NATIONAL RURAL HEALTH MISSION
DISTRICT HEALTH ACTION PLAN
Reasi
December 2007
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PREFACE
The Hon’ble Prime Minister launched the NRHM on 12 th April 2005 throughout the country with the basic objective of providing accessible, affordable and accountable health care in rural areas. Its primary focus is on making the public health system fully functional at all levels. While detailing the functioning of the NRHM, the present planning process initiated in the State provides the entire framework for making the Public Health System fully functional and standardized upto the Indian Public Health Standards at all levels. In doing so, it emphasizes the need for communitisation of the Public Health System, improved financing and management of public health, human resource innovations, and a long-term financial commitment to enable the state and districts to undertake programmes aimed at achieving the Mission goals.
National Rural Health Mission envisages the planning process to be participatory and decentralized starting with the Village. It seeks to empower the community by placing the health of the people in their own hands and determine the ways they would like to improve their health. This is the only way to ensure that health plans are local specific and need based. The State should facilitate the processes by providing enabling environment and required financial and technical support. NRHM was launched in April 2005 and is being implemented by the Department of Health and Medical Education, Government of Jammu & Kashmir.
In accordance with the National Rural Health Mission, Jammu & Kashmir. The district has constituted the District Health Mission and significant progress has been made since it’s beginning. As per the NRHM guidelines, it has merged multiple societies at the district level. The District Action Plan was the most important aspect of the NRHM and to make District Plan more meaningful and address local health problems, preparation of Block Health Plans was considered essential. The decentralized planning process involved village consultations and preparation of Village Health Plans by the Village Health Water and Sanitation committees; followed by development of Block Action Plans through integration of Health Facility Surveys and block specific needs. The Block Action Plans were then integrated to form District Action Plan.
As result of this exercise, the district now has developed capacity for preparing the need based health action plans following participatory processes. A District Planning Team (DPT) was set up for this purpose in the month of July 2007 with representation from various sectors concerned with NRHM. This group was responsible for management of the entire planning process in the district and also for provision of the technical support. The DPT is the standing body and will take charge of ensuring implementation of the plan. Thus the DPT not only owns the plan but will also be responsible for monitoring the progress of implementation to achieve the objectives of the plan. The members of the DPT are:
4 # Name Designation Department 1. R.C Puri Asstt. Commissioner Development RDD 2. Vinay Mohan Raina Chief Education Officer Education 3. Dina Nath DEPO Education 4. Dr. Jagdish Mehra Distt. Information Officer Information 5. N K Rohmetra Xen PHE Div. Udhampur PHE 6. Anil Kumar Kailu TO to Xen PHE PHE 7. S K Padha Xen M& RE Div. Udhampur M&RE 8. K K Sharma AEE PWD (R&B) PWD (R&B) 9. Dr. Bansi Lal Gupta Chief Medical Officer Health 10. Dr. K K Gupta Medical Suptd. DH Health 11. Dr. M H Malik Distt TB Officer Health 12. Dr. R K Sharma Distt. Immunisation Officer Health 13. Dr. Santosh Sharma Distt. Leprosy Officer Health 14. Dr. Arun Sharma Nodal Officer NRHM Udhampur Health 15. Dr. Chander Prakash Block Medical Officer Ramnagar Health 16. Dr. Jagdish Lal MO (ISM) Health 17. Shivali Bakshi DPM (NRHM) Health 18. Minerwa Raina DAM (NRHM) Health 19. Kuldeep Gupta SA (CMO office) Health
The orientation of DPT, facilitated by EPOS Health India, was held on 14 July 2007. This enabled the DPT members to not only understand NRHM approach, key components and strategies of NRHM, but also manage the planning process and develop the District Action Plan. The DPT met a number of times and the individual members reviewed the situation of their respective sectors/areas and collectively developed the strategic vision for improving the health status of the district population.
We the members of the DPT on behalf of the entire Core Group reiterate and certify that this District Action Plan has been prepared through participatory processes. It has been developed by integrating the Block Action Plans prepared by integrating health facility surveys and village health plans in each block of the District. This plan also incorporates the needs and plans from 97 Sub health centres, 35 PHCs, 5 CHCs and 1 DH in the District.
Name of Chief Medical Officer Signature Date
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CONTENTS
PREFACE ...... 4 ABBREVIATIONS ...... 7 PRIORITY MATRIX OF THE DISTRICT ...... 11 EXECUTIVE SUMMARY ...... 17 1. SITUATION ANALYSIS...... 20 SOCIO ECONOMIC AND HEALTH INDICATORS...... 27 2. PLANNING PROCESS...... 39 3. PRIORITIES AS PER BACKGROUND AND PLANNING PROCESS ...... 44 4. GOALS ...... 46 5. TECHNICAL COMPONENTS...... 48 PART A: Reproductive and Child Health (RCH) II ...... 48 B- NRHM Initiatives...... 75 PART C: Immunisation ...... 93 PART D: National Disease Control Programme...... 97 6: INTER SECTORAL CONVERGENCE...... 112 7. COMMUNITY ACTION PLAN...... 124 8.PUBLIC PRIVATE PARTNERSHIP...... 126 9. GENDER AND EQUITY...... 129 10. CAPACITY BUILDING...... 132 11. HUMAN RESOURCE PLAN...... 138 12. PROCUREMENT AND LOGISTICS ...... 140 13. DEMAND GENERATION - IEC...... 142 14. FINANCING OF HEALTH CARE...... 145 16. HMIS, MONITORING AND EVALUATION ...... 147 17. BIO-MEDICAL WASTE MANAGEMENT...... 150 ANNEXURE: ...... 167
6 ABBREVIATIONS
ANC Ante natal Care ANM Auxiliary Nurse and Midwife ASHA Accredited Social Health Activist BPHC Block Primary Health Centre CBO Community Based Organizations CHC Community Health Centre CMO Chief Medical officer DoHFW Department of Health and Family Welfare DH District Hospital ENMR Early Neo-natal Mortality Rate EmOC Emergency Obstetric Care EAP Externally Aided Projects FRU First Referral Unit HMIS Health Management Information System HIV Human immuno-deficiency syndrome IPHS Indian Public Health Standards ISM Indian System of Medicine IMNCI Integrated Management Neo-natal of Child Illness JSY Janani Suraksha Yojana IMR Infant Mortality Rate NMR Neo-natal Mortality Rate MTP Medical Termination of Pregnancy MMR Maternal Mortality Rate MNGO Mother NGO MO Medical Officer MH Maternal Health NNMR Neo-natal Mortality Rate NGO Non-Government Organization NRHM National Rural Health Mission NAMP National Anti Malaria Programme NLEP National Leprosy Eradication Programme NKAP National Kala-Azar Programme NFP National Filaria Programme NIDDP National Iodine Deficiency Disorder Programme NBCP National Blindness Control Programme OPD Out Patient Department PNMR Primary Neo-natal Mortality Rate PHC Primary Health Centre RH Rural Hospital RCH II Reproductive and child Health Programme-II RI Routine Immunization
7 RNTCP Revised National Tuberculosis Control Programme SDH Sub-divisional Hospital SHSDP II State Health System Development Project-II SGH State General Hospitals SRHM State Rural Health Mission TFR Total Fertility Rate
8 Introduction
Jammu and Kashmir initially had 14 districts namely Kupwara, Baramulla, Srinagar, Budgam, Pulwama, Anantnag, Udhampur (Ladakh), Kargil, Doda, Udhampur, Poonch, Rajouri, Jammu and Kathua. But their number has now been increased to 22 by Government Order. The newly added districts in Jammu Division are: Ramban, Kishtwar, Samba & Reasi and in Kashmir Division are: Ganderbal, Shopian, Kulgam and Bandipora. These districts are in the process of boundary demarcation. Total population of the State was 1,00,69,917 in 2001. The decadal growth rate was 29.04 during 1991-2001. Overall density of population in the State was 90 persons per square Kilometre. Sex ratio was 900 females per thousand males.
Mission Statement
The Mission of the department of Health and Family Welfare is to work in active partnership with the community to ensure health and well being of all its citizens.
Vision
The vision of the government of J & K is to achieve the goals and objectives envisaged in the NPP- th 2000, NHP-2002, and the 10 Plan and those under NRHM. We envision path breaking progress and development in healthcare delivery in all the districts in the state. We plan, making available the necessary health care for improving the primary health care services, secondary health care, specialised medical care through an integrated, focused and participatory programme.
Based on earlier lessons learnt from implementation of various health programmes and projects, the project incorporates certain changes such as adopting a uniform structure of the program; strong supervision and monitoring with advanced analytical tools; and greater inter-sectoral convergence at all levels.
The Road Map
The Road Map to achieve the aforesaid vision is that the State would strive for achieve various indicator in a rising trend mode , that is, in the earlier years (say FY 2007 and FY 2008) the objectives are to be achieved a bit slow initially but picking up in FY 2009 through to FY 2011. There is a need to schedule extension and up gradation of services over five years period keeping in view growth in population and absorptive capacity of the State in general and district in particular .
9 The support and resources made available through NRHM initiatives and through convergence would be utilised for the purpose.
In order to propel and sustain the desired progress, there is an urgent need to construct, upgrade and renovate health infrastructure and health facilities to make them fully functional. Consequently, more investment is needed upfront on creation of the necessary infrastructure, construction, civil works, renovation and maintenance. There is a need for increased investment in this respect in earlier years (say FY 2007 and FY 2008) in this respect.
Also, a lot of activities cannot materialise due to the shortage of human resources in the state health services. Thus, there is an urgent need to recruit professionals and support staff on a priority basis. In the short term, this may be achieved by filling vacancies on contract basis. However, to attract requisite staff, compensation needs to be based on reasonable calculations. It needs to be attractive enough for persons to join and continue.
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PRIORITY MATRIX OF THE DISTRICT
S.No Thematic Critical Issues of the District Specific Priorities Area 1. District Health Being a new district, there Constitution of DHS. Management: is no DHS constituted till Societies need functional integration date. and strengthening. Functional integration of Capacity building of the DHS vertical societies like members regarding the programme, Blindness Control Society, their roles, various schemes and TB Control Society, District mechanisms for monitoring and Malaria Society etc. regular reviews and also operational guidelines for running the District Monitoring and evaluation. Health Society. Monitoring of health activities by health personnel only. Members from other departments and also from the elected representatives need to become members for better monitoring and implementation. Strengthening the functioning of the DHS. 2. District & Need for providing more Development of total clarity at the Block technical support to the district and the block levels amongst Programme CMO office for better all the officials and Consultants about Management implementation especially NRHM activities in light of the increased Training of district officials and Block volume of work in NRHM. SMOs for programme management Strengthening the Streamlining Financial management monitoring and reporting and systems especially in the areas of Strengthening the CMO office with Maternal and Child Health, DPMU with extra computers, Civil works, Behaviour telephone system and human change and accounting resources. right from the level of the Capacity building of the DPMU Subcentre. personnel for monitoring Strengthening the Block Management Units by establishing BPMUs.
11 3. Reducing Lack of 24X7 facilities for Increase coverage of full ANC and maternal and safe deliveries in Postpartum Care to pregnant women child deaths subcentres and PHCs. Increase in Institutional deliveries by and Lack of authentic data operationalsing 24X7 PHCs Population regarding the maternal and Strengthen FRUs for Emergency stabilization infant deaths in the district. Obstetric Care services along with Equipments are not minimum basic infrastructure, Blood working properly or not Storage facilities, Facilities for available as per the need Neonatal Care, drugs and in subcentres, PHCs & equipments. CHCs to provide quality Increase availability of safe abortion services. services at all block level CHCs/ Lack of facilities with for PHCs. emergency obstetric care. Increased coverage under JSY Non-availability of Strengthening the Village Health Day Specialists for an To increase awareness among aesthesia, obstetric care, mothers and communities about the paediatric etc. importance of institutional deliveries Lack of referral transport Improved behaviour practices in the systems. community Lack of Blood Storage Operationalization of all the facilities at FRUs sanctioned Anganwadis Lack of Neonatal care facilities at FRUs 4. Family Low level of FP acceptance Increased awareness for Emergency Planning due to lack of awareness or Contraception and 10 yr Copper T motivation and low male Decreasing the Unmet Need for participation Family Planning Ensure availability of all FP methods at block level facilities. Train more MOs for NSV and promote the same. Partner with private doctors for FP and RCH services Increasing Access to Emergency Contraception and spacing methods through Social marketing Building alliances with other departments, PRIs, Private sector
12 providers and NGOs 5. Adolescent Adolescents especially the Implement ASRH programme to Health boys are exposed to increase the knowledge levels of smoking, addictions, peer Adolescents on RH and Life skills pressure and there is no Implement of Kishori Shakti Yojana in one to counsel them. coordination with ICDS and NGOs. Teenage pregnancies also Operationalise Adolescent Friendly emerging as a problem Health services at the health facilities and unsafe abortion & premarital sex trend are on rise. 6. Mobile Remote population is not Coverage of the tribal populations Medical Units covered due to lack of which are migratory in blocks. (MMUs) required staff, Provide one-MMU equipped with infrastructure. GPRS for services. Communications system is Contract MOs and staff nurses for poor. MMUs 7. Upgrading None of the CHCs are as Following CHCs needs to be upgraded as CHCs to per the IPHS standards. per IPHS Standards in the first year:- IPHS CHC Reasi CHC Mahore CHC Pouni 8. Upgrading None of the PHCs are as Construction of 14 buildings PHC PHCs for 24 per the IPHS standards. buildings as per IPHS standards. hr Services Out of 22 PHCs and Names of PHCs are enclosed as and IPHS Allopathic Dispensaries, 7 Annexure-1 standards PHCs are housed in Construction of staff quarters in all government buildings and PHCs 15 are still functioning from rented accommodation with out sufficient facilities. 20 of PHCs/ADs are without staff quarters 9. Upgrading None of the Subcentres Need to construct 45 Subcentre Sub Centres are as per he norms of buildings ( Names of SCs are to IPHS IPHS enclosed as Annexure-2) standards Out of 68 subcentres, 45 Construction of staff quarters in all subcentres are running in subcentres for ANM’s stay. (Names rented buildings and 23 of subcentres given in Annexure -
13 subcentres are running 2) from government owned Construction of Labour rooms at all buildings. Subcentres for promoting institutional There are no labour deliveries rooms in any of the Subcentres for Institutional deliveries There is no staff quarter in subcentres of the district Reasi. The numbers of Subcentres is also inadequate 10. Immunisation Lack of awareness to Strengthening the District Family mothers Welfare Office Alternate vaccine delivery Enhancing the coverage of Lack of Cold storage Immunization Efficient monitoring and Alternative Vaccine delivery supervision mechanisms in place Gaps in difficult, flung Effective Cold Chain Maintenance areas & inaccessible areas upto sub centre level Reporting and Zero Polio cases and quality documentation surveillance for Polio cases Large number of cold Close Monitoring and documentation chain equipment are not of the progress functional and need repair Repair and replacement of c0ld chain or need to be replaced equipment as per the need 11. Inter Sectoral Lack of coordination b/w ICDS Linkages to be developed between ICDS Convergence and health department workers and health workers for timely diagnosis of malnourished children and their management (detailed activities under thematic heads)
14 Lack of coordination b/w RDD Linkages to be developed between the and health department Health Department and the Rural Development department • Improving the health standard & general quality of life of rural community. • Awareness on sanitation/ Hygiene & health education. • Covering of school/ Anganwari in rural areas with sanitation facilities & promote Hygiene education & sanitary habits among students. • Promote & encourage cost effective construction of household latrine & their proper use. • Elimination of open defection to minimise the risk of contamination of water source & food. Lack of coordination b/w PHE • Bleaching powder and chlorine and health department tablets will be provided by PHE and distributed by field functionaries to households • Joint communication strategy. • Copy of water quality monitoring reports generated by IPH department will be shared with the Health Department at block, district and state levels • Community based organisations formed under various programmes/sectors will be engaged by a team of frontline workers – health, ICDS and PHE departments. 12. Human Lack of manpower at all levels • All staff to be in place as IPHS norms Resource starting from sub centres to by 2012 PHCs to CHCs to DH in district • Increased salaries for contractual Reasi doctors and Specialists • Special allowances for Regular staff Sub centre level
15 • The number of sub centres • Increase in the number of training will have to be increased centres for LHV, ANM, Staff Nurses, from 68 - 93 Lab Technicians • The requirement of ASHAs • Rational placement of Specialists and will be around 278 trained staff • The requirement of ANM • Recruitment of staff on contract will be around 186 as per where vacancies IPHS norms of 2 ANMs per • Recruitment of staff for new facilities Sub centre in 2008-09. as per the infrastructure requirements PHC level • Computers at all PHC and for each • The PHCs are adequate MO and Specialist at the CHC • As per IPHS 2 MOs per • Allowing Specialists and MOs for PHC will be required developing special skills as per their whereas at resent there is needs by attending special courses only one MO per PHC anywhere in India. • Proposal for Staff Nurse College and other Paramedical training college.
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EXECUTIVE SUMMARY
Reasi district comprises of large unserved and underserved areas due to difficult hilly terrain. Hence there has been very little development including lack of health facilities, poor transport network and communication. Number of SCs are inadequate as per the population norms and there is a need to upgrade all health facilities like PHCs and CHCs as per IPHS norms. Not even one of the facilities is as per the IPHS standards. Some most difficult and unreachable villages have been identified in different blocks of Reasi for which special outreach sessions are required.
The District Action Plan was developed in a participatory manner with EPOS as a facilitator. There was wide participation from all the related departments. A District Planning Team was constituted who carried out the block consultations and the Subcentre level consultations. Facility Survey was carried out for each facility. The consultations focussed on each of the thematic areas with the present situation, the bottlenecks, strategies and how to achieve the goals. The hot spots were identified from the village plans and the Block plans after incorporating the Facility survey reports, were consolidated to form the district plan. These were approved by the District Health society and the District Action Plan was finalized after incorporation of the DHS suggestions.
The District Action Plan comprises of the situational analysis, goals and objectives for each of the defined indicators, strategies, activities, support required from the state, work-plan and the budget for each of the thematic areas. All the aspects of health have been incorporated including the NRHM additionalities of ASHA, Untied funds, Mobile Medical Unit, Facilities as per IPHS norms, the National Disease control programmes, and Intersectoral Coordination and Community involvement. Capacity building and Human Resources have been dealt with in details. The other Cross cutting issues of Gender, Logistics and Warehousing, HMIS, IEC and Biomedical Waste management have been also incorporated.
The priorities of the district include providing services for the unreached, accurate data collection, strong district management, developing facilities as per IPHS norms and thereby meeting the national goals of NRHM.
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District R easi NRHM BUDGET - AT- A GLANCE (in lakhs) S. 2008-09 2009-10 2010-11 2011-12 Total No . Components A RCH-II 1 DHS 1.62 2.032 2.2452 2.45972 8.35692 2 DPMU 255.85 124.56 135.79 151.358 667.558 3 Maternal health 103.941 104.7751 109.38261 122.640871 440.739581 4 Child Health 59.494 18.3009 19.93099 22.224089 119.949979 5 Family Welfare 48.55 36.785 45.4435 56.68685 187.46535 6 Adolescent Health 20.25 13.915 15.3065 16.93715 66.40865 9 Gender & Equity 19.2 22.22 24.432 26.8452 92.6972 10 Capacity Building 94.7042 74.8857 76.90215 29.725345 276.217395 11 HR 613.12 621.298 629.476 637.654 2501.548 12 IEC 54.129 34.6619 37.03309 40.721399 166.545389 13 HMIS 61.928 10.478 10.713 11.089 94.208 Total A 1332.786 1063.9116 1106.65504 1118.341624 4621.694464 B NRHM 1 ASHA 57.46 26.206 26.951 27.716 138.33226 SC Untied Fund & 19.4 19.6 20.2 20.8 80 2 Maintenance PHCUntied Fund & 15.75 15.75 15.75 15.75 63 3 Maintenance CHCUntied Fund & 12.5 12.5 12.5 12.5 50 4 Maintenance 5 MMU 39.468 14.060 15.526 17.128 86.181938 Upgradation of GH & 1257.34 6 CHC 895.1 146.75 56.75 158.740 7 Upgradation of PHC 758.755 471.154 130.409 128.930 1489.24874 8 Upgradation of SC 206.25 180.58 130.44 82.44 599.71 9 VHWSC 36 36 36 36 144 Community Action 14.85 16.335 17.9685 19.76535 68.91885 10 Plan 11 PPP 2.75 3.03 3.34 3.74 17.36 12 Health Care Financing 31.416 26.666 26.666 26.666 111.414 13 Logistics 140.81 3.808 4.19 4.618 153.426 Total B 2230.509 972.439 496.690 554.794 4254.431788 C Immunization 1 Immunization 68.77 73.341 79.7401 86.86531 308.71641 Total C 68.77 73.341 79.7401 86.86531 308.71641 D NDCP 1 RNTCP 46.36896 42.832356 44.6752916 51.59552076 185.4721284 2 Leprosy 5.7 7.15 7.55 8.15 33.35 3 Malaria 194.66 188.477 206.7917 227.20187 817.13057 4 Vector Borne 3.25 3.635 3.9975 4.40025 15.28275 5 Blindness Control 28.505 31.3555 34.49105 37.940155 132.291705 6 IDSP 40.51 20.658 24.6488 29.28168 115.09848
18 7 IDD 7.25 8.085 8.8925 9.77875 34.00625 Total D 326.244 302.19286 331.046842 368.3482258 1327.831883 E Others 1 Inter-Sectoral 73.224 76.1464 79.36104 82.897144 311.628584 2 School Health 30.28 33.308 36.6388 40.30268 140.52948 Bio-Medical Waste 18.34 20.454 22.4964 24.72304 86.01344 3 Management Total E 121.844 129.9084 138.49624 147.922864 538.171504
Grand total 4080.153 2541.7927 2152.6285 2276.271732 11050.84605
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1. SITUATION ANALYSIS
Profile of the District Reasi District is one of the 22 districts of the State of Jammu & Kashmir which has recently been bifurcated from its parent district Udhampur. It has 5 CD blocks. District headquarters is situated at Reasi. The District Reasi has 2,77,526 population, which lives in 275 villages and 83 Gram Panchayats. Geographically it covers an area of 248930 hectors.
Distinguishing features There are certain features in respect of J and K State in general, and Reasi district in particular, which have affected the availability and reliability of data. Some of the useful features of the district are as under:
Parts of the district are hilly. In certain CD Blocks most of the portion is inaccessible and hilly. Further, forest covers good proportion of the area of the districts. Consequently, depending upon topography, district Reasi consist of difficult and inaccessible areas. While it is difficult for the people to access services, on one hand, on the other, it is also difficult for health services to extend, upgrade and improve services. It is difficult to organise outreach activities and maintain regular supplies, especially in the context of essential medicines, vaccines, etc.
Due to the lack of amenities, it is very difficult to attract and retain human resources. There are significant number of vacancies in respect of various professional (specialists, surgeons, GDMOs), nursing, technical and support staff. This necessitates development of human resources policies and strategies appropriate to the region. In this connection modes like PPP and contracting may be used but after proper elaboration of the terms and conditions and payment system
There seems to be different administrative units prevalent in respect of different agencies (Census, Revenue Department, Medical and Health, etc.). The Medical and Health department has Medical Blocks. There are Tehsils, Community Development Blocks, Medical Blocks, Panchayats, Patwar Halqas, Gram Sabha and Villages. The units, which are conventional and are adopted by Agencies like Census and Rural Development Department may be taken as popular units than inventing or adopting different administrative units (for example Medical Blocks). It is some time difficult to reconcile geographical areas covered by them, which renders it impossible to compare data emanating from different units.
20 Even at the lowest level, the concept of village is a bit misleading. Excepting some, most of the villages do comprise a number of settlements with different names than the overall village; commonly known as ‘Modas’. Usually it takes considerable time to travel from one settlement to another, especially in hilly areas. This aspect is particularly important, inter alia, when we chose Anganwadi Worker or ASHA or conduct immunisation sessions.
As motorable roads do not connect all settlements, travelling on foot and local modes of transport becomes necessary. At some hilly and inaccessible places, mules are resorted to for transportation of supplies as well as ill or incapacitated persons. Consequently while tackling about the issues of accessibility (from the side of community) as well outreach and ensuring timely supplies (on the part of Health Department and other agencies), these factors need to be taken into account and provided for in the future plans.
The district is comprised of a large number of unserved and underserved areas. This is due to the fact that there are straight and dangerous mountains, no health facilities, no transport, no social development, speadout population and migratory tribes.
1. Identifying information of Reasi District
Name of District Reasi Name of District Headquarters Reasi
No. of Blocks in the District 4
No. of Gram Panchayats in the District 83
No. of Villages 275 1-500 201 501-1500 45 Size of Villages 1501-5000 20 5000+ 9 Villages without motorable roads DNA
No. of Towns 1 Municipal Corporation Municipality Urban Local Bodies (ULB) Municipality: 1 Notified Area Committee Others
21 Administrative Structure: Structure Details Tehsils 5 Community Development Blocks 5 4 Health department Blocks
Municipal Committees 1 No. of CHCs 3 No. of PHCs 22 No. of Sub-Centres 68
Panchayati Raj Institution: 3 Tier Setup
Total Villages : 275 Village Level : Panchayat Block Level : Panchayat Samiti District Level : Zila Parishad
Blockwise BPL Status Total Final BPL Families Population BPL Families No. Of Name of Rural # Block Families SC ST OC Total SC ST OC Total 1 Reasi 7252 522 713 1105 2340 25856 3613 5433 11632 2 Pouni 6666 343 561 1176 2080 1537 2771 5209 9517 3 Arnas 10346 801 2707 2471 5979 4069 14182 12530 30781 4 Gool 7924 164 1344 2642 4150 933 6331 13316 20580 5 Mahore 12739 36 4163 6618 10817 171 20188 32428 52787 27752 6 Total 121078 12543 14025 28772 55340 63992 71053 142481 6 Source : DRDA BPL census 2002-07
22 Medical Administrative Sectors Block No of Names of Sector Sectors 1 Reasi 1 Tote 2 Pouni 5 Laiter, Thakrakot, Barakh, Ransoo, Pouni 3 Katra 0 4 Mahore 16 Balmatkot,Deral,Thuroo,Ind,Sangaldan,Tuli,Lar,Surndi, Banna,Arnas,Gota,Bogadass,Dedha,Dharmari,Budhan, Mahore Total 22 Source : CMO Office
Status of ICDS Programme as on 13.4.07 Name of AWC's Name of AWC's SNo. Name of ICDS Project Sanctioned Operational 1. Arnas 100 97 2. Mahore 155 142 3. Reasi 108 106 4. Gool 92 84 5. Pouni 96 87 6. Total 551 516 Source : Dir SW Jammu
Status of ICDS Programme (Reasi District) Total ChildrenTotal malnourished preg. preg. Women Total eligibleTotal Total No. of No. Total No. ofchild No. Benefited Benefited Total No. No. Total below 03 below Children children children ANC's years years
Block Total AWW's In- Eligible- Nursing- Sanct. position attended Attended Arnas 100 97 5316 2780 490-350 1093-410 470 5 100 1593- Mahore 155 142 7418 4399 660 1922-829 336 - 155 Reasi 108 106 5770 2399 407-202 637-347 433 4 108 Gool 92 84 2147 1440 297-147 480-150 443 - 92 Pouni 96 87 3689 2638 250-200 531-325 749 - 96 Total 551 516 24340 13656 2431 9 551
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Development Indicators of the District S.No Indicators State District as per District data*
1 Crude Birth Rate 18.7 SRS -05 30.1 2 Crude Death Rate 5.6 SRS -05 DNA 3 Infant Mortality Rate 49.0 SRS -05 50* 5 TFR 2.4 NFHS III 2.9 6 Couple Protection Rate 53 % NFHS III 61% 7 Decadal Growth Rate 29.93 28.3
8 Population Density 99/ sq. km 350 9 Sex Ratio (General) 900 Census 2001 860 10 Sex Ratio (0 – 6 years) 937 Census 2001 931 11 Sex Ratio at birth DNA DNA 12 Literacy rate (overall) 54.46 Census 2001 55.2 13 Literacy rate (male) 65. 75 Census 2001 67.1 14 Literacy rate (female) 41.82 Census 2001 41.2 Enrolment of students T 77158 15 elementary education M 38599 F 38559 Source: Census, 2001; DLHS-RCH-II Survey, 2004, CMO office. * Parent district Udhampur
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DLHS-RCH-II Survey, 2004
Related to Pregnancy and Maternal Health Issue % Issue % Mean age at marriage for boys 27.5 Mean age at marriage for girls 21.5 Boys married below legal age at Girls married below legal age at marriage 21 years 5.4 marriage 18 yrs 0.0 Any antenatal check up 89.6 Antenatal check up at home 1.0* Who had one TT injection during 3 or more antenatal check ups 81.7 pregnancy 16.5* Who had two or more TT injection during Who had no TT injection during pregnancy 61.8 pregnancy 7.7* Who received 100 or more IFA tablets 32.7 Who consumed two or more IFA 59.2 during pregnancy tablets regularly during pregnancy Received adequate IFA tablets/syrup 39.0 Who consumed one IFA tablet regularly 19.4* Full ANC1 - (At least 3 visits for ANC + 23.4 Safe Delivery (Either institutional at least one TT injection + 100 or more * delivery or home delivery attendant - 76.7 IFA tablets) Doctor/Nurse/TBA) Full ANC2 - (At least 3 visits for ANC + Safe Delivery (Either institutional at least one TT injection + 100 or more 29.7 delivery or home delivery attendant by 59.5 IFA tablets/syrup) Doctor/Nurse) Institutional delivery 50.1 Home delivery 42.3 Women who had pregnancy Institutional delivery - government 38.1 complications 28.1 12.0 Institutional delivery - private * Women who had delivery complications 39.3
Related to Family Planning Issue % Issue % Women aware of RTI/STI 2.9 Birth order 3+ 33.0* Women aware of HIV/AIDS 18.4 Unmet need for limiting-1 9.2 Knowledge of any modern family planning method 87.7 Unmet need for spacing-1 3.7* Knowledge of any modern spacing 75.8 12.9 family planning method Unmet need -total-1 Knowledge of all modern family planning methods 18.3 Unmet need -total-1 9.2 Knowledge of any traditional method 13.3 Unmet need for spacing-2 11.2 Current use of any family planning method 55.1 Unmet need -total-2 10.4* Current use of any modern family planning method 50.9 Unmet need -total-2 20.4 Current use of any traditional family planning method 3.7 Current use - Male sterilization Current use - Female sterilization 15.4 Current use – PILLS 2.5* Current use - Male sterilization 1.4* Current use – CONDOM 30.0 Women had side effects due to use of 9.0* Women had side effects due to Pills 4.3*
25 female sterilization Women had side effects due to use of Sought treatment abnormal vaginal IUD 6.9* discharge 69.0* Women who utilized government health facility for treatment of RTI/STI (vaginal Women who had any symptom of 27.5 discharge) RTI/STI
Related to Child Health Issue % Issue % Breastfeeding within 2 hours (children 8.2 Percentage of children age 12-35 age below 36 months) months received BCG 91.2 Percentage whose mother squeezed out the first breast milk (children age below 52.6 Percentage of children age 12-35 41.5 36 months) months received DPT 3 Exclusive breastfeeding at least 4 18.2 Percentage of children age 12-35 64.3 months (children age 4-12 months) months received Measles Percentage of children age 12-35 67.9 Percentage of children age 12-35 23.9 months received Polio 0 months received Full Immunization Percentage of children age 12-35 46.2 Percentage of children age 12-35 0.0 months received POLIO 3 months not received any vaccination Awareness of diarrhoea 63.2 Knowledge of ORS 41.6 Who had diarrhoea (two weeks prior to Given ORS to children during survey) 7.7 Diarrhoea 76.3* Sought treatment for Diarrhoea 88.7* Aware of danger signs of Pneumonia 18.5 Who had Pneumonia (two weeks prior to survey) 17.7 Sought treatment for Pneumonia 94.6*
26 SOCIO ECONOMIC AND HEALTH INDICATORS
Total for Name of Health Block Reasi Katra Mahore Pouni District Demographic indicators Total Population 59365 53145 130258 34758 277526 Population of males 32002 31887 69494 18033 151416 Population of females 27363 21258 60764 16725 126110 % Scheduled Castes DNA DNA DNA DNA 19.1 % Scheduled Tribes DNA DNA DNA DNA 14.8 Socio-economic indicators No. of girls enrolled in primary 5731 5846 4990 730 17471 schools last year No. of private health 1 02 0 0 3 facilities/clinicians No. of women registered for 843 1171 2540 1090 5644 JSY Scheme till now 1 No. of Tubectomies conducted 241 10 97 69 65 in the last reporting year No. of IUD insertions done in 588 50 40 62 436 the last reporting year No. Of vasectomies done in the DNA DNA DNA DNA 12 last reporting year No. of pregnant women DNA DNA DNA DNA DNA No. of pregnant women DNA DNA DNA DNA registered for ANC during the DNA last reporting year No. of pregnant women who 5378 received both TT1 and TT2 1144 691 1001 2542 during pregnancy in the last reporting year No. of institutional deliveries in 804 114 239 125 326 the last reporting year No. of women referred for 247 85 72 22 68 MTPs in the last reporting year No. of children given measles 6253 1143 900 1663 2547 vaccine in the last reporting year Prevalent Diseases 1. Diaharea Skin Diaharea Diaharea Allergy
1 No. of pregnant women with the following mandatory characteristics: Belonging to BPL family Should be 19 years or older Up to two live births
27 Total for Name of Health Block Reasi Katra Mahore Pouni District 2. Hyper Hyper TB Hyper tension tension tension 3. TB Diaharea Snake Bite No. of patients currently DNA DNA DNA DNA DNA undergoing DOTS therapy in the block Number of new leprosy cases DNA DNA DNA DNA DNA reported in last reporting year
28
Workforce Vacancy Position * Given below is the information about Workforce Vacancy Position in the District
Table: 2 Identified Gaps of Manpower in The District District- Reasi Staff Staff Katra Reasi Pouni Pouni No. 0f No. of No. of Mahore Existing Existing
Name of Blocks Required Total IPHS No. of Sub- Centres Norm 11 9 34 14 68 ANM 2 15 9 34 15 136 63 73 N0. Of PHC's 1 0 16 5 22 MO 2 1 17 5 44 21 23 Pharmacist 1 1 3 0 22 18 4 Nurse 3 3 42 15 66 6 60 Female Health Worker 1 1 2 2 22 17 5 Health Educator 1 1 15 5 22 1 21 Health Assistant (one male and one Female) 2 2 29 8 44 44 0 Clerks 2 2 30 10 44 2 42 LT 1 1 10 3 22 8 14 Driver _ 0 Class lV 4 1 41 10 88 36 52 No. of CHC's A. CLINICAL MANPOWER 1 1 2 1 5 1 General Surgeon 1 1 0 2 1 5 1 4 2 Physician 1 0 0 2 1 5 2 3 Obstetrician / 3 Gynaecologist 1 1 0 2 1 5 1 4 4 Paediatrics 1 1 1 2 1 5 0 5 5 Anaesthetist 1 0 -1 2 1 5 3 2 Public Health Programme 6 Manager 1 1 1 2 1 5 0 5 7 Eye Surgeon 1 1 0 2 1 5 1 4 Other specialists 8 (if any) General duty officers (Medical 9 Officer)
29 B. SUPPORT MANPOWER 1 Nursing Staff 7+2 Public Health a Nurse 1 1 1 2 1 5 0 5 b ANM 1 -6 0 -2 -1 5 14 -9 c. Staff Nurse d. Nurse/Midwife 7 4 2 6 7 35 16 19 6 Dresser 1 1 1 2 1 5 0 5 Pharmacist / 7 compounder 1 -3 -3 5 0 5 6 -1 8 Lab. Technician 1 0 0 0 1 5 4 1 9 Radiographer 1 -1 0 1 1 5 4 1 Ophthalmic 10 Assistant 1 0 0 2 0 5 3 2 Ward boys / 11 nursing orderly 2 1 -5 -2 -2 10 18 -8 12 Sweepers 3 -2 0 2 2 15 13 2 13 Chowkidar 1 1 0 1 0 5 3 2 14 OPD Attendant 1 1 1 2 1 5 0 5 Statistical Assistant / Data 15 entry operator 1 1 1 2 1 5 0 5 16 OT Attendant 1 1 0 2 1 5 1 4 17 Registration Clerk 1 1 1 2 1 5 0 5 Any other staff 18 (specify)
Note: ( - ) Surplus staff
30 Details of Janani Suraksha Yojna – CMO Office Data
Number of beneficiaries Registered as on December 2007 Block Total Total Total Beneficiaries Beneficiaries Beneficiaries (Oct– Dec 07) (April – June 07) (July – Sept 07) 1 Pouni 417 385 288 2 Reasi 336 308 199 3 Katra 265 543 363 4 Mahore 856 771 913 Total 1874 2007 1763
Status of Deliveries:
Deliveries Dec-06 Dec-07
Block Domestic Institution Domestic Institution 158 95 104 114 Katra
Reasi 217 151 212 239
Pouni 729 233 707 125
Mahore 2053 713 1754 326
Total 3157 1192 2777 804
Immunization Status for 2006-2007 (CMO Office Data) DPT/OPV TT2 + BCG 3rd Measles Hep. B all Booster Vit. A all Dec-06 Dec-07 Dec-06 Dec-07 Dec-06 Dec-07 Dec-06 Dec-07 Dec-06 Dec-07 Dec-06 Dec-07
Katra 943 1011 888 937 904 1143 2209 2292 977 1144 989 1056 Reasi 797 1013 954 818 785 900 2661 2671 627 691 1547 2339 Pouni 1096 1453 1132 1284 1251 1663 3023 4805 1066 1001 2087 1178 Mahore 2454 2122 2598 2163 22689 2547 7545 6386 2928 2542 2087 1178 Total 5290 5599 5572 5202 25629 6253 15438 16154 5598 5378 6710 5751
31 Family Planning Status:
Sterlization IUD Condoms Oral Pills Block Dec-06 Dec-07 Dec-06 Dec-07 Dec-06 Dec-07 Dec-06 Dec-07 Katra 23 10 41 50 19000 9000 410 431 Reasi 40 97 60 40 10750 14050 394 418 Pouni 152 69 71 62 20000 22800 593 582 Mahore 20 65 308 436 14500 34030 1319 1863 Total 235 241 480 588 64250 79880 2716 3294
Status of Health Centre Buildings in the District
Sub-Centre (SC) Status: Sub Centres No. Overall Status Sub-Centres in own building But the condition of building is very poor. Sub-Centre in Panchayat Bldg / rented Building required with furniture. building SC without Electricity connection Funds for electricity connection required. SC without Water Supply Drinking water collected from near by houses. SC without Toilets No toilet available at SC level.
Block Pouni Status Names of PHC PHC PHC PHC PHC Laiter Thakrakot Bharakh Ransoo 24 hour PHC Yes Nil Nil Nil Total beds 5 Nil Nil 5 No. of OPD cases 25 10 8 10 No. of indoor cases 1 0 0 1 Rogi Kalyan Samiti Nil Yes Yes Nil
32 Block Reasi Status Name of PHC PHC Tote 24 hour PHC Yes Total beds Nil No. of OPD cases 200 No. of indoor cases 0 Rogi Kalyan Samiti Yes
Block Mahore Status Name of PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC PHC 1 2 3 4 5 6 7 8 9 10 11 24 hour Yes Nil Yes Yes Nil Yes Nil Yes Yes Yes Yes PHC Total beds 1 1 1 1 1 1 1 1 1 10 2 No. of 30 40 20 30 30 30 30 30 50 50 50 OPD cases No. of 0 0 0 0 0 0 0 0 0 0 0 indoor cases Rogi Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Kalyan Samiti
Block Mahore Status Name Of PHC PHC PHC PHC PHC 12 13 14 15 24 hour PHC Nil Yes Yes Nil Total beds 1 1 6 1 No. of OPD cases 55 55 200 55 No. of indoor cases 0 0 2 0 Rogi Kalyan Samiti Yes Yes Yes Yes
33 Name of PHC’s of Block Mahore 1. Balmatkot 2. Deral 3. Thuroo 4. Ind 5. Sangaldan 6. Tuli 7. Lar 8. Surndi 9. Banna 10. Arnas 11. Gota 12. Bogadass 13. Dedha 14. Dharmari 15. Budhan Community Health Centre (CHC) District Reasi (BPHC)/CHC Status CHC CHC CHC CHC Mahore Gool Pouni Reasi Total no. of beds Nil 5 10 12 Total no of OPD cases 150 60 110 200 Bed occupancy rate Nil 40-60% 40-60% 40%
Up gradation of RKS Nil Yes Yes Yes
Vehicle/Ambulance Yes Yes Yes Yes Ambulance with NGO DNA DNA DNA DNA partner Rogi Kalyan Samiti Yes Yes Yes Yes
Number of Institutions Requiring New Buildings
# Category of Institution Numbers 1 SC 45 2 PHC 15 3 CHC 0 Source: CMO office
34
Number of Buildings Requiring Repairs # Category of Institution Numbers 1 SC 23 2 PHC 7 3 CHC 3
Table:2 Percentage Availability of Infrastructure District: Reasi
Indicators SC (68) PHC (22) CHC (3) DH 1 Building (Govnt. + Donated) 47 63 100 2 Building (Rented) 53 37 0 3 Condition of Building (Good + Fair) 47 55 90 Water Supply (Tap, borewell/ 4 handpump/tubewell, well) 19 50 30
4.1 Tap water supply 18 25 70 5 Electricity 45 80 100 5.1 In all parts of hospital 0 50 100 Electric supply (power generation stablization) 0 0 0 6 Separate Toilet 0 0 80 6.1 Sep.Toilet with running water 0 0 80
7 Examination Table 77 71 100
8 Labor Room 0 0 90 8.1 Aseptic labor room 0 0 90 9 Avail. of Quater for staff 0 22 0 Number of beds available 10 (Average) 2 12 11 Laboratory 30 100 12 Operation Theatare 0 100 13 Waste Disposal (Burnt+Dump) 76 100 14 Availability of incenator 0 0 15 Telephone 0 80 16 Computer 0 80
35 17 Generator/Invertor 6 100 18 Vehicle 23 100 19 Emergency Room / Casualty 80 Separate wards for males and 20 females (Yes/No) 50 21 No. of beds : Male 5 22 No. of beds : Female 5 23 Availability of ECG facilities 70 24 X-Ray facility 90 25 Ultrasound facility 50 26 Cardiac Monitor for OT 20 27 Blood Storage Unit available 0 28 Blood Bank Facility 29 Other Investigative Facility Heating ventilatoin & air 30 conditioning 31 Lift & vertical transport 32 Refrigeration
36 Status of Staff Quarters attached to CHC, PHC and SC in the District Building Staff Quarters Condition Available /Not available. (G: Good, NMR: Needs Minor Repairs, MR: Needs Major Repairs, NAD: Needs Additions Yes ( GDMO, ANM , STAFF NAD, MR NURSE,PHARMACIST,LAB TECH.SWEEPER,AMBULANCE CHC Mahore DRIVER) CHC Gool Yes( Only for GDMO ) NAD PHC Banna No PHC Arnas No PHC Gota No NAD,NMR PHC Bogadass No PHC Dedha No Yes (MEDICAL NAD, NMR PHC Dhamari OFFICER,PHARMACIST) AD Balmatkot No AD Deval No AD Thuroo No AD Ind No AD Sangaldan No AD Tuli No NAD,MR AD Lar No AD Sarundi No AD Budham No Block-KATRA CHC Katra Yes ( Only for GDMO ) NAD, NMR Block-REASI CHC Reasi No PHC Tote No Block-Pouni CHC Pouni Yes ( GDMO,PHARMACIST) NAD,MR PHC Laiter No PHC Thakrakot No PHC Bharakh Yes ( MEDICAL OFFICER ) AD Ramsoo No
37
Non-Governmental Organization [NGOs]:
• The department of Health and Family Welfare in the 9 th Five Year Plan introduced the Mother NGO scheme under the RCH Programme with underline indent of the collaboration to address the gaps in RCH services, building institutional capacity as well as advocacy and awareness generation amongst the community. The scheme aims at involving NGOs in service delivery and addressing RCH needs in un-served and underserved areas. Under this scheme department of Family Welfare has identified and sanctioned grants to selected NGOs called mother NGOs in each district of the State, these MNGOs in-turn issue grants to smaller NGOs called Field NGOs for promoting goals and objectives of RCH Programme.
• Under revised MNGO scheme a sum of Rs 15 lakh is given to each MNGO for each district to carry out Need based RCH intervention in underserved or un-served areas with special focus in providing basic health care services and IEC activities.
• Some NGOs also implemented RCH related projects in the district on issues such as Gender, MCH, Immunization, RTI/STI management and adolescent Health etc by funds received from external donor agencies or funds under externally aided projects available with state government • The district Health and FW society monitor the activities periodically. • There is no service NGO under SNGO scheme that could be identified despite of government efforts • Other significant contribution of NGOs is in health sector (e.g. Rotary Club conducts eye camps)
Significant NGOs working in district Reasi are:
• J & K Ex-Services League is the Mother NGO for Udhampur district. Their focus is on maternal Health, Child Health, Adolescent health, RTI/STI • Lok Sewa Sangathan, a Field NGO for RCH programme. Their work area is in Block Majalta • J & K Paryavaran Samiti is also working in Block Majalta as a Field NGO for RCH programme • SEAS is working in Block Reasi as a Field NGO for RCH programme • Chandrabagha Lok Sewa Sangathan is working as FNGO in block Pouni for RCH Programme.
38 2. PLANNING PROCESS
A decentralized participatory planning process has been followed in development of this District Action Plan. This bottom-up planning process began with consultations with block stakeholder groups, Block /core Group members and village communities in all villages of each Block of the District.
Block Action Plans were developed based on the inputs gathered through village action plans prepared by Village Health Water Sanitation Committees. The health facilities in the block viz. SC, PHC and, CHC were surveyed using the template developed by Government of India. The inputs from these facility surveys were taken into account while developing the Block Action Plan.
The District Planning Team (DPT) provided technical oversight and strategic vision for the process of development of District Action Plan. The members of the District Planning Team (DPT) had also taken the responsibility of contributing to the selected thematic areas such as RCH, Newer initiatives under NRHM, immunization etc. Assessment of overall situation of the District and development of broad framework for planning was done through a series of meetings of the District Planning Team (DPT).
This District Action Plan has been prepared through a long process of integration of Block Action Plans including Health Facility Surveys. An initial meeting was held in which the current status of the District Action Plan was presented and suggestions and feedback taken. The membership and roles and responsibilities of District Planning Team (DPT) and the chapterization plans were discussed. Based on the inputs received from the Blocks, a draft of each chapter was developed after discussions. These were further improved upon through individual consultations with groups and nodal officers. Specific dates and times were fixed for this purpose. A date was also proposed for a meeting during which the individual chapters would be discussed and approved before the final DAP was prepared for presentation to the District Health Society for approval.
39
HEALTH SERVICE INDICATORS FOR THE DISTRICT BASIC HEALTH SERVICES Goal Posts & S.No Indicator Criteria SCORE IMMUNIZATION Maximum No. completely % of fully COVERAGE No. <3 years 100% 1 immunised immunized children < 3 YEAR OF Minimum 0% AGE 26760 100% 100% No of women Total no. of % of women Maximum ESSENTIAL who got full pregnant getting antenatal 100% 2 ANTENATAL antenatal care women care as defined Minimum 0% CARE as defined 817 Total no of % of pregnant Total no. of Maximum women who women who had INSTITUTIONAL pregnant 100% 3 had institutional institutional DELIVERY women Minimum 0% delivery delivery.
WEIGHING OF Total no. of No. of newborn Percentage of Maximum NEWBORN WITH births in the weighed within newborn weighed 100% 4 IN THREE DAYS year three days within three days Minimum 5%
No of newborns Percentage of BREASTFEEDIN Total no of Maximum who were newborns who G IN FIRST births in the 100% 5 breastfed in the were breastfed HOUR last year Minimum 0% first hour within an hour
Approx no of Maximum REPORTING OF blood slides Average time taken for reporting of over 30 days 6 BLOOD SLIDE sent in last 3 blood slide Minimum 1 months day 9184 1-2 days
40 No. who wanted % of No of target Total no. of to get FP unmet couples for couples with at Maximum ACCESS TO operatio deman sterilisation least one of 100% 9 STERILISATION n done d for FP services them wanting Minimum 0% SERVICES last year operati ( > 2 children) FP operation: but could on not
HEALTH RELATED SERVICES WATER & SANITATION 15 USE OF Total no. of Total no. of Percentage of Max imum : DOMESTIC/ families families where families where all 50 % COMMUNITY all members are members are using Minimum TOILET using domestic/ domestic/ community 0% community toilet toilet 6250 DNA DNA DNA FOOD SECURITY RELATED Total no. of Percentage children Actual No. getting diet of ANGANWADI 16 eligible for regularly Anganwadi
Anganwadi beneficiaries 51470 18066 35.10 Percentage Total no. of Total no. of schools of schools primary and MIDDAY MEAL giving cooked midday giving 17 middle meals midday schools meals 999 999 100 Total no. of BPL families Percentage PDS No. of families getting eligible for of 18 FUNCTIONING grains from PDS shop lower cost beneficiaries
grains DNA DNA DNA
41 Total no. of No. of families getting Percentage ANTYODAYA BPL families free grains from PDS of 19 YOJNA eligible for shop beneficiaries free grains DNA DNA DNA Percentage Total no. of No. of children in age of school SCHOOL children in 6- group not going to 20 going ENROLMENT 14 age group school children 244196 109672 55.08 HEALTH STATUS Total no. of no. of children with gr CHILD children below % of children Max 200% I or above 21 MALNUTRITION 3 with wt malnourished Minimum 0% malnutrition** record. DNA DNA DNA DNA Total no. of Percentage LOW BIRTH newborn who Total no. of babies Max 100% of babies 22 WEIGHT were weighed with LBW Min 10% with LBW last year DNA DNA DNA DNA 100% - % of Total no. of married No. of girls married Max 100% AGE OF girls married women 23 below 19 year of age Min 0% MARRIAGE last year below 19 year of age DNA DNA DNA DNA Total number % of of births last No. of children born unspaced Max 100% year which with more than 36 second or 24 SPACING Minimum 0% were second months difference third children or > child born DNA DNA DNA DNA Total number Any deaths of any % of infant Maximum 20% of births last 25 INFANT DEATHS child below one year deaths Minimum 0% year DNA DNA DNA DNA
42 Diarrhoeal outbreaks(Mo Sum of water OUTBREAK OF re than three Jaundice outbreaks borne Maximum 4 WATER BORNE 26 cases of a (as defined) disease Minimum 0 DISEASE disease in outbreaks
same week ) DNA DNA DNA DNA
INFRASTRUCUTRE PLANNING – District Reasi
INFRASTRUCTURE PLANNING Facility 2001 2007- 08 2008-09 2009- 2010- 2011-12 10 11 Projected Population (Calculated Decadal Growth rate of 30 as per the Pop. of 2007) 7,43,509* 277526 285852 294427 303260 312358 District Hospital 1 1 1 1 1 1 CHC 5 5 5 5 5 5 PHC + AD 22 22 22 22 22 22 Subcentre 68 93 95 98 101 104 ASHAs 272 278 286 294 303 312 AWCs 516 551 551 551 551 551
43 3. PRIORITIES AS PER BACKGROUND AND PLANNING PROCESS
National Rural Health Mission encompasses a wide range of health concerns including the determinants of the good health. Though there is a significant increase in resource allocation for the NRHM, there can never be adequate resources for all the health needs and all that needs to be done for ensuring good health of all the people. It is therefore necessary to prioritize the areas where appropriate emphasis needs to be given.
As per the situational analysis and need identified through the participatory planning process, Jammu district requires additional inputs to achieve the goals of NRHM. Extra resources including personnel and additional infrastructure and innovative schemes are required for reaching the essential health services to the people. Following are the overall priorities of this District identified through the process;
Access to services: 1. Reaching the unreached population through out reach services and mobile health units 2. Ensuring availability of service providers like Specialists, Doctors and Staff Nurses and retaining the staff in the difficult areas. 3. Increasing overall access to RCH services, especially FP services through public private partnerships Quality of services: 4. Improving quality of services at all levels through the use of standard protocols and systems 5. Improving the condition of the facilities as per the IPHS norms including provision of quarters for the personnel 6. Building capacity of functionaries at all levels for improving quality of services Programme management: 7. Strengthening programme management and CMO office with good Infrastructure and additional human resources through DPMUs. 8. Strengthening the HMIS through the development of GIS based MIS. 9. Building capacity of programme managers at the district and block levels for improving quality of management. 10. Improving supervision and monitoring of services and resource utilisations for achieving intended health results. Community mobilisation: 11. Increasing the utilisation of public health services by the community 12. Involving PRI members and other community leaders for communitisation of health 13. Increasing male involvement in RCH services, especially FP.
44 Specific Priorities of the District:
1. Availability of Primary health care services: Providing services of ANC, Safe delivery, PNC, Immunization, DOTS, Anaemia prevention, prevention of Malaria at the village level. 2. Programme Management: Efficient functioning of the District Health Society, a strengthened CMO’s office with efficient district and Block programme managers and management units. 3. Demand Generation, IEC/BCC: Behaviour Change for utilization of services. 4. Human Resources: Filling of the vacancies as per the population based norms, increased mobility, increased incentives for retaining the personnel in difficult areas, motivational issues, provision of residential facilities, Availability of well-trained ASHAs. 5. Capacity Building: Focussed capacity building in Emergency Obstetric Care, Management, Continuous skill building of all personnel as per needs expressed and also the new job responsibilities under NRHM, opening a Staff Nurse Training College and Paramedical Staff training centre. 6. Maternal Health: Well managed system of deliveries by skilled birth attendants, promotion of institutional deliveries (labour rooms in all sub centres with residential facilities for ANMs), Emergency Obstetric Care services, JSY extended to all the pregnant women, Blood Storage Units in all CHCs. All CHCs to be developed as FRUs, PHC to be developed as 24x7 facilities with good referral mechanisms. 7. Neonatal and Child Health: Provision of Neonatal services at CHC, PHC, with trained personnel on IMNCI and IMCI and addressing Anaemia and Malnutrition 8. Immunization: Total coverage for immunization of children, pregnant women and adolescents 9. Family Planning: Improving the coverage for Spacing methods, NSV and Tubectomy. 10. Adolescent Health: Adolescent Reproductive and Sexual health education through schools and also awareness building on good health practices, responsible family life, marriage at right age. 11. National Disease Control Programmes: Prevention and treatment of Malaria, Tuberculosis, Anemia and malnutrition 12. Infrastructure : Increase in the number of Subcentres, PHC, CHC and General hospitals catering to the entire population and developing all the facilities as per IPHS norms. 13. Procurement and Logistics: Construction of a scientific Warehouse for Drugs 14. Monitoring and Evaluation: Data validation and computerized data availability upto PHC with district linkages 15. Public-Private Partnership: Involvement of the private facilities for providing services and NGOs. 16. Intersectoral Convergence: Involving the related departments as members in the District Health Society, Fixing Responsibilities of each sector for their accountability and Intersectoral Coordination
45 4. GOALS
The District will strive to improve the availability of and access to quality health care by people, especially for those residing in rural areas, the poor, women and children and will achieve the following goals: Goals INDICATOR Current 07-08 08-09 09-10 10-11 11-12 10 % 20 % 30 % 40 % 50 % Reduction in Infant Mortality Rate (IMR) 50** Baseline Baseline Baseline Baseline Baseline 10 % 20 % 30 % 40 % 50 % Reduce Neo-natal Mortality Rate (NMR) DNA Baseline Baseline Baseline Baseline Baseline Reduction Maternal Mortality Ratio (MMR) 10 % 20 % 30 % 40 % 50 % DNA per lakh births Baseline Baseline Baseline Baseline Baseline
Reduction in Birth Rate (Estimated from 31.47 30 28 25 23 20 deliveries reported in MPR)
Reduction in Total Fertility Rate 2.9 2.6 2.5 2.4 2.3 2.1
Full ANC as defined 44.8%** 50% 60% 75% 90% 100 % 21.5%* Increase 3 Ante-Natal Care 30% 50% 70% 90% 100 %
Increase Proportion o f Women getting IFA 70% 80% 90% 100% 100 % tablets 64.6**
Increase Proportion of Women getting 2 21.5%* 30% 50% 70% 90% 100 % TT Injections
Increase Institutional Deliveries 40%* 30% 50% 60% 70% 80 %
Increase Delivery by Skilled Birth 11.8%* 30% 50% 60% 70% 90 % Attendants
Increase Contraceptive Prevalence Rate 69.7%** 70% 75% 80% 85% 90 %
Increase Complete Immunisation of 65.6%* 50% 60% 75% 90% 100 % Children (12-23 month of age) 44%**
Increase Proportion of Children 29.6%** 40% 60% 75% 90% 100 % Exclusively Breastfed
Reduce Prevalence of STI/RTI (have 25.7%** 25% 20% 15% 12% 10 % symptom) Source: (*) CMO Office data (**) DLHS 2002-2004 data DNA means data not available
The dat a regarding IMR, CBR, TFR, TT, CPR, Complete Immunization does not appear to be accurate and needs to be revalidated through a baseline survey.
46
INFRASTRUCTURE PLANNING:
Facility 2001 2007- 08 2008-09 2009-10 2010-11 2011-12 Projected Population (Calculated Decadal Growth rate of 30 as per the Pop. of 2007) 7,43,509* 2,77,526 2,85,852 2,94,427 3,03,260 3,12,358 District Hospital 1 1 1 1 1 1 CHC 5 5 5 5 5 5 PHC + AD 22 22 22 22 22 22 Subcentre 68 93 95 98 101 104 ASHAs 272 278 286 294 303 312 AWCs 516 551 551 551 551 551 (*) old district population (**) Block Population
47
5. TECHNICAL COMPONENTS
PART A: Reproductive and Child Health (RCH) II A-1. Strengthening of District Health Management Situation Since Reasi district has recently carved out from District Udhampur and as such Analysis/ there is no District Health Society constituted till date. CMO Reasi has already Current initiated process of formation and constitution of DHS Reasi with due Status consultation with District Development Commissioner.
Contractual appointments of various categories of staff are yet to made. Objectives • Formation and Registration of DHS Reasi • Empowered District Health Society to effectively plan, implement and monitor the progress of the health status and services in the district and achieve the goals of the District action Plan. Strategies 1. Constitution of DHS at the earliest. 2. Functional Integration of all the vertical Societies 3. Capacity building of the members of the District Health Mission and District Health Society regarding the programme, their role, various schemes and mechanisms for monitoring and regular reviews and also on GoI / GoJ&K guidelines for running the District. Health & FW Society 4. Strengthening the functioning of the DHS 5. Establishing Monitoring mechanisms Activities 1. Developing systems for proper management, governance and functioning through: • Effective Planning – Annual, quarterly, monthly and as per needs • Supervision mechanisms • Convergence systems • Procedures, • Reporting systems, • Regularity of meetings, • Agenda of meetings, Maintaining minutes and its timely circulation • Decentralisation, • Delegation of decision-making power • Rational decision making 2. Orientation Workshop of the members of the District health Mission and society. 3. Issue based orientation in the monthly Review and Planning meetings as per needs. 4. Ensuring provision of Technical Assistance at the district, block levels and sector levels and their ongoing capacity building. 5. Exposure visits of members of the District health Society to well functioning Panchayats in two states 6. Improving the Review and planning meetings through a holistic review of all the programmes under NRHM and proper planning. 7. Formation of a monitoring Committee from all departments. 8. Development of a Checklist for the Monitoring Committee. 9. Arrangements for travel of the Monitoring Committee 10. Sharing of the findings of the committee during the Field visits in each
48 Review Meeting with follow-up of the recommendations. Support 1. State to provide support for building the capacity of the DHS through required participation in DHS meetings 2. A GO should be taken out that at the district level each department should monitor the meetings closely and ensure follow-up of the recommendations. 3. Instructions should be issued to the DHS that all approvals should be done in the DHS Governing board meetings and the CMO should implement them instead of sending each file to the DC for approval. Timeline 2008 2009- 2010- 2011- Activities -09 10 11 12 Developing systems Orientation Workshop of the members x x x x Issue based orientation x x x x Ensuring provision of Technical Assistance at the district, block levels and sector levels x x x x Exposure visits of DHS members x x x x Formation of a monitoring Committee from all departments. Development of a Checklist for the Monitoring Committee. Budget Activity / Item 2008- 2009- 2010 2011- Total ( In Lakhs) 09 10 -11 12 Orientation Workshop 0.5 0.6 0.65 0.7 2.45 Issues based Workshops 0.5 0.7 0.8 0.9 2.90 Bi-monthly meetings @2000x6 0.12 0.132 0.145 0.160 0.56 Mobility for Monitoring 0.5 0.6 0.65 0.7 2.45 Total 1.62 2.032 2.245 2.460 8.36
Detailed Calculations # Description Amount Exposure Visit 1 Airfare and travel expenses (Taxi, Bus, etc;) 200000/- 2 Lodging, Boarding, Food 100000/- 3 Misc. 10000/- Total 3,10,000/- Mobility for Monitoring by the DHS members 1 Vehicle on Rent/ Mules trips @ Rs 1000 per visit x 5 days 60,000 visit per month x 12 months
49
A- 2 District Programme Management Status In NRHM a large number of activities have been introduced with very definite outcomes. The cornerstone for smooth and successful implementation of NRHM depends on the management capacity of District Programme officials. The officials in the districts looking after various programmes are overworked and there is immense pressure on the personnel. There is also lack of capacities for planning, implementing and monitoring. The decisions are too centralized and there is little delegation of powers.
In order to strengthen the district PMU, three skilled personnel i.e. Programme Manager, Accounts Manager and Data Assistant will be provided to the district. These personnel would be providing basic support for programme implementation and monitoring at district level.
The District Programme Manager will be responsible for all programmes and projects in district and the District Accounts Manager (DAM) is responsible for the finance and accounting function of District RCH Society including grants received from the state society and donors, disbursement of funds to the implementing agencies, preparation of submission of monthly/quarterly/annual SoE, ensuring adherence to laid down accounting standards, ensure timely submission of UCs, periodic internal audit and conduct of external audit and implementation of computerised FMS.
The District Data Assistant (DDA) has to work in close consultation with district officials, facilitate working of District RCH Society, maintain records, create and maintain district resource database for the health sector, inventory management, procurement and logistics, planning and monitoring and evaluation, HMIS, data collection and reporting at district level.
In Reasi district, since there is no DHS, so all vacant posts of District Programme Manager and District Accounts Manager needs to be filled up along with Block Programme Management units. Objectives Strengthen District Management Unit for effective programme implementation. Strategies • Support to the CMO proper implementation of NRHM. • Capacity building of the personnel • Development of total clarity at the district and the block levels amongst all the district officials and Consultants about all activities • Provision of infrastructure for the personnel • Training of district officials and MOs for management • Use of management principles for implementation of District NRHM • Streamlining Financial management • Strengthening the CMO’s office • Strengthening the Block Management Units • Convergence of various sectors
1. Support to the CMO for proper implementation of NRHM through involvement of more consultants for support to CMO for data analysis, trends, timely reports and preparation of documents for the day-to-day implementation of the district plans so that the CMO and the other district officers:
50 • Finalizing the TOR and the selection process • Advertisements for vacant positions of DPM, DAM, DDA and other consultants, one each for Maternal Health, Civil Works, Child health, Behaviour change. If properly qualified and experienced persons are not available then District Facilitators to be hired which may be retired persons. • Selection of consultants
2. Capacity building of the personnel • Joint Orientation of the District officers and the consultants • Induction training of the DPM and consultants • Training on Management of NRHM for all the officials • Review meetings of the District Management Unit to be used for orientation of the consultants.
3. Development of total clarity in the Orientation workshops and review meetings at the district and the block levels amongst all the district officials and Consultants about the following set of activities: • Disease Control • Disease Surveillance • Maternal and Child Health • Accounts and Finance Management • Human Resources and Training • Procurement, Stores and Logistics • Administration and Planning • Access to Technical Support • Monitoring and MIS • Referral, Transport and Communication Systems • Infrastructure Development and Maintenance Division • Gender, IEC and Community Mobilization including the cultural background of the Masses • Block Resource Group • Block Level Health Mission • Coordination with Community Organizations, PRIs • Quality of Care systems
4. Provision of infrastructure for officers , DPM, DAM, DDM and the consultants of the District Project Management Unit and also provision of office space with furniture and computer facilities, photocopy machine, printer, Mobile phones, digital camera, fax, etc.
5. Use of Management principles for implementation of District NRHM • Development of a detailed Operational manual for implementation of the NRHM activities in the first month of approval of the District Action Plan including the responsibilities, review mechanisms, monitoring, reporting and the time frame. This will be developed in participatory consultative workshops at the district level and block levels. • Financial management training of the officials and the Accounts persons • Provision of Rs. 500000 as untied funds at the district level under the jurisdiction of the CMO.
51 • Compendium of Government orders for the DC, CMO, district officers, hospitals, CHC, PHC and the Subcentres need to be taken out every 6 months. Initially all the relevant documents and guidelines will be compiled for the last two years.
6. Development of a District CMO office • Construction of multi-storeyed district Swasthya Bhawan for housing the CMO and all the officials and their staff. There will be pooling of funds available for office expenses, personnel and better utilization of resources. • This complex will also have a modern Conference Hall with speaker systems and facilities for LCD projector and a meeting hall along with a common Computer Cell. There will be a Control Room, Consultant Unit, Library, Waiting room, a record room, • The Swasthya complex will be furnished and partitions will be made as per the modern offices to give each one of the staff a separate working area. • Office Automation will be done through installation of PABX system, Computers systems with UPS, Printer and Scanner for each district office section, Laptop for CMO, District Family Welfare Officer, Fax machines, Photocopy machine, Broadband Internet connectivity, Digital Camera with date and time etc.
7. Strengthening the Block Management Unit : The Block Management units need to be established and strengthened through the provision of: • Block Programme Managers (BPM), Block Accounts Managers (BAM) and Block Data Assistants (BDA) for each block. These will be hired on contract. For the post of BPM and the BAM retired persons may also be considered. • Office set-up will be given to these persons • Accountants on contract for each PHC since under NRHM Subcentres have received Rs 10,000; also the village committees will get Rs 10,000 each, besides the funds for the PHC. • Provision of Computer system, printer, Digital Camera, furniture etc.
8. Convergence of various sectors at district level Provision of Convergence fund for workshops, meetings, joint outreach and monitoring with each CMO
9. Monitoring the Physical and Financial progress by the officials as well as independent agencies.
10. Yearly Auditing of accounts Support 1. State should ensure delegation of powers and effective decentralization. from state 2. State to provide support in training for the officials and consultants. 3. State level review of the DPMU on a regular basis. 4. Development of clear-cut guidelines for the roles of the DPMs, DAM and District Data Manager. 5. Developing the capacities of the CMOs and other district officials to utilize the capacities of the DPM, DAM and DDA fully. 6. Each of the state officers Incharge of each of the programmes should develop total clarity by attending the Orientation workshops and review meetings at the district and the block levels for all activities.
52 7. If qualified persons for the posts of DPM, DAM are not available then State should allow the appointment of facilitators or Coordinators or retired qualified persons by the District Health Society. Time Frame 2008- 2009 2010 2011 09 -10 -11 -12 Activity DPM, DAM, DDA and Consultants x x x x Infrastructure, furniture, computer systems, fax, x UPS, Printer, Digital Camera Workshops for development of the operational x x x x Manual at district and Block levels Construction of Zila Swasthya Bhawan x Furnishing and Office Automation, Conference Hall x with speakers, ACs Compendium of Govt orders x x x x Joint Orientation of Officials and DPM, DAM, DDM x x x x Management training workshop of Officials Establishment of BPMU x Training of DPM and Consultants x x x x Review meetings x x x x Computer systems with printer and Digital Camera x and furniture for DPMU, BPMUs, District, block personnel Monitoring of the progress x x x x Budget
2008- 2009- 2010-11 2011- Total Activity/Item 09 10 12 Honorarium DPM,DAM,DDA and 29.4 32.34 35.57 39.13 136.45 Consultants Hiring of vehicles at District level @ Rs 1000 1.8 1.98 2.18 2.40 8.35 x 15 days /mth 12 mths Workshops for development of the 1 1.10 1.21 1.33 4.64 operational Manual at district and Block levels Untied Fund 5 5.50 6.05 6.66 23.21 Construction Cost of Health Complex 110 0.00 0.00 0.00 110.00 (11000sq.f @ 1000/sq.f) Furnishing and Office Automation, 15 0.00 0.00 0.00 15.00 Conference Hall with speakers, ACs Maintenance of the Health Complex 0 1.00 1.50 2.00 4.50 Compendium of Govt orders 0. 50 0.60 0.65 0.70 1.95 Joint Orientation of Officials and DPM, DAM, 0.25 0.30 0.00 0.35 0.90 DDM Management training workshop of Officials 0.5 0.70 0.80 0.90 2.90 Personnel for BPMU 64.56 71.02 78.12 85.93 299.62 Training of DPM, BPMU and Consultants 0.5 1.00 0.00 1.50 3.00 Review meetings @ Rs 2000/ per month x 0.24 0.26 0.29 0.32 1.11
53 12 months Office Expenses @ Rs 10,000/month x 12 1.2 1.32 1.45 1.60 5.57 months for district Computer systems (36) with printer and 0.00 0.00 0.00 21.60 Digital Camera and furniture for DPMU, BPMUs and District and block & sectoral personnel 21.6 Annual Maintenance Contract for the 2.16 2.16 2.16 6.48 equipment 0 Hiring of vehicles at block level @ Rs 1000 x 2.4 2.64 2.90 3.19 11.14 5 days /mth x 4 blocksx12 mths Office expenses for Blocks @ Rs 5000 x 4 2.4 2.64 2.90 3.19 11.14 blocks x 12 Total 255.85 124.56 135.79 151.36 667.56
Detailed calculation for Personnel at DPMU for one year Details Units Unit Cost Amount for 12 months Personnel at District level District Programme Manager 1 18000 216000 District Accounts Manager 1 15000 180000 District Data Assistant 1 12000 144000 Consultant for Maternal Health 1 40000 480000 Consultant for Child Health 1 40000 480000 Consultant for Civil Works 1 40000 480000 Consultant for HMIS 1 40000 480000 Consultant for Behaviour Change 1 40000 480000 SubTotal 2940000
Detailed calculation for Personnel at BPMU for one year Personnel at Block level Block Programme manager 4 15000 720000 Block Accounts Manager 4 12000 576000 Block Data Assistant 4 10000 480000 Sectoral Manager 21 10000 2520000 Retired Accountants for each 21 5000 1260000 PHC @ Rs 5000 per month x 21 PHCs x 12 months Subtotal 5556000 Office Automation with Furniture, 12 for BPMU 60,000 900000 Computer system, Camera, 3 for DPMU Printer, etc Subtotal 900000
54 A-2. MATERNAL HEALTH Status Indicator No of Pregnancies 4477 Maternal Deaths(April-07 to DNA December 07 ) ANC registration 4029 as per the CMO 90 % office Full ANC coverage as defined DNA 80.86 TT 1 DNA TT -2 DNA Booster 5378 Institutional Deliveries 804 22.4 Total Deliveries 3581 Home deliveries 2777 77.5 No. of pregnancy related DNA complications referred to FRU level MTP 247
Maternal Mortality: There is no authentic data available regarding the Maternal deaths in the district since there is a lot of under reporting due to lack of personnel and improper supervision. ANC: Out of the estimated pregnancies 100 % pregnancies had been registered of which 85 % were administered TT2 from April 06 to Jan 07. This data needs to be validated since the institutional deliveries are only 40%. Full ANC coverage is 80%.. The reasons for low ANC coverage are the shortage of staff, socio-cultural beliefs, large areas and populations unreached and the unmotivated staff. Anaemia: There is no data available regarding the consumption of IFA. As per DLHS 2002 only 45.8 % of the pregnant women received 100 IFA tablets percent and among them 51.9 % had consumed it daily. TT: As per data from CMO office 100% of the pregnant women had received TT2. As per DLHS 2002, 34.5 % of the pregnant women had received two doses of TT. This hence carries a grave risk for the pregnant women. Immunization needs to be strengthened with thrice a week sessions. Deliveries: Institutional deliveries are 40 % as per estimated number of births based on BCG achievement. As per DLHS 2002 only 30.2% were institutional deliveries. 57.8% were safe deliveries by Doctor/Nurses/TBA and 35% by Doctor/Nurses. This is a reflection of the availability of services, accessibility and also the perception of people.
55 Referrals: There is no inadequate data for referrals during complications. As per DLHS-2002, 23% women had complications during delivery. MTP: There were 247 MTPs carried out last year which is 4.6% of the total pregnancies. Male participation : There is no data available for the level of male participation and also on what issues does male participation occur Services: The Community does not have enough confidence in the government facilities since the personnel are not always available and also adequate infrastructure, equipment and drugs. The private facilities also are not available. Training : Regular training programmes on TBA, EmOC and MTP need to be arranged for the personnel. Also the TBAs need to be trained and equipped Village Health Day (VHD days) are being organized but there is little awareness amongst the community about the days when these are held and also regarding the services being provided. Also staff is inadequate to cover all the AW Cs . The daughter-in-laws are now making presence in these meetings. Earlier only the mother in laws would show up but now these daughter-in-laws are taking initiative. RCH Camps: RCH camps are organized by the department to reach the community and provide services at the doorsteps. These camps provide specialist services with simple diagnostic tests. They also serve for screening of RTI and STDs. Objectives/ 1. Decrease in the Maternal Mortality ratio to 50% of the baseline by 2012 Milestones/ 2. 100% ANC coverage by 2012 Benchmark 3. 100% pregnant women administered two doses of TT by 2012 s 4. 80% pregnant women to consume 100 IFA tablets by 2010 and 100% by 2012 5. 60% Institutional deliveries by 2010 and 90% by 2012 6. 75% deliveries to be carried out by trained /Skilled Birth Attendant by 2010, 100% by 2012 7. 100% women to get improved Postnatal care by 2010 8. 50 % increase the safe abortion services by 2010 9. Reduction in Anaemia to less than 20 per cent by 2012 Strategies 1. Provision of quality Antenatal and Postpartum Care to all pregnant women 2. Increase in Institutional deliveries 3. Provision of Quality services in the health facilities and availability of Emergency Obstetric Care services 4. Availability of safe abortion services at all CHC and PHC 5. Increased coverage under JSY 6. Strengthening the Village Health Day 7. To increase awareness among mothers and communities about the importance of institutional deliveries
56 8. Improved behaviour practices in the community 9. Increase accessibility to services 10. Operationalization of all the sanctioned Anganwadis
Activities 1. Identification of all pregnancies through house-to-house visits by AWWs, ASHAs and TBAs 2. Operationalizing the Village Health Day • Once a week ANC clinic at all PHC and CHC • Weekly ANCs at all AWCs wherever possible • Development of a microplan for the ANMs in a participatory manner with the ICDS at the level of PHC to cover all the AWCs. In the beginning it is expected that there should be 100% coverage at the population covered by the AWCMO and later each hamlet need to develop its microplan. • Wide publicity regarding the VHD day by AWWs and ASHAs and their services • A day before the VHD day the AWW and the ASHA should visit the homes of the pregnant women needing services and motivate them to attend the VHD day • If the pregnant women do not attend the VHD day then they should be brought from their homes to the AWC • Registration of all pregnancies • Each pregnant woman to have at least 3 ANCs, 2 TT injections and 100 IFA tablets • Nutrition and Health Education session with the mothers at each of the mother’s meetings 3. Improving accessibility to care • Monthly Outreach sessions at each of the 120 difficult area villages in blocks Basantgarh, Cheneni and Ramgarh. • Pooling of resources at the PHC for conducting sessions for all services • Team to consist of MO PHC, LS, LHV, ANM, AWW, ASHA, Rehbar-e- Sehat teachers • Wide publicity for these outreach sessions by the ANMs/ AWWs/ ASHAs 4. Postnatal Care • The AWW along with ANM will use IMNCI protocols and visit neonates and mothers at least thrice in first week after delivery and in total 5 times within one month of delivery. They will use modified IMNCI charts to identify problems, counsel and refer if necessary. There is a need to train the AWWs intensively since initially till the posts are filled the ANM cannot do
57 joint visits 5. Active involvement of TBAs: • Training to all TBAs focussing on their involvement in VHD days, motivating clients for registration, ANC, institutional deliveries, safe deliveries, postnatal care, care of the newborn & infant, prevention and cure of anaemia and family planning , on the 5 cleans, danger signs and timely referral • Delivery kits to be given to all TBAs • TBA to be attached with the ANM • Incentive of Rs 100 per delivery should be given to TBAs for promoting safe and institutional delivery through Skilled Birth Attendant • The recruitment of new ASHAs should be from the TBA taskforce. 6. Reduction of Anaemia • Wider distribution of IFA tablets and overseeing their consumption • ASHAs to be developed as depot holders for IFA tablets • ASHA to ensure that all pregnant women take 100 IFA tablets Promotion of kitchen gardens to promote intake of iron rich vegetables. Attractive packaging and Ayurvedic preparations of Iron and Folic Acid as an alternative to persons not consuming IFA tablets for increasing acceptance • Availability of IFA tablets 7. Operationalization of the non functional AWCs in a phased manner 8. Tracking bags • Provision of tracking bags for all the Pregnant mothers • Training of ANM and AWWs for the use of Tracking bags 9. Provision of Weighing machines to all Subcentres and AWCs 10. Training of personnel for Safe motherhood and Emergency Obstetric Care (Details in Component on Capacity building) 11. Training for skilled birth attendant 12. Developing the CHC and PHC for quality services and IPHS standards (Details in Component Upgradation of CHC& PHC and IPHS Standards) 13. Increase accessibility of 24-hour delivery services (BEmoC) in 13 PHC. Repairs and renovations of PHC to be carried out. 14. Availability of Blood at the CHC • Establishing Blood storage units at all CHC • Certification of the Blood Storage centres 15. Improving the services at the Subcentres (Details in Component on Upgradation of Subcentres and IPHS)
58 16. Behaviour Change Communication (BCC) efforts for awareness and good practices in the community (Details in Component on IEC) 17. Increasing the Janani Suraksha coverage • Wide publicity of the scheme (Details in Component on BCC) • List of BPL pregnant women to be part of each month’s report • Advance Funds for JSY should be available with the ANMs • Timely payments to the beneficiary should be ensured • Starting of Janani Suraksha Yojana Helpline in each block through Rogi Kalyan Samitis 18. Provision of Mobile Phones to all the ANMs, PHC MOs and CHC personnel • Provision of Mobile phone instrument to ANMs. • Display of the Mobile numbers at all Subcentres, AWCs, Panchayat Ghar, PHC and CHC • Plan of Rs. 225 per month of BSNL, which includes facility for 50 free calls 19. Provision of Safe Abortion: • Provision of MTP kits and necessary equipment and consumables at all PHC • Training of the MOs in MTP • Wide publicity regarding the MTP services and the dangers of unsafe abortions • Encourage private and NGO sectors to establish quality MTP services. • Promote use of medical abortion in public and private institutions: disseminate guidelines for use of RU-486 with Mesoprestol. 20. Development of a proper referral system with referral cards 21. Improvement of supervision and monitoring of ANM tour programme, Fixed VHD days, outreach sessions, payment of JSY, EmOC services, referral • Fixed VHD days and Tour plan of ANM to be available at the PHC with the MOs • Checklist for monitoring to be developed • Visits by MOs and report prepared on basis of checklist filled • Findings of the visits by MOs to be shared by MO in meetings 22. Use of the Village Chowkidar and Numberdar as Social Mobilizers for getting data on Maternal deaths, abortions, Pregnancies 23. Involvement of Rehbar-e-Sehat teachers for IEC, reporting and community mobilization • Training of RIS teachers • Regular meetings for progress and follow-up • Increase of emoluments to Rs 500 per mot for motivation of families, giving
59 some safe drugs, promotion of good health practices and disease control 24. RCH Camps: These will be organized monthly to provide specialist services especially for RTI/STD cases. Build public-private partnership in this area. Support 1. Issue of joint letters from Health & WCD department for joint working and required ensuring its implementation 2. The Social Welfare department should ensure operationalization of no functional Anganwadis 3. Ensuring availability of personnel especially specialists and Public Health Nurses for the 24 hour PHC, CHC and two ANM at the subcentres 4. Ensuring availability of formats and funds with the ANM for JSY and timely payments 5. Certification of PHC as MTP centres 6. Ensuring smooth flow of Blood from the Blood Bank at District Hospital to the Blood Storage units 7. The State should closely monitor the progress of all the activities 8. JSY should be extended to all the pregnant women irrespective of BPL and APL Timeline 2007 2008- 2009- 2010- 2011- -08 09 10 11 12 Identification of all pregnancies through house-to- house visits x x x x X Operationalizing the VHDs x x x x X Once a week ANC clinic All PHC and CHC Weekly ANCs All AWCs wherever possible Microplan for ANMs x x x x X Monthly Outreach sessions 50 difficult villages Delivery kits to be given to all TBAs 275 275 275 275 275 Incentive for TBA referral @Rs 100 per referral 2000 3000 4000 5000 6000 Provision of tracking bags for all the AWCs 550 550 550 550 550 Provision of Weighing machines to all Subcentres and AWCs 550 Regular meetings for progress and follow-up x x x x X Establishing Blood storage units at all CHC 3 CHC 2 CHC 1000 Increasing the Janani Suraksha coverage 0 12000 14000 16000 18000 Janani Suraksha Yojana Helpline 1 2 3 4
60 Block Blocks Blocks Blocks Provision of MTP kits and necessary equipment 22 22 22 PHC 22 22 and consumables at all PHC PHC PHC PHC PHC Training of the MOs in MTP x x x x X RCH Camps 12 12 12 12 12 Training of personnel for Safe motherhood and Emergency Obstetric Care x x x x x Training of the MOs in MTP x x x x X Training for skilled birth attendant x x x x X Training of RIS teachers x x x x X Training to all TBAs x x x x X Training of ANM and AWWs for the use of Tracking bags x x x x
Budget Activity / Item 2008-09 2009-10 2010-11 2011-12 Total Consultancy support for developing 1 1.1 1.21 1.33 4.64 Microplan for MCH & N days Tracking Bags @ Rs 300/ bag x (550 1.94 2.14 2.35 2.58 9.01 AWCs+ 97 SCs) Adult Weighing machines @ Rs 800 per 4.4 0 0 0 4.40 machine x 550 AWCs & Maintenance One day training workshop on Tracking 2 2.2 2.42 2.662 9.28 bags at the district level and each sector Janani Suraksha Yojna @1400 X 5000 70 77 84.7 93.170 324.87 inst. deliveries Janani Suraksha Yojna @500 X 2500 12.5 12.5 12.5 12.5 50.00 Home deliveries of BPL families Blood Storage @ Rs 3 lakhs per unit 0 0 0 0 0.00 Referral Cards @ Rs 2 per card x 20,000 0.4 0.44 0.484 0.532 1.86 MTP kits @ Rs 15000 Per kit (PHCs + 3.9 3.9 0 3.9 11.70 CHCs) Mobile phone instrument to ANMs @ Rs 2 0 0 0 2.00 2000 Mobile Phones recurring cost to ANMs @ 2.7 2.7 2.7 2.7 10.80 Rs 2700 Mobile phone instrument to Supervisory 0.5 0 0 0 0.50 Staff like CMO, Dy CMO, DIO, DTO & BMOs @ Rs 5000 Mobile Phones recurring cost to 0.6 0.6 0.6 0.6 2.40 Supervisory Staff like CMO, Dy CMO, DIO, DTO & BMOs @ Rs 500/month RCH Camps @ Rs 25000 per camp x 8 2 2.2 2.42 2.662 9.28 camps per year Total 103.941 104.775 109.383 122.641 440.74
61 A-3. NEWBORN & CHILD HEALTH Situation Indicator No. Analysis Number of birth 5202 Live Births DNA Infant Deaths( as per CMO data) DNA Low birth weight newborns (> 2.5 kgs.) DNA Pneumonia under 5 years of age DNA Diarrhoea cases in the last year DNA
Anaemia in children : There is no data available `with the CMO or the ICDS regarding the levels of anaemia in children. Children are given IFA tablets for iron supplements under the national programme.
Malnutrition: Under nutrition is a cause of serious concern amongst the children of the 0-6 years age group. In the ICDS programme Supplementary nutrition is provided to children below 6 yrs. The coverage of ICDS is only 23 %. Nutrition is being provided at the AWC and 37.3 % of the children at the AWCs are malnourished and there are no severely malnourished as per the data from the MPR of ICDS programme. The data for the severely malnourished appears unrealistic. The reasons for malnutrition are related to repeated diarrhoeal episodes, feeding practices of not giving colostrums, late weaning, poor sanitation and worm infestation.
Breast feeding: There is no data regarding exclusive breast feeding. As per DLHS 30.4 % children were breastfed exclusively for the stipulated period of 4 months. There is lack of knowledge regarding the significance of Colostrum and the socio-cultural factors associated with it since 94.7 % of mothers squeezed out the first breast milk as per DLHS.
Childhood illnesses Diarrhoea : Undernutrition is associated with diarrhea, which further leads to malnutrition. There is no data on diarrhoea but according to the district MOs it is common. According to the DLHS 2002 43 % of the women were aware of what was to be done when a child got diarrhea and 32 % were aware about Oral Rehydration Solution (ORS) and 35.9% give ORS to children and a negligible percentage gave more fluids to drink. Also only 30.5% sought treatment for Diarrhoea. This shows that there is a need for more knowledge regarding the use of ORS and increased intake of fluids and the type of food to be given.
Pneumonia : There is no data on childhood Pneumonia but as per the district official there is a need to create awareness regarding the danger signs of Pneumonia. As per DLHS 2002, 42.8% persons were aware of danger signs of Pneumonia and all persons sought treatment for Pneumonia
Newborn and Neonatal Care: There is very little data available for the newborns and the neonates. The District data shows that a negligible percentage of newborns and neonates died which is doubtful. Reporting regarding these deaths is not done properly. The various health facilities also are poorly equipped to handle newborn care and morbidity. The TBAs and the personnel doing home deliveries are unaware regarding the neonatal care especially warmth, prevention
62 A-3. NEWBORN & CHILD HEALTH of infection and feeding of Colostrum.
Training: IMCI and IMNCI training is essential for the MOs, Staff Nurses, ANMs. Training on the home based care package is required for the ANMs/AWWs/ASHAs/TBAs. However some portion is being covered under SBA trainings.
Data: There is no data available for childhood diseases, Prenatal mortality, Low birth weight at birth, deaths due to various causes Objectives 1. Reduction in IMR to 50% from baseline by 2012 Benchmarks 2. Reduction in Neonatal mortality to 50% from baseline by 2012 3. Increased proportion of women who exclusively breastfeed for 6 months to 100% by 2010-2012 4. Increased in Complete Immunization to 100% by 2010-2012 5. Increased use of ORS in diarrhoea to 100% by 2009-2010 6. Increase in the Treatment of 100% cases of Pneumonia in children by 2010- 2012 7. Increase in the utilization of services to 100% by 2012 Strategies & 1. Improving feeding practices for the infants and children including breast Activities feeding 2. Promotion of health seeking behaviour for sick children 3. Community based management of Childhood illnesses 4. Improving newborn care at the household level and availability of Newborn services in all CHC & hospitals 5. Improving the care for Malnourished children 6. Enhancing the coverage of Immunization 7. Zero Polio cases and quality surveillance for Polio cases Support 1. Promote early and exclusive breastfeeding up to 6 months of age and required complementary feeding thereafter 2. Promoting Integrated management of neonatal and childhood illnesses (IMNCI) • IMNCI training will be carried out for the health workers • Assess the FRUs with reference to IPHS developed by GOI and identify the gaps • Provide necessary instruments and equipment needed to ensure CEmOC • Training of MO in CEmOC, newborn care and lifesaving saving anaesthesia skills as per the models developed per GOI. Also resuscitation skills. • Blood storage facilities will be operationalized in all 7 CHC/ PHC/ FRUs to be proposed (only district hospital working as FRU) • Referral transport facility will be provided to all health facilities for bringing the patients to FRUs. • Training neonatal nurses (one month at medical college) • Strengthening the neonatal services and emergency Child care services in District hospital and at all CHC. This will be done in phases ••• In all of these units, newborn corners would be established and staff trained in management of sick newborns and immediate management of newborns. For all the equipment for establishing newborn corners, a five year maintenance contract would be drawn with the suppliers. The
63 A-3. NEWBORN & CHILD HEALTH suppliers would also be responsible for installing the equipment and training the local staff in basic operations • The equipment required for establishing a newborn corner would include Newborn Resuscitation trolley, Ambubag (including newborn sizes), Laryngoscopes, Phototherapy units, Room warmers, Inverters for power back-up, Centralized oxygen and Pedal suctions 3. Improving feeding practices for the infants and children including breast feeding • Study on the feeding practices for knowing what is given to the children • Education of the families for provision of proper food and weaning • Educate the mothers on early and exclusive breast feeding and also giving Colostrum • Introduction of semi-solids and solids at 6 months age with frequent feeding • Administration of Micronutrients – Vitamin A as part of Routine immunization, IFA and Vitamin A to the children who are anaemic and malnourished 4. Promotion of health seeking behaviour for sick children and Community based management of Childhood illnesses • Training of LHV, AWW and ANM on IMCI including referral • BCC activities by ASHA, AWW and ANM regarding the use of ORS and increased intake of fluids and the type of food to be given • Availability of ORS through ORS depots with ASHA • Identification of the nearest referral centre and also Transport arrangements for emergencies with the PRIs and community leaders with display of the referral centre and relevant telephone numbers in a prominent place in the village 5. Improving newborn care at the household level ••• Adaptation of the home based care package of services and scheduling of visits of all neonates by ASHA/AWW/ANM on the 1st, 2nd, 7th, 14th and 28th day of birth. ••• In case of suspicion of sickness the ASHA /AWW must inform the ANM and the ANM must visit the Neonate ••• Referral of the Neonate in case of any symptoms of infection, fever and hypothermia, dehydration, diarrhoea etc; ••• Training on IMNCI of ASHA/AWW/ANM/MOs on the home based Care package ••• Supply of medicine kit and diagnosis and treatment protocols (chart booklets) for implementation of the IMNCI strategy ••• Training of staff in Newborn Care, IMNCI and IMCI (MOs, Nurses) including the management of sick children and severely malnourished children. ••• Availability of Paediatricians in all the CHC ••• Ensuring adequate drugs for management of Childhood illnesses. 6. Strengthening the fixed Village Health Days (Also discussed in the component on Maternal Health) • Use of Tracking Bag for Tracking of Left-outs and dropouts by ASHA, AWW and contacting them a day before the session
64 A-3. NEWBORN & CHILD HEALTH • Information of the dropouts to be given by ANM to AWW and ASHA to ensure their attendance • Wide publicity regarding the VHD days 7. Developing Malnutrition Centres for the care and treatment of malnourished children at all CHC 8. Strengthening Immunization (Discussed in Component C) Timeline 2007- 2008- 2009 201 2011 08 09 -10 0-11 -12 Promoting (IMNCI) x x X x x IMNCI training x x X x x Assessment of FRUs with reference to IPHS for NB Care x x X Newborn corners – All CHC 1 CHC 4 CHC X x x Malnutrition Corners – DH and all CHC DH , DH , 1 CHC 4 CHC Study on the feeding practices for knowing what is given to the children x Education on early and exclusive breast feeding and Colostrum x x X x x Promotion of health seeking behaviour for sick children x x X x x Improving newborn care at the household level x x X x x Training on the home based Care IMNCI of ASHA/AWW/ANM/MOs x x X x x Training of MO in CEmOC, IMNCI x x X x x Training of LHV, AWW and ANM on IMCI including referral, Tracking Bags x x X x x Wide publicity regarding VHD days x x X x x Budget Activity / Item 2008- 2009- 2010- 2011- Total 09 10 11 12 Study on the feeding practices 2 0 0 0 2.00 Innovative activities based on the study 0 2 2 2 6.00 Newborn Corner furnished with equipment @ Rs 7 0 0 0 7.00 1.40 lakh per CHC Generator @ Rs. 50000 for PHC/CHC & Rs 1.5 14.5 0 0 0.5 15.00 lakhs for District Hospital POL Generator @ Rs.140/PHC & CHC x 365 14.82 16.30 17.93 19.72 68.77 days and Rs 420 x 365 for District hospital Examination table, chair, stool, table, other 16.5 0 0 0 16.50 equipment @ Rs. 3000 x 550 AWCs Infant Weighing Machines@Rs. 800/AWCx 550 4.4 0 0 0 4.40 Foetoscope @ Rs. 50 x 550 AWCs 0.275 0 0 0 0.28 Total 59.494 18.301 19.931 22.224 119.95
65 A-4. FAMILY PLANNING Situation Indicators No. Analysis Eligible Couple 47,179 Couple Protection Rate 48.2% (CMO data), 22.7% DLHS 2002
Female Sterilization operations during last 241 year Vasectomies during the last year 12 Couples using temporary method 250
In Reasi district there are many people, who are not adopting family planning methods, especially in rural areas. Only 241 women had gone for Sterlization last year and vasectomies performed last year are only 12. As most of the population is living in rural areas and there livelihood is based on agriculture so, they think that sterilisation operation make weakness in them and they will not work in fields for longer time. There are some other reasons like:-
• Low level of knowledge and acceptance of Contraceptive use. • Existing Unmet need for contraception. • Low status of women in the society. • Poor infrastructures for delivery of high quality Health and Family Welfare services related mainly to mothers and children. • Population stabilization is not possible without addressing the health issues related to women and children. The status of women, gender equity, literacy, reduction of infant and maternal mortality, improved Health and Nutrition status of women and children are the key determinants of fertility behavior. Objectives • Reduction in Total fertility Rate from 2.9 to 2.1 by 2012 • Increase in Contraceptive Prevalence Rate to 80 % by 2012 • Decrease in the Unmet need for modern Family Planning methods to 0% by 2012 • Increase in the awareness levels of Emergency Contraception to 100% by 2010 Strategies • Family Planning services will emphasize on a multi pronged strategy. • Developing client centre communication strategies. • Strengthening community based distribution. • Expanding the range of Providers and making contraceptives affordable accessible and available. Engaging the private sector to provide quality family planning services • Assess the needs of the population, promote the mix of the methods offered for family planning and strengthen the provision of high quality family planning service. • Promote the importance of male responsibility and enhanced the involvement of male as responsible sexual partners, husbands, and fathers. • Improved use of NSV by promoting positive attitude amongst users. • Strengthen the community distribution system for regular and timely supply of contraceptives. • Focus on hard to reach population to communication strategies. • 100% immunization to be assured to all the children of beneficiaries accepting
66 A-4. FAMILY PLANNING contraceptive methods.
Activities 1. Counselling of couples for Family Planning • Establishment of Family Planning Counselling Unit at SC/PHC/CHC level for improvement of quality services of Planning • Engage one trained person on contractual basis for Family Planning Counselling to the couple. • Training of MOs and Specialists counselling. • Training of Health Supervisors, Health workers, ASHAs, Ayush doctors, AWW in FP- counselling • Counselling of newly married couples on importance of birth spacing
2. Improving t he quality of services of Public Sector providers for Terminal methods • Specialists from District hospitals and CHC will be trained in Laparoscopic Tubal Ligation. • At CHC, one medical officer will be trained in NSV • Each CHC will be a static center for the provision of sterilization services on regular basis. The Static centers will be developed as pleasant places, clean, good ambience with TV, music, good waiting space and clean beds and toilets. • About 4 -7 PHC come under the catchments area of CHC and the camps will be organized on fixed days in each of the PHC. • Equipments and supplies will be provided at CHC for conducting sterilization services. • A systemic effort will be made to assess the needs of all facilities, including staff in position and their training needs, the availability of electricity and water, Operation theatre facilities for District hospitals/CHC/PHC, Inventory of equipment, consumables and waste disposal facilities and the condition, location and ownership of the building. • At least three functional Laparoscopes will be made available per team, as will the equipment and training necessary to provide IUD and emergency contraception services. The existing non-functional Laparoscopes need to be replaced. For effective coverage 4 teams are required with minimum three Laparoscopes for each team. • Vacant positions will be filled in on a contractual basis. • Provision of Sterilization services every day in the hospital and at CHC.
3. NSV • Formation of District implementation team consisting of DC, CMO, District MEIO, District NSV trainer • One day Workshop with elected representatives, Media, NGOs, departments for sensitisation and implementation strategy, fixing pre-camp, camp and post- camp responsibilities • Development of a Microplan in one day Block level workshops • NSV camp every quarter in all hospitals initially and then CHC • IEC for NSV • Trained personnel • Follow-up after NSV camp on fixed days after a week and after 3 months for
67 A-4. FAMILY PLANNING Semen analysis.
4. Access to non-clinical contraceptives increased in all the villages • AWWs and ASHAs as Depot holders • Training in Spacing methods, Emergency Contraceptives and interpersonal communication for dissemination of information related to the contraceptives in an effective manner. • Supply of Emergency Contraceptives to all facilities • IEC campaign on importance of birth spacing • Improving the availability of spacing methods in villages through all possible deport holder.
5. Access for the quality IUD insertion improved at all the subcentres. • All the ANMs at 68 subcentres will be given a practical hands on training on insertion of IUD • Diagnosis and treatment of RTI/STI as per syndromic approach. The various screening protocols related to the IUD insertion enabling her to screen the cases before the IUD insertion. This will result in longer retention of IUDs. • Counselling of the cases • Repair of subcentres so that the IUD services can be provided and ensuring privacy and confidentiality. • IUD 380 will be used due to its long retention period and can be used as an alternative for sterilization.
6. Awareness on the various methods of contraception for making informed choices Discussed in the Component on IEC
7. Increasing the gender awareness of providers and increasing male involvement • Empowering women • Increasing male involvement in family planning through use of condoms for safe sex • BCC activities to focus on men for Vasectomy. • Gender sensitization training will be provided for all health providers in the CHC/PHC and integrated into all other training activities. ( Component on Gender) • Service delivery sites for male methods by training health providers in NSV and conventional vasectomy will be expanded so that each CHC and Block PHC in the district has at least a provider trained in NSV.
8. Improving and integrating contraceptives/RCH services in PHC and Sub- centres • Skill-based clinical training for spacing methods including IUD insertion and removal, LAM, SDM and EC of Health Supervisors and Auxiliary Nurse Midwives (ANM). • Training in infection prevention and follow up for different family planning methods. • MIS training to the health workers to enable them to collect and use the data
68 A-4. FAMILY PLANNING accurately. • Health supervisors training for facilitative supervision and MIS. • Follow up of trained Health Supervisors and ANMs after one month and six months of training and provide supportive feedback to the service providers.
9. Strengthening linkages with ICDS programme of women and child development department and ISM (Ayurveda) • A detailed action plan will be produced in co-ordination with the ICDS department for involvement of the AWWs and their role in increasing access to contraceptive services. • Department of health officials and ICDS officers will be orientated to the plan. • AWWs and their supervisors will receive technical training and training in communication skills and record keeping by Medical Officer of the PHC and LHV. • Staff of ISM department will be trained in communication and non-clinical methods to promote and increase the availability of FP methods.
10. Role of ASHAs: • Training for provide counselling and services for non-clinical FP methods such as pills, condoms and others. • Act as depot holders for the supplies of pills and condoms by the ANM for free distribution • Procurement of pills and condoms from social marketing agencies and provide these contraceptives at the subsidized rate • Provide referral services for methods available at medical facilities • Assist in community mobilization and sensitisation.
11. Proper Supervision and Monitoring and reporting • Each Health Supervisor to be trained for supportive supervision and monitoring • Developing Micro-plans for each personnel with their participation to ensure maximum coverage. • Ensuring proper filling of formats ad meaningful review and planning meetings • Followup as per the action plans. Support 1. Ensuring Timely payments to ASHA, other stakeholders required 2. Availability of a team of master trainers/ANM tutors and State trainers for follow up of trained Supervisor and ANM after one month and six months of training and provide supportive feedback to the service providers 3. A training cell will be created in the medical college for the training of the medical officers in the area of various sterilization methods 4. Availability of equipment, supplies and personnel Timeline 2008-09 2009-10 2010-11 2011-12 Training of MOs for NSV 16 MOs 20 MOs 20 MOs 20 MOs Training of MOs for Minilap 16 MOs Training of Specialists for 2 CHC 3 CHC Laparoscopic Sterilization Development of Static Centres at 2 CHC 3 CHC General hospitals and all CHC
69 A-4. FAMILY PLANNING Sterilization camps (Persons) 6000 7000 8000 10000 NSV Camps 700 800 1000 1200 Supply of Copper T – 380 4500 6000 9000 12000 Emergency Contraception 6000 8000 10000 12000 Laparoscopes 2 CHC Budget Activity / Item 2008 2009- 2010-11 2011-12 Total -09 10 NSV camps @ Rs. 50000 x 10 camps 5 5.5 6.71 7.38 24.59 Sterilization Camps @ 600 per case(Including 12 18 24 30 84.00 medicine and compensation) Copper T-380 @ Rs 45 / piece 1.35 1.485 1.634 1.797 6.27 EmergencyContraception@Rs10/2 tabs 0.2 0.8 1 1.2 3.20 Development of Static Centres @Rs 1 lakh 5 0 0 0 5.00 Laparoscopes for CHC @ Rs3.00 lakhs 15 0 0 3 18.00 IEC activities 10 11 12.1 13.31 46.41 Total 48.55 36.785 45.4435 56.6868 187.47
Detailed Calculations
Calculations per Case of NSV S.No Head Unit Cost 1. Payment to NSV acceptor 1000 2. Mobilization/Transport cost 50 3. Payment to Service Provider 50 4. Payment to IEC advocate/Motivator 25 5. Payment to Assistant/OT Nurse etc; 10 6. Drugs and Dressing 27.5 Total 1162.5
Requirements for organizing one camp (600 cases) Head Unit Unit Cost 2008-09 2009-10 2010-11 2011-12 Total District Workshop 1 4000 4400 4840 5324 10164 28728 Block workshops 4 7500 33000 36300 39930 76230 215460 TA/DA for NSV 5 2000 11000 12100 13310 25410 71820 surgeons IEC activities 112832. 102575 124116 236948 669722 5 TA to Acceptor for 600 50 35000 40000 50000 90000 245000 Semen Analysis Payment to NSV 1162. Advocate/motivator, 600 813750 930000 1162500 2092500 5696250 50 Drugs & Dressings Total 999725 1136073 1395180 2531252 6926980
70 Budget for IEC activities for NSV camp S.No Head Unit Unit Cost Amount 1. Hand Bills 100000 0.15 15000 2. NSV booklets 10000 2 20000 3. Banners 250 54 13500 4. Posters 11000 2.50 27500 5. DA for Driver & 2 persons 45 Mondays 50 2250 6. Electronic Media Publicity for 15 5000 days 7. Wall writing & publicity 1000 8. Other Innovative activities 9000 9. Total 93250
Budget for sterilization per case S.No Head Unit Cost (Rs) 1. Payment to acceptor 500 2. Mobilization/Transport cost 50 3. Payment to Service Provider 50 4. Payment to IEC advocate/Motivator 35 5. Payment to Assistant/OT Nurse etc; 10 6. Drugs and Dressing 93.5 Total 738.5
Budget for sterilization camps benefiting 5000 cases S.No Head Unit Unit Cost 2008-09 09-10 10-11 11-12 Total 1. Medicines 500000 5.5 6.05 6.655 7.3205 30.5255 2. Per Case @ 5000 738.5 424.638 738.50 55.3875 73.85 110.775 147.7 3. IEC activities 100000 1.1 1.21 1.331 1.4641 6.1051 4. Other 300000 18.3153 activities and Office Expenses 3.3 3.63 3.993 4.3923 Total 65.2875 84.74 122.754 160.877 479.583
71 A-5 ADOLESCENT HEALTH Current The adolescents are very vulnerable since the awareness levels for various issues Status of RCH are low. Adolescence have unmet needs regarding nutrition, reproductive health, mental health and require appropriate counselling. No efforts have been made for any counselling of the adolescents. There is hence a great lacuna in the knowledge of the Adolescents.
Adolescents especially the boys are exposed to smoking, addictions, peer pressure and there is no one to counsel them. Teenage pregnancies also emerging as a problem ad Unsafe abortion & premarital sex trend is on rise.
The Kishori Shakti Yojana for Adolescent girls in AWCs is not functional. In this scheme they are given IFA tablets, Deworming, Supplementary Nutrition and also given vocational training. Adolescents need to be brought under the ambit of this programme so that the levels of anaemia are reduced due to IFA and Deworming.
The School Health programme and The school AIDS education programme and school sanitation programme are covering the entire state. Some degree of anaemia and severe anaemia is reported but the data needs to be validated.
Data regarding the perceptions and practices of girls and boys is lacking especially in the context of rural setting. Objectives 1. Increase the knowledge levels of Adolescents on RH and Life skills 2. Enhance the access of RH services to all the Adolescents 3. Improvement in the levels of Anaemia to 50% by 2012 Strategy 1. Implementation of Kishori Shakti Yojna 2. Awareness amongst all the adolescents regarding Reproductive health and Life skills 3. Provision of Adolescent Friendly Health package at the health facilities 4. Provision of Adolescent Health Counselling services Activity 1. Research study involving quantitative and qualitative aspects on the perceptions and practices of girls and boys in the context of rural setting and also the age of marriage and consummation. 2. Operationalization of Kishori Shakti Yojna • Adolescent Mentoring group consisting of Master Trainers for carrying out trainings, mentoring, monitoring the process of formation of Kishore- Kishori groups • Set up Kishore-Kishori Groups in all villages and family life education and IEC on high risk behaviour 3. School based programmes. • The district of Reasi will be covered for anaemia prophylaxis programme during 2006/2007 to be scaled to all districts by 2012 • Specialists for school adolescence health 4. The Adolescent Health package will consist of the following activities: • Formation of a Subcommittee as part of District Partnership for Adolescent Health (DPAH) consisting of representatives of: Health department, Education department, Social Welfare department, ICDS, NGOs, PRIs, National Service Volunteers, other youth organizations, local chapters of Indian Academy of Paediatricians & FOGSI and other stakeholder groups. • Workshop to develop an understanding regarding the Adolescent health and
72 to finalize the operational Plan • Provision of Adolescent friendly health services at PHC, CHC, FRUs and district hospitals in a phased manner. Training of the MOs, ANMs on the needs of this group, vulnerabilities and how to make the services Adolescent friendly. • Adolescent Health Clinics will be conducted at least once every week by the MO to provide Clinical services, Nutrition advice, Detection and treatment of anaemia, easy and confidential access to medical termination of pregnancy, Antenatal care and advice regarding child birth, RTIs /STIs detection and treatment, HIV detection and counselling, • In the 96 difficult villages the clinics will be part of the monthly Outreach session • Carrying out the services at the fixed VHD days • Provision of IFA tablets to all Adolescents, deworming every 6 months, Vitamin A administration and Inj. TT • Awareness building amongst the PRIs, Women’s groups, ASHA, AWWs 5. Developing a cadre of Peer Educators • Selection of Peer Educators, two for each village in a phased manner, and their training for three days. • Selection of Counsellors for Peer Educator workshops and carrying out counselling clinics. These will be selected one per PHC. There will be equal number of Male and female counsellors and will alternate between two PHC – one week the male counsellor is in one PHC and the female counsellor in the other and they switch PHC in the next week so that both the boys and girls benefit. The counsellor will be • Providing ongoing training to the Peer Educators, • Facilitating group meetings • Organizing Counselling session once per week at the PHC. • Organization of counselling sessions at PHC with wide publicity regarding the days of the sessions • Collecting data and information regarding the problems of Adolescents 6.Close monitoring of the under 18 marriages, pregnancies, prevalence of RTI/STDs. 7.Three-day health camps for Adolescent boys and girls at block level for Deaddiction, Mental health and problems of adolescents quarterly • Involvement of NGOs for awareness generation, Appointment of Counsellors, Peer Educators State Approval by State for Life skill education and Life skill education to be initiated in all Support school
Timeline Activities 2007-08 2008-09 2009- 2010- 2011- 10 11 12 Research x Awareness generation x x x Formation of Adolescent Mentoring Group x Workshop of all the partners x x x Training a district pool of Master trainers x
73 Selection of Peer Educators 1 block 2 Blocks 1 Block Counsellor through NGOs All PHC Training of Peer Educators 200 200 200 172 Retraining of Peer Educators 0 200 400 600 772 Orientation of the Health personnel x x x Counselling Clinics All PHC All PHC All PHC All PHC All PHC Three day health camps for Adolescents x x x Training of Peer Educators 200 200 200 172 Retraining of Peer Educators 0 200 400 600 772 Orientation of the Health personnel x x x Counselling Clinics All PHC All PHC All PHC All PHC All PHC Three day health camps for Adolescents x x x Budget Activity 2008- 2009- 2010- 2011- Total 09 10 11 12 Research on adolescent health 5 0 0 0 5.00 Awareness generation @ Rs 2000 per village x 5.5 6.050 6.655 7.321 275 villages 25.53 Training a district pool of Master trainers 0.5 0.550 0.605 0.666 2.32 Orientation & Reorientation Health and ICDS 1 1.100 1.210 1.331 personnel 4.64 Setting up of Adolescent Friendly Health Corners at CHC and PHC level (renovation, furnishing and 2.6 0 0 0.1 2.70 Misc. expenses) @ Rs 10000/- Health camps for Adolescents once per quarter x 4 4.400 4.840 5.324 18.56 4 x Rs 100000 per camp Monitoring and supervision 1 1.100 1.210 1.331 4.64 Workshop of All the Partners @ 50000 (Once in a 0.5 0.550 0.605 0.666 year) 2.32 Training of Peer Educators @ Rs 100 per person 0.15 0.165 0.182 0.200 x 3 days x 2 batches and retraining 0.70 Total 20.25 13.915 15.307 16.937 66.41
74 B- NRHM Initiatives
B-1. ASHA – Accredited Social Health Activist Situation At present every ASHA is being paid an incentive of Rs.150 per month for Analysis mobilizing the children for immunization. Besides these they are also entitled for Rs.600. for escorting a pregnant to near by Health Institution for delivery, Rs.250 is paid to ASHA as DOT provider if she will provide full dot medicine to a TB patient and rest of the activities mentioned below supposed to performed by the a trained ASHA is not being paid any incentives. ASHA is supposed to perform following activities:
• Registration of Births • Complete immunization of children/tracing the left-overs • Coordination with Anganwadi Worker and ANM • Motivating women for safe deliveries and institutional deliveries • Newborn care • Counseling about spacing and help in getting sterilization services • Adolescent health issues
• ASHA is the first step from grossroot level who make link with institutional delivery systems and the health care providers both formal and informal. • 425 ASHAs have been selected in district Reasi. Blockwise status is given below: Reasi 54 Pouni 119 Mahore 80 Katra 19 Total 272
1. The selection is entrusted to PRIs at various level the clear and detailed communication is required urgently for completion of selection process. Keeping in view the past record of health and FW services preference will be given to the TBAs to be appointed as ASHA. Out of total Rs 10000/- per ASHA for their recruitment training on five prescribed manuals and medical kit. The medical kit to be provided in kind by the state government from flexi pool every year. To meet the cost of training it is recommended that the training to be carried out at block level and may be out sourced to external agency under PPP, so as to meet the benchmark of training of 272 ASHAs in time bound manner. The services of master trainers can be hired by external agency. 2. The ToT is proposed to be organized and expenditure to be met by state government. In case the training part is to be out sourced to private agency the Master trainers of identified agency to be involved in ToT. 3. The incentive of Rs 500 for various activities i.e. ANC registration, institutional delivery and PNC etc to be paid to ASHA in addition Rs 100 for Performing Immunization related actives. There fore the budget line per ASHA is calculated @ Rs 600 /Month in case she achieve the targets or on actual basis. The incentive part will pool in from various schemes as well as RCH flexi pool.
75 4. Assuming that there will be requirement of re orientation of ASHAs about the changes and other developments / roles etc. under NRHM the reorientation is planned in 2010-11. This component may be out sourced. 5. In year 2007-08 department of health will do the evaluation and monitoring. In subsequent year it is recommended to out source the monitoring and evaluation work to independent external agency. 6. The contingencies are required assuming that during the plan period there may be need on appointment of additional ASHAs due to ongoing increase in population or induction and training of new ASHAs due to non-availability of old ASHAs to perform the role for natural and other reasons. Objectives To provide the link worker at grass root level to mobilizes the community so as to • Address unmet needs for primary health care. • Increase institutional deliveries. • Enhance immunization coverage, nutrition education and ANC/ PNC coverage Improvement • To generate demand for health services through ASHA (to act as communication resources, service provider, guide, mobiliser and an escort to village people to access health services. • Counselling women on birth preparedness, immunization, contraceptive, RTI, STI. • Mobilize the community and assist them in accessing the services, already available at aganwadi, sub-centre, PHC. • To work with village health and sanitation committees under panchayats. • Act as depot holder for ORS, IFA, chloroquine, delivery kits, oral pills, condoms etc. promote construction of toilets under TSC. Strategies 1. Selection of a woman from the community 2. Capacity building of this worker 3. Constant mentoring, monitoring and supportive supervision by district Mentoring group Activities 1. Strengthening of the existing ASHAs through support by the ANM. . and their involvement in all activities. 2. Reorientation of existing ASHAs 3. Selection of new ASHAs to have one ASHA in all the villages 4. Training of these ASHAs and those selected ASHAs who have not received any training. 5. Training for Module 2,3,4 6. Provision of a kit to ASHAs 7. Formation of a District ASHA Mentoring group to support efforts of ASHA and problem solving 8. Review and Planning at the Monthly sector meetings 9. Periodic review of the work of ASHAs through Concurrent Evaluation by an independent agency 10. ASHA Performance Diaries is to be printed Support • Timely Payments to ASHA required • Advance of Rs. 5000 always with ASHA for prompt payments to the women
76 Timeline 2008- 2009- 2010- 2011- 09 10 11 12 Selection of additional ASHAs x x x x Total ASHAs 286 294 303 312 Training of new & untrained ASHAs x x x Training of ASHAs for module 2,3,4 x x x x Reorientation of the ASHAs x x x x ASHA Performance Diaries x x x x District ASHA Mentoring group x x x x Budget Activity / Item 2008- 2009- 2010- 2011- Total 09 10 11 12 Training & kit @ Rs 10000 X No ASHAs 27.8 0.8 0.8 0.8 30.20 Module 2,3,4 Training @ 2000 5.56 0.16 0.16 0.16 6.04 Reorientation @ Rs 2000 X No ASHA 5.56 5.56 5.56 5.56 22.24 Intersectoral meeting at PHC level 1000 X 21 X 6 1.26 1.386 1.525 1.677 5.85 Compensation to ASHA @ Rs. 500 X 12 X No of 16.68 17.64 18.18 18.72 71.22 ASHAs Expenses for the District mentoring group – 0.6 0.66 0.73 0.80 2.78 meetings, travel @ Rs 5000 per month x 12 months Total 57.46 26.206 26.951 27.716 138.33
77
B-2. Untied Funds and an Annual Maintenance grant for Sub Centres Situation Till NRHM was launched there was no provision for any fund for the subcentres for Analysis/ maintenance, electricity, water, any fund for consumables and cleanliness of the Current subcentre. Rs 2000 was given as contingency funds, which were totally Status inadequate to meet any demands. Due to this the Subcentres were in a pathetic condition and the ANM worked alone for deliveries sometimes helped by the family members. A number of equipment needed some repair due to which they were lying unutilized. The Gram Panchayat members were never involved in any activities of the Subcentre.
Untied fund for 68 Sub centre @ Rs 10000/- have been paid to ANMs for opening joint accounts with sarpanchs in 2006-07 in their respective sub centre village for carrying out various health activities and they have all been utilized. Objectives To undertake minor construction and maintenance in the existing and newly recommended Subcentres so as to provide quality basic health care at grass root to community at large. • To provide the flexibility in order to provide the better services. • To increase institutional delivery. • To improve health status of the village. • To Improve Mother and child health. Strategies • The fund to be kept in a joint bank account of the ANM and the Sarpanch. • Untied fund will be used for maintenance of the sub centre building including minor repair and purchase of essential equipments/ goods etc. • Provision of safe water and sanitation facilities in sub centre. Activities 1. Besides the usual recurring cost support to the sub-centres, each Subcentre would be given an untied support of Rs. 10,000 per annum. The fund would be kept in a joint account to be operated by the ANM and the local Sarpanch. 2. Rs 10000 will be given as annual maintenance grant to each Subcentre. This will be under the mandate of the VHWSC for undertaking construction and maintenance. This will bring in greater community control and the sub-centres would be brought fully under the Panchayati Raj framework. 3. Activities suggested for the untied funds include minor modifications, cleanliness of premises, transport of emergencies, transport of samples, purchase of consumables, etc; 4. This fund will not be used for salaries, vehicle purchase and recurring expenses of Gram Panchayat 5. Monthly and quarterly expenditure statement will be submitted along with UC Support 1. Funds to be transferred on time to the ANM required 2. Sarpanch to ensure proper usage and accounts Timeline 2008- 2009- 2010- 2011 09 10 11 -12 Untied Fund of Rs 10000/subcentre 95 98 101 104 Annual Maintenance grant of Rs 10000/SC 95 98 101 104 Plan for maintenance to be developed and x x x x approved by Gram Panchayat Plan for use of untied funds x x x x Gram Panchayat to identify mode of construction x x x x and repair
78 Budget Activity / Item 2008- 2009 2010 2008 Total 09 -10 -11 - 12 Untied Fund of Rs 0.10 Lakh X SCs 9.7 9.8 10.1 10.4 40.00 Annual Maintenance Grant of Rs 0.10 9.7 9.8 10.1 10.4 40.00 Lakh X SCs Total 19.4 19.6 20.2 20.8 80.00
79
B-3. Provision of Untied Funds an Annual Maintenance grant at PHC Situation Untied fund is made for competing day-to-day needs of the PHCs like some drugs Analysis/ or some minor Upgradation. Current In district Reasi only the PHCs have received untied funds but ADSs have not Status received untied funds that are equivalent to PHC as per IPHS and accounts of these PHCs have already opened. In district Reasi out of 22 PHCs + Allopathic Dispensaries (which are equivalent to PHC as per IPHS), only 11 PHCs have got untied fund+ annual maintenance fund @ 75000/- each Objectives • To provide the flexibility in order to provide the better services. • The objective of the untied fund is to mange the basic requirement of the PHC at the local level with community participation. • To increase institutional delivery. • To improve Mother and Child Care • To improve health status of the village. Strategies 1. Provision of Untied funds of Rs 25000 each year to the PHC at the disposal of the Rogi Kalyan Samities 2. Provision of an Annual Maintenance grant of Rs 50,000 to the PHC Activities • Untied funds will be used only for the common good and not for individual need except in the case of referral and transport in emergency situations • Untied fund will be used for maintenance of the PHC building including minor repair and purchase of essential equipments/ goods etc. • Provision of safe water and sanitation facilities in PHC. • Activities suggested for the untied funds include minor modifications, cleanliness of premises, transport of emergencies, transport of samples, purchase of consumables, etc; • This fund will not be used for salaries, vehicle purchase and recurring expenses of Gram Panchayat Support 1. Timely release of funds required 2. Meetings of the Rogi Kalyan Samitis to be regularly held Timeline Activity 2008- 2009 2010 2011 09 -10 -11 -12 Untied Fund of Rs 25000/PHC 22 22 22 22 PHC PHC PHC PHC Annual Maintenance grant of Rs 50000/PHC 22 22 22 22 PHC PHC PHC PHC Plan for maintenance to be developed and x x x x approved by the Rogi Kalyan Samitis Plan for use of untied funds x x x x Rogi Kalyan Samitis to identify mode of x x x x construction and repair Activity/item 2008- 2009- 2010- 2011- Total 09 10 11 11 Untied Fund of Rs 0.25 Lakh X Per PHC 5.25 5.25 5.25 5.25 21.00 including Allopathic Dispensaries. Budget Annual Maintenance grant of Rs 0.5 10.5 10.5 10.5 10.5 42.00 Lakh X Per PHC including Allopathic Dispensaries. Total 15.75 15.75 15.75 15.75 63.00
80
B-4. Provision of Untied Funds an Annual Maintenance grant at CHC Situation Under NRHM provision of untied grants and other grants namely maintenance Analysis/ grants, support money for Rogi Kalian Samiti (RKS) are being kept. Keeping such Current important provisions, the services of facilities e.g. maintenance, minor repair, Status electricity, water, any fund for consumables, telephone, hiring transport in emergencies, travel, IEC and cleanliness can be improved.
No fund has been received under untied fund for 5 CHCs of district Reasi including old PHCs.
Accounts had been opened but no funds transferred in those accounts.
Objectives • To provide the flexibility in order to provide the better services. • The objective of the untied fund is to mange the basic requirement of the CHC at the local level with community participation. • To increase institutional delivery. • To improve Mother and Child Care Strategies 1. Provision of Untied funds of Rs 50000 each year to the CHC at the disposal of the Rogi Kalyan Samites 2. Provision of an Annual Maintenance grant of Rs 100,000 to the CHC Activities These funds will be routed through the Rogi Kalyan Samitis who will approve the yearly activities and the related budgets and also undertake and supervise improvement and maintenance of physical infrastructure. 1. An untied fund of Rs 50000 will be provided each year for activities as per the local needs including minor modifications, cleanliness of premises, transport of emergencies, transport of samples, purchase of consumables, etc; This fund will not be used for salaries, vehicle purchase and recurring expenses of Panchayat or any other facility. 2. An Annual Maintenance grant of Rs 100,000 will be given to the CHC for water, toilets,, maintenance of building. 3. Monthly and quarterly expenditure statement will be submitted along with UC Support 3. Timely release of funds required 4. Meetings of the Rogi Kalyan Samitis to be regularly held Timeline Activity 2008 2009 2010 2010 -09 -10 -11 -12 Untied Fund of Rs 50000/CHC 5 5 5 5 Annual Maintenance grant of Rs 100000/CHC 5 5 5 5
Plan for maintenance to be developed and x x x x approved by the Rogi Kalyan Samitis Plan for use of untied funds x x x x Rogi Kalyan Samitis to identify mode of x x x x construction and repair
81 Budget Activity / Item 2008 2009 2010 2011 Total -09 -10 -11 -12 Untied Fund of Rs 0.5 Lakh X No of CHCs 2.5 2.5 2.5 2.5 10.00 Annual Maintenance grant of Rs 1.0 Lakh 5 5 5 5 20.00 X No of CHCs Seed Money for RKS for District hospital @ 5 5 5 5 20.00 5.0 lakhs Total 12.5 12.5 12.5 12.5 50.00
82
B- 5. Mobile Medical Units Situation • Reasi district have some villages that are located in hilly and difficult terrain Analysis/ and, there are also some areas where health facilities are not in place. So Current Mobile Medical Unit is important for those areas. So, it will be much Status convenience and cost effective projects to ensure mobile medical units in the cut-off, remote, fur flung areas of the District. So, that a comprehensive Health Care services to the people living in the remote areas at their doorsteps. Such mobile Medical Units can be used during natural disaster also.
• It is proposed that one mobile Medical Unit ambulances/CHC may be provided to this District with surgical facilities with allied equipments like X-ray, laboratory, Ultra Sonography etc
• Medical mobile units are envisaged under NRHM. Apart from providing health care to the far flung areas and the areas where desirable quality services could not be provided due to lack of staff, there mobile units would be viable option. Objectives/ • The Mobile Medical will cover at least three remote villages in a day and the community members will be informed about the timings and days of the vans visits in advance. The mobile medical van will be a travelling medical facility, which will cater to those who do not have access to basic health care. • To provide a comprehensive Health Care Services to the people living in fur flung area. • To ensure immediate response during epidemic and disaster. Strategies • Mapping of unserved and underserved areas in the District. • Monthly plan of activities to be detailed out (the villages that will be covered, the services that will be rendered etc Activities 1. Joint meeting of the District Health Society and the Rogi Kalyan Samiti (RKS) to decide the appropriate modality for Operationalization of the MMU. 2. Formation of a Monitoring Committee 3. The RKS will operate the MMU for long-term sustainability of the intervention. 4. Staff will be hired on contract by the RKS – MO, male and Female Nurse, Lab Technician, Pharmacists, Members of Ayush, private providers, IMA members, NGOs, two drivers, Specialist from District Hospital and Medical Colleges, etc; 5. Need Analysis to be carried out for determining the areas of MMU. 6. Development of a monthly roster for Operationalizing MMU 7. Services will be given from 9 am to 4 pm from Monday to Friday. Saturday is for the maintenance of the vehicle. 8. Wide publicity before the arrival of the MMU 9. Communication support for the personnel 10. Periodic Review. 11. Services to be provided: • ANC, PNC, Immunization • Diagnostic – Haemoglobin, Urine, Blood Sugar, Blood slide for Malaria, etc; • Treatment of minor ailments • Referral of cases needing Specialist care • Provision of Emergency services • Dissemination of information through the use of TV/DVD player
83 • Holding meetings of Village water and Sanitation Committees • Maintenance of Records
Support Govt Order from the State for exemption of the Regular Staff from providing required services in the MMU Timeline 2008-09 2009-10 2010-11 2011-12 Operationalizing the MMU Orientation of the staff x x x x Wide Publicity x x x x Strengthening the MMU x x x x Addition of services x x x x Budget Activity / Item 2008- 2009- 2010- 2011- Total 09 10 11 12 Hiring staff 9.9 10.89 11.979 13.177 45.95 Orientation of the staff 0.1 0.2 0.25 0.3 0.85 Joint Workshop for finalizing 0.1 0.2 0.25 0.3 0.85 modalities Cost of Vehicle, equipment and 26.85 0 0 0 26.85 accessories Recurring Cost of Drivers, Drugs, supplies, Mobile phones, POL, 2.518 2.770 3.047 3.351 74.50 Maintenance Total 39.468 14.0598 15.526 17.128 86.18
Detailed Calculations
Budget for Vehicles, Equipment and Accessories S.No Head Unit Cost 1. Cost of Vehicle for staff to MMU 5,00,000 2. Cost of Vehicle for carrying A/V aids, equipment etc 18,00,000 3. Prefabricated tents & Furniture 1,50,000 4. Equipment 2,00,000 5. Mobile Phone (one for each Driver) 10,000 6. Computer system with Printer 30,000 Total 26,85,000
Budget of Personnel
S.No Head Unit Unit Cost Amount 1. Emoluments to MOs -1 12 months 15000 180000 2. Emoluments to Specialists –2 12 months 40000 480000 (Part time) 3. Lab Technician 12 months 5000 60000 4. Pharmacist 12 months 5000 60000 5. Nurse 12 months 7500 90000 Total 870000
84 Budget for Recurring Expenses
S.No Head Unit Unit Cost Amount 1. Salary of Drivers –2 12 6660 159840 months 2. Drugs 30000 3. POL & Maintenance of Vehicles 40000 4. Maintenance of equipment 10000 5. Mobile Phone bill -2 12 500 12000 months Total 251840
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B – 6. Upgrading CHC to IPHS Situation • All CHCs are running in government buildings. Analysis/ • 70% of the CHCs have facility of water supply and 30% are connected with tap Current water supply. Status • 80% CHCs have facility of separate male and female utilities. • 90% CHCS have facility of labour room which is very critical indicator for safe deliveries. • Blood storage is not available in any of the CHCs. • There are vacancies of specialists and support manpower in all CHCs. Objectives To upgrade all the CHC as per IPHS standards Strategies 1. Availability of all personnel as per IPHS 2. Proper building 3. Adequate Laboratory, Blood Storage Unit, Equipment and Drugs Activities All CHC to be equipped having facilities of FRUs as per IPHS standards • Hiring of additional staff as per IPHS with 7 Specialists and MOs, in each of the facilities, 10 staff nurses,! PHN, 1 Computer clerk, 1 Dresser, 1 Pharmacist, 1 Lab Technician, 1 BEE, 1 Radiographer, 1UDC, 1Accountant, 1Clerk, 1Epidemiologist and ancillary staff like Aya, Chowkidar, Dhobi, Sweepers, Peon and filling of Vacancies • Building to be built for CHC with staff quarters Support State to sanction posts as per IPHS required Allowing Contractual Personnel at Market Rates Timeline Activity / Item 2008- 2009- 2010- 2011- 09 10 11 12 Repair /alterations/additions of CHC 3 Repair /alterations/additions of Staff Quarters 3 Construction of Staff Quarters 5 Equipment 5 5 5 5 Medicines, x x x x Furniture 5 Generator 5 Computer 5 Maintenance x x x x
Budget Activity / Item 2008- 2009- 2010- 2011- Total 09 10 11 12 Strengthening of Existing CHCs including Staff 60 90 0 0 quarters (for IPHS) @ 30 X CHCs 150.00 Construction of 2 new CHCs (24 Lakhs for CHC 79.2 0 79.2 building and 55.2 Lakhs for 4 MOs and 4 SN and 1 guard quarters) @ Rs. 79.2X CHCs 0 158.40 Construction of new staff Qtrs at existing 79.2 CHCs(14.40 Lakhs for 2MOs and 12 Lakhs for 2SN )@26.4X 3 CHCs 79.20 Medicines @10.0 CHCs 50 50 50 50 200.00 Furniture @1.2 X No of CHCs 6 0 0 0 6.00
86 Equipment @ 22.19 X No of CHCs & FRUs 110.95 0 0 22.19 133.14 Hiring of vehicle for S/MOs @ 1000 x 7 days 4.2 4.2 4.2 4.2 x12monthsX No of CHCs 16.80 Purchase of generator sets @ 0.6 lakh x No of 3 0 0 0.6 CHCs 3.60 Recurring & Maintenance cost of generator sets 2.55 2.55 2.55 2.55 10.20 Rs. 140 X 30 days X 12 months X 6 No of CHCs & FRUs Strengthening of DH Reasi 500 500.00 Total 895.1 146.75 56.75 158.74 1257.34
87 B – 7. Upgrading PHC for 24 hr Services Situation District Reasi is having 22 PHCs including Allopathic dispensaries. It has been Analysis/ decided that under NRHM these ADs will also be considered as PHCs. Main Current constraint is insufficient posting of doctors so to ensure 24 hours service delivery Status and it has to ensure that all the posts of doctors are filled.
Objectives • To upgrade 50 per cent of PHCs • To promote institutional deliveries • To provide health services to the poor people.
Strategies • PHCs required sufficient manpower for round the clock duty. • In first phase, above said two PHCs will upgraded as 24 hr service provider. • At least one female doctor should be there in PHC for emergency delivery. • Staff quarters should be there in the PHCs.
Activities 1. Hiring of additional staff as per IPHS with 2 MOs( maybe Ayush), in each of the facilities, 3 staff nurses, 1 PHN, 1 Lab Technician, Part time Pharmacist, 1UDC, 1 Accountant, and Class IV and filling of Vacancies 2. Building with adequate quarters in all the PHC 3. Upgrading the Laboratory for tests necessary for 24 hour PHC 4. Furniture, Drugs and Equipment as per IPHS norms Support State to sanction posts as per IPHS required Allowing Contractual Personnel at Market Rates Time Frame Activity / Item 2008 2009 2010 2011- -09 -10 -11 12 Repair/ additions/ alterations of PHC @ 2 10 lakhs/PHC Repair/ additions/ alterations of Staff Quarters @ 10 10 1 5 lakhs/PHC Staff Quarters at PHC @28.80/PHC 6 7 Furniture 22 Electricity connections 22 Equipment 22 Water Connections 22 Generator 22 Computer System 22 Toilets 22 Budget Activity / Item 2008-09 2009- 2010-11 2011-12 Total 10 Staff quarters for 10 PHCs where PHC 288 0 0 0 288.00 buildings are available (28.8Lakhs for 2 MOs and 3 SNs quarters) Strengthening PHCs for 24X7@ 10X 21 PHCs 100 100 10 210.00
88 Construction of building on 13 building- less PHCs with Staff Quarters (9 Lakhs for PHC building and 28.8Lakhs for 2 MOs and 3 SNs quarters) 226.8 264.6 491.40 Medicines @3.0 X PHCs 63 69.3 76.23 83.853 292.38 Furniture @0.45 XPHCs 9.45 0 3.2 0 12.65 Equipment @ 1.115 X PHCs 23.415 0 0 0 23.42 Vehicle will be hired for MOs @ 1000 x 7 17.64 19.404 21.344 23.479 days x 12MonthsX PHC 81.87 Purchase of generator sets @ 0.6 lakh x 12.6 0 0 0 PHC 12.60 Recurring & Maintenance cost of 17.85 17.85 19.635 21.599 generator sets Rs. 140 X 30 days X 12 months 76.93 Total 758.755 471.154 130.4094 128.9303 1489.25
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B – 8. Upgrading Sub Centres Situation In district Reasi out of 68 subcentres, 45 subcentres are running in rented Analysis buildings and 23 subcentres are running from government owned buildings. There are no labour rooms in any of the Subcentres for Institutional deliveries There is no staff quarter in subcentres of the district Reasi. The numbers of Subcentres is also inadequate
Objectives 1. Upgrading of Subcentres as per IPHS standards 2. Quarters for the ANMs 3. Opening Additional Subcentres to cater to the entire population Strategies & 1. All subcentres should be upgraded IPHS Standard during the project period. Activities 2. Additional ANMs, Safaiwalas for each Sub-Centres must be recruited in each sub centre whose population is more than 6000 3. Electricity, Water facilities in every Sub-Centre. As per population norm under IPHS, Reasi district needs total 95 Sub-Centres at the end of mission period. Hence 81 additional subcentres are to be made functional. 5. Sufficient drugs, machinery equipments, cold chain unit for each sub-centre, etc. Support Smooth flow of Funds. required Time line Activity / Item 2008- 2009 2010 2011 09 -10 -11 -12
Total Subcentres 95 98 101 104 New buildings with quarters, equipment and 10 20 12 Furniture for new centres New buildings with quarters, equipment and x 1 3 3 Furniture for existing centres Repair/Addition/Alteration 20 20 30 2 Staff Quarters 20 40 10
Budget Activity / Item 2008- 2009- 2010- 2011- Total 09 10 11 12 New Building for Existing Sub Center with Equipment and Furniture 49.3 98.6 591.6 0 739.50 New Building for Additional Sub Center with Equipment and furniture 0 4.93 14.79 14.79 34.51 2 Staff Quarters 120 120 60 12 312.00 Equipment For SC 24.25 1.25 1.25 1.25 28.00 Furniture For SC 8 0.4 0.4 0.4 9.20 Drugs and Medicine For SC 18 18 18 18 72.00 Travel allownce@ 6000 XSC 36 36 36 36 144.00 Total 206.25 180.58 130.44 82.44 599.71
90 B-9 Untied Funds and Incentive Fund for the Village Health and Water Sanitation Committees Situation NRHM has placed a lot of stress on Community involvement and formation of Analysis/ Village Health & Water Sanitation Committees (VHWSC) in each village. These Current committees are responsible for the health of the village. In District Reasi these Status committees have been formed but need strengthening to improve their functioning. The selection of ASHA, her working, progress of the village is part of the responsibilities of the Gram Panchayat.
In Reasi district there are 246 villages with population less than 1500. There are 20 villages with population between 1500 and 3000. There are 9 villages with population more than 3000. Hence these amount to 310 units of 1500 population. Objectives Strengthening the Village Health & Water Sanitation Committees through financial support Strategies 1. Provision of annual Untied funds of Rs 10000 each year to the villages upto a population of 1500 2. Provision of Rs 5000 as permanent advance fund for Incentives for ASHA Activities 1. Provision of Annual Untied funds of Rs 10000 each year to the villages upto a population of 1500. Villages with more than 1500 population upto 3000 will get twice the funds. Villages with population more than 3000 will get three times the funds. Hence there will be 539 units of population 1500 or less to get the funds annually of Rs 10,000.00.This untied fund is to be used for household surveys, health camps, sanitation drives, revolving fund etc; 2. Orientation of the MPHWF for the utilization of the untied funds and she in turn will orient the Village, Health & Water Sanitation committee. 3. Provision of Rs 5000 as permanent advance fund for Incentives for ASHA based on performance norms. 4. Monthly meetings of the VHWSC for reviewing the funds and activities. This is to be facilitated by the MPHWF 5. Monthly review at the PHC level regarding the VHWSC functioning and utilization of funds. Support 1. State should ensure the orientation procedure for the VHWSC required 2. Funds to be transferred on time to the MPHWF 3. PRIs to ensure proper usage and accounts Timeline 2007 2008- 2009 2010 2011 -08 09 -10 -11 -12 Untied Fund of Rs 10000/unit for Pop x x x x x 1500/unit x 310 units Orientation and reorientation of the x x x x x VHWSC Provision of Rs 5000 as permanent x x x x x advance for incentives to ASHA Monthly meetings of the VHWSC x x x x x Review of the VHWSC functioning at x x x x x PHC level
91 Budget Activity / Item 2008 2009- 2010- 2011- Total - 09 10 11 12 Untied Fund of Rs 10000/unit ( 1500population 31 31 31 31 =1unit) x 310 units 124.00 Permanent Advance to VHWSC for ASHA incentive 5 5 5 5 @ Rs5000/SC 20.00 Total 36 36 36 36 144.00
92 PART C: Immunisation C-1. Strengthening Immunization Situation As per the District data for 2006-2007, 5202 children had received DPT & Polio Analysis vaccination, BGC had been given to the children to 5599 and Measles to 6253. Vitamin A second dose had been administrated to 5751 children.
The reasons for children not being Immunized are related to the ignorance of the mothers on the importance of immunization, the place and time of Immunization sessions and fear of side effects. The community perceives that the Polio drops given repeatedly at the time of Pulse Polio campaign is equivalent to the complete immunization.
The ANM have to take the vaccines from the PHC headquarters resulting in them not reaching the hamlets and also the difficult areas and also the Pulse Polio campaign. Supervision is not done properly at PHC level.
Also there is large gap between reported and evaluated coverage. Objectives/ Reduction in the IMR to 25 by 2012 Milestones/ 1. 100 % Complete Immunization of children (12-23 month of age) by 2012 Benchmark 2. 100 % BCG vaccination of children (12-23 month of age) by 2012 s 3. % DPT 3 vaccination of children (12-23 month of age) by 2012 4. % Polio 3 vaccination of children (12-23 month of age) by 2012 5. % Measles vaccination of children (12-23 month of age) by 2012 6. % Vitamin A vaccination of children (12-23 month of age) by 2012 Strategies 1. Strengthening the District Family Welfare Office 2. Enhancing the coverage of Immunization 3. Alternative Vaccine delivery 4. Effective Cold Chain Maintenance 5. Zero Polio cases and quality surveillance for Polio cases 6. Close Monitoring of the progress Activities 1. Strengthening the District Family Welfare Office • Support for the mobility District Family Welfare Officer (@ Rs.3000 per month (towards cost of POL) for supervision and monitoring of immunization services and VHD Days • One computer assistant for the District Family Welfare Office will be provided for data compilation, analysis and reporting @ Rs 7000 per month.
2. Training for effective Immunization Training for all the health personnel will be given including ANM, Health Supervisor, MPWs, Cold chain handlers and statistical assistants for managing and analyzing data at the district.
3. Alternative vaccine delivery system (mobility support to PHC for vaccine delivery) • For Alternative vaccine delivery, Rs. 50 to the ANM will be given per session. It is proposed to hold two sessions per week per Subcentre. • Mobility support (hiring of vehicle) is for vaccine delivery from PHC to VHD days site where the immunization sessions are held for 8 days in a month.
4. Immunization sessions to be carried out at each VHD day weekly
93
5. For difficult villages the monthly outreach sessions will be used for Immunization. The ANM, ASHA, AWW will inform the parents a day in advance.
6. Incentive for Mobilization of children by Social Mobilizers Rs.100 per month will be given to Social Mobilizers for each village for mobilization of children to the immunization session site. This money will be provided to ASHA wherever possible but if there is no ASHA then it will be given to someone nominated from the village by the PRIs. This could be given to the Numberdars and Chowkidars.
7. Incentive to for each child (12 – 23 months) completely immunized Rs 150 will be given for each child completely immunized including Vitamin A two doses – Mothers, ASHAs / SHG groups, Numberdars and Chowkidars. This will be verified by the AWW and ANM.
8. Contingency fund for each block Rs. 100/ month per block will be given as contingency fund for communication.
9. Disposal of AD Syringes For proper disposal of AD syringes after vaccination, hub cutters will be provided by Govt. of India to cut out the needles (hub) from the syringes. Plastic syringes will be separated out and will be treated as plastic waste. Regarding the disposal of needles, Pits will be formed at at every village as per CPCB guidelines. For construction of the pits at PHC, SC and villages a sum of Rs. 2000/ pit has been provisioned.
10. Outbreak investigation • Rapid Action Team for epidemics will be formed • Dissemination of guidelines • Training of Rapid Action Team for investigating outbreaks who will in turn orient the ANM during Sector meetings
11. Adverse effect following Immunization (AEFI) Surveillance: Standard Guidelines have been developed at national level and will be disseminated to the district officials and block levels in Review meetings.
12. IEC & Social Mobilization Plans Rs 25 per session of Immunization fro IEC activities ( 96 villages once a month and In 290 villages 4 times a month) (Discussed in details in the Component on IEC)
13. Cold Chain • Repairs of the cold chain equipment (@ 750/- per PHC & CHC will be given each year • For minor repairs, Rs. 10,000 will be given per year. • Electricity & POL for Genset & preventive maintenance (Running Cost) of Walk in Coolers (WICs) & Walk in Refrigerators (WIF) () @ 15000/equipment per two months plus Rs. 1000 per machine for POL for Genset.
94 • Payment of electricity bills for continuous maintenance of cold chain for the PHC @ 300 per month PHC (vaccine distribution centres) has been budgeted under this head. • POL & maintenance of vaccine delivery van @ Rs. 3000/month for maintenance and POL for Vaccine delivery van for regular supply of vaccine to the PHC.
14. Effective Supervision and monitoring: For increasing the immunization supervision and monitoring are very important. • The number of LHVs and Male Health Supervisors need to be adequate hence vacancies need to be filled up. • Mobility support for MOs @ Rs 1000/session for hiring a vehicle/ mules
15. HMIS The formats for Immunization should be properly filled for each child. The data should be shared in each review meeting for further planning. Support State to ensure the following: required • Regular supply of vaccines and Autodestruct syringes • Reporting and Monitoring formats • Monitoring charts • Cold Chain Modules and monitoring formats • Temperature record books • Polythene bags to keep vaccine vials inside vaccine carrier • Polythene for the vaccines to avoid labels being damaged • Training of Cold Chain handlers • Training of Mid level managers Timelne Activity 2008- 2009- 2010- 2011- 09 10 11 12 Alternative Vaccine delivery x x x x Children for Immunization Incentive 7500 10000 12000 14000
Mop up Round x x x x Pit formation 275 275 275 275 MCH Cards 50000 50000 50000 50000 IEC activities x x x x Tracking bags x x x x Orientation in Tracking bags x x x x Maintenance of Cold Chain x x x x Provision of Generator
Budget Activity/item 2008- 2009- 2010- 2011- Total 09 10 11 12
95 Mobility support for alternative vaccine delivery 4.8 4.8 4.848 4.992 19.44 Rs. 50 per session for 2 planned sessions per week at each Subcentre village for 12 months = Rs. 50x2 sessionsx4 weeks/mthx12 monthsx SCs Vehicle for distribution of vaccines in remote 20.16 22.176 24.394 26.833 93.56 areas @ Rs 1000 per PHC for 2 times per week x 4 weeks x 12 months x PHCs Mobility Support Mop up campaign @ Rs 12.6 13.860 15.246 16.771 58.48 10000 per PHC ( Including travel, vaccine delivery, IEC) x 6 rounds/ year x PHCs Mobilization of Children by Social Mobilizers 13.2 14.520 15.972 17.569 61.26 @ Rs. 100/ session x4 sessions per month X 275 units x12 month Contingency fund for each block @ 0.6 0.660 0.726 0.799 2.78 Rs.1000/month x 4 blocks x 12 months Pit Formation for disposal of AD Syringes and 2 0.1 0.1 0.1 2.30 broken vials (@ Rs. 2000 per pit per Subcentre and PHC Printing of Immunisation cards @1.50 per card x 0.45 0.495 0.545 0.599 2.09 30000 cards each year Maintenance of Cold Chain Equipments (funds 4.94 4.94 4.94 4.94 19.76 for minor &major repair) (@ Rs.750 per PHC/CHC for the first year then Rs. 500 per PHC/CHC) monthly and Rs 10,000 annual for major repairs POL & maintenance for Vaccine delivery van at 1.8 1.980 2.178 2.396 8.35 district level @ Rs.15000/month x 12 mths Running Cost of WICs & WIF (Electricity & POL 7.02 8.490 9.340 10.270 35.12 for Genset & preventive maintenance) Rs. 90000 for electricity @ 15000 equipment per two months plus Rs.8000 per annum @1000 for POL for genset at DH Mobility suppot to District Family Welfare Officer 0.36 0.396 0.436 0.479 1.671 @ 3000/month Computer Assistant for District Family Welfare 0.84 0.924 1.016 1.118 3.898 Office @ 7000 Total 68.770 73.341 79.740 86.865 308.72
96 PART D: National Disease Control Programme
D-1. RNTCP Situation Analysis New New Total TB cases Put on Sputum Sputum treatment ## Particulars OPD Exam Positive DOTS N DOTS Total TU Reasi 500 38 141 - 141 1 DMC Reasi 176 17 35 - 35 2 CHC Katra 76 4 22 - 22 3 DMC Pouni 74 6 19 - 19 4 PHC Arnas 107 3 10 - 10 PHC 5 Mahore 67 8 55 - 55
To fight Tuberculosis the revised National Tuberculosis Control Programme based on the DOTS regime was launched in 1993. The status of TU Reasi is given above. No training has been given to the staff during this year. Objectives The goal of RNTCP is to decrease mortality and morbidity due to TB and cut Transmission of infection until TB ceases to a major public health problem. The objectives of RNTCP are: • To achieve and maintain detection of at least 85 % of new sputum smear positive patients , and • To achieve and maintain detection of at least 70 % of such cases in the population. • The only effective means by which 85 % cure rate or more has been shown to be achievable on a programme basis is by application of the DOTS strategy Strategies 1. Improvement in the infrastructure 2. Improvement in the quality of the intervention 3. Increasing the outreach of the programme 4. Increasing the awareness regarding Tuberculosis Activities 1. Improvement in the infrastructure • Improved DTC building with a computer room • Improved MC centres and TC centre 2. Improvement in the quality of testing of sputum • Training to the RNTCP staff in the district • Equipment maintenance – Microscope, Computer and Others • Adequate supply of drugs 3. Increasing the outreach of the programme by Increasing the DOTS providers through involvement of ASHAs who will be paid Rs. 500 per year for providing services. She will be oriented regarding DOTS. Also the AWH should be involved in reporting suspicious cases. Training will be given to ASHA for identifying the suspects. 4. Incentive scheme (prizes of 1000, 2000, 3000) to various people (sweeper, DOT provider, LTs etc.) 5. The patient will be given an incentive of Rs 250 on completion of the treatment. 6. Increasing the awareness regarding the various issues of Tuberculosis through involvement of Rehbar-e-Sehat teachers and NGOs. Special drive for detection
97 of cases on World TB day through the involvement for all departments 7. DOTS regime to be strictly monitored through the VHWSC, Rehbar-e-Sehat teachers, the PRIs and the PHC MO 8. Address verification system to be developed 9. Electronic information sharing to be initiated 10. Strengthen prevention Support • Persons carrying the sputum to DMC required • Every health centre should be a collecting centre • Private DOT provider may be paid as a Govt allowed payment to 25% payment • Supervisory Vehicles is being required for monitoring purpose. • POL/Maintenance of vehicle is being required. • Telephones and computers Persons carrying the sputum to DMC Timeline 2008 2009 2010 2011 -09 -10 -11 -12 Improving the DTC building, MC Centres and TC centres x Increasing the DOT providers through ASHAs x x x x Training to RNTCP staff and ASHA x x x x Awareness drives x x x x Mask Provision Budget Activity / Item 2008- 2009- 2010- 2011- Total 09 10 11 12 Civil Works 2.13 0 0 0 2.13 DTC building 1.5 lakhs MC 0.28/MC TU 0.35/Tu except DTC Material and supplies 1.2 1.45 1.6 1.76 6.01 Laboratory material 1 1.21 1.33 1.46 5.00 Strengthening of District TB Clinic 2 0 0 0 2.00 Awareness drive on World TB day 1 1.21 1.33 1.46 5.00 Salary of contractual staff 6.33 6.963 7.659 8.425 18.01 Training of Staff 22.424 24.666 27.133 29.846 104.07 IEC activities 1 1.21 1.33 1.46 5.00 Procurement of vehicle 6 0 0 0 6.00 Vehicle maintenance inc POL 1 1.21 1.33 1.46 5.00 Hiring of vehicle 1.7 2.06 2.27 2.5 8.53 DTO MO TC @ Rs 0.42lakh/yr Equipment and maintenance 0.085 0.103 0.113 0.124 0.43 Microscope @ Rs1000/yr/microscope Computer@ Rs 5000/yr Photocopier/Fax Rs2500/ machine Miscellaneous – TA/DA, Telephone, Meetings, 0.2 0.25 0.28 0.3 1.03 Electricity repair etc Orientation of PRIs 0.3 0.3 0.3 0.3 1.20 Re-orientation of PRIs and School Teachers 0 2.2 0 2.5 4.70 Total 46.369 42.832 44.675 51.596 185.47
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Detailed Calculations Training in RNTCP Personnel Unit Cost Units 2007-08 DTO State MOTC 23320 3 69960 MO 15580 40 623200 STS 6726 2 13452 STLS 16720 2 33440 LT 5972 10 59720 MPW 2875 22 63250 ANM 2875 178 511750 1374772 Personnel RNTCP Personnel Unit Cost Units Months Amount TB health visitor 6750 6 12 486000 STS 7000 2 12 168000 STLS 7000 2 12 168000 LT 6500 2 12 156000 Data Entry Operator 6000 1 12 72000 Accountant 1250 1 12 15000 Driver 4500 1 12 54000 Total 1119000
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D-2. LEPROSY Situation Balance New Cases Balance Per 10,000 Proportion Analysis Cases at cases Discharged Cases at Population of Deformity beginning detected in year end of year Ratio of year in year among PB M PB MB RFT O.D PB MB PR NCD cases B R 7 23 1 0 1 1 3
There are 0.5 cases per 10,000 hence 2-3 new cases per month are detected each month. Objectives Eradication of Leprosy by 2012 Strategies 1. Detection of New cases & Activities 2. House to house visit for detection of any cases 3. IEC for awareness regarding the symptoms and effects of Leprosy 4. Prompt treatment to all cases 5. Rehabilitation of the disabled persons Timeframe 2008-09 2009-10 2010-11 2011-12 House to house detection x x x x Wide publicity x x x x Rigorous follow-up x x x x Treatment x x x x Budget Activity / Item 2008- 2009- 2010- 2011 Total 09 10 11 -12 Routine Budget for Leprosy control 1.45 1.8 2 2.2 9.05 programme Monitoring & Supervision 1 1.2 1.3 1.5 6.10 Additional medicines 1 1 1 1 5.00 IEC Activities 1 1.2 1.3 1.5 6.10 POID Camps one per year @5000 1.05 1.75 1.75 1.75 6.30 XPHC Celebration of world Anti Leprosy 0.2 0.2 0.2 0.2 0.80 day@20000 Total 5.7 7.15 7.55 8.15 33.35
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D-3. NATIONAL MALARIA CONTROL PROGRAMME Situation Analysis Issues No. Total Blood Slides Examined (BSE) Jan 2006 –Dec 2006 46128 (old Udhampur) Total Positive Cases: Plasmodium Vivax (Pv): 24 Plasmodium Falciparum (Pf): NIL Slide Positivity Rate (SPR) 0.52 % Slide Positive plasmodium falciparum Rate (PFR) 0 Annual Blood Examination Rate (ABER) NIL Deaths NIL Source: CMO office Malaria is a serious health problem due to many reservoirs of stagnant water. Each year there are many epidemics and these result in a lot of morbidity. In J & K disease surveillance for Malaria was introduced under National Malaria Eradication Programme. Now the programme is known as National Vector Borne Disease Control programme. Under this District malaria Working Committee has been constituted and representatives from various departments are there but there is very little help from these departments. In the DDCs 46128 fever cases were treated during the year. The main bottlenecks are related to shortage of manpower especially for the remote areas. There are 12 posts of Health Supervisor (LHV) and only 4 are in position. There are no posts of Health Supervisor (M). Also there is lack of skills for taking blood slides, record keeping and there is lack of motivation. Objectives Reduction in SPR, API, PFR death rate to 10% by 2012 Strategies 1. Provision of additional Manpower 2. Training of personnel 3. Strengthening of Malaria clinics 4. Addressing Disease outbreak 5. Health education 6. Involvement of Private sector 7. Innovative methods of Mosquito control Activities 1. Provision of additional Manpower • The posts of MPW Male and the MPHS need to be filled up • Hiring of personnel till regular staff in place 2. Training of personnel The MOs, Laboratory Technicians, MPWs and Health Supervisors, ANMs, ASHAs will be trained in various techniques relating to the job 3. Strengthening of Malaria clinics • Provision of Proper equipment and reagents – 3 small Fogging machines for each PHC, sprayers, • Pulse Fog Machine at District HQ • Provision of Jeep, Truck, 4. Addressing Disease outbreak
101 • District Outbreak teams will be created at the district headquarter • In the team MO, LT, one MPW, one field worker • Provision of mobility, Lab equipments, spray equipment 5. Health education to the community through the ANM, AWW, ASHAs, RMPs, Ayush personnel 6. Involvement of Private sector: The private practitioners will be closely involved 7. Innovative methods of Mosquito control: Promotion of Gambusia fish needs to be done at every facility. The CMO office should have a hatchery and at each CHC level storage tank full of Gambusia, which can be easily distributed by any of the personnel. 8. Hoardings at each CHC, PHC and DH Support • Availability of supplies required • Filling up of vacancies • Supply of health Education material • Regular Supply of Gambusia fish Timeline Activity / Item 2008-09 2009-10 2010-11 2011-12 Hiring Contractual Staff x x x x Purchase of Jeep and Trucks x x x x Fogging & Spraying x x x x Hoardings 10 PHC 12PHC , Hatcheries for Gambusia Fish 10 PHC 12PHC , , IEC activities x x x x Budget Activity / Item 2008-09 2009-10 2010-11 2008-12 Total Salary Contractual staff 46.62 51.282 56.410 62.051 216.363 Travel expenses @ Rs 4000 per month 0.72 0.87 0.95 1.05 3.59 x 12 months Office expenses @ Rs 5000 per month x 0.6 0.73 0.8 0.88 3.01 12 Jeep and maintenance 6 0.66 0.73 0.8 8.19 Trucks – 3 and maintenance 24 2.64 2.9 3.19 32.73 One small Fogging machines for each 43 47.3 52.03 57.233 199.563 PHC @ Rs 1.00 lakh and one at District HQ Pulse Fog Machines @ Rs.8.00 lakh per unit and maintenance Training 23.44 25.784 28.362 31.199 108.785 Misc @ Rs 1Lakh per DH and Rs 20000 4.71 5.181 5.699 6.269 21.859 per CHC and Rs 10000 for PHC Board hoarding: 8’x 12’ Initially at the 1.75 1.75 1.75 2 7.25 CHCs and District hospitals @ Rs 25,000/- Board hoarding: 5’x3’ initially at the 3.5 3.5 3.5 3.5 14 PHCs@ Rs 10,000/- POL @ Rs 48,000/- per vehicle jeep and 40.32 48.78 53.66 59.03 201.79 truck for 12 months x 4 Total 194.66 188.477 206.792 227.202 817.131
102 Detailed calculations
Contractual Staff Personnel Unit Cost Units Months Amount Spray and Fogging staff 4000 4 12 192000 LT 6500 4 12 312000 Data Entry Operator 6000 1 12 72000 Accountant 1250 1 12 15000 Driver 4500 1 12 54000 Total 645000
Training Malaria Personnel Unit Units 2007-08 Cost units 2008-09 units 2009-10 units 2020-11 units 2011-12 DTO State MO 15580 73 1137340 101 1573580 101 1573580 101 1573580 101 1573580 LT 5972 7 41804 51 304572 51 304572 51 304572 51 304572 MPHS 1925 4 7700 40 77000 40 77000 40 77000 40 77000 MPW 2875 22 63250 180 517500 200 575000 220 632500 220 632500 ANM 2875 178 511750 360 1035000 400 1150000 440 1265000 440 1265000 ASHA 100 410 41000 600 60000 630 63000 640 64000 640 64000 1802844 3567652 3743152 3916652 3916652
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D-4. OTHER VECTOR BORNE DISEASES Situation Other VBDs No. Analysis Kalazaar NIL Dengue NIL Lymphatic Filariasis NIL Japanese Encephalitis NIL
Objectives No incidence of Dengue by 2012 Prevention of JE, Chikingunya and other new infections Strategies 1. Reduction of vector density 2. Mosquito-man contact reduction 3. Community awareness Activities 1. Reduction of vector density • Identification of breeding sites • Fogging and spraying • Covering of any breeding sites 2. Preparedness for new infections • Increase in Manpower • Training of personnel for identification of new infections • Preparation of Laboratories in the district and State to diagnose the new diseases • Preparedness of dealing with the epidemic outbreak 3. Community awareness as part of the IEC for Malaria and IDSP • Group meetings • Pamphlets/ handbills • Public announcements • Kala Jathas 4. One jeep for Entomologist (already covered in malaria budget) 5. One truck for shifting manpower and drums /equipment (in malaria budget) Support Support from State Laboratory and the NICD for diagnosing Dengue, Chikingunya, required JE etc; Support from District Administration, PRIs, WCD, PHEd, Time Frame Activity / Item 2008-09 2009- 2010 - 2011-12 10 11 Fogging and Spraying x x x x Pamphlets x x x x Kala Jathas for Malaria, Dengue and x x x x Chikingunya
Budget Activity / Item 2008 2009- 2010- 2008- Total -09 10 11 12 Unforseen expenses 0.5 0.61 0.67 0.74 2.52 Kala Jathas for Malaria, Dengue and 2.75 3.025 3.328 3.660 6.69 Chikingunya @ Rs 1000 per village x 275 Total 3.25 3.635 3.998 4.400 15.28
104 D-5. BLINDNESS CONTROL PROGRAMME Situation Indicators No. Analysis Total Cataract surgery performed 1028* Cataract surgery with IOL 949* Cataract surgery plain 79* School going children screened 1850* Children detected with refractive error 150* Children provided with free corrective spectacles NIL *old Udhampur Eye Care is being provided through the DH but there is one Ophthalmologist in the district and one Ophthalmic Assistant. `The norm for GOI is 1 Ophthalmologist for a population of one lakh. Hence in this district at least 3 Ophthalmologist are required. The norm for Ophthalmologist to Ophthalmic Assistant is 1: 3-4 hence a minimum of 12 are required.
There is a need to urgently tackle the cataract cases and hold eye camps each month. There is no Eye Bank or Eye donation centre in District Reasi. The nearest Eye Bank is at Jammu Medical College. Objectives 1. Reduction in the Prevalence Rate of blindness to 0.5 % by 2012 2. Decrease in the Prevalence Rate of Childhood blindness to 0.6 % per 1000 children by 2010 3. Usage of IOL in 100 % of Cataract operations Strategies 1. Provision of high quality Eye Care 2. Expansion of coverage 3. Reduce the backlog of blindness 4. Development of institutional capacity for eye care services Activities 1. Determining the prevalence of Cataract through a study by an external agency. • One time house-to-house survey for study of prevalence of vision defects and Cataract of entire population leading to referrals and appropriate case management including cataract surgeries 2. Increasing the number of Ophthalmologists either by hiring or through involvement of Private Sector. 3. Training in IOL to private Ophthalmologists 4. Training of Paramedical staff and Teachers, NGOs, Patwaris and AWW for screening of school children and IEC activities. 5. AMC for all equipment will be done. 6. Equipment: Purchase of latest equipment for regular surgeries 7. Construction of Eye Unit in Hospitals and later CHC 8. Supply of basic Eye medicines like eye drops, eye ointments and consumables for Primary Eye Care in PHC/CHC. 9. All PHC and CHC to be developed for vision screening and basic eye care Eye Care centre Vision Centre Screening Eye Surgeon Primary Eye Care Identify Blind Treatment of eye conditions Vision Test Maintain Blind and follow-up Register Training Screening Eye Camps Motivator Supervision Referral for surgery Referral 10. Blind Register to be filled up by the AWW, together with PRIs
105 11. Health Mela at each CHC 12. Eye Camps with the involvement of Private sector and NGOs from other districts if no agency is available in Reasi. 13. School Eye Screening sessions • IEC activities Support Procurement of latest equipment for hospitals by GOI required Timely Repair of equipment
Timeline Activity / Item 2008-09 2009-10 2010-11 2011-12
H-H Survey for Vision defects Health Mela 5 CHC 5 CHC 5 CHC 5 CHC IEC activities x x x x School Eye Screening 100 100 100 100 Blind Register x x x x Observance of Eye Donations x x x x Cataract Camps 22 PHC 22 PHC 22 PHC 22 PHC Development of PHC and CHC as 10 PHC 12 PHC Vision Centres 5 CHC Development for CHC for Eye Unit 1 Training of School teachers 200 100 100 100 100 Training of PRIs 200 200 200 200 Repair and purchase of equipment x x x x and maintenance Budget Activity / Item 2008- 2009- 2010- 2011- Total 09 10 11 12 Health Mela 2 2.2 2.42 2.662 9.28 IEC 1 1.1 1.21 1.331 4.64 Blind Register@100X 275 villages 0.275 0.303 0.333 0.366 1.28 Cataract Camps @ Rs 20000 per camp x 22 4.2 4.62 5.082 5.590 19.49 PHC POL for Eye Camps @ Rs 3000/camp x22 0.63 0.693 0.762 0.839 2.92 Training of School teachers @ Rs 100/head x 0.2 0.22 0.242 0.266 0.93 200 Training of PRIs @ Rs 100/head x 200 0.2 0.22 0.242 0.266 0.93 Purchase, Maintenance and Repair of 20 22 24.2 26.620 92.82 equipments Total 28.505 31.356 34.491 37.940 132.29
106 D-6. Integrated Disease Surveillance Programme Situation The programs with major surveillance components include: Analysis/ • The National Anti-Malaria Control Program • National Leprosy Elimination Program • Revised National Tuberculosis Control Program • Nutritional Surveillance • National AIDS Control Program • National Polio Surveillance Program as part of the Polio eradication initiative • National Programme for Control of Blindness (Sentinel Surveillance)
Surveillance activities of all these vertical programs of Malaria, Tuberculosis, Polio, HIV are functioning independently leading to duplication of Surveillance efforts. Surveillance has been ineffective due to There are a number of parallel systems existing under various programs which are not integrated. The existing programs do not cover non-communicable diseases. Medical colleges and large tertiary hospitals in the private sector are not under the reporting system as well as for utilization of laboratory facilities. The laboratory infrastructure and maintenance is very poor Presently, surveillance is sometimes reduced to routine data gathering with sporadic response systems thereby leading to slow response to Epidemics, Information technology has not been used fully for information and to analyze and sort data so as to predict epidemics based on trends of the reported data.
In response to these issues the Integrated Disease Surveillance Programme was launched in J & K to provide essential data to monitor progress of on going disease control programs and help in optimizing the allocation of resources.
IDSP includes 15 diseases/ conditions (Malaria, Acute diarrhoeal disease-Cholera, Typhoid, Jaundice, Tuberculosis, Acute Respiratory Infection, Measles, Polio, Road Traffic Accidents, Plague, Yellow Fever, Meningoencephalitis /respiratory distress, etc., HIV, HCB, HCV) ) and 5 state specific diseases (Thyroid diseases, Cutaneous Leishmaniosis, Acid Peptic Diseases, Rheumatic Heart Diseases). Establishing of District Surveillance unit Upgradation of 1 PSU Labs Water testing labs are in place V-Sat is been installed but training is required Rapid response teams are being established at District levels. DSUs (District Surveillance Units) are being established in all districts One Computer, Printer and Scanner has been received Objectives 1. Improving the information available to the government health services and private health care providers on a set of high-priority diseases and risk factors, with a view to improving the on-the-ground responses to such diseases and risk factors. 2. Establishing a decentralized state based system of surveillance for communicable and non-communicable diseases, so that timely and effective public health actions can be initiated in response to health challenges in the country at the state and national level. 3. Improving the efficiency of the existing surveillance activities of disease control programs and facilitate sharing of relevant information with the health
107 administration, community and other stakeholders so as to detect disease trends over time and evaluate control strategies. Strategies 1. Strengthening data quality, analysis and links to action; 2. Improving the laboratories 3. Training of all the stakeholders in disease surveillance and action 4. Coordinating and decentralizing surveillance activities 5. Intersectoral Coordination and involvement of communities and the private sector Activities 1. Strengthening of the District Surveillance Unit (DSU), established under the project, • Training of the Unit Incharge for epidemiology – {DMO) • Administrative Assistant • Training of contract staff on disease surveillance and data analysis and use of IT • Providing support for collection and transport of specimens to laboratory networks • Provision of computers and accessories • WEN connectivity to be operationalized • Provision of software of GOI 2. Setting up of Peripheral Surveillance Units at CHC 3. Sensitizing the Community for • Notifying the nearest health facility of a disease or health condition selected for community-based surveillance • Supporting health workers during case or outbreak investigations • Using feedback from health workers to take action, including health education and coordination of community participation. • Meetings with the SHGs, school teachers, Numberdar and Chowkidars for sensitisation and prompt reporting of cases 4. Improvement in the Laboratories at the district and at CHC through provision of equipment and consumables Support Provision of supplies on time required Time Frame Activity / Item 2008- 2009- 2010- 2011- 2009 2010 2011 12 Renovation of Labs with provision of PSU at equipment, furnishings, material 5 CHC + 1DH Training x x x x Contractual staff Software for DSU & training of staff x x x x WEN connectivity x x x x Sensitization of Community x x x Meetings with SHGs x x x x Meetings with teachers x x x x Meetings with Numberdar and Chowkidars x x x x
108 Budget Activity / Item 2008- 2009- 2010-11 2011- Total 09 10 12 Renovation of Labs at CHCs @ Rs 20,000 1 0 0 0.2 1.20 Renovation of Lab at District Hospital @ Rs 1.4 0.18 0.2 0.22 2.00 140,000 and maintenance Equipment for Lab at PSU at CHCs @ Rs 2 0 0 0.4 2.40 40,000 Equipment for Lab at District @ Rs 850,000 8.5 0 0 0 8.50 Computer and Accessories at CHC @63000 3.15 0 0 0.63 3.78 Computer and Accessories at DSU@63000 0.63 0 0 0 0.63 Office Equipment for PSU at CHC @ Rs 1 0 0 0.2 1.20 20,000 per unit Office Equipment for DSU @ Rs 20,000 0.2 0 0 0 0.20 Software for DSU@ Rs 335000 3.35 0 0 0 3.35 Furnishing of Lab at PSU at CHCs @ Rs 0.5 0 0 0.1 0.60 10,000 Furnishing of Lab at DSU @ Rs 60,000 0.6 0 0 0 0.60 Material and supplies at Lab at PSU at CHCs 0.4 0.44 0.484 0.5324 1.86 @ Rs 8,000 Material and supplies at Lab at DSU @ Rs 0.75 0.91 1 1.1 3.76 75,000 Contract Staff at District level @ 200000/yr 2 2.92 3.71 4.58 13.21 for 4 staff IEC activities 1 1.21 1.33 1.46 5.00 Training and retraining 2.6 3.15 3.47 3.82 13.04 WEN connectivity 0.5 0.61 0.67 0.73 2.51 Operational costs at PSU for Surveillance @ 0.75 0.9 1.31 1.59 4.55 Rs 15000/year x 5 Operational costs at DSU for Surveillance @ 1.3 0.57 1.73 1.9 5.50 Rs 130000/year Honorarium to Numberdars and Chowkidars 8.88 9.768 10.745 11.819 21.59 for reporting @ Rs 100 pm x 275 Numberdars and 275 Chowkidars x12 Total 40.510 20.658 24.649 29.282 115.10
Detailed Budget for Trainings Unit Units for Amount for Units for Amount for Personnel Cost 2007-08 2008-09 2008-09 2008-09 MPW 785 22 17270 22 17270 Lab Assistant at CHC 905 7 6335 7 6335 Lab Assistant at District 3110 2 6220 2 6220 MOs 1835 73 133955 101 185335 DST 4 members 6950 4 27800 4 27800 191580 242960
109 D-7. Iodine Deficiency Disorders Situation Iodine is one of the essential micronutrients. Minimum requirement is 150 Analysis microgram per day. The main source of Iodine is from soil and water. Iodine is taken from food grown in iodine rich soil.
At present there is a depletion of Iodine in the soil due to which there is a deficiency of Iodine. Deficiency result in a variety of disorders ranging from Abortion, stillbirths, Goitre, impaired mental function, retarded growth. In J & K the National Iodine Deficiency Programme is being implemented. People in J & K consume rock Salt and crystal salt Objectives/ 1. Prevention of Iodine Deficiency diseases 2. Consumption of Iodized salt by 100% families Strategies 1. Supply/monitor quality of Iodized salt 2. Assessment of the magnitude of the problem 3. Laboratory Monitoring of Iodized salt and urine samples 4. Health Education Activities 1. Supply/monitor quality of Iodized salt • Monitoring is done through Food Inspectors who collect two samples of salt per month per district and send it to a laboratory. • The Health workers have been supplied with Kits to test samples at least five per month. • Review is done in the monthly meetings • Monitoring through School health programme – Testing of samples and awareness • Supply of Testing kits to AW Cs , Schools, SHGs 2. Assessment of the magnitude of the problem 3. This will be done by the Central Survey team 4. Laboratory Monitoring of Iodized salt and urine samples 5. Health Education: An IEC strategy is essential to promote the consumption of Iodized salt through AWWs, PRIs, NGOs, ASHA, SHGs etc; Demonstration of Iodized salt by school children through testing, Rallies, sensitisation of shopkeepers for keeping Iodized salt. 6. Testing of salt at shops and homes Support 1. Regular Supply of Testing Kits required 2. Regular Supply of Iodized salt 3. Regular supply of IEC material Timeline Activity / Item 08-09 09-10 10-11 11- 2012 Large Village meetings for awareness on x x x X IDD and consumption of Iodized salt Programme in schools – 100 Primary, x x x X Upper Primary, Secondary- Govt and Private by School health team
Awareness programme with the SHGs 275 275 275 275 and shopkeepers villages villages villages villages
110 Budget Activity / Item 2008- 2009- 2010- 2011- Total 09 10 11 12 Large Village meetings for awareness on IDD and 1 1.21 1.33 1.46 5.00 consumption of Iodized salt Programme in schools – Primary, Upper Primary, 3.5 3.850 4.235 4.659 8.51 Secondary- Govt and Private by School health team @ 500 Awareness programme with the SHGs and 2.75 3.025 3.328 3.660 6.69 shopkeepers @ Rs 500 per village x 275 villages Total 7.25 8.085 8.893 9.779 34.01
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6: INTER SECTORAL CONVERGENCE
6.1 Partnership with AYUSH department There are 47 ISM dispensaries working in district Udhampur (OLD). All of them are understaffed and do not have adequate buildings, equipment and medicine supplies. Hence goals set under NRHM cannot be achieved through the present available facilities. Out of 47 ISM institutions, 29 are running in rented buildings.
To achieve the desired goals, following steps need to be taken:
• Strengthening of existing ADMO office at Udhampur by providing building and required staff. • Establishment of atleast 50 bedded district ISM hospital. • Establishment of block level administrative units with required facilities.
Separate funds have not been provided to this department for creation of infrastructure as per the IPHS including staff quarter accommodation, requisite medicines (including emergency Medicines) & manpower.
ISM doctors are fully trained & competent to conduct deliveries & can contribute a lot in implementing the concept of institutional deliveries .But it is unfortunate that these services are not being utilized maybe out of bias or some other reasons. Without any special facility the ISM Doctors are conducting deliveries where they are posted & no alternative facility is available with the people. For implementation of national programme hundred all ISM (AYUSH) staff is involved in the field. But there is no cold chain facility, lab facility & other incentives.
There are no guidelines for conducting of joint meetings between ISM (Ayurvedic/ Unani) & allopathic at District & block levels. However an informal meeting is held once in a year. There is no binding by way of govt. orders from the higher authorities. The status IEC strategy for Ayurveda & allopathic should be jointly prepared & planned by director ISM & Director health (Allopathic).The IEC funds & material should be jointly shared & should be at the disposal of director ISM & director Health separately.
1. Constitution of RKS in ISM 2. CHC and PHC will provide AYUSH services 3. Involvement of Ayurvedic dispensaries in implementation of national health programmes.
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Issues / Areas Areas of cooperation Areas of convergent action Curative ; In order to provide medicare facilities The ISM doctors are providing the Patient care, to the masses there is a vast potential health Medicare facilities by the way Surveillance for cooperation with health of providing Ayurvedic / Unani referral department so as to implement all the medicine but as the dispensaries of national programes like National AYUSH are located in the Isolation / Malaria eradication Programme, T.B. far flung areas where there is no control programme (DOTS), HIV / existence of any health facility Aids awareness programme, (Allopathic) in the form of primary implementation of institutional health centres / community health deliveries. centres or even allopathic dispensaries. Here people come The cooperation is also needed from across emergencies which are the department of social welfare, supposed to be attended by (ICDS) Anganwari centres located in Ayurvedic / Unani doctors or staff. the areas where the ISM dispensaries Therefore there is dire need of are functioning by the way that the emergency drugs, life saving drugs , staff of these centres (Anganwari bandaging material , antiseptic workers) can bring the unvaccinated lotions , antibiotics which are not children to the nearest ISM institutions supplied in ISM dispensaries. Due to so that their complete vaccination non availability of these drugs in should be done. Old routine is that some cases precious lives are lost medical officer of the concerned ISM and wrath of people falls on the staff institution visits the Anganwari centre of ISM institutions. Therefore life once in a month should be started for saving drugs, antiseptic lotions & general health check up of the dressing materials need to be children of Anganwari centres. supplied to avoid suffering of the ailing masses. Preventive; Health department’s cooperation is As the facility of cold chain in the Immunization, needed in providing ILR, Deep form of ILR’s & deep freezers is Prophylaxis freezers to the ISM dispensaries. provided to ISM institutions. Routine services vaccination as well as out reach Promotive, IEC vaccination camps should organised easily in remotest & far flung areas. For IEC funds should be kept at the disposal of the Asstt. District. Medical officer so as it should be
113 used for awareness Programmes. Specific issues in Health Department to assist ISM As Kits of Iron folic acid tablets be Implementation of institutions & to provide kits of iron provided to ISM institutions. ISM national Folic acid tablets directly to the Doctors can treat Pregnant women programmes dispensaries through the Asstt. as well as cases of iron deficiency Maternal care District. Medical officer. All ASHAs anaemia is better way. In present operational in the areas of ISM situation only Ayurvedic / Unani institutions should be given training on medicines which contain iron are providing emergency health care given to pregnant women for services. deficiencies of Iron Child care Health department should cooperate As it contains Iron, Septran (Paed) & with Assistant District. Medical officer Antihelminthics tabs be provided Udhampur & kits containing Iron small ISM dispensaries better care of & folic acid, Septran (paed) & children suffering from iron Antihelminthics tabs should be deficiency anaemia, worm supplied to ADMO office & then it is infestation & other diseases. supplied to all the ISM institutions. As Anganwadi workers / helpers As far as social welfare department is bring the children to the ISM concerned Anganwadi workers can Dispensaries on a fixed date of bring unvaccinated children to the immunization through this goal of dispensaries. 100 % immunization could be achieved. Adolescent Health department & education Some funds should be kept at the health department organised camp far the disposal of the concerned ADMO for awareness of adolescent health age procuring IEC materials like banners group. Ayurvedic / Unani doctors / posters etc. for organising should be invited to give awareness awareness camps. With this people lectures & these camps should be living in remotest & far flung areas organised at ISM institution also. particularly adolescent age groups Education department can cooperate children can be benefited from this with ISM institutions in a particular awareness campaign as most of the areas & through chief education ISM institutions are in remotest & far officers or Zonal education officers, it flung areas. should be made mandatory that medical officer of that area should visit schools & give awareness lectures to the adolescent children on different issues.
114 School Health Education department’s help is When approached by the concerned needed for the health check up of chief education officer/ Zonal children as done as a routine matter education officers, the ISM Doctors few years back. are willing to provide these services for general health check up of children of different schools. Leprosy Cooperation from health department After diagnosis of a case of leprosy is needed to train ISM doctors/ the anti-Leprotic drugs should be Paramedical staff. All ISM doctors, made available directly to ISM paramedical staffs should be given institution so that patients can avail training to address sensitive health the medicines from the nearest issues like Leprosy. dispensary IDD Health department cooperation is Only IEC activities are done on our needed own to aware the masses about the iodine deficiency diseases. Tuberculosis Health department should cooperate Anti tuberculosis drugs Dots therapy with ISM department & all ISM should be provided directly to ISM doctors /paramedical staff should be dispensaries so that patient of trained through regular training / Tuberculosis can avail the facility workshop from to time laboratory from the nearest dispensary as in facility with laboratory technician some far flung areas. There is no should be provided existence of allopathic institutions & only ISM institutions are catering the health needs of the areas HIV/AIDS Cooperation from health department Funds for AIDS awareness camps is needed for training of ISM Doctors / should be kept at the disposal of Paramedical staff for AIDS. Regular Asstt. District. Medical officer at workshops training Programmes District. Level so that IEC material should be organised so that like Banners , pamphlets etc should knowledge of the staff is updated be disturbed to the masses so that about the disease. exact cases of the disease its sign & symptoms are known to the people or IEC material from health (allopathic ) department should be supplied to the ADMO’s Water borne PHE department & health If the cases of the particular disease diseases departments’ cooperation is needed. on particular area rises. In order to As water born disease are due to the check it chlorine tablets & other infected water chlorine tablets should drugs should be supplied to the ISM
115 be supplied. institutions so that Medical officers / officials can treat the cases. IEC materials for water born diseases should be kept at the disposal of ADMO .So that according to need it should be distributed about the masses & awareness camps about the staff drinking water should be organised as in rural areas major source of drinking water is well, springs, & the water is often polluted in rainy season. RTI/ STI Health department to provide As antibiotics are provided to ISM medicines, antibiotics as to check RTI institutions, Medical officers of these / STI. One laboratory technician with institutions can treat the patients of laboratories should be given to RTI /STI in a better way & by dispensaries providing laboratory facilities in these institutions which are situated in remotest areas , the diagnosis of diseases is made in initial stage that helps in treatment of the patient.
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6.2 ICDS projects Issues / Areas Areas of Areas of convergent action cooperation Linkages to be • AWW share information/records of pregnant Coordination with allied developed between mothers and newborns with ANMs departments ICDS workers and • AWW help in tracking beneficiaries and bring health workers for them for immunization timely diagnosis of • They keep community informed of next malnourished session’s date of health checkup camp and children and their immunization. management. • AWW should reports disease outbreaks in the village to ANM. Health Department • IEC to be developed and disseminated to the community regarding food and nutrition. • For proper management of malnourished cases, medicines will be supplied along with the PHC and CHC drug kits annually.
6.3 Rural Development Department Issues / Areas Areas of cooperation Areas of convergent action During the initial base line survey Linkages to be developed • Demand driven approach conducted in district Reasi for between the Health with increased emphasises assessment of the hygienic Department and the Rural on awareness behaviour and knowledge about Development department • Subsidy for individual sanitation in the rural population, household units replaced by it was observed that barely 7% of • Improving the health incentive the poorest of poor the rural population has basic standard & general household. sanitary related facilities like quality of life of rural • Rural school sanitation is household toilets & rest of the community. major component for wider population nearly 93% go for • Awareness on acceptance of children who open defecation. The (KAP) sanitation/ Hygiene & can encourage their parents study conducted revealed that health education. for sanitation environment. the basic hygiene behaviour of • Covering of school / • Awareness generation the general public in district Anganwari in rural areas amongst the A.P.L families Reasi was very poor. with sanitation facilities for construction of toilet by & promote Hygiene their own. education & sanitary
117 habits among students. • Amount of Rs Four thousand • Promote & encourage Per school toilet to be added cost effective from NRHM as the twenty construction of thousand is not sufficient for household latrine & their construction of school toilet proper use. in hilly belt. • Elimination of open • Anganwadi toilet in private defection to minimise houses with a cost of Rs Five the risk of contamination thousand for each of water source & food. Anganwadi • Toilet facility at PHC, CHC, DH, • Services of doctor & paramedical staff for awareness for sanitation condition & environment.
6.4 Public Health department Issues / Areas Areas of Areas of convergent action cooperation People of the district Reasi are still Health and ICDS Bleaching powder and chlorine dependant on traditional water Departments tablets will be provided by IPH sources, in certain areas water from and distributed by field hand-pumps is perceived to be unfit functionaries to households for consumption, and water Joint communication strategy. availability is falling short of Copy of water quality requirement. monitoring reports generated by The practice of boiling water for IPH department will be shared drinking purpose is not prevalent with the Health Department at block, district and state levels Community based organisations formed under various programmes/sectors will be engaged by a team of frontline workers – health, ICDS and IPH departments.
118 6.5 PRIs Issues / Areas Areas of cooperation Areas of convergent action • The PRIs have been envisaged to Motivating the Joint plans play a very important role in NRHM community Joint review and monitoring • At the village level they are part of Availability of Mobilization of the community the VHWSC. personnel and for action on health care • At the Gram Panchayat level they are services issues, safe drinking water part of the Gram Panchayat health Participation in the VH and sanitation. committee. Similarly at the Block and Days Advocacy at village, Gram the District they are part of the Block Giving importance to panchayat, block and district and District health mission. issues of health in the level. • At the Subcentre the Sarpanch is the Gram Panchayat joint signatory to the bank account for meetings the operation of the Untied funds of Rs 10000. • In the Gram Panchayat meetings held twice each month the PRIs review the activities of the health department along with the ICDS
119
Convergence –PRI system and capacity building, NGO coordination, Public Private Partnership, Training and Meetings of committee members Problem 1. Non Existence of PRI and systems. Identified & Core 2. Lack of quality conscious private health service providers for partnership Issues. 3. Need for strengthening Village health, water and sanitation committees and training them 4. Difficult to communitise health services due to non-availability of good NGOs and community organisations. 5. Lack of formal institutional mechanisms for convergent actions with NRHM related sectors Solutions • PRI systems need to be in place proposed • PPP need to be developed and CME to be provided to private providers (Activity plan) • All the members especially the members of PRIs need to be imparted training in primary health care delivery system, which can be imparted at the PHC/ CHC level by the block MO or Medical Officers. • For joint efforts, monthly meetings of the committee as constituted above must be held and the meeting should be fixed in advance and the local panjayath leaders and MPHWs of the sub centres should arrange the meeting at sub centres. The local Medical Officer and Health Supervisors can also attend the monthly meeting. • MNGOs scheme need to be strengthened to communitise health services. • At the policy level formal mechanisms need to be put in place for convergent actions with other NRHM sectors Support needed Policy and funding support for implementing changes Cost of • PPP initiative ( Chiranjeevi) has been proposed under RCH implementing • For training of PRI and VHWS committee members: Rs. 22 Lakhs changes • For regular monthly meetings: Rs.- 12 Lakhs • Educational materials-Rs 10 lakhs • Total Rs. 44 lakhs for one year and Rs 2 crores for 5 years Time needed to Three months after constitution of the committees. implement changes Sustainability of capacity of the committee members with decentralised powers. the changes Benchmark(s) Reduction in IMR & MMR and improvement in sex ratio by 10 points 2012. derived from this component
120 Inter Sectoral Convergence Situation Health is a social responsibility and is not the domain of the health department Analysis/ only. Unfortunately the total responsibility has fallen on the health department. The Current various departments have been involved in the Pulse Polio campaign which has Status led to the massive mobilization and success of the campaign.
The District Health Society is yet to constitute in district Reasi. At the Gram Panchayat level under the Sarpanch Gram Panchayat committees have been formed consisting of various sectors. The Village health and Water Sanitation Committees also consist of various sectors and the community.
In reality these committees need to be strengthened since they are not functional. All the various sectors are working separately although for the same cause. Hence there is a lot of duplication and wastage of resources.
Although orders have been issued for convergence but other sectors do not participate readily. Joint working of the ICDS and health is happening on the Fixed Maternal Child Health and Nutrition day. This needs to be strengthened and streamlined. The community is not aware regarding this day.
The forum of the fixed health day each week has a lot of potential and has not been used properly. Objectives 1. Providing Primary and basic quality health care services at the village level 2. Providing quality RCH services 3. Optimal utilization of RCH services by community especially women 4. Empowering women to facilitate them to seek and demand quality RCH services. Strategies 1. Strengthening the various Committees and Societies 2. Strengthening the VHD days 3. Joint action for various issues Activities 1. Joint workshops for Planning and Review at all levels • Orientation programmes • Monthly meetings 2. Strengthening the VHD days • Wide participation of all the sectors in preparation of the community and in the actual activities, in health education • Each Wednesday during Immunization sessions joint orientations by all sectors and problem solving for each of the sectors 3. Joint Action for Sanitation, provision of safe water, provision of services and personnel at facilities 4. Joint review at the Gram Panchayat meetings 5. Joint efforts for education of the girls, improving the sex ratio, raising age of marriage, improving the nutritional status, identifying the correct BPL families, income generation. 6. Joint CNAA to determine the needs and thereby developing the plans jointly 7. Realignment of the Health and the ICDS sectors for common data and common work boundaries. 8. ASHA to participate in all the meetings of the ICDS held between the 20 th and 22 nd of each month. 9. At the CHC level monthly meetings are organized. This should be jointly
121 organized with the ICDS 10. At the monthly meetings of the CMO, the officers of all the departments should come 11. Annual action Plans to be developed jointly through meetings at the village, Gram Panchayat, Sector and culminating in Block workshops and District workshops 12. Chiranjeevi Scheme to involve PRIs for promoting safe deliveries for rural BPL women through PPP initiative by involving the private sector 13. Upgrading Ayush at all levels from PHC to DH. 14. Involvement of the RDD for construction of toilets in all health facilities and public places Support Govt orders for intersectoral coordination with clear roles and responsibilities and If required the various sectors do not attend the meetings then the decisions will be taken and will be binding for all the sectors. Strict follow-up at the State level for ensuring coordination. Timeline Activity / Item 2008- 2009- 2010- 2011- 09 10 11 12 Meetings of the Block Committees x x x x Meetings of the Village groups x x x x Joint CNAA training ( 559 AWW, 320 ANM, 570 x x x x ASHAs, 40 Supervisors, 80 MOs, 7 CDPOs) Joint monitoring at the sector level x x x x Hiring of vehicle x x x x Joint monitoring at the block level x x x x Yearly joint Planning Workshops at the Block x x x x level for development of the Action Plans Yearly joint Planning Workshops at the District x x x x level for development of the Action Plans Yearly joint Workshops to consolidate the plans x x x x from the village to the Gram Panchayats to the Sectors and then Blocks at the Block level for Annual Action Plans Budget Activity / Item 2008 2009- 2010- 2011- Total -09 10 11 12 Meetings of the Block Committees @ Rs 1000 0.48 0.528 0.581 0.639 2.23 /meeting x 4 blocks x 12 months Meetings of the Village groups @ Rs 50 per 1.65 1.815 1.997 2.196 7.66 village x 275 villages x 12 Joint CNA training @ Rs 200 per person ( 550 2.094 2.303 2.534 2.787 9.72 AWW, 200 ANMs, 272 ASHAs, 21 MOs, 4 CDPOs) x 1047 Joint monitoring at the sector level Hiring of vehicle @ Rs 1000/ day x 5 days/month 12.6 13.86 15.246 16.771 58.48 x 21 sectors x 12 months Joint monitoring at the block level Hiring of vehicle @ Rs 1000/ day x 5 days/month 2.4 2.64 2.904 3.194 11.14 x 4 blocks x 12 months
122 Yearly joint Planning Workshops at the Block level 4 4.4 4.84 5.324 18.56 for development of the Action Plans @ Rs 1.00 lakhs per block x 4 blocks Yearly joint Planning Workshops at the District 1 1.1 1.21 1.331 4.64 level for development of the Action Plans @ Rs 1.00 lakh Yearly joint Workshops to consolidate the plans 4 4.4 4.84 5.324 18.56 from the village to the Gram Panchayats to the Sectors and then Blocks at the Block level for Annual Action Plans @ Rs 1.00 lakhs per block x 4 blocks Yearly joint Workshops to consolidate the findings 1 1.1 1.21 1.331 4.64 at the block levels at the District level for development of the Action Plans @ Rs 1.00 lakh Training of PRIs, VHWS committee members 22 22 22 22.000 88.000 under Chiranjeevi Scheme @22 lakhs Regular monthly meetings under Chiranjeevi 12 12 12 12.000 48.000 Scheme @12 lakhs Development of Education material and hands on 10 10 10 10.000 40.000 training under Chiranjeevi Scheme @ 10 lakhs Total 73.22 76.15 79.361 82.897 311.629
123 7. COMMUNITY ACTION PLAN
Community Health Action Situation Health is a social responsibility and is not the domain of the health department only. Analysis Unfortunately the total responsibility has fallen on the health department. The various departments have been involved in the Pulse Polio campaign which has led to the massive mobilization and success of the campaign.
The District Health Society is not functional in district Reasi. At the Gram Panchayat level under the Sarpanch Gram Panchayat committees have been formed consisting of various sectors.
The Village health and Water Sanitation Committees also consist of various sectors and the community.
In reality these committees need to be strengthened since they are not functional. All the various sectors are working separately although for the same cause. Hence there is a lot of duplication and wastage of resources.
Although orders have been issued for convergence but other sectors do not participate readily. Joint working of the ICDS and health is happening on the Fixed Maternal Child Health and Nutrition day. This needs to be strengthened and streamlined. The community is not aware regarding this day. The forum of the fixed Village health day each week has a lot of potential and has not been used properly Objectives 1. Providing Primary and basic quality health care services at the village level 2. Providing quality RCH services 3. Optimal utilization of RCH services by community especially women 4. Empowering women to facilitate them to seek and demand quality RCH services. Strategies 1. Strengthening the various Committees and Societies 2. Strengthening the VHD days 3. Joint action for various issues Activities 1. Joint workshops for Planning and Review at all levels • Orientation programmes • Monthly meetings 2. Strengthening the VHD days • Wide participation of all the sectors in preparation of the community and in the actual activities, in health education • Each Wednesday during Immunization sessions joint orientations by all sectors and problem solving for each of the sectors 3. Joint Action for Sanitation, provision of safe water, provision of services and personnel at facilities 4. Joint review at the Gram Panchayat meetings 5. Joint efforts for education of the girls, improving the sex ratio, raising age of marriage, improving the nutritional status, identifying the correct BPL families, income generation. 6. Joint CNAA to determine the needs and thereby developing the plans jointly 7. Realignment of the Health and the ICDS sectors for common data and common work boundaries. 8. ASHA to participate in all the meetings of the ICDS held between the 20 th and
124 22 nd of each month. 9. At the CHC level monthly meetings are organized. This should be jointly organized with the ICDS 10. At the monthly meetings of the CMO the officers of all the departments should come 11. Annual action Plans to be developed jointly through meetings at the village, Gram Panchayat, Sector and culminating in Block workshops and District workshops Support Govt orders for inter-sectoral coordination with clear roles and responsibilities and If required the various sectors do not attend the meetings then the decisions will be taken and will be binding for all the sectors. Strict follow-up at the State level for ensuring coordination. Timeline Activity / Item 2008- 2009- 2010- 2011 09 10 11 -12 Formation of Block Committees Orientation of Committee members at all levels
Joint Community action x x x x Joint Annual Action Plan x x x x Sector Alignment x Reorientation of the Committees and Societies x x x x
Strengthening the Gram Panchayat meetings x x x x and Gram Sabhas
Budget Activity / Item 2008- 2009- 2010- 2008- Total 09 10 11 12 Training of the VHWSC @ Rs 200 per person x 15 8.25 9.075 9.983 10.981 20.06 persons/village x 275 villages Meetings of the VHWSC @ Rs 100 per village x 3.3 3.630 3.993 4.392 8.02 275 villages x 12 months Meetings of Women SHGs @ Rs 100 per year x 3.3 3.630 3.993 4.392 8.02 275 villages Total 14.850 16.335 17.969 19.765 68.92
125 8.PUBLIC PRIVATE PARTNERSHIP
Public Private Partnerships Situation The private sector includes NGOs, Private Practitioners, Trade and Industry Analysis/ Organisations, Corporate Social Responsibility Initiatives. Current Status The private sector is the major provider of curative health services in the country. 43% of the total IUD clients obtain their services from the private sector. Engaging with it to provide family planning services has the potential to significantly expand the coverage of quality services. Public-private partnerships can stimulate and meet demand and have a synergistic impact of the RCH. To ensure efficient services of good quality from the private and public sectors, robust monitoring and regulatory mechanisms need to be developed so that the private sector can come forward and cooperate in all the National programmes and also in sharing its resources.
At present, no any Public Private Partnership activity is going on in the District. MNGO is J & K Ex-Services league putting its best efforts to improve RCH indicators in hilly and mountainous district of Reasi. No initiatives taken under Public Private Partnership. Objectives 1. Increasing the coverage of the health services and also increasing the accessibility for health services 2. Widening the scope of the services to be provided to the clients Strategies Incentives and training to encourage private providers to provide sterilization services Activities Involve private players including NGOs/Trusts by providing a conducive environment for accessing quality and affordable health care services to the community. Partnership for Services for Training: Lot of capacity building activities are envisaged under NRHM, but departments neither have that much of expertise nor sufficient time to carry out the capacity building activities properly. Therefore, all such training programme will be outsourced to a capable agency selected by the DHS. Partnership for Services for IEC: For implementing and managing IEC activities (mela, shows, campaign, rally, Village Contact Drives etc) including designing and printing of IEC material, a technical and Technical Support Agency will be hired. Partnership for Services for Transportation: One agency will be hired for getting services of vehicles with drivers for field monitoring by the officers at District and below level, for transportation of drugs, equipment, linen and others up to the Sub Centre level. Drivers for department’s vehicles and ambulances will also be hired from such agency. Annual contract will be done for this purpose.
This kind of partnership will much effective for the unreached and far flung areas where there no motorable roads available. Alternate transport like Mules can be hired from the private sector. Partnership for Services for conducting Studies, survey and evaluations: For understanding the trends of diseases, impact of programs being implemented, assessing the health scenario, a technical support agency will be
126 hired for conducting surveys, evaluation, Data analysis, HMIS etc. Partnership for School Health Programme: For covering all the primary schools both government and private and strengthening School Health Programme private organisations specially local NGOs will be involved. Partnership for Security: As Reasi district is highly affected with the militancy, security of health personals and institutions is a major concern of the district. For providing security to all PHC and some selected Subcentres, Ex- servicemen council or committees can be hired. Annual contract will be done for this purpose.
The following activities will be carried out: • To conduct Feasibility study for various PPP options in the district. • To develop detailed operational framework and schemes for various feasible options in the district. • To identify technical support agency for studies on above activities • To initiate one pilot innovative intervention based on the priority in each block of district. under PPP • To prepared resource directory of all active NGOs involved in health and development issues in the district. • To prepared a list of all private health care providers including Practitioners of alternative system of medicine in the district. • To conduct training need assessment (TNA) for all the identify private partners • To orient all identified privet partners on NRHM and various national health programmes • To develop detailed framework or monitoring and evaluation of various PPP interventions • To conduct exit polls at General and Civil hospitals CHC, PHC from OPD IPD patients to improve the condition of the health facilities • Workshops for involvement of the Private sectors (one each with NGOs/Trusts/Private institutions; Media; Ex-servicemen association, transportation ,HR agencies) • Sharing Workshops with Private players Support Support required form the State to allow PPP; to develop a conducive environment required by formulating a workable PPP Policy. Timeline Activity / Item 2007 2008 2009 2010 2011 -08 -09 -10 -11 -12 Feasibility study Operational Frame work x Operationalization of PPP x x x x x Innovative interventions x x x x x Advertisement for hiring technical support agency for assisting for achievement of objective of PPP mentioned above Establishing technical support agency Preparation of directories of resource x agencies and privet partners TNA for private partners x
127 Capacity building x x x x x NGOs, CBOs, ToT 2 batches x 25per batch on national health programme Training of pvt. Health care providers 2 x x x x x batches x 25per batch on national health programme Capacity building of PRIs, VHWSC, SHGs x x x x x and other field functionaries Area specific training modules Monitoring and evaluation of PPP initiative x x x x x Budget Activity / Item 2008 200 201 201 Total -09 9-10 0-11 1-12 5 Workshops for involvement of the Private sectors (one 1.5 0.5 0 0 2.50 each with NGOs/Trusts/Private institutions; Media; Ex- servicemen association, transportation ,HR agencies) @ 50000 per workshop Sharing Workshops with Private players 0 0.61 0.67 0.74 2.57 Admin and overhead Charges for hiring the agencies 2 2.2 2.42 2.66 12.29 2 TOTAL 2.75 3.03 3.34 3.74 17.36
128
9. GENDER AND EQUITY
Gender and Equity Situation Gender discrimination is a common phenomenon. It has a direct bearing on the Analysis health status of women and children. Some of the parameters are the Sex Ratio, Age at marriage, enrolment of girls in schools, Male sterilization. The main reasons are dowry.
The Age at marriage for boys is 23.2 and 21.1 for girls as per DLHS 2002 and that no girls in the rural areas were married below 18 years.
There is no specific data on Gender Based Violence but women take it as part of marriage and hence undermine the facts. Male involvement in Family Welfare is minimal since there are very few Vasectomies as against Tubectomies. The indicators for morbidity and mortality also show differential values for boys and girls. The service providers are also not gender sensitive .
• Foeticide and infanticide of female children is still occurring in some areas of the district. • The dowry system and other traditional beliefs are perpetuating discrimination against girl children • Domestic abuse is rife in homes where the men drink. In such a situation there is a lack of options for the abused wife and children – there needs to be more support in this situation. • Usually men do not go for sterilization and asked their wives for sterilization. Objectives 1. To improve the decline in sex ratio in 0-6 years of age group 2. To reduce the domestic violence 3. To empower women in all age groups for gender equity 4. To enhances male participations in ensuring the gender balance and equity in the community 5. To develop capacities of various stake holder in Govt. and privet sectors on gender issues and various laws and acts related to establishing gender balance in the society 6. To ensure implementations of PC-PNDT and MTP act in the district. 7. To establish strong mechanism for monitoring of sex ratio and implementations of various acts to ensure gender balance and equity in the society Strategies 1. Addressing Adverse Sex ratio 2. Increasing male involvement in family planning 3. Increasing male involvement in family planning 4. Gender sensitization Activities 1. Addressing Adverse Sex ratio • Workshops with private providers, IMA members, Religious leaders, Caste leaders, PRIs, MLAs • Early registration of pregnancies through TBAs, ASHAs, AWWs, Numberdar and Chowkidar and any of these to get Rs 50 per case for early registration of pregnancy • Rallies in all schools and colleges and generating discussions in schools and colleges through debates
129 • Regular advertisements in the newspapers • Swearing-in-ceremonies at the time of marriages regarding female foeticide • Regular meetings of the Appropriate Authorities • Registration of all Ultrasonography machines • Review of the monthly format to be filled by the Ultrasonography machines providers 2. Increasing male involvement in family planning • Use of condoms for safe sex • Vasectomy and NSV are safer and easier to perform in primary health centres than Tubectomy. • BCC activities to focus on men for Vasectomy. Service delivery sites for male methods by training health providers in NSV and conventional vasectomy will be expanded so that each CHC and Block PHC in the district has at least a provider trained in NSV. • Demand for male contraceptive methods, men’s reproductive health services through designing and implementing male-focused BCC activities. 3. A Research Study on the sex ratio to understand the increase in the sex ratio for 0- 6 yrs age. 4. Gender sensitization training will be provided for all health providers in the CHC/PHC and integrated into all other training activities so that they will have greater awareness of factors that influence women’s decision making and thereby help them respond better to the needs of women and support her in exercising her choice. 5. Health card would be provided to all girl children upto the age of 18 years. 6. Improving the Literacy status and promotion of education upto 10 th standard. 7. Treatment of anaemia in girls and also improving their nutritional status through Supplementary food at the AWCs 8. Reporting of Gender Based Violence cases by all the departments 9. Affidavit in court should be given regarding the dowry given to prevent false cases. 10. Preparation of GIS maps as planning tool to monitor and control decline sex ratio 11. IEC activities to raise the awareness regarding gender discrimination 12. Development of training modules Support Strict enforcement of the PCPNDT Act required Timeline Activity / Item 2007 2008 2009- 2010 2011 -08 -09 10 -11 -12 Research study for the increase in sex ratio for 0-6 years Preparation of GIS maps as planning tool x to monitor and control decline sex ratio Up gradation of GIS x x x x x IEC campaign through print audio visual x x x x x and folk media Capacity building x x x x x
130 Orientation of public and Pvt health care x x x x x providers including NGOs on various laws related to health specially PC-PNDT & MTP act
Reorientation x x x x x Development/procurement training modules
Monitoring x x x x x Periodic advisory committee meeting and x x x x x field monitoring @ Rs.5000 x 4(this includes meeting, travel and other contingencies)
Panchayat level vigilance committees to x x x x x check decline in sex ratio and violence against women
Training of all MOs, ANMs on gender x x x x x issues
Budget Activity / Item 2008- 2009- 2010- 2011- Total 09 10 11 12 Orientation and sensitization programmes 10 12.1 13.3 14.6 50.00 Media workshops 2 2.200 2.420 2.662 9.28 Monitoring and supervision 2 2.200 2.420 2.662 9.28 IEC campaigns 5 5.500 6.050 6.655 23.21 Health Card for Girl Child @ Rs 2 /card x 10,000 0.2 0.220 0.242 0.266 0.9282 cards TOTAL 19.2 22.22 24.432 26.845 92.70
131 10. CAPACITY BUILDING
Capacity Building Situation Training is an essential part of human development. Although the personnel have Analysis the basic skills necessary for carrying out their duties there is a need to upgrade the skills as well as to keep pace with the new developments under NRHM. There is a skill gap for managing safe deliveries, Abortions, Newborn Care, managing Childhood illnesses, Obstetric and Paediatric emergencies, morbidity and epidemics. There is no system for continuing education of the personnel.
The management skills are also lacking resulting in poor management of programmes including financial management. Most of the personnel are unable to use computers and internet.
Status of trainings in Distt Reasi: 1. Trainings of M.O in IMNCI is going on and there is a need for more such trainings for MOs and other staff including refresher trainings 2. Orientation of TBAs is going on under RCH but there is a need for refresher training 3. Some of the Skill Birth Attendants are already trained and rest are required to be trained 4. Under RCH II the following trainings have taken place • Training of 3 staff nurses on newborn care • Training on mini lab – 2 batches. • Training of 410 ASHAS • Induction training of 6 MOs
The trainings are carried out by the RIHFW along with the Regional training centres and the district training centres. There is a shortage of staff and also rapid turnover.
The monitoring of the trainings needs to be done for the quality of trainings. Also monitoring of the work output of the personnel for which they have received the trainings should also be done.
278 ASHAs have been trained in module 1.
Objectives 1. Reduction in the MMR and IMR from baseline to 50% of baseline by 2012 2. Fully skilled personnel at all levels in the Health sector, ICDS, PRIs, NGOs and private sector for provision of services Strategies 1. Development of training plan and methodology for all the personnel on various issues of RCH to reduce the Maternal and Neonatal mortality, meeting the unmet needs, building Gender perspective, good programme management and managing various components of NRHM 2. Ensuring the quality of trainings Activities 1. Capacity building for the reduction in Maternal and Neonatal mortality • TBA training for 15 days in the concept of clean deliveries, danger signs, early referral, Newborn care and family planning, communication, • MTP training on MVA to all PHC MOs for 15 days. • Training in Obstetric management & skills for operationalization of 24x7 PHC for 16 weeks
132 • Training in skilled Birth attendants (ANM, LHV, SN) for 15 days • IMNCI training to ANM/LHV, SN, MO, CDPO for 8 days in the area covering the 24 x 7 PHC • Training on Blood transfusion for MOs and Lab Technicians for CEmOC centres with Blood storage facilities for 3 days • Training in Life saving/Anaesthesia for EmOC at FRUs for MOs for 18 weeks • Integrated skill training of all SN • Integrated skill training for MPHWF • Training of ASHAs • Training in management of newborns and sick children of the MOs & SN • Training in BCC for MOs, MPHS, MPHWF • Training of Ayush personnel on issues of RCH and reporting for 3 days 2. Capacity building to meet the unmet needs • Training on NSV for MOs for 5 days • Training for Laparoscopic Sterilization for Surgeons, Gynaecologists, SN, OT attendants for 12 days • Skill upgradation of MPHWF & MPHS for 5 days • Orientation on contraceptive devices for MOs of Govt facilities as well as private facilities 3. Training on Medico-legal aspects 4. Continuing Medical Education sessions for doctors each month during the monthly meetings on current topics. An expert from a reputed institution will be invited on the current topics and Certificates will be given. 5. Capacity building for Gender equality • Orientation on Gender equality & PCPNDT Act for doctors both Govt and private, members of District Appropriate authority NGOs 6. Capacity building for good programme management • Professional Development course for District Programme Managers, Senior district officials, MOs for 10 weeks • Management Development course for MOs for 5 days • General and Financial rules (G & FR) for the district officials, MOs, clerical staff for 3 days • Financial management training for Accounts Officers, Accountants for 3 days • Computer training to all the MOs, Clerical staff, accounts personnel • CNAA for MOs, MPHS, MPHWF, AWW 7. Capacity building for managing the other components of NRHM
RNTCP • Reorientation Training of DOT providers for 1 day • Orientation of MOs on revised Paediatric & PWBs under Paediatric management for 1 day Convergence for Sanitation and hygiene under NRHM • One day orientations of VHWSC for total sanitation Disease Control Programme – Blindness Control, Malaria, IDSP, IDDM • MPW • LT training PRIs • Training on NRHM and their roles of the members of the Zila Parishad, Panchayat Samitis, Gram Panchayat members, VHWSC for 1 day
133 NGOs • Training in BCC • Training of Field NGOs Private Sector Training on Family Planning issues, PCPNDT Act, Reporting 8. Ensuring the quality of trainings • A district quality training team will be formed to ensure the organization of trainings as per schedule, arrangements and monitoring the quality of all the trainings on the basis of checklists to be developed by the state. • They will ensure the availability of trainers and the staff at the District Training Centre. • The team will also monitor the work output of the trained personnel and give recommendations regarding improvements in the training and the future requirements. • For ensuring the availability of trainers a District Resource team and Block Resource teams will be formed for various issues. • A list of Resource persons will be developed from the State for specialized issues. 9. Establishing a Staff Nurse training College: due to shortage of staff there is a need to open a Staff Nursing College in District Hospital with a batch of 60. 10. There is a need of Hostel and Mess/ Kitchen and dining hall facilities of the training centre. Currently there is no hostel facility. Support • RIHFW to develop the training calendar and organize the trainings as per required schedule • Medical colleges to be prepared for providing trainings on EmOC, MTP, Neonatal Care • Monitoring by the State the quality of trainings and the work output through the development of a format and checklist • Placement of the personnel trained in various specialized issues at the right facilities • Ensuring staff at the District training centre Time Line Activity 2008 –2009 2009-2010 2010-2011 2011-2012 (Numbers) (Numbers) (Numbers) (Numbers) TBA training 275 275 275 275 MVA MTP training to all PHC MOs 22 Training on Blood transfusion for 6 MO MOs and Lab Technicians for 6 LT CEmOC centres with Blood storage facilities for 3 days Training in Obstetric management & Staff of 10 Staff of 10 Staff of 10 Staff of 8 skills for 24x7 PHC for 16 weeks PHC PHC PHC PHC
Training in Skilled Birth attendants 64 64 64 64 for 15 days: IMNCI training to ANM/LHV, SN, 25 ANM 25 ANM 25 ANM 25 ANM ASHA for 8 days 4 SN 4 SN 4 SN 4 SN 50 ASHA 50 ASHA 50 ASHA 50 ASHA 4 LHV 4 LHV 4 LHV 4 LHV
134 IMNCI training to MOs 20 MOs 25 MOs 25MOs 25 MOs Training in Life saving/Anaesthesia 2 MOs 4 MOs 4 MOs 6 MOs for EmOC at CHC for MOs (State Budget ) Integrated skill training of all SN 20 SNs 30 SNs 30 SNs 40 SNs
Integrated skill training for ANMs 25 ANMs 25 ANMs 25 ANMs 25 ANMs
Integrated skill training for MOs 5 MOs 5 MOs 5 MOs 5 MOs
Training of MOs, SN in Mgt of 2 MOs 2 MOs 2 MOs 2 MOs Newborns & sick children at Medical 2 SN 2 SN 2 SN 2 SN College Jammu
Training in BCC for MOs, LHV, ANM 13MOs 13 MOs 13 MOs 13 MOs 4 LHV 4 LHV 4 LHV 4 LHV 25 ANM 25 ANM 25 ANM 25 ANM Training of Ayush personnel on 22 Ayush 22 Ayush 22 Ayush 22 Ayush issues of RCH and reporting Training on NSV for MOs at NSV 16 MOs 16 MOs 16 MOs 16 MOs camps Training on Minilap 4 MOs 4 MOs 4 MOs 4 MOs Training for Laparoscopic 2 Sp 2 Sps 2 Sps 2 Sps Sterilization for Surgeons, 2 SN 2 SN 2 SN 2 SN Gynaecologists, SN, OT attendants 2 OT 2 OT 2 OT 2 OT for 12 days attendants attendants attendants attendants Orientation on contraceptive devices 100 MOs 100 MOs 100 MOs 100 MOs for MOs - Govt as well as private facilities Training on Medico-legal aspects to 150 150 150 150 MOs
Continuing Medical Education 10 CME 10 CME 10 CME 10 CME sessions for doctors each month sessions sessions sessions sessions during the monthly meetings on current topics Orientation on PCPNDT Act for Dy. x x x x CMO, CMOs, doctors both Govt and private, members of District Appropriate authority NGOs in a workshop General & Financial rules (G & FR) 20 Distt 20 Distt for Officials, MOs, clerical staff for 3 officials and officials and days MOs MOs 50 clerks 50 clerks
135 Financial management training for 50 persons 50 persons 50 persons 50 persons Accounts Officers, Accountants for 2 days Computer training to all the MOs, 50 Clerical staff, accounts personnel CNAA for MOs, LHV, ANM & MPW, 22 MOs 100 AWWs 100 AWWs 100 AWWs AWW 18 LHV 178 ANM 41 AWWs Total sanitation orientation and 275 villages 275 villages 275 villages 275 villages reorientation of VHWSC x 1 day Training of NGOs in BCC 30 30 40 40 persons persons persons persons Staff Nurse Training College ANMTC Professional Development course for District Programme Managers, Senior district officials, MOs for 10 weeks Training of ASHAs Budget
Budget for Capacity Building Activity 2008– 2009- 2010- 2011- Total 09 10 11 12 TBA training @ Rs 10100 x 275 27.775 12.1 13.3 14.6 67.78 MVA MTP training to all PHC MOs for 15 days @ 1.575 1.733 1.906 2.096 7.31 Rs 500 x 15 days x 42 MOs Training on Blood transfusion for MOs and Lab 0.345 0.069 0 0 0.41 Technicians for CEmOC centres with Blood storage facilities for 3 days, MOs @ Rs 500/day/person x 3 days and Lab Technicians @Rs 200/person x 3 days Training in Obstetric management & skills for 24x7 3.136 0 0 0 3.14 PHCs for 16 weeks MOs: Rs 500/day x 112 days x 4MO,StaffNurses:Rs200/dayx112daysx 4 SN Training in skilled Birth attendants for 15 days: 2 9.28 One batch of 4 persons: Rs. 7500 as hon. to participants, Rs 13500 hon. to training team, 15% institutional charges 2.200 2.420 2.662 IMNCI training to ANM/LHV, SN, ASHA for 8 2.592 2.736 2.784 2.496 10.61 days,Rs 300 as hon. to participant x 8 days IMNCI training to MOs @ Rs 5390 /participant 0.8624 0.8624 0.8624 0 2.59 Integrated skill training for MOs @ Rs 3683 0.5888 0.5888 0.5888 0 1.77 Training of MOs, SN in Mgt of Newborns & sick 1.44 0.48 0 0 1.92 children at Medical College Jammu @ Rs 7500/MO, Rs 4500 ( Rs 300 x 15 days)/SN Training in BCC for MOs, LHVs, ANMs 1.28 0 0 0 1.28 MOs: Rs 500/MO x 5 days LHVs & ANMs: Rs 300/person x 5 days
136 Training of Ayush personnel on issues of RCH and 0.153 0.153 0.153 0 0.46 reporting for 3 days Rs 300/person x 3 days Training on NSV for MOs at NSV camps 40.8 45.6 45.6 0 132.00 Rs 500/MO /camp x 12 camps, Rs 3000 per camp for trainer x 12 camps Training on Minilap @ Rs 500 per day for 15 days 0.6 1.8 1.2 1.2 4.80 and during camps Training for Laproscopic Sterilization for Surgeons, 0.6 0.6 0.6 0.6 2.40 Gynaecologists, SN, OT attendants for 12 days SMO: Rs 500/SMO x 12 days SN: Rs 300/SN x 12 days OT Attendant: Rs 200 x 12 days Orientation on contraceptive devices for MOs - Rs 0.42 0.462 0.508 0.559 1.95 500 /MO x 1 day Training on Medico-legal aspects to Mos @ Rs 0.445 0.47 0.92 500/MO x 1 day Orientation on PCPNDT Act for DCs, CSs, doctors 1 1.2 1.32 1.45 4.97 both Govt and private, members of District Appropriate authority NGOs in a workshop General & Financial rules (G & FR) for Officials, 1.8 0 1.8 0 3.60 MOs, clerical staff for 3 days Rs 500/official and MOs x 3 days Rs 200 /clerical staff x 3 days Financial management training for Accounts 0.172 0.172 0.172 0.52 Officers, Accountants for 2 days Rs 200/Accounts persons x 2 days Computer training to all the MOs, Clerical staff, 3.72 3.72 accounts personnel @ Rs 200 per person x 15 days CNAA for MOs, LHVs, ANMs, AWW 2.3 2.38 2.4 2.43 9.51 @ Rs 200/person x 1 day each year Total sanitation orientation and reorientation of 0.74 0.74 0.74 0.74 2.96 VHWSCs x 1 day @ Rs 200/person/day Training of NGOs in BCC @ Rs 300 per person x 6 0.36 0.54 0.72 0.72 2.34 days Total 94.704 74.886 76.902 29.725 276.22
137 11. HUMAN RESOURCE PLAN
Human Resource Plan Situation The Human Resources in district Reasi is not as per IPHS norms. There is no Analysis motivation for the doctors to work and promotions are hard to happen. No doctors and Specialists want to work in the rural areas.
Subcentre level • The number of subcentres will have to be increased from 68 to 95 • The requirement of ASHAs will be around 278
PHC level • The PHC are adequate • As per IPHS 2 MOs per PHC will be required whereas at resent there is only one MO per PHC • For IPHS norms 66 Staff Nurses for PHC [3 per PHC] are required. At present there are just 6 SN • There are only 8 Lab Technicians as against the required 22 today. • At present there are 18 Pharmacists in the PHC as against 22. CHC Level • At CHC level there are vacant positions for specialists and also support staff. In the CHC there should be at least 7 specialists, 3 MOs, 10 Staff Nurses, I PHN, 1 Computer clerk, 1 Dresser, 1Pharmacist, 1 Lab technician, 1 BEE, 1 radiographer, 1 UDC, 1 Accountant, 1 LDC, 1 Epidemiologist, and Ancillary staff on contract. Objectives 1. All staff to be in place as IPHS norms by 2012 Benchmark 2. Increased salaries for contractual doctors and Specialists s 3. Special allowances for Regular staff 4. Increase in the number of training centres for LHV, ANM, Staff Nurses, Lab Technicians Strategies & 1. Rational placement of Specialists and trained staff Activities 2. Recruitment of staff on contract where vacancies 3. Recruitment of staff for new facilities as per the infrastructure requirements 4. Computers at all PHC and for each MO and Specialist at the CHC 5. Allowing Specialists and MOs for developing special skills as per their needs by attending special courses anywhere in India. 6. Proposal for Staff Nurse College and other Paramedical training college. Support 1. The State must approve and give sanctions for the necessary personnel for required each facility before actually starting the facilities. 2. Contractual staff should be allowed recruitment as and when required. Permission from State should not be taken each time. Timeline Activity / Item Current 2008- 2009- 2010- 2011- 2008- 2009 2010 2011 Status 09 10 11 12 09 -10 -11 -12 Total requirements(IPHS Norms) Subcentre 68 95 98 101 104 27 30 33 36 ANM 63 190 196 202 208 127 133 139 145 PHC 22 22 22 22 22 0 0 0 0 MO 21 44 44 44 44 23 23 23 23
138 Staff Nurse 6 66 66 66 66 60 60 60 60 Health worker (F) 17 22 22 22 22 5 5 5 5 Health Educator 1 22 22 22 22 21 21 21 21 Health Assistant 44 44 44 44 44 0 0 0 0 Clerk 2 44 44 44 44 42 42 42 42 Pharmacist 18 22 22 22 22 4 4 4 4 Lab.Tech 8 22 22 22 22 14 14 14 14 Class IV 36 88 88 88 88 52 52 52 52 CHC 5 5 5 5 5 0 0 0 0 Specialist(4) 4 20 20 20 20 16 16 16 16 PHN 1 5 5 5 5 4 4 4 4 SN 16 35 35 35 35 19 19 19 19 Dresser 0 5 5 5 5 5 5 5 5 lab.Tech 4 5 5 5 5 1 1 1 1 Radiographer 4 5 5 5 5 1 1 1 1 Opthalmic 3 5 5 5 5 2 2 2 2 Assistant Class IV 16 30 30 30 30 14 14 14 14 Statistical 0 5 5 5 5 5 5 5 5 Assistant Registration clerk 0 5 5 5 5 5 5 5 5
Budget Activity / Item 2008-09 2009-10 2010-11 2011-12 Total Subcentre ANM 173.101 181.279 189.457 197.635 741.472 PHC MO 72.496 72.496 72.496 72.496 289.984 Staff Nurse 92.22 92.22 92.22 92.22 368.88 Health worker (F) 7.685 7.685 7.685 7.685 30.74 Health Educator 32.277 32.277 32.277 32.277 129.108 Health Assistant 0 0 0 0 0 Clerk 49.896 49.896 49.896 49.896 199.584 Pharmacist 6.12 6.12 6.12 6.12 24.48 Lab.Tech 16.632 16.632 16.632 16.632 66.528 Class IV 37.44 37.44 37.44 37.44 149.76 CHC Specialist(4) 59.04 59.04 59.04 59.04 236.16 PHN 6.848 6.848 6.848 6.848 27.392 SN 29.203 29.203 29.203 29.203 116.812 Dresser 3.45 3.45 3.45 3.45 13.8 lab.Tech 1.188 1.188 1.188 1.188 4.752 Radiographer 1.188 1.188 1.188 1.188 4.752 Opthalmic Assistant 2.376 2.376 2.376 2.376 9.504 Class IV 10.08 10.08 10.08 10.08 40.32 Statistical Assistant 5.94 5.94 5.94 5.94 23.76 Registration cleark 5.94 5.94 5.94 5.94 23.76 Total 613.12 621.298 629.476 637.654 2501.548
139 12. PROCUREMENT AND LOGISTICS
Procurement and Logistics Situation In district Reasi there is no proper Warehouse. There are rooms in which drugs are Analysis/ stored but it is not a scientific Warehouse. Most of the drugs are supplied by the Current State but some drugs are locally procured. Status Inventory Management is not very scientific and the records are not computerized. There is no system of wastage control, replacements, transfer of stocks from one centre to the other. Record Keeping is done manually. Objectives Development of a Scientific Warehouse system by 2008
Strategies 1. Developing a Warehouse 2. Capacity building of the personnel for stores and also record keeping 3. Computerization of all the stocks Activities 1. Construction of a scientific Warehouse 2. Procurement of software and computer hardware for the Warehouse from TNMSC 3. Proper Equipment and hardware 4. Availability of Pharmacist, Assistant Pharmacist, Packers 5. Training of personnel 6. Appointment of an agency for Operationalization of the Scientific Warehouse Support State to develop a scientific and transparent Procurement, Logistics and required Warehousing system with quality control Budget Activity / Item 2007 2008 2009 2010 2011-12 2006-07 -08 -09 -10 -11 Construction of Warehouse x Software x Computer system with UPS, Printer, x Scanner, Equipment & Hardware x Pharmacist @ Rs 9000/mth x Assistant Pharmacist @ Rs 5000/mth x Packers -2 @ Rs 4000/mthx2 x Security Staff @ Rs 6000/mth x Training of personnel x Consultancy to agency for x x Operationalization of the Warehouse
140 Budget Activity / Item 2008- 2009- 2010- 2011- Total 09 10 11 12 Construction of Warehouse 100 0 0 0 100 Software 0.25 0 0 0 0.25 Computer system with UPS, Printer, Scanner, 0.6 0 0 0 0.6 Equipment & Hardware 34.5 0 0 0 34.5 Pharmacist @ Rs 9000/mth 1.08 1.19 1.31 1.44 5.02 Assistant Pharmacist @ Rs 5000/mth 0.6 0.66 0.726 0.799 2.785 Packers -2 @ Rs 4000/mthx2 0.96 1.056 1.162 1.278 4.456 Security Staff @ Rs 6000/mth 0.72 0.792 0.871 0.968 3.351 Training of personnel 0.1 0.11 0.121 0.133 0.464 Consultancy to agency for Operationalization of 2 0 0 0 2 the Warehouse Total 140.81 3.808 4.19 4.618 153.426
141 13. DEMAND GENERATION - IEC
IEC Status There is lack of awareness and good practices amongst the community due to which they neither avail the services nor take any positive action. There is lack of awareness regarding the services, schemes including the Fixed Village Health days.
The following issues need special focus: • Spacing methods, ideal interval between births, no scalpel vasectomy, information about FP facilities and MTP facilities available at different levels • Importance of 3 visits for ANC, advantages of institutional delivery, Post natal care, availability of skilled birth attendants, balanced diet during pregnancy, anaemia, misgivings about IFA, kitchen garden • Importance of complete immunization, disadvantages of drop outs, nutritional requirements of infants and children, malnutrition, exclusive breastfeeding • Problems of adolescents, drugs addiction, malnutrition, problems of sexuality, age at marriage, tendency to take risks in sexual matters • DOTS programme for TB, location of microscopy centres, cardinal symptoms of TB, • High risk behaviour in the community in relation to water born diseases, heart diseases and lung diseases, and HIV/AIDS, STDs • Ill effects of drugs addiction affecting adolescents, • High prevalence of RTIs, including STDs, • Issues of malaria spread and prevention and also other diseases • JSY, Fixed Health days , availability of services The personnel have had no training on Interpersonal communication. Objective Widespread awareness regarding the good health practices Knowledge on the schemes, Availability of services Strategy 1. Information Dissemination through various media, 2. Interpersonal Communication 3. Promoting Behaviour change Activity 1. Awareness on • Fixed VHD days • JSY • Services available 2. Designing of BCC messages on exclusive breast feeding and complimentary feeding, ANC, Delivery, PNC, FP, Care of the Newborn, Gender, male involvement in the local language 3. Consistent and appropriate messages on electronic media – TV, radio 4. Use of the Folk media, Advertisements, hoardings on highways and at prominent sites 5. Training of ASHA/AWW/ANM on Interpersonal communication and Counselling on various issues related to maternal and Child health 6. Display of the referral centres and relevant telephone numbers in a prominent place in the village 7. Promoting inter-personal communication by health and nutrition functionaries during the Fixed health & Nutrition days 8. Orientation and training of all frontline government functionaries and elected
142 representatives 9. Integration of these messages within the school curriculum 10. Kit for the newly married and during first pregnancy to be given at the time of marriage and during pregnancy 11. Mothers meeting to be held in each village every month to address the above mentioned issues and for community action 12. Kishore Kishori groups to be formed in each village and issues relevant to be addressed in the meetings every month 13. Meetings of adult males to be held in each village to discuss issues related to males in each village every month and for community action. 14. Village Contact Drives with the whole staff remaining at the village and providing services, drugs, one to one counselling and talks with the Village Health & Water Sanitation Committee and the Mother’s groups. The whole district administration will get geared up for 33 days quarterly to carry out this massive drive in which registration of birth, death, Immunization of each child, ANC of each pregnant woman, growth monitoring of each child, disinfection of wells, spraying of houses and fogging, treatment of the stagnant water sites, detection of TB and Leprosy, treatment of all ailments, eye conditions through massive publicity. This will be carried out in each village through Rath Yatra. 15. Monthly Swasthya Darpan describing all the forthcoming activities and also what happened in the month along with achievements 16. Bal Nutrition Melas 4 times at each Subcentre 17. Wall writings Pamphlets for various issues packed in an envelope State State to give guidelines for the good practices and also training module on BCC Support Timeline Activities 2007- 2008- 2009 2010 2011 08 09 -10 -11 -12 Finalizing the messages x x x x x Advertisements x x x x x TV spots x x x x x Radio Jingles x x x x x Folk Media shows x x x x x Hoardings on highways and x x x x x prominent places Display boards x x x x x Pamphlets x x x x x
Developing Nirdeshika for holding x x VHD days Monthly Swasthya Darpan x x x x x Orientation & training of all frontline x govt functionaries and elected representatives VCD in each village quarterly x x x x x Bal Nutrition Melas x x x x x Adolescent meetings x x x x x Opinion leaders workshops x x x x x Wall writings x x x x x
143 Budget Activities 2008- 2009- 2010- 2011- Total 09 10 11 12 Finalizing the messages 1 1.1 1.21 1.331 4.64 Advertisements 5 5.5 6.05 6.655 23.21 TV spots 1 1.1 1.21 1.331 4.64 Radio Jingles 1 1.1 1.21 1.331 4.64 Folk Media shows @ Rs 1000/vill 3.7 4.070 4.477 4.925 17.17 Hoardings @ Rs 10000/hoarding 10 11 12.1 13.31 46.41 Display boards @ Rs 2000/board 1.8 1.98 2.178 2.396 8.35 Pamphlets @ Rs 10/pamphlets 1 1.1 1.21 1.331 4.64 Nirdeshika for Fixed Health Nutrition days @ Rs 0.8 1 0 0 1.80 20/ Nirdeshika [email protected] /copy/mth 0.8 1.2 1.4 1.6 5.00 Orientation of frontline government functionaries 0.8 0.88 0.968 1.065 3.71 & elected rep @ Rs 200 x 400 persons x1 day VCD @ Rs 15000 per SC and maintenance 23.7 0.75 0.75 0.75 25.95 MSS meetings @ Rs 100/vill x 275 0.179 0.197 0.217 0.238 0.83 Bal Nutrition Melas @ Rs 300 x 4 times x No of 1.2 1.320 1.452 1.597 5.57 SCs Opinion leaders workshops @ Rs 300 /person x 0.3 0.330 0.363 0.399 1.39 100 Wall writings @ Rs 500 x 370 villages 1.85 2.035 2.239 2.462 8.59 Total 54.129 34.662 37.033 40.721 166.55
144 14. FINANCING OF HEALTH CARE
Financing Health Care Situation For sustainability and needs based care, health financing is the key. Analysis/ In District Reasi Rogi Kalyan Samitis (RKS) have been formed in each of the CHC Current and PHC. These are hospital autonomous societies which are allowed to take user Status fees for services provided at the facilities. Formation of these RKS has resulted in great satisfaction amongst the patients and also the staff since now funds is available with the facilities to care for the people.
No trainings have been given for the skill building of the Incharges of these facilities. There is no standardized reporting format and information regarding these RKS is not there. Objectives Availability of sufficient funds for meeting the needs of the patients Strategies 1. Generation of funds from User charges 2. Donations from individuals 3. Efficient management of the RKS 4. Provision of Seed money to each RKS Activities 1. Generation of funds from User charges: User charges are taken for Registration, IPD, Laboratory investigations from persons who can afford to pay. 2. Donations from individuals: Donations are to be generated from individuals. For the betterment of hospitals, equipment, additions to the buildings, etc 3. Efficient management of the RKS: Training will have to be given for efficient management and utilization of the funds for activities that generate funds. Computerization of data and all the parameters need to be carried out preferably through customized software. Trainings can be organized with the help of RIHFW Rajasthan who have developed modules and conducted trainings for the management of these Societies. 4. Provision of Seed money to each RKS at CHC and PHC of Rs 100000 each year for repair, purchase of new equipment, additions, alterations, etc’; 5. Development of customized software and training of staff for the use of this software 6. Regular filling of formats Support 1. Timely meetings of Rogi Kalyan Samitis required 2. RIHFW Jammu to agree for providing trainings on the management of the RKS Timeline Activity 2007- 2008 2009- 2010 2011 08 -09 10 -11 -12 Provision of Seed money @ Rs 1 lakh per x x x x x CHC and PHC Training of the Incharges and second in x x x x x command Development of Software for RKS with x x x x x training of personnel on the use
145 Budget Activity / Item 2008- 2009- 2010- 2011- Total 09 10 11 12 Baseline survey 20 0 0 0 20 Software development 20 0 0 0 20 Internet connectivity @ Rs 900 /mth x No of 2.808 2.808 2.808 2.808 11.232 facilities x12 mths AMC for computers @ Rs 5000 /computer /year x 2.1 2.1 2.31 2.541 9.051 No of computers Consumables for computers @ Rs 4.92 4.92 4.92 5.04 19.800 1000/mth/facility x 12 mths GIS for the district, training and updation 12 0.5 0.5 0.5 13.5 Printing monitoring Charts @ Rs. 5 per monitoring 0.1 0.15 0.175 0.2 0.625 chart Total 61.928 10.478 10.713 11.089 94.208
146 16. HMIS, MONITORING AND EVALUATION HMIS Status HMIS is a monitoring tool for the performance that provides information to support planning, decision-making and executive control for managers in the Health & FW department.
In this sector Data collection is ongoing for more than 60-90 different conditions. The basis of HMIS is the data collected by the ANM who is over burdened with a substantial amount of her time being spent on surveillance related activities. Each year a CNAA exercise is carried out but the set procedures under the CNAA are generally not followed in development of annual action plans and in their utilization in planning the activities of health workers. The action plans are prepared more as a normative exercise rather than as a management tool for estimation of service needs and monitoring the programme outputs.
There is no horizontal integration of surveillance activities of existing disease control programmes. Absence of clear case definitions and poor supervision or crosschecking of the data collected hampers the quality of reporting. Non- Communicable diseases are not included in surveillance even though the burden due to them is high. Absence of formats for reporting diseases also affects quality of the data collect.
The data from the ANM is sent upto the district level with no analysis done at any of the higher levels. There is no system of feedback to the lower levels in the health system. The transmission of data is affected by poor communication facilities available.
Data is not collected from private practitioners, private laboratories and private hospitals both in rural and urban setting. Data collected during emergencies and an epidemic is of better quality. The response system at the District level is activated only in times of outbreaks.
There is lack of coordination between departments. Discrepancy between the data of the Health department and the ICDS. There is large gap between reported and evaluated coverage. The District administrative system not able to make use of the health data.
In District Reasi there is a dearth if authentic baseline data especially on IMR, MMR, NMR and TFR. There is inadequate understanding regarding the classification of diseases. HMIS software consisting of all the data collected right from the Subcentres with online facilities is not available. Computers need to be supplied at each PHC. Objective 1. Integration of several parallel running programme software 2. HMIS is used for decision making on regular basis 3. Inclusion of RCH indicators monitoring 4. Linkage to decision making at Central level 5. Refresher training 6. Make it more useful for State level officials Strategy 1. Research on various issues related to RCH to get a correct baseline 2. Improvement in the CNAA 3. Computerized HMIS
147 Activity 1. Survey for Data on • Newborn deaths, births, maternal deaths, Infant deaths, Level of malnutrition in Pregnant women, Adolescents and children at birth, one year, two years and six years • Newborn Care and practices at home for the newborn and neonate • Male participation in Maternal and Child health • Actual poor people who need free treatment • Coverage of hamlets • Access to services • Health Care practices and behaviour patterns • Number of Eligible couples, data on all the RCH parameters and indicators 2. One time house to house survey for correct data through 50 youth employed on contract. Each youth will survey 20 houses per day for 90 days each. 3. Joint CNAA by the ANM, AWW, ASHA along with the PRIs so that there is one data validated by the PRIs 4. Printing of Reporting & Monitoring Formats 5. Data entry of each Household, Eligible couples, Adolescents 6. Computerization of all the formats and software for the various programmes and finances 7. Computer training for data entry 8. Internet connectivity upto all PHC for online transfer of data. The MPHWF will get the data entered each month after the household and Eligible Couple entries have been made 9. GIS for the district covering all the parameters 10. Computers at all CHC and PHC including AMC for all computers State Provision of software for data entry Support Time line Activities 2007- 2008- 2009 2010- 2011 08 09 -10 11 -12 Survey house-to-house by youth x Survey for practices, coverage, behaviour x etc through independent agency Software development x Data Entry of each household x x x x x Internet connectivity x x x x x Provision of computers for each CHC and x x x x x PHC r AMC for computers x x x x x GIS for the district, training and updation x x x x x Printing monitoring Charts x x x x x Budget Activity / Item 2008- 2009- 2010- 2011- Total 09 10 11 12 Baseline survey 20 0 0 0 20 Software development 20 0 0 0 20 Internet connectivity @ Rs 900 /mth x No of 2.808 2.808 2.808 2.808 11.232 facilities x12 mths AMC for computers @ Rs 5000 /computer /year 2.1 2.1 2.31 2.541 9.051
148 x No of computers Consumables for computers @ Rs 4.92 4.92 4.92 5.04 19.800 1000/mth/facility x 12 mths GIS for the district, training and updation 12 0.5 0.5 0.5 13.5 Printing monitoring Charts @ Rs. 5 per 0.1 0.15 0.175 0.2 0.625 monitoring chart Total 61.928 10.478 10.713 11.089 94.208
149 17. BIO-MEDICAL WASTE MANAGEMENT
Bio-Medical Waste Management Situation As per the Bio-Medical Waste Rules, 1998, indiscriminate disposal of hospital waste Analysis / was to be stopped with handling of Waste without any adverse effects on the health Current and environment. In response to this the Government has taken steps to ensure the Status proper disposal of Biomedical waste from all Nursing homes, hospitals, Pathological labs and Blood Banks.
The District Health Officer is the Nodal Person in each district for ensuring the proper disposal of Biomedical Waste.
For effective disposal of Biomedical waste in the district; Trainings to the personnel for sensitizing them, Pits. Segregation of Waste is taking place though Separate Colour Bins/containers it has to be done more systematically. Proper Supervision is lacking.
The treatment (incineration) of waste is being by handled by a company selected at the State level that is also managing additional 3-4 districts. Since there is a monopoly of these companies they charge very high rates. Objectives 1. Stopping the indiscriminate disposal of hospital Waste from all the facilities by 2008 2. Ensuring proper handling and disposal of Biomedical Waste in each Facility Strategies 1. Capacity Building of personnel 2. Proper equipment for the disposal and disposal as per guidelines 3. Strict monitoring and Supervision Activities 1. Review of the efforts made for the Biomedical Waste Interventions 2. Development of Microplan Plan for each facility in District & Block workshops 3. Capacity Building of personnel. Biomedical Waste management to be part of each training in RCH and IDSP 4. Proper equipment for the disposal Installation of the Separate Colour Bins/containers and Plastic Bags for the bins 5. Segregation of Waste as per guidelines 6. Partnering with Private providers for waste disposal 7. Proper Supervision and Monitoring Formation of a Supervisory Committee in each facility by the MOs and the Supervisors Timeline 2007 2008 2009 2010 2011 Activity -08 - 09 -10 -11 -12 Orientation and Reorientation for the personnel for Biomedical Waste x x x x x Management at District and Block levels Consumables x x x x x Payment for the incinerators x x x x x Budget Activity / Item 2008- 2009- 2010- 2011- Total 09 10 11 12 Orientation and reorientation for Biomedical Waste Management at District and Block levels 1.5 1.820 2.000 2.200 7.52
150 Consumables 1 1.210 1.330 1.440 4.98 Payment for incinerators@ Rs. 8 per bed 12 mths 15.84 17.424 19.166 21.083 73.513 Total 18.34 20.454 22.496 24.723 86.013
151
District Reasi Detailed NRHM Budget in Lakhs Strengthening of District Health Management # Activity / Item 2008-09 2009-10 2010-11 2011-12 Total Orientation Workshop 0.5 0.6 0.65 0.7 2.45 Issues based Workshops 0.5 0.7 0.8 0.9 2.90 Bi-monthly meetings @2000x6 0.12 0.132 0.145 0.160 0.56 Mobility for Monitoring 0.5 0.6 0.65 0.7 2.45 Total 1.62 2.032 2.245 2.460 8.36 District Programme Management Activity/Item 2008-09 2009-10 2010-11 2011-12 Total Honorarium DPM,DAM,DDA and 29.4 32.34 35.57 39.13 136.45 Consultants Hiring of vehicles at District level @ Rs 1.8 1.98 2.18 2.40 8.35 1000 x 15 days /mth 12 mths Workshops for development of the 1 1.10 1.21 1.33 4.64 operational Manual at district and Block levels Untied Fund 5 5.50 6.05 6.66 23.21 Construction Cost of Health Complex 110 0.00 0.00 0.00 110.00 (11000sq.f @ 1000/sq.f) Furnishing and Office Automation, 15 0.00 0.00 0.00 15.00 Conference Hall with speakers, ACs Maintenance of the Health Complex 0 1.00 1.50 2.00 4.50 Compendium of Govt orders 0. 50 0.60 0.65 0.70 1.95 Joint Orientation of Officials and DPM, 0.25 0.30 0.00 0.35 0.90 DAM, DDM Management training workshop of 0.5 0.70 0.80 0.90 2.90 Officials Personnel for BPMU 64.56 71.02 78.12 85.93 299.62 Training of DPM, BPMU and 0.5 1.00 0.00 1.50 3.00 Consultants Review meetings @ Rs 2000/ per 0.24 0.26 0.29 0.32 1.11 month x 12 months Office Expenses @ Rs 10,000/month x 1.2 1.32 1.45 1.60 5.57 12 months for district Computer systems (36) with printer and 0.00 0.00 0.00 21.60 Digital Camera and furniture for DPMU, BPMUs and District and block & sectoral personnel 21.6 Annual Maintenance Contract for the 2.16 2.16 2.16 6.48 equipment 0 Hiring of vehicles at block level @ Rs 2.4 2.64 2.90 3.19 11.14 1000 x 5 days /mth x 4 blocksx12 mths Office expenses for Blocks @ Rs 5000 2.4 2.64 2.90 3.19 11.14 x 4 blocks x 12 Total 255.85 124.56 135.79 151.36 667.56 Maternal Health
152 Activity / Item 2008-09 2009-10 2010-11 2011-12 Total Consultancy support for developing 1 1.1 1.21 1.33 4.64 Microplan for MCH & N days Tracking Bags @ Rs 300/ bag x (550 1.94 2.14 2.35 2.58 9.01 AWCs+ 97 SCs) Adult Weighing machines @ Rs 800 4.4 0 0 0 4.40 per machine x 550 AWCs & Maintenance One day training workshop on Tracking 2 2.2 2.42 2.662 9.28 bags at the district level and each sector Janani Suraksha Yojna @1400 X 5000 70 77 84.7 93.170 324.87 inst. deliveries Janani Suraksha Yojna @500 X 2500 12.5 12.5 12.5 12.5 50.00 Home deliveries of BPL families Blood Storage @ Rs 3 lakhs per unit 0 0 0 0 0.00 Referral Cards @ Rs 2 per card x 0.4 0.44 0.484 0.532 1.86 20,000 MTP kits @ Rs 15000 Per kit (PHCs + 3.9 3.9 0 3.9 11.70 CHCs) Mobile phone instrument to ANMs @ 2 0 0 0 2.00 Rs 2000 Mobile Phones recurring cost to ANMs 2.7 2.7 2.7 2.7 10.80 @ Rs 2700 Mobile phone instrument to 0.5 0 0 0 0.50 Supervisory Staff like CMO, Dy CMO, DIO, DTO & BMOs @ Rs 5000 Mobile Phones recurring cost to 0.6 0.6 0.6 0.6 2.40 Supervisory Staff like CMO, Dy CMO, DIO, DTO & BMOs @ Rs 500/month RCH Camps @ Rs 25000 per camp x 2 2.2 2.42 2.662 9.28 8 camps per year Total 103.941 104.775 109.383 122.641 440.74 Newborn and Child Health Activity / Item 2008-09 2009-10 2010-11 2011-12 Total Study on the feeding practices 2 0 0 0 2.00 Innovative activities based on the study 0 2 2 2 6.00 Newborn Corner furnished with 7 0 0 0 7.00 equipment @ Rs 1.40 lakh per CHC Generator @ Rs. 50000 for PHC/CHC 14.5 0 0 0.5 15.00 & Rs 1.5 lakhs for District Hospital POL Generator @ Rs.140/PHC & CHC 14.82 16.30 17.93 19.72 68.77 x 365 days and Rs 420 x 365 for District hospital Examination table, chair, stool, table, 16.5 0 0 0 16.50 other equipment @ Rs. 3000 x 550 AWCs Infant Weighing Machines@Rs. 4.4 0 0 0 4.40 800/AWCx 550
153 Foetoscope @ Rs. 50 x 550 AWCs 0.275 0 0 0 0.28 Total 59.494 18.301 19.931 22.224 119.95 Family Welfare Activity / Item 2008-09 2009-10 2010-11 2011-12 Total NSV camps @ Rs. 50000 x 10 camps 5 5.5 6.71 7.38 24.59 Sterilization Camps @ 600 per 12 18 24 30 84.00 case(Including medicine and compensation) Copper T-380 @ Rs 45 / piece 1.35 1.485 1.634 1.797 6.27 EmergencyContraception@Rs10/2 0.2 0.8 1 1.2 3.20 tabs Development of Static Centres@Rs 1 5 0 0 0 5.00 lakh Laparoscopes for CHC @ Rs3.00 15 0 0 3 18.00 lakhs IEC activities 10 11 12.1 13.31 46.41 Total 48.55 36.785 45.4435 56.6868 187.47 5 Adolescent Health Activity 2008-09 2009-10 2010-11 2011-12 Total Research on adolescent health 5 0 0 0 5.00 Awareness generation @ Rs 2000 per 5.5 6.050 6.655 7.321 village x 275 villages 25.53 Training a district pool of Master 0.5 0.550 0.605 0.666 trainers 2.32 Orientation & Reorientation Health and 1 1.100 1.210 1.331 ICDS personnel 4.64 Setting up of Adolescent Friendly Health Corners at CHC and PHC level 2.6 0 0 0.1 2.70 (renovation, furnishing and Misc. expenses) @ Rs 10000/- Health camps for Adolescents once per 4 4.400 4.840 5.324 18.56 quarter x 4 x Rs 100000 per camp Monitoring and supervision 1 1.100 1.210 1.331 4.64 Workshop of All the Partners @ 50000 0.5 0.550 0.605 0.666 (Once in a year) 2.32 Training of Peer Educators @ Rs 100 0.15 0.165 0.182 0.200 per person x 3 days x 2 batches and retraining 0.70 Total 20.25 13.915 15.307 16.937 66.41 ASHA Activity / Item 2008-09 2009-10 2010-11 2011- Total 12 Training & kit @ Rs 10000 X No 27.8 0.8 0.8 0.8 30.20 ASHAs Module 2,3,4 Training @ 2000 5.56 0.16 0.16 0.16 6.04 Reorientation @ Rs 2000 X No ASHA 5.56 5.56 5.56 5.56 22.24 Intersectoral meeting at PHC level 1.26 1.386 1.525 1.677 5.85 1000 X 21 X 6
154 Compensation to ASHA @ Rs. 500 X 16.68 17.64 18.18 18.72 71.22 12 X No of ASHAs Expenses for the District mentoring 0.6 0.66 0.73 0.80 2.78 group – meetings, travel @ Rs 5000 per month x 12 months Total 57.46 26.206 26.951 27.716 138.33 Untied Funds and an Annual Maintenance grant for Sub Centres Activity / Item 2008-09 2009-10 2010-11 2008- Total 12 Untied Fund of Rs 0.10 Lakh X SCs 9.7 9.8 10.1 10.4 40.00 Annual Maintenance Grant of Rs 0.10 9.7 9.8 10.1 10.4 40.00 Lakh X SCs Total 19.4 19.6 20.2 20.8 80.00 Untied Funds and an Annual Maintenance grant for PHCs Activity/item 2008-09 2009-10 2010-11 2011-11 Total Untied Fund of Rs 0.25 Lakh X Per 5.25 5.25 5.25 5.25 21.00 PHC including Alopathic Dispencieries.
Annual Maintenance grant of Rs 0.5 10.5 10.5 10.5 10.5 42.00 Lakh X Per PHC including Alopathic Dispencieries. Total 15.75 15.75 15.75 15.75 63.00 Untied Funds and an Annual Maintenance grant for CHCs Activity / Item 2008-09 2009-10 2010-11 2011-12 Total Untied Fund of Rs 0.5 Lakh X No of 2.5 2.5 2.5 2.5 10.00 CHCs Annual Maintenance grant of Rs 1.0 5 5 5 5 20.00 Lakh X No of CHCs Seed Money for RKS for District 5 5 5 5 20.00 hospital @ 5.0 lakhs Total 12.5 12.5 12.5 12.5 50.00 Mobile Medical Unit Activity / Item 2008-09 2009-10 2010-11 2011-12 Total Hiring staff 9.9 10.89 11.979 13.177 45.95 Orientation of the staff 0.1 0.2 0.25 0.3 0.85 Joint Workshop for finalizing modalities 0.1 0.2 0.25 0.3 0.85 Cost of Vehicle, equipment and 26.85 0 0 0 26.85 accessories Recurring Cost of Drivers, Drugs, supplies, Mobile phones, POL, 2.518 2.770 3.047 3.351 74.50 Maintenance Total 39.468 14.0598 15.526 17.128 86.18 Upgrading of CHCs to IPHS Activity / Item 2008-09 2009-10 2010-11 2011-12 Total Strengthening of Existing CHCs 60 90 0 0 including Staff quarters (for IPHS) @ 30 X CHCs 150.00 Construction of 2 new CHCs (24 Lakhs 79.2 0 79.2 for CHC building and 55.2 Lakhs for 4 MOs and 4 SN and 1 guard quarters) 0 158.40
155 @ Rs. 79.2X CHCs
Construction of new staff Qtrs at 79.2 existing CHCs(14.40 Lakhs for 2MOs and 12 Lakhs for 2SN )@26.4X 3 CHCs 79.20 Medicines @10.0 CHCs 50 50 50 50 200.00 Furniture @1.2 X No of CHCs 6 0 0 0 6.00 Equipment @ 22.19 X No of CHCs & 110.95 0 0 22.19 FRUs 133.14 Hiring of vehicle for S/MOs @ 1000 x 7 4.2 4.2 4.2 4.2 days x12monthsX No of CHCs 16.80 Purchase of generator sets @ 0.6 lakh 3 0 0 0.6 x No of CHCs 3.60 Recurring & Maintenance cost of 2.55 2.55 2.55 2.55 10.20 generator sets Rs. 140 X 30 days X 12 months X 6 No of CHCs & FRUs Strengthening of DH Reasi 500 500.00 Total 895.1 146.75 56.75 158.74 1257.34 Upgrading PHCs for 24 hr Services, IPHS Activity / Item 2008-09 2009-10 2010-11 2011-12 Total Staff quarters for 10 PHCs where PHC 288 0 0 0 288.00 buildings are available (28.8Lakhs for 2 MOs and 3 SNs quarters) Strengthening PHCs for 24X7@ 10X 21 PHCs 100 100 10 210.00 Construction of building on 13 building- less PHCs with Staff Qurters (9 Lakhs for PHC building and 28.8Lakhs for 2 MOs and 3 SNs quarters) 226.8 264.6 491.40 Medicines @3.0 X PHCs 63 69.3 76.23 83.853 292.38 Furniture @0.45 XPHCs 9.45 0 3.2 0 12.65 Equipment @ 1.115 X PHCs 23.415 0 0 0 23.42 Vehicle will be hired for MOs @ 1000 x 17.64 19.404 21.344 23.479 7 days x 12MonthsX PHC 81.87 Purchase of generator sets @ 0.6 lakh 12.6 0 0 0 x PHC 12.60 Recurring & Maintenance cost of 17.85 17.85 19.635 21.599 generator sets Rs. 140 X 30 days X 12 months 76.93 Total 130.409 128.930 758.755 471.154 4 34 1489.25 Upgrading Sub Centres and additional Subcentres Activity / Item 2008-09 2009-10 2010-11 2011-12 Total New Building for Existing Sub Center with Equipment and Furniture 49.3 98.6 591.6 0 739.50 New Building for Additional Sub Center with Equipment and furniture 0 4.93 14.79 14.79 34.51
156 2 Staff Quarters 120 120 60 12 312.00 Equipment For SC 24.25 1.25 1.25 1.25 28.00 Furniture For SC 8 0.4 0.4 0.4 9.20 Drugs and Medicine For SC 18 18 18 18 72.00 Travel allownce@ 6000 XSC 36 36 36 36 144.00 Total 206.25 180.58 130.44 82.44 599.71 Untied Funds and Incentive Fund for the Village Health and Water Sanitation Committees Activity / Item 2008- 2009- 2010- 11 2011- Total 09 10 12 Untied Fund of Rs 10000/unit ( 31 31 31 31 1500population =1unit) x 310 units 124.00 Permanent Advance to VHWSC for 5 5 5 5 ASHA incentive @ Rs5000/SC 20.00 Total 36 36 36 36 144.00 Immunisation Activity/item 2008-09 2009-10 2010-11 2011-12 Total Mobility support for alternative vaccine 4.8 4.8 4.848 4.992 19.44 delivery Rs. 50 per session for 2 planned sessions per week at each Subcentre village for 12 months = Rs. 50x2 sessionsx4 weeks/mthx12 monthsx SCs Vehicle for distribution of vaccines in 20.16 22.176 24.394 26.833 93.56 remote areas @ Rs 1000 per PHC for 2 times per week x 4 weeks x 12 months x PHCs Mobility Support Mop up campaign 12.6 13.860 15.246 16.771 58.48 @ Rs 10000 per PHC ( Including travel, vaccine delivery, IEC) x 6 rounds/ year x PHCs Mobilization of Children by Social 13.2 14.520 15.972 17.569 61.26 Mobilizers @ Rs. 100/ session x4 sessions per month X 275 units x12 month Contingency fund for each block @ 0.6 0.660 0.726 0.799 2.78 Rs.1000/month x 4 blocks x 12 months Pit Formation for disposal of AD 2 0.1 0.1 0.1 2.30 Syringes and broken vials (@ Rs. 2000 per pit per Subcentre and PHC Printing of Immunisation cards @1.50 0.45 0.495 0.545 0.599 2.09 per card x 30000 cards each year Maintenance of Cold Chain 4.94 4.94 4.94 4.94 19.76 Equipments (funds for minor &major repair) (@ Rs.750 per PHC/CHC for the first year then Rs. 500 per PHC/CHC) monthly andRs 10,000 annual for major repairs POL & maintenance for Vaccine 1.8 1.980 2.178 2.396 8.35 delivery van at district level @ Rs.15000/month x 12 mths
157 Running Cost of WICs & WIF 7.02 8.490 9.340 10.270 35.12 (Electricity & POL for Genset & preventive maintenance) Rs. 90000 for electricity @ 15000 equipment per two months plus Rs.8000 per annum @1000 for POL for genset at DH Mobility suppot to District Family 0.36 0.396 0.436 0.479 1.671 Welfare Officer @ 3000/month Computer Assistant for District Family 0.84 0.924 1.016 1.118 3.898 Welfare Office @ 7000 Total 68.770 73.341 79.740 86.865 308.72 RNTCP Activity / Item 2008-09 2009-10 2010-11 2011-12 Total Civil Works 2.13 0 0 0 2.13 DTC building 1.5 lakhs MC 0.28/MC TU 0.35/Tu except DTC Material and supplies 1.2 1.45 1.6 1.76 6.01 Laboratory material 1 1.21 1.33 1.46 5.00 Strengthning of District TB Clinic 2 0 0 0 2.00 Awareness drive on World TB day 1 1.21 1.33 1.46 5.00 Salary of contractual staff 6.33 6.963 7.659 8.425 18.01 Training of Staff 22.424 24.666 27.133 29.846 104.07 IEC activities 1 1.21 1.33 1.46 5.00 Procurement of vehicle 6 0 0 0 6.00 Vehicle maintenance inc POL 1 1.21 1.33 1.46 5.00 Hiring of vehicle 1.7 2.06 2.27 2.5 8.53 DTO MO TC @ Rs 0.42lakh/yr Equipment and maintenance 0.085 0.103 0.113 0.124 0.43 Microscope @ Rs1000/yr/microscope Computer@ Rs 5000/yr Photocopier/Fax Rs2500/ machine Miscellaneous – TA/DA, Telephone, 0.2 0.25 0.28 0.3 1.03 Meetings, Electricity repair etc Orientation of PRIs 0.3 0.3 0.3 0.3 1.20 Re-orientation of PRIs and School 0 2.2 0 2.5 4.70 Teachers Total 46.369 42.832 44.675 51.596 185.47 Leprosy Activity / Item 2008-09 2009-10 2010-11 2011-12 Total Routine Budget for Leprosy control 1.45 1.8 2 2.2 9.05 programme Monitoring & Supervision 1 1.2 1.3 1.5 6.10 Additional medicines 1 1 1 1 5.00 IEC Activities 1 1.2 1.3 1.5 6.10 POID Camps one per year @5000 1.05 1.75 1.75 1.75 6.30 XPHC
158 Celebration of world Anti Leprosy 0.2 0.2 0.2 0.2 0.80 day@20000 Total 5.7 7.15 7.55 8.15 33.35 National Malaria Control Programme Activity / Item 2008-09 2009-10 2010-11 2008-12 Total Salary Contractual staff 46.62 51.282 56.410 62.051 216.363 Travel expenses @ Rs 4000 per 0.72 0.87 0.95 1.05 3.59 month x 12 months Office expenses @ Rs 5000 per month 0.6 0.73 0.8 0.88 3.01 x 12 Jeep and maintenance 6 0.66 0.73 0.8 8.19 Trucks – 3 and maintenance 24 2.64 2.9 3.19 32.73 One small Fogging machines for each 43 47.3 52.03 57.233 199.563 PHC @ Rs 1.00 lakh and one at District HQ Pulse Fog Machines @ Rs.8.00 lakh per unit and maintenance Training 23.44 25.784 28.362 31.199 108.785 Misc @ Rs 1Lakh per DH and Rs 4.71 5.181 5.699 6.269 21.859 20000 per CHC and Rs 10000 for PHC Board hoarding: 8’x 12’ Initially at the 1.75 1.75 1.75 2 7.25 CHCs and District hospitals @ Rs 25,000/- Board hoarding: 5’x3’ initially at the 3.5 3.5 3.5 3.5 14 PHCs@ Rs 10,000/- POL @ Rs 48,000/- per vehicle jeep 40.32 48.78 53.66 59.03 201.79 and truck for 12 months x 4 Total 194.66 188.477 206.792 227.202 817.131 Other Vector Borne Diseases Activity / Item 2008-09 2009-10 2010-11 2008-12 Total Unforseen expenses 0.5 0.61 0.67 0.74 2.52 Kala Jathas for Malaria, Dengue and 2.75 3.025 3.328 3.660 6.69 Chikingunya @ Rs 1000 per village x 275 Total 3.25 3.635 3.998 4.400 15.28 Blindness Control Programme Activity / Item 2008-09 2009-10 2010-11 2011-12 Total
Health Mela 2 2.2 2.42 2.662 9.28 IEC 1 1.1 1.21 1.331 4.64 Blind Register@100X 275 villages 0.275 0.303 0.333 0.366 1.28 Cataract Camps @ Rs 20000 per 4.2 4.62 5.082 5.590 19.49 camp x 21 PHC POL for Eye Camps @ Rs 3000/camp 0.63 0.693 0.762 0.839 2.92 x21 Training of School teachers @ Rs 0.2 0.22 0.242 0.266 0.93 100/head x 200 Training of PRIs @ Rs 100/head x 200 0.2 0.22 0.242 0.266 0.93 Purchase, Maintenance and Repair of 20 22 24.2 26.620 92.82 equipments
159 Total 28.505 31.356 34.491 37.940 132.29 Integrated Diseases Control Programme Activity / Item 2008-09 2009-10 2010-11 2011- Total 12 Renovation of Labs at CHCs @ Rs 1 0 0 0.2 1.20 20,000 Renovation of Lab at District Hospital 1.4 0.18 0.2 0.22 2.00 @ Rs 140,000 and maintenance Equipment for Lab at PSU at CHCs @ 2 0 0 0.4 2.40 Rs 40,000 Equipment for Lab at District @ Rs 8.5 0 0 0 8.50 850,000 Computer and Accessories at CHC 3.15 0 0 0.63 3.78 @63000 Computer and Accessories at 0.63 0 0 0 0.63 DSU@63000 Office Equipment for PSU at CHC @ 1 0 0 0.2 1.20 Rs 20,000 per unit Office Equipment for DSU @ Rs 0.2 0 0 0 0.20 20,000 Software for DSU@ Rs 335000 3.35 0 0 0 3.35 Furnishing of Lab at PSU at CHCs @ 0.5 0 0 0.1 0.60 Rs 10,000 Furnishing of Lab at DSU @ Rs 60,000 0.6 0 0 0 0.60 Material and supplies at Lab at PSU at 0.4 0.44 0.484 0.5324 1.86 CHCs @ Rs 8,000 Material and supplies at Lab at DSU @ 0.75 0.91 1 1.1 3.76 Rs 75,000 Contract Staff at District level @ 2 2.92 3.71 4.58 13.21 200000/yr for 4 staff IEC activities 1 1.21 1.33 1.46 5.00 Training and retraining 2.6 3.15 3.47 3.82 13.04 WEN connectivity 0.5 0.61 0.67 0.73 2.51 Operational costs at PSU for 0.75 0.9 1.31 1.59 4.55 Surveillance @ Rs 15000/year x 5 Operational costs at DSU for 1.3 0.57 1.73 1.9 5.50 Surveillance @ Rs 130000/year Honorariun to Numberdars and 8.88 9.768 10.745 11.819 21.59 Chowkidars for reporting @ Rs 100 pm x 275 Numberdars and 275 Chowkidars x12 Total 40.510 20.658 24.649 29.282 115.10 Iodine Deficiency Disorders Activity / Item 2008-09 2009-10 2010-11 2011-12 Total Large Village meetings for awareness 1 1.21 1.33 1.46 5.00 on IDD and consumption of Iodized salt Programme in schools – Primary, 3.5 3.850 4.235 4.659 8.51 Upper Primary, Secondary- Govt and Private by School health team @ 500
160 Awareness programme with the SHGs 2.75 3.025 3.328 3.660 6.69 and shopkeepers @ Rs 500 per village x 275 villages Total 7.25 8.085 8.893 9.779 34.01 Intersectoral Coordination Activity / Item 2008-09 2009-10 2010-11 2011-12 Total Meetings of the Block Committees @ 0.48 0.528 0.581 0.639 2.23 Rs 1000 /meeting x 4 blocks x 12 months Meetings of the Village groups @ Rs 1.65 1.815 1.997 2.196 7.66 50 per village x 275 villages x 12 Joint CNA training @ Rs 200 per 2.094 2.303 2.534 2.787 9.72 person ( 550 AWW, 200 ANMs, 272 ASHAs, 21 MOs, 4 CDPOs) x 1047 Joint monitoring at the sector level Hiring of vehicle @ Rs 1000/ day x 5 12.6 13.86 15.246 16.771 58.48 days/month x 21 sectors x 12 months Joint monitoring at the block level Hiring of vehicle @ Rs 1000/ day x 5 2.4 2.64 2.904 3.194 11.14 days/month x 4 blocks x 12 months Yearly joint Planning Workshops at the 4 4.4 4.84 5.324 18.56 Block level for development of the Action Plans @ Rs 1.00 lakhs per block x 4 blocks Yearly joint Planning Workshops at the 1 1.1 1.21 1.331 4.64 District level for development of the Action Plans @ Rs 1.00 lakh Yearly joint Workshops to consolidate 4 4.4 4.84 5.324 18.56 the plans from the village to the Gram Panchayats to the Sectors and then Blocks at the Block level for Annual Action Plans @ Rs 1.00 lakhs per block x 4 blocks Yearly joint Workshops to consolidate 1 1.1 1.21 1.331 4.64 the findings at the block levels at the District level for development of the Action Plans @ Rs 1.00 lakh Training of PRIs,VHWS committee 22 22 22 22.000 88.000 members under Chiranjeevi Scheme @22 lakhs Regular monthly meetings under 12 12 12 12.000 48.000 Chiranjeevi Scheme @12 lakhs Development of Education material 10 10 10 10.000 40.000 and hands on trainingunder Chiranjeevi Scheme @ 10 lakhs Total 73.22 76.15 79.361 82.897 311.629 Community Health action Activity / Item 2008-09 2009-10 2010-11 2008-12 Total
161 Training of the VHWSC @ Rs 200 per 8.25 9.075 9.983 10.981 20.06 person x 15 persons/village x 275 villages Meetings of the VHWSC @ Rs 100 per 3.3 3.630 3.993 4.392 8.02 village x 275 villages x 12 months Meetings of Women SHGs @ Rs 100 3.3 3.630 3.993 4.392 8.02 per year x 275 villages Total 14.850 16.335 17.969 19.765 68.92 Public Private Partnership Activity / Item 2008-09 2009-10 2010-11 2011-12 Total 5 Workshops for involvement of the 1.5 0.5 0 0 2.50 Private sectors (one each with NGOs/Trusts/Private institutions;Media; Ex-servicemen association, transportation ,HR agencies) @ 50000 per workshop Sharing Workshops with Private 0 0.61 0.67 0.74 2.57 players Admin and overhead Charges for hiring 2 2.2 2.42 2.662 12.29 the agencies TOTAL 2.75 3.03 3.34 3.74 17.36 Gender and Equity Activity / Item 2008-09 2009-10 2010-11 2011- Total 12 Orientation and sensitisation programmes 10 12.1 13.3 14.6 50.00 Media workshops 2 2.200 2.420 2.662 9.28 Monitoring and supervision 2 2.200 2.420 2.662 9.28 IEC campaigns 5 5.500 6.050 6.655 23.21 Health Card for Girl Child @ Rs 2 /card 0.2 0.220 0.242 0.266 0.9282 x 10,000 cards TOTAL 19.2 22.22 24.432 26.845 92.70 Capacity Building Activity 2008– 2009-10 2010-11 2011-12 Total 09 TBA training @ Rs 10100 x 275 27.775 12.1 13.3 14.6 67.78 MVA MTP training to all PHC MOs for 1.575 1.733 1.906 2.096 7.31 15 days @ Rs 500 x 15 days x 42 MOs Training on Blood transfusion for MOs 0.345 0.069 0 0 0.41 and Lab Technicians for CEmOC centres with Blood storage facilities for 3 days,MOs @ Rs 500/day/person x 3 days and LabTechnicians@Rs 200/person x 3 days Training in Obstetric management & 3.136 0 0 0 3.14 skills for 24x7 PHCs for 16 weeksMOs: Rs 500/day x 112 days x 4MO,StaffNurses:Rs200/dayx112daysx 4 SN
162 Training in skilled Birth attendants for 2 9.28 15 days: One batch of 4 persons: Rs. 7500 as hon. to participants, Rs 13500 hon. to training team, 15% institutional charges 2.200 2.420 2.662 IMNCI training to ANM/LHV, SN, ASHA 2.592 2.736 2.784 2.496 10.61 for 8 days,Rs 300 as hon. to participant x 8 days IMNCI training to MOs @ Rs 5390 0.8624 0.8624 0.8624 0 2.59 /participant Integrated skill training for MOs @ Rs 0.5888 0.5888 0.5888 0 1.77 3683 Training of MOs, SN in Mgt of 1.44 0.48 0 0 1.92 Newborns & sick children at Medical College Jammu @ Rs 7500/MO, Rs 4500 ( Rs 300 x 15 days)/SN Training in BCC for MOs, LHVs, ANMs 1.28 0 0 0 1.28 MOs: Rs 500/MO x 5 days LHVs & ANMs: Rs 300/person x 5 days Training of Ayush personnel on issues 0.153 0.153 0.153 0 0.46 of RCH and reporting for 3 days Rs 300/person x 3 days Training on NSV for MOs at NSV 40.8 45.6 45.6 0 132.00 camps Rs 500/MO /camp x 12 camps, Rs 3000 per camp for trainer x 12 camps Training on Minilap @ Rs 500 per day 0.6 1.8 1.2 1.2 4.80 for 15 days and during camps Training for Laproscopic Sterilization 0.6 0.6 0.6 0.6 2.40 for Surgeons, Gynaecologists, SN, OT attendants for 12 days SMO: Rs 500/SMO x 12 days SN: Rs 300/SN x 12 days OT Attendant: Rs 200 x 12 days Orientation on contraceptive devices 0.42 0.462 0.508 0.559 1.95 for MOs - Rs 500 /MO x 1 day Training on Medico-legal aspects to 0.445 0.47 0.92 Mos @ Rs 500/MO x 1 day Orientation on PCPNDT Act for DCs, 1 1.2 1.32 1.45 4.97 CSs, doctors both Govt and private, members of District Appropriate authority NGOs in a workshop General & Financial rules (G & FR) for 1.8 0 1.8 0 3.60 Officials, MOs, clerical staff for 3 days Rs 500/official and MOs x 3 days Rs 200 /clerical staff x 3 days Financial management training for 0.172 0.172 0.172 0.52 Accounts Officers, Accountants for 2 days
163 Rs 200/Accounts persons x 2 days Computer training to all the MOs, 3.72 3.72 Clerical staff, accounts personnel @ Rs 200 per person x 15 days CNAA for MOs, LHVs, ANMs, AWW 2.3 2.38 2.4 2.43 9.51 @ Rs 200/person x 1 day each year Total sanitation orientation and 0.74 0.74 0.74 0.74 2.96 reorientation of VHWSCs x 1 day @ Rs 200/person/day Training of NGOs in BCC @ Rs 300 0.36 0.54 0.72 0.72 2.34 per person x 6 days Total 94.704 74.886 76.902 29.725 276.22 Human Resources Activity / Item 2008-09 2009-10 2010-11 2011-12 Total Subcentre ANM 173.101 181.279 189.457 197.635 741.472 PHC MO 72.496 72.496 72.496 72.496 289.984 Staff Nurse 92.22 92.22 92.22 92.22 368.88 Health worker (F) 7.685 7.685 7.685 7.685 30.74 Health Educator 32.277 32.277 32.277 32.277 129.108 Health Assistant 0 0 0 0 0 Clerk 49.896 49.896 49.896 49.896 199.584 Pharmacist 6.12 6.12 6.12 6.12 24.48 Lab.Tech 16.632 16.632 16.632 16.632 66.528 Class IV 37.44 37.44 37.44 37.44 149.76 CHC Specialist(4) 59.04 59.04 59.04 59.04 236.16 PHN 6.848 6.848 6.848 6.848 27.392 SN 29.203 29.203 29.203 29.203 116.812 Dresser 3.45 3.45 3.45 3.45 13.8 lab.Tech 1.188 1.188 1.188 1.188 4.752 Radiographer 1.188 1.188 1.188 1.188 4.752 Opthalmic Assistant 2.376 2.376 2.376 2.376 9.504 Class IV 10.08 10.08 10.08 10.08 40.32 Statistical Assistant 5.94 5.94 5.94 5.94 23.76 Registration cleark 5.94 5.94 5.94 5.94 23.76 Total 613.12 621.298 629.476 637.654 2501.548 Procurement and Logistics Activity / Item 2008-09 2009-10 2010-11 2011-12 Total Construction of Warehouse 100 0 0 0 100 Software 0.25 0 0 0 0.25 Computer system with UPS, Printer, 0.6 0 0 0 0.6 Scanner, Equipment & Hardware 34.5 0 0 0 34.5 Pharmacist @ Rs 9000/mth 1.08 1.19 1.31 1.44 5.02 Assistant Pharmacist @ Rs 5000/mth 0.6 0.66 0.726 0.799 2.785 Packers -2 @ Rs 4000/mthx2 0.96 1.056 1.162 1.278 4.456
164 Security Staff @ Rs 6000/mth 0.72 0.792 0.871 0.968 3.351 Training of personnel 0.1 0.11 0.121 0.133 0.464 Consultancy to agency for 2 0 0 0 2 Operationalization of the Warehouse Total 140.81 3.808 4.19 4.618 153.426 IEC Activities 2008-09 2009-10 2010-11 2011-12 Total Finalizing the messages 1 1.1 1.21 1.331 4.64 Advertisements 5 5.5 6.05 6.655 23.21 TV spots 1 1.1 1.21 1.331 4.64 Radio Jingles 1 1.1 1.21 1.331 4.64 Folk Media shows @ Rs 1000/vill 3.7 4.070 4.477 4.925 17.17 Hoardings @ Rs 10000/hoarding 10 11 12.1 13.31 46.41 Display boards @ Rs 2000/board 1.8 1.98 2.178 2.396 8.35 Pamphlets @ Rs 10/pamphlets 1 1.1 1.21 1.331 4.64 Nirdeshika for Fixed Health Nutrition 0.8 1 0 0 1.80 days @ Rs 20/ Nirdeshika [email protected] /copy/mth 0.8 1.2 1.4 1.6 5.00 Orientation of frontline government 0.8 0.88 0.968 1.065 3.71 functionaries & elected rep @ Rs 200 x 400 persons x1 day VCD @ Rs 15000 per SC and 23.7 0.75 0.75 0.75 25.95 maintenance MSS meetings @ Rs 100/vill x 275 0.179 0.197 0.217 0.238 0.83 Bal Nutrition Melas @ Rs 300 x 4 times 1.2 1.320 1.452 1.597 5.57 x No of SCs Opinion leaders workshops @ Rs 300 0.3 0.330 0.363 0.399 1.39 /person x 100 Wall writings @ Rs 500 x 370 villages 1.85 2.035 2.239 2.462 8.59 Total 54.129 34.662 37.033 40.721 166.55 Financing of Health Care Activity 2008-09 2009-10 2010-11 2011-12 Total Provision of Seed money @ Rs 1 lakh 26 26 26 26 104.00 per CHC and PHC @ Rs 1.00 lakhs Training of the Incharges and second 0.416 0.416 0.416 0.416 1.66 in command @ Rs 800 per person x 1 day Development of Software for RKS with 5 0.25 0.25 0.25 5.75 training of personnel on the use Total 31.416 26.666 26.666 26.666 111.41 HMIS: Data Monitoring and Support Activity / Item 2008-09 2009-10 2010-11 2011-12 Total Baseline survey 20 0 0 0 20 Software development 20 0 0 0 20 Internet connectivity @ Rs 900 /mth x 2.808 2.808 2.808 2.808 11.232 No of facilities x12 mths AMC for computers @ Rs 5000 2.1 2.1 2.31 2.541 9.051 /computer /year x No of computers Consumables for computers @ Rs 4.92 4.92 4.92 5.04 19.800
165 1000/mth/facility x 12 mths GIS for the district, training and 12 0.5 0.5 0.5 13.5 updation Printing monitoring Charts @ Rs. 5 per 0.1 0.15 0.175 0.2 0.625 monitoring chart Total 61.928 10.478 10.713 11.089 94.208 School Health Program Activity / Item 2008-09 2009-10 2010-11 2011-12 Total Health Check up camps @2000/school 28.68 31.548 34.703 38.173 133.10 IEC campaigns 1 1.1 1.21 1.331 4.64 Monitoring and supervision (10% 0.66 0.726 0.799 increase per year) 0.6 2.78 TOTAL 30.280 33.308 36.639 40.303 140.53 BioMedical Waste management Activity / Item 2008-09 2009-10 2010-11 2011-12 Total Orientation and reorientation for Biomedical Waste Management at District and Block levels 1.5 1.820 2.000 2.200 7.52 Consumables 1 1.210 1.330 1.440 4.98 Payment for incinerators@ Rs. 8 per 17.424 19.166 21.083 bed 12 mths 15.84 73.513 Total 18.34 20.454 22.496 24.723 86.013
Grand Total 4080.15 2541.79 2152.63 2276.27 11050.85
166 ANNEXURE:
DISTT-REASI
S.NO. Name of Block- Building Needed to Staff Quarters Needed REASI Constructed for SC to be constructed for SC 1 Bhabber Bhabber 2 Sujandhar Sujandhar 3 Kotli Sukhal Gatti 4 Sukhal Gatti Dangakote 5 Dangakote Bakal 6 Bakal Ser Sandwan 7 Ser Sandwan Chorakute 8 Chorakute
Building Needed to Staff Quarters Needed to Constructed for PHC be constructed for PHC 1 Tote Tote
S.NO. Name of Block- Building Needed to Staff Quarters Needed MAHORE Constructed for SC to be constructed for SC 1 Thillo Dhandli 2 Shivras Thillo 3 Sarh Chakls 4 Ban Dachan Shajroo 5 Gulab Garh Kalwah 6 Lancha Jamasla 7 Hara Shivras 8 Gundi Sarh 9 Mahakund Ban Dachan 10 Gagra Gulab Garh 11 Shakari Lancha 12 Kainthi Hara 13 Challad Gundi 14 Masloote Mahakund 15 Thuroo Pattian Gagra 16 Handh Shakari 17 Bathoi Kainthi 18 Dharmatha Challad 19 Mamakote Masloote 20 Sundgri Thuroo Pattian 21 Angralla Handh 22 Sahadole Bathoi 23 Badder Dharmatha 24 Chayee Dalwa
167 25 Kunderdan Mamakote 26 Hasote Sundgri 27 Chassana Angralla 28 Dhandakote 29 Sahadole 30 Badder 31 Chayee 32 Kunderdan 33 Hasote 34 Chassana
Building Needed to Staff Quarters Needed Constructed for PHC for PHC 1 Balamakot Balamakot 2 Deral Deral 3 Thuroo Thuroo 4 Ind Ind 5 Sangaldan Sangaldan 6 Lar Tuli 7 Banna Sarundi 8 Gota Arnas 9 Bogadass Gota 10 Dedha Bogadass 11 Dedha 12 Dharmari(available only for Nurse & Pharmacist) 13 Budhan 14 15
Building Needed to Staff Quarters Needed Constructed for to be constructed for CHC CHC 1 Mahore(available only for general duty officer, Staff Nurse, ANM) 2 Gool
S.NO. Name of Block- Building Needed to Staff Quarters Needed KATRA Constructed for SC to be constructed for SC 1 Nomain AkhliButan 2 Manoon Sanji Chat 3 Agharjeeto Charan Paduka 4 Didi Pangal 5 Nomain 6 Manoon 7 Agharjeeto
168 S.NO. Name of Block- Building Needed to Staff Quarters Needed POUNI Constructed for SC to be constructed for SC 1 Dhanwa Dhanwa 2 Dharan Dharan 3 Sangar Thakrakote 4 Kheral 2 Kothian 5 Talwara KundKhanyari 6 Chinkah Sangar 7 Matoh Kheral 1 8 Kheral 2 9 Talwara 10 Tiyot 11 Chinkah 12 Matoh
S.NO. Building Needed to Staff Quarters Needed Constructed for PHC to be constructed for PHC 1 Laiter Laiter 2 Thakrakot Thakrakot 3 Barakh(available only M.O)
4 Ransoo Ransoo(available only for M.O)
S.NO. Building Needed to Staff Quarters Needed to Constructed for CHC be constructed for CHC
1 Pouni(available only for General Duty Officer,Pharmacist)
169 Assessment of District Health Action Plan (DHAP) Appraisal Criteria to be used by State/ District Planning & Appraisal Team
District Riasi Sl. Criteria Remarks No. Yes/ No
A. OVERALL 1 Has the DHAP been reviewed in detail by the District Yes authorities to ensure internal consistency? If yes, by whom? This means that Situation analysis, goals, strategies, activities, work plan budget are in line with the proposed interventions and are evidence based. 2 Has Account Person from the Department reviewed the Yes budget in detail? 3 Executive summary /At a Glance has been enclosed in the Yes, beginning of the document. 4 Has plan developed in all inclusive and participatory Yes process by involving representatives of health, water and sanitation, ISM, ICDS, Rural Development, NGOs and community members? 5 Funds requirement matches with the absorption capacity Yes and has judicious increase over the years (The planning should be based on past experiences in implementing interventions and realistic time frame/ workplan ) 6 The Plan caters needs of vulnerable groups (SC/ST, BPL, Yes Women and Children, others) (Activities proposed to cover SC/ST population for Immunization coverage, JSY scheme etc.) 7 Inter-department coordination and convergence Yes, mechanism is clearly mentioned for multi-sectoral inputs/elements. (Planned joint sector ,block and dist level meetings with ICDS, education and local self Govt. etc and joint circulars for implementing intervention) 8 The findings of the facility survey/ assessment has been Yes, integrated in the Plan 9 Plan has been approved by appropriate district authority Yes, attached after the District (District Health Society) cover page 11 Training Plan Yes, The training strategy to strengthen existing HR. The training plan has indicated target groups (e.g. MO, ANM, ASHAs, AWW etc), training load and broad details e.g. duration, quality assurance for training, etc 12 BCC /IEC strategy Yes A service oriented BCC strategy based on assessment of the current status of issues with MMR, IMR, TFR, awareness of PNDT, etc. has been narrated in the plan 13 Work Plan Yes, Is the work plan consistent with stated
170 Sl. Criteria Remarks No. Yes/ No
components/objectives, strategies and activities? And whether the proposed phasing of activities would lead to increase in delivery/utilization of services? 14 COSTS/BUDGET Key criteria are: Does the budget follow the prescribed formats? Yes The justification column has break-up of total amount 1. Absorptive capacity: If very ambitious utilization of Yes funds is envisaged compared to performance of 05- 06/06-07, then key steps have been proposed to achieve plan expenditure? B RCH-II PROGRAM PROGRAM MANAGEMENT ARRAGEMENTS 1 Steps to establish financial management system including Yes, Page 55-60 fund flow mechanisms to blocks and downward level and accounting system including timely reporting expenditure 2 Steps to establish quality assurance committees/system in Yes the district. 3 Step to ensure systems for holistic monitoring (Outputs, Yes activities, costs) against DHAP .( Dist level review meeting and DHS meetings) 4 Strengthening of HMIS with emphasis on timely availability Yes, of reliable and relevant information at appropriate level e.g. community, SC, PHC, Block and district, analysis and feedback system, steps to ensure implementation of revised HMIS system. 5 Provision of logistics management of drugs and medical Yes, supplies in order to ensure continuous availability of essential supplies at S/C, PHC and CHC level. TECHNICAL STRATEGIES A. Reproductive & Child Health 1 Maternal Health A. Interventions for 100% ANC coverage, Yes, B. 24x7 for EmOC services at selected institutions C. Skill birth attendance during labour (ANM) D. Provision for av ailability of safe blood in FRUs/CEmOCs, E. Intervention for anesthesia training for MOs, F. Provision of Safe abortion services and, G. Management of RTI/STI Cases H. Provision for Janani Suraksha Yojana 2 Child Health
171 Sl. Criteria Remarks No. Yes/ No
A. Organizing MCHN days for complete immunization Yes, coverage, B. Interventions for IMNCI services (Optional) C. Provision for new born care at institutions and, D. Promotion of breast feeding E. School Health Programme 3 Family Planning A. Interventions to provide regular FP services in every Yes, block facilities, B. Increase number of service providers for vasectomy, NSV, Tubectomy, and Laproligation , C. Intervention to improve quality of camps, D. Quality IUD insertion services, E. Increased availability of OP, Condoms through community workers, ASHA, AWW, NGOs 4 ARSH A. Intervention for training of MOs, paramedic for ARSH Yes services ( optional) B. Provision of AFHS services at selected institutions (optional)
5 Gender Mainstreaming Activities planned for awareness generation of gender, Yes, PCPNDT Act and strengthening implementation of PCPNDT Act. 7 Urban RCH Interventions for provision of MH/CH/FP services in urban NA slums and urban areas. 8 Tribal Health Interventions to cover tribal population for FP/MH/CH. NA B NRHM ADDITIONALITIES Whether provision made for- 1 ASHA Training in the district Yes 2 PRI Trainings (Block/Village health & Sanitation Yes Committees) 3 Untied Funds at SC & Yes Untied funds to RKS at PHC/CHC/District Hospitals 4 Civil Works as per IPHS (CHC/PHC/SC) Yes Hospital Building- Staff Quarters 5 Strengthening Field Monitoring and Supervision (Enhance Yes the provision of POL, Maintenance and of vehicle) 6 Need assessment done for-Procurements as per IPHS Yes CHC/PHC/SC) 7 Appropriate provision made for-Programme Management Yes, Units at Divisional, District and Block levels-Adequate
172 Sl. Criteria Remarks No. Yes/ No
salary and OE provisions ( District PMU is a part of RCH II and Block level PMUs are part of NRHM) 8 Adequate provision made for-Additional Manpower Yes Specialists at CHCs ANMs at SCs Divisional/Block Programme Managers 9 Provision made for-Drug Kits at different institutions Yes 10 Plan for management of Mobile Medical Units at districts Yes 11 No of Ambulances available and required Yes District specific innovative activities to address local needs Yes, addressed in all the have been incorporated technical chapters 12 Public private partnerships ( optional) Yes, 12 Provision of hiring of vehicle for BMOs (as per Yes requirements) C IMMUNIZATION PROGRAM Whether provision made for- 1 Social mobilization Yes 2 Alternative vaccine delivery Yes 3 Cold Chain Maintenance Yes 4 PoL & Maintenance requirement for vehicles Yes, D National Disease Control Programme 1 Water Borne Diseases Yes Clear strategy prepared for combating Water Borne Diseases like Malaria, dengue etc 2 TB Whether Separate section on TB with operational details Yes, and budget prepared 3 Leprosy Separate section on Leprosy with detailed operational Yes, guidelines and budget
4 Blindness 1 Separate section on Blindness Control with detailed targets Yes, and budget 2 Monitoring mechanism for NGO E CONVERGENCE/ INTER-DEPARTMENTAL Yes, COORDINATION Whether interventions in the following areas have been planned 1 ISM Integration Activities Yes 2 Department of Social Welfare (ICDS) Yes 3 PHED Yes
173