Records & Reports Maintained at Sub-Centre and PHC levels

Records & Reports Maintained at Sub-Centre and PHC levels Dr PVM LakshmiAssociate ProfessorPGIMER, ChandigarhOutlineBackgroundRegistered maintained at primary levelDetails of variables enteredProcess of gathering informationIssues in recording variablesSolutions

BackgroundHealth record keeping is necessary for assessing the health situation in the sub-centre areaIt help in decision making; includes managerial aspects such as planning, organising and control of health care facilities at the local level

Record MaintenanceList of minimum number of registers to be maintained at sub-centre level which keep the record of services provided at the sub-centreRegistered maintained at primary levelSub CentreSurvey & Eligible couple registerANC registerImmunization registerBirth register Death registerStock registerFamily planning registerPHCDrug RegisterStock RegisterTB RegisterMalaria RegisterBirth and death registerOPD registerLabour room registerLab register

Survey & Eligible Couple Register

House No.AreaEligible coupleName of family membersTotal no. of family membersAgeSexRelationshipOccupation Marital Status Pregnant

Post menopausalSterility Lactating CasteBPL Family PlanningNo. of children Infection diseasesImmunizationVitamin A Remarks

Issues in recording variablesAddress not recorded properly; sometimes difficult to trace; sometime beneficiaries dont have address proof to attachAge is not properly enquired and arbitrarily enteredPregnancy status is not revealed in early months; difficult for early registration

Issues in recording variablesIf there is a female child, there is also delay in registration for next pregnancyLactating history, specially duration and nature of breastfeeding not enteredEntry of infectious disease like ARI, TB, Diarrhoea are not entered correctly or timelyImmunization records are not tracked for dropouts Solutions Address issues can be discussed with Sarpanch of the village for possible solution for house identificationANMs should be trained and oriented at regular intervals in collecting appropriate information regarding age, lactating history, Immunization history ANM should get information from ASHAs about early pregnancies and motivate for early registration

ANC RegisterNameHusband nameAddressCasteAge at marriageLMPEDDFirst, second, third visitIf JSY registeredHBBPAnaemia

WeightHeight of womenFundal heightFHSGeneral conditionsOdema on feetPlace of deliverySex of babyBaby weightPost natal visitReferral

Issues in recording variablesWomen are not registered in first trimesterHigh risk is not marked many timesFHS, Fundal Height are kept as blank and not even examinedPost natal visit are not recordedSome time instrument are not present On many sub centre no height measuring scale available

Issues in recording variablesBP entered without measuring, so high risk case like preeclampsia are missedDiscrepancy of gestational age by LMP & fundal height should be referred to medical officerBaby weight not recorded properly and filled as approximatelyLength of baby not recordedSolutionSupply of required infrastucture like BP apparatus, weighing scale, height scale, hb meter, etc..Regular supervision of registers and more emphasis to be given over baby weight measurements, postnatal visits SolutionTraining should be given to ANMs regarding fundal height and FHS measurementHigh risk pregnancy can me marked in separate column and prompt referral to medical officer to be done. Cross checking of number of high risk cases and number of cases referred, can be done medical officers periodicallyImmunization RegisterBCG and OPV 0 doseOPV 1st, 2nd , 3rd dose BoosterDPT 1st , 2nd , 3rd dose BoosterHepatitis B 1st , 2nd , 3rd dose Measles 1st, 2nd TT 10 year and 16 year

Issues in recording variablesDetails of BCG vaccination are not known to many mothers as they delivery in different place or their mothers homeDate of next vaccination and details for the diseases for which vaccination is given were not clearly explained to motherBirth & Death RegistersBirth RegisterName Village NameDate of BirthPlace of birthJSYNo. of children

Death RegisterName AddressPlace of DeathSexAgeCause of Death Remarks

Issues in recording variablesBirth: Some time name of the baby has been changed which leads a problem laterDeath: cause of deaths were not properly enquired and entered. Place and age were also not proper in most dataSolutionBirth: change of name should be mentionedDeath: ANM should visit the home of dead person and should do the verbal autopsy to find the main cause; age as recorded in documents like voter card/adhar card or bank account should be noted

Stock RegisterProblemsStock register not maintained on regular basisSolutionsEntry should be done on the same day when they received medicineThere should be sub stock register for daily consumption

Family Planning RegisterName Husband NameAge No. of childrenMethod usedName of motivatorsComplication

Issues in recording variablesCouple taking contraceptives from private providers do not tell which method they are using when asked by ANM Monthly record are not maintained by ANM

SolutionANM or ASHA should gain the confidence of couples when they talk so that they can share about contraceptive usesCommon Issues in recording variablesDuplication of data in many registersBurden of writing works and register maintenance is time consuming for ANMsLack of adequate manpower

Other RegisterGrowth MonitoringCommunicable diseases/Epidemic Register/ Register for Syndromic SurveillancePassive surveillance register for malaria casesOther RegisterRegister for water quality and sanitationMinor ailments RegisterRecords/register as per various National Health Programme guidelines (NLEP, RNTCP, NVBDCP, etc. )Health Management Information System (HMIS) Reporting Format for Sub-Centre may be Strictly followed for collection, recording and reporting of DataIDSP FormatReporting Format for Syndromic Surveillance (From S) under Integrated Disease Surveillance Project

Issues in recording variables

Cases of fever cases in IDSP are underreported. Difficult to identify these cases.Interactive discussionPoint out the problems you faced

Thank you