Delivery Table(Foot stool, Repair needed or not, painting needed or not, mattress, blood or fluid stains)| 0 no info about mattress & stirrup| 1 mattress damaged, stirrup absent, blood stains on the delivery table. | * Delivery table complete now with all its part intact| Delivery tray ( artery forceps 2, cord cutting scissors 1, sponge holding forceps 1, stainless steel bowl 2 , kidney tray 1, stainless steel tray 1, straight stitch scissors 1 | 1 only trays and 1 forceps present| 1 data inaccurate, cord cutting scissors absent| * curved scissors absent * ANMs do not find it necessary to be used.
| Episiotomy tray (Artery forceps 2, needle holder1, dissecting forceps toothed 1, dissecting forceps standard 2, vaginal speculum 1, cord cutting scissors 1, episiotomy scissors 1, straight stitch scissors 1, sponge holding forceps 1, stainless steel bowl 2, kidney tray1, stainless steel tray)1 | 0| 1 cord cutting scissors curved absent, only 1 artery forceps| * Complete set absent * Episiotomy not practiced as incision is not allowed to be performed by nurses. | Surgical items (Chromic catgut 0 with needle, triangular point suture needles, round bodied needles)| 0| 0| * Complete| Other instruments : 1.
clock with a second hand, 2. stethoscope, BP apparatus, 3. thermometer, 4. fetoscope or foetal Doppler, 5. focussed light| 22200| 00000| * complete| Drugs | FAT- ROUND 1| FAT ROUND 2| REMARKS| Oxytocics and prostaglandins 1. Oxytocin injection, 2. Methylergometrine, 3. Misoprostol| 002| 022| * Oxytocin not supplied by district * Misoprostol tablets are used instead * Dexofrost injections are used. | Anaesthetic agents and gases ( Lignocaine 2% injection, Lignocaine 2% with adrenaline injection, | Data unavailable| 0.
| * Not required| Analgesics (Diclofenc sodium injection, diclofenc sodium tablets, Ibuprofen tablets, paracetamol tablets)| 1 no paracetamol| 1 paracetamol & ibuprofen tablets absent| * Paracetamol available now * Ibuprofen not required. | 2) ESSENTIAL NEW BORN CARE | FAT- ROUND 1| FAT ROUND 2| REMARKS| New born tray (stainless steel tray 1, 2 towels)| 0| 0| * complete| Other equipments 1. Thermometer, 2. baby weighing machine or scale, 3. Thread for cord tie, 4. paediatric stethoscope, 5. clock with second hand, 6.
mucus extractor, | 000002| 022000| * paediatric stethoscope absent, all other equipments present. | Equipment status 3) PARENTERAL ANTIBIOTICS Drugs | FAT- ROUND 1| FAT ROUND 2| REMARKS| Antibiotics in labor room ( Ampicillin injection, gentamicin injection, Metronidazole injection)| 0| 0 metronidazole, gentamicin injection absent| * Ceftaxone injection used in place of ampicillin as it is considered better * Gentamicin injection not required as it is useful during serious complications in which case it is considered safer to refer.
| Antibiotics in NBCC (Ampicillin injection, gentamicin injection)| 2| 1 gentamicin injection absent| * complete| Drugs in OT (ampicillin injection, gentamicin injection, metronidazole injection, cefotaxime injection)| 2| 1 cefotaxime absent| * metronidazole tablets present, * cefotaxime injection now available. | 4) Emergency Drugs (Complication management) Drugs |
FAT- ROUND 1| FAT ROUND 2| REMARKS| Drugs for PPH (oxytocin, misoprostol)| 0| 0| * Misoprostol available| Drugs for eclampsia (Magnesium sulphate injections)| 0| 2| * complete|.
5) NEONATAL RESUSCITATION Equipments | FAT- ROUND 1| FAT ROUND 2| REMARKS|.
aInstruments 1. Ambu ventilator bag, 2. oxygen cylinder with pressure meter, oxygen cylinder flow meter, oxygen cylinder humidifier, oxygen cylinder key 3. infant face mask size 0, 1, 2, 4. oxygen concentrator, | 01 no humidifierData unavailable0| 221 size 0 available2| * infant face mask of all the sizes available * oxygen concentrator present but most of the times it is non functional. | Equipments 1. Foot operated suction machine 2. suction catheter 10F, 12F, 3. disposable uncuffer tracheal tubes sizes 2. 5, 3. 5, 3. 0 4. umbilical catheter 5. low pressure electric suction machine) 6.
Naso Gastric feeding tube| 0 0000 0| 200020| * Umbilical catheter not known to ANMs * Tracheal tubes not required. * Naso gastric feeding tubes not required as it is used in serious cases. PHC is not equipped to handle such cases, so referred. | Radiant warmer (Mobile new born resuscitation table, mattress, skin temperature probe, air temperature probe)| 2| 2| * complete| Drugs |.
FAT- ROUND 1| FAT ROUND 2| REMARKS| Vitamin K injection| 0| 2| * complete| 6) INTRA UTERINE DEVICE Equipments | FAT- ROUND 1| FAT ROUND 2| REMARKS| IUD set 1)Sponge holding forceps| 2| 2| * complete|.
2) Cusco’s speculum, , | 2| 2| * complete| 3)long sharp cutting scissors| 2| 2| * complete| 4) long artery straight forceps| 2| 2| * complete| 5) kidney tray| 2| 0| * complete| 6) stainless steel tray and bowl| 0| 0| * complete| 7) uterine sound| 0| 0| * complete| 7) TUBAL LIGATION Equipments |FAT- ROUND 1| FAT ROUND 2| REMARKS| TL set (Sponge holding forceps, scalpel, allis forceps, medium artery forceps straight, medium artery forceps curved, needle holder, straight scissors, curved scissors, retractor, dissecting forceps toothed and non toothed, stainless steel bowl, kidney tray, vaginal speculum, volsellum.
Tubal hook)| Data inaccurate| NA| * Retractor and volsellum are not used by the ANMs as they are not required as per their understanding. | 8) GENERAL EMERGENCY PREPAREDNESS Equipments | FAT- ROUND 1| FAT ROUND 2| REMARKS| Surgical items (urine collection bag, folley’s catheter 16, folley’s catheter 18, 90/91 catheter, hypodermic needle 21, 23, intra venous cannula 21,23, syringe, 2ml,20ml, endotracheal tubes with cuff 7mm, 7. 5mm, 8mm, 8.
5mm, 10mm, endotracheal tube connectors 8mm, 10mm)| 0| 0 only syringe 2ml present | * Plain catheter used, foley’s catheter required only in serious cases which are not handled in the PHC. * Syringe 3 ml present| Anaesthesia equipments (adult face mask size 3,4,5, ambu(ventilator) bag, adult laryngoscope blade sizes small, medium, large, oropharyngeal airway size 3, 4, 5, oxygen concentrator, intubating forceps, anaesthesia trolley, flow meter, pressure meter, humidifier with tube)| 0| Ambu ventilator, oxygen concentrator, oxygen cylinder with all the parts present.
| * Laryngoscope not required * Adult mask of only 1 size. * Each ANM keeps 2-3 personal masks| Drugs | FAT- ROUND 1| FAT ROUND 2| REMARKS| Emergency drugs (adrenaline injection, altopine injection, aminophylline, dexamethasone, diazepam, diagoxin tablet, feusemide injection, glucose 25% & 50%, hydrocortisone injection, promethazine injection, phenaramine maleate injection, calcium gluconate injection, nitroglycerine injection)|.
0 except altopine everything absent| 1 diazepam, diagoxin tablet, feusemide injection, glucose 25% & 50%, hydrocortisone injection, promethazine injection, phenaramine maleate injection, calcium gluconate injection, nitroglycerine injection absent| * Separate emergency drug tray maintained which consists of 8- drugs that are considered essential and are used frequently * Those drugs which are required during serious cases are not kept because such a patient is directly referred to higher hospital.
| Fluids (normal saline, ringer’s lactate, distilled water, dextran/hemacel, dextrose 5%, dextrose normal saline)| 1 distilled water absent| 1 Distilled water, hemacel absent| * complete| 9) BIOMEDICAL WASTE MANAGEMENT | FAT- ROUND 1| FAT ROUND 2| REMARKS| Items ( 1. Heavy duty gloves, bleaching powder 2. Hypochlorite solution 3. 4. Yellow color puncture proof container 5. Red colour puncture proof container 6. Blue colour puncture proof container 7. Yellow color bags 8.
Red color bags, 9. Blue color bags 10. Needle cutter 11. Scissor 12. Container for non infectious waste, | 00000000000| 1 heavy duty gloves only in labor roomOnly in labor room00000000Only in labor room| * Needle cutter is common for all he rooms, at present non functional * Separate dustbins not present in labor room. The waste from the labor room is packed in polythene bags and then thrown into the dustbins kept in common area due to space crunch in the labor room.
* Black colored dustbins present in maternity ward| Findings in BARAUNI: * In terms of equipments, the PHC almost all the essential instruments. Few instruments are absent because they are not deemed necessary by the ANMs and therefore neither they are intended nor asked to be bought. According to the ANMs these instruments are considered necessary during serious complications for which the training given to them is not enough and therefore they do not handle such cases.
* In case of drugs too, same condition prevails. The ANMs keep only 9-10 drugs which are often required and are common drugs. Drugs for serious complications were absent in the PHC. * Some of the essential items such as mask and IUDs were given by the counsellor to the roster duty ANMs individually so that they could keep it with them and use it whenever required or whenever the counsellor was not available at the PHC.
* Biomedical waste management has not upgraded much in the PHC as compared to other skill lab PHCs. The 3 colored dustbins for throwing the segregated waste were present only at 1 common place. In the labor room the waste was collected in polythene bags and then thrown outside into the dustbins. * The type of waste that should be thrown in the red colored dustbin was unclear to the ANMs. They emphasized that different government and non government agencies teach different things due to which they are confused.