Bilaspur SRM

8/12/2019 Bilaspur SRM

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Wel-Come

To

SRM Bilaspur Debriefing


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State Review Mission -NRHM

-Vision -

Review of Progress in Health status and Health Delivery System

Assessment of Impact on Accessiility ! "#uity! affordaility and

Identify the $est practices !succes stories and innovations

Identify the %onstrains and issues

Strategies to solve the prolems within availale resources


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&eam Memers

State-Dr' ('R' Sonwani Deputy Director )NRHM*

Dr' (haparde )+H,*

Dr' A'(' $harti )Ayush M, Dantewada*

District

Dr' iwani! DI,

.t/arsh &iwari! DPM

0ilson! DAM

r' a yasan pan ra an

Neelu 1hritalhre )DPM /ondagaon*

0irendra Singh &ha/ur )DAM /an/er*

Neera2 0erma )DD, Raipur*

.day $hanu )D&% Narayanpur*

0i/ram ra2 sahu )S" Sargu2a*

Nilesh )H% $alrampur*

0andana 1upta )SHR% an2gir*

Mo' &a r S e ! DD,

Pradeep Roy! D&%


4/40

3acility 0isited

DH CHC PHC SHC VHND VHSC

$I4HA%HA(RA$HA&A

&A(HA&P.R$"4PAN $"4PAN $IA

DAIA

MAS&.RIMA4HAR 4IM&ARA RA(

$I4ASP.R (,&A(AR1I(A4A N"0RA

SHI0&ARAI SHI0&ARAI

1A0R"4A ("0%HI ("0%HI

P"NDRA DANI (.NDI

MAR0AHIDH,$HAR

SHI0NI


5/40

District Hospital

+ell estalished NR%!$lood $an/!

5' "stalished %all %entre

Peripheral Health acilit!5' %ommitted 4eadership and Management .nit

6' insured Service delivery at %H% and PH% identified

Positi"es

'

PH%s

8' Some RMAs are doing well

9' 1ood Infrastructure and road connectivity !"lectrical supply!

Solar system:' 1ood Initiatives for Infrastructure development

;' +ell estalished 3inancial system up %H%s level


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Some good practices

Well maintaine# $mergenc! tra!%&orella' Well labelle# me#icine containers in nursingstation


7/40

Facilities in LR

?

5

6

7

8

9

:

;

%H%s PH%s

;

7

?

8

()*+ ,ater suppl!

Present

Asent

?

5

6

7

8

9

Present Asent not at proper

location

7 7

5

6

9

?

NBCC in R

%H%s

PH%s

?

5

6

7

8

9

:

%H%s PH%s

:

55

:

$lectricit! Bac.up

PresentAsent

?

5

6

7

8

9

:

;

%H%s PH%s

;

8

?

7

$mergenc! Tra!

Present

Asent


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6'9

7

7'9

8

7

6

8

6

Drugs in R

%H%s

?

?'9

5

5'9

6

only ,@ytocin only Misoprostol $oth Present $oth not Present

5 55

?

PH%s


9/40

Infrastructure Progress

59?

6??

69?

7??6;5

55;

Sanctioned

%ompleted

.nder construction

PH% SH% Residential

Sanctioned %ompleted

.nder

%onstructio

n

Sanctio

ned %ompleted

.nder

%onstruct

ion

Sanctio

ned

.nder

%onstructio

n

9: 7: 9 6;5 55; 95 66 5;

?

9?

5??

PH% SH% Res

9:

66

7:

?9

95

5;


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HMIS


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/0Monthl! facilit! reporting status

HMIS

Reporting status in the Sept2012

Total Facility

Total Facility

filled %

District Facility

SC 268 268 100.00

55

Bilaspur

PHC 56 56 100.00

CHC 7 7 100.00

SDH

DH 1 1 100.00

Total 332 332 100.00


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MCTS - Registration of pregnant ,omen an# chil#

)Apr- Sept 6?56*

d z- fod kl k M d kuke

Mother Details Child Details

TotalRegistration

x HkZorh

efgyk d k

y{;

d qy efgy k

iat h;u

x HkZorh

efgy k d h

iat h;u d k

izfr'kr

f'k'kq

iat h;u d k

y{;

d qy f'k'kq

iat h;u

f'k'kqiat h;u d h

, Vh d k

izfr'kr

1 13572 4973 36.64 11504 2349 20.42 28.53

56

2 12956 4699 36.27 11318 2542 22.46 29.363 8330 2970 35.65 7258 2095 28.86 32.26

4 11080 3493 31.53 9693 2003 20.67 26.10

5 2935 782 26.65 2583 756 29.27 27.96

6 4295 1087 25.31 3746 767 20.48 22.89

7 5534 1562 28.23 4799 1318 27.47 27.85 58700 19566 33.33 50900 11830 23.24 28.29


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/0MCTS- Number of #eli"eries entr! against e*pecte# #eli"eries as

on Sept /(

d zekad fod kl k M

d kuke

visf{kr

izlo dqy izlo

dqy izlo izfr'kr

1 fcYgk 4212 2141 51

2 eLrwjh 4248 2369 56

57

3 dksk 2!14 18"6 6!4 r#kriqj 2893 166" 5!

5 is$%&k 812 !19 896 k(jsyk 1231 !55 61

dqy 1!53" 1"588 6"


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S.No

Name oftraining

Target GroupTarget

Achievement

% ofAchievement

1 MTP MO 3 2 66.672 Bemoc MO 5 5 100.00

3 Bemoc RMA 7 10 142.86

4 SBA SN, LHV, ANM 18 12 66.67

HR - &raining

5 RTI STI LT, RMA, SN 60 56 93.33

6 IUCD MO, SN,LHV, RMA,

ANM 165 140 84.85

7 NSSK ANM 150 57 38.00

8 Quality

ANC ANM 180 28 15.56

Post training Monitoring and 3ollow-up = 0ery wea/

.se of Partograph =Not satisfactory


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%hild Health NR% at 1ourela -Progress Not Satisfactory

SN%. =Not Started

N$S.-Pendra well functioning

N$%%- 0isited 3acility Not Proper School Health %hec/-up---Satisfactory


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School Health

Block Examined Sick % Reffered %

Takhatpur 10576 2919 27.60 188 6.44

Bilha 2784 1905 68.43 23 1.21

Marwahi 8831 1811 20.51 769 42.46

Masturi 30355 8129 26.78 246 3.03

Kota 16133 2982 18.48 40 1.34

endra 2881 478 16.59 41 8.58

!aurela 18826 3773 20.04 100 2.65

Total 90386 21997 24.34 1407 6.40


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RN&%P


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$asic Services


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Performance 756

&uerculosis .nit

Suspects "@aminationBlac

population

AnnualiCed %ase

Detection Rate for NSP

%target 1/2/3lac' %target 1 +45'

D&% $ilaspur 57< 99

$ilha :8 78

1aurela 5


20/40

%ase Detection Rate for NSP &$ cases )75? to756*

5??

56?

58?

5:?

7?7;

95

79 7985 88 8?

78

?

6?

8?

:?


21/40

3ocussed $loc/ in the district =

$ilha! Masturi E &a/hatpur

Possible Solution to impro"e case #etection

rate6 Instruction )target ased* to all the MP+Fs to

&arget oriented'

Referral slips for monitoring of the referrals

SensitiCation of MitaninFs for referral of &$suspects to the nearest microscopy centre


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3indings of SRM E Possile Solutions

Directly ,served &reatment )D,&* is very

wea/ in the district =field visit reported Mitanin has given whole P+$

Mitanin not aware of D,& provision E treatmentcard mar/ings

Poor supervision E monitoring y the contractual

staff


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No medicines )P+$* at PH% level

P+$ to e made availale at PH% level withpharmacist

Monthl re ort not ein sumitted the PH%Fs

All PH%Fs to sumit monthly reports on time

It needs to e incorporated in HMIS

Poor supervision E monitoring activities in thedistrict

No contractual staff availale at the time of visit


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Poor visiility )I"%* of the programme

No postersBwall paintings at S%s E PH%s

.tiliCation of untied funds

&reatment card entry at NI(SHAG software)online entry of &$ treatment cards* is very

slow&raining of PADA E $ADA is pending


25/40

&$-HI0 %oordination


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&$-HI0 +hole $lood finger

&esting )+$3&*

All DM% 4&s should

&uerculosis .nit

of &$ patientstested for HI0

perform +$3&')target - 5??*

D&% $ilaspur 68

$ilha 99

1aurela 5;

Marwahi ?


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Programmatic Management of Drug Resistant &$

)PMD&*

Implementing from Dec 6?55


28/40

PMD& None of the 4&s at %H%BDM% (ota are trained

in PMD&4&s needs to e trained at the earliest! as they play

suspects

Sputum transportation o@ were not availalein the 4aBDM%


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Mitanin Programme

5' Mitanin Help des/ visile in facility visited

6' Incentive payment are regular'

7' Mitanin Dawa Peti Reffiling Irregular'

8' Information to SG $eneficiary satisfactory'


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Issues

1. Out of Pocket Expenditure in some facilities.2. Patients being charged for Normal eli!er"

#. $% expenditures against the Norms.


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Areas of Improvements

5' Reduction of wor/load of District Hospital and %H%s y operationaliCation of PH% and

SH%

6' Regular Monitoring and guidance for waste disposal Management ! %leanliness within

4aour room

7' ,rganiCation of "#uipments! Drugs!and %onsumales within 4aour

8' Identification of High ris/ AN% detection at SH% and PH%s with regular support to staff

9' %hec/in of ANMs records and monitorin of their s/ills -M, RMA Mana ement

.nits:' ,rientation to ANMs aout Nearest Delivery points and % S Point

;' Display of &a@i and 0ehicle with %ontact Numer of Drivers


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5' Monitoring of functional status of Traine# HR

6' "nsure the Staying of Staff at their Head#uarter =$oth Paramedical and Management

7' Provision and maintenance of Proper Duty room B %ain for Doctors and Nursing Staff

at all Delivery Points

8' Records /ee in =$oth 3inancial and Pro ramme re ortin at PH%s and SH%s

Areas of Improvements )%ont'*

9' "nsure regular supply system of Drugs and %onsumales

:' Monitoring of Awareness aout 1uideline and their use y %H%s! PH%s and SH%s

;' DecentraliCation of &he D,&s supply system


33/40

Suggestions for PIP 6?57 - 58

5' Separate ,& and 4aour room at 1aurella Sanitorium

6' Staff uarter for Paramedics At 1aurella

-

8' Display of Protocol at 4aour Rooms


34/40

Suggestions for 4aor Room

1& Emergenc" tra".

2& N'(( Resuscitation e)uipments to be located atproper place

#& Partograph to be maintained and stored forretrie!al.

*& Running +ater facilit" +ith proper hand+ashingresources. Pictorial hand+ashing instructionsshould be displa"ed at all strategic locations.

,& (urtains for pri!ac" bet+een deli!er" tables

-& Proper segragation and transportation of '/should be done.


35/40

%uggestions for rug storage

5* Medicines and other supplies should e

stored in order = alphaet wiseB disease wise

6* 3I3, should e followed7* Near "@piry drug list should e prepared


36/40

Suggestions for 4aoratory5* .se of PP" )gloves and aprons*

6* Segregation of $M+ at point of generation

7* Different Cones for different activities =%ollection area! testing area! report

'


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"@cellent

"@ecution-

5R,P 6?56-57 approved y District Health

3inancial Management

'

6Approved $loc/wise R,P 3'G' 6?56-57forwarded to all the loc/ '

7

&ally "RP >'7 version - DHS Ball loc/ tally

generated 3MR reporting to State HealthSociety! Raipur'


38/40

3inancial Management

3indings-

5 4ac/ of Accounting Policies e@ecution in PH%! SH% levels'

6Proper illing procedure was not followed in $ilha

%ha/rahata! Masturi! Malhar'

7During the 0isit of DH team oserved that cashoo/

maintained a ainst 1,I Norms'


39/40

Suggestions for financial Management-

5 District Authorities have to ta/e more attention and

initiatives towards $M,S )%H%BPH% 4evel* for

implementation of Accounting Policies'

6"@ enditure to e monitored as er DS uidelines'


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Action &a/en $y SRM

Identify the 1aps

Discussed issues with All staff

%orrected the minor issues on spot li/e re-arrangment of 4aour room

Demonstrated the gaps and aware the concerned staff

Action ta/en $y District

%MH, have circulated instruction to $M,s

$M,s have een circulated the instruction to Mos and RMAs

%orrective measure at Some 3acilities

Documents

Bilaspur SRM