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Records & Reports Maintained at

Sub-Centre and PHC levels


Dr PVM Lakshmi
Associate Professor
PGIMER, Chandigarh

Outline
Background
Registered maintained at primary level
Details of variables entered
Process of gathering information
Issues in recording variables
Solutions

Background
Health record keeping is necessary for
assessing the health situation in the subcentre area
It help in decision making; includes
managerial aspects such as planning,
organising and control of health care
facilities at the local level

Record Maintenance
List of minimum number of registers to be
maintained at sub-centre level which keep
the record of services provided at the subcentre

Registered maintained at
primary level
Sub Centre
Survey & Eligible couple
register
ANC register
Immunization register
Birth register
Death register
Stock register
Family planning register

PHC
Drug Register
Stock Register
TB Register
Malaria Register
Birth and death register
OPD register
Labour room register
Lab register

Survey & Eligible Couple Register

House No.
Area
Eligible couple
Name of family members
Total no. of family members
Age
Sex
Relationship
Occupation
Marital Status
Pregnant

Post menopausal
Sterility
Lactating
Caste
BPL Family Planning
No. of children
Infection diseases
Immunization
Vitamin A
Remarks

Issues in recording variables


Address not recorded properly; sometimes
difficult to trace; sometime beneficiaries
dont have address proof to attach
Age is not properly enquired and arbitrarily
entered
Pregnancy status is not revealed in early
months; difficult for early registration

Issues in recording variables


If there is a female child, there is also delay
in registration for next pregnancy
Lactating history, specially duration and
nature of breastfeeding not entered
Entry of infectious disease like ARI, TB,
Diarrhoea are not entered correctly or timely
Immunization records are not tracked for
dropouts

Solutions
Address issues can be discussed with Sarpanch
of the village for possible solution for house
identification
ANMs should be trained and oriented at regular
intervals in collecting appropriate information
regarding age, lactating history, Immunization
history
ANM should get information from ASHAs about
early pregnancies and motivate for early
registration

ANC Register

Name
Husband name
Address
Caste
Age at marriage
LMP
EDD
First, second, third visit
If JSY registered
HB
BP
Anaemia

Weight
Height of women
Fundal height
FHS
General conditions
Odema on feet
Place of delivery
Sex of baby
Baby weight
Post natal visit
Referral

Issues in recording variables


Women are not registered in first trimester
High risk is not marked many times
FHS, Fundal Height are kept as blank and
not even examined
Post natal visit are not recorded
Some time instrument are not present
On many sub centre no height measuring
scale available

Issues in recording variables


BP entered without measuring, so high
risk case like preeclampsia are missed
Discrepancy of gestational age by LMP &
fundal height should be referred to
medical officer
Baby weight not recorded properly and
filled as approximately
Length of baby not recorded

Solution
Supply of required infrastucture like BP
apparatus, weighing scale, height scale,
hb meter, etc..
Regular supervision of registers and more
emphasis to be given over baby weight
measurements, postnatal visits

Solution
Training should be given to ANMs
regarding fundal height and FHS
measurement
High risk pregnancy can me marked in
separate column and prompt referral to
medical officer to be done. Cross checking
of number of high risk cases and number of
cases referred, can be done medical
officers periodically

Immunization Register

BCG and OPV 0 dose


OPV 1st, 2nd , 3rd dose Booster
DPT 1st , 2nd , 3rd dose Booster
Hepatitis B 1st , 2nd , 3rd dose
Measles 1st, 2nd
TT 10 year and 16 year

Issues in recording variables


Details of BCG vaccination are not known
to many mothers as they delivery in
different place or their mothers home
Date of next vaccination and details for the
diseases for which vaccination is given
were not clearly explained to mother

Birth & Death Registers


Birth Register

Death Register

Name
Address
Place of Death
Sex
Age
Cause of Death
Remarks

Name
Village Name
Date of Birth
Place of birth
JSY
No. of children

Issues in recording variables


Birth: Some time name of the baby has
been changed which leads a problem later
Death: cause of deaths were not properly
enquired and entered. Place and age
were also not proper in most data

Solution
Birth: change of name should be
mentioned
Death: ANM should visit the home of dead
person and should do the verbal autopsy
to find the main cause; age as recorded in
documents like voter card/adhar card or
bank account should be noted

Stock Register
Problems

Stock register not


maintained on regular
basis

Solutions
Entry should be done on
the same day when they
received medicine
There should be sub
stock register for daily
consumption

Family Planning Register

Name
Husband Name
Age
No. of children
Method used
Name of motivators
Complication

Issues in recording variables


Couple taking contraceptives from private
providers do not tell which method they
are using when asked by ANM
Monthly record are not maintained by
ANM

Solution
ANM or ASHA should gain the confidence
of couples when they talk so that they
can share about contraceptive uses

Common Issues
in recording variables
Duplication of data in many registers
Burden of writing works and register
maintenance is time consuming for ANMs
Lack of adequate manpower

Other Register
1. Growth Monitoring
2. Communicable diseases/Epidemic
Register/ Register for Syndromic
Surveillance
3. Passive surveillance register for malaria
cases

Other Register
4. Register for water quality and sanitation
5. Minor ailments Register
6. Records/register as per various National
Health Programme guidelines
(NLEP, RNTCP, NVBDCP, etc. )

Health Management Information System


(HMIS) Reporting Format for Sub-Centre
may be Strictly followed for collection,
recording and reporting of Data

IDSP Format
Reporting Format for Syndromic
Surveillance (From S) under
Integrated Disease Surveillance
Project

Issues in recording variables


Cases of fever cases in IDSP are
underreported.
Difficult to identify these cases.

Interactive discussion
Point out the problems you faced

Thank you