The document provides an evaluation of the Jawan health sub-centre in India over a one year period. It summarizes the sub-centre's inputs including infrastructure, equipment, drugs, staffing and funds. It describes the services provided and process of care. Key outputs analyzed include maternal and child health indicators like antenatal care attendance, institutional deliveries, immunization rates, which largely met expectations. The evaluation concludes with recommendations to address gaps in infrastructure, record keeping, quality monitoring and expansion of services.

1. Health sub-centre evaluation
Dr. Rizwan S A, M.D.,
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2. Outline
• Definitions
• Basic information about SC – Jawan
• Evaluation
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–
–
–
–
Methodology
Input
Process
Output
Impact
• Conclusions
• Recommendations
2

3. What is evaluation?
• Process to determine as systematically & objectively as possible
the relevance, effectiveness and impact of activities in light of
their objectives (John M Last)
• Components involved – Input : The sum total of resources & energies purposefully engaged
– Process : Sequence of steps in executing the program
– Output: Immediate results of health care activities
– Outcome/Impact: All identified changes in health status arising as a
consequences of the intervention or program
3

4. What is supportive supervision?
• A process that promotes quality at all levels of
the health system
– by strengthening relationships within the system
– focusing on identification and resolution of
problems
– optimizing the allocation of resources
– promoting high standards, team work and better
two-way communications.
4

5. Basic information
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6. Basic information
•
•
•
•
•
•
Under PHC Chhainsa, CHC Kurali
Functioning as sub-centre since 1995
Distance from PHC – 12 km
Villages covered – Jawan, Ahmedpur
HW (M) – Mr. Roshan Lal
HW (F) – Mrs. Meena Solanki
Total
Male
3305
Female
2923
Total
6228
Sex ratio
884
Sex ratio at birth
1154
As on September 2011
6

7. Location of Jawan
7

8. Methodology
• Design – cross-sectional study
• Reference period – Apr. 2011 to Mar. 2012
• Input & process
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–
–
–
–
–
Using IPHS 2012
Sub centre visit
Record review
House visits
Interview of HW
Monthly report review
• Output and outcome
– Record review
8

9. Steps of evaluation
9

10. Steps of evaluation
INPUT
PROCESS
• Manpower
OUTPUT
• Infrastructure
• Services
• Maternal
Health
• Equipments
• Record keeping
• Child Health
• Drugs
• Quality control
IMPACT
• Family
planning
• Vital
statistics
• Furniture
10

11. Input
1.
2.
3.
4.
5.
6.
Manpower
Infrastructure
Equipments
Drugs
Furniture
Funds
11

12. Manpower – Type A HSC
Staff
Essential
Existing
Health Worker (Female) 1 / 2 (desirable)
1
Health Worker (Male)
1
1
Safai karmachari
(contractual, part time)
1
1
12

13. Sub-centre layout as per IPHS
• The original building of Jawan sub-centre is not being used
• For the past 3 months the sub-centre is functioning in a single hall (16X20sq.ft)
of a govt. school under the instructions of Panchayat
13

14. Infrastructure – 1/3
Location of sub centre
Location
On the outskirts of Jawan village
Whether easily accessible?
Yes, but not for Ahmedpur
Distance from the remotest place
Ahmedpur is 5 Km from the SC
Travel time from the remotest place
1 hour (by walk)
Distance from the PHC
12 km
Distance from the CHC
16 km
14

15. Infrastructure – 2/3
Building ownership
Panchayat
Construction
Complete
Compound wall
All around, no gates
Plaster on walls
Intact everywhere
Ramp
No
Floor
Concrete
Separate toilets for males & females No
Cleanliness
Satisfactory
Complaint box
No
Prominent name board
Yes
Labour room
It is a Type A HSC
Clinic room
Yes
Examination room
Yes
15

16. Infrastructure – 3/3
Residential facility for staff
No
Does staff stay in SC village
No
Water supply
No
Waste disposal
Garbage – disposal at public dump, or
burnt in the premises.
Needles used in immunization session
sent to PHC
Electricity
No
Telephone
No
Transport facilities
No
Residential facility
No
16

17. Equipment – 1/3
N/A
N/A
N/A
N/A
1
N/A
1
1
1
N/A
1
N/A
1
N/A
1
17

18. Equipment – 2/3
1
N/A
1
N/A
1
N/A
1 oral
18

19. Equipment – 3/3
N/A
1
N/A
1
N/A
19

20. Consumables – 1/2
Yes
Yes
No
No
No
No
No
Yes
20

21. Consumables – 2/2
Yes
Yes
Yes
Yes
Yes
Yes
N/A
N/A
N/A
Yes
N/A
Yes
No
N/A
21

22. Furniture
1
1
1
N/A
4
N/A
2
2
2
N/A
1
N/A
1
N/A
* For type B HSC only
22

23. Sundry articles
1
N/A
1
N/A
1
N/A
* For type B HSC only
23

24. Drugs – Kit A
Yes
Yes
Yes
Yes
No
Yes
Yes
N/A
Yes
24

25. Drugs – Kit B
N/A
Yes
N/A
Yes
N/A
25

26. Other drugs
Name
Availability
Syp. Cotrimoxazole
Yes
Tab. Cotrimoxazole (Adult)
Yes
Syp. Paracetamol
Yes
Tab. Chloroquine
Yes
Syp. Chlorquine
No
Tab. Primaquine
Yes
Tab. DEC
No
Anti-leprosy drugs
No
Anti-TB drugs
Yes, PWB
Inj. Gentamicin
No
Betadine ointment
No
26

27. Contraceptives
Name
Availability
Condoms
Yes
Oral pills
Yes
Copper T
Yes
Emergency contraceptive pills
Yes
27

28. IEC materials
• Display boards
Programme
Status
JSSK
Yes
JSY
Yes
Routine Immunisation
No
IMNCI
No
Family Planning
No
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29. Funds supply
Source
Availability
Remarks
Untied funds for subcentre
No,
Not av. for study period
Shared with Naryala
SC, no separate fund
received
JSY
Yes
through PHC
Village Level
Committee
(Jawan, Ahmedpur)
Not available in Jawan,
Fund received in 2011
from VLC of Ahmedpur
SMS group
Name board for
immunization session
site was made from
SMS of Ahmedpur
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30. Process
1. Services provided
2. Record keeping
3. Quality control
30

31. Services provided – 1/2
Services
Visit by doctor (at least once a month)
Availability
Yes
Is the day and time of this visit fixed?
Yes
(every wed afternoon)
Are the residents of the village aware of the
timings of the doctor's visit?
Yes
Visit by HA (at least once a week)
Yes
Referral facilities for delivery cases (24 hr)
No
Escorting Delivery Cases by ANM
No
Treatment of minor ailments
Yes
First aid (specify)
Peripheral blood smear in case of fever
No
Is it a DOTS centre?
Yes
Yes
31

32. Services provided – 2/2
Services
Availability
Disease surveillance by IDSP format
No
Control of local endemic diseases
Yes
Promotion of sanitation
No
Field visits and home care
National Health Programmes
Yes
Traditional birth attendants
Yes (one)
ASHA
Yes (5+1)
Yes
Coordinated services with AWWs, ASHA, Village
Yes
Health and Sanitation Committee, PRIs
Village Health Plan / Sub Centre Plan
No
Watch over unusual health events
Yes
32

33. Record keeping – 1/2
Registers maintained
Registers not maintained
1. Birth register (includes immunization
details)
2. Death register
3. ANC register
4. Family planning register
5. OPD register
6. TB register
7. Malaria register
8. Visitors register
9. Monthly report register
10. ANC camp register
11. Stock book (Drug register)
12. Equipment , furniture and other
accessories register
13. FRC
14. JSY register
1. Eligible couple register including
contraception
2. Epidemic, communicable, syndromic
surveillance register
3. Register for water quality &
sanitation
4. Under five growth monitoring register
5. Above 5 child immunization register
6. Number of HIV/STI screening and
referral
7. Fund register
33

34. Record keeping – 2/2
Name of register
Whether
available?
Remarks
ANC record
Yes
Complete
Eligible couple register
No
From work plan
Maternal death record
Yes
Maintained in death
register
Infant and still birth
Yes
Maintained in birth
and death register
IMNCI field visits
Yes
Since sep 2012
Maintenance of PNC visit records
No
From work plan
ANC + immunisation cards
Yes
Given to all
Referral transport voucher book
Yes
Not used since April
IBSY register
Yes
Since oct. 2012
List of severely anaemic children
No
-
Last month monthly report given to PHC
Yes
Complete
34

35. Skills and training of ANM
Skill
Whether proficient?
SBA trained
Yes
IMNCI trained
Yes
Measuring BP
Yes
Use of Haemoglobinometer
Yes
Use of Uristix
Yes
Giving DPT vaccine
Yes
Danger signs for referring sick child
Yes
Identifying HRP
Yes
Maintaining aseptic precautions during labour
Yes
When not to use vaccine
Yes
Treatment of anaemic pregnant women
Yes
Some skills were observed directly
35

36. Quality control
Particulars
Availability
Citizen’s charter
No
Internal monitoring
Yes
External monitoring
No
No. of visits by MO in the last month
2
No. of visits by LHV in the last month
3
No. of visits by CMO in last year
0
No. of visits by state official in last year 0
36

37. Checking by house visits - 1
House 1
House 2
Name of woman
Latha
Krishna
Husband
Vedpal
Krishnapal
First ANC
5th month
2th month
No. of ANC visits at HSC
4
4
Approx. no. of IFA
50
40
Was BP taken
Yes
Yes
Was weight taken
Yes
Yes
Was urine tested
No
No
Was Hb tested
Yes
Yes
Place of delivery
PHC Chhainsa
Home
Was JSY given
Not eligible
Not eligible
No. of PNC visits made by ANM
3
4
Houses in which a child between 1 and 2 months of age was selected for this purpose
37

38. Checking by house visits - 2
House 1
House 2
House 3
House 4
Name of child
Nanshi
Krishna
Prakash
Manu
Age
6m
3m
7m
3m
Immunisation card?
Yes
Yes
Yes
Yes
Who informs about sessions?
ASHA
ASHA
ASHA
ASHA
Whether immunised appropriately Yes
for age
Yes
Yes
Yes
Whether ANM gave ORS for
diarrhoea
Yes
NA
NA
NA
Whether ANM gave
cotrimaxazole for ARI
NA
NA
Yes
NA
Houses in which a child between 2 months and 1 year of age was selected for this purpose
38

39. Output
1. Maternal health
2. Child health
3. Family welfare
39

40. Maternal health – 1/2
Services
Sub centre
Expected
Population covered
6228 (mid year) 5000
New ANC registration
148
131
Registration <12 weeks
134 (90.5%)
100%
High Risk Pregnancy
34
13
40

41. Maternal health – 2/2
Services
Sub centre
Expected
Remarks
Institutional Deliveries 87/114 (76.3%)
100%
80.2%
MOHFW stats for
2010-11
Home Deliveries
27/114 (23.7%)
0
T Dai is atleast
partly responsible
Deliveries at sub
centre
0
0
It’s a Type A HSC
41

42. Child Health
Services
Achieved
Expected
Remarks
DPT3 (%)
99.2
100
Haryana (R) –73*
OPV3 (%)
99.2
100
Haryana (R) - 76*
BCG (%)
97.1
100
Haryana (R) –83.2*
Measles (%)
93.6
100
Haryana (R) –
78.7*
No of under five children
with malnutrition
-
-
Not maintained
No of newborns whose
birth weight recorded
104/108 (96.3%)
100
Home deliveries not
measured
Newborns with low birth
weight (< 2500 kg)
18/108
(16.7%)
22% in NFHS 3
*CES 2009
42

43. Family welfare – 1/2
Services
Achieved*
No. of eligible couples
1184
Tubectomy
523
Vasectomy
10
IUD
51
OCP
50
Condom
200
Total couples protected
634
Parameter
India
Jawan
Couple protection rate
56.0% (All India, NFHS 3)
53.5%
Contraception prevalence
rate for modern methods
55.6% (Rural India , DLHS 3)
70.4%
* As on march 2012
43

44. Family welfare – 2/2
Monthly target
to be achieved
Achieved
Sterilisation
3
0
IUD
5
1
OCP
2
2
Condom
2
10
Services
* For March 2012
Formulae for calculating target:
1. C = no. of eligible couples – couples who adopted sterilisation
2. Target for IUCD = (C X 30)/400
3. Target for sterilisation = (C X 20)/400
4. Target for CC user = (C X 37.5)/400
5. Target for OCP = (C X 12.5)/400
6. To get Monthly target divide by 12.
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45. Impact
1. Vital statistics
45

46. Vital Statistics
Indicator
Jawan HSC
PHC Chhainsa
Haryana (Rural)
CBR (per 1000
population)
18.3
23.7
22.9**
CDR (per 1000
population)
5.3
6.9
7.0**
IMR (per 1000 live birth)
26.3
52.8
48**
NNMR ( per 1000 live
birth)
8.8
37.0
38*
U5MR (per 1000 live
birth)
43.9
62.0
74.0#
MMR (per lakh live birth)
No maternal death reported in the
study period
212* (2007-09)
For the period 2011-12
** SRS 2012, * SRS(2009), # NFHS 3
46

47. Conclusion
47

48. Conclusion
• Overall functioning of Sub-centre was satisfactory
• Visibility of SC to the public needs to be improved, Location outside the
village seems to be a hindrance
• Water supply and power are not available
• Some items like Cu T insertion set, dressing materials, salter weighing
scale, uristix are not available but furniture is adequate
• Most drugs are available in ample amounts, but signage inadequate
• Inadequate funds supple to SC
• Overall record keeping is satisfactory, however under 5 malnutrition status
is not recorded
• ANM is well trained
• Home deliveries conducted by village Dai seems to be a problem
• Family welfare activities, immunization coverage are satisfactory
48

49. Recommendations
49

50. Recommendations
• Urgent repair of the building and provision of electricity and water supply
• Making the SC more prominent with signage
• More efforts for surveying under 5 children for nutritional status and
anemia
• Timely release of untied funds will help in procuring items which are not
available
• Village Health Plan and SC plan should be initiated
• More time is spent for records keeping and report preparing
50

51. Thank you
51