Srikakulam - PIP Report

Study No. 132

REPORT ON QUALITY MONITORING OF IMPORTANT COMPONENTS OF PROGRAMME IMPLEMENTATION PLAN (PIP) 2013-14

SRIKAKULAM DISTRICT OF ANDHRA PRADESH

March, 2014

Prof.R.Ramakrishna

Honorary Director

Dr.K.V.R.Subrahmanyam

Dr.M.Sudhakar Babu

Population Research Centre,

AndhraUniversity,

Visakhapatnam-530 003.

C O N T E N T S

Page No.

Executive Summary

Introduction……………………………………………………1

State and District Profile………………………………..……1

District Health Infrastructure………….…………………..…2

Human Resources…………………………………..….……5

Institutional Deliveries……………………….…….…….…..5

JSSK………………………………………………………...... 6

JSY………………………………………………………..…..8

HDS………………………………………………….………..8

Maternal Death Review……………………………………..8

Family Planning……………………………..…….…………9

Community Processes: ASHAs………………………….… 10

Field Observations………………………………………….. 10

Feedback to concerned officials…..………………………. 15

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Executive Summary

As per the direction of the Ministry of Health and Family Welfare, Government of India, New Delhi, the Population Research Centres (PRCs) in Indiaare to carryout quality monitoring of important components of Programme Implementation Plans (PIPs) in their respective States. In tune with the above guidelines the PIP for the year 2013-14 was carried out in Srikakulam district of Andhra Pradesh in consultation with the Mission Director (NRHM) during 21 – 25 March, 2014.

In Srikakulam district there are 18 Community Health and Nursing Clusters (CHNCs). There are a total of 75 PHCs of which 26 are round the clock (24 x 7) PHCs. The total number of Sub-Centers (SCs) in the district is 478. Out of the 478 Sub-centers, only 82 are functioning in government buildings while 69 PHCs are having government building. One Sick New Born Care Unit (SNCU) is operational (RIMS, Srikakulam) and all the 6 sanctioned New Born Stabilization Units (NBSUs) are also reported as operational.

There are 84 regular Medical Officers and 53 Specialist doctors on regular basis apart from 5 on contractual basis.There are 503 ANMs, of whom 443 are functioning on regular basis and the remaining 62 are contractual ANMs. In addition, there were 419 ANMs working under NRHM. Regular Staff Nurses are 470 while 18 are contractual and 69 were appointed under NRHM. In all there are 2786 ASHA workers in the district.

As per the information provided by the DPO, there were 16,426 deliveries reported up to the month of February 2014. More than half of the deliveries held at Government facilities were in two AreaHospitals and 16 CHCs. It is to be mentioned here that out of the 45 non 24x7 PHCs, there are as many as 11 PHCs without even a single delivery. Among the 24x7 PHCs, in 2 out of the 26, there were no deliveries reported during the year.

The information given by the DPMU reflects that for the year 2013-14 an amount of Rs.7,69,000/- was received by the district under JSSK up to 20.3.2014. Out of this grant, an amount of Rs.6,03,943/- was shown as expenditure. Information obtained from the DPMU reveals that all the institutions where the deliveries are being conducted have not been covered by the JSSK. Fund is not being providedto 16 of the 34 regular PHCs, where deliveries are taking place. It has been also gathered that there is no grievance redressal cell for JSSK at District or Sub-District level.

(ii)

Payment of the JSY amounts to the beneficiaries is being done through cheques and the district has not shifted to direct cash transfer. As per the information provided, an amount of Rs.1,68,82,000/- has been released up to 20-3-2014 and out of this, an amount of Rs. 1,01,63,106/-is shown as expenditure for the year 2013-14.

As per the DPMU, there are no releases under HDS for the year 2013-14 till the time of visit. However, there is an expenditure of Rs. 62.29 lakhs under HDS during the year and this amount is the previous years’ balance with different institutions.

In Srikakulam district, 2786 ASHAs arein position at the time of visit. As per the nodal officer almost all of them except 2 or 3 have been trained in module 6 and 7. As per the district information the ASHA incentive are being paid regularly.

As per the information provided by the DPMU the maternal deaths reported for the year 2013-14 are 25 up to the month of February 2014. Twenty-four of them have been reported from the PHCs and the remaining one from a UHC.It is reported that the district MDR review committee has reviewed all the 25 maternal deaths reported. The number of infant deaths reported for the year 2013-14is466 up to the month of February 2014.

There is no record of line listing of severely anemic pregnant women nor the line listing with respect to low birth weight newborns.

Srikakulam district has shifted to facility based reporting of HMIS. The reporting of the data from the PHCs and Sub-Centers has improved.

With regard to the health facilities visited, the CHNC hasrequired infrastructureand is functioning in a government building. There are only 2 out of the 8 sanctioned posts vacant.In this cluster three PHCs are functioning of which two are 24 x 7 PHCs. The total number of Sub-Centers is 26. In these facilities, there are 4 regular Medical Officers and 1 contract Medical Officer under NRHM. Two more posts of Medical Officers were sanctioned, but not filled. Also there are three Staff Nurses on regular basis and four under NRHM are in position.Out of the 26 Sub-Centers, regular ANMs are present in 22 Sub-Centers and 2nd ANMs are present in 23 Sub-Centers.

(iii)

The 24 x 7 PHC visited is functioning in an old government building. One regular Medical Officer is present against the two positions sanctioned and there is also one contract Medical Officer.The PHC has 14 Sub-Centers of which 11 have regular ANMs. Twelve 2ndANMsare also in position.At the time of visit,75 ASHAs were in position and73 of them were trained in module 6 and 7. It is reported that ASHA incentives are being paid regularly.

The total deliveries recorded for the year is 126 till February 2014. At the PHC, information on implementation of JSSK is very scanty as the JSSK register is not available. From the JSY register, it is noticed that the payments were regular and date of payment of the cheque is within one week from the date of delivery and also majority of the cheques were paid on the day of discharge.

At the end of the monitoring visit, feedback on major observations was shared with the concerned officials at the District Level.

. . .

I. INTRODUCTION

The Ministry of Health and Family Welfare, Government of India, New Delhi, has directed the Population Research Centres (PRCs) in India to carryout quality monitoring of important components of Programme Implementation Plans (PIPs) in their respective States and to submit a report to the Ministry based on qualitative monitoring of PIP from the State and through visits to districts and facilities.

Accordingly, the PRC, Visakhapatnam has carried out the monitoring of the PIP in Srikakulam district of Andhra Pradesh in consultation with the Mission Director, NRHM and Commissioner, Health & Family Welfare, Govt. of Andhra Pradesh during 21 – 25 March, 2014.

The inputs obtained from the State Programme Management Unit (SPMU) indicate that the ROP of PIP was cleared by Government of India in May, 2013. The district ROPs have been sent to the concerned districts by the state in the month of October, 2013.

II.STATE AND DISTRICT PROFILE

According 2011 Census, Srikakulam districthas a population of 27,03,114. The total area of the district is 5837 sq.km. and the district has a 193 km long coast line. The district has 38 sub-district units which are known as Mandals in Andhra Pradesh covering 3 Revenue divisions. The profile of Srikakulam district is given below:

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Profile of Srikakulam district

III. DISTRICT HEALTH INFRASTRUCTURE

In Srikakulam district there are 18 Community Health and Nursing Clusters (CHNCs). A maximum of 6 Primary Health Centres (PHCs) are covered bythe CHNCs – Palasa, Pathapatnam, RIMS-Srikakulam and Amudalavalasa, while the CHNCs Ichapuram and Seethampeta are covering only two PHCs each.

There are a total of 75 PHCs of which 26 are round the clock (24 x 7) PHCs. The total number of Sub-Centers (SCs) in the district is 478. Out of the 478 Sub-centers, only 82 are functioning in government buildings while 69 PHCs are having government building.

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One Sick New Born Care Unit (SNCU) is operational (RIMS, Srikakulam) and all the 6 sanctioned New Born Stabilization Units (NBSUs) are also reported as operational (Statement-1).

In all, 89 facilities have been registered with Rogi Kalyan Samiti (RKS)and Village Health Sanitation and Nutrition Committees (VHSNCs) have been constituted in all the 1100gram panchayats.It is informed that all the 29 ambulances (108 services) and 20 (104 services) are operational in the district.

Statement – 1

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IV. HUMAN RESOURCE

It may be seen from Statement-2 thatthere are 84 regular Medical Officers and 53 Specialist doctors on regular basis apart from 5 on contractual basis.

There are 503 ANMs, of whom 443 are functioning on regular basis and the remaining 62 are contractual ANMs. In addition, there were 419 ANMs working under NRHM. Regular Staff Nurses are 470 while 18 are contractual and 69 were appointed under NRHM. In all there are 2786 ASHA workers in the district.

Statement - 2

In Srikakulam district, 2 Medical Officers were trained in LSAS and 3 were trained in EmOC.

V. INSTITUTIONAL DELIVERIES

Information on the number of deliveries reported at Government facilities during the year 2013-14 is obtained from the D.P.O., Srikakulam. As per this information, there were 16,426 deliveries reported up to the month of February 2014. It may be noted that more than half of the deliveries held at Government facilities were in two AreaHospitals and 16 CHCs.

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Institutional Deliveries reported at Government facilities in Srikakulam district during 2013-14, up to the month of February 2014 are shown in Statement -3.

Statement - 3

It is to be mentioned here that out of the 45 non 24x7 PHCs, there are as many as 11 PHCs without even a single delivery. Among the 24x7 PHCs, in 2 out of the 26, there were no deliveries reported during the year.

1. JSSK

With the launching of NRHM in the year 2005 a number of innovative schemes are being introduced and implemented to achieve the ultimate objective of reducing the maternal mortality and infant and child mortality. The latest such scheme is the Janani Sishu Surakasha Karyakram (JSSK). The continuous efforts of the Government of India have been to improve the institutional deliveries and make the out of pocket expenses of deliveries as nil for the vast majority of the rural women.

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The implementation of Janani Surakasha Yojana (JSY) has remarkably increased the institutional deliveries. However, there is a gap observed with respect to the stay of delivered women at the health facility after delivery for atleast 48 hours and the out of pocket expenditure towards delivery. The JSSK is implemented to fill the gap and assures the nursing mothers and the newborns certain entitlements which are aimed at not only making all deliveries as cashless deliveries and to improve the duration of stay of the women after delivery at the facility. The entitlements are with respect to transport, diet, drugs and diagnostic services. Government of Indiawhile bearing the costs towards this novel scheme emphasizes on implementation at field level by the state governments.

Given this background the implementation of JSSK is an important component in the quality monitoring of PIP at district level. As such information has been collectedon the implementation of JSSK in Srikakulam district.

The information given by the DPMU reflects that for the year 2013-14 an amount of Rs.7,69,000/- was received by the district under JSSK upto 20.3.2014. Out of this grant, an amount of Rs.6,03,943/- was shown as expenditure.

Information obtained from the DPMU reveals that all the institutions where the deliveries are being conducted have not been covered by the JSSK. Fund is not being providedto 16 of the 34 regular PHCs, where deliveries are taking place.

It has been also gathered that there is no grievance redressal cell for JSSK at District or Sub-District level.

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1. JSY

Payment of the JSY amounts to the beneficiaries is being done through cheques and the district has not shifted to direct cash transfer.

As per the information provided, an amount of Rs.1,68,82,000/- has been released up to 20-3-2014 and out of this, an amount of Rs. 1,01,63,106/-is shown as expenditure for the year 2013-14.

1. HDS

As per the DPMU, there are no releases under HDS for the year 2013-14 till the time of visit. However, there is an expenditure of Rs. 62.29 lakhs under HDS during the year and this amount is the previous years’ balance with different institutions.

1. MDR

As per the information provided by the DPMU the maternal deaths reported for the year 2013-14 are 25 up to the month of February 2014. Twenty-four of them have been reported from the PHCs and the remaining one from UHC-Gujarathipeta (Statement-4).

Statement –4

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The information is also gathered on maternal death reviews undertook by the district administration. As per the information provided by the DPMU, the district MDR review committee has reviewed all the 25 maternal deaths reported. The cause of death is reported as Haemorrhage (4 cases), Sepsis (3 cases), Obstructed labour (2 cases), Hypertensive disorders in pregnancy (4 cases) and others (12 cases including 2 moderate anaemia cases).

As per the information provided by the DPMU the infant deaths reported for the year 2013-14 are 466 up to the month of February 2014. The number ofinfant deaths for the month of February 2014 is 25. Out of the total infant deaths, 18 are reported from the UHCs and the remaining are from PHCs(Statement-5).

Statement –5

The number of infant deaths reported is more in Donubai PHC (28) followed by Jalumuru PHC (20). Ten or more infant deaths are recorded in 13 PHCs.

X. FAMILY PLANNING

Information on actual performance of sterilizations is gathered from the DPMU for the year 2013-14 up to February, 2014. The information shows that so far a total of12620sterilizations were carried out in the district. Of these Tubectomies accounted for 12452 and

Vasectomies are only 168. In addition 2880 tubectomies were reported to be done through PMPs.

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XI. COMMUNITY PROCESSES

ASHAs

The information given by the DPMU shows that in Srikakulam district, 2786 ASHAs arein position at the time of visit. As per the nodal officer almost all of them except 2 or 3 havebeen trained in module 6 and 7. As per the district information the ASHA incentive are being paid regularly.

XII. FIELD OBSERVATIONS

Emphasis is laid on the field visits in order to monitor the actual implementation of the PIP with respect to some important components like JSSK, JSY, ASHAs and HDS funds. In this connection, one CHNC and one 24 x 7 PHC were visited in Srikakulam district. The following are the names of the facilities visited:

(a)CHNC:Ranasthalam

(b)PHC:Patharlapalli

(a)CHNC

As already reported Andhra Pradesh has created Community Health and Nutrition Clusters (CHNCs) to decentralize the administrative processes at District level. One of the important objectives of creating clusters is for close monitoring of the health facilities under the jurisdiction of each CHNC. Also the HMIS and MCTS data entry is also being carried out at these clusters by providing dedicated I.T. facilities as well as data entry staff. The number of PHCs covered by a CHNC ranged from 2 to 6.

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As part of PIP monitoring in Srikakulam district, one CHNC namely Ranasthalamwas visited to elicit the information on staff position and the progress of HMIS and MCTS data entry.

In Statement-6 the staff position of the CHNCRanasthalam is shown.

Statement – 6

It is reported that at Ranasthalam CHNC, only 2 out of the 8 sanctioned posts are vacant. The Senior Assistant post is vacant since November 2011 while the post of the PHN was also not filled.

In this clusterthree PHCs are functioning of which two are24 x 7 PHCs. The total number of Sub-Centersis 26 in Ranasthalam CHNC area.

Information with regard to the position of Medical Officers and Staff Nurses at the PHC level reflects that in the3 PHCs in Ranasthalam CHNC area, there are4 regular Medical Officers and 1 contract Medical Officer under NRHM. Two more posts of Medical Officers were sanctioned, but not filled.

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There are three Staff Nurses on regular basis and four under NRHM are in position.Out of the 26 Sub-Centers, regular ANMs are present in 22 Sub-Centers and 2nd ANMs are present in 23 Sub-Centers.

At this CHNC the HMIS and MCTS data is being uploaded with respect to two PHCs only as the Patharlapalli PHC has its own IT facility and data pertaining to HMIS and MCTS gets uploaded at the PHC.

(b) PHC - Patharlapalli

Patharlapalli PHC is one of the 26 round the clock (24 x 7) PHCs in the district which is located at a distance of about 35kms from the district headquarters. The PHC is functioning in a old government building.

One regular Medical Officer is present against the two positions sanctioned and there is also one contract Medical Officer.There are two male and twofemale Supervisors. There is one regular Staff Nurse and also two NRHM Staff Nurses at the PHC. Eleven out of the 14 sanctioned ANMs are in position and twelve 2nd ANMs are available. One PHN is also available. There is one Pharmacist, one Lab Technician and one LD Computer.