Supportive supervision report to Bargarh, Orissa


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SUPPORTIVE SUPERVISION REPORT TO BARGARH, ORISSA

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Contents
The Context......................................................................................................................................... 3 Bargarh Healthcare ............................................................................................................................. 4 Infrastructure Upgradation .................................................................................................................. 6 Human Resource ................................................................................................................................. 7 Facility assessment.............................................................................................................................. 8 DHH Baragarh ..................................................................................................................................... 8 CHC Barapali....................................................................................................................................15 SDH Padampur ................................................................................................................................. 20 CHC Sohella ..................................................................................................................................... 23 Talpali PHC ...................................................................................................................................... 26 Gaisilet NPHC .................................................................................................................................. 29 PHCN Kamgaon ............................................................................................................................... 32 SHC Gaisilet ..................................................................................................................................... 35 SHC Lenda (kadalipali Club)............................................................................................................35 Phulapali Anganwadi (Kusanpuri Sub Centre) ................................................................................. 35 Maidhanumunda Village...................................................................................................................36 Findings and recommendations ........................................................................................................ 38

Bargarh, Orissa

Page 2

Supportive Supervision Report on High Focus District Bargarh, Orissa
The Context
An inscription of the 11th Century A.D. mentions name of the place as "Baghar Kota.” It was called "Bargarh" headquarter of Balaram Dev, the Chauhan Raja of Sambalpur. The headquarter of the district is situated on the left bank of Jira River connected by National Highway 6. Baragarh, spread across area of 5837 sq. Km, has 2 sub divisions, ten tahasils, twelve CD blocks, one Municipality, 248 Grampanchayat and 1208 Revenue Villages. The average annual rainfall in the district is 1527 mm.

Bargarh, Orissa

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A Brief Profile of the District

Geographical Area No. of Subdivisions No. of Tahasils
No. of CD Blocks
No. of Municipalities No. of Grampanchayat (GP) No. of Revenue Villages Population Population Density Literacy Rate Population Distribution

5837 (in Sq. Kms) 2 (Bargarh & Padampur) 10 (Attabita, Bargarh, Barpali, Bhatli, Bheden, Padampur, Paikmal, Sohella, Bijepur & Gaisilet) 12 (Ambabhona, Attabira, Bargarh, Barpali, Bhatli, Bheden, Bijepur, Gaisilet, Jharbandh, Padampur, Paikmal & Sohella) 1 (Bargarh) 248 1208 1242795 231 per Sq. Km 64% (Male: 77% Female: 50%) 92.3% rural, 7.7% Urban

Bargarh Healthcare
The blocks have been arranged in the descending order of the population. Baragarh block is 5th in terms of the area but has second highest population and has highest number of health facilities.

Blocks Area sq km Population DH

Attabira

404.96

153195

0

Bargarh

369.37

146407

1

Sohela

515.11

125570

0

Bheden

362.75

122362

0

Barpali

266.18

102323

0

Paikmal

564.64

100032

0

Padampur

488.4

99882

0

Bijepur

323.94

95843

0

Bhatli

355.55

84909

0

Gaisilet

354.93

79335

0

Jharbandh

422.97

69266

0

Ambabhona 182.26

63671

0

Total

1242795 1

CHC 1 0 1 1 1 1 0 1 0 0 1 0 7

BPHC 0 0 0 0 0 0 0 0 1 0 0 0 1

PHC 1 1 0 0 1 0 1 0 0 1 0 1 6

PHCN 4 4 6 6 3 5 3 3 2 3 2 3 44

HSC 22 23 19 21 19 16 17 14 15 14 12 12 204

Bargarh, Orissa

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Bargarh, Orissa

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Infrastructure Upgradation
A total of 27 health facilities are to be upgraded in the current year. Padampur SDH is to be upgraded to level 3 in the year 2010-11. Four CHCs of level I are to be converted to level II institutions.

Sr. Name of the

No.

Facility

1 Padampur

2 Attabira

3 Bheden

4 Dava

5 Bukuramunda

6 Talpali

7 Bhutka

8 Bhatli

9 Katapali

10 Paikmal

11 Gaisilet

Category Current Level Proposed

SDH

II

III

CHC

I

II

CHC

I

II

CHC

I

II

CHC

I

II

PHC

I

II

PHC

I

II

PHC

I

II

PHC

I

II

PHCN

I

II

PHCN

I

II

Two PHCN are to be upgraded to level II from current level I. There are 16 subcentres to be operationalised in the current year. Details of some of the institutions assessed during the visit shall be dealt in the facility assessment section.
One SNCU at the district hospital is to be fully operationlised in the year 2010-11. There are 11 health facilities (8 CHC, 2 SDH and 1 DHH) to be provided with a stabilisation unit in the current year.

Bargarh, Orissa

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Human Resource

Post Specialists Total Medical Officers Pharmacists Staff Nurse BEE Male Supervisors Female Supervisors MPHW (Male) MPHW (Female) Lab Technician (Pathology) PMW Drivers

Sanctioned 28 89 62 41 12 52 40 145 257 18 34 26

In Position 22 72 62 32 6 7 29 122 242 15 16 17

Vacant 6 17 0 9 6 45 11 23 15 8 18 9

Human Resource Requirement in Bargarh
Numbers % of total required
87

44 50 53 45

35

15

23 16

17 19

21

22

28

6

6

9

11

9

8

18 6

Eighty seven percent of the posts of male supervisor are vacant. For meeting the current requirement, 45 male supervisors are to be recruited. The district has 19 percent shortfall of the medical officers. Though number is not alarming, the medical officer is cardinal part of the service delivery and should be given apt attention.

Bargarh, Orissa

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Facility assessment
The visit was made from 22.06.2010 to 25.06.10. During this period, following institutions were visited. There is ample repetition of the findings between each individual health facility. However, it is important to examine each facility on most possible indicators and record it. This may help when the authorities in charge of the particular health institution refer to the report. It is important that they find the recommendation specifically for their hospital and not the generic advises. The consultant has taken a chance to sound repetitious with the hope of incremental improvements in each of the visited hospital. It is also desired that the recommendations be conveyed to other hospitals in the district so as to improve delivery of services. Following health institutions were visited to assess the facility according to the given format. Anganvadi was visited to examine the functioning of immunization day.
 DHH Bargarh  CHC barapali  CHC Padampur  CHC Sohella  PHC Talpali  PHCN Gaisilet  PHCN Kamgaon  SC Gaisilet  SC Lenda (kadalipali Club)  AW Phulapali  Village Maidhanumunda
DHH Baragarh
The doctors are available round the clock for emergency cases and labour cases. Family planning services are also available at the facility. There are no fixed days for the ANC clinics or RTI/STI clinics. The health education messages were present on almost every wall of the hospital and have good visibility. There is no public display of the JSY beneficiaries.
The campus is relatively clean and does not have biomedical waste all over the campus as seen in most of the other facilities.
Facility Assessment
The facility scored 59% points based on the facility assessment format. Due to heterogeneous nature of the indicators evaluated, the points scored by the facility have been converted into percentages to give a fair idea of the scoring on each account. (Raw scores can be seen in Annexure III)

Bargarh, Orissa

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DHH Bargarh

100

100

88

83

75 79

61 57

The facility scored well in terms of availability of the equipments, OT equipments and services. However, on other accounts, it did not fare well. Overall score of the facility is also on the lower side.
The walls and roof of the building were in good condition. The electric connections were well insulated and switch boards were in good condition. There were electric bulbs in the corridors and pathways to toilet. The wards had been whitewashed from inside. The signage was present at most of the necessary locations. The hospital rooms were not dumped with the condemned articles. Enough seating arrangement was present for the OPD waiting area.
The wards had intact window glasses. This was the only hospital where the mosquito screens were found on the windows. However, the windows did not have curtains for ensuring the privacy of the patient. Sufficient number of fans was present in the working condition. The bed sheets were not provided to all the patients. The number of stools for the attendant in the ward was not sufficient. Some of the cots in the ward need to be repaired. Some of the Mattresses also were in worn out state, torn and had coir coming out of them. Dust bins for the wards were not sufficient. IV stands were also not available in the sufficient number. Running water supply was present in the labour room and the toilets. However, the cleanliness of the toilets is a concern. The Patients have been provided with 2 water purifiers for OPD and IPD patients. The water purifiers have been installed inside metal cages to prevent stealing of taps which had happened in the recent past.
The hospital has trolley and stretcher but does not have a wheelchair in working condition. The hospital has enough supply of sterilised gloves. The supply of the drugs was also sufficient according to the medical officer.
The labour room has two spot lights. One of them was not in working condition. The labour room has 4 labour tables and the labour tables have been separated with the help of plywood

Bargarh, Orissa

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separators which have wheels. These separators are portable and can be easily moved around in case the need arises.

The labour boards were not broken or rusted and were in a working condition. Labour room had resuscitation equipments for the newborn along with mucous sucker and baby weighing machine. Partograph was not maintained and display of the protocols for the active management of the third stage of the labour was missing in the labour room. There were curtains in the labour room to ensure privacy of the patients. There was no separate column in the delivery register for recording major complications leading to maternal death. The register mentions the status of the child at the birth but not the status of the mother after delivery. All the JSY beneficiaries were paid after the delivery and there was no backlog of the JSY payments.
The operation theatre was in working condition. According to the hospital manager, the Boyle’s apparatus was not working. The OT had an ante room. Colour coded buckets were used but in separation and not as a set. The hospital had functioning autoclave.
The hospital has condemnation area for the biomedical waste but the area is not suitable for the purpose. The area shares one of its 4 walls with the toilets. The area within these walls is being used for dumping the medical waste.

Bargarh, Orissa

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Supportive supervision report to Bargarh, Orissa