Improving Healthcare Services in Bihar: Addressing Challenges and Action Taken

Bihar

Positives PPIUCD Insertion at delivery points and good record keeping. Availability of FP commodities in new packing. Establishment of KMC in delivery points. Open Vial policy and AVD being followed. District Action Plans in place for all communicable & vector borne diseases. Sanjivani Online Patient Registration System. Bi-monthly outreach Camps are being organized in the slum localities of each UPHCs.

Issues Free Drugs & Diagnostics services not up to the mark Sufficient number of medicines not available. High out of pocket expenditure ANC up to Rs1000 , Delivery Rs. 5000-7000 . Most PWs/emergency patients coming to govt facilities by private vehicle Huge shortage in numbers of health facilities/ delivery points and number of beds. Quality hugely compromised Delivery rooms lack basic amenities Lack of basic facilities and cleanliness in District hospital of West Champaran. Poor BMW management at all facilities. Training weak. No structure at district level to support training. ASHA training on the ground has slowed down substantially since 2014.

Issues Weak HR and Program Management : HR policy under preparation for many years not implemented yet Delay in recruitment affecting all programs Weak supportive supervision. District officials not visiting Disease surveillance grossly compromised due to HR shortage State/ District Health Mission meetings not taking place regularly In spite RMNCH+A DP support no high risk PW list available in any facility visited Delay in transfer of Funds from State Treasury to SHS i.e. 60 -65 days. Funds for 2016-17 not received by SHS as on 13.11.2016.

Action Taken by State

Issue -Free drugs and diagnostics Action taken Future plan with timeline Drugs: Drugs to health facilities is being provided by BMSICL. BMSICL has finalized rate contract of 95 essential drugs and issued indent/ purchase order of 81 drugs Already indented 37 drugs have been stored in warehouse of BMSICL Quality test of stored medicine through NABL Accredited Laboratories received and found to be of standard quality. Interim arrangement allowed procurement at local level either through tender or local purchase to meet emergency situation Diagnostics: Three Part Blood Cell Counter made available at all DH and FRU level Semi-autoanalyser already available in all block PHC Enhanced skill of 200 RNTCP Lab technician on general lab services Drugs: Rate remaining drugs process and will be completed three months. Diagnostic: Cost for replenishment of laboratory reagent proposed in PIP 2017- 18. Tendering process outsourcing advanced test through PPP mode RNTCP Lab technicians will be given additional responsibility general service. contract of essential under are within of the state has is under for of for laboratory

Issue -High out of pocket expenses Action taken Supply facilities improved through tracking of supply chain mechanism and empowering DHS to tender or local purchase to meet emergency situation. All entitlements provisioned under JSSK were continuously monitored from state level. Three Part Blood Cell Counter made available at all DH and FRU level and Semi- autoanalyser was also made available in all block PHC to ensure free diagnostic services. All related grievance addressed through centralized 104 call centre with real time monitoring (Average redressed/day and 35524 calls addressed in FY 2016-17) Client satisfaction survey and patient feedback mechanism through NQAS. Future plan with timeline Monitoring of access to entitlements done regularly by DHS and SHSB 24X7 lab services will be ensured by engaging lab technicians different within 3 month of essential drugs to health will be of program 100 grievances strengthened

Issue -Delay in transfer of funds from state treasury Action taken Future plan with timeline Funds during 2016-17 have been received Accounts in 2017. Discussions officials of department held to resolve the issue Transfer of Funds from treasury to SHSB is being monitored on higher level. Now it is expected that it will be received in shortest possible time during fund transfer in December, SHSB with higher concerned

Issue ASHA Training Action taken MoU with District Training Agencies has been expired from 01st September 2015. Hence, Tenders were invited for the selection of District Training Agencies. Two (2) District Training Agencies were selected. Retendering remaining 36 districts. Scrutiny of DTA for 1st phase is done. Till 31st August 2015, status of ASHA Training on Module 5 6 & 7 is as follows :- No. of ASHA trained in 1st Phase 78336/ 85272 (91.86 % ) . No. of ASHA trained in 2nd phase - 67725/85272 (79.24 % ). No. of ASHAs trained in 3rd Phase - 55818/85272 (65.45 % ) No. of ASHA trained in 4th Phase - 7148/85272( 8.34 %) District West champaran initiated ASHA web portal for real time tracking of issues related to ASHA Future plan with timeline District Training Agencies will be finalized after the Field Appraisal. Training will be resumed after selection of agencies. is done for -

Issue Referral services Action taken Earlier 102 referral transport services was running through DHS, currently the contract has been signed between state & out-sourced agency on 21-4- 2017 In the financial year 2016-17 a total of 702945 cases provisioned referral services out of 1548396 reported deliveries. ASHA have been sensitized on referral system during routine meetings and mobilized for generating community awareness Future plan with timeline Three month time line is given to out source agency to take over from DHS and expects improvement in referral services Issues related to referral transport services will be linked with grievance redressal system. the State

Issue BMW management and Cleanliness Action taken Training in new BMW-2016 guideline provided to the all health personnel and outsourced staff Every facility has purchased color coded- bins following the BMW - 2016 guideline. Regular monitoring and supportive supervision conducted Kayakalp & NQAS assessment. To ensure cleanliness assessment using Kayakalp checklist has been extended up to APHC level in current year. Future plan with timeline Planning is being done for Kayakalp assessment of the functional PHCs under NUHM. Regular monitoring for adherence to new BMW- 2016 guideline will be conducted through NQAS & Kayakalp assessers. through facility

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