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JHARKHAND HEALTH SYSTEM - Coggle Diagram
JHARKHAND HEALTH SYSTEM
CHALLENGES (Left Side - RED)
HRH CRISIS
Specialists
Gynecologists: None in Palamu, Godda, Deoghar
Anesthetists: No 24/7 in Hazaribagh, Deoghar
Pediatrician: Vacant at Deoghar
Impact: Excessive referrals, maternal risk
Nursing Staff
Shared across Labor, Maternity, NBSU
No GNMs at Sadar Hospital Deoghar
Support staff: Cold chain, warehouse understaffed
Salary Crisis
Irregular payments across facilities
Months unpaid causing demotivation
Staff retention: Losing experienced personnel
Training Gaps
Labor room protocols lacking
Emergency obstetric care: Many untrained
SBA: ANMs lack certification
BMW management: Inconsistent practices
Digital literacy: Platform training needed
INFRASTRUCTURE
Diagnostic Gaps
BSU: Non-functional in most facilities
X-ray: Absent at CHC/SDH levels
USG: Missing at multiple facilities
Equipment Shortages
Delivery trays: 2 for 120 deliveries (Hazaribagh)
Giridih: 6 trays for 250 deliveries/month
Digital watches: Chronic shortage
Thermometers: Frequently missing
Ambu bags: Functional ones insufficient
Facility Issues
Space: Extreme cramping in units
Water: Absent in many facilities
Electricity: Inconsistent supply
Lighting: Poor in delivery rooms
CLINICAL PROTOCOLS
Maternal Care
C-sections: Non-functional at CHC level
Complicated deliveries: Cannot manage
Result: All high-risk referred to DH
Transport System
108 Ambulances: Insufficient, unreliable
Mamta Vaahan: Limited availability
Impact: Delayed emergency response
Infection Control
BMW management: Inconsistent
PPE: Staff lack protective gear
DATA SYSTEMS
Documentation
Registers: Only 9 of 36 available (Hazaribagh)
Partographs: Labor charts unrecorded
Manual entry errors: Common
Digital Platforms
ABDM: Poor integration, compliance gaps
eAushadhi: Not updated, no drug tracking
HMIS: Data entry inconsistent
Workforce
Computers: Shortage, many non-working
DEOs: Significant gaps
Quality: Poor data quality
COMMUNITY
Registration
Late registrations: Post-1st trimester
Pattern: Only come with complications
Impact: Prenatal screening missed
Cultural Barriers
Home delivery preference: Strong tradition
Myths: About institutional delivery
Literacy: Very low health awareness
STRENGTHS (Right Side - GREEN)
PATIENT LOADS
DH Garhwa: 180+ monthly deliveries
CHC Godda: 300+ cases/month
CHC Deoghar: 350+ cases/month
Status: High capacity despite staff constraints
STAFF MOTIVATION
Motivation: Relatively stable
Management: Supportive supervision
Result: Coping well with heavy loads
ESSENTIAL MEDICINES
Availability: Multiple facilities stocked
Impact: Drug supply not a constraint
DIAGNOSTIC SERVICES
DH Deoghar: CT-scan, X-ray, ultrasound (Manipal partnership)
DH Garhwa: Ultrasound (Manipal partnership)
X-ray: MEDAL chargeable services
Model: PPP ensures diagnostic access
FACILITY STANDARDS
Hygiene: Good cleanliness maintained
Environment: Functional clinical spaces
Status: Quality despite resource constraints
QUALITY CERTIFICATION
NQAS: Several facilities pursuing certification
Example: Aam Centre Kariyatpur (Hazaribagh) accredited
Commitment: Quality improvement underway