Tamil Nadu Overview w Visit Profile Two Districts-Thiruppur & - PowerPoint PPT Presentation

VI VI Common R Revie iew M Mis ission F Fin indin ings Tamil Nadu

Overview w Visit Profile Two Districts-Thiruppur & Cuddalore- GH-3, DH-2, CHC-4, PHC- • 8, HSC-12, & 7 Villages. CRM team- 12 members from different organization, supported by • state and district officials. State Profile & Performance One of the best performing- already achieved the NRHM/RCH • goals. IMR-24 (SRS 2011); MMR-97 (SRS 2009); TFR-1.7 (DLHS-III). • Service Delivery Indicators improved exponentially under NRHM. • Institutional delivery- 245%; • IPD services-205% during 2005-12 period; •

Best Practices/ s/ I Innovations 1. Public Health Cadre. 4. Well Functional & Co-located 2. Tamil Nadu Medical Service AYUSH services. Corporation (TNMSC) & TAMPCOL 5. Mortuary Van Services. for AYUSH. 6. State Health Data Resource Centre. 3. Maternal & Child Health Innovations- 7. Involvement of District Collectors i. Injectable Iron Sucrose , in NRHM through sensitization and ii. Birth Companion Program , performance rewards. iii. Maternity Picnic and Bengal Ceremony , 8. Program specific ASHAs to bridge iv. Congenital Fetal Abnormality specific gaps. Detection, 9. NCD Clinics. v. Non-Pnuematic Anti Shock 10. Palliative Care treatment. Garment (NASG) 11. Community Monitoring. Recommendation- Innovation Cell at State level to document outcomes of innovations.

Public H Heal alth I Infrastructure OBSERVATIONS Over the years State strengthened primary care infrastructure. Most institutions • in govt. buildings. (75% of HSC in govt. buildings). Limited shortfall in primary care institutions (PHC+CHC+DH). 33% shortage • of HSC as per population norm. Infrastructure development by PWD- Executive Engineer looking after 3-4 • districts. No involvement of Health Department in the whole process. New constructions done nearby to the existing structure without integration. • RECOMMENDATIONS Infrastructure development should integrated - good architecture design. • Infrastructure development team should be formed at district level- comprises • of district health officials, PWD engineers and architect, helping with design, construction and supervision. State needs to assess utilization of residential accommodation by PHC/CHC • staff and ensure stay of staff nurse in the PHC premise if MO is staying outside.

Supportive Services OBSERVATIONS Laboratory, radiography investigations, medicines and equipments, diet are • available free of cost. Citizen Charter, Signage system and bio-medical waste management available in all facilities. No OOP found for drug, diet, and other ancillary services except for the drop-back • for mothers. Quality Management Systems (ISO/NABH)- Quality of services provided by the • facilities has improved significantly. RECOMMENDATIONS Security needs to be strengthened, stay arrangements for ASHA and patient • relatives required. Injection rooms need separate beds and curtains for both male and female patients . • Waste segregation at source needs to be strengthened . Deep burial for final • disposal of sharps. Ensure- Grievance redressal in all facilities & patient information kiosk at- • SDH/DH. Ensure- Common signage boards in all SDH/DH indicating services in each • building. Strengthen- Quality Assurance Cell at State level and Quality Assurance team at • District level for speedy implementation of quality management system.

Outreac ach & & P Pat atie ient T Tran ansport Se Servic ices OBSERVATIONS Sub Centers -good infrastructure, no 2nd ANM. Deliveries reduced- 7.2% in 2005- • 06 to 0.4% in 2011-12. MMU: Available in each block with dedicated staff. Visit schedule prepared & • followed. Emergency transport : Provisioned through EMRI. Wide range of emergencies • rescued most being accidental followed by obstetric. Inter-facility transfers is being provided and has a large share of obstetric emergencies. RECOMMENDATIONS Service delivery reduced from HSC; advisable to strengthen HSC to reduce • overcrowding at the PHCs and to streamline referrals. Additional plans for service provision and screening of NCD can be tested at HSC. • Strengthen IEC/BCC activities at HSC esp. Family Planning counseling. • Ensure supply of family planning consumables & Pediatric IFA tab/syrup at the • HSC level. Hb estimation should be done from all HSCs. Improve the frequency, range and quality of services rendered by MMU’s to the • tribal areas and assess impact. IEC/BCC activities need to be done to improve utilization of EMRI services for • obstetric and newborn rescue especially from rural and remote areas which is very low currently ( 13%)

Hu Human an R Resources OBSERVATIONS Good Progress noted. • Two cadres: Public Health & Medical and Rural Services employed in public health system. • Additional support- Psychiatrists, Dentists etc in districts. • Vacant positions are still there in both directorates- Specialists (Obs, Paed, Anes) have higher • vacancies. Others include- MPW (HIs), MCH Officer, MMU MOs, Sector Health Nurse & Nursing Assistant, Adequate institutions for production of Human Resources for Doctors, Paramedical & • AYUSH Cadre. Arrangements made for rational deployment, retention & promotion and skill development for • Human Resources in the State. Residential facilities available for MOs but utilisation is low. RECOMMENDATIONS Delegate recruitment responsibility to recruit contractual MOs, specialist at the District level. • Some of the training institutes should be strengthened for MPW training to ensure availability. • Payment of Grade IV staff should be raised up to the daily wage norms. • Limited promotions opportunities for the doctors and nurses in Directorate of Public Health & • Preventive Medicine; need to have more career progression opportunities for retention. More absorption and career progression opportunities for AYUSH contractual staff - Multi- • skilling.

RC RCH OBSERVATIONS All PHCs - 24x7 services with new born corner, 3 Staff Nurses trained in SBA, F-IMNCI, • NSSK, IMEP. All PHC MO – trained in short term anaesthesia skills and EmOC.. EmOC-42 L-II MCH Centers and 18 MCH hospitals, 29 well functional DH and 232 SDH. • Blood Banks- SDH/DH. Blood Storage -few PHC, CHC (50.6%) ,SDH (16.4%), DH (6.9%). • Abortion Services- Ist trimester – Few PHCs (5%), all CHCs, SDH, DH and MCH centres . • IInd trimester – all DH &MCH centers, half of the SDH and 20% of CHCs. 47 Sick newborn Care Units located at medical colleges, DH & large SDH. • Adolescent Health Program - through 17 Medical colleges by establishing Teen Clinics. • More focus towards sterilizations and spacing methods form a miniscule proportion of CPR. • RECOMMENDATIONS Ensure- Web listing of JSY beneficiaries & JSSK entitlements display in all facilities. • Strengthen Drop-back and collect proper data for further improvement. • Monitor- Injectable iron sucrose beneficiaries for outcomes and new born from SNCU for • survivals. Sensitization of providers in appropriate use of non-pneumatic anti-shock garment. Ensure- Safe abortion services through MVA at designated service delivery points. • Adolescent health needs to be established in all districts at the CHC/SDH/DH level. • Focus more on spacing methods and PPFP services need to be strengthened. • Ensure display of uniform SOP’s related to RMNCH at various levels of facilities. •

Dis Diseas ase C Control l OBSERVATIONS JE & Dengue has emerged as a newer challenge. • Limited involvement of PHC MOs in Disease control activities. • Started program for non-communicable disease screening. Mass CA Cervix • detection & Breast Cancer Screening done in the last year. RECOMMENDATIONS Acceleration of anti malaria activities for- surveillance and management. • Malaria Drugs & Mosquito nets should be available in facilities. • Line list lymphoedema and hydrocele cases to help in morbidity management. • Sentinel surveillance system for Dengue/Chikungunya and JE needs to be • established in endemic districts. Data should be used at all levels for program improvement. • District and Block officers’ needs to be motivated to conduct local review • meetings more frequently. To improve TB case detection Factory Health Inspectors need to be involved • for referral of cases to the public health facilities. Intensive IEC efforts needs to done to educate community about the • availability of free TB treatment in the facilities.