Improving Healthcare Practices and Systems in Madhya Pradesh

Madhya Pradesh

Best Practices vaccine and logistics management, temperature monitoring, walk in coolers are well functional and utilized. Skill based competency test has been introduced for assessing nurses and ANMs. The nurse mentors equipped with good knowledge and skills are adding value and providing hands on support to the ANMs. Lab technicians and counsellors have been integrated for comprehensive testing and counselling. Robust system in place for payments of incentives on monthly basis to ASHA Real time maps with the help of GIS department are prepared of all urban cities. eVIN system of

Best Practices Most of the labor rooms in the districts were equipped with systematically arranged drug trays, functional equipment, NBCC, correctly drawn partographs, technically proficient nurses and ANMs. OOPE was not reported under JSSK, FDSI and other disease control programmes. Systemic appraisal of contractual and adhoc staff. Good treatment success rate (90%) in RNTCP. The active involvement of mobilization covering community, livelihood, micro-finance and women empowerment. Good interdepartmental convergence at Dindori for district level review meetings. Tejaswini in community

Observations Retention of these Specialists in hard to reach areas despite giving incentives in HPDs found to be difficult. No systemic policy for rational deployment and transfer policy of personnel was observed including those trained in skills. EmOC and L-SAS training needs to be scaled up along with provision of performance incentives. EmOC services to be made available based on geographical mapping and time to care approach. High unreported deliveries along with Maternal and Child death review limited to clinical cause and no systemic gaps. Lack of District specific planning within state and district. Urgent need for improving Supportive supervision for outreach services and VHND. (Integration of supportive supervision) There is an urgent need to recruitment or placing the staff (MOs, Pharmacist, LT etc.) at UPHC level to make UPHCs fully functional. The RKS has not been constituted at the UPHCs. In lieu of high case detection of MB cases than PB cases indicates delay in early detection. High Grade- II disability rate for leprosy (18.7%)

Observations Poor knowledge of EMT, malfunctioning equipments, 108 (Omni) ambulances have high kilometre coverage but load trips (216 Km per day and 4.6 cases per day) indicative of referral to higher facilities due to non functionality of primary care facilities. Call verification time for 108 is very high i.e. 12 Min. Need to operationalise MMUs lying non functional in Dindori district. Most of the campuses have been expanded horizontally leading to no scope for future growth. Adherence, segregation and improvement. Comprehensive IEC for Kilkari and Mobile Academy to be implemented. Intersectoral convergence with other department, while preparing Annual PIP is needed. disposal of BMW needs

Action taken by State on CRM finding CRM Finding:- Retention of these Specialists in hard to reach areas despite giving incentives in HPDs found to be difficult- IN PIP 2017-18, State has proposed for Differential pay/top up of Doctors in earmarked institutions (unmanned FRUs and PHCs) CRM Finding:- Most of the campuses have been expanded horizontally leading to no scope for future growth -Action taken by State:-In PIP 2017-18, State has proposed for Hospital planning experts and accordingly the works for aligning existing old buildings with the newly constructed buildings

Action Taken by State

Madhya Pradesh

Best Practices vaccine and logistics management, temperature monitoring, walk in coolers are well functional and utilized. Skill based competency test has been introduced for assessing nurses and ANMs. The nurse mentors equipped with good knowledge and skills are adding value and providing hands on support to the ANMs. Lab technicians and counsellors have been integrated for comprehensive testing and counselling. Robust system in place for payments of incentives on monthly basis to ASHA Real time maps with the help of GIS department are prepared of all urban cities. eVIN system of

Best Practices Most of the labor rooms in the districts were equipped with systematically arranged drug trays, functional equipment, NBCC, correctly drawn partographs, technically proficient nurses and ANMs. OOPE was not reported under JSSK, FDSI and other disease control programmes. Systemic appraisal of contractual and adhoc staff. Good treatment success rate (90%) in RNTCP. The active involvement of mobilization covering community, livelihood, micro-finance and women empowerment. Good interdepartmental convergence at Dindori for district level review meetings. Tejaswini in community

State response OBSERVATION ACTION TAKEN Retention of these Specialists in hard to reach areas despite giving incentives in HPDs found to be difficult. IN PIP 2017-18, State has proposed for Differential pay/top up of Doctors in earmarked institutions (unmanned FRUs and PHCs) No systemic policy for rational deployment and transfer policy observed including those trained in skills. Lack of District specific planning within state and district. Urgent need for improving Supportive supervision for outreach services and VHND. (Integration supervision) A detailed HR manual exist for NHM employees which includes transfer & rationalization/ integration In past needs of individual districts are included in PIP. Supportive Supervision allocation to districts increased in 2016-17 monitoring of outreach & VHND Rationalization of staff is under process for better utilization of existing HR to implement NUHM to make UPHC fully functional. RKS bylaws are in process of revision with inclusion of UPHC RKS. of personnel was of supportive There is an urgent need to recruitment or placing the staff (MOs, Pharmacist, LT etc.) at UPHC level to functional. The RKS constituted at the UPHCs. make UPHCs not fully been has

State response OBSERVATION ACTION TAKEN Total 118 MO trained in EmOC skills but only 60 are performing & out of 82 LSAS trained doctors, 37 are performing rest have either done PG, left jobs or on admin post The state had gone ahead for CPS diploma course for in-service MOs but since it has been disapproved by GoI, hence we would be continuing with EmOC & LSAS training with performance based incentives Geo mapping of all delivery points have been done & rationalization of Delivery Points is in process along with EmOC and L-SAS training needs to be scaled up along with provision of performance incentives. EmOC services available based on geographical mapping and time to care approach. to be made

State response OBSERVATION ACTION TAKEN Nearly 30% unreported deliveries & 60% maternal death is a matter of concern for the state. A study has been conducted by AIIMS Bhopal for ensuring reporting of each delivery & maternal death from rural area ANMOL & RCH portal implementation is in process. In urban area the state plans to develop mechanism of reporting of delivery, spontaneous & medical abortion under NUHM ince the MDR software of GoI is non functional as it was linked to MCTS, the state is developing state specific maternal death & reporting software. High Maternal and Child death review limited to clinical cause and no systemic gaps. unreported deliveries along with

State response OBSERVATION ACTION TAKEN State has planned focal Leprosy survey in the month of April 2017/survey of hard to reach area in 3rdQtr of the year so that early cases detection ensured. Out of total 144 sanctioned, 115 new MMUs are currently operational including 08 in Dindori district. Rest all will be operationalized till first week of June. In PIP 2017-18, State has proposed for Hospital planning experts and accordingly the works for aligning existing old buildings with the newly constructed buildings In lieu of high case detection of MB cases than PB cases indicates delay in early detection. High Grade- II disability rate for leprosy (18.7%) Need to operationalise MMUs lying non functional in Dindori district. Most of the campuses have been expanded horizontally leading to no scope for future growth.

State response OBSERVATION ACTION TAKEN All EMTs were trained by service provider in BLS & ALS training. A quality audit of all ambulances is being carried out for functionality & availability of Equipments. complete audit, damaged equipment will be replaced. Data for facilities with higher referral is being extracted every month & reasons for referral is being identified facilities. This practice will be carried out on monthly basis. Call verification time was increased due to shifting of Old call centre to new call centre & old software to new software, Now New call centre is established completely & avg. call dispatch time is reduced to 90 second. Instructions issued to service provider for Screening of cases with higher dispatch time & corrective measures (at Call centre end) to reduce the Poor equipments, 108 (Omni) ambulances have high kilometer coverage but load trips (216 Km per day and 4.6 cases per day) indicative of referral to higher facilities due to non functionality of primary care facilities. Call verification time for 108 is very high i.e. 12 Min. knowledge of EMT, malfunctioning After non-functional & asked from take necessary dispatch time to

State response OBSERVATION Adherence, segregation and disposal of BMW needs improvement. ACTION TAKEN District level master trainer has been trained for amended 2016 rules and institution level training is undergoing Kilkari message ANMOL. All beneficiaries being informed through SMS All departments consulted before sending PIP to GoI Comprehensive IEC for Kilkari and Mobile Academy to be implemented. included in Intersectoral department, while preparing Annual PIP is needed. convergence with other

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