personal

Protective Equipment).



Page 47 of 84

1 1

7

1 1

4

3

1

Collected and sendto District Hospital

Collected but notDiscared

Van comes forWaste collection

Waste collected bynagar Nigam Van

Thrown insideHospital compound

Civil Dispensary Urban-PHC

Figure 4.6 (a): Is Bio-medical Waste Management in place?

No of Civil Dispensary and Urban-PHC with biomedical waste management practices

The above figure 4.6 (a) shows that the waste generated by one Civil Dispensary and

Urban-PHC surrender to the district hospital. The district hospital waste collection van

collects biomedical waste from 11 facilities (7 Civil Dispensaries and 4 urban PHCs)

whereas, 3 facilities were depended on local urban body/Nagar Nigam. Status of

following and implementation of Bio-Medical Waste Management Rules, 2016, has

been studied in 19 facilities. Compliance against basic indicators related to Bio-Medical

Waste Management Rules (2016) was observed and recorded. The findings have been

tabulated in table 18 and presented below.

Table 18: Status of Compliance of Provisions related to BWM

Sl.

No.

Particular Civil

Dispensary

(N-10)

Urban-PHC

(N-9)

Total

(N-19)

1 Biomedical Waste Registration 7 3 10

2 Facility use color coded Bins 5 3 8

3 Needle destructed and discard in Bins 4 7 11

4 Sterilization facility

(spirit/Autoclave/Boiling )

3 6 9

5 Linkages with agency for common

treatment of waste

10 7 17

In study, out of total 19 facilities, 10 facilities reported to have Biomedical waste

registration but none of the facility shows the registration number or certificate at the

time of visit. The renewal of the Bio medical waste registration number was due for

Civil Dispensary Indore. During discussion with the facility staff, study team learnt that

the staff is not clear about Bio medical waste registration number.



Page 48 of 84

Some of the observations related to biomedical waste management were recorded

are:

a) Study team observed the status of use of bins at

facilities. It was found that in some places the bins

were filled up to 3/4th level and in most the

facilities the bins were overfilled with biomedical

waste;

b) Segregation, of biomedical waste, was not done

properly. The sharp waste items were found mixed

with the other waste items. The Infectious and

noninfectious waste were dumped in same bins in

some of the facilities.

c) The biomedical waste kept in the bins for more

than 48 hours.

d) None of the staff trained enough to manage

biomedical waste management protocol.

e) Suggested practice of disinfecting before disposing the Recyclables waste and sharp

waste materials such as IV set, bottles, syringes, latex gloves, catheters etc. are not

followed.

Use of Colour coded bins: The colour coded bins were available only in 8

facilities. Rest of the facilities discard biomedical waste in general bins.

Segregation of biomedical waste was not according to the guidelines.

Essentials for Proper Waste Segregation

In order to ensure the proper BMW segregation at the point of source HCF has

to ensure following:

Display work instructions like posters for waste segregation at the point of

generation

Provide proper sized and adequate number of color coded bins, bags and

containers at the point of generation as per the expected.

Provide PPEs (Personal Protective Equipment) to waste handlers for waste

segregation and collection



Page 49 of 84

Sterilization, Destruction and Discarding of Equipment: The used needles were

destroyed and discarded properly in 11 facilities but not kept in the right bin. In all the

facilities, sterilization of instruments was in practice. Majority of the facilities were

using boiling method or spirit as sterilizer. No

sterilization dates found in any of the instruments

checked at the time of visit.

Disposal of non-infectious waste: It was observed

that Harda and Bhind Urban-PHC either burns the

Bio-medical waste or dumps outside the hospital

premise. This leads to inviting the flies, insects,

rodents, cats and dogs in the nearby areas. This

practice also increases the Also, rag pickers are at a

risk of getting tetanus and other infections.

Linkages with common treatment facility:

In survey, Bhopal Civil Dispensary reported that the

facility has tied up with MP Pollution Control Board

and Civil Dispensary Jabalpur tied up with Elite

Engineers for management of biomedical waste.

However, 7 facilities are using Nagar Nigam van for

waste disposal.

Important Points

1. Incorrect waste

segregation practices

2. Mix of biomedical

and non infectious

waste

3. Lack of monitoring

by district authority

Classification of Bio-Medical Waste Rules (2016) The bio-medical waste generated from the health care facility into four categories based on the segregation pathway and colour code. 1. Yellow Category 2. Red Category 3. White Category 4. Blue Category



Page 50 of 84

Dressing: good practice and malpractice

4.6.2 Record and Documentation

The record maintenance system was also observed at the time of visit. The update

registers were found in most of the Civil Dispensary and Urban-PHCs. It is evident

from the table below that register related to OPD, maternal and child health, national

health programme, immunization and health staff registers were in place in most of

the facility visited.

Table 19: Registers Maintained by the Facilities

Register/Document

Civil Dispensary

(N-10)

Urban-PHC

(N-9)

Total

(N-19)

OPD registers 9 9 18

HMIS formats 9 7 16

ANM registers 6 7 13

ANC/PNC/Eligible couple register 6 7 13

Report-National Health Programmes 5 8 13

ASHA Diary 5 7 12

Immunization register 5 6 11

lab Registers 6 5 11

Referral Registers 3 6 9

Stock Registers 3 3 6

Monthly Report Register 1 1 2

RKS Register 2 0 2

Indent Book 1 1 2

Balance Register 1 0 1

Daily Patient Record Register 1 0 1

Family Planning Register 0 1 1



Page 51 of 84

4.6.3 Fund flow and utilization

In survey, information related to fund management was also enquired from the health

staff. Health staff posted in Civil Dispensary and Urban-PHCs did not have any

information about status of fund to the facility. The Medical Officer posted in Urban-

PHC was also not aware about fund status. The fund flow and utilization of Civil

Dispensary manage by Civil Surgeon whereas fund management of Urban-PHC was

managed by Chief Medical Officer.

4.6.4 Monitoring and Supervision

The monitoring and supervision of Civil Dispensaries and Urban-PHCs was also

investigated at the time of visit. The table below describes the response of health staff

regarding monitoring of the facility. It is interesting to note that multiple authorities

were involved in monitoring and supervision.

Table 20: Supervision Practice

Sl.

No.

District At Civil Dispensary

At Urban-PHC

1 Bhopal Civil Surgeon APM

2 Harda - CMHO

3 Sagar Civil Surgeon NUHM - Bhopal

4 Indore Medical Officer/Civil Surgeon -

5 Dhar Civil Surgeon/RMO DPM/CMHO

DTO

6 Ujjain For Family Planning - LHV/CMHO

For TB – Staff Nurse/DTO

Dispensary - Civil Surgeon

DHO

7 Bhind Civil Surgeon NO

8 Gwalior CMHO

9 Jabalpur NO CMHO

10 Umaria - NO

11 Rewa NO CMHO

The District authority was mostly engage in redeploying the health staff from one

facility to another facility. There is no focus on ensuring delivery of better quality of

services through health facilities and outreach services. Civil surgeon mostly managed

the Civil Dispensaries whereas Chief Health and Medical Officer (CMHO) managed

Urban-PHC.



Page 52 of 84

4.7 Convergence and Partnership

National Urban Health Mission promotes inter-sectoral and intra-sectoral convergence

to avoid duplication of resources and efforts. In study, the understanding about

convergence within health and outside health departments was explored by the study

team.

The convergence with other department was found in initial stage. Most of the health

staff was not aware about the possibility to engage other departments for health

services at their level. However, Bhopal Sai baba Urabn-PHC is successfully

undertaking a disease surveillance project in partnership with AIIMS Bhopal. The

Urban Local Body is actively involved in Jabalpur and Umaria Urban-PHC. During field

visit the study team learnt about the Rotary Club support in OPD services in Ratlam

Civil Dispensary.

Key findings related to convergence:

i. Formats were available in all the facility related to National Disease Control

Programme

ii. Department of Ayush - services of AYUSH doctor available

iii. Distribution of condoms and IEC materials

iv. Coordination among frontline workers, i.e. ANM and Aganwadi workers etc.

v. Possibility to link with school health programme

vi. Lack of awareness among health staff to explore possibility of potential

partnership with the Department of Urban Development & Housing, Urban

Poverty Alleviation and Jawaharlal Nehru National Urban Renewal Mission

(JnNURM).



Page 53 of 84

5. Conclusion

National Urban Health Mission envisage to meet health care needs of the urban

population with special focus on urban poor, by providing essential primary health care

services with easy access. It could be achieve by strengthening the existing health

care service delivery system particular urban primary health care services in the state.

An attempt has been undertaken to understand current situation of Urban Primary

health care services provided by Civil Dispensaries and Urban- Primary Health Centres

in Madhya Pradesh.

The present study has utilized the primary and secondary source of data. The service

data highlights the geographical distribution of urban health centers engage in primary

health care delivery and its Out Patient performance of the last year. The National

Health Mission - HR data also referred to understand the existing human resource gap.

The geographical distribution of Civil Dispensaries and Urban Primary Health Centers

highlights the current status in terms of physical structure, distance between two or

more facilities and density. Study brings out the need for verification of actual number

of functional Civil Dispensaries and Urban-PHCs for performance monitoring. In order

to understand the actual number of Civil Dispensary and Urban-PHC in Madhya

Pradesh two dataset (1) HMIS facility database (2) NHM-HR records were analyzed

through data triangulation method. It was found that no uniform list of Civil

Dispensary and Urban-PHC is in use by all the departments.

The health staff posted in Civil Dispensaries and Urban-PHCs found to be big challenge

as there is no single Human Resource unit or cell responsible to keep and update HR

data. The mix of regular and contractual staff posted in Civil Dispensaries and Urban-

PHCs with frequent attachment to the district hospital creates ambiguity in facility

performance.

The Health Management Information System was used to ascertain the general health

profile of the patients who visited Civil Dispensaries and Urban-PHCs from April 2017

to March 2018. Most of the facilities updated only total OPD records in HMIS with

details of non-communicable disease. The volume of patients found high with

hypertension, followed by diabetes, ophthalmic and dental problems. It is important to

know the substantial outpatient records related to Mental illness reasons, Acute Heart

Diseases, Epilepsy and Stroke (Paralysis) at Urban-PHC.

The urban health mission has a mandate to improve the urban health care services

with special focus on poor and deprive population. The health service provision faces

services related challenges like availability of medical and paramedical staff. Most

compromised services were found to be lab services due to non-availability of lab

technician. No mechanism of continuous capacity building and minimum supportive



Page 54 of 84

supervision leads lack of confidence among health staff. Investment and maintenance

of physical infrastructure of the health facility was another barrier to build the trust

among community and staff.

It was expected to utilize potential inter-sectoral and intra-sectoral development

partner to improve the urban health in Madhya Pradesh. Lack of awareness among

health staff with limited knowledge and ignorance of district administration is a

challenge to unfold the opportunity. Following key components affects urban health

care services

Factors affect

Urban Primary Health Care Services

Infrastructure & Sanitation

facilities

Availability of Medical Officer & Health staff

Lab Facility

Supportive Supervision

Inter department coordination

Confidence among Health

Staff

Administrative issues



Page 55 of 84

6. Recommendations

Administration:

It is very important to verify and made available list of all the functional Civil

Dispensary and Urban-PHC to all the departments.

It is recommended to have only one administrative control at district level to avoid

any discrepancy in service delivery.

Access and Infrastructure:

It is recommended to have disabled friendly infrastructure to avail OPD services

with ease. Ramp, Hand- railing, proper lightning etc. must be provided.

The infrastructure should have separate and proper rooms for consultation,

dressing, pharmacy and lab with seating arrangements for the patients.

The display boards with location indicators of health facilities help easy

identification for vulnerable population.

There must be provision of timely rent payment to avoid inconvenience of the

service providers and patients.

It is recommended to ensure the provision of basic facilities like safe drinking

water, hand wash and separate toilets for men and women.

Maintenance of the buildings and premises is highly recommended

Human Resource/Health Staff:

In order to improve the lab services in Civil Dispensaries and Urban-PHCs,

recruitment and posting of lab technician needs to be done on priority basis.

The availability of Medical Officers on regular basis (avoid deputation to District

Hospital) at facility would help in creating the trust among community members.

There is need for capacity building of health staff on counseling, family planning

methods, management and referral of maternal and neonatal complicated cases,

screening and identification of cervical/breast cancer, mental health to improve the

confidence level as well meeting the objectives of urban health mission.

It is recommended that the service requirement would be shared with Nursing

Training Institutions to bridge the knowledge gap at the time of joining.

Service Provision:

It is recommended to have uniform service provision for all the Civil Dispensaries

and Urban-PHC with single point of contact at district level.

The primary care should be made at facility level and referral should be made for

advance treatment.

Basic lab with sufficient essential equipment’s must be provided to all the facilities

for timely identification, diagnosis and treatment.



Page 56 of 84

Table 21: Issue wise key recommendations to strengthen the urban primary health

care services in Madhya Pradesh

1 Administration

Recommendations Suggested methods

1.1 Verification of functional status

of all the Civil Dispensaries and

Urban-PHCs

Through enforcement actual number of

urban health centers engage in primary

health services can be verified

Referred list of urban health facilities

enclosed as annexure in the report

1.2 Either CMHO or CS should be

made responsible for overall

functioning of the urban health

care

Release of Office order by the State that

CMHO or CS should be responsible for

overall function of urban primary health

facilitates

1.3 Availability of uniform list of all

the civil dispensary and Urban-

PHCs across department

Online display list of facilities with in-

charge details

1.4 Uniform services of all the health

facilities engage in primary

health care services

Ensuring uniform norms and services at

the Civil dispensary and UPHC;

Develop an online system of monitoring

the functioning of health facilities

1.5 Ensuring Quality Assurance of

Urban PHCs

Regular monitoring and implementation of

quality assurance system.

2 Infrastructure and sanitation facilities


2.1 Basic infrastructure of the

centers should be of good

condition with adequate space

for basic amenities specific ally

separate toilets for men and

women

Regular Monitoring of basic Infrastructure

and sanitation facility

2.2 Maintenance of buildings and

premises

Proper implementation of Quality

Assurance guidelines for regular

monitoring

2.3 Timely rent payment Develop online payment system

2.4 Separate rooms for consultation,

dressing, pharmacy and lab with

seating arrangements

Float public advertisement for requirement

of building with required specifications

Check list with specifications for exploring

the new building with requisite facilities



Page 57 of 84

3 Human Resource/Health Staff


3.1 Availability of MO and health

staff

Develop a pool of doctors to post as MO in

urban areas

Part time services of private doctors for

example Red Cross Hospital

4 Lab Facility


4.1 Basic lab with essential

equipment should be made

available

Explore outsource possibility of lab

services

Recruitment and posting of lab technician

at vacant posts

Ensuring advance and proper planning

and requisition of essential drug list and

equipment.

5 Confidence among health staff


5.1 Training of health staff to handle

MCH services/screening of

patients for communicable and

non-communicable diseases

Appoint district level mentor for supportive

supervision and capacity building of health

staff

Service requirement would be shared with

the public and private Nursing Institutions

to bridge the knowledge gap

6 Interdepartmental coordination


6.1 Convergence with other

department would help in

addressing the urban primary

health care services

Appoint state and district level nodal

officers to explore potential partner for

convergence and partnership

7. Limitations

1. In study, various service records were referred and analyzed. The discrepancies in

total number of Civil Dispensaries and Urban-PHCs in the various reports were

found. Hence, the total number of Civil Dispensaries and Urban-PHCs varies from

HR records and HMIS reports.

2. It was expected to identify the potential stakeholders; service partners (Public

Private Partnership) and referral points of Civil Dispensaries and Urban-PHCs in the

study. However, in survey, very limited information related to partnership was

reported due to lack of awareness among health staff.



Page 58 of 84

8. References

1. A Review of Existing Regulatory Mechanisms To address the Shortage of Doctors

in Rural, Remote and Underserved Areas: A Study Across Five States In India

NHSRC 2016

2. Framework for Implementation National Urban Health Mission Ministry of Health &

Family Welfare Government of India May 2013

3. Global Health Risk Mortality and burden of disease attributable to selected major

risks WHO 2009

4. Healthy Cities Initiative: Approaches and Experience in the African Region WHO

2002

5. Implementation Guidelines for Management of Healthcare Waste in Health Care

Facilities as per Bio Medical Waste Management Rules, 2016; National Health

System Resource Centre GOI

6. Operational Guidelines Conducting Outreach Sessions in Urban Areas, Ministry of

Health & Family Welfare 2015

7. Strengthening the District Hospital (DH) for multi-specialty care & as a site for

training, NHSRC 2017

8. State of Urban Health in Madhya Pradesh Urban Health Resource Centre 2006

9. Terms of Reference, 10th Common Review Mission National Health Mission Ministry

of Health & Family Welfare 2016



Page 59 of 84

Annexure

Table A1: District wise list of Urban-PHC and Civil Dispensary where facility survey conducted

Sl.

No.

District Proposed Facility Survey conducted Remark

1 Bhopal CD Anand Nagar CD Anand Nagar

2 Bhopal UPHC Sai baba Nagar UPHC Sai baba Nagar

3 Bhind CD Bhind CD Bhind

4 Bhind UPHC B.T. I. Road UPHC B.T. I. Road

5 Gwalior CD Falka Bazar CD Falka Bazar

6 Gwalior UPHC Gol Pahariya CD Gol Pahariya U-PHC closed; staff

shifted to DH; CD-

Operation same building

7 Indore CD Bhanwarkuan CD Bhanwarkuan

8 Dhar CD Branch 2 CD Branch 1 CD closed; non

functional

9 Dhar UPHC Ganji Khana UPHC Ganji Khana

10 Jabalpur CD Gohalpur Ward CD Gohalpur Ward

11 Jabalpur UPHC Ghamapur UPHC Ghamapur

12 Harda UPHC Harda UPHC Harda

13 Rewa CD Univ Rewa CD Univ Rewa

14 Rewa UPHC Bodabag UPHC Bodabag

15 Sagar CD Bhagwanganj CD Bhagwanganj

16 Sagar UPHC Bina UPHC Bina

17 Umaria UPHC Loharganj UPHC Loharganj

18 Ujjain CD Madhavnagar CD Chattichowk CD closed; difficult to

locate

19 Ujjain UPHC Pawasa UPHC Pawasa



Page 60 of 84

Table A2: District wise NHM health staff posted in Urban-PHCs

Sl.

No.

District Urban-

PHC

(no)

MO RBSK

AMO

Staff

Nurse

Lab

Tech

Pharm

-acist

LDC for

MIS

ANM Total

1 Ashoknagar 1 - - 2 - - 1 4 7

2 AgarMalwa - - - - - - - - -

3 Alirajpur - - - - - - - - -

4 Anuppur - - - - - - - - -

5 Balaghat 1 - - 1 - - - 1

6 Barwani 2 1 - 4 - - 2 4 11

7 Betul 2 2 - 1 1 2 1 5 12

8 Bhind 3 2 - 4 - - 1 14 21

9 Bhopal 8 6 - - 2 - 6 - 14

10 Burhanpur 2 1 - 3 1 1 - - 6

11 Chhatarpur 2 1 - 2 1 - - - 4

12 Chhindwara 2 1 - 2 - - - - 3

13 Damoh 1 - - 1 - - - - 1

14 Datia 1 - - 1 - - 1 - 2

15 Dindori 0 - - - - - - - -

16 Dhar 0 - - - - - - - -

17 Dewas 2 2 - 1 1 - 2 3 9

18 Guna 3 2 - 4 1 - 2 15 24

19 Gwalior 14 7 - 9 6 2 16 32 72

20 Harda 1 - 1 - - - 1 2

21 Hoshangabad 3 - 6 1 - 2 8 17

22 Indore 13 8 - 3 4 1 3 22 41

23 Jabalpur 16 7 - 21 10 1 10 44 93

24 Jhabua 1 - - 1 - - 1 2

25 Katni 2 1 - 1 2 - 1 4 9

26 Khandwa 2 2 - 2 1 1 1 1 8

27 Khargone 1 1 - 2 - - 1 3 7

28 Mandla 1 1 - - - 1 1 3

29 Mandsaur 1 - - 1 - - 1 1 3

30 Morena 1 - - 1 - - - - 1

31 Narsinghpur 2 1 - 4 - - - 4 9

32 Neemuch 1 - - - - - 1 - 1

33 Panna 1 - - 1 - - - - 1

34 Raisen 1 1 - - - 1 - 2

35 Rajgarh 1 - - 1 - 1 - - 2

36 Ratlam 4 1 - 4 3 2 3 6 19

37 Rewa 2 1 - 2 - - 1 4 8

38 Sagar 2 3 - 3 - - - 5 11



Page 61 of 84

Sl.

No.

District Urban-

PHC

(no)

MO RBSK

AMO

Staff

Nurse

Lab

Tech

Pharm

-acist

LDC for

MIS

ANM Total

39 Satna 2 - 2 - - - 7 9

40 Sehore 2 1 - 2 - - 1 8 12

41 Seoni 1 - 2 - - 1 3 6

42 Shahdol 1 1 - 1 - - - 3 5

43 Shajapur 2 1 - 2 - - - 1 4

44 Sheopur 1 - - 1 - - 1 1 3

45 Shivpuri 1 - - - 1 - 1 - 2

46 Sidhi 1 - - 1 - - 1 3 5

47 Singrauli 1 - - 2 - - 1 - 3

48 Tikamgarh 1 - - 2 - - - 6 8

49 Ujjain 7 3 2 - - 1 3 9 18

50 Umaria 1 1 - 1 - 1 - 3 6

51 Vidisha 4 3 - 7 - 1 1 18 30

Total 125 62 2 111 36 14 68 244 537

Table A3: District wise NHM health staff posted in District Programme Management Unit

Sl.

No.

District DPMU MO Ayush

MO

APM

Urban

Health

Staff

Nurse

Lab

Technician

ANM Total

1 Bhopal DPMU Bhopal - - 1 - - - 1

2 Dewas DPMU Dewas - - 1 - - - 1

3 Dhar DPMU Dhar - - - - 2 2

4 Gwalior DPMU Gwalior - - 1 - - - 1

5 Jabalpur DPMU

Jabalpur

- - 1 - - - 1

6 Katni DPMU Katni - - 1 - - - 1

7 Satna DPMU Satna - - 1 - - - 1

8 Ujjain DPMU Ujjain - - 1 - - - 1

9 Indore DPMU

Malharganj

1 1 1 1 2 6

Total 1 1 7 1 1 4 15



Page 62 of 84

Table A4: District wise Regular and NHM health staff posted in Civil Dispensary

Sl.

No.

District Civil Dispensary MO

(Regular)

MO

(NHM)

Other Staff

(NHM)

1 Alirajpur CD Branch Dispensary 1 0 0

2 Badwani CD Rajpur (Harijan) 0 0 0

3 Bhind CD Bhind 0 0 0

4 Bhopal CD Satpuda Bhawan 1 0 0

5 Bhopal CD Vindhyachal Bhawan 1 0 0

6 Bhopal CD Vallabh Bhawan 1 0 0

7 Bhopal CD Govt. Press 1 0 0

8 Bhopal CD Raj Bhawan 3 0 0

9 Bhopal CD MLA Rest House 1 0 0

10 Bhopal CD Vidhan Sabha 2 0 0

11 Bhopal CD Professor Colony 1 0 0

12 Bhopal CD Panchshil Nagar 1 0 3

13 Bhopal CD 1100 Quarters 2 0 4

14 Bhopal CD Govindpura 0 0 0

15 Bhopal CD Ahmedabad 0 0 0

16 Bhopal CD Kotra 1 0 0

17 Bhopal CD Bagsevania 1 0 0

18 Bhopal CD Barkhera Pathani 1 0 0

19 Bhopal CD Anand Nagar 1 0 0

20 Bhopal CD Sevania Gaud 1 0 0

21 Bhopal CD Misrod 0 0 0

22 Bhopal C.D. PIPLANI 0 0 1

23 Bhopal C.D. RUKMABAI 0 0 5

24 Bhopal C.D. TELAJAMALPURA 0 0 6

25 Chhatarpur CD Harijan Dispensary 1 0 0

26 Chhindwara CD Gandhiganj 0 0 0

27 Datia CD Datia 1 0 0

28 Datia CD Ward No 11 (Chhalapura) 1 0 0

29 Dhar CD Branch 0 0 0

30 Dhar CD Branch 0 0 0

31 Dhar CD Manabar 0 0 0

32 Guna CD Cant 1 0 0

33 Gwalior CD Thatipur 0 0 0

34 Gwalior CD Falka Bazar 2 0 0

35 Gwalior CD Janakganj 1 0 5

36 Gwalior CD AG Office 1 1 0

37 Gwalior CD Fort 1 0 0

38 Gwalior CD Gole Pahardia 1 0 0

39 Gwalior CD Motimahal 2 1 0



Page 63 of 84

Sl.

No.


(Regular)

MO

(NHM)

Other Staff

(NHM)

40 Gwalior CD Shabdpratap Ashram 1 1 2

41 Gwalior CD Gole ka Mandir 1 0 0

42 Gwalior CD Hemsingh Ki Pared 1 0 0

43 Gwalior CD Harijan Dispensary 0 0 0





48 Gwalior CD Deendayal 1

49 Gwalior CD High Court 1 0

50 Gwalior CD MH Birlanagar 5

51 Gwalior CD MH Laxmiganj 1

52 Indore CD Baanganga (HD) 1 0 0

53 Indore CD Bhanwarkuan 1 1 0

54 Indore CD Harsiddhi 1 1 7

55 Indore CD Residency 1 0 0

56 Indore CD Hukumchand 1 0 0

57 Indore CD DRP Line 1 0 0

58 Indore CD Juni Indore (HD) 0 1 2

59 Indore CD Krishnapura 1 0 2

60 Indore CD Bhagirathpur (HD) 0 0 0

61 Indore CD Jabran Colony 0 0 0

62 Indore CD Vinoba Nagar 0 0 0

63 Indore CD Aranya Hospital (HD) 1 0 3

64 Indore CD Baanganga 0 0 0

65 Indore CD Azad Nagar (sanyogitaganj) 1 0

66 Indore CD Brindawan Colony (Nanda Nagar) 7

67 Indore CD KHAJRANA (SANYOGITAGANJ) 2

68 Indore CD MANGILAL CHURIYA(NANDA NAGAR) 7

69 Indore CD MOG LINE (MALHARGANJ) 1 14

70 Indore CD MOHTA NAGAR (NANDA NAGAR) 7

71 Jabalpur CD Shankarshah Nagar 1 0 0

72 Jabalpur CD Gohalpur Ward 0 0 0

73 Jabalpur CD Agriculture College 0 0 0

74 Jabalpur CD Govt. Eng. College 0 0 0

75 Jabalpur CD Govt. College 0 0 0

76 Jabalpur CD Ghamapur 0 0 0

77 Jabalpur CD Gorakhpur 1 0 0

78 Jabalpur CD Miloniganj 1 0 0

79 Jabalpur CD Adhartal 1 0 0

80 Jabalpur CD Kotwali 1 0 0



Page 64 of 84

Sl.

No.


(Regular)

MO

(NHM)

Other Staff

(NHM)

81 Khargone CD Harijan Dispensary Maheswar 0 0 0

82 Khargone CD Harijan Dispensary Kasraabad 0 0 0

83 Morena CD Sabalgarh (Ward 1 0 0

84 Morena CD Morena (Ward 0 0 0

85 Morena CD Morena 1 0 0

86 Rajgarh CD Khilchipur (Ward 2) 0 0 0

87 Rajgarh CD Narsinghgarh (Ward 2) 1 0 0

88 Ratlam CD Mominpura 0 0 0

89 Rewa CD Univ., Rewa 0 0 0

90 Rewa CD Engg. College 0 0 0

91 Sagar CD Sagar 1 0 0

92 Sagar CD Bhagwanganj 0 0 0

93 Sagar CD Vitthal Nagar 0 0 0

94 Sagar CD Mahaveer Ward, Rehli 0 0 0

95 Sagar CD Ward No 1, Khurai 1 0 0

96 Sagar CD Ward No 10, Khurai 1 0 0

97 Sagar CD Ward No 1, Bina 0 0 0

98 Satna CD Sindhi Colony 0 0 0

99 Satna CD Dhawari 0 0 3

100 Sehore CD Riot Affected Area 0 0 0

101 Tikamgarh CD Ward 10 0 0 0

102 Ujjain CD Chhatrichowk 0 0 0

103 Ujjain CD Kartikchowk 0 0 0

104 Ujjain CD Bherugarh, Ujjain 0 0 0

105 Ujjain CD Sanjay Nagar 0 0 0

106 Ujjain CD Jaysingh Pura 0 0 0

Total 54 9 87



Page 65 of 84

Table A5: Cadre wise staff strength against NHM norm in survey facilities

Sl.

No.

Cadre Proposed

basic staff by

NHM

Staff at

Urban-

PHC

Staff at Civil

Dispensary

Total

1 MO full time 1 6/9 9/10 15/19

2 MO Part Time 1 3/9 4/10 7/19

3 ANM 3-5 14/9 16/10 30/19

4 Staff Nurse 3 8/9 3/10 11/19

5 Pharmacist 1 2/9 5/10 7/19

6 Lab Technician 1 2/9 3/10 5/19

7 LHV 1 3/9 4/10 7/19

8 Account keeping and MIS 2 2/9 0/10 2/19

9 Support Staff 1 7/9 11/10 18/19

10 Public Health Manager/Community

Mobiliser

1 1/9 0/10 1/19



Page 66 of 84

Table A6: Status of Civil Dispensary according to HMIS, HR -Directorate of Health and NHM

Sl.

No.

District

Name

Facility Name HMIS Directorate-

MO

NHM-HR

1 Alirajpur CDU Branch Dispensary N Y NA

2 Barwani CDU Rajpur Harijan N N NA

3 Bhind CDU Bhind N N NA

4 Bhopal CDU 1100 Quarters Y Y Y

5 Bhopal CDU 23rd Btln Y NA NA

6 Bhopal CDU 25th Btln Y NA NA

7 Bhopal CDU 7th Btln Y NA NA

8 Bhopal CDU Ahmedabad Y N NA

9 Bhopal CDU Anand Nagar Y Y NA

10 Bhopal CDU Bagsevania N Y NA

11 Bhopal CDU Barkhera Pathani Y Y NA

12 Bhopal CDU Govindpura N N NA

13 Bhopal CDU Govt. Press Y Y NA

14 Bhopal CDU Kamala Nagar Y NA NA

15 Bhopal CDU Kotra Y Y NA

16 Bhopal CDU Misrod Y N NA

17 Bhopal CDU MLA Rest House N Y NA

18 Bhopal CDU Panchshil Nagar Y Y Y

19 Bhopal CDU Piplani Y NA Y

20 Bhopal CDU Professor Colony N Y NA

21 Bhopal CDU Raj Bhawan Y Y NA

22 Bhopal CDU Satpuda Bhawan Y Y NA

23 Bhopal CDU Sevania Gaud Y Y NA

24 Bhopal CDU Vallabh Bhawan Y Y NA

25 Bhopal CDU Vidhan Sabha Y Y NA

26 Bhopal CDU Vindhyachal Bhawan Y Y NA

27 Bhopal C.D. RUKMABAI NA NA Y

28 Bhopal C.D. TELAJAMALPURA NA NA Y

29 Chhatarpur CDU Harijan Dispensary Y Y NA

30 Chhindwada CDU Gandhiganj N N NA

31 Datia CDU Datia N Y NA

32 Datia CDU Ward No 11 Chhalapura N Y NA

33 Dhar CDU Manabar N N NA

34 Dhar CDU NALCHA DARWAJA Y N NA

35 Dhar CDU RAJWADA Y N NA

36 Guna CD Cant NA Y NA

37 Gwalior CD DEENDAYAL NAGAR Y NA Y

38 Gwalior CD FPAI KAMPOO NGO Y NA NA

39 Gwalior CD FPAI KHEDAPATI NGO Y NA NA

40 Gwalior CD JANAKGANJ Y Y Y

41 Gwalior CD LADHEDI PRASUTIGARH Y NA NA

42 Gwalior CD SABDPRATAP ASHRAM Y Y Y



Page 67 of 84

Sl.

No.

District

Name


MO

NHM-HR

43 Gwalior CDU 13th BATT SAF N NA NA

44 Gwalior CDU 14th BATT SAF N NA NA

45 Gwalior CDU 2ND BATT SAF N NA NA

46 Gwalior CDU AG Office N Y Y

47 Gwalior CDU Fort N Y NA

48 Gwalior CDU Gole ka Mandir N Y NA

49 Gwalior CDU Govt Press N NA NA

50 Gwalior CDU Harijan Dispensary 1 N N NA





55 Gwalior CDU Motimahal N Y Y

56 Gwalior CD Thatipur NA N NA

57 Gwalior CD Falka Bazar NA Y NA

58 Gwalior CD Gole Pahardia NA Y NA

59 Gwalior CD Hemsingh Ki Pared NA Y NA

60 Gwalior CD MH Birlanagar NA NA Y

61 Gwalior CD MH Laxmiganj NA NA Y

62 Gwalior CD High Court NA NA Y

63 Indore CD ARANYA Y Y Y

64 Indore CD AZAD NAGAR Y NA Y

65 Indore CD Bhanwarkuan N Y Y

66 Indore CD HARSIDDHI Y Y Y

67 Indore CD KHAJRANA Y NA Y

68 Indore CD Mohta Nagar Y NA Y

69 Indore CD RADIO COLONY Y NA NA

70 Indore CDU Baanganga HD N Y NA

71 Indore CDU Baanganga ii N N NA

72 Indore CDU Bhagirathpur HD N N NA

73 Indore CDU DRP Line N Y NA

74 Indore CDU Jabran Colony N N NA

75 Indore CDU Juni Indore HD N N Y

76 Indore CDU Krishnapura N Y Y

77 Indore CDU Residency N Y NA

78 Indore CDU Vinoba Nagar N N NA

79 Indore CD Hukumchand NA Y NA

80 Indore C.D.BRINDAWAN COLONY(NANDA NAGAR) NA NA Y

81 Indore C.D.MANGILAL CHURIYA(NANDA NAGAR) NA NA Y

82 Indore C.D.MOG LINE(MALHARGANJ) NA NA Y

83 Jabalpur CDU Agriculture College N N NA

84 Jabalpur CDU Ghamapur N N NA

85 Jabalpur CDU Gohalpur Ward N N NA

86 Jabalpur CDU Gorakhpur N Y NA



Page 68 of 84

Sl.

No.

District

Name


MO

NHM-HR

87 Jabalpur CDU Govt. College N N NA

88 Jabalpur CDU Govt. Eng. College N N NA

89 Jabalpur CDU Kotwali N Y NA

90 Jabalpur CDU Miloniganj N Y NA

91 Jabalpur CDU Shankarshah Nagar N Y NA

92 Jabalpur CD Adhartal NA Y NA

93 Khargone CD Christian Dispensary Kasrawad N NA NA

94 Khargone CDU Christian Dispensary Kasrawad N NA NA

95 Khargone CDU Harijan Dispensary Kasraabad N N NA

96 Khargone CDU Harijan Dispensary Maheswar N N NA

97 Khargone CDU Police Line Khargone Y NA NA

98 Morena CDU Morena N Y NA

99 Morena CDU Morena Ward 8 N N NA

100 Morena CDU Sabalgarh Ward 8 N Y NA

101 Rajgarh CDU Khilchipur Ward 2 N N NA

102 Rajgarh CDU Narsinghgarh Ward 2 Y Y NA

103 Ratlam CDU Mominpura N N NA

104 Rewa CDU Engg. College Y N NA

105 Rewa CDU Univ Rewa Y N NA

106 Sagar CDU Bhagwanganj N N NA

107 Sagar CDU Govt Eng College N NA NA

108 Sagar CDU Mahaveer Ward Rehli N N NA

109 Sagar CDU Sagar N Y NA

110 Sagar CDU Vitthal Nagar N N NA

111 Sagar CDU Ward No 1 Bina N N NA

112 Sagar CDU Ward No 1 Khurai N Y NA

113 Sagar CDU Ward No 10 Khurai N Y NA

114 Satna CDU Sindhi Colony N N NA

115 Satna CD Dhawari NA NA Y

116 Sehore CDU Riot Affected Area N N NA

117 Sehore CDU Sehore N NA NA

118 Tikamgarh CDU Ward 10 N N NA

119 Ujjain CDU Bherugarh N N NA

120 Ujjain CDU Chhatrichowk N N NA

121 Ujjain CDU Engineering College N NA NA

122 Ujjain CDU Jaysingh Pura N N NA

123 Ujjain CDU Kartikchowk N N NA

124 Ujjain CDU Madhavnagar N NA NA

125 Ujjain CDU Sanjay Nagar N N NA



Page 69 of 84

Table A7: District wise status of Urban-PHC according to HMIS and NHM - HR Cell

Sl. No. District Name Facility Name HMIS NHM-HR

1 Agar Malwa UPHC Agar Y NA

2 Ashok Nagar UPHC Ashok Nagar Y Y

3 Balaghat UPHC Balaghat Y Y

4 Barwani UPHC Barwani Y Y

5 Barwani UPHC Sendhwa Y Y

6 Betul UPHC Betul Y Y

7 Betul UPHC Sarani Y Y

8 Bhind UPHC Bhawanipura Y Y

9 Bhind UPHC Gohad Y Y

10 Bhind UPHC Vikrampura Y Y

11 Bhopal UPHC Anandnagar Y Y

12 Bhopal UPHC Ashoka Garden Y Y

13 Bhopal UPHC Bagsewaniya Y Y

14 Bhopal UPHC Berkheda Pathani Y NA

15 Bhopal UPHC Kokta Y Y

16 Bhopal UPHC Kolua Y Y

17 Bhopal UPHC Kotra Y Y

18 Bhopal UPHC Saibaba Nagar Y Y

19 Bhopal UPHC Alamganj Y Y

20 Bhopal UPHC Doulatpura Y Y

21 Bhopal UPHC Chhatarpur Y Y

22 Bhopal UPHC Tatoriya Y Y

23 Bhopal UPHC Lalbag Y Y

24 Bhopal UPHC Sukludhana Y Y

25 Damoh UPHC Damoh Y Y

26 Datia UPHC Datia Y Y

27 Dewas UPHC Bawadia Y Y

28 Dewas UPHC Itawa Y Y

29 Dhar UPHC Brahmakundi Y NA

30 Dhar UPHC Pithampur N NA

31 Dhar UPHC Veersanwarkar Ganjikhana Y NA

32 Guna UPHC Boode Balaji Y Y

33 Guna UPHC Cantt Y Y

34 Guna UPHC Raghogarh Y Y

35 Gwalior UPHC Bahodapur N Y

36 Gwalior UPHC CD Falka Bazar Y Y

37 Gwalior UPHC CD Gol Pahadiya Y Y

38 Gwalior UPHC Dabra Y Y

39 Gwalior UPHC Gudagudi ka Naka Y Y

40 Gwalior UPHC Harijan Basti Dullapur Y Y

41 Gwalior UPHC Harijan Basti Gendewali Sadak Y Y

42 Gwalior UPHC Hathikhana Y Y

43 Gwalior UPHC Hurawali Y Y



Page 70 of 84


44 Gwalior UPHC Ohadpur Y Y

45 Gwalior UPHC Panth Nagar Y Y

46 Gwalior UPHC Purani Chhawani Y Y

47 Gwalior UPHC Shankarpur Y Y

48 Harda UPHC Harda Y Y

49 Hoshangabad UPHC Gwaltoli Y Y

50 Hoshangabad UPHC Itarasi Y Y

51 Hoshangabad UPHC Malakhedi Y Y

52 Indore UPHC Baabu Murai Y Y

53 Indore UPHC BHAWARKUAN Y Y

54 Indore UPHC BRINDAWAN COLONY Y Y

55 Indore UPHC Gwaltoli Y NA

56 Indore UPHC KAMLAKANT MODi Y Y

57 Indore UPHC KRISHNAPURA Y Y

58 Indore UPHC Kulkarni ka Bhatta Y Y

59 Indore UPHC Mhow N NA

60 Indore UPHC Musakhedi Y Y

61 Indore UPHC Nihalpurmandi Y Y

62 Indore UPHC Sadar Bazar Y Y

63 Indore UPHC Shivbaag Y Y

64 Indore UPHC Shivbrahm Nagar Y Y

65 Indore UPHC Sirpur Y Y

66 Indore UPHC Sudama Nagar Y Y

67 Jabalpur UPHC ADHARTAL Y Y

68 Jabalpur UPHC Amanpur Y NA

69 Jabalpur UPHC Bara Pathar Y Y

70 Jabalpur UPHC Cherital Y NA

71 Jabalpur UPHC Ganga nagar Y NA

72 Jabalpur UPHC Gupteshwar Y Y

73 Jabalpur UPHC Hanumantala N NA

74 Jabalpur UPHC Kajarwada Y Y

75 Jabalpur UPHC Lalmati Y NA

76 Jabalpur UPHC Motinala Maqsuda Y Y

77 Jabalpur UPHC Polipathar Y Y

78 Jabalpur UPHC Richai Y NA

79 Jabalpur UPHC Shanti Nagar Y Y

80 Jabalpur UPHC Suhagi Y NA

81 Jabalpur UPHC TILWARA Y Y

82 Jabalpur UPHC Ukhari Y Y

83 Jabalpur Urban PHC Ghamapur, Jabalpur NA Y

84 Jabalpur Urban PHC Gohalpur,Ram Nagar, Jabalpur NA Y

85 Jabalpur Urban PHC Chandmari, Jabalpur NA Y

86 Jabalpur Cantt, Jabalpur NA Y

87 Jabalpur Urban PHC Sneh Nagar, Jabalpur NA Y

88 Jabalpur Urban PHC Paraswara, Jabalpur NA Y



Page 71 of 84


89 Jabalpur Urban PHC Prasutika Grah,Kotwali, Jabalpur NA Y

90 Jhabua UPHC Jhabua Y Y

91 Katni UPHC Rafi Ahmed Kidwai Y Y

92 Katni UPHC Vivekanand Y Y

93 Khandwa UPHC Ram Nagar Y Y

94 Khandwa UPHC Sanjay Nagar Y Y

95 Khargone UPHC Aurangpura Y NA

96 Khargone UPHC Khargone Y Y

97 Mandla UPHC Mandla Y Y

98 Mandsaur UPHC Mandsaur Y Y

99 Morena UPHC Morena Y Y

100 Morena UPHC Ram Nagar Y NA

101 Narsinghpur UPHC Gadarwada Y Y

102 Narsinghpur UPHC Narsinghpur Y Y

103 Neemuch UPHC Neemuch Y Y

104 Panna UPHC Panna Y Y

105 Raisen UPHC Mandideep Y Y

106 Raisen UPHC Raisen Y NA

107 Rajgarh UPHC Biaora Y Y

108 Ratlam UPHC Dilip Nagar Y Y

109 Ratlam UPHC Hakeemwada Y Y

110 Ratlam UPHC Jaora Y Y

111 Ratlam UPHC TIT Road Y Y

112 Rewa UPHC Bodabag Y Y

113 Rewa UPHC Ratahara Y Y

114 Sagar UPHC Bina Y Y

115 Sagar UPHC Khurai Y NA

116 Sagar UPHC Sagar Y Y

117 Sagar UPHC Vitthal Nagar Y NA

118 Satna UPHC Hanuman Nagar Y Y

119 Satna UPHC Kasaudhan Y Y

120 Sehore UPHC Ashta Y Y

121 Sehore UPHC Sehore Y Y

122 Seoni UPHC Chhindwara Chowk Y Y

123 Shahdol UPHC Sohagpur Y Y

124 Shajapur UPHC Shajapur Y Y

125 Shajapur UPHC Shujalpur Y Y

126 Sheopur UPHC Sheopur Y Y

127 Shivpuri UPHC Karaundi Y NA

128 Shivpuri UPHC Shivpuri Y Y

129 Sidhi UPHC Madariya Y Y

130 Singroli UPHC Navjeevan Vihar Y Y

131 Tikamgarh UPHC Tikamgarh Y Y

132 Ujjain UPHC Adarshnagar Y Y

133 Ujjain UPHC Bherugarh Y Y



Page 72 of 84


134 Ujjain UPHC Jaisinghpura Y Y

135 Ujjain UPHC Mitranagar Y Y

136 Ujjain UPHC Nagda Y NA

137 Ujjain UPHC Pawasa Y Y

138 Ujjain UPHC Sanjaynagar Y Y

139 Umaria UPHC Umaria Y Y

140 Vidisha UPHC Basoda Y Y

141 Vidisha UPHC Karaiyakheda Y Y

142 Vidisha UPHC Mohangiri Y Y

143 Vidisha UPHC Sironj Y Y



Page 73 of 84

Table A8: District wise status of Urban-PHC according to HMIS and detail of health staff

Sl.

No. District Name Facility Name HMIS

Health Staff

ANM LT LDC/

MIS MO

Phar

ma

RBSK

AMO SN Total

1 Agar Malwa UPHC Agar Y

2 Ashok Nagar UPHC Ashok Nagar Y 4 1 2 7

3 Balaghat UPHC Balaghat Y 1 1

4 Barwani UPHC Barwani Y 2 1 1 2 6

5 Barwani UPHC Sendhwa Y 2 1 2 5

6 Betul UPHC Betul Y 5 1 1 1 1 9

7 Betul UPHC Sarani Y 1 1 1 3

8 Bhind UPHC Bhawanipura Y 8 1 2 11

9 Bhind UPHC Gohad Y 1 1

10 Bhind UPHC Vikrampura Y 6 1 2 9

11 Bhopal UPHC Anandnagar Y 1 1 1 3

12 Bhopal UPHC Ashoka

Garden Y 1 1

13 Bhopal UPHC Bagsewaniya Y 1 1 2

14 Bhopal UPHC Berkheda

Pathani Y

15 Bhopal UPHC Kokta Y 1 1

16 Bhopal UPHC Kolua Y 1 1 2

17 Bhopal UPHC Kotra Y 1 1 1 3

18 Bhopal UPHC Saibaba

Nagar Y 1 1 2

19 Bhopal UPHC Alamganj Y 1 1 2

20 Bhopal UPHC Doulatpura Y 1 1 2 4

21 Bhopal UPHC Chhatarpur Y 1 1 1 3

22 Bhopal UPHC Tatoriya Y 1 1

23 Bhopal UPHC Lalbag Y 1 1 2

24 Bhopal UPHC Sukludhana Y 1 1

25 Damoh UPHC Damoh Y 1 1

26 Datia UPHC Datia Y 1 1 2

27 Dewas UPHC Bawadia Y 3 1 1 1 1 7

28 Dewas UPHC Itawa Y 1 1 2

29 Dhar UPHC

Brahmakundi Y

30 Dhar UPHC Pithampur N

31 Dhar

UPHC

Veersanwarkar

Ganjikhana

Y

32 Guna UPHC Boode Balaji Y 5 1 2 8

33 Guna UPHC Cantt Y 5 1 1 1 8

34 Guna UPHC Raghogarh Y 5 1 2 8

35 Gwalior UPHC Bahodapur N 3 1 2 1 7

36 Gwalior UPHC CD Falka

Bazar Y 4 2 1 7



Page 74 of 84

Sl.


Health Staff

ANM LT LDC/

MIS MO

Phar

ma

RBSK

AMO SN Total

37 Gwalior UPHC CD Gol

Pahadiya Y 2 1 1 4

38 Gwalior UPHC Dabra Y 1 1

39 Gwalior UPHC Gudagudi ka

Naka Y 3 1 1 1 2 8

40 Gwalior UPHC Harijan Basti

Dullapur Y 1 2 3

41 Gwalior UPHC Harijan Basti

Gendewali Sadak Y 2 1 3

42 Gwalior UPHC Hathikhana Y 4 1 1 1 1 2 10

43 Gwalior UPHC Hurawali Y 2 1 3 6

44 Gwalior UPHC Ohadpur Y 3 1 1 1 6

45 Gwalior UPHC Panth Nagar Y 4 1 1 6

46 Gwalior UPHC Purani

Chhawani Y 2 1 1 2 6

47 Gwalior UPHC Shankarpur Y 2 1 1 1 5

48 Harda UPHC Harda Y 1 1 2

49 Hoshangabad UPHC Gwaltoli Y 3 1 1 2 7

50 Hoshangabad UPHC Itarasi Y 4 3 7

51 Hoshangabad UPHC Malakhedi Y 1 1 1 3

52 Indore UPHC Baabu Murai Y 2 2

53 Indore UPHC

BHAWARKUAN Y 2 2

54 Indore UPHC BRINDAWAN

COLONY Y 2 2

55 Indore UPHC Gwaltoli Y

56 Indore UPHC KAMLAKANT

MODi Y 1 1 2

57 Indore UPHC

KRISHNAPURA Y 1 1

58 Indore UPHC Kulkarni ka

Bhatta Y 2 1 1 4

59 Indore UPHC Mhow N

60 Indore UPHC Musakhedi Y 2 1 1 1 5

61 Indore UPHC

Nihalpurmandi Y 2 1 1 1 5

62 Indore UPHC Sadar Bazar Y 2 1 1 4

63 Indore UPHC Shivbaag Y 2 1 1 4

64 Indore UPHC Shivbrahm

Nagar Y 1 1 2

65 Indore UPHC Sirpur Y 1 1 2

66 Indore UPHC Sudama

Nagar Y 2 1 1 1 1 6

67 Jabalpur UPHC ADHARTAL Y 8 1 1 1 11

68 Jabalpur UPHC Amanpur Y



Page 75 of 84

Sl.


Health Staff

ANM LT LDC/

MIS MO

Phar

ma

RBSK

AMO SN Total

69 Jabalpur UPHC Bara Pathar Y 3 1 1 5

70 Jabalpur UPHC Cherital Y

71 Jabalpur UPHC Ganga nagar Y

72 Jabalpur UPHC Gupteshwar Y 1 1 1 1 1 5

73 Jabalpur UPHC

Hanumantala N

74 Jabalpur UPHC Kajarwada Y 2 1 1 1 5

75 Jabalpur UPHC Lalmati Y

76 Jabalpur UPHC Motinala

Maqsuda Y 4 1 2 7

77 Jabalpur UPHC Polipathar Y 3 1 1 1 5 11

78 Jabalpur UPHC Richai Y

79 Jabalpur UPHC Shanti Nagar Y 2 1 1 1 5

80 Jabalpur UPHC Suhagi Y

81 Jabalpur UPHC TILWARA Y 1 1 2

82 Jabalpur UPHC Ukhari Y 1 1 1 1 4

83 Jabalpur

Urban PHC

Ghamapur,

Jabalpur

NA 1 1 1 3

84 Jabalpur

Urban PHC

Gohalpur, Ram

Nagar, Jabalpur

NA 6 1 1 8

85 Jabalpur

Urban PHC

Chandmari,

Jabalpur

NA 2 2

86 Jabalpur Cantt, Jabalpur NA 1 1 1 3

87 Jabalpur Urban PHC Sneh

Nagar, Jabalpur NA 2 1 2 5

88 Jabalpur

Urban PHC

Paraswara,

Jabalpur

NA 4 1 1 1 7

89 Jabalpur

Urban PHC

Prasutika Grah,

Kotwali, Jabalpur

NA 5 1 1 3 10

90 Jhabua UPHC Jhabua Y 1 1 2

91 Katni UPHC Rafi Ahmed

Kidwai Y 2 1 1 1 5

92 Katni UPHC Vivekanand Y 2 1 1 4

93 Khandwa UPHC Ram Nagar Y 1 1 1 1 4

94 Khandwa UPHC Sanjay

Nagar Y 1 1 1 1 4

95 Khargone UPHC Aurangpura Y

96 Khargone UPHC Khargone Y 3 1 1 2 7

97 Mandla UPHC Mandla Y 1 1 1 3

98 Mandsaur UPHC Mandsaur Y 1 1 1 3

99 Morena UPHC Morena Y 1 1



Page 76 of 84

Sl.


Health Staff

ANM LT LDC/

MIS MO

Phar

ma

RBSK

AMO SN Total

100 Morena UPHC Ram Nagar Y

101 Narsinghpur UPHC Gadarwada Y 1 2 3

102 Narsinghpur UPHC Narsinghpur Y 3 1 2 6

103 Neemuch UPHC Neemuch Y 1 1

104 Panna UPHC Panna Y 1 1

105 Raisen UPHC Mandideep Y 1 1 2

106 Raisen UPHC Raisen Y

107 Rajgarh UPHC Biaora Y 1 1 2

108 Ratlam UPHC Dilip Nagar Y 2 1 1 2 6

109 Ratlam UPHC

Hakeemwada Y 1 1 1 1 1 5

110 Ratlam UPHC Jaora Y 1 1 2

111 Ratlam UPHC TIT Road Y 2 1 1 1 1 6

112 Rewa UPHC Bodabag Y 3 1 1 5

113 Rewa UPHC Ratahara Y 1 1 1 3

114 Sagar UPHC Bina Y 1 1

115 Sagar UPHC Khurai Y

116 Sagar UPHC Sagar Y 5 2 3 10

117 Sagar UPHC Vitthal Nagar Y

118 Satna UPHC Hanuman

Nagar Y 4 1 5

119 Satna UPHC Kasaudhan Y 3 1 4

120 Sehore UPHC Ashta Y 4 1 5

121 Sehore UPHC Sehore Y 4 1 1 1 7

122 Seoni UPHC Chhindwara

Chowk Y 3 1 2 6

123 Shahdol UPHC Sohagpur Y 3 1 1 5

124 Shajapur UPHC Shajapur Y 1 1

125 Shajapur UPHC Shujalpur Y 1 1 1 3

126 Sheopur UPHC Sheopur Y 1 1 1 3

127 Shivpuri UPHC Karaundi Y

128 Shivpuri UPHC Shivpuri Y 1 1 2

129 Sidhi UPHC Madariya Y 3 1 1 5

130 Singroli UPHC Navjeevan

Vihar Y 1 2 3

131 Tikamgarh UPHC Tikamgarh Y 6 2 8

132 Ujjain UPHC Adarshnagar Y 1 1 1 3

133 Ujjain UPHC Bherugarh Y 2 1 3

134 Ujjain UPHC Jaisinghpura Y 2 1 1 4

135 Ujjain UPHC Mitranagar Y 2 1 1 4

136 Ujjain UPHC Nagda Y

137 Ujjain UPHC Pawasa Y 1 1

138 Ujjain UPHC Sanjaynagar Y 2 1 3

139 Umaria UPHC Umaria Y 3 1 1 1 6

140 Vidisha UPHC Basoda Y 5 1 2 8



Page 77 of 84

Sl.


Health Staff

ANM LT LDC/

MIS MO

Phar

ma

RBSK

AMO SN Total

141 Vidisha UPHC

Karaiyakheda Y 4 1 1 1 1 8

142 Vidisha UPHC Mohangiri Y 5 1 2 8

143 Vidisha UPHC Sironj Y 4 2 6

Total 244 36 68 62 14 2 111 537

Table A9: District wise status of essential services in selected Civil Dispensary

Sl.

No.

Essential Heath Service Provision

District

Bhopal Sagar Indore Dhar Ujjain Bhind Gwalior Gwalior Jabalpur Rewa

1 Maternal health (ANC, PNC, initial management of complicated

delivery cases and referral, management of regular maternal

health conditions, referral of complicated cases) √ -

√ - √ √ √ -

2 Family welfare (Distribution of OCP/ CC, IUD insertion, referral for

sterilization, management of contraceptive related complications)

√

-

√ - √ √ √

√

-

-

3 Child health and nutrition √ √ √ √ - √ √ √ - √

4 RTI/STI (including HIV/AIDS) (Symptomatic Diagnosis and primary

treatment and referral of complicated cases)

√

-

√

- -

√ √ √

- -

5 Nutrition deficiency disorders (Diagnosis and treatment of seriously

deficient patients, referral of acute deficiency cases)

√ √ √ √ √ √ √

- - -

6 Vector borne diseases (Diagnosis and treatment, referral of

terminally ill cases)

√ √ √ √ √

- √ - -

√

7 Mental Health (Initial screening and referral) - - - - - - - - - √

8 Oral Health (Diagnosis and referral) - √ √ - - - √ - - -

9 Chest infections -TB/Asthma (Diagnosis and treatment, referral of

complicated cases)

√ √ √

-

√ √

- √ -

√

10 Cardiovascular diseases (Diagnosis and treatment and referral

during specialist visits)

√ √ √

-

√ √

- - -

√

11 Diabetes (Diagnosis and treatment, referral of complicated cases) √ - √ - √ √ - - - -

12 Cancer (Identification and referral, follow-up) - - √ - - - - - - -

13 Trauma care -burns & injuries (First aid , emergency resuscitation,

documentation for MLC (if applicable) referral) - √

√ √ √

- - √ - √

14 Other surgical interventions (Identification and referral) - - - - - - - - - -



Page 79 of 84

Table A10: District wise status of essential services in selected Urban-PHC

Sl.

No.

Essential Heath Service Provision

District

Bhopal Harda Sagar Dhar Ujjain Bhind Jabalpur Umaria Rewa

1 Maternal health (ANC, PNC, initial management of complicated

delivery cases and referral, management of regular maternal

health conditions, referral of complicated cases)

√ √ - - √ √ √ √ -

2 Family welfare (Distribution of OCP/ CC, IUD insertion, referral for

sterilization, management of contraceptive related complications)

√ √ √ - √ √ √ √ √

3 Child health and nutrition √ √ √ - √ √ √ √ √

4 RTI/STI (including HIV/AIDS) (Symptomatic Diagnosis and

primary treatment and referral of complicated cases)

- √ √ - √ √ √ √ √

5 Nutrition deficiency disorders (Diagnosis and treatment of

seriously deficient patients, referral of acute deficiency cases)

√ √ √ - √ √ √ √ -

6 Vector borne diseases (Diagnosis and treatment, referral of

terminally ill cases)

√ √ √ - √ √ √ √ √

7 Mental Health (Initial screening and referral) √ - - - - - √ - √

8 Oral Health (Diagnosis and referral) √ √ √ - √ - √ - -

9 Chest infections -TB/Asthma (Diagnosis and treatment, referral of

complicated cases)

√ √ √ - - √ √ √ √

10 Cardiovascular diseases (Diagnosis and treatment and referral

during specialist visits)

√ √ √ - √ - √ √ √

11 Diabetes (Diagnosis and treatment, referral of complicated cases) √ √ - - √ - √ √ √

12 Cancer (Identification and referral, follow-up of √ - √ - √ - - √ -

13 Trauma care -burns & injuries (First aid , emergency

resuscitation, documentation for MLC (if applicable) and referral)

√ √ √ - √ - √ - √

14 Other surgical interventions (Identification and referral) - - - - - - - - -



Page 80 of 84

Table A11: District wise availability OPD equipment in Urban -PHC

Sl.

No.

Equipments Bhopal Harda Sagar Dhar Ujjain Bhind Jabalpur Umaria Rewa

1 Adult weighing scale √ √ √ √ √ √ √ √ √

2 Baby weighing scale - √ - √ - √ √ √ -

3 Bowl for antiseptic solution for soaking cotton swabs - - - - - √ √ √ √

4 Chairs, Stool √ √ √ √ √ √ √ √ √

5 Examination couch, steps, etc √ √ √ - √ - √ √ √

6 Height measuring Scale - √ - - - - - - √

7 IUCD insertion kit - - - - √ - - - √

8 Measuring tap - - - - - - √ √ √

9 Minor OT instruments - - - - - √ - - -

10 Spot light - - - - √ - - - -

11 Standard Surgical Set - - - - - - - - -

12 Stethoscope √ √ √ √ √ √ √ - √

13 Thermometers Alcohol (stem) √ √ √ - √ √ √ - √

14 Torch without batteries – 2 - - √ - √ √ √ √ √

Table A12: District wise availability of Lab equipment in Urban -PHC

Sl.

No.

Equipments Bhopal Harda Sagar Dhar Ujjain Bhind Jabalpur Umaria Rewa

1 Refrigerator √ √ - - - √ √ √ √

2 Battery dry cells 1.5 volt (large size) – 4 - - √ - √ √ √ - √

3 Binocular microscope √ - - - - - - - -

4 Domestic refrigerator √ - - - - - - √ √

5 Equipment/reagents - essential laboratory investigations - √ - - √ - - √ √

6 H2 S Strip test bottles - - - - - √ - - -

7 Kits for testing residual chlorine in drinking water - - - - - √ - - √



Page 81 of 84

Table A13: District wise availability of Other/Genera equipments in Urban -PHC

Sl.

No.

Equipments Bhopal Harda sagar Dhar Ujjain Bhind Jabalpur Umaria Rewa

1 Autoclave - - - - - √ - - -

2 Cold Boxes (Small & Large): Small- one, Large – two √ - - √ - √ √ - √

3 ECG machine - - - - - - - - -

4 Equipments under various National Programmes - - - - - √ √ √ √

5 Fire extinguisher √ - - - √ √ - - -

6 Freeze Tag: 2 per ILR bimonthly √ - - - - √ √ - -

7 Hand washing facilities & Alcohol based hand-rub √ √ - - √ √ √ √ √

8 Ice box √ - - - - √ √ - √

9 ILR (Small) and DF (Small) with Voltage Stabilizer √ - - √ - √ √ - -

10 Lead apron - - - - - - - - -

11 Spare ice pack box: 8, 25 & 60 ice pack boxes per vaccine

carrier, Small cold box & Large cold box respectively

√ - - - - √ √ - √

12 Standard Surgical Set - - - - - - - - -

13 Stretcher - - - - - - - - -

14 Suction machine - - - - - - - - -

15 Tray containing chlorine solution for keeping soiled

instruments

- - - - - √ - - √

16 Trolley - - - - - - - - -

17 Vaccine Carriers with 4 Icepacks: √ - - √ - √ √ - √

18 Waste disposal twin bucket, hypochlorite solution/ bleach √ - - - - √ √ √ √



Page 82 of 84

Table A14: District wide availability of OPD equipments in Civil Dispensary

Sl.

No.

Equipments

Bhopal Sagar Indore Dhar Ujjain Bhind Gwalior Gwalior Jabalpur Rewa

1 Adult weighing scale √ √ √ √ √ - √ √ √ √

2 Baby weighing scale √ - √ - - - - - - √

3 Bowl for antiseptic solution for soaking cotton swabs √ - √ - √ √ √ √ - √

4 Chairs, Stool √ √ √ √ √ √ √ √ √ √

5 Examination couch, steps, etc √ √ √ √ √ √ √ √ - √

6 Height measuring Scale √ - √ - - - √ - - -

7 IUCD insertion kit - - √ - √ - - √ - -

8 Measuring tap - √ √ - - - √ - - √

9 Minor OT instruments - - √ - - √ - - - √

10 Spot light - - √ - √ - - - - -

11 Standard Surgical Set - - √ - - - - - - -

12 Stethoscope √ - - √ √ √ √ √ - √

13 Thermometers Alcohol (stem) - - √ √ √ - - - - √

14 Torch without batteries – 2 - - √ √ √ - √ - - -

Table A15 : District wise availability of Lab equipment in Civil Dispensary

Sl.

No.

Equipments Bhopal Sagar Indore Dhar Ujjain Bhind Gwalior Gwalior Jabalpur Rewa

1 Refrigerator - - √ - - - √ √ - -

2 Battery dry cells 1.5 volt (large size) – 4 - - √ - √ - √ - - -

3 Binocular microscope √ √ √ - √ - - - - -

4 Domestic refrigerator - - √ - - - √ - - -

5 Equipment/reagents- essential laboratory

investigations

√ - √ - √ - - √ - -

6 H2 S Strip test bottles - - - - - - - - - -

7 Kits for testing residual chlorine in drinking water - - - - - √ - √ - -



Page 83 of 84

Table A16: District wise availability other/general Equipment in Civil Dispensary

Sl.

No.

Equipments Bhopal Sagar Indore Dhar Ujjain Bhind Gwalior Gwalior Jabalpur Rewa

1 Autoclave - - - - √ - - √ - -

2 Cold Boxes (Small & Large): Small- one,

Large – two

√ - √ - √ - √ √ - -

3 ECG machine - - - - - - - - - -

4 Equipments under various National

Programmes

√ - √ - √ - - √ - -

5 Fire extinguisher - - √ - √ - - - - -

6 Freeze Tag: 2 per ILR bimonthly - - √ - √ - √ √ - -

7 Hand washing facilities & Alcohol based

hand-rub

√ √ √ - - √ √ √ - -

8 Ice box √ - √ - √ - √ √ - -

9 ILR (Small) and DF (Small) with Voltage

Stabilizer

√ - √ - √ - √ √ - -

10 Lead apron - - - - - - - - - -

11 Spare ice pack box: 8, 25 & 60 ice pack

boxes per vaccine carrier, Small cold box &

Large cold box respectively

√ - √ - √ - √ √ - -

12 Standard Surgical Set - - √ - - - - - - -

13 Stretcher - - √ - √ - - - - √

14 Suction machine - - - - - - - - - -

15 Tray containing chlorine solution for

keeping soiled instruments

- - √ - - √ √ √ - √

16 Trolley - - √ - √ - - - - -

17 Vaccine Carriers with 4 Icepacks: √ - √ - √ - √ √ - -

18 Waste disposal twin bucket, hypochlorite

solution/ bleach

√ - √ - √ - √ - - -



Page 84 of 84

Date post:	13-Feb-2022
Category:	Documents
Upload:	others
View:	1 times
Download:	0 times

Study of Civil Dispensaries & Urban-Primary Health Centers ...

Documents