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Bapid Appraisal ot Mational Bural Hcalth Mission






District: Jan|gir-Champa
(Chhattisgarh)


























Population Bcscarch Ccntrc Ministry ot Hcalth & Iamily Wcltarc
Department ol Ceneral & Applied CeograpLy (Covernment ol India)
Dr. H. S. Cour Central Lniversity irman BLavan
Sagar (M. P.) +/0003 ew DelLi 110 108

Dralt Report, july 2009
Janjgir
Nawagarh
Champa
Sakti
Pamgarh
Dabhra
Malkharoda
Jaijaipur
BaIoda
i

Contcnts


Pagc
Acknowledgements ii
List ol Jables iv
Key Iindings vii

Chaptcr Titlc

CLapter 1: Introduction and State Prolile 1

CLapter 2: District Prolile 15

CLapter 3: Community HealtL Centre 22

CLapter +: Primary HealtL Centre 3/

CLapter 5: Sub Centre 5/

CLapter 6: HouseLold Survey //

CLapter /: Status and Perlormance ol ASHA 109

CLapter 8: Role, Awareness and Involvement ol Cram PancLayat 115

CLapter 9: Quality ol Care and Client Satislaction IPD Exit Interview 119

CLapter 10: Quality ol Care and Client Satislaction CPD Exit Interview 132

Appendix-1 State ScLedule 1+5

Appendix-2: District ScLedule 1+9

Appendix-3: Standard ol Living Index 169

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Acknowlcdgcmcnts

JLe PRC study on Rapid Appraisal ol RHM Implementation in CLLattisgarL could be
successlully completed due to tLe Lelp received lrom ol many individuals at dillerent
stages ol tLe survey. I take tLis opportunity to express my gratitude towards tLem. I am
tLanklul to tLe Ministry ol HealtL and Iamily Wellare, Covernment ol India lor assigning
tLis study to tLe PRC, Sagar. We are gratelul to tLe autLorities ol tLe MCHIW,
particularly to Dr. Ratan CLand (CLiel Director, Statistics), SLri Praveen Srivastava
(Director, Statistics) and SLri RajesL BLatia (joint Director, Statistics), lor tLeir Lelp and
inputs tLey provided at various stages ol tLe study. JLanks are also due to Dr. R.
agarajan, ol PRC, Pune lor Lis valuable support in solving emerging problems related to
data entry and table generation soltware as and wLen needed.

I am gratelul to Prol. R. P. Agarwal, (tLe tLen Vice-CLancellor ol our university) and Prol.
. S. CajbLiye, Vice-CLancellor ol our Lniversity lor tLeir valuable support and
encouragement. JLanks are due to Dr. PariksLit SingL, Registrar and Mr. P. . SingL,
Iinance Cllicer ol Dr. HarisingL Cour Lniversity wLo provided necessary administrative
support.

I am also tLanklul to tLe state level ollicers ol Directorate ol HealtL Services, SPML and
SHRC ol CLLattisgarL state lor providing necessary support and inlormation, district
administrative and accounts stall ol our university lor tLeir Lelp to carry out tLe study
smootLly. I would like to specially tLank, Dr. R. . Pandey, CLiel Medical and HealtL
Cllicer (CMHC), Dr. L. S. SLarma, Civil Surgeon and Mr. Padmaker SLinde, District
Programme Manager RHM, janjgir- CLampa lor tLeir logistic support to carry out tLe
lieldwork in tLe district. I also express my gratitude to tLe ollicials ol tLe District Hospital
janjgir-CLampa, and tLe stall ol selected Community HealtL Centres, Primary HealtL
Centres and tLe Sub Centres lor providing data and inlormation painstakingly on LealtL
lacilities and supporting us to carry out tLe LouseLold survey.

JLis exercise could Lave not been completed witLout painstaking involvement and zeal ol
Dr. (Mrs.) Reena Basu (Assistant Director, PRC Sagar) and Mr. ikLilesL ParcLure (Iield
iii
Investigator, PRC Sagar). BotL are tLe core members ol tLe PRC Lave sLared complete
responsibility ol tLe study lrom inception, planning and upto report writing. Mr. AksLya
Srivastav ResearcL Iellow carried out tLe lield activities witL lull responsibility. I am
tLanklul to our ollice stall SLri Manoj amdeo and SLri. RoLini Prasad Yadav lor
managing tLe entire ollice work and coordination ol activities at university level.

We cannot ignore to acknowledging tLe sincere ellorts ol our 23 investigators wLo carried
out tLe dillicult job ol taking interviews ol respondents putting in Lard labour. Last but
not least, credit goes to tLose respondents wLo patiently answered to tLe long
questionnaire witLout expectation ol any kind.

july 2009 (Prol. SantosL SLukla)
Dire ctor
PRC, Sagar

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LIST CI TABLES

Tablc Titlc Pagc
1 JLe sampling design lor tLe selection ol LealtL lacilities/LouseLolds/
respondents lor tLe rapid appraisal ol RHM
/
2 ScLedules canvassed lor tLe study and survey period 8
3 List ol selected District Hospital, CHCs, PHCs, SCs and Villages lor tLe survey
in janjgir-CLampa District as per tLe sample design
9
C1 Coverage and availability ol inlrastructure 28
C2 Position ol Medical Stall and Paramedical Stall 30
C3 Availability ol specilic services in CHC 31
C+ Status ol specilic interventions 31
C5 Status ol residential lacilities lor Doctors and otLer stall 31
C6 Availability ol laboratory lacilities 31
C/ umber ol Lab tests done in CHC in last 3 calendar montLs 32
C8 umber ol surgeries perlormed during 200/-2008 32
C9 Reasons lor not conducting surgeries 32
C10 Status ol perlormance ol Labour Room during 200/-2008 33
C11 Reasons lor not conducting deliveries 33
C12 Status ol availability ol equipments and drugs 33
C13 Availability ol specilic services 35
C1+ Service outcome (based on data lor last tLree montLs) 36
P1 Coverage and lacilities ol Primary HealtL Centre ++
P2 Primary HealtL Centres by inlrastructure +5
P3 Stall position in Primary HealtL Centre +6
P+ Status ol training ol personnel at Primary HealtL Centre +/
P5 Availability ol Labour Room in Primary HealtL Centre +/
P6 Status ol perlormance ol Labour Room during 200/-2008 +/
P/ Availability ol Laboratory Jesting in PHC +8
P8 umber ol tests done in PHC in last tLree calendar montLs +8
P9 Status ol specilic interventions +9
P10 Availability ol selected equipments in PHC 50
P11 Status ol availability ol drugs 51
P12A Service outcome (based on data lor last tLree montLs) PHC, Hasoud 52
P12B Service outcome (based on data lor last tLree montLs) PHC, Raipura 53
P12C Service outcome (based on data lor last tLree montLs) PHC, Pantora 5+
P12D Service outcome (based on data lor last tLree montLs) PHC, Catwa 55
P13 Status ol record maintenance 56
S1 Sub Centres coverage 6+
S2 Sub Centres inlrastructure 65
S3 Sub Centres witL AM staying witL or away lrom SC village by distance lrom
Sub Centre and reasons lor not staying in Sub Centre
66
S+ Sub Centres witL stall in position 66
S5 Availability ol Labour Room in Sub Centre 6/
S6A umber ol deliveries perlormed during 200/-2008 6/
S6B Sub-Centres witL arrangement lor deliveries between 8 PM to 8 AM 68
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Tablc Titlc Pagc
S/A Sub Centres witL availability ol equipments 68
S/B Percentage ol SCs witL lunctional equipments (among tLe SCs reported tLe
availability ol tLe equipment)
69
S8 Status ol availability ol drugs on tLe date ol survey /0
S9 Status ol specilic skills and procedures /1
S10 Service outcome (based on data lor last 3 montLs) /2
S11 Status ol record maintenance /3
S12A Status ol awareness ol AM about jSY scLeme /+
S12B Status ol procedure under jSY scLeme /+
S13 Status ol perlormance ol AM under jSY scLeme /5
S1+ Status ol Lntied Crants /6
H1 CLaracteristics ol tLe respondents 90
H2 CLaracteristics ol tLe LouseLold 91
H3 Percent distribution ol LouseLolds by tLeir waste disposal, stagnation ol waste
water and mosquito breeding around tLe Louse and system ol medicine
prelerred by tLem
92
H+ Percent distribution ol LouseLold respondents by tLeir inlormation about
availability ol LealtL worker, LealtL lacilities and transport used to take serious
patients
93
H5 Percent distribution ol LouseLold respondents by tLeir knowledge about
RHM, ASHA and Ler activities, VHD, VHSC and jSY
9+
H6 Percent distribution ol jSY beneliciaries by tLeir background cLaracteristics 95
H/ Jiming, person and place ol registration lor jSY scLeme 96
H8 Receipt ol jSY card, role ol ASHA in getting jSY card and dilliculties
laced by tLe beneliciary in getting tLe jSY card
96
H9 Role ol ASHA during tLe pregnancy ol tLe beneliciaries 9/
H10 Place ol delivery and reason lor opting institutional delivery 9/
H11 Jransport ol tLe beneliciaries to reacL tLe LealtL institution 98
H12 Waiting time at tLe LealtL lacility, type ol delivery, amount spent at tLe LealtL
lacility and satislaction regarding services available in tLe LealtL lacility.
99
H13 Reason lor tLe jSY beneliciary to opt Lome delivery, in spite ol casL incentives
being available under tLe jSY scLeme
99
H1+ CasL incentive received by tLe beneliciary under jSY scLeme 100
H15 Ltilization ol government LealtL lacility in last 6 montLs 101
H16 CLaracteristics ol tLe respondents wLo Lave availed tLe services in government
LealtL lacility in last 6 montLs
101
H1/ Jype ol LealtL lacility visited, purpose ol visit and client satislaction regarding
beLaviour ol LealtL worker, privacy and availability ol medicines
102
H18 Lser lees and extra cLarges 103
H19 Services lor tLe BPL patients 103
H20 Cutbreak ol selected diseases (Malaria, Measles, Castroenteritis, jaundice &
CtLer Diseases) in tLe respondents area in last six montLs
10+
H21 Action to be taken lor selected diseases (diarrLoea, LigL lever, persistent cougL,
loose motion, persistent cougL and breatLing problems lor a cLild)
105
H22 Awareness about spacing metLods and ideal gap between 1st & 2nd cLild 106
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Tablc Titlc Pagc
H23 Awareness about modes ol getting AIDS, source ol inlormation about AIDS
and awareness about VCJC
10/
H2+ Suggestions given by tLe respondents 108
A1 Status ol ASHA 113
A2 Role and Perlormance ol ASHA 113
A3 Distribution ol ASHAs by reported types ol dilliculties laced and kind ol
support required
11+
A+ Distribution ol ASHAs by reported awareness on dillerent aspects 11+
C1 Status ol Cram PancLayats covered 11/
C2 Level ol awareness and involvement ol Cram PancLayats 118
EI-1 Background cLaracteristics ol tLe in-patients 12+
EI-2 Purpose ol admission in tLe HealtL Institution 12+
EI-3 Waiting time 125
EI-+ Satislaction regarding waiting time 125
EI-5 BeLaviour ol stall 126
EI-6 Lnique/innovative measure taken to improve tLe stall beLaviour 126
EI-/ Privacy 12/
EI-8 Patient-Doctor/Provider Communication 12/
EI-9 Cleanliness ol tLe lacility 128
EI-10 Satislaction ol patients regarding cleanliness ol tLe lacility 129
EI-11 Crowding in tLe lacility 130
EI-12 Amenities provided by tLe Lospital 131
EI-13 Continuity ol treatment 131
EC-1 Background cLaracteristics ol tLe patients 13/
EC-2 Purpose ol visit to tLe LealtL institution 13/
EC-3 Average waiting time (in minutes) lor services by type ol lacility 138
EC-+ Satislaction regarding waiting time by type ol Lospital 139
EC-5 BeLaviour ol stall 1+0
EC-6 Privacy 1+0
EC-/ Patient-Doctor/Provider Communication 1+1
EC-8 Satislaction ol CPD patients regarding cleanliness ol tLe lacility 1+2
EC-9 Satislaction ol CPD patients regarding crowding in tLe lacility 1+3
EC-10 Continuity ol treatment 1++


Kcy Iindings ot thc Study

In April 2005, tLe Covernment ol India (CoI) launcLed tLe ational Rural HealtL Mission
RHM) witL tLe objectives ol meeting tLe goals set in tLe Vision 2020, otLer policy
documents and tLe Millennium Development Coals (MDC). Covernment ol India Las
undertaken tLis Rapid Appraisal ol tLe Mission at tLe state, district and local level tLrougL its
18 Population ResearcL Centres (PRC) in 20 states ol India. Civen tLe very wide scope ol tLe
Mission and diverse nature ol its activities, tLe PRC study on rapid appraisal is restricted to
selected core components tLat directly address tLe LealtL and lamily wellare needs ol tLe
people. JLis rapid appraisal Las covered lollowing lour core components ol tLe RHM: (1)
Ltilization ol Lntied Iunds at SC, PHC and CHCs, (2) Implementation ol janani SuraksLa
Yojana (jSY), (3) Iacility up-gradation under tLe RHM at dillerent levels and (+) HealtL and
lamily wellare situation in tLe district.

Rapid Appraisal was carried out in janjgir-CLampa district ol CLLattisgarL witL tLe Lelp ol
10 interview scLedules. Iive semi-structured scLedules lor state, district, CHC, PHC, and SC,
were used to collect inlormation about dillerent lacilities, manpower, equipments, RKS,
untied lunds etc at tLese levels. Cram PancLyat, and ASHA scLedule were used to assess tLe
awareness ol RHM and LealtL services availability at tLe village level. Exit interviews ol
indoor and outdoor patients were canvassed at tLe various LealtL lacilities to assess tLe quality
and satislaction witL services. HouseLold scLedule was canvassed to1200 Lundred LouseLolds
in tLe district to assess tLe awareness ol RHM and LealtL programmes and tLeir utilization,
particularly tLe jSY and utilization ol government LealtL services.

(A)Statc Protilc
CLLatisgarL witL a population ol 20.8 million in 2001 is tLe tentL largest state area wise and
1/
tL
in tLe LierarcLy ol population density India. JLirty two percent ol CLLattisgarLs
population belonged to scLeduled castes and eleven percent belonged to scLedule tribes as per
2001 census.


CLLattisgarL Las relatively limited network ol LealtL services delivery system. JLe state Las a
total ol +/+1 SCs, /21PHCs, 136 CHCs, 8 SDHs, and 16 district Lospitals to implement its
public LealtL programme at various levels. RHM is implemented tLrougL tLese LealtL
lacilities. Cut ol tLe /21 PHCs only 5 PHCs (1percent) are designated as 2+"/ PHCs. ew
buildings are under construction lor 1139 SCs 239 PHCs and 65 CHCs in tLe state. In tLe
state only tLe District Hospitals Laving blood storage may be considered as lunctional IRL.
In CLLattisgarL IPHS upgradation is completed in none ol SCs, PHCs, CHCs or IRLs, in
tLe wLole state. Except very lew LealtL lacilities, RKS popularly known as jeevan Deep
Samiti in CLLatttisgarL are registered in all tLe DHs, SDHs,CHCs and PHCs ol tLe state.
JLis indicates tLe states initiatives towards tLe implementation ol tLe RHM. JLe state Las
also undertaken tLe Public-Private-PartnersLip initiative by accrediting 13 private LealtL
lacilities in dillerent districts lor tLe implementation ol jSY scLeme. In tLe state as a wLole,
1/59/8 women were registered under tLe jSY and out ol tLese 101/+9 opted lor institutional
delivery i.e.58 percent ol tLe total deliveries.

Cut ol tLe +/+1 SCs in tLe state, (99.6 percent) Lave operational joint bank account ol AM
and SarpancL. Lntied Crant lor tLe current year Las not been translerred to all tLe CHCs and
PHCs in tLe district due to non utilization ol previous grants. +692 SCs (out ol +/22 witL
operational joint accounts) Lave received tLe untied grants

(B)District Protilc
As per 2001 census, tLe total population ol tLe district was 1.3 million and constitutes nearly
six percent ol tLe population ol tLe state. Cut ol tLe total population ol tLe district, 22.5
percent belong to ScLeduled Caste and 11.6 percent belong to ScLeduled Jribe. JLe district
Las limited public private LealtL lacilities lor tLe delivery ol services. JLe district Las a total ol
2+6 SCs, 36 PHCs, 8 CHCs, 1 SDH and 1 District Hospital to implement tLe public LealtL
programme at various levels. Cut ol tLe 36 PHCs, none are lunctioning as 2+"/ PHC.
AltLougL IPHS survey Las been completed in all tLe LealtL lacilities none Lave been

upgraded. JLe district Las only 2 private nursing Lomes wLicL are less tLan 30 bedded and
Lave been accredited lor jSY. umber ol institutional deliveries reported during 200/-08 in
tLe district was +5+9. Among tLe total number ol registered jSY women +/ percent belonged
to APL and 53 percent to BPL category. Among tLe women registered under tLe jSY, tLe
percentage ol women opting lor institutional delivery among tLe SC, SJ and BPL category is
+/ percent, +/ percent and 68 percent respectively.

JLe untied grants lor tLe linancial year Lave been provided to 8 CHCs and 36 PHCs. All tLe
2+6 Sub Centres in tLe district Lave operational joint bank account ol AM and SarpancL
and tLe Lntied Crant was translerred to all tLese Sub-Centres in tLe current linancial year.
(C) District Hospital
JLe DH is located at a distance ol 5 kilometres lrom tLe nearest bus stop. JLe DH witL bed
strengtL ol 100 beds is spread over in 25 acre area at a distance ol 5 kilometres lrom janjgir-
CLampa bus stand. WLile 12 acres Lave been allocated to tLe Lospital building tLe rest 13
acres are lor residential stall quarters, wLicL Lave yet to be built. JLe DH Las a registration
counter and waiting space adjacent to eacL consultation and treatment room, doctors duty
room, treatment room, isolation room, blood storage unit, pLarmacy, critical care area, and
examination and preparation room. However, tLe ICL, or LigL dependency wards are not
lunctional. JLe kitcLen and tLe relrigerator placed in it are non-lunctional.

JLe Lospital Las tLe lollowing services: Central Sterile and Supply Department, medical and
general stores, backup, ventilation, water coolers, round tLe clock water supply, overLead
water storage tank witL pumping and boosting arrangements, provision lor lire ligLting, and
proper drainage and sanitation system.

JLe Lospital does not Lave a separate ward lor lemale patients. During tLe last tLree calendar
montLs 1/3 CPD patients were attended in tLe section and 26/ deliveries were conducted.
JLe number ol surgical CPD and IPD conducted in tLe section during tLe last tLree montLs
prior to tLe survey was 150 and 31/ respectively. JLe number ol CPD and IPD attended by

patients in tLe Medical Section during tLe last tLree montLs prior to tLe survey was 6+20 and
505 respectively. JLe medical section provides only limited services. During tLe year 200/-
2008 tLe number ol paediatric CPD attended in tLe section was 2590 and number ol IPD
admitted was 652. JLe section Las 10 designated beds lor newborns. JLe diagnostic section
Las conducted CPD diagnostics lor 353 male patients and 21+ lemale patients during tLe last
tLree montLs prior to tLe survey. JLe section Las tLe services like x-ray, and ECC but no
ultra sono grapLy. JLe lab Las provided 6,869 laboratory services to tLe patients during tLe
last tLree montLs prior to tLe survey.

(D) Community Hcalth Ccntrcs
As per tLe study design, tLe two CHCs selected lor tLe study are CHC jaijaipur (designated
IRL & lartLest) and CHC Baloda. jaijaipur is serving a population ol 158, 000 and Baloda is
serving a population ol 1+9,/82. jaijaipur is not a lunctional IRL. altLougL tLey are
providing services on 2+"/. BotL tLe CHCs are 30 bedded Lospitals but only 10 and 8 beds
out ol 30 are in use at jaijaipur and Baloda respectively and tLere are no allocation ol separate
male or lemale bed. In botL tLe Lospitals, tLe availability ol paramedical and support stall is
better tLan stall in tLe medical category. JLe stall situation ol paramedical and support stall is
better in Baloda CHC in comparison to jaijaipur. BotL tLe CHCs jaijaipur and Baloda are
low perlorming Lospitals. JLe BCR ol CHC jaijaipur is 28 percent, and CHC Baloda is 2+
percent. JLe reasons lor tLe low perlormance reported are lack ol medical ollicers at CHC
jaijaipur (wLo also visit Hasoud PHC alternately) wLo are not regularly available at tLe
Lospital. Also all types ol services are not available. Similarly, Baloda PHC is also lunctioning
witL 2 medical ollicers and all types ol services are not available. BotL tLe CHCs are
maintaining tLe records ol tLe jSY beneliciaries. IPHS lacility survey Las not been completed
in botL tLe CHCs. JLey do not receive tLe grants electronically lrom tLe district.
RKS/jeevandeep is registered in botL tLe CHCs. JLe display boards sLow tLe composition ol
jeevandeep witL tLe names ol tLe members Leld only in Baloda CHC. JLe jeevandeep is
generating resources tLrougL user lees in botL tLe CHCs. In botL tLe CHCs, tLere is no
leedback mecLanism in place lor grievances redressed by jeevandeep.


JLe number ol deliveries conducted during 200/-2008 in jaijaipur and Baloda is 299 and 163
respectively. In jaijaipur CHC 122 deliveries and in CHC Baloda 39 deliveries were carried
out between 8 pm to 8 am. It may be mentioned tLat as per tLe prevailing rules (in
CLLattisgarL) all pregnant women wLo came to jaijaipur and Baloda CHCs lor delivery were
considered as jSY beneliciary (CLLattisgarL is an EAC state).

(E) Primary Hcalth Ccntrcs
Covcragc: Lnder CHC jaijaipur, tLe selected PHCs are Hausaud and Raipura. Lnder CHC
Baloda, tLe selected PHCs are Pantora and PHC Catwa. one ol tLe PHCs are 2+"/. JLe
number ol SCs covered by tLese lour PHCs varies lrom + to / and tLe population covered
varies lrom lrom 8, 000 to 35,000. Cut ol tLe lour PHCs, one is Laving 6 beds (3 male and 3
lemale beds) and tLe otLer one Las + beds.

one ol tLe + PHCs are equipped to provide basic obstetrics services. All tLe lour PHCs are
lunctioning lrom a designated government building. AltLougL labour rooms are available in
Hasoud and Pantora PHCs due to non-availability ol doctors/stall AMs and stall nurses no
deliveries are taking. Poor condition ol tLe labour room and no power supply in tLe labour
room are also reasons lor deliveries not being carried out at tLe PHCs. Raipura and Catwa
PHCs are lunctioning lrom old buildings witL no labour room lacilities. Likewise tLese two
PHCs Lave no separate laboratory or testing lacilities available. In Hasuad and Pantora PHCs
altLougL rooms are available lor laboratory purpose tLere is no lab tecLnician available nor
are tLere required laboratory testing lacilities available at tLe two LealtL lacilities.

Intrastructurc and Human Bcsourccs: one ol tLe lour PHCs put up a prominent display
boards regarding service availability in local language. one ol tLe lour PHCs Lave any ew
Born Care Corner. As lor as sanctioned posts and number in position are concerned, tLe stall
position in none ol tLe PHCs, eitLer medical or paramedical can be said to be satislactory.

Except lor a pLarmacist, dresser or ward boy/ward ayaL Lardly any paramedical or otLer stall
was available lor providing inlormation and data.

Status ot Training ot Pcrsonncl at PHC: one ol tLe stall in tLe lour PHCs Lave
undergone Pre Service IMCI (Integrated Management ol eonatal and CLild Inlections)
training. Sale Abortion MetLods training and Skill BirtL Attendant Jraining and ew Born
Care Jraining Lave also been attended by none ol tLe stall.

Availability and Pcrtormancc ot Labour Boom: one ol tLe PHCs are providing labour
room services, tLerelore jSY records are not being maintained by tLem. AltLougL labour
rooms are available in Hausaud and Pantora PHCs due to non availability ol doctors/stall
AMs and stall nurses. Poor condition ol tLe labour room and no power supply in tLe
labour room are also reasons lor deliveries not being carried out at tLe PHCs. In case ol
Raipura and Catwa PHCs, wLicL are still lunctioning lrom tLe old buildings do not Lave a
labour room.

Status ot Spccitic Intcrvcntions: IPHS lacility survey Las been completed in all tLe +PHCs
altLougL tLe medical ollicers concerned Lave no knowledge about tLe survey done. one ol
tLe PHCs are lunctioning on 2+"/ bases AYLSH doctors are not providing services in any ol
tLe PHCs. All tLe lour PHCs Lave registered RKS but Lave no display boards sLowing tLe
composition ol tLe RKS witL tLe names ol tLe members and number ol meetings Leld. In all
tLe PHCs jeevandeep is generating resources tLrougL user lees.

Scrvicc Cutcomc: JLe service outcome statistics was collected lrom tLe PHCs lor last tLree
montLs prior to tLe survey. Cut ol 2+ listed services tLe PHCs are only providing CPD
services. Castewise breakup is not being maintained. PHC wise breakup ol CPD cases
reported is as lollows Hasuad 62+, Raipura 562, Pantora 62+, and Catwa 3085. All tLese PHCs
are just providing skeletal CPD services.


Status ot Bccord Maintcnancc: Except lor tLe untied lunds register ol PHC Hausaud and
jeevandeep meeting register ol Panotora no otLer registers were available. Raipura and Catwa
PHCs are not maintaining any registers at all. JLe record maintenance is poor at tLe PHCs.

(I) Sub Ccntrc
Covcragc: JLe number ol villages covered by tLe SCs varies lrom 2 to 5 and tLe population
covered varies lrom 102+ to 83+1. JLe average number ol villages covered by tLe SCs is +.2
and average population covered is 5921. Jwelve 12 SCs are covered lor tLe survey under lour
selected PHCs. JLe number ol ASHAs working under tLe eleven SCs is 1/9 and tLe average
lor all tLe 12 SCs turns out to be 16.3.

Availability ot Intrastructurc: Cut ol tLe 12 SCs, only 1 (9 percent) is running lrom
designated government building. In one SC no regular AM was available tLerelore SC
inlormation is available lor 11centres. JLe remaining SCs are lunctioning lrom tLe AMs
own Louse (9 SCs). In atleast one SC drugs medicines etc were not visible. IPHS lacility
survey Las been done in 100 percent ol tLe SCs altLougL none ol tLe AMs or MPW knows
about it. Labour room is available only in 9 percent ol tLe SCs i.e., 1 out ol 11. Cnly 2 SCs
Lave quarters lor AM. Among tLe two SCs witL AM quarters, only in one SC tLe AM
is occupying tLe quarters. JLe otLer AM is staying outside tLe village. JLe reason cited by
tLe AM lor not staying in SC quarter is tLe remoteness ol tLe SC and lamily reasons.

Availability ot Statt: All tLe 11 SCs are Laving at least one LealtL worker (male or lemale)
working in regular position and 3 SCs Lave botL male and lemale workers in regular position.
JLe stall availability sLows tLat 100 percent ol SCs Lave male and lemale LealtL workers in
regular positions. one ol SCs Lave any contractual AMs.

Availability ot Equipmcnts and Drugs: one ol tLe SCs Lave all tLe 12 listed equipments
available witL tLem. Cut ol tLe 12 equipments listed, 5 instruments are available in tLe 11 SCs
Cut ol tLe 12 equipments listed, only one SC Las reported tLe availability ol 10 equipments

and all tLe remaining SCs Lave reported less tLan 10 equipments. Availability ol drugs on tLe
date ol survey was collected lrom tLe SCs. JLe inlormation was obtained lor 16 drugs. JLe
availability ol drugs sLows tLe mixed picture. Cut ol 16 drugs, only one SC sLowed tLe
availability ol 12 drugs and anotLer 9 drugs. All otLer SCs reported ol possessing 3-8 drugs at
tLe time ol survey.

Spccitic Skills and Proccdurcs: AMs in all tLe 11 SCs reported tLat tLey register pregnancy
witLin tLree montLs, carryout 3 AC visits as per tLe RCH scLedule; provide JJ and IIA,
and Immunisation Services. inety one percent ol tLe AMs carryout 3 AC visits as per
tLe RCH scLedule and reported tLat tLey are trained in syndromic treatment ol RJI/SJI.
EigLty two percent ol tLe AMs reported tLat tLey carry out specilic examinations like
Blood Pressure, Haemoglobin and Lrine and stated tLat tLey are carrying out ILCD
insertion/removal. Among tLe AMs wLo reported tLat tLey carry out ILCD
insertion/removal, one-tLird said tLat ILCD A380 is used and its supply is regular. Also only
one- tLird ol tLe AMs reported tLat tLey are trained on insertion/removal ol ILCD A380.

Scrvicc Cutcomc: JLe service outcome data lor tLe last tLree montLs sLow tLat, on an
average, eacL AM Las registered +9 ACs. Cut ol tLe total ACs, tLe average number
registered by tLe AMs in 1st Jrimester is 19.6. JLe average number lor tLe tLree AC
visits as per RCH scLedule is 2/.8 in last tLree montLs. Cn an average, eacL AM Las
identilied 3./ LigL risk cases, conducted 0 deliveries and relerred +.3 pregnant women to next
LigLer lacility. eonate inlections reported during tLe last tLree montLs on an average is 1.1.
Among tLe nine SCs wLere AM is carrying out ILCD insertion/removal, tLe average
ILCD insertion is 56 during 200/-2008. JLe service outcome data reveal tLat tLe perlormance
ol tLe AMs varies across tLe SCs.

Status ot Bccord Maintcnancc: Jo know tLe status ol record maintenance, tLe inlormation
was collected lor 11 registers lrom tLe SCs. Registers lor Antenatal Cases, Immunisation, and
jSY are maintained by10 (92 percent) out ol 11 SCs. Iamily Planning and BirtL and DeatL

registers are maintained by 9 (82 percent) SCs. early two-tLirds (6+ percent) ol tLe SCs
maintain Lntied Iunds register, CasL Book and Meeting registers. Eligible Couple registers
HouseLold register and Post natal care register is maintained in only 6 out ol tLe 11 sub-
centres. WLile + sub-centres maintain 10 registers, 1 sub-centre maintains only 3 registers.

Awarcncss about JSY: Awareness about tLe jSY and tLe amounts to be given to tLe
beneliciaries is universal among tLe AMs. EigLt out ol eleven AMs reported tLat tLere is
an increase in tLe demand lor institutional deliveries alter tLe implementation ol tLe jSY
scLeme.

Proccdurc undcr JSY Schcmc: EigLty two percent ol tLe AMs reported tLat tLe jSY
beneliciaries are being paid in casL and remaining 18 percent reported tLat tLe beneliciaries
are being paid by cLeque or voucLer. A little more tLan Lall (5+ percent) ol tLe AMs
reported tLat tLe jSY beneliciaries are paid witLin a week and +6 percent said tLat tLe
beneliciaries are paid alter two weeks (1/ percent) later. Cnly two out ol 11 AMs reported
tLat tLe transport support is available under jSY lor sLilting tLe pregnant woman lrom SC to
PHC, in case ol emergency but it is done on private basis and tLere is no government support.
Jen out ol 11 AMs said tLat tLe Register is available witL tLem to record jSY expenditure.

Pcrtormancc ot AMM undcr JSY Schcmc: All tLe 12 SCs togetLer Lave registered 116 jSY
cases during tLe last tLree calendar montLs and tLe average number per SC turns out to be
10.5 cases. JLree out ol 11 SCs Lave not registered a single jSY case in tLe last tLree montLs.
JLe average number ol jSY cases resulted in institutional deliveries during tLe last tLree
montLs is 2.3. JLe average amount disbursed lor jSY cases in last tLree calendar montLs tLe
SCs is Rs.111+. JLe perlormance ol SCs/AMs under jSY varies considerably across tLe SCs.
During tLe linancial year 200/-2008, tLe average amount disbursed under jSY by tLe SCs lor
Lome deliveries are Rs. 9+32. ot a single SC Las paid any money lor institutional delivery.
one ol tLe SCs Lave reported tLe transport costs under tLe jSY. one ol tLe SCs Lave
reported payments to ASHA.


Status ot Lnticd Crants: All tLe 11 SCs Lave received tLe Lntied Crants. All except Catwa
PHC Lave reported tLe expenditure lrom tLe grants. All tLe SCs are Laving joint bank
account witL tLe SarpancL/any otLer CP lunctionary. Sixty lour percent ol tLe SCs maintain
written record ol transactions being carried out on Lntied Iunds and +6 percent SCs reported
maintenance ol register to record tLe decisions taken to spend tLis amount.

(C) Houschold Survcy
Charactcristics ot thc Houscholds: Distribution ol tLe LouseLolds by social category sLows
tLat Lall ol tLe LouseLolds belong to CBC, 29 percent belongs to Caste (SC) 19 ScLedule
Jribe (SJ), and 2 percent to CtLer castes. Seventy lour percent ol LouseLolds Lave
electricity. Cne-tLird ol tLe LouseLolds are living in pucca Louses. Joilet lacility is available
only in 1+ percent ol tLe LouseLolds. Piped water is used by only 6 percent ol tLe LouseLolds.
Sixty percent ol tLe LouseLolds belong to BPL category. Sixty percent ol tLe LouseLolds
belong to BPL category. JLe BPL status is also exactly rellected in tLe LouseLolds witL tLe
low standard ol living index (+/ percent). Among tLe living cLildren born in tLese rural
LouseLolds during tLe last live years, Lardly 1+ percent ol tLem were born in institutions.

Wastc Disposal, Stagnation ot Watcr and Mosquito Brccding and Systcm ot Mcdicinc
Prctcrrcd: MetLod ol waste disposal sLows tLat majority ol tLe rural LouseLolds (9+ percent)
tLrow tLeir waste in tLe open space and tLe remaining bury in a pit. During tLe survey, in 22
percent ol tLe LouseLolds, investigators Lave observed tLe stagnation ol wastewater around
tLe LouseLold. System ol medicine prelerred by tLe rural LouseLolds reveals tLat tLe
allopatLic medicine is universally prelerred (99 percent).

Intormation about Hcalth Workcrs and Hcalth Iacilitics: About tLree-lourtLs respondents
(/+ percent) Lave Leard about AM and only 38 percent ol tLem Lave Leard about a Male
HealtL Worker. Respondents were asked about tLe availability ol tLe LealtL lacilities to tLe
LouseLolds wLen required. JLe responses reveal tLe combination ol public and private

lacilities available to tLem wLen required. Respondents quoted jLola CLLap doctor (8+
percent) most lrequently. Respondents were lurtLer asked about tLe LealtL lacility lor wLicL
tLe serious patients are taken. Majority ol tLe respondents (5+ percent) mentioned tLat tLey
take tLe serious patients to tLe CC Lospital/clinic. Seven, 18 percent and 33 percent ol tLe
respondents mentioned public LealtL lacilities like PHC, CHC and District Hospital
respectively.

MBHM, ASHA and JSY: A little more tLan one liltL ol tLe respondents (22 percent) Lave
Leard about RHM About one lourtL ol tLe respondents (2+ percent) Lave Leard about
RHM. Cverall, majority ol tLe respondents (9+ percent) espondents Lave Leard about
ASHA wLo is popularly known as Mitanin in tLe state ol CLLattisgarL. Jwo liltLs ol tLe
respondents (+2 percent) reported tLat tLe Village HealtL and utrition Day (VHD) is
being organised in tLe village. Hardly 11 percent ol tLe respondents reported tLe presence ol
Village HealtL and Sanitation Committee (VHSC) in tLe village. Among tLose wLo are aware
about tLe jSY scLeme, twelve percent ol tLem reported tLat tLe LouseLold is a beneliciary ol
tLe jSY scLeme. JLe percentage ol tLe beneliciary LouseLolds is sligLtly more in SC HQ
villages (13 percent) tLan in otLer villages (11 percent). Among tLe total surveyed LouseLolds,
6 percent (/2 out ol 1200) are beneliciaries ol tLe jSY scLeme.

JSY Bcncticiarics: Social category ol tLe beneliciaries reveals tLat about Lall ol tLem (+/
percent) are CBCs lollowed by ScLeduled Castes (33 percent) and ScLeduled Jribes (18
percent). All tLe beneliciaries are Hindus. Distribution ol beneliciaries by Standard ol Living
Index (SLI) sLows tLat more tLan Lall ol tLem (53 percent) belong to low SLI LouseLolds, 31
percent belong to medium SLI LouseLolds and 1/ percent to LigL SLI LouseLolds. More tLan
two tLirds (6/ percent) ol tLe beneliciaries are lrom BPL category.

Bcgistration ot JSY Bcncticiarics: Cnly one-lourtL ol tLe beneliciaries Leard about tLe jSY
scLeme belore being pregnant and tLe rest /5 percent during pregnancy. About two liltL (38
percent) ol tLe beneliciaries got registered during tLe lirst trimester ol tLe pregnancy and Lall

ol tLem during 5tL montL ol tLe pregnancy or even later. early Lall ol tLe beneliciaries
were registered by AM/IHW (+/ percent), 21 percent by Anganwadi worker, 1+ percent by
ASHA and tLe remaining 18 percent by Doctor/LHV/CtLers.

JSY Card: Cnly 19 percent ol tLe beneliciaries reported tLat tLey received tLe jSY card.
Among tLose wLo received tLe jSY card, more tLan Lall ol tLem were Lelped by ASHA in
getting tLe jSY card. (It may be mentioned tLat separate jSY cards Lave not been provided in
tLe district ICDS maternal and cLild LealtL cards may Lave been reported as jSY cards by
beneliciaries).

Bolc ot ASHAs during thc Prcgnancy ot thc Bcncticiarics: In CLLattisgarL, 3 to 5
ASHAs/Mitanins are appointed in eacL village depending upon tLe population size and most
respondents are aware about tLem. In janjgir-CLampa district, among tLe villages surveyed,
ASHAs/Mitanins are appointed in all tLe villages ol tLe two blocks selected lor tLe study. In
spite ol a large presence ol ASHA /mitanins tLere involvement in tLe jSY programme is
negligible. In spite ol a large presence ol ASHA /mitanin in all tLe villages only 35 percent ol
tLe beneliciaries said tLat tLe ASHA worker provided specilic Lelp during last pregnancy.

Placc ot Dclivcry and Bcason tor Cpting Institutional Dclivcry: Among tLe beneliciaries,
only +/ percent (3+ out ol /2) delivered in Institutions and tLe remaining 53 percent delivered
at Lome. Among tLe beneliciaries, 3/ percent (23 out ol 62) delivered in Institutions and tLe
remaining 63 percent delivered at Lome. Most ol tLese institutional deliveries (32 out ol 3+)
took place in public institutions (DH and CHC).

Transport ot thc Bcncticiarics to Bcach thc Hcalth Institutions: Among tLe beneliciaries
wLo delivered in LealtL institutions, / ol tLem received a relerral slip lrom ASHA/LealtL
personnel to access delivery services Cut ol tLe 3+ beneliciaries wLo delivered in institutions,
11 ol tLem laced dilliculty in reacLing LealtL institution due to late/ non availability ol
transport, insullicient money and nigLt timing. JLe average distance to tLe ultimate place ol

delivery lrom tLe beneliciaries residence is about 22 kilometres. Majority ol tLe beneliciaries
(9/ percent) used otLer means ol conveyance like public transport or cycle to reacL tLe
ultimate place ol delivery, and 3 percent used a private veLicle. Ior majority ol tLe
beneliciaries mainly lamily members /relatives /Lusbands Lad arranged tLe veLicle, and 3
percent were lacilitated by ASHA in arranging tLe transport.

Bcason tor Cpting Homc Dclivcry: Iilty tLree percent beneliciaries opted lor tLe Lome
delivery in spite ol casL incentives being available under tLe jSY scLeme. JLe major reasons
cited by tLe beneliciaries are Lome delivery is more convenient (81 percent); non availability
ol transport (11 percent); lack ol allordability (11 percent); and cultural/social reasons (3
percent).

Cash Inccntivc Bcccivcd by thc Bcncticiary undcr JSY Schcmc: Cut ol tLe /2 beneliciaries,
60 (83 percent) Lad received tLe casL incentive under jSY scLeme and tLe average amount
received by tLem is Rs. 913. Cut ol tLose wLo received tLe casL incentive, all received it in
one installment. Among tLose wLo received tLe casL incentive, 10 percent received
immediately alter tLe delivery, 18 percent received witLin a week alter tLe delivery and /2
percent received it mucL later.

Ltilisation ot Covcrnmcnt Hcalth Iacility in Last Six Months: Jen percent ol tLe rural
LouseLolds (120 out ol 1200) Lave availed tLe LealtL services in government LealtL lacility in
last six montLs. JLe selected socioeconomic cLaracteristics ol tLe patients/respondents wLo
Lave availed tLe LealtL services in government LealtL lacilities reveal tLat more tLan Lall (53
percent) ol tLem are illiterates, 53 percent are ScLeduled Castes and ScLedule Jribes, and more
tLan two tLirds ol tLem (66 percent) belong to BPL LouseLolds. JLe percentage ol LouseLolds
witL low SLI is +8 percent. JLe cLaracteristics ol tLe respondents clearly reveal tLat most ol
tLem come lrom poor LouseLolds. JLe type ol LealtL lacility visited by tLe respondents sLow
tLat 3/ percent visited District Hospital 29 percent visited PHC, 25 percent visited tLe CHC
and 5 percent visited tLe SC.


Lscr Iccs and Extra Chargcs: In tLe survey, among tLe respondents wLo Lave availed tLe
services in government LealtL lacility in last six montLs, 6/ percent (i.e., 80 out ol 120) said
tLat tLey were cLarged user lees by tLe LealtL lacility (Jable H18). Among tLose wLo paid
tLe user lees, /8 percent paid lor registration, 13 percent lor X-ray, 13 percent lor lab test and
+ percent lor ultrasound and 19 percent lor otLer services.

Cutbrcak ot Discascs: All tLe respondents were asked wLetLer tLere is any outbreak ol
malaria, measles, gastroenteritis, jaundice and otLer diseases in tLeir area in tLe last six
montLs. JLe percentage ol respondents reported tLe outbreak ol tLe above diseases in tLeir
area in tLe last six-montL is 26 percent, 12 percent, 1/ percent, 5 percent and 3 percent
respectively.

Awarcncss about Spacing Mcthods and Idcal Cap bctwccn Childrcn: Majority ol tLe
respondents (// percent) reported tLe ideal spacing between 1st and 2nd cLild reveals tLat
preler tLe ideal spacing to be 3 and more years. JLe ideal spacing ol 3 years reported by
majority ol tLe respondents clearly indicates tLe need lor spacing metLods in our lamily
planning programme. Knowledge regarding tLe spacing metLods reveals tLat Cral Pills is
known to 88 percent ol tLe respondents lollowed by Condom (+3 percent) and ILD is known
only to 19 percent respondents. About one lourtL (23 percent) ol tLe respondents said tLat
tLey dont know tLe lamily planning metLods available lor spacing.

AIDS and VCTC: Among tLe respondents, more tLan Lall ol tLem (5+ percent) are aware
about tLe HIV/AIDS. WitL regard to knowledge about tLe modes ol translormation ol
HIV/AIDS, tLe table rellects tLat /6 percent ol tLe respondents aware tLat unsale sexual
contact, 60 percent sLaring ol needles/syringes and +6 percent blood translusion are tLe very
important modes ol translormation. Cnly / percent ol tLe respondents are aware about tLe
nearby Counselling centre/VCJC. Among tLose wLo are aware about tLe location ol VCJC,
reported tLat tLat it is located in tLe government LealtL lacility (DH/CHC/PHC).


Suggcstions givcn by thc rcspondcnts: JLe suggestions given by tLe respondents sLows tLat
respondents generally expect toilet lacility, LealtL lacility, LealtL workers, cleanliness,
sanitation, sale drinking water, pucca road and transport lacility lor tLeir villages. JLe
suggestions given by tLem reveal tLe genuine expectations ol tLe villagers lor tLe
improvement ol tLe LealtL and sanitation in tLeir villages.

(H) Status and Pcrtormancc ot Mitanin (ASHA)
CLLattisgarL state Las pioneered tLe concept ol Mitanin, wLicL is now popularly
known as ASHA in tLe country as a wLole. JLere is a network ol 60,000 mitanins spread
across tLe lengtL and breadtL ol tLe state in all 16 districts. EacL village Las atleast one
Mitanin and many villages Lave 3-5 mitanins. Jwenty-six ASHAs /Mitanin were interviewed
lrom SC as well as lartLest villages covered under tLe 2 CHCs in janjgir-CLampa district.
Average population served by Mitanins is 3+3 i.e lor every 3+3 persons tLere is one mitanin
to provide LealtL related services. All tLe Mitanins Lave undergone training (100 percent).
Majority ol tLe Mitanins Lave covered tLe (96 percent) Lave completed tLe tentL round ol
training wLicL is comparable to 1-+ modules ol ASHA in otLer states.

Bolc and Pcrtormancc ot Mitanin: Jwelve percent Mitanins are DCJs provider in tLeir
villages and tLey Lave lacilitated only 1.2 jSY cases in tLe last tLree montLs. Mitanins on an
average Lave Landled 3./ cases ol diarrLoea and given CRS to cLildren in tLe last tLree
montLs. Mitanins Lave accompanied Lardly any institutional delivery cases (0.2). Cn an
average a Mitanin Las distributed 2 Cral Pills. Cn an average 6 Malaria patients Lave been
given drugs, and tLe number ol new pregnancies identilied is 2.0. umber ol group meetings
like MaLila mandals arranged by a mitanin is 2.2. umber ol HealtL & utrition days
arranged is 1.+. Average money incentive received by a Mitanin during one montL lor tLe
dillerent LealtL activities carried out by tLem is Rs. 1+ lor jSY Rs. 28 lor Sterlisation, Rs. 8
lor VHD, and Rs 35 lor otLer activities like motivating lor immunization. Cn an average
tLe total amount received by a Mitanin is Rs. 85 lor dillerent types ol services given by Ler.


Ditticultics Iaccd and support Bcquircd: Iorty percent reported mitanins reported delayed
supply ol drugs, wLicL allected tLeir work. Inadequate lacilities lor institutional deliveries in
tLe village are reported by 23 percent mitanins. Jwo issues, wLicL were stated by majority ol
tLem, are payments sLould be made timely (65 percent) and Mitanins sLould be paid a lixed
remuneration (62 percent).
(I) Cram Panchayat
Regarding tLe regular availability ol AM, less tLan Lall (++ percent) ol tLe Cram PancLayats
reported tLat tLe AM is regularly available in tLe village. A little more tLan one- lourtL 26
percent reported tLat tLe Sub Centre is providing timely services to tLe patients in tLe village.
EigLty percent Cram PancLyats Lave reported tLe existence ol tLe VHSC in tLeir village and
tLe receipt ol Lntied Iunds lor tLe VHSC is reported by majority (95 percent) ol tLem.
Moreover, two-tLird (65 percent) ol tLe Cram PancLayats reported tLe regular meetings ol
tLe VHSC but only Lall ol tLem (50 percent) Lave reported tLe preparation ol tLe Village
HealtL Plan. More tLan Lall (52 percent) ol tLe Cram PancLayats reported conducting ol IEC
activities during last 6 montLs. All tLe 23 Cram PancLayats (100 percent) reported tLe
appointment ol Mitanins in tLeir respective villages. Awareness about tLe benelits under tLe
jSY scLeme was reported by 96 percent ol tLe Cram PancLayats. Hardly + (1/ percent)
pancLyat members reported tLat tLe RHM Las brougLt improvement in tLeir area. Among
tLose Cram PancLayats, wLicL Lave reported improvements due to RHM, stated tLat lunds
are available lor maintenance ol Sub-Centres (50 percent), community support is available as
Mitanin worker (50 percent), tLere is availability ol lunds/lacilities under jSY (25 percent),
and availability ol transport lacilities lor delivery (25percent). JLirty percent Cram
PancLayats Lave reported tLe dilliculties in implementing programme activities under
RHM. JLe kind ol support required reported by tLe Cram PancLayats are: more lunds and
more training lor ASHA and Community members, control over lunds and otLer like
lacilities lor transportation to tLe Lospital, and adequate publicity ol RHM lor
implementing tLe programme under RHM.


(J) Quality ot Carc and Clicnt Satistaction IPD Exit Intcrvicw
Waiting Timc: Iive inpatients Lave been interviewed. JLe average waiting time lor tLe
patients (DH: +; CHC:1) lor tLe Registration is 8 minutes. JLe average waiting time lor
Registration in DH is sligLtly more tLan tLat in tLe CHCs. Alter tLe Registration, tLe
patients Lad to wait on an average 19 minutes lor tLe Doctors call in tLe Lospitals. JLe
average waiting time lor Doctors call is more or less same in tLe DH and CHC (1+-15
minutes). Cn an average; tLe doctors Lave examined tLe patients lor 1/ minutes. JLe doctors
Lave given more time to tLe patient lor examination in tLe DH tLan at tLe CHC. Alter tLe
examination it takes 16 minutes to get admitted to tLe ward. Alter admission to tLe ward, it
takes about Lall an Lour (29 minutes) lor tLe patients to get tLe services. Waiting time in tLe
DH is less and patients lrom DH got tLe services relatively laster (21 minutes) tLan tLe
patients lrom CHC (60 minutes).

Satistaction Bcgarding Waiting Timc: JLe satislaction witL tLe waiting time lor
registration, doctors call, doctors examination, admission to ward, getting services was eitLer
sLort or appropriate lor patients. All tLe patients indicated complete satislaction botL at tLe
DH or CHC.

Bchaviour ot thc Statt: All tLe patients said tLat tLe doctor greeted tLem in a lriendly
manner in tLe lirst instance. Regarding tLe beLaviour ol doctors, nurses and tecLnical stall,
tLe patients said tLat tLeir beLavior in general is good. Satislaction regarding tLe beLaviour ol
ayaL, ward boys and counter clerk appears to be lurtLer LigL as almost all tLe patients said
tLat eitLer tLey are good or very kind. JLe ligures indicate tLat tLe patients in general are
satislied witL tLe beLaviour ol all categories ol stall in tLe LealtL lacilities.

Privacy: Cn tLe wLole, only 1 out + ol patients said tLat tLere was privacy in tLe place ol
examination at tLe DH.JLe lone inpatient at tLe CHC was satislied witL tLe privacy. JLis
indicates tLat patients at tLe district Lospital expect more privacy tLan wLat is provided by
tLe Lospital at tLe place ol examination.


Paticnt-Doctor/Providcr Communication: JLe response ol tLe patients witL respect to
tLeir interaction witL tLe doctor sLows tLat tLe patients Lave a mixed opinion about tLe
response received. Regarding listening to tLe patients ailment, + patients (DH: 3; CHC: 1)
said tLat tLe doctor always listened to tLeir ailment patiently, and 1 ol tLem said tLat tLe
doctor listened somewLat at tLe DH. All tLe 5 patients said tLat tLe eitLer tLe doctor
always/somewLat allowed to ask questions or responded to questions (DH: +; CHC:1). JLe
analysis ol client-provider communication indicates tLat clients are more or less satislied witL
tLe doctors beLavior.

Clcanlincss ot thc Iacility: Cleanliness ol LealtL lacilities is assessed tLrougL tLe lrequency
ol cleaning ol lloor and toilet/batLroom, cLanging patients unilorm and cLanging bedsLeets.
Cverall, according to tLe patients, tLe cleanliness ol lloor and toilet/batLrooms are poor in
CHC as compared to tLe and DH. Irrespective ol type ol lacility, cLanging patients unilorm
and bed sLeets are not a common practice. JLe data on lrequency ol tLe cleanliness and
satislaction regarding tLe same clearly sLows tLat lack ol cleanliness is a major issue in tLe
LealtL lacilities.

Crowding in thc Iacility: Almost all tLe patients said tLat tLey got tLe cot immediately alter
tLe admission to tLe ward and all ol tLem said tLat tLe cot was available to tLem till tLe time
ol discLarge. As tLe bed occupancy in tLe Lospitals is low, in botL tLe DH and CHCs,
availability ol cot is not a problem in tLe Lospitals. Regarding tLe adequacy ol space in tLe
ward, all 5 patients said tLat tLe space is adequate. All tLe patients were eitLer satislied or
somewLat satislied witL tLe ward arrangements. All tLe patients reported adequacy ol space in
IPD as satislactory.

Amcnitics providcd by thc Hospital: As per tLe reporting ol patients, amenities are
relatively better in DH compared to tLe CHC wLere only ambulance lacility is reported.
Among tLose wLo said tLat tLe particular amenity is available in tLe Lospital were lurtLer

asked about tLeir satislaction regarding tLe amenity. Satislaction witL medical sLop and
accommodation lor relatives is comparatively less tLan patients reporting availability.

Continuity ot Trcatmcnt: Cverall, + out 5 patients are satislied witL tLeir visit to tLe
lacility and only 1ol tLem was dissatislied. Hence, tLe patients are neitLer LigLly satislied nor
dissatislied tLe satislaction lies in between. JLree ol tLe patients said tLat tLey would come
again to tLe lacility, in case tLey lell sick. Iour ol tLem said tLat tLey would recommend tLe
Lospital to otLers.

(I) Quality ot Carc and Clicnt Satistaction CPD Exit Intcrvicw
Avcragc waiting timc tor scrviccs: Cverall, to get all tLe CPD services it takes on an average
51 minutes lor tLe patients in tLe Lospitals. Average time to get tLe CPD services is LigLest in
PHCs (60 minutes) lollowed by CHCs (+1 minutes) and DH (2+ minutes). JLe waiting time
lor tLe CPD services by type ol Lospital sLows tLat, to get tLe services, tLe patients Lave to
wait more time in DH tLan in CHCs and PHCs. JLe waiting time lor tLe CPD services
sLows tLat, to get tLe services, tLe patients Lave to wait more time in PHCs tLan in CHCs
and DH.

Satistaction Bcgarding Waiting Timc: JLe satislaction witL tLe waiting time lor
registration, doctors examination, injection, dressing, getting medicines, and paying bill is
assessed witL lour categories (too long, appropriate, too sLort and cant say). It sLows tLat,
dissatislaction witL services is not at all LigL as only 2-/ percent ol tLe patients said tLat tLe
waiting time is too long lor tLese services, except at tLe CHCs wLere tLe waiting time lor
getting medicines is reported too long by patients (1+ percent). In lact, most ol tLe patients
(65-8/ percent) perceived and reported tLat tLe waiting time lor tLese services is appropriate.

Bchaviour ot Statt: Jwo percent ol tLe patients said tLat tLe doctor did not greet tLem in a
lriendly manner in tLe lirst instance, + percent said tLat tLe doctor greeted tLem in
somewLat lriendly manner and 66 percent said tLat tLe doctor greeted tLem in a lriendly

manner and 29 percent patients did not interact at all witL tLe doctors due to tLeir non
availability. More tLan Lall (53 percent) patients) did not interact witL tLe doctors in tLe
PHCs mostly due to tLeir non availability during CPD Lours. Cverall tLe beLavior ol nurses
and dispenser were seen as reasonable, good and kind by patients ol DH and CHC. JLe
ligures indicate tLat, tLe patients in general, are satislied witL tLe beLaviour ol all categories ol
stall in tLe LealtL lacilities.

Privacy: Cn tLe wLole, /1 percent ol patients said tLat tLere was privacy in tLe place ol
examination. JLe percentage ol patients reporting tLe presence ol privacy is mucL lower in
DH (30 percent) as compared to PHCs and CHCs (80-81 percent). It is clear tLat tLe privacy
is an issue, particularly in DH and PHCs.

Paticnt-Doctor/Providcr Communication: Regarding listening to tLe patients ailment, 66
percent ol tLe patients said tLat tLe doctor always listened to tLeir ailment patiently, +
percent said tLat tLe doctor listened somewLat and only 2 percent said tLat doctor did not
listen and 29 percent patients did not interact at all witL tLe doctors due to tLeir non
availability. More tLan Lall tLe patients did not interact witL tLeir doctors at tLe PHC due to
tLeir non availbility. JLe percent ol patients said tLat tLe doctor did not allow to ask
questions is + percent, did not respond to questions is 9 percent, did not discuss about tLe
ailment is 9 percent, did not talk about recovery is 1+ percent, and did not give otLer advice
is 36 percent. Doctors did not talk to patients about recovery (CHC: 25 percent: PHC: 10
percent) and did not give otLer advise (CHC: 63 percent; PHC: 2/ percent). JLe results sLow
tLat tLe CPD patients at tLe CHCs and PHCs are not Lappy witL tLe communication ol tLe
doctors.

Clcanlincss ot thc CPD Iacility: Satislaction ol tLe patients regarding tLe cleanliness ol tLe
CPD lacilities (CPD room, examination room, dispensary, laboratory, injection room and
dressing room) was asked. Cverall, 80-100 percent ol tLe patients lelt tLat tLe CPD lacilities
are clean and almost none ol tLe patients said tLat tLe lacility is not clean. Compared to IPD

patients, less number ol CPD patients expressed tLeir dissatislaction regarding tLe cleanliness.
Because, IPD patients stay longer in tLe Lospital and expect a cleaner environment wLereas,
CPD patients visit only lor a sLorter period and not mucL botLered about tLe cleanliness ol
tLe CPD area.

Crowding in thc CPD Arcas: Lot ol dissatislaction may exist due to crowding/inadequacy
ol space in tLe CPD lacilities. But Lardly 2-6 percent patients expressed dissatislaction lor
crowding/inadequacy ol space CPD lacilities CPD Room, Examination Room and
Dispensary.

Continuity ot Trcatmcnt: Cverall, 5/ percent ol tLe patients are satislied witL tLeir visit to
tLe lacility, 36 percent somewLat satislied and / percent is dissatislied. Compared to IPD
patients (20 percent), more CPD patients (5/ percent) are satislied witL tLeir visit to tLe
LealtL lacility.
AltLougL overall 80 percent patients said tLat tLey would visit tLe LealtL lacility again, +0
percent patients at tLe DH and 18 percent at tLe PHC expressed tLat tLey were not sure
about visiting tLe same LealtL lacility again. Cverall, 98 percent ol tLe patients said tLat tLey
would recommend tLe Lospital to otLers.

Salicnt Iindings
Intrastructurc
x JLe district Lospital ol janjgir-CLampa is lunctioning lrom a new building (constructed
under IPHS norms) but tLe CHCs are lunctioning lrom old buildings, wLicL do not Lave
adequate space. Jwo PHCs are lunctioning lrom new building and two are lunctioning
in tLe old building. Cl all tLe SCs only two (KLisora and Catwa) Las tLeir own building.

x JLe MCs ol two PHCs wLere tLe building is already constructed or under construction
are not in a position to say wLen tLe new buildings will be available lor use. EstablisLing
new buildings lor LealtL lacilities Las made slow progress.

x JLe district Lospital Las tLe designated number ol 100 beds. JLe two CHCS and 3 PHCs
do not Lave tLe designated number ol beds.

x JLe district Lospital and tLe CHCs Lave labour room lacilities and are providing delivery
services. Labour rooms are not lunctional at tLe PHCs and normal delivery lacilities are
not available at tLe PHCs or SCs. At tLe SC level most deliveries are being conducted at
Lome by majority ol tLe AMs.

x JLe district Lospital and tLe CHCs Lave laboratory lacilities. one ol tLe PHCs Lave
any laboratory lacilities, and tLus do not provide laboratory services. Lack ol trained
manpower Las been cited as reasons lor tLeir being non-lunctional, resulting in delayed
diagnosis and treatment.

x ew born care corner is not available at tLe DH, CHCs or PHCs. DH Las a pediatric
ward but CHCs and PHCs are not providing any services to neonates and inlants.

x JLe District Hospital at janjgir-CLampa does not maintain a waste management protocol
and neitLer do tLe two CHCs Lave any ol tLis lacility. Collection ol Lospital waste by
municipal agency, burying in pit or burning was reported to be tLe usual practice lor
waste disposal in all types ol LealtL lacilities; not a single institution uses an incinerator
lor waste disposal.


Human Bcsourccs
x JLere is scarcity ol specialist services at tLe district level and sLortage ol medical and
paramedical stall at tLe CHCs and tLe PHC level.

x Due to lack ol adequate numbers ol Stall urses/AMs /LHVs in CHCs and PHCs (at
CHCs) except lor CPD Lardly any otLer type ol services are being provided by tLese
LealtL lacilities on day to day basis.


x Jrained personnel is scarce lor most lacilities, be it MCs or paramedics. Jrained doctors
especially in anaestLesia, and obstetrics care are not available at tLe CHCs. Jraining in
Pre Service IMCI, Sale Abortion MetLods, Skill BirtL Attendant Jraining ew Born
Care, Lave been not been received by any stall at tLe PHC level.
x In District Hospital tLere are no stall quarters and tLus no stall resides witLin tLe
campus. JLe situation is somewLat satislactory at CHCs wLere tLe medical stall is living
witLin tLe campus ol tLe LealtL lacility. At tLe PHC level none ol tLe medical ollicers
are living in tLe PHC Leadquarters.

x JLe BPMs and BAMs Lave yet to take cLarge at tLe CHC level. JLe programme
management is tLereby sullering due to lack ol mecLanism to monitor tLe
implementation ol RHM at tLe CHC level and below.

x Rural HealtL Assistants (states initiatives) are providing services at some ol tLe PHCs.
JLey are zealous and eager to provide services in remote areas. JLeir internsLip is being
Landled by tLe district Lospital.

Equipmcnts and Drugs
x one ol tLe LealtL lacilities, eitLer tLe district Lospital or CHCs and PHCs Lave all tLe
essential drugs and instruments. At tLe time ol survey tLe ++ percent essential drugs
were not been supplied at tLe CHCs and tLirty six percent at tLe PHCs. Most ol tLe SCs
Lave 20-50 percent ol tLe essential drugs. Supplies ol tLese items are periodic and not
demand driven.

x JLe drugs/vaccines essential lor maternal and cLild LealtL as well as lamily planning
services are not available at tLe PHCs. one ol tLe PHCs are providing tLese services at
tLeir respective LealtL lacilities. At tLe CHCs due to irregular supply ol second and
tLird dose ol DPJ (between September-ovember 2008) tLe vaccination scLedule was
discontinued at tLe CHCs and SCs.

x Cnly 2/-33 percents ol tLe essential equipments listed are available witL tLe CHCs. JLe
PHCs Lave +0-60 percent ol tLe listed equipments. JLe SCs do not Lave all tLe listed
equipments. Hall or less tLan Lall ol tLe equipments are available witL tLem. Pregnancy
Jest kits, BP macLine, DDK, are some essential instruments not available at many SCs.
Except lor a lew most ol tLe available equipments are not being used at tLe PHCs and
SCs.

Bccord Kccping
x In respect to perlormance statistics, records are available at tLe district Lospital.
However records are not being maintained separately lor dillerent types ol services
being provided. Except lor services at radiology and patLology sections, a single register
lor all types ol CPD services is observed. Data maintenance needs systematization at tLe
district, CHC and PHC level.


x WitL regards to maternal LealtL and lamily planning services, tLe records status is
unsatislactory in tLe CHCs (no records ol condom, oral pills) and tLe PHCs. Very little
data and inlormation is available lrom tLese LealtL lacilities regarding service
outcomes.Register maintenance is virtually nonexistent at PHC level. At tLe SCs
altLougL data is being maintained it is not systematic and is illegible.

x JLe stock registers entries lor essential drugs and equipments Lave been maintained
properly at all tLe LealtL lacilities.

x jSY records are being maintained properly at tLe district Lospital and tLe CHCs. AMs
ol SCs wLo are conducting Lome deliveries are also maintaining tLe jSY records. Since
no delivery is taking place at tLe PHC level, jSY records are not being maintained at tLe
PHC level.


Scrviccs and Pcrtormancc

IBL and 24"7 Scrviccs
x Delivery lacilities under cesarean section are available only in tLe District Hospital but not
in tLe two CHCs. Moreover, only tLe District Hospital Las blood storage lacilities, wLicL
tLe two CHCs do not Lave. JLus tLe DH is only lunctioning as IRL lacilities in tLe
district.

x JLe CHCs are providing BeMCC services. Lack ol stall, specialists blood storage lacilities,
emergency drugs, upgraded operation tLeatre are reasons lor not conducting caesarean
However, not a single PHC is lunctioning 2+"/ in tLe district nor are tLey providing
BeMCC services.

x Except lor DH and CHCs none ol tLe PHCs Lave a mecLanism ol relerral transport in
place to assure 2+x/ services. JLe provision ol 2+x/ relerral transport is crucial in
providing emergency obstetric care.

x JLere is no procedure lor relerral services at tLe SC, PHC, CHC and district level.
Records ol patients relerred to tLe LigLer LealtL lacility are not maintained. JLerelore tLe
relerral linkage to tLe LigLer LealtL lacility does not exist.

Hcalth and Iamily Wcltarc

x Limited IPD services are available at tLe DH, skeletal at tLe CHCs, and virtually non
existent at tLe PHCs due to lack ol specialists and lacilities at tLese Lospitals.


x Except lor tLe district Lospital and partially at tLe CHCs none ol tLe PHCs are providing
essential maternal and cLildcare (antenatal, postnatal care) services or lamily planning
services. Most ol tLese services are being provided by tLe AMs at tLe SC level.

x Capacity building training ol Mitanins is commendable but tLeir services are
underutilized. JLe mitanins are receiving a paltry incentive ol Rs. 50 per montL lor
motivating motLers lor immunization services.

x Mitanins Lave knowledge about dillerent aspects ol LealtL and lamily wellare issues but
tLere services Lave not been utilized to educate tLe local community. About one lourtL
LouseLold respondents Lave reported lack ol awareness about temporary metLods ol
lamily planning.

x JLe PHCs are only providing skeletal CPD services due to lack ol manpower and otLer
essential inlrastructure. o maternal and cLild LealtL or lamily planning services are being
provided by tLem.

Janani Surksha Yo|ana

x JLe AMs know about tLe importance ol institutional deliveries. Yet tLey are not
preparing tLe micro-birtL plan a pre-requisite lor jSY services. Most ol tLem Lave
reported tLat Lome delivery is convenient lor botL tLey and tLeir clients. Payment ol Rs.
500 to BPL beneliciaries serves tLe purpose. umber ol institutional deliveries Las not
progressed as expected.

x Ior tLe jSY programme botL at tLe district and tLe CHC level casL incentive lor jSY
beneliciary is Rs.1+00 and additional Rs. +00 is being paid as transport money in case ol
institutional delivery. JLe ASHA/Mitanin is only receiving an incentive ol Rs. 200 as
onetime payment.

x AltLougL Mitanins are expected to be tLe key lacilitators lor jSY programme, tLeir role in
motivating women lor institutional delivery Las been negligible. JLis is mainly due to
tLeir ignorance about tLeir role as lacilitators in jSY. JLey Lave accepted Lome deliveries
as a norm.

x Incentive payment to Mitanin Las been linked to accompanying pregnant women lor
institutional delivery but post natal care and lollow up services to be provided by tLem
Las been totally ignored.

x JLere is lack ol monitoring ol implementation ol jSY programme in tLe district, because
beneliciaries Lave reported delayed payments and Laving to pay money lor receiving casL
assistance.


x Awareness at tLe community level is low about botL jSY and RHM. Linkages between
PRIs and LealtL workers are weak. PRIs are not actively monitoring jSY and RHM
activities.

x Jwo CCs Lave been recently accredited lor Public Private PartnersLip to provide
institutional delivery services in tLe district.


Lnticd Iunds
x Iormation ol VHSC and untied lunds account are in place, but utilization ol untied lunds
is low due to inadequate or lack ol proper guidelines regarding Low to optimally use tLese
lunds.

x JLe VHSCs Lave neitLer documented tLe Village HealtL plans, nor are tLey maintaining
records or minutes ol meetings or decision taken lor any village level activities. JLe
linkages between PRIs and Mitanins may be considered weak.

x In tLe District Hospital, CHCs and PHCs jeevandeep Samiti (jDS) is registered and
lunctional. jDS lunds are mostly used lor purcLase ol essential drugs and essential items
lor tLeir LealtL lacility. jDS lunds Lave been utilized by tLe CHCs and partially by tLe
PHCs lunds lor maintenance work, purcLasing ol stationary, payment to part time stall
and Lospital cleaning etc.

x All SCs Lave reported Laving received untied lunds and most ol tLese Lave been spent on
otLer activities. WLereas less tLat Lall ol tLe sub centres Lave reported maintaining
written record ol transactions on untied lunds, majority ol tLem Lave stated tLat tLe
records are being reviewed by tLe PRIs. JLis indicates anomaly in tLe record
maintenance and poor interaction between tLem in tLis regard.

x Partial utilization ol allocated untied lunds is observed and reported by state autLorities.
on release ol untied lunds to CHCs and PHCs lor 2008-2009 Las been reported at tLe
state level.

Bccommcndations

Intrastructurc
A separate department lor inlrastructure development (witLin LealtL sector) can be an
alternative option lor tLe PWD. Linkages between tLe district, CHC, PHC level
ollicials and PWD is poor as its contractors do not report tLe progress ol construction to
tLem. Speedy Landover ol newly constructed lacilities is necessary.


JLe construction ol SC buildings needs to be immediately locused upon. JLe
equipments and drug keeping at tLe SCs are not properly managed because tLere is no
proper storage lacility.

Residential stall quarters sLould be provided to encourage tLe stall to stay at tLe Lead
quarters.

Speeding up setting ol blood storage lacilities at tLe CHC level is crucial lor upgradation
to IRLs as per IPHS norms.

ew born care corners need to be establisLed in eacL ol tLe LealtL lacilities lor
providing critical cLild care services

Human rcsourccs
Iilling ol vacant posts ol required specialists at tLe district Lospital and MCs Stall
nurses/Lab tecLnicians at tLe CHCs and PHCs needs immediate attention. Process ol
contractual appointments, wLicL is more or less non-existent, sLould be given impetus
because tLey are critically Lampering tLe services.

JLe training requirements ol MCs need to be addressed regarding BemCC services. In
tLe absence ol specialists, available MCs must be provided skills training lor capacity
building. It is crucial to Lave a skilled birtL attendant lor conducting institutional
deliveries and to be able to detect danger signs in time and reler cases. urses/AMs
need SBA training lor capacity building.

Scrviccs
JLe up gradation ol tLe PHCs in terms ol pLysical inlrastructure, equipments and drugs,
and personnel needs special locus, (beyond CPD services) so tLat tLeir existence can be
justilied in terms ol services tLey will provide.

Iocus on good relerral and MCH services and appropriate placement ol multi-skilled
providers at CHCs and PHCs, is crucial to expedite tLe process ol acLieving RHM
goals. JLe skills ol Rural HealtL Assistants may be upgraded to matcL increasing
demands.
Ensure improvement in overall lacilities in logistics, inlrastructure, Luman resources and
management at DH, CHC PHC, and SC to meet out minimum quality and service
guarantees lor potential clients ol LealtL services.

Process ol providing laboratory lacilities witL skilled manpower is crucial at tLe PHC
level lor last diagnostic services in tLe peripLery.

Relerral transport service, wLicL is one ol tLe most critical lactors in decreasing
maternal mortality by translerring complicated cases to IRLs tLat are equipped to
Landle complicated and emergency deliveries, is critical lor sale motLerLood. JLis could

be in tLe lorm ol lunctional ambulance, entering a public private partnersLip or
outsourcing tLe service to a private provider altogetLer.

Strong worklorce ol Mitanin witL LigL degree ol skills is an asset along witL Mitanin
Lelp desks and otLer support structures is in place. JLere is urgent need lor streamlining
incentive distribution to tLem (jSY, immunisation, otLer programs). A more proactive
role by tLem would increase in proportion ol institutional deliveries in tLe district.

Programmc Managcmcnt
A stringent monitoring ol implementation ol RHM at all levels, by Programme
Managers, DPML, BMC and BPML is crucial lor lullilling tLe goals to be acLieved
under RHM.

Record keeping and data management need systematization. Ior purposes ol ellective
monitoring and planning everylacility is expected to maintain records on everyactivity
carried out. Computerized record keeping sLould be encouraged lor systematic
management ol data and inlormation at tLe DH, CHCs and PHCs.


JLere is an urgent need lor orientation about jSY, a key component ol RHM at tLe
state level and beyond to clarily certain misconceptions regarding tLe amount ol casL
assistance (including transport) lor beneliciaries and incentives lor Mitanins.

Monitoring ol payment ol casL assistance (10 percent cLecking) sLould be carried out by
BMC, MCs and district level LealtL autLorities to verily problems ol beneliciaries in
receiving casL assistance under jSY.

AMs and Mitanins need joint orientation regarding preparation ol micro-birtL plan lor
pregnant women, wLicL is a mandatory process lor sale institutional delivery under jSY.


Ensuring community involvement tLrougL intensive IEC on RHM to enroll tLe
PRIs participation in village LealtL activities is essential. CoLesion between PRI and
mitanin wLicL is presently weak must be strengtLened lor encouraging strong
community participation in village LealtL planning and community monitoring ol
programmes.

Sensitization ol MCs on spending ol jeevandeep Samiti lunds and untied lunds is
essential lor improving and upgrading inlrastructure and services at tLeir respective
lacilities. JLey must also monitor tLe expenses ol untied lunds ol AMs so tLat lunds
are utilized witLin tLe current linancial year.


Monitoring mecLanism lor timely lund disbursements lrom state to tLe district, proper
expenditure plan and reclamation ol utilization certilicate in time is essential. Iund llow
must be consistent and clear guidelines lor spending untied lunds are essential so tLat tLe
lund is used witLin a single linancial year.

Electronic transler ol lunds lrom tLe district to tLe block is essential lor translerring
lunds speedily.

DPML must closely monitor implementation ol RHM at district and BPML at tLe
block to ensure tLat services in all areas matcL tLe district LealtL action plan and take
correctional measures wLerever necessary.

DAM wLo is not presently in cLarge needs to take cLarge ol accounts, disbursement ol
lunds, ensure lund utilization in tLe district.

Irequent cLange around ol administrative and tecLnical ollicials at tLe state level is a
cause ol concern and sLould be treated witL utmost seriousness lor providing
momentum to tLe programme.

JLe security ol tLe LealtL personnel in tLe axalite inlested districts need special
interventions and tLeir security needs protected.

Better coordination between tLe Directorate, State HealtL Resource Centre, and State
Mission is required to take tLis programme to mission mode.
1
Chaptcr - 1

Background tor thc Bapid Appraisal ot MBHM
Study Dcsign and Statc Protilc

I. Background tor thc Bapid Appraisal ot MBHM

JLe Covernment ol India, witL tLe objective ol meeting tLe basic requirement ol
HealtL lor all, Las launcLed tLe ational Rural HealtL Mission (RHM) in April 2005 to
carry out necessary arcLitectural correction in tLe basic LealtL care delivery system. JLe
Mission aims at provision ol compreLensive and integrated primary LealtLcare to tLe
people, especially to tLe rural poor, women and cLildren. It adopts a synergic approacL by
relating HealtL to determinants ol good LealtL viz nutrition, sanitation, Lygiene and sale
drinking water. It also aims at mainstreaming tLe Indian systems ol medicine to lacilitate
LealtL care. JLe Plan ol Action includes increasing public expenditure on LealtL, reducing
regional imbalance in LealtL inlrastructure, pooling resources, integration ol
organizational structures, optimization ol LealtL manpower, decentralization and district
management ol LealtL programmes, community participation and ownersLip ol assets,
induction ol management and linancial personnel into district LealtL system, and
operationalising Community HealtL Centres, Primary HealtL Centres and Sub Centres
into lunctional Lospitals meeting Indian Public HealtL Standards.

JLe Mission lists a set ol core strategies to meet its goals like decentralized village
and district level LealtL planning and management, appointment ol lemale Accredited
Social HealtL Activists (ASHAs) to lacilitate access to LealtL services. JLe Mission
attempts a major sLilt in tLe governance ol public LealtL by giving leadersLip to
PancLayati Raj Institutions in matters related to LealtL at district and sub-district levels.
AnotLer key strategy ol tLe Mission is decentralization ol programmes lor district level
management ol LealtL. Lnder tLe scLeme, all existing societies lor LealtL and lamily
wellare programmes, Reproductive and CLild HealtL and ational Programmes lor JB,
Malaria, Blindness, Iilaria, Kala Azar, Iodine Deliciency and Integrated Disease
Surveillance, sLall integrate into a unilied District HealtL Mission. Iunding lor all tLese
programmes will be eventually lunneled into tLe District HealtL Mission,wLicL will be
empowered to lormulate integrated LealtL plan ol tLe district.
2
Cne ol tLe core strategies ol tLe Mission is to empower local governments to
manage, control and be accountable lor public LealtL services at various levels. JLe Village
HealtL and Sanitation Committee, tLe Standing Committee ol tLe Cram PancLayat, will
provide oversigLt ol Missions all activities at tLe village level and be responsible lor
developing tLe Village HealtL Plan witL tLe support ol tLe AM, ASHA, Anganwadi
Worker and Sell-Help Croups. Block level PancLayat Samitis will co-ordinate tLe work ol
tLe Cram PancLayats in tLeir jurisdiction and will serve as link to tLe District HealtL
Mission, wLicL will be led by Zilla ParisLad and will control, guide and manage all public
LealtL institutions in tLe district. States will be encouraged to devolve greater powers and
lunds to PancLayati Raj Institutions.

Bapid Appraisal ot MBHM
In ligLt ol tLe above background and also tLe lact as tLe Mission is now in its
lourtL year ol existence, tLe Ministry ol HealtL and Iamily Wellare, Covernment ol India
Las undertaken tLis Rapid Appraisal ol tLe Mission at tLe state, district and local level
tLrougL its 18 Population ResearcL Centres (PRC) in 20 states ol India. Civen tLe very
wide scope ol tLe Mission and diverse nature ol its activities, tLe PRC study on rapid
appraisal is restricted to selected core components tLat directly address tLe LealtL and
lamily wellare needs ol tLe people. It is tLerelore tLis rapid appraisal is restricted to tLe
lollowing lour core components ol tLe Mission:
(A) Ltilization ol Lntied Iunds at SC, PHC and CHCs
(B) ]anani SuraksLa Yojana (]SY)
(C) Iacility up-gradation under tLe RHM
(D) Assessment ol LealtL and lamily wellare situation at tLe village level

Cb|cctivcs ot thc Bapid Appraisal ot MBHM
(A) Ltilization ot Lnticd Iunds
RHM Las drawn a plan ol action at all levels ol LealtLcare to build up sustainable
LealtLcare delivery system, wLere all citizens Lave access to allordable and appropriate
quality LealtLcare. Jo acLieve its goals, RHM in its strategies, set up a platlorm lor
involving tLe PancLayati Raj Institutions (PRIs) in primary LealtL programmes and
inlrastructure. JLe Mission also envisages tLe lollowing roles lor PRIs: (i) States are
3
required to commit lor devolution ol lunds, lunctionaries and programmes lor LealtL to
PRIs; (ii) At grassroots level, Village HealtL and Sanitation Committee (VHSC) Las been
lormed to decentralize tLe planning and monitoring ol various programmes; and (iii) Ior
strengtLening tLe LealtL centres, all tLe LealtL lacilities are provided witL Lntied Iunds.

Lntied Iunds can be used only lor tLe common good and not lor tLe individual
needs,except in tLe case ol relerral and transport in emergency situations. EacL Sub Centre
will Lave an Lntied Iund _ Rs.10,000 per annum. Like wise, eacL PHC and CHC is
provided witL Lntied Iunds ol Rs. 25,000 and Rs.50,000 respectively lor local LealtL
action. At Sub Centre level, tLe lund will be deposited in a joint account ol tLe AM and
tLe woman SarpancL or tLe woman member ol PancLayat, but tLe account will be
operated by AM in consultation witL Village HealtL and Sanitation Committee and
Multipurpose HealtL Workers. At tLe PHC and CHC level, Lntied Iunds will be kept in
tLe bank account ol tLe concerned Rogi Kalyan Samiti (RKS)/Hospital Management
Committee. JLe lunds will be spent and monitored by RKS. JLis rapid appraisal study
attempts to analyze tLe utilization ol Lntied Iunds at Sub Centre and PHC level. It will
also Lelp to know Low actively PRIs/RKS are involved witL tLe utilization ol Lntied
Iunds in rigLt perspective. JLe specilic objectives ol tLe rapid appraisal under tLe
utilisation ol Lntied Iunds are:
1. Jo examine tLe utilization ol Lntied Iunds under dillerent activities at Sub Centre,
PHC and CHC level.
2. Jo LigLligLt tLe problems laced by CHC and PHC In-cLarge and AMs in receiving
and utilization ol lunds.
3. Jo seek tLe opinions ol CHC and PHC In-cLarge and AMs regarding tLe sulliciency
ol lunds.
+. Jo study tLe role ol Village HealtL Committee particularly at Sub Centre level and
Rogi Kalyan Samiti in tLe utilization ol lunds at CHC and PHC level.

(B) Janani Suraksha Yo|ana (JSY)
]anani SuraksLa Yojana (]SY), an integral component lor sale motLerLood under
RHM, was launcLed in 2005 witL tLe objective ol reducing maternal and neo-natal
mortality. JLe scLeme aims to promote institutional deliveries amongst poor pregnant
4
women in all tLe states and Lnion Jerritories (LJs) ol tLe country witL special locus on
low perlorming states (LPS). It is a 100 percent centrally sponsored scLeme and links casL
assistance witL delivery and post-delivery care. In availing institutional delivery services,
tLe client is usually escorted, would be requiring transport to reacL tLe institution and in
case ol complications, relerral services would be required. JLe scLeme Las considered all
tLese elements and Las made provision lor transport including relerral and escort and at
tLe same time invested in improving public LealtL institutions and services tLrougL tLe
Reproductive and CLild HealtL (RCH) programme interventions. JLis apart, states Lave
been given llexibility to evolve public-private partnersLip (PPP) mecLanism and accredit
private LealtL institutions lor providing institutional delivery services. JLe special
dispensation lor Low Perlorming States (LPS) in botL rural and urban areas Las been made
and linked to tLe ASHA intervention. JLe LPS are tLose tLat Lave low institutional
delivery rates and include Lttar PradesL, LttarancLal, BiLar, ]LarkLand, MadLya PradesL,
CLLattisgarL, Assam, RajastLan, Crissa, and ]ammu and KasLmir. In tLe remaining states
and LJs, categorized as HigL Perlorming States (HPS), similar provisions Lave been made
wLerein Anganwadi worker or traditional birtL attendant or ASHA like activist could be
engaged and associated witL tLe ]SY scLeme. JLe ]SY locuses on:
(a) Maternal care tLrougL micro-planning ol birtL,
(b) CasL assistance to all eligible motLers lor delivery care
(c) CasL assistance lor relerral transport
(d) CasL assistance to institutions lor Liring specialists lor Caesarean Section or lor tLe
management ol Cbstetric complications
(e) CasL benelit to ASHA lor lacilitating institutional delivery

JLe specilic objectives ol tLe rapid appraisal under tLe ]SY are:
1. Jo assess tLe role ol AM/ASHA in providing services to tLe beneliciaries ol tLe ]SY
2. Jo seek tLe opinions ol AMs/ASHAs regarding tLe sulliciency ol lunds and timely
disbursement ol lunds.
3. Jo study tLe role ol otLer LealtL ollicials in tLe implementation ol tLe scLeme at
district.
+. Jo review engagement ol private sector including accreditation and compensation.
5. Jo LigLligLt tLe problems laced by beneliciaries in receiving tLe services/lunds.
6. Jo analyze nature and scope ol IEC interventions lor raising awareness ol ]SY.


5
(C) Iacility Lpgradation undcr MBHM
Ior meeting tLe LealtL needs ol tLe rural masses, one ol tLe key strategies ol tLe
RHM is to strengtLen all tLe LealtL lacilities by upgrading tLem witL necessary
inlrastructure according to tLe type ol lacility (CHC, PHC, SC etc). JLe main aim is to
strengtLen Lospital care lor rural areas, provide specialized care to tLe community and also
to improve tLe standard ol quality ol care in order to enLance tLe level ol patient
satislaction. JLus, tLe rapid appraisal examines as to wLat extent tLe SC, PHCs and CHCs
Lave been upgraded under RHM. JLe objectives ol tLe study under tLis component are:
1. Jo assess tLe availability and adequacy ol inlrastructure, lurniture, equipment,
medicines/drugs and veLicle in tLe upgraded sub centres, PHCs and CHCs.
2. Jo examine tLe availability ol manpower - medical and paramedical.
3. Jo assess tLe type ol services and availability ol lacilities.
+. Jo assess tLe clients perception regarding quality ol services tLrougL exit interviews.

(D) Asscssmcnt ot Hcalth and Iamily Wcltarc Situation at thc Villagc Lcvcl
It Las been envisaged under RHM tLat indicators ol LealtL depend as mucL on
drinking water, nutrition, sanitation, lemale literacy, womens empowerment as tLey do
on lunctional LealtL lacilities. RHM seeks to adopt a convergent approacL lor
interventions under tLe umbrella ol tLe district plan wLicL seeks to integrate all tLe related
initiatives at tLe village, block and district level. WLerever village committees Lave been
ellectively constituted lor drinking water, sanitation, ICDS etc., HRM attempts to move
towards one common Village HealtL Committee covering all tLese activities. PancLayati
Raj Institutions are being lully involved in tLis convergent approacL so tLat tLe gains ol
integrated action can be rellected in district plans. Lnder RHM, LouseLold surveys
tLrougL ASHA, AWW will target availability ol drinking water, lirewood, liveliLood,
sanitation and otLer issues in order to allow a lramework lor ellective convergent action in
tLe Village HealtL Plans. Hence, one ol tLe important objectives ol tLe rapid appraisal is
to:
1. Assess tLe LealtL and lamily wellare situation in tLe village in terms ol availability ol
drinking water, sanitation, lunctional LealtL lacilities, quality ol services provided,
nutritional status, womens empowerment, maternal and cLild LealtL, disease prevalence
etc.

III. Mcthodology and Study Dcsign
JLe rapid appraisal covers all tiers ol tLe public LealtL care delivery system rigLt
lrom tLe village level up to tLe state level. Ior tLe sake ol objectivity, tLe rapid appraisal
exercise is organised broadly in terms ol policy lormulation, programming and
implementation lor eacL ol tLe lour components ol tLe Mission listed above.

At tLe state level, tLe rapid appraisal exercise locuses primarily on policy
lormulation witL respect to tLe above listed lour components. At tLe district and
community LealtL centre level, tLe rapid appraisal exercise primarily locuses on
programming necessary to translate policy into specilic action wLile at tLe primary LealtL
centre, sub-LealtL centre and village levels, tLe rapid appraisal exercise concentrates on tLe
implementation aspects.

A mix ol quantitative and qualitative tools is used lor tLe rapid appraisal. At tLe
village level, a LouseLold survey is carried out to assess tLe LealtL and lamily wellare
situation as well as to assess tLe use ol public LealtL lacilities by tLe community at large.
At tLe institution level, tLe rapid appraisal is based on review and analysis ol tLe available
records ol public LealtL institutions and in-deptL interviews witL tLe policy makers,
programme managers and service providers at dillerent tiers. EacL ol tLese ScLedules is
lurtLer divided into a number ol separate Blocks capturing inlormation on specilic areas ol
interest. Inlormation lor one ScLedule Las been gatLered lrom a number ol dillerent
individuals. In every Block, indication about tLe corresponding respondent / source ol
inlormation is given.

Hcalth Iacilitics and thc Villagcs Covcrcd tor thc Study in Jan|gir-Champa District
District Hospital, ]anjgir-CLampa was covered lor tLe study. Jwo CHCs, + PHCs,
12 Sub-Centres and 2+ villages were to be covered in tLe district as per tLe sampling design
mentioned in Jable 1. JLe lacilities and tLe villages covered in tLe district are given below
in Jable 3. Ior LouseLold survey, two-tLree villages were selected lrom eacL selected Sub
Centre area (because ol villages witL less number ol LouseLolds). JLus, 39 villages were
selected lor tLe LouseLold survey. Jo complete tLe sample size ol 50 LouseLolds 15
additional villages were covered to lullil tLe LouseLold selection criteria as per tLe
sampling design. HouseLolds were selected lrom eacL ol tLe selected village by lollowing
7
tLe systematic circular random sampling procedure. Ior selecting tLe LouseLolds, tLe total
number ol LouseLolds in a village was divided by 50 to lind out tLe selection interval.
Alter tLat, tLe lirst LouseLold situated at tLe nortL-west corner ol tLe village was
randomly selected and subsequently every rtL LouseLold was selected moving in an anti-
clock wise direction till 50 LouseLolds were selected.
Tablc 1: Thc sampling dcsign providcd by thc Ministry tor thc sclcction ot hcalth
tacilitics / houscholds / rcspondcnts tor thc rapid appraisal ot MBHM
Sl.
o
Iacility/
HouseLold
Jotal
/district
Selection Criteria Alternate criteria
1

District
Hospital
1

In States wLere tLe Male and Iemale DH
are separate, scLedule to be lilled lor botL.
SDH or District HQ
Hospital

2

CHC

2
Cne CHC to be tLe lartLest lrom tLe
district HQ.Il tLe lirst CHC selected is an
IRL tLen tLe second CHC could be any
CHC; else tLe second CHC sLould
prelerably be an IRL, il available.
In case no CHC is
available, tLe largest
Block /Addl. PHC


3

PHC


+
2 PHCs lor eacL CHC.PHC to be
vertically under selected CHC.Prelerably
one 2+x/, il available.



+

SC

12
3 SCs lor eacL PHC. All to be vertically
under selected PHC. Cne SC to be lartLest
lrom PHC.



5

HouseLold

1200

2 villages to be selected lrom catcLment
area ol SC (il tLere is one village under tLe
elected Sub Centre, tLe same will be
covered). Cne village to be wLere Sub-
Centre is located and second village tLat is
lartLest lrom tLe Sub-Centre. 50
LouseLolds per village to be randomly
selected (total 100 LouseLolds per SC).


6

ASHA

All ASHAs in tLe selected village to be
selected lor canvassing ASHA ScLedule.


/

Cram
PancLayats
Cram PancLayat (CP) ScLedule to be
canvassed to tLe member ol CP (including
SarpancL) representing tLe selected village.

8 Patients
lor Exit
Interview

Exit interview be canvassed lor 5-10 IPD
and CPD patients at eacL ol tLe lacility
including District Hospital, CHC and
PHC.



8
Tablc 2: Schcdulcs canvasscd tor thc study and survcy pcriod
ScLedule Survey Period
ScLedule (S) : State ScLedule Iebruary 2009
ScLedule (D) : District ScLedule Part A Iebruary 2009
ScLedule (D): District ScLedule Part B District
Hospital
Iebruary 2009
ScLedule (C) : Community HealtL Centre ScLedule ]anuary 2009
ScLedule (P) : Primary HealtL Centre ScLedule ]anuary 2009
ScLedule () : Sub Centre /AM ScLedule ]anuary 2009
ScLedule (A) : ASHA ScLedule December 2008 ]anuary 2009
ScLedule (C) : Cram PancLayat ScLedule ]anuary 2009
ScLedule (H) : HouseLold ScLedule ]an & Iebruary2009
ScLedule (EI) : Exit Interview ScLedule lor IPD
Patients
]an & Iebruary2009
ScLedule (EI) : Exit Interview ScLedule lor CPD
Patients
]an & Iebruary2009

Iicld Work
Jo carry out tLe study in tLe district, 22 experienced ad Loc investigators (12
lemale; 10 male) were recruited. JLese selected investigators Lave earlier worked lor tLe
DLHS-3 in M.P. and were lamiliar witL tLe LouseLold survey metLods. A tLirteen days
training programme was organised lor tLem in Population ResearcL Centre in Sagar. JLe
lieldwork lor tLe LouseLold survey was carried out during and ]anuary and Iebruary
2009. JLese 23 investigators were divided into + teams and eacL team was supervised by
one PRC stall. All tLe LouseLold interviews and exit interviews were carried out by tLese
investigators and tLe Iacility, Cram PancLayat and ASHA questionnaires were
administered by tLe PRC stall.

During tLe entire duration ol tLe lieldwork, PRC stalls were witL tLe lield teams and
continuously monitored tLe lieldwork.


Tablc 3: List ot sclcctcd District Hospital, CHCs, PHCs, SCs and Villagcs tor thc
survcy in Jan|gir-Champa District as pcr thc samplc dcsign


District
Hospital

District Hospital Jan|gir-Champa
2CHCs CHC: ]aijaipur (IartLest) CHC: Baloda (2)
+PHCS PHC Hasoud PHC Raipura PHC Pantora PHC Catwa
12 SCs 1 CLeora
2 KarLi
3 CLisda (IartLest)

1 BLutiya
2 CLikLalraunda
3 Malni (IartLest)

1 Pantora
2 KLisora
3 Kurma (IartLest)

1 Catwa
2 KLeja (IartLest)
3 Deori


2+ villages

(includes 15
additional
villages)
1 CLeora

2 Kikirda (IartLest)
Malda"

3 KarLi

+ DeorimatL(IartLest)
]Larap, agaridi"

5 CLisda

6 Parasda,(IartLest)
Dotma, Barkekala"
1 BLutiya

2 ]Lalraunda (IartLest)
CLitapararia"

3 CLikLalraunda

+ Senduras(IartLest)
Amapali, Dongaria"

5 Malni

6 Salni (IartLest)
DLanuLarpara"

1 Pantora

2 Hedaspur (IartLest)
Buxra"

3 KLisora

+ avgava
(IartLest)

5 Kurma

6 Dongipendri
(IartLest)
Levai, avapara"

1 Catwa

2 CLeetapali (IartLest)
AngarkLan"

3 KLeja

+ Beltukri (IartLest)
MadLaipura"

5 Deori

6 Sattigudi(IartLest)
augaon"


"Additional villages covered witL tLe lartLest village to complete tLe sample size ol 50 LouseLolds

Chaptcr Schcmc
JLe present cLapter provides (a) tLe background lor tLe rapid appraisal ol RHM,
(b) metLodology and sampling design lor tLe study, and (c) tLe state level status ol LealtL
inlrastructure, lormation ol RKS, perlormance under tLe ]SY, and linancial mecLanism
including transler ol Lntied Iunds based on tLe State ScLedule. JLe CLapter two is
divided in two parts. JLe Part-I presents tLe current status ol RHM interventions
(LealtL inlrastructure, lacilities available lor delivery, Luman resources, RKS, ]SY and
linancial mecLanisms) in ]anjgir-CLampa district. JLe Part-II provides tLe inlrastructural
lacilities and Luman resources available in tLe district Lospital. JLe tLird and lourtL
cLapters presents tLe inlormation on: lramework and structure related issues;
inlrastructure status; Luman resources; availability ol services, diagnostic lacilities,
10
equipments and drugs; and service outcome statistics lor tLe selected CHCs and PHCs in
tLe district. JLe liltL cLapter presents tLe lindings based on tLe Sub-Centre/AM
scLedule. Specilically it presents tLe inlormation on population coverage, Luman
resources, inlrastructure status, availability ol equipments and drugs, skills and practices ol
AM, record maintenance, lunctioning ol ]SY scLeme, and utilization ol Lntied Crants.
JLe sixtL cLapter presents tLe lollowing inlormation about tLe Cram PancLayat:
population, LouseLolds and villages covered; IEC activities; lunctioning ol VHSC,
involvement in ASHA programme and ]SY scLeme; and awareness about RHM at Cram
PancLayat level. JLe seventL cLapter explains tLe status ol tLe ASHA scLeduled canvassed
in tLe district. CLapter eigLt presents lindings ol tLe LouseLold survey. JLe lindings are
presented lor background cLaracteristics ol tLe LouseLold, amenities available to tLe
LouseLold, awareness ol ASHA programme and ]SY ScLeme, and leedback lrom tLe
LouseLold about tLe kind ol services availed lrom a public LealtL lacility, quality ol care
provided and level ol satislaction lrom tLe services provided. CLapter 10 presents tLe
lindings ol tLe exit interview ol tLe IPD and CPD patients about tLe quality ol services
received in tLe district Lospital, CHC and PHC.

II. Status ot MBHM intcrvcntions at thc Statc Lcvcl
JLis section presents tLe inlormation based on tLe State ScLedule collected lrom
tLe State Programme Management Lnit lor RHM. JLe inlormation is presented lor tLe
state level status ol LealtL inlrastructure, lormation ol RKS, perlormance under tLe ]SY,
and Iinancial mecLanism including transler ol Lntied Iunds. JLe duly lilled-in State
ScLedule is given in Appendix-1.

Population
CLLatisgarL witL a population ol 20.8 million in 2001 is tLe tentL largest state area
wise and 1/
tL
in tLe LierarcLy ol population density India. It Las been carved out ol
erstwLile MadLya PradesL in 2000 and is undergoing a process ol transition and rapid
development. JLere are 16 districts, 1+6 blocks, and 20,308 villages. JLe State Las
population density ol 15+ per sq. km. (as against tLe national average ol 312). As per 2001
census, 80 percent ol tLe total population ol tLe state was living in and tLe remaining 20
percent was residing in rural areas. JLe rural population is residing in its20, 308 villages.
11
JLirty two percent ol CLLattisgarLs population belonged to scLeduled castes and eleven
percent belonged to scLedule tribes as per 2001 census.

Intrastructurc (as on Junc 30, 2008)
CLLattisgarL Las relatively limited network ol LealtL services delivery system. JLe
state Las a total ol +/+1 SCs, /21PHCs, 136 CHCs, 8 SDHs, and 16 district Lospitals to
implement its public LealtL programme at various levels. RHM is implemented tLrougL
tLese LealtL lacilities. Cut ol tLe /21 PHCs only 5 PHCs (1percent) are designated as 2+"/
PHCs. ew buildings are under construction lor 1139 SCs 239 PHCs and 65 CHCs in tLe
state. In tLe state only tLe District Hospitals Laving blood storage may be considered as
lunctional IRL. one ol tLe 96 CHCs designated as IRL are lunctional IRLs because
none ol tLem are Laving blood storage lacilities as per tLe standard norm ol critical
determinants ol lunctionality. In CLLattisgarL IPHS upgradation is completed in none ol
SCs, PHCs, CHCs or IRLs, in tLe wLole state.

Bogi Kalyan Samitis and PPPs
Except very lew LealtL lacilities, RKS popularly known as ]eevan Deep Samiti in
CLLatttisgarL are registered in all tLe DHs, SDHs, CHCs and PHCs ol tLe state. JLis
indicates tLe states initiatives towards tLe implementation ol tLe RHM. JLe state Las
also undertaken tLe Public-Private-PartnersLip initiative by accrediting 13 private LealtL
lacilities in dillerent districts lor tLe implementation ol ]SY scLeme. However, alter tLe
bilurcation ol MP, in CLLattisgarL new medical council is yet to be constituted lor
accreditation ol bigger nursing Lomes.

Pcrtormancc undcr thc JSY
Jo assess tLe perlormance ol tLe ]SY by caste and APL/BPL categories in public
and private LealtL lacilities, tLe required data are not maintained by tLe State Programme
Management Lnit (SPML) as per tLe State ScLedule lormat given by tLe Ministry.
However, tLe SPML provided tLe total number ol registered ]SY woman during 200/-08
and number ol tLese women opted lor institutional delivery during 200/-08. by caste. In
tLe state as a wLole, 1/59/8 women were registered under tLe ]SY and out ol tLese 101/+9
opted lor institutional delivery i.e., 58 percent ol tLe total deliveries.
12
Iinancial Mcchanisms
JLe state Las already merged all tLe vertical LealtL societies created under dillerent
programmes witL tLe State HealtL Society under RHM. All tLe districts Lave also
merged tLe registered LealtL societies. State HealtL Society is presently not maintaining a
common bank account lor all programmes but tLe processes are in progress to link all tLe
accounts tLe programmes. Ior tLe year 2008-09, tLe state Las prepared tLe perspective
State HealtL Plan. All tLe 16 districts in tLe state Lave prepared tLe District Action Plans
lor tLe year 2008-09 and tLe District Action Plans Lave been approved by tLe State HealtL
Society. Iunds are being allocated to tLe districts as llexi pool lunds, and are electronically
translerred to tLe districts.

Cut ol tLe +/+1 SCs in tLe state, (99.6 percent) Lave operational joint bank account
ol AM and SarpancL. Lntied Crant lor tLe current year Las not been translerred to all
tLe CHCs and PHCs in tLe district due to non utilization ol previous grants. +692 SCs
(out ol +/22 witL operational joint accounts) Lave received tLe untied grants.

Bcmarks ot Dircctor Hcalth Scrviccs and Joint Dircctor In-Chargc MBHM
Administrativc Issucs: At tLe state level tLe Directorate ol HealtL Services Las
very recently (six montLs) been roped in to operationalize tLe goals ol RHM.
Prior to tLis implementation ol RHM was being monitored by otLer
departments. Administrative control ol tLe Directorate ol HealtL services in
implementing RHM is vital to its progress. CLLattisgarL Las recently (200/
onwards) initiated tLe process ol decentralized LealtL planning alter launcLing ol
RHM. Earlier tLe LealtL plan lor all tLe districts in tLe state was prepared at tLe
state level.

Lnticd Iunds: Provision ol united lunds at all levels Las eased some ol tLe
linancial constraints at all levels, district Lospital, CHC PHC and SCs. However,
lack ol clarity in guideline regarding its utilization Las led to non utilization ol
lunds. At tLe grass roots tying up ol PancLyats witL AMS and ASHAs and
opening joint accounts is at times creating problems and Las been a cause lor non
utilization ol lunds. Clear guidelines are essential lor utilization ol tLese lunds
13
Manpowcr: JLe sLortage ol Medical Cllicers /AMs/stall nurses and laboratory
tecLnicians and otLer stall wLo are tLe key service providers at dillerent levels
Lave adversely allected tLe implementation ol tLe scLeme. Jo overcome tLis state
government Las taken new initiatives and started tLe process ol training and
appointing Rural HealtL Assistants to overcome tLe sLortage ol medical ollicers in
tLe state. Special incentives Lave been announced lor tLose wLo serve in lorests,
remote and tribal areas.

Buildings: Ior expediting tLe process ol completing tLe Lospital buildings tLe
Directorate ol HealtL services sLould Lave proper inlormation regarding tLe
progress about construction ol buildings. We Lave Lardly any coordination witL
outside agencies wLo Lave been assigned tLe task. JLis Las created delays and tLe
progress is not reported to tLe directorate. JLere is no mecLanism to know about
tLe progress ol tLe buildings under construction. JLere sLould be a separate unit
witLin tLe LealtL department to monitor tLe progress, because in CLLattisgarL
presently a large number ol LealtL lacilities are under dillerent stages ol
construction .

Programmc Managcmcnt: JLe programme management ol RHM by SPML
Las been allected due to lrequent cLange ol SPMs. JLis Las allected tLe progress in
implementation ol RHM in tLe state. Moreover, appointment and training ol
BPMs, and BAMs is still in progress. At tLe district and CHC levels all posts ol
DAM, BPM and BAM need to be lilled up to give impetus to tLe programme (at
tLe time ol survey tLere were 12 DPMs in position and process ol recruitment ol
DAM, BPM and BAM was in progress). JLe programme Las not yet received tLe
impetus it needs to acLieve some ol its goals.

PublicPrivatc Parncrship: Accreditation ol bigger nursing Lomes lor providing
]SY services Las not made progress because a regulatory mecLanism like medical
council wLicL oversees tLe process ol norms lor registration Las not yet been
lormed. JLirteen small nursing Lomes Lave been accredited lor providing
institutional delivery services.
14

Sccurity Issucs: Monitoring tLe implementation ol RHM in tLe axalite
inlested districts (11 districts) or lor tLat matter providing services in tLese districts
is a major cLallenge lor tLe LealtL department. Security needs ol LealtL ollicials
and workers in tLese areas need to be addressed.

Bcmarks ot thc Cbscrvcr
x JLe RHM programme Las yet to take oll on a mission mode in tLe newly
constituted
state ol CLLattisgarL.

x Irequent cLange ol Mission Directors ol RHM Las not allowed tLe programme
to gain
momentum it requires to lullil tLe goals. Since tLe launcLing ol RHM live
mission directors Lave cLanged. JLese mission directors are lrom dillerent
administrative services otLer tLan LealtL. Irequent cLanges Lave allected tLe
programme adversely.

x JLe services ol Directorate ol HealtL Services at tLe state level Lave been enrolled
only in
tLe past 6 montLs to monitor RHM programme. A better coordination/
interaction between Mission Director and Directorate HealtL Services are essential
lor successlul implementation ol tLe programme.

x JLe state needs to pay immediate attention to tLe manpower and inlrastructure
sLortage to
improve quality ol services. Lack ol specialist services at tLe CHCs is a serious
limitation in providing a large number ol services as envisaged in tLe RHM.

x Lack ol blood storage lacilities and specialists beyond tLe district is an impediment
lor IRLs becoming lully lunctional in Landling critical cases at tLe peripLery.
15
Chaptcr 2
District Protilc

I. District Schcdulc Part A
Population: As per 2001 census, tLe total population ol tLe district was 1.3 million and
onstitutes nearly six percent ol tLe population ol tLe state. Cut ol tLese, 1.1 million (89
percent) were residing in rural areas and 0.2 million (11 percent) were residing in urban
areas. Cut ol tLe total population ol tLe district, 22.5 percent belong to ScLeduled Caste
and 11.6 percent belong to ScLeduled Jribe.

Intrastructurc: JLe district Las limited public private LealtL lacilities lor tLe delivery ol
services. JLe district Las a total ol 2+6 SCs, 36 PHCs, 8 CHCs, 1 SDH and 1 District
Hospital to implement tLe public LealtL programme at various levels. Cut ol tLe 36
PHCs, none are lunctioning as 2+"/ PHC. Iour LealtL lacilities are designated as IRLs
but still do not lullil tLe criteria ol IRLs as per tLe government norms. ew buildings are
under construction lor 21 SCs and 3 PHCs in tLe district. JLe district Lospital Las a
AYLSH wing. JLere is not a single LealtL lacility wLere IPHS upgradation Las taken
place in ]anjgir-CLampa eitLer at tLe SC, PHC, CHC, and SDH altLougL tLe IPHS
lacility survey Las been completed at all levels. JLe district Las only 2 private ursing
Homes wLicL are less tLan 30 bedded.

Human Bcsourccs: WLen we compare tLe number ol sanctioned posts in dillerent
categories witL total in position we can say tLat tLe district is not doing well in terms ol
Luman resource availability. Among medical ollicers about Lall (+9 percent) ol tLe posts
are lilled including tLose appointed on contractual position. JLere is only 1 gynecologist
and 1 paediatrician against tLe sanctioned post ol 9 working in eacL ol tLe two categories
and 1 anaestLetist working against tLe sanctioned post. It is notewortLy tLat against tLe
sanctioned post ol 2+ otLer specialist not a single specialist is in position in tLe wLole
district. Seventy tLree percent ol tLe stall nurses and /5 percent AMs including 2 in
contractual position are working against tLe sanction posts.

1
Bogi Kalyan Samitis: JLe RKS popularly known as ]eevan Deep Samitiis constituted in
tLe LigLer level lunctioning LealtL lacilities (DH,SDH,CHC) ol tLe district and all ol
tLem are registered. Jwenty two ol tLe 36 PHCs (61 percent) are registered in tLe district.
JLis indicates tLe districts initiatives and commitment towards tLe implementation ol tLe
RHM.

PPP initiativcs: JLe Public-Private-PartnersLip initiative in ]anjgir-CLampa is very less
due to lack ol private LealtL lacilities in tLe district. Cnly 2 private LealtL lacilities Lave
been accredited lor tLe implementation ol ]SY scLeme. JLese nursing Lomes are only
providing delivery services.

Pcrtormancc undcr thc jSY: Jo assess tLe perlormance ol tLe ]SY by caste and
APL/BPL categories in public and private LealtL lacilities, tLe required data was obtained
lrom tLe District Programme Management Lnit (DPML) as per tLe District ScLedule
lormat given by tLe Ministry lor government lacilties. However, data regarding ]SY in
private accredited LealtL lacilities was not available because tLese LealtL lacilities Lave
recently been accredited in tLe year 2008-09. DPML provided data lor public LealtL
lacilities tLe total number ol institutional deliveries, number ol registered ]SY women and
number ol woman opting lor institutional delivery among tLe women registered lor ]SY
by caste lor tLe year 200/-08. umber ol institutional deliveries reported during 200/-08
in tLe district was +5+9. Among tLe total number ol registered ]SY women +/ percent
belonged to APL and 53 percent to BPL category. Among all tLe women registered under
tLe ]SY +/ percent women opted lor institutional delivery in tLe district as a wLole.
Among tLe women registered under tLe ]SY, tLe percentage ol women opting lor
institutional delivery among tLe SC, SJ and BPL category is +/ percent, +/ percent and 68
percent respectively.

Iinancial Mcchanisms: JLe district is in tLe process ol merging all tLe vertical LealtL
societies created under dillerent programmes witL tLe District HealtL Society under
RHM. Iunds are being translerred to DHS common bank account. Some ol tLe old
linancial accounts ol dillerent programmes are under settlement is underway and it is not
yet lormally recognized as merged. JLe District HealtL Society is also already registered.
17
JLe District HealtL Society maintains a common bank account lor all tLe programmes.
Ior tLe year 2008-09, tLe district Las prepared tLe District Action Plan and tLe District
HealtL Society Las approved tLe same. Iunds are being allocated to tLe districts activity
wise under Leads like ]SY, lamily planning and immunisation. JLe district receives tLe
lunds tLrougL electronic transler lrom tLe state ollice. JLe untied grants lor tLe linancial
year Lave been provided to 8 CHCs and 36 PHCs. All tLe 2+6 Sub Centres in tLe district
Lave operational joint bank account ol AM and SarpancL and tLe Lntied Crant was
translerred to all tLese Sub Centres.

II. District Schcdulc Part B: District Hospital (DH), jan|gir-Champa

Location ot thc Hospital: By using tLe public transport, tLe DH, ]anjgir-CLampa
popularly known as Barrister JLakur CLedilal District Hospital can be reacLed in 60
minutes lrom tLe nearest CHC and +.5 Lours lrom tLe lartLest CHC. JLe new Lospital
building Las been lunctional since December 200/. JLe DH is located at a distance ol 5
kilometres lrom tLe nearest bus stop. JLe DH witL bed strengtL ol 100 beds is spread over
in 25 acre area at a distance ol 5 kilometres lrom ]anjgir-CLampa bus stand. WLile 12
acres Lave been allocated to tLe Lospital building tLe rest 13 acres are lor residential stall
quarters wLicL Lave yet to be built. JLe Lospital is located away lrom tLe residential area
tLe city and tLe necessary environmental clearance Lave not been obtained lrom tLe
Pollution Control Board by tLe Lospital. JLe Lospital building is disabled lriendly as per
tLe provisions ol tLe Disability Act.

Physical Intrastructurc: JLe DH Las a registration counter and waiting space adjacent to
eacL consultation and treatment room, doctors duty room, treatment room, isolation
room, blood storage unit, pLarmacy, critical care area, and examination and preparation
room. However, tLe ICL, or LigL dependency wards are not lunctional. JLe kitcLen and
tLe relrigerator placed in it are non-lunctional.

JLe Lospital Las tLe lollowing services: Central Sterile and Supply Department, medical
and general stores, backup, ventilation, water coolers, round tLe clock water supply,
overLead water storage tank witL pumping and boosting arrangements, provision lor lire
18
ligLting, and proper drainage and sanitation system. JLe Lospital disposes tLe bio-medical
waste tLrougL outsourcing to tLe municipality wLicL collects it on weekly or lortnigLtly
basis. JLe bio-medical waste is disposed but tLere is no lacility lor segregating into
dillerent bins. JLe Lospital Las yet to build tLe residential quarters lor its medical and
paramedical stall. It Las a separate parking place lor veLicles. It Las a medical records
section and disease classilication is being carried out as per protocols. JLe Lospital Las
telepLone and lax lacilities, but computers and internet lacilities are not available.

Cbstctrics and Cynaccology Scction: JLe Lospital does not Lave a separate ward lor
lemale patients. During tLe last tLree calendar montLs 1/3 CPD patients were attended in
tLe section and 26/ deliveries were conducted. JLe Lospital Las a separate CJ lor
Cbstetrics and gynaecology. JLe section also Las lacilities to provide services related
obstetrics and gynaecology (caesarean section deliveries, MJP, assisted/lorceps delivery,
abortion, eclampsia, PPH, sterilization, Lysterectomy, suturing cervical tear and inlertility
treatment). JLe Lospital Las provided tLe ligures lor all tLese services during tLe year
200/-2008.

Surgical Scction: JLe number ol surgical CPD and IPD conducted in tLe section during
tLe last tLree montLs prior to tLe survey was 150 and 31/ respectively. Iacilities lor
emergency surgical services are available in tLe section. However, tLe section does not
Lave lacilities to conduct pancreas surgery, abdomen surgery, spleen and portal
Lypertension surgery, breast surgery and leprosy reconstructive surgery.

Mcdical Scction: JLe number ol CPD and IPD attended by patients in tLe Medical
Section during tLe last tLree montLs prior to tLe survey was 6+20 and 505 respectively.
JLe medical section provides only limited services. Most ol tLe services listed in tLe
scLedule are not available (dermatology and venerology, pleural biopsy, broncLoscopy,
lumbar puncture, pericardial tapping, skin scraping lor lungus/AIB, bone marrow biopsy,
endoscopic specialised procedures and psycLiatric services) in tLe section except lor
services under LEP.

1
Pacdiatric Scction: During tLe year 200/-2008 tLe number ol paediatric CPD attended in
tLe section was 2590 and number ol IPD admitted was 652. JLe section Las 10 designated
beds lor newborns. JLe number ol neonates, otLer inlants and cLildren under live years
admitted in tLe section during 200/-08 is 25, 5/ and 260 respectively. JLe section Las tLe
services to manage aspLyxia, neo natal sepsis, deLydration and diarrLoea cases and
respiratory tract/pneumonia cases but not lor treatment ol malnourisLed cLildren. JLe
section Las tLe essential equipments like radiant Leat warmer, pLototLerapy unit,
laryngoscope, suction macLine and tLermometer witL working condition. JLe section
does not Lave Incubator, cradle, bag witL mask and oxygen mask. JLe section Las tLe
essential drugs like CRS, iron lolic acid syrups and paediatric antibiotics but Vitamin A
solution is not available.

Diagnostic Scction: JLe section Las conducted CPD diagnostics lor 353 male patients and
21+ lemale patients during tLe last tLree montLs prior to tLe survey. JLe section Las tLe
services like x-ray, and ECC but no ultra sonograpLy.

Clinical Pathology: JLe lab Las provided 6,869 laboratory services to tLe patients during
tLe last tLree montLs prior to tLe survey. Lab Las lacilities to provide Laematology, urine
analysis, stool analysis, semen analysis, sputum, serology and biocLemistry split skin smear
examination lor leprosy. It does not Lave lacilities lor CSI analysis, Aspirated lluids (cell
count cytology PAP smear, ListopatLology, and pulmonary lunction test.

Human Bcsourccs: Cut ol tLe 29 sanctioned medical posts in tLe Lospital only Lall ol
tLem (15) Are appointed in regular position. JLe Lospital Las recruited only 1 general duty
doctor and 1 dental surgeon in tLe contractual position among tLe medical stall. JLe
sLortage is LigL in tLe category ol Ceneral Duty Doctor and out ol tLe 15 sanctioned posts
only 9 are appointed. JLe sanctioned specialists positions like surgery specialist,
anaestLetist (sLort term trained M.C.) public LealtL manager, ayusL pLysician, patLologist,
psycLiatrist, dermatologist, EJ surgeon and ortLopaedician are lying vacant in tLe
Lospital. However, among tLe paramedical stall, tLe situation is better witL 80 percent (36
out ol +5) ol tLe sanctioned posts are lilled-in. Among tLe otLer category ol personnel
(tecLnicians and administrative stall), tLe Lospital does not Lave all tLe sanctioned posts.
20
Among tLe posts wLicL are sanctioned / out ol 8 posts are lilled up in tLe tecLnician
category, but only 3 in tLe administrative category witL no manager to take administrative
cLarge ol tLe Lospital.

BKS: JLe Lospital Las a registered RKS. JLe Lospital exempts tLe SC, SJ and BPL patients
lor tLe user cLarges. Jo avail tLe exemption, patients Lave to produce tLe BPL Ration Card.
JLrougL tLe user lees tLe RKS generates additional resources otLer tLan government grants.
JLe user lees are retained witLin tLe Lospital lor tLe local use. JLe Lospital Las not put up a
display board sLowing number ol members, number ol meetings ol RKS.

Commcnts and Cbscrvations
Remarks by gynaecologist: Ior providing 2+"/ services at tLe district Lospital even il a
doctor is available supportive services like emergency lab and diagnostic lacilities are not
available. Ior providing services 2+"/ delivery services tLese supportive services are
essential. In ]anjgir- CLampa tLe AMs at tLe peripLery need major orientation about
importance ol institutional delivery and create awareness about it in local community.
Home delivery is still prelerred in tLe district.

Remarks by medical ollicer: Due to lack ol specialist services most ol tLe cases Lave to be
relerred outside. JLere is paucity ol stall and equipment. Due to poor accessibility tLe
CPD Las gone down. Canteen lacilities witLin tLe Lospital sLould be provided to doctors
wLo come lrom a distance.

Remarks by tLe Civil Surgeon: Iund llow to tLe Lospital in tLe lorm ol ]DS, llexipool
grants Las eased out tLe linancial constraints. But tLe Lospital Las sLortage ol manpower
in botL general as well as specialists in medical category and paramedical stall. More
decision making power/lunctional autonomy and administrative control sLould be given
to tLe Lospital autLorities to implement tLe RHM scLemes. More publicity is needed lor
tLe RHM programmes.

Remarks ol CMHC: Manpower sLortage lill up gap lund llow sLould come to tLe
district directly but it is still being cLannelized tLrougL tLe state. Institutional delivery is
21
low, male MPW s are not tLere to assist in tLe ational Programmes. Cut ol 36 PHCs
only 6 Lave building, and out ol 2+6 SCs only /8 Lave building. WitLout building it is not
possible to carry out institutional delivery. Accredition ol two private nursing Lomes Las
sligLtly improved tLe condition. Limited manpower, limited inlrastructure, and
dependence on tLe state lor drugs procurement state are limitations we Lave to cope witL.
Remarks ol DPM: I need my complete team including DAM, BPMs and BAMs to be
lully lunctional. Cne BAM lrom tLe bock is providing assistance in linancial management.
JLe district Lospital is a new development and CHCs and PHCs Lave limited
inlrastructure lacilities. Lltra SonograpLy lacilities are required at least at tLe district level
to detect obstetric complications. Blood storage lacilities need to be set up at tLe CHC
level, AMS need better orientation on Low to spend untied lunds.

Bcmarks/suggcstions tor thc improvcmcnt ot scrviccs by thc obscrvcr:
Cverall, tLe Lospital Las a new building, witL tLe pLysical inlrastructure still being put in
place. It is located about 5 kilometers away lrom tLe city and tLerelore tLe patient load
Las yet to pick up due to poor accessibility. JLe laboratory is lunctioning well but
provides limited testing lacilities. LSC lacilities are required lor last diagnosis and
treatment. Rural Medical Assistants (RMA) are doing tLere internsLip at tLe district
Lospital.

SLortage ol Luman resources is more in medical category ol stall tLan in paramedical stall.
JLere is no manager to take administrative cLarge ol tLe Lospital, as tLe post is not
sanctioned in DH. JLe CS requires an administrator to assist Lim in tLe day-to-day
running ol tLe Lospital and monitor tLe stall attendance, punctuality, Lospital load, and
overall management ol tLe Lospital. JLe records ol CPD services being provided under
dillerent sections are being maintained in a single register. Record maintenance needs
immediate attention.

JLe DPML unit is understalled and does not Lave tLe DAM to assist Lim in linancial
matters. Crientation about tLe objectives ol RHM is required by all categories ol stall at
DH, CHC, and PHC involved in programme implementation.

Chaptcr 3

Community Hcalth Ccntrcs

Covcragc
As per tLe study design, tLe two CHCs selected lor tLe study are CHC ]aijaipur
(lartLest) at a distance ol 59 kilometres lrom tLe district Lospital and CHC Baloda is 25
kms lar lrom tLe DH. WLereas ]aijaipur is serving a population ol 158,000 and Baloda is
serving a population ol 1+9,/82. Ior CHC ]aijaipur tLe nearest PHC is at a distance ol 18
kms and lartLest is +0 kms. In case ol Baloda CHC tLe nearest PHC is 15 kms away and
tLe lartLest is at a distance ol 25 kms. AltLougL ]aijaipur CHC Las been designated as
IRL it is not lunctioning as an IRL.

Availability ot Intrastructurc
BotL CHCs ]aijaipur and Baloda are 30 bedded Lospitals altLougL separate beds lor
males and lemales Lave not been allotted in ]aijaipur CHC. In ]aijaipur CHC 10 beds are
in use in tLe wards and 20 otLers are kept in tLe store room. In Baloda CHC only 8 beds
are in use ol wLicL + are allotted to male and + to lemale patients in tLe wards. Seven more
beds are being used in tLe labour, CJ, CPD, duty room, placed on tLe verandaL, lor nigLt
stall, and 15 otLers Lave been placed in tLe storeroom lor want ol space. However, tLere
are no separate wards lor male or lemale patients in eitLer ol tLe two CHCs.

BotL tLe CHCs are lunctioning lrom tLeir own government buildings. BotL tLe
CHCs are Laving regular electricity supply, telepLone, computer, running
veLicle/ambulance and laboratory. BotL CHCs Lave investigative lacilities like X-Ray, CJ
and labour room. Cenerator lacilities are available witL only Baloda CHC and CJ lor
gynecology is neitLer being used by ]aijaipur nor Baloda CHC on regular basis. BotL tLe
CHCs do not Lave internet lacilities, ECC lacilities, separate areas lor septic and aseptic
deliveries, and new born care is not available in botL tLe LealtL lacilities. In botL tLe
CHCs ]aijaipur and Baloda, tLe sewerage system used is a soak pit. CHC ]aijaipur is
disposing tLeir bio-medical waste by burning and Baloda CHC by burying in a pit. As per
our observation, tLe cleanliness ol CPD, compound/premises and rooms/wards are better

in CHC at Baloda as compared to ]aijaipur CHC. BotL tLe Lospitals are maintaining tLe
names ol ]SY beneliciaries in record.

Human Bcsourccs
BotL ]aijaipur and Baloda CHCs Lave / sanctioned posts ol medical stall. Cut ol /,
lour are working in a regular position at ]aijaipur. JLis also includes one medical ollicer
wLo is trained in sLort term obstetrics course. Jwo medical ollicers are working in
Baloda CHC. Against tLe sanctioned post. o contractual appointments Lave been made
against any ol tLe vacant posts ol medical stall.

In terms ol paramedical and support stall, in CHC ]aijaipur , out ol 18 sanctioned
positions 8 are working in regular positions and 2 in contractual position. In CHC Baloda,
out ol 19 sanctioned positions 1+ are working in regular positions and 1 laboratory
tecLnician is working on contractual basis. In botL tLe Lospitals, tLe availability ol
paramedical and support stall is better tLan in medical stall category. JLe stall situation ol
para medical and support stall is better in Baloda CHC in comparison to ]aijaipur.

Availability ot Spccitic Scrviccs
BotL tLe CHCs Lave reported tLat tLey are working 2+"/ altLougL tLey Lave no
lacilities lor carrying out caesarean deliveries. eitLer ol tLe two CHCs Lave any blood
storage lacilities. AltLougL ]aijaipur is a designated IRL it does not lullil tLe criteria
required lor a lunctional IRL.

Status ot Spccitic Intcrvcntions
IPHS lacility survey Las been completed in botL tLe CHCs. BotL tLe CHCs
receive tLe grants tLrougL cLeque lrom tLe district. RKS is registered in botL tLe CHCs
but tLe display board sLow tLe composition ol tLe RKS witL tLe names ol tLe members
only in Baloda CHC. RKS is generating resources tLrougL user lees in botL tLe CHCs. In
botL tLe CHCs, tLere is no leedback mecLanism in place lor grievances redressed by RKS.
All standard treatment guidelines and protocols are not available in tLe two CHCs.
Citizens cLarter is publicly displayed only in CHC Baloda.


Status ot Bcsidcntial Iacilitics tor Doctors and Cthcr Statt
BotL CHC ]aijaipur and Baloda Lave residential lacility lor tLe Doctors and otLer
stall and tLe residences are occupied by tLe stall. JLe Medical Cllicers quarters are lully
occupied in tLe two CHCs but tLe stall quarters ol tLe supporting stall is partly occupied
because in case ol ]aijaipur CHC some ol tLe quarters Lave been allotted to otLer
government departments or as is tLe case ol stall ol tLe Baloda CHC tLey Lave tLeir own
residence in block Leadquarters.

Availability ot Laboratory Iacilitics
BotL tLe CHCs Lave limited testing lacilities in tLeir laboratory lor Laemoglobin,
urine RE, blood smear examination lor malaria parasite, rapid test lor pregnancy. Blood
grouping is carried out in CHC ]aijaipur blood smear, bleeding and clotting time. BotL tLe
CHCs do not Lave tLe testing lacilities lor blood Smear, bleeding time, clotting time,
blood sugar and diagnosis ol RJI/SJI.

Mumbcr ot Laboratory Tcsts Donc in CHC in Last Thrcc Months
JLe CHCs maintain tLe records related to tLe number ol laboratory tests done
during tLe last tLree montLs prior to tLe survey. Records ol Laemoglobin, urine RE, blood
smear examination lor malaria parasite, rapid test lor pregnancy were observed. Blood
grouping is carried out in ]aijaipur CHC. BotL being 30 bedded Lospital witL limited stall
and limited laboratory lacilities only lew tests are carried out at tLe CHCs.

Status ot Pcrtormancc ot CT during 2007-2008
JLe perlormance ol tLe CJ sLows tLat botL tLe CHCs ol ]aijaipur and Baloda
Lave very limited CJ perlormance due to lack ol surgeons and anaestLetist in tLe two
CHCs. In botL tLe CHCs mainly laproscopic tubectomy was perlormed. In Baloda CHC
a lew minor operations ol Lydrocil (6/) were perlormed during 200/-2008.

Status ot Pcrtormancc ot Labour Boom during 2007-2008
In botL tLe CHCs tLe labour rooms are in use and deliveries are being conducted.
JLe number ol deliveries conducted during 200/-2008 in ]aijaipur and Baloda is 299 and
163 respectively. In ]aijaipur CHC 122 deliveries and in CHC Baloda 39 deliveries were
carried out between 8 pm to 8 am. It may be mentioned tLat all pregnant women wLo

came to ]aijaipur and Baloda CHCs lor delivery were considered as ]SY beneliciary
because CLLattisgarL being an EAC state all women wLo come lor institutional delivery,
irrespective ol socio-economic status are considered beneliciaries .

Status ot Availability ot Equipmcnts
In botL tLe CHCs ]aijaipur and Baloda, very lew ol tLe listed equipments are
available and are in working condition. Cut ol 15 essential equipments only + and 5 are
available and in working condition in CHC ]aijaipur and Baloda respectively. Boyles
apparatus, ECC macLine, oxygen cylinder and Lydraulic operation table are available and
seen in working condition. A vertical LigL pressure sterilizer 2/3 drum capacity and pLoto
tLerapy unit are additionally available in CHC Baloda and is in working condition. JLe
ECC macLine altLougL in working condition in botL CHCs is not being used because
tLere is no tecLnician to Landle it in eitLer CHCs.

Availability ot Drugs
Cut ol tLe 25 listed drugs, in CHC ]aijaipur about Lall ol tLe essential drugs (11)
Lave never been supplied to tLe CHC, 12 drugs Lave regular supply, and in case ol 2 drugs
, iron lolic acid, and IIA syrup tLere Las been a stock out in tLe last 6 montLs and
irregular supply. In CHC Baloda 6 drugs Lave never been supplied to tLe CHC 12 drugs
Lave regular supply and lor / drugs tLere Las been a stock out in tLe last 6 montLs and
irregular supply.

Availability ot Spccitic Scrviccs
Cut ol tLe 2+ specilic services listed, CHC ]aijaipur Las / services and CHC Baloda
Las 9 services eacL. Some services wLicL are provided by botL tLe CHCs are emergency
services (2+ Lours), leprosy diagnosis management and relerral services, DCJs, primary
management ol wounds primary management ol burns, poisoning, and dogbites.
Additionally, Baloda CHC is providing surgery services lor minor operations and doing
primary management ol lractures.

Scrvicc Cutcomc
JLe service outcome statistics was collected lrom tLe CHCs lor last tLree montLs.
Jable C1+ presents tLe average montLly ligure based on tLe data collected lor tLe last

tLree montLs. JLe caste wise ligures are also maintained in ]aijaipur CHC lor many ol tLe
indicators wLicL are not available in Baloda CHC. In almost all tLe indicators ol maternal
and cLild LealtL, tLe average montLly ligures ol ]aijaipur are more tLan tLe ligures lor
Baloda. JLe Bed Cccupancy Rate ol tLe CHCs reveals tLat botL Lospitals are
underutilised. JLe BCR ol CHC ]aijaipur is 28 percent and CHC Baloda is 2+ percent.
Cne ol tLe reasons lor tLe very low BCR tLat very limited services are available at botL
tLe CHCs. Lnder utilisation ol tLe Lospitals reveals tLe inelliciency in tLe utilisation ol
tLe allocated public resources.

CHC, jai|aipur: Bcmarks and Suggcstions:

Bcmarks by BMC: We Lave very little orientation about RHM in tLe CHC. We need
clear guidelines to spend tLe RHM grants. Presently ]SY cases are not being registered
by tLe grassroots workers as tLey are not clear about tLe registration process and micro
birtL plan. JLe guidelines given currently are vague and not very clear. We Lave to
provide services at tLe PHCs under us wLicL do not Lave a single medical ollicer and tLus
regular work at tLe CHC gets Lampered.

Suggcstions by BMC: We need a decentralization ol linancial powers. Drawing and
disbursing powers upto a certain limit must be provided. Stall lrom dillerent categories
specially more nurses are required to support institutional delivery. More specialists are
also required to provide specialist services. More orientation about dillerent aspects ol
RHM sLould be provided to us at all levels.

Bcmarks/suggcstions tor thc improvcmcnt ot scrviccs by thc obscrvcr:
A sLortage ol supply ol some important drugs was reported lrom September 2008.
Continuity in vaccine supply Lampered complete immunization process. JLe Lospital in
spite ol Laving an CJ was not carrying out surgery because ol lack ol doctors and
specialists and limited paramedical stall. However, tLe BMC is carrying out some
renovation work like electrical littings, wLite wasL witL tLe untied grants. Hospital is
under utilized as tLe bed occupancy is very low. Ellorts sLould be made to increase tLe
utilization ol tLe Lospital by lilling up tLe vacant posts in all categories. CtLer
inlrastructure and equipment related lacilities need upgradation as per tLe IPHS

standards.JLe paramedical stall also needs orientation about tLe RHM programme
wLicL is presently poor.

CHC-Baloda: Bcmarks and Suggcstions

Bcmarks by BMC: JLere Las been improvement in availability and supply ol medicines,
and lurniture due to untied lunds under RHM. But I can spend just Rs. 2000 at a time
as impress money. However, tLe power to spend lunds is limited; some spending is
possible lrom ]eevandeep lunds.CHC lacks basic inlrastructure lor institutional delivery,
labour room and laboratory lacilities. Stall is less at tLe CHC and lield AMs do not stay
at SC Lead quarters because residential quarters are not tLere. JLe residential quarters are
in poor condition at tLe CHC and need immediate attention.

Suggcstions by BMC: All vacant posts ol medical, paramedical and computer operator
sLould be lilled up lor smootL lunctioning ol CHC. Stall lrom dillerent categories
especially more nurses are required to support institutional delivery. More specialists are
also required to provide specialist services.

JLe BMC sLould Lave control over tLe ]eevandeep lunds and joint accounts could be
operated witL ollicers ol ICDS, and PHE to lacilitate smootL and last transactions in lund
spending. Iund spending gets delayed olten due to delays in meeting tLe SDM.

Bcmarks/suggcstions tor thc improvcmcnt ot scrviccs by thc obscrvcr: Record
maintenance in dillerent sections ol tLe CHC altLougL manually done is up to tLe mark.
JLere is paucity ol medical stall at tLe CHC. Hospital is under utilized as tLe bed
occupancy is very low. Except lor institutional deliveries tLe CHC does not provide
regular maternal and cLild LealtL services like ante-natal cLeckup, immunization, etc
wLicL is carried out by tLe lield stall on tLe lield. WitL regards to Iamily Planning
services, tLe records status is unsatislactory in CHC. JLe service outcomes on tLese
aspects were tLus not readily available. A lady medical ollicer is essential to monitor
maternal and cLild LealtL services. Private practice by medical ollicers also sLortens tLe
CPD time by 2 Lours.


28
Community Hcalth Ccntrcs

Tablc C 1: Covcragc and Availability ot Intrastructurc
Covcragc and Availability ot Intrastructurc CHC 1 (jai|aipur) CHC 2 (Baloda)
Population served by CHC 158,000 149,782
Distance & Jime Jaken to travel to CHC in public
transport / available mode lrom
Distancc
(in Kms)
Timc(inMi
nutcs)
Distancc
(in Kms)
Timc (in
Minutcs)
earest PHC in tLe coverage area 18 60 15 30
IartLest PHC in tLe coverage area +0 150 25 60
District Hospital 59 210 25 60
Mo. ot Bcds availablc
Male 0 +
Iemale 0 +
Availability ot Intrastructurc (Ycs:1, Mo: 0) CHC 1 (jai|aipur) CHC 2 (Baloda)
Status ol Building
Cwn government Building 1 1
Rented premises - -
CtLer Rent-lree Building - -
Electricity in all parts:
o regular electricity supply - -
Regular electricity supply in all parts 1 1
30 or more beds 1 1
Cenerator 0 1
JelepLone 1 1
Computer 1 1
Internet 0 0
Running VeLicle/Ambulance 1 1
Laboratory 1 1
Invcstigativc tacilitics
ECC 0 0
X-Ray 1 1
Lltrasound 0 0
CJ (Cperation JLeatre) 1 1
CJ used lor Cynaecology 0 0
Labour Room 1 1
Separate areas lor septic and aseptic deliveries 0 0
ew Born Care Corner 0 0
ames ol ]SY beneliciaries maintained in record 1 1
PLarmacy lor drug dispensing and drug storage 1 1
Counter near entrance ol CHC to obtain contraceptives,
CRS packets, Vitamin A medicines
1 1
Separate public utilities (toilets) lor males & lemales 0 1
Suggestion / complaint box 0 0
CPD rooms / cubicles 1 0
Waiting room lor patients 1 1
Waiting room Lave adequate sitting place 0 0
Drinking water available in tLe waiting area 0 1
Emergency Room / Casualty 0 0
Separate wards lor males and lemales 0 0
Table Contd . ...





29
Covcragc and Availability ot Intrastructurc CHC 1 (jai|aipur) CHC 2 (Baloda)
Typc ot scwcragc systcm
Soak pit 0 0
Cpen drain 1 1
Connected to Municipal Sewerage 0 0
CtLer 0 0
Wastc disposal
Buried in a pit
Collected by an agency
Incineration/Burning
JLrown in open
1
0
0
0
0
0
1
0
Status ol Cleanliness ol CPD reported good or
lair
1 1
Status ol Cleanliness ol Compound / Premises
reported good or lair
1 1
Status ol Cleanliness ol Room/Wards reported
good or lair
1 1
Prominent display boards regarding service
availability in local language
0 1
ames ol ]SY beneliciaries maintained in record 1 1
PLarmacy lor drug dispensing and drug storage 1 1
Counter near entrance ol CHC to obtain
contraceptives, CRS packets, Vitamin A and
medicines

1

1


30
Tablc C2: Position ot Mcdical Statt and Paramcdical Statt
Typc ot Statt CHC 1 (jai|aipur) CHC 2 (Baloda)
umbers in position umbers in position
Position ot Mcdical Statt (clinical)
umbers
Sanctioned Regular Contractual Jotal
umbers
Sanctioned Regular Contractual Total
Ceneral Surgeon 1 0 0 0 1 0 0 0
PLysician 1 0 0 0 1 0 0 0
Cbstetrician / Cynaecologist 1 0 0 0 1 0 0 0
Medical Cllicer trained witL sLort
term obstetrics course)
0 1 0 1 0 - - -
Paediatrician 1 0 0 0 1 0 0 0
AnaestLetist 1 0 0 0 1 0 0 0
Medical Cllicer trained witL sLort
term AnestLesia course)
0 - - - 0 - - -
Ceneral Duty Medical Cllicer 2 3 0 3 2 2 0 2
Eye Surgeon 0 - - - 0 - - -
Public HealtL urse 0 - - - 0 - - -
Position ot Paramcdical and Support Statt
Lady HealtL Visitor (LHV) 2 0 0 0 2 2 0 2
Block Extension Educator (BEE) 1 0 0 0 1 0 0 0
AM 1 0 0 0 1 0 0 0
Stall urse 3 2 0 2 3 3 0 3
Dresser 2 2 0 2 2 2 0 2
PLarmacist / Compounder 2 1 0 1 2 1 0 1
Lab. JecLnician 1 1 0 1 1 0 0 0
RadiograpLer 1 0 0 0 1 0 1 1
CpLtLalmic Assistant 1 1 0 1 1 1 0 1
Statistical Assistant / Data entry
operator
1 0 1 1 1 1 0 0
CJ attendant 0 - - - 1 1 0 1
Ambulance Driver 2 - 1 1 2 2 0 2
Registration Clerk 1 1 0 1 1 1 0 1



31
Tablc C3: Availability ot Spccitic Scrviccs in CHC

Availability ot Spccitic Scrviccs(Ycs: 1, Mo: 0)
CHC 1
(jai|aipur
)
CHC 2
(Baloda)
Iunctioning on 2+x/ 1 1
Iunctioning as IRL 0 0

Tablc C4: Status ot Spccitic Intcrvcntions
Status ot Spccitic Intcrvcntions (Ycs: 1, Mo: 0)
CHC 1
(jai|aipur)
CHC 2
(Baloda)
IPHS Iacility Survey done 1 1
Iunds being electronically translerred lrom District 0 0
Registered Rogi Kalyan Samiti 1 1
RKS generating resources tLrougL user lees 1 1
Money generated by RKS being used 1 1
Display board sLowing no. ol meetings & members ol RKS 0 1
Ieedback mecLanism in place lor grievances redressed by RKS 0 0
Citizens CLarter publically displayed 0 1
All Standard Jreatment Cuidelines and Protocols available 0 0

Tablc C5: Status ot Bcsidcntial Iacilitics tor Doctors and Cthcr Statt
Bcsidcntial Iacilitics (Ycs: 1, Mo: 0)
CHC 1
(jai|aipur)
CHC 2
(Baloda)
Ior Doctors
Residential Iacility lor Doctors 1 1
on-Cccupied Residential Quarters 0 0
Reason lor non-occupancy being poor condition / insecurity /
lack ol electricity and water supply
- -
Ior Cthcr Statt
Residential Iacility lor Stall 1 1
on-Cccupied Residential Quarters 0 0
Reason lor non-occupancy being poor condition /
insecurity/Lack ol electricity and water supply
- -

Tablc C6: Availability ot Laboratory Iacilitics
Laboratory Tcsting (Ycs: 1, Mo: 0)
CHC 1
(jai|aipur)
CHC 2
(Baloda)
Typc ot Laboratory Tcsting
Haemoglobin 1 1
Lrine RE 1 1
Blood sugar 0 0
Blood grouping 1 0
Blood Smear 0 0
Bleeding time, clotting time 0 0
Diagnosis ol RJI/ SJIs witL wet mounting, grams stain etc. 0 0
Blood smear examination lor malaria parasite 1 1
Rapid test lor Pregnancy 1 1
RPR test lor SypLilis 0 0
Rapid test lor HIV 0 0



32
Tablc C7: Mumbcr ot Laboratory tcsts donc in CHC in last 3 calcndar months

Typc ot tcsts donc
CHC 1
(jai|aipur)
CHC 2
(Baloda)
Haemoglobin 26 2+9
Urine RE 26 235
Blood sugar 0 0
Blood grouping 26 0
Blood Smear 0 0
Bleeding time, clotting time 0 0
Diagnosis oI RTI/ STIs with wet mounting, grams stain etc. 0 0
Blood smear examination Ior malaria parasite 320 125
Rapid test Ior Pregnancy 53 2+0
RPR test Ior Syphilis 0 0
Rapid test Ior HIV 0 0

Status ot Pcrtormancc ot CT

Tablc C8: Mumbcr ot surgcrics pcrtormcd during 2007-2008

Mumbcr ot surgcrics
pcrtormcd during 2007-
2008 Typc ot surgcrics
CHC 1
(jai|aipur)
CHC 2
(Baloda)
Caesarean Sections 0 0
No. oI C-section deliveries Ior JSY Card holders 0 0
Surgical cases 0 6/
Cataract 0 0
Tubectomy 0 0
Laproscopic Sterlisation 1008 1161
NSV 0 0
Conventional Vasectomy 0 0
MTP 0 0
Laprotomy 0 0

Tablc C9: Bcasons tor not conducting surgcrics
(Il CJ available but surgeries not conducted)

Bcasons tor not conducting dclivcrics(Ycs: 1, Mo: 0)
CHC1
(jai|aipur)
CHC
2 (Baloda)
on availability ol doctor/anaestLetist/stall 1 -
Lack ol equipment/poor pLysical state ol tLe operation
tLeatre
- -
o power supply in tLe CJ - -
CtLer - -







33
Status ot pcrtormancc ot Labour Boom

Tablc C 10: Status ot pcrtormancc ot Labour Boom during 2007-2008

Mumbcr ot dclivcrics pcrtormcd during
2007-2008
Mumbcr ot dclivcrics
CHC 1
(jai|aipur)
CHC 2
(Baloda)
Jotal Institutional Deliveries 299 163
Deliveries carried out lrom 8 pm to 8 am 122 39
Institutional deliveries lor ]SY card Lolders 299 163
umber ol neonates resuscitated 0 0

Tablc C11: Bcasons tor not conducting dclivcrics

Bcasons tor not conducting dclivcrics (Ycs: 1, Mo:
0)
CHC 1
(jai|aipur)
CHC 2
(Baloda)
on availability ol doctors/stall - -
Poor condition ol tLe labour room - -
o power supply in tLe labour room - -


Tablc C12: Status ot availability ot Equipmcnts and drugs

Status ot availability ot cquipmcnts

Equipmcnts availablc / working (Ycs:1,
Mo: 0)
CHC 1
(jai|aipur)
CHC 2
(Baloda)
Availablc Working Availablc Working
Boyles Apparatus 1 1 1 1
ECC MacLine 1 1 1 1
Cardiac Monitor lor CJ 0 - 0 -
Delibrillator lor CJ 0 - 0 -
Ventilator lor CJ 0 - 0 -
Horizontal HigL Pressure Sterilizer 0 - 0 -
Vertical HigL Pressure Sterilizer 2/3 drum
capacity
0 - 1 1
CJ Care Iumigation Apparatus 0 - 0 -
Cloves & Dusting MacLines 0 - 1 1
Cxygen Cylinder 1 1 1 1
Hydraulic Cperation Jable 1 1 1 1
Resuscitation trolley 0 - 0 -
PLototLerapy unit 0 - 1 1
MVA syringe 0 - 0 -
Baby incubator 0 - 0 -
Table Contd.



34
Status ot availability ot drugs

CHC rcporting stock out or irrcgular supply ot
spccitic drugs in last 6 months(Ycs: 1, Mo: 0)
CHC 1 (jai|aipur) CHC 2 (Baloda) Typc ot Drugs
Stock Cut Irrcgular
Supply
Stock Cut Irrcgular
Supply
Iron Iolic Acid (IIA) 1 1 1 1
Cral Pills (CPs) 0 0 0 0
ILD 380 0 0 0 0
CRS (Cral ReLydration Salts) 0 0 0 0
CRS witL Zinc adjutant as per
policy
-" - - -
Vitamin A 0 0 0 0
Jab. Iluconazole 0 0 1 1
Jab. Metronidazole 0 0 0 0
Jab. Co-trimoxazole (Kid) - - 1 1
Jab. elidipine - - - -
Inj. Cxytocin - - 0 0
Inj. Centamycin 0 0 0 0
Inj. Magnesium SulpLate - - - -
Jab. Misoprostal - - - -
Jab. Progestrone - - - -
Inj. Lignocaine HydrocLloride 0 0 0 0
Inj. Pentazocine Lactate 0 0 0 0
Inj. Adrenaline 0 0 0 0
Cap. Doxycycline - - 1 1
Silver SulpLadiazine oint. - - 1 1
IV Iluids 0 0 0 0
Inj. Prociane Penicillin - - 1 1
Inj. Atropine 0 0 0 0
Syp Amoxycyclin - - 1 1
IIA Syrup 1 1 - -
"-Drugs never supplied to CHC

















35
Tablc C13. Availability ot Spccitic Scrviccs (Ycs: 1, Mo: 0)

Typc ot Scrvicc
CHC 1
(jai|aipur)
CHC 2
(Baloda)
Medicine
0 0
Surgery
0 1
Obstetric & Gynae
0 0
Pediatrics
0 0
DOTS
1 1
Cataract Surgery
0 0
Leprosy diagnosis management and reIerral services
1 1
Emergency Services (24 Hrs)
1 1
mobile medical unit
0 0
Separate neo-natal care unit
0 0
Emergency care Ior sick children
0 0
Full Range oI Family Planning Services including
Laproscopic ligation
0 0
SaIe abortion services
0 0
Treatment oI STI/RTI
0 0
Blood Storage Iacility
0 0
Counseling Facility on HIV/AIDS/STD etc
0 0
Voluntary Counselling and Testing Centre (VCTC)
0 0
AYUSH Iacility
0 0
Primary management oI wounds 1 1
Primary management Iracture 0 1
Primary management oI cases oI poisoning/snake, insect
or scorpion bite
1 1
Primary management oI dog bite 1 1
Primary management oI burns 1 1
Management oI RTI/STI 0 0
















36
Tablc C14: Scrvicc Cutcomc (bascd on data tor last thrcc months)

Avcragc monthly tigurc rcportcd in CHC bascd on last thrcc months
Indicator
CHC 1 (jai|aipur) CHC 2 (Baloda)

SC SJ CtLers Jotal SC SJ CtLers Jotal
Jotal AC Registration 36 18 1+5 199 - - - +/
Jotal ]SY cases registered 36 18 1+5 199 - - - +/
Ist Jrimester Registration 20 5 /2 9/ - - - -
AC given 3 CLeckups as per RCH
ScLedule
3/ 3 60 100 - - -
Cut ol above, tLe no. ol ]SY beneliciaries 3/ 3 60 100 - - - -
AC given JJ (2
nd
doseBooster) 30 12 93 135 20 8 23 51
Cut ol above, tLe no. ol ]SY beneliciaries 30 12 93 135 20 8 23 51
AC completed IIA PropLylaxis 3/ 3 60 100 - - -
Cut ol above, tLe no. ol ]SY beneliciaries 3/ 3 60 100 - - - -
umber ol pregnant women identilied and
attended witL obstetric complications
- - - - - - -
Cut ol tLese, Low many Lave been relerred
lrom PHC/SHC
- - - - - - - -
Jotal Institutional Deliveries 20 1 32 53 20 8 23 51
o. ol ]SY cases (out ol total institutional
deliveries)
20 1 32 53 20 8 23 51
o. ol inlants given BCC 19 0 19 38 - - - 1+
o. ol inlants given DPJ3 5 1 1+ 20 - - - 0
o. ol inlants given Measles 13 1 15 29 - - - 3
o. ol inlants given Vit. A-lirst dose 13 1 15 29 - - - -
CLildren given IIA Syp. (6-60 MontLs) 0 0 0 0 - - - -
ILD Inserted 2 1 9 12 - - - -
Jotal Indoor Patients - - - 81 20 1+ 32 66
o. ol cases relerred beyond CHC 1 0 1 2 0 1 1 2
o. ol Leprosy cases currently under
treatment
/ + 16 2/ 10 8 2+ +2
o. ol new JB cases enrolled lor DCJS 8 16 1/ 31 1 3 + 8
o. ol cases given Blood Jranslusion in last
3 montLs
0 0
Bed occupancy rate in tLe last 12 montLs (As
on MarcL 31, 2008)
28.32 23.69
Average Daily CPD Attendance (Jotal)
Average Daily CPD Attendance
50 58
Average Daily CPD Attendance Male 20 21
Average Daily CPD Attendance Iemale 18 21
Average Daily CPD Attendance CLildren 13 16
Cut ol tLe total CPD attendance, specily tLe
relerred cases lrom PHC/ SHC
0 0

37
Chaptcr 4
Primary Hcalth Ccntrcs

As per tLe study design, two PHCs are selected under eacL selected CHC. JLe
selected PHCs are vertically under tLe CHCs. Lnder CHC ]aijaipur, tLe selected PHCs
are Hausoud and Raipura. Lnder CHC Baloda, tLe selected PHCs are Pantora and Catwa.
one ol tLe PHCs are lunctioning on 2+"/ basis. JLis cLapter presents tLe inlormation
collected lrom tLese lour PHCs.

Covcragc and Iacility
JLe number ol SCs covered by tLese lour PHCs varies lrom + to / and tLe
population covered varies lrom 8, 000 to 35,000. JLe distance lrom tLe nearest SCs in tLe
coverage areas to tLese PHCs varies lrom 0 to 18 kilometres and distance lrom tLe lartLest
SC varies lrom / to 28 kilometres. Jime taken to reacL tLe PHCs lrom tLe nearest SCs
varies lrom 0 to 60 minutes and lrom tLe lartLest SCs it varies lrom 20 to 120 minutes.
Cut ol tLe lour PHCs, one is Laving 6 beds (3 male and 3 lemale beds eacL) and tLe otLer
PHC Las + beds. one ol tLe PHCs are lunctioning on 2+"/ basis. one ol tLe lour PHCs
are equipped to provide basic obstetrics services.

Intrastructurc
All tLe lour PHCs are lunctioning lrom a designated government building and 2 ol
tLem Hasoud and Pantora Lave labour rooms and laboratory altLougL nonlunctional.
Since no deliveries are taking place at tLe PHCs tLey are not maintaining tLe records
containing tLe names ol ]SY beneliciaries. one ol tLe lour PHCs put up a prominent
display board regarding service availability in local language. PLarmacy lor drug dispensing
and drug storage is available in all lour PHCs. CPD rooms/cubicles, are available in all tLe
PHCs, but regular electricity supply is only available in Pantora PHC wLile otLers Lave
made some type ol temporary arrangements. Cenerator lor power backup is available in
none ol tLe lour PHCs and separate toilets lor males and lemales are available only in
Hausoud but not in use. In none ol tLese PHCs suggestion/complaint box is kept. Piped
water supply is available in none ol tLe PHCs. JelepLone is available only in Pantora
38
PHC, none ol tLe PHCs Lave a computer and none ol tLem Lave internet lacility. Jype ol
sewerage in tLese PHCs is eitLer a soak pit or open drain. JLe PHCs dispose tLeir bio-
medical waste by burying in a pit or by burning. Cut ol lour PHCs, none Lave ew Born
Care Corner. As per our observation, tLe cleanliness ol CPD, compound/premises and
rooms/wards are not good in Raipura PHC under ]aijaipur CHC as construction work is
going on bringing a lot ol dust in tLe building.

Statt Position
In none ol tLe PHCs all tLe sanctioned positions are lilled in. In PHCs Raipura,
Pantora and Catwa, out ol two sanctioned posts ol Medical Cllicers only one post is lilled
up.Cne medical ollicer in Raipura PHC is appointed on regular basis. PHC Hausoud is
being run by medical ollicers lrom ]aijaipur CHC wLo take turns to run tLe CPD as per
tLeir duty roster. one ol PHCs Lave sanctioned positions ol Medical Cllicer AYLSH,
urses, Stall urse, Block HealtL Education and Inlormation Cllicer, Lady HealtL
Visitor, Lab Assistant, and Statistical Assistant and Driver. Except lor a pLarmacist, dresser
or ward boy/ward ayaL Lardly any paramedical or otLer stall was available lor providing
inlormation and data. JLe stall position in none ol tLe PHCs eitLer medical or
paramedical can be said to be satislactory.

Status ot Training ot Pcrsonncl at PHC
JLe stall in none ol tLe PHCs Las undergone training in Pre -Service IMCI
(Integrated management ol eonatal and CLild Inlections) Sale Abortion MetLods, Skill
BirtL Attendant Jraining and ew Born Care Jraining. JLe training component is also
extremely poor in all tLe + PHCs.

Availability and Pcrtormancc ot Labour Boom
AltLougL labour rooms are available in Hausoud and Pantora PHCs due to non
availability ol doctors/stall AMs and stall nurses tLey are non lunctional. Poor
condition ol tLe labour room and no power supply in tLe labour room are also reasons lor
deliveries not being carried out at tLe PHCs. In case ol Raipura and Catwa PHCs, tLey are
still lunctioning lrom tLe old buildings wLicL do not Lave a labour room.

39
Availability ot Laboratory Tcsting in PHC
JLe two PHCs ol Raipura and Catwa Lave no separate laboratory or testing
lacilities available as tLey are lunctioning lrom old buildings witL no space lor laboratory
lacilities. In Hasuad and Pantora PHCs altLougL rooms are available lor laboratory
purpose tLere is no lab tecLnician available nor are tLere required laboratory testing
lacilities. JLus tLe tests lor Haemoglobin, Lrine RE, Blood Smear, Blood Smear
Examination lor malaria, Parasite, and Rapid Jest lor Pregnancy, Blood Sugar, Diagnosis
lor RJI/SJI and Rapid Jest lor HIV are not available in any ol tLe + PHCs.one ol tLe
PHCs also Lave tLe testing lacility lor Blood Crouping, Bleeding and Clotting Jime, and
RPR Jest lor SypLilis.

Mumbcr ot Tcsts Donc in PHCs
AltLougL no laboratory tests are carried out at tLe PHCs blood collection lor
preparation ol blood smear examination lor malaria parasite was reported in all + PHCs
and 9+, 38, 85 and 95 at Hausaud, Raipura, Pantora and Catwa respectively

Status ot Spccitic Intcrvcntions
IPHS lacility survey Las been done in all + PHCs altLougL none ol tLe medical
ollicers at tLe + PHCs Lad any knowledge about it. JLis inlormation was obtained lrom
tLe district ollicials. one ol tLe PHCs are lunctioning on 2+"/ basis (Lave 1 MC and 3 or
more AMs/Stall urses round tLe clock). o AYLSH doctors are providing services in
any ol tLe PHCs. In Pantora PHC tLere is an old ayurvedic dispensary adjoining tLe PHC
building. All tLe lour PHCs Lave registered RKS but tLere are no display boards sLowing
tLe composition ol tLe RKS witL tLe names ol tLe members and number ol meetings Leld.
In all + PHCs RKS is generating resources tLrougL user lees wLicL is being used locally. In
none ol tLe PHCs leedback mecLanism is in place lor grievances redressed by RKS.
Standard treatment guidelines and protocols are not available witL tLe PHCs. Citizens
cLarter is not publicly displayed in any ol tLe PHCs.

Availability ot Spccitic Scrviccs
All tLe lour PHCs Lave tLe specilic services lor primary management ol wounds
and lacility lor minor surgeries is available in all + PHCs. Burn cases are Landled in
40
Raipura PHC. Primary management ol lracture, care ol malnourisLed cLildren, treatment
ol poisoning/snake/insect/scorpion bite, dog bite and MJP is available in two PHCs and
management ol RJI/SJI is available in 3 PHCs. AYLSH services are not available in any
ol tLe PHCs.

Availability ot Sclcctcd Equipmcnts in PHC
Cut ol 23 equipments lor wLicL tLe inlormation collected lrom tLe PHCs,
Hausoud PHC Las 9 equipments all ol wLicL are in working order, Raipura PHC Las 12,
all in working condition Pantora Las 10 equipments in working condition and Catwa Las
1+ out ol wLicL 13 are lunctional and only a wLeel cLair is not in working condition. JLe
equipments wLicL are not available in any ol tLe PHCs are Inlant warmer, Radiant
warmer, Cradle and Auto Analyser. JLe equipments wLicL are available altLougL in
working condition are Lardly being used because tLe PHCs are not lunctioning in lull
capacity and are not providing a large number ol services.

Status ot Availability ot Drugs
Cut ol tLe 25 drugs 9 drugs (36 percent) Vitamin A, measles vaccine, ILDs, MVA
syringe, PartograpL, tablet Iluconazole AYLSH drugs, DCJS drugs, and MDJ drugs and
blister packs Lave never been supplied to any ol tLe + PHCs. Magnesium sulpLate is only
available at Catwa PHC, and injection Cxytocin at Pantora and Catwa PHCs. IIA tablets
and Iron syrup are eitLer not supplied or tLe supply is irregular. All tLe PHCs reported
stock out and irregular supply ol 2-+ drugs in last 6 montLs. one ol tLe drugs/vaccines
essential lor maternal and cLild LealtL as well as lamily planning services are available at
tLe PHCs as none ol tLem are providing tLese services at tLeir respective LealtL lacilities.

Scrvicc Cutcomc
JLe service outcome statistics was collected lrom tLe PHCs lor last tLree montLs
prior to tLe survey. Cut ol 2+ listed services tLe PHCs are only providing CPD services.
Castewise breakup is not being maintained. PHC wise breakup ol CPD cases is reported
as lollows: Hasuad 62+, Raipura 562, Pantora 62+, and Catwa 3085.


41
Status ot Bccord Maintcnancc
Except lor tLe untied lunds register ol PHC Hausoud and ]eevandeep meeting
register ol Panotora no otLer registers were available lor verilication because tLey are not
being maintained. Raipura and Catwa PHCs are not maintaining any registers at all.

Bcmarks and Suggcstions: PHCs undcr CHC jai|aipur

Bcmarks by MC (Baipura): All categories ol stall sLould be available in tLe PHC lor
implementation ol RHM and lor providing a range ol maternal and cLild LealtL services.
JLe new PHC building is under construction and tLe old building is not lully lunctioning
to provide all services under RHM. AMs and nurses are required lor providing
institutional delivery services wLicL is not available presently. We sLould get good
allowances like private doctors. I Lave not spent tLe ]eevandeep lunds because I Lave not
been given clear guidelines.

Bcmarks/suggcstions tor thc improvcmcnt ot scrviccs by thc obscrvcr: o maternal
and cLild care lacilities and no ol ]SY services are being provided at tLe PHC wLicL
indicates tLat tLe programme Las not made inroads in Raipura PHC and impact ol
RHM is not visible. JLe PHC is only providing skeletal CPD services due to lack ol
stall, equipments and drugs and laboratory lacilities. Most ol tLe equipments seen are not
being used or kept packed. Presently tLe PHC building is under construction and tLe
PHC is Lardly lunctional. JLere is no stall nurse or AM to provide maternal and cLild
LealtL services at tLe PHC. JLe MC lives at Sakti wLicL is about +0 kms away lrom
Raipura and does not visit tLe PHC regularly. o ]SY or LealtL and lamily wellare
services are being provided by tLe PHC. Lack ol involvement and poor motivation on tLe
part ol tLe M.C. is observed. A resident doctor is needed to improve perlormance. And
monitor tLe implementation ol tLe programme at tLe PHCs, and at tLe SCs lunctioning
under it.
42
Bcmarks/suggcstions tor thc improvcmcnt ot scrviccs by thc obscrvcr Hasoud PHC:
Hasuad PHC Las a new building but is totally underutilized because tLere is no doctor in
position against tLe sanctioned post. Doctors lrom CHC ]aijaipur visit tLe PHC by
rotation on Monday, Wednesday and Iriday. As a result patient inllow is low. JLe PHC is
only providing skeletal CPD services due to lack ol stall, equipments and drugs and
laboratory lacilities. o IPD services are being provided inspite ol tLe PHC Laving beds
lor patients. JLere is a major public demand lor a resident doctor. JLe record maintenance
is also poor. o ]SY or LealtL and lamily wellare services are being provided. A resident
doctor is needed to make it a lully lunctional PHC.

Bcmarks and Suggcstions: PHCs undcr CHC Baloda

Bcmarks by MC (PHC Pantora): We Lave acute paucity ol stall. JLere is no regular
water supply Lere at tLe Lospital. We need a regular supply ol regular supply ol drugs,
increase in tLe made permanent, and all tLe sanctioned post sLould be lilled up. I do not
Lave any drawing and disbursing power because I Lave been appointed on contractual
basis.

Bcmarks/suggcstions tor thc improvcmcnt ot scrviccs by thc obscrvcr: Pantora PHC
is not providing any maternal and cLild care lacilities under RHM or ]SY services. JLis
indicates tLat tLe programme Las not made inroads in Pantora PHC and impact ol
RHM is not visible. JLe M.C. wLo is contractually appointed Lardly visits tLe PHC and
resides at ]anjgir-CLampa tLe district Lead quarters. JLere is lack ol orientation among tLe
M.C. and Lis stall regarding goals to be acLieved under RHM. JLe PHC is lunctioning
lrom a new building but is grossly underutilized due to non availability ol M.C. and otLer
stall. JLe PHC is only providing skeletal CPD services due to lack ol stall, equipments
and drugs and laboratory lacilities.An ayurvedic doctor lrom an adjacent government
ayurvedic dispensary is seeing CPD patients at tLe PHC. An RMA was also seeing patients
at tLe CPD. JLe record maintenance is also poor.. Most ol tLe equipments are not being
used at tLe PHC. JLe BMC ( Baloda CHC) needs to monitor tLe MCs activities because
tLe PRI Las also complaints against Lis long absence and irregular visits to tLe PHC.

43
Bcmarks by MC (PHC Catwa): We are lunctioning lrom an old donated pancLyat
building wLicL is not sullicient lor running a laboratory and also tLere is no labour room
to carry out institutional deliveries. Most ol tLe drugs are purcLased lrom tLe district and
no need assessment is done at our level. We Lave urine pots but no IPD services are being
provided. I am working as a contractual doctor and tLerelore Lave not mucL Lold over my
stall I will spend lunds lor establisLing a laboratory.

Bcmarks/suggcstions tor thc improvcmcnt ot scrviccs by thc obscrvcr: JLe new PHC
building is in tLe linal stage ol construction. Catwa PHC Las yet to sLilt to a new building
but is totally underutilized because tLere is no resident doctor. JLe MC wLo is
contractually appointed stays at Balaoda and is a visiting doctor lor two PHCs Catwa and
Pantora. He visits tLem on alternate days. JLerelore tLe CPD services are mostly being
Landled by a dresser or pLarmacist. A resident doctor is essential lor smootL lunctioning
ol tLe PHC. JLe record maintenance is also poor. JLe PHC is just providing skeletal
CPD services. JLe PHC is only providing skeletal CPD services due to lack ol stall,
equipments and drugs and laboratory lacilities. o ]SY or LealtL and lamily wellare
services are being provided by tLe CHC. Lack ol involvement and poor motivation on tLe
part ol tLe M.C. is observed. A resident doctor is needed to improve perlormance. And
monitor tLe implementation ol tLe programme at tLe PHCs, and at tLe SCs lunctioning
under it.


44
Primary Hcalth Ccntrcs


Tablc P1: Covcragc and tacilitics ot Primary Hcalth Ccntrc

CHC 1 jai|aipur CHC 2 Baloda
Covcragc and tacilitics
PHC 1 (Hasoud) PHC 2
(Baipura)
PHC 1 (Pantora) PHC 2 (Catwa)
umber ol Sub-Centres
covered by PHC
+ + 3 6
Population covered 31908 318/9 8000 35000

PHC 1 (Hausoud) PHC 2 (Baipura) PHC 1 (Pantora) PHC 2 (Catwa)
Distance & Jime Jaken
to travel in public
transport / available
mode lrom
Distance
(in Kms)
Time (in
Minutes)
Distance
(in Kms)
Time (in
Minutes)
Distance
(in Kms)
Time (in
Minutes)
Distance
(in Kms)
Time (in
Minutes)
earest Sub Centre
in tLe coverage area
3 25 18 60 0
_
0 0
$
0
IartLest Sub Centre
in tLe coverage area
1/ 120 28 120 10 20 / 20
earest CHC 20 60 28 120 25 +0 22 60
o. ol Beds available
Male 2 0" 3 0
#

Iemale 2 0 3 0
Jotal + 0 6 0
PHC lunctioning on
2+x/ basis (Yes:1; o: 0)
0 0 0 0
PHC equipped to
provide basis obstetric
services (Yes:1; o: 0)
0 0 0 0
PHC witL +-6 beds
(Yes:1; o: 0)
1 0 1 0


_ Sub-centre Pantora located in PHC village $Sub-centre Catwa located in PHC village
" In Raipura new 6 bedded PHC building under construction.
#
In Catwa new 6 bedded PHC building to be Landed over.














45
Tablc P2: Primary Hcalth Ccntrcs by Intrastructurc
CHC 1 jai|aipur CHC 2 Baloda
Intrastructurc
PHC 1
(Hausoud)
PHC 2
(Baipura)
PHC 1
(Pantora)
PHC 2
(Catwa)
PHC lunctioning in designated govt. Building
(Ycs:1, Mo: 0)
1 1 1 1
Labour Room (Ycs:1, Mo: 0) 1 0 1 0
Laboratory(Ycs:1, Mo: 0) 0 0 0 0
Prominent display boards regarding service availability
in local language (Ycs:1, Mo: 0)
0 0 0 0
ames ol ]SY beneliciaries maintained in
record(Ycs:1, Mo: 0)
0 0 0 0
PLarmacy lor drug dispensing and drug storage (Ycs:1,
Mo: 0)
1 1 1 1
Separate public utilities (toilets) lor males and lemales
(Ycs:1, Mo: 0)
1 0 0 0
Suggestion / complaint box (Ycs:1, Mo: 0) 0 0 0 0
CPD rooms / cubicles (Ycs:1, Mo: 0) 1 1 1 1
Piped Water Supply (Ycs:1, Mo: 0) 0 0 0 0
Electricity Supply
o regular electricity supply(Ycs:1, Mo: 0)
Regular electricity supply in all parts(Ycs:1, Mo: 0)

1
-

1
-

-
1

1
-
JelepLone (Ycs:1, Mo: 0) 0 0 1 0
Computer (Ycs:1, Mo: 0) 0 0 0 0
Internet (Ycs:1, Mo: 0) 0 0 0 0
Typc ot scwcragc systcm(Ycs:1, Mo: 0)
Soak pit
Connected to Municipal
Sewerage
Cpen Drain
CtLer

1
-
-
-
-
-

-
-
-
-
1
-

1
-
-
-
-
-

-
-
-
-
1
-
Wastc disposal(Ycs:1, Mo: 0)
Buried in a pit
Collected by an agency
Incineration
/
Burning
JLrown in open

1
-
-
-

1
-
-
-

-
-
1
-

-
-
1
-
Standby lacility (generator etc.) available in working
condition(Ycs:1, Mo: 0)
0 0 0 0
Separate areas lor septic and aseptic deliveries available:
(Ycs:1, Mo: 0)
- - - -
ew Born Care Corner available: (Ycs:1, Mo: 0) 0 0 0 0
Status ol Cleanliness ol CPD reported good or lair
1 0 1 1
Status ol Cleanliness ol Compound / Premises
reported good or lair
1 0 1 1
Status ol Cleanliness ol Room/Wards reported good or
lair
1 0 1 1
"Laboratory tacilitics arc not availablc in thc PHC # burning in opcn


46
Tablc P 3: Statt Position ot in Primary Hcalth Ccntrc


S: Sanctioncd, B: Bcgular, C: Contractual, T: Total
Post ol 1dresser, 1opLtLalmic assistant, 1sweeper, 1ayaL, and1 ward boy are sanctioned in tLe above PHCs




CHC 1 ( jai|aipur) CHC 2 ( Baloda)
PHC 1 (Hausoud) PHC 2 (Baipura) PHC 1 (Pantora) PHC 2 (Catwa)
umbers in
Position
umbers in Position umbers in
Position
umbers in Position


Typc ot Statt

S
R C J

S
R C J

S
R C J

S
R C J
Medical OIIicer 1 0 0 0 2 1 0 1 2 0 1 1 2 0 1 1
Pharmacist 1 1 0 1 2 1 0 1 1 1 0 1 1 1 0 1
Nurses 0 - - - 0 - - - 0 - - - 0 - - -
ANM 1 0 0 0 1 0 0 0 1 0 0 0 1 0 0 0
Lab Technician 1 0 0 0 1 0 0 0 1 0 0 0 1 0 0 0
Driver 0 - - - 0 - - - - - - - 0 - - -
Medical OIIicer AYUSH 0 - - - 0 - - - - - - - 0 - - -
StaII Nurse 0 - - - 0 - - - - - - - 0 - - -
Lady Health Visitor 0 - - - 0 - - - - - - - 0 - - -
Lab Assistant 0 - - - 0 - - - - - - - 0 - - -
Block Health Education
and InIormation OIIicer
0 - - - 0 - - - - - - - 0 - - -
Statistical Assistant 0 - - - 0 - - - 0 - - - 0 - - -


47
Tablc P4: Status ot training ot pcrsonncl at Primary Hcalth Ccntrc

PHC having pcrsonncl traincd in spccitic catcgory ot
training during 2007 (Ycs:1, Mo: 0)
CHC 1 (jai|aipur) CHC 2 (Baloda) Training
PHC 1
(Hausoud)
PHC 2
(Baipura)
PHC 1
(Pantora)
PHC 2
(Catwa)
Pre Service IMCI 0 0 0 0
Sale Abortion MetLods 0 0 0 0
Skill BirtL Attendant
Jraining
0 0 0 0
ew Born Care 0 0 0 0

Tablc P5: Availability ot Labour Boom in Primary Hcalth Ccntrc

(Ycs:1, Mo: 0)
CHC 1 (jai|aipur) CHC 2 (Baloda)
Labour Boom
PHC 1
((Hausoud)
PHC 2
(Baipura)
PHC 1
(Pantora)
PHC 2
(Catwa)
Availability ol Labour Room 1 0 1 0
Labour Room Currently in Lse 0 - 0 -
Reasons lor not using Labour
Room

on availability ol doctors/stall 1 - 1 -
Poor condition ol tLe labour
room
1 - 0 -
o power supply in tLe labour
room
1 - 0 -
CtLer 0 - 0 -


Tablc P6 : Status ot pcrtormancc ot Labour Boom during 2007-2008

Mumbcr ot dclivcrics pcrtormcd in PHC
during 2007-2008
CHC 1 (jai|aipur) CHC 2 (Baloda)
Mumbcr ot dclivcrics

PHC 1
(Hausoud)
PHC 2
(Baipura)
PHC 1
(Pantora)
PHC 2
(Catwa)
Jotal Institutional Deliveries - - - -
Deliveries carried out lrom 8
pm to 8 am
- - - -
Institutional deliveries lor
]SY card Lolders
- - - -
umber ol neonates
resuscitated
- - - -
Dclivcrics not conductcd at thc PHCs


48


Tablc P 7: Availability ot laboratory tcsting in PHC
(Ycs:1, Mo: 0)
CHC 1 (jai|aipur) CHC 2 (Baloda)
Availability Laboratory
Tcsting"
PHC 1
(Hasoud)
PHC 2
(Baipura)
PHC 1
(Pantora)
PHC 2
(Catwa)
Haemoglobin - - - -
Urine RE - - - -
Blood sugar - - - -
Blood grouping - - - -
Blood Smear - - - -
Bleeding time, clotting time - - - -
Diagnosis oI RTI/ STIs with wet
mounting, grams stain etc.
- - - -
Blood smear examination Ior
malaria parasite
- - - -
Rapid test Ior Pregnancy - - - -
RPR test Ior Syphilis - - - -
Rapid test Ior HIV - - - -
"Mo laboratory tcsting tacility in thc abovc PHCs


Tablc P 8: Mumbcr ot tcsts donc in PHC in last thrcc calcndar months
Mumbcr ot tcsts donc in last 3 calcndar months
CHC 1 (jai|aipur) CHC 2 (Baloda)
Typc ot Tcst"
PHC 1
(Hausoud)
PHC 2
(Baipura)
PHC 1
(Pantora)
PHC 2
(Catwa)
Haemoglobin - - - -
Urine RE - - - -
Blood sugar - - - -
Blood grouping - - - -
Blood Smear - - - -
Bleeding time, clotting time - - - -
Diagnosis oI RTI/ STIs with wet
mounting, grams stain etc.
- - - -
Blood smear examination Ior
malaria parasite
- - - -
Rapid test Ior Pregnancy - - - -
RPR test Ior Syphilis - - - -
Rapid test Ior HIV - - - -
"Mo tcsts donc in thc PHCs








49


Tablc P 9: Status ot Spccitic Intcrvcntions

(Ycs:1, Mo: 0)
CHC 1 (jai|aipur) CHC 2 (Baloda)
Status ot Spccitic Intcrvcntions
PHC 1
(Hausoud)
PHC 2
(Baipura)
PHC 1
(Pantora)
PHC 2
(Catwa)
IPHS Iacility Survey done 1 1 1 1
PHC Iunctioning on 24 x 7 basis (have 1
MO and 3 or more ANMs / StaII Nurses
round the clock)?
0 0 0 0
AYUSH doctor providing services 0 0 0 0
Registered Rogi Kalyan Samiti 1 1 1 1
RKS generating resources tLrougL user
lees
1 1 1 1
Money generated by RKS being used 1 1 1 1
Display board sLowing no. ol meetings
& members ol RKS
0 0 0 0
Ieedback mecLanism in place lor
grievances redressed by RKS
0 0 0 0
Citizens CLarter publically displayed 0 0 0 0
All Standard Jreatment Cuidelines and
Protocols available
0 0 0 0
Availability ot Spccitic Scrviccs
Primary management ol wounds 1 1 1 1
Primary management lracture 0 0 0 0
Management ol eonatal aspLyxia,
sepsis
0 0 0 0
Management ol malnourisLed cLildren 0 0 0 0
Minor surgeries like draining ol abscess
etc
1 1 1 1
Primary management ol cases ol
poisoning/snake, insect or scorpion bite
0 0 0 0
Primary management ol dog bite cases 0 0 0 0
Primary management ol burns 0 1 0 0
Iacility lor MJP available 0 0 0 0
Management ol RJI/SJI 0 0 0 0
AYLSH services 0 0 0 0












50

Tablc P 10: Availability ot sclcctcd cquipmcnts in PHC

Availability ot sclcctcd cquipmcnts in PHC
(Ycs:1, Mo: 0)
CHC 1 (jai|aipur) CHC 2 (Baloda)
PHC 1
(Hasoud)
PHC 2 (Baipura) PHC 1 (Pantora) PHC 2 (Catwa)




Equipmcnts availablc
/ working
Availa-
blc
Work
-
ing
Availa-
blc
Work-
ing
Avail-
ablc
Work-
ing
Avail-
ablc
Work-
ing
Patient Trolley 1 1 1 1 1 1 0 -
Examination table 1 1 1 1 1 1 1 1
Delivery table 1 1 1 1 0 - 1 1
Wheel chair 0 - 0 - 1 1 1 0
Stretcher/ trolley 1 1 1 1 1 1 1 1
Oxygen Cylinder 0 - 0 - 1 1 1 1
Suction Apparatus 0 - 1 1 0 - 1 1
InIant warmer 0 - 0 - 0 - 0 -
Radiant Warmer 0 - 0 - 0 - 0 -
Cradle 0 - 0 - 0 - 0 -
Autoclave 1 1 1 1 1 1 1 1
Sterlisation equipment 1 1 0 0 1 1 1 1
Bag & Mask 0 - 1 1 0 - 1 1
Laryngoscope 0 - 0 - 0 - 0 -
Oxygen Mask 0 - 0 - 0 - 1 1
Thermometer 1 1 1 1 1 1 1 1
Suction Machine 0 - 1 1 0 - 1 1
Water PuriIier 0 - 0 - 0 - 0 -
Microscope 0 - 0 - 0 - 0 -
Haemoglobinometer 1 1 1 1 0 - 0 -
Auto Analyser 0 - 0 - 0 - 0 -
Autoclave 1 1 1 1 1 1 1 1
Resuscitation
equipment
0 - 1 1 1 1 1 1
















51


Tablc P 11: Status ot Availability ot Drugs











PHC rcporting stock out or irrcgular supply ot spccitic drugs in last 6
months (Ycs:1, Mo: 0)
CHC 1 (jai|aipur) CHC 2 (Baloda)
PHC 1
(Hasoud)
PHC 2
(Baipura)
PHC 1
(Pantora)
PHC 2
(Catwa)
Typc ot Drugs
Stock
Cut
Irregula
r
Supply
Stock
Cut
Irregula
r
Supply
Stock
Cut
Irregula
r
Supply
Stock
Cut
Irregular
Supply
IIA tablets - - 1 1 1 1 1 1
Iron Syrup 0 1 1 1 1 1 1 1
Cral Pills 0 0 1 1 0 0 0 0
Vitamin A - - - - - - - -
Measles Vaccine - - - - - - - -
CRS 0 0 0 0 0 0 0 0
Jab. MetLergin - - - - - - - -
Jab. Albendazole/
Mabendazole
0 0 0 0 1 0 1 0
ILDs - - - - - - - -
Inj oxytocin - - - - 0 0 0 0
Magnesium sulpLate - - - - - - 0 0
Jab. Iluconazole - - - - - - 1 1
PartograpL - - - - - - - -
MVA syringe - - - - - - - -
Jab Ciprolloxacin 1 1 0 0 0 0 1 0
Syp Cotrimoxazole 0 0 1 1 0 0 1 0
Syp Paracetamol 0 0 0 0 0 0 1 0
Ringers Lactate 0 0 0 0 0 0 0 0
Haemoccele - - - - - - - -
AD syringes - - - - - - 1 0
Disposable Cloves 0 1 0 0 0 0 0 0
Bandages 1 1 0 0 0 0 0 0
AYLSH drugs - - - - - - - -
DCJS drugs - - - - - - - -
MDJ drugs, blister
packs
- - - - - - - -


52



Tablc P12 A: Scrvicc Cutcomc (bascd on data tor last thrcc months)

CHC 1 (jai|aipur)
Avcragc monthly numbcr rcportcd
in PHC 1 ( Hausoud)
Indicator
SC ST Cthcrs Total
Jotal AC Registration -" - - -
Jotal ]SY cases registered - - - -
Ist Jrimester Registration - - - -
AC given 3 CLeckups - - - -
AC given JJ1 - - - -
AC given JJ2Booster - - - -
AC completed IIA PropLylaxis - - - -
Jotal Institutional Deliveries0 - - - -
o. ol ]SY cases (out ol total institutional
deliveries)
- - - -
o. ol inlants given BCC - - - -
o. ol inlants given DPJ3 - - - -
o. ol inlants given Measles - - - -
o. ol inlants given Vit. A-lirst dose - - - -
CLildren given IIA Syp. - - - -
ILD Inserted - - - -
Male sterilisation carried out - - - -
Iemale sterilisation carried out - - - -
Jotal indoor patients - - - -
Jotal outdoor patients A A A 62+
RJI/SJI cases treated - - - -
umber ol maternal deatLs in 200/-2008 - - - -
o. ol cases ol obstetric complications
relerred beyond PHC
- - - -
o. ol cataract surgeries carried out - - - -
o. ol new JB cases enrolled lor DCJS - - - -
o. ol new leprosy cases registered lor
MDJ
- - - -
o. ol leprosy cases completed treatment
lor leprosy
- - - -
" Monc ot thc abovc scrviccs arc bcing providcd at thc PHC











53




Tablc P12 B: Scrvicc Cutcomc (bascd on data tor last thrcc months)

CHC 1 (jai|aipur)
Avcragc monthly numbcr rcportcd
in PHC 2 ((Baipura)
Indicator
SC ST Cthcrs Total
Jotal AC Registration -" - - -
Jotal ]SY cases registered - - - -
Ist Jrimester Registration - - - -
AC given 3 CLeckups - - - -
AC given JJ1 - - - -
AC given JJ2Booster - - - -
AC completed IIA PropLylaxis - - - -
Jotal Institutional Deliveries - - - -
o. ol ]SY cases (out ol total
institutional deliveries)
- - - -
o. ol inlants given BCC - - - -
o. ol inlants given DPJ3 - - - -
o. ol inlants given Measles - - - -
o. ol inlants given Vit. A-lirst dose - - - -
CLildren given IIA Syp. - - - -
ILD Inserted - - - -
Male sterilisation carried out - - - -
Iemale sterilisation carried out - - - -
Jotal indoor patients - - - -
Jotal outdoor patients A A A 562
RJI/SJI cases treated - - - -
umber ol maternal deatLs in 200/-2008 - - - -
o. ol cases ol obstetric complications
relerred beyond PHC
- - - -
o. ol cataract surgeries carried out - - - -
o. ol new JB cases enrolled lor DCJS - - - -
o. ol new leprosy cases registered lor
MDJ
- - - -
o. ol leprosy cases completed treatment
lor leprosy
- - - -
" Monc ot thc abovc scrviccs arc bcing providcd at thc PHC










54





Tablc P12 C: Scrvicc Cutcomc (bascd on data tor last thrcc months)

CHC 2 (Baloda0
Avcragc monthly numbcr rcportcd
in PHC 1 (Pantora)
Indicator
SC ST Cthcrs Total
Jotal AC Registration -" - - -
Jotal ]SY cases registered - - - -
Ist Jrimester Registration - - - -
AC given 3 CLeckups - - - -
AC given JJ1 - - - -
AC given JJ2Booster - - - -
AC completed IIA PropLylaxis - - - -
Jotal Institutional Deliveries - - - -
o. ol ]SY cases (out ol total
institutional deliveries)
- - - -
o. ol inlants given BCC - - - -
o. ol inlants given DPJ3 - - - -
o. ol inlants given Measles - - - -
o. ol inlants given Vit. A-lirst dose - - - -
CLildren given IIA Syp. - - - -
ILD Inserted - - - -
Male sterilisation carried out - - - -
Iemale sterilisation carried out - - - -
Jotal indoor patients - - - -
Jotal outdoor patients A A A 62+
RJI/SJI cases treated - - - -
umber ol maternal deatLs in 200/-2008 - - - -
o. ol cases ol obstetric complications
relerred beyond PHC
- - - -
o. ol cataract surgeries carried out - - - -
o. ol new JB cases enrolled lor DCJS - - - -
o. ol new leprosy cases registered lor
MDJ
- - - -
o. ol leprosy cases completed treatment
lor leprosy
- - - -
" Monc ot thc abovc scrviccs arc bcing providcd at thc PHC









55








Tablc P12 D: Scrvicc Cutcomc (bascd on data tor last thrcc months)

CHC 2 (Baloda)
Avcragc monthly numbcr rcportcd
in PHC 2 (Catwa)
Indicator
SC ST Cthcrs Total
Jotal AC Registration -" - - -
Jotal ]SY cases registered - - - -
Ist Jrimester Registration - - - -
AC given 3 CLeckups - - - -
AC given JJ1 - - - -
AC given JJ2Booster - - - -
AC completed IIA PropLylaxis - - - -
Jotal Institutional Deliveries - - - -
o. ol ]SY cases (out ol total
institutional deliveries)
- - - -
o. ol inlants given BCC - - - -
o. ol inlants given DPJ3 - - - -
o. ol inlants given Measles - - - -
o. ol inlants given Vit. A-lirst dose - - - -
CLildren given IIA Syp. - - - -
ILD Inserted - - - -
Male sterilisation carried out - - - -
Iemale sterilisation carried out - - - -
Jotal indoor patients - - - -
Jotal outdoor patients A A A 3085
RJI/SJI cases treated - - - -
umber ol maternal deatLs in 200/-
2008
- - - -
o. ol cases ol obstetric complications
relerred beyond PHC
- - - -
o. ol cataract surgeries carried out - - - -
o. ol new JB cases enrolled lor
DCJS
- - - -
o. ol new leprosy cases registered lor
MDJ
- - - -
o. ol leprosy cases completed
treatment lor leprosy
- - - -
" Monc ot thc abovc scrviccs arc bcing providcd at thc PHC




56

Tablc P 13: Status ot rccord maintcnancc (Ycs:1, Mo: 0)

Typc ot Bccords CHC 1 CHC 2:Baloda

PHC 1
(Hausoud)
PHC 2
(Baipura)
PHC 1
(Pantora)
PHC 2
(Catwa)
Ante atal Register 0 0 0 0
Eligible Couple Register 0 0 0 0
Post atal Care Register 0 0 0 0
Iamily Planning Register 0 0 0 0
BirtL & DeatL Register 0 0 0 0
Immunisation Register 0 0 0 0
Meeting Register 0 0 1 0
]SY Register 0 0 0 0
Lntied Iunds Register 1 0 0 0


Chaptcr
5WD%GPVTG
As per tLe study design, tLree SCs are to be covered lor tLe survey under eacL
selected PHCs and one ol tLe tLree SCs sLould be lartLest lrom tLe PHC. Accordingly, 12
SCs were under lour PHCs but in Malni SC no regular AM was available tLerelore SC
inlormation is available only lor 11centres. JLe list ol selected SCs as per tLe study design
is given in Jable 2 ol tLe introductory cLapter.

%QXGTCIGD[5WD%GPVTGU
Jable S1 sLows tLat tLe number ol villages covered by tLe SCs varies lrom 2 to 5
and tLe population covered varies lrom 102+ to 83+1. JLe average number ol villages
covered by tLe SCs is +.2 and average population covered is 5921. JLe average distance
between tLe PHC and SC is 10.+ kilometres and tLe actual distance varies between 0 to 25
kilometres. JLe average time taken to travel in public/available mode ol transport lrom
lurtLest village to SC is 5+ minutes, lrom SC to PHC is +3 minutes and SC to CHC is 8+
minutes. Cut ol tLe 11 SCs, ASHAs are providing services in all tLe SCs .JLe number ol
ASHAs working under tLe eleven SCs is 1/9 and tLe average lor all tLe 12 SCs turns out
to be 16.3.

#XCKNCDKNKV[QH+PHTCUVTWEVWTG
Cut ol tLe 12 SCs, only 1 (9 percent) is running lrom designated government
building. JLe remaining SCs are lunctioning lrom tLe AMs/male LealtL workers own
Louse (10 SCs). IPHS lacility survey Las been done in 100 percent ol tLe SCs altLougL
none ol tLe AMs or MPW knows about it. Labour room is available only in 1 out ol 11
SCs. Piped water supply and regular electricity are available to none ol tLe SCs. JelepLone
lacility is available majority (9) ol tLe SCs. JLe type ol sewerage system ol tLe SCs sLows
tLat tLe single sub centre in Catwa releases its sewerage tLrougL an open drain. JLirty six
percent ol tLe SCs dispose tLeir bio-medical waste by burying in a pit, 36 percent by
burning and 2/ percent tLrow it in open.


4GUKFGPVKCN5VCVWUQH#0/
Cnly 2 SCs one in KLisora and tLe otLer in Catwa Lave residential quarters lor
AM. Between tLe two SCs witL AM quarters, only in one SC tLe AM is occupying
tLe quarters. JLe otLer AM is staying outside tLe village. JLe reason cited by tLe AM
ol KLisora lor not staying in SC quarter is tLe remoteness ol tLe SC and lamily reasons.

#XCKNCDKNKV[QH5VCHH
All tLe 11 SCs are Laving at least one LealtL worker (male or lemale) working in
regular position and 3 SCs Lave botL male and lemale workers in regular position. JLe
stall availability sLows tLat 100 percent ol SCs Lave male and lemale LealtL workers in
regular positions. one ol SCs Lave any contractual AMs.

#XCKNCDKNKV[QH.CDQWT4QQOCPFPWODGTQHFGNKXGTKGUEQPFWEVGF
As mentioned above, only 1 out ol 11 SCs (9.1percent) Lave labour rooms. At
Catwa SC tLe labour room is being used but it is not in a very Lygienic condition. AM
ol Catwa reported tLat most women preler delivery at Lome. JLe AM ol Pantora SC
also Las converted a room in Ler Louse lor delivery purpose. Cnly 3 deliveries were
conducted at Catwa CHC during tLe year 200/-2008.At Catwa PHC tLere is provision lor
delivery between 8PM to AM but most ol tLe deliveries are conducted at Lome in tLe
nigLt.

#XCKNCDKNKV[QH'SWKROGPVU
one ol tLe SCs Lave all tLe listed 12 equipments available witL tLem. Steriliser,
JLermometer, BP Apparatus and WeigLing MacLine are tLe common equipments
available at all tLe 11 SCs. Ietoscope (91 percent) Haemoglobinometer (82 percent) and
mucus extractor (/3 percent) are tLe tLree otLer most commonly available equipments at
tLe SCs ranking second, tLird, and lourtL in order ol availability. Cuscos Speculum is
available witL / SCs. Bag and mask and Suction MacLine are available at one-tLird ol tLe
SCs . HeigLt Measuring Scale is available witL only one SC. Surprisingly Regent Strips lor
Lrine Jest used lor testing pregnancy is not available witL a single SC. Cut ol tLe 12
equipments listed, only one SC Las reported tLe availability ol 10 equipments and all tLe
remaining SCs Lave reported less tLan 10 equipments. Except lew cases, most ol tLe

equipments available witL tLe SCs are by and large in working condition. AltLougL BP
macLine is available in all SCs it is lound in not working condition in +SCs.

#XCKNCDKNKV[QH&TWIU
Availability ol drugs on tLe date ol survey was collected lrom tLe SCs. JLe
inlormation was obtained lor 16 drugs. JLe availability ol drugs sLows tLe mixed picture.
Cut ol 16 drugs, only Deori SC sLowed tLe availability ol 12 drugs lollowed by Catwa SC
reporting availability ol 9 drugs. Except lor tLese two otLer SCs reported availability ol 3-
8 drugs. JLe availability ol drugs in tLe SCs under ]aijaipur CHC is comparatively poorer
tLan tLose lunctioning under Baloda CHC. Vitamin A was available in all tLe11 SCs on
tLe date ol survey. Condom (82 percent), oral pills and CRS (/3 percent) were tLe otLer
most available drugs. Pregnancy test kit was not available in any ol tLe SCs. Iron lolic
Acid, Emergency Contraceptive Pill, Syp Paracetamol, Syp Cotrimoxazole and DDK were
present in 2-+ SCs. PartograpL and Syp Ciprolloxacin were available only at one SC.

5RGEKHKE5MKNNUCPF2TQEGFWTGU
AMs in all tLe 11 SCs reported tLat tLey register pregnancy witLin tLree montLs,
identily LigL risk pregnancies, providing JJ and IIA and Immunisation Services. inety
one percent ol tLe AMs carryout 3 AC visits as per tLe RCH scLedule and reported
tLat tLey are trained in syndromic treatment ol RJI/SJI. EigLty two percent ol tLe
AMs reported tLat tLey carryout specilic examinations like Blood Pressure,
Haemoglobin and Lrine and stated tLat tLey are carrying out ILCD insertion/removal.
Among tLe AMs wLo reported tLat tLey carry out ILCD insertion/removal, one tLird
said tLat ILCD A380 is used and its supply is regular. Also only one- tLird ol tLe AMs
reported tLat tLey are trained on insertion/removal ol ILCD A380.

5GTXKEG1WVEQOG
JLe service outcome data lor tLe last tLree montLs sLow tLat, on an average, eacL
AM Las registered +9 ACs. Cut ol tLe total ACs, tLe average number registered by
tLe AMs in 1st Jrimester is 19.6. JLe average number lor tLe tLree AC visits as per
RCH scLedule is 2/.8 in last tLree montLs. Cn an average, eacL AM Las identilied 3./
LigL-risk cases, conducted zero deliveries at tLe sub-centre and relerred +.3 pregnant

women to next LigLer lacility. eonate inlections reported during tLe last tLree montLs
on an average is 1.1. Among tLe nine SCs wLere AM is carrying out ILCD
insertion/removal, tLe average ILCD insertion is 56 during 200/-2008. JLe service
outcome data reveal tLat tLe perlormance ol tLe AMs varies across tLe SCs.

5VCVWUQH4GEQTF/CKPVGPCPEG
Jo know tLe status ol record maintenance, tLe inlormation was collected lor 11
registers lrom tLe SCs. Registers lor Antenatal Cases, Immunisation, and ]SY are
maintained by10 (92 percent) out ol 11 SCs. Iamily Planning and BirtL and DeatL registers
are maintained by 9 (82 percent) SCs. early two-tLirds (6+ percent) ol tLe SCs maintain
Lntied Iunds register, CasL Book and Meeting registers. Eligible Couple registers
HouseLold register and Postnatal care register is maintained in only 6 out ol tLe 11 sub-
centres. WLile + sub-centres maintain 10 registers, tLe sub-centre at agridi maintains only
3 registers.

#YCTGPGUUCDQWV,5;
Awareness about tLe ]SY and tLe amounts to be given to tLe beneliciaries are
universal among tLe AMs. EigLt out ol eleven AMs reported tLat tLere is an increase
in tLe demand lor institutional deliveries alter tLe implementation ol tLe ]SY scLeme.

2TQEGFWTGWPFGT,5;5EJGOG
EigLty two percent ol tLe AMs reported tLat tLe ]SY beneliciaries are being paid
in casL and remaining 18 percent reported tLat tLe beneliciaries are being paid by cLeque
or voucLer. A little more tLan Lall (5+ percent) ol tLe AMs reported tLat tLe ]SY
beneliciaries are paid witLin a week and +6 percent said tLat tLe beneliciaries are paid alter
two weeks (1/ percent) later. Cnly two out ol 11 AMs reported tLat tLe transport
support is available under ]SY lor sLilting tLe pregnant woman lrom SC to PHC, in case
ol emergency but it is done on private basis and tLere is no government support. Jen out
ol 11 AMs said tLat tLe Register is available witL tLem to record ]SY expenditure.

2GTHQTOCPEGQH#0/WPFGT,5;5EJGOG

All tLe 12 SCs togetLer Lave registered 116 ]SY cases during tLe last tLree calendar
montLs and tLe average number per SC turns out to be 10.5 cases. JLree out ol 11 SCs
Lave not registered a single ]SY case in tLe last tLree montLs. JLe average number ol ]SY
cases resulted in institutional deliveries during tLe last tLree montLs is 2.3. JLe average
amount disbursed lor ]SY cases in last tLree calendar montLs tLe SCs is Rs.111+. JLe
perlormance ol SCs/AMs under ]SY varies considerably across tLe SCs.

During tLe linancial year 200/-2008, tLe average amount disbursed under ]SY by tLe SCs
lor Lome deliveries are Rs. 9+32. ot a single SC Las made payments to tLe beneliciaries
money lor institutional delivery. one ol tLe SCs Lave reported tLe transport costs under
tLe ]SY. one ol tLe SCs Lave even reported payments to ASHA.

5VCVWUQH7PVKGF)TCPVU
All tLe 11 SCs Lave received tLe Lntied Crants. All except Catwa PHC Lave
reported tLe expenditure lrom tLe grants. All tLe SCs are Laving joint bank account witL
tLe SarpancL/any otLer CP lunctionary. Sixty lour percent ol tLe SCs maintain written
record ol transactions being carried out on Lntied Iunds and +6 percent SCs reported
maintenance ol register to record tLe decisions taken to spend tLis amount. Iorty six
percent ol tLe SCs are maintaining tLe register to record tLe decision taken to spend tLe
grant. Jen SCs except Pantora Las reported tLat tLe SarpancL/otLers Lave reviewed tLe
expenditure records. SCs (90 percent) Lave reported tLe lollowing expenditure lrom tLe
Lntied Crants: purcLase ol stationaries, pLotocopy, and lurniture like table, cLair carpet,
lan, signboard, cup, kettle, cup and glasses.

4GOCTMUD[5WD%GPVTGU
JLe remarks given by some ol tLe AMs regarding tLe programmes are given below in
tLeir own words (tLe name ol tLe SC is given brackets):
1. I sLould be provided a building lor running tLe SC and carrying out institutional
deliveries. Currently I am running tLe SC lrom my own residence. Jraining on all
components ol ]SY is essential lor us. (SC Pantora).
2. JLere sLould be government building along witL lacilities ol oxygen cylinder,
drugs and delivery kit (SC CLeora).

3. We need training regarding tLe guidelines to utilise tLe grants given under RHM,
and Lntied Iund (SC BLutia).
+. Jraining regarding tLe various scLemes under RHM sLould be given to AMs.
We also need a building, medicines and transport lacility (SC CLikLalraunda).
5. Water and electricity lacility sLould be made avialble at tLe earliest so tLat we can
sLilt to tLe new SC building and start providing services.(SC KLisora).
6. Stall quarters sLould be provided in tLe SC village to lacilitate our stay (
SCKurma).
/. Suction macLine, examination table, water and electricity lacility is essential at tLe
LealtL centre (SC Catwa).

5WIIGUVKQPUD[VJGQDUGTXGTHQTVJGKORTQXGOGPVQHUGTXKEGU
1. Except lor Catwa and KLisora all tLe 10 SCs need buildings wLicL are lully
equipped to make tLe lunctioning ol tLe SC more ellicient. JLe AMs require
residential quarters so tLat tLey are able to stay in tLe SC village and provide active
services.

2. ew building Las been constructed lor tLe SC lor past six montLs. But electricity
and
water connection Las not yet been given to tLe SC. Due to tLis; tLe AM is not
staying in tLe SC village (SC KLisora).

3. Deliveries are conducted in Catwa SC, wLicL urgently needs a separate labour
room, water and electricity connection (SC Catwa).

+. Many ol tLe SCs do not Lave pregnancy test kit, BP macLines, wLicL are
lunctional, DDK wLicL are bare essentials to identily pregnancy conduct cLeckups,
and delivery.

5. JLe AMs Lave not received clear instructions or guidelines lor utilizing Lntied
Crants. Most ol tLe expenditures Lave been made under otLer Lead instead ol

relerral transport services or emergency drugs lor wLicL tLese lunds are meant.
AMs need clear guidelines on expenditures to be made lrom untied grants.

6. Most ol tLe AMs lack orientation about tLe importance ol institutional delivery
and preparation ol microplan lor institutional delivery under ]SY. o linkages
witL ASHA/Mitanin ol tLeir area are observed in tLis connection. Most ol tLe
AMs reported tLat tLey are still encouraging Lome delivery because it is
convenient lor tLem and tLeir clients.

/. AMs need training and orientation regarding ]SY to ellectively implement tLe
programme and to create awareness in tLe community about importance ol
institutional delivery.

8. Mostly, tLe SCs are lunctioning witL single AMs. JLey need additional stall to
improve tLe quality ol services.

9. Carelul monitoring ol tLe implementation ol RHM programme at SC level by
Medical Cllicers ol tLe PHCs is essential to give it an impetus.

10.one ol tLe AMs are aware ol tLe IPHS survey conducted lor tLeir LealtL
lacility by tLe district level LealtL ollicials. JLe inlormation about IPHS survey
was obtained lrom tLe district. Communication needs improvement among tLe
stakeLolders ol RHM.
64
Sub Ccntrc

Tablc S1: Sub Ccntrcs Covcragc

Sub Ccntrc
CHC 1 (]aijaipur) CHC 2 ( Baloda)
PHC 1 (Hasoud) PHC ( Raipura) PHC 1 (Pantora) PHC 2 (Catwa)

Covcragc ot
Sub-Ccntrc
CLeora agaridi CLisda BLutia CLikalrounda Malni Pantora KLisora Kurma Catwa KLeja Deori
Average
per Sub
Centre
umber ol
villages covered
by Sub Centre
3 5 + + + -" 3 2 6 6 + 5 +.2
Population
coverage
102+ 83+1 8500 8200 /003 - 6502 +800 5500 5/9+ 5000 ++66 5920.9
Distance
between PHC
and Sub Centre
13 1+ 5 2+ / - 00 10 25 00 10 6 10.+
Jime Jaken (In
minutes) to
travel in public
transport /
available mode
lrom

IartLest village
to Sub Centre
60 60 30 60 150 - 30 30 60 20 60 30 53.6
Sub Centre to
PHC
60 60 30 90 30 - 00 30 120 00 60 30 +3.3
Sub Centre to
CHC
120 90 90 90 90 - 60 30 30 150 80 90 83.6
o. ol ASHAs
working in tLe
Sub Centre area
21 5 21 19 18 - 16 13 16 21 1+ 15 16.3
"Bcgular AMM not availablc at SC
65
Tablc S 2: Sub Ccntrcs Intrastructurc

Sub Ccntrc
CHC 1 (]aijaipur) CHC 2 ( Baloda)
PHC 1 (Hasoud) PHC ( Raipura) PHC 1 (Pantora) PHC (Catwa)
Availability ot
Intrastructurc in Sub
Ccntrcs (Ycs:1, Mo: 0)
CLeora agaridi CLisda BLutia CLikalrounda Malni Pantora KLisora Kurma Catwa KLeja Deori
% ol SCs
Laving
respective
lacility
Iunctioning in designated
government building
0 0 0 0 0 - 0 0 0 1 0 0 9.1
IPHS Iacility Survey
Done
1 1 1 1 1 1 1 1 1 1 1 1 100.0
Labour Room 0 0 0 0 0 - 0 0 0 1 0 0 9.1
Piped water supply 0 0 0 0 0 - 0 0 0 0 0 0 0.0
Regular electricity supply 0 0 0 0 0 - 0 0 0 0 0 0 0.0
JelepLone 1 1 1 0 1 - 1 1 1 1 1 0 81.8
Type of sewerage system
Soak pit
Connected to any
Sewerage line
Open Drain

0
0
0

0
0
0

-
-
-


0
0
0

0
0
0

-
-
-


-
-
-


0
0
0

0
0
0

0
0
1

0
0
0

0
0
0

0.0
0.0
9.1
Waste disposal
Buried in a pit
Collected by an agency
Incineration*
Thrown in open

0
0
1
0

0
0
1
0

1
0
0
0


0
0
0
1

1
0
0
0

-
-
-
-


0
0
0
1

0
0
0
1

1
0
0
0

0
0
1
0

0
0
1
0

1
0
0
0

36.+
36.+
2/.2

"By Burning




66
Tablc S3: Sub Ccntrcs with AMM staying with or away trom SC villagc by distancc trom Sub Ccntrc and rcasons tor not staying in Sub Ccntrc
quartcr

Sub Ccntrc
CHC 1 (]aijaipur) CHC 2 ( Baloda)
PHC 1 (Hasoud) PHC ( Raipura) PHC 1 (Pantora) PHC (Catwa)
Bcsidcntial status ot
AMM (Ycs:1, Mo: 0)
CLeora agaridi CLisda BLutia CLikalrounda Malni Pantora KLisora Kurma Catwa KLeja Deori

% ol sub
centres
Sub Centre witL AM
quarter
0 0 0 0 0 - 0 1 0 1 0
0 18.2
Sub Centre witL AM
staying in SCs quarters - - - - - - - 0 - 1 - - 9.1
staying witLin SCs village 0 0 0 1 1 - 1 0 0 1 0 0 2/.l
staying outside SCs
village
1 1 1 0 0 - 1 1 1 0 1 1 /2./
Reason lor AM not
staying on SC quarter:

Quality ol quarter 0 0 0 0 0 - 0 0 0 0 0 0 0
Iamily related reason 0 0 0 0 0 - 0 1 0 0 0 0 0
Security reason 0 0 0 0 0 - 0 0 0 0 0 0 0

Tablc S 4: Sub Ccntrcs with Statt in Position

Sub Ccntrc (Mamcs to bc givcn)
CHC 1 (]aijaipur) CHC 2 ( Baloda)
PHC 1 (Harsoud) PHC ( Raipura) PHC 1 (Pantora) PHC (Catwa)
Availability ot Statt
(Ycs: 1, Mo: 0)
CLeora agaridi CLisda BLutia CLikalrounda Malni Pantora KLisora Kurma Catwa KLeja Deori
% ol SCs
witL
specilic
stall
available
HealtL Worker Male in
position
0 0 1 0 0 - 0 1 1 0 0 1 2/.1
HealtL Worker Iemale
in position
1 1 1 1 1 - 1 1 1 1 1 0 90.9
Additional AM
contractual
0 0 0 0 0 - 0 0 0 0 0 0 0.0

67
Tablc S 5: Availability ot Labour Boom in Sub Ccntrc

Sub Ccntrc
CHC 1 (]aijaipur) CHC 2 ( Baloda)
PHC 1 (Hasoud) PHC ( Raipura) PHC 1 (Pantora) PHC (Catwa)
Labour Boom
(Ycs: 1, Mo: 0)
CLeora agaridi CLisd
a
BLutia CLikalround
a
Malni Pantora KLisora Kurma Catwa KLeja Deori
% ot
Sub
Ccntrcs
Availability ol
Labour room
0 0 0 0 0 0 0 0 0 1 0 0 9.1
Labour Room
currently in use
0 0 0 0 0 0 0 0 0 1 0 0 9.1
Reasons lor not
using Labour Room

AM not staying
- - - - - - - - - - - - -
Poor condition/no
power/electric
supply
- - - - - - - - - - - - -
CtLer - - - - - - - - - - - - -

Tablc S 6 A: Mumbcr ot dclivcrics pcrtormcd during 2007-2008

Sub Ccntrc
CHC 1 (]aijaipur) CHC 2 ( Baloda)
PHC 1 (Hasoud) PHC ( Raipura) PHC 1 (Pantora) PHC (Catwa)
Dclivcrics
Pcrtormcd
CLeora agaridi CLisda BLutia CLikalrounda Malni Pantora KLisora Kurma Catwa KLeja Deori
Average
deliveries
conducted
per Sub
Centre
Jotal deliveries
conducted
0 0 0 0 0 - 0 0 0 3 0 0

3




68
Tablc S6 B: Sub-Ccntrcs with arrangcmcnt tor dclivcrics bctwccn 8 PM to 8 AM

Sub Ccntrc
CHC 1 (]aijaipur) CHC 2 ( Baloda)
PHC 1 (Hasoud) PHC ( Raipura) PHC 1 (Pantora) PHC (Catwa)
Arrangcmcnt tor Dclivcrics
(Ycs:1, Mo:0)
CLeora agaridi CLisda BLuti
a
CLikalround
a
Malni Pantora KLisora Kurma Catwa KLeja Deori
% ot Sub
Ccntrcs
Deliveries conducted at Sub Centre
itsell and il required relerred to
LigLer lacility

0

0

0

0

0

-

0

0

0

1

0

0

100.0
Deliveries not conducted at Sub
Centre but relerred to LigLer
lacility

-

-

-

-

-

-

-

-

-

0

-

-

-
Relerred to Private/CC lacility
-

-

-

-

-

-

-

-

-

0

-

-

-

Tablclc S7 A : Sub Ccntrcs with availability ot cquipmcnts

Sub Ccntrc
CHC 1 (]aijaipur) CHC 2 ( Baloda)
PHC 1 (Hasoud) PHC (Raipura) PHC 1 (Pantora) PHC (Catwa)
Availability ot thc
cquipmcnts
(Ycs: 1, Mo: 0)
CLeora agaridi CLisda BLutia CLikalrounda Malni Pantora KLisora Kurma Catwa KLeja Deori
% ol SCs
witL
equipment
available
Sterliser 1 1 1 1 1 - 1 1 1 1 1 1 100.0
Haemoglobinometer 1 1 0 1 1 - 1 1 1 0 1 1 81.8
Bag & Mask 0 1 0 0 1 - 0 0 0 0 1 1 36.+
Suction Machine 0 1 1 1 0 - 1 0 0 0 0 0 36.+
Thermometer 1 1 1 1 1 - 1 1 1 1 1 1 100.0
BP Apparatus 1 1 1 1 1 - 1 1 1 1 1 1 100.0
Weighing Machine 1 1 1 1 1 - 1 1 1 1 1 1 100.0
Height Measuring Scale 0 0 0 0 0 - 0 0 0 0 1 0 9.1
Reagent Strips lor Lrine Jest 0 0 0 0 0 - 0 0 0 0 0 0 0.0
Cuscos Speculum 0 1 1 1 1 - 0 1 0 0 1 1 63.6
Mucus Extractor 1 1 1 1 1 - 0 0 1 1 1 0 /2./
Fetoscope 1 1 1 1 1 - 1 1 1 1 1 0 90.9
69

Tablc S7 B: Pcrccntagc ot SCs with tunctional cquipmcnts

Sub Ccntrc
CHC 1 (]aijaipur) CHC 2 ( Baloda)
PHC 1 (Hasoud) PHC (Raipura) PHC 1 (Pantora) PHC (Catwa)
Iunctional
cquipmcnts (Ycs: 1,
Mo: 0)
CLeora agaridi CLisda BLutia CLikalrounda Malni Pantora KLisora Kurma Catwa KLeja Deori
% ol Sub
Centres witL
lunctional
equipment
Sterliser 1 1 1 1 1 - 1 1 1 1 1 1 100.0
Haemoglobinometer 1 1 - 0 0 - 1 1 1 - 1 1 //.8
Bag & Mask - 1 - - 1 - - - - - 1 0 /5.0
Suction Machine - 1 1 0 - - 1 - - - - - /5.0
Thermometer 1 1 1 1 1 - 1 1 1 1 1 1 100.0
BP Apparatus 0 1 1 1 1 - 1 0 0 1 1 0 63.6
Weighing Machine 1 1 1 0 1 - 1 1 1 1 1 1 90.9
Height Measuring
Scale
- - - - - - - - - - 0 -

0.0
Reagent Strips Ior
Urine Test
- -- - - - - - - - - - - 0.0
Cuscos Speculum 0 1 1 1 1 - 0 1 0 0 1 1 100.0
Mucus Extractor 1 0 1 1 1 - - - 1 1 1 - 8/.5
Fetoscope 1 1 1 1 1 - 1 1 1 1 1 - 100.0

JLe denominator is tLe number ol SCs witL tLe available equipment.









70

Tablc S 8: Status ot availability ot drugs






Sub Ccntrc
CHC 1 (]aijaipur) CHC 2 ( Baloda)
PHC 1 (Hasoud) PHC (Raipura) PHC 1 (Pantora) PHC (Catwa)
Typc ot Drugs
Availablc (Ycs: 1,
Mo: 0)
CLeor
a
agarid
i
CLisda BLutia CLikalround
a
Malni Pantora KLisora Kurma Catwa KLeja Deori
% ol Sub
Centres
reporting
availability ol
drug on date ol
survey
Iron/ Folic acid 0 0 0 0 0 - 0 0 1 1 1 1 36.+
Disposable Delivery Kit 1 0 0 0 1 - 0 0 0 0 0 1 2/.3
Oral Pills 0 0 1 1 0 - 1 1 1 1 1 1 /2./
Emergency contraceptive
pills
0 1 0 0 1 - 0 0 0 1 0 1 36.+
Condoms 1 1 1 1 1 - 1 1 0 0 1 1 81.8
IUD 1 0 1 1 0 - 1 1 1 0 1 1 /2./
ORS 0 0 1 0 0 - 0 1 0 1 1 1 +5.5
Tab. Ilucanazole Vaginal 0 0 0 0 0 - 0 0 1 0 0 0 9.1
Tab. Misoprostal 0 0 0 0 0 - 0 0 0 1 0 1 18.2
Partograph 0 0 0 0 0 - 0 0 0 0 0 1 9.1
Pregnancy test kit 0 0 0 0 0 - 0 0 0 0 0 0 0.0
Syp. Cotrimoxazole 0 0 0 0 0 - 1 1 0 1 1 0 36.+
Syp. Paracetamol 0 0 0 0 0 - 1 1 0 1 0 1 36.+
Vi. A 1 1 1 1 1 - 1 1 1 1 1 1 100.0
Tab. CiproIloxacin 0 0 0 1 0 - 0 0 0 0 0 0 9.1
Disposable Gloves 0 0 0 0 0 - 1 0 0 1 1 1 36.+
71

Tablc S 9: Status ot Spccitic Skills and Proccdurcs


Sub Ccntrc
CHC 1 (]aijaipur) CHC 2 ( Baloda)
PHC 1 (Hasoud) PHC (Raipura) PHC 1 (Pantora) PHC (Catwa)
Typc ot Skill / Proccdurc
(Ycs: 1, Mo: 0)

CLeora

agaridi

CLisd
a

BLutia

CLikalrounda

Malni

Pantora

KLisora

Kurma

Catwa

KLeja

Deori
oI SCs
reporting
availability oI
drug on date
oI survey
Register pregnancy within three
months
1 1 1 1 1 - 1 1 1 1 1 1

100.0
Carry out 3 ANC visits as per
the RCH schedule (1
st
: 6
month, 2
nd
: 7
th
Month, 3
rd
: 9
th

Month)
1 1 1 1 1 - 1 1 1 1 1 0

90.9
Carry out speciIic examinations
like Blood Pressure,
Haemoglobin, and Urine
1 1 1 1 0 - 1 1 1 1 0 1

81.8
Provision oI TT, IFA etc. 1 1 1 1 1 - 1 1 1 1 1 1 100.0
IdentiIication oI High Risk
Pregnancies
1 1 1 1 1 - 1 1 1 1 1 1

100.0
Is the ANM carrying out IUCD
Insertion/ Removal
1 1 1 1 1 - 1 1 0 1 1 0

81.8
Is IUCD insertion being carried
out using IUD A380*
0 1 0 0 0 - 0 0 0 1 1 0

33.3
Is the supply oI IUD A380
regularly available *
0 1 0 0 0 - 0 0 0 1 1 0

33.3
Has the ANM been trained on
the insertion/ Removal oI IUD
A380
0 1 0 0 0 - 0 0 0 1 1 0

33.3
Is the ANM trained in
syndromic treatment oI
RTI/STI?
1 1 1 1 1 - 0 1 1 1 1 1

90.9
Immunisation services 1 1 1 1 1 - 1 1 1 1 1 1 100.0
" Among tLe SCs wLere AM is carrying out ILCD Insertion/Removal
72
Tablc S 10: Scrvicc Cutcomc(bascd on Data tor last 3 months)

Sub Ccntrc
CHC 1 (]aijaipur) CHC 2 ( Baloda)
PHC 1 (Hasoud) PHC (Raipura) PHC 1 (Pantora) PHC (Catwa)
Indicator
CLeora agaridi CLisda BLutia CLikalrounda Malni Pantora KLisora Kurma Catwa KLeja Deori
Average
per Sub
Centre
Jotal AC
registered
/0

1+

59

36

38

- 33 // 111 +8 15 +1

+9.3
Cut ol total AC,
o. Registered in 1
st

Jrimester
30 8 +0 2+ 1+ - 8 2/ 3/ 1 11 16 19.6
o. given 3 AC
visits as per tLe RCH
scLedule
30 10 62 36 3 - 38 22 20 29 2+ 32 2/.8
o. ol HigL Risk
Cases identilied
8 2 6 0 8 - 3 8 0 0 2 + 3./
Deliveries conducted
by AM at Sub
Centre
0 0 0 0 0 - 0 0 0 0 0 0 0.0
Pregnancies relerred
and attended by tLe
next LigLer lacility
8 2 6 0 8 - 1 8 5 2 3 + +.3
o. ol neonate
inlections identilied
and relerred
0 0 0 0 0 - 0 + 0 0 5 3 1.1
o. ol ILCD
insertions in 200/-
2008"
22 0 0 +3 0 - 30 0 0 +9 35 0 55.5





73

Tablc S 11 : Status ot Bccord Maintcnancc
Sub Ccntrc (Mamcs to bc givcn)
CHC 1 (]aijaipur) CHC 2 ( Baloda)
PHC 1 (Hasoud) PHC (Raipura) PHC 1 (Pantora) PHC (Catwa)
Typc ot
Bccords
maintaincd
(Ycs: 1, Mo: 0)
CLeora agaridi CLisda BLutia CLikalrounda Malni Pantora KLisora Kurma Catwa KLeja Deori
% ol SCs
reporting
maintenance
ol record "
Household
Survey Register
1 0 0 1 0 - 1 1 0 1 1 0 5+.5
Ante Natal
Register
1 1 1 1 1 - 1 1 0 1 1 1 90.9
Eligible Couple
register
1 0 0 0 0 - 1 1 0 1 1 1 5+.5
Post Natal care
Register
1 0 0 1 0 - 1 1 0 1 1 0 5+.5
Family
Planning
Register
1 1 1 1 1 - 1 1 0 1 1 0 81.8
Birth & Death
register
1 0 1 1 1 - 1 1 0 1 1 1 81.8
Immunisation
Register
1 1 1 1 1 - 1 1 0 1 1 1 90.9
Meeting
Register
1 0 1 1 1 - 1 1 0 0 0 1 63.6
JSY register 0 1 1 1 1 - 1 1 1 1 1 1 90.9
Untied Funds
register
0 0 1 1 1 - 0 1 0 1 1 1 63.6
Cash Book 1 0 1 1 1 - 1 0 0 1 1 0 63.6
74
Tablc S12 A: Status ot Awarcncss ot AMM about jSY Schcmc
Mumbcr ot AMMs AMMs awarcncss about jSY
Intcrvicwcd Bcporting Awarcncss
Aware about ]SY 11 11
Aware about amounts to be given to beneliciaries 11 11
AM reporting increase in demand lor Institutional
delivery alter implementation ol ]SY ScLeme
11 8



Tablc S12 B: Status ot proccdurc undcr jSY Schcmc
AMMs awarcncss about jSY % ot AMMs according to rcsponsc

Funds being paid to beneIiciaries by
Cash
Cheque
Vouchers

81.8
9.1
9.1
Average time taken aIter birth Ior JSY payment to beneIiciary
Less than 1 week...1
1- 2 weeks..... 2
More than 2 weeks....3

54.5
0.0
45.5
Transport support Ior shiIting oI cases available Irom Sub Centre
to PHC/CHC
18.2
Register available Ior recording oI JSY Expenditure 90.0
Total no. of ANMs interviewed 11


75
Tablc S 13: Status ot pcrtormancc ot AMM undcr jSY Schcmc


CHC 1 (]aijaipur) CHC 2 ( Baloda)
PHC 1 (Hasoud) PHC (Raipura) PHC 1 (Pantora) PHC (Catwa)
Pcrtormancc ot AMM
undcr jSY Schcmc
CLeora agaridi CLisda BLutia CLikalrounda Malni Pantora KLisora Kurma Catwa KLeja Deori
Avcragc
pcr Sub
Ccntrc
Jotal cases ol ]SY
registered in last 3
calendar montLs
10 0 10 15 20 - 33 15 1 12 0 0 10.5
Jotal ]SY cases
resulted in Institutional
deliveries in last tLree
montLs:
10 0 0 0 0 - 5 1 1 2 2 + 2.3
Jotal casL disbursed in
last 3 calendar montLs
lor ]SY cases: (Rs.)
3000 500 0 0 0 - 0 3000 0 2000 1/50 2000 1113.6
Cut ol total amount
disbursed, tLe amount
disbursed on tLe
lollowing
-
Home Deliveries
(Rs.)
3000 500 0 10500 1+000 - 1/500 18500 20000 1/000 1/50 18000 9+31.8
Institutional
deliveries: (Rs.)
0 0 0 0 0 - 0 0 0 0 0 0 0.0
Jransport Costs
(Rs.)
0 0 0 0 0 - 0 0 0 0 0 0 0.0
Amount given to
ASHA (Rs.)
0 0 0 0 0 - 0 0 0 0 0 0 0.0
76
Tablc S 14: Status ot Lnticd Crants

Sub Ccntrc
CHC 1 (]aijaipur) CHC 2 ( Baloda)
PHC 1 (Hasoud) PHC (Raipura) PHC 1 (Pantora) PHC (Catwa)
Status ot Lnticd Crants
(Ycs: 1, Mo:0)
CLeora agaridi CLisda BLutia CLikalrounda Malni Pantora KLisora Kurma Catwa KLeja Deori
% ol sub
centre
Sub Centre received Lntied Crant 1 1 1 1 1 - 1 1 1 1 1 1 100.0
Sub Centre reported expenditure
lrom Lntied Crant"
1 1 1 1 1 - 1 1 1 0 1 1 90.9
AM Laving a joint account witL
tLe SarpancL/any otLer CP
lunctionary"
1 1 1 1 1 - 1 1 1 1 1 1 100.0
Sub Centre reporting maintenance
ol register to record tLe decisions
taken to spend tLis amount"
1 1 0 1 1 - 0 0 0 1 1 1 63.6
Sub Centre reporting written
record ol transactions being carried
out on Lntied Iunds
1 1 0 0 0 - 0 0 0 1 1 1 +5.5
Sub Centre reporting tLat
SarpancL/otLers ever reviewed tLe
expenditure records "
1 1 1 1 1 - 0 1 1 1 1 1 90.9
Sub Centre reporting expenditure
lrom Lntied Crant on tLe
lollowing:

Spent on PurcLase ol Drugs"" 0 0 0 0 0 - 0 0 0 0 0 0 0.0
Arranging Jransport"" 0 0 0 0 0 - 0 0 0 0 0 0 0.0
Paying ol Power/ Jele"pLone
bills""
0 0 0 0 0 - 0 0 0 0 0 0 0.0
Arranging lacilities like Water
Cooler etc. lor patients""
0 0 0 0 0 - 0 0 0 0 0 0 0.0
CtLer (like wLite wasL,
maintenance etc.)""
1 1 1 1 1 - 1 1 1 0 1 1 90.9
" Among tLe SCs received Lntied Crant. "" Among tLe SCs reported tLe expenditure lrom Lntied Crants
//
CJCRVGT- 6
Houschold Survcy
JLis cLapter presents tLe lindings ol tLe LouseLold survey on RHM. Ior tLe
survey, two-tLree villages were selected lrom eacL selected Sub Centre area. Jo complete
tLe sample size ol 50 LouseLolds 15 additional villages were covered to lullil tLe
LouseLold selection criteria as per tLe sampling design. HouseLolds were selected lrom
eacL ol tLe selected village by lollowing tLe systematic circular random sampling
procedure. JLus, altogetLer 39 villages were selected lor tLe LouseLold survey. Ior
selecting tLe LouseLolds, tLe total number ol LouseLolds in a village was divided by 50 to
lind out tLe selection interval. Alter tLat, tLe lirst LouseLold situated at tLe nortL-west
corner ol tLe village was randomly selected and subsequently every rtL LouseLold was
selected moving in an anti-clock wise direction till 50 LouseLolds were selected. In tLe
district, lrom tLe selected i villages, we Lave covered about 2 percent more tLan tLe
stipulated 1200 LouseLolds. HouseLolds lrom wLicL incomplete inlormation was received
were linally dropped. In all 1200 LouseLolds are considered lor data analysis, tLe coverage
rate being 100 percent. Presented below are tLe lindings ol tLe LouseLold survey.

Charactcristics ot thc Bcspondcnts
Jable H1 presents tLe background cLaracteristics ol tLe respondents (Lead/senior
member ol tLe LouseLold). RougLly, about Lall ol tLe respondents are aged +0 years and
above and tLe rest lilty percent are less tLan +0 years ol age. More tLan tLree liltLs ol tLe
respondents are males and two-liltLs are lemales. Cne tLird ol tLe respondents are
illiterates. Majority ol respondents are currently married (85 percent) and tLe rest are
unmarried (9 percent), divorced/separated (1 percent) or widowed (5 percent).

Charactcristics ot thc Houscholds
Jable H2 presents tLe percentage distribution ol tLe rural LouseLolds by selected
background cLaracteristics. Distribution ol tLe LouseLolds by social category sLows tLat
Lall ol tLe LouseLolds belong to CBC, 29 percent belongs to Caste (SC) 19 ScLedule Jribe
(SJ), and 2 percent to otLer castes. Distribution ol LouseLolds by religion sLows tLat 99
percent ol tLe LouseLolds are Hindus. Seventy lour percent ol LouseLolds Lave electricity.
Cnly one-tLird ol tLe LouseLolds are living in pucca Louses. Joilet lacility is available
/8
only in 1+ percent ol tLe LouseLolds. Piped water is used by only 6 percent ol tLe
LouseLolds. Hardly + percent ol LouseLolds use LPC/Biogas lor cooking. More tLan two
tLirds (68 percent) ol tLe LouseLolds own/cultivate agricultural land. Jwenty percent ol
tLe LouseLolds own a mobile pLone. About Lall ol tLe LouseLolds (+9 percent) possess a
colour/B&W television. Sixty percent ol tLe LouseLolds belong to BPL category. JLe BPL
status is also exactly rellected in tLe LouseLolds witL tLe low standard ol living index (+/
percent). JLe standard ol living index is calculated by using tLe various LouseLold items
possessed by tLe LouseLolds. Among tLe living cLildren born in tLese rural LouseLolds
during tLe last live years, Lardly 1+ percent ol tLem were born in institutions.

Wastc Disposal, Stagnation ot Watcr and Mosquito Brccding and Systcm ot Mcdicinc
Prctcrrcd
MetLod ol waste disposal sLows tLat majority ol tLe rural LouseLolds (9+ percent)
tLrow tLeir waste in tLe open space and tLe remaining bury in a pit (Jable H3).
Percentage ol LouseLolds tLrowing tLe waste in open space is sligLtly more in tLe
LouseLolds located in otLer villages (96 percent) tLan tLose LouseLolds located in SC
Leadquarter village (92 percent). During tLe survey, in 22 percent ol tLe LouseLolds,
investigators Lave observed tLe stagnation ol wastewater around tLe LouseLold.

Among tLe LouseLolds wLere tLe stagnation ol wastewater was observed, tLe
investigators Lave lurtLer observed tLe mosquito breeding in tLe stagnant water in almost
all tLese LouseLolds (99 percent). JLere is no dillerence in tLe stagnation ol wastewater
and tLe instances ol mosquito breeding between tLe LouseLolds located in tLe SC
Leadquarter village and LouseLolds located in otLer villages. System ol medicine prelerred
by tLe rural LouseLolds reveals tLat tLe allopatLic medicine is universally prelerred (99
percent). In addition to tLis, 2 percent ol tLe LouseLolds preler Ayurveda and tLere is
Lardly any prelerence lor traditional Lealing.

Intormation about Hcalth Workcrs and Hcalth Iacilitics
About tLree-lourtLs respondents (/+ percent) Lave Leard about AM and only 38
percent ol tLem Lave Leard about Male HealtL Worker (Jable H+). Hardly one-liltL (21
percent) ol tLe respondents reported tLat tLe LealtL worker Las visited tLem in last one
montL. JLere is a little dillerence in tLese aspects between tLe LouseLolds located in tLe
/9
SC Leadquarter village (23 percent) and LouseLolds located in otLer villages (19 percent).
IurtLer two liltLs ol tLe respondents reported tLat tLe LealtL workers are available to
tLem wLen needed. A LigLer proportion ol respondents living in SC Leadquarter village
(53 percent) reported tLat tLe LealtL workers are available to tLem wLen needed tLan tLe
respondents living in otLer villages (29 percent).

Respondents were asked about tLe availability ol tLe LealtL lacilities to tLe
LouseLolds wLen required. JLe responses reveal tLe combination ol public and private
lacilities available to tLem wLen required. RMP was reported by Lardly one percent ol tLe
respondents and private clinic/CC was reported by 10 percent respondents. Public
LealtL lacilities like SC, 8 and 5 percent ol tLe respondents mentioned PHC respectively.
Cnly tLose respondents living in SC Leadquarter village (1/ percent) reported tLat tLe SC
and PHC (9 percent) is available to tLem wLen required. one ol tLe respondents living in
otLer villages Lave reported about availability ol government lacility. Majority ol tLe
respondents Lave stated about tLe availability ol otLer lacility, wLicL lor tLem is a jLola
cLLap doctor (8+ percent), or quack. JLe presence ol quack is more prominently reported
in tLe otLer village (9+ percent). Respondents were lurtLer asked about tLe LealtL lacility
wLere tLe serious patients are taken. Majority ol tLe respondents (5+ percent) mentioned
tLat tLey take tLe serious patients to tLe CC Lospital/ clinic. PHC, CHC and District
Hospital were mentioned by / percent, 18 percent and 33 percent ol tLe respondents
respectively. JLere is not mucL dillerence in tLe responses ol tLe respondents lrom SC
Leadquarter villages and otLers villages.

Mode ol transport used to take serious patients wLen required was asked lrom tLe
respondents. Majority ol tLe respondents mentioned otLer means ol transport (/1
percent) wLicL is generally a Lired veLicle or sometimes on motorcycle to carry serious
patients. Bus/public transport are used by one tLird respondents are used to take tLe
serious patients, wLen required. Hardly / percent respondents are reported ol Laving
access to private veLicles and only very lew reported tLat tLe bullock cart is used.

80
MBHM, ASHA/Mitanin and jSY
Jable H5 presents tLe distribution ol respondents by tLeir knowledge about
RHM, ASHA and Ler activities, VHD, VHSC and ]SY. A little more tLan one liltL ol
tLe respondents (22 percent) Lave Leard about RHM and tLere is very little dillerence in
tLis between LouseLolds located in SC HQ villages (2+ percent) and otLer villages (21
percent). Ior tLose wLo Lave Leard about RHM, radio/television is tLe major source ol
inlormation (52 percent) lollowed by community member (25 percent), otLers (13
percent), PancLayat (8 percent), ASHA (8 percent) and newspaper (6 percent).

Cverall, majority ol tLe respondents (9+ percent) ol tLe respondents Lave Leard
about ASHA wLo is popularly known as Mitanin in tLe local community. JLose wLo
Lave Leard about ASHA were lurtLer asked about tLeir awareness/knowledge regarding
various activities ol ASHA. More tLan two-tLirds (/0 percent) ol tLe respondents are
aware tLat ASHA carries a kit, 82 percent are aware tLat ASHA provide common
medicines lree ol cost, +8 percent are aware tLat ASHA Leld discussions about Land
wasLing, +2 percent aware tLat ASHA Leld discussions about construction ol LouseLold
toilets and +9 percent aware tLat ASHA Leld discussions about sale drinking water. JLe
percentage ol tLe respondents wLo are aware about dillerent activities ol ASHA is sligLtly
LigLer in SC Leadquarter villages tLan in otLer villages. Jwo liltLs ol tLe respondents (+2
percent) reported tLat tLe Village HealtL and utrition Day (VHD) is being organised
in tLe village. Hardly 11 percent ol tLe respondents Lave reported about tLe presence ol
Village HealtL and Sanitation Committee (VHSC) in tLe village. More tLan Lall ol tLe
respondents (5/ percent) Lave reported tLat VHD is being organised once in a montL in
tLe village. JLe percentage ol tLe respondents reporting tLe lrequency ol tLe VHD as
quarterly and annually is 1+ percent and 19 percent respectively. VHSC Las not made
mucL impact at tLe community level, as awareness about it is low among beneliciaries.

All tLe respondents were asked about tLeir awareness regarding ]SY scLeme. It
sLows tLat Lall ol tLe respondents are aware about ]SY scLeme and tLere is very little
dillerence in tLe awareness level ol respondents lrom SC HQ villages (51 percent) and
tLose lrom otLer villages (+9 percent). JLose wLo are aware about tLe ]SY scLeme were
lurtLer asked about tLeir source ol inlormation about tLe ]SY. It sLows tLat tLe major
81
sources ol inlormation about ]SY are ASHA worker (32 percent) lollowed by
Radio/television (25 percent). CtLers (35 percent) Lave also inlormed tLem about tLe
scLeme.

JLose wLo said tLat tLey are aware about tLe ]SY scLeme were lurtLer asked
wLetLer anyone in tLe LouseLold is a beneliciary ol ]SY scLeme. Among tLose wLo are
aware about tLe ]SY scLeme, twelve percent ol tLem reported tLat tLe LouseLold is a
beneliciary ol tLe ]SY scLeme. JLe percentage ol tLe beneliciary LouseLolds is sligLtly
more in SC HQ villages (13 percent) tLan in otLer villages (11 percent). Among tLe total
surveyed LouseLolds, 6 percent (/2 out ol 1200) are beneliciaries ol tLe ]SY scLeme.

jSY Bcncticiarics
Selected cLaracteristics ol tLe beneliciaries are presented in Jable H6. Age
distribution ol tLe beneliciaries sLows tLat, as expected, majority ol tLem are aged 20-2+
years (61 percent). More tLan one liltL (21 percent) ol tLe beneliciaries are aged 25-29 years
and 11 percent are less tLan 20 years. Parity ol tLe beneliciaries sLows tLat nearly 53
percent are second parity woman and +/ percent are second tLird parity woman.
CLLattisgarL being one ol tLe EAC states, cent percent LouseLolds are eligible lor ]SY
benelits irrespective ol tLe social category tLese represent. Social category ol tLe
beneliciaries reveals tLat about Lall ol tLem (+/ percent) are CBCs lollowed by ScLeduled
Castes (33 percent) and ScLeduled Jribes (18 percent). All tLe beneliciaries are Hindus.
Distribution ol beneliciaries by Standard ol Living Index (SLI) sLows tLat more tLan Lall
ol tLem (53 percent) belong to low SLI LouseLolds, 31 percent belong to medium SLI
LouseLolds and 1/ percent to LigL SLI LouseLolds. More tLan two tLirds (6/ percent) ol
tLe beneliciaries are lrom BPL category. In more tLan Lall ol tLe LouseLolds (5/ percent)
place ol tLe last delivery is reported at Lome ratLer tLan a LealtL institution. JLus casL
incentives may Lave motivated beneliciaries lor institutional deliveries.

Bcgistration ot jSY Bcncticiarics
]SY lirst starts witL tLe registration ol tLe pregnant woman lor receiving tLe
benelits. Cnly 25 percent ol tLe beneliciaries Leard about tLe ]SY scLeme belore being
pregnant and tLe rest /5 percent during pregnancy. Stage ol pregnancy wLen beneliciary
got registered lor ]SY scLeme reveals tLat about two liltL (38 percent) ol tLe beneliciaries
82
got registered during tLe lirst trimester ol tLe pregnancy and more tLan Lall (53 percent)
during and 5tL montL ol tLe pregnancy or even later. early Lall ol tLe beneliciaries were
registered by AM/IHW (+/ percent), 21 percent by Anganwadi worker, 1+ percent by
ASHA and tLe remaining 18 percent by Doctor/LHV/CtLers. Place ol registration ol
beneliciaries sLows tLat 25 percent ol tLem were registered in Anganwadi Centre. JLe
percent ol beneliciaries registered in CHC is 21 percent; SC is 15 percent DH 1+ percent
and at Lome is 18 percent (Jable H/).

jSY Card
Cnly 19 percent ol tLe beneliciaries reported tLat tLey received tLe ]SY card (Jable
H8). Among tLose wLo received tLe ]SY card, more tLan Lall ol tLem were Lelped by
ASHA in getting ]SY card. one ol tLe beneliciaries reported any dilliculty in getting tLe
]SY card. (It may be mentioned tLat separate ]SY cards Lave not been provided in tLe
district. Maternal and cLild LealtL cards provided by Aganwadis or tLose provided by
AMs may Lave been reported as ]SY cards. o ]SY registration is being done in tLe
district on cards printed witL ]SY wLicL is a prerequisite lor receiving ]SY benelits).

Bolc ot ASHA/Mitanin during thc Prcgnancy ot thc Bcncticiarics
In CLLattisgarL, 3 to 5 ASHAs/Mitanins are appointed in eacL village depending
upon tLe population size and most respondents are aware about tLem. In ]anjgir-CLampa
district, among tLe villages surveyed, ASHAs/Mitanins are appointed in all tLe villages ol
tLe two blocks selected lor tLe study. In spite ol a large presence ol ASHA /mitanins tLere
involvement in tLe ]SY programme is negligible. Jable H9 presents tLe role ol ASHAs
during tLe pregnancy ol tLe beneliciaries. In spite ol a large presence ol ASHA /mitanin in
all tLe villages only 35 percent ol tLe beneliciaries said tLat tLe ASHA worker provided
specilic Lelp during last pregnancy. A little more tLan two-liltLs beneliciaries received
advice about diet lrom ASHA. JLe percentage ol beneliciaries wLo received advice lrom
ASHA on delivery care, breastleeding and newborn care is only 25-26 percent. A small
proportion ol beneliciaries received advice lrom ASHA on danger signs during pregnancy
(21 percent), and lamily planning (13 percent). Beneliciaries were lurtLer asked about tLe
type ol inlormation received during tLe antenatal period (micro birtL planning) lrom
Doctor/AM/ASHA. It sLows tLat tLe percent beneliciaries received tLe inlormation
83
regarding date ol next cLeck up is 5+ percent, place ol next cLeck up is 38 percent,
expected date ol delivery is 33 percent and place ol delivery is 32 percent. Cnly 25 percent
beneliciaries were told about tLe relerral place, il complications arise.

Placc ot Dclivcry and Bcason tor Cpting Institutional Dclivcry
Among tLe beneliciaries, only +/ percent (3+ out ol /2) delivered in institutions and
tLe remaining 53 percent delivered at Lome (Jable H10). Most ol tLese institutional
deliveries (32 out ol 3+) took place in public institutions (DH and CHC). Major reasons
cited by tLe beneliciaries lor delivering in institutions are: better care lor motLer and new
born cLild (+/percent); support services provided by ASHA (32 percent); money available
under ]SY scLeme (2+ percent) and better access to institutional delivery (21 percent).

Transport ot thc Bcncticiarics to Bcach thc Hcalth Institutions
Among tLe beneliciaries wLo delivered in LealtL institutions, / ol tLem received a
relerral slip lrom ASHA/LealtL personnel to access delivery services (Jable H11). Cut ol
tLe 3+ beneliciaries wLo delivered in institutions, 11 ol tLem laced dilliculty in reacLing
LealtL institution due to late non availability ol transport, insullicient money and nigLt
timing. JLe average distance to tLe ultimate place ol delivery lrom tLe beneliciaries
residence is about 22 kilometres. Majority ol tLe beneliciaries (9/ percent) used otLer
transport like Lired veLicle, auto, train, motorcycle cycle, carried pregnant woman on cot,
and on loot to reacL tLe ultimate place ol delivery, Cnly 3 percent used a private veLicle
to reacL tLe LealtL lacility. Ior majority ol tLe beneliciaries mainly lamily members
/relatives /Lusbands Lad arranged tLe veLicle, and 3 percent were lacilitated by ASHA in
arranging tLe transport.

Majority ol tLe beneliciaries (91 percent) Lad tLe money to pay lor tLe transport
services. JLree beneliciaries Lad no money to pay lor tLeir transport. Average amount ol
transport assistance received by beneliciaries is Rs.158. JLirty two beneliciaries spent
money on transport. JLe amount spent is mucL more tLan tLe transport assistance
received under ]SY casL assistance. JLe average amount spent by tLese beneliciaries on
transport is Rs 952. Ior 85 percent ol tLe beneliciaries, relatives accompanied tLem to tLe
LealtL institution.

8+
Waiting Timc, Typc ot Dclivcry and Satistaction Bcgarding Scrviccs
JLe average waiting time at tLe lacility until someone attended tLe beneliciary is 12
minutes. Cut ol 3+ beneliciaries 22 Lad tLe normal delivery (65 percent) and tLe remaining
12 Lad delivery assisted by lorceps or caesearean . JLe average number ol days spent in tLe
LealtL lacility till discLarge is 3.1 days. More tLan tLree-lourtLs (// percent) ol tLe
beneliciaries Lad to pay at tLe LealtL centre and tLe average amount paid is Rs. 1383.

Among tLe 3+ beneliciaries, 22 were satislied witL tLe services available in tLe
LealtL centre, 8 were somewLat satislied and + were not satislied. JLe reason lor tLe non
satislaction stated by tLem was poor quality ol services beneliciary and tLe rudeness ol tLe
stall at tLe LealtL lacility.

Bcason tor Cpting Homc Dclivcry
As mentioned earlier, 38 out ol /2 beneliciaries (53 percent) opted lor tLe Lome
delivery in spite ol casL incentives being available under tLe ]SY scLeme. All tLese 38
beneliciaries were asked lor tLe reason lor opting Lome delivery. JLe major reasons cited
are Lome delivery is more convenient (81 percent); non availability ol transport (11
percent); lack ol allordability (11 percent); and cultural/social reasons (3 percent).

Cash Inccntivc Bcccivcd by thc Bcncticiary undcr jSY Schcmc
Cut ol tLe /2 beneliciaries, 60 (83 percent) Lad received tLe casL incentive under
]SY scLeme and tLe average amount received by tLem is Rs. 913 JLe average amount is
low because beneliciaries wLo deliver at Lome receive Rs.500). Cut ol tLose wLo received
tLe casL incentive, all received it in one installment. Among tLose wLo received tLe casL
incentive, 10 percent received immediately alter tLe delivery, 18 percent received witLin a
week alter tLe delivery and /2 percent received it mucL later. Iorty percent beneliciaries
received casL incentive lrom tLe doctor, AM/IHW delivered tLe casL incentive to +9
percent beneliciaries, and a lew received it lrom Anganwadi worker. Ior 10 percent
beneliciariesotLer like Lospital clerk, compounder, MPW and SarpancL delivered it. Place
ol delivery ol casL incentive sLows tLat tLe beneliciaries Lave mainly received tLe casL
incentive at tLe lollowing places: Lome (10 percent), DH (22 percent) CHC (22 percent)
PHC (12 percent) and SC (12 percent). Cne beneliciary reported tLat sLe Lad laced
dilliculty in getting tLe incentive. ine (15 percent beneliciaries) reported tLat tLey laced
85
dilliculty in getting tLeir incentive. Iive ol tLem reported ol Laving to pay bribes,
payment tLrougL cLeque (2) and Lad to visit twice to get tLe incentive money (2).

7VKlK\CVKon ot Covcrnmcnt Hcalth Iacility in Last Six Months
JLis section addresses some ol tLe issues related to tLe quality ol care in
government LealtL lacilities. Iirst, to understand tLe extent ol utilisation ol tLe
government LealtL lacilities in last six montLs, all tLe surveyed LouseLolds were asked
wLetLer anyone lrom tLe LouseLold availed tLe services in any government LealtL lacility
in last six montLs. It sLows tLat 10 percent ol tLe rural LouseLolds (120 out ol 1200) Lave
availed tLe LealtL services in government LealtL lacility in last six montLs. (in case tLe
LouseLold availed tLe services lor tLe cLildren below 16 years ol age, tLe adult LouseLold
member accompanied tLe cLild was interviewed). JLe proportion ol LouseLolds availed
tLe services in government LealtL lacility is sligLtly more in LouseLolds located in SC
Leadquarter villages (11 percent) tLan in otLer villages (9 percent).

JLe selected cLaracteristics ol tLe patients/respondents wLo Lave availed tLe LealtL
services in government LealtL lacilities are presented in Jable H16. JLe age distribution ol
tLe respondents sLows tLat ++ percent are age below 30 years and 13 percent are age 60
years and above. Sex ol tLe respondents sLow tLat 5/ percent are lemales and +3 percent
are males. JLe socioeconomic cLaracteristics ol tLe respondents reveal tLat more tLan Lall
(53 percent) ol tLem are illiterates, 53 percent are ScLeduled Castes and ScLedule Jribes,
and more tLan two tLirds ol tLem (66 percent) belong to BPL LouseLolds. JLe percentage
ol LouseLolds witL low SLI is +8 percent. JLe cLaracteristics ol tLe respondents clearly
reveal tLat most ol tLem come lrom poor LouseLolds.

Clicnt Satistaction
Jable H1/ presents tLe type ol LealtL lacility visited and purpose ol visit; and
satislaction regarding beLaviour ol LealtL worker, privacy and availability ol medicine at
tLe lacility. JLe type ol LealtL lacility visited by tLe respondents sLow tLat 3/ percent
visited District Hospital 29 percent visited PHC, 25 percent visited tLe CHC and 5 percent
visited tLe SC. JLe major reason reported by tLe respondents lor tLe visit sLows tLat more
tLan lour-liltLs (85 percent) visited lor tLe treatment ol minor ailment and otLer services
tLe remaining 15 percent visited lor AC care, cLild care, and immunization.
86

Regarding tLe beLaviour ol tLe stall at tLe LealtL lacility, 95 percent ol tLe
respondents said tLat tLe stalls were courteous. Cnly lew (1 percent) respondents reported
tLat tLe beLaviour ol tLe stall were insulting/derogatory. inety two percent ol tLe
respondents said tLat tLe doctor/stall at tLe LealtL lacility listened to tLeir complaints, 6
percent said tLat tLey Lave somewLat listened and 2 percent said tLat tLey did not listen. It
appears tLat, except lew, tLe respondents are generally satislied witL tLe beLaviour ol stall
at tLe LealtL lacility.

Cne ol tLe problems olten cited lor tLe government LealtL lacilities is tLe lack ol
privacy lor tLe woman patients. JLe problem can be easily addressed witL eitLer a simple
partition ol tLe examination room or witL a clotL curtain. Jo know about tLis, tLe
respondents were asked wLetLer women patients treated witL privacy and dignity. JLree
lourtL ol tLe respondents reported tLat women patients are treated witL privacy and
dignity and 18 percent said tLat tLey are not treated witL privacy and dignity.

Regarding tLe availability ol medicines, +1 percent ol tLe respondents said tLat
patients witL cLronic illnesses (like joint pains, Leart disease, blood pressure, diabetes etc.)
get medicines regularly lrom tLe government LealtL lacility. However, 19 percent ol tLe
respondents said tLat tLey dont get medicines and two liltL said tLey dont know wLetLer
medicines are supplied at tLe LealtL lacility. Respondents were lurtLer asked wLetLer
doctor lrom government LealtL lacility do private practice during or alter tLe duty Lours.
Ior tLis question, one tLird said tLat tLey dont know, one tLird ol tLem said no, and
3+ percent said yes. Satislaction ol tLe respondents regarding tLe overall services ol tLe
government LealtL lacility reveals tLat 63 percent are satislied, 21 percent are somewLat
satislied and 16 percent are not satislied. Satislaction ol tLe respondents regarding tLe
beLaviour ol stall at tLe government LealtL lacility also sLows a similar level ol LigLer
satislaction witL // percent satislied, 16 percent somewLat satislied and / percent are not
satislied. JLougL tLe level ol satislaction appears to be LigLer, even a smaller level ol
dissatislaction regarding services and beLaviour ol stall Las to be looked into.
7scr Iccs and Extra Chargcs
In ]anjgir-CLampa, user lees are cLarged lor various services in tLe government
LealtL lacilities witL some categories ol patients exempted lor tLe cLarges. In tLe survey,
8/
among tLe respondents wLo Lave availed tLe services in government LealtL lacility in last
six montLs, 6/ percent said tLat tLey were cLarged user lees by tLe LealtL lacility (Jable
H18). Among tLose wLo paid tLe user lees, /8 percent paid lor registration, 13 percent lor
X-ray, 13 percent lor lab test and + percent lor ultrasound and 19 percent lor otLer like
medicines, injections, drips etc.. Among tLose wLo Lave paid user lees, about tLree lourtLs
(/+ percent) said tLat tLey Lave received tLe receipt lor tLe same and tLe remaining two
tLird said tLat receipts was not given. Among tLose wLo paid user lees, 30 percent said tLat
extra money was cLarged lrom tLem lor tLe services provided.

Scrviccs tor thc BPL Paticnts
BPL respondents were asked wLetLer BPL patients were provided lree/subsidized
services (Jable H19). Ior tLis question, 38 percent ol tLe respondents said tLat tLey are
provided lree/subsidized services, 38 percent said tLat tLey are not provided
lree/subsidized services and 2+ percent said tLat tLey dont know. About Lall ol tLe BPL
respondents (+8 percent) said tLat tLey dont lace dilliculty in getting lree/subsidized
services wLereas; 12 percent ol tLem said tLat BPL patients lace dilliculty in getting
lree/subsidized services. Cnly 10 percent BPL respondents said tLat RKS lacilitates tLe
paper work lor BPL patients. Lack ol awareness among BPL respondents regarding
availability ol lree treatment is seen.

Cutbrcak ot Discascs
All tLe respondents were asked wLetLer tLere is any outbreak ol malaria, measles,
gastroenteritis, jaundice and otLer diseases in tLeir area in tLe last six montLs (Jable H20).
JLe percentage ol respondents wLo reported tLe outbreak ol tLe above diseases in tLeir
area in tLe last six montL is 26 percent, 12 percent, 1/ percent, 5 percent and 3 percent
respectively. JLese ligures sLould be noted witL caution, as tLese are orally reported
outbreaks by tLe respondents. However, it indirectly indicates tLat mosquito breeding is a
major issue in tLe villages as outbreak ol malaria is reported by 26 percent ol tLe
respondents.
Action to bc takcn tor Sclcctcd Discascs
All tLe respondents were asked about tLe lollowing: steps lor prevention ol
diarrLoea; actions to be taken il a lamily member Las a LigL lever, persistent cougL lor
88
more tLan two weeks and loose motions lasting lor more tLan 2+ Lours; and action to be
taken il a cLild in tLe lamily Las persistent cougL and breatLing problems (Jable H21).
Ior tLe prevention ol diarrLoea, tLe proportion ol respondents mentioned tLe Land
wasLing; use ol sale lood and water, and use ol covered containers is 32 percent, +/ percent
and 19 percent respectively. JLe proportion ol respondents wLo do not know any simple
steps lor tLe prevention ol diarrLoea is +6 percent, wLicL is considerably LigL. Actions to
be taken lor LigL lever, persistent cougL and loose motions lor a lamily member and
persistent cougL and breatLing problems lor tLe cLild in tLe lamily sLows tLat percentage
ol respondents wLo will take tLe lamily member/cLild to tLe jLola cLaap or quack
doctor wLo visits tLe village is /8-88 percent lollowed by 26-30 percent to tLe nearest
government LealtL lacility. Jaking tLe lamily member/cLild to tLe jLola cLaapdoctor
wLo lrequent tLe village and to tLe nearest government LealtL lacility are tLe two
prominent actions reported by respondents. It indicates tLat tLere is lack ol tLe availability
ol government LealtL lacility nearer to tLe people at tLe times ol need and tLerelore tLe
otLer option becomes prominent. JLe proportion wLo reported tLat tLey will try witL
Lome remedies vary between 28 to 30 percent lor persistent cougLing and diarrLoea. It is
Leartening to know tLat, lor tLe loose motions, atleast 2+ percent ol tLe respondents said
tLat tLey will start giving CRS.

Awarcncss about Spacing Mcthods and Idcal Cap bctwccn Childrcn
JLe ideal spacing between 1st and 2nd cLild mentioned by tLe respondents reveals
tLat majority ol tLem (// percent) preler tLe ideal spacing to be 3 and more years (Jable
H22). AnotLer 20 percent said tLat tLe ideal spacing sLould be 2 years. Cnly a lew
respondents mentioned tLe ideal spacing as one year. JLe ideal spacing ol 3 years
reported by majority ol tLe respondents clearly indicate tLe need lor spacing metLods in
our lamily planning programme. Knowledge regarding tLe spacing metLods reveals tLat
Cral Pills is known to 88 percent ol tLe respondents lollowed by Condom (+3 percent)
and only 19 percent respondents know about ILD. About one lourtL (23 percent) ol tLe
respondents said tLat tLey dont know tLe lamily planning metLods available lor spacing.
Publicity lor temporary metLods ol lamily planning is needed.

AIDS and VCTC
89
JLe awareness, modes ol getting and source ol inlormation lor HIV/AIDS are
presented in Jable H23. Among tLe respondents, 5+ percent are aware about tLe
HIV/AIDS. WitL regard to knowledge about tLe modes ol translormation ol HIV/AIDS,
tLe table rellects tLat /6 percent ol tLe respondents are aware tLat unsale sexual contact, 61
percent sLaring ol needles/syringes and +6 percent blood translusion are tLe very
important modes ol translormation. About 12 percent ol tLe respondents are aware tLat
HIV/AIDS translorms lrom inlected motLer to cLild. JLe percent ol respondents do not
know about tLe modes ol getting HIV/AIDS is +6 percent, wLicL is considerably LigL.
Hardly any respondent reported tLe misconceptions like sLaking Lands, sneezing and
insect bite are tLe modes ol getting HIV/AIDS. Source ol inlormation lor tLe HIV/AIDS
reveals tLat JV is tLe single most prominent source ol inlormation (/5 percent) lor tLe
respondents. Some (10 percent) Lave got inlormation lrom lriends /relatives /neigLbours /
community etc. JLose wLo were aware about HIV/AIDS were lurtLer asked about tLeir
awareness regarding tLe HIV/AIDS Counselling Centre/Voluntary Counselling and
Jesting Centre (VCJC) nearby. JLe response sLows tLat, only / percent (+5) ol tLe
respondents are aware about tLe nearby Counselling Centre/VCJC. JLose wLo are aware
about tLe nearby Counselling Centre/VCJC were lurtLer asked about tLe location ol
Counselling Centre/VCJC. JLe percent ol respondents said tLat tLe Counselling
Centre/VCJC is located in PHC is 9 percent, CHC is ++ percent, District Hospital is +0
percent and Sub District Hospital is / percent. Among tLose wLo are aware about tLe
location ol VCJC, most ol tLem (93 percent) reported tLat tLat it is located in tLe
government LealtL lacility.

Suggcstions Providc by thc Bcspondcnts
JLe suggestions given by tLe respondents lor tLe improvement ol services in tLe
villages are given in Jable H2+. It sLows tLat respondents generally expect government
Lospital/PHC/SC in tLe village, doctor/AM are needed in tLe village, Doctor/AM/
LealtL worker sLould stay in tLe village, lacility lor delivery sLould be available witLin tLe
village, toilet lacility, LealtL lacility, LealtL workers, cleanliness, sanitation, sale drinking
water, pucca road and transport lacility lor tLeir villages. Some ol tLese suggestions given
by tLem reveal tLe genuine expectations ol tLe villagers lor tLe improvement ol tLe LealtL
and sanitation in tLeir villages.
90
Houschold Charactcristics


Tablc H1. Charactcristics ot thc rcspondcnts
Percent distribution ol respondents by background cLaracteristics

Charactcristics ot thc rcspondcnts Pcrccnt
Agc
< 30 years
30-39 years
+0-+9 years
50-59 years
60 years or more

30.0
26.3
22.3
12.2
9.3
Scx
Male
Iemale

61.9
38.1
Ycars ot Schooling
Illiterate
1-5 years
5-9 years
10 years or more

33.3
23.2
22.5
21.0
Marital Status
Lnmarried
Currently Married
Widowed/Divorced
Separated

9.5
8+.6
0./
5.3
Total numbcr ot rcspondcnts 1200

91
Tablc H 2. Charactcristics ot thc houschold
Percent distribution ol LouseLolds by tLeir background cLaracteristics

Charactcristics ot thc houschold Pcrccnt
Social Catcgory
SC
SJ
CBC
CtLers

28.5
19.2
50.2
2.1
Bcligion
Hindu
Muslim
CLristian
SikL
CtLers

99.+
0.5
0.1
-
-
HouseLolds Laving BPL status
HouseLolds living in pucca Louse
HouseLolds witL electricity
HouseLolds witL toilet lacility
HouseLolds witL piped water supply
HouseLolds using LPC/Biogas lor cooking
HouseLold Laving own agricultural land /cultivating any
agricultural land
HouseLold own a colour/B&W television
HouseLold Lave a mobile pLone
HouseLolds witL low Standard ol Living Index
% ol cLildren born in HealtL Institutions during last 5 years
60.1
33./
/+.3
1+.1
6.3
3.6
6/.5

+8.8
26.8
+6.5
1+.0
Total numbcr ot houscholds 1200

92
Tablc H 3. Pcrccnt distribution ot houscholds by thcir wastc disposal, stagnation ot
wastcwatcr and mosquito brccding around thc housc and systcm ot mcdicinc
prctcrrcd by thcm.

Wastc disposal, stagnation ot watcr and
mosquito brccding and systcm ot
mcdicinc prctcrrcd
Houscholds
locatcd in
Sub Ccntrc
HQ Villagc
Houscholds
locatcd in othcr
villagc

All
Mcthod ot wastc disposal by thc
houschold
JLrown in tLe open
Buried in a pit
Burnt
CtLer metLods


92.2
6.8
1.0
-


96.0
3.3
0./
-


9+.1
5.1
0.8
-
Stagnation ot wastc watcr around thc
houschold (stagnation ol waste water
observed by tLe interviewer)

23.5

20./

22.1

Instancc ot mosquito brccding in thc
stagnant watcr
(among tLe LouseLolds wLere stagnation ol
water is observed)

98.6

98.+

98.5



Systcm ot mcdicinc prctcrrcd OWNVKRNG
CPUYGT
AllopatLic
Ayurveda
Yoga and aturopatLy
Lnani
SiddLa
HomeopatLy
Jraditional Healing
Any otLer
one

98.3
2./
-
-
-
-
0.5
-
-

98./
1.3
-
-
-
-
0.3
-
-

98.5
2.0
-
-
-
-
-
-
-
Total numbcr ot houscholds 600 600 1200

93
Tablc H 4. Pcrccnt distribution ot houschold rcspondcnts by thcir intormation about
availability ot hcalth workcr, hcalth tacilitics and transport uscd to takc scrious
paticnts


Intormation about hcalth workcrs and
hcalth tacilitics
Houscholds
locatcd in
Sub Ccntrc
HQ Villagc
Houscholds
locatcd in
othcr
villagc

All
Availability ot hcalth workcrs
Heard about AM
Heard about Male HealtL Worker
Visited by a HealtL Worker in last one
montL
HealtL Workers are available wLen needed

/3.2
+1.0
23.3
52.8

/5./
35.0
19.2
29.2

/+.+
38.0
21.3
+1.0
Availability ot hcalth tacilitics to thc
houscholds, whcn rcquircd (multiplc
rcsponscs)
RMP
Private Clinic/CC
Sub Centre
PHC
CHC
CtLers



2.0
13.5
16.5
9.0
-
/+.0



0.2
6./
-
0.2
-
9+.3



1.1
10.1
8.3
+.6
-
8+.2
Iacility tor which scrious paticnts arc takcn,
whcn rcquircd (multiplc rcsponscs)
RMP/private Clinic
CC Hospital Clinic
PHC
CHC
District/Sub Divisional Hospital
CtLers


2.2
5+.8
/.8
1/.0
28.8
12.0


+.5
53.8
6.3
18.2
36.5
9.0


3.3
5+.3
/.1
1/.6
32./
10.5
Modc ot transport uscd to takc scrious
paticnts, whcn rcquircd (multiplc rcsponscs)
Bullock Cart
Bus
Private VeLicle
Ambulance
CtLers


0./
35./
9.3
-
66.2


0.5
30.2
5.0
-
/5.0


0.6
32.9
/.2
-
/0.6
Total numbcr ot houschold rcspondcnts 600 600 1200








94
Tablc H 5. Pcrccnt distribution ot houschold rcspondcnts by thcir knowlcdgc about
MBHM, ASHA and hcr activitics, VHMD, VHSC and jSY
MBHM, ASHA and jSY
Houscholds
locatcd in
Sub Ccntrc
HQ Villagc
Houscholds
locatcd in
othcr villagc
All
Hcard ot MBHM 23./
(1+2)
21.0
(126)
22.3
(268)
It hcard ot MBHM, sourcc ot intormation
about MBHM (multiplc rcsponscs)
ASHA
Radio/television
ewspaper
PancLayat
Community Member
CtLer


8.5
52.1
/./
+.9
25.+
1+.1


6.3
52.+
+.0
10.3
23.8
12./


/.5
52.2
6.0
/.5
2+.6
13.+
Hcard ot ASHA 95.2
(5/1)
92.5
(555)
93.8
(1126)
ASHA and hcr activitics, VHMD and VHSC
ASHA carry a kit
ASHA provide a common medicines lree ol
cost
ASHA Leld discussions about Land wasLing
ASHA Leld discussions about construction ol
LouseLold toilets
ASHA Leld discussions about sale drinking
water
Village HealtL and utrition Day being
organized
in tLe village
Presence ol Village HealtL and Sanitation
Committee in tLe village

/0./
82.+
51.3
+5.0

51.8
+2.0

10./

68.9
81.8
++.9
39.8

+6.2
+2.5

11.2

69.8
82.1
+8.1
+2.+

+9.0
+2.3

10.9
Ircqucncy ot Villagc Hcalth and Mutrition
Day
Weekly
MontLly
Quarterly
Annual

13./
61.0
10.0
15.3

5.+
53.1
18.1
23.2


9.6
5/.1
1+.1
19.2

Awarc about thc jSY schcmc 51.2
(30/)
+8./
(292)
+9.9
(599)
It awarc about jSY, sourcc ot intormation
about thc jSY OWNVKRNGQRVKQPU
Radio/Jelevision
PampLlets
Hoardings at SC/PHC etc.
ASHA Worker
Anganwadi Centre/Worker
AM
Doctor
Cram PancLayat
CCs/SHCs
CtLer


23.1
3.6
3.9
31.3
/.8
15.3
6.2
6.5
1.6
3+.9


2/./
3.+
0./
31.8
/.5
9.6
/.9
9.6
1.0
35.6


25.+
3.5
2.3
31.6
/./
12.5
/.0
8.0
1.3
35.2
Houschold is a bcncticiary ot jSY Schcmc 12.7
(38)
11.3
(3+)
12.0
(/2)
Total numbcr ot houschold rcspondcnts 600 600 1200
95

Tablc H 6. Pcrccnt distribution ot jSY bcncticiarics by thcir background
charactcristics

Charactcristics ot thc jSY bcncticiarics Pcrccnt
Agc
< 20 years
20-2+ years
25-29 years
30-3+ years
35-39 years
+0-++ years
+5-+9 years

11.1
61.1
20.8
2.8
+.2
-
-
Parity
0
1
2
3 & 3
-
-
-
52..8
+/.2
Social catcgory
SC
SJ
CBC
CtLers

33.3
18.1
+/.2
1.+
Bcligion ot thc houschold
Hindu
Muslim
CLristian
SikL
CtLers

100.0
-
-
-
-
SLI ot thc houschold
Low
Medium
HigL

52.8
30.6
16./
BPL houschold 66./
Placc ot last dclivcry (dclivcry prcvious to this dclivcry)
HouseLold
HealtL Institution

56.9
+3.1
Total numbcr ot jSY bcncticiarics intcrvicwcd 72

96
Tablc H 7. Timing, pcrson and placc ot rcgistration tor jSY schcmc

Timing, placc ot rcgistration tor jSY schcmc and jSY card Pcrccnt
Timing ot hcaring about jSY schcmc
Belore being pregnant
During pregnancy

25.0
/5.0
Stagc ot prcgnancy whcn bcncticiary got rcgistcrcd tor jSY
schcmc
1
st
montL
2
nd
montL
3
rd
montL
+
tL
montL
5
tL
montL or later

5.2
10.3
22.+
8.6
53.+
Pcrson who rcgistcrcd thc bcncticiary tor jSY schcmc
Doctor
LHV
AM/IHW
Anganwadi worker
ASHA worker
CtLers

11.1
2.8
+/.2
20.8
13.9
+.2
Placc whcrc thc bcncticiary was rcgistcrcd tor jSY schcmc
District/Sub-district Hospital
Community HealtL Centre
PHC
Sub-Centre
Anganwadi Centre
Private Lospital accredited by tLe government
At Lome
CtLer places

13.9
20.8
2.8
15.3
25.0
-
18.1
+.2

Total numbcr ot jSY bcncticiarics 72


Tablc H 8. Bcccipt ot jSY card, rolc ot ASHA in gctting jSY card and ditticultics taccd by thc
bcncticiary in gctting thc jSY card

jSY Card Pcrccnt
jSY card rcccivcd by thc bcncticiary

19.+
ASHA workcr hclpcd thc bcncticiary in gctting jSY card

5/.1
Bcncticiary taccd ditticulty in procuring jSY card

0.0
It taccd ditticulty, typc ot ditticultics taccd by bcncticiary
(OWNVKRNGQRVKQPU
Cards were not available
Iormalities lor making cards were too cumbersome
Was asked to pay money lor tLe card
CtLer dilliculties


-
-
-
Total numbcr ot jSY bcncticiarics 72

97
Tablc H 9. Bolc ot ASHA during thc prcgnancy ot thc bcncticiarics

Bolc ot ASHA during thc prcgnancy ot thc bcncticiarics Pcrccnt
ASHA workcr providcd spccitic hclp during last prcgnancy

3+./
Bcncticiary rcccivcd advicc trom ASHA during prcgnancy tor
thc tollowing OWNVKRNGQRVKQPU
Diet
Danger signs
Delivery care
Breastleeding
ewborn care
Iamily planning
ot applicable (ASHA not appointed in tLe village)


++.+
20.8
25.0
25.0
26.+
12.5
-
Intormation givcn to thc bcncticiary (Micro Birth Planning)
during antcnatal pcriod by Doctor/AMM/ASHA OWNVKRNG
QRVKQPU
Date ol next cLeck-up
Place ol next cLeck-up
Date ol expected delivery
Place ol delivery
Place ol relerral, il complications arise


5+.2
3/.5
33.3
31.9
25.0
Total numbcr ot jSY bcncticiarics 72

Tablc H 10. Placc ot dclivcry and rcason tor opting institutional dclivcry




Placc ot dclivcry and rcason tor opting institutional dclivcry Pcrccnt
Placc ot dclivcry
District/Sub-district Hospital
Community HealtL Centre
PHC
Sub-Centre
Jrust/CC Hospital
Private Lospital
Private Lospital accredited by tLe government
At Lome

20.8
22.2
1.+
-
1.+
-
1.+
52.8
Bcasons tor opting Institutional Dclivcry OWNVKRNGTGCUQPU
Money available under ]SY scLeme
Better access to institutional delivery
Better care lor motLer and new born cLild
Services in tLe area
Support provided by ASHA
Availability ol transport assistance
Previous cLild was born in an institutions
CtLer
Jotal

23.5
20.6
+/.1
-
32.+
-
2.9
1+./
(34)
Total numbcr ot jSY bcncticiarics 72
98

Tablc H 11. Transport ot thc bcncticiarics to rcach thc Hcalth Institution

Proccss ot Transport Pcrccnt
Bcccivcd rctcrral slip trom ASHA/hcalth pcrsonncl to acccss
dclivcry scrviccs

20.6
Iaccd ditticulty in rcaching Hcalth Institution
It taccd ditticulty, typc ot ditticultics taccd in rcaching thc
Hcalth Institution by thc bcncticiarics OWNVKRNGQRVKQPU
It was late in tLe nigLt
Did not Lave sullicient money
Jransport was not immediately available
Male members in tLe LouseLold were not present
ASHA was not readily available
CtLers

32.+
18.2
36.+
/2./
-
9.1
-
Avcragc distancc to thc ultimatc placc ot dclivcry trom thc
bcncticiarys rcsidcncc (in kms)
22.2

Modc ot transport uscd by thc bcncticiary to rcach thc ultimatc
placc ot dclivcry
Covernment Ambulance
Private veLicle
VeLicle arranged by Local HealtL Committee
CtLer


-
2.9
-
9/.1
Pcrsons tacilitatcd in arranging thc transport
ASHA
AM/HealtL Worker
Village HealtL Committee
Iamily members/relatives
CtLers

2.9

-
-
9/.1
Bcncticiary had moncy to pay tor thc transport scrviccs 91.2
Avcragc amount spcnt on transport (in Bs.) 951.5
Avcragc amount ot transport assistancc rcccivcd undcr jSY
schcmc by thc bcncticiary (in Bs.)
15/.6

Cascs whcrc amount spcnt on transport is morc than thc
amount rcccivcd
32
Pcrsons accompanicd thc bcncticiary to thc Hcalth Institution
ASHA
Relatives
MotLer/MotLer-in-law
Husband
AM/LealtL Worker
CtLers

11.8
85.3
-
-
-
2.9
Total numbcr ot jSY bcncticiarics 34

99
Tablc H 12. Waiting timc at thc hcalth tacility, typc ot dclivcry, amount spcnt at thc
hcalth tacility and satistaction rcgarding scrviccs availablc in thc hcalth tacility

Waiting timc, typc ot dclivcry and satistaction rcgarding scrviccs Pcrccnt
Avcragc waiting timc at thc tacility until somconc attcndcd thc
bcncticiary (in minutcs)
11.5
Typc ot dclivcry (Pcrccnt)
ormal
Assisted (Iorceps, Vacuum)
Caesarean

6+./
1/.6
1/.6
Avcragc numbcr ot days spcnt in thc tacility till dischargc 3.1
Pcrccnt bcncticiary who havc to pay at thc hcalth ccntrc /6.5
Avcragc amount paid to thc hcalth ccntrc (Bs.) 1382./
Satistaction rcgarding thc scrviccs availablc in thc hcalth ccntrc
(Pcrccnt)
Satislied
SomewLat satislied
ot satislied

6/.6
20.6
11.8
Bcasons tor not satisticd with thc scrviccs in thc hcalth ccntrc (Pcrccnt)
Stall was rude
Iacility was not clean
Poor quality ol services
CtLer

25.0
-
50.0
25.0
Total numbcr ot jSY bcncticiarics 34



Tablc H 13. Bcason tor thc jSY bcncticiary to opt homc dclivcry, in spitc ot cash
inccntivcs bcing availablc undcr thc jSY Schcmc

Bcason tor thc bcncticiary to opt homc dclivcry Pcrccnt
Bcasons tor homc dclivcry OWNVKRNGQRVKQPU
Home delivery is more convenient
Iear ol stitcLes/caesarean
Indillerent beLaviour ol Medical/paramedical stall
Cultural/social reasons
Jransport not being available
Cant allord
CtLers

81.6
-
-
2.6
10.5
10.5
-
Total numbcr ot jSY bcncticiarics undcr Homc Dclivcry 38

100
Tablc H 14. Cash inccntivc rcccivcd by thc bcncticiary undcr jSY schcmc

Cash inccntivc
Pcrccnt
Mo. ot bcncticiary rcccivcd cash inccntivc undcr jSY schcmc 60
Pcrccnt ot bcncticiary rcccivcd cash inccntivc undcr jSY schcmc 83.3
Avcragc amount rcccivcd by bcncticiary as cash inccntivc (in Bs.) 912.5
Bcccivcd thc cash inccntivc:
In one go
In 2 instalments
In 3 instalments

100.0
-
-
Timing ot thc rcccipt ot thc cash inccntivc by bcncticiary
At tLe time ol registration
At tLe time ol antenatal cLeckups
MucL belore tLe delivery
WitLin a week belore tLe EDD
Immediately alter tLe delivery
WitLin a week alter tLe delivery
MucL later
ot received yet
Do not know/Lusband knows
CtLer

-
-
-
-
10.0
18.3
/1./
-
-
-
Thc pcrson who dclivcrcd thc cash inccntivc to thc bcncticiary
Doctor
LHV
AM/IHW
Anganwadi worker
ASHA worker
CtLers

+0.0
1./
+6./
1./
-
10.0
Placc whcrc thc cash inccntivc rcccivcd by thc bcncticiary
District/Sub-district Hospital
Community HealtL Centre
PHC
Sub-Centre
Anganwadi Centre
Private Lospital accredited by tLe government
At Lome
CtLer place

21./
21./
11./
11./
6./
-
10.0
16./
Iaccd ditticulty in gctting inccntivc moncy 15.0
It taccd ditticulty, typc ot ditticulty taccd by thc bcncticiary
Was asked to pay tLe bribe
WLen paid by cLeque/dralt
CtLer dilliculty

55.6
22.2
22.2
Total numbcr ot jSY bcncticiarics 63

101
Tablc H 15. Ltilization ot govcrnmcnt hcalth tacility in last 6 months
Ltilization ot govcrnmcnt hcalth tacility
Houscholds
locatcd in
Sub Ccntrc
HQ Villagc
Houscholds
locatcd in
othcr
villagc
All
Percent ol LouseLold wLo availed LealtL services in
government LealtL lacility in last 6 montLs
11.0
(66)
9.0
(5+)
10.0
(120)
Total numbcr ot houscholds 600 600 1200

Tablc H 16. Charactcristics ot thc rcspondcnts who havc availcd thc scrviccs in
govcrnmcnt hcalth tacility in last 6 months
Charactcristics ot thc rcspondcnt Pcrccnt
Agc
<16 years
16-19 years
20-29 years
30-39 years
+0-+9 years
50-59 years
60 years or more

19.2
10.0
15.0
13.3
15.8
1+.2
12.5
Scx
Male
Iemale

+3.3
56./
Ycars ot schooling complctcd
Illiterate
1-5 years
6-9 years
10 years

52.9
21.8
11.8
13.+
Marital status
Lnmarried
Currently Married
Divorced/Separated
Widowed

2+.2
66./
-
9.2
Social catcgory ot thc houschold
SC
SJ
CBC
CtLers

29.2
23.3
+2.5
5.0
Bcligion ot thc houschold
Hindu
Muslim
CLristian
SikL
CtLers

100.
-
-
-
-
BPL Houschold 66./
Standard ot Living Indcx ot thc houschold
Low SLI
Medium SLI
HigL SLI

+/.5
36./
15.8
Total rcspondcnts who havc availcd thc scrviccs in govcrnmcnt
hcalth tacility in last 6 months
120
102
Clicnt Satistaction

Tablc H 17. Typc ot hcalth tacility visitcd, purposc ot visit and clicnt satistaction
rcgarding bchaviour ot hcalth workcr, privacy and availability mcdicincs

Typc ot hcalth tacility visitcd, purposc ot visit and clicnt
satistaction
Pcrccnt
Typc ot hcalth institution whcrc scrvicc availcd
District/Sub District Hospital
CHC
PHC
Sub Centre
AYLSH

36./
25.0
29.2
5.8
3.3
Purposc ot visit to thc hcalth tacility
Jreatment ol minor ailment
AC care
CLild care
Immunization
CtLer

85.0
5.8
+.2
-

Bchaviour ot thc statt at thc hcalth tacility
Courteous
Casual/Indillerent
Insulting/Derogatory

95.0
+.2
0.8
Listcning ot complaints by Doctor/statt
Listened to complaints
SomewLat listened
ot listened
Cant say

92.5
5.8
1./
-
Womcn paticnts trcatcd with privacy and dignity
Yes
o
Dont know

/+.2
1/.5
8.3
Paticnts with chronic illncsscs (likc |oint pains, hcart discasc,
blood prcssurc, diabctcs ctc.) gct mcdicincs rcgularly trom hcalth
tacility
Yes
o
Dont know


+0.8
19.2
+0.0
Privatc practicc ot thc doctors during and attcr thc duty hours
Yes
o
Dont know

3+.2
33.3
32.5
Satistaction with thc ovcrall scrviccs ot thc govt hcalth tacility
Satislied
SomewLat satislied
ot satislied

63.3
20.8
15.8
Satistaction with bchaviour ot statt at thc govt hcalth tacility
Satislied
SomewLat satislied
ot satislied

/6./
15.8
/.5
Total rcspondcnts who havc availcd thc scrviccs in govcrnmcnt
hcalth tacility in last 6 months
120



103


Tablc H 18. Lscr tccs and cxtra chargcs

Lscr tccs and cxtra chargcs tor thc scrviccs providcd
Pcrccnt
Lscr tccs chargcd trom thc uscrs
Yes
o

66./
33.3
It uscr tccs chargcd, typc ot uscr tccs
Registration
X-ray
Lltrasound
Lab test
CtLer

//.5
12.5
3.8
12.5
18.8
Bcccipt givcn tor thc uscr tccs
Civen
ot given

/3.8
26.3
Extra moncy chargcd tor thc scrviccs providcd
Yes
o
Dont know

30.0
65.0
5.0
Total rcspondcnts who havc paid thc uscr tccs 80



Tablc H 19. Scrviccs tor thc BPL paticnts

BPL Patcnts Pcrccnt
BPL paticnts providcd trcc/subsidizcd scrviccs
Yes
o
Dont know

3/.9
3/.9
2+.1
BPL paticnts tacc ditticulty in gctting trcc/subsidizcd
scrviccs
Yes
o
Dont know


12.1
+8.3
39./
BKS tacilitatcs thc papcrwork tor BPL paticnts
Yes
o
Dont know

10.3
51./
3/.9
Total BPL rcspondcnts who havc availcd thc scrviccs in
govcrnmcnt hcalth tacility in last 6 months

58


104
Tablc H 20. Cutbrcak ot sclcctcd discascs (Malaria, Mcaslcs, Castrocntcritis,
jaundicc and Cthcr Discascs) in thc rcspondcnts arca in thc last six months

Cutbrcak ot discascs Pcrccnt
Cutbrcak ot Malaria in thc last six months
Yes
o
Dont know

26.+
63.2
10.3
Cutbrcak ot Mcaslcs in thc last six months
Yes
o
Dont know

12.3
/5.9
11.8
Cutbrcak ot Castrocntcritis in thc last six months
Yes
o
Dont know

1/.0
/3.0
10.0

Cutbrcak ot jaundicc in thc last six months
Yes
o
Dont know

5.3
81.8
12.9

Cutbrcak ot Any Cthcr Discascs in thc last six months
Yes
o
Dont know

3.+
/8.+
18.2
Total numbcr ot houschold rcspondcnts 1200


105
Tablc H 21. Action to bc takcn tor sclcctcd discascs (diarrhoca, high tcvcr,
pcrsistcnt cough, loosc motion, pcrsistcnt cough and brcathing problcms
or a child)

Action to bc takcn tor sclcctcd discascs (Multiplc rcsponscs) Pcrccnt
Prcvcntion ot diarrhoca
Hand wasLing
Lse ol sale lood and water
Lse ol covered containers
Proper disposal ol garbage
CtLer
Dont know

31./
+6.8
19.0
8.0
3.0
+5.8

Action to bc takcn it a tamily mcmbcr has a high tcvcr
Cet tLe blood tested lor malaria
Jaken to tLe RMP
Jake to tLe nearest govt. LealtL lacility
Consult ASHA
Jry Lome remedies
CtLer
Dont know

6.1
0.8
30.0
3.0
6.8
8/./
0.1
Action to bc takcn it a tamily mcmbcr has a pcrsistcnt
cough tor morc than two wccks
Jaken lor sputum testing
Jaken to tLe RMP
Jake to tLe nearest govt. LealtL lacility
Consult ASHA
Jry Lome remedies
CtLer
Dont know

3.0
0.8
28.2
3.3
2/.6
2/.6
86.3
0.3
Action to bc takcn it a tamily mcmbcr has loosc motions
lasting tor morc than 24 hours
Stop giving Cral Iluids/Iood etc
Start giving CRS
Jaken to tLe RMP
Jake to tLe nearest govt. LealtL lacility
Consult ASHA
Jry Lome remedies
CtLer
Dont know


3.5
23.6
1.5
26.3
5.0
29.8
/8.+
0.6
Action to bc takcn it a child in thc tamily has pcrsistcnt
cough and brcathing problcms
Jry Lome remedies
Jaken to tLe RMP
Jake to tLe nearest govt. LealtL lacility
Consult ASHA
CtLer
Dont know


31.6
1.1
2/.+
+.1
81.8
0.8
Total numbcr ot houschold rcspondcnts 1200


106
Tablc H 22. Awarcncss about spacing mcthods and idcal gap
bctwccn 1
st
and 2
nd
child

Awarcncss about spacing mcthods and idcal gap bctwccn
childrcn
Pcrccnt
Awarc about thc tamily planning mcthods

//.2
Idcal gap bctwccn 1
st
and 2
nd
child
1 year
2 year
3 and more years

3.8
19.8
/6.5
Mcthods availablc tor spacing
ILD
Cral Pills
irodL/Condom
Any otLer
Dont know

18.6
88.0
+/.+
1.5
5.0
Total numbcr ot houschold rcspondcnts awarc ot spacing
mcthods
926
































107


Tablc H 23. Awarcncss about modcs ot gctting AIDS, sourcc ot intormation
about AIDS and awarcncss about VCTC

AIDS and VCTC Pcrccnt
Hcard ot HIV/AIDS 5+.1
(6+9)
Awarcncss about modcs ot gctting HIV/AIDS (out ot
rcspondcnts who havc hcard ot AIDS)
Lnsale sexual contact
Blood translusion
SLaring needles/syringes
Irom motLer to cLild
SLaking Lands
Sneezing
Insect bite
Kissing
CtLers


/6.+
+6.1
60.9
/.6
0.8
-
0.5
-
10.3

Sourcc ot intormation tor HIV/AIDS (out ot rcspondcnts
who havc hcard ot AIDS)
Radio
JV
HealtL workers
Posters
ewspapers
CtLers


11.+
/+.9
+.8
2.6
+.8
10.6
Awarc about HIV/AIDS counsclling ccntrc/VCTC
ncarby(out ot rcspondcnts who havc hcard ot AIDS)

6.9
(+5)
Bcspondcnts by rcportcd location ot HIV/AIDS
counsclling ccntrc/VCTC(out ot rcspondcnts who arc
awarc about HIV/AIDS counsclling ccntrc/VCTC ncarby)
PHC
CHC
District Hospital
Sub-District Hospital
Private Hospital
CtLer



8.9
++.+
+0.0
6./
-
-
Total numbcr ot houschold rcspondcnts 1200

108
Tablc H 24: Suggcstions givcn by thc rcspondcnts

x Covt. Hospital/PHC/SC needed in tLe village
x Doctor/AM needed in tLe village
x Doctor/AM/ LealtL worker sLould stay in tLe village
x Iacility lor delivery sLould be available witLin tLe village
x Jreatment sLould be available lor all types ol diseases
x Medicines sLould be available regularly
x Jreatment sLould be lree ol cost
x Joilets needed in tLe village
x eed transport lacility lrom tLe village
x Cleanliness needed in tLe village
x Pucca roads needed/roads sLould be repaired
x Inlormation/publicity about LealtL scLemes needed
x Closed drainage system needed/gutters sLould be repaired or
closed
x Sale/clean drinking water needed
x o suggestions/cant say/satislied-5+




CJCRVGT-7

Status and Pcrtormancc ot Mitanin (ASHA)

CLLattisgarL state Las pioneered tLe concept ol Mitanin wLicL is now popularly
known as ASHA in tLe country as wLole. JLere is a network ol 60,000 mitanins spread across
tLe lengtL and breadtL ol tLe state in all 16 districts. EacL village Las atleast one Mitanin and
many villages Lave 3-5 mitanins. Jwenty six ASHAs /Mitanin were interviewed lrom tLe SC
as well as lartLest villages covered under tLe 2 CHCs in ]anjgir-CLampa district. Presented
below is tLe status and perlormance ol Mitanin, role and perlormance ol Mitanin and tLeir
awareness about dillerent programmes.
Status ot Mitanin
Average population served by Mitanins is 393 i.e lor every 393 persons tLere is one
Mitanin to provide LealtL related services in tLe village. Average number ol
village/Labitations served by Mitanin is 1.6. Regarding tLeir selection process majority
Mitanins (86 percent) Lave been selected on tLe recommendation ol AM, 19 percent on
recommendation ol Cram PradLan and 15 percent on tLe recommendation ol Anganwadi
Worker and Village HealtL Committee. JLus AMs Lave played a major role in identilying
and selecting tLe Mitanin ol tLeir areas.
All tLe Mitanins Lave undergone training (100 percent). Majority (96 percent) ol tLe Mitanins
Lave completed tLe tentL round ol training wLicL is comparable to 1-+ modules ol ASHA in
otLer states. JLus tLe training component is very strong in tLe Mitanin Programme. Majority
(96 percent) ol tLe Mitanins Lave received a kit popularly known as dawa peti .
Bolc and Pcrtormancc ot Mitanin
Jwelve percent Mitanins are DCJs provider in tLeir villages and only 1.2 ]SY cases
Lave been lacilitated by tLem in tLe last tLree montLs. Mitanins on an average Lave Landled
3./ cases ol diarrLoea and given CRS to cLildren in tLe last tLree montLs. Mitanins Lave
accompanied Lardly any institutional delivery cases (0.2). Cn an average a Mitanin Las

distributed 2 Cral Pills. Cn an average 6 Malaria patients Lave been given drugs, and tLe
number ol new pregnancies identilied is 2.0. umber ol group meetings like MaLila mandals
arranged by a mitanin is 2.2. umber ol HealtL & utrition days arranged is 1.+. Average
money incentive received by a Mitanin during one montL lor tLe dillerent LealtL activities
carried out by tLem is Rs. 1+ lor ]SY Rs. 28 lor Sterlisation, Rs. 8 lor VHD, and Rs 35 lor
otLer activities like motivating lor immunization. Cn an average tLe total amount received by
a Mitanin is Rs. 85 lor dillerent types ol services given by Ler.
Ditticultics taccd by Mitanins
Mitanins were asked about tLe types ol dilliculties laced in implementing programme
activities under RHM. Iorty two percent Mitanins stated tLat lunds are not available in
time to carry out dillerent activities and +2 percent reported delayed supply ol drugs wLicL
allected tLeir work. and tLe same proportion reported tLat lunds are not available on time.
BeLaviour ol stall in LealtL lacilities is not appropriate (15 percent) and adequate training is
not provided (12 percent) is also reported by tLem.
Support rcquircd by Mitanin
Mitanins were asked about tLe type ol support tLey required lor ellective lunctioning
and implement tLe programme in tLeir area. Jwo issues wLicL were stated by majority ol
tLem are payments sLould be made timely (65 percent) and Mitanins sLould be paid a lixed
remuneration (62 percent). Some Mitanins expressed tLe necessity ol more training to be
arranged lor Mitanin and community members(2/ percent) wLile some ol tLem also raised
otLer (2/ percent) issues like provision ol traveling allowance and transport lacilities, more
medicines sLould be provided and a LealtL lacility sLould be nearby.
Awarcncss Lcvcl ot Mitanins
JLe Awareness level ol tLe Mitanins on dillerent LealtL aspects is LigL. Majority (92
percent) ol tLem know about one or more steps about tLe prevention ol diarrLoea. Breast
leeding sLould be started soon alter birtL is known to all tLe 26 Mitanins. Correct age ol cLild
till wLen Le/sLe sLould be exclusively breastled is also known to all tLe Mitanins. Amount ol

casL incentive given under ]SY is also known to all tLe Mitanins. However, majority know
tLat amount ol casL incentive given under ]SY is Rs 500 lor Lome delivery and Rs.1800
including transportation lor institutional delivery.

Bcmarks ot Mitanins
JLe remarks given by some ol tLe Mitanins regarding tLe programmes are given below in
tLeir
own words (tLe name ol tLe village is mentioned in tLe brackets):
1. We must receive our drugs like CRS; oral pills etc regularly so tLat continuity is
maintained in providing tLese to tLe local people. Il we stop distributing medicines
people lose laitL in us (Beltukri).
2. We Lardly receive Rs. 50 per montL lor bringing cLildren lor immunization. JLis
amount is meager and insullicient lor sustaining our interest in providing services. We
are tLerelore looking lor alternative source ol income as we do not receive any otLer
incentive (avapara /Levai).
3. We sLould receive a lixed montLly remuneration to provide regular services and it
sLould be paid on time (Deori and KarLi).
+. JLe PancLyat Secretary does not provide tLe details ol expenditure made lrom VHSC
lunds and does not sLow tLe bank accounts. Lnder tLese circumstances it is dillicult to
work jointly witL Lim (avapara /Levai).
5. Clear instructions regarding Low to spend untied lunds Lave not been provided to us.
AltLougL I Lave a joint account witL tLe SarpancL I Lave not spent tLe money
(agaridi).

Bcmarks /Suggcstions by thc obscrvcr tor thc improvcmcnt ot scrviccs
1. Mitanins ol majority ol tLe villages covered in tLe district are well trained, inlormed,
vocal and motivated workers wLo Lave a presence in tLe local community. In most ol

tLe villages tLey were identilied by tLe local people. JLey are an asset at tLe grassroots
lor lacilitating tLe RHM programme.

2. Mitanins Lave received ten rounds ol training (covering tLe + Modules ol ASHA) by
SHRC
and awareness levels are LigL. JLey can be a uselul link lor LealtL promotion and BCC
activities under RHM.

3.JLe services ol Mitanins are grossly underutilized lor RHM programme (as tLere is a
mismatcL between tLe training received and actual perlormance).JLis is due to total
lack ol dissemination ol inlormation and monitoring by district LealtL ollicials about
tLeir expected role in lacilitating tLe programme.
+. AltLougL Mitanins are expected to be tLe key lacilitators lor ]SY programme, tLey are
not
motivating women lor institutional delivery. JLis is largely due to tLeir ignorance
about tLe
programme. JLey Lave tLus accepted Lome deliveries as a norm.

5. Mitanins are totally ignorant about tLeir expected role and linkages witL AMs in
preparation ol micro-birtL plan and promoting institutional delivery at tLe
community level lor ]SY.

6. Mitanins also lack awareness about tLe casL incentives tLey are likely to get in case
tLey promote institutional delivery.(In ]angir-CLampa a total package ol Rs. 1+00
plus +00 as transport cLarges is being directly paid to tLe beneliciary leaving only Rs.
200 lor tLe Mitanin).

/. Presently, majority ol tLe Mitanins are only receiving a paltry sum ol Rs. 50 per
montL lor lacilitating immunization programme. JLis amount is also not being paid
on time wLicL Las led to lrustration among majority ol tLem.


8. Majority ol tLe Mitanins are not clear about utilization ol untied lunds lrom VHSC
altLougL all ol tLem Lave received tLe lunds. Clear guidelines lrom tLe district are
essential so tLat tLe money does not remain unutilized.

9. JLe Mitanins are still motivated to provide services to tLe community. Jo elicit
maximum services lrom tLem and to retain tLe Mitanins active support in lacilitating
tLe RHM programme, tLe state government ellorts sLould be made to resolve tLe
issues related to incentives by concretizing payments.

Status and Pcrtormancc ot ASHA

Tablc A1. Status ot ASHA

A. umber ol ASHA interviewed in tLe district 26
B. Average population served by ASHAs interviewed 392.5
C. Average number ol village / Labitations served by AHSAs covered 1.6
D. Percentage ol ASHAs by metLod ol selection
Selected on recommendation ol AM 85./
Selected on recommendation ol Cram PradLan 19.2
Selected on recommendation ol Anganwadi Worker 15.+
Selected by Village HealtL Committee 15.+
Previously working as Dai 0
CtLer 0
E. Percentage ol ASHAs undergone training 100.0
I. Percentage ol ASHAs undergone training by modules
Module 1 96.2
Module 2 23.1
Module 3 0
Module + 0
C. Percentage ol ASHAs issued ASHA Kit 96.2

Tablc A2: Bolc and Pcrtormancc ot ASHA

A. Percentage ol ASHAs wLo are DCJS provider 11.5
B. Average montLly no. ol ]SY cases lacilitated in last 3 montLs by
ASHA
1.2
C. Average no. ol cases Landled in last tLree montLs
CLildren witL diarrLea given CRS 3./
Accompanied Institutional deliveries cases 0.2
umber ol Cral Pills distributed 1.8
umber ol Malaria Patients given drugs 6.3
umber ol new pregnancies identilied 2.0
umber ol group meetings like MaLila mandals arranged 2.2
umber ol HealtL & utrition days arranged 1.+
D. Average money incentive received by an ASHA on an average
during one montL

]SY 1+
Sterlisation 28
VHD 8
CtLer 35
Jotal 85

Tablc A3. Distribution ot ASHAs by rcportcd typcs ot ditticultics taccd and kind ot
support rcquircd

A. Percentage ol ASHAs by types ol dilliculties laced in
implementing programme activities under RHM

Iunds not available in time +2.3
Adequate training is not provided 11.5
Delayed supply ol drugs +2.3
BeLaviour ol stall in LealtL lacilities is not appropriate 15.+
Inadequate lacilities lor institutional deliveries 23.1
B. Reported kind ol support require ASHA to enable Ler to
implement tLe programme more ellectively

More training is to be arranged lor ASHA & Community
members
26.9
ASHA sLould be paid a lixed remuneration 61.5
Payments sLould be made timely 65.+
CtLer 26.9

Tablc A4 Distribution ot ASHAs by rcportcd awarcncss on dittcrcnt aspccts

A. Percentage ol ASHAs reporting awareness about
Important steps lor prevention ol diarrLea 92.3
Jime ol initiating Breast Ieeding 100.0
Age ol cLild till wLen Le/sLe sLould be exclusive breastled 100.0
Amount ol casL incentive given under ]SY 100.0


%JCRVGT

)TCO2CPEJC[CV

Cram PancLayat scLedule was canvassed to tLe member ol CP/SarpancL
representing tLe selected village. It covered tLe basic inlormation about tLe Cram
PancLayat (population and LouseLolds covered), IEC activities carried out, lunctioning ol
tLe VHSC, implementation ol Mitanin and ]SY, and awareness about tLe Mitanin at tLe
Cram PancLayat level. Cut ol 39 villages covered lor tLe survey, interview ol 23 Cram
PancLayatsMembers/SarpancLes was done lrom 2+ PancLayat villages.

JLe average population ol tLe 23 villages is 2660 witL an average SC population ol
686 (10.+ percent) and SJ population ol +/9 (18 percent). JLe average number ol
LouseLolds per village is 598 witL an average ol 12/ SC and 86 SJ LouseLolds. JLe average
number ol BPL lamilies per village is 300 witL an average ol 8/ SC and 59 SJ LouseLolds.

#YCTGPGUUCPF+PXQNXGOGPVQH)TCO2CPEJC[CVUKP04*/
Regarding tLe regular availability ol AM, less tLan Lall (++ percent) ol tLe Cram
PancLayats reported tLat tLe AM is regularly available in tLe village. Less tLan one
tLird Cram PancLayats (30 percent) reported tLat tLey know tLe tour plan ol tLe AM
and little more tLan one lourtL (26 percent) reported tLat tLe Sub Centre is providing
timely services to tLe patients in tLe village. More tLan tLree lourtLs (/8 percent) ol tLe
Cram PancLayats reported tLat it Lad a role in conducting/linalising IEC programme in
tLe village.

Cut ol 23 Cram PancLayats (95 percent) Lave reported tLe existence ol tLe VHSC
in tLeir village and tLe receipt ol Lntied Iunds lor tLe VHSC is reported by 95 percent.
Moreover, two-tLird (65 percent) ol tLe Cram PancLayats reported about tLe regular
meetings ol tLe VHSC but only Lall ol tLem (50 percent) Lave reported about tLe
preparation ol tLe Village HealtL Plan. More tLan Lall (52 percent) ol tLe Cram
PancLayats reported conducting ol IEC activities during last 6 montLs

All tLe 23 Cram PancLayats (100 percent) reported tLe appointment ol Mitanins in
tLeir respective villages. Awareness about tLe benelits under tLe ]SY scLeme was reported

by 96 percent ol tLe Cram PancLayats. Jwelve out ol 23 (52 percent) pancLyats reported
about conducting IEC activities during last 6 montLs. Hardly + (1/ percent) pancLyat
members reported tLat tLe RHM Las brougLt improvement in tLeir area. Among tLose
Cram PancLayats wLicL Lave reported improvements due to RHM Lave stated tLat
lunds are available lor maintenance ol Sub-Centres (50 percent), Community support is
available as Mitanin worker (50 percent), tLere is availability ol lunds/lacilities under ]SY
(25 percent), and availability ol transport lacilities lor delivery (25 percent). Seven Cram
PancLayats (30 percent) Lave reported tLe dilliculties in implementing programme
activities under RHM. Some ol tLe reported dilliculties are inadequate lacilities lor
institutional deliveries (22 percent), ASHA Las not been adequately trained (13 percent)
lunds are not available on time (9 percent) and /+ percent reported otLer dilliculties like
lack ol adequate publicity about RHM, lack ol transport lacilities and lack ol adequate
LealtL services and lacilities at tLe village level. JLe PancLayats were asked about tLe kind
ol support required to enable tLem to implement RHM more ellectively. EigLteen (/8
percent) out ol twenty tLree PancLayat members stated tLat support was required. JLe
kind ol support required reported by tLe Cram PancLayats are: more lunds (+8 percent)
lor maintenance/ellective lunctioning, and more training lor ASHA and community
members (35 percent) control over lunds (22 percent), and otLer like lacilities lor
transportation to tLe Lospital, Mitanin sLould get regular salary, regular meetings ol
VHSC, and adequate publicity ol RHM.

4GOCTMUQHVJG1DUGTXGT
x Lack ol orientation and involvement is seen among PRI members regarding
RHM. RHM Las not percolated lrom tLe top to tLe community level.
Communitization ol tLe programme is possible only il PRI members Lave a
tLorougL knowledge about tLe programme and tLe level ol participation expected
lrom tLem.
x Lack ol clear guidelines regarding VHSC untied lunds Lave created dillerences
between PRI members and Mitanins and lund management is poor. District
programme managers and DPML sLould reorient tLem about tLese issues so tLat
lunds do not remain unutilized.

Bolc, Awarcncss and Involvcmcnt ot Cram Panchayats


Tablc A1: Status ot Cram Panchayats Covcrcd

A. umber ol Cram PancLayats covered in tLe district 23
B. Average population ol tLe Cram PancLayat covered
ScLeduled Caste 685.5
ScLeduled Jribe +/9.2
Jotal 2,660.0
C. Average number ol HouseLolds in tLe Cram PancLayats
covered

ScLeduled Caste 12/.2
ScLeduled Jribe 86.3
Jotal 598.+
D. Average number ol BPL lamilies in tLe Cram PancLayats
covered

ScLeduled Caste 8/.+
ScLeduled Jribe 58.6
Jotal 300.3











Tablc A2: Lcvcl ot awarcncss and involvcmcnt ot Cram Panchayats


A1. Percentage ol Cram PancLayat reporting regular availability ol AM +3.5
A2. Percentage ol Cram PancLayat reporting awareness about AM Jour Plan 30.+
B. Percentage ol Cram PancLayat reporting timely services provided by Sub Centre to tLe patients 26.1
C. Percentage ol Cram PancLayat reporting role ol Cram PancLayat in conducting/linalizing IEC
programme in Cram PancLayat
/8.3
D. Percentage ol Cram PancLayat reporting existence ol VHSC in tLeir Cram PancLayat 95.0
E. Percentage ol Cram PancLayat reporting regular meetings ol VHSC 65.0
I. Percentage ol Cram PancLayat reporting Village LealtL Plan been prepared by VHSC 50.0
C. Percentage ol Cram PancLayat reporting tLat VHSC Las received any Lntied Iund 95.0
H. Percentage ol Cram PancLayat reporting ASHA workers in position 100.0
I. Percentage ol Cram PancLayat reporting awareness ol tLe benelits under ]SY scLeme 95./
]. Percentage ol Cram PancLayat reporting tLat RHM brougLt about any improvement in tLeir area 1/.+
K. Percentage ol Cram PancLayat reporting conduct ol IEC activities during last 6 montLs 52.2
L. Distribution ol Cram PancLayats covered by type improvement reported due to RHM
Iunds available lor maintenance ol Sub Centres 50.0
Community support is available as ASHA worker 50.0
Iunds/lacilities are available under ]SY 25.0
Better lacilities are available lor CHCs/PHCs lor relerred patients 0.0
Jransport lacilities are available 25.0
CtLer 25.0
M. Distribution ol Cram PancLayats by type ol dilliculties laced in implementing programme activities
under RHM

Iunds not available in time 8./
Decision making witL tLe community leaders is dillicult 0.0
ASHA Las not been adequately trained 13.0
Adequate lacilities lor institutional deliveries not available 21./
Any otLer /3.9
M. Distribution ol Cram PancLayats by kind ol support required to enable tLem in implementing tLe
programme more ellectively

More lunds are required lor maintenance/ ellective lunctioning +/.8
Cram PancLayat sLould be given direct control over lunds 21./
More training is to be arranged lor ASHA and Community Mem members 3+.8
Any otLer 60.9
119
Chapter - 9
Quality of Care and Client Satisfaction
(Based on IPD Exit Interview)

Introduction
As per the study design, 5-10 IPD patients were to be interviewed at each of the
health facility (1 District Hospital, 2 CHCs and 4 PHCs) covered at the time of discharge.
Hence, the expected number of exit interview in the district varies between minimum of
35 and maximum of 70. However, in Janjgir-Champa district the inpatient services are
virtually non- existent at the PHC as well as at the CHC level. The district hospital is also
providing very limited IPD services. Thus only 1 IPD interview could be conducted at the
CHC level and 4 at district level inspite of consistent efforts by the study team. As the
number of patients interviewed is small (4 for DH, 1for CHCs and none for PHCs),
extreme caution is necessary while interpreting the figures. The age distribution of the 5
IPD patients shows that 2 patients are in the age group of 30-39 years and one in the age
20-29, one less than 20 years of age and one above 40 years of age. Among IPD patients
interviewed 3 are females, 4 currently married and 3 are from rural areas. Purpose of
admission to the health facility shows that 3 of the patients were admitted for minor
illnesses, 1 for delivery and 1 for other illness (Table EI 2).

Waiting Time
The average waiting time for the patients for the Registration is 8 minutes (Table
EI- 3). The average waiting time for Registration in DH is slightly more than that in the
CHCs. After the Registration, the patients had to wait on an average 19 minutes for the
Doctors call in the hospitals. The average waiting time for Doctors call is more or less in
the DH and CHC (14-15 minutes).On an average; the doctors have examined the patients
for 17 minutes. The examination time of the doctors is higher in DH (20 minutes) than at
the CHC (5 minutes). After the examination it takes 16 minutes to get admitted to the
ward. Here again, the waiting time for admission to the ward is higher in DH (15 minutes)
than in CHCs (20 minutes). After admission to the ward, it takes about half an hour (29
minutes) for the patients to get the services. Patients from DH got the services relatively
faster (21 minutes) than the patients from CHC Baloda (60 minutes). The average time for
getting discharged for the patients was 21 minutes (24 minutes at DH and 10 at CHC).
120

Satisfaction regarding Waiting Time
Satisfaction of the patients regarding waiting time for different services is given in
Table EI-4. The satisfaction with the waiting time for registration, doctors call, doctors
examination, admission to ward, getting services and to get discharged is assessed with four
categories: too long, appropriate, too short and cant say. All the patients felt that the
waiting time was either short or appropriate for registration, doctors call, doctors
examination, indicating complete satisfaction both at the DH or CHC. For two patients 1
at DH and 1 at CHC getting admission to the ward took a long time. One patient at the
DH expressed that getting services and getting discharged took a long time. The patient at
the CHC was satisfied with getting services and getting discharged at the appropriate time.

Behaviour of Staff
Behaviour of each category of staff (doctor, nurse, and technical staff) is assessed
with a four point scale - rude, reasonable, good and very kind (Table EI-5). All the patients
said that the doctor greeted them in a friendly manner in the first instance. Regarding the
behaviour of doctors, nurses and technical staff, the patients said that their behavior in
general is good. However, one patient from the district hospital reported that the
behaviour of the doctor was rude. The lone IPD patient was satisfied with the behaviour
of doctors, nurses and technical staff. The behavior of ayah, ward boy and counter clerk is
also assessed on 4 point scale-negligent, arrogant, indifferent and good. One patient said the
behavior of ward boy is indifferent and 2 at the DH reported the behavior of counter clerk
as indifferent. Satisfaction regarding the behaviour of ayah, ward boys and counter clerk
appears to be further high as almost all the patients said that either they are good or very
kind. The figures indicate that the patients in general are satisfied with the behaviour of all
categories of staff in the health facilities. The patients were asked whether the hospital
authorities have taken some unique/innovative measure to improve the staff behaviour in
the hospital (Table EI-6). For this question, none of the patients reported that any
unique/innovative measure was taken to improve the behaviour of the staff.

Privacy
One of the criticisms for the services in public health facilities in India is lack of
privacy during the examination, particularly for female patients. This can be addressed
easily by making partitioning of the room or by keeping a curtain in the examination
121
room. In the exit interview all the patients were asked whether there was privacy at the
place of examination. On the whole, only one out 4 of patients said that there was privacy
in the place of examination at the DH. The lone inpatient at the CHC was satisfied with
the privacy. This indicates that patients at the district hospital expect more privacy than
what is being provided by the hospital at the place of examination (Table EI-7).

Patient-Doctor/Provider Communication
Client-provider communication is one of the important dimensions of the quality
of care. The doctor-patient communication was assessed from the patients in the following
issues: doctor listened to the description of the ailment; doctor allowed to ask questions;
doctor responded to questions; doctor discussed about ailment; doctor talked about
recovery; and doctor gave other advice (Table EI-8). The response of the patients with
respect to their interaction with the doctor shows that the patients have a mixed opinion
about the response received. Regarding listening to the patients ailment, 4 patients (DH: 3;
CHC: 1) said that the doctor always listened to their ailment patiently, and one of them at
the DH said that the doctor listened somewhat. All the 5 patients said that the either the
doctor always/somewhat allowed to ask questions or responded to questions (DH: 4;
CHC: 1). All the patients at the DH said that the doctor discussed about the ailment with
them, but this was not done at the CHC level. Except for 1 patient all others at the DH
said that the doctor talked about recovery but the CHC doctor never discussed recovery
with the patient (probably because it was a delivery case). One patient each at the DH and
CHC level were given other advise and 3 at the DH were not given any advise.Overall,
the analysis of client-provider communication indicates that clients are more or less
satisfied with the doctors behavior.

Cleanliness of the Facility
Cleanliness of health facilities is assessed through the frequency of cleaning of floor
and toilet/bathroom, changing patients uniform and changing bed-sheets. Regarding the
frequency of cleaning of the floor, the 3 patients at DH reported that the cleaning is done
twice in a day, once in day is reported by 2 patients one at the DH and the other at the
CHC. Two patients at the DH said that the toilet/bathroom is cleaned twice a day. Once
a day is reported by 2 patients (1 DH, and 1CHC) and 1 patient at the DH has reported
less than once a day about toilet cleaning. Only two patients (DH: 1; CHC: 1) said that
122
patient uniform was changed once a day during their hospitalization. Less than once a day
and not changed at all was reported by 3 patients at the DH. It appears that changing bed
sheet is not a common practice in the hospitals as only 1 patient at the DH reported that
the bed sheet was changed twice a day during his hospitalization and the patient at the
CHC said that it was changed once a day. Three patients at the DH reported that bed
sheet is changed less than once a day. Changing beds sheets regularly does not seem to be a
regular feature.

Satisfaction Regarding the Cleanliness of the Facility
The satisfaction regarding the cleanliness of the facility is assessed through three
categories of satisfaction satisfied, somewhat satisfied and not satisfied (Table EI-10). It
shows that 4 patients are clearly satisfied with cleaning of floor (DH: 3; CHC: 1) and 3 are
somewhat satisfied with cleaning of toilet/bathroom (DH: 3; CHC: 1). Two patients at the
DH are not satisfied with the cleaning of toilet/bathroom. Regarding the changing of
patients uniform and bed sheets except for 2 patients at the DH who are somewhat
satisfied rest of the 3 patients have expressed dissatisfaction for not changing uniform and
bed sheets than for cleanliness. Dissatisfaction with not changing of bed sheets by 3
patients (DH: 2; CHC: 1) is clearly expressed. Only 2 persons at the DH expressed
satisfaction /somewhat satisfaction about bed sheet changing. The data on frequency of the
cleanliness and satisfaction regarding the same clearly shows that lack of cleanliness is
major issue in the health facilities. Although the number of in patients are few their
dissatisfaction regarding cleanliness of uniform and bed sheets are important observations
and need to be taken seriously.

Crowding in the Facility
Crowding in the facility is assessed through availability of cot for the patients,
adequacy of the space in the ward, satisfaction with the arrangement of ward and adequacy
of space in IPD (Table EI-11). Two patients at DH said that they got the cot immediately
after the admission to the ward and all of them and the rest of the 3 patients (DH: 2; CHC:
1) said that the cot was not available immediately but on the same day. The cot remained
available for the all the 5 patients till the time of discharge. As the bed occupancy in the
hospitals is low, in both the DH and CHCs, availability of cot is not a problem in the
123
hospitals. Regarding the adequacy of space in the ward, all 5 patients said that the space is
adequate. All the patients were either satisfied or somewhat satisfied with the ward
arrangements. All the patients reported adequacy of space in IPD as satisfactory.

Amenities Provided by the Hospital
The availability of amenities in health facilities as reported by the patients are given
in Table EI-12. It shows that the among the amenities 3 patients know about medical shop,
one reported about accommodation for relatives and all 4 of them reported about
ambulance facilities at the DH. At the CHC out of 6 amenities only 1 amenity
ambulance was reported by the patient. The number of patients who expressed
satisfaction with medical shop and accommodation for relatives are comparatively less in
number than patients reporting availability of amenities.

Continuity of Treatment
Patients satisfied with the services will continue to visit the facility. However,
dissatisfied patients may cause harm to the public health programmes/facilities by
discouraging others to go the government facility. Hence, any dissatisfaction may lead to
underutilisation of the facilities and wastage of precious public resources. To understand
this, the patients were asked about their overall satisfaction with the visit to the health
facility, their willingness to visit again and their willingness to recommend the facility to
others. Table EI- 13 shows that, overall, 3 patients at the DH expressed somewhat
satisfied and 1 patient at the CHC reported satisfaction with visit to the health facility.
Only 1 patient at the DH expressed dissatisfaction, giving the reason that charges are
exorbitant. Three patients (DH: 2; CHC: 1) said that they would come again to the
facility, in case they fell sick. But 2 other patients at DH either said they would not visit
the health facility again or they were unsure of their visit to the health facility in future.
Overall, 4 patients (DH: 3; CHC: 1) said that they would recommend the hospital to other
but one of them reported that he would not recommend the hospital to others.

124
IPD Facilities

Table EI 1: Background characteristics of the in-patients

Background Characteristics of the In-Patients Percent
Age
< 20 years
20-29 years
30-39 years
40-49 years
50-59 years
60 years or more

20.0
20.0
40.0
20.0
-
-
Sex
Male
Female

40.0
60.0
Marital Status
Unmarried
Currently Married
Divorced/Separated
Widowed

20.0
80.0
-
-
Residence
Rural
Urban

60.0
40.0
Type of Health Facility
DH
CHC
PHC

80.0
20.0
-
Total In-patients interviewed 5



Table EI 2: Purpose of admission in the Health Institution


Percent
Type of Health Facility
Purpose of admission in the Health
Institution
DH CHC PHC All
Minor illness
Family planning surgery
Delivery
Cataract surgery
Child admitted
Other
75.0
-
-
-
-
25.0
-
-
100.0
-
-
-
-
-
-
-
-
-
60.0
-
20.0
-
-
20.0
Total In-patients interviewed 4 1 - 5



Table EI 3: Waiting time
Average waiting time for: Average waiting time (in minutes)
125
Type of Health Facility
DH CHC PHC All
Registration 8.8 3.0
-
7.6
Doctors call 13.8 15.0
-
14.0
Doctors examination 20.0 5.0 - 17.0
Admission to ward 15.0 20.0 - 16.0
Getting services 21.3 60.0 - 29.0
To get discharged 23.8 10.0 - 21.0
Total In-patients interviewed 4 1
-
5

Table EI 4: Satisfaction regarding waiting time

Percent
Type of Health Facility
Waiting time for/Satisfaction
DH CHC PHC All
Registration
Too long
Appropriate
Too short
Can't say

-
75.0
25.0
-

-
100.0
-
-

-
-
-
-

-
80.0
20.0
-
Doctor's call
Too long
Appropriate
Too short
Can't say

-
75.0
25.0
-

-
100.0
-
-
-
-
-
-

-
80.0
20.0
-
Doctor's examination
Too long
Appropriate
Too short
Can't say

-
100.0
-
-

-
100.0
-
-

-
-
-
-

-
100.0
-
-
Admission to ward
Too long
Appropriate
Too short
Can't say

25.0
25.0
50.0
-

100.0
-
-
-

-
-
-
-

20.0
40.0
40.0
Getting services
Too long
Appropriate
Too short
Can't say

25.0
25.0
50.0
-

-
100.0
-
-

-
-
-
-

40.0
20.0
40.0

To get discharged
Too long
Appropriate
Too short
Can't say

25.0
25.0
50.0
-

-
100.0
-
-

-
-
-
-

20.0
40.0
40.0
Total In-patients interviewed 4 1 - 5
126
Table EI 5: Behaviour of Staff

Percent
Type of Health Facility
Staff Behaviour
DH CHC PHC All
Doctor greet in a friendly manner
Yes
Somewhat
No

100.0
-
-

100.0
-
-

-
-
-

100.0
-
-
Behaviour of Doctor
Rude
Reasonable
Good
Very kind

25.0
25.0
50.0
-

-
-
100.0
-

-
-
-
-

20.0
20.0
60.0
-
Behaviour of Nurse
Rude
Reasonable
Good
Very kind

-
50.0
50.0
-


-
-
100.0
-

-
-
-
-

-
40.0
60.0
-

Behaviour of Technical Staff
Rude
Reasonable
Good
Very kind

-
100.0
-
-

-
100.0
-
-

-
-
-
-

-
100.0
-
-
Behaviour of Ayah
Negligent
Arrogant
Indifferent
Good

-
-
-
100.0

-
-
-
100.0

-
-
-
-

-
-
-
100.0
Behaviour of Ward Boys
Negligent
Arrogant
Indifferent
Good

-
-
25.0
75.0

-
-
-
100.0

-
-
-
-

-
-
20.0
80.0
Behaviour of Counter Clerk
Negligent
Arrogant
Indifferent
Good

-
-
50.0
50.0

-
-
-
100.0

-
-
-
-

-
-
40.0
60.0
Total In-patients interviewed 4 1 - 5

Table EI 6: Unique/innovative measure taken to improve the staff behaviour


Type of Health Facility
Staff Behaviour Staff
DH CHC PHC All
Unique/innovative measure taken to improve
the staff behaviour
Yes
No
Dont know

-
100.0
-

-
100.0
-


-
-
-

-
100.0
-
Total In-patients interviewed 4 1 - 5
127
Table EI 7: Privacy in health facility

Type of Health Facility
Privacy
DH CHC PHC All
Patients reporting Presence of privacy at the
place of examination


25.0

100.0

0

40.0
Total In-patients interviewed 4 1 0 5


Table EI 8: Patient-Doctor/Provider Communication

Type of Health Facility Patient-Doctor Communication
DH CHC PHC All
Doctor listened to description of ailment
patiently
Yes, somewhat
Yes, always
No
Did not interact with the doctor


25.0
75.0
-
-


-
100.0
-
-



-
-
-
-


20.0
80.0
-
-

Doctor allowed to ask questions
Yes, somewhat
Yes, always
No
Did not interact with the doctor

50.0
50.0
-
-


-
100.0
-
-


-
-
-
-

40.0
60.0
-
-
Doctor responded to questions
Yes, somewhat
Yes, always
No
Did not interact with the doctor

50.0
50.0
-
-


-
100.0
-
-


-
-
-
-

40.0
60.0
-
-

Doctor discussed about the ailment
Yes
No
Did not interact with the doctor

100.0
-
-

-
100.0
-

-
-
-

80.0
20.0
-
Doctor talked about the recovery
Yes
No
Did not interact with the doctor

75.0

-

-
100.0
-

-
-
-

60.0
40.0

Doctor gave other advice
Yes
No
Did not interact with the doctor

25.0
75.0
-

-
100.0
-

-
-
-

40.0
60.0
-
Total In-patients interviewed 4 1 - 5

128
Table EI 9: Cleanliness of the facility

Type of Facility Type of Health Facility(Percent)

Frequency of cleaning
DH CHC PHC All
Floor
Thrice a day
Twice a day
Once a day
Less than once a day
Not applicable

-
75.0
25.0
-
-

-
-
100.0
-
-

-
-
-
-
-

-
60.0
40.0
-
-
Toilet/Bathroom
Thrice a day
Twice a day
Once a day
Less than once a day
Not applicable

-
50.0
25.0
25.0
-

-
-
100.0
-
-

-
-
-
-
-

-
60.0
20.0
20.0
-
Changing patients
uniform
Twice a day
Once a day
Less than once a day
Not changed
Not applicable


-
25.0
50.0
25.0
-


-
100.0
-
-
-


-
-
-
-
-



-
40.0
40.0
20.0
-
Changing patients Sheets
Twice a day
Once a day
Less than once a day
Not changed
Not applicable

25.0
-
75.0
-
-


-
100.0
-
-
-

-
-
-
-
-


-
20.0
20.0
60.0
-
Total number of in-
patients interviewed
4 1 0 5

129
Table EI 10: Satisfaction of patients regarding cleanliness of the facility

Type of Health Facility (Percent)

Type of Facility/
Satisfaction
DH CHC PHC

All
Floor cleaning
Satisfied
Somewhat satisfied
Not satisfied


75.0
-
25.0

100.0
-
-

-
-
-


80.0
-
20.0

Toilet/Bathroom
cleaning
Satisfied
Somewhat satisfied
Not satisfied


-
50.0
50.0

-
100.0
-

-
-
-


-
60.0
40.0
Changing patients
uniform
Satisfied
Somewhat satisfied
Not satisfied



-
50.0
50.0


-
-
100.0


-
-
-


-
40.0
60.0
Changing bed-sheets
Satisfied
Somewhat satisfied
Not satisfied


25.0
25.0
50.0

-
-
100.0

-
-
-


20.0
20.0
60.0
Total number of in-
patients interviewed
4
1 - 5
.
130
Table EI 11: Crowding in the facility

Type of Health Facility (Percent)
Crowding in the facility
DH CHC PHC All
Availability of cot
Immediately
Not immediately but same day
Next day
After more than a day

50.0
50.0
-
-

-
100.0
-
-

-
-
-
-

40.0
60.0
-
-
Availability of cot/bed till the time of
discharge
Yes
No


100.0
-


100.0
-


-
-


100.0
-
Adequacy of space in the ward
Not adequate
Somewhat adequate
Adequate

-
-
100.0

-
-
100.0

-
-
-

-
-
100.0
Satisfaction with the ward arrangement
Not satisfied
Somewhat satisfied
Satisfied

-
75.0
25.0

-
-
100.0

-
-
-

-
60.0
40.0
Adequacy of space in IPD
Not adequate
Somewhat adequate
Adequate

-
100.0
-

-
100.0
-

-
-
-

-
100.0
-
Lot of noise in the ward
Yes
No

-
100.0

-
100.0

-
-

-
100.0
Total number of in-patients interviewed 4 1
-
5



131
Table EI 12: Amenities provided by the hospital

Type of Health Facility

DH

CHC

PHC

All

Percentage of in- patients reporting
availability/ % reporting satisfaction
% No. % No. % No. % No.
Availability of amenities
Television
Canteen
Medical shop
Telephone
Accommodation for relatives
Ambulance

-
-
75.0
-
25.0
100.0

-
-
3
-
1
4

-
-
-
-
-
100.0

-
-
-
-
-
1

-
-
-
-
-
-

-
-
-
-
-
-

-
-
60.0
-
20.0
100.0

-
-
3
-
1
5
Satisfaction among those who said
amenity is available
Television
Canteen
Medical shop
Telephone
Accommodation for relatives
Ambulance


-
-
50.0
-
-
100.0


-
-
2
0
0
4


-
-
-
-
-
100.0


-
-
-
-
-
1


-
-
-
-
-
-


-
-
-
-
-
-


-
-
50.0
-
-
100.0


-
-
2
-
-
5

Table EI 13: Continuity of treatment

Percent
Type of Health Facility
Continuity of treatment
DH CHC PHC All
Satisfaction with the visit to the health facility
Dissatisfied
Somewhat satisfied
Satisfied

25.0
75.0
-


0
0
100.0

-
-
-


20.0
60.0
20.0
Reason for dissatisfaction (if dissatisfied)
Lack of facilities
Bad experience with the Doctor
Poor quality of services
Charges are exorbitant
Other

-
-
-
100.0
-

-
-
-
-
-

-
-
-
-
-

-
-
-
100.0
-
Visit again to the facility (if fell sick)
Yes
No
May come/unsure

50.0
25.0
25.0

100.0
-
-

-
-
-

60.0
20.0
20.0
Recommend this hospital to others
Yes
No

75.0
25.0

100.0
-

-
-

80.0
20.0
Total number of in-patients interviewed 4 1 - 5


132
Chapter - 10
Quality of Care and Client Satisfaction
(Based on OPD Exit Interview)
As per the study design we have to interview 5-10 OPD patients at each of the selected
health facility (1 District Hospital, 2 CHCs and 4 PHCs) at the time of their exit from the
hospital. Hence, the expected number of OPD exit interview in the district varies between
minimum of 35 and maximum of 70. We have conducted total 56 OPDs out of which, 10
OPD interviews from DH, 16 from the two selected CHCs and 30 from the four selected
PHCs have been done. As the number of patients interviewed is small (10 for DH, 16 for
CHCs and 30 for PHCs), a caution is necessary while interpreting the figures.

Characteristics of the patients interviewed for the OPD exit-interview are presented in
Table EO-1. The age distribution of the OPD patients shows that 25 percent of the patients
are aged less than 30 years, 45 percent between 30-49 years of age, and the remaining 30
percent are above 50 years of age. A little above one-fifth of the patients are aged 60 years and
above. Male OPD patients are slightly more in proportion (52 percent) than female patients,
currently married (84 percent) and from rural areas (80 percent). Purpose of visit to the health
facility shows that about two thirds of them (64 percent) visited for availing treatment for
minor illness, 9 percent for child illness and 13 percent for other illnesses (Table EO-2).
Purpose of OPD visit by type of facility shows that minor and child illnesses are the two
major reasons for the visit to the health facility.

Average Waiting Time for Services
Overall, to get all the OPD services it takes on an average 51 minutes for the patients
in the hospitals (Table EO-3). Average time to get the OPD services is highest in PHCs (60
minutes) followed by CHCs (41 minutes) and DH (24 minutes). The waiting for the different
OPD services shows that, except getting medicines, all the other OPD services takes less than
10 minutes in the hospitals. The average waiting time for the Registration is 6 minutes. The
average waiting time for Registration in PHC is higher (8 minutes) than in CHCs (5 minutes)
and DH (3 minutes). After the Registration, the patients have to wait on an average 6 minutes
133
for the examination of the doctor. The average waiting time for Doctors examination is
higher in DH (9 minutes) than in PHCs (7 minutes) and CHCs (4 minutes). For getting
injection, patients have to wait on an average 10 minutes in the hospitals. Getting medicines
on an average takes 11 minutes in the hospitals. Time taken for getting medicines is maximum
in CHCs (25 minutes) and minimum at the PHCs (4 minutes). Patients have to wait for 31
minutes for getting dressing done at the PHC.

The waiting time for the OPD services shows that, to get the services, the patients
have to wait for more time in PHCs than in CHCs and DH.

Satisfaction Regarding Waiting Time
Satisfaction of the patients regarding waiting time for different services is given in
Table EO-4. The satisfaction with the waiting time for registration, doctors examination,
injection, dressing, getting medicines, and paying bill is assessed with four categories (too long,
appropriate, too short and cant say). It shows that, dissatisfaction with services is not at all
high as only 2-7 percent of the patients said that the waiting time is too long for these services,
except at the CHCs where the waiting time for getting medicines is reported too long by
patients (14 percent). In fact, most of the patients (65-87 percent) perceived and reported that
the waiting time for these services is appropriate. Dissatisfaction for different services shows
that the dissatisfaction is slightly higher in CHCs than in PHCs. Patients are satisfied by the
different services provided by the DH. Though the dissatisfaction levels of OPD services are
not very high even the small level of dissatisfaction at the CHCs or PHCs which provide
limited services has to be properly addressed.

Behaviour of Staff
Behaviour of each category of staff (doctor, nurse, technical staff, ayah, ward boy and
counter clerk) is assessed with a four point scale - rude, reasonable, good and very kind (Table
EO-5). Two percent of the patients said that the doctor did not greet them in a friendly
manner in the first instance, 4 percent said that the doctor greeted them in somewhat
friendly manner and 66 percent said that the doctor greeted them in a friendly manner and
134
29 percent patients did not interact at all with the doctors due to their non availability.
Among the doctors who did not greet in a friendly manner one was from the DH. More than
half of the patients (53 percent) did not interact with the doctors in the PHCs mostly due to
their non-availability during OPD hours. Similarly the interaction of patients with nurses is
also very limited in the PHCs (20 percent) due to paucity of nurses at the PHCs. Overall the
behavior of nurses and dispenser were seen as reasonable, good and kind by patients of DH
and CHC. The figures indicate that, the patients in general, are satisfied with the behaviour of
all categories of staff in the health facilities.

Privacy
In the exit interview, all the OPD patients were asked whether there was privacy at
the place of examination. On the whole, 71 percent of patients said that there was privacy in
the place of examination. The percentage of patients reporting the presence of privacy is much
lower in DH (30 percent) as compared to PHCs and CHCs (80-81 percent). It is clear that the
privacy is an issue, particularly in the DH .

Patient-Doctor/Provider Communication
The response of the OPD patients with respect to their interaction with the doctor
shows that the patients have lot of concern about this. Regarding listening to the patients
ailment, 66 percent of the patients said that the doctor always listened to their ailment
patiently, 4 percent said that the doctor listened somewhat and only 2 percent said that doctor
did not listen. Twenty nine percent patients did not interact at all with the doctors due to
their non availability. As already mentioned above more than half the patients did not
interact with their doctors at the PHC. The percent of patients said that the doctor did not
allow to ask questions is 4 percent, did not respond to questions is 9 percent, did not discuss
about the ailment is 9 percent, did not talk about recovery is 14 percent, and did not give
other advice is 36 percent. Doctor-patient communication by type of hospital shows that
more patients from CHC and PHC expressed their unhappiness about it. OPD patients have
expressed their dissatisfaction regarding their communication with the doctors. Doctors did
not talk to patients about recovery (CHC: 25 percent: PHC: 10 percent) and did not give
135
other advise (CHC: 63 percent; PHC: 27 percent). The results show that the OPD patients at
the CHCs and PHCs are not very happy with the communication of the doctors.

Cleanliness of the OPD Facility
Satisfaction of the patients regarding the cleanliness of the OPD facilities (OPD room,
examination room, dispensary, laboratory, injection room and dressing room) is presented in
Table EO-8. It shows that, overall, 80-100 percent of the patients felt that the OPD facilities
are clean and almost none of the patients said that the facility is not clean. Compared to IPD
patients, less number of OPD patients expressed their dissatisfaction regarding the cleanliness.
Only one patient each expressed some dissatisfaction with services in the injection room and
laboratory at the DH and one with the services of OPD in PHC. It appears that, cleanliness is
more of an issue for IPD patients rather than for OPD patients. Because IPD patients stay
longer in the hospital and expect a cleaner environment whereas, OPD patients visit only for
a shorter period and may be not concerned about the cleanliness of the OPD area.

Crowding in the OPD Areas
Compared to cleanliness, lot of dissatisfaction exists for crowding/inadequacy of space
in the OPD facilities (OPD Room, Examination Room, Dispensary, laboratory, Injection
Room and dressing Room) of the hospitals. Hardly 2-6 percent patients expressed
dissatisfaction for crowding/inadequacy of space OPD facilities OPD Room, Examination
Room and Dispensary.

Continuity of Treatment
Table EO-10 shows that, overall, 57 percent of the patients are satisfied with their
visit to the facility, 36 percent somewhat satisfied and 7 percent is dissatisfied. Compared to
IPD patients (20 percent), more OPD patients (57 percent) are satisfied with their visit to the
health facility. Satisfaction by type of hospital shows that while 88 percent of the patients
from CHCs are satisfied with their visit, only 40 percent of the patients from DH and 47
percent from PHCs are satisfied. Further, twenty percent of the patients from DH are
dissatisfied with their visit. Eighty percent patients said that they would come again to the
136
facility, in case they fell sick. Although overall 80 percent patients said that they would visit
the health facility again, 40 percent patients at the DH and 18 percent at the PHC expressed
that they were not sure about visiting the same health facility again. Overall, 98 percent of the
patients said that they would recommend the hospital to others.

Remarks of the Observer:
The PHCs are providing skeletal OPD services at the 4 PHCs observed in Janjgir-
Champa district. In Hausaud PHC there is no regular MO; and in Raipura PHC
the regular doctor is not present at the PHC on daily basis (Jaijaipur CHC). In
Pantora the doctor does not report to the PHC regularly although he is the only
MO there. In Gatwa, the MO visits the PHC on alternate days. Under these
circumstances a pharmacist/ dresser/ ward boy is providing the OPD services.
The PHCs are expected to open from 8AM to 1PM in the morning and for 1 hour
in the evening. Hardly 2-3 hours of OPD services are being provided at these
PHCs.
Most of the OPD exit interviews conducted indicate that more than half of the
patients have been attended by a pharmacist/ dresser/ ward boy, other than the
doctor.
The patients coming for checkups remain underserved or partially served and
hardly receive any expert opinion about their illness or treatment.
There is no provision of ANMs at the PHCs. Thus in the absence of doctors and
staff nurse there is hardly any one to provide basic health and family planning
services.
The PHCs remain underutilized because none of them are providing regular
laboratory services.
137
OPD Facilities

Table EO 1: Background characteristics of the patients

Background Characteristics of the Out-Patients Percent
Age
< 20 years
20-29 years
30-39 years
40-49 years
50-59 years
60 years or more

8.9
16.1
23.2
21.4
8.9
21.4
Sex
Male
Female

51.8
48.2
Marital Status
Unmarried
Currently Married
Divorced/Separated
Widowed

7.1
83.9
1.8
7.1
Residence
Rural
Urban

80.4
19.6
Type of Health Facility
District Hospital
CHC
PHC

17.9
28.6
53.6
Total out-patients interviewed 56


Table EO 2: Purpose of visit to the Health Institution







Type of Health Facility (Percent)
Purpose of visit in the Health
Institution
DH CHC PHC All
Minor Illness
FP Services
Antenatal Care
PNC
Eye Check-up
MDT-DOTs
Child Illness
Other
50.0
0.0
0.0
10.0
10.0
10.0
10.0
10.0
37.5
0.0
6.3
0.0
0.0
6.3
18.8
31.3
83.3
0.0
3.3
0.0
6.7
0.0
3.3
3.3
64.3
0.0
3.6
1.8
5.4
3.6
8.9
12.5
Total out-patients interviewed 10 16 30 56
138

Table EO 3: Waiting time (in minutes) for services by type of facility

District Hospital
Average waiting time for No. of patients
availed the service
Average waiting
time (in minutes)
A. District Hospital
Registration 9 2.8
Doctors examination 10 8.7
Injection 4 2.5
Getting medicines 8 8.1
Dressing 1 0
Paying bill 3 1.7
Total time taken for OPD services * 23.8
B. CHC
Registration 16 4.8
Doctors examination 16 4.0
Injection 12 4.3
Getting medicines 15 24.6
Dressing 0 0
Paying bill 15 3.5
Total time taken for OPD services * 41.2
C PHC
Registration 29 7.6
Doctors examination 28 6.7
Injection 16 7.8
Getting medicines 28 3.8
Dressing 1 30.8
Paying bill 21 2.9
Total time taken for OPD services * 59.6
D. ALL
Registration 54 6.0
Doctors examination 54 6.3
Injection 32 9.6
Getting medicines 51 10.6
Dressing 2 15.0
Paying bill 39 3.0
Total time taken for OPD services * 50.5

139
Table EO 4: Satisfaction regarding waiting time by type of hospital


Satisfaction
(% of patients)
Waiting time for
No. of
patients
availed the
service
Too Long Appropriate Too Short Cant
Say
A- District.
Registration 10 - 90.0 10.0 -
Doctors
examination
10 - 50.0 50.0 -
Injection 4 - 25.0 50.0 25.0
Getting medicines 8 - 50.0 50.0 -
Dressing 1 - - - 100.0
Paying bill 3 - 66.7 - 33.3
B -CHC
Registration 16 6.3 93.8 - -
Doctors
examination
16 6.3 87.5 6.3 -
Injection 12 8.3 83.3 8.3 -
Getting medicines 14 14.3 71.4 14.3 -
Dressing 0 - - - -
Paying bill 15 - 93.3 6.7 -
C-PHC
Registration 30 - 66.6 33.3 -
Doctors
examination
30 6.7 53.3 33.3 -
Injection 16 - 75.0 25.0 -
Getting medicines 28 - 71.4 28.6 -
Dressing 1 - 100.0 - -
Paying bill 21 - 85.7 14.3 -
D-ALL
Registration 56 1.8 78.6 19.6 -
Doctors
examination
56 5.4 62.5 28.6 3.6
Injection 32 3.1 71.9 21.9 3.1
Getting medicines 50 4.0 68.0 28.0 -
Dressing 2 - 50.0 - 50.0
Paying bill 39 - 87.2 10.3 2.6








140

Table EO 5: Behaviour of Staff

Type of Health Facility (Percent)
Staff Behaviour
DH CHC PHC All
Doctor greets in a friendly
manner
Not friendly
Yes, somewhat
Yes
Did not interact

10.0
20.0
70.0
-

-
-
100.0
-

-
6.7
40.0
53.3

1.8
3.6
66.1
28.6
Behaviour of Doctor
Rude
Reasonable
Good
Very kind
Did not interact

-
10.0
80.0
10.0
-

-

75.0
25.0
-

-
10.0
33.3
3.3
53.3

-
7.1
53.6
10.7
28.6
Behaviour of Nursing Staff
Rude
Reasonable
Good
Very kind
Did not interact

-
30.0
70.0
0
-

-
25.0
62.5
12.5
-

-
6.7
6.7
6.7
80.0

-
16.1
33.9
7.1
42.9
Behaviour of Dispenser
Rude
Reasonable
Good
Very kind
Did not interact

-
40.0
30.0
30.0
-

-
31.3
62.5
6.3
-

-
16.7
66.7
10.0
6.7

-
25.0
58.9
12.5
3.6
Behaviour of Technician
Rude
Reasonable
Good
Very kind
Did not interact

-
40.0
50.0
-
10.0

-
50.0
40.0
-
10.0

-
3.3
-
-
96.7

-
20.0
18.0
-
62.0
Total out-patients interviewed 10 16 30 56


Table EO 6: Privacy

Type of Health Facility (Percent)
Privacy
DH CHC PHC All
Patients reporting presence of privacy at
the place of examination

30.0 81.3 80.0 71.4
Total out-patients interviewed 10 16 30 56





141

Table EO 7: Patient-Doctor/Provider Communication

Type of Health Facility (Percent)
Patient-Doctor Communication
DH CHC PHC All
Doctor listened to description of ailment
patiently
Yes, somewhat
Yes, always
No
Did not interact/not applicable


-
90.0
10.0
-


-
100.0
-
-


6.7
40.0
-
53.3


3.6
66.1
1.8
28.6
Doctor allowed to ask questions
Yes, somewhat
Yes, always
No
Did not interact/not applicable

40.0
60.0
-
-

12.5
87.5
-
-

3.3
36.7
6.7
53.3

12.5
55.4
3.6
28.6
Doctor responded to questions
Yes, somewhat
Yes, always
No
Did not interact/not applicable

20.0
60.0
20.0
-

18.8
75.0
6.3
-

-
6.7
40.0
53.3

8.9
53.6
8.9
28.6
Doctor discussed about the ailment
Yes
No
Did not interact/not applicable

90.0
10.0
-

81.3
18.8
-

43.3
3.3
53.3

62.5
8.9
28.6
Doctor talked about the recovery
Yes
No
Did not interact/not applicable

90.0
10.0
-

75.0
25.0
-

36.7
10.0
53.3

57.1
14.3
28.6

Doctor gave other advice
Yes
No
Did not interact/not applicable

80.0
20.0
-

37.5
62.5
-

20.0
26.7
53.3

35.7
35.7
28.6
Total out-patients interviewed 10 16 30 56















142


Table EO 8: Satisfaction of OPD patients regarding cleanliness of the facility


Satisfaction regarding
No. of
patients
availed the
service
Not Clean
Partially
Clean
Clean
A. District Hospital
OPD Room 10 - 50.0 50.0
Examination Room 10 - 30.0 70.0
Dispensary 10 - 20.0 80.0
Laboratory 6 16.6 16.6 66.6
Injection Room 4 25.0 25.0 50.0
Dressing Room 1 - 100.0 -
B.CHC
OPD Room 16 - 31.3 68.8
Examination Room 16 - 25.0 75.0
Dispensary 16 - 12.5 87.5
Laboratory 1 - 0 100.0
Injection Room 12 - 8.3 91.7
Dressing Room 0 - - -

C. PHC
OPD Room 30 6.7 16.7 76.7
Examination Room 29 - 24.1 95.8
Dispensary 29 - 13.8 86.2
Laboratory 2 - 2 100.0
Injection Room 16 - - 100.0
Dressing Room 2 - - 100.0
D. All
OPD Room 56 3.6 26.8 69.6
Examination Room 55 - 25.5 74.5
Dispensary 55 - 14.5 85.5
Laboratory 9 11.1 11.1 77.8
Injection Room 32 3.1 6.3 90.6
Dressing Room 3 - - 100.0






143
Table EO 9: Satisfaction of OPD patients regarding crowding in the facility

Crowding (% of patients)
Satisfaction regarding
No. of
patients
availed the
service
Not
Adequate
Somewhat
Adequate
Adequate
A. District Hospital
OPD Room

10

-

30.0

70.0
Examination Room 10 - 30.0 70.0
Dispensary 10 - 30.0 70.0
Laboratory 6 - 16.6 83.3
Injection Room 4 - 25.0 75.0
Dressing Room 1 - - 100.0
B. CHC
OPD Room 16 - 18.8 81.3
Examination Room 16 6.3 12.5 81.3
Dispensary 16 6.3 12.5 81.5
Laboratory 1 - - 100.0
Injection Room 12 - 8.3 91.7
Dressing Room 0 - - -
C. PHC
OPD Room 30 3.3 20.0 76.7
Examination Room 29 0 17.2 82.8
Dispensary 29 6.9 34.5 58.6
Laboratory 2 - 0 100.0
Injection Room 16 - 12.5 87.5
Dressing Room 2 - 0 100.0
D. All
OPD Room 56 1.8 21.4 76.8
Examination Room 55 1.8 18.2 80.0
Dispensary 55 5.5 27.2 67.3
Laboratory 9 - 11.1 88.9
Injection Room 32 - 12.5 87.5
Dressing Room 3 - - 100.0

















144

Table EO 10: Continuity of treatment


Type of Health Facility (Percent) Continuity of treatment
DH CHC PHC All
Satisfaction with the visit to the health
facility
Dissatisfied
Somewhat satisfied
Satisfied


20.0
40.0
40.0


6.3
6.3
87.5


3.3
50.0
46.7


7.1
35.7
57.1
Reason for dissatisfaction, if dissatisfied
Lack of facilities
Bad experience with the Doctor
Poor quality of services
Charges are exorbitant
Other

-
50.0
-
50.0
-

100.0
-
-
-
-

-
-
100.0
-
-

-
25.0
25.0
25.0
25.0
Visit again to the facility (if fell sick)
Yes
No
May come/unsure

60.0
-
40.0

93.8
-
6.3

80.0
3.3
16.7

80.4
1.8
17.9
Recommend this hospital to others
Yes
No

100.0
-

100.0
-

96.7
3.3

98.2
1.8
Total out-patients interviewed 10 16 30 56

145
SCHEDULE (S): STATE SCHEDULE (Appendix-1)
Block A. Identification Details (Information to be collected from State Health Department)
Q. No. Questions
S101. Name of the State Chhattisgarh
S102. Total Number of Districts 16
S103. Total Number of Census Villages (2001 census) 20,308
S104. Name of the Respondent Mr.Oriya Nag
S105. Designation of the Respondent State Programme Manager

Block B. (I) Population of the State (As on 2001 as per Population Census)
Rural Urban Total
Q. No. Category
Male Female Male Female Male Female

S106.
Scheduled caste 950335 948720 264474 255193 1213194
1205528

S107.
Scheduled Tribe 3106086 3158749 181248 170513 3287334 3329262

S108.
Others 4251022 4233144 1721053 1593266 5973690
5824795

S109.
Total 8307443 8340613 2166775 2018972 10474218 10359585


Block B. (II) Population of the State (As on March, 2008) (Information to be collected from State Health
Department)
Rural Urban Total
Q. No. Category
Male Female Male Female Male Female
Source Code
(Population
Projection
1; State
Estimate
2; Not
Available-3)
S110.
Scheduled Caste
- - - - - -
3
S111.
Scheduled Tribe
- - - - - -
3
S112.
Others
- - - - - -
3
S113.
Total
- - - - - -
3




146
Block C. Infrastructure (Information to be collected from Programme Manager in State Programme
Management Unit (SPMU))
Q. No.
S114. Name of the Respondent MR. Anand Sahu
S115. Designation of the Respondent Monitoring and Evaluation Consultant
Public Health
Infrastructure
Total
Existing
(In Nos.)
(As on
30.6.2008)
New
Buildings
Under
Construction
(In Nos.)
(As on
30.6.2008)
Total
Number
where IPHS
facility
survey
completed
(As on
30.6.2008)
No. of facilities
where IPHS
Upgradation
completed (As on
30.6.2008)
S116.
Sub Centre 4741 1139 na 0
S117.
PHC 721 239 721 0
S118.
24x7 PHC 5 0 5 0
S119.
CHC 136 65 129 96*
S120.
First Referral
Units(FRU)
0 0 0 0
S121.
Mobile medical unit 0
S122.
Sub Divisional Hospital 8 3 NA 0
S123.
District Hospital 16 16 16
S124.
AYUSH 692 NA 0 0
Private Health
Infrastructure
Total Existing
(In Nos.) (As on 30.6.2008)
S125.
Hospitals (More than
30 bedded)
0
S126.
Nursing Homes (Less
than 30 bedded)
13
Block D.
Rogi Kalyan Samities (RKS)(Information to be collected from Programme Manager in State
Programme Management Unit (SPMU))
Q. No.
How many facilities have Rogi Kalyan Samities (RKS) Registered?

Total Functioning No. with Registered RKS
S127.
District Hospital 16 16
S128.
Sub Divisional Hospital 8 8
S129.
CHC 129 129
S130.
PHC 707 695
S131.
Block PHC
- -
147
S132.
Addl. PHC/ civil
dispensary
13 13

Block E.
Janani Suraksha Yojana(JSY)(Information to be collected from Programme Manager in
State Programme Management Unit (SPMU))
Q. No.
Response Category Skip
S133.
Whether any PPP
initiative undertaken in
the state for the
implementation of JSY
Scheme?
Yes.1


No.2


> Q. S135
S134.
If yes, number of
private health facilities
accredited for JSY
scheme
13

Q. No. Total Institutional
Deliveries Reported
during 2007-08
Total number of
Registered JSY
Women during 2007-
08
Out of total number of
Registered JSY
Women, number of
women opting for
Institutional Delivery
during 2007-08
At Govt. Facilities
S135.
Scheduled
Caste
N.A
- -
S136.
Scheduled
Tribe
N.A
- -
S137.
General
N.A
- -
S138. BPL
N.A
- -
S139. APL
N.A
- -
S140. Total 101749 175978 101749
At Private Facilities (Wherever accredited for services)
S141.
Scheduled
Caste
N.A
- -
S142.
Scheduled
Tribe
N.A
- -
S143.
General
N.A
- -
S144. BPL
N.A
- -
S145. APL
N.A
- -
S146. Total N.A - -
148
Block F.
Financial Mechanisms (Information to be collected from Finance Manager in State
Programme Management Unit (SPMU))
Q. No. Response Category Skip
S147.
Name of the Respondent Mr. Salvin Mika
S148.
Designation of the Respondent Accountant NRHM
S149.
Have all the vertical health
societies created under different
programmes merged in to State
Health Society under NRHM?
Yes.1
No.2

> Q. S152
S150.
How many districts have
merged registered health
societies?

16

S151.
Is there a common bank account
for all programmes in State
Health Society
Yes.1
No..2

S152.
Has the perspective State Health
Plan been prepared for 2008-09?
Yes.1
No.2

> Q. S155
S153.
How many districts have
District Action Plans for the
current year (2008-09)?

16

S154.
Have these plans been approved
by the state society?
Yes.1
No.2

S155.
How are the funds being
allocated to the districts
(Encircle all applicable options)
Activity wiseA
As flexi pool funds..B
Based on a set formula like size of
district etcC
Based on previous years
expenditure..D
Others (please specify) E

S156.
Are the funds being transferred
electronically by the State to the
district?
Yes.1
No.2

>Q S158
S157.
If yes, then to how many
districts is it being transferred
electronically?

16

S158.
How many Sub Centres have
Operational Joint Bank Account
of ANM and Sarpanch?
4722

No. of centres for which Untied Grant for the current year transferred?
S159.
CHC Untied Grant not transferred*
S160.
PHC Untied Grant not transferred
S161.
Sub Centre 4692
*not transferred due to non-utilization of previous grants

149
SCHEDULE (D): DISTRICT SCHEDULE (Appendix-2)
The interviewer is expected to interact with District NRHM society (Part A) member for collection of district
level information and follow this up with a visit to the district hospital (Part B)
Part A

Block A. Identification Details (Information to be collected from District NRHM Society)
Q. No. Questions
D101. Name of the District Janjgir-Champa
D102. Total Number of Blocks in the District 9
D103. Total Number of Census Villages (2001 census) in
the District
913
D104. Name of the Respondent Dr. R. N. Pandey
D105.
Designation of the Respondent Chief Medical and Health Officer

Block B.
(I)
Population of the District (As on 2001 as per Population Census)
Rural Urban Total
Q. No. Category
Male Female Male Female Male Female

D106.
Scheduled Caste
137037 137353 11036 10773 148073 148126 296199
D107.
Scheduled Tribe
71939 74331 3515 3284 75454
77615 153069
D108.
Others
375544 375908 60317 56394 435861 432302
868163
D109.
Total
584520 587592 74868 70451 659388 658043
1317431

Block B.
(II)
Population of the District (As on March, 2008) (Information to be collected from State Health
Department)
Rural Urban Total
Q. No. Category
Male Female Male Female Male Female
Source Code
(Population
Projection 1;
State Estimate
2; Not Available-
3)
D110.
Scheduled Caste
- - - - - -
3
D111.
Scheduled Tribe
- - - - - -
3
D112.
Others
- - - - - -
3
D113.
Total
- - - - - -
3
150

Private Health Infrastructure Total Existing
(In Nos.) (As on 30.6.2008)
D125.
Hospitals (More than 30 bedded) 0
D126.
Nursing Homes (Less than 30 bedded) 2
Facilities available in the district for delivery
Facility
Number of Facilities

Total
existing in
the District
(As on
30.6.2008)
Operational
24x7

Providing
BeMOC
Providing
CeMOC
(Having Blood
Storage,
Anesthetist
and
Gynecologist)
With New Born
Care Unit
D127.
District Hospital 1 1 1 1 0
D128.
Sub Divisional
Hospital
1 0 1 0 0
D129.
CHC 8 8 8 0 0
Block C. Infrastructure [Information to be collected from Chief Medical Officer (CMO) Office]
Q. No.
D114. Name of the Respondent
D115. Designation of the Respondent
Public Health
Infrastructure
Total
Existing
(In Nos.) (As
on 30.6.2008)
New
Buildings
Under
Construction
(In Nos.) (As
on 30.6.2008)
Total
Number
where IPHS
facility
survey
completed
(As on 30.6.2008)
No. of
facilities
where IPHS
Upgradation
completed
(As on 30.6.2008)
D116.
Sub Centre 246 21 246 0
D117.
PHC 36 3 36 0
D118.
24x7 PHCs 0 0 0 0
D119.
CHC 8 0 8 0
D120.
First Referral Units
(FRUs)
4*
(only
designated)
0 4 0
D121.
Mobile medical units 0
D122.
Sub Divisional Hospitals 1 0 1 0
D123.
District Hospitals 1 0 1 0
D124.
AYUSH 1 0 0 0
151
D130.
PHC 36 1 1 0 0
D131.
Public Maternity
Homes
0 0 0 0 0
D132.
Others Public
(ESI, Railways
etc.)
0 0 0 0 0
D133.
Others Private 2 2 2 0 0
D134.
Private
accredited for
JSY
2 2 2 0 0

Block D. Human Resources Available in the District (Information to be collected from Chief Medical
Officer (CMO) Office)
Q. No.
Category No.
sanctioned
Regular in
Position
Contractual
Recruits
Total in Position
D135.
Medical Officer 123 51 9 60
D136.
Gynaecologist 9 1 0 1
D137.
Anaesthetist 1 0 0 1
D138.
Paediatrician 9 1 0 1
D139.
Other Specialists 24 0 0 0
D140.
Staff Nurses 52 38 0 38
D141.
ANM 290 216 2 218

Block E.
Rogi Kalyan Samities (RKS) Information to be collected from District Programme
Management Unit (DPMU)
Q. No.
D142. Name of the Respondent Mr.Padmaker Shinde
D143. Designation of the
Respondent
District Programme Manager

Number of facilities having Rogi Kalyan Samities (RKS) Registered?

Total functioning No. with Registered
RKS
D144.
District Hospital 1 1
D145.
Sub Divisional Hospital 1 1
D146.
CHC 8 8
D147.
PHC 36 22

152
Block F

Janani Suraksha Yojana(JSY) (Information to be collected from District Programme
Management Unit (DPMU))
Q. No.

Response Category Skip
D 148.
Whether any PPP initiative
undertaken in the state for the
implementation of JSY
Scheme?

Yes.1

No.2


D149.
If yes, number of private health
facilities accredited for JSY
scheme
2
D 150. Which of the following areas
are covered under PPP
initiatives (Encircle all
applicable options)

Lab services.A
Diagnostics like Ultrasound & X-
Rays...B
Bio Medical waste Disposal..C
Sanitation..D
Security..E
Hiring of specialist services.F
Procurement of Drugs/
Equipment...G
Providing transportation facility for
delivery & referral cases....H
Other.......................................I

Q. No. Total
Institutional
Deliveries
Reported
during 2007-08
Total number of
Registered JSY
Women during 2007-
08
Out of total number of
Registered JSY Women,
number of women opting
for Institutional Delivery
during 2007-08
At Govt. Facilities
D 151.
Scheduled Caste 1023 1633 765
D 152.
Scheduled Tribe 529 844 395
D153.
General 2997 4787 2242
D154. APL 1839 3402 773
D155. BPL 2710 3862 2629
D156. Total 4549 7264 3402
153
Block F

Janani Suraksha Yojana(JSY) (Information to be collected from District Programme
Management Unit (DPMU))
Q. No.
At Private Facilities
(Wherever accredited
for services)
Total
Institutional
Deliveries
Reported
during 2007-
08*
Total number of
Registered JSY
Women during 2007-
08
Out of total number of
Registered JSY Women,
number of women opting
for Institutional Delivery
during 2007-08
D157. Scheduled Caste - - -
D158. Scheduled Tribe - - -
D159. General - - -
D160. APL - - -
D161. BPL - - -
D162. Total - - -
NA=not available as the private health facilities were accredited in 2008-09


Block G.
Financial Mechanisms (Information to be collected from Finance Manager in District Programme
Management Unit (DPMU))
Q. No.
D163. Name of the Respondent Mr.Padmaker Shinde
D164. Designation of the Respondent DPM

Response Category Skip
D.165
Have all the vertical health societies
created under different programmes
merged in to a District Health Society?
Yes.1
No.2

>Q
D168
D166. Whether the merged district health
society is registered?
Yes.1
No..2

D167. Is there a common bank account for all
programmes in District Health Society
Yes.1
No.2

D168.
Whether the district has prepared
District Action Plan for the current
year?
Yes.1
No.2

>Q
D170
D169.
If yes, has the plan been approved by
the district society?
Yes.1
No.2

154
Block G.
Financial Mechanisms (Information to be collected from Finance Manager in District Programme
Management Unit (DPMU))
Q. No.
D170. How are the funds being received
from the State in the district
(Encircle all applicable options)
Activity wise.A
As flexi pool funds....B
Based on a set formula like size of
district etc.C
Based on previous years expenditure
....D
Based on Annual Action Plan ...E
Others (pl Specify) F
Not aware...................................G


D171.
Are the funds received were
transferred electronically by the
State
Yes.1
No.2


D172.
How many Sub Centres have
Operational Joint Bank Account of
ANM and Sarpanch?
246
No. of centres for which Untied
Grant for the current year
transferred?
246
D173. CHC 8
D174. PHC 36
D175. Sub Centre 246


155

Part B
District Hospital
The infrastructure details to be supported by digital photographs of the facility and other areas like operation
Theater, wards, pharmacy, lab etc
Block A. Identification Details (Information to be collected from the Office Of Medical
Superintendent of the Hospital)
Q. No. Questions (for both Male/Female)
D176.
Name of District Hospital Barrister Thakur
Chedilal Distict
Hospital
D177.
Name of the Respondent Dr. U. S. Sharma
D178.
Designation of the Respondent Civil Surgeon

Distance & Time Taken to travel to District Hospital in
public transport from
Distance (in
Kms.)
Time (in
Hrs.)
D179.
Nearest CHC in the coverage area 22 60
D180.
Farthest CHC in the coverage area 100 270
D181.
Distance of District Hospital from the nearest bus stop
(in Kms.)
< 0.5 Km..1
0.5 1 Km2
>1 Km......................3
D182.
Has the IPHS facility survey been carried out in the
District Hospital
Yes1
No.2



Block B. Physical Infrastructure (Information to be collected from the Office Of Medical
Superintendant of the Hospital and supplemented by observation)

Q. No. Questions Response Category
D183.
Area of the Hospital (in Sq. mtrs.)
3415Sq mtrs
D184.
Number of indoor beds available
100 beds
D185.
Is the hospital located near residential area?
Yes.1
No.2
D186.
Is necessary environmental clearance obtained from
Pollution Control Board by the Hospital?
Yes.1
No.2
D187.
Whether hospital building is disable friendly as per
provisions of Disability Act? (Ramp, Lift, wheel
chair movement etc.)
Yes.1
No.2
156



Administrative/ Main Block (Availability of following)

D188.
Waiting Space adjacent to each consultation and
treatment room
Yes- in all .1
No.2
Yes in some3
D189.
Registration Counter
Yes.1
No.2
D190.
Blood Bank/ Blood storage Unit
Yes.1
No.2
D191.
Doctors' Duty Room
Yes.1
No.2
D192.
Isolation Room
Yes.1
No.2
D193.
Treatment Room
Yes.1
No.2
D194.
Pharmacy (Dispensary)
Yes.1
No.2
D195.
Intensive Care Unit (ICU)
Yes.1
No.2
D196.
High Dependency Wards
Yes.1
No.2
D197.
Critical Care Area (Emergency Services)
Yes.1
No.2
D198.
Examination and Preparation Room
Yes.1
No.2

Hospital Services
D199.

Hospital Kitchen (Dietary Service)

Yes.1
No.2
D200.

Central Sterile and Supply Department (CSSD)

Yes.1
No.2
D201. Hospital Laundry
Yes.1
No.2
D202. Medical and General Stores
Yes.1
No.2
D203. Engineering Services Backup
Yes.1
No.2
D204.
Ventilation (Natural or mechanical exhaust) in the
wards
Yes.1
No..2
D205.
Water coolers / Refrigerators

Yes.1
No..2
157
D206. Round the clock water supply
Yes.1
No.2
D207.
Overhead water storage tank with Pumping and
boosting arrangements

Yes.1
No.2
D208. Provision for fire fighting
Yes.1
No.2
D209.
Proper drainage and sanitation system for waste
water, surface water, sub soil water and sewerage
Yes.1
No.2
D210.
How is the Bio Medical Waste disposed? (Encircle
all applicable options)
Buried ..A
Incerrnation. B
Outsourced to agency
C
Thrown in open.D
D211.
Is Bio Medical Waste segregated in three different
bins?
Yes.1
No.2

Obstetrics & Gynae Section (Information to be collected from the Sister In charge of Gynae
ward & supplemented by Observation from records)
D221.
Name of the Respondent Smt. Seema Samuel
D222. Designation of the Respondent Staff Nurse

Response Category Skip

Number of Residential Quarters available for all
medical and Para medical staff
No.
Available
No.
Occupied
D212. Medical Staff
0 0
D213. Para medical staff
0 0
D214. Parking place
Yes.1
No.2
D215. Medical Records Section
Yes.1
No.2
D216.
Is the disease classification being carried out as per
protocols
Yes.1
No.2
D217. Availability of telephone
Yes.1
No.2
D218. Availability of Fax equipment
Yes.1
No.2
D219. Availability of Computers
Yes.1
No.2
D220. Availability of Internet services
Yes.1
No.2
158
D223. Is there a separate Ward for
Female Patients?
Yes.1
No.2

>Q D226
D224. If Yes, the number of beds
D225. Bed Occupancy Rate in the last
12 months (As on March 31,
2008)

D226. Total OPD in last 3 calendar
months
173
D227. Total deliveries in last 3
calendar months
52
D228. Is there a separate OT available
for Gynaecology & Obstetrics
Yes..1
No..2

Procedures Carried Out
Particulars Availability of Services If Yes, Numbers
in 2007-2008
D229.
Total deliveries conducted
267
D230. Caesarean section deliveries
Yes.1
No..2
17

If yes, no. done
in 2007-08
D231. Caesarean section for JSY
Yes.1
No..2
17
D232. Assisted Delivery
Yes.1
No..2
3
D233. Forceps delivery
Yes.1
No..2
1
D234. MTP
Yes.1
No..2
13
D235. Mid trimester Abortion
Yes.1
No..2
11
D236. Ectopic Pregnancy
Yes.1
No..2

D237. Retained Placenta
Yes.1
No..2

D238. Eclampsia
Yes.1
No..2
5
D239. PPH
Yes.1
No..2
1
159
D240. Sterlisation
Yes.1
No..2
351
D241. Suturing Cervical Tear
Yes.1
No..2

D242. Hysterectomy
Yes.1
No..2
1
D243. Infertility Treatment
Yes.1
No..2
43

Surgical Section (Information to be collected from the Sister In charge of Surgical ward & supplemented by
Observation)
D244. Name of the Respondent Amit Kumar Rathore
D245. Designation of the Respondent OT Attendant

No. of Surgical OPD in last three
months
150
D246. Female 30
D247. Male 120

No. of Surgical IPD in last three
months
317
D248. Female 310
D249. Male 7


Availability of Services Response Category
If Yes, Numbers in
last 3 months
D250.
Emergency (Accident & other
emergency) (Casualty)
Yes.1
No..2

211
D251.
Pancreas Surgery
Yes.1
No..2

D252.
Spleen and Portal Hypertension
Surgery
Yes.1
No..2

D253.
Abdomen Surgery
Yes.1
No..2

D254.
Breast Surgery
Yes.1
No..2

D255.
Leprosy Reconstructive surgery
Yes.1
No..2

160

Medical Section (Information to be collected from the Sister In charge of Medical ward & supplemented by
Observation)
D256. Name of the Respondent Smt Seema Samuel
D257. Designation of the Respondent Staff Nurse

Medical OPD in last three months 6420
D258. Female 2097
D259. Male 3513

Medical IPD in last three months 505
D260. Female 212
D261. Male 293

Availability of Services Response Category
If Yes,
Numbers in
last 3 months
D262.
Dermatology and Venerology (Skin &
VD) RTI / STI
Yes.1
No..2

D263.
Services under NLEP
Yes.1
No..2
289
D264.
Pleural Aspiration
Yes.1
No..2

D265.
Pleural Biopsy
Yes.1
No..2

D266.
Bronchoscopy
Yes.1
No..2

D267.
Lumbar Puncture
Yes.1
No..2
Nos. NA
D268.
Pericardial tapping
Yes.1
No..2

D269.
Skin scraping for fungus / AFB
Yes.1
No..2

D270.
Bone Marrow Biopsy
Yes.1
No..2

D271.
Endoscopic Specialised Procedures
Yes.1
No..2

D272.
Psychiatry Services
Yes.1
No..2


161
Pediatric Section (Information to be collected from the Sister In charge of Pediatric ward & supplemented
by Observation)
D273. Name of the Respondent Sister Seema Samuel
D274. Designation of the Respondent Staff Nurse
Pediatric OPD in 2007-2008
Numbers
D275.
Female
1205
D276.
Male
1340
D277.
Designated/identified Beds for
newborns available?
Yes -------------------1
No ---------------------2


>Q D279
D278.
If yes, no. of beds
10
Pediatric Patients admitted in
2007-2008
Numbers
D279.
Total Admitted
652
D280.
Neonates admitted
25
D281.
Other Infants (0-1 years)
admitted
57
D282.
Children under 5 yrs admitted
126
Services Available

D283.
Asphyxia Management
Yes.1
No..2
D284.
Management of severe
malnourished children
Yes.1
No..2
D285.
Management of Neo Natal
Sepsis
Yes.1
No..2
D286.
Management of Dehydration
and Diarrhoeal Cases
Yes.1
No..2
D287.
Management of Respiratory
Tract / Pnuemonia Cases
Yes.1
No..2

Equipment Available
Available? If available, whether
working?
D288.
Cradle
Yes.1
No..2
Yes.1
No..2
162
D289.
Incubator
Yes.1
No..2

D290.
Radiant Heat Warmer
Yes.1
No..2
Yes.1
No..2
D291.
Phototherapy Unit
Yes.1
No..2
Yes.1
No..2
D292.
Bag with Mask
Yes.1
No..2

D293.
Laryngoscope
Yes.1
No..2
Yes.1
No..2
D294.
Oxygen Mask
Yes.1
No..2

D295.
Suction Machine
Yes.1
No..2
Yes.1
No..2
D296.
Thermometer
Yes.1
No..2
Yes.1
No..2

Availability of drugs
D297.
ORS (WHO new formula)
Yes.1
No..2


D298.
Vitamin A Solution
Yes.1
No..2


D299.
Iron folic Acid Syrup
Yes.1
No..2


D300.
Paediatric Antibiotics
Yes.1
No..2



Diagnostic Section (Information to be collected from Radiology Section & supplemented by Observation)
D301. Name of the Respondent Mr. Singh
D302. Designation of the Respondent X-Ray Technician
Diagnostic OPD in last 3 months
567
D303.
Female
214
D304.
Male
353
163
Diagnostic Section (Information to be collected from Radiology Section & supplemented by Observation)

Availability of services Response Category If Yes, Number
carried out in last
3 months
D305. X-Ray Yes.1
No..2
470
D306.
Ultrasound
Yes.1
No..2

D307.
Ultrasound guided Biopsy
Yes.1
No..2

D308.
ECG
Yes.1
No..2
97


Lab Services (Information to be collected from the Lab Technician & supplemented by Observation)
D309. Name of the Respondent T.L. Sahu
D310. Designation of the Respondent Laboratory Technician
Number attended in last 3 months
6869
D311.
Female
4769
D312.
Male
2100

Availability of services Response Category If Yes, Number
carried out in last
3 months

CLINICAL PATHOLOGY

D313.
Haematology
Yes.1
No..2
4303
D314.
Urine Analysis
Yes.1
No..2
2083
D315.
Stool Analysis
Yes.1
No..2
3
D316.
Semen Analysis (morphology,
count)
Yes.1
No..2
2
D317.
CSF Analysis (Cell count, culture
sensitivity etc., gram staining)
Yes.1
No..2

164
Lab Services (Information to be collected from the Lab Technician & supplemented by Observation)
D318.
Aspirated fluids (cell count
cytology)
Yes.1
No..2


PATHOLOGY

D319.
PAP smear
Yes.1
No..2

D320.
Split Skin Smear Examination for
leprosy
Yes.1
No..2
1
D321.
Sputum
Yes.1
No..2
24
D322.
Histopathology
Yes.1
No..2

D323.
Microbiology
Yes.1
No..2

D324.
Serology
Yes.1
No..2
76
D325.
Biochemistry
Yes.1
No..2
377
D326.
Physiology (Pulmonary function
test)
Yes.1
No..2


Block C. Human Resource (Information to be collected from the Statistics Section of the Office of
Medical Superintendent of the Hospital)
D327. Name of the Respondent
D328. Designation of the Respondent

Category of Personnel Sanctioned Regular
In Position
Contractual
In Position
Total
D329. Hospital Superintendent 1 1 0 1
D330. Medical Specialist 1 1 0 1
D331. Surgery Specialist 1 1 0 1
D332. Gynaecologist 1 1 0 1
D333.
Gynaecologist (short term trained
MO)
1 1 0 1
D334. Pediatrician 1 1 0 1
165
Block C. Human Resource (Information to be collected from the Statistics Section of the Office of
Medical Superintendent of the Hospital)
D335. Anesthetist 1 1 0 1
D336.
Anesthetist (short term trained
MO)
0 0 0 0
D337. Radiologist 1 0 0 0
D338. General Duty Doctor 15 8 1 9
D339. Public Health Manager 0 0 0 0
D340. AYUSH Physician 0 0 0 0
D341. Pathologists 1 0 0 0
D342. Psychiatrist 1 0 0 0
D343. Dermatologist / Venereologist 0 0 0 0
D344. ENT Surgeon 1 0 0 0
D345. Ophthalmologist 1 0 0 0
D346. Orthopaedician 1 0 0 0
D347. Microbiologist 0 0 0 0
D348. Dental Surgeon 1 0 1 1

Para-Medicals
D349. Staff Nurse 18 11 0 11
D350.
Hospital worker (OP/ward +OT+
blood bank)
27 25 0 25
D351. Sanitary Worker

Category of Personnel Sanctioned Regular
In Position
Contractual
In Position
Total
D352.
Ophthalmic Assistant /
Refractionist
0 1 0 1
D353.
Social Worker / Counselor
1 0 1 1
D354.
ECG Technician
0 0 0 0
D355.
Audiometrician
0 0 0 0
D356.
Laboratory Technician ( Lab +
Blood Bank)
2 2 0 2
D357.
Laboratory Attendant (Hospital
Worker)
0 0 0 0
D358.
Dietician
0 0 0 0
D359.
ANM
0 0 0 0
166
Block C. Human Resource (Information to be collected from the Statistics Section of the Office of
Medical Superintendent of the Hospital)
D360.
LHV
0 0 0 0
D361.
PHN
0 0 0 0
D362.
Radiographer
2 2 0 2
D363.
Pharmacist
2 1 0 1
D364.
Matron
1 0 0 0
D365.
Physiotherapist
0 0 0 0
D366.
Medical Records Officer /
Technician
0 0 0 0
Administrative Staff

D367.
Manager (Administration)
0 0 0 0
D368.
Junior Administrative Officer
0 0 0 0
D369.
Office Superintendent
0 0 0 0
D370.
Accounts Manager
1 1 0 1
D371.
Driver
4 0 1 1
D372.
Peon
4 2 0 2

Block D. Other Framework and Structure Related Issues (Information to be collected from the
Office of Medical Superintendent of the Hospital)

Response Category Skip
D373.
Whether the Rogi Kalyan Samiti
established for the Hospital
Yes.1
No..2

>Q D382
D374.
If Yes, whether Rogi Kalyan
Samiti Registered for the
Hospital?
Yes.1
No..2


D375.
Are there any official charges for
consultation/ procedures?
Yes.1
No..2

>Q D378
D376.
If yes, are people belonging to BPL/
SC/ ST exempted/ subsidized?
Yes.1

No..2


>Q D378
167
Block D. Other Framework and Structure Related Issues (Information to be collected from the
Office of Medical Superintendent of the Hospital)
D377.
If yes, what is the procedure for
granting exemption (Encircle all
applicable options)
Based on BPL Ration
CardA
Based on Certification by
hospital authorities/
Govt....B
Based on recommendation of
RKSC
Based on Financial
compensation by
RKS.D
Others (please
specify). E

D378.
How do RKS generate additional
resources other than govt. grants?
(Encircle all applicable options)

Donation.A
User
fees....B
Other innovative means
(through arrangements like
PPP, outsourcing of services
etc.)C

D379.
How is the money generated used?
(Encircle all applicable options)
Retained within the facility
for local
use....A
Retained but not used.....B
Transferred to district
Accounts..C
Other ...D

D380.
Is display board put up in Hospital
showing number of members, number
of meetings of RKS etc?
Yes.1
No..2

D381.
How feedback is taken for grievance
redressal by RKS?

Social Audit....1
Public Scrutiny of action
taken ....2
No feedback mechanism
.....3
Others (please specify)....4


168

D382. Any Other Special Ward/ Procedures not covered above

Observations presented at the end of chapter-2
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________
D383. Any other remarks by MS of the hospital/ Other members which have not been captured
in the questions above but are relevant

Observations presented at the end of chapter-2
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
________________________________________________________________________
D384. Any other remarks or suggestions for improvement of services by Observer which have
not been captured in the questions above but are relevant

Observations presented at the end of chapter-2
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_________________________________________________________________________
If the patient has availed service either in (OPD or IPD) the observer to go to Exit
Interview Schedule
D D M M Y Y
0 3 0 2 0 9 Reena Basu


169
APPENDIX 3
Scores given for the computation of Standard of Living Index
Variables Categories Categories Scores
Type of house Pucca 4
Semi Pucca 2
Kachcha 0
Ownership of house Yes 2
No 0
Separate Kitchen Yes 1
No 0
Toilet facility Separate toilet Yes 2
No 0
Fuel for cooking LPG/Biogas for cooking Yes 2
No 0
Source of drinking water Water supply - piped Yes 2
No 0
Ownership of items Mattresses Yes 1
Pressure cooker Yes 1
Chair Yes 1
Cot/Bed Yes 1
Table Yes 1
Clock/ Watch Yes 1
Electricity Yes 2
Sofa set Yes 2
Fan Yes 2
Radio/Transistor Yes 2
Television (Black & White) Yes 2
Sewing Machine Yes 2
Telephone (Other than
mobile)
Yes
2
Bicycle Yes 2
An Animal Drawn Cart Yes 2
Water pump Yes 2
Thresher Yes 2
Television (Colour) Yes 3
Telephone (mobile) Yes 3
Computer Yes 3
Motor Cycle/Scooter Yes 3
Refrigerator Yes 3
Washing Machine Yes 3
Car/Van/Jeep Yes 4
Tractor Yes 4
Ownership of agricultural land 5 acres or more 4
2 - 4.9 acres 3
< 2 acres/Not known 2
No agricultural land 0
Ownership of irrigated land At least some irrigated
land
2
No irrigated land 0
Total (Maximum) 78

SLI (Standard of Living Index) Score
Low 0 14
Medium 15 24
High 25 - 78