Revised Damage Assessment and Remediation Plan

Annexure No. 1

REVISED DAMAGE ASSESSMENT AND REMEDIATION PLAN

1 DAMAGE ASSESSMENT AND REMEDIATION PLAN – AIR ENVIRONMENT

Activity Concern Issues / Damage Remediation Plan Budgetary Estimate impacts Assessment (in Rs.) 1. Site Clearance 1. Dust generation 1. Air Pollution due to 1. Dust suppression and 1. The dust suppression and 2. Excavation 2. Gases emissions particulates and Water sprinkling system at water sprinkling system 3. Infrastructure 3. Vehicle exhaust gases construction sites outside the project consists of water sprinkler development . 4. Emissions from 2. Change in water site where there is no requirement of nozzles (about ½ dozen @ 4. Transportation fire wood and quality due to dust E.C. Rs. 1,000 per nozzle i.e. Rs. of materials cooking gas. 3. Emission of VOC 2. Conduction of a vehicle check up camp 6,000), Online twin filtration 5. Operation of from wood work in consultation with the motor vehicle system (Rs. 15,000), D.G. sets and and painting. Department once in 6 months. Booster pump (1 HP (@ Rs. other 3. Providing enclosures / wind breakers 10,000)) ,Water distribution construction (shed nets) at construction sites within pipeline (LS Rs. 10,000) equipments / the panchayat (public work places) and water storage tank machinery. where loose construction materials are (5,000 ltr @ Rs. 25,000.). 6.Construction stored outside the project site. Labour cost of Rs . 10,000. activity. 4. Regular monitoring of ambient air The total cost on water 7. Temporary stay quality near sensitive locations (2 sprinkling and dust of construction locations) in the panchayat (once in 3 suppression system is workers. months) in consultation with local Rs. 76,000 panchayat. 2. Wind breakers / barricades 5. Providing Personnel protection in the periphery of project equipments to the health department site (3 m. height GI sheet) of the panchayat for supply the same (Rs. 1,00,000) to the construction workers engaged in 3. Vehicle check up camp construction sites (@Rs. 10,000 per camp and 6. Regular wetting of loose construction Rs. 20,000 annual) materials at sites (public work places) 4. Ambient air quality outside the project. monitoring in sensitive areas (@Rs. 5,000 per month x 12 months i.e. Rs. 60,000 x 2 locations = Rs. 1,20,000 ). Total cost on remediation measures on Air Environment is Rs. 3,16,000/- 2 DAMAGE ASSESSMENT & REMEDIATION PLAN – ECOLOGICAL ENVIRONMENT

Concern Issues / Budgetary Estimate Activity Damage Assessment Remediation Plan impacts (in Rs.) 1. Site clearance 1. Loss of Loss of native flora and 1. Plantation of native species 1. Plantation with native species of 2. Cutting of vegetation in the aesthetic view as per the guidelines flowering and fruit bearing trees to existing trees project site (about (@1:10) to compensate the compensate the removal of trees. 560 56 trees were cutting trees and vegetation trees within the surrounding area are existing at site) to regenerate the aesthetic proposed for plantation at a cost of @ 2. Habitat loss to view. Rs. 1,100 per plant which includes fauna specially maintenance for three years. The total avi-fauna. 2. Development of eco-friendly cost estimate for tree plantation is 560 situation in the project site to trees x Rs. 1100 = Rs. 6,16,000. welcome to faunal species again at the project site 2.Cost of development of butterfly garden is Rs. 1,64,000 (L.S. estimate) 3. Development of butterfly garden within the site. 3.Cost of development of medicinal garden is Rs. 1,60,000 (L.S. estimate) 4. Development of medicinal garden within the site. 4.Rs. 50,000/- for development of panchayat park / avenue plantation 5. 200 trees are already towards habitat compensation. planted at site.

Total cost on remediation measures on Ecological Environment is Rs. 9,90,000/-

3 DAMAGE ASSESSMENT & REMEDIATION PLAN – WATER ENVIRONMENT

Damage Budgetary Estimate Activity Concern Issues / impacts Remediation Plan Assessment (in Rs.) 1. Utilization of large quantity of 1.The rain water 1.Restoration of 5 water for dust suppression, stored at site was abandoned wells within the Rs. 50,000/- for restoration A. Fresh water consolidation and compaction. used for panchayat including the of abandoned wells (Rs. 1. Site preparation 2. Impact on competing users due construction half yearly water sampling 10,000 x 5 wells) + Rs. & infrastructure to large consumption of water for purposes. & monitoring. 50,000/- for water sampling development. various construction activities and monitoring (Rs. 5,000 2.Through tankers (@1.10 KL per sq.m. of built-up x 10 samples). from Kerala Water 2. Construction area for the following activities : Total = Rs. 1,00,000/- Authority water activities. Ready mix concrete (RMC) Supply Scheme for production, Cement block / brick 2. Rehabilitation of village Rs.2,00,000/- for 3. Temporary stay domestic production, Curing, Bricks / block pond by providing soft rehabilitation of village of construction consumption. soaking, concrete curing, landscaping around the pond. workers (domestic masonry and cement plastering pond and cleaning. consumption). curing, flooring works etc.). total Total Rs. 3,00,000/- water consumed is about 40,000 KL 3.Domestic water consumption of about 11 KL/day for about 1,000 days (over a period of 6 years) i.e. 11,000 KL. The total fresh water consumed is 41,000 KL 4 DAMAGE ASSESSMENT & REMEDIATION PLAN – WATER ENVIRONMENT

Concern Issues / Budgetary Estimate Activity Damage Assessment Remediation Plan impacts (in Rs.) B. Waste water 1. Waste water 1. Discharge of 1. Setting up of mobile toilets 1. Rs. 60,000/- towards set up of 2 units of portable toilet at site (1 for male and generation from contaminated water to for the workers in public 1 for female) cleaning the land and to the works ( panchayat 2. Rs. 5,50,000 on setting up of an STP machinery, water channel / development works) outside of 5 KLD capacity. equipments and drainage . the project site Total cost on remediation measures vehicles, 2. Discharge of 2. Setup of a STP for the is Rs. 6,10,000/- 2. Domestic waste domestic sewage to treatment from the panchayat water generation the project site. school from workers

C. Storm water 1. Proper channalization of 1. Sediment load 1. Deterioration of the 1. Chanalization of storm water runoff storm water with intermediate 2. Contamination of water channel / drain grit chambers (0.5 km.) in the (Rs. 4,00,000). public drain within the run off due to non- and impact on aquatic 2 Frequent cleaning of the vicinity of panchayat. point source life. 2. The vicinity of the project site before monsoon (Rs. 50,000) . pollution. site is frequently cleaned to remove all non-point sources before monsoon. Total cost on remediation measures is Rs. 4,50,000/- (L.S. estimated)

Total cost on remediation measures on Water Environment is Rs. 13,60,000/- 5 DAMAGE ASSESSMENT AND REMEDIATION PLAN – LAND ENVIRONMENT

Budgetary Estimate Activity Concern Issues / impacts Damage Assessment Remediation Plan (in Rs.) 1. Excavation 1. Un-manage / un-control 1. Change in soil quality storage of excavated soil, (texture, productivity 1. Assistance to the panchayat in Rs. 50,000/- for 2. Loosing its texture, and fertility status) storage of excavated top soil in a creating barriers to productivity and fertility (Excavation of top soil is designated place and consume it avoid erosion and to status, 4,609 cu.m.). for the common greenery maintain its integrity 2. Soil degradation, development. so as to use it further 3. Chocking of drains due to for landscaping. surface runoff during rainy overflow of drains due season. to chocking with soil during rainy season, 4. Change in topography and dust pollution in dry drainage pattern season 2. Solid waste 1. Un-managed disposal of 1. Contamination or 1. Printing & distributing leaflets on Rs. 10,000 (LS) for generation domestic solid waste degradation of soil / proper segregation (degradable printing & distribution during without segregation. water quality. and non-biodegradable at source of leaflets. construction 2. Un-managed disposal of 2. Effect on plant growth itself) activity construction wastes 3. Nuisance due to un- 2. Proving colour coded bins in the Rs. 60,000/- for 20 managed disposal or panchayat building, school, etc. bins (@Rs. 3,000 per storage of MSW and (20 bins). bin). construction wastes. Total Rs. 70,000/-

6 DAMAGE ASSESSMENT AND REMEDIATION PLAN – LAND ENVIRONMENT

Concern Issues / Budgetary Estimate Activity Damage Assessment Remediation Plan impacts (in Rs.)

3. Generation of 1. Un-managed 1. Contamination of soil / 1. Providing a isolated 1. Secured intermediate leachate

hazardous dumping, water, leachet proof storage proof facility for storage (LS.

wastes like nuisance 2. Effect on flora / fauna, facility for hazardous Rs. 1,00,000)

empty cans of creation, toxicity 3. Health effect on workers waste within the

varnish , paints generation, handling chemicals / panchayat in consultation

etc. during health effect paints etc. with the panchayat.

construction

activity

Total cost on remediation measures on Land Environment is Rs. 2,20,000/-

7 DAMAGE ASSESSMENT AND REMEDIATION PLAN - NOISE ENVIRONMENT

Concern Issues / Damage Budgetary Estimate Activity Remediation Plan impacts Assessment (in Rs.)

1. Movement of 1. Noise generation 1.Health issue due to 1. Providing Personnel protective Rs. 50,000/- (LS.)

construction & increase in noise increase in noise equipments (PPE) to the to the

equipments and level. level to construction Health Department of the

machineries. 2. Noise & vibration workers panchayat

2. Construction due to construction

activities activity and

3. Operation of D.G. operation of D.G.

set of 62.5 kVA set of 62.5 KVA

capacity. capacity.

Total cost on remediation measures on Water Environment is Rs. 50,000/-

8 DAMAGE ASSESSMENT AND REMEDIATION PLAN – SOCIO ECONOMIC ENVIRONMENT

Activity Concern Issues Damage Remediation Plan Budgetary Estimate / impacts Assessment (in Rs.)

Occupational 1. Health aspects 1. Secure facilities to 1. Providing first aid kits (5 Rs. 10,000 /- (@Rs. 2,000 Health and of the the construction nos.) to the construction per kit) amenities construction workers sites (public works workers and within the panchayat). facilities related 2. Providing a wheel chair Rs. 24,000 (@Rs. 12,000 to hygiene and (2 nos.) + stretchers (2 per wheel chair) + sanitation. nos.) to the primary (Rs. 10,000 (Rs. 5,000 per 2. Pressure on health centre within the stretcher) the existing panchayat and in infrastructure consultation. Total = Rs. 34,000/-

Total cost estimate on remediation measures on Socio Economic Environment is Rs. 34,000/-

9 SUMMARY OF REMEDIATION PLAN (BUDGETARY ALLOCATION)

Budget Allocation Sr. No. Particulars ( In Rs.)

1. Air Environment 3,16,000/-

2. Ecological Environment 9,90,000/-

3. Water Environment 13,60,000/-

4. Land Environment 2,20,000/-

5. Noise Environment 50,000/-

6. Socio – Economic Environment 34,000/-

Total Fund allocated for Remediation Measures 29,70,000/-

10 REVISED NATURAL & COMMUNITY

SERVICES AUGMENTATION PLAN

11 NATURAL RESOURCE AUGMENTATION PLAN NATURAL & COMMUNITY SERVICES AUGMENTATION PLAN The remediation plan concentrated on site activity and presented measures related to mitigation / control of pollution during construction. The impacts of the construction activity related to transport of materials, employment, resource consumption have a bearing on the surroundings areas. Hence it is proposed to prepare and natural and community services augmentation plan to compensate the impacts.

Year wise implementation and Budgetary provision Total Sr. during operation phase budgetary Activity No. 1st year 2nd year 3rd year 4th year 5th year provision (Rs.) 1. Development of greenery in the surrounding area and road 25,000 25,000 25,000 25,000 25,000 1,25,000 side plantation 2. Provision of drinking water facilities through construction of hand pumps / dug wells / tube wells. 5 hand pups / wells 40,000 40,000 40,000 40,000 40,000 2,00,000 per year in the nearby villages with maintenance 3. Maintenance of village road, near the panchayat office or any other badly damaged road and consultation with 2,00,0000 2,00,0000 2,00,0000 2,00,0000 2,00,0000 10,00,0000 panchayat (7 m. carriage way (1 km. length) 4. Construction of pipeline network in the village in association with grama panchayat and water resource department 1,00,000 1,00,000 1,00,000 1,00,000 1,00,000 5,00,000 (Kerala Water Supply Authority) 5. Provision of solar system in common areas through local 25,000 25,000 25,000 25,000 25,000 1,25,000 administration 6. Rainwater harvesting and ground water recharge 20,000 20,000 20,000 20,000 20,000 1,00,000 development 7. Construction of storm water drainages in the nearby areas 1,00,000 - - - - 1,00,000 Total 21,50,000

12 COMMUNITY RESOURCES AUGMENTATION PLAN Year wise implementation and Budgetary Total budgetary SN Activity provision during operation phase provision (Rs. ) 1st year 2nd year 3rd year 4th year 5th year 1. Creation of irrigation facilities to the farmers 25,000 25,000 25,000 25,000 25,000 1,25,000 supporting for irrigation 2. Construction of sanitation facilities (toilet) in 25,000 25,000 25,000 25,000 25,000 1,25,000 schools and villages (5 toilets each year) 3. Periodic medical check-up camp by appointing specialist doctor for eyes, skin, heart and dental 50,000 50,000 50,000 50,000 50,000 2,50,000 twice in a year 4 Free of cost distribution of medicine / body check 25,000 25,000 25,000 25,000 25,000 1,25,000 up tests in the area 5 Training to the farmers related to healthcare 10,000 10,000 10,000 10,000 10,000 50,000 6 Assistance in development of technical skills and 20,000 20,000 20,000 20,000 20,000 1,00,000 training to the children of farmers and fishermen 7 Assistance in providing study materials, uniform, 20,000 20,000 20,000 20,000 20,000 1,00,000 books to the poor students located nearby area 8 Scholarship to the clever students for higher 50,000 50,000 50,000 50,000 50,000 2,50,000 education Total 11,25,000 Total budgetary provision made towards the implementation of natural community augmentation plan 1. Natural Resources Augmentation plan Rs.21,50,000 2. Community Resources Augmentation plan Rs. 11,25,000 Total budgetary provision Rs. 32,75,000

13 SUMMARY OF REMEDIATION PLAN & NATURAL AND COMMUNITY RESOURCE AUGMENTATION PLAN (BUDGETARY ALLOCATION)

Total budgetary provision w.r.t. violation (not taking prior Environment Clearance under the provisions of EIA Notification, 2006) as envisaged in Notification dt. 14-03-2017 (Cost proposed on Remediation plan + Natural and Community Resources Augmentation plan

Sr. No. Aspects Amount (Rs. in lakhs)

Estimated cost on remediation plan based on the damage 1. 29,70,000/- assessment due to violation

Cost estimate for natural resources augmentation plan and 2. 32,75,000/- Community resources augmentation plan

Grand Total 62,45,000/-

14 Annexure No. 2

REVISED TREE PLANTATION PLAN

Total plot area 36,295 sq.m. No. of trees to be planted as per 450 trees MoEF guidelines (@1 tree for every 80 sq.m. of land area) Total no. of trees which where 56 trees existing at site before development No. of trees to be planted as part 560 trees (@10 trees for every 1 tree cut) of compensatory afforestation Total no. of trees to be planted 450 + 560 = 1010 trees

List of native trees to be planted at site and surroundings

Sr. Botanical Vernacular name / Family Type No. Name English name 1. Cassia fistula Konna (Golden Fabaceae Flowering shower) 2. Citrus Limon Chrunaregam (Lemon) Rutaceae Domestic use 3. Moringa Muringa (Drumstick Moringaceae Domestic pterygosperma tree) use & flowering 4. Psidium Peru (Guava) Myrtaceae Fruit tree guajava 5. Garcinia Kodampuli (Malabar Clusiaceae Domestic cambogia Gamboge) use 6. Azadirachta Ariyaveppu (Neem) Meliceae Medicinal indica tree 7. Mangifera Mavu (Mango tree) Anacardiaceae Fruit tree indica 8. Mimusops Elangi tree (Spanish Sapotaceae Medicinal & elengi cherry) flowering tree 9. Plumeria White Champa Apocynaceae Flowering obtuse (Vellachampakam)

Annexure No. 3

MULTI SPECIALTY HOSPITAL PROJECT AT KADAPRA, THIRUVALLA, PATHANAMTHITTA DIST., KERALA

ECBC COMPLIANCE REPORT

Prepared for: St. Gregorios International Cancer Care Centre. Perumala, Pathanamthitta District, Kerala689626

Prepared by: M/s GTCS 38/324, 38/325, 1 st floor, Pulickkal building, Karshaka road, Kochi-682016, Kerala

CONTENTS

1. Project Brief

2. ECBC Compliance Process

3. Energy Efficiency Measures Taken for the hospital project

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1. Project Brief

St. Gregorios International Cancer Care Centre (SGICCC) has constructed a hospital at Kadapra Village, Thiruvalla Taluk, Pathanamthitta District, Kerala. The project comprises of construction of Hospital building, Nursing College with associated activities & supporting infrastructure facilities. The total plot area is 3.6295 hectares. The total builtup area is 38,123.48 sq. m. (8,745.48 sq. m., pre 2006 + 29,378 sq. m., post2006). The power requirement of the project is 3,00,000 kWh.

The project is located in “Warm & Humid Zone”.

The construction of the buildings of the project is completed.

The project has taken several measures to reduce its energy consumption of its hospital portion in order to make it an ECBC compliant building. These measures have been described in detail in this report.

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2. ECBC Compliance Process

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3. Proposed Energy Efficiency Measures Taken for Hospital Building

Sr. Building ECBC Prescriptive Compliance Proposed No. Envelope Component

1 Roof U = 0.33 W/sqm K (max) ; Reflective paint + 20 mm external plaster + 75 mm XPS insulation + Waterproofing+ 150 mm RCC + putty finish

U = 0.31 W/sqm K;

2 External Wall U = 0.40 W/sqm K (max) 25 mm plaster + 200 mm AAC Block + 50 mm XPS + 20 mm internal plaster + putty + paint

U = 0.36 W/sqm K . This value is for better than usual construction practice where U Value is 2 /sqmK

3 Fenestration U : 3.0 W/sqm K (max) Double glazed glass to be used in project Max SHGC North for lat ≥ 15°N: 0.5 U = 2.1 W/sqm K

Max SHGC NonNorth: 0.27 SHGC = 0.21

VLT = 0.27 (min) VLT = 0.33

Max WWR is 40% if no tradeoff

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Sr. No. Component ECBC Prescriptive Proposed Compliance

1 Service Water Solar water heating 20% of Hot water catered through solar Heating No. of beds = 480 beds

Total no. of Occupants @ 2 person / bed = 960 nos.

+ Doctors & Staff (1626) = 2586 persons

Hot water requirement @ 25 lpcd = 64650 liters

Solar Hot water system for 20% capacity = 12930 liters.

Piping insulation as per IS 13129 part (1& 2).

2 Pumps Min Efficiency 70% Efficiency 78%

3 Cooling Towers NA

4. Minimum The cooling Specifying energy efficient minimum 3 star Equipment equipment must meet rated AC's Efficiency minimum efficiency parameters as prescribed by ECBC and ASHRAE 90.1 2010

5 Economizers NA

6 Controls NA

7 Energy NA Recovery

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Sr. Lighting ECBC Prescriptive Compliance Proposed No.

1 Lighting Scheduled based lighting Timer based on /off control shall be Controls controls or Occupancy based provided for common area lighting. Exterior lighting controls to be provided lighting controlled by time switches.

2 Interior Building Area Method mentioned LED lights installed will reduce the LPD to 7.5. Lighting in ECBC 2017` They have a Light Output Ratio more than 7.5 Power

3 Exterior Building entrance (with canopy): Building entrance (with canopy): 9 W/sqm of Lighting 10 W/sqm of canopy area canopy area Power Building exit: 60 W/linear m of Building exit: 50 W/linear m of door width door width Building façade: 4.5.0 W/m2 of vertical Building façade: 5.0 W/m2 of façade area vertical façade area Pedestrian walkways: 1.8 W/m2 Pedestrian walkways: 2.0 W/m2 Stairways: 8 W/m2 Stairways: 10.0 W/m2 Landscaping: 0.44 W/m2 Landscaping: 0.5 W/m2

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Sr. Component ECBC Prescriptive Proposed No. Compliance

1 Transformers Maximum Allowable All transformers used in the project are energy losses as per ECBC efficient and comply with ECBC norms.

2 Energy Efficient Minimum Efficiency as per All the motors used by pumps proposed in the Motors ECBC project are energy efficient and comply with ECBC norms.

3 Diesel BEE star rated DG sets We are using BEE 3 Star rated DG sets Generator (DG) shall be used in all Sets compliant buildings.

4 CheckMetering At Building mains, Meter installed at building mains is capable of and Monitoring installed meters must be monitoring Energy use (kWh), Energy Demand capable of monitoring (kW) and total Power Factor on an hourly basis. Energy use (kWh), Energy

Demand (kW) and total Power Factor on an hourly basis.

5 Power Factor All 3 phase shall maintain Power Factor 0.97 Correction their power factor 0.97

6 Power Distribution losses do not Less than 2.8% in the building Distribution exceed 3% of the total Systems power usage

7 Uninterruptible NA Power Supply (UPS)

8 Renewable All buildings shall have More than 30% of roof area is left for Energy Systems provisions for installation renewable energy generation in future. of renewable energy systems in the future on rooftops or the site.

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Annexure No. 4

BASELINE HEALTH STATUS REPORT

OF THE STUDY AREA

Prepared for M/s St. Gregorios International Cancer Care Centre Kadapra Village & Panchayat, Thiruvalla Taluk, Pathanamthitta District, Kerala

Prepared by M/s Environmental Engineers & Consultants Pvt. Ltd. (QCI/NABET Accredited consultancy organization) A1 – 198, Janak Puri, New Delhi – 110058.

(October, 2018)

BASELINE HEALTH STATUS REPORT

1.0 Introduction

The Kerala model is a renowned phrase in India in the field of Health. The health indicators of Kerala are comparable with some of the developed countries in the world. The effective Community Health Services is the base of this achievement. Historically, the princely rules of the state, made a small beginning to provide infrastructural facilities for a primary health care system. After the re-organisation of the state, it has reached a fairly high level of standard and soundness. The availability of facilities for primary health care, their accessibility, the very high degree of awareness and acceptability among the people have made in Kerala model an almost perfect one.

The level of achievements attained in the implementation of the various national programmes for control / eradication of diseases and also of family welfare programme including universal immunisation programme and maternal and child health activities has helped the state to reduce the mortality rates and improve the health status of the people. The maternal mortality rate, Life expectancy has enhanced especially that of females to over 73 years. Today the infant mortality rate is as low as 16 and the maternal mortality is below 1, which are comparable to that of some of the developed countries. In 1995 the crude death rate is as low as 6, and the per school child mortality rate is also quite low. In 1991 the general fertility rate was 64.4 and in 1995 the birth rate have reduced to 17.7. The total fertility rate is as low as 1.8 in Kerala by 1992 itself which is the lowest among all the major states in the country. Under all major indicators, the state has already achieved what the country has targeted for achieving "Health for all by 2000 AD".

2.0 Kadapra Grama Panchayat

The Grama Panchayath situated in Pulikeezhu Block Panchayat, Thiruvalla Taluk, Pathanamthitta district, Kerala. The village is having a long back history along with myths. The disciple of Christ, St. Thomas came in Kadapra valanjavattom in the first

BASELINE HEALTH STATUS REPORT

decades of AD and established Niranam Valiya Pally, the church is situated in Kadapra Grama Panchayath. The Khabar of Mar Gregorios thirumen i is situated in Parumala Seminari church which is one of the important pilgrim centres in Kerala.

In the field of education, Manipuzha Asanmar taught the people to read and write before the advent of schools. The first school up to second standard came in to exist in the mid of 19 th century. Parumala Seminary Primary School, Govt. U P School, English Middle school, Niranam and many other schools were established in the 19 th century. In 1969 a junior college was established under Devaswam Board Management. Libraries also helped a lot to improve the educational and cultural development of people.

The development in the field of education, socio – cultural sectors played a catalyser in health care system. In the field of Health care, Ayurveda was the main method of treatment till first half of 20 th century. There were eminent specialised ayurveda doctors in the field of snake bite and ophthalmology. Dr. Arrackal velupilla, Dr. Pallikadavil Nainan started Alopothic treatment in the village. Later Dr. SankaraNarayanapilla established S N Nursing Home which became a reliable health care centre in Panchayath. In 1956 Govt. Established Ayurvedic dispensary at Parumala. The Parumala Seminary started a hospital with modern facility at Parumala. 3.0 Kadapra Gram Panchayat at glance Name of Panchayat Kadapra Gram Panchayat Geographical area 14.74 Sq. Km No. of wards 15 Block Pulikezhu District Ernakulam Boundary North – Nedumpuram and Thalavadi Gram panchayat East –Thiruvandoor and Pandanad Gram Panchayat South – Thriperumth and Mannar Gram Panchayath West – Niranam and Mannar Gram panchayat

BASELINE HEALTH STATUS REPORT

Kadapra Village, with population of about 24,000 is Thiruvalla sub district's the 3rd most populous village, located in Thiruvalla sub district of Pathanamthitta district in Kerala. Total geographical area of Kadapra village is 17 sq.km and it is the 3rd biggest village by area in the sub district. Population density of the village is 1391 persons per sq.km.

Nearest town of the village is Thiruvalla and distance from Kadapra village to Thiruvalla is 6 km. The village has its own post office and the pin code of Kadapra village is 689104. The village comes under Niranam, Kadapra panchayat. Thiruvalla is the sub district head quarter and the distance from the village is 6 km. District head quarter of the village is Pathanamthitta which is 43 km away.

4.0 Demographics

The village is home to about 24,000 people, among them about 11,000 (46%) are male and about 13,000 (54%) are female. 86% of the whole population are from general caste, 13% are from schedule caste and 0% are schedule tribes. Child (aged under 6 years) population of Kadapra village is 8%, among them 49% are boys and 51% are girls. There are 6,242 households in the village and an average 4 persons live in every family.

BASELINE HEALTH STATUS REPORT

Caste wise male female population 2011 - Kadapra

Total General Schedule Caste Schedule Tribe Child

Total 23,502 20,295 3,172 35 1,953

Male 10,810 9,288 1,509 13 963

Female 12,692 11,007 1,663 22 990

5.0 Growth of population

Population of the village has decreased by -6.4% in last 10 years. In 2001 census total population here were about 25,000. Female population growth rate of the village is -3.7% which is 5.6% higher than male population growth rate of -9.3%. General caste population has decreased by -7.1%; Schedule caste population has decreased by -2.3%; Schedule Tribe population has increased by 288.9% and child population has decreased by -23.2% in the village since last census.

BASELINE HEALTH STATUS REPORT

Growth of population (percent) 2001 to 2011 - Kadapra

Total General Schedule Caste Schedule Tribe Child

Total -6 -7 -2 289 -23

Male -9 -11 -2 160 -25

Female -4 -4 -2 450 -22

6.0 Sex Ratio - Females per 1000 Male

As of 2011 census there are 1,174 females per 1000 male in the village. Sex ratio in general caste is 1,185, in schedule caste is 1,102 and in schedule tribe is 1,692. There are 1,028 girls under 6 years of age per 1,000 boys of the same age in the village. Overall sex ratio in the village has increased by 69 females per 1,000 male during the years from 2001 to 2011. Child sex ratio here has increased by 42 girls per 1,000 boys during the same time.

BASELINE HEALTH STATUS REPORT

Change in sex ratio 2001 to 2011 - Kadapra

Total General SC ST Child

Change 69 79 0 892 42

2011 1,174 1,185 1,102 1,692 1,028

2001 1,105 1,106 1,102 800 986

7.0 Literacy

Total about 21,000 persons in the village are literate, among them 9,580 are male and about 11,000 are female. Literacy rate (children under 6 are excluded) of Kadapra is 97%. 97% of male and 97% of female population are literate here. Overall literacy rate in the village has decreased by 1%. Male literacy has gone down by -1% and female literacy rate has gone up by 3%.

BASELINE HEALTH STATUS REPORT

Change in literacy rate 2001 to 2011 - Kadapra

Total Male Female Change 1 -0 3 2011 97 97 97 2001 96 98 94

8.0 Workers profile

Kadapra has 36% (8482) population engaged in either main or marginal works. 51% male and 24% female population are working population. 40% of total male population are main (full time) workers and 11% are marginal (part time) workers. For women 13% of total female population are main and 11% are marginal workers.

BASELINE HEALTH STATUS REPORT

Percentage of working population - Kadapra

Worker (Among Main Worker Marginal Non total population) (Among Worker (Among Worker (Among total workers) workers) population) Total 36 25 11 64 Male 51 40 11 49 Female 24 13 11 76

9.0 Infectious Diseases in Kadapra The community health wing is working effectively in the Panchayat. Therefore, they could prevent the outbreak of various infectious diseases in the community. The numbers of affected persons with communicable diseases were very low. A brief details of communicable diseases affected in the area is given below. There is no Nipah and Zika reported in this panchayath. Sl. No Diseases 2017 2018 1 Chikungunya Nil 6 2 TB 15 12 3 Leptospirosis 2 Nil 4 Dengue 1 Nil 5 Malaria Nil Nil

BASELINE HEALTH STATUS REPORT

Mortality

The community health delivery system and ICDS is working effectively in the community to prevent nutritious problem and other communicable and non communicable diseases. There are below 2 infant mortality is reported in the Community. The number of child mortality is below 5. There is one maternal mortality reported in the year 2018.

Cancer

There are 32 persons taking treatment against cancer. The number of patients suffering from cancer is relatively high in the panchayat. The Community Health service providers is seeking the reason behind the problem.

Suicide

Suicide has devastating impacts on families and communities; high suicide rate in the community has been a major focus of community concern and prevention efforts. There were 8 persons committed suicide in 2017 and No person attempted for suicide in this year. This may be the results of awareness programmes conducted by the PHC, Ngo s and Community Based Organisations.

Bed ridden patients There are more than 30 patients are bed ridden. The Grama Panchayath suppurated Pain and palliative programme provides adequate support with home care to more than 15 patents.

HIV/ AIDS Acquired immunodeficiency syndrome (AIDS) is one of the most significant health and social problems facing the world today. Over the last decade, due to the rise of ‘mobile prostitution’ with illegal workers from abroad, infection with STDs has risen. There is no person taking ART from PHC to control the effects of HIV.

BASELINE HEALTH STATUS REPORT

Child marriage and teen Birth Gender inequality, social norms, perceived low status of girls, poverty, lack of education, safety concerns about girl children and control over sexuality are considered to be reasons for prevalence of child marriages. The high literacy rate of female and educated women in the community prevents such a mal practice in Kadapra Grama Panchayath.

Delivery All pregnant ladies will be come under the purview of Community health team of PHC. There is no delivery happens in house. 100 percent deliveries are taken place in hospital.

Still Birth Stillbirth is typically defined as fetal death at or after 20 to 28 weeks of pregnancy. It results in a baby born without signs of life. The number of still birth is below three in 2018 in kadapra village.

Mental health

The other major concerns in the field of health metal health problems. In kadapra community, the number of person with mental illness is negligibly low. People with retardation are attending special schools. MR with slightly moderate is attending normal schools.

10.0 Primary Health Centres (PHC)

Primary Health Centre ( PHC ), sometimes referred to as public health centre , are state-owned rural health care facilities in India. They are essentially single-physician clinics usually with facilities for minor surgeries, too. They are part of the government-funded public health system in India .

BASELINE HEALTH STATUS REPORT

There is One Primary Health centre in Kadapra Grama Panchayath with 5 sub centres. To accelerate community health delivery system several community health experts are working the details are given below:

Health inspector – 1 Junior Health Inspector – 3 Junior Public health Nurse – 4 ASHA workers – 21

Focus

Apart from the regular medical treatments, PHCs have some special focuses.

Infant immunization programs: Immunization for newborns under the national immunization program is dispensed through the PHCs. This program is fully subsidised Anti-epidemic programs: The PHCs act as the primary epidemic diagnostic and control centres for the rural India. Whenever a local epidemic breaks out, the system's doctors are trained for diagnosis. They identify suspected cases and refer for further treatment. Birth control programs: Services under the national birth control programs are dispensed through the PHCs. Sterilization surgeries such as vasectomy and tubectomy are done here. These services, too, are fully subsidised. Pregnancy and related care: A major focus of the PHC system is medical care for pregnancy and child birth in rural India. This is because people from rural India resist approaching doctors for pregnancy care which increases neonatal death. Hence, pregnancy care is a major focus area for the PHCs. Emergencies: All the PHCs store drugs for medical emergencies which could be expected in rural areas. For example antivenoms for snake bites, rabies vaccinations, etc.

BASELINE HEALTH STATUS REPORT

Functions

The Primary Health Centre (PHC) is consistent with the eight elements of primary health care outlined in the Alma-Ata declaration. These are listed below:

Provision of medical care Maternal-child health including family planning

Safe water supply and basic sanitation Prevention and control of locally endemic diseases

Collection and reporting of vital statistics Education about health National health programmes, as relevant Referral services

Training of health guides, health workers, local dais and health assistants Basic laboratory workers

PROGRAMMES AND SCHEMES The Health Services perform the chief function of delivery of primary health care in a wholesome manner. Preventive and promotive health care in addition to the routine curative services and rehabilitation aspects of health care constitute the main activities of the department. The activities include the establishment and maintenance of medical institutions with necessary infrastructure, control of communicable diseases, rendering of Family Welfare services including Maternal and Child Health Services, implementation of National Control / Eradication programmes providing curative services and administration. The Analytical Laboratories and Public Health Laboratory function as a single-purpose units under the department with independent controlling officer for each.

National TB Control Programme

The National TB Control Programme is a comprehensive socially acceptable and economically feasible programme evolved with the objective of controlling the problem of Tuberculosis in the country.

BASELINE HEALTH STATUS REPORT

Aim : The aim of the scheme is to detect as large a number of patients as possible and to treat them effectively so that the infectious patients become non-infectious and the active and noninfectious cases do not become infectious.

Revised National TB Control Programme: This programme is implemented through 100 % World Bank assistance and was first implemented in Pathanamthitta district in 1994.The prime aim is to achieve 85% cure rate. Treatment organisers are appointed for the supervision and laboratory technicians for cross checking the results in microscopic camera. This programme is being executed by the wing of PHC

Sexually Transmitted Diseases Control Programme

Sexually Transmitted Diseases (STDs) are known to be one of the major health problems. As women are major reservoirs of infection in syphilis, screening of all pregnant women are taken place with the consent of pregnant ladies in the community..

National AIDS Control Programme Considering the gravity of increasing prevalence of HIV / AIDS the state Government has intensified and started a control programme. An AIDS surveillance centre was established in 1986 at Medical College, Thiruvananthapuram. The main activities are surveillance, training of staff, IEC activities including adolescent education. The PHC is actively conducting programmes to aware the public and school children about this problem.

Mental Health Programme The State has a Mental Health Programme of its own and the first District Psychiatry unit was opened in 1970 attached to District Hospital, Ernakulam. The Social Welfare Department is running a rehabilitation centre for ex-female mental patients of Mental Health Centre. The mental health status of the community people is fairly good.

BASELINE HEALTH STATUS REPORT

Family Welfare Programme The Family Planning Programme was officially implemented in India in 1952. During the first and second plan periods (1951-61) the programme was taken up in a very modest way. It was reorganised in the third plan period and it gathered momentum with the starting of full fledged department in 1966. During the fourth plan period, it was implemented as a target-oriented, time-bound, incentive-based programme. During the fifth plan period it was integrated with maternal health and child care and nutrition and was implemented as a package programme, which include health, family planning, maternal and child health and nutrition. The Junior Public Health Nurses located at the sub-centre along with Junior Health Inspectors are the front line workers providing services in the community. For skill up gradation of medical and paramedical personnel at the sub centre, are functioning in the Panchayath. The social factors such as high female literacy, higher age at marriage of girls, status of women, effective role played by non Governmental Organisations and the general socio-economic consciousness of the people have contributed to this unique position.

Maternal and Child Health Programme Right through the ages care for mothers and children has been one of the causes to which Indian policy has remained committed. Since independence Human Resource Development programmes focused on maternal and child health. The immunisation programme is one of the most cost effective public health measures and is an important component of the primary health care services. Recognising the need for immunization, Government of India launched the expanded programme of immunization (EPI) UN 1978, with the objective of increasing the average levels of various antigens.

BASELINE HEALTH STATUS REPORT

Immunisation Programme Immunisation plays a vital role in the control of infectious diseases, by building up immunity among immunised persons against some specific vaccine preventable diseases and by helping to decrease the transmission of diseases from one person to another. In Kerala the EPI started in 1978 . T.T immunisation to pregnant women started integrated with EPI in 1978 itself. Polio and typhoid vaccinations were included in 1979-80 and T.T immunisation for school children , while BCG vaccination was brought under the purview of EPI. Measles vaccination was initiated. The PHC and its community Health service providers have good facilities and community reach in the Grama panchayat. All announced vaccination as for children and adolescents are being done by the Grama panchayat.

Cold Chain Programme The cold chain system of storage of vaccines is maintained. Vaccines are generally sensitive to heat. Hence the shortage and transport of vaccines should be done at the required low temperature levels. The system of storage and transport of vaccines at low temperature from manufacturer to the point of use is called the Cold Chain System.

Oral Rehydration Therapy (ORT) ORT was launched as a national child health programme from 1985 along with UIP. The ORT was introduced in 1971 by WHO on a part of improving the management of diarrhoeal diseases, so as to control deaths due to these diseases. Oral fluid therapy is based on the observation that glucose given orally enhances the intestinal absorption of salt and water and is capable of correcting the electrolyte and water deficit. The aim of the programme is to prevent diarrhoeal deaths due to dehydration among children under five years.

BASELINE HEALTH STATUS REPORT

11.0 MEDICAL CARE FACILITIES IN KADAPRA GRAMA PANCHAYAH

1. St. Gregorious Medical mission Hospital, Parumala

2. Primary Health centre, Kadapara

3. Govt. Ayurvedic Dispensary

4. Govt. Homeo dispensary, Kadapara

5. SN Hospital

6. S N Nursing Home

7. Netra Chikilsalyam Eye clinic

8. Pearl Dental clinic

9. K M Cherian Heart foundation, Parumala