Observations of Rajasthan T eam New Delhi, 12 th January, 2012 T - PowerPoint PPT Presentation

5 th Common Review Mission Observations of Rajasthan T eam New Delhi, 12 th January, 2012

T eam Composition  Ms Rita Chaterjee, JS (HRD)  Dr. Sajjan Yadav, Director (NRHM)  Dr. A C Baishya Director RRC- NE, NHSRC  Dr Sanjeev Gupta, Addl Dir (NVBDCP)  Dr V Shekhawat, RD I/C, Jaipur, Rajasthan  Sh. A.K.Deori, US (EPW)  Dr. S.K. Mondal, PFI  Dr. Sonali Rawal, Consultant, NRHM  Asmita Jyoti Singh, Consultant, NRHM  Ms Rajshree Panicker, PHFI  Mr Rahul Govila, Consultant, FMG  Mr. Vijay Paulraj, Family Planning, USAID

Positive Developments  Good health Infrastructure  Health facilities well equipped  SNCUs established in District Hospitals  Labour rooms and maternity wards are present in all institutions- privacy and maintenance need improvement.  ANMs, GNMs, Lab Technicians are available  Improved utilization of public health facilities- increase in IPD, OPD and institutional deliveries. Free Drug Scheme likely to further increase the demand

Change in Institutional Delivery Load- Barmer 40 35 30 2008-09 25 2009-10 20 2010-11 15 10 5 0 DH/SDH CHC PHC SC Private •Gradual shift in institutional deliveries from DH/SDH and CHC towards PHC and SC which are taking up more of the normal delivery load over time – SC were handling 12.26 % of institutional deliveries in 2008-09 which increased to 27.68 % of institutional deliveries in 2010-11.

Positive Developments  ASHAs emerged as symbol of women empowerment and torch bearers of health issues in remote areas  Good Community involvement and ownership  Establishment of Rajasthan Medical Services Corporation Limited(RMSCL) for centralized procurement  Electronic funds transfer system is being used for transfer of funds from State to districts and districts to blocks.

Areas for improvement  Redundancy in infrastructure and equipment. New infrastructure being planned without taking into account availability, gap analysis and prioritization  Poor quality of civil work found in some cases  Acute shortage of specialists and MOs  Rational deployment  Large number of Male nurses are posted in the health facilities who are not conducting deliveries and are also not being utilized optimally

Areas for improvement  Doctors allowed private practice. Instances of calling patients home and prescribing drugs and tests on their private prescription slips. But subsequently using government facilities for surgical interventions.  No training calendar. No follow up plan after training.  Training capacity needs strengthening at district level

Areas for improvement  System for biomedical waste management, sterilization of equipment, infection control needs improvement.  Lack of privacy in labour rooms  New MMUs procured but are not utilized due to non selection of operator  Lack of awareness about 108 services among people. 108 service is confined to 35 KM of block headquarter  Funds of all VHSCs under a Gram Panchayat are being operated through a single account.

Areas for improvement  Lack of awareness about JSSK among implementing officers. JSSK beneficiaries found spending thousands of rupees on purchasing medicine in DH Barmer.  Facility based new born care need to be expanded  Requirement of vaccines not generated from the field. All blocks are given the same number of doses of a vaccine regardless of population.  Reporting issues- All children reported vaccinated even when vaccine was not available.  Meetings of RMRS are irregular and limited just for fund utilization. Lack of awareness

Areas for imporovement  Family Planning sterilization focused, greater focus on spacing methods needed.  Midwifery was not included in GNMTC course till 2003. These GNMs are not conducting delivery  Poor fund utilization in NDCPs  Presumptive treatment is still being used for suspected Malaria cases and Bivalent RDK is used for diagnosis of Malaria against the programme guidelines  Shortage of Ophthalmic Assistants in CHCs for screening of eye disorders.  HIV testing for AFB positive cases not being done  Media alert on IDSP portal not being used regularly

Areas for Improvement  Budget allocation for Drugs and consumables for different level health facilities is grossly inadequate and has impacted availability of drugs for JSSK and NVBDCP  Supply done without analyzing requirement of health facility.  Due to pressure to operationalize Free Drug Scheme, GoI Supplies of vaccines and drugs shifted outside the warehouses to office building and other unsuitable places

Areas for improvement  Financial management poor. Books of accounts not properly maintained.  Shortage of manpower like BPM, PHC accountant especially in high focus blocks  Medical Officers are managing funds with help of nurses, Lab. Tech. and LHV’s who are not properly trained.  The customized version of Tally ERP 9 software has been installed at state, district and block level but its not implemented in most of the blocks due to lack of training and technical issues.  monitoring for settlement of longstanding advances to implementing agencies like PWD, BDO etc.

THANKS