RCH- ARSH Program (2010-11)Reporting formats from Civil Surgeon’s office to State Office, NRHM

Name of District : GONDIA

Reporting Format

MONTH - MAY. 2011

District Hospital Gondia 2010-11 May-11

Information regarding ARSH Clinic District Name

GondiaYes

If Yes, location of the space - Near OPD

If no, which space is being used for the clinics –

Tuesday 11.00am To 2.00 pm

Yes

Yes

No

Yes

Yes

Yes

Yes

Yes

Yes

No

Using Services of DH lab.

No

q) Formation of Adolescent Health Committee. ( Bring the orders reg. the committee ) Yes

Nil

a)    Availability of separate ( designated ) space –

b)   Fixed timings / days -

c)  Availability of essential furniture provided for the clinics.(Pl. give details)

d)   Provisions made for maintaining confidentiality/ privacy. (Pl. give details)

e)  Name of Medical Officer designated for the clinics (Nodal Officer) with qualification & training status under ARSH.

Dr.Ajay Ghormare, Dr. D.P. Pardhi

f)    Name of another Medical Officer who will look after the clinic in the absence of first Medical Officer with qualification & training status under ARSH.

g)    Whether Waiting area, sitting arrangements, drinking water & clean toilet facilities available. (give details)

h)    IEC material available. (give details)

i)    Whether Health exhibition is available at the clinic site.

j)    Separate staff designated for ARSH Clinic –

Names & designations of staff assigned for clinic or staff given additional duties- Names with designation & original duties.

Mr. Sanjay Bisen (cons.), Mrs.Chhabu Kanere (Staff Nur.) Mrs. Ashvini Dehare(Staff Nur.)

k)  Whether Appropriate sign board displayed.(Maitree Clinic )

l)    Whether counselor appointed at district hospital for ARSH clinics.

m)   If yes give name and date of joining. Mr. Sanjay Bisen (cons.) 1st sep. 2009

n)   Involvement of counselors working in ICTC at Sub District/ Rural/ Hospitals in ARSH activities - ( Mention details).

o)   Provision of essential laboratory / other investigations.( give details )

p)  Involvement of educational institutions at District HQ.

r) Dates of committee meetings held so far. ( Bring the minutes of last meeting )

Womans Hospital Gondia 2010-11 May-11

Information regarding ARSH Clinic District Name

GondiaYes

If Yes, location of the space - Near OPD

If no, which space is being used for the clinics –

Thursday At 1.00am To 3.00 pm

Yes (Table-1,Chair-4 )

Yes

Dr.Sanjay Dodke(MBBS,Pead)

Yes

Yes

NO

Yes

Yes

Yes

No

Using Services of BGW lab.

No

q) Formation of Adolescent Health Committee. ( Bring the orders reg. the committee ) Not Format

Nil

a)    Availability of separate ( designated ) space –

b)   Fixed timings / days -

c)  Availability of essential furniture provided for the clinics.(Pl. give details)

d)   Provisions made for maintaining confidentiality/ privacy. (Pl. give details)

e)  Name of Medical Officer designated for the clinics (Nodal Officer) with qualification & training status under ARSH.

Dr.Asha Agrawal(MBBS,Gyne)

f)    Name of another Medical Officer who will look after the clinic in the absence of first Medical Officer with qualification & training status under ARSH.

g)    Whether Waiting area, sitting arrangements, drinking water & clean toilet facilities available. (give details)

h)    IEC material available. (give details)

i)    Whether Health exhibition is available at the clinic site.

j)    Separate staff designated for ARSH Clinic –

Names & designations of staff assigned for clinic or staff given additional duties- Names with designation & original duties.

Mr. Sanjay Bisen (cons.), Mrs.Vishranti Lonare (Staff Nur.)

k)  Whether Appropriate sign board displayed.(Maitree Clinic )

l)    Whether counselor appointed at district hospital for ARSH clinics.

m)   If yes give name and date of joining. Mr. Sanjay Bisen (cons.) 1st sep. 2009

n)   Involvement of counselors working in ICTC at Sub District/ Rural/ Hospitals in ARSH activities - ( Mention details).

o)   Provision of essential laboratory / other investigations.( give details )

p)  Involvement of educational institutions at District HQ.

r) Dates of committee meetings held so far. ( Bring the minutes of last meeting )

Sub District Hospital Tirora 2010-11 May-11

Information regarding ARSH Clinic District Name

GondiaYes

If Yes, location of the space - Near OPD

If no, which space is being used for the clinics –

Wednesday At 1.00am To 3.00 pm

Yes (Table-1,Chair-4 Almari-1 )

Yes

Dr.Sachin Bansod (MBBS)

Yes

Yes

Yes

Yes

Yes

Yes

No

Using Services of SDH lab.

No

q) Formation of Adolescent Health Committee. ( Bring the orders reg. the committee ) Yes

Nil

a)    Availability of separate ( designated ) space –

b)   Fixed timings / days -

c)  Availability of essential furniture provided for the clinics.(Pl. give details)

d)   Provisions made for maintaining confidentiality/ privacy. (Pl. give details)

e)  Name of Medical Officer designated for the clinics (Nodal Officer) with qualification & training status under ARSH.

Dr.Rekha Ramteke (MBBS)

f)    Name of another Medical Officer who will look after the clinic in the absence of first Medical Officer with qualification & training status under ARSH.

g)    Whether Waiting area, sitting arrangements, drinking water & clean toilet facilities available. (give details)

h)    IEC material available. (give details)

i)    Whether Health exhibition is available at the clinic site.

j)    Separate staff designated for ARSH Clinic –

Names & designations of staff assigned for clinic or staff given additional duties- Names with designation & original duties.

Mr. Sanjay Bisen (cons.), Mrs.Priti Katre (Staff Nur.)

k)  Whether Appropriate sign board displayed.(Maitree Clinic )

l)    Whether counselor appointed at district hospital for ARSH clinics.

m)   If yes give name and date of joining. Mr. Sanjay Bisen (cons.) 1st sep. 2009

n)   Involvement of counselors working in ICTC at Sub District/ Rural/ Hospitals in ARSH activities - ( Mention details).

o)   Provision of essential laboratory / other investigations.( give details )

p)  Involvement of educational institutions at District HQ.

r) Dates of committee meetings held so far. ( Bring the minutes of last meeting )

Rural Hospital Deori 2010-11 May-11

Information regarding ARSH Clinic District Name

GondiaYes

If Yes, location of the space - Near OPD

If no, which space is being used for the clinics –

Friday 2.00pm To 4.00 pm

Yes

Yes

Dr.P.Nikhade

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Using Services of RH lab.

Yes

q) Formation of Adolescent Health Committee. ( Bring the orders reg. the committee ) Yes

1/17/2011

a)    Availability of separate ( designated ) space –

b)   Fixed timings / days -

c)  Availability of essential furniture provided for the clinics.(Pl. give details)

d)   Provisions made for maintaining confidentiality/ privacy. (Pl. give details)

e)  Name of Medical Officer designated for the clinics (Nodal Officer) with qualification & training status under ARSH.

Dr.Dipak Dhumankhede

f)    Name of another Medical Officer who will look after the clinic in the absence of first Medical Officer with qualification & training status under ARSH.

g)    Whether Waiting area, sitting arrangements, drinking water & clean toilet facilities available. (give details)

h)    IEC material available. (give details)

i)    Whether Health exhibition is available at the clinic site.

j)    Separate staff designated for ARSH Clinic –

Names & designations of staff assigned for clinic or staff given additional duties- Names with designation & original duties.

Mr.Pramod Kadmkar (ICTC cons.), Smita Dhale (Staff Nur.)

k)  Whether Appropriate sign board displayed.(Maitree Clinic )

l)    Whether counselor appointed at district hospital for ARSH clinics.

m)   If yes give name and date of joining.

n)   Involvement of counselors working in ICTC at Sub District/ Rural/ Hospitals in ARSH activities - ( Mention details).

o)   Provision of essential laboratory / other investigations.( give details )

p)  Involvement of educational institutions at District HQ.

r) Dates of committee meetings held so far. ( Bring the minutes of last meeting )

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Name of District Hospital,GondiaMonth-MAY - 2011

Month wise attendance at ARSH clinic during 2010-11Particulars During Month Progressive

Male Female Total Male Female Total1 Attended clinic on their own 10 10 20 42 35 77

2 Referred 0 0 0 13 12 25

3 Total 10 10 20 55 44 99

4 Married 2 3 5 12 9 21

5 Unmarried 8 7 15 43 35 78

6 Services provided 0 0 0 0 0 0

i Ante natal 0 0 0 0 0 0

ii ECP and counseling 0 0 0 0 0 0

iii TT 0 0 0 0 0 0

iv IFA and counseling 0 3 3 2 10 12

v Counseling for MTP 0 0 0 0 0 0

vi Treatment of RTI / STI 0 0 0 8 3 11

vii Menstrual problem 0 7 7 0 14 14

viii 5 6 11 8 9 17

ix Violence 0 0 0 0 0 0

x Screening of Goiter, sickle cell 0 0 0 0 0 0

xi 10 10 20 30 23 53

xii Contraceptives 7 4 11 19 12 31

7 Referred to DH / WH 0 0 2 2 0 2

Sr.No.

Counseling for sex problem & scholastic problems

Counseling for life skills, social skills

Name of WH : Bai Gangabai W.H. GondiaMonth-MAY- 2011

Month wise attendance at ARSH clinic during 2010-11Particulars During Month Progressive

Male Female Total Male Female Total

1 Attended clinic on their own 3 8 11 164 444 608

2 Referred 0 0 0 22 41 63

3 Total 3 8 11 186 485 671

4 Married 0 0 0 12 15 27

5 Unmarried 3 8 11 174 470 644

6 Services provided 0 0 0 0 0 0

i Ante natal 0 0 0 0 0 0

ii ECP and counseling 0 0 0 0 0 0

iii TT 0 0 0 0 0 0

iv IFA and counseling 0 3 3 18 40 58

v Counseling for MTP 0 0 0 0 0 0

vi Treatment of RTI / STI 0 0 0 3 2 5

vii Menstrual problem 0 4 4 0 19 19

viii 0 1 1 3 8 11

ix Violence 0 0 0 0 0 0

x Screening of Goiter, sickle cell 0 0 0 0 1 1

xi 3 8 11 11 33 44

xii Contraceptives 3 2 5 5 10 15

7 Referred to DH / WH 0 0 0 0 0 0

Sr.No.

Counseling for sex problem & scholastic problems

Counseling for life skills, social skills

Name of SDH : TiroraMonth-MAY- 2011

Month wise attendance at ARSH clinic during 2010-11Particulars During Month Progressive

Male Female Total Male Female Total1 Attended clinic on their own 6 4 10 193 155 348

2 Referred 3 2 5 17 20 37

3 Total 9 6 15 210 175 385

4 Married 0 0 0 6 1 7

5 Unmarried 9 6 15 204 174 378

6 Services provided 0 0 0 0 0 0

i Ante natal 0 0 0 0 0 0

ii ECP and counseling 0 0 0 0 0 0

iii TT 0 0 0 0 0 0

iv IFA and counseling 0 6 6 7 21 28

v Counseling for MTP 0 0 0 0 0 0

vi Treatment of RTI / STI 0 0 0 10 5 15

vii Menstrual problem 0 5 5 0 12 12

viii 0 0 0 8 12 20

ix Violence 0 0 0 0 0 0

x Screening of Goiter, sickle cell 0 0 0 0 0 0

xi 9 6 15 19 21 40

xii Contraceptives 5 2 7 13 8 21

7 Referred to DH / WH 0 0 0 0 0 0

Sr.No.

Counseling for sex problem & scholastic problems

Counseling for life skills, social skills

Rural Hospital DeoriMonth-MAY- 2011

Month wise attendance at ARSH clinic during 2010-11Particulars During Month Progressive

Male Female Total Male Female Total1 Attended clinic on their own 6 7 13 42 81 123

2 Referred 0 0 0 0 0 0

3 Total 6 7 13 42 81 123

4 Married 0 0 0 0 0 0

5 Unmarried 6 7 13 42 81 123

6 Services provided 0 0 0 0 0 0

i Ante natal 0 0 0 0 0 0

ii ECP and counseling 0 0 0 0 0 0

iii TT 0 0 0 0 0 0

iv IFA and counseling 2 4 6 11 21 32

v Counseling for MTP 0 0 0 0 0 0

vi Treatment of RTI / STI 3 2 5 8 8 16

vii Menstrual problem 0 5 5 0 18 18

viii 0 0 0 0 0 0

ix Violence 0 0 0 0 0 0

x Screening of Goiter, sickle cell 0 0 0 0 0 0

xi 6 7 13 30 50 80

xii Contraceptives 2 2 4 9 17 26

7 Referred to DH / WH 0 0 0 0 0 0

Sr.No.

Counseling for sex problem & scholastic problems

Counseling for life skills, social skills

Outreach Activities during 2009-10Dist- Gondia

Activity Venue Issues discussed

1Youth melava 11/12/2009 60 Z.P. Gondia ARSH, HIV-AIDS

Outreach Activities during 2009-10

Sub Distirct Hospital Tirora Distirct:- Gondia

Activity Venue Issues discussed

1 Youth Melava 11/11/2009 60 SDH Tirora ARSH, HIV-AIDS

Outreach Activities during 2010-11Sub Distirct Hospital Tirora Distirct:- Gondia

Activity Venue Issues discussed

1 Youth Melava 2/23/2010 50 Gandhi Vidhalaya Tirora ARSH, HIV-AIDS2 Camp 2/24/2010 35 SDH Tirora ARSH, HIV-AIDS3 Camp 3/10/2010 31 SDH Tirora ARSH, HIV-AIDS4 Youth Melava 3/20/2010 100 Sahid Mishra Vidhalaya Tirora ARSH, HIV-AIDS

Sr. No.

Date organized

No. of participants

Co-ordinating agency

Sr. No.

Date organized

No. of participant

Co-coordinating agency

Sr. No.

Date organized

No. of participant

Co-coordinating agency

Outreach Activities during 2010-11

Dist- Gondia

Activity Venue Issues discussed

1 Information 7/23/2010 35 High School Dhapewada ARSH, HIV-AIDS

2 Information 8/16/2010 30 High School Bhanpur ARSH, HIV-AIDS

3 Information 9/14/2010 30 Govt. Ashram School Gondia ARSH, HIV-AIDS

4 Information 9/20/2010 40 ARSH, HIV-AIDS

5 Information 10/13/2010 35 ARSH, HIV-AIDS

6 Information 10/16/2010 34 Sarshwati Jr. College Gondia ARSH, HIV-AIDS7 Information 6/12/201 25 Adasi Tanda High School Adasi ARSH, HIV-AIDS8 Information 12/9/2010 23 Bhanpur High School Bhanpur ARSH, HIV-AIDS9 Information

12/13/201030 ARSH, HIV-AIDS

10 Information 12/26/2010 27 Shreram High School Khamari ARSH, HIV-AIDS11 Information 1/3/2011 20 Hindal Madhamik School Mundipar ARSH, HIV-AIDS12 Information 1/8/2011 25 Shriram Vidhalaya Kamari ARSH, HIV-AIDS13 Information 1/25/2011 25 Z.P. Varith High School Banathar ARSH, HIV-AIDS14 Information 1/27/2011 22 G.E. S. High School Kamtha ARSH, HIV-AIDS

Sr. No.

Date organized

No. of participants

Co-ordinating agency

Sant. Gyaneshwar Ashram School, Pandharabodi

Rajiv Gandhi College Of Socialwork, Gondia

Rastriya Madhyamik Vidhyalay Savari