HARYANA PROGRAM MONITORING REPORT Q4, 2012-13 (Jan –March 2013)

National Health Systems Resource Centre

EXECUTIVE SUMMARY

District Mewat was visited in the state of Haryana towards the end of Q4 2012-13. CHC Firozpur Zirka, PHC Nagina and SCs Raoli and Uleta were visited

Deleivery points: The district has 25 facilities which have been designated as delivery points . Of these Marora and Tigaon PHCs are not reporting deliveries.

 The caseloads of PHCS Ghasera and Biwan, which are delivery points are less than 30 per month , while the remaining perform over 30 deliveries per month, PHCs Tauru and Pinangwan report over 100 deliveries per month.  The CHC designated as delivery point have OPDs of over 100 per day and the PHC DPs have OPDs of 50 per day.  Mapping of caseloads in delivery points shows that the PHCs and Sub centres perform well with 56% deliveries, while 31% deliveries iare conducted n the three CHCs. The District hospital caters to 37% of the total delivery load of the district.

1. MATERNAL HEALTH

1.1. Institutional deliveries

 Institutional deliveries for the district against the reported deliveries is 36% and home deliveries is 63%  A positive trend is also seen in the sharp rise in deliveries in government institutions : from 7474 in 2010-11 to 14399 in 2012-13,  Deliveries in the district are restricted to normal deliveries, which are conducted across the 25 delivery points  District Hospital Mandikhera is not attending to obstetric complication , due to the absence of a gynaecologist. Obstetric complications are referred to the Syed Hasan Khan Mewati Medical College ( 26 kms from the GH).

1.2.ANC and PNC

 70% women who had registered for ANC had undergone 3 ANC checks.Except for TT , the other important components, Hb, Blood pressure and fundal examination were carried out infrequently.  Most facilities visited with substantial deliveries had empty post natal wards and women do not stay beyond 2-3 hours except in the case of the DH.  35% women have Hb below 11 gms. but linelist of such lists iasnt in hand at the facilities visited

1.3 Maternal deaths

 Only 9 deaths were recorded from Dec, 2012 to 2013) District is yet to undertake a review of the cases .At least three cases of death mention ‘Anemia/ bleeding ’ as the cause of death.

1.4 JSSK

 The JSSK entitlements are being provided in the delivery points of the districts and free services are availed in most of the entitlement areas except for diagnostics and referral transport.  . The Referral transport system , 102 is functioning sub optimally due to problem with the telecom network.  Signanges on JSSK were displayed in the facilities visited.  Dry diet is being made available to mothers the post natal wards, but very few can avail of this service due to stay for less than 48 hours .

2. CHILD HEALTH

2.1. SNCU

 The district hospital has an 8 bedded SNCU , supervised by a paediatrician. Most of the sick new born are inborn cases and admissios are low;. During the visit, a single pre term baby was admitted in the SNCU.  10% SNCUs are LAMA and outcome data provided by district seems inaccurate

2.2. Immunization

 Full immunization in the district is around 35%  There are 14 cold chain points and two immunization sessions are held in a week ( Wed and Fri). Approximately 1000-1500 children are immunized in a session.  26% drop outs from BCG to DPT 3 and 21% from BCG to measles.  There is a supportive supervision

3. FAMILY PLANNING

 The district has an unmet need of 13.3, 29.1% for limiting and 35.1% for spacing  The utilization of family planning services is low, for permanent methods ( 1% sterilization) spacing methods is better , IUD users being 30%  The fixed day family planning services at DH is currently not available due to lack of gynaecologist and surgeon. Services are currently provided on Tuesdays and Thursdays, where gynaecologists from Gurgaon perform sterilization.  ASHAs reported that there has been a mixed response from the community to home deleivery of contraceptives.

8. ARSH

 The Menstrual hygience scheme is yet to be implemented at community level. Training of trainers has been conducted following which the programme will be rolled out.

9. REFERRAL TRANSPORT

 The district has 16 ambulances under the 102 services, 1 ALS which has 2 EMTs.  The functionality of the patient transport system is low since due to the erratic telecom network in the district.

10.COMMUNITY PROCESSES

10.1 ASHA

 716 ASHAs in place as against requirement of 1089 ASHAs .  Total 75 trained Dais have been appointed as ASHA in 2011-12. The district has of late put in place 26 ASHA facilitators and a District Community Mobiliser.

10.2 Skill development

 All ASHAs of the district have been trained in module I to 5 and 1st round of HBPNC.  270 ASHAs have completed second round of the HBPNC training and have received the kits. Drug kits are available with the ASHAs interviewed and are being refilled from the DH, from its central stores

10.3 Functionality of the ASHAs

 ASHAs in the district range from young to senior women and are pro-active in their role of mobilisers.  They accompany women to the institutional for deliveries and have managed to mobilise family planning cases ( for IUD insertion and few sterilization cases), though with a lot of convincing.  The ASHAs are earning Rs. 2000 and above and were satisfied with the income as well as the response they have received from the community.

11. DISEASE CONTROL PROGRAMMES

MALARIA

 The ABER of the district was 13.5 and the API was 1.5 ( 2011, ). Some pockets of the district are high risk for malaria, e.g. the region of the PHC Ujina which has an API of over 5. The district reported 1317 malaria cases in last year of which 12 PF cases .  The district has a shortfall of staff in the Malaria programme, several LT positions are lying vacant which has affected the preparation of malaria slides. The districts has 25 of 84 MPW positions sanctioned filled.

12. NON COMMUNICABLE DISEASES

 NCD Cell is functioning since 2010-11, However, the cell does not have a dedicate Programme Manager and the Paediatrician of the DH is in charge of the Cell.  Screening reports for the year (till march 2013) show that diabetes and hypertension are the major suspectedNCDs

13. HUMAN RESOURCES

 The district faces a severe crunch of skilled health human resources as well as techno managerial staff. only 1 position of District programme nmanger is filled  The SMO of the DH is also the Medical Superintendant. The district hospital does not have a gynaecologist, and the other specialists positions (Eye, Medicine, Ortho, ENT) are vacant.  25 positions of MOs and 47 ANM positions are lying vacant,

13. HMIS

 The district has started facility wise data reporting. However, there are several data quality issues at large. The district does not have an M&E manager and a former data entry operator is managing the HMIS.  Lack of technical capacity to collate and analyse data requires training of the data entry persons

DISTRICT BACKGROUND

Mewat, carved out of the erstwhile Gurgaon district and Hathin block of Faridabad district, is situated at a distance of 50 kms from Delhi, and currently it is included in the National Capital region (NCR).

Even though the farthest point of Mewat is no farther than 145 km from the national capital, yet the district remains under developed on almost every yardstick of development indices as compared to the other districts of Haryana, , l. Low female literacy, gender discrimination, large family sizes and socio cultural beliefs are the determinants which have a profound impact on the health seeking behaviour of the population in the district.

Mewat has a population of 10.89 lakhs spread over five administrative blocks and the community is composed of the Meo ( 80%) general caste ( 10%) and Scheduled caste (8%). The density of population is 729 persons per square kms. The Average literacy rate of Mewat is 56%, male and female literacy is 73% and 37% respectively ( Census, 2011). The sex ratio of the district is 906..

1. HEALTH INFRASTRUCTURE

The district has the following health infrastructure:

Health Facility Status Sub centres 84 PHCs 13 CHCs 3 (Punhana, Ferozpur Jhirka, Nuh) District Hospital 1

Most health facilities in the district cover population much higher than expected: CHCs cater to an average population of 3.5 lakhs10 PHCs cover population of 1 lakh whereas the sub centres cover over 10,000 population. Most sub centres are covering 8-10 villages.

Using current population norms for SCs, PHCs and CHCs vis-a-vis the population, the district requires the following facilities for adequate coverage of population There are 10 stand alone PHCs, while 3 PHCs are operating from CHC premises( Nuh, Punhana, F.P Jhirka) :

Health Facility Current Status Required 1 Gap Sub centres 84 218 134 PHCs 13 22 9 CHCs 3 (Punhana, Ferozpur 9 6 Jhirka, Nuh) District Hospital 1 1 -

1 As per population norms for facility levels and current district population

5 PHCs are functioning in government building (Nagina, Ghasera, Tauru, Tigaon Pinagwan) while 3 PHCs (Biwan, Ujjina, M.P Ahir) are running in private building. Out of the 84 sub centres , 43 are functioning in government buildings, 30 are in private building and 11 are located along with a PHC building.PHC, Pingwan is being upgraded to a CHC and the district has planned for one more CHC. Seven more PHCs and two new SCs are being planned for the district.

The Al-Afia District Hospital, \ in Mandikhera receives the maximum footfalls, annual OPD of 24847; 2558 in Causality and 2395 indoor admissions. Currently it conducts over 350 normal deliveries in a year. It has Ultrasound, X-ray and an entire range of laboratory facilities. The 50

bedded hospital is well equipped with a day care room for cancer patients (a chemotherapy room). The hospital has well maintained, well stocked major and minor OTs and also eclampsia room, sepsis and asepsis labour rooms. The DH includes a 8 bedded SNCU, manned by a paediatrician and 2 MOs and a staff nurse.

2. FACILITIES VISITED

The following facilities were visited during the district visit. Most of the facilities visited were Delivery Points except Sub Centre Uleta :

Facility Status Block PHC, Nagina Delivery point, 24*7 facility Nagina CHC, Firozpur Zirka Delivery point Firozpur Zirka SC/ Delivery hut, Raoli Delivery point Firozpur Zirka SC, Uleta Non delivery point Nagina

3. FACILITY DEVELOPMENT FOR RCH

The district has 25 facilities which have been designated as delivery points. Of these Marora and Tigaon PHCs are not reporting deliveries. The caseloads of PHCs Ghasera and Biwan are low, less than 30 per month , while the remaining conduct over 30 deliveries per month, the PHCs Tauru and Pinangwan report over 100 deliveries per month. Pinangwan is currently being upgraded to a CHC. Under the delivery hut scheme of the state, the district has 3 stand alone sub centre –delivery huts.

Total Facilities No. identified as delivery Annual deliveries2 points 1 DH 1 DH 1848 3 CHCs 3 CHCs 4577 13 PHCs 10 PHCs 5399 84 SCs 8 SCs 784

2 Source : Civil Surgeon Mewat’s database

In terms of distribution of deliveries across the delivery points, the PHCs and SCs cater to approximately 56% of the delivery load of the district. The Sub centre delivery huts which have been strengthened with additional drugs are performing well. One such facility, Raoli was visited during this tour . The facility is managed by a dedicated ANM, who is also assisted by a Dai who works as an ASHA. This facility, located o the road head ,with three rooms , one functioning as the ANMs residence had conducted 27 deliveries in March , 2013 and 16 deliveries have taken place till the time of the visit in April. The SBA trained ANM had maintained the records meticulously and the facility was adequately stocked with delivery kits, drugs and consumables.

Mewat : Deliveries in Delivery Points

5% 13% 14%

31% CHC PHC 37% SC delivery hut Sub centre

As per HMIS data for the district for April 12-March 13, the expected deliveries of the district is 24,733 ( using a state CBR of 21.8) . The district Civil Surgeon reports 14,627 deliveries Institutional deliveries, which amounts to 59% (using the HMIS expected deliveries figure). However, the institutional deliveries of the reported deliveries is 36% and home deliveries is 63% which somewhat closer to the reality, in this area where the socio cultural factors and limited availability of health services, which is a limitation for institutional deliveries. The district visit and interactions with the community and in patients shows that there has been a gradual shift in the community and institutional deliveries are increasing. A positive trend is also seen with the sharp rise in deliveries at government institutions: from 7474 in 2010-11 to 14399 in 2012-13, which may be attributed to the JSY and the more recent JSSK schemes (Mewat , being the launch pad of the latter scheme) which have received good response from the community.

80% 70% 70% 60% 58% 60%

50% % insti del 40% 41% % home del 40% 30% 30%

20%

10%

0% 2010-11 2011-12 2012-13

Deliveries in the district are restricted to normal deliveries, which are conducted across the 25 delivery points, by the Staff Nurses ANMs. The district has 45 Staff Nurses and 38 ANMs trained in SBA. Currently the District Hospital , Al-Afia General hospital ,Mandikhera is not attending the obstetric complication , due to the absence of a gynaecologist. Complicated cases are referred to the Syed hasan Khan Mewati Medical College ( 26 kms from the GH). The other Tertiary care facility for referral is th Nallan medical college, a govt medical facility. However, this facility refers out most cases including normal delivery.

Home deliveries continue to be popular in the district , especially in blocks with problems of geographical access , such as Punhana. Dais are popular, though several have joined as ASHAs and encourage women to opt for home deliveries .

Post natal care is weak area. Most facilities visited with substantial deliveries had empty post natal wards and service providers and beneficiary interactions show that women do not stay beyond 2-3 hours except in the case of the DH. The district would need to tie up the drop back and diet to improve post natal care , especially for institutional deliveries .

Anaemia

The service providers in the district highlighted that anaemia is common among the women of the district, arising from frequent births at short intervals. HMIS reports for the district shows 35% women with Hb below 11 gms. The DH staff mentioned that they have frequent case reporting with 5 gms of Hb. The state had a plan for tracking of high risk pregnancies and line listing of anemic women, such lists were not found in hand at the facilities visited. Though in SC Raoli the ANM had marked the names of ANC cases with low Hb. The district has recently set up a blood bank in the DH.

Recommendation: The district needs to undertake a campaign on awareness of anemia using the services of the ASHAs and the AWWs and the NGOs/ IRRAD; the FM radio could be useful media for dissemination of information on anemia . Line lists of anemic women, especially with severe anemia need to be maintained at the SC and PHC level and MOIC needs to track and follow up on the cases during monthly meeting. State may consider the use of Iron sucrose at the DH , subject to availability of a gynaecologist and under his/ her supervision.

Maternal deaths records of the district for months ( Dec, 2012 to 2013) showed merely 9 deaths for four months period. Except two cases of deaths in transit, the 7 cases were deaths reported in the institution, including 3 cases in the DH. Currently, the district is maintaining basic data on the cases and is yet to undertake review of the cases. At least three cases of death mention ‘Anemia/ bleeding ’ as the cause of death. One case was multipara women with 11th child.

Recommendation: The district should start maternal death audits and consequently be responsive to the systemic reasons behind the deaths. Appropriate response needs to be prepared for each level of delay.

ANC and outreach

HMIS data (April 12- March 13) for the district shows that 70% women who had registered for ANC had undergone 3 ANC checks. However, quality of ANCs conducted and the number of ANCs was low as seen from the Sub centre ANC records. Administration of TT is 93% and this is also substantiated by the mothers interviewed during the facility visits, who mentioned having received TT injections and the ‘red pills’. HMIS data for distribution of IFA tablets to ANC registered women is low at 43%. Further, consumption of IFA tablets was infrequent as derived from interview with mothers. Delay in ANC registration and less than 3 ANC checks was observed from records of sub centres Uleta and Raoli.

JSSK and the residual cost of care to pregnant women and sick new born

User fee for OPD and IPD services

In Mewat district, the maximum caseload for deliveries is in the DH Mandikhera and 7 pregnant women who were admitted in the post natal wards were interviewed . None of the admitted women were charged any user fee for admission into OPD and IPD.

Drugs and equipment Drugs for delivery and post natal were received by all 7 beneficiaries in house and free of cost as a part of the free entitlement under JSSK. The DH and the CHCs visited were well stocked with essential medicines. EDL was displayed in the DH and the other facilities visited.

Diagnostics

The DH has an USG machine, manned by an MO trained in sinology and 6 of the mothers interviewed had got USG done in the hospital free of charge. A mother who had undergone ultra sonography in a private diagnostic centre had spent Rs. 400. The other ANC related diagnostic tests are available in the CHCs and the DH and being provided free of cost to pregnant women.

Diet

At the District hospital, bread, milk and egg was received by the 5 mothers interviewed in the post natal wards. The hospital has space constraints and kitchen is not set up for cooking meals. In the CHC and PHCs, one time dry diet of biscuits and kismis (raisins) is being provided to the mothers. The reasons as cited by the BMOs and MOICs being the low caseloads in the facility and short stay duration in the facility. During the visit to the CHC Firozpur Zirka, husband of a women who deleivered normally was adament to take her wife home same day in spite of the reasoning by the BMO and available staff.

Transport

The interviews with mothers in the district showed that nearly half (4 of the 7) mothers had reached the facility by private vehicle- i.e., the personal vehicle of the patient. The district has 16 ambulances as a part of the 102 fleet; 1 ALS which has 2 EMTs. Currently the functionality of the patient transport system is low since the toll free number in the district is not functioning due to the erratic telecom network in the district. A TATA Indicom number has been provided in lieu of the BSNL number, which is available with the ASHAs. However, not many in the community are aware of this number and hence are missing out on this free entitlement.

4. HUMAN RESOURCES

The district by virtue of being underdeveloped than the rest of Haryana, faces a severe crunch of skilled health human resources as well as techno managerial staff. The state has sanctioned Deputy Civil surgeon / Programme Officers positions in the district , of which only 1 could be filled so far. Considering the problem of getting manpower in the district from outside, The district has been provided the flexibility to recruit retired Civil Surgeons who have served in Mewat. Currently, a retired Civil Surgeon is working as a District Malaria Officer . The vacancies are especially high for Staff Nurses and MOs. There are 25 positions of MOs lying vacant, this in spite of a special incentive to MOs of Rs. 10,000 and Rs. 25,000 per month. Mewat has also been provided the scope to hire specialists with a much higher salary ( up to 1.20 lakhs) compared to other districts. The district hospital does not have a

12 gynaecologist, and the other specialists positions ( Eye, Medicine, Ortho, ENT) are vacant. The DH has two EmOC trained MOs, one of whom undertakes assisted and vaginal deliveries, but is yet to conduct a C-section. There are 84 Sub centres with 2 ANMs. Category/ type of personnel

Regular Contractual Staff Position Sanction In Sanctioned In position In position ed posts positio posts (through State/ from NRHM n other sources) LTs 23 1 8 22 8 Pharmacists 18 5 4 13 4 Paramedics AYUSH Paramedics 8 8 X ray Technician 6 3 MOs total 79 62 4 AYUSH MO 8 8 Specialists total Gynaecologist Anaesthetist 1 Paediatrician 2

5. CHILD HEALTH

For facility based care for sick new born, the district hospital has a 8 bedded SNCU , supervised by a paediatrician. The unit has a full time NSSK trained staff nurse in charge. Most of the sick new born are inborn cases. During the visit, a single pre term baby was admitted in the SNCU. The team of paediatrician and SNs, manage most of the cases and only 7% cases are referred . A issue that needs to be looked into is the 10% LAMA cases (this needs to be improved considering the free entitlements for sick new born under JSSK).

MONTH/YEAR ADMISSION DISCHARGE LAMA/DOR REFERRED DEATHS April,12 45 29 1 2 2 May,12 78 37 6 6 8 June,12 65 39 4 2 3 July,12 94 58 22 7 17 August,12 75 40 5 5 9 September,12 85 52 4 11 12 October,12 69 42 15 1 6 November,12 50 31 5 4 5 December, 12 39 20 0 1 6 January, 13 29 11 2 3 5 February, 13 34 16 3 2 6 March ,13 30 12 2 5 3 Total 693 387 69 49 82 Source : Civil Surgeon’s office , Mewat. Note: The data seems incomplete as the figures don’t add up, and the officials could not provide satisfactory explanation

Below the DH, the CHCs , PHCs and SC/ delivery huts have new born care corners ( observed during the visit to CHC, Firozpur Zirka in Labour room and ward) . The district has a pool of 25 MOs trained in F-IMNCI and 8 SNs and 45 ANMs. Further 18 MOs , 51 SNs and 134 ANMs are trained in NSSK.

For provision of Home based new born care, the district has undertaken the HBPNC training for 16 MOs, 341 ASHAs and 4 LHVs. Home visits are being undertaken by the ASHAs. The ASHAs that we interacted with during the visit were well versed with the schedule of visits for new born .

6.IMMUNIZATION

Full Immunization coverage in the district is around 35% ( as per state data) - this being a result of a resistance from the Meo community, due to beliefs regarding side effects and related taboos. There are 14 cold chain points and two immunization sessions are held in a week ( each Wed and Fri). Approximately 1000-1500 children are immunized per session.

Drop outs and missed out cases are large in numbers – HMIS reports for the district shows 26% drop outs from BCG to DPT 3, and 21% from BCG to measles. In order to address the problem of high drop outs and missed out cases , the district has prepared microplans at the village / sub centre level Immunization calendar and an ANM roster for every facility . A plan for integrated supervision for RI and polio ( in high risk areas such as Punhana) has been prepared where 50% supervision would be done by MOs, 25%by CDPOs and Supervisors, 25% by WHO staff based in the district ( they have also provided 10 monitors for the district). Further, with the support of the District Administration, a directory of ANMs, AWWs, ASHAs , MOs and Panchayat members have been prepared for monitoring of the RI sessions.

Recommendation: The district would need to plan more sessions, and work strengthen BCC strategy to reach the missed cases. The VHNDs need to be utilised as a platform for mobilising parents for full immunization. The ASHAs need to be utilised for door to door advocacy on this .

7. FAMILY PLANNING SERVICES

As per HMIS data, the district has an unmet need of 13.3; 29.1% for limiting and 35.1% for spacing. The response to the family planning services is low, for permanent methods ( 1% sterilization) and family sizes range from 6-8. Response to spacing methods is better, IUD users being 30% and this has picked up gradually. The fixed day family planning services desired for DH is currently not available due to lack of gynaecologist and surgeon. Services are currently provided through camps in the DH on Tuesdays and Thursdays, where gynaecologists from Gurgaon perform sterilization. CHC Firozpur Zirka is also a camp site.

Mewat is the pilot district in Haryana selected by the MoHFW for rolling out the Scheme for ‘home delivery of contraceptives by ASHAs.’ During the interactions with ASHAs in the PHC Nagina and SC Uleta, the ASHAs reported that there has been a mixed response from the community to this scheme. While a few women have welcomed the initiative, others have a problem with this home delivery since they face the wrath of their husbands and family members.

8.ARSH

The Menstrual hygience scheme is yet to be implemented in the community. Training of trainers has been conducted following which the programme will be rolled out. The ASHA would be distributing the napkins and felt that the adolescent girls would be responsive to this scheme.

9. REFERRAL TRANSPORT

The district has 16 ambulances under the 102 services, 1 ALS which has 2 EMTs . Currently the functionality of the patient transport system is low since the toll free number in the district is not functioning due to the erratic telecom network in the district. A TATA Indicom number has been provided in lieu of the BSNL number, which is available with the ASHAs. However, not many in the community are aware of this number and hence are missing out on this free entitlement.

10. COMMUNITY PROCESSES

ASHA

The district requires a team of 1,089 ASHAs to ensure adequate coverage of each habitat and currently only 716 ASHAs are in place. The district has several villages with large population e.g. village Bichor with 15,000 population and having 15 ASHAs. As a special case, the basic qualification for selecting an ASHA in Mewat has been reduced to Class V . Special permission has also been given to Mewat to select trained Dais as ASHA. Total 75 trained Dais have been appointed as ASHA in 2011-12. The district has of late put in place 26 ASHA facilitators and a District Community Mobiliser.

Skill development : All ASHAs of the district have been trained in module 1 to 5, and 1st round of HBPNC. So far 270 ASHAs have completed second round of the HBPNC training and have received the kits. Drug kits are available with the ASHAs interviewed and are being refilled from the DH, from its central stores

Interaction with ASHAs at the facility level ( in PHC Nagina and SCs Raoli and Uleta) shows that the ASHAs in the district range from young to older women, who are pro-active in their role of mobilisers. They accompany women to the institutional for deliveries and have managed to mobilise family planning cases ( for IUD insertion and few sterilization cases),

15 though with a lot of convincing. They are currently engaged in the home delivery of contraceptive schemes which started off with a mixed response from the community and is gradually getting a positive response. However, during the group discussion, when enquired why they not charging any money (Re .1) for sale of the contraceptives, the responses ranged from “they feel shy to ask for money” to “people know that this is free stuff available in sub centres, so why would they pay for it.”

Group discussions with ASHAs in PHC Nagina

There are several NGOs who are engaged in social mobilization in the district. Among these, IRRAD also known as Sehgal foundation has a strong foundation in the district and good rapport with the community. Local girls from the Meo community have been trained and inducted into social work by this NGO ( one of them is employed as a District Community Mobiliser). They are reaching out to the community through a popular radio station called ‘Alfaz e Mewat’, which broadcasts popular and informative programmes in the Nagina, Puhnana and Firozpur Zirka areas. This radio station was visited during this tour and we had interactions with the local staff members. The community workers of this organization also supported us by organising interaction with the VHSC members trained by them.

The radio Mewat station studio in IRRAD premises

ASHAs displaying the aids received by them (thermometer, torch and uniform)

VHSNC – 297 are functioning in the district. Most of the VHSNCs have women members, including the AWWs, ASHAs and adolescents (two VHSNCs were interviewed during this visit). Most members have been actively engaged with the VHSNCs for two years. Meetings are held every month. The members had been active in aware generation through talks and meetings on seasonal ailments e.g diarrhoea, disability and general cleanliness drives for the locality. The VHSNC funds have been used to undertake cleanliness of the village areas, construction of ramps for delivery huts, purchase of medicines for SCs. The members are trained from time to time by the IRRAD members.

Recommendation : The VHSNCs need to utilise the VHNDs for mobilising the community for ANCs, PNCs and immunization. Counselling on FP choices, especially spacing methods needs to be introduced , through the ASHAs.

11. DISEASE CONTROL PROGRAMMES

MALARIA

Mewat has been identified as one of the high risk areas by the Haryana. The ABER of the district was 13.5 and the API was 1.5 ( 2011). Some pockets of the district are high risk for malaria, e.g. the region of the PHC Ujina which has an API of over 5. The district reported 1,317 malaria cases in last year of which 12 were PF cases . The district has a shortfall of staff in the Malaria programme, several LT positions are lying vacant which has affected the preparation of malaria slides. The districts has 84 MPW positions sanctioned and currently 25 positions are filled ( 8 regular and 17 contractual). There are vacancies in LT positions in PHCs Ujina, Nuh, Ghasera and Pingewa.The state plans to depute MPWs from other districts so that the district can undertake source surveys in April.

12. NON COMMUNICABLE DISEASES

The two key programmes under NCD, NPHCE (National Programme for the Health Care of Elderly) and NPDCDCS (National Programme for Prevention of Cancer, Diabetes, Cardiovascular diseases and Stroke) are being implemented in the district. NCD Cell formed for the operationalization of the schemes have been functioning since 2010-11 , comprising a SN, a computer operator and a counsellor . However, the cell does not have a dedicated Programme Manager and the Paediatrician of the DH is in charge of the Cell. Reporting units are also available in CHCs. Earlier the screening was done in a campaign mode. Screening reports for the year ( till march 2013) show that major suspected NCDs are hypertension (2.9%) and diabetes (1.8%), however this is comparatively lower than the national average (nearly 7% each)

Facilities Total no. Diabetes Hypertension CVD Cancer Referred screened Sub centre 172,033 2351 3,679 7 0 6037 based CHC report NCD clinic 15,440 1224 1,665 0 2 193 in CHC GH 16,542 297 633 73 42 70 Mandikhera 204,015 3872 5977 (2.9%) 80 44 6300 (1.8%)

13. HMIS

The district has started facility wise data reporting. However, there are several data quality issues at large . The district does not have an M&E manager and a former data entry operator is managing the HMIS.

Recommendation: The district needs more support and handholding from the state to improve the quality of reporting in HMIS. A team of HMIS Manager and data assistant is required to supervise the data quality for accuracy and authencity ( issues of over reporting of deliveries needs to be probed and investigated). Further, quarterly data analysis needs to be done and used for identifying gaps and improving the programme implementation . A additional round of training of the data entry persons for HMIS may be organised by the state level HMIS officers.

14.BCC/ IEC

The Meo community of the district has deep rooted beliefs borne out of their religious affiliation and historic and cultural mores. A resistance towards adopting family planning

19 methods and immunization is one of the challenges faced by the district health administration in achieving IEC/BCC needs focussed attention in the district.

Recommendation: State should place a district BCC coordinator with professional skills in health planning . A district plan for IEC/ BCC needs to be prepared with the consultation of ASHAs, ANMs, AWWs, panchayat members, VHSC members, ICDS officers and community members ( especially adolescent women and mothers) for identifying the key behaviours that would need to be influenced. Subsequently, develop a plan and use the local FM radio station, local folklore and traditional arts for BCC.

Annexure 1

Haryana

April 12 - Jan 13

Comparison with Last Year Performance using HMIS data from National Web portal

National Health Systems Resource Centre

Haryana - Apr'12 - Jan'13 DLHSIII

Population (Census-2011) Estimated Pregnancies ANC 2,53,53,081 6,28,270

ANC Check-up in first CBR (SRS-2011) 22 Estimated Deliveries 5,71,154 55 trimester

Apprehended Infant Deaths ( IMR 3 or more ANC Check- 26773 Estimated Live Births 5,57,768 51.8 = 48 taken from SRS - 2011 ) up Estimated Maternal Estimated Eligible couples ( 17% Complications( 15% of Atleast 1 TT received of population) 43,10,024 94,240 85.9 Estimated pregnancies) Last Year 2011 - Indicator Apr'12 - Jan'13 Projected for 2012 - 13 100 IFA Tablets 29 12 3ANC Check up against estimated 63% 76% 78% Deliveries pregnancies Institutional Deliveries (Public+Private) against estimated 56% 68% 76% Institutional Delivery 46.8 deliveries

Met need for EmOC * 28.54% 34% 33.47% Home Delivery 52.7

Reported Live Births against 72% 87% 95% Home Delivery by SBA 6.4 estimated Live Births New born & post BCG to Measles dropout rate 4% 4% 6% natal care Fully Immunised against Abortion (Induced + 74% 89% 90% estimated Live Births Spontaneous) Immunisation session held as % of 58% 58% 51% Still Birth 1.8 required VHNDs Childhood Disease Diphtheria 127 152.4 100 Live Birth 84.5 Breastfed within 1 Childhood Disease Pertussis 14 16.8 4 hour of birth 16.5 PNC within 48 hrs of Childhood Disease Measles 188 225.6 192 delivery

Childhood Disease Malaria 3104 3724.8 3036 Immunisation

Sterilization - Female per 1000 BCG 86.5 eligible couple 12.12 14.55 16.42 Sterilization - Male per 1000 DPT3 69 eligible couple 1.05 1.25 1.60

Reported Abortion Rate per 1000 65.7 93.8 Measeles 69 Estimated live births 78.9

OPD All (per 1000 population) 470.7 549.5 Full immunisation 564.8 59.6

IPD (per 1000 population) 24.5 30.0 Unmet need for FP 29.3

Operation Major (per Lakh 150.5 151.914 Spacing 5.2 population) 180.6

Reported Infant and Child Deaths 5086 8751 Limiting 10.2 6,103.2

Reported Maternal Deaths 369 416 Total 15.4 442.8 * Total Maternal complications ( C-section deliveries + Eclampsia cases )treated against estimated maternal complication

Ambala - Apr'12 - Jan'13 DLHSIII

Population (Census-2011) 11,36,784 Estimated Pregnancies ANC 28,170 ANC Check-up in first CBR (SRS-2011) 22 Estimated Deliveries 25,609 59.5 trimester Apprehended Infant Deaths ( IMR = 3 or more ANC Check- 1200 Estimated Live Births 25,009 57.7 48 taken from SRS - 2011 ) up Estimated Maternal Estimated Eligible couples ( 17% of Complications( 15% of Atleast 1 TT received population) 1,93,253 4,226 83 Estimated pregnancies) Apr'12 - Last Year 2011 - Indicator Projected for 2012 - 13 100 IFA Tablets 37.7 Jan'13 12

3ANC Check up against estimated 62% 75% 71% Deliveries pregnancies

Institutional Deliveries (Public+Private) against estimated 46% 55% 73% Institutional Delivery 55.4 deliveries

Met need for EmOC * 19.29% 23% 26.69% Home Delivery 43.7

Reported Live Births against 55% 66% 85% Home Delivery by SBA 7.5 estimated Live Births New born & post BCG to Measles dropout rate -7% -7% -13% natal care Fully Immunised against estimated Abortion (Induced + 76% 91% 96% Live Births Spontaneous) Immunisation session held as % of 59% 59% 55% Still Birth 1.5 required VHNDs

Childhood Disease Diphtheria 0 0 0 Live Birth 82.4

Breastfed within 1 Childhood Disease Pertussis 0 0 0 19 hour of birth PNC within 48 hrs of Childhood Disease Measles 0 0 0 69.9 delivery Childhood Disease Malaria 49 58.8 0 Immunisation

Sterilization - Female per 1000 BCG eligible couple 10.19 12.23 13.47 95.2 Sterilization - Male per 1000 DPT3 82 eligible couple 0.42 0.51 0.59 Reported Abortion Rate per 1000 93.8 175.2 Measeles 91.9 Estimated live births 112.6

OPD All (per 1000 population) 565.6 888.8 Full immunisation 678.7 79.1

IPD (per 1000 population) 82.5 120.7 Unmet need for FP 99.0 Operation Major (per Lakh 121.9 185.259 Spacing population) 146.3 3.9

Reported Infant and Child Deaths 300 383 Limiting 360.0 10.7

Reported Maternal Deaths 11 1 Total 13.2 14.7 * Total Maternal complications ( C-section deliveries + Eclampsia cases )treated against estimated maternal complication

Bhiwani - Apr'12 - Jan'13 DLHSIII

Population (Census-2011) 16,29,109 Estimated Pregnancies ANC 40,371 ANC Check-up in first CBR (SRS-2011) 22 Estimated Deliveries 36,701 48.9 trimester Apprehended Infant Deaths ( IMR = 3 or more ANC Check- 1720 Estimated Live Births 35,840 48.3 48 taken from SRS - 2011 ) up Estimated Maternal Estimated Eligible couples ( 17% of Complications( 15% of Atleast 1 TT received population) 2,76,949 6,056 90.8 Estimated pregnancies) Apr'12 - Last Year 2011 - Indicator Projected for 2012 - 13 100 IFA Tablets 22.2 Jan'13 12 3ANC Check up against estimated 56% 67% 69% Deliveries pregnancies Institutional Deliveries (Public+Private) against estimated 41% 49% 69% Institutional Delivery 35.7 deliveries

Met need for EmOC * 4.76% 6% 2.96% Home Delivery 64.6

Reported Live Births against 56% 67% 85% Home Delivery by SBA estimated Live Births 9.1

New born & post BCG to Measles dropout rate 7% 7% 5% natal care Fully Immunised against estimated Abortion (Induced + 74% 89% 89% Live Births Spontaneous) Immunisation session held as % of 45% 45% 46% Still Birth 0.6 required VHNDs

Childhood Disease Diphtheria 20 24 0 Live Birth 86.7

Breastfed within 1 Childhood Disease Pertussis 1 1.2 0 24.1 hour of birth PNC within 48 hrs of Childhood Disease Measles 5 6 0 delivery 38.8 Childhood Disease Malaria 409 490.8 120 Immunisation Sterilization - Female per 1000 BCG 88.5 eligible couple 15.11 18.14 21.70 Sterilization - Male per 1000 DPT3 eligible couple 0.33 0.40 0.52 70.8 Reported Abortion Rate per 1000 24.3 30.3 Measeles 71.8 Estimated live births 29.1

OPD All (per 1000 population) 312.6 441.1 Full immunisation 58.4 375.2

IPD (per 1000 population) 19.8 24.1 Unmet need for FP 23.7 Operation Major (per Lakh 168.9 92.750 Spacing population) 202.6 5.6

Reported Infant and Child Deaths 71 6 Limiting 85.2 8.8

Reported Maternal Deaths 1 4 Total 1.2 14.4 * Total Maternal complications ( C-section deliveries + Eclampsia cases )treated against estimated maternal complication

Faridabad - Apr'12 - Jan'13 DLHSIII

Population (Census-2011) 17,98,954 Estimated Pregnancies ANC 44,580 ANC Check-up in first CBR (SRS-2011) 22 Estimated Deliveries 40,527 45.5 trimester Apprehended Infant Deaths ( IMR = 3 or more ANC Check- 1900 Estimated Live Births 39,577 48 taken from SRS - 2011 ) up 43.8 Estimated Maternal Estimated Eligible couples ( 17% of Complications( 15% of Atleast 1 TT received population) 3,05,822 6,687 78.9 Estimated pregnancies) Apr'12 - Last Year 2011 - Indicator Projected for 2012 - 13 100 IFA Tablets 29.1 Jan'13 12 3ANC Check up against estimated 65% 78% 87% Deliveries pregnancies Institutional Deliveries (Public+Private) against estimated 78% 93% 87% Institutional Delivery 39.1 deliveries

Met need for EmOC * 26.25% 31% 25.42% Home Delivery 60.6

Reported Live Births against 96% 115% 112% Home Delivery by SBA estimated Live Births 3.6

New born & post BCG to Measles dropout rate -10% -10% -3% natal care Fully Immunised against estimated Abortion (Induced + 102% 122% 112% Live Births Spontaneous) Immunisation session held as % of 74% 74% 43% Still Birth 2.4 required VHNDs

Childhood Disease Diphtheria 0 0 0 Live Birth 84.1

Breastfed within 1 Childhood Disease Pertussis 0 0 0 10.9 hour of birth PNC within 48 hrs of Childhood Disease Measles 0 0 0 delivery 35 Childhood Disease Malaria 0 0 0 Immunisation Sterilization - Female per 1000 BCG 79.2 eligible couple 11.42 13.70 16.62 Sterilization - Male per 1000 DPT3 54.8 eligible couple 0.45 0.54 0.77 Reported Abortion Rate per 1000 171.8 237.1 Measeles 57 Estimated live births 206.2

OPD All (per 1000 population) 666.3 772.6 Full immunisation 46.4 799.5

IPD (per 1000 population) 32.9 35.9 Unmet need for FP 39.5 Operation Major (per Lakh 187.1 176.769 Spacing population) 224.5 7.7

Reported Infant and Child Deaths 277 282 Limiting 332.4 13.6

Reported Maternal Deaths 2 1 Total 2.4 21.3 * Total Maternal complications ( C-section deliveries + Eclampsia cases )treated against estimated maternal complication

Fatehabad - Apr'12 - Jan'13 DLHSIII Population (Census- 9,41,522 Estimated Pregnancies ANC 2011) 23,332 ANC Check-up in first CBR (SRS-2011) 22 Estimated Deliveries 21,211 51.2 trimester Apprehended Infant Deaths ( IMR = 48 taken 994 Estimated Live Births 20,713 3 or more ANC Check-up 41.7 from SRS - 2011 ) Estimated Eligible Estimated Maternal

couples ( 17% of Complications( 15% of 1,60,059 3,500 Atleast 1 TT received 88.9 population) Estimated pregnancies) Apr'12 - Last Year 2011 - Indicator Projected for 2012 - 13 100 IFA Tablets 22.8 Jan'13 12

3ANC Check up against 68% 82% 79% Deliveries estimated pregnancies Institutional Deliveries (Public+Private) against 73% 87% 81% Institutional Delivery 48.6 estimated deliveries Met need for EmOC * 49.17% 59% 55.98% Home Delivery 51.1 Reported Live Births against estimated Live 83% 99% 99% Home Delivery by SBA 9.5 Births BCG to Measles dropout 11% 11% 9% New born & post natal care rate Fully Immunised against 71% 85% 87% Abortion (Induced + Spontaneous) estimated Live Births Immunisation session held as % of required 58% 58% 48% Still Birth 2.1 VHNDs Childhood Disease 1 1.2 0 Live Birth 83.5 Diphtheria Childhood Disease Breastfed within 1 hour of 0 0 0 10.8 Pertussis birth Childhood Disease 11 13.2 0 PNC within 48 hrs of delivery 36.7 Measles Childhood Disease 79 94.8 6 Malaria Immunisation

Sterilization - Female BCG 86.8 per 1000 eligible couple 18.43 22.12 26.75

Sterilization - Male per DPT3 72.5 1000 eligible couple 0.24 0.28 0.37 Reported Abortion Rate per 1000 Estimated live 44.5 46.6 53.4 Measeles 76.2 births OPD All (per 1000 454.4 449.7 Full immunisation 62.8 population) 545.3 IPD (per 1000 29.1 30.2 Unmet need for Family Planning population) 34.9 Operation Major (per 266.5 376.199 Lakh population) 319.8 Spacing 4.4 Reported Infant and 435 579 Child Deaths 522.0 Limiting 6.7 Reported Maternal 9 9 Deaths 10.8 Total 11 * Total Maternal complications ( C-section deliveries + Eclampsia cases )treated against estimated maternal complication

Gurgaon - Apr'12 - Jan'13 DLHSIII Population (Census- 15,14,085 Estimated Pregnancies ANC 2011) 37,520 ANC Check-up in first CBR (SRS-2011) 22 Estimated Deliveries 34,109 56.1 trimester Apprehended Infant Deaths ( IMR = 48 taken 1599 Estimated Live Births 33,310 3 or more ANC Check-up 60.1 from SRS - 2011 ) Estimated Eligible Estimated Maternal

couples ( 17% of Complications( 15% of 2,57,394 5,628 Atleast 1 TT received 93.1 population) Estimated pregnancies) Apr'12 - Last Year 2011 - Indicator Projected for 2012 - 13 100 IFA Tablets 38.1 Jan'13 12

3ANC Check up against 75% 89% 90% Deliveries estimated pregnancies Institutional Deliveries (Public+Private) against 65% 78% 77% Institutional Delivery 52.3 estimated deliveries

Met need for EmOC * 61.53% 74% 74.47% Home Delivery 47.5

Reported Live Births against estimated Live 71% 85% 82% Home Delivery by SBA 4.5 Births BCG to Measles dropout 10% 10% 11% New born & post natal care rate Fully Immunised against 90% 108% 100% Abortion (Induced + Spontaneous) estimated Live Births Immunisation session held as % of required 51% 51% 43% Still Birth 1 VHNDs Childhood Disease 0 0 0 Live Birth 81.9 Diphtheria Childhood Disease Breastfed within 1 hour of 0 0 0 17.6 Pertussis birth Childhood Disease 0 0 0 PNC within 48 hrs of delivery 41.3 Measles Childhood Disease 111 133.2 2 Malaria Immunisation

Sterilization - Female BCG 90.7 per 1000 eligible couple 13.23 15.88 17.70

Sterilization - Male per DPT3 74.7 1000 eligible couple 1.94 2.33 2.51 Reported Abortion Rate per 1000 Estimated live 87.8 154.0 105.4 Measeles 76.5 births OPD All (per 1000 538.0 596.2 Full immunisation 70.5 population) 645.6 IPD (per 1000 20.3 23.3 population) 24.4 Unmet need for Family Planning Operation Major (per 168.8 213.330 Lakh population) 202.6 Spacing 3.8 Reported Infant and 349 419 Child Deaths 418.8 Limiting 10 Reported Maternal 0 17 Deaths - Total 13.8 * Total Maternal complications ( C-section deliveries + Eclampsia cases )treated against estimated maternal complication

Hisar - Apr'12 - Jan'13 DLHSIII

Population (Census-2011) 17,42,815 Estimated Pregnancies ANC 43,188 ANC Check-up in first CBR (SRS-2011) 22 Estimated Deliveries 39,262 56 trimester Apprehended Infant Deaths ( IMR = 48 taken 1840 Estimated Live Births 38,342 3 or more ANC Check-up 44.3 from SRS - 2011 ) Estimated Maternal Estimated Eligible couples ( Complications( 15% of 17% of population) 2,96,279 6,478 Atleast 1 TT received 90.6 Estimated pregnancies) Apr'12 - Last Year 2011 - Indicator Projected for 2012 - 13 100 IFA Tablets 18.7 Jan'13 12

3ANC Check up against 51% 61% 63% Deliveries estimated pregnancies Institutional Deliveries (Public+Private) against 58% 69% 73% Institutional Delivery 48.6 estimated deliveries

Met need for EmOC * 32.85% 39% 25.73% Home Delivery 50.7

Reported Live Births against estimated Live 68% 82% 85% Home Delivery by SBA 5.9 Births BCG to Measles dropout 8% 8% 10% New born & post natal care rate Fully Immunised against 75% 90% 89% Abortion (Induced + Spontaneous) estimated Live Births Immunisation session held 63% 63% 51% Still Birth 0.5 as % of required VHNDs Childhood Disease 0 0 0 Live Birth 83.3 Diphtheria Childhood Disease Breastfed within 1 hour of 0 0 0 23 Pertussis birth

Childhood Disease Measles 1 1.2 0 PNC within 48 hrs of delivery 39.7 Childhood Disease Malaria 136 163.2 63 Immunisation

Sterilization - Female per BCG 93.7 1000 eligible couple 24.06 28.87 33.52

Sterilization - Male per DPT3 69.6 1000 eligible couple 0.29 0.34 0.52 Reported Abortion Rate per 1000 Estimated live 57.5 68.1 69.0 Measeles 65.7 births OPD All (per 1000 589.2 601.0 Full immunisation 55.8 population) 707.1

IPD (per 1000 population) 22.6 23.4 Unmet need for Family Planning 27.2 Operation Major (per Lakh 62.1 63.805 population) 74.5 Spacing 6.2 Reported Infant and Child 400 552 Deaths 480.0 Limiting 7.3

Reported Maternal Deaths 0 47 - Total 13.5 * Total Maternal complications ( C-section deliveries + Eclampsia cases )treated against estimated maternal complication

Jhajjar - Apr'12 - Jan'13 DLHSIII

Population (Census-2011) 9,56,907 Estimated Pregnancies ANC 23,713 ANC Check-up in first CBR (SRS-2011) 22 Estimated Deliveries 21,557 54.5 trimester Apprehended Infant Deaths ( IMR = 48 taken 1010 Estimated Live Births 21,052 3 or more ANC Check-up 59.7 from SRS - 2011 ) Estimated Maternal Estimated Eligible couples ( Complications( 15% of 17% of population) 1,62,674 3,557 Atleast 1 TT received 91 Estimated pregnancies) Apr'12 - Last Year 2011 - Indicator Projected for 2012 - 13 100 IFA Tablets 26.3 Jan'13 12

3ANC Check up against 53% 63% 63% Deliveries estimated pregnancies Institutional Deliveries (Public+Private) against 43% 51% 59% Institutional Delivery 48 estimated deliveries

Met need for EmOC * 6.72% 8% 10.18% Home Delivery 51.6

Reported Live Births against estimated Live 51% 61% 84% Home Delivery by SBA 9.9 Births BCG to Measles dropout 4% 4% -1% New born & post natal care rate Fully Immunised against 63% 76% 94% Abortion (Induced + Spontaneous) estimated Live Births Immunisation session held 66% 66% 63% Still Birth 1.9 as % of required VHNDs Childhood Disease 0 0 0 Live Birth 81.8 Diphtheria Childhood Disease Breastfed within 1 hour of 0 0 0 15.7 Pertussis birth

Childhood Disease Measles 10 12 36 PNC within 48 hrs of delivery 40.9 Childhood Disease Malaria 26 31.2 14 Immunisation

Sterilization - Female per BCG 90.6 1000 eligible couple 10.85 13.02 14.32

Sterilization - Male per DPT3 81.2 1000 eligible couple 0.28 0.33 0.55 Reported Abortion Rate per 1000 Estimated live 50.4 60.9 60.5 Measeles 69.6 births OPD All (per 1000 670.5 707.5 Full immunisation 64.8 population) 804.6

IPD (per 1000 population) 29.7 33.9 Unmet need for Family Planning 35.6 Operation Major (per Lakh 125.0 110.042 population) 150.0 Spacing 7.5 Reported Infant and Child 234 358 Deaths 280.8 Limiting 10.6

Reported Maternal Deaths 8 18 9.6 Total 18 * Total Maternal complications ( C-section deliveries + Eclampsia cases )treated against estimated maternal complication

Jind - Apr'12 - Jan'13 DLHSIII

Population (Census-2011) 13,32,042 Estimated Pregnancies ANC 33,009 ANC Check-up in first CBR (SRS-2011) 22 Estimated Deliveries 30,008 58 trimester Apprehended Infant Deaths ( IMR = 48 taken from SRS - 1407 Estimated Live Births 29,305 3 or more ANC Check-up 55.4 2011 ) Estimated Maternal Estimated Eligible couples ( Complications( 15% of 17% of population) 2,26,447 4,951 Atleast 1 TT received 92.3 Estimated pregnancies) Apr'12 - Last Year 2011 - Indicator Projected for 2012 - 13 100 IFA Tablets 17.5 Jan'13 12

3ANC Check up against 55% 66% 79% Deliveries estimated pregnancies Institutional Deliveries (Public+Private) against 52% 62% 77% Institutional Delivery 42.1 estimated deliveries Met need for EmOC * 5.86% 7% 8.60% Home Delivery 56.9 Reported Live Births against 67% 80% 100% Home Delivery by SBA 6.2 estimated Live Births BCG to Measles dropout 2% 2% 0% New born & post natal care rate Fully Immunised against 61% 73% 93% Abortion (Induced + Spontaneous) estimated Live Births Immunisation session held 47% 47% 50% Still Birth 0.9 as % of required VHNDs Childhood Disease 4 4.8 0 Live Birth 85.2 Diphtheria Breastfed within 1 hour of Childhood Disease Pertussis 6 7.2 0 12.1 birth

Childhood Disease Measles 1 1.2 0 PNC within 48 hrs of delivery 42.5 Childhood Disease Malaria 0 0 0 Immunisation Sterilization - Female per BCG 92.5 1000 eligible couple 9.30 11.15 19.21

Sterilization - Male per DPT3 66.4 1000 eligible couple 1.11 1.34 1.17 Reported Abortion Rate per 31.4 30.1 Measeles 67.3 1000 Estimated live births 37.6 OPD All (per 1000 234.4 169.1 Full immunisation 55.4 population) 281.3

IPD (per 1000 population) 14.2 10.6 17.0 Unmet need for Family Planning Operation Major (per Lakh 47.2 62.986 population) 56.7 Spacing 6.1 Reported Infant and Child 26 7 Deaths 31.2 Limiting 7.8

Reported Maternal Deaths 1 0 1.2 Total 13.9 * Total Maternal complications ( C-section deliveries + Eclampsia cases )treated against estimated maternal complication

Kaithal - Apr'12 - Jan'13 DLHSIII

Population (Census-2011) 10,72,861 Estimated Pregnancies ANC 26,586 ANC Check-up in first CBR (SRS-2011) 22 Estimated Deliveries 24,169 65.3 trimester Apprehended Infant Deaths ( IMR = 48 taken from SRS - 1133 Estimated Live Births 23,603 3 or more ANC Check-up 64 2011 ) Estimated Maternal Estimated Eligible couples ( Complications( 15% of 17% of population) 1,82,386 3,988 Atleast 1 TT received 93.1 Estimated pregnancies) Apr'12 - Last Year 2011 - Indicator Projected for 2012 - 13 100 IFA Tablets 29.5 Jan'13 12

3ANC Check up against 64% 76% 92% Deliveries estimated pregnancies Institutional Deliveries (Public+Private) against 57% 69% 80% Institutional Delivery 48 estimated deliveries

Met need for EmOC * 13.69% 16% 15.35% Home Delivery 52

Reported Live Births against 71% 85% 94% estimated Live Births Home Delivery by SBA 9.4

BCG to Measles dropout rate 9% 9% 8% New born & post natal care

Fully Immunised against 89% 107% 105% Abortion (Induced + Spontaneous) estimated Live Births Immunisation session held as 58% 58% 36% Still Birth 0.4 % of required VHNDs

Childhood Disease Diphtheria 0 0 0 Live Birth 85.8 Breastfed within 1 hour of Childhood Disease Pertussis 1 1.2 0 18.5 birth

Childhood Disease Measles 1 1.2 0 PNC within 48 hrs of delivery 45.8 Childhood Disease Malaria 1 1.2 0 Immunisation

Sterilization - Female per BCG 91.9 1000 eligible couple 9.57 11.48 11.89

Sterilization - Male per 1000 DPT3 83.5 eligible couple 1.73 2.08 2.11

Reported Abortion Rate per 59.4 74.5 Measeles 73.7 1000 Estimated live births 71.3

OPD All (per 1000 population) 558.0 631.7 669.6 Full immunisation 72.5

IPD (per 1000 population) 15.0 17.9 Unmet need for Family Planning 18.0 Operation Major (per Lakh 93.3 113.155 population) 112.0 Spacing 3.5 Reported Infant and Child 604 518 Deaths 724.8 Limiting 8.3

Reported Maternal Deaths 25 107 30.0 Total 11.8 * Total Maternal complications ( C-section deliveries + Eclampsia cases )treated against estimated maternal complication

Karnal - Apr'12 - Jan'13 DLHSIII

Population (Census-2011) 15,06,323 Estimated Pregnancies ANC 37,328 ANC Check-up in first CBR (SRS-2011) 22 Estimated Deliveries 33,934 61.9 trimester Apprehended Infant Deaths ( IMR = 48 taken from SRS - 1591 Estimated Live Births 33,139 3 or more ANC Check-up 58.9 2011 ) Estimated Maternal Estimated Eligible couples ( Complications( 15% of 17% of population) 2,56,075 5,599 Atleast 1 TT received 88.2 Estimated pregnancies) Apr'12 - Last Year 2011 - Indicator Projected for 2012 - 13 100 IFA Tablets 28.1 Jan'13 12

3ANC Check up against 56% 67% 70% Deliveries estimated pregnancies Institutional Deliveries (Public+Private) against 60% 72% 85% Institutional Delivery 51.3 estimated deliveries

Met need for EmOC * 15.47% 19% 21.15% Home Delivery 47.8

Reported Live Births against 69% 83% 95% Home Delivery by SBA 5.8 estimated Live Births

BCG to Measles dropout rate -5% -5% 7% New born & post natal care

Fully Immunised against 43% 52% 48% Abortion (Induced + Spontaneous) estimated Live Births Immunisation session held as 54% 54% 51% Still Birth 2.1 % of required VHNDs Childhood Disease Diphtheria 0 0 0 Live Birth 85.9 Breastfed within 1 hour of Childhood Disease Pertussis 0 0 0 7.8 birth

Childhood Disease Measles 0 0 84 PNC within 48 hrs of delivery 58 Childhood Disease Malaria 62 74.4 0 Immunisation Sterilization - Female per 1000 BCG 98.1 eligible couple 6.58 7.90 10.49 Sterilization - Male per 1000 DPT3 89.9 eligible couple 2.98 3.57 6.03 Reported Abortion Rate per 66.3 71.5 Measeles 87.1 1000 Estimated live births 79.6

OPD All (per 1000 population) 286.9 333.2 344.3 Full immunisation 75.2

IPD (per 1000 population) 13.5 14.3 Unmet need for Family Planning 16.2 Operation Major (per Lakh 32.7 35.119 population) 39.3 Spacing 5.4 Reported Infant and Child 227 159 Deaths 272.4 Limiting 10.6

Reported Maternal Deaths 32 31 38.4 Total 16 * Total Maternal complications ( C-section deliveries + Eclampsia cases )treated against estimated maternal complication

Kurukshetra - Apr'12 - Jan'13 DLHSIII

Population (Census-2011) 9,64,231 Estimated Pregnancies ANC 23,894 ANC Check-up in first CBR (SRS-2011) 22 Estimated Deliveries 21,722 65.9 trimester Apprehended Infant Deaths ( IMR = 48 taken from SRS - 1018 Estimated Live Births 21,213 3 or more ANC Check-up 61.5 2011 ) Estimated Maternal Estimated Eligible couples ( Complications( 15% of 17% of population) 1,63,919 3,584 Atleast 1 TT received 90.7 Estimated pregnancies) Apr'12 - Last Year 2011 - Indicator Projected for 2012 - 13 100 IFA Tablets 24.3 Jan'13 12 3ANC Check up against 60% 72% 73% Deliveries estimated pregnancies Institutional Deliveries (Public+Private) against 44% 53% 81% Institutional Delivery 64.2 estimated deliveries Met need for EmOC * 59.07% 71% 103.59% Home Delivery 35.5

Reported Live Births against 48% 58% 86% Home Delivery by SBA 3.6 estimated Live Births

BCG to Measles dropout rate -8% -8% 13% New born & post natal care

Fully Immunised against 67% 80% 73% Abortion (Induced + Spontaneous) estimated Live Births Immunisation session held as 60% 60% 57% Still Birth 1.7 % of required VHNDs

Childhood Disease Diphtheria 36 43.2 0 Live Birth 86.9

Breastfed within 1 hour of Childhood Disease Pertussis 6 7.2 0 18.8 birth Childhood Disease Measles 3 3.6 18 PNC within 48 hrs of delivery 65.6 Childhood Disease Malaria 0 0 32 Immunisation Sterilization - Female per BCG 93.8 1000 eligible couple 7.75 9.30 12.93 Sterilization - Male per 1000 DPT3 77.9 eligible couple 2.25 2.69 4.11 Reported Abortion Rate per 81.8 113.0 Measeles 82.7 1000 Estimated live births 98.1

OPD All (per 1000 population) 560.0 744.3 Full immunisation 67.8 672.0

IPD (per 1000 population) 21.3 25.1 25.6 Unmet need for Family Planning Operation Major (per Lakh 473.5 299.513 population) 568.2 Spacing 2.7 Reported Infant and Child 161 240 Deaths 193.2 Limiting 9.6

Reported Maternal Deaths 8 10 9.6 Total 12.3 * Total Maternal complications ( C-section deliveries + Eclampsia cases )treated against estimated maternal complication

Mahendargarh - Apr'12 - Jan'13 DLHSIII

Population (Census-2011) 9,21,680 Estimated Pregnancies ANC 22,840 ANC Check-up in first CBR (SRS-2011) 22 Estimated Deliveries 20,764 55 trimester Apprehended Infant Deaths ( IMR = 48 taken from SRS - 973 Estimated Live Births 20,277 3 or more ANC Check-up 53.1 2011 ) Estimated Maternal Estimated Eligible couples ( Complications( 15% of 17% of population) 1,56,686 3,426 Atleast 1 TT received 94.9 Estimated pregnancies) Apr'12 - Last Year 2011 - Indicator Projected for 2012 - 13 100 IFA Tablets 17.2 Jan'13 12 3ANC Check up against 65% 78% 68% Deliveries estimated pregnancies Institutional Deliveries (Public+Private) against 48% 57% 72% Institutional Delivery 56.8 estimated deliveries

Met need for EmOC * 33.25% 40% 43.55% Home Delivery 43.1

Reported Live Births against 62% 74% 85% estimated Live Births Home Delivery by SBA 8.3

BCG to Measles dropout rate -1% -1% 12% New born & post natal care

Fully Immunised against 98% 118% 81% Abortion (Induced + Spontaneous) estimated Live Births Immunisation session held as 65% 65% 57% Still Birth 0.8 % of required VHNDs

Childhood Disease Diphtheria 6 7.2 0 Live Birth 85.3

Breastfed within 1 hour of Childhood Disease Pertussis 0 0 0 23.3 birth Childhood Disease Measles 0 0 0 PNC within 48 hrs of delivery 51.3 Childhood Disease Malaria 4 4.8 0 Immunisation Sterilization - Female per BCG 92.1 1000 eligible couple 13.08 15.69 18.80 Sterilization - Male per 1000 DPT3 79.4 eligible couple 1.27 1.52 1.21 Reported Abortion Rate per 60.6 87.4 Measeles 71.9 1000 Estimated live births 72.7 OPD All (per 1000 469.4 612.7 Full immunisation 67.7 population) 563.3

IPD (per 1000 population) 12.0 40.9 14.4 Unmet need for Family Planning Operation Major (per Lakh 167.6 135.296 population) 201.2 Spacing 4.1 Reported Infant and Child 40 16 Deaths 48.0 Limiting 8.8

Reported Maternal Deaths 0 6 - Total 12.9 * Total Maternal complications ( C-section deliveries + Eclampsia cases )treated against estimated maternal complication

Mewat - Apr'12 - Jan'13 DLHSIII

Population (Census-2011) 10,89,406 Estimated Pregnancies ANC 26,996 ANC Check-up in first CBR (SRS-2011) 22 Estimated Deliveries 24,542 17.4 trimester Apprehended Infant Deaths ( IMR = 48 taken from SRS - 1150 Estimated Live Births 23,967 3 or more ANC Check-up 17 2011 ) Estimated Maternal Estimated Eligible couples ( Complications( 15% of 17% of population) 1,85,199 4,049 Atleast 1 TT received 52.7 Estimated pregnancies) Apr'12 - Last Year 2011 - Indicator Projected for 2012 - 13 100 IFA Tablets 48.8 Jan'13 12 3ANC Check up against 78% 93% 104% Deliveries estimated pregnancies Institutional Deliveries (Public+Private) against 47% 56% 58% Institutional Delivery 14.8 estimated deliveries

Met need for EmOC * 0.44% 1% 0.07% Home Delivery 84.5

Reported Live Births against 124% 149% 139% estimated Live Births Home Delivery by SBA 1.5

BCG to Measles dropout rate 18% 18% 14% New born & post natal care

Fully Immunised against 92% 111% 109% Abortion (Induced + Spontaneous) estimated Live Births Immunisation session held as 54% 54% 54% Still Birth 1.9 % of required VHNDs

Childhood Disease Diphtheria 0 0 0 Live Birth 88.7

Breastfed within 1 hour of Childhood Disease Pertussis 0 0 0 7.5 birth Childhood Disease Measles 2 2.4 0 PNC within 48 hrs of delivery 33.5 Childhood Disease Malaria 78 93.6 849 Immunisation Sterilization - Female per BCG 48.5 1000 eligible couple 0.33 0.40 2.40 Sterilization - Male per 1000 DPT3 14 eligible couple 0.04 0.05 0.14 Reported Abortion Rate per 1.9 4.1 Measeles 20.3 1000 Estimated live births 2.3

OPD All (per 1000 population) 245.9 329.7 Full immunisation 11 295.1

IPD (per 1000 population) 11.7 12.5 14.1 Unmet need for Family Planning Operation Major (per Lakh 105.5 11.750 population) 126.6 Spacing 13.3 Reported Infant and Child 392 623 Deaths 470.4 Limiting 21.9

Reported Maternal Deaths 81 60 97.2 Total 35.1 * Total Maternal complications ( C-section deliveries + Eclampsia cases )treated against estimated maternal complication

Panchkula - Apr'12 - Jan'13 DLHSIII

Population (Census-2011) 5,58,890 Estimated Pregnancies ANC 13,850 ANC Check-up in first CBR (SRS-2011) 22 Estimated Deliveries 12,591 68.2 trimester Apprehended Infant Deaths ( IMR = 48 taken from SRS - 590 Estimated Live Births 12,296 3 or more ANC Check-up 72.3 2011 ) Estimated Maternal Estimated Eligible couples ( Complications( 15% of 17% of population) 95,011 2,077 Atleast 1 TT received 90 Estimated pregnancies) Apr'12 - Last Year 2011 - Indicator Projected for 2012 - 13 100 IFA Tablets 27.9 Jan'13 12

3ANC Check up against 117% 140% 150% Deliveries estimated pregnancies Institutional Deliveries (Public+Private) against 74% 88% 90% Institutional Delivery 64.3 estimated deliveries

Met need for EmOC * 104.50% 125% 121.69% Home Delivery 35.4

Reported Live Births against 80% 96% 93% estimated Live Births Home Delivery by SBA 3.5

BCG to Measles dropout rate -13% -13% 12% New born & post natal care

Fully Immunised against 82% 99% 109% Abortion (Induced + Spontaneous) estimated Live Births Immunisation session held as 94% 94% 63% Still Birth 1.8 % of required VHNDs

Childhood Disease Diphtheria 6 7.2 0 Live Birth 84.2

Breastfed within 1 hour of Childhood Disease Pertussis 0 0 4 19.7 birth

Childhood Disease Measles 14 16.8 18 PNC within 48 hrs of delivery Childhood Disease Malaria 8 9.6 39 Immunisation Sterilization - Female per 1000 BCG 94.9 eligible couple 10.86 13.03 16.27 Sterilization - Male per 1000 eligible couple 5.30 6.37 1.16 DPT3 88.7 Reported Abortion Rate per 257.6 453.7 Measeles 82.8 1000 Estimated live births 309.1

OPD All (per 1000 population) 1185.0 1237.6 1,422.0 Full immunisation 78.1

IPD (per 1000 population) 75.6 113.3 90.7 Unmet need for Family Planning Operation Major (per Lakh 757.4 886.400 population) 908.9 Spacing 4.6 Reported Infant and Child 43 18 Deaths 51.6 Limiting 7.4

Reported Maternal Deaths 6 0 7.2 Total 12 * Total Maternal complications ( C-section deliveries + Eclampsia cases )treated against estimated maternal complication

Panipat - Apr'12 - Jan'13 DLHSIII

Population (Census-2011) 12,02,811 Estimated Pregnancies ANC 29,807 ANC Check-up in first CBR (SRS-2011) 22 Estimated Deliveries 27,097 65.3 trimester Apprehended Infant Deaths ( IMR = 48 taken from SRS - 1270 Estimated Live Births 26,462 3 or more ANC Check-up 51.1 2011 ) Estimated Maternal Estimated Eligible couples ( Complications( 15% of 17% of population) 2,04,478 4,471 Atleast 1 TT received 84.6 Estimated pregnancies) Apr'12 - Last Year 2011 - Indicator Projected for 2012 - 13 100 IFA Tablets 20.7 Jan'13 12

3ANC Check up against 39% 47% 60% Deliveries estimated pregnancies Institutional Deliveries (Public+Private) against 52% 62% 78% Institutional Delivery 39 estimated deliveries

Met need for EmOC * 12.28% 15% 22.12% Home Delivery 60.4

Reported Live Births against 73% 88% 108% Home Delivery by SBA 9.4 estimated Live Births

BCG to Measles dropout rate 17% 17% 13% New born & post natal care

Fully Immunised against 73% 87% 89% Abortion (Induced + Spontaneous) estimated Live Births Immunisation session held as 45% 45% 41% Still Birth 3.5 % of required VHNDs Childhood Disease Diphtheria 19 22.8 0 Live Birth 84.3 Breastfed within 1 hour of Childhood Disease Pertussis 0 0 0 12.3 birth Childhood Disease Measles 0 0 0 PNC within 48 hrs of delivery 48.8 Childhood Disease Malaria 27 32.4 6 Immunisation Sterilization - Female per BCG 83.8 1000 eligible couple 8.98 10.78 13.81 Sterilization - Male per 1000 DPT3 70.7 eligible couple 1.43 1.72 2.56 Reported Abortion Rate per 16.9 28.2 Measeles 71.8 1000 Estimated live births 20.3

OPD All (per 1000 population) 381.9 464.2 458.3 Full immunisation 57

IPD (per 1000 population) 10.9 13.1 Unmet need for Family Planning 13.1 Operation Major (per Lakh 40.8 64.848 population) 49.0 Spacing 4.9 Reported Infant and Child 31 3 Deaths 37.2 Limiting 11.6

Reported Maternal Deaths 2 3 2.4 Total 16.5 * Total Maternal complications ( C-section deliveries + Eclampsia cases )treated against estimated maternal complication

Rewari - Apr'12 - Jan'13 DLHSIII

Population (Census-2011) 8,96,129 Estimated Pregnancies ANC 22,207 ANC Check-up in first CBR (SRS-2011) 22 Estimated Deliveries 20,188 68.4 trimester Apprehended Infant Deaths ( IMR = 48 taken from SRS - 946 Estimated Live Births 19,715 3 or more ANC Check-up 70 2011 ) Estimated Maternal Estimated Eligible couples ( Complications( 15% of 17% of population) 1,52,342 3,331 Atleast 1 TT received 95.9 Estimated pregnancies) Apr'12 - Last Year 2011 - Indicator Projected for 2012 - 13 100 IFA Tablets 30.3 Jan'13 12

3ANC Check up against 57% 68% 65% Deliveries estimated pregnancies Institutional Deliveries (Public+Private) against 72% 87% 84% Institutional Delivery 65 estimated deliveries

Met need for EmOC * 21.83% 26% 22.13% Home Delivery 35.1

Reported Live Births against 74% 89% 91% estimated Live Births Home Delivery by SBA 8.5

BCG to Measles dropout rate -5% -5% 3% New born & post natal care

Fully Immunised against 65% 78% 87% Abortion (Induced + Spontaneous) estimated Live Births Immunisation session held as 58% 58% 55% Still Birth 2.1 % of required VHNDs

Childhood Disease Diphtheria 0 0 0 Live Birth 78.7 Breastfed within 1 hour of Childhood Disease Pertussis 0 0 0 33.3 birth

Childhood Disease Measles 0 0 0 PNC within 48 hrs of delivery 62.4 Childhood Disease Malaria 2 2.4 0 Immunisation

Sterilization - Female per BCG 94.8 1000 eligible couple 14.15 16.97 17.55

Sterilization - Male per 1000 DPT3 82.2 eligible couple 2.41 2.89 5.34

Reported Abortion Rate per 67.8 77.7 Measeles 74.3 1000 Estimated live births 81.3 OPD All (per 1000 220.8 270.6 Full immunisation 67.3 population) 265.0

IPD (per 1000 population) 19.6 18.1 23.5 Unmet need for Family Planning Operation Major (per Lakh 164.7 198.967 population) 197.7 Spacing 4.2 Reported Infant and Child 241 2439 Deaths 289.2 Limiting 8.6

Reported Maternal Deaths 1 19 1.2 Total 12.8 * Total Maternal complications ( C-section deliveries + Eclampsia cases )treated against estimated maternal complication

Rohtak - Apr'12 - Jan'13 DLHSIII

Population (Census-2011) 10,58,683 Estimated Pregnancies ANC 26,235 ANC Check-up in first CBR (SRS-2011) 22 Estimated Deliveries 23,850 66.7 trimester Apprehended Infant Deaths ( IMR = 48 taken from SRS - 1118 Estimated Live Births 23,291 3 or more ANC Check-up 60.1 2011 ) Estimated Maternal Estimated Eligible couples ( Complications( 15% of 17% of population) 1,79,976 3,935 Atleast 1 TT received 96.1 Estimated pregnancies) Apr'12 - Last Year 2011 - Indicator Projected for 2012 - 13 100 IFA Tablets 35.7 Jan'13 12 3ANC Check up against 51% 61% 75% Deliveries estimated pregnancies Institutional Deliveries (Public+Private) against 81% 97% 94% Institutional Delivery 52.8 estimated deliveries

Met need for EmOC * 68.99% 83% 46.40% Home Delivery 46.4

Reported Live Births against 90% 108% 112% Home Delivery by SBA 6.1 estimated Live Births

BCG to Measles dropout rate 20% 20% 19% New born & post natal care

Fully Immunised against 32% 39% 90% Abortion (Induced + Spontaneous) estimated Live Births Immunisation session held 58% 58% 44% Still Birth 1.2 as % of required VHNDs Childhood Disease 0 0 99 Diphtheria Live Birth 80.8 Breastfed within 1 hour of Childhood Disease Pertussis 0 0 0 20.3 birth

Childhood Disease Measles 0 0 0 PNC within 48 hrs of delivery 39.8 Childhood Disease Malaria 1140 1368 1101 Immunisation Sterilization - Female per BCG 95.1 1000 eligible couple 14.70 17.64 22.28 Sterilization - Male per 1000 eligible couple 0.29 0.35 0.65 DPT3 86.7 Reported Abortion Rate per 115.4 121.5 Measeles 80.6 1000 Estimated live births 138.5 OPD All (per 1000 551.7 623.3 Full immunisation 75.7 population) 662.0

IPD (per 1000 population) 20.9 22.9 25.1 Unmet need for Family Planning Operation Major (per Lakh 195.2 196.282 population) 234.3 Spacing 4.2 Reported Infant and Child 45 209 Deaths 54.0 Limiting 7.8

Reported Maternal Deaths 6 2 7.2 Total 12 * Total Maternal complications ( C-section deliveries + Eclampsia cases )treated against estimated maternal complication

Sirsa - Apr'12 - Jan'13 DLHSIII

Population (Census-2011) 12,95,114 Estimated Pregnancies ANC 32,094 ANC Check-up in first CBR (SRS-2011) 22 Estimated Deliveries 29,176 58.1 trimester Apprehended Infant Deaths ( IMR = 48 taken from SRS - 1368 Estimated Live Births 28,493 3 or more ANC Check-up 56 2011 ) Estimated Maternal Estimated Eligible couples ( Complications( 15% of 17% of population) 2,20,169 4,814 Atleast 1 TT received 92.1 Estimated pregnancies) Apr'12 - Last Year 2011 - Indicator Projected for 2012 - 13 100 IFA Tablets 29.2 Jan'13 12 3ANC Check up against 52% 63% 67% Deliveries estimated pregnancies Institutional Deliveries (Public+Private) against 41% 49% 54% Institutional Delivery 53.5 estimated deliveries

Met need for EmOC * 20.21% 24% 28.00% Home Delivery 46.4

Reported Live Births against 47% 56% 62% estimated Live Births Home Delivery by SBA 16

BCG to Measles dropout rate 2% 2% -41% New born & post natal care

Fully Immunised against 57% 68% 73% Abortion (Induced + Spontaneous) estimated Live Births Immunisation session held as 53% 53% 44% Still Birth 1.9 % of required VHNDs

Childhood Disease Diphtheria 5 6 1 Live Birth 83.9

Breastfed within 1 hour of Childhood Disease Pertussis 0 0 0 27.5 birth Childhood Disease Measles 116 139.2 34 PNC within 48 hrs of delivery 57.9 Childhood Disease Malaria 821 985.2 52 Immunisation Sterilization - Female per BCG 94.1 1000 eligible couple 13.41 16.09 7.73 Sterilization - Male per 1000 DPT3 69.5 eligible couple 0.24 0.28 0.47 Reported Abortion Rate per 31.5 28.8 Measeles 76.2 1000 Estimated live births 37.8

OPD All (per 1000 population) 438.3 495.0 Full immunisation 61.3 526.0

IPD (per 1000 population) 23.8 19.6 28.5 Unmet need for Family Planning Operation Major (per Lakh 118.2 173.730 population) 141.9 Spacing 3.5 Reported Infant and Child 63 44 Deaths 75.6 Limiting 7.4

Reported Maternal Deaths 7 31 8.4 Total 10.8 * Total Maternal complications ( C-section deliveries + Eclampsia cases )treated against estimated maternal complication

Sonipat - Apr'12 - Jan'13 DLHSIII

Population (Census-2011) 14,80,080 Estimated Pregnancies ANC 36,678 ANC Check-up in first CBR (SRS-2011) 22 Estimated Deliveries 33,343 69.6 trimester Apprehended Infant Deaths ( IMR = 48 taken from SRS - 1563 Estimated Live Births 32,562 3 or more ANC Check-up 57.7 2011 ) Estimated Maternal Estimated Eligible couples ( Complications( 15% of 17% of population) 2,51,614 5,502 Atleast 1 TT received 95.4 Estimated pregnancies) Apr'12 - Last Year 2011 - Indicator Projected for 2012 - 13 100 IFA Tablets 23.1 Jan'13 12 3ANC Check up against 70% 84% 91% Deliveries estimated pregnancies Institutional Deliveries (Public+Private) against 54% 65% 67% Institutional Delivery 53.7 estimated deliveries

Met need for EmOC * 13.72% 16% 9.78% Home Delivery 45.4

Reported Live Births against 64% 77% 84% estimated Live Births Home Delivery by SBA 7.3

BCG to Measles dropout rate -2% -2% -1% New born & post natal care

Fully Immunised against 86% 104% 103% Abortion (Induced + Spontaneous) estimated Live Births Immunisation session held as 49% 49% 62% Still Birth 0.8 % of required VHNDs Childhood Disease 22 26.4 0 Live Birth 84 Diphtheria Breastfed within 1 hour of Childhood Disease Pertussis 0 0 0 8 birth Childhood Disease Measles 0 0 0 PNC within 48 hrs of delivery 60.9 Childhood Disease Malaria 0 0 357 Immunisation Sterilization - Female per BCG 95.6 1000 eligible couple 10.87 13.05 15.22 Sterilization - Male per 1000 DPT3 81.6 eligible couple 0.49 0.59 1.35 Reported Abortion Rate per 47.2 117.9 Measeles 83.9 1000 Estimated live births 56.6 OPD All (per 1000 246.9 564.1 Full immunisation 73 population) 296.3

IPD (per 1000 population) 14.5 29.6 17.4 Unmet need for Family Planning Operation Major (per Lakh 24.3 38.309 population) 29.1 Spacing 4.8 Reported Infant and Child 394 717 Deaths 472.8 Limiting 10.9

Reported Maternal Deaths 78 10 93.6 Total 15.7 * Total Maternal complications ( C-section deliveries + Eclampsia cases )treated against estimated maternal complication

Yamunanagar - Apr'12 - Jan'13 DLHSIII

Population (Census-2011) 12,14,162 Estimated Pregnancies ANC 30,088 ANC Check-up in first CBR (SRS-2011) 22 Estimated Deliveries 27,353 72.5 trimester Apprehended Infant Deaths ( IMR = 48 taken from SRS - 1282 Estimated Live Births 26,712 3 or more ANC Check-up 60.8 2011 ) Estimated Maternal Estimated Eligible couples ( Complications( 15% of 17% of population) 2,06,408 4,513 Atleast 1 TT received 90.7 Estimated pregnancies) Apr'12 - Last Year 2011 - Indicator Projected for 2012 - 13 100 IFA Tablets 31.6 Jan'13 12 3ANC Check up against 75% 90% 69% Deliveries estimated pregnancies Institutional Deliveries (Public+Private) against 55% 67% 82% Institutional Delivery 52.3 estimated deliveries

Met need for EmOC * 72.06% 86% 94.79% Home Delivery 47.5

Reported Live Births against 73% 88% 100% estimated Live Births Home Delivery by SBA 6.1

BCG to Measles dropout rate 6% 6% 13% New born & post natal care Fully Immunised against 65% 79% 86% Abortion (Induced + Spontaneous) estimated Live Births Immunisation session held 65% 65% 57% Still Birth 2.7 as % of required VHNDs Childhood Disease 0 0 0 Live Birth 85.6 Diphtheria Breastfed within 1 hour of Childhood Disease Pertussis 0 0 0 8.5 birth Childhood Disease Measles 17 20.4 0 PNC within 48 hrs of delivery 68.7 Childhood Disease Malaria 60 72 0 Immunisation Sterilization - Female per BCG 97.7 1000 eligible couple 7.10 8.52 8.25 Sterilization - Male per 1000 eligible couple 0.88 1.06 1.46 DPT3 82.1 Reported Abortion Rate per 50.1 61.4 Measeles 85.7 1000 Estimated live births 60.1 OPD All (per 1000 528.3 602.8 Full immunisation 70 population) 634.0

IPD (per 1000 population) 31.7 33.7 38.0 Unmet need for Family Planning Operation Major (per Lakh 274.3 276.981 population) 329.2 Spacing 3.9 Reported Infant and Child 294 593 Deaths 352.8 Limiting 12.2

Reported Maternal Deaths 15 21 18.0 Total 16.1 * Total Maternal complications ( C-section deliveries + Eclampsia cases )treated against estimated maternal complication