Gujarat Quarterly Monitoring Visit Report

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Gujarat Quarterly Monitoring Visit Report

Quarter 1, April- June 2013

NHSRC

Contents

Map of the District

Executive Summary

Detailed Monitoring Report

Annexures

HMIS Tables for district

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Map of the Porbandar District

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Gujarat Integrated Monitoring Visit Report

Quarter 1, April- June 2013

Executive summary

Purpose: Monitoring &Technical Assistance to districts for planning and implementation of NRHM activities; To assess the status of implementation of free and cashless services for delivery and referral transport for pregnant women and children under JSSK (separate detailed report submitted) .

The integrated monitoring visit for the first quarter of 2013 has covered the better performance district

of Porbandar for three days with visits to the district hospital (DH), one CHC Madhavpur, one 24x7 PHC

at Adityana, one subcentre at Bhade village under Garej PHC . The exit interview checklists for JSSK, User

fees facility checklist, interviews with the district officials and district data from DPMO are analyzed to

examine the existing situation.

Main findings:

DLHS III & HMIS data indicates that District performance is considerably high and much above the state

average in the major maternal health parameters of % ANC Check-up in First Trimester, 3 or More ANC

Check-up (%),Institutional Delivery (%), and Full Immunization (%) and so on. Breastfeeding within 1hour

of birth aspect, which is merely 51.8 percent, requires attention, as it is an important parameter in

neonatal care. Situation of reported maternal deaths (10) is more or less same as last year. Among the

causes of maternal deaths against total reported known causes of maternal deaths, bleeding constitutes

66.7% and 33.3% high fever.

41.2% infant deaths occurred between 24 hrs& under 1 week and 15.4 % deaths occurred within 24 hrs

of deaths and 21.3 % child deaths between one month and under 1 year. Among the known causes of

infant and child deaths against total reported known causes, LBW constitutes to a significant 64% and

Asphyxia 18%.

HR issues: There is a shortage of qualified personnel in the DH such as medical doctors, gynecologists,

specialists, in the class 1 & 2 categories and class 3 staff such as staff nurses, head nurses, and junior

pharmacists etc against sanctioned. As per district data, in CHC too, critical positions of medical

officers and staff nurses are vacant and requires to be filled. In PHCs, all six staff nurses positions, 68

positions of MPW s are vacant. This calls for immediate focus to initiate steps to improvement in HR

situation

Facilities visited: 24x7 PHC Adityana falls short of IPHS norms, without a single staff nurse so far, and

without 6 bedded arrangements in maternity ward. Subcentre, Bhade is housed in a government

building, is well equipped with a delivery room, senior trained ANM, MPW, ASHAs, and all other

equipment including colour coded bins.

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CHC Madhavpur facility needs strengthening on many aspects. Maternity ward/ room is very small could

accommodate two beds though on record there is a sanction for 30 beds.Case load is maternal below

average with 24 normal delivered conducted from April 2012-march 13 and total general OPD of 2485.

No FP operations conducted for the same period.

Blood bank: one government blood bank at the DH, and at the time of the visit there are only 4 units of

blood available. Two other private/NGO banks available in city.Facility has not put in place any system

for regular collection and maintenance of stocks, including a rational system of assessment of the need,

even though there is referral dependence from lower units. NO BSUs at other facilities.

JSY & JSSK: A total of 2466 beneficiaries received the incentives of JSY in the district and total number of

JSSK beneficiaries upto May 2013 are 3411.

Causes of Mortality Heart disease / hypertension related causes constitutes to a predominant 47.2% in

the known causes of deaths against total known causes of deaths 6 years and above

Quality Control: Protocols for bio medical waste management are in place except in CHC Madhavpur.

The state health department has a tie up with an NGO by name “Manavseva Trust” for the biomedical

waste management.

As part of system for monitoring and supervision, checklists are provided to district officials for periodic

assessments.

Display of proper Cityzen charter, RKS list, essential drugs position list, adequate information on JSSK

and breast feeding are needed in all facilities, DH, CHC and 24x7 PHC.

A system /mechanism is needed to be in place for grievance handling and it should be displayed in all

facilities visited.

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Detailed Report

Purpose

Monitoring &Technical Assistance to districts for planning and implementation of NRHM activities

To assess the status of implementation of free and cashless services for delivery and referral transport for pregnant women and children under JSSK

The integrated monitoring visit for the first quarter of 2013 has covered the better performance district of Porbandar for three days with visits to the district hospital, one CHC Madhavpur, one 24x7 PHC at Adityana, one subcentre at Bhade, under PHC Garaj . The exit interview checklists for JSSK, User fees facility checklist, interviews with the district officials and district data from DPMO are analyzed to examine the existing situation. For a macro analysis, HMIS data is utilized.

Profile of the District- Demographic Indicators

Porbandar, acoastal district surrounded by the neighbouring districts of Junagadh, Rajkot and Jamnagar,

has a population of 586,062(as per 2011 census), four Nagarapalikas, 3 Talukas, and 156 villages.It has a

population density 234 persons per sq. km, with a literacy rate of 76.63 %, and a sex ratio of 808females

per 1000 males.

Particulars / Parameters Gujarat Porbandar District

Population - Census - 2011

Persons 6,03,83,628 586,062

Male 31,482,282 300,967

Female 28,901,346 285,095

Population in the Age Group 0-6 - Census - 2011

Persons - 63,620

Male - 33,687

Female - 30,133

Sex Ratio ( No. of Females per 1000 Males)census 2011

811 808

Sex Ratio 0 – 6 years 886 894

IMR (per thousand live births) 44 -

MMR( per one lakh population)SRS 2007-09)

148 -

TFR( census 2011) 2.4 -

CBR( per 1000 population) 21.8

Literacy Rate (%) - Census - 2011

Persons 79.31 76.63

Male 87.23 84.56

Female 70.73 68.32

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Tab 2: Maternal Child Health Indicators2011-12, April 2012- Mar 2013& State

Indicators (DLHS III) Gujarat 2012-13 Porbandar District2011-12

Porbandar April2012-13 March

ANC

ANC Check-up in First Trimester (%)

52.3

76.6 76.6

3 or More ANC Check-up (%) 54.8 71.3 71.3

Deliveries

Institutional Delivery (%) 56.4 68.1 68.1

Home Delivery (%) 42.2 31 31

Home Delivery by SBA (%) 5.2 10.1 10.1

New Born & Post Natal Care

Live Births 96.1 97.9 97.9

PNC within 48 Hours of Delivery (%)

NA 68.2 68.2

Breastfed within 1hourof birth 48 51.8 51.8

Immunization

Full Immunization ((%) 54.8 76.7 76.7

As indicated by the above table, district performance is better and much above the state average in the

major maternal health parameters.In terms of comparativeperformanceof the district, progress

remained the same as the previous year in the major indicators.Breastfeeding within 1hour of birth is

merely 51.8 percent and requires attention, as it is an important parameter in neonatal care.

Tab.3 Maternal health-Comparison of district performance of 2012-13 with Previous year

Select Indicators (HMIS) Apr 2012- Mar 2013

Projected April 2012 -Mar13

Last year2011-March 12

Remark

3 ANC checkups against est. pregnancies ( HMIS)

90% 88% 76% Considerable Increase over estimation & last year

Institutional deliveries against est. deliveries

86% 83% 80% Moderate Increase over estimation &overlast year

Reported live births against est. live births

88.8% 86% 83% 5.8 %increase over last year

Fully Immunized against est. live births 90% 90% 93% Decreased by three % points over last year

Reported infant and child deaths 136 139.2 122 Reported deaths increased moderatelyover last year

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Reported maternal deaths 10 10.8 9 Increased by onenumber over last year

New borns breastfed within one hr of birth against reported live births

89% - -

% C. Section against institutional deliveries (public+pvt)

11.8 - - -

Abortion rate against reported pregnancies

3.7% - - -

Based on the above indicators, the overall situation of maternal health is improved over the previous

year. However reported maternal deaths remained same as last year, except that one more death

reported. Analysis of the causes of maternal deaths against total reported maternal deaths for this

period, indicate that ‘40.0% is due to bleeding’, 20% is due to high fever and 40% constitute ‘other

causes’. Among the causes of maternal deaths against total reported known causes of maternal deaths,

bleeding constitutes 66.7% and high fever 33.3%.

HMIS analysis reveals that out of a total of 581 complicated deliveries reportedly managed, 83.3% (484)

are managed and close to 30% of C. Sections (of total reported) are managed by the DH/SDH.

Breast feeding: There is a lot of variation in the data between DLHS III and HMIS with regard to the

‘breastfeeding within the first hour’. The plethora of IEC displayed in the DH facility did not include any

information on the importance of breast-feeding and colostrum in particular. The only women

interviewed at hospital did not initiate breastfeeding within one hr and was neither counseled by the

hospital staff. The same was brought to the notice of the facility authorities. Therefore emphasis is

needed on the importance of breastfeeding to pregnant women in the outreach programs,campaigns

and in many other innovative ways.

Infant and Child mortality: As indicated by the above table,the ‘fully immunized against total estimated

live births’ performance has reduced by 3 percentage points over the previous year. There is slight

increase in the reported infant (122 within one year) and child (14 between 1st year and 5 years) deaths.

41.2% infant deaths occurred between 24 hrs& under 1 week and 15.4 % deaths occurred within 24 hrs

of deaths and 21.3 % child deaths between one month and under 1 year.10.3 % deaths occurred

between 1 year and under 5 years.

Analysis of the causes of infant & child deaths against total reported deaths reveals, a significant 24%

deaths are due to low birth weight (LBW), 7% due to Asphyxia and 4% due to fevers. 62% are in the

category of others. Again in the known causes of infant and child deaths against total reported known

causes, LBW constitutes to a significant 64% and Asphyxia 18%.Cause of LBW correspondingly highlights

the significance of breastfeeding, as one of strategies to address this issue, which requires adequate

advocacy by authorities.

Maternal Death Review (MDR): The district has adopted the multi level MDR process beginning from

the verbal autopsy at Taluk health office to the review by district magistrate with all team.On the day of

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the monitoring visit, scheduled review process was going on, with the district magistrate/ collector

actively engaged in it.

Health care facilities map in the district

Public Health Care Infrastructure in the district includes 1 District Civil Hospital (DH), 4 CHCs, 11 PHCs

and 84 subcentres.

HR situation in the facilities in the district as in 2013

CHC ( 4) PHC (11) DH General

Category of staff sanction filled vacant sanction filled vacant Sanction Filled vacant

MBBS MO 12 4 8 10 8 2 - - -

Ayush MO 1 1 0 - 3 - - - -

Staff Nurse 28 14 14 6 0 6 46 32 14

Head Nurse - - - - - - 11 5 6

XRay tech 4 1 3 - - -

Lab tech 4 2 2 10 5 5 3 1 2

Pharmacist 4 3 1 10 8 2 12 2 10

Ophthalmic Asst 2 1 1 - - - - - -

Female health Worker (FHW)

- - - 84 80 4 - - -

FHSupervisor - - - 10 11 8

MPH S 10 1 9

MPW 84 68 16

Calss 1 category - - - - 18 11 7

Class2 - - - - - - 19 12 7

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HR positions in the facilities in the district include a total of 80 FHW/ANMs, 59 MPW,14 staff

Nurse(CHC), 3 PHC (Ayush) doctors, 8 PHC (MBBS) doctors, 4 CHC (MBBS) doctors and 1 CHC ( Ayush)

doctor.

From the above table, it is evident that there is a shortage of qualified personnel in the DH such as

medical doctors, gynecologists,specialists, in the class 1 & 2 categories and class 3 staff such as staff

nurses, head nurses, and junior pharmacists etc. In CHCS too, critical positions of medical officers and

staff nurses are vacant and requires to be filled. In PHCs, all six staff nurses positions, 68 positions of

MPW s are vacant. This calls for immediate focus to initiate steps to improvement in HR situation.

Facility Readiness: Key Observations:

The visit covered the district hospital at Porbandar, which is housed in two separate Government

buildings, one exclusively for maternity wing. Maternity ward is equipped with OT, laboratory,

pharmacy, SNCU, sonography, colour Doppler units and generator back up.The case load is high

compared to human resources available.

Caseload of DH April 2012- May 2013

Total OPD Total IPD

Gyn USG

NICU/SNCU

196436 16467 4480 317

Waiting halls and OPD exam rooms are available. However arrangement for adequate facilities for of

pregnant and senior citizens, such as washrooms close to OPD, drinking water is required. OPD

management practices are in place such as tokens, registration cards; OPD lists on computer etc.

Crowded Maternity wards are maintained without provision of privacy. Screens are required to be

initiated by the facilities.

Photos: OPD at maternity wing of DH Porbandar. In-Patient ward at Maternity hospital at the DH

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DH: The DH general unit is well equipped with different separate units for male, female, ICUs, male,

female Burn-wards, Ophthalmic, district cell for Non Communicable Diseases (NCD) and a separate wing

(NPCDCS-NPHCE), OPD & IPD, Bloodbank, laboratory, data entry rooms, ART centre with a councilor,

and award for prisoners. Hygiene is maintained well including the washrooms, except in the maternity

wing. Essential drug list is available and registers are updated and maintained in order. Computers are

actively used for various purposes.

Display: Citizens charter is displayed only at the general DH building and not at the separate unit of

maternity wing.Display of RKS/HDS members, essential drug list stock position, adequate JSSK

information,grievance handling mechanism, information on breastfeeding are required. IEC display

should be kept at a strategic, place where patients can notice and find it convenient to read on.

NICU/ SNCUs at DH:There is a SNCU in the DH and a full time pediatrician and a staff nurse available. It

has 4 units out of which one is not functional /condemned. There are no infants/patients in the SNCU at

the time of visit. As mentioned already caseload for the entire year is only 317.

Utilization is low and needs to be improved.

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24x7 Maternity home (PHC)Adityana: Upgraded as 24x7 PHC ,operates in a government building with a

MO and a Ayush doctor.

Case load: It caters to an average case load-a total OPD (April 2012- March 2013) of 11074; 73 deliveries

(of which 16 are night deliveries).

The PHC falls short of IPHSnorms. There is not a single staff nurse from the beginning and deliveries are

conducted by a Dai stationed at residential quarters and the local senior FHW. The maternity ward has

only 2 beds instead of required 6 beds. The single maternity room with 2 beds is used for multi

purposes of meetings etc. a birth waiting room is initiated recently.

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Registers and Data maintenance arewell in order. Stock lists are available. Display of proper Cityzen

charter, RKS list, essential drugs position list, adequate information on JSSK and breast feeding are

needed.

Needed interventions: Recruitment of at least one staff nurse and provision for full fledgedsix

maternity beddedward are important actions.

Madhavpur CHC and Bhadesubcentre:

Sub-centre Bhade is housed in a government building, is well equipped with a delivery room, and all

other equipment including colour coded bins. It has all the trained, senior staff and ASHAs attached to

it. Per month an average 2 o 3 deliveries take place. Lab technician from the nearest PHC visits the SC on

schedules for conducting blood exam for ANCs, in addition to the blood exam kits that are maintained

there. It carries an ANC OPD for all 6 days and 2 days particularly are allotted for national programs.

Subcentre has some IEC material but requires adequate information on breast feeding and JSSK.

Photograph- subcentre.

CHC Madhavpur is also housed in a government building and converted froma PHC to CHC in

Feb 2012. At the time of visit the regular medical officer was reportedly on leave and another medical

officer TB in charge is posted that day. There Is one staff nurse. the CHC is not equipped in general , for

example, without any arrangements for patient waiting( patients were observed as waiting on the exit

cantilever, waiting for OPD), no display of information on any important aspects including citizen

charter, RKS, drug list, grievance handling mechanism, and JSSK ( one banner washurridly hung, loosely

to tube lights).

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Maternity ward room is very small could accommodate two beds though on record there is a sanction

for 30 beds. It has a baby warmer, with one common wash room provision. Labour room is so tiny that

baby warmer had to be located in the injection room of the nurse, did not have colour coded bins.

Proper arrangements are required for the maternity room. Laboratory technician is trained in HIV

testing and no register is maintained for ANC tests particularly for HB tests count record.

Case load is maternal below average with 24 normal delivered conducted from April 2012-march 13 and

total general OPD of 2485. No FP operations conducted for the same period.

CHC has no BSU. It is mentioned that in case blood transfusion is required patient is referred to the DH,

which is 70 km far away.

CHC Madhavpur, delivery room without colour bins. Baby warmer in the injection room

RKS & VHNCs in the district

RKS data in the district& state

Porbandar Gujarat

RKS status PHCs CHCS PHCs CHCs

Facilities functional 11 4 1156 300

RKS formed 10 4 1146 299

RK S not formed 1 10 1

RKS registered 10 3 1136 297

Not registered - 1 8 2

The district hospital has the new hospital development society formed. However details of the society

or RKs and its members have not been on display in any of the facilities visited. There are a Total of 148

VHSCs as on April 2012.

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ASHAs

State has a total of 31780 ASHAs in position and Porbandar district has 276 ASHAs and all have

completed 5th module training. 12 of them completed fourth round of 6th& 7th module in the district. In

the state 18438 completed fourth round of 6th& 7th module.

Blood Bank:

There is only a government blood bank at the DH and at the time of the visit there are only 4 units of

blood available. There are 2 NGO/ private blood bankslocated in the city covering the district, from

which blood supply is sought if& when required. However it is revealed during interviews with the

authorities, facility has not put in place any system for regularcollection andmaintenance of stocks,

including a rational system of assessment of the need. The physical infrastructure of the blood bank is

maintained well at DH.

None of the facilities visited such as CHC, 24X7 PHC have any BSUs. It is repeatedly revealed during

discussions with doctors/ officials/ paramedical staff in the visited facilities, that any slightest sign of

criticality or requiring blood transfusion, case is essentially referred to the DH in Porbandar. There is

only one referral ambulance for each facility in general, which can crop up the issue of availability in

time for critical cases.

This clearly indicates the high dependence from all quarters of district on the DH even for blood

transfusion, calls for creating self-sufficiency of the CHCs, &allied facilities for maintaining BSUs and

simple blood transfusion services.

Required intervention: Systems to be put in place at DH to maintain adequate supply of blood, based on

a rational assessment of needs. BSUs are to be initiated in facilities on the basis of assessment and make

them self-sufficient.

JSY& JSSK

A total of 2466 beneficiaries received the incentives of JSY in the district (upto may 2013). As per

analysis of HMIS, 10.99% of JSY paid against reported Home deliveries and19.05% JSY paid against

reported public institutional deliveries.

It is revealed during the course of exit interviews of JSSK, that many women (for first and second child)

did not receive the JSY benefit, though they belonged to the Below Poverty Line (BPL) category, as they

did not possess the statutory document.

Needed intervention: As a social determinant of health this aspect is highly significant which is related

to mothers nutrition support during pregnancy.

Convergence with other relevant department may be called for. Strategies are needed to be initiated

through RKS and HDS (as they often consist of members from political bodies) to address this issue.

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JSSK REPORT 2012-13 & 2013-14 march (Source: DPMU, Porbandar)

Year Free Drugs Free Diagnostic

Free Diet Free B.T. Drop Back

2012-13 10979 6171 2900 73 916

Target for 2013-14 1900 1801 4154 73 910

2013-14 2610 424 511 43 398

Per.% 137.37 23.54 12.30 58.90 43.74

Total number of JSSK beneficiaries upto May 2013 were 3411.

Both OPD and IPD services are free of cost in all facilities visited. Blood services are provided free of

cost. Drugs, Diagnostics and diet are provided free of cost in all the facilities visited.

75 percent of the exit interview respondents mentioned that they used their own personal transport

such as rickshaws, vans and train incurring OOP expenses. The 75 percent of those who used rickshaws

as transport, the reported out-of- pocket expenses range is Rs 15 to100/- and Rs.100 to 400/- for those

used vans.The woman delivered in the 24x7 PHC mentioned that they used facility ambulance to reach.

ARSH

At the DH the ARSH clinic is reported as initiatedonly 3 days prior to the visit. There is no separate

counselor.

NRC

There is no NRC in the district.

ART Centre

Separate ART centre is available with a trained councilor. Out of a total of 21,774 tested for HIV, there is

0.3% positive for HIV and are on ART drugs.

Immunization

HMIS analysis shows, the ‘fully immunized against total estimated live births’ is 90 %( o-11 months) and

between April to march2013, drop out from BCG to DPT3 is minus 4% and same for drop out from BCG

to Measles.Though overall district performance is substantive, it has reduced by 3 percentage points

over the previous year.

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Family Planning:

As per HMIS analysis, between April to March, of the total 1885 sterilizations, there 100% female

sterilization(1879) and male sterilization are only 6.

FP Performance (April 2012- May 2013) source: DPMU

Category District Target

District Achievement

% Achievement

State achievement % (upto march 2013)

Sterilizations 2388 2259 94.59 83.81

Copper T 4081 4295 95 89.9

Oral Pills 1722 2135 123 53.6 (equivalent users)

Condoms 6098 4161 68.23 39.83 (equivalent users)

There is found to be variation between the HMIS figures and the DPMU figures, which are on higher

side. However, analysis of HMIS( upto march2013) indicated, of the total FP method users42% is the

reported IUD users,; 15% is OCP users; and 21% Limiting method users. As 0.3 % is male sterilization

figure of the total reported sterilizations, focus is required to work out gender sensitization strategies

for the promotion of Male sterilization in the district.

As per HMIs analysis, 11% “limiting” and 44% “ spacing” unmet need met by reported family planning

methods during the period April 12 –march 13.

Mortality - Communicable diseases:

HMIs analysis of major cause group of mortality indicates that 20.9 % fall in the category of

Communicable, maternal & perinatal diseases; 35.1 in Non Communicable disease category; 8.2 % in

Injuries and 35.8% in the category of ‘others’.

Predominantly, 32% deaths are owing to heart disease/ hypertension related; 6% is due to suicide and

4.8 % is due to respiratory diseases ( other than TB) against the total reported deaths 6years & above (

during 2012 April-march 13). Again, Heart disease / hypertension related causes constitutes to a

predominant 47.2% in the known causes of deaths against total known causes of deaths 6 years and

above. This certainly calls for special emphasis in adopting preventive and curative strategies to address

this. The NCD cell created has a major role.

Performance in other National Programs:

In the blindness control Program a total of 8827 patients were operated for cataract and 8827 were

provided Intraocular lens (IOL) implantations (Up to May 2013).

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School Health:

A total of 2066 school children were detected and provided with Refractive errors and 3271 were

provided with free glasses during 2012 April to may 2013.

NVBDCP, Waterborne disease control:

Total number of patients treated under this program during april 2012-May 2013

Diarrhea Decentry Viral hepatitis

Enteric fever

14363 329 20 261

Malaria achievements:

Upto June 2012 Blood Sample Collection is 42672, Positive Case load is 167, PF 11

Total Dengue Cases 172, Positive 29; Mosquito Net Distributed 8941

June 2013 Ending Blood Sample Collection 42869, Positive Cases 115, PF 5

Total Dengue Case June Ending 57, Positive10.

RNTCP:

Progress during2012-2013 march

Sl Activity Target Achievement

1 New Sputum Positive Cases

340 377

2 New Sputum Positive Detection Rate

56 Per Lakh Per Year

63.22

3 Sputum Conversion Rate

> 90%

90.7%

4 Cure Rate

>85%

91.4%

5 Defaulter Rate

<5%

3.5%

6 Death Rate

<4% 3.2%

7 Failure Rate

<3% 1.0%

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Program management

The district program management unit is housed in the district health office. There is a district program

coordinator and a regional coordinator who is the in-charge for 3-4 districts in the region, including

Porbandar.

System in place: For monitoring and supervision checklists are provided to district officials for

Immunization aspect and other aspects and inspection report formats for facilities. Filled in checklists

are supposed to send with feedback to concerned THO( Taluk Health Officer) and PHC MOs with the

signature of the CDMO for action to be taken by THO & PHC MO. The later are expected to send action

taken report within 7 days to the CDHO. In addition to this there are monthly review meetings.

Quality Control:

Infection Control- Biomedical waste management:

Protocols for bio medical waste management are in place. The state health department has a tie up with

an NGO by name “Manavseva Trust” for the biomedical waste management. Colour coded bins are

available and maintained in critical places such as OT, labs etc. in the DH and the 24x7 Adityana PHC.

CHC madhavpur did not maintain them.

Colour coded bins at delivery room at DH

Grievance handling mechanism

There is no system /mechanism in place for grievance handling at any facility visited.

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Annexure: Key Findings of last PRC Report

Monitoring&Evaluation of Program Implementation Plan 2012-13 Gujarat PRC, Vadodara - August 2012

Summary

PIP evaluation study was conducted in the high focus district of Narmada and Non-high focus district of

Vadodara. In each district, I district hospital, 2 CHCs (1 FRU and 1non-FRU), 2 PHCs as well as 3 Sub

centres under each PHC were selected for the study. In addition to the above, at Vadodara, the hospital

attached to the medical college and 2 urban health centres were also covered.

Findings: The mandatory disclosures are not displayed on the state NRHM website. The JSSK is not yet

implemented in total in Narmada district, though JSSK benefits are provided to the women under one or

other scheme at Baroda, except uniform pick up, drop-back and free diet to the attendant at all

facilities. The JSY guidelines are being followed in identifying beneficiaries and making payments in both

the districts.

Adolescent health program, the school health component is implemented according to the guidelines

while the same cannot be said for the other two aspects viz., MHS and WIFS.

All the service delivery points especially those below district level at Vadodara are not yet operational in

terms of eithermanpower or infrastructure/ equipment to provide safe delivery and ensure child

survival. In Narmada, one of the delivery points including the district hospital are fully operational to

provide mandated services. This is mainly due to lack of trained staff or essential infrastructure /

equipment.

None of the sub-centres included in the study have two ANMS. Only one out of 6 PHCs approved as

24X7 at Narmada is functioning, and with only one Medical officer.

At Baroda, training of ASHA s in modules 6 & 7 is ongoing whereas in Narmada 80% ASHA workers are

trained in module 6&7.

The present evaluation during the first quarter has brought to light the fact that due to delay in receiving

the grant from the state for the quarter, the district authorities were only able to carry out routine

activities and not any of the activities/ programs planned under the current PIP.

Strengths:AYUSH practitioners have been co-located in the CHCs / PHCs

Pregnant women visiting the health facilities are screened for anemia and free treatment provided if

necessary. JSY guidelines are being followed in identifying beneficiaries and making payments.

ARSH and school health program is being implemented as per the guidelines.

___________________

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HMIS

National Health Systems Resource Center

HMIS Analysis – Gujarat –

Porbandar - Apr’12 – mar’13

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Note for Information Users

This data analysis is primarily presented to facilitate the use of this information by District level

Programme Managers. They are in a better position to interpret this information in context and act on

it. Even what are apparently data of poor quality or errors can be useful if the nature of error is

understood. However those not sensitized to the data quality issues and those trying to use this for

policy or journalistic purposes will find serious limitations – especially due to incomplete reporting of

private sector data and poor quality of death reporting. Also please note that interpretation of

information will differ with choice of denominator. We should be familiar with choice of denominator in

use. Do consult HMIS Training Manual 2 for further understanding of these issues. Data is also analyzed

and presented so as to help districts, find data errors and correct them. Only when data is converted

into information and used, do many errors become apparent. Some states are likely to notice data entry

errors & change their data- for which reason also, care should be taken when quoting from this source.

We would advise you to check with state government and take permission before quoting from this.

Executive Director

National Health Systems Resource Centre

May 2013

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Gujarat - District - Porbandar

State Statistics - Gujarat District Statistics - Porbandar


Person 60,383,628 Indicators DLHSIII

Male 31,482,282 ANC

Female 28,901,346 ANC Check-up in first trimester 76.6

Sex Ratio ( No. of Females per1000 males)

Census - 2011 811 3 or more ANC Check-up 71.3

Sex Ratio 0 - 6 years Census - 2011 886 Atleast 1 TT received 86.5

MMR ( per 100,000 live births)

SRS - 2011

148 100 IFA Tablets 46

CBR ( per 1000 population) 21.8 Deliveries

CDR ( per 1000 population) 6.7 Institutional Delivery 68.1

IMR 44 Home Delivery 31

Neo- natal Mortality Rate Home Delivery by SBA 10.1

Under Five Mortality Rate New born & post natal care

District Statistics - Porbandar Still Birth 0


Person 586,062 Live Birth 97.9

Male 300,967 Breastfed within 1 hour of birth 51.8

Female 285,095 PNC within 48 hrs of delivery 68.2

Population in the age group 0-6 - Census - 2011

Person 63,820 Immunisation

Male 33,687 BCG 97

Female 30,133 DPT3 90.8

Sex Ratio ( No. of Females per1000 males) 808 Measeles 86.7

Sex Ratio 0 - 6 years 894 Full immunisation 76.7

Literacy Rate - Census - 2011

Person 76.63 Unmet need for Family Planning

Male 84.56 Spacing 6.2

Female 68.32 Limiting 10

% Decadal Growth Rate 9.17 Total 16.2

Population Density per Sq.K.m 255

Infrastructure - District Statistics - Porbandar

SC

RHS - March - 2011

85

PHCs 10

CHCs 3

22

Gujarat-Porbandar- Key Performance Indicators -Apr'12 to Mar'13

ANM Related

% ANC Registration in First Trimester against Reported ANC registration

78% % PNC visits within 48 hours and 14 days against total deliveries

91%

% Three ANC check ups against estimated pregancies.

90% % DPT3 immunisation against Estimated Live Births

91%

% Hypertension in pregnancy- detected against ANC Reported

1.0% % Measles Immunization against Estimated Live Births

90%

% Severe anaemia (Hb<7) treated gainst Reported ANC registration

0.8% % Full immunisation against Estimated Live Births

90%

ASHA Related

% Newborns weighed at birth against Estimated live Births

88% JSY Paid to ASHA as % of reported Institutional deliveries

0%

% of Newborns having weighed less than 2.5 kg against newborns weighed

7% % ASHAs present during immunisation Sessions

75%

% Newborns visited within 24 hrs of Home deliveries

58%

Facility Related

OPD per 1000 population 668

% C- Section against Institutional Deliveries 11.8%

IPD per 1000 population 27

Abortion Rate against Reported pregnancies 3.7%

Major surgeries per lakh population. 35

Total sterilisation done per 1000 eligible couples.

19

Institutional deliveries against estimated deliveries.

86% Total IUD inserted per 1000 eligible couples 37.84

Institutional deliveries against Reported deliveries.

99%

23

Gujarat-Porbandar- Summary -Apr'12 to Mar'13

ANC

ANC Registration against Expected Pregnancies

95% TT2/ Booster given to Pregnant women against ANC Registration

93%

3 ANC Check ups against ANC Registrations 94% 100 IFA Tablets given to Pregnant women against ANC Registration

90%

Deliveries

Reported Deliveries against Expected Deliveries

87.2% Home Deliveries( SBA& Non SBA) against Estimated Deliveries

0.7%

Institutional Deliveries against Estimated Deliveries

86.5% Home Deliveries( SBA& Non SBA) against Reported Deliveries

0.8%

Institutional Deliveries against Reported Deliveries

99.2% C Section Deliveries against Institutional Deliveries( Pvt& Pub)

11.8%

Births & Neonates Care

Live Births Reported against Estimated Live Births

88.8% Newborns weighed against Reported Live Births

99%

Still Births against reported 1000 live Births 7.7

Newborns weighed less than 2.5 kgs against newborns weighed

7%

Sex Ratio at Birth 898

Newborns breastfed within one hr of Birth against Reported live Births

89%

Child Immunisation( 0 to 11 mnths)

Measles given against Expected Live Births 90% Measles given against Reported Live Births

102%

Fully Immunised Children against Expected Live Births

90% Fully Immunised Children against Reported Live Births

102%

Required numbers of VHNDs per thousand population in 12 mnths

7,158 Immunisation Sessions held as percentage of required VHNDs

63%

Family Planning & Abortions

24

Family Planning Methods Users( Sterilisations(Male &Female)+IUD+ Condom pieces/72 + OCP Cycles/13)

9,129

Total Sterilisations ( Male & Female) 1,885

MTP up to 12 weeks 85

Abortion (spontaneous/induced) 413

MTP more than 12 weeks 1

Abortion Rate against Expected pregnancies

3.6%

Demographic Denominators - Gujarat-Porbandar

IMR of the state - Gujarat-Porbandar

CBR - Gujarat-Porbandar

Total Population

Expected Pregnancies Apr'12 to Mar'13

Expected Deliveries Apr'12 to Mar'13

Eligible Couple ( 17% of total population)

Source SRS -2011 SRS -2011 Projectd population for 2012

Derived Derived Derived

41 21.3 596,517 13,976 12,966 101,408

Gujarat-Porbandar- Deliveries - Apr'12 to Mar'13

Total Population 596,517 Expected Deliveries - Apr'12 to Mar'13 12,966

Home SBA Home Non SBA Institutional ( Pub&Pvt) Total Deliveries Reported Unreported Deliveries

18 73 11,211 11,302 1,664

Home SBA % Home Non SBA% Institutional % Total Deliveries Reported % Unreported Deliveries %

0% 1% 86% 87% 13%

25

Gujarat-Porbandar- C sections & Complicated Deliveries Apr'12 to Mar'13

Home Non SBA 1%

Institutional 86%

Unreported Deliveries 13%

Gujarat-Porbandar- Home ( SBA & Non SBA) & Institutional Deliveries against Expected Deliveries - Apr'12 to Mar'13

Home SBA 0.2%

Home Non SBA 0.6%

Institutional (Pub) 35.9%

Institutional (Pvt) 63.3%

Gujarat-Porbandar- Home ( SBA & Non SBA) & Institutional Deliveries against Reported Deliveries - Apr'12 to Mar'13

26

Institutional Deliveries (Public) Institutional Deliveries (Pvt) Total Institutional deliveries

Total Deliveries 4,053 7,158 11,211

C Section 394 932 1,326

C Section% 9.7% 13.0% 11.8%

Complicated Pregnancies attended

581 - 581

Complicated Pregnancies attended %

14.3% 0.0% 5.2%

Gujarat-Porbandar- Facility wise %ge of C sections & Complicated Deliveries Apr'12 to Mar'13

PHC CHC SDH/DH

Other State owned institution

Private Facilities

Total

Complicated deliveries managed ( Reported)

- 97 484 - - 581

Complicated deliveries managed as %ge of total reported

0.0% 16.7% 83.3% 0.0% 0.0%

C Section (reported ) - - 394 - 932 1,326

C Section as percentage of total reported

0.0% 0.0% 29.7% 0.0% 70.3%

Gujarat-Porbandar- Complicated Pregnancies & Deliveries Treated - Apr'12 to Mar'13

C- section % 11.8%

Complicated Pregnancies attended %

5.2%

Normal deliveries % 83.0%

Gujarat-Porbandar- C-Section, Complicated & Normal Deliveries against Reported Institutional Deliveries ( Pvt. & Public) Apr'12 to Mar'13

27

Reported Deliveries 11,302

Complicated Pregnancies attended

Complicated Pregnancies Rate

C - Section Deliveries

PNC Maternal Complications

Abortions Still Births

581 4.2% 1,326 26 413 87

Complicated Deliveries Treated with No Of Eclampsia cases Treated

No Of severe anemia cases treated IV Antibiotics

IV antihypertensive/Magsulph injection

IV Oxytocis Blood Transfusion

109 2 50 30 7 103

Gujarat-Porbandar - JSY Paid to Mothers as % of reported deliveries - Apr'12 to Mar'13

Deliveries JSY Paid to mothers

%age JSY paid against reported deliveries

Home 91 10 10.99%

Institutional (Public) 4,053 772 19.05%

Institutional ( Accredited - Pvt ) 7,158 649 9.07%

Stay for less than 48 hrs after delivery

38%

Stay for more than 48 hrs after delivery

62%

Gujarat-Porbandar- Stay duration as percentage of Reported Institutional Deliveries - Apr'12 to Mar'13

28

Gujarat-Porbandar- Management of Complications (Reflecting Quality of ANC )against Reported ANC Registration- Apr'12 to Mar'13

Reported %age against reported ANC Registration

Hypertensive cases detected at institution 135 1.0%

Eclampsia cases managed during delivery 7 0.1%

ANC women having Hb level<11 4046 30.3%

ANC women having severe anaemia (Hb<7) treated at institution

103 0.8%

11%

19%

9%

0%

5%

10%

15%

20%

25%

Home Institutional (Public) Institutional (Pvt)

Gujarat-Porbandar -JSY Paid to Mothers as % of reported deliveries - Apr'12 to Mar'13

13,976 13,344

10,344

2,051

12,572

9,640

12,437 11,990

-

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

ExpectedPregnancies -

Apr'12 toMar'13

Total ANCRegistration

ANCRegistrationwithin firsttrimester

ANCregistration for

JSY

3 ANC checkups

TT1 TT2 or Booster 100 IFA tabletsgiven

Gujarat-Porbandar-ANC Services - Apr'12 to Mar'13

29

1.0% 0.1%

30.3%

0.8%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

Hypertensive cases detectedat institution

Eclampsia cases managedduring delivery

ANC women having Hblevel<11

ANC women having severeanaemia (Hb<7) treated at

institution

Gujarat-Porbandar- Management of Complications (Reflecting Quality of ANC )against Reported ANC Registration- Apr'12 to Mar'13

96% 91%

0%

20%

40%

60%

80%

100%

120%

PNC within 48 hours after deliveries PNC between 48 hours and 14 days of Deliveries

Gujarat-Porbandar- Post Natal Check up against Reported deliveries -Apr'12 to Mar'13

30

Gujarat-Porbandar - Births - Apr'12 to Mar'13

Live Birth - Males Live Birth - females Live Birth - Total Still Births Sex Ratio at birth Still Birth per 1000 live births ( reported)

5,942 5,336 11,278 87 898 7.7

12,706

11,278 11,140

812

10,043

-

2,000

4,000

6,000

8,000

10,000

12,000

14,000

Estimated Live Births -Apr'12 to Mar'13

Reported Live Birth -Apr'12 to Mar'13

Newborns weighed atbirth

Number of Newbornshaving weight less than

2.5 kg

Newborns breast fedwithin 1 hour

Gujarat-Porbandar-Births - Apr'12 to Mar'13

87% 91% 91% 90% 90%

0%

20%

40%

60%

80%

100%

BCG % DPT3% OPV3% Measles % Fully Immunised %

Gujarat-Porbandar-Immunisation ( 0 to 11mnths) Against Estimated Live Births- Apr'12 to Mar'13

31

Gujarat-Porbandar- Adverse Event Following Immunisation(AEFI) - Apr'12 to Mar'13

Abscess 1

Death -

Others 5

Gujarat-Porbandar- Immunisation - Dropouts - Apr'12 to Mar'13

Dropout from BCG to DPT3 Dropout from BCG to Measles Dropout from DPT3 to Measles

-4% -4% 0%

Gujarat-Porbandar - Abortions - Apr'12 to Mar'13

MTP Less than 12 weeks

MTP More than 12 weeks

Abortions (spontaneous/Induced)

Abortions in Pvt Facilities

Abortion Rate against expected pregnancies

98% 102% 102% 102% 102%

0%

20%

40%

60%

80%

100%

120%

BCG % DPT3% OPV3% Measles % Fully Immunised %

Gujarat-Porbandar-Immunisation ( 0 to 11mnths) Against Reported Live Births- Apr'12 to Mar'13

4,528 4,512

3,379

-

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

5,000

Immunisation sessions planned Immunisation sessions Held Sessions where ASHAs were present

Gujarat-Porbandar-Immunisation Sessions- Apr'12 to Mar'13

32

85 1 413 - 3.6%

Gujarat-Porbandar - RTI Cases - Apr'12 to Mar'13

Total OPD Total RTI/STI cases - Male

Total RTI/STI cases - Female

Total RTI/STI cases RTI/STI cases as %ge of Total OPD

Number of wet mount tests conducted

398,766 - - - 0.000% -

Gujarat-Porbandar-Sterilisations - Apr'12 to Mar'13

Reported %age of Reported Sterilisation

Total Sterilisation 1,885

NSV 6 0%

Laparoscopic 1,879 100%

MiniLap - 0%

Post Partum - 0%

Male Sterilisation 6 0%

Female Sterilisation 1,879 100%

MTP less than 12 weeks 17.03%

MTP more than 12 weeks 0.20%

Abortion (spontaneous/induced)

82.77%

Gujarat-Porbandar-Abortions - Apr'12 to Mar'13

33

Gujarat-Porbandar-FP Methods - Apr'12 to Mar'13

Reported %age of All Reported FP Methods

Total Reported FP Method (All types) Users 9,129

-

Sterilisations 1,885

21%

IUD 3,837

42%

Condom Users 2,027

22%

OCP Users 1,380

15%

Limiting Methods 1,885

21%

Spacing Methods 7,244

79%

Gujarat-Porbandar- Facility wise % of Sterilisations& IUDs - Apr'12 to Mar'13

Subcenter PHC CHC SDH/DH Other State owned institution

Private Facilities

NSV as % of total reported 0.0% 0.0% 100.0% 0.0% 0.0%

Laparoscopic as % of total reported

0.0% 9.4% 70.6% 0.0% 20.0%

MiniLap as % of total reported

Post Partum as % of total reported

IUD inserted as % of total reported

84.1% 0.0% 0.2% 12.4% 0.0% 3.3%

Sterilisations 21%

IUD 42%

Condom Users 22%

OCP Users 15%

Gujarat-Porbandar- Distribution of Family Planning Methods against Total Reported -Apr'12 to Mar'13

34

Gujarat-Porbandar- Unmet need ( DLHSIII) met by reported FP Methods - Apr'12 to Mar'13

Estimated total Eligible Couples ( 17% of population)

101,407.93

Eligible Couples for unmet need- Calculated Using DLHSIII Unmet need - Gujarat-Porbandar

Total reported FP Users - HMIS - Apr'12 to Mar'13

Unmet need met by Reported Family Planning Methods - Apr'12 to Mar'13

Unmet Needs Total

16.2 16,428 9,129 56%

Limiting 10 10,141 1,885 11%

Spacing 6.2 6,287 7,244 44%

Gujarat-Porbandar- Service Delivery - Apr'12 to Mar'13

Total OPD Total IPD

Operation major (General and spinal anaesthesia)

Operation minor (No or local anaesthesia)

AYUSH Dental Procedures

Adolescent counselling services

398,766 16,246 208 1,176 4,186 231 1

OPD Visit Per 1000 Population

IPD per 1000 population

Operation major (General and spinal anaesthesia) per 100000 Population

Operation minor (No or local anaesthesia)as %ge of OPD

AYUSH as %ge of OPD

Dental Procedures as %ge of OPD

Adolescent counselling services as %ge of OPD

668.5 27.2 34.9 0.3% 1.0% 0.06% 0.0%

Gujarat-Porbandar- Childhood Disease - Vaccine Preventable -Apr'12 to Mar'13

Diphtheria Pertussis Tetanus Neonatorum

Tetanus others Polio Measles

0 0 1 0 0 4

Gujarat-Porbandar-Childhood Disease - Others - Apr'12 to Mar'13

Diarrhoea and dehydration Malaria Number admitted with Respiratory Infections

540 42 215

35

Gujarat-Porbandar- Lab Services - Apr'12 to Mar'13

Total Population Total HB tested Total HIV tested Total VDRL Tested

Total Widal Test Conducted

Blood Smear Examined

596,517 41,161 21,774 4,439 2,839 44,054

Total OPD HB test conducted as %age of OPD

HB<7gm as %age of HB tested

HIV test conducted as %age of OPD

HIV positive as %age of HIV tested

VDRL test conducted as %age of OPD

Widal test conducted as %age of OPD

Blood Smear Examined as % of Population

398,766 10.3% 1.8% 5.5% 0.3% 1.1% 0.71% 7.39%

36

Gujarat-Porbandar - Mortality Data - Apr'12 to Mar'13

Gujarat-Porbandar - Mortality - Major Causes Group - Apr'12 to Mar'13

Death Groups Cause-wise deaths included in the group Reported deaths

Communicable Disease , Maternal & Perinatal

Maternal & Perinatal, Diarrhoea, Tuberculosis, Respiratory (excluding TB), Malaria, Other Fever related, HIV/AIDS

239

Non communicable disease Heart Disease/ Hypertension, Neurological including Stroke

401

Injuries Trauma, Accidents, Burns, Suicide, Animal Bites 94

37

Others Other known acute diseases, Other known chronic diseases, Other diseases (Causes not known)

409

Gujarat-Porbandar- Still Births, Neonatal , Infant ,Under 5 and Maternal Deaths - Apr'12 to Mar'13

Live Births - Reported Live Births -Estimated Still Births Early Neonatal deaths

11,278 12,706 87 77

Late Neonatal Deaths Infant Death Under 5 Child Deaths Maternal Deaths

Communicable Disease , Maternal & Perinatal

20.9%

Non communicable disease 35.1%

Injuries 8.2%

Others 35.8%

Gujarat-Porbandar - Mortality - Major Causes Group -Apr'12 to Mar'13

38

16 122 136 10

Gujarat-Porbandar- Still Birth Rate, Perinatal,Neonatal& Infant Mortality Rates - Apr'12 to Mar'13

Against Reported Live Births( 1000)

Against Estimated Live Births ( 1000)

Reported Still Birth 7.71 6.85

Reported Perinatal Mortality 14.54 13

Reported Neonatal Mortality 8.25 7.32

Reported Infant Mortality 10.82 9.60

Reported Under 5 Child Deaths 12.1 10.70

Reported Maternal Deaths 88.67 78.70

Gujarat-Porbandar - Infant & Child Deaths - Apr'12 to Mar'13

Infant Deaths within 24 hrs of birth

Infant Deaths between 24hrs & under 1 week

Infant Deaths between 1 week & under 1 month

Child Deaths between 1 month & under 1 year

Total Infant Deaths

Child Deaths between 1yr & under 5years

Total Deaths

Total Reported 21 56 16 29 122 14 136

% against total deaths

15.4% 41.2% 11.8% 21.3% 89.7% 10.3%

39

Gujarat-Porbandar- Causes of Infant & Child Deaths - Apr'12 to Mar'13 - Total Deaths - 115

Sepsis Asphyxia LBW

Up to 1 Weeks of Birth

Between 1 week & 4 weeks of birth

Total Up to 1 Weeks of Birth




Total

1 1 2 7 1 8 23 5 28

Pneumonia Diarrhoea Fever related

Between 1 month and 11 months

Between 1 year & 5 years

Total Between 1 month and 11 months




Total

1 0 1 0 0 0 4 1 5

Measels Others ( For age upto 4 weks of Birth) Others( For age from 1 month to 5 yrs)

Between 1 month and 11 months






Total

- - - 25 9 34 24 13 37

Infant Deaths within 24 hrs of birth

15.4%

Infant Deaths between 24hrs & under 1 week

41.2%

Infant Deaths between 1 week & under 1 month

11.8%

Child Deaths between 1 month & under 1 year

21.3%

Child Deaths between 1yr& under 5years

10.3%

Infant & Child Deaths against reported Infant & Child deaths - Gujarat-Porbandar-Apr'12 to Mar'13

40

Sepsis 2%

Asphyxia 7%

LBW 24%

Pneumonia 1%

Fever related 4% Others

62%

Gujarat-Porbandar - Causes of Infant & Child Deaths against total reported infant & child deaths-Apr'12 to Mar'13

41

Gujarat-PorbandarMaternal Deaths & Causes-Apr'12 to Mar'13

Causes Reported % against total reported

% against total reported known causes

Abortion - 0.0% 0.0%

Obstructed/prolonged labour

- 0.0% 0.0%

Severe hypertension/fits - 0.0% 0.0%

Bleeding 4 40.0% 66.7%

High Fever 2 20.0% 33.3%

Other Causes 4 40.0%

Total 10

Sepsis 5%

Asphyxia 18%

LBW 64%

Pneumonia 2%

Fever related 11%

Gujarat-Porbandar - Known Causes of Infant & Child Deaths against total reported known causes of infant & child deaths -Apr'12 to Mar'13

42

Gujarat-Porbandar - Causes of deaths above 6 yrs of age-Apr'12 to Mar'13

6-14 yrs 15-55 yrs. Above 55yrs Total

Diarrhoeal Diseases - 4 - 4

Tuberculosis - 12 14 26

Respiratory Diseases (Other than TB)

- 6 38 44

Bleeding 40.0%

High Fever 20.0%

Other Causes 40.0%

Gujarat-Porbandar - Causes of Maternal Deaths against total reported maternal deaths-Apr'12 to Mar'13

Bleeding 66.7%

High Fever 33.3%

Gujarat-Porbandar - Known Causes of Maternal Death against total reported Known Causes of maternal deaths -Apr'12 to Mar'13

43

Malaria - 1 - 1

Other fever Related 3 12 23 38

HIV/AIDS - 2 4 6

Heart Disease/ Hypertension related

2 81 208 291

Neurological Disease including strokes

1 8 28 37

Trauma/Accidents/ Burn Cases

3 20 6 29

Suicide - 44 11 55

Animal Bites & Stings 2 6 2 10

Known Acute Disease - 6 34 40

Known Chronic Disease 1 6 28 35

Causes not known 1 17 276 294

Total Deaths 13 225 672 910

44

Diarrhoeal Diseases 0.6%

Tuberculosis 4.2%


7.1%

Malaria 0.2% Other fever Related

6.2%

HIV/AIDS 1.0%


47.2%

Neurological Disease including strokes

6.0%

Trauma/Accidents/ Burn Cases 4.7%

Suicide 8.9%

Animal Bites & Stings 1.6%

Known Acute Disease 6.5%

Known Chronic Disease 5.7%

Gujarat-Porbandar - Known causes of deaths 6 yrs & above against total reported Known causes of deaths 6 yrs & above - Apr'12 to Mar'13

45

National Health System Resource Centre National Rural Health Mission, Ministry of Health & Family Welfare Government of India NIHFW Campus Baba Gangnath Marg, Munirka New Delhi- 110067 Email: [email protected] Website: www.nhsrcindia.org

Diarrhoeal Diseases 0.4%

Tuberculosis 2.9%


4.8%

Malaria 0.1%

Other fever Related 4.2%

HIV/AIDS 0.7%


32.0% Neurological Disease including strokes

4.1% Trauma/Accidents/ Burn Cases 3.2%

Suicide 6.0%

Animal Bites & Stings 1.1%

Known Acute Disease 4.4%

Known Chronic Disease 3.8%

Causes not known 32.3%

Gujarat-Porbandar - Cause of deaths 6 yrs & above against total reported deaths 6 yrs & above - Apr'12 to Mar'13

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Documents

Gujarat Quarterly Monitoring Visit Report