strengthening chc for first referral care – meghalaya

Strengthening CHC for First Referral Care –

Meghalaya

Ibadasuklin Kharshandi and Mornrina J Nongkynrih

North East Network, Meghalaya, Shillong

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Background/Context Meghalaya the “abode of clouds” currently

has 7 districts. Although it has a matrilineal form of lineage, the general health conditions of the women in the state are poor.According to NIN, Hyderabad (2008) it was found that Meghalaya mothers were among the most anaemic in the country. Inspite of the implementation of the NRHM programme, there still exist an upward trend towards home delivery of 74.9% (DLHS-3) in the state. Besides the low literacy rate 63.31% (census 2001), a severe shortage of medical personnel, inadequate infrastructure and medicines, mis-utilisation of funds and certain other reasons has created a major problem in the NE region. Based on these different and regular problems an assessment study on “Strengthening CHC for First Referral Care” was undertaken.


Background/Context

Meghalaya the “abode of clouds” currently has 7 districts and has a matrilineal form of lineage

• Meghalaya mothers were found to be among the most anaemic in the country (NIN, Hyderabad 2008)

• There still exists an upward trend towards home delivery of 74.9% (DLHS-3) in the state.

• A severe shortage of medical personnel, inadequate infrastructure and medicines, mis-utilisation of funds and certain other reasons has created a major problem in the NE region.


Research Questions/Objectives

How well do the 4 CHCs in 4 districts of Meghalaya meet NRHM standard?

To map out the target population that the CHC caters toTo understand and describe factors concerning availability and quality, accountability and affordability.To find out and understand the service gurantees from CHCs for essential and emergency obstetric care including surgical interventions To make recommendations based on the findings emerging from the study


Geographical Boundaries

4 CHC from 4 districts were covered under the study

•Khliehriat CHC (Jaintia Hills District) ≈ 100km /sq

•Nongpoh CHC (Ri Bhoi District) ≈ 53km/sq

•Pynursla CHC (East Khasi Hills District)≈ 55km/sq

•Mairang CHC (West Khasi Hills District)≈ 44km/sq


Time BoundariesThe time line of the research is for 5 months

• 1 month for the Preparatory and Approval process

• 2 ½ months for Fieldwork

• 1 month for Analysis

• ½ month Draft report.

Limitations

• Short time period because of delay in introductory letter

• Sample size

• Language (diverse ethnic groups/ many dialects)

• Lack of co-operations from some beneficiaries/ subjects


Stakeholders readiness to participate in study

Opposition SupportActive Opponents

Fence-sitters

Active supporters

Some MHO

Some beneficiaries

Some RKS members

Commissioner, State Programme Manager,

DMHO, MHO, Nursing Superintendent, RKS members, Executive members of the society, Women’s Group.


Sampling

•Purposive sampling was used for interviewing the CHC staff.

•Selective sampling for exit interview

•Snowball technique was used for household interview with the women from 3 localities and FGD with the Women’s Group in the least functional CHC.

The sample size consisted of 63 respondents comprising of:

•CHC staffs:7 in 4 CHCs

•CHC clients :5 in 4 CHCs

•Household interview:5 women each in 3 localities

•FGDs: 3 FGDs with women’s group and 1 with RKS members


Methods of data collection

• Semi Structured Interview with the CHC staff•Exit interviews with clients accessing services from the CHC.• Semi Structured interview with women in the least functional CHC.•FGD with the RKS members and Women’s Group in the least functional CHC.•Observation of all 4 CHC. •Desk review of records.

Ethical issues•Acquisition of introduction letter from the funding organization for obtaining an official permission from the State to conduct the study.•Gain informed consent of the respondents.•Anonymity of the respondents were to be maintained•Findings of the study should be used purely for research purpose


Findings The major findings revealed through the audit study are:

•All four CHCs do not have blood storage facility.

•Operation theatre is not functional in all four CHCs.

•Supply of basic medicines is inadequate

•Only one CHC provides diet for the indoor patients.

•Complicated cases are referred to the District hospital.

•Unavailability and lack of clinical manpower in all four CHCs

•3 CHCs have transport facility – Ambulance

•3 CHCs has Functional RKS

•3CHCs are satisfactorily clean

•All four CHCs do not have

•citizens charter.

•redressal mechanism.

•24 hour electric supply

•toilet facility in the OPD


Out of the four CHCs, one CHC was found to be the least functional in terms of the following:

•Non-functionality of the X-ray machine.

•Labour room with no equipment

•Autoclave is not available, only boiling equipments

•Quality of service delivery is not satisfactory asDoctors hardly conduct deliveriesAcute water shortage and very impure water with coal debrisStaff attendance and timings not maintained

•No transport facility.

•Non-functionality of the RKS

•Did not receive the referral transport fund.

•Maintenance of cleanliness is not hygienic.


Findings of FGDsWomen’s Group

• Lack of awareness on Government sponsored schemes and types of funds received under the CHC

• Selection of ASHA was not as per IPH Standard.

• No knowledge regarding role of ASHAs

• No knowledge of the RKS and its roleRKS

• The RKS did not meet the IPHS criteria in terms of number of members.

• Instability in membership.

• No records / minutes were maintained.

• All the RKS members were not called for the meeting nor held regularly

• There is no transparency in handling of money and the decision is taken individually by the MHO.


Conclusions

• Immediate steps is required to improve all 4 CHCs to meet IPHS norm•Equipments, Infrastructure and trained staff need to be provided and supplemented. •The district hospitals are burdened with cases ( normal & complicated )affecting the quality of treatment to the patients.•Awareness generation activities regarding the NRHM programmes.

Strength: The launching of EMRI operating in PPP mode has reduce the transport crisis.


Recommendations

During the course of the research work, a few suggestions emerged out of the study:

•Government should emphasised more in improving the three functioning CHCs as there’s a heavy flow of patients accessing the health services

•There’s adequate staff and equipments in the 3 functioning CHCs

• Involvement of locality executive committees in CHCs health programmes.

•Extensive training for the existing members of monitoring unit.

•Hygienic disposal of medical wastes

•Provide expensive medications apart from the basic ones

•Maintenance of computerised record.

•Timing for OPD must be fixed at convenient time for women to access health services

strengthening chc for first referral care – meghalaya

Documents

strengthening chc

kmsq free template

study free template

chc staff

shillong free template

districts of meghalaya

sqnongpoh chc ri bhoi

state programme manager