ISI Monitoring Survey - Round IV

Urban Primary Health Care Services Delivery Project
Local Government Division

Ministry of Local Government, Rural Development & Cooperatives
Government of the People’s Republic of Bangladesh
ISI Monitoring Survey Round IV

(January-June 2017)
A Trend Analysis of Findings of ISI Surveys
Eusuf and Associates

Project Performance Monitoring and Evaluation Firm
February 2018
ISI Monitoring Survey
Abbreviations
ADB Asian Development Bank

ANC Antenatal Care
ARI Acute Respiratory Infection
BAPSA Bangladesh Association for Prevention of Septic Abortion
BCC Barisal City Corporation
BCC Behavioral Change Communication
BCG Bacille Calmette Guerin
BIN Batch Identification Number
CRHCC Comprehensive Reproductive Health Care Center
CoCC Comilla City Corporation
C/S Caesarian Section
DAM Dhaka Ahsania Mission
DMF Design and Monitoring Framework
DSCC Dhaka South City Corporation
DNCC Dhaka North City Corporation
ESDO Eco Social Development Organization
ESD+ Essential Services Delivery Package
EPI Expanded Program on Immunization
FGD Focus Group Discussion
FP Family Planning
GaCC Gazipur City Corporation
GIS Geographical Information System
GM Gopalganj Municipality
HMIS Health Management Information System
IP Infection Prevention
ISI Integrated Supervisory Instrument
IUD Intra Uterine Device
KCC Khulna City Corporation
KMSS Khulna Mukti Seba Sangstha
KsM Kishoreganj Municipality
KM Kushtia Municipality
LGD Local Government Division
LQAS Lot Quality Assurance Sampling
MDG Millennium Development Goal
M&E Monitoring and Evaluation
MIS Management Information System
MoHFW Ministry of Health and Family Welfare
MR Menstrual Regulation
NaCC Narayanganj City Corporation
NVD Normal Vaginal Delivery
ORS Oral Rehydration Salt
OT Operation Theatre
PA Partnership Area
PAHQ Partnership Area Head Quarter
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PA NGO Partnership Area Non-government Organization

PHC Primary Health Care
PHCC Primary Health Care Center
PIU Project Implementation Unit
PMU Project Management Unit
PNC Postnatal Care
PPH Postpartum Hemorrhage
PPM&E Project Performance Monitoring and Evaluation
PPP Public Private Partnership
PSKP & PPS Progati Samaj Kalyan Protisthan and Paribar Parikalpana Sangstha
PSTC Population Services and Training Center
QA Quality Assurance
RaCC Rangpur City Corporation
RCC Rajshahi City Corporation
RDU Rational Drug Use
RIC Resource Integration Center
RTI Reproductive Tract Infection
SC Satellite Clinic
SCC Sylhet City Corporation
SIDA Swedish International Development Cooperation Agency
SM Sirajganj Municipality
STI Sexually Transmitted Infection
ULB Urban Local Body
UNFPA United Nations Population Fund
UPHCSDP Urban Primary Health Care Services Delivery Project
UTPS Unity Through Population Services
VAW Violence against Women
WUHCC Ward Urban Health Coordination Committee
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EXECUTIVE SUMMARY
1. Local Government Division (LGD), Ministry of Local Government, Rural

Development and Cooperative is providing primary health care services in selected
city corporations and municipalities from 1998. On the backdrop of demands for
primary health care services from ever increasing urban population the ‘Urban
Primary Health Care Services Delivery Project (UPHCSDP) was undertaken from
July 2012 following the success of two earlier completed projects. The project
covered 25 partnership areas of 14 major cities (10 city corporations and four
municipalities. The project was scheduled to close on 30 June 2017 but has been
extended up to 31 March 2018 to bridge the gap with the follow-up UPHCSDP-II
(2018-2023). The goal of the project is to improve the health status of the urban
population, especially the poor and particularly the women and children through
providing primary health care services free of cost to the poor and at low cost to the
non-poor. The project is design for public private partnership arrangement.
2. The project attached high importance to monitoring and evaluation and one of
the major monitoring activities was half-yearly performance monitoring in each of the
25 partnership areas using an Integrated Supervisory Instrument (ISI) developed
jointly by project and development partners. The project conducted four half-yearly
performance monitoring and evaluation of the 25 partnership areas during July 2015
and June 2017 and assessed project outcomes and impact.
3. The present monitoring report includes monitoring findings of ISI-IV (Jan-Jun

2017) and a comparative analysis of progressive improvements of management,
quantity and quality of services delivery in the last two consecutive years assessed
through ISII, ISIII, ISIIII and ISIIV. The comparative analysis provided a time series
feedback of demand side trend of health services seeking behaviors of beneficiaries
and supply side targeted service delivery by the project partnership area NGOs.
4. In the four ISI monitoring studies, performance of all 25 Partnership Area

Headquarters (PAHQs), 25 Comprehensive Reproductive Health Care Centers
(CRHCCs), 113 Primary Health Care Centers (PHCCs), and 226 Satellite Clinics
(SCs) were assessed using the Integrated Supervisory Instrument (ISI). The
performance of these centers was assessed in terms of the management, quality
and quantity of services to beneficiaries over previous six months.
5. In an analysis of the target and achievements of 17 selected important services

(eight in CRHCC, five in PHCC and four in SC) in 25 PAs over four consecutive half-
yearly periods (two years) indicated that the PAs met the targets as planned.
ISI Survey(s) Period(s) Target(s) Achievement(s) % Achievement
ISI I Jan-Jun 2016 1,877,822 1,873,669 99
ISI II Jan-Jun 2015 2,055,496 2,014,465 98
ISI III Jul-Dec 2016 2,177,614 2,297,075 105
ISI IV Jan-Jun 2017 2,252,144 2,493,144 111
6 It is found from four ISI surveys that overall percentage of ultra poor, poor and
non-poor service recipients are respectively 52.7%, 45.4% and 1.9%. It is also found
that among the red card holder patients, percentage of patients received normal
vaginal delivery increased from only 40% in ISII to 72% in ISI IV. Likewise,
percentage of red card holder patients received caesarean section delivery services
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increased from 32% in ISII to 72% in ISI IV. The increased focus and attention to red
card holder ultra poor is appreciable.
7. It is found in ISIIV that among the ultra poor and poor, 81.3% received red
card in ISIIV compared to 31.6% in ISII. In focus group discussion with exit patients,
88% and 76% respectively of ISIIV and ISII reported improved staff attitudes
manifesting a significant change in quality health services delivery. Moreover, 88%
exist patients of ISIIV reported that the staff provided explanation and information to
patients compared to 80% exist patients of ISII. It also reported by 84% exist patients
of ISIIV that quality of service delivery at CRHCCs are good compared to 68% in
ISII. There is also significant improvement of the level of beneficiary satisfaction with
the cost of services – level of satisfaction improved to 76% exist patients of ISIIV
compared to 64% of ISII. Numbers of people know project health facilities,
particularly the “Rainbow Clinic”, has increased to 97%.
8. The comparison of the levels of achievements of service delivered in PAs

between ISII and ISIIV indicated significant improvements. Number of PAs achieved
score of 90% and above increased from four in ISI I to sixteen in ISI IV. On the other
hand, number of PAs scored 80% to 89% decreased from seven in ISI I to four in ISI
IV. More significant improvement is seen among low scoring PAs – number of PAs
scored below 80% decreased from 14 in ISI I to five in ISI IV.
ISI Survey(s)/Period Covered Achievement Level(s) NO. of PA(s)
ISI IV (Jan-Jun 2017 90% and above 16
80% to 89% 4
Below 80% 5
ISI I(Jul-Dec 2015) 90% and above 4
80% to 89% 7
Below 80% 14
9. In overall, it is found that improvement of performance of PAs or PA NGOs

from ISI I through ISI IV widely varied (improvement varied from -3.0% to 113.1%). In
municipalities, minimum and maximum improvement of performance are -3.0% and
22.8%, in other city corporations the minimum and maximum improvement of
performance are 3.2% and 113.1%, and minimum and maximum improvement of
performance in Dhaka city corporations are 2.9% and 30.2%.
10. Overall performance of the PAs over the four ISI Monitoring periods of two years
presents a progressive improvement of the performance of primary health care services
delivered from the project facilities through the individual partnership area NGOs.
11. It is recommended that while setting performance targets, the capacity of the
respective PA NGO and its existing achievement level, potential of partnership area
in respect of population and health seeking behavior, incidence of poverty as well as
diseases, and existence of other health care facilities in the catchments area should
be considered. An achievable half-yearly target of each PA NGO should be set on
mutual discussions between the PMU, the respective PA NGO and PPME firm at the
beginning of service delivery which the PA NGOs can chase and achieve higher.
12. It is also recommended that performance-based monitoring and incentive

package for PA NGOs are important tools for efficient and effective tools for
achieving higher level of service delivery in quantity and quality.
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TABLE OF CONTENTS
Abbreviations i-ii
Executive Summary iii-iv
Chapter I Introduction 1-3
A. The Project 1
B. Project Outputs 2
C. Project Performance Monitoring and Evaluation 2
D. Performance Monitoring Using Integrated Supervisory Instrument 3
E. Scoring of Performance 3
Chapter II Methodology of ISI Monitoring Survey 4-6
A. Strategy and Approach 4
B. Methodology and Tools 4
C. Focus Group Discussion 5
D. Data Processing, Analysis and Presentation of Findings 6
Chapter III Comparative Performance of PA Headquarters, CRHCC, 7-27
PHCC and Satellite Clinic
A. Calculation of Performance of and Scores of PA NGOs 7
B. PA Headquarters (PA HQTRs) 7
C. Comprehensive Reproductive Health Care Center 12
D. Primary Health Care Center (PHCC) 17
E. Satellite Clinic (SC) 26
Chapter IV Survey of Ultra Poor and Poor Using Poverty Score Cards 28-35
Chapter V Beneficiary Perceptions of the Quality of Services at 36-43
CRHCCs and PHCCs
A. Services in the CRHCCs 36
B. Services in the PHCCs 39
Chapter VI Overall Performance of Partnership Areas (PAs) 44-50
A. Achievement Performance of the PAHQs 44
B. Achievement Performance of the CRHCCs 45
C. Achievement Performance of PHCCs 46
D. Achievement Performance of Satellite Clinics 47
E. Overall Performance of PAs 48
Chapter VII Recommendations and Conclusions 51-52
A. Recommendations 51
B. Conclusions 52
Appendices
Appendix 1 Performance of CRHCCs for Providing Major PHC Services – ISI-IV 53
Appendix 2 Performance of PHCCs for Providing Major PHC Services – ISI-IV 61
Appendix 3 Performance of Satellite Clinics for Providing Major PHC 66
Services – ISI-IV
Appendix 4 Comparative Analysis of the Targets and Achievements of 70
Selected 17 Items of Important Services
Appendix 5 Poverty Score of all PA areas for ISI Survey Round I, II, III and IV 72
Appendix 6 Overall Performance of the PAs/PA NGOs 73
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CHAPTER I
Introduction
A. The Project – Urban Primary Health Care Services Delivery Project
1. The Local Government Division (LGD)of the Ministry of Local Government,

Rural Development & Cooperatives is implementing the Urban Primary Health Care
Services Delivery Project (UPHCSDP) in 10 city corporations1 and four
municipalities2. The project is jointly financed by the Government of Bangladesh,
Asian Development Bank (ADB), United Nations Population Fund (UNFPA), and
Swedish International Development Cooperation Agency (SIDA). The project started
on 1 July 2012 targeting closure on 30 June 2017 but was extended by nine months
up to 31 March 2018 to bridge the gap between the UPHCSDP and the follow-up
additional financing Second Urban Primary Health Care Services Delivery Project
(UPHCSDP-II) due to start from 1 April 2018 and closing on 31 March 2023.
2. UPHCSDP was designed based on the successful implementation and

experiences of two earlier projects namely, Urban Primary Health Care Project3
(1998-2005) and Second Urban Primary Health Care Project4 (2005-2012). The
projects are designed and implemented on public private partnership (PPP) basis
involving Urban Local Bodies (ULBs) and Partnership Area Non-Government
Organizations (PA NGOs).
3. Ultimate aim of the project is to improve the health status of urban population,
especially the poor, women and children, in project area. The immediate outcome of
the project is sustainable good quality Primary Health Care (PHC) services provided
in project area targeting the urban poor and the needs of women and children.
4. Objectives of the project are to contribute to achievement of ultimate aim as

well as the immediate outcomes through improving accessibility to primary health
care services in urban areas covered by the project and ensuring delivery of quality
primary health care services to urban populations.
5. Scope of the project are to deliver essential services delivery packages

(ESD+) developed by the Ministry of Health and Family Welfare (MoHFW). The
project contributes to increasing coverage of all five major services under ESD
package namely: reproductive health care, child health care, family planning,
communicable disease control and limited curative care as well as contributing
increase of the capacity of the Urban Local Bodies (ULBs) to deliver primary health
care services according to their mandate.
6. UPHCSDP was designed to support government pro poor health policy to

ensure health care services for all at affordable or no costs even though health
services are generally expensive. The pro poor health policy in general and the
1
Dhaka South, Dhaka North, Narayangonj, Gazipur, Rajshahi, Rangpur, Khulna, Barisal, Sylhet and Comilla
City Corporations
2
Sirajgonj, Kushtia, Kishoregonj and Gopalgonj
3
Dhaka, Chittagong, Rajshahi and Khulna
4
Dhaka North, Dhaka South, Rajshahi, Chittagong, Khulna, Barisal, Sylhet, and Comilla city corporations; and Bogra,
Sirajganj, Madhabdi, Savar, Gopalganj, Kishoreganj and Kushtia seven municipalities
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UPHCSDP in particular considerably contribute to achieving the Millennium

Development Goals (MDGs).
B. Project Outputs
7. The project had three major outputs such as:(i) strengthening institutional
governance capacity to sustainably deliver urban primary health care services; (ii)
improving the accessibility, quality, and optimize the utilization of urban primary
health care services delivery, with a focus on the poor, women, and children, through
public private partnership; and (iii) effective support to decentralize project
management. The other outputs are: (i) improving accessibility (financial and
physical) to primary health care services in urban areas covered by the project; (ii)
ensuring delivery of quality primary health care services to urban populations; (iii)
increasing utilization of primary health care services by urban poor, especially
women, newborns, and children; (iv) strengthening institutional arrangements for
delivery of primary health care services in urban areas; (v) increasing capacity of
urban local bodies to ensure delivery of primary health care services according to
their mandate; and (vi) increasing sustainability of delivery of urban primary health
care services by strengthening ownership and commitment of urban local bodies to
ensure delivery of primary health care services particularly for the poor.
8. UPHCSDP delivers primary health care services through establishing primary

health care service networks with Comprehensive Reproductive Health Care Centers
(CRHCC), Primary Health Care Centers (PHCC), and Satellite Clinics (SC) in 25
partnership areas under partnership agreements with NGOs. The project had a
significant training component to build capacity in management, service delivery, and
project monitoring and reporting skills for staff at various levels.
C. Project Performance Monitoring and Evaluation
9. The project has a provision of conducting Project Performance Monitoring and

Evaluation (PPM&E) through an external independent agency as PPM&E firm. Eusuf
and Associates, a private project management consultant firm specialized in
monitoring and evaluation was engaged as PPM&E firm in August 2015 for 22
months period (September 2015 to 30 June 2017). The assignment was extended by
nine months up to 31 March 2018 to complete unaccomplished monitoring activities,
undertake routine monitoring during extended period as needed, and conducting
advance actions needed by the UPHCSDP-II such as baseline survey and mapping.
10. PPM&E firm assisted Project Management Unit (PMU) in tracking progress of
PA NGOs in achieving results, providing regular independent assessment of
performance, undertaking mapping GIS-based activities and providing support to
routine project monitoring. PPM&E firm also suggested improvements where needed
in performance based results and facilitated broader awareness and participation
among stakeholders in use of monitoring and evaluation (M&E), quality assurance
(QA) and geographical information system (GIS).
11. Scope of services and tasks of PPM&E firm was to support the PMU to
measure project outputs and impact through several surveys. The measurement of
the outputs and outcome and impact were based on project design and monitoring
framework (DMF) indicators. PPM&E firm assessed project outputs, outcome and

impact using the DMF indicators and additional indicators and proxy indicators as
needed to monitor project implementation outputs, objective outcome, and expected
impact.
12. PPM&E firm as per contract and monitoring plans captured necessary data
corresponding to the DMF indicators for impact, outcome and outputs using various
tools and produced results as output deliverables. In addition, agreed additional
output deliverables were prepared as needed in the course of the PPM&E studies.
PPM&E firm also utilized the project set guidelines and monitoring framework and
tools such as the Integrated Supervisory Instrument (ISI) for monitoring, Simple
Poverty Scorecard Questionnaire for Identification of Ultra Poor, Poor and non-poor
and Lot Quality Assurance Sampling (LQAS) to measure household poverty ranking
as applicable and appropriate. PPM&E also assessed quantity and quality of primary
health care services delivered by PA NGOs to urban population particularly the poor
women and children free of cost and at least cost to non-poor.
D. Performance Monitoring Using Integrated Supervisory Instrument (ISI)
13. PPM&E firm produced progress reports quarterly and annually to

supplementing project management with implementation progress and development
and suggested measures for improvement. As part of the progress monitoring,
PPM&E firm conducted half-yearly surveys in PAHQ, CRHCC, PHCC and Satellite
Clinics of PAs and assessed their performance using Integrated Supervisory
Instrument (ISI). The ISI is a survey tool designed jointly by the LGD and ADB to
assess performance of PAs and PA NGOs based on services provided during
previous six months.
14. ISI monitoring survey assessed quality of services delivered by the PA NGOs
under the project as well as management and basic accounting practices using
certain performance indicators. The survey covered all levels of PA NGOs, namely:
(i) PA Headquarters, (ii) CRHCC facilities, (iii) PHCC facilities, and (iv)Satellite
clinics. As the ISI monitoring survey was conducted every six months, the feedback
provided time series data of performance of all 25 PAs and PA NGOs that showed
trend of project operating performance at large. The ISI monitoring survey findings
also helped the project in identifying the areas requiring improvement.
E. Scoring of Performance
15. Performance of PAs and PA NGOs was assessed in terms of quantity, quality,
and management at the levels of PA Headquarters, CRHCCs, PHCCs, and Satellite
Clinics. Weight of quantity, quality and management was respectively 30%, 50%,
and 20%. On the other hand, weight on PA Headquarters, CRHCCs, PHCCs, and
Satellite Clinics were respectively 13%, 25%, 45%, and 17%. Detailed break-down of
weight is at table 1.1.
Table 1.1: Distribution of Score Points
Service Centers Quantity Quality Management Total Score
PA Headquarter - 50 80 130
CRHCC 100 100 50 250
PHCC 250 150 50 450
Satellite Clinics 100 50 20 170
Total Score 450 350 200 1,000

CHAPTER II
METHODOLOGY OF ISI MONITORING SURVEY
A. Strategy and Approach
16. Several approaches were adopted for conducting the ISI survey at the levels
of PA headquarters, CRHCCs, PHCCs, and Satellite Clinics and collected both
quantitative and qualitative data through secondary data sources, household survey,
and focus group discussions using different data collection tools including the
Integrated Supervisory Instrument (ISI). Collected data were processed using SPSS
statistical tools. Findings of ISI monitoring survey were shared with the PMU, PIUs
and PA NGOs for dissemination and further improvements.
B. Methodology and Tools
17. Methodology of the ISI survey included design of proper sampling of facilities
surveyed, key informants for interview, sampling of households for survey, focus
groups discussions, and data collection techniques. In designing data collection
tools, set guidelines and tools for ISI for monitoring, simple poverty scorecard for
identification of ultra poor, poor and non-poor, and Lot Quality Assurance Sampling
(LQAS) were followed to ensure scientific and standard sampling of households as
appropriate. Survey data was collected both digitally and paper-based tools strictly
following ISI tools designed by the LGD and ADB. The enumerators were provided
intensive training on the ISI tools in classroom and field conditions. Data was
collected for the half-yearly period of 1 January-30 June 2017.
18. Sample frame was designed for individual items in survey. Both census and
statistical sampling techniques were followed for selection of samples. Census
method was followed for selection of health facilities and statistical sampling
technique was followed for selection of service recipients. Detailed sample design is
presented in the following paragraphs.
1. Selection of PAHQ, CRHCC, PHCC and Satellite Clinic
19. All 25 PAHQs and CRHCCs, all 113 PHCCs and all 226 Satellite Clinics were
covered ensuring 100% coverage. Main source of information was relevant registers,
documents and key persons involved in project implementation. Data were collected
using structured questionnaires contained in the ISI monitoring survey tools.
2. Selection of Households
20. Lot Quality Assurance Sampling (LQAS) technique was used for selection of
beneficiary households for the survey. LQAS is based on the statistical principle that
a sample size of 19 provides an acceptable level of error for making management
decisions. Major steps for conducting LQAS survey follows.
21. First, list of all households of catchments area of each PA-NGO was collected
by blocks or neighborhoods for assessing number of households in each section or
block to define the sections or blocks as sampling units. The sections or blocks were

numbered consecutively for identification and preparation of a comprehensive list of

the sampling units of catchments area with number of households in each section.
Total number of households was divided by 19 to find the sample interval. The
website namely, www.random.org was used to choose a random number between 1
and total number of households. First household was located within sampling unit
that contained the random numbered household and added the sampling interval to
first household and each subsequent household until 19 sample households were
identified. The survey team selected a random starting point within the sampling unit
to select households and administered the poverty scorecard. Summary of sample
size is presented at table 2.1.
Table 2.1: Summary of Sample Size
Item(s) Sample Coverage Percent (%)

PA Headquarters 25 All 25 PA Headquarters 100.00
CRHCCs 25 All 25 CRHCCs 100.00
PHCCs 113 All 113 PHCCs 100.00
Satellite clinics 226 All 226 satellite clinics 100.00
Survey of sample households 475 All 25 partnership areas 100.00
FGD for community score card in CRHCC 25 All CRHCC areas 100.00
FGD for community score card in PHCC 113 All PHCC areas 100.00
3. Selection of Sample Pregnant Women and Couples for Verification
22. Five sample pregnant women and five couples visited in PHCC in last six
months (1 January-30 June 2017) were selected randomly from the pregnancy
register and five couples register for verification. Numbers of pregnant women listed
in past 6 months (X) were counted and divided the number by 5 (Y). A random
number from 1 to X (Z) was obtained from www.random.org. The Zth woman in the
list (Case 1) and subsequent numbers continued by selecting woman (Z+Y) (Case
2), (Z+2Y) (Case 3), (Z+3Y) (Case 4), and (Z+4Y) (Case 5). All information for these
five cases was noted.
C. Focus Group Discussion (FGD)
23. Focus Group Discussion technique was used to gather qualitative information
including opinions and insights from community about services of the project. As part
of this process, a quantitative score card was filled up by each group participated in
focus group discussions. Focus group discussions were conducted in catchments
areas of all 25 PA NGOs and obtained a score from the community for each CRHCC
and PHCC. Outcome of each focus group discussion was recorded as community
score regarding performance of particular PA NGO in different aspects related to
health service delivery. Participants provided their agreed ratings of five different
issues discussed in a 20 point scale called community score card questionnaire. The
community score card provided a score out of 20 that was added to the total score
on PA NGO performance. Guideline and method of scoring were prepared by survey
team for selecting participants of focus group discussions.
24. Community score helped to obtain community inputs into health and other
social development interventions of the project. The community score card is a

method of qualitative research used to obtain community views on community-based

interventions including quantitative scores on several dimensions such as client
satisfaction and quality of services. The community score card helped to obtain
perceptions and ratings of clients served based on their satisfaction with quantity and
quality of services received.
25. Participants of focus group discussion (FGD) in CRHCC were women who: (i)
were currently pregnant and came to the CRHCC for an antenatal visit in past three
months; (ii) gave birth to child at CRHCC within past three months; or (iii) brought a
child for an examination at CRHCC in past three months. Total 266 participants
participated in 25 FGD sessions held in 25 CRHCCs.
26. Participants of focus group discussions in PHCC included: (i) couples who
came to PHCC for counseling on contraceptives in past three months; (ii) women
who brought a child of age 0-9 months to PHCC for growth monitoring or illness in
past three months; and (iii) adults who came to PHCC for their own health problems
in past three months. In total, 1,171 participants (1,155 female and 16 male)
participated in 113 focus group discussions held in catchments areas of 113 PHCCs.
27. Survey team selected participants for focus group discussions randomly
following criteria listed in foregoing paragraph. Respective PA NGO provided a list of
participants drawn following set categories as above and survey team selected ten
participants from list on a random basis. Survey team went to house of participants
to confirm selection through an informal invitation for focus group discussion. While
visiting houses of participants, survey team ensured that participants meet set
criteria including red card and non-red card holders.
D. Data Processing, Analysis and Presentation of Findings
28. Collected data were checked and entered in a pre-designed computer

program and processed using SPSS. The data processing included in-depth analysis
according to the objectives of ISI monitoring survey and scoring guidelines of ISI.
29. The processed and analyzed data were used for presentation of the findings
in the report. ISI Monitoring Survey included performance of PA NGOs by PA
Headquarters, CRHCCs, PHCCs and Satellite clinics; overall performance of
partnership areas; other internal and external factors including socioeconomic
characteristics, health services provided in quantity and quality, clients’ satisfaction,
and health care seeking behaviors. The present report included findings of round IV
(Jan-June 2017) and comparison of three other ISI surveys conducted covering
periods Jul-Dec 2015 (ISI I), Jan-Jun 2016 (ISI II), Jul-Dec 2016 (ISI III) to see trend
of the performance of PAs and PA NGOs for the two-year PPM&E monitoring period.
30. The present report summarized the findings of all four ISI surveys and
included a comparative analysis. However, the report attached selected important
data of ISI IV for reference.

CHAPTER III
COMPARATIVE PERFORMANCE OF PA HEADQUARTERS,
CRHCCs, PHCCs AND SATELLITE CLINICS
A. Calculation of Performance and Scores of PA NGOs
31. Targets for each service and activity of all PA NGOs from1 January to 30
June 2017 were collected during survey by the enumerators to compare actual
achievements made on each service and activity. It was observed that target for
many services and activities were not pre-fixed. Hence each PA NGOs set their own
targets for services and activity according to their plans. While analyzing targets with
corresponding achievements it was observed that targets for many services and
activities were not consistent to that of previous half-yearly targets. The project in
order to meeting its impact objectives, it is essential that all PA NGOs work pursuing
a set target to achieve more than or at least the same targets of earlier half-yearly
achievements. Therefore, is suggested target of all PA NGOs for each half-year
period of should be agreed between PMU/PIU and PA NGOs in advance prior to the
particular assessment period.
32. The issue was shared and discussed with the PMU and agreed that in case
any PA NGO reduce the target than previous half-yearly target the evaluated target
of present ISI survey round (same as previous ISI survey) will be considered and
accordingly performance is assessed. The outputs of the PAHQs, CRHCCs, PHCCs
and Satellite Clinics in terms of major services delivery assessed under ISI Round IV
are presented in Appendices 1, 2 and 3.
B. PA Headquarters
33. Survey team assessed performance of PA-NGOs based on performance of its

headquarters specifically for overall management of PA, meetings with Ward Urban
Health Coordination Committee (WUHCC), meetings with user forum, advocacy
activities, reporting to health management information system (HMIS), income
generated against target, maintenance of accounts, record keeping and coordination
with CRHCC, PHCCs and Satellite Clinics. Performance of PA headquarters was
assessed using ISI tools based on performance of previous six months.
34. Distribution of Scores: Performance scoring of PA Headquarters was

assessed only on quality and management and quantity was not estimated as it is
not applicable (PA HQ is not a service delivery point). Out of total score of 130, score
for quality is 50 and that management was 80.
1. Management
35. Survey team assessed management performance on several aspects. Major

areas of assessment included number of meetings held with Ward Urban Health
Coordination Committee (WUHCC) during reporting period, maintenance of record of
meetings, particulars of committee members, minutes of meetings, agenda
discussed in meetings, number of meetings planned and conducted with User
Forum. Also, included quality of maintaining documents of meeting such as

attendance, agenda of meetings, minutes of meetings; number of advocacy activities

held in catchments area of partnership area in past six months, dates of submission
of reports on Health Management Information System (HMIS), and number of
reports submitted on or before due dates.
36. Performance of PAHQs was found good for conducting meetings with
WUHCCs and User Forum, advocacy activities, and submitting HIMS reports on
time. Performance of all PAHQs achieved 100% on documentation during reporting
period (Table 3.1). It is noted from a comparison of overall performance of PA HQs
in terms of conducting meeting with WUHCC, conducting meeting with User Forum,
meeting target of advocacy activities, and timely submission of HMIS reports, all 25
PAs performed very well without any lapse or major failures (Table 3.1).
Performance of PAHQs was high right from beginning of monitoring and remained
high over past two years period what served as one key to success of project.
Table 3.1: Performance of the PAHQs on Documentation

Performance
st nd rd th
Particulars 1 Round 2 Round 3 Round 4 Round
N % N % N % N %
1 Conducted meeting with WUHCC 25 100 25 100 25 100 25 100
2 Conducted meeting with User Forum 25 100 25 100 25 100 25 100
3 Meeting target of advocacy activities 21 84 25 100 25 100 25 100
4 Submission of HMIS reports on time 25 100 25 100 25 100 25 100
37. ISI monitoring team noted that achievements of meeting income targets
improved overtime in the two years of close monitoring. The overall performance
fluctuated but showed upward trend (Table 3.2 and Figure 3.1).
Table 3.2: Achievement of Income Target by PAHQ

Performance of Meeting Income Target
st nd rd th
Target of Income (%) 1 Round 2 Round 3 Round 4 Round
N % N % N % N %
1 Achievement 100% and above 13 52 16 64 15 60 14 56
2 Achievement less than 100% 12 48 9 36 10 40 12 44
Total 25 100 25 100 25 100 25 100
Figure 3.1: % Achievement of Income Target
70%
64% 60%
60% 56%
52%
% Achievement
50% 48%
44%
36% 40%
40%
30%
20%
10%
0%
1st Round 2nd Round 3rd Round 4th Round
Achievement 100% and above Achievement less than 100%

2. Planning and Fund Management
38. All PA NGOs deposited their entire money earned during previous six months
to bank accounts as mandated and cash book was updated. Income and
expenditure ledger books of 25 PA NGOs were found updated. Survey team
checked financial records in ledger book and cash book of all PA-NGOs and found
that all PA NGOs maintained records without any overwriting (Table 3.3).
39. Survey team checked achievement of planning activities against target and
found that all PA NGOs have fully achieved their targets. Plan was analyzed for
services and by PHCC and CRHCC. Process of preparing planned Gantt-Chart was
checked and found that all PA NGOs worked as planned and targeted for the type of
services, and all CRHCCs and PHCCs maintained Gantt-Chart. All PA NGOs
assessed training needs and developed work plan for its staff members, maintained
training register and job training, annual procurement plan, and updated during past
six months (Table 3.3).
Table 3.3: Management Performance of PAHQ
Performance
st nd rd th
Management Performance 1 Round 2 Round 3 Round 4 Round
N % N % N % N %
Deposited entire money earned in bank account 17 68 24 96 25 100 25 100
Worked as plan and target by the type of services 25 100 25 100 25 100 25 100
Assessed training needs and developed work
24 96 25 100 25 100 25 100
plan and annual procurement plan
3. Health Management Information System
40. Flow of information between PAHQ and CRHCC, PAHQ and PHCCs, and
PAHQ and Satellite Clinics were reviewed. Flow of information between PAHQ and
CRHCC was checked for normal vaginal delivery (NVD), caesarean section (C/S),
couples accepting longer acting and permanent methods at CRHCC, number of
adolescents visited, postnatal care (PNC), reproductive tract infection (RTI)/sexually
transmitted infection (STI), and family planning visits and diagnostic services
delivered from CRHCC. It is noted that targets and corresponding achievements in
all four half-yearly periods over two years period showed an upward trend(Table 3.4
and Figure 3.2).
41. Considering eight major services delivered from CRHCCs during Jul-Dec
2015 (ISI I) as the base period, it is noted that the total of the eight services
increased by 3%, 113% and 9% of the successive half-yearly periods manifesting
progressive increase of the services delivery (Table 3.4).

Table 3.4: Services Provided by Major Category by CRHCCs
Performance
st nd rd th
1 Round 2 Round 3 Round 4 Round
Types of Services
Target Achiev Target Achiev Target Achieve Target Achiev
ement ement ment ement
1 Normal vaginal deliveries 10,203 10,144 10,570 10,597 11,871 11,567 12,233 10,769
(NVD)
2 Caesarian sections (C/S) 5,005 5,841 4,954 5,468 5,126 6,451 5,453 5,706
3 Under 5 child visits at 41,773 47,736 49,328 54,567 52,772 61,582 54,010 64,753
CRHCC
4 Couples accepting longer 3,544 4,239 4,537 4,309 4,759 5,099 4,915 4,842
acting and permanent
method
5 Adolescent visited 15,089 12,243 15,852 13,631 16,506 19,145 17,229 20,370
6 PNC visits 24,204 30,530 28,795 31,098 31,935 35,672 32,540 34,956
7 RTI/STI visits 11,913 8,272 14,423 12,804 14,505 14,647 14,911 16,232
8 Diagnostic services 92,277 84,983 109,945 112,062 119,069 134,587 123,570 130,074
delivered
Total Services 204,008 203,988 238,404 244,536 256,543 288,750 264,861 287,702
% Achievement target of
100 103 113 109
services
Figure 3.2: % Achievement of Target Services of CRHCCs
120%
113%
115%
% Achievement
109%
110%
103%
105% 100%
100%
95%
90%
42. Flow of information between PAHQ and PHCC during half-yearly period was
checked for five major services such as accepting modern method of contraception
(pill, condom, injectables, IUD) eligible couples during reporting period, using IUD
acceptor for first time, continuation of using same modern method of contraception
or switch over to another method by eligible couples, children received measles
rubella vaccine (MR vaccine) at age 9-15 months, and ANC visits and diagnostic
services performed.
43. It is found that targets as well as achievements maintained a slow but steady
increase during the four half-yearly periods. The level of achievements of targets of
the five major category of services PHCCs were 95%, 93%, 97% and 110%
respectively during the ISI I, ISI II, ISI III and ISI IV (Table 3.5 & Figure 3.3).

Table 3.5: Services Provided by Major Category from PHCCs

Performance
st nd rd th
Types of Services
Target Achieve Target Achieve Target Achieve Target Achieve
ment ment ment ment
1 Eligible couples accepting
a modern method of 181,916 157971 204,343 148,064 203,573 15,3477 205,874 224,950
contraception
2 Eligible couples continuing
a modern method of 114,751
18,103 21694 84,792 110,168 106,767 10,5782 105,899
contraception or to switch
to another method
3 Children receiving
77,807 93,061
complete vaccination at 61,163 63228 72,147 49,045 72,917 7,6486
age 9-15 months
4 ANC visits 134,421 126877 146,363 136,877 147,261 14,4473 150,502 164,399
5 Diagnostic services
193,989 191750 225,047 239,269 238,333 26,8666 253,679 291,789
performed
Total Services 589,592 561,520 732,692 683,423 768,851 748,884 802,613 880,098
% Achievement target of
95 93 97 110
services
Figure 3.3: % Achievement of Target Services of PHCCs
115%
110%
110%
% Achievement
105%
100% 97%
95% 93%
95%
90%
85%
80%
44. Survey team checked flow of information between PAHQ and satellite clinic
during the previous six months. Main information included clients visited, visiting for
continuing family planning methods, health educational sessions/ community group
meetings. It is found that activities and services of satellite clinics increased slightly
between the half-yearly surveys through the fourth half-yearly survey. Total targets
as well as achievements of all four services continued to increase. Level of
achievements of targets in the four half-yearly periods in two years of ISI monitoring
were 102%, 94%, 109% and 112% respective during ISI I, ISI II, ISI III and ISI IV.
The ratio of targets and corresponding achievements in three out of four half-yearly
periods are positive manifesting increased operating performance (Table 3.6 and
Figure 3.4).

Table 3.6: Activities and Services of Satellite Clinics

Performance
st nd rd th
Types of Services
Target Achieve Target Achieve Target Achieve Target Achieve
ment ment ment ment
1 Satellite clinics held 33,091 32,857 34,962 33,341 35,794 34,742 35,954 35,664
2 Client visited 797,881 843,786 849,900 826,667 843,956 950,148 871,833 986,557
3 Client visited for
continuing FP 233,185 202,214 239,204 239,136 243,269 267,301
methods 225,627 197,801
4 Health educational
sessions/ community 32,821 24,284 33,266 35,415 33,614 35,882
group meetings 30,884 33,717
Total Services 1,087,483 1,108,161 1,150,868 1,086,506 1,152,220 1,259,441 1,184,670 1,325,404
% Achieved of target
102 94 109 112
of services
Figure 3.4: % Achievement of Target Services of Satellite Clinics
120%
112%
109%
% Achievement
110% 102%
100% 94%
90%
80%
C. Comprehensive Reproductive Health Care Center (CRHCC)
45. Overall performance of CRHCCs were assessed using ISI tools based on
information of maintenance and updating of registers, receiving service through red
card and non-red card holding patients, reproductive health services, record keeping
of stock, observation of health service delivery friendly environment, and assessment
of knowledge of medical staff. Performance of CRHCC during each of the four half-
yearly assessments is presented in the following paragraphs.
46. Distribution of Score: Performance scoring of CRHCC on quality, quantity

and management of PA NGOs was undertaken. Total score is 250 that were
distributed as 100 for quality, 100 for quantity, and 50 for management.
1. Maintaining and Updating of Registers
47. Among three service delivery centers, CRHCC plays the most vital role in
providing services to urban population particularly the poor and especially the mother
and child. Each CRHCC maintain several registers such as attendance register,
master register, visitor’s book, movement register, register for VAW, growth
monitoring register for under5 children, referral register, meeting register, stock
register, and ambulance register.

48. A remarkable improvement of CRHCC is noted relating to maintenance of

registers over the two year monitoring period observed through four surveys.
Number of CRHCCs (of PA NGOs) maintained all 10 registers increased from only
11 out of 25 PA NGOs in ISI I to 23 in ISI IV (Table 3.7).
Table 3.7: Status of Maintaining and Updating Registers

Performance
st nd rd th
Number of registers 1 Round 2 Round 3 Round 4 Round
N % N % N % N %
1 All 10 registers maintained 11 44 21 84 19 76 23 92
2 Nine registers maintained 5 20 1 4 5 20 1 4
3 Five to eight registers 9 36 3 12 1 4 1 4
maintained
Total 25 100 25 100 25 100 25 100
2. Delivery of Child at the CRHCC
49. Among services provided by CRHCC, delivery is the major one. CRHCC
provided services for both normal vaginal delivery (NVD) and cesarean section (C/S)
delivery. Performance of CRHCC in terms of CHRCC targets and achievements of
providing delivery services in each of four half-yearly periods, there is significant
improvement of achievements of targets for both NVD and C/S services provided by
CRHCC. During first half-yearly assessment in July-December 2015, only 10
CRHCCs and 8 CRHCCs out of 25 could fully meet its targets for NVD and C/S
respectively. During 4th half-yearly survey (Jan-June 2017), achievements of targets
for NVD and C/S delivery increased to 14 CRHCCs and 18 CRHCCs out of 25 could
meet its target for NVD & C/S respectively (Tables 3.8-3.11).
Table 3.8: Achievement of Normal Vaginal Delivery Services of

Red Card Holder Patients
Performance of CRHCC for NVD

Achievement of Targets for NVD st nd rd th
Delivery Services (%)
N % N % N % N %
1 100 10 40 18 72 14 56 14 56
2 81-99 4 16 3 12 6 24 3 12
3 61-80 4 16 1 4 2 8 3 12
4 Less than 60 7 28 3 12 3 12 5 20
Total 25 100 25 100 25 100 25 100
Table 3.9: Achievement of Cesarean Section (C/S) Delivery Service of

Red Card Holder Patient
Performance of CRHCC for C/S

Achievement of Targets for C/S st nd rd th
Delivery Services (%)
N % N % N % N %
1 100 8 32 18 72 18 72 18 72
2 81-99 4 16 0 0 1 4 3 12
3 61-80 6 24 5 20 4 16 2 8
4 Less than 60 7 28 2 8 2 8 2 8
Total 25 100 25 100 25 100 25 100

Table 3.10: Achievement of NVD Targets Red Card and

Non-red Card Holding Patients
Level of achievement of NVD Performance of NVD

st nd rd th
Targets (%) of Red Card Holding 1 Round 2 Round 3 Round 4 Round
Patients N % N % N % N %
1 100 10 40 18 72 14 56 14 56
2 81-99 4 16 3 12 6 24 3 12
3 61-80 4 16 1 4 2 8 3 12
4 Less than 60 7 28 3 12 3 12 5 20
Total 25 100 25 100 25 100 25 100
Table 3.11: Achievement of C/S Targets Red Card and

Non-red Card Holding Patients
Continue
Performance of C/S
st nd rd th
Level of achievement (%) 1 Round 2 Round 3 Round 4 Round
N % N % N % N %
1 100 16 64 19 76 21 84 17 68
2 81-99 4 16 2 8 3 12 2 8
3 61-80 3 12 3 12 0 0 2 8
4 Less than 60 2 8 1 4 1 4 4 16
Total 25 100 25 100 25 100 25 100
50. Although it is stipulated that at least 30% services should be delivered to red
card holders it is noted that number of PA NGOs having provided NVD and C/S to
30% and above red card holders increased during the two-year monitoring period.
During ISI I 16 CRHCCs and seven CRHCs respectively provided NVD and C/S
services to 30% and above red card holders. In contrast, 18 and 16 CRHCCs
respectively provided NVD and C/S services to 30% and above during ISI IV (Tables
3.12-3.13).
Table 3.12: Ratio of NVD Services Recipients by Red Card Holders
Performance of NVD
Achievement of Targets for NVD st nd rd th
Services to Red Card Holders (%)
N % N % N % N %
1 30 and above 16 64 18 72 18 72 18 72
2 25-29 4 16 1 4 2 8 5 20
3 20-24 1 4 1 4 3 12 1 4
4 Less than 20 4 16 5 20 2 8 1 4
Total 25 100 25 100 25 100 25 100
Table 3.13: Ratio of C/S Services Recipients by Red Card Holders

Performance of C/S
Achievement of Targets for C/S st nd rd th
Services to Red Card Holders (%)
N % N % N % N %
1 30 and above 7 28 17 68 16 64 16 60
2 25-29 6 24 2 8 1 4 1 4
3 20-24 5 20 0 0 4 16 3 16
4 Less than 20 7 28 6 24 4 16 5 20
Total 25 100 25 100 25 100 25 100

3. Preparation and Preservation of Partograph
51. Survey team randomly selected 19 records of birth (took place in previous six
months) from Birth Register of each of 25 CRHCCs to assess status of preparation
and preservation of partograph in terms of completion and correctness. It is noted
that there is improvement in preparation and preservation of pantographs during ISI I
and ISI IV. It is found that during ISI I,5CRHCCs could correctly prepare and
preserve 19 partographs and during ISI IV, the number increased to 24 (Table 3.14).
Table 3.14: Preparation and Preservation of Partograph by CRHCCs

Performance
st nd rd th
Number of partograph 1 Round 2 Round 3 Round 4 Round
N % N % N % N %
1 19 15 60 19 76 24 96 24 96
2 Less than 19 10 40 6 24 1 4 1 4
Total 25 100 25 100 25 100 25 100
52. ISI survey assessed the level of awareness of mothers on ANC and PNC. It is
found that during ISI I numbers of ANC and PNC visits were respectively 34,125 and
30,530 that increased to 44,026 for ANC and 34,956 for PNC visits in ISI IV.
Improvement on increase of awareness among pregnant mothers in only two years
is significant (Table 3.15). Likewise, there is improvement of awareness for couples
accepting longer acting and permanent methods. Besides visits to RHCC by under five
children, RTI/STI, adolescent and diagnostic services are satisfactory (Table 3.15-
3.16, and Figure 3.5).
Table 3.15: Status of Antenatal Visits
Performance
st nd rd th
Number antenatal visits 1 Round 2 Round 3 Round 4 Round
N % N % N % N %
1 Third or more visits 34,125 50.6 37234 53.6 45,583 61.7 44,026 57.6
2 Second visit 12,886 19.1 14134 20.6 14,952 20.2 16,370 21.4
Table 3.16: Status of PNC and other Visits to CRHCC
Performance
st nd rd th
Purpose of visit 1 Round 2 Round 3 Round 4 Round
N % N % N % N %
1 PNC visits 30,530 126 31,098 108 35,672 112 34,956 115
2 Couples accepting longer acting 4,239 120 4,309 95 5,099 107 4,842 112
and permanent methods
3 Under Five child visited at 47,736 114 54567 111 61,582 117 64,753 130
CRHCC
4 RTI/STI visits 8,272 69 12,804 89 14,647 101 16,232 127
5 Adolescents visited CRHCCs 12,243 81 13,631 86 19,145 116 20,370 128
6 Diagnostic services 84,983 92 112,062 102 134,587 113 130,074 124

Figure 3.5: Status of ANC and PNC Visits
140% 126%
108% 112% 115%
120%
% Visit 100%
80%
54% 62% 58%
51%
60%
40%
20%
0%
ANC Visits(3 or more visits) PNC visits
4. Updating of General Registers
53. ISI survey team checked general stock register, medicine register and BIN
cards against actual stock. Stock of selected items was verified following set
guidelines and found stock same as register stated in 24 CRHCCs.
5. Feedback of Observation of CRHCC
54. ISI survey team observed available facilities and important hygienic practices
in all 25 CRHCCs and feedback are summarized hereunder.
 Labor room of 25 CRHCCs are equipped with essential equipment and

instruments including PPH kit, eclampsia kit, and emergency kit in good
working condition in all CRHCCs;
 All seven important service providing technical staff such as surgeon
(obstetrician), anesthesiologist, assistant doctor, trained nurse, paramedic,
support staff and cleaner are found present in 24 CRHCCs; one technical staff
(Specialist Physician) of DSCC PA-4 PSTC was not present.
 Proper hand wash with water and soap before and after each patient served
and after handling any waste products is in practice in all CRHCCs;
 All eight important steps for infection prevention (IP) are followed -
decontamination in 0.5% chlorine solution, washing instruments with
detergent and water using a brush and then rinsing, sterilization or high level
disinfection, maintain disposable (single use) injection practices, wearing
heavy duty gloves (except one), and facility for functioning autoclave are
observed in all CRHCCs;
 Syringes disposed of in sharps container, waste containers have lining
(essentially in OT, labor room and lab technician’s room), and wastes
disposed in proper containers with lining in 23 CRHCCs;
 Two PA NGOs (GaCC PA-2 PSKP & PPS and GM PA-1 GM) did not follow all
the protocol of waste disposal; and
 All CRHCCs have separate toilets for women, and breastfeeding corner with
privacy.

6. Knowledge of Medical Staff
55. ISI survey team assessed level of knowledge of five medical staff of all
CRHCCs present on the day of visit, and five nurses and paramedic were asked if
they could tell all six danger signs for newborn. All six danger signs (baby doesn’t
suck breast, discharge from umbilicus, baby is hot or too cold, convulsion, respiration
difficulty, and baby is lethargic) were known to all five staff interviewed in all 25
CRHCCs, and all five respondents correctly answered all six signs.
56. The team also assessed level of knowledge of five selected medical staff of all
CRHCC for six danger signs for a pregnant woman (severe bleeding, convulsion,
prolonged /obstructed labor, high fever, cervical tear, headache and blurred vision).
All interviewed five staff could answer all six questions correctly from 25 CRHCCs,
and all five respondents correctly answered all six signs.
D. Primary Health Care Center (PHCC)
57. ISI monitoring surveys were carried out in all 113 PHCCs and performance of
PHCCs was assessed on maintenance and updating registers, maintenance of
satellite clinic registers, checking red cards, checking MR and lab registers, checking
child health records, keeping stock record, providing services protecting
environment, availability of staff on duty, compliance of infection prevention system,
compliance of waste disposal method, adequate and appropriate facilities for female
clients.
58. Distribution of Score: Score on performance of PHCC in terms of quality,

quantity and management of PHCCs was undertaken. Total score is 450 distributed
as 150 for quality, 250 for quantity and 50 for management.
1. Maintenance and Updating of Registers
59. Each PHCC maintains BIN cards and 11 registers (attendance register,
master register, training register, visitor’s book, movement register, register for
violence against women, growth monitoring register for under 5 children, referral
register, meeting register, general stock register, and medicine stock register).
60. It is found in ISI IV that all PHCCs (113) maintain and update all 12 items.
Updating register of satellite clinic for pregnancy and eligible couple is one of the
functions of PHCC. Updated pregnancy register was found in 113 PHCCs (100%),
and updated eligible couple register was found in 113 PHCCs (100%). Nineteen
pregnant women and 19 couples were selected from respective registers following
Lot Quality Assurance Sampling (LQAS) technique.
61. Five sample pregnant women visited in the PHCC in last six months (1
January-30 June 2017) were selected randomly from pregnancy registers using
guidelines. Five specific things were verified for each selected woman such as
correctness of address in pregnancy register, living at the address, correctness of
due date in pregnancy register, awareness of pregnant women about the CRHCC,
and status of update in pregnancy register in case of delivery. It is noted from review
and spot checks during survey of the status of maintenance of pregnancy register

while all five points could not be maintained in register during ISI I, all 113 PHCCs
are found to be able to maintain all five points (Table 3.15) during ISI IV (Table 3.17).
Table 3.17: Pregnancy Register Verification of PHCCs

Performance
st nd rd th
Five Points Verified (Yes in all) 1 Round 2 Round 3 Round 4 Round
N % N % N % N %
1 Address in pregnancy register
112 99.1 113 100.0 113 100 113 100
was complete and correct
2 The sample pregnant women live
105 92.9 112 99.1 113 100 113 100
in the respective addresses
3 Due dates shown in pregnancy
111 98.2 110 97.3 113 100 113 100
register are correct
4 The sample pregnant women
109 96.5 110 97.3 113 100 113 100
are aware of CRHCC
5 Status updated in pregnancy
78 69.0 109 96.5 113 100 113 100
register in case of delivery
62. ISII survey verified like all previous ISI surveys couple registers on sample
basis in all 113 PHCCs who visited PHCC in last six months. In all 19 couples were
selected randomly from the couple registers using the specific guidelines. Five
specific things were verified for each selected couple such as correctness of address
in couple register, living at the address, correctness of due date of contraceptive use,
awareness of PHCC, and knowledge of the availability of contraceptives in PHCC
and Satellite clinics. It is noted from review and spot checks during the survey of the
maintenance of couple register that while all five points could not be maintained in
the register during ISI I, all 113 PHCCs are found to be able to maintain all five
points in ISI IV (Table 3.18).
Table 3.18: Findings of Verification of Couple Registers of PHCCs

Performance
st nd rd th
Five Points Verified (Yes in all) 1 Round 2 Round 3 Round 4 Round
N % N % N % N %
1 Addresses in couples registers
112 99.1 113 100.0 113 100 113 100
are complete and founded
2 Sample couples found to live at
103 91.2 112 99.1 113 100 113 100
the respective addresses
3 Data of contraceptive use by
111 98.2 112 99.1 113 100 113 100
the couples are correct
4 Sample couples are aware of
112 99.1 112 99.1 113 100 113 100
PHCC
5 Sample couples aware of
availability of contraceptives at 110 97.3 109 96.5 113 100 113 100
PHCC and satellite clinic
2. Red Card Holder Clients
63. PHCCs provide services of menstrual regulation (MR), laboratory, and

prescription to both red card holders and non-red card holders. Ratio of the red card
holding recipients of three services to total numbers of service recipients were as low
as 9%, 23%, and 37% during ISI I but the ratio gradually increased to 38%, 39%,
and 39 respectively for menstrual regulation service, laboratory service, and
prescription services during the ISI IV (Table 3.19 and Figure 3.6).

Table 3.19: Services Delivered to Red Card Holders

Performance
st nd rd th
Type of Services 1 Round 2 Round 3 Round 4 Round
N % N % N % N %
1 Menstrual regulation (MR) service 3,048 9 4,093 33 4,842 38 4,808 38
2 Laboratory service 27,626 23 41,416 32 53,930 36 55,084 39
3 Prescription services 140,991 37 160,061 37 125,542 40 134,821 39
Total services 171,665 205,570 184,314 194,713
Increase of services (%) ± 20 10 6
Figure 3.6: Trend of Increase of Services
205,570
210,000
No. of Service/Result
200,000 194,713
190,000 184,314
180,000 171,665
170,000
160,000
150,000
64. ISI survey monitored records of diagnosis and services provided by PHCCs
for diarrhea to children. It is found that out of 113 PHCCs only 82 PHCCs maintained
up to 16 records of diagnosis and services provided (72%) during ISI I and during ISI
IV the number increased to 112 PHCCs (Table 3.20).
Table 3.20: Diagnosis and Provided Treatment for Diarrhea to Children
Performance
Number of Records Diagnosed st nd rd th
and Provided Treatment
N % N % N % N %
1 16-19 82 72 105 93 109 96 112 99
2 Less than 16 31 28 8 7 4 4 1 1
Total 113 100 113 100 113 100 113 100
3. Child Health Care Services
65. ISI survey monitored records of diagnosis and services provided by PHCCs
for child care services. Data of child health care service was collected from child
register. Nineteen child growth monitoring cards were selected randomly and
checked record of weight and height/length indicated in all sample cards. It is found
that out of 113 PHCCs only 87 PHCCs maintained up to 16 records of diagnosis and
services provided (77%) for growth monitoring of children during ISI I that increased
to 113 PHCCs in ISI IV (Table 3.21).

Table 3.21: Status of Record Keeping for Growth Monitoring of Children

Performance
Number of records updated st nd rd th
properly
N % N % N % N %
1 16-19 87 77 95 84 112 99 113 100
2 Less than 16 26 23 18 16 1 1 113 100
Total 113 100 113 100 113 100 113 100
66. Records of children who visited PHCCs for suspected ARI were checked
using 19 randomly picked up records of suspected ARI patients from each PHCC.
The survey team checked records and counted number of children given antibiotic
for suspected ARI and found that during ISI I only 58 PHCCs out of 113 (51%)
patients were provided antibiotic that increased to 113 in ISI IV (Table 3.22).
Table 3.22: Status of Providing Antibiotic to Children Suspected ARI

Performance
st nd rd th
Number of providing antibiotic 1 Round 2 Round 3 Round 4 Round
N % N % N % N %
1 16-19 58 51 100 88 111 98 113 100
2 Less than 16 55 49 13 12 2 2 113 100
Total 113 100 113 100 113 100 113 100
67. Records of children who visited PHCC for suspected diarrhea were checked
using 19 randomly chosen records of suspected diarrhea patients from each PHCC.
On checking records and counting number of children who were diagnosed as
diarrhea patients and provided ORS was counted. It is found that 82 PHCCs out of
113 (72%) did diagnosis and provided ORS during ISI I compared to 112 PHCCs
(99%) during ISI IV (Table 3.23).
Table 3.23 Diagnosis and Services Provided for Diarrhea to Children

Performance
Number of Records Diagnosed st nd rd th
and Provided Treatment
N % N % N % N %
1 16-19 82 72 105 93 109 96 112 99
2 Less than 16 31 28 8 7 4 4 1 1
Total 113 100 113 100 113 100 113 100
4. Reproductive Health Services to Eligible Couples
68. PHCC provides reproductive health services to eligible couples. Reproductive

health services include accepting modern methods of contraception (pill, condom,
injectable), IUD, achievement of continuation or shifting to another method, ANC
visits. Average achievement of immunization, achievement of target for providing
diagnostic services, red card holder patients received prescribed medicines. ISI
survey team collected information on target and achievement from respective
registers maintained at PHCCs.
69. Achievement of target for eligible couples accepting a modern method of

contraception (pill, condom, injectable) during ISI I was 87% that increased to 124%
in ISI IV. Similarly, PHCCs achieved 79% of its targets for accepting first-time IUD in
ISI I that increased to 127% in ISI IV (Table 3.24).

70. ISI survey team collected information on target and achievement of

continuation of the use of modern methods of contraception by eligible couples from
respective register and also ANC visits from respective registers. Information of
using same method or switch over to another method was also collected and
performance of PHCCs was determined on the basis of achievement against the
target. The achievements of the five out of seven services significantly increased
from ISI I to ISI IV and slightly reduced in two services (Table 3.24).
71. Information was collected for children receiving complete vaccination (BCG,
Pentavalent, MR) at age 9-15 months for the reporting period and it is found that
103% and 126% achievements were made by PHCCs respectively during ISI I and
IV. Information on diagnostic services provided by PHCCs was collected from
respective registers and it is found that 99% and 127% achievements were made by
PHCCs respectively during ISI I and IV. Moreover, 202% and 135% achievements
targets for red card holder patients received prescribed medicines respectively
during ISI I and IV. Details are at Table 2.24 and Figure 3.7.
Table 3.24: Reproductive Health Services Provided by the PHCCs

Performance
st nd rd th
Type of Services 1 Round 2 Round 3 Round 4 Round
N % N % N % N %
1 Pill, condom, injectable 157,971 87 148,064 72 153,477 75 224,950 124
2 IUD 1,640 79 2,101 85 2,689 146 2,607 127
3 Achievement of continuation or 216,94 120 110,168 130
105,782 99 105,899 115
shifting to another method
4 ANC visit 126,877 94 136,877 94 144,473 98 164,339 113
5 Average achievement of 63,228 103 49,045 68
76,486 105 93,061 126
immunization
6 Achievement of target for 191,750 99 239,269 106
268,666 113 291,789 127
providing diagnostic services
7 Red card holder patients 149,067 202 91,414 49
99,561 162 110,087 135
received prescribed medicines
Total Services 690,843 776,938 851,134 992,732
% income change 12 10 17
Figure 3.7: Growth of Reproductive Health Services Overtime
1,200,000 992,732
% Performance
1,000,000 851,134
776,938
800,000 690,843
600,000
400,000
200,000
0
72. ISI survey team collected information of providing prescribed medicines to red
card holder patients and found that 90% and 94% PHCCs provided prescribed
medicines to 30% and above red card holders respectively during ISI I and IV (Table
3.25 and Figure 3.8).

Table 3.25: Ratio of Red Card Holder Clients Received Prescribed Medicines
Performance
% Red Card Holder Clients st nd rd th
Received Drugs
N % N % N % N %
1 30 and above 102 90 103 91 110 97 106 94
2 Less than 30 11 10 10 9 3 3 7 6
Total 113 100 113 100 113 100 113 100
Figure 3.8: Red Card Holder Clients Received Prescribed Medicines
97%
98%
clients received drugs
% of Red card holder
96% 94%
94%
91%
92%
90%
90%
88%
86%
5. Information of Activities and Services
73. It is found that all PHCCs have held targeted number of satellite clinics.
Survey team collected information of holding satellite clinics from quarterly satellite
work plan register and found that out of 113 PHCCs surveyed, 57% and 97%
PHCCs had achieved target of holding satellite clinics respectively during ISI I and
IV.
74. It is also found that 61% and 97% satellite clinics could provide satellite
service delivery as per their registers during respectively the ISI I and IV. Besides,
satellite clinics of 50% and 95% PHCCs were visited by clients and received family
planning (FP) services as per registers respectively during ISI I and ISI II. In addition,
it is found that 66% and 98% PHCCs respectively could organize health education
sessions/ community group meetings during ISI I and IV. ISI survey team checked
EPI, FP and Clinical Supply Registers and noted actual position of all selected items
following set guidelines and found that physical stock was same as in register in 95%
and 100% PHCCs respectively during ISI I and IV. Details are at Table 2.26 and
Figure 3.9.
Table 3.26: Information of Activities and Services in PHCCs
Performance
Type of Services 1st Round 2nd Round 3rd Round 4th Round
N % N % N % N %
1 Holding satellite clinics 64 57 100 88 107 95 110 97
2 Target of serving visitors 69 61 104 92 109 96 110 97
3 Number of clients visited satellite 108 96
clinics for family planning (FP) 109 96
service 56 50 107 95
4 Health educational sessions/ 102 90
110 97
community group meetings 75 66 111 98
5 Updating of Stock Registers 107 95 105 93 108 96 113 100

Figure 3.9: Target of Serving Visitors in PHCCs
96% 97%
100% 92%
% Target of serving visitors

80%
61%
60%
40%
20%
0%
6. Infection Prevention at PHCC
75. It is found that practices for proper hand wash before and after serving a client
and after handling any waste products, steps followed in infection prevention and
decontamination, washing instruments with detergent and water and brush,
sterilization or high level disinfection, using disposable syringe, wearing heavy duty
gloves, and availability of autoclave at each PHCC.
76. It is observed that physicians of all 99% and 100% PHCCs wash hands
before and after serving clients, and after handling any waste products respectively
during ISI I and IV. All 113 PHCCs properly follow three steps for infection prevention
of equipment (uterine sound, tenaculum, speculum, forceps, and scissors) both
during ISI I and IV. It is observed that the instruments are decontaminated in a 0.5%
chlorine solution for 10 minutes before processing by all 113 PHCCs and
instruments are washed with detergent and water using a brush and then rinsing by
all PHCCs. Disposable syringes (single use) are used by 99% and 100% PHCCs.
Persons involved in carrying out infection prevention activities and housekeeping or
handling medical waste wear heavy duty gloves in all cases by all PHCC as found
during ISI I and IV. Autoclaves were found functioning in 96% and 97% PHCCs
during respectively ISI I and IV. Details are at table 2.27.
Table 3.27: Infection prevention at PHCCs

Performance
N % N % N % N %
1 Wash hands before and after
serving clients and handling waste 112 99 113 100 113 100 113 100
products
2 Decontamination of Instruments 113 100 112 99 113 100 113 100
3 Disposable syringe is used 112 99 113 100 111 98 108 96
4 Wear heavy duty gloves for
carrying out infection prevention
activities, 113 100 113 100 112 99 113 100
housekeeping/handling medical
waste
5 Availability of functioning
108 96 106 94 111 98 110 97
autoclaves

7. Waste Disposal
77. ISI survey team observed disposal of used syringes. It is found that 100% and
98% PHCCs dispose used syringes in a container. It is also found that proper waste
containers with lining are available in labor room in all PHCCs and waste containers
with lining are available in rooms of 97% and 99% PHCCs respectively during the ISI
I and IV. Besides, clinic wastes are disposed of in proper containers with lining in
100% and 97% PHCCs respectively during the ISI I and IV. Details are at Table
3.28.
Table 3.28: Waste disposal PHCCs
Performance
N % N % N % N %
1 Used syringes are disposed in
113 100 111 98 111 98
a sharps container 113 100
2 Proper waste containers with
lining are available in labor 110 97 113 100 113 100
room 108 96
3 Availability of waste containers
with lining in rooms of lab 113 100 112 99 112 99
technicians 110 97
4 Waste containers with lining are
111 98 111 98 111 98
available in the OT 112 99
5 Clinic wastes are disposed of in
113 100 110 97 110 97
proper containers with lining 113 100
8. Facilities for Female Clients

78. Facilities for female clients were observed during every ISI survey. It was
found that there are separate toilet facilities for patients in 97% and 100% PHCCs
visited during ISI I and ISI IV respectively. Moreover, specific breast feeding corners
were found all PHCCs in convenient locations. Details are at Table 3.29.
Table 3.29: Information of Facilities for Female Clients in PHCCs

Performance
N % N % N % N %
1 Availability of separate toilet 110 97 113 100 113 100
113 100
facilities for women
2 Availability of breast feeding 113 100 113 100 113 100
110 97
corners with adequate privacy
9. Sharing with Exit Clients
79. ISI survey team shared with randomly selected five clients while leaving
PHCCs to know their opinion about services received, dealings of staff with patients,
quality of diagnosis and providing prescriptions and medicines and money receipts,
etc. It is found that 94% and 86% exit clients received diagnosis respectively during
ISI I and IV. Among the exit clients, 88% and 88% had mention of dosage of
medicines, and 82% and 88% had mention of how many times medicines are to be
taken as observed during the ISI I and IV respectively. Details are at Table 3.30 and
Figure 3.10.

Table 3.30: Exit Clients of PHCC could Correctly Understand Prescription

Performance
Content of the Prescription 1st Round 2nd Round 3rd Round 4th Round
N % N % N % N %
1 Diagnosis 106 94 112 99 113 100 97 86
2 Dose of medicine 99 88 112 99 110 97 99 88
3 Duration of medicine to be taken 93 82 111 98 108 96 100 88
Figure 3.10: Content of the Prescription of Diagnosis
99% 100%
100%
94%
95%
% Diagnosis
90%
86%
85%
80%
75%
10. Availability of Staff
80. Availability of staff especially physician, trained nurse/paramedic/midwife,

counselor, receptionist and cleaner were observed during ISI surveys using proper
instruments. It was found that out of 113 PHCCs, there were 110 Physicians, 113
Paramedics/ trained Nurse/ Midwife, 113 Councilors, 111 Receptionist, and 113
Cleaner during ISI I. In contrast, there were 112 Physicians, 112 Paramedics/ trained
Nurse/ Midwife, 113 Councilors, 113 Receptionist, and 113 Cleaner during ISI IV
indicating improvements. Details are at Table 3.31.
Table 3.31: Availability of Staff for Duty in PHCC
Performance
Category of staff 1st Round 2nd Round 3rd Round 4th Round
N % N % N % N %
1 Physician 110 97 111 98 113 100 112 99
2 Trained nurse/paramedic/midwife 113 100 113 100 113 100 112 99
3 Counselor 113 100 113 100 113 100 113 100
4 Receptionist 111 98 113 100 113 100 113 100
5 Cleaner 113 100 112 99 113 100 113 100
81. ISI survey team also checked the maintenance of numbers of registers
including regular updating with up to date data, maintenance of BIN cards, and
delivery of different services including menstrual regulation (MR) in the PHCC and
found well maintained in general.

E. Satellite Clinic
82. Like CRHCC and PHCC, ISI monitoring survey teams conducted monitoring
in all 226 satellite clinics. Performance of satellite clinics was assessed in terms of
presence of outreach workers, timely holding of clinic, availability of BCC materials,
and observation of activities.
83. Distribution of Score: Performance scoring of satellite clinics was

undertaken in terms of quality, quantity and management of PA NGOs based on total
score of 170 -50 for quality, 100 for quantity, and 20 for management.
1. Holding Satellite Clinic
84. It was found that out of 226 satellite clinics all staff was present on the day of
visit during ISI I and IV but absenteeism were noted during ISI II and ISI III. Besides,
it was ascertained that 100% clinics are held timely. Details are at Table 3.32.
Table 3.32: Presence of Staff and Timely Holding of Clinics

Performance
Content of the prescription 1st Round 2nd Round 3rd Round 4th Round
N % N % N % N %
1 % of clinics with all staff present 226 100 222 98 225 99.5 226 100
on the day of visit
2 % of clinics held timely 226 100 222 98 225 99.5 226 100
N=Number of Satellite Clinics had 100% staff present
2. Availability of the BCC Materials
85. Survey team checked whether all prescribed BCC materials are available in
satellite clinics. It is found that all six prescribed items of BCC materials (pregnancy,
family planning, child care, maternal and child nutrition, violence against women, and
breast feeding/immunity) are available in 204 clinics during ISI Survey – Round I visit
out of 226 clinics (90.3%), and all 226 clinics had all six items during the visit of ISI
Survey – Round IV. Details are at Table 3.33.
Table 3.33: Availability of BCC Materials in Satellite Clinic
Performance
st nd rd th
Availability of BCC Materials 1 Round 2 Round 3 Round 4 Round
N % N % N % N %
1 All six items were available 204 90.3 222 98.2 223 98.7 226 100.0
2 Five items were available 11 4.9 4 1.8 2 0.9 0 0
3 Three items were available 1 0.4 0 0 1 0.4 0 0
Total 216 95.6 226 100.0 226 100.0 226 100.0
3. Observation in Satellite Clinic
86. ISI survey team observed performance of outreach team including their active
presence over one full day, hand wash practice before and after examining a client,
filling up of female health cards, providing money receipt to clients, writing
prescription as per Rational Drug Use (RDU) principle, filling up of a tally sheet for

vaccination, filling up of vaccination card for vaccinated child, updating of poverty

status, and updating pregnancy record and updating couple record register. It is
found in that all nine activities were performed in 87 and 149 clinics out of 226 during
ISI I and IV respectively. Details are at Table 3.34.
Table 3.34: Observation of Activities at Satellite Clinics

Performance
Observation of activities 1st Round 2nd Round 3rd Round 4th Round
N % N % N % N %
1 All nine activities performed
87 38.5 140 61.9 185 81.9 149 65.9
properly
2 Eight activities performed
40 17.7 44 19.5 22 9.7 33 14.6
properly
3 Seven activities performed
43 19.0 31 13.7 15 6.6 24 10.6
properly
4 Six activities performed
45 20.0 11 4.9 4 1.8 20 8.8
properly
Total 215 95.0 226 100.0 226 100.0 226 100.0

CHAPTER IV
SURVEY OF ULTRA POOR AND POOR USING POVERTY SCORE CARDS
87. ISI survey included household survey for identification of ultra poor and
poor among beneficiaries using ISI tools. Purpose of the exercise is to assess the
numbers of ultra poor and poor and non-poor beneficiaries by domain and PA areas.
Household survey was conducted on a sample basis following Lot Quality Assurance
Sampling (LQAS) technique. Survey team randomly selected 19 beneficiary
households from the catchments area of each PA Area using LQAS technique and
total 475 households (19x25) were selected from 25 PAs for survey.
1. Identification of Ultra Poor, Poor and Non-poor Households
88. PAs were selected considering concentration of poor population as one of the
key criteria. Survey used definition of ultra poor, poor and non-poor household as
defined in the ISI Tool. The 25 PAs were arranged in three groups: Group 1 (10 PAs
of Dhaka; two PAs of Gazipur; one PA of each of Barisal and Narayanganj city
corporation; group 2 comprising other city corporations like Rajshahi, Khulna,
Rangpur, Comilla, and Sylhet; and group 3 consisting of Sirajganj, Kushtia,
Kishoreganj, and Gopalganj municipalities.
89. It is found that average percentage of ultra poor, poor and non-poor service
recipients of the four ISI surveys are 52.6%, 45.5% and 1.9% respectively. It is also
noted that according to last ISI survey (ISIIV), percentage of ultra poor households is
the highest (60%) in Dhaka City Corporations (South & North), Narayangonj City
Corporation, and Barisal City Corporation compared to 58% in other city
corporations, and 30.3% in municipalities (Table 4.1, Figures 4.1(a)-(d). Details of all
domains, PAs and four ISI Surveys are at Appendix 4.
Table 4.1: Ultra Poor, Poor and Non-Poor Households of Service Recipients
Major Domains Ultra Poor (%) Poor (%) Non-Poor (%)

ISI-I ISI-II ISI-III ISI-IV ISI-I ISI-II ISI-III ISI-IV ISI-I ISI-II ISI-III ISI-IV
City Corporations of
49.6 51.1 60.2 60.1 49.2 48.1 39.7 38.3 1.1 0.75 0.7 1.5
Dhaka, N.& Barisal
Other City
49.4 69.2 81.2 58.0 38.3 30.1 17.3 40.6 2.2 6.6 1.5 1.5
Corporations
Municipalities 46.5 10.5 22.4 30.3 85.5 82.9 68.4 65.8 1.3 1.7 9.2 3.9
Overall for 25 PAs 46.5 49.7 59.8 54.7 52.0 48.6 37.9 43.4 1.8 1.7 2.3 1.9

Figure 4.1(a) Trend of Providing Service to Ultra-poor
100%
81%
% of Ultra-poor by Domains
80% 69% 60%
60%
58%
60% 50% 51%
49%
40% 47%
22% 30%
20% 11%
0%
DDC OCC Municipalities
Figure 4.1(b) Trend of Providing Service to Poor
100%
81%
% of Ultra-poor by Domains
80% 69%
60% 60%
60% 50% 58%
51%
49%
40% 47%
22% 30%
20% 11%
0%
Figure 4.1(c) Trend of Providing Service to Non-poor
9%
10%
% of Non-poor by Domains
8% 7%
6%
4%
4%
2%
2% 2% 2%
2% 1%
1% 1%
1%
0%
Figure 4.1(d) Average % Service goes to Ultra-poor Poor and Non-poor

2%
45%
53%
Ultra-poor Poor Non-poor

2. Socioeconomic Characteristics
90. Ultra poor and poor people live generally in slums and squatters located in the
least developed areas of each city who are constrained to shift homes for various
reasons beyond their control. Therefore, these people have high rate of involuntary
migration. It is important for effective service delivery that the beneficiaries live in one
location for longer time or permanently. It is found through the four ISI surveys in the
last two years that in average 45.8% service recipients born in the location and lived
for longer time and 45.9% recipients lived for more than one year prior to the
respective surveys. The rest 8.3% on average lived for shorter time than one year
(Table 4.2).
Table 4.2: Duration of Respondents’ Living in Partnership Area

Performance
Duration of living of respondents
in the project area
N % N % N % N %
1 One month 3 0.6 6 1.3 1 0.2 1 0.2
2 One to six months 22 4.6 10 2.1 11 2.3 11 2.3
3 Seven months to one year 37 7.8 25 5.3 14 2.9 15 3.2
4 More than one year 206 43.4 177 37.3 205 43.2 285 60.0
5 Born here/have always been 207 43.6 257 54.1 244 51.4 163 34.3
here – permanent residents
Total 475 100 475 100.0 475 100.0 475 100.0
91. It is also found in the survey that 56.4%, 45.9%, 49.9% and 40.0% surveyed
household population were migrants respectively in the ISII, ISIII, ISIIII, and ISIIV
and the rest are local (Table 4.3 and Figure 4.2). High rate of migration is a problem
for service delivery particularly for serving the poorest through red card.
Table 4.3: Migration of Population in Partnership Area

Performance
Place from where Respondents’
Migrated
N % N % N % N %
1 Other slums 68 14.3 60 12.6 91 19.2 1 0.2
2 Villages 107 22.5 117 24.7 91 19.2 11 2.3
3 Other towns 93 19.6 41 8.6 55 11.5 15 3.2
4 Local 207 43.6 257 54.1 238 50.1 285 60.0
Total 475 100 475 100.0 475 100.0 475 100.0
Rate of Migration (%) 56 46 50 40
Figure 4.2: Rate of Migration in Slums

56%
60%
50%
46%
50%
40%
% Slum HH
40%
30%
20%
10%
0%

92. Among the total 475 beneficiary households surveyed in each ISI survey the
number of residents were respectively 1,961, 1,947, 1,802, and 1,904. The
percentage of female population was respectively 50.3%, 51.9%, 51.8% and 51.7%
(Table 4.4 and Figure 4.3). It is seen that the ratio of male-female remained almost
same (49.7:50.3, 49.1:51.9, 49.2:51.8, and 49.3:51.7) with little increase of the
female population among the ultra poor, poor and non-poor beneficiary households.
Table 4.4: Sample Population in Surveyed Households and Ratio of Female

Performance
Family Members by Gender 1st Round 2nd Round 3rd Round 4th Round
N % N % N % N %
1 Male 975 49.7 936 48.1 868 48.2 920 48.3
2 Female 986 50.3 1011 51.9 934 51.8 984 51.7
Total 1,961 100.0 1,947 100.0 1,802 100.0 1904 100.0
Figure 4.3: Population in Surveyed of Ratio of Female
60% 50% 52% 52% 52%

50%
% Raio of Female
40%
30%
20%
10%
0%
-10% 1st Round 2nd Round 3rd Round 4th Round
93. Among 475 households surveyed every time in the four ISI surveys,
percentage of very poor households do no pay house rents were 37.0%, 37.3%,
37.1% and 39.8% respectively in ISII, ISIII, ISIIII, and ISIIV (Table 4.5 and Figure
4.4). These households do not pay rents as they either live in their own house or live
in other’s houses free of charge. Households pay monthly rent less than Tk.2,000
were respectively 34.1%, 35.6%, 33.1%, and 27.8% (Table 4.6) in the four ISI surveys.
Table 4.5: Households Pay or Do Not Pay House Rents
Performance
Households Pay or Do not Pay
House Rents
N % N % N % N %
1 Do not pay house rent 176 37.0 177 37.3 176 37.1 189 39.8
2 Pay house rent 299 63.0 298 62.7 299 62.9 286 60.2
Total 475 100 475 100 475 100.0 475 100.0
Figure 4.4: % Poor Households Pay House Rent
41% 40%
% Don't pay house rent
40%
39%
38% 37% 37% 37%
37%
36%
35%

Table 4.6: Monthly House Rent Paid by the Respondents

Performance
House Rent per Month in Taka 1st Round 2nd Round 3rd Round 4th Round
N % N % N % N %
1 Less than 1000 Taka 26 8.7 25 8.4 20 6.7 9 3.2
2 1000-1999 Taka 76 25.4 81 27.2 79 26.4 70 24.6
3 2000-2999 Taka 70 23.4 90 30.2 128 42.8 110 38.6
4 3000-3999 Taka 79 26.4 58 19.5 45 15.1 54 18.9
5 Above 4000 48 16.1 44 14.8 27 9.0 42 14.7
Total 299 100 298 100.0 299 100.0 285 100.0
94. Monthly average per capita income of 89%, 94%, 96%, and 93% households
were within Tk.1,000 to Tk.4000. Monthly average expenditures on health care were
Tk.661, Tk.544, Tk.529, and Tk.576 in respectively ISI-I, ISI-II, ISI-III, and ISI-IV
(Table 4.7). Considering average monthly income of Tk.4,000 the expenditures on
health care during the four ISI surveys were respectively 16%, 14%, 13%, and 14%
which is inadequate (Table 4.8). It is also estimated that 39.6%, 44.0%, 63.6%, and
42.7% households were found deficient and indebted respectively during ISI-I, ISI-II,
ISI-III, and ISI-IV (Table 4.9).
Table 4.7: Monthly per Capita Income

Performance
Monthly Income (Taka) Per
Capita
N % N % N % N %
1 Less than 1000 29 6.10 11 2.3 18 3.8 5 1.1
2 1001-2000 211 44.40 257 54.1 239 50.3 182 38.3
3 2001-4000 183 38.50 178 37.5 198 41.7 254 53.5
4 4001-6000 44 9.30 18 3.8 16 3.4 26 5.5
5 6001-10000 8 1.70 11 2.3 4 0.8 8 1.7
Total 475 100.00 475 100.0 475 100.0 475 100.0
Table 4.8: Average Monthly Expenditure on Food, Medical and Education

Performance
st nd rd th
Major Heads of Expenditure 1 Round 2 Round 3 Round 4 Round
N % N % N % N %
1 Food 5,680 80.0 5,557 80.8 4,974 81.3 5,933 83.5
2 Health care 661 9.0 544 7.9 529 8.7 576 8.1
3 Education 804 11.0 777 11.3 617 10.1 594 8.4
Total 7,145 100.0 6,878 100.0 6,120 100.0 7,103 100.0
Table 4.9: Status of Borrowing Money

Performance
Status of borrowing 1st Round 2nd Round 3rd Round 4th Round
N % N % N % N %
1 Money borrowed in last week 188 39.6 209 44.0 302 63.6 203 42.7
2 Did not borrow 287 60.4 266 56.0 173 36.4 272 57.3
Total 475 100 475 100.0 475 100.0 475 100.0
95. It is found in the survey that 99.4%, 98.9%, 100.0% and 100.0% surveyed
households used safe water from pipelines supply source and tube wells (Table 4.10
and Figure 4.5). It is also noted that 83.8%, 96.8%, 97.1%, and 84.0% surveyed

households surveyed respectively under ISII, ISIII, ISIIII, and ISIIV surveys used
sanitary latrines (Table 4.11 and Figure 4.6).
Table 4.10: Sources of Drinking Water

Performance
Sources of Drinking Water 1st Round 2nd Round 3rd Round 4th Round
N % N % N % N %
1 Hand/motorized pump/tube well 250 52.6 288 60.6 269 56.6 236 49.7
2 Supply/piped water 222 46.8 182 38.3 206 43.4 239 50.3
3 Other sources 3 0.6 5 1.1 0 0.0 0 0.0
Total 475 100.0 475 100.0 475 100.00 475 100.0
Figure 4.5: Access of the Ultra poor and Poor Household to Safe Water
1% 1% 0% 0%
100
99% 99% 100 %
%
Access to safe water Access to safe water
Access to not safe water Access to safe water Access to safe water
Access to not safe water
Round I Round II Round III Round IV
Table 4.11: Use of Sanitary Latrines

Performance
Type of Latrines 1st Round 2nd Round 3rd Round 4th Round
N % N % N % N %
1 Flush connected to pit, septic
246 51.8 315 66.3 343 72.2 293 61.7
tank or open drain
2 Flush connected to public
152 32.0 145 30.5 118 24.9 106 22.3
sewerage
3 Latrines not sanitary 77 16.2 15 3.2 14 2.9 76 16.0
Total 475 100.0 475 100.0 475 100.0 475 100.0
Figure 4.6: Access to Sanitation

3% 3%
26% 16%
74% 84%
97% 97%
Access to santation Access to santation Access to santation Access to santation
Access to not santation Access to not santation Access to not santation Access to not santation
96. Though the surveyed households are predominantly ultra poor and poor with
very fewer non-poor households, the surveyed households are seen to have limited
access to refrigerator but good access to essential urban facilities like television,
radio, electric fan, mobile phones, and furniture (Table 4.12). Access to mobile

phones under the four ISI surveys are 88.6%, 86.7%, 88.8% and 93.1% respectively
in ISII, ISIII, ISIIII, and ISIIV (Table 4.12).
Table 4.12: Access to and Ownership of Essential Urban Household Assets

Performance
Household Assets 1st Round 2nd Round 3rd Round 4th Round
N % N % N % N %
1 Television 276 58.10 313 65.89 223 46.9 242 50.9
2 Radio 7 1.50 21 4.42 3 0.60 2 0.40
3 Refrigerator 58 12.20 59 12.42 66 13.9 38 8.0
4 Electric fan 422 88.80 424 89.26 428 90.1 454 95.6
5 Mobile phone 421 88.60 412 86.74 422 88.8 442 93.1
6 Furniture (bed, table, chair) 389 81.90 419 88.21 441 92.8 435 91.6
97. The ISI Surveys gathered information on the percentage of surveyed

households having red cards. It is noted that the percentage of households having a
red card progressively increased on average by 33.2%, 7.8%, and 8.7% between
ISII & II, ISIII &ISIIII, and ISIIII &ISIIV respectively with average change of 16.6% per
half-yearly assessment (Table 4.13 and Figure 4.7). The trend indicated a gradual
increase which is appreciable.
Table 4.13: Households having Red Cards

Performance
Status of having red card 1st Round 2nd Round 3rd Round 4th Round
N % N % N % N %
1 Households having red card 150 31.6 308 64.8 345 72.6 386 81.3
2 Household do not have red card 325 68.4 167 35.2 130 27.4 88 18.5
Figure 4.7: Survey Households have Red Cards
32% 35% 27% 19%
68%
65% 73% 81%
Have red card Have not red card Have red card Have not red card Have red card Have not red card Have red card Have not red card
98. The surveys gathered the level of knowledge of respondents about existence
of health facilities in their locality particularly the UPHCSDP facilities. It is found the
beneficiaries had good knowledge about Rainbow Clinic/ Urban clinic (Table 4.14).
In ISII 91% households had knowledge about urban clinics that increased to 91.6%
during ISIIV. It is also noted that their knowledge about other health facilities is
limited (Table 4.14 and Figure 4.8).

Table 4.14: Knowledge about availability of Health Services
Performance
Knowledge of about Health
Services
N % N % N % N %
1 Knowledge of Rainbow
433 91 440 92.6 459 96.6 435 91.6
Clinic/Urban Clinic
2 Knowledge of other government
110 23 120 25.3 105 22.1 129 27.2
hospitals
2 Knowledge of pharmacy 35 7 100 21.1 131 27.6 111 23.4
3 Knowledge of private hospital 68 14 72 15.1 35 7.4 31 6.5
4 Knowledge of homeopathic 0 0 0 0 0 0 9 1.9
Note: Multiple answers
Figure 4.8: Knowledge of UPHCSDP Served Household

9% 7% 3% 8%
91 97% 92%
93%
% Know UPHCSDP
Know UPHCSDP Know UPHCSDP Know UPHCSDP
No Know UPHCSDP No Know UPHCSDP No Know UPHCSDP No Know UPHCSDP

CHAPTER V
BENEFICIARY PERCEPTIONS OF THE QUALITY OF
SERVICES AT CRHCCs AND PHCCs
A. Services in the CRHCCs
99. ISI monitoring surveys gathered both quantitative and qualitative information.
The quantitative data was collected from different files, registers and field while the
qualitative information was gathered through focus group discussion (FGD). The
qualitative assessment of performances of the CRHCCs and PHCCS through focus
group discussions with service recipients were carried out in all four ISI surveys. The
present report deals with the ISI IV along with the earlier three ISI surveys in
comparison to see the trend of the performance of the PA NGOs and the services
delivery. In the ISI IV a total of 138 focus group discussion sessions were hold (25 in
25 CRHCCs and 113 in 113 PHCCs). The participants demonstrated good
knowledge about the project and the opportunity of quality health services for the
poor especially the women and children free of cost and at reasonable cost to noon
poor. Poverty Score of all PA are presented at Appendix 5.
100. In each focus group discussion, five issues were discussed such as
atmosphere, convenience and privacy maintained during providing health services,
attitudes of staff towards service recipients, explanations and information given by
medical staff, quality of care given by medical staff, and cost of services and
medicines. Participants discussed all five points under facilitation of survey team and
rated each point on a four points scale. Survey team observed focus group
discussions and noted outcome of feedback.
1. Atmosphere in the CRHCCs
101. Comparative feedback of four ISI surveys on score on facilities, timing and
atmosphere indicate that there is gradual improvement of atmosphere in CRHCCs. It
is noted that participants of 80%, 80%, 76% and 88% FGD sessions of ISI surveys I,
II, III and IV rated 4 out of 4 (Table 5.1and Figure 5.1) respectively.
Table 5.1: Summary of Score about Facilities, Timing and Atmosphere
Improvements of Facilities, Timing and Atmosphere
st nd rd th
Rating of the Participants 1 Round 2 Round 3 Round 4 Round
N % N % N % N %
1 Very good (4 out of 4) 20 80 20 80 19 76 22 88
2 Good (3 out of 4) 5 20 5 20 6 24 3 12
Total 25 100 25 100 25 100 25 100
Figure 5.1: Improvement Atmosphere in CRHCCs

88%
90%
Improved Atmosphere
85% 80% 80%

% CRHCCs in
80% 76%
75%
70%

2. Attitudes of the Staff towards the Service Recipients
102. Participants of focus group discussions discussed how they are greeted,
received and welcomed, showed respects, answered questions, general attitude,
attentiveness to patients, difficulty of patients during waiting for doctor or counselor
and rescheduling appointments, long waiting in queue, and dealing of staff during
giving birth at the CRHCCs. Score on staff attitudes towards service recipients
continued to improve as indicated during the four ISI surveys. It is noted that the
participants of 76%, 80%, 88% and 88% FGDs rated staff attitudes towards patients
as 4 out of 4 (Table 5.2 and Figure 5.2).
Table 5.2: Improvements of Staff Attitudes to Patients in CRHCC
Improvements of Staff Attitudes to Patients

st nd rd th
N % N % N % N %
1 Very good (4 out of 4) 19 76 20 80 22 88 22 88
2 Good (3 out of 4) 6 24 5 20 3 12 3 12
Total 25 100 25 100 25 100 25 100
Figure 5.2: Change staff attitude Patients in CRHCCs

% CRHCCs Rated on 4 out of 4
90% 88% 88%
85%
80%
80%
76%
75%
70%
3. Explanations and Information given by Medical Staff
103. Participants assessed medical staff and counselors at CRHCC for information
provided by them particularly when patients ask questions. Participants also
assessed counselors for their dealings with patients and ways of understanding
problems of patients. They also assessed doctors on satisfaction of patients,
explanation of antenatal visits, patients condition, complication, possible measures,
prescribing medicines, responses of doctors to questions of patients, time spent for
each patient, and respects shown to patients irrespective of gender, economic class,
ethnicity, and encouraging patients. Participants of 80%, 72%, 76% and 88% FGD
sessions rated 4 out of 4 on level of sharing information by medical staff to patients
during ISI I, II, III and IV respectively. The improvement is notable but it is fluctuating
(Table 5.3 and Figure 5.3).

Table 5.3: Staff Improvement on providing Explanation and Information to Patients

Performance FGD
st nd rd th
N % N % N % N %
1 Very good (4 out of 4) 20 80 18 72 19 76 22 88
2 Good (3 out of 4) 5 20 7 28 6 24 3 12
Total 25 100 25 100 25 100 25 100
Figure 5.3: Staff Improvement in Providing Explanation and Information to Patients
100% 88%
80% 76%
80% 72%
60%
40%
20%
0%
4. Quality of Services at the CRHCCs
104. Quality of services provided from CRHCCs were also discussed in all FGDs
and rated. It is noted that 4 out of 4 score was awarded in 68%, 64%, 72% and 84%
FGDs during ISI I, II, III and IV respectively (Table 5.4 and Figure 5.4). This indicated
uninterrupted improvements in quality of services. It is also noted there are scope of
improvements of quality of services in CRHCCs.
Table 5.4: Summary of Score about Quality of Services at the CRHCCs

Performance FGD
st nd rd th
N % N % N % N %
1 Very good (4 out of 4) 17 68 16 64 18 72 21 84
2 Good (3 out of 4) 8 32 9 36 7 28 4 16
Total 25 100 25 100 25 100 25 100
Figure 5.4: Improvement of Quality of Services in CRHCCs
100%
84%
80% 72%
68%
64%
60%
40%
20%
0%

5. Cost of Services at CRHCCs
105. Participants opined about cost of services at CRHCCs and medicine and
process and getting red card and difficulty in getting red card. Participants provided
their feedback in receiving treatment free of cost and quality of treatment and
observation on receiving services at cost and free of cost. Beneficiaries opined that
cost of services regardless of free services for red card holders and reduced cost for
others are expensive according to them. Level of satisfaction of beneficiaries
improved continuously as indicated in rating of participants of FGD sessions as 4 out
of 4. It is found that participants of 64%, 64%, 64% and 76% FGD sessions during
ISI I, II, III, and IV respectively rated high (Table 5.5 and Figure 5.5). It is noted from
findings of last four ISI surveys that level of beneficiary satisfaction with cost of
services in CHRCCs is relatively low (64% up to first three surveys and 76% in the
last survey). Beneficiaries considered indirect costs like travel cost to reaching
CRHCC located far away and wage loss to take services during work hours, and
delays in getting services due to lack of attention and efficiencies in service delivery
are high in some cases. While it is not possible to establish facilities close to all
beneficiaries within partnership area but question of putting facilities in a mid-point
convenient to all beneficiaries is desirable as far as possible.
Table 5.5: Improvement of the Level of Beneficiary Satisfaction in CRHCCs

Improvement of the Level of Beneficiary Satisfaction
st nd rd th
N % N % N % N %
1 Very good (4 out of 4) 16 64 16 64 16 64 19 76
2 Good (3 out of 4) 9 36 9 36 9 36 6 24
Total 25 100 25 100 25 100 25 100
Figure 5.5: Cost of Services in CRHCCs
80%
CRHCCs Scord 4 out of 4 for
76%
Beneficiary Satisfaction
75%
70%
64% 64% 64%

65%
60%
55%
B. Services in the PHCCs
106. Survey team conducted 113 focus group discussions (one in each PHCC
area) with participation of 1,226 persons in the ISI survey – Round IV. In these FGD
sessions same five issues as of CRHCCs were discussed. Participants discussed all
five issues under facilitation of survey team and rated their conclusion on a four-point
scale.

1. Atmosphere of the PHCCs
107. Likewise, participants of CRHCCs rating on atmosphere of PHCCs continued

to increase during the four survey periods (July 2015 to 30 June 2017). Participants
of 73%, 91%, 72% and 88% FGD sessions of ISI I, II, III and IV respectively rated
facilities, timing and atmosphere in PHCCs as 4 out of 4 (Table 5.6 and Figure 5.6).
However, there are fluctuations of ratings leaving scope for further improvements.
Table 5.6: Improvement of Facilities, Timing and Atmosphere
Improvement of Facilities, Timing and Atmosphere

st nd rd th
N % N % N % N %
1 Very good (4 out of 4) 83 73 92 91 81 71.7 99 87.6
2 Good (3 out of 4) 30 27 21 19 32 28.3 14 12.4
Total 113 100 113 100 113 100 113 100
Figure 5.6: Improvement of Atmosphere in PHCCs
100%
% CRHCCs Record on 4 out of 4
91% 88%
in Improvment atmosphere
80% 73% 72%
60%
40%
20%
0%
2. Attitudes of the Staff towards the Service Recipients
108. Patients of 67%, 91%, 74% and 85% FGD sessions of four ISI I, II, III and IV
respectively rated as 4 out of 4 attitudes on staff of PHCCs towards patients (Table
5.7 and Figure 5.7). This indicated a sharp increase with fluctuations of level of
friendly behaviors of staff in PHCCs overtime.
.
Table 5.7: Trend of Improvements of Staff Attitudes towards Patients at PHCCs
Trend of Improvements of Staff Attitudes

Rating of the Participants 1st Round 2nd Round 3rd Round 4th Round
N % N % N % N %
1 Very good (4 out of 4) 76 67 92 91 84 74.3 96 85.0
2 Good (3 out of 4) 37 33 21 19 29 25.7 17 15.0
Total 113 100 113 100 113 100 113 100

Figure 5.7: Trend of Improvements of Staff Attitudes
100% 91%
% PHCCs Rated on 4 out of

85%
80% 74%
67%
4 in Improved
60%
40%
20%
0%
3. Explanations and Information given by Medical Staff
109. Participants of 64%, 78%, 71%, and 82% FGD sessions of ISI I, II, III, and IV
respectively rated dealing of staff and doctor at PHCCs as 4 out of 4. The data of
four surveys indicate gradual improvements. Staff and doctors increasingly provided
more explanations and information to patients than before (Table 5.8 and Figure
5.8). It is considered that there is need and room for further improvements in this
regard to enhance reputation of PHCC.
Table 5.8: Explanation and Information Provided to Patients in PHCCs
Explanation and Information Provided to Patients

N % N % N % N %
1 Very good (4 out of 4) 72 64 88 78 80 70.8 93 82.3
2 Good (3 out of 4) 41 36 25 22 33 29.2 20 17.7
Total 113 100 113 100 113 100 113 100
Figure 5.8: Explanation and Information Provided to Patients

4 for Proficing Explanation &
% PHCCs Rated on 4 out of
100%
78% 82%
80% 71%
64%
Information
60%
40%
20%
0%
4. Quality of Services at the PHCCs
110. Participants of 57%, 79%, 76% and 81% FGD sessions of ISI I, II, III, and IV
respectively rated quality of services at PHCCs as 4 out of 4 on quality of services.
Trend manifests gradual improvement of quality of services (Table 5.9 and Figure
5.9). Both PA NGOs and project need to place high importance in improving quality
of services failing which number of patients may reduce and facilities remain
underutilized.

Table 5.9: Quality of Services at the PHCCs

Quality of Services at the PHCCs
N % N % N % N %
1 Very good (4 out of 4) 64 57 89 79 86 76.1 92 81.4
2 Good (3 out of 4) 49 43 24 21 27 23.9 21 18.6
Total 113 100 113 100 113 100 113 100
Figure 5.9: Quality of Services at the PHCCs
100%
% PHCCs RAted on 4 out
of 4 in Quality of Services
79% 81%
76%
80%
57%
60%
40%
20%
0%
5. Cost of Services at PHCCs
111. Participants of 56%, 66%, 72% and 76% FGD sessions of four ISI I, II, III and
IV respectively rated as 4 out of 4 (Table 5.10). Trend shows gradual improvements
of level of beneficiary satisfaction on cost of services provided from PHCC.
Eventually level of less satisfaction or dissatisfaction reversely reduced from 44% in
ISI I to 24% in ISIIV (Table 5.10 and Figure 5.10). Nevertheless, matter relating to
cost of services, particularly time spent for receiving PHCC services may reduce.
Table 5.10: Level of Satisfaction of Participants with Cost of Services at PHCCs
Improvement of Patient Satisfaction on Cost of Services

N % N % N % N %
1 Very good (4 out of 4) 63 56 75 66 81 71.7 86 76.1
2 Good (3 out of 4) 50 44 38 34 32 28.3 27 23.9
Total 113 100 113 100 113 100 113 100
Figure 5.10: Quality of Services at the PHCCs
100%
4 on Satisfaction of Services
% PHCCs Rated as 4 out of
72% 76%
80% 66%
56%
60%
40%
20%
0%

112. General findings of qualitative feedback of service recipients on overall

performance and quality and cost of services in CRHCCs and PHCCs are gradually
improving. PA NGOs providing services need to further improve services in terms of
quantity and quality including their attitudes and behaviors to patients. Proper
maintenance with timely replacements and up gradation of the facilities as needed,
training and motivation of staff and doctors, careful recruitment of staff and doctors
considering their level of commitment and experience and skill for specific skills, cost
of services including travel cost, and timing of servicing at PHCC, etc. may be looked
into by the Project. Project facilities and quality of services delivered from CRHCCs
and PHCCs should of high enough to beneficiaries.

CHAPTER VI
OVERALL PERFORMANCE OF PARTNERSHIP AREAS (PAs)
113. ISI survey team assessed overall performance of 25 PA Areas in terms of the
performances of respective PA HQ, CRHCC, PHCCs and Satellite Clinics based on
a total 1,000 score points. Performance assessment of PA HQ, CRHCC, PHCC and
Satellite Clinic are based on quantity, quality and management achievements
respectively on 130, 250, 450, and 170 score points. In earlier three ISI surveys,
assessments were made for each survey on previous 6month achievements.
Present report primarily included assessment of ISI survey IV that covered period
January-June 2017. In addition, the report included a comparative analysis of
findings of four ISI surveys to see changes and improvements of achievements of
major activities in terms of quantity, quality and management. Overall performance of
the 25 PAs and PA NGOs are presented at Appendix 6 for all four ISI I, II, II, and IV.
A. Achievement Performance of the PAHQs
114. Total scores of 130 were allocated for assessment of PA HQ including 50 on

quality and 80 on management. Quality included indicators like activities whether full-
time staff was available, whether poor households having red card are
knowledgeable about available services. Management included indicators related to
advocacy carried out par target, timely submission of data on HMIS, income
generation as per target, updated financial records maintained up to standard, and
management documents updated and used.
115. ISI survey round IV indicated that like previous three other surveys PA HQs of
DCC performed best followed by OCC and municipality. However, overall
performance of PA HQs in the ISIIV could not keep pace with the trend of three other
survey periods (80%, 88% and 91%). Separately, PA HQs of DCC, OCC and
municipality maintained steady growth over the four half-yearly assessment periods.
Progressive increased improvements indicated that monitoring oversight played
positive role in improving performance of PA HQs (Table 6.1 and Figure 6.1).
Table 6.1: Trend of Improvements of Performance of PA HQs by

Domains in Four ISI Surveys
Domain(s) Achievements in Four ISI Surveys (%)

ISII ISIII ISIIII ISIIV
Dhaka (South & North) City Corporations 87 91 95 94
Other City Corporations 78 87 90 88
Municipalities 75 87 87 85
Overall Assessment of 4Survey Periods 81 88 92 90

Figure 6.1: Trend of Improvements of Performance of PA HQs
91% 95% 94%

87% 90% 88%
100% 87% 87% 85%
78%
% Performance Achievements
87%
75%
80%
60%
40%
20%
0%
ISI I ISI II ISI III ISI IV
DCC OCC Municipalities
B. Achievement Performance of the CRHCCs
116. Performance of CRHCC is assessed on total 250 score covering three major
areas (100 for quality, 100 for quantity, and 50 for management). Quality of services
in CRHCC covered indicators related to maintaining partograph, ANC visits,
availability and completeness of PPH kit, emergency kit and eclamptic kit, infection
protocol, clinical waste management, medical staff knowledge of newborn danger
signs and maternal danger signs, and community satisfaction. Performance of
CRHCC on quantity of services is assessed on total 100 score based on indicators
related to number of NVD, C/S, PNC visits, couples accepting longer acting and
permanent methods, RTI/STI visits, adolescent visits, child under five visits and
diagnostic services. Performance of management of CRHCC was assessed on
activities related to registers used and updated, red card clients at 30% (NVD, C/S
and prescribed medicine), inventory management and facilities for women clients.
Score varied reasonably.
117. Assessment of performance of CRHCCs in ISI survey round IV indicated that

like previous three other surveys CRHCs of DCC performed best followed by OCC
and municipality. Overall performance of CRHCCs maintained positive trend
throughout four survey series (76%, 84%, 89% and 89%). Separately, CRHCCs of
DCC, OCC and municipality maintained steady growth anyway over the four half-
yearly assessment periods. Increasing improvements indicated that monitoring
oversight played positive role in improving the performance of CRHCCs (Table 6.2
and Figure 6.2).
Table 6.2: Trend of Improvements of Performance of CRHCCs by

Domain in Four ISI Surveys


Figure 6.2: Trend of Improvement of Performance of CRHCC
94% 95%
100% 90%
85% 83% 89% 91%
% Improvements of
72% 73% 72%
Performance
80% 67%
62%
60%
40%
20%
0%
C. Achievement Performance of PHCCs
118. Performance of PHCCs is assessed on a total score of 450 (150 for quality,
250 for quantity, and 50 for management). Quality of services of PHCCs assessed
based on indicators related to growth monitoring of children, treatment of ARI with
antibiotic, treatment of diarrhea with ORS, patient knowledge about diagnosis and
treatment, infection protocol, clinical waste management and community satisfaction.
Assessment of performance of PHCCs on quantity of services is assessed on total
250 score based on indicators related to number of new couples accept modern
methods/IUD, number of couples visits for continuing or switch over another modern
method, number of ANC visits, number of measles and rubella vaccination and
diagnostic services. Assessment of performance of PHCCs on its management is
assessed on total score 50 score based on indicators related to registers used and
updated, red card clients at 30% (MR, diagnostic services and prescribed medicine),
inventory management and facilities for women clients, WUHCC meetings held
quarterly and UF meetings held quarterly.
119. Assessment of performance of PHCCs in ISI survey round IV indicated that

like previous three other surveys PHCCs of DCC performed best followed by OCC
and municipality. The overall performance of PHCCs maintained positive trend
throughout four survey series (69%, 77%, 82% and 89%). Details are at table 6.3.
Separately, PHCCs of DCC and OCCs maintained steady growth over four half-
yearly assessment periods. However, municipalities could not keep pace of
increasing trend in ISI-IV period with progress of previous three survey periods.
Increasing improvements indicated that monitoring oversight played positive role in
improving performance of CRHCCs (Table 6.3 and Figure 6.3).
Table 6.3: Trend of Improvements of Performance of PHCCs by Domain in Four ISI Surveys


Figure 6.3: Trend of Improvement of Performance of PHCCs
97%
91%
Improvement of Performance
100% 83% 85% 92%
82%
74%
80% 65%
61% 62% 62%
59%
60%
40%
20%
0%
D. Achievement Performance of Satellite Clinics
120. Performance of satellite clinics was assessed covering three major areas like
quality, quantity and management based on total 170 scores (50 for quality, 100 for
quantity, and 20 for management). Assessment of quality of services of satellite
clinics covered activities related to availability of BCC material, quality observation
checklist, pregnancy register updating verification and eligible couples register
verification at household. Performance of satellite clinic on quantity of services
covered activities related to number of satellite clinics held, client visits, client visits
for FP methods, health educational sessions/community group meetings.
Performance of satellite clinic on management covered areas like activities related to
updating pregnancy register and eligible couples register.
121. Assessment of performance of Satellite Clinics in ISI survey round IV

indicated that like previous three other surveys, Satellite Clinics of DCC performed
best followed by OCC and municipality. The overall performance of Satellite Clinics
in ISI-IV maintained positive trend throughout the four survey series (77%, 79%, 89%
and 90%). Separately, Satellite Clinics of DCC, OCC and municipality maintained
steady growth over the four half-yearly assessment periods. Increasing
improvements indicated that monitoring oversight played positive role in improving
performance of Satellite Clinics (Table 6.4 and Figure 6.4).
Table 6.4: Trend of Improvements of Performance of Satellite Clinic by

Domain in Four ISI Surveys


Figure 6.4: Trend of Improvement of Performance of Satellite Clinic
97% 97%
100% 90% 86% 87% 89%
75%
80% 68%
% Performance
66%
60% 49% 50%
48%
40%
20%
0%
E. Overall Performance of PAs
ISI Survey – Round IV
122. ISI Survey – Round IV conducted recently covering the period Jan-Jun 2017
suggest that overall performance of the PAs during the time is consistent to the
previous three surveys (ISII, ISIII and ISIIII). However, performance of the 4 PAs of
municipality domain fluctuated and decline progressively compared to the ISI I
(Table 6.5). Overall, the performance is found flat across PA HQ, CRHCC, PHCCs,
and Satellite Clinics (89%,89%, 89% and 90% respectively in PA HQ, CRHCC,
PHCCs, and Satellite Clinics) (Table 6.5 and Figure 6.5).
Table 6.5: Overall Achievement Performance of PAs by Domain in Four ISI Surveys
Domain(S) Average Performance in Four Levels (Total Score)

PAHQ CRHCC PHCC Satellite Average
Dhaka (South & North) City Corporations 94 95 97 97 96
Other City Corporations 88 91 92 89 91
Municipalities 85 67 62 68 71
Overall Assessment of 4Survey Periods 90 89 89 85 88
Figure 6.5: Overall Performance of PAs in ISI IV
94% 95% 97% 97% 96%

100% 91% 92% 91%
88% 85% 89%
% Improvment of Performance
80% 71%
67% 68%
62%
60%
40%
20%
0%
PAHQ CRHCC PHCC Satellite Average

123. In overall, PAs of DCC performed better than the two other domains (OCC
and municipality) and maintained a steady growth of improvements of 2%, 6% and
3% (point to point) with previous ISI survey (Table 6.6). PAs of OCCs maintained a
lower performance achievement than DCC domain but much higher performance
than municipality domain. PAs of OCC domain also progressively improved
performance at a relatively higher rate than DCC like 11%, 8% and 5% (point to
point) over the previous ISI survey periods (Table 6.6). PAs of municipally domain
improved first in ISI-II over ISI survey (6%) and then slowed down by 1% in following
two ISI survey periods (Table 6.6). Overall pace of improvement of performance of
PAs over four ISI survey periods is uniform and steady upwards at rate of 7%, 5%
and 4% (point to point) with subsequent ISI surveys (Table 6.6 and Figure 6.6).
Table 6.6: Overall Performance of PAs by Domain in Four ISI Surveys

Figure 6.6: Trend of Overall Improvement of Performance by Domain in 4 ISI Survey
96%
93%
87%
% Improvement of Performance of
100% 91%
85% 86%
78%
67%
80% 71% 70% 69%
65%
60%
all PAs
40%
20%
0%
124. A summary of the overall performance of all PAs indicated that out of 25 PAs,
three PAs scored 90% and above in all four ISI surveys and six PAs scored on
average 90% and above but not in all four ISI surveys. Among remaining 16 PAs,
eight scored 80% and above but less than 90% on average – five PAs 70% and
above but less than 80%, two PAs scored 60% and above but less than 60%, and
one PA scored less than 50%. Table 6.7 below summarizes percentage
achievements, PAs and respective PA NGOs by domains.

Table 6.7: Summary of Overall Performance by Domain in Four ISI Surveys
Score Level(s)-average No. of PAs Name(s) of PAs (PA NGOs)

of 4 ISI Surveys
90% and above 3 DSCC-PA3 (BAPSA), DNCC-PA1 (NariMaitree), DNCC-
throughout PA5 (DAM)
90% and above on 6 DSCC-PA5 (PSTC), DNCC-PA2 (NariMaitree) DNCC-PA3
average (UTPS), KCC-PA1 (KMSS), GaCC-PA2 (PSKP & PPS),
KsM-PA1 (NariMaitree)
80% and above but less 8 DSCC-PA1 (PSTC), DSCC-PA2 (KMSS), DSCC-PA4
than 90% (PSTC), DNCC-PA4 (KMSS), RCC-PA1 (RIC), KCC-PA2
(KMSS), SCC-PA-1 (Simantic), BCC-PA1 (Srizony)
Below 80% 8
70%-79% 5 NaCC-PA1 (PSKP&PPS), GaCC-PA-1 (PSTC), RCC-PA2
(PSTC), CoCC-PA1 (DAM), SM-PA1 (ESDO)
60%-69% 3 KsTM-PA1 (Srizony), RaCC PA1 (KMSS)
50%-59% 0
Below 50% 1 GM-PA1 (GM)
125. In conclusion, it can be remarked that over the last two years of original
project period (Jan 2015 to Jun3 2017) the four ISI surveys found considerable
progressive improvements of the performance of the PAs across the three domains.
The progress attributed from project monitoring efforts as well as the routine
monitoring and evaluation of the project through the PPM&E activities. It may also be
recommended that in future routine monitoring through ISI survey should continue
right from the beginning of the project.

CHAPTER VII
RECOMMENDATIONS AND CONCLUSIONS
A. Recommendations
126. Achievement of performance of one out of every two PA NGOs fluctuated. It is

important to identify the reasons of fluctuations of performance particularly for those
PAs perform low.
127. Lower income generation indicates lower level of service delivery and so the
under utilization of health facilities of the project. It is known that there is high
demand for health services in all urban centers compared to the available health
facilities which is proved from high utilization of facilities in other public and private
health facilities. It is suggested that project should fix targets for both income and
services for all PA NGOs depending on location, surveyed potential demand, and
capacity of PA NGOs for every six months well ahead of the half-yearly period. The
project may assess financial and economic viability of each facility through an
assessment of the economic internal rate of return to the huge financial investment
to the facilities (CRHCC, PHCCs, and Satellite Clinics).
128. Level of performance of PAs at CRHCC, PHCC and Satellite Clinic widely
vary depending on the demand in the PA and capacity of service providing PA
NGOs. While demand for services in PAs and capacity of service providing PA
NGOs may not be properly matched the project has to undertake an advance
realistic assessment of each PA and set the target as needed. The project should set
an overall optimum monthly and half-yearly target of different health services for
delivery from the CRHCC, PHCC and Satellite clinic. At present, the contract with the
PA NGOs contains financial target only but there is no specific target for services
delivery. It is important to mention that the agreed financial target proposed by the
respective PA NGOs in their bids with provision of changing the provision mutually
for setting financial as well as physical targets of each PA considering the estimated
demands for services, availability of similar other facilities in the area, purchasing
power of the people (especially the poor) and capacity of the particular PA NGOs.
129. Recognizing the lack of availability of sufficient numbers of experienced and

skilled technical staff for the project health facilities, the project may take steps to on-
the-job hands on local level training of all technical as well as management staff. A
local in-country training program may be thought of for all type of technical and
management staff where such staff of all PA NGOs should compulsorily attend in the
specified training managed jointly by the project, PA NGOs, and suitable training
providers.
130. ISI survey findings generally suggest that ANC services are quite high
compared to the number of deliveries in the CRHCCs. It is important to identify the
reasons for not availing existing facilities of CRHCCs for delivery services and find
ways to attract patients to increasing utilization of project facilities.

131. Performance of CRHCCs and PHCCs widely vary even though these are
located in the same domain and in same town. It is suggested that project may
motivate respective PA NGOs to improve performance to an optimum level and sites
for new CRHCCs and PHCCs and Satellite Clinics should be carefully selected and
established so that location specific problems of efficient operation and management
can be avoided.
132. There is weakness in maintaining and updating registers and BIN cards which
need to be addressed.
133. It is suggested that the red card holders should get due attention in getting
services particularly menstrual regulation and delivery services.
134. Expanded and fully-fledged diagnostic facilities are keys to attract and retain
patients and ensure sustainability of the project facilities.
135. Low performing PA NGOs should improve utilization of the capacity of the
facilities through public campaign and increasing service delivery to everyone who
seeks services.
136. Institutionalization of the primary health service delivery is yet to emerge as a

successful model. Local Government Institutions (city corporations and
municipalities) do not seem to be as serious and involved as needed and expected.
It is recommended that a suitable and effective institutional mechanism be evolved
that can ensure PHC services for all urban populations especially the poor women
and children on a sustainable basis.
B. Conclusions
137. Capacity utilization of the primary health care services by the operator PA NGOs
is critical and demands top priority.
138. There is need for high level political decision to increase the level of
participation of city corporations and municipalities in providing primary health care
services to the urban population on a sustainable basis.
139. Full-scale diagnostic facilities in health facilities might enhance the rate of
utilization, income, reputation, retention of patient, and benefits of the beneficiaries
especially the ultra poor and poor who cannot afford high diagnostic services that are
pre-cursor of the proper modern medical treatment.

Appendix 1
PERFORMANCE OF CRHCCs FOR PROVIDING MAJOR PHC SERVICES - ISI-IV
Table 1.1: Service Delivery from CRHCC for Normal Vaginal Delivery (NVD)
C2.1 (NVD)
Partnership Area Name of NGO Location
Target Achievement %
1 DSCC PA-01(6) PSTC Dhaka south city corporation 744 719 97
2 DSCC PA-02(6) KMSS Dhaka south city corporation 642 643 100
3 DSCC PA-03(6) BAPSA Dhaka south city corporation 744 771 104
6 DNCC PA-01(5) NariMaitree Dhaka north city corporation 721 725 101
8 DNCC PA-03(5) UTPS Dhaka north city corporation 588 587 100
9 DNCC PA-04(4) KMSS Dhaka north city corporation 720 746 104
10 DNCC PA-05(6) DAM Dhaka north city corporation 414 420 101
Average of DCC >>>>> 641 613 98
11 RCC PA-01(5) RIC Rajshahi city corporation 540 165 31
12 RCC PA-02(5) PSTC Rajshahi city corporation 363 71 20
13 KCC PA-01(6) KMSS Khulna city corporation 600 543 91
15 SCC PA-01(7) Shimantik Sylhet city corporation 500 537 107
16 BCC PA-01(4) Srizony BD Barisal city corporation 480 520 108
17 CoCC PA-01(6) DAM Comilla city corporation 396 481 121
18 NaCC PA-01(3) PSKP&PPS Narayanganj city corporation 228 248 109
19 RaCC PA-01(3) KMSS Rangpur city corporation 378 248 66
20 GaCC PA-01(2) PSTC Gazipur city corporation 240 285 119
21 GaCC PA-02{2) PSKP&PPS Gazipur city corporation 300 337 112
Average of OCC >>>>>> 399 372 97
22 SM PA-01(3) ESDO Sirajganj municipality 540 190 35
23 KstM PA-01(2) Srizony BD Kushtia municipality 300 141 47
24 KsM PA-01(2) NariMaitree Kishoreganj municipality 240 178 74
25 GM PA-01(2) Gopalganj Munc. Gopalganj municipality 360 44 12
Average of Municipality>>>> 360 138 42
Total Services 12,233 10,769 88
Overall Average 489 431 4

Table 1.2: Service Delivery from CRHCC on Caesarian Section (C/S) Delivery–ISI-IV
C2.2 (C/S)
Average of DCC >>>>> 299 287 99
Average of OCC >>>>>> 163 193 128
Total Service 5,453 5,706 105

Table 1.3: Service Delivery from CRHCC for Post Natal Care Visits (PNC) – ISI-IV
C3.2D (PNC Visits)

Average of DCC >>>>> 1889 2107 123
Average of OCC >>>>>> 912 1017 115
Total Service 32,540 34,956 107

Table 1.4: Service Delivery from CRHCC for Couples Accepting Longer Acting and
Permanent Methods – ISI-IV
C3.2e (Couples accepting longer

Partnership Area Name of NGO Location acting & permanent methods)
Average of DCC >>>>> 231 246 107
Average of OCC >>>>>> 194 185 88

Table 1.5: Service Delivery from CRHCC for RTI/STI Visits – ISI-IV
C3.2f (Total number of RTI/STI visits)

Average of DCC >>>>> 657 810 117
Average of OCC >>>>>> 561 634 130
Total Service 14,911 16,232 109

Table 1.6: Service Delivery from CRHCC for Adolescent Visits – ISI-IV
C3.2g (Total number of adolescent

Partnership Area Name of NGO Location visits)
Average of DCC >>>>> 927 1160 130
Average of OCC >>>>>> 553 707 154
Total Service 17,229 20,370 118

Table 1.7: Service Delivery from CRHCC for Under Age 5<Child Visits – ISI-IV
C3.3a (Under age 5< child visits)

Average of DCC >>>>> 2436 3062 132
18 NaCC PA-01(3) PSKP&PPS Narayangang city corporation 1600 1833 115
Average of OCC >>>>>> 2003 2409 126
Total Service 54,010 64,753 120

Table 1.8: Service Delivery from CRHCC for Diagnostic Services – ISI-IV
C3.4a (Diagnostic Services)

Average of DCC >>>>> 5053 6081 137
Average of OCC >>>>>> 4222 4899 122
Total Service 123,570 130,074 105

Appendix 2
PERFORMANCE OF PHCCs FOR PROVIDING MAJOR PHC SERVICES - ISI-IV
Table 2.1: Service Delivery from PHCC for Modern Method Received/ Adopted
P4.1a (Modern Method Received)

Average of DCC >>>>> 6603 7609 119
Average of OCC >>>>>> 10609 12582 116
Total Service 205,874 224,950 109

Table 2.2: Services Delivery from PHCCs for Switching to Modern Methods – ISI-IV
P4.2a (Modern Method Switch Target

Partnership Area Name of NGO Location & Achieved)
Average of DCC >>>>> 5498 4975 94
Average of OCC >>>>>> 5049 4976 88
Total Service 114,751 105,899 92

Table 2.3: Services Delivery from PHCCs for ANC Visits – ISI-IV
P4.2b (ANC visits Target & Achieved)

Average of DCC >>>>> 8573 9418 112
Average of OCC >>>>>> 5114 5892 111
Total Service 150,502 164,339 109

Table 2.4: Services Delivery from PHCCs for Complete Vaccination – ISI-IV
P4.3a (Complete vaccination Target &

Partnership Area Name of NGO Location Achieved)
5 DSCC PA-05(4) PSTC Dhaka, south city corporation 1357 1555 115
Average of DCC >>>>> 3286 4203 157
Average of OCC >>>>>> 3964 4524 119
Total Service 77,807 93,061 120

Table 2.5: Services Delivery from PHCCs for Diagnostic Services – ISI-IV
P4.4a (Diagnostic services performed

Partnership Area Name of NGO Location Target & Achieved)
Average of DCC >>>>> 13583 16199 120
Average of OCC >>>>>> 9370 10831 117
Total Service 253,679 291,789 115

Appendix 3
PERFORMANCE OF SATELLITE CLINICs FOR PROVIDING MAJOR

PHC SERVICES – ISI-IV
Table 3.1: Services Delivery from Satellite Clinics for Holding Satellite Clinics
P4.5a.1 (Satellite clinic held Target &

Partnership Area Name of NGO Location Achieved)
Average of DCC >>>>> 1683 1717 102
Average of OCC >>>>>> 1444 1446 101

Table 3.2: Services Delivery from Satellite Clinic for Client Visits – ISI-IV
P4.5a.2 (Total client visit in satellite

Partnership Area Name of NGO Location clinic Target & Achieved)
Average of DCC >>>>> 38292 43939 116
Average of OCC >>>>>> 39324 44463 112
Total Service 871,833 986,557 113

Table 3.3: Services Delivery from Satellite Clinics for Visits for FP Methods – ISI-IV
P4.5a.3 (Visit for FP method in satellite

Partnership Area Name of NGO Location clinic Target & Achieved)
Average of DCC >>>>> 7881 8953 115
Average of OCC >>>>>> 13443 14166 107
Total Service 243,269 267,301 110

Table 3.4: Services Delivery from Satellite Clinics for Holding Health
Education Sessions – ISI-IV
P4.5a.4 (Health education session held

Partnership Area Name of NGO Location in satellite clinic Target & Achieved)
Average of DCC >>>>> 2288 2418 109
Average of OCC >>>>>> 843 929 120
Total Service 33,614 35,882 107

Appendix 4
COMARATIVE ANALYSIS OF THE TARGETS AND ACHIEVEMENTS OF

SELECTED 17 ITEMS OF IMPORTANT SERVICES
Table 4.1: Targets and Achievements of PAs during ISI-I, ISI-II, ISI-III and ISI-IV
PA Area(s) Location(s) PA-NGO(s) Target(s) Achievement(s)
ISI-I ISI-II ISI-III ISI-IV ISI-I ISI-II ISI-III ISI-IV
1 DSCC PA-01 Golapbag PSTC 93,339 106,351 132,166 133,530 108,841 130,130 129,598 152,022
2 DSCC PA-02 Agasadeq KMSS 91,164 97,654 99,196 99,910 93,457 88,165 97,235 107,822
3 DSCC PA-03 Hazaribag BAPSA 59,609 67,765 71,353 71,986 98,968 109,520 107,335 107,728
4 DSCC PA-04 Mughda PSTC 82,216 95,803 100,427 106,616 86,403 103,663 105,679 121,180
5 DSCC PA-05 South Goran PSTC 78,415 78,585 84,661 84,661 79,218 86,568 94,266 89,075
6 DNCC PA-01 Moghbazar NariMaitree 82,530 106,480 113,904 138,451 108,945 126,109 138,448 143,438
7 DNCC PA-02 Banshbari NariMaitree 78,323 85,552 89,884 89,884 84,921 83,286 100,480 101,998
8 DNCC PA-03 Mirpur UTPS 84,791 89,958 89,958 97,132 83,646 97,623 94,382 100,034
9 DNCC PA-04 Pallabi KMSS 77,578 78,276 81,190 81,190 93,686 75,913 114,887 105,869
10 DNCC PA-05 Uttara DAM 71,181 91,465 94,820 94,850 90,871 94,943 109,195 108,803
Average of DCC >>>>> 79,915 89,789 95,756 99,821 92,896 99,592 109,151 113,797
11 RCC PA-01 Rajshahi RIC 93,676 110,700 118,380 118,380 87,405 107,134 108,927 136,684
12 RCC PA-02 Rajshahi PSTC 97,080 97,195 102,640 102,690 78,661 84,994 90,637 90,003
13 KCC PA-01 Khulna KMSS 94,110 102,707 117,213 119,142 121,593 136,372 136,393 133,268
14 KCC PA-02 Khulna KMSS 106,812 112,010 115,890 115,928 135,958 113,612 131,469 149,093
15 SCC PA-1 Sylhet Shimantik 153,708 156,808 172,069 200,197 142,075 123,914 186,680 242,483
16 BCC PA-01 Barisal Srizony Bd. 59,464 73,632 77,166 77,190 52,410 70,183 84,143 86,168
17 CoCC pa-01 Comilla DAM 134,781 137,938 138,130 138,990 53,414 63,649 111,111 127,201
18 NaCC PA-01 Bandar PSKP&PPS 56,386 71,554 77,943 77,999 47,873 71,872 81,611 107,921
19 RaCC PA-01 Rangpur KMSS 31,521 35,655 35,757 35,763 19,668 32,792 27,096 31,255
20 GaCC PA-01 Joydebpur PSTC 40,773 42,513 43,175 43,178 19,827 36,380 51,280 52,918
21 GaCC PA-02 Tongi PSKP&PPS 45,378 47,327 48,175 50,367 51,197 51,116 56,113 55,477
Average of OCC >>>>>> 83,063 89,822 95,140 98,166 73,644 81,093 96,860 110,225
22 SM PA-01 Sirajganj ESDO 46,481 47,787 50,462 51,035 51,162 39,657 55,170 53,114
23 KstM PA-01 Kushtia Srizony Bd. 39,232 40,812 40,876 40,876 36,442 28,618 25,659 26,059
24 KsM PA-01 Kishoreganj NariMaitree 44,767 44,883 46,093 46,113 37,259 46,351 50,164 53,422
25 GM PA-01 Gopalgonj G.Paurashava 34,507 36,086 36,086 36,086 9,769 11,901 9,117 10,109
Average of Municipality>>>> 41,247 42,392 43,379 43,528 33,658 31,632 35,028 35,676
Total Targets and Achievements 1,877,822 2,055,496 2,177,614 2,252,144 1,873,669 2,014,465 2,297,075 2,493,144
Overall Average 75,113 82,220 87,105 90,086 74,947 80,579 91,883 99,726

Table 4.2: Essential PHC services used in assessment of Performances of

PA NGOs in ISI Monitoring
Essential PHC Services used in ISI Surveys Essential PHC Services used in ISI Surveys
1 Number of NVD 10 No. of couples visited for new method who returned
2 Number of C/S 11 Number of measles rubella vaccinations provided
3 Number of PNC 12 Number of ANC visits
4 No. of couples accepting longer acting method 13 Number of diagnostic services delivered
5 Number of RTI/STI 14 Number of clinics held
6 Number of adolescent Visits 15 Number of clients visited
7 Number of child <5 visits 16 Number of clients visited for family planning methods
8 Number of Diagnostic services 17 Number of health education sessions held in community
9 Number of new couples accepting modern method

Appendix 5
Table 5.1: Poverty Score of all PA area for ISI Survey Round I, II, III and IV
Performance of % Poverty Scores
PA Area Score Level
Group 1: Dhaka (S), Dhaka Ultra Poor Range Non-Poor Ultra Poor Range Non-Poor Ultra Poor Range Non-Poor Ultra Poor Range Non-Poor
(N) Barisal, Gazipur & PoorRange (21-30) Range (30+) PoorRange (21-30) Range (30+) PoorRange (21-30) Range (30+) PoorRange (21-30) Range (30+)
Narayanganj CC (0-20) (0-20) (0-20) (0-20)
N % N % N % N % N % N % N % N % N % N % N % N %
1 DSCC PA-01(6) 6 31.58 13 68.42 0 0.00 15 78.95 4 21.05 0 0.00 9 47.37 10 52.63 0 0.00 8 42.11 11 57.89 0 0.00
2 DSCC PA-02(6) 8 42.11 11 57.89 0 0.00 10 52.63 9 47.37 0 0.00 13 68.42 6 31.58 0 0.00 8 42.11 11 57.89 0 0.00
3 DSCC PA-03(6) 8 42.11 11 57.89 0 0.00 8 42.11 11 57.89 0 0.00 8 42.11 10 52.63 1 5.26 9 47.37 10 52.63 0 0.00
4 DSCC PA-04(6) 5 26.32 12 63.16 2 10.53 4 21.05 15 78.95 0 0.00 9 47.37 10 52.63 0 0.00 19 100.00 0 0.00 0 0.00
5 DSCC PA-05(4) 8 42.11 11 57.89 0 0.00 6 31.58 13 68.42 0 0.00 17 89.47 1 5.26 1 5.26 16 84.21 1 5.26 2 10.53
6 DNCC PA-01(5) 10 52.63 9 47.37 0 0.00 9 47.37 10 52.63 0 0.00 16 84.21 3 15.79 0 0.00 17 89.47 2 10.53 0 0.00
7 DNCC PA-02(7) 5 26.32 13 68.42 1 5.26 10 52.63 9 47.37 0 0.00 10 52.63 9 47.37 0 0.00 6 31.58 12 63.16 1 5.26
8 DNCC PA-03(5) 5 26.32 14 73.68 0 0.00 6 31.58 12 63.16 1 5.26 12 63.16 7 36.84 0 0.00 5 26.32 14 73.68 0 0.00
9 DNCC PA-04(4) 14 73.68 5 26.32 0 0.00 5 26.32 14 73.68 0 0.00 8 42.11 11 57.89 0 0.00 4 21.05 15 78.95 0 0.00
10 DNCC PA-05(6) 12 63.16 7 36.84 0 0.00 9 47.37 9 47.37 1 5.26 9 47.37 10 52.63 0 0.00 17 89.47 1 5.26 1 5.26
11 BCC PA-01(4) 19 100.00 0 0.00 0 0.00 19 100.00 0 0.00 0 0.00 14 73.68 5 26.32 0 0.00 17 89.47 2 10.53 0 0.00
12 NaCC PA-01(3) 13 68.42 6 31.58 0 0.00 15 78.95 4 21.05 0 0.00 18 94.74 1 5.26 0 0.00 14 73.68 5 26.32 0 0.00
13 GaCC PA-01(2) 13 68.42 6 31.58 0 0.00 13 68.42 6 31.58 0 0.00 13 68.42 6 31.58 0 0.00 11 57.89 8 42.11 0 0.00
14 GaCC PA-02{2) 6 31.58 13 68.42 0 0.00 7 36.84 12 63.16 0 0.00 3 15.79 16 84.21 0 0.00 9 47.37 10 52.63 0 0.00
Group 1 Poverty Score Level 132 49.62 131 49.25 3 1.13 136 51.13 128 48.12 2 0.75 159 60.23 105 39.77 2 0.76 160 60.15 102 38.35 4 1.50
Group 2:Other City Corp. Range (0-15) Range(16-25) Range (25 +) Range (0-15) Range(16-25) Range (25 +) Range (0-15) Range(16-25) Range (25 +) Range (0-15) Range(16-25) Range (25 +)
1 RCC PA-01(5) 14 73.68 5 26.32 0 0.00 14 73.68 5 26.32 0 0.00 14 73.68 4 21.05 1 5.26 15 78.95 4 21.05 0 0.00
2 RCC PA-02(5) 12 63.16 7 36.84 0 0.00 16 84.21 3 15.79 0 0.00 16 84.21 2 10.53 1 5.26 16 84.21 3 15.79 0 0.00
3 KCC PA-01(6) 15 78.95 4 21.05 0 0.00 14 73.68 5 26.32 0 0.00 14 73.68 5 26.32 0 0.00 11 57.89 8 42.11 0 0.00
4 KCC PA-02(6) 9 47.37 9 47.37 1 5.26 12 63.16 7 36.84 0 0.00 12 63.16 7 36.84 0 0.00 10 52.63 8 42.11 1 5.26
5 SCC PA-01(7) 2 10.53 15 78.95 2 10.53 5 26.32 13 68.42 1 5.26 18 94.74 1 5.26 0 0.00 8 42.11 10 52.63 1 5.26
6 CoCC PA-01(6) 9 47.37 10 52.63 0 0.00 14 73.68 5 26.32 0 0.00 18 94.74 1 5.26 0 0.00 5 26.32 14 73.68 0 0.00
7 RaCC PA-01(3) 18 94.74 1 5.26 0 0.00 17 89.47 2 10.53 0 0.00 16 84.21 3 15.79 0 0.00 12 63.16 7 36.84 0 0.00
Group 3: Municipalities Range (0-10) Range(11-20) Range (20 +) Range (0-10) Range(11-20) Range (20 +) Range (0-10) Range(11-20) Range (20 +) Range (0-10) Range(11-20) Range (20 +)
1 SM PA-01(3) 6 31.58 13 68.42 0 0.00 5 26.32 14 73.68 0 0.00 7 36.84 12 63.16 0 0.00 3 15.79 14 73.68 2 10.53
2 KstM PA-01(2) 0 0.00 19 100.00 0 0.00 2 10.53 15 78.95 2 10.53 3 15.79 15 78.95 1 5.26 9 47.37 10 52.63 0 0.00
3 KsM PA-01(2) 3 15.79 15 78.95 1 5.26 0 0.00 17 89.47 2 10.53 6 31.58 11 57.89 2 10.53 7 36.84 12 63.16 0 0.00
4 GM PA-01(2) 1 5.26 18 94.74 0 0.00 1 5.26 17 89.47 1 5.26 1 5.26 14 73.68 4 21.05 4 21.05 14 73.68 1 5.26
All 25 PA Poverty Score Level 221 46.53 247 52.00 7 1.47 236 49.69 231 48.63 8 1.68 284 59.80 180 37.90 11 2.30 260 54.74 206 43.37 9 1.89
Note: Assessment carried out following ISI Tool Guidelines

Appendix 6
OVERALL PERFORMANCE OF THE PAs/PA NGOS
Table 6.1: Score of PAHQ on Quality and Management for ISI Survey Round I, II, III and IV

Total Total Total Total
Partnership Areas Name of PA Qlty Mngt Qlty Mngt Qlty Mngt Qlty Mngt
Score Score Score Score
50 80 130 % 50 80 130 % 50 80 130 % 50 80 130 %
1 DSCC PA-1 PSTC 40 60 100 77 48 80 128 98 48 80 128 98 48 60 108 83
2 DSCC PA-2 KMSS 36 80 116 89 50 60 110 85 48 80 128 98 48 80 128 98
3 DSCC PA-3 BAPSA 35 80 115 88 40 80 120 92 50 80 130 100 50 80 130 100
4 DSCC PA-4 PSTC 40 60 100 77 46 60 106 82 33 80 113 87 48 60 108 83
5 DSCC PA-5 PSTC 39 60 99 76 50 60 110 85 48 60 108 83 48 60 108 83
6 DNCC PA - 1 NariMaitree 40 80 120 92 50 80 130 100 50 80 130 100 50 80 130 100
7 DNCC PA - 2 NariMaitree 40 80 120 92 46 60 106 82 46 80 126 97 46 80 126 97
8 DNCC PA - 3 UTPS 40 80 120 92 40 80 120 92 46 80 126 97 46 80 126 97
9 DNCC PA - 4 KMSS 40 80 120 92 46 80 126 97 46 80 126 97 46 80 126 97
10 DNCC PA - 5 DAM 37 80 117 90 40 80 120 92 46 80 126 97 46 80 126 97
Average of DCC >>>>>> 39 74 113 87 46 72 118 91 46 78 124 95 48 74 122 94
11 RCC PA - 1 RIC 40 60 100 77 46 60 106 82 50 60 110 85 50 60 110 85
12 RCC PA - 2 PSTC 40 60 100 77 48 60 108 83 50 60 110 85 50 60 110 85
13 KCC PA - 1 KMSS 40 80 120 92 50 80 130 100 50 80 130 100 50 70 120 92
14 KCC PA - 2 KMSS 40 60 100 77 50 80 130 100 50 80 130 100 50 80 130 100
15 SCC PA - 1 Shimantik 40 50 90 69 46 80 126 97 50 80 130 100 50 80 130 100
16 BCC PA - 1 Srizony BD 40 70 110 85 50 80 130 100 46 80 126 97 46 80 126 97
17 CoCC PA - 1 DAM 40 80 120 92 50 80 130 100 48 80 128 98 43 80 123 95
18 NaCC PA - 1 PSKP & PPS 40 60 100 77 50 50 100 77 48 60 108 83 48 60 108 83
19 RaCC PA - 1 KMSS 40 50 90 69 43 60 103 79 40 60 100 77 40 40 80 62
20 GaCC PA - 1 PSTC 25 60 85 65 20 60 80 62 46 60 106 82 44 60 104 80
21 GaCC PA - 2 PSKP & PPS 40 60 100 77 40 60 100 77 46 60 106 82 46 70 116 89
Average of OCC >>>>>> 39 63 101 78 45 68 113 87 48 69 117 90 47 67 114 88
22 SM PA – 1 ESDO 40 60 100 77 46 60 106 82 48 60 108 83 48 60 108 83
23 KstM PA - 1 Srizony BD 32 80 112 86 50 80 130 100 48 60 108 83 48 60 108 83
24 KsM PA - 1 NariMaitree 40 80 120 92 40 80 120 92 48 80 128 98 48 80 128 98
25 GM PA – 1 GM 10 50 60 46 35 60 95 73 46 60 106 82 46 50 96 74
Average of Municipality >> 31 68 98 75 43 70 113 87 48 65 113 87 48 63 110 85
Project Average>>>>>>> 37 68 105 81 45 70 115 88 47 72 119 92 47 69 117 90

Table 6.2: Performance Score of CRHCC on Quality, Quantity and Management of

Services for ISI Survey Round I, II, III and IV

Total Total Total Total
Partnership Qlty Qnty Mngt Qlty Qnty Mngt Qlty Qnty Mngt Qlty Qnty Mngt
Name of PA Score Score Score Score
Areas
% % 25 % %
100 100 50 250 100 100 50 250 100 100 50 100 100 50 250
0
1 DSCC PA-1 PSTC 100 97 50 247 99 99 82 50 231 92 99 96 50 245 98 99 83 50 232 93
2 DSCC PA-2 KMSS 95 10 37 142 57 95 55 43 193 77 100 75 45 220 88 100 70 45 215 86
3 DSCC PA-3 BAPSA 98 100 50 248 99 100 100 50 250 100 98 100 50 248 99 99 100 50 249 100
4 DSCC PA-4 PSTC 100 77 40 217 87 99 80 50 229 92 99 93 50 242 97 100 100 50 250 100
5 DSCC PA-5 PSTC 97 55 45 197 79 100 33 50 183 73 100 73 50 223 89 100 70 50 220 88
6 DNCC PA - 1 NariMaitree 100 85 44 229 92 100 100 50 250 100 100 100 50 250 100 100 100 50 250 100
8 DNCC PA - 3 UTPS 97 54 45 196 78 100 65 50 215 86 98 58 44 200 80 98 84 50 232 93
9 DNCC PA - 4 KMSS 77 62 45 184 74 93 74 50 217 87 94 100 49 243 97 99 100 50 249 100
10 DNCC PA - 5 DAM 93 93 45 231 92 95 100 50 245 98 100 100 50 250 100 100 100 50 250 100
Average of DCC >>>>>> 96 73 45 213 85 98 78 49 225 90 98 90 48 236 94 100 90 49 238 95
11 RCC PA - 1 RIC 98 27 37 162 65 97 54 45 196 78 98 85 40 223 89 100 85 50 235 94
12 RCC PA - 2 PSTC 98 25 45 168 67 98 15 50 163 65 99 53 45 197 79 94 30 40 164 66
13 KCC PA - 1 KMSS 94 82 42 218 87 100 85 50 235 94 100 95 50 245 98 100 70 50 220 88
14 KCC PA - 2 KMSS 96 76 44 216 86 98 64 47 209 84 98 90 45 233 93 98 100 50 248 99
15 SCC PA - 1 Shimantik 94 83 49 226 90 100 89 50 239 96 100 87 50 237 95 100 94 50 244 98
16 BCC PA - 1 Srizony BD 87 16 39 142 57 76 46 45 167 67 100 100 49 249 100 95 100 50 245 98
17 CoCC PA - 1 DAM 97 74 37 208 83 95 81 50 226 90 98 88 47 233 93 98 100 50 248 99
18 NaCC PA - 1 PSKP & PPS 84 45 32 161 64 90 64 40 194 78 98 72 45 215 86 98 82 45 225 90
19 RaCC PA - 1 KMSS 90 25 33 148 59 92 60 45 197 79 99 41 35 175 70 100 53 40 193 77
20 GaCC PA - 1 PSTC 75 0 35 110 44 95 75 40 210 84 99 75 40 214 86 99 100 40 239 96
21 GaCC PA - 2 PSKP & PPS 97 85 45 227 91 100 98 45 243 97 87 100 49 236 94 97 100 50 247 99
Average of OCC >>>>>> 92 49 40 181 72 95 66 46 207 83 98 81 45 223 89 98 83 47 228 91
22 SM PA – 1 ESDO 100 25 36 161 64 96 45 37 178 71 99 60 40 199 80 99 47 45 191 76
23 KstM PA - 1 Srizony BD 88 1 37 126 50 88 77 40 205 82 100 24 50 174 70 80 35 33 148 59
24 KsM PA - 1 NariMaitree 87 72 40 199 80 100 75 45 220 88 98 90 45 233 93 99 55 40 194 78
25 GM PA – 1 GM 98 0 36 134 54 80 15 30 125 50 78 0 29 107 43 99 6 35 140 56
Average of Municipality>>> 93 25 37 155 62 91 53 38 182 73 94 44 41 178 72 94 36 38 168 67
Project Average >>>>>>> 94 55 41 190 76 95 69 46 210 84 97 78 46 221 89 98 78 46 222 89

Table 6.3: Average Scores of PHCCs on Quality, Quantity and Management of

Services for ISI Survey Round I, II, III and IV

Partnership Total Total Total Total
Name of PA Qlty Qnty Mngt Qlty Qnty Mngt Qlty Qnty Mngt Qlty Qnty Mngt
Areas Score Score Score Score
150 250 50 450 % 150 250 50 450 % 150 250 50 450 % 150 250 50 450 %
1 DSCC PA-1 PSTC 105 126 40 271 60 149 139 50 338 75 150 50 50 250 56 150 250 50 450 100
2 DSCC PA-2 KMSS 126 164 32 322 72 117 117 37 271 60 150 174 40 364 81 150 224 45 419 93
3 DSCC PA-3 BAPSA 144 250 46 440 98 150 247 50 447 99 143 250 50 443 98 149 250 50 449 100
4 DSCC PA-4 PSTC 150 160 41 351 78 150 212 48 410 91 119 192 45 356 79 149 200 50 399 89
5 DSCC PA-5 PSTC 148 230 45 423 94 145 226 50 421 94 150 250 50 450 100 150 250 50 450 100
8 DNCC PA - 3 UTPS 141 203 48 392 87 147 226 49 422 94 150 238 50 438 97 150 250 50 450 100
9 DNCC PA - 4 KMSS 122 121 34 277 62 147 90 50 287 64 145 250 45 440 98 137 200 50 387 86
10 DNCC PA - 5 DAM 119 231 47 397 88 150 210 47 407 90 149 250 50 449 100 150 250 50 450 100
Average of DCC >>>>>> 135 196 42 374 83 145 190 48 383 85 145 215 48 409 91 148 237 50 435 97
11 RCC PA - 1 RIC 127 110 38 275 61 149 160 50 359 80 147 150 50 347 77 150 250 50 450 100
12 RCC PA - 2 PSTC 140 96 37 273 61 148 140 48 336 75 149 186 50 385 86 149 144 50 343 76
13 KCC PA - 1 KMSS 139 192 40 371 82 149 169 49 367 82 148 250 50 448 100 148 250 44 442 98
14 KCC PA - 2 KMSS 128 234 38 400 89 144 181 40 365 81 147 150 45 342 76 147 250 50 447 99
15 SCC PA - 1 Shimantik 134 31 49 214 48 147 50 49 246 55 150 66 50 266 59 150 250 50 450 100
16 BCC PA - 1 Srizony BD 119 174 44 337 75 85 130 46 261 58 149 250 50 449 100 149 250 50 449 100
17 CoCC PA - 1 DAM 82 49 37 168 37 142 119 46 307 68 147 84 45 276 61 147 220 50 417 93
18 NaCC PA - 1 PSKP & PPS 85 46 32 163 36 147 159 50 356 79 149 200 50 399 89 149 250 50 449 100
19 RaCC PA - 1 KMSS 102 84 34 220 49 105 170 39 314 70 150 112 40 302 67 150 100 35 285 63
20 GaCC PA - 1 PSTC 103 39 35 177 39 150 175 50 375 83 137 212 50 399 89 144 250 50 444 99
21 GaCC PA - 2 PSKP & PPS 120 250 38 408 91 136 202 48 386 86 147 250 50 447 99 147 200 50 397 88
Average of OCC >>>>>> 116 119 38 273 61 137 150 47 334 74 147 174 48 369 82 148 219 48 416 92
22 SM PA – 1 ESDO 121 64 40 225 50 123 150 46 319 71 150 70 50 270 60 150 90 50 290 64
25 GM PA – 1 GM 133 0 28 161 36 45 51 26 122 27 78 50 30 158 35 92 50 35 177 39
Average of Municipality>>> 129 99 36 264 59 103 148 40 290 65 129 108 43 279 62 135 101 44 280 62
Project Average >>>>>>> 126 146 40 312 69 134 166 46 346 77 144 180 47 371 82 146 208 48 402 89

Table 6.4: Average Scores of Satellite Clinics on Quality, Quantity and Management for
ISI Survey Round I, II, III and IV

Partnership Total Total Total Total
Name of PA Qlty Qnty Mngt Qlty Qnty Mngt Qlty Qnty Mngt Qlty Qnty Mngt
Areas Score Score Score Score
50 100 20 170 % 50 100 20 170 % 50 100 20 170 % 50 100 20 170 %
1 DSCC PA-1 PSTC 46 83 20 149 88 50 88 20 158 93 50 92 20 162 95 50 100 20 170 100
2 DSCC PA-2 KMSS 43 90 20 153 90 50 55 20 125 74 50 92 20 162 95 50 65 20 135 79
3 DSCC PA-3 BAPSA 47 100 20 167 98 50 88 20 158 93 50 100 20 170 100 50 100 20 170 100
4 DSCC PA-4 PSTC 50 84 20 154 91 50 93 20 163 96 48 90 20 158 93 50 96 20 166 98
5 DSCC PA-5 PSTC 50 99 20 169 99 49 77 20 146 86 49 100 20 169 99 50 100 20 170 100
8 DNCC PA - 3 UTPS 40 66 20 126 74 50 90 20 160 94 50 84 20 154 91 50 84 20 154 91
9 DNCC PA - 4 KMSS 34 74 20 128 75 42 50 20 112 66 43 100 20 163 96 50 100 20 170 100
10 DNCC PA - 5 DAM 39 100 20 159 94 50 93 20 163 96 50 100 20 170 100 50 100 20 170 100
Average of DCC >>>>>> 44 88 20 152 90 49 77 20 146 86 49 96 20 165 97 50 95 20 165 97
11 RCC PA - 1 RIC 40 49 20 109 64 50 74 20 144 85 50 100 20 170 100 50 100 20 170 100
12 RCC PA - 2 PSTC 40 38 20 98 58 50 52 20 122 72 50 46 20 116 68 50 65 20 135 79
13 KCC PA - 1 KMSS 43 68 20 131 77 50 91 20 161 95 50 98 20 168 99 50 25 20 95 56
14 KCC PA - 2 KMSS 45 83 18 146 86 50 74 20 144 85 50 82 20 152 89 50 100 20 170 100
15 SCC PA - 1 Shimantik 41 78 20 139 82 50 70 20 140 82 50 100 20 170 100 50 100 20 170 100
16 BCC PA - 1 Srizony BD 48 50 20 118 69 50 41 20 111 65 50 100 20 170 100 50 100 20 170 100
17 CoCC PA - 1 DAM 35 8 15 58 34 50 4 20 74 44 50 71 20 141 83 40 50 20 110 65
18 NaCC PA - 1 PSKP & PPS 42 50 13 105 62 50 80 20 150 88 50 90 20 160 94 50 100 20 170 100
19 RaCC PA - 1 KMSS 50 19 20 89 52 40 58 20 118 69 50 0 20 70 41 50 69 20 139 82
20 GaCC PA - 1 PSTC 40 10 20 70 41 40 50 20 110 65 45 78 20 143 84 50 100 20 170 100
21 GaCC PA - 2 PSKP & PPS 48 95 20 163 96 48 56 20 124 73 48 100 20 168 99 50 100 20 170 100
Average of OCC >>>>>> 43 50 19 111 66 48 59 20 127 75 49 79 20 148 87 49 83 20 152 89
22 SM PA – 1 ESDO 50 67 17 134 79 50 47 20 117 69 50 92 20 162 95 50 94 20 164 96
25 GM PA – 1 GM 45 50 15 110 65 43 13 20 76 45 48 0 20 68 40 50 0 20 70 41
Average of Municipality>> 68 18 133 78 48 58 20 126 74 49 60 20 129 76 50 59 20 129 76 68
Project Average >>>>>>> 44 68 19 131 77 48 66 20 135 79 49 82 20 152 89 50 84 20 153 90

Table 6.5: Total Scores obtained by PA NGOs for ISI Survey Round I, II, III and IV

Sate Tota Sate Tota Sate Tota Sate Tota
Partnership PAH CRH PHC llite l PAH CRH PHC llite l PAH CRH PHC llite l PAH CRH PHC llite l
Name of PA
Areas Q CC C Clini Scor Q CC C Clini Scor Q CC C Clini Scor Q CC C Clini Scor
c e c e c e c e
130 250 450 170 1000 130 250 450 170 1000 130 250 450 170 1000 130 250 450 170 1000
1 DSCC PA-1 PSTC 100 247 271 149 767 128 231 338 158 855 128 245 250 162 785 108 232 450 170 960
2 DSCC PA-2 KMSS 116 142 322 153 733 110 193 271 125 699 128 220 364 162 874 128 215 419 135 897
3 DSCC PA-3 BAPSA 115 248 440 167 970 120 250 447 158 975 130 248 443 170 991 130 249 449 170 998
4 DSCC PA-4 PSTC 100 217 351 154 822 106 229 410 163 908 113 242 356 158 869 108 250 399 166 923
5 DSCC PA-5 PSTC 99 197 423 169 888 110 183 421 146 860 108 223 450 169 950 108 220 450 170 948
6 DNCC PA-1 NariMaitree 120 229 447 170 966 130 250 450 157 987 130 250 450 170 1000 130 250 450 170 1000
7 DNCC PA-2 NariMaitree 120 242 415 147 924 106 238 374 122 840 126 240 448 169 983 126 234 448 170 978
8 DNCC PA-3 UTPS 120 196 392 126 834 120 215 422 160 917 126 200 438 154 918 126 232 450 154 962
9 DNCC PA-4 KMSS 120 184 277 128 709 126 217 287 112 742 126 243 440 163 972 126 249 387 170 932
10 DNCC PA-5 DAM 117 231 397 159 904 120 245 407 163 935 126 250 449 170 995 126 250 450 170 996
Average of DCC >>>>> 113 213 374 152 852 118 225 383 146 872 124 236 409 165 934 122 238 435 165 959
11 RCC PA-1 RIC 100 162 275 109 646 106 196 359 144 805 110 223 347 170 850 110 235 450 170 965
12 RCC PA-2 PSTC 100 168 273 98 639 108 163 336 122 729 110 197 385 116 808 110 164 343 135 752
13 KCC PA-1 KMSS 120 218 371 131 840 130 235 367 161 893 130 245 448 168 991 120 220 442 95 877
14 KCC PA-2 KMSS 100 216 400 146 862 130 209 365 144 848 130 233 342 152 857 130 248 447 170 995
15 SCC PA-1 Shimantik 90 226 214 139 669 126 239 246 140 751 130 237 266 170 803 130 244 450 170 994
16 BCC PA-1 Srizony BD 110 142 337 118 707 130 167 261 111 669 126 249 449 170 994 126 245 449 170 990
17 CoCC PA-1 DAM 120 208 168 58 554 130 226 307 74 737 128 233 276 141 778 123 248 417 110 898
18 NaCC PA-1 PSKP &PPS 100 161 163 105 529 100 194 356 150 800 108 215 399 160 882 108 225 449 170 952
19 RaCC PA-1 KMSS 90 148 220 89 547 103 197 314 118 732 100 175 302 70 647 80 193 285 139 697
20 GaCC PA-1 PSTC 85 110 177 70 442 80 210 375 110 775 106 214 399 143 862 104 239 444 170 957
21 GaCC PA-2 PSKP &PPS 100 227 408 163 898 100 243 386 124 853 106 236 447 168 957 116 247 397 170 930
Average of OCC >>>>> 101 181 273 111 667 113 207 334 127 781 117 223 369 148 857 114 228 416 152 910
22 SM PA-1 ESDO 100 161 225 134 620 106 178 319 117 720 108 199 270 162 739 108 191 290 164 753
23 KstM PA-1 Srizony BD 112 126 308 135 681 130 205 302 142 779 108 174 249 116 647 108 148 253 120 629
24 KsM PA-1 NariMaitree 120 199 361 153 833 120 220 418 169 927 128 233 439 169 969 128 194 399 160 881
25 GM PA-1 GM 60 134 161 110 465 95 125 122 76 418 106 107 158 68 439 96 140 177 70 483
Average of Municipality>> 98 155 264 133 650 113 182 290 126 711 113 178 279 129 699 110 168 280 129 687
Average Score per PA
105 190 312 131 738 115 210 346 135 806 119 221 371 152 862 117 222 402 153 894
NGO – Project
Overall Performance
81 76 69 77 74 88 84 77 79 81 92 88 82 89 86 89 89 89 90 90
Achievement (%)

Table 6.6: Comparison of Overall Average Scores of PA NGOs among Round I, II, III and IV
City Corporations/ Overall average score obtained out of 1000

Municipalities PAs PA NGOs
ISI I ISI II ISI III ISI IV Average
1 Dhaka South City Corporation DSCC PA-1 PSTC 767 855 785 960 842
2 Dhaka South City Corporation DSCC PA-2 KMSS 733 699 874 897 801
3 Dhaka South City Corporation DSCC PA-3 BAPSA 970 975 991 998 984
6 Dhaka North City Corporation DNCC PA – 1 NariMaitree 966 987 1000 1000 988
7 Dhaka North City Corporation DNCC PA – 2 NariMaitree 924 840 983 978 931
8 Dhaka North City Corporation DNCC PA – 3 UTPS 834 917 918 962 908
9 Dhaka North City Corporation DNCC PA – 4 KMSS 709 742 972 932 839
10 Dhaka North City Corporation DNCC PA – 5 DAM 904 935 995 996 958
Average of DCC >>>>> 852 872 934 959 904
11 Rajshahi City Corporation RCC PA – 1 RIC 646 805 850 965 817
12 Rajshahi City Corporation RCC PA – 2 PSTC 639 729 808 752 732
13 Khulna City Corporation KCC PA – 1 KMSS 840 893 991 877 900
14 Khulna City Corporation KCC PA - 2 KMSS 862 848 857 995 891
15 Sylhet City Corporation SCC PA - 1 Shimantik 669 751 803 994 804
16 Barisal City Corporation BCC PA - 1 Srizony BD 707 669 994 990 840
17 Comilla City Corporation CoCC PA - 1 DAM 554 737 778 898 742
18 Narayangonj City Corporation NaCC PA - 1 PSKP & PPS 529 800 882 952 791
19 Rangpur City Corporation RaCC PA - 1 KMSS 547 732 647 697 656
20 Gazipur City Corporation GaCC PA - 1 PSTC 442 775 862 957 759
21 Gazipur City Corporation GaCC PA - 2 PSKP & PPS 898 853 957 930 910
Average of OCC >>>>>> 667 781 857 910 804
22 Sirajgong Municipality SM PA – 1 ESDO 620 720 739 753 708
23 Kushtia Municipality KstM PA - 1 Srizony BD 681 779 647 629 684
24 Kishoregonj Municipality KsM PA - 1 NariMaitree 833 927 969 881 903
25 Gopalgonj Municipality GM PA – 1 GM 465 418 439 483 451
Average of Municipality >>>> 650 711 699 687 687
Average Score per PA NGO – Project 738 806 862 894 825
Overall Performance Achievement (%) 74 81 86 90 83

ISI Monitoring Survey - Round IV

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ISI Monitoring Survey - Round IV

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Urban Primary Health Care Services Delivery Project

Local Government Division

Government of the People’s Republic of Bangladesh

ISI Monitoring Survey Round IV

A Trend Analysis of Findings of ISI Surveys

Eusuf and Associates

ADB Asian Development Bank

Eusuf and Associates Page i

PA NGO Partnership Area Non-government Organization

Eusuf and Associates Page ii

1. Local Government Division (LGD), Ministry of Local Government, Rural

3. The present monitoring report includes monitoring findings of ISI-IV (Jan-Jun

4. In the four ISI monitoring studies, performance of all 25 Partnership Area

5. In an analysis of the target and achievements of 17 selected important services

Eusuf and Associates Page iii

8. The comparison of the levels of achievements of service delivered in PAs

9. In overall, it is found that improvement of performance of PAs or PA NGOs

12. It is also recommended that performance-based monitoring and incentive

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A. The Project – Urban Primary Health Care Services Delivery Project

1. The Local Government Division (LGD)of the Ministry of Local Government,

2. UPHCSDP was designed based on the successful implementation and

4. Objectives of the project are to contribute to achievement of ultimate aim as

5. Scope of the project are to deliver essential services delivery packages

6. UPHCSDP was designed to support government pro poor health policy to

Eusuf and Associates Page 1

UPHCSDP in particular considerably contribute to achieving the Millennium

8. UPHCSDP delivers primary health care services through establishing primary

C. Project Performance Monitoring and Evaluation

9. The project has a provision of conducting Project Performance Monitoring and

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D. Performance Monitoring Using Integrated Supervisory Instrument (ISI)

13. PPM&E firm produced progress reports quarterly and annually to

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B. Methodology and Tools

1. Selection of PAHQ, CRHCC, PHCC and Satellite Clinic

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numbered consecutively for identification and preparation of a comprehensive list of

Table 2.1: Summary of Sample Size

Item(s) Sample Coverage Percent (%)

3. Selection of Sample Pregnant Women and Couples for Verification

C. Focus Group Discussion (FGD)

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method of qualitative research used to obtain community views on community-based

D. Data Processing, Analysis and Presentation of Findings

28. Collected data were checked and entered in a pre-designed computer

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33. Survey team assessed performance of PA-NGOs based on performance of its

34. Distribution of Scores: Performance scoring of PA Headquarters was

35. Survey team assessed management performance on several aspects. Major

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attendance, agenda of meetings, minutes of meetings; number of advocacy activities

Table 3.1: Performance of the PAHQs on Documentation

Table 3.2: Achievement of Income Target by PAHQ

Figure 3.1: % Achievement of Income Target

Achievement 100% and above Achievement less than 100%

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2. Planning and Fund Management

Table 3.3: Management Performance of PAHQ

3. Health Management Information System

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Table 3.4: Services Provided by Major Category by CRHCCs

Figure 3.2: % Achievement of Target Services of CRHCCs