TABLE OF CONTENTS
Table of contents ......................................................................................................................ii List of Acronyms .....................................................................................................................iv Executive Summary .................................................................................................................1 1.1. Major findings ..............................................................................................................1 1.2. Recommendations ........................................................................................................2
1.2.1. 1.2.2. 1.2.3. 1.2.4. Equipment....................................................................................................................................... 2 Management and Logistics ............................................................................................................. 2 Personnel ........................................................................................................................................ 2 Government of Jharkhand............................................................................................................... 3
3.2. Logistics and maintenance: ..........................................................................................5 4. METHODOLOGY............................................................................................................5 4.1. Assessment of site ........................................................................................................6 4.2. Assessment of electrical cold chain..............................................................................6 4.3. Assessment of non-electrical cold chain equipment.....................................................6 4.4. Assessment of power situation and back-up power supply mechanism.......................6 4.5. Assessment of vaccine storage and delivery mechanism .............................................6 4.6. Assessment of sharp waste disposal .............................................................................7 4.7. Assessment of cold chain personnel.............................................................................7 4.8. Assessment of cold chain equipment maintenance ......................................................7 5. Optimum size of cold chain equipment ...........................................................................8 6. SITUATIONAL ASSESSMENt.....................................................................................10 6.1. Cold Chain network....................................................................................................11
6.1.1. 6.1.2. 6.1.3. 6.2.1. 6.2.2. 6.2.3. 6.2.4. 6.2.5. 6.2.6. 6.2.7. Central store site assessment......................................................................................................... 11 District store site assessment ........................................................................................................ 12 PHC site assessment ..................................................................................................................... 13 State-level inventory ..................................................................................................................... 13 State-level CFC and CFC-free equipment inventory .................................................................... 14 State-level age profile of equipment ............................................................................................. 14 District-wise CFC and CFC-free equipment................................................................................. 15 District wise condmned equipment............................................................................................... 18 Stabilizers ..................................................................................................................................... 19 Non-electrical equipment.............................................................................................................. 20
6.3. Power supply ..............................................................................................................24 6.4. Back-up power supply ................................................................................................25 6.5. Wiring and power plugs .............................................................................................27 6.6. Alternative power supply: the solar energy solution ..................................................28
6.6.1. Assessment of dual mode solar system......................................................................................... 28
6.7. Vaccine storage, handling and delivery system..........................................................29 6.8. Repair and Maintenance .............................................................................................30
6.8.1. 6.8.2. 6.8.3. Cold chain equipment operational conditions............................................................................... 31 Maintenance of electrical equipment including generator and stabilizer...................................... 31 Maintenance of non-electrical equipment..................................................................................... 32
ii
Availability of technicians, spares and workshops ....................................................................... 32 Training in cold chain ................................................................................................................... 33 Training in maintenance of solar equipment................................................................................. 33
7. Major observations .........................................................................................................34 7.1. Buildings, equipment and transport............................................................................34 7.2. Management and logistics ..........................................................................................34 7.3. Repair and maintenance..............................................................................................35 7.4. Personnel ....................................................................................................................35 7.5. Record keeping ...........................................................................................................36 8. Recommendations ...........................................................................................................36 8.1. Short-term...................................................................................................................36 8.2. Medium-term ..............................................................................................................37 8.3. Long-term ...................................................................................................................38 9. Conclusion........................................................................................................................38 Appendixes..............................................................................................................................39 A to O ......................................................................................................................................39 Appendix: A Optimum size of cold chain equipment for all the store facilities of state .40 Appendix: B: Analysis of cold chain equipment (Shortage): site wise................................1 Appendix: C Detailed inventory of CFC ILRs in the state .................................................1 Appendix: D detailed inventory of CFC free ILRS site wise ...............................................6 Appendix: E Detailed inventory of CFC DF by site .............................................................9 Appendix: F Detailed inventory of CFC Free DF site wise................................................13 Appendix: G Detailed age profile of refrigeration units site wise .....................................17 (a) age profile of ilrs...............................................................................................................17 (b) age profile of df(s) ............................................................................................................22 Appendix: H status of power supply situation ....................................................................28 Appendix: H status of power supply situation ....................................................................28 Appendix: I Detailed list of generator status site wise........................................................34 Appendix: I Detailed list of generator status site wise........................................................34 Appendix: J Detailed analysis on adequacy of stabilisers..................................................42 Appendix: K Detailed inventory of Ice-packs site wise .....................................................50 Appendix: L Detailed inventory of vaccine carrier site wise .............................................56 Appendix: M Detailed inventory of cold boxes and calculation of net requirement for the state ...................................................................................................................................62 Appendix: N Detailed inventory of condemned refrigeration units in the state ................1
iii
LIST OF ACRONYMS
AMC ANM BR CFC DF DHQ DIO EPI EVSM HC HDI HFC ILR IPPI ITPI LHV MIS MOiC PHC ToR UNICEF UPS VVM WHO WIC WIF
Annual Maintenance Contract Auxiliary Nurse and Mid-wife Beyond Repair Chlorofluorocarbons Deep Freezer District Headquarter District Immunization Officer Expanded Programme of Immunization Effective Vaccine Store Management Hydrocarbons Human Development Index Hydro fluorocarbons Ice-Lined Refrigerator Intensified Pulse Polio Immunization IT Power India Pvt. Ltd Lady Health Volunteer Management Information System Medical Officer in-Charge Primary Healthcare Centre Terms of Reference United Nations Childrens Fund Uninterrupted Power Supply Vaccine Vial Monitor World Health Organization Walk-in Cooler Walk-in Freezer
iv
Appendices
EXECUTIVE SUMMARY
ITPI assessed the cold chain in Jharkhand as part of an UNICEF initiative to equip the government to make informed decisions regarding cold chain rehabilition in the state. The quantitative and qualitative assessment was conducted over a span of 23 daysf rom 21.9.2005 to 18.10.2005, excluding 4 holidays. Three independent teams covered the entire state, assessing the cold chain in 22 district stores and 190 PHCs, reviewing onsite facilities and procedures. Equipped with assessment questionnaires, the teams visited each site, gathering data and information on equipment, both electrical and non-electrical, vaccine management, logistics, maintenance and training. Cold chain staff were interviewed, including the District Immunization Officer (DIO) and the Civil Surgeon (CS). To aid future maintenance/replacement follow-up, all electrical units were assigned asset numbers. The field assessment enabled identification of the weak links in the cold chain. It becomes the basis for making short-term and long-term recommendations. All findings and suggestions are substantiated with data. 1.1. Major findings The following are the major findings of the field survey: There are 56 PHCs which require either a Deep Freezer or an Ice-lined Refigerator. Seventy-eight PHCs do not have adequate functional vaccine storage capacity. 41.5% sites have inadequate electric supply to operate cold chain equipment; 7% (15 PHCs) have <8 hr of supply; 13.5 % (29 PHCs) have no supply at all. Except during catch-up rounds, no funds are available for fuel for generators. The solar hybrid refrigerator systems are NOT appropriate for vaccine storage anywhere in Jharkhand unless substantial technical improvements are made to the accessories and the installation standards improved. Even with appropriate technical improvement, the systems are inadequate to store vaccines at the 29 PHC locations in the state where no electricity supply is available, unless the size of the solar panel is increased by approximately 3 times. The systems with appropriate technical improvements could provide adequate vaccine storage capacity at 60 other PHC locations, but only if the PHC personnel are trained to conscientiously switch the units from one operating mode to the other during periods of power outage from the electrical grid. This would require that the facility be staffed 7 days/week. The T series vaccine was found to be frozen at --- sites. There is a general lack of awareness regarding loss of vaccine potency due to freezing. It is very likely that immunization sessions are using T series vaccines that lack integrity. In this context, there is a total lack of awareness regarding Ice-pack conditioning. Poor distribution practices have also contributed to vaccine freezing. Only frozen Ice-packs are used in vaccine carriers. Temperature monitoring devices are not functioning at 64 sites. There is no cold chain monitoring device or freeze indicator accompanying transported vaccine from intermediate sites to health centres and from health centres to outreach sites. There is a mismatch between stock indents and available stocks. Consumables stocks are in excess of vaccine stocks at some sites.
Appendices
There is a dearth of trained technicians, spareparts and workshops. The average technican response time is in months. At the state-level, no technician has been assigned to the Expanded Programme of Immunization (EPI). No preventive maintenance is undertaken. Personnel handling cold chain have not received sufficient training. In some cases the incumbent has received no training at all. The lack of training is visible not only in vaccine handling and thermostat adjustments but also routine maintenance and waste disposal. There are no government-initiated technician training programmes. No training has been imparted for handling solar refrigerators and CFC-free equipment. At most sites there is no proper waste disposal method. Broken/used vials and syringes are scattered on the premises. Recordkeeping is poor whether it has to do with vaccine stocks or temperature monitoring. There is no record of damaged stocks. 1.2. Recommendations Based on the field assessment, IPTI makes the following recommendations: 1.2.1. Equipment Assign and train a team of maintenance technicians with adequate operational budget, or outsource maintenance services. Restructure plan for dual mode (solar/electricity) refrigerators and rationalize distribution. Conduct repair operations for rehabilitation of present equipment. Adopt a plan for disposal of obsolete/beyond repair equipment and draw up an equipment replacement sechedule. A strong preventive maintenance plan should be drawn up and implemented. Rationalize assignment of equipment and adopt a 5-year equipment procurement plan. Pursue WHO accreditation for Effective Vaccine Store Management (EVSM) for central store of the state. 1.2.2. Management and Logistics Prevent freezing of freeze sensitive vaccines Revamp vaccine management and stock control system in accordance with WHO recommended procedures. Adopt and implement waste management plan. Examine transport facilities afresh and make budgetary allocations. 1.2.3. Personnel Motivate personnel through regularizing payment of salaries etc. Conduct extensive EPI training at MLM level as per WHO training modules. Train ALL health workers who are assigned CC responsibilities.
Appendices
1.2.4. Government of Jharkhand Assign dedicated staff at PHC level Strengthening the information system Capacity building (Training of MLM in EPI) Maintain adequate stock of spare parts and establish maintenance workshop.
Appendices
1. INTRODUCTION
Immunization is a crucial component of the Public Health Services. Commonsense tells us that prevention is better than cure. Immunization averted about 2 million deaths in 2002. In addition, contagion is reduced, strain on the healthcare system is eased and money is frequently saved that can be used on other health services. 1 It is acknowledged among the most cost-effective and highest health-impact interventions.2 The backbone of an efficient immunization system is the cold chain. The cold chain is the network of equipment, personnel and processes that ensures that vaccines are transported and stored at appropriate temperatures up to the point of administration, ensuring that they retain their potency. A wellmanaged cold chain will increase the proportion of effective vaccines that are administered and reduce vaccine wastage.
2. BACKGROUND
Jharkhand gained statehood on 15 November 2000. Having formerly been a part of Bihar, which is categorized among the Bimaru states, Jharkhand inherited the low indices on all development criteria. It is relevant to note that 9 out of the 18 poorest districts in the country are in Jharkhand.3 In fact, it ranks very low on the Human Development Index (HDI), indicating poor achievements on the education, standard of living and health dimensions. Among the many goals listed by the State with regard to health is: Universal immunization for pregnant mothers and infants.4 To achieve this goal, an efficient cold chain system becomes imperative. In Jharkhand, the existing vaccine management and logistics system has been adversely affected by a virtually non-existent demand forecasting system, inadequate and/or improper storage conditions, lack of trained manpower, non-existent transportation facilities, exceedingly poor infrastructure in terms of roads in parts of the state, unrealiable, and sometimes non-existent, power supply, poor record keeping, wastage, irregular supplies, low motivation among health workers and lack of sufficent financial and material resources. UNICEF initiated the cold chain assessment in the state in order to support the Jharkhand government in making informed and substantiated decisions on cold chain rehabilitation in the state.
3. SCOPE OF ASSESSMENT
The specific objectives of the assessment included the following: 3.1. Inventory: 3.1.1. Electrical cold chain List the existing number of Ice-Lined Refrigerators (ILRs) and Deep Freezers (DFs), including details regarding date of installation, serial number, make, model, CFC/CFC1 2
Appendices
free, type, size, functional status and available accessories like thermometers at the district stores and the Public Health Centre (PHC). List the existing number of stabilizers and gensets, including details regarding manufacturer, type, specifications (volts/power), number of machines connected to it (type of machine and size of machine), functional status, quality of wiring and number of plug points and output PHC and district-wise. 3.1.2. Non- Electrical cold chain List the existing number of cold boxes, vaccine carriers, Ice-packs PHC/district-wise. 3.2. Logistics and maintenance: List PHCs with normal power supply/low voltage (< 150v)/less than 8 hours of power supply/no power supply/type of power supplysingle phase, two-phase, three-phase and whether earthing is present. Assess the vaccine delivery systemhow vaccines reach from the state vaccine store to the immunization session, covering each link in the chain: responsibilities, transport, and frequency of dispatches. Assess working condition of electrical and non-electrical cold chain equipment at all levels, including ILRs, DFs, temperature monitors, diesel gensets (including typical monthly fuel requirement) and voltage stabilizers, cold boxes, vaccine carriers and Icepacks. Assess whether the existing electrical and non-electrical cold chain equipment is adequate to meet vaccine demands and whether the units are well maintained. Assess the reporting system that exists when electrical and non-electrical cold chain equipment breaks down and the response time; and list the problems that arise both at the PHC and the technician level when the response time is more than 48 hours. Assess the availability and adequacy of spare parts for repair; cost of major and minor repairs of electrical cold chain equipment; and examine procedures followed for addressing minor and major repairs. Determine the availability of skilled maintenance technicians, the average travel distances for them, and the time required to carry out the repairs.
4. METHODOLOGY
The first phase of the project consisted of a briefing with the Government of India, the Department of Health and Family Welfare (DH&FW) and UNICEF. An assessment form was prepared to evaluate the status of the cold chain equipment, maintenance and staff training at the PHC and district levels. Three independent assessment teams were mobilized to cover the 22 districts and 192 PHCs in the state. The assessment began on 21 September 2005 and continued till 18 October 2005, with a break of 4 days from 10 to 14 October 2005 due to national holidays. The assessment teams first visited the district stores, followed by the PHCs in the district. They reviewed onsite facilities and procedures, evaluating both electrical and non-electrical equipment. All the electrical units were assigned asset numbers by the assessment team to aid follow-up in the future. The cold chain staff were interviewed to determine skills and efficiency.
Appendices
Totally, 213 sites were visited, which included 190 PHCs and 22 district stores. The teams were advised against visiting two sites: Gawan (Giridhi district) and Satgawan (Koderma district) since they were considered potentially unsafe. The forms used to record the findings were countersigned by the staff responsible for handling the cold chain. In most cases, the Medical Officer in-Charge (MOiC), or the Lady Health Volunteer (LHV) or Computer operator (an accounts-related post) was interviewed; in the absence of the cold chain in-charge, the Auxiliary Nurse and Mid-wife (ANM) or other staff were interviewed. Wherever possible, all staff related to the cold chain were interviewed. Based on the feedback and data collected from the field, a list of recommendations has been drawn up. A more detailed description of the methodology is given below. 4.1. Assessment of site The assessment team visited each site in the state to review quality of buildings, equipment and transport. Sites were assessed to determine adequacy of space, ventilation, space for packing and loading vaccine for onward despatch, location of burial pit or incineration site used for the disposal of safety boxes, and availability of staff to monitor cold chain in the event of power failure. 4.2. Assessment of electrical cold chain All the sites were assessed to evaluate vaccine storage capacity, stacking procedures, capacity to produce Ice-packs for regular and campaign programmes and functional status of equipment. The power supply connections, stabilizer support, earthing of equipment, and temperature log books were also examined. The equipment was broadly classified into three categories namely: Working (functional), Not Working (non-functional equipment, but could be repaired) and Condemned or Beyond Repair.5 Maintenance and record keeping procedures were evaluated. 4.3. Assessment of non-electrical cold chain equipment Non-electrical cold chain equipment includes cold boxes, vaccine carriers, ice-packs and thermometers. All sites were reviewed for their present stock and condition of the equipment. Cold boxes were physically checked for damage to hinges, locks, handles, lids, gaskets and chains and the body itself. 4.4. Assessment of power situation and back-up power supply mechanism To evaluate the power supply situation, the staff at the site were interviewed regarding hours of assured supply, usage of the generator, fuel purchase, and funds for fuel. The temperature record book was examined to corroborate information. Information garnered on power supply tended to be rather subjective and was often not substantiated by the frequently incorrect recording of temperature in the log and the records for generator usage. 4.5. Assessment of vaccine storage and delivery mechanism Stock books used for recording the entry and despatch of vaccines and diluents were checked to evaluate stock management and record keeping. Vaccine consumption during routine im5
Beyond repair: extensive damage to the body; rusted, damaged CFC-based compressors; the Voltas maintenance technicians have marked the equipment as condemned. 6
Appendices
munization, entry of recently delivered vials and despatch to PHCs and sub-centres as well as entry of damaged/expired vaccine was also checked. This was co-related with stock and supply of consumables. The delivery system and the frequency of procurement/delivery were assessed by interviewing the staff and verifying the indent challans. The vaccine transport mechanism was also evaluated. 4.6. Assessment of sharp waste disposal Sites were assessed for their sharp waste disposal practices. Usage of safety boxes and hub cutters was assessed and some correlation was sought to be made between vials used and the number of children vaccinated against the number of safety boxes used. Sharp waste disposal locations were inspected and the waste disposal method recorded. 4.7. Assessment of cold chain personnel The staff responsible for the cold chain operations were interviewed to determine whether they had received sufficient training and to assess their understanding of the cold chain and its operation and maintenance, including defrosting cycle, thermostat setting, and cleaning of equipment. Additionally, information was sought on vaccine handling, shipment and transportation, handling in case of electricity supply breakdown, usage of gensets, record keeping of damaged vaccine, disposal of damaged vials, conditioning of Ice-packs, storage of vaccine at different levels within the refrigeration unit, VVM awareness, shake test for the T series vaccines, and use and disposal of safety boxes. 4.8. Assessment of cold chain equipment maintenance The staff responsible for the maintenance of electrical and non-electrical equipment were interviewed to assess cold chain equipment maintenance practices. Assessors met the staff responsible for maintenance of the electrical cold chain in Jamshedpur, East Singhbhum. They spoke to Mr B.K. Ghosh, the Servicing Manager from Voltas in Patna to discuss the nature and scope of Voltass maintenance contract with UNICEF. An unsuccessful attempt was made to meet one sub-contractor in West Singhbhum, Cool Life, Badi Bazar, Chaibasa. Assessors later learnt that this company no longer held the servicing contract.
Appendices
Figure 1: Cold Chain System Requirement as per PIS 2000 (page 6 of general information)
Table 1 lists the optimum size of cold chain equipment summarized for each district. Detailed analysis for each site is available as Appendix: A. Adequate capacity of cold chain equipment is calculated based on population being served for each site. Optimum size of cold chain equipment ILR6 DF6 Cold Box Total Popula- (Gross (Gross tion Litres) Litres) ( Gross Litres) 10 1773 1285 405 7 8 9 11 10 9 13 8 11 14 5 743 877 2019 872 1864 753 1748 810 611 1726 512 526 621 1361 610 1319 533 1226 573 416 1221 362 164 193 411 189 410 166 379 178 127 380 113
Appendices
Koderma Latehar Lohardaga Pakur Palamu Ranchi Sahebganj Saraikela Kharsawan Simdega West Singhbhum Grand Total
4 7 6 6 11 24 8 9 9 13 212
466 439 272 457 1330 14111 693 663 420 960 34119
317 311 192 302 909 6886 490 468 297 663 20885
Following table shows the requirement of cold chain equipment at district stores of the state. Optimum size of cold chain equipment at district stores ILR7 DF7 Cold Box Total (Gross (Gross ( Gross Litres) District Population Litres) Litres) Bokaro Chatra Deoghar Dhanbad Dumka East Singhbhum Garhwa Giridih Godda Gumla Hazaribagh Jamtara Koderma 1775961 790680 933113 2394434 950853 1982988 801350 1901564 861182 707555 1836068 544856 540901 888 395 467 1197 475 991 401 951 431 354 918 272 270 400 178 210 539 214 446 180 428 194 159 413 123 122 83 37 44 113 45 93 38 89 40 33 86 26 25
Appendices
Optimum size of cold chain equipment at district stores ILR7 DF7 Cold Box Total (Gross (Gross ( Gross Litres) District Population Litres) Litres) Latehar Lohardaga Pakur Palamu Ranchi Sahebganj Saraikela Kharsawan Simdega West Singhbhum 467071 288886 564253 1533173 2214088 736835 707175 446421 1080780 223 540 100 243 51 234 144 282 767 1107 368 354 105 65 127 345 498 166 159 33 21 22 14 27 72 104 35
6. SITUATIONAL ASSESSMENT
The state immunization policy is implemented under the Reproductive and Child Health (RCH) Programme and covers OPV, BCG, DPT, DT, TT and Measles. The state has a good network of PHCs, substantially covering the rural and urban populations. Each PHC ensures optimum coverage of sub-centres and health posts serviced by a network of health workers and anganwadi members. EPI was initiated in India in 1978 and in 1985-86 the Universal Immunization Programme was launched. To ensure programme implementation all PHCs in the state were equipped with an ILR, a DF, and a generator to act as the power supply backup. The DF at the PHC level is required to facilitate the making of ice-packs, which are used in the vaccine carriers to transport vaccines to health posts and rural areas for the regular weekly immunization programme. However, with 40.16% of equipment not functional throughout the state, maintaining the cold chain becomes a challenging task. ----- percentage of the equipment has aged and use CFC refrigerants; while ----- of the equipment is beyond repair. Electricity supply to most of the cold chain sites is inadequate or unreliable with persistently low voltage, which is insufficient to efficiently run the ILRs (even after taking into consideration normal hold-over time). The power supply is unable to support use of DFs at 29 PHCs. Generators were supplied to all sites187 were recorded at sites throughout the state, of which 53 are not working. Availability of funds for fuel is an issue. Provision is now being made for hybrid solar refrigerators, which, if supported by relevant training and maintenance and repair, could possibly help towards a long-term and sustainable solution if the load requirement at the PHC is not too heavy. But the current dual mode solar system is NOT suitable for use at any site unless major technical improvements are made with cost implications. Only -----% of the equipment is connected to voltage regulators and as a consequence exposing costly equipment to breakdown due to voltage instability.
10
Appendices
Supply of vaccine is found to be regular but frequent, probably in order to address the inadequacy of quality storage conditions. There was no report of non-availability of any vaccine at the PHC level. However, supply of AD-syringes and diluents is not recorded and there is no co-relation maintained between vaccine supply and other consumables required for vaccination. In many instances, the assessors found excess stock of AD syringes at many PHCs and DHQs. Transportation of vaccine to the PHCs poses many problems. The vaccine is generally fetched by the PHC staff from the district store (except during campaign rounds such as the Pulse Polio Programme for instance) in preparation for the appointed immunization day (either Wednesday or Thursday). Most PHCs do not possess a vaccine delivery van, but some have ambulances, which are frequently no longer functioning. As a general practice, vaccine is either fetched in the ambulance or public transport is used to fetch the vaccine. The Sahebganj district store, is an exception, and vaccine is delivered from here to the PHCs on a weekly basis since mode of transport communication within district is very poor, and one vehicle at district store spends one full day to deliver vaccine at all the PHCs in the district .) The following sub-sections describe in greater detail the findings of the field assessment. The findings are followed by recommendations which point towards solutions to strengthen the cold chain in the state. 6.1. Cold Chain network 6.1.1. Central store site assessment The central store, located at Namkum, Ranchi, has 3 WICs and 1 WIF. All the units are operational. The WICs are connected to auto-start generators, but the generators were under repair at the time of the site assessment. One solar hybrid refrigerator has been installed at central store as part of a pilot assessment. Pre-shipment and arrival procedures have ensured that all shipments were in satisfactory condition when received in the primary stores. All vaccines have been stored within WHO recommended temperature ranges except for measles which is still being kept in WIF. The capacity of cold storage has been sufficient to meet the demand with 3 WIC and 1 WIF in place. The buildings and equipment available to the programme have enabled the cold store to function effectively. Transportation is managed by district stores, as vaccine is collected on routine basis from central store. Stock management has been ineffective. There has been situations of over stocks and stockouts. This is primarily because the vaccine distribution system is pull basis with no regular and standard intimation in advance. There is no accountability of deliveries of vaccine to the next level for being timely, sufficient and correct. No damage reported occurred to the vaccine during distribution. The facility does not follow standard operating procedures completely.There is no reliable backup of staff operating the store, especially on weekends and holidays. There is no temperature alarming system in place. Facility is provided 24 hrs backup of electricity through centralized generator for entire complex where store is located. This would en-
11
Appendices
sure good power supply to cold rooms, however prevention of freeze sensitive vaccine from freezing is still volunerable. 6.1.2. District store site assessment
There are 22 districts in Jharkhand, with as many district stores The Sadar (District) Hospital premises normally houses the district store. All the district stores fetch vaccine from the central store at Namkum. A WIC has been installed at the Giridih district store with the purpose of easing supply of vaccine in the North-Eastern part of the state (Deogarh, Godda, Sahebganj, Pakur, Jamtara and Dumka). However the WIC at Giridih has not been working since the past three years. The supply of vaccine to these districts therefore poses a challenge as the distance from the central store to these districts is considerable: Sahebganj, for instance, is more than 400 km by road. Vaccine to some of these districts was supplied from the Bhagalpur regional store situated in Bihar before Jharkhand emerged as a separate state. Table 3 summarizes the number of refrigeration units available at each district store (where the vaccine is held normally for a period of three months).
List of refrigeration units at district stores District Operational Units ILR DF Small (94 Ltr gross) Large (204 Ltr Goss) Small (94 Ltr gross) Large (204 Ltr Goss) Small Repairable units ILR DF Small Large Large 4 4 1 3 1 3 2 1 1 2 3 2 1 1 1 1 3 2 3 2 1 1 1 1
Bokaro Chatra Deoghar Dhanbad Dumka East Singhbhum Garhwa Giridih Godda Gumla Hazaribagh Jamtara Koderma Latehar Lohardaga Pakur Palamu Ranchi Sahebganj
1 1 4 7 2 2
1 3 5 2 2 2 1 1 1 4
1 1
1 1 1 3 1
1 2
1 4 3 4
1 2 2 2 1
3 3 1 1 4 2 2 7 4 1 2
12
Appendices
5 3 6 3 1
2 3
2 3 4 1 1
At the Sahebganj, Godda, Giridhi, Ranchi and Saraikhela Kharsawa district stores, the cold chain equipment is located in congested rooms, preventing easy access for receiving and despatching vaccines, as well as the preparation of cold boxes, vaccine carriers and icepacks for transportation. As for the Pakur district store, a new hall is now being provided by UNICEF. The new location is satisfactory; proper electrical wiring has been done; and there is adequate ventilation and storage space is available for storing and packing vaccines. 6.1.3. PHC site assessment At many PHCs, the equipment is stored in damp and ill-ventilated rooms. The normal practice is to close all windows and lock the door at the end of duty hours. Often the surroundings are not clean. Access to some PHCs is jeopardized by bad roads. The assessment team encountered difficulties in spite of 4-wheel vehicles. But the PHC staff mainly go on foot, use 2-wheelers or infrequent and congested public transport. In West Singhbhum there is railway line with two trains per day running PHCs. The team encountered vaccinators providing OPV on these trains, but it is not evident that health service staff use this service.
Jharkhand has 4 WICs and 1 WIF for the storage of vaccine coming into Jharkhand. Three WICs and one WIF are located at the central store, Namkum, Ranchi; and one WIC is installed at the Giridih district store. WICs and WIF at the central store, Namkum The WICs and WIF at the central store are operational and fairly well maintained. The WIF has a problem with the left hand-side compressor, as the drainage is broken. The right-handside compressor is functioning well, but the heating cable was not in the drainage pipe. There is some ice formation on the compressors. The auto-shift function is not working and has to be operated manually to change from one compressor to the other. The WIC delay start is not functioning and the auto-cut off is unreliable.The generator does not start up in the automatic mode and has again to be manually operated. There is no temperature alarm system in place at any of the cold room facility. WIC at Giridih The WIC at the Giridih district store has not been functioning for the past three years. One of the two compressors is not working. When the WIC was rewired, the security controls governing power supply to the WIC have been bypassed. The state RCH officer had attempted to procure a dedicated three-phase power connection for the WIC and funds for rewiring the entire electrical circuit, but has met with little success. A feasible solution is yet to be found to repair the WIC. No manual or technical information on the WIC is available at the store.
13
Appendices
Since the past two years, the generator does not switch on automatically and has to be manually operated. In addition the post of refrigeration mechanic has been lying vacant for many years. ILRs and DFs
The entire state of Jharkhand is equipped with 426 ILRs and 422 DFs allocated to 22 district stores and 190 PHCs. An electronic database of the electric and non-electric cold chain, giving the state-level inventory site-wise, in MS Access (2002 version) is provided along with this report. This database can be used as a management tool to incorporate future changes in the cold chain network in the state as well as estimate the storage capacity at each level of the chain. 6.2.2. State-level CFC and CFC-free equipment inventory
Totally, the state has 288 ILRs and 262 DFs using CFC refrigerant, which constitutes 64% of the total cold chain equipment in the state. Out of the 550 CFC units, 227, 41%, are still operational; the remaining 59% is not functioning or beyond repair .As per the Montral Protocol, the CFC machines should be replaced by CFC-free equipment as soon as it is economically feasible to do so; till then, the units should be maintained using a CFC refrigerant and serviced as per best practices. Summary of cold chain refrigeration unit present in state
Status Beyond Repair Not Working Working Grand Total SMALL CFC CFC FREE 90 9 18 117 5 9 103 117 DF LARGE CFC CFC FREE 52 38 53 143 SMALL CFC CFC FREE 106 32 141 279 4 12 92 108 ILR LARGE CFC CFC FREE 6 1 16 23 3 3 24 30
Total
Total
5 51 56
Appendix: B lists out the shortage of equipment at each site. This shortage should be addressed as a priority with CFC-free equipment. 45 CFC-free units are reported not working or beyond repair. These were installed probably after 1998/2000. Major problems associated with failure of CFC free equipment are: 1) Equipment not cooling after being serviced by refrigerator technician 2) Failure of compressor due to voltage fluctiations (machines connected without stabilizers)
6.2.3.
The effective age of a refrigeration unit may be considered as roughly 15 years, however WHO recommendation is 10 years for a refrigeration unit. In the Jharkhand cold chain, rougly 10% of the equipment is more than 15 years old, of which 7% is not working. More than 27% of the equipment is between 8 and 15 years old of which 16.1% is working.
14
Appendices
Equipment that has aged should be replaced on a priority basis, but this will depend on the replacement plan and the finanacial resources available. Table 5 shows the age profile (based on the refrigerant used) to facilitate drawing up an adequate replacement plan. Detailed age profile of refrigeration unit is available at Appendix: G. Age profile of cold chain refrigeration units present in state CFC Upto Upto 10 15 47 5 52 13 4 17 84 20 104 38 39 77 Above 15 8 5 13 10 2 12 CFC FREE Upto Upto 10 15 57 10 67 75 8 83 4 2 6 8 1 9 Above 15
Equipment Type ILR Operational ILR Repairable ILR Total DF Operational DF Repairable DF Total 6.2.4.
Upto 5 18 3 21 11 2 13
Upto 5 55 3 58 70 5 75
Following table summarises the inventory of CFC ILRs district wise. The detailed inventory of CFC ILRs site wise is available at Appendix: C. Inventory of CFC ILRs, summarised district wise
SMALL Working Working Beyond Repair Total District Bokaro Chatra Deoghar Dhanbad Dumka East Singhbhum Garhwa Giridih Godda Gumla Hazaribagh Jamtara Koderma Latehar Lohardaga Pakur Palamu Ranchi Sahebganj Saraikela KharsaNumber of Sites 10 7 8 9 11 10 9 13 8 11 15 5 4 7 6 6 11 24 8 9 NW NW LARGE Beyond Repair Total 1 1 4 2 1 1 2 3 4 1 1 1
6 1 6 4 6 16 5 11 6 6 6 3 5 3 5 5 6 15 10 2
3 4 1 1 2 3 3 2 2
2 1 1 1 1
9 3 7 9 3 1 5 10 2 4 11 1 2 6 3 5 1 13 1 2
15 4 13 16 13 18 11 23 11 13 19 6 7 9 10 10 8 29 12 5
1 1 3 1
1 1
1 1 2 3 4
1 1 1
15
Appendices
9 6 4 10 13 8 5 4 17 1 213 141 32 106 279 16 1 Table 6: Present status of CFC ILRs summarised district wise
Following table summarises the inventory of CFC Free ILRs district wise. The detailed inventory of CFC free ILRs site wise is available at Appendix: D. Inventory of CFC Free ILRs, summarised district wise
SMALL Working Working Beyond Repair Total NW No of Sites 10 7 8 9 11 10 9 13 8 11 15 5 4 7 6 6 11 24 8 LARGE Beyond Repair 1 1 1 2 1 4 NW 1
District Bokaro Chatra Deoghar Dhanbad Dumka East Singhbhum Garhwa Giridih Godda Gumla Hazaribagh Jamtara Koderma Latehar Lohardaga Pakur Palamu Ranchi Sahebganj Saraikela Kharsawan Simdega West Singhbhum Grand Total
2 4 3 7 4 2 5 2 4 2 7 3 1 4 4 4 4 8 3
1 1 1 1
1 2 1
1 3 1 1
3 5 4 7 5 2 5 3 6 2 8 3 1 5 8 4 5 9 3
2 2 2 1 2 1 1 1 1 1
2 1 2 1
9 8 1 1 9 9 6 3 6 13 5 1 5 213 92 12 4 108 25 3 Table 7: Present status of CFC Free ILRs summarised district wise
Following table summarises the inventory of CFC DF district wise. The detailed inventory of CFC DF site wise is available at Appendix: E. Inventory of CFC DFs, summarised district wise
16
Appendices
District No of Sites Bokaro 10 5 5 3 1 Chatra 7 4 4 1 Deoghar 8 2 7 9 1 4 Dhanbad 9 1 2 3 5 8 Dumka 11 1 1 2 1 East Singhbhum 10 7 2 9 6 4 Garhwa 9 5 5 2 Giridih 13 15 15 7 2 Godda 8 1 1 2 Gumla 11 1 5 6 5 4 Hazaribagh 15 1 13 14 1 3 Jamtara 5 1 1 1 Koderma 4 1 1 2 Latehar 7 4 4 Lohardaga 6 1 1 4 Pakur 6 Palamu 11 2 2 1 Ranchi 24 1 1 11 13 10 2 Sahebganj 8 2 2 4 1 Saraikela Kharsawan 9 2 7 9 1 1 Simdega 9 1 1 1 1 West Singhbhum 13 4 2 4 10 1 1 Grand Total 18 9 90 117 53 38 Table 8: Present status of CFC DF summarised district wise
4 1 1 6 4 2 1 8 3 3 4
2 2 5 1 4 1 52
Following table summarises the inventory of CFC Free DF district wise. The detailed inventory of CFC DF site wise is available at Appendix: F. Inventory of CFC Free DFs, summarised district wise
SMALL Working Working Beyond Repair Total NW LARGE Beyond Repair NW
District Bokaro Chatra Deoghar Dhanbad Dumka East Singhbhum Garhwa Giridih Godda Gumla Hazaribagh Jamtara Koderma Latehar
No of Sites 10 7 8 9 11 10 9 13 8 11 15 5 4 7
3 3 3 7 4 3 2 8 4 4 11 2 4
1 1 1
3 5 3 7 6 3 2 8 5 5 12 2 6
2 1 6 1 1 3 3 2 1 2 2 3
17
Appendices
District No of Sites Lohardaga 6 9 9 3 Pakur 6 4 1 5 3 Palamu 11 6 1 7 2 Ranchi 24 8 8 2 Sahebganj 8 6 2 8 1 Saraikela Kharsawan 9 4 1 5 2 Simdega 9 3 3 8 West Singhbhum 13 5 5 3 Grand Total 213 103 9 5 117 51 5 Table 9: Present status of CFC Free DF summarised district wise
The present vaccine storage capacity available at all PHCs and DSs is provided inAppendix: B This is broken up into presently operational ILRs and Deep Freezers at each location. 6.2.5. District wise condmned equipment Table 10 lists the summarised inventory to district level of refrigeration units that are condemned state. Detailed list of condemned equipment is provided in Appendix: N. Number of condemned refrigeration units District Bokaro Chatra Deoghar Dhanbad Dumka East Singhbhum Garhwa Giridih Godda Gumla Hazaribagh Jamtara Koderma Latehar Lohardaga Total DF 9 5 8 8 6 4 6 23 4 8 17 0 1 5 3 Total ILR 9 3 8 10 4 1 5 13 2 6 11 2 2 6 4
18
Appendices
Number of condemned refrigeration units District Pakur Palamu Ranchi Sahebganj Saraikela Kharsawan Simdega West Singhbhum Grand Total Total DF 0 5 16 1 12 2 4 147 Total ILR 5 1 15 1 3 4 4 119
6.2.6. Stabilizers Many of the brands, particularly the stock issued by UNICEF at the start of the programme: Sagar, Electroguard and Selvel, cannot deal with low voltage, which is a problem encountered at many PHCs. Voltas has identified a locally manufactured stabilizer, which they have placed at some stores with the rating of 100-280 volts, was able to handle voltage fluctuation.
Table 11 displays the stock and operational status of stabilizers summarised district wise.Table
shows the comparison of functional stabilizers with number of equipment present on site. Minimum of one stabilizer is required to run two refrigeration units. Table shows the net shortage of stabilizers and excess of stabilizers as persent on site. Refer to Appendix: J to see the detailed list of sites with stabilizer status. Following table helps in solving stabilizer shortage problem by switching stabilzers from sites where there is excess stock to those sites where there is shortage. To easy movement of stabilizers, shortage and excess of stock is summarized for each district.
District
Bokaro Chatra Deoghar Dhanbad Dumka East Singhbhum
No of sites
10 7 8 9 11 10
Total Stabilizers
22 13 20 22 15 19
19
Appendices
District
Garhwa Giridih Godda Gumla Hazaribagh Jamtara Koderma Latehar Lohardaga Pakur Palamu Ranchi Sahebganj Saraikela Kharsawan Simdega West Singhbhum Grand Total
No of sites
9 13 8 11 15 5 4 7 6 6 11 24 8 9 9 13 213
Total Stabilizers
21 29 18 19 30 6 10 10 23 11 19 43 10 18 15 28 421
Many of the cold chain appliances were running without stabilizers, which seems to be due to shortage of supply, or non-replacement of broken stabilizers. In the whole state, there are only 421 stabilizers, of which 322 are working and can service the cold chain equipment.
6.2.7.
Non-electrical equipment
Table 12 & 9 give a comprehensive picture of the non-electrical equipment stock site-wise, covering the district stores and the PHCs. It also indicates the number of damaged units at each site.
Cold Box inventory and status at a glance Number of cold boxes Size 5L W
930
Chain W
359
Hinge
Handle W
1020
Cover W
1057
Gasket W
663
NW Total
204 1134
NW W NW
775 679 455
NW
114
NW
77
NW
471
20
Appendices
Cold Box inventory and status at a glance Number of cold boxes Size 8L 20 L 25 L W
59
Chain W
23
Hinge
Handle W
67
Cover W
66
Gasket W
53
NW Total
9 68
NW W NW
45 59 9
NW
1
NW
2
NW
15
660
132
792
556
236
517
275
725
67
743
49
511
281
28
18
46
45
27
19
45
43
15
31
Table 13 lists the status of cold boxes by size, summarized to district level. Detailed list of inventory with present status and net requirement of cold boxes is available at Appendix: M Operational status of cold boxes, summarised by district
Not Working Not Working Not Working Not Working Net requirement (20 L Boxes) 1 9 2 9 11 2 3 6 2 2 6 1 6 3 2 1 1 Required capacity (gross ltr) 606 253 299 682 296 635 256 594 276 207 588 174 158 149 92 154 450 709 236 226 134 203 Net Shortage (Gross Ltr) 17 123 21 157 206 24 51 90 22 25 93 16 83 41 33 9 7 25 Litres Working District 20 Litres Working 8 Litres Working 5 Litres Working Net Transportantion capacity (gross ltrs) 1089 309 860 1290 625 2575 990 1156 501 788 1007 425 577 560 340 173 935 1497 1016 795 525 989
Bokaro Chatra Deoghar Dhanbad Dumka East Singhbhum Garhwa Giridih Godda Gumla Hazaribagh Jamtara Koderma Latehar Lohardaga Pakur Palamu Ranchi Sahebganj Saraikela Kharsawan Simdega West Singhbhum
1 1
42 9 34 43 26 18 55 37 44 15 30 37 20 24 17 10 7 36 53 34 31 21 35
8 13 12 4
8 3 1
37 16 36 81 21 205 50 52 37 36 42 5 13 29 20 5 35 66 56 35 13 40
30 21 6 32 3 1 2 23 2 7 19 3 7 3 7 9 16 2
18
1 11 13 6 8 2 7 1 15 6 14 4
2 2 1 4 4 5 1 5 4 7
1 6
5 8
11
21
Appendices
Grand Total
28
18
660
132
59
930
204
There was a mismatch between the physical count of cold boxes available at the site and the record of cold boxes issued. This was because the Pulse Polio Programme was on at the time of the assessment and probably the cold boxes and vaccine carriers were left at the different sites to be collected at the end of the day. Some sites could not furnish the record of cold boxes issued to them, therefore only the number of cold boxes available at the site was recorded and the estimates of cold boxes out in the field were added based on staff interviews. Vaccine carrier and ice box inventories were also based on physical count and approximations of units despatched to the field.
Table 14 lists out the inventory of vaccine carrier along with present status summarized district
Status of vaccine carrier, summarised by district District Bokaro Chatra Deoghar Dhanbad Dumka East Singhbhum Garhwa Giridih Godda Gumla Hazaribagh Jamtara Koderma Latehar Lohardaga Type 10 7 8 9 11 10 9 13 8 11 15 5 4 7 6 Good Condition 1860 804 937 1793 1311 2079 1208 1376 1355 955 1865 787 452 562 599 Beyond use 203 95 17 93 86 47 75 137 80 69 310 27 100 90 22
22
Appendices
Status of vaccine carrier, summarised by district District Pakur Palamu Ranchi Sahebganj Saraikela Kharsawan Simdega West Singhbhum Grand Total Type 6 11 24 8 9 9 13 213 Good Condition 868 1313 2631 575 1521 502 1652 27005 Beyond use 27 56 86 26 35 20 69 1770
Table 15 lists out the Ice-pack inventory summarized district wise. Detailed inventory of icepack site wise is available at Appendix: K. Summarised inventory of Ice-pack District Type Bokaro 10 Chatra 7 Deoghar 8 Dhanbad 9 Dumka 11 East Singhbhum 10 Garhwa 9 Giridih 13 Godda 8 Gumla 11 Hazaribagh 15 Jamtara 5 Koderma 4 Latehar 7 Lohardaga 6 Pakur 6 Palamu 11 Ranchi 24 Sahebganj 8 Saraikela Kharsawan 9 Simdega 9 West Singhbhum 13 Grand Total 213 Functional 12549 5060 6120 13290 5134 9000 7175 10020 5420 9928 13050 5810 2425 3078 3560 7735 7000 13647 6150 10120 2525 18120 176916 Non Functional 1348 890 430 810 130 3020 400 1875 355 210 2275 110 1075 111 400 800 650 610 50 30 205 305 16089
23
Appendices
6.3. Power supply The efficiency of the cold chain equipment depends on the availability of regular, continuous and reliable power supply with adequate voltage, and, in the case of power failure, the availability of operational and regularly serviced back-up facilities. Insufficient voltage cannot run an ILR, which requires 8 hours of continuous good quality power supply in order to hold over for 16 hours without power 8. A fairly large number of PHCs in the state have power breakdowns of more than 30 days and have therefore less than 8 hours of stable and continuous power supply. Some DFs were being used as ILRs as voltage was insufficient to maintain freezing conditions. The reasons for irregular or no power supply ranged from transformer breakdowns to disconnection due to non-payment of dues. Cold rooms At the central store, the power supply is dependable with no voltage fluctuation. The site is equipped with 3 WICs and 1 WIF. But the auto-start generators have broken down. However, at the Giridih district store, which has aWIC, the power supply is unreliable with frequent voltage fluctuations. The WIC was installed here in order to facilitate vaccine distribution. As soon as the WIC is repaired, it is imperative that the automatic power back-up systems be repaired as the 4 generators are manually operated at present. District stores and PHCs Only 79 of the 190 sites assessed have reliable power supply. At 15 PHCs, there is less than 8 hours of regular power; 7 additional sites have less than 8 hours of continuous, reliable electricity, and also suffer from low voltage; 29 sites suffer from low voltage continuously although the power cuts are few; 31 sites have no power supply at all. The existing voltage stabilizers are unable to cope with voltage below 150 kVa. Irregular power supply is handled in various ways at different locations. While at some PHCs, short-term needs for the pulse polio catch-up rounds are met by buying blocks of ice and using the cold boxes to store the vaccines; at others, the vaccines are transferred to an alternative site when there are extended power breakdowns. In many cases, however, this same system is used for the regular programme, with vaccine held for some days in cold boxes with Ice-packs and ice slabs from factories. In order to assure quality vaccine, thermometers must accompany such storage systems, and this is frequently not the case. At Tonto, the MoIC sought an alternative storage system by requesting unofficial authorization to transfer the operation of refrigeration equipment to the ACC plant medical service. The routine programme is now run from this facility, as is the management of Pulse Polio campaigns. Irregular power supply is most often handled by avoiding long periods of vaccine storage at the PHC site. Vaccine is fetched on a weekly basis, a day prior to the routine immunization day, and only the quantity required to meet the PHC and its sub posts demands is brought. The vaccine is then stored in cold boxes and vaccine carriers. The surplus vaccine remaining after immunization is returned to the district store, but, the practice of returning the unused vials is reported only at a few sites and is not reflected in the stock records.
Appendices
At Saraikhela Kharsawa, the equipment from the district store has been shifted to Chandil due to frequent breakdowns and poor voltage at the DHQ. Appendix: H provides an exhaustive list of sites with power supply status. High maintenance is required to protect vaccine integrity at all the locations with low voltage and poor power supply as listed in Appendix: H,. Following table sumarises the power supply situation in the state. Summary of power supply situation in the state
Sites with Adequate Power Supply 4 1 4 4 2 8 1 3 4 3 6 4 2 1 1 2 2 13 Sites with Low voltage 2 1 1 4 3 3 1 1 2 2 Sites with Inadequate Power Supply 4 3 3 1 6 2 3 4 2 4 3 1 1 4 5 5 7 3 4 3 3 71 Sites with No Power Supply at all 2
District Bokaro Chatra Deoghar Dhanbad Dumka East Singhbhum Garhwa Giridih Godda Gumla Hazaribagh Jamtara Koderma Latehar Lohardaga Pakur Palamu Ranchi Sahebganj Saraikela Kharsawan Simdega West Singhbhum Grand Total
No of Sites 10 7 8 9 11 10 9 13 8 11 15 5 4 7 6 6 11 24 8 9 9 13 213
2 5 1 2 4 1 1 2 3 1 3 1 2 2 32
1 2 1 2 2
4 4 7 80
1 29
6.4. Back-up power supply At 132 sites, the generators were working and reported to be used whenever the power cuts extended over eight hours, especially during the Pulse Polio Campaign. Operationally, funds for generator use are made available under the RCH Programme, and more specifically provided for Pulse Polio campaigns. However, many PHCs reported that they had no or insufficient funds for fuel to run the generators when required.
25
Appendices
Table 17 lists the sites at which the power situation is very bad (less than 8 hours of power
available in general, no power supply or consistent low voltage), where, in addition, the generators are not working. Detailed status of generator availability is available at Appendix: I.
Power Condition of Sites with operational CC equipment and generator non-operational District Bokaro Deoghar Dhanbad Dhanbad Dhanbad Dumka Dumka Dumka Dumka East Singhbhum East Singhbhum Giridih Giridih Godda Godda Godda Hazaribagh Hazaribagh Hazaribagh Hazaribagh Jamtara Jamtara Koderma Latehar Latehar Lohardaga Pakur Ranchi Ranchi Sahebganj Sahebganj Saraikela Kharsawan Saraikela Kharsawan Simdega Simdega West singhbhum West singhbhum West Singhbhum West Singhbhum Site Kasmar Sarat Sadar PHC Topchanchi Bhagmara Shikaripara Raneswar Masalia Jama Potka Musabani Dumri Sadar Block Godda DS Mehorma Sadar Block PHC Borhi Sadar Hospital DS Mandu Chaporan Narayanpur Nala Jainagar Barawadhi Chandwa Lohardaga DS Hiranpur Aarki Lapung Baharawa Rajmahal Kharsawan Ichagarh Kuradeg Simdega Manjgaun Jagganathpur Sadar-Chaibasa Sonua Type PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC DS PHC PHC PHC DS PHC PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC Power Status Power supply less than 8 hrs Poor supply Low voltage Low voltage Power supply less than 8 hrs Poor supply Power supply less than 8 hrs Low voltage
Poor supply Poor supply Low voltage Power supply less than 8 hrs Low voltage Poor supply Low voltage Poor supply Power supply less than 8 hrs No power supply No power supply Poor supply
Low voltage
26
Appendices
Power Condition of Sites with operational CC equipment and generator non-operational District Site Type Power Status West singhbhum Barajamda PHC Table 17: Power supply and generator back-up status at sites throughout Jharkhand
Following table summarises the status of generators district wise. Summary of status of generator district wise
District Bokaro Chatra Deoghar Dhanbad Dumka East Singhbhum Garhwa Giridih Godda Gumla Hazaribagh Jamtara Koderma Latehar Lohardaga Pakur Palamu Ranchi Sahebganj Saraikela Kharsawan Simdega West Singhbhum Grand Total Number of sites 10 7 8 9 11 10 9 13 8 11 15 5 4 7 6 6 11 24 8 9 9 13 213 Genset Available 8 5 7 9 9 10 9 12 8 10 14 4 4 7 6 2 9 20 7 7 7 10 184 Genset Operational 7 4 5 7 5 7 6 9 5 8 9 2 4 5 6 1 6 17 4 4 5 5 131 Genset Required 3 3 3 2 6 3 3 4 3 3 6 3 0 2 0 5 5 7 4 5 4 8 82
6.5. Wiring and power plugs Wiring for the refrigeration equipment was found to be satisfactory at 113 sites. It was poor for 45 sites. Generally, the quality of wiring is sub-standard except in East Singhbhum, where the CS managed to get funds to upgrade and install a new 3-phase circuit to ensure proper load distribution among the three phases. Several sites has no proper plugs and sockets were not available and the wires were often directly inserted into the sockets.
27
Appendices
It seems to be a common practice to bypass the earthing. In Bokar DS, for example, out 12 total cold chain units, only four had been earthed. The earthing wire was often cut at the equipment, stabilizer or point of supply. This is a cause for concern since improper earthing may harm the operator in case of electrical failure of the equipment. Many sites do not have proper neutral and use the earth as neutral. Under such conditions, the equipment may draw two to three times more current to start running and may eventually fail to start. Again, any open wire/loose contact may result in equipment failure. All ILRs and DFs originally came with the three-pin plug moulded on the cable. Vestfrost equipment was supplied with a power supply plug designed for special power sockets; these are not often compatible with the three-pin sockets on the stabilizers supplied. Hence, either the original equipment power supply plug was removed or an electrical extension box was used to connect the equipment to the stabilizer. 6.6. Alternative power supply: the solar energy solution In areas where power supply may not be available or reliable, solar energy could be an option. But for solar energy to be a viable option, the following criteria have to be met: For solar-powered refrigerators: Not less than 3.5kWh/day of global solar insolation during the least sunny month(s) of the year and appropriate sizing of the appliance to match climate and levels of solar energy.9 Solar equipment is site-specific and requires high investments, is costly to maintain and requires specially trained technicians for smooth operation, so the solar option decision has to be made after considerable thought and planning. At present, preparation for the installation of solar equipment, which consists of wiring, painting the room, fitting of an exhaust fan with three and sometimes four sockets to plug in equipment, one light point and, frequently, a room fan, have been made at ------ sites. In some instances the wiring for the solar electrical supply to the refrigerator has been wired into the general electrical circuit. This is considered highly unadvisable as this indicates a much higher load demand than was probably accounted for the solar hybrid systems. It does appear that the proposed solar installation has resulted in the staff adopting a lackadaisical and indifferent attitude towards maintenance of existing equipment 6.6.1. Assessment of dual mode solar system
Three solar hybrid refrigerators have been installed as part of the pilot project (mention the sites). Procurement is in process for more than 140 units for installation at the PHCs of districts except (.List out) The solar hybrid refrigerators are intended to function either by drawing power from the electrical grid or from solar energy. The model provided requires that it be manually switched from one mode to the other. This will be a significant operational constraint unless PHC personnel are very well trained. Solar panels were stolen from two locations, and the replacement panels have not been mounted for fear of further theft. The unit installed at Ranchi approximately two years ago no longer operates in the solar mode since the battery is defective. Premature battery failure is due to poor standards of installation and substandard components procured from the local market. The refrigerator cabinet, which has been imported from the USA, is of good quality, although not WHO-approved.
Appendices
The solar hybrid refrigerator systems are NOT appropriate for vaccine storage anywhere in Jharkhand unless substantial technicial improvements are made to the accessories and the installation standards are improved. The systems, even with appropriate technical improvement, are inadequate to store vaccines at the 29 PHC locations where no electricity supply is available unless the size of the solar panel is increased by approximately 3 times. The systems could, with appropriate technical improvements, provide adequate vaccine storage capacity at 60 other PHC locations, but only if the PHC personnel are trained to conscientiously switch the units from one operating mode to the other during periods of power outage from the electrical grid. This would also require that the facility be staffed 7 days/week. The solar hybrid systems are not required at 125 PHC locations since electricity from the state grid is adequate to power ILRs. This is a substantially more cost-effective, reliable and simpler solution. This matter should be addressed urgently and immediately to prevent an investment of approximately USD 4,500 per unit, which will not provide adequate storage standard at more than 100 PHC locations as the capacity of these units is less than 1/3 of standard ILR provided at PHCs. 6.7. Vaccine storage, handling and delivery system Vaccine collection/delivery system At 181 PHCs, vaccines are collected by health staff from the district store on fixed days of the week and transported in cold boxes using public transport. This normally coincides with weekly meetings of MOICs held at DHQ. In the case of those sites that have an ambulance or some other vehicle, these vehicles are used to fetch vaccines. Immunization was originally done on Wednesday, but was subsequently changed to Thursday as it was learnt that farming populations did not work in the fields on that day. However, many PHCs continue to operate the regular programme on Wednesday. Constraints in terms of budgets for fuel or transportation were often expressed. This is particularly relevant since 83 PHCs fetched the vaccine weekly, 7 additional sites fetching on a demand basis while 33, where electricity supply is more regular, continued to fetch vaccine according to the normal monthly routine. 10 of the sites reported fetching monthly on demand. Once the vaccine is brought to the PHC it is then transferred either to the ILR, or kept in cold boxes, depending on whether the equipment is working or power supply is available. Vaccine is distributed to the LHVs and vaccinators, often on the next day, and they then carry the vials to the outreach posts in vaccine carriers. Vaccine storage Staff responsible for maintaining the cold chain are well aware of the storage norms. However due to non-availability or non-use of vaccine trays, or due to negligence, vaccines are stacked inside the unit without sufficient space for air circulation. Further, T series vaccines are stacked at the bottom, rendering the vials vulnerable to freezing. Standard procedure of EEFO is not followed anywhere. At sites where the cold chain is not operational (breakdown of equipment or no power supply), ice blocks are used to maintain the vaccine temperature. At some sites, for example, Sadar Block, Raneshwar, it was observed that ice blocks were used in ILRs, DFs and cold
29
Appendices
boxes, but there was no maintenance/cleaning of equipment after use, which could damage the equipment. Conditioning of ice packs After a training programme was initiated at the state level 2 years ago, the practice of using hard frozen Ice-packs has been followed since the last two years religiously. Solid, frozen Ice-packs are used for transporting vaccines right from the central store down to sub-centres. As a result, vaccines are frequently in direct contact with icepacks or ice. This is particularly relevant when freeze sensitive vaccines are concerned and could explain why frozen (damaged state) T series vaccine vials were found at quite a few sites, which included the following district stores: Chenipur, Dumri, Chakulia, Borio. Vaccine handling All staff can read the VVM indicates and are aware at what stages the vaccine can be used or must be discarded. However, there is very little awareness of the quality indicators for the T series vaccines. None of the staff knew how to perform or interpret the shake test. In fact, when the assessment team pointed out the frozen vials, the staff used their palms to warm the vials. There is also a lack of awareness of the WHO policy with regard to open vials. Frequently, storage in wet conditions either in the cold boxes containing melted ice-packs or in refrigeration equipment where low temperatures cannot be maintained, leads to loss of labels indicating date of manufacture, expiry date, name of vaccine and VVM. Delivery/Fetching Usually, public transport is used for bringing vaccine to the PHC and the sub-centre. The state has adopted the vaccine pull method, whereby vaccine is primarily fetched by the PHC from district stores on fixed days regularly. Since all PHCs do not have vaccine vans, they have made their own arrangements to transport the vaccine. Often the visits are clubbed with visits to the district headquarters for training, regular meetings or salary payments, etc. 6.8. Repair and Maintenance Cold Chain maintenance at the sites is largely corrective rather than preventive. But even when it comes to corrective maintenance, no complaint seems to be have been attended to within 7 days of the reported breakdown. There is a dearth of trained technicians, workshops and spare parts. The state does not have a dedicated technician for each district and equipment maintenance and repair has been contracted to Voltas Refrigeration by UNICEF. The service contract was not reviewed during the assessment The equipment maintenance record throughout the state is poor. There are no regular cleaning and maintenance schedules for equipment. Thermostat setting is not done in a systematic manner. There are long gaps between the reporting of breakdowns and the visit of the servicing technicians. Though technician visits to some PHCs (in Koderma, Godda, Giridih districts for example) were more regular than to others. This was probably because the maintenance contract in East Singhbhum is held by a contractor who has a wide-reaching service network. At the moment, several different firms have been contracted for maintenance but performance has been unsatisfactory. Servicing technicians made visits to few sites to review the status of equipment prior to the Pulse Polio campaign. At that time, some machines were labelled as either condemned or non-functioning. In some cases, CFC-free equipment had been frequently repaired, but had
30
Appendices
always failed within 24 hours of repair. This could be due to the fact that the sub-contracted servicing firms had little knowledge of how to correctly service CFC-free equipment. Masalia PHC, in Dumka district, has an ILR, which has never been used. It has apparently been stored at the PHC for the past 10 years as rats have damaged the wiring and never been repaired. 6.8.1. Cold chain equipment operational conditions
Overall operational conditions are far from satisfactory. In frequent instances the rooms where cold chain equipment is being stored were damp and ceilings leaking with the buildings in a general state of disrepair. Often, the rooms in which the equipment is stored were not well ventilated. At night, the common practice was to shut all windows, leaving the rooms airless. It was also found that the equipment was exposed to direct sunlight at some locations. Even at Giridih district store, many units did not seem to have been cleaned for a long time and had a thick coat of dust on them. Hygiene and cleanliness of locations is definitely a matter for concern. At more than one location, there was a considerable amount of waste strewn around with insufficient attention to immunization equipment: used needles and opened vials left in unsafe conditions after regular immunization. The lack of Grade IV staff was cited as the reason. However, the lack of motivation to maintain cleaner surroundings is possibly due to the fact that the health staff are not being paid regularly. No defrosting or cleaning routine is maintained. There were instances were there was water in the freezer compartment. Internal rusting was also observed in many units. There are units which do not shut tight; gaskets and hinges require replacement; or the insulation has given away. Most units do not lock properly. In the whole state, only 388 thermometers were counted of which many were not working. Many units did not contain thermometers, or if they were available, the temperatures were not recorded correctly. There seems to be a lack of awareness regarding thermostat control. 6.8.2. Maintenance of electrical equipment including generator and stabilizer
Preventive maintenance is a must when it comes to cold chain electrical equipment. The regular maintenance routine for refrigeration equipment should include defrosting, drainage of the defrosted water, cleaning of the condenser and checking of the thermostat operation. Refrigeration units should be placed at a minimum distance of 20cm from the walls and 30cm space should be provided between units. Similarly, the genset requires a periodic change of engine oil and general maintenance. The time allocated for recharging of batteries required to start-up generators requires follow-up and clarification. At 53 sites where the generators had broken down, the problems had arisen some years before; but neither the CS nor the UNICEF office had responded to the reported problem. In some instances, the maintenance and repair costs were met from the pocket of the MOiC or the cold chain in-charge. There is no preventive maintenance or replacement plan with allocation for human, material and financial resources. Ideally, visits for preventive maintenance should be carried out to each site by the maintenance technicians under a contract. Site visits should cover all cold chain refrigeration equipment as well as generators. This would help reduce repairs and response time.
31
Appendices
6.8.3.
There seems to be no maintenance when it comes to non-electrical equipment. The inner surfaces of the cold boxes are very often not cleaned and, all too frequently, water is left in the cold boxes between their use. Some units had cracks and the locks, hinges/handles were not working, but the cold boxes and vaccine carriers continued to be used. The equipment is frequently stored under improper conditions, resulting in rusting of metallic parts, deformation of the plastic body, etc. 6.8.4. Availability of technicians, spares and workshops
The response time after reporting a breakdown has been found to be very long. In some cases the complaint has yet to be attended to and the machine has not been repaired. Assessors spoke to Mr B.K. Ghosh in Patna to discuss the contract held with UNICEF. The maintenance of the cold chain is assured under a UNICEF contract with Voltas in Patna. This contract was entered into with Voltas before Jharkhand was formed and is still managed from Patna with sub-contracts issued to different local firms in Jharkhand.The sub-contract in West Singhbum is managed by Superior Aircon (39 Golmuri Market, Jamshedpur, Tel: 0657 2340212). Technicians at Superior Aircon are well equipped to handle CFC-free repair as they have been trained by Voltas, but it is not evident that the same facilities are available in the other districts. Servicing in this district is done from Jamshedpur using UNICEF funds for repair of equipment, including transport to Jamshedpur when necessary of equipment which is not functioning. It was found that response to breakdown reports in this district was relatively rapid. 6.9. Personnel Even with the most sophisticated equipment, finally the efficiency of the cold chain will depend on the personnel managing it. Usually the LHV or Computer (an accounts-related post) is in charge of the equipment. Often, no back-up staff is available if the designated staff is absent. Lack of staff motivation was generally observed. This could have to do with non-payment of salariesat many of the PHCs the staff had not received salaries for more than four months. But staff motivation was also highly dependent on the CS, MOiC and UNICEF extenders interest and initiative. There were rare instances where personal motivation was high in spite of the setbacks.
32
Appendices
Appendix: O provides the list of all the staff placed on sites visited. The list includes the status of training received. 6.9.1. Training in cold chain
Only 88 cold chain staff has received any training in cold chain. The records were better for some districts than others. For instance, East Singbhum had provided at Jamshedpur in MayJune 2005. In most instances where training has been imparted, it has been a one-time programme with no follow-up. All the staff involved in the cold chain has received training in handling OPV. No specialized training has been provided on equipment maintenance and vaccine storage. The practice of using Early Expiry First Out (EEFO) is not followed at any site visited. There was no knowledge of Bin cards at the staff level. There is considerable ignorance when it comes to handling the T series vaccines. 6.9.2. Training in maintenance of solar equipment
Since solar refrigerators are being introduced in the Jharkhand cold chain for the first time, it is extremely important that staff be trained to operate and maintain the system. A comprehensive initial training programme should be followed by shorter sessions at regular intervals. Training requirements to be added in by TJH 6.10. Monitoring and reporting systems
Recording keeping is a very important component of the cold chain. It is important in vaccine forecasting, requisitioning and stock management, assuring the quality of the cold chain through temperature monitoring, tracking wastage, implementing maintenance and repair, drawing up replacement and contingency plans and identifying training needs. It becomes the basis for evaluating the performance of the cold chain. 6.10.1. Temperature monitoring systems Temperature monitoring seems to lack the kind of accuracy and consistency that is required, although it appears that the staff are aware of the purpose of the entire exercise. Temperature readings are manually recorded at 74 sites. There was however no information available at 62 sites. Often the temperature recording in WHO-recommended temperature booklet are mechanically entered and do not reflect actual readings. At most sites where temperature recording is done, the twice-a-day routine seems to be followed. 6.10.2. Vaccine stock registers
Vaccine stock registers are fairly well-maintained at 140 sites with clear entries of stock received and dispatched. Stock mismatch in terms of physical vs. book stock was found at ----sites. Vaccine wastage is not recorded. 6.10.3. Computerization
At all sites, the cold chain data is manually recorded in registers. In Ranchi district, all PHCs have been computerized as part of the governments computerization programme. The hardware comprises a monitor, a central processing unit, a UPS, a printer, a genset and a specially designed software to collect information related to the cold chain. The hardware has been supplied by Mumbai-based 3DI Systems (India) Pvt. Ltd.
33
Appendices
7. MAJOR OBSERVATIONS
7.1. Buildings, equipment and transport In quite a few instances, the buildings in which the equipment is located are poorly ventilated and damp. The current models of stabilizers provided at most PHCs cannot handle low voltage. At many sites the equipment has not been earthed properly. Often, generators are not run when there are power outages during the routine immunization programme. Generators are frequently out of order and need repair or replacement. -----% of the equipment run without voltage stabilizers. Cold boxes with rusted locks, broken hinges and without gaskets continue to be used. Hygiene and cleanliness at most PHCs is neglected. Only a few PHCs have running water supply and usable toilets. Most PHCs rely on public transport to fetch routine vaccine supplies. 7.2. Management and logistics There is no general strategy adopted for disposal of medical waste, which is buried, burnt or stored. At most locations, safety boxes have been provided and in some, hub cutters which are often not being used. The allocation and placement of the cold chain equipment is more dependent on assured and reliable power supply than the needs of the programme. Functioning thermometers are frequently not available and many PHCs do not have thermometers. Thermometers which are not working have not been replaced. Temperature reading is not done regularly and accurately at all sites. There were innumerable instances of incorrect temperature recording or regular recording of the same daily temperature. No regular fund is provided to run the generators except during campaigns and IPPI. Interested MoICs succeed in finding their own sources, but are frequently not adequately reimbursed. PHCs seem to have access to diesel budgets only during catch-up rounds. There are ----- locations which have had no power supply for the past 5 years. In Birni, Tandwa and Kanke there is no official power supply. Distribution of funds seems to be unequal within districts; some PHCs have had to prefinance the solar wiring installation instead of being provided with the funds allocated for this purpose. Day carriers have been called back to the central level but have not been replaced. The cold chain equipment at Tandwa was delivered two years ago but lies unpacked in a dilapidated building because the village has no power supply. Hundreds of used vials were stored in plastic bags in condmned freezers at---- PHC.
34
Appendices
Some CSs take excellent initiatives to support and prioritize the cold chain programme. Rapid improvement in electrical installations (3-phase) at East Singbhum is an example. 7.3. Repair and maintenance In most instances where the R-134a (CFC-free) units were repaired and failed, the failure seems to be largely due to the fact that the technician was ill-equipped to rectify the problem. The post of the refrigeration technician at Giridih district store, which has a WIC, has been lying vacant for several years. At Giridih, all the precautionary and safety measures for the WIC have been bypassed. Many stabilizers which have been repaired locally, have had the delay bypassed, defeating the very purpose of its use. There is no stock of stabilizers and no replacement of stabilizers that have failed. No instructions have been given with regard to the non-working/beyond repair machines. These occupy the already limited space at the PHCs. No product manuals are available for the WICs and WIFs. There is no itemised replacement plan. No contingency or emergency plans exist. 7.4. Personnel There is negligence when it comes to the T series vaccines. The use of VVMs on OPV vaccine is well integrated, but there is a considerable lack of knowledge about the vulnerability of T series vaccines to freezing. Not one person questioned performs the shake test for the T series. Improper storage of vaccines in damp and water- logged condition in cold boxes and plastic carry bags leads to the loss of labels; which are important to identify the batch number, vaccine name, manufacturing date, expiry date as well as VVMs. It was reported that UNICEF extenders provide unequal support. In some districts such as East Singhbhum, the UNICEF extender does an excellent job and is well supported by the Civil surgeon. However, this approach is not the same in every district. The clerk, computer or LHV usually handles the cold chain. Very few staff have undergone any training. Of those who have undergone training, the last training programme they attended was in the year May/June 2005 at Jamshedpur. Other global training on cold chain operation and management seems to date back 5-6 years. The staff lack awareness on how vaccine should be stored in ILRs with no allowance made for air circulation or stacking same vaccines together. The T series vials are often placed at the bottom of the ILR. The general view is that only frozen Ice-packs should be used. T series vaccines are placed in the centre in poly bags with no attempt made to isolate the T series from icepacks by newspaper or card. The cold chain staff is unaware of the hazards of leaving vials and used syringes undisposed. No training has been provided on the use of safety boxes and hub cutters.
35
Appendices
7.5. Record keeping Temperature recording in not accurate. The vaccine stock registers do not reflect damaged and returned stocks and are not up-todate at all sites. At quite a few sites there was a mismatch between stocks available and stocks recorded. Maintenance and repair activities (equipment and transport) are not recorded. There is no record of training programmes attended.
8. RECOMMENDATIONS
8.1. Short-term A plan as to what is to be done with beyond repair and non-working equipment needs to be prepared. Special care needs to be taken when it comes to disposal of CFC machines. Define the average working life for each piece of equipment and advise on procedures for removing equipment from inventory. Units which are rusted externally and internally (CFC/non-CFC) and where the fault lies in the sealed system should not be repaired and should be removed from the inventory. All CFC equipment which is not working and the body has rusted (indicating reduced life-span) should not be repaired. All non-CFC, once repaired and again non-functional should not be repaired again. Frequently, the unit has been damaged beyond repair by the local mechanics if the sealed system has been touched. Stabilizers need to be repaired centrally with clear instructions not to by-pass any safety control measure. Wiring and earthing need to be corrected on priority. Voltas now supplies a stabilizer which can deal with low voltage. It is recommended that its performance be observed for some time and if found efficient, it be adopted for use at all PHCs. Maintenance should preferably be preventive and not fire-fighting as is the present approach. Funds must be made available through UNICEF for better and more regular maintenance coverage. Contract could be given to one sub-contractor with strict performance-bound contract renewal clauses. Some PHCs stock relatively large quantities of vaccine. This is inadvisable when there is insufficient backup power. Although the catch up programme could be one explanation for the stocks, it is suggested that UNICEF immediately review quality and size of stock at each location. An immediate review is required of the proposed solar systems. Although this is a hybrid system, allowance should be made for low grid electricity inputs and frequent breakdowns. The load seems also relatively high: extractor fan, plugs and lights as well as often a room fan. Systems should be sized according to demand, electricity availability and load. Further substantial technical improvements need to be made to the accessories and the installation standards have to be considerably improved. Equipment operation/management instructions be supplied in the local languages.
36
Appendices
Product manuals be supplied with all new equipment installed. Following table summarises the net requirement (shortage) of refrigeration units. This shortage is drawn based on idea requirement in state (as listed in Appendix: A). Detailed analysis is available at Appendix: B. Recommended number of equipment required, summarised district wise
District Small Net requirement of new units ILR DF Large Small Large
Bokaro 3 3 9 1 Chatra 2 3 Deoghar 1 4 Dhanbad 3 4 4 Dumka 5 8 East Singhbhum 5 2 4 Garhwa 1 4 Giridih 1 4 2 Godda 1 4 Gumla 2 1 5 Hazaribagh 2 1 2 2 Jamtara 1 3 Koderma 1 2 Latehar 1 1 6 Lohardaga 1 Pakur 1 Palamu 2 1 5 Ranchi 5 4 11 Sahebganj 3 Saraikela Kharsawan 4 3 Simdega 2 4 West Singhbhum 6 7 Grand Total 49 23 88 7 Table 18: Shortage of cold chain equipment (sumamrised district wise)
8.2. Medium-term It is essential to repair the WIC and the power back-up equipment at the Giridih district store in order to supply vaccine to Deogarh, Godda, Sahibganj, Pakur, Dumka, Jamtara, and Koderma. It is recommended that an additional WIC be established at East Singhbum (Jamshedpur) to supply vaccine to East and West Singhbum, Saraikela, and Chaibasa districts, and one at Palamu (Daltenganj) to supply vaccine to Chatra, Latehar, Garwha districts. Districts like Hazaribagh, Gumla, Lohardaga and Dhanbad can continue to receive vaccine directly from the Ranchi central store. An intensive training programme needs to be conducted for all health workers with cold chain responsibilities covering importance of cold chain, equipment operation and maintenance, site maintenance, temperature recording and its importance, handling freeze sensitive vaccines, conducting and interpreting the shake test, sharp waste disposal and efficient record keeping. EPI training also needs to be conducted for middle-level managers.
37
Appendices
Technician training programmes also need to be conducted, which should also cover best practices for CFC-free machines. Drawing up a policy for systematic disposal of sharps and vaccine. Budgetary allocations for fuel to run the generator must be made. Appropriate personnel should be identified and trained for the operation and maintenance of solar equipment. The contract for the provision of the solar hybrid equipment must be accompanied by a maintenance contract to cover the repair and maintenance of this equipment. This should include a provision for the replacement of solar batteries. Itemised replacement plans should be drawn up and financial, material and personnel allocations made. All sites should have contingency/emergency plans for sudden breakdowns. 8.3. Long-term On-going training must be provided to upgrade skills and knowledge of existing and new staff in the operation and maintenance of equipment, and vaccine handling. Developing local capacity for equipment repair and maintenance and manufacturing spares. Improve efficiencies in cold chain to pursue WHO accreditation for EVSM.
9. CONCLUSION
To sum up, when evaluated against WHO-recommended standards the cold chain system in the state leaves much to be desired. The conclusion is that quality immunization services cannot be provided reliably and with confidence. The fragile system relies considerably on the goodwill of the health service staffs efforts to sustain the regular programme. Though the Pulse Polio campaigns and catch-up programmes have additional resources to fill the gaps, the regular programme lacks both financial and material resources. Preventive maintenance is minimal. Speedy corrective maintenance is also not possible due to the lack of trained technicians and spare parts. No official contingency or emergency plans have been drawn up to handle sudden breakdowns. There is no replacement plan for equipment or transport. Training is insufficient and some of the cold chain personnel have received no training at all. There is gross ignorance when it comes to preserving integrity of freeze-sensitive vaccines and none know how to perform or interpret the shake test. Cold Chain Monitors (CCMs) and freeze indicators are not used. Record keeping, whether it is related to stocks, fuel usage or maintenance, is unsatisfactory.
38
Appendices
APPENDIXES A TO O
39
Appendices
APPENDIX: A OPTIMUM SIZE OF COLD CHAIN EQUIPMENT FOR ALL THE STORE FACILITIES OF STATE
Net Requirement based Transportaon target population tion ILR ( Gross Litres) 888 30 87 57 50 93 87 85 307 89 395 58 58 58 58 58 58 467 59 59 59 59 59 59 59 1197 133 37 69 152 146 190 49 45 475 14 46 DF (Gross Litres) 400 30 87 57 50 93 87 85 307 89 178 58 58 58 58 58 58 210 59 59 59 59 59 59 59 539 133 37 69 152 146 190 49 45 214 14 46 Cold Box ( Gross Litres) 83 11 32 21 18 34 32 31 112 32 37 21 21 21 21 21 21 44 21 21 21 21 21 21 21 113 48 14 25 55 53 69 18 16 45 5 17
District
Site
Type
Total Population 1775961 68553 197329 129827 113608 212090 197329 193160 697690 201989 790680 131780 131780 131780 131780 131780 131780 933113 133302 133302 133302 133302 133302 133302 133302 2394434 302598 84802 157881 344624 331133 432839 111024 102834 950853 31744 104245
40
Bokaro Bokaro Bokaro Bokaro Bokaro Bokaro Bokaro Bokaro Bokaro Bokaro Chatra Chatra Chatra Chatra Chatra Chatra Chatra Deoghar Deoghar Deoghar Deoghar Deoghar Deoghar Deoghar Deoghar Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Dumka Dumka Dumka
Bokaro Jiridih Kasmar Nawadhi Peterwar Bermo Bokaro Chandankyari Chas Gumia Chatra Chatra Hunterganj Itkhori Pratappur Simaria Tandwa Deoghar Jasidih Karon Madhupur RH Mohanpur Palajori Sarat Sarwan Dhanbad Bagmara Baliapur Govindpur Johrapokhar Nirsa Sadar PHC Topchanchi Tundi Dumka DS Gopi Kandar Jama
DS PHC PHC PHC PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC PHC PHC DS PHC PHC
Appendices
District
Site
Type
Total Population 117204 52801 95121 113705 79797 108825 101862 95536 1982988 149530 108806 72528 53615 115130 1076544 104299 131879 170657 801350 100169 100169 100169 100169 100169 100169 100169 100169 1901564 236482 118951 134425
Net Requirement based Transportaon target population tion ILR ( Gross Litres) 52 23 42 50 35 48 45 42 991 66 48 32 24 51 474 46 58 75 401 44 44 44 44 44 44 44 44 951 104 52 59 DF (Gross Litres) 52 23 42 50 35 48 45 42 446 66 48 32 24 51 474 46 58 75 180 44 44 44 44 44 44 44 44 428 104 52 59 Cold Box ( Gross Litres) 19 8 15 18 13 17 16 15 93 24 17 12 9 18 172 17 21 27 38 16 16 16 16 16 16 16 16 89 38 19 22
Dumka Dumka Dumka Dumka Dumka Dumka Dumka Dumka East Singhbhum East Singhbhum East Singhbhum East Singhbhum East Singhbhum East Singhbhum East Singhbhum East Singhbhum East Singhbhum East Singhbhum Garhwa Garhwa Garhwa Garhwa Garhwa Garhwa Garhwa Garhwa Garhwa Giridih Giridih Giridih Giridih
Jarmundi Kathikund Masalia Ramgarh Raneswar Sadar PHC Saraya Shikaripada Jamshedpur DHQ Baharagharah Chakulia Dalbhumgarh Dhumria Ghatsella Jugsalai Musabani Patomda Potka Garhwa DS Bhandaria Bhavaanathpur Dhurki Garhwa Block Majhion Meral Nagaruntari Ranka Giridih Bagodar Bengabad Birni
PHC PHC PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC PHC PHC DS PHC PHC PHC
41
Appendices
District
Site
Type
Total Population 140436 179114 136112 210107 149195 87204 198145 73604 149195 861182 123026 123026 123026 123026 123026 123026 123026 707555 50561 41700 44573 60059 75056 59626 61388 55641 75738 59626 1836068 141236 141236 141236 141236 141236 141236 141236 141236 141236 141236 141236 141236 141236
Net Requirement based Transportaon target population tion ILR ( Gross Litres) 62 79 60 92 66 38 87 32 66 431 54 54 54 54 54 54 54 354 22 18 20 26 33 26 27 24 33 26 918 62 62 62 62 62 62 62 62 62 62 62 62 62 DF (Gross Litres) 62 79 60 92 66 38 87 32 66 194 54 54 54 54 54 54 54 159 22 18 20 26 33 26 27 24 33 26 413 62 62 62 62 62 62 62 62 62 62 62 62 62 Cold Box ( Gross Litres) 22 29 22 34 24 14 32 12 24 40 20 20 20 20 20 20 20 33 8 7 7 10 12 10 10 9 12 10 86 23 23 23 23 23 23 23 23 23 23 23 23 23
Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Godda Godda Godda Godda Godda Godda Godda Godda Gumla Gumla Gumla Gumla Gumla Gumla Gumla Gumla Gumla Gumla Gumla Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh
Deori Dumri Gandey Jamua MCH Pirtand Raj Dhanwar Tisri Sadar Block Godda Boarijore Mahagama Meharma Patthargama Podayahat Sadar Block Sundarpahari Gumla Bharno Bishnupur Chainpur Dumri Ghagra Kamdara Palkot Raidih Sisai RH Basia Hazaribagh Churchu Barakatha Barhi Berkagaon Chaparan Gola Ichak Katkamsari Keredari Mandu Patratu Ramgarh Vishnugarh
PHC PHC PHC PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC PHC PHC PHC RH DS FPC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC
42
Appendices
District
Site
Type
Total Population 544856 136214 136214 136214 136214 540901 119961 221147 102479 467071 77845 77845 77845 77845 77845 77845 288886 57777 57777 57777 57777 57777 564253 47291 56331 73762 140665 79612 1533173 133862 92078 177013 166843 87499 177013 79345 97622 123820 146139
Net Requirement based Transportaon target population tion ILR ( Gross Litres) 272 60 60 60 60 270 53 97 45 234 34 34 34 34 34 34 144 25 25 25 25 25 282 21 25 32 62 35 767 59 41 78 73 38 78 35 43 54 64 DF (Gross Litres) 123 60 60 60 60 122 53 97 45 105 34 34 34 34 34 34 65 25 25 25 25 25 127 21 25 32 62 35 345 59 41 78 73 38 78 35 43 54 64 Cold Box ( Gross Litres) 26 22 22 22 22 25 19 35 16 22 12 12 12 12 12 12 14 9 9 9 9 9 27 8 9 12 23 13 72 21 15 28 27 14 28 13 16 20 23
Jamtara Jamtara Jamtara Jamtara Jamtara Koderma Koderma Koderma Koderma Latehar Latehar Latehar Latehar Latehar Latehar Latehar Lohardaga Lohardaga Lohardaga Lohardaga Lohardaga Lohardaga Pakur Pakur Pakur Pakur Pakur Pakur Palamu Palamu Palamu Palamu Palamu Palamu Palamu Palamu Palamu Palamu Palamu
Sadar DS Jamtara Kundahit Nala Narayanpur Koderma Jainagar Koderma (Jhumri Talaya) PHC Markacho Latehar Balumath Barawadhi Chandwa Latehar Mahuatan Manika Lohardaga Bandra Kisko Kuru Lohardaga Senha Pakur Amrapada Hiranpur Littipara Maheshpur Pakudia Daltanganj Bishrampur Block PHC Chainpur Chattarpur Hariharganj Husainabad Lisliganj Manatu Panki Patan
DS PHC PHC PHC PHC DS PHC PHC PHC DS PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC
43
Appendices
District
Site
Type
Total Population 24060187 2214088 88554 103733 61917 63734 78792 84033 46615 62696 91451 62514 32105 94347 83231 99132 61931 117760 738686 78865 97179 66773 736835 105262 105262 105262 105262 105262 105262 105262 707175 115295 109877 93832 53801
Net Requirement based Transportaon target population tion ILR ( Gross Litres) 12030 1107 39 46 27 28 35 37 0 21 0 28 40 28 14 42 37 44 27 52 325 35 43 29 368 46 46 46 46 46 46 46 354 51 48 41 24 DF (Gross Litres) 5414 498 39 46 27 28 35 37 0 21 0 28 40 28 14 42 37 44 27 52 325 35 43 29 166 46 46 46 46 46 46 46 159 51 48 41 24 Cold Box ( Gross Litres) 1131 104 14 17 10 10 13 13 0 7 0 10 15 10 5 15 13 16 10 19 118 13 16 11 35 17 17 17 17 17 17 17 33 18 18 15 9
Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Sahebganj Sahebganj Sahebganj Sahebganj Sahebganj Sahebganj Sahebganj Sahebganj Saraikela Kharsawan Saraikela Kharsawan Saraikela Kharsawan Saraikela Kharsawan Saraikela
Namkum Ranchi DS Anigara Bero Bundu Chancho Karra Khunti Khunti Lapung MCH Murhu Namkum Oremanjhi Rania Silli Sonahatu Tamar Aarki Burmu Kanke Mander Ratu Torpa Sadar Hospital Baharawa Barhait Borio Pathna Rajmahal Sadar PHC Taljhari Chandel (DS) Chandel Ghamaria Ichagarh Kuchai
CS DS PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC
44
Appendices
District
Site
Type
Total Population
Net Requirement based Transportaon target population tion ILR ( Gross Litres) 36 31 51 27 223 25 25 25 25 25 25 25 25 540 38 50 29 70 32 25 26 22 40 32 32 24 DF (Gross Litres) 36 31 51 27 100 25 25 25 25 25 25 25 25 243 38 50 29 70 32 25 26 22 40 32 32 24 Cold Box ( Gross Litres) 13 11 19 10 21 9 9 9 9 9 9 9 51 14 18 11 26 12 9 9 8 14 12 12 9
Kharsawan Saraikela Kharsawan Saraikela Kharsawan Saraikela Kharsawan Saraikela Kharsawan Simdega Simdega Simdega Simdega Simdega Simdega Simdega Simdega Simdega West Singhbhum West singhbhum West Singhbhum West Singhbhum West singhbhum West Singhbhum West Singhbhum West Singhbhum West singhbhum West Singhbhum West Singhbhum West Singhbhum West
Nemdeah Raj Kharsawan Rajnagar Saraikela Sub Depot Simdega Bano Bolba Jaldega Kolebera Kurdeg Simdega Simdega PHC Thethaitnagar Chaibasa Sadar Barajamda
PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC PHC PHC DS PHC
82854 69889 116817 60294 446421 55803 55803 55803 55803 55803 55803 55803 55803 1080780 86763 113764 66362 159656 72901 57325 58924 48931 89898 72391 73280 53911
45
Chakradharpur PHC Goilkara Jagganathpur Jinkpani Khutpani Kumardungi Manjgaun Manoharpur SadarChaibasa Sonua Tonto PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC
Appendices
District
Site
Type
Total Population
Net Requirement based Transportaon target population tion ILR ( Gross Litres) DF (Gross Litres) Cold Box ( Gross Litres)
Singhbhum
Table 19: Optimum size of cold chain equipment
46
Appendices
1 1 1 1 1
1 1 1
1 1 1
1 1 1 8
3 3
3 1 1 1
3 1
1 1 1 2 5 1 1 1 2 1 1 1 1
1 3 5 3 1 1 1 1 1 1 2 1
-590 64 7 37 44 111 117 9 -213 5 -409 217 -58 36 36 36 -58 130 339 647 35 35 129 35 35 35 35
-102 64 -87 37 154 -93 -87 119 -307 -89 -391 120 -58 36 36 -58 146 -58 164 -6 35 35 -59 35 35 145 35
Appendices
Net Requirement (in Gross ltr) District Site Type ILR Deoghar Total Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Total Dumka Dumka Dumka Dumka Dumka Dumka Dumka Dumka Dumka Dumka Dumka Dumka Total East Singhbhum East Singhbhum East Singhbhum East Singhbhum East Singhbhum East Singhbhum East Singhbhum 877 1197 133 37 69 152 146 190 49 45 2019 475 14 46 52 23 42 50 35 48 45 42 872 991 66 48 32 24 51 474 DF 621 539 133 37 69 152 146 190 49 45 1361 214 14 46 52 23 42 50 35 48 45 42 610 446 66 48 32 24 51 474
Operational Units ILR DF Large (204 Ltr Goss) Large (204 Ltr Goss) Small (94 Ltr Gross) Small (94 Ltr gross)
9 2 2 1 2 1 1 1 1 11 4 1 1 1 1 1 1 10 7 1 1 1 1 2 1
Dhanbad Bagmara Baliapur Govindpur Johrapokhar Nirsa Sadar PHC Topchanchi Tundi Dumka DS Gopi Kandar Jama Jarmundi Kathikund Masalia Ramgarh Raneswar Sadar PHC Saraya Shikaripada Jamshedpur DHQ Baharagharah Chakulia Dalbhumgarh Dhumria Ghatsella Jugsalai
DS PHC PHC PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC
5 2
5 1
2 3 2 2 3 1
2 2
2 1 1 2 7 1
11 1
1 4 2 1 1 1 1 2
1 4
989 -789 55 151 25 36 -52 -96 45 49 -577 309 80 -46 42 71 -42 44 -35 46 49 -42 476 -333 28 46 62 70 137 -380
257 73 -39 371 339 460 246 -96 45 143 1541 84 -14 -46 42 -23 -42 44 -35 -48 -45 52 -30 558 28 46 62 70 153 -286
4 4 1
1 1 1 1 3 1 2 1 1 1 1 1 8 3 1 2
1 1 1
1 4
4 1 1
1 5
1 5
Appendices
Net Requirement (in Gross ltr) District Site Type ILR East Singhbhum Musabani East Singhbhum Patomda East Singhbhum Potka East Singhbhum Total Garhwa Garhwa DS Garhwa Bhandaria Garhwa Bhavaanathpur Garhwa Dhurki Garhwa Garhwa Block Garhwa Majhion Garhwa Meral Garhwa Nagaruntari Garhwa Ranka Garhwa Total Giridih Giridih Giridih Bagodar Giridih Bengabad Giridih Birni Giridih Deori Giridih Dumri Giridih Gandey Giridih Jamua Giridih MCH Giridih Pirtand Giridih Raj Dhanwar Giridih Tisri Giridih Sadar Block Giridih Total Godda Godda Godda Boarijore PHC PHC PHC DS PHC PHC PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC DS PHC 46 58 75 1864 401 44 44 44 44 44 44 44 44 753 951 104 52 59 62 79 60 92 66 38 87 32 66 1748 431 54 DF 46 58 75 1319 180 44 44 44 44 44 44 44 44 533 428 104 52 59 62 79 60 92 66 38 87 32 66 1226 194 54
Operational Units ILR DF Large (204 Ltr Goss) Large (204 Ltr Goss) Small (94 Ltr Gross) Small (94 Ltr gross)
1 1 2 18 2 1 1 1 1 1 1 2 10 1 1 1 1 1 1 2 1 1 1 1 1 13 2 1
1 1 1 10 2 1 7 3
1 1 1 1 5 4 1
2 1
2 1
2 2 1 1 1 1 1 1 1 8 1 1
1 1
10 1
48 36 113 -172 195 50 50 50 -44 50 50 50 144 595 -747 -10 42 35 32 15 34 96 28 56 7 62 28 -322 -39 40
158 36 223 1049 432 -44 -44 -44 -44 50 50 160 160 675 388 194 -52 -59 346 109 144 112 28 260 7 62 28 1566 104 -54
1 1 1 4 5 2
1 1
1 2 1 1 2 1 4 1
Appendices
Net Requirement (in Gross ltr) District Site Type ILR Godda Godda Godda Godda Godda Godda Godda Total Gumla Gumla Gumla Gumla Gumla Gumla Gumla Gumla Gumla Gumla Gumla Gumla Total Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Mahagama Meharma Patthargama Podayahat Sadar Block Sundarpahari Gumla Bharno Bishnupur Chainpur Dumri Ghagra Kamdara Palkot Raidih Sisai RH Basia Hazaribagh Churchu Barakatha Barhi Berkagaon Chaparan Gola Ichak Katkamsari Keredari Mandu PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC PHC PHC PHC RH DS FPC PHC PHC PHC PHC PHC PHC PHC PHC PHC 54 54 54 54 54 54 810 354 22 18 20 26 33 26 27 24 33 26 611 918 62 62 62 62 62 62 62 62 62 62 DF 54 54 54 54 54 54 573 159 22 18 20 26 33 26 27 24 33 26 416 413 62 62 62 62 62 62 62 62 62 62
Operational Units ILR DF Large (204 Ltr Goss) Large (204 Ltr Goss) Small (94 Ltr Gross) Small (94 Ltr gross)
2 1 1 1 1 1 10 1 1
1 1 1 1 2 2
1 1
4 1 1
1 1 1 1 1 1 1 8 1 1 1 1 1 1 2 1 1 1
1 1 4 4 1 1 1 1 2 1 1 1
1 1 6 2
134 40 40 40 40 40 334 -150 72 76 -20 -26 61 68 67 70 61 68 345 -102 32 32 32 -62 32 32 -62 32 126 32
40 -54 40 40 -54 150 211 249 72 76 184 -26 265 -26 -27 180 265 -26 1184 -5 32 32 32 -62 32 126 -62 32 32 32
2 1 1 5 1 1 1
1 1 2 3
1 1 1
1 1 3 1 1 1 1 1 1 1 2 1 4 2 2 1 1
Appendices
Net Requirement (in Gross ltr) District Site Type ILR Hazaribagh Hazaribagh Hazaribagh Hazaribagh Total Jamtara Jamtara Jamtara Jamtara Jamtara Jamtara Total Koderma Koderma Koderma Koderma Koderma Total Latehar Latehar Latehar Latehar Latehar Latehar Latehar Latehar Total Lohardaga Lohardaga Lohardaga Lohardaga Lohardaga Lohardaga Patratu Ramgarh Vishnugarh Sadar DS Jamtara Kundahit Nala Narayanpur Koderma Jainagar Koderma (Jhumri Talaya) PHC Markacho Latehar Balumath Barawadhi Chandwa Latehar Mahuatan Manika Lohardaga Bandra Kisko Kuru Lohardaga Senha PHC PHC PHC DS PHC PHC PHC PHC DS PHC PHC PHC DS PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC 62 62 62 1726 272 60 60 60 60 512 270 53 97 45 466 234 34 34 34 34 34 34 439 144 25 25 25 25 25 DF 62 62 62 1221 123 60 60 60 60 362 122 53 97 45 317 105 34 34 34 34 34 34 311 65 25 25 25 25 25
Operational Units ILR DF Large (204 Ltr Goss) Large (204 Ltr Goss) Small (94 Ltr Gross) Small (94 Ltr gross)
1 1 2 13 3 1 1 1 6 3 1 1 1 6 1 1 1 1 1 2 7 1 1 3 1 2 1
1 1 4 1 11 3 2
1 3 2 1 4 1 2 2 1 1 3
32 32 126 312 10 34 34 34 -60 52 828 41 -3 49 914 -140 60 60 60 60 -34 154 219 -50 69 257 69 163 69
32 142 32 425 285 -60 -60 144 -60 250 380 -53 107 49 483 83 60 60 -34 -34 -34 -34 65 343 273 257 477 367 367
1 3 1
1 2 4 2 1
1 2
1 1 1 1 2
1 1
1 1
4 1 3 1 2 2 2 1 2 1 1
1 1 1 1 2
1 1
Appendices
Net Requirement (in Gross ltr) District Site Type ILR Lohardaga Total Pakur Pakur Pakur Pakur Pakur Pakur Pakur Total Palamu Palamu Palamu Palamu Palamu Palamu Palamu Palamu Palamu Palamu Palamu Palamu Total Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi 272 282 21 25 32 62 35 457 767 59 41 78 73 38 78 35 43 54 64 1330 1107 39 46 27 28 35 37 21 DF 192 127 21 25 32 62 35 302 345 59 41 78 73 38 78 35 43 54 64 909 498 39 46 27 28 35 37 21
Operational Units ILR DF Large (204 Ltr Goss) Large (204 Ltr Goss) Small (94 Ltr Gross) Small (94 Ltr gross)
Pakur Amrapada Hiranpur Littipara Maheshpur Pakudia Daltanganj Bishrampur Block PHC Chainpur Chattarpur Hariharganj Husainabad Lisliganj Manatu Panki Patan Namkum Ranchi DS Anigara Bero Bundu Chancho Karra Khunti Khunti Lapung
DS PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC CS DS PHC PHC PHC PHC PHC PHC PHC PHC
9 4 1 1 1 1 1 9 2 1 1 1 1 1 1 1 1 10 2 1 2 1 1 1 1
9 3 1 1 1 1 4
7 3
3 2
3 2
1 1 2 1
2 1
1 6 1 1
1 3 3 1 1 1
2082 485 73 69 62 -62 59 686 63 -59 -41 -78 21 56 110 59 -43 -54 234 267 208 55 158 177 176 -35 57 298 -21
5 1
1 1
1 1 2 2
1 1
Appendices
Net Requirement (in Gross ltr) District Site Type ILR Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Total Sahebganj Sahebganj Sahebganj Sahebganj Sahebganj Sahebganj Sahebganj Sahebganj Sahebganj Total Saraikela Kharsawan Saraikela Kharsawan Saraikela Kharsawan Saraikela Kharsawan Saraikela Kharsawan Saraikela Kharsawan MCH Murhu Namkum Oremanjhi Rania Silli Sonahatu Tamar Aarki Burmu Kanke Mander Ratu Torpa Sadar Hospital Baharawa Barhait Borio Pathna Rajmahal Sadar PHC Taljhari Chandel (DS) Chandel Ghamaria Ichagarh Kuchai Nemdeah PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC DF
Operational Units ILR DF Large (204 Ltr Goss) Large (204 Ltr Goss) Small (94 Ltr Gross) Small (94 Ltr gross)
1 1 2 1 1 1 1 1 1 1 1 1 1 23 7 1 2 2 1
1 1 1 1 1 1
1 1 1 1 9 1 1 1 1 2 1 1 8 2
1 1
12 2 1 1
13 5 1 1
5 2 1
94 66 148 66 80 52 57 50 -27 42 -231 59 51 65 285 494 48 142 -46 142 48 -46 -46 733 116 43 46 -41 -24 -36
66 54 176 -14 256 167 -44 -27 152 -231 169 -43 65 1822 336 252 252 48 142 158 48 48 1282 437 153 -48 -41 -24 58
1 1 3
2 1
1 1
2 1
1 1 1 1 1 3
1 1 1
Appendices
Net Requirement (in Gross ltr) District Site Type ILR Saraikela Kharsawan Raj Kharsawan Saraikela Kharsawan Rajnagar Saraikela Kharsawan Saraikela Sub Depot Saraikela Kharsawan Total Simdega Simdega Simdega Bano Simdega Bolba Simdega Jaldega Simdega Kolebera Simdega Kurdeg Simdega Simdega Simdega Simdega PHC Simdega Thethaitnagar Simdega Total West Singhbhum Chaibasa Sadar West singhbhum Barajamda West Singhbhum Chakradharpur West Singhbhum Goilkara West singhbhum Jagganathpur West Singhbhum Jinkpani West Singhbhum Khutpani West Singhbhum Kumardungi West singhbhum Manjgaun West Singhbhum Manoharpur West Singhbhum Sadar-Chaibasa West Singhbhum Sonua West Singhbhum Tonto West Singhbhum Total Grand Total PHC PHC PHC DS PHC PHC PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC 31 51 27 663 223 25 25 25 25 25 25 25 25 420 540 38 50 29 70 32 25 26 22 40 32 32 24 960 22088 DF 31 51 27 468 100 25 25 25 25 25 25 25 25 297 243 38 50 29 70 32 25 26 22 40 32 32 24 663 15472
Operational Units ILR DF Large (204 Ltr Goss) Large (204 Ltr Goss) Small (94 Ltr Gross) Small (94 Ltr gross)
1 2 10 3 2 1 2 1 1 2 12 6 1 2 1
1 1 3
1 1 1 6 1
3 3 1 2 2
3 1
1 3 3 1 1
1 9 4
1 1 1 1 1 1 9 121
1 13 233 1 40
4 104
-31 43 365 481 671 163 -25 69 163 -25 69 69 163 1320 228 56 138 -29 24 -32 -25 68 72 -40 -32 62 -24 466 7974
63 43 67 708 512 273 -25 383 477 -25 -25 -25 273 1821 855 -38 44 65 -70 -32 -25 -26 -22 54 62 62 70 999 17118
1 1 1
1 1 1 1 1 1 1 1
1 1
1 1 1 6 49
1 5 44
1 4
2 18
1 43
23
Appendices
District Bokaro Bokaro Bokaro Bokaro Bokaro Bokaro Bokaro Bokaro Bokaro Bokaro Total Chatra Chatra Chatra Chatra Total Deoghar Deoghar Deoghar Deoghar Deoghar Deoghar Deoghar Total Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Total Dumka Dumka Dumka Dumka Dumka Dumka Dumka Dumka Dumka Dumka Total East Singhbhum East Singhbhum East Singhbhum
Site Bokaro Jiridih Kasmar Nawadhi Peterwar Bermo Chandankyari Chas Gumia Chatra Pratappur Simaria Deoghar Jasidih Karon Madhupur RH Mohanpur Sarat Dhanbad Bagmara Johrapokhar Nirsa Sadar PHC Topchanchi Tundi Dumka DS Jama Jarmundi Kathikund Masalia Raneswar Sadar PHC Saraya Shikaripada Jamshedpur DHQ Baharagharah Chakulia
Type DS PHC PHC PHC PHC PHC PHC PHC PHC DS PHC PHC DS PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC PHC PHC DS PHC PHC
1 1 1 1 1
1 2 1 1 2 9 1 2 3 7
1 6 1 1 1 1 1 1 1 1 6 1 1 1 1 1 4 2 1 1 1 1 1 1 6 5 1 1 1 4 3 1 1 3 2 1
7 8
9 1 1
3 1 1 2 3 1 1 1 2 15 1 1 2 4 8 1 1 1 1 1 13 8 1 1 2 1 1 2 16 2 3 2 1 1 1 1 1 1 13 5 1 1
1 1
1 3
3 1
Appendices
District East Singhbhum East Singhbhum East Singhbhum East Singhbhum East Singhbhum East Singhbhum East Singhbhum East Singhbhum Total Garhwa Garhwa Garhwa Garhwa Garhwa Garhwa Garhwa Garhwa Garhwa Total Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Total Godda Godda Godda Godda Godda Godda Godda Godda Total Gumla Gumla Gumla Gumla Gumla Gumla Gumla
1 1 2 1 1 1 2 16
1 1 1
1 1 3 1 1 1 3 18 1 1 1 1 2 2 2 2 11 3 1 2 2 1 2 2 1 2 2 3 2 23 4 2 1 1 1 1 1 11 3 1 2 1 1 1 2
Garhwa DS Bhandaria Bhavaanathpur Dhurki Garhwa Block Meral Nagaruntari Ranka Giridih Bagodar Bengabad Birni Deori Dumri Gandey Jamua MCH Pirtand Raj Dhanwar Tisri Sadar Block Godda Boarijore Mahagama Meharma Patthargama Podayahat Sadar Block Gumla Bharno Bishnupur Chainpur Ghagra Kamdara Palkot
DS PHC PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC
1 1 1 2 2 1 1 5 2 1 1 1 1 1 1 1 1 1 1 11 2 1 1 1 1 1 1 1 1 1 1 10 2
1 2 5 1 1 1 1
1 2 1
6 1 1
1 1 3
2 3
1 1 1
1 1
Appendices
District Gumla Gumla Gumla Gumla Total Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Total Jamtara Jamtara Jamtara Jamtara Jamtara Total Koderma Koderma Koderma Koderma Koderma Total Latehar Latehar Latehar Latehar Latehar Latehar Latehar Total Lohardaga Lohardaga Lohardaga Lohardaga Lohardaga Lohardaga Lohardaga Total Pakur Pakur
Site Raidih Sisai RH Basia Hazaribagh Churchu Barakatha Barhi Berkagaon Chaparan Gola Ichak Katkamsari Keredari Mandu Patratu Ramgarh Vishnugarh
Type PHC PHC RH DS FPC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC
1 1 6
1 1 13 1 1 2 1 2 1 2 1 1 1 1 1 2 2 19 2 1 1 2 6 2 2 1 2 7 2 1 2 1 1 2 9 2 2 2 1 1 2 10 7 1
3 1
4 1 2
1 2 1 1 1
1 1 1
1 1 1 1 6 1 1 1 3 2 1 1 1 5 1 1 1 1 2 1 11
Sadar DS Jamtara Kundahit Narayanpur Koderma Jainagar Koderma (Jhumri Talaya) PHC Markacho Latehar Barawadhi Chandwa Latehar Mahuatan Manika Lohardaga Bandra Kisko Kuru Lohardaga Senha
DS PHC PHC PHC DS PHC PHC PHC DS PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC
1 2
1 1 1
1 2 2 1 1 1 1 6 1 1 1
1 3 1 1 1 1 1
1 5 2 1 2
1 3 5
Pakur Amrapada
DS PHC
Appendices
District Pakur Pakur Pakur Total Palamu Palamu Palamu Palamu Palamu Palamu Palamu Palamu Palamu Total Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Total Sahebganj Sahebganj Sahebganj Sahebganj Sahebganj Sahebganj Sahebganj Total Saraikela Kharsawan Saraikela Kharsawan Saraikela Kharsawan Saraikela Kharsawan Saraikela Kharsawan Total Simdega Simdega
Site Littipara Pakudia Daltanganj Bishrampur Block PHC Chattarpur Hariharganj Husainabad Lisliganj Panki Ranchi DS Anigara Bero Bundu Chancho Karra Khunti MCH Namkum Oremanjhi Rania Sonahatu Aarki Mander Ratu Sadar Hospital Baharawa Barhait Borio Pathna Rajmahal
Type PHC PHC DS PHC PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC
1 1 5 1 1 1 1 1 1 6 1 1 2 1 1 1 1 1 1 1 1 1 1 1 15 5 1 1 2 1 10 1 1
1 1 10 1 1 1 1 1 2 1 8 11 1 2 2 1 1 2 1 1 1 1 1 1 1 2 29 5 1 1 1 2 2 12 1
1 1
1 1 10
1 1 13
1 1 1 1
1 1 1 1 2 1 2 1 1 2 1
1 1 2 5 1 3
Simdega Bano
DS PHC
Appendices
District Simdega Simdega Simdega Simdega Simdega Simdega Total West Singhbhum West Singhbhum West Singhbhum West Singhbhum West Singhbhum West Singhbhum West Singhbhum West Singhbhum West Singhbhum West Singhbhum West Singhbhum Total Grand Total
1 1
1 1 1
1 6 4 1 2 1 1
2 1 1 1 1 10 5 1 2 1
Chaibasa Sadar Barajamda Chakradharpur Goilkara Jagganathpur Jinkpani Kumardungi Manjgaun Manoharpur Tonto
1 1
2 1 1 1
1 1 1 1 1 8 141 5 32 4 106 1
1 2 1 17 279 1 1
16
Appendices
District Bokaro Bokaro Bokaro Bokaro Bokaro Total Chatra Chatra Chatra Chatra Chatra Total Deoghar Deoghar Deoghar Deoghar Deoghar Deoghar Total Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Total Dumka Dumka Dumka Dumka Dumka Total East Singhbhum East Singhbhum Total Garhwa Garhwa Garhwa Garhwa Garhwa Total Giridih Giridih Giridih Giridih Giridih Giridih Total Godda
Site Bermo Bokaro Chandankyari Gumia Chatra Hunterganj Itkhori Tandwa Deoghar Jasidih Madhupur RH Palajori Sarwan Dhanbad Bagmara Baliapur Govindpur Johrapokhar Nirsa Topchanchi Dumka DS Gopi Kandar Ramgarh Raneswar Jamshedpur DHQ Garhwa DS Bhavaanathpur Majhion Meral Giridih Dumri Jamua Tisri Sadar Block Godda
Type PHC PHC PHC PHC DS PHC PHC PHC DS PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC DS PHC PHC PHC DS DS PHC PHC PHC DS PHC PHC PHC PHC DS
1 1 1 2 1 1 2 4
1 1 1 3 1 2 2 5 1 1 1 1 4 1 2 1 1 1 1 7 2 1 1 1 5 2 2 2 1 1 1 5 1 1 1 3
1 1
2 2
1 1 1
2 2
1 1 1 3 1 2 1 1 1 1 7 2 1 1 4 2 2 2 1 1 1 5 1 1
2 1
1 2
1 1
1 1
1 2 1
1 1
Appendices
District Godda Godda Godda Godda Godda Total Gumla Gumla Gumla Gumla Total Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Total Jamtara Jamtara Jamtara Total Koderma Koderma Total Latehar Latehar Latehar Latehar Latehar Total Lohardaga Lohardaga Lohardaga Lohardaga Lohardaga Lohardaga Total Pakur Pakur Pakur Pakur Total Palamu Palamu Palamu Palamu Palamu Total Ranchi Ranchi Ranchi Ranchi
Site Mahagama Podayahat Sadar Block Sundarpahari Gumla Ghagra Sisai RH Hazaribagh Churchu Barakatha Chaparan Keredari Mandu Patratu Vishnugarh Sadar DS Nala Koderma Latehar Balumath Latehar Manika Bandra Kisko Kuru Lohardaga Senha Pakur Hiranpur Maheshpur Daltanganj Chattarpur Panki Patan Ranchi DS Khunti Lapung Murhu
Type PHC PHC PHC PHC DS PHC PHC DS FPC PHC PHC PHC PHC PHC PHC DS PHC DS DS PHC PHC PHC PHC PHC PHC PHC PHC DS PHC PHC DS PHC PHC PHC DS PHC PHC PHC
1 1 1 1 4 1 1 2 1 1 1 1 1 1 1 7 2 1 3 1 1 1 1 1 1 4 2
1 1 2
1 2 1 2 6 1 1 2 1 1 1 1 2 1 1 8 2 1 3 1 1 2 1 1 1 5 1 3 1 1 2 8 2 1 1 4 2 1 1 1 5 1 1 1
1 1
1 1
1 1 1 1
1 1 4 2 1 1 4 2 1 1 4 1
1 3
2 1
1 1
1 1
Appendices
District Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Total Sahebganj Sahebganj Sahebganj Total Saraikela Kharsawan Saraikela Kharsawan Saraikela Kharsawan Saraikela Kharsawan Saraikela Kharsawan Saraikela Kharsawan Total Simdega Simdega Simdega Simdega Simdega Simdega Total West Singhbhum West Singhbhum West Singhbhum West Singhbhum West Singhbhum Total Grand Total
Site Namkum Silli Tamar Burmu Kanke Torpa Sadar Hospital Barhait Chandel (DS) Chandel Kuchai Rajnagar Saraikela Sub Depot
Type PHC PHC PHC PHC PHC PHC DS PHC DS PHC PHC PHC PHC
1 1 1 1 1 1 8 2 1 3 5 1 1 1 8 2 1 1 1 1 6 2 1 1 1 5 92
1 1 1 1 1 1 9 2 1 3 5 1 1 1 1
1 1 1
1 1 3
Simdega Kolebera Simdega Simdega PHC Thethaitnagar Chaibasa Sadar Jagganathpur Manjgaun Sonua
12
9 2 1 1 1 1 6 2 1 1 1 5 108
3 1
1 24
Appendices
District Bokaro Bokaro Bokaro Bokaro Bokaro Bokaro Bokaro Total Chatra Chatra Chatra Total Deoghar Deoghar Deoghar Deoghar Total Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Total Dumka Dumka Dumka Dumka Dumka Dumka Total East Singhbhum East Singhbhum East Singhbhum East Singhbhum East Singhbhum East Singhbhum East Singhbhum East Singhbhum East Singhbhum East Singhbhum East Singhbhum Total Garhwa Garhwa Garhwa
1 1
1 1 1
1 1 1
1 1
3 1 1
Appendices
District Garhwa Garhwa Garhwa Garhwa Total Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Total Godda Godda Godda Godda Godda Total Gumla Gumla Gumla Gumla Gumla Gumla Gumla Gumla Total Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Total Jamtara Jamtara Jamtara Total Koderma Koderma Koderma Total Latehar Latehar
Site Meral Nagaruntari Ranka Giridih Bagodar Bengabad Birni Deori Dumri Gandey Jamua Pirtand Raj Dhanwar Tisri Sadar Block Godda Boarijore Podayahat Sadar Block Gumla Bishnupur Chainpur Ghagra Raidih Sisai RH Basia Hazaribagh Churchu Barhi Berkagaon Chaparan Patratu Ramgarh Nala Narayanpur Jainagar Koderma (Jhumri Talaya) PHC Balumath Latehar
Type PHC PHC PHC DS PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC DS PHC PHC PHC DS PHC PHC PHC PHC PHC RH DS FPC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC
1 1 5 3 1 2 1 1 2 2 1 1 1 15
1 1 5 3 1 2 1 1 2 2 1 1 1 15 1 2 2 1
1 1 4 1 1
1 1 4 1 1
1 1 1 1 1 5
5 8 1 1 2 1
6 8 1 1 2 1 1 14 1 1 1
1 1 1 1
13
1 1 1 1
1 1 1
1 1 1
10
Appendices
District Latehar Latehar Latehar Total Lohardaga Lohardaga Lohardaga Lohardaga Lohardaga Total Palamu Palamu Palamu Palamu Palamu Total Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Total Sahebganj Sahebganj Sahebganj Sahebganj Sahebganj Sahebganj Sahebganj Total Saraikela Kharsawan Saraikela Kharsawan Saraikela Kharsawan Saraikela Kharsawan Saraikela Kharsawan Saraikela Kharsawan Saraikela Kharsawan Saraikela Kharsawan Saraikela Kharsawan Total Simdega
Site Mahuatan Manika Lohardaga Bandra Kisko Kuru Daltanganj Bishrampur Panki Patan Ranchi DS Bero Bundu Burmu Chancho Khunti Lapung Mander Oremanjhi Rania Ratu Silli Sonahatu Tamar Aarki Sadar Hospital Baharawa Barhait Borio Pathna Rajmahal Chandel Ghamaria Ichagarh Kuchai Nemdeah Raj Kharsawan Rajnagar Saraikela Sub Depot
Type PHC PHC DS PHC PHC PHC DS PHC PHC PHC DS PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC
1 1 4
1 1 4 1 1
1 1 1 1 2 7
1 1 1 1 2 8 1 1 1 1 1 1 1 1
1 1
1 1
1 1
1 1 1 1
1 11
1 13
10 1 1 1
2 2 1 1 1 2 1 1 1 2 1 7 1
2 2 1 1 1 2 1 1 2 9 1 1 4 1
Jaldega
PHC
11
Appendices
District Simdega Simdega Simdega Total West Singhbhum West Singhbhum West Singhbhum West Singhbhum West Singhbhum West Singhbhum West Singhbhum West Singhbhum West Singhbhum West Singhbhum Total Grand Total
Site Kurdeg Thethaitnagar Chaibasa Sadar Barajamda Goilkara Jagganathpur Jinkpani Manjgaun Manoharpur Sadar-Chaibasa Sonua
Type PHC PHC DS PHC PHC PHC PHC PHC PHC PHC PHC
1 1 1 1 1 1 2 1 1 1 4 18
2 9
4 90
1 1 1 1 1 1 2 1 1 1 10 117
1 1
1 53
12
Appendices
District Bokaro Bokaro Bokaro Bokaro Total Chatra Chatra Chatra Chatra Chatra Chatra Total Deoghar Deoghar Deoghar Deoghar Deoghar Total Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Total Dumka Dumka Dumka Dumka Dumka Dumka Total East Singhbhum East Singhbhum East Singhbhum Total Garhwa Garhwa Garhwa Garhwa Garhwa Total Giridih Giridih Giridih
Site Bokaro Jiridih Nawadhi Chatra Hunterganj Itkhori Pratappur Simaria Mohanpur Palajori Sarat Sarwan Dhanbad Bagmara Baliapur Govindpur Johrapokhar Nirsa Sadar PHC Topchanchi Tundi Dumka DS Jama Jarmundi Ramgarh Shikaripada Jamshedpur DHQ Potka
Type DS PHC PHC DS PHC PHC PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC DS PHC
1 1 1 3 1 1 1
1 3 1 1 1 3 1 2
1 1 1 3 2 1 1 1 5 1 1 1 3 1
1 2
1 1 2 1 1 2 2 1 1 2 7 1 1 1 1 1 4 2 1 3 2 1 1 2 7 2 1 1 1 1 6 2 1 3 1 1 2 1 1 1 3 2
6 1
1 1
1 2
1 1 2 1
13
Appendices
District Giridih Giridih Giridih Giridih Giridih Giridih Giridih Total Godda Godda Godda Godda Godda Godda Godda Total Gumla Gumla Gumla Gumla Gumla Gumla Total Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Total Jamtara Jamtara Total Koderma Koderma Koderma Koderma Total Latehar Latehar Latehar Latehar Latehar Latehar Total Lohardaga
Site Dumri MCH Pirtand Raj Dhanwar Tisri Sadar Block Godda Mahagama Meharma Patthargama Podayahat Sundarpahari Gumla Bharno Bishnupur Ghagra Sisai RH Hazaribagh Churchu Barakatha Barhi Chaparan Gola Ichak Katkamsari Keredari Mandu Patratu Vishnugarh Sadar DS Koderma Koderma (Jhumri Talaya) PHC Markacho Latehar Balumath Barawadhi Chandwa Latehar Lohardaga
Type PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC DS PHC PHC PHC PHC DS FPC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC DS DS PHC PHC DS PHC PHC PHC PHC DS
2 1 1 1 1 1 8 1 1 1 1 1 4 1 1 1 1 4 1 1 1 1 2 1 1 1 1 1 1 11 1
2 1 1 1 1 1 8 1 1 1 1 1 5 1 1 1 2 5 1 1 1 1 2 1 1 1 1 1 1 12
3 1
1 2 1
1 1
1 2
2 2 2 2 1
1 2 2 1 1 1 4 1 1 1
1 2 2 1 1 1 1 6
1 1 1
14
Appendices
District Site Lohardaga Bandra Lohardaga Kisko Lohardaga Kuru Lohardaga Lohardaga Lohardaga Senha Lohardaga Total Pakur Pakur Pakur Amrapada Pakur Hiranpur Pakur Littipara Pakur Pakudia Pakur Total Palamu Daltanganj Palamu Bishrampur Palamu Chattarpur Palamu Hariharganj Palamu Husainabad Palamu Lisliganj Palamu Patan Palamu Total Ranchi Ranchi DS Ranchi Anigara Ranchi Khunti Ranchi Murhu Ranchi Namkum Ranchi Silli Ranchi Kanke Ranchi Torpa Ranchi Total Sahebganj Sadar Hospital Sahebganj Baharawa Sahebganj Barhait Sahebganj Borio Sahebganj Rajmahal Sahebganj Sadar PHC Sahebganj Taljhari Sahebganj Total Saraikela Kharsawan Chandel (DS) Saraikela Kharsawan Nemdeah Saraikela Kharsawan Raj Kharsawan Saraikela KharsaSaraikela Sub Dewan pot Saraikela Kharsawan Total Simdega Simdega Simdega Bano
Type PHC PHC PHC PHC PHC DS PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC
1 3 1 2 2 9 1 1 1 1 1 4
1 1
1 3 1 2 2 9 1 1 1 1 1 5 1 1 1 2 1 1 7 1 2 1 1 1 1 1 8 2 1 1 1 1 1 1 8 2 1 1 1 1 1 5 1
1 1 3 3
3 2
1 1 2 1 1 6 1 2 1 1 1 1 1 8 1 1 1 1 1 1 6 2 1 1
2 2
2 1
1 2
4 DS PHC 1
2 3 1
15
Appendices
District Site Simdega Jaldega Simdega Kolebera Simdega Thethaitnagar Simdega Total West Singhbhum Chaibasa Sadar West Singhbhum Chakradharpur West Singhbhum Goilkara West Singhbhum Tonto West Singhbhum Total Grand Total
1 1 3 2 1 1 1 5 103
1 1 3 2 1 1 1 5 117
1 2 1 8 3
3 51
16
Appendices
APPENDIX: G DETAILED AGE PROFILE OF REFRIGERATION UNITS SITE WISE (A) AGE PROFILE OF ILRS
CFC Above 15 Upto 10 Upto 15 Upto 5 District Site Type Upto 5 CFC FREE Above 15 Upto 10 1 1 1 1 1 1 3 2 1 1 2 1 1 1 1 1 Dhanbad Bagmara Baliapur Govindpur Johrapokhar Nirsa Sadar PHC Topchanchi Tundi Dumka DS Gopi Kandar Jama DS PHC PHC PHC PHC PHC PHC PHC PHC DS PHC PHC 1 1 1 7 1 2 1 1 4 1 1 1 1 1 5 4 1 Upto 15
Bokaro Bokaro Bokaro Bokaro Bokaro Bokaro Bokaro Bokaro Bokaro Bokaro Bokaro Total Chatra Chatra Chatra Chatra Chatra Chatra Chatra Total Deoghar Deoghar Deoghar Deoghar Deoghar Deoghar Deoghar Deoghar Deoghar Total Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Total Dumka Dumka Dumka
Bokaro Bermo Bokaro Chandankyari Chas Gumia Jiridih Kasmar Nawadhi Peterwar Chatra Hunterganj Itkhori Pratappur Simaria Tandwa Deoghar Jasidih Karon Madhupur RH Mohanpur Palajori Sarat Sarwan
DS PHC PHC PHC PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC PHC
1 1 1 1 1
3 1
3 2 1 2
1 1 6 4 1 1 1 1
1 1 1 1 1 1 3 1 1 3 1 2 1 1 3 1
17
Appendices
Dumka Dumka Dumka Dumka Dumka Dumka Dumka Dumka Total East Singhbhum East Singhbhum East Singhbhum East Singhbhum East Singhbhum East Singhbhum East Singhbhum East Singhbhum East Singhbhum East Singhbhum East Singhbhum Total Garhwa Garhwa Garhwa Garhwa Garhwa Garhwa Garhwa Garhwa Garhwa Total Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Total Godda Godda Godda Godda
Jarmundi Kathikund Masalia Ramgarh Sadar PHC Saraya Shikaripada Jamshedpur DHQ Baharagharah Chakulia Dalbhumgarh Dhumria Ghatsella Jugsalai Musabani Patomda Potka Garhwa DS Bhandaria Bhavaanathpur Dhurki Majhion Meral Nagaruntari Ranka Giridih Bagodar Bengabad Birni Deori Dumri Gandey Jamua MCH Pirtand Raj Dhanwar Sadar Block Tisri Godda Boarijore Mahagama Meharma
PHC PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC DS PHC PHC PHC
1 1 1 1 1 1 3 5 1 1 1 1 1 1 1 1 1 7 1 1 1 1 7 1 1
1 3
7 1
1 1 1 1 1 1 1 1 1 1 1 1 1 2 1 1 6 3 2 3 1 1
5 2 1 1
2 1 1
18
Appendices
Godda Godda Godda Godda Godda Total Gumla Gumla Gumla Gumla Gumla Gumla Gumla Gumla Gumla Gumla Gumla Total Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Total Jamtara Jamtara Jamtara Jamtara Jamtara Jamtara Total Koderma Koderma Koderma Koderma Koderma Total Latehar Latehar Latehar Latehar Latehar
Patthargama Podayahat Sadar Block Sundarpahari Gumla Bharno Bishnupur Chainpur Ghagra Kamdara Palkot Raidih Sisai RH Basia Hazaribagh Churchu Barakatha Barhi Chaparan Gola Ichak Katkamsari Keredari Mandu Patratu Ramgarh Vishnugarh Sadar DS Jamtara Kundahit Nala Narayanpur Koderma Jainagar Koderma (Jhumri Talaya) PHC Markacho Latehar Balumath Barawadhi Chandwa Latehar
PHC PHC PHC PHC 1 DS PHC PHC PHC PHC PHC PHC PHC PHC RH DS FPC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC DS PHC PHC PHC
1 1 1 1 6 1 2 1 1 1 2 1 1 3 1 1 3 3 1 1 1 1 1 1 2 2 1 1 1 1 1 1 4
1 1 7 3 2 1 1
1 1 1 7 2
1 1 1 3 4 3 1 1 1 6 3 1
1 1 1
19
Appendices
Latehar Latehar Total Lohardaga Lohardaga Lohardaga Lohardaga Lohardaga Lohardaga Lohardaga Total Pakur Pakur Pakur Pakur Pakur Pakur Pakur Total Palamu Palamu Palamu Palamu Palamu Palamu Palamu Palamu Palamu Palamu Total Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi
Manika Lohardaga Bandra Kisko Kuru Lohardaga Senha Pakur Amrapada Hiranpur Littipara Maheshpur Pakudia Daltanganj Bishrampur Block PHC Chattarpur Hariharganj Husainabad Lisliganj Panki Patan Ranchi DS Anigara Bero Bundu Burmu Chancho Kanke Karra Khunti Lapung Mander MCH Murhu Namkum Oremanjhi Rania Ratu Silli Sonahatu Tamar
PHC DS PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC
1 2
1 1 1
2 1 1 1 3 1 3 1 1 2
1 3
1 1 1 1 1 1 1 4 1 1 1 1 1 1 1 5 3 1 1 1 2 1 2
1 1 1 1 1 1 1 1 1 1 1 1
20
Appendices
Ranchi Ranchi Total Sahebganj Sahebganj Sahebganj Sahebganj Sahebganj Sahebganj Sahebganj Sahebganj Sahebganj Total Saraikela Kharsawan Saraikela Kharsawan Saraikela Kharsawan Saraikela Kharsawan Saraikela Kharsawan Saraikela Kharsawan Saraikela Kharsawan Saraikela Kharsawan Total Simdega Simdega Simdega Simdega Simdega Simdega Simdega Simdega Total West singhbhum West singhbhum West singhbhum West singhbhum West singhbhum West singhbhum West singhbhum West singhbhum West singhbhum West singhbhum West singhbhum West singhbhum West singhbhum Total Grand Total
Torpa Sadar Hospital Baharawa Barhait Borio Pathna Rajmahal Sadar PHC Taljhari Chandel (DS) Chandel Ghamaria Nimdih Raj Kharsawan Rajnagar Saraikela Sub Depot
PHC 2 DS PHC PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC 1 1 2 2 1 10 5 3 4
10
1 1
1 1 2 1 2 1 1
2 7 5
Simdega Bano Jaldega Kolebera Simdega Simdega PHC Thethaitnagar Chaibasa Sadar Barajamda Chakradharpur Goilkara Jagganathpur Jinkpani Kumardungi Manjgaun Manoharpur Sadar-Chaibasa Sonua Tonto
DS PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC
1 5 6 1 2 1
1 1 1
1 3 21
52
11 104
13
58
21
Appendices
Bokaro Bokaro Bokaro Bokaro Bokaro Bokaro Bokaro Bokaro Bokaro Bokaro Bokaro Total Chatra Chatra Chatra Chatra Chatra Chatra Chatra Total Deoghar Deoghar Deoghar Deoghar Deoghar Deoghar Deoghar Deoghar Deoghar Total Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Total Dumka Dumka Dumka Dumka Dumka
Bokaro Bermo Bokaro Chandankyari Chas Gumia Jiridih Kasmar Nawadhi Peterwar
22
Appendices
Dumka Dumka Dumka Dumka Dumka Dumka Total East Singhbhum East Singhbhum East Singhbhum East Singhbhum East Singhbhum East Singhbhum East Singhbhum East Singhbhum East Singhbhum East Singhbhum East Singhbhum Total Garhwa Garhwa Garhwa Garhwa Garhwa Garhwa Garhwa Garhwa Garhwa Total Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Total Godda Godda Godda Godda
Masalia Ramgarh Sadar PHC Saraya Shikaripada Jamshedpur DHQ Baharagharah Chakulia Dalbhumgarh Dhumria Ghatsella Jugsalai Musabani Patomda Potka Garhwa DS Bhandaria Bhavaanathpur Dhurki Majhion Meral Nagaruntari Ranka Giridih Bagodar Bengabad Birni Deori Dumri Gandey Jamua MCH Pirtand Raj Dhanwar Sadar Block Tisri
PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC 1 2 1
1 4
23
Appendices
Godda Godda Godda Godda Godda Total Gumla Gumla Gumla Gumla Gumla Gumla Gumla Gumla Gumla Gumla Gumla Total Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Total Jamtara Jamtara Jamtara Jamtara Jamtara Jamtara Total Koderma Koderma Koderma Koderma Koderma Total Latehar Latehar Latehar
Patthargama Podayahat Sadar Block Sundarpahari Gumla Bharno Bishnupur Chainpur Ghagra Kamdara Palkot Raidih Sisai RH Basia Hazaribagh Churchu Barakatha Barhi Chaparan Gola Ichak Katkamsari Keredari Mandu Patratu Ramgarh Vishnugarh
PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC PHC PHC RH DS FPC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC
1 1 1 3 6 1
1 1
1 1 1 2 1
1 1 1 1 1 2 1 2 3
24
Appendices
Latehar Latehar Latehar Latehar Total Lohardaga Lohardaga Lohardaga Lohardaga Lohardaga Lohardaga Lohardaga Total Pakur Pakur Pakur Pakur Pakur Pakur Pakur Total Palamu Palamu Palamu Palamu Palamu Palamu Palamu Palamu Palamu Palamu Total Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi
Chandwa Latehar Manika Lohardaga Bandra Kisko Kuru Lohardaga Senha Pakur Amrapada Hiranpur Littipara Maheshpur Pakudia Daltanganj Bishrampur Block PHC Chattarpur Hariharganj Husainabad Lisliganj Panki Patan Ranchi DS Anigara Bero Bundu Burmu Chancho Kanke Karra Khunti Lapung Mander MCH Murhu Namkum Oremanjhi Rania
PHC PHC PHC DS PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC 1 1
2 1
1 1
25
Appendices
Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Total Sahebganj Sahebganj Sahebganj Sahebganj Sahebganj Sahebganj Sahebganj Sahebganj Sahebganj Total Saraikela Kharsawan Saraikela Kharsawan Saraikela Kharsawan Saraikela Kharsawan Saraikela Kharsawan Saraikela Kharsawan Saraikela Kharsawan Saraikela Kharsawan Total Simdega Simdega Simdega Simdega Simdega Simdega Simdega Simdega Total West singhbhum West singhbhum West singhbhum West singhbhum West singhbhum West singhbhum West singhbhum West singhbhum West singhbhum West singhbhum West singhbhum West singhbhum West singhbhum Total
1 1
1 4
1 1 2 1
1 7
1 1 1 1
1 1 1 2 5 1 1 3
26
Appendices
Grand Total
13
16
77
12
75
27
Appendices
28
Appendices
East Singhbhum Count Garhwa Garhwa DS Garhwa Bhandaria Garhwa Bhavaanathpur Garhwa Dhurki Garhwa Garhwa Block Garhwa Majhion Garhwa Meral Garhwa Nagaruntari Garhwa Ranka Garhwa Count Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Count Giridih Bagodar Bengabad Birni Deori Dumri Gandey Jamua MCH Pirtand Raj Dhanwar Sadar Block Tisri
29
Appendices
30
Appendices
31
Appendices
32
Appendices
Simdega Count West Singhbhum Chaibasa Sadar West singhbhum Barajamda West Singhbhum Chakradharpur West Singhbhum Goilkara West singhbhum Jagganathpur West Singhbhum Jinkpani West singhbhum Khutpani West Singhbhum Kumardungi West singhbhum Manjgaun West Singhbhum Manoharpur West Singhbhum Sadar-Chaibasa West Singhbhum Sonua West Singhbhum Tonto West Singhbhum Count Grand Count
33
Appendices
34
Appendices
35
Appendices
36
Appendices
37
Appendices
38
Appendices
39
Appendices
40
Appendices
41
Appendices
District Bokaro Bokaro Bokaro Bokaro Bokaro Bokaro Bokaro Bokaro Bokaro Bokaro Chatra Chatra Chatra Chatra Chatra Chatra Chatra Deoghar Deoghar Deoghar Deoghar Deoghar Deoghar Deoghar Deoghar Dhanbad Dhanbad Dhanbad
Site Bokaro Bermo Bokaro Chandankyari Chas Gumia Jiridih Kasmar Nawadhi Peterwar Chatra Chatra Hunterganj Itkhori Pratappur Simaria Tandwa Deoghar Jasidih Karon Madhupur RH Mohanpur Palajori Sarat Sarwan Dhanbad Bagmara Baliapur
Type DS PHC PHC PHC PHC PHC PHC PHC PHC PHC 10 DS PHC PHC PHC PHC PHC PHC 7 DS PHC PHC PHC PHC PHC PHC PHC 8 DS PHC PHC
Total Stabilizers 6 3
Shortage
Excess 2
Bokaro Total
Chatra Total
Deoghar Total
42
Appendices
District Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Dumka Dumka Dumka Dumka Dumka Dumka Dumka Dumka Dumka Dumka Dumka
Site Govindpur Johrapokhar Nirsa Sadar PHC Topchanchi Tundi Dumka DS Gopi Kandar Jama Jarmundi Kathikund Masalia Ramgarh Raneswar Sadar PHC Saraya Shikaripada
Type PHC PHC PHC PHC PHC PHC 9 DS PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC 11 DS PHC PHC PHC PHC PHC PHC PHC PHC PHC 10 DS PHC
Total Stabilizers 2 3 4 2 1 3 22 7 1 1 1 1 1 2 1 15 8 1 1 1
Functional Stabilizers 2 2 2 1 1 12 7 1
Shortage 1 1 1 1 3 12
Excess
Dhanbad Total
1 2
1 1 1 1 1 1 1 1 14 8 1 1 1 1 1 4 2 1 1
Dumka Total East Jamshedpur Singhbhum DHQ East Singhbhum Baharagharah East Singhbhum Chakulia East Singhbhum Dalbhumgarh East Singhbhum Dhumria East Singhbhum Ghatsella East Singhbhum Jugsalai East Singhbhum Musabani East Singhbhum Patomda East Singhbhum Potka East Singhbhum Total Garhwa Garhwa Garhwa DS Bhandaria
1 2
1 4 1 19 9 1
1 2
2 14 9 1 9 1 5
43
Appendices
District Garhwa Garhwa Garhwa Garhwa Garhwa Garhwa Garhwa Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Godda Godda Godda Godda Godda Godda Godda Godda Gumla Gumla Gumla Gumla
Site Bhavaanathpur Dhurki Garhwa Block Majhion Meral Nagaruntari Ranka Giridih Bagodar Bengabad Birni Deori Dumri Gandey Jamua MCH Pirtand Raj Dhanwar Sadar Block Tisri Godda Boarijore Mahagama Meharma Patthargama Podayahat Sadar Block Sundarpahari Gumla Bharno Bishnupur Chainpur
Type PHC PHC PHC PHC PHC PHC PHC 9 DS PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC 13 DS PHC PHC PHC PHC PHC PHC PHC 8 DS PHC PHC PHC
Total Stabilizers 2
Functional Stabilizers 2
Shortage
Excess 1
2 2 2 3 20 5 3 1 1 3 5 2 3 2 3 2 3 3 36 5 2 3 1 2 6 3 3 25 7 2 4 2
1 4 1 3 21 9 1 1 1 2 1 1 2 2 3 3 2 1 29 6 2 2 2 1 1 2 2 18 5 1 2 1
1 1 1 2 17 6 1 1 1 2 1 1 1 1 2 2 1 20 5 1 2 2 1 1 2 2 15 3 1 1 1 1 3 1 3 2 1 1 2 7 4 2 1 1 2 1 1 6 3
Garhwa Total
Giridih Total
Godda Total
44
Appendices
District Gumla Gumla Gumla Gumla Gumla Gumla Gumla Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Jamtara Jamtara Jamtara Jamtara Jamtara Koderma Koderma Koderma Koderma
Site Dumri Ghagra Kamdara Palkot Raidih Sisai RH Basia Hazaribagh Churchu Barakatha Barhi Berkagaon Chaparan Churchu Gola Ichak Katkamsari Keredari Mandu Patratu Ramgarh Vishnugarh Sadar DS Jamtara Kundahit Nala Narayanpur Koderma Jainagar Koderma (Jhumri Talaya) PHC Markacho
Type PHC PHC PHC PHC PHC PHC RH 11 DS FPC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC 15 DS PHC PHC PHC PHC 5 DS PHC PHC PHC 4
Total Stabilizers 2 1 1 2 3 1 19 6 2 2 2 1 3 1 1 1 1 4 1 3 2 30 3 1 1 1 6 5 2 1 2 10
Functional Stabilizers 2 1 1 2 3 1 16 5 1 2 2
Shortage
Excess
1 1 2 1 1 2 1
Gumla Total
2 2 1 1 2 1 1 2 2 17 3 1 1 1 1 6 5 2 1 1 9 1 1 1 1 1 9 2 1
Hazaribagh Total
Jamtara Total
Koderma Total
45
Appendices
District Latehar Latehar Latehar Latehar Latehar Latehar Latehar Lohardaga Lohardaga Lohardaga Lohardaga Lohardaga Lohardaga Pakur Pakur Pakur Pakur Pakur Pakur Palamu Palamu Palamu Palamu Palamu Palamu Palamu Palamu Palamu Palamu Palamu Ranchi Ranchi
Site Latehar Balumath Barawadhi Chandwa Latehar Mahuatan Manika Lohardaga Bandra Kisko Kuru Lohardaga Senha Pakur Amrapada Hiranpur Littipara Maheshpur Pakudia Daltanganj Bishrampur Block PHC Chainpur Chattarpur Hariharganj Husainabad Lisliganj Manatu Panki Patan Namkum Ranchi DS
Type DS PHC PHC PHC PHC PHC PHC 7 DS PHC PHC PHC PHC PHC 6 DS PHC PHC PHC PHC PHC 6 DS PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC 11 CS DS
Total Stabilizers 1 1 1 2 4 1 10 3 2 6 2 7 3 23 7 1 1 1 1 11 7 1 1 3 2 2 1
Functional Stabilizers 1 1 1 2 1 1 7 3 1 5 2 4 3 18 7
Shortage 1
Excess
Latehar Total
1 1 1 1 1 1 2 1 3 1
Lohardaga Total
1 1 1 1 10 7 1 1 1 2 1 1 1 1 1 1 2 1 4
Pakur Total
2 19 6
2 15 6 4 5 2
Palamu Total
46
Appendices
District Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi
Site Aarki Anigara Bero Bundu Burmu Chancho Kanke Karra Khunti Khunti Lapung Mander MCH Murhu Namkum Oremanjhi Rania Ratu Silli Sonahatu Tamar Torpa
Type PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC 24 DS PHC PHC PHC PHC PHC PHC PHC 8 DS PHC PHC
Total Stabilizers 1 2 3 1 2 2 2 1 1 2 2 1 4 1 2 2 2 2 2 2 43 6 1 1 1 1 10 9 1 1
Functional Stabilizers 1 3 1 2 2 2
Shortage
Excess
1 1 1 1 1 1
1 1 1 2 1 2 1 2 1 1 2 2 2 1 33 5 1 1 2 1 1 1 9 6 1 1 9 1 1 7 2 2 1 11 1 1 1 1 1 1
Ranchi Total Sadar HospiSahebganj tal Sahebganj Sahebganj Sahebganj Sahebganj Sahebganj Sahebganj Sahebganj Baharawa Barhait Borio Pathna Rajmahal Sadar PHC Taljhari
Sahebganj Total Saraikela Kharsawan Chandel (DS) Saraikela Kharsawan Chandel Saraikela Kharsawan Ghamaria
47
Appendices
District Site Saraikela Kharsawan Ichagarh Saraikela Kharsawan Kuchai Saraikela Kharsawan Nimdih Saraikela Raj KharsaKharsawan wan Saraikela Kharsawan Rajnagar Saraikela Saraikela Sub Kharsawan Depot Saraikela Kharsawan Total Simdega Simdega Simdega Simdega Simdega Simdega Simdega Simdega Simdega Simdega Bano Bolba Jaldega Kolebera Kurdeg Simdega Simdega PHC Thethaitnagar
Type PHC PHC PHC PHC PHC PHC 9 DS PHC PHC PHC PHC PHC PHC PHC PHC 9 DS PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC
Total Stabilizers
Functional Stabilizers
Shortage
Excess
1 2 1 2 5 22 9 4 3 5 1 1 5 28 16 2 3 2 2 2 2 15 9 3 3 1 3 1 1 1 1 3 18 3 2 3 4 1
1 1 1 1 3 14 3 2 1 4 1 1 1 11 8 1 3 1 1 1 2 7 1 1 2
Simdega Total West Chaibasa SaSinghbhum dar West singhbhum Barajamda West ChakradharSinghbhum pur West Singhbhum Goilkara West singhbhum Jagganathpur West Singhbhum Jinkpani West singhbhum Khutpani West Singhbhum Kumardungi West singhbhum Manjgaun West Singhbhum Manoharpur West SadarSinghbhum Chaibasa West Singhbhum Sonua
1 1 2 1 2
1 1 2 1 2
1 1 1 1 2 1
48
Appendices
Site Tonto
Shortage
Excess
2 90
2 62
49
Appendices
50
Appendices
East Singhbhum Total Garhwa Garhwa DS Garhwa Bhandaria Garhwa Bhavaanathpur Garhwa Dhurki Garhwa Garhwa Block Garhwa Majhion Garhwa Meral Garhwa Nagaruntari Garhwa Ranka Garhwa Total Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Total Giridih Bagodar Bengabad Birni Deori Dumri Gandey Jamua MCH Pirtand Raj Dhanwar Sadar Block Tisri
51
Appendices
52
Appendices
53
Appendices
Saraikela Kharsawan Total Simdega Simdega Simdega Bano Simdega Bolba Simdega Jaldega Simdega Kolebera Simdega Kurdeg Simdega Simdega Simdega Simdega PHC
54
Appendices
Simdega Total West Singhbhum Chaibasa Sadar West singhbhum Barajamda West Singhbhum Chakradharpur West Singhbhum Goilkara West singhbhum Jagganathpur West Singhbhum Jinkpani West singhbhum Khutpani West Singhbhum Kumardungi West singhbhum Manjgaun West Singhbhum Manoharpur West Singhbhum Sadar-Chaibasa West Singhbhum Sonua West Singhbhum Tonto West Singhbhum Total Grand Total
55
Appendices
10 5 17 10 2 10 54 7 10 93 6 15
56
Appendices
30 2 10 5 86 10 1 10 10
16
47 15 5 20 25
5 5 75 10 25 5 27 10 10 10 5 28 7 137
57
Appendices
20 25 25 80
2 30 10 7 10 10 69 5 12 35 35 25 10 34 5 30 89 30 310 4 15 8 27 96 1 3
58
Appendices
30 40 90 6 15 1 22 5
10 12 27 10
2 4
10 30 56
12 10 8
10 5 2
59
Appendices
10
24 5 86 26
26
15 4 15 35
502 9 180
20 20
60
Appendices
10 8
8 3 69 1770
61
Appendices
APPENDIX: M DETAILED INVENTORY OF COLD BOXES AND CALCULATION OF NET REQUIREMENT FOR THE STATE
Inventory of cold boxes with additional requirement site wise
Net requirement (20 L Boxes) 1 1 6 2 1 9 2 2 8 Required capacity (gross ltr) 284 34 32 31 112 32 11 32 21 18 606 127 21 21 21 21 21 21 253 149 21 21 21 21 21 21 21 299 383 48 14 25 55 53 69 18 16 682 152 Not Working Not Working Not Working Not Working Net Shortage (Gross Ltr) 17 17 101 21 1 123 21 21 152 25 Litres Working District Site Type 20 Litres Working 8 Litres Working 5 Litres Working Net Transportantion capacity (gross ltrs) 454 55 50 80 120 15 85 50 100 80 1089 26 80 20 75 35 73 309 385 70 60 85 85 115 60 860 420 85 60 50 235 210 95 75 60 1290
Bokaro Bokaro Bokaro Bokaro Bokaro Bokaro Bokaro Bokaro Bokaro Bokaro Bokaro Total Chatra Chatra Chatra Chatra Chatra Chatra Chatra Chatra Total Deoghar Deoghar Deoghar Deoghar Deoghar Deoghar Deoghar Deoghar Deoghar Total Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Total Dumka
Bokaro Bermo Bokaro Chandankyari Chas Gumia Jiridih Kasmar Nawadhi Peterwar Chatra Chatra Hunterganj Itkhori Pratappur Simaria Tandwa Deoghar Jasidih Karon Madhupur RH Mohanpur Palajori Sarat Sarwan Dhanbad Bagmara Baliapur Govindpur Johrapokhar Nirsa Sadar PHC Topchanchi Tundi Dumka DS
DS PHC PHC PHC PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC PHC PHC DS
19 2 2 4 6 3 1 3 2 42
1 2 2
2 3 2
8 2 3 2 2 2 2 13
8 2
3 5 6 8 8 37 2
4 2 5 14 5
30 4 4 3 4 4 2 21
4 3 1 1 9 18 2 2 2 3 5 2 34 20 3 1 1 8 6 2 2 1 43
1 1
1 3
4 3 3 4 16 5 6 4 9 5 3 4 36 4 5 8 10 10 18 11 7 8 81
2 4 6 5 3 12 5 5 2 32
4 1 3
2 3 12
62
Appendices
Dumka Dumka Dumka Dumka Dumka Dumka Dumka Dumka Dumka Dumka Dumka Total East Singhbhum East Singhbhum East Singhbhum East Singhbhum East Singhbhum East Singhbhum East Singhbhum East Singhbhum East Singhbhum East Singhbhum
Gopi Kandar Jama Jarmundi Kathikund Masalia Ramgarh Raneswar Sadar PHC Saraya Shikaripada Jamshedpur DHQ Baharagharah Chakulia Dalbhumgarh Dhumria Ghatsella Jugsalai Musabani Patomda Potka
PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC PHC PHC PHC 18 18
1 2 1 5 5 4 2 4 2 26 36 9 1 1 4
4 2 6 1 1 2 4 2 5 2 21 185 6 1 3 1 2 3
East Singhbhum Total Garhwa Garhwa DS Garhwa Bhandaria Garhwa Bhavaanathpur Garhwa Dhurki Garhwa Garhwa Block Garhwa Majhion Garhwa Meral Garhwa Nagaruntari Garhwa Ranka Garhwa Total Giridih Giridih Giridih Bagodar Giridih Bengabad Giridih Birni Giridih Deori Giridih Dumri Giridih Gandey Giridih Jamua Giridih MCH Giridih Pirtand Giridih Raj Dhanwar Giridih Sadar Block
1 2 3 3
2 1 2 4
2 7
63
Appendices
Giridih Giridih Total Godda Godda Godda Godda Godda Godda Godda Godda Godda Total Gumla Gumla Gumla Gumla Gumla Gumla Gumla Gumla Gumla Gumla Gumla Gumla Total Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Total Jamtara Jamtara Jamtara Jamtara Jamtara Jamtara Total
Tisri Godda Boarijore Mahagama Meharma Patthargama Podayahat Sadar Block Sundarpahari Gumla Bharno Bishnupur Chainpur Dumri Ghagra Kamdara Palkot Raidih Sisai RH Basia Hazaribagh Churchu Barakatha Barhi Berkagaon Chaparan Gola Ichak Katkamsari Keredari Mandu Patratu Ramgarh Vishnugarh Sadar DS Jamtara Kundahit Nala Narayanpur
PHC DS PHC PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC PHC PHC PHC RH DS FPC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC
2 44 4 2 3 2
11 4 2
2 2
4 2 2 15 5 2 3 2 5 1 3 4 3 2 30 9 2 2 2 2 4 2 2 1 3 2 3 3 37 16 1 1 2 20
1 52 2 5 8 11 6 4 1 37 3 5 5 3 3 5 3 2 3 3 1 36 2 3 2 3 6 4 4 4 5 2 3 1 2 1 42 2 1 2
4 23 2
3 13
2 1
3 1
2 1 2 1 6 1
3 7 1 1 2 2 1 1 1 2 2 3 3 19
1 2
2 2 1 1 8 1 4 6 2
1 1
64
Appendices
Koderma Koderma
Koderma Jainagar Koderma (Jhumri Talaya) PHC Markacho Latehar Balumath Barawadhi Chandwa Latehar Mahuatan Manika Lohardaga Bandra Kisko Kuru Lohardaga Senha Pakur Amrapada Hiranpur Littipara Maheshpur Pakudia Daltanganj Bishrampur Block PHC Chainpur Chattarpur Hariharganj Husainabad Lisliganj Manatu Panki Patan Namkum Ranchi DS Aarki
DS PHC
4 9
2 2
4 3
Koderma Koderma Koderma Total Latehar Latehar Latehar Latehar Latehar Latehar Latehar Latehar Total Lohardaga Lohardaga Lohardaga Lohardaga Lohardaga Lohardaga Lohardaga Total Pakur Pakur Pakur Pakur Pakur Pakur Pakur Total Palamu Palamu Palamu Palamu Palamu Palamu Palamu Palamu Palamu Palamu Palamu Palamu Total Ranchi Ranchi Ranchi
PHC PHC DS PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC CS DS PHC
3 8 24 2 2 5 3 5 3 17 2 1 3 2 2 10
2 5 7 4
2 1
1 1 1 2 5
5 1 13 2 5 4 7 8 2 1 29 3 2 6 3 4 2 20 1 2 1
3 7 3
2 3 2 7 12 2 2 1 4 2 7 1 5 36 20
1 10 3 15
1 3 6 5
6 35 2 5
3 9
65
Appendices
Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Total Sahebganj Sahebganj Sahebganj Sahebganj Sahebganj Sahebganj Sahebganj Sahebganj Sahebganj Total Saraikela Kharsawan Saraikela Kharsawan Saraikela Kharsawan Saraikela Kharsawan Saraikela Kharsawan Saraikela Kharsawan
Anigara Bero Bundu Burmu Chancho Kanke Karra Khunti Khunti Lapung Mander MCH Murhu Namkum Oremanjhi Rania Ratu Silli Sonahatu Tamar Torpa Sadar Hospital Baharawa Barhait Borio Pathna Rajmahal Sadar PHC Taljhari
PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC PHC
1 1 3 2 2 2 1 1 4 2 2 2 1 1 2 3 3 53 25 2 2 2 3
2 1
2 4 4 3 2 4 3 1 2 6 1 2 4 5 3 5 3 5 66 45 2 1 4 2 2
3 1 1 2 1
2 3
1 1 2 2
14 4
2 16
1 6
34 Chandel (DS) Chandel Ghamaria Ichagarh Kuchai Nimdih DS PHC PHC PHC PHC PHC 19
56 21
66
Appendices
PHC PHC PHC DS PHC PHC PHC PHC PHC PHC PHC PHC
2 2 2 31 4 2 2 2 1 4 3 3 21 1 14 3 2 1 2 4 2 1 1 2 1 1 1 3 5
2 2 3 35 2 1 4 3 1 1 2 13 3 3 5 5 3 4 5
Saraikela Kharsawan Total Simdega Simdega Simdega Bano Simdega Bolba Simdega Jaldega Simdega Kolebera Simdega Kurdeg Simdega Simdega Simdega Simdega PHC Simdega Thethaitnagar Simdega Total West Singhbhum West singhbhum West Singhbhum West Singhbhum West singhbhum West Singhbhum West singhbhum West Singhbhum West singhbhum West Singhbhum West Singhbhum Chaibasa Sadar Barajamda Chakradharpur Goilkara Jagganathpur Jinkpani Khutpani Kumardungi Manjgaun Manoharpur Sadar-Chaibasa
5 7 1
DS PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC
2 2 2
1 3 1
West Singhbhum
Sonua
PHC PHC 1 28 18
5 2 40 930
35 660
6 132
8 59
67
Appendices
68
Appendices
Total
CFC FREE
CFC FREE
Bokaro Bokaro Bokaro Bokaro Bokaro Bokaro Bokaro Bokaro Total Chatra Chatra Chatra Chatra Chatra Total Deoghar Deoghar Deoghar Total Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Dhanbad Total Dumka Dumka Dumka Dumka Dumka Dumka Total East Singhbhum East Singhbhum East Singhbhum East Singhbhum Total Garhwa Garhwa Garhwa Garhwa Garhwa
Bokaro Chandankyari Chas Gumia Nawadhi Peterwar Bermo Chatra Hunterganj Itkhori Simaria Deoghar Jasidih Bagmara Baliapur Dhanbad Govindpur Nirsa Topchanchi Dumka DS Jama Jarmundi Raneswar Sadar PHC Jamshedpur DHQ Dalbhumgarh Potka
PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC
3 1
6 1 1 1
2 1 2 1 2 1 9 1
CFC FREE
CFC
CFC Free
CFC
CFC
1 1 5 4 1 4 4 7 7 1 3 1 1 2 1 1 1 4 2 1 1 2 1 1 1 1 1 2 1 1 6 3 1 1 1 1
9 1 4 5 7 1 8 1 1 3 1 1 1 8 4 1 1 6 2 1 1 4 2 1 1 1 1
2 3 7 7
1 1
8 1 9 1 1 1 3
1 1
1 DS PHC PHC
1 1
2 2 1
Total 2 1 2 1 2 1 9 1 2 3 8 8 9 1 10 1 1 2 4 1 1 2 2 1
District
Site
Type
Appendices
ILR LARGE
Total
CFC FREE
CFC FREE
Garhwa Total Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Giridih Total Godda Godda Godda Godda Total Gumla Gumla Gumla Gumla Total Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Hazaribagh Total Jamtara Jamtara Jamtara Total Koderma Koderma Koderma Total Latehar Latehar Latehar Latehar Latehar
Bagodar Bengabad Birni Deori Dumri Gandey Giridih Jamua Pirtand Raj Dhanwar Tisri Sadar Block Boarijore Godda Meharma Ghagra Gumla Sisai RH Barakatha Barhi Berkagaon Chaparan Churchu Gola Hazaribagh Ichak Mandu Patratu Vishnugarh Sadar DS Narayanpur Jainagar Markacho Balumath Chandwa Latehar Mahuatan Manika
PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC RH PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC PHC PHC
5 1 2 1 1 2 2 3 1 1 1 15
1 1 2 1 2 1 8 1 2 1 1 3 3 3
6 1 2 2 1 3 2 5 2 3 1 1 23 1 2 1 4 1 7 8 1 3 1
5 2 1 1 1 1 1 1 1 1 1 10 2 2 1 3 4 2 2 1 1 1 1 1 1 1 11 1 1 1 1 1 2 1 3 1 1 1
CFC FREE 1 1
CFC
CFC Free
CFC
CFC
1 1 1
1 4 5 1 2 1 8
1 1 2
11
1 13 4
1 17
1 1 1 1 1 1 1
1 1 1 2 1 1
Total 5 2 1 1 1 1 1 1 1 2 2 13 2 2 1 4 1 6 2 2 1 1 1 1 1 1 1 11 1 1 2 1 1 2 1 3 1 1
District
Site
Type
Appendices
ILR LARGE
Total
CFC FREE
CFC FREE
Latehar Total Lohardaga Lohardaga Lohardaga Lohardaga Lohardaga Total Pakur Pakur Total Palamu Palamu Palamu Palamu Palamu Total Ranchi Ranchi Ranchi Ranchi Ranchi Ranchi Total Sahebganj Sahebganj Total Saraikela Kharsawan Saraikela Kharsawan Saraikela Kharsawan Saraikela Kharsawan Saraikela Kharsawan Saraikela Kharsawan Saraikela Kharsawan Saraikela Kharsawan Total Simdega Simdega Simdega Simdega Simdega Simdega Total West Singhbhum West Singhbhum West Singhbhum West Singhbhum West Singhbhum Total Grand Total
4 Bandra Kisko Lohardaga Senha Pakur Bishrampur Daltanganj Lisliganj Panki Ranchi DS Chancho Khunti Ratu Aarki Borio Ghamaria Ichagarh Kuchai Nemdeah Raj Kharsawan Rajnagar Saraikela Sub Depot PHC PHC PHC PHC PHC PHC PHC PHC PHC DS PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC 1 1 1 2 1 1 1
1 1 1 2
5 2 1 3
6 1 1 1 1 3 5 5
CFC FREE 1 1 3
CFC
CFC Free
CFC
CFC
1 2
2 2 1 1 1 11 2 1 1 15 1 1 1 5 12 1 1 1 1 16 1 1 2 1 2 2 1 2 2
1 2 7 1 1 1 1 11
2 5
1 10 1 1 1 13 1 1
5 1 1 1 1
1 1
2 1 7 1 1 4
1 2 1 1 1 1 4 1 1 1 1 4 106 1
12 1 1
Bano Jaldega Kurdeg Simdega Simdega PHC Goilkara Jagganathpur Manjgaun Manoharpur
1 1
1 1 1 2
2 1 1 2
4 90
52
4 147
4 119
Total 6 1 1 1 1 4 5 5 1 1 1 3 1 1 1 1 4 1 1 1 1
District
Site
Type
Appendices
District
Remarks
No Cold cha training Pulse polio cold chain Immunizatio -
Appendices
Dr. P.N. Prasad Dr. Panchandad prasad Jaled Ansari Chatra Chatra DS Dr. E. Tigga Satyender singh Suresh Yadav Chatra Chatra PHC Dr. Suresh Sahu Ansar Ahmed Chatra Chatra Hunterganj Itkhori PHC PHC Verender prasad Dr. K.P Lal Sarju prasad Vijay shankar singh Dr. shiv Narayan singh Radha Ram singh Chatra Simaria PHC Dr. S.K. Pathak Kameshwar/Shambu Shoba Kujur Chatra Tandwa PHC Priyanka Kumari Dr. surendra prasad Singh Bishwanath Das Somnath Mukherjee Babul Mehtan Dr. S.S. P singh Deoghar Jasidih PHC Dr. Sudhir prasad Manju kumar Deoghar Deoghar Karon Madhupur RH PHC PHC Usha kumari Raja Kajal Kiran Asha Kumari Deoghar Mohanpur PHC Kajal Kiran Hemant Mishra Ajay Kumar Das Dr. Ramesh Prasad Deoghar Palajori PHC Magdali Aind Mridula kumari Salom Kishu Deoghar Deoghar Sarat Sarwan PHC PHC Babita Kumari Minoti Das Alo Banarji
Clerk MOIC Warden CS Clerk Store Keeper MOIC Clerk Family planning worker & cc in charge MOIC Assistant Computer Operator MOIC Family planning worker MOIC Vaccinator Nurse Nurse MOIC Grade IV Assistant Dist. RCH officer Grade IV MOIC Immunization officer Nurse ANM Polio coordinator Grade A Nurse ANM Grade A Nurse Store keeper MOIC MOIC Head ANM Grade A Nurse ANM Grade A Nurse ANM LHV
Patna Deogha r -
On deputatio -
Chatra
Pratappur
PHC
Deoghar
Deoghar
DS
Appendices
Sulochna Devi Neelam Kumari Dr. Deepak Kumar singh Sholam lal Ram Parvesh Paswan Arun Kumar Dhanbad Dhanbad Bagmara Baliapur PHC PHC Hemant Kumar Dr. Kalavaty Pandey Thakur Prasad Das Dr.Akilesh Sharma Dr.Digvijay Kumar Dhanbad Govindpur PHC Dr. Digvijay Singh Amulya Rani Chandeshwar Singh Govinda Topo Dhanbad Johrapokhar PHC Dr. Jaima Lakra Roopa Kumari Dr. Shashi Bhushan Geeta Sinha Sameer Kumar Pal Dhanbad Nirsa PHC Vinod Ranjan Sinha Prasad Singh Dr.Shahi Bhusan Saroj Sinha Gangadhar Dhanbad Sadar PHC PHC Ratna Bhatacharya Dr.Ashutosh Kumar Singh Bahalen Gudiya Dhanbad Topchanchi PHC N.K. Ram Dr. M.M.P. Singh Kumari Madhavi Raja Ram pd. Singh Dhanbad Tundi PHC Saloni Anando Arvind Tirki Raja Ram pd. Singh Nirmala Hembram Dumka Gopi Kandar PHC Dr. Narendra Kumar Dr. Surya Narayan Pradhan Dr. Narendra Kumar
ANM ANM MOIC Grade IV Asst Investigator Clerk Clerk-cold chain MOIC Clerk MOIC MOIC MOIC LHV Grade IV BHI AC ANM MOIC LHV Family planning worker Computer Operator MOIC MOIC ANM Computer Operator ANM MOIC LHV Clerk MD ANM Clerk LHV Health Educator Clerk ANM MO MOIC MO
Numkum Dhanbad -
Trained by MOIC -
Dhanbad
Dhanbad
DS
Appendices
Grashila Marandi Dumka Jama PHC Savitri sinha Grashila Marande Dr. Sakaldeep Mandal Vimla das Dumka Jarmundi PHC Vimal Das Dr. Virendrakumar singh Dr. D.K. Mishra Dumka Kathikund PHC Ramhari Prasad Malti Sorin Kokil Manto Dumka Masalia PHC Dr. Sanjay Kumar Dr. Mohd. Javed Bipin Kumar singh Dumka Ramgarh PHC Savitri Dr. R.D. singh Dumka Dumka Raneswar Sadar PHC PHC PHC Sushila Kumar Dr. Mohd Nazirudin Philomina Hembran Heera mani Arjun Yadav Ashok Mitra Dumka Saraya PHC Jaikant Devi Sarojini Kumari Raj Devi Navin kuma singh Dumka Shikaripada PHC Dr. D. Hembram Hariballab singh Dr. S. Prasad East Singhbhum East Singhbhum Jamshedpur DHQ DS M.K. Prasad M.K. Prasad Jitendranath Das Dr. C.N Jha Hidsi Kesgiri Manju Kumari East Singhbhum Chakulia PHC Tirki P Tiriki Dr. H.K. Alok East Singhbhum Dalbhumgarh PHC R.N. Manna Dankapuri
LHV LHV LHV MOIC LHV LHV MOIC MOIC Extension Educator LHV Pharmacist MOIC MOIC Clerk ANM MOIC LMV Medical Officer LHV LHV Clerk LHV LHV ANM LHV Health Worker MO Store incharge MOIC Clerk Clerk Male family planning worker MOIC Clerk ANM LHV MOIC Supervisor Male Ward Attendent
5 5
20
Dumka -
1 4
Baharagharah
PHC
5 5
5 1
Appendices
Dashpurh East Singhbhum East Singhbhum R.N Manna Dr. shashi Kumar singh Shadeo Ram Ghatsella PHC Bimal Kr. DAs P.L Mishra Rajendra Kalindi East Singhbhum Jugsalai PHC Ramchandra Ramachandra singh Dr. M.L. Keshari East Singhbhum East Singhbhum East Singhbhum Musabani Patomda PHC PHC Shaber Alam Meenu Maya Dr. A.A. Ekka Vivekanand chand Dr. Paul Astha Potka PHC Mani Manzi Mantu Chandras Garhwa Garhwa DS DS Vijay Dr. Raja K Roop mandal Dr. Rajendra Prasad singh Sikendar Kumar Garhwa Bhandaria PHC Dr. Ravi Prakash Arun Nagendra Rajani Kirkela Anil Kirpola Garhwa Bhavaanathpur PHC Kerolina Eleka Kerolina Eleka D. Laleada Garhwa Dhurki PHC D. Laleada Dr. R.K. Choudhari Dr. V.K. Gupta Sushi Phulmati Kumari Garhwa Garhwa Block PHC Shashi Bhashan Ram Dr. Virendra K. Tiwari Dr. Sohail Akhtar Ansari Shilwanti surgan Garhwa Meral PHC Jenet Fransis
Male Ward Attendent Supervisor Medical Officer VHW BHW Clerk Grade IV Clerk Clerk MOIC Clerk LHV MOIC Storekeeper/Clerk MOIC LGV Health worker Computer Operator RCM Officer LHV MOIC Grade IV MOIC Peon ANM Grade IV LHV LHV LHV LHV MO MO LHV MOIC MOIC MOIC LHV ANM
Jamshedpur -
Dhumria
PHC
Garhwa
Majhion
PHC
Appendices
Dr. Jaiswal Dr. Premchandran Shuka Kanij Fatma Garhwa Nagaruntari PHC Mohini MInz Dr. Ravindra prasad
No No No No No 3
Cold Chain RCHRanchi 1 Ranchi Giridih 3 Gindih 5 Giridihsadar hospital Giridihsadar Hospital
Usha Kumari Garhwa Ranka PHC Ramjanam Singh Dr. M. P. Singh Arun Lakda Geela Kumari Giridih Giridih DS Prem Kumar Dr. Bijay kumar sharma Prem kumar Lakshmi Devi Giridih Bagodar PHC Dr. R.N Singh Gyansham Arvind singh Dr. Richards Raj Shekhar Anant prasad Tiwari Giridih Birni PHC Kamla Devi Mohd. Sallahudin Shivanand Mishra Giridih Deori PHC Dr. Hasan Sukhdev Rain Bhagat Sheela Ghosh Beena sinha Giridih Gandey PHC Sarojni Devi Kalavati K.P. Verma Jageshwar prasad singh Govind prasad Dr. Harihar prasad singh Sandhya Jaiswal Shakuntla sinha
ANM Clerk/Servilene Inspector MOIC Clerk ANM Assistant clerk CS Assistant clerk LHV MOIC Accountant Vaccinator MOIC Computer Operator LHV Computer Operator Computer Operator MOIC Computer Operator LHV ANM LHV ANM Staff Head clerk MOIC LHV ANM
Giridih
Bengabad
PHC
Giridih
Dumri
PHC
Giridih
Jamua
PHC
Giridih
MCH
PHC
3 3
Appendices
Celestina Toppo Giridih Pirtand PHC Dr. Mahavir Oraon Kumari Rosi Rani Giridih Raj Dhanwar PHC Dr. Vijayakumar Shivani Chakravathy Mahamaya Devi Giridih Sadar Block PHC Dr. Nitranand singh Sant Kumar sinha Kamla Ramot Savitri sinha Giridih Tisri PHC Kedar Prasad sharma Birendra kumar M.S.K Ahemed Dr.Jitender Kumar Subodh Kumar Das Godda Godda DS Rajnikant Hazari S.K. Das Dr. Ram Jee Ram Subodh K Manju Murthur Godda Boarijore PHC Manju Murmu Dr. Y.N. Singh Pankaj Kumar Godda Mahagama PHC Pankaj Kumar Dr. Laxmi Narayan sharma Nepal mandal Godda Meharma PHC Pradeep singh Nandakumar Jha Savita Devi Godda Patthargama PHC Nagendra Kumar Sr. S.N. Chowdary Mahesh Thakur Godda Podayahat PHC Syan and sinha Lchha/Sarawati Toppo Kanita Gupta Dr. V.R. Razzah Godda Godda Sadar Block Sundarpahari PHC PHC Pahnath Dr. V.K. Bhagat Om Prakash Susheela Devi B.N. singh 10
LHV MOIC ANM MOIC ANM LHV MOIC Block Extensive Educator LHV LHV Computer Operator Pharmacist MO CS Clerk Peon Clerk RCH ANM ANM MOIC Clerk Clerk MOIC Clerk Clerk Computer Operator LHV SFW MOIC Block Extension Educator Grade IV LHV Immunization MOIC Health worker MOIC Computer Operator LHV Family planning
Immunizatio -
Appendices
worker Sanjeev Kumar varma Mayarani das Gumla Gumla DS Anjula Dube Shudarshan Singh Sunita Ekka Gumla Bharno PHC Chavidas Dr. S. Bhaski Dr. Attul naque Ansari Maria Gracica Indu Kumari Samsuddin Khan Imlani Herenze Kiran Kujur Ashok Prasad Gumla Gumla Dumri Ghagra PHC PHC Rosalia Lakola Dr. Rameshwar Ramesh Jasmani Danata Jaikant Ram Gumla Kamdara PHC Saroj Minz Sukra Pradhan Saroj Minl Dr. M.K.M Sahi Suganthi Kajoor Gumla Palkot PHC Agathala Dr.Mahendra Bhagat Budhdev Ram Gumla Raidih PHC Dayamani Bora Basudev prasad verma Shrefena Ekka Shankar Chaudry Gumla Sisai RH PHC Rukmani Devi Geeta Srivatsav Sarita Devi Gumla Basia RH Budhwa Badair Dr. Vinod Kr. Gupta Narsila Kujur Hazaribagh Hazaribagh DS Kajru Kajruindwar Pharmacist ANM Computer Operator FWP ANM LHV MOIC MO LHV ANM Computer Operator ANM ANM Dresser LHV MOIC LHV Computer Operator LHV Driver LHV MOIC LHV Computer Operator MO Grade IV LHV MOIC LHV Driver ANM LHV Computer Operator Driver MOIC LHV Cold chain incharge Clerk No No Yes No No No No No No No No No No No No No No Yes Yes No No No Yes No No No No No No No No No No No No No No No 5 15 2 2 1 Ranchi Immunizatio No info No info No info -
Gumla
Bishnupur
PHC
Gumla
Chainpur
PHC
11
Appendices
Muneshwar prasad Ghulam Rabbani Anju Kumari Hazaribagh Churchu FPC LisiFas Dum dum Avinash Kumar sinha Chitralekha semal Hazaribagh Barakatha PHC Rameshwar Sharma Dr. Ashok Kumar Verma Vinay Kumar sinhe Dr. B.B. Singh Dr. Md. Sabir Hazaribagh Berkagaon PHC Rameshwar prasad Ramyodhya prasad Anuradha kumari Hazaribagh Chaparan PHC Rudal singh Manju Ram Naresh Hazaribagh Churchu PHC Vijay Karmali Bigal Mahali Karmila Hazaribagh Hazaribagh Hazaribagh Gola Ichak Katkamsari PHC PHC PHC Dr. R.V.Raman Upendra prasad Vinay Kumar Sahni Dr. G.K. Singh S.N. Verma Terersa MInge/Preeti vandana Shambusaran Varma Hazaribagh Keredari PHC Bahalen samad Mariam Thopno Ravikumar Dr. Sanjay Jaiswal Asha Kumari Hazaribagh Hazaribagh Hazaribagh Mandu Patratu Ramgarh PHC PHC PHC Kamala kumari Kamala Kumari Dr. P.P. Sanga Bharat Narayan Sahu Manoj Kumar
Computer Operator Driver ANM LHV ANM Computer Operator MOIC Computer Operator Medical Officer MOIC Block Extension Educator Family planning worker LHV Clerk ANM Supervisor ANM Volunteer ANM MOIC Computer Operator Medical Officer Computer Operator ANM Clerk handling cold chain ANM LHV Clerk MOIC AMV ANM Incharge-medical officer Male Health worker Surveillance Inspector
Hazaribagh Hazaribagh -
No Training
Hazaribagh
Barhi
PHC
12
Appendices
Dr. Mahadev prasad Rajeshwar Pandit Anjani Kumar Hazaribagh Vishnugarh PHC Parmeshwar Dayal Dr. A.K. Singh Jamtara Sadar DS DS Anil Kumar Singh Pankaj Kumar Tiwari Vinod kumar sinha Dr. Ashok kumar Jamtara Jamtara PHC Ajay kumar chand Dr. Ashok kumar Mukesh kumar Krishna Pd. Singh Jamtara Kundahit PHC Bhagwan Saha Dr.Rampreet Ramo Shyama Chaudhry Isnidha Hemram Jamtara Nala PHC B.V Ram Mohd Sayed Alam Jamtara Koderma Koderma Narayanpur Koderma Jainagar Koderma (Jhumntalaya) PHC Markacho PHC DS PHC Shanti devi Indu Kumari Shedeshwar Prasad Shyama saransingh Kapil Dev Thakur Koderma PHC Mrutungan singh PHC Ashok kumar pandey Randhir prasad Nandu Rao Latehar Latehar DS Saroj Minz Arjun Ram Vimla Kumari Latehar Balumath PHC Santa brigit Khakha Dr. M.E. Haqu Sunil Kumar Dr. Chandarsekar Praleash Karunesh Kumar Sunil Kumar
Doctor Male Health worker Clerk Computer Operator MOIC Store keeper Cold Chain VHW Computer Operator MOIC BHW MOIC BHW Clerk Computer Operator MOIC ANM ANM MO Grade IV LHV ANM Male faculty planning worker Head clerk Computer Operator Eye Assistant Dresser Computer Operator Driver LHV Assistant ANM ANM MOIC MOIC Head clerk Surveillance worker
Koderma
Latehar
Barawadhi
PHC
13
Appendices
Indrani Belanjar Poonam kumari D.R.R. Prasad Teresa Bingra Latehar Chandwa PHC Teresa Bhingra Monika Kujar Sumitra Kumari Sanjay sinha Taramani Kumari Latehar Latehar PHC Dr. S.P. Sharma Istdor sing Mania Minj Latehar Mahuatan PHC Mane Stellor Elizebeth Narangi Raju Kashyap Riazudin Ansan Latehar Manika PHC Raghunandan Ram Gandhavan devi Dr. Harishchandra Mahato Deen Dayal Topo Jaigovind prasad Lohardaga Lohardaga DS Torus Lakra Deen dayal Topa Dr. B.P. Ranjan Nindu Mati Lohardaga Bandra PHC Prabu Bhagat Indumati Nirmala Hora Dr. Rajendra prasad Rajendra Prasad Gupta Solani Topno Lohardaga Kisko PHC Seema kumar Rajendra prasad Gupta Sadhya Prahima Latra Ram shankar Prasu Ram shankar prasad Lohardaga Kuru PHC Jabuoraom Dr. Rajmohan Khalkho Chonhati Dadel Lohardaga Lohardaga PHC Abdul Yusuf Sanjay Kumar Saraya prasad singh
LHV ANM MOIC LHV LHV ANM ANM Assistant ANM MOIC Educator ANM ANM LHV MOIC Ward boy Educator ANM MOIC Clerk Peon Driver RCH Officer LHV LHV MOIC Lab Technician LHV ANM Lab Technician ANM Clerk Clerk Grade IV MOIC ANM Grade IV Clerk Health worker
No No No No No No No No Yes No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No 5 1 8 2 2
14
Appendices
Magdalli Tinki Lohardaga Pakur Senha Pakur PHC DS Maharangi Khajar B. Kajoor Ashok srivastav Rampravesh singh Dr. Prem Kumar Pakur Amrapada PHC Aparna Ghosh Dr. Hemant Kr. Murmu Dayamanti Kumari smt. Jhumma dey Pakur Hiranpur PHC Rakesh kumar Shambhu Rd. singh Patel K. Jha DR. Sohail Anwar Pakur Littipara PHC Dr. Kalidas Murmu Mukesh kr. Mohli Dr. Sohail Anwar Ramdharii Murmu Dulal Rajeswari Pakur Maheshpur PHC Dr. B.P singh Suresh kumar Manohor Kumar Rema Dutta Pakur Pakudia PHC Abul Hasnath Dr. Akhilesh kumar Dr. Bhagat Palamu Daltanganj DS Ashok Dinesh Kr. Singh Dr. Harishankar singh Roshan Tara Palamu Palamu Block PHC Chainpur PHC PHC Sugneer singh Manorma Devi Pushpa Kumari Kar Dr. S.R. Gupta Kumari Gayatri Palamu Chattarpur PHC Kumari Gayatri Sidhanand sing Palamu Palamu Palamu Hariharganj Husainabad Lisliganj PHC PHC PHC Dr. Kalanand Mij Shaileshwari sinha Gayatri devi Bibhuti Dube Zeber Ahmed
LHV Ward Attendent LHV Clerk Clerk MO Computer Operator MOIC LHV ANM Pharmacist Grade IV BHW MOIC MOIC Head clerk MO LHV Clerk MOIC Senatory Inspector Health Inspector ANM MOIC RCH Officer Driver Clerk MOIC LHV Block Extension Educator LHV ANM MOIC LHV LHV Computer Operator MOIC ANM LHV/ANM Clerk Medical Officer
No Yes No No No Yes Yes No No No No No Yes No No No No Yes No No No No Yes Yes No No No No No No No Yes No No Yes No No No No Yes No No
Trained -
1 1
Pakur Pakur -
Pakur -
Pakur -
1 1 1
Palamu
Bishrampur
PHC
15
Appendices
Subhadro kumari Dr. S. Shah Teresa Tirki Mayakumari (Padma sub Centre) Palamu Manatu PHC Subhagy Devi Dr. Kedar Prasad Anaja Kerketla Palamu Panki PHC Krishna Tirky Dr. Chandra Bhanu Pralapan Dr. Dilip Kumar Singh Visundev prasad Ganga Devi Ranchi Ranchi DS DS Gupateswar prasad Pradeep Kumar Mehta Brajesh Sahu Ranchi Aarki PHC Dilip Tirky Alisaba Gulia Dr. Janardhan Pd Helen Lakda Hemrensia Ekka Leela Dafruza minz Parden Tirli Tarsila Topo Ranchi Bero PHC Ram Prasad Barahi Shailes kumar Roy Dr. P.Lal Ranchi Bundu PHC Tagaran Ekka Dr. R.C. Jhaha Surender Ranchi Burmu PHC Malini Ethel Rota Nalini Ranchi Chancho PHC Dhanashri Kumari Malim Sushama Dr. Mohammd En16
ANM MOIC Supervisor (LHV) ANM LHV MOIC LHV Health Educator MOIC MOIC Pharmacist LHV BHW Clerk/Store Keeper Clerk Clerk LHV MOIC NMN LHV NMN LHV LHV LHV Family planning worker Grade IV staff (cold chain) MOIC LHV MOIC ANM LHV ANM Grade IV ANM MOIC
No information in field Pulse polio training Sept 05 Pulse polio training Sept 05 Pulse polio training Sept 05 Immunizatio -
Palamu
Patan
PHC
Ranchi
Anigara
PHC
Appendices
son Nakul Kashyap Dr. G.P. Singh Ranchi Kanke PHC Deepali Premlata Ranchi Karra PHC Shail Bala Pandey Dr P.P Singh Indrani Kumari Dorothy Tuti Ranchi Khunti PHC Kanta Toppo Gobai Bhengra Dr. S.K. Varma Kanta Toppo Maryamagdali Lagda Shri Rambhari Nand Dr. T.P. Singh Parmila sinha Margaret Thalesey Ranchi Mander PHC Maheshan Bala Anju Bhattacharya Dr. A.N. Prasad Umrawah Devi Puspha kumar Ranchi MCH PHC Vimla Kumari Shyamali Sarkar Mariamma C.V Dr. A.K. Chowdhry Ranchi Ranchi Murhu Namkum PHC PHC F.F. Kongari Sanjeev kumar Sonmani Devi Lalitha devi Heera Kumari Ranchi Oremanjhi PHC Radhika devi Kalu Mathur Alakh Niranjan Ranchi Rania PHC Dr. G.S. Chaudhri Naveen Solomi Danga Ranchi Ranchi Ratu Silli PHC PHC Arun Kumar Kusum Kusum Warla Dr. Dinesh Prasad JTL MOIC LHV LHV LHV MOIC ANM ANM LHV Store keeper MOIC LHV LHV Peon MOIC Vaccinator ANM LHV Ladies health visitor MOIC LHV ANM ANM ANM Staff Nurse MCH LHV Store-Incharge LHV LHV ANM LHV Computer Operator MO Senetory Inspector Ward Attendent LHV LHV MOIC No No No No No No Yes No No No No No Yes No No Yes Yes No No No Yes Yes Yes Yes No No No No No No No No No No No No No No Yes No No 2 2 2 2 2 3 3 1 5 1 Sadar NoneRecommend None Recommend -
Ranchi
Lapung
PHC
17
Appendices
Ranchi Ranchi
Sonahatu Tamar
PHC PHC
Tagaran Ekka Dr. R.C. Jhaha Dr. Aravindkumar sinha Mr. Chamelidevi Elina Horo Dr. Nageshwar Moghi Asha Devi Sharda Dr. Naresh Kumar Krishnendu Acharya Dr. Praveen kumar Santhal Raghu Murmu Dr. K.E. Kejriwal Happan soren
LHV MOIC MOIC LHV LHV MOIC ANM ANM District RCH Officer Computer Operator MO Grade IV MOIC LHV Head clerk MO Extension Educator Sewak MOIC MOIC Vaccinator Vaccinator MOIC Grade IV ANM Computer Operator Purushar sevak LHV ANM Incharge Health worker District RCH Officer MOIC Computer Operator Clerk
No No No No No No No No No No No No No No No No No Yes No No No No No No No No No No No No No No No No No No 1 1 1 3
Sahibganj -
Ranchi
Torpa
PHC
Sahebganj
Sadar Hospital
DS
Sahebganj
Baharawa
PHC
Sahebganj
Barhait
PHC
Ram swaroop singh Dr. A.K Marandi Ashok Gorai Yogendra shah Dr. V.N . Chowdry Dr. Ram Bachan Chowdry Krishnan Chandra kant Krishna Chand kewat A.R. Srivastastav Ajay Kuroza Rani shashikala kiran Ramesh Tudu
Sahebganj
Borio
PHC
Sahebganj
Pathna
PHC
Phekan ghosh Chanchala Kumari Kalavah Gupta Pandau Mandal Rajeshwari prasad Surender Prasad Dr. Maheshwar prasad Dr. Sunil Urawan Rama Shankar Satyandar lenmar and Ramashankar
18
Appendices
Ram Saraikela Kharsawan Lal Babu Ichagarh PHC Dr. Jagdis prasad Dr. Bhola prasad Rajendra Singh Munda Pamkishun Bhol Dr. R.N. Soren Saraikela Kharsawan Nimdih PHC Preety Datta Arun Chandra Gop Alishany Nayar PHC Marshal Ranjit Kumar Ranjit Kumar Health worker MO MOIC Educator/computer Operator Pharmasist MO LHV Computer Operator Health worker/Computer Operator MO Clerk Clerk Health worker/staff MOIC Health staff/store keeper Store keeper Clerk Accountant Clerk Computer Operator Computer Operator FWP Clerk/Computer Operator MOIC Grade IV SW MOIC ANM Clerk LHV MOIC Store incharge Grade IV Pharmasist Driver No No No Yes No No Yes No No No No No 3 2 1 Chaibasa Sarikela and Chaibasa 3 Ranchi 3 Ranchi 2 -
Saraikela Kharsawan
Kuchai
PHC
Saraikela Kharsawan
Raj Kharsawan
Saraikela Kharsawan
Rajnagar
PHC
Maranda Tape Dr. Birendra Kumar Maranda Tape Devprasad Surendar singh S.K Mahapatro
Yes No No No No No No No No No No No No No No No No Yes No No No No No
Saraikela Kharsawan
PHC
Simdega
Simdega
DS
Surender singh Udit Manshid Mundu Rajesh Kumar Yadav Akhilesh Kumar Prasad Sanjay Kumar Ghosh Dr.Yuvram Ram Lakhan Singh Satendra Kumar Dr. Sanjay Kajoor
Simdega
Bano
PHC
Simdega
Bolba
PHC
Premika Ba M.D. Syed Meri Blanch Tirki Dr.Vishram Singh Kapil dev prasad Sanjay Arun Kumar Singh Ramesh Ram
Simdega
Jaldega
PHC
19
Appendices
Simdega
Kolebera
PHC
Satendra Sinha Dr.H Kiran Tigga Dr. Arun Kumar Smt. Rabban hildaminz Baidnath Tiwari Dr. Dmesh Prasad Modulike Ekka Akelash prasad
Health worker MOIC MOIC LHV Computer Operator Contract medical officer Store keeper Health worker ANM MOIC ANM Computer Operator LHV Store keeper LHV ANM LHV Grade IV Clerk Extension Educator BHW ANM SI LHV Computer Operator Computer Operator MOIC LHV ANM Clerk Store keeper MOIC Non-medical Assistant Computer Operator Dresser Grade IV MO
Simdega
Kurdeg
PHC
Simdega
Simdega
PHC
Shaadi grace Khaik Dr. V.C sinha Shanti grace Khalle Rajesh Kumar Yahav Putul Minj (Bethesade) Ahmed Hussain Shanti devi Indu Kumari Smt. Poorri Khan Deepak kumar singh Pravesh kumar Brajnandan Singh
PHC DS
Barajamda
PHC
Chakradharpur Goilkara
PHC PHC
West singhbhum
Jagganathpur
PHC
Jinkpani
PHC
Shanti swaroop sinha Premlata Parti Lalsi Pustt Hemant Kumar Dr. Chandwati Boifan Narayan Biruli S.S Malik
Khutpani
PHC
West Singhbhum
Kumardungi
PHC
West singhbhum
Manjgaun
PHC
20
Appendices
West Singhbhum
Manoharpur
PHC
PHC
Avinashik Huzur Parabhat Kumar sahu Dr. Meena Kumari Arun Dr. V.K. Pandit Dr. Meena Kalundia
LHV MFW Medical Officer Medical Officer Medical Officer MOIC BHW MOIC
chaibasaNandpur -
PHC PHC
Dr. Sanjay kumar Balaram sen Dr. Rajbind kumar Lolati Khalkho
21