Arunachal Pradesh 10TH CRM: ARUNACHAL PRADESH Best Practices:

Arunachal Pradesh 10TH CRM: ARUNACHAL PRADESH Best Practices:

Arunachal Pradesh 10TH CRM: ARUNACHAL PRADESH Best Practices: Herbal Garden Initiative @ PHC in Pasighat Positives Overall Neat and clean infrastructure. Facilities have boundary walls, at places beautiful bamboo fencing and herbal garden Dialysis unit: Machine, trained HR and Infrastructure available.

Basic ANC services provided. Early initiation of breast feeding practiced. C-section available at General Hospital, East Siang and FRU, Ruksin. Well functioning SNCU State insurance with coverage up to Rs 2 lakhs for all patients.

Positives contd. ASHA : minimal attrition . Almost all ASHAs have bank account. ANM and GNM school at GH and plans for starting BSc Nursing. State Quality Assurance structures in place. Funds being transferred online. HPDs given funds as per norms

Widespread Dengue outbreak in 2015 controlled well: mortality. Both the districts have dedicated TB hospitals one Major Findings HR systems non existent:

Highly irrational posting especially in Sub centres Ad-hoc recruitment, no skill assessment Urban Health Centers a place to accommodate personnel in HQ Weak supportive supervision

Sub optimal service utilization: assured services not provided in facility and community despite adequate staffing. Major Findings Actual requirements of field not reflected in the plans and implementation: No Micro-plans for VHND and due list for immunization RNTCP Microscopy centers are under-utilized and cases sent

directly to DH Sub optimal utilization of NCD clinics at DH and CHC Non Functioning MMU No Condoms, OCPs, ECPs, Nischay kit in facilities except DH Major Findings

High Out of pocket expenditure due to non availability of free drugs, diagnostics, dialysis initiatives and weak referral transport system Districts unclear about Quality Assurance Program, still following ISO Grievance redressal mechanism not found in any facility Labour room protocols, partographs not practiced. Labour room

nurses rotated every week ASHA recruited last year, have not got any orientation training. Overall weak training system Action Taken by State Highly irrational posting especially in Sub centres Transfer order issued vide order No MEST-2016/88 dated Nlg the 13th May 2017 where 118 staffs transferred.(36 ANMs) link East Siang -one facility namely SC Takilalung where 5 ANM were posted

during the visit of 10th CRM team. Now 3 ANMs were posted out on 21st Nov2016 vide order no. M-5271/T/P/11-12. HRMIS is being implemented. Timeline March 2018 Ad-hoc recruitment, no skill assessment Contractual recruitment done at State HQ & regular through Public Service Commission, They undergo induction training at State Undergo continuing training on MH, CH, FP and other program to enhance their skill. Currently, contractual recruitment on hold.

All recruitment through Public Service Commission only for Doctors. Other category recruitment through state department central recruitment board (Written, practical & viva) Recurrent baseline assessment ongoing for Nurses & LT and will scale up to include Doctors also Timeline December 2017 Urban Health Centers a place to accommodate personnel in HQ Current status of staff at UPHC following CRM:At Pasighat

1 MO, 1 pharma, 2 GNM, 4 ANM, 1 LT, 2 FA, 1 Male Attendant, 1 N/Chowkidar, 1 Sweeper. At Naharlagun/Itanagar Transfer order issued vide order No MEST-2016/88 dated Nlg the 13th May 2017 (118 manpower transferred) Timeline December 2017 Weak supportive supervision Difficult topography and poor road connectivity impedes on planned supportive supervision.

No proper monitoring vehicle in majority districts. Private vehicles used for Monitoring and supervision. Supportive supervision plan in place at state To place S/S plan at district Technical support from DPs for NHPDs also Timeline December 2017 Sub optimal service utilization: assured services not provided in facility and community despite adequate staffing.

Functionality an issue due to irrational manpower placement Basics services are provided in all functional SCs. Beneficiaries prefer going to PHC/CHC/DH. Functionalisation being initiated through rational posting Regular review at district level planned Regular S/S visit is being ensured from district & state More training on all services ongoing and planned. Timeline September 2017

No Micro-plans for VHND and due list for immunization Micro-plan for RI in place (Post MI) Timeline 7 districts plan being corrected & improved. Micro-plan and due list in place during MI rounds Districts directed to generate due list for RI sessions also September Micro Plan for VHND available in 12 2017 districts & rest furnishing shortly. RNTCP Microscopy centers are under-utilized and cases sent directly to DH

Low population leading to low Timeline cases Cases needing FNAC or complicated looking are referred August 2017 to DH Sub optimal utilization of NCD clinics at DH and CHC It is a new programme Systems to be placed and consolidated in all districts and functionalise clinics in health facilities. Training ongoing at ToT level

Timeline September 2017 Non Functioning MMU 2 unit MMUs in 16 districts MMU camp is conducted 6 camps per month (Ave). MMU specific manpower not in place Team constituted from among manpower in health facilities Notice for combining School health mobile teams Districts with fully non-functional MMUs identified and issued notice.

Timeline August 2017 No Condoms, OCPs, ECPs, Nischay kit in facilities except DH The observation has been reviewed for Timeline all districts FP commodities now in place at districts Condoms, OCPs, ECPs, Nischay kit received on 28/12/2016 and issued to all the facilities and ASHAs. Supply chain management need revamping through use of IT (DVDMS) August

More training being planned on FP 2017 services. High Out of pocket expenditure due to non availability of free drugs, diagnostics, dialysis initiatives and weak referral transport system The state Govt provides free drugs in the health facilities

State Govt provides fund for procurement of drugs (Health Deptt & DC) Plan for Free diagnostic services under NHM will be shared during NPCC PM Dialysis program underway. Tender floated on 30 th May 2017 and by August, it should be functional in atleast 3 GHs. JSSK in operation but need dramatic improvement at facilities Plan for orientation of MO incharges of all facilities. Quarterly Review Meeting of districts on NHM Performance at State Chaired by Commissioner (Health & Family Welfare) Awareness on JSSK, JSY and free referral transport through IEC media including 102 ERC (in Place at Naharlagun) Timeline Dec 2017

Districts unclear about Quality Assurance Program, still following ISO GH Pasighat was ISO certified. Timeline Quality Assurance cell being improved More orientation on importance of quality assurance for health staff planned. Training on Quality assurance to Mos being planned. December Training of assessors, peer planned 2017 Overall, National quality certification of DH planned.

Grievance redressal mechanism not found in any facility Grievance redressal mechanism Timeline through online system 104 EoI already floated. 104 toll free no for comprehensive grievance (Health information, ASHA and any grievance) Redressal mechanism is being inbuilt in the call centre. September Effective GR cell will be functionalised 2017 on hospitals and then to health facilities Labour room protocols, partographs not practiced. LR nurses rotated every week

Due to shortage of Nurses, roration is Timeline practiced. LR protocols are in place It is a challenge to ensure use of Partograph even in the hospitals More Doctors / Nurses are trained in SBA / BeMOC which will improve use. Several notice issued for permanent Sept posting of nurses to Labour / SNCU / 2017 ANC clinic and after 10th CRM too. ASHA recruited last year, have not got any orientation training. Overall weak training system Induction training of newly recruited Rural ASHA and Urban ASHA has been completed.

Orientation training of all existing ASHA done. ASHA trainings started from Jan2017. Timeline August 2017 Thank you

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