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Wel-Come
To
SRM Bilaspur Debriefing
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State Review Mission -NRHM
-Vision -
Review of Progress in Health status and Health Delivery System
Assessment of Impact on Accessiility ! "#uity! affordaility and
Identify the $est practices !succes stories and innovations
Identify the %onstrains and issues
Strategies to solve the prolems within availale resources
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&eam Memers
State-Dr' ('R' Sonwani Deputy Director )NRHM*
Dr' (haparde )+H,*
Dr' A'(' $harti )Ayush M, Dantewada*
District
Dr' iwani! DI,
.t/arsh &iwari! DPM
0ilson! DAM
r' a yasan pan ra an
Neelu 1hritalhre )DPM /ondagaon*
0irendra Singh &ha/ur )DAM /an/er*
Neera2 0erma )DD, Raipur*
.day $hanu )D&% Narayanpur*
0i/ram ra2 sahu )S" Sargu2a*
Nilesh )H% $alrampur*
0andana 1upta )SHR% an2gir*
Mo' &a r S e ! DD,
Pradeep Roy! D&%
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3acility 0isited
DH CHC PHC SHC VHND VHSC
$I4HA%HA(RA$HA&A
&A(HA&P.R$"4PAN $"4PAN $IA
DAIA
MAS&.RIMA4HAR 4IM&ARA RA(
$I4ASP.R (,&A(AR1I(A4A N"0RA
SHI0&ARAI SHI0&ARAI
1A0R"4A ("0%HI ("0%HI
P"NDRA DANI (.NDI
MAR0AHIDH,$HAR
SHI0NI
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District Hospital
+ell estalished NR%!$lood $an/!
5' "stalished %all %entre
Peripheral Health acilit!5' %ommitted 4eadership and Management .nit
6' insured Service delivery at %H% and PH% identified
Positi"es
'
PH%s
8' Some RMAs are doing well
9' 1ood Infrastructure and road connectivity !"lectrical supply!
Solar system:' 1ood Initiatives for Infrastructure development
;' +ell estalished 3inancial system up %H%s level
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Some good practices
Well maintaine# $mergenc! tra!%&orella' Well labelle# me#icine containers in nursingstation
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Facilities in LR
?
5
6
7
8
9
:
;
%H%s PH%s
;
7
?
8
()*+ ,ater suppl!
Present
Asent
?
5
6
7
8
9
Present Asent not at proper
location
7 7
5
6
9
?
NBCC in R
%H%s
PH%s
?
5
6
7
8
9
:
%H%s PH%s
:
55
:
$lectricit! Bac.up
PresentAsent
?
5
6
7
8
9
:
;
%H%s PH%s
;
8
?
7
$mergenc! Tra!
Present
Asent
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6'9
7
7'9
8
7
6
8
6
Drugs in R
%H%s
?
?'9
5
5'9
6
only ,@ytocin only Misoprostol $oth Present $oth not Present
5 55
?
PH%s
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Infrastructure Progress
59?
6??
69?
7??6;5
55;
Sanctioned
%ompleted
.nder construction
PH% SH% Residential
Sanctioned %ompleted
.nder
%onstructio
n
Sanctio
ned %ompleted
.nder
%onstruct
ion
Sanctio
ned
.nder
%onstructio
n
9: 7: 9 6;5 55; 95 66 5;
?
9?
5??
PH% SH% Res
9:
66
7:
?9
95
5;
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HMIS
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/0Monthl! facilit! reporting status
HMIS
Reporting status in the Sept2012
Total Facility
Total Facility
filled %
District Facility
SC 268 268 100.00
55
Bilaspur
PHC 56 56 100.00
CHC 7 7 100.00
SDH
DH 1 1 100.00
Total 332 332 100.00
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MCTS - Registration of pregnant ,omen an# chil#
)Apr- Sept 6?56*
d z- fod kl k M d kuke
Mother Details Child Details
TotalRegistration
x HkZorh
efgyk d k
y{;
d qy efgy k
iat h;u
x HkZorh
efgy k d h
iat h;u d k
izfr'kr
f'k'kq
iat h;u d k
y{;
d qy f'k'kq
iat h;u
f'k'kqiat h;u d h
, Vh d k
izfr'kr
1 13572 4973 36.64 11504 2349 20.42 28.53
56
2 12956 4699 36.27 11318 2542 22.46 29.363 8330 2970 35.65 7258 2095 28.86 32.26
4 11080 3493 31.53 9693 2003 20.67 26.10
5 2935 782 26.65 2583 756 29.27 27.96
6 4295 1087 25.31 3746 767 20.48 22.89
7 5534 1562 28.23 4799 1318 27.47 27.85 58700 19566 33.33 50900 11830 23.24 28.29
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/0MCTS- Number of #eli"eries entr! against e*pecte# #eli"eries as
on Sept /(
d zekad fod kl k M
d kuke
visf{kr
izlo dqy izlo
dqy izlo izfr'kr
1 fcYgk 4212 2141 51
2 eLrwjh 4248 2369 56
57
3 dksk 2!14 18"6 6!4 r#kriqj 2893 166" 5!
5 is$%&k 812 !19 896 k(jsyk 1231 !55 61
dqy 1!53" 1"588 6"
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S.No
Name oftraining
Target GroupTarget
Achievement
% ofAchievement
1 MTP MO 3 2 66.672 Bemoc MO 5 5 100.00
3 Bemoc RMA 7 10 142.86
4 SBA SN, LHV, ANM 18 12 66.67
HR - &raining
5 RTI STI LT, RMA, SN 60 56 93.33
6 IUCD MO, SN,LHV, RMA,
ANM 165 140 84.85
7 NSSK ANM 150 57 38.00
8 Quality
ANC ANM 180 28 15.56
Post training Monitoring and 3ollow-up = 0ery wea/
.se of Partograph =Not satisfactory
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%hild Health NR% at 1ourela -Progress Not Satisfactory
SN%. =Not Started
N$S.-Pendra well functioning
N$%%- 0isited 3acility Not Proper School Health %hec/-up---Satisfactory
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School Health
Block Examined Sick % Reffered %
Takhatpur 10576 2919 27.60 188 6.44
Bilha 2784 1905 68.43 23 1.21
Marwahi 8831 1811 20.51 769 42.46
Masturi 30355 8129 26.78 246 3.03
Kota 16133 2982 18.48 40 1.34
endra 2881 478 16.59 41 8.58
!aurela 18826 3773 20.04 100 2.65
Total 90386 21997 24.34 1407 6.40
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RN&%P
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$asic Services
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Performance 756
&uerculosis .nit
Suspects "@aminationBlac
population
AnnualiCed %ase
Detection Rate for NSP
%target 1/2/3lac' %target 1 +45'
D&% $ilaspur 57< 99
$ilha :8 78
1aurela 5
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%ase Detection Rate for NSP &$ cases )75? to756*
5??
56?
58?
5:?
7?7;
95
79 7985 88 8?
78
?
6?
8?
:?
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3ocussed $loc/ in the district =
$ilha! Masturi E &a/hatpur
Possible Solution to impro"e case #etection
rate6 Instruction )target ased* to all the MP+Fs to
&arget oriented'
Referral slips for monitoring of the referrals
SensitiCation of MitaninFs for referral of &$suspects to the nearest microscopy centre
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3indings of SRM E Possile Solutions
Directly ,served &reatment )D,&* is very
wea/ in the district =field visit reported Mitanin has given whole P+$
Mitanin not aware of D,& provision E treatmentcard mar/ings
Poor supervision E monitoring y the contractual
staff
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3indings of SRM E Possile Solutions
No medicines )P+$* at PH% level
P+$ to e made availale at PH% level withpharmacist
Monthl re ort not ein sumitted the PH%Fs
All PH%Fs to sumit monthly reports on time
It needs to e incorporated in HMIS
Poor supervision E monitoring activities in thedistrict
No contractual staff availale at the time of visit
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3indings of SRM E Possile Solutions
Poor visiility )I"%* of the programme
No postersBwall paintings at S%s E PH%s
.tiliCation of untied funds
&reatment card entry at NI(SHAG software)online entry of &$ treatment cards* is very
slow&raining of PADA E $ADA is pending
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&$-HI0 %oordination
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&$-HI0 +hole $lood finger
&esting )+$3&*
All DM% 4&s should
&uerculosis .nit
of &$ patientstested for HI0
perform +$3&')target - 5??*
D&% $ilaspur 68
$ilha 99
1aurela 5;
Marwahi ?
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Programmatic Management of Drug Resistant &$
)PMD&*
Implementing from Dec 6?55
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PMD& None of the 4&s at %H%BDM% (ota are trained
in PMD&4&s needs to e trained at the earliest! as they play
suspects
Sputum transportation o@ were not availalein the 4aBDM%
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Mitanin Programme
5' Mitanin Help des/ visile in facility visited
6' Incentive payment are regular'
7' Mitanin Dawa Peti Reffiling Irregular'
8' Information to SG $eneficiary satisfactory'
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Issues
1. Out of Pocket Expenditure in some facilities.2. Patients being charged for Normal eli!er"
#. $% expenditures against the Norms.
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Areas of Improvements
5' Reduction of wor/load of District Hospital and %H%s y operationaliCation of PH% and
SH%
6' Regular Monitoring and guidance for waste disposal Management ! %leanliness within
4aour room
7' ,rganiCation of "#uipments! Drugs!and %onsumales within 4aour
8' Identification of High ris/ AN% detection at SH% and PH%s with regular support to staff
9' %hec/in of ANMs records and monitorin of their s/ills -M, RMA Mana ement
.nits:' ,rientation to ANMs aout Nearest Delivery points and % S Point
;' Display of &a@i and 0ehicle with %ontact Numer of Drivers
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5' Monitoring of functional status of Traine# HR
6' "nsure the Staying of Staff at their Head#uarter =$oth Paramedical and Management
7' Provision and maintenance of Proper Duty room B %ain for Doctors and Nursing Staff
at all Delivery Points
8' Records /ee in =$oth 3inancial and Pro ramme re ortin at PH%s and SH%s
Areas of Improvements )%ont'*
9' "nsure regular supply system of Drugs and %onsumales
:' Monitoring of Awareness aout 1uideline and their use y %H%s! PH%s and SH%s
;' DecentraliCation of &he D,&s supply system
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Suggestions for PIP 6?57 - 58
5' Separate ,& and 4aour room at 1aurella Sanitorium
6' Staff uarter for Paramedics At 1aurella
-
8' Display of Protocol at 4aour Rooms
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Suggestions for 4aor Room
1& Emergenc" tra".
2& N'(( Resuscitation e)uipments to be located atproper place
#& Partograph to be maintained and stored forretrie!al.
*& Running +ater facilit" +ith proper hand+ashingresources. Pictorial hand+ashing instructionsshould be displa"ed at all strategic locations.
,& (urtains for pri!ac" bet+een deli!er" tables
-& Proper segragation and transportation of '/should be done.
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%uggestions for rug storage
5* Medicines and other supplies should e
stored in order = alphaet wiseB disease wise
6* 3I3, should e followed7* Near "@piry drug list should e prepared
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Suggestions for 4aoratory5* .se of PP" )gloves and aprons*
6* Segregation of $M+ at point of generation
7* Different Cones for different activities =%ollection area! testing area! report
'
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"@cellent
"@ecution-
5R,P 6?56-57 approved y District Health
3inancial Management
'
6Approved $loc/wise R,P 3'G' 6?56-57forwarded to all the loc/ '
7
&ally "RP >'7 version - DHS Ball loc/ tally
generated 3MR reporting to State HealthSociety! Raipur'
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3inancial Management
3indings-
5 4ac/ of Accounting Policies e@ecution in PH%! SH% levels'
6Proper illing procedure was not followed in $ilha
%ha/rahata! Masturi! Malhar'
7During the 0isit of DH team oserved that cashoo/
maintained a ainst 1,I Norms'
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Suggestions for financial Management-
5 District Authorities have to ta/e more attention and
initiatives towards $M,S )%H%BPH% 4evel* for
implementation of Accounting Policies'
6"@ enditure to e monitored as er DS uidelines'
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Action &a/en $y SRM
Identify the 1aps
Discussed issues with All staff
%orrected the minor issues on spot li/e re-arrangment of 4aour room
Demonstrated the gaps and aware the concerned staff
Action ta/en $y District
%MH, have circulated instruction to $M,s
$M,s have een circulated the instruction to Mos and RMAs
%orrective measure at Some 3acilities
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