Environmental and Social Management Framework
for the
Andhra Pradesh Health Systems Strengthening Project
Final Report
Volume -2: Stakeholder Consultation Report
February 2019
By
Project Management Unit
Department of Health, Medical and Family Welfare (DoHMFW)
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TABLE OF CONTENT
Documentation of Stakeholder Consultation in East Godavari ............................................................. 3
Documentation of Stakeholder Consultation in GUNTUR ................................................................. 22
Documentation of Stakeholder Consultation in KADAPA ................................................................. 33
Documentation of Stakeholder Consultation in NELLORE ................................................................ 44
Documentation of Stakeholder Consultation in PRAKASAM ............................................................ 54
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DOCUMENTATION OF STAKEHOLDER CONSULTATION IN EAST GODAVARI
O/O DMHO-DCHS OFFICE, EAST GODAVARI DISTRICT
EAST GODAVARI DISTRICT BRIEF REPORT ON STAKEHOLDERS CONSULTATION
MEETING - ON AP HEALTH SYSTEM STRENGTHENING PROJECT
DATE:23/12/2018
As per the the instructions from the Director, SPIU O/o Special Chief Secretary, Health
Medical & Family Welfare Department through video conference on 19.12.2018, the District Medical
& Health Officer is organized a meeting on 21st at DMHO office meeting hall O/O DMHO Office
Kakinada with different following stakeholders to identify the priority needs on Health System
Strengthening Project.
Group wise prescribed stakeholders are as follows
1. Medical staff including doctors, specialists, nurses, administrative staff, staff in-charge of
outreach activities, patient satisfaction surveys, etc. (10-15 personnel).
2. ANMs and ASHAs (10-15 personnel).
3. District Medical and Health Officer(DM&HO)(1) and District Coordinator Hospital
services(DCHS)(1)
4. Deputy DMHO (1).
5. Superintendent In- charge : A). District hospitals(1), B). Area hospitals (1), 3). CHCs(1).
6. NQAS - District Quality Consultant (1) and District Quality Manager (1)
7. Representatives from at least 5-6 village health communities, including vulnerable groups
and women. (10)
8. Representatives from service providers of PPP programs. (5)
9. Officials working on Tribal Reform Yardstick (TRY) (if applicable to the district)(5)
10. Representatives of self-help groups(10)
Preparatory Plan: The DPMU team and the Quality Assurance team jointly organized a planning
meeting with the DM&HO and DCHS on 19th December at the DM&HO Chamber after the Video
Conference and made a list of the names of the participants for this stakeholders consultation
meeting, and planned to conduct the meeting on 21st December’18. On 20
th /12/2018 we interacted
with all the participants over the phone and invited them to attend the meeting on 21st at DMHO
office,Kakinada. The DPMU team was asked to look after all the arrangements at the Meeting Venue.
The district Quality team & Quality nodal officer has taken initiative for questionnaire translation in
to telugu.
Inaugural session of the Meeting: The DCHS inaugurated the meeting by explaining the concept of
the meeting and he requested all the participants to participate actively and discuss on each and every
point/Question each group was asked to identify a person who would be representing the group to
share the information of the group. Before start of the consultation meeting all the facilitators were
briefed the questions in Telugu and distributed the validation sheets to record their valuable
discussions and requested them to write their group no on top of the page and the last page the names
of the Group participants. The DCHS ,DMHO, Quality nodal officer, District quality team addressed
the participants and requested all to list out the priorities by analyzing the situation in their areas and
existing facilities in their areas and mentioning their requirements to improve the quality further in
their centers. Expecting active participation and discussion of the all stake holders in various groups
which might be useful to give a quality report after the meeting.
4
Question wise Group Discussion Details are As follows:
QUESTION NO.1 (CATEGORY 1 TO 6)
PRIORITY NEEDS
1. Priority needs: (this question was discussed by 1 to 6 groups as mentioned above).
a) What are some of the priority needs at the community level in your area? (health, education,
water, electricity, communication, transport and connectivity, etc.)
Group Feed back after the Discussion
01 Water, Communication
02 Transport, Communication and Electricity
03 Transport, Health,
04 Health, Communication, Education
05 Transport, Health, Education & Communication
06 Health, Education, Transportation, Water & Electricity
Most of the participants have identified top Priority need as Transport followed by Health,
Communication,water,Education and Electricity priority wise. Most of them expressed improved
transport would provide better health services to the community.
QUESTION NO.2.(CATEGORY 1 TO 6)
SOCIO ECONOMIC BACK GROUND
2. Socio economic background: (this question was discussed by 1 to 6 groups as mentioned
above.)
a) What is the socio-economic background of the patients visiting the health facility? (Caste,
income level, profession, etc.)
b) Do you capture this information in your records?
Group Feed back after the Discussion
Patient foot fall Registration of data
01 All Categories mainly SC, BC.
Majority of patients are BPL.
Yes. (Name, Age, Sex, Area details are capturing
while in OP registration) while in In-patient
registration are capturing the details of Caste, &
Occupation etc.)
02 All Categories SC,BC,ST, OC,
Majority of patients belong to
BPL.
Information is recorded & also maintaing ANMOL
03 All categories mainly
BC,SC,ST. Majority of patients
belong to BPL.
Yes. (Name, Age, Sex, Area details are capturing
while in OP registration) while in In-patient
registration are capturing the details of Caste, &
Occupation etc.)
04 All Categories SC,BC,ST, OC,
Majority of patients belong to
BPL. Mostly Labourers.
Yes. . (Name, Age, Sex, Area details are capturing
while in OP registration) while in In-patient
registration are capturing the details of Caste, &
Occupation etc.)
5
05 All Categories SC,BC,ST, OC,
some from middle income
group,employees both from private
and govt institutes.Majority of
patients belong to BPL. Mostly
Agricultural Labourers.
Yes. . (Name, Age, Sex, Area details are capturing
while in OP registration) while in In-patient
registration are capturing the details of Caste, &
Occupation etc.)
06 All categories mainly
BC,SC,ST. Majority of patients
belong to BPL.
Yes. . (Name, Age, Sex, Area details are capturing
while in OP registration) while in In-patient
registration are capturing the details of Caste, &
Occupation etc.)
Most of the groups have expressed that majority of patients visited belong to below poverty line
people mainly SC, BC, ST and Economically Back Ward OCs and most of the aged people are mainly
attending, the ratio of BPL is above 70% and APL are below 30%, regarding occupation most of them
are Agriculture back ground especially farmers and agriculture labors and Construction workers. All
of them expressed that they are capturing the information by recording of their Name, Age, Sex and
residential area and suffering disease & Provided treatment particulars, but in Maternal & Child
Health services especially at the time of registration they are collecting the information of all their
socio economic details like cast, religion, income, and their occupation particulars etc.,
QUESTION NO.3 ACCESS- (CATEGORY 1 TO 6)
c) Is your health facility accessible to your target population? What radius do you serve?
Group Feed back after the Discussion
01 Health facility is accessible, Radius to serve is 8 to 10kms
02 Health facility is accessible, In tribal areas from village to PHC journey time
is1hr.Remaining facilities village to PHC journey time is 1/2hr. Most of them coming by
Auto, buses, 108 own vehicles.
03 In tribal areas due to difficult terrain accessibility to health facility is not good. But our
A.P Govt has arranged 2 wheeler feeder(Bike) ambulances (108) on emergency
situtations.
04 Accessible
05 Accesible. But in Tribal area accessibility is very difficult due to geographical variations.
Atmospheric conditions
06 Most of the facilities accessible. But in tribal areas due to transport facilities it is difficult
access on emergency situations
07 Yes. Accessible. They are able to reach to health facilities in 15mins by walk.
08 Accessible. Walkable and most of them coming by own vehicles.
09 Not accessible. Radius to serve 20kms is 20kms-40kms. Most of the patients coming to
tribal PHCs come either by walk or over crowded auto due to poor transportation facilities.
10 Accessible. Going to E-UPHC(MAK CENTERS).Going to facilities by walk 20 to
30mins. By 2 wheeler 15mins.
Most of the groups are expressed that the Health facilities are accessible to the target population
especially all the sub Health Centers are situated in the village and accessible areas, 85% of the
Primary Health Centers are also situated in the accessible areas, the rest of 15% centers are outskirts
of the village with in 1 KM distance of main village, but all these centers have road accessibility. All
the Secondary and tertiary care facilities are situated in the main villages/towns and accessible to the
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communities. But in Tribal areas of East Godavari District areas due to difficult terrain accessibility
to health facility is not good. Most of the patients coming to tribal PHCs come either by walk or over
crowded auto due to poor transportation facilities. In Urban areas accessibility to health facility is
very good.
QUESTION NO.4 (CATEGORY 1,2,5)
Question No.4 Footfall:
d) What is the average patient foot-fall? Average number figure (male and female). (Will be
available in the OP register)
Group Feed back after the Discussion
01 Sub center-20-30/day, PHC-150-200/day, CHC-300-400/day, AH-500-600/day, DH-700-
1200/day. Maintaining OPD register
02 Sub center patients 20-25/day. More females are coming.
05 District Hospital-Rajahmundry OPD /day -700-1200. Area Hospital Ramacahndra puram
-OPD/day is 400-500. Area Hospital -Amalapuram- opd/day is400-500 CHC-Rampa
chodavaram OPD is 200-300/day.
All the Groups are expressed that at the Sub Centre on an average daily OP is around 20-30, at the
PHC OP is 150-200, and CHC Op is 300 to 400, AH OP is 500 – 600/DAY and Tertiary care facilities
OP is more than 700-1200 per day. All of the group members informed that they are maintain OPD
Registers.They are also recording every day OP in E Aushadi and segregated male and Female on
every day. More females are coming to all health facilities based on their observation and available
data.
QUESTION NO.5 (ALL CATEGORIES)
A.Comment on the infrastructure in your facility from a safety and adequacy
perspective. (since AP is a disaster zone).
Are there public buildings (Schools, hostels, etc) that can serve as storm shelters.
B.What is the process followed in case of a natural disaster?
Group Feed back after the Discussion
a) Question b) Question
01 Infrastructure good in some areas. YES TV,News,SMS.
02 YES. Tom-Tom, mike,news, sms, television. some
sub centers need rennovations. Some sub
centers running in rented houses and need new
buildings.
03 Infrastructure is good .Shelters are
available.
Under the supervision district
collector,revenue, health officials, planning is
done in all cyclone alerts. In East Godavari we
have successfully reduced damage and deaths
in recent cyclone
04 Yes. Radio & Television
05 Yes Yes.TOM-TOM, Radio, Television, SMS
06 Rehabilitation centers are available East Godavari district is most prone to Bay of
7
Bengal cyclones. Disaster alerts are giving
through TV news,Radio, sms
07 Yes TV news,Radio, sms, TOM-TOM
08 Yes Schools are available for cyclones reliefs.
09 Yes Schools and hostels are available.
10 Yes Schools and hostels are available.
In all group members informed that Public buildings are available for cyclone relief or flood. All
expressed that are buildings are available in nearest place. All are said that they are getting news
through tom-tom, TV news, Radio,SMS in of natural disasters time.
QUESTION NO.6 ( 1 to 6 categories)
Disaster management:
e) Do you have a disaster management plan?
f) In case of a disaster what is your role and what is the chain of command?
Group Feed back after the Discussion
a) Question b) Question
01 Yes .Plan is available In coordination with other departments
necessary precautions will be taken to reduce
the damage. During disasters we are
conducting special medical camps, sanitation
measures will be taken.
02 Yes. Plan is available Conducting medical camps, shifting of
antenatal cases along with high risk antenatal,
post natal cases to nearest hospitalts. Sick
patients are admitted in the hospital.
03 Plan is available Medical camps, rehabilitation centers,
epidemic cells, drug indenting sufficient stock
of drugs are maintained, medical personael to
deployed in all medical camps.In the
collecteoroate all cyclone effected coastal
villages monitored under the supervision of the
district collector. We have plan in our district.
04 Plan is available Yes. Arrangement of medical team at
cyclone/flood relief centers and maintaining
prevention of contagious diseases.
05 Yes. All the doctors,paramedical staff, staff nurses
are informed
06 Yes. We have disaster plan Conducting medical camps, shifting of
antenatal cases along with high risk antenatal,
post natal cases to nearest hospitalts. Sick
patients are admitted in the hospital.
East Godavari District, one of the nine coastal districts of Andhra Pradesh, is a regular victim of
multiple disasters and this district was badly affected by all major natural disasters time to time since
8
independent era. In this question every body said that they are aware of disaster plan. Medical camps,
rehabilitation centers, epidemic cells, drug indenting sufficient stock of drugs are maintained, medical
personnel to deployed in all medical camps. In the collectorate all cyclone effected coastal villages
monitored under the supervision of the district collector. All NQAS accredited facilities have good
disaster management plan. All members are aware of chain of command.
QUESTION NO.7 ( 1 to 6 categories)
7 Feedback and Patient Satisfaction
a) Do you gather feedback from patients? (Y/N) and details, if yes.
b) How does the hospital monitor patient satisfaction? Sample, frequency, etc
Group Feed back after the Discussion
a) Question b) Question
01 Yes. 1patient/day. In PHCS suggestions &
complaints boxes are available to get
information.
02 Yes But no details are available.
03 Yes We will gather patient satisfaction from
AH,DH. Collecting daily (random selection)
and also received from 1100 number
portal.(Some of the feed backs & grievances
04 Yes. Recently started
05 Yes. 1Patient/dayX30 samples in month Area
Hosptial in Ramachandrapuram. Other Area
Hospitals by feed back forms and arranging
complaint boxes in every ward, which are
taken in every Saturday.
06 Yes. By feed back forms and 1100 ONLINE
PORTAL.
For this question every body aware of importance of feed back forms. They are collecting feed back
forms through complaint/Suggestions boxes. Some of the grievances received through 1100. Quality
group expressed that needs improvement in patient feed back collection. It can be doing through
online sms or feed back kiosks at OPD,IPD areas.
QUESTION NO.8 (All Categories)
8. Awareness Programmes Does the HCF undertake awareness programs/activities at the
community level? Please given details.
a) Do you conduct programs at the village and tanda level?
b) Do you share preventive, curative and palliative care information with the community?
c) Do you have IEC material
Group Feed back after the Discussion
a) Question b) Question c) Question
9
01 Yes Yes Yes. Information is giving on
all state & national
programmes(like
PMSMA,PMAVY /Talli bidda
express, MMHC,NTR baby
kits, Immunization, swineflu
awareness, National TB control
programme, TV, IEC material
(Pomplets,banners,posters).
02 Yes Door to door surveillance, IEC
activities, Anti larva operations,
sanitation maintenance,
conducting Rallies school
children
Yes. Flip charts, Posters,
Pomplets, Audio,Video visuals,
Banners, Flexis, charts
03 Yes Share the information in all
aspects. Local TV channel
announce ments, Paper
advertisements. Following
VHNC meetings.
Yes. Flip charts, Posters,
Pomplets, Audio,Video visuals,
Banners, Flexis, charts.
Following all IEC mehthods.
Information giving on PMSMA,
PMMVY, 102, 104,
108,MAK(E-UPHC), NTR
VAIDYA SEVA, UIP,Cinemal
hall advts for PCPNDT act.
04 Yes Yes. Through Pomplets,
Banners and door to door
surveillance.
Yes. Awareness on Vector
borne disease, swineflu, water
borne diseases,UIP
05 Yes Yes Sharing the information through
PMSMA,PMVVY, 102,
conducting Seemantham
programme in DH. Following
breast feeding week etc.
Following important health
days ex: World TB day,
Leprosy, AIDS, No smoking
day.
06 Yes Yes Conducting good awareness
camps by using all IEC
material. All NQAS accredited
hospitals have good IEC
Material.
07 YES Receiving information through
door to door information & IEC
activities, Group meetings
Health officials are doing IEC
activities. Ex: Hygiene
surrounding maintenance,
Importance of
boiled/Chlorinated water,
Immunization, Importance of
antenatal registration in first
trimester, Importance of 100
IFA tablets for HB
improvement.
08 Yes Yes Creating awareness on clean
10
environment,NCD,CD
awareness, Healthy food habits
for ANC women, Awareness on
UIP, Creating Awareness on
high risk pregnancy by MAK
centers.
09 Yes Yes Conducting IEC activities
through Kalajathara, VHND
Meetings, Gram Sabha.
10 Yes Yes IEC activities are conducting
for controlling of dengue,
Malaria, NCD & CD,
Enviornmental hygiene, Breast
cancer screening methods.
Effective Information, Education and Communication (IEC) materials are an important component of
the comprehensive HEALTH education campaign. It will help the Road to Good Health.
IEC is an extremely important component of the programme that should lay the basis for its
Successful Implementation.
IEC activities are doing in following in all programmes.It is very well implementing coordination
with other Govt health departments.( RBSK (Mukya Mantri Bala Suraksha
karyakramam, RKSK, RNTCP, NLEP, NPCB, Maternal Health ( NTR Baby Kits, Delivery kits,
JSSK, JSK, PMSMA, PMMVY, (Programmes), NIDDCP, NPCDCS(Mlae and Female master Health
check ups) NPHCE, NTCP, NVBDCP, NACO programmes. Healthcare ATM, Free Drugs &
Supply Chain, NTR Vaidya Seva, NTR vaidya Parikshalu.
In entire district all end users happy with IEC activities based on above information.
QUESTION NO.9 (All Categories)
9. Committees:
a) Does the HCF have a health monitoring committees/hospital representative committees?
b) How frequently do they meet?
c) What is their role?
d) How are the members selected? (Please take a note of the minutes.)
Group Feed back after the Discussion
a) Question b) Question c) Question d) Question
01 Yes Once in a month Suggestions on
hospital development
Nominated by
district collector
02 Yes. In Sub centers
level VHSNC are
present
15days (Two times in
a month)
Suggestions and
helping on mainly
village people health
and pregnant women
nutrition status
Elected and
nominated by
village people and
VHSNC operational
guide lines.
03 Yes Monthly once. MOM
also recorded
Hospital development,
drugs local purchasing,
HDS funds utilization
Nominated by
district collector.
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04 Yes Monthly once To improve facilities to
beneficiaries
Nominated by
district collector
05 Yes Monthly once Hospital development By district collector
06 Yes Monthly once All NQAS accredited
facilities have good
HDS and all other
committees based on
NQAS standards
By district collector
07 Yes Monthly Once Hospital development Not aware
08 Yes Monthly Once Better improvement
and focus on good
service delivery
Nominated by
district collector
09 Yes Monthly once Improvement of health
services
By district collector
10 Not aware Not aware Not aware Not aware
In our district HDS committee actively involved in Hospital development, drugs local purchasing,
HDS funds utilization and the committees are mainly focus on Better improvement and good service
delivery.
QUESTION NO.10 (All Categories)
10. Gender:
a) Based on your observations, do you feel that women come for check-ups/treatments at
advanced stages of the disease compared to men?
b) Do women ignore their health?
Feed back after discussion
Group a) Question b) Question
01 Both female and males are equally
coming and they are more aware
of their health
No negligence on helath by females
02 Females are coming early No
03 Females are coming early Now a days women are proactive and
more aware of their health.
04 Yes Yes. Due to fear of disease and diagnosis
05 Coming early NO
06 Females are coming early In some villages due to economical
problems most of the women’s are
neglecting their helath
07 Coming early and Good
precautions taken
No negligence on their health
08 Yes No
09 Yes.Women are coming on early
stages
NO
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10 Females are coming early No negligence about their health
Women’s are coming for treatment and checkups at initially stages only. Now a day’s women are
proactive and more aware of their health. They are visiting the health facility due to fear of disease
and diagnosis. In some villages due to economical problems most of the women’s are neglecting their
health. Most of the women’s are well aware about Govt initiatives and schemes on women’s health.
11. Please capture details of the functioning medicine dispensing ATMs located in tribal
areas.
Group 9 is actively participated and shared the following information.
We have 10 Health ATMs (Mukhyamantri Giri Aarogya Kendrams) in East Godavari District, they
are installed in the Tribal PHCs they are at following locations
covering of 15,000 village population. The main aim of these ATMs are to work on issue that the
patients where there is no medical officer is available by using malty parameter monitor operated by
Para Medical Staff through consultancy of concerned medical officer by using SMS service. It is
worked on remote invocation method, networking based through SMS service. The System work on
any cell number, this number was shared with four or five phone numbers. Each ATM consists of
Drug vending Machine, Multipara Meter Monitor, Non-invasive Hemoglobin Meter, and this ATM
have 32 Blocks we can insert the Prescribed medicine in the prescribed block, and fill these blocks
with the concerned medicines whenever it is empty and daily monitor the drug consumption by
concerned pharmacist and Medical Officer. In this regard we trained the Medical Officer, pharmacist
and Staff Nurse on operating of these ATMs and also on submission of Reports. The total numbers of
patients served through these ATMs are 772.
The 3-5 minute cycle connects the patient & ANM at facility, the remote doctor and provides
"Diagnostics-Doctor-Drug" to the patient. The entire process is free of internet to avoid
communication failure. These ATMS working very well. End users are very satisfactory for these
services.
Environment Safeguards
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1. Is the current waste segregation adequate for infectious wastes and sharps? (Categories-
1,2,3,5,6,8,10)
Group Feed back after the Discussion
01 Yes
02 Yes
03 Yes. Segregation is happening in all the CHC,AH,DH and also PHC centers recently.
05 Yes.Some places need improvement
06 Only it is happening only in District hospital,Area Hospitals, and CHC’s. In PHC’s needs
to improve.
08 Yes
10 Yes.
Segregation is happening in all the CHC,AH,DH and also PHC centers recently. In PHC’S sub
centers level needs to improve.
2. What could be potential impacts of the incremental increase in waste generated through the
Project? (Categories,12,5,6,8,10)
Group Feed back after the Discussion
01 No bad impact. Providing adequate support to PHC through biomedical waste
management agency.
02 NO bad impact
05 No bad impact
06 NO bad impact
08 No bad impact
10 No bad impact
All are expressed that no bad impact of the incremental increase in waste generated through the
project.
3. How can the project help manage these risks/impacts?(All categories)
Group Feed back after the Discussion
01 This project helps to prevent soil and water contamination. It will prevent hospital
acquired infections (Nosocomial infections)
02 Not aware
03 This project helps to prevent environmental pollution
04 By safe disposal of infectious waste risk to health personnel & community is prevented.
05 Quality of care can be improved
06 This project helps to prevent soil and water contamination. It will prevent hospital
acquired infections (Nosocomial infections)
07 Not aware
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08 It is very useful project if we create more awareness
09 Very useful project
10 Needs to create more awareness.
This project helps to prevent soil and water contamination. It will prevent hospital acquired infections
(Nosocomial infections) By safe disposal of infectious waste risk to health personnel & community is
prevented.
4. What is the current treatment system of effluents/contaminated wastewater?(1 to 6)
Group Feed back after the Discussion
01 Disposing in drain after disinfection. Send proposal for STP
02 Send proposals to higher officials
03 In small scale/Lab waste disinfected with Hypochlorite solution. Proposals sent to
district collector for STP in District Hospital, Area Hospitals, CHC’s
04.05,06 STP plants not available. We require STP plants. Small scale disinfection is carried out
now. Proposals sent to district collector for STP plants. STP plants are required at
teaching hospitals,DH,AH,CHC.
In small scale/Lab waste disinfected with Hypochlorite solution. Proposals sent to district collector for
STP in District Hospital, Area Hospitals, CHC’s. Most of the facilties not having STP.
5. Can the project help to ensure effluents are suitably treated and disposed so that there are
no risks to the environment (soil and water bodies)?(Categories-1 to 6)
Group Feed back after the Discussion
01 Yes.
02 Very useful
03 Definitely project will help in maintaining the waste disposal.We can strengthen the
system so that we can prevent environmental pollution.
04 Yes. Infections and harmful chemicals are neutralized and disposed so that they are not
harmful to soil and water bodies.
05 Yes
06 Yes. Its prevent more pollution in water and soil.
Definitely project will help in maintaining the waste disposal.We can strengthen the system so that we
can prevent environmental pollution.Infections and harmful chemicals are neutralized and disposed so
that they are not harmful to soil and water bodies. Its prevent more pollution in water and soil.
6. Is Environment Health and Safety performance in larger hospitals being monitored?
(energy use, cleaning schedules, waste generation, effluent treatment, and occupational
safety of medical staff) (Categories-1,3,5,5,6)
Group Feed back after the Discussion
1,3,5,5,6 Monitored in Teaching hospital, DH,AH,CHC through SSP survivellance.Online portal
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and manual scoring by MS,RMO, Nursing Superintendent/Head nurse. In PHC no
proper monitoring. After Kayakalp programme implementation it is happening in some
PHC.
In NQAS accredited facilities and Kayakalp winner facilities it is monitored regularly
2
Data is captured on daily Basis which gives the the thorough knowledge &
understanding not only about the processes, functionality but also overall
Performance.
MEASURING METRICS
“When you can measure what you are speaking about and express it in
numbers, you know something about it.”
Assessment Process
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Hospital Sanitation Monitoring Application (HSMS)
Services
SSP2015
Monitoring Item
Measurable Elements
Checkpoint
Checkpoint Hospital Score card
Measurable Elements
Checkpoint
Checkpoint
Monitoring Item
Measuring Parameters
No.of Monitoring
ItemsNo.of Measurable
ElementsNo.of Check
points
Sanitation 9 53 53
Security 6 5 54
Pest Rodent Control 7 39 48
Kayakalp- an initiative has been launched to promote cleanliness, hygiene and infection control
practices in public health facilities. Under this initiative, public healthcare facilities shall be appraised
and such public healthcare facilities that show exemplary performance meeting standards of protocols
of cleanliness, hygiene and infection control will receive awards and commendation.
Under this initiative, the number of awards are as under:
Best two District Hospitals in each state (Best District hospital in small states)
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Best two Community Health Centres/Sub District Hospitals (CHC/ SDH) (limited
to one in smaller states).
Three Primary Health Centre (PHC) in every district (1st ,2
nd,3
rd place)
7. Is there adequate availability of the consumables i.e. colored bins, bags, PPE gear for staff,
puncture proof containers, needle cutters etc.?(Categories-1 to 6,7,8,10)
Group Feed back after the Discussion
01 Yes
02 Yes
03 Yes
04 Yes
05 Yes
06 Yes
07 Yes
08 Yes
10 Yes
In all facilities adequate available the consumables i.e. colored bins, bags, PPE gear for staff,
puncture proof containers, needle cutters etc.
8. How frequently is health checkup and immunization conducted for staff and sanitation
workers? (Category- 1to 6)
Group Feed back after the Discussion
01 Yes. Once in a year and (as per schedule)
02 No immunization in subcenters level
03 Once in a year in DH,AH,CHC’S.
04 Yes
05 Once in a year. Health checkups, Immunization is being done.
06 It is happening DH,AH,CHC and some PHC. All Kayakalp implemented facilities
following Health checkups and immunization. It is not happening in subcenters.
It is happening DH,AH,CHC and some PHC. All Kayakalp implemented facilities following Health
checkups and immunization. It is not happening in subcenters.
9. Institutional Arrangements (Category- 1 to 6 & 8)
a. What are the institutional arrangements for healthcare waste management and infection
control?
b. Are they sufficient to train, guide and implement these activities?
c. Can the project help?
Group Feed back after the Discussion
A B C
01 By tie up with EVB Yes Yes
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technologies.All necessary
equipment of waste management,
infection control management
02 Sufficient. No proper
arrangements for health care
waste management.
Yes Yes
03 By tie up with EVB technologies
.All necessary equipment of waste
management, infection control
management. . Safety pits are
available in all PHC
Yes Yes
04 By tie up with EVB technologies
.All necessary equipment of waste
management, infection control
management. Safety pits are
available in all PHC.
Yes Yes
05 By tie up with EVB technologies
.All necessary equipment of waste
management, infection control
management
Yes Yes
06 By tie up with EVB technologies
.All necessary equipment of waste
management, infection control
management. All NQAS
accredited facilities managing
Hospital infection control
management committees,
Biomedical waste management
committiees.
By tie up with EVB technologies .All necessary equipment of waste management, infection control
management. All NQAS accredited facilities managing Hospital infection control management
committees, Biomedical waste management committiees. Recently in East Godavari District health
officials implemented and tied up EVB technologies for Biomedical waste management in all PHC’S.
There is no arrangement for Helath care waste management in sub-centers level. EVB technologies is
the service provider/agency for Health care waste management in East Godavari District.
10. What are the current methods of disposal of chemical reagents and disinfectants- is
there impact to water bodies?(Categories 1 to 6 and 8)
Group Feed back after the Discussion
01 Tied up EVB technologies for infected waste management. No impact on water bodies
02 Due to improper disposals in present methods water sources are polluted in village level.
Need improvement in present methods.
03 Tied up with EVB technologies for infectious waste management. In small scale/Lab
waste disinfected with Hypochlorite solution. Proposals sent to district collector for STP
in District Hospital, Area Hospitals, CHC’s.
04 Tied up with EVB technologies in PHCs. In PHCS no proper methods for disposal of
chemical reagents. Major impact on water bodies.
19
05 Presently tied with EVB technologies for infectious waste management. . In small
scale/Lab waste disinfected with Hypochlorite solution.After that drained in to
municipality drains. Some impact on Godavari river.
06 Presently tied with EVB technologies for infectious waste management. Should treat
liquid waste before emptying in to drain. Some impact on Godavari river, canals, ponds,
sub rivers.
08 Tied up with EVB technologies for infectious waste management.
Presently tied with EVB technologies for infectious waste management in Teaching hospital,District
Hospital,Area Hospitals and Community health centers. Some PHC are following safety pit/deep
dural pits for management. In small scale/Lab waste disinfected with Hypochlorite solution.After that
drained in to municipality drains. Should treat liquid waste before draining in to drain. Some impact
on Godavari river, canals, ponds, sub rivers.
11.Present methods of BMW disposal in rural areas (PHCs and the SCs) (where
decentralized treatment facilities are not available) and is there any pollution impacts due to
these systems, can the project support better alternatives? (1 to 6 and 8)
Group Feed back after the Discussion
01 Yes.This project can help the community by safe disposal of waste with no risk to
environment.
02 Yes. Pollution can be controlled.
03 Yes.Biomedical waste management methods started in PHC Level.Not in subcenters
level. We can prevent the communicable diseases,(Viral and microbial,Nosocomial
infections) and also prevent Hepatitis B and C infections can be avoided due to needle
pricks. This project will help prevent environmental pollution. Project will help in
strengthening and preventions of disease spread.
04 Present methods in rural areas safety pit /Deep burial pit, out door burning. Project will
help in safe disposal with no risk to the community.
05 In PHCs recently tied up with EVB technologies.Wastage transferred to storage room
from where EVB technologies take over. Project will help the decrease the pollution
06 Present methods in rural areas safety pit /Deep burial pit, out door burning. Project will
help in safe disposal with no risk to the community.
08 In PHCs recently tied up with EVB technologies. Project will help the decrease the all
types of pollution due to health care waste.
Biomedical waste management methods started in PHC Level.Not in subcenters level. Present
methods in rural areas safety pit /Deep burial pit, out door burning. Project will help in safe disposal
with no risk to the community.We can prevent the communicable diseases,(Viral and
microbial,Nosocomial infections) and also prevent Hepatitis B and C infections can be avoided due to
needle pricks. This project will help prevent environmental pollution. Project will help in
strengthening and preventions of disease spread. Hospital untreated wastage may cause serious water
pollution.Disease-causing microorganisms are referred to as pathogens. Pathogens can
produce waterborne diseases in either human or animal hosts. Coliform bacteria, which are not an
actual cause of disease, are commonly used as a bacterial indicator of water pollution. Other
microorganisms sometimes found in contaminated surface waters that have caused human health
problems include:
20
Burkholderia pseudomallei
Cryptosporidium parvum
Giardia lamblia
Salmonella
Roto virus and other viruses
High levels of pathogens may result from on-site sanitation systems (septic tanks, pit latrines) or
inadequately treated sewage discharges. untreated sewage from Hospitals sewage discharges. pollutes
water bodies.
All are expressed that project will help definitely to reduce water,soil, Environmental pollution.
Project will help the decrease the all types of pollution due to health care waste.
Total audience/participants opinion about this project:-
1. This Project will support the Andhra Pradesh government implement selected key intervention
areas of its health sector strategy, as a component of its larger strategy “Vision 2029” for the
economic and social development of the state. This project will help comprehensive Quality of
care by following NQAS standards to deserved population. This project will help to address the
increasing burden of NCDs in the state, while continuing to tackle the unfinished MCH agenda,
the program will focus on transitioning existing primary health care facilities into comprehensive
health care centers. This project will help improving health data systems, and project will
empower citizens to better manage their healthcare, and on the other, empower health staff
(doctor and nurses) to provide better diagnosis, treatment and management through the health
system.
2. All health care professional(Participated in this meeting) expressed that NQAS AND
KAYAKALP programmes implementation will help definitely to deserved people.
3. All are expressed that project will help definitely to reduce water,soil, Environmental pollution.
4. Most of the participants have identified top Priority need as Transport followed by Health,
Communication, water,Education and Electricity priority wise. Most of them expressed improved
transport would provide better health services to the community.
5. Project will help the decrease the all types of pollution due to health care waste.
----
Reported & attested by
Dr.Ramesh Kishore
District Coordinator for HOsptal Services,
O/O DCHS Office, Rajamahendravaram,
East Godavari District.
Dr.N.Prasanna Kumar,
I/C DM & HO,
O/O DM & HO, Kakinada,
East Godavari District.
21
22
DOCUMENTATION OF STAKEHOLDER CONSULTATION IN GUNTUR
BRIEF REPORT ON STAKEHOLDERS CONSULTATION MEETING OF GUNTUR
DISTRICT ON AP HEALTH SYSTEM STRENGTHENING PROJECT
As per the As per the instructions from the Director, SPIU O/o Special Chief Secretary,
Health Medical & Family Welfare Department through video conference on 19.12.2018, the District
Medical & Health Officer is organized a meeting on 21st at Susrutha Hall, Government General
Hospital, Guntur with different following stakeholders to identify the priority needs on Health System
Strengthening Project.
Group wise prescribed stakeholders are as follows
1. Medical staff including doctors, specialists, nurses, administrative staff, staff in-charge of
outreach activities, patient satisfaction surveys, etc. (10-15 personnel).
2. ANMs and ASHAs (10-15 personnel).
3. District Medical and Health Officer(DM&HO)(1) and District Coordinator Hospital
services(DCHS)(1)
4. Deputy DMHO (1).
5. Superintendent In- charge : A). District hospitals(1), B). Area hospitals (1), 3).CHCs(1).
6. NQAS - District Quality Consultant (1) and District Quality Manager (1)
7. Representatives from at least 5-6 village health communities, including vulnerable groups
and women. (10)
8. Representatives from service providers of PPP programs. (5)
9. Officials working on Tribal Reform Yardstick (TRY) (if applicable to the district)(5)
10. Representatives of self-help groups(10)
Preparatory Plan: The DPMU team and the Quality Assurance team is jointly organized a planning
meeting with the DM&HO and DCHS on 19th December at the DM&HO Chamber after the Video
Conference and then list out the name of the participants for this stakeholder consultation meeting,
and plan to conduct this meeting on 21st December’18, In this regard we also approached the GGH
Superintendent to get permission to organize this stakeholders consultation meeting at Susrutha hall,
GGH Guntur. On 20th
we interacted with all the participants over by phone and invited them to attend
the meeting on 21st at GGH. The Quality Assurance team is look after all the arrangements at the
Meeting Venue.
Inaugural session of the Meeting: The District Medical & Health Officer is inaugurated the meeting
by explaining the concept of the meeting and she requested all the participants to participate actively
and discuss on each and every point/Question and present any one of the active person in the group.
The DCHS also addressed the participants and requested all to list out the priorities by analyzing of
the situation in their areas and quality output are to be expecting from each discussion, which might
be useful to give a quality report after the meeting.
While before start the consultation meeting all the facilitators are briefed the questions in Telugu and
distributed the validation sheets to record their valuable discussions and requested them to write their
group no on top of the page and the last page the name of the Group participants.
Question wise Group Discussion Details are As follows:
3. Priority needs: (this question was discussed by 1 to 6 groups as mentioned above).
b) What are some of the priority needs at the community level in your area? (health, education,
water, electricity, communication, transport and connectivity, etc.)
23
Group Feed back after the Discussion 01 Health, Education, Water, Electricity, Transport and Connectivity 02 Health, Education, Drainage facility, safe drinking water 03 Health, Transport, water, Electricity, Education & Communication 04 Electricity, Communication, Health, Education 05 Education, Health, Transport, Water, Electricity & Communication 06 Health, Education, Water, Transportation, Electricity & Communication
Most of the participants are identified top Priority need is Health and the second Priority is Education
and 3rd
Priority is Water, 4th
priority Electricity, 5th
priority is Transportation, 6th
Priority is
Communication & last priority Connectivity. They expressed that the person is healthy the other
needs are automatically filled up.
4. Socio economic background:(this question was discussed by 1 to 6 groups as mentioned
above.)
a) What is the socio-economic background of the patients visiting the health facility? (Caste,
income level, profession, etc.)
b) Do you capture this information in your records?
Group Feed back after the Discussion
a) Question b) Question
01 All Categories mainly SC,BC,ST,
OC, Yes (Name, Age, Sex, Area details are capturing
while in OP registration) while in registration of
specific programmes like MCH MMHC, TB,
HIV/AIDS we are capturing the details of Case,
income, & Occupation details)
80% of the patients belongs to
BPL & rest are 20% are APL
Mostly Agriculture labor &
Construction worker 02 Most of the people belongs to
BPL mainly SC,ST,BC and
occupation wise they belongs to
Agriculture & Construction
Yes, capturing the data in the records
03 Most of the visited people to the
health facility are BPL
background and Mainly they
belongs to SC,ST, BC
communities
Partially recording the data
04 Most Of the people visiting to the
health facility they all are belongs
to BPL & Mainly belongs to
SC,ST,BC
Partially Recording (Name,Age, Sex,Adress)
05 All Categories mainly SC,BC,ST,
& Minorities
75% Of the people belongs to
BPL& 25% APL families and
Daily wages &Labour
06 All Categories mainly SC,BC,ST,
OC, Partially recording
80% of the patients belongs to
BPL & rest are 20% are APL
Mostly Agriculture labor &
Construction worker
Most of the teams are expressed that the visited patients are all below poverty line people mainly SC,
BC, ST and Economically Back Ward OCs and most of the aged people are mainly visiting the health
facilities for various aliments, the ratio of BPL is above 70% and APL are below 30%, regarding
24
occupation most of them are Agriculture back ground especially farmers and agriculture labors, daily
coolies and Construction workers. All of them expressed that they are capturing the information by
recording of their Name, Age, Sex and residential area and suffering disease & Provided treatment
particulars, but in Maternal & Child Health services especially at the time of registration they are
collecting the information of all their socio economic details like cast, religion, income, and their
occupation particulars etc.,
5. Access:
a) Is your health facility accessible to your target population? What radius do you serve?
Group Feed back after the Discussion
01 Yes, all Health facilities are located in accessible areas, the coverage areas of PHC is 7 to
8 km , AH- 25 to 30 km, DH- 40 to 50 km radius, the mode of Transportation by Bus,
Auto. 02 Yes, the SCs are Walkable distance, Some of the PHCs By walk or own vehicles
Maximum time will reach any health facility may around to take 30 Minutes 03 Yes, it is accessible to the population & due to having better health care services the
neighboring Districts like Prakasham, Krishna people are utilizing our facilities
04 Yes, almost all the centers are situated near to the public and they are coming by Walk,
Auto, own vechile and bus 05 80% of the hospitals are accessible to the target population (DH,AH,CHC) and take
time to reach within 15 min by Autos, bus and by walk, each centre coverage is around
30 km radious 06 Yes, But some of the PHCs are farway from the connected villages (8 to 10 km radius) 07 In some of the areas the Sub centers are located in 3km distance to the villages, the Mode
of Transportation they used to come by Bus, Auto time 30 minits. 08 Yes, most of the centres are in walkable distance & Public transportation is available all
urban e-UPHCs PP units are very near to the public and to reach just 5 to 10 min, but the
sub centers are walkable in villages, and to reach some PHCs/ CHCs may take around 15
to 30 min 09 At the sea coast there is no PHC to fisher folk communities to reach any health facility
they have to go 10 km radius, they usually goes to Bapatla which is 10 KM distance by
Riksha, Auto /Bus for getting first aid treatment. 10 Almost all Health care facilities are situated in accessible areas, if patient is stable they
will go by walk or by Auto, in case of emergency using EMRI (108) services,
Most of the groups are expressed that the Health facilities are accessible to the target population
especially all the sub Health Centers are situated in the village and accessible areas, 85% of the
Primary Health Centers are also situated in the accessible areas, the rest of 15% centers are outskirts
of the village with in 1 KM distance of main village, but all these centers have road accessibility. All
the Secondary and tertiary care facilities are situated in the main villages/towns and accessible to the
communities.
6. Footfall:
a) What is the average patient foot-fall? Average number figure (male and female). (Will be
available in the OP register)
Group Feed back after the Discussion 01 OP Average in PHCs are 75 out of which -Male:30, Female:45, Average Patient flow at
AH is around 700 Patients out of which male: 300, Female:400 and at District Hospital is
around 1100 out of which 500 Male & Female is 600 02 The Sub Centre OP per day is around 10 out of which male 4 and female 6 05 Monthly OP on an average at DH is 20,000, at AH is 10,000 and at CHC is 4000
25
approximately the ratio of Female 60% and the rest 40% are male & Pediatrics. At the District level the ratio of sharing of OP at PHC 10%, CHC 20% AH 30% & DH
40%
All the Groups are expressed that at the Sub Centre on an average daily OP is around 15-20, at the
PHC OP is 50-80, and CHC Op is 100 to 200, AH OP is 200 – 400 and Tertiary care facilities OP is
more than 400 per day. We are also recording every day OP in E Aushadi and segregated male and
Female on every day.
7. Comment on the infrastructure in your facility from a safety and adequacy perspective.
(since AP is a disaster zone).
a) Are there public buildings (Schools, hostels, etc) that can serve as storm shelters.
b) What is the process followed in case of a natural disaster?
Group Feed back after the Discussion
c) Question d) Question
01 Yes, the Govt., constructed thufon
shelters and also utilizing the Schools,
hostel buildings during the disaster
period.
Alert the public by using of local media like
tom-tom, mike announcements, scrolling in
local tv channels.
02 Utilizing all the public Building during
disaster period Tomtom, communicating information through
proper channel 03 Pakka buldings are available and use
them as storm shelters. Alerting the public by all line department staff
as per Disaster Response Action Plan 04 Yes, the School & hostel buildings are
being used during storm period. All are
in good condition
TV advertisement and Phone Communication
to the villagers
05 Yes utilizing the schools & hostel
buildings during disaster period all the
existing buildings in coastal belt are in
good condition and accessible distance.
Alert the public by local tom-tom, news
channels evacuating the people to the safest
places, relief and rehabilitation activities are in
round the clock while in disaster period(Health
Camps, Serving food Etc.,) 06 Utilizing the existing School & Hostels
buildings, community halls they are in
good condition
Revenue teams will alert the villages & shift
the risky population to nearest public buildings
07 Public buildings are available to meet
the load .
08 Community halls ,School, hostel
Buildings are available and those are in
good condition 09 Buildings are in good condition but they
are not sufficient & need to construct
some more in big size. 10 Hostel & School Buildings are in good
condition and sufficient
8. Disaster management: 1 to 6 Groups
a) Do you have a disaster management plan?
b) In case of a disaster what is your role and what is the chain of command?
Group Feed back after the Discussion
26
c) Question d) Question
01 Yes we have disaster Management Plan
and have the committee at District level,
we meet at the time of disaster for
proper implementation of Disaster
Management Plan.
In evacuating the villagers, organizing round
the clock Health camps at the rehabilitation
centers
02 Yes, we have the plan & follow as per
the Planning process Alert the target audience for evacuation,
carried out the water & sanitation activities
after the disaster, Providing of treatment
services for the needy 03 Yes, we have Disaster Management
Plan. Organize special health camps round the
clock, Procurement of all the drugs, See
alternate power supply, separate ward for
emergency, deputation of Manpower and
utilizing the NGO services. 04 Yes, we have Disaster Management
Plan As per the prescribed action plan
implementing various relief and Rehabilitation
activities. 05 Yes, we have Disaster Management
Plan Alert all ANC & PNCs to reach the storm
shelters, to alert the staff procure the
emergency drugs, keep Ambulance at rescue
homes implementing triage protocals 06 Yes, implementing as per norms Act as per the instructions of the control room,
Providing round the clock Services Medical
camps, Rescue camps, mobilize EDD women,
Old age People, utilizing all the department
staff in rescue operations.
8 Feedback and Patient Satisfaction (1 to 6 Groups)
c) Do you gather feedback from patients? (Y/N) and details, if yes.
d) How does the hospital monitor patient satisfaction? Sample, frequency, etc
Group Feed back after the Discussion
c) Question d) Question
01 Yes we gather feedback from OP and IP
patients Hospital regularly monitor the patient
satisfaction levels through the questioner. 02 No No 03 Yes 5% of interaction from OP and IP patients 04 Yes Interaction with the Patients of OP and IP and
to get the feedback of Compliant box 05 Yes Maintaining the questioner 06 Yes At the time of visiting the facility, we interact
with OP and IP patients to know their
satisfaction levels on patient services.
12. Awareness Programmes Does the HCF undertake awareness programs/activities at the
community level? Please given details.
d) Do you conduct programs at the village and tanda level?
e) Do you share preventive, curative and palliative care information with the community?
f) Do you have IEC material
Group Feed back after the Discussion
27
d) Question e) Question f) Question
01 Yes Yes Yes 02 Yes Yes Yes 03 Yes Yes Yes 04 Yes Yes Yes 05 Yes Yes Yes 06 Yes Yes Yes 07 Yes, Conducting
awareness camps on
Domala pai Danda
Yaatra, VHNDs, CSC,
Mothers meeting,
PMSMA
Yes giving relevant
information Yes
08 Yes, Yes Yes 09 Yes Yes Yes 10 Yes, involving the
Village level committees
for tanda people
sensitization on nutrition
& MCH Careetc.,
Yes, providing relevant
information Yes
13. Committees: (1to 10 Groups)
e) Does the HCF have a health monitoring committees/hospital representative committees?
f) How frequently do they meet?
g) What is their role?
h) How are the members selected? (Please take a note of the minutes.)
Group Feed back after the Discussion
e) Question f) Question g) Question h) Question
01 Yes (Hospital
Development
Society (HDS)
Monthly Once To discuss issues & approve
action Plans Members are selected
based on Government
guidelines 02 Yes, VHSNCs Once in 15 Days To discuss Village Health
Plans As Above
03 Yes HDS Once in a Month To discuss Hospital
development Plans &
Review Key Performance
indicators
As above
04 Yes Monthly ones Hospital development
activities As per Government
Guidelines 05 Yes Monthly Ones Review, planning,
Suggestions on
Development activities
As per Government
Guidelines
06 Yes Monthly Ones Review, planning,
Suggestions on
Development activities
As per Government
Guidelines
07 Yes VHSNCs Once in 15 days Discuss on village health
Plan, review village health
activities especially on
Public Sensitization
As Per Government
Guidelines
08 -- -- -- The service providers
have no Idea on it 09 Yes VHSNCs Once in a
Monthly ones Discuss village level health
issues like Health awareness,
As per Government
Guidelines
28
MCH care, Water &
Sanitation & other epidemic
control etc., 10 Yes Monthly Twice Review of all village
development activities As per guidelines
14. Gender ( 1 to 10 Groups):
c) Based on your observations, do you feel that women come for check-ups/treatments at
advanced stages of the disease compared to men?
d) Do women ignore their health?
Group Feed back after the Discussion
a) Question b) Question
01 Yes Yes 02 Yes No 03 No Yes 04 No Yes 05 Yes Yes 06 Yes Yes 07 Yes Yes 08 Female % is high than Man due to the
low immunity power and lack of
nutrition
Yes very few Person are ignore their health,
but we overcome this ignorance by sensitizing
the village women by our ASHA , ANM etc., 09 Yes Yes 10 Yes Yes
15. Please capture details of the functioning medicine dispensing ATMs located in tribal areas.
Group 9 is actively participated and shared the following information.
We have Two Health ATMs in Guntur District, they are installed in the Tribal PHCs they are at
Sirigiripaducovering of 3000 village population and Bollapalli covering of 5000 population. The main
aim of these ATMs are to work onissue that the patients where there is no medical officer is available
by using malty parameter monitor operated by Para Medical Staff through consultancy of concerned
medical officer by using SMS service. It is worked on remote invocation method, networking based
through SMS service. The System work on any cell number, this number was shared with four or five
phone numbers. Each ATM consists of Drug Wending Machine, Multipara Meter Monitor, Non-
invasive Hemoglobin Meter, and this ATM have 32 Blocks we can insert the Prescribed medicine in
the prescribed block, and fill these blocks with the concerned medicines whenever it is empty and
daily monitor the drug consumption by concerned pharmacist and Medical Officer. In this regard we
trained the Medical Officer, pharmacist and Staff Nurse on operating of these ATMs and also on
submission of Reports. The total numbers of patients served through these ATMs are 5178.
Environment Safeguards
10. Is the current waste segregation adequate for infectious wastes and sharps? (1,2,5,6,8,10)
Group Feed back after the Discussion 01 Yes, Proper segregation is done at DH, AH, CHC level through Safenviron, at PHC level
by safe Pits, and at the sub centre level the waste brought the PHC for dispose. 02 Yes, At the SC level using needle cutter and the concerned waste disposed at connected
PHC in weekly twice. 05 Yes, as per the guidelines of BMWM. 06 Segregation is being done as per the BMWM guidelines 08 Yes as per the Bio Medical Waste act.
29
10 Yes doing Properly at all the villages
11. What could be potential impacts of the incremental increase in waste generated through the
Project? (1,2,5,6,8,10)
Group Feed back after the Discussion 01 It will improve man power, budget, infrastructure and improved patient care 02 Prevent the outbreak epidemic, Pollution control etc., 05 Environmental care free and control of contagious diseases 06 Create Safe Environment and reduce the communicable disease burden 08 The main impact is to reduce the communicable diseases & prevent transmission 10 Pure environment and free from diseases
12. How can the project help manage these risks/impacts? (1 to 10 Groups)
Group Feed back after the Discussion 01 Improve Bio Medical Waste Management, Improving Infrastructure & Equipment and
increase HR which leads to improves the patient satisfaction 02 Upgraded skills and knowledge on manage these risks by proper training on BMW 03 Mainly hospital acquired infections mosocomial infections and environment safety
thereby providing good health to all the population 04 Create awareness among the public on proper dispose of waste at Health Institutions as
well as in villages 05 Proper Disposal and destruction of waste 06 Building the capacity of the staff for proper manage of these risks and make a sustainable
plan for prevention of these risks in future. 07 Free from un expected risks 08 Provides proper awareness among the public about the waste separation & on how to
manage these risks 09 By creating awareness among the tribal people we can manage the risk of infections. 10 By creating awareness among the public by proper dispose of waste.
13. What is the current treatment system of effluents/contaminated wastewater? ( 1 to 6 Groups)
Group Feed back after the Discussion 01 For disinfections using chlorination tank for contaminated waste water 02 Preparation of Hypo Chlorine Solution at the SC level 03 At present there is no establishment of prevent effluent plant at all Health care facilities
under control of DH and APVVP 04 Preparation of Hypo Chlorine Solution at the PHCs and at SCs level 05 Through chlorination tank 06 In DH/AH/CHC They are using chlorination tank but in sub centers they are preparing
Hypo Chlorine Solution
14. Can the project help to ensure effluents are suitably treated and disposed so that there are no risks
to the environment (soil and water bodies)? ( 1 to 6 Groups)
Group Feed back after the Discussion 01 yes, it will help for improving BMW to all facilities 02 Yes, to avoid unnecessary infections 03 Yes 04 Yes 05 Yes, by preventing contamination of soil & water 06 To avoid unnecessary exposures to the public health and reduce the infection rate at the
hospital level
30
15. Is Environment Health and Safety performance in larger hospitals being monitored? (energy use,
cleaning schedules, waste generation, effluent treatment, and occupational safety of medical staff)
Group Feed back after the Discussion 06 Yes it is being monitored by the Quality assurance team in the District and slowly
extending this monitoring process to all health care facilities, right now it is implemented
at GGH, Guntur, DH Tenali, AH Bapatla, Narasaraopet and 6 CHCs and we are
proposing some of the CHCs in the next phase. At the abvoe health care institutions in
Guntur there is no effluent treatment plant but the rest of activities are being
implemented on every day which is regularly monitored by the District QA team
16. Is there adequate availability of the consumables i.e. colored bins, bags, PPE gear for staff,
puncture proof containers, needle cutters etc.? (12,3,4,5,6,7,8,10)
Group Feed back after the Discussion 01 Some of the institutions are having Color coated bins, Bags, PPE, gear for staff puncture
proof containers, and all the Institutions have Needle Cutters 02 All the SCs have Needle cutters 03 In APVVP Hospitals some of the facilities are having color coated bins, PPE gear for
staff, puncture proof containers, needle cutters etc. at the PHC level we have only
Needle cutters but some of the PHCs have color coated bins. 04 At PHC level and SC level have the Needle Cutters and some of the PHCs have color
coated bins. 05 In APVVP Hospitals some of the facilities are having color coated bins, PPE gear for
staff, puncture proof containers, needle cutters etc. 06 Color coated bins, PPE gear for staff, Puncture Proof Containers and Needle cutters are
having at secondary and tertiary care facilities and need to be initiated color coated bins
and bags, PPE gear for staff at PHC level 07 Not using color coated bins at the SC level 08 Yes available as per new sanitation policy follow all rules and regulations, used color
coated bins, PPE gear for staff, Puncture proof container, needle cutters etc., 10 Yes, being used at health facilities
17. How frequently is health checkup and immunization conducted for staff and sanitation workers? (
1 to 6 Groups)
Group Feed back after the Discussion 01 Yes, Providing Health Checkup once in a year 02 At SC level and at Village level it is not implementing but whenever require provide free
health check up. 03 Yes, Providing Health Checkup once in a year at all APVVP Hospitals and at PHCs we
are referring to the secondary and tertiary care facilities whenever required. 04 No its not conducting at Village, SC, and PHC level 05 Yes, Providing Health Checkup once in a year 06 Yes, Providing Health Checkup once in a year at Higher care health facilities
18. Institutional Arrangements: ( 1,2,3,4,5,6 & 8)
a. What are the institutional arrangements for healthcare waste management and infection
control?
b. Are they sufficient to train, guide and implement these activities?
c. Can the project help?
31
Group Feed back after the Discussion
a b c 01 Implementing BMW
guidelines Sufficient but need manpower and to extend
trainings capacities to all the staff. Yes
02 Currently preparing hypo
chloride solution & Proper
segregation of waste
No and required to train all the staff on BMW
Management Yes
03 Implementing BMW
guidelines Yes, but need Infrastructure, manpower and
to extend trainings to all the staff on capacity
building
Yes
04 Implementing BMW
guidelines Yes, but need Infrastructure, manpower and
to extend trainings to all the staff on capacity
building
yes
05 Implementing BMW
guidelines Sufficient but need manpower and to extend
trainings capacities to all the staff. Yes
06 Regularly monitoring the
implementation of BMW
guidelines, organizing the
capacity building trainings
on infection control
Not sufficient there is a need to upgrade the
capacities of all health care staff on BMW
Management & on Scientific Sanitation
Policy
Yes
08 As per the BMW guidelines Sufficient and conducting trainings to the staff
periodically Yes
19. 10What are the current methods of disposal of chemical reagents and disinfectants- is there
impact to water bodies? : ( 1,2,3,4,5,6 & 8)
Group Feed back after the Discussion 01 At all health care facilities the Chlorination tanks are using for disposal of Chemical
reagents and disinfectants. Yes the impact is there on water bodies 02 Prepare Hypo chloride solutions for disposal of Chemical reagents & Disinfections and
there is no impact on water bodies 03 In APVVP Institutions mostly using chlorination tanks and at PHCs preparation of Hypo
chloride solutions for disinfections, Yes there is impact on water bodies 04 Preparation of Hypo chloride solution at PHCs and SC level, Yes some impact is there on
water bodies 05 At all health care facilities of secondary and tertiary care health facilities using
Chlorination tanks are using for disposal of Chemical reagents and disinfectants. Yes the
impact is there on water bodies 06 Preparing 1% chlorine solution for disinfection, after it is mixing with drainage lines as
per guidelines, at some of the facilities are mixing directly in drainage system so we are
planning to restrict it in future by upgrading the staff capacities on Proper dispose of
waste water. 08 Disposal of Chemical reagents in maximum facilities by chlorination tanks or hypo
chlorine solution.
20. Present methods of BMW disposal in rural areas (PHCs and the SCs) (where decentralized
treatment facilities are not available) and is there any pollution impacts due to these systems, can
the project support better alternatives? : ( 1 to 6 Groups)
Group Feed back after the Discussion 01 The bio Medical waste disposal in Rural areas is not available, Yes this project may
helpful to improve the BMW management in the rural areas and the PHCs and SC level
in various aspects. Plan to construct own treatment plant at 50 Bedded and above
institutions for proper dispose of waste. 02 Not available at the Villages the sub centre waste is took to the PHC for proper
32
disposable and some waste is disposed in the outskirts of the village by digging deep
pits., this project definitely useful to all the villages as well as primary health care
institutions 03 BMW is not at villages, but at some of the health institutions (DH,AH & CHCs) are
empanelled with Pollution board affiliated institution Safenviron for proper BMW, it is
too cost, so if we construct our own plant atleast in CHCs the connected PHCs & SCs can
utilize these plants for proper BMW. So this new Project may have better alternatives for
proper disposing of BMW. 04 Village level not using BMW process, this project may be helpful to protect the public
from various pollution aspects. 05 Not being implementing of BMW process at all the villages, this Project might be useful
to protect the public and free from pollution. 06 Not available in Rural areas, Bio Medical Waste is mixing with Panchaith or
Municipality waste, so its harmful to the public, the pollutions impact is more on the
health so this project might be useful for better alternative to protect the public free from
pollution.
Report Prepared by
(Dr.R.RAMA RAO)
DPO-NHM-GUNTUR
33
DOCUMENTATION OF STAKEHOLDER CONSULTATION IN KADAPA
BRIEF REPORT ON STAKEHOLDERS CONSULTATION MEETING OF KADAPA
DISTRICT ON AP HEALTH SYSTEM STRENGTHENING PROJECT
As per the instructions from the Director, SPIU O/o Special Chief Secretary, Health Medical
& Family Welfare Department through video conference on 19.12.2018, the District Medical &
Health Officer is organized a meeting on 21st at conference Hall, DM&HO Office, kadapa with
different following stakeholders to identify the priority needs on Health System Strengthening Project.
Group wise prescribed stakeholders are as follows
1. Medical staff including doctors, specialists, nurses, administrative staff, staff in-charge of
outreach activities, patient satisfaction surveys, etc. (10-15 personnel).
2. ANMs and ASHAs (10-15 personnel).
3. District Medical and Health Officer(DM&HO)(1) and District Coordinator Hospital
services(DCHS)(1)
4. Deputy DMHO (1).
5. Superintendent In- charge : A). District hospitals(1), B). Area hospitals (1), 3).CHCs(1).
6. NQAS - District Quality Consultant (1) and District Quality Manager (1)
7. Representatives from at least 5-6 village health communities, including vulnerable groups
and women. (10)
8. Representatives from service providers of PPP programs. (5)
9. Officials working on Tribal Reform Yardstick (TRY) (if applicable to the district)(5)
10. Representatives of self-help groups(10)
Preparatory Plan: The DPMU team and the Quality Assurance team is jointly organized a planning
meeting with the DM&HO and DCHS on 19th December at the DM&HO Chamber after the Video
Conference and then list out the name of the participants for this stakeholder consultation meeting,
and plan to conduct this meeting on 21st December’18, at conference hall,DM&HO office,Kadapa.
Inaugural session of the Meeting: The District Medical & Health Officer is inaugurated the meeting
by explaining the concept of the meeting and she requested all the participants to participate actively
and discuss on each and every point/Question and present any one of the active person in the group.
The DCHS also addressed the participants and requested all to list out the priorities by analyzing of
the situation in their areas and quality output are to be expecting from each discussion, which might
be useful to give a quality report after the meeting.
While before start the consultation meeting all the facilitators are briefed the questions in Telugu and
distributed the validation sheets to record their valuable discussions and requested them to write their
group no on top of the page and the last page the name of the Group participants.
Question wise Group Discussion Details are As follows:
1. Priority needs: (this question was discussed by 1 to 6 groups as mentioned above).
a) What are some of the priority needs at the community level in your area? (health, education,
water, electricity, communication, transport and connectivity, etc.)
Group Feed back after the Discussion 01 Health, Education, Water, Electricity, Transport and Connectivity 02 Health, Education, Drainage facility, safe drinking water 03 Health, Transport, water, Electricity, Education & Communication 04 Electricity, Communication, Health, Education 05 Education, Health, Transport, Water, Electricity & Communication 06 Health, Education, Water, Transportation, Electricity & Communication
34
Most of the participants are identified top Priority need is Health and the second Priority is Education
and 3rd
Priority is Water, 4th
priority Electricity, 5th
priority is Transportation, 6th
Priority is
Communication & last priority Connectivity. They expressed that the person is healthy the other
needs are automatically filled up.
2. Socio economic background:(this question was discussed by 1 to 6 groups as mentioned
above.)
a) What is the socio-economic background of the patients visiting the health facility? (Caste,
income level, profession, etc.)
b) Do you capture this information in your records?
Group Feed back after the Discussion
a) Question b) Question
01 All Categories mainly SC,BC,ST,
OC, Yes (Name, Age, Sex, Area details are
capturing while in OP registration) while in
registration of specific programmes like MCH
MMHC, TB, HIV/AIDS we are capturing the
details of Case, income, & Occupation details)
80% of the patients belongs to BPL
& rest are 20% are APL
Mostly Agriculture labor &
Construction worker 02 Most of the people belongs to BPL
mainly SC,ST,BC and occupation
wise they belongs to Agriculture &
Construction
Yes the data was captured in the op
registers,while the data regarding caste was not
registered
03 Most of the visited people to the
health facility are BPL background
and Mainly they belongs to SC,ST,
BC communities
Yes the data was captured in the op
registers,while the data regarding caste was not
registered
04 Most Of the people visiting to the
health facility they all are belongs to
BPL & Mainly belongs to
SC,ST,BC
Yes the data was captured in the op
registers,while the data regarding caste was not
registered
05 All Categories mainly SC,BC,ST, &
Minorities
75% Of the people belongs to
BPL& 25% APL families and
Daily wages &Labour
06 All Categories mainly SC,BC,ST,
OC, Yes the data was captured in the op
registers,while the data regarding caste was not
registered 80% of the patients belongs to BPL
& rest are 20% are APL
Mostly Agriculture labor &
Construction worker
Most of the teams are expressed that the visited patients are all below poverty line people mainly SC,
BC, ST and Economically Back Ward OCs and most of the aged people are mainly visiting the health
facilities for various aliments, the ratio of BPL is above 70% and APL are below 30%, regarding
occupation most of them are Agriculture back ground especially farmers and agriculture labors, daily
coolies and Construction workers. All of them expressed that they are capturing the information by
recording of their Name, Age, Sex and residential area and suffering disease & Provided treatment
particulars, but in Maternal & Child Health services especially at the time of registration they are
collecting the information of all their socio economic details like cast, religion, income, and their
occupation particulars etc.,
3. Access:
a) Is your health facility accessible to your target population? What radius do you serve?
35
Group Feed back after the Discussion
01 Yes, all Health facilities are located in accessible areas, the coverage areas of PHC is 10
to 15 km , AH-40 to 50 km, DH-73 to 78km radius, the mode of Transportation by Bus,
Auto. 02 Yes, the SCs are Walkable distance, Some of the PHCs By walk or own vehicles
Maximum time will reach any health facility may around to take 30 to 45 Minutes 03 Yes, it is accessible to the population & due to better health care services
04 Yes, almost all the centers are situated near to the public and they are coming by Walk,
Auto, own vechile and bus 05 80% of the hospitals are accessible to the target population (DH,AH,CHC) and take
time to reach within 10 to 20 min by Autos, bus and by walk, each centre coverage is
around 15 to 20km radious 06 Yes, But some of the PHCs are farway from the connected villages (more than 20km
radius) 07 In some of the areas the Sub centers are located in 5 to 7km distance to the villages, the
Mode of Transportation they used to come by Bus, Auto time 30 to 45 minutes. 08 Yes, most of the centres are in walkable distance & Public transportation is available all
urban e-UPHCs PP units are very near to the public and to reach just 5 to 10 min, but the
sub centers are walkable in villages, and to reach some PHCs/ CHCs may take around 10
to 15 min 09 ----
10 Almost all Health care facilities are situated in accessible areas, if patient is stable they
will go by walk or by Auto, in case of emergency using EMRI (108) services,
Most of the groups are expressed that the Health facilities are accessible to the target population
especially all the sub Health Centers are situated in the village and accessible areas, 85% of the
Primary Health Centers are also situated in the accessible areas, the rest of 15% centers are outskirts
of the village with in 1 KM distance of main village, but all these centers have road accessibility. All
the Secondary and tertiary care facilities are situated in the main villages/towns and accessible to the
communities.
4. Footfall:
a) What is the average patient foot-fall? Average number figure (male and female). (Will be
available in the OP register)
Group Feed back after the Discussion 01 OP Average in PHCs are 50 to 70out of which -Male:30, Female:40, Average Patient
flow at AH is around 850 Patients out of which male: 450, Female:300 at CHC are 600
out of which males:400 and females: 200and at District Hospital is around 1000 out of
which 500 Male & Female is 500 02 The Sub Centre OP per day is around 8 out of which male 4 and female 4 05 Monthly OP on an average at DH is 30,000, at AH is 25400 and at CHC is 18000
approximately the ratio of male 60% and the rest 40% are Female & Pediatrics. At the District level the ratio of sharing of OP at PHC 18%, CHC 20% AH 27% & DHC
35%
All the Groups are expressed that at the Sub Centre on an average daily OP is around 10, at the PHC
OP is 50-70, and CHC Op is 600, AH OP is 800 and Tertiary care facilities OP is more than 1000 per
day. We are also recording every day OP in E Aushadi and segregated male and Female on every day.
36
5. Comment on the infrastructure in your facility from a safety and adequacy perspective.
(since AP is a disaster zone).
a) Are there public buildings (Schools, hostels, etc) that can serve as storm shelters.
b) What is the process followed in case of a natural disaster?
Group Feed back after the Discussion
a) Question b) Question
01 Yes, the Govt., constructed thufon
shelters and also utilizing the Schools,
hostel buildings during the disaster
period.
Alert the public by using of local media like
tom-tom, mike announcements, scrolling in
local tv channels.
02 Utilizing all the public Building during
disaster period Tomtom, communicating information through
proper channel 03 Pakka buldings are available and use
them as storm shelters. Alerting the public by all line department staff
as per Disaster Response Action Plan 04 Yes, the School & hostel buildings are
being used during storm period. All are
in good condition
TV advertisement and phone Communication
to the villagers
05 Yes utilizing the schools & hostel
buildings during disaster period all the
existing buildings in the district are in
good condition and accessible distance.
Alert the public by local tom-tom, news
channels evacuating the people to the safest
places, relief and rehabilitation activities are in
round the clock while in disaster period(Health
Camps, Serving food Etc.,) 06 Utilizing the existing School & Hostels
buildings, community halls they are in
good condition
Revenue teams will alert the villages & shift
the risky population to nearest public buildings
07 Public buildings are available to meet
the load .
08 Community halls ,School, hostel
Buildings are available and those are in
good condition 09 ---- 10 Hostel & School Buildings are in good
condition and sufficient
6. Disaster management: 1 to 6 Groups
a) Do you have a disaster management plan?
b) In case of a disaster what is your role and what is the chain of command?
Group Feed back after the Discussion
a) Question b) Question
01 Yes we have disaster Management Plan
and have the committee at District level,
we meet at the time of disaster for
proper implementation of Disaster
Management Plan.
In evacuating the villagers, organizing round
the clock Health camps at the rehabilitation
centers
02 Yes, we have the plan & follow as per
the Planning process Alert the target audience for evacuation,
carried out the water & sanitation activities
after the disaster, Providing of treatment
services for the needy 03 Yes, we have Disaster Management
Plan. Organize special health camps round the
clock, Procurement of all the drugs, See
37
alternate power supply, separate ward for
emergency, deputation of Manpower and
utilizing the NGO services. 04 Yes, we have Disaster Management
Plan As per the prescribed action plan
implementing various relief and Rehabilitation
activities. 05 Yes, we have Disaster Management
Plan Alert all ANC & PNCs to reach the storm
shelters, to alert the staff procure the
emergency drugs, keep Ambulance at rescue
homes implementing triage protocals 06 Yes, implementing as per norms Act as per the instructions of the control room,
Providing round the clock Services Medical
camps, Rescue camps, mobilize EDD women,
Old age People, utilizing all the department
staff in rescue operations.
7 Feedback and Patient Satisfaction (1 to 6 Groups)
a) Do you gather feedback from patients? (Y/N) and details, if yes.
b) How does the hospital monitor patient satisfaction? Sample, frequency, etc
Group Feed back after the Discussion
a) Question b) Question
01 Yes we gather feedback from OP and IP
patients Hospital regularly monitor the patient
satisfaction levels through the questioner. 02 No No 03 Yes 5% of interaction from OP and IP patients 04 Yes Interaction with the Patients of OP and IP and
to get the feedback of Compliant box 05 Yes Maintaining the questioner 06 Yes At the time of visiting the facility, we interact
with OP and IP patients to know their
satisfaction levels on patient services.
8. Awareness Programmes Does the HCF undertake awareness programs/activities at the
community level? Please given details.
a) Do you conduct programs at the village and tanda level?
b) Do you share preventive, curative and palliative care information with the community?
c) Do you have IEC material
Group Feed back after the Discussion
a) Question b) Question c) Question
01 Yes Yes Yes 02 Yes,conducting camps on
swine flu,awareness on
TB, palakarimpu
programmes
Yes Yes
03 Yes Yes Yes 04 Yes Yes Yes 05 Yes Yes Yes 06 Yes Yes Yes 07 Yes, giving relevant
information Yes giving relevant
information Yes
38
08 Yes, Yes Yes 09 ---- ---- ---- 10 Yes, involving the
Village level committees
for tanda people
sensitization on nutrition
& MCH Careetc.,
Yes, providing relevant
information Yes
9. Committees: (1to 10 Groups)
a) Does the HCF have a health monitoring committees/hospital representative committees?
b) How frequently do they meet?
c) What is their role?
d) How are the members selected? (Please take a note of the minutes.)
Group Feed back after the Discussion
a) Question b) Question c) Question d) Question
01 Yes (Hospital
Development
Society (HDS)
Monthly Once To discuss issues & approve
action Plans Members are selected
based on Government
guidelines 02 Yes, VHSNCs Once in 15 Days To discuss Village Health
Plans As Above
03 Yes HDS Once in a Month To discuss Hospital
development Plans &
Review Key Performance
indicators
As above
04 Yes Monthly once Hospital development
activities As per Government
Guidelines 05 Yes Monthly Oncs Review, planning,
Suggestions on
Development activities
As per Government
Guidelines
06 Yes Monthly Once Review, planning,
Suggestions on
Development activities
As per Government
Guidelines
07 Yes Once in 15 days Discuss on village health
Plan, review village health
activities especially on
Public Sensitization
As Per Government
Guidelines
08 -- -- -- The service providers
have no Idea on it 09 -- -- -- -- 10 Yes Monthly Twice Review of all village
development activities As per guidelines
10. Gender ( 1 to 10 Groups):
a) Based on your observations, do you feel that women come for check-ups/treatments at
advanced stages of the disease compared to men?
b) Do women ignore their health?
Group Feed back after the Discussion
a) Question b) Question
01 Yes Yes 02 Yes No 03 No Yes 04 No Yes
39
05 Yes Yes 06 Yes Yes 07 Yes Yes 08 Female % is high than Man due to the
low immunity power and lack of
nutrition
Yes very few Person are ignore their health,
but we overcome this ignorance by sensitizing
the village women by our ASHA , ANM etc., 09 Yes Yes 10 Yes Yes
11. Please capture details of the functioning medicine dispensing ATMs located in tribal areas.
Yes we have two ATMS in kadapa district they are installed in PHC. They are at Nuliveedu and
Veeraballi with 15000 and 28000 population respectively.
Environment Safeguards
1. Is the current waste segregation adequate for infectious wastes and sharps? (1,2,5,6,8,10)
Group Feed back after the Discussion 01 Yes, Proper segregation is done at DH, AH, CHC level through Safenviron, at PHC level
by safe Pits, and at the sub centre level the waste brought the PHC for dispose. 02 Yes, At the SC level using needle cutter and the concerned waste disposed at connected
PHC in weekly twice. 05 Yes, as per the guidelines of BMWM. 06 Segregation is being done as per the BMWM guidelines 08 Yes as per the Bio Medical Waste act. 10 Yes doing Properly at all the villages
2. What could be potential impacts of the incremental increase in waste generated through the
Project? (1,2,5,6,8,10)
Group Feed back after the Discussion 01 It will improve man power, budget, infrastructure and improved patient care 02 Prevent the outbreak epidemic, Pollution control etc., 05 Environmental care free and control of contagious diseases 06 Create Safe Environment and reduce the communicable disease burden 08 The main impact is to reduce the communicable diseases & prevent transmission 10 Pure environment and free from diseases
3. How can the project help manage these risks/impacts? (1 to 8,10 Groups)
Group Feed back after the Discussion 01 Improve Bio Medical Waste Management, Improving Infrastructure & Equipment and
increase HR which leads to improves the patient satisfaction 02 Upgraded skills and knowledge on manage these risks by proper training on BMW 03 Mainly hospital acquired infections mosocomial infections and environment safety
thereby providing good health to all the population 04 Create awareness among the public on proper dispose of waste at Health Institutions as
well as in villages 05 Proper Disposal and destruction of waste 06 Building the capacity of the staff for proper manage of these risks and make a sustainable
plan for prevention of these risks in future. 07 Free from un expected risks 08 Provides proper awareness among the public about the waste separation & on how to
manage these risks 09 ----
40
10 By creating awareness among the public by proper dispose of waste.
4. What is the current treatment system of effluents/contaminated wastewater? ( 1 to 6 Groups)
Group Feed back after the Discussion 01 For disinfections using chlorination tank for contaminated waste water 02 Preparation of Hypo Chlorine Solution at the SC level 03 At present there is no establishment of prevent effluent plant at all Health care facilities
under control of DH and APVVP 04 Preparation of Hypo Chlorine Solution at the PHCs and at SCs level 05 Through chlorination tank 06 In DH/AH/CHC They are using chlorination tank but in sub centers they are preparing
Hypo Chlorine Solution
5. Can the project help to ensure effluents are suitably treated and disposed so that there are no risks
to the environment (soil and water bodies)? ( 1 to 6 Groups)
Group Feed back after the Discussion 01 yes, it will help for improving BMW to all facilities 02 Yes, to avoid unnecessary infections 03 Yes 04 Yes 05 Yes, by preventing contamination of soil & water 06 To avoid unnecessary exposures to the public health and reduce the infection rate at the
hospital level
6. Is Environment Health and Safety performance in larger hospitals being monitored? (energy use,
cleaning schedules, waste generation, effluent treatment, and occupational safety of medical staff)
Group Feed back after the Discussion 06 Yes it is being monitored by the Quality assurance team in the District and slowly
extending this monitoring process to all health care facilities, right now it is implemented
at RIMS KADAPA,DH PRODUTUR,and we are proposing some of the CHCs in the
next phase. At the abvoe health care institutions in Kadapa there is no effluent treatment
plant but the rest of activities are being implemented on every day which is regularly
monitored by the District QA team
7. Is there adequate availability of the consumables i.e. colored bins, bags, PPE gear for staff,
puncture proof containers, needle cutters etc.? (1,2,3,4,5,6,7,8,10)
Group Feed back after the Discussion 01 Some of the institutions are having Color coded bins, Bags, PPE, gear for staff puncture
proof containers, and all the Institutions have Needle Cutters 02 All the SCs have Needle cutters 03 In APVVP Hospitals some of the facilities are having color coded bins, PPE gear for
staff, puncture proof containers, needle cutters etc. at the PHC level we have only
Needle cutters but some of the PHCs have color coated bins. 04 At PHC level and SC level have the Needle Cutters and some of the PHCs have color
coded bins.but not in a sufficient number 05 In APVVP Hospitals some of the facilities are having color coated bins, PPE gear for
staff, puncture proof containers, needle cutters etc. 06 Color coded need to be initiated color coated bins and bags, PPE gear for staff at PHC
level 07 Not using color coded bins at the SubCenter level they are supplied with red and black
41
plastic covers 08 Yes available as per new sanitation policy follow all rules and regulations, used color
coated bins, PPE gear for staff, Puncture proof container, needle cutters etc., 10 Yes, being used at health facilities
8. How frequently is health checkup and immunization conducted for staff and sanitation workers? (
1 to 6 Groups)
Group Feed back after the Discussion 01 Yes, Providing Health Checkup once in a year 02 At SC level and at Village level it is not implementing but whenever require provide free
health check up. 03 Yes, Providing Health Checkup once in a year at all APVVP Hospitals and at PHCs we
are referring to the secondary and tertiary care facilities whenever required. 04 No its not conducting at Village, SC, and PHC level 05 Yes, Providing Health Checkup once in a year 06 Yes, Providing Health Checkup once in a year at Higher care health facilities
9. Institutional Arrangements: ( 1,2,3,4,5,6 & 8)
a. What are the institutional arrangements for healthcare waste management and infection
control?
b. Are they sufficient to train, guide and implement these activities?
c. Can the project help?
Group Feed back after the Discussion
a b c 01 Implementing BMW
guidelines Sufficient but need manpower and to extend
trainings capacities to all the staff. Yes
02 Currently preparing hypo
chloride solution & Proper
segregation of waste
No and required to train all the staff on BMW
Management Yes
03 Implementing BMW
guidelines Yes, but need Infrastructure, manpower and
to extend trainings to all the staff on capacity
building
Yes
04 Implementing BMW
guidelines Yes, but need Infrastructure, manpower and
to extend trainings to all the staff on capacity
building
yes
05 Implementing BMW
guidelines Sufficient but need manpower and to extend
trainings capacities to all the staff. Yes
06 Regularly monitoring the
implementation of BMW
guidelines, organizing the
capacity building trainings
on infection control
Not sufficient there is a need to upgrade the
capacities of all health care staff on BMW
Management & on Scientific Sanitation
Policy
Yes
08 As per the BMW guidelines Sufficient and conducting trainings to the staff
periodically Yes
10. 10What are the current methods of disposal of chemical reagents and disinfectants- is there
impact to water bodies? : ( 1,2,3,4,5,6 & 8)
Group Feed back after the Discussion 01 At all health care facilities the Chlorination tanks are using for disposal of Chemical
reagents and disinfectants. Yes the impact is there on water bodies 02 Prepare Hypo chloride solutions for disposal of Chemical reagents & Disinfections and
there is no impact on water bodies
42
03 In APVVP Institutions mostly using chlorination tanks and at PHCs preparation of Hypo
chloride solutions for disinfections, Yes there is impact on water bodies 04 Preparation of Hypo chloride solution at PHCs and SC level, Yes some impact is there on
water bodies 05 At all health care facilities of secondary and tertiary care health facilities using
Chlorination tanks are using for disposal of Chemical reagents and disinfectants. Yes the
impact is there on water bodies 06 Preparing 1% chlorine solution for disinfection, after it is mixing with drainage lines as
per guidelines, at some of the facilities are mixing directly in drainage system so we are
planning to restrict it in future by upgrading the staff capacities on Proper dispose of
waste water. 08 Disposal of Chemical reagents in maximum facilities by chlorination tanks or hypo
chlorine solution.
11. Present methods of BMW disposal in rural areas (PHCs and the SCs) (where decentralized
treatment facilities are not available) and is there any pollution impacts due to these systems, can
the project support better alternatives? : ( 1 to 6 Groups)
Group Feed back after the Discussion 01 The bio Medical waste disposal in Rural areas is not available, Yes this project may
helpful to improve the BMW management in the rural areas and the PHCs and SC level
in various aspects. Plan to construct own treatment plant at 50 Bedded and above
institutions for proper dispose of waste. 02 Not available at the Villages the sub centre waste is took to the PHC for proper
disposable and some waste is disposed in the outskirts of the village by digging deep
pits., this project definitely useful to all the villages as well as primary health care
institutions 03 BMW is not at villages, but at some of the health institutions (DH,AH & CHCs) are
empanelled with Pollution board affiliated institution Safenviron for proper BMW, it is
too cost, so if we construct our own plant atleast in CHCs the connected PHCs & SCs can
utilize these plants for proper BMW. So this new Project may have better alternatives for
proper disposing of BMW. 04 Village level not using BMW process, this project may be helpful to protect the public
from various pollution aspects. 05 Not being implementing of BMW process at all the villages, this Project might be useful
to protect the public and free from pollution. 06 Not available in Rural areas, Bio Medical Waste is mixing with Panchaith or
Municipality waste, so its harmful to the public, the pollutions impact is more on the
health so this project might be useful for better alternative to protect the public free from
pollution.
Report Prepared by
Sd/- Dr.UMA SUNDARI
DM&HO, KADAPA.
43
44
DOCUMENTATION OF STAKEHOLDER CONSULTATION IN NELLORE
As per the As per the instructions from the Director, SPIU O/o Special Chief Secretary, Health
Medical & Family Welfare Department through video conference on 19.12.2018, the District Medical
& Health Officer is organized a meeting on 21st at Training Hall O/o DMHO- SPSR Nellore with
different following stakeholders to identify the priority needs on Health System Strengthening Project.
Group wise prescribed stakeholders are as follows
1. Medical staff including doctors, specialists, nurses, administrative staff, staff in-charge of
outreach activities, patient satisfaction surveys, etc. (10-15 personnel).
2. ANMs and ASHAs (10-15 personnel).
3. District Medical and Health Officer(DM&HO)(1) and District Coordinator Hospital
services(DCHS)(1)
4. Deputy DMHO (1).
5. Superintendent In- charge : A). District hospitals(1), B). Area hospitals (1), 3). CHCs(1).
6. NQAS - District Quality Consultant (1) and District Quality Manager (1)
7. Representatives from at least 5-6 village health communities, including vulnerable groups
and women. (10)
8. Representatives from service providers of PPP programs. (5)
9. Representatives of self-help groups(10)
Preparatory Plan: The DPMU team and the Quality Assurance team is jointly organized a planning
meeting with the DM&HO and DCHS on 19th December at the DM&HO Chamber after the Video
Conference and then list out the name of the participants for this stakeholder consultation meeting,
and plan to conduct this meeting on 21st December’18,
Inaugural session of the Meeting: The District Medical & Health Officer is inaugurated the meeting
by explaining the concept of the meeting and he requested all the participants to participate actively
and discuss on each and every point/Question and present any one of the active person in the group.
The DCHS also addressed the participants and requested all to list out the priorities by analyzing of
45
the situation in their areas and quality output are to be expecting from each discussion, which might
be useful to give a quality report after the meeting.
While before start the consultation meeting all the facilitators are briefed the questions in Telugu and
distributed the validation sheets to record their valuable discussions and requested them to write their
group no on top of the page and the last page the name of the Group participants.
Question wise Group Discussion Details are As follows:
9. Priority needs: (this question was discussed by 1 to 6 groups as mentioned above).
c) What are some of the priority needs at the community level in your area? (health,
education, water, electricity, communication, transport and connectivity, etc.)
Group Feed back after the Discussion Participants
01 to 6 Health, Education, Water, Electricity,
Transport and Connectivity
Medical Officers, Superintendents,
DY DM&HOs
QAC DM & DC SHGs ,ASHAs
&Committee Representatives
Most of the participants are identified top Priority need is Health and the second Priority is Education
and 3rd
Priority is Water, 4th
priority Electricity, 5th
priority is Transportation, 6th
Priority is
Communication & last priority Connectivity. They expressed that the person is healthy the other
needs are automatically filled up.
10. Socio economic background: (this question was discussed by 1 to 6 groups as mentioned
above.)
a) What is the socio-economic background of the patients visiting the health facility?
(Caste, income level, profession, etc.)
b) Do you capture this information in your records?
Group Feed back after the Discussion Participants
01 to 6 70% of BPL and 30% of above APL are utilizing
Health Services
SC, ST and BCs are utilizing the health services at
SC and PHC level
Most of Laymen people
Yes, all Details of the patient’s information was
registered at PHC records
Medical Officers,
Superintendents, DY
DM&HOs
QAC DM & DC SHGs
,ASHAs &Committee
Representatives
Most of the teams are expressed that the visited patients are all below poverty line people mainly SC,
BC, ST and Economically Back Ward OCs and most of the aged people are mainly attending, the
ratio of BPL is above 70% and APL are below 30%, regarding occupation most of them are
Agriculture back ground especially farmers and agriculture labors and Construction workers. All of
them expressed that they are capturing the information by recording of their Name, Age, Sex and
residential area and suffering disease & Provided treatment particulars, but in Maternal & Child
Health services especially at the time of registration they are collecting the information of all their
socio economic details like cast, religion, income, and their occupation particulars etc.,
46
11. Access:
a) Is your health facility accessible to your target population? What radius do you serve?
Group Feed back after the Discussion Participants
1 to 10 Yes, Health facility is accessible to the target
population
The Radius of Health facility is 0 km to 15 km
maximum
Accessible to all villages with proper roads
0 km to 03 km access to Urban Health Centers for
slum dwellers
Medical Officers,
Superintendents, DY DM&HOs
QAC DM & DC SHGs ,ASHAs
&Committee Representatives,
PPP, SN
Most of the groups are expressed that the Health facilities are accessible to the target population
especially all the sub Health Centers are situated in the village and accessible areas, 85% of the
Primary Health Centers are also situated in the accessible areas, the rest of 15% centers are outskirts
of the village with in 1 KM distance of main village, but all these centers have road accessibility. All
the Secondary and tertiary care facilities are situated in the main villages/towns and accessible to the
communities.
12. Footfall:
a) What is the average patient foot-fall? Average number figure (male and female). (Will
be available in the OP register)
Group Feed back after the Discussion Participants
1,2,5 The average patient foot – fall of Health
facility is 100 to 120 persons
Out of OP 60% of women and 40% of Men are
patients ratio
Exclusively at SC level 15 to 20
PHC level 60 to 150
Area Hospital 150 to 200
District Hospital 200 to 300
Tertiary care facility is above 300
Medical Officers, Superintendents, DY
DM&HOs
ASHAs & ANMs
All the Groups are expressed that at the Sub Centre on an average daily OP is around 15-20, at the
PHC OP is 50-80, and CHC Op is 100 to 200, AH OP is 200 – 400 and Tertiary care facilities OP is
more than 400 per day. We are also recording every day OP in E Aushadi and segregated male and
Female on every day.
13. Comment on the infrastructure in your facility from a safety and adequacy perspective.
(since AP is a disaster zone).
a) Are there public buildings (Schools, hostels, etc) that can serve as storm shelters.
b) What is the process followed in case of a natural disaster?
Group Feed back after the Discussion Participants
1 to 5 Health facilities are fully equipped
infrastructure with safety measures and
adequate resources
Yes, every village have school building and
major villages have hostels, all these
institutions can serve as storm shelters
Ready with life safe medicines, emergency
Medical Officers, Superintendents, DY
DM&HOs
47
medicines
Storage of drinking water, power back up,
drugs, as shelters for ANCs
24x7 round the clock, qualified staff
Round clock OP and IP services are
avaliable
14. Disaster management:
a) Do you have a disaster management plan?
b) In case of a disaster what is your role and what is the chain of command?
Group Feed back after the Discussion Participants
1 to 6 Yes, Disaster Management plan is maintain
at District Hospital
Disaster Management committee has been
constitute at DH and AH
Costal area Health facility staff has
undergone training on disaster management
Maintain emergency drugs
Medical relief committee and volunteers
should be on force
108 vechles should be alert at time of
disasters time
Medical Officers, Superintendents, DY
DM&HOs
QAC DM & DC
9 Feedback and Patient Satisfaction
e) Do you gather feedback from patients? (Y/N) and details, if yes.
f) How does the hospital monitor patient satisfaction? Sample, frequency, etc/
Group Feed back after the Discussion Participants
1 to 8 Yes, getting satisfaction from face book,
Interaction with the Patients of OP and IP
and to get the feedback of Compliant box
At the time of visiting the facility, we
interact with OP and IP patients to know
their satisfaction levels on patient services
Medical Officers, Superintendents, DY
DM&HOs
QAC DM & DC SHGs ,ASHAs
&Committee Representatives, PPP, SN
16. Awareness Programmes Does the HCF undertake awareness programs/activities at the
community level? Please given details.
g) Do you conduct programs at the village and tanda level?
h) Do you share preventive, curative and palliative care information with the community?
i) Do you have IEC material
Group Feed back after the Discussion Participants
1 to 6 Yes , we have been organizing HCF
awareness programs
Every Progrmme is been organizing at
Medical Officers, Superintendents, DY
DM&HOs
QAC DM & DC, supervisors, ANMs
48
Village and Tandas
Yes, Health staff sharing the preventive,
curative and palliative care through IEC and
groups meeting in prescribed time at all
villages and tandas
Every Programme have separate IEC
materials
Door sticks, Flims display at move halls,
pamphlets, hand bills, announcements
through media, and local TVs etc.
Yes, involving the Village level committees
for tanda people sensitization on nutrition &
MCH Careetc.,
and and Staff Nurses
17. Committees:
i) Does the HCF have a health monitoring committees/hospital representative committees?
j) How frequently do they meet?
k) What is their role?
l) How are the members selected? (Please take a note of the minutes.)
m)
Group Feed back after the Discussion Participants
1 to 9 Yes (Hospital Development Society (HDS)
Every Month HDS meeting has been
organizing
To discuss Hospital development Plans &
Review Key Performance indicators
Discuss on village health Plan, review
village health activities especially on Public
Sensitization
Members are selected based on Government
guidelines
Medical Officers, Superintendents, DY
DM&HOs
QAC DM & DC SHGs ,ASHAs
&Committee Representatives, PPP, SN
18. Gender:
e) Based on your observations, do you feel that women come for check-ups/treatments at
advanced stages of the disease compared to men?
f) Do women ignore their health?
Group Feed back after the Discussion Participants
1 to 10
Female % is high than Man due to the low
immunity power and lack of nutrition
Yes very few Person are ignore their health,
but we overcome this ignorance by
sensitizing the village women by our ASHA ,
ANM etc.,
Medical Officers, Superintendents, DY
DM&HOs
QAC DM & DC SHGs ,ASHAs
&Committee Representatives, PPP, SN
19. Please capture details of the functioning medicine dispensing ATMs located in tribal areas.
49
The ATM is not located at Trible ares, because SPSR Nellore district doesn’t have prescribed
Tribal areas, it was located at PHC MD Puram.
Environment Safeguards
21. Is the current waste segregation adequate for infectious wastes and sharps?
Group Feed back after the Discussion Participants
1,2,5,6,8,10
Yes, Proper segregation is done at DH, AH,
CHC level through SS Bia care, at PHC
level by safe Pits, and at the sub centre
level the waste brought the PHC for
dispose.
At the SC level using needle cutter and the
concerned waste disposed at connected
PHC in weekly twice.
Segregation is being done as per the
BMWM guidelines
Doing Properly at all the villages
Medical Officers, Superintendents, DY
DM&HOs
QAC DM & DC SHGs ,ASHAs
&Committee Representatives, PPP, SN
22. What could be potential impacts of the incremental increase in waste generated through the
Project?
Group Feed back after the Discussion Participants
1,2,5,6,8,10
It will improve man power, budget,
infrastructure and improved patient care
Prevent the outbreak epidemic, Pollution
control etc.,
Environmental care free and control of
contagious diseases
Pure environment and free from diseases
Create Safe Environment and reduce the
communicable disease burden
The main impact is to reduce the
communicable diseases & prevent
transmission
Medical Officers, Superintendents, DY
DM&HOs
QAC DM & DC
23. How can the project help manage these risks/impacts?
Group Feed back after the Discussion Participants
1 to 10
By creating awareness among the public by
proper dispose of waste.
Provides proper awareness among the public
about the waste separation & on how to
manage these risks
Building the capacity of the staff for proper
manage of these risks and make a sustainable
plan for prevention of these risks in future.
Improve Bio Medical Waste Management,
Improving Infrastructure & Equipment and
increase HR which leads to improves the
patient satisfaction
Medical Officers, Superintendents, DY
DM&HOs
QAC DM & DC,PPP
50
Mainly hospital acquired infections
mosocomial infections and environment
safety thereby providing good health to all
the population
24. What is the current treatment system of effluents/contaminated wastewater?
Group Feed back after the Discussion Participants
1 to 6
There is no establishment of prevent effluent
plant at all Health care facilities under
control of DH and APVVP
In DH/AH/CHC They are using chlorination
tank but in sub centers they are preparing
Hypo Chlorine Solution
Preparation of Hypo Chlorine Solution at the
SC level
For disinfections using chlorination tank for
contaminated waste water
Medical Officers, Superintendents, DY
DM&HOs
QAC DM & DC PPP
25. Can the project help to ensure effluents are suitably treated and disposed so that there are no risks
to the environment (soil and water bodies)?
Group Feed back after the Discussion Participants
1 to 6
Yes, it will help for improving BMW to all
facilities
To avoid unnecessary exposures to the public
health and reduce the infection rate at the
hospital level
Can avoid unnecessary infections
Medical Officers, Superintendents, DY
DM&HOs
QAC DM & DC, PPP
26. Is Environment Health and Safety performance in larger hospitals being monitored? (energy use,
cleaning schedules, waste generation, effluent treatment, and occupational safety of medical staff)
Group Feed back after the Discussion Participants
6
Yes it is being monitored by the Quality
assurance team in the District and slowly
extending this monitoring process to all
health care facilities
Activities are being implemented on every
day which is regularly monitored by the
District QA team
Medical Officers, Superintendents, DY
DM&HOs
QAC DM & DC
51
27. Is there adequate availability of the consumables i.e. colored bins, bags, PPE gear for staff,
puncture proof containers, needle cutters etc.?
Group Feed back after the Discussion Participants
1 to 1o
In APVVP Hospitals some of the facilities are
having color coated bins, PPE gear for staff,
puncture proof containers, needle cutters etc. at
the PHC level we have only Needle cutters but
some of the PHCs have color coated bins.
Some of the institutions are having Color coated
bins, Bags, PPE, gear for staff puncture proof
containers, and all the Institutions have Needle
Cutters
Not using color coated bins at the SC level
Yes available as per new sanitation policy follow
all rules and regulations, used color coated bins,
PPE gear for staff, Puncture proof container,
needle cutters etc.,
Medical Officers, Superintendents,
DY DM&HOs
QAC DM & DC SHGs ,ASHAs
&Committee Representatives, PPP,
SN
28. How frequently is health checkup and immunization conducted for staff and sanitation workers?
Group Feed back after the Discussion Participants
1 to 6
Yes, Providing Health Checkup once in a year at
all APVVP Hospitals and at PHCs we are
referring to the secondary and tertiary care
facilities whenever required.
No its not conducting at Village, SC, and PHC
level
At SC level and at Village level it is not
implementing but whenever require provide free
health check up.
Medical Officers, Superintendents,
DY DM&HOs
QAC DM & DC
29. Institutional Arrangements:
a. What are the institutional arrangements for healthcare waste management and infection
control?
b. Are they sufficient to train, guide and implement these activities?
c. Can the project help?
Group Feed back after the Discussion Participants
1 to 6,8
Yes, Implementing BMW guidelines
Sufficient but need manpower and to extend
trainings capacities to all the staff.
Not sufficient there is a need to upgrade the
capacities of all health care staff on BMW
Management & on Scientific Sanitation
Policy
Yes it is really help this project
Sufficient and conducting trainings to the
staff periodically
Medical Officers, Superintendents, DY
DM&HOs
QAC DM & DC
30. What are the current methods of disposal of chemical reagents and disinfectants- is there impact
to water bodies?
52
Group Feed back after the Discussion Participants
1 to 6,8
Yes the impact is there on water bodies, At
all health care facilities the Chlorination
tanks are using for disposal of Chemical
reagents and disinfectants
Prepare Hypo chloride solutions for disposal
of Chemical reagents & Disinfections and
there is no impact on water bodies
At all health care facilities of secondary and
tertiary care health facilities using
Chlorination tanks are using for disposal of
Chemical reagents and disinfectants. Yes the
impact is there on water bodies
Preparing 1% chlorine solution for
disinfection, after it is mixing with drainage
lines as per guidelines, at some of the
facilities are mixing directly in drainage
system so we are planning to restrict it in
future by upgrading the staff capacities on
Proper dispose of waste water.
Medical Officers, Superintendents, DY
DM&HOs
QAC DM & DC SHGs ,ASHAs
&Committee Representatives, PPP, SN
31. Present methods of BMW disposal in rural areas (PHCs and the SCs) (where decentralized
treatment facilities are not available) and is there any pollution impacts due to these systems, can
the project support better alternatives?
Group Feed back after the Discussion Participants
1 to 6,
The bio Medical waste disposal in Rural
areas is not available, Yes this project may
helpful to improve the BMW management in
the rural areas and the PHCs and SC level in
various aspects. Plan to construct own
treatment plant at 50 Bedded and above
institutions for proper dispose of waste.
Not available at the Villages the sub centre
waste is took to the PHC for proper
disposable and some waste is disposed in the
outskirts of the village by digging deep pits.,
this project definitely useful to all the
villages as well as primary health care
institutions
Municipality waste, so its harmful to the
public, the pollutions impact is more on the
health so this project might be useful for
better alternative to protect the public free
from pollution.
Medical Officers, Superintendents, DY
DM&HOs
QAC DM & DC SHGs ,ASHAs
&Committee Representatives, PPP, SN
Report Prepared by
(K. Ramesh) District Medical and Halth Officer
DPO-NHM-Nellore
53
Photo Gallery
54
DOCUMENTATION OF STAKEHOLDER CONSULTATION IN PRAKASAM
Govt. of Andhra Pradesh
Health, Medical & Family Welfare Department
(Prakasam Dist ., Ongole)
AP Health Systems Strengthening Project (P167581)
STAKEHOLDERS CONSULTATION MEET
Venue: Collector’s Conference Hall Date: 21-12-2018
Environmental and Social Management Framework workshop was inaguarated by in charge DMHO
Dr.K.Padmavathi and DCHS Dr.S.Usharani and Dy DMHO Dr.B.Madhavilatha with identified list of
stake holders for consultation. Workshop conducted in Collectors conference hall with 10 round
tables for stakeholder.64 members participated from different groups. Explained the questioner by
DCHS and DCQ. All the stakeholders were formed groups at their allotted seats, they participated
actively. All the stakeholders raised their doubts positively, District team clarified their doubts and
also done active consultation in effective manner. Stakeholder’s filled questioner after discussion with
their group members.
The programme was closed by vote of thanks by DMHO, DCHS and Dy DMHO.
Group wise prescribed stakeholders are as follows
1. Medical staff including doctors, specialists, nurses, administrative staff, staff in- charge of
outreach activities, patient satisfaction surveys, etc. (10-15 personnel). Group 2
2. ANMs and ASHAs (10-15 personnel). Group 5
3. District Medical and Health Officer(DM&HO)(1) and District Coordinator Hospital
services(DCHS)(1) Group 8
4. Deputy DMHO (1). Group 10
5. Superintendent In- charge : A). District hospitals(1), B). Area hospitals (1), 3). CHCs(1).
Group 1
6. NQAS - District Quality Consultant (1) and District Quality Manager (1) Group 9
7. Representatives from at least 5-6 village health communities, including vulnerable groups
and women. (10) group 6
8. Representatives from service providers of PPP programs. (5) group 4
9. Officials working on Tribal Reform Yardstick (TRY) (if applicable to the district)(5)-
group 3
10. Representatives of self-help groups(10) group 7
Question wise Group Discussion Details are As follows:
15. Priority needs: (this question was discussed by 1 to 6 groups as mentioned above).
d) What are some of the priority needs at the community level in your area? (health, education,
water, electricity, communication, transport and connectivity, etc.)
Group Feed back after the Discussion
01 Tropical Diseases like T.B, Malaria, Kidney Diseases, Fluorosis or these needs more
awareness health education.
Water :- Water scarcity for drinking due to less rainfall.
02 Safe and protected water sufficient drugs to be provided. Frequent bus facilities is to be
improved for transport.
55
Frequent bus facility is to be improved for transportation of patient from their distances to
health facility.
03 Tribal :- No transport for 28 tribal gudes in Prakasam District. No communication for 22
tribal gudes.
Full pledged infrastructure and skilled man power needed.
04 Domestic and drinking water needed.
05 Roads, Power, water, sanitation, toilets, public transport R.O Plants, Parks, Soakage pits.
06 Street lights, toilets, drainage system, anganawadi centres and health centres needed.
07 Roads, Power, water, sanitation, toilets, public transport R.O Plants, Parks, Soakage pits
08 Health, water & communication
09 Hygiene, Sanitation
10 Health, Eduation, Water, electricity, transport are important priority needs in our
community
Most of the participants are identified top Priority need is Health, water, education, roads, toilets,
public transports, in specially tribal area prioritized transport and communication system.
16. Socio economic background: (this question was discussed by 1 to 6 groups as mentioned
above.)
a) What is the socio-economic background of the patients visiting the health facility? (Caste,
income level, profession, etc.)
b) Do you capture this information in your records?
Group Feed back after the Discussion
c) Question d) Question
01 Low socio economic background
people are visited like SC, ST,
Maintained daily OP register.
02 Middle class people are came to
hospitals.
Patients details in the records.
03 All are belongs to BPL and
Agriculture labourers, those are
SC 40%, 35% ST, 20% BC, Other
50%.
We entering the records with detail report.
04 Daily wages and economical
backwards
Yes,
05 Everybody came to the hospitals Yes
06 Below poverty line Yes
07 Below poverty line Yes
08 Middle class and Below Poverty yes
09 All Cates mainly SC, ST and OBC Not all times
10 Irrespective of cast, community,
income all the people in the
community will come to hospital
depending on their needs
Yes, we will record in OP register daily.
56
Most of the teams are expressed that the visited patients are all below poverty line people mainly SC,
BC, ST and Economically Back Ward OCs and most of the aged people are mainly attending, the
ratio of BPL is above 70% and APL are below 30%, regarding occupation most of them are
Agriculture back ground especially farmers and agriculture labors and Construction workers. All of
them expressed that they are capturing the information by recording of their Name, Age, Sex and
residential area and suffering disease & Provided treatment particulars, but in Maternal & Child
Health services especially at the time of registration they are collecting the information of all their
socio economic details like cast, religion, income, and their occupation particulars etc.,
17. Access:
a) Is your health facility accessible to your target population? What radius do you serve?
Group Feed back after the Discussion
01 Accessible, needs more transportation services like ambulances.
02 By walk, auto, own vehicle, for more to be village, nearly it will take 30minutes.
03 Majority people came by walk and no own vehicles, auto facilities, no bus services, in
most of the tribal area.
Nearly 20 to 30 Kms radius, takes 1 to 3 hours.
04 Mostly came by own vehicle but required more ambulances.
05 Sub centres are Accessible
06 Accessible
07 Accessible
08 Yes, District Radius is 17,626 KM and Target Population is 36,0000
09 Accessible
10 Yes, Health Facility is accessible to target population, but at present it may modified
depending on community needs that the health facility may be increased. The patient we
will use to come to facility by Bus or Auto or by their own arrangements.
Most of the groups are expressed that the Health facilities are accessible to the target population
especially all the sub Health Centers are situated in the village and accessible areas, 85% of the
Primary Health Centers are also situated in the accessible areas, the rest of 15% centers are outskirts
of the village with in 1 KM distance of main village, but all these centers have road accessibility. All
the Secondary and tertiary care facilities are situated in the main villages/towns and accessible to the
communities.
18. Footfall:
a) What is the average patient foot-fall? Average number figure (male and female). (Will be
available in the OP register)
All the Groups are expressed that at the Sub Centre on an average daily OP is around 15-20, at the
PHC OP is 50-80, and CHC Op is 100 to 200, AH OP is 200 – 400 and Tertiary care facilities OP is
more than 400 per day. We are also recording every day OP in E Aushadi and segregated male and
Female on every day.
Group Feed back after the Discussion
01 CHC level, 300, 50% Female, Male 40%, 10% children,
Ahs, 500, 60% Female, Male 30%, 10% Children.
Dist. Level, 800, 50% Female, Male 30%, 20% Children.
57
02 Monthly OP 1000, 70% are Female, 30% are Males.
03 Sub-centre - 60% Female, 40% Male.
PHCs – 60% Female, 40% Male.
04 PHCs - 60% Female, 40% Male.
05 PHCs - 70% Female, 30% Male.
06 PHCs - 45% Female, 35% Male. Children 20%
07 PHCs - 50% Female, 50% Male.
08 About 85 to 90 / Month/ Dis, Females more than males
09 500-700@ AH, 250-300@ CHC, 200-100 @ PHC and 10 – 20 Sub Centre.
10 Because I am divisional Officer, I don’t have information, PHC nearly 100 per day
19. Comment on the infrastructure in your facility from a safety and adequacy perspective. (since
AP is a disaster zone).
a) Are there public buildings (Schools, hostels, etc) that can serve as storm shelters.
b) What is the process followed in case of a natural disaster?
Group Feed back after the Discussion
e) Question f) Question
01 AHs safe place, CHCs safe zone, DHs
side by Gundlakamma may be flood,
forway from the town.
02 Yes, separate cyclone centres, schools,
utilizing for cyclone centres and all are
in good condition.
Keeping sufficient midlines, necessary
transport to be nearest rehabilitation centres.
03 No cyclone effects the Tribal area
frequently we effect with floods and far
that we are having adequate shelter . we
are not having adequate facility it is
highly draught area and majority people
will be migrated only PAS we are
having
-
04 - -
05 Yes,
06 Yes, we have To create awareness through tom tom and
mike announcement.
07 Schools, rehabilitation centers’. Coordinate concerned Departments.
08 Yes Radio, Television and Massage
09 Yes Radio, Television and Massage
10 In some places we safe buildings, but in
some places we have but latest
information must be gathered by doing
survey
During disasters we follow TAM TAM, Radio,
TV in alert warning by Revenue and Police
58
20. Disaster management:
a) Do you have a disaster management plan?
b) In case of a disaster what is your role and what is the chain of command?
Group Feed back after the Discussion
e) Question f) Question
01 Yes, we have disaster management plan.
We will coordinate with all related
departments and NGOs.
02 Taking immediate steps by preparedness
of special planning i.e. avocation
shifting the people nearest safety places.
Preparing action plan, appointing rapid action
teams’ arrangements and medical camps,
health awareness camps to be conducted.
03 We are follow the dist. Authority
instructions and messaged by whatsup
and prepared with epidemic team at
PHC and Mandal level.
Yes, arranged medical camps, shelters.
04 - -
05 To connect with concerned departments,
arranged food, water and also
generators.
Conducting health camps.
06 Yes To cooperate with departments.
07 No plan, Acting as volunteer to decrease disasters
effect.
08 Yes Yes
09 There is no District specific
management plan
No chain of Command
10 In PHCs we are having permanent
Disaster or Cyclone control plans When
alert warnings comes the divisional
officer must available at my head
quarters in monitor health and medical
activities when ever needed
No communications to command control
centre
10 Feedback and Patient Satisfaction
g) Do you gather feedback from patients? (Y/N) and details, if yes.
h) How does the hospital monitor patient satisfaction? Sample, frequency, etc
Group Feed back after the Discussion
e) Question f) Question
01 Yes, We have complaint box verifying the
complaints and feed back every week and
taken actions.
02 Maintaining 9 suggestion boxes, at all
health facilities and maintaining
register, Present satisfaction score is
around 90%.
By collecting feedback form and sometimes
orally also.
03 Complaint box, ITDA Grievance cell, We conducting regularly hospitals staff
59
Meekosam-1100 since one year. meeting and discussion about required
complaints and taking preventable measures
and rectify the issues.
04 - -
05 Yes, Taking feed back from patients.
06 Yes Taking complaint and clarifying the problem.
07 Yes Not collecting
08 Yes Regularly
09 No Very Less Monitoring
10 No feed back from patients Not collecting
20. Awareness Programmes Does the HCF undertake awareness programs/activities at the
community level? Please give details.
j) Do you conduct programs at the village and tanda level?
k) Do you share preventive, curative and palliative care information with the community?
l) Do you have IEC material
Group Feed back after the Discussion
g) Question h) Question i) Question
01 At hospital level, not in
community level
Yes, whoever visit our hospital Yes but not adequate
02 Yes Health education school health
educatiion,VHND meeting,ANC
clinics, implementation of all
national health
programmes,handwash,Swatch
barath ,Palaklarimpi I and II
YES
03 Health education school health
education, VHND meeting, ANC
clinics, implementation of all
national health programmers,
hand wash, Swatchbarath
,Palaklarimpi I and II
YES YES
04 Yes Only for seasonal diseases yes
05 Through Gramasabha,VHND and
flyers
-- --
06 Through
Gramasabha,VHND,VHNC
,HDS.
Through home visits Pam plates, wall
posters, home visits
07 Health awareness
camps,community health camps
-- No
08 Yes Yes yes
09 Yes Not Adequate Yes
10 All National Programmes PH Staff sharing preventive, Yes, Good IEC
60
awareness or conducting at
village level by ASHAS, ANM’s
& AWW
curative information with
community
material.
21. Committees:
n) Does the HCF have a health monitoring committees/hospital representative committees?
o) How frequently do they meet?
p) What is their role?
q) How are the members selected? (Please take a note of the minutes.)
Group Feed back after the Discussion
i) Question j) Question k) Question l) Question
01 Yes Monthly We will involve all
activities
Philanthropists
,NGO,Social
workers
02 HDS,VHNSC,Gra
masamakya,IFC,D
MC,Drug audit
committee.
Monthly twice --- --
03 Convergence
meeting with line
dept.,ITDA
,Mandal
level,village
level.HDS,VHNS
C,Gramasamakya,I
FC,DMC,Drug
audit committee
Monthly Avtive role in Hospital
development and
community welfare.
Formulated by
govtrnment and
involved in placing,
implementation and
resolution passing
following NHM
guidelines
04 -- -- -- For government
officials for PPP
quality control
qualified staff
05 Yes Home visits Group
meetings,panchayat
meetings
Following important
resolutions according
to government rules.
By Panchayat
president and Asha
06 Yes Meet regularly Create awareness According to their
role
07 Yes Meet regularly Create awareness and
empowerment of the
community(women).
NA
08 Monthly Once They will give
suggestions for
Improvement of HCF
Participate in Meeting As per state officer
Guidelines
09 HDS Monthly Activley participating Elected yearly by
District collector
and Magistrate as
per GO
10 PHC, HDS Once in every month Discussion and As per State
61
committees implementation of
developmental needs at
PCH level and
subcentre level
Government
guidelines
22. Gender:
g) Based on your observations, do you feel that women come for check-ups/treatments at
advanced stages of the disease compared to men?
h) Do women ignore their health?
Group Feed back after the Discussion
a) Question b) Question
1 YES YES
2 Yes- coming late due to lack of
awareness
Yes up to some extent
3 Yes –it is male dominating
community (Tribal)
Yes-Due to illiteracy in women.
4 Yes No
5 Yes Due to work tensions
6 Yes- Male dominating No –they take care of their own health.
7 Yes- Male dominating They forgot their health.
8 No No
9 Yes Yes
10 No Male and Female reference Depending on severity of disease they will
attend to at PHC,CHC , AH & DH level
23. Please capture details of the functioning medicine dispensing ATMs located in tribal areas.
Only 3rd
group is having ATM at PHC Palutla it is not working due to proper network .some
more required in tribal CHCs.
Group 9 is actively participated and shared the following information.
Environment Safeguards
32. Is the current waste segregation adequate for infectious wastes and sharps?
Group Feed back after the Discussion
01 Needs Bio Medical Waste management Segregation Rooms
02 Biomedical waste Management is not maintained properly
03 Yes in CHC only, PHC/ Sub centers Inadequate.
04 Yes
05 No
06 No
62
07 Not adequate
08 Yes
09 Not adequate
10 Yes, correctly happening in PHCs
33. What could be potential impacts of the incremental increase in waste generated through the
Project?
Group Feed back after the Discussion
01 Definitely this project helps in Biomedical waste Management
02 For better improvement of BMW of at all levels i.e Sub centre, PHC, CHC, and AH
03 To Prevent health of High risk group and Community.
04 There will be no impact since it is sterile and damped
05 Improvement of BMW at Sub centers
06 No Idea
07 No idea
08 ---
09 High Impact will be there if granted
10 This project definitely help us
34. How can the project help manage these risks/impacts?
Group Feed back after the Discussion
01 By providing infrastructure and Material and HR for BMW
2 Recycling of environmental sanitation, to prevent cross infection and Nosocomial
infections.
03 It needs effective implementation and monitoring by the higher authorityand ground
level.
04 Has to train more in BMW and Increase the staff for BMW management.
05 Very much
06 No Idea
07 No Idea
08 ---
09 Yes
10 This project help by providing infrastructure, establishing all medical and health needs at
community level
35. What is the current treatment system of effluents/contaminated wastewater?
Group Feed back after the Discussion
01 There is no current treatment system of effluents/contaminated wastewater
2 Not Present
63
03 At PHC/CHC primary level treatment for liquid waste and Proper disposal with Hypo
04 Will neutralize the chemicals and drain out in general drainage, but no proper system for
viral waste water.
05 Not present at Sub centre level
06 Not present
07 Not applicable
08 Abate Stray & Oil Balls, chlorination.
09 There is no any system in place
10 Not there at present level
36. Can the project help to ensure effluents are suitably treated and disposed so that there are no risks
to the environment (soil and water bodies)?
Group Feed back after the Discussion
01 Yes, definitely helpful by providing , Infrastructure, material and HR
02 Yes it is usefull
03 Yes.
04 To bring the advanced system of treatment of water and avoid the waste in contact to soil.
05 Yes
06 Yes
07 Yes
08 Yes with proper Drainage for waste water.
09 Yes
10 Yes
37. Is Environment Health and Safety performance in larger hospitals being monitored? (energy use,
cleaning schedules, waste generation, effluent treatment, and occupational safety of medical staff)
Group Feed back after the Discussion
01 Yes
02 Yes
03 Yes- it is not upto the optimum level, ssp at CHC level only, TT, Ever six month health
check up
04 Yes – health and Safety is being monitored by hospital admin staff.
05 No idea
06 No Idea
07 Not applicable
08 Yes
09 No Monitoring
10 Iam divisional office at PCH level . CHCs and AH doe’nt cover my supervison
64
38. Is there adequate availability of the consumables i.e. colored bins, bags, PPE gear for staff,
puncture proof containers, needle cutters etc.?
Group Feed back after the Discussion
01 Yes, Need to Impove
02 Yes
03 Yes it is not up to the optimum level.
04 Yes
05 Not Adequate
06 No
07 No
08 Yes
09 Not Adequate
10 In some PHC, it is adequate and in some PHC it must be improved.
39. How frequently is health checkup and immunization conducted for staff and sanitation workers?
Group Feed back after the Discussion
01 Conducting for every 6th
months
02 Once in 6 months for health staff
03 Ever six month
04 Investigation and Viral screening- Every 3 months – Monthly vaccination – as per
protocol( By the respective Organisation)
05 Once in Six months
06 Once in year
07 Once In six month
08 Health checkup once in 6 moths an dwhen ever necessary immunization is conducted.
09 Not done regularly
10 Not conducting up to my knowledge
40. Institutional Arrangements:
a. What are the institutional arrangements for healthcare waste management and infection
control?
b. Are they sufficient to train, guide and implement these activities?
c. Can the project help?
Group Feed back after the Discussion
A Questions B Question C Question
01 Collection, Segregation and
Transportation
Sufficient Yes Definitely
2 Formed committees, Supply
of PPE’s to all persons who
Training to b
needed in a
It helps a lot
65
are involved in BMW and
Infection control
regular manner
03 Bio medical waste
management formation and
implemented actively
SSP by worker,
Staff nurse,
training forever 3
months.
To prevent health hazards.
04 By Local Waste
management vendor for
Medical waste and General
waste by Municipality.
Yes by Giving
Advanced
Equipment for
Collection.
--
05 In Sub centers there is no
Such Practice
No Training Yes
06 Not applicable Not applicable Not applicable
07 Not applicable Not applicable Not applicable
08 Through authorized Private
agency.
Yes yes
09 PPE No Yes
10 Presently conducting by
private management at
PHCs
PHCs need
training and need
improvement
Yes
41. 10 What are the current methods of disposal of chemical reagents and disinfectants- is there
impact to water bodies?
Group Feed back after the Discussion
01 Washed in the Sink – NO
02 It is not properly done, ys there is a impact of water bodies,
03 BMW is use full, Yes required implementation of liquid waste
04 Neutralization of chemicals and disinfectants and no impact of watr bodies.
05 No methods at present
06 Not applicable
07 Not applicable
08 Through private agency
09 NO chemical reagents and Disinfectants
10 No methods at present
42. Present methods of BMW disposal in rural areas (PHCs and the SCs) (where decentralized
treatment facilities are not available) and is there any pollution impacts due to these systems, can
the project support better alternatives?
Group Feed back after the Discussion
01 Yes
2 BMW material of Sub centers`` is brought to PHC and buried in a Pit of PHC, which is
Polluting the Environment. By providing BMW services at Sub centers and PHCs It can
66
be improved.
03 Bio medical Waste management required effective implementation at ground level, PHC/
Sub centers and habitation level
04 By dumping the deep ground, need tp provide proper BMW disposal in rural areas.
05 In Sub centers present there is no such situation , But BMW management is required
06 Not applicable
07 Not applicable.
08 BMW system available at PHCs, But in sub centers it is not available, Sub centres need
proper buildings and link to BMW disposal management system.
09 Not available. Yes if project supports
10 Presently doing EMW by private organization at PHC but it must be improved.
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