Background Information Required for Approval of State Pips for 2013-14

Background Information Required for Approval of State PIPs for 2013-14

F.M.R Code: B. 13 & 14 & B. 18 - PPP/NGOs/ Innovations/ New Initiatives

Activities Proposed:

 Name of the Activity: PHC Tousem under PPP

 Whether New/ or being continued: Continued

 Achievements if continued from previous years(April to Oct., 2012):

Name of the Total Expected No. of pregnant No. of pregnant No. of OPD/ IPD/ Health Facility Population Pregnancy women women received Inst. month month registered for 3 ANC Delivery ANC

PHC Tousem 17929 298 83 31 10 325 10

 Justification:

 Funding Proposed: Please see in the following Section:  Tousem PHC is a very difficult area to access.  Doctors are unable to performed due to remoteness, poor road connectivity. People have to walk two to four days on foot to reach District Head Quarter.  Very few manpower to run the PHC.  Public Private Partnership (PPP) under NRHM with Karuna Trust Model is proposed for this PHC and it was approved in the state GB meeting.

In the first step Expression of Interest (EoI) is to be handed over PHCs after signing MoU between the two parties.

Following are the services provided in these PHCs as per MoU.

a) 24 hours Emergency/Casualty Services. b) 6 days OPD. c) 5 to 10 Bed inpatient facility. d) 24 hrs labour Room and Essential Obstetrics facility. e) Minor Operation Theatre Facility f) Antenatal care and Post natal care g) Early and safe abortion services (including MVA) h) Prevention and management of RTIs/STIs i) Essential new born care j) Routine immunization services k) Family planning services l) Essential laboratory services m) 24 hrs Ambulance Facility n) Make available essential medicines as per the details at Schedule B to the MOU. The Agency would be encouraged to keep in stock such additional medicines as are found necessary after assessing the field situation. o) Participation in and implementation of National Programs of Health & Family Welfare including the National Rural Health Mission. Outreach/IEC activities by conducting medical camps p) Outreach camps

Few important points:-

1. PHCs of difficult areas will be handed over to NGOs 2. All the govt. staff working in these PHCs will be transferred/posted to other govt. hospitals. NGO will appoint its own staff. 3. All the assets including building, equipment, ambulance, medicines, related to that PHC will be also handed over to NGOs. 4. A PHC management committee will be constituted (RKS) to help NGOs in various ways 5. Govt has to provide all the medicines, vaccines etc under any National Health programs 6. There will be an annual budget for management of a PHC. In Arunachal, govt has given a flat budget equal for all PHCs. While in Meghalaya, it varies from PHC to PHC (Rs 23 lacs to Rs 30 lacs). Big PHC with large population will get high fund and small PHC will get less fund in Meghalaya. 7. NGO has to contribute 10% of the total budget allotted per PHC. 8. In Arunachal, total annual budget is Rs 29,37,000/- where NGO has to contribute 10% (around Rs 3 lakhs per PHC). In Meghalaya, they have mentioned in the MoU about 10% NGOs contribution, but verbally it was told us not necessary to pay it. In Karnatka we are getting 100% grant. 9. This is the details of the budget for Arunachal PHCs during Dec2005 to July 2009. In August 2009, we renewed the MoU and changed few budget heads. In the new budget we included one more GNM (total 3 as per IPHS) and we also increased the salary of MOs in new budget. Following is the old budget for a PHC.

Sl.No. Items Max. Fund per annum 1 Medicines and other Healthcare Consumables. Medicines - Rs.3,00,000/- Materials & Supplies - Rs. 30,000/-

Laboratory Reagents, - Rs. 10,000/- Rs.3,50,000/- Surgical Items - Rs. 10,000/- 2. Maintenance, Furniture, Equipment Civil Works(Maintenance)- Rs.1,00,000/-

Office furniture - Rs. 50,000/- Rs. 5,50,000/- Hospital furniture -Rs. 1,00,000/- Surgical Equipments -Rs. 3,00,000/- 3. Other Administrative Charges Water & Electricity - Rs. 10,000/- Traveling Allowances - Rs. 20,000/-

Ambulance Services - Rs. 70,000/- Rs. 1,00,000/-

4. Personnel Cost

Sl No Category of staff No of posts Max. fund per annum 1 Medical Officer 2 Rs 3,66,000 2 Pharmacist 1 Rs 99,600 3 Staff Nurse 2 Rs 1,99,200 4 ANM 2 (PHC) Rs 1,62,000 6 (SCs) Rs 4,86,000 5 LHV 1 Rs 90,300 6 Lab Tech 1 Rs 90,300 7 Driver 1 Rs 61,524 8 HA (Jr) 1 (Gen) Rs 90,300 1 (EPI) Rs 90,300 9 Group D(Including SA) 4 Rs 2,01,648 Rs 19,37,172

Say Rs.19, 37,000/-

Total maximum fund per annum – 1 + 2 + 3 + 4

= Rs.3, 50,000 + Rs. 5, 50,000 + Rs. 1, 00,000 + Rs.19, 37,000

= Rs.29, 37,000/-.

10. Along with the PHC, subcentres (SCs) attached to the PHC will also be handed over to NGOs. 11. Any medical staff who are posted to that PHC under any national health programs by the state govt (like Malaria worker etc) have to continue in that PHC for the continuation of such National health programs during NGO run period also. 12. PPP steering committee have to review the performance of NGOs in every quarter 13. Reporting from NGOs to District and the state NRHM PPP cell also. 14. Diet can be given to indoor patient 15. NGO can do the audit by their own CAs. Or govt can appoint a common auditor 16. Any savings in the budget heads can be utilized in other heads for that PHC 17. In case of poor performance of NGO, 3 months time to be given to NGOs for handing over back it to Govt. 18. There must be a list of medicines/surgicals as per PHC norms of GOI 19. There must be flexibility in the budget heads. NGOs have to procure the surgicals, medicine, chemicals, equipment and minor repairing work in these health centres. 20. Govt. can appoint external evaluation team for the performance of NGOs. District health authority can visit NGO run PHCs to monitor it. 21. State govt releases fund to the NGOs at state level in Arunachal Pradesh. Fund is release 6 monthly. 22. NGOs in Arunachal are also involved in PRI training, ASHA training (1-3 modules) in all the districts. 23. NGO will operate the RKS, SC accounts, VHSCs etc of that PHC. B. 14: Innovations

Activities Proposed:

 Name of the Activity: Establishment of six (Six) First Aid Centres in the District

 Whether New/ or being continued: New

 Justification: Tamenglong District is one of the most difficult and backward district of Manipur. Though thinly populated, the topography of the land is mountainous with many inacessible areas and poor road connectivity. Added to the woes is tha lack of infrastructure and manpower in the remote health centres. Even today, one has to traverse the thick forest and terrains on foot, taking days to reach their place of posting. As such, health workers are reluctant to go for their duties posted in such areas. The contraints are numerous and poor people in the flung areas are yet to see the light of development and receive basic health care services at their doorsteps. In order to reach health care services to all villages, the District Health Society proposed to set up 6 (six) First Aid Centers, 2 under PHC Tousem, 2 under PHC Tamei and 2 under DH during 2013-14 under New Initiatives where 10% of the funds allocated for the district can be genuinely utilized as untied fund. The name of these six villages where establishment of First Aid Centers are proposed are: a) Inem village which is under PHC Tousem has a population of 592 people and is located about 46 km from Tousem HQ. b) Old Magulong under PHC Tousem which has a population of 1152 people and is about 52 kms from Tamenglong HQ. c) Bamgaijang village with a population of 569 people and is about 22 km from PHSC Akhui. d) Kuilong village under PHC Tamei of 2384 popullation and is about 40 kms from Tamei HQ. e) Kadi village under PHC Tamei of 1370 population and is about 30 kms from Tamei HQ. f) Bhalok village under DH, Tamenglong of 1439 popularion and is about 20 km from Tamenglong HQ.

These villages are all inaccessible and health workers had to go on foot for days to reach the village and give immunization and other health programs. The ASHAs particularly of these six villages are very dynamic and they have been working to their best at the village level since the launch of NRHM. Moreover, all ASHAs are trained to deal with basic health problems such as giving first aid to minor injuries, patients with fever, identifying high risk pregnancies or even conduct normal deliveries if necessary and they are also trained to do malarial kit test, pregnancy test, collection of sputum etc. Besides ASHAs, there are also village health workers and AWWs who are also trained in this field. To give proper care to the patients, they need a special place for examination in the village where there are no health facility. Given a room to work and care the sick people, it will definitely enhance their dignity of labour and boost their moral spirit to give their best services to the village. The entity of a health worker or activist will be easily identified by the local villagers if given a separate atmosphere to work.

 Funding Proposed:

Sl. No Particulars No.of Unit Budgets (Rs in lakhs) 1 Building (two room 15’ X 10’ each) with 6 @ 4 lakhs each 24.00 toilet a) Examination room b) Equipment and medicine room 2 Essential logistic such as delivery kits, first 6 @1 lakhs each 6.00 aid kit with stitching material, emergency durgs Total 30.00