Environmental and Social Management Framework for the ......2019/02/26 · perspective. (since AP is a disaster zone). Are there public buildings (Schools, hostels, etc) that can

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

3

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?


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



Occupation etc.)


Majority of patients belong to

BPL. Mostly Labourers.

Yes. . (Name, Age, Sex, Area details are capturing



Occupation etc.)

5


some from middle income

group,employees both from private

and govt institutes.Majority of

patients belong to BPL. Mostly

Agricultural Labourers.




Occupation etc.)

06 All categories mainly

BC,SC,ST. Majority of patients

belong to BPL.




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?


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

6

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)


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?


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?



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



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


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.


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.)


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.

http://hmfw.ap.gov.in/rbsk-program.aspx

http://hmfw.ap.gov.in/rksk-program.aspx

http://hmfw.ap.gov.in/rntcp-program.aspx

http://hmfw.ap.gov.in/nlep-program.aspx

http://hmfw.ap.gov.in/npcb-program.aspx

http://hmfw.ap.gov.in/maternal-program.aspx



http://hmfw.ap.gov.in/niddcp-program.aspx

http://hmfw.ap.gov.in/npcdcs-program.aspx

http://hmfw.ap.gov.in/nphce-program.aspx

http://hmfw.ap.gov.in/ntcp-program.aspx

http://hmfw.ap.gov.in/nvbdcp-program.aspx

http://hmfw.ap.gov.in/healthcare-atm-program.aspx

http://hmfw.ap.gov.in/free-drugs-program.aspx



11

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.


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

12

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

13

1. Is the current waste segregation adequate for infectious wastes and sharps? (Categories-

1,2,3,5,6,8,10)


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)


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)


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

14

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)


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)


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)


1,3,5,5,6 Monitored in Teaching hospital, DH,AH,CHC through SSP survivellance.Online portal

15

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

16

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)

17

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)


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)


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?


A B C

01 By tie up with EVB Yes Yes

18

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




management. Safety pits are

available in all PHC.

Yes Yes




management

Yes Yes




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)


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)


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:

https://en.wikipedia.org/wiki/Microorganism

https://en.wikipedia.org/wiki/Pathogen

https://en.wikipedia.org/wiki/Waterborne_diseases

https://en.wikipedia.org/wiki/Coliform_bacteria

https://en.wikipedia.org/wiki/Indicator_bacteria

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.

https://en.wikipedia.org/wiki/Burkholderia_pseudomallei

https://en.wikipedia.org/wiki/Cryptosporidium_parvum

https://en.wikipedia.org/wiki/Giardia_lamblia

https://en.wikipedia.org/wiki/Salmonella

https://en.wikipedia.org/wiki/Norovirus

https://en.wikipedia.org/wiki/Sanitation

https://en.wikipedia.org/wiki/Septic_tank

https://en.wikipedia.org/wiki/Pit_latrine

https://en.wikipedia.org/wiki/Sewage

https://en.wikipedia.org/wiki/Sewage

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.






services(DCHS)(1)

4. Deputy DMHO (1).

5. Superintendent In- charge : A). District hospitals(1), B). Area hospitals (1), 3).CHCs(1).



and women. (10)




Preparatory Plan: The DPMU team and the Quality Assurance team is jointly organized a planning


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.



b) What are some of the priority needs at the community level in your area? (health, education,


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.)






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)


& Minorities

75% Of the people belongs to

BPL& 25% APL families and

Daily wages &Labour


OC, Partially recording

80% of the patients belongs to

BPL & rest are 20% are APL


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?


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,






communities.

6. Footfall:

a) What is the average patient foot-fall? Average number figure (male and female). (Will be


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%


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?


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?


26


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



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.



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


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.)


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


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


d) Do women ignore their health?



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.


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.


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


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


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)


control?



31


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



building

yes

05 Implementing BMW



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.






services(DCHS)(1)

4. Deputy DMHO (1).

5. Superintendent In- charge : A). District hospitals(1), B). Area hospitals (1), 3).CHCs(1).



and women. (10)







and plan to conduct this meeting on 21st December’18, at conference hall,DM&HO office,Kadapa.


by explaining the concept of the meeting and she requested all the participants to participate actively










a) What are some of the priority needs at the community level in your area? (health, education,


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


and 3rd




Priority is



2. Socio economic background:(this question was discussed by 1 to 6 groups as mentioned

above.)







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


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



registered

04 Most Of the people visiting to the

health facility they all are belongs to

BPL & Mainly belongs to

SC,ST,BC



registered

05 All Categories mainly SC,BC,ST, &

Minorities

75% Of the people belongs to

BPL& 25% APL families and

Daily wages &Labour


OC, Yes the data was captured in the op


registered 80% of the patients belongs to BPL

& rest are 20% are APL


Construction worker


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:


35


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,






communities.

4. Footfall:



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







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





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



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.



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


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.)


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


As per Government

Guidelines

06 Yes Monthly Once Review, planning,

Suggestions on


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


b) Do women ignore their health?



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


but we overcome this ignorance by sensitizing

the village women by our ASHA , ANM etc., 09 Yes Yes 10 Yes Yes


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.


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


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



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



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


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)


control?




a b c 01 Implementing BMW



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



building

Yes

04 Implementing BMW



building

yes

05 Implementing BMW



06 Regularly monitoring the

implementation of BMW

guidelines, organizing the

capacity building trainings

on infection control




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.



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.






services(DCHS)(1)

4. Deputy DMHO (1).




and women. (10)






and plan to conduct this meeting on 21st December’18,


by explaining the concept of the meeting and he requested all the participants to participate actively



45








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


and 3rd




Priority is




above.)

a) What is the socio-economic background of the patients visiting the health facility?

(Caste, income level, profession, etc.)



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


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




46

11. Access:



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


&Committee Representatives,

PPP, SN






communities.

12. Footfall:

a) What is the average patient foot-fall? Average number figure (male and female). (Will

be available in the OP register)


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










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


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:




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


DM&HOs

QAC DM & DC


e) Do you gather feedback from patients? (Y/N) and details, if yes.

f) How does the hospital monitor patient satisfaction? Sample, frequency, etc/


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


DM&HOs


&Committee Representatives, PPP, SN



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


1 to 6 Yes , we have been organizing HCF

awareness programs

Every Progrmme is been organizing at


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)


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


DM&HOs



18. Gender:

e) Based on your observations, do you feel that women come for check-ups/treatments at


f) Do women ignore their health?


1 to 10

Female % is high than Man due to the low

immunity power and lack of nutrition


but we overcome this ignorance by

sensitizing the village women by our ASHA ,

ANM etc.,


DM&HOs




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.


21. Is the current waste segregation adequate for infectious wastes and sharps?


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


DM&HOs




Project?


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


DM&HOs

QAC DM & DC

23. How can the project help manage these risks/impacts?


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


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?


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


Preparation of Hypo Chlorine Solution at the

SC level

For disinfections using chlorination tank for

contaminated waste water


DM&HOs

QAC DM & DC PPP


to the environment (soil and water bodies)?


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


DM&HOs

QAC DM & DC, PPP




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


DM&HOs

QAC DM & DC

51


puncture proof containers, needle cutters etc.?


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.,


DY DM&HOs


&Committee Representatives, PPP,

SN

28. How frequently is health checkup and immunization conducted for staff and sanitation workers?


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.


DY DM&HOs

QAC DM & DC

29. Institutional Arrangements:


control?




1 to 6,8

Yes, Implementing BMW guidelines

Sufficient but need manpower and to extend

trainings capacities to all the staff.




Policy

Yes it is really help this project

Sufficient and conducting trainings to the

staff periodically


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


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.


DM&HOs





the project support better alternatives?


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.


DM&HOs



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.


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


services(DCHS)(1) Group 8

4. Deputy DMHO (1). Group 10


Group 1

6. NQAS - District Quality Consultant (1) and District Quality Manager (1) Group 9


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



d) What are some of the priority needs at the community level in your area? (health, education,



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.


above.)






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


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




17. Access:



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.






communities.

18. Footfall:








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.


06 PHCs - 45% Female, 35% Male. Children 20%


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).




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:





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


g) Do you gather feedback from patients? (Y/N) and details, if yes.

h) How does the hospital monitor patient satisfaction? Sample, frequency, etc



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


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


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.)


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


h) Do women ignore their health?



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


Only 3rd

group is having ATM at PHC Palutla it is not working due to proper network .some

more required in tribal CHCs.



32. Is the current waste segregation adequate for infectious wastes and sharps?


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


Project?


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?


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?


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


to the environment (soil and water bodies)?


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




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


puncture proof containers, needle cutters etc.?


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?


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:


control?




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?


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



the project support better alternatives?


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.

Documents

Environmental and Social Management Framework for the ......2019/02/26 · perspective. (since AP is a disaster zone). Are there public buildings (Schools, hostels, etc) that can