Government of Jammu & Kashmir National Rural Health Mission

GOVERNMENT OF JAMMU & KASHMIR

NATIONAL RURAL HEALTH MISSION

DISTRICT HEALTH ACTION PLAN

District Doda

September 2007

1 2

Map of the District

3 PREFACE

The Hon’ble Prime Minister launched the NRHM on 12 th April 2005 throughout the country with the basic objective of providing accessible, affordable and accountable health care in rural areas. Its primary focus is on making the public health system fully functional at all levels. While detailing the functioning of the NRHM, the present planning process initiated in the State provides the entire framework for making the Public Health System fully functional and standardized upto the Indian Public Health Standards at all levels. In doing so, it emphasizes the need for communitisation of the Public Health System, improved financing and management of public health, human resource innovations, and a long-term financial commitment to enable the state and districts to undertake programmes aimed at achieving the Mission goals.

National Rural Health Mission envisages the planning process to be participatory and decentralized starting with the Village. It seeks to empower the community by placing the health of the people in their own hands and determine the ways they would like to improve their health. This is the only way to ensure that health plans are local specific and need based. The State should facilitate the processes by providing enabling environment and required financial and technical support. NRHM was launched in April 2005 and is being implemented by the Department of Health and Medical Education, Government of Jammu & Kashmir.

In accordance with the National Rural Health Mission, Jammu & Kashmir. The district has constituted the District Health Mission and significant progress has been made since it’s beginning. As per the NRHM guidelines, it has merged multiple societies at the district level. The District Action Plan was the most important aspect of the NRHM and to make District Plan more meaningful and address local health problems, preparation of Block Health Plans was considered essential. The decentralized planning process involved village consultations and preparation of Village Health Plans by the Village Health Water and Sanitation committees; followed by development of Block Action Plans through integration of Health Facility Surveys and block specific needs. The Block Action Plans were then integrated to form District Action Plan.

As result of this exercise, the district now has developed capacity for preparing the need based health action plans following participatory processes. A District Planning Team (DPT) was set up for this purpose in the month of July 2007 with representation from various sectors concerned with NRHM. This group was responsible for management of the entire planning process in the district and also for provision of the technical support. The DPT is the standing body and will take charge of ensuring implementation of the plan. Thus the DPT not only owns the plan but will also be responsible for monitoring the progress of implementation to achieve the objectives of the plan. The members of the DPT are:

# Name Designation Department 1. Sourav Bhagat DC Doda DC Office 2. A A Malik Chief planning officer DC Office 3. I A Shapu CMO Doda Health 4. Dr M I Zargar Dy. CMO Health 5. Kamlesha Kumar TSWO SWO 6. Shayesta Sultana CDPO Social welfare 7. Dr Kuldeep Kumar MO (ISM) ADMO

4 8. J M Tharmta DEPO Education 9. Dr M S Wani DHO Health 10. Waseem Raja District program manager Health 11. Ashok kumar District account manager Health 12. Surnnder Singh PMA Health 13. Tariq Hussan Data assistant Health

The orientation of DPT, facilitated by EPOS Health India, was held on 12 th July 2007. This enabled the DPT members to not only understand NRHM approach, key components and strategies of NRHM, but also manage the planning process and develop the District Action Plan. The DPT met a number of times and the individual members reviewed the situation of their respective sectors/areas and collectively developed the strategic vision for improving the health status of the district population.

We the members of the DPT on behalf of the entire Planning Team reiterate and certify that this District Action Plan has been prepared through participatory processes. It has been developed by integrating the Block Action Plans prepared by integrating health facility surveys and village health plans in each block of the District. This plan also incorporates the needs and plans from - 108 Sub health centres, 32 PHCs, 3 CHCs and 1 District Hospital in the District.

Name of Chief Medical Officer Signature Date

5 CONTENTS PREFACE...... 4

CRITICAL ISSSUES AND PRIORITY ACTIONS...... 7

EXCECUTIVE SUMMARY...... 13

PLAN AT A GLANCE...... 14

1. SITUATION ANALYSIS...... 36

SOCIO-ECONOMIC INDICATORS...... 46

2. PLANNING PROCESS...... 64

3. PRIORITIES AS PER BACKGROUND AND PLANNING PROCESS ...... 68

4. GOALS ...... 70

5. TECHNICAL COMPONENTS...... 71 PART A: REPRODUCTIVE AND CHILD HEALTH (RCH) II ...... 71 PART B: NEW NRHM INITIATIVES ...... 91 PART C: IMMUNIZATION ...... 108 PART D: NATIONAL DISEASE CONTROL PROGRAMME ...... 111 6. INTER SECTORAL CONVERGENCE...... 124

7. COMMUNITY ACTION PLAN...... 135

8. PUBLIC PRIVATE PARTNERSHIP...... 137

9. GENDER AND EQUITY...... 140

10. CAPACITY BUILDING...... 143

11. HUMAN RESOURCE PLAN...... 151

12. PROCUREMENT AND LOGISTICS ...... 155

13. DEMAND GENERATION - IEC...... 157

14. FINANCING OF HEALTH CARE...... 160

15. PROGRAMME MANAGEMENT ...... 162

16. BIO MEDICAL WASTE MANAGEMENT...... 167

17. MONITORING & INFORMATION SYSTEM...... 168

BUDGET AT A GLANCE...... 174

6 CRITICAL ISSSUES AND PRIORITY ACTIONS

# Thematic Critical Issues of the District Specific Priorities Area 1. District Functional integration of Societies need functional integration Health vertical societies like and strengthening. Management: Blindness Control Society, Capacity building of the DHS TB Control Society, District members regarding the programme, Malaria Society etc. their roles, various schemes and mechanisms for monitoring and Monitoring and evaluation. regular reviews and also operational guidelines for running the District Health Society. Monitoring of health activities by health personnel only. Members from other departments and also from the elected representatives need to become members for better monitoring and implementation. Strengthening the functioning of the DHS. 2. District & Need for providing more Development of total clarity at the Block technical support to the district and the block levels amongst Programme CMO office for better all the officials and Consultants Management implementation especially about NRHM activities in light of the increased Training of district officials and volume of work in NRHM. Block SMOs for programme Strengthening the management monitoring and reporting Streamlining Financial management especially in the areas of and systems Maternal and Child Health, Strengthening the CMO office with Civil works Behaviour DPMU with extra computers, change and accounting telephone system and human right from the level of the resources. Subcentre. Capacity building of the DPMU personnel for monitoring Strengthening the Block Management Units by establishing BPMUs.

7 3. Reducing Lack of 24X7 facilities for Increase coverage of full ANC and maternal and safe deliveries in Postpartum Care to pregnant child deaths subcentres and PHCs. women and Lack of authentic data Increase in Institutional deliveries by Population regarding the maternal and operationalsing 24X7 PHCs. stabilization infant deaths in the district. Strengthen FRUs for Emergency Equipments are not Obstetric Care services along with working properly or not minimum basic infrastructure, Blood available as per the need in Storage facilities, Facilities for subcentres, PHCs & CHCs Neonatal Care, drugs and to provide quality services. equipments. Lack of facilities with for Increase availability of safe abortion emergency obstetric care. services at all block level CHCs/ Non-availability of PHCs. Specialists for an Increased coverage under JSY aesthesia, obstetric care, Strengthening the Village Health paediatric etc. Day Lack of referral transport To increase awareness among systems. mothers and communities about the Lack of Blood Storage importance of institutional deliveries facilities at FRUs Improved behaviour practices in the Lack of Neonatal care community facilities at FRUs Operationalization of all the sanctioned Anganwadis 4. Family Low level of FP acceptance Increased awareness for Planning due to lack of awareness or Emergency Contraception and 10 yr motivation and low male Copper T participation Decreasing the Unmet Need for Family Planning Ensure availability of all FP methods at block level facilities. Train more MOs for NSV and promote the same. Partner with private doctors for FP and RCH services Increasing Access to Emergency Contraception and spacing methods through Social marketing

8 Building alliances with other departments, PRIs, Private sector providers and NGOs 5. Adolescent Adolescents especially the Implement ASRH programme to Health boys are exposed to increase the knowledge levels of smoking, addictions, peer Adolescents on RH and Life skills pressure and there is no Implement of Kishori Shakti Yojana one to counsel them. in coordination with ICDS and Teenage pregnancies also NGOs. emerging as a problem and Operationalise Adolescent Friendly unsafe abortion & Health services at the health premarital sex trend are on facilities rise. 6. Mobile Remote population is not Coverage of the tribal populations Medical Units covered due to lack of which are migratory in blocks (MMUs) required staff, Gandooh, Bhaderwah. infrastructure. Provide one-MMU equipped with Communications system is GPRS for services. poor. Contract MOs and staff nurses for MMUs 7. Upgrading None of the CHCs are as Following CHCs needs to be upgraded CHCs to per the IPHS standards; as per IPHS Standards in the first year:- IPHS however the condition of all CHC Bhaderwah existing CHCs is deplorable CHC Thathri and needs to be upgraded CHC Gandooh as per IPHS standard.

8. Upgrading None of the PHCs are as Construction of 18 PHC buildings as PHCs for 24 per the IPHS standards. per IPHS standards. Names of hr Services Out of 32 PHCs and PHCs are enclosed as Annexure and IPHS Allopathic Dispensaries, 12 Construction of staff quarters in 37 standards PHCs are housed in PHCs (Names of PHCs given in government buildings and Annexure) 20 are still functioning from rented accommodation with out sufficient facilities. 30 PHCs/ADs are without staff quarters

9 9. Upgrading None of the Subcentres are Need to construct 98 Subcentre Sub Centres as per he norms of IPHS buildings ( Names of SCs are to IPHS Out of 108 subcentres, 88 enclosed as Annexure) standards subcentres are running in Construction of staff quarters in all rented buildings and 20 subcentres for ANM’s stay. (Names subcentres are running of subcentres given in Annexure) from government owned Construction of Labour rooms at all buildings. Subcentres for promoting There are no labour rooms institutional deliveries in any of the Subcentres for Institutional deliveries There is no staff quarter in any of the subcentres of the district Doda. The numbers of Subcentres is also inadequate 10. Immunisation Lack of awareness to Strengthening the District Family mothers Welfare Office Alternate vaccine delivery Enhancing the coverage of Lack of Cold storage Immunization Efficient monitoring and Alternative Vaccine delivery supervision mechanisms in place Gaps in difficult, flung areas Effective Cold Chain Maintenance & inaccessible areas upto sub centre level Reporting and Zero Polio cases and quality documentation surveillance for Polio cases Large number of cold chain Close Monitoring and equipment are not documentation of the progress functional and need repair Repair and replacement of cold or need to be replaced chain equipment as per the need 11. Inter Sectoral Lack of coordination b/w ICDS Linkages to be developed between Convergence and health department ICDS workers and health workers for timely diagnosis of malnourished children and their management (detailed activities under thematic heads)

10 Lack of coordination b/w RDD Linkages to be developed between the and health department Health Department and the Rural Development department • Improving the health standard & general quality of life of rural community. • Awareness on sanitation/ Hygiene & health education. • Covering of school/ Anganwari in rural areas with sanitation facilities & promote Hygiene education & sanitary habits among students. • Promote & encourage cost effective construction of household latrine & their proper use. • Elimination of open defection to minimise the risk of contamination of water source & food. Lack of coordination b/w PHE • Bleaching powder and chlorine and health department tablets will be provided by PHE and distributed by field functionaries to households • Joint communication strategy. • Copy of water quality monitoring reports generated by IPH department will be shared with the Health Department at block, district and state levels • Community based organisations formed under various programmes/sectors will be engaged by a team of frontline workers – health, ICDS and PHE departments. 12. Human Lack of manpower at all levels • All staff to be in place as IPHS Resource starting from sub centres to norms by 2012 PHCs to CHCs to DH in district • Increased salaries for contractual Doda doctors and Specialists

11 • Special allowances for Regular staff Sub centre level • Increase in the number of training • The number of sub centres centres for LHV, ANM, Staff Nurses, will have to be increased Lab Technicians from108 to 131 • Rational placement of Specialists • The requirement of ASHAs and trained staff will be around 640 • Recruitment of staff on contract • The requirement of ANM where vacancies will be around 394 as per • Recruitment of staff for new facilities IPHS norms of 2 ANMs per as per the infrastructure Sub centre. requirements PHC level • Computers at all PHC and for each • As per IPHS 2 MOs per MO and Specialist at the CHC PHC will be required • whereas at resent there is Allowing Specialists and MOs for only 19 Mos against developing special skills as per their requirement of 64. needs by attending special courses anywhere in India. • For IPHS norms 96 Staff • Nurses for PHC [3 per Proposal for Staff Nurse College PHC] are required. At and other Paramedical training present there are just 3 SN college. • There are only 12 Lab Technicians as against the required 32 today. • At present there are 18 Pharmacists in the PHC as against 32. CHC Level At CHC level there are again shortfall of specialists and other support staff in District Doda

12 EXCECUTIVE SUMMARY

Doda district is the third largest in terms of area after Leh and Kargil. Doda District is one of the difficult districts of the State of Jammu & Kashmir and recently bifurcated into 3 districts i.e Ramban, Kistwar and Doda. Now new Doda district has 4 CD blocks. District headquarters is situated at Doda. Due to difficult hilly terrain there has been very little development including limited health facilities, poor transport network and communication. Although the number of CHCs and PHCs is adequate as per the population norms there is a need to upgrade the facilities as per the IPHS standards. The overall rank of the District in terms of major health indicators is 530 out of 593 districts. The health status of district is very poor. There is a huge gap in the present Human Resources especially of critical posts like ANMs, MOs, and Staff Nurses. The District Action Plan was developed in a participatory manner with EPOS as a facilitator. There was wide participation from all the related departments. A District Planning Team was constituted who carried out the block consultations and the Sub centre level consultations. Facility Survey was carried out for each facility. The consultations focused on each of the thematic areas with the present situation, the bottlenecks, and strategies and how to achieve the goals. The hot spots were identified from the village plans and the Block plans after incorporating the Facility survey reports, were consolidated to form the district plan. These were approved by the District Health society and the District Action Plan was finalized after incorporation of the DHS suggestions. The District Action Plan comprises of the situational analysis, goals and objectives for each of the defined indicators, strategies, activities, support required from the state, work plan and the budget for each of the thematic areas. All the aspects of health have been incorporated including the NRHM additionalities of ASHA, Untied funds, Mobile Medical Unit, Facilities as per IPHS norms, the National Disease control programmes, inter sectoral Coordination and Community involvement. Capacity building and Human Resources have been dealt with in details. The other Cross cutting issues of Gender, Logistics and Warehousing, HMIS, IEC and Biomedical Waste management have been also incorporated The priorities of the district include providing services to the un served and un reached, accurate data collection, strong district management, developing facilities as per IPHS norms and thereby meeting the national goals of NRHM. The total budget for 5 years is Rs. 22782.70 lakhs with an allocation of Rs. 6607.63 for the current year.

13 PLAN AT A GLANCE

PART A: Reproductive and BUDGET Child Health ACTIVITIES (RCH) II In Lakhs

A-1. 1. Developing systems for proper management, governance 109.90 Strengthening of and functioning through: District Health • Effective Planning – Annual, quarterly, monthly and as Management per needs • Supervision mechanisms • Convergence systems • Procedures, • Reporting systems, • Regularity of meetings, • Agenda of meetings, Maintaining minutes and its timely circulation • Decentralization, • Delegation of decision-making power • Rational decision making 2. Orientation Workshop of the members of the District health Mission and society. 3. Issue based orientation in the monthly Review and Planning meetings as per needs. 4. Ensuring provision of Technical Assistance at the district, block levels and sector levels and their ongoing capacity building. 5. Exposure visits of members of the District health Society to well functioning Panchayats in two states 6. Improving the Review and planning meetings through a holistic review of all the programmes under NRHM and proper planning. 7. Formation of a monitoring Committee from all departments. 8. Development of a Checklist for the Monitoring Committee. 9. Arrangements for travel of the Monitoring Committee 10. Sharing of the findings of the committee during the Field visits in each Review Meeting with follow-up of the recommendations. A-2. MATERNAL 1. Identification of all pregnancies through home visits by 1401.38 HEALTH ANMs, AWWs and ASHAs 2. Fixed Maternal, Child Health and Nutrition days followed with IEC sessions. • Publicising VHD day by AWWs and ASHAs • Registration of all pregnancies • Ensuring 3 ANCs, 2 TT injections and 100 IFA tablets 3. Postnatal Care: The AWW along with ANM will use IMNCI protocols and visit neonates and mothers at least thrice in first week after delivery and in total 5 times within one

14 month of delivery. They will use modified IMNCI charts to identify problems, counsel and refer if necessary 4. Tracking bags • Provision of tracking bags for dropout Pregnant mothers 5. Provision of Weighing machines at all Subcentres and AWCs 6. Availability of IFA tablets • ASHAs to be developed as depot holders for IFA tablets 7. Training of personnel for Safe motherhood and Emergency Obstetric Care (Details in Component on Capacity building) 8. Developing the CHCs and PHCs for quality services and IPHS standards (Details in Component Upgradation of CHCs & PHCs and IPHS Standards) 9. Developing CHC Doda as DH and FRU 10. Availability of Blood at the General Hospital and CHCs • Establishing Blood storage units at all CHCs 11. Improving the services at the Subcentres (Details in Component on Upgradation of Subcentres and IPHS) 12. Behaviour Change Communication (BCC) efforts for awareness and good practices Increasing the Janani Suraksha coverage • Wide publicity of the scheme (Details in Component on BCC …) • Availability of advance funds with the ANMs and timely payments to the beneficiary 13. Provision of Mobile Phones to all the ANMs, PHC MOs and one CHC Incharge • Display of the Mobile numbers at all Subcentres, AWCs, Panchayat Bhawans, PHCs and CHCs 14. Training of TBAs focussing on their involvement in VHD days, motivating clients for registration, ANC, institutional deliveries, safe deliveries, post natal care, care of the newborn & infant, prevention and cure of anaemia and family planning 15. Safe Abortion: • Provision of MTP kits and necessary equipment and consumables at all PHCs • Training of the MOs in MTP • IEC regarding the MTP services and the danger sign of unsafe abortions • Encourage private and NGO sectors to establish quality MTP services. • Promote use of medical abortion in public and private institutions: disseminate guidelines for use of RU-486 with Mesoprestol • Promotion of Emergency contraceptive. 16. Improvement of monitoring of ANM tour programme and Fixed village Health days • Fixed village Health days and Tour plan of ANM to be available at the PHCs with the MOs

15 • Checklist for monitoring to be developed • Visits by MOs and report prepared on basis of checklist filled • Findings of the visits by MOs to be shared by MO in meetings 17. Use of the Village Chowkidar and Numberdar as social Mobilizers for getting data on Maternal deaths, abortions, Pregnancies 18. RCH Camps: These will be organized once each quarter through NGOs/Rotary/Lions clubs to provide specialist services especially for RTI/STD cases. 19. Involvement of Rahber-e-sehat/Rahber –e-Taleem in motivating and mobilizing the women for VH days. A-3. NEWBORN & 1. Improving feeding practices for the infants and children 356.02 CHILD HEALTH including breast feeding • Study on the feeding practices for knowing what is given to the children • Education of the families for provision of proper food and weaning • Educate the mothers on early and exclusive breast feeding and also giving Colostrum • Introduction of semi-solids and solids at 6 months age with frequent feeding • Administration of Micronutrients – Vitamin A as part of Routine immunization, IFA and Vitamin A to the children who are anaemic and malnourished 2. Promotion of health seeking behaviour for sick children and Community based management of Childhood illnesses • Training of LHV, AWW and ANM on IMCI including referral • BCC activities by ASHA, AWW and ANM regarding the use of ORS and increased intake of fluids and the type of food to be given • Availability of ORS through ORS depots with ASHA • Identification of the nearest referral centre and also Transport arrangements for emergencies with the PRIs and community leaders with display of the referral centre and relevant telephone numbers in a prominent place in the village 3. Improving newborn care at the household level • Adaptation of the home based care package of services and scheduling of visits of all neonates by ASHA/AWW/ANM on the 1st, 2nd, 7th, 14th and 28th day of birth. • In case of suspicion of sickness the ASHA /AWW must inform the ANM and the ANM must visit the Neonate • Referral of the Neonate in case of any symptoms of infection, fever and hypothermia, dehydration, diarrhoea etc; • Training on IMNCI of ASHA/AWW/ANM/MOs on the home

16 based Care package • Supply of medicine kit and diagnosis and treatment protocols (chart booklets) for implementation of the IMNCI strategy • Strengthening the neonatal services and Child care services in and all CHCs and PHC : This will be done in phases • In all of these units, newborn corners would be established • Provision and supply of the equipment required for establishing a newborn corner • Training of staff in Newborn Care, IMNCI and IMCI (MOs, Nurses) including the management of sick children and severely malnourished children. • Availability of Pediatricians in all the General hospitals and CHCs • Ensuring adequate drugs for management of Childhood illnesses. 4. Strengthening the fixed Maternal and Child health days (Also discussed in the component on Maternal Health) • Developing a Microplan in joint consultation with AWW • Organize Mother and Child protection sessions twice a week to cover each village and hamlet at least once a month • Use of Tracking Bag • Tracking of Left-outs and dropouts by ASHA, AWW and contacting them a day before the session • Information of the dropouts to be given by ANM to AWW and ASHA to ensure their attendance • Wide publicity regarding the VH days 5. Strengthening Immunization (Discussed in Component C) • ASHAs and ANMs to conduct weekly survey (door to door) to ensure the condition of nursing mothers and children. • ASHAs and ANMs and other ground level workers to provide necessary education to mother (or) parents of newly born babies and guide them. • Training of ASHAs and ANMs and other ground level staff to ensure group work and communities organization in the rural communities. • To ensure weighing of new born weighing machine must be present in every health institution anganwari centers and school of elementary education. • Generally every child should be sponsored from with in the womb of the mother by ensuring nutritious diet complete immunization and safe delivery • Child groups to be formulated in each village and counseling sessions and group work to be done in order to understand the problems of children related to health and hygiene.

17 • Promotion of healthy diet and hygiene of children to in community A-4. FAMILY • Expanding the range of Public Sector providers for 626.29 PLANNING Terminal/spacing methods • Each CHC and PHC will have one MO trained in any sterilization method. • All the CHC/PHC will have at least one MO posted who can be trained for abdominal Tubectomy and NSV. • Specialists from District hospitals and CHCs will be trained in Laparoscopic Tubal Ligation. • Each CHC will be a static center for the provision of sterilization services on regular basis. The Static centers will be developed as pleasant places, clean, good ambience with TV, music, good waiting space and clean beds and toilets. • About 4 -7 PHCs come under the catchments area of CHCs and the camps will be organized on fixed days in each of the PHCs. • Equipments and supplies will be provided at CHCs and PHCs for conducting sterilization services. • A systemic effort will be made to assess the needs of all facilities, including staff in position and their training needs, the availability of electricity and water, Operation theatre facilities for District hospitals/CHCs/PHCs, Inventory of equipment, consumables and waste disposal facilities and the condition, location and ownership of the building. • At least three functional Laparoscopes will be made available per team, as will the equipment and training necessary to provide IUD and emergency contraception services. The existing Laparoscopes need to be replaced. For effective coverage 4 teams are required with minimum three Laparoscopes for each team. • Vacant positions will be filled in on a contractual basis. • Organization of Sterilization camps on fixed days at all CHCs

• NSV camp every quarter in all CHCs and PHCs

• Access to non-clinical contraceptives increased in all the villages • AWWs and ASHAs as Depot holders

18 • Empowering women • Increasing male involvement in family planning through use of condoms for safe sex and also in Vasectomy. • Service delivery sites for male methods by training health providers in NSV and conventional vasectomy Improving and integrating contraceptives/RCH services in PHCs and Sub-centres • Skill-based clinical training • Training in infection prevention, counselling and follow up for different family planning methods. • MIS training Strengthening linkages with ICDS programme and ISM (Ayurveda) • A detailed action plan • technical training and training in communication skills, non- clinical methods and record keeping Engaging the private sector to provide quality family planning services • Incentives and training to encourage private providers to provide sterilization services • Training to private lady doctors in IUD insertion • Detailed plan will be developed for partnerships. • Accreditation of private hospitals and clinics for sterilization and NSV • Involvement of NGOs Role of ASHAs: • Training to Act as depot holders for the supplies of pills and condoms by the ANMs for free distribution • Provide referral services for methods available at medical facilities Assist in community mobilization and sensitization. A-5 Adolescent 1. Research study involving quantitative and qualitative 339.79 Health aspects on the perceptions and practices of girls and boys in the context of rural setting and also the age of marriage and consummation. 2. Operationalization of Kishori Shakti Yojna • Adolescent Mentoring group consisting of Master Trainers for carrying out trainings, mentoring, monitoring the process of formation of Kishore- Kishori groups • Set up Kishore-Kishori Groups in all villages and family life education and IEC on high risk behaviour 3. School based programmes. • The district of Doda will be covered for anaemia prophylaxis programme during 2006/2007 to be scaled to all districts by 2012 4. The Adolescent Health package will consist of the following activities: • Formation of a Subcommittee as part of District

19 Partnership for Adolescent Health (DPAH) consisting of representatives of: Health department, Education department, Social Welfare department, ICDS, NGOs, PRIs, National Service Volunteers, other youth organizations, local chapters of Indian Academy of Paediatricians & FOGSI and other stakeholder groups. • Workshop to develop an understanding regarding the Adolescent health and to finalize the operational Plan • Provision of Adolescent friendly health services at PHC, CHC, FRUs and district hospitals in a phased manner. Training of the MOs, ANMs on the needs of this group, vulnerabilities and how to make the services Adolescent friendly. • Adolescent Health Clinics will be conducted at least once every week by the MO to provide Clinical services, Nutrition advice, Detection and treatment of anaemia, easy and confidential access to medical termination of pregnancy, Antenatal care and advice regarding child birth, RTIs /STIs detection and treatment, HIV detection and counselling, • In the 96 difficult villages the clinics will be part of the monthly Outreach session • Carrying out the services at the fixed VHD days • Provision of IFA tablets to all Adolescents, deworming every 6 months, Vitamin A administration and Inj. TT 5. Developing a cadre of Peer Educators • Selection of Peer Educators, two for each village in a phased manner, and their training for three days. • Selection of Counsellors for Peer Educator workshops and carrying out counselling clinics. These will be selected one per PHC. There will be equal number of Male and female counsellors and will alternate between two PHC – one week the male counsellor is in one PHC and the female counsellor in the other and they switch PHC in the next week so that both the boys and girls benefit.The counsellor will be Involvement of NGOs for awareness generation, Appointment of Counsellors, Peer Educators • Providing ongoing training to the Peer Educators, • Facilitating group meetings • Organizing Counselling session once per week at the PHC. Organization of counselling sessions at PHC with wide publicity regarding the days of the sessions • Collecting data and information regarding the problems of Adolescents 6. Close monitoring of the under 18 marriages, pregnancies, prevalence of RTI/STDs. 7. Three-day health camps for Adolescent boys and girls at block level for Deaddiction, Mental health and problems of

20 adolescents quarterly

PART B: New NRHM initiatives

B-1. ASHA – 1. Strengthening of the existing ASHAs through support by the 132.37 Accredited Social ANM. . and their involvement in all activities. Health Activist 2. Reorientation of existing ASHAs 3. Selection of new ASHAs to have one ASHA in all the villages 4. Training of ASHAs and selected ASHAs who have not received any training. 5. Training for Module 2,3,4 6. Provision of a kit to ASHAs 7. Formation of a District ASHA Mentoring group to support efforts of ASHA and problem solving 8. Review and Planning at the Monthly sector meetings 9. Periodic review of the work of ASHAs through Concurrent Evaluation by an independent agency 10. ASHA Performance Diaries is to be printed B-2. Provision of 1. Besides the usual recurring cost support to the sub-centres, 138.60 Untied Funds at each Subcentre would be given an untied support of Rs. Sub Centres 10,000 per annum. The fund would be kept in a joint account to be operated by the ANM and the local Sarpanch. 2. Rs 10000 will be given as annual maintenance grant to each Subcentre. This will be under the mandate of the VHWSC for undertaking construction and maintenance. This will bring in greater community control and the sub-centres would be brought fully under the Panchayati Raj framework. 3. Activities suggested for the untied funds include minor modifications, cleanliness of premises, transport of emergencies, transport of samples, purchase of consumables, etc; 4. This fund will not be used for salaries, vehicle purchase and recurring expenses of Gram Panchayat Monthly and quarterly expenditure statement will be submitted along with UC B-3. Provision of 1. 8 more PHCs yet to get registered as RKS. 120.00 Untied Funds at 2. Untied Fund, Maintenance Grant and Support Money will be PHCs provided to all PHCs including Allopathic Dispensaries. 3. Such funds will be used as per the need after due approval of RKS. 4. Proper accounts will be maintained for such funds. 5. Timely submission of Utilization Certificate to DHS through BMOs will be ensured by the facility In- Charge 6. Making an action plan on a quarterly basis for the utilization of funds for maintenance works besides emergency expenses e.g. short term purchase of drugs etc. 7. RKS will be registered at all the PHCs including new PHCs. ` B-4. Provision of These funds will be routed through the Rogi Kalyan Samitis who 37.50

21 Untied Funds at will approve the yearly activities and the related budgets and CHCs also undertake and supervise improvement and maintenance of physical infrastructure. 1. An untied fund of Rs 50000 will be provided each year for activities as per the local needs including minor modifications, cleanliness of premises, transport of emergencies, transport of samples, purchase of consumables, etc; This fund will not be used for salaries, vehicle purchase and recurring expenses of Panchayat or any other facility. 2. An Annual Maintenance grant of Rs 100,000 will be given to the CHC for water, toilets, maintenance of building. Monthly and quarterly expenditure statement will be submitted along with UC B- 5. Mobile 1. Joint meeting of the District Health Society and the Rogi 99.66 Medical Units Kalyan Samiti (RKS) to decide the appropriate modality for Operationalization of the MMU. 2. Formation of a Monitoring Committee 3. The RKS will operate the MMU for long-term sustainability of the intervention. 4. Staff will be hired on contract by the RKS – MO, male and Female Nurse, Lab Technician, Pharmacists, Members of Ayush, private providers, IMA members, NGOs, two drivers, Specialist from District Hospital and Medical Colleges, etc; 5. Need Analysis to be carried out for determining the areas of MMU. 6. Development of a monthly roster for Operationalizing MMU 7. Services will be given from 9 am to 4 pm from Monday to Friday. Saturday is for the maintenance of the vehicle. 8. Services to be provided: • ANC, PNC, Immunization • Diagnostic – Hemoglobin, Urine, Blood Sugar, Blood slide for Malaria, etc; • Treatment of minor ailments • Referral of cases needing Specialist care • Provision of Emergency services • Dissemination of information through the use of TV/DVD player • Holding meetings of Village water and Sanitation Committees • Maintenance of Records 9. Wide publicity before the arrival of the MMU 10. Communication support for the personnel 11. Periodic Review. B – 6. Upgrading 1. Hiring of additional staff as per IPHS and filling of 1380.83 CHCs to IPHS Vacancies 2. Building to be built for New CHC with staff quarters 3. Repair of CHC 4. Equipment as per IPHS norms

22 B – 7. Upgrading 1. Hiring of additional staff as per IPHS with 2 MOs( maybe 2139.32 PHCs for 24 hr Ayush), in each of the facilities, 3 staff nurses, 1 PHN, 1 Services Lab Technician, Part time Pharmacist, 1UDC, 1 Accountant, and Class IV and filling of Vacancies( Budget mentioned in the HR section) 2. Building addition /Expansion of and Repairing of 15 PHCs. Construction of staff quarters for the existing PHCs 3. Upgrading the Laboratory for tests necessary for 24 hour PHCs 4. Furniture, Drugs and Equipment as per IPHS norms 5. Existing PHCs will be upgraded as per IPH Standards. 6. Staff quarters for the existing PHCs B – 8. Upgrading 1. Building new buildings for 32 Subcentres 1590.52 Sub Centres 2. New sub center as per the population distribution. 3. Provision of Electricity, water storage and sanitation facilities to all sub centres 4. Construction of Staff Qtrs to all Sub Centers B-9 Untied 1. Provision of annual untied funds of Rs 10000 each year to 162.40 Funds and the villages’ up to a population of 1500. Villages with more Incentive Fund than 1500 population up to 3000 will get twice the funds. for the Village Villages with population more than 3000 will get three times Health and Water the funds, hence the district have 240 units. This untied fund Sanitation is to be used for household surveys, health camps, Committees sanitation drives, revolving fund etc; 2. Orientation of the ANMs for the utilization of the untied funds and she in turn will orient the Village, Health & Water Sanitation committee. 3. Provision of Rs 5000 as permanent advance fund for Incentives for ASHA based on performance norms. 4. Monthly meetings of the VHWSC for reviewing the funds and activities. This is to be facilitated by the ANMs 5. Monthly review at the PHC level regarding the VHWSC functioning and utilization of funds. PART C: Immunization

C-1. 1. Strengthening the District Family Welfare Office 690.52 Strengthening • One computer assistant for the District Family Welfare Immunization Office will be provided for data compilation, analysis. • Training for all the health personnel will be given including ANMs, LHVs, MPWs, Cold chain handlers and statistical assistants for managing and analyzing data at the district. • Alternative vaccine delivery system (mobility support to PHCs for vaccine delivery) • For Alternative vaccine delivery, Rs.50 to the ANM will be given per session, two sessions per week per Sub centre. • Mobility support (hiring of vehicle) is for vaccine delivery

23 from PHC to VH Days site where the immunization sessions are held for 8 days in a month.

2. Incentive for Mobilization of children by Social Mobilizers • Rs.100 per month will be given to Social Mobilizers for each village for mobilization of children to the immunization session site. This money will be provided to ASHA wherever possible but if there is no ASHA then it will be given to someone nominated from the village by the PRIs. • Contingency fund for each block • Rs. 1000/ month per block will be given as contingency fund for communication • Disposal of AD Syringes • Outbreak investigation: Rapid Action Team for epidemics will be formed • Dissemination of guidelines • Training of Rapid Action Team for investigating outbreaks who will in turn orient the ANMs during Sector meetings. • Standard Guidelines have been developed at national level and will be disseminated to the district officials and block levels in Review meetings. • IEC & Social Mobilization Plans • Cold Chain :Repairs of the cold chain equipment at PHC & CHC each year • Selection and training of volunteers from each of the far- flung area for delivering the vaccines. They can be paid Rs 50 per carriage. • Horses for the block Assar, Ghat, Bhaderwah, Gandoh for carrying vaccine to the areas where there is no road connectivity and are far flung. • One person and other requirements for maintaining the horses. PART D: National Disease Control Programme D-1. RNTCP 1. Improvement in the infrastructure 214.94 • Improved DTC building with a computer room • Improved MC centres and TC centre 2. Improvement in the quality of testing of sputum • Training to the RNTCP staff in the district • Equipment maintenance – Microscope, Computer and Others • Adequate supply of drugs 3. Increasing the outreach of the programme by Increasing the DOTS providers through involvement of ASHAs who will be paid Rs. 500 per year for providing services. She will be

24 oriented regarding DOTS. Also the AWH should be involved in reporting suspicious cases. Training will be given to ASHA for identifying the suspects. 4. Increasing the awareness regarding the various issues of Tuberculosis through involvement of Community leaders, NGOs, Ex-servicemen. Special drive for detection of cases on World TB day through the involvement for all departments 5. DOTS regime to be strictly monitored through the VHWSC, the PRIs and the PHC MO Orientation of PRIs and Rehbar-e-sehat for early detection of TB. D-2. LEPROSY 1. Institutional development: Expand the service availability 35.25 from CHC to PHC level. 2. Strengthening and Integration of Service delivery: Diagnosis and treatment facilities will be made available closer to the people through daily outreach. 3. IEC for awareness regarding the symptoms and effects of Leprosy 4. Prompt treatment to all cases with effective referral system. 5. Trainings programs of MOs on general health care & IEC, Lab Tech and Pharmacist. POID Camps. D-3. NATIONAL 1. IEC activities regarding the malaria prevalence and public 346.68 MALARIA awareness. CONTROL 2. Formulating community groups and seeking solution of PROGRAMME cleanliness quarterly. D-4. OTHER 1. Reduction of vector density 32.74 VECTOR BORNE • Identification of breeding sites DISEASES • Fogging and spraying • Covering of any breeding sites 2. Mosquito-man contact reduction • Use of Insecticide coated mosquito nets • Promotion of the mosquito nets 3. Preparedness for new infections • Increase in Manpower • Training of personnel for identification of new infections • Preparation of Laboratories in the district and State to diagnose the new diseases • Preparedness of dealing with the epidemic outbreak 4. Community awareness as part of the IEC for Malaria and IDSP • Group meetings • Pamphlets/ handbills • Public announcements • Kala Jathas D-5. BLINDNESS 1. Increase in number of cataract camps by strengthening 108.64 existing infrastructure and by involving private

25 CONTROL sector/NGO/Trust. PROGRAMME 2. Strengthening the CHCs, and new proposed District Hospitals (DH) for cataract operation by equipping them with operation theatre, vision box, colour vision, ophthalmoloscope and required medicines 3. Eye OT at CHC Gandoh and CHC Bheradwah will be contracted to meet the demand. 4. Ophthalmologist surgeon, ophthalmologic assistant will be posted at all the CHCs, 5. All the PHCs will be equipped with vision box, colour vision, ophthalmoloscope and required medicines. 6. NGOs/private agencies/trusts will be encouraged to participate in the National Blindness Control Programme. 7. Eye checkup and early detection and prompt treatment of ophthalmologic infections/diseases among children will be done during School Health Programme (Details is given in the School Health Component) 8. Training in IOL to Ophthalmologists 9. Training of Paramedical staff and Teachers, NGOs, Patwaris and AWW for screening and IEC activities. 10. Procurement of new Equipment 11. AMC for all equipment will be done. 12. Blind Register to be filled up by the AWW, together with PRIs 13. School Eye Screening sessions 14. IEC activities D-6. Integrated 1. Strengthening of the District Surveillance Unit (DSU), 133.33 Disease established under the project, Surveillance • Training of the Unit Incharge for epidemiology – {DMO) Program • Hiring of Administrative Assistant • Training of contract staff on disease surveillance and data analysis and use of IT • Providing support for collection and transport of specimens to laboratory networks • Provision of computers and accessories • WEN connectivity to be operationalized • Provision of software of GOI 2. Setting up of Peripheral Surveillance Units at DH 3. Sensitizing the Community for • Notifying the nearest health facility of a disease or health condition selected for community-based surveillance • Supporting health workers during case or outbreak investigations • Using feedback from health workers to take action, including health education and coordination of community participation. • Meetings with the SHGs, school teachers, Numberdar and Chowkidars for sensitization and prompt reporting of cases 4. Improvement in the Laboratories at the district and at CHCs

26 through provision of equipment and consumables D-7. Iodine 1. Supply/monitor quality of Iodized salt 29.46 Deficiency • Monitoring is done through Food Inspectors who collect Disorders two samples of salt per month per district and send it to a laboratory. • The Health workers have been supplied with Kits to test samples at least five per month. • Review is done in the monthly meetings • Monitoring through School health programme – Testing of samples and awareness • Supply of Testing kits to AWCs, Schools, SHGs 2. Assessment of the magnitude of the problem This will be done by the Central Survey team 3. Laboratory Monitoring of Iodized salt and urine samples The samples are collected by MPHW and sent for analysis. 4. Health Education: An IEC strategy is essential to promote the consumption of Iodized salt through AWWs, PRIs, NGOs,

ASHA, SHGs etc; Demonstration of Iodized salt by school children through testing, Rallies, sensitization of shopkeepers for keeping Iodized salt. 5. Testing of salt at shops and homes 6. INTER 1. Joint workshops for Planning and Review at all levels 1529.64 SECTORAL • Orientation programmes CONVERGENCE • Monthly meetings 2. Strengthening the VHD days • Wide participation of all the sectors in preparation of the community and in the actual activities, in health education • Each Wednesday during Immunization sessions joint orientations by all sectors and problem solving for each of the sectors 3. Joint Action for Sanitation, provision of safe water, provision of services and personnel at facilities 4. Joint review at the Gram Panchayat meetings 5. Joint efforts for education of the girls, improving the sex ratio, raising age of marriage, improving the nutritional status, identifying the correct BPL families, income generation. 6. Joint CNAA to determine the needs and thereby developing the plans jointly 7. Realignment of the Health and the ICDS sectors for common data and common work boundaries. 8. ASHA to participate in all the meetings of the ICDS held between the 20 th and 22 nd of each month. 9. At the CHC level monthly meetings are organized. This should be jointly organized with the ICDS 10. At the monthly meetings of the CMO, the officers of all the departments should come 11. Annual action Plans to be developed jointly through meetings at the village, Gram Panchayat, Sector and culminating in Block workshops and District workshops

27 12. Chiranjeevi Scheme to involve PRIs for promoting safe deliveries for rural BPL women through PPP initiative by involving the private sectors 7. COMMUNITY Facilitation of the process with the support of an external 84.10 ACTION PLAN agency Trainings of the VHWSC Regular meetings of the committee, twice a month, shall be held. Regular meetings of the MSS with linking with the SHGs and formation of Emergency Fund through the collections. Also developing a microplan for the MSS Local Gram Panchayat shall review the functioning of VHSC Based on village plans; sub-centre action plan shall be formulated. Joint CNA and development of the Village health register by ANM assisted by ASHA and AWW Tour plan of ANM to be shared with local Gram Panchayat Verbal autopsy for Maternal and Child deaths by the members for each mortality District level team to support household survey and survey of health facilities 8.PUBLIC Involve private players including NGOs/Trusts by providing a 146.83 PRIVATE conducive environment for accessing quality and affordable PARTNERSHIP health care services to the community.

Partnership for Services for Training: Lot of capacity building activities are envisaged under NRHM, but departments neither have that much of expertise nor sufficient time to carry out the capacity building activities properly. Therefore, all such training programme will be outsourced to a capable agency selected by the DHS. Partnership for Services for IEC: For implementing and managing IEC activities (mela, shows, campaign, rally, Village Contact Drives etc) including designing and printing of IEC material, a technical and Technical Support Agency will be hired. Partnership for Services for Transportation: One agency will be hired for getting services of vehicles with drivers for field monitoring by the officers at District and below level, for transportation of drugs, equipment, linen and others up to the Sub Centre level. Drivers for department’s vehicles and ambulances will also be hired from such agency. Annual contract will be done for this purpose.

28 the health scenario, a technical support agency will be hired for conducting surveys, evaluation, Data analysis, HMIS etc. Partnership for School Health Programme: For covering all the primary schools both government and private and strengthening School Health Programme private organizations specially local NGOs will be involved. Partnership for Security: As Doda district (Doda) is affected with the militancy, security of health personals and institutions is a major concern of the district.

For providing security to all PHCs and some selected Sub Centers , Ex-servicemen council or committees can be hired. Annual contract will be done for this purpose. 9. GENDER AND 1. Addressing Adverse Sex ratio 216.64 EQUITY • Workshops with private providers, IMA members, Religious leaders, Caste leaders, PRIs, MLAs • Early registration of pregnancies • TBAs, ASHAs, AWWs, Numberdar and Chowkidar and any of these to get Rs 50 per case for early registration of pregnancy • Educational activities in all schools and colleges and generating discussions in schools and colleges through debates • Regular meetings of the Appropriate Authorities • Registration of all Ultrasonography machines • Review of the monthly format to be filled by the Ultrasonography machines providers 2. Increasing male involvement in family planning • Use of condoms for safe sex • Couple Counselling for contraceptive choices • Counselling for planned parenthood • BCC activities to focus on men for Vasectomy. 3. Service delivery sites for male methods by training health providers in NSV and conventional vasectomy will be expanded so that each CHC and Block PHC in the district has at least a provider trained in NSV. • Demand for male contraceptive methods, men’s reproductive health services through designing and implementing male-focused BCC activities. 4. Gender sensitization training for all health providers in the CHC/PHC/SC and integrated into all other training activities. 5. Increasing the age of marriage • IEC activities for the harmful effects of early marriage • Registration of marriages • All the printing press people who print wedding cards should send one card to the CMO’s office 6. Health card would be provided to all girl children upto the age of 18 years.

29 7. Improving the Literacy status and promotion of education upto 10 th standard. 8. The Panchayats shall be granted incentives for ensuring 100 % enrolment of girls in the age group of 6-14 years in schools. 9. Treatment of anaemia in girls and also improving their nutritional status through Supplementary food at the AWCs Reporting of Gender Based Violence cases by all the departments 10. CAPACITY 1. Capacity building for the reduction in Maternal and 527.93 BUILDING Neonatal mortality • TBA training for 15 days in the concept of clean deliveries, danger signs, early referral, Newborn care and family planning, communication, • MTP training on MVA to all PHC MOs for 15 days. In 2007, 10 Lady MOs will be trained. Refresher trainings on MVA to be given • Training in Obstetric management & skills for Operationalization of 24x7 PHCs for 16 weeks • Training in skilled Birth attendants (ANM, LHV, SN) for 15 days • IMNCI training to ANM/LHV, SN, MO, CDPO for 8 days in the area covering the 24 x 7 PHCs • Training on Blood transfusion for MOs and Lab Technicians for CEmOC centres with Blood storage facilities for 3 days • Training in Life saving/Anaesthesia for EmOC at FRUs for MOs for 18 weeks • Integrated skill training of all SN • Integrated skill training for ANMs • Training of ASHAs • Training in management of newborns and sick children at Medical College Jammu of the MOs, SN, • Training in BCC for MOs, LHVs, ANMs • Training of Ayush personnel on issues of RCH and reporting for 3 days 2. Capacity building to meet the unmet needs • Training on NSV for MOs for 5 days • Training for Laproscopic Sterilization for Surgeons, Gynaecologists, SN, OT attendants for 12 days • Skill upgradation of ANMs & LHVs for 5 days • Orientation on contraceptive devices for MOs of Govt facilities as well as private facilities 3. Training on Medico-legal aspects 4. Continuing Medical Education sessions for doctors each month during the monthly meetings on current topics. An expert from a reputed institution will be invited on the current topics and Certificates will be given. 5. Capacity building for Gender equality • Orientation on Gender equality & PCPNDT Act for doctors both Govt and private, members of District Appropriate

30 authority NGOs 6. Capacity building for good programme management • Professional Development course for District Programme Managers, Senior district officials, MOs for 10 weeks • Management Development course for MOs for 5 days • General and Financial rules (G & FR) for the district officials, MOs, clerical staff for 3 days • Financial management training for Accounts Officers, Accountants for 3 days • Computer training to all the MOs, Clerical staff, accounts personnel • CNAA for MOs, LHVs, ANMs, AWW 7. Capacity building for managing the other components of NRHM RNTCP • Reorientation Training of DOT providers for 1 day • Orientation of MOs on revised Paediatric & PWBs under Paediatric management for 1 day • Training of newly appointed MOs (1) under RNTCP for 10 days • Convergence for Sanitation and hygiene under NRHM • One day orientations of VHWSCs for total sanitation Disease Control Programme – Blindness Control, Malaria, IDSP, IDDM • MPW • LT training PRIs • Training on NRHM and their roles of the members of the Gram Panchayat members, VHWSCs for 1 day NGOs • Training in BCC • Training of Field NGOs Private Sector Training on Family Planning issues, PCPNDT Act, Reporting 8. Ensuring the quality of trainings • A district quality training team will be formed to ensure the organization of trainings as per schedule, arrangements and monitoring the quality of all the trainings on the basis of checklists to be developed by the state. • They will ensure the availability of trainers and the staff at the District Training Centre. • The team will also monitor the work output of the trained personnel and give recommendations regarding improvements in the training and the future requirements. • For ensuring the availability of trainers a District Resource team and Block Resource teams will be formed for various issues. A list of Resource persons will be developed from the State for specialized issues.

31 11. HUMAN 1. Ensuring the quality of trainings 6577.58 RESOURCE 2. To induct new ASHAs as per requirement one ASHA/ 500 PLAN population. 3. To recent and trained specialists, MOs, Staff nurse, ANMs and other persons identified in gap analysis. 4. Development of training plan and methodology for all the personnel on various issues of RCH to reduce the Maternal and Neonatal mortality, meeting the unmet needs, building Gender perspective, good programme management and managing various components of NRHM 12. 1. Construction of a scientific Warehouse 155.53 PROCUREMENT 2. Procurement of software and computer hardware for the & LOGISTICS Warehouse from TNMSC 3. Proper Equipment and hardware 4. Availability of Pharmacist, Assistant Pharmacist, Packers 5. Training of personnel 6. Appointment of an agency for Operationalization of the Scientific Warehouse 13. DEMAND 1. Awareness on 1565.69 GENERATION- • Fixed VHD days IEC • JSY • Services available 2. Designing of BCC messages on exclusive breast feeding and complimentary feeding, ANC, Delivery, PNC, FP, Care of the Newborn, Gender, male involvement in the local language 3. Consistent and appropriate messages on electronic media – TV, radio 4. Use of the Folk media, Advertisements, hoardings on highways and at prominent sites 5. Training of ASHA/AWW/ANM on Interpersonal communication and counselling on various issues related to maternal and Child health 6. Display of the referral centres and relevant telephone numbers in a prominent place in the village 7. Promoting inter-personal communication by health and nutrition functionaries during the Village Health days 8. Orientation and training of all frontline government functionaries 9. Integration of these messages within the school curriculum 10. Kit for the newly married and during first pregnancy to be given at the time of marriage and during pregnancy 11. Mothers meeting to be held every month to address issues and for community action 12. Kishore Kishori groups to be formed in each village 13. Meetings of adult males to be held in each village to discuss issues related to males in each village every month and for community action. 14. Village Contact Drives and providing services, drugs, one to one counselling and talks with the Village Health & Water Sanitation Committee and the Mother’s groups.

32 15. quarterly massive drive in which registration of birth, death, Immunization of each child, ANC of each pregnant woman, growth monitoring of each child, disinfection of wells, spraying of houses and fogging, treatment of the stagnant water sites, detection of TB and Leprosy, treatment of all ailments, eye conditions through massive publicity. 16. Bal Nutrition Melas 4 times at each Subcentre 17. Wall writings 18. Pamphlets for various issues 14. FINANCING 1. Generation of funds from User charges: User charges are 183.14 OF HEALTH taken for Registration, IPD, Laboratory investigations from CARE persons who can afford to pay. 2. Donations from individuals: Donations are to be generated from individuals. For the betterment of hospitals, equipment, additions to the buildings, etc 3. Efficient management of the RKS: Training will have to be given for efficient management and utilization of the funds for activities that generate funds. Computerization of data and all the parameters need to be carried out preferably through customized software. Trainings can be organized with the help of RIHFW Rajasthan who have developed modules and conducted trainings for the management of these Societies. 4. Provision of Seed money to each RKS at CHC and PHC of Rs 100000 each year for repair, purchase of new equipment, additions, alterations, etc’; 5. Development of customized software and training of staff for the use of this software 6. Regular filling of formats 15. PROGRAMME 1. Support to the CMO : 1061.43 MANAGEMENT • Finalizing the TOR and the selection process • Hiring of consultants, one each for Maternal Health, Civil Works, Child health, Behaviour change. • If properly qualified and experienced persons are not available then District Facilitators to be hired which may be retired persons. • Selection of personal for BPMU 2. Capacity building of the personnel • Joint Orientation of the District officers and the consultants • training of the DPM and consultants • on Management of NRHM for all the officials • Induction, Training and Review meetings of the District Management Unit to be used for orientation of the consultants 3. Development of total clarity in the Orientation workshops and review meetings at the district and the block levels amongst all the district officials and Consultants about the following set of activities: • Disease Control • Disease Surveillance

33 • Maternal & Child Health • Accounts and Finance Management • Human Resources & Training • Procurement, Stores & Logistics • Administration & Planning • Access to Technical Support • Monitoring & MIS • Referral, Transport and Communication Systems • Infrastructure Development and Maintenance Division • Gender, IEC & Community Mobilization including the cultural background • Block Resource Group • Block Level Health Mission • Coordination with Community Organizations, PRIs 4. Infrastructure for officers , DPM, DAM, DDM and the consultants of the District Project Management Unit. • Provision of office space with furniture and computer facilities, photocopy machine, printer, Mobile phones, digital camera, fax, etc; 5. Use of Management principles for implementation of District NRHM • Development of a detailed operational manual for implementation of the NRHM activities in the first month of approval of the District Action Plan including the responsibilities, review mechanisms, monitoring, reporting and the time frame. This will be developed in participatory consultative workshops at the district level and block levels. • Financial management training of the officials and the Accounts persons • Provision of Rs. 500000 as Untied funds at the district level for DPMU • Compendium of Government orders for the DC, CMO, district officers, hospitals, CHCs, PHCs and the Subcentres need to be taken out every 6 months. Initially all the relevant documents and guidelines will be compiled for the last two years. 6. Strengthening the Block Management Unit : The Block Management units need to be established and strengthened through the provision of : • Block Programme Managers (BPM), Block Accounts Managers (BAM) and Block Data Assistants (BDA) for each block. These will be hired on contract. For the post of BPM and the BAM retired persons may also be considered. • Office setup will be given to these persons • Accountants on contract for each PHC since under NRHM Subcentres have received Rs 10,000, also the

34 village committees will get Rs 10,000 each, besides the funds for the PHCs. • Provision of Computer system, printer, Digital Camera with date and time, furniture 7. Convergence of various sectors at district level • Provision of Convergence fund for workshops, meetings, joint outreach and monitoring with each CMO 8. Monitoring the Physical and Financial progress by the officials as well as independent agencies

16. BIO MEDICAL 1. Review of the efforts made for the Biomedical Waste 111.95 WASTE Interventions MANAGEMENT 2. Development of Microplan Plan for each facility in District & Block workshops 3. Capacity Building of personnel. Biomedical Waste management to be part of each training in RCH and IDSP 4. Proper equipment for the disposal Installation of the Separate Colour Bins/containers and Plastic Bags for the bins 5. Segregation of Waste as per guidelines 6. Partnering with Private providers for waste disposal 7. Proper Supervision and Monitoring 8. Formation of a Supervisory Committee in each facility by the MOs and the Supervisors 17. MONITORING 1. Base line Survey on RCH parameters and indicators. The 243.84 & INFORMATION Baseline survey will be conducted by and external agency. SYSTEM 2. Joint CNAA by the ANM, AWW, ASHA alongwith the PRIs so that there is one data validated by the PRIs 3. Printing of Reporting & Monitoring Formats 4. Data entry of each Household, Eligible couples, Adolescents 5. Computerization of all the formats and software for the various programmes and finances 6. Computer training for data entry 7. Internet connectivity upto all PHCs for online transfer of data. The ANMs will get the data entered each month after the household and Eligible Couple entries have been made 8. GIS for the district covering all the parameters 9. AMC for all computers TOTAL BUDGET 22782.70

35 1. SITUATION ANALYSIS

Profile of the District

This District has a rich history. The district derived its name from its district headquarter Doda. It is said that one of the ancient Rajas of Kishtwar whose dominion extended beyond Doda persuaded one utensil maker Deeda, a migrant from Multan (now in Pakistan), to settle permanently in this territory and set up an utensil factory there. Deeda is said to have settled in a village which later on came to be known after him. With the passage of time the name Deeda has changed into Doda, The present name of the town.

Doda district is the third largest in terms of area after Leh and Kargil. The district falls between 32 degree-53' and 34 degree-21' north latitude and 75 degree -1' and 76 degree - 47' east longitude. Spread over in area of 11,691 Sq.Kms, the district has a population of 6, 91,929 (2001-census). The sex ratio was 903 females per 1,000 males and the density of population 36 per Sq. Kms. The literacy percentage as per 2001 census was 46.92 percent. The district has been divided into four Sub - Divisions viz Doda, Ramban, Bhaderwah and Kishtwar. It has seven tehsils viz Doda, Bhaderwah, Kishtwar, Ramban, Banihal, Thathri and Gandoh. The No. of Panchayats is 262.

The altitude varies from 8,000 ft. to 15,000 ft. The average rainfall is 35 inches per annum which is lowest as compared to other districts of the division. The Chenab, main river flowing through the district is commercially very vital for transportation of timber from forests and power generation. Chenab River has a hydel potential of about 15,000 MWs. Prestigious hydel projects of Salal and Dul Hasti are on this river. The district is known for its rich mineral Deposits. Lead, mica, gypsum, manganese, marble, graphite copper etc are found here. The district is pre-dominantly rural and has agricultural and pastoral economy. The district has good potential for tourism including piligrim and adventure. Monuments of archeological importance in the district include a fort at Bhadarwah, Bhandharkot fort in Kishtwar and Ghajpat Qila at Ramban. Kashmiri, Dogri, Bhadarwahi, Kishtwari, Siraji, Pogli, Paddri, Punjabi etc are the languages being spoken here in different areas.

The population comprises different communities and complete communal amity is being maintained. The majority of population though having different religions being to the same class and colour, so much so, that most of the families are pursuing the Vedic dharma while the

36 others are the followers of Islam. The people inhabiting this vast land may differ from each other in a number of ways but they have an essential unity viz their faith in secular way of life.

The secular outlook of the people therefore is due to the fact that population is mixed one and emotionally integrated. Both the Hindus and Muslims are in over whelming majority whereas other communities like Sikhs, Budhists and Christians also reside but in a very small numbers.

District Headquarter Doda is located about 175 Kms. from Jammu and about 200 Kms. from Srinagar. The District is having mountainous terrain. There are two National Highways connecting the District. These National Highways are NH-1A and NH-1 B. The general approach to the whole of the District is through road transport i.e. Taxi, Deluxe Buses etc. Visitors coming from other parts of the country can also utilize the Flight or Train services upto Jammu / Srinagar. From Jammu / Srinagar, road transport services are easily available to reach District Head Quarter Doda and to other Tourist Spots of District Doda. One can have the view of River Chenab while approaching to Doda, Bhadarwah, Kishtwar etc.

Doda District is one of the difficult districts of the State of Jammu & Kashmir and recently bifurcated into 3 districts i.e Ramban, Kistwar and Doda. Now new Doda district has 4 CD blocks. District headquarters is situated at Doda. The District has population of 3, 94,092 persons which lives in 365 villages and 129 Gram Panchayats . The overall rank of the District in terms of major health indicators is 530 out of 593 districts.

Profile of the District Doda District is one of the 22 districts of the State of Jammu & Kashmir. It has 4 CD blocks. District headquarters is situated at Doda. The District Doda has population 3, 94,092 which lives in 365 villages and 129 Gram Panchayats. 1. Identifying information

Name of District Doda Name of District Headquarters City Doda No. of Blocks in the District 4 No. of Gram Panchayats in the District 129 No. of Villages 365 1-500 124 501-1500 150 Size of Villages 1500-3000 73 3001-5000 11 5000+ 7 Villages without motorable roads 292 (80%) Villages without electricity 54 (15%) No. of Towns 2 Municipal Corporation Municipality Urban Local Bodies (ULB) Municipality: 2 Notified Area Committee Others

38 Administrative Structure old Doda: Structure Details Sub Divisions ( 4 ) Assar, Ghat, Bhaderwah, Gandooh Doda, Bhaderwah, Kishtwar, Ramban, Banihal, Tehsils* ( 7 ) Thathri and Gandoh Blocks ( 4 ) Assar, Ghat, Bhaderwah, Gandooh Municipal Committees ( 4) 4 No. of CHCs 3 No. of PHCs 32 No. of Sub-Centres 108 * Old Doda District

ASHA Status of the District Doda (Block wise).

To be Trained Already To be Name of Trained in 06- Selected in 07-08 Trained in Trained in Block 07 (Module I) (Module I) Mod II Mod II Assar 41 41 0 0 41 Ghat 104 91 13 0 104 Bhaderwah 137 127 10 0 137 Gandoh 95 95 0 0 95 Total 377 354 23 0 377

Un-served / underserved / vulnerable areas, population in the District -

The total population of Scheduled caste is 11813 ( Source: census of India 2001) The total population of Scheduled caste is 27917 The data of BPL families is not available since Doda is a new District.

39 District Data on Population Population' 'Total Population' 'Male Population' 'Female ratio Sex 06Years' Population 'Total 06Years' Population 'Male 06Years' Population 'Female 06Years' ratio 'Sex Rate' 'Literacy Household' of 'Number

Name 69192 3635 32840 Doda Total 9 26 3 903 119031 60591 58440 964 47.9 109500 64423 3359 30832 Doda Rural 4 06 8 918 113532 57625 55907 970 45.2 101506 2762 Doda Urban 47695 0 20075 727 5499 2966 2533 854 81.3 7994 Bhalessa 3006 (Gandoh) Total 58245 7 28178 937 11377 5811 5566 958 48.2 8563 Bhalessa 3006 (Gandoh) Rural 58245 7 28178 937 11377 5811 5566 958 48.2 8563 Bhalessa (Gandoh) Urban 0 0 0 0 0 0 0 0 0 0 3280 Bhaderwah Total 62164 4 29360 895 8748 4493 4255 947 69.5 9908 2681 Bhaderwah Rural 51648 9 24829 926 7629 3899 3730 957 66.6 8205 Bhaderwah Urban 10516 5985 4531 757 1119 594 525 884 83.1 1703

Source: census of India 2001

SC Population ST Population Population' SC 'Total Population' SC 'Male Population' SC 'Female SC' 'Sex ratio SC' '% Population' ST 'Total Population' ST 'Male Population' ST 'Female ST' 'Sex ratio ST' '%

Name 3221 Doda Total 62962 6 30746 954 9.1 79751 42053 37698 896 11.5 3154 Doda Rural 61658 1 30117 955 9.6 79256 41772 37484 897 12.3 Doda Urban 1304 675 629 932 2.7 495 281 214 762 1 Bhalessa (Gandoh) Total 5639 2926 2713 927 9.7 13655 7076 6579 930 23.4 Bhalessa (Gandoh) Rural 5639 2926 2713 927 9.7 13655 7076 6579 930 23.4 Bhalessa (Gandoh) Urban 0 0 0 0 0 0 0 0 0 0 18. Bhaderwah Total 11341 5711 5630 986 2 3348 1705 1643 964 5.4 21. Bhaderwah Rural 11056 5573 5483 984 4 3226 1638 1588 969 6.2 Bhaderwah Urban 285 138 147 1065 2.7 122 67 55 821 1.2

40 DLHS-RCH-II Survey, 2004 Related to Pregnancy and Maternal Health Issue % Issue % Mean age at marriage for boys 24.9 Mean age at marriage for girls 20.7 Boys married below legal age at Girls married below legal age at marriage 21 years 22.5 marriage 18 yrs 22.9 Any antenatal check up 56.5 Antenatal check up at home 0.0 Who had one TT injection during 17.6 3 or more antenatal check ups 52.7 pregnancy * Who had two or more TT injection Who had no TT injection during during pregnancy 34.0 pregnancy 39.8 Who received 100 or more IFA tablets Who consumed two or more IFA during pregnancy 32.7 tablets regularly during pregnancy 27.5 Received adequate IFA tablets/syrup 33.9 Who consumed one IFA tablet regularly 22.6 Full ANC1 - (At least 3 visits for ANC + Safe Delivery (Either institutional at least one TT injection + 100 or more delivery or home delivery attendant - IFA tablets) 22.6 Doctor/Nurse/TBA) 58.3 Full ANC2 - (At least 3 visits for ANC + Safe Delivery (Either institutional at least one TT injection + 100 or more delivery or home delivery attendant by 52.3 IFA tablets/syrup) 22.6 Doctor/Nurse) * Institutional delivery 34.0 Home delivery 64.4 Women who had pregnancy Institutional delivery - government 31.1 complications 34.8 Institutional delivery - private 2.9* Women who had delivery complications 44.1

Related to Child Health Issue % Issue % Breastfeeding within 2 hours (children Percentage of children age 12-35 age below 36 months) 37.5 months received BCG 89.9 Percentage whose mother squeezed out the first breast milk (children age Percentage of children age 12-35 below 36 months) 2.9 months received DPT 3 25.4 Exclusive breastfeeding at least 4 Percentage of children age 12-35 months (children age 4-12 months) 0.0 months received Measles 81.2 Percentage of children age 12-35 Percentage of children age 12-35 months received Polio 0 65.6 months received Full Immunization 16.2 Percentage of children age 12-35 Percentage of children age 12-35 months received POLIO 3 16.2 months not received any vaccination 0.0 Awareness of diarrhoea 58.6 Knowledge of ORS 49.6 Who had diarrhoea (two weeks prior to survey) 15.9 Given ORS to children during Diarrhoea 39.3* Sought treatment for Diarrhoea 40.4* Aware of danger signs of Pneumonia 33.8 Who had Pneumonia (two weeks prior to survey) 21.5 Sought treatment for Pneumonia 46.6

Related to Family Planning Issue % Issue % Women aware of RTI/STI 0.0* Birth order 3+ 22.6* Women aware of HIV/AIDS 46.0 Unmet need for limiting-1 59.6 Knowledge of any modern family planning method 99.9 Unmet need for spacing-1 3.1* Knowledge of any modern spacing family planning method 99.5 Unmet need -total-1 62.7 Knowledge of all modern family planning methods 39.8 Unmet need -total-1 59.6 Knowledge of any traditional method 0.0* Unmet need for spacing-2 6.3 Current use of any family planning method 16.4 Unmet need -total-2 65.9 Current use of any modern family planning method 16.2 Unmet need -total-2 43.5 Current use of any traditional family planning method 0.1* Current use - Male sterilization 0.3* Current use - Female sterilization 7.5 Current use – PILLS 1.6* Current use - Male sterilization 0.4* Current use – CONDOM 5.5 Women had side effects due to use of female sterilization 8.9* Women had side effects due to Pills 0.0* Women had side effects due to use of Sought treatment abnormal vaginal IUD 11.4* discharge 0.0 * Women who utilized government health facility for treatment of RTI/STI (vaginal Women who had any symptom of discharge) NA * RTI/STI 2.1

42 DISTRICT DODA- Maternal Health

District .achi District. Name of CHC 2006- Target Doda D.H activities 07 2007-08 Ach Assar Doda Ghat Bhaderwah Total estimated 812094 828335 67215 78087 117204 Population ANC Registration 15827 24850 63.69 2015 2217 2340 3515 No. of Deliveries 8120 24850 32.68 2015 2217 2340 3515 No. of Deliveries 7890 9607 82.13 779 856 904 1358 by Skilled Staff T.T (Preg. 15491 24850 62.34 2015 2217 2341 3516 Women) IFA. Tabs (Nos) 989300 2485000 39.81 189100 213000 219700 237200 MTP Cases 766 1685 45.46 52 312 32 52

DISTRICT DODA- Family Planning District.a District. Name of CHC chi 2006- Target Doda D.H activities 07 2007-08 Ach Assar Doda Ghat Bhaderwah Total estimated Population 812094 828335 133092 40491 53580 227163 Sterilization 797 3017 26.42 156 624 312 156 I.U.D. 1283 2080 61.68 104 208 104 104 Condom Pieces 136537 222645 61.32 17686 8323 20808 35373 O.P Cycles 4198 22784 18.43 1560 1040 5202 1768

DISTRICT DODA- Child Health District.a District. Name of CHC chi 2006- Target Doda D.H activities 07 2007-08 Ach Assar Doda Ghat Bhaderwah Total estimated Population 812094 828335 133092 40491 53580 227163 Infant Immunization 20606 22099 93.24 3552 2217 2082 3126 Vitamin A ( All Doses) 14896 66548 22.38 10691 6701 6273 9416 D.T (5 years) 25833 107683 23.99 17301 9982 10151 16238 T.T (10 years) 8733 6876 127.01 1104 525 647 973 T.T (10 years) 5854 5768 101.49 926 624 543 816

Source : CMO office

43 ICDS Data Name of ICDS Name of AWC's Name of AWC's Name of AWC's S.No Project Sanctioned Operational Reporting 1 Assar 69 69 69 2 Marmat 61 61 61 3 Bhagwah 72 70 72 4 Doda 120 120 120 5 Gundana 52 52 52 6 Bhaderwah 143 141 143 7 Thathri 113 110 110 8 Gandoh 144 142 144 Total 774 765 771 Source: Director social Welfare, July 2007

Monthly progress report for the month of 7/2007 district, doda Total population with in the project No. of SNP Beneficiaries Name of ICDS Name of Project AWC's 0-6 Lect 0-3 3-6 Lect S.No (R/T/U) Reporting Yrs Preg Women yrs years Preg Women 1 Assar 69 3552 274 370 1010 882 150 216 2 Marmat 61 3613 301 399 1000 728 162 219 3 Bhagwah 72 4546 357 496 1162 794 300 273 4 Doda 120 5773 459 545 1996 1381 305 369 5 Gundana 52 2544 181 162 969 621 133 146 6 Bhaderwah 143 7280 580 763 2067 1230 420 537 7 Thathri 110 5505 481 627 1812 1191 344 458 8 Gandoh 144 5573 670 615 1770 1150 480 500 Total 771 38386 3303 3977 11786 7977 2294 2718

Classification of Nutrition status No Total Name Rep of Grad No of Name of of orte No of Dea -e Childr ICDS AWC's d Dea ths Grad 3rd en Project Reporti live ths 0-1 1- Nor Grad -e & weight S.No (R/T/U) ng birth yrs 5yrs mal -e Ist 2nd 4th -ed 1 Assar 69 14 -- -- 325 146 15 -- 486 2 Marmat 61 11 -- -- 459 142 17 -- 618 3 Bhagwah 72 25 1 -- 803 384 71 -- 1258 4 Doda 120 15 1 -- 1277 445 5 1 1728 5 Gundana 52 18 -- -- 483 248 10 -- 741 6 Bhaderwah 143 38 -- -- 1934 15 -- -- 1949 7 Thathri 110 20 -- -- 1976 148 3 -- 2127 8 Gandoh 144 47 -- -- 1130 530 195 -- 1855 Total 771 188 2 -- 8387 2058 316 1 10762

Development Indicators of the District Indicators S.No State District

1 Crude Birth Rate 18.7Srs-06 23.5 2 Crude Death Rate 5.6 DNA 3 Infant Mortality Rate 49.0 DNA 5 TFR 2.4 NFHS III DNA 6 Couple Protection Rate 53 % NFHS III DNA 7 Sex Ratio (General) 900 Census 904 2001

8 Sex Ratio (0 – 6 years) 937 Census 894 2001

9 Sex Ratio at birth DNA DNA 10 Literacy rate (overall) 54.46 Census 43.3% Census 2001 2001

11 Literacy rate (male) 65. 75 Census 50% 2001

12 Literacy rate (female) 41.82 Census 35% 2001

13 Enrolment of students elementary T 10475 education M 5761

F 4714

Source: Census, 2001; DLHS-RCH-II Survey, 2004

45 Socio Economic and Health Indicators of the District Total for Name of Block DH District Name of Health Ghat Assar Bhaderwah Gandooh 1 Blocks Demographic indicators Total Population 120640 65000 112000 96963 - 3,94,092 Population of males 61000 33180 61556 50603 - 206339 Population of 59640 31820 50444 46360 - 187753 females Population of children less than a 17530 1950 3344 2025 - 24849 year old Population of children in age 15923 9100 15608 8520 - 49151 group between 1 and 6 years % Scheduled 22% 6% 7% 12% - 11.5% Castes % Scheduled Tribes 11.53% 8% 12% 14% - 10% Number of Inhabited ------Villages

Socio-economic indicators No. of <2 children benefiting from the 2630 439 2808 1869 - 7746 ICDS scheme No. of children aged 2 years and above 1392 1116 3240 2145 - 7894 benefiting from the ICDS scheme No. of BPL ------households No. of girls enrolled in primary schools 899 466 623 312 - 2203 last year No. of girls dropping out of primary Nil Nil Nil Nil - - schools last year Number of overhead tanks or hand 23 30 25 8 - 86 pumps Number of functional hand Nil Nil Nil Nil - - pumps in sub centres

46 Total for Name of Block DH District Name of Health Ghat Assar Bhaderwah Gandooh 1 Blocks Number of wells currently being used Nil Nil Nil Nil - - for drinking water purposes Number of households with 1005 560 1220 350 - 3130 access to toilets No. of private health NIL Nil Nil Nil - - facilities/clinicians No. of women who have benefited 104 84 186 70 - 444 through the JSY Scheme till now 1 No. of girls who got DNA DNA DNA DNA - - married last year No. of girls who got married last year and were <18 years DNA DNA DNA DNA - - at the time of marriage

Health Indicators No. of Tubectomy conducted in the DNA DNA DNA DNA - 797 last reporting year No. of IUD insertions done in 155 112 135 65 - 457 the last reporting year No. of vasectomies done in the last 0 13 0 0 - 13 reporting year No. of pregnant 4294 2015 3410 2340 2217 14276 women No. of pregnant women registered 3169 1493 1841 434 2217 9154 for ANC during the last reporting year

1 No. of pregnant women with the following mandatory characteristics: Belonging to BPL family Should be 19 years or older Up to two live births

47 Total for Name of Block DH District Name of Health Ghat Assar Bhaderwah Gandooh 1 Blocks No. of pregnant women who received both TT1 3212 1493 1841 434 - 6980 and TT2 during pregnancy in the last reporting year No. of institutional deliveries in the last 454 84 421 255 - 1214 reporting year No. of women operation of MTPs 113 63 209 91 - 476 in the last reporting year No. of RTI/STI cases reported in 560 804 205 42 - 1611 the last reporting year No. of children given measles vaccine in the 2870 6578 1856 5000 - 16304 last reporting year No. of outpatients 11131 165 6251 4000 - 21547 (monthly average) No. of inpatients 30 50 60 60 - - (monthly average) Prevalent 1. Tubercul Tubercul ARI ARI - - Diseases osis osis 2. Gastroint Gastrointesti ARI ARI - - estinal nal 3. Skin Skin anemia Tuberculosis - - disease disease

TUBERCULOSIS and LEPROSY No. of patients currently undergoing DNA DNA 51 63 - 114 DOTS therapy in the block Number of new leprosy cases DNA DNA 4 0 - 4 reported in last reporting year NVBDCP No. of slides examined for 5314 1295 276 1040 - 7925 malaria in last reporting year

48 Total for Name of Block DH District Name of Health Ghat Assar Bhaderwah Gandooh 1 Blocks No. of notified malaria cases (last Nil Nil Nil Nil - - reporting year) No. of new kala-azar cases in the block in Nil Nil Nil Nil - - the last reporting year No. of microfilaria cases reported in the Nil Nil Nil Nil - - last reporting year No. of JE cases reported in the last Nil Nil Nil Nil - - reporting year Blindness Control No. of cataract operations DNA DNA DNA DNA 94 94 conducted in the block last year School Health

Programme No. of schools covered under in the 41 32 45 32 - 120 last reporting year

49 Health Institutions, Population Coverage Ratios and Health Functionaries in the District

Name of Block DH Total for

District Name of Health Ghat Assar Bhaderwah Gandooh Blocks Health Institutions No. of Speciality Nil Nil Nil Nil 1 1 Hospitals No. Referral Hospitals 0 0 0 0 - 0 No. of CHC/BPHCs 1 1 2 1 - 5 No. of Blood Banks Nil Nil Nil Nil - 0 No. of CHCs (IPHS 0 0 0 1 - 1 Standards) No. of Blood Storage 0 0 0 0 - 0 Units No. of PHCs + ADs in 12 4 11 6 - 33 the Block No. of MOs in 3 2 9 12 - 26 Positions No. of 24 hrs. PHCs 1 1 0 0 - 2 No. of MTP Centres 1 1 2 1 - 5 No. of Sub Health 34 20 32 19 - 105 Centres + MAC No. of ANMs in 37 14 24 26 - 101 Position No. of AYUSH 0 6 8 0 - 38 Dispensaries No. of Private Nil Nil Nil Nil - 0 Hospitals No. of Beds in Govt. 6 6 40 20 100 172 Institutions No. of Beds in Pvt. Nil Nil Nil Nil - 0 Institutions No. of Anganwari 145 130 216 143 - 634 Centres Govt. - Nil 1 1 - 2 No. of Pvt. ------Ultrasoun Unregiste d Clinics ------red Population Coverage Population covered 120640 65000 112000 96963 - 3,94,092 No. of Sub-centres covering more than Nil Nil Nil Nil - 0 the current norm (5000) Health Personnel & Support Staff No. of Govt. 0 0 0 0 2 2 Obstetricia Pvt. 0 0 0 0 0 ns

50 Name of Block DH Total for

District Name of Health Ghat Assar Bhaderwah Gandooh Blocks Health Institutions No. of Govt. 0 0 1 0 2 3 Gynaecolo gists Pvt. 0 0 0 0 Nil

No. of Govt. 0 0 2 0 1 3 Paediatrici Pvt. ans No. of Govt. 0 0 2 1 2 5 Surgeons Pvt. No. of Govt. 0 0 1 0 2 3 Anaestheti sts Pvt. No. of Govt. 0 0 2 0 2 4 Orthopaedi Pvt. sts No. of Govt. 3 0 2 1 2 8 Dentists Pvt. Govt. 0 0 0 0 1 0 No. of Eye Surgeons Pvt. No. of Gen. Govt. 0 0 1 1 2 4 Physicians Pvt. No. of Govt. 0 0 0 0 1 1 Radiograph Pvt. ers No. of Public Health 0 0 0 0 - 0 Nurses No. of Staff Nurses 3 1 11 7 7 29 No. of LHVs 2 2 3 1 - 8 No. of Pharmacists 43 21 45 29 6 144 No. of Lab. 0 0 1 1 1 3 Technicians No. X Ray 0 0 2 1 2 5 Technicians No of Ophthalmic 1 1 1 1 1 5 Assts. No. Dental 2 2 4 1 - 9 Mechanics/Hygienists No. of Male Health 0 0 0 0 1 1 Supervisors No. of ANMs 40 20 38 23 4 115 No. of Male Health 2 1 6 1 - 10 Workers No. of AW Workers 145 118 216 143 622

51 Name of Block DH Total for

District Name of Health Ghat Assar Bhaderwah Gandooh Blocks Health Institutions No. of UDCs No. of LDCs No. of Computer/Statistical Nil Nil Nil Nil 0 Assts. No. of Drivers 2 1 4 1 4 12 No. of ASHAs 10104 41 137 95 377 selected No. of Trained Dais 40 50 40 0 130

52 Workforce Vacancy Position * Given below is the information about Workforce Vacancy Position in the District

Identified Gaps of Manpower in The District

District- Doda

Name of Blocks Ghat Assar Gandooh Bheradwah Ghat Existing NExisting Identified Identified Required Required Required Required Required Required Required Required Required Required Required Existing Existing Gaps Gaps Gaps Gaps Staff Staff Staff staff staff IPHS staff staff staff staff staff staff staff

Norm

No. of Sub- Centres 34 20 19 32 105

ANM 2 68 22 46 40 14 26 38 15 23 64 24 40 115 N0. Of PHC's 12 4 6 11 33 MO 2 24 3 21 8 2 2 12 5 7 22 9 15 45 Pharmacist 1 12 3 9 4 2 0 6 5 1 11 8 4 14 Nurse 3 36 0 36 12 0 9 18 2 16 33 4 32 93 Female Health 1 12 4 17 Worker 8 4 4 0 6 5 1 11 4 8 Health Educator 1 12 4 8 4 4 0 6 5 1 11 4 8 17 Health Assistant (one male and one 2 24 2 62 Female) 22 8 0 4 12 0 12 22 0 24 Clerks 2 24 3 21 8 0 4 12 0 12 22 0 24 61 LT 1 12 5 7 4 2 0 6 1 5 11 4 8 20 Driver _ 1 _ 1 _ 0 _ 4 _ Class lV 4 48 4 44 16 6 24 22 2 4 44 20 28 100 No. of CHC's A. CLINICAL NA NA 1 2 3 MANPOWER 1 General Surgeon 1 1 0 1 2 0 2 3 2 Physician 1 1 0 1 2 2 0 1 Obstetrician / 3 1 1 0 3 Gynaecologist 1 2 0 2 4 Paediatrics 1 1 1 0 2 1 1 1 5 Anaesthetist 1 1 1 0 2 2 0 0 Public Health 6 Programme 1 1 1 1 Manager 0 2 1 1 7 Eye Surgeon 1 1 0 1 2 0 2 3 8 Other specialists (if 2 1 1 1

53 any) General duty 9 officers (Medical 7 12 Officer) 0 12 0 12 B. SUPPORT 0 MANPOWER 1 Nursing Staff 7+2 0 7 14 2 12 19 Public Health a 1 1 0 3 Nurse 1 2 0 2 b ANM 1 1 2 0 2 1 1 1 c. Staff Nurse 7 1 14 2 18 7 d. Nurse/Midwife 6 12 0 6 Dresser 1 1 0 1 1 0 1 2 Pharmacist / 7 1 8 3 13 compounder 5 10 2 8 8 Lab. Technician 1 5 1 4 2 1 1 5 9 Radiographer 1 1 0 1 2 0 2 3 1 Ophthalmic 1 1 0 1 0 Assistant 1 2 2 0 1 Ward boys / 2 6 4 2 1 nursing orderly 2 2 6 0 1 Sweepers 3 3 4 0 2 0 3 5 0 1 Chowkidar 1 1 0 2 3 1 1 0 1 1 OPD Attendant 1 1 0 2 4 1 1 0 1 Statistical 1 Assistant / Data 1 1 0 2 5 entry operator 1 1 0 1 1 OT Attendant 1 1 0 2 6 1 1 0 1 1 Registration Clerk 1 1 0 2 7 1 1 0 1 1 Any other staff 1 1 2 8 (specify) Note: ( - ) Surplus staff Source : Health Facility Survey August

District hospital -Availability of Manpower and Identified Gaps

S.No. Personnel IPHS Norm Current Availability Identified Gaps

1 1 0 Hospital Superintendent 1 2 Medical Specialist 3 2 1 3 Surgery Specialists 2 2 0 4 O&G specialist 4 2 -2 5 Psychiatrist 1 0 1 6 Dermatologist / Venereologist 1 0 1 7 Paediatrician 2 1 1 8 Anesthetist (Regular / trained) 2 1 1 9 ENT Surgeon 1 1 0 10 Opthalmologist 1 1 0 11 Orthopedician 1 3 -2 12 Radiologist 1 1 0 13 Microbiologist 1 0 1 Casualty Doctors / General 14 6 0 Duty Doctors 6 15 Dental Surgeon 1 1 0 16 Forensic Expert 1 0 1 17 Public Health Manager 1 1 0 1 18 AYUSH Physician 2 2 0 2 19 Pathologists 2 1 1 23 7 Total 34

B. Para-Medicals Current S.No. Personnel IPHS Norm Availability Gaps 1 Staff Nurse* 75 to 100 9 66 Hospital worker (OP/ward +OT+ blood 2 bank) 20 0 20 3 Sanitary Worker 15 16 -1

4 Ophthalmic Assistant / Refractionist 1 1 0

5 Social Worker / Counsellor 1 0 1 6 Cytotechnician 1 0 1

55 7 ECG Technician 1 0 1 8 ECHO Technician 1 0 1 9 Audiometrician 1 0 1 Laboratory Technician ( Lab + Blood 10 Bank) 12 2 10 Laboratory Attendant (Hospital 11 Worker) 4 2 2 12 Dietician 1 0 1 13 PFT Technician - - 14 Maternity assistant (ANM) 6 4 2 15 Radiographer 2 0 2 16 Dark Room Assistant 1 0 1 17 Pharmacist 1 5 5 0 18 Matron 1 0 1 19 Assistant Matron 2 0 2 20 Physiotherapist 1 0 1 21 Statistical Assistant 1 0 1

22 Medical Records Officer / Technician 1 0 1 23 Electrician 1 1 0 24 Plumber 1 1 0

C. Administrative Staff Current S.No. Personnel IPHS Norm Availability Gaps 1 Manager (Administration) -

2 Junior Administrative Officer 1 0 1 3 Office Superintendent 1 1 0 4 Assistant 2 2 0 5 Junior Assistant / Typist 2 0 2 6 Accountant 2 0 2 7 Record Clerk 1 0 1 8 Office Assistant 1 0 1 9 Computer Operator 1 0 1 10 Driver 2 1 1 11 Peon 2 0 2 12 Security Staff* 2 0 2 Total 17 4 13

D. Operation Theatre S.No. Staff IPHS Norm Emergency Current Availability Identified Gaps General OT / FW OT 1 Staff Nurse 8 1 0 8+1 2 OT Assistant 4 2 1 4+1 3 Sweeper 3 1 1 2+1 Total 15 4 2 14+3

E. Blood Bank / Blood Storage S.No. Staff IPHS Norm Current Blood Identified Gaps Blood Bank Availability Storage

1 Staff Nurse 3 1 0 3+1

2 MNA / FNA 1 1 0 1+1

3 Lab Technician 1 - 1 0

4 Safai Karamchari 1 1 1 1

Total 6 3 2 7

Source : Health Facility Survey August 2007

Percentage Availability of Infrastructure District: Doda

Indicators SC (105) PHC (33) CHC (3) DH

1 Building (Govnt. + Donated) 31 42 100 100

2 Building (Rented) 69 58 0 0 Condition of Building (Good + 3 0 70 100 100 Fair) Water Supply (Tap, borewell/ 4 10 20 100 100 handpump/tubewell, well) 4.1 Tap water supply 10 72 100 100 5 Electricity 30 75 100 100

5.1 In all parts of hospital 0 60 100 100

Electric supply (power 0 60 100 100 generation stablization) 6 Separate Toilet 0 25 100 100 6.1 Sep.Toilet with running water 0 20 100 100 7 Furniture 0 20 100 70 8 Labor Room 0 20 100 100 8.1 Aseptic labor room 0 0 100 100 9 Avail. of Quater for staff 0 2 10 Number of beds available 10 20 100 100 (Average) 11 Laboratory 20 100 100

12 Operation Theatare - 100 100

13 Waste Disposal (Burnt+Dump) 0 50 100

14 Availability of incenator 0 - -

15 Telephone 6 100 100 16 Computer 6 100 100

17 Generator/Invertor 6 100 100

18 Vehicle 67 100 100

19 Emergency Room / Casualty 100 100

Separate wards for males and 20 10 100 females (Yes/No)

58 21 No. of beds : Male 10 60

22 No. of beds : Female 100 40 23 Availability of ECG facilities 100 100 24 X-Ray facility 100 100

25 Ultrasound facility 66 100 26 Cardiac Monitor for OT 0 100

27 Blood Storage Unit available 0 100

28 Blood Bank Facility 100

29 Other Investigative Facility 73

Heating ventilatoin & air 30 0 conditioning 31 Lift & vertical transport 100 100 32 Refrigeration 100 100

Source : Health Facility Survey August 2007

Average Percentage Availability of Equipments District: Doda

Name of Blocks Ghat Assar Assar Gandooh Gandooh Total Total Avg. Bhaderwah IPHS Norm No. of SC's 35 21 20 32 Recommended 108 Equipment kit 55 21.8 21.8 40.0 5.5 22.3 ( kit- C ) No. of PHC's 12 2 6 12 32 Suggested equipments 36 27.8 36.1 19.4 13.0 24.1 Operational labour room 10 30.0 20.0 30.0 50.0 32.5 Pap Smear 11 0.0 36.3 63.0 27.0 31.6 Laboratory Reagents 10 0.0 40.0 30.0 0.0 17.5 Glassware and other 7 100.0 85.7 100.0 14.3 75.0 equipment Furniture 25 48.0 52.0 100.0 32.0 58.0 No. of CHC's NA NA 1 2 3

Standard Surgical Set-1 32 37.5 37.5 59.9 Standard Surgical Set - II 33 30.3 30.3 26.8 IUD Insertion Kit 19 21.1 21.1 47.4 Standard Surgical Set - III 17 52.9 52.9 34.3 Normal Delivery 12 66.7 66.7 31.9 Standard Surgical Set - IV 16 62.5 62.5 33.3 Standard Surgical Set - V 21 61.9 61.9 25.4 Standard Surgical Set - VI 11 45.5 45.5 30.3 Equip. for Anaesthesia 17 35.3 35.3 20.6 Equip.for Neo-natal 10 70.0 70.0 16.7 Resuscitation Materials Kit for Blood trans. 15 73.3 73.3 17.8 Equip. for OT 11 72.7 72.7 48.5 Equip. for Labour room 13 46.2 46.2 39.7 Equip. for Radiology 9 66.7 66.7 48.1 Source : Health Facility Survey August 2007

Status of Health Centre Buildings in the District

Sub-Centre (SC) Status:- Sub Centres No. Overall Status Sub-Centres in own building 33 Sub Centers are in workable condition but need minor and major repairs. Sub-Centre in Panchayat 72 In workable condition but need new building Bldg / rented building SC without Electricity 88 All SCs are running without electricity. connection SC without Water Supply 90 11 Subcentres are without source of water supply. Storage facility and man power required for water collection in all subcentres. SC without Toilets 10 No toilet facility available in all Sub Centers

Primary Health Centres: Status Names of PHCs 24 hour PHC PHC Assar, Ghat. Total beds 8 No. of OPD cases 600 per month No. of indoor cases 2-3 Rogi Kalyan Samiti Functional functioning

Block Primary Health Centre (BPHC)/CHC (BPHC)/CHC Status Ghat Assar Bhaderwah Gandooh

Total no. of beds 6 6 40 20 Total no of OPD cases 650 500 2000 1500 Total no. of indoor admissions 20 20 70 60

Bed occupancy rate 70% 75% 80% 80% Total no. of deliveries 7-8 8-10 100-150 95-130 Ambulance with NGO partner Nil Nil Nil Nil Rogi Kalyan Samiti functioning Functional Functional Functional Functional

Number of Institutions Requiring New Buildings # Category of Institution Numbers 1 PHCs 20 Requiring New building 2 SCs 88 requiring new building 3 CHCs Nil Source: CMO office

61 Number of Buildings Requiring Additions/Expansion (staff quarters) Category of Institution Numbers # 1 SCs 105 2 PHCs 33 3 CHCs 3

Number of Buildings Requiring Repairs # Category of Institution Numbers 1 SCs 33 2 PHCs 14 3 CHCs 3

Status of Staff Quarters attached to CHCs, PHCs and SCs in the District Building Staff Quarters Condition (G: Good, NMR: Needs Minor Repairs, MR: Needs Major Repairs, NAD: Needs Additions

CHC Bhaderwah Yes NAD CHC Thathri Yes NAD CHC Gandooh Yes NAD PHC Assar Yes NAD PHC Goha No PHC Behota No PHC Shamti No PHC Ghat Yes NAD PHC Bhagwah No PHC Gundna No PHC Bhart No PHC Tanta No PHC Dhara No PHC Jodhpor No PHC Koti No PHC Kalihand No PHC Parnoo No PHC Kastigarh No PHC Dessa No PHC Chinta No PHC Premnagar No PHC Bhalla No PHC Behla No PHC Malothi No PHC sartingal No PHC Sarnaa No PHC Gatha No PHC Thanala No

62 PHC Rokali No PHC Panshaia No PHC Changa No PHC Manaloo No PHC Tipri No PHC Chilly No PHC Jakyas No PHC Kansoo No

Non-Governmental Organization [NGOs]: There is no significant contribution of NGOs in health sector. Only two three local NGOs are working in the district and they are not directly involved in health related activities.

MNGO : MNGO for RCH is not yet selected in district Doda

INFRASTRUCTURE PLANNING

Facility Existing 2007-08 2008-09 2009-10 2010-11 2011-12

Projected Population 691291* 394092** 404732 415660 426883 438409

District Hospital 1 1 1 1 1 1

CHC 3 5 5 5 5 5

PHC 33 32 32 32 32 32

Subcentre 105 131 135 139 142 146

ASHA 377 394 405 416 427 438 * Population of Doda district (old) as per census 2001 **Population of Doda district (new) as per block data

63 2. PLANNING PROCESS

A decentralized participatory planning process has been followed in development of this District Action Plan. This bottom-up planning process began with consultations with block stakeholder groups, Block /core Group members and village communities in all villages of each Block of the District.

Block Action Plans were developed based on the inputs gathered through village action plans prepared by Village Health Water Sanitation Committees. The health facilities in the block viz. SCs, PHC and, CHC were surveyed using the templates developed by Government of India. The inputs from these facility surveys were taken into account while developing the Block Action Plan.

The District Planning Team (DPT) provided technical oversight and strategic vision for the process of development of District Action Plan.

The members of the DPT had also taken the responsibility of contributing to the selected thematic areas such as RCH, Newer initiatives under NRHM, immunization etc. Assessment of overall situation of the District and development of broad framework for planning was done through a series of meetings of the DPT.

This District Action Plan has been prepared through a long process of integration of Block Action Plans including Health Facility Surveys. An initial meeting was held in which the current status of the District Action Plan was presented and suggestions and feedback taken. The membership and roles and responsibilities of DCG and the chapterization plans were discussed. Based on the inputs received from the Blocks, a draft of each chapter was developed after discussions. These were further improved upon through individual consultations with groups and nodal officers. Specific dates and times were fixed for this purpose.

A date was also proposed for a meeting during which the individual chapters would be discussed and approved before the final DAP was prepared for presentation to the District Health Society for approval.

64 HEALTH SERVICE INDICATORS FOR THE DISTRICT

BASIC HEALTH SERVICES

S.N Goal Posts & Indicator Criteria o SCORE

Immunizatio No. <3 No. completely % of fully immunized Maximum 100% n coverage years immunized children Minimum 0% 1 < 3 year of age 12250 10290 84%

Total no. of No of women who % of women getting Maximum 100% Essential pregnant got full antenatal antenatal care as defined Minimum 0% 2 Antenatal women care as defined Care 72% 14276 10276

Total no of Total no. of % of pregnant women women who had Maximum 100% pregnant who had institutional Institutional institutional Minimum 0% 3 women delivery. Delivery delivery

14276 1214 8.50

Weighing of Total no. of No. of newborn Percentage of newborn Maximum 100% Newborn births in the weighed within weighed within three days Minimum 5% with in three year three days 4 Days 14276 1214 9%

No of newborns Breastfeedin Total no of Percentage of newborns who were Maximum 100% g in First births in the who were breastfed within breastfed in the Minimum 0% 5 Hour last year an hour first hour

14276 14276 100%

Approx no of Maximum over blood slides Reporting of Average time taken for reporting of blood slide 30 days sent in last 6 Blood Slide Minimum 1 day year

7925 2-3 days

No. who No of target Total no. of wanted to % of unmet couples for couples with at get FP demand for Maximum 100% Access to sterilization least one of them operation FP Minimum 0% 9 Sterilization services wanting FP done last operation Services ( > 2 children) operation: year but could not

DNA DNA DNA

HEALTH RELATED SERVICES

65 WATER & SANITATION 15 Use of Total no. of Total no. of Percentage of families Max : 50 % Domestic/ families families where all where all members are Minimum 0% Community members are using domestic/ Toilet using domestic/ community toilet community toilet 65771 19731 30%

FOOD SECURITY RELATED Total no. of Percentage of children Actual No. getting Anganwadi Anganwadi eligible for diet regularly 16 beneficiaries Anganwadi

30960 280046 90.50

Total no. of Total no. of Percentage of schools giving primary and schools giving Midday Meal cooked midday 17 middle schools midday meals meals

738 738 100

Total no. of BPL families No. of families Percentage of eligible for getting grains PDS Functioning beneficiaries 18 lower cost from PDS shop

grains

74700* DNA DNA

Total no. of No. of families BPL families getting free Percentage of Antyodaya Yojna eligible for free grains from PDS beneficiaries 19 grains shop

74700* DNA DNA

Total no. of No. of children in Percentage of children in 6- age group not school going School Enrolment 20 14 age group going to school children

51220 7683 15

HEALTH STATUS Total no. of No. of children children below with gr I or % of children Max 200% Child Malnutrition 3 with wt above malnourished Minimum 0% 21 record. malnutrition**

1214 110 9

66 Total no. of Total no. of newborn who Percentage of babies Max 100% babies with Low Birth Weight were weighed with LBW Min 10% 22 LBW last year

1214 35 3

Total no. of No. of girls 100% - % of married Max 100% girls married married below women below 19 year Min 0% 23 Age of Marriage last year 19 year of age of age

DNA DNA DNA

Total number No. of children of births last born with more % of unspaced second Max 100% year which than 36 or third children born Minimum 0% 24 Spacing were second or months > child difference

DNA DNA DNA

Any deaths of Total number any child Maximum 20% of births last % of infant deaths below one Minimum 0% 25 Infant Deaths year year

14276 60 0.42%

Diarrhoeal outbreaks(Mor Jaundice e than three Sum of water borne Maximum 4 Outbreak of Water outbreaks (as cases of a disease outbreaks Minimum 0 26 Borne Disease defined) disease in

same week ) DNA DNA DNA

* Old Doda district

67 3. PRIORITIES AS PER BACKGROUND AND PLANNING PROCESS

National Rural Health Mission encompasses a wide range of health concerns including the determinants of the good health. Though there is a significant increase in resource allocation for the NRHM, there can never be adequate resources for all the health needs and all that needs to be done for ensuring good health of all the people. It is therefore necessary to prioritize the areas where appropriate emphasis needs to be given.

Based on the background and the planning process following are the overall priorities of this District:

1. Strengthening District Health Society and DPMU. 2. Strengthening CMO and Dy CMO office. 3. Providing services to the difficult and unreached population. 4. Alternative provisions of transport to reach the far-flung and difficult areas. 5. Availability of programme Officers, Specialists, Doctors and Staff Nurses and retaining the staff. 6. Quality services at all levels. 7. Capacity building of functionaries at all levels. 8. Increase in the number of facilities as per the population norms and developing them as per IPHS. 9. Developing and strengthening HMIS and monitoring system for data collection and reports. 10. Formation of Disaster Management Unit.

Specific Priorities of the District:

1. Programme Management: Formation and better functioning of the District Health Society and a strengthened CMO office. 2. Intersectoral Convergence: Fixing Responsibilities of each sector for their accountability and hence better Intersectoral Coordination. 3. Demand Generation, IEC/BCC: Nutrition, Health & RCH Education to Adolescents, behaviour change in the difficult populations and for improving the adverse sex ratio. 4. Human Resources: Filling of the vacancies as per the population based norms for the year 2007, increased mobility, motivational issues, provision of quarters at all facilities, availability of well trained ASHAs for each 1000 population

68 5. Capacity Building: Focused capacity building in Emergency Obstetric Care, Continuous skill building of all personnel as per needs expressed and also the new job responsibilities under NRHM, opening an ANM Training College. To equip the whole workforce i.e. ASHA, ANMs, including VWSC with new techniques and update their skills. 6. Infrastructure : Increase in the number of Subcentres, PHCs, CHCs and Urban Health centre for the slums and urbanized population 7. Procurement and Logistics: Construction of a scientific Warehouse for Drugs 8. Monitoring and Evaluation: Data validation and computerized data availability upto PHCs with district linkages 9. Maternal Health: Well managed system of institutional deliveries through Delivery huts and Emergency Obstetric Care services, JSY extended to all poor categories of persons, Blood Storage Units at all CHCs, All CHCs to be developed as FRUs, PHCs to be developed as 24x7 facilities, good referral mechanisms. 10. Neo Natal and Child Health: Provision of Neonatal services at CHCs, PHCs, Training on IMNCI and IMCI, addressing Anaemia and Malnutrition 11. Immunization: Total coverage for immunization 12. Family Planning: Improving the coverage for Spacing methods and NSV 13. Adolescent Health: The focus is on provision of Adolescent Reproductive and Sexual health education through schools and also awareness building on good health practices, responsible family life, harmful effects of drug abuse & Alcoholism, 14. National Disease Control Programmes: Prevention of Mosquito transmitted diseases 15. Public-Private Partnership: Increase in the number of private facilities for accreditation with the Government for providing services like immunization, RCH, Adolescent

69 4. GOALS

The District will strive to improve the availability of and access to quality health care by people, especially for those residing in rural areas, the poor, women and children and will achieve the following goals: Goals INDICATOR Current J&K Doda 07-08 08-09 09-10 10-11 11-12 50 DNA 10%Ba 20%B 30%B 40%B 50%B Reduction in Infant Mortality Rate (IMR) (SRS seline aselin aselin aselin aselin 2005) e e e e 2/3 rd of DNA 10%Ba 20%B 30%B 40%B 50%B Reduce Neo-natal Mortality Rate (NMR) IMR seline aselin aselin aselin aselin e e e e DNA 10%Ba 20%B 30%B 40%B 50%B Reduction Maternal Mortality Ratio seline aselin aselin aselin aselin (MMR) e e e e 18.9(SRS 23.3 Est 10%Ba 20%B 30%B 40%B 50%B Reduction in Birth Rate -2006) seline aselin aselin aselin aselin e e e e 2.4 DNA 2.3 2.3 2.2 2.1 2.1 Reduction in Total Fertility Rate (NFHS-3) 5.5 DNA 5.4 5.3 5.2 5.0 4.75 Reduction in Death Rate (SRS- 2006) 22.6%** 25% 40% 60% 75% 90% Increase Ante-Natal Care as defined 52.7%** 60% 70% 80% 90% 100% Increase three Ante-Natal Checkups 32.7%** 40% 60% 80% 90% 100% Increase Proportion of Women getting IFA tablets 34%** 40% 60% 80% 90% 100% Increase Proportion of Women getting 2 TT Injections 54 34%** 40% 50% 60% 70% 80% Increase Institutional Deliveries (NFHS-3) Increase Delivery by Skilled Birth 60.5 2.9%** 40% 50% 60% 70% 80% Attendants (NFHS-3) 53(NFHS- 16.2%** 30% 50% 70% 75% 80% Increase Contraceptive Prevalence Rate 3) 66.7 16.2%** 40% 60% 75% 90% 100% Increase Complete Immunisation of (NFHS-3) Children (12-23 month of age) 42.3 0.0%** 20% 30% 50% 70% 80% Increase Proportion of Children (NFHS-3) Exclusively Breastfed

Source: (*) CMO Office data (**) DLHS 2002-2004 data DNA means data not available

There is no data available on IMR, NMR, MMR, TFR, CDR and CBR and the DLHS data seems to be inadequate, hence a detailed baseline is mandatory

70 5. TECHNICAL COMPONENTS

PART A: Reproductive and Child Health (RCH) II A-1. Strengthening of District Health Management Situation The District Health Society Doda has been formed under the Chairmanship of the District Development Commissioner. Quarterly meetings of the District Health Analysis Society are being held regularly. The members are from health, AYUSH, Education, SDM, PHE, ICDS, Rural Development etc. There is a need to add one representative from each block. The Societies under the vertical Health Programmes like Blindness Control Society, TB Control Society, District Malaria Society, and society for IDSP have not been integrated into single society at the district level yet. Thus societies need functional integration and strengthening. Contractual appointments of various categories of staff have been made by the District Health Society. A district project management unit has been set up to provide technical support to the CMO for efficiency in carrying out the programmes. Recently the Block Management Units have been established for providing technical support to the blocks. Monitoring of the activities of the health department is carried out by the DHS but it is comprised of members of the health department only. Members from other departments and also from the elected representatives need to become members for better monitoring and implementation. Objectives Empowered District Health Society to effectively plan, implement and monitor the progress of the health status and services in the district Doda and achieve the goals Benchmark of the District action Plan. s Strategies Functional Integration of all the vertical Societies Capacity building of the members of the District Health Mission and District Health Society regarding the programme, their role, various schemes and mechanisms for monitoring and regular reviews and also on GoI / GoJ&K guidelines for running the District. Health & FW Society. Strengthening the functioning of the DHS. Establishing Monitoring mechanisms. Activities 1. Developing systems for proper management, governance and functioning through: • Effective Planning – Annual, quarterly, monthly and as per needs • Supervision mechanisms • Convergence systems • Procedures, • Reporting systems, • Regularity of meetings, • Agenda of meetings, Maintaining minutes and its timely circulation • Decentralization, • Delegation of decision-making power • Rational decision making 2. Orientation Workshop of the members of the District health Mission and society. 3. Issue based orientation in the monthly Review and Planning meetings as per needs. 4. Ensuring provision of Technical Assistance at the district, block levels and sector levels and their ongoing capacity building.

71 5. Exposure visits of members of the District health Society to well functioning Panchayats in two states 6. Improving the Review and planning meetings through a holistic review of all the programmes under NRHM and proper planning. 7. Formation of a monitoring Committee from all departments. 8. Development of a Checklist for the Monitoring Committee. 9. Arrangements for travel of the Monitoring Committee 11. Sharing of the findings of the committee during the Field visits in each Review meeting with follow-up of the recommendations. Support 1. State to provide support for building the capacity of the DHS through participation required in DHS meetings 2. A GO should be taken out that at the district level each department should monitor the meetings closely and ensure follow-up of the recommendations. 3. Instructions should be issued to the DHS that all approvals should be done in the DHS Governing board meetings and the CMO should implement them instead of sending each file to the DC for approval. Timeline 2007-08 2008-09 2009-10 2010-11 2011- 12 Developing systems x Orientation Workshop of the members x x x x X Issue based orientation x x x x X Ensuring provision of Technical Assistance at the district, block levels and sector levels x x x x X Exposure visits of DHS members x x x x X Construction of NRHM cell (DC Office) x Formation of a monitoring Committee from all departments. x Development of a Checklist for the Monitoring Committee. x

72 Budget Activity / Item 2007- 2008- 2009- 2010- 2011- Total 08 09 10 11 12 Orientation Workshop 0.5 0.55 0.605 0.666 1.271 3.591 Exposure visit 3.1 3.41 3.751 4.126 7.877 22.264 Issues based Workshops 0.5 0.55 0.605 0.666 1.271 3.591 Mobility for Monitoring 0.6 0.66 0.726 0.799 1.525 4.309 Construction of NRHM cell (DC 25 0 0 0.000 0.000 25.000 Office) Staff cost NRHM Cell (DC 7.56 8.316 9.1476 10.06 11.06 46.155 Office) Infrastructure costs, furniture, 5 0 0 0.000 0.000 5.000 computer systems, fax, UPS, Printer, Digital Camera, Total 42.26 13.486 14.835 16.31 23.01 109.91 0

Detailed Calculations # Description Amount Exposure Visit 1 Airfare and travel expenses (Taxi, Bus, etc;) 200000/- 2 Lodging, Boarding, Food 100000/- 3 Misc. 10000/- Total 3,10,000/- Mobility for Monitoring by the DHS members 1 Vehicle on Rent/ Mules trips @ Rs 1000 per visit x 5 days visit 60,000 per month x 12 months

NRHM Cell (DC Office) Unit 2009- 2007-08 2008-09 2010-11 2011-12 Total Personnel Cost 10 District Coordinator 25000 300000 330000 363000 399300 439230 1831530 Finance Manager 20000 240000 264000 290400 319440 351384 1465224 Computer Operator 12000 144000 158400 174240 191664 210830 879134 Support Staff 6000 72000 79200 87120 95832 105415 439567 Total 63000 756000 831600 914760 1006236 1106860 4615456

73 A-2. MATERNAL HEALTH Situation Analysis Indicator No. Pregnancies last year 24850 Maternal Deaths DNA %

ANC registration 15827 63.7% Full ANC coverage DNA DNA Full ANC coverage DNA DNA ( 3 ANC) TT1 & TT2 15491 62.0%

Institutional Deliveries 1214 5.42% Deliveries by skilled birth 7890 35.27% attendants JSY Beneficiaries 181 0.81% Home deliveries Number % 5821 26.03% No. of pregnancy related DNA complications referred to FRU level No of MTPs last year 766 Source: CMO Office

Maternal Mortality: There is no data available regarding the Maternal deaths in the district as well as in the State. ANC: Out of the all pregnancies 64 % pregnancies had been registered. There is no data available on full ANC checkups. There are only 17% institutional deliveries and data needs to be validated. IFA: There is no data available regarding the consumption of IFA. As per DLHS 2004 only 22.6% of the pregnant women were given 100 or more iron and folic acid tablets TT: 48.54% of the pregnant women had received TT2 as per District data. Deliveries: Institutional deliveries are 17 % Referrals: There is no inadequate data for referrals during complications. MTP: There were 476 MTPs carried out last year Male participation : There is no data available for the level of male participation and also on what issues does male participation occur Janani Suraksha Yojana : Under JSY scheme there are 181 women benefited last year. This low uptake has been due to poor awareness and also due to the fact that the data of BPL families needs to be updated. Services: in the government facilities staff are not always available especially Lady MOs are not there in any PHCs and also inadequate infrastructure, equipment and drugs. The private facilities also are not available. The government has started intensive efforts to improve the facilities through 24 hour PHCs, development of CHCs as per IPHS standards. One CHC is being developed as per IPHS norms. Training: regular staff training programmes on SBA, EmOC and MTP need to be arranged. Fixed Village Health Days (VHD days) are being organized but there is little awareness amongst the community about the days

74 A-2. MATERNAL HEALTH RCH Camps: RCH camps are organized by the department and also through MDA to reach the community and provide services at the doorsteps. These camps provide specialist services with simple diagnostic tests. They also serve for screening of RTI and STDs. In district Doda only one VHND held in first quarter of 2007,which shows the status of maternal health services Objectives 1. Decrease in the Maternal Mortality ratio to 50% of the baseline by 2012 Benchmark 2. 100% ANC coverage by 2012 s 3. 100% pregnant women administered two doses of TT by 2012 4. 80% pregnant women to consume 100 IFA tablets by 2010 and 100% by 2012 5. 60% Institutional deliveries by 2010 and 90% by 2012 6. 75% deliveries to be carried out by trained /Skilled Birth Attendant by 2010, 100% by 2012 7. 100% women to get improved Postnatal care by 2010 8. 50 % increase the safe abortion services by 2010 9. Reduction in Anaemia to less than 20 per cent by 2012 Strategies 1. Provision of quality Antenatal and Postpartum Care to all pregnant women 2. Increase in Institutional deliveries 3. Quality services in the health facilities 4. Availability of safe abortion services at all CHCs and PHCs 5. Increased coverage under JSY 6. Strengthening the Fixed village Health Days (VHD) days 7. Improved behaviour practices in the community through BCC and IEC activities. 8. Construction of S/Cs and PHCs where ever required and service delivery for 24 hour in all PHCs 9. To improve quality services in all PHCs especially for institutional delivers. 10. Training should be given to more skill birth attendants; in district Doda the number of ASHAs should be doubled. 11. More incentives for ASHAs and ANMs for increasing institutional deliveries 12. Capacity building of ASHAs ANMs and other ground level staff. Activities 1. Identification of all pregnancies through home visits by ANMs, AWWs and ASHAs 2. Fixed Maternal, Child Health and Nutrition days followed with IEC sessions. • Publicising VHD day by AWWs and ASHAs • Registration of all pregnancies • Ensuring 3 ANCs, 2 TT injections and 100 IFA tablets 3. Postnatal Care: The AWW along with ANM will use IMNCI protocols and visit neonates and mothers at least thrice in first week after delivery and in total 5 times within one month of delivery. They will use modified IMNCI charts to identify problems, counsel and refer if necessary 4. Tracking bags : Provision of tracking bags for dropout Pregnant mothers 5. Provision of Weighing machines at all Subcentres and AWCs 6. Availability of IFA tablets :ASHAs to be developed as depot holders for IFA tablets 7. Training of personnel for Safe motherhood and Emergency Obstetric Care (Details in Component on Capacity building) 8. Developing the CHCs and PHCs for quality services and IPHS standards (Details in Component Upgradation of CHCs & PHCs and IPHS Standards) 9. Developing CHC Doda as DH and FRU 10. Availability of Blood at the General Hospital and CHCs: Establishing Blood storage units at all CHCs

75 A-2. MATERNAL HEALTH 11. Improving the services at the Subcentres (Details in Component on Upgradation of Subcentres and IPHS) 12. Behaviour Change Communication (BCC) efforts for awareness and good practices Increasing the Janani Suraksha coverage • Wide publicity of the scheme (Details in Component on BCC …) • Availability of advance funds with the ANMs and timely payments to the beneficiary 13. Provision of Mobile Phones to all the ANMs, PHC MOs and one CHC Incharge • Display of the Mobile numbers at all Subcentres, AWCs, Panchayat Bhawans, PHCs and CHCs 14. Training of TBAs focussing on their involvement in VHD days, motivating clients for registration, ANC, institutional deliveries, safe deliveries, post natal care, care of the newborn & infant, prevention and cure of anaemia and family planning 15. Safe Abortion : • Provision of MTP kits and necessary equipment and consumables at all PHCs • Training of the MOs in MTP • IEC regarding the MTP services and the danger sign of unsafe abortions • Encourage private and NGO sectors to establish quality MTP services. • Promote use of medical abortion in public and private institutions: disseminate guidelines for use of RU-486 with Mesoprestol • Promotion of Emergency contraceptive. 16. Improvement of monitoring of ANM tour programme and Fixed village Health days • Fixed village Health days and Tour plan of ANM to be available at the PHCs with the MOs • Checklist for monitoring to be developed • Visits by MOs and report prepared on basis of checklist filled • Findings of the visits by MOs to be shared by MO in meetings 17. Use of the Village Chowkidar and Numberdar as social Mobilizers for getting data on Maternal deaths, abortions, Pregnancies 18. RCH Camps: These will be organized once each quarter through NGOs/Rotary/Lions clubs to provide specialist services especially for RTI/STD cases 19. Involvement of Rahber-e-sehat/Rahber –e-Taleem in motivating and mobilizing the women for VH days. Support 1. Issue of joint letters from Health & WCD department for joint working and required ensuring its implementation 2. The Social Welfare department should ensure Operationalization of no functional Anganwadis 3. Ensuring availability of personnel especially specialists and Public Health Nurses for the 24 hour PHC, CHC and two ANM at the subcentres 4. Ensuring availability of formats and funds with the ANM for JSY and timely payments 5. Certification of PHC as MTP centres 6. Ensuring smooth flow of Blood from the Blood Bank at District Hospital to the Blood Storage units

76 A-2. MATERNAL HEALTH 7. The State should closely monitor the progress of all the activities 8. JSY should be extended to all the pregnant women irrespective of BPL and APL Timeline Activities 2007-2008 2008- 2009- 2010- 2011- 2009 2010 2011 2012 Strengthening of the x x x X x Fixed VH days Developing the CHC CHC Doda CHC CHC for CEmOC Gandoh Bhade wah Establishing Blood CHC Doda CHC CHC 2PHC 2PHC Storage Unit Gandoh Bhade rwah Mobile phones to ANMs, MOs at PHCs and CHC, BMOs and CMO Developing MTP 5 PHCs 7PHCs 5PHC centres s Tracking Bags All AWCs All AWCs All All All Operational AWCs AWCs AWCs JSY 3100 3600 4100 4600 5400 beneficiaries(4% of Total population) Promoting Medical - CHCs All additional CHCs Abortion RCH Camps x x x Budget Activity / Item 2007- 2008- 2009- 2010- 2011- Total 08 09 10 11 12 Consultancy for support for developing 1 1.1 1.210 1.331 1.464 6.105 Microplan for Village health Day Tracking Bags @ Rs 300/ bag x 650 1.95 2.1 0 0 0 4.050 AWCs Adult Weighing machines @ Rs 800 5.2 3.216 0 0 0 8.416 per machine x 650 AWCs & Maintenance(10% cost of machine) Monthly special outreach session in 2.4 2.64 2.904 3.1944 3.5138 14.652 120 difficult villages @ 2000/session 4 Blood Bank @ Rs 35 lakhs per unit 70 70 35 0 0 175.00 0 Blood Storage @ Rs 3 lakhs per unit 6.000 6.000 3.000 15.000 Referral Cards @ Rs 2 per card x 0.4 0.44 0.484 0.532 0.586 2.442 20,000 MTP kits @ Rs 15000 Per kit 4.8 5.28 5.808 6.3888 7.0276 29.304 8 One day training workshop on 1 0 1.100 0.000 1.200 3.300 Tracking bags at the district level and each sector

77 A-2. MATERNAL HEALTH JSY beneficiaries @ Rs 1400/person 140 168 196.00 224.00 252.00 980.00 0 0 0 0 Mobile phone instrument to ANM @ 3 1 1.000 0.600 0.400 6.000 Rs 2000 Mobile Phones recurring cost to ANMs 15.9 16.38 16.920 17.160 17.760 84.120 @ Rs 6000/annum Mobile phone instrument to MOs & 4.25 0 0.000 0.000 0.000 4.250 Supervisory staff @ Rs 5000 (85x5000) Mobile Phones recurring cost to MOs 25.500 & Supervisory staff @ Rs 6000/annum 5.1 5.1 5.1 5.1 5.1 Delivery kits to TBA's@3000and 3.9 1.3 1.430 1.573 1.730 9.933 reffeling @ 1000 Incentives to TBA @ 100 per 1 2 3 4 5 15.000 deliveryby skilled birth attendent RCH Camps @ Rs 25000 per camp x 3 3.3 3.630 3.993 4.392 18.315 12 Total 268.9 287.85 276.58 267.87 300.17 1401.3 6 6 26 39 885

78 A-3. NEWBORN & CHILD HEALTH Situation Analysis S.No Indicator Total Rate% 1 Live Births Estimated 22365 2 Total number of children under 6 years 59516 (as per 2001Census data) 3 Children covered under ICDS 18754 31.5% 4 Neonatal Deaths DNA 5 Infant Deaths 60 0.27% 6 Child Deaths (1-5 years) DNA 7 Still birth in the last year DNA 8 Low birth weight newborns (less than 2.5 kgs) 35 0.13% 9 Complete Immunization 12-23 months age DNA Measles vaccination DNA 10 Total number of children malnourished 2375 22.07% 11 Severely malnourished children (Grade III & IV) 1 Malnutrition Grade I & II 2374 22.07% 12 Pneumonia cases upto Oct 06 DNA 13 Deaths in the last year due to pneumonia in DNA children 14 Diarrhoea cases upto Oct 06 DNA 15 Deaths in last year due to Diarrhoea in children DNA

There are 4695 total infants from the age group of 0 -11 months old out of which 1439 are given BCG and 2049 are given DPT i.e only 43%. There were 594 live births recorded the month of august in the whole old district Doda out of which 13 were still births. Out of new born weighed i.e 444 (Male 197+ 247 female) 5 where less then 2.5 kg. 61 cases of pertusis (36 male 25 female) were recorded in the month of august, in the same month there were 60 cases of measles seen i.e male 35 female 25. Children having problems of diarrhea and dehydration were noticed of the no of 511 i.e 245 male and 266 female. There were 4208 cases of ARI also noticed (Male 209 female 219) Total no of children fully immunized of the age group of 9-11 1426: More then 18 months it was 638 covered under immunization in August 2007. Children more than five years who received (DTS) male 622 female 548 total 1170 Acute Respiratory Tract infections: The problem of new born and child health has a very high rate. Due to lack of proper staff (or) other problems there is no exact data maintained in all the institutions. People are living at far-flung places and it is not possible to ensure complete immunization coverage with out proper facilities. There is a big number of malnourished children and children suffering from Anemia As the area is totally hilly and cold and the outreach of govt. services is seriously effected Objectives 1. To reduce IMR to 50% by 2012 Benchmark 2. Reduction in Neonatal mortality to 50% by 2012 s 3. To increase proportion of women for exclusive breast feeding for 6 months to 80% by 2007-2008 4. To promote 100% immunization and vaccination awareness on child health 5. To get all birth /death registered

79 A-3. NEWBORN & CHILD HEALTH 6. To increase the use of ORS in diarrhoea to 100% by 2010-2012 7. Treatment of 100% cases of Pneumonia in children by 2010-2012 Strategies Improving feeding practices for the infants and children including breast feeding Promotion of health seeking behaviour for sick children Community based management of Childhood illnesses Improving newborn care at the household level and availability of Newborn services in all CHCs & hospitals Enhancing the coverage of Immunization

Activities 1. Improving feeding practices for the infants and children including breast feeding • Study on the feeding practices for knowing what is given to the children • Education of the families for provision of proper food and weaning • Educate the mothers on early and exclusive breast feeding and also giving Colostrum • Introduction of semi-solids and solids at 6 months age with frequent feeding • Administration of Micronutrients – Vitamin A as part of Routine immunization, IFA and Vitamin A to the children who are anaemic and malnourished 2. Promotion of health seeking behaviour for sick children and Community based management of Childhood illnesses • Training of LHV, AWW and ANM on IMCI including referral • BCC activities by ASHA, AWW and ANM regarding the use of ORS and increased intake of fluids and the type of food to be given • Availability of ORS through ORS depots with ASHA • Identification of the nearest referral centre and also Transport arrangements for emergencies with the PRIs and community leaders with display of the referral centre and relevant telephone numbers in a prominent place in the village 3. Improving newborn care at the household level • Adaptation of the home based care package of services and scheduling of visits of all neonates by ASHA/AWW/ANM on the 1st, 2nd, 7th, 14th and 28th day of birth. • In case of suspicion of sickness the ASHA /AWW must inform the ANM and the ANM must visit the Neonate • Referral of the Neonate in case of any symptoms of infection, fever and hypothermia, dehydration, diarrhoea etc; • Training on IMNCI of ASHA/AWW/ANM/MOs on the home based Care package • Supply of medicine kit and diagnosis and treatment protocols (chart booklets) for implementation of the IMNCI strategy • Strengthening the neonatal services and Child care services in and all CHCs and PHC : This will be done in phases • In all of these units, newborn corners would be established • Provision and supply of the equipment required for establishing a newborn corner • Training of staff in Newborn Care, IMNCI and IMCI (MOs, Nurses) including the management of sick children and severely malnourished children. • Availability of Pediatricians in all the General hospitals and CHCs • Ensuring adequate drugs for management of Childhood illnesses. 4. Strengthening the fixed Maternal and Child health days (Also discussed in the component on Maternal Health)

80 A-3. NEWBORN & CHILD HEALTH • Developing a Microplan in joint consultation with AWW • Organize Mother and Child protection sessions twice a week to cover each village and hamlet at least once a month • Use of Tracking Bag • Tracking of Left-outs and dropouts by ASHA, AWW and contacting them a day before the session • Information of the dropouts to be given by ANM to AWW and ASHA to ensure their attendance • Wide publicity regarding the VH days 5. Strengthening Immunization (Discussed in Component C) • ASHAs and ANMs to conduct weekly survey (door to door) to ensure the condition of nursing mothers and children. • ASHAs and ANMs and other ground level workers to provide necessary education to mother (or) parents of newly born babies and guide them. • Training of ASHAs and ANMs and other ground level staff to ensure group work and communities organization in the rural communities. • To ensure weighing of new born weighing machine must be present in every health institution anganwari centers and school of elementary education. • Generally every child should be sponsored from with in the womb of the mother by ensuring nutritious diet complete immunization and safe delivery • Child groups to be formulated in each village and counseling sessions and group work to be done in order to understand the problems of children related to health and hygiene. • Promotion of healthy diet and hygiene of children to in community

Support 1. Availability of trained staff including Pediatricians required 2. Technical Support for training of the personnel 3. Timely availability of vaccines, drugs and equipment 4. Good cooperation with the ICDS and PRIs

Timeline Activity 2007-08 2008-09 2009- 2010- 2011 10 11 -12 Health Education of the families x x x including mothers on breast feeding, weaning, ORS and good practices by the ASHA/ANM/AWW Identification of the x x x x x malnourished children Availability of ORS at ORS x x x x x depots with ASHA Identification of the nearest x x x x x referral centre with yearly updation Transport arrangements for x x x x x emergencies by the PRIs and community leaders Display of the referral centres x x x x x and relevant telephone numbers in a prominent place

81 A-3. NEWBORN & CHILD HEALTH Training of the LHV, ANM and x x x x x MOs on IMCI and IMNCI including referral Training on IMNCI of x x x ASHA/AWW/ANM/MOs on the home based Care package Supply of medicine kit & x x x x x diagnosis and treatment protocols Development of Referral system x & referral cards Establishing Newborn Corner in CHC CHC 1 new 1new 1 hospitals and CHCs Doda Gandooh & CHC CHC new Bhaderwah CHC

Equipment and drugs for x x x management of Childhood illnesses Provision of generator GH, 13 4 PHC , 3 1 1 1 PHCs, CHC CHC CHC CHC Budget Activity / Item 2007- 2008- 2009- 2010- 2011- Total 08 09 10 11 12 Orientation of Staff Nurse and MOs on 1.5 2 0 0 0 3.500 Baby Friendly Hospital at all the CHCs (one day orientation) ORS, nutrients, vaccines, medicines 5 5.5 6.1 6.7 7.3 30.600 for children Newborn Corner furnished with 8.4 4.2 4.2 2.8 4.2 23.800 equipment @ Rs 1.40 lakh per facility Generator & stabilizer @ Rs. 3 lakhs 30 30 30 6 0 96.000 for PHC 3x32 PHC ( 2lakhs+1 lakh) Generator & stabilizer @ Rs. 4 lakhs 12 8 0 0 0 20.000 for CHC 4x3 CHCs (3lakhs+1 lakh) Generator & stabilizer @ Rs.5 lakhs 5 0 0 0 0 5.000 for DH 4x1 DH (4lakhs+1 lakh) POL Generator @ Rs.140/PHC x 365 24.02 24.02 24.02 24.02 24.02 120.085 days and Rs 420 x 365 for CHC Examination table, chair, stool, table, 19.5 0 0 0 0 19.500 other equipment @ Rs. 3000 x 650 AWCs Infant Weighing Machines@Rs. 800x 5.2 0 0 0 0 5.200 473 AWC Foetoscope @ Rs.50 x 473 AWCs 0.2365 0 0 0 0 0.237 Massive IEC on CH 5 5.5 6.1 6.7 7.3 30.600 Malnutrition Corners @ Rs 50,000 per 1.5 0 2.500 CHC 0.5 0.5 0 Total 117.35 79.717 70.917 46.217 42.817 357.022 35

A-4. FAMILY PLANNING Situation Indicators No. or Rate Analysis Eligible Couple 140817

Couple Protection Rate 16.2%, DLHS Data Female Sterilization operations 797(CMO, combined Doda data) Vasectomies 13 Using Copper -T 1283 (CMO, combined Doda data) Using Conventional contraceptives DNA Using Oral Pills users DNA Couples using temporary method DNA Prevalence of RTI /STDs last year 1611

There is no availability of family planning methods is the district weather temporary or permanent people are willing to go for tubectomy but due to non availability of services. It is not becoming possible vicinities are not accepted by people at such a large-scale people do not have temporary methods available at S/Cs and PHCs. More over their serious concern over use of predetermined sex technology and sea selective abortion in future. There is a great shortage of Graduate doctors who can handle the cases of sterilization. Objectives 1. Reduction in Total fertility Rate to 2.1 by 2012 Benchmark 2. Increase in Contraceptive Prevalence Rate to 80 % by 2012 s 3. Decrease in the Unmet need for modern Family Planning methods to 0% by 2012 4. Increase in the awareness levels of Emergency Contraception from 50% to 100% by 2012 5. To increase of %age of tubectomy and vasectomy 6. To increase male participation 7. To reduce the prevalence of RTI/STD to 70% by 2012 Strategies 1. Increased awareness for Emergency Contraception and popularising IUD 380- A as an alternative to sterilization. 2. Decreasing the Unmet Need for Family Planning 3. Availability of all methods at all places to increase the basket of choice 4. Increasing access to terminal methods of Family Planning 5. Promotion of NSV 6. Expanding the range of Providers 7. Increasing Access to Emergency Contraception and spacing methods through Social marketing 8. Building alliances with other departments, PRIs, Private sector providers and NGOs 9. Monitor progress, quality and utilization of services Activities • Expanding the range of Public Sector providers for Terminal/spacing methods • Each CHC and PHC will have one MO trained in any sterilization method. • All the CHC/PHC will have at least one MO posted who can be trained for

83 A-4. FAMILY PLANNING abdominal Tubectomy and NSV. • Specialists from District hospitals and CHCs will be trained in Laparoscopic Tubal Ligation. • Each CHC will be a static center for the provision of sterilization services on regular basis. The Static centers will be developed as pleasant places, clean, good ambience with TV, music, good waiting space and clean beds and toilets. • About 4 -7 PHCs come under the catchments area of CHCs and the camps will be organized on fixed days in each of the PHCs. • Equipments and supplies will be provided at CHCs and PHCs for conducting sterilization services. • A systemic effort will be made to assess the needs of all facilities, including staff in position and their training needs, the availability of electricity and water, Operation theatre facilities for District hospitals/CHCs/PHCs, Inventory of equipment, consumables and waste disposal facilities and the condition, location and ownership of the building. • At least three functional Laparoscopes will be made available per team, as will the equipment and training necessary to provide IUD and emergency contraception services. The existing Laparoscopes need to be replaced. For effective coverage 4 teams are required with minimum three Laparoscopes for each team. • Vacant positions will be filled in on a contractual basis. • Organization of Sterilization camps on fixed days at all CHCs

• NSV camp every quarter in all CHCs and PHCs

• Access to non-clinical contraceptives increased in all the villages • AWWs and ASHAs as Depot holders

• Training in Spacing methods, Emergency Contraceptives and interpersonal communication for effective dissemination. Access for the quality IUD insertion at all the 61 subcentres. • Training to all the ANMs on insertion of IUD • Diagnosis and treatment of RTI/STI as per syndromic approach. • IUD 380 A will be used as an alternative for sterilization. • Empowering women • Increasing male involvement in family planning through use of condoms for safe sex and also in Vasectomy. • Service delivery sites for male methods by training health providers in NSV and conventional vasectomy Improving and integrating contraceptives/RCH services in PHCs and Sub- centres • Skill-based clinical training • Training in infection prevention, counselling and follow up for different family planning methods. • MIS training Strengthening linkages with ICDS programme and ISM (Ayurveda) • A detailed action plan • technical training and training in communication skills, non-clinical methods and record keeping Engaging the private sector to provide quality family planning services

84 A-4. FAMILY PLANNING • Incentives and training to encourage private providers to provide sterilization services • Training to private lady doctors in IUD insertion • Detailed plan will be developed for partnerships. • Accreditation of private hospitals and clinics for sterilization and NSV • Involvement of NGOs Role of ASHAs: • Training to Act as depot holders for the supplies of pills and condoms by the ANMs for free distribution • Provide referral services for methods available at medical facilities • Assist in community mobilization and sensitization. Support • Availability of a team of master trainers/ANM tutors required • A training cell will be created in the medical college for the training of the medical officers in the area of various sterilization methods • Availability of equipment, supplies and personnel • Improvement of quality of services. • Introduction of the concept of quality care in family planning Programmes Timeline Activities 2007-08 2008-09 2008 2008- 2009- -09 09 12 Training of MOs for NSV 10 MOs 21 MOs 21 20 20 MOs MOs MOs Training of MOs for Minilap 4 MOs 16 MOs Training of Specialists for GH CHC 1 1 New Laparoscopic Sterilization (CHC Bhaderwah New CHC Doda & Gandoh CHC

Development of Static Centres 2 CHCs 1 1 New at DH and all CHCs New CHC CHC 1 CHC Sterilization camps (Persons) 5000 7500 1000 15000 20000 0 NSV Camps 600 700 800 1000 1200 Accreditation of private 5 10 15 20 institutions for sterilization Supply of Copper T – 380 and 3000 4500 6000 9000 12000 Emergency Contraception Emergency Contraception 2000 6000 8000 10000 12000 Budget Activity / Item 2007-08 2008-09 2009- 2010-11 2011-12 Total 10 NSV camps @ Rs. 359750 8.6475 9.9973 11.361 13.952 25.313 69.27 Sterilization Camps @ 19.50 for 45.925 65.2875 84.740 122.754 160.877 5000 cases 479.58 Development Static Centres @ 12 3 0.000 0.000 0.000 Rs 3 lakh 15.00 Copper T-380 @ Rs 45 / piece 1.35 2.03 2.700 4.060 5.400 15.54 EmergencyContraception@Rs10 0.1 0.2 0.3 0.8 0.5 1.90

85 A-4. FAMILY PLANNING /2 tabs Laparoscopes 3 per CHC @ 27 18 0.000 0.000 0.000 Rs3.00 lakhs x 3 45.00 Total 95.0225 98.51475 99.101 141.566 192.090 626.29

Detailed Calculations

Calculations per Case of NSV S.No Head Unit Cost 1. Payment to NSV acceptor 1000 2. Mobilization/Transport cost 50 3. Payment to Service Provider 50 4. Payment to IEC advocate/Motivator 25 5. Payment to Assistant/OT Nurse etc; 10 6. Drugs and Dressing 27.5 Total 1162.5

Requirements for organizing one camp (600 cases) S.N Head Uni Unit 2007- 2008- 2009- 2010- 2011- o t Cost 08 09 10 11 12 Total 1. District Workshop 1 4000 4000 4400 4840 5324 10164 28728 2. Block workshops 4 7500 30000 33000 36300 39930 76230 215460 3. TA/DA for NSV 5 2000 10000 11000 12100 13310 25410 71820 surgeons 4. IEC activities 112832. 93250 102575 124116 236948 669722 5 5. TA to Acceptor for 600 50 30000 35000 40000 50000 90000 245000 Semen Analysis 6. Payment to NSV 1162. 116250 209250 569625 Advocate/motivator, 600 697500 813750 930000 50 0 0 0 Drugs & Dressings Total 139518 253125 692698 864750 999725 1136073 0 2 0

Budget for IEC activities for NSV camp S.No Head Unit Unit Amount Cost 1. Hand Bills 100000 0.15 15000 2. NSV booklets 10000 2 20000 3. Banners 250 54 13500 4. Posters 11000 2.50 27500 5. DA for Driver & 2 persons 45 Mondays 50 2250 6. Electronic Media Publicity for 15 days 5000 7. Wall writing & publicity 1000 8. Other Innovative activities 9000 9. Total 93250

Budget for sterilization per case S.No Head Unit Cost (Rs) 1. Payment to acceptor 500 2. Mobilization/Transport cost 50 3. Payment to Service Provider 50 4. Payment to IEC advocate/Motivator 35 5. Payment to Assistant/OT Nurse etc; 10 6. Drugs and Dressing 93.5 Total 738.5

Budget for sterilization camps benefiting 5000 cases S.No Head Unit Unit 2007- 2009- Cost 08 2008-09 10 2010-11 2011-12 Total 1. Medicines 500000 5 5.5 6.05 6.655 7.3205 30.5255 2. Per Case @ 5000 738.5 36.925 424.638 738.50 55.3875 73.85 110.775 147.7 3. IEC activities 100000 1 1.1 1.21 1.331 1.4641 6.1051 4. Other 300000 3 18.3153 activities and Office Expenses 3.3 3.63 3.993 4.3923 Total 45.925 65.2875 84.74 122.754 160.877 479.583

87 A-5 Adolescent Health Situation The adolescents are very vulnerable since the awareness levels for various issues of Analysis RCH are low. Adolescence have unmet needs regarding nutrition, reproductive health, mental health and require appropriate counselling. No efforts have been made for any counselling of the adolescents. There is hence a great lacuna in the knowledge of the Adolescents. Adolescents especially the boys are exposed to smoking, addictions, peer pressure and there is no one to counsel them. Teenage pregnancies also emerging as a problem ad Unsafe abortion & premarital sex trend is on rise. The Kishori Shakti Yojana for Adolescent girls in AWCs is not functional. In this scheme they are given IFA tablets, Deworming, Supplementary Nutrition and also given vocational training. Adolescents need to be brought under the ambit of this programme so that the levels of anaemia are reduced due to IFA and Deworming. The School Health programme and The school AIDS education programme and school sanitation programme are covering the entire state. Some degree of anaemia and severe anaemia is reported but the data needs to be validated. Objectives 1. Increase the knowledge levels of Adolescents on RH and Life skills 2. Enhance the access of RH services to all the Adolescents 3. Improvement in the levels of Anaemia to 50% by 2012 Strategy 1. Implementation of Kishori Shakti Yojna 2. Awareness amongst all the adolescents regarding Reproductive health and Life skills 3. Provision of Adolescent Friendly Health package at the health facilities 4. Provision of Adolescent Health Counselling services Activity 1. Research study involving quantitative and qualitative aspects on the perceptions and practices of girls and boys in the context of rural setting and also the age of marriage and consummation. 2. Operationalization of Kishori Shakti Yojna 3. Adolescent Mentoring group consisting of Master Trainers for carrying out trainings, mentoring, monitoring the process of formation of Kishore- Kishori groups 4. Set up Kishore-Kishori Groups in all villages and family life education and IEC on high risk behaviour 5. School based programmes. 6. The district of Doda will be covered for anemia prophylaxis programme during 2006/2007 to be scaled to all districts by 2012 7. Specialists for school adolescence health 8. The Adolescent Health package will consist of the following activities: 9. Formation of a Subcommittee as part of District Partnership for Adolescent Health (DPAH) consisting of representatives of: Health department, Education department, Social Welfare department, ICDS, NGOs, PRIs, National Service Volunteers, other youth organizations, local chapters of Indian Academy of Pediatricians & FOGSI and other stakeholder groups. 10. Workshop to develop an understanding regarding the Adolescent health and to finalize the operational Plan • Provision of Adolescent friendly health services at PHC, CHC, FRUs and district hospitals in a phased manner. Training of the MOs, ANMs on the needs of this group, vulnerabilities and how to make the services Adolescent friendly. • Adolescent Health Clinics will be conducted at least once every week by the MO to provide Clinical services, Nutrition advice, Detection and treatment of

88 anemia, easy and confidential access to medical termination of pregnancy, Antenatal care and advice regarding child birth, RTIs /STIs detection and treatment, HIV detection and counseling, • In the 96 difficult villages the clinics will be part of the monthly Outreach session • Carrying out the services at the fixed VHD days • Provision of IFA tablets to all Adolescents, de-worming every 6 months, Vitamin A administration and Inj. TT • Awareness building amongst the PRIs, Women’s groups, ASHA, AWWs 11. Developing a cadre of Peer Educators • Selection of Peer Educators, two for each village in a phased manner, and their training for three days. • Selection of Counselors for Peer Educator workshops and carrying out counseling clinics. These will be selected one per PHC. There will be equal number of Male and female counselors and will alternate between two PHC – one week the male counsellor is in one PHC and the female counsellor in the other and they switch PHC in the next week so that both the boys and girls benefit. The counsellor will be • Providing ongoing training to the Peer Educators, • Facilitating group meetings • Organizing Counseling session once per week at the PHC. Organization of counseling sessions at PHC with wide publicity regarding the days of the sessions • Collecting data and information regarding the problems of Adolescents 12. Close monitoring of the under 18 marriages, pregnancies, prevalence of RTI/STDs. 13.Three-day health camps for Adolescent boys and girls at block level for Deaddiction, Mental health and problems of adolescents quarterly • Involvement of NGOs for awareness generation, Appointment of Counselors, Peer Educators State Approval by State for Life skill education and Life skill education to be initiated in all Support schools

Timeline Activity 2007- 2008-09 2009- 2010- 201 08 10 11 1-12 Research x Awareness generation x x x Workshop of all the partners x x x Training a district pool of Master x trainers Selection of Peer Educators Ghat Assar Gando & h Bhader wah Counsellor though NGOs 7 10 add 10 add 5 add PHCs PHCs PHCs Training of Peer Educators 150 100 200 114 Retraining of Peer Educators 0 150 250 450 564 Orientation of the Health personnel x x x

89 Counselling Clinics 7 10 add 10 add 5 add PHCs PHCs PHCs Three day health camps for x x x Adolescents Budget Activity 2007- 2008- 2009- 2010- 2011-12 Total 08 09 10 11 Research 5 0 0.000 0.000 0.000 5.000 Awareness generation @ Rs 2000 per 7.3 8.03 8.833 9.7163 10.6879 44.567 village x 365 villages 3 Workshop of all the partners 0.5 0.55 0.605 0.6655 0.73205 3.053 Training of Adolescent Mentoring Group 1 1 1.000 1.000 1.000 5.000 and other expanses@1 Lakh Counsellors@ Rs 8000 per month x 30.72 33.792 37.171 40.888 44.9771 187.549 PHCs x12 mths 2 32 5 Training of Peer Educators @ Rs 50 per 0.3 0.3 0.300 0.258 1.158 person x 3 days xNo of Peer Educators Re-Training of Peer Educators @ Rs 50 0 0.3 0.600 0.900 1.158 2.958 per person x 3 days x peer Educators Orientation & Reorientation Health 0.25 0.28 0.310 0.340 0.370 1.550 personnel Counselling sessions @ Rs 2 4 6.000 7.720 7.720 27.440 1000/yr/peer Educator Counselling Clinics renovation, 7.5 8.25 9.075 9.9825 10.9807 45.788 furnishing and Misc expenses @ Rs 5 50000.00 Health camps for Adolescents once per 2 2.2 2.42 2.662 2.9282 12.210 quarter x 4 x Rs 50000 per camp Joint Evaluation by an agency & Govt 1 0 1.200 0.000 1.320 3.520 Total 57.57 58.702 67.514 74.133 81.874 339.793

90 PART B: New NRHM initiatives

B-1. ASHA – Accredited Social Health Activist Situation The Sub-centre caters to a population of approximately 3000 spread over an Analysis average of 3-5 villages. Hence keeping in view the difficulties faced by the ANM to provide health and family welfare services in all the villages and also carry out effective community contact, under NRHM a village level community based functionary has been brought in all villages and will be trained for meeting the health-related demands of people and will create awareness on health and its social determinants and mobilize the community towards local health planning and increased utilization and accountability of the existing health services indicators in the villages. ASHA is an honorary worker and will be reimbursed on performance-based incentives and will be given priority for involvement in different programmes wherever incentives are being provided (like institutional delivery being promoted under Janani Suraksha Yojana, motivation for sterilization, DOTS provider, etc.). It is conceived that she will be able to earn about Rs. 1,000.00 per month. In district Doda, 377 ASHA workers have been selected and received training for module 1 Objectives 1. To provide a link between the health workers & public for improving the basic Benchmark health care, Ante Natal & Post Natal care, safe deliveries & registration of Death s & birth cases & to educate mothers for breast feeding etc, Promotion of Household toilets under T.S.C. & completion of DOTS treatment under National TB Control Programme etc. 2. To generate demand for health services through ASHA (to act as communication resources, service provider, guide, mobilizer and an escort to village people to access health services 3. To address the unmet needs Strategies • Selection of a woman from the community • Capacity building of ASHA • Constant mentoring, monitoring and supportive supervision by district Mentoring group Activities 1. Strengthening of the existing ASHAs through support by the ANM. . and their involvement in all activities. 2. Reorientation of existing ASHAs 3. Selection of new ASHAs to have one ASHA in all the villages 4. Training of ASHAs and selected ASHAs who have not received any training. 5. Training for Module 2,3,4 6. Provision of a kit to ASHAs 7. Formation of a District ASHA Mentoring group to support efforts of ASHA and problem solving 8. Review and Planning at the Monthly sector meetings 9. Periodic review of the work of ASHAs through Concurrent Evaluation by an independent agency 10. ASHA Performance Diaries is to be printed Support • Timely Payments to ASHA required • Advance of Rs. 5000 always with ASHA for prompt payments to the women

91 B-1. ASHA – Accredited Social Health Activist Timeline 2007- 2008- 2009- 2010- 2011- 08 09 10 11 12 Selection of additional ASHAs 20 10 14 ASHAs ASHAs Total ASHAs 394 405 416 427 438 Training of new & untrained 40 10 14 ASHAs Reorientation of the initial 394 405 416 427 438 ASHAs District ASHA Mentoring group x x x x x

Budget Activity / Item 2007- 2008- 2009- 2010- 2011- Total 08 09 10 11 12 Training & kit @ Rs 10000/ ASHA 39.4 1.1 1.100 1.100 1.100 43.8 Training of ASHA in Module II,III,IV @ 7.88 8.1 8.32 8.54 8.76 41.6 2000/ASHA Reorientation @ Rs 1000/ ASHA 3.94 4.05 4.16 4.27 4.38 20.8 Expenses for the District mentoring group – 0.6 0.66 0.730 0.800 0.880 3.67 meetings, travel @ Rs 5000 per month x 12 months ASHA Performace Diary @ 100/ASHA 0.5 0.3 0.3 0.3 0.3 1.7 Compensation to ASHA @1000/ASHA 3.94 4.05 4.16 4.27 4.38 20.8 Total 56.26 18.26 18.77 19.28 19.8 132.37

Compensation to ASHA

ASHA will be paid double the amount prescribed so that she gets a package of at least Rs 1000.00 per month

S.No Activity Compensation Cases per ASHA Amount/ ASHA 1 Full ANC & 3 PNCs Rs 25/case 2/mth 50 2 Facilitating Institutional delivery Rs 100/case 2/mth 200 3 Providing essential newborn Care & Rs 25/case 2/mth 50 counseling 4 Counseling mothers for safe MTPs Rs 50/case 1/2mths 25 5 Counseling women for RTIs/STDs Rs 5/case 6/mth 30 6 Birth & death registration Rs 15/case 3/mth 45 Total per ASHA 400

92 B-2. Provision of Untied Funds at Sub Centres Situation Till NRHM was launched there was no provision for any fund for the subcentres Analysis/ for maintenance, electricity, water, any fund for consumables and cleanliness of the subcentre. Rs 2000 was given as contingency funds, which were totally inadequate to meet any demands. Due to this the Subcentres were in a pathetic condition and the ANM worked alone for deliveries sometimes helped by the family members. A number of equipment needed some repair due to which they were lying unutilized. The Gram Panchayat members were never involved in any activities of the Subcentre.

Under NRHM provision of untied grants and maintenance grants are being kept at Sub Centre level. Keeping such important provisions, the services of facilities e.g. maintenance, minor repair, electricity, water, any fund for consumables, hiring transport in emergencies, travel, IEC and cleanliness can be improved. There are 108 sub centers in the district out of which the untied grants have been given to 75 sub centers i.e. 145000 rupees was given to the 145 sub centers in the old district doda. Objectives To improve condition of sub centers at grass root level. To have a decentralized direct flow of funds so as to have money in time. To improve over all status of health institution at the grass root level. Strategies Provision of Untied funds of Rs 10000 each year to the Sub centres at the disposal of the ANM for local needs Provision of Rs 10000 for construction and annual maintenance Activities 5. Besides the usual recurring cost support to the sub-centres, each Subcentre would be given an untied support of Rs. 10,000 per annum. The fund would be kept in a joint account to be operated by the ANM and the local Sarpanch. 6. Rs 10000 will be given as annual maintenance grant to each Subcentre. This will be under the mandate of the VHWSC for undertaking construction and maintenance. This will bring in greater community control and the sub-centres would be brought fully under the Panchayati Raj framework. 7. Activities suggested for the untied funds include minor modifications, cleanliness of premises, transport of emergencies, transport of samples, purchase of consumables, etc; 8. This fund will not be used for salaries, vehicle purchase and recurring expenses of Gram Panchayat 9. Monthly and quarterly expenditure statement will be submitted along with UC Support Funds to be transferred on time to the ANM required Sarpanch to ensure proper usage and accounts

93 B-2. Provision of Untied Funds at Sub Centres Timeline Activities 2007- 2008-09 2009-10 2010- 2011-12 08 11 Untied Fund of Rs x x x x x 10000/subcentre Annual Maintenance grant of x x x x x Rs 10000/SC Plan for maintenance to be x x x x x developed and approved by Gram Panchayat Plan for use of untied funds x x x x x Gram Panchayat to identify x x x x x mode of construction and repair Budget Activity / Item 2007- 2008 2009- 2010- 2008- Total 08 -09 10 11 12 Untied Fund of Rs 13.1 13.5 13.9 14.2 14.6 69.3 10000/subcentre Annual Maintenance grant of Rs 13.1 13.5 13.9 14.2 14.6 69.3 10000/SC Total 26.2 27 27.8 28.4 29.2 138.6

94 B-3. Provision of Untied Funds at PHCs Situation Under NRHM provision of untied grants and other grants namely maintenance Analysis grants, support money for Rogi Kalian Samiti (RKS) are being kept. Keeping such important provisions, the services of facilities e.g. maintenance, minor repair, electricity, water, any fund for consumables, telephone, hiring transport in emergencies, travel, IEC and cleanliness can be improved. There are 34 PHCs in district Doda out of which only 13 PHCs have got registered and their accounts have been opened 21 more PHCs yet to get registered as RKS Each PHC is to have untied funds to the tune of Rs 25,000/- per PHC Objectives Strengthening of the PHC through financial support Strategies Training for maintenance of books for accounts Exact guidelines for utilization of the funds Provision of Untied funds of Rs 25000 each year to the PHCs at the disposal of the Rogi Kalyan Samities Provision of an Annual Maintenance grant of Rs 50,000 to the PHCs. Activities 1. 8 more PHCs yet to get registered as RKS. 2. Untied Fund, Maintenance Grant and Support Money will be provided to all PHCs including Allopathic Dispensaries. 3. Such funds will be used as per the need after due approval of RKS. 4. Proper accounts will be maintained for such funds. 5. Timely submission of Utilization Certificate to DHS through BMOs will be ensured by the facility In- Charge 6. Making an action plan on a quarterly basis for the utilization of funds for maintenance works besides emergency expenses e.g. short term purchase of drugs etc. 7. RKS will be registered at all the PHCs including new PHCs. ` Support Timely release of funds required Meetings of the Rogi Kalyan Samitis to be regularly held District level State level support. Convergence with other link departments Timeline Activity 2007-08 2008-09 2009-10 2010-11 2011-12

Untied Fund of Rs 32 32 32 32 32 25000/PHC Annual Maintenance x x x x x grant of Rs 50000/PHC Plan for maintenance to x x x x x be developed and approved by the Rogi Kalyan Samitis Plan for use of untied x x x x x funds Rogi Kalyan Samitis to x x x x x identify mode of construction and repair

95 B-3. Provision of Untied Funds at PHCs Budget Activity 2007 2008 2009 201 201 Total -08 -09 -10 0-11 1-11 Untied Fund of Rs 25000/PHC 8 8 8 8 8 40 Annual Maintenance grant of Rs 16 16 16 16 16 80 50000/PHC Total 24 24 24 24 24 120

96 B-4. Provision of Untied Funds at CHCs Situation Till NRHM was launched there was no provision for any fund for the subcentres for Analysis maintenance, electricity, water, any fund for consumables, telephone, hiring transport in emergencies, travel and cleanliness of CHC. Although the Rogi Kalyan Samitis were formed still more funds were required on a regular basis. Due to this the CHC were in a bad shape. They were unable to provide services as per the needs of the patients. A number of equipment needed some repair due to which they were lying unutilized. Objectives Strengthening of CHCs through financial support Strategies 1. Provision of Untied funds of Rs 50000 each year to the CHCs at the disposal of the Rogi Kalyan Samities 2. Provision of an Annual Maintenance grant of Rs 100,000 to the CHCs Activities These funds will be routed through the Rogi Kalyan Samitis who will approve the yearly activities and the related budgets and also undertake and supervise improvement and maintenance of physical infrastructure. 3. An untied fund of Rs 50000 will be provided each year for activities as per the local needs including minor modifications, cleanliness of premises, transport of emergencies, transport of samples, purchase of consumables, etc; This fund will not be used for salaries, vehicle purchase and recurring expenses of Panchayat or any other facility. 4. An Annual Maintenance grant of Rs 100,000 will be given to the CHC for water, toilets, maintenance of building. 5. Monthly and quarterly expenditure statement will be submitted along with UC Support • Meetings of the Rogi Kalyan Samitis to be regularly held required • Timely release of funds Timeline Activity 2007- 2008- 2009- 2010- 2010- 08 09 10 11 12 Untied Fund of Rs 50000/CHC 5 5 5 5 5

Annual Maintenance grant of Rs x x x x X 100000/CHC Plan for maintenance to be x x x x X developed and approved by the Rogi Kalyan Samitis Plan for use of untied funds x x x x X Rogi Kalyan Samitis to identify x x x x X mode of construction and repair

Budget Activity / Item 2007 2008 2009 2010 2011- Total -08 -09 -10 -11 12 Untied Fund of Rs 50000/CHC 2.5 2.5 2.5 2.5 2.5 12.5 Annual Maintenance grant of Rs 5 5 5 5 5 25 100000/CHC Total 7.5 7.5 7.5 7.5 7.5 37.5

97 B- 5. Mobile Medical Units Situation The District Doda is located in hilly terrain with tiny villages scattered all around. Analysis With such a topographic condition it is not feasible to establish Health Centre at every nook and corner of the District. So, it will be much convenience and cost effective projects to ensure mobile medical units in the cut-off, remote, fur flung areas of the District. So, that a comprehensive Health Care services to the people living in the remote areas at their door steps is required. Such mobile Medical Units can be used during natural disaster also.

Medical mobile units are envisaged under NRHM. Apart from providing health care to the far flung areas and the areas where desirable quality services could not be provided due to lack of staff, there mobile units would be viable option.

Chandrani in Ghat Block Mobile Medical Unit is working There are no specialist available There are no vehicles available for MMU MMU keeps on changing the place in the district to cover wide population. As the district is hilly and cold climatic conditions and unavailability of road makes it more difficult to reach the beneficiaries. People living in hilltops usually (STs) migrate from place to place and thus MMU also needs to be changing the positions. Objectives Meeting the unmet health needs of the people residing in difficult and underserved areas, through provision of healthcare at their doorstep Strategies Operationalizing a Medical Mobile Unit (MMU) Activities Joint meeting of the District Health Society and the Rogi Kalyan Samiti (RKS) to decide the appropriate modality for Operationalization of the MMU. 1. Formation of a Monitoring Committee 2. The RKS will operate the MMU for long-term sustainability of the intervention. 3. Staff will be hired on contract by the RKS – MO, male and Female Nurse, Lab Technician, Pharmacists, Members of Ayush, private providers, IMA members, NGOs, two drivers, Specialist from District Hospital and Medical Colleges, etc; 4. Need Analysis to be carried out for determining the areas of MMU. 5. Development of a monthly roster for Operationalizing MMU 6. Services will be given from 9 am to 4 pm from Monday to Friday. Saturday is for the maintenance of the vehicle. 7. Services to be provided: • ANC, PNC, Immunization • Diagnostic – Hemoglobin, Urine, Blood Sugar, Blood slide for Malaria, etc; • Treatment of minor ailments • Referral of cases needing Specialist care • Provision of Emergency services • Dissemination of information through the use of TV/DVD player • Holding meetings of Village water and Sanitation Committees • Maintenance of Records 8. Wide publicity before the arrival of the MMU 9. Communication support for the personnel 10. Periodic Review.

98 Support Govt Order from the State for exemption of the Regular Staff from providing required services in the MMU , Funds for purchase of MMU and its maintenance. Manpower Timeline 2007- 2008- 2009- 2010- 2011- 08 09 10 11 12 Operationalizing the MMU 1 1 1 1 1

Orientation & reorientation of the X X X X X staff

Wide Publicity X X X X X Strengthening the MMU X X X X X

Addition of services X X X X X Budget Activity / Item 2007- 2008-09 2009- 2010- 2011- Total 08 10 11 12 Cost of Vehicle, equipment and accessories 26.85 0 0.000 0.000 0.000 26.85 Hiring staff 8.7 9.57 10.527 11.580 12.738 53.114 Recurring Cost of Drivers, Drugs, supplies, Mobile phones, POL, Maintenance 2.518 2.770 3.047 3.351 3.687 15.373 Orientation of the staff 0.25 0.275 0.3025 0.333 0.366 1.526 Joint Workshop for finalizing modalities 0.25 0.275 0.3025 0.333 0.366 1.526 Mobile phone for MMU staff @ 2000 x 6 phone 0.12 0 0.000 0.000 0.000 0.120 Recuring cost of mobile phone @2700 x 6 phone 0.189 0.208 0.229 0.252 0.277 1.154 Total 38.877 13.0977 14.407 15.848 17.433 99.663

Detailed Calculations Budget for Vehicles, Equipment and Accessories S.No Head Unit Cost 1. Cost of Vehicle for staff to MMU 5,00,000 2. Cost of Vehicle for carrying A/V aids, equipment etc 18,00,000 3. Prefabricated tents & Furniture 1,50,000 4. Equipment 2,00,000 5. Mobile Phone (one for each Driver) 10,000 6. Computer system with Printer 30,000 Total 26,85,000

99 Budget of Personnel

S.No Head Unit Unit Cost Amount 1. Emoluments to MOs -1 12 months 25000 300000 2. Emoluments to Specialists –2 (Part 12 months 40000 480000 time) 3. Lab Technician 12 months 5000 60000 4. Pharmacist 12 months 5000 60000

5. Nurse 12 months 7500 90000 Total 990000

Budget for Recurring Expenses S.No Head Unit Unit Amount Cost 1. Salary of Drivers –2 12 months 8000 96000 2. Drugs 30000 3. POL & Maintenance of Vehicles 40000 4. Maintenance of equipment 10000 5. Mobile Phone bill -2 12 months 500 12000 Total 188000

100 B – 6. Upgrading CHCs to IPHS Situation Two CHCs to be upgraded to the level of IPHS i.e. Gandooh and Bhaderwah Analysis One more CHC more at Assar required in project period. All the Facilities need to be strengthened as IPH Standard. Presently the number of available staff Qtrs is too less and need more staff Qtrs Road accidents are quite frequent. So casualty services need to be strengthened at CHCs Objectives To Strengthen all the CHCs as per Indian Public Health Standards Opening new Community Health Centres to cater to the entire population Strategies 1. Availability of all personnel as per IPHS 2. Proper building 3. Adequate Laboratory, Blood Storage Unit, Equipment and Drugs Activities 1. Hiring of additional staff as per IPHS and filling of Vacancies 2. Building to be built for New CHC with staff quarters 3. Repair of CHC 4. Equipment as per IPHS norms Support State to sanction posts as per IPHS required Allowing Contractual Personnel at Market Rates Timeline Activity/ Item 2007- 2008- 2009 2010 2011- 08 09 -10 -11 12 Upgradation of DH X X

Gandoh and Bhaderwah CHCs will be X X strengthened as per IPHS. The process of 1 new CHCs building X X construction will be initiated it includes permission from the state, identification of location and land, allotment & release of funds for construction, hiring of staff etc. Hiring of required number of staff will X X X X X be done. Adequate medicines, furniture, and X X X X X equipment will be procured and supplied to the CHCs. Vehicle will be hired for S/MOs. X X X X X X X Repair and renovation of building, and equipment will be made from maintenance and untied funds in the existing CHCs as per the requirement. Purchase of generator sets & their X X X X X maintenance for ensuring the 24 hours electricity supply in existing 3 CHCs. X X X X X Activities, which are routine in nature, will be carried out every year.

101 X X X X X Construction of new staff Qtrs for the staff. (2MO and 2 Staff Nurse Qtrs) Budget Activity/Item 2007- 2008- 2009- 2010 2011 Total 08 09 10 -11 -12 Upgradation of DH Doda @ 5 crores 500 0 0.000 0.00 0.00 500.0 0 0 Upgradtion of CHC Bhaderwah to the level 500.0 500.0 0.0 0.0 0.0 1000.0 of DH @ 5 crore & CHC Gandooh @ 5 crores CHC Building Repair, Altration and Edition @ 10 Lakh 30.0 20.0 0.0 0.0 0.0 50.0 Construction of Staff Qtrs of MO/ Specialist @ 12 lakhs 60.0 0.0 0.0 0.0 0.0 60.0 Construction of Staff Qtrs of SN @6 lakhs 210.0 0.0 0.0 0.0 0.0 210.0 Construction of Staff Qtrs of class [email protected] lakhs 84.0 0.0 0.0 0.0 0.0 84.0 Furniture @0.5 X No of CHCs 2.5 0.0 0.0 0.0 0.0 2.5 Equipment @ 11 X No of CHCs 55.0 5.5 6.1 6.7 7.3 13.4 Reccuring cost of CHC excluding Man Power 26.4 26.4 26.4 26.4 26.4 132.0 Computer ,printer,fax @ 1lakh X 5CHC 3.0 2.0 0.0 0.0 0.0 5.0 AMC of computer @ 6000 X5 CHC 0.3 0.3 0.4 0.4 0.4 1.8 Total 1471.2 554.2 32.8 33.4 34.2 2125.8

102

B – 7. Upgrading PHCs for 24 hr Services Situation There are twelve PHCs running in govt. building and 22 in rented buildings. Analysis Majority of PHCs running in govt. buildings even do not have facilities and condition of building as suggested by IPHS Objectives Provide round the clock Emergency services at the PHC level Strengthening, PHCs as per IPH Standard. Strategies Availability of all personnel as per IPHS Proper building with staff quarters in all PHCs Adequate Laboratory, Equipment and Drugs Activities 1. Hiring of additional staff as per IPHS with 2 MOs( maybe Ayush), in each of the facilities, 3 staff nurses, 1 PHN, 1 Lab Technician, Part time Pharmacist, 1UDC, 1 Accountant, and Class IV and filling of Vacancies( Budget mentioned in the HR section) 2. Building addition /Expansion of and Repairing of 15 PHCs. Construction of staff quarters for the existing PHCs 3. Upgrading the Laboratory for tests necessary for 24 hour PHCs 4. Furniture, Drugs and Equipment as per IPHS norms 5. Existing PHCs will be upgraded as per IPH Standards. 6. Staff quarters for the existing PHCs Support State to sanction posts as per IPHS required Allowing Contractual Personnel at Market Rates Timeline Activity / Item 2007- 2008 2009 2010- 2011 08 -09 -10 11 -12 No of PHCs 32 0 0 0 0 Hiring of additional staff as per IPHS 32 PHCs New Buildings with equipment, Drugs and 10 10 Furniture and quarters as per IPHS Equipment and furniture for existing 20 13 facilities as per IPHS Repair/Additions of PHCs 7 7 Staff Quarters as per IPHS 16 16

103 Budget Activity / Item 2007-08 2008-09 2009- 2010- 2011- Total 10 11 12 Construction of Building with 756 756 staff Qtrs for building less PHCs @ 37.80 PHC Building Repair, Altration and Edition @ 2 Lakh 16 16 0.000 0.000 0.000 32 Construction of Staff Qtrs for PHCs having own building 230.4 345.6 0.000 0.000 0.000 576 Repairing of Staff Qtrs @ 5Lakh/PHC 40 40 0.000 0.000 0.000 80 Furniture @1 X No of PHCs 30 0 0.000 0.000 0.000 30 Equipment @ 11 X No of PHCs 330 0 0.000 0.000 0.000 330 Recuring cost of PHCs excluding Man Power 26.4 26.4 26.4 26.4 26.4 131.974 Computer with 32 0 0.000 0.000 0.000 scanner,printer,UPS, Fax @1lakh /PHC 32 AMC of computer @ 6000 X No 1.92 2.112 2.323 2.556 2.811 of PHC 11.722 Total 1462.715 430.1068 28.718 28.95 29.206 1979.696

104 B – 8. Upgrading Sub Centres Situation Doda out of 108 sub centers 87 rented and 21 are govt. Analysis There are 108 sub centers in district doda in four blocks Ghat, Gandooh, Assar, and Bhaderwah with overall population of 3,94,092 out of which only 21 sub centers are in govt. building and rest 87 are in rented buildings. No proper water supply or electricity supplies. No regulars supply of kit A+B moreover the supplies like IFA condoms and other necessary medicines are falling very short since last year. Not all staff positions filled Objectives Upgrading of Subcentres as per IPHS standards Quarters for the ANMs Opening Additional Subcentres to cater to the entire population Strategies 1. Building new buildings for 32 Subcentres & Activities 2. New sub center as per the population distribution. 3. Provision of Electricity, water storage and sanitation facilities to all sub centres 4. Construction of Staff Qtrs to all Sub Centers Support State to sanction posts as per IPHS required Allowing Contractual Personnel at Market Rates Timeline Activity / Item 2007- 2008 2009- 2010- 2011 08 -09 10 11 -12

New buildings with quarters, equipment 18 25 22 4 3 and Furniture (88) Repair of SCs (20) 30 20 20 2 Staff Quarters (108) 12 42 12 11 New Subcentres with staff Qtrs ,Furniture 16 19 22 25 28 and Equipment SCs SCs SCs SCs SCs Electricity Connections 108 Water Connections 11 Toilets 108 Budget Activity / Item 2007-08 2008-09 2009-10 2010- 2011-12 Total 11 New buildings with quarters, equipment and Furniture 100.000 180 180 180 180 820.000 New Subcentres @ Rs. 10 lakhs/SC non recurring for existing SCs 200.000 50 20 20 20 310.000 Repair,Addition and Alteration of Subcenter @2lakh 40 0 0.000 0.000 0.000 40.000 Rent till building constructed 3.33 0.12 0.12 0.09 0.12 3.780 Recurring costs of the 78.777 81.182 83.588 85.392 87.797 additional Subcentres 416.736 Total 422.107 311.302 283.708 285.482 287.917 1590.516

105 B-9 Untied Funds and Incentive Fund for the Village Health and Water Sanitation Committees Situation NRHM has placed a lot of stress on Community involvement and formation of Analysis/ Village Health & Water Sanitation Committees (VHWSC) in each village. These Current committees are responsible for the health of the village. In District Doda these Status committees have been formed but need strengthening to improve their functioning. The selection of ASHA, her working, progress of the village is part of the responsibilities of the Gram Panchayat.

In Doda there are 124 villages with population less than 500, 150 villages with population 501-1501, There are 73 villages with population between 1501 and 3000. There are 11 villages with population more than 3001- 5000 and 7 villages with more than 5000 population. Objectives Strengthening the Village Health & Water Sanitation Committees through financial support Strategies 1. Provision of annual Untied funds of Rs 10000 each year to the villages upto a population of 1500 2. Provision of Rs 5000 as permanent advance fund for Incentives for ASHA Activities 1. Provision of annual untied funds of Rs 10000 each year to the villages’ up to a population of 1500. Villages with more than 1500 population up to 3000 will get twice the funds. Villages with population more than 3000 will get three times the funds, hence the district have 240 units. This untied fund is to be used for household surveys, health camps, sanitation drives, revolving fund etc; 2. Orientation of the ANMs for the utilization of the untied funds and she in turn will orient the Village, Health & Water Sanitation committee. 3. Provision of Rs 5000 as permanent advance fund for Incentives for ASHA based on performance norms. 4. Monthly meetings of the VHWSC for reviewing the funds and activities. This is to be facilitated by the ANMs 5. Monthly review at the PHC level regarding the VHWSC functioning and utilization of funds. Support 1. State should ensure the orientation procedure for the VHWSC required 2. Funds to be transferred on time to the MPHWF 3. PRIs to ensure proper usage and accounts

106 Timeline 2007 2008 2009 2010 2011 -08 -09 -10 -11 -12 Untied Fund of Rs 10000/unit for Pop x x x x x 1500/unit x 539 units Orientation and reorientation of the VHWSC x x x x x Provision of Rs 5000 as permanent advance x x x x x for incentives to ASHA Monthly meetings of the VHWSC x x x x x Review of the VHWSC functioning at PHC x x x x x level

Budget Activity / Item 2007 2008 2009- 2010- 2011- Total -08 - 09 10 11 12 Untied Fund of Rs 10000/unit 1500/unit x 559 24 24 24 24 24 120 units Permanent Advance to VHWSC for ASHA 8 9 10.00 4.400 11.00 42.4 incentive @ Rs5000/SC Total 32 33 34 28.4 35 162.4

107 PART C: Immunization

C-1. Strengthening Immunization Current Status District Doda is hilly and very tough area in the whole country. Here Govt. services are seriously impaired especially complete vaccination is one of the biggest challenge moreover people are living at hilltops and at very far places. In August only 43% infants from 0-11 mothers were given DPT.

The reasons for low immunization are related to the ignorance of the mothers on the importance of immunization, the place and time of Immunization sessions and fear of side effects. The community perceives that the Polio drop given repeatedly at the time of Pulse Polio campaign is equivalent to the complete immunization.

The ANMs have to take the vaccines from the PHC headquarters resulting in them not reaching the hamlets and also the difficult areas and also the Pulse Polio campaign. Supervision is not done properly at PHC level.

IEC session have been started the district manages presently up to Aug 2007 there is record of since camps which includes RCH and camp and 2 health meals at through yet electronic media has not been involved due to various financial and staff problems.

District Doda there the cold chain is being maintained at some places in all the blocks details are as under. Out of 32 PHCs and 108 sub centers following is the status of maintain cold chain: SDH Gandooh, SDH Bhaderwah and CHC Thathri 5ILR+ 3 Deep freezer. PHCs: - Ghat, Bhagwa, Assar, Goha, Bhalla, Bhella, Premnager, Changa, Tipri, Malano, 12 ILR + 8 Deep freezer Sub centers (7) & 7 ILR and two Deep freezer. There are far-flung areas which takes seven to eight hours to go by foot from block head quarter and in these areas the cold chain maintenance without generator ILR and Deep freezer is very difficult.

There is a Shortage of Refrigerator Mechanics. Objectives/ Reduction in the IMR to 25 by 2012 Milestones/ 100 % Complete Immunization of children (12-23 month of age) by 2010 Benchmark 100 % BCG vaccination of children (12-23 month of age) by 2008 s 100% DPT 3 vaccination of children (12-23 month of age) by 2009 100% Polio 3 vaccination of children (12-23 month of age) by 2009 100% Measles vaccination of children (12-23 month of age) by 2010 100% Vitamin A vaccination of children (12-23 month of age) by 2008 Strategies Strengthening the District Family Welfare Office Enhancing the coverage of Immunization Alternative Vaccine delivery Effective Cold Chain Maintenance Zero Polio cases and quality surveillance for Polio cases Close Monitoring of the progress

108 Activities 3. Strengthening the District Family Welfare Office One computer assistant for the District Family Welfare Office will be provided for data compilation, analysis. Training for all the health personnel will be given including ANMs, LHVs, MPWs, Cold chain handlers and statistical assistants for managing and analyzing data at the district. Alternative vaccine delivery system (mobility support to PHCs for vaccine delivery) For Alternative vaccine delivery, Rs.50 to the ANM will be given per session, two sessions per week per Sub centre. Mobility support (hiring of vehicle) is for vaccine delivery from PHC to VH Days site where the immunization sessions are held for 8 days in a month.

4. Incentive for Mobilization of children by Social Mobilizers Rs.100 per month will be given to Social Mobilizers for each village for mobilization of children to the immunization session site. This money will be provided to ASHA wherever possible but if there is no ASHA then it will be given to someone nominated from the village by the PRIs. Contingency fund for each block Rs. 1000/ month per block will be given as contingency fund for communication Disposal of AD Syringes Outbreak investigation: Rapid Action Team for epidemics will be formed Dissemination of guidelines Training of Rapid Action Team for investigating outbreaks who will in turn orient the ANMs during Sector meetings. Standard Guidelines have been developed at national level and will be disseminated to the district officials and block levels in Review meetings. IEC & Social Mobilization Plans Cold Chain :Repairs of the cold chain equipment at PHC & CHC each year Selection and training of volunteers from each of the far-flung area for delivering the vaccines. They can be paid Rs 50 per carriage. Horses for the block Assar, Ghat, Bhaderwah, Gandoh for carrying vaccine to the areas where there is no road connectivity and are far flung. One person and other requirements for maintaining the horses. Support • Regular supply of vaccines and Autodestruct syringes required • Reporting and Monitoring formats • Cold Chain Modules and monitoring formats • Temperature record books • Polythene bags to keep vaccine vials inside vaccine carrier • Polythene for the vaccines to avoid labels being damaged • Training of Cold Chain handlers and middle level managers Timeline Activity 2007- 2008- 2009- 2010- 2011- 08 09 10 11 12 Alternative Vaccine delivery x x x x x Mop up Round x x x x x IEC activities x x x x x Tracking bags x x x x x

109 Orientation on Tracking bags x x x x x Maintenance of Cold Chain x x x x x Provision of Generator x

Budget Activity 2007- 2008- 2009- 2010- 2011- Total 08 09 10 11 12 Mobility support for alternative vaccine 4.40 4.67 4.94 5.18 5.47 24.65 delivery Rs. 70 per session for 1 planned session per week at each Subcentre village for 12 months = Rs. 70 x 1 session x4 weeks/mthx12 monthsx SCs Vehicle for distribution of vaccines in 12.29 12.39 13.63 16.36 17.99 72.66 remote areas @ Rs 800 per PHC per week x 4 weeks x 12 months x PHCs Mobility Support Mop up campaign @ 19.20 19.20 19.20 19.20 19.20 96.00 Rs 10000 per PHC ( Including travel, vaccine delivery, IEC) x 6 rounds/ year x PHCs Mobilization of Children by Social 17.52 17.52 17.52 17.52 17.52 87.60 Mobilizers @ Rs. 100/ session x1 session per week x 4 weeks/mth X 365village x12 mths Pit Formation for disposal of AD 73.00 73.00 73.00 73.00 73.00 365.00 Syringes and broken vials (@ Rs. 2000 per pit per village Printing of Immunisation cards @1.50 0.75 0.83 0.91 1.00 1.10 4.58 per card x 50000 cards each year Maintenance of Cold Chain Equipments 3.83 2.72 2.72 3.22 3.22 15.71 (funds for major repair) (@ Rs.750 per PHC/CHC for the first year then Rs. 500 per PHC/CHC per month) and 50,000 for minor repairs POL & maintenance for Vaccine delivery 1.80 1.98 2.18 2.40 2.64 11.00 van at district level @ Rs.15000/month x 12 mths Mobility suppot to District Family Welfare 0.36 0.40 0.44 0.48 0.53 2.20 Officer@ 3000/month Computer Assistant for District Family 0.54 0.59 0.65 0.72 0.79 3.30 Welfare Office @ 4500 Mobility support for Monitoring 1.28 1.41 1.55 1.70 1.87 7.81 Immunization sessions for MO's & supervisory staff@1000/session Total 134.97 134.7 136.73 140.78 143.33 690.51

110

PART D: National Disease Control Programme

D-1. RNTCP Situation IDMCs (designated microscopic centres) are examining the patients. Patients are Analysis taking treatment at DOT centres. Objectives Reduction in the cases of Tuberculosis by 25% 1. 100 % detection of Cases 2. 85 % Cure rate in New Cases 3. Detection of 70% new smear positive cases once cure rate of 85% is achieved 4. Reduction in the defaulter rate to less than 5% Strategies 1. Improvement in the infrastructure 2. Improvement in the quality of the intervention 3. Increasing the outreach of the programme 4. Increasing the awareness regarding Tuberculosis Activities 1. Improvement in the infrastructure • Improved DTC building with a computer room • Improved MC centres and TC centre 2. Improvement in the quality of testing of sputum • Training to the RNTCP staff in the district • Equipment maintenance – Microscope, Computer and Others • Adequate supply of drugs 3. Increasing the outreach of the programme by Increasing the DOTS providers through involvement of ASHAs who will be paid Rs. 500 per year for providing services. She will be oriented regarding DOTS. Also the AWH should be involved in reporting suspicious cases. Training will be given to ASHA for identifying the suspects. 4. Increasing the awareness regarding the various issues of Tuberculosis through involvement of Community leaders, NGOs, Ex-servicemen. Special drive for detection of cases on World TB day through the involvement for all departments 5. DOTS regime to be strictly monitored through the VHWSC, the PRIs and the PHC MO 6. Orientation of PRIs and Rehbar-e-sehat for early detection of TB. Support DHS required Timeline Timely supply of medicines 2007-2008 1. Improving the DTC building, MC Centres and TC centres 2. Increasing the DOT providers through ASHAs 3. Training to RNTCP staff and ASHA 4. Awareness drives 2008 – 2012 Yearly increase in the ASHAs and involvement of the AWH

111 Budget Activity / Item 2007- 2008- 2009- 2010 2011- Total 08 09 10 -11 12 Civil Works DTC building 15 lakhs 15.00 0.00 0.00 0.00 0.00 15.00 MC 0.28/MC 2.80 0.00 0.00 0.00 0.00 2.80 TU 0.35/Tu except DTC 1.05 0.00 0.00 0.00 0.00 1.05 Material and supplies 1.20 1.32 1.45 1.60 1.76 7.33 Laboratory material 1.00 1.10 1.21 1.33 1.46 6.10 Training 13.75 15.13 16.64 18.30 20.13 83.95 Awareness drive on World TB day 1.00 1.10 1.21 1.33 1.46 6.10 IEC activities 1.00 1.10 1.21 1.33 1.46 6.10 Salaries of contractual staff 11.19 12.31 13.54 14.89 16.33 68.26 Vehicle maintenance including POL 1.00 1.10 1.21 1.33 1.46 6.10 2 wheeler 0.00 4 wheeler 0.00 Hiring of vehicle 1.70 1.87 2.06 2.27 2.50 10.40 DTO 0.00 MO TC @ Rs 0.42lakh/yr 0.00 Equipment and maintenance 0.09 0.09 0.10 0.11 0.12 0.52 Microscope @ Rs1000/yr/microscope 0.00 Computer@ Rs 5000/yr 0.00 Photocopier/Fax Rs2500/ machine 0.00 Miscellaneous – TA/DA, Telephone, Meetings, 0.20 0.22 0.25 0.27 0.30 1.23 Electricity repair etc Total 50.97 35.33 38.88 42.77 46.99 214.93

Training S.No Personnel Unit Cost Units Amount 1. DTO State 2. MOTC 23320 2 46640 3. MO 15580 64 997120 4. STS 6726 2 13452 5. STLS 16720 2 33440 6. LT 5972 2 11944 7. MPH 1925 32 61600 8. MPW 2875 120 345000 9. ANM 2875 240 690000 10. ASHA 100 432 43200 2242396

112

Salaries of Contractual Staff S.No Personnel Unit Cost Units Months Amount 1. STS 7000 2 12 168000 2. STLS 7000 2 12 168000 3. LT 6500 2 12 156000 4. Data Entry Operator 6000 1 12 72000 5. Accountant 1250 1 12 15000 6. Driver 4500 1 12 54000 Total 633000

113 D-2. LEPROSY Situation 0.5 cases per 10,000, so 3-5 new cases per month (these cases are imported cases Analysis from outside – not coming from within district itself). 40 cases on treatment per month x 393.01 and 480 x 1167.53) Objectives Eradication of Leprosy by 2012 Maintain the gain achievements. Provide quality leprosy services with integrated health care system. Strategies 1. Institutional development: Expand the service availability from CHC to PHC & Activities level. 2. Strengthening and Integration of Service delivery: Diagnosis and treatment facilities will be made available closer to the people through daily outreach. 3. IEC for awareness regarding the symptoms and effects of Leprosy 4. Prompt treatment to all cases with effective referral system. 5. Trainings programs of MOs on general health care & IEC, Lab Tech and Pharmacist. 6. POID Camps. Support Availability of drugs Required Inter sectoral coordination for identifying new cases and rehabilitation of disabled. Adequate funds for various activities Timeline 2007-2008 House to house detection Wide publicity Training Programs POID Camps 2008-2009: Rigorous follow-up Budget Activity / Item 2007 2008 2009- 201 201 Total -08 -09 10 0-11 1-12 Routine Budget for Leprosy control 1.45 1.6 1.8 2 2.2 9.05 programme Monitoring & Supervision 1 1.1 1.2 1.3 1.5 6.1 Additional medicines 1 1 1 1 1 5 IEC Activities 1 1.1 1.2 1.3 1.5 6.1 POID Camps one per year @5000 1.6 1.6 1.6 1.6 1.6 8 XPHC Celebration of world Anti Leprosy 0.2 0.2 0.2 0.2 0.2 1 day@20000 TOTAL 6.25 6.6 7 7.4 8 35.25

114 D-3. NATIONAL MALARIA CONTROL PROGRAMME Situation The District is cold one and usually the malaria cases are not noticed here. It is negligible although slides are examined regularly in District Doda; slides have been Analysis examined last year out of which no slide has been found positive. Objectives To prevent the malaria To create awareness and education in the community about anti malaria

operations and seek their support. Strategies 1. IEC activities regarding the malaria prevalence and public awareness. 2. Formulating community groups and seeking solution of cleanliness & Activities quarterly. Support Availability of supplies Filling up of vacancies required Supply of health Education material Timeline Activities 2007-08 2008- 2009- 2010- 2011-12 09 10 11 House to house detection x x x x x Wide publicity x x x x x Rigorous follow-up x x x x x Treatment x x x x x

Budget Activity / Item 2007- 2008- 2009- 2010- 2008- Total 08 09 10 11 12 Salary Contractual staff 6.45 7.095 7.805 8.585 9.443 39.38 Travel expenses @ Rs 4000/ 3.36 3.696 4.066 4.472 4.919 20.51 monthfor jeep x 12 months, @6000/month for Truck Office expenses @ Rs 5000 per month 0.6 0.66 0.730 0.800 0.880 3.67 x 12 Jeep and maintenance 6 0.6 0.660 0.730 0.800 8.79 Trucks – 3 and maintenance 32 3.2 3.52 3.872 4.259 46.85 3 small Fogging machines for each 128 12.8 14.08 15.488 17.037 187.40 PHC @ Rs 1.00 lakh and one at District HQ Pulse Fog Machines @ Rs.8.00 lakh per unit and maintenance Misc @ Rs 1.00 and Rs 20000 per 2.1 2.31 2.541 2.795 3.075 12.82 CHC, and for PHC Rs 10000 Board hoarding:8’x 12’ at the CHCs 0.75 0.75 0.75 0.75 0.75 3.75 and District hospitals @ Rs 25,000/- Board hoarding: 5’x3’ initially at the 1.5 1.5 1.5 1.5 1.5 7.50 PHCs@ Rs 10,000/- Rs 50,000 for PHC 0 2.5 7.500 6.000 0.000 16.00 Total 180.76 35.111 43.151 44.992 42.663 346.68

115 D-4. OTHER VECTOR BORNE DISEASES Situation Dengue cases nil There are no reported cases of Lymphatic Filariasis Analysis There is no reported cases of Japanese Encephalitis Generally the area is cold and such diseases are very less or negligible. Objectives Decrease in incidence of Dengue to nil by 2012 Prevention of JE, Chikingunya and other new infections Strategies 1. Reduction of vector density 2. Mosquito-man contact reduction 3. Community awareness Activities 1.Reduction of vector density • Identification of breeding sites • Fogging and spraying • Covering of any breeding sites 2.Mosquito-man contact reduction • Use of Insecticide coated mosquito nets • Promotion of the mosquito nets 3.Preparedness for new infections • Increase in Manpower • Training of personnel for identification of new infections • Preparation of Laboratories in the district and State to diagnose the new diseases • Preparedness of dealing with the epidemic outbreak 4.Community awareness as part of the IEC for Malaria and IDSP • Group meetings • Pamphlets/ handbills • Public announcements • Kala Jathas Support Support from State Laboratory and the NICD for diagnosing Dengue, Chikingunya, required JE etc; Support from District Administration, PRIs, WCD, PHEd, Timeline One jeep for Entomologist (already covered in malaria budget) One truck for shifting manpower and drums/equipment (in malaria budget) Budget Activity / Item 2007 2008- 2009- 2010- 2011- Total -08 09 10 11 12 Unforeseen expenses 0.5 0.55 0.610 0.670 0.740 3.1 Pamphlet, poster @1lakh 1 1.1 1.210 1.331 1.464 6.1 Kala Jathas for Malaria, Dengue and 3.86 4.246 4.671 5.138 5.651 23.6 Chikingunya @ Rs 1000 per village x 386 Total 5.36 5.896 6.491 7.139 7.856 32.7

116 D-5. BLINDNESS CONTROL PROGRAMME Situation Eye Care is being provided through the DH and cataract surgeries are being done at Analysis DH only. There is dearth of eye specialists in CHCs. Objectives 1. Reduction in the Prevalence Rate of blindness to 0.5 % by 2012 2. Decrease in the Prevalence Rate of Childhood blindness to 0.6 % per 1000 children by 2010 3. Usage of IOL in 95% of Cataract operations Strategies 1. Provision of high quality Eye Care 2. Expansion of coverage 3. Reduce the backlog of blindness 4. Development of institutional capacity for eye care services Activities 1. Increase in number of cataract camps by strengthening existing infrastructure and by involving private sector/NGO/Trust. 2. Strengthening the CHCs, and new proposed District Hospitals (DH) for cataract operation by equipping them with operation theatre, vision box, colour vision, ophthalmoloscope and required medicines 3. Eye OT at CHC Gandoh and CHC Bheradwah will be contracted to meet the demand. 4. Ophthalmologist surgeon, ophthalmologic assistant will be posted at all the CHCs, 5. All the PHCs will be equipped with vision box, colour vision, ophthalmoloscope and required medicines. 6. NGOs/private agencies/trusts will be encouraged to participate in the National Blindness Control Programme. 7. Eye checkup and early detection and prompt treatment of ophthalmologic infections/diseases among children will be done during School Health Programme (Details is given in the School Health Component) 8. Training in IOL to Ophthalmologists 9. Training of Paramedical staff and Teachers, NGOs, Patwaris and AWW for screening and IEC activities. 10. Procurement of new Equipment 11. AMC for all equipment will be done. 12. Blind Register to be filled up by the AWW, together with PRIs 13. School Eye Screening sessions 14. IEC activities Support Procurement of latest equipment for hospitals by GOI required Timely Repair of equipment Timeline Activity 2007-08 2008- 2009- 2010- 2011- 09 10 11 12 Health mela X X X X X Development of vision 3CHC 12 New centers at CHC and PHC and 5 PHC CHC PHC School Screening X X X X X Cataract camps X X X X X Development of Eye units 2CHC 1CHC 1CHC at CHC IEC Campaign X X X X X Budget for development of Eye units is mentioned in Up gradation of CHCs, IPHS

117 School screening budget is mentioned in school health. Budget Activity / Item 2007- 2008 2009 2010- 2011 Total 2008 -09 -10 11 -12 Health Mela @50000 / CHC 1.50 1.65 1.82 2.00 2.20 9.16 IEC @1lakh 1.00 1.10 1.21 1.33 1.46 6.11 School Eye Screening @1000 X100 school 1.00 1.10 1.21 1.33 1.46 6.11 Blind Register 0.37 0.40 0.44 0.49 0.53 2.23 Observance of Eye Donations 0.15 0.17 0.19 0.21 0.23 0.95 Cataract Camps @ Rs 20000 per camp x 32 6.40 7.04 7.74 8.52 9.37 39.07 PHC POL fro Eye Camps @ Rs 2000/camp x 32 0.64 0.70 0.77 0.85 0.94 3.91 House to house survey for vision defects @ 0.00 10.0 0.00 0.00 0.00 10.00 10 lakhs 0 Training of School teachers @ Rs 100/head x 0.10 0.11 0.12 0.13 0.15 0.61 100 Training of PRIs @ Rs 100/head x 200 0.20 0.22 0.24 0.27 0.29 1.22 Repair and purchase of equipment and 20.00 2.00 2.20 2.42 2.66 29.28 maintenance Total 31.36 24.5 15.95 17.54 19.3 108.64

118 D-6. Integrated Disease Surveillance Program

Situation Integrated Disease Surveillance Programme is to provide essential data to monitor Analysis/ progress of on going disease control programs and help in optimizing the allocation of resources. IDSP includes 15 diseases/ conditions (Malaria, Acute Diarrhoeal disease-Cholera, Typhoid, Jaundice, Tuberculosis, Acute Respiratory Infection, Measles, Polio, Road Traffic Accidents, Plague, Yellow Fever, Meningoencephalitis /respiratory distress, etc., HIV, HCB, HCV) ) and 5 state specific diseases namely Thyroid diseases, Cutaneous Leishmaniosis, Acid Peptic Diseases, Rheumatic Heart Diseases.

Surveillance is ineffective due to Number of parallel systems existing under various programs which are not integrated. Programs not covering non-communicable diseases. Medical colleges and large tertiary hospitals in the private sector are not under the reporting system as well as for utilization of laboratory facilities. Unavailability of laboratory infrastructure in the district Presently, surveillance is sometimes reduced to routine data gathering with sporadic response systems thereby leading to slow response to Epidemics.

For establishing & strengthening the IDSP in district Doda the following are necessarily required. Establishing of District Surveillance unit. Establishment of Rapid response teams at District levels. Establishment of DSUs (District Surveillance Units) Computers with installed software, provided by the GoI and one data operator and one data manager. Objectives To fully develop the Integrated Disease Surveillance System for Communicable and Non-Communicable disease Strategies 1. Strengthening data quality, analysis and links to action; 2. Improving the laboratories 3. Training of all the stakeholders in disease surveillance and action 4. Coordinating and decentralizing surveillance activities 5. Intersectoral Coordination and involvement of communities and the private sector Activities 4. Strengthening of the District Surveillance Unit (DSU), established under the project, • Training of the Unit Incharge for epidemiology – {DMO) • Hiring of Administrative Assistant • Training of contract staff on disease surveillance and data analysis and use of IT • Providing support for collection and transport of specimens to laboratory networks • Provision of computers and accessories • WEN connectivity to be operationalized • Provision of software of GOI 5. Setting up of Peripheral Surveillance Units at DH 6. Sensitizing the Community for • Notifying the nearest health facility of a disease or health condition selected for community-based surveillance • Supporting health workers during case or outbreak investigations

119 • Using feedback from health workers to take action, including health education and coordination of community participation. • Meetings with the SHGs, school teachers, Numberdar and Chowkidars for sensitization and prompt reporting of cases 4. Improvement in the Laboratories at the district and at CHCs through provision of equipment and consumables Support Timely trainings for the Nodal persons required Government Order for involvement of teachers in Disease Surveillance Timeline Activity / Item 2007- 2008- 2009- 2010- 2011- 08 2009 2010 2011 12 Renovation of Labs with provision 2CHC CHC 1 addl of equipment, furnishings, material Dacchan new CHCs Training x X x x x Contractual staff 3 3 4 4 x Software for DSU & training of staff x x x x x

WEN connectivity x x x x x Sensitization of Community x x x Meetings with SHGs x x x x x Meetings with teachers x x x x x Meetings with Numberdar and x x x x Chowkidars

Budget Activity / Item 2007- 2008- 2009- 2010- 2011- Total 08 09 10 11 12 Renovation of Labs at CHCs a@ Rs 0.4 0.2 0.000 0.000 0.000 0.6 20,000 Establishing Lab at District Hospital @ 1.4 0.14 0.180 0.200 0.220 2.14 Rs 140,000 and maintenance Equipment for Lab at PSU at CHC 0.8 0.4 0.000 0.000 0.000 1.2 and @ Rs 40,000 Equipment for Lab at District @ Rs 8.5 0 0.000 0.000 0.000 8.5 850,000 Computer and Accessories at CHC 1 2.5 0.000 0.000 0.000 3.5 @50000 Office for PSU at Maintenance CHC 0.2 0.7 0.770 0.830 0.910 3.41 @ Rs 10,000 per unit Office Maintenance for DSU @ Rs 0.1 0.1 0.100 0.100 0.100 0.50 10,000 Software for DSU@ Rs 335000 3.35 0 0.000 0.000 0.000 3.35 Furnishing of Lab at PSU at CHCs 0.2 0.1 0.000 0.000 0.000 0.30 and @ Rs 10,000 Furnishing of Lab at DSU @ Rs 0.6 0 0.000 0.000 0.000 0.60

120 60,000 Material and supplies at Lab at PSU at 0.16 0.8 0.000 0.000 0.000 0.96 CHCs @ Rs 8,000 Material and supplies at Lab at DSU 0.75 0.83 0.910 1.000 1.100 4.59 @ Rs 75,000 Contract Staff at District level @ 2 2.2 2.920 3.710 4.580 15.41 200000/yr for 4 staff yearr wise IEC activities 1 1.1 1.210 1.330 1.460 6.10 Training and retraining 1.916 2.430 2.673 2.940 3.234 13.19 WEN connectivity 0.5 0.55 0.610 0.670 0.730 3.06 Operational costs at PSU for 0.3 1.05 1.05 1.05 1.05 4.50 Surveillance @ Rs 15000/year x 7 Operational costs at DSU for 1.3 1.430 1.573 1.730 1.903 7.94 Surveillance @ Rs 130000/year Honorariun to Numberdars and 8.76 9.636 10.600 11.66 12.826 53.48 Chowkidars for reporting @ Rs 100pm 0 x 365 Numberdars and 365 Chowkidars x12 Total 33.236 24.166 22.595 25.22 28.113 133.329

121 D-7. Iodine Deficiency Disorders Situation Iodine is one of the essential micronutrients. Minimum requirement is 150 Analysis microgram per day. The main source of Iodine is from soil and water. Deficiency result in a variety of disorders ranging from Abortion, stillbirths, Goitre, impaired mental function, retarded growth.

In J&K the National Iodine Deficiency Programme is being implemented since 1986. There is a ban on the sale on non Iodized salt in J&K. In district Doda exact data is not available of Iodine deficiency disorders but as per the medical departments assumption there might be possibility of one –two cases in each village. Objectives/ 1. Prevention of Iodine Deficiency diseases 2. Consumption of Iodized salt by 100% families Strategies 1. Supply/monitor quality of Iodized salt 2. Assessment of the magnitude of the problem 3. Laboratory Monitoring of Iodized salt and urine samples 4. Health Education Activities 1. Supply/monitor quality of Iodized salt • Monitoring is done through Food Inspectors who collect two samples of salt per month per district and send it to a laboratory. • The Health workers have been supplied with Kits to test samples at least five per month. • Review is done in the monthly meetings • Monitoring through School health programme – Testing of samples and awareness • Supply of Testing kits to AWCs, Schools, SHGs 2. Assessment of the magnitude of the problem This will be done by the Central Survey team 3. Laboratory Monitoring of Iodized salt and urine samples The samples are collected by MPHW and sent for analysis. 4. Health Education: An IEC strategy is essential to promote the consumption of Iodized salt through AWWs, PRIs, NGOs, ASHA, SHGs etc; Demonstration of Iodized salt by school children through testing, Rallies, sensitization of shopkeepers for keeping Iodized salt. 5. Testing of salt at shops and homes Support 1. Regular Supply of Testing Kits required 2. Regular Supply of Iodized salt 3. Regular supply of IEC material Timeline 2008-2009 • Widespread awareness regarding the consumption of Iodized salt • Testing of Salt samples in each AWC by AWW, ANM, ASHA • Awareness in schools and SHGs 2009-2010 • Testing of Iodized salt in all the village shops • Strict enforcement of iodised salt in shops

122 Budget Activity / Item 2007- 200 2009 2010- 2008 Total 08 8-09 -10 11 - 2012 Large Village meetings for 1.00 1.10 1.21 1.33 1.46 6.11 awareness on IDD and consumption of Iodized salt Programme in schools – 100 2.00 2.20 2.42 2.66 2.93 12.21 Primary, Upper Primary, Secondary- Govt and Private by School health team Awareness programme with the 1.83 2.01 2.21 2.43 2.67 11.14 SHGs and shopkeepers @ Rs 500 per village x 365 villages Total 4.83 5.31 5.84 6.42 7.06 29.46

123 6. INTER SECTORAL CONVERGENCE

6.1 Partnership with AYUSH department

In District Doda (old) there are 73 ISM (AYUSH) Dispensaries in which 67 dispensaries are sanctioned & 6 dispensaries are working with internal arrangements. Majority of the dispensaries are situated in far-flung areas & along with actual line of control. All are in rural areas Building Status Rented: 61 Govt: 12 Separate funds have not been provided to this department for creation of infrastructure as per the IPHS including staff quarter accommodation, requisite medicines (including emergency Medicines) & manpower.

ISM doctors are fully trained & competent to conduct deliveries & can contribute a lot in implementing the concept of institutional deliveries .But it is unfortunate that these services are not being utilized maybe out of bias or some other reasons. Without any special facility the ISM Doctors are conducting deliveries where they are posted & no alternative facility is available with the people. For implementation of national programme hundred all ISM (AYUSH) staff is involved in the field. But there is no cold chain facility, lab facility & other incentives.

There are no guidelines for conducting of joint meetings between ISM (Ayurvedic/ Unani) & allopathic at District & block levels. However an informal meeting is held once in a year. There is no binding by way of govt. orders from the higher authorities. The status IEC strategy for Ayurveda & allopathic should be jointly prepared & planned by director ISM & Director health (Allopathic).The IEC funds & material should be jointly shared & should be at the disposal of director ISM & director Health separately.

1. Constitution of RKS in ISM 2. CHC and PHC will provide AYUSH services 3. Involvement of Ayurvedic dispensaries in implementation of national health programmes.

Issues / Areas Areas of cooperation Areas of convergent action Curative ; In order to provide medicare The ISM doctors are providing the Patient care, facilities to the masses there is a health Medicare facilities by the way of Surveillance vast potential for cooperation providing Ayurvedic / Unani medicine referral with health department so as to but as the dispensaries of AYUSH are implement all the national located in the Isolation / far flung areas programes like National Malaria where there is no existence of any eradication Programme, T.B. health facility (Allopathic) in the form of control programme (DOTS), HIV primary health centres / community / Aids awareness programme, health centres or even allopathic implementation of institutional dispensaries. Here people come deliveries. across emergencies which are supposed to be attended by Ayurvedic The cooperation is also needed / Unani doctors or staff. Therefore from the department of social there is dire need of emergency drugs, welfare, (ICDS) Anganwari life saving drugs ,bandaging material , centres located in the areas antiseptic lotions , antibiotics which are where the ISM dispensaries are not supplied in ISM dispensaries. Due functioning by the way that the to non availability of these drugs in staff of these centres (Anganwari some cases precious lives are lost and

124 workers) can bring the wrath of people falls on the staff of ISM unvaccinated children to the institutions. Therefore life saving nearest ISM institutions so that drugs, antiseptic lotions & dressing their complete vaccination materials need to be supplied to avoid should be done. Old routine is suffering of the ailing masses. that medical officer of the concerned ISM institution visits the Anganwari centre once in a month should be started for general health check up of the children of Anganwari centres. Preventive; Health department’s cooperation As the facility of cold chain in the form Immunization, is needed in providing ILR, Deep of ILR’s & deep freezers is provided to Prophylaxis services freezers to the ISM dispensaries ISM institutions. Routine vaccination Promotive, IEC as well as out reach vaccination camps should organized easily in remotest & far flung areas. For IEC funds should be kept at the disposal of the Asstt. District. Medical officer so as it should be used for awareness Programmes. Specific issues in Health Department to assist ISM As Kits of Iron folic acid tablets be Implementation of institutions & to provide kits of provided to ISM institutions. ISM national iron Folic acid tablets directly to Doctors can treat Pregnant women as programmes the dispensaries through the well as cases of iron deficiency Maternal care Asstt. District. Medical officer. All anaemia is better way. In present ASHAs operational in the areas situation only Ayurvedic / Unani of ISM institutions should be medicines which contain iron are given given training on providing to pregnant women for deficiencies of emergency health care services. Iron . Child care Health department should As it contains Iron, Septran (Paed) & cooperate with Assistant District. Antihelminthics tabs be provided ISM Medical officer & kits containing dispensaries better care of children Iron small & folic acid, Septran suffering from iron deficiency anaemia, (paed) & Antihelminthics tabs worm infestation & other diseases. should be supplied to ADMO office & then it is supplied to all As Anganwadi workers / helpers bring the ISM institutions. the children to the ISM Dispensaries As far as social welfare on a fixed date of immunization department is concerned through this goal of 100 % Anganwadi workers can bring immunization could be achieved. unvaccinated children to the dispensaries. Adolescent Health department & education Some funds should be kept at the health department organized camp far disposal of the concerned ADMO for the awareness of adolescent procuring IEC materials like banners / health age group. Ayurvedic / posters etc. for organizing awareness Unani doctors should be invited camps. With this people living in to give awareness lectures & remotest & far flung areas particularly these camps should be adolescent age groups children can be organized at ISM institution also. benefited from this awareness Education department can campaign as most of the ISM

125 cooperate with ISM institutions in institutions are in remotest & far flung a particular areas & through areas. chief education officers or Zonal education officers, it should be made mandatory that medical officer of that area should visit schools & give awareness lectures to the adolescent children on different issues. School Health Education department’s help is When approached by the concerned needed for the health check up chief education officer/ Zonal of children as done as a routine education officers, the ISM Doctors are matter few years back. willing to provide these services for general health check up of children of different schools. Leprosy Cooperation from health After diagnosis of a case of leprosy the department is needed to train anti-Leprotic drugs should be made ISM doctors/ Paramedical staff. available directly to ISM institution so All ISM doctors, paramedical that patients can avail the medicines staffs should be given training to from the nearest dispensary address sensitive health issues like Leprosy. IDD Health department cooperation Only IEC activities are done on our is needed own to aware the masses about the iodine deficiency diseases. Tuberculosis Health department should Anti tuberculosis drugs Dots therapy cooperate with ISM department should be provided directly to ISM & all ISM doctors /paramedical dispensaries so that patient of staff should be trained through Tuberculosis can avail the facility from regular training / workshop from the nearest dispensary as in some far to time laboratory facility with flung areas. There is no existence of laboratory technician should be allopathic institutions & only ISM provided institutions are catering the health needs of the areas HIV/AIDS Cooperation from health Funds for AIDS awareness camps department is needed for training should be kept at the disposal of Asstt. of ISM Doctors / Paramedical District. Medical officer at District. staff for AIDS. Regular Level so that IEC material like Banners workshops training Programmes , pamphlets etc should be disturbed to should be organised so that the masses so that exact cases of the knowledge of the staff is updated disease its sign & symptoms are about the disease. known to the people or IEC material from health (allopathic ) department should be supplied to the ADMO’s Water borne PHE department & health If the cases of the particular disease diseases departments’ cooperation is on particular area rises. In order to needed. As water born disease check it chlorine tablets & other drugs are due to the infected water should be supplied to the ISM chlorine tablets should be institutions so that Medical officers / supplied. officials can treat the cases. IEC materials for water born diseases should be kept at the disposal of

126 ADMO .So that according to need it should be distributed about the masses & awareness camps about the staff drinking water should be organized as in rural areas major source of drinking water is well, springs, & the water is often polluted in rainy season. RTI/ STI Health department to provide As antibiotics are provided to ISM medicines, antibiotics as to institutions, Medical officers of these check RTI / STI. One laboratory institutions can treat the patients of RTI technician with laboratories /STI in a better way & by providing should be given to dispensaries laboratory facilities in these institutions which are situated in remotest areas , the diagnosis of diseases Is made in initial stage that helps in treatment of the patient.

6.2 ICDS projects Issues / Areas Areas of cooperation Areas of convergent action Linkages to be developed AWW share information/records of Coordination with between ICDS workers and pregnant mothers and newborns with allied departments health workers for timely ANMs diagnosis of malnourished AWW help in tracking beneficiaries children and their and bring them for immunization management. They keep community informed of next session’s date of health checkup Health Department camp and immunization. AWW should reports disease outbreaks in the village to ANM. IEC to be developed and disseminated to the community regarding food and nutrition. For proper management of malnourished cases, medicines will be supplied along with the PHC and CHC drug kits annually.

127 6.3 Rural Development Department

Issues / Areas Areas of cooperation Areas of convergent action Linkages to be developed • Demand driven approach with Data not available between the Health Department increased emphasis on awareness and the Rural Development • Subsidy for individual household units department replaced by incentive the poorest of poor household. • Improving the health standard • Rural school sanitation is major & general quality of life of rural component for wider acceptance of community. children who can encourage their • Awareness on sanitation/ parents for sanitation environment. Hygiene & health education. • Awareness generation amongst the • Covering of school / Anganwari A.P.L families for construction of in rural areas with sanitation toilet by their own. facilities & promote Hygiene education & sanitary habits among students. • Promote & encourage cost effective construction of household latrine & their proper use. • Elimination of open defection to minimize the risk of contamination of water source & food.

6.4 Public Health department Issues / Areas Areas of cooperation Areas of convergent action People of the district Doda are still Health and ICDS Bleaching powder and dependant on traditional water Departments chlorine tablets will be provided by IPH and sources, in certain areas water distributed by field from hand-pumps is perceived to functionaries to households be unfit for consumption, and Joint communication strategy. Copy of water quality water availability is falling short of monitoring reports generated requirement. by IPH department will be The practice of boiling water for shared with the Health drinking purpose is not prevalent Department at block, district and state levels Per Capita 10-20 gallons per day Community based water is required organisations formed under various programmes/sectors will be engaged by a team of frontline workers – health, ICDS and IPH departments.

128 6.5 PRIs Issues / Areas Areas of cooperation Areas of convergent action The PRIs have been envisaged to play a Motivating the Joint plans very important role in NRHM. community Joint review and Availability of monitoring At the village level they are part of the personnel and services Mobilization of the VHWSC. Participation in the VH community for action Days on health care issues, At the Gram Panchayat level they are part of Giving importance to safe drinking water the Gram Panchayat health committee. issues of health in the and sanitation. Similarly at the Block and the District they Gram Panchayat are part of the Block and District health meetings Advocacy at village, mission. Gram panchayat, block and district At the Subcentre the Sarpanch is the joint level. signatory to the bank account for the operation of the Untied funds of Rs 10000. In the Gram Panchayat meetings held twice each month the PRIs review the activities of the health department along with the ICDS

6.6 Education Department Issues / Areas Areas of Areas of convergent action cooperation Co-operation with Strengthening of school 1. For regular check up of school health department health programme. children there should be a provision for a PHED, RDD, ICDS doctor (physician specialist) & expert department. Promotion of yoga in the team which will assist the doctor. school.

2. Mid day meal in school is being Launching of Adolescent successfully carried. Cooks are engaged Health programme at Rs 500/mth Regular school health 3. The message of balanced diet is not programmes being successfully carried out.

4. School health education programme is not taking place regularly.

5. There is no Adolescent Health programme in the district..

129 Convergence –PRI system and capacity building, NGO coordination, Public Private Partnership, Training and Meetings of committee members Problem 1. Non Existence of PRI and systems. Identified & 2. Lack of quality conscious private health service providers for partnership Core 3. Need for strengthening Village health, water and sanitation committees and Issues. training them 4. Difficult to communitise health services due to non-availability of good NGOs and community organisations. 5. Lack of formal institutional mechanisms for convergent actions with NRHM related sectors Solutions • PRI systems need to be in place proposed • PPP need to be developed and CME to be provided to private providers (Activity • All the members especially the members of PRIs need to be imparted training plan) in primary health care delivery system, which can be imparted at the PHC/ CHC level by the block MO or Medical Officers. • For joint efforts, monthly meetings of the committee as constituted above must be held and the meeting should be fixed in advance and the local panjayath leaders and MPHWs of the sub centres should arrange the meeting at sub centres. The local Medical Officer and Health Supervisors can also attend the monthly meeting. • MNGOs scheme need to be strengthened to communitise health services. • At the policy level formal mechanisms need to be put in place for convergent actions with other NRHM sectors Support Policy and funding support needed for implementi ng changes Cost of PPP initiative ( Chiranjeevi) has been proposed under RCH implementi For training of PRI and VHWS committee members: Rs. 22 Lakhs ng changes For regular monthly meetings: Rs.- 12 Lakhs Educational materials-Rs 10 lakhs Total Rs. 44 lakhs for one year and Rs 2 crores for 5 years Time Three months after constitution of the committees. needed to implement changes Sustainabili Capacity of the committee members with decentralised powers. ty of the changes Benchmark Reduction in IMR & MMR and improvement in sex ratio by 10 points 2012. (s) derived from this component

130 Inter Sectoral Convergence Situation Health is a social responsibility and is not the domain of the health department only. Analysis Unfortunately the total responsibility has fallen on the health department. The various departments have been involved in the Pulse Polio campaign which has led to the massive mobilization and success of the campaign.

The District Health Society has been formed consisting of members of various departments. Block health societies will be formed and also at the sector, and village level. At the Gram Panchayat level under the Sarpanch Gram Panchayat committees have been formed consisting of various sectors. The Village health and Water Sanitation Committees also consist of various sectors and the community.

In reality these committees need to be strengthened since they are not functional. All the various sectors are working separately although for the same cause. Hence there is a lot of duplication and wastage of resources. Although orders have been issued for convergence but other sectors do not participate readily. Joint working of the ICDS and health is happening on the Fixed Maternal Child Health and Nutrition day. This needs to be strengthened and streamlined. The community is not aware regarding this day.

The forum of the fixed health day each week has a lot of potential and has not been used properly . Objectives 1. Providing Primary and basic quality health care services at the village level 2. Providing quality RCH services 3. Optimal utilization of RCH services by community especially women 4. Empowering women to facilitate them to seek and demand quality RCH services. Strategies 1. Strengthening the various Committees and Societies 2. Strengthening the VHD days 3. Joint action for various issues Activities 1. Joint workshops for Planning and Review at all levels • Orientation programmes • Monthly meetings 2. Strengthening the VHD days • Wide participation of all the sectors in preparation of the community and in the actual activities, in health education • Each Wednesday during Immunization sessions joint orientations by all sectors and problem solving for each of the sectors 3. Joint Action for Sanitation, provision of safe water, provision of services and personnel at facilities 4. Joint review at the Gram Panchayat meetings 5. Joint efforts for education of the girls, improving the sex ratio, raising age of marriage, improving the nutritional status, identifying the correct BPL families, income generation. 6. Joint CNAA to determine the needs and thereby developing the plans jointly 7. Realignment of the Health and the ICDS sectors for common data and common work boundaries. 8. ASHA to participate in all the meetings of the ICDS held between the 20 th and 22 nd of each month. 9. At the CHC level monthly meetings are organized. This should be jointly organized with the ICDS 10. At the monthly meetings of the CMO, the officers of all the departments should

131 come 11. Annual action Plans to be developed jointly through meetings at the village, Gram Panchayat, Sector and culminating in Block workshops and District workshops 12. Chiranjeevi Scheme to involve PRIs for promoting safe deliveries for rural BPL women through PPP initiative by involving the private sectors Support Govt orders for intersectoral coordination with clear roles and responsibilities and If required the various sectors do not attend the meetings then the decisions will be taken and will be binding for all the sectors. Strict follow-up at the State level for ensuring coordination. Timeline Activity / Item 2007 2008 2009 2010 2011- -08 -09 -10 -11 12 Meetings of the Block Committees x x x x x Meetings of the Village groups x x x x x Joint CNAA training ( 559 AWW, 320 x x x x x ANM, 570 ASHAs, 40 Supervisors, 80 MOs, 7 CDPOs) Joint monitoring at the sector level x x x x x Hiring of vehicle x x x x x Joint monitoring at the block level x x x x x Yearly joint Planning Workshops at the x x x x x Block level for development of the Action Plans Yearly joint Planning Workshops at the x x x x x District level for development of the Action Plans Yearly joint Workshops to consolidate the x x x x x plans from the village to the Gram Panchayats to the Sectors and then Blocks at the Block level for Annual Action Plans Budget Activity / Item 2007- 2008- 2009- 2010- 2011- Total 08 09 10 11 12 Meetings of the Block Committees @ 0.48 0.53 0.58 0.64 0.70 2.93 Rs 1000 /meeting x 4 blocks x 12 months Meetings of the Village groups @ Rs 2.32 2.55 2.80 3.08 3.39 14.14 50 per village x 386 villages x 12 Joint CNAA training @ Rs 200 per 2.64 2.64 2.64 2.64 2.64 13.20 person ( 600 AWW, 216 ANMs, 377 ASHAs, 32 Supervisors, 64 MOs, 4 CDPOs) x 1320 Joint monitoring at the sector level (PHC level) Hiring of vehicle @ 1000/ day x 5 19.20 21.12 23.23 25.56 28.11 117.22 days/month x 32 sectors x 12 months Joint monitoring at the block level Hiring of vehicle @ 1000/ day x 5 2.40 2.64 2.90 3.19 3.51 14.65 days/month x 4 blocks x 12 months

132 Yearly joint Planning Workshops at the 4.00 4.40 4.84 5.32 5.86 24.42 Block level for development of the Action Plans @ Rs 1.00 lakhs per block x 4 blocks Yearly joint Planning Workshops at the 1.00 1.10 1.21 1.33 1.46 39.07 District level for development of the Action Plans @ Rs 1.00 lakh Yearly joint Workshops to consolidate 4.00 4.40 4.84 5.32 5.86 10.70 the plans from the village to the Gram Panchayats to the Sectors and then Blocks at the Block level for Annual Action Plans @ Rs 1.00 lakhs per block x 4blocks Yearly joint Workshops to consolidate 1.00 1.10 1.21 1.33 1.46 6.11 the findings at the block levels at the District level for development of the Action Plans @ Rs 1.00 lakh AYUSH dispensaries (PHC) Furniture and Equipment@ 0.25X 32 8.00 8.80 9.68 10.65 11.71 48.84 Nodal Officer @ 3000X12months X22 5.28 5.81 6.39 7.03 7.73 32.23 Vehicle / Mules will be hired for 18.48 20.33 22.36 24.60 27.06 112.82 AYUSH Drs @ 1000 x 7 days x 12MonthsX 22 Purchase of AYUSH Drugs and 16.00 16.00 16.00 16.00 16.00 80.00 consumables@ 0.5X32 AYUSH Corners at CHC Construction of ISM corners at CHC @ 12.00 18.00 0.00 0.00 0.00 30.00 6 X 5 CHC Furniture and Equipment@ 1.5X5 3.00 4.50 0.00 0.00 0.00 7.50 Specialist (1 Ayurveda, 1 Unani)@ 18.00 19.80 21.78 23.96 26.35 109.89 15000 X 12months X 10 AYUSH Doctors 9.60 10.56 11.62 12.78 14.06 58.61 @Rs8000X12monthsX10Drs AYUSH Pharmacist @Rs 4.80 5.28 5.81 6.39 7.03 29.30 4000X12monthsX10 AHYUSH MPW@Rs 4.80 5.28 5.81 6.39 7.03 29.30 4000X12monthsX10 AYUSH Asst.(Class IV) Rs 3.60 3.96 4.36 4.79 5.27 21.98 3000X12monthsX10 AYUSH Therapies Tech @Rs 9.60 10.56 11.62 12.78 14.06 58.61 4000X12monthsX20 Vehicle / Mules will be hired for 4.20 4.62 5.08 5.59 6.15 25.64 AYUSH Drs @ 1000 x 7 days x 12MonthsX 5 Purchase of AYUSH Drugs and 5.00 5.50 6.05 6.66 7.32 30.53 consumables@ 1 lakh X 5 AYUSH DH Phy.Specialist 3.60 3.96 4.36 4.79 5.27 21.98 @Rs15000X12monthsX2Drs AYUSH Doctors 11.52 12.67 13.94 15.33 16.87 70.33 @Rs8000X12monthsX12Drs

133 AYUSH Pharmacist @Rs 5.76 6.34 6.97 7.67 8.43 35.17 4000X12monthsX12 AYUSH Therapies Tech @Rs 0.96 1.06 1.16 1.28 1.41 5.86 4000X12monthsX2 AHYUSH MPW@Rs 5.76 6.34 6.97 7.67 8.43 35.17 4000X12monthsX12 AHYUSH Nursing oredrly@Rs 1.44 1.58 1.74 1.92 2.11 8.79 3000X12monthsX4 Vehicle / Mules will be hired for 9.00 9.90 10.89 11.98 13.18 54.95 AYUSH Drs @ 1000 x 15 days x 12MonthsX 5 Renovation and Repairing @ 10 lakh 10.00 0.00 0.00 0.00 0.00 10.00 Equipment @ 15 lakh 15.00 0.00 0.00 0.00 0.00 15.00 Medicine and Diet @ 5 Lakhs 5.00 5.50 6.05 6.66 7.32 30.53 Training of Medical and Pera Medical 1.00 0.00 1.00 0.00 1.00 3.00 staff @ 1lakh Contengency funds @ 2Lakh 2.00 2.20 2.42 2.66 2.93 12.21 RDD IEC @ 12.6 Lakhs 12.60 13.86 15.25 16.77 18.45 76.92 Solid waste disposels @ 8.4 lakhs 8.40 9.24 10.16 11.18 12.30 51.28 PRIs Chiranjeevi Scheme 24.00 44.00 44.00 44.00 44.00 200.00 Total 275.44 296.12 295.71 317.92 344.45 1529.63

134

7. COMMUNITY ACTION PLAN

Community Health Action Situation • Constitution of 207 Village Health and Sanitation Committees in four medical Analysis blocks by the concerned Block Medical Officers in consultation with District Rural Health Society. Each committee comprises of Concerned ANM, AWW and Village Representatives (Nambardar etc). • Training of these committee members has not been taken up. • Because of prevailing circumstances PRIs could not be involved. The said committees have facilitated the process of selection of ASHAs and are actively involved in utilization in untied funds ear marked for subcentres. • The members have not been trained so far through the core trainers at district level although the block trainers have received training. • Meetings are not held regularly under the current scenario. • The village health registers have not been prepared by the concerned ANMs though village health days are being conducted by concerned medical officers. Objectives Ensuring availability of quality health services to the community Motivating the community for good health seeking behaviour Strategies Formation and Strengthening the VHWSC and the Gram Panchayat meetings Monitoring the progress of the Village health Action Plan and also the village morbidity and mortality Activities 1. Facilitation of the process with the support of an external agency 2. Trainings of the VHWSC 3. Regular meetings of the committee, twice a month, shall be held. 4. Regular meetings of the MSS with linking with the SHGs and formation of Emergency Fund through the collections. Also developing a microplan for the MSS 5. Local Gram Panchayat shall review the functioning of VHSC Based on village plans; sub-centre action plan shall be formulated. 6. Joint CNA and development of the Village health register by ANM assisted by ASHA and AWW 7. Tour plan of ANM to be shared with local Gram Panchayat 8. Verbal autopsy for Maternal and Child deaths by the members for each mortality 9. District level team to support household survey and survey of health facilities Support 1. District Collector/DDC to ensure that meetings of Gram Panchayats are held and to review what issues of health are being discussed. required 2. State officials to provide the capacity building of the District officials for village health action 3. State to develop the training module for the members of VHSC and also the TOTs Timeline 2007-2008 Formation of the VHWSC and their training Village Health Register by the ANMs Joint CNAA Review of Village health action Plans Formation of Emergency Fund and development of Microplan for the MSS

135 2008-2009 Verbal Autopsy training to all members and MOS & ANMs Public hearing in every cluster Health camps 2009-2012 Strengthening the Block health committee Budget Activity / Item 2007- 2008 2009- 2010- 2008- Total 08 -09 10 11 12 Training of the VHWSC @ Rs 200 per person 10.95 12.05 13.25 14.57 16.03 66.85 x 15 persons/village x365 villages Meetings of the VHWSC @ Rs 50 per village x 2.19 2.41 2.65 2.91 3.21 13.37 365 villages x 12 months Meetings of Women SHG @ Rs 100 per year 0.37 0.40 0.44 0.49 0.53 2.23 x365 villages Honorarium for MOs for promoting Community 0.27 0.30 0.33 0.36 0.40 1.65 health Action @ Rs 1000 pm and travel charges Rs 800 pm Total 13.78 15.15 16.67 18.33 20.17 84.10

136 8. PUBLIC PRIVATE PARTNERSHIP

Public Private Partnerships Situation The private sector includes NGOs, Private Practitioners, Trade and Industry Organizations, Corporate Social Responsibility Initiatives. Analysis The concept of public private partnership is very new for the district Doda, still no activity has been done under this program. The PPP is going to be tried on pilot basis only there is no mother NGO and SNGO identified yet under RCH scheme. Objectives To initiate innovative pilot interventions on priority issues to be addressed under PPP. To develop the capacity of RKS members and private partners eg NGOs, CBO, Pvt Health care providers' etc. Strategies Incentives and training to encourage private providers to provide sterilization services Activities Involve private players including NGOs/Trusts by providing a conducive environment for accessing quality and affordable health care services to the community.

This kind of partnership will much effective for the unreached and far flung areas where there no motorable roads available. Alternate transport like Mules can be hired from the private sector. Partnership for Services for conducting Studies, survey and evaluations: For understanding the trends of diseases, impact of programs being implemented, assessing the health scenario, a technical support agency will be hired for conducting surveys, evaluation, Data analysis, HMIS etc. Partnership for School Health Programme: For covering all the primary schools both government and private and strengthening School Health Programme private organizations specially local NGOs will be involved. Partnership for Security: As Doda district (Doda) is affected with the militancy, security of health personals and institutions is a major concern of the district.

For providing security to all PHCs and some selected Sub Centers , Ex-servicemen council or committees can be hired. Annual contract will be done for this purpose.

137 Support Support required form the State to allow PPP; to develop a conducive environment by formulating a workable PPP Policy. required Timeline All the activities will be initiated in the year 07-08 and will carry on through out the mission period. Activity / Item 2006 2007 2008 2009 2010 2011 -07 -08 -09 -10 -11 -12 Feasibility study x Operational Frame work x x Operationalization of PPP x x x x x x Innovative interventions x x x x x x Advertisement for hiring technical x support agency for assisting for achievement of objective of PPP mentioned above Establishing technical support x agency Preparation of directories of x x resource agencies and privet partners TNA for private partners x x Capacity building x x x x x x NGOs, CBOs, ToT 2 batches x 25per batch on national health programme Training of pvt. Health care x x x x x x providers 2 batches x 25per batch on national health programme Capacity building of PRIs, x x x x x x VHWSC, SHGs and other field functionaries Area specific training modules x Monitoring and evaluation of PPP x x x x x x initiative

138 Budget Activity / Item 2007 2008 2009- 2010- 2011- Total -08 -09 10 11 12 Fesiability study on PPP issues 10.0 0.00 0.00 0.00 0.00 10.00 Innovative activities based on the study 0.00 20.0 20.00 20.00 20.00 80.00 0 Capacity Building of NGOs 0.50 0.00 0.50 0.00 0.50 1.50 Establishing Tech. Support Agency 2.00 2.20 2.42 2.66 2.93 12.21 Capacity Building of PRIs,SHGs,VHWSCs 0.50 0.55 0.61 0.67 0.73 3.05 Area specific Modules 0.50 0.00 0.00 0.00 0.00 0.50 Exit poles 2.00 2.20 2.42 2.66 2.93 12.21 Fesiability study on PPP issues 10.0 0.00 0.00 0.00 0.00 10.00 5 Workshops for involvement of the Private 2.50 0.00 0.00 0.00 0.00 2.50 sectors (one each with NGOs/Trusts/Private institutions;Media; Ex-servicemen association, transportation ,HR agencies) @ 25000 per workshop Sharing Workshops with Private players 0.00 0.55 0.61 0.67 0.74 2.57 Admin and overhead Charges for hiring the 2.00 2.20 2.42 2.67 3.00 12.29 agencies TOTAL 30 27.7 28.98 29.33 30.83 146.83

139 9. GENDER AND EQUITY

Gender and Equity Situation Gender discrimination is a common phenomenon. It has a direct bearing on the health status of women and children. Some of the parameters are the Sex Ratio, Analysis Age at marriage, enrolment of girls in schools, Male sterilization etc.

There is no specific data on Gender Based Violence but women take it as part of marriage and hence undermine the facts. Male involvement in Family Welfare is minimal since there are very few Vasectomies as against Tubectomies. The indicators for morbidity and mortality also show differential values for boys and girls. The service providers are also not gender sensitive . Objectives • To improve the decline in sex ratio in 0-6 years of age group • To reduce the domestic violence • To empower women in all age groups for gender equity • To enhances male participations in ensuring the gender balance and equity in the community • To develop capacities of various stake holder in Govt. and privet sectors on gender issues and various laws and acts related to establishing gender balance in the society • To ensure implementations of PC-PNDT and MTP act in the district. • To establish strong mechanism for monitoring of sex ratio and implementations of various acts to ensure gender balance and equity in the society Strategies To enhances male participation in ensuring the gender balance and equity in the community. To develop capacities of various stake holder in Govt. and privet sectors on gender issues and various laws and acts related to establishing gender balance in the society. To ensure implementations of PC-PNDP and MTP act in the district. To establish strong mechanism for monitoring of sex ratio and implementations of various acts to ensure gender balance and equity in the society. To control explosion of population. To prevent child marriage female infanticide genders based violence and keep in tune the sex ratio. To conduct health check ups in schools monthly. Activities 1. Addressing Adverse Sex ratio • Workshops with private providers, IMA members, Religious leaders, Caste leaders, PRIs, MLAs • Early registration of pregnancies • TBAs, ASHAs, AWWs, Numberdar and Chowkidar and any of these to get Rs 50 per case for early registration of pregnancy • Educational activities in all schools and colleges and generating discussions in schools and colleges through debates • Regular meetings of the Appropriate Authorities • Registration of all Ultrasonography machines • Review of the monthly format to be filled by the Ultrasonography machines providers 2. Increasing male involvement in family planning • Use of condoms for safe sex

140 • Couple Counselling for contraceptive choices • Counselling for planned parenthood • BCC activities to focus on men for Vasectomy. 3. Service delivery sites for male methods by training health providers in NSV and conventional vasectomy will be expanded so that each CHC and Block PHC in the district has at least a provider trained in NSV. • Demand for male contraceptive methods, men’s reproductive health services through designing and implementing male-focused BCC activities. 4. Gender sensitization training for all health providers in the CHC/PHC/SC and integrated into all other training activities. 5. Increasing the age of marriage • IEC activities for the harmful effects of early marriage • Registration of marriages • All the printing press people who print wedding cards should send one card to the CMO’s office 6. Health card would be provided to all girl children upto the age of 18 years. 7. Improving the Literacy status and promotion of education upto 10 th standard. 8. The Panchayats shall be granted incentives for ensuring 100 % enrolment of girls in the age group of 6-14 years in schools. 9. Treatment of anaemia in girls and also improving their nutritional status through Supplementary food at the AWCs 10. Reporting of Gender Based Violence cases by all the departments Support Strict enforcement of the PCPNDT Act required Timeline 2007- 2008- 2009- 2010- 2011- 2008 2009 2010 2011 2012 Workshops with all stakeholders X x x x x

Incentives for early registration of X x x x x Pregnancy Promoting male involvement X x x x x through Vasectomy Study on the plight of bachelors X

Developing strategies to publicize x x x the problem of the bachelors

IEC for Vasectomy X x x x Health Card for girl Child X Advisory group meetings X x x x

141 Budget Activity / Item 2007- 2008- 2009- 2010- 2011- Total 08 09 10 11 12 Research Study 10.00 0.00 0.00 0.00 0.00 10.00 Preparation of GIS maps for monitoring 5.00 1.00 1.00 1.00 1.00 9.00 IEC Campaign @2000 X 365 villages 3.65 4.02 4.42 4.86 5.34 22.28 Periodic Advisory committee meetings @ 0.20 0.22 0.24 0.27 0.29 1.22 5000 Development of Trg. Modules 1.00 0.00 0.00 0.00 0.00 1.00 Traning of MO's &,ANMs 2.00 2.20 2.42 2.66 2.93 12.21 Panchayat level vigilence committees 1.29 1.42 1.56 1.72 1.89 7.88 @1000X129 Workshops with private providers, IMA 10.00 11.00 12.10 13.31 14.64 61.05 members, Religious leaders, Caste leaders, PRIs, MLAs in every block and Gram Panchayat and with SHGs Rallies in all schools and colleges and 5.00 5.50 6.10 6.70 7.40 30.70 generating discussions in schools and colleges through debates Regular advertisements in the newspapers 5.00 5.50 6.10 6.70 7.40 30.70 IEC campaigns 5.00 5.50 6.10 6.70 7.30 30.60 TOTAL 48.14 36.35 40.04 43.91 48.19 216.64

142 10. CAPACITY BUILDING

Situation Training is an essential part of human development. Although the personnel have Analysis the basic skills necessary for carrying out their duties there is a need to upgrade the skills as well as to keep pace with the new developments under NRHM. There is a skill gap for managing safe deliveries, Abortions, Newborn Care, managing Childhood illnesses, Obstetric and Paediatric emergencies, morbidity and epidemics. There is no system for continuing education of the personnel. The management skills are also lacking resulting in poor management of programmes including financial management. Most of the personnel are unable to use computers and internet.

Status of trainings in Distt Doda: 1. Trainings of M.O in IMNCI is going and there is a need for more such trainings for MOs and other staff including refresher trainings 2. Orientation of TBAs is going on under RCH but there is a need for refresher training 3. Some of the Skill Birth Attendants are already trained and rest are required to be trained 4. Under RCH II the following trainings have taken place • Training of staff nurses on newborn care • Training on mini lab – 2 batches. • Training of 375 ASHAS • Induction training of MOs

The trainings are carried out by the RIHFW along with the Regional training centres and the district training centres. There is a shortage of staff and also rapid turnover.

The monitoring of the trainings needs to be done for the quality of trainings. Also monitoring of the work output of the personnel for which they have received the trainings should also be done.

375 ASHAs have been trained in module 1.

Objective • Reduction in the MMR and IMR from baseline to 50% of baseline by 2012 • Fully skilled personnel at all levels in the Health sector, ICDS, PRIs, NGOs and private sector for provision of services Strategy 1. Development of training plan and methodology for all the personnel on various issues of RCH to reduce the Maternal and Neonatal mortality, meeting the unmet needs, building Gender perspective, good programme management and managing various components of NRHM 2. Ensuring the quality of trainings Activity 9. Capacity building for the reduction in Maternal and Neonatal mortality • TBA training for 15 days in the concept of clean deliveries, danger signs, early referral, Newborn care and family planning, communication, • MTP training on MVA to all PHC MOs for 15 days. In 2007, 10 Lady MOs will be trained. Refresher trainings on MVA to be given • Training in Obstetric management & skills for Operationalization of 24x7 PHCs for 16 weeks

143 • Training in skilled Birth attendants (ANM, LHV, SN) for 15 days • IMNCI training to ANM/LHV, SN, MO, CDPO for 8 days in the area covering the 24 x 7 PHCs • Training on Blood transfusion for MOs and Lab Technicians for CEmOC centres with Blood storage facilities for 3 days • Training in Life saving/Anaesthesia for EmOC at FRUs for MOs for 18 weeks • Integrated skill training of all SN • Integrated skill training for ANMs • Training of ASHAs • Training in management of newborns and sick children at Medical College Jammu of the MOs, SN, • Training in BCC for MOs, LHVs, ANMs • Training of Ayush personnel on issues of RCH and reporting for 3 days 10. Capacity building to meet the unmet needs • Training on NSV for MOs for 5 days • Training for Laproscopic Sterilization for Surgeons, Gynaecologists, SN, OT attendants for 12 days • Skill upgradation of ANMs & LHVs for 5 days • Orientation on contraceptive devices for MOs of Govt facilities as well as private facilities 11. Training on Medico-legal aspects 12. Continuing Medical Education sessions for doctors each month during the monthly meetings on current topics. An expert from a reputed institution will be invited on the current topics and Certificates will be given. 13. Capacity building for Gender equality • Orientation on Gender equality & PCPNDT Act for doctors both Govt and private, members of District Appropriate authority NGOs 14. Capacity building for good programme management • Professional Development course for District Programme Managers, Senior district officials, MOs for 10 weeks • Management Development course for MOs for 5 days • General and Financial rules (G & FR) for the district officials, MOs, clerical staff for 3 days • Financial management training for Accounts Officers, Accountants for 3 days • Computer training to all the MOs, Clerical staff, accounts personnel • CNAA for MOs, LHVs, ANMs, AWW 15. Capacity building for managing the other components of NRHM RNTCP • Reorientation Training of DOT providers for 1 day • Orientation of MOs on revised Paediatric & PWBs under Paediatric management for 1 day • Training of newly appointed MOs (1) under RNTCP for 10 days • Convergence for Sanitation and hygiene under NRHM • One day orientations of VHWSCs for total sanitation Disease Control Programme – Blindness Control, Malaria, IDSP, IDDM • MPW • LT training PRIs • Training on NRHM and their roles of the members of the Gram Panchayat members, VHWSCs for 1 day

144 NGOs • Training in BCC • Training of Field NGOs Private Sector Training on Family Planning issues, PCPNDT Act, Reporting 16. Ensuring the quality of trainings • A district quality training team will be formed to ensure the organization of trainings as per schedule, arrangements and monitoring the quality of all the trainings on the basis of checklists to be developed by the state. • They will ensure the availability of trainers and the staff at the District Training Centre. • The team will also monitor the work output of the trained personnel and give recommendations regarding improvements in the training and the future requirements. • For ensuring the availability of trainers a District Resource team and Block Resource teams will be formed for various issues. • A list of Resource persons will be developed from the State for specialized issues. State • RIHFW to develop the training calendar and organize the trainings as per Support schedule • Medical colleges to be prepared for providing trainings on EmOC, MTP, Neonatal Care • Monitoring by the State the quality of trainings and the work output through the development of a format and checklist • Placement of the personnel trained in various specialized issues at the right facilities • Ensuring staff at the District training centre Timeline Activity 2007- 2008 – 2009- 2010- 2011- 08 2009 2010 2011 2012

TBA training 207 207 207 207 207

MVA MTP training to 20 20 20 20 20 all PHC MOs for 15 days Training on Blood 3MO 1MO transfusion for MOs and Lab Technicians 5LT 1LT for CEmOC centres with Blood storage facilities for 3 days Training in Obstetric 4 4MOs management & skills MOs for 24x7 PHCs for 16 4Staff 4SN weeks Nurse s Training in skilled 4Batc 4Batch 4Batch 4Batch 4Batch Birth attendants for 15 h days:

145 IMNCI training to 14AN 14ANM 12ANM 12ANM 12ANM ANM/LHV, SN, ASHA Ms s s s s for 8 days 7SN 7SN 6SN 6SN 6SN

80 90 90 92 80 ASHA ASHA ASHA ASHA ASHA 7 LHV 7 LHV 6 LHV 6LHV 6 LHV

IMNCI training to MOs 16 16 MOs 16 MOs 16 MOs MOs

Integrated skill 16 16 MOs 16 MOs 16 MOs training for MOs MOs Training of MOs, SN 10MO 2 MOs in Mgt of Newborns & s sick children at 10 2 SN Medical College SNs Jammu / Srinagar for 15 days Training in BCC for 32 32 MOs MOs, LHVs, ANMs for MOs 5 days 32LH 32LHVs Vs 32 32 ANMs ANMs Training of Ayush 17 17 17 17 personnel on issues Ayush Ayush Ayush Ayush of RCH and reporting for 3 days Rs 300/person x 3 days Training on NSV for 8 24 MOs 16 MOs 16 MOs MOs at NSV camps MOs

Training on Minilap - 8MOs 24 MOs 16 MOs 16

MOs

Training for 5 5 MOs 5 MOs 5 MOs 5 MOs Laproscopic MOs Sterilization for 5 SN 5 SN 5 SN 5 SN 5 SN Surgeons, Gynaecologists, SN, OT attendants for 12 5 OT 5 OT 5 OT 5 OT 5 OT days attend attenda attenda attenda attenda ants nts nts nts nts

146 Orientation on 84 84 84 84 84 contraceptive devices for MOs Training on Medico- 84 88 MOs legal aspects to MOs MOs & @ Rs 500/MO x 1 day & 6SMOs 5SM Os Orientation on x x x x X PCPNDT Act for doctors both Govt and private, members of District Appropriate authority NGOs in a workshop General & Financial 100Di 100 100 rules (G & FR) for strict District District Officials, MOs, clerical officia officials officials staff for 3 days ls and and and MOs MOs MOs Rs 500/official and 50 50 50 MOs x 3 days clerks clerks clerks Rs 200 /clerical staff x 3 days Financial 43per 43perso 43perso management training sons ns ns for Accounts Officers, Accountants for 2 days Rs 200/Accounts persons x 2 days Computer training to 84MO all the MOs, Clerical s staff, accounts 40 personnel @ Rs 200 Office per person x 15 days staff CNAA for MOs, LHVs, 64 64 MOs 64 MOs 64 MOs 64 MOs ANMs, AWW MOs 32 32 32 32 @ Rs 200/person x 1 32 LHVs LHVs LHVs LHVs day each year LHVs 160 166 172 178AN 154 ANMs ANMs ANMs Ms ANMs 473 473 473 473 473 AWWs AWWs AWWs AWWs AWW s Total sanitation orientation and reorientation of 179 VHWSCs x 1 day @ villag 179 179 179 179 Rs 200/person/day es villages villages villages villages

147 Training of NGOs in 30 30 40 40 BCC @ Rs 300 per 20 person x 6 days perso persons persons persons persons ns Professional 1DPM 1DPM Development course 3 BPM 3 BPM for District 5 SMO 6SMO Programme Managers, Block Programme From Managers, Senior State district officials, SMOs Budge for 10 weeks t Training in Life 0 2 MOs 4 MOs 4 MOs 6 Mos From saving/Anaesthesia State for EmOC at FRUs for Budge MOs for 18 weeks t Training of ASHAs Discussed in the respective chapters Budget Activity 2007- 2008 2009- 2010- 2011- Total 08 –09 10 11 12 TBA training @ Rs 10100 /TBA 36.87 40.55 44.61 49.07 53.97 225.06 MVA MTP training to all PHC MOs for 15 72.00 3.00 0.00 0.00 0.00 75.00 days @ Rs 500 x 15 days x MOs

Training on Blood transfusion for MOs and Lab Technicians for CEmOC centres with Blood storage facilities for 3 days

MOs @ Rs 500/day/person x 3 days 0.02 0.09 0.00 0.00 0.00 0.11 LabTechnicians@Rs 200/person x 3 days 0.01 0.04 0.00 0.00 0.00 0.04 Training in Obstetric management & skills for 24x7 PHCs for 16 weeks MOs: Rs 500/day x 112 days x 2 MOs 1.12 8.40 8.40 8.40 10.08 36.40 StaffNurses:Rs200/dayx112daysx 2 SNs 0.45 4.48 4.48 4.48 4.03 17.92 Training in skilled Birth attendants for 15 0.00 0.00 0.00 0.00 0.00 days: One batch of 4 persons: Rs. 7500 as hon. 4.00 16.00 16.00 16.00 16.00 68.00 to participants, Rs 13500 hon. to training team, 15% institutional charges, = Rs 25000/batch - 16 batches IMNCI training to ANM/LHV, SN, ASHA 0.00 0.00 0.00 0.00 for 8 days Rs 300 as hon. to participant x 8 days 1.03 2.19 2.41 2.65 2.92 11.20 IMNCI training to MOs @ Rs 5390 0.32 1.19 1.62 1.78 1.96 6.86 /participant

148 Integrated skill training of all SN @ Rs 0.41 0.90 1.47 1.59 2.28 6.65 4080/person Integrated skill training for ANMs @ Rs 0.20 0.56 0.61 0.67 0.72 2.76 2048/person Integrated skill training for MOs @ Rs 0.18 0.20 0.22 0.25 0.27 1.12 3683 Training of MOs, SN in Mgt of Newborns 0.24 0.26 0.29 0.32 0.35 1.47 & sick children at Medical College Jammu @ Rs 7500/MO, Rs 4500 ( Rs 300 x 15 days)/SN Training in BCC for MOs, LHVs, ANMs 0.76 0.84 0.92 1.01 1.11 4.64 MOs: Rs 500/MO x 5 days LHVs & ANMs: Rs 300/person x 5 days Training of Ayush personnel on issues of 0.46 0.50 0.56 0.61 0.67 2.80 RCH and reporting for 3 days Rs 300/person x 3 days Training on NSV for MOs at NSV camps 0.42 0.46 0.51 0.56 0.61 2.56 Rs 500/MO /camp x 12 camps, Rs 3000 per camp for trainer x 12 camps Training on Minilap @ Rs 500 per day for 0.60 2.64 2.90 3.19 3.51 12.85 15 days and during camps Training for Laproscopic Sterilization for 0.24 0.26 1.16 1.28 1.41 4.35 Surgeons, Gynaecologists, SN, OT attendants for 12 days Specialist: Rs 500/Specialist x 12 days SN: Rs 300/SN x 12 days OT Attendant: Rs 200 x 12 days Orientation on contraceptive devices for 0.40 0.44 0.48 0.53 0.59 2.44 MOs - Govt as well as private facilities Rs 500 /MO x 1 day Training on Medico-legal aspects to MOs 0.50 0.83 0.91 1.00 1.10 4.33 @ Rs 500/MO x 1 day Continuing Medical Education sessions for 2.50 2.75 3.03 3.33 3.66 15.26 doctors each month during the monthly meetings on current topics @ Rs 25000 per CME Orientation on PCPNDT Act for DCs, CSs, 0.50 0.55 0.61 0.67 0.73 3.05 doctors both Govt and private, members of District Appropriate authority NGOs in a workshop General & Financial rules (G & FR) for 1.05 1.16 1.27 1.40 1.54 6.41 Officials, MOs, clerical staff for 3 days Rs 500/official and MOs x 3 days Rs 200 /clerical staff x 3 days

149 Financial management training for 0.20 0.22 0.24 0.27 0.29 1.22 Accounts Officers, Accountants for 2 days

Rs 200/Accounts persons x 2 days Computer training to all the MOs, Clerical 3.00 1.65 0.00 0.00 0.00 4.65 staff, accounts personnel @ Rs 200 per person x 15 days CNAA for MOs, LHVs, ANMs, AWW 1.57 0.52 0.22 0.22 0.22 2.75 @ Rs 200/person x 1 day each year Total sanitation orientation and 0.77 0.85 0.93 1.03 1.13 4.71 reorientation of VHWSCs x 1 day @ Rs 200/person/day Training of NGOs in BCC @ Rs 300 per 0.54 0.59 0.65 0.72 0.79 3.30 person x 6 days Total 130.36 92.12 94.50 101.01 109.95 527.94

150 11. HUMAN RESOURCE PLAN Human Resource Plan Situation The personnel have necessary basic skills for carrying out their duties, there is a Analysis need to upgrade the skills as well as to keep pace with the new developments under NRHM. There is a skill gap for managing safe deliveries, Abortions, Newborn Care, managing Childhood illnesses, Obstetric and Paediatric emergencies, morbidity and epidemics. There is no system for continuing education of the personnel.

The management skills are also lacking resulting in poor management of programmes including financial management.

Most of the personnel are unable to use computers and internet. The trainings are carried out by the SIHFW along with the Regional training centres and the district training centres. There is a shortage of staff and also rapid turnover.

The monitoring of the trainings needs to be done for the quality of trainings. Also monitoring of the work output of the personnel for which they have received the trainings should also be done.

377 No ASHAs in district Doda are already in place. More ASHAs will be required far-flung areas where out of govt services is seriously effected needs to have more skilled birth attendants, some have been already trained but still there are some uncovered areas. There are 101 ANMs working in 108 sub centers which is showing a gap similarly PHCs and CHCs are also have manpower gap as depicted in facility report.. More as per population records more institutions are needed to be opened in the project period so it needs additional ANMs. Many areas, which are uncovered pocket, need medical mobile unit. Gap analysis of PHCs and CHCs is shown in the facility survey.

Objectives To equip health system with adequate manpower especially as per IPHS to Benchmarks meet the NRHM goals. Strategies Ensuring the quality of trainings To induct new ASHAs as per requirement one ASHA/ 500 population. To recent and trained specialists, MOs, Staff nurse, ANMs and other persons identified in gap analysis. Development of training plan and methodology for all the personnel on various issues of RCH to reduce the Maternal and Neonatal mortality, meeting the unmet needs, building Gender perspective, good programme management and managing various components of NRHM Activity / Current 2007 200 200 201 201 200 200 2009 2010 2011- Item Status -08 8-09 9-10 0-11 1-12 7-08 8-09 -10 -11 12 Total requirements(IPHS Norms) Additional requirement - Contractual Subcentre 108 131 135 139 142 146 16 19 22 25 28 MPHW(F) 101 262 270 278 284 292 161 169 177 183 191 MHW(M) 13 131 135 139 142 146 118 122 126 129 133 PHC 32 20 20 21 21 22 -12 -12 -11 -11 -10 MO 19 20 20 21 21 22 1 1 2 2 3

151 LMO 20 20 21 21 22 20 20 21 21 22 Staff Nurse 6 60 60 63 63 66 54 54 57 57 60 Health worker 17 20 20 21 21 22 3 3 4 4 5 (F) Health 17 20 20 21 21 22 3 3 4 4 5 Educator Health 2 34 34 34 34 34 32 32 32 32 32 Assistant Clerk 3 34 34 34 34 34 31 31 31 31 31 Pharmacist 18 20 20 21 21 22 2 2 3 3 4 Lab.Tech 12 20 20 21 21 22 8 8 9 9 10 Class IV 32 80 80 84 84 88 48 48 52 52 56 CHC 3 5 5 5 5 5 2 2 2 2 2 Specialist(7) 35 35 35 35 35 26 26 26 26 26 9 MO General 15 15 15 15 15 8 8 8 8 8 Duty (3) 7 PHN 0 3 3 4 4 4 3 3 4 4 4 ANM 3 3 3 4 4 4 0 0 1 1 1 SN 3 50 50 50 50 50 47 47 47 47 47 Dresser 0 3 3 4 4 4 3 3 4 4 4 Pharmacist 5 3 3 4 4 4 -2 -2 -1 -1 -1 lab.Tech 2 3 3 4 4 4 1 1 2 2 2 Radiographer 0 3 3 4 4 4 3 3 4 4 4

Opthalmic 2 3 3 4 4 4 1 1 2 2 2 Assistant Class IV 19 50 50 50 50 50 31 31 31 31 31 Statistical 0 3 3 4 4 4 3 3 4 4 4 Assistant Registration 0 3 3 4 4 4 3 3 4 4 4 clerk Accountant 0 3 3 4 4 4 3 3 4 4 4 Block 0 3 3 4 4 4 3 3 4 4 4 extension Educator Epidemiologis 0 3 3 4 4 4 3 3 4 4 4 t UDC 0 3 3 4 4 4 3 3 4 4 4

Budget Activity / Item 2007-08 2008-09 2009-10 2010-11 2011-12 Total Subcentre MPHW(F) 219.44 230.35 241.25 249.43 260.33 1200.80 MPHW(M) 140.18 144.94 149.69 153.25 158.00 746.06 PHC MO 0.00 3.15 6.30 6.30 9.46 25.22 LMO 63.04 63.04 66.19 66.19 69.34 327.81 Staff Nurse 83.00 83.00 87.61 87.61 92.22 433.43 Health worker (F) 0.00 0.00 0.00 6.15 7.69 13.83

152 Health Educator 4.61 4.61 6.15 6.15 7.69 29.20 Health Assistant 54.75 54.75 54.75 54.75 54.75 273.76 Clerk 28.52 28.52 28.52 28.52 28.52 142.60 Pharmacist 3.06 3.06 4.59 4.59 6.12 21.42 Lab.Tech 9.50 9.50 10.69 10.69 11.88 52.27 Class IV 34.56 34.56 37.44 37.44 40.32 184.32 CHC Specialist (4) 95.94 95.94 95.94 95.94 95.94 479.70 MO General Duty (3) 25.22 25.22 25.22 25.22 25.22 126.08 PHN 5.14 5.14 6.85 6.85 6.85 30.82 ANM 0.00 0.00 1.54 1.54 1.54 4.61 SN 72.24 72.24 72.24 72.24 72.24 361.20 Dresser 2.88 2.88 3.84 3.84 3.84 17.28 lab.Tech 1.19 1.19 2.38 2.38 2.38 9.50 Radiographer 3.56 3.56 4.75 4.75 4.75 21.38 Opthalmic Assistant 1.19 1.19 2.38 2.38 2.38 9.50 Class IV 22.32 22.32 22.32 22.32 22.32 111.60 Statistical Assistant 3.56 3.56 4.75 4.75 4.75 21.38 Registration clerk 3.56 3.56 4.75 4.75 4.75 21.38 Accountant 5.79 5.79 7.72 7.72 7.72 34.74 Block extension Eucator 4.59 4.59 6.12 6.12 6.12 27.54 Epidemologist 8.25 8.25 11.00 11.00 11.00 49.50 UDC 5.79 5.79 7.72 7.72 7.72 34.74 District Hospital Hospital Superintendent 0.00 0.00 0.00 0.00 0.00 0.00 Medical Specialist 3.69 3.69 3.69 3.69 3.69 18.45 Surgery Specialists 0.00 0.00 0.00 0.00 0.00 0.00 O&G specialist 0.00 0.00 0.00 7.38 7.38 14.76 Psychiatrist 3.69 3.69 3.69 3.69 3.69 18.45 Dermatologist / Venereologist 3.69 3.69 3.69 3.69 3.69 18.45 Paediatrician 3.69 3.69 3.69 3.69 3.69 18.45 Anesthetist (Regular / trained) 3.69 3.69 3.69 3.69 3.69 18.45 ENT Surgeon 0.00 0.00 0.00 0.00 0.00 0.00 Opthalmologist 0.00 0.00 0.00 0.00 0.00 0.00 Radiologist 0.00 0.00 0.00 0.00 0.00 0.00 Microbiologist 3.69 3.69 3.69 3.69 3.69 18.45 Casualty Doctors / General Duty 0.00 0.00 0.00 0.00 0.00 0.00 Doctors Dental Surgeon 0.00 0.00 0.00 0.00 0.00 0.00 Forensic Expert 3.69 3.69 3.69 3.69 3.69 18.45 Public Health Manager1 3.69 3.69 3.69 3.69 3.69 18.45 AYUSH Physician2 7.38 7.38 7.38 7.38 7.38 36.90 Pathologists 3.69 3.69 3.69 3.69 3.69 18.45 Paramedical 0.00 0.00 0.00 0.00 0.00 0.00 Staff Nurse* 0.00 208.03 208.03 208.03 208.03 832.13 Hospital worker (OP/ward +OT+ 63.04 63.04 63.04 63.04 63.04 315.20 blood bank) Ophthalmic Assistant / 0.00 0.00 0.00 0.00 0.00 0.00 Refractionist

153 Social Worker / Counsellor 1.54 1.54 1.54 1.54 1.54 7.69 Cytotechnician 1.71 1.71 1.71 1.71 1.71 8.56 ECG Technician 0.92 0.92 0.92 0.92 0.92 4.60 ECHO Technician 1.53 1.53 1.53 1.53 1.53 7.65 Audiometrician 1.19 1.19 1.19 1.19 1.19 5.94 Laboratory Technician ( Lab + 7.20 7.20 7.20 7.20 7.20 36.00 Blood Bank) Laboratory Attendant (Hospital 0.00 6.30 6.30 6.30 6.30 25.22 Worker) Dietician 3.15 3.15 3.15 3.15 3.15 15.76 Maternity assistant (ANM) 3.07 3.07 3.07 3.07 3.07 15.37 Radiographer 2.38 2.38 2.38 2.38 2.38 11.88 Dark Room Assistant 3.07 3.07 3.07 3.07 3.07 15.37 Pharmacist1 0.00 0.00 0.00 0.00 0.00 0.00 Matron 1.19 1.19 1.19 1.19 1.19 5.94 Assistant Matron 3.06 3.06 3.06 3.06 3.06 15.30 Physiotherapist 1.19 1.19 1.19 1.19 1.19 5.94 Statistical Assistant 1.54 1.54 1.54 1.54 1.54 7.69 Medical Records Officer / 0.00 1.19 1.19 1.19 1.19 4.75 Technician Electrician 0 0 0 0 0 0 Plumber 0 0 0 0 0 0 Administrative Staff 0 0 0 0 0 0 Junior Administrative Officer 1.54 1.54 1.54 1.54 1.54 7.69 Office Superintendent 0.00 0.00 0.00 0.00 0.00 0.00 Assistant 0.00 0.00 0.00 0.00 0.00 0.00 Junior Assistant / Typist 2.38 2.38 2.38 2.38 2.38 11.88 Accountant 3.86 3.86 3.86 3.86 3.86 19.30 Record Clerk 0.72 0.72 0.72 0.72 0.72 3.60 Office Assistant 0.00 1.19 1.19 1.19 1.19 4.75 Computer Operator 1.19 1.19 1.19 1.19 1.19 5.94 Driver 1.54 1.54 1.54 1.54 1.54 7.69 Peon 0.00 0.00 0.00 3.07 3.07 6.15 Security Staff* 3.07 3.07 3.07 3.07 3.07 15.37 Operation Theatre 0.00 0.00 0.00 0.00 0.00 0.00 Staff Nurse 10.69 10.69 10.69 10.69 10.69 53.46 OT Assistant 5.94 5.94 5.94 5.94 5.94 29.70 Sweeper 2.16 2.16 2.16 2.16 2.16 10.80 Blood Bank 0.00 0.00 0.00 0.00 0.00 0.00 Staff Nurse 0.00 4.75 4.75 4.75 4.75 19.01 MNA / FNA 2.38 2.38 2.38 2.38 2.38 11.88 Lab Technician 0.00 0.00 0.00 0.00 0.00 0.00 Safai Karamchari 0 0 0 0 0 0 Total 1073.72 1313.99 1365.98 1394.33 1429.57 6577.58

154 12. PROCUREMENT AND LOGISTICS

Procurement and Logistics Situation Majority of equipment, drugs and supplies are made available on requisition from State Govt and GoI. Analysis

Currently there is no warehouse facility for storage of medicines, contraceptive and cold chain storage of vaccines. One warehouse is needed at district headquarter of Doda including the facility of cold chain.

Inventory Management is not very scientific and the records are not computerized. There is no system of wastage control, replacements, transfer of stocks from one centre to the other. Record Keeping is done manually. For proper inventory system and management proper human resources also needed. Objectives Development of a Scientific Warehouse system by 2008 Strategies 1. Developing a Warehouse 2. Capacity building of the personnel for stores and also record keeping 3. Computerization of all the stocks Activities 1. Construction of a scientific Warehouse 2. Procurement of software and computer hardware for the Warehouse from TNMSC 3. Proper Equipment and hardware 4. Availability of Pharmacist, Assistant Pharmacist, Packers 5. Training of personnel 6. Appointment of an agency for Operationalization of the Scientific Warehouse Support State to develop a scientific and transparent Procurement, Logistics and Warehousing system with quality control required Timeline Activity / Item 2007 2008- 2009- 2010- 2011 2006-07 -08 09 10 11 -12 Construction of Warehouse x Software x Computer system with UPS, Printer, x Scanner, Equipment & Hardware x Pharmacist x x x x Assistant Pharmacist x x x x Packers -2 x x x x Security Staff x x x x Training of personnel x x x x Consultancy to agency for x x Operationalization of the Warehouse

155 Budget Activity / Item 2007- 2008- 2009- 2010- 2011- Total 08 09 10 11 12 Construction of Warehouse 100 0 0.000 0.000 0.000 100 Software 1 0 0.000 0.000 0.000 1 Computer system with UPS, Printer, 0.6 0 0.000 0.000 0.000 0.6 Scanner, Equipment & Hardware 34.5 0 0.000 0.000 0.000 34.5 Pharmacist @ Rs 9000/mth 0 1.08 1.190 1.310 1.440 5.02 Assistant Pharmacist @ Rs 5000/mth 0 0.6 0.660 0.726 0.799 2.785 Packers -2 @ Rs 4000/mthx2 0 0.96 1.056 1.162 1.278 4.456 Security Staff @ Rs 6000/mth 0 0.72 0.792 0.871 0.968 3.351 Training of personnel 0 0.1 0.110 0.121 0.133 0.464 Consultancy to agency for 2 2.1 0.000 0.000 0.000 4.1 Operationalization of the Warehouse Total 138.1 5.56 3.808 4.19 4.618 156.28

156 13. DEMAND GENERATION - IEC

IEC Situation There is lack of awareness and good practices amongst the community due to which they neither avail the services nor take any positive action. There is lack of Analysis awareness regarding the services, schemes including the Fixed Village Health days. The following issues need special focus:

• Spacing methods, ideal interval between births, no scalpel vasectomy, information about FP facilities and MTP facilities available at different levels • Importance of 3 visits for ANC, advantages of institutional delivery, Post natal care, availability of skilled birth attendants, balanced diet during pregnancy, anaemia, misgivings about IFA, kitchen garden • Importance of complete immunization, disadvantages of drop outs, nutritional requirements of infants and children, malnutrition, exclusive breastfeeding • Problems of adolescents, drugs addiction, malnutrition, problems of sexuality, age at marriage, tendency to take risks in sexual matters • DOTS programme for TB, location of microscopy centres, cardinal symptoms of TB, • High risk behaviour in the community in relation to water born diseases, heart diseases and lung diseases, and HIV/AIDS, STDs • Ill effects of drugs addiction affecting adolescents, • High prevalence of RTIs, including STDs, • Issues of malaria spread and prevention and also other diseases • JSY, Fixed Health days , availability of services The personnel have had no training on Interpersonal communication. Objective Widespread awareness regarding the good health practices Knowledge on the schemes, Availability of services Strategy 1. Information Dissemination through various media, 2. Interpersonal Communication 3. Promoting Behaviour change Activity 1. Awareness on • Fixed VHD days • JSY • Services available 2. Designing of BCC messages on exclusive breast feeding and complimentary feeding, ANC, Delivery, PNC, FP, Care of the Newborn, Gender, male involvement in the local language 3. Consistent and appropriate messages on electronic media – TV, radio 4. Use of the Folk media, Advertisements, hoardings on highways and at prominent sites 5. Training of ASHA/AWW/ANM on Interpersonal communication and counselling on various issues related to maternal and Child health 6. Display of the referral centres and relevant telephone numbers in a prominent place in the village 7. Promoting inter-personal communication by health and nutrition functionaries during the Village Health days 8. Orientation and training of all frontline government functionaries 9. Integration of these messages within the school curriculum

157 10. Kit for the newly married and during first pregnancy to be given at the time of marriage and during pregnancy 11. Mothers meeting to be held every month to address issues and for community action 12. Kishore Kishori groups to be formed in each village 13. Meetings of adult males to be held in each village to discuss issues related to males in each village every month and for community action. 14. Village Contact Drives and providing services, drugs, one to one counselling and talks with the Village Health & Water Sanitation Committee and the Mother’s groups. 15. quarterly massive drive in which registration of birth, death, Immunization of each child, ANC of each pregnant woman, growth monitoring of each child, disinfection of wells, spraying of houses and fogging, treatment of the stagnant water sites, detection of TB and Leprosy, treatment of all ailments, eye conditions through massive publicity. 16. Bal Nutrition Melas 4 times at each Subcentre 17. Wall writings 18. Pamphlets for various issues Support State to give guidelines for the good practices and also training module on BCC required Timeline Activities 2007- 2008- 2009- 2010 2011- 08 09 10 -11 12 Finalizing the messages x x x x x Advertisements x x x x x TV spots x x x x x Radio Jingles x x x x x Folk Media shows x x x x x Hoardings on highways and x x x x x prominent places Display boards x x x x x Pamphlets x x x x x Orientation & training of all frontline x govt functionaries and elected representatives VCD in each village quarterly x x x x x Bal Nutrition Melas x x x x x Kishori Shakti meetings x x x x x Opinion leaders workshops x x x x x Wall writings x x x x x

158 Budget Activities 2007- 2008- 2009- 2010- 2011- 08 09 10 11 12 Total Hiring of an agency for carrying out 40.00 44.00 48.40 53.24 53.24 238.88 the intensive IEC and behaviour change activities Finalizing the messages in the local 1.00 1.10 1.21 1.33 1.33 5.97 language Advertisements 5.00 5.50 6.05 6.66 6.66 29.86 TV spots 1.00 1.10 1.21 1.33 1.33 5.97 Radio Jingles in local language 1.00 1.10 1.21 1.33 1.33 5.97 Folk Media shows @ Rs 1000/vill 0.37 0.40 0.44 0.49 0.49 2.18 Hoardings @ Rs 10000/hoarding 10.00 11.00 12.10 13.31 36.41 82.82 Display boards @ Rs 2000/board 1.80 1.98 2.18 2.40 6.55 14.91 Pamphlets @ Rs 10/pamphlets x 10.00 11.00 12.10 13.31 36.41 82.82 100000 Orientation of elected rep and PRIs@ 4.00 4.40 4.84 5.32 14.56 33.13 Rs 200 x 2000 persons x1 day Village campaign @ Rs 69.132 lakhs 207.17 207.17 207.17 207.17 207.17 1035.86 per Campaign x 4 times in a year Bal Nutrition Melas @ Rs 300 x 4 1.57 1.62 1.67 1.70 1.75 8.32 times x No.of SCs Kishori Shakti meetings @ Rs 100 per 0.37 0.40 0.44 0.49 1.33 3.02 group x 365 villages Community and religious leaders 1.20 1.32 1.45 1.60 4.37 9.94 workshops @ Rs 300 /person x 100 x 4 times Wall writings @ Rs 200 x 386 villages 0.77 0.85 0.93 1.03 2.81 6.39 Total 285.25 292.94 301.41 310.70 375.74 1566.04

159 14. FINANCING OF HEALTH CARE

Financing Health Care Situation For sustainability and needs based care, health financing is the key. Analysis In District Doda Rogi Kalyan Samitis (RKS) have been formed in 1 CHCs and 5 PHCs. These are hospital autonomous societies which are allowed to take user fees for services provided at the facilities. Formation of these RKS has resulted in great satisfaction amongst the patients and also the staff since now funds is available with the facilities to care for the people.

Still 12 PHCs and 2 CHC don’t have RKS and no trainings have been given for the skill building of the Incharges of these facilities. There is no standardized reporting format and information regarding these RKS is available.. Objectives Availability of sufficient funds for meeting the needs of the patients Strategies 1. Generation of funds from User charges 2. Donations from individuals 3. Efficient management of the RKS 4. Provision of Seed money to each RKS Activities 1. Generation of funds from User charges: User charges are taken for Registration, IPD, Laboratory investigations from persons who can afford to pay. 2. Donations from individuals: Donations are to be generated from individuals. For the betterment of hospitals, equipment, additions to the buildings, etc 3. Efficient management of the RKS: Training will have to be given for efficient management and utilization of the funds for activities that generate funds. Computerization of data and all the parameters need to be carried out preferably through customized software. Trainings can be organized with the help of RIHFW Rajasthan who have developed modules and conducted trainings for the management of these Societies. 4. Provision of Seed money to each RKS at CHC and PHC of Rs 100000 each year for repair, purchase of new equipment, additions, alterations, etc’; 5. Development of customized software and training of staff for the use of this software 6. Regular filling of formats Support 1. Timely meetings of Rogi Kalyan Samitis required 2. SIHFW Rajasthan to agree for providing trainings on the management of the RKS Timeline Activity 2007 2008 2009 2010 2011 - 08 -09 -10 -11 -12 Provision of Seed money @ Rs 1 lakh per x x x x x CHC and PHC Training of the Incharges and second in x x x x x command Development of Software for RKS with x x x x x training of personnel on the use

160 Budget Activity 2007- 2008- 2009- 2010- 2011- Total 08 09 10 11 12 Provision of Seed money @ Rs 1 lakh per 35.00 35.00 35.00 35.00 35.00 175.00 CHC and PHC @ Rs 1.00 lakhs Training of the Incharges and second in 0.35 0.39 0.42 0.47 0.51 2.14 command @ Rs 1000 per person x 1 day Development of Software for RKS with 5.00 0.25 0.25 0.25 0.25 6.00 training of personnel on the use Total 40.35 35.64 35.67 35.72 35.76 183.14

161 15. PROGRAMME MANAGEMENT

Program Management Situation In NRHM a large number of activities have been introduced with very definite Analysis outcomes. The cornerstone for smooth and successful implementation of NRHM depends on the management capacity of District Programme officials. The officials in the districts looking after various programmes are overworked and there is immense pressure on the personnel. There is also lack of capacities for planning, implementing and monitoring. The decisions are too centralized and there is little delegation of powers.

In order to strengthen the district PMU, three skilled personnel i.e. Programme Manager, Accounts Manager and Data Assistant have being provided in each district. These personnel are there for providing the basic support for programme implementation and monitoring at district level.

The District Programme Manager is responsible for all programmes and projects in district and the District Accounts Manager (DAM) is responsible for the finance and accounting function of District RCH Society including grants received from the state society and donors, disbursement of funds to the implementing agencies, preparation of submission of monthly/quarterly/annual SoE, ensuring adherence to laid down accounting standards, ensure timely submission of UCs, periodic internal audit and conduct of external audit and implementation of computerised FMS.

The District Data Assistant (DDA) has to work in close consultation with district officials, facilitate working of District RCH Society, maintain records, create and maintain district resource database for the health sector, inventory management, procurement and logistics, planning and monitoring & evaluation, HMIS, data collection and reporting at district level.

There is a need for providing more support to the CMO office for better implementation especially in light of the increased volume of work in NRHM, monitoring and reporting especially in the areas of Maternal and Child Health, Civil works, Behaviour change and accounting right from the level of the Subcentre. Objectives Strengthening District Management unit Benchmark s Strategies 1. Recruitment of manpower as per norms 2. Capacity building of the personnel 3. Developing clarity at the district / block levels officials and Consultants on activities 4. Provision of infrastructure for the personnel 5. Training of district officials and MOs for management 6. Use of management principles for implementation of District NRHM 7. Streamlining Financial management 8. Strengthening the CMOs office 9. Strengthening the Block Management Units 10. Convergence of various sectors Activities 1. Support to the CMO : • Finalizing the TOR and the selection process • Hiring of consultants, one each for Maternal Health, Civil Works, Child health,

162 Behaviour change. • If properly qualified and experienced persons are not available then District Facilitators to be hired which may be retired persons. • Selection of personal for BPMU 2. Capacity building of the personnel • Joint Orientation of the District officers and the consultants • training of the DPM and consultants • on Management of NRHM for all the officials • Induction, Training and Review meetings of the District Management Unit to be used for orientation of the consultants 3. Development of total clarity in the Orientation workshops and review meetings at the district and the block levels amongst all the district officials and Consultants about the following set of activities: • Disease Control • Disease Surveillance • Maternal & Child Health • Accounts and Finance Management • Human Resources & Training • Procurement, Stores & Logistics • Administration & Planning • Access to Technical Support • Monitoring & MIS • Referral, Transport and Communication Systems • Infrastructure Development and Maintenance Division • Gender, IEC & Community Mobilization including the cultural background • Block Resource Group • Block Level Health Mission • Coordination with Community Organizations, PRIs 4. Infrastructure for officers , DPM, DAM, DDM and the consultants of the District Project Management Unit. • Provision of office space with furniture and computer facilities, photocopy machine, printer, Mobile phones, digital camera, fax, etc; 5. Use of Management principles for implementation of District NRHM • Development of a detailed operational manual for implementation of the NRHM activities in the first month of approval of the District Action Plan including the responsibilities, review mechanisms, monitoring, reporting and the time frame. This will be developed in participatory consultative workshops at the district level and block levels. • Financial management training of the officials and the Accounts persons • Provision of Rs. 500000 as Untied funds at the district level for DPMU • Compendium of Government orders for the DC, CMO, district officers, hospitals, CHCs, PHCs and the Subcentres need to be taken out every 6 months. Initially all the relevant documents and guidelines will be compiled for the last two years. 6. Strengthening the Block Management Unit : The Block Management units need to be established and strengthened through the provision of : • Block Programme Managers (BPM), Block Accounts Managers (BAM) and Block Data Assistants (BDA) for each block. These will be hired on contract. For the post of BPM and the BAM retired persons may also be considered.

163 • Office setup will be given to these persons • Accountants on contract for each PHC since under NRHM Subcentres have received Rs 10,000, also the village committees will get Rs 10,000 each, besides the funds for the PHCs. • Provision of Computer system, printer, Digital Camera with date and time, furniture 7. Convergence of various sectors at district level • Provision of Convergence fund for workshops, meetings, joint outreach and monitoring with each CMO 8. Monitoring the Physical and Financial progress by the officials as well as independent agencies

Support 1. State should ensure delegation of powers and effective decentralization. required 2. State to provide support in training for the officials and consultants. 3. State level review of the DPMU on a regular basis. 4. Development of clear-cut guidelines for the roles 5. If qualified persons for the posts of DPM, DAM are not available then State should allow the appointment of facilitators or Coordinators or retired qualified persons by the District Health Society. Timeline 2007- 2008- 2009- 2010- 2011- Activities 2008 2009 2010 2011 2012

Selection of District level consultants, their capacity building and infrastructure x x Development of an operational Manual x Selection of Block management units and provision of Office setup x x Strengthening of Block Management Units x x Capacity building up of District and Block level Management Units x x x x x Provision of adequate infrastructure and office automation for the Block Management Unit x x Development of Operational Manual for 08-09 x x Reorientation of personnel x x x Ongoing Capacity building up of District and Block level Management Units x x x x Development of Operational Manual for 09-10 x Reorientation of personnel x x x All the routine activities will be implemented x x x x

164 Budget Activity / Item 2007- 2008- 2009-10 2010-11 2011-12 Total 08 09 Honorarium DPM, DAM, DDA and 22.8 25.08 27.588 30.347 33.381 Consultants 139.20 Travel Costs for DPMU @ Rs 1.2 1.32 1.452 1.597 1.757 10,000/ per month x 12 mths 7.33 Infrastructure costs, furniture, 5 0 0.000 0.000 0.000 computer systems, fax, UPS, Printer, Digital Camera, 5.00 Workshops for development of the 1 1.1 1.210 1.331 1.464 operational Manual at district and Block levels 6.11 Untied Fund 5 6 7.000 8.000 9.000 35.00 Construction Cost of Health 110 0 0.000 0.000 0.000 Complex @ Rs 1000 /sq.ft x 11000sq ft 110.00 Furnishing and Office Automation, 25 0 0.000 0.000 0.000 Conference Hall with speakers, ACs 25.00 Maintenance of the Health 0 0.5 1.000 1.500 2.000 Complex 5.00 Compendium of Govt orders 0. 50 0.55 0.610 0.670 0.730 2.56 Joint Orientation of Officials and 0.25 0.275 0.303 0.333 0.366 DPM, DAM, DDM 1.53 Management training workshop of 0.5 0.55 0.605 0.666 0.732 Officials 3.05 Personnel for BPMU 89.76 98.736 108.610 119.471 131.418 547.99 Training of DPM and Consultants 0.5 0.75 1.000 1.250 1.500 5.00 Review meetings @ Rs 1000/ per 0.12 0.132 0.145 0.160 0.180 month x 12 months 0.74 Office Expenses @ Rs 1.2 1.32 1.450 1.600 1.800 10,000/month x 12 months for district 7.37 Computer systems (15) with 15 0 0.000 0.000 0.000 printer and Digital Camera and furniture for DPMU, BPMUs and District and block personnel @1lakh/system 15.00 Annual Maintenance Contract for 0.9 0.99 1.089 1.198 1.318 the equipment 5.49 Travel costs for BPMU @ Rs 5000 10.08 11.088 12.1968 13.4164 14.7581 per month per block 8 3 61.54 Monitoring of the progress by 1 1.1 1.200 1.300 1.400 independent agencies 6.00 Office expenses for Blocks & 10.08 11.088 12.1968 13.4164 14.7581 Sectors @ Rs 5000 x 4 blocks x 8 3 12, Rs 2000 x 32 Sectors x 12 61.54 Total 299.3 160.57 177.654 196.254 216.562 1050.4 9 9 7 7 1 4

165 Detailed calculation for Personnel at DPMU for one year

Details Units Unit Cost Amount for 12 months Personnel at District level District Programme manager 1 18000 216000 District Accounts Manager 1 15000 180000 District Data Assistant 1 12000 144000 Consultant for Maternal Health 1 40000 480000 Consultant for Child Health 1 40000 480000 Consultant for Civil Works 1 40000 480000 Consultant for HMIS 1 40000 480000 Consultant for Behaviour Change 1 40000 480000

SubTotal 2940000 Personnel at Block level Block Programme manager 3 15000 540000 Block Accounts Manager 3 12000 432000 Block Data Assistant 3 10000 360000 Retired Accountants for each PHC @ 17 5000 1020000 Rs 5000 per month x 32 PHCs x 12 months Subtotal 3252000 Hiring of vehicles at block level @ Rs 17 9600 1958400 800 x 30 PHCs x 3 blocks x12 months Office Automation with Furniture, 3 for 100,000 500000 Computer system, Camera, Printer, etc BPMU 1 for DPM 1 for DAM

166 16. BIO MEDICAL WASTE MANAGEME Bio-Medical Waste Management Situation As per the Bio-Medical Waste Rules, 1998, indiscriminate disposal of hospital waste Analysis was to be stopped with handling of Waste without any adverse effects on the health and environment. In response to this the Government has taken steps to ensure the proper disposal of Biomedical waste from all Nursing homes, hospitals, Pathological labs and Blood Banks. The District Health Officer is the Nodal Person in each district for ensuring the proper disposal of Biomedical Waste. For effective disposal of Biomedical waste in the district; Trainings to the personnel for sensitizing them, Pits. Segregation of Waste is taking place though Separate Colour Bins/containers it has to be done more systematically. Proper Supervision is lacking. The treatment (incineration) of waste is being by handled by a company selected at the State level that is also managing additional 3-4 districts. Since there is a monopoly of these companies they charge very high rates. Objectives 1. Stopping the indiscriminate disposal of hospital Waste from all the facilities by 2008 2. Ensuring proper handling and disposal of Biomedical Waste in each Facility Strategies 1. Capacity Building of personnel 2. Proper equipment for the disposal and disposal as per guidelines 3. Strict monitoring and Supervision Activities 1. Review of the efforts made for the Biomedical Waste Interventions 2. Development of Microplan Plan for each facility in District & Block workshops 3. Capacity Building of personnel. 4. Biomedical Waste management to be part of each training in RCH and IDSP 5. Proper equipment for the disposal 6. Installation of the Separate Colour Bins/containers and Plastic Bags for the bins 7. Segregation of Waste as per guidelines 8. Partnering with Private providers for waste disposal 9. Proper Supervision and Monitoring 10. Formation of a Supervisory Committee in each facility by the MOs and the Supervisors Timeline 2007- 2008 2009 2010 201 Activity 08 - 09 -10 -11 1-12 Orientation and Reorientation for the personnel for Biomedical Waste x x x x x Management at District and Block levels Consumables x x x x x Payment for the incinerators x x x x x Budget 2007- 2008- 2009- 2010- 2011- Activity 08 09 10 11 12 Total Orientation and reorientation for Biomedical Waste Management at District and Block levels 1.50 1.65 1.82 2.00 2.20 9.17 Consumables 1.00 1.10 1.21 1.33 1.44 6.08 Payment for incinerators@ Rs. 8 per bed 12 17.42 19.17 21.08 23.19 mths 15.84 96.70 Total 18.34 20.17 22.20 24.41 26.83 111.95

167 1 7. MONITORING & INFORMATION SYSTEM

MONITORING & INFORMATION SYSTEM Situation HMIS is a monitoring tool for the performance that provides information to support Analysis planning, decision-making and executive control for managers in the Health & FW department.

In this sector Data collection is ongoing for more than 60-90 different conditions. The basis of HMIS is the data collected by the ANM who is over burdened with a substantial amount of her time being spent on surveillance related activities. Each year a CNAA exercise is carried out but the set procedures under the CNAA are generally not followed in development of annual action plans and in their utilization in planning the activities of health workers. The action plans are prepared more as a normative exercise rather than as a management tool for estimation of service needs and monitoring the programme outputs.

There is no horizontal integration of surveillance activities of existing disease control programmes. Absence of clear case definitions and poor supervision or crosschecking of the data collected hampers the quality of reporting. Non- Communicable diseases are not included in surveillance even though the burden due to them is high. Absence of formats for reporting diseases also affects quality of the data collect.

The data from the ANM is sent upto the district level with no analysis done at any of the higher levels. There is no system of feedback to the lower levels in the health system. The transmission of data is affected by poor communication facilities available.

Data is not collected from private practitioners, private laboratories and private hospitals both in rural and urban setting. Data collected during emergencies and an epidemic is of better quality. The response system at the District level is activated only in times of outbreaks.

There is lack of coordination between departments. Discrepancy between the data of the Health department and the ICDS. There is large gap between reported and evaluated coverage. The District administrative system not able to make use of the health data.

In newly formed district Doda there is a dearth if authentic baseline data especially on IMR, MMR, NMR and TFR. There is inadequate understanding regarding the classification of diseases. HMIS software consisting of all the data collected right from the Subcentres with online facilities is not available. Computers need to be supplied at each PHC. Objective Integration of several parallel running programme software HMIS is used for decision making on regular basis Inclusion of RCH indicators monitoring Linkage to decision making at Central level Refresher training Make it more useful for State level officials Strategy Research on various issues related to RCH to get a correct baseline Improvement in the CNAA

168 Computerized HMIS Activity 1. Base line Survey on RCH parameters and indicators. The Baseline survey will be conducted by and external agency. 2. Joint CNAA by the ANM, AWW, ASHA alongwith the PRIs so that there is one data validated by the PRIs 3. Printing of Reporting & Monitoring Formats 4. Data entry of each Household, Eligible couples, Adolescents 5. Computerization of all the formats and software for the various programmes and finances 6. Computer training for data entry 7. Internet connectivity upto all PHCs for online transfer of data. The ANMs will get the data entered each month after the household and Eligible Couple entries have been made 8. GIS for the district covering all the parameters 9. AMC for all computers Support Provision of software for data entry Required Time line Activities 2007 2008 2009 2010 2011 -08 -09 -10 -11 -12 Survey house-to-house by youth x Survey for practices, coverage, behaviour x etc through independent agency Software development x Data Entry of each household x x x x x Internet connectivity x x x x x Provision of computers for each CHC and x x x x x PHCs AMC for computers x x x x x GIS for the district, training and up gradation x x x x x

169 Budget Activities 2007- 2008- 2009- 2010- 2011- Total 08 09 10 11 12 Survey house-to-house by youth @ Rs 10.98 0.00 0.00 0.00 0.00 10.98 6000 pm x 3 months x 61 persons Survey for practices, coverage, behaviour 15.00 0.00 0.00 0.00 0.00 15.00 etc through independent agency Software development 20.00 0.00 0.00 0.00 0.00 20.00 Data Entry of each household @ Rs 2 per 2.19 0.18 2.01 2.21 2.41 9.00 household x 109500 HH(from IIInd year each Village Nambardar Rs.500) Internet connectivity @ Rs 900 /mth x No 4.00 4.40 4.84 5.32 5.85 24.40 of facilities x12 mths Provision of computers for each CHC and 28.00 0.00 0.00 0.00 0.00 28.00 PHC @ Rs 50,000/computer system with UPS and printer AMC for computers @ Rs 5000 /computer 2.30 2.53 2.78 3.06 3.37 14.04 /year x 25 computers Consumables for computers @ Rs 17.76 19.54 21.49 23.64 26.00 108.43 4000/mth/facility x 12 mths GIS for the district, training and updation 12.00 0.50 0.50 0.50 0.50 14.00 Total 112.23 27.14 31.62 34.73 38.13 243.84

170 Annexure

PHC buildings need to be constructed: -

S.No Name of the Block Name of PHC/Allopathic Dispensary 1 Bhaderwah Premnagar Chinta Bhalla AD Gatha AD Panchyae Sartangal AD Malothi AD Thanala AD Sarna Bhella Rokali 2 Gandooh Malanoo Kansoo 3 Assar Shamti AD Behota 4 Ghat Bhagwah

Subcentre buildings need to be constructed: -

S.No Name of the Block Name of Subcentres 1 Assar Chaka Kuthyara Shaya Paryoti Malhari Bartund Dedni Chaka Kuthyara Shaya Paryoti Malhari Bartund Dedni Chaka Kuthyara Shaya Paryoti Malhari Bartund Dedni Bhaderwah Dholote Bhalra Brassu

171 Bimola Nalthi Katyara Malani Dhereja Puneja Guraka Renkha Kandot Gatassa Sindra Bajja Beraru Bheja Chakka Mathola Dranga Kurhari Jagota Hanga Rokalikhurd Drownjamani Drownjamani Chakrabatti Nandana Bheja Gandooh Dhadkaie Kilhotran Kancha Chanti Chilly Bala Champal Kakoti Batara Dherewri Haddle Dagroon Tanta Sinoo Johra Gandow Challar Inharara Bharthi Kahra Ghat Mahrana Mohalla Cherrote Ganika Sheyat

172 Gangatha Puldoda Thanote Troun Tantna Pranoo Godper Koti Kastigarh Bijarni Hanch Dhar Breswana korara Panzau Bagla Malna

*Staff Quarters required in all Subcentres and PHCs except PHC Ghat and PHC Assar

173

BUDGET AT A GLANCE

2007-08 2008- 2009-10 2010-11 2011-12 Total 09 (in S. No. Components lakhs) A RCH-II 1 DHS 42.26 13.49 14.83 16.32 23.01 109.91 2 DPMU 301.19 162.56 179.83 198.65 219.20 1061.43 3 Maternal health 268.90 287.86 276.59 267.87 300.17 1401.39 4 Child Health 117.35 79.22 70.42 46.22 42.82 356.02 5 Family Welfare 95.02 98.51 99.10 141.57 192.09 626.29 6 Adolescent Health 57.57 58.70 67.51 74.13 81.87 339.79 8 Gender & Equity 48.14 36.35 40.04 43.91 48.19 216.64 9 Capacity Building 130.36 92.12 94.50 101.01 109.95 527.94 10 HR 1073.72 1313.99 1365.98 1394.33 1429.57 6577.58 11 IEC 285.20 292.90 301.36 310.64 375.59 1565.69 12 HMIS 112.23 27.14 31.62 34.73 38.13 243.84 Total 2531.94 2462.84 2541.78 2629.37 2860.60 13026.53 B NRHM 1 ASHA 56.26 18.26 18.77 19.28 19.80 132.37 SC Untied Fund & 26.20 27.00 27.80 28.40 29.20 138.60 2 Maintenance PHCUntied Fund & 24.00 24.00 24.00 24.00 24.00 120.00 3 Maintenance CHCUntied Fund & 7.50 7.50 7.50 7.50 7.50 37.50 4 Maintenance 5 MMU 38.88 13.10 14.41 15.85 17.43 99.66 Upgradation of GH & 6 CHC 976.19 304.22 32.81 33.45 34.15 1380.83 7 Upgradation of PHC 1494.64 462.03 60.64 60.88 61.13 2139.32 8 Upgradation of SC 422.11 311.30 283.71 285.48 287.92 1590.52 9 VHWSC 32.00 33.00 34.00 28.40 35.00 162.40 10 Commuity Action Plan 13.78 15.15 16.67 18.33 20.17 84.10 11 PPP 30.00 27.70 28.98 29.33 30.83 146.83 12 Health Care Financing 40.35 35.64 35.67 35.72 35.76 183.14 13 Logistics 137.35 5.56 3.81 4.19 4.62 155.53 14 Biomedical Waste 18.34 20.17 22.20 24.41 26.83 111.95 Total 3317.59 1304.64 610.96 615.22 634.34 6482.75 C Immunization 1 Immunization 134.97 134.70 136.73 140.78 143.33 690.51

D NDCP 1 RNTCP 50.97 35.33 38.88 42.77 46.99 214.93 2 Leprosy 6.25 6.60 7.00 7.40 8.00 35.25 3 Malaria 180.76 35.11 43.15 44.99 42.66 346.68

174 4 Vector Borne 5.36 5.90 6.49 7.14 7.86 32.74 5 Blindness Control 41.36 14.50 15.95 17.54 19.30 108.64 6 IDSP 33.24 24.17 22.60 25.22 28.11 133.33 7 IDD 4.83 5.31 5.84 6.42 7.06 29.46 Total 322.76 126.91 139.90 151.48 159.98 901.03 E Others 1 InterSectoral 275.44 296.12 295.71 317.92 344.45 1529.63 Biomedical waste 2 management 18.34 20.17 22.20 24.41 26.83 111.95 Total 293.78 316.29 317.91 342.33 371.28 1641.59

Grand Total 6607.63 4352.64 3755.27 3887.97 4179.19 22782.70

175

ANNUAL WORK PLAN

Objectives:

Reduction in neonatal, infant, child and maternal mortality Prevention and control of communicable and non – communicable diseases Universal access to integrated and comprehensive primary health care services

S. No. Activity Indicators Planned for 2007-2008 No. % 1 ANC registration during the first trimester increased to* (existing 63.7%) 18636 75%

2 Complete ANC coverage increased to* (existing 22.6%) 6212 25%

3 Institutional Deliveries increased to* 8946 40% 4 Deliveries by skilled birth attendants increased to* 8946

No. of women benefited under JSY 3100 5 Low birth weight new born reduced 7455 30% 6 Complete Child Vaccination 8320 40% 7 Use of contraception increased to* 42245 30% 8 Female sterilization operations to be performed during the year 5000

9 Vasectomies to be performed in the year 600 10 Tuberculosis – Detection of New cases 207 11 Tuberculosis- No. of defaulters reduced to 20

176

RCH II Suggested Activities / Annual Plan Responsibili Time Frame Issues Suggested Sub-activities ty strategies Q1 Q2 Q3 Q4 Maternal Encourage - No. of ANMs 60 DFWO 40 45 50 60 Health ANMs for conducting sub-centre PHC MOs conducting and home deliveries sub-centre - Follow up of necessary and home infrastructure and deliveries equipment. Participation of ANMs in 16 DTO 4 12 Skilled Birth Attendants PHC MOs training 24 hours PHC – infrastructure / 10 DFWO 1 4 5 delivery equipment – identify and PHC MO follow-up Behaviour Awareness Generation Training on DFWO √ √ √ √ Change for Early registration, IPC, IPC, Block MOs, Communica complete ANC , birth VHWSC Mtgs, PHC MOs tion preparedness and Using all complication readiness media Improvemen Identify means and Meeting of all DFWO √ √ t of referral operational aspects of PHC MOs, All PHC MOs transport Referral transport ANMs to identify and submit transport facilities Improve RCH camps 12 DFWO 1 1 3 7 Access Implement JSY scheme 3100 cases PHC MOs 200 500 900 150 0 Ongoing Maternal death Audit Orientation on PHC MOs 5 25 30 40 situational Maternal analysis death audit during monthly mtgs 100 audits Child ANM Training of ANMs on 10 ANMs DTO 4 6 Health training Nutrition, ARI, Diarrhoea PHC MOs & RTI / STI Care of New Community level care 10 Sub PHC MOs √ √ √ √ born centres ANMs Stabilization Unit at 1 General Med √ CHC – space/ hospitals Superintende equipment follow-up nt of GH Bi-annual Implement project At all AWCs CDPO √ √ strategy for Vitamin A Family Promote Organize Vasectomy 1 camp per DFWO √ √ √ √ Planning Vasectomy camps month Continue Organize Sterilization 1 camp/mth at DFWO √ √ √ √ Sterilization camps GH and CHCs MS programme CHC I/C

177 Behaviour Conduct special IEC VCD in each DFWO √ √ √ √ Change campaigns village PHC MOs Communica ANMs tion Partnership Follow-up on NGO MNGO DFWO √ √ √ √ with NGOs partners in RCH-II Scheme MNGO Adolesc Focus on Distribution of IFA and Monthly at CDPO √ √ √ √ ent adolescent Albendazole to each AWC AWW Health girls adolescent girls Access Reaching RCH camps 12 DFWO 5 7 out to MMU 1 DFWO √ √ difficult areas Commu Community PRI functionaries to 564 villages DFWO √ √ nity Health Care participate in training PHC MO Manage Managemen Involve Self Help 564 villages PHC MO, √ √ √ ment t Initiative Groups in programme ANM, AWW activities NRHM Manage Untied Utilization of Untied All CHCs, Facility √ √ √ ment Funds funds PHCs, SCs Incharges and PRIs fro SCs Annual Repair and 32 PHCs PHC MOs √ √ √ Maintenanc maintenance of PHCs e of PHC Annual Repair and 3 CHCs CHC √ √ √ Maintenanc maintenance of CHCs Incharges e of CHC Human Engagemen Assist in selection of 161ANMs CMHO √ √ Resourc t of second second ANMs and e ANM filling vacancies Training of Motivation of AYUSH 15 AYUSH DFWO √ √ Ayush and practitioners and Non practitioners other Non Government providers Government providers Infrastru Up- Follow up on 10 SCs PHC MOs √ √ √ √ cture gradation of construction / Sub- renovation and Centres ensuring equipment, manpower placement Up- Follow up on 10 PHCs Block PHC √ √ gradation of construction / I/C PHC renovation and ensuring equipment, manpower placement Up- Follow up on 5 MS √ √ √ √ gradation of construction / CHC and renovation and GH ensuring equipment, manpower placement ROUTINE IMMUNIZATION Human Social Involvement of ASHAs 377 ASHAs DTO √ √ √ √ Resourc Mobilization and AWWs 774 AWWs PHC MOs e ANMs, LS

178 Re- Participate in 87 ANMs DTO √ √ √ √ orientation orientation 15 MOs PHC MOs of Health workers Material Cold Chain Ensure proper storage 108 SCs DTO √ √ √ √ s & and storage of vaccines at SC. PHC MOs Infrastru Waste Construction of waste 108 SCs DTO √ √ cture Disposal disposal pits at Sub PHC MOs pits Centres Support for Ensure supply of 108 SCs DTO √ √ √ √ SC kerosene oil PHC MOs Access Support to Alternate Vaccine 108 SCs DTO √ √ √ √ difficult delivery PHC MOs areas NATIONAL DISEASE CONTROL PROGRAMME Leprosy Case Identification of new 40 Distt TB √ √ √ √ detection cases Officer Follow up of Identification of cases Cases to be Distt TB √ √ √ √ old cases for ( Re-constructive / identified Officer Physiotherapy services(RCS) Provision of preventive Cases to be Distt TB √ √ √ √ devices identified Officer Counselling services for 40 Distt TB √ √ √ √ self care Officer Behaviour Awareness generation In all villages Distt TB √ √ √ √ Change and advocacy Officer Communica tion Vector Malaria Identify and contain In all villages Distt Health √ √ √ √ borne control outbreak Officer diseases PHC MO Participate in training In all villages PHC MO √ √ √ √ on insecticide treated ANM nets PRIs Awareness generation In all villages PHC MO √ √ √ √ ANM PRIs Water-bodies : In all GH and MS GH √ √ √ √ Larvicidal Fish Culture CHCs CHC I/C Mass Drug In all villages PHC MO √ √ √ √ administration ANM PRIs Dengue and Identify and contain In all villages Distt Health √ √ √ √ Chikingunya outbreak Officer PHC MO Awareness generation In all villages PHC MO √ √ √ √ ANM PRIs TB Revised Identification and follow 207 PHC MO 150 150 150 150 National up on cases ANM Tuberculosi Partnership with NGO 2 BPHC I/C 10 10 s Control partners and private Programme practitioners for Microscopy centres and DOT providers

179 Ensure availability of In all SCs, Distt Health √ √ √ √ drugs and supplies PHCs and Officer CHCs Awareness generation In all villages Distt Health √ √ √ √ Officer PHC MO Surveilla Integrated Data gathering and In all villages Distt Health √ √ √ √ nce Disease linkage Officer Surveillance PHC MO Programme Involving private sector 2 Private Distt Health √ √ √ √ in disease surveillance facilities Officer Blindnes National Maintaining records in All SCs Distt Health √ √ √ √ s Blindness Blind register Officer Control PHC MO Programme Case referral for All PHCs Distt Health √ √ √ √ cataract surgery and Officer others PHC MO Other Untied Utilization of Untied In all villages DFWO √ √ √ √ Activities funds to fund PHC MO Village ANMs Health Water, Sanitation Committee Computeriz Follow up and proper Of all the CMHO √ √ √ ation of use ensured households PHC MO each HH ANMs data

180

Assessment of District Health Action Plan (DHAP) Appraisal Criteria to be used by State/ District Planning & Appraisal Team

Sl. Criteria Remarks No. Yes/ No

A. OVERALL 1 Has the DHAP been reviewed in detail by the District Yes, authorities to ensure internal consistency? If yes, by It has been reviewed by whom? This means that Situation analysis, goals, DM and Health Society strategies, activities, work plan budget are in line with the Members proposed interventions and are evidence based. 2 Has Account Person from the Department reviewed the Yes budget in detail? 3 Executive summary /At a Glance have been enclosed in Yes the beginning of the document. 4 Has plan developed in all inclusive and participatory Yes process by involving representatives of health, water and sanitation, ISM, ICDS, Rural Development, NGOs and community members? 5 Funds requirement matches with the absorption capacity Yes and has judicious increase over the years (The planning This has been done in should be based on past experiences in implementing consultation with DM interventions and realistic time frame/ workplan ) and Health society members 6 The Plan caters needs of vulnerable groups (SC/ST, BPL, Yes Women and Children, others) (Activities proposed to cover SC/ST population for Immunization coverage, JSY scheme etc.) 7 Inter-department coordination and convergence Yes mechanism is clearly mentioned for multi-sectoral inputs/elements. (Planned joint sector ,block and dist level meetings with ICDS, education and local self Govt. etc and joint circulars for implementing intervention) 8 The findings of the facility survey/ assessment has been Yes, findings have integrated in the Plan been used to define provisions of untied funds /upgrading of SCs, PHCs and CHCs 9 Plan has been approved by appropriate district authority Yes, attached after the District (District Health Society) cover page 11 Training Plan Yes The training strategy to strengthen existing HR. The training plan has indicated target groups (e.g. MO, ANM, ASHAs, AWW etc), training load and broad details e.g. duration, quality assurance for training, etc 12 BCC /IEC strategy Yes A service oriented BCC strategy based on assessment of

181 Sl. Criteria Remarks No. Yes/ No

the current status of issues with MMR, IMR, TFR, awareness of PNDT, etc. has been narrated in the plan 13 Work Plan Yes, all the chapters Is the work plan consistent with stated and sub chapters have components/objectives, strategies and activities? And situation analysis, whether the proposed phasing of activities would lead to objectives, strategies, increase in delivery/utilization of services? activities, support required, timeline and budget 14 COSTS/BUDGET Key criteria are: Does the budget follow the prescribed formats? Yes

The justification column has break-up of total amount Yes 1. Absorptive capacity: If very ambitious utilization of Yes, every component funds is envisaged compared to performance of 05- has break of budget 06/06-07, then key steps have been proposed to according to the achieve plan expenditure? activities B RCH-II PROGRAM PROGRAM MANAGEMENT ARRAGEMENTS 1 Steps to establish financial management system including Yes fund flow mechanisms to blocks and downward level and accounting system including timely reporting expenditure 2 Steps to establish quality assurance committees/system in Yes the district. 3 Step to ensure systems for holistic monitoring (Outputs, Yes activities, costs) against DHAP .( Dist level review meeting and DHS meetings) 4 Strengthening of HMIS with emphasis on timely availability Yes of reliable and relevant information at appropriate level e.g. community, SC, PHC, Block and district, analysis and feedback system, steps to ensure implementation of revised HMIS system. 5 Provision of logistics management of drugs and medical Yes supplies in order to ensure continuous availability of essential supplies at S/C, PHC and CHC level. TECHNICAL STRATEGIES A. Reproductive & Child Health 1 Maternal Health A. Interventions for 100% ANC coverage, Yes B. 24x7 for EmOC services at selected institutions C. Skill birth attendance during labour (ANM) D. Provision for availability of safe blood in FRUs/CEmOCs, E. Intervention for anesthesia training for MOs, F. Provision of Safe abortion services and, G. Management of RTI/STI Cases H. Provision for Janani Suraksha Yojana

182 Sl. Criteria Remarks No. Yes/ No

2 Child Health A. Organizing MCHN days for complete Yes immunization coverage, B. Interventions for IMNCI services (Optional) C. Provision for new born care at institutions and, Yes , it has been D. Promotion of breast feeding addressed in ARSH, E. School Health Programme Iodine deficiency, Blindness control etc. 3 Family Planning A. Interventions to provide regular FP services in Yes everyh block facilities, B. Increase number of service providers for vasectomy, NSV, Tubectomy, and Laproligation , C. Intervention to improve quality of camps, D. Quality IUD insertion services, E. Increased availability of OP, Condoms through community workers, ASHA, AWW, NGOs 4 ARSH A. Intervention for training of MOs, paramedic for ARSH Yes services ( optional) B. Provision of AFHS services at selected institutions (optional)

5 Gender Mainstreaming Activities planned for awareness generation of gender, Yes PCPNDT Act and strengthening implementation of PCPNDT Act. B NRHM ADDITIONALITIES Whether provision made for- Yes 1 ASHA Training in the district 2 PRI Trainings (Block/Village health & Sanitation Yes Committees) 3 Untied Funds at SC & Untied funds to RKS at PHC/CHC/District Hospitals 4 Civil Works as per IPHS (CHC/PHC/SC) Yes Hospital Building- Staff Quarters 5 Strengthening Field Monitoring and Supervision (Enhance the provision of POL, Maintenance and of vehicle) 6 Need assessment done for-Procurements as per IPHS Yes CHC/PHC/SC) 7 Appropriate provision made for-Programme Management Units at Divisional, District and Block levels-Adequate salary and OE provisions ( District PMU is a part of RCH II and Block level PMUs are part of NRHM) 8 Adequate provision made for-Additional Manpower Yes Specialists at CHCs

183 Sl. Criteria Remarks No. Yes/ No

ANMs at SCs Divisional/Block Programme Managers 9 Provision made for-Drug Kits at different institutions 10 Plan for management of Mobile Medical Units at districts Yes 11 No of Ambulances available and required Yes, District specific innovative activities to address local needs Yes , this has been have been incorporated addressed in all the technical chapters 12 Public private partnerships ( optional) Yes 12 Provision of hiring of vehicle for BMOs (as per Yes requirements) C IMMUNIZATION PROGRAM Whether provision made for- 1 Social mobilization Yes 2 Alternative vaccine delivery Yes 3 Cold Chain Maintenance Yes 4 PoL & Maintenance requirement for vehicles Yes D National Disease Control Programme 1 Water Borne Diseases Yes Clear strategy prepared for combating Water Borne Diseases like Malaria, dengue etc 2 TB Whether Separate section on TB with operational details Yes and budget prepared 3 Leprosy

Separate section on Leprosy with detailed operational Yes guidelines and budget

4 Blindness 1 Separate section on Blindness Control with detailed targets Yes and budget 2 Monitoring mechanism for NGO Yes E CONVERGENCE/ INTER-DEPARTMENTAL Yes COORDINATION Whether interventions in the following areas have been planned 1 ISM Integration Activities Yes 2 Department of Social Welfare (ICDS) Yes 3 PHED Yes

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