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Ministry of Health & Family Welfare

(Monitoring & Evaluation Division)


Monthly Return under NRHM

Name of District/Block : BHOPAL/FANDA


Reporting Month: AUGST Year 2009

Part A. REPRODUCTIVE HEALTH

M1 Ante Natal Care Services (ANC)


1.1 MÑüsÉ mÉÇeÉÏ¢üiÉ qÉÌWûsÉÉrÉÉåÇ MüÐ xÉÇZrÉÉ

1.1.1 izFke frekgh esa iathd`r xHkZorh efgyk,sa

1.2 bl ekg esa tuuh lqj{kk ;kstuk esa iathd`r efgyk,W

1.3 xHkZorh efgyk,W ftudh 3 tkWp gqbZ gSA

1.4 xHkZorh efgykvksa dh la[;k ftUgs fuEu lqfo/kk nh xbZ


1.4.1 TT1

1.4.2 TT2 ;k Booster

1.5 dqy xHkZorh efgyk,W ftUgsa 100 IFA tablets nh

1.6 mPp jDrpki okyh xHkZorh efgyk,W (BP>140/90)


1.6.1 laLFkk esa bl ekg ntZ u, dsl
1.6.2 ,DysfE'k;k izca/ku ds dsl dh la[;k
1.7 [kwu dh deh okyh xHkZorh efgyk,W
1.7.1 ftudk Lrj Hb 11 ls de gS ¼tkWp ds ckn½

1.7.2 vfr xzHkhj ,uhfe;k ¼7 th-,e-½ ds dsl ftudk mipkj laLFkk esa gqvk

M2 Deliveries
2.1 x`g izlo
2.1.1 ?kj ij izlo fdlds }kjk djok, x,

(a) ,l-ch-,- izf'kf{kr O;fDr }kjk

(b) vizf'kf{kr O;fDr }kjk By Non SBA (Trained TBA/Relatives/etc.)


Total {(a) to (b)}
2.1.2 uotkr f'k'kqvks dh la[;k ftUgsa 24 ?kUVs ds vUnj x`g HksV dh xbZ

2.1.3 ilwrh efgykvksa dh la[;k ftUgsa ?kj ij izlo ds ckn tuuh lqj{kk ;kstuk dh jkf'k nh xbZ

2.2 laLFkk es gq, izlo Deliveries conducted at Public Institutions

(a) SHC

(b) PHC

(c ) CHC
(d) Sub-divisional hospital/District Hospital

(e) At Other State Owned Public Institutions

Total {(a) to (e)}

2.2.1 izloks dh la[;k tks 48 /kaVs rd laLFkk es jgs

2.2.2 tuuh lqj{kk ;kstuk jkf'k dk Hkqxrku fd;k


(a) izlwrk efgyk dks
(b) vk'kk dks
(c) ,-,u-,e-@vkaxuckMh dk;ZdrkZ dks ¼dsoy ,p-ih-,l- jkT;ksa esa ½

2.3 Number of Deliveries at accredited Private Institutions


laLFkkxr izlo ftUgs tuuh lqj{kk ;kstuk jkf'k dk Hkqxrku fd;k Number of institutional delivery cases
2.3.1
where JSY incentive paid to
(a) izlwrk efgyk dks
(b) vk'kk dks

(c) ,-,u-,e-@vkaxuckMh dk;ZdrkZ dks ¼dsoy ,p-ih-,l- jkT;ksa esa ½

M3 Number of Caesarean (C-Section) deliveries performed at


3.1 Public facilities
3.1.1 PHC

3.1.2 CHC

3.1.3 Sub-divisional hospital/District Hospital


3.1.4 At Other State Owned Public Institutions
Total {(3.1.1) to (3.1.4)}
3.2 Private facilities
M4 xHkkZoLFkk dk ifj.kke o uotkr f'k'k tkudkjh
4.1 xHkkZoLFkk ifj.kke ¼la[;k½
4.1.1 Live Birth
(a) Male

(b) Female

Total ({a} + {b})


4.1.2 e`r tUe
4.1.3 xHkZikr Abortion (spontaneous/induced)
4.2 otu fy, x, uotkr f'k'kq dh tkudkjh
4.2.1 uotkr f'k'kq dh la[;k ftudk tUe ds le; out fy;k
4.2.2 2-5 fdyks ls de otu dh uotkr f'k'kqvks dh la[;k
4.2.3 1-8 fdyks ls de otu dh uotkr f'k'kqvks dh la[;k
4.3 uotkr f'k'kqvks dh la[;k ftUgs 1 ?k.Vs ds vUnj Lruiku djk;k x;k
M5 tfVy izlo
laLFkk ij tkap dh xbZ xHkZorh efgyk,Wa ftUgsa tfVyrk Fk Number of cases of pregnant women with
5.1
Obstetric Complications and attended at Public facilities
5.1.1 PHC

5.1.2 CHC
5.1.3 Sub-divisional hospital/District Hospital
5.1.4 At Other State Owned Public Institutions
Total {(5.1.1) to (5.1.4)}
5.2 Number of cases of pregnant women with Obstetric Complications and attended at Private facilities

5.3 tfVy izlo dk izca/ku fd;k


5.3.1 vkbZ-Ogh- ,UVhck;ksfVDl
5.3.2 vkbZ-Ogh- ,Uvhgk;ijVsfUlo@esxlYQ batsD'ku IV antihypertensive/Magsulph injection
5.3.3 vkbZ-Ogh- vkWDlhVksfDll IV Oxytocis
5.3.4 Blood Transfusion
M6 Post - Natal Care
6.1 izlwrk efgyk ftUgsa 48 ?k.Vs ds vanj izlo Ik'pkr lqfo/kk feyh

6.2 izlwrk efgyk ftUgsa 48 ?k.Vs o 14 fnu ds vanj izlo Ik'pkr lqfo/kk feyh

6.3 izlo Ik'pkr tfVyrk izca/ku dh la[;k PNC maternal complications attended
M7 xHkZikr Medical Termination of Pregnancy (MTP)
7.1 laLFkk esa fd, x, xHkZikr dh la[;k
7.1.1 xHkkZoLFkk ds 12 g¶rs rd
7.1.2 xHkkZoLFkk ds 12 g¶rs ls vf/kd More than 12 weeks of pregnancy
Total {(7.1.1) to (7.1.2)}
7.2 futh laLFkkvksa esa fd, x, xHkZikr dh la[;k Number of MTPs conducted at Private Facilities
M8 RTI/STI Cases
8.1 u;s dslksa dh la[;k ftudk mipkj 'kq: fd;k
(a) Male

(b) Female

Total {(8.1.1) to (8.1.2)}


8.2 bl ekg fd;s x;s osV ekmUV tkap dh la[;k
M9 Family Planning
9.01 laLFkk esa dh xbZ NSV/iq:"k ulcanh dh la[;k
9.1.1 At Public facilities

(a) At PHCs

(b) At CHCs

(c) At Sub-divisional hospitals/ District Hospitals


(d) At Other State Owned Public Institutions
Total {(a) to (d)}
9.1.2 At Private facilities
9.02 laLFkk esa dh xbZ LTT dh la[;k Number of Laparoscopic sterilizations conducted
9.2.1 At Public facilities
(a) At PHCs
(b) At CHCs
(c) At Sub-divisional hospitals/ District Hospitals

(d) At Other State Owned Public Institutions

Total {(a) to (d)}


9.2.2 At Private facilities
9.03 laLFkk esa fd;s x;s feuhysi ulcUnh dh la[;k Number of Mini-lap sterilizations conducted
9.3.1 At Public facilities
(a) At PHCs
(b) At CHCs
(c) At Sub-divisional hospitals/ District Hospitals

(d) At Other State Owned Public Institutions

Total {(a) to (d)}


9.3.2 At Private facilities
9.04 laLFkk esa fd;s x,s izlo Ik'pkr ulcUnh dh la[;k Number of Post-Partum sterilizations conducted
9.4.1 Public facilities
(a) At PHCs

(b) At CHCs
(c) At Sub-divisional hospitals/ District Hospitals
(d) At Other State Owned Public Institutions
Total {(a) to (d)}
9.4.2 Private facilities
9.05 bl ekg laLFkk esa fd, x, ywi fuos'ku dh la[;k Number of IUD Insertions
9.5.1 Publicfacilities
(a) At Sub-Centres
(b) At PHCs
(c) At CHCs
(d) At Sub-divisional hospitals/ District Hospitals

(e) At Other State Owned Public Institutions


Total {(a) to (e)}
9.5.2 Private facilities
9.06 ywi dh la[;k fudkys x, Number of IUD removals
9.07 forfjr vksjy fiy pØ dh la[;k Number of Oral Pills cycles distributed

9.08 forfjr fd, x, fujks/k dh la[;k Number of Condom pieces distributed

9.09 forfjr lkIrkfgd xksyh ¼lsUVØkseku½ dh la[;k Number of Centchroman (weekly) pills given

9.10 forfjr vkikrdkyhu xHkZfujks/kd dh la[;k Number of Emergency Contraceptive Pills distributed
9.11 ulcanh lsokvksa dh xq.koRrk Quality in sterilization services
9.11.1 ulcanh ds dkj.k mith tfVyrk Number of complications following sterilization
(a) Male

(b) Female
9.11.2 vlQy ulcUnh Number of failures following sterilization
(a) Male

(b) Female

9.11.3 ulcUnh ds ckn e`R;q Number of deaths following sterilization


(a) Male

(b) Female

9.12 laLFkk esa NSV izf'kf{kr fpfdRld gSa ¼gkW@ugh½


M10 CHILD IMMUNIZATION
10.1 Number of Infants 0 to 11 months old who received the following:

10.1.01 ch-lh-th-

10.1.02 Mh-ih-Vh- 1
10.1.03 Mh-ih-Vh- 2
10.1.04 Mh-ih-Vh- 3
10.1.05 iksfy;ks 0 ¼tUe ds le;½
10.1.06 iksfy;ks 1
10.1.07 iksfy;ks 2
10.1.08 iksfy;ks 3
10.1.09 fgi ch 1
10.1.10 fgi ch 2
10.1.11 fgi ch 3
10.1.12 ehtYl

Total number of children aged between 9 and 11 months who have been fully immunized
10.1.13
(BCG+DPT123+OPV123+Measles) during the month
(a) Male

(b) Female

Total {(a) to (b)}

10.2 Number of children more than 16 months who received the following

10.2.1 DPT Booster


10.2.2 OPV Booster
10.2.3 Measles, Mumps, Rubella (MMR) Vaccine
10.3 Immunization Status

10.3.1
Total number of children aged between 12 and 23 months who have been fully immunized
(BCG+DPT123+OPV123+Measles) during the month

(a) Male

(b) Female

Total {(a) to (b)}

10.3.2 5 o"kZ rd ds cPps ftUg DT5 fn;kA

10.3.3 10 o"kZ ls vf/kd cPps ftUgsa TT10 fn;k


10.3.4 16 o"kZ ls vf/kd cPps ftUgsa TT16 fn;k

10.3.5 Vhdkdj.k Ik'pkr~ izfrdwy izHkko Adverse Event Following Immunisation (AEFI)

(a) TüÉåQûÉ

(b) qÉëirÉÑ

(c) AlrÉ

10.4 ekg esa Vhdkdj.k l= dh la[;k Number of Immunization sessions during the month

10.4.1 ÌlÉrÉÉåÎeÉiÉ xɧÉ

10.4.2 AÉrÉÉåÎeÉiÉ xɧÉ

10.4.3 xÉ§É eÉWûÉÇ AÉzÉÉ EmÉÎxjÉiÉ jÉÏÇ

10.5 vU; ¼tsiuhl budsQsykbfVl½


10.5.1

10.5.2

10.5.3

M11 foVkfeu , [kqjkd dh la[;k Number of Vitamin A doses

11.1 9 ekg ls 5 o"kZ ds chp nh xbZ [kqjkd Administered between 9 months and 5 years

11.1.1 Dose-1

11.1.2 Dose-5

11.1.3 Dose-9

M12 Number of cases of Childhood Diseases reported during the month (0-5 years)

12.1 ÌQûmjÉåËUrÉÉ

12.2 mÉUšÔÍxÉxÉ

12.3 ÌOûOûlÉåxÉ (lÉuÉeÉÉiÉ ÍzÉzÉÔ qÉåÇ)

12.4 ÌOûOûlÉåxÉ ( AlrÉåÇ)

12.5 mÉÉåÍsÉrÉÉå

12.6 ÍqÉeÉsxÉ

12.7 SxiÉ uÉ ÌlÉeÉïsÉÏMüUhÉ

12.8 qÉsÉåËUrÉÉ

12.9 NûÉiÉÏ qÉåÇ xÉÇ¢üqÉhÉ Måü pÉiÉÏï qÉUÏeÉ

Part B. Other Programmes

M13 vU/kRo fuokj.k dk;Øe Blindness Control Programme


13.1 qÉÉåÌiÉrÉÉÌoÉlS Måü AÉmÉUåzÉlÉ WÒûL UÉåaÉÏrÉÉåÇ MüÐ xÉÇZrÉÉ

13.2 UÉåaÉÏ ÎeÉlÉqÉåÇ IOL sÉaÉÉrÉå aÉrÉå

13.3 ËUTåüYOûUÏ LUU MüÐ mÉWûcÉÉlÉ ÌMüL aÉrÉå xMÔüsÉÏ oÉŠÉåÇ MüÐ xÉÇZrÉÉ

13.4 oÉŠÉåÇ MüÐ xÉÇZrÉÉ ÎeÉlWåÇû qÉÑniÉ qÉåÇ cÉxqÉåÇ ÌuÉiÉËUiÉ ÌMüL

13.5 lÉå§É SÉlÉ WåûiÉÑ lÉå§É eÉqÉÉ lÉÑL


13.6 lÉå§É SÉlÉ xÉå qÉUÏeÉÉåÇ qÉåÇ lÉå§É sÉaÉÉrÉå aÉrÉå

Part C. Health Facility Services

M14 Patient Services


14.01 Number of CHC/ SDH/ DH functioning as an FRU

14.02 Number of PHCs functioning 24X7 (3 Staff Nurses)

14.03 Number of Anganwadi centres reported to have conducted VHNDs

14.04 Number of facilities having a Rogi Kalyan Samiti

14.05 Number of RKS meetings held during the month

14.06 Number of facilities having Ambulance services (Assured Referral Services) available

14.07 Total Number of times the Ambulance was used for transporting patients during the month

14.08 Number of Institutions having operational Sick New Born and Child Care Units

14.09 Number of functional Laparoscopes in CHC/SDH/DH


14.10 Inpatients
Children
14.10.1 HkrhZ Admissions (< 19 Adults
yrs)
(a) Male 0 50
(b) Female 6 84
Total {(a) to (b)} 6 134
14.10.2 e`R;q Deaths

(a) Male

(b) Female

Total {(a) to (b)}


14.11 jkr esa fdrus ejht laLFkk esa HkrhZ Fks In-Patient Head Count at midnight
14.12 ckg~; jksxh Outpatients
14.12.1 dqy ckg~; jksxh OPD attendance (All)
14.13 vkWijs'ku fFk;sVj Operation Theatre
14.13.1 cM+h 'kY; fØ;k ¼tujy@LikbZuy ,usLFksfl;k fn;k½

14.13.2 NksVh 'kY; fØ;k ¼yksdy ,usLFksfl;k fn;k½

14.14 vU; ¼nar fpfdRlk us= jksx] vk;q"k vkfn½


14.14.1 AÉrÉÑwÉ

14.14.2 SliÉ ÍcÉÌMüixÉÉ

14.14.3 ÌMüzÉÉåUÉåÇ MüÉå mÉUÉqÉzÉï xÉÑÌuÉkÉÉ

14.14.4

14.14.5

M15 iz;ksx'kkyk esa tkap Laboratory Testing


15.1 foLr`r tkudkjh Laboratory Test Details
15.1.1 Hb Tests conducted
(a) fd, x, Hb VsLV dh la[;k (No. of Hb tests conducted)
(b) VsLV fd, x, esa ls 7 gm ls de Hb (Of which numbers having Hb < 7 mg)
Number
15.1.2 HIV tests conducted tested
(a) mÉÑÃwÉ

(b) qÉÌWûsÉÉ(aÉpÉïuÉÌiÉ qÉÌWûsÉÉ lÉWûÏ)

(c) aÉpÉïuÉÌiÉ qÉÌWûsÉÉ

Total {(a) to (c)}


15.2 foMky VsLV dh la[;k Widal tests conducted
Number
15.3 VDRL VsLV dh la[;k VDRL tests conducted tested
(a) mÉÑÃwÉ

(b) qÉÌWûsÉÉ(aÉpÉïuÉÌiÉ qÉÌWûsÉÉ lÉWûÏ)

(c) aÉpÉïuÉÌiÉ qÉÌWûsÉÉ

Total {(a) to (c)}


15.4 qÉsÉåËUrÉÉ OåûxOû
15.4.1 U£ü mɏûÏ MüÐ eÉÉÇcÉ
15.4.2 Plasmodium Vivax mÉÉrÉå aÉrÉå

15.4.3 Plasmodium Falciparum mÉÉrÉå aÉrÉå


Part D. Monthly Inventory Status
Balance from Previous
M16 Stock Position (During the month) Stocks received Unusable stock
month
16.1 Vaccines
16.1.1 DPT

16.1.2 OPV

16.1.3 TT

16.1.4 DT

16.1.5 BCG

16.1.6 Measles

16.1.7 JE

16.1.8 Hepatitis B
16.2 Family Planning
16.2.1 IUD 380 A
16.2.2 Condoms

16.2.3 Oral Contraceptive


16.2.4 Emergency Contraceptive Pills
16.2.5 Tubal rings
16.3 Other Items
16.3.01 Injection Oxytocin

16.3.02 Gloves

16.3.03 MVA Syringes


16.3.04 Tab. Fluconazole
16.3.05 Blood Transfusion sets
16.3.06 Gluteraldehyde 2%
16.3.07 IFA tablets
16.3.08 IFA Syrup (Pediatric)
Pediatrics Antibiotics (Cotrimaxozole and
16.3.09
Injectable Gentamicin)
16.3.10 Vitamin A solution
16.3.11 ORS (New WHO)
16.4 Syringes
16.4.1 0.1 ml (AD)
16.4.2 0.5 ml (AD)
16.4.3 5.0 ml (Disposable)
Part E. Mortality Details
M17 Details of deaths reported during the month with probable causes:
17.1 tUe ds 24 ?kaVs ds vUnj gqbZ uotkr f'k'kq dh e`R;q Infant deaths within 24 hrs of birth
Up to 1 Weeks of Between 1 week &
17.2 Infant Deaths up to 4 weeks by cause
Birth 4 weeks of birth

Male Female Male Female Total

17.2.1 xÉÇ¢üqÉhÉ

17.2.2 xÉÉxÉ sÉålÉå qÉåÇ iÉMüsÉÏTü


17.2.3 MüqÉ uÉeÉlÉ
17.2.4 AlrÉ

Between 1 month Between 1 year & 5


17.3 Infant/Child Deaths up to 5 years by cause
and 11 months years

Male Female Male Female Total

17.3.1 ÌlÉqÉÉåÌlÉrÉÉ

17.3.2 SxiÉ

17.3.3 oÉÑZÉÉU

17.3.4 ÍqÉeÉsxÉ

17.3.5 AlrÉ
15-55 Above 55
17.4 Adolescent/Adult deaths by cause 6-14 yrs
yrs. yrs.
male Female male Female male

17.4.1 SèxiÉ

17.4.2 ¤ÉçrÉ UÉåaÉ


xÉÉxÉ MüÐ ÌoÉqÉÉUÏ (¤ÉrÉ UÉåaÉ Måü
17.4.3
AÉsÉÉuÉÉ)
17.4.4 qÉsÉåËUrÉÉ

17.4.5 AlrÉ oÉÑZÉÉU xÉÇoÉÇÍkÉiÉ


17.4.6 LcÉ.AÉrÉ.uWûÏ./LQûxÉ

17.4.7 ÌSsÉ/EŠ U£ü cÉÉmÉ MüÐ ÌoÉqÉÉUÏ

17.4.8 iÉÇ̧ÉMüÉ/SÉæUÉ

17.4.9 Maternal Deaths


(a) aÉpÉïmÉÉiÉ

(b) AuÉî/ÌuÉsÉÇÌoÉiÉ mÉëxÉuÉ


(c ) EŠ U£ü cÉÉmÉ/fÉOûMåü
(d) U£ü x§ÉÉuÉ
(e) iÉåeÉoÉÑZÉÉU
(f) AlrÉ MüÉUhÉ
17.4.10 cÉÉåOû/SÒkÉïOûlÉÉ/eÉsÉeÉÉlÉå Måü MüÉUhÉ
17.4.11 AÉiqÉWûirÉÉ

17.4.12 mÉzÉÔ/ÌMüQåû Måü MüÉOûlÉå xÉå


17.4.13 AlrÉ oÉÏqÉÉUÏ
(a) aÉÇpÉÏU oÉÏqÉÉUÏ
(b) sÉqoÉÏ oÉÏqÉÉUÏ
(c ) MüÉUhÉ mÉiÉÉ lÉWûÏ
/FANDA

Numbers
reported during
the month

Z
#REF!

#REF!
#REF!

#REF!

al delivery cases

#REF!

egnant women with


at Private facilities

tion

e Facilities

conducted
conducted

conducted

pills given

distributed

tion
#REF!

n fully immunized

mmunized
(AEFI)

he month

and 5 years
ilable

the month

midnight
Numbers
Positive

Numbers
Positive

Numbers

Unusable stock
Stock
Distributed
Male Female

Total

Male Female

Total

Male Female

Total
Female