District Health Action Plan 2012-2013 District Health Society Vaishali 1 Table of contents Foreword About the Profile CHAPTER 1- INTRODUCTION 1.1 Background 1.2 Objectives of the process 1.3 Process of Plan Development 1.4 Preparation of DHAP CHAPTER 2- DISTRICT PROFILE History Geographic Location Govt administrative setup District Health Administrative setup Vaishali at a Glance Comparative Population Data 2.1 Socio economic Profile 2.2 Health Profile 2.2.1 Maternal Health 2.2.2 Child Health 2.2.3 Family Planning 2.2.4 ARSH 2.2.5 Health Infrastructure & Facilities of Vaishali 2.2.6 Human Resource Development including training 2.2.7 Inequity and gender 2 CHAPTER 3- SITUATION ANALYSIS 3.1 Gaps in infrastructure 3.1.1 HSC Infrastructure 3.1.2 Services of HSC 3.1.3 HSC Human Resource 3.2 APHC 3.3 PHC 3.4 District Hospital CHAPTER 4 Setting Objectives and suggested Plan of Action 4.1 Introduction 4.2 Targeted objectives and suggested Strategies 4.2.1 Maternal Health Maternal Death Review 4.2.2 Child Health Nayee Pidhi Swasthya Guarantee Karyakarm 4.2.3 Family Planning Yukti Yojna 4.3 Main streaming AYUSH under NRHM VHSND 4.4 Muskan Ek Abhiyan 4.5 HMIS monitoring & Evaluation 4.6 Behaviour Change Communication 4.7 Infrastructure and Human Resource 4.8 Institution Strengthening 4.9 Training 4.10 IEC/BCC ISO Certification of PHC SABLA Karyakarm SWOT analysis 5 Budget-Part A, B, C, D 6 Summary of Budget 3 Foreword National Rural Health Mission (NRHM) was introduced to undertake architectural corrections in the public Health System of India. District Health Action Plan (DHAP) is an integral part of National Rural Health Mission. District Health Action Plan is critical for achieving decentralization, interdepartmental convergence, capacity building of health system and most importantly facilitating people‟s participation in health programme. District Health Action Plan provides opportunity and space to creatively design and utilize various NRHM initiatives such as flexi –financing, Rogi Kalyan Samiti, Village Health and Sanitation Committee to achieve our goals in the socio-cultural context of Vaishali. The NRHM regards district level health planning as a significant step towards achieving a decentralized, pro-poor and efficient public health system. District level health planning and management facilitate improvement of health systems by 1) Addressing the local needs and specificities 2) Enabling decentralization and public participation and 3) Facilitating interdepartmental convergence at the district level. DHAP seeks to achieve pooling of financial and human resources allotted through various central and state programme by bringing in a convergent and comprehensive action plan at the district level. Recognizing the importance of Health in the process of economic and social development and improving quality of life of our citizens, Government of India has resolved to launch National Rural Health Mission to carry out necessary architectural correction in the basic health care delivery system. This District Health Action Plan (DHAP) is one of the key instruments to achieve NRHM goals. This plan is based on health needs of the district. After a thorough situational analysis of district health scenario this document has been prepared. This plan address health care needs of rural poor especially women and children. The focus has also been given on current availability of health care infrastructure in pubic/NGO/private sector, availability of wide range of providers. This DHAP has been evolved through a participatory and consultative process, wherein community and other stakeholders have participated and ascertained their specific health needs in villages, problems in accessing health services, especially poor women and children at local level. The goals of the Mission are to improve the availability of and access to quality health care by people, especially for those residing in rural areas, the poor, women and children. I need to congratulate the department of Health and Family Welfare and State Health Society of Bihar for their dynamic leadership of the health sector reform programme and we look forward to a rigorous and analytic documentation of their experiences so that we can learn from them and replicate successful strategies. I am sure that this excellent report will galvanize the leaders and administrators of the primary health care system in the district, enabling them to go into details of implementation based on lessons drawn from this study. Prem Singh Meena, IAS (DM, Vaishali) 4 Acknowledgement Under the National Rural Health Mission (NRHM) this District Health Action Plan (DHAP) of Vaishali district has been prepared. From here the situational analysis proceeds to make recommendations towards a policy on workforce management, emphasis on organizational, motivational and capacity building aspects. It recommends on existing resources as manpower and materials can be optimally utilized, critical gaps identified and addressed. It looks at the facilities at different levels can be structured and reorganized. The commitment is to bridge the gaps in public health care delivery system, has led to the formulation of District Health Action Plan. The collaboration of different departments which directly or indirectly related to determinants of health will lead to betterment of health care delivery, and to make this collaboration possible actions are to be outlined in the District Health Action Plan. Thus this assignment is a shared effort between the departments of Health and Family Welfare, ICDS, PRI, Water and Sanitation, Education to draw up a concerted plan of action. The development of a District Health Action Plan for Vaishali district of Bihar entailed a series of Consultative Meetings with stakeholders at various levels, collection of secondary data from various departments, analysis of data and presentation of the existing scenario at District-level workshop. District level Workshop was organized to identify district specific strategies based on which the District Health Action Plan has been prepared by the District & Block Program Management Unit. The information related to data and others used in this action plan is authentic and correct according to my knowledge as this has been provided by the concerned medical officers of every block. I am grateful to the ACMO, MOICs, Block Health Managers and ANMs and AWWs from their excellent effort we may be able to make this District Health Action Plan of Vaishali District. I hope that, this District Health Action Plan would fulfill the intended purpose. Dr. Vibhesh Prasad Singh Civil Surgeon Vaishali 5 Chapter - 1 Introduction 1.1 Background The health status of its population reflects the socio-economic development of a state. Health status is shaped by a variety of factors-level of income and standard of living, housing, sanitation, water supply, education, employment, health consciousness and personal hygiene, and the coverage, availability, accessibility, acceptability and affordability of health services. The poor health status of states is a product of inadequate nutrition, lack of protected water supply, and overcrowded and in sanitary housing conditions. These conditions are conducive to deficiency diseases, airborne diseases, focally related and waterborne diseases, which dominate the morbidity and mortality pattern in less developed regions. The relationship between health and poverty or health and development is complex and multifaceted. Poverty in its various dimensions could be a manifestation as well as a determinant of an individual‟s health. In its most basic form- as a state of food deprivation and nutritional inadequacy – poverty has a direct bearing on the morbidity and longevity of people. The other aspects of deprivation such as lack of access to critical amenities including safe water, sanitation, non-polluting domestic fuels, connectivity of life support services and, most importantly to education and general awareness, contribute to reinforcing ill health and morbidity, even leading to higher mortality levels. High child mortality levels on account of supervening infections, particularly diarrhoea and respiratory infections are fairly widespread among people deprived of these basic amenities of life. These commonly seen childhood infections often exacerbate malnourishment. Undernourishment in children in turn reinforces the consequences of such infections. Health is a state of physical, mental & social well being & not merely an absence of disease or infirmity. Hence recognizing the importance of health in the process of economic & social development & improving the quality of life of our citizens, the Government of India has resolved to launch the National Rural Health Mission (NRHM) to carry out necessary architectural correction in the health care delivery system to achieve a positive health. The National Rural Health Mission (NRHM) seeks to provide effective health care to the entire rural population in the country with special focus on 18 states, which has weak public health indicators. It aims to undertake some architectural correction of the health system to enable it to be effective in providing “Health for All”. The mission envisages strategy for integrating ongoing vertical programs of health and family welfare, addressing issues related to the determinants of health like sanitation, nutrition and safe drinking water. The National Rural Health Mission seeks to adopt sector wide approach and aims at systemic reforms to enable efficiency in