District Report and Tabulation for PRC Study on Rapid Appraisal of RHM

Madurai

CO TE TS
Chapter 1. Chapter 2. Chapter 3. Chapter 4. Chapter 5. Chapter 6. Chapter 7. Chapter 8. Chapter 9. State Profile District Profile Community Health Centre Primary Health Centre Sub-centre Household Characteristics Gram Panchayat Exit Interview In-patient Exit Interview Out-patient

CHAPTER 1 STATE PROFILE

The state of Tamil Nadu, located in the southern part of the country is the sixth largest state in India. The state of Tamil Nadu is located in the eastern side of the southern extreme of peninsular India. In the north it is boarded by the states of Karnataka and Andhra Pradesh, where as the southern tip is edged by the Indian ocean and the Arabian sea. The state of Kerala in the west and the Bay of Bengal in the east. The state consist of 32 districts, 206 Taluks, 385 blocks and 16317 revenue villages.

According to 2001 census, the population of Tamil Nadu is 62.4 million out of which 31.4 million are males and 31.0 million are females. About forty-four percent of the

population lives in urban area. The sex distribution of the population shows that 17.3 million are males and 13.8 million are females in rural. In urban the male and female population are 17.5 million and 17.3 million respectively. The proportion of Scheduled caste and Scheduled tribe population is 19 percent and one percent respectively. According to recent estimates (2008) the Population of Tamil Nadu is 65.9 million out of which 33.2 million were males and 32.7 million were females. The rural and urban distribution shows that, 32.2 million belongs to rural (16.2 million males; 16.0 million

females) and 33.7 million (17.0 million male and 16.9 million female).

STATUS OF RHM I TERVE TIO S

In Tamil Nadu state 29 district hospitals are functioning, all the district hospitals are first referral units. Apart from this 234 sub divisional hospitals are functioning . As on June 2008, Madurai district has 8,706 sub-centres and 1,277 primary health centres. Among them 1166 were 24x7 PHCs. At present, 256 CHCs and 385 mobile medical units and

25 AYUSH hospitals are functioning. IPHS facility survey was carried out in all the districts hospitals. In addition to that, 2,208 private hospitals (more than 30 bedded) and nursing homes (less than 30 bedded) were also providing health care services.

Rogi Kalyan samities were registered and functioning in all the 29 district hospitals, 234 Sub divisional hospitals. 256 PHCs and 1,277 PHCs. Janani Suraksha Yojana (JSY) was implemented in all the rural primary level public health facilities. Public Private

Partnership was not undertaken in the state for implementation of the JSY Scheme. During 2007-08, totally 8,29,490 institutional deliveries were reported. In Tamil Nadu, all the vertical health programmes functioning under different programmes were merged into State Health Society under NRHM. This was implemented in all the districts and for all the health programmes had a common bank account in the state Health society. State health plan was prepared for the year 2008-09. All the 29 districts have District Action Plan for the current year (2008-09) and it was approved by the state society. The funds are allocated to the district according to activity wise. All the funds are being transferred electronically. All the sub-centers have operational joint bank account of ANM and village president (Sarpanch). For all the PHCs, CHCs and Sub Centers Untied fund for the current year has been transfered.

SURVEY PERIOD A. Household Survey:

Survey Period 02.12.08 to 03.12.08 04.12.08 to 05.12.08 06.12.08 07.12.08 08.12.08 to 09.12.08 10.12.08 to 11.12.08 12.12.08 Team I Team II CHC : Chellampatty, PHC : Thummagundu Nallaperumalpatti Mettupatti Ramanathpuram Peyampatti Nallaperumalpatti & Mettupatti & Ramanathpuram Peyampatti Sunday Holiday CHC : Chellampatty, PHC : Vikkramangalam Nadumudalaikulam Kannanur Kasbamudalaikulam Keelapatcheri Nadumudalaikulam & Kannanur & Kasbamudalaikulam Keelapatcheri CHC : Samayanallur, PHC : Koilpapakudi Athalai Pillaiyarnatham Sunday Holiday Rengarajapuram Vitankulam Athalai & Pillaiyarnatham & Rengarajapuram Vitankulam CHC : Samayanallur, PHC : Kancharampettai Chatrapatti Kodimangalam Sunday Hoiday Kallampatti Sundarajanpatti Chatrapatti & Kodimangalam & Kallampatti Sundarajanpatti Team III Poothipuram Iyyankoilpatti Poothipuram & Iyyankoilpatti

Sakkarappanayackanur Poollakkapatti Sakkarappanayackanur & Pullakkapatti Thodanerry Kallikudi Thodanerry & Kallikudi Thirupalai Ayyarpudur Thirupalai & Ayyarpudur

13.12.08 to 15.12.08 14.12.08 16.12.08 to 17.12.08 18.12.08

19.12.08 to 20.12.08 21.12.08 22.12.08 to 23.12.08 24.12.08

B. Facility Survey : Date 04.12.08 & 05.12.08 08.12.08 & 09.12.08 10.12.08 to 12.12.08 13.12.08 to 15.12.08 16.12.08 & 17.12.08 18.12.08 & 19.12.08 22.12.08 & 23.12.08 Type of Facility PHC CHC District Hospital PHC PHC PHC PHC ame of the Facility Thummagundu Chellampatti Usilampatti Vikkaramangalam Koilpapakudi Samayanallur Block Kancharampattai

ote : Sub-centre were covered along with the Households survey by the supervisors of the team.

LIST OF FACILITIES COVERED:

CHC PHC Thummagundu Cellampatty Vikkaramangalam Sub-centre Nallaperumalpatti Mettupatti Poothipuram Nadumudalaikulam Kannanur Sakkarappanayackanur Athalai Pillaiyarnatham Thodanerry Chatrapatti Kodimangalam Thirupalai

Koilpappakudi Samayanallur Kancharampettai

HOUSEHOLD A D EXIT I TERVIEW COVERED

Exit Interview

Households

District Hospital CHC PHC Sub-centre Village

o. of IPD o. of OPD o. of OPD o. of IPD

o. of House holds

Village

o. of House holds

Thummagundu Cellampatty Vikkaramangalam IPD 10 OPD - 10 Koilpappakudi Samayanallur Kancharampettai 10 10 10 8 10 10 10 5 10 10

10

Nallaperumalpatti Mettupatti Poothipuram Nadumudalaikulam Kannanur Sakkarappanayackanur Athalai Pillaiyarnatham Thodanerry Chatrapatti Kodimangalam Thirupalai

50 50 50 50 50 50 50 50 50 50 50 50

Ramanathapuram Peyampatti Iyyankoilpatti Kasabamudalaikulam Keelapatcheri Pollakkapatti Rengarajapuram Vitankulam Kallikudi Kallampatti Sundarajanpatti Ayyar Pudur

50 50 50 50 50 50 50 50 50 50 50 50

CHAPTER 2 DISTRICT PROFILE PART-A Madurai district is one of the important district of the Tamil Nadu state. The district has 13 blocks. The total land area of the district is 3,696 sq.km., which is very high compared to 480 of the state. As per 2001 census, population of Madurai district is about 26 lakhs and it constitutes four percent of the population of the state population.. The sex ratio of the district is 978 females for 1000 population.

POPULATIO CHARACTERISTICS According to 2001 census, the population of is 25.8 lakhs out of which 13.0 lakhs are males and 12.8 lakhs are females. About 56 percent of the population of the district

lives in urban areas. The sex distribution of the population shows that 5.7 lakh are males and 5.6 lakh are females in rural. In urban the male and female population are 7.3 lakh and 7.1 lakh respectively. The proportion of Scheduled caste and Scheduled tribe population is 12.7 percent, 6.9 percent of the urban and 19.7 percent of the rural population belongs to SC/ST.

STATUS OF RHM I TERVE TIO S Health Infrastructure As on June 2008, Madurai district has 314 sub-centres and 42 primary health centres. Among them 29 were 24x7 PHCs and 13 were block PHCs. IPHS facility survey was carried out in all the Sub-Centre and PHCs . In addition to this one District hospital, six first referral units, three mobile medical units, five sub divisional, hospitals and 16 AYUSH hospitals were functioning in Madurai. IPHS facility survey was not carried out in these facilities. New building were under construction in three PHCs and two sub divisional hospitals. Five private hospitals (more than 30 bedded) were also

located in Madurai district. IPHS upgradation was not completed.

One district hospital, five sub divisional hospitals, one CHC, 42 PHCs, 17 public maternity homes and four other public sector hospitals like Medical College hospital, ESI, Railway are available in this district for delivery services. Among them all the PHCs (42), public maternity homes (17) and other public sector hospitals like Railway

and ESI were providing (Basic Emergency Obstetric Care (BeMOC).

District hospital

(1) and two sub divisional hospitals are providing Comprehensive Emergency and Obstetric Care, (CeMOC), .i.e., having Blood storage, Anesthetist and Gynaecologist, with new born care unit. Private health facilities were not accredited for JSY.

Human Resources As per as human resources are concerned at the district level 104 medical officers were sanctioned and all the posts were regular and are in position. Separate information regarding number of Gynecologists, Anaesthetist, Paediatrician and, other specialists were not available. On the whole, 138 staff nurses were sanctioned, among them 136 were regular in position. Forty-eight ANM posts were sanctioned as regular and are in position.

RKS and JSY Rogi Kalyan Samities were registered in the district hospital, all the sub divisional hospital (5), CHC (1) and PHCs (42) and all are functioning. Initiative on Public Private Partheship (PPP) was not under taken in the district for the implementation of Janani Suraksh Yojana (JSY) scheme.

Totally 20,929 institutional deliveries were reported during 2007-08. Number of women registered under JSY during 2007-08 were 10,978. Among them nearly onefourth (23 percent) were SC/ST, and three-fourth (77 percent) belongs to general population. Ninety-two percent (10,075) of the registered JSY women were opting institutional delivery during 2007-08. Among them twenty-three percent (2259) were SC/ST women.

FI A CIAL MECHA ISMS

In Madurai district all the vertical health programmes were merged with the District Health Society. The district health society is registered. The district health society has common bank account for all the health programmes which are functioning under the district health society.. District Action Plan was prepared for the current year,

2009-10 and it was approved by the district society. The funds are received from the state according to activity wise, based on to set formula like size of district and previous years expenditure. All the funds are being transferred electronically. All the 314 subcenters, one CHC and 42 PHCs got United grant for the Current year and it was transfered through electronically. Sub centres are having operational joint account of ANM and village President (Sarpanch)

A. LOCATIO OF THE DISTRICT HOSPITAL A D STATUS OF IPHS

District hospital is located in Usilampatti, 20 kms away from the district Head Quarters. Chellampatti is the nearest CHC to the district head quarter hospital which is located with a distance of 10 Kms and it will take 30 minutes to reach the Government head quarters hospital. Elumalai is the farthest CHC in the coverage area which is located a distance of 20 kms and it will take 45 minutes to reach the facility. Distance between the nearest bus stop and the district hospital is less than 0.5 kms. IPHS facility survey was not carried out in the district hospital. B. PHYSICAL I FRASTRUCTURE Total land area of the hospital is 6680.38 square meters. Totally 135 beds were available in the hospital. Hospital is located in the residential area. The hospital building is disable friendly as per the provisions of Disability Act (Ramp, Lift, Wheel Chair movement etc.,). Waiting space is not adjacent to each consultation and treatment room in all the blocks. It is available only in some places. Registration counter, Blood bank / Blood storage unit, doctors duty room, Treatment room, Pharmacy (Dispensary) , Intensive Care Unit (ICU) and high dependency wards were available. Isolation room, Critical care area, and examination and preparation room were not available.

C. OTHER FRAME WORK A D STRUCTURAL ISSUES

Hospital kitchen (Dietary Service), Medical and General stores, Engineering services backup, round the clock water supply, overhead water storage tank with pumping and boosting arrangements were the available in the hospital. Central sterile

and supply department (CSSD), Laundry, Ventilation (Natural on Mechanical exhaust) in the ward, water coolers / Refrigerators, provision for fire fighting and drainage and sanitation system for waste water, surface water, sub-soil water and sewerage services were not available. Bio medical wastages are disposed by using incarnation and some time outsourced. As per the norm the bio-medical waste were segregated in different bins. Residential quarters were not available for medical staff as well as paramedical staff. Medical records section, telephone, fax, computers and internet services were available. Parking place for vehicles is inadequate. . OBSTETRICS A D GY AECOLOGY SECTIO Female patients have separate ward for obstetrics and gynaecology section. This section has 26 beds, and the bed occupancy rate as on March 31, 2008 was 1:4. Total OPD during the last three calendar months is 471. There is no separate operation theatre (OT) for gynaecology and obstetrics.

During 2007-08, totally 1,565 deliveries were conducted. Among them 501 were caesarean section deliveries, 17 were assisted delivery and 25 forceps delivery. Total MTPs conducted during 2007-08 was 106, among this five were mid-trimester abortions, and four belongs to ectopic pregnancy. Eclampsia and retained placenta cases treated were two each. Ten PPH, 551 sterilization, two suturing cervical and 15 hysterectomy were carried out. Infertility treatment was not carried out.

SURGICAL During the last three months, totally 1,579 surgical OPDs and 404 IPDs were attended. Separate data for male and female was not available. Services like Emergency (Accident & other Emergency surgery), Abdomen surgery and Breast surgery were also available. Pancreas surgery, Spleen and Portal hypertension surgery, and Leprosy

reconstructive surgery were not done.

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MEDICAL In the medical section 35,320 female OPD and 41,000 male OPD and 1,446 female and 960 male IPD were registered during the last three months. Services such as Dermatology and Venerology (Skin & VD) RTI / STI, NLEP, Pleural Aspiration, Pleural Biopsy and Psychiatry were available. Services such as bronchoscopy, Lumber Puncture, Pericardial tapping, Skin scraping for fungus / AFB, Bone Marrow Biopsy and Endoscopic specialized procedures were not available.

PEDIATRIC Under pediatric section 6,273 female and 7,061 male OPD were registered in 2007-2008. Four beds were specially designated / identified for newborns. During 2007-2008, 1,812 pediatric patients (732 neonates, 480 infants (0-1 year) and 600 children under 5 years.) were admitted in the Pediatric section

Services such as birth Asphyxia management, management of severe malnourished children, neonatal sepsis, dehydration and diarrhoea management and respiratory tract / pneumonia management were available.

Equipments like cradle, incubator, Radiant Heat Warmer, Phototherophy Unit, Bag with Mask, Laryngoscope, Oxygen Mask, Suction Machine and Thermometer were available and are in working condition. Except Laryngoscope, ORS (WHO new formula) all the Paediatric Antibiotics were available. But Vitamin A solution and Iron folic Acid syrup were not in stock.

DIAG OSTIC A D LABORATORY FACILITIES Totally 3,550 diagnostics OPD were carried out in the last three months. X-ray, Ultrasound and ECG were the diagnostic facilities available in the Madurai district hospital. During the last three months 1,172 X-ray, 1806 Ultrasound and 322 ECG were done. Provision for Ultrasound guided Biopsy was not available.

Totally 14,021 persons were utilizing the lab services in the last three months. Number of tests carried out in the last three months includes Haematology (12, 580), 11

Urine analysis (7,770), Biochemistry (2810), Sputum (454), Serology (2101), Stool Analysis (73) and Semen Analysis (4).

Lab services like CSF Analysis (Cell count, Culture sensitivity etc., gram staining), Aspirated fluids (Cell count cytology), PAP smear, split skin smear examination for leprosy, Histopathology, Microbiology and Physiology (Pulmonary function test) were not available.

C. HUMA RESOURCES
C. A. MEDICAL

Hospital Superintendent (1), Surgery specialist (2), Gynaecologist (1), Gynaecologist (Regular trained) / Short term trained MO-3), Anesthetist (regular shorterm

(1), General duty doctors (14), AYUSH Physician(1) Head Quarters,

Microbiologist (4), Dental Surgeon (1) were the medical personnel available in the Madurai district hospital. Except contractual under NRHM general duty doctors (2) and Microbiologist (1) all are sanctioned posts.

C. B. PARAMEDICAL STAFF

Paramedical staff like, Staff Nurse (28), Hospital Worker (OP Ward + OT + Blood Bank) (10) and sanitary workers (9) were sanctioned among them only seven staff nurses and two sanitary workers were regular in position.

Other Category of Personnel such as Ophthalmic Assistant / Refractionist (1), Social Worker / Counselor (7), Laboratory Technician (Lab + Blood Bank), Laboratory Attendant (Hospital Worker) (10), LHV (2), Radiographer (2), Pharmacist (6), Matron (1), Physiotherapist (1), Medical Records Officer / Technician (2) were the sanctioned post in the district hospital. Among them social worker / counselor (7), Laboratory Attendant (4), Radiographer (1), Pharmacist (1), Physiotherapist (1), Medical Records Officer / Technician (2) were posted under contract.

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C. ADMI ISTRATIVE STAFF

For administrative purpose, Manager (Administration), Junior Administrative Officer (1), Office Superintendent (3), and Driver (5) were sanctioned. Among them three drivers, two office superintendents and one junior administrative officer were under contract.

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CHAPTER 3 COMMU ITY HEALTH CE TERS I. COVERAGE A D AVAILABILITY OF I FRASTRUCTURE A. COVERAGE In Madurai District, Chellampattyis the only CHC functioning is selected.and the Samayanallur block PHC is considered as a CHC is also selected. Chellampatty Community Health Center covering nearly ninety thousand(87,867) population and the Community Health Center (Block Primary Health Centre) in Samayanallur covers about 60,000 population.

For the Chellampatty, Community Health Center the nearest primary health centre is located with in a distance of 10 kms and it takes 15 minutes to reach the CHC by public transport. Farthest PHC is 20 kms away from the CHC, it takes 30 minutes to reach the CHC from the PHC by public transport. The District headquarter hospital is located with in a distance of 11 kms and the time taken to travel the District Hospital from the CHC is only 15 minutes. All the PHC and CHC are having good public transportation facilities to reach the higher facility.

In Samayanallur Community Health Center the nearest PHC is located in a distance of six kms and the farthest PHC is located with a distance of 30 kms. The time taken to reach the CHC from the nearest and farthest PHCs in public transport is 30 minutes and 120 minutes respectively. District Hospital is located in a distance of 60 kms from the CHC and it takes 120 minutes to reach this hospital by public transport.

As per the IPHS norm the Chellampatty Community Health Center had 30 beds. i.e 15 for males and 15 for females. But the BPHC in Samayanallur had only four beds, this is only for women.

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B. AVAILABILITY OF I FRASTRUCTURE All the Community Centers are having good infrastructure facilities, they are functioning under their own government building, having regular electric supply in all parts. They have their own Generators, Telephone, Computer, Internet, Vehicle/ Ambulance (Running) and laboratory services except difference in number of beds. Chellampatty CHC is having 30 beds and the CHC in Samayanallur is not having adequate beds (only four beds).

Investigative facilities such as ECG, Ultrasound, OT (Operation Theatre), Labour room were available in both the CHCs. But X ray and newborn care corner were available only in the Chellampatty CHC. It was observed that in both the CHCs Operation Theatre was not used for Gynaecology and there is no separate areas for septic and aseptic deliveries.

Records of JSY beneficiaries were maintained properly. Both the CHCs are having separate pharmacy for drug dispensing and drug storage, separate counters to obtain contraceptives, ORS packets, vitamin A and medicines, separate public utilities (toilets) for males and females, OPD rooms/cubic waiting room for patients and drinking water facilities in the waiting area.

Suggestion/ Complaint box was seen only in Samayanallur CHC. Chellampatty CHC is not having adequate sitting place in the waiting room and separate wards for males and females. Emergency room/ causality is not seen in both the CHCs. For drainage, soak pits are available in both the CHCs. In Samayanallur waste materials were buried in a pit but the Chellampatty CHC is having incarnation for waste disposal.

While considering about the cleanliness, in both the CHCs the OPD is very clean, compound premises are good without carbage, rooms and wards are very neat and boards displaying the availability of services in local languages.

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Table C1 : Coverage and Availability of Infrastructure Coverage Population served by CHC Distance & Time Taken to travel to CHC in public transport / available mode from Nearest PHC in the coverage area Farthest PHC in the coverage area District Hospital No. of Beds available Male Female Availability of Infrastructure (Yes:1; o: 0)
Status of Building

CHC Chellampatti
87,867 Distance (in Kms.) Time (in Minutes.)

CHC Samayanallur
57,930 Distance (in Kms.) Time (in Minutes.)

10 20 11

15 30 15

6 30 60

30 120 120

15 15 CHC Chellampatti

0 4 CHC Samayanallur

Own government Building Rented premises Other Rent-free Building Electricity in all parts: No regular electricity supply Regular electricity supply in all parts 30 or more beds Generator Telephone Computer Internet Running Vehicle/Ambulance Laboratory Investigative facilities ECG X-Ray Ultrasound OT (Operation Theatre) OT used for Gynaecology Labour Room

1 0 0

1 0 0

0 1 1 1 1 1 1 1 1

0 1 0 1 1 1 1 1 1

1 1 1 1 0 1

1 0 1 1 0 1

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Separate areas for septic and aseptic deliveries New Born Care Corner Names of JSY beneficiaries maintained in record? Pharmacy for drug dispensing and drug storage Counter near entrance of CHC to obtain contraceptives, ORS packets, Vitamin A and medicines Separate public utilities (toilets) for males and females Suggestion / complaint box OPD rooms / cubicles Waiting room for patients Does the waiting room have adequate sitting place Is drinking water available in the waiting area? Emergency Room / Casualty Separate wards for males and females Sewerage Type of sewerage system Soak pit Open drain Connected to Municipal Sewerage Other Waste disposal Buried in a pit Collected by an agency Incernation Thrown in open Status of Cleanliness of OPD reported good or fair Status of Cleanliness of Compound / Premises reported good or fair Status of Cleanliness of Room/Wards reported good or fair Prominent display boards regarding service availability in local language Names of JSY beneficiaries maintained in record? Pharmacy for drug dispensing and drug storage Counter near entrance of CHC to obtain contraceptives, ORS packets, Vitamin A and medicines

0 1 1 1 1

0 0 1 1 1

1 0 1 1 1 1 0 1

1 1 1 1 0 1 0 0

1 0 0 0 0 0 1 0 1 1 1 1 1 1 1

1 0 0 0 1 0 0 0 1 1 1 1 1 1 1

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Position of Medical and Paramedical Staff

Table C2 explains the human resources available in the selected CHCs. While considering about the position of medical staff and paramedical staff, there is a shortfall (lacunae) found in both the CHCs. Both the CHCs are having only one regular medical staff trained with short term obstetrics course. General surgeon, physician, obstetrician/ Gyneacologist, Anaesthetist, eye surgeon and public health nurse were not sanctioned. But on behalf of them in Chellampatty five general duty medical officers were sanctioned and working in regular position. The Samayanallur Block PHC is having four sanctioned regular general duty medical officers.

Position of Paramedical and supportive staff is sufficient in both the CHCs. Chellampatty CHC is having two lady health visitors (LHV), one block extension educator (BEE), ANM, Dresser, Pharmacist/ compounder, Lab technician, Opthalmic assistant, OT attendent, four staff nurses and two ambulance drivers under regular. All the sanctioned posts were filled.

The CHC in Samayanallur is having one Lady Health Visitor (LHV), ANM, Dresser, Pharmacist/ Compounder, Opthalmic Assistant, OT attendant and one lab technician, one registration clerk, two ANMs and two ambulance drivers in regular. Staff nurses (3) are appointed under contractual i.e., Under NRHM. Radiographer, OT attendant, Block Extension Educator (BEE) and statistical Assistant /Data Entry Operator are not sanctioned. The posts like Radiographer and statistical assistant/ data entry operator were not sanctioned in both the CHCs.

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Table C2 : Position of Medical Staff and Paramedical Staff

CHC 1 Chellampatti
Type of Staff Regular umbers Sanctione d
0 0 0 1 0 0 1 5 0 0 0 0 5 0 0 5 0 0 0 0 1 0 0 0 0 1 0 0 0 4 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 1 0 0 0 4 0 0

umbers in position Contractual Total

CHC 2 Samayanallur umbers umbers in position Sanctioned Regular Contractual Total

0 0 0 0 0 0 0

0 0 0 1 0 0 0

Position of Medical Staff (clinical) General Surgeon Physician Obstetrician / Gynaecologist Medical Officer trained with short term obstetrics course) Paediatrician Anaesthetist Medical Officer trained with short term Anesthesia course) General Duty Medical Officer Eye Surgeon

Public Health Nurse Position of Paramedical and Support Staff

2 1 1 5 1 1 1 0 1 0 1 2 0 1 2 0 2 1 1 0 1 1 1 0 1 0 0 0 0 4 0 0 0 0 0 0 0 0 0

0 0

4 0 0

Lady Health Visitor (LHV) Block Extension Educator (BEE) ANM Staff Nurse Dresser Pharmacist / Compounder Lab. Technician Radiographer Ophthalmic Assistant Statistical Assistant / Data entry operator OT attendant Ambulance Driver Registration Clerk

2 1 1 4 1 1 1 0 1 0 1 2 0

1 1 2 3 1 1 1 0 1 0 0 2 1

1 0 2 0 1 1 0 0 1 0 0 2 1

0 0 0 3 0 0 1 0 0 0 0 0 0

1 2 3 1 1 1 1 0 0 2 1

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3. AVAILABILITY OF SPECIFIC SERVICES The selected two CHCs are functioning as 24X7, but they are not first referral units.

Table C3: Availability of Specific Services in CHC Availability of Specific Services(Yes: 1; o: 0) Functioning on 24x7 Functioning as FRU CHC 1 Chellampatti 1 0 CHC 2 Samayanallur 1 0

4. STATUS O SPECIFIC I TERVE TIO S In both the CHCs, IPHS facility survey was done, Rogi Kalyan Samiti(RKS) was registered, RKS was used and display boards showing number of meetings and members of RKS. Both the CHCs have all standard treatment, Guidelines and protocols.

In both the CHCs funds are not being transferred electronically from district. RKS is not generating resources through user fees; citizens character are not publicly displayed and feed back mechanism was not taken for grievances redressed by RKS. All standard / treatment guidelines and Protocols are available with the in-charge of the facility.

Table C4: Status of Specific Interventions CHC 1 Status of Specific Interventions (Yes: 1; o: 0) IPHS Facility Survey done Funds being electronically transferred from District Registered Rogi Kalyan Samiti RKS generating resources through user fees Money generated by RKS being used Display board showing no. of meetings & members of RKS Feedback mechanism in place for grievances redressed by RKS Citizens Charter publically displayed All Standard Treatment Guidelines and Protocols available CHC 2 Samayanallur 1 0 1 0 1 1 0 0 1

Chellampatti
1 0 1 0 1 1 0 0 1

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C5. STATUS OF RESIDE TIAL FACILITIES Table C5 explains about the availability of residential facilities for healthcare providers in the
CHCs. Both the CHCs have residential facilities for doctors and other staff and all are

occupied.
Table C5: Status of Residential Facilities for Doctors and Other Staff Residential Facilities (Yes: 1; o: 0) For Doctors Residential Facility for Doctors Non-Occupied Residential Quarters Reason for non-occupancy being poor condition / insecurity/ lack of electricity and water supply For Other Staff Residential Facility for Staff Non-Occupied Residential Quarters Reason for non-occupancy being poor condition / insecurity / Lack of electricity and water supply CHC 1

Chellampatti
1 0 1 0 -

CHC 2 Samayanallur 1 0 1 0 -

C6. AVAILABILITY OF LABORATORY FACILITIES.

Table C6 : Availability of Laboratory Facilities (Yes: 1; o: 0) CHC 1 CHC 2 Chellampatti Samayanallur 1 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 0 0 1 1 1 1

Laboratory Testing
Type of Laboratory Testing Heamoglobin Urine RE Blood sugar Blood grouping Blood Smear Bleeding time, clotting time Diagnosis of RTI/ STIs with wet mounting, grams stain etc. Blood smear examination for malaria parasite Rapid test for Pregnancy RPR test for Syphilis Rapid test for HIV

Table C6 explains the availability of laboratory facilities in the CHC. Haemoglobin, Urine RE, Blood sugar, Blood grouping, Blood smear, Blood smear for malarial parasite, rapid test for pregnancy, RPR test for syphilis and rapid test for HIV were available in both the CHCs. Diagnosis of RTI/STIs with wet mounting, grass stains were not available in both the CHCs. Chellampatty CHC. Bleeding time, clotting time was available only in

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Table C7 indicates the number of lab tests done in the CHCs in the last three calendar months. In general more number of lab tests were done in Samayanallur BPHC than in Chellampatty CHC. The number of tests done during the last three months in the Chellampatty and Samayanallur CHC were Haemoglobin (242;894), Urine R.E (667;1014). Blood sugar (180;812). Blood grouping (180;313), Blood smear (494; 433) RPR test for syphilis (160;245), Rapid test for HIV (864;809), Blood smear examination for malarial parasite (937;433) and Rapid test for Pregnancy (97;67).
Table C7 : umber of Lab. tests done in CHC in last 3 calendar months Type of tests done Haemoglobin Urine RE Blood sugar Blood grouping Blood Smear Bleeding time, clotting time Diagnosis of RTI/ STIs with wet mounting, grams stain etc. Blood smear examination for malaria parasite Rapid test for Pregnancy RPR test for Syphilis Rapid test for HIV Note: NA- Not available CHC 1 - Chellampatti 242 677 180 180 494 1 NA 937 97 160 864 CHC 2 - Samayanallur 894 1014 812 313 433 NA NA 433 67 245 809

Surgeries were not preferred in CHCs except tubectomy. Surgeries such as caesarian sections, surgical, cataract, Laproscopic sterilization, NSV, conventional vasectomy and laprotomy were not performed during 2007-2008; only tubectomy was performed in Chellampatty CHC (316 cases) and only one MTP was done (Table C8)
Table C 8: umber of surgeries performed during 2007-2008 Type of surgeries Caesarean Sections No. of C-section deliveries for JSY Card holders Surgical cases Cataract Tubectomy Laproscopic Sterlisation NSV Conventional Vasectomy MTP Laprotomy umber of surgeries performed during 2007-2008 CHC 1 CHC 2 Chellampatti Samayanallur 0 0 0 0 0 0 0 0 316 0 0 0 0 0 0 0 1 0 0 0

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Non-availability of surgeon / anesthetist staff is the only reason for not performing surgeries in CHCs (Table C9).
Table C9 : Reasons for not conducting surgeries (if OT available, but surgeries not conducted) Reasons for not conducting deliveries(Yes: 1; o: 0) Non availability of doctor/anaesthetist/staff Lack of equipment/poor physical state of the operation theatre No power supply in the OT Other

CHC 1 Chellampatti 1 0 0 0

CHC 2 Samayanallur 1 0 0 0

Table C10, explains the performace of labour room during 2007-2008. In general performance of labour room is well in both the CHCs. During 2007-08 total number of institutional deliveries conducted in Chellampatty CHC was 384 and in Samayanallur CHC it was 211. More number of deliveries were carried out from 8 pm to 8 am in Chellampatty (161) than in Samayanallur (121). Fifteen neo-nates were resuscitated in Chellampatty and it was 11 in Samayanallur.
Table C10 : Status of performance of Labour Room during 2007-2008 umber of deliveries performed during 2007-2008 umber of deliveries CHC 1 Chellampatti CHC 2 Samayanallur Total Institutional Deliveries 384 211 Deliveries carried out from 8 pm to 8 am 161 121 Institutional deliveries for JSY card 0 0 holders Number of neonates resuscitated 15 11

STATUS OF AVAILABILITY OF EQUIPME T A D DRUGS Boyles Apparatus, ECG machine, vertical high pressure sterilizer 2/3 drum capacity, oxygen cylinder, Hydraulic operation table and phototheraphy unit were available in both the CHCs and are in working condition. Cardiac monitors for OT, Gloves & dusting machines were available and in working condition in the Chellampatty CHC, but they were not available in the Samayanallur CHC. Horizontal high pressure sterilizer and MVA syringe are available in Samayanallur CHC and are in working condition. These are not available in Chellampatty CHC. Defi. brillator for OT, Ventilator for OT, OT care Fumigation Apparatus, Resuscitation trolley and baby incubator were not available in both the CHCs 23

Table C12 : Status of availability of Equipments & drugs Equipments available / working CHC 1 -Chellampatti CHC2- Samayanallur (Yes:1; o: 0) Available Working Available Working Boyles Apparatus 1 1 1 1 ECG Machine 1 1 1 1 Cardiac Monitor for OT 1 1 0 0 Defibrillator for OT 0 0 0 0 Ventilator for OT 0 0 0 0 Horizontal High Pressure Sterilizer 0 0 1 1 Vertical High Pressure Sterilizer 2/3 1 1 1 1 drum capacity OT Care Fumigation Apparatus 0 0 0 0 Gloves & Dusting Machines 1 1 0 0 Oxygen Cylinder 1 1 1 1 Hydraulic Operation Table 1 1 1 1 Resuscitation trolley 0 0 0 0 Phototherapy unit 1 1 1 1 MVA syringe 0 0 1 1 Baby incubator 0 0 0 0 CHC reporting stock-out or irregular supply of specific drugs in last 6 months (Yes: 1; o: 0) CHC 1- Chellampatti CHC 2-Samayanallur Type of Drugs Stock Out Irregular Stock Out Irregular Supply Supply Iron Folic Acid (IFA) 0 0 0 0 Oral Pills (OPs) 0 0 0 0 IUD 380 0 0 0 0 ORS (Oral Rehydration Salts) 0 0 0 0 ORS with Zinc adjutant as per policy 1 1 1 1 Vitamin A 1 1 1 1 Tab. Fluconazole 0 0 0 0 Tab. Metronidazole 0 0 0 0 Tab. Co-trimoxazole (Kid) 0 0 0 0 Tab. Nefidipine 0 0 0 0 Inj. Oxytocin 0 0 0 0 Inj. Gentamycin 0 0 0 0 Inj. Magnesium Sulphate 0 0 0 0 Tab. Misoprostal 0 0 0 0 Tab. Progestrone 0 0 1 1 Inj. Lignocaine Hydrochloride 0 0 0 0 Inj. Pentazocine Lactate 0 0 0 0 Inj. Adrenaline 0 0 0 0 Cap. Doxycycline 0 0 0 0 Silver Sulphadiazine oint. 0 0 0 0 IV Fluids 1 0 0 0 Inj. Prociane Penicillin 1 1 0 0 Inj. Atropine 0 0 0 0 Syp Amoxycyclin 1 1 1 1 IFA Syrup 1 1 1 1

24

Drugs position in both the CHCs are good. Almost all the drugs are available in both the CHCs especially ORS with Zinc adjutant as per policy. Vitamin A, Syrup Amoxyciline and IFA syrup were the stock-out drugs/irregular supply drugs during the last six months.

AVAILABILITY OF SPECIFIC SERVICES. Table C13 explains the services available in the CHCs. Services like DOTs, obstetric and Gynaecology, Leprosy diagnosis management and referral services, Emergency services (24 hrs), RTI/STI treatment , counseling in facility on HIV/AIDS/STD etc, Voluntary Counseling and Testing Centre (VCTC), AYUSH, Primary management for wounds and dog bites, management of RTI/STI were available in both the CHCs. Table C13. Availability of Specific Services (Yes: 1; o: 0) Type of Service
Medicine Surgery Obstetric & Gynae Pediatrics DOTS Cataract Surgery Leprosy diagnosis management and referral services Emergency Services (24 Hrs) mobile medical unit separate neo-natal care unit emergency care for sick children Full Range of Family Planning Services including Laparoscopic ligation Safe abortion services Treatment of STI/RTI Blood Storage facility Counseling Facility on HIV/AIDS/STD etc Voluntary Counselling and Testing Centre (VCTC) AYUSH facility Primary management of wounds Primary management fracture Primary management of cases of poisoning/snake, insect or scorpion bite Primary management of dog bite Primary management of burns Management of RTI/STI CHC 1CHC 2-

Chellampatti
0 0 1 0 0 0 1 1 0 0 0 1 1 1 0 1 1 1 1 0 1 1 1 1

Samayanallur
1 0 1 0 1 0 1 1 0 0 0 0 0 1 0 1 1 1 1 0 0 1 0 1

25

Services like Surgery, Pediatrics, cataract surgery, mobile medical unit, separate neonatal care unit , emergency care for sick children, blood storage facility and primary management for fracture were not available in both the CHCs. In addition to that full range of family planning service including laproscopic ligation ,safe abortion services, primary management of poisoning/ snake, insect or scorpion bite and primary management of burns were available in Chellampatty CHC. These services were not available in Samayanallur CHC (Table C13).

SERVICE OUTCOME Table C14 indicates the service outcome of the CHCs based on data for last three months. Data related to total ANC registration. JSY cases registered, 1st trimester registration, three ANC checkups given as per RCH schedule, number of JSY beneficiaries, ANC given TT (2nd Dose + booster) were not available in both the CHCs. These are

maintained by the PHCs. Data on SC/ST break up is also not available. The total service outcome based on the data shows that during the last three months in Chellampatty 32 ANCs were completed with IFA prophylaxis, 13 pregnant women were identified and attended with obstetric complications, three cases were referred from PHC/CHC, 178 institutional deliveries were conducted, 53 infants were given BCG, 46 received DPT, 95 given and measles, 16 IUDs were inserted. Total indoor patients were 117 and 17 cases were referred beyond CHC. Only one was currently under treatment. Six new cases were enrolled for DOTs and the bed occupancy rate as on March 31st 2008 is 25. Average daily OPD attendance reported is 304. Among them 95 were male , 160 were female and 49 were children. Among these three cases were referred from PHC/SHC.

In Samayanallur BPHC 40 JSY beneficiaries were reported, three cases were completed ANC with IFA prophylaxis and all the three were JSY beneficiaries. Sixteen pregnant women were identified and attended with Obstetric complications among them 10 were referred from PHC/SHC. Total institutional deliveries were 86 out of these intuitional deliveries 40 were JSY cases. The number of children given BCG, DPT3 and measles were 92, 95 and 101 respectively. Twenty-nine IUDs were inserted. During the last three months 105 indoor patients were reported among them 36 were referred from PHC and these cases were currently under treatment. Only one new TB case was enrolled for

26

DOTs. Bed occupancy rate in the last 12 months is 35. Average daily OPD attendance is 332, among them female OPD attendance (211) is more than male (104) and children (17). Among them only two OPD attendance were referred from PHC/HSC(Table C14)
Table C14 : Service Outcome (based on data for last three months) Average monthly figure reported in CHC based on last three months CHC 1 CHC 2-

Indicator

Chellampatti
Total ANC Registration Total JSY cases registered Ist Trimester Registration ANC given 3 Checkups as per RCH Schedule Out of above, the no. of JSY beneficiaries ANC given TT (2nd dose+Booster) Out of above, the no. of JSY beneficiaries ANC completed IFA Prophylaxis Out of above, the no. of JSY beneficiaries Number of pregnant women identified and attended with obstetric complications Out of these, how many have been referred from PHC/SHC Total Institutional Deliveries No. of JSY cases (out of total institutional deliveries) No. of infants given BCG No. of infants given DPT3 No. of infants given Measles No. of infants given Vit. A-first dose Children given IFA Syp. (6-60 Months) IUD Inserted Total Indoor Patients No. of cases referred beyond CHC No. of Leprosy cases currently under treatment No. of new TB cases enrolled for DOTS No. of cases given Blood Transfusion in last 3 months Bed occupancy rate in the last 12 months? (As on March 31, 2008) Average Daily OPD Attendance (Total) Average Daily OPD Attendance Average Daily OPD Attendance Male Average Daily OPD Attendance Female Average Daily OPD Attendance Children Out of the total OPD attendance, specify the referred cases from PHC/ SHC
ote: A- ot applicable.
NA NA NA NA NA NA

Samayanallur
NA NA NA NA NA NA

0 32 0 13 3 178 0 53 46 95 0 0 16 117 17 1 6 0 25 304 95 160 49 3

40 3 3 16 10 86 40 92 95 101 0 0 29 105 36 3 1 0 35 332 104 211 17 2

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CHAPTER 4 PRIMARY HEALTH CE TRE Thummakundu and Vikkaramangalam Primary Health Centres (PHC) were selected under Chellampatty Community Health Centre and Koilpappakudi and Kancharam patti PHCs were selected under the Chellampatty BPHC.

Table P1: Coverage and facilities of Primary Health Centre CHC 1- Chellampatti CHC 2 - Samayanallur Coverage and PHC 1 PHC 2 PHC 1 PHC 2 facilities Thummakundu Vikkramangalam Koilpappakudi Kancharampetti Number of Sub7 7 6 6 Centres covered by PHC Population 29034 30291 24051 55558 covered PHC 1 PHC 2 PHC 1 PHC 2 Thummakundu Vikkramangalam Koilpappakudi Kancharampetti Distance Time Distance Time Distance Time Distance Time Distance & (in Kms.) (in (in Kms.) (in (in Kms.) (in (in Kms.) (in Time Taken to Minutes.) Minutes.) Minutes.) Minutes.) travel in public transport / available mode from Nearest Sub 1 5 1 5 2 5 2 10 Centre in the coverage area Farthest Sub 18 60 8 20 12 60 8 30 Centre in the coverage area Nearest CHC 25 75 8 30 10 40 25 120 No. of Beds available Male 0 1 0 0 Female 2 4 2 2 Total 2 5 2 2 PHC functioning 1 1 1 1 on 24x7 basis (Yes:1; o: 0) PHC equipped 1 1 1 1 to provide basis obstetric services (Yes:1; o: 0) PHC with 4-6 0 1 0 0 beds (Yes:1; o: 0)

28

.In Chellampatty CHC, Thummakundu and Vikkaramangalam PHCs each covers seven sub-centres and 29,034 and 30,291 population respectively. In both the PHCs the nearest sub centre is located in a distance of only one kms and it will take only five minutes to reach the PHC. In Thummakundu PHC, the farthest sub centre is located at a distance of 18 kms and the time taken to reach the sub centre is 60 minutes. In the Vikkramangalam PHC the farthest sub centre in the coverage area is located at a distance of eight kms and the time taken to reach the PHC is 20 minutes. For Thummakundu PHC the nearest CHC is located in a distance of 25 kms and it will take 75 minute to reach the CHC from the PHC. For Vikkramangalam PHC the nearest CHC is located at a distance of eight kms and it takes 30 minutes to reach that CHC. Thummakundu PHC has only two beds i.e., females, it is functioning on a 24X7 basis and well equipped to provide basic obstetric services. Vikkramangalam PHC has five beds i.e., four female beds and one male beds and it is also functioning on 24X7 basis well equipped to provide basic obstetric services

In Samayanallur BPHC,

Koilpappakudi and Kancharampettai PHCs covers six sub

centers each. The nearest sub centre is located with in a distance of 2kms and the time taken to reach these sub centers is 5 minutes and 10 minutes respectively. In Samayanallur the farthest sub centre for the Koilpappakudi is located in 12 kms and it will take 60 minutes to reach this sub centre. In Kancharampettai PHC, the farthest sub centre is located at a distance of eight kms and the time taken to reach this sub centre is 30 minutes..For Koilpappakudi and Kancharampetti PHCs the nearest CHC are located in a distance of 10 and 25 kms respectively and the time taken to reach these nearest subcentres from the PHCs were 40 minutes and 120 minutes respectively. . Koilpappakudi and Kancharampettai PHCs have two beds i.e Female beds both are functioning on 24X7 basis and are well equipped to provide basic obstetric services. They are not belongs to the PHC with 4-6 beds (Table P1). Table P2 explains the infrastructure of the selected primary health centers. All the four PHCs are functioning in designated government buildings. They have labour room, laboratory services, prominent display boards regarding service availability in local language, pharmacy for drug storage and drug dispensing, OPD room / cubic ; piped water supply; regular electricity supply in all parts telephone, computer, internet facility, standby facility in working condition and new born care corner.

29

Table P2 : Primary Health Centres by Infrastructure

CHC 1- Chellampatti PHC 1 PHC 2 Thummakundu Vikkramangalam
1 1 1 1 1 1 1 1

Infrastructure
PHC functioning in designated govt. Building (Yes:1; o: 0) Labour Room (Yes:1; o: 0) Laboratory(Yes:1; o: 0) Prominent display boards regarding service availability in local language (Yes:1; o: 0) Names of JSY beneficiaries maintained in record(Yes:1; o: 0) Pharmacy for drug dispensing and drug storage (Yes:1; o: 0) Separate public utilities (toilets) for males and females (Yes:1; o: 0) Suggestion / complaint box (Yes:1; o: 0) OPD rooms / cubicles (Yes:1; o: 0) Piped Water Supply (Yes:1; o: 0) Electricity Supply No regular electricity supply
(Yes:1; o: 0)

CHC 2- Samayanallur PHC 1 PHC 2 Koilpapakudi Kancharampetti

1 1 1 1 1 1 1 1

1 1 0 0 1 1 0 1 1 1 1 0 0 0 0 1 0 0 1 0 1 0 1 1 1 1

1 1 1 0 1 0 0 1 1 1 1 0 0 0 1 0 1 0 0 0 1 0 1 1 1 1

0 1 1 0 1 0 0 1 1 1 1 1 0 0 0 0 0 0 1 0 1 0 1 1 1 1

0 1 1 0 1 0 0 1 1 1 1 1 0 0 0 0 0 0 1 0 1 0 1 1 1 1

Regular electricity supply in all parts

(Yes:1; o: 0)

Telephone (Yes:1; o: 0) Computer (Yes:1; o: 0) Internet (Yes:1; o: 0) Type of sewerage system (Yes:1; o: 0) Soak pit Connected to Municipal Sewerage Open Drain Other Waste disposal (Yes:1; o: 0) Buried in a pit Collected by an agency Incernation Thrown in open Standby facility (generator etc.) available in working condition (Yes:1; o: 0) separate areas for septic and aseptic deliveries available? (Yes:1; o: 0) New Born Care Corner available? (Yes:1; o: 0) Status of Cleanliness of OPD reported good or fair Status of Cleanliness of Compound / Premises reported good or fair Status of Cleanliness of Room/Wards reported good or fair

In all the PHCs suggestion/ complaint box, separate areas are septic and aseptic deliveries are not available. Sewerage system of these PHCs varied from each other. PHC like Koilpappakudi and Kancharampettai have soak pits and in Vikkramangalam it is open drain. In Thummakundu, Koilpappakudi and kancharampettai PHCs wasted materials

30

were disposed by incarnation and in Vikkaramangalam it was buried in a pit. In all the PHCs the OPD, compound / premises and rooms/wards were clean and the status of cleanliness is good.

STAFF POSITIO I PRIMARY HEALTH CE TRES

Table P3 details the staff position of Primary Health Centres. In all the PHCs the medical officer (2), Pharmacist (1), Nurses (7), ANM (1), Driver (1), Staff Nurse (3), Lady Health Visitor (1) and Lab assistant (1) posts were sanctioned under regular in position.

Table P4 shows the status of training of personnel at Primary Health Centre during 2007. Skilled birth Attendant training and training on new born care were attended by all the health personnals at the Primary Health Centres. Training on safe abortion methods were not attended by any of the health personnels. Health personnel in Thummakundu, Koilpapakudi and Kancharampettai were trained on pre service IMNCI.

31

Table P3 : Staff Position of in Primary Health Centre CHC 2 - Samayanallur PHC 1- Koilpappakudi PHC 2 - Kancharampetti S Numbers in Position S Numbers in Position

Type of Staff 2 1 6 1 1 0 0 3 1 1 0 3 1 0 0 R 2 1 6 1 0 0 0 3 1 0 0

CHC 1- Chellampatti PHC 1 - Thummakundu PHC 2 - Vikkramangalam S Numbers in S Numbers in Position Position R C T R C T 2 1 0 1 2 2 0 2 1 1 0 1 1 1 0 1 7 7 0 7 7 7 0 7 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 0 0 0 0 3 1 1 0 3 1 1 0 0 0 0 0 3 1 1 0 3 1 1 0 3 1 1 0 0 0 0 0

T 2 1 6 1 0 0 0 3 1 0 0

2 1 6 1 1 3 1 1 -

R 2 1 6 1 1 3 1 1 -

C -

T 2 1 6 1 1 3 1 1 -

Medical Officer Pharmacist Nurses ANM Lab Technician Driver Medical Officer AYUSH Staff Nurse Lady Health Visitor Lab Assistant Block Health Education and Information Officer (BHEIO) Statistical Assistant 0 0 0 0 0 0 0 0 0 S: Sanctioned; R: Regular; C: Contractual; T: Total

32

Table P4 : Status of training of personnel at Primary Health Centre PHC having personnel trained in specific category of training during 2007 (Yes:1; o: 0) CHC 1- Chellampatti CHC 2- Samayanallur PHC 1 PHC 2 PHC 1 PHC 2 Thummakundu Vikkramangalam Koilpappakudi Kancharampetti 1 0 1 1 0 1 0 1 0 1 0 1

Training

Pre Service IMNCI Safe Abortion Methods Skill Birth Attendant Training New Born Care

Table P5 indicate that in all the four selected PHCs labour rooms are available and are currently in use.

Table P5: Availability of Labour Room in Primary Health Centre Labour Room (Yes:1; o: 0) CHC 1- Chellampatti CHC 2- Samayanallur PHC 1 PHC 2 PHC 1 PHC 2 Thummakundu Vikkramangalam Koilpappakudi Kancharampetti 1 1 1 1

Availability of Labour Room Labour Room Currently in Use Reasons for not using Labour Room Non availability of doctors/staff Poor condition of the labour room No power supply in the labour room Other

33

During 2007-2008 the number of institutional deliveries ranged from 92-238. It was less in Thummakundu (92) and Vikkramangalam (111) PHCs than in Koilpapapkudi (238) and Kancharampettai(216). In Thummakundu and Vikkramangalam PHCs totally 41 and 62 deliveries were carried out from 8 PM to 8 am and this was 105 and 66 respectively in Koilpapakudi and Kancharampettai PHCs. Two in Thummakundu, eight in Koilpapakudi and nine in Kancharampettai PHC (Table P6). The number of neonates resuscitates were 2 in Thummakundu, 8 and 9 in Koilpappakudi and Kancharampettai PHCs.
Table P6: Status of performance of Labour Room during 2007-2008 umber of deliveries umber of deliveries performed in PHC during 2007-2008 CHC 1- Chellampatti
PHC 1 Thummakundu PHC 2 Vikkramangalam

CHC 2- Samayanallur
PHC 1 Koilpappakudi PHC 2 Kancharampetti

Total Institutional Deliveries Deliveries carried out from 8 pm to 8 am Institutional deliveries for JSY card holders Number of neonates resuscitated

92 41

111 62

238 105

216 66

Table P7 explains the availability of laboratory testing in PHC. Haemoglobin, urine RE, Blood grouping and blood smear tests were available in all the PHCs. RPR test for syphilis is not available in all the PHCs, testing for blood sugar and Rapid test for HIV, diagnostic of RTI/STIs with wet mounting, grams stain etc were available in the Koilpapappakudi and Kancharampettai PHCs (Table P7).

In Vikkramangalam and Koilpapakudi PHCs. Blood smear examination for malaria parasite and Rapid test for pregnancy were available. Table P8 shows the number of tests done in each PHC during the last three calendar months. In Thummakundu PHC the number of tests done includes Haemoglobin (288), Urine RE (762), Blood grouping (361) and Blood smear (764). In Vikkramangalam PHC, 60 Haemoglobin, 96 Urine RE, 60 Blood grouping, 210 Blood smear, 210 blood smear examination for malaria parasite and 51 rapid test for pregnancy were conducted during the last three calendar months.

34

Table P7 : Availability of laboratory Testing in PHC

Availability Laboratory Testing (Yes:1; o: 0) CHC 1- Chellampatti PHC 1 PHC 2 Thummakundu Vikkramangalam Haemoglobin 1 1 Urine RE 1 1 Blood sugar 0 0 Blood grouping 1 1 Blood Smear 1 1 Bleeding time, clotting 0 0 time Diagnosis of RTI/ STIs 0 0 with wet mounting, grams stain etc. Blood smear 0 1 examination for malaria parasite Rapid test for Pregnancy 0 1 RPR test for Syphilis 0 0 Rapid test for HIV 0 0

CHC 2- Samayanallur PHC 1 PHC 2 Koilpappakudi Kancharampetti 1 1 1 1 1 1 1 1 1 1 0 1 1 1

1 0 1

0 0 1

In Koilpapakudi PHC almost all the test like Haemoglobin (177), Urine RE (327), Blood sugar (110), Blood grouping (153), Blood smear (1299), Diagnosis of RTI/STI and with wet mounting., grams stain etc (121), blood smear examination for malaria parasite (1299), Rapid test for Pregnancy (28), and Rapid test for HIV(128) were done during the last three calendar months, except bleeding time, clothing time and RPR test for syphilis.
Table P8 : umber of tests done in PHC in last three calendar months

Type of Test

umber of tests done in last 3 calendar months CHC 1 - Chellampatti CHC 2 - Samayanallur
PHC 1 Thummakund u 388 762 0 361 764 0 0 PHC 2 Vikkramangala m 60 96 0 60 210 0 0 PHC 1 Koilpappakudi 177 327 110 153 1,299 0 121 PHC 2 Kancharampetti 257 632 52 382 1,356 1,396 121

Haemoglobin Urine RE Blood sugar Blood grouping Blood Smear Bleeding time, clotting time Diagnosis of RTI/ STIs with wet mounting, grams stain etc. Blood smear examination for malaria parasite Rapid test for Pregnancy RPR test for Syphilis Rapid test for HIV

0 0 0 0

210 51 0 0

1,299 28 0 128

0 0 0 128

35

In Kancharampettai PHC during the last three months more number of tests on bleeding time, clothing time (1356) and Blood smear (1356) were done than Urine RE (632), Haemoglobin (257), Rapid test for HIV (128), Diagnosis of RTI/ STIs with wet mounting, grams stain etc (121) and blood Sugar (52). (Table P8).

Status of specific interventions

Table P9 indicates the status of specific interventions conducted in the selected PHCs. IPHS facility survey was done in all the selected four PHCs. They are functioning on 24X7 basis (have 1 MO and 3 or more ANMs/ Staff Nurse round the clock). In all the selected PHCs Rogi Kalyan Samiti was registered , the money generated by RKS was utilized and feed back mechanism and grievances were redressed by RKS. All the standard treatment guideline and protocols were available with the medical officer in charge. AYUSH doctors were not providing services, RKS is not generating resources through user fees, display boards are not showing number of meeting and members of RKS and also citizens character is not publicly displayed.

AVAILABILITY OF SPECIFIC SERVICES

Services such as primary management of wards, minor surgeries like draining of abscess, primary management of poisoning/snake, insect or scorpion bite and primary management of dog bite and management of RIT/STI is available in all the PHCs. Services on Primary Management of wounds, Management of Neonatal Asphyxia, Sepsis, Management of malnourished children, primary management for burns, AYUSHC services, facility for MTP is not available.

36

Table P9: Status of Specific Interventions

Status of Specific Interventions (Yes:1; o: 0) CHC 1- Chellampatti PHC 1 PHC 2 Thummakundu Vikkramangalam IPHS Facility Survey 1 1 done PHC functioning on 24 x 1 1 7 basis (have 1 MO and 3 or more ANMs / Staff Nurses round the clock)? AYUSH doctor 0 0 providing services Registered Rogi Kalyan 1 1 Samiti RKS generating 0 0 resources through user fees Money generated by 1 1 RKS being used Display board showing 0 0 no. of meetings & members of RKS Feedback mechanism in 1 1 place for grievances redressed by RKS Citizens Charter 0 0 publically displayed All Standard Treatment 1 1 Guidelines and Protocols available Availability of Specific Services Primary management of 1 1 wounds Primary management 0 0 fracture Management of Neonatal 0 0 asphyxia, sepsis Management of 0 0 malnourished children Minor surgeries like 1 1 draining of abscess etc Primary management of 1 1 cases of poisoning/snake, insect or scorpion bite Primary management of 1 1 dog bite cases Primary management of 0 0 burns Facility for MTP 0 0 available Management of RTI/STI 1 1 AYUSH services 0 0 CHC 2- Samayanallur PHC 1 PHC 2 Koilpappakudi Kancharampetti 1 1 1 1

0 1 0

0 1 0

1 0

1 0

0 1

0 1

1 0 0 0 1 1

1 0 0 0 1 1

1 0 0 1 0

1 0 0 1 0

37

AVAILABILITY OF EQUIPME T I PHC

Table P10 explains the availability of equipments in the selected PHCs. Examination table, delivery table, Oxygen Cylinder, Suction apparatus, cradle, oxygen mask, Thermometer, Suction machine, Microscope and Haemoglobinometer were available in all the PHCs and are in working condition. Patient trolley, wheel chair, Stretcher/trolley, Radiant warmer, laryngoscope and auto analyzer are not available in the selected PHCs.

Table P10 : Availability of selected equipments in PHC Equipments available / working (Yes:1; o: 0) CHC 1- Chellampatti PHC 1 PHC 2 Thummakundu Vikkramangalam Available Working Available Working Equipments Patient Trolley 0 0 0 0 Examination 1 1 1 1 table Delivery table 1 1 1 1 Wheel chair 0 0 0 0 Stretcher/ trolley 0 0 0 0 Oxygen 1 1 1 1 Cylinder Suction 1 1 1 1 Apparatus Infant warmer 0 0 1 1 Radiant Warmer 0 0 0 0 Cradle 1 1 1 1 Autoclave 0 0 1 1 Sterlisation 1 1 1 1 equipment Bag & Mask 0 0 1 1 Laryngoscope 0 0 0 0 Oxygen Mask 1 1 1 1 Thermometer 1 1 1 1 Suction 1 1 1 1 Machine Water Purifier 0 0 0 0 Microscope 1 1 1 1 Haemoglobinom 1 1 1 1 eter Auto Analyser 0 0 0 0 Autoclave 1 1 1 0 Resuscitation 1 1 0 0 equipment

CHC 2- Samayanallur PHC 1 PHC 2 Koilpappakudi Kancharampetti

Available Working Available Working

0 1 1 0 0 1 1 1 0 1 1 0 0 0 1 1 1 1 1 1 0 1 1

0 1 1 0 0 1 1 1 0 1 1 0 0 0 1 1 1 1 1 1 0 1 1

0 1 1 0 0 1 1 1 0 1 1 0 0 0 1 1 1 1 1 1 0 1 1

0 1 1 0 0 1 1 1 0 1 1 0 0 0 1 1 1 1 1 1 0 1 1

38

STATUS OF AVAILABILITY OF DRUGS Table P11 shows that during the last six months there is stock out/ irregular supply of iron syrup, Vitamin A, MVA syringe, Haemoccele and AYUSH drugs in all the selected PHCs.

Type of Drugs

PHC reporting stock out or irregular supply of specific drugs in last 6 months (Yes:1; o: 0) CHC 1- Chellampatti CHC 2- Samayanallur PHC 1 PHC 2 PHC 1 PHC 2 Thummakundu Vikkramangala Koilpappakudi Kancharampetti m
Stock Out Irregular Supply Stock Out Irregular Supply Stock Out Irregular Supply Stock Out Irregular Supply

IFA tablets Iron Syrup Oral Pills Vitamin A Measles Vaccine ORS Tab. Methergin Tab. Albendazole/ Mabendazole IUDs Inj oxytocin Magnesium sulphate Tab. Fluconazole Partograph MVA syringe Tab Ciprofloxacin Syp Cotrimoxazole Syp Paracetamol Ringers Lactate Haemoccele AD syringes Disposable Gloves Bandages AYUSH drugs DOTS drugs MDT drugs, blister packs

0 1 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 0 0

0 1 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 0 0

0 1 0 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 1 0 0 0 1 0 0

0 1 0 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 1 0 0 0 1 0 0

0 1 0 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 1 0 0 0 1 0 0

0 1 0 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 1 0 0 0 1 0 0

0 1 0 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0

0 1 0 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0

Drugs such as IFA tablets , orall pills, Measles vaccine, ORS, Tab. Methergin, Tab. Albendazole/ Mabendazole, IUDs, oxytocin injection, Magnesium sulphate, Tab Fluconazole Partograph Tab Ciprofloxin, Syp Contrimoxazole, Syp Paracetamol, and Ringers Lactate, AD syringes, Disposable Gloves, Bandages, DOTS drugs and MDT

39

drugs, blaster packs are available in all the selected PHC and there is no stock out or irregular supply was reported during the last six months.

SERVICE OUTCOME

Table P12indicates the service outcome of the selected PHCs during the last three months. The average monthly ANC registration varied from 41 to 105. Total JSY cases Average number of first trimester registration ranged from

registered from 15-53.

33-102. The number of total institutional deliveries varies from 40-105. Out of total institutional deliveries, number of JSY cases registered were from 8 to 30. Total reported indoor patients is 17 to 42. The lowest number of outdoor patients registered were in Koilpapakudi and it is registered as 39 and it is highest in Vikkramangalam PHC (5,135). Average number of indoor patient reported was low in Themmakudu PHC (17) and the highest is in Vikkaramangalam PHC (42). More number of IUD was inserted in

Koilpapakudi (12). In Kancharampettai PHC, IUD insertion was not reported. Number of new TB cases enrolled for DOTS in Vikkramangalam (4), Thummakundu PHC (5), Kancharampettai (2) was very less. Leprosy cases registered for MDT is very less it ranged for 0 1. Data on number of Children given Vitamin A first dose was not available. Cataract surgeries were not carried out in PHCs. During 2007- 2008, not a single male sterilization was carried out. Maternal deaths were also not reported.

STATUS OF RECORD MAI TE A CE Registers on antenatal care, postnatal care, family planning, and immunization were maintained in all the PHCs. Vikkramangalam PHC. Eligible couple register was maintained by only in

Family planning register, meeting register and untied fund

registers were maintained by all the PHCs except Kancharamanpettai. JSY register was maintained by PHCs under Chellampatty (Table P 13) .

40

Table P12. Service Outcome (based on data for last three months) Average monthly number reported Chellampatti CHC 1 Vikkramangalam PHC 2 Thummakundu PHC 1 Indicator Samayanallur CHC 2 Kancharampetti PHC 2 105 17 89 63 61 102 56 94 17 95 75 136 0 0 26 0 22 30 5201 0 0 7 0 2 1 0 Koilpappakudi PHC 1 41 15 33 30 25 41 24 40 8 37 33 42 0 0 12 0 0 39 4343 4 0 0 0 0 1 0

Total ANC Registration Total JSY cases registered Ist Trimester Registration ANC given 3 Checkups ANC given TT1 ANC given TT2+Booster ANC completed IFA Prophylaxis Total Institutional Deliveries No. of JSY cases (out of total institutional deliveries) No. of infants given BCG No. of infants given DPT3 No. of infants given Measles No. of infants given Vit. A-first dose Children given IFA Syp. IUD Inserted Male sterilisation carried out Female sterilisation carried out Total indoor patients Total outdoor patients RTI/STI cases treated Number of maternal deaths in 2007-2008 No. of cases of obstetric complications referred beyond PHC No. of cataract surgeries carried out No. of new TB cases enrolled for DOTS No. of new leprosy cases registered for MDT No. of leprosy cases completed treatment for leprosy

54 30 40 54 42 53 35 53 30 52 52 71 0 0 6 0 13 17 4975 22 0 9 0 5 0 0

105 53 102 105 34 37 105 28 28 38 48 64 0 0 2 0 0 42 5135 0 0 2 0 4 0 0

41

Table P13 : Status of record maintenance (Yes:1; o: 0) CHC 1- Chellampatti CHC 2- Samayanallur PHC 1 PHC 2 PHC 1 PHC 2 Thummakundu Vikkramangalam Koilpappakudi Kancharampetti 1 1 1 1 0 1 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 0 1 1 0 0 0

Type of Records Ante Natal Register Eligible Couple Register Post Natal Care Register Family Planning Register Birth & Death Register Immunisation Register Meeting Register JSY Register Untied Funds Register

42

Chapter - 5 SUB-CE TRE

In Chellampattai CHC, Nallaperumalpatty, Mettupatty and Boothipatty sub-centre were selected under Thumakkundu PHC. Nadumuthalaikulam, Kannur and in

Sakkarappanayakkanur sub-centre were selected under Vikkramangalam PHC.

Samayanallur Block Primary Health Centre,. Athalai, Pillayarnatham and Thodaneri subcentres were selected under Koilpapakudi PHC and Chatrapatti, Kodimangalam and Thirupalai sub-centres were selected under Kancharampettai PHC. Table S1: Sub Centres Coverage
CHC1- Chellampatti PHC1PHC2Thummakundu Vikkramangalam 1 Nallaperumalpatt y 2 P.Methupatti 1 Nedumuthalaikul am 2 3 Boothipuram Kannanur Coverage of SubCentre CHC2- Samayanallur PHC1PHC2Koilpappakudi Kancharampetti 2 Kodimangulam 2 Pillayarnatham 1 Chatrapathi 3 Thirupalai 3 Thodaneri Averag e per Sub Centre

3 Sakkarappanayak anur 1

Number of villages covered by Sub Centre 8 10 10 9 10 14 4 6 2 6 11 6 8 Population on coverage 4804 4,223 4,130 3,910 4,957 4,636 4,387 2,343 3,146 2,002 5,418 6,676 11827 Distance between PHC and SC (in 10.0 8.0 18.0 5.0 8.0 5.0 4.0 9.0 19.0 2.0 6.0 8.0 8.5 kms) Time Taken (In minutes) to travel in public transport / available mode from Farthest village to Sub Centre 30 60 20 60 15 15 45 60 60 15 36 45 38.0 Sub Centre to PHC 30 30 30 15 25 20 15 30 45 5 6 30 23.4 Sub Centre to CHC 90 120 25 60 30 60 90 60 10 75 45 80 62.1 NA NA NA NA NA NA NA NA NA NA NA NA NA No. of ASHAs working in the Sub Centre
ote: A ot applicable

43

Athalai

Table S1 shows that on an average 8 villages were covered by each sub-centre, it varied from 2 to 11. Pillaiyarnatham sub-centre covers only two villages and at the highest of 14 villages were covered by Sakkarappanayakkanur. The sub-centres, P. Methupatti, Boothipuram, and Nedumuthalaikulam were covering 10 villages each. Pillaiyarnatham, Chatrapatti and Thiruppalai sub-centre each covering six villages. Nallaperumalpatty and Nedumuthalaikulam sub-centres covering eight and nine villages respectively.

In Madurai district each sub-centre covering a population 4,804.

The coverage

population of the sub-centre varies form at the lowest of 2002 at the highest of 11,827. The coverage population of the sub-centres under Thummakundu is around 4,000. The population coverage of sub-centres under Vikkaramangalam PHC varies from 4000 5000 (Nedumuthalaikulam 4,957: Kannanur, 4,636: Sakkarappanayakkanur, 4,387) Subcentres under Koilpapakudi PHC serves a population of 2000 3000 (Athalai, 2,343: Pillayarnatham, 3,146; Thodaneri, 2,002), sub-centre under Kancharampettai PHC serves a population of 5000 10,000 population (Chatrapatti, 5,418; Kodimangalam, 6,676 and Thirupallai, 11,827). On an average

Distance between the sub-centres and PHC ranged the lowest of 2 Kms to the highest of 19 Kms. The average distance between sub-centres and PHCs is 8.5 Kms. The distance between SC and PHC under Thumakundu PHC is 8 18 Kms (P. Mettupatti, 8 kms; Nallaperumalpatti, 10 kms; Boothipuram, 18 kms), sub-centres under Vikkramangalam PHC are located at a distance of 5 8 kms (Kannanur, 8 kms; Nedumuthalaikulam and Sakkarappanayakkanur, 5 kms each). In Koilpapakudi PHC, the sub-centres located at distance of 4 19 kms (Athalai, 4 kms; Pillayarnatham, 9 kms; Thodaneri, 19 kms). Sub-centres under Kancharampettai PHC were located at a distance of 2 8 kms (Chatrapatti, 2 kms; Kodimangalam, 6 kms; Thiruppalai, 8 kms_.

The average time taken to reach the farthest village to the sub-centres by public transport is 38 minutes, and the average time takes to reach sub-centre to PHC is 23 minute, and the sub-centre to CHC is 62 minutes.

44

The time taken to reach the farthest village to the sub-centre under the Thummakundu PHC is 20 minutes 60 minutes, and the sub-centre to PHC is only 30 minutes and the Sub-Centre to CHC varies from 25-120 Kms. . In Vikkramangalam PHC the time taken to reach the farthest villages to subcentre ranged from 15 60 minutes, the time taken to reach the sub-centre to the PHC is 15 25 minutes, and the time taken to reach the sub-centre to the CHC by public transport varies from 30 60 minutes.

In Samayanallur, the time taken to reach the farthest village to the sub-centre by public transport for the sub-centre under Koilpapakudi PHC is 15 60 minutes, the subcentre to PHC is 15 45 minutes, and the sub-centre to the CHC is 10 90 minutes.

The time taken to reach of the farthest village to the sub-centre in the Kancharampattai PHC areas is 15 45 minutes, sub-centre to PHC is 5 30 minutes and sub centre to CHC is 45 80 minutes (Table S1). ASHA was not appointed in the subcentre.

SUB-CE TRES I FRASTRUCTURE

Table S2 indicates the availability of infrastructure in sub-centres . Fifty-eight percent of the sub-centres are functioning in designated government building. In 83 percent of the sub-centre IPHS facility survey was done. Sixty-seven percent of the facility had labour room. One-third (33 percent) have piped water and regular electricity supply. Majority (92 percent) of the sub-centres have telephone facilities.

In majority of the sub-centre open drainage (92 percent) is prevailing. Only eight percent have soak pit. In one-fourth (25 percent) of the sub-centres waste are buried in pit. In 17 percent incarnation is used for waste disposal. In fifty-eight percent of the HSCs waste were thrown in open.

45

Table S2: Sub Centre Infrastructure percent of Sub Centre having respectiv e facility

CHC1-Chellampatti Availability of PHC1Infrastructure in Thummakundu Sub Centres (Yes:1; o:0)

Nallaperumalpatty Boothipuram P.Methupatti

CHC2-Samayanallur

PHC2Nedumuthalaikulam Sakkarappanayakan

PHC1-

PHC2Kancharampetti
Kodimangulam

Vikkramangalam Koilpappakudi
Pillayarnatham

Chatrapathi

Thodaneri

Kannanur

Athalai

Functioning in designated government building 0 1 IPHS Facility Survey Done 1 1 Labour Room 1 1 Piped water supply 1 0 Regular electricity supply 0 0 Telephone 1 1 Type of Sewerage System Soak Pit 0 0 Connected to any Sewerage Line 0 0 Open Drain 1 1 Waste Disposed Buried in Pit 0 0 Collected by Agency 0 0 Incernation 1 0 Thrown in Open 0 1

1 1 1 1 1 1 0

0 0 1 0 00 1 0

1 1 0 1 0 1 1

0 1 0 0 1 1 0

1 1 1 0 0 0 0

1 1 0 0 0 1 0

1 0 0 0 0 1 0

0 1 1 0 1 1 0

0 1 1 0 0 1 0

Thirupalai

1 1 1 1 1 1 0

58.3 83.3 66.7 33.3 33.3 91.7 8.3

0 1 0 0 1 0

0 1 0 0 0 1

0 1 0 0 0

0 1 0 0 0 1

0 1 1 0 0 0

0 1 0 0 0 1

0 1 0 0 0 1

0 1 1 0 0 0

0 1 0 0 0 1

0 1 0 0 0 1

0 91.7 25.0 0 16.7 58.3

46

RESIDE TIAL STATUS I THE SUB-CE TRES

Table S3 explains the residential status of the ANM, i.e., sub-centres with ANM staying with or away from sub-centre village by distance from sub-centre and reasons for not staying in sub-centre quarters.

Three-fourth (75 percent) of the sub-centres are having ANM quarters. Only 22 percent of the ANM were staying in the sub-centre. Among those who staged out-side, one-tenth of the ANMs were staying with in the sub-centre village. Ninety percent of the ANMs were staying out-side of the sub-centre village. Poor security and poor quality of the quarters (14 present), family related reasons. (14 percent) are the reasons mentioned by ANM for not staying in sub-centre quarters.

Sakkarappanayakan

Nallaperumalpatty

Nedumuthalaikula m

Kodimangulam

Pillayarnatham

Boothipuram

P.Methupatti

Sub Centre with ANM quarter Sub Centre with ANM staying in SC's quarter staying within SC's village staying outside SC's village Reason for A M not staying in SC quarter: Quality of quarter Family related reasons Security reason

3 1

Thirupalai

Chatrapathi

Thodaneri

Kannanur

Table S3: Sub Centres with A M staying with or away from SC village by distance from Sub Centre and reasons for not staying in Sub Centre quarter Sub Centre CHC1-Chellampatti CHC2-Samayanallur PHC2PHC1PHC1PHC2Kancharampett percent of Residential status Thummakundu Vikkramangalam Koilpappakudi i Sub of A M (Yes:1; o:0) Centres
Athalai

3 1

75.0

0 0 1

0 0 1

1 0 0

0 0 1

0 0 1

0 0 1

0 0 1

0 0 1

0 0 1

1 0 0

0 0 1

0 1 0

22.2 10.0 90.0

1 0 0

0 0 1

0 0 0

1 0 1

0 0 1

1 0 0 47

0 0 0

0 0 0

0 0 0

0 0 0

0 0 0

0 0 0

42.9 14.3 42.9

Table 4 explains the staff position in sub-centres.

All the sub-centres

(100 percent) have female health workers in position. Forty-two percent of the subcentre have male health workers. Additional ANM / Contractual were not appointed.

In all the sub-centres labour rooms are not in use and deliveries were not conducted (Table S5). The reason for not using labour room includes ANM not staying in the sub-centers (75 percent), poor condition of the labour room (50 percent), no power supply/electricity supply (63 percent).

Table S4: Sub Centres with Staff in Position Sub Centre percent of Sub Centres with specific staff available

CHC1-Chellampatti Availability of Staff (Yes:1; o:0)

CHC2-Samayanallur

Kancharampett Thummakundu Vikkramangalam Koilpappakudi i

Sakkarappanayaka n Nallaperumalpatty Nedumuthalaikula m Kodimangulam Pillayarnatham Boothipuram P.Methupatti

PHC1-

PHC2-

PHC1-

PHC2-

Health worker male in position Health worker female in position Additional ANM contractual

1 1 0

0 1 0

0 1 0

0 1 0

1 1 0

0 1 0

0 1 0

0 1 0

1 1 0

1 1 0

0 1 0

1 1 0

Thirupalai

Chatrapathi

Thodaneri

Kannanur

Athalai

3 1

2 3

41.7 100.0 0

48

Table S5: Availability of Labour Room in Sub Centre Sub Centre CHC1-Chellampatti CHC2-Samayanallur PHC2PHC1PHC1PHC2Kancharampett
i
Kodimangulam Nedumuthalaikulam Sakkarappanayakan Pillayarnatham

Thummakundu Vikkramangalam Koilpappakudi

Nallaperumalpatty

Boothipuram

P.Methupatti

Labour Room (Yes:1; o:0) 1

Labour Room currently in use Reasons for not using Labour Room ANM not staying Poor condition No power supply No electric supply Other

Thirupalai

Chatrapathi

Thodaneri

Kannanur

percent of Sub Centres

Athalai

2 2 2 2 1

1 1 1 1 0

0 0 0 0 1

2 2 2 2 1

1 1 1 1 0

0 0 0 0 1

1 0 1 0 1

1 0 1 1 0

1 1 0 1 1

1 0 1 0 1

1 0 1 1 0

1 1 0 1 1

75.0 50.0 62.5 62.5 50.0

Deliveries were not conducted in sub-centre (Table S6A) and the sub-centres have no arrangement for conducting delivery (Table S6B).

Table S6A: umber of deliveries performed during 2007-08 Sub Centre Average delivery CHC1-Chellampatti CHC2-Samayanallur conducted per PHC2PHC1PHC1PHC2Kancharampett Sub Centre Thummakundu Vikkramangalam Koilpappakudi
i
Sakkarappanayakan Nallaperumalpatty Nedumuthalaikula Kodimangulam Pillayarnatham Boothipuram P.Methupatti

Total deliveries conducted

3 0

Thirupalai

Chatrapathi

Thodaneri

Kannanur

Athalai

49

Table S6B: Sub-Centres with arrangement for deliveries Sub Centre CHC1-Chellampatti PHC1PHC2Arrangement for deliveries (Yes:1; o:0)

CHC2-Samayanallur PHC1PHC2-

percent of Sub Centres

Kancharampett Thummakundu Vikkramangalam Koilpappakudi i

Nedumuthalaikulam Sakkarappanayakan Nallaperumalpatty Kodimangulam Pillayarnatham Boothipuram P.Methupatti

Deliveries conducted at Sub Centre Itself if required referred to higher facility Deliveries not conducted at Sub Centre but referred to higher facility Referred to Private/NGO facility

Thirupalai

Chatrapathi

Thodaneri

Kannanur

Athalai

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

Table S7A explains the availability of equipments in the selected sub-centres. BP apparatus, weighing machine and fetoscope (100 percent each) were available in all the selected sub-centres. Majority of the sub-centres have sterilizer (83 percent). Onefourth have Cusos speculum (75 percent). One half of the sub-centre have Mucus

extractor (50 percent). Fifty-eight percent have Bag&Mask. In forty-two percent of the sub-centres Haemoglobine meter is available. In one-third of the sub-centres Height measuring scale (33 percent) is available. Reagent strip for Urine test and Suction machine is available in 25 percent of the selected sub-centres.

50

Table S7 A: Sub Centres with availability of equipments Sub Centre CHC1-Chellampatti CHC2-Samayanallur PHC2PHC1PHC1PHC2Kancharampett
Vikkramangalam Koilpappakudi
Nedumuthalaikulam Sakkarappanayakan Pillayarnatham

Nallaperumalpatty

Kodimangulam

Boothipuram

P.Methupatti

Sterliser Haemoglobinometer Bag & Mask Suction Machine Thermometer BP Apparatus Weighing Machine Height Measuring Scale Reagent Strip for Urine Test Cuscos Speculum Mucus Extractor Fetoscope

1 0 0 0 1 1 1 1 0 0 0 1

1 0 1 1 1 1 1 0 1 1 1 1

1 0 0 1 0 1 1 0 0 1 1 1

1 0 0 0 0 1 1 0 0 1 1 1

1 0 1 1 0 1 1 0 0 0 1 1

1 0 1 0 1 1 1 1 0 1 1 1

1 1 1 0 1 1 1 1 0 1 0 1

0 1 0 0 1 1 1 0 0 1 0 1

0 1 1 0 0 1 1 0 0 1 0 1

1 1 0 0 0 1 1 1 1 0 0 1

1 0 1 0 1 1 1 0 1 1 1 1

1 1 1 0 0 1 1 0 0 1 0 1

Thirupalai

Chatrapathi

Thodaneri

Kannanur

Thummakundu Availability of the equipments (Yes:1; o:0)

percent of Sub Centres with equipmen t available 83.3 41.7 58.3 25.0 50.0 100.0 100.0 33.3 25.0 75.0 50.0 100.0

Athalai

Table S7B shows the percentage of sub-centres with functional equipments. All the sub-centres have fuctional Thermometer, BP apparatus, Weighing Machine, Reagent Strips for Urine test, Height Measuring Scale and Fetoscope (100 percent each). In majority of the selected sub-centre Cusor Speculum (89 percent), Bag & Mask (71 percent) and Mucus Extractor are in functional condition. Haemoglobino meter and sterilizer are functional in 40 percent and 20 percent of the sub-centres respectively.

51

Table S7 B: Percentage of SCs with functional equipments

Sub Centre CHC1-Chellampatti CHC2-Samayanallur

PHC1 PHC1 PHC2 Thummakundu Vikkramangalam Koilpappakudi
Nedumuthalaikulam Sakkarappanayakan Nallaperumalpatty Pillayarnatham Boothipuram P.Methupatti Thodaneri Kannanur

PHC2
Kancharampetti
Kodimangulam

Sterliser Haemoglobinometer Bag & Mask Suction Machine Thermometer BP Apparatus Weighing Machine Height Measuring Scale Reagent Strips for Urine Test Cuscos Speculum Mucus Extractor Fetoscope

0 0 0 0 1 1 1 1 0 0 0 1

0 0 0 0 1 1 1 0 1 1 1 1

0 0 0 1 0 1 1 0 0 1 1 1

0 0 0 0 1 1 0 0 1 0 1

1 0 1 1 0 1 1 0 0 0 1 1

0 0 1 0 1 1 1 1 0 1 1 1

0 1 1 0 1 1 1 1 0 1 0 1

0 0 0 0 1 1 1 0 0 0 0 1

0 0 1 0 0 1 1 0 0 1 0 1

1 1 0 0 0 1 1 1 1 0 0 1

0 0 0 0 1 1 1 0 1 1 0 1

0 0 1 0 0 1 1 0 0 1 0 1

Thirupalai

Chatrapathi

Functional equipments (Yes:1; o:0)

percent of Sub Centres with functional equipment

Athalai

20.0 40.0 71.4 66.7 100.0 100.0 100.0 100.0 100.0 88.9 66.7 100.0

In 92 percent of the sub-centres ORS is available. Disposable Gloves, Oral Pills and Iron / Folic Acid are available in 58 percent of the sub-centres. IUD is available in fifty percent of the sub-centre. Syrup cotrimoxazole and Syrup paracetamol are available in 42 percent of the sub-centre. Disposable delivery kit, emergency contraceptive pills, Tablet Flus Canazode Vagiral, Misoprostal, and Cipro floxacin, vitamin A and pregnancy test kit are not available in the sub-centers (Table S8).

52

Table S8: Status of availability of drugs Sub Centre CHC1-Chellampatti CHC2-Samayanallur

Type of Drugs Available (Yes:1; o:0)
PHC1 PHC1 PHC2 Thummakundu Vikkramangalam Koilpappakudi
Sakkarappanayaka n Nallaperumalpatty Nedumuthalaikula m Pillayarnatham Boothipuram P.Methupatti Thodaneri Kannanur

PHC2 Kancharampetti
Kodimangulam

Iron/ Folic Acid Disposable Delivery Kit Oral Pills Emergency Contraceptive pills Condoms IUD ORS Tab. Flucanazole Vaginal Tab. Misoprostal Partograph Pregnancy Test Kit Syp Cotrimoxazole Syp Paracetamol Vi. A Tab Ciprofloxacin Disposable Gloves

0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0

1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0

1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 1

0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0

0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 1

0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1

1 0 1 0 1 1 1 0 0 0 0 0 0 0 0 1

1 0 1 0 1 1 1 0 0 0 0 1 1 0 0 1

1 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0

1 0 1 0 1 1 1 0 0 1 0 1 1 0 0 1

1 0 1 0 1 1 1 0 0 0 0 1 1 0 0 0

0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 1

Thirupalai

Chatrapathi

Athalai

percent of Sub Centres reporting availability of drug on date of survey

58.3 0 58.3 0 33.3 50.0 91.7 0 0 8.3 0 41.7 41.7 0 0 58.3

Table S9 explains the availability of specific skits / procedures reported by the subcentres. All most all the sub-centres have registers on pregnancy within three months, reports on 3 ANC visits as per the RCH schedule (1st: 6th month, 2nd : 7th month, 3rd : 9th month) identification of high risk pregnancies, IUD insertion / removal and immunization services (100 percent). Eight-three percent of the sub-centre have registers on provision for TT, IFA etc. In eighty-three percent of the sub-centres ANM were trained on

syndomic treatment of RTI/STI. In eight percent of the sub-centres IUCD insertion being carried out by using IUDA 380, 17 percent of the sub-centres carried out speciafic examinations like blood pressures, Hemoglobin and Urine analysis. Regular supply of IUDS 380 is not reported.

53

Table S9: Status of Specific Skills and Procedures

Sub Centre

percent of CHC2-Samayanallur
PHC2 Kancharampetti
Kodimangulam

CHC1-Chellampatti
PHC1 Thummakundu
Nallaperumalpatty Boothipuram P.Methupatti Sakkarappanayaka n

PHC2 PHC1 Vikkramangalam Koilpappakudi

Nedumuthalaikula m Pillayarnatham Thodaneri Kannanur

Register pregnancy within three month Carry out 3 ANC visits as per the RCH schedule (1st: 6th month, 2nd: 7th month, 3rd: 9th month) Carry out specific examinations like Blood Pressure, Hemoglobin and Urine Provision of TT, IFA etc. Identification of High Risk Pregnancies Is the ANM carrying out IUCD insertion/ removal Is IUCD insertion being carried out using IUD A380 Is the supply of IUD A380 regularly available Has the ANM been trained on the insertion/ removal of IUD A380 Is the ANM trained in syndromic treatment of RTI/ STI? Immunization services

Thirupalai

Chatrapathi

Type of Skills/ Procedure (Yes: 1; o: 0)

Athalai

Sub Centres reporting availability of specific skills/ procedure

100.0

100.0

0 1 1 1 1 0 1 0 1

0 1 1 1 0 0 0 1 1

0 0 1 1 0 0 0 0 1

0 0 1 1 0 0 0 1 1

0 1 1 1 0 0 0 1 1

0 1 1 1 0 0 0 1 1

0 1 1 1 0 0 0 1 1

0 1 1 1 0 0 0 1 1

1 1 1 1 0 0 0 1 1

0 1 1 1 0 0 0 1 1

0 1 1 1 0 0 0 1 1

1 1 1 1 0 0 0 1 1

16.7 83.3 100.0 100.0 8.3 0 8.3 83.3 100.0

Table S10 shows the services out come of the sub-centres based on the last three months. On an average 25 ANCs were registered in the selected sub-centres during the last three months. Among them 18 were registered in 1st trimester. Sixteen were given 3 ANC visit as per the RCH schedule. During 2007-08, 12 IUCD insertions were carried out. Two neonatal infection were identified and referred. Six pregnancies were referred and attended by the next higher facility. Three high risk cases were identified.

54

Table S10: Service Outcome (Based on data for last 3 months)

Sub Centre CHC1-Chellampatti CHC2-Samayanallur PHC2PHC1PHC1PHC2Thummakundu Vikkramangalam Koilpappakudi
Sakkarappanayakan Nallaperumalpatty Nedumuthalaikula m

Average per Sub Centre

Kancharampett i
Kodimangulam

Indicator

Pillayarnatham

Boothipuram

P.Methupatti

Total ANC registered Out of total ANC, number registered in 1st trimester No. given 3 ANC visits as per the RCH schedule No. of High Risk Cases identified Deliveries conducted by ANM at Sub Centre Pregnancies referred and attended by the next higher facility No. of neonate infections identified and referred No. of IUCD insertions in 2007-2008

23 18 18 4

25 6 20 4

22 16 17 4

27 18 25 3

21 12 5 0

22 22 6 3

8 8 7 2

19 17 10 2

10 7 11 1

33 27 7 6

25 13 13 2

63 48 50 7 1 7

Thirupalai

Chatrapathi

Thodaneri

Kannanur

Athalai

3 1

25 18 16 3 * 6 2 12

0
15 0 17

0
13 0 21

0
2 1 7

0
3 0 22

0
2 0 2

0
3 15 2

0
3 0 11

0
13 1 12

0
1 0 11

0
6 2 7

0
8

0
16

0
18

Household survey register, antenatal register, family planning register, birth & death register, immunization register, JSY register, Untied funds register and cash book were maintained in all the sub-centres. Eighty-three percent of the sub-centres Sixty-seven percent

maintained antenatal register and post natal care registers. maintained meeting registers (Table S11).

55

Table S11: Status of Record Maintenance

Sub Centre CHC1-Chellampatti CHC2-Samayanallur PHC2PHC1PHC1PHC2Nedumuthalaikulam Sakkarappanayakan Nallaperumalpatty

Kodimangulam

Pillayarnatham

Boothipuram

P.Methupatti

Chatrapathi

Household Survey Register Ante Natal Register Eligible Couple Register Post Natal Care Register Family Planning Register Birth & Death Register Immunisation Register Meeting Register JSY Register Untied Funds Register Cash Book

1 1 1 1 1 1 1 0 1 1 1

1 1 1 1 1 1 1 1 1 1 1

1 0 1 0 1 1 1 1 1 1 1

1 1 1 1 1 1 1 0 1 1 1

1 1 1 1 1 1 1 1 1 1 1

1 1 1 1 1 1 1 1 1 1 1

1 1 1 1 1 1 1 1 1 1 1

1 1 1 1 1 1 1 1 1 1 1

1 1 1 1 1 1 1 0 1 1 1

1 1 1 1 1 1 1 0 1 1 1

1 1 1 1 1 1 1 1 1 1 1

Thirupalai

Thodaneri

Kannanur

Type of Records maintained (Yes:1; o:0)

Thummakundu Vikkramangalam

Athalai

percent of SCs reportin g Kancharampett Koilpappakudi i mainten ance of record

1 0 1 0 1 1 1 1 1 1 1

100.0 83.3 100.0 83.3 100.0 100.0 100.0 66.7 100.0 100.0 100.0

Table S12 A: Status of Awareness of A M about JSY Scheme A Ms awareness about JSY umber of A Ms Interviewed Reporting Awareness 12 12 12 12 12 12

Aware about JSY Aware about amounts to be given to beneficiaries ANM reporting increase in demand for Institutional delivery after implementation of JSY Scheme

Table S12A indicate that all the twelve ANMs had awareness on JSY and the amount given to beneficiaries under JSY. All the 12 ANMs reported that three is an increase in demand for institutional delivery after implementation of JSY scheme.

56

Table S12 B: Status of procedure under JSY Scheme

A M's awareness about JSY Funds being paid to beneficiaries by Cash Cheque Vouchers Average time taken after birth for JSY payment to beneficiary Less than 1 Week..1 1 - 2 Weeks ..2 More than 2 Weeks...3 Transport for shifting of cases available from Sub Centre to PHC/ CHC Register available for recording of JSY expenditure Total no. of A Ms interviewed percent of A Ms according to response 0 100.0 0

0 0 100.0 66.7 100.0 12

Table S13A shows that all the ANMs said that funds under JSY scheme was paid to the beneficiaries by cheque (100 percent). Average time taken after birth for JSY payment to beneficiary was more than three weeks (100 percent), 67 percent of the ANMs had aware about transport for shifting of cases available from sub-centre to PHC / CHC. Register was available for recording of JSY expenditure (100 percent).

Table S13 shows that status of performance of ANM under JSY scheme. During the last three months on an average 17 cases were registered under JSY scheme and it ranged from 6-36. Among these 15 were resulted as institutional deliveries with a range of 5-33. An average amount of Rs.8,142 was disbursed during the last three calendar months for JSY cases. One hundred and sixty seven home deliveries and 20,050 institutional

deliveries were reported during the last three months and Rupees 1,132 was spent for transport costs. Home deliveries were reported in Pillayanatham and Thodaneri subcentre village.

57

Table S13: Status of performance of A M under JSY Scheme

Sub Centre CHC1-Chellampatti PHC1Nallaperumalpatty Nedumuthalaikula m

CHC2-Samayanallur PHC1PHC2-

Average per Sub Centre

PHC2-

Sakkarappanayaka n

Kodimangulam

Pillayarnatham

Boothipuram

P.Methupatti

Chatrapathi

Total cases of JSY registered in last 3 calendar months 30 23 36 33 21 11 8 10 12 13 6 6 Total number of JSY cases resulted in Institutional deliveries in last 3 months 30 23 16 33 21 11 8 10 5 13 6 6 Total cash disbursed in last 3 calendar months for JSY cases (Rs.) 1,400 15,100 11,200 7,000 13,300 8,400 10,500 14,700 9,800 6,300 Out of total amount disbursed, the amount disbursed on the following Home Deliveries (Rs.) 0 0 0 0 0 0 0 1,500 500 0 0 0 Institutional Deliveries (Rs.) 18,200 19,600 18,200 18,900 38,300 32,900 16,800 18,900 10,500 35,700 7,000 5,600 Transport Costs (Rs.) 2,000 800 600 450 0 750 100 500 4,500 2,380 1,200 300

Thirupalai

Thodaneri

Kannanur

Performance of A M under JSY Scheme

Thummakundu

Vikkramangalam

Koilpappakudi
Athalai

Kancharampetti

17

15

8,142

167 20,050 1,132

Status of untied grants in the sub-centre was explained by Table S14. All the 12 sub-centres were received untied grant, reported expenses from untied grant, ANM having a joint account with the sarpanch / any other GP functionary, maintain registers to record the decisions taken to spend the untied funds. All the sub-centres have written record of transactions being carried out on untied funds. Ninety-two percent of the subcentres reporting that sarpanch / other reviewed the expenditure of Untied fund.

58

Eight percent of the untied grant was spent on purchase of drugs. Fifty percent each for arranging transport and paying of power / telephone bills and sixty-seven percent was spent for other purposes like white wash and maintenance etc., Table S14: Status of Untied Grants
Sub Centre CHC1-Chellampatti
PHC1Thummakundu Nallaperumalpatt y PHC2Vikkramangalam
Sakkarappanayakan Nedumuthalaikula m

CHC2-Samayanallur
PHC1Koilpappakudi

Sub Centre received Untied Grant Sub Centre reported expenditure from Untied Grant ANM having a joint account with the Sarpanch/ any other GP functionary Sub Centre reporting maintenance of register to record the decisions taken to spend this amount Sub Centre reporting written record of transactions being carried out on Untied funds Sub Centre reporting that Sarpanch/ others ever reviewed the expenditure records

1 1

1 1

1 1

1 1

1 1

1 1

1 Athalai 2 Pillayarnatham 3 Thodaneri 1 Chatrapathi 2 Kodimangulam 3 Thirupalai 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

2 P.Methupatti 3 Boothipuram 1

2 Kannanur

Status of Untied Grants (Yes:1; o:0) 1

perce nt of Sub PHC2Centr Kancharampetti es

1 100.0 1 100.0

1 100.0

1 100.0

1 100.0

91.7

59

CHAPTER 6 HOUSEHOLD CHARACTERISTICS

CHARACTERISTICS OF THE RESPO DE TS

Two-fifth (40 percent) of the respondent were below 30 years. One-fourth (25 percent) were 30 39 years old. The percentage of respondents above 40 years accounts 35 percent of the sample population, i.e., 16 percent were in 40 49 years, ten percent belongs to 50 59 years. Only nine percent were 60 or more years. Majority of the respondents were female (87 percent). One-third of the study population is illiterate. One-fourth (25 percent) of them completed 1 5 years of schooling and 24 present completed 5 9 years of schooling. Only 17 percent had 10 or more years of schooling. Currently married constitute a major proportion of the study population (86 percent).

Table H1. Characteristics of the respondents

Percent distribution of respondents by background characteristics
Characteristics of the respondents Age < 30 years 30-39 years 40-49 years 50-59 years 60 years or more Sex Male Female Years of Schooling IIiterate 1-5 Years 5-9 years 10 years of more Marital status Unamrried Currently Married Divorced/Separated Widowed Total number of respondents Percent 40.8 24.3 15.7 10.2 9.1 12.6 87.4 33.9 24.1 25.4 16.6 3.3 85.8 0.8 10.1 1,200

Table H2 explains the characteristics of the selected households.

A higher

proportion of the households belongs to OBC (66 percent) and the remaining were SC (34 percent). All most all the households belongs to Hindus (99 percent).

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Table H2. Characteristics of the household

Percent distribution of household by their background characteristics
Characteristics of the household Social category SC ST OBC Others Religion Hindu Muslim Christian Sikhs Other Households having BPL status Household living in pucca house Households with electricity Households with toilet facility Households with piped water supply Households using LPG/Biogas for cooking Household with own agricultural land/cultivating any agricultural land Households own a colour / B&W television Households have a mobile phone Households with low standard of living index percent of children born in Health Institutions during last 5 years Total number of respondents Percent 34.2 65.8 0.1 98.7 0.4 0.9 8.8 30.8 93.7 12.8 24.4 17.8 32.0 83.8 38.2 33.7 1,200

Nine percent of the households have BPL status. Thirty-one percent of were living in pucca house. Ninety-four percent of the houses were electrified. Thirteen percent had toilet facility. Twenty-four percent of the households had piped water

supply. Eighteen percent of the households using LPG / Biogas for cooking. Thirty-two percent of the households had own agriculture land. Eighty-four percent of the

households owned a colour / B&W television. Thirty-eight percent have a mobile phone. Thirty-four households were belongs to low standard of living index.

Table H3 explains the percentage distribution of households by their waste disposal, stagnation of waste water and mosquito breeding around the house and the system of medicine preferred by them. Nine-eight percent of the households thrown out the waste in the open. Only one percent burnt the wastages. There is no difference in waste disposal between the households located in sub-centres, head quarter village and households located in other villages. In five-five percent of the households, the interviewer observed that wastewater is stagnated around the house. More number

households located in sub-centre head quarter villages (58 present) were surrounded by

61

waste water than villages away from sub-centre. In all the households mosquito breeding was observed in the stagnated water (100 percent). All most all the households preferred allopathic system of medicine (100 percent).

Table H3: Percent distribution of households by their waste disposal, stagnation of waste water and mosquito breeding around the house and system of medicine preferred by them Waste disposal, stagnation of waste water Households Households and mosquito breeding and system of located in Sub located in other Centre HQ medicine preferred village
Village Method of waste disposal by the household Thrown in the open Buried in a pit Burnt Other Stagnation of waste water around the household (Stagnation of waste water observed by the interviewer ) Instance of mosquito breeding in the stagnant water ( among the households where stagnation of water is observed) System of medicine preferred: ( Multiple answer ) Allopathic Ayurveda Yoga and Naturopathy Unani Siddha Homeopathy Traditional healing Any other None Total umber of Households 98.0 0.5 1.3 0.2 97.0 1.3 1.5 0.2

All

97.5 0.9 1.4 0.2

57.8

52.8

55.3

99.4

99.7

99.5

99.7 0.2 0 0 0.5 0.5 0.7 0 0 600

100.0 0.2 0.2 0 0.2 0 0.2 0 0 600

99.8 0.2 0.1 0 0.3 0.3 0.4 0 0 1,200

Information about availability of health worker, health facilities and transport used to take serious patients to the health facility is explained in table H4. Almost all the respondents in the selected households heard about ANM. Nineteen percent heard about male health worker. More number of respondent in the sub-centre head quarter villages (24 percent) were heard about male health worker than respondent belongs to non-subcentre village (18 percent). Only twenty-three percent of the respondents says that health worker visited to their home in the last one months, this percentage is more in households located in sub-centre head quarter village (28 percent) than in other village (19 percent). Twenty-eight percent of the respondents says that health worker is available whenever

62

they need. Availability of health worker at the time of need is more in sub-centre head quarter village (35 percent) than in other villages (21 percent). Table H 4. Percent distribution of household respondents by their information about availability of health worker, health facilities and transport used to take serious patients
Information about health worker and health facilities Availability of health workers Heard about ANM Heard about male health worker Visited by a Health Worker in last one month Health worker available when need Available health facility to the households, when required (multiple responses) RMP Private clinic / NGO Sub Centre PHC CHC Other Facilities for which serious patients are taken, when required ( multiple response) RMP / Private Clinic NGO hospital Clinic PHC CHC District / Sub Divisional Hospital Other Mode of transport used to take serious patients, when required ( multiple responses) Bus Private vehicle Ambulance Other Total number of household respondents Households located in Sub Centre HQ Village 100.0 23.7 27.8 34.7 Households located in other village 99.2 13.2 18.8 20.3 All

99.6 18.4 23.3 27.5

2.8 39.3 17.5 69.5 9.8 38.3

2.5 38.8 1.5 72.7 14.5 48.8

2.7 39.1 9.5 71.1 12.2 43.6

28.5 2.5 33.8 6.3 82.3 3.5

27.5 2.2 33.3 6.0 86.7 1.0

28.0 2.3 33.6 6.2 84.5 2.3

5.8 92.8 1.5 0 600

3.0 96.7 0.2 0.3 600

4.4 94.8 0.8 0.2 1,200

For majority of the respondent PHC (71 percent) is the available health facility to their households, for 39 percent private clinic/NGO is easily available. Twelve percent said CHC is the available facility for them. Forty-four percent depending on other facility. Sub-center is the available health facility for one-tenth of the households (10 percent), the percentage informed about availability of sub-centers were more in head quarters village (18 percent) than households located in other villages (2 percent).

Majority of the serious patient are taken to district / sub divisional hospital (85 percent) when required. Thirty-four percent were taken to PHC and 28 percent to RMP /

63

Private clinic. Private vehicle (95 percent) is the main mode of transport used to take serious patients followed by bus (4 percent).

Table 5. Percent distribution of household respondents by their knowledge about RHM, ASHA and her activities, VH D, VHSC and JSY
RHM,ASHA and JSY Heard of RHM If heard of RHM, Source of information about RHM (multiple responses) ASHA Radio/television Newspaper Panchayat Community member Other Heard about ASHA ASHA and her activities, VH D and VHSC ASHA carries a kit ASHA provides common medicine free of cost ASHA held discussion about hand washing ASHA held discussion about construction of household toilets ASHA held discussion about safe drinking water Village Health and Nutrition Day being organized in the village Presence of village health and Sanitation Committee in the village Frequency of Village Health and utrition Day Weekly Monthly Quarterly Annual Aware about the JSY scheme If aware about JSY, source of information about the JSY (multiple options) Radio / Television Pamphlets Hoardings at SC / PHC etc ASHA worker Anganwadi Centre / Worker ANM Doctor Gram Panchayat NGOs / SHGs Others Household beneficiary of JSY scheme Total number of household respondents Households Household located in s located in Sub Centre other HQ Village village 95.0 93.0

All
94.0

NA 37.7 4.4 0.7 29.5 63.5 NA NA NA NA NA NA NA 3.2 18.5 36.8 15.8 47.4 97.3

NA 30.3 2.7 0.5 27.4 69.2 NA NA NA NA NA NA NA 2.7 1.8 62.5 6.3 31.3 97.2

NA 34.0 3.5 0.6 28.5 66.3 NA NA NA NA NA NA NA 2.9 10.2 48.6 11.4 40.0 97.3

23.6 0.9 6.5 NA 6.2 64.2 0.3 0.9 3.1 46.1 16.8 584

20.1 0.3 3.4 NA 9.8 57.8 0.3 0.5 2.2 58.5 12.0 583

21.9 0.6 5.0 NA 8.0 61.0 0.3 0.7 2.7 52.3 14.4 1,167

NA- Not Applicable Table 5 shows the respondents knowledge about NRHM, VHND, VHSC and JSY. Ninety-four percent of the respondents heard about NRHM. Radio / television (34 percent), community Member (29 percent) were the sources of information for NRHM.

64

Only three percent of the respondents known about the village health and nutrition day organized in the village. Only ten percent were aware about the presence of village health and sanitation committee in the village. Awareness of village health and sanitation committed is more in households located in sub-centres village (19 percent) than in other villages (2 percent).

Knowledge about the frequency of village health and nutrition day was less. Forty-nine percent of the respondent said that village health and nutrition day was celebrated by weekly. Forty percent said it is quarterly. Eleven percent said frequency of village health and nutrition day was monthly.

Ninety-seven percent of the respondents had awareness about JSY scheme the main source of awareness is ANM (61 percent) followed by radio / television (22 percent), Anganwadi centre / worker (8 percent), Hoarding at SC / PHC at (5 percent) and NGOs / SHGs (3 percent). Fifty-two percent heard through other source. Among them 14 percent were beneficiaries of JSY scheme, and the percentage of beneficiaries is 17 percent in sub-centres head quarter village and 12 percent in other village.

REGISTRATIO OF JSY BE EFICIARIES

Table H7 explains the timing, person, and place of registration for JSY scheme. Majority (90 percent) of the women heard about JSY during pregnancy. Only ten percent heard before being pregnant. Eighty-eight percent of the beneficiaries got registered for JSY scheme in the 5th month or later. Nine percent registered in the 3rd month of pregnancy. The percentage of women registered in the 2nd and 4th month of pregnancy were one and two percent respectively. ANM (92 percent) is main person who registered the beneficiary for JSY scheme. The contribution of LHV (5 percent) and Anganwadi worker (2 percent) is less.

65

Table H6. Percent distribution of JSY beneficiaries by their background characteristics Characteristics of JSY beneficiaries Percent
Age < 20 years 20-24 years 25-29 years 30-34 years 35-39 years 40-44 years 45-49 years Parity 0 1 2 3 & 3+ Social category SC ST OBC Others Religion of the household Hindu Muslim Christian Sikhs Other SLI of the household Low Medium High BPL household Place of last delivery (delivery previous to this delivery) Household Health Institution Total number of JSY beneficiaries interviewed 5.4 55.4 31.5 6.0 1.8 0.6 31.0 68.5 46.4 53.6 99.4 0.6 34.5 44.0 21.4 9.5 1.2 98.8 168

PHC (60 percent) is the place where most of the beneficiaries registered for JSY scheme followed by sub- centre (26 percent) and anganwadi centre (13 present).

66

Table H7. Timing, person place of registration for JSY scheme

Timing, place of registration for JSY card scheme and JSY card Timing of hearing about JSY scheme Before being pregnant During pregnancy Stage of pregnancy when beneficiary got registered for JSY scheme 1st month 2nd month 3rd month 4th month 5th month or later Person who registered the beneficiary for JSY scheme Doctor LHV ANM / FHW Anganwadi worker ASHA worker Others Place where the beneficiary was registered for JSY scheme District/Sub-DIstrict Hospital Community Health Centre PHC Sub-Centre Anganwadi Centre Pvt. Hosp. accredited by the Govt. At home Other places Total number of JSY beneficiaries Percent 9.8 90.2 0 0.8 9.2 2.3 87.8 0.6 5.4 91.7 2.4 0 0 0.0 0.0 60.1 26.2 13.1 0 0.6 0 168

JSY Card Table H8 detailed the receipt of JSY card, role of ASHA in getting JSY card and difficulties faced by the beneficiaries in getting the JSY card. Five percent of the

beneficiaries received JSY card. Beneficiaries were not facing any difficulty in getting JSY cars. Table H8. Receipt of JSY card, role of ASHA in getting JSY card and difficulties faced by the beneficiary in getting the JSY card
JSY Card JSY card received by the beneficiary ASHA worker helped the beneficiary in getting JSY card Beneficiary faced difficulty in procuring JSY card If faced difficulty, type of difficulties faced by beneficiary (multiple options) Cards were not available Formalities for making card were too cumbersome Was asked to pay money for the card Other difficulties Total number of JSY beneficiaries Percent 4.8 NA 0 0 0 0 0 168

In Tamil Nadu ASHA was not appointed. Information on micro birth planning such as date of expected delivery (83 percent), date of next checkup (85 percent), place of next checkup (70 percent), place of delivery (56 percent) and place of referral, if

67

complications arise (11 percent) were given to the beneficiaries by the doctor / ANM during antenatal check-up (Table H9). able H 9. Role of ASHA during the pregnancy of the beneficiaries
Role of ASHA during the pregnancy of the beneficiaries ASHA worker provided specific help during pregnancy for the following (multiple options) Beneficiary received advice from ASHA Diet Danger signs Delivery Care Breastfeeding Newborn care Family Planning Not applicable (ASHA not appointed in the village) Information given to the beneficiary ( Micro Birth Planning) during antenatal period by doctor / A M / ASHA (multiple options) Date of next check-up Place of next check-up Date of expected delivery Place of delivery Place of referral, if complications arise Total number of JSY beneficiaries Percent 0 0 0 0 0 0 0 100.0

85.1 70.2 83.3 56.0 11.3 168

Table H10 denotes the place of delivery and reason for opting institutional delivery. One-half of the deliveries took place in district / sub-district hospital

(52 percent) followed by PHC (29 percent), private hospital (11 percent) community health centre (5 percent) and home (3 percent). Table H 10. Place of delivery and reason for opting institutional delivery
Place of delivery and reason for opting institutional delivery Place of delivery District / Sub-District Hospital Community Health Centre PHC Sub-Centre Trust / NGO Hospital Private Hospital Private Hospital accredited by the Govertment At home Reasons for opting Institutional Delivery ( multiple reasons) Money available under JSY scheme Better access to institutional delivery Better care for mother and new born child Services in the area Support provided by ASHA Availability of transport assistance Previous child was born in an institutions Other Total number of JSY beneficiaries Percent 52.1 4.8 28.7 10.8 0.6 3.0 3.7 10.5 89.5 4.9 NA 18.5 1.2 162

Note: NA-Not applicable

68

Better care for mother and new born child (90 percent) is the main reason for opting institutional delivery. The reasons such as previous child was born in institution (19 percent), better access to institutional delivery (11 percent), services with in the area (5 percent), money available under JSY (4 present ) were the reasons mentioned by the JSY beneficiaries, for opting institutional deliveries (Table H 10).

Table H 11. Transport of the beneficiaries to reach the Health Institution

Process of Transport Received referral slip from ASHA / health personnel to access delivery services Faced difficulty in reaching Health Institution If faced difficulty, type of difficulties faced in reaching the Health institution by the beneficiaries (multiple options) It was late in the night Did not have insufficient money Transport was not immediately available Male members in the household were not present ASHA was not readily available Others Average distance to the ultimate place of delivery from the beneficiary residence (in kms) Mode of transport used by the beneficiary to reach the ultimate place of delivery Government Ambulance Private Vehicle Vehicle arranged by Local Health Committee Others Persons facilitated in arranging the transport ASHA ANM Village Health Committee Others Beneficiary had money to pay for the transport services Average amount spent on transport (in Rs.) Average amount of transport assistance received under JSY scheme by the beneficiary (in Rs.) Cases where amount spent on transport is more than the amount Received Person accompanied the beneficiary to the health institution ASHA Relatives Mother / Mother-in-Law Husband ANM / health Worker Others Total number of JSY beneficiaries Percent 2.5 5.6

22.2 0 77.8 11.1 NA 0 10.7 0.6 80.9 0 18.5 0 1.3 0 98.8 97.5 0 164.7

NA 98.1 1.9 162

ote: A- ot applicable

Three percent of the women received referral slip from health personnel to access delivery services. Six percent faced difficulty in reaching health institution. The

difficulties faced by the beneficiaries is the non availability of transport (78 percent), and absence of male members in the households (11 percent) and other reasons such as it was

69

late in the night (22.2 percent) was also reported. The average distance to the ultimate place of delivery from the beneficiaries residence is 11 kms. Private vehicle (81 percent) is the mode of transport used by the beneficiary to reach the ultimate place of delivery. Village health committee (99 percent) facilitating the arrangements for transport. Ninetyeight percent of the beneficiaries had money to pay for the transport services. The average amount of transport assistance received under JSY scheme by the beneficiaries is Rs.165. Ninety-eight percent of the beneficiaries were accompanied by their relatives to the health institution (Table H11).

Table H12 explains the waiting time at the health facility, type of delivery, amount spent at the health facility and satisfaction regarding services available in the health facility. Average waiting time at the facility until some one attend the beneficiaries is nine minutes. More than three-fourth of the beneficiaries (78 percent) had normal delivery. Two-fifth were caesarean section delivery (20 percent) and only two percent were assisted (Forceps, Vacuum) delivery. Average number days spent in the facility till discharge was four. Thirty-six percent of the beneficiaries said they paid at the health centre. An average amount Rs.2,667 was paid at the health centre. Ninety-seven percent of the beneficiaries were satisfied about the services available in the health centre. Rude behaviour of the staff was the only reason for the dissatisfaction of the services provided in the health centres. Only five home deliveries were reported (Table H13). Table H 12. Waiting time at the health facility, type of delivery, amount spent at the health facility and satisfaction regarding services available in the health facility
Waiting time, type of delivery and satisfaction regarding services Average waiting time at the facility until someone attended the beneficiary (in minutes) Type of delivery ( Percent ) Normal Assisted (Forceps, Vacuum) Caesarean Average number of days spent in the facility till discharge Percent beneficiary who have to pay at the health centre Average amount paid at the health centre (Rs.) Satisfaction regarding the services available in the health center (Percent) Satisfied Somewhat satisfied Not satisfied Reason for non satisfied with the services in the health center (Percent) Staff was rude Facility was not clean Poor quality of services Others Total number of JSY beneficiaries Percent 8.6 78.4 1.9 19.8 4 36.4 2667 95.7 3.7 0.6 100.0 162

70

Table H13. Reason for the JSY beneficiary to opt home delivery, in spite of cash incentives being available under the JSY Percent Reason for the beneficiary to opt home delivery
Reasons for home delivery (multiple options) Home delivery is more convenient Fear of stitches / caesarean Indifferent behaviour of medical / paramedical staff Cultural / social reasons Transport not being available Can't afford Others Total number of JSY beneficiaries under Home Delivery 20.0 80.0 5

Table H.14 Cash incentive received by the beneficary under JSY scheme
Case incentive Beneficiary received cash incentive under JSY scheme Total number of JSY beneficiaries Average amount received by beneficiary as cash incentive Received the cash incentive In one go In 2-3 installments Timing of the receipt of the cash incentive by beneficiary At the time of registration At the time of antenatal check up Much before the delivery Within a week before the EDD Immediately after the delivery Within a week after the delivery Much later Not received yet Do not know/ Husband knows Other Person who delivered the cash incentive to the beneficiary Doctor LHV ANM/FHW Anganwadi worker ASHA worker Other Place where the cash incentive received by the beneficiary District/Sub-District Hospital Community Health Centre PHC Sub-Centre Anganwadi Centre Private Hospital accredited by the Government At home Other place Faced difficulty in getting incentive money If faced difficulty, type of difficulty faced by the beneficiary Was asked to pay the bribe Was paid by cheque / draft Others Total number of JSY beneficiaries Percent 68.9 167 698.3 100.0 0.9 3.5 95.7 8.7 17.4 73.0 0.9 0.9 13.0 70.4 11.3 2.6 1.7 5.2 83.3 16.7 6

71

Table H14 explains the cash incentive received by the beneficiary under JSY scheme. Sixty-nine percent of the beneficiaries received cash incentive under JSY scheme. An average amount of Rs.698 was received by the beneficiary as cash incentive under JSY scheme, and the amount is received in one go.

Majority of the women received the cash long time after the delivery (96 percent). ANM / FHW delivered the cash incentive to the beneficiary (73 percent), followed by LHV (17 percent) and doctor (9 percent). The cash incentive was received by the beneficiary at the PHC (70 percent), CHC (13 percent), sub-centre (11 percent) and anganwadi centre (3 percent). Five percent of the beneficiaries feported difficulty in getting incentive money. The difficulties faced by the beneficiaries is bribe (83 percent) and the cash was paid by cheque / draft (17 percent).

During the last six months, sixty-five percent of the households in the selected villages availed health services in Government health facility (Table H15). There is not much variation between households located in the sub-centre village (64 percent) and other villages (65 percent).

Table H 15. Utilization of government health facility in last 6 months

Utilization of government health facility Percent of household who availed health services in government health facility in last 6 months Total number of households Households located in Sub Centre HQ Village Households located in other village All

64.2 600

65.0 600

64.6 1,200

Table H16 explains the characteristics of the respondents who have availed the services in Government health facility in last six months. Two-fifth of the respondents were in the age group of 20-29 years (40 percent) and one-fifth (21 percent) were 30-39 years. Majority of the users (65 percent) were less than 40 years. Females constitute the major proportion of users (88 percent). Non-literate (36 percent) and respondent with 1-5 years of education (23 percent) and 6-9 years (27 percent) were the main users of Government health facility. Currently married (86 percent) were the prime users of Government health facility. Other backward caste (61 percent) were the prime users of Government health facility followed by scheduled caste (39 percent). One-tenth of the

72

users were BPL households (10 percent). Medium (44 percent) and low SLI (37 percent) households were mainly used Government health facility than high SLI (19 percent) households.

Table H. 16 Characteristics of the respondents who have availed the services in government health facility in last 6 months
Characteristics of the respondent Age <16 years 16-19 years 20-29 years 30-39 years 40-49 years 50-59 years 60 years or more Sex Male Female Years of schooling completed Illiterate 1-5 years 6-9 years 10+ years Marital status Unmarried Currently married Divorced/Separated Widowed Social category of the household SC ST OBC Others Religion of the household Hindu Muslim Christian Sikhs Other BPL Household Standard of Living Index of the household Low SLI Medium SLI High SLI Total respondents who have availed the services in government health facility in last 6 months Percent 3.7 40.1 21.0 14.2 10.5 10.5 12.3 87.7 36.1 23.4 26.8 13.7 3.0 85.9 0.5 10.6 38.7 61.2 0.1 98.5 0.4 1.2 10.2 37.2 44.3 18.6 775

Table H17 denotes the type of health facility visited, purpose of visit and client satisfaction regarding behaviour of health worker, privacy and availability of medicines. Fifty-five percent of the respondent availed the services at the PHC, and 38 percent

73

utilized district / sub-district hospitals. Services availed at CHC (5 percent) and subcentre (3 percent) is very meager. Table H.17 Type of health facility visited, purpose visit and client satisfaction regarding behaviour of health worker, privacy and availability medicines Type of health facility visited, purpose visit and client satisfaction Percent
Type of health facility where service availed District/ Sub district hospital CHC PHC Sub Centre AYUSH Purpose of visit to health facility Treatment of minor ailment ANC care Child care Immunisation Other Behaviour of staff at health facility Courteous Causal/Indifferent Insulting/Derogatory Listening of complaints by Doctor/staff Listened to complaints Somewhat listened Not listened Cannot say Women patient were treated in privacy Yes No Dont know Patients with chronic disease get regular medicines from health facility Yes No Dont know Private practice of the doctors during and after the duty hours Yes No Dont know Satisfied with overall services and staff of Govt Health Facility Satisfied Somewhat satisfied Not satisfied Satisfied with the behaviour of staff at Govt. Health Facility Satisfied Somewhat satisfied Not satisfied Total respondents who have availed the services in government health facility in last 6 months 37.8 4.5 54.7 3.0 67.0 5.4 14.6 2.5 10.6 88.6 11.0 0.4 84.0 14.6 1.4 89.5 6.2 4.3 91.0 2.5 6.6 9.4 29.7 60.9 77.9 19.4 2.7 77.8 19.5 2.7 775

Treatment for minor ailment (67 percent) is the main purpose to visit to the health facility followed by child care (15 percent), ANC care (5 percent) and immunization (3 percent).

74

Eighty-nine percent of the client said the behaviour of staff at health facility is courteous and for 11 percent their behaviour is causal / in different. According to 84 percent of the clients doctors / staff listened their complaints, and for 15 percent doctor / staff listened their clients complaints some what. Ninety percent of the women patient were treated in privacy. Ninety-one percent of the patients with chronic disease get regular medicines from the Government health facility. Table H.18 User fees and extra charges Type of health facility visited, purpose visit and client satisfaction
Type of health facility where service availed District/ Sub district hospital CHC PHC Sub Centre AYUSH Purpose of visit to health facility Treatment of minor ailment ANC care Child care Immunisation Other Behaviour of staff at health facility Courteous Causal/Indifferent Insulting/Derogatory Listening of complaints by Doctor/staff Listened to complaints Somewhat listened Not listened Cannot say Women patient were treated in privacy Yes No Dont know Patients with chronic disease get regular medicines from health facility Yes No Dont know Private practice of the doctors during and after the duty hours Yes No Dont know Satisfied with overall services and staff of Govt Health Facility Satisfied Somewhat satisfied Not satisfied Satisfied with the behaviour of staff at Govt. Health Facility Satisfied Somewhat satisfied Not satisfied Total respondents who have availed the services in government health facility in last 6 months

Percent 37.8 4.5 54.7 3.0 67.0 5.4 14.6 2.5 10.6 88.6 11.0 0.4 84.0 14.6 1.4 89.5 6.2 4.3 91.0 2.5 6.6 9.4 29.7 60.9 77.9 19.4 2.7 77.8 19.5 2.7 775

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According to 30 percent of the clients doctors were not doing private practice during and after the duty hours, and 10 percent of the clients said doctors doing private practice. Sixty-one percent were not known about the private practice of the doctors during and after duty hours.

Seventy-eight percent of the clients were satisfied with the over all services and staff of government health facility. Seventy-eight percent of the clients were satisfied with the behaviour of staff at government health facility and 25 percent of the clients were somewhat satisfied.

According to ninety-eight percent of the respondents users feel was not charged from the users. The users fee was charged for ultrasound (4 percent), X-ray

(12 percent), and registration and lab services (6 percent each) (Table H18). Equal opinion exist on feel on subsidized services, difficulties in getting subsidized/free services and RKS facilitated the paper work for BPL patients were prevailed (Table H19). Table H19. Services for the BPL patients BPL Patents
BPL patients provided free / subsidized services Yes No Dont know BPL patients faced difficulty in getting free / subsidized services Yes No Dont know RKS facilitated the paperwork for BPL patients Yes No Dont know Total BPL respondents who have availed the services in government health facility in last 6 months Percent 50.0 50.0 50.0 50.0 50.0 50.0 2

Table H20, shows the outbreak of selected diseases (malaria, Gastroenteritis, Jaundice and other diseases) in the respondents area in the last six months. During the last six month out break of malaria is not reported. Measles (13 percent), gastroenteritis (2 percent), Jaundice (6 percent) and other diseases such as Denque (1 percent) were reported.

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Table H21 explains the preventive and curative actions to be taken for selected diseases (diarrhea, high fever, persistent cough, loose motion, and breathing problem for a child). Use of safe food and water (60 percent), hand washing (49 percent), use of covered containers (21 percent) and proper disposal of garbage (9 percent) were the actions taken in the selected households for prevention of diarrhea reported by the respondents. Seventeen percent were not knowing the preventive measures of diarrhea.

Table H 20. Outbreak of selected diseases (Malaria, Gastroenteritis, Jaundice and other Diseases) in the respondents area in the last six months
Outbreak of diseases Outbreak of Malaria in last six months Yes No Donot know Outbreak of Measles in last six months Yes No Donot know Outbreak of Gastroenteritis in last six months Yes No Dont know Outbreak of Jaundice in last six months Yes No Dont know Outbreak of Any Other disease in last six months Yes No Dont know Total number of household respondents Percent 0.4 98.4 1.2 13.4 86.1 0.5 1.5 95.6 2.9 6.3 93.2 0.5 1.3 92.8 6.0 1,200

Approaching the nearest Government health facility (83 percent), or registered medical practitioner (43 percent), (43 percent) was the actions taken if a family member has high fever. If a family member has a persistent cough for more than two-weeks, the action to be taken includes, approaching the nearest government health facility (83 percent), taken to the RMP (38 percent) and sputum testing (5 percent), Home remedies (15 percent) were also reported.

For loose motions lasting for more than 24 hours, the immediate action taken was referred to the nearest Government health facility (80 percent), start giving ORS (35 percent), taken to RMP (34 percent) and home remedy (19 percent).

77

When a child in the family has persistent cough and breathing problems. Like other diseases, they were taken to the nearest government health facility (83 percent) or taken to RMP (35 percent). Home remedy (5 percent) was also reported.

Table H 21. Action to be taken for selected diseases (diarrhoea, high fever, persistent cough, loose motion, persistent cough and breathing problem for a child )
Action to be taken for selected diseases (Multiple responses) Prevention of diarrhoea Hand washing Use of safe food and water Use of covered container Proper disposal of garbage other Don't know Action to be taken if a family member has a high fever Blood test for malaria Taken to RMP Taken to nearest govt health facility Consult ASHA Try home remedies Other Don't know Action to be taken if a family member has a persistent cough for more than two weeks Taken for sputum testing Taken to the RMP Taken to nearest govt health facility Consult ASHA Try home remedies Other Don't know Action to be taken if a family member has loose motions lasting for more than 24 hours Stop giving oral fluids/food etc Start giving ORS Taken to RMP Taken to nearest govt health facility Consult ASHA Try home remedies Other Don't know Action to be taken if a child in the family has persistent cough and breathing problems Try home remedies Taken to the RMP Taken to the nearest govt. health facility Consult ASHA Other Don't know Total number of household respondents Percent 49.3 59.9 20.9 9.4 0.8 17.2 2.0 42.8 82.8 5.3 9.1 -

4.6 38.1 82.8 0.2 14.5 7.1 -

0.6 35.1 34.4 80.1 19.3 7.1 -

5.3 35.3 82.7 0.2 1.6 1,200

Table H22 explains the respondents awareness about spacing methods and ideal gab between 1st and 2nd child. Ninety-nine percent of the respondent had awareness

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about family planning methods. According to 57 percent of the women the ideal gab between first and second child was 3 or more years for 40 percent it was 2 years. Only four percent said about one year gab between first and second child.
Table H 22. Awareness about spacing methods and ideal gap between 1st and 2nd child
Awareness about spacing methods and ideal gap between children Aware of family planning methods Ideal gap between first and second child 1 year 2 year 3 and more year 3.6 39.9 56.5 75.0 28.6 23.9 4.3 11.1 1,182 Percent 98.5

Methods available for spacing

IUD Oral Pills Nirodh / Condom Any other Don't know Total number of household respondents

Three-fourth of the respondents known about IUD (75 percent) and 29 percent aware of Oral pills. Twenty-four percent known of Nirodh / Condom.

AWARE ESS ABOUT MODES OF GETTI G AIDS, SOURCE OF I FORMATIO A D AWARE ESS ABOUT VCTC

Ninety-five percent of the respondents heard about HIV/AIDS. More than 93 percent said unsafe sexual contact is the mode of getting HIV/AIDS followed by sharing needles (67 percent) and blood transfusion (46 percent). Awareness on other modes of transmission such as mother to child (10 percent), sneezing (4 percent) is very less.

Television (80 percent) is the main source of information on HIV/AIDS followed by health worker (33 percent) and radio (20 percent). The contribution of posters (6 percent) and news papers (79 percent) in making awareness is very less.

Fifty-eight percent of the respondents had awareness on

HIV/AIDS by the

nearest counseling centre / VCTC centres. Among them, 48 percent reported the near by location of HIV/AIDS counseling centre / VCTC centre is PHC (48 percent), district hospital (34 percent) sub-district hospital (9 percent) and CHC (5 percent). 79

Table H23. Awareness about modes of getting AIDS, source of information about AIDS and awareness about VCTC AIDS and VCTC Percent
Heard about HIV/AIDS Awareness about modes of getting HIV/AIDS (out of respondents who have heard of AIDS) Unsafe Sexual contact Blood transfusion Sharing needles/syringes From mother to child Shaking hands Sneezing Insect bite Kissing Other Source of information on HIV/AIDS (out of respondents who have heard of AIDS) Radio TV Health workers Posters News papers Other Aware about HIV/AIDS counseling center / VCTC nearby (out of respondents who have heard of AIDS) Respondents by reported location of HIV / AIDS counseling center / VCTC (out of respondents who are aware about HIV/AIDS counseling center / VCTC nearby ) PHC CHC District Hospital Sub District Hospital Private Hospital Other Total number of household respondents 94.9

92.5 45.6 66.5 9.5 1.1 2.3 3.6 0.4 3.0

19.8 80.2 32.8 6.0 7.9 24.0 57.8

48.3 4.9 34.2 9.4 1.7 1.5 658

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Chapter - 7 GRAM PA CHAYAT

Twelve Gram Panchayats were covered in Madurai districts. Table A1 explains the states of Gram Panchayat covered. Total population covered by a Gram Panchayat is 3, 394, and among them nearly one fourth (777) were Scheduled caste. Total number of households covered by a Gram Panchayat was 958, among them nearly are one-fourth (229) were SC households. Total number of BPL families covered by a gram panchayat was 302, among them nearly one- half (142) belongs to Scheduled Caste (Table A1).
Table A1: Status of Gram Panchayats Covered Status of Gram Panchayat Covered A. umber of Gram Panchayats covered in the district B. Population of the Gram Panchayat covered Scheduled Caste Scheduled Tribe Total C. Average number of Households in the Gram Panchayat covered Scheduled Caste Scheduled Tribe Total D. Average number of BPL families in the Gram Panchayat covered Scheduled Caste Scheduled Tribe Total Value 12 776.8 3,394.4 229.4 958.4 142.3 302.4

Table A2 indicates the level of awareness on NRHM activities and involvement of Gram Panchayat in NRHM activities. Majority of Gram Panchayat (831) reporting regular availability of ANM. Three-fourth of the gram panchayat reporting about timely services provided by sub-centre to the patients and their role in conducting finalizing IEC Programme. All the Gram panchayat (100 percent) reporting about existence of VHSC in their panchayat and they all received untied fund, they had awareness about the benefit under JSY scheme, and reporting about improvements in the area due to NRHM. Eightythree percent of the Gram Panchayat reporting regular meeting of VHSC, and thirty-three percent reporting about village health plan prepared by VHSC.

Due to NRHM in 58 percent of the Gram Panchayats said funds were available for maintenance of Sub-Centre. Three-fourth (75 percent) of gram panchayats reported that funds are available under JSY. Seventeen percent of the Gram Panchayats used

81

NRHM funds to avail better facilities available at CHC/ PHC for referral patients and another 17 percent used it for transporting the patients.

Table A2: Level of awareness and involvement of Gram Panchayats Level of awareness and involvement of Gram Panchayats A1. Percentage of Gram Panchayat reporting regular availability of ANM A2. Percentage of Gram Panchayat reporting awareness about ANM tour plan B. Percentage of Gram Panchayat reporting timely services provided by Sub Centre to the patients C. Percentage of Gram Panchayat reporting role of Gram Panchayat in Conducting / finalizing IEC programme in Gram Panchayat D. Percentage of Gram Panchayat reporting existence of VHSC in their Gram Panchayat E. Percentage of Gram Panchayat reporting regular meetings of VHSC F. Percentage of Gram Panchayat reporting Village Health Plan been prepared by VHSC G. Percentage of Gram Panchayat reporting that VHSC has received any Untied Fund H. Percentage of Gram Panchayat reporting ASHA worker in position I. Percentage of Gram Panchayat reporting awareness of the benefits under JSY scheme J. Percentage of Gram Panchayat reporting that NRHM brought about any improvement in their area K. Percentage of Gram Panchayat reporting conduct of IEC activities during last 6 months L. Distribution of Gram Panchayat covered by type improvement reported due to NRHM Funds available for maintenance of Sub Centres Community support is available as ASHA worker Funds/facilities are available under JSY Better facilities are available for CHCs / PHCs for referred patients Transport facilities are available Other M. Distribution of Gram Panchayats by type of difficulties faced in Implementing programme activities under NRHM Funds not available in time Decision making with the community leaders is difficult ASHA has not been adequately trained Adequate facility for institutional deliveries are not available Other N. Distribution of Gram Panchayats by kind of support required to enable them in implement the programme more effectively More funds are required for maintenance / effective functioning Gram Panchayat should be given direct control over funds More training is to be arranged for ASHA and Community members Any other

Percent 83.3

75.0 75.0 100.0 83.3 33.3 100.0 100.0 100.0 -

58.3 75.0 16.7 16.7 -

83.3 8.3 16.7 -

91.7 50.0 8.3

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Difficulties such as funds not available in time (83 percent) inadequate facility for institutional deliveries (17 percent) and difficulties decision making with the community leader (8 percent) are mentioned by the Grampanchayats in implementing programme activities under NRHM at the Panchayat level.

More funds for maintaining/ ffective functioning (92 percent) and direct control of Gram Panchayat over funds are the supports required by the gram panchayats to enable them in implementing the NRHM programme more effectively.

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Chapter - 8 I -PATIE T FACILITIES (IPD)

Majority of the inpatients belongs to 20-29 years (81 percent). A small proportion were less than 20 years (9 percent). Rural (95 percent), female (93 percent) and currently married (90 percent) constitute the major part of the inpatients. Forty-eight percent of the in-patient were from PHC, 35 percent belongs to CHC and 17 percent were from district hospitals. Table 1: Background characteristics of the in-patients Background Characteristics of the In-Patients Age < 20 years 20-29 years 30-39 years 40-49 years 50-59 years 60 years or more Sex Male Female Marital status Unmarried Currently married Divorced/Separated Widowed Residence Rural Urban Type of Health Facility District Hospital CHC PHC Total In-patients interviewed Percent 8.6 81.0 1.7 1.7 6.9 6.9 93.1 5.2 89.7 5.2 94.8 5.2 17.2 34.5 48.3 58

Table 2 explains the purpose of the admission in the health institution. Most of the inpatients were admitted in the hospitals for delivery (69 percent), followed by family planning surgery 14 percent) and minor illness (10 percent). Majority (96 percent) of the inpatients in the PHC were admitted for delivery. In the CHCs 45 percent of the patients were admitted for delivery followed by Family Planning Surgery (40 percent) and minor illness(15 percent). Delivery (40 percent) and minor illness (30 percent) were main purpose of inpatients admission in the Government Hospital.

84

Table 2: Purpose of the admission in the Health Institution

Purpose of admission in the Health Institution Minor illness FP surgery Delivery Cataract surgery Child admitted Other Total In-patients interviewed Type of Health Facility (Percent) District Hospital CHC PHC 30.0 15.0 40.0 40.0 45.0 96.4 30.0 3.6 10 20 28

All 10.3 13.8 69.0 6.9 58

Table 3 explained the average waiting time of the in-patients in the health facility. Patients were waiting more for doctors call (105 minutes) and doctors examination (104 minutes) compare to discharge (36 minutes), getting services (17 minutes), registration (13 minutes) and admission to ward (15 minutes). Patients wait more time for doctors call and doctors examination (16 minutes each) in the PHC compare to the CHC (70 minutes and 68 minutes respectively) and Districts hospital (20 minutes and 18 minutes respectively). Average waiting time for registration (23 minutes), admission to ward (29 minutes), getting services (36 minutes) and to get discharge (66 minutes) were more in District hospital compare to CHC and PHC. Table 3: Waiting time
Average waiting time for: Average waiting time (in minutes) Type of Health Facility District Hospital CHC PHC 23.0 12.5 9.8 20.0 69.7 160.9 17.5 68.0 160.5 29.0 8.8 14.1 36.0 10.8 13.8 66.0 29.3 30.2 10 20 28

Registration Doctor's call Doctor's examination Admission to ward Getting services To get discharged Total In-patients interviewed

All 13.0 105.2 104.0 14.8 16.6 36.0 58

Table 4 explains the patients satisfaction regarding waiting time. Seventy percent of the in-patients opinioned that waiting time for registration, doctors call and doctor s examination were appropriate, and for 30 percent their weighting time for doctors call and examination is too short. For 50 percent of the patients waiting time to get

discharged is too long in the district hospitals.

85

Table 4: Satisfaction regarding waiting time A. Type of Facility District Hospital Satisfaction (percent of patients) Waiting time for Too Long Appropriate Too Short Cant Say Registration 10 70 20 Doctors call 70 30 Doctors examination 70 30 Admission to ward 10 50 40 Getting services 20 50 30 To get discharged 50 50 10 10 Total In-patients interviewed 10

B.
Type of Facility Waiting time for: Registration Doctors call Doctors examination Admission to ward Getting services To get discharged Total In-patients interviewed CHC Satisfaction (percent of patients) Too Long Appropriate Too Short 10 80 10 25 60 15 25 65 10 85 15 85 15 30 60 10 20 20 20 PHC Satisfaction (percent of patients) Too Long Appropriate Too Short 82.1 17.9 35.7 60.7 3.6 35.7 60.7 3.6 10.7 75.0 14.3 7.1 82.1 10.7 32.1 64.3 3.6 28 28 28 All Satisfaction (percent of patients) Appropriate Too Short 79.3 15.5 62.1 12.1 63.8 10.3 74.1 19.0 77.6 15.5 60.3 5.2 58 58

Cant Say -

C.
Type of Facility Waiting time for: Registration Doctors call Doctors examination Admission to ward Getting services To get discharged Total In-patients interviewed

Cant Say -

D.
Type of Facility Waiting time for: Registration Doctors call Doctors examination Admission to ward Getting services To get discharged Total In-patients interviewed Too Long 5.2 25.9 25.9 6.9 6.9 34.5 58

Cant Say -

In the CHCs waiting time for registration (80 percent), admission to ward and getting services (85 percent). Doctors call (60 percent) were appropriate. According to

86

10percent of the inpatients waiting time for registration is too long, for 25 percent waiting time to doctors call and doctors examination is too long. Thirty percent viewed that in the CHC waiting time for discharge is too long.

While considering PHCs the waiting time for registration and getting services (82 percent), admission to ward (75 percent) doctors call and examination (61 percent) and to get discharged (64 percent) were appropriate. Thirty-six percent viewed in the PHCs waiting time for doctors call, examination (26 percent) and to get discharged (35 percent) were too long.

Overall, majority of the inpatients opinioned that waiting

time for registration

(79 percent), getting services (78 percent), admission to ward (74 percent), doctors examination (64 percent), doctors call (62 percent) and to get discharged (60 percent) were appropriate. Twenty-six percent of the inpatients viewed waiting time for doctors call and doctors examination are too long. For thirty-five percent waiting time to get discharged was too long.

BEHAVIOUR OF STAFF:

Table 5 explains the behaviour of the staff with the inpatients in the Government health facilities. Almost all the inpatients (97 percent) said doctor greet them in a friendly manner. For sixty-seven percent of the inpatients the behaviour of the doctor is good, and twenty-four percent said doctors behaviour is reasonable. Behaviour of nurse in the Government health facilities were good (72 percent) and reasonable (24 percent). Behaviour of technical people with the inpatients is also mentioned as good (76 percent) and reasonable, and the same attitude prevails among the behaviour of counter clerk (96 percent) also.

According to fifteen percent of the inpatients (CHC 10 percent; PHC 25 percent) unique /innovative measures has to be taken to improve the behaviour of staff. Sixtythree percent of the inpatients has no idea (District hospital 90 percent; CHC 65 percent and PHC 54 percent) about the unique / innovative measure taken to improve the behaviour of the staff (Table 6).

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Table 5: Bahaviour of Staff

Staff Behaviour Doctor greet in a friendly manner Yes Somewhat No Behaviour of Doctor Rude Reasonable Good Very kind Behaviour of urse Rude Reasonable Good Very kind Behaviour of Technical Staff Rude Reasonable Good Very kind Behaviour of Ayah Negligent Arrogant Indifferent Good Behaviour of Ward Boys Negligent Arrogant Indifferent Good Behaviour of Counter Clerk Negligent Arrogant Indifferent Good Total of In-patients interviewed
District Hospital

Type of Health Facility (Percent) CHC PHC 90.0 10.0 10.0 10.0 80.0 10.0 10.0 80.0 11.1 88.9 10.0 10.0 80.0 12.5 87.5 10.0 90.0 10 95.0 5.0 25.0 70.0 5.0 30.0 70.0 44.4 55.6 5.3 94.7 100.0 5.3 94.7 20 100.0 28.6 60.7 10.7 25.0 71.4 3.6 100.0 100.0 100.0 100.0 28

All 96.6 3.4 1.7 24.1 67.2 6.9 1.7 24.1 72.4 1.7 23.8 76.2 1.8 3.5 94.7 6.7 93.3 3.6 96.4 58

Table 6: Unique/ innovative measure taken to improve the staff behaviour

Staff Behaviour
District Hospital

Percent Type of Health Facility CHC PHC

All

Unique/innovative measure taken to improve the staff behaviour Yes No Don't know
Total In-patients interviewed

10 10.0 90.0 10

20 10.0 25.0 65.0 20

28 25.0 21.4 53.6 28

58 15.5 20.7 63.8 58

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Table 7: Privacy
Privacy District Hospital Patients reporting presence of privacy at the place of examination Total no. of in-patients interviewed Percent Type of Health Facility CHC PHC All

100.0 10

100.0 20

100.0 28

100.0 58

All the inpatients (100 percent) reported about presence of privacy at the place of examination in all the health facilities (table 7).

Table 8 : Patient-Doctor/ Provider Communication

Percent Type of Health Facility District Hospital CHC PHC All

Patient-Doctor/ Provider Communication Doctor listened to description of ailment patiently Yes, somewhat Yes, always No Doctor allowed to ask question Yes, somewhat Yes, always No Doctor responded to question Yes, somewhat Yes, always No Doctor discussed about ailment Doctor talked about the recovery Doctor gave 'other advice' Total In-patients interviewed

30.0 70.0 40.0 60.0 40.0 60.0 60.0 90.0 90.0 10

5.0 95.0 10.0 90.0 100.0 75.0 95.0 95.0 20

10.7 89.3 28.6 71.4 10.7 89.3 57.1 100.0 82.1 28

12.1 87.9 24.1 75.9 12.1 87.9 63.8 96.6 87.9 58

Table 8 denotes the patient doctor / provider communication in the government health facilities. Eighty-eight percent of the inpatients said doctors always listened the description of ailment patiently, the percentage varies from 70 percent in the District hospital to 95 percent in the CHC. Seventy-six percent of the inpatients said doctor always allowed them to ask questions. This percentage varies from 60 percent in District hospitals to 90 percent CHC. Eighty-eight percent of the inpatients says that doctors

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always responded to their questions, the response of the doctors to patients question was more in CHC(100 percent) compare to PHC (89 percent) and District hospital (60 percent). Sixty-four percent of the inpatients said doctor discussed with them about their ailment and it varies from 57 percent in PHC to 75 percent in CHC.

Ninety-seven percent of the inpatients accept that doctor talked about their recovery. Overall eighty-eight percent of the inpatients said doctor gave other advice to the inpatients. This was reported more in CHC (95 percent) compare to District hospital (90 percent) and PHC (82 percent).

Table 9 indicates the cleanliness of the Government health facilities. In district hospital patients uniform was changed once in a day (100 percent). Floor and toilet/ bathrooms were cleaned once a day (90 percent each). Bed sheets were changed less than once a day (70 percent).

Table 9: Cleanliness of the facility A. Type of Facility Frequency of cleaning Thrice a day Twice a day Once a day Less than once a day Total number of inpatients interviewed B. Type of Facility Frequency of cleaning Thrice a day Twice a day Once a day Less than once a day Total number of inpatients interviewed Floor Floor

10.0 90.0 10

District Hospital Percent of In-patient Toilet/Bathroom Changing Patients Uniform 10.0 90.0 100.0 10 10

Changing Bed Sheets 10.0 20.0 70.0 10

5.0 60.0 35.0 20

CHC Percent of In-patient Toilet/Bathroom Changing Patients Uniform 5.0 55.0 20.0 40.0 80.0 20 20

Changing Bed Sheets 5.0 40.0 55.0 20

90

C. Type of Facility Frequency of cleaning Thrice a day Twice a day Once a day Less than once a day Total number of inpatients interviewed Floor

17.9 64.3 10.7 7.1 28

PHC Percent of In-patient Toilet/Bathroom Changing Patients Uniform 10.7 3.6 39.3 17.9 46.4 78.6 3.6 28 28

Changing Bed Sheets 14.3 53.6 32.1 28

D. Type of Facility Frequency of cleaning Thrice a day Twice a day Once a day Less than once a day Total number of in-patients interviewed Floor All Percent of In-patient Toilet/ Changing Changing Bathroom Patients Bed Uniform Sheets 6.9 1.7 39.7 15.5 10.3 51.7 82.8 43.1 1.7 46.6 58 58 58

10.3 53.4 32.8 3.4 58

In the CHC, Floor was cleaned twice a day (60 percent) and toilet / Bath rooms (55 percent) were cleaned twice a days (55 percent) and patients uniform was changed once in a day (80 percent). Bed sheets (55 percent) were changed less than once a day.

In the PHC floor was cleaned twice a day (64 percent), toilet / Both room (46 percent) were cleaned once in a day, patients uniform (7 percent) and Bed sheet (54percent) were changed once a day.

According to the inpatients of the Government health facilities, floor was cleaned twice a day (53 percent), toilet / Bath room (52 percent) were cleaned once in a day and patients uniform (83 percent) was changed once a day and bed sheets were changed less than once a day (47 percent).

Table 10 explains the satisfaction of patients regarding cleanliness of the Government health facilities. In the district hospital, 40 percent of the inpatients were satisfied with the floor cleaning and toilet / Both room cleaning, 60 percent satisfied with 91

the changing of patients uniform and 30 percent with changing of bed sheets. Seventy percent of the inpatients were not satisfied with the changing of bed sheets.

In the CHCs percentage of inpatients satisfied regarding the cleaning of floor was 80 percent. Sixty percent satisfied with the toilet / Both room, and the percentage of inpatients had had satisfaction on changing patients uniform and bed sheets were 45 percent and 35 percent respectively. Fifty-five percent of the inpatients were not satisfied with changing of bed sheets.

Table 10: Satisfaction of patients regarding cleanliness of the facility A.

Type of Facility
Satisfaction regarding Floor cleaning Toilet/Bathroom cleaning Changing patients uniform Changing bed-sheets

District Hospital Satisfaction (percent of in-patients) Satisfied 40.0 40.0 60.0 30.0 Somewhat satisfied 60.0 50.0 40.0 ot satisfied 10.0 70.0

Total number of in-patients interviewed 10 10 10 10

B.

Type of Facility
Satisfaction regarding Floor cleaning Toilet/Bathroom cleaning Changing patients uniform Changing bed-sheets

CHC Satisfaction (percent of in-patients) Satisfied 80.0 60.0 45.0 35.0 Somewhat satisfied 20.0 30.0 55.0 10.0 ot satisfied 10.0 55.0

Total number of in-patients interviewed 20 20 20 20

C. Type of Facility Satisfaction regarding Floor cleaning Toilet/Bathroom cleaning Changing patients uniform Changing bed-sheets

PHC Satisfaction (percent of in-patients) Satisfied 82.1 71.4 82.1 53.6 Somewhat satisfied 3.6 7.1 17.9 14.3 ot satisfied 14.3 21.4 32.1

Total number of in-patients interviewed 28 28 28 28

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D. Type of Facility Satisfaction regarding Floor cleaning Toilet/Bathroom cleaning Changing patients uniform Changing bed-sheets

All Satisfaction (percent of in-patients) Satisfied 74.1 62.1 65.5 43.1 Somewhat satisfied 19.0 22.4 34.5 10.3 ot satisfied 6.9 15.5 46.6

Total number of in-patients interviewed 58 58 58 58

In the PHCs majority of the inpatients were satisfied with the floor cleaning (82 percent), toilet / Both room cleaning (71 percent), changing patients uniform 982 percent) and changing of bed sheets (54 percent). Nearly one-third (32 percent) were not satisfied with changing of bed sheets, and one-fifth (21 percent) were not satisfied with the cleanliness of the toilet / Both room and 14 percent were not satisfied with floor cleaning.

Overall, 74 percent inpatients were satisfied with cleanliness of floor, 62 percent satisfied with toilet / both room, 66 percent satisfied with changing patients uniform. But 47 percent were not satisfied regarding changing of bed sheets and seven percent were unsatisfied with cleaning bathroom and floor.

Table 11 denotes the crowding in various Government health facilities. Almost all the inpatients reported that immediately they avail cot (95 percent). The percentage varies from 89 percent in the PHC to 100 percent in the District hospital and CHC. Ninety-five percent of the inpatients avail the cot/ bed till the time of discharge. This percentage varies from 90 percent in the District hospital to 95 percent in CHC and 96 percent in PHC.

Two-fifth (40 percent) of the inpatients in the Government health facilities reported about adequate space in the ward and 17 percent reported about inadequate space in the ward. Thirty percent of the inpatients of District Hospital, 36 percent of inpatients form PHC and 50 percent of inpatients form CHC reported about adequate space in the ward. This percentage varies form 5 percent in CHC, 20 percent and 25 percent respectively in District Hospital and PHC respectively. Forty-five percent of the inpatients were satisfied with the ward arrangements. Only 5 percent were not satisfied

93

with ward arrangements. Two percent of inpatients satisfied with ward arrangements were 55 percent, 43 percent and 30 percent in CHC, PHC and DH respectively. Fortytwo percent of the inpatients reported about adequate space in IPD. This percentage varies from 30 in DH to 55 in CHC.

Table 11: Crowding in the facility Crowding in the facility Availability of cot Immediately Not immediately but same day Next day After more than a day Availability of cot/bed till the time of discharge Yes No Adequacy of space in the ward Not adequate Somewhat adequate Adequate Satisfaction with the ward arrangement Not satisfied Somewhat satisfied Satisfied Adequacy of space in IPD Not adequate Somewhat adequate Adequate Lot of noise in the ward Yes No Total no. of in-patients interviewed Percent Type of Health Facility (Percent) District Hospital CHC PHC 100.0 100.0 89.3 3.6 3.6 3.6

All 94.8 1.7 1.7 1.7

90.0 10.0 20.0 50.0 30.0

95.0 5.0 5.0 45.0 50.0

96.4 3.6 25.0 39.3 35.7

94.8 5.2 17.2 43.1 39.7

10.0 60.0 30.0 10.0 60.0 30.0

45.0 55.0 45.0 55.0

7.1 50.0 42.9 28.6 35.7 35.7

5.2 50.0 44.8 15.5 43.1 41.4

10

20

28 Medical shop

58

Table12 explains the amenities provided by the hospital.

(Pharmacy) is available in all the Government health facilities. All the inpatients are satisfied with the pharmacy. Thirty percent of the inpatients in the district hospital reporting about availability of accommodation for relatives in the district hospital, and

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among them one-third (33 percent) were satisfied with this facility. Television, canteen, telephone and Ambulance were not available in the Government head quarters hospital. Television (90 percent) and telephone (60 percent) were available in CHCs. The

percentage of inpatients satisfied with the amenities was 72 percent and 92 percent respectively. Television and telephone were available in the PHC. Majority of the

inpatients were satisfied with this facilities. Table 12: Amenities provided by the hospital A.
Type of Facility Amenities Television Canteen Medical shop Telephone Accommodation for relatives Ambulance percent of Total in-patients number of reporting in-patients Availability interviewed 10 10 100.0 10 10 30.0 10 10 CHC Total percent of in-patients percent of number of reporting Satisfaction in-patients in-patients among those who that reporting Availability interviewed the amenity is available 90.0 20 72.2 20 100.0 20 100.0 60.0 20 91.7 45.0 20 100.0 20 PHC percent of Total in-patients number of reporting in-patients Availability interviewed 89.3 28 3.6 28 100.0 28 92.9 28 71.4 28 28 percent of in-patients Total number of inreporting Satisfaction patients interviewed among those who that who said that the the amenity is available amenity is available 92.0 28 100.0 28 100.0 28 100.0 28 65.0 28 28 Total number of inpatients interviewed who said that the amenity is available 20 20 20 20 20 20 District Hospital percent of in-patients reporting Satisfaction among those who that the amenity is available 100.0 33.3 Total number of inpatients interviewed who said that the amenity is available 10 10 10 10 10 10

B.
Type of Facility Amenities Television Canteen Medical shop Telephone Accommodation for relatives Ambulance

C.
Type of Facility Amenities Television Canteen Medical shop Telephone Accommodation for relatives Ambulance

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D.
Type of Facility Amenities Television Canteen Medical shop Telephone Accommodation for relatives Ambulance percent of in-patients reporting Availability 74.1 1.7 100.0 65.5 55.2 All Total percent of in-patients number of reporting Satisfaction in-patients among those who that interviewed the amenity is available 58 83.7 58 100.0 58 100.0 58 97.4 58 71.9 58 Total number of inpatients interviewed who said that the amenity is available 58 58 58 58 58 58

Table 13: Continuity of treatment Continuity of treatment Overall satisfaction on visiting to facility Dissatisfied Somewhat satisfied Satisfied Reason of dissatisfaction Lack of facilities Bad experience with doctor Poor quality of services Charges are exorbitant Other Visit again to the facility (if fell sick) Yes No May come/unsure Recommend this hospital to other Yes No Total no. of in-patients interviewed Type of Health Facility (Percent) District Hospital CHC PHC

All

10.0 20.0 70.0 100.0 -

20.0 80.0 -

28.6 71.4 -

1.7 24.1 74.1 100.0 -

90.0 10.0 -

100.0 -

100.0 -

98.3 1.7 -

100.0 10

100.0 20

100.0 28

100.0 58

As reported by the inpatients (89 percent), medical shop (100 percent), telephone (93 percent) and accommodation for relatives (71 percent) were the amenities available in

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the PHC. The percentage of inpatients (100 percent) satisfied with television and accommodation for relatives was 92 percent and 65 percent respectively.

Television was available in 74 percent of the facilities and 84 percent of the inpatients were satisfied with this. Sixty-six percent of the facilities have telephone and 97 percent of the inpatients were satisfied with this. Fifty-five percent of the inpatient reported about accommodation for relatives and 72 percent were satisfied.

Table 13 explains the continuity of treatment in the government health facilities. Overall 74 percent of the inpatient were satisfied about visiting to the government facilities (District Hospital 70 percent ; CHC 80 percent; PHC 71 percent). Only two percent had dissatisfaction on visiting the hospital i.e., only in District hospital (10 percent). The main reason for dissatisfaction is lack of facilities (100 percent). Ninetyeight percent of the inpatients said they will visit again to the facility if they fell sick and all the inpatients said they will recommend this hospital to others (100 percent).

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Chapter - 9 OUTPATIE T (OPD)

Table 1 explains the background characteristics of the out patients. Fortyeight percent of the out patient were in the age group of 20-29 years. Sixteen percent belongs to 40-49 years and 14 percent were 60 years or more. Majority of the outpatient were female (73 percent) and currently married (70 percent). All most all the outpatients belongs to rural (97 percent). Fifty seven percent of the outpatient were from PHC, 29 percent were from CHC and 14 percent from district hospital.
Table 1:Background characteristics of the out-patients Background Characteristics of the Out-Patients Age < 20 years 20-29 years 30-39 years 40-49 years 50-59 years 60 years or more Sex Male Female Marital status Unmarried Currently married Divorced/Separated Widowed Residence Rural Urban Type of Health Facility District Hospital CHC PHC Total no. of out-patients interviewed Percent 7.1 45.7 10.0 7.1 15.7 14.3 27.1 72.9 15.7 70.0 14.3 97.1 2.9 14.3 28.6 57.1 70

Table 2 explains the purpose of visit to the health institution. Overall 47 percent of the out patient visit to the health facility for minor illness (District Hospital 80 percent; CHC, 35 percent, PHC 45 percent). Twenty-three patients visited for childrens illness, (District Hospital 20 percent; CHC 25 percent, PHC 23 percent) and 13 percent visited for antenatal care (CHC 10 Percent and PHC 18 percent).

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Table 2: Purpose of visit to the Health Institution Purpose of visit in the Health Institution Minor illness FP services Antenatal care PNC Eye checkup MDT-DOTs Child illness Other Total out-patients interviewed Percent Type of Health Facility District Hospital 80.0 20.0 10 CHC 35.0 10.0 25.0 30.0 20 PHC 45.0 17.5 22.5 15.0 40 All 47.1 12.9 22.9 17.1 70

Table 3 explains about the waiting time in the Government hospitals. In the district hospitals, average, waiting time as reported by out patients was 14 minutes for doctors examination, 12 minutes for registration, nine minutes and 10 minutes for getting injection and medicines respectively.

In the CHC, average waiting time for registration (22 minutes), doctors examination (19 minutes), injection (13 minutes), getting medicines (15 minutes) and dressing (5 minutes) is less than 30 minutes.

In the PHCs average waiting for registration and doctors examination was 21 minute and 23 minute respectively. Waiting time for injection, getting medicine and dressing was 15 minutes, 16 minutes and 5 minutes respectively.
Table 3: Waiting time A. Type of Facility Average waiting time for: Registration Doctors examination Injection Getting medicines Dressing Paying bill Total time taken for OPD services

District Hospital o. of patients Average waiting availed the service time (in minutes) 10 11.5 10 13.5 9 9.4 10 9.5 -

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B. Type of Facility Average waiting time for: Registration Doctors examination Injection Getting medicines Dressing Paying bill Total time taken for OPD services C. Type of Facility Average waiting time for: Registration Doctors examination Injection Getting medicines Dressing Paying bill Total time taken for OPD services D. Type of Facility Average waiting time for: Registration Doctors examination Injection Getting medicines Dressing Paying bill Total time taken for OPD services

CHC o. of patients availed the service 20 20 8 19 1 Average waiting time (in minutes) 22.1 19.3 12.5 14.9 5.0 -

PHC o. of patients Average waiting availed the service time (in minutes) 40 21.1 40 23.3 28 14.8 39 16.3 1 5.0 -

All o. of patients Average waiting availed the service time (in minutes) 70 20.0 70 20.7 45 13.3 68 14.9 2 5.0 -

Overall, in the Government health facilities average waiting time taken for registration in the OPD was 20 minutes and doctors call is 21 minutes. The average time taken for injection and getting medicines was 13 minutes and 15 minutes respectively.

Table 4 explains the satisfaction regarding waiting time. All the OPD patients viewed that waiting time for registration, doctors examination, injection and getting medicines (100 percent) is appropriate.

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Table 4: Satisfaction regarding waiting time A. Type of Facility o. of patients Waiting time for: availed the Too Long service Registration 10 Doctors examination 10 Injection 10 Getting medicines 10 Dressing 10 Paying bill 10 B. Type of Facility Waiting time for: Registration Doctors examination Injection Getting medicines Dressing Paying bill C. Type of Facility Waiting time for: Registration Doctors examination Injection Getting medicines Dressing Paying bill D. Type of Facility Waiting time for: Registration Doctors examination Injection Getting medicines Dressing Paying bill o. of patients availed the service 70 70 70 70 70 70 o. of patients availed the service 40 40 40 40 40 40 o. of patients availed the service 20 20 20 20 20 20

District Hospital Satisfaction (percent of patients)

Appropriate Too Short Cant Say

100.0 100.0 100.0 100.0 -

CHC Satisfaction (percent of patients) Appropriate Too Short 30.0 35.0 55.0 20.0 75.0 25.0 31.6 42.1 100.0 -

Too Long 35.0 25.0 26.3 -

Cant Say -

PHC Satisfaction (percent of patients) Appropriate Too Short 67.5 15.0 62.5 10.0 71.4 14.3 69.2 12.8 100.0 -

Too Long 17.5 27.5 14.3 17.9 -

Cant Say -

All Satisfaction (percent of patients) Appropriate Too Short 61.4 18.6 65.7 11.4 77.8 13.3 63.2 19.1 100.0 -

Too Long 20.0 22.9 8.9 17.6 -

Cant Say -

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In the CHCs, 30 percent of the patient felt that waiting time for registration is appropriate (30 percent), 35 percent felt it was too long and for 35 percent it was too short. According to 55 percent of the out patient waiting time for doctors examination was appropriate and for 25 percent it was too long and it was too short for 20 percent of OPD patients. According to three fourth of the outpatient waiting time for injection was appropriate and for 25 percent it was too short. As reported by the out patients the time for getting medicines was appropriate for 32 percent, too long for 26 percent and 42 percent for too short.

In the PHCs majority of the out patients felt that waiting time for registration (68 percent), doctors examination (63 percent), injection (71 percent), getting medicines (69 percent) and dressing (100 percent) was appropriate.

Overall higher proportion of the out patients felt that waiting time for registration (61 percent), doctors examination (66 percent), injection (78 percent), getting medicines (63 percent) and dressing (100 percent) was appropriate.

Table 5 explains the behaviour of staff with the patient in the government health facilities. Majority of the out patient opinioned that in the District Hospitals the doctors greets the patient in friendly manner (70 percent) behaviour of doctor was reasonable (100 percent), good behaviour of nursing staff (90 percent) and dispenser (100 percent). The same situation exists in the CHCs and PHCs also. Over all 77 percent of the out patients opinioned that doctor greet them friendly (CHC 75 percent; PHC 80 percent), behaviour of doctor is reasonable (CHC 80 percent; PHC 76 Percent), Good behaviour of nursing staff (CHC 75 percent; PHC 98 percent), and good behavior of dispenser (CHC 80 percent; PHC 95 percent).

All the out patients (94 percent) reported about privacy at the place of examination, in the District Hospital (100 per cent), CHC (95 percent), PHC (93 percent). (Table 6).

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Table 5: Behaviour of staff Staff Behaviour Doctor greet in a friendly manner Not friendly Yes, somewhat Yes Behaviour of Doctor Rude Reasonable Good Very kind Behaviour of ursing Staff Rude Reasonable Good Very kind Behaviour of Dispenser Rude Reasonable Good Very kind Behaviour of Technician Rude Reasonable Good Very kind Total out-patients interviewed Table 6: Privacy Type of Health Facility District Hospital CHC PHC All

20.0 10.0 70.0 100.0 10.0 90.0 100.0 10

25.0 75.0 10.0 80.0 10.0 5.0 15.0 75.0 5.0 5.0 10.0 80.0 5.0 10.0 5.0 20

5.0 15.0 80.0 10.0 77.5 12.5 2.5 97.5 2.5 95.0 2.5 2.5 20.0 40

5.7 17.1 77.1 8.6 81.4 10.0 1.4 7.1 90.0 1.4 1.4 4.3 91.4 2.9 4.3 11.4 1.4 70

Privacy
Patients reporting presence of privacy at the place of examination Total out-patients interviewed

Type of Health Facility (Percent) District Hospital CHC PHC

All

100.0 10

95.0 20

92.5 40

94.3 70

Table 7 denotes the patient-doctor /provider communication according to the outpatients. Fifty-six percent of the out patients viewed, doctors always listened to description of ailment patiently, allowed to ask questions (53 percent), always allowed to respond to questions (50 percent), discussed about the ailment with the patient (77 percent) and gave other advice (69 percent).

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Table 7: Patient-Doctor/Provider Communication Percent Type of Health Facility (Percent) District CHC PHC Hospital

Patient-Doctor Communication Doctor listened to description of ailment patiently Yes, somewhat Yes, always No Doctor allowed to ask questions Yes, somewhat Yes, always No Doctor responded to questions Yes, somewhat Yes, always No Doctor discussed about the ailment Yes No Doctor talked about the recovery Yes No Doctor gave 'other advice' Yes No Total out-patients interviewed

All

30.0 70.0 10.0 60.0 30.0 10.0 50.0 40.0

65.0 35.0 55.0 45.0 60.0 40.0 -

37.5 62.5 42.5 55.0 2.5 42.5 55.0 2.5

44.3 55.7 41.4 52.9 5.7 42.9 50.0 7.1

50.0 50.0 30.0 70.0 30.0 70.0 10

85.0 15.0 90.0 10.0 70.0 30.0 20

80.0 20.0 80.0 20.0 77.5 22.5 40

77.1 22.9 75.7 24.3 68.6 31.4 70

Table 8 explains the satisfaction of OPD patients regarding cleanliness of the facility. All most all the patients were satisfied with the cleanliness of OPD room, examination room, dispensary (90 percent each), injection room (80 percent) and laboratory (100 percent).
Table 8: Satisfaction of OPD patients regarding cleanliness of the facility A. Type of Facility Satisfaction regarding OPD Room Examination Room Dispensary Laboratory Injection Room Dressing Room o. of patients availed the service 10 10 10 10 10 10

District Hospital Cleanliness (percent of patients) Partially ot Clean Clean Clean 10.0 90.0 10.0 90.0 10.0 90.0 10.0 10.0 80.0 -

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B. Type of Facility Satisfaction regarding OPD Room Examination Room Dispensary Laboratory Injection Room Dressing Room C. Type of Facility Satisfaction regarding OPD Room Examination Room Dispensary Laboratory Injection Room Dressing Room D. Type of Facility Satisfaction regarding OPD Room Examination Room Dispensary Laboratory Injection Room Dressing Room o. of patients availed the service 70 70 70 70 70 70 o. of patients availed the service 40 40 40 40 40 40 o. of patients availed the service 20 20 20 20 20 20

CHC Cleanliness (percent of patients) Partially ot Clean Clean Clean 5.0 95.0 5.0 95.0 5.0 90.0 10.0 5.0 35.0 5.0 5.0 -

PHC Cleanliness (percent of patients) Partially ot Clean Clean Clean 12.5 37.5 7.7 92.3 5.4 94.9 2.5 5.0 65.0 10.0 -

All Cleanliness (percent of patients) Partially ot Clean Clean Clean 10.0 90.0 7.2 92.8 5.8 92.8 5.7 5.7 58.6 1.4 7.1

In the CHCs also almost all the out patient were satisfied with the cleanliness of OPD room, examination room (95 percent each), dispensary (90 percent), laboratory (100 percent), injection room (95 percent).

Examination room (92 percent) dispensary (95 percent) and injection room (65 percent), OPD room (88 percent) were clean in the PHCs. Overall according to 90 percent of the outpatient OPD room was clean, for 93 percent examination room and dispensary were clean. Fifty nine percent viewed that injection room was clean.

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Table 9 viewed the satisfaction of OPD patient regarding crowding in the facility. According to out patient in the District Hospitals, OPD room, examination rooms, dispensary were reported about crowded at some extent (70 percent) and 60 percent reported about crowd in the injection room. The percentage of the patients satisfied with adequate crowd was 35 percent, OPD room (37 percent), examination room (30 percent), dispensary.
Table 9: Satisfaction of OPD patients regarding crowding in the facility A. Type of Facility Satisfaction regarding OPD Room Examination Room Dispensary Laboratory Injection Room Dressing Room B. Type of Facility Satisfaction regarding OPD Room Examination Room Dispensary Laboratory Injection Room Dressing Room C. Type of Facility Satisfaction regarding OPD Room Examination Room Dispensary Laboratory Injection Room Dressing Room o. of patients availed the service 40 40 40 40 40 40 o. of patients availed the service 20 20 20 20 20 20 o. of patients availed the service 10 10 10 10 10 10 District Hospital Crowding (percent of patients) ot Somewhat Adequate Adequate Adequate 70.0 30.0 70.0 30.0 70.0 30.0 10.0 60.0 30.0 -

CHC Crowding (percent of patients) ot Somewhat Adequate Adequate Adequate 35.0 30.0 35.0 47.4 36.8 15.5 45.0 30.0 20.0 5.0 5.0 10.0 25.0 5.0 5.0 5.0 -

PHC Crowding (percent of patients) ot Somewhat Adequate Adequate Adequate 15.0 65.0 20.0 74.4 25.6 72.5 25.0 2.5 40.0 22.5 7.5 10.0 -

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D. Type of Facility Satisfaction regarding OPD Room Examination Room Dispensary Laboratory Injection Room Dressing Room o. of patients availed the service 70 70 70 70 70 70

All Crowding (percent of patients) ot Somewhat Adequate Adequate Adequate 18.6 55.7 25.7 66.2 29.4 4.4 5.7 64.3 27.1 1.4 4.3 7.1 38.6 18.6 7.1 1.4 -

In the PHCs also OPD room (65 percent), examination room (74 percent), dispensary (73 percent) and injection room were some what crowded. Table 10 explains the out patient view about the continuity of the treatment in the Government health facility. Sixty-seven percent of the outpatients were fully satisfied with their visit to the Government health facility (District Hospital 60 percent; CHC 65 percent; PHC 70 percent). All most all the patients (99 percent) viewed that they will visit again to the facility if they fell sick and also they recommend this hospitals to others. Table 10: Continuity of treatment
Continuity of treatment Continuity of treatment Satisfaction with the visit to the health facility Dissatisfied Somewhat satisfied Satisfied Reason of dissatisfaction, if dissatisfied Lack of facilities Bad experience with the doctors Poor quality of services Charges are exorbitant Other Visit again to the facility (if fell sick) Yes No May come / unsure Recommend this hospital to others Yes No Total out-patients interviewed Percent Type of Health Facility District Hospital CHC PHC

Total

40.0 60.0

35.0 65.0

30.0 70.0

32.9 67.1

100.0 -

100.0 -

97.5 2.5 -

98.6 1.4 -

100.0 10

100.0 20

97.5 2.5 40

98.6 1.4 70

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