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Comprehensive plan to assess operational needs of First Referral Units, Madhya Pradesh
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Subject Area="First Referral Units." Objective="24 hour service."
Details for Reform Option "Comprehensive plan to assess operational needs of First Referral Units, Madhya Pradesh"

Background: Huge operational difficulties including lack of staff, training, equipment, maintenance and poor availability of drugs were preventing First Referral Units (FRUs) in the State, including some district hospitals, from functioning. Action: The State Government, under the European Commission-assisted State Improvement Programme (SIP), drew up an action plan to carry out rapid and comprehensive assessments of the operationalisation needs of FRUs. It developed a operationalisation needs assessment form which took a comprehensive look at the physical condition and location of the FRU, its manpower, their training, the service it provided, other services in the area and the quality and quantity of its existing equipment and supplies. It drew on facility survey assessments previously carried out by UNICEF and UNFPA. The exercise was initiated in July 2004 with the intended goal of making at least one facility fully operational at each block headquarters. The needs assessment was carried out by the Medical Officers/ Post Graduate Medical Officers (MOs/PGMOs) posted in the FRUs, approved by the District Health Societies and further cross checked by officials of the Directorate of Health Services. The MOs/PGMOs were given training on how to fill in the form via the State’s SATCOM system. Once the needs were assessed at headquarters (this took about 4.5 months), moves were made to operationalise the FRUs. This included: (i) Appointment of specialists on contract by the District Health Societies responsible for the facility. (ii) Procurement of equipment (both by district as well as state in line with the delegation of powers, approved specifications of the equipments and guidelines by the Government of India GoI). (iii) Training of MOs in speciality skills and refresher training for PGMOs. (iv) Contracting in of private specialists. (v) Provision of referral transport charges to women belonging to the Below Poverty Line and Scheduled Caste and Scheduled Tribe category needing institutional delivery/emergency obstetric care. (vi) Matching grant to Rogi Kalyan Samitis for effecting planned improvement in service delivery. Results: Implementation of the scheme was initially weak as MOs/PGMOs failed to understand the importance of giving a comprehensive needs assessment and the FRUs had to be visited twice by officials from the Directorate of Health Services before this was finally achieved. However, at the time of writing (May 2005), advertisements had been placed for 137 specialist vacancies in 173 FRUs. In addition INR 2.58 Crores of equipment had been ordered and training had begun of existing MOs/PGMOs in anaesthesia, paediatrics and gynaecology.

Cost INR 24 Crores under EC-supported SIP to carry out the needs assessment and operationalise the FRUs. Site visits of 24 senior health officers to FRUs to carry out needs assessment cost approximately INR 12 lakh.
Place Madhya Pradesh at all district hospitals, civil hospitals, community health centres, Primary Health Centres with the criteria that there will be at least one Comprehensive Emergency Obstetric and Neonatal Care (CEmONC) facility for a population of five lakhs and 50% PHCs to provide Basic Emergency Obstetric and Neonatal Care (BEmONC). Scheme started July 2004.
Time Frame Two to three weeks to draw up the operational needs assessment form. One day orientation of senior health officers in how to use the form. Three hours for them to train MOs/PGMOs (via SATCOM system).

Systematic: Provides a routine and comprehensive way to assess the needs of each FRU. Efficient: When done properly, the needs assessment can be done in just four days. Improved coverage: Will supply an unmet need for CEmONC and BEmONC.


Officer dependent: The MO/PGMO must take the exercise seriously. In this case, many did not and passed the form to the computer operator to fill in – giving poor results. Possibility for misinterpretation: Many of the MOs/PGMOs limited themselves to talking about equipment and did not include building/site condition or manpower. Requires comprehensive training: Senior health officials and the MOs/PGMOs need good training to understand that the form is more than just a questionnaire and requires thought and time.


Needs assessment form. Training of MOs in how to fill it in. Team to assess the forms. Funds to carry out the improvements once the assessment has been done.

Who needs to be consulted

Directorate of Health Services.



Moderate: depends on funding. This scheme has been funded by the EC until December 2005 and then will be included under Reproductive Child Healthcare 2 (RCH2).

Chances of Replication

Judged to be promising.


Practical but needs careful handling. In this case, many MOs/PGMOs did not take the exercise seriously and took more than one month to return the form. The forms were often returned incomplete and the State then had to send a team of senior health officials out to the FRUs to complete them. It then took them two attempts to complete the forms properly. Only one FRU filled in the form correctly on the first attempt.


Submitted By

Clare Kitchen, Research Consultant, ECTA, New Delhi. May 2005.

Status Active
Reference Files
NeedsAssessment Format for FRUs.doc Needs Assessment Form for FRUs
ToRs for the Assessment Team.doc Terms of Reference for the Assessment Team
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