MID-TERM REVIEW INDIA POPULATION PROJECT-VIII BANGALORE MAHANAGARA PALIKE
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MID-TERM REVIEW
INDIA POPULATION PROJECT-VIII
BANGALORE MAHANAGARA PALIKE - extracted text
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SDA-RF-CH-1B.18
MID-TERM REVIEW
INDIA POPULATION PROJECT-VIII
BANGALORE MAHANAGARA PALIKE
CENTRE FOR RESEARCH IN HEALTH
AND SOCIAL WELFARE MANAGEMENT
861, BANASIIANK.ARI II STAGE. BANGALORE- 560070
July, 199S
6
MID-TERM REVIEW
INDIA POPULATION PROJECT-VIII
BANGALORE MAHANAGARA PALIKE
CENTRE FOR RESEARCH IN HEALTH
AND SOCIAL WELFARE MANAGEMENT
861, BANASHANKARIII STAGE, BANGALORE- 560070
July, 1998
I
Table of Contents
Executive Summary
1. Introduction
2. Civil Works
2.1
Background
2.2
Methodologies adopted for the Review
2.3. Findings of Review
2.4. Recommendations
3. Maternal & Child Health and Family Planning Services
3.1. Background
3.2. Methodologies adopted for the Review
3.3. Findings from the Review
3.4. Recommendations.
4. Training
4.1
Background
4.2. Methodologies adopted for the Review
4.3. Findings of the Review
4.4. Recommendations
5. Information, Education and Communication Activities
5.1.
Background
5.2. Methodologies adopted for the Review
5.3. Findings of the Review
5.4.
Key Recommendations
6. Innovative Programmes
6.1.
Introduction
6.2.
Link Workers Programme
6.3.
Social Health and Environmental (She) Clubs
6.4. Non-Formal Education
6.5.
Crdches
6.6.
Income Generation Activities.
7. Project Management
7.1. Background
7.2
Meetings of the Committees
7.3.
Staff Position
7.4. Procurement & Logistics of Supplies
7.5.
Management Information System
7.6. Flow of Funds
7.7.
Utilisation of Funds
7.8. Recommendations
8. An Overview of Project Impact
8.1. Background
8.2. Methodology adopted for Assessment
8.3. Findings of Evaluation
1
30
34
34
36
59
62
62
64
83
85
85
86
99
101
101
102
112
114
117
125
133
137
145
151
151
152
153
155
156
157
158
164
164
164
9. Summary of Findings & Recommendations
9.1.
Civil Works
9.2. Maternal & Child Health and Family Planning Services
9.3. Training
9.4. Information, Education and Communication Activities
9.5. Innovative Programmes
9.6.
Project Management
176
178
180
182
183
186
List of Tables
Table 2.1.
Table 2.2.
Details of Sample selected for Field Assessment of Quality.
36
Staff Position of Civil Works Unit
36
Table 2.3. Targets for Construction of Buildings
37
Table 2.4. Details of Progress of Preparatory activities for Construction
♦ 39
Table 2.5 Notification for Tender.
40
Table 2.6. Status of Civil Works
41
Table 2.7. Performance of Works.
45
Table 2.8 Desk Review of Quality
47
Table 2.9. Details of Field Assessment of Quality
50
Table 2.10: Realistic Cost Estimate for Civil Works
55
Table 2.11. Comparison between Project Proposal & Schedule of Rates
57
Table 3.1. Details of Sample size for Facility Survey
63
Table 3.2. Status of Completion of Health Centres
65
Table 3.3. Staff Position at Health Centres
66
Table 3.4. Services Provided at the Health Centres
68
Table 3.5. Job Responsibilities of Field Workers
69
Table 3.6. Performance Statistics of Health Centres (1994 - 98)
69
Table 3.7. Facility Survey at Health Centers
72
Table 3.7 (A). Facilities Requested by LMOs.
74
Table 3.8. Profile of Facilities at Health Centres as per Training Centre’s Survey74
Table 3.9. Profiles of Beneficiaries attending Maternity Homes / Referral
76
Health Centres.
77
Table 3.10. Opinion of Beneficiaries on Services at Mat. Homes / Referral
Health Centres
Table 3.11. Opinion on Willingness & Affordability to pay User Fees
78
Table 3.12. Results of Household Survey of Family Planning Beneficiaries
79
Table 3.13. Profile of Beneficiaries at Female Sterilization Camps
82
Table 3.14. Asepsis Standards at Female Sterilisation Camps
83
Table 4.1. Staff Position of the Centre
86
Table 4.2. Annual Training Plan/Calendar
88
Table 4.3. Type, Duration, Category of Personnel Trained
90
Table 4.4. Category-Wise Number of Personnel Trained in different Years
91
Table 4.5. Type, Duration and Year Wise Distribution of Persons Trained
92
Table 4.6. Analysis of Training Programmes
94
Table 4.7. Impact Evaluations & Follow up action taken for CSSM Training
Programmes
98
Table 4.8. Progress of Training Component
99
Table 5.1. Year-Wise Planning activities Undertaken
103
Table 5.3. Details of IEC Materials Prepared
104
Table 5.3. Year-Wise Performance of IEC Activities
106
Table 6.1. Year -Wise Performance of Innovative Scheme.
116
Table 6.2. Socio-Demographic Particulars of Link Workers
121
Table 6.3. Knowledge of Link Workers on MCH and F.P.
122
Table 6.4. Perfonnance of Link Workers
Table 6.5. Socio-Demographic Particulars of SHE Club Members
Table 6.6. Knowledge and F.P. Practices of SHE Club Members
Table 6.7. Activities of SHE Clubs
Table 6.8. Infrastructure Facilities at the Centers
Table 6.9. Infrastructure Facilities at Crdches
Table 6.10. Comparative Information from Mothers of Creche Beneficiaries
and Non Beneficiaries
Table 6.11. Socio-Demographic Particulars of Beneficiaries
Table 6.12. Details of Training Programmes and Opinion of Beneficiaries 149
Table 6.13. Health awareness of Beneficiaries
Table 7.1. Staff Position of the Project
Table 7.2. Year-Wise Cumulative Performance of Procurements
Table 7.3. Grants Received from GOK and released to IPP VIII
Amount In Lakhs of Rupees
Table 7.4. Realistic Estimates of Budgetary Requirements for the next Three
Years of Project
Table 7.5. Component Wise Expenditure Analysis
Table 7.6 Expenditure Analysis
Table 7.7 Projected Estimates of IPP VIII, B’lore
Table 8.1. Comparative Coverage Evaluation Statistics
123
129
130
131
135
141
143
148
150
152
154
157
159
160
161
162
173
List of Abbreviations
A.E.E
A. V
AC
AE
AFP
ANC
ANM
ANMTC
ARI
Asst
Avg.
AWW
B. C.C
B.DA
BCCTC
BMC
BMP
BMRDA
B. Sc.
BWSSB
C. C cubes
CC
CREST
CSSM
CUT
DD
Demo
DGO
DHO
DHS
DIO
Dir (Try)/ Dir(T)
Disc
DNS
DPHN
DPT
DTP
EC
Assistant Executive Engineer.
Audio Visual.
Air - Conditioner.
Assistant Engineer.
Associated Flaccid Polio
Antenatal care.
Auxiliary Nurse Mid Wife.
Auxiliary Nurse Mid Wife Training Centre.
Acute Respiratory Infection.
Assistant.
Average.
Anganwadi Worker.
Bangalore City Corporation.
Bangalore Development Authority.
Bangalore City Corporation Training Centre.
Bangalore Municipal Corporation.
Bangalore Mahanagar Palike.
Bangalore Metropolitan Development Authority.
Bachelor of Science.
Bangalore Water Supply & Sewerage Board
Cement Concrete Cube.
Conventional Contraceptive.
Christian Missionary Organization.
Child Survival and Safe Motherhood.
Copper - T
Deputy Director.
Demonstration.
Diploma in Gynecology and Obsterctics.
District Health Officer.
District Health Superintendent.
District Immunisation Officer.
Director Training.
Discussion.
District Nursing Superintendent.
District Public Health Nurse.
Diphtheria, pertussis, (Whooping cough), Tetanus.
Desk Top Printer.
Eligible Couple.
Eval.
Evaluation.
Extension Educator.
Ext - ED
F.P
F.W
GOT
GOK
Gynaec / Gynec
H.C
HIV/AIDS
HO
HOs
Hosp
HQ
HS
HFPTC
ICP
IEC
LFA tabs
EPP IX
IPP -VIII
IUD
KAP
KEB
KSCB
Lab. T
Lady Med. Off. / L.M.OLHV
LW
Mat. Homes / M.H
MBBS
MCH
Min
MIS
MOI/C
MOHFW
MPW
MSc.
MTP
MTR
NA
NEE
NGO
NIHFW
No
NSV
O&M
O.T
Family Planning.
Family Welfare.
Government of India.
Government of Karnataka.
.Gynecologist.
Health Centre.
Human Immuno Virus/Acquired Immuno Deficiency Syndrome.
Health Officer.
Head Office.
Hospital.
Head Quarters.
Health Supervisor.
Health and Family Planning Training Centre.
Infection Control Practices.
Information, Education and Communication.
Iron and Folic Acid Tablets.
India Population Project - IX.
India Population Project - VIII.
Intro-Uterine Contraceptive Device.
Knowledge Attitude and Practice.
Karnataka Electricity Board.
Karnataka Slum Clearance Board.
Laboratory Technician.
Lady Medical Officer.
Lady Health Visitor
Link Worker.
Maternity Homes.
Bachelor of Medicine and Bachelor of Surgery.
Maternal &, Child Health.
Minimum.
Management Information System.
Medical Officer In - Change.
Medical Officer of Health and Family Welfare.
Multi Purpose Worker.
Master of Science.
Medical Termination of pregnancy
Mid term Review.
Not Applicable.
Non-Formai Education.
Non-Governmental Organisation.
National Institute of Health and Family Welfare.
Number.
No Scalpel Vasectomy.
Operation <£ Maintenance.
Operation Theater.
(
OBG
OCPs
OP
OPD
OPV
Org
ORS
ORT
Paed
PHN
PK
PMP
PPU
Progr. Officer / P.O
Proj. Cord
Pvt
Pvt. M.P
Quits
R. C.C
RCH
Re.trg.
Ref. Hospital
Ref.
RO (FW)
Rs
S. R
SC
Sco.W
SDC
SHE C.M
SHE
SIHFW
SI. No.
Sqft
Sq m
Sr.
ST
STD
Surv
T. C
T. T
TBA
TO
Trg. / Try
TV
U. F.W.C
Obstetrics and Gynecology.
Oral Contraceptive Pills.
Oral Pills.
Out Patient Department.
’Oral Polio Vaccine.
Organisation.
Oral Rehydration Solution.
Oral Rehydration Therapy.
Pediatrics.
Public Health Nurse.
Pourakarmikas
Private Medical Practitioners.
Post - Partum Unit.
Programme Officer.
Project Co-ordinator.
Private.
Private Medical Practitioners.
Quarters.
Reinforced Cement Concrete.
Reproductive and Child Health.
Retraining.
Referral Hospital.
Referral.
Research Officer Family Welfare.
Rupees.
Schedule of Rates.
Scheduled Caste.
Social Worker.
Skill Development Centre.
SHE Club Member.
Social, Health and Environment.
State Institute of Health and Family Welfare.
Serial number.
Square Feet.
Square meter.
Senior.
Scheduled Tribe.
Sexually Transmitted Disease.
Survey.
Training Centre.
Tetanus Toxoid.
Trained birth attendant.
Tubectomy Operation.
Training.
Television.
Urban Family Welfare Centre.
U/P
UNICEF
VCR
VHAI
Vit-A
WHO
Yrs
Under Progress/Processing.
United Nations Children’s Fund.
Video Cassette Recorder.
Voluntary Health Association of India.
Vitamin A.
World Health Organization.
Years.
EXECUTIVE SUMMAR Y
1. Background
The National Health policy aims at taking services nearer to the door steps of the people and
ensuring the full participation of the community in the process of health development.
With this in background. Government of India with the aid of World Bank have targeted to
provide basic health and family welfare sendees to the urban poor especially the slum dwellers by
the turn of the century. Consequently India Population Project-VHI (IPP-Vm) was formulated and
implemented in the slums of Bangalore Mahanagara Palike. With the ultimate goal of providing
Family welfare (FW), Maternal & Child Health (MCH) services, the project is to focus on the
reduction of fertility levels in the area.
The broad objective of the Project were to deliver Family Welfare and Maternal & Child
health services to almost all the urban poor in Bangalore City.
The specific objectives were to:
•
Improve maternal and child health
•
Reduce the fertility among the urban poor
In order to suitably plan and implement the strategies of this programme it is planned to
undertake a Midterm Review of the Project Activities through the Consultancy services of M/s.
Center for Research in Health and Social Welfare Management, Bangalore.
2. Objectives of present Review
i.
To review the physical and financial progress of all the components of the project,
objectively and critically and suggest ways and means for effective implementation in the
remaining duration of the Project
ii.
To review the innovative programmes undertaken through SHE Club, Link Workers and
Health Centers staff and assess their impact on improving the services delivered by the
Health Centres.
iii.
To Compare the Base line survey results done in the year 1992 with the results of Multi
Indicator Survey conducted in 1997 and assess the impact of the Project interventions
undertaken in the first three years.
3. Methodologies for the review
The review was carried out under the following components.
1.
Review of the achievements under the component civil works in terms of completion rates
and steps taken for construction, quality assessments.
ii.
Review of the activities of MCH centers
iii.
Review of the activities under Training programmes in terms of content, quality and
impact
iv.
Review of the IEC programmes in terms of content, utility and accomplishments
v.
Review of Innovative programmes and community participation activities undertaken in
the Project.
vi.
Review of Project management activities accompanied by updated expenditure
projections for each component of the project viz.. Civil Works, Procurement, IEC,
Innovative Schemes, Training, MIES and MCH & FW services.
4. Review period
The review was carried out during the period April to June 1998 and covered all the activities
undertaken by the Project since its inception.
5. Review Team
The review team consisted of Specialists in the areas of Civil Engineering, Community Health,
Medical Education, Health Management, Community Development, Survey Operations and Health
Education assisted by qualified field Investigators.
6. Methodologies adopted for review
The review was carried out by following procedures.
(L Civil Works
1.
Review of various documents available in IPP VIII office such as reports of physical
progress, financial progress, identification of sites, problems related to land acquisition,
cost estimates, test results of bricks, cement, steel and concrete, soil investigations, check
list and drawings.
ii.
Field survey of sample of buildings to check the deviations from working drawings/
observations of aide memories as well as the defects in the buildings.
iii.
Visits to architect and other consultants.
2
I
iv.
Meetings with the staff of IPP VIII to review the requirement of staff and reasons for
shortfall in progress, and actions taken for quality control measures at site, and to estimate
the realistic programme for completion of civil works
b. MCH & F.P. Services
i.
Records analysis of progress of establishment of Health Centres viz. Numbers, status,
staffing and activities as well as programme performance in terms of output indicators.
ii.
Service delivery assessments through:
a. Facility survey at Health Centres, U.F.W.Cs, and Maternity Homes.
b. Beneficiaries ’ survey at Maternity Home /Referral Health Centres.
c. FP beneficiaries ’ survey in slums.
d. Assessment of Quality of care at Female sterilisation camps.
c. Training
i.
Assessment of achievements in Physical targets of training programmes for each category
of service providers like Medical officers, Paramedical staff. Community workers. This
was carried out through a Desk review of Progress reports of the Centre.
ii.
An Assessment of the Quality of training was carried out for Content of training. Duration
of training, Methods and Media used for training. Materials prepared for training and
Capabilities of trainers.
iii.
An assessment of the impact of training was done on the basis of pre and post training
evaluation records maintained at the Centre.
iv.
Further the MTR process adopted a participatory approach and a feedback was given to the
Project Co-ordinator and Director of the Training Centre.
(L TEC Programmes
i.
Desk review of assessment of achievements in Physical targets of IEC programmes in
terms of:
a. Analysis of targets with actual achievements.
b. Content analysis of all IEC material for Validity of messages. Completeness,
Message transmission.
ii.
Focus group interviev's with community and analysis of results from the mid term survey
on IEC.
3
iii.
Exit interviews of clients on a sample of clients in 50% MCH centres and 30 sub centres
for 15 days.
iv.
Assessment of Impact of IEC programmes at the Health centre level.
v.
Review of the observations of IEC Consultants.
a Innovative programmes
i.
Desk review of Progress reports.
ii.
Analysis of targets with actual achievements and reasons for shortfalls.
iii.
Facility survey as per standard techniques.
iv.
Random sample surveys of Institutions and beneficiaries for assessing the impact of the
innovations under the different components.
v.
Focus group discussions in the slums to assess the impact of Link workers, SHE clubs, and
involvement of NGOs and Community in the activities of the project.
f. Project achievements
The indicators worked out in the baseline survey in 1992 and multi-indicator survey in 1997
have been used here for the assessment of the impact. Comparisons are also made on the basis of
NFHS data for rural and urban areas.
7. Findings of Review
7.1. Civil Works
Management of Civil Engineering unit
The staff working on the Civil Engineering unit were from Bangalore City Corporation or
on deputation from public works department. All the posts sanctioned were not filled up.
Since available Assistant Engineers are busy in achieving physical progress and are
available at site only, they do not have time to follow up on other preparatory work like approvals,
change of location of site, change orders and evaluation of tenders, which has lead to delay in
implementation of the targets.
Target achievement
There was no physical progress in the first two years of the project, main reasons for which
were the problems associated with the acquisition of land from Corporation and other Government
agencies, which varied from 15 to 28 months. There was considerable delay in other stages of
4
planning relating to soil investigation, preparation of drawing, approval of drawing, preparation and
approval of cost estimates, tendering process and of work order, ranging from 24 to 36 months. The
first work order was issued only on Sth May 1996, 24 months after the initiation of the project It
was observed that the period between approval of drawing to issue of work order varied from 15 to
36 months, which should have been completed in 6 months (24 weeks) as per the project proposals.
The period taken form notification of tender to issue of work order varied form 4 !^to 6 months
which should have been completed in 2 Vi months.
The tenders for civil works were called for in the local newspapers.
The participation in the first and second tender was less. The participation from the third
notification onwards was good and on an average the participation ranged between 1.75 to 11 for
different tender notifications. In few cases single tenders were also considered.
Status of Civil Works
By the end of this review period 12 Health Centers, 4 Staff Quarters, 5 renovation of
existing UFWCs and Maternity Homes were completed. The other buildings were under
construction / renovation. Still the process of planning have to start for 10 UFWCs and 9 Maternity
homes. •
The reasons for delay were:
Land problems. Protest by local residents and change of location for Health Centres.
Insufficient contract period of 6 months, release of work front in stages, absence of construction
programme of contractor and restriction on stacking of contractors material and plant and M/C
for renovation of MH & UFWC.
Implementation for Quality of Work
a. Actions taken andfindings
No Contractor has furnished any programme for execution of work. The soil investigation
was being done through M/S Nagadi Consultants and reports were available. The bricks were tested
by the contractors and the test certificates were available. For reinforcement, the contractors were
submitting the manufacturer’s test certificates. The contractors were arranging for sampling and
testing of cube strength of concrete from reputed laboratory.
5
There was no documentation of the modifications done at job sites. Though the sire order
books were available, complete instructions were not recorded. No records of permission to go
ahead with concrete works were available.
The construction sites were regularly visited by the Project Co-ordinator and rhe Programme
Officer. However, these visits were unscheduled. The visits of the Architect/ his representative were
notified to project authorities.
The contractors were not conducting the following tests, which were mandator/.
1. Pressure testing of G.I Pipes.
2. Testing of sewer lines.
3. Testing of Electrical works.
Check lists for taking over of buildings from contractors were not available, while only
inventory list was prepared, signed by the L.M.O.
“As built drawings” of plumbing and sanitary and electrical works have not been prepared.
Field Assessment of quality of Buildings
Buildings completed
In general the quality of construction of buildings was satisfactory. The quality of general
works like brickwork, plaster, painting, flooring was satisfactory. The quality of form work and
concrete for columns and slabs were satisfactory and the sample cubes for concrete were taken
from all the work spots.
The sanitary fittings in all the units were found to be in working condition.. All the taps
were working and no leakage was found in most of the cases.
The Form work for lintel, lofts and sides of beams was not satisfactory. Providing covers to
reinforcement was also not satisfactory.
In some of the buildings there were deviations from the approved drawings as well as in the
constructions. Some of them are highlighted below.
1. Sinks in minor OT not provided in the location as per drawing.
2. Elbow operated taps not provided in minor OT.
3. Floor traps provided in minor OT in spite of specific contra instructions.
4. Pumps provided inside the buildings in spite of specific contra instructions.
5. Change of location and number of electrical points.
6. The necessity of certain basic provisions for delivery of efficient services overlooked in
6
the constructions.
7. Defects in the constructions impeding the delivery of services.
8. Difficulty in closing door and window shutters.
9. Ramp to emergency room not provided.
10. Approach to the terrace not provided.
11. Drinking water facilities not provided.
12. No provision for maintenance of buildings.
Realistic Estimates for completion of Civil works
The realistic estimates for the completion of the Civil Works is as below.
a. Health Centers
i. For 30 units where work is in progress:
June-98 to March-99.
ii. For 13 units where work is expected to start by July-98:
Septemher-99.
b. Staff Quarters
For the 3 units, where work is expected to start by July 98:
June-99.
c. Training Centre
Work is in progress and completed up to plinth level, the scheduled completion is
December-99.
(L Renovation of Existing UFWCs
i. For 4 units where work is in progress and are in the finishing stage: 15th July 1998.
ii. For 7 units for which tender evaluation is in progress,
work is expected to start from August-98:
August-99.
Hi. For 5 units tenders are expected to be notified by July-98 and
the work is programmedfrom:
Jan-99 to Dec-99.
iv. Fo r 5 units for which drawings are to be prepared
from June to August 98. Notification for this is being planned
in October-98 and the programme for work is:
March-99 to March-2000.
& Renovation of Existing Maternity Homes
i.
For 2 unitsfor which work is in progress are in finishing stage:
ii.
For 8 unitsfor which tender evaluation is in progress, work is
expected to start from July-98
July-98
June-99.
7
iii. For 4 units tenders are expected to be notified by July-98 and
the work is programmed
Jan-99 to Dec-99.
iv. For 5 units for which Architectural drawings are to be prepared
is expected by Aug-98. Notification for the same is being
planned in October-98
March-99 to March-2000
Review of Escalation of cost
The project proposal envisaged the following expenditure for civil component.
Civil work
Departmental Charges
705.13 lakhs
84.62 lakhs
Total
789.75 lakhs
The realistic cost estimate based on the work orders issued and the forecast based on the
present schedule of rates and market scenario is Rs 2188 lakhs.
The increase in cost over Project Proposal is 177%.
The reasons for increase were;
i.
Time gap of 4 years between execution and proposal
ii.
Change in specifications
iii.
Increase in the scope of work
iv.
Increase in the deposit rates of KEB and BWSSB
v.
Increase in cost of building materials and labour due to large scale construction for National
Games
Maintenance of Buildings
The newly constructed and renovated buildings will be under the custody of IPP-VIII till the
tenure of the project, which will be ultimately handed over to Bangalore Mahanagara Palike.
As on date, no maintenance work has started. Since some of the building were completed over an
year back, maintenance has become necessary. As such it is suggested to provide maintenance work
“on contract basis” following regular departmenial procedures. The LMOs of the centers may be
made responsible for coordinating maintenance work with the Civil Works unit There is already a
provision in the budget for maintenance. An annual budget of Rs.5000/- towards minor repairs per
building may be allocated. For all newly construcred buildings which will be completing 3 years of
completion before the tenure of the project, annual maintenance work as per the departmental
regulations are to be done.
Review of Consultancy Services
The following consultants were engaged to provide services for different aspects.
a. M/S Susri Associatesfor Architectural and Structural consultations.
b. M/S Nagadi Consultantsfor Soil investigation works.
c. M/S Doddamma Enterprisefor providing Group 'D ’ stafffor supervising the building works.
(L M/S Tiger Servicesfor providing security and cleaning services to Health Center and Maternity
Homes.
Generally the task accomplished by them were satisfactory.
Recommendations
a. Recommendations on Management aspects
1. Recruitment of staff on contract basis to be done. Retired engineers may also be considered for
these jobs.
2. An undertaking to be taken for staff on deputation from the concerned departments that they
will not be disturbed during the tenure of the project.
3. One Engineer to be earmarked for planning activities and follow up action with Architect and
Consultants. His duties to include progress-monitoring, preparation of cost estimates, obtaining
approval for cost estimates, tendering and evaluation and reports.
b. Recommendationsfor Quality assessments
1.
Strict adherence to drawings and specifications.
2.
Proper supervision and pour cards for concrete work.
3.
Access for cleaning terrace to be provided in Health centers and staff quarters.
4.
Requirements for providing basic services like elbow operated taps.
5.
Modifications to be done only after written instruction of Architect
6.
Combined services drawing for renovation work.
7.
Engaging services of consultants for quality control.
8.
Maintenance wing to be established.
9.
All defects pointed out must be rectified and documented.
c. Recommendationsfor quality improvements
9
1. Construction programme for individual structure to be submitted by the contractor with mil
stone achievements and should be monitored every month.
2. Check list for taking over buildings from contractors to be prepared and shall be signed by P.O,
only after which the building will be handed over.
3. Check lists for concrete work, brickwork, flooring plastering and painting to be prepared.
4. As built drawings to be prepared and preserved properly.
d Recommendations for completion of civil works in time
1.
Master plan for all the activities of construction like identification of site, preparation
of Architectural drawings, preparation and approval of cost estimates, tender
notification and evaluation, issue of work orders, contractors programme including
milestone events to be prepared.
2.
Tender evaluation to be done with the aid of computers.
3.
In case of land problems, relocation of sites and issue of change order to be expedited.
e. Recommendations for reducing cost escalation
1. The notification for tender to be given in all leading local and national news papers in loca’
language and English.
2. The requirements of electrical points for Health Centre and Maternity Home to be rechecked.
f Recommendations for Proper Maintenance of buildings
The present scenario is that maintenance funds are not readily available. It is therefore suggested t(
explore the possibility of finding funds for maintenance through alternate channels such as:
a. Sponsorship by individuals and other pnvate sectors.
b. Creating a Corpus fund for maintenance
c. Collection of nominal fee from patients.
7.2.Maternal & Child Health and Family Planning Services
Earlier to the initiation of the project, there were 31 Maternity Homes, 32 Urban Famih
Welfare Centres (U.F.W.C) and 5 Post ?zrtum Units (PPUs) in the City. In the Project, it was
planned to have in all 97 Health Centres and 24 Referral Health Centres under the project b}
strengthening or converting the existing 32 U.F.W.Cs and 5 PPUs (total 37) on par with the
proposed Health Centres and set up, build ind operate and maintain, in a phased manner, 60 new
Health Centres.
10
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Status of Health Centres
There was no integration and co-ordination between the Public health and Engineering
Units as was indicated by the fact that in a few Health Centres basic physical infrastructure and
facilities, which are essential for delivering good and acceptable health services to the people, were
not provided.
Staff Position
It was seen that a few of the posts of the Medical Officers were vacant affecting the
programme performance. Further staff were on deputation from BCC/State Govt, and were less
motivated/committed/interested in work aggravated by frequent transfers of deputed staff.
Programme Performance
A few changes were made in the activities of the Centres and also in the job responsibilities
of ANM and Link workers (field staff) from the original project proposals which have been
smoothly implemented.
The FP performance has been consistent for sterilisation (female) and IUD but more efforts
are needed to popularise and increase usage of spacing methods of oral pills and condoms. The
male participation (vasectomy) is practically nil. Though ANC registration is improving there is
considerable drop in the proportion of deliveries conducted in Government institutions (62% to
53%). This trend was noticed for immunisation services also, could be due to renovations in
maternity homes affecting delivery and extension of services.
Facilities at Health Centres
The general physical facilities like “waiting area”
“drinking water” facilities needed
improvements. The OPDs needed adequate equipment viz. Weighing machine, BP apparatus, etc.
In the wards of maternity homes the existing costs/beds needed replacements with adequate facility
for post operative care. The stores needed “closed cupboards” for storing drugs and FP supplies.
The ANC services need improvements by providing weighing machines, IFA tabs. Supplies,
etc. the laboratory services may include Hepatitis B screening and in select centres facilities for
HTV testing with counselling to be provided.
The supplies of IFA tabs, vitamin A, ORS and vaccines (in case of U.F.W.Cs/New centres)
need improvement. Similarly facilities for STD and AIDS control is needed under the project.
11
Waste disposal facilities are needed in the U.F.W.Cs / new centres and solar water heater
maintenance to be ensured.
(
(
(
A careful reorganisation of ambulance services is recommended.
Beneficiaries at Maternity Homes / Referral Health Centres
The proportion of beneficiaries from the slums was only 41%.
Majority of them visited for MCH services (86%) and around 11% for F.P. services. They
had to wait for about 25 minutes on an average, with a range of 5 to 60 minutes, for getting the
desired services and expressed satisfaction of services.
Majority expressed their willingness to pay ‘user fees’ for various MCH services viz. OPD,
laboratory services, wards, delivery and medicinal costs.
Quality of services for Family Planning
There were some gaps in the knowledge and practice of uses of spacing methods There is a
need to ensure adequate stock and supply at house hold level by the link workers/field staff.
There was a need to screen and identify a correct case for IUD.
For female sterilisation there was a need to look into the system of incentive distribution and a
proper medical follow up of operated cases.
Quality Standards at the Female Sterilisation Camps
The beneficiaries of tubectomy were young with an average age of 25 years, comprising of
Hindus and Muslims, almost similar to the religious pattern of the area. There were 17% who were
educated above High School.
Two-thirds had two or less number of children reflecting good
performance of the programme.
Informed consent was very poor, with only 18% being informed of the contents of the
‘Consent Form’. 28% of them did not know that tubectomy is a permanent method of contraception
and 32% did not have their bath before coming for the operation reflecting on the lack of
“Interpersonal communication” between the clients and health personnel.
The observations at tubectomy camps in the Maternity Homes/UF.W.Cs revealed that there
were gross deficiencies in the maintenance of aseptic standards inside Operation Theatres, with
regard to OT sanitation, OT dress linen, satisfactory disinfecting of Laproscope in cidex solution
and undesirable movement of non theatre personnel into operation theatres.
12
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Key Recommendations
1. To accelerate the construction of new health centers and renovation of existing maternity
homes/U.F.W.Cs.
2. To fill up staff vacancies, popularize No Scalpel Vasectomy and spacing methods viz. oral pills
and IUDs.
3. To improve logistics of supplies of IFA tabs, ORS and vitamin A, provide air conditioner and
generator to select OTs conducting FP camps regularly.
4. To improve coverage and utilization of services by slum population, to introduce on
experimental basis “user charges” for select services in a few maternity homes.
7.3. TRAINING
Skills improvement of the service providers is one the important objectives of the Project.
To fulfil this objective a residential Training Centre was established.
Infrastructure
Presently the Training Centre is operating in a Corporation building without any residential
facilities with inadequate facilities. The new building proposed for the Centre with a adequate
accommodation is under construction in the present premises and is expected to be completed only
by the end of 1999.
Two of the senior posts meant for training activities are vacant, adversely affecting the
training programmes. There is a need for additional staff viz. one Senior Consultant, a Steno-typist
and an Asst, statistical Officer to bring about improvements in the quality of training particularly
with reference to content, skill development, monitoring and post training performance evaluation.
Training Programmes
A tentative Training calendar was proposed which however was revised in subsequent years
of implementation, due to delays, without much changes in the content of the programme, and
training programmes actually started in 19°5-96, due to non establishment of the facilities.
Progress in training
A total of 17 types of training programmes have been conducted covering 2763 trainees in
the last 2 years. The most frequently conducted training programmes were “Pre Service Training”
13
for Link Workers (690) followed by CSSM training (397 persons) and Baby Friendly Hospital
(305 persons), besides concentrating on Lady Medical Officers on different aspects.
The envisaged training programmes for Municipal Councillors and Local leaders has been a
non starter, besides the coverage being very poor for the categories of School teachers. Private
Medical Practitioners, and the administrative staff of the Project.
The availability of suitable
training material to make the training more effective is also a felt need of the Centre.
The training programmes were hampered mainly due to lack of trainers and adequate
facilities.
There is a need for more emphasis to improve and strengthen clinical skills and
competencies of field staff viz. LMOs and ANMS and Link Workers, besides improving the
quality of training programmes.
It is important to ensure proper monitoring of the training activities as well as trainees
participation.
Content Analysis of Training programmes
On the whole, the training programmes were satisfactorily conducted with available
resources. However, the documentation with regard to the content and follow-up of the training
programmes is poor.
Training Materials
a) Link workers module: More information on FP methods; Maternity care with emphasis on
institutional care; immunisation including pulse polio campaign; AFP surveillance; Job chart of
LWs and services and facilities at HCs and maternity homes. This may be provided as an
addendum (DTP and photocopies) to the existing module as a cost saving measure.
b) Extension Approach Module: Areas on Pulse Polio Campaign, AFP surveillance; facilities
available and services provided in Health Centres/UFWCs/Matemity Homes.
c) RCHguidelines (in kannada): The training of TBAs & DD kits are to be substituted with
information for promoting institutional deliveries besides including more details on FP methods
viz. Nirodh, OCPs, IUD, Sterilisation including NSV.
d) IUD insertion guidelines for LMOs (GOI version): A checklist of evaluation (for post training
performance evaluation) to be prepared by the Training Centre and provided to benefit both the
trainers and trainees.
14
The library maintenance \vas poor and unsatisfactory. Adequate reading materials to suit the
needs of the trainees are lacking. Any further purchases of books and journals should be made in
consideration of the needs of trainees.
Evaluation and Follow-up Action of Training programmes
An effort has been made by the Training Centre through a “Standard Format” to
systematically evaluate the impact of CSSM training through post training evaluation of ANMs,
LHVs and Staff \nurses at their work places. Inspite of limitations, the Training Centre has
organised “retraining” following these evaluations, which is quite commendable.
But similar efforts are needed for Link Workers and LMOs and for other types of training
programmes (major ones) as well as on Management. Besides there is a need to organise a current
‘training needs assessment’ (quick and simple) and revise the training plan accordingly. It was also
informed that there is a lack of interest and passive participation of trainees viz. LMOs during
training programmes. They need to be oriented to the importance of training by the programme
officers and post training follow-up by Training Officers / Senior Consultant should improve the
situation.
Integration with other Training Institutions
An integration and co-ordination mechanism does not exist for training both IPP-VIII and
other health staff of BMP at the Training Centre to avoid duplication and multiplication of training
programmes for all health staff of BMP. In this direction as a first step towards integration, it is
desirable to rename the Centre as “Bangalore Mahanagara Palike Training Centre” to bring a sense
of ownership of the Centre from the Bangalore Mahanagar Palike.
Co-ordination and linkage of the activities of the Training Centre with SMFW, does not
exist for sharing information, facilities and trainers.
No concrete plans were developed to promote the Centre as the nodal training Centre for
medical and health staff of Municipal Corporations of other cities in the State.
Key Recommendations
1. To immediately fill up the staff vacancies at the training center and recruit additional staff viz.
senior consultant etc. on contract basis and accelerate the training activities.
2. To identify additional territory hospitals as skill development centers and organize training to
strengthen clinical competencies of medical and paramedical staff.
1E
3. To improve the facilities in the training center and to strengthen the monitoring, documentation
and evaluation of training programmes.
7.4. INFORMATION, EDUCATION AND COMMUNICATION ACTIVITIES
The planning of IEC activities are done on the basis of micro plans at Health Centre Level
and action plans at the community level.
Varied types of media were used in the propagation of messages. Educational materials
comprising of all the important messages on MCH and F.P. were prepared.
Recently conducted survey on IEC has brought out certain changes in the needs of strategies
of EEC. The focus group discussions held in the Community has highlighted that propagation of
messages through A.V. vans has been the most effective, but the timings of shows are to be
modified according to the needs of some special groups like working men and women. The group
meetings at Health centres have benefited only women and that the Folk media programmes are not
properly propagated. Pamphlets and display boards were not known to many.
Funds Earmarked for IEC activities have been fully utilised and part of the funds available
with Innovative Programmes have been diverted for IEC programmes.
The following recommendations emerged out of the above survey for improving IEC
component.
•
Slums being inhabited by three major religions Hindus, Muslims and Christians with
differences in knowledge, attitude and practices, the approaches and messages for each aspect of
the program should confirm to these differences. In other words the messages are to be tailored as
per the religious compositions of the slums.
•
Couples in the slums being young, the messages should suit their needs and should be in an
acceptable manner.
•
Since the slums have got working groups mostly engaged in day time labour, the timings of the
programs should fit into their leisure hours may be late evenings.
•
Co-ordination with different agencies involved in improving the status of women should be
considered as such agencies have more expertise in these specific areas.
•
Co-ordination with population education cells especially for adolescents both in the school and
out of school would enhance the efficiency of adolescent education programmes.
16
•
Co-ordination with private practitioners for educational programmes should be incorporated.
They are to be equipped with necessary materials and incentives along with an orientation in
imparting the messages.
•
Television being a popular media in the community, as compared to others, utilisation of this
media in a bigger way should be explored.
•
Group orientation programme which are at present covering only a scanty proportion of
population should be given a top priority.
•
Literacy amongst both male and female being considerably satisfactory, increased propagation
of messages through print media should be considered. Simple brochures and booklets prepared in
an interesting and appealing manner should be distributed.
•
Age at menarche being low especially with Muslim communities, population and sex education
through schools should be emphasised.
The concerned departments engaged in population
educational programmes at the district level should be co-ordinated.
•
Environmental Sanitation education programmes especially amongst Hindus and Muslims have
to concentrate on messages pertaining to hygienic methods of disposal of garbage, waste water and
use of community latrines.
•
Messages to improve the personal hygiene habits regarding bathing etc., especially among
Muslims and Christians require emphasis.
•
Importance of obstetrical care especially for antenatal and post natal checkup amongst
Christian women needs emphasis in messages.
•
Importance of institutional deliveries in reducing maternal complications needs to be stressed
in the messages.
•
Breast feeding habits and its importance in the child care and prolonging amenorrohea should
be incorporated in the messages especially with Muslims.
•
Messages on management of dirrohea in terms of increased food and fluid intake and
administration of ORS especially amongst Christians need to be included.
•
To reduce malnutrition amongst under fives which is very high in the community messages on
nutritional supplementation, using locally available food in sufficient quantities and concepts of
balanced diet require attention.
•
Messages on risks of teenage pregnancy need to be emphasised especially amongst Muslims.
17
•
Messages on legal age at marriage requires emphasis with Hindus and Muslims.
•
Messages on different family planning methods their importance, contra indications and
availability needs to be spread especially amongst Hindus and Muslims.
•
Information on spacing methods especially with Muslims is to be reinforced.
•
Women autonomy needs to be improved by incorporating messages on rights of women and
co-ordinating with agencies involved in such activities.
Recommendations
1. Before developing any new IEC materials an assessment has to be done for the effectiveness
of the media which are being used at present in propagating the messages. This should be
one of the tasks to be undertaken by the Consultants who are engaged with the Unit
2. Cost effectiveness in terms of coverage of different media should also be assessed by the
consultants who should also provide a feed back on suitable mix of media.
3. Follow-up should be done at Health Centres’ level for effective utilisation of materials
which are supplied to them.
4. Some of the messages recommended by the survey undertaken in Mid July 1998, should get
priority in the materials to be prepared from now on.
5. Grass root level workers especially ANMs, SHE club members and Link workers are to be
provided a better orientation of the health messages to be propagated by them as well as
using the materials in an effective manner.
18
7.5. Innovative Programmes
To make the programme more community based, several innovative schemes have been
incorporated in the present Project. The main objective of these innovative schemes is to strengthen
the NGO and Community Participation in the programmes besides improving the status of women
ultimately aiming at the sustainability of the programmes.
The unit is managed by one Programme Officer assisted by a few Social Workers, appointed
recently.
Important activities initiated under the scheme are:
• Involving Link workers from the community for effective implementation of the project.
• Establishing Social, Health and Environmental (SHE) clubs as a resource group for planning,
implementation and monitoring of the programmes.
• Providing educational opportunities to adolescent girls through non-formal schools.
• Providing care for the children of working women through Crdches.
• Income generation activities.
a. LINK WORKERS
Even though these workers were to belong to the same slums of their area of duty, only a
third of them were the residents of their work area, contrary to the concept of selecting workers
from the same slums.
Religion wise 92% of the workers were Hindus, 2.9% Muslims and 5.1% Christians
adequately representing the religious composition of the slums.
Most of the workers were young with a little less than two thirds of the workers aged up to 29 years
(61.5%) and another about a quarter from 30-34 years age group (24.6%).
Education wise all workers were educated with a majority with education up to middle school
(85.5%) and the rest were with higher secondary education.
94.2% were married while only 1.4% were unmarried. 84.2% of the currently married link
workers were practising family planning method. 63.8% of the link workers had undergone female
sterilisation, while 0.7% have adopted male sterilisation. 15.2% had IUD, 1.4% were using oral
pills and another 3.6% nirodh.
Level of awareness of workers on health and family planning
19
Only 23.9% of the workers had complete knowledge of the duties they were to perform.
Knowledge on identification of either eligible couples for F.P. or pregnant women was very
poor with only 10.9% and 44.9 % having complete knowledge on these two aspects respectively.
Knowledge on calculation of expected date of delivery or factors of risk during pregnane}
was better (79% for both).
89.9% knew the correct dose ofT.T to be administered to pregnant mothers.
Only 37.7% of workers had complete knowledge on advises to be given to pregnant women
while only 56.5% knew about all the danger signs of new bom and another 62.3% knew all the
advises to be given to mother immediately after delivery.
However their knowledge on different family planning method was 100% with all of then
having knowledge on male sterlisation, female sterlisation IUD, oral pills and nirodh.
All the link workers were aware of the complete immunisation schedule for infants.
91.3%. of the workers were aware as to when a women is to be advised to adopt a
permanent F.P method while 97.8% were aware of spacing methods.
Only 57.2% had complete knowledge of vitamin A deficiency while another 52.9% had
knowledge of iodine deficiency and 23.2% for causes of anemia.
Their knowledge on advises to be given to diarrhoea cases was very good (97.8%), but only
17.4%% had knowledge on the danger signs of diarrhoea. All the workers were aware about the
method of preparation of ORS.
Only 59.4% knew what are the advises to be given regarding personal hygiene.
The knowledge on STD was almost nil and it was informed by Project authorities that there
was no component of either STD or HTV/ AIDS in the training curriculum to the workers.
Activities performed by the workers
Link workers during the previous year, on average had referred 101 children for
immunisation, motivated 120 cases for adopting various family planning methods. They were
successful in motivating couples for spacing methods as out of the cases motivated nearly two
thirds were for spacing methods.
Majority of workers were practising family planning (84.7%).
20
Community opinion on the programme
Almost all the females, except for a few working women, knew who was the link worker in
their area and also what activities were being performed by her and were of the opinion that she is
working effectively and that she visits their area regularly and distribute oral pills, condoms and
ORS packets on need basis. However only a few of the males were aware of her existence that too
through their wives.
Recommendations
1. Link workers should be recruited from the same slums of their area of work, which will enable
community members to use their services in a better manner.
2. Emphasis on STD/AIDS as well as identifying eligible couple and pregnant women in training
programme is required.
3. Since identification cards and uniforms
were desired by the workers, the feasibility of providing
them these facilities can be explored.
4. The project should look into sustainability of their services.
5. To improve upon better male participation in the programme a few male link workers may be
enlisted.
b. SHE CLUBs
The pace of establishment of the clubs is rather slow. During the year 1994-95 only 12 clubs
were formed while by the end of 1995-96, there were only 36 clubs which increased to 70 by the
end of 1996-97. However, during the year 1997-98, 67 clubs could be added to take the number of
clubs to 137. The target of establishing 401 clubs is still far behind.
Most of the members (97%) resided in the slums of the respective clubs and majority of
them were from the elderly age group of over 35 years (43.4%) and another 19.2% from 30-34
years. However, there were about a third of the members from younger age group 20-29 years of
age (36.4%). Adequate representation of some of the older age groups especially from -mothers-inlaw” who influence certain decision-making would help the programmes.
73.7% were Hindus, 20.2% Muslims and another 6.1% were Christians representing the
religious composition of the slums.
Education wise majority were educated beyond middle school (72.7%) and there
were
substantial proportion of graduates (40.4%'i amongst them.
21
Majority (90.9%) were currently married and of the married 83.3% had adopted different
family planning methods mostly tubectomy (72.7%). The proportion practising RJD was 6.1%, oral
pills 4.0% and only 1.0% Nirodh.
Level of awareness of members on MCH and F.P.
Knowledge on legal age at marriage of girls was quite satisfactory (97.0°o), but not so on
legal age at marriage of boys (82%).
Knowledge on different methods of family planning for prevention of pregnancy was almost
universal (99.0%). While female sterilisation was known to majority of members (93.9%),
knowledge on male sterilisation was very poor (29.3%) but on spacing methods of family planning
was not high except for Oral pills (93.9%), (85.9% for Nirodh and 72.7% for IUD).
All the members had knowledge on the immunisation schedule for children.
Knowledge on prevention of HIV/AIDS was fairly good (81.7%) but on STD was known
only to a few (34.3%). Even though the media had contributed well (93%) for this, training
programmes had also equally contributed (84%),
Activities of the Clubs
Average number of programmes conducted through the clubs were mostly related to the
Immunisation (11) and Family planning programmes (9). The other programmes relating to
environmental hygiene & personal hygiene or disease prevention were not many ranging only
between 8 to 6. The number of camps or competitions conducted were not many (7 in all) and
mostly for Immunisation or Health Check-up.
Community opinion on the programme
Majority of the females were aware of the existence of the Club and the activities carried
out by them but not so with males. Many of the women had participated in the programmes of the
club. Both males and females, who were aware of the Clubs were of the opinion that they were
working effectively and are useful to them.
Recommendations
1. The formation of the Clubs should be accelerated to meet the targets of the Project and the
composition of members should have due representation for mothers-in-law.
22
2. Reorientation programmes to the members on Spacing methods of family planning , STD and
environmental sanitation including personal hygiene should be done, besides training them on
organising more and more innovative programmes.
3. The awareness programmes and camps organised by the Clubs should be more on programmes
on different components of the Project besides concentrating on Family Planning.
4. More Innovative meetings should be arranged in the community by the Clubs
5. Prior announcement of programmes in the community should be ensured.
6. Proper usage of pamphlets and exhibits by the staff should be ensured.
c. NON-FORMAL EDUCATION
Progress of establishment of the centers
Till 1995-96 there were no activities for the establishment of the centers. During the year,
1996-97 9 centers were established at different slums and another four centers were added in 199798. Thus there were only 12 centers functioning with students. All the centers were operated by
NGOs.
Infra Structure facilities at the Centers
Most of them had enrolled only up to ten students (87.9%) and the demand was around only 58%.
The centers were to cater mostly to the young girls in the age group 6-16 years. But only 12 % of
the beneficiaries were over 10 years of age. The main reason behind this is that most of the older
girls go out for work and the working hours of the centers were not suitable to them.
Position of staff was adequate. Majority of the centers functioned in single rooms (75%)
while a few centres share there accommodation with other innovative programmes like Creche. The
ventilation and natural lighting conditions were not satisfactory in majority of the centers (50 % to
67%). The basic amenities like toilet facilities were lacking in 50% of the centers while the
cleanliness of toilets was also poor (41.7? o). Drinking water facility was available only in 33.3% of
the centers.
Most of the girls sit on the floor and only 25% of the centers provide mats for the purpose.
Proficiency of teachers and standard of teaching methods
All the teachers were found to be educationally qualified and two thirds of them had
professional qualifications. Majority of the centres were adopting standard teaching methods.
23
Majority (75%) of the centers had adopted flexibility in curriculum according to the needs .
of the beneficiaries. But still there were areas of improvement like incorporating vocational training
and teaching of different languages as per needs.
75% of the teachers felt that the priority should be gix'en to environmental and personal
hygiene while teaching health education. Only 8% of the teachers felt the priority of imparting
menstrual hygiene while a similar proportion for nutrition. 83.3% of the teachers felt the need for
further orientation training on various health topics.
Recommendations
1. Infrastructure facilities should be ensured while sanctioning NEE centers.
2. Teachers should be oriented to impart MCH and reproductive health education to the girls.
3. Vocational component of non-formal education should be incorporated.
4. Timings should be accommodated as per the requirement of the students.
d. CRECHES
Demand for the Creches
The project envisaged establishment of 50 creches in dirferent slums of Bangalore by the
end of the project period, out of which 33 creches have already been established. 3 creches were
established in 1995-96, followed by 11 in the subsequent year 1996-97 and 19 during the year 199798.
All the Creches had a good demand for admission of children. 60% of the creches had
enrolled more than the optimum number of children (25 children). The age group of the children
enrolled varied between 2 to 6 years.
Even though the main objective of establishing the creches was to cater to the needs of the
working mother it was found that only 76% of the children were of working mothers and the
remaining were of housewives.
Infrastructure facilities
Staff position in the all the creches was found to be adequate, but the continuity of the
workers was not satisfactory as only 73.3% of the staff were working in the same creche for the
last two years. Only about half of the <53.2%) caretakers were professionally qualified with
Balsevika or Child development training.
24
Majority of creches were accommodated in single rooms (86.6%) and about half of them
did not have the recommended space for accommodating the children (46.7%).
Ventilation and natural light facilities were available in only 60% to 80% of the creches.
Toilet facilities were glaringly lacking in nearly half of the institutions (46.5%) and children used
the roadside for their needs. Even though water supply facilities were adequate, only 73.4% were
storing the drinking water properly in container with lid or water filter.
Availability of mats for children to sit and sleep was very poor in most of the creches
(33.3%). There were no cradles in any of the creches.
Play materials were available in only 53.5%. Outdoor playing space was inadequate in more
than two thirds of the creches.
Only 13.3% of the creches had first aid box with essential medical kit and only 26.6% of the
caretakers were trained in first aid.
Health Activities at the Creches
In most of the creche (80%) health check-up camps were held regularly once in 3 months
However health cards were available in only 46.6% of the creches.
Since one of the aims of the creche was to promote F.P methods amongst the mothers, the
percentage of mothers who have accepted F.P methods was quite satisfactory (72.7%). In almost
every creche mothers meetings were held regularly once every month where different topics on
MCH and F.W were discussed. Awareness of mothers on causes and prevention of HIV/AIDS was
satisfactory (80%).
Impact of Health activities at Creche on mothers
The health activities conducted in the creches such as mother’s meetings etc. have
influenced the knowledge and practices of the mothers, especially on spacing methods for F.P.
Even the adoption of these spacing methods for F.P. was higher with creche beneficiaries.
Knowledge on HIV/AIDS and STD was better with creche beneficiaries.
Recommendations
1. More creches should be started, as there is great demand for it.
2. Since the grant given for creche is found to be insufficient as expressed by many NGOs,
feasibility of increasing this amount should be looked into and an undertaking should be taken
from organisation that they would provide necessary infrastructure and training.
25
3. The staff of creche should be given periodical training on MCH aspect including STD/AIDS.
4. First aid box should be provided in all the creches with training to Care takers in First aid.
e. INCOME GENERATION ACTIVITIES.
Progress of achievements
The programmes started only in the year 1995-96 with the starting of a Radio and T.V repair
training center and gradually picked up in the year 1996-97 and 1997-98 and at present 24 units are
operating.
Characteristics and opinion of beneficiaries
There were a mix of all religious groups amongst the beneficiaries, however Muslims
constituting a higher proportion (35.7%).
Age wise majority were adolescent girls aged between 15-19 years (54.8%). Unmarried
girls constituted the majority of beneficiaries (67.1%). Even though majority of the beneficiaries
were from the same locality (86.3%), there were a few from other slums, indicating the need for
starting similar programmes in other slums also. Majority (98.6%) of the beneficiaries were
satisfied with the training programme, and with the training materials supplied to them (79.5%).
Health awareness of beneficiaries
Most of the (89%) beneficiaries had attended awareness programme on various health
topics. Except for a small proportion of 9% of beneficiaries all had knowledge on legal age at
marriage for boys and girls. Knowledge on menstrual cycle before its onset was found to be very
low (28.7%). 86.3% were knowledgeable about different methods of family planning. 72.6% knew
about tubectomy/Lap, 58.9% about lUD/Copper T, 67.1% about Oral pills and 53.4% about Nirodh.
However, knowledge on vasectomy was very low (27.4%).
Only 21.9% beneficiaries had heard about STD and another 90.4% about HTV/AIDS. Their
main source of information was through print media, 57.7% through health personnel and 67.6%
through relatives, friends, neighbours, social workers etc.
Recommendations
1. The scheme should be extended to all other slums where it is available however after a need
based survey.
2. Centers should propagate messages on reproductive health to adolescent girls.
26
7.7. PROJECT MANAGEMENT
A Steering committee at the State level chaired by the Chief Secretary of Government of
Karnataka and another Project implementation committee at the Corporation level, chaired by the
Commissioner, Bangalore City Corporation, guide and control all the managemeni aspects of the
project. The Project Co-ordinator has the overall responsibility of implementation of the
programme and is assisted by all the Programme Officers. Since the inception of the Project the
Steering Committee has met 6 times while the Project Implementation Committee 11 times.
The decisions were taken fast by these committees and have been conducive to the implementation
of the Project.
Staff Position
Many of the personnel were on deputation either from Bangalore City Corporation or from
other Departments of GOK, posing some problems of frequent transfers and non commitment from
the deputed persons because of uncertainties.
A few of the key posts like Training Officers, Engineering staffs and a Statistician were
vacant hampering the programmes. There is no full time post of Programme Officer for MCH and
FP delivery services and one of the Senior Medical Officers of the Maternity Hospital was on
additional duty.
Procurement & Logistics of Supplies
The purchases in the Project for equipment, medicines and supplies were done through a
Project Purchase committee which meets as per requirements. The supplies are procured on the
basis of tenders. The FP supplies. Vaccines, ORS, Vitamin A were procured from the State Family
Welfare Bureau on quarterly basis and issued to the Maternity Homes/U.F.W.C’s/NHC’s on
indents. The general drugs required for IPP VIII Health Centers were procured through public
tendering (through leading News papers) annually and stores at the IPP VIII stored at a central
Stores of the Project presently located at the Training center, Malleswaram. There was no regular
Warehouse building for the Project. Generally in most of the Centers proper storage equipment
were not adequate.
Management Information System
The Project has a Management Information System Unit with one Demographer, Statistician
and Computer operators. The unit is well equipped with Computers and Accessories.
27
Even though the unit was collecting regularly information on programmes directly
undertaken by the Project, such as EC, Training, Civil Works and Innovative Programmes,
information on Service delivery through Health Centres, was being collected and compiled at
Dasappa Maternity Home under the Municipal Corporation. The reporting formats, although
confirm to the Government of India requirements did not completely reflect the Project activities.
Recently an attempt has been made to develop MIS system for the Project through a
Consultant. The pace work by Consultants was rather slow, they have now committed that they
would complete the task by the end of July 1998.
Regarding monitoring of Project activities, it seems that no formal meetings were held every
month with the Medical Officers I/C of Health Centres to review the performance on the basis of
the reports. The MIS Unit has compiled some interesting reports on Status of Girls’ Education. The
Unit has also brought out periodical status reports on the Project.
Receipt and Utilisation of Funds
The project funds are received by Government of Karnataka from Government of India and
then to the Project. Even though, GOK has received Rs 3431 lakhs from GOI, only Rs 1807.1 1
lakhs have been released to the project and the surplus amount is retained at GOK level. The
Project Co-ordinator in a recent request has asked GOK to release the balance with them to the
Project.
The cumulative percentage spending out of the total outlay were respectively 1.3%, 3.3%
and 16.4% in the first three years. However during 1997-98 it touched 34.4%. The low spending
was mainly due to non-completion of Civil Works resulting in slow pace of spending in other
components like Procurement and Supplies. The ratio of average monthly expenditures over the
corresponding figure of previous year shows that during 1995-96 it was 1.68, which raised to 6.16
in 1996-97 indicating that the utilisation gathered momentum in 1996-97. This was very
appreciable for Civil Works with a ratio of 30.72. The Cumulative Percentage of expenditure over
the allocated budget is lowest for Training and Consultancy activities (only 14.6%) even though for
EC activities it has exceeded the budgeted amount, mainly because of under spending under
Innovative programmes. It is heartening that operating costs have not shotup.
The cost of Civil works have escalated as already reviewed under Civil Works. Based on
these cost escalation and probable expenditures on other components, realistic estimates of
28
expenditure for the remaining.period of the project was discussed in the Review meeting of the
Project with GOI and World Bank Officials.
It is estimated that the project would require an outlay of Rs 3831 lakhs in the remaining
period of execution to undertake all envisaged activities. This amounts to an additional requirement
of 1260 lakhs for the project
Recommendations
1. Ensure retaining deputed persons on various Posts nil the completion of Project.
2. Additional posts sanctioned are to be filled up immediately.
3. Project Co-ordinator to be assisted by a technical Consultant in Management for speedy
implementation of Management aspects.
4. Expenditure position to be improved by speeding up Civil Works.
7.8 OVER VIEW OF PROJECT IMPACT
The impact of the programme is appreciable in the areas of MCH and F.P. The targets set forth
for the projects are on the way for achievement. However educational programmes on age at
marriage, propagation of spacing methods amongst young couples, motivation for institutional
deliveries and service programmes on diarrhoea management, nutritional supplementation to
underfives should receive priority attention.
29
INTRODUCTION
1. INTRODUCTION
1.1.
Background
The family welfare programmes in India have been in operation for well over 40 years and
despite additional inputs the progress has been well below the targeted goals. The progress
especially in the urban slums are much below the desired levels. Urban slums have been growing at
an alarming rate and the implementation of different programmes have not been catching up with
this growth and thus the health care available to urban slums, especially with respect to family
welfare programmes have been far below the desired standards. The National Health policy aims at
taking services nearer to the doorsteps of the people and ensuring the full participation of the
community in the process of health development.
In this background. Government of India with the aid of World Bank have targeted to
provide basic health and family welfare services to the urban poor especially the slum dwellers by
the turn of the century. Consequently India Population Project-VIII (IPP-VIII) was formulated and
implemented in the slums of Bangalore Mahanagar Palike. With the ultimate goal of providing
Family welfare (FW), Maternal & Child Health (MCH) services, the project is to focus on the
reduction of fertility levels in the area.
The broad objective of the programme as per the Project document is to deliver family welfare
and maternal and child care services to almost all the urban poor in Bangalore City.
•
The specific objectives are to:
Improve maternal and child health.
•
Reduce the fertility among the urban poor.
The strategies to be adopted for the implementation are:
i.
Improving the quality of family welfare and maternal & child health care services provided
by the Corporation.
ii.
Strengthening the existing health and family welfare delivery services in the city.
iii.
Expanding the coverage of care for the urban poor by establishing new facilities.
Providing selected family welfare and maternal & child care services at the door steps of
the poor.
iv.
Developing close co-ordination with Government agencies involved in water supply,
sanitation, child development, female education and employment.
30
V.
Involving community leaders, private medical practitioners in health education and
delivery of comprehensive health services.
In order to suitably plan and implement the strategies of this programme it is planned to
undertake a Midterm Review of the Project Activities through the Consultancy services of M/s.
Center for Research in Health and Social Welfare Management, Bangalore.
1.2 Objectives of present Review
To review the projects physical and financial progress of all the components objectively
1.
and critically and suggest ways and means for effective implementation in the coming
months.
ii.
To compare the indicators revealed in the Multi-Indicator survey undertaken in Bangalore
Slums with the Base line survey results which was done in the year 1992 and suggest
improvements in the system for better delivery of FW services.
iii.
To undertake a detailed analysis of several Innovative Schemes under the project, like
creches, non-formal school for female school dropouts, Zeri & Embroidery training and
Computer training etc, and to assess the impacts of the programme.
1.3 Methodologies for the review
The review was carried out under the following components and the details of the
methodologies followed have been spelled out under each component.
i.
Review of the achievements under the component civil works in terms of completion rates
and steps taken for construction, quality assessments.
ii.
Review of the activities of MCH centers.
iii.
Review of the activities under Training programmes in terms of content, quality and
impact.
iv.
Review of the IEC programmes in terms of content, utility and accomplishments.
v.
Review of the project management activities.
vi.
Review of Women’s development and community participation activities under innovative
Schemes.
vii.
Preparation of revised implementation plan accompanied by updated expenditure
projections for each component of the project viz.. Civil Works, Procurement, EEC,
31
innovative Schemes, Training, MIES and FW services, including Realistic Annual/
Quarterly Projections of future expenditures.
viii.
Preparation of a comprehensive Mid-Term review report with a critical analysis
incorporating the findings of Baseline survey conducted in 1992, recent reports of MTF.S &
IEC consultants, available records and reports including official. World Bank AidMemories and special reports.
1.4.
Review period
The review was carried out during the period April to June 1998 and covered all the
activities undertaken by the Project since its inception.
1.5.
Review Team
The Review team consisted of Specialists in the areas of Civil Engineering, Community
Health, Medical Education, Health Management, Community Development, Survey Operations and
Health Education assisted by qualified field Investigators. The deUils of the Specialists are given
here under.
1.
Dr. N.Suryanarayana Rao
Team Leader
Consultant for
Review of
Project Management
and IEC component
Overall guidance
Review of Management aspects
Review of IEC component
2.
Dr. M.K.Sudarshan
Consultant for
Review of
Training and
MCH centres
Training programmes
Review of Health Centre activities
3. Mr. M.C.Keshava Murthy
4. Mr. M.V.Satish
Consultant for
Review of
Civil works
Review of Civil works activities
5. Ms. Vasanthi Satish
Consultant for
Review of schemes
under Innovative
programmes
Review of schemes under
Innovative programmes
32
Z- Z
6. Mr. A. Prakash Rao
Consultant for
Organising
Surveys and
Statistical Analysis
Planning and Supervision
of surveys
7. Mr. M.K. ChandraSekhar
Consultant for
Assist in field Review
1EC activities
of IEC component
1.6.
Acknowledgements
The Team Leader and other Consultants of The Review Team convey their sincere thanks to
The Project Co-ordinator Dr.M.Jayachandra Rao and Other Programme Officers Mr. S. Rajanna,
Dr. Mala Ramachandran, Dr. H.R.Kadam, Mr.H.B. Subbe Gowda, Mr. Mumyappa, Ms. Shobana
Kolothungan, Mr.S.Balaraju and other staff members of IPP VIII, Bangalore Mahanagar Palike,
who whole heatedly co-operated with the review team in accomplishing the mission.
The Team members gratefully acknowledge the suggestion offered by World Bank Officials
during the preliminary presentation of the review observations.
33
I
I
CIVIL WORKS
2. CIVIL WORKS
2.1
Background
The project envisages to strengthen the existing health and family welfare services in the
city by expanding the coverage of urban poor through establishing new facilities. In this direction it
was proposed to establish new health centres, renovation of existing U.F.W.C and Maternity home
and providing residential accommodation to staff besides establishing a training centre.
As such a substantial proportion of funds allocated for project activities were proposed
under Civil works component of the project.
The Mid Term Review of the Civil works component of the project was to be carried out to
assess the following aspects.
1. Assessment of achievements in physical targets of construction and renovation of buildings.
2. Implementations taken for quality assurance.
3. Field assessment of buildings for quality of construction.
4. Assessment of functional utility of buildings constructed.
5. Realistic projections for the physical achievement of targets in remaining duration of the
project.
6.
2.2
Estimation of cost escalation for the remaining constructions.
Methodologies adopted for the review
The review was carried out by following methods.
i.
Review of various documents available at IPP VIII office such as reports of physical
progress, financial progress, identification of sites, problems related to land acquisition,
cost estimates.
n.
Review of documents available in IPP VIH office regarding test results of bricks, cement,
steel and concrete, soil investigations, check list and drawings.
iii.
Field survey to check the deviation from working drawings/aide memories and the defects
in the constructions.
iv.
Visit to architect and other consultants.
v.
Meetings with the staff of IPP VIII to review the requirement of personnel, reasons for
shortfall in progress and actions taken for quality control measures at site.
34
A sample of buildings both completed as well as those still under construction were randomly
selected on zonal basis for field review. The stages of construction was kept in mind in the
selection of the sample.
The Programme Officer and his team were interviewed to find out the tests and other checks
carried out for implementation of the quality checks as envisaged in the tender documents. Records
at site level and correspondence of IIP VIII and Architect were also referred.
The field assessment of buildings were done as per the standards prescribed for construction
and recorded on a format.
The programme of field visit
was finalised after discussions with the Programme Officer and
his Engineers.
For all the field visits, the consultants and their team were accompanied by the concerned
Assistant Engineer and Contractor. The Project Coordinator and the Assistant Executive Engineers
also accompanied the Team for some of the visits.
For buildings still under construction, the review concentrated on assessing the work procedure.
The quality of plinth fill, brick work, form work and concrete were assessed as per the provisions in
technical specifications.
In the completed buildings, the field inspection was earned on to assess mainly on the
deviations from the approved plan which affected the functioning of the unit besides assessing the
working of sanitary and water supply fixtures, condition of doors and windows, seepage/dampness
and maintenance.
The number of buildings included in the sample are detailed m Table 2.1
The Mid -Term review was carried out by two consultants, both civil Engineers by profession.
The consultants were assisted by two Civil Engineering Graduates and an Electrical Engineer.
The estimates for the realistic programme for completion of civil works w» done on the basis
of discussions held with th. Project Coordinator. Project Officer and his team about the future
programme for completion of the civil works. The opinion of the Architect and the Contractors who
are executing the project were also taken.
35
Table 2.1. Details of sample selected for field assessment of quality.
SI
No
Description
c.
Completed Buildings
Health Centre____________
Staff Quarters._____ ______
Renovation of Existing
U.F.W.C & Maternity
homes.__________________
Buildings in progress
Health Centre____________
Renovation of Existing
U.F.W.C & Maternity homes
Training Centre
2.3.
Findings of Review
a.
b.
c.
a.
b.
No. Completed
Sample
size
Number of
buildings included
in the sample
12
100%
4
5
50%
40%
12
2
2
30
25%
50%
8^
2
4
1
1
2.3.1. Management of Civil Engineering unit
a. Organisational arrangements
The Civil Engineering unit is headed by a Programme Officer (P.O.) of Executive Engineer
cadre reporting to Project Coordinator. The P.O is assisted by two Assistant Executive Engineers
(A.E.E.) & one Technical Assistant. Each A.E.E. has two Assistant Engineers.
The staff working on the Civil Engineering unit were on deputation from Bangalore City
Corporation or Public Works Department of GOK.
All the posts sanctioned were not filled up and the status of staffing at the time of review is
furnished in Table 2.2.
Table 2.2. Staff position of Civil works unit
Designation___________
Executive Engineer
Asst. Executive Engineer
Assistant Eng,_________
Drafts man___________
Work inspector
Sanctioned Filled
j____
2________ 2____
8________ 4____
j________ j____
10
10
J_____
Discussions with the Project Coordinator, P.O. & A.E.E. revealed that there has been a
shortfall of engineers from the inception of the project Even during the course of the present Mid-
36
Term review, all the civil engineering staff sparing one A.E were transferred. This has led to a
situation where in there was no Engineer who had worked in the project since inception. As there
were only a few Assistant Engineers, there was no proper supervision and the, quality of work
suffered. The engineers did not have time to follow up on approvals, change of location of site,
change of work orders and evaluation of tenders, which has led to delays in implementation of the
project.
To overcome the shortage of Engineering staff work inspectors were engaged through a
manpower Agency.
b. Reporting system
Every month a report of progress of work was sent to Ministry of Health and Family
welfare. New Delhi, besides reporting to World Bank twice a year.
c. Schedule of Meetings
Meetings of Civil Engineering unit. Architect and the Project Coordinator were held every
month to review the progress of work.
2.3.2. Achievements in Physical targets of Construction and Renovation of buildings
a.
Target achievement
The total Project targets and the proposed construction schedule in the first two years were
as in Table 2.3.
Table 2.3. Targets for construction of buildings
Category of building
Total target for
the Project
Target for
first two
years
45______
_1________
5________
22
60
New Health Centre
1
Training Centre_____
7
Staff quarters_______
37
Renovation of existing
U.F.W.C__________
17
24
Renovation of existing
Maternity Homes____
There was no physical progress in the first two years of the project during 1994-95 and
1995 —96. One of the main reasons for the delay was the problems associated with the acquisition of
land from Corporation and other Government agencies. The period of delay varied from 18 to 24
months. There was considerable delay in other stages of planning relating to soil investigation.
37
preparation of drawing, approval of drawing, preparation and approval of cost estimates, tendering
process and issue of work order, ranging from 24 to 36 months. The first work order was issued
only on 8th May 1996,24 months after the initiation of the project
All the records about the identification and investigation of sites were not available with the
Project office particularly for the initial stages of construction.
The milestone events in the civil component of the project up to the work order stages are
detailed in Table 2.4.
It is observed from the above data that the period between approval of drawing to issue of
work order varied from 15 to 28 months, which should have been completed in 6 months (24
weeks) as per the project proposals
The period taken from notification of tender to issue of work order varied form 4 ’/ito 6
months which should have been completed in 2 ‘/a months.
38
Table 2.4. Details of progress of preparatory activities for construction
SI.
No.
Activity
Health Center
1.
September 1995
5^
Identification of
location____________
Approval of drawing
Approval of estimates
Approval of bid
documents_________
Notification for tender
6.
Issue of work order
2.
3.
4
7.
Time taken for issue
of work order from
initiation of Project
Staff Quarters
Training Center
Renovat
existing
Maternit
homes a
U.F.W.C
November 1994
December 1994
September 1995
December 1994
September 1995
October 1995
January 1996
January 1997
March 1
Decemb
October 1995
May 1996
24 months
October 1995
May 1996
24 months
May 1997
January 1998
44 months
October
May 19
24 mon
6. Notification for tender.
The tenders for civil works were called for in the local newspapers. The date of
notification and units covered were as in Table 2.5
Table 2.5 Notification for tender.
Date
Notification
31-10-95
pr-
13-03-96
26-05-97
25-08-97
14- 02-98
■pjry
3^
7^
ynr
Health
Centres
18___
5
Staff
quarters
4
Training
centres
M.H & U.F.W.C
U.F.W.C.
7
2
1
19
13
3
8
7
The participation in the first and second tender was less. The reason was the construction of
facilities for National Games which were in full swing. The participation from the third
notification onwards was good and the findings are as follows
1. In the first notification the average participants were 1.75 per tender.
2. 13 bidders tendered for the first notification.
3. In the second notification the average participants were 1.92 per tender.
4. For the second notification 14 bidders tendered which included 13 bidders of first
notification.
5. In the third notification there were 11 participants for one tender.
6. In the fourth notification the average participants were 2.5 per tender.
7. 11 out of 20 bidders who tendered for the fourth notification were new.
8. For the fifth notification, the average participants were 3.19 per tender.
9. 8 new bidders have tendered for the fifth notification.
10. Works were awarded to single bid tenders.
40
2.3.3. Status of Civil Works
Table 2.6. Status of Civil Works
Unit Description
Target
Health Centres
60
Handed Over
1994
-95
1995 1996 1997
-96 -97 -98
2
Staff Quarters
07
4
01
Training Center
37
Handed over
Renovation of
Maternity homes
Handed over
(i) 30 Units under
Construction Completion by
March. 99
(ii) 13 Units Tender under
process, will be finalised by
June 30th 1998
(iii) 5 Units deleted
(i) 3 Units tender under process 1
will be finalised by 30 June
Handed Over
Renovation of existing
UFWCs
10
1998 Remarks
-99
05
24
5
1998
j
Construction under progress,
j
anticipated date of
completion Dec 31 St 1999,
i. 4 units under construction
expected to complete by July
1998
ii. 7 units tendering process is
on, to be finalised by August
1998
iii. 5 units tender to be invited
by July 1998
iv. Drawing to be prepared for I
5 units in batches from June to
August 1998
v. 11 units deleted__________
i. 2 units under construction to
be completed by July 1998
ii. 8 units under tendering, to
be finalised by June 1998
iii. 4 units tender to be invited
by July 1998
iv. 5 units architectural
drawings to be submitted to
bank for review by August
1998
41
STATUS OF CIVIL WORKS
SL NO
DESCRIPTION
TOTAL
QUANTITY
NOS
1
TRAINING CENTRE
1
1
2
HEALTH CENTRE
55
13
IDENTIFICATION
ARCHCTTURAL
DRAWINGS
CONSTRUCTION
START
TENDER
NOTTFICADON
PUNTH
LEVEL
UNTEL
LEVEL
ROOF
LEVEL
5
Tz>
6
6
5
3
STAFF QUARTERS
7
8
BHll
12
SS SIB
3
: Il
4
4
RENOVATION OF
MATERNITY HOMES
24
5
4
8
Si
Si
MW^ZWi^
2
<>:• •:;:|
5
5
RENOVATION OF
U FWC
26
5
5
7
4
5
agfe ■ ><>-■>.•
I
)
Progress of Health Centres
Sites Deleted
8% (5)
TenderUnd e r^P ro c e s sf
Work
Completed
20% (12)
22%
□ Work Completed
Work in
Progress
50% (30)
BiWork in Progress
□ Tender Under Process
□ Sites Deleted
Status of staff Quarters
□Tender Uhder
FYocess
43%(3)
□VUikCcnpleted
'Atrk
Ccrryfeted
57%(4)
■VUrk in Progress
□Tencfer Uhder Process
Status of Renovation of Existing Maternity Homes
Drawings to be
Submitted
21% (5)
Work Completed
21% (5)
Work in Progress
8% (2)
Tender to be
Notified
17% (4)
□ Work Completed
Tender Under
Process
33% (8)
■ Work in Progress
□ Tender Under Process
□ Tender to be Notified
■ Drawings to be Submitted
Status of Renovation of Existing U.F.W.C’s
Work Completed
14% (5)
Sites Deleted
29%(11)
Work in Progress
11% (4)
Tender Under
Process
18% (7)
Drawings to be
prepared
14% (5)
Tender to be
Notified
14% (5)
□ Work Completed
■ Work in Progress
□ Tender Under Process
□ Tender to be Notified
■ Drawings to be prepared
□ Sites Deleted
44
Performance of works with reference to time frame as per contract is furnished in Table 2.7.
Table 2.7.Performance of works’
Health Center
Work order issued
No. of
buildings
18_____
5
May 96_________
Sept 96_________
Staff Quarters
Completed
in time
11
Completed
with delay
2
Delayed & still
not handed over
5____________
5
Work order issued
No. of
Completed
buildings
in time
May 96
4
Renovation of existing maternity homes and U. F.W.Cs.
Work order issued No. of
Completed Completed
buildings
in time
with delay
May 96
3
Sept 04
4
Renovation of existing U.F.W.C
Delay & still
not handed
over
2
2
2
Delayed &
still not
handed over
1
Work order issued
No. of
buildings
Completed
In time
Completed
with delay
Nov. 96
2
Nil
1
2
The reasons for delay were.
Health centres
• Land problems
• Protest by local residents.
• Change of location.
Renovation of M.H & U.F.W.C.
• Insufficient contract period of 6 months.
• Release of work front in stages.
• Absence of construction programme of contractor.
• Restriction on stacking of contractors material and plant and M/C.
45
2.3. 4. Implementation for Quality of Work
a. Actions taken andfindings
The discussion with the Project Officer and his team revealed that no Contractor has
furnished any programme for execution of work. The soil investigation was being done through
M/S Nagadi Consultants and reports were available. The bricks were tested by the contractors
and the test certificates were available. For reinforcement, the contractors were submitting the
manufacturer’s test certificates. The contractors were arranging for sampling and testing of cube
strength of concrete from reputed laboratory.
There was no documentation of the modifications done at job sites. Though the site order
books were available, complete instructions were not recorded. No records of permission to go
ahead with concrete works were available.
The construction sites were regularly visited by the Project Coordinator and the
Programme Officer. However, these visits were unscheduled. The visits of the Architect/ his
representative were notified to project authorities.
The contractors were not conducting the following tests which were mandatory.
1. Pressure testing of G.I Pipes.
2. Testing of sewer lines.
3. Testing of Electrical works
Check lists for taking over of buildings from contractors were not available, while only
inventory list was prepared, signed by the L.M.O.
“As built drawings” of plumbing and sanitary and electrical works have not been
prepared.
46
A brief summary of the desk review of quality is enclosed is furnished in Table 2.8.
_Table 2.8 Desk review of quality______
1. Construction Programme of Contractor
2. Testing of materials and certificate
i.
SBC of soil
ii.
Bricks
iii.
Reinforcement
3. Site record books
4. Reports
5. Testing during the progress of work and
documents
i.
Cube strength
ii.
Test of G.I. pipes
Test for sewer
iii.
_____ iy^
Tests for Electrical works
6. Tests during take over of buildings
Completion report of
i.
Electrical works
ii.
Check list for taking
over from contractors
Inventory list_______
iii.
7. As built drawings
Sanitary and plumbing
i.
Electrical works
ii.
Not Furnished
Available
Available
Available
Available
All the instruction and changes not
recorded.
Clearance given for concrete not recorded
Monthly sent to Ministry of Health and
Family Welfare.
Available
Not carried out
Not carried out
Not earned out
Available
I
Not available
Available
Not available.
Not available.
2.3.5.Field Assessment of quality of Buildings
a. Buildings completed
In general the quality of construction of buildings were satisfactory. The quality of
general works like brickwork, plaster, painting, flooring were satisfactory. The quality of form
work and concrete for columns and slabs were satisfactory and the sample cubes for concrete
were taken from all the work spots.
The sanitary fittings in all the units were found to be in working condition. All the taps
were working and no leakage was found in most of the cases.
47
The following deficiencies were observed:
The Form work for liniel, lofts and sides of beams was not satisfactory. Providing covers
to reinforcement was also not satisfactory.
In one Health Centre, the ramp was not provided even though specified in the drawing.
This deviation was due to the fact that there was no alternate place available in the locality to
construct the health center and the slum is one of the largest in Bangalore.
In one Maternity Home cracks are observed in beams and slabs of ward. In another
plastering of ceiling of about 1 Sq m area has fallen down and reinforcement is visible.
In joinery work, it was observed that there were difficulties of closing of doors at some
units. In 90% of the units the top and bottom of the shutter was not painted. Gaps between
doorframe and wall and between particleboard and panel were observed in most places. Closure
of steel windows was difficult at some units.
Regarding sanitary fittings, the sinks in the minor O.T. were not placed in the location as
per the drawing in all the Health Centres. Floor traps were provided inside the minor OT in the
Health Centres in spite of specific instructions. Elbow operated taps were not provided in sinks
of minor OT. The sinks/WHB in all the Health centres were also not provided as per drawing.
The sewage and the waste lines were laid but not tested. The gully traps were not
provided outside the buildings for waste pipes as per drawing. The G.I lines laid were not tested
for pressure as mentioned in the specification. Manhole covers in few units were too big and set
in flogging concrete. The pumps have been provided inside the LMO/ANM’s room causing lot
of disturbance.
There was no provision of drinking water supply at any of the units. It is now envisaged
to provide Xqua guards for the buildings.
Even though the Electrical work was generally satisfactory, there were some deviations
from drawings, in numbers and position of the fittings, particularly in Maternity Homes. Exhaust
fans in some of the health centers were not properly fixed and were tied to ventilators with
binding wire. No records were available for the testing of electrical circuits and completion as
per the tender documents.
As built drawings for sanitary and plumbing work and electrical work were not prepared.
The maintenance work has not starred so for resulting in inconveniences. In all the
48
Health Centers and Staff Quarters, no access was provided for the terrace causing difficulty in
cleaning of roofs and water tanks etc.
No ventilation was provided in the OT. Provision for A.C opening was also not provided.
Provision for back up power was not available in any unit.
The condition of sump was far from satisfactory. In most of the places, the automatic
level controller were not working. The slope of the pavement was towards the cover at some
locations and locks were not provided for sump at many places.
e
Details of the quality assessment of units is furnished in table 2.9.
b. Buildings under Execution
The following are the findings of the review on buildings under construction.
1.
Earth filling in plinth is not being done in layers.
2.
In 50% of units, observed soaking of bricks.
3.
230 mm thick brickwork workmanship satisfactory.
4.
In 50% of units ,115 mm thick brickwork reinforcement not provided as per
Specifications.
5.
In 33% of units, 115 mm thick brickwork not in plumb.
6.
Internal plastering work is satisfactory.
7.
In 100% of units, bulging of concrete observed in plinth beams.
8.
Bonding provided properly in 50% of units for subsequent pour of concrete.
9.
In 33% of units, sides of roof beams bulged.
10.
In 50% of units, cover to reinforcement of lintels and lofts not satisfactory
and visual exposure of reinforcement and aggregate observed.
11.
Concrete surfaces in contact with filled up soil not painted with bitumen.
12.
Trenches were filled with filled up soil.
13.
R.C. Works of columns and roof slab satisfactory.
49
Table 2.9. Details of Field Assessment of Quality
Particulars
I
Nos.(12)
Health centers (Functioning)
1. Door and Window shutters difficult to close, sagging and warping 9
observed
_____________________ _______________________
2. Top and bottom of door shutters not painted
__ _________ 12
12
3. Gap between door and window frame and wall_________ _______
12
4. Reverse slope in the corridor at ramp entry___________ ________
10
5,Stains and dampness in walls due to seepage
12
_
_
6.Surface cracks in walls
V.Glazed tile Dadoing
1
Out of plumb
a.
b.
Chippings and cracks observed_________________ _____ 7
2
_
_
_
8. Racks out of plumb
1
9. Ramp not provided for emergency as per drawing
_
_
___________ 12
lO Floor traps provided in Minor-OT
11, Pump provided inside the building___________________ — ------ 12
12. Automatic water controller not working
____________ 6
13.I.W.C.level not proper
_____________ ____ __________ ___ 7
14, Corporation water supply through mains_________ __________ _ 10
15. Corporation water supply through tankers_________ __________ _ 2
11
Ib.Gully traps not provided for sewage lines as per drawing
17.1nspection chamber covers set in flogging concrete
-------------- 1
7
18. Exhaust fans loosely fixed (tied with binding wire)
__ ___________________ — 12
19. Change of location of points
20 Portico and bulkhead fittings not working____________________ 10
21 .No. of switches not working__________________ _____________ 12
22.Maintainance
7
Glasses broken
a.
6
Sump cover not proper/stolen
b.
Cleaning of tank not done______ _------------------------------ 7____
________
c.
Renovation of M.H. and U.F.W.C_______ ----------------------- -— Nos (4)
1 .Window locking arrangement not proper___________________ 4____
2____
2. Joints between old and new masonry not proper____ ___________
3. Collapsible gate track between wards and labour filled with mortor
4. All the screws not provided for the door hinges _____________ _ 2____
5. Gap between door frame and wall____________ _________ _— 4____
6. Dampness in wall due to seepage_________ __________________ 2____
7. Cuddappa platform for seating not provided in waiting hall---------- 2_____
J__
S.Cracks along the length of the slab in ward
9.Ceiling plaster fallen off and reinforcement is visible in waiting
hall
_________________ ____
J__
1
50
Particulars
Nos.(12)
10. Existing wall not removed in examination room leading to no
ventilation in attached toilet_______ _______ _________
11. Wardrobe shown in drawing not provided in change room_____
12. Toilet between Labour ward and Enema room not provided
13. Dadoing - Tiles are broken and falling in some places
14. No ventilation in O.T rooms__________________
15. Flooring level not proper______________________
16. Wash basin provided instead of sink in Minor-OT___________
17. Elbow operated tap not provided in Minor-OT______________
18.1. W.C, level and grouting between IWC and floor not proper
19. Aluminium plates not provided in toilet door_______________
20, In wards, 15 Amp heating point not provided by the bed side
21 .Electrical points are provided above mirror in toilets_________
22.Solar heaters provided ____________
23.15 Ampere heater points provided in waiting hall____________
24. Electrical points deviated from drawing in numbers and location
25. Maintainance
~
a.
Glasses broken
b.
Tube lights not working
c.
Fans not working
d.
Panels of solar heater broken
e.
C.P.Grating for trap missing
f.
Window and ventilator stays missing
________
_______
26. Corporation water supply
27. Bore well water supply
STAFF QUARTERS
1. Door shutters not closing and top and bottom not painted
2. Gaps between wall and frame
3. Dampness is observed in walls_____________
— ~
4. Aluminium plate not provided for toilet shutters_______________
5. Joints between Dado and floor not proper
_____
~ ——
6. Cracks in living room walls
7
_1
J
J_
J-
J_
2
2
2
2
2
2
2
2
4
3
2
2
I
3
2___
2___
_2____
Nos(2)
2_____
2_____
J___
2____
_1_____
2
51
2.3.6. Realistic Estimates for completion of Civil works
Realistic estimates for the completion of the Civil Works is summarised below.
a. Health Centers
Health Center: Target - 60 Nos - Revised Target - 55 Nos
Handed over - 12 Nos
Work in progress - 30 units
i. Finishing stage - 8 Nos
ii. Roof level
-5 Nos
iii. Lintel level
- 6 Nos
iv. Plinth level
- 6 Nos
v. Just started
-5 Nos
Tender Evaluation Stage - 13 units
Construction of 5 Health centers were cancelled due to non-availability of land and problems in
some of the locations where work is in progress.
The estimated dates of completion of construction would be:
For 30 units where work is in progress:
June-98 to March-99.
For 13 units where work is expected to start by July-98:
September-99.
b. Staff Quarters
Target - 7 Nos
Completed - 4 Nos
Tender Evaluation Stage - 3 Nos
The estimated dates of completion of construction would be:
For the 3 units, where work is expected to start by July 98:
June-99.
c. Training Centre
Target - 1 no.
Work is in progress and completed up to plinth level, the scheduled completion is December-99.
tL Renovation of Existing UFWCs
Target -37 Nos
Handed over - 5 Nos
Work in progress - 4 Nos (finishing stage)
52
P&MH3O
Tender evaluation stage - 7 units
Tenders to be invited - 5 units
Architectural drawing to be prepared - 5 units
Deleted - 11 units
The estimated dates of completion of construction would be:
/.
For 4 units where work is in progress and are in the finishing stage: 15^ July 1998.
ii. For 7 units for which tender evaluation is in progress,
work is expected to startfrom August-98:
August-99.
Hi. For 5 units tenders are expected to be notified by July-98 and
the work is programmed from:
Jan-99 to Dec-99.
iv. For 5 units for which drawings are to be prepared
from June to August 98. Notification for this is being planned
in October-98 and the programme for work is:
March-99 to March-2000.
e. Renovation of Existing Maternity Homes
Target - 24 Nos
Completed - 5 Nos
Work in progress - 2 Nos
Tender Evaluation stage - 8 Nos
Tenders to be invited - 4 Nos
Architectural drawing to be prepared - 5 Nos
For 2 units for which work is in progress are in finishing stage:
July-98
For 8 units for which tender evaluation is in progress, work is
expected to startfrom July-98
June-99.
For 4 units tenders are expected to be notified by July-98 and
the work is programmed
Jan-99 to Dec-99.
For 5 units for which Architectural drawings are to be prepared
is expected by Aug-98. Notification for the same is being
planned in October-98.
March-99 to March-2000.
The programme for balance civil works are shown in the bar chart.
53
PROGRAMME FOR BALANCE CIVIL WORKS
SL NO
DESCRIPTION
TOTAL
NOS
QUANTITY
IDENTIFICATION
AACHCITURA4.
TENDER
DRAWINGS
NOTIFICATION
TRAINING CENTRE
2
HEALTH CENTRE
CONSTRUCTION
START
j*n »a
45
30
Feb 98
Jul-98
STAFF QUARTERS
3
3
19
2
Dec 99
BSS
Mar-9
13
3
FINISH
:w?3
Sep-9
Feb-98
RENOVATION OF
EXISTING
Jul-9
MATERNITY HOMES
8
Feb-98
4
|
5
9
Jul 98
Jun-9
JuM»
Jan-99
Dec-9
Oct-98
Mar-99
March -
Aug-98
RENOVATION OF
EXISTING U F W C
20
7
Jul 9
7
5
S
Feb 98
'&////&
Aug-94
________
Aug 18
Aug 9
Jul 98
Jan-99
Dec-9
Oct-88
Mar-H
March -
A.3.7. Review of Escalation of cost
The project proposal envisaged the following expenditure for civil component.
Civil work
705.13 lakhs
Departmental Charges
84.62 lakhs
Total
789.75 lakhs
The realistic cost estimate based on the work orders issued and the forecast based on the present
schedule of rates and market scenario is furnished in Table 2.10.
The assumptions made in estimating the realistic cost were:
1. The tendered cost has been considered for all works which were issued work orders
2. The works for which tender evaluation were in progress, margin over sanctioned estimate
assumed.
3. For the remaining works of renovation of Maternity Homes and U.F.W.C. an average of 25
lakhs per building assumed.
Table 2.10: Realistic Cost Estimate for Civil Works
SI.
No
Category and Details
1
Health Center-Revised Target 55
i. Work orders issued
42
ii. Tender Evaluation in progress
13
Staff Quarters-Target 7 Nos
i. Work order issued
4
ii. Tender Evaluation in progress
3
Training Center-Target 1 No.
i. Work order issued
1
Renovation of existing Maternity
Homes and UFWC-Target 24 Nos
i. Work orders issued
7
ii. Tender Evaluation in progress
8
iii. In architectural drawing stage
9
Renovation of UFWC
2
3
4
5
i. Work order issued
Nos
2
Total (estimate for civil works after considering I
escalation in cost.
Estimated
amount
(In lakhs)
Tender
Amount
(In lakhs )
639.80
248.62
849.45
296.84
72.50
76.89
103.42
88.42
195,00
199.41
106.00
257.61
225.00
139.60
306.93
225.00
12.95
17.62
Remarks
I
20% margin assumed
15% margin assumed
I
20% margin assumed
25 lakhs per unit assumed
2226.69
J
£5
The increase in cost with respect to project proposal is 182%.
The reason for cost escalation in general were:
1. Time gap of 4 years between proposal and execution.
2. Change in specifications.
3. Increase in the scope of work.
4. Increase in the deposit rates of KEB and BWSSB.
5. Increase in cost of building materials and labour due to large scale construction for National
Games.
The details of reasons for cost escalation for each category were as follows:
(L Health Center
1.
The structure was changed from conventional size stone masonry foundation and
load- bearing walls to R..C framed structure.
2. Change of specifications like Marble flooring in O.T, Tandur blue flooring and dado.
Aluminum Entrance doors, Windows and partitions.
3. Items like sanitary & plumbing, electrical works & compound wall might not have
been considered while estimating.
Increase in cost between project proposal and sanction estimate was 229% (Refer Table 2.11).
The cost of Health Center Sq m.
sq.ft.
6. Staff quarters
=
=
Rs.9050.10
Rs. 841.
I. Additional items were later included like compound wall for individual quarters.
Increase in cost between project proposal and sanctioned estimate was 123% (Refer Table
2.11)
Rs. 83 82.
=
Cost per Sqm
Rs.779.
=
per Sq ft
c. Renovation of Existing maternity homes and U.F.W.C
1. Increase in the scope of work
2. Replacement of damage flooring, dadoing, plastering and weather proof course
Increase in the cost between the project proposal and the sanctioned estimate was 340%
(Refer Table 2.11)
EA
Table 2. 11. Comparison Between Project Proposal & Schedule of Rates
SI
No
_L
2.
3.
4.
Cost as per Cost as per Sanctioned
SR 92-93 estimate
project
(96-97)
proposal in in lakhs.
lakhs
Category
Health Center
Staff Quarters
Training Center
Renovation
of
Existing Maternity
Homes & U.F.W.C
5.70
11.47
79.50
5.5 lakhs
11.50
15.50
NA
NA
18,75
25.63
195,00
24.24
(AVG)
Increase in percentages %.
PP to
92-93
102%
35%
NA
NA
92-93
96-97
63%
65%
NA
NA
to
i
PP to 96
97______
229%
123%
145%
340%
2.3.8. Maintenance of Buildings
The newly constructed and renovated buildings will be under the custody of IPP-VUI till
the tenure of the project. After the completion of the project, these buildings will be handed over
to Bangalore Mahanagara Palike.
As on date, no maintenance work has started. Since some of the building were completed
over an year back, maintenance has become necessary. As such it is suggested to provide
maintenance work “on contract basis” following regular departmental procedures. The LMOs
of the centers may be made responsible for coordinating maintenance work with the Civil Works
unit. There is already a provision in the budget for maintenance. An annual budget of Rs.5000/towards minor repairs per building may be allocated. For all newly constructed buildings which
will be completing 3 years completion before the tenure of the project, annual maintenance work
as per the departmental regulations are to be done.
23.9. Review of Consultancy Services
Consultants were engaged to provide services for different aspects. The objectives, the
status and work accomplished by them is reviewed here under.
cl
M/S Susri Associates
Objectives:
i.
ii.
iii.
To carry out Architectural, structural and services drawings & obtaining
approval.
Preparation and approval of cost estimate.
Preparation of tender documents.
57
iv.
v.
Periodic sites visits to ensure that works are carried out as per drawings and
specifications.
Modification of drawings to suit site condition.
Status:
The Architect has prepared the following drawings and estimates.
1.
Health Centre
55Nos.
2.
Staff Quarters
7Nos.
3.
Renovation of Maternity homes
19Nos.
4.
Renovation of U.F.W.C
21Nos.
5.
Training Centre
INo.
Findings:
1.
2.
3.
4.
5.
6.
7.
8.
9.
The Architect has given the drawings and documents on time.
The architect / representative were visiting sites regularly.
The defects / deviations pointed out by architect were not being attended.
The site visits of architect were not always attended by 1PP VIII Engineers.
The details of opening in the plinth beam for sanitary lines not given.
Provision for A.C opening in O.T not given.
In the first batch of health centers, floor trap was shown in Minor O.T
Combined services drawing not prepared for Health Centre and Maternity homes.
The reinforcement provided for health center was high.
b, M/S Nagadi Consultants.
Objective:
Soil investigation for works under IPP VIII.
Status:
Soil tests conducted at 81 locations earmarked for buildings.
Findings:
The work was satisfactory.
a M/S Doddamma Enterprise.
Objectives:
Providing Group ‘D’ staff for supervising the building works.
Status:
10 personnel provided at building sites.
Findings:
The personnel engaged did not have experience in construction of
buildings.
d. M/S Tiger Services
Objectives:
Providing security and cleaning services to health center and maternity
Homes.
Status:
Service provided at 25 centers.
58
Findings:
1.
The service is satisfactory.
2.
The sump tanks were not cleaned at all centers.
2.4. Recommendations
a. Recommendations on Management aspects
1. Recruitment of staff on contract basis to be done. Retired engineers may also be considered
for these jobs.
2. An undertaking to be taken for staff on deputation from the concerned departments that thev
will not be disturbed during the tenure of the project
3. One Engineer to be earmarked for planning activities and follow up action with Architec*
and Consultants. His duties to include progress monitoring, preparation of cost estimates,
obtaining approval for cost estimates, tendering and evaluation and reports.
4. One staff to be earmarked for liaison work only. His duties to include identification of sites,
clearance from BDA/BCC/BMRDA, liaison with police, KER & BWSSB.
b. Recommendations for Quality assessments
1. Strict adherence to drawings and specifications.
2. Proper supervision and pour cards for concrete work.
3. Use of cover blocks to reinforcement.
4. Seasoned timber to be used for door shutters, provision of Architraves for door
frames and shutters.
5. Access for cleaning terrace to be provided in Health center and staff quarters.
6. Elbow operated taps to be provided in O.T
7. Provision of bottle trap to sinks in O.T
8. Pumps to be shifted outside the building and grills to be provided for safety.
9. All exhaust fans to be fixed with frames.
10. Modifications of drawing and approval of the same in case of any restrictions.
11. Modifications to be done only after written instruction of Architect
12. Combined services drawing for renovation work.
13. Provision of AC openings in OT of Maternity Homes.
14. Engaging services of consultants for quality control.
15. Maintenance wing to be established.
59
16. All defects pointed out must be rectified and documented.
17. Training to work inspectors on specifications of work and quality control.
18. Back up power for Maternity Homes and Health Centers.
c. Recommendationsfor quality improvements
1. Construction programme for individual structure to be submitted by the contractor with
mile stone achievements & should be monitored every month.
2. All modifications, sites instructions for quality and permission for concrete and other
activities to be documented.
3. All tests to be carried out as per specifications and documented.
4. Visit of Architect, P.O and Assistant Engineers to be co-ordinated and minuted.
5. Check list for taking over buildings from contractors to be prepared and shall be signed by
P.O, only after which the building will be handed over.
6. Check lists for concrete work. Brick work, flooring plastering and painting to be prepared.
7. As built drawings to be prepared and preserved properly.
(L Recommendationsfor completion of civil works in time
1.
Master plan for all the activities of construction like identification site, preparation
of Architectural drawings, preparation and approval of cost estimates, tender
notification and evaluation, issue of work orders, contractors programme including
milestone events to be prepared.
2. Monitoring of the progress of the project regularly is required with respect to Master
plan.
3. Before deciding on the location of the site, the likely hood of any problem has to be
ascertained.
4. Tender evaluation to be done with the aid of computers.
5. In case of land problems, relocation of sites and issue of change order to be expedited.
e. Recommendationsfor reducing cost escalation
1. The notification for tender to be given in all leading local and national news papers in
local language and English.
2. Tenders to be re notified in case of lowest bid rates higher than 25% of estimates amount
60
3. The folding type MS shutters for Health Centres to be reduced to the width of door and
grills to be provided for window.
4. Economy in structural design to be enforced.
5. The requirements of electrical points for Health Centre and Maternity Home to be
rechecked.
6. Grey mosaic may be used for flooring instead of Tandur blue.
/.Recommendations for Proper Maintenance of buildings
The present scenario is that maintenance funds are not readily available. It is therefore
suggested to explore the possibility of finding funds for maintenance through alternate
channels such as :
a. Sponsorship by individuals and other private sectors
b. Creating a Corpus fund for maintenance
c. Collection of nominal fee from patients
1
MATERNAL & CHILD HEALTH
AND
FAMILY PLANNING SERVICES
3. MATERNAL & CHILD HEALTH AND FAMILY PLANNING SERVICES
3.1.
Background
The present project was planned to deliver MCH & FP services to the urban poor
particularly in slums of Bangalore Mahanagara Palike through a network of Health Centres and
Referral Health Centres. Earlier to the initiation of the project, there were 31 Maternity Homes,
32 Urban Family Welfare Centres (U.F.W.C) and 5 Post Partum Units (PPUs) in the City. On the
basis of one Health Centre for 50,000 population and a Referral Health Centre for 200,000
population (1:4 ratio), it was planned to have in all 97 Health Centres and 24 Referral Health
Centres under the project. Consequently it was decided to strengthen and convert the existing 32
U.F.W.Cs and 5 PPUs (total 37) on par with the proposed Health Centres and set up, build,
operate and maintain, in a phased manner, 60 new Health Centres. Of the existing 31 maternity
homes, 24 were to be upgraded as Referral Health Centres. Besides, a recent proposal (1998) of
starting five Maternity Hospitals with a provision of 12 beds, in fringe areas of Bangalore, is
under consideration.
The present Mid Term Review (MTR) conducted during April-June 1998 reviewed the
following aspects for this component
i. Progress of Health Centres viz. status, staffing position and provision of services.
ii. Programme performance in terms of output indicators.
iii. Service delivery in terms of:
a. Facilities at Health Centres, U.F.W.Cs, and Maternity Homes.
b. Profile of beneficiaries using services at Maternity Home /Referral Health
Centres.
c. Profile of FP beneficiaries in the slums.
d. Quality of care at Female sterilization camps.
3.2.
Methodologies adopted for the Review
The following methods were adopted for the present review.
i.
Desk review of the reports and records at the Project Office and discussions with
Programme Officer and Project Co-ordinator.
62
ii.
Facilities at Service delivery Centres were assessed through observations at the Centre
and their different sections & subsequent discussions with the Lady Medical Officers
(LMOs) and staff of the Centres by the Consultant and his team.
A pre tested, structured, interview cum observation schedule was used for data collection.
A random sample of the Health Centres were selected for the purpose and the sample sizes o
different categories of Centres selected for the purpose are given below.
Table 3.1. Details of Sample size for Facility Survey
Category of Centres
Existing Number
Sample Size (%)
1.
Maternity Homes (old)
24
12(50)
2.
Existing (old) U.F.W.Cs
37
18(50)
3.
New Health Centres(under
I 32
16 (50)
IPP-VI1I)
a) Reporting Centres
7
4
b) EC Survey Completed
14 I
7
c) Survey in Progress
11 I
5
Total
46(50)
While choosing the sampled centres due consideration was given to the construction
programme obtained from Civil Works Unit and appropriate geographical representation an
location of centres.
iii.
Survey of beneficiaries at Maternity Homes/ Referral Health through exit interview
were conducted to obtain information on their profiles and opinions on the quality of
services, payment for services etc. Interviews were conducted by trained wome
investigators and recorded on pre-designed and pre-tested proforma. These interviews
were done at ten Maternity homes (out of 24), which were randomly chosen with du
considerations of geographical scatter. The interviews were conducted for a day at each
of the centres covering up to 10 women per Centre per day.
iv.
Survey of F.P. beneficiaries in the slums were done through door to door survey foinformation on profile of acceptors and some aspects of quality of services receivec.
These surveys were carried out by trained
women field investigators and me:
e;
investigators (for condom beneficiaries only) and information recorded on a structured
pre tested interview schedules. The sample for this survey comprised of a sub sample of
ten slums selected out of randomly chosen U.F.W.Cs / HCs for the facility survey.
These slums were visited by trained investigators as per the convenience/availability of
beneficiaries and a door to door survey was conducted. A list of F.P. acceptors was
obtained from Link workers and ten acceptors of each FP method viz. IUD, oral pills,
tubectomy and condom, from each of the selected slums were randomly chosen. The
desired information were collected on a pre-designed and pre-tested proforma. In all 99
oral pills users, 100 women sterilised, 102 IUD (CUT) acceptors and 101 men using
nirodh (condom) were interviewed.
V.
Standards maintained for Quality of care at Tubectomy camps were assessed by a
trained medical person, with work experience in a medical college hospital.
Observations were made in the operation theatre (OT) on the maintenance of aseptic
conditions and remarks of the Operating Surgeon/ Lady Medical Officer 1/C of
Maternity Homes / RHC were obtained wherever possible. Ten Operation camps were
visited on different days for observations and in each of these visits five consecutive
operations were observed (total 50 cases). A minimum of 60 minutes were spent for
observation in each visit.
One hundred beneficiaries were also interviewed to know some of their socio-
demographic profiles as well as on some aspects of communication they had about the operation
they are undergoing.
The entire review process adopted a “participatory approach” and a feed back was given
to the Project Coordinator and Programme Officer (MCH and FW).
The reviews were carried out by the Consultant and his team consisting of two medically
qualified personnel with Public Health experience.
33.
Findings from the Review
33.1. Status of Health Centres:
On the overall there was progress of construction of buildings for new centres and
renovation of old centres (Table 3.2), even though with some delays, which were mostly due to
the problems faced by the Engineering Unit. During the visits to the Health Centres (new and
64
under renovation) it was revealed that integration and co-ordination between the Health deliver7
Units and Engineering Units was lacking, as indicated by the fact that in a few Health Centre
basic physical infrastructure and facilities, which are essential for delivering good anJ
acceptable health services to the people, were not provided. More details of these are provide^
in the findings of Facility survey and Civil works component of this report.
Table 3.2. Status of completion of Health Centres
1.
2.
3.
4.
Types of work
New Health
Centres
construction
Staff Quarters
construction
Renovation of
existing Mat.
Homes______
Renovation of
U.F.W.Cs
Remarks ___________________
Delay due to site location, drawing
approval, tendering water &
electricity connections, etc.
Target
60
Status____________
12 completed
30 works in progress
7
4 completed
3 under progress
5 completed
2 work in progress
Some delays due to engineering
problems.
6 completed
2 work in progress
Slightly delay due
implementation.
24
37
to
phased
33.2. Staff Position
It was seen that a few of the posts of the Medical Officers were vacant (Table 3.3)
affecting the programme performance. Further staff were on deputation from BCC/State Govt
and in the case of few of them necessary motivation and commitment/ interest was lacking.
There were frequent transfers of deputed staff.
65
Table 3. 3. Staff Position at Health Centres
Post______
X.UFWCs/Health
Centres
1. Medical
Officers
ii. Paramedical
workers
Hi. Link workers
2. MAT. HOMES/
REF HEALTH
CENTRES
i. Medical
Officers
ii. Paramedical
workers
iii. Drivers
Sanctioned
Working
Vacant
60
48(80%)
12
58
40(69%)
18*
970
734(75%)
236*
14
8(57%)
6
106
12
86(81%)
4(33%)
20*
8
These vacancies are due to non-starting of centres
3.3.3. Health Centres Activities
A desk review and discussions with the Project Coordinator and Programme Officer
revealed that a few changes from the original proposals were effected in the activities of the
Centres (Table 3.4.). Similarly a review ofjob responsibilities of ANM and Link Workers (field
staff) of the programme also revealed a few changes from the original proposal (Table 3.5).
These changes which were intended for improvement in the efficiency were smoothly
implemented after due thought, carefid consideration and proper planning by the project
authorities and programme officers.
66
3.3.4. Programme Performance
The FP performance has been consistent for sterilization (female) and IUD but the
coverage for spacing methods of oral pills and condoms were poor. The male participati
(vasectomy) was practically nil as no vasectomies were performed and needs a tremendous boos;
and all out efforts to popularize ‘No Scalpel vasectomy’. Even though the number of Al '
registrations have improved there was considerable drop in the proportion of deliveries in
Government institutions (62% to 53%). A similar trend was noticed for immunization servic t
also (Table 3.6). This could be due to disruption of services at some of the Maternity Homes doe
to renovation work being carried out, affecting delivery and extension of services. These wt .
also perhaps due to ‘Settling down’ problems with the new Centres as well as expansion
c
coverage and creation of facilities with inexperienced new/transferred staff. These problems
were further aggravated by the fact that there was no full time Programme Officer (MCH
FW), accountable for results and performance. Besides logistics of supply of equipment such as
refrigerator and electrical connectors, vaccines, etc. were not given due attention especially
new centres/located on the outskirts of Bangalore City.
The break up of information on the utilisation of services by the ‘slum’ & ‘non-slum’
populations was lacking in all the reports and records maintained.
c.
Table 3.4. Services provided at the Health Centres
Services
A.PROMOTIVE
1. Heal th & Nutrition
Education
2. Knowledge of VPDs &
Diarrhoea
3. Family Planning
UFWC/ Mat. Home
Health
I Referral
Centres Health
Centres
Yes
No
Yes
No
Yes
No
B.HEALTH CARE
1 .Antenatal Care
Yes
2. Normal Deliveries
No*
3. Highrisk Deliveries
Yes
4. Postnatal Care
Yes
5.Immunisation of mother
Yes
and child
6.Nutritional care of
Yes
under fives
T.Mcdical check-up &
Yes
follow up of school
children
8. Treatment of minor
Yes
ailments
9. Non Surgical Care of
No
children by specialists
10. Minor Gynac.
No
Procedures
11 .Laboratory Tests:
a)
Basic
No*
b)
Comprehensive
No
G FAMIL Y PLANNING
1.Advice on methods
Yes
2.Supply of condoms/pills
Initial
Yes
Subsequent
Yes
3.Insertion of IUD (CUT)
Yes
4. Sterilisation
No
5. MTP
No
6. Domicilliary follow up of
Yes
acceptors_____________
* Yes} in Original Proposal **No}
Yes
Yes
Yes
Yes
Yes
No
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes**
Yes
Yes
Yes
No
68
Table 3.5. Job Responsibilities of Field Workers
I Job Responsibility / Activity
ANM
1. Detection of antenatal cases
No
2. Registration of antenatal cases
Yes
3. Antenatal & Postnatal
Yes
care
4.Immunisation
No*
5. Conducting deliveries
Yes
6. Primary curative services
Yes
for mother and children
7. Health education
Yes
8. Nutrition education
Yes
9. Motivation of cases for
Yes
FP
10. Depot holder for
Yes
condom, oral pills &
ORS packets
11.Supervision & training
Yes
of Link workers
12.Referral to next level________
PHN/LHV
*Yes - In original proposal NA - Not applicable
Link
Workers
Yes
No
No*
No*
No
Yes
Yes
Yes
Yes
Yes
NA
ANM
Table 3.6. Performance Statistics Of Health Centres (1994-98)
Particulars_____
1994-95
No. of Reporting
37
1.
_______units_____
Family Planning
2.
a. Sterilization
29065
b. IUD_________
25841
c. Oral Pills_____
7885
d. Condoms_____
19024
Total________
81815
3. ANCs Registered
72363
4.
ANCs Delivered in
44966
Govt. Instit.( %)
(62.1)
5. Immunization
services__________
113365
Children(DPT &
OPV)
TT for pregnant
149830
Mothers
1995 -96
37
1996-97
37
1997-98
44
30645
27354
8823
17032
83854
67995
45267
(66,5)
37260
34143
9221
15521
96145
81528
45055
(55.3)
37478 (39.7%)
35104 (37.2%)
7109 (7.5%)
14749(15,6%)
94440
83080
44471
125702
122523
106955
139201
148669
126050
(53.5)
C_
Performance of Health Centres (1994-1998)
z
.......
144471
--------------------- j 45055
■■■H 45267
- - ---------_----- —
44966
..
83080
“T81528
7995
72363
<2^
z
194440
196145
-
.
■
J81815
□ 1997-98
□ 1996-97
■ 1995-96
□ 1994-95
70
Year Wise Immunisation of Mothers TT
n
149830
148669
• •
■
. .
139201
W
ss«'
;
I
if ■ .■
■
■
■
;
■
?
„
f
••
•
■
fffi Bi
f
‘K-
126050
■
?
«
• ;
■
■■
y>‘-
■
■
■
1994-95
1995-96
:
1997-98
1996-97
□ Mothers (TT)
Immunisation of Children in different years
122523
■
.
<’ ■'-yj'
113365
I
1994-95
1995-96
1996-97
1997-98
□ Children (DPT&OPV)
71
3.3.5. Facilities at Health Centres
The main thrust of the project was to augment the facilities in the existing Centres viz.
Maternity homes & U.F.W.Cs besides starting new ones to provide efficient MCH & FP services
to urban poor/ slum population. Hence during the present Review a detailed facility survey at the
Service delivery centres was conducted. The findings of the survey is presented hereunder (Table
3.7).
Table 3.7.Facility Survey at Health Centers
Facility status(adequate)
Maternity
Homes(n=12)
Existing
U.F,W.C(n=18)
New Health
Centre (n=16)
a) Physical facilities (general)
5(41%)
9(50%)
10(62%)
b) OPD facilities
8(66%)
12(66%)
10(62%)
c) Wards
6(50%)
NA
NA
d) Stores
5(41%)
5(27%)
11(68%)
e) Record keeping
12(100%)
18(100%)
14(87%)
f) 1EC Materials
12(100%)
18(100%)
14(87%)
2.
Staff
8(66%)
15(83%)
10(62%)
3.
Antenatal services
12(100%)
18(100%)
10(62%)
4.
Laboratory services.
9(75%)
8(44%)
5.
Post natal services
12(100%)
18(100%)
6(37%)
6.
Family planning
11(91%)
17(94%)
13(81%)
7.
Operation theatre
11(91%)
7(38%)
2(12%)
8.
Labour room (Delivery)
6(50%)
4(22%)
9.
New bom care (basic)
12(100%)
5(27%)
10.
Nutrition, etc.
- IFA tabs
8(66%)
8(44%)
14(87%)
- Vitamin A solution
8(66%)
6(33%)
8(50%)
- ORS Supplies
11(91%)
6(33%)
12(75%)
ARI management
7(58%)
1(5%)
1.
11.
General
72
12.
Immunization services
Maternity
Homes(n=12)
12(100%)
13.
STD &AIDS control
Nd
Nd
14.
Inf. Control practices
7(58%)
15(83%)
5(31%)
15.
Waste disposal
12(100%)
13(72%)
10(62%)
16.
Solar water heater
10(83%)
NA
NA
17.
Ambulance
6(50%)
12(66%)
7(43%)
Facility status(adequate)'
Existing
U.F.W.C(n=18)
17(94%)
New Health
Centre (n=16)
10(62%)
NA = Not Available and Not Applicable.
It was revealed that the general physical facilities like “waiting area” “drinking water”
facilities needed improvements. The OPDs needed adequate equipment viz. Weighing machine,
BP apparatus, etc. In the wards of maternity homes the existing costs/beds needed replacements
with adequate facility for postoperative care. The stores needed “closed cupboards” for storing
drugs and FP supplies.
At the new Health Centres in particular the ANC services needed improvements by
providing weighing machines, 1FA tabs. Supplies etc., the laboratory services such as Hepatitis B
screening and in select centres facilities for HIV testing with counseling. There was need for
vitamin A, ORS and vaccines at U.F.W.Cs/new centres. Similarly facilities for STD and AIDS
control is needed under the project in selected Centres.
Improvement of‘infection control’ practice in all the centres is a matter of concern to be
looked into. Waste disposal facilities were lacking in the U.F.W.Cs / new centres. A careful
reorganization of ambulance services was also needed.
LMOs desired facilities like adequate piped water supply, security services and laundry
services and these need consideration by the Programme officer on individual merit Similarly
providing AC and generator facilities to select OTs of FP camps need attention of the project
authorities (Table 3.7.a).
73
Table 3.7 (a). Facilities-Requested By LMOs.
Facilities Requested
Maternity
Existing
New
Homes (n=12)
U.F.W.Cs(n=18)
Centre (n=16)
F
1.
Water supply
3
7
2.
Security services
3
3
3.
OP equipment
4.
Ultrasound scanner
2
5.
AC and generator to OT
3
6.
Refrigerator
3
7.
Autoclave
2
8.
Sterilizer
9.
Laundry services
io.
Ambulance
____
1
Health
5
1
nI1
5
3
2
J—
2
A rapid assessment conducted by the Training Centre also revealed similar findings (Table
3.8).
Table 3.8. Profile of Facilities at Health Centres as per Training centres Survey
Facilities
No. of Institutions with satisfactory facilities
Maternity
UFWCs including New Health
Homes (n=31)
Centres(n=60)
L
Maternal & Reproductive Health
1.
Normal Delivery
31(100%)
NA
2.
Forceps Delivery
31(100%)
NA
3.
Caesarean Section
2(6.4%)
NA
4.
Canur cervix Examination
31(100%)
19(31.6%)
5.
Reproductive Tract Infections
31(100%)
43(71.6%)
Recognition
74
Facilities
No. of Institutions with satisfactory facilities
Maternity
UFWCs including New Health
Homes (n=31)
Centres(n=60)
IL Family Planning
1.
Nirodh Distribution
31(100%)
60(100%)
2.
Oral Pills Distribution
31(100%)
60(100%)
3.
IUD
31(100%)
22(36.6%)
4.
Tubectomy Operation
31(100%)
NA
5.
Laproscopic Female
9(29%)
NA
Sterilization.
6.
No Scalpel Vasectomy
1(3.2%)
NA
7.
MTP
~31(100%)
NA
/ii. Child Health Services
1.
New bom Care
31(100%)
NA
2.
Resuscitation
34(100%)
NA
3.
Asphyxia nconatum
10(32%)
NA
4.
Care of premature baby
10(32%)
NA
IV. Others
1.
Laboratory Services
25(80.6%)
NA
2.
1EC
31(100%)
60(100%)
3.3.6. Profiles of beneficiaries at Maternity Homes / Referral Health Centres
In all 93 women were interviewed of which 38 were from slums. The findings from
theses surveys are presented below (Table 3.9 and 3.10).
Table 3.9. Profiles of beneficiaries attending Maternity Homes / Referral
Health Centres._____________
Socio-Demographic & other details
%(n=93)
1. Age
Mean 24/3 years
Range 18-38 years
2. Religion_______________
Hindu _______________
72.0%
Muslim _______________
20,4%
Christian
__________
7.6%
3. Caste (If Hindu)_________
SC________________
22,4%
ST________
13,4%
Others_______ __________
64.2%
4. Residence ______________
Slum___________________
40,9%
Non - Slum__________
59.1%
5. Travel To Mat Home
By Foot_________________
54.8%
Public conveyance________
36.6%
Others_______
8.6%
Cost______
Cost of travel __________
| Mean : Rs 5/- to Rs 50/ ■
6. Purpose Of Visit ________
MCH_____________ _____
86,0%
FP______________________
11.8%
Medical care & Others_____
2.2%
7.
Waiting Time At Mat Home
Mean______
25 minutes
Range
5-60 minutes
Majorities of the beneficiaries were Hindus (70%) and were young. The proportion of the
beneficiaries attended from the slums was only 41%.
The accessibility of maternity home from their residences was satisfactory, and were
within walking distances in about 55%. Those who had used a conveyance for reaching the
Centre had spent amounts ranging between Rs 5 to 50.
76
Majority of them visited for MCH services (86%) while 11% for F.P. services. They had
to wait for about 25 minutes on an average, with a range of 5 to 60 minutes, for getting the
desired services.
Most of the beneficiaries expressed that maternity service and child health services were
satisfactory and the staff were courteous (ranging between 86% to 95%). However for Family
1
planning services, even though majority were satisfied with the staff, quite a significant
proportion were not satisfied with the services (31%).
Table 3.10. Opinion of beneficiaries on services at Mat. Homes / Referral
Health Centres_______________________________
Services
___________________________________ % women beneficiaries
L_
MA TERNITY SER VICES_____________________
(N=93)_________
L.
ANC Services availed________________________
92.5%
2.
ANC Services
Had availed ANC services
92.5%
With Adequate services availed
88.2%
(3ANC+2TT+100IFA)
With satisfaction about services______________
87.1%
3.
Natal services ( Delivery services)
Had availed Natal Services
94.6%
With Satisfactory opinion on services availed
86.0%
With satisfaction about Courtesy of staff_______
92.5%
4.
Post natal services
Had Post natal follow up visit to Mat. Home
97.8%
With satisfaction about Courtesy of staff_________
92.5%
II.
EAMIL Y PIANNINCj SER VICES_______________
1.
FP services advised at HC_____________________
84.9%
CC (Nirodh) availed_________________________
2.
7.5%
3.
Oral pills availed____________ _______________
5.4%
4.
IUD availed________________________________
26.9%
5.
Sterilization (Female) availed__________________
71.0%
6.
Satisfied with FP services provision_____________
68.8%
7.
Satisfied with Courtesy of staff________________
89.2%
HL CHILD HEALTH & OTHERS__________________
1.
Child Immunization services (& card given) availed
95.7%
2.
Satisfied with Courtesy of staff________________
94.6%
3.
Provided with advice on
a.
Motivation for FP
93.5%
Breast feeding
b.
96.8%
Weaning
c.
95.7%
ORT
d.
94.6%
e.
Immunization Schedule
97.8%
77
!
3.3.7 Opinion on Payment for services
An attempt was made to explore information on the willingness and affordability of
beneficiaries to pay “user charges/fees” for services at maternity homes. Interestingly and
surprisingly majority of the beneficiaries both from slums and otherwise expressed their
willingness to pay ‘user fees’ for various MCH services viz. OPD, laboratory services, wards,
delivery and medicinal costs. This finding suggests the possibilities of introducing on
experimental basis a graded payment of ‘user fees’ for some services in selected Maternity
Homes (dual system of free and payment both on the basis of affordability from clients) in a
phased manner after proper administrative approvals (Table 3.11).
Table 3.11. Opinion on Willingness & Affordability To Pay User Fees
Opinion
1.
2.
3.
4.
5.
Willingness (& affordability)to pay
user fees for hospital services (yes)
Willingness (& affordability) to pay out
patient consultation charges (yes)_____
- Amount specified
Willingness(& affordability) to pay for
Laboratory services charges (yes)
- Amount specified
Wi!lingness(& affordability) to pay for
Ward charges (yes)________________
- Amount specified
Willingness(& affordability)to pay for
Delivery charges (yes)_____________
- Amount specified
Particulars__________
Beneficiaries from
All
slums(n=38)_____
Beneficiaries (n=93)
71.0%
63.2%
71.0%
63.2%
Mean Rs 11/Range Rs Nil to
100/-_________
69.9%
Mean Rs 8/Range Rs Nil to
50/-__________
60.5%
Mean Rs 10/-_____
Range Rs Nil to 60/-
Mean Rs 6/Range Rs Nil to
25/-__________
63.2%
71.0%
Mean Rs 11/-______
Range Rs Nil to 100/68.8%
Mean Rs 54/-_____
Range Nil to Rs 500/-
Mean Rs 7/Range Rs Nil to
20/-__________
60.5%
Mean Rs 30/Range Nil to Rs
300/-
78
Opinion
Particulars
6.
All
Beneficiaries (n=93)
68.8%
Beneficiaries from
slums(n=38)_____
60.5%
Mean Rs 10/Range Nil to Rs 100/-
Mean Rs 7/Range Nil to Rs
25/-
Willingness(& affordability)to pay for
Medicines cost (yes)
- Amount specified
3.3.8. Quality of Family Planning services availed by beneficiaries
The results of the review of the acceptors in the community reveal certain technical and
management actions to be followed up by the service providers to make the family planning
programme more acceptable (Table 3.12). The details of the findings are described below.
Table 3.12. Results of House Hold Survey of Family Planning Beneficiaries
(Supplies from BCC Health Centres)
Oral pills
Beneficiaries (n=99)
1.
Age of beneficiary
Mean 25 years
2.
Duration of use (in months)
Mean 8.5 months
3.
Satisfied with the courteous behaviour of providers
100%
4.
Adequate & satisfactory knowledge about OP use
80.8%
5.
Satisfied with adequacy of OP supplies (from BCC)
79.8%
6.
Purchased OPs from market
21.2%
IUD
Beneficiaries (n=102)
1.
Age of Beneficiary
Mean 24 years
2.
Duration of use (in months)
Mean 6.4 months
3.
Satisfied with the courteous behaviour of providers
98.0%
4.
Adequate & satisfactory knowledge about IUD use
93.1%
5.
Satisfactory & proper screening of IUD beneficiaries
by MO-BCC
J
79
I
6.
- Clinical history & examination
88.2%
- Use of IEC materials
65.7%
Adequate counselling & advice given during IUD
90.2%
insertion by L MO
Condoms
Beneficiaries (men)
(n=101)
1.
Age of beneficiary
Mean 31 years
2.
Duration o f use (months)
Mean 12 months
3.
Satisfied with the courteous behaviour of providers
100%
4.
Adequate and satisfactory knowledge about condom
90.1% (However, 55.4%
use
were not aware of expiry
date)
5.
Adequacy of supplies from Health Centres
91.1%
6.
Purchased condoms from market
58.4%
7.
Affordable to purchase of condoms
96.6%
Sterilization (female)
Beneficiaries (n=100)
1.
Age of beneficiary (years)
Mean 25.8
2.
Duration of use of the method (months)
Mean 12(1 year)
3.
Satisfied with the Courteous behaviour of service
99%
providers
4.
Incentives received in time
63%
5.
Had Medical Complaints* after sterilization (yes)
37%
(Mostly backache, abdominal pain, white discharge,
menstrual bleeding, leg pain, etc.)
6.
Had prompt Follow up action (symptoms Treated /
17%
Cured / Relived) for post operative complaints
80
cl
Oral pill users
The average age of pill users was 25 years and were using the method on average for only
8.5 months which seems to be in right direction. The information obtained from oral pills
beneficiaries revealed gaps in the knowledge and method of use of pills, especially on the action
to be taken for missed pill and as to conditions of side effects for which a doctor is to be
consulted. The correct knowledge was available with only 81% of users. This reflects on the
interpersonal contacts of health workers with the users. The stock and supply position was also
deficient. Nearly 20% users complained about inadequate supplies.
b. IUD users
The average age of the users was 24 years and have been using the method for about 6
months on an average. Even though the age of acceptors seems to be all right the duration of use
suggests possible dropouts. Even though overall knowledge of use was satisfactory (93.1%),
some of them did not know about feeling of the thread and when to contact Medical Officer, etc.
But the most important observation which came out of the data was that there was a need
to screen and identify cases for IUD correctly. Cases needing treatment for gynecological
problems need to be cured first before IUD insertion. Failing this any symptom/ aggravation
(which is generally present due to poor health, personal hygiene and sanitation) will be attributed
to IUD insertion bringing the FP method to disrepute in the community through adverse opinion.
Hence, the Lady Medical Officers at Maternity Homes should be given adequate training on
screening the cases correctly before its insertion and then provide complete advice and follow up
services.
a Condom users
The average age of condom users was around 31 years indicating that the younger
couples, especially newly married ones, might not have been motivated adequately for the use of
this method. Even though the knowledge on the correct use of the method was with 91%, and
more than half of the users (55.4%) were not aware about the expiry date of condoms.
It was
also observed that there is a need to educate them about proper disposal of condoms after use.
Even though majority procured condoms from the market, those who procured from the Health
Centre had complaints about irregular supplies (9%).
81
(L Female Sterilisation
The mean age of the acceptor was around 25 years. The acceptors had complaints about
incentive payments (37%). About 37% of acceptors had some complaints after operation and
only 17% of them were followed up for the complaints.
3.3.9. Standards of Quality maintenance at the Female Sterilization Camps
Results of the entry surveys of the clients at the Tubectomy camps are detailed
hereunder.
The clients were young with an average age of 25 years, in age range of 18- 37,
comprising of Hindus (87%) and Muslims (16%), almost similar to the religious pattern of the
area. There were 17% who were educated above High School. Two-thirds had two or less
number of children reflecting on the appropriate selection of clients (Table 3.13).
Table 3.13. Profile of Beneficiaries at Female Sterilization Camps
1
2
3
4.
5.
6.
7.
Particulars
Age
a) mean___________
b) range
Religion a) Hindu____________
b) Muslim
c) Christian
Caste a) SC
b) ST
c) others
Education -10dl Class and above
Living children
a) (two or less)
b) (one only)
____ ______
Age of youngest child:_________
a) Mean____
b) Range__________
Age of spouse________________
a) Mean________
b) Range
(n=100)
25 years
18-37 years
87%
16%
3%
17%
4%
79%
17%
67%
4%
1 Vi years
0-10 years
31 years
24-46 years
However, ‘Informed consent’ was very poor with the clients and only 18% were
informed of the contents of the ‘Consent Form’. The fact that 28% of them did not know that
tubectomy is a permanent method of contraception and also that 32% did not have their bath
82
before coming for the operation reflects on the lack of “Interpersonal communication” between
the clients and health personnel.
Table 3.14. Asepsis Standards at Female Sterilisation Camps
Particulars observed
1.
Theatres having personnel with satisfactory attire (cap +
mask + gown)________________________
Adequate scrubbing by surgeon and assistants (3-5 minutes)
Undesirable movement by non- theatre personnel
Change of glove after each case_______________________
Satisfactory disinfection of Laproscope_________________
Satisfactory sedation/analgesia________________________
Satisfactory local anaesthesia________________________
Satisfactory in sufflation (pheumuperitoneum) for
laproscope_______________________________
Satisfactory OT sanitation__________
2.
3.
4.
5.
6.
7.
8.
9.
% OTs with
Unsatisfactory
standards
100.0
30,0
50,0
Nil
60.0
Nil
Nil
Nil
80.0
The observations at the Operation Theatres of the camps in the Maternity Homes/
U.F.W.Cs revealed that there were gross deficiencies in the maintenance of aseptic standards
inside Operation Theatres. It was observed that in all the OTs, the attendants did not have the
necessary complete attire (100%). The disinfection of Laproscope after every operation was also
lacking (60.0%). There was undesirable movement by non-theatre personnel in 50% of the
camps. OT sanitation was not satisfactory in 80% of the OT camps (Table 3.14).
3.4.
Recommendations.
1. Improvement in the coverage of slum population attendance for utilisation of services.
2. Acceleration of construction of new Health Centres and renovation of existing U.F.W.Cs and
Maternity Homes.
3. Early recruitment for staff vacancies, avoid deputation and ensure the availability of senior
staff (avoid transfers) till the project completion. Doctors may be appointed on contract
basis.
4. Improvement in the coverage of spacing method viz. Oral pills, copper T and nirodh and to
strongly promote male participation through ‘No scalpel vasectomy’ through popularisation
of methods.
83
5. Improvement in the general physical facilities at the Health Centres, facilities in the OPDs,
ward and stores.
6. Improvement of laboratory services, facilities for IUD insertion in the new centres.
7. Improvement of OT facilities in the U.F.W.Cs and new centres.
8. Improvement in the supplies of 1FA tabs, vitamin A and ORS and vaccines particularly in the
new centres.
9. Streamlining of the ambulance services.
10. Provision of Air conditioners and generators for select OTs conducting FP camps regularly.
11. Provision of adequate drinking water supply, security services and laundry services.
12. Introduction of “user fees” for selected services in a few Maternity Homes on dual system
(free and payment).
13. Adequate training of LMOs to screen cases carefully for IUD.
14. Proper and adequate follow up medical care for tubectomy beneficiaries.
15. Improvement in sanitation conditions in OTs, provision of adequate OT linen, prevent
undesirable movement of non — theatre personnel in the OTs and satisfactory disinfection of
Laproscope in cidex solution. Besides proper “signed informed consent” of tubectomy
beneficiaries has to be obtained.
16. Provision of adequate training to peripheral health workers in Interpersonal communications
84
TRAINING
4. TRAINING
4.1.
Background
Improvement of skills of the service providers is one of the important objectives of the
Project. To fulfil this objective a residential Training Centre was to be established. It was
planned that the Centre was initially to cater the needs of Bangalore City Corporation (Bangalore
Mahanagara Palike-BMP) and to subsequently provide training facilities to health staff of other
Municipal Corporations in Karnataka. A team of core staff at the Gaining Centre was provided
while other faculty is to be drawn from health department of BMP and other educational and
training institutions in the City. The main functions of the Training Centre was to impart training
to the service providers to develop skills, consistent with their job descriptions through an
appropnate mix of various training methods and modules. The Centre was also expected to
evaluate their training programmes periodically and make suitable modifications and
improvements.
4.2.
Methodologies adopted for Review
The present Mid Term Review of the Training component was carried out through the
following methods.
i.
Assessment of achievements in Physical targets of training programmes for each
category of service providers like Medical officers. Paramedical staff. Community
workers. This was carried out through a Desk review of Progress reports of the Centre.
ii.
An Assessment of the Quality of training was carried out for content of training.
Duration of training. Methods and Media used for training. Materials prepared for
training and Capabilities of trainers.
iii.
An assessment of the impact of training was done on the basis of pre and post training
evaluation records maintained at the Centre.
iv.
Further the MTR process adopted a participatory approach and a feedback was given to
the Project Co-ordinator and Director of the Training Centre.
85
Findings of the Review
4.3.
4.3.1. Infrastructure
a. Building for the Centre and other facilities
The Training Centre planned under the Project was to provide residential training facilities and
cater to the needs of the Bangalore City Corporation initially and subsequently to provide
training facilities to health staff of other municipal corporations in Karnataka State. However,
presently the Training Centre is operating at Malleswaram (Kodandarampura) in a Corporation
building without any residential facilities with the following facilities:
Office accommodation for Training Centre Staff.
One Training Hall with Audio-Visual facilities for training.
Library.
One Mini Bus (32 seater) with only a parking space (without shed facility).
The new building proposed for the Centre with adequate accommodation consisting of a
ground and additional two floors with a provision of residential accommodation for trainees is
under construction in the present premises and is expected to be completed only by the end of
1999.
b. Staff at the Centre
Two of the senior posts meant for training activities were vacant, adversely affecting the
training programmes (Table 4.1).
Table 4.1. Staff position of the Centre
Designation______
1. Director_______
2. LMO with DGO
Qualification
3. Training officers
4. Clerks_______ _
5. Driver________
6. Watchman_____
I 7, Sweepers
Sanctioned
j________
1
2
2
2
2
2
In position
J_____
0
_2
2
'T
2
ti
Vacant
Nil___
1
1 (Nursing Tutor)
Nil____________
Nil__________
1
________
Nil
Immediate efforts are needed to fill up these vacancies. Besides, the present sanctioned
staff is inadequate to cater to all the training programmes. Additional staff viz. one Senior
Consultant, a Steno-typist and an Asst statistical Officer were required, who may be appointed
86
on “contract basis” in consideration of the quantum of work and to bring about improvements in
the quality of training particularly with reference to content, skill development, monitoring ai
post training performance evaluation.
43.2. Training Programmes
a. Progress and Achievements
The plan of training for various categories of staff proposed as per the Project proposals was
to be undertaken to cover the following components.
1.
Management Development
2.
Planning and Organisation.
3.
Monitoring and Supervision.
4.
Communication.
5.
Motivation.
6.
Clinical Update.
7.
Health Care and FW Update.
8.
Promotive and Preventive Health Care including Family Welfare for Link Workers.
9.
Management and Operation of Laboratory for Laboratory Technicians.
10.
Maintenance of Stock Records and Compilation of Statistics for Clerks.
11.
Promotive Health Care and Motivation for Family Welfare.
12.
Orientation on Extension Approach.
A tentative Training calendar (Table 4.2) was proposed which however was revised i
subsequent years of implementation, due to delays, without much changes in the content of the
programme.
87
Table 4.2. Annual Training Plan/Calendar
Type of
Training*
I
I
£
0
I
I
I
I
Categories of
staff to be
trained
Location of Curricul
Training
um
Project Head
Quarter staff
Health Officer
Deputy.H.O
M.O.H
Municipal
Councillors
Senior
Medical
Officers/
Gynae.______
Paediatricians
Extension
Education
Officers_____
LMOs
(1992)
Content
Duration
of
Course
NIHFW,
Delhi
NIHFW
1,2,3,4
3
12
1,2,3,4
3
8
NIHFW
BCCTC
1,2,3,4
16
12
3
1
BCCTC
2,3,4,5
2
24
BCCTC
BCCTC
2,3,4,5
2,3,4,5
2
2
12
4
BCCTC
2,3,4,5,
5
1994-95
1995-96
(1993)
1996-97
(1994)
1997-97
(1995)
37
30
15
5
38
30
16
5
111
90
45
43
44
6_____
I
Staff Nurses
BCCTC
2,3,4,5,
6 _____
I
ANMs
BCCTC
I
Laboratory
Technicians
Pvt. Medical
Practitioner
NGOs
BCCTC
9
5
9
8
7
BCCTC
12
1
120
90
45
BCCTC
12
1
90
50
30
I
0
2,3,4,5,
7 _____
0
0
Local Leaders
KSCB
Personnel
Anganwadi
Workers
School
Teachers
0
0
BCCTC
BCCTC
12
1
12
BCCTC
BCCTC
120
65
1
150
30
11
1
75
60
35
12
1
50
50
50
1211
886
48
Grand
Total _________________________________
79
* (P^Pre- service; O^Orientation, l=In- service
Note: 1. The years in parenthesis indicate the originally proposed years of undertaking the training activities.
2. The numbers in the column 4 refer to the SI. No. of the components of training stated earlier.
(
Table 4.3. Type, Duration, Category of Personnel Trained
SL
No
1
Type of
Training_____
New bom care
Duratiorl
(days)
1-2
2
IPP 8 Aims &
Objectives
1
3
Baby Friendly
Hospital_____
Health Aware
ness________
CSSM
1
Category of Personnel & No. trained (1994 ; Total
-98)______________ ______________________ _
LMO (23),StaffNurse (14),LHV (23), ANM ; 172
(112)_____________________
230
LMO (91), Paed.(10),Gynae.(22),Staff
Nurse (37)
LHV(17), ANM (53)
i 305
LMO (81), Ayah PK 224
1
AWW (188), SHE Club Members (87)
5-6
4
i
275
6
Reproductive
Health
(clinical)
2
; 397
LMO (34), Staff Nurse (53),LHV (52),
ANM (258) ________________________
LMO (79), Paed.(3),Staff Nurse (17), LHV( 321
40)
ANM (185)
7
Natural FP
methods_____
Endocrinology
(Clinical)
Management
Training_____
Pre Service
Training_____
Induction
Training_____
Extension
approach
O&M of
Laboratories
Medicinal
Plants______
Neonatalogy
1
LMO (47)
47
1
LMO (29)
29
2-3
LMO (57)
57
5-6
Link Workers (690)
690
1
LMO (12)
12
1-2
105
2
School Teachers (12), Pvt. Med. Pract. (55)
Social Workers (Bal. Sevikas)(38)*
Laboratory Technicians (23)
23
72
LMO (12)
12
1
LMO (87)
87
5
8
9
10
11
12
13
14
15
LMO (87), Staff Nurse (18),LHV (9)
2
RCH
Programme
LMO (28)
2
17. Orientation
Training____________________
Note: Number in the parenthesis indicates number of personnel trained
16
114
28
90
From the review of this calendar of training activities it can be seen that the training
programmes should have been started from 1994-95. However, they did not start till 1995-96,
due to non-establishment of the facilities.
4.3.3. Personnel trained since project inception
The number and category of staff trained since project inception is given in Table 4.3.
Even though training programmes have been conducted in large numbers, the envisaged training
programmes for Municipal Councillors and Local leaders has been a non starter besides the
coverage being very poor for the categories of School teachers. Private Medical Practitioners,
and the administrative staff of the Project The availability of suitable training material to make
the training more effective is also a felt need of the Centre.
4.3.4. Progress of Training programmes/ activities
A review of progress of training programmes revealed that (Table 4.4) most of the
training programmes were conducted mostly from 1996 onwards which is after recruitment of a
limited staff and provision of facilities at the present Training Centre. Thus the training
programmes were hampered mainly due io lack of trainers and adequate facilities.
Table 4.4. Category-wise Number of Personnel Trained in different Years___________
Year wise achievement
Trainees
Project 1994- 1995 - 1996 — 1997 Total(%)
Target 95___ 96___ 92___ -98
1
Project. HQ. Staff
2 ____ ~Nil
12___ 5
7(58,0 )
Nil
2 Municipal Councillors 87____ Nil
Nil
Nil
Nil_____
Nil
3 Sr. MOs / Gynae_____ 24____ Nil___ Nil___ 20____ 2___ 22(91.6)
4 Paediatricians_______ 12____ Nil___ 3 ____ Nil
7___
10(83,0)
4(100,0)
5 Ext. Ed. Officers
4
Nil___ 4 ____ Nil___ Nil
6 Lady Med. Off.______ 97____ Nil___ Nil___ 56____ 35__ 91(93,8)
7 Staff Nurses________ 96 ___ Nil___ Nil
22____ 56__
78(81,0)
8 LHV/PHN__________ 97 ___ Nil
Nil___ 45____ 10__
55(62,5)
Nil___ 150
96____ 23__
9 ANM/MPW________ 291
269(92.4)
10 Private. Med.
55
Nil
300
Nfi
Nil
55(18.3)
Practitioner.________
Nil
11 Clerks/Computers
16(21.6)
84
Nil
16
Nil
390
300
690(71.4)
NS
12 Link Workers_______ 970
' 15
62
12
13 NGOs._____________ 200
113
202(101.0)
IV,
14 Local leaders________ 400
Nil
Nil
Nil_____
Nil
Nil
188
NS
Nil
188(94,0)
200
15 Anganwadi workers
Nil
16 Lab. Technicians
Nil
23(95.8)
24
23
91
Trainees
17 School Teachers
18 Social Workers_____
19 Trainers viz. Addl.
Hos. I Sr. MOs / Paed.
ZLMOs____________
She Club members
20
Year wise achievemen
Project 1994 - 1995- 1996 - 1997
Target 95___ 96___ 97__ -98
12___ Nil
Nil___ Nil
200
15___ Nil___ Nil__ Nil__ 15__
Nil
12
Nil
Nil
12
Nil
Nil
Nil
33
54
Total(%) .
12(6.0)
15(100.0)
12(100.0)
87
A total of 17 types of training programmes have been conducted covering 2763 trainees
in the last 2 years. The most frequently conducted training programmes were “Pre Service
Training” for Link Workers (690) followed by CSSM training (397 persons) and Baby
Friendly Hospital (305 persons) (Table 4.5), besides concentrating on Lady Medical Officers
on different aspects.
Table 4.5. Type, Duration and Year Wise Distribution of Persons Trained
SL
NO,
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
Types of Training
New bom care________
1PP 8 Aims & objects
Baby Friendly Hospital
Health Awareness_____
' CSSM_______________
Reproductive Health
(Clinical)____________
Natural FP methods
Endocrinology (Clinical)
Management Training
Pre Service Training
Induction Training_____
Extension approach
O&M of laboratories
Medicinal Plants______
Neonatalogy__________
RCH Programme______
Orientation Training
Total
Year Wise Distribution Of Persons Trained
Duration 1994 1995
1996 1997 Total
-97 -98
-95 -96
(days)
' 1-2
172
172
230
_1______
_1______
J____
305
' 5-6
173
38
7
1
1-2
s
25
47
29
1
1
1Z
275
199
227
390
12
55
12
38
23
12
87
114
1179
801
' 1
544
28
239
57
315
230
305
275
397
265
47
29
57
705
12
105
23
12
87
114
28
2763
92
There is a strong need for filling up existing vacant posts and provide other facilities
(as per recommendations made in this report else where) to improve training facilities, without
which the Training Centre will not be able to accomplish the set targets during the remaining
period of the project. This is more so as there is already an accumulated backlog (viz. Municipal
councillors, Private Medical Practitioners and School Teachers) in addition to the present
targets. Further, a quick review of the training programmes conducted reveal that there is a need
for more emphasis to improve and strengthen clinical skills and competencies of field staff viz.
LMOs and ANMS and Link Workers. Besides improving the quality of training programmes, it
is important to ensure proper monitoring of the training activities as well as trainees
participation. As such additional inputs in terms of staff supplementation, part-time honorary
and other facilities like transport/communications are very crucial. This will provide adequate
time for the Director of the Centre to assume more managerial and academic responsibilities of
organising the training programmes with in built monitoring, evaluation and feed back instead of
actually functioning as a regular trainer which presently is the case due to staff shortage and
other factors.
43.5. Content Analysis of Training programmes
Each training programme/activity conducted till date was critically reviewed along with Director
(Training) and other staff on the following criteria:
Content, Duration, Methods, Media, Material, Trainers’ competencies Trainees’
participation. Evaluations, Feedback, Follow up action taken.
Based on this evaluation and specific remarks (for a particular training programme) the
following general remarks/observations are made:
93
Table 4.6. Analysis of Training Programmes
SI.
No
1.
Training, venue
Duration (days)______
New Born Care
Try. Centre & Hospital
(1 day)
Trainees
Trainers
LMOs
Paediatricians
2.
Orientation to 1PP VIII
Try. Centre & field visit
(2 days)
LMOs, LHVs
ANMs
3.
Baby Friendly Hospital
Try. Centre, Mat. Hops.
(1 day)_____________
MCH FW & IPP 8
()rientution to N( i()s on
IPP^
Try. Centre,
(1 day)_________
CSSM
Try. Centre & field
visits
(5-6 days)
LMOs, Ethos
& Class IV
Project. Co
ordinator
Dir.(Try)
Other Officers
Paediatricians
Orientation to
Anganwadi workers
MCH&FW&IPP8
Try. Centre,
(1 day)___________
AWWs
4.
5.
6.
NGO Reps.
LMOs,
LHVs,
ANMs &
staff Nurses
Project Co
ordinator
IPP 8,
Director Try.
Centre_______
DIO,
DD(MOH)
RO(FW):
Dir(Try), DNS,
HS(HFPTC)
Principal
(ANMTC)
Dir(Try) &, Try
officers
Content &
Materials
Content
recorded
material NA
Module
Methods & Media
Ev
Lecture,
Discussions, OHP,
SP, Case
demonstration
Lecture, OHP, SP.
Content
recorded
Material NA
Content
recorded
Material NA
Lecture / Talk &
Discussions
Modules
Lectures, Discs,
Modules,
Demonstrate, Role
Play, etc.
Pr
&
ev
D
Modules
Lectures, Disc,
Video
-N
Lecture & Disc
OHP
SI.
No
7.
Training, venue
Duration (days)
Natural FP methods
Try. Centre,
(‘/j day)
8.
9.
10.
11.
12.
Trainees
Trainers
Content
Methods &
Media
Evaluati
Lecture & Disc
Yes
Lectures, Disc
video & Gr.
Disc.
NO
NA
Lecture & Disc
NO
Module
Lecture,
G Disc, video
Yes
Not
available
Lecture &
Discussion; case
Demo
NO
Content
Not
available;
Handouts
given
Lecture, Disc,
SP, OHP, Group
Disc.
Yes
&
LMOs & Sr.
Gynae.
Christian
Mission
organisation.
(CREST)
Dir(Try) Try.
Off.
Extension approach
Creche
orientation
Teachers;
Try. Centre
NGOs
( 1 day)______________
Endocrinology disorders LMOs; Paed; Endocrinologist
in women (clinical)'.
Gynae.
(Super
Try. Centre
speciality
day)______________ Hospital)_____
School / Teachers
School
Dir (Try.) Try.
Orientation to IPP 8 &
Teachers
Officers
MCH&FW
Try. Centre;
(2 days)_____________
Neonatology
Sr.
LMOs &
Try. Centre & children
Paediatrician Paediatricians
Hosp.
s
(1 day)____________
Training in management LMOs
Faculty of
Try. Centre,
Community
(3days)
Health
Cell(NGO,
Professional
body)
Materials
Handout
given
(not
available)
Modules
13.
14.
a)
MCH&FW&IPP8
Orientation
Try Centre
(5 days)_________
RCH
Try Centre
Handouts
Lecture, Disc,
video field visit
Handout
Lecture; Disc.
OHP
LHV/ANM/
Staff nurses
DHS/ANM Try.
Staff
Modules
Lecture; Gr. Disc Pre &
test
LMOs
Sr.
Gynaecologist
Modules
contra
sample
Lecture:
IUD insertion
Demonstrations.
Hands on
Training given
Lectures & case
demonstration
LMOs
(’/i day)
b)
15.
16.
Try. Centre & Mat.
Home
(5 days)_________
IUD skills Training
Try Centre &
Disp(Health Centre)
(1 ^y)
Pre &
test
evalu
done
Pre &
test
Dir(Try);
faculty from
ISEC(GOK);
Prog, Officers
Add/ Dir. (FW)
GOK.
Social
workers
&
Modules
Reproductive Health
Sr.
Not
LMOs
available
(screening for cancer
Paramedical Gynaecologist
cervix)
staff
Mat. Home & Kidwai
Cancer Hospital
(2 days)__________
Note: OHP = Over head Projector; SP = Slide Projector; Disc = Discussion;
Pre
test
&
feed
give
NO
In general, the training programmes were satisfactorily conducted with available resource;
However, the documentation with regard to the content and follow-up of the training programmes is
poor. It is necessary to ensure proper documentation of the training programmes through a structure!
format and to orient the honorary/visiting trainers on the feedback of the training programmes to
improve upon the quality of training. A Senior Consultant and the Director of the Centre shall ensun
content analysis of training programmes and provide feedback to trainers and as well as trainees
whenever needed.
43.6. Training Materials
The following training materials have been developed by the Centre:
(a) Link Workers module (in Kannada).
(b) RCH guidelines (in English and Kannada).
(c) Extension Approach (in Kannada) (module).
(d) Clinical skill in FP methods for LMOs.
(e) IUD insertion guidelines for LMOs (Booklet).
(f) Material on no scalpel vasectomy (NSV, in Kannada) is under preparation.
From a scrutiny and critical evaluation of the contents of the training materials, it is revealed
that the following additional features in the modules would make them more useful.
a) Link workers module-. More information on FP methods; Maternity care with emphasis on
institutional care; immunisation including pulse polio campaign; AFP surveillance; Job
chart of LWs and services and facilities at HCs and maternity homes. This may be
provided as an addendum (DTP and photocopies) to the existing module as a cost saving
measure.
b) Extension Approach Module: Areas on Pulse Polio Campaign, AFP surveillance;
facilities available and services provided in Health Centres/UFWCs/Matemity Homes.
c) RCH guidelines (in kannada): The training of TBAs & DD kits are to be substituted with
information for promoting institutional deliveries; besides including more details on FP
methods viz. Nirodh, OCPs, IUD Sterilisation including NSV.
d) IUD insertion guidelines for LMOs (GOI version): A checklist of evaluation (for post
training performance evaluation) to be prepared by the Training Centre and provided to
benefit both the trainers and trainees.
97
From a review of the functioning of the library of the Training Centre, it was found that the
library maintenance was poor and unsatisfactory. Adequate reading materials to suit the needs of the
trainees are lacking.
Hence, any further purchases of books and journals should be made in
consideration of the needs of trainees.
43.7
Evaluation and Follow-up Action of Training programmes
An effort has been made by the Training Centre through a “Standard Format” to
systematically evaluate the impact of CSSM training through post training evaluation of ANMs,
LHVs and Staff nurses at their work places. Inspite of limitations, the Training Centre has
organised “retraining” following these evaluations, which is quite commendable.
But similar efforts are needed for Link Workers and LMOs and for other types of training
programmes (major ones) as well as on Management issues. Besides there is a need to organise a
current ‘training needs assessment’ (quick and simple) and revise the training plan accordingly.
It was also informed that there was a lack of interest and passive participation of trainees viz.
LMOs during training programmes. Onentation by the Programme officers to the trainees on the
importance of the training as well as post training follow-up by the Training Centre through a
Senior Consultant would improve the situation.
Table 4.7. Impact Evaluations & Follow Up action taken for CSSM training programmes
Post Try.
Evaluation
Follow up action
taken
Category of personnel
Scores
> 75%
ANMs
(n=140)
LHVs
(n=21)
24(17%)
14(67%)
Staff
Nurses.
(0-15)
5(34%)
Total (176)
43(24%)
Reorientation for 1
day______________
Retraining for 2 days
Retraining for 3 days
64(36%)
4(26%)
69(40%)
6(40%)
4(19O/O)
176(100%)
15(100%)
140(100%)
21(100%)
Total
ow-up
of training activities
The following reporting format may be followed for fol
50-74%
< 50%
57(41%)
59(42%)
3(14%)
98
Table 4.8. Progress of Training Component
(From DD/MM/YY TO DD/MM/YY)
Trainees
Type of
Training
SAR
Training
(//of
people)
1
2
3
%of
People # of
Revised
target (# of Trained_____ Biannual from
Biannual from dd/mm/yy to
people)
dd/mm/yy
(Biannual dd/mm/yy to
dd/mm/yy)
from
dd/mm/yy Since the
inception of
to
dd/mm/yy) project
7
4
6
I5
Achievement
Since
inception
8
43.8. Integration with other Training Institutions
An integration and co-ordination mechanism does not exist for training both IPP-VIII and
other health staff of BMP at the Training Centre to avoid duplication and multiplication of
training programmes for all health staff of BMP. In this direction as a first step towards
integration, it is desirable to rename the Centre as “Bangalore Mahanagara Palike Training
Centre” to bring a sense of ownership of the Centre by Bangalore Mahanagara Palike.
Co-ordination and linkage of the activities of the Training Centre with SIHFW, at Magadi
Road, Bangalore (about 7 kins away) does not exist for sharing information, facilities and
trainers.
No concrete plans as yet were developed to promote the Centre as the nodal training Centre
for medical and health staff of Municipal Corporations of other cities in the State.
4.4. Recommendations
A review of the programmes of the Centre and in the light of the present activities and
planned future activities, the following measures are to be under taken immediately to make
the functioning of the Centre more effective.
1. Take measures to complete the construction of the proposed Training Centre.
2. Fill up the vacant posts of Training Officer (Lady with DGO qualification) and Nursing tutor
(Lady with DPHN qualification or equivalent).
3. Appoint one stenographer on contract basis to improve office efficiency.
4. Appoint one Assistant Statistical Officer (MSc or BSc. With experience) on contract basis
for compilation, analysis and evaluation of training programmes.
99
5. Appoint a Senior Consultant (Lady, DGO with atleast 10 years training experience) for
organising and evaluating training programmes including field visits and for liaison work
with skill development Centres (SDCs).
6. Hire one Matador van (on contract basis as it is economical) for visits to SDCs and transport
to trainers / trainees (in small numbers).
7. Purchase a Xerox machine. Duplicator, Fax machine and an additional telephone receiver (at
office) to improve training facilities.
8. Purchase an additional Slide Projector, Overhead Projector (with spare bulbs) and
videocassettes from WHO/UNICEF/VHAI/Other organisations on MCH & FW for MOs and
other staff
9. Shift the stores from the second training hall and make it available for training purposes.
10. Identify additional bigger tertiary care hospitals (both Govt, and willing private) as skill
development Centres for LMOs, LHVs, ANMs, Staff Nurses and Lab Technicians ex.
Vanivilas Hospital, KC General Hospital, KIMS Hospital, MS Ramaiah Hospital, St.Johns
Hospital etc. This is particularly required for clinical skill updating in MCH & FW viz.
Newborn care, complicated deliveries, MTPs, IUD insertion, TO & LTO etc. It is important
to prepare a list of academic counsellors (senior specialists) from these hospitals to function
as honorary trainers (part-time) from the departments of OBG, Paediatrics and Laboratory
medicine and the trainer: trainee ratio shall not exceed 1:5. It is recommended to increase the
honorarium to these trainers in these hospitals to Rs.250/- per session (of up to 90 minutes)
and to Rs.400/- per session (up to 3 hours) including conveyance.
100
INFORMATION, EDUCATION
&
COMMUNICATION ACTIVITIES
5. INFORMATION, EDUCATION AND COMMUNICATION ACTIVITIES
5.1.
Background
In order to achieve the overall objective of the Project, apart from initiating various
activities, IEC component has been planned as one of the major components with the following
objectives under the component.
•
To create awareness for higher age at marriage.
•
To enhance male participation in the programmes.
•
To motivate younger couples to accept small family norm and adopt different methods
especially spacing methods.
•
To motivate for acceptance of referral services for programmes.
•
To create awareness on the importance of environmental sanitation.
•
To educate mothers to accept immunization services and improve nutritional status by
consuming locally available food.
To involve local organizations and private practitioners for improving IEC activities.
•
5.2.
Methodologies adopted for the review
The review was carried out by the following methodology
1.
Desk review of assessment of achievements in Physical targets of IEC programmes in
terms of:
a. Analysis of targets with actual achievements.
b. Content analysis of all 1EC material for Validity of messages. Completeness,
Message transmission.
ii.
Focus group interviews with community and analysis of results from the mid term
survey on IEC.
iii.
Exit interviews of clients on a sample of clients in 50% MCH centres and 30 sub centres
for 15 days.
iv.
Assessment of Impact of IEC programmes at the Health centre level.
v.
Review of the observations of Mid-Term Review Consultants.
101
; j ■ rrv
5.3.
Findings of the review
53.1. Staff position
The Unit is headed by a Director, a person with long years of experience in organising
and supervising IEC activities. He is assisted by four Extension Educators, whose duties consist
of organising and supervising the activities. All IEC activities were implemented through Service
delivery centres and at the level of slums by SHE club members and Link workers, while the
planning and monitoring were done by the project staff .The supervision of programmes was
lacking due to shortage of supervisory staff
53.2. Achievements of activities
No targets were fixed for the activities. The planning and implementation of IEC
activities started only from 1995-96 and a large number of activities have been undertaken in the
last three years, the details of which are given in the tables below (Tables 5.1 &, 5.2).
The planning of IEC activities were done in a systematic manner. Micro plans for the
activities at the Health Centre level were formulated which were then transformed into Action
plans at the level of slums. However these plans were not completed for all the Health Centres
and Slums.
The important Media used in the propagation ofmessages were:
•
Audio- Visual media like Screening of Films.
•
Exhibitions.
•
Door Darshan and Radio broad casting.
•
Print Media Interms Of Posters, Leaflets, Hoardings, Folders, Metal Sheets , Labels for
School Children.
•
Interpersonal Communications.
•
Group and Mass education Programmes For Adolescents, mothers-in-law and Satisfied
Acceptors
•
Folk Media Programmes
Television programmes were sponsored through some of the Corporate sector agencies.
Video films produced by the unit had taken local culture in to consideration and also had some
popular artists.
102
Table 5.1. Year-wise Planning Activities Undertaken
Activities
1994-95
Action Plans
Preparation Of Micro Plans For H.Cs
Preparation Of Action Plan For Slums
Audio-Visual material developed
U-Matic Video Films________ _
Cinema Slides (200 Each) _______
Print materials developed
Posters(5,000 Copies Each)________
Leaf Lets______________________
Printing Of Flip BookaNos)________
Stickers (10,000 Each)____________
Folders (3,000) Each______________
Brouchers______________________
School Labels___________________
Exhibition materials developed
Hoardings______________________
Metallic Thin Sheets Small_________
Banners________________________
Vfodels(On FW Methods) Nos_______
Exhibition Panels With Photos
Cumulative Performance
1995-96
1996-97
1997-98
20
82
12
70
23
68
2
4
___ 8
2 Types 4 Types
1
___ 1_
1 Type
4
2
2
2000
3
1 Type
4
20
450
____ 2
2 Types
6 types
4
4 Types
577
50 Sets
103
The number of activities undertaken are given table 5.2.
Table 5,2. Details of IEC materials prepared______________________
SI. No,
Materials_____
Messages_____________
1
Video cassettes
Age at marriage
Care of pregnancy
Small Family Norm
Child care
Family planning methods
Project profile
Fillers on project
Female Education
Adolescent Girl
Community participation
Environmental sanitation
T. V Spots on pulse polio
Nutrition
Male participation Fillers
2
Metallic sheets- Big size
Age at Marriage
Small Family Norm
Care of Pregnancy______
3
Metallic sheets- Small size
Age at Marriage
Small Family Norm
No scalpel vasectomy
4
School labels
5
Folders
Small family
Age at marriage
Care of pregnancy
Female education
Project profile
6
Stickers
Male participation
Adolescent girl
Age at marriage
Small family
Care of pregnancy
1i L
t
Table 5.2. Details of IEC materiftfc prepared - continued _________
SI. No.
Materials
Messages____________________
7
Flip Book
Project profile
Small family
Care of pregnancy
Breast feeding
Immunisation six killer diseases
F.W. methods
Vocational training
Implementation Health Education
8
Exhibition sets
Age at marriage
Temporary methods
T.M.(Temporary methods)
ANC check up
Nutritional Education
Hospital delivery
Breast feeding
Primary immunisation
B.C.G. polio, D.P.T
Measles
Infant weaning
Vitamin "A’
ORS demonstration
One child norm (Male or Female)
No scalpel vasectomy
Tubectomy__________________
8
Desk Calenders
Age at marriage
Nirodh
Oral pills
T.T. Injection
A.N.P. for ANC
Prima Immunisation
Infant weaning
Vitamin
ORS Demonstration
One child
NSV
TRO & LTO
Project Profile glance___________
9
Pamphlets
50 Years of Independence
No scalpel Vasectomy
Rajalaxmi scheme pamphlets
Pulse polio Immunisation
105
Table 5.3. Year-Wise Performance of EC Activities
Activities
Year wise Performance
1997-98
1996-97
1995-96
624
624
260
5000
5000
10,000
Screening Of Video Films
Posters distributed___________
Stickers distributed___________
Metallic Tin Boards distributed
3000
Folders distributed___________
6000
6000
6000
Hoardings exhibited__________
____ 4
8
School Labels distributed______
50000
50000
Awareness Programme For
5 HCs
Adolescents_________________
Satisfied Customer Contact
5 HCs
programmes________________
Mother-In-Laws Motivation
5 HCs
Programme_________________
Public Meetings_____________
18
32
Folk Media Programmes_______
20
39
165
Telecast programmes_________
6
Radio broad casting programmes
5
Important messages which were covered by these activities are given in table 5.2.
533. Monitoring of IEC activities at peripheral level
Even though a stock register was maintained at the project level for the materials
procured and distributed to the Health Centres, a follow up of these materials from the Project
EC unit was lacking. Consultancy services were made available to the Unit since August 1997,
to monitor and give feed back on the implementation of EC activities. These consultants besides
monitoring the performance from reports, have also monitored the implementation of EC
activities at the Health Centre and field level on a sample basis and have provided feed back
every month to the Director in writing. The EC unit has taken suitable follow up actions based
on these reports.
Major observations of the Consultants during the yearlong monitoring were:
1. The materials produced by the unit were available at the Health centres.
2. The most popular media was video film.
3. Selection of media was to be done keeping the language barriers in to consideration.
4. Male participation in the communin’ awareness programmes was lacking.
106
■
-
5. Advance announcement of different types of programmes in the community required
improvements.
6. Proper accounting of educational materials at the peripheral centres was lacking.
5.3.4. Community opinion on IEC programmes
A. V Vans
Almost all the females were aware of the programmes and many of them had viewed the
films on different topics. They could recall the topics like age at marriage, small family norm,
childcare, care at pregnancy, AIDS awareness, female empowerment, female education etc.
However, few of them were of the opinion that the time was not suitable while some suggested
more of such shows. Most of them expressed that they liked this particular programme more
than any other IEC activity.
Meetings
Some of the women had participated in the Awareness meetings held by U.F. W.C’s on
various topics of family welfare and M.C.H during the clinic hours. Many of the male
participants expressed the need for such meetings with them also.
Folk media
Most of the participants were unaware of the programmes like Harikatha, Bhavgeetha,
puppet show etc, which were held in the community. Many of them said they were never
informed of such programmes.
Pamphlets and display boards
Most of the males as well as females expressed unawareness regarding the availability of
pamphlets. However, a few of them had seen the pamphlets on pulse polio and AIDS.
Regarding display boards and exhibits, many of them have seen it in the U.F. W.C’s and
read them.
53.5. Findings from DEC baseline study done during 1997
A mid term survey was conducted in the month of July 1997 by the above Consultancy
Services to redefine the strategies of IEC programmes. The major findings from the study on
knowledge, attitude and practices as detected during the survey highlighted below.
107
*■ '
•
Environmental sanitation conditions and personal hygiene
•
Less than one third of the households (61.0%) washed the floor of their house everyday.
•
The storage of drinking water was not satisfactory in majority of the households, as majority
did not wash their drinking water containers daily (46.7%).
•
Of those without toilets, there are substantial proportion using agricultural fields (11.1%),
front/back yard (10.3%) and roadside (5.1%) as toilets.
•
Hygienic disposal of garbage was practised only in 51% of the households and habit of
throwing them indiscriminately existed with nearly a fifth of the households.
•
Habit of taking bath daily was only with a quarter of the mothers and 41% of children. There
were mothers and children who bathed once in three days or more.
Media exposure
•
Newspaper reading habit amongst the women is as low as 22%.
•
Orientation programmes through health workers was not effective as messages on nutrition,
family planning, child care, immunization and disease prevention, had reached only around
16 to 21% of the women through these programmes.
•
Only around 21 to 26% had accessed some messages on nutrition, family planning,
childcare, immunisation or disease prevention through radio broadcast.
•
Television seems to be more accessible media than any of the other ones. The percentage
women who had watched one or the other health programmes related to nutrition, family
planning, childcare, immunization or disease prevention was around 56 to 58%.
Nuptiality
•
About 58% of the women had married before the age of 18 years. The mean age at marriage
in the sample was 16.9 years, with 16.8 years for Hindus, 16.7 years for Muslims and 18.0
years for Christians.
•
More than three fourths (77.4%) of women had their consummation of marriage before 18
years of age.
•
Majority had their first pregnancy before the age of 19 years (67.2?zo).
108
Fertility
•
Majority of the women (57.3%) had conceived for more than two times. There were also
16.2% who had more than
four pregnancies. However only 11.7% ‘viewed the latest
pregnancy as unwanted. This observation indicates that that about 12% of births could have
been averted if these women were properly motivated to adopt some family planning
method.
•
The proportion of women who had induced abortions was 4.7%. It is a matter of concern
that 10% of abortions are still being performed by unqualified persons.
•
Majority of the women who had delivered during the previous one year were in the younger
age group (66.0% in aged 19-24 years). However, there were about 9% of the mothers,
comprising of only Hindus and Muslims, who were below the marriageable age of 18 years,
which is a matter of concern.
Obstetrical care during pregnancy
•
Except for about 5% of mothers all had antenatal check up during pregnancy, most of them
had initiated the same in the first trimester.
•
Significantly only a small proportion of the check up (7.6%) was done by the peripheral
workers while the remaining were from doctors (90.3%). A third of the mothers utilise
private practitioners. About 8% of the mothers did not have tetanus toxoid immunisation
during pregnancy comprising mostly of Christian women.
•
About 84% of the mothers had iron and folic acid supplementation during pregnancy but .
only about a fifth of them had full course of 60-90 tablets.
•
There were still 14.5% home deliveries which were mostly done by unqualified personnel.
•
Availing postnatal check up was not very common as only 30.5% of the mothers had such a
care.
Management of diarrhoea
•
Nearly 45% of the children had reduced . food intake during the episode while the rest had
the same quantum as usual.
109
V-
•
Only 18.8% children were offered more fluids during the episode and in 30.0% of the
children the quantum of fluid intake had reduced. Further ORS was administered in only
51.2% of the episodes.
Malnourishment in children
•
In the community only 26.4% of the children were nutritionally normal
as per WHC
standards of MAC (MAC >14.0 cms.). There were 35.8% of children moderately
malnourished (MAC between 12.6 to 14.0 cms.) and 26.4% severely malnourished (MAC<
12.5 cms).
Opinion on Age at marriage of children
•
There were still 11.5% who wanted their sons to be married before 20 years and 7.2% whe
wanted daughters to married before 18 years of marriage.
•
Only 62.6% of women were knowledgeable about the legal age of marriage of boys while the
percentage was only 41.5% for the knowledge on legal age of marriage for girls.
Opinion on spacing between births
•
About one third of the women sun eyed wanted the second child in about two years from the
first. This interval was desired more by Hindu and Christian women as compared tc
Muslims.
Knowledge on family planning methods
•
The most common methods known were sterilisation of women (92.5%), oral pills (62.4%):
IUD (49.8%) and Nirodh (27.7%). Vasectomy was known only to a negligible proportion of
women (1.6%).
Family planning methods practiced
•
The couple protection rate was 58.6%, Majority of the women had undergone sterilisatior
and the proportion adopting spacing methods were very small (9.6%).
•
Inter-spousal communications varied extensively between different aspects. While the
communication was moderately good in discussions about finances (78.3%), it was moderate
with regard to children’s education (68.8%) and minimal for discussion on spacing oi
children (34.6%). This may be because of the male dominance in the areas of sex. Christian
women had better communicanons with their husbands as compared to women in other
religions.
110
The following recommendations emerged out ofthe above surveyfor improving IEC
component.
Planning ofstrategies
•
Slums being inhabited by three major religions Hindus, Muslims and Christians with
differences in knowledge, attitude and practices, the approaches and messages for each aspect
of the program should confirm to these differences. In other words the messages are to be
tailored as per the religious compositions of the slums.
•
Couples in the slums being young, the messages should suit their needs and should be in an
acceptable manner.
•
Since the slums have got working groups mostly engaged in day time labour, the timings of
the programs should fit into their leisure hours may be late evenings.
•
Co-ordination with different agencies involved in improving the status of women should be
considered as such agencies have more expertise in these specific areas.
•
Co-ordination with population education cells especially for adolescents both in the school
and out of school would enhance the efficiency of adolescent education programmes.
•
Co-ordination with private practitioners for educational programmes should be incorporated.
They are to be equipped with necessary materials and incentives along with an orientation in
imparting the messages.
Methods and Media
♦ Television being a popular media in the community, as compared to others, utilisation of this
media in a bigger way should be explored.
♦ Group orientation programme, which are at present covering only a scanty proportion of
population should be given a top priority.
♦ Literacy amongst both male and female being considerably satisfactory, increased
propagation of messages through print media should be considered. Simple Brouchers and
booklets prepared in an interesting and appealing manner should be distributed.
Messages to be emphasised in the programmes
♦
Age at menarche being low especially with Muslim communities, population and sex
education through schools should be emphasised. The concerned departments engaged in
population educational programmes at the district level should be co-ordinated.
111
V
•
Environmental Sanitation education programmes especially amongst Hindus and Muslims
have to concentrate on messages pertaining to hygienic methods of disposal of garbage,
wastewater and use of community latrines.
•
Messages i-j improve the personal hygiene habits regarding bathing etc., especially among
Muslims and Christians require emphasis.
•
Importance of obstetrical care especially for antenatal and postnatal checkup amongst
Christian women needs emphasis in messages.
•
Importance of institutional deliveries in reducing maternal complications needs to be
stressed in the messages.
•
Breast feeding habits and its importance in the childcare and prolonging amenorrohea should
be incorporated in the messages especially with Muslims.
Messages on management of diarrhea in terms of increased food and fluid intake and
•
administration of ORS especially amongst Christians need to be included.
To reduce malnutrition amongst under fives which is very high in the communit}' messages
•
on nutritional supplementation, using locally available food in sufficient quantities and
concepts of balanced diet require attention.
•
Messages on risks of teenage pregnancy need to be emphasised especially amongst Muslims.
•
Messages on legal age at mam age requires emphasis with Hindus and Muslims.
•
Messages on different family planning methods, their importance, contra indications and
availability needs to be spread especially amongst Hindus and Muslims.
•
Information on spacing methods especially with Muslims is to be reinforced.
•
Women autonomy needs to be improved by incorporating messages on rights of women and
coordinating with agencies involved in such activities.
53.6. Utilisation of Funds
Funds earmarked for IEC programmes have been fully utilised and re-appropriation of
funds was done from funds of Innovative Programmes since many of the IEC activities covered
the beneficiaries of those programmes.
5.4.
Recoinmendations
1. Before developing any new IEC materials an assessment has to be done for the
effectiveness of the media which are being used at present in propagating the messages.
112
This should be one of the tasks to be undertaken by the Consultants who are engaged
with the Unit.
2. Cost effectiveness in terms of coverage of different media should also be assessed by the
consultants who should also provide a feed back on suitable mix of media.
3. Follow-up should be done at Health Centres’ level for effective utilisation of materials
which are supplied to them.
4. Some of the messages recommended by the survey undertaken in Mid July 1998 should
get priority in the materials to be prepared from now on.
5. Grass root level workers especially ANMs, SHE club members and Link workers are to
be provided a better orientation of the health messages to be propagated by them as well
as using the materials in an effective manner.
113
■
INNOVATIVE PROGRAMMES
6. INNOVATIVE PROGRAMMES
6.1.
Introduction
The Family Welfare programmes in India are operating for well over forty years and
despite additional inputs, the progress has been well below the targeted goals. One of the
reasons for the limitations is that it is run as a government programme and not as a people’s
programme. To make the programme more community based, several innovative schemes have
been incorporated in the present Project. The main objective of these innovative schemes is to
strengthen the NGO and Community Participation in the programmes besides improving the
status of women ultimately aiming at the sustainability of the programmes.
The unit is managed by one Programme Officer assisted by a few Social Workers, appointed
recently.
Important activities initiated under the scheme were:
•
Involving Link workers from the community for effective implementation of the project.
•
Establishing Social, Health and Environmental (SHE) clubs as a resource group for planning,
implementation and monitoring of the programmes.
•
Providing educational opportunities to adolescent girls through non-formal schools.
•
Providing care for the children of working women through Creches.
•
Income generation activities.
The Mid Term Review was undertaken for each of these activities broadly by the
following methodologies and the findings and recommendations are presented in the subsequent
sections.
The following aspects of each of the components of the scheme were reviewed:
•
Achievements in Physical targets of different programmes envisaged under the component
of project.
•
Facilities at different Centres established by the Project under the component
•
Fulfilment of objectives under the different components.
114
Different methodologies adopted for the review were:
1. Desk review of Progress reports;
2. Analysis of targets with actual achievements and reasons for shortfalls;
3. Facility survey as per standard techniques;
4. Random sample surveys of Institutions and beneficiaries for assessing the impact of the
innovations under the different components;
5. Focus group discussions in the slums to assess the impact of Link workers, SHE clubs, and
involvement of NGOs and Community in the activities of the project.
The details of the methodologies adopted for Review of each of the components are
described under each section separately.
115
Table 6.1 Year-Wise Performance of Innovative Programmes
Activities
No. of Social Health and
Environment (She) Clubs Formed
Establishing Creches at Slums
Vocational Training for________
Adolescent Girls______________
A/Tailoring & Knitting_________
B)Radio & TV Repair_________
QZari & Embroidery Work_____
D)Computer Course___________
Non-Formai Education Centres to
School Dropouts & Non
Beginners____________________
Environment Health, Sanitation,
Personal Hygiene,Mch & Fw
Programmes__________________
Clean Hut Competitions________
Well Baby Contest____________
Health Check-Up Camps for Slum
| Dwellers
Project
Target
401
Cumulative Performance
1994-95 1995-96 1996-97
12
50
36
70
137
3
14
33
1UNIT
2 Units
2 Units
12 Units
1 Unit
lunit
2 unit
2 Unit
1 Unit
9 Unit
250
250
250
250
14
2
1997-98
13 Units
42
228
536
10
32
34
60
72
74
12
26
104
116
6.2.
LINK WORKERS PROGRAMME
6.2.1. Background
Link workers. Women, selected from the respective Slums act as Community Agents of
the Health Centres. They represent about 5000 population. Their activities include listing of
eligible couples, propagation of messages of the Project and participation in ail out reach and
health education activities and help in achieving the targets of the project. She will also act as a
liaison between the community and various government programmes. Further she is the depot
holder for ORS, Oral pills and Condoms.
6.2.2. Methodology of the Review
A sample of 15 U.F W.Cs out of the 60 centres were randomly selected for the study. All
the link workers in each of :he 15 selected Health Centers were interviewed separately by trained
Investigators and information on their knowledge and the activities performed by them were
recorded on a predesigned and pretested proforma. The questionnaires were developed on the
basis of link worker’s training manual. A total 138 link workers were interviewed as few of the
selected could not be contacted.
Focus group discussions were held in randomly selected slums to study the opinion of the
community on the programme. For this purpose, 8 focus group discussions were held with male
members in the slums wh:.e another 12 with females. A group of about ten persons from the
community were grouped and discussions were conducted by trained investigators in local
language. The main aim of these discussions were to elicit the opinion of the community
members on the programme.
6.23. Findings of the Review
CL
Socio-demographic characteristics of workers
Even though these workers were to belong to the same slums of their area of duty, only a
third of them were the residents of their work area, contrary to the concept of selecting workers
from the same slums.
Religion wise 92° ? of the workers were Hindus, 2.9% Muslims and 5.1% Christians
adequately representing the religious composition of the slums.
117
A little less than two thirds of the workers were aged up to 29 years (61.5%) and another
about a quarter from 30-34 years age group (24.6%). Thus most of the workers were young.
Education wise all workers were educated with a majority with education up to middle
school (85.5%) and the rest were with higher secondary education.
94.2% were married while only 1.4% were unmarried. Others were either widowed ordivorced.
84.2% of the currently married link workers were practising family planning method.
63.8% of the link workers had undergone female sterlisation, while 0.7% had adopted male
sterlisation. 15.2% had IUD, 1.4% were using oral pills and another 3.6% nirodh (Table 6.2).
b. Level of awareness of workers on health andfamily planning
Since the main function of these workers were identification of antenatal cases, health
education, nutrition education, motivation of cases for FP, and to act as Depot holders for
condom, oral pills & ORS packets, the knowledge of the workers was assessed in the above
areas of work they were supposed to perform.
Only 23.9% of the workers had complete knowledge of the duties they were to perform.
Knowledge on identification of either eligible couples for F.P. or pregnant women was very poor
with only 10.9% and 44.9 % having complete knowledge on these two aspects respectively.
Knowledge on calculation of expected date of delivery or factors of risk during pregnancy
was better (79% for both).
89.9% knew the correct dose of T.T to be administered to pregnant mothers.
Only 37.7% of workers had complete knowledge on advises to be given to pregnant
women while only 56.5% knew about all the danger signs of new bom and another 62.3% knew
all the advises to be given to mother immediately after delivery.
However their knowledge on different family planning methods was 100% with all of
them having knowledge on male sterlisation, female sterlisation IUD, oral pills and nirodh.
All the link workers were aware of the complete immunisation schedule for infants.
91.3%. of the workers were aware as to when a women is to be advised to adopt a permanent
F.P method while 97.8% were aware of spacing methods.
118
Only 57.2% had complete knowledge of vitamin A deficiency while another 52.9% hac
knowledge of iodine deficiency and 23.2% for causes of anemia.
However, their knowledge on advises to be given to diarrhoea cases was very gooc
(97.8%), but only 17.4%% had knowledge on the danger signs of diarrhoea. All the workers
were aware about the method of preparation of ORS.
Only 59.4% knew what are the advises to be gi ven regarding personal hygiene.
The knowledge on STD was almost nil and it was informed by the Project authorities that there
was no component of either STD or HIV/ AIDS in the training curriculum to the workers (Table
6.3).
c. Activities performed by the workers
Link workers during the previous year, on an average had referred 101 children for
immunisation, motivated 120 cases for adopting various family planning methods. They were
successful in motivating couples for spacing methods as out of the cases motivated nearly two
thirds were for spacing methods.
Majonty of workers were practising family planning (84.7%) (Table 6.4).
d Community opinion on the programme
Almost all the females, except for a few working women, knew who was the link worker
in their area and also what activities were being performed by her. However only a few of the
males were aware of her existence that too through their wives. The main reason for this may be
that Link worker performed duties related to females only.
All the members participating in the discussions were of the opinion that Link worker
was working effectively, and that she visits their area regularly and distribute oral pills, condoms
and ORS packets on need basis. They also opined that she is instrumental in creating awareness
in the community on all the aspects of family welfare.
e, Conclusions
Link workers are acting as good link between the community and the service providers
and have been able to motivate the community for MCH and F.P. services Knowledge on various
aspects of services provided are satisfactory but needs improvements in the areas of MCH.
119
6.2.4. Recommendations
1. Link workers should be recruited from the same slums of their area of work, which will
enable community members to use their services in a better manner.
2. Emphasis on STD/AIDS as well as identifying eligible couple and pregnant women in
training programme is required.
3. As Identification cards and uniforms were desired by the workers, the feasibility of providing
them these facilities can be explored.
4. The project should look into sustainability of their services.
5. To improve upon better male participation in the programme a few male link workers may
be enlisted.
120
Table 6.2. Socio-demographic particulars of Link workers
Particulars
__________
Residents of the same slum ,
Religion
Hindu
Muslim
Christian______________
Age in years
15-19
20-24
25-29
30-34
354-___________________
Educational qualifications
Middle
Higher Secondary______
Marital status
Mamed
Unmarried
Widowed
Separated/Divorced
%(n=138)
33.3
92.0
2.9
5.1
0.7
15.9
44.9
24.6
13.8
85.5
14.5
94.2
1.4
2.2
2.2
..T
121
Table 6.3. Knowledge of Link workers on MCH and F.P.
Particulars of knowledge_______________
Duties of Link worker
Complete
Partial
Identification of Eligible couples
Complete
Partial
Identification of Pregnan: women
Complete
Partial
Calculation of Expected Late of delivery
Factors of risk during delivery
All factors
up to 60% factors
Doses of TT to pregnant-others
Advice to pregnant lady
Dangers signs of new borr.
Advice to mother immedirely after delivery
Complete Immunisation schedule to infants
Advice to adopt permaner: F.P. method
Advice to adopt spacing F ?. method
Symptoms of Vit-A deficiency
Complete
Partial
Symptoms of Iodine deficiency
Complete
Partial
Causes of anaemia
Complete
Partial
Advice to diarrhoea cases
Danger signs of diarrhoea
Method of preparation of jRS
Advice regarding personal hygiene
Symptoms of STD___________
Knowledge about preventing pregnancy
F.P. methods known
Sterilisation- Male
Sterilisation - Female
LU.D
Oral pills
Condoms
%(n=138)
23.9
76.1
10.9
81.9
44.9
54.3
79.0
79.0
21.0
89.9
37.7
56.5
62.3
100.0
91.3
97.8
57.2
34. <8
52.9
23.2
23.2
71.7
97.8
17.4
100.0
59.4
2.9
100.0
i
100.0
100.0
100.0
100.0
100.0
122
Table 6.4. Perfonnance of Link workers
Particulars________________ ____________________
Average no. of cases referred in the last one year by
each link worker
Immunisation
F.P. cases
Sterilisation-Male
Sterilisation - Female
I.U.D
Oral pills
Condoms______________________________
Average no. of follow-up visits in a month___________
Suggestion to improve the working conditions
1. Identification card and uniform
2. More salary
3. Other facilities
4. Nothing
%(n=138)
101.2
0.2
35.8
29.5
22.8
31.6
16.5
44.9
85.5
52.9
2.9
*
123
Knowledge of Link Workers
■ Preparation of ORS.
~~~
■........................................................................ ..
'
□ Danger signs of diarrhoea.
HHHHHHHHioo%
17.40%
_
_____________________
S Advice to adopt spacing
F.P method
□ advice to adopt permanent
F.P method
■ Immunization shedule of
infant
□ Advice to pregnant lady
97.80%
91.30%
100%
37.70%
44.90%
I
10.90%
□ identification of pregnant
women
■ Identification of eligible
couples
□ Duties of Link Worker
23.90%
Performance of link workers
101.1
•• .
: -
.
ft?;
w
•
■
-
35.8
29.5
|
22.8
0.2
L
□ Immunisation
■ Steriirsation-Male
□ Sterilisation - Female
□ I.U.D
■ Oral pills
□ Condoms
194
63.
SOCIAL HEALTH AND ENVIRONMENTAL (SHE) CLUBs
63.1. Background
The main thrust of the project is to involve the community in:
a) The decision making process.
b) Planning and co-ordination of programmes.
c) Effective implementation of programmes.
To enable the above said factors and in keeping with the goals and objectives of the project,
“Social Health and Environmental” Club or SHE Clubs are formed, at the level ot the slum by
the inhabitants themselves. 5-6 females residing in the slum are enrolled as members of the club
and one among them is elected as a chairperson.
The Objectives to be achieved through these clubs are:
a)
Create awareness on environmental hygiene.
b)
Chart out hygiene and sanitation programmes for the slum.
c)
Create awareness on MCH and FW programmes.
d)
Prepare a mini plan of activities based on felt needs.
e)
Co-ordinate with the Health Centre to ensure availability of services and
free medical aid.
f)
Discourage child marriages and early mother hood.
g)
Organise non-formal education for dropouts and working children.
h)
Manage the funds of the SHE Clubs.
63.2. Methodology adopted for the Review
The Review was carried out by the following methods.
a) Desk review of the progress reports to assess the target achievement of establishment of the
clubs.
b) A random sample of 20 SHE clubs selected out of all the clubs in the project provided
information on the background characteristics of the club members and assessment of the
activities undertaken by them. One hundred members, five from each club, were interviewed
for the required information. The desired information was collected on a predesigned and
pretested questionnaire.
125
c) Trained investigators interviewed the members to collect the desired information.
d) Focus group discussions were held in randomly selected slums to study the opinion of the
community on the programme. For this purpose, 8 focus group discussions were held with
male members in the slums while another 12 with females. A group of about ten persons from
the community were grouped and discussions were conducted by trained investigators in local
language. The main aim of these discussions were to elicit the opinion of the community
members on the programme.
63.3. Findings of the Review
(L
Progress in establishment of clubs
The pace of establishment of the clubs is rather slow. During the year 1994-95 only 12
clubs were formed while by the end of 1995-96, there were only 36 clubs which increased to 70
by the end of 1996-97. However, during the year 1997-98, 67 clubs could be added to rake the
number of clubs to 137. The target of establishing 401 clubs is still far behind (Table 6.1 •.
b. Background characteristics of members
Most of the members (97%) resided in the slums of the respective clubs.
Majority of the members were from the elderly age group of over 35 years (43Ao/o) and
another 19.2% from 30-34 years. However, there were a about a third of the members from
younger age group of 20-29 years age (36.4%1 Adequate representation of some of the older age
groups especially from “mothers-in- law” who influence certain decision-making would help the
programmes.
73.7% were Hindus, 20.2% Muslims and another 6.1% were Christians. The religious
composition is more or less in comparison with the composition in different slums as was seen
in Multi Indicator Study which indicates that due consideration of the religious, composition of
the slums has been taken into account while forming the Clubs.
Education wise majority were educated beyond middle school (72.7%) and there were
substantial proportion educated up to higher secondary (40.4%).
Majority (90.9%) were currently married, 3.0% unmarried and the rest widowed or
divorced. Married women would definitely help the activities of the Club.
126
Of the married members 83.8% had adopted different family planning methods. Most of
the members have adopted tubectomy with 72.7%. The proportion practising IUD was 6.1% and
oral pills 4.0% and only 1.0% Nirodh (Table 6.5).
a Level of awareness of members on MCH and F.P.
Knowledge on legal age at marriage of girls was quite satisfactory (97.0%), however
their awareness on legal age at marriage of boys was not up to the desired level (82%).
Knowledge on different methods of family planning for prevention of pregnancy was
almost universal (99.0%). While female sterilisation was known to majority of the members
(93.9%), knowledge on male sterilisation was very poor (29.3%). The knowledge on spacing
methods of fanvly planning was not high except for Oral pills (93.9%), (85.9% for Nirodh and
72.7% for IUD).
All the members had knowledge on the immunisation schedule for children.
Knowledge on prevention of HIV/AIDS was fairly good (81.7%). Even though the media
had contributed well (93%) for their knowledge, training programmes had also equally
contributed (84%).
However, the knowledge on STD was found to be meagre, with only 34.3% having
knowledge on causes and prevention of the diseases related to STD (Table 6.6).
d. Activities of the Clubs
Since, the major objective of the SHE club was to help in organising programmes in the
community, activities of the clubs in terms of average number of programmes conducted by
them in last one year was analysed.
Even though varied types of awareness programmes were undertaken by the Clubs,
average number of programmes conducted through the clubs were mostly related to the
Immunisation (11) and Family planning programmes (9). The other programmes relating to
environmental hygiene & personal hygiene or disease prevention were not many ranging only
between 8 to 6.
The number of camps or competitions conducted were not many ( 7 in all) and mostly
for Immunisation or Health Check-up (Table 5.7).
127
f. Community opinion on the programme
Majority of the females in the community were aware ©f the existence of the Club and
the activities carried out by them. Many of them had participated in the programmes of the club.
However, only a few males were aware of the existence the SHE Club but most of them
are unaware of the activities.
Both males and females, who were aware of the Clubs were of the opinicn that they were
working effectively and were useful to them.
g. Conclusions
The members of the Club have acquired fairly good knowledge on MCH and F.P. and
have been responsible for organising various types of programmes in the community. Hdwever
certain types of programmes like meetings of ‘Mother-in-law’ or ‘daughters-in-law’ were
lacking.
63.4. Recommendations
1. The formation of the Clubs should be accelerated to meet the targets of the Project and the
composition of members should have due representation for mothers-in-law.
2. Reorientation programmes to the members on Spacing methods of family planning , STD
and environmental sanitation including personal hygiene should be done, besides training
them on organising more and more innovative programmes.
3. The awareness programmes and camps organised by the Clubs shou’.d be more on
programmes on different components of the Project besides concentrating on Family
Planning.
4. More Innovative meetings should be arranged in the community by the Clubs.
5. Prior announcement of programmes in the community should be ensured.
6. Proper usage of pamphlets and exhibits by the staff should be ensured.
128
*
Table 6.5. Socio-demographic particulars of SHE club members
Particulars
%of
members
Residents of the same slums
97.0%
Age of members in years
15-19
1.0
20-24
17.2
25-29
19.2
30-34
19.2
35+
43.4
Religion
Hindu
73.7
Muslim
20.2
________ Christian
6.1
Educational Qualification
Illiterate
10.1
Just Literate
8.1
Primary
9.1
Middle
32.3
Higher Secondary
40.4
Martial Status
Currently Married
90.9
Unmarried
3.0
Widowed
4.0
Separated /Divorced
2.0
129
Table 6.6. Knowledge and F.P. practices of SHE club members
%
Particulars of knowledge and F.P. practice
members
Knowledge about legal age at marriage
82.8
Boy
97,0
Girl________________________
_________
99.0
Knowledge about preventing pregnancy ______
F.P. methods known
29.3
Sterilisation- Male
93.9
Sterilisation - Female
72.7
I.U.D
93.9
Oral pills
85.9
Condoms_________________________
100.0
Aware about the immunisation schedule of the child
93.9
Heard about HIV/AIDS______________________
Knowledge on prevention of HIV/AIDS
26.9
Excellent
54.8
Good
17.2
Satisfactory
1.0
Poor_________________________
__
Heard about STD____________________ 34.3
81.8
Practising F.P. method_________________ ____
F.P. Method practised
0.0
Sterilisation- Male
72.7
Sterilisation - Female
4.0
I.U.D
4.0
Oral pills
2.0
Condoms__________________________ ___
Reasons for not practising F.P. method
4.1
Want more child
2.0
Health reason
3.0
Religious reason
I
i
I
I
130
T
■
Table 6.7. Activities of.SHE^ubs____________________________
Activities_______ ______________________ .________ % of clubs
Average no. of Awareness programmes conducted
through SHE club in the lasz one year
) 8
Environmental Hygiene
Personal Hygiene
: 6
Child Care
7
Nutrition
i 9
Family Planning
! 9
Immunisation
Disease Prevention
I5
Age at Marriage
HIV/AIDS
, 3
_______ STD
_____________________________ ! 0.5
Average no. of camps/ competitions conducted in the last
i
one year
2
Health check-up camps
Reproductive heahh check-up
| 2
Immunisation camps
[ 3
Clean hut competmons
j 1
Well baby shows
! 1
j
Adult literacy programme
' 7
in
I8
131
□ Environmental Hygiene
■ Personal Hygiene
□ Child Care
□ Nutrition
9
9
8
■ Family Planning
| I
□ Immunization
■ Disease Prevention
I
6
r 1
Li
□ Age at Marriage
5
■ HIV/AIDS
M
3
M
■ STD
0.5
Number of Camps / Compitetions Conducted Through SHE Club in the Last year
□2
07
□ Health checkup camps
■ Reproductive health checkup I
□ Immunisation camps
□ Clean hut competitions
■ Well baby shows
a Adult literacy programme
■1
□1
■2
□3
132
6.4.
NON-FORMAL EDUCATION
6.4.1. Background
&
Organising Non-formal Education (NEE) programmes for neo-literates and school drop
outs amongst young girls is one of the innovative schemes, which was implemented through
NGOs. The girls were given minimum literacy education through the programme and those who
wish to have regular schooling are trained and brought into the main stream. The programme
was also intended to enrich girls awareness on Health and Family planning so that these young
girls can propagate such messages in the community and act as peer educators.
The aims of the programme were:
a)
To improve literacy status of girls
b)
To create a cadre who will propagate Health and Family Welfare message in
the area.
6.4.2. Methodology adopted for the Review
1. Desk review of records and reports was carried out to assess the progress of establishment
of non-formal education centres.
2. A survey was conducted of all the functioning centres conducted under the project to
assess the availability of adequate infrastructure in the centers. Information was collected on
a standard pretested questionnaire.
The investigators were trained thoroughly for the job before.
6.4.3. Findings of the Review
a. Progress of establishment of the centers
There were no targets as such for the establishment of non-formal education centers
under the Project programme. Till 1995-96 there were no activities for the establishment of the
centers. During the year 1996-97, 9 centers were established at different slums and another four
centers were added in 1997-98. Thus there were only 12 centers functioning with nearly 300
students. All the centers were operated by NGOs (Table 6.1).
b. Infra Structurefacilities at the Centers
Position of staff was adequate in all the centres and the sanctioned posts were filled up.
133
Majority of the centers functioned in single rooms, even though a few centres share their
accommodation with other innovative programmes like creche. The ventilation and natural
lighting conditions were not satisfactory in majority of the centres (50 % to 67%).
The basic amenities like toilet facilities were lacking in 50% of the centers while -the
!
cleanliness of toilets was also poor (41.7%). Drinking water facility was available only in 33.3%
of the centers.
All the Centers provided food to the girls but the cooking place was clean only in 66.7% .
Most of the girls sit on the f oor and only 25% of the centers provide mats for the purpose.
The centers were to cater mostly to the girls in the age group of 6 to 16 years. But only 12
% of the beneficiaries were over 10 years of age. The main reason behind this is that most of the
older girls go out for work and the working hours of the centers were not suitable to them.
c. Proficiency of teachers and standard of teaching methods
All the teachers were found to be educationally qualified and two thirds of them had
professional qualifications.
Majority (91.7%) of die centers were adopting standard teaching methods which included
informal talks, songs, role piay, practical activity, puppet shows etc. Use of teaching tools like
black-board, charts, posters, models, books etc., were satisfactory’ in most of the centers (83.3%).
All the centers had adopted standard approaches of education (91.7%) like combinations of child
centred, problem solving, decision making, and self-esteem enhancement in the teaching
methods.
Majority (75%) of ±e centers had adopted flexibility in curriculum according to the
needs of the beneficiaries. But still there were areas of improvement like incorporating
vocational training and teaching of different languages as per needs.
Apart from undertakmg teaching programmes, all the centers provided meals to the girls,
while school uniform was provided by only 8.3% centers, 75% of the centers provided books and
other educational materials :□ the beneficiaries.
75% of the teachers felt that health education is an important aspect of school education.
Out of them 75% of the teachers felt that the priority should be given to environmental and
personal hygiene while teaching health education. Only 8% of the teachers felt the priority of
imparting menstrual hygiene while a similar proportion for nutrition.
134
83.3% of the teachers felt the need for further orientation training on various health
topics (Table 6.8).
e. Conclusions
1. The centers have been instrumental in improving the literacy level of school dropouts and
neo-literate girls. But the coverage of girls in adolescent age group was very poor due to the
reasons of the non-suitability of working hours of the centers.
2. Importance was given only to improvements in literary standards and there i$ demand for
vocational training and teaching of languages other than Kannada in the centers.
3. Infrastructure and basic facilities in most of the centers were lacking.
6.4.4. Recommendations
1. Infrastructure facilities should be ensured while sanctioning NEE centers.
2. Teachers should be oriented to impart MCH and reproductive health education to the girls.
3. Vocational component of non-formal education should be incorporated.
4. Timings of the centres should be accommodated as per the requirement of the students.
Table 6.8. Infrastructure facilities at the Centers
Particulars
________
Demand for admissions
Adequate Staff position
( All sanctioned posts are filled)
Age of the beneficiaries
Up to 10 years
More than 10 years
Adequacy of rooms
Single room
__________ More than one room
Cross ventilation available_____
Electricity available___________
Toilets available______________
Satisfactory Cleanliness of toilets
____ ( Cleaned every day)______
Availability of clean cooking
Space
________________
% Institutions
58,3________
100%
87.9
12.1
75%
NIL
50.0%
33,3%
50%
41.7%
66.7%
Particulars__________________________
% Institutions
Adequacy of qualification of teacher ( If 100%
more than Higher secondary)
135
No. of schools with professionally qualified
teachers____________________ __________
Satisfactory teaching methods____________
Satisfactory use^of teaching tools__________
Satisfactory approach in educational methods
Flexibility of procedures
Curriculum____________________________
Provision of other facilities
Lunch
School uniform
Books and other educational
Materials___________________________
Improvements suggested
Water supply
Toilets
Waste disposal
School meals______________________
No of teachers feeling need for Health
education in the school_____________
Opinion of teachers about priorities
1. Environmental & personal hygiene
2. Menstrual hygiene
3. Nutritional health______________
Opinion of teachers for scope for
improvement through teachers training
66.7%
91.7%
83.3%
91.7%
75%
100%
8.3%
75%
41.6%
58.3%
58.3%
58.3%
75%
81.8%
9.1%
9,1%
83%
136
6.5.
CRECHES
6.5.1. Background
Operating creches for the children of working mothers in slum areas was one of the
innovative schemes taken up under the project, which was implemented through NGOs. The
ultimate aim of running these creches was to provide suitable care to the children of the working
mothers. Also through the programme as a spin off benefit the mothers were educated about
MCH and F.P. aspects.
The objectives envisaged under the programme were:
a) To provide care to children of working mothers during their duty hours.
b) To improve the health status of the children by providing supplementary' nutrition.
c) To provide complete immunisation to the children.
d) To spread the message of small family norm to the parents.
e) To increase the demand for family welfare services amongst the parents.
f) Promote the health status of women by developing linkage with the health centre.
6.5.2. Methodology adopted for the Review
A random sample of 15 out of the 33 creaches were selected and reviewed to assess the
activities of the creches, the quality of services provided by the Creche and its usefulness to the
working mother. A predesigned and pretested questionnaire containing questions related'to the
quality of services was administered to the teachers of the creches. Another questionnaire was
administered to the mothers of the children to assess other objectives related to the parents. The
sample for this consisted of 150 mothers, 10 mothers randomly selected from each creche. A
sample of another 150 mothers randomly selected from the 15 slums, whose children were not
attending the Creche were interviewed to compare the impact of health activities undertaken in
creches.
6.5.3. Findings of the Review
a. Demand for the Creches
The project envisaged establishment of 50 creches in different slums of Bangalore by the end of
the project period, out of which 33 creches have already been established. 3 creches were
137
established in 1995-96, followed by 11 in the subsequent year 1996-97 and 19 during the year
1997-98 (Table 6.1).
All the Creches had good demand for admission of children. 60% of die creches had
enrolled optimum number of children (25 children). The group of the children enrolled varied
between 2 to 6 years.
Even though the main objective of establishing the creches was to cater :o the needs of
the working mother it was found that only 76% of the children were of working mothers and the
remaining were of housewives. One of the reasons may be that only 73% of the teachers knew
the correct criteria for selection of the child for enrolment.
b. Infrastructure facilities
Staff position in the all the creches was found to be adequate with al’, the sanctioned
posts filled up. However the continuity of the workers was not satisfactory as or.y 73.3% of the
staff were working in the same creche for the last two years. Only about half at the (53.2%).
Caretakers were professionally qualified with Balsevika or Child development training.
Majority of creches were accommodated in single rooms (86.6°b) and about hair at them did not
have the recommended space for accommodating the children (46.7%).
Ventilation and natural light facilities were available in only 60% to 80% of the creches. Toilet
facilities were glaringly lacking in nearly half of the institutions (46.5%) and children used the
roadside for their needs. However, the toilets wherever existed were by and large clean (86.6%).
Supply of potable water was generally available in all the creches either with own tap / hand
pump or nearby public tap. However, only 73.4% were storing the drinking water properly in
container with lid or water filter.
In majority of the creches the cooking area was clean.
Availability of mats for children to sit and sleep was very poor in most of the creches
(33.3%). In most of the creches the number of children per mat (medium) was more than 5.
There were no cradles in any of the creches.
Play materials like toys, puzzles, buildings blocks, clay models, drawing materials etc. which
were required for physical and mental development of the child, were available in only 53.5%.
Outdoor playing space was inadequate in more than two thirds of the creches.
138
Only 13.3% of the creches had first aid box with essential medical kit and only 26.6% ot
the caretakers were trained in first aid.
c. Health Activities at the Creches
In most of the creches (80%) health checkup camps were held regularly once in 3 months
where screening for growth, hearing, eyesight dental health and symptoms of childhood diseases
like ringworm, malaria were checked up. However health cards were available in only 46.6% of
the creches. Almost for all the creches (93%) referral health center were within a walkable
distance.
Since one of the aims of the creche was to promote F.P methods amongst the mothers,
the percentage of mothers who have accepted F.P methods was quite satisfactory (72.7%). In
almost every creche mothers meetings were held regularly once every month where different
topics on family welfare like age at marriage, small family norm, childcare, nutrition, family
planning methods are discussed. Awareness of mothers on causes and prevention ol HIV/AIDS
was satisfactory (80%) (Table 6.9).
d. Impact of Health activities at Creche on mothers
The health activities conducted in the creches such as mother’s meetings etc. have
influenced the knowledge and practices of the mothers. Even though there was no significant
difference between mothers of creche and non-creche beneficiaries on knowledge on legal age at
marriage, higher proportion of creche beneficiaries were knowledgeable about spacing methods
for F.P. Even the adoption of these spacing methods for F.P. was higher with creche
beneficiaries. Knowledge on HIV/AIDS and STD was better with creche beneficiaries. Most of
the knowledge was acquired through Health workers at creches (Table 6.10).
e. Conclusions
a) The creches wherever they were existing have been of much help to the working mother.
There was a good demand for creche at all the slums.
b) Children enrolled in the creches have improved physically, mentally, socially and
nutritionally.
c) The creches have been instrumental in motivating mothers for family planning methods as
well as improving their knowledge on health snd F.P.
d) Basic infrastructure in many of the creches wzs lacking.
139
e) Professionally trained teachers in creches are also lacking.
6.5.4. Recommendations
1. More creches should be started, as there is great demand for it.
2. Since the grant given for creche was found to be insufficient as expressed by many NGOs,
feasibility of increasing this amount should be looked into and an undertaking should be taken
from organisation that they would provide necessary infrastructure and training to the
teachers.
3. The staff of creche should be given periodical training on MCH aspect including STD/AIDS.
4. First aid box should ’ e ^rc\ided in all the creches.
140
Table 6.9. Infrastructure facilities at Creches
Particulars
Demand for more admissions__________________
Adequate Staff position
Care taker
______________Ayas_________________________
Knowledge on correct criteria for the selection of
child_______________________________________
Continuity of the workers in last two years________
Enrolment of children
No. of children < 25
______________No, of children 25
Age & Sex structure of children
2-3 Yrs
2-3 Yrs
4-5 Yrs
______________ >5 Yrs.
Adequacy of rooms
Single room
______________More than one room
Adequacy of space
< Recommended space
______________ > = Recommended space
Cross ventilation available____________
Natural light available________________
Electricity available__________________
Toilets available_____________________
Satisfactory Cleanliness of toilets_______
Satisfactory storage of drinking water
Availability of clean cooking
Good
Satisfactory
______________ Not satisfactory________
Adequacy of mats___________________
Availability of cradles________________
Adequacy of Play materials____________
Adequacy of creative ability materials
Adequacy of indoor playing space_______
Adequacy of outdoor playing space_____
Availability of trained teacher__________
Adequacy of skills of teacher
% Institutions
(n=15)
100%
100%
100%
72.8%
73.3%
40%
60%_________
No. of children
Boys
Girls
54
52
55
68
56
60
10
11
86.6%
13.4%
46.7%
53.3%
60%
80%
66.6%
53.3%
80%
73.3%
73.3%
20.0%
6,6%
' 33.3%
Nil
' 53.3%
' 41%
' 46.7%
' 33.4%
' 53.2%
100%
141
Particulars
Availability of First aid kits with medicines
Availability of Trained teachers in first aid
Regular health check-up___________________
Availability of referral services if child falls sick
Availability of medical records
% Institutions
(n=15)
13,3%
26.6%
80%________
93,3%
46.6%
-
142
Table 6.10. Comparative information from mothers of creche beneficiaries
and non beneficiaries
Particulars
%. Of
%. Of
Mothers
Mothers
of
of
children
children
attending not
Creche
attending
Creche
(n=150)
0=150^
Correct knowledge on legal age of
marriage
Girl
55.3
58.7
___________ Boy
_____________
.29.3
36.7
’ 96.7
Knowledge about preventing pregnancy
98.0
F.P. methods known
Sterilisation- Male
1.3
0.7
Sterilisation - Female
94.0
96.0
I.U.D
73.3
62.7
Oral pills
30.7
39.3
Condoms
__________________
58,7
46,7
F.P. methods practised
70.0
61.4
Sterilisation- Male
Sterilisation - Female
55.3
54.0
I.U.D
5.3
4.7
Oral pills
0.7
2.7
Condoms ______________________
8,7
Couples motivated by Creche stafT for F.P. 4,0
N.A.
Heard about HIV/AIDS_______________
80.7
75.3
Knows AIDS not curable______________
18.2
Nil
Knowledge on HIV/AIDS
_________________
Excel lent/Good
68.6
54.9
Source of information on HIV/ AIDS
Print media
28.9
12.3
TV/Radio
89.3
81.4
Health personnel
62.0
24.8
Others
53.7
35.4
143
Comparative Family Plannng Knowledge of Bemficianes of Creche With
Non Bemficiaries
□ Creche Mother
■ Non Crerche Mother
Male
startization
Female
startizaU on
Oral Pills
Condoms
•U
144
6.6,
INCOME GENERATION ACTIVITIES.
6.6.1. Background
Job oriented vocational training, like Zari and embroidery, knitting, T.V and radio repair,
typing and computer training for adolescent girls and young mother was one of the welfare
activities taken up under the innovative scheme to improve the socio-economic status of the
adolescent girls and young mothers in the slums through NGOs involvement.
The objectives of these activities were:
a) To promote employment opportunity Tor adolescent girls and young mothers in order to
make them self-reliant.
b) To create awareness on small family norm.
c) To create awareness about the Mothers and Child Health services that are available
through Health Centers/UFWCs.
d) To help them to raise their socio-economic status.
e) To train them to spread the MCH and FW messages and services provided through the
Health Centers/UFWCs to the community.
6.6.2. Methodology adopted for Review
wi performance of vocational training
1. Desk review was carried out to review the year wise
Programmes under the scheme.
2. A sample of 78 beneficiaries from different vocational training programmes was selected by
random sampling technique. For the selection of the sample a detailed list of beneficiaries
presently undergoing training in all the five income generation programme namely Zan and
embroidery, knitting, typing, computer training and TV and radio repair were obtained from
the project. However, the list of the beneficiaries who have already completed the course
couldn’t be obtained due to the non-availability of such list. Information on usefulness of the
programme as well as health awareness of beneficiaries was obtained from these
beneficiaries.
A pre-designed and pre-tested Questionnaire was used for the purpose. The investigators,
who were thoroughly trained for the job, interviewed each beneficiary independently to
collect information.
145
6.6J. Findings of the Review
a. Progress of achievements
There was no target set out for the establishment of vocational training programmes in
terms of numbers. The programmes started only in the year 1995-96 with the starting of a Radio
and T.V repair training center. During the year 1996-97, there was some progress in the activity
with starting of six more units, one for Tailoring & Knitting, two for T.V & Radio repair, two
for Zari & Embroidery work for Computer training. Similarly during 1997-98, 17 more units
were added. Zari and Embroidery units were very popular, contributing 14 out of the 24 units
being operated now (Table 6.1).
b. Characteristics and opinion of beneficiaries
There were a mix of all religious groups amongst the beneficiaries, however Muslims
constituting a higher proportion (35.7%).
Age wise majority were adolescent girls aged between 15-19 years (54.8%). Unmarried
girls constituted the majority of beneficiaries (67.1%). Even though majority of the beneficiaries
were from the same locality (86.3%), there were a few from other slums, indicating the need for
starting similar programmes in other slums also.
Majority (98.6%) of the beneficiaries were satisfied with the training programme, and
with the training materials supplied to them (79.5%) (Tables 6.11 and 6.12).
c. Health awareness of beneficiaries
Majority (89%) of the beneficiaries had attended awareness programme on various health
topics which included topics on nutrition, family planning, disease prevention, age at marriage,
environmental sanitation and personal hygiene.
Except for a small proportion of 9% of beneficiaries all had knowledge on legal age at
marriage for boys and girls.
Knowledge on menstrual cycle before its onset was found to be very low (28.7%).
86.3% were knowledgeable about different methods of family planning. 72.6% knew about
tubectomy/Lap, 58.9% about TUD/Copper T, 67.1% about Oral pills and 53.4% about Nirodh..
However, knowledge on vasectomy was very low (27.4%).
Only 21.9% beneficiaries had heard about STD and another 90.4% about HIV/AIDS.
Their main source of information was through print media, 57.7% through health personnel and
146
67.6% through relatives, friends, neighbours, social workers etc (Table 6.12).
d. Conclusions,
1. Among the innovative schemes typing, computer training, tailoring, machine embroidery has a
higher demand.
2. The training centers have been instrumental in propagating health awareness messages
6.6.4. Recommendations
1. The scheme should be extended to all other slums however after a need based survev.
2. Centers should propagate messages on reproductive health to adolescent girls.
V
i
147
Table 6 .11. Socio-demographic particulars of beneficiaries
Particulars
Religion
Hindu
Muslim
Christian
Others____________
Age
< 15
15-19
20-24
25-29
30-34
35+______________
Educational qualifications
Illiterate
Primary
Middle
Higher Secondary
Marital status
Married
Unmarried
Widowed
% of beneficiaries
(n= 78)____________
60.3
35.7
4.1
5.5
54.8
16.4
12.3
4.1
6.8
4.1
2.7
89.1
1.4
31.5
67.1
1.4
r
148
Table 6.12. Details of training programmes and Opinion of beneficiaries
Particulars
% of beneficiaries
(n-78)
Training programme attended
1. Knitting
8.2
2. Zeri & embroidery
64.4
3. Typing
20.5
4. Computer course
4.1
5. T.V & radio repair___________
2,7
Completed the course____________
Nil
Reasons if not completed the course
1. Ongoing
95.9%
2. Waiting for re-examination
f.4%
3. Left the course____________
1.4%
Satisfied about training materials
79.5%
Reasons for dissatisfaction
1. Insufficiency of training material
16.4%
2. Want more design
2.7%
3. More machines for typing______
1.4%
Opinion
on usefulness of training
programme
1. Self employment
46.6%
2. To get job
41.1%
3. Self use
8.2%
4. Uncertain ___________
4.1%
Opinion on changes needed in the training
v
programme
1. No change
52.1%
2. More material
21.9%
3. Tailoring course
11.0%
4. Computer course
8.2%
5. Typing course
8.2%
6. Improved quality of teaching
4.1%
7. Embroidery course________
2.9%
Beneficiaries attending health awareness
programmes
1. None
11.0%
2. Nutrition
87.6%
3. Family Planning
83.6%
4. Child care
76.7%
5. Immunisation
83.4%
6. Disease prevention
83.5%
7. Age at marriage
84.9%
8. Environmental sanitation
82.2%
9. Personal hygiene
80.7%
149
Table 6. 13. Health awareness of beneficiaries
Knowledge about Legal age at marriage
Girl
Boy________
Previous knowledge about menstrual cycle
Source of Knowledge on menstrual cycle
1. Mother
2. Friend
3. Book__________
Appropriate Practice of menstrual hygiene
1. No restriction during the period
2. Taking bath
3. Usage of home made napkins
4. Use of sanitary napkin’s.
5. Source of information
Mother
_______TV.
______________________
Knowledge about preventing pregnancy
FP methods known
Sterilisation- Male
Sterilisation - Female
I.UD
Oral pills
___________________
Condoms
Heard about STD __________________
Knowledge prevention of STD
Excellent
Good
Satisfactory
Poor____________________________
Heard about HIV/AIDS________________
Knowledge on HIV/AIDS
Excellent
Good
Satisfactory
Poor________________________
Source of information on HIV/ AIDS
Print media
TV/Radio
Health personnel
Others
% beneficiaries (n=78')
94.5%
90.4%
28.7%
21.9%
5.4%
1.4%
72.6%
98.6%
82.2%
20.5%
9.5%
11%
86.3%
T
27.4%
72.6%
58.9%
67.1%
53.4%
21.9%
NIL
NIL
50%
NIL
90.4%
24.0%
62.0%
5.6%
8.5%
56.3%
94.4%
57.7%
67.6%
150
PROJECT MANAGEMENT
7. PROJECT MANAGEMENT
7.1.
Background
The Project is directly under the administrative control of Bangalore Mahanagara Palike
(Bangalore City Municipal Corporation). The Commissioner is overall incharge of the
programme. However, for smooth administration the Project Coordinator has been given all the
powers for implementation of the project. A Steering committee at the State level chaired by the
Chief Secretary of Government of Karnataka and another Project implementation committee at
the Corporation level, chaired by the Commissioner, Bangalore City Corporation, guide and
control all the management aspects of the project. While all the pdiicy matters are decided by the
Steering committee, decisions regarding administration and financial matters relating to
implementation aspects of rhe programme are taken by the Implementation committee. The
Implementation committee is composed of, besides the Commissioner of Bangalore city
corporation as Chairman, all the Programme Officers of the Project. The Project Coordinator is
the convenor of the committee. The committee meets periodically and takes all decisions.
The Project Coordinator has the overall responsibility of implementation of the programme and
is assisted by Programme Officers.
7.2.
Meetings of the Committees
Since the inception of the Project the number of meetings held by the committees are as
follows.
Steering Committee
Project Implementation Committee
Year
1994- 95
1995- 96
1996-97
1997- 98
No. Of meetings
2
Nil
2
2
1994- 95
1995- 96
1996- 97
1997- 98
2
3
3
3
The decisions were taken fast bv these committees and have been conducive to the
smooth implementation of the Project.
'\
151
J***''
7
7.3. Staff Position
Besides the Project Coordinator and the programme officers, each unit was provided with
technical and administrative staff for the implementation of activities. The staff position at the
time of present Review is given in Table 7.1.
Many of the personnel were on deputation either from Bangalore City Corporation or
from other Departments of GOK. This has posed some problems of frequent transfers and non
committment from the deputed persons because of uncertainties.
The Project Coordinator, a medical, person, is deputed from BCC on full time from the
Health Department of Bangalore City Corporation. The present incumbent is working on the post
for over an year, subsequent to the super annuary retirement of the previous incumbent.
Further a few of the key posts like Training Officers, Engineering staffs and a Statistician were
vacant hampering the programmes. There is no full time post of Programme Officer for MCH
and FP delivery services and one of the Senior Medical Officers of the Maternity Hospital was
on additional duty. Infact she was transferred recently during the course of Mid term review.
However, her services are continued with the Project on some mutual adjustment basis.
Table 7.1. Staff Position of the project
Category of Posts _______________ Sanctioned
Health Centres
Medical
60
Para-Medical
58
Link Workers_______
970
Referral Health Centres
Medical
14
Para Medical
_________________
106
Training
Technical
5
Others_________________________ ______ 6
I.E.C__________________________ ______ 10
M.LE.S________________________
2
Category of Posts________________
Sanctioned
Programme
Officers
5
Vacant
12
18
236
6
20
2
___ Nil
____1_
Vacant
Nil
152
Additional Posts
Civil Works
Accounts
MLLES.
Women Development
21
3
4
28
9
1
1
12
7.4. Procureiiient & Logistics of Supplies
The purchases in the Project for equipment, medicines and supplies were done through a
Project Purchase committee, which meets as per requirements. The supplies are procured on the
basis of tenders.
The FP supplies viz. IUDs, Oral pills and Nirodh etc. and Vaccines, ORS, Vitamin A were
procured from the State Family Welfare Bureau on quarterly basis and stored at the City Family
Welfare Bureau of BMP at Dasappa Maternity Home. On quarterly basis, based on the indents
obtained from the Maternity Homes/U.F.W.C’s/NHC’s these were supplied to them from the
BMP stores.
The general drugs required for IPP VTII Health Centers were procured through public
tendering (through leading News papers) annually and stores at the IPP VIII stored at a central
Stores of the Project presently located at the Training centre, Malleswaram. These were supplied
to the health centers on quarterly basis on indent received from them. The BMP/IPP VIII vehicles
were used for transportation. There was no regular Warehouse building for the Project.
Generally in most of the Centers steel cupboards were not available to ensure proper
storage of the supplies. Besides there were at times inadequacy of supplies of ORS, vitamin A,
IFA (adult). However, generally there were no problems in the supply and logistics of FP supplies
and general drugs under the Project.
The procurement of equipment done during the project period is given in Table 7.4. Most
of the equipment required for the Centers already established have been procured except for
furniture.
153
Table 7.2. Year-Wise Cumulative Performance of Procurements
Cumulative Performance
Items of Equipment and Furnishings
Target
1994-95
1995-96
1996-97
1997-987
MIS Equipment
Computer System & Software
1
1
Ups-2 Hrs Backup
1
1
Photo Copier
1
2
Duplicator
1
1
Typewriters
1
Electronic Typewriter
MCH Care Equipment
Health Centres
97 Sets
29 Sets
24 Sets
17 Sets
Referral Centres (Upgraded
Maternity Homes)
Paediatric Centres
10 Sets
Laboratory Equipment for MHs
17 Sets
Pharmaceuticals for:29+17
Health Centres & MHs
Vehicles
Admn/MIS(Car)
1
Training Centre (Mini Bus)
1
EEC
4
Referral Centres (Ambulance)
12
Health & Ref. Centres (Tippers)
4
1
1
1
1
1
1
7
4
Furniture
Existing Health Centres
37 Sets
New Hlth. Cen. To Be Constructed
60 Sets
Referral Centres (Upgraded M.H.)
25 Sets
Admn/MIS
1 Set
1
1
EEC
1 Set
1
1
Training Centre
1 Set
1
2 Sets
154
7.5. Management Information System
The Project has a Management Information System Unit headed by a Demographer with
long years of experience, deputed from Department of Statistics, GOK. He was to be assisted by
another Statistician, but the post is presently vacant for nearly a year. Recently the Unit has been
provided with additional posts of Computer operators. The unit is well equipped with Computers
and Accessories.
The unit has developed a system of monitoring of Project activities directly undertaken
by them such as IEC, Training, Civil Works and Innovative Programmes. These reports were
received and compiled monthly. However, for another important component of Service delivery
through Health Centres, the reports were received and compiled at Dasappa Maternity Home
managed by Bangalore City Corporation. This reporting and qpmpilation was supervised by the
Programme Officer for MCH & F.P., who had no special training in MIS management. These
compiled reports were forwarded to MIS Unit of the Project. The reporting formats although
confirmed to the Government of India requirements did not completely reflect the Project
activities.
Recently an attempt has been done to integrate and improve upon the system through a
Consultancy work carried on by M/S General Automata Pvt. Ltd., Bangalore.
The objectives of this Consultancy were:
• To develop direct and indirect indicators for monitoring of the project activities.
• To establish baseline indicators through a Multi Indicator survey.
• To develop suitable monitoring formats and test them in the field.
• To develop software for processing MIS informafibft Collected through the above
formats.
• To train the staff in the use of above software.
The Consultancy was awarded in September 1997.
The tasks accomplished by the Consultants till date were:
a) Development of Baseline Indicators through a Multi Indicator Survey.
b) Development of Indicators for monitoring.
c) Development monitoring formats.
d) Development of software for processing of MIS data.
155
The Consultants have yet to field test the software developed by them and then to train
the staff for the use of the same.
Even though the pace of work by the Consultants was rather slow, they have now
committed that they would complete the task by the end of July 1998.
Regarding monitoring of Project activities, it seems that no formal meetings were held
every month with the Medical Officers I/C of Health Centres to review the performance on the
basis of the reports.
The MIS Unit has compiled some interesting reports on Status of Girls’ Education.
The Unit has.also brought out periodical status reports on the Project.
7.6. Flow of Funds
The project funds are received by Government of Karnataka from Government of India
and then to the Project.
FLOW OF FUNDS
WORLD BANK
G.O.I
G.O.K.
90%
+ 10% SHARE
IPP-VIII
The status of receipt of funds till now and released at various levels is given below
156
expenditure for the remaining period of tire project was discussed in the Review meeting of the
Project with GOI and World Bank Officials. The same is presented in Table 7.7.
It is estimated that the prelect would require an outlay of Rs.3831 lakhs in the remaining
period of execution to undertake all envisaged activities. This amounts to an additional
requirement of Rs. 1260 lakhs for the project.
Recommendations
1 Ensure retaining deputed persons on various Posts till the completion of Project.
2. Additional posts sanctioned are to be filled up immediately.
3. Project Co-ordinator to be assisted by a technical Consultant in Management tor
speedy implementation of Management aspects.
4. Expenditure position to be improved by speeding up Civil Works.
158
Table 7,4. Expenditure Performance As On March -1998
SI
No.
CATEGORY
TOTAL
PROVI
SION
2 Civil Works______________
2 Civil works
2
n
I
_2
2
4
5
6
Departmental charges
TOTAL;
Procurement (Goods &
Services)
~
hmiiliiic
Equipment
Vehicles
Books/IEC material
MCH/IWmateriais
I
und Medicines
_________ TOTAL;
III Training & Consultancy
1 Local Trg (TA & DA
allowances)_______________
2 Local Consultancy
3 Contract of Innovative Scheme
4 Professional fee of Architect
~
TOTAL;
IV Operating Costs
Salaries of Additional Staff
2 Honorarium to Voluntary
workers_______
3 Rent
4 O & M of vehicles
5 O & M of others
1994-95
1995-96
PROVI
SION
EXPENDI
TURE
951 92
114 24
1066.16
529 13
63 49
592.62
11 91
87 24
202.27
16897
84 64
76 14
240 JO
859.54
58 87
133 86
125.15
1.28
17_22_
0 68
31 90
104 53
471.56
1 63
0 01
3.6
31 90
104 53
471.56
77.38
25.42
0.42
25.42
82 09
756.47
28 55
944.41
27 75
76 18
20 84
150.19
629
0 10
5.86
12.67
27.75
76 18
20.84
569.56
203 43
62.62
8 04
7.49
16.20
12.00
26 68
1042
109.34
17.91
109.34
132171
4164
132371
J52.09
110 09
TOTAL:_____1051.37
392148
GRAND TOTAL COST
3 55
15.46
1996-97
PROVI EXPENDI PROVI EXPEN
SION
TURE
SION
TUR
529 13
63 49
592.62
6 07
3^90
402 30
27 00
429.30
300 9
6.30
307.2
3 50
40 OO
3 98
3.59
95.30
72.00
50.66
62 60
300.60
40 7
19.0
17:6
14 9
29.4
125.8
1.80
28.90
5.15
82 60
20 07
Tso. 19
4 75
0.29
6.84
62.62
8.04
0.28~
58 87
133 86
125 15
<97
2212
LL22
1 97
2 43
30 70
3.61
111.50
28.83
85 go
27.30
38.18
7.40
46.30
<79
041
15.71
158.60
50.78
83.18
1000.00
5117
12.00
26 68
Table 7.5. Component Wise Expenditure Analysis
Year
Civil Work
1994- 95
1.55
1995- 96
1.00
1996- 97
30.72
1997- 98
25,90
Total_______
59,17
AVERAGE
1.23
MONTHLY
EXPEND ITU
RE ( Since
Inception To
March 1998 )
Average
Monthly
Expenditure
1994- 95
0.13
1995- 96
0.08
1996- 97
2.56
1997- 98
2.16
Ratio Of
Average
Monthly
Expenditure to
previous year
95- 96
0.65
96- 97
30.72
97- 98
0.84
Procure
Ment
0.36 ~
5.07
12.59
20.70
38.72
0.80
! 1.27
I 0.68
j 2.88
! 8,95
I 13.78
0.29
_____ Unit Rs, n Millions
Operational
Cost________ Total
1.79________ 4.96
1,57________ 8.32
5.09________ 51.27
14,95_______ 70.51
23.40
135.06
0.49
2.81
0.03
j 0.11
0.42
1.05
1.73
0.15
0.06
0.24
0.75
0.13
0.42
14.08
2.48
1.64
0.54
4.24
3.11
Training
0.41
0.69
1.25
4.27
5.87
0.88
3.24
2.94
6.16
1.38
1.68
160
Table 7.6 EXPENDITURE PERFORMANCE ANALYSIS AS ON MARCH -1998
Cumu
1996-97
Cumu
1995-96
1994-35
Total
Category
lative
expend
upto
lative
expen
provision expen
upto
iture
1995-96
diture
diture
for the
1996-97
project
period
307.26
9.97
15.46
1066.16
Civil
1997-98
259.00
Total'
expen
diture
from
inception
591.69
24.3
207.03
55.5
387.15 •
expen
diture
Works
%
Utilisation
Procurem
ent &
Supplies
859.54
0.9
50.66
2.4
28.8
125.86
31.2
■
%
Utilisation
Training
1.50
3.6
5.9
6.84
6.4
14.60
28.83
21.0
944.41
0.4
12.67
24.1
89.53
45.1
137.87
0.7
15.71
2.00
3.1
50.78
5.1
1051.37
1.3
17.91
9.50
149.49
14.6
233.89
1.5
83.18
3.2
4.8
8.0
14.2
3921.48
1.7
49.64
705.05
22.2
1350.60
1.3
2.0
3.3
18.0
34.4
&
Consulta
noy
%
Utilisation
Operating
cost
%
Utilisation
GRAND
TOTAL
%
512.73
13.1
16.4
Utilisa
tion
161
Table 7. 7. Realistic Estimates of Budgetary Requirements for the Next Three Years of Project
Category
Total provision
Total
Balance
including 35%
Expenditure
available
contin-gency
till March
Anticipated expenditure / shortfall
1998
Civil Works
1998-
1999-
2000-
Total requ
1999
2000
2001
for 3 years
490 98
998.02
146.00
1635.00
474.47
49098
998.02
146.00
1635.00
30.03
57.22
40.00
27.00
67.00
202.27
99.58
102.69
180.00
70.00
250.00
Vehicles
168.95
100.00
68 95
25.00
25.00
25.00
75.00
IEC Materials and Activities
84.64
46.46
38.18
18.18
1000
10.00
38.18
MCH & FW Materials
76.14
53.66
22.48
50.00
50.00
50.00
15000
Drugs and Medicines
240 30
57 42
182 88
60 00
55.00
55.00
170 00
Total
859.55
387.15
472.40
373.18
237.00
140.00
750.18
Training Activities
77.38
13 26
64 12
25 00
25 00
25 00
75 00
Local Consultancies
82 01
15 54
66 47
35.00
30.00
40.00
105.00
Contract for Innovative Schemes
756 47
85 84
67063
72.74
72.74
65.73
211 21
Professional fees- Architect
28.55
23.23
5 32
15.00
30.00
4.5
49.5
Total
944.41
137.87
806.54
147.74
157.74
135.23
Civil works
951.92
552.90
399.02
Departmental charges
114.24
38.79
75 45
Total
1066.16
591.69
Furniture
87.25
Equipment
Procurement
(Gooch & Services)
Training & Consultancy
440.71
Operating Cost
Salaries of additional staff
569.56
175 32
394 24
230.00
250.00
260.00
740.00
Honoraria for Volunteers
203.43
32 65
17078
40.00
50.00
50.00
140.00
162
15 21
0 99
O& M of Vehicles
152.09
10.71
141 38
25.00
25.00
25.00
75.00
O& M of others
110 09
110 09
20 00
15 00
15.00
50.00
Total
1051.37
233.89
817.48
315.00
340.00
350.00
1005.0
GRAND TOTAL
3921.49
1350.60
2570.89
1326.90
1732.76
771.23
3830.8
Rent
Budget available including price contingencies
= 3921.48lakhs
Anticipated shortfall for realistic estimate of budgetary requirements = 1260.00 lakhs
Estimated cost for proposed 5 no. Maternity Homes in peripheral
areas of Bangalore city
= 475.00 lakhs
Total revised estimate cost for the project
= 5656.48 lakhs
AN OVERVIEW
of
PROJECT IMPACT
8. AN OVERVIEW OF PROJECT IMPACT
8.1. Background
The project has been in operation for the last three years. Different interventions have
been undertaken to attain the project activities. An attempt is made here to assess the impact of
these interventions.
8.2. Methodology adopted for assessment
A baseline survey was conducted in 1992 as a pre- Project activity and certain indicators
of MCH and F.P. were worked out which formed a basis for Project formulation. Again in 1997
a Multi- Indicator study was undertaken to work out certain direct and indirect indicators for
assessment of situation. The indicators worked out in these surveys have been used here for the
assessment of the impact. In 1997 survey a large number of indicators were covered which were
not done in 1992. For such indicators comparison is based on NFHS data for rural and urban
areas. The comparison with rural areas seems to be more appropriate as most of the slum
dwellers had migrated from Rural areas and Urban area data takes into account all sections of
the society.
83. Findings of Evaluation
The comparison of indicators suggest that there were substantial impact on vanous
aspects of MCH and F.P. in the community may be due to Project interventions. The details of
these improvements are highlighted below.
Nuptiality
The mean age at marriage for girls had improved and was presently 16.86 years as
compared to 16.29 years in 1992. But in comparison to rural population of Karnataka this figure
was lower (19.0). However, the mean age at marriage for the control group of 15-19 years, was
16.39 years.
1A4
The proportion of women currently married in the age group 15-19 years also indicated an
improvement in the age at marriage of girls (41.1%) as compared to a previous proportion of
59.9%. The proportion was almost similar to rural areas (41.9%).
Percent currently married
women in the age group 15-19
Yrsi
59.90%
60.00% 50.00% 40.00% 30.00% -
a. 20.00% 10.00% -
I
Ii
41.90%41.1Q%:
26.70%
s I
_i_
Sa
0.00% -
Is I
TS
|
.-•-'J
4
&
a>
Periods
Fertility
Jhe decline in fertility has also shown an improvement in the area. The present general
fertility rate was 87.0 as compared to 119 of NFHS for rural Karnataka. No similar figures are
available for 1992. The Total Fertility rate has also declined to 2.53 from a level of 3.37 in 1992.
Even on comparison with rural data the decline is significant (3.07). A similar trend is reflected
by the Crude birth rate also. Present CBR in the area was 22.9 as compared to 31.9 in 1992 and
27.5 for rural Karnataka.
The age specific fertility rate has shown a marked decrease in all the prime child bearing
age groups and especially in the important age group of 25-29 years with a decline to a level of
0.0975 from 0.1907, (a decline of 49%). Similarly it has declined to 0.2727 from 0.2742, though
marginally, in the age group 20-24 years.
1RE
General fertility rate
Total fertility rate
K
3.37
3.5 r
3 -- «
25
2
1.5 - •,>V
1 - ■i
0.5 - S1
0 in S
H a>
CO
119
120
3 07
Z34
f
9 I I
I
0 i
a:
I
60 40 -
-
20o J—I
+
+
hFHSUrban
o>
a>
£t
87
80
’9
23
89
100 -■
2.53
+
hFHSRurai
1
1997
Periods
Periods
Crude Birth Rate
CB
X
35 p 31.9
30
25
20
15 10
5
0 -
27.5
aa
22.7
f
-
w
■
S CM
in cn
H a>
<0
g §
^5
22.9
i If
t
£1
I
o>
Periods
1RR
Age specific fertility rates
0.3
Ji fll J~
□ 15-19Yrs.
■ 20-24 Yrs.
S7H41992
NFHS-utan
M^HS- Rural
1997
□ 25-29 Yrs.
Periods
Natality
There was no impact of the programme in reducing early pregnancies in the area. The
percentage of women with pregnancy before the age of 18 years was 58.4%, much higher than
the Rural Karnataka figure of 20.2%.
The length of open birth intenai in the area was 30 months, almost similar to rural
Karnataka figure of 29.9 months.
Lengtti of open birth interval
30
*
£
c
o
Z
30 29.98 29.96 29.94 29.92 - 29.9
29.9 29.88 29.86 29.84 ■NFHSUrbari
1
29.9
f
rFHSfajral
gS'
1997
Period
1A7
Knowledge on Family Planning
The awareness on prevention methods for pregnancies has gone up from 64.6% in 1992
to 96.3% in 1993. The knowledge especially for spacing methods have gone up substantially
Knowledge of FP methods
::|L a
J,
100 n------------------------------------------------------------------------ - --------------c
-?o
5
u
0
Q.
“ | |1 T--J1 If
dllB MIm II
NFHS-Urban
M=HS-Rural
Periods
1997
i
Total
■ Fem Stef
KJD
Rte
■ Condone
Vasect
Couple protection rate
There is substantial increase in the couple protection rates from 39.9% in 1992 to 57.0%
in 1997, an increase of over 42%, effecting a decrease of fertility rates as already indicated.
The method specific rates for spacing methods have also increased over the period. The
increases are irrespective of religion and the rates are similar amongst all the major religions in
the area. The contribution to the couple protection rates are more from the older women and
with over second parity, which suggests that programme has to be concentrated more on younger
couples. Still there was an unmet demand of 34% for family planning, of whom about 13% can
be immediately motivated for adoption of some F.P. method if concerted efforts are made by the
Project. The percentage of unmet demand is comparable to the figures of Karnataka state as a
whole (33%, NFHS, 1992).
16R
Couple protection rate
60 ---------------------------------------------------------------------------------------------
<A
50
Fl
'"I
“a.
. h
I
"I
0!l
II
I
I LLL
__11
STB^I92
'i
rB I ■ -If-n_
^HS-U 'FHS-R
1997
Perioas
□ Total
■ Fem. Ster.
□ HJD
□ FWs
■ Condoms
Antenatal care
The proportion of mothers who availed antenatal care increased to 95% in 1997 from
71% in 1992. These rates are much higher than the rural figures of NFHS.
Similarly coverage for T.T. immunisation during pregnancy also increased. The
proportion of non immunised mothers came down to 7.6% from 28.0%.
However the proportion of mothers consuming IFA tablets during pregnancy (45.7%) was
lower than rural Karnataka (73.5%).
1AQ
. Antenatal care
100 -T90
71
80
70 60 50 40t
30.
o
z
<
£
±2
$
O
2
95
82.7
II II
1
s®
J t
Q.
20 410 X li
.Ji
0
i
£s XI h
is
Q.
co
o>
z K
Periods
Antenatal women consuming
atieast 30 IFA tablets
Prog, without TT
immunisation
•S'
30 .
78.4
28
80 p
70 60
£ 50 -
25
W
20
3 15
a.
10
5
0 -
17.4
I I
jjsi
£s
h £
.1 1
co
r 3
3 40
7.6
ffl
I 30 -
z
Period
20
10 0 -
73.5
i'
w s
8
J
NFHSUtban
.
NFHSRurai
45.7
i
1997
Period
Natal service
There were still 14.5% home deliveries in the area which is a matter of concsm, even
though this percentage has reduced over these 5 years.
The postnatal check up has also gone up with the mothers from 20.4% to 305% but still
far below the desired levels.
170
Home deliveries
37.9
40 y
35
«
£
a.
~
8
30
25 20 15 10 -5 -0 -
Postnatal Checkups
23.1
14.5
>
!
I
>
35 r
30
25 -
■6
“
15 -
o
aj
10 5 -0 -
<A
<U
NFHSU&R
Period
1997
I
20.4
t 20 -
o.
STB/I
92
3Q5
IM
■
•'■“I;*
1997
S7H4
92
Period
Child care
Very large proportion of mothers breasted their children within one to two hours from
delivery (53.2%) as compared to mothers in rural areas (3.8%). But still this proportion needs
improvement.
The weaning patterns have not changed from rural areas as only 77.7% mothers weaned
their infants after six months.
The severely malnourished amongst underfives was about 24%, proportion being much
lower than rural areas (57.3%).
The diarrhoea episode management amongst underfives was also better in the area in
comparison to rural areas as 51% episodes were administered ORS as compared to 39.6% in
rural areas.
171
Newborns breastfed within 1-2
hrs.
Under Fives severly
malnourished
60
♦J
50
60 -
40
50
20
10
0
47
<9
9.3
2<9 30 -
o.
a
3.8
NFHSUrban
NFHS-
20 T
101
0 -L-
1997
+
NFHSUTban
Rjrai
Period
■fe
B
40 -
s9 30
Q.
57.3
NFHSRurai
I
24
j
1997
Period
Diarrohea amongst under
Fives administered ORS
50
SO -
42
39.6
40 '
3 30
CL
32 •0 3
ll
M=HSUTban
ft
fc
M=HSRural
1
+
1997
Period
General conclusions
The impact of the programme is appreciable in the areas of MCH and F.P. The
targets set forth for the projects are on the way for achievement. However educational
programmes on age at marriage, propagation of spacing methods amongst young couples,
motivation for institutional deliveries and service programmes on diarrhoea management,
nutritional supplementation to underfives should receive priority attention.
179
Table 8.1. Comparative Coverage Evaluation Statistics
Indicators
At the start of the Project
Proportion of currently married
women in the age group 15-19
years_____________________
Mean age at marriage________
Crude birth rate____________
General fertility rate_________
Total fertility rate___________
Age-specific fertility rates
15-19 yrs
20-24 yrs
25-29 yrs
% women with 1st pregnancy < 18
yrs________ __________________
% Women with over 3rd parity for
last pregnancy
Mean parity of last
Pregnancy_________________
Length of open birth interval_____
% Women with knowledge of
F.P.. methods (spontaneous)
Knowledge of female sterilisation
I.U.D
Oral pills
Condoms
Vasectomy
At 1997-98
STEM
Data
( 1992)
59.9%
NFHS (1992-93)
1997 Survey
MIS
Urban
26.7%
Rural
41.9%
41.1%
16,29
31.9
3.37
20.8
22.7
89
2.34
19,0
27.5
119
3.07
16,9
22.9
87,0
2.53
0.0961
0.2742
0.1907
0.094
0.169
0.127
0.147
0.226
0.138
0.0829
0.2727
0.0975
13.0%
20.2%
58.4 %
19.3%
26.7%
32.3%
3.0
64.6%
19.8%
17.9%
12.2%
13.4%
29.9
91.6%
29.9
85.5%
30 Months
96.3%
87.0%
61.8%
60.0%
47.0%
56.0%
82.8%
41.2%
39.1%
19.5%
47.1%
92.5%
49.8%
62.4%
27.7%
1.6% (NSV)
17^
Table 8.1. continued
Indicators
At 1997-98
At the start of the Project
■ STEM
Data
( 1992)
Couple protection rate- total 39.9%
Female sterilisation 36.1%
Oral pills 0.8%
LU.D. 1.6%
____________________ Condoms 0.5%
Couple protection rates by
Religion
Hindus 42.3%
Muslims 33.6%
____________________ Christians 37.8%
Age-wise contraceptive rate
15-29 yrs
____________30-<- yrs_________
Parity-wise contraceptive use
NFHS (1992-93)
Urban
55.8%39.5%
5.6%
14.6%
7.4%
Both Rural
& Urban
48.8%
35.9%
39.3%
Rural
47.7%
41.8%
2.4%
5.7%
2.5%
71.0%
28.0%
23.1%
20.4%
57.0%
48.9%
5.1%
2.6%
1.5%
56.5%
58.3%
59.6%
49.1%
72.8%
0-2 parity
____________ 2+ parity_______
% Antenatals with ANC________
% Starting anc in first trimester
% Antenatals hadnoT.T,.______
% Antenatals consuming > 60 IFA
tablets__________________
% Home deliveries_____________
_____
% post-natal check-up
% New-borns breast fed within 12 hours of birth_______________
Weaning after six months
1997 Survey
MIS
87.9%
45.3%
17.4%
78.4%
82.7%
47.6%
26.0%
73.5%
37.9%
37.9%
9.3%
3.8%
79.2%
Rural &
Urban
35.0%
75.0%
95.0%
61.5%
7.6%
45.7%
14,5%
30.5%
53.2%
77.7%
174
Table 8.1. continued
Indicators
At the start of the Project
At 1997-98
STEM
Data
( 1992)
1997 Survey
MIS
NFHS (1992-93)
Urban
47.0%
Weight For
Age <2 SD
% Underfives severely
malnourished
( MAC <12.5 cms) ________
% Diarrhoea cases with reduced
food intake_________________
% Diarrhoea cases with reduced
10.8%
fluid intake_________________
% Diarrhoea cases administered
42.0%
ORS____________________
% 0-23 Months children
immunised with
3 doses of
DPT
73.3%
73.3%
Polio
Rural_____
57.3%
Weight For
Age <2 SD
24.0%
44.7%
11.1%
30.0%
39.6%
51.2%
69.6%
70.6%
82.3%
79.4%
175
SUMMARY OF FINDINGS
RECOMMENDATIONS
9. SUMMARY OF FINDINGS AND RECOMMENDA TIONS
9.1. CIVIL WORKS
a. Findings
♦
The staff working on the Civil Engineering unit were on deputation either from
Bangalore City Corporation or from Public Works Department of GOK. However there were
some vacancies through out the project period.
There were considerable delay in all the activities starting from the acquisition of land to
issue of work order. The first work order was issued only after 24 months from the initiation of
the project. The time taken from approval of drawing to issue of work order varied from 15 to 28
months. The average tender participation varied from 1.75 to 3.19 with number of bidders
varying from 11 to 20.
Generally the actions taken for the quality assessment of works were as per
specifications. However there was no documentation of the modifications done at job sites or for
permission to go ahead with concrete. Check lists for taking over of buildings from contractors
were not available and only inventory list was prepared. “As built drawings” of plumbing and
sanitary and Electrical works have not been prepared.
Generally the quality of construction was satisfactory. The quality of general works like
brickwork, plaster, painting, flooring were satisfactory. The quality of form work and concrete
for columns and slabs were also satisfactory and the sample cubes for concrete were taken form
all the work spots. The sanitary fittings in all the units were found to be in working condition.
Some ofthe Deficiencies observed:
The Form work for lintel, lofts and sides of beams was not satisfactory. Providing of
cover to reinforcement was also not satisfactory.
Regarding sanitary fittings, there were changes from the drawings like change of position
of sinks, provision of floor traps at inappropriate places.
17A
Certain basic tests were not done in connection with the sewage, waste and G.L pipelines
for pressure.
Even though the Electrical work was generally satisfactory, there were some deviations
from drawings, in numbers and position of the fittings, particularly in Maternity Homes.
Even though field assessment of quality during execution revealed that they were
generally satisfactory, there were deficiencies in the works for earth filling, soking of bricks,
brickwork reinforcement, plumb lining in brickwork, internal plastering, cover to reinforcement
of lintels and lofts, filling of trenches, bitumen painting of concrete surfaces in contact with filled
up soil and bonding for subsequent pour of concrete.
Realistic Estimates for completion of Civil works would be as follows:
Health Centers
For 30 units where work is in progress :
For 13 units where work is expected to start by July-98 :
June-98 to March-99.
September-99.
Staff Quarters
For the 3 units, where work is expected to start by July 98 :
June-99.
Training Centre
Work is in progress and completed up to plinth level, the scheduled completion is December-99.
Renovation of Existing UFWCs
For 4 units where work is in progress and are in the finishing stage: 15lh July 1998.
For 7 units for which tender evaluation is in progress,
work is expected to start from August-98:
August-99.
Hi.
For 5 units tenders are expected to be notified by July-98 and
the work is programmedfrom:
Jan-99 to Dec-99.
iv.
For 5 units for which drawings are to be prepared is expected
from June to August 98. Notification for this is being planned
in October-98 and the programme for work is:
March-99 to March-2000.
Renovation of Existing Maternity Homes
For 2 units for which work is in progress and are in finishing stage:
Juiy-98
For 8 units for which tender evaluation is in progress, work is
expected to startfrom July-98
June-99.
For 4 units tenders are expected to be notified by July-98 and
the work is programmed
Jan-99 to Dec-99.
For 5 units for which Architectural drawings are to be prepared
is expected by Aug-98. Notification for the same is being
planned in October-98
March-99 to March-2000.
i.
ii.
177
Taking into consideration a cost escalation of 182% as indicated in the revised tenders
and on discussions with the Project Coordinator, Programme Officer of Civil Works and the
Architect ,the Realistic Cost Estimate for Civil Works would be Rs 2227.00 lakhs.
As on date, no maintenance work has started. As the buildings require some maintenance
it is suggested to provide maintenance amount to be controlled by LMO.
b. Key Recommendations
1. Provision of one Engineer exclusively for planning activities and follow up with Architect
and Consultants.
2. Strict adherence to drawings and specifications
3. Proper supervision and pour cards for concrete work Form work for plinth
beams, lintels, lofts and external sides of roof beams to be checked for supports
and gaps
4. Modifications to be done only after written instructions of the Architect
5. Engaging services of consultants for quality control
6. Project overall construction programme indicating identification of site, approval of
drawings, estimate, tender notification and evaluation and time frame for construction to be
prepared and monitored every month.
7. All modifications, sites instructions for quality and permission for concrete and other
activities to be documented.
8. All tests to be carried out as per specifications and documented.
9. Check list for taking over buildings from contractors to be prepared and shall be signed by
P.O, only after which the building to be handed over.
10. “As built drawings” to be prepared and preserved properly.
11. The notification for tender to be given in all leading local and national news papers in local
language and English.
11. Tenders to be re notified in case of lowest bid rates being higher than 25% of sanctioned
estimate
9.2. Maternal & Child Health and Family Planning Services
a. Findings
Few posts of Medical Officers were vacant affecting the programme performance.
Further
staffs
were
on
deputation
from
BCC/State
Govt,
and
were
less
motivated/committed/interested in work aggravated by frequent transfers of deputed staff.
A few changes were made in the activities of the Centres and also in the job
responsibilities of ANM and Link workers (field staff) from the original project proposals which
were smoothly implemented.
-!7ft
The proportion of beneficiaries attending the centres from the slums was 41%, majority
of whom visited for MCH services and a few for F.P services. The waiting time for services was
about 25 minutes on an average, ranging from 5 to 60 minutes.
The FP performance had been consistent for sterilisation (female) and IUD but were not
so for spacing methods of oral pills and condoms. The male participation (vasectomy) was
practically nil.
Though ANC registration was improving there was considerable drop in the proportion
of deliveries conducted in Government institutions.
The general physical facilities like “waiting area” “drinking water” facilities needed
improvements. The OPDs needed adequate equipment along with “closed cupboards” for storing
drugs and FP supplies.
Facilities for STD and AIDS control was needed under the project. At times there were
shortages in the supplies of IFA tabs, vitamin A, ORS and vaccines (at U.F.W.Cs/new centres).
There was a need to ensure adequate stock and supply at household level also by link
workers/field staff.
Infection control practices were poor in all the centres. Waste disposal facilities were
poor at U.F. W.Cs / new centres
Majority of the beneficiaries were willing to pay ‘user fees’ for various MCH services
viz. OPD, laboratory services, wards, delivery and medicinal costs.
LMOs needed training to screen and identify a correct case for IUD.
The beneficiaries of tubectomy at the camps were young with an average age of 25 years,
comprising of both Hindus and Muslims, almost similar to the religious pattern of the area.
There were gross deficiencies in the maintenance of aseptic standards inside Operation
Theatres.
Informed consent was very poor with lack of‘‘Interpersonal communication” between the
clients and health personnel.
17Q
b. Key Recommendations
1. To accelerate the construction of new health centers and renovation of existing maternity
homes/U.F.W.Cs.
2. To fill up staff vacancies immediately.
3. Popularize No Scalpel Vasectomy and spacing methods viz oral pills and IUDs.
4. To improve logistics of supplies of IFA tabs, ORS and vitamin A.
5. Provide air conditioner and generator to select OTs conducting FP camps regularly.
6. To improve coverage and utilization of services by slum population.
7. To introduce on experimental basis “user charges” for select services in a few maternity
homes.
9.3. TRAINING
a. Findings
Presently the Training Centre is operating in a Corporation building without any
residential facilities with inadequate facilities. The new building proposed for the Centre with a
adequate accommodation is under construction in the present premises and is expected to be
completed only by the end of 1999.
Two of the senior posts meant for training activities are vacant, adversely affecting the
training programmes. There is a need for additional staff viz. one Senior Consultant, a Stenotypist and an Asst, statistical Officer to bring about improvements in the quality of training
particularly with reference to content, skill development, monitoring and post training
performance evaluation.
Training programmes started only in 1995-96, due to non-establishment of the facilities.
A total of 17 types of training programmes have been conducted covering 2763 trainees
in the last 2 years. The most frequently conducted training programmes were “Pre Service
Training” for Link Workers followed by CSSM training and Baby Friendly Hospital, besides
concentrating on Lady Medical Officers on different aspects.
The envisaged training programmes for Municipal Councillors and Local leaders has
been a non starter besides the coverage being very poor for the categories of School teachers.
Private Medical Practitioners, and the administrative staff of the Project The availability of
suitable training material to make the training more effective is also a felt need of the Centre.
1R0
There is a need for more emphasis to improve and strengthen clinical skills and
competencies of field staff viz. LMOs and ANMs and Link Workers, besides improving the
quality of training programmes.
It is important to ensure proper monitoring of the training activities as well as trainees
participation.
Generally, the training programmes were satisfactorily conducted with available
resources. However, the documentation with regard to the content and follow-up of the
training programmes is poor.
Some changes were needed in the training materials to improve the quality of training.
The library maintenance was poor and unsatisfactory. Adequate reading materials to suit
the needs of the trainees were lacking.
An effort has been made by the Training Centre through a “Standard Formal" to
systematically evaluate the impact of CSSM training through post training evaluation of ANMs,
But similar efforts are needed for Link Workers and LMOs and for other types of training
programmes (major ones)
There was a need to organise a current ‘training needs assessment’ (quick and simple)
and revise the training plan accordingly.
Integration and co-ordination mechanism does not exist for training both EPP-VIII and
other health staff of BMP at the Training Centre.
Co-ordination and linkage of ±e activities of the Training Centre with SIHFW, does not
exist for sharing information, facilities and trainers.
b. Key Recommendations
1. To immediately fill up the staff vacancies at the training center and recruit additional staff
viz. senior consultant, etc. on contract basis and accelerate the training activities.
2. To identify additional territory hospitals as skill development centers and organize training to
strengthen clinical competencies of medical and paramedical staff.
3. To improve the facilities in the training center and to strengthen the monitoring,
documentation and evaluation of training programmes.
1R1
9.4. INFORMATION, EDUCATION AND COMMUNICATIONACTIVITIES
a. Findings
The planning of EC activities were done on the basis of micro plans at Health Centre
level and action plans at the community level.
Varied types of media were used in the propagation of messages, comprising of all the
important messages on MCH and F.P.
Recently conducted survey on EC has brought out certain changes in the needs of
strategies of EC. The focus group discussions held in the Community has highlighted that
propagation of messages through A.V. vans has been the most effective, however,the timings of
shows are to be modified according to the needs of some special groups like working men and
women. The group meetings at Health centres have benefited only women and that the Folk
media programmes are not properly propagated. Pamphlets and display boards were not known
to many.
Funds Earmarked for EC activities have been fully utilised and funds available with
Innovative Programmes have been diverted for EC programmes.
b. Key Recommendations
1. Before developing any new EC materials an assessment has to be done for the effectiveness
of the media which are being used at present in propagating the messages. This should be
one of the tasks to be undertaken by the Consultants who are engaged with the Unit.
2. Cost effectiveness in terms of coverage of different media should also be assessed by the
consultants who should also provide a feed back on suitable mix of media.
3. Follow-up should be done at Health Centres’ level for effective utilisation of materials which
are supplied to them.
4. Some of the messages recommended by the survey undertaken in Mid July 1998, should get
priority in the materials to be prepared from now on.
5. Grass root level workers especially ANMs, SHE club members and Link workers are to be
provided a better orientation of the health messages to be propagated by them as well as
using the materials in an effective manner.
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9.5. INNOVATIVE PROGRAMMES
L Link workers
a. Findings
Even though they were to be from the same slums of their area of duty, only a third of
them were the residents of their work area, contrary to the concept of selecting workers from
the same slums.
The Knowledge on their duties and some aspects of MCH care needed re-orientation..
In the previous year, on average they had referred 101 children for immunisation,
motivated 120 cases for adopting various family planning methods. They were successful in
motivating couples for spacing methods as out of the cases motivated nearly two thirds were for
spacing methods.
Majority of workers were practising family planning.
Almost all the women in the community were aware of the worker and her activities,
except for a few working women, and were of the opinion that she was working effectively,
visits their area regularly and distribute oral pills, condoms and ORS packets on need basis.
However only a few of the males were aware of her existence that too through their wives.
b. Key Recommendations
1. Link workers should be recruited from the same slums of their area of work, which will
2.
3.
4.
5.
enable community members to use their services in a better manner.
Emphasis on STD/AIDS as well as identifying eligible couple and pregnant women in
training programme is required.
As identification cards and uniforms were desired by the workers, the feasibility of providing
them these facilities can be explored.
The project should look into sustainability of their services.
To improve upon better male participation in the programme a few male link workers may
be enlisted
//. SHE Clubs
a. Findings
The pace of establishment of the clubs is rather slow. At present only 137 clubs are
functioning against the project target of 401.
Most of the members of the club resided in the slums of the respective clubs.
Level of awareness of members on MCH and F.P was quite satisfactory, including HTV/AIDS.
Average number of programmes conducted through the clubs were mostly related to
Immunisation and
Family planning programmes. The other programmes relating to
environmental hygiene & personal hygiene or disease prevention were not many.
Majority of the women in the community were aware of the Club and its activities of
whom many had participated in the programmes of the club. They were of the opinion that they
were useful to them.
b. Key Recommendations
1. The formation of the Clubs should be accelerated to meet the targets of the Project
2. Reorientation programmes to the members on Spacing methods of family planning , STD
and environmental sanitation including personal hygiene should be done, besides training
them on organising more and more innovative programmes.
3. The awareness programmes and camps organised by the Clubs should be more on
programmes on different components of the Project besides concentrating on Family
Planning.
4. More innovative meetings should be arranged in the community by the Clubs
5. Prior announcement of programmes in the community should be ensured.
6. Proper usage of pamphlets and exhibits by the staff should be ensured.
HL Non-Formal Education
a. Findings
At present there were only 12 centers functioning all operated by NGOs.
Most of the beneficiaries of the centres were aged below 10 years even though the
centers were to cater also to the young girls beyond this age.
Even though staff position was adequate in the centres but majority of them lacked infra
structure facilities.
All the teachers were found to be educationally qualified and two thirds of them had
professional qualifications. Majority of the centres were adopting standard teaching methods.
Majority of the teachers felt that the pnority should be given to environmental and
personal hygiene while teaching health education. Only a small proportion of them felt the need
for priority for imparting menstrual hygiene education while a similar proportion for nutrition.
Most of the teachers needed further orientation training on various health topics.
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b. Key Recommendations
1.
2.
3.
4.
Infrastructure facilities should be ensured while sanctioning NFE centers.
Teachers should be oriented to impart MCH and reproductive health education to the girls.
Vocational component of non-formal education should be incorporated.
Timings should be accommodated as per the requirement of the students.
iv. Creches
Out of the target of establishing 50 creches in different slums of Bangalore by the end of
the project period, 33 have already been established.
Even though the main objective of establishing the creches was to cater to the needs of
the working mother it was found that about a quarter of the children were of housewives.
Staff position in the all the creches was adequate but not all the care takers had desired
qualifications and also the continuity of them on the post was not satisfactory
Majority of the centers lacked infra structure facilities.
In most of the creches health check-up camps were held regularly once in 3 months
However health cards were available only in less than half of the centres.
The health activities conducted in the creches such as mother’s meetings etc. have
influenced the knowledge and practices of the mothers, especially on spacing methods for F.P.
including HIV/AIDS and STD. Even the adoption of these spacing methods for F.P. was higher
with creche beneficiaries.
b. Key Recommendations
1. More creches should be started, as there is great demand for it
2. Since the grant given for creche is found to be insufficient as expressed by many NGOs,
feasibility of increasing this amount should be looked into and an undertaking should be
taken from organisation that they would provide necessary infrastructure and training.
3. The staff of creche should be given periodical training on MCH aspect including STD/AIDS.
4. First aid box should be provided in all the creches.
vi Income Generation Activities
a. Findings
There were 24 units operating for different types of training. Even though majority of the
beneficiaries were from the same locality, there were a few from other slums, indicating the
need for starting similar programmes in other slums also. Almost all the beneficiaries were
satisfied with the training programme, and majority with the training materials supplied to them .
Most of the beneficiaries had attended awareness programme on various health topics.
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Except for a small proportion of beneficiaries all had knowledge on legal age at
marriage for boys and girls. Knowledge on menstrual cycle before its onset was found to be very
low while majority were knowledgeable about different methods of family planning including
spacing methods. Many of the heard about STD and HTV/AIDS.
b. Key Recommendations
1. The scheme should be extended to all other slums where it is available however after a need
based survey.
2. Centers should propagate messages on reproductive health to adolescent girls.
9.6. PROJECTMANAGEMENT
a. Findings
L Staff
The committees at state level and BCC level functioned smoothly for taking policy decisions and
for implementation of the programme.
Many of the personnel in the project were on deputation either from Bangalore City
Corporation or from other Departments of GOK, posing some problems of frequent transfers
and non commitment from the deputed persons because of uncertainties.
iL Procurement & Logistics of Supplies
The timely purchases in the Project for equipment, medicines and supplies were done
through a Project Purchase Committee and supplied"to the service deliver points on need basis.
There was no regular Warehouse building for the Project. Generally in most of the Centers
proper storage equipment were not adequate.
HL Management Information System
The Project had a Management Information System Unit, with adequate staff and is well
equipped with Computers and Accessories.
Even though the unit was collecting regularly information on programmes directly
undertaken by the Project, such as IEC, Training, Civil Works and Innovative Programmes,
information on Service delivery through Health Centres, was being collected and compiled at
Dasappa Maternity Home under the Municipal Corporation. The reporting formats although
confirmed to the Government of India requirements did not completely reflect the Project
activities.
Recently an attempt has been made to develop MIS system for the Project through a
Consultant. The pace of work by Consultants was rather slow, they have now committed that
they would complete the task by the end of July 1998.
Regarding monitoring of Project activities, it seems that no formal meetings were held
every month with the Medical Officers I/C of Health Centres to review the performance on the
basis of the reports. The MIS Unit has compiled some interesting reports on of Status of Girls’
Education. The Unit has also brought out periodical status reports on the Project.
iv. Receipt and utilisation of funds
The project funds are received by Government of Karnataka from Government of India
and then passed on to the Project.
Even though, GOK has received Rs "4'1
from GOI, only Rs 1807.11 lakhs have
been released to the project and the surplus amount is retained at GOK level. The Project Co
ordinator in a recent request has asked GOK to release the balance with them to the Project.
The cumulative percentage spending out of the total outlay were meager in the first two
years and improved slightly in the third year. The Cumulative Percentage of expenditure over the
allocated budget is lowest for Training and Consultancy activities even though for EEC activities
it has exceeded the budgeted amount, mainly because of under spending under Innovative
programmes.
The cost of civil works have escalated as reviewed under civil works. Based on these cost
escalation and probable expenditure of other components, realistic estimate for the remaining
penod of the project was discussed in the review meeting of the project with GOI and World
Bank officials.
It is estimated that that the Project would require an outlay of Rs.3831 lakhs in the
remaining period of execution to undertake all envisaged activities. This amounts to an
additional requirement of Rs. 1260 lakhs for the project.
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b. Key Recommendations
1. Ensuring retaining of deputed persons on various posts till the completion of Project
2. Additional posts sanctioned are to be filled up immediately
3. Project Co-ordinator to be assisted by a technical Consultant in Management for speedy
implementation of Management aspects.
4. Expenditure position to be improved by speeding up Civil Works and undertaking more
activities under innovative programmes
7.8 OVER VIEW OF PROJECT IMPACT
The impact of the programme is appreciable in the areas of MCH and F.P. The
targets set forth for the projects are on the way for achievement. However educational
programmes on age at marriage, propagation of spacing methods amongst young
couples, motivation for institutional deliveries and service programmes on diarrhoea
management, nutritional supplementation to underfives should receive priority attention
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- Media
SDA-RF-CH-1B.18.pdf
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