Sitamarhi - PIP Report

Evaluation of Programme Implementation Plan (PIP)

under NRHM in Sitamarhi district of Bihar State

Study Team

Dilip Kumar

S. K. Pandey

Population Research Centre

Department of Statistics

Patna University

Patna-800005

FOREWORD

At the instance of the Ministry of Health and Family Welfare (MoHFW), Government of India, New Delhi, our Centre had undertaken a study ‘Evaluation of Programme Implementation Plan (PIP) under NRHM in Sitamarhi district of Bihar State’. This study was launched by the MoHFW, Government of India on the urgent basis with the aim to improve the quality of services under NRHM.

A team of the technical staff had visited the Sitamarhi district to interview the health functionaries in the district public hospital, FRU, PHC and HSC for assessing the quality of NRHM services etc. on the basis of structured schedule, personal observations etc. The report has been written by Dr. Dilip Kumar, Joint Director and Sri S. K. Pandey, Analyst of the study team.

The present report provides some important findings regarding the district covered under the study. We hope these findings would be useful to the policy makers and researchers.

Amarendra Mishra

March 2014 Hony. Director

PRC, Patna

Executive Summary

It is the rapid evaluation of the PIP of National Rural Health Mission (NRHM). Technical staff of the Center had visited in the Sitamarhi district to interview the health functionaries in the district sadar hospital, First Referral Unit (FRU), Primary Health Center (PHC) and Health Sub Center (HSC) to assess the availability of infrastructure facilities, human resources, programme management etc. The framed schedules and personal observation apart from the other records were used for the information collection from the district sadar hospital, Mejorgunj FRU, Mejorgunj PHC and Dumri Khurd HSC level health functionaries in the Sitamarhi district of Bihar State during the assigned period of 14th February to 18th February 2014.

Situational Analysis in Sitamarhi district

District sadar hospital of Sitamarhi is 30-bedded hospital. It has almost all the basic facilities needed, such as water supply, power supply etc. It has the standby generator facility.The district sadar hospital has the dilapidated condition of the boundary wall. The district sadar hospital is likely to be constructed soon. The Mejorgunj FRU is also functioning from its own old building but it has no boundary wall. The Mejorgunj FRU has the facilities of computer for the Data Centre. This FRU is almost non functional. Mejorgunj PHC is functioning from its own building. The Dumri Khurd HSC is also functioning from its own building without the boundary wall.

Only about 50 percent of the HR is available in the district sadar hospital. None of the LHVs is functioning in the hospital at the time of survey. The Mejorgunj FRU has one Paediatrician, one ENT specialist, one Radiographer and one RMNCHA and counselor for family planning. The Mejorgunj FRU has the vacant position of OBG, Anaaesthetist, SNs, Pharmacist and LHV.The Mejorgunj PHC has three Medical Officers and three ANMs functioning. The Dumri Khurd HSC has only one ANM in working position. The posts of 2nd ANM and MPW-male are vacant in the HSC.

In the district sadar hospital none of the medical personnel trained for the Emergency Obstetric Care (EmOC) and two of the persons were trained on Basic Emergency Obstetric and newborn Care (BeMOC). None of the medical and para medical staff has received any kind of training in the Mejorgunj FRU. In Mejorgunj PHC, staff has received training on SBA, LSAS, IUCD, PPIUCD and etc. except of the EmOC, F-IMNCI and NSSK. In Dumri Khurd HSC, the ANM was trained on the IMNCI in Sitamarhi.

Some of the O.T equipments like; functional O.T ceiling lights, mobile ventilators, functional C-arm units are reported to be not available in the district sadar hospital. In the Mejorgunj FRU, most of the essential equipments are reported to be not available. In Mejorgunj PHC, most of the essential equipments are reported to be functional except some of the laboratory equipments like functional centrifuge, haemoglobinometer and semi auto analyzer etc.

Most of the essentials drugs are reported to be available except the supplies of urine albumin and sugar testing kits, EC pills in the district sadar hospital. The Mejorgunj FRU most of the drugs are also reported to be not available. The Mejorgunj PHC, it was reported about the availability of the essential drugs except the supplies of IFA syrup with dispenser and drugs for hypertension, diabetes, anti-allergic drugs and etc. The Dumri Khurd HSC reported about supplies of Vitamin A syrup, ORS packets etc. except the non supplies of drugs for common ailments.

There is functional BB/ESU unit in the district sadar hospital. There are no functional newborn stabilizhation unit and the functional Sick Newborn Care Unit (SNCU) in the district sadar hospital. The district sadar hospital lacks availability of nutritional rehabilitation centre.

There is functional new born care corner (functional radiant warmer with neo-natal ambu bag) in the Mejorgunj PHC. As reported, there are functional newborn stabilization unit and no functional Sick Newborn Care Unit (SNCU) in the PHC. In the district sadar hospital, except the EC pills, there are supplies of OCPs and IUCDs. There was no any case of Minilap in the district sadar hospital. In the Mejorgunj FRU, there are supplies of EC pills, OCPs and IUCDs. In the Mejorgunj PHC, there are supplies of EC pills except the supplies of OCPs and IUCDs. In Dumri Khurd HSC, there was no supply of EC pills.

There is no display of all the services (Citizen's charter) at the Mejorgunj FRU. It is needed to display all of the services (Citizen's charter) provided by the health facilities as well as display of it in the prominent places of the villages.

In the district sadar hospital, there is availability of Government ambulance services. There is requirement of more ambulance up to the PHC level. The Global Positioning System (GPS) in MMUs is not available. The ANMs require retraining on the work activities from time to time. There is no coordination among health & ICDS workers.

The district sadar hospital has the facilities of the treatment of Leprosies, Malaria, Kalazar and Tuberculosis (TB). The Mejorgunj PHC has also the facilities of the same. The Mejorgunj FRU has no facilities of the same disease control. At the Sitamarhi district sadar hospital andMejorgunj PHChave not very useful chronic diseases control programme.

The district sadar hospital effectively works for the births deliveries and the family planning services. The district sadar hospital refers the patients of serious ailments to the Sri Krishna Medical College Hospital (SKMH) at Muzaffarpur. Rogi Kalyan Samitis have been established at the PHC level and RKS funds are being utilized at the PHC and HSC levels, however, fund flows and submission of utilization certificates is not regular at the HSC.The District Health Society is monitoring the progress on the regular basis at the PHC and HSC levels.

The District sadar hospital, Mejorgunj FRU and Mejorgunj PHC have the facilities of data entry of HMIS. Most of the ANMs and Data Operators need refresher training on HMIS. The maternal death review is lacking at the PHC level also. There is no micro birth planning for the anemic pregnant women at the district level. There are no SMS alerts to the beneficiaries under the MCTS.

There is no provision of services of hospital waste treatment and disposal of Bio-Medical Waste Management in all health facility up to HSC level.

Evaluation of Programme Implementation Plan (PIP) under NRHM in Sitamarhidistrict of Bihar State

Background

It is the rapid evaluation of the PIP under the National Rural Health Mission (NRHM) assigned by the Ministry of Health and Family Welfare, Government of India, New Delhi. The NRHM aims of providing equitable, affordable and quality health care services to the vulnerable sections of the population, particularly among the poor, women and children residing in rural areas.

The technical staff of the Center had visited in the Sitamarhi district to interview the health functionaries in the District sadar hospital, CHC, PHC and Health Sub Center (HSC) to assess the availability of infrastructure facilities, human resources, programme management etc. The framed schedules and personal observation apart from the other records were used for the information collection from the District sadar hospital, PHCand HSClevel health functionaries in the selected Sitamarhi district during the assigned period of 14th February to 18th February 2014.In the Sitamarhi district, one district sadar hospital, Mejorgunj FRU, Mejorgunj PHC and Dumri Khurd HSC had been covered apart from the information collected from the pregnant women and the women having 0-6 years of children.

Demographic profile of Sitamarhi district

In 2011, Sitamarhi had population of 3,423,574 of which male and female were 1,803,252 and 1,620,322 respectively. Thepopulation density of Sitamarhi district for 2011 is 1,492 people per sq. km. In 2001, Sitamarhi district density was at 1,170 people per sq. km. Sitamarhi district administers 2,294 square kilometers of areas.Average literacy rate of Sitamarhi in 2011 were 52.05 compared to 38.46 of 2001.With regards to Sex Ratio in Sitamarhi, it stood at 899 per 1000 male compared to 2001 census figure of 892. The average national sex ratio in India is 940 as per latest reports of Census 2011. In 2011 Census, child sex ratio is 930 girls per 1000 boys compared to figure of 924 girls per 1000 boys of 2001 Census data. There were total 663,227 children under age of 0-6 against 556,582 of 2001 Census. Of total child population 663,227 male and female were 343,555 and 319,672 respectively. Child Sex Ratio as per Census 2011 was 930 compared to 924 of Census 2001.

Table 1: Some demographic facts of Sitamarhi district, 2001-11

Description / 2011 / 2001
Total Population / 3,423,574 / 2,682,720
Male / 1,803,252 / 1,417,611
Female / 1,620,322 / 1,265,109
Population Growth / 27.62% / 32.58%
Area Sq. Km / 2,294 / 2,294
Density/km2 / 1,492 / 1,170
Proportion to Bihar Population / 3.29% / 3.23%
Sex Ratio (Per 1000) / 899 / 892
Child Sex Ratio (0-6 Age) / 930 / 924
Average Literacy / 52.05% / 38.46%
Male Literacy / 60.64% / 49.36%
Female Literacy / 42.41% / 26.13%
Total Child Population (0-6 Age) / 663,227 / 556,582
Male Population (0-6 Age) / 343,555 / 289,273
Female Population (0-6 Age) / 319,672 / 267,309

Results

Here we discuss about the status of health infrastructure, facility up gradation under NRHM and availability of Human Resources, Rogi Kalyan Samiti (RKS) and assessment of health and family welfare situation etc. of Sitamarhi district.

A. Situational Analysis in Sitamarhi district

Infrastructure

It is situated in a separate and spacious building at Sitamarhi town. It is the district sadar hospital. The approach road of the hospital is narrow which needs to be widening up. The building is old with not very clean. It is 30-bedded hospital. It has almost all the basic facilities needed, such as water supply, power supply etc. It has the standby generator facility.The district sadar hospital has the dilapidated condition of boundary wall. The district sadar hospital is likely to be constructed soon.

The Mejorgunj FRU is also functioning from its own old building but it has no boundary wall. It is located in the remote areas. There is the availability of the facilities of labour room, laboratory, OPD room, electric supply. The Mejorgunj FRU has the facilities of computer for the Data Centre. This FRU is almost non functional due to non availability of the full strength of the medical staff. The cleanliness of OPD room, other room/ward, compound and premises was not good. It needs high boundary walls for the safety and security of the patients. There was no patient available in the FRU at the time of visits in the FRU. The staff quarters are old.

Mejorgunj PHC is functioning from its own building. There is the availability of the facilities of labour room, laboratory, OPD room, regular electric supply having generator facility also.It has also facilities of telephone, computer with internet connectivity for the Data Centre. The cleanliness of OPD room, other room/ward and premises was somewhat good. The condition of the boundary wall was not good.

The Dumri Khurd HSC is also functioning from its own building without the boundary wall.It has a small room for the regular supply and distribution of medicine among the villagers. The cleanliness of HSC was good. It has poor sanitation facility but needs maintenance properly.

Human Resources

Only about 50 percent of the HR is available in the district sadar hospital. The district sadar hospital lacks the full strength of permanent doctors and other specialists. The district sadar hospital have one OBG, one paediatrician, two general surgeons, two other specialists, seven medical officers, fifty nine nurses, one each of LTs and radiographer, four pharmacists. None of the LHVs is functioning in the hospital at the time of survey.

The Mejorgunj FRU has one Paediatrician, one ENT specialist, one Radiographer and one RMNCHA and counselor for family planning. The Mejorgunj FRU has the vacant position of OBG, Anaaesthetist, SNs, Pharmacist and LHV.

The Mejorgunj PHC has three Medical Officers and three ANMs functioning at the day of survey. It has only one LT and one GNM available. It lacks pharmacist and LHV/PHN. The posts of SNs/GNMs, LHV/PHN are reported to be vacant. The Dumri Khurd HSC has only one ANM in working position. The posts of 2nd ANM and MPW-male are vacant in the HSC.

Other health System inputs

In the district sadar hospital none of the medical personnel trained for the Emergency Obstetric Care (EmOC) and two of the persons were trained on Basic Emergency Obstetric and newborn Care (BeMOC). None of the staff nurses have been trained in the Navjaat Shishu Suraksha Karykram (NSSK). None of the medical and para medical staff has received any kind training in the Mejorgunj FRU. In Mejorgunj PHC, two of the staff trained on BeMOC. Two of the staff is trained on NSV in this PHC. In Mejorgunj PHC, staff has received training on SBA, LSAS, IUCD, PPIUCD and etc. except of the EmOC, F-IMNCI and NSSK. In Dumri Khurd HSC, the ANM was trained on the IMNCI in Sitamarhi.

In the district sadar hospital, except the functional foetal Doppler/CTG and functional mobile light, all the equipments like BP instruments, MVA/EVA equipment etc. is reported to be available and functional. Some of the O.T equipments like; functional O.T ceiling lights, mobile ventilators, functional C-arm units are reported to be not available in the district sadar hospital. In the Mejorgunj FRU, most of the essential equipments are reported to be not available.In Mejorgunj PHC, most of the essential equipments are reported to be functional except some of the laboratory equipments like functional centrifuge, haemoglobinometer and semi auto analyzer etc. In Dumri Khurd HSC, RBSK pictorial tool kit is reported to be not available at the time of reporting.

Most of the essentials drugs are reported to be available except the supplies of urine albumin and sugar testing kits, EC pills in the district sadar hospital. In Mejorgunj FRU most of the drugs are also reported to be not available. In Mejorgunj PHC, it was reported about the availability of the essential drugs except the supplies of IFA syrup with dispenser and drugs for hypertension, diabetes, anti-allergic drugs and etc. The Dumri Khurd HSC reported about supplies of Vitamin A syrup, ORS packets etc. except the non supplies of drugs for common ailments.

Maternal health

The total deliveries conducted in the district sadar hospital were 2279 and 1764 in the 1st and 2nd quarters in the district sadar hospital. The number of C-section deliveries conducted in the district sadar hospital was 81 and 105 in the 1st and 2nd quarters respectively. There was no maternal death reported in the district sadar hospital for review. There were no delivery services available in the Mejorgunj FRU.

There were no delivery services available in the Mejorgunj FRU. In Mejorgunj FRU, the number of out door patients was reported to be 4096 and 4485 in the first quarter and the second quarter respectively.

In Mejorgunj PHC, the number of ANC1 registration was 855 in the first quarter and 578 in the second quarter. The ANC3 registration was reported to be 495 and 481 in the first and second quarters respectively. The total deliveries conducted in the PHC were 702 and 823 in the 1st and 2nd quarters. There was no maternal death reported in the 1st and 2nd quarters in the PHC for review. There was no still birth in the 1st and 2nd quarters respectively in the PHC. The JSY payment is being given to mother through the bearer cheque before discharge from the hospital.

In Dumri Khurd HSC, the number of ANC1 registration was 65 in the first quarter and 63 in the second quarter. The number of deliveries conducted at home by the ANM of HSC was 30 in a year and none in the 1st and 2nd quarters respectively. There was no maternal death in the 1st and 2nd quarters in the HSC for review. There was no still births reported in the in the HSC.

5.Child health