KISHTWAR DISTRICT VISIT REPORT DATE: 17.06.2015 … DISTRICT VISIT REP… · · 2016-03-09KISHTWAR DISTRICT VISIT REPORT DATE: 17.06.2015-20.06.2015 ... Protocol posters are available

1 | P a g e K i s h t w a r D i s t r i c t V i s i t R e p o r t

KISHTWAR DISTRICT VISIT REPORT

DATE: 17.06.2015-20.06.2015

OFFICE OF THE MISSION DIRECTOR

NHM, J&K


Executive Summary of Kishtwar District Visit

4 facilities ( PHC Afti, CHC Marwah, PHC Keruu and DH Kishtwar)visited during this supportive

supervision

Non availability of electricity and water facility are the major problem in PHC Afti and CHC

Marwah

Maximum number of staff from PHC Afti, CHC Marwah and nearest PHC and SC are attached

at PHC Dachhan and it is hampering the service delivery to the community and regular availability

of staff is a major concern

Availability of SBA trained SNs is one of the major concern at CHC and PHC. Sr. Pharmacist and

CHO are conducting delivery at CHC Marwah

Monitoring from block level officials is very poor at PHC Afti and CHC Marwah

ANC status and tracking of PW is very poor.

Immunization status and drop out tracking mechanism is poor at PHC Afti, CHC Marwah and

PHC Keruu. Knowledge regarding the immunization schedule is very poor among the staffs.

Proper recording and reporting is a major concern throughout the facility

Labor room of CHC Marwah is well maintained and all the necessary logistics are available.

Protocol posters are available at all delivery point though knowledge regarding the protocol

posters is poor

Staff quarter is not available at PHC Afti.

At present diet is not being provided at CHC Marwah and lab tests are free for PW at all facilities.

Reporting and recording of SNCU at DH is not as per the standard. Sister in charge SNCU has

not clear idea about the RW handling. Out born admission is very poor at SNCU

Labour room of DH Kishtwar has enough space but poorly managed. On duty SNs have poor idea

about the Essential New Born Care. Practice of cleaning and sterilization of equipment are major

issues.

Poor knowledge in Essential New Born Care Management at all facilities


Summary of Visit

Block wise supportive supervision visit was carried out in Kishtwar District from 17.06.15 to 20.06.2015. Total number of 4 facilities were visited and details observation were taken from each facility to assess the current situation and status of ongoing of NHM programme. In addition to this suggestion for improvement also given.

Duration of visit: 17.06.15 to 20.06.15

Team Members

Tapas Chatterjee, State Coordinator-RMNCH+A

Mr.Manoj Kumar, DM&EO-Kishtwar

Mr. Umar Nazir, District Coordinator-RMNCH+A

A.D. Mansoor, BM&E Officer, Dachhan

Facilities Visited

PHC Afti

CHC Marwah

PHC Keruu

District Hospital-Kishtwar


Major Findings of PHC Afti

Date of visit: 18.06.2015

Brief status of PHC Afti:

PHC Afti is 24X7 PHC though there is no provision of institutional delivery covering near about 2500 population scattered in 5 villages. There are 3 SCs and 1 NTSC under this PHC. Nearest referral is PHC Larnoo which is 72 km away from the facility though CHC Marwah is only 42 kms but due to poor road condition no one prefer to go there. 15 ASHAs are working under this PHC.

Services provided: OPD, IPD, Vaccination and diagnostics

Infrastructure:

The PHC is functioning in old building though the new building already constructed but handover is pending.

There is no water supply facility at this PHC There is no provision of toilet as a result diagnostic tests specially urine test of PW is a major

problem PHC has no connection of electricity though they have 5 kb gen set for power supply Only 3 beds are currently functional There is no quarter for Medical officer and other staff

Manpower and Training:

HR Permissible In position Remarks

MO 4 1 (ISM) 2 Medical officer attached one at DH Kishtwar and another one at SHS, Sringara( recently detached)

Jr. SN 2 2 One attached to NTPHC Inshan

Pharmacist 2 1 Only ISM pharmacist from NHM is available where as another Supervisor pharmacist from regular side is attached to NTPHC Inshan

MFMPHW 1 1 Absconding from 15th May 2013. She is from regular side

LT 1 1 Health Educator 1 1 PTS (from HDF) - 1 NO 3 2 from regular side Safaiwala 2 1

Lab Technician, Jr.SN and ISM Pharmacist found absent on the date of visit


Labour room status:

Labour room is well equipped with required equipment One labor table is available with foot rest is available Suction machine is available and functional One phototherapy unit is kept inside the labour room but

there is no radiant Warmer All protocol posters were available

Major constrains for delivery: Water supply Electricity Non availability of SBA trained personnel Toilet availability Poor road connection

25000/- was given to Block Development Officer in 2013 for minor repairing of the community hall to make it a delivery point nearest to the community but the community hall is being used by the army people now.

Laboratory test:

Functional laboratory is available at the facility Lab Technician was absent at the time of visit None of the laboratory register was available at the time of

visit Urine test is a major problem at this facility due to non-

availability of water and toilet Basic tests are being conducted at this facility

Indoor:

3 functional beds are available at the facility Major cause of emergency admission at this facility are diarrhea, vomiting, RTI and UTI

Drug Store room:

Separate drug store room is available


Arrangement of the drugs are satisfactory though none of the record was available at the facility at the time of visit

BCG syringe found expired at drug store 39 cartons of sanitary napkins were available at the

PHC

ANC and Immunization Status:

As per the HMIS report 2015-16 only 4 women were registered for ANC and none of them registered with 1st trimester

None of the mother received 3 ANC 4 mother received 100 IFA There is no status of IUCD 12 infants received BCG up to May’15 Only 5 infants received Measles 1st dose There is no status of Vit-A

Record Keeping:

Non-availability of documents like MCTS Register, HMIS Reports, ANC Register and Immunization Registers.

Non-availability of financial Records like RKS cash Books, RKS Minutes of meeting, JSY, JSSK cash Books.

Non-availability of Stock Register, Drug Register, Asset/Dead stock Register.

Community visit:

Maximum number of home deliveries Interviewed 5 mothers regarding Immunization and ANC service Poor immunization status at the community None of the mother completed full ANC Community awareness is very poor regarding institutional delivery, immunization and family

planning No follow up drop out mother and child

Referral Mechanism:

One functional ambulance with driver is available at the facility Only one mother , namely-Ms.Afroza w/0 Mr.Shabir Ahmad R/O Margi have been referred

to PHC-Larnoo on dated : 23-08-14 and the amount of Rs.2500/= for the referral transport have been beard by Dr. Haqnawaz Kichloo MOIC ,from his own pocket and He didn’t got the money back.

Facility didn’t receive any fund for referral transport in 2014-15 Community people or mothers are not aware about the JSSK scheme


Few glimpses of PHC Afti……………….

Recommendation:

Ensure the availability of attached staff to PHC Afti to make it a functional 24X7 PHC and functional delivery point.

Ensure availability of SBA trained SN One lady doctor is very much essential to ensure the institutional delivery Provision of toilet and water supply is very much essential to start delivery Regular monitoring from block and district level Strengthening of referral mechanism Immunization camp at the community to cover the dropout and left out Follow up and tracking mechanism for pregnant, postnatal mother and child Ensure all types of registers should available at facility ASHA need to be more proactive to create awareness among the community for institutional

delivery and Immunization Regular RKS meeting need to be conducted


Major Findings of CHC Marwah

CHC Marwah is a designated FRU under the Dachhan block caters 14500 population scattered in 5 SCs, 2 Ads, 2 NTPHCs and 1 NTSC. The road connection is very poor at Marwah. There is no provision of electricity and network communication at this facility. During winter the road become block for 6 months.

Infrastructure:

CHC is functioning in old and very congested building and only 3 beds are there

Only one quarter is available at the facility 24*7 water facility is available at the facility There is no provision of electricity at the facility but under “Sat Bhavna Scheme” of army they

have provided generator set for this facility The road communication is very poor There is no such standard waste management mechanism for this facility

Manpower Status:

Manpower Status from NHM Side HR Sanctioned Posted Remarks

MO (MBBS) 2 2 one attached at DH Kishtwar Jr. SN 2 2 ( one available) 1 attached at PHC Dachhan LT 2 2 ( one available) 1 attached at PHC Dachhan OT Tech 2 2 There is no status of 1 OT Tech since April'15

X-Ray 2 2

PTS 4

Manpower Status from Regular Side HR Sanctioned Posted Remarks Medical Officer 2 0 Dental Surgeon 1 0 CHO 1 0 Health Educator 1 0 Head Pharmacist 1 0 Sup. Pharmacist 1 1 Attached at PHC Dachhan Jr. Grade Nurse 1 0

FMPHW 2 2 0ne attached at PHC Atholi and one at PHC Dachhan and both are SBA trained

Jr. Dental Tech. 1 0 Sr. Assistant 2 1 Nursing Orderlies 4 2 One attached at PHC Dachhan LHV 1 1 Attached at PHC Dachhan


Maximum number of staff is attached to another facility and services are being hampered at CHC Marwah due to this reason. Delivery is being conducted by the Sr. Pharmacist. One MO from RBSK is doing OPD.

Labour Room:

Labour room found clean and well maintained One labour table is available in the labour room Attached toilet is available with labour room All protocol posters are available inside the labour

room but not in specific place Eg. Breast feeding protocol posters was displayed over the hand washing place and hand washing protocol displayed elsewhere

Medicine tray, emergency tray, delivery tray, baby trays were welly labelled

NBCC is in place but not is use Basinet of the RW is not clean and RW is not properly

maintained One phototherapy unit is there but not in use. One oxygen concentrator provided by the army under

‘Sat Bhavna Scheme” available inside of the labour room

Designated hand washing place is available in the labour room

Color coded bins are available but only black plastic bag is available Inj. Oxytocin, Inj. Magsulph was available but oxytocin kept in trays. Foetal Doppler and autoclave is available Adult and newborn weighing machine both are available

Laboratory Test:

All diagnostic tests are free for pregnant women Outcome of laboratory test result not mentioned in the laboratory register

Equipmentreceivedunder“SathBhavnaScheme”ofArmy:

1. Generatorset 2. OxygenConcentrator 3. X-Raymachine 4. ECGMachine


ANC Status:

ANC clinic has been established in X-ray room 36 mothers are registered up to May’15, out of which only 3 mothers have received 3ANC. ANM has poor knowledge on ANC and high risk pregnancy There is no list of high risk pregnancy with the ANM There is no tracking mechanism of PW Due list is neither prepared by ANM or by ASHA

Services April May Total ANC Registration 16 20 36 1st Trim. Registration 7 20 27 3 ANC 14 24 38 Number of pregnant women given 100 IFA tablets 16 20 36

Number of mother severe anemia (Hb<7) 0 0 0 Live Birth 14 22 36 Still Birth 2 2 4 IUCD 0 0 0

Immunization

ANM doesn’t have clear idea about birth dose vaccination. Hepatitis birth dose vaccination given after one month No follow up or tracking mechanism There is provision of due list preparation by ANM or ASHA

Immunization service delivery of Marwah CHC up to May’15

Vaccination April May Total BCG 12 22 34 Pentavalent 1 3 11 14 Pentavalent 2 1 8 9 Pentavalent 3 2 16 18 OPV 0 (Birth Dose) 12 22 34 OPV1 3 11 14 OPV2 1 8 9 OPV3 2 12 14 Hepatitis-B0 12 22 34 Measles 6 5 11


Family planning:

Family planning service is very poor There is no status of IUCD insertion since Aprill’15 Only OCP and condoms are distributed Community awareness is very poor

ASHA:

10 ASHAs were interviewed regarding their functionality and home based newborn care

None of the ASHAs are well aware about the assured incentives and other incentives None of the ASHA received HBNC kit ASHAs have not clear idea about the home based new born care Drop out list is not prepared by any ASHA Pending liabilities of ASHA Incentives. Last meeting with ASHA was conducted by BM&EO, Dachhan

MCTS

Incomplete MCTS Register, maintained up to 20-01-15 and non-availability of HMIS Reports.

JSSK: Diagnostic tests are free for pregnant women Las year (2014-15) an amount of Rs. 30000 was received with an opening balance of Rs. 13130. Balance as on 1st April was 1041. Whole fund was utilized in dietary provision of post mother. There is no diet chart at this facility Since April’15 none of the mother received diet under JSSK scheme

JSY:

In 2014-15 170 mothers were benefitted under JSY scheme Total amount of 2 lakhs was received in 2014-15 with an opening balance of Rs. 73890.0 Rs. 50400.0 was paid to ASHA under JSY scheme Balance as on 1st April was Rs 40738 None of the mother received JSY payment from April’15

Duringconversationwithcommunity itwascame toknow thatnoneof thevolunteer in IPPI2ndround received the honorarium but acquaintance has been prepared at block level. As per thestatementgivenbylocalpeople,theredaccountfoundwasnothavingtheSignaturesoftheboothworkersandsupervisorsandtheirsignatureswereforgerydone.


Few glimpses of CHC Marwah…………..

Recommendation for better service delivery:

All attached staffs need to be detached for the benefit of the community and better service delivery

Ensure that deliveries are being conducted by the SBA trained staff nurse. MO of RBSK should be in the field Training ANM on Immunization and cold chain management Block and district level follow up


Major Findings at PHC Keruu

PHC Keruu under Kishtwar block catering near about 15000 population with an average delivery load of 10-12 per month. Average OPD is near about 300 and IPD 20 per month.

Manpower:

HR In position Remarks MO 1 MBBS MO 2 ISM Dental Technician 1 Regular Jr.SN 2 NHM LT 2 ( 1NHM) Pharmacist 1 1 ISM/NHM Sr. Pharmacist 1 Regular FMPHW 1 Regular

Staff Attendance:

The Attendance Register for the staff of NHM was maintained from May’15 instead of April’15. As per the attendance register one MO namely Dr. Anuradha-MBBS, is on Casual Leave with effect from

01-05-2015 to 06-05-2015 and Absent from 07-05-2015 to 11-05-2015 , then again casual Leave from 12-05-15 to 14-05-15 , then on leave from 10-05-15 to 17-06-15 and then no attendance marked from 18-06-15 to 20-06-15.

Labour room:

Labour room was very unorganized and unclean One labour table is available Mackintosh of the labour table was full with blood strains Only two trays were available one is for drugs and another is for delivery set, but none of the

trays were labelled Oxygen cylinder was available but without key NBCC is there but none of SNs are well aware about the RW handling RW basinet was not clean One sterilizer was available Labour room floor was very dirty


A team work for labour room transformation:


Team work……………


Present Status of Labour Room………..


ANC:

28 mothers were registered for ANC up to May’15 and none of the mother registered within 1st trimester

28 mothers received 100 IFA, ANM giving 100 IFA at a time to all pregnant women but there is no follow up of pregnant

women As per the register available with ANM none of the mother received 3 ANC but as per HMIS

report its shows that 9 mothers were received ANC 3. In spite of having Hb% testing facility ANM didn’t mention the Hb% status in ANC register There is no tracking mechanism of PW Line listing of high risk mothers not followed MCTS Register, HMIS report and village register were unavailable at the time of visit

Immunization and cold chain:

ANM kept lots of vaccine vial in vaccine carrier though she has not any due list of beneficiaries with her

Frozen Pentavalent vaccine found at vaccine carrier ANM has not clear idea about vaccination and cold chain

management There is drop out tracking mechanism One ILR and one DF available at the facility There is no practice of temperature recording None of the vaccines kept in ILR ANM kept all vaccines in domestic refrigerator available

inside the laboratory

Laboratory:

Functional laboratory available at the facility with 1 Lab Technician Lab register was unavailable at the time of visit and as per the MOIC it was send to block

Kishtwar for reporting Basic test like Hb%, urine, blood grouping are conducting here All diagnostic tests are free

Financial status:

As per the JSY Cash Book 2014-15, the funds available found were 15, 8980 up to 31-03-15, thus the cash book found was not maintained.

RKS funds found available up to 31-03-15 amount of Rs.43342 and cash book was not maintained for the year 2015-16.


Major Findings at District Hospital Kishtwar

Service delivery:

Service Delivery April May Total ANC Registration 23 31 54 ANC Registration within 1st trimester 5 7 12 Women registered under Janani Suraksha Yojana 23 31 54 3 ANC 56 30 86 TT1 21 25 46 TT2 or Booster 45 33 78 Deliveries conducted at the facility (Including C-Sections) 165 276 441 C -Section 50 67 117 Number discharged under 48 hours of delivery 115 209 324 Live Birth 164 261 425 Still Birth 5 15 20 Number of Newborns weighed at birth 169 276 445 Number of Newborns having weight less than 2.5 kg 3 2 5 Number of newborns breast fed within 1 hour of birth 164 261 425 Pregnant women with Obstetric Complications 67 67 134

Labour room:

Labour room has enough space but unorganized On an average 6-7 deliveries are being conducted 4 labour tables are available but none of the labour table has

mackintosh There is no partition in between the labour table, a curtain kept

back of the labour table 24*7 running water supply and attached toilet are available Color coded bins are available but the on duty staff has no clear

idea about the color coding of waste bins Partograph is not in practice Only two trays are available Standard labour room register is not being followed,

existing OPD register is being used as delivery register NBCC is in place, two RW is available inside the labour

room and one is non functional SNs have not clear idea about the Essential New Born

Care Management Radiant Warmer basinet was not clean and bandage, gauze and medicine found below the

bassinet towel

RW Basinet at LR


Post Natal Ward:

6 mothers were interviewed to assess the post natal care service Diet is being provided to all mothers Counseling on early initiation of breastfeeding is poor JSSK is not implemented properly Some of the mothers purchased medicine and consumable from outside Referral is not being provided to all, some of the mothers came with their own vehicle or hired

vehicle Birth dose vaccination is provided

Referral Mechanism:

11 ambulances are functional but only 5 drivers are available As per the MS there is no such maintenance fund for the vehicle and it is very difficult to maintain

the ambulance. He received an amount of 10 lakhs from MLA and out of which 3.5 lakhs was utilized for replacement of tier. Generally maintenance cost is utilized from HDF.

Laboratory service:

All tests and diagnostics are free for pregnant women and senior citizen Test wise user fees are charged for general patient

USG, ECG, X-ray and CT scan facility:

Functional USG unit and CT Scan units are available at the facility User charge for general patients is 100 Rs On an average USG load per moth is 600 ECG and X-ray charge for general patient is Rs. 50, but there is a problem of supply of films.

HDF funds are utilized for purchasing the films

Blood Bank:

Functional blood bank is available with an storage limit of 40 units Renewal of license is pending 2 functional blood storage refrigerators are available with proper labelling of blood group Blood collection unit is clean and well maintained

During the month of May 31 mothers received blood and 1 infant

Waste Management:

There is no such standard waste management mechanism. As per the MS waste pits are full and they made a waste storage dump shade in the hospital premises. Every Sunday Municipal Corporation collect the waste from hospital. The cost of the P Oil borne by the hospital.


JSSK Status:

JSSK Status April-May'15 April May Total No. of Pregnant Women given Drugs and consumables for Normal Deliveries 108 184 292 C-Section 26 32 58 No. of Pregnant Women provided free Diagnostics 345 415 760 Blood transfusion 1 19 20 No.of Pregnant Women provided diet for during Normal Deliveries 108 184 292 C-Section 26 32 58 During stay of sick children 0 No. of Pregnant Women given free referral transport from Home to facility 0 Drop back facility 37 57 94 Referral to higher facility 3 5 8 No. of Sick Neonates provided Drugs and consumable 28 48 76 No. of Sick Neonates given free referral transport from Home to facility 0 Drop back facility 2 3 5 Referral to higher facility 3 3

Out of 350 deliveries only 94 mothers received drop back facilities 8 mothers were referred to higher facilities 3 infant referred to higher facility till date

JSSK Financial Status 2014-15

Janani Shishu Suraksha Karyakram(JSSK)

Opening Balance as on 1st

April'2014

Fund Received in 2014-

15

Total fund for the year 2014-15

Expenditure Balance

as on 1.04.15

Drugs and Consumables for Normal Deliveries including ANC,INC & PNC 555573 3194699 3750272 3719242 31030

Drugs and Consumables for Caesarean Deliveries including ANC,INC & PNC 0 0 0 0 0

Diagnostic including ANC,INC & PNC 45226 300000 345226 334274 10952 Blood Transfusion 5000 5000 0 5000 Diet (3 days for Normal Delivery) 87500 409600 497100 497100 0 Diet (7 days for Caesarean) 65550 285000 350550 350550 0 Referral Transport for Pregnant women Home to facility 229 110000 110229 110229 0 Drop Back facility 31917 210251 242168 242168 0 Facility to Higher Facility 17116 240000 257116 257116 0

Sub Total JSSK 803111 4754550 5557661 5510679 46982


JSSK Financial Status 2014-15

Janani Shishu Suraksha Karyakram (JSSK) - (for Sick neonates & infants up to 1 yr.)

Opening Balance as on 1st

April'2014

Fund Received in 2014-

15

Total fund

for the year

2014-15

Expenditure Balance

as on 1.04.15

Drugs & Consumables for Infants 8000 8000 8000 0 Diagnostics 5952 5000 10952 10724 228 Free Referral Transport for Pick up and Drop Back Home 39547 10000 49547 49547 0

Iron Sucrose intervention 5000 5000 5000 0 Total 45499 28000 73499 73271 228

JSY Status:

Janani Suraksha Yojana / JSY 2014-15

Opening Balance as

on 1st April'2014

Fund Received in 2014-15

Total fund for the year 2014-15

Expenditure Balance

as on 1.04.15

Incentives to Mothers (Institutional Delivery) Rural 450600 2401200 2851800 2851800 0

Incentives to Mothers (Institutional Delivery) Urban 30000 101000 131000 131000 0

Performance Related incentive to ASHAs under JSY 5096 17800 106210 129106 122793 6313

Total 485696 2520000 106210 3111906 3105593 6313

Financial Status:

No cash books of JSSK, JSY & RKS were produced for verification by the concerned staff. As the post for District Hospital Accounts Manager is vacant so the work has been given to ARSH

data entry operator. Drug register under JSSK found incomplete only MRD NO and contact no is mentioned there, no

other details for verification is given. Expenditure for current financial year is nil.


SNCU:

Functional 10 bedded SNCU is available at DH One pediatric, One SNCU in-Charge, 4 Medical Officers and

5 SNs are designated for SNCU At the time of visit Paediatric and SNCU in charge was present Basinet of the RW was not clean SNCU Sister in charge has not clear idea about RW handling There is no standard register for SNCU SNCU reporting system is poor, major portion like delivery, CS and birth weight are missing in

the report available with SNCU in Charge Maximum duration stay at SNCU is 1-2 days There is no systematic follow up system of SNCU discharge babies, those who are coming at

their own received the follow up

Service delivery:

Admissions in the unit

April May Total

Inborn Out born Inborn Out born Inborn Out born

Male 18 3 25 5 43 8

Female 6 1 14 4 20 5

Total 24 4 39 9 63 13

Since April’15 76 newborns are admitted in SNCU Out born admissions are very low

Cause of admission:

Sepsis Pneumonia Respiratory distress Hypothermia

RW basinet at SNCU


Outcome:

Outcomes April-May'15 April May Total

Discharge 25 43 68

Referral 1 3 4

Left against medical advice (LAMA) 0 1 1

Died 2 1 3

Other findings:

Basic requirements like shoe caps, head caps, hand sanitizer etc. are not available. Operational cost of an amount of 5 lakhs received in 2014-15 and as per the FMR 5 lakhs have

been utilized.

89.5

5.3

1.33.9

Outcomes of SNCU Admission Babies

Discharge Referral Left against medical advice (LAMA) Died


Glimpses of DH Kistwar………….

Major recommendation for better service delivery:

Staff need to be more cooperative, basic record need to be shared and discussed with the monitoring officials during their visit

Orientation of SNCU sister in charge on NSSK is very much essential Labour room staff nurse need to be oriented on ENBC Proper cleanliness of labour room is very much essential Ensure availability of fund of different programme like JSY, JSSK etc. Basic supplies for need to be assured from MS level Standard labour room register need to be implemented for proper recording Labour room protocol need to be followed by the staff nurse Monthly monitoring of DPMU staff is very much essential to monitor the progress of ongoing

NHM scheme.


Feedback sharing Meeting with CMO:

Feedback sharing meeting was held with CMO on 20th June after completion of visit. Facility wise details feedback share with him for his action.

Major points discussed:

1. All the attached staff need to be detached at Dachhan block for better service delivery and functionality of the facility

2. Requirement of one lady doctor at PHC Afti to start the delivery 3. Availability of SBA trained staff nurse at delivery point 4. Proper implementation of JSSK at PHC Afti, CHC Marwah, PHC Keruu and DH 5. Strengthening the tracking mechanism for ANC, PNC and Immunization 6. Regular attendance of staff at facility 7. Regular monitoring of facility by concerned BMO 8. Register availability at facility level 9. Immunization and family planning status of the facility visited 10. Regular monitoring of ASHA functionality 11. DMPU staff along with the District Coordinator-RMNCH+A filed visit

Decision taken:

Matter regarding the detachment of staff shall be discussed with the higher authority DPMU and District Coordinator-RMNCH+A will monitor District hospital twice in a month to

review the progress of NHM programme All the findings will be shared with the BMO in coming meeting for their feedback and

rectification A letter will be issued to BMO for proper recording and reporting District ASHA Coordinator and Block ASHA coordinator will monitor the functionality of

ASHA on regular basis Priority should be given on SBA training for smooth delivery Refresher training on Immunization and Cold Chain Management will be organized in the month

of July;15


Submitted By:

Tapas Chatterjee State Coordinator-RMNCH+A Jammu & Kashmir

Documents

KISHTWAR DISTRICT VISIT REPORT DATE: 17.06.2015 … DISTRICT VISIT REP… · · 2016-03-09KISHTWAR DISTRICT VISIT REPORT DATE: 17.06.2015-20.06.2015 ... Protocol posters are available