Insights from Regional Workshop on AB-HWCs for North Eastern States and West Bengal
Health center field visit findings from the 4th Regional Workshop on AB-HWCs highlight various updates and progress in human resources, essential medicines, and essential diagnostics across different states such as Manipur, Sikkim, Meghalaya, Nagaland, Assam, Tripura, West Bengal, and Andhra Pradesh. The findings cover aspects like HR training completion, VIA screening, PBI implementation, essential drugs availability, EDL display, and diagnostic tests conducted. Challenges and improvements in service delivery, team collaboration, and training requirements are also discussed.
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AB-HWC- Sub Health Centre Field visit findings 4thRegional Workshop on AB-HWCs for North Eastern States and West Bengal
Human Resources Manipur: Adequate HR, trainings completed. CHO had good knowledge. CHO trained in cervical cancer screening (VIA) & started screening too. PBI being discussed for regular cadre, Rs 15000 for contractual CHO. Sikkim: CHO & ANM trained on VIA. Screening also carried out. Trainings for all staff yet to be completed. Meghalaya: Planning for VIA training for CHOs. Training as per norms. Induction training also done. PBI started. Indicators for PBIs designed in such a way that all CPHC team members are involved in service delivery. Tripura: Adequate HR. MPW (M) more involved in RCH and NCD screening activities (mainly managerial). PBI started since 3 months. Regular as well as contractual CHOs. PBI of max Rs 15000 applicable to all CHOs. 7 days induction training for CHOs. HWC & NCD trainings not completed for all the Staff members
Human Resources AP: Adequate HR. Reorientation training required for all staff. Rs 5000 honorarium for regular HWO planned. Vacancies created at CHCs from where GNMs taken to function as CHO/HWO. PBI to be initiated by November 2019. Nagaland: Induction training done. No MPW (M), only MPW (F). PBI started. CHO transferred without replacement. Assam: Adequate HR. Need for hands-on skills based training in the 5 days induction training of CHOs. WB: Only regular cadre as CHOs. GR released on roles & responsibilities of individual staff. Female nurses employed. Fixed incentive (performance linked) for regular CHOs. Staff Quarters needed for CHOs in AP and Nagaland. Disparities in understanding about roles and responsibilities to be addressed for CPHC team members. Team work has improved though.
Essential Medicines Manipur: EDL not displayed. 10-20% buffer maintained. DVDMS up to DH level, to be extended up to PHC level. Sikkim: EDL not displayed. Expired drugs available. DVDMS not implemented in State. Proper structure of manual indenting lacking. No buffer stock. Meghalaya: EDL displayed. NCD drugs available. No shortage reported. DVDMS implemented up to PHC level. Mizoram: EDL not displayed. Assam: EDL displayed. No shortage. DVDMS implemented up to PHC level.
Essential Medicines AP: EDL not displayed. Shortage of medicines. DVDMS recently started up to CHC level only. Proper structure of manual indenting lacking. No buffer stock. Tripura: Approx 50% of the Essential Drugs were displayed. NCD drugs inadequately available. Central procurement agency formed but still procurement done by HNM, DHS, DFW Nagaland: Shortage of medicines. DVDMS not implemented. Proper structure of manual indenting lacking WB: Shortage of medicines. DVDMS not implemented. NCD drugs available. No stock-outs. 35-46 EDL available out of 91.
Essential Diagnostics Manipur: VIA training done for CHOs. 5-7 tests available. Sikkim: 7 tests available, VIA testing conducted. Meghalaya: 5-6 tests excluding VIA. Assam: Except VIA, all tests done. *True Hb being piloted in 120 SCs in the State. AP: Only 3 tests (RBS, PTK & RDT- malaria) available. Training needed for CHOs before starting with Hemoglobin estimations at SCs. Tripura: VIA not Done. Heavy User charges for diagnostics at SDH, DH, State hospital. State has implemented Free Diagnostics Nagaland: 5 tests done. WB: 5 tests currently available. 12-15 tests being planned for SCs.
Population based NCD screening NCD screening conducted in all States. CBAC forms filled and family folders available at SCs. Completeness of data in CBAC forms to be ensured across all States. Community participations and involvement of SHGs, village committee members, etc have improved screening rates. 23rdSeptember observed as a day for intensive NCD screening in Arunachal Pradesh as part of Ayushman Bharat Pakhwada. Meghalaya: NCD screening kit provided to ANMs. NCD follow up registers & referral slips ensured for diagnosed cases. NCD tracking bag used in Assam. Symptom based/ opportunistic screening done mostly in AP, Nagaland, WB (for cancers) Universal NCD screening for 30+ population done in Meghalaya, Assam, Manipur, Sikkim & Tripura.
AB-HWC Portal Reporting Tablets provision is an issue in all NE states & WB Internet connectivity along with Log in and password issues reported in many of the NE states & WB, more so in hilly districts. Arunachal Pradesh: Monthly data entered at district level through manual reports submitted by CHOs due to internet issues. Daily reporting is an issue due to internet issues. Discrepancy (variations) in entered data in NCD application and HWC portal reported.
Branding/ Infrastructure Adequate branding done in all NE states except Mizoram. Dedicated room/space for wellness activities needs to be identified at SCs in most of the NE states. WB: Double storey buildings being reorganized to provide adequate OPD services. AP: Uniform display of IEC materials required. Buildings donated by agriculture department wanting to return them. Inadequate funds reported by Sikkim, AP, Meghalaya, Tripura for infrastructure upgradation of HWCs under NHM, particularly in hilly districts & those districts with old buildings.
Wellness Yoga not initiated in AP, Sikkim, WB. Meghalaya: Basic Yoga Skill training in Certificate Course in Community Health included for CHOs. Zumba, sports activities more popular. Tripura: Art of living course initiated free of cost for CHOs. 450 ASHAs trained for 2 days in Yoga Mizoram: Tobacco cessation awareness drives. Yoga/ physical exercises initiated. Nagaland: sports like volley ball, jogging initiated, Sikkim: SHC has made peer groups for peer /patients group counselling.
Ensuring RCH activities Nagaland: IUCD insertions and institutional deliveries started by CHOs at SC-HWCs. Sikkim & Assam: SC-HWCs as Delivery points. Arunachal Pradesh: Rs 1000 incentive given to parents on completely full immunization of their children by 1 year of age.
Expanded range of services Manipur, Tripura: Home based Palliative care started at SC- HWCs. Nagaland: Elderly care during home visits. Meghalaya: Distribution of Walker and Walking Sticks at SC- HWCs to the elderly patients on World Elderly Day.
Best Practices Manipur & Tripura: Home based Palliative Care Services provided by CHOs. Nagaland: Good linkages with School Health Program. Active community participation to develop HWCs. CHO weekly schedule prepared. West Bengal: Mothers Picnic celebration at the Rural Hospital. Review meetings every Saturday at SC-HWCs. Sikkim: Proud Mother Scheme (to address low TFR). Herbal gardens. NCD screening & follow up registers maintained. Meghalaya: Zumba & NCD referral slips and follow ups conducted Nagaland: Sports as wellness activities. Assam: NCD Tracking Bag.
