bihar state quarterly monitoring report

NATIONAL HEALTH SYSTEMS RESOURCES CENTRE

Bihar State Quarterly

Monitoring Report April to June 2013

V Roddawar

06/17/13

This report is based on health providers and beneficiary interviews and HMIS data analysis of Bihar state and Aurangabad district. The monitoring visit includes all levels of health facilities in the district. One needs to be cautious in interpretation of HMIS data, the state and districts may have good health service delivery but there might be problems in reporting data.

1

Table of Contents Executive Summary ...................................................................................................................................... 4

1. Introduction ........................................................................................................................................... 6

2. State and District Profile ..................................................................................................................... 6

3. Key health and service delivery indicators ...................................................................................... 7

4. Health Infrastructure ............................................................................................................................ 9

5. Human Resources for Health ............................................................................................................ 10

6. Maternal Health .................................................................................................................................. 12

6.1 ANC and PNC ................................................................................................................................ 12

6.2 institutional deliveries ................................................................................................................. 12

6.3 Maternal Death Review ............................................................................................................... 14

6.4 Janani-Shishu Suraksha Karyakram (JSSK) ............................................................................ 14

6.4. A User fee in Out Patient Department (OPD) and In Patient Department (IPD) ........ 14

6.4. B. Drugs and Consumables .................................................................................................... 15

6.4. C. Diagnostics ........................................................................................................................... 15

6.4. D. Diet ........................................................................................................................................ 15

6.4. E. Referral Transport ............................................................................................................... 16

6.4. F. Display of entitlements ...................................................................................................... 16

6.4. G. Awareness of community .................................................................................................. 16

6.4. H. Grievance Redressal Cell .................................................................................................. 16

6.4. I. Out of pocket expenditure / informal charges ................................................................ 17

6.5 Janani-Shishu Yojana (JSY) ......................................................................................................... 17

7 Child Health .......................................................................................................................................... 17

7.1 SNCU ................................................................................................................................................. 17

7.2 Nutritional Rehabilitation Centre ............................................................................................. 18

7.3 Immunization ................................................................................................................................ 19

8. Family Planning .................................................................................................................................. 20

9. Quality in Health Services ................................................................................................................ 21

9.1 Infection Control and Bio-Medical Waste Management ....................................................... 21

9.2 Information Display ..................................................................................................................... 22

10. Community Processes ...................................................................................................................... 22

10.1 ASHA and MAMTA ................................................................................................................... 22

2

10.2 Skill Development ...................................................................................................................... 23

10.3 Functionality of the ASHAs ...................................................................................................... 23

11. Disease Control Programme ........................................................................................................... 23

11.1 Revised National Tuberculosis Control Programme ........................................................... 23

11.2 National Leprosy Eradication Programme (NLEP) ............................................................... 24

11.3 National Vector Borne Diseases Control Programme .......................................................... 24

11.4 National Programme for Control of Blindness (NPCB) ...................................................... 25

12. Others .................................................................................................................................................. 26

12.1 OPD and IPD ............................................................................................................................... 26

12.2 Information Systems .................................................................................................................. 27

12.2a Mother and Child Tracking System (MCTS) .................................................................. 27

12.3 Village Health and Nutrition Day ........................................................................................... 28

Table 1 Description of the area and facilities visited in Aurangabad, Bihar ..................................... 6

Table 2 State and District Profile .............................................................................................................. 7

Table 3 Key health and service delivery indicators .............................................................................. 8

Table 4 Health Facility Mapping – Bihar and Aurangabad ................................................................ 9

Table 5 Block wise health facilities in Aurangabad, Bihar Source: DHS, Aurangabad .................... 9

Table 6 Delivery points – Bihar and Aurangabad .............................................................................. 10

Table 7 Human Resources Status in Bihar ........................................................................................... 11

Table 8 Selected maternal indicators of Bihar and Aurangabad from Jan to May 2013 ................ 12

Table 9 Functional delivery points in public health facilities – Bihar and Aurangabad ............... 12

Table 10 Causes of maternal deaths – Bihar and Aurangabad, January to May 2013 ................... 14

Table 11 Status of different type of new born care facilities in Bihar and Aurangabad ................ 17

Table 12 Immunization session held in Bihar and Aurangabad from Jan to May 2013 ................ 20

Table 13 Family Planning Key Indicators – Bihar and Aurangabad from January to May 2013 . 21

Table 14 Block wise ASHAs against target as on April 2013 ............................................................ 22

Table 15 Status of Facility Wise Data Uploading, Aurangabad........................................................ 27

Table 16 Block wise VHND held and ANC coverage for the month of April 2013, Aurangabad

.................................................................................................................................................................... 28

Table 17 Block wise VHND held and hemoglobin test conducted for the month of April 2013,

Aurangabad .............................................................................................................................................. 28

Graph 1Human Resources Status in Aurangabad .............................................................................. 11

Graph 2 Institution wise Deliveries from January to May 2013 – Aurangabad ............................. 13

Graph 3Duration of stay after delivery in Aurangabad district from Jan to May 2013 ................. 15

Graph 4Month wise ambulance service (both to and fro) against reported deliveries from Jan to

May 2013 – Aurangabad ......................................................................................................................... 16

Graph 5 Assessment of NBCC Centers – Aurangabad, Bihar ........................................................... 18

3

Graph 6 Output Indicators of NRC Aurangabad, Bihar .................................................................... 19

Graph 7 Immunization Coverage of various antigens against estimated live births from January

to May 2013 ............................................................................................................................................... 20

Graph 8 RNTCP Month wise performance of Aurangabad, Bihar .................................................. 23

Graph 9 Year wise Bihar state Malaria situation from 2009 to 2013 ................................................. 24

Graph 10 Malaria Situation of Aurangabad between two periods 2012 and 2013 (up to May) ... 25

Graph 11 State level progress of NPCB, Bihar (up to May 2013) ...................................................... 25

Graph 12 Correlation of health staff and Out Patient Attendance for the month of May 2013,

Aurangabad .............................................................................................................................................. 26

Graph 13 % MCTS reported against total expected registration as on May 2013 .......................... 27

Map 1 Block wise Aurangabad district ................................................................................................... 7

4

Executive SummaryExecutive SummaryExecutive SummaryExecutive Summary

• Services delivery indicators like ANC, PNC, institutional deliveries, TFR and unmet

needs for family planning indicate that Bihar’s performance is far below national

average.

• % of three ANC check-ups and institutional deliveries against estimated deliveries in

Bihar is 25% and 14.3% lower than national average.

• Bihar state unmet need for FP is 39.2%, which is 26.4% higher than national unmet need

• The major concern across the state and district is identifying high risk pregnant women;

those with severe anemia and hypertension.

• PHC’s alone contributes 53% of deliveries and rests of the health facilities contribute

47% in the district.

• APHC’s, which are equal to PHC in comparison with other states contributes only 1% of

total deliveries during first five months of 2013.

• The state and district needs to review the low performance of C Section deliveries across

state, which is mere 1.5%, much below the physiological need of around 15%

• In terms of required facilities, there is a deficit of 83.5%, 67.5%, 53.8% and 26.9% of

health sub-centers, additional PHC’s, Community health centers and sub-divisional

hospitals respectively in the state.

• Similar in Aurangabad, only 21.3%, 59.2% and 28.5% of health sub-centers, additional

PHC’s and CHC are available in the district in terms of required facilities as per

population norm.

• Out of 11,584 health facilities available in the state only 8% of them are serving as

delivery points. Excluding HSC, 45% of health facilities are operationalized as delivery

points in the state

• Large number of vacancies in regular posts in Bihar – Medical Officers 2476, ANMs

2388, LT 1925, MPW 1216, LHV 749, and Staff nurses 393

• The state has 13 medical officers and 27 staff nurse per one lakh population in public

health sector.

• Out of 226 sanctioned MO posts, only 43% of them are in position. 12 MO’s and 18 staff

nurse per 1 lakh population available in public health sector, which is below than state

average.

• State needs to develop a mechanism to follow-up trained MOs whether they are using

acquired skills in preventing and reducing maternal mortality at health facility level.

• There are total 34 blood bank and 115 blood storage units available but only 28 BBs and

9 BSUs are functional in the state.

• Renewal of license for existing BSU’s is a concern in the state and there should be proper

action plan for the renewal

• Non-performing EmOC trained doctors is one of the major concern in the state.

• There is a need to constitute/strengthen MDR task force at district and state level to

regularly review MDs and follow-up action to reduce MMR.

5

• Priority of the state is to train district, block MOs, MOICs and private hospitals on

maternal death review in regular interval to strengthen MD reviews

• It is observed that there is shortage of drugs in all health facilities in the district.

• Districts need to renew the contract of outsourced agencies to provide interrupted

services such as diet, diagnostic and bio-medical waste management.

• The signage of JSSK well displayed in PHC and above health facilities but there is no

display of any IEC material below PHC facilities. There is no grievance redressal

mechanism available in the visited facilities. Out of pocket expenditure arises mostly

from transportation and drug charges.

• The state need to ensure regular release of funds to outsourced agencies for

uninterrupted diet, diagnosis and referral transport services to the beneficiary

• State should monitor and ensure timely procurement of drug with two months of buffer

stock. Avoid administrative delays in procuring drugs and releasing funds to

outsourced agencies

• State should develop mechanism to monitor JSSK with physical verification to provide

onsite correction and recommendations

• NRC, Aurangabad admitted 83 SAM children and completed 5 batches. Total 42%

children cured and discharged and 58% children were followed up till 8th week.

• The full immunization coverage of Aurangabad is 82%, which is 13% higher than state

average.

• Build supportive supervision structure at regional and district level for successful

implementation of JSSK

• Ensure flow of communication from state to district and district to block

• Need to reorient district and block level officials on JSSK scheme

• Conduct state level JSSK reviews and submit monthly state progress report on JSSK

entitlement to GoI

• Display and distribute JSSK IEC material and it would be appropriate to have wall

paintings on every levels of health facilities (HSC, APHC/PHC, CHC/RH, SDH and

DH).

6

1. Introduction

The report is based on monitoring visit carried out in Aurangabad district of Bihar from 4th to

6thJune 2013. The monitoring visit include all levels of health facilities – Health Sub Centre

(HSC), Additional Primary Health Centre (APHC), Primary Health Centre (PHC), Community

Health Centre (CHC) / Referral Hospital (RH) and District Hospital (DH). Few of Health Sub-

Centers are operationalized as delivery point and rest of them are yet to operationalize as

delivery points in the district. PHCs and CHC/Referral hospitals are catering to the health

needs of the people. Details of visit provided in the below table.

Table 1 Description of the area and facilities visited in Aurangabad, Bihar

Block Description Facilities visited

Madanpur Comprise of one PHC 24x7, five APHC's and 29 HSC's which caters to 1.96 lakhs population

Pharpura APHCs, Aajan HSC

Barun Comprise of one PHC 24x7, five APHC's and 19 HSC's which caters to 1.99 lakhs population

Jankop HSC, Jankop VHND, Barun PHC, Barun DMC

Kutumba Comprise of one RH (FRU), eight APHC's and 26 HSC's which caters to 2.25 lakhs population

Kutumba RH/CHC/PHC, Kutumba DMC

Aurangabad Comprise of one DH, fivet APHC's and 27 HSC's which caters to 2.82 lakhs population

District Hospital, DTCO, DLO, DBCS

2. State and District Profile

Bihar state and Aurangabad district profile

State/District Bihar Aurangabad

State/Dist. Headquarters

Patna Aurangabad

No. of Blocks 534 11

No. of Revenue Villages

45,103 1884

No. of Panchayats

8463 203

Population (2011)

10,38,04,637 25,11,243

Literacy 63.82% 72.77%

Sex Ratio 919 916

Density of Population

1100/km2 760/km2

7

Table 2 State and District Profile

Bihar, third most populated state in the

country has four regions, nine divisions and

38 districts. Bihar population constitute

8.58% of total India population. The state has

534 blocks, 45103, revenue villages and 8463

Panchayats. Aurangabad is one of the 38

districts located at southwest of the state with

a population of 2.51million, which is 2.4% of

the state population. The district literacy rate is 72.77%, which is 8.95% higher in comparison

with state literacy rate, 63.82%. Bihar state density of population is 1100/km2, which is higher

by 340 persons/km2 in comparison with Aurangabad district, 760 persons/km2.

Map 1 Block wise Aurangabad district

3. Key health and service delivery indicators

The key health indicators of Bihar reflects poor performance in comparison with national level.

Bihar recorded 305 Maternal Mortality Ratio (MMR) per 100,000 live births, which is 93 points

State/District Boarder

North Nepal Jahanabad

East West

Bengal Gaya

West Uttar

Pradesh Rohtas

South Jharkhand Jharkhand

8

higher in comparison with national average, 212/100,000 live births. However, when compare

with Aurangabad district, 119 points higher than national average and 26 points higher than

state average. The MMR of Bihar and Aurangabad indicate 305 and 331 female deaths per

100,000 live births from any cause related to or aggravated by pregnancy.

Maternal health is one of the eight goals of Millennium Development Goals (MDG’s) that

targets to reduce MMR by three quarters (of 1990) by 2015. India has substantially reduced the

MMR from 523 in 1990 to 212 in 2007-09. Despite the progress, India tends to fall short to

achieve MDG maternal goal by 135 per 100,000 live births in 2015. The southern states like

Kerala and Tamil Nadu have achieved considerable success in arresting incidence and tend to

reach targets before 2015. Whereas northern states like Bihar, Uttar Pradesh, Madhya Pradesh

and Rajasthan might fall behind the targets. Broadly, some of the challenges include socio-

economic barrier, human resource and management, monitoring and accountability, linkages

and role of local institutions.

Table 3 Key health and service delivery indicators

Sl. No. Health indicators India Bihar Aurangabad

1 MMR 212 (SRS '07-09) 305 331

2 CBR 21.8 (SRS 2011) 26.7 25.6

3 CDR 7.1 (SRS 2011) 7.2 6.4

4 IMR 44(SRS 2011) 55 48

5 Neo- natal Mortality Rate 33 (SRS 2010) 35 29

6 Under Five Mortality Rate 59 (SRS 2010) 77 61

7 Antenatal Care (AHS 2011)

a ANC Check-up in first trimester - 44% (HMIS '12-13)

35% (HMIS '12-13)

b 3 or more ANC Check-up 69% (HMIS '11-12)

44% (HMIS '12-13)

55% (HMIS '12-13)

8 Postnatal Care (AHS 2011)

a Breastfed within 1 hour of birth - 30.3% 23.5%

9 Instit. Deli. Against Esti. Deliveries

62% 47.7% 53.4%

10 Total Fertility Rate 2.5 (SRS 2010) 3.7 (SRS 2010) -

11 Full Immunization 82 (HMIS '11-12) 64.5 69.8

12 Unmet Need for FP 12.8 (DLHS '05-06) 39.2 41.3

a Spacing 6.2 21.3 24.1

b Limiting 6.6 17.9 17.2 Source: AHS 2011

IMR for the country declined by nine points between 2008 and 2011, with IMR at national level

being 44 in 2010. However, the set target of MDG is to reduce IMR by 27 per 1000 by 2015.

Bihar IMR is 55 per 1000 live births, which is 11 points higher than national average and 7

points higher than Aurangabad district. Bihar and Aurangabad is short of 50% (28 points) and

43.75% (21 points) in achieving MDG’s IMR goal by 2015. Under 5 Mortality Rate (U5MR) in

India for the year 2010, stands at 59 and it varies from 66 in rural areas to 38 in urban areas.

9

Given to reduce U5MR to 42 per thousand live birthsby 2015, India tends to short of 28.8% at

the current rate of U5MR. Bihar and Aurangabad reported 77 and 61 U5MR as per AHS 2011

and they shortfall of 45.45% and 31.14% to reach the goal of MDG by 2015.

Services delivery indicators like ANC, PNC, institutional deliveries, TFR and unmet needs for

family planning indicate that Bihar’s performance is far below national average. % of three

ANC check-ups and institutional deliveries against estimated deliveries in Bihar is 25% and

14.3% lower than national average. Bihar state unmet need for FP is 39.2%, which is 26.4%

higher than national unmet need

4. Health Infrastructure Bihar has inadequate health infrastructure as per population norms. In terms of required

facilities, there is a deficit of 83.5%, 67.5%, 53.8% and 26.9% of health sub-centers, additional

PHC’s, Community health centers and sub-divisional hospitals in the state. The state of the

health infrastructure in such a condition, which is one of the essential factor, shows deficiency

in providing public health services in the state. Similar picture reflects in Aurangabad district

in terms of required facilities, only 21.3%, 59.2% and 28.5% of health sub-centers, additional

PHC’s and CHC available in the district.

Table 4 Health Facility Mapping – Bihar and Aurangabad

Health Facility Level

Bihar Aurangabad

Required Existing Under Const.

Short fall

Required Existing Under Const.

Short fall

District Hospital 38 36 4 2 1 1 0 0

Sub-Divisional Hospital

63 46 9 8 1 1 0 0

Referral Hospital NA 71 NA NA NA 3 NA NA

Community Health Centre

864 399 NA 465 21 6 6 9

Additional PHCs 3460 1122 381 1957 84 50 11 23

Health Sub-Centre

20761 3415 3983 13366 502 107 93 302

Source: Bihar State PIP 2013-14

Aurangabad district has 11 blocks with a population of 2.5 million. Block population range

from minimum 1.6 lakhs in Haspura block to maximum 3.1 lakhs in Rafiganj block. On average

every block has 5 to 6 health sub-centers and each sub-center covers minimum eight thousands

to maximum 13 thousand population, which is above the population norms. The catchment

area of APHCs covers minimum 28 thousands to maximum of 62 thousand in Aurangabad

district.

Table 5 Block wise health facilities in Aurangabad, Bihar Source: DHS, Aurangabad

Name of Block

Population Sub Centers Additional

PHCs PHC

Referral Hospital

Aurangabad 282224 27 5 - -

Barun 199745 19 5 1 -

10

Daudnagar 206808 16 4 1 -

Deo 172606 19 6 1 -

Goh 234019 21 5 1 -

Haspura 160350 16 4 - 1

Kutumba 225139 26 8 - 1

Madanpur 196310 29 5 1 -

Nabinagar 296679 23 8 - 1

Obra 226401 18 5 1 -

Rafiganj 310962 20 5 1 -

Total 2511243 234 60 7 3

There are total 11,584 health facilities available at different level in the state and out of which

only 8% of them are serving as delivery points. Mere 8% health facilities catered to 3.1 million

expected pregnancies and 2.9 million expected deliveries during these five months in the state.

By this calculation every delivery point in the state need to cater 263 deliveries per month.

Excluding HSC in calculating delivery points, the state has only 45% of health facilities as

operationalized delivery point in the state, which is below than the 50% of total health facilities.

The situation is different across different delivery points and mostly PHCs and above level

facilities supply the needs of pregnant women. There is a need for strategy to strengthen

APHCs and HSC as delivery points in the state.

The situation remains the same at district level, for example in Aurangabad district out of 305

health facilities only 8% serve as delivery points that catered to 72,327 expected pregnancy and

67,330 expected deliveries during these five months. Similarly, excluding HSC, the district has

32% of available health facilities operationalized as delivery points in the district. The below

table provides facility level institutions and delivery points.

Table 6Delivery points – Bihar and Aurangabad

Health Facilities Bihar Aurangabad

State Total Delivery Points District Total Delivery Points

HSC 9696 74 234 0

PHC 1243 204 60 12

CHC Non FRU/PHC 588 588 7 7

CHC/FRU 20 20 3 3

DH/DWH 37 37 1 1

Total 11584 923 [8%] 305 23 [8%] Source: State and district PIP 2013-14

5. Human Resources for Health Large number of vacancies in regular posts in Bihar – Medical Officers 2476, ANMs 2388, LT

1925, MPW 1216, LHV 749, and Staff nurses 393. State has huge gap of medical, nursing and

paramedic staff in terms of requirement, sanctioned and in position at different level health

facilities. Irregular recruitment and lack of qualified manpower has led to vacancies in critical

healthcare workforce both in regular and contractual positions. There is no mechanism existing

11

in the state to regularise contractual medical officers under NRHM in the state. The state has 13

medical officers and 27 staff nurse per one lakh population in public health sector.

Table 7Human Resources Status in Bihar

HR categories

HR Requirement Current HR Situation

Delivery points

All Facilities

In position

Sanctioned posts

Regular Contractual Total Shortfall/

Excess

ANM 2784 23928 23772 9420 8196 17616 -6312 SN 9029 12146 13415 393 1619 2012 -10134 LHV 204 1243 1181 432 0 432 -811 LT 1642 2681 2207 282 387 669 -2012 Pharmacist 960 1999 NA NA NA NA NA MO 3003 12094 7315 2464 1581 4045 -8049 Specialist 878 878 NA 684 273 957 79 Source: Bihar state PIP 2013-14

The situation in Aurangabad is similar to the state. There are around 554 various para-medical

personnel available across different health facilities. Out of 969 sanctioned HR, only 47% of

them are available in the district. Regarding medical officers, out of 226 sanctioned posts, only

43% of them are in position. In Aurangabad district, 12 MO’s and 18 staff nurse per 1 lakh

population available in public health sector, which is below the state average.

Graph 1Human Resources Status in Aurangabad

Source: District PIP 2013-14

12 13 2241

97

466

23 76 72

150

226

648

0

100

200

300

400

500

600

700

LHV LT Pharmacist SN MO ANM

HUMAN RESOURCES- SANCTIONED VS POSITIONED AURANGABAD, BIHAR 2013

In Position Sanctioned posts

12

6. Maternal Health

6.1 ANC and PNC

ANC registration against expected pregnancies and ANC in first trimester against reported

ANC of Aurangabad district recorded below 4% and 5% in comparison with state average.

However, the major concern across the state and district is identifying severe anemia and

hypertensive cases who are high risk pregnant women group. Reported number of severe

anemia and hypertension cases in the state and district is far below than expected level.

Table 8 Selected maternal indicators of Bihar and Aurangabad from Jan to May 2013

Sl. No. Key Indicators Jan to May 2013

Bihar Aurangabad

1 ANC Registration against Expected Pregnancies 83% 79%

2 ANC Registration in first trimester against Reported ANC registration

45% 37%

3 Severe anemia (Hb<7) treated against reported ANC registration

0.60% 0.40%

4 Hypertension in pregnancy- detected against ANC reported

2.50% 2.50%

5 Institutional Deliveries against Estimated Deliveries 56% 59%

6 Home deliveries( SBA& Non SBA) against estimated deliveries

14.70% 20.10%

7 C Section deliveries against institutional deliveries 1.50% 1.10% Source: DHIS2

6.2 institutional deliveries

As shown in the table 8 above, institutional deliveries of the district is higher by 3% in

comparison with state. The state and district needs to review the low performance of C Section

deliveries across state, which is mere 1.5%. However, to improve the situation, the state has

trained 101 medical officers in EmOC and 113 MOs in LSAS in the year 2012. State needs to

develop a mechanism to follow-up trained MOs whether they are using acquired skills in

preventing and reducing maternal mortality at health facility level.

Table 9 Functional delivery points in public health facilities – Bihar and Aurangabad

Sl .No

Health facilities Bihar Aurangabad

1 Total No. of SCs/conducting >3 deliveries per month 9696/74 234/0

2 Total No. of 24X7 PHCs/conducting >10 deliveries per month

496/496 8/8

3 Total No. of any other PHCs/Conducting >10 deliveries per month

1243/204 60/12

4 Total No. of CHCs ( FRU) conducting > 20 deliveries /month /C-section

67/67/8 3/3/0

5

Total No. of any other FRUs (excluding CHC-FRUs)/conducting > 20 deliveries per month with C-section

45/45/12 2/2/2

13

6 Total No. of DH conducting > 50 deliveries /month with C-section

36/36/36 1/1/1

7 Total No. of Medical colleges conducting > 50 deliveries/month with C-section

06/06/06 0/0/0

8 No. of Blood bank licensed / functional 34/28 1/1

9 No. of Blood Storage Units licensed / functional 115/9 NA Source: State and district PIP 2013-14

Only 8% of the total available health facilities are operationalized as delivery points in the state

and district. State and district needs to prioritize health sub-centers as delivery

points based on maternal indicators and need of the locality. Only 1% of sub-centers are

operationalized as delivery points at state level and in Aurangabad district none of them are

operationalized as DP who are conducting >3 deliveries. However, few of the HSC in

Aurangabad have been operationalized as DP but fall below the requirement of >3 deliveries

per month. Availability of round the clock FRU services in the state and district is

questionable.

There are total 34 blood bank and 115 blood storage units available but only 28BBs and 9 BSUs

are functional in the state. Renewal of license for existing BSU’s is a concern in the state and

there should be proper action plan for the renewal and maintenance of these BSU’s.

Graph 2Institution wise Deliveries from January to May 2013 – Aurangabad

Out of total deliveries, PHC’s alone contributes 53% and rest of the health facilities contribute to

the remaining 47% in the district. APHC’s, which are equal to PHC in comparison with other

states contributes only 1% of total deliveries during first five months of 2013. Only 18% of

Aurangabad Institution wise Deliveries January to May 2013

DH

RH

PHCs

APHCs

HSCs

14

available 60 APHCs are conducting deliveries. Strategically 5 to 6 APHCs are located in every

block serving 30 to 60 thousand population, which are best positioned to meet the demand of

maternal services. However, the state adopted to operationalize these APHCs equal to PHCs

but the progress is very slow. Mere 2 HSC conducted 3 deliveries during first five months of

2013.

Non-performing EmOC trained doctors is one of the major concern in the state. Quality of

training and post training follow-up needs to strengthen to improve the utilization of acquired

skills in the health facilities. Rational deployment of human resources particularly in APHCs

and PHCs to ensure functionality of health facilities at primary level would improve the

maternal outcomes.

6.3 Maternal Death Review

Bihar is one of the high MMR (305/100,000) burden state in India but yet to establish robust

mechanism to review maternal deaths in the district and state level. No facility and community

based MDR committees are constituted in the district. Total 5 MDs reviewed by Civil Surgeon

(CS) from April ’12 to March ’13 out of 22 reported MDs.There is need to constitute/strengthen

MDR task force at district and state level to regularly review MDs and follow-up action to

reduce MMR. Of total 495 reported MDs in the state during 2013, 71% of cases fall under other

causes that includes causes not known. Second major cause of death is abortion followed by

hemorrhage and severe hypertension. Priority of the state is to train district, block MOs, MOICs

and private hospitals on maternal death review in regular interval to strengthen MD reviews, to

understand major cause of death and to reduce MMR burden.

Table 10 Causes of maternal deaths – Bihar and Aurangabad, January to May 2013

Maternal Deaths Bihar Aurangabad

Abortion 74 [15%] 1

Obstructed/prolonged labor 11 [2%] 0

Severe hypertension/fits 13 [3%] 0

Bleeding 40 [8%] 1

High fever 5 [1%] 0

Other Causes (including causes not known) 352 [71%] 3

Total 495 5 Source: DHIS2

6.4 Janani-ShishuSurakshaKaryakram (JSSK)

6.4. A User fee in Out Patient Department (OPD) and In Patient Department (IPD)

User charge of Rs. 2 observed for OPD in DH, Aurangabad and IPD services are free in all

facilities. Out of 15 beneficiaries interviewed across different health facilities, no one reported

paying any money for IPD services.

6.4. B. Drugs and Consumables

It is observed that there is shortage of drugs in all health facilities in the district. Out of 15

beneficiaries interviewed at PHC, Barun and DH Aurangabad, 7 beneficiaries reported buying

prescribed medicine from private medical store. On an average, each beneficiary spent Rs.170.

Beneficiaries revealed that after delivery MOs prescribed few medicine, which are common

across beneficiaries.

6.4. C. Diagnostics

Diagnostic services are available at the facilities visited, which include routine blood and urine

examination. Pregnant women are exempted from paying money for laboratory tests.

However, exit interview with beneficiaries revealed that almost all beneficiaries undergo partial

laboratory test and most of the facilities depend on ANC test results. It is evident from the

visited facilities that due to lack of human resource and inadequate facilities, these services are

not available. Hence, many of the beneficiaries (pregnant women)

diagnostic test which has direct implication on out of pocket expenditure.

6.4. D. Diet

Provision of free diet available in the facilities visited. At DH

services outsourced to third party, which pr

Women (PW). It is learned that the renewal of outsourced agency is pending due to end of the

contract. During the field visit, it is observed that the food quality need to improve.

It was observed across all the facilities that more than 90% of the beneficiaries leave the health

facilities immediate after delivery, within 2 to 6 hours. All most all deliveries are normal

deliveries except DH Aurangabad and no other PHC caters to complications. Hence,

the deliveries discharged within few hours. Although the provision of diet is available across all

health facilities designated as delivery points but due to immediate discharge, utilization of diet

service is questionable.

Graph 3Duration of stay after delivery in Aurangabad district from

Source: DHIS2

1400

1500

1600

1700

1800

1900

2000

March '13

D U R A T I O N O F S T A Y -

Deliveries conducted at Public Institutions





ailable at the facilities visited, which include routine blood and urine



oratory test and most of the facilities depend on ANC test results. It is evident from the


not available. Hence, many of the beneficiaries (pregnant women) dependent on private labs for

diagnostic test which has direct implication on out of pocket expenditure.

Provision of free diet available in the facilities visited. At DH Aurangabad

services outsourced to third party, which provides meals for all in-patients including Pregnant



ross all the facilities that more than 90% of the beneficiaries leave the health


deliveries except DH Aurangabad and no other PHC caters to complications. Hence,



Duration of stay after delivery in Aurangabad district from March to May 2013

April '13 May '13

A U R A N G A B A D , B I H A R


15





ailable at the facilities visited, which include routine blood and urine



oratory test and most of the facilities depend on ANC test results. It is evident from the


dependent on private labs for

Aurangabad, food catering

patients including Pregnant



ross all the facilities that more than 90% of the beneficiaries leave the health


deliveries except DH Aurangabad and no other PHC caters to complications. Hence, most of



to May 2013

16

6.4. E. Referral Transport

In Aurangabad district, there are 11 blocks and each block has one JananiShishuArogya Express

(102) exclusively for pregnant women to transport nearby health facility. Out of 15

beneficiaries interviewed only three of them availed the ambulance service to reach the health

facility and for drop-back 8 beneficiaries utilized or utilizing the service. Remaining 7

beneficiaries are not aware how they will go.

It is evident from the reported data that only 30 to 40 percent of the beneficiaries are availing

the ambulance facility and remaining of them are dependent on private vehicles which is one of

the major contribution for out of pocket expenditure among the PWs.

Graph 4Month wise ambulance service (both to and fro) against reported deliveries from March to May 2013 – Aurangabad

Source: DHIS2

6.4. F. Display of entitlements

The signage of JSSK well displayed in PHC and above health facilities but there is no display of

any IEC material below PHC facilities.

6.4. G. Awareness of community

When enquired about JSSK entitlements with beneficiaries, there is no clear differentiation

between JSY and JSSK. Almost all aware about Rs.1400 incentives under JSY but no clarity

about JSSK entitlements like assured referral transport, diet, diagnostic and medicines for

mothers and new born babies. The source of information for PWs are ASHAs, 15 out of 15

beneficiaries informed that ASHAs are the point person for the information.

6.4. H. Grievance Redressal Cell

There is no grievance redressal mechanism available in the visited facilities, when enquired

with the beneficiaries, 8 out of 15 informed that they will approach ASHA and rest of them said

they don’t know whom to approach for their grievances.

19

56

17

51

18

76

77

6

72

8

74

4

M A R C H ' 1 3 A P R I L ' 1 3 M A Y ' 1 3

A M B U L A N C E S E R V I C E A G A I N S T D E L I V E R I E S -A U R A N G A B A D , B I H A R


Total Number of times the Ambulance was used for transporting patients during the

month

17

6.4. I. Out of pocket expenditure / informal charges

Interaction with beneficiaries revealed that out of pocket expenditure arise mostly on

transportation and drug charges. Regarding informal charges, there are some instance where

paramedics also demand money after deliveries in the health facilities.

Regarding diet, PHCs, SDH/RHs and DH empanelled agencies to provide cooked food, but

hardly any beneficiaries stay more than 6 hours in PHC and SDH/RH because most of the

deliveries are normal and complications are referred to DH or nearby private hospitals.

6.5 Janani-ShishuYojana (JSY)

JSY is known as JBSY in Bihar and the DHS trying hard to disburse the prescribed money to

beneficiary on the same day of delivery. However, it is observed that there is no pending

amount under JSY and regularly disbursing amount to the beneficiaries within one or two days

of time.

7 Child Health

7.1 SNCU7.1 SNCU7.1 SNCU7.1 SNCU

According to AHS (2011) IMR of the state was 55 and the Aurangabad was reported 48, which is

7 points below the states average. State has 484 NBCCs, 7 NBSU and 37 nutritional

rehabilitation centers. However, in the district one SNCU sanctioned and separate building has

been constructed within DH campus but yet to operational since 2 years.

Table 11 Status of different type of new born care facilities in Bihar and Aurangabad

Status NBCC NBSU SNCU NRC

Approved

Operational

Approved

Operational

Approved

Operational

Approved

Operational

Bihar 484 484 40 7 39 8 38 37

Aurangabad

11 11 1 0 1 0 1 1

Source: Bihar PIP 2013-14

UNICEF in collaboration with State Health Society, Bihar conducted state wide quality

assessment of NBCC in April 2012. The assessment conducted in 11 NBCC in Aurangabad

district and found that only three NBCC’sare fully functional and remaining 8 NBCCs are

partially functional.45% of NBCCs are located inside labor room and remaining 55% were

reported outside of the labor room. Around 44 ANM/Staff Nurse trained and only 64% of

them possess required skills for NBCCs.

18

Graph 5 Assessment of NBCC Centers – Aurangabad, Bihar

None of the NBCC were reported with essential drugs in place and only one units reported

with all consumables. Only 5 units displayed proper protocols and 2 showing utility of

protocol. However, the report says 82% of the facilities have updated NBCC registers 91% of

the facilities have regular monthly report but none of the centers have equipment maintenance

register.

7.2 Nutritional Rehabilitation Centre

Malnutrition1 is a serious issue in Bihar with a high prevalence of 58.4% (NFHS-3; 2005-06).

Children suffering from severe and acute malnutrition are reported to be 8.3%. Based on

population figures, it is estimated that in Bihar 2.5 million children under 5 years of age are

threatened to face the consequences of severe malnutrition.

1Severe and acute malnutrition (SAM) is defined by a very low weight for height, below -3 z∗ scores of the median WHO growth

standards, presence of visible severe wasting or ‘bipedal Oedema’, or mid - upper arm circumference (MUAC) of <11 or 11.5 cm in children between 6 to 60 months.

0

2

4

6

8

10

12

14

16

Radiant

warmer

Photo

Therapy

Oxygen

Concentrator

Suction

Machine

AMBU Bag &

Mask

Stablilizer

Assessment of 11 NBCC centres - Aurangabad, Bihar (2012)

Available Functional

Graph 6 Output Indicators of NRC Aurangabad, Bihar

NRCs run through district health society via qualified NOGs and UNICEF continuously

provide technical and supervisory support to NRCs. In

hospital run by NGO. NRC, Aura

Demonstrator (FD), a cook, two helpers and a pediatrician who checks children for their

nutritional and medical needs. NRC,

batches. Total 42% children cured and discharged and 58% children were followed up till 8

week. However, no defaulter and deaths

referred to any other facilities.

male and 59% females. Of the total 83 children, 84% of children fall under 6 to 36 months and

remaining 16% fall under 37 to 60 months.

7.3 Immunization

Cumulative figures of Aurangabad from Jan

compared to Bihar state. The full immunization coverage of Aurangabad is 82%, which is 13%

higher than state average. Except BCG, all other

comparably higher than state’s average. DPT3 to Measles dropout

and Bihar, by 20% and 18%. However,

11% in Aurangabad and Bihar.

temperature card duly filled and adequate temperature maintained. In Bihar,

power supply, most of the ILR/deep freezer dependent on power generator, which were

outsourced to third party. Facility level official informed that in case of generator failure, they

depend on ice cubes which are locally available.

Output Indicators of NRC Aurangabad, Bihar

Cured (C)

Non Respondent (NR)

Deaths (D)

icators of NRC Aurangabad, Bihar


provide technical and supervisory support to NRCs. In Aurangabad, NRC is located in

Aurangabad is 20 bedded facility staffed by a nurse, a Feeding


NRC, Aurangabad admitted 83 SAM children and completed

cured and discharged and 58% children were followed up till 8

week. However, no defaulter and deaths reported and none of the children were transferred or

referred to any other facilities. All admitted children belong to SC/EBC/OBC, of which


remaining 16% fall under 37 to 60 months.

Cumulative figures of Aurangabad from Jan to May 2013 show improved performance as

Bihar state. The full immunization coverage of Aurangabad is 82%, which is 13%

higher than state average. Except BCG, all other immunization coverage in the district

comparably higher than state’s average. DPT3 to Measles dropout observed in

and 18%. However, BCG-DPT3 drop out percentage decreased by 37% and

. Facilities visited had functional ILR and deep freezer with

temperature card duly filled and adequate temperature maintained. In Bihar,



depend on ice cubes which are locally available.

Output Indicators of NRC Aurangabad, Bihar

Defaulter (DF)

Medical Transfer/ Referred (R)

Under follow up till 8th week

19


, NRC is located in district

is 20 bedded facility staffed by a nurse, a Feeding


SAM children and completed 5

cured and discharged and 58% children were followed up till 8th

and none of the children were transferred or

to SC/EBC/OBC, of which 41%


improved performance as

Bihar state. The full immunization coverage of Aurangabad is 82%, which is 13%

immunization coverage in the district is

observed in Aurangabad

decreased by 37% and

Facilities visited had functional ILR and deep freezer with

temperature card duly filled and adequate temperature maintained. In Bihar, due to short of



Graph 7 Immunization Coverage of various antigens against estimated live births from January to May 2013

The district shows good performance of planned versus held immunization sessions which

correlates with immunization achieveme

improvement shown in sessions held

immunization sessions were attended by ASHAs who are supposed to do community

mobilization.

Table 12 Immunization session held in Bihar and Aurangabad from Jan to May 2013

Immunization Sessions

Bihar

Aurangabad

8. Family Planning

Performance of family planning programmes reflects poor outcome in the

per the DLHS III, state and district has 39.2% and 41.3%

district population, total eligible couples for unmet need calculated for the

2013. 11% of the total unmet needs were catered in the district, which

state average in meeting family planning needs. Aurangabad district outperformed in

providing IUDs against total reported FP users in comparison with state, which is 17%

than the state’s average.

79%88%

73%

100%

0%

20%

40%

60%

80%

100%

120%

BCG DPT 3

% I M M U N I Z A T I O N C O V E R A G E A U R A N G A B A D

Bihar

Immunization Coverage of various antigens against estimated live births from January

performance of planned versus held immunization sessions which

correlates with immunization achievement in the district. However, in comparison with

improvement shown in sessions held. It is concern to note that only 83% to 88


mmunization session held in Bihar and Aurangabad from Jan to May 2013

% of immunization sessions held vs planned

% of immunization sessions where ASHA were present (out of the held sessions)

96% 83%

99% 88%

Performance of family planning programmes reflects poor outcome in the state and

state and district has 39.2% and 41.3% total unmet needs and on the basis of

district population, total eligible couples for unmet need calculated for the first five months of

% of the total unmet needs were catered in the district, which is 3% higher than the

family planning needs. Aurangabad district outperformed in

providing IUDs against total reported FP users in comparison with state, which is 17%

85%

72% 69%

99%

80% 82%

OPV 3 Measles Full

Immunization

% I M M U N I Z A T I O N C O V E R A G E - B I H A R A N D A U R A N G A B A D

Bihar Aurangabad

20

Immunization Coverage of various antigens against estimated live births from January

performance of planned versus held immunization sessions which

nt in the district. However, in comparison with state,

is concern to note that only 83% to 88% of


mmunization session held in Bihar and Aurangabad from Jan to May 2013

% of immunization sessions where ASHA were present (out of the held sessions)

83%

88%

state and district. As

total unmet needs and on the basis of

first five months of

% higher than the

family planning needs. Aurangabad district outperformed in

providing IUDs against total reported FP users in comparison with state, which is 17% more

21

Table 13 Family Planning Key Indicators – Bihar and Aurangabad from January to May 2013

FP Key Indicators Bihar Aurangabad

Unmet Need 39.2 41.3

Eligible Couples for unmet need- Calculated Using DLHSIII Unmet need

6917541.01 176314.371

Total reported FP Users against estimated eligible couples 8.3%

[579693] 11%

[19371]

Total IUDs reported against total reported FP users 29.4%

[170534] 47.2% [9150]

Total OCP users against total reported FP users 4%

[25400] 4%

[679] of Total sterilization (against Estimated Level of Achievement)

5% [346229]

5% [8510]

Postpartum sterilization out of total female sterilizations 1.75% [6017]

0.11% [10]

Male sterilizations out of total sterilizations 0.7%

[2458] 1.5% [126]

Female sterilizations out of total sterilizations 99.2%

[343771] 98.5% [8384]

Source: DHIS2

99% of total sterilization are female sterilization and there is a need for proper counselling for

male partners to improve the male sterilization. OCP users remain the same across state and

district and there is a need to promote OCP for spacing. However, postpartum sterilization is

very low and it seems state has already worked out the training schedule for MO to impart

skills in PPIUCDs. The unmet need (41.3) for Aurangabad district correlates well with literacy

rate of the district (72.77). Yet, there is huge gap between demand and supply but the district

health facilities are not equipped to fill the gap. There is an urgent need to appraise family

planning activities in the district, which should accommodate the needs of the district.

9. Quality in Health Services

9.1 Infection Control and Bio-Medical Waste Management

The state has outsourced the Biomedical Waste Management (BWM) system for all health

facilities from medical colleges to PHC level. MOs and paramedical staff are satisfied with

outsourced agency and they are regular in picking bio-waste. Infection prevention practices

needs improvement in all health facilities. Many of the health facilities, which visited do not

have proper coded buckets for segregation of biomedical waste management, some facilities

have coded buckets but they are in partial usage. Disposable gloves and masks are not

available almost in all health facilities. Needles and syringes are not properly mutilated and

disinfected before putting in waste bin. The district has need for additional trainings and robust

monitoring as far as infection prevention (IP) practices are concerned.

DH in Aurangabad district is ISO certified and diagnostic services are outsourced to third party

in the district. However, to improve the quality of delivery of diagnostic services, state needs to

22

develop program for capacity building and quality assurance in laboratory and radiology

services. Standardized quality norms should be maintained at sub-centre, APHC and PHC

level for delivery of effective RCH services. Supportive supervision at block level, district level

and follow-up action by state level should be streamlined.

9.2 Information Display

Information related to health programs are not well displayed in PHCs and below health

facilities. DH Aurangabad has displayed citizen charter at the entrance of DH and various

other information related to national schemes like JSSK well displayed in the DH campus.

However, no sub-center which are the first contact point for community access basic health

services, has any IEC material on any health programmes,. Proper display of information will

have a positive impact on utilization of health services and also improve the accountability

health system.

10. Community Processes

10.1 ASHA and MAMTA

The state currently has about 84,365 ASHAs, representing 97% of the total selected. As per the

revised norm, Aurangabad requires 2511 ASHAs and only 2146 ASHAs are placed, which is

about 85% of the required ASHAs. There are total 105mamatas position approved in the district

and 97 of them are placed in DH and RH/CHC hospitals.

Table 14 Block wise ASHAs against target as on April 2013

Sl. No.

Block ASHA Selection Shortfall

Target Achievement

1 Aurangabad 157 155 2

2 Daudnagar 152 151 1

3 Deo 161 161 0

4 Goh 217 215 2

5 Haspura 148 147 1

6 Kutumba 215 215 0

7 Madanpur 195 193 2

8 Nabinagar 264 264 0

9 Obra 210 209 1

10 Rafiganj 252 252 0

11 Barun 189 184 5

Total 2160 2146 14

Source: DHS, Aurangabad

The state has established support structures at state, divisional, district, block level for ASHA

functioning. There are 102 ASHA facilitator available in the district out of 103 positions

available in the district and 8 Block Community Mobilizer (BCM) available out of 11 approved

post. DCM at district level and BCM at block level take responsibility of ASHAs. The district

has identified 14 villages where ASHAs are yet to be selected. Wherever ASHAs are not

available ANMs are taking care of outreach activities.

23

10.2 Skill Development

All ASHA were trained up to module 4 and 95% (2052) of ASHA were trained in first round of

module 6 and 7, which is fully residential. Round 3rd, 4th, and 5th of module 6 and 7 yet to start.

District has distributed drug kits to all ASHAs however, no HBNC kits were distributed. The

district has identified DORD, an NGO for rolling out trainings for ASHA in the district.

10.3 Functionality of the ASHAs

There are total 10 ASHA’s dropout and 40 terminated. Reasons for dropout are lack of interest

and some of them are migrated to other areas and some expired. There is no grievance

redressal mechanism available for ASHA in the district. The process of refilling of drug kit of

ASHAs is done from PHC once in a year. The payment of ASHAs in the state and district is

through bank account and there is no pending of ASHA payment in the district. However,

ASHAs lack the provision of rest houses in the health facilities, no help desk available in the

district.

11. Disease Control Programme

11.1 Revised National Tuberculosis Control Programme

Aurangabad has 4 Treatment Units (TUs), 11 Designated Microscopic Centers (DMCs) with 4

Senior Treatment Supervisor (STSs) and 4Senior TB Laboratory Supervisor (STLS). As per the

population norms there should be one DMC for every 100,000 (50,000 per tribal and hilly areas)

population and one TU per 5 lakh population (2 to 2.5 lakhs tribal and hilly areas. As per the

population norms, the district has inadequate RNTCP facilities available for screening,

diagnosis and treatment.

Graph 8 RNTCP Month wise performance of Aurangabad, Bihar

District has various administrative and operational problems associated with RNTCP

programme, which revealed during interaction with District TB Officer (DTO). Pediatric TB

medicine are not available at district. RNTCP programme suspected 50 Multi Drug Resistant

(MDR) cases in the district, of them 23 sent for bacteria culture and 16 confirmed as MDR as of

77 87 87

783 801 811

0

100

200

300

400

500

600

700

800

900

March '13 April '13 May '13

Chart Title

Sputum Positive Diagnosed

24

June 2013. DTCO office informed that there are two suspected Extreme Drug Resistance (XDR)

in the district but yet to confirmed.

It is observed that there is no referral linkages for TB suspect in the field, only OPD cases were

screened in the DMCs. Need for reorientation of LT training as per RNTCP modules and many

of the LTs do not have information on referral of suspected MDR cases in the district. As per

RNTCP, it is estimated 75 new smear-positive (NSP) cases per 100,000 populations and the

national target is to detect at least 70% of the total estimated cases, which is 53 cases per 100,000

population. However, the performance of the district shows far below the national target of the

total NSP cases per annum as per estimated district population.

11.2 National Leprosy Eradication Programme (NLEP)

Bihar is one of the high burden state for leprosy with a prevalence of 0.89 cases per 10,000 and

2.51 child cases per 100,000 population with 16.77 annual new case detection rate as on March

2012. There is no adequate staff for leprosy detection at PHC level and CMO is the in-charge of

DLO. There is no skin smear test available in any health facility and almost all cases were

detected based on nerve and skin patches. Total 60 cases detected in the month of April and

May 20013, which include 40 PB and 20 MB, which include 15 child cases. Around 27 cases

were released from treatment and 396 cases under treatment in the district by the end of May

2013. Every block has one non-medical assistant for leprosy outreach activities and other para-

medic staff include ASHA’s also support in leprosy outreach activities in the district. However,

health facilities do not have the capacity to treat disabilities and they refer to nearby referral

center in the district.

11.3 National Vector Borne Diseases Control Programme

As on April 2013, the state has examined 39,586 blood smear and confirmed 313 cases. Out of

313 positive cases, 21% of them are Plasmodium falciparum (Pf) cases. Aurangabad district

examined 11,612 blood smear and 84 found positive out of which 4.8% cases are Pf. Out of 80

basic health worker (BHW) sanctioned in the district only 7 BHW available and there is no

malaria LT available in the district.

Graph 9 Year wise Bihar state Malaria situation from 2009 to 2013

32

55

19

08

26

43

24

19

31

3

24

08

93

3 12

73

84

5

65

21

1 0 0 0

2 0 0 9 2 0 1 0 2 0 1 1 2 0 1 2 ( P ) 2 0 1 3 *

Y E A R W I S E M A L A R I A S I T U A T I O N - B I H A R

Malaria Cases Pf Cases Deaths

25

The district received Mass Drug Administration (MDA) stock for prevention of filariasis but

due to lack of human resources it would be a challenge for the district to distribute across 11

blocks.

Graph 10 Malaria Situation of Aurangabad between two periods 2012 and 2013 (up to May)

11.4 National Programme for Control of Blindness (NPCB)

The state has annual target of 607070 cataract operations and 85640 free spectacles to school

children out of which 46.2% and 7.1 achieved for cataracts and spectacles the end of May 2013.

The district has a target of 5000 cataracts of which only 20 achieved from April to May 2013.

Around 143 school teachers trained in screening of refractive errors in the month of April and

14,705 school going children screened out of which 85 detected with refractive error and

distributed spectacles to them.

Graph 11 State level progress of NPCB, Bihar (up to May 2013)

10336

70 0 0

11612

83 4 00

2000

4000

6000

8000

10000

12000

14000

BS Examination Positive cases Pf Deaths

Malaria situation between 2012 and 2013 (up to May)

2012 2013

607070

281067

0

100000

200000

300000

400000

500000

600000

700000

Target achieved

Cataract Operations as on May 2013 Bihar

85640

6138

0

20000

40000

60000

80000

100000

Target achieved

Free Spectacles to School Children

26

12. Others

12.1 OPD and IPD

On an average 300 OPD per 1000 population at state level and 467 OPD per 1000 population at

district level reported for the first five months of 2013. 15 and 18 IPD per 1000 population

recorded at state and district level. However, when correlated district OPD and IPD with

available human resources, it doesn’t correlate well with available resources in the district. The

staff include medical officers and staff nurse grade-A.

Graph 12 Correlation of health staff and Out Patient Attendance for the month of May 2013, Aurangabad

Referral hospitals are best positioned in terms of available human resource but the OPD attendance is far below than PHCs in the district. This correlation indicates that PHC perform better than RH with minimal human and infrastructure resources.

27

12.2 Information Systems

In Bihar, DHIS2 application is in use for HMIS and data entry takes place at block level. Block

level BPMU structure is similar to DPMU, but district and block level HMIS analysis needs to be

strengthen to provide feedback and improve the facility level performance. RHMIS indicates

85.3% facility wise data uploading in Aurangabad.

Table 15 Status of Facility Wise Data Uploading, Aurangabad

Facility No. of Facility Facility wise uploading

SC 400 338

PHC 81 72

CHC 0 0

SDH 2 2

DH 0 0

Total 483 412

Source: RHMIS

12.2a Mother and Child Tracking System (MCTS)

The below graph provides block wise MCTS performance against total expected registration as

on May 2013. Only six blocks achieved above 50% of expected registrations and Obra block

achieved the highest MCTS registrations by 82.2%.

28

Graph 13 % MCTS reported against total expected registration as on May 2013

12.3 Village Health and Nutrition Day

VHND Table 16 Block wise VHND held and ANC coverage for the month of April 2013, Aurangabad

Block Name No. of VHND Session Held

Coverage of ANC

Up to 12 week (1st )

13 to 24 week (2nd)

25 to 34 week (3rd)

More than 35 week (4th)

Aurangabad Sadar 292 280 238 154 98

Daudnagar 219 76 48 84 32

Deo 240 85 283 152 55

Goh 258 254 170 128 0

Haspura 276 204 218 152 57

Kutumba 215 122 433 242 77

Madanpur 234 137 321 165 75

Nabinagar 322 217 86 10 0

Obera 214 145 340 271 7

Rafiganj 312 180 164 184 47

Varun 219 71 224 59 1

Table 17Block wise VHND held and hemoglobin test conducted for the month of April 2013, Aurangabad

Block Name No. of VHND Session Held

Hemoglobin

Below 7 gm 7-11 gm 11+ gm

Aurangabad Sadar 292 10 250 17

Daudnagar 219 25 54 45

Deo 240 21 154 14

Goh 258 15 184 55

82.2

76.7

71.1

71.0

68.6

68.3

53.4

43.6

40.4

34.0

22.0

0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0

Obra

Madanpur

Aurangabad(PHC)

Deo

Kutumba

Goh

Barun

Haspura

Nabinagar

Daudnagar

Rafiganj

% MCTS reported against total expected registration as on May 2013

29

Haspura 276 0 122 36

Kutumba 215 0 0 0

Madanpur 234 0 13 0

Nabinagar 322 0 0 0

Obera 214 0 141 0

Rafiganj 312 4 0 5

Varun 219 0 11 0

bihar state quarterly monitoring report

Documents