Jan Samvad (Public dialogue) at Roop Nagar, Punjab On June 5, 2014

Introduction

Community-based Monitoring of health services is a key strategy of National Rural Health Mission (NRHM) to ensure that the services reach those for whom they are meant, especially for those residing in rural areas, the poor, women and children. Community Monitoring is also seen as an important aspect of promoting community led action in the field of health.

Process Adopted

RRC Mamta in collaboration with department of Health and Family Welfare conducted community Monitoring in two districts of Punjab on pilot basis. From each district , two blocks were selected and from each block 3 PHCs were taken . In each PHC 5 villages were selected . In this way 15 villages from block Kiratpur Sahib and 16 villages from block Chamkaur Sahib were covered and total 31 villages were taken. In District Roop Nagar selected blocks were Kiratpur Sahib and Chamkaur Sahib . NGOs were selected to conduct community Monitoring .

Following activities were done:

Activity at CHC level:

One interview with CHC Medical officer
Exit interview of 5 patients at CHC level
Observation of CHC using checklist

Activity at PHC level:

One interview with PHC Medical officer
Exit interview of 5 patients at PHC level
Observation of PHC using checklist

Activity at Sub center level:

Observation of Sub-center using checklist

Activity at Village level

One group discussion with community members
One group discussion with women
One group discussion with marginalized women
One interview with ASHA
Interview with five women who have delivered in last three months

Formats used were developed and printed by Department of Health and Family welfare, Government of Punjab. After all the activities enlisted above cumulative report card was developed , which were shared in Jan Samvad.

Public dialogue /Jan Samvad: In district , Jan samvad was held at Bhasin Bhawan, Roop Nagar .

Officials present

State Programme Manager : Dr. V.K. Gagneja
Consultant Community processes: Dr. Monika Pathak
Mr. Daman Ahuja, AGCA Representative, Government of India.
Civil Surgeon, SBS Nagar: Dr. Surinder Ghangad
District Family Welfare officer, Dr. J.N. Sharma
District program manager: Ms. Reetika
SMO Kiratpur Sahib:Dr. Sunil Thakur
SMO Chamkaur Sahib: Dr. Jaspal
District Mass Media officer: Mr. Jagat Ram

Panel Members:

Mr. Satinder Satti, District Beauro Chief, Daily Ajit
Mr. Narender Singh Nali , Chairperson BPM Committees
Dr. A.K. Chadhoury Retd. Civil Surgeon
Ms. Manjula Sharma
Mr. B.D. Vashitat

Community Persons present: 135 Persons were present

PRIs
Women Panch
Village women
ASHA
ANMs

Following issues needs attension in block Kiratpur Sahib and chamkaur sahib:

Janani Suraksha Yojna
Disease Surveillance
Untied fund
Quality of care
Equity Index
Adverse outcome or experience reports
Analysis was done to know the reason of Gap in the services, the details of which are as follows:
Janani Suraksha Yojna:
Block Kiratpur Sahib:
No. of women who delivered last three months:- 35
No. of Government Deliveries : 17
Private Hospital deliveries:- 18
JSY Received:- 11
JSY not received- 6 (3 Gen. Category institutional Delivery)

Under this issue there is some percentage of deliveries were private deliveries (18 out of 35 ), only 17 were Goverment hospital deliveries. Although block Kiratpur Sahib people are aware about benefits of institutional deliveries but most of the deliveries i.e. 50% were private hospital deliveries . 3 women were not able to take the JSY benefit due to procedural delays.

Block Chamkaur Sahib:

No . of Pregnant Women interviewed:- 15
No. of Government Deliveries :- 7
Private Hospital deliveries :-5
JSY Received:- 2
No. of home deliveries:- 3
JSY not received:- 4

Under this issue most of the deliveries were Government hospital deliveries (7 out of 15), Still 30% deliveries are private hospital deliveries . Although in block Chamkaur Sahib people are aware about benefits of institutional deliveries but most of women complained about lack quality of care and behavoural problems at government institutions as the reason for opting private delivery

Action Taken:

The major cause of turning JSY issue red is high percentage of private hospital deliveries as only one gyeanacologist is posted at Kiratpur Sahib. It was recommended by panel members, community members that more gyaenacologist should be posted in the district hospitals . The proposal was accepted by officials present.

Untied fund:Although community is aware about untied but awareness level is low on utilization of untied fund in most of villages visited untied fund is used for purchasing chairs, durries for anganwadi center. Untied fund is also used for repair of roads or cleaning of streets or pond but there is need to build the capacities of VHSNC members for utilization of untied fund for curative and disease prevention services

Action Taken:

Although people have awareness about untied fund but members of VHSNC requires more capacity building on the issues of utilization of untied fund. It was perceived that continues training should be given to VHSNC members so as to make the fully capable undertake responsibilities of their respective VHSNCs

Disease Surveillance: This issue is red because in most of villages MPHW post is vacant and most of functions are performed by ANM Posted in that area.birth death are registered by ANM. She visits the community area in case of spread of specific disease.No. of villages where MPHW(M) not posted:- Khokhran, Chuhar Majra .

Action Taken:

There is policy decision that there should no more recruitment of MPHW(M) as there is more need of MPHW(F) . So large no. of females are being recruited to provide services. As female workers are needed to provide services to vulnerable population such as pregnant women , lactating mothers, eligible women and childern

Quality of Care: For quality of care questions related behavior of medical and paramedical service providers were asked . The behavior of all ANMS found to be good but in case of staff nurse and PHC medical officer only 50% people said it is good remaining 50% said it was average.

villages which said the behavior of ANM , PHC Nurse, Medical officer was average:

No. of person present in the meeting:-

Tapprian Amar Singh (20 members Attendede the meeting
Bhurare (25 members attended the meeting)

Action taken: It was felt by panel members as well as service providers, there is need to provide training on providing quality of care to para medical staff as well as medical staff.

Adverse outcomes:

Six villages which are listed as follows:

Ban Majra
Barsalpur
Kakrali
Rasidpur
Wajidpur
Bhurdey

No. of villages in red:-

Bann Majra:-Name- Chand Devi w/o Ram Chand Age -27 Caste BC (Home Delivery) after few days started heavy bleeding and Fever.
Barsaalpur:- Name - Kuldeep kaur w/o Sr. Jagtar Singh delivery case in private hospital after delivery her child’s death in private hospital in her parents house.
Kakrali:- Name - Preet kaur w/o Gurwinder Singh Age- 22 years Caste- SC Dated 10-August -2012 her deliver case in Mohali -6 Phase Hospital after delivery her child’s death and after few days started heavy bleedings and fever.
Raseedpur:-Name- Smt Mamta Rani w/o Ashok Kumar Age - 24 years caste - category Delivery at Behrampur Bet (Dr. Dharampal Hospital Private) She gave birt female child died after two days birth D.O.B -17-12-2013 D.O.D- 18-12-2013 in normal delivery case.
Bazeedpur:-Name- Ravinder Kaur w/o Avtar Singh Age- 25 years Caste -Gen. 3/ 01/ 2014 delivery case in PGI Doctors and nurses not attended the case after 2 hours attended the case after delivery her child’s death.
Bhurare:- Name- Sarita w/o Manoj Age- 23 years Caste SC normal delivery case in Civil Hospital Chamkaur Sahib after few days her started heavy bleedings and fever.

Action taken:

A committee was formed to look into the reasons for the adverse outcomes and submit the report within fifteen days so that measures can be taken to ensure that no adverse outcome is experienced by any patient

SUB-CENTER REPORT CARD:

4 sub center were covered under the block Kiratpur Sahib , gaps were found because in one subcenter namely Dolowal , as the post of MPHW is vacant.

In block Chamkaur Sahib 6 sub center were covered , gaps were found because in one subcenter namely Khokhrana , as the post of MPHW is vacant.

Action Taken:

PHC/CHC REPORT CARD: Six PHCs were covered under this

PHC Amrali
PHC Boor Majra
PHC Morinda
PHC Kiratpur Sahib

Two PHCs are working 24x7 and working very effectively some gaps were found in infrastructure in PHC Boor Majra

PHC Boor Majra caters to approximately 20,000 papulation. It is red because of following reasons :

Medical officer is not on full basis comes on alternative days
Nurse/ PHNM is not posted
Residence of doctor/ paramedical is not constructed in PHC building

Ambulance and telephone are not in working condition

Action Taken:

It was instructed by state Programme Manager Dr. V.K. Gagneja that Full time medical officer should be posted in PHC Boor Majra. instruments which are deficient at the PHCs should be purchased immediately from PHC untied fund

Denial of Health services/ guarantees :

Name of village surewal
PHC: Kiratpur Sahb

During the community meeting villagers informed that the pregnant women are not receiving feed from anganwadi centre. Anganwadi Helper informed that they provide feed regularly but most of the ladies whom we have talked about in front of PRI members and lady panch they Declined that they have not received any feed from anganwadi centre. The Anganwadi centre is situated in govt. Primary School because anganwadi room is not fully established and without roof since 8- 10 years, so school provide a room to anganwadi worker to operate Anganwadi centre.( Testimonial attached)

Action Taken:

Dr. Surinder Ghangad , Civil Surgeon , Roop Nagar , instructed S.M.O Kiratpur sahib to look into the matter. Civil surgeon has already informed the Programme officer , Women and child development ,Roopnagar.

village surewal has serious water and sanitation problems are very serious. Water problem is the major problem children drink water of tanks which are full of plastic substance and other ill substances.( Picture attached)

Action Taken:

Dr. Surinder Ghangad , Civil Surgeon , Roop Nagar , instructed Mr. J.N. Sharma , DFW, Roopnagar to immediately take the water samples to check its impurities.

Name of village Makrana Khurd
Block: Chamkaur Sahib
Name of Patent:Lakhmir Singh

The patient had accident at Chamkaur sahib first aid was given to patient at PHC Chamkaur sahib then he was referred to civil hospital roopnagar , where he was not treated immediately but was made to wait for 2 hours . when the surgeon came he told him to come after the weekend on Monday . ( Testimonial attached)

Action Taken:

Dr. Surinder Ghangad , Civil Surgeon , Roop Nagar , immediately formed the fact finding committee to look into the matter. She stated that if lapses would found then action will be taken against the guilty.

Name of village Wajidpur
Block: Chamkaur Sahib
Name of Patent: Harwinder Kaur w/o Ranjeet Singh

Harwinder Kaur w/o Ranjeet Singh had delivery at PHC Chamkaur Sahib . Two twin babies were born to her on 18-3-2013. At night the condition of one of the baby get critical but , nurses present on duty kept on sleeping and did not listen to attendants of Harwinder Kaur. At 4.00 a.m. when condition of baby worsen then he was referred to PGI . But on the way the baby died. ( Testimonial attached)

Action Taken:

Name of village Kakrali
Block: Chamkaur Sahib

The community of village Kakrali complained that they had to purchase the medicines from outside and behavior of doctors is not good( Testimonial attached)

Action Taken

Dr. Surinder Ghangad , Civil Surgeon , Roop Nagar , immediately instructed SMO Chamkaur Sahib to look into the matter as no medicines should be recommended to purchased . All medicines should be available at PHC.

Village Nakkian

Block: Kiratpur Sahib

Name of Patient: Asha Rani

Asha Rani w/o Davinder singh want to PHC Kiratpur for delivery but the the para medical present did not attended her properly then she went to the washroom as she was undergoing too much pain . she had delivery in wash room ( Testimonial attached)l

Action Taken:

Conclusion: It was felt during the whole activity of community monitoring that there is greater need of community mobilization/awareness about health entitlements and health guarantees and to enable them to do community based planning and monitoring activities . Community members requires hand holding and support to carry out the perceived activities at least for one year\

Testimonials