FUNCTIONING OF

VILLAGE HEALTH
AND
NUTRITION DAY
IN
JAGATSINGHPUR
DISTRICT OF ODISHA
Thesis for the Degree of
DOCTOR OF MEDICINE
(Community Medicine)

Utkal University, 2011.

Dr. Sandeep Kumar Panigrahi

 ACKNOWLEDGEMENT

I am extremely indebted to my esteemed honorable teacher & Guide, Prof. (Dr.) Bijayeeni
Mohapatra M. D. (SPM), MSc (Applied Nutrition) H.O.D, Department of Community
Medicine, S.C.B. Medical College, Cuttack for her love and affection, constant inspiration,
keen interest & scholarly guidance at every step during the conduction of this research work.
Without her invaluable suggestions at every step of my research work & support during the
entire process, this piece of work would not have materialized.

My utmost regards & gratitude to my revered teacher Dr. R. N. Rout, Associate

Professor, Department of Community Medicine, S.C.B Medical College, Cuttack for his valuable
advice, constant encouragement & generous guidance.

My sincere regards to my co-guide Dr. Kaushik Mishra, Associate Prof R.H.T.C

Jagatsinghpur, for his keen interest, constant encouragement, unending support and active
guidance throughout my thesis work. Without his support my research would have always been
a dream.

I extend my deepest feelings of gratitude & obligations to Dr. Krishna Kar, Associate
Professor, Department of Community Medicine, for her meticulous guidance, constant
inspiration, valuable advice at every step of my study, starting from the development and
finalization of the instrument to my thesis writing.

I am very much grateful to Dr. K. C. Behera, Asst. Prof, Department of Community

Medicine for his constant encouragement & support.

I convey my deep sense of gratitude to Dr. Manasee Panda, Asst. Prof, Department of
Community Medicine for her inspiration and advice regarding time management in completion
of my research work.

I also extend my sincere thanks to Dr. M. Mohanty and Dr. Mohua Biswas, Asst Prof of
Community Medicine, for their support & encouragement.

My sincere gratitude to Dr. S. K. Das & Dr. Shanta Nivedita for their encouragement,
cooperation & constant help at the time of need.

I am very much obliged to Dr. K. C. Pani, Statistician, Department of Community

Medicine, S.C.B. Medical College for his sincere guidance, and untiring help in completion of
my thesis work.

My sincere gratitude to Dr. Manoranjan Jena, Dr. S. P. Parida, Dr. K. N Sastry & Dr. P.
K. Dey (Tutors, Dept of Community Medicine) for their encouragement, cooperation& constant
help at the time of need.
 I am extremely grateful to my friends Dr. M. K Das, Dr. Ajaya Bhatta, Dr. Alpana
Mishra, Dr Abhisekh Mishra, Dr. Debi Kalyan Mishra and Dr Aliva Patra for their encouraging
ideas, support & constant help at the time of need.

I thank Mr. Priyaranjan Ray, Mr. Bibhu Prakash Das, and Mr. Dhananjay Sahu for their
invaluable help at the time of need.

My hearty thanks to Mr. N. Tarai, Mr. S. K. Behera Mr.Prasanna Barik, Mr.Sauni &
other staff members of the department for their generous help.

I am also grateful to few other persons who have helped me a lot during my field work
without whom evaluating the program at the community level would have been a very tedious
job. Included in the list are Mr. Pravas Ch Tripathy (BPO, Raghunathpur), Mrs Gitanjali Singh
(BPO, Kujang), Mrs Pramila Mallick (Headquarter Sector LHV, Kujang), Mrs. Sasmita Satpathy
(BPO, Ballikuda), Mrs Annapurna Dei (Headquarter Sector LHV, Ballikuda) and Mr Dhaneswar
Baral (BEE CHC Manijanga, Tirtol block). I also owe a lot to the Department of Women and
Child Development, Government of Orissa for providing me the MPR report for December 2009
without which the necessary sampling procedure could not have been completed.

This work could not have been completed successfully without the blessings of God &
the wholehearted cooperation of my near & dear ones. Acknowledgements would be incomplete
without expressing my gratitude to my parents & family members who have been the
inspirational force behind me throughout my work. Special thanks to Dr J. P. Samal, Dr. Sameer
K Panigrahy, Snigdha and Dipti for their continuous mental support. They all have been an
epitome of love, inspiration, patience & deserve special accolade.

Last but never the least I am indebted to ADMO(FW), DPM and DSWO of Jagatsinghpur
district and all the HWFs, AWWs, ASHAs, LHVs and the village people who participated in my
study and gave their valuable feedback for the ongoing program.

I thank everyone once again from the core of my heart.

(Dr. Sandeep Kumar Panigrahi)

CONTENTS
LIST OF TABLES AND GRAPHS
 INTRODUCTION
The Government of India launched the National Rural Health Mission to carry out
necessary architectural correction in the basic health care delivery system, recognizing the
importance of Health in the process of economic and social development and improving the
quality of life of our citizens. The Mission has adopted a synergistic approach, till date, by
relating health to determinants of good health viz. segments of nutrition, sanitation, hygiene and
safe drinking water. It has also tried to mainstream the Indian systems of medicine to facilitate
health care.
The Plan of Action of National Rural Health Mission 1 not only includes increasing public
expenditure on health but also other measures like reducing regional imbalance in health
infrastructure, pooling resources, integration of organizational structures, optimization of health
manpower, decentralization and district management of health programmes, community
participation and ownership of assets, induction of management and financial personnel into
district health system, and operationalizing community health centers into functional hospitals
meeting Indian Public Health Standards in each Block of the Country.
     
The Goal of the Mission is to improve the availability of and access to quality health care
by people, especially for those residing in rural areas, the poor, women and children.

In our Maternal and Child health package of services we have different programmes
operationalized by different departments such as W & CD department and H & FW department
for provision of antenatal services, intra-natal care, post natal services, routine immunization and
ICDS services etc. In spite of all the efforts the various MCH indicators reveal a very poor state
of Maternal and Child Health in India and more so in Orissa.

Mothers having complete antenatal check-up still remain very low in the rural areas
(20.9% according to DLHS-3 Orissa). Mothers having 3 or more antenatal check-ups are only
52.0% (DLHS-3 Orissa). Ante-natal registration is still not 100% (87% according to NFHS-3).
Institutional delivery is only 40.4% (DLHS-3 Orissa-2007-08) in the rural areas in spite of the
tremendous efforts of ASHAs in these areas (2-3 years after launching of NRHM). Children aged
0 to 5 months who are exclusively breast fed are 50.0% in the rural Orissa (NFHS-3 Orissa)
while two-thirds of those aged 6-9 months receive semi-solid food (weaning or complimentary
feeding). 43.7% of married women of the age group 15-49 years were found be having BMI less
than normal, while 71.3% of pregnant women were found to be anemic which moreover
perpetuates the vicious cycle of under-nutrition anemia among children (41.2% of children under
3 years are underweight and 75.8% children 6 mon-6 years are anemic).

Hence in order to address the issues related to health and nutrition of mother and
children, the concept and operational guidelines of Monthly Village Health and Nutrition Day
were developed by NRHM7, India with the technical assistance of Maternal Health Division
(GoI) and UNFPA. Since then various states in the country have adopted and modified the
concept and developed their own operational guidelines to make it an effective MCH
intervention in their own state.

Village Health and Nutrition Day (VHND), or “Mamata Diwas” 2, is a concept for
interdepartmental convergence to ensure desirable health outcomes of children below five years
and pregnant and lactating mothers. It was introduced in the State of Orissa by the Department of
Health and Family Welfare in Feb 2007. But it was in a dwindled state till 2008. It was re-
launched again in Feb 2009 all over the state with a definite operational guideline. Mamata
Diwas would provide the first point of contact for essential primary health care and would work
as the common platform for convergence amongst service providers of Health and ICDS
department along with the community at large. Strategically, trainings were also planned to be
given at State, regional, district and sector levels to various categories of functionaries to ensure
effective implementation of the program.

Within the purview of the program, the target beneficiaries are 2 pregnant women,
lactating mothers, children below five years and adolescent girls. Basic components of primary
healthcare services, including early antenatal registration, de-worming, counseling on early
breastfeeding, identification and timely referral of high risk cases of children and pregnant
women, as well as ANC and PNC care are to be provided at community level in order to address
the essential requirements of pregnancy, delivery, referral, childhood illnesses and adolescent
health.

The VHND programme is being organized once a month in every Anganwadi Centre 2 on
a fixed day basis (either Tuesday or Friday) with joint efforts of HW (F), AWW and ASHA
under the leadership of the HW (F). On an average, there are six to eight AWCs under the
operational jurisdiction of one Sub Centre and thus there are about eight fixed Village Health and
Nutrition days in a month per Sub Centre. According to the guidelines, there should be monthly
planning for organizing the VHND sessions at the AWC so that the service providers as well as
the community members become aware of the event much in advance.

The objectives of the VHND program have been put forth in the operational guidelines 2
as follows:
 To provide essential and comprehensive health & nutrition services to pregnant women,
lactating mothers, children (0-5 yrs) and adolescent girls.
 To ensure early registration, identification and referral of high risk children and pregnant
women.
 To provide an effective platform for interaction of service providers and the community
(through Gaon Kalyan Samiti or the mothers group)
  To provide information to families on care of mothers and children at the household and
community level through discussion of various health topics (as envisaged in the Health
Calendar); and
 To ensure establishment of linkage between health & ICDS so as to promote maternal &
child survival programmes.
Children identified with severe degree of malnutrition in each VHND session are referred to
“Pustikar Diwas” held at the block level health center accompanied with ASHA or AWW. The
child receives the treatment after being diagnosed and the treatment cost of the child is being
reimbursed immediately before the child leaves the hospital.
There are 30 districts in the state of Orissa. Jagatsinghpur is one among them. It is a coastal
district located in the neighborhood of commercial capital Cuttack. It has 8 CD blocks and two
urban units namely Jagatsinghpur & Paradeep. As per the information of Department of Women
& Child Development, Orissa: Dec 2009 there are 1647 sanctioned AWCs in the district, out of
which 1,331 are operational and reporting. The number of beneficiaries in the AWCs account for
1,00,805 children of 0 to 6 years and 17,878 pregnant women.

On an exposure visit to the Anganwadi Center at Madhusudhanpur Sasan under Manda

Sahi Block PHC (Jagatsinghpur Sadar Block) on 05.03.2010 (Friday) there were many gaps
observed in the quality of services delivered. The VHND session though was conducted as per
the micro plan yet it was not arranged properly. Only 30 out of 90 beneficiaries attended the
session. The session was conducted in an open place and it lasted only for one hour.
Supplementary nutrition and even referral were not taken proper care. All the logistics needed
for conducting the VHND were also not available.

Hence the need of evaluation of the functioning of the VHND was felt. Since
Jagatsinghpur district is the field study area of Community Medicine department, SCB Medical
College (Cuttack), hence the evaluation study was planned as a pilot evaluation in this district.
On this backdrop the present study is designed.

BROAD OBJECTIVE
To evaluate functioning of Village Health and Nutrition Day (VHND) in Jagatsinghpur
District of Orissa and find out the gaps, if any, and suggest some remedial measures.

SPECIFIC OBJECTIVES
1. To study the process of implementation of Village Health and Nutrition Day in the
district.
2. To study the availability of action plan, logistics and resources needed for conducting
the Village Health and Nutrition Day sessions.
3. To study the availability and utilization of services provided at Village Health and
Nutrition Day sessions.
4. To assess the quality of services provided in the Village Health and Nutrition Day at
the AWC.
5. To assess the level of awareness regarding various aspects of Village Health and
Nutrition Day among the service providers and beneficiaries.
6. To identify gaps if any and suggest remedial measures.
 REVIEW OF LITERATURE

Exit interview10

Clients are interviewed as they leave the health facility to measure the effectiveness of your
services and to learn about the users’ satisfaction with your services. Client satisfaction is an important
component of good quality of care. Client interviews can reveal how well your educational messages
are understood and the client’s perspective on whether or not she was treated with respect.
Information from client interviews can be used to improve service delivery.

For client exit interviews, the interviewer interviews clients as they leave the service site after they
received care. The questionnaire is usually short; the interview should take only 5-15 minutes.

Informed Consent

Every respondent has the right to refuse the interview, or to refuse to answer specific survey
questions. The interviewers must respect this right.

Privacy

It is important that the interview with each respondent be conducted in a manner that is
comfortable for her or him, and in which she or he is able to speak openly and honestly. No other adult
man, woman or older child should be present or be able to hear the interview. Small children may be
present.

Confidentiality

The interviewers may not discuss the respondents’ answers with anyone, except the
supervisor when clarification is needed. Respondents’ names or other identifying information should
not appear on the questionnaire; there should be no way to link a specific questionnaire to a specific
respondent.

Data Collection Forms

A closed-ended, pre-coded questionnaire can be used. The draft questionnaire should be pre-
tested at least once and revised as needed; a second round of pre-testing and revision should be done if
substantial changes are made after the first round.

Sampling Plan
 Client exit interviews are not expected to be representative of the population of the whole
community since only people who attend the clinic are interviewed. However, they should be
representative of clinic attendees, so steps should be taken to assure that the sampling is systematic. It
may be important to sample clients on different days of the week or different weeks of the month. An
example of how this could be significant is that women from rural areas may only come to the clinic on
market day or certain services are only offered on certain days. It also may be important to note the
time of day the interview is conducted since women who are served later in the day may have a
different experience or different needs than women who are served early in the day.

In a relatively small clinic, all clients visiting the clinic during the days of the study could be asked
for an interview. In larger facilities, a sample of clients can be interviewed. In this case, every n th client
should be identified when they register in the morning so the sampling is systematic (e.g. every 5 th
client). It is best to have no fewer than about 20 interviewees per facility.

Data Collection Procedures

For an exit interview, the interviewer meets clients as they leave the clinic, after their visit
is completed. They sit in a private, quiet place for the 5-15 minutes necessary to complete the
questionnaire. It is useful to have at least two people on the interview team, so that all clients
are met and asked to wait or are directed to the interviewer, as appropriate.
 MATERIALS AND METHODS

Prelude
Village health and nutrition day (VHND) is a national maternal and child survival
program with specific objectives. The present study “Functioning of Village Health and
Nutrition Day in Jagatsinghpur” basically aims to evaluate the functioning of Village Health and
Nutrition Day (VHND) in Jagatsinghpur District of Orissa and find out the gaps, if any, and
suggest some remedial measures. It also aims to find out the awareness of service providers and
beneficiaries regarding Village Health and Nutrition Day.

The objectives of the study were:

1. To study the process of implementation of Village Health and Nutrition Day in the
district.
2. To study the availability of action plan, logistics and resources needed for conducting
the Village Health and Nutrition Day sessions.
3. To study the availability and utilization of services provided at Village Health and
Nutrition Day sessions.
4. To assess the quality of services provided in the Village Health and Nutrition Day at
the AWC.
5. To assess the level of awareness regarding various aspects of Village Health and
Nutrition Day among the service providers and beneficiaries.
6. To identify gaps if any and suggest remedial measures.

Place of study:
Considering the feasibility of the study, Jagatsinghpur district was selected as the study
area for evaluating the functioning of Village Health and Nutrition Day program.

Profile of the study area:

The study was conducted in Jagatsinghpur district as it is the field practice area of the
department. The Rural Health and Training Centre (RHTC) is also located in the premises of the
District Head Quarter Hospital, Jagatsinghpur. There is fixed term posting of the post graduates
in the RHTC too. All these provided ample opportunity to complete the research work in the
stipulated time period.

Jagatsinghpur district is one of the coastally located districts in Orissa and bounded by
Kendrapada district in the North, Puri district in the South, Bay of Bengal in the East and
Cuttack district in the West. Formerly it was a part of the undivided Cuttack district (prior to
1992). The climate is generally hot with high humidity during April and June and cold during
December and January. The monsoon generally starts off by July.
Fig: Map of Jagatsinghpur district

The district accounts for only 1.07 per cent of the State’s territory and 2.87 per cent of the
State’s population. It is very densely populated (the density of population of the district is 634
per sq kms as against the State’s 236 per sq km). It has 1228 villages (61 uninhabited) covering 8
Community Development blocks, 4 tahasils and 1 sub-division.

The tribal population in the district is meager and amounts to less than one per cent
(0.82%), while the scheduled caste population is 21.05% (Source: 2001 Census data)

Jagatsinghpur district has also got good set up of hospitals for delivering the health care
need of its population. Apart from the district head quarter hospital, there are 6 CHCs and 35
PHCs working for the health of its population. Along with that there are 189 sub-centers
reaching the people at the grass root level. Details are shown in table .

Table : Health institutions in Jagatsinghpur district

Sl. Block DHH/ Medical CHCs PHCs Mobile health Unit/ Total
Colleges/Area Maternity Centers
hospitals
1 Ballikuda 0 1 5 0 6
2 Biridi 0 0 3 0 3
3 Ersama 0 1 3 0 4
4 Jagatsinghpur 0 0 4 1 5
5 Kujang 0 1 6 1 8
6 Naugaon 0 1 2 0 3
7 Raghunathpur 0 1 4 0 5
8 Tirtol 0 1 8 0 9
9 Jagatsinghpur (M) 1 0 0 0 1
10 Paradeep (M) 2 0 0 0 2
TOTAL 3 6 35 2 46
Source: District Statistical Handbook Jagatsinghpur 2007

There were 888 primary schools, 382 middle schools, 265 secondary schools and 27 general
colleges in the district recorded in 2005-06. The literacy status of the district is higher than that of
the whole state (Jagatsinghpur- 79.08% and Odisha- 63.08%). There are 1647 sanctioned and 1331
operational Anganwadi centers in the district that are working towards the betterment of maternal and
child health in the district, and also imparting pre-school education to children.

Time period of study:

The study was conducted from December 2009 till November 2010 (One year). The research
activity consisted of the following activities:
 Review of literature
 Development of the instrument
 Pre-testing and finalization of the instrument
 Data collection and validation
 Data cleaning
 Data entry
 Analysis
 Report writing
 Fig: Time frame of the research activities undertaken
TIME TAKEN FOR THE ACTIVITIES
ACTIVITIES UNDERTAKEN May’1
Dec’09 Jan’10 Feb’10 Mar’10 Apr’10 Jun’10 Jul’10 Aug’10 Sep’10 Oct’10 Nov’10
0
Review of literature

Instrument development

Pretesting and finalization of

instrument
Data collection

Data cleaning and data entry

Analysis

Thesis writing and finalization

Total period

Type of study:
It is an evaluation study which is cross-sectional in nature and is a blend of both
qualitative and quantitative components. Methodological triangulation8-10 was used in the study.

Study Unit:
A Village Health and Nutrition day session for evaluation of functioning.

Study respondents:
a. Program managers at the district level:
 ADMO (FW), DPM from Department of H & FW.
 DSWO from Department of ICDS.
b. Program managers at the block level:
 BPO, Medical Officer, BEE from Department of H & FW.
 CDPO, ICDS supervisor from ICDS department.
c. Service providers at the grass root level:
 HWF, ASHA from Department of H & FW.
 AWW from ICDS department.
d. Service utilizers/ Beneficiaries at the grass root level:
 Adolescent girls
 Mothers of children (0-5 years)
 Pregnant women
 Lactating mothers
Study instruments:
A set of pre-defined (See Annex: Key to Instruments) and pre-tested instruments were
used. The study instruments were designed by the consensus of the guide and co-guide along
with other faculties of the department. The instruments were designed in such a way so as to
cover every aspect of the evaluation, starting from facilities available to the awareness among
service providers and beneficiaries.

The instruments used were broadly of the following types:

1. Key informant interview at the district level (Annexure )
District level supervisors who were actively involved in implementation and
supervision of VHND program were interviewed using this schedule.

The information regarding the sub-centers where VHND sessions had not yet
started, the number of VHND sessions where sessions were not held last month, status of
training of the service providers and any group of service providers who had been
deprived of training, availability and sharing of micro plan with the ICDS department at
the district level were looked upon.

The instrument also tried to find out the level and type of supervision done by the
supervisors. Whether there is a planning for supervision, how many VHND sessions are
usually visited in one month and whether a definite supervision checklist is used for
supervision were recorded. Problems identified during the visits and some suggested
solutions to these, were also noted down and used for providing inputs for improvising
the program.

The level of satisfaction was also noted in general and regarding functioning of
VHND in hard to reach areas. Along with all these information, the recording and
reporting system for VHND and incentives given to various service providers were also
noted.

2. Key informant interview at the block level (Annexure )

Block level supervisors who were actively involved in implementation and
supervision of VHND were interviewed using this schedule. This schedule incorporated
areas which could give more inputs for the betterment of the program.

The information regarding the sub-centers where VHND sessions had not yet
started, the number of VHND sessions where sessions were not held last month, status of
training of the service providers and any group of service providers who had been
deprived of training, availability and sharing of micro plan with the ICDS department at
the block level were looked upon.

The instrument also tried to find out the level and type of supervision done by the
supervisors. Whether there is a planning for supervision, how many VHND sessions are
usually visited in one month and whether a definite supervision checklist is used for
supervision were recorded. Problems identified during the visits and some suggested
 solutions to these, were also noted down and used for providing inputs for improvising
the program.

The level of satisfaction was also noted in general and regarding functioning of
VHND in hard to reach areas. Along with all these information, the recording and
reporting system for VHND and incentives given to various service providers were also
noted.

Lastly supply of all the logistics (equipments and drugs) was also noted in the
instrument. There was also a brief questionnaire for facilitative supervision assessment
for all these block level supervisors.

3. Facility survey checklist (Annexure ).

This checklist was the key instrument for evaluating the functioning of the Village
Health and Nutrition Day services. The checklist contained mainly closed ended options
(Yes/No or Multiple Options type), with a few open ended ones. The options included in
the checklist were mostly the ones as expected per the guidelines, and the rest were the
ones which were modified after field testing of the instrument. There was also provision
of adding remarks for every finding noted and comments section at the end to document
the problems and best practices noted at each session.

The instrument consisted of the following parts:

a. General information about VHND session:
This section gathered information about the date, day, weather, starting and
closing time of the VHND session along with a unique code specific for the
VHND session.

b. Basic Information about the VHND session:

This section contains the details of the Anganwadi center where the session was
being conducted like name of the Anganwadi center where the VHND was
supposed to be held, village where the AWC is located, sub-center and block to
which the session belonged to.

c. General Information about the VHND session:

This section tried to collect information regarding the VHND in general like
whether it is held or not, and is it according to the micro plan. It also recorded
information regarding presence of service providers, mobilizer, GKS members,
supervisors at the VHND session and whether any display of services had been
made or not.

d. Logistics available at the VHND session:

Procurement, availability and usability of the logistics (equipments and drugs)
were noted in this section. The checklist also included housing condition and
general amenities for conducting the session. Besides the presence or absence of
all the logistics as prescribed in the guidelines of VHND was noted in a simple
Yes/No format.
 e. Services delivered to the beneficiaries at the VHND session:
The services delivered to all groups of beneficiaries (Adolescents, Pregnant
women, Lactating mothers and Children 0-5 years) along with identification and
treatment of minor illness’ detected at the VHND session was noted using this
part of the schedule. An option ‘Nap’ (Not applicable) was used and the
corresponding reason why it is not applicable for Yes/No was noted in the
remarks column of each service (details given in Annex- Key to Instruments).

f. Assessment of skills of the service providers:

Skills of the service providers were assessed according to the nature of services
delivered by each of them (only if the services were found to be delivered at the
session) and noted in this section of the schedule.

g. Beneficiary attendance at the VHND session:

The records/ registers/ reports/ summary present in diary of the AWW (or of the
HWF if that of AWW was not available) were used to note the number of
beneficiaries ought to be present from various sections of the society (SC, ST and
Unreserved). It was marked as ‘DNA’ wherever the data was not available. The
number of beneficiaries present at the session was similarly noted under the same
heads at the end of the session.

h. Health topic discussed at the VHND session:

The content of the health topic discussion was noted here with special mention to
whether it was according to health calendar or not.

i. Referral services of the VHND session:

Number of children or other beneficiaries referred to Pustikar Diwas or other
health care facilities for any reason were noted using this part of the checklist.
The number of referrals for the present session and cumulative figure for the last 3
months (last 3 sessions in the same Anganwadi center) was noted using this part
of the schedule.

j. Follow up services of the VHND session:

Number of referral cases of last month (out of the total cases referred) attending
the present session was recorded in this part. If there were no referrals in the
previous month, then ‘Nap’ (Not applicable) was used.

4. In depth interview schedule with service providers (Annexure )

This instrument was meant to find out the awareness level of the service providers
(HWF/HWM/AWW/LHV- providing VHND services on the day of visit for evaluation)
regarding objectives of VHND, their roles and responsibilities in VHND session.

It also meant to collect information regarding the training status of the service
providers, regularity of services in the area where the session was held and also in the
 sub-center area of the HWF, usual timing of the sessions, supervision and its
documentation and merits and demerits of the VHND program, if any.

Lastly it also tried to find out the level of satisfaction of the service providers
regarding the VHND services in that area and need for the continuity of VHND services.
It also tried briefly to find out about the regularity of disbursement of incentives, if any,
to the service providers.

The instrument contained a mix of close and open ended options. Close ended
options enhanced the speed of data collection and the options were selected after pre-
testing of the instruments. Open ended options were present in nearly every question (as
an option ‘Others’) to allow the researcher to include any other option the researcher had
not thought of even after field testing.

5. In depth interview schedule with mobilizer of the VHND session (Annexure ).

This instrument meant to know about the awareness of ASHA, who is the
recognized mobilizer for the VHND session, regarding the fixed day when VHND is held
in that area, purpose of VHND, her roles and responsibilities for the VHND session.

It also tried to find out the way of mobilization used by ASHAs like when and
what do they say to the beneficiaries while mobilizing for the VHND session. It also
incorporated major problems observed during mobilization of the beneficiaries.

As the whole of the mobilization process of VHND was incentive based, hence
this part was not left out and included to find out the regularity of disbursement of
incentives to the ASHAs.

The instrument here also contained a mix of closed and open ended questions
similarly prepared to the one for IDI of service providers.

6. Exit interview schedule with beneficiaries of the VHND session (Annexure )

Mothers of 0-5 year children, pregnant women, lactating mothers and adolescent
girls were the beneficiaries interviewed using this schedule. This schedule tried to
triangulate the information provided through IDI of beneficiaries with that of the service
providers and contained mainly the same areas regarding the awareness about the VHND
services.

The instrument tried to find out the level of awareness of beneficiaries regarding
VHND first of all, whether they have heard about VHND (or similar terms like ‘Mamata
Diwas’, ‘Health Day’, ‘Health Meeting’, etc.). Next it tried to find out whether they know
about the typed of services they are to receive in the VHND session, place where the
session is usually held, regularity of services, timing of services and whether does this
timing suit the local needs, service providers and supervisors they were acquainted with,
in the VHND session.
 It tried to record the level of satisfaction of the beneficiaries regarding the VHND
services, any kind of support they have ever provided (Community Support) and their
interest in attending the VHND sessions. From beneficiary point of view, what are the
lacunas in the program and how these could be enhanced were also included in the
instrument.

This instrument here also contained a mix of closed and open ended questions
similarly prepared to the one for IDI of service providers. This facilitated the speed of
data collection, so that more of the information could be recorded from the beneficiaries
within a limited time period.

Sampling frame:

All the Village Health and Nutrition day sessions held in Jagatsinghpur district were
included in the list for evaluating the functioning of VHND sessions and assessing the level of
awareness of beneficiaries attending these sessions.

Sampling method adopted:

Multistage stratified random sampling design was adopted for the study.

Details of the sampling procedure:

Multistage stratified random sampling design was adopted for the study. Stratification
was done based on the performance different blocks during review of literature and development
of Study tool. Percentage of severely malnourished children (Grade III and Grade IV) in each
block was taken as the performance indicator. The Monthly Progress Report (MPR) data
available from Office of the Director, W & CD Department, Odisha for the month of December
2009 was used for stratifying the blocks (See table ).

There were 3 conventionally identified strata in the district, based on the level/prevalence
of severely malnourished children in the blocks.
1. Low level of malnutrition
2. Moderate level of malnutrition
3. High level of malnutrition

Based on the stratification 1 block from each stratum was randomly selected using
random number table. Raghunathpur block from stratum I, Ballikuda from stratum II and
Kujanga from stratum III were hence selected as the blocks for the evaluation study to be done.

Table : Blockwise distribution of severely malnourished children in Jagatsinghpur district 4

(Source: MPR Dec 2009, Dept. of W & CD, Orissa).
Sl Name of the block No. of Grade III No. of Grade No. of severe % of severe
no malnutrition IV malnutrition malnutrition malnutrition
(Gr III+Gr IV) (A) A/B X 100
1 Raghunathpur 16 0 16 7.4
2 Kujanga 59 0 59 27.4
3 Naugaon 17 1 18 8.4
4 Biridi 12 0 12 5.6
5 Tirtol 22 2 24 11.2
6 Ballikuda 39 1 40 18.6
7 Jagatsinghpur 14 6 20 9.3
8 Ersama 23 3 26 12.1
Total 202 13 215 (B) 100

Table : Stratification of the blocks according to the distribution of severe malnutrition

(Source: MPR Dec 2009, Dept. of W & CD, Orissa).
Strata Block names % of severe malnutrition
(According to % of severe
malnutrition)
I (0-10%) 1. Biridi 5.6
(Low level of malnutrition) 2. Raghunathpur 7.4
3. Naugaon 8.4
4. Jagatsinghpur 9.3
II (10-20%) 1. Tirtol 11.2
(Moderate level of malnutrition) 2. Ballikuda 18.6
3. Ersama 12.1
III (>=20%) 1. Kujanga 27.4
(High level of malnutrition)

5% of the VHND sessions were randomly selected from each of these 3 blocks.
The 5% level was set taking into consideration the feasibility of the study within the
stipulated time period by the researcher. Hence nine VHND sessions from Ballikuda
block, ten VHND sessions from Kujang and four from Raghunathpur were selected for
the evaluation study. The number of VHND sessions that were evaluated from each block
(rounding it off to the next whole number) is given in table :
Table : Number of VHND sessions randomly chosen from the selected blocks.

Number of VHND sessions 5% of the VHND

Sl. Selected blocks conducted monthly sessions
1 Ballikuda 165 8.25 (say 9)
2 Kujanga 183 9.15 (say 10)
3 Raghunathpur 78 3.9 (say 4)
  Total 426 23
 The next step was identification of the VHND sessions from each of the blocks.
To avoid duplication of evaluation of activities and awareness of a Health Worker
Female (Key Service Provider for VHND), a consensus was agreed upon to choose a sub-
center once only. From each block the list of sub-centers was obtained as a first step. The
micro plan for VHND sessions was used for obtaining the list of sub-center where VHND
sessions were being held.
Key informants were identified, first of all, who could give information about the
VHND services at the district and block level. Key informant interview was done both
from H & FW department and ICDS department. Key informant interview, one each
from either department, was done using key informant interview schedule and the
occasion was utilized for collecting the micro plan of the district and the block.

Sub centers were randomly identified corresponding to the number of sessions to

be assessed in that block with 50% additional sub-centers at hand. (e.g. if there were 9
VHND sessions to be assessed for functioning, 14 (9 plus 50% of 9) number of sub-
centers were randomly selected).

Selection of the sub-centers was done randomly using the random number table
(random sampling without replacement so as to avoid duplication). Hence nine sub
centers from Ballikuda, ten from Kujanga and four from Raghunathpur were randomly
selected.

One VHND session from each of the identified sub-centers was selected for
study. Micro plan, obtained from the block hospital, was used for identifying the VHND
sessions where evaluation was done. Only one VHND will be evaluated on a single day
of visit. The VHND sessions identified from each block was evaluated using pre-defined
and pre-tested instrument.

Selection of beneficiaries for exit interview was done using convenience

sampling. Exit interview10 was conducted with a maximum of 5 beneficiaries in each
VHND session (preferably in order- previous referrals (if any), mothers of 6 months-5
years children, pregnant women, lactating mother, adolescent girl(if present)) using a
brief and pre-designed questionnaire.

Work plan details:

Sl. Block/ District No. of facility No. of exit No. of IDI No. of IDI IDI/ Key
 surveys of interviews with service with informant
the VHND with providers of mobilizers of interviews at
sessions beneficiaries VHND VHND block/
of VHND session session district level
sessions
1 Raghunathpur 4 BPO, BEE,
CDPO
2 Kujang 10 BPO, CDPO,
LHV
3 Ballikuda 9 BPO, CDPO,
LHV
4 Jagatsinghpur district - - - - DPM,
ADMO (FW),
DSWO
Total 23
1. Place of study: Jagatsinghpur district.

2. Time period of study: 1 year (includes pre-testing and finalization of schedule, data
collection, compilation, analysis and report writing).

3. Type of study:

 An evaluation study which is cross-sectional in nature

 Both qualitative and quantitative components were included in the study.
 Methodological triangulation8-10 was done to draw conclusions.

4. Sampling frame: All the VHND sessions of Jagatsinghpur district.

5. Sampling technique: Multistage stratified random sampling design will be adopted

for the study. Strata are formed taking into consideration the performance of the blocks as
the stratifying factor. Here percentage of severely malnourished children (Grade III and
Grade IV) in each block as per December 2009 data available from Office of the
Director, W & CD Department, Orissa is used for dividing the blocks into 3 strata as
shown in the tables below (Table 1 and Table 2).

Table 1: Blockwise percentage of (in numbers) severely malnourished children of

Jagatsinghpur district4 (Source: MPR Dec 2009, Dept. of W & CD, Orissa).
Sl Name of the block No. of No. of Grade No. of severe % of severe
no Grade III IV malnutrition malnutrition
malnutrition malnutrition (Gr III + A/B X 100
Gr IV)
(A)

1 Raghunathpur 16 0 16 7.4
2 Kujanga 59 0 59 27.4
3 Naugaon 17 1 18 8.4
4 Biridi 12 0 12 5.6
5 Tirtol 22 2 24 11.2
6 Ballikuda 39 1 40 18.6
7 Jagatsinghpur 14 6 20 9.3
8 Ersama 23 3 26 12.1
Total 202 13 215 100
(B)

Table 2: Stratification of the blocks according to the percentage of severe malnutrition

(Source: MPR Dec 2009, Dept. of W & CD, Orissa).
Strata Block names % of severe malnutrition
(According to % of severe
 malnutrition)
I (0-10%) 5. Biridi 5.6
6. Raghunathpur 7.4
7. Naugaon 8.4
8. Jagatsinghpur 9.3
II (10-20%) 4. Tirtol 11.2
5. Ballikuda 18.6
6. Ersama 12.1
III (>=20%) 2. Kujanga 27.4
Based on the stratification 1 block from each stratum will be selected randomly
using random number table. Thus Raghunathpur block from stratum I, Ballikuda from
stratum II and Kujanga from stratum III were selected. 5% of the VHND sessions will be
randomly selected from each of these 3 sampled blocks. The number of VHND sessions
that will be assessed from each block (rounding off to the nearest whole number) hence is
as follows in table 3:

Table 3: Number of VHND sessions randomly chosen from the selected blocks.
5% OF THE
SELECTED NUMBER OF VHND SESSIONS VHND
BLOCKS CONDUCTED MONTHLY SESSIONS
1 BALLIKUDA 165 8.25 (say 9)
2 KUJANGA 183 9.15 (say 10)
3 RAGHUNATHPUR 78 3.9 (say 4)
  TOTAL 426 23

From each block the list of sub-centers will be obtained as a first step. Sub centers
will be randomly identified corresponding to the number of sessions to be assessed in that
block. Selection of the sub-centers will be done using a random number table (random
sampling without replacement). Hence nine sub centers from Ballikuda, ten from
Kujanga and four from Raghunathpur will be randomly selected. One VHND session
from each of the identified sub-centers will be selected. Only one VHND will be
evaluated on a single day of visit. The VHND sessions identified from each block will be
evaluated using pre-defined and pre-tested instruments.

6. Data collection: Prior to initiating the study necessary permission will be obtained
from district authorities (ADMO FW, Jagatsinghpur and respective block MOs) with a
request to extend all possible cooperation in the field.
The researcher will be present at the VHND session site from the beginning till
the end of the session to assess all the components of the sampled VHND session. The
logistics available at the VHND sessions will be verified using a pre-designed and pre-
tested check list (Facility Survey checklist).
 The quality of services delivered in the VHND will also be noted. Exit interview 10
will be conducted with at least 5 beneficiaries (preferably in order- previous referrals (if
any), mothers of 6 months-5 years children, pregnant mother, lactating mother,
adolescent girl(if present) using a brief and pre-designed questionnaire. This
questionnaire will record the views of the beneficiaries regarding the quality of services
delivered, awareness of the beneficiaries and gaps if any and also some of the felt needs
of the beneficiaries. The PRI members of the revenue village to which the AWC belongs,
AWW and HW (F)/(M) will be interviewed to know the issues and problems.
Interview with at least 2 designated supervisors of the VHND program (one from
Department of H & FW and other from Department of W & CD) both at the block level
(like MO I/C Block PHC/ BEE/ BPO/ AYUSH MO/SECTOR SUPERVISOR/CDPO)
and district level (with DSWO/ PO/ CDMO/ADMO (FW)), will also be conducted who
will provide all the key information about the ongoing activities in VHND. Details about
the training status of the service providers can also be known from them.
The records and registers of VHND maintained by the HWF and the AWW will
also be verified. The number of beneficiaries who were given health check up, referred or
given treatment for minor ailments and also the number of children in different grades of
malnutrition in that VHND will be noted.

7. Analysis and report writing: The data collected will be cleaned and then
entered in Microsoft Excel Sheet /Access database 2007 and then analyzed using SPSS
v 17.0.

8. Expected direct products.

 Identification of existing gaps/deficits in the functioning of the Village Health and
Nutrition Day Services in Jagatsinghpur district and prescribing necessary remedial
measures.
9. Risks, assumptions and quality assurance.

 The entire evaluation will be undertaken in a mode of supportive/facilitative

supervision5.Hence there is no risks foreseen in the study.

 Quality assurance will be maintained by validating 10 % of the village health and

nutrition day evaluations (i.e. 3 VHND sessions evaluation) by the guide of the
research work.

10. Ethical considerations.

The study will be safe in all respects. In-depth interviews and exit interviews will
be done after getting informed verbal consent from the concerned persons.
 11. Dissertation plan and duration.

 Review of literature…………………………………………………..8 weeks

 Preparing the instrument for evaluation………………………………6 weeks

 Pretesting and finalization of instrument……………………………..2 weeks

 Data collection, data cleaning and data entry

(includes visits to the VHND sessions, exit interviews with beneficiaries,
in-depth interviews with service providers and officials at various levels) …...24 weeks
 Analysis and dissertation writing and
submission……………………………………………………………12 weeks

Total time……………………………………………………………………..52 weeks

(say 12 months or 1 year)

Timeline for dissertation:

MONTHS

Dec’09 Jan’10 Feb’10 Mar’10 Apr’10 May’10 Jun’10 Jul’10 Aug’10 Sep’10 Oct’10 Nov’10
KEY MILESTONES
Review of literature

Pretesting and finalization of

instrument
Data collection, data cleaning
and data entry
Analysis and dissertation
writing
 OBSERVATION AND DISCUSSION

GENERAL:
1. Sessions where functioning of VHND was evaluated

Sl Block No. of sessions No. of sessions No. of sessions % of sessions held

attended for held (%) held as per micro on holidays
evaluation plan (%)
1 Raghunathpur 4 4 (100%) 4 (100%) -
2 Kujang 13 10 (76.92%) 3 (30%) 100%
3 Ballikuda 15 9 (66.7%) 6 (66.7%) 0%
Total 32 23 (71.9%) 13 (56.5%) 50%
71.9% of all the sessions visited for VHND evaluation were held and out of these only 56.5% of
sessions were held as per micro plan. Planning is an important step for any program. The VHND sessions
are generally regarded as fixed sessions, in the sense that they should be held on a particular day of the
month. This definitely helps to increase the attendance of the session and also easy mobilization, at least,
of the educated strata in the village.

There were 2 occasions where sessions were visited on public holidays (important festivals). Out of
these one was in Kujang block and the other in Ballikuda. 50% of the sessions were not being held in the
district on holidays. The session in Kujang block was conducted with poor attendance of beneficiaries
while that at Ballikuda was postponed to the next Monday, and it was found that the beneficiary
attendance was quite good compared to that in Kujang.

2. Service providers interviewed during the study

SERVICE PROVIDER INTERVIEWED

Sl. No Block HWF AWW ASHA
1 Raghunathpur
2 Kujang
3 Ballikuda
Total (Jagatsinghpur district)

3. Supervisors interviewed during the study

SL NO SUPERVISOR RAGHUNATHPUR KUJANG BALLIKUDA

1 LHV
2 BPO
3 BEE
4 CDPO
5 ICDS SUPERVISOR
 4. Beneficiaries interviewed during the study

Table: Beneficiaries interviewed at the VHND sessions

Sl Type of beneficiary Raghunathpur Kujang Ballikuda Total

1 Mothers of children 6 mon- 5 yrs
2 Pregnant women
3 Nursing mothers
4 Guardian of children 6 mon-5yrs
5 Adolescent girls
6 Others
TOTAL

Table: General profile of the respondents (beneficiaries)

Sl Profile Mean (S.D.) Range

1 Age
2 Years of education
3 Distance of house from VHND session site
SPECIFIC:

1. PROCESS OF IMPLEMENTATION OF VHND IN THE DISTRICT

a. How VHND started
b. When VHND started
c. Development of guidelines for VHND
d. Who is the coordinator of VHND
e. Training and development of skills of resource persons for VHND services
f. Training and development of skills of service providers for VHND services
g. Development of PIP/micro plan
h. Supply of instrument and logistics for conducting the VHND session
i. Process of arranging the logistics for the VHND sessions
Table: Method for procurement of equipment at VHND session site

Hospital supply

from any source

Other method
(SC untied fund)Local purchase

(GKS untied Local purchase

supplyCDPO office

Not procured
Sl Equipment
1 Adult weighing No. of sessions 22 0 1 0 0 0
machine where procured
% 95.7 0.0 4.3 0.0 0.0 0.0
2 Child weighing No. of sessions 0 0 2 0 0 21
machine where procured
% 0.0 0.0 8.7 0.0 0.0 91.3
3 Salter scale No. of sessions 0 1 0 18 1* 3
where procured
% 0.0 4.3 0.0 78.3 4.3 13.0
4 Examination No. of sessions 3 2 0 0 1 17
table/cot where procured
% 13.0 8.7 0.0 0.0 4.3 73.9
5 Hemoglobinometer No. of sessions 14 0 0 0 0 9
where procured
% 60.9 0.0 0.0 0.0 0.0 39.1
6 Talquist paper No. of sessions 0 0 0 0 0 23
where procured
% 0.0 0.0 0.0 0.0 0.0 100.0
7 Uristix No. of sessions 0 0 1 0 0 22
where procured
% 0.0 0.0 4.3 0.0 0.0 95.7
8 Stethoscope (adult) No. of sessions 23 0 0 0 0 0
where procured
 % 100.0 0.0 0.0 0.0 0.0 0.0
9 Stethoscope (fetal) No. of sessions 23 0 0 0 0 0
where procured
% 100.0 0.0 0.0 0.0 0.0 0.0
10 BP instrument No. of sessions 22 1 0 0 0 0
where procured
% 95.7 4.3 0.0 0.0 0.0 0.0
11 Measuring tape No. of sessions 3 0 3 0 0 17
where procured
% 13.0 0.0 13.0 0.0 0.0 73.9
12 MUAC tape No. of sessions 0 0 0 4 0 19
where procured
% 0.0 0.0 0.0 17.4 0.0 82.6
13 IMNCI Chart No. of sessions 0 0 0 0 0 23
where procured
% 0.0 0.0 0.0 0.0 0.0 100.0
14 MCP Card No. of sessions 0 0 0 0 0 23
where procured
% 0.0 0.0 0.0 0.0 0.0 100.0
15 IEC/BCC materials No. of sessions 0 0 4 1 0 18
where procured
% 0.0 0.0 17.4 4.3 0.0 78.2
*The salter scale at one Anganwadi center was using the salter scale of the nearby Anganwadi center.

N.B: The damaged child weighing machine is also

from the hospital supply
N.B: Eye training as a source of measuring tape is included under hospital supply

Fig: Procurement of equipment for the VHND session

 Local purchase (SC untied fund) Local purchase (GKS untied fund)
Hospital supply CDPO office supply
Other method Not procured from any source
Adult WM
IEC/BCC materials Child WM
100
MCP Card Salter scale

50
IMNCI chart Examination table

0
MUAC tape Hemoglobinometer

Measuring tape Talquist Paper

BP instrument Uristix
Fetal stethoscope
Adult Stethoscope

It can be made out from the radar diagram that the majority of the equipment for conducting the
VHND sessions had been procured mostly from the local funds (Sub-center untied funds) and the
remaining other equipment/logistics (measuring tape, mid-upper arm circumference tape, IMNCI chart,
MCP chart, IEC/BCC materials, child weighing machine, examination table, talquist paper and uristix)
were not procured from any source. CDPO office was a source for only salter machine and in some
sessions for the MUAC tape.

Table: Method for procurement of drugs and other supplies at VHND session site
Hospital supply

No stock

from any source

(SC untied fund)Local purchase

(GKS untied Local purchase

supplyCDPO office

Not procured
Sl Equipment
1 IFA(small) No. of sessions 0 0 18 0 5 0
where procured
% 78.3 21.7
2 IFA(large) No. of sessions 0 0 22 0 1 0
where procured
% 95.7
3 IFA(liquid) No. of sessions 0 0 22 0 1 0
where procured
% 95.7
4 Paracetamol No. of sessions 0 0 14 0 9 0
where procured
% 60.9 39.1
5 Cotrimoxazole No. of sessions 0 0 11 0 12 0
where procured
 % 47.8 52.2
6 ORS No. of sessions 0 0 17 0 6 0
where procured
% 73.9 26.1
7 Deworming tablet No. of sessions 0 0 13 0 10 0
where procured
% 56.5 43.5
8 Gentian Violet No. of sessions 0 0 11 0 10 2
where procured
% 47.8 43.5 8.7
9 Condoms No. of sessions 0 0 22 0 1 0
where procured
% 95.7 4.3
10 Oral pills No. of sessions 0 0 21 0 2 0
where procured
% 91.3 8.7
11 Other drugs* No. of sessions 0 0 12 0 - -
where procured
%
* Other drugs were found in 12 VHND sessions only.
 2. AVAILABILITY OF ACTION PLAN, LOGISTICS AND RESOURCES NEEDED FOR
CONDUCTING THE VHND SESSIONS
a. Existence of complete micro plan at the District, block and sub-center level
b. Existence of micro plan for hard to reach area at district, block and sub-center level
c. Sharing of micro plan between H and FW department and ICDS department at various
levels
d. Availability of infrastructure at the VHND sessions
i. Percentage of the sessions held at AWCs

Table: Location of the VHND sessions

Sl Place where session was held Number Percent

1 Anganwadi Center 17 73.9
2 School 4 17.4
3 Community center 1 4.3
4 Open place 0 0.0
5 Private house 1 4.3
Most of the sessions were held at the AWC (17 Sessions or 73.9%).

Table: Anganwadi center position where the sessions were held

Sl. Infrastructure status of the AWCs where sessions were held Number Percent
1 Sessions held at AWCs having their own building 4 23.5
2 Sessions held at AWCs not having their own building 13 76.5
Out of those held at the Anganwadi centers, only 4 had their own building. 1 VHND session was
held in a community center though there was an existing own AWC building in the village to facilitate
mobilization to all people (Bada Sahi AWC of Kujang block). 13 out of the rest 17 did not have their
own AWC building and utilized the school building for running the Anganwadi. They had to manage in
some space provided by the school authorities or run Anganwadi before usual school hours.

ii. Percentage of sessions having proper housing conditions (adequate space,

cleanliness, lighting, ventilation).

Table: Housing condition of the VHND sessions

SL Housing condition Raghunathpur Kujang Ballikuda Total

Number % Number % Number % Number %
1 Pucca house
2 Satisfactory roof
condition
3 Adequate space for
session
4 Adequate
ventilation
5 Adequate lighting
6 Electric supply
7 Clean environment
e. Availability of logistics at the session sites of VHND
i. General amenities- Drinking water, sitting arrangement

Table: Availability of general amenities at the session sites of VHND

Sl Type of amenity Raghunathpur Kujang Ballikuda Total

available Number % Number % Number % Number %
1 Drinking water at
the session
2 Drinking water
source at/near the
session
3 Proper storage of
drinking water
4 Hygienic way for
taking out drinking
water from storage
container
5 Bucket
6 Mug
7 Both bucket and
mug
8 Soap
9 Waiting place
10 Mat/sitting
arrangement
ii. Percentage of sessions having the equipment as per guidelines.

Table: Availability of equipment at VHND session site

Sl Instrument Raghunathpur Kujang Ballikuda Total

Number % Number % Number % Number %
1 Adult weighing
machine
2 Child weighing
machine
3 Examination
table/cot
4 Hemoglobinometer
5 Talquist paper
6 Uristix
7 Stethoscope(adult)
8 Stethoscope(fetal)
9 BP instrument
10 Measuring tape
11 MUAC tape
12 IMNCI Chart
13 MCP Card
14 IEC/BCC materials
iii. Percentage of sessions having the drugs and other supplies mentioned in the
guidelines.

Table: Availability of drugs and other supplies at VHND session site

Sl Drugs and other Raghunathpur Kujang Ballikuda Total

supplies Number % Number % Number % Number %
1 IFA(small)
2 IFA(large)
3 IFA(liquid)
4 Paracetamol
5 Cotrimoxazole
6 ORS
7 Deworming tablet
8 Gentian Violet
9 Condoms
10 Oral pills
11 Other drugs
IV. Percentage of sessions with drugs and other supplies in usable stage

Table :Availability of drugs and other supplies in usable stage at VHND session site

Sl Drugs and other supplies Drug available Drug in usable condition

Number % Number %
1 IFA(small)
2 IFA(large)
3 IFA(liquid)
4 Paracetamol
5 Cotrimoxazole
6 ORS
7 Deworming tablet
8 Gentian Violet
9 Condoms
10 Oral pills
11 Other drugs
 3. AVAILABILITY AND UTILIZATION OF SERVICES PROVIDED AT VHND SESSIONS
a. Percentage of sessions held out of the sessions visited
b. Percentage of sessions held as per micro plan

Sl Block No. of sessions Sessions held (%) Sessions held as per

attended for micro plan (%)
evaluation
1 Raghunathpur 4 4 (100%) 4 (100%)
2 Kujang 13 10 (76.92%) 3 (30%)
3 Ballikuda 15 9 (66.7%) 6 (66.7%)
Total 32 23 (71.9%) 13 (56.5%)
Though follow up was not done to find out whether the missed sessions were covered on any
other day, but it was found that 72% of the sessions were usually held on the scheduled day in the
respective areas. Out of these nearly half of them (43.5%) were not held as per micro plan. Creating an
awareness among the people in the locality about the day of VHND and regularity of the services can
only be made if the services are deliver regularly every month on a fixed day basis. This was what the
plan had been done.

c. Percentage of sessions conducted by the HWF in her sub-center area in the last month

Sl Indicator Number of sub-centers %

1 100% of the sessions held
2 80-100% of the sessions held
3 50-80% of the sessions held
4 <50% of the sessions held
Source: VHND register wherever available (Number of sessions where VHND register verified n= )

d. Presence of service providers at the sessions

Sl Type of service provider No of sessions Percent

no
1 HWF 21 91.3
2 AWW 21 91.3
3 AWH 11 47.8
4 ASHA 22 95.7
5 Supervisors 7 30.4
6 GKS members 6 27.3*
*GKS had not been formed in one village of Raghunathpur block where the session was organized. Hence percentage is
calculated from 22 instead of 23.
 Table :Supervision at the session site
Sl. No Type of supervisor No. of sessions Percent
1 AYUSH MO 2 8.7
2 BPO 1 4.3
3 ICDS SUPERVISOR 1 4.3
4 LHV 3 13.0
5 None 16 69.6
Total 23 100.0

There was no supervision at around 70% of the sessions and wherever present it was
LHV in majority of the cases who did the supervision.

Supervision at the VHND sessions

None AYUSH MO BPO
ICDS SUPERVISOR LHV

13%

4%
4%

9%

70%

e. Presence of beneficiaries at the session

Sl no Type of beneficiary No of sessions Percent

1 0-6 month
2 6 mo-5 year child
3 Pregnant women
4 Lactating mothers
5 Adolescent girls
 f. Percentage of sessions where adolescent beneficiaries were provided VHND services

Table : Services to the adolescent girls at the session site of VHND

Sl Services Raghunathpur Kujang Ballikuda Total

Number % Number % Number % Number %
1 TT at 10 yrs
2 TT at 16 yrs
3 Weekly IFA
4 6 monthly
deworming
Percent is calculated from the number of sessions where adolescent beneficiaries were present( )

g. Percentage of sessions where services were provided to pregnant women and nursing
mothers

Table : Services provided to the pregnant women at the VHND session site

Sl Services Raghunathpur Kujang Ballikuda Total

Number % Number % Number % Number %
1 New registrations*
2 Weight measurement
3 Blood pressure
measurement
4 Hemoglobin
estimation
5 Urine examination
6 P/A examination
7 IFA supplementation
8 TT injection
*Percentage to be calculated from sessions with new pregnancies (Refer table no )

Table: Services provided to nursing mothers at the VHND sessions*

Sl Services Raghunathpur Kujang Ballikuda Total

Number % Number % Number % Number %
1 Contraceptive
distribution
2 Referral for IUD
insertion
3 Counseling on
promotion of breast
feeding
4 Birth registration
5 Identification of
danger signs of
Nursing mother
6 Weighing newborn
7 Identification of
danger signs of
Sl Services Raghunathpur Kujang Ballikuda Total
Number % Number % Number % Number %
newborn
8 Referral after
identification of
danger signs of
newborn
*percentage to be calculated from the number of sessions where pregnant women attended the sessions
(RNP= ; KUJ= ; BLK= )

Table : Services delivered to children 5 mon-6 years at the VHND Sessions

Sl Services Raghunathpur Kujang Ballikuda Total

Number % Number % Number % Number %
1 Weight measurement
2 Growth plotting using
IAP/WHO Chart
3 Growth plotting in
Growth register
4 MUAC measurement
N= _________ (No of sessions where children 6 months- 5 years attended the session)

h. Percentage of sessions where common illness’ were managed

Table : Management of common illness’ at the VHND sessions

Sl Management Raghunathpur Kujang Ballikuda Total

Number % Number % Number % Number %
1 Treatment of minor
illness of children using
IMNCI
2 Treatment of minor
ailments for adolescent
girls, lactating mothers
and pregnant women
3 Identification of
disability/malnutrition /
anemia/ high risk
pregnancy/TB/Malaria /
Leprosy/ Kalazar cases
i. Timing of services
j. Services available but not provided
k. Provider knowledge and skill for providing the service
l. Beneficiary attendance at the VHND sessions

Table : Beneficiary coverage pattern at the VHND sessions

Sessions with attendance of the beneficiaries in the particular range

Type of beneficiary 0-6 mon 6 mon-5 yr Pregnant Lactating Adolescent girls
children children women mother
Sl Attendance range No. % No. % No. % No. % No. %
1 0%-25 %
2 25% - 50%
3 50% - 75%
4 75% or more
m. Beneficiary coverage at the VHND sessions
Table: Beneficiary coverage in the VHND sessions
Sl Type of beneficiary SC (in %) ST (in %) Others (in %) Total (in %)

1 0-6 months
2 6 mon- 5 yrs
3 Pregnant women
4 Lactating women
5 Adolescent girls
6 Overall beneficiary coverage
n. Accessibility of the services

Table: Accessibility of the session site to the beneficiaries of VHND

Sl no Type of beneficiary No of sessions with distance of house of beneficiary from the
session is in the range of
0 m- 500 m 500 m – 1000 m >1000 m
1 0-6 months children
2 6 months to 5 years
children
3 Pregnant women
4 Nursing mothers
5 Adolescent girls
Source: Beneficiary interview

Table: Area covered under the VHND sessions

Sl no Farthest house from the session site Number Percent

1 0 m – 500 meters
2 500 m – 1000 meters
3 More than 1000 meters
Source: Interview with service providers (The farthest of the points in case of conflict between HWF and AWW is taken for a
session)

o. Referral and follow up services

Table: Referral and follow up services at the VHND session

Sl Nature of referral Number %

1 Sessions where referral children (Grade II with
illness/III/IV) identified in current session
2 Sessions where children were referred to Pustikar Diwas
3 Sessions where referral children were sent to other
higher centers
4 Sessions with cent percent referral of identified
 underweight cases in last quarter
5 Sessions with no referral of identified referral cases in
last quarter
6 Sessions with at least 1 referral in last month
7 Sessions with follow up of all referral cases of last
month
8 Sessions with incomplete follow up of referral cases of
last month
9 Sessions with no follow up of referral cases of last
month

Table : Referral services availed by the respondents

SL SERVICE NUMBER %
1 Number of respondents who had availed referral services
2 Number of respondents who had complete knowledge on the
reason for referral
3 Number of respondents who had incomplete knowledge about
the reason for referral
4 Number of respondents who had no knowledge about the
reason for referral
5 Number of respondents who had been accompanied by either
ASHA or AWW to the Pustikar Diwas
6 Number of respondent who had been given the yellow card
7 Number of respondents who got back more than 90% or their
spent money
8 Number of respondents who immediately got back their spent
money at the Pustikar Diwas site
9 Number of beneficiaries who faced some or the other form of
difficulties in the referral services
10 Number of beneficiaries who did not face any difficulty in the
referral services
(SOURCE: INTERVIEW WITH BENEFIARIES)

p. Awareness regarding the services

Table: Awareness of respondents (beneficiaries) about VHND

SL AWARENESS REGARDING NUMBER %

1 What is VHND/Mamata Diwas/Health day?
2 What is done on VHND (brief idea)?
3 When it is held (Correct day and week)?
4 Where is it held?
5 Usually at what time is it held (Correct time)?
q. Percentage of beneficiaries who want the services of VHND in their area in the long run
r. Percentage of beneficiaries who support the VHND sessions in any form

Table: Key information from respondents (beneficiaries) regarding VHND services in their area
Sl Information Number %
1 Beneficiaries who want to come regularly for the VHND session
2 Beneficiaries who want that the VHND should continue
3 Beneficiaries who support the VHND session in any form
4 Beneficiaries who find the VHND useful (in any form)
5 Beneficiaries who find no demerits in attending the VHND regularly
6 Beneficiaries who are find the time of VHND sessions inconvenient
7 Beneficiaries who are satisfied with the services they receive usually
from the VHND sessions held in their area

s. Mobilization for the services

Table: Key information from respondents regarding this VHND session

SL INFORMATION NUMBER %
1 Beneficiaries who have come of their own (without mobilization)
2 Beneficiaries who have been mobilized by ASHA
3 Beneficiaries who have been mobilized by any service provider
(ASHA, AWW, AWH, HWF or HWM)
4 Beneficiaries who have come for the first time to the session
5 Beneficiaries who were asked to come in the next session
6 Beneficiaries who were aware when the next session will be held
7 Beneficiaries who know the reason of their referral (or their child’s)
if referred
8 Beneficiaries who have received health and nutrition advices as per
health calendar (using recall method)
9 Beneficiaries who are satisfied with the services they received
 4. QUALITY OF SERVICES PROVIDED IN THE VILLAGE HEALTH AND NUTRITION DAY
AT THE AWC
a. Planning for conducting the VHND sessions

Table: Planning and execution of VHND services

Sl Information HWF AWW

1 Planning for VHND made
2 A microplan made for the session
3 Microplan available with the service provider
4 Supervision present within last 3 months
5 Conducting VHND on the scheduled day
6 Conducting VHND every month
Source: Interview with the service providers

b. Supervision and monitoring found at the session site

Sl Type of supervisor No of sessions where Percent

no supervisors were present
1 LHV
2 BEE
3 BPO
4 MO
5 AYUSH MO
6 ADMO FW
7 CDMO
8 ICDS SUPERVISOR
9 CDPO
10 DSWO
Source : Facility survey checklist

c. Internal supervision system of the VHND program

Table: Internal supervision in VHND

Sl Information Health dept ICDS dept

Supervision Supervision Supervision Supervision
present documented present documented
1 Present session
2 Last session
3 Not last session but within last 3
months
4 More than 3 months back
5 No supervision
Source : Interview with service providers (N.B. Supervision was taken to be present if either HWF or AWW agrees to it and then
verified from any documents if it was available)
 Table: Supervisors who usually visit the VHND sessions

SL SUPERVISOR TYPE DEPT. NUMBER % DOCUMENTED

1 Medical Officer
2 AYUSH Medical Officer
3 Lady Health Visitor (LHV)
4 Block Program Officer (BPO)
5 Block Extension Educator
6 ICDS Supervisor
7 CDPO
8 ADMO FW
9 DPM
10 CDMO
11 DSWO
Source : Interview with service providers (N.B. Supervision was taken to be present if either HWF or AWW agrees to it and then
verified from any documents if it was available)

d. Supervision method adopted by the supervisors usually

Table : Nature of supervisory visits by the supervisors

SL INDICATOR YES (%) NO (%)

1 Frequent supervision
2 See as part of their team
3 Primary aim is to improve service quality
and not collect data
4 Empower rather than criticize
5 Take enough time to understand problems
6 Speak to all levels of staffs
7 Help staff identify and solve their
problems
8 Practice active listening
9 Provide staff with the information they
need to perform their jobs well
10 Provide or arrange training for providing
high quality services
e. Perception of supervisors at the block and district level: Positive and negative points
about the VHND sessions under their area of supervision

f. Percentage of sessions managed by trained service providers

TABLE : Training status of the service providers

SL Status of training HWF AWW

Number % Number %
1 Trained
2 Untrained
3 Cannot recollect anything
4 Can recollect even details of training
 (like personnel imparted training or
place or content of training)

g. Percentage of sessions having various records and registers of HWF and AWW for
recording the services of the session

Table: Availability of registers of HWF at the session sites of VHND

Sl Registers Raghunathpur Kujang Ballikuda Total

Number % Number % Number % Number %
1 VHND register
2 Referral register
3 MCH/immunization
register
4 Minor ailment
treatment register
5 Oral pill distribution
register

Table: Availability of registers of AWW at the session sites of VHND

Sl Registers Raghunathpur Kujang Ballikuda Total

Number % Number % Number % Number %
1 VHND register
2 Referral register
3 SNP register
4 Survey register
5 Growth Chart
register
6 New WHO Chart
7 PS Attendance
register
8 Weight register

h. Percentage of sessions having updated records and registers of HWF and AWW

Table: Availability of updated records and registers with HWF*

Sl Registers Raghunathpur Kujang Ballikuda Total

Number % Number % Number % Number %
1 VHND register
2 Referral register
3 MCH/immunization
register
4 Minor ailment
treatment register
5 Oral pill distribution
register
 * Percentage is calculated from the total number of sessions where the particular register was available
(Refer table no.____)

Table: Availability of updated records and registers with AWW*

Sl Registers Raghunathpur Kujang Ballikuda Total

Number % Number % Number % Number %
1 VHND register
2 Referral register
3 SNP register
4 Survey register
5 Growth Chart
register
6 New WHO Chart
7 PS Attendance
register
8 Weight register
* Percentage is calculated from the total number of sessions where the particular register was available
(Refer table no.____)

i. Reports and returns : Percentage of sub-centers having reported about their VHND
sessions in the last quarter (from reports at the block and district level)
j. Adopting correct methods while providing services

Table : Correct method adopted while providing a particular VHND service*

providing the service

providing the service

providing the service

providing the service

providing the service

providing the serviceNo. of HWFs

providing the serviceNo. of ASHAs

providing the serviceNo. of AWWs

No. of ASHAs
No. of AWWs

No. of AWHs

No. of AWHs
No. of HWFs

Sl Type of service
no
correctly

correctly

correctly

correctly
No. No. No. No. No. No. No. No.
(%) (%) (%) (%) (%) (%) (%) (%)
1 Blood pressure
measurement ( )
2 Weight measurement of
pregnant women ( )
3 Weight measurement of
children
4 Plotting on growth chart
5 MUAC measurement
6 Hemoglobin estimation
7 Urine examination
8 P/A examination of
pregnant women
 providing the service

providing the service

providing the service

providing the service

providing the service

providing the serviceNo. of HWFs

providing the serviceNo. of AWWs

providing the serviceNo. of ASHAs

No. of ASHAs
No. of AWWs

No. of AWHs

No. of AWHs
No. of HWFs
Sl Type of service
no

correctly

correctly

correctly

correctly
No. No. No. No. No. No. No. No.
(%) (%) (%) (%) (%) (%) (%) (%)
9 Identification of danger
signs of pregnant women
10 Identification of danger
signs of newborn
*percentage for providing the service is calculated from total number of sessions where service was provided
(indicated in small parenthesis ‘( )’) and percentage for providing correctly is calculated from the total number of
sessions where the particular service was provided by that service provider

k. Percentage of sessions where no health topic discussion was undertaken

l. Percentage of sessions with health topic discussion as per the health calendar

Table: Health education at the VHND session

Sl Nature of health topic Number %

1 General topics related to health and hygiene
2 Focused topic according to health calendar
3 Focused topic but not according to health calendar
4 No health topic discussed

m. Method of mobilization of the beneficiaries

Table: Mobilization of beneficiaries to the VHND session site

Sl Mobilizer Number %
1 ASHA
2 AWW
3 AWH
4 HWF
5 GKS members
6 Self-awareness
7 Others

n. Adequacy of logistics and equipment

Table: Session wise stock position of drugs and other supplies for VHND

Sl Drugs and other supplies No stock (%) Stock available Available at Available with
no with service the session site ASHA (%)
 providers (%) (%)
1 IFA(small)
2 IFA(large)
3 IFA(liquid)
4 Paracetamol
5 Cotrimoxazole
6 ORS
7 Deworming tablet
8 Gentian Violet
9 Condoms
10 Oral pills
11 Other drugs

Table: Session wise availability of instrument for the VHND sessions

Sl Instrument Already Available at the Procured but not Procured but not in
no procured session site available at the usable condition
session
1
2
3
4
5
6
7
8
9
10
11

o. Display of services provided on the VHND

Table: Display content at the VHND sessions

Raghunathpur Kujang Ballikuda Total
Sl Display content No. % No. % No. % No. %

1 No display
2 Types of services

3 Beneficiary group

4 Name of the
AWC
5 Date/day
6 Swasthya Kantha
used for display
p. Performance of the VHND sessions
Sl Category Raghunathpur Kujang Ballikuda Total
No. % No. % No. % No. %
1 Poor performing
(Score <5)
2 Average performing
(Score 5-10)
3 Good performing
(Score 10-13)
4 Excellent performing
(Score 13-15)
Refer annexure A
 5. LEVEL OF AWARENESS REGARDING VARIOUS ASPECTS OF VHND AMONG THE
SERVICE PROVIDERS AND BENEFICIARIES
a. Providers: Purpose of VHND, type of services to be provided, day and timing of VHND,
supervision, health topic for discussion

Table : Service providers interviewed at VHND sessions

Sl Block HWF AWW ASHA

1 Raghunathpur
2 Kujang
3 Ballikuda

Table 33: Knowledge of service providers regarding* objectives/purpose of VHND

SL PURPOSE HWF** AWW**

Number % Number %
1 Provision of essential and comprehensive health and
nutrition services to beneficiaries
2 Ensure early registration, identification and referral of
high risk children and pregnant women
3 Provide an effective platform for interaction of service
providers and the community
4 Provide information to families on care of mothers and
children at the household and community level through
discussion of various health topics
5 Ensure establishment of linkage between health and
ICDS so as to promote maternal and child survival
programs
*Interview was done with service provider with an aim to find out which objective they did not stress
upon.

**Table to be used for calculating the percentage

TABLE : Correct knowledge about their roles and responsibilities in VHND among various service
providers

Sl Service provider Number Percent

1 HWF
2 AWW
3 ASHA

Information regarding VHND from the service providers

Sl Information HWF AWW

1 Conducting VHND on the scheduled day
2 Conducting VHND every month
3 Planning for VHND made
 4 A microplan made for the session
5 Microplan available with the service provider
6 Supervision present within last 3 months

b. Beneficiaries: Place, time and day, providers providing the services, type of services,
place of referral and its cause, knowledge of the health topic discussed after attending the
session

Table: Key information from respondents (beneficiaries) regarding VHND services in their area

Sl Information Number %
1 Beneficiaries who want to come regularly for the VHND session
2 Beneficiaries who want that the VHND should continue
3 Beneficiaries who support the VHND session in any form
4 Beneficiaries who find the VHND useful (in any form)
5 Beneficiaries who find no demerits in attending the VHND regularly
6 Beneficiaries who are find the time of VHND sessions inconvenient
7 Beneficiaries who are satisfied with the services they receive usually
from the VHND sessions held in their area

Table: Key information from respondents regarding this VHND session

Sl Information Number %
1 Beneficiaries who have come of their own (without mobilization)
2 Beneficiaries who have been mobilized by ASHA
3 Beneficiaries who have been mobilized by any service provider
(ASHA, AWW, AWH, HWF or HWM)
4 Beneficiaries who have come for the first time to the session
5 Beneficiaries who were asked to come in the next session
6 Beneficiaries who were aware when the next session will be held
7 Beneficiaries who know the reason of their referral (or their child’s)
if referred
8 Beneficiaries who have received health and nutrition advices as per
health calendar (using recall method)
9 Beneficiaries who are satisfied with the services they received

Table 31: Awareness about referral services availed by the respondents

Sl Service Number %
1 Number of respondents who had availed referral services
2 Number of respondents who had complete knowledge on the
reason for referral
3 Number of respondents who had incomplete knowledge about
the reason for referral
4 Number of respondents who had no knowledge about the
reason for referral
5 Number of respondents who had been accompanied by either
ASHA or AWW to the Pustikar Diwas
6 Number of respondent who had been given the yellow card
7 Number of respondents who got back more than 90% or their
spent money
8 Number of respondents who immediately got back their spent
money at the Pustikar Diwas site
9 Number of beneficiaries who faced some or the other form of
difficulties in the referral services
10 Number of beneficiaries who did not face any difficulty in the
referral services
 6. GAPS IDENTIFIED AND RECOMMENDATIONS
a. Infrastructure
b. Process
c. Services
d. Records and registers
e. Knowledge and skill of providers
f. Knowledge of beneficiaries
g. Logistics and equipment
h. Guidelines
i. Manpower
j. Supervision and monitoring
k. Inter sectorial coordination

Sl Suggestions Number of beneficiaries Feasibility

who gave the suggestion (Y/N)
1
2
3
CONCLUSION
RECOMMENDATIONS
APPENDIX
 REFERENCES
1. http://nrhmorissa.gov.in/aboutus.html
2. Operational guidelines for VHND final; Source: Health and Family Welfare department,
GoO and http://www.nrhmorissa.gov.in/pdf/Mamata.pdf
3. Operational guidelines for Pustikar Diwas final; Source: Health and Family Welfare
department, GoO
4. I.C.D.S Format-I & Format-II for December, 2009; Source: Office of the Women and
Child Development Department, GoO
5. A new approach to supervision: Facilitative Supervision Handbook © 2001
EngenderHealth
6. http://censusindia.gov.in/vital_statistics/SRS_Bulletins/SRS-Bulletin-October-2009.pdf
7. http://www.mohfw.nic.in/NRHM/Documents/VHND_Guidelines.pdf
8. Methodological Triangulation in a Study of Social Support for Siblings of Children With
Cancer John S. Murray Journal of Pediatric Oncology Nursing October 1999 vol. 16 no.
4 194-200
9. Three techniques for integrating data in mixed methods studies Alicia O’Cathain,
Elizabeth Murphy, Jon Nicholl BMJ 2010; 341:c4587
10. http://www.referenceworld.com/sage/socialscience/triangulation.pdf
11. RHRC Consortium Monitoring and Evaluation Tool Kit Client Exit Interview Protocol
12. Basics healthy timing and spacing of pregnancy toolkit client exit interview:
www.basics.orgdocumentsClient-Exit-Interview-for-HTSP.pdf
13. Rebecca C.Robert, Joel Gittelsohn, Hilary M.Creed-Kanashiro, Mary E.Penny,
LauraE.Caulfield, M.RocioNarro, and Robert E.Black. Process Evaluation Determines
the Pathway of Success for a Health Center–Delivered, Nutrition Education Intervention
for Infants in Trujillo, Peru. Journal of Nutrition:
http://jn.nutrition.orgcgireprint1363634.pdf
ANNEXURE
ANNEX 1: LIST OF VHND SESSIONS COVERED WITH DAYS OF VISIT

Sl Day/Wee Code Block Sub center VHND Session held or Weather

k session not
1
2
3
4
5
6

ANNEX 2: BENEFICIARY (CHILDREN 0-6 MON) COVERAGE SESSION WISE

SL VHND SESSION SC (IN ST (IN %) OTHERS (IN %) TOTAL (IN

(BLOCK) %) %)
1
2
3
4
5
6

ANNEX 3: BENEFICIARY (CHILDREN 6 MON- 5 YRS) COVERAGE SESSION WISE

SL VHND SESSION SC (IN ST (IN %) OTHERS (IN %) TOTAL (IN

(BLOCK) %) %)
1
2
3
4
5
6
ANNEX 4: BENEFICIARY (PREGNANT WOMEN) COVERAGE SESSION WISE

SL VHND SESSION SC (IN ST (IN %) OTHERS (IN %) TOTAL (IN

(BLOCK) %) %)
1
2
3
4
5
6
ANNEX 5: BENEFICIARY (LACTATING MOTHERS) COVERAGE SESSION WISE

SL VHND SESSION SC (IN ST (IN %) OTHERS (IN %) TOTAL (IN

(BLOCK) %) %)
1
2
3
4
5
6

ANNEX 6: BENEFICIARY (ADOLESCENT GIRLS) COVERAGE SESSION WISE

SL VHND SESSION SC (IN ST (IN %) OTHERS (IN %) TOTAL (IN

(BLOCK) %) %)
1
2
3
4
5
6

ANNEX 7: TOTAL BENEFICIARY COVERAGE SESSION WISE

SL VHND SESSION SC (IN ST (IN %) OTHERS (IN %) TOTAL (IN

(BLOCK) %) %)
1
2
3
4
5
6
 SL NO

4
3
2
1

 
 
 
 
VHND CODE

0=NO, 1= YES
 
 
 
 
VHND SESSION HELD AS PER
MICROPLAN

 
 
 
 
DISPLAY DATE/DAY

 
 
 
 
ASHA SUPPORT

 
 
 
 
MEAN COVERAGE AREA <1 KM

 
 
 
 
PRIVACY FOR EXAMINATION

 
 
 
 

DIGNITY TO BENEFICIARY
 
 
 
 

EQUITY OF SERVICES
 
 
 
 

100% FOLLOW UP OF REFERRAL/

ANNEX 8: PERFORMANCE OF THE INDIVIDUAL VHND SESSIONS

BENEFICIARY ASKED TO COME

NEXT TIME
 
 
 
 

SUPERVISION THIS SESSION/ IN

LAST 3 MONTHS
 
 
 
 

HWF WITH KNOWLEDGE ON

HEALTH TOPIC
 
 
 
 

ASHA KNOWING VHND DAY

 
 
 
 

MOST OF THE INSTRUMENTS

 
 
 
 

MOST OF THE ESSENTIAL DRUGS

 
 
 
 

PUCCA HOUSE
 
 
 
 

ADEQUATE SPACE FOR SERVICES

TOTAL SCORE