Pakistan: Nowshera Health Centre

 

Third Party Evaluation:  The trend of disease presentation in this quarter is markedly different and this difference became apparent from as early as the first month of the quarter (January). Although the average numbers of patients being reported were the same, surprise M&E visits by the head office on different days revealed that the number of patients observed were fewer than the official records.  However, use of drug supply and hence its monthly demand was unchanged. We had had a change in staff where we had hired a new LHV in replacement of the previous one who had to resign for personal reasons. However, in our opinion at the head office, keeping the administrative M&E reports aside, the degree of change in disease presentation was very important as it was too marked to be a simple attribution to the change of personnel since diagnosis of case presentation follows medical and technical guidelines other than personal opinions. It needed to be investigated.
 
We hired a consultant as a third party evaluation party for a period of 10 working days. We had to limit our selection to a female consultant in keeping with the women-only arena of our MCH Center. Also female patients would not object to a woman taking photographs. An observership-participation methodology was the approach adopted for the evaluation process and was based on electronic monitoring and evaluation to give a continuous ‘real time’ report of every hour of every working day during this consultancy.
Requirements for this e-M&E was a smart phone with a 3G connection and every patient receiving treatment was photographed and sent by the WhatsApp application to the head office in real time. This was followed by the end-of-the-day of both the patient record and the Pharmacy record registers. The Pathology lab and Ultrasound register records for each day were also submitted simultaneously. 
 
Results and Conclusion: The number of women and children frequenting our MCH Centre were consistent with the average number reported in the morbidity reports and hence the drug stocks statistics exhibited congruency along the same lines. The numbers of tests performed in the pathology lab were similar to the previous quarter but there was a tremendous increase in the ultrasounds being conducted. Here it became interesting in that the number of women seeking ultrasound were significantly higher. The word has spread in the community, including in the other health care facilities, private, government as well as not-for-profit in the district and pregnant women were being referred to us for ultrasounds. Naturally every woman needed to have an antenatal consultation as well and hence the explanation for the sudden increase in antenatal and postnatal visits.
 

RMF Health Centre Nowshera from 1st January to March 31st 2015
	Month	Jan-15	Feb-15	Mar-15	Total
	Total Patients for the month	1023	1086	969	3078
1	Female	714	761	548	2023
	Male	10	11	6	27
	Total Adults				2050
2	Children (Male)	123	185	213	521
	Children (Female)	176	129	202	507
	Total children	299	314	415	1028
	MCH Details
1	Antenatal Care	201	178	228	607
2	Postnatal Care	23	50	20	93
3	Family Planning	12	15	5	32
4	Infertility	1	7	3	11
5	Amenorrhea	3	15	5	23
6	Dysmenorrhea	44	30	15	89
7	Leukorrhea	75	80	90	245
8	P/V Discharge	13	20	10	43
9	P/V Bleeding	6	5	2	13
10	Ovarian Cyst	2	7	5	14
11	Irregular Period	53	30	30	113
12	Polymenorrhoe	12	16	5	33
13	PID Pelvic Inflammatory Disease	31	25	20	76
14	Fibroid	0	3	2	5
	Total MCH	476	481	440	1397
	Primary Health Details
15	Anemia	65	84	79	228
16	Abdominal Pain	33	15	19	67
17	Respiratory Tract Infections	123	112	150	385
18	Enteric Fever (Typhoid)	4	20	10	34
19	Dyspepsia	45	50	30	125
20	Vomiting	22	25	20	67
21	Scabies	29	40	30	99
22	Food Poisoning	1	5	2	8
23	Urinary Tract Infections	45	50	30	125
24	Hypertension	23	50	35	108
25	Suspected Meningitis	0	2	1	3
26	Burns	0	5	2	7
27	Acute Appendicitis	0	1	1	0
28	Jaundice	6	5	2	13
29	General body aches & weakness	67	30	25	122
30	Diarrhea	67	100	85	252
	Total Primary Health	530	594	521	1645
31	Non-RTA Injuries	6	2	1	9
32	RTA (Road Traffic Accident)	4	8	5	17
33	Referral	7	1	2	10
		17	11	8	36
Lab Tests and Ultrasounds Performed from 1st January to 31st March 2015
	Lab Test and Ultrasound	Jan-15	Feb-15	Mar-15	Total
	Pregnancy Urine Test	45	38	30	113
	Urine Routine Examination	36	20	10	66
	Blood Grouping	15	14	17	46
	Blood Hb	61	53	47	161
	Blood Glucose	11	15	9	35
	Vidal Test	5	13	11	29
	Blood Malarial Parasite (MP)	6	10	10	26
	RA Factor	3	4	1	8
	Toxoplasma	1	2	4	7
	SGPT	0	0	0	0
	Total Lab Test	183	169	139	491
	Ultrasound for antenatal check-up	115	149	135	399
	Ultrasound abdomen	8	15	5	28
	Ultrasound pelvis	24	61	11	96
	Ultrasound abdomen & pelvis	32	25	10	67
	Fatty lever	0	0	0	0
	Total Ultrasounds	179	250	161	590