ABHWC Sub Health Centre Field visit findings 4

AB-HWC- Sub Health Centre Field visit findings 4 th Regional 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, 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. • 23 rd September 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 SCHWCs. • Nagaland: Elderly care during home visits. • Meghalaya: Distribution of Walker and Walking Sticks at SCHWCs 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.

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