Jharkhand Monitoring Visit Report Period: Fourth Quarter

Latehar

Jharkhand Monitoring Visit Report

DR NAVNEET Period: Fourth Quarter (January to March-2013) RANJAN CONSULTANT - PHP,NHSRC 30/04/2013

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Abbreviations

ANC Ante Natal Care ACMO Additional Chief Medical Officer ANM Auxiliary Nurse Midwife AMG Annual Maintenance Grant AYUSH Ayurveda Yoga Unani Siddha Homeopathy BSU Blood Storage Unit BEmOC Basic Emergency Obstetric Care CEmOC Comprehensive Emergency Obstetric Care CHC Community Health Center CMO Chief Medical Officer CS / C-section Caesarean Section DF Deep Freezer DH District Hospital DHAP District Health Action Plan DMO District Malaria Officer DP Delivery Points DPM District Programme Manager DPMU District Programme Management Unit EMRI Emergency Medical Research Institute FRU First Referral Unit HMIS Health Management Information System I/C In-charge IFA Iron Folic Acid IPD In-patient IEC / BCC Information Education communication / Behaviour Change Communication IUD Intra Uterine Device ILR Ice Line Refrigerator JSY Janani Suraksha Yojana LHV Lady Health Visitor LSAS Life Saving Anaesthesia Skills MCTS Mother & Child Tracking System MTC Malnutrition Treatment Centre NBCC New Born Care Corner NRHM National Rural Health Mission NSSK Navjat Shishu Suraksha Karyakram OBGY Obstetric and Gynaecologist ORS Oral Rehydration Salt PNC Post Natal Care PPP Public Private Partnership PPS Post Partum Sterilisation PW Pregnant Woman RIMS Rajendra Institute of medical sciences SC Sub Center SN Staff Nurse SNCU Sick Newborn Care Unit SAM Severely Acute Malnourishment VHND Village Health & Nutrition Day VHSC Village Health & Sanitation Committee

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Executive Summary

The Fourth quarter monitoringreport for Jharkhand is based on the HMIS data of the state and a field visit to Latehar. The visit was conducted during 02nd -05th April 2013. This visit was carried out by a team with representatives from NHSRC, New Delhi, Govt. of Jharkhand and District health officials with an objective to review the progress of NRHM/RCH program including, implementation of JSSK scheme.

Maternal health: Maternal Mortality Ratio (MMR) has been reduced from 312 (SRS 04-06) to 261 (SRS 07-09). However it is higher than the National average of 212 maternal deaths per 100,000 live births (SRS 2007-09). Institutional arrangement:   The state has 23 DH, 188 CHC, 330 PHC, and 3958 SC to cater the health care needs of 32,966,238 people.  In the visited district 19 sub centers, 3 PHC, 6CHC and district hospital are prioritized for RCH services. The civil works for 2 sub centers are undergoing. In Chandawa block-the building of Laharsi PHC is completed but not yet notified as PHC. Health Service delivery indicators:  As per HMIS (2012-13) ANC3 coverage in the district is 71%  However, only 40% pregnant women received IFA tablets. The shortage of IFA tablets was also observed during the district visit. No record of hemoglobin levels of pregnant women was maintained to identify high risk pregnancies (anaemic).  47% deliveries are institutional and equal number are home deliveries. Only 1.7% deliveries are identified as complicated and most of them are attended at district hospital. The DH started conducting C-sections after the establishment of blood bank. The post natal care is poor as only few PW remain stayed at facility.  Only district hospital was found to be providing safe abortion services and that too to a very small number of clients. JSY:  JSY payments are made through bearer cheques to the beneficiaries. List of JSY beneficiaries was available at facility.  HMIS 2012-13 statistics shows 88% mothers of reported institutional deliveries received JSY payment. . Maternal Death Review:  Total 450 maternal deaths were reported in the state of Jharkhand. The review highlighted severe hypertension(31%),Bleeding(24%) and Obstructed/prolonged labour(24%) are the leading cause of maternal deaths.  In Latehar total 5 deaths were reported, which were all were reviewed.

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Janani-Shishu Suraksha Karyakram (JSSK):  The level of awareness about cashless services for pregnant women and sick infants was found very low. Although signage for JSSK was displayed at facilities visited.  OPD,IPD and diagnostic services are free across the facilities visited.  The prescribed drugs are ensured free of cost to most of the beneficiaries, however few beneficiaries reported to have incurred OOPs on purchasing medicine from private pharmacy  . Free diet is available up to CHC level. Nearly 40% of the interviewed women used Mamta Vahan to reach the facility, while remaining came by hired or personal vehicles.  Informal payments to avail the medical services were also reported by beneficiaries There  No robust mechanism for redressal of grievances exists in facilities visited. Human Resources:  Total 28 positions of doctor/specialist are lying vacant in the district. The position of District Malaria officer, District Filaria officer and District Leprosy officer is vacant.  One paediatrician and two gynaecologists under regular employment are in position at Balumath CHC and district hospital respectively. However there is no anaesthetist available in the district. Two and three MOs are trained in LSAS and EmOC respectively, while 53 SN/ANM are SBA trained Child Health: In Latehar district 9 NBCC are present but no NBSU and SNCUs are available. A six bedded NBSU for DH was approved in FY 2012-13 but not yet to be operationalised. There is an urgent need to operationalise NBSU with appropriate human resources in DH to improve newborn survival. Immunization:  As per HMIS analysis (Apr’12-Mar’13) fully immunized against estimated live births was 74%, very close to the last year’s figure (73%). Malnutrition Treatment Centre (MTC):  There are 3 MTC established in the district.  At Chandawa, a 6 bedded NRC was functional, however only 50% beds were occupied. There is 1 doctor and 3 ANMs deployed at this NRC. So far there were 267 admissions,out of whch 245 were discharged, 7 readmitted, 9 referred and 21 were LAMA cases.  At district hospital only 4 children were admitted against the 15 beds. The utilization of MTCs is poor. There is need to sensitize the community about malnutrition and improved convergence of ASHA and AWW for identification and referral of SAM cases.

Family Planning:  As per HMIS (2012-13) sterilization (34% of all methods) is the most accepted method of family planning..

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 There is need to improve the uptake ofspacing methods like IUD and PPIUD.  IEC related to family planning seems to be neglected. Outreach Services:  Out of 4 MMUs, 3 are functional in the district to cover 7 blocks. They are run and managed by NGOs under PPP. There is need to monitor and analyze the performance of MMU. Proactive involvement of ASHA and ANMs is required for effective utilization of MMU. School Health program (SHP):  Total 466 schools have been covered so far under SHP. Out of 187,074 students 154,637 have been screened and 27,020 health cards distributed. Adolescent Reproductive and Sexual Health (ARSH):  There are 7 ARSH clinics established in the district and all are functional. Every six months kishori Swasthya Pakhwara is being observed. During these periods special focus is given to identify severely anaemic adolescent girl and their further management. ASHA  There are 1325 ASHAs in position in the district. During the visit Round one training of module 6 was undergoing.  District has distributed drug kits to all ASHAs however, many ASHAs complaint about not refilling of drug kit.  Shayiya Helpdesk was functional at district hospital and Manika CHC. This helpdesk also redress grievances of patient Disease Control Program; Status of NPCDCS: The NPCDCS program was piloted in Bokaro in year 2010-11 andscaled up to two more districts i.e. Ranchi and Dhanbad next year. The screening statistics shows that proportion of suspected hypertension cases (6. 6%) is higher than the proportion of suspected diabetics (5.6%).  Quality of Services:  Deep pits for disposal of bio medical waste were found at all the facilities visited. Colour coded bins for biomedical waste disposal was being used in visited DH & CHCs. The infection prevention practices were observed in the facility visited but it varied from facility to facility.  Equipments were available at the facility visited as per the facility norms. The radiant warmers were not functional due to poor power supply and voltage. Stabilizer may be installed to make radiant warmer functional. Program Management and Support services:  The position of District Data Manager is vacant however recruitment is going on for all 7 Block Data Manager. At block level, position of 2 BPM and 1 BAM is lying vacant.  Power backup and security personnel were available at every facility. Mobile/Internet connectivity is poor in the district that affects service delivery and data entry

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1.1 Introduction The Fourth quarter monitoring report for Jharkhand is based on visit to Latehar district and the HMIS data analysis.

Latehar is one among the 30 districts classified for IAP 1 across the country. The visit was conducted during 02nd -05th April 2013. There are 97 SC, 07 PHC, 7 CHC, 2 Malnutrition treatment centre (MTC) and a district hospital functional in Latehar. Out of these 1 SHC, 1 PHC, 2 CHC, 2NRC and DH were selected as sample facilities to visit and understand program management and implementation at field level. After this visit the findings were shared with concerned officers at district level and state level. Table 1 shows the visit schedule and team composition.

Table1- Visit Schedule and Team composition

Date 03rd April 2013 04th April 2013 Facility visited Latehar District Hospital, Chipadohar PHC, Chandwa CHC, Manika CHC, Latdag SHC, NRC Latehar NRC Chandawa, ASHAs training at Latehar Team Members Dr Navneet Ranjan,Consultant, NHSRC Mr Deepak Tubid, State Consultant, Quality Assurance. Ms Jaya Reshma Xaxa , DPM Latehar Mr. Pramod kumar sahoo, DAM, Latehar

1.1. Approach and methodology:

The methods used by observations at different facilities, patients’ interviews and interactions with providers and beneficiaries. In meeting with civil surgeon, planning for the field visit was discussed. Data was collected from the District Programme Management Unit and the facilities visited.

The team interacted with medical officers, ANM, ASHA and discussed the different issues related to health services at the visited facilities. Interviews were carried out with pregnant women in the post natal ward of the visited facilities.

1 IAP = Integrated Action Plan (30 Districts) which include backward, tribal and LWE districts. The categorization is done by statistical division of Ministry of Health & Family Welfare, Govt. of India

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1.2. Background Information

Latehar district was created on 4th April 2001 and falls under Palamu division. Population is 725,673 as per Census 2011. It is predominantly tribal district with almost 40% of the population belonging to the schedule tribes and more than 66 % of total population comprising of SCs and STs. There are nine Development Blocks, namely Latehar, Chandwa, Balumath, Bariyatu, Herhanj, Manika, Barwadih, Garu and Mahuadar. The fertility of soil is poor due to extensive erosion, acidic character and low retaining capacity. The district does not have any significant industrial activities. Table 2. Status of major health indicators Health Profile Indicator Jharkhand Latehar CBR 23.7 24.8 CDR 6.1 5.9 IMR 41 49 MMR 310( Palamu 278 division) Source: DHAP

Table 3. Health Infrastructure in Latehar: Institutions No. District Hospital 1 Block 09 CHC 07 PHC 07

SC 97 FRU 0 24X7 PHC -- No. of licensed blood banks (include 1 pvt)

Source: District Data

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2.0 Maternal Health:

Maternal Mortality Ratio (MMR) has been reduced from 312 (SRS 04-06) to 261 (SRS 07-09). There are 51 points drop in MMR. However it is higher than the National average of 212 maternal deaths per 100,000 live births (SRS 2007-09).

2.1. Institutional arrangement: The state has 23 DH, 188 CHC (out of these 150 are under construction) 330 PHC (out of these 92 are under construction), 3958 SC (out of these 775 are under construction) to cater the health care needs of 32,966,238 population.

In Latehar 97 SC, 07 PHC, 7 CHC, 2 Malnutrition treatment centre (MTC) and a district hospital is functional. Out of these 19 sub centers, 3 PHC, 6CHC and district hospital are prioritized for RCH services. The civil works for 2 sub centers are undergoing. In Chandawa block-the building of Laharsi PHC is completed but not yet notified as PHC.

Beside this four private health facilities are accredited for JSY. The presence of private health care providers is negligible in the district.

Table 3: Functional delivery points in Latehar SNo. Type of Facility Latehar Total number Functional Delivery points

Level I facility 1 Sub center 97 19 Level II facility 2 PHC 07 03 3 CHC 07 06 4 Other Hospital 00 00 Level III facility 5 SDH 00 00 6 DH 01 01 Total 112 29 Source: District Data

2.2. ANC Services As per HMIS 2012-13, total ANC registration against expected pregnancies in district was 93%. Out of the total registration 71% pregnant women underwent 3 ANC services. However only 40% of women received IFA tablets. The shortage of IFA tablets was confirmed during the visit

Page 8 of 48 to Chhipadohar PHC. It was also observed that, no record on haemoglobin levels of pregnant women was maintained at the visited facilities to identify high risk pregnancy (anaemic). There is need of line listing of high risk pregnant women to avert the maternal death.

2.3. Delivery services/ Labour room: As per HMIS 2012-13, 47% deliveries are institutional which is very close to the state AHS 2011 statistics (45%). The proportion of unreported deliveries is less (6%) however home deliveries are same the institutional deliveries i.e. 47%. The reason for high proportion of home deliveries is hilly terrain, wide geographical stretch and, scattered population. Also social condition (LWE affected) of this area is not conducive for the PW to Chipadohar PHC surrounded by live wire in night to protect building from LWE reach the facilities particularly at night. Majority of the home deliveries are reported from Manika block. 98% of institutional deliveries are normal deliveries. However only 1.7% deliveries are complicated and most of them are attended at district hospital. Only ten pregnancies (0.1%) were taken up for C-section, which is nearly 100 times less as compared to the estimated no. of women requiring C sections. The reasons for very few C-section are unavailability of blood bank at DH. Recently the Blood bank has been operationalzed and the report of next few quarters will show whether it was only the lack of blood leading to low C section rate.

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Figure 2: Latehar- C-Section, Complicated & Normal Deliveries against Reported Institutional Deliveries ( Pvt. & Public) Apr'12 to Mar'13 C- section % Complicated 0.1% Pregnancies attended % 1.7%

Normal deliveries % 98.2%

The labour room in district hospital has only 1 Labour table however the DH is conducting nearly 100 deliveries per month. The Labour room was not found clean and tidy. The NBCC was found functional. Oxytocin, IV fluid and other essential drugs were available in the emergency tray. Distribution of institutional deliveries across the blocks of district is shown in the figure given below. % of institutional delivery Balumath 8% Chandwa 9%

DH 33%

Barwadih 15%

Garoo Manika 9% 4% Latehar Mahuwadar 7% 15% Figure3.Distribution of institutional deliveries in CHC & DH: Q4 2.4. Post delivery stay / PNC The infrastructure of the post natal ward of the health facilities visited was insufficient to cater to mothers’ needs. It is difficult to deliver PNC at the facility as only few women stayed back at facilities for the mandatory 48 hrs after delivery. The HMIS data suggests that 81% women stay less than 48 hours in the facility after delivery.

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During the visit it was observed that few facilities (Chipadohar PHC) do not have functional beds to accommodate the post natal cases. There is need to improve the stay at facilities by providing free diet and drop back facility. (Details in JSSK section).

2.5. Safe Abortion Services: Table.4: Abortions - Apr'12 to Mar'13

MTP Less than MTP More Abortions Abortions in Abortion Rate 12 weeks than 12 (spontaneous/Induced) Pvt Facilities against expected weeks pregnancies 89 7 203 -- 1.6% Only district hospital was found to be providing safe abortion services and that too to a very small number of clients. However the rate of abortion against expected pregnancies is 1.6 % which again is much lower than expected abortions/miscarriages. The concern is that abortion services were not available in CHCs and PHCs.

2.6. Janani Suraksha Yojna (JSY): HMIS 2012-13 statistics shows 88% mothers of reported institutional deliveries received JSY payment. This figure is only for delivery at Public institution. JSY payments are made through bearer cheques to the beneficiaries. List of JSY beneficiaries was available at facility.

2.7. Maternal Death Review:

Total 450 maternal deaths were reported in the state of Jharkhand. The review highlighted severe hypertension(31%),Bleeding(24%) and Obstructed/prolonged labour(24%) are the leading cause of maternal deaths.

2.8. Janani shishu suraksha Karyakaram (JSSK)

The exit interviews were conducted at facilities visited where delivery conducted. Total (n=7) beneficiary were interviewed.The key findings of interview are as follows: Awareness about entitlements of JSSK  Almost all interviewed PW were not aware about cashless services being provided under JSSK to PW. The service providers also do not know about JSSK. Although signage for JSSK was displayed at facilities visited.

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OPD/IPD charges  The OPD and IPD charges were exempted to PW and sick new born at all facilities visited. Drugs:  All the women interviewed were getting drugs free of cost from the facilities visited. At Latehar DH two women reported that they purchased medicine from private pharmacy and spent Rs. 50/- and Rs. 90/- respectively.  Blood bank was established recently and C-section was also carried out however adequate utilization of blood bank is stillto be acheived. The lab technician of blood bank reveals that blood was collected through blood donation camp organised by Red Cross but due to poor absorption the blood units were shifted to Palamu DH or RIMS, Ranchi. Diet:  At DH, diet is being provided through in house kitchen to the pregnant women as reported by facility in-charge. At Chandawa CHC, single pregnant women was present at facility and confirmed about getting food from the hospital free of cost. A local hotel/restaurant is empanelled to supply the cooked diet for pregnant women. During the visit, l. Generally PW are not willing to stay more than 4-5 hours post delivery. At Chipadohar PHC remaining visited facilities, the diet was not being arranged for PW under JSSK.. Informal charges:  Out of 7 Post natal mothers interviewed 2 of them paid informal charges, 150/- and Rs 300/- to service providers.

Diagnostic facilities:  Labouratory tests are available at the facilities visited as per the facility norms. The free diagnostic services are available for pregnant women and sick new born. The line listing of anaemic PW (whose Hb level is <7mg) was not practiced.  There is no OOPS incurred on the diagnostic tests by

the interviewed PW. Post Natal ward of Latehar District Hospital

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Transportation:  Seven ambulances are functional in the district out of which four are managed by NGO.  Out of 7 women interviewed only three used ‘Mamta vahan’ to reach facility for delivery. Remaining PW reached facility either by own vehicle or through hired vehicle. The out of pocket expense ranged from Rs 50/- to Rs 600/- for transportation depending upon the distance travelled and type of vehicle used.  One PW revealed that the mobile network connectivity is one of the issues that’s why she was not able to call Mamta Vahan. Five interviewed PW did not attempt to call Mamta Vahan because they were not aware about the free transport facility.  Drop back to home is only provided to those who stayed mandatory 48 hours in the facility. It was also observed through records that utilization of Mamta Vahan for drop back is very less as beneficiaries left the facility soon after the delivery. Inter-facility transfer:  For up referral Rs 1000/= is being provided to the PW and sick new born for transportation. If government vehicle (ambulance) is available then this money is used for the fuel. However generally the vehicle is arranged by the family member of beneficiary. Grievance Redressal Cell:  There is no mechanism to redress grievances under JSSK in facilities visited. Not even a suggestion box has been placed at the facility visited.  None of the interviewed PW knew where to contact in case they are charged for the cashless services under JSSK

3.0. Human Resources Table: 5. Human resources available in the District Requi Regular Contractual red Sancti In position Sanctio In position In Total in oned from State ned (through positio positio posts posts state/othe n from n r sources) NRHM 1st ANM 119 119 82 0 0 0 82 2nd ANM 150 0 0 150 0 102 102 MPW/ Male HW 18 18 16 0 0 0 0 Staff Nurse total 59 3 0 0 2 29 31 DH 20 0 0 20 2 2 4 FRU/ CHC 36 0 0 36 0 7 7 24X7 PHCs 21 0 0 0 0 0 0 LHV/ PHNs 7 7 5 0 0 0 5 Other supervisory cadre LTs 23 23 4 23 4 11 19

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DH 4 4 0 4 1 2 3 FRU/ CHC 12 12 2 12 4 6 12 24X7 PHCs 14 14 4 14 7 3 14 Other facilities (Pls. 0 0 0 0 0 0 0 specify) Pharmacists 23 23 0 14 9 4 4 AYUSH Pharmacists 0 0 0 0 0 0 0 MOs total 15 9 6 1 0 3 AYUSH MOs 8 8 6 0 6 0 0 DENTAL MOs 8 1 0 0 8 0 1 Specialists total 10 2 0 0 8 0 0 Obstetricians 4 2 0 0 4 0 2 &Gynaecologist Anaesthetist 3 0 0 0 3 0 0 Paediatrician 3 0 0 0 0 0 Source: District Data

The details of the human resources available in the district are depicted in the table 5. One paediatrician and two gynaecologists under regular employment are in position at Balumath CHC and district hospital respectively. However there is no anaesthetic available in the district. 3.1. Vacancies: Total 28 positions of doctor/specialist are lying vacant in the district. The position of District Malaria officer, District Filaria officer and District Leprosy officer are vacant.

3.2. Trainings: Two and three MOs are trained in LSAS and EmOC respectively. Total 53 SN/ANM is SBA trained

4.0 . Child health

In FY 12-13, total 7 SCNU were proposed out of which 2 were functional at Ghatshila in East Singhbhum and Department of Pediatrics-RIMS, Ranchi. Also 32 NBSU were proposed out of which 7 are functional.

In Latehar district 9 NBCC are present and situated in 6 CHC and 2 PHC and District hospital. There is no NBSU and SNCU available in the district. A six bedded NBSU for DH was approved in FY 2012-13 but not yet operationalise. There is an urgent need to operationalise NBSU with appropriate human resources in DH to improve newborn survival.

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4.1. Immunization:

Table: 6.Immunization in Jharkhand & Latehar Indicator Jharkhand Latehar

April'12 to Last Year April'12 to Last Year Mar'13 2011-12 Mar'13 2011-12 BCG to Measles dropout 6% 1% 6% 11% rate Fully Immunized against 75% 83% 74% 73% estimated Live Births Immunisation session held 94% 99% 122% 73% as % of required VHNDs Childhood Diseases Measles 2908 8415 16 115

Source: HMIS 2012-13 As per HMIS (Apr’12-Mar’13) analysis fully immunized children against the estimated live births was 74%. This is very close to the last year’s figure (73%). The dropout rate of BCG to measles was 6%. The HMIS statistics also show 122% immunization sessions held as against the required number of VHNDs in Latehar.

4.2. Malnutrition Treatment Centre (MTC): There are 3 MTC established in the district- at Chandawa CHC 6 bedded, Mahuadar CHC 6 bedded and district hospital 15 beded. The team visited to MTC wards of district hospital and Chandawa CHC.

At Chandawa MTC it was observed that a 6 bedded MTC was functional. Out of six beds only three beds were found occupied during the visit. Separate kitchen was created for NRC. There is 1 doctor and 3 ANM deployed at this NRC. So far 267 admissions have been recorded, out of these 245 were discharged, 7 readmitted, 9 were referred and 21 were LAMA cases. After discharge from NRC, ASHA follow up the cases. At district hospital only 4 children were admitted against the 15 beds. The utilization of MTCs is poor. The facility in-charge told that due to festivals the admissions are low. There is need to sensitize the community about malnutrition and convergence of ASHAs and AWWs for identification and referral of SAM cases.

5.0. Family Planning:

The Total Fertility Rate (TFR) of Jharkhand is 3.2 whereas TFR of India is 2.6 (SRS 2008). Jharkhand has high fertility rate and fall under the group of states having >3 TFR. The unmet need for spacing is 16.2% and limiting is 14.2% in the state (AHS 2010).

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Table 07. Family Planning Methods in Latehar Reported %age of All Reported FP Methods

Total Reported FP Method (All types) 6,695 - Users Sterilizations 2,272 34% IUD 1,743 26% Condom Users 1,421 21% OCP Users 1,259 19% Limiting Methods 2,272 34% Spacing Methods 4,423 66% Source: HMIS (2012-13)

As per HMIS (2012-13) sterilization is the most accepted method of family planning. The proportion of sterilization is 34% in all reported FP methods. Table 8 shows that 96% female sterilization was conducted in Latehar district. The district hospital has Fixed Day Service. There is need to strengthen, with focus of spacing methods like IUD and PPIUD. IEC related to family planning seems to be neglected. Table: 08. Status of Sterilizations in Latehar Reported %age of Reported Sterilization Total Sterilization 2,272 NSV 99 4% Laparoscopic 15 1% MiniLap 1,834 81% Post Partum 324 14% Male Sterilization 99 4% Female Sterilization 2,173 96% Source: HMIS (2011-12) 6.0. Outreach Services:

MMUs

Out of 4 MMUs, 3 are functional in the district covering 7 blocks. One MMU is allocated for 2 blocks and remaining three blocks are covered by one MMU. Two are run and managed by Vikas Bharti and one by ICERT; both NGOs under PPP. There is need to monitor and analyze the performance of MMUs which currently is lacking. Also, involvement of ASHA and ANMs is required for effective utilization of MMU.

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7.0. School Health program (SHP):

Total 466 schools have been covered so far under SHP. Out of 187,074 students 154,637 are screened and 27,020 health cards have been distributed.

8.0. Adolescent Reproductive and Sexual Health (ARSH):

There are 7 ARSH clinic established in the district and all are functional. The ARSH training Module is made available in local language. There is one MOi/c, 3 LHV/ANM are engaged in this program. Beside this a counselor was appointed in each facility. Every six months kishori Swasthya Pakhwara is being observed. During these periods special focus was given to identify severely anemic adolescent girl and their further management. Also supplementation of WIFS is priority as told by civil surgeon.

9.0. ASHA Program:

ASHA Selection:

ASHA is known as Sahiya in Jharkhand. 1325 ASHAs have been selected in the district. The in- depth interview with ASHA shows that the workload and incentive varies, for some it is full time job whereas for some only few cases to attend.

ASHAs Training: All ASHAs have been trained up to 5th Module. The training was ongoing on module 6 B during the visit. The district has proposed to train all 1325 ASHAs in Module 6 and 7 in FY 2013-14. The State has 15 State Trainers for Module 6 & 7.

Sahiyas undergoing Training of Module 6b at district

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Drug Kit:

All 1325 ASHAs in Latehar are equipped with drug kit. The drugs are replenished at facilities but this is not a regular event. Many ASHAs complaint about not getting a drug kit refill.

ASHA Support Structure:

There are 69 ASHA facilitators and one District Program coordinator (equivalent to ASHA coordinator) is in place in the district. 7 positions of block level ASHA coordinators are vacant. It was observed that ASHA help desk was well functioning in the district hospital & Manika CHC.

10.0. Status of NPCDCS programme:

The NPCDCS program was piloted in Bokaro in year 2010-11, and further scaled up to two more districts i.e. Ranchi and Dhanbad in 2011-12. The screening data under this program is given in the table 9.

Table: 9. Status of screening

No. of Suspected for % of Hypertension ( % of Districts persons Diabetes ( Diabetes >90 ) Hypertension screened >140 ) suspected

Bokaro 185,420 10,529 18,778 5.67 10.12 Dhanbad 140,044 10,710 11,505 7.65 8.21 Ranchi 304,914 14,020 11,061 4.60 3.63 Total 630,378 35,259 41,344 5.59 6.56 The table 9 shows that proportion of suspected hypertension cases (6. 6%) is higher than the proportion of suspected diabetics (5.6%).

11.0. Program Management

Programme Management Units has been established at districts & block levels to coordinate & implement different activities of NRHM. The position of District data Manager is vacant however recruitment is going on for all 7 Block Data Managers. At block level position of 2 BPM and 1 BAM is lying vacant.

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12.0. Quality of Services:

12.1. Infection prevention practices and Biomedical waste disposal:

Deep pit for disposal of bio medical waste was found at all the facilities visited. Colour coded bins for biomedical waste disposal were being used at visited DH & CHCs. The infection prevention practices were observed in the facility visited, but it varied from facility to facility.

12.2. Information Display: Shayiya Helpdesk was functional at district hospital and manika CHC.This helpdesk also redress grievances of patient. The list of diagnostic tests performed was also displayed. IEC material pertaining to various programmes including JSSK is displayed in the facilities visited however name and contact number of the nodal person of JSSK should be displayed. There is need to display the entitlements with pictorial diagram.

12.3. Equipments

All equipments are available at the facility visited as per the facility norms. O2 Cylinder was functional and SN was trained to operate them. The radiant warmerwas not functional due to poor power supply and voltage.

12.4. Records:

Labour room:

The labour room are clean and well maintained at district hospital but at CHC & PHC the cleanliness was lacking. Technical protocols were not displayed in the labour room at Chipadohar PHC. It was also observed there is no consistency in Partograph preparation. Emoc drugs (e.g. Oxytocin, Prostaglandin etc) are available in the labour room. The delivery records were well maintained in all the facilities visited. Sahiya Help desk at Manika CHC

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Laboratory Records:

Laboratory records were maintained at the facilities visited in the district. Routine Lab tests are conducted. However Line listing of anemic pregnant women is not done at the facilities.

13.0. Support services:

Power Back up: Power back up as generator and inverter was available in all the facilities visited.

Security: Security personnel are hired for security purposes at every facility. Mobile/Internet connectivity: This is poor in the district that affects service delivery and data entry.

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

Jharkhand - Apr'12 - Jan'13 AHS 2011

Population (Census-2011) 3,29,66,238 Estimated Pregnancies ANC 8,77,048 ANC Check-up in first CBR (AHS-2011) 23.7 Estimated Deliveries 7,97,316 trimester 56.3 Apprehended Infant Deaths ( IMR = 3 or more ANC Check- 32033 Estimated Live Births 7,81,300 41 taken from AHS - 2011 ) up 56.3 Estimated Maternal Estimated Eligible couples ( 17% of Complications( 15% of Atleast 1 TT received population) 56,04,260 1,31,557 Estimated pregnancies) 85.7 Apr'12 - Projected for April'12 to Last Year Apr'11- Indicator 100 IFA Tablets Jan'13 Mar'13 Mar'12 15.1

3ANC Check up against estimated 44% 53% 51% Deliveries pregnancies Institutional Deliveries (Public+Private) against estimated 46% 55% 46% Institutional Delivery deliveries 37.6

Met need for EmOC * 20.57% 25% 14.17% Home Delivery 62.0

Reported Live Births against 66% 79% 75% Home Delivery by SBA estimated Live Births 24.7 New born & post BCG to Measles dropout rate 6% 6% 1% natal care Fully Immunised against estimated Abortion (Induced + 68% 82% 83% Live Births Spontaneous) 4.2 Immunisation session held as % of 102% 102% 99% Still Birth required VHNDs

Childhood Disease Diphtheria 104 124.8 186 Live Birth

Breastfed within 1 Childhood Disease Pertussis 58 69.6 75 hour of birth 37.9 PNC within 48 hrs of Childhood Disease Measles 2702 3242.4 8415 delivery 59.1 Childhood Disease Malaria 19872 23846.4 38516 Immunisation Sterilization - Female per 1000 BCG eligible couple 11.93 14.32 20.94 91.8 Sterilization - Male per 1000 eligible DPT3 couple 1.16 1.40 2.33 71.8

Reported Abortion Rate per 1000 26.8 28.3 Measeles Estimated live births 32.2 79.0

OPD All (per 1000 population) 287.0 327.8 Full immunisation 344.4 63.7

IPD (per 1000 population) 14.2 18.4 Unmet need for FP 17.0

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Operation Major (per Lakh 53.6 77.907 Spacing population) 64.3 16.2

Reported Infant and Child Deaths 1187 925 Limiting 1,424.4 14.3

Reported Maternal Deaths 395 372 Total 474.0 30.5 * Total Maternal complications ( C-section deliveries + Eclampsia cases )treated against estimated maternal complication

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Jharkhand-Pashchimi Singhbhum - Apr'12 - Jan'13 AHS 2011

Population (Census-2011) Estimated Pregnancies ANC 1501619 43,788 ANC Check-up in first CBR (AHS-2011) 25.8 Estimated Deliveries 39,807 trimester 51.4 Apprehended Infant Deaths ( IMR = 3 or more ANC Check- 2131 Estimated Live Births 38,742 55 taken from AHS - 2011 ) up 51.5 Estimated Maternal Estimated Eligible couples ( 17% of Complications( 15% of Atleast 1 TT received population) 2,55,275 6,568 Estimated pregnancies) 74.3 Apr'12 - Projected for April'12 to Last Year Apr'11- Indicator 100 IFA Tablets Jan'13 Mar'13 Mar'12 21.1

3ANC Check up against estimated 64% 77% 68% Deliveries pregnancies Institutional Deliveries (Public+Private) against estimated 45% 54% 40% Institutional Delivery deliveries 28.0

Met need for EmOC * 1.32% 2% 0.69% Home Delivery 71.3

Reported Live Births against 73% 87% 81% Home Delivery by SBA estimated Live Births 15.9 New born & post BCG to Measles dropout rate -4% -4% 1% natal care Fully Immunised against estimated Abortion (Induced + 81% 97% 82% Live Births Spontaneous) 6.5 Immunisation session held as % of 164% 164% 145% Still Birth required VHNDs

Childhood Disease Diphtheria 0 0 10 Live Birth

Breastfed within 1 Childhood Disease Pertussis 0 0 2 hour of birth 45.2 PNC within 48 hrs of Childhood Disease Measles 234 280.8 481 delivery 32.6 Childhood Disease Malaria 1620 1944 3888 Immunisation

Sterilization - Female per 1000 BCG eligible couple 2.97 3.57 6.75 90.7

Sterilization - Male per 1000 DPT3 eligible couple 1.77 2.12 3.65 70.4

Reported Abortion Rate per 1000 20.1 12.4 Measeles Estimated live births 24.1 79.0

OPD All (per 1000 population) 391.7 422.0 Full immunisation 470.0 64.7

IPD (per 1000 population) 6.6 6.9 Unmet need for FP 7.9 Operation Major (per Lakh 6.5 3.263 Spacing population) 7.8 19.4

Reported Infant and Child Deaths 198 139 Limiting 237.6 20.2

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Reported Maternal Deaths 33 28 Total 39.6 39.6 * Total Maternal complications ( C-section deliveries + Eclampsia cases )treated against estimated maternal complication

Jharkhand-Bokaro - Apr'12 - Jan'13 AHS 2011

Population (Census-2011) Estimated Pregnancies ANC 2061918 54,304 ANC Check-up in first CBR (AHS-2011) 23.6 Estimated Deliveries 49,367 trimester 60.6 Apprehended Infant Deaths ( IMR = 3 or more ANC Check- 1411 Estimated Live Births 48,661 29 taken from AHS - 2011 ) up 71.4 Estimated Maternal Estimated Eligible couples ( 17% of Complications( 15% of Atleast 1 TT received population) 3,50,526 8,146 Estimated pregnancies) 95.0 Apr'12 - Projected for April'12 to Last Year Apr'11- Indicator 100 IFA Tablets Jan'13 Mar'13 Mar'12 19.3

3ANC Check up against estimated 52% 62% 60% Deliveries pregnancies Institutional Deliveries (Public+Private) against estimated 42% 51% 44% Institutional Delivery deliveries 48.9

Met need for EmOC * 5.46% 7% 7.16% Home Delivery 50.7 Reported Live Births against 59% 70% 67% Home Delivery by SBA estimated Live Births 16.3 New born & post BCG to Measles dropout rate 2% 2% 4% natal care Fully Immunised against estimated Abortion (Induced + 77% 92% 87% Live Births Spontaneous) 2.5 Immunisation session held as % of 93% 93% 86% Still Birth required VHNDs

Childhood Disease Diphtheria 0 0 0 Live Birth

Breastfed within 1 Childhood Disease Pertussis 0 0 0 hour of birth 40.6 PNC within 48 hrs of Childhood Disease Measles 42 50.4 135 delivery 75.5 Childhood Disease Malaria 150 180 509 Immunisation

Sterilization - Female per 1000 BCG eligible couple 14.89 17.87 29.52 94.5

Sterilization - Male per 1000 DPT3 eligible couple 6.02 7.22 7.08 86.2

Reported Abortion Rate per 1000 111.7 89.0 Measeles Estimated live births 134.0 84.0

OPD All (per 1000 population) 196.1 214.9 Full immunisation 235.4 79.0

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IPD (per 1000 population) 4.3 4.9 Unmet need for FP 5.1 Operation Major (per Lakh 4.3 22.406 Spacing population) 5.1 11.2

Reported Infant and Child Deaths 35 38 Limiting 42.0 7.0

Reported Maternal Deaths 13 23 Total 15.6 18.2 * Total Maternal complications ( C-section deliveries + Eclampsia cases )treated against estimated maternal complication

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Jharkhand-Chatra - Apr'12 - Jan'13 AHS 2011

Population (Census-2011) Estimated Pregnancies ANC 1042304 28,585 ANC Check-up in first CBR (AHS-2011) 24.3 Estimated Deliveries 25,987 trimester 42.7 Apprehended Infant Deaths ( IMR 3 or more ANC Check- 1317 Estimated Live Births 25,328 = 52 taken from AHS - 2011 ) up 41.8 Estimated Maternal Estimated Eligible couples ( 17% of Complications( 15% of Atleast 1 TT received population) 1,77,192 4,288 Estimated pregnancies) 70.3 Apr'12 - Projected for April'12 to Last Year Indicator 100 IFA Tablets Jan'13 Mar'13 Apr'11-Mar'12 7.7

3ANC Check up against estimated 34% 41% 43% Deliveries pregnancies Institutional Deliveries (Public+Private) against estimated 31% 38% 36% Institutional Delivery deliveries 25.5

Met need for EmOC * 0.58% 1% 1.03% Home Delivery 74.3

Reported Live Births against 55% 66% 63% Home Delivery by SBA estimated Live Births 17.9 New born & post BCG to Measles dropout rate 18% 18% -3% natal care Fully Immunised against estimated Abortion (Induced + 57% 69% 76% Live Births Spontaneous) 1.7 Immunisation session held as % of 90% 90% 87% Still Birth required VHNDs

Childhood Disease Diphtheria 0 0 0 Live Birth

Breastfed within 1 Childhood Disease Pertussis 0 0 0 hour of birth 27.9 PNC within 48 hrs of Childhood Disease Measles 76 91.2 470 delivery 55.9 Childhood Disease Malaria 1874 2248.8 3161 Immunisation

Sterilization - Female per 1000 BCG eligible couple 7.71 9.25 19.10 82.8

Sterilization - Male per 1000 DPT3 eligible couple 0.78 0.94 6.13 55.7

Reported Abortion Rate per 1000 1.0 9.9 Measeles Estimated live births 1.2 65.2

OPD All (per 1000 population) 268.2 276.2 Full immunisation 321.9 49.0

IPD (per 1000 population) 37.8 35.5 Unmet need for FP 45.3 Operation Major (per Lakh 6.4 54.207 Spacing population) 7.7 21.8

Reported Infant and Child Deaths 0 5 Limiting 17.2

Page 26 of 48

Reported Maternal Deaths 2 0 Total 2.4 39.0 * Total Maternal complications ( C-section deliveries + Eclampsia cases )treated against estimated maternal complication

Jharkhand-Deoghar - Apr'12 - Jan'13 AHS 2011

Population (Census-2011) Estimated Pregnancies ANC 1491879 37,662 ANC Check-up in first CBR (AHS-2011) 22.5 Estimated Deliveries 34,239 trimester 55.8 Apprehended Infant Deaths ( IMR = 3 or more ANC Check- 1343 Estimated Live Births 33,567 40 taken from AHS - 2011 ) up 48.9 Estimated Maternal Estimated Eligible couples ( 17% of Complications( 15% of Atleast 1 TT received population) 2,53,619 5,649 Estimated pregnancies) 79.3 Apr'12 - Projected for April'12 to Last Year Apr'11- Indicator 100 IFA Tablets Jan'13 Mar'13 Mar'12 10.6

3ANC Check up against estimated 35% 42% 52% Deliveries pregnancies Institutional Deliveries (Public+Private) against estimated 43% 52% 57% Institutional Delivery deliveries 32.1

Met need for EmOC * 2.16% 3% 0.90% Home Delivery 67.6

Reported Live Births against 59% 71% 80% Home Delivery by SBA estimated Live Births 24.3 New born & post BCG to Measles dropout rate 19% 19% 4% natal care Fully Immunised against estimated Abortion (Induced + 66% 80% 93% Live Births Spontaneous) 2.4 Immunisation session held as % of 97% 97% 111% Still Birth required VHNDs Childhood Disease Diphtheria 0 0 0 Live Birth Breastfed within 1 Childhood Disease Pertussis 0 0 4 hour of birth 29.3 PNC within 48 hrs of Childhood Disease Measles 103 123.6 500 delivery 63.7 Childhood Disease Malaria 45 54 1056 Immunisation Sterilization - Female per 1000 BCG eligible couple 19.38 23.26 32.70 87.6

Sterilization - Male per 1000 DPT3 eligible couple 0.17 0.20 0.51 55.8

Reported Abortion Rate per 1000 13.1 19.8 Measeles Estimated live births 15.8 61.5

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OPD All (per 1000 population) 227.3 299.6 Full immunisation 272.8 40.6

IPD (per 1000 population) 14.7 15.9 Unmet need for FP 17.6 Operation Major (per Lakh 3.7 5.765 Spacing population) 4.4 18.4

Reported Infant and Child Deaths 16 16 Limiting 19.2 18.1

Reported Maternal Deaths 11 0 Total 13.2 36.5 * Total Maternal complications ( C-section deliveries + Eclampsia cases )treated against estimated maternal complication

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Jharkhand-Dhanbad - Apr'12 - Jan'13 AHS 2011

Population (Census-2011) Estimated Pregnancies ANC 2682662 72,711 ANC Check-up in first CBR (AHS-2011) 24.3 Estimated Deliveries 66,101 trimester 60.6 Apprehended Infant Deaths ( IMR = 3 or more ANC Check- 1825 Estimated Live Births 65,189 28 taken from AHS - 2011 ) up 70.6 Estimated Maternal Estimated Eligible couples ( 17% of Complications( 15% of Atleast 1 TT received population) 4,56,053 10,907 Estimated pregnancies) 90.8 Apr'12 - Projected for April'12 to Last Year Apr'11- Indicator 100 IFA Tablets Jan'13 Mar'13 Mar'12 20.3

3ANC Check up against estimated 49% 59% 28% Deliveries pregnancies Institutional Deliveries (Public+Private) against estimated 47% 56% 34% Institutional Delivery deliveries 46.9

Met need for EmOC * 51.99% 62% 25.07% Home Delivery 52.7

Reported Live Births against 59% 70% 51% Home Delivery by SBA estimated Live Births 35.6 New born & post BCG to Measles dropout rate 3% 3% -1% natal care Fully Immunised against estimated Abortion (Induced + 77% 93% 67% Live Births Spontaneous) 6.4 Immunisation session held as % of 90% 90% 78% Still Birth required VHNDs

Childhood Disease Diphtheria 4 4.8 3 Live Birth

Breastfed within 1 Childhood Disease Pertussis 0 0 8 hour of birth 34.1 PNC within 48 hrs of Childhood Disease Measles 176 211.2 1389 delivery 79.2 Childhood Disease Malaria 116 139.2 384 Immunisation

Sterilization - Female per 1000 BCG eligible couple 11.45 13.74 20.26 89.3

Sterilization - Male per 1000 DPT3 eligible couple 0.47 0.56 1.79 70.1

Reported Abortion Rate per 1000 6.4 7.9 Measeles Estimated live births 7.6 77.8

OPD All (per 1000 population) 131.1 169.6 Full immunisation 157.3 60.2

IPD (per 1000 population) 2.5 1.5 Unmet need for FP 3.0 Operation Major (per Lakh 35.9 66.166 Spacing population) 43.1 12.8

Reported Infant and Child Deaths 20 32 Limiting 6.3

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24.0

Reported Maternal Deaths 6 29 Total 7.2 19.1 * Total Maternal complications ( C-section deliveries + Eclampsia cases )treated against estimated maternal complication

Jharkhand-Dumka - Apr'12 - Jan'13 AHS 2011

Population (Census-2011) Estimated Pregnancies ANC 1321096 38,188 ANC Check-up in first CBR (AHS-2011) 25.7 Estimated Deliveries 34,716 trimester 53.0 Apprehended Infant Deaths ( IMR = 3 or more ANC Check- 1528 Estimated Live Births 33,952 45 taken from AHS - 2011 ) up 58.8 Estimated Maternal Estimated Eligible couples ( 17% of Complications( 15% of Atleast 1 TT received population) 2,24,586 5,728 Estimated pregnancies) 85.4 Apr'12 - Projected for April'12 to Last Year Apr'11- Indicator 100 IFA Tablets Jan'13 Mar'13 Mar'12 16.2 3ANC Check up against estimated 41% 49% 48% Deliveries pregnancies Institutional Deliveries (Public+Private) against estimated 36% 43% 42% Institutional Delivery deliveries 19.4

Met need for EmOC * 9.08% 11% 10.51% Home Delivery 80.4 Reported Live Births against 64% 76% 78% Home Delivery by SBA estimated Live Births 14.9 New born & post BCG to Measles dropout rate 3% 3% 0% natal care Fully Immunised against estimated Abortion (Induced + 64% 77% 74% Live Births Spontaneous) 3.8 Immunisation session held as % of 138% 138% 135% Still Birth required VHNDs

Childhood Disease Diphtheria 0 0 30 Live Birth

Breastfed within 1 Childhood Disease Pertussis 0 0 6 hour of birth 39.1 PNC within 48 hrs of Childhood Disease Measles 141 169.2 395 delivery 53.8 Childhood Disease Malaria 1145 1374 2879 Immunisation Sterilization - Female per 1000 BCG eligible couple 8.99 10.79 15.32 89.2 Sterilization - Male per 1000 DPT3 eligible couple 0.68 0.82 0.63 71.8 Reported Abortion Rate per 1000 49.2 46.6 Measeles Estimated live births 59.0 75.2

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OPD All (per 1000 population) 363.5 445.0 Full immunisation 436.1 59.8

IPD (per 1000 population) 13.7 14.6 Unmet need for FP 16.5 Operation Major (per Lakh 98.3 93.407 Spacing population) 118.0 15.7

Reported Infant and Child Deaths 23 25 Limiting 27.6 14.8

Reported Maternal Deaths 23 28 Total 27.6 30.5 * Total Maternal complications ( C-section deliveries + Eclampsia cases )treated against estimated maternal complication

Jharkhand-Garhwa - Apr'12 - Jan'13 AHS 2011

Population (Census-2011) Estimated Pregnancies ANC 1322387 35,312 ANC Check-up in first CBR (AHS-2011) 23.8 Estimated Deliveries 32,102 trimester 38.6 Apprehended Infant Deaths ( IMR = 3 or more ANC Check- 1259 Estimated Live Births 31,473 40 taken from AHS - 2011 ) up 22.1 Estimated Maternal Estimated Eligible couples ( 17% of Complications( 15% of Atleast 1 TT received population) 2,24,806 5,297 Estimated pregnancies) 70.0 Apr'12 - Projected for April'12 to Last Year Indicator 100 IFA Tablets Jan'13 Mar'13 Apr'11-Mar'12 4.4 3ANC Check up against estimated 36% 43% 42% Deliveries pregnancies Institutional Deliveries (Public+Private) against estimated 53% 64% 51% Institutional Delivery deliveries 30.2 Met need for EmOC * 0.76% 1% 0.93% Home Delivery 69.5 Reported Live Births against 67% 80% 72% Home Delivery by SBA estimated Live Births 50.1 New born & post BCG to Measles dropout rate 17% 17% 2% natal care Fully Immunised against estimated Abortion (Induced + 65% 78% 82% Live Births Spontaneous) 2.2 Immunisation session held as % of 87% 87% 84% Still Birth required VHNDs Childhood Disease Diphtheria 0 0 12 Live Birth Breastfed within 1 Childhood Disease Pertussis 33 39.6 0 hour of birth 18.6 PNC within 48 hrs of Childhood Disease Measles 193 231.6 419 delivery 49.9 Childhood Disease Malaria 3519 4222.8 4730 Immunisation Sterilization - Female per 1000 BCG eligible couple 13.25 15.90 39.57 89.4 Sterilization - Male per 1000 DPT3 eligible couple 0.09 0.11 0.24 74.9

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Reported Abortion Rate per 1000 1.4 3.4 Measeles Estimated live births 1.6 79.9

OPD All (per 1000 population) 267.6 336.2 Full immunisation 321.1 68.0

IPD (per 1000 population) 15.7 12.7 Unmet need for FP 18.8 Operation Major (per Lakh 63.9 43.860 Spacing population) 76.7 13.8

Reported Infant and Child Deaths 69 35 Limiting 82.8 10.7

Reported Maternal Deaths 35 12 Total 42.0 24.5 * Total Maternal complications ( C-section deliveries + Eclampsia cases )treated against estimated maternal complication

Jharkhand-Giridih - Apr'12 - Jan'13 AHS 2011

Population (Census-2011) Estimated Pregnancies ANC 2445203 61,608 ANC Check-up in first CBR (AHS-2011) 22.5 Estimated Deliveries 56,007 trimester 52.7 Apprehended Infant Deaths ( IMR = 3 or more ANC Check- 1981 Estimated Live Births 55,017 36 taken from AHS - 2011 ) up 55.9 Estimated Maternal Estimated Eligible couples ( 17% of Complications( 15% of Atleast 1 TT received population) 4,15,685 9,241 Estimated pregnancies) 78.4 Apr'12 - Projected for April'12 to Last Year Apr'11- Indicator 100 IFA Tablets Jan'13 Mar'13 Mar'12 11.7

3ANC Check up against estimated 39% 46% 36% Deliveries pregnancies Institutional Deliveries (Public+Private) against estimated 42% 51% 26% Institutional Delivery deliveries 26.5

Met need for EmOC * 19.25% 23% 1.05% Home Delivery 73.2

Reported Live Births against 69% 83% 55% Home Delivery by SBA estimated Live Births 26.7 New born & post BCG to Measles dropout rate 7% 7% 8% natal care Fully Immunised against estimated Abortion (Induced + 86% 103% 70% Live Births Spontaneous) 4.1 Immunisation session held as % of 81% 81% 86% Still Birth required VHNDs

Childhood Disease Diphtheria 0 0 0 Live Birth

Breastfed within 1 Childhood Disease Pertussis 0 0 0 hour of birth 26.2 PNC within 48 hrs of Childhood Disease Measles 153 183.6 682 delivery 63.0

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Childhood Disease Malaria 926 1111.2 1740 Immunisation

Sterilization - Female per 1000 BCG eligible couple 10.95 13.14 6.36 84.4

Sterilization - Male per 1000 DPT3 eligible couple 0.94 1.13 1.61 40.4

Reported Abortion Rate per 1000 6.7 10.5 Measeles Estimated live births 8.0 59.1

OPD All (per 1000 population) 101.9 118.2 Full immunisation 122.3 28.0

IPD (per 1000 population) 3.6 3.5 Unmet need for FP 4.3 Operation Major (per Lakh 0.4 42.982 Spacing population) 0.5 21.0

Reported Infant and Child Deaths 11 8 Limiting 13.2 19.5

Reported Maternal Deaths 12 8 Total 14.4 40.5 * Total Maternal complications ( C-section deliveries + Eclampsia cases )treated against estimated maternal complication

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Jharkhand-Godda - Apr'12 - Jan'13 AHS 2011

Population (Census-2011) Estimated Pregnancies ANC 1311382 35,133 ANC Check-up in first CBR (AHS-2011) 23.6 Estimated Deliveries 31,939 trimester 42.1 Apprehended Infant Deaths ( IMR = 3 or more ANC Check- 1981 Estimated Live Births 30,949 64 taken from AHS - 2011 ) up 29.7 Estimated Maternal Estimated Eligible couples ( 17% of Complications( 15% of Atleast 1 TT received population) 2,22,935 5,270 Estimated pregnancies) 66.7 Apr'12 - Projected for April'12 to Last Year Apr'11- Indicator 100 IFA Tablets Jan'13 Mar'13 Mar'12 9.8

3ANC Check up against estimated 53% 64% 55% Deliveries pregnancies Institutional Deliveries (Public+Private) against estimated 51% 61% 48% Institutional Delivery deliveries 24.4

Met need for EmOC * 3.74% 4% 5.10% Home Delivery 75.2

Reported Live Births against 73% 87% 82% Home Delivery by SBA estimated Live Births 35.3 New born & post BCG to Measles dropout rate 9% 9% 14% natal care Fully Immunised against estimated Abortion (Induced + 67% 81% 83% Live Births Spontaneous) 1.9 Immunisation session held as % of 110% 110% 105% Still Birth required VHNDs

Childhood Disease Diphtheria 0 0 0 Live Birth

Breastfed within 1 Childhood Disease Pertussis 0 0 0 hour of birth 34.7 PNC within 48 hrs of Childhood Disease Measles 193 231.6 423 delivery 51.4 Childhood Disease Malaria 579 694.8 1079 Immunisation

Sterilization - Female per 1000 BCG eligible couple 13.95 16.75 21.19 87.2

Sterilization - Male per 1000 DPT3 eligible couple 1.12 1.34 3.15 55.3

Reported Abortion Rate per 1000 6.2 8.8 Measeles Estimated live births 7.4 69.1

OPD All (per 1000 population) 222.6 246.6 Full immunisation 267.1 44.1

IPD (per 1000 population) 16.8 34.7 Unmet need for FP 20.1 Operation Major (per Lakh 35.5 79.458 Spacing population) 42.6 21.6

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Reported Infant and Child Deaths 3 5 Limiting 3.6 21.2

Reported Maternal Deaths 5 4 Total 6.0 42.8 * Total Maternal complications ( C-section deliveries + Eclampsia cases )treated against estimated maternal complication

Jharkhand-Gumla - Apr'12 - Jan'13 AHS 2011

Population (Census-2011) Estimated Pregnancies ANC 1025656 30,038 ANC Check-up in first CBR (AHS-2011) 26 Estimated Deliveries 27,307 trimester 53.0 Apprehended Infant Deaths ( IMR = 3 or more ANC Check- 1280 Estimated Live Births 26,667 48 taken from AHS - 2011 ) up 41.2 Estimated Maternal Estimated Eligible couples ( 17% of Complications( 15% of Atleast 1 TT received population) 1,74,362 4,506 Estimated pregnancies) 92.1 Apr'12 - Projected for April'12 to Last Year Apr'11- Indicator 100 IFA Tablets Jan'13 Mar'13 Mar'12 12.2 3ANC Check up against estimated 46% 55% 55% Deliveries pregnancies Institutional Deliveries (Public+Private) against estimated 47% 56% 51% Institutional Delivery deliveries 25.6

Met need for EmOC * 5.39% 6% 9.23% Home Delivery 74.3

Reported Live Births against 63% 75% 81% Home Delivery by SBA estimated Live Births 17.6 New born & post BCG to Measles dropout rate -5% -5% 0% natal care Fully Immunised against estimated Abortion (Induced + 58% 70% 75% Live Births Spontaneous) 2.0 Immunisation session held as % of 156% 156% 151% Still Birth required VHNDs

Childhood Disease Diphtheria 0 0 27 Live Birth

Breastfed within 1 Childhood Disease Pertussis 0 0 0 hour of birth 40.5 PNC within 48 hrs of Childhood Disease Measles 80 96 241 delivery 34.5 Childhood Disease Malaria 623 747.6 752 Immunisation Sterilization - Female per 1000 BCG eligible couple 7.85 9.41 13.97 94.3 Sterilization - Male per 1000 eligible DPT3 couple 4.03 4.83 7.44 76.8 Reported Abortion Rate per 1000 104.3 100.8 Measeles Estimated live births 125.2 85.3

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OPD All (per 1000 population) 393.0 423.5 Full immunisation 471.6 71.5

IPD (per 1000 population) 19.8 19.2 Unmet need for FP 23.8 Operation Major (per Lakh 24.1 47.092 Spacing population) 28.9 18.7

Reported Infant and Child Deaths 102 33 Limiting 122.4 15.1

Reported Maternal Deaths 31 18 Total 37.2 33.8 * Total Maternal complications ( C-section deliveries + Eclampsia cases )treated against estimated maternal complication

Jharkhand-Hazaribagh - Apr'12 - Jan'13 AHS 2011

Population (Census-2011) Estimated Pregnancies ANC 1734005 39,825 ANC Check-up in first CBR (AHS-2011) 20.5 Estimated Deliveries 36,205 trimester 64.1 Apprehended Infant Deaths ( IMR = 3 or more ANC Check- 1315 Estimated Live Births 35,547 37 taken from AHS - 2011 ) up 64.5 Estimated Maternal Estimated Eligible couples ( 17% of Complications( 15% of Atleast 1 TT received population) 2,94,781 5,974 Estimated pregnancies) 90.8 Apr'12 - Projected for April'12 to Last Year Apr'11- Indicator 100 IFA Tablets Jan'13 Mar'13 Mar'12 9.4 3ANC Check up against estimated 39% 47% 59% Deliveries pregnancies Institutional Deliveries (Public+Private) against estimated 64% 76% 63% Institutional Delivery deliveries 44.0

Met need for EmOC * 10.26% 12% 11.78% Home Delivery 55.6

Reported Live Births against 91% 109% 101% Home Delivery by SBA estimated Live Births 34.2 New born & post BCG to Measles dropout rate 12% 12% 9% natal care Fully Immunised against estimated Abortion (Induced + 79% 94% 103% Live Births Spontaneous) 5.6 Immunisation session held as % of 88% 88% 83% Still Birth required VHNDs

Childhood Disease Diphtheria 33 39.6 3 Live Birth

Breastfed within 1 Childhood Disease Pertussis 0 0 0 hour of birth 30.5 PNC within 48 hrs of Childhood Disease Measles 140 168 360 delivery 75.0 Childhood Disease Malaria 333 399.6 811 Immunisation Sterilization - Female per 1000 BCG eligible couple 16.29 19.54 36.44 97.0

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Sterilization - Male per 1000 eligible DPT3 couple 0.22 0.27 0.49 82.9 Reported Abortion Rate per 1000 14.8 17.9 Measeles Estimated live births 17.8 84.3

OPD All (per 1000 population) 216.5 232.2 Full immunisation 259.8 76.4

IPD (per 1000 population) 54.0 90.6 Unmet need for FP 64.8 Operation Major (per Lakh 18.2 34.487 Spacing population) 21.8 14.4

Reported Infant and Child Deaths 75 62 Limiting 90.0 12.9

Reported Maternal Deaths 25 41 Total 30.0 27.3 * Total Maternal complications ( C-section deliveries + Eclampsia cases )treated against estimated maternal complication

Jharkhand-Jamtara - Apr'12 - Jan'13 AHS 2011

Population (Census-2011) Estimated Pregnancies ANC 790207 18,149 ANC Check-up in first CBR (AHS-2011) 20.5 Estimated Deliveries 16,499 trimester 64.1 Apprehended Infant Deaths ( IMR = 3 or more ANC Check- 599 Estimated Live Births 16,199 37 taken from AHS - 2011 ) up 64.5 Estimated Maternal Estimated Eligible couples ( 17% of Complications( 15% of Atleast 1 TT received population) 1,34,335 2,722 Estimated pregnancies) 90.8 Apr'12 - Projected for April'12 to Last Year Apr'11- Indicator 100 IFA Tablets Jan'13 Mar'13 Mar'12 9.4

3ANC Check up against estimated 49% 59% 65% Deliveries pregnancies Institutional Deliveries (Public+Private) against estimated 47% 57% 50% Institutional Delivery deliveries 44.0

Met need for EmOC * 0.48% 1% 3.31% Home Delivery 55.6

Reported Live Births against 79% 94% 101% Home Delivery by SBA estimated Live Births 34.2 New born & post BCG to Measles dropout rate -8% -8% 15% natal care Fully Immunised against estimated Abortion (Induced + 76% 91% 90% Live Births Spontaneous) 5.6 Immunisation session held as % of 128% 128% 122% Still Birth required VHNDs

Childhood Disease Diphtheria 24 28.8 37 Live Birth

Breastfed within 1 Childhood Disease Pertussis 0 0 17 hour of birth 30.5

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PNC within 48 hrs of Childhood Disease Measles 58 69.6 212 delivery 75.0 Childhood Disease Malaria 184 220.8 272 Immunisation Sterilization - Female per 1000 BCG eligible couple 10.27 12.32 21.16 97.0 Sterilization - Male per 1000 DPT3 eligible couple 0.19 0.22 0.69 82.9 Reported Abortion Rate per 1000 12.5 14.0 Measeles Estimated live births 15.0 84.3

OPD All (per 1000 population) 343.8 328.7 Full immunisation 412.5 76.4

IPD (per 1000 population) 20.6 34.7 Unmet need for FP 24.7 Operation Major (per Lakh 10.6 0.000 Spacing population) 12.8 14.4

Reported Infant and Child Deaths 18 16 Limiting 21.6 12.9

Reported Maternal Deaths 11 2 Total 13.2 27.3 * Total Maternal complications ( C-section deliveries + Eclampsia cases )treated against estimated maternal complication

Jharkhand-Kodarma - Apr'12 - Jan'13 AHS 2011

Population (Census-2011) Estimated Pregnancies ANC 717169 18,632 ANC Check-up in first CBR (AHS-2011) 23.2 Estimated Deliveries 16,938 trimester 62.6 Apprehended Infant Deaths ( IMR = 3 or more ANC Check- 599 Estimated Live Births 16,638 36 taken from AHS - 2011 ) up 65.9 Estimated Maternal Estimated Eligible couples ( 17% of Complications( 15% of Atleast 1 TT received population) 1,21,919 2,795 Estimated pregnancies) 89.5 Apr'12 - Projected for April'12 to Last Year Apr'11- Indicator 100 IFA Tablets Jan'13 Mar'13 Mar'12 10.0

3ANC Check up against estimated 39% 47% 39% Deliveries pregnancies Institutional Deliveries (Public+Private) against estimated 71% 85% 71% Institutional Delivery deliveries 45.8

Met need for EmOC * 61.97% 74% 61.79% Home Delivery 53.9

Reported Live Births against 82% 98% 89% Home Delivery by SBA estimated Live Births 54.5 New born & post BCG to Measles dropout rate 29% 29% 11% natal care Fully Immunised against estimated Abortion (Induced + 65% 78% 73% Live Births Spontaneous) 2.8 Immunisation session held as % of 81% 81% 73% Still Birth required VHNDs

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Childhood Disease Diphtheria 0 0 0 Live Birth

Breastfed within 1 Childhood Disease Pertussis 0 0 12 hour of birth 31.8 PNC within 48 hrs of Childhood Disease Measles 46 55.2 115 delivery 82.6 Childhood Disease Malaria 241 289.2 951 Immunisation

Sterilization - Female per 1000 BCG eligible couple 35.75 42.90 42.02 95.8 Sterilization - Male per 1000 DPT3 eligible couple 0.37 0.44 1.10 70.9 Reported Abortion Rate per 1000 10.6 4.2 Measeles Estimated live births 12.7 78.1

OPD All (per 1000 population) 186.5 244.6 Full immunisation 223.8 58.5

IPD (per 1000 population) 10.4 10.0 Unmet need for FP 12.5 Operation Major (per Lakh 0.0 0.000 Spacing population) - 18.3

Reported Infant and Child Deaths 23 17 Limiting 27.6 16.0

Reported Maternal Deaths 6 13 Total 7.2 34.3 * Total Maternal complications ( C-section deliveries + Eclampsia cases )treated against estimated maternal complication

Jharkhand-Kodarma - Apr'12 - Jan'13 AHS 2011

3ANC Check up against estimated 39% 47% 39% Deliveries pregnancies Institutional Deliveries (Public+Private) against estimated 71% 85% 71% Institutional Delivery deliveries 45.8

Met need for EmOC * 61.97% 74% 61.79% Home Delivery 53.9

Reported Live Births against 82% 98% 89% Home Delivery by SBA estimated Live Births 54.5

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New born & post BCG to Measles dropout rate 29% 29% 11% natal care Fully Immunised against estimated Abortion (Induced + 65% 78% 73% Live Births Spontaneous) 2.8 Immunisation session held as % of 81% 81% 73% Still Birth required VHNDs

Childhood Disease Diphtheria 0 0 0 Live Birth

Breastfed within 1 Childhood Disease Pertussis 0 0 12 hour of birth 31.8 PNC within 48 hrs of Childhood Disease Measles 46 55.2 115 delivery 82.6 Childhood Disease Malaria 241 289.2 951 Immunisation Sterilization - Female per 1000 BCG eligible couple 35.75 42.90 42.02 95.8 Sterilization - Male per 1000 DPT3 eligible couple 0.37 0.44 1.10 70.9 Reported Abortion Rate per 1000 10.6 4.2 Measeles Estimated live births 12.7 78.1

OPD All (per 1000 population) 186.5 244.6 Full immunisation 223.8 58.5

IPD (per 1000 population) 10.4 10.0 Unmet need for FP 12.5 Operation Major (per Lakh 0.0 0.000 Spacing population) - 18.3

Reported Infant and Child Deaths 23 17 Limiting 27.6 16.0

Reported Maternal Deaths 6 13 Total 7.2 34.3 * Total Maternal complications ( C-section deliveries + Eclampsia cases )treated against estimated maternal complication

Jharkhand-Latehar - Apr'12 - Jan'13 AHS 2011

Met need for EmOC * 0.29% 0% 61.79% Home Delivery 53.9

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Reported Live Births against 87% 105% 89% Home Delivery by SBA estimated Live Births 54.5 New born & post BCG to Measles dropout rate 5% 5% 11% natal care Fully Immunised against estimated Abortion (Induced + 68% 82% 73% Live Births Spontaneous) 2.8 Immunisation session held as % of 134% 134% 73% Still Birth required VHNDs

Childhood Disease Diphtheria 0 0 0 Live Birth

Breastfed within 1 Childhood Disease Pertussis 0 0 12 hour of birth 31.8 PNC within 48 hrs of Childhood Disease Measles 16 19.2 115 delivery 82.6 Childhood Disease Malaria 456 547.2 951 Immunisation Sterilization - Female per 1000 BCG eligible couple 12.36 14.83 42.02 95.8 Sterilization - Male per 1000 DPT3 eligible couple 0.55 0.66 1.10 70.9 Reported Abortion Rate per 1000 15.7 4.2 Measeles Estimated live births 18.8 78.1

OPD All (per 1000 population) 596.9 244.6 Full immunisation 716.3 58.5

IPD (per 1000 population) 10.5 10.0 Unmet need for FP 12.6 Operation Major (per Lakh 49.1 0.000 Spacing population) 58.9 18.3

Reported Infant and Child Deaths 40 17 Limiting 48.0 16.0

Reported Maternal Deaths 5 13 Total 6.0 34.3 * Total Maternal complications ( C-section deliveries + Eclampsia cases )treated against estimated maternal complication

Jharkhand-Lohardaga - Apr'12 - Jan'13 AHS 2011

Population (Census-2011) Estimated Pregnancies ANC 461738 14,553 ANC Check-up in first CBR (AHS-2011) 27.9 Estimated Deliveries 13,230 trimester 54.0 Apprehended Infant Deaths ( IMR = 3 or more ANC Check- 696 Estimated Live Births 12,882 54 taken from AHS - 2011 ) up 50.0 Estimated Maternal Estimated Eligible couples ( 17% of Complications( 15% of Atleast 1 TT received population) 78,495 2,183 Estimated pregnancies) 93.7 Apr'12 - Projected for April'12 to Last Year Apr'11- Indicator 100 IFA Tablets Jan'13 Mar'13 Mar'12 12.3 3ANC Check up against estimated 41% 49% 49% Deliveries pregnancies

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Institutional Deliveries (Public+Private) against estimated 57% 68% 60% Institutional Delivery deliveries 38.6

Met need for EmOC * 27.90% 33% 34.49% Home Delivery 60.5

Reported Live Births against 66% 79% 83% Home Delivery by SBA estimated Live Births 15.2 New born & post BCG to Measles dropout rate -4% -4% 7% natal care Fully Immunised against estimated Abortion (Induced + 71% 85% 78% Live Births Spontaneous) 5.8 Immunisation session held as % of 146% 146% 135% Still Birth required VHNDs

Childhood Disease Diphtheria 0 0 0 Live Birth

Breastfed within 1 Childhood Disease Pertussis 0 0 0 hour of birth 60.2 PNC within 48 hrs of Childhood Disease Measles 26 31.2 65 delivery 52.6 Childhood Disease Malaria 120 144 254 Immunisation Sterilization - Female per 1000 BCG eligible couple 13.50 16.20 22.15 95.5 Sterilization - Male per 1000 DPT3 eligible couple 2.45 2.94 5.08 83.8 Reported Abortion Rate per 1000 22.7 45.6 Measeles Estimated live births 27.2 95.1

OPD All (per 1000 population) 421.2 445.1 Full immunisation 505.4 82.5

IPD (per 1000 population) 10.9 38.0 Unmet need for FP 13.1 Operation Major (per Lakh 21.7 186.036 Spacing population) 26.0 17.4

Reported Infant and Child Deaths 11 9 Limiting 13.2 10.8

Reported Maternal Deaths 4 1 Total 4.8 28.2 * Total Maternal complications ( C-section deliveries + Eclampsia cases )treated against estimated maternal complication

Jharkhand-Pakaur - Apr'12 - Jan'13 AHS 2011

Population (Census-2011) Estimated Pregnancies ANC 899200 30,243 ANC Check-up in first CBR (AHS-2011) 29.7 Estimated Deliveries 27,494 trimester 39.4 Apprehended Infant Deaths ( IMR = 3 or more ANC Check- 1576 Estimated Live Births 26,706 59 taken from AHS - 2011 ) up 49.7 Estimated Maternal Estimated Eligible couples ( 17% of Complications( 15% of Atleast 1 TT received population) 1,52,864 4,537 Estimated pregnancies) 90.0 Apr'12 - Projected for April'12 to Last Year Apr'11- Indicator 100 IFA Tablets Jan'13 Mar'13 Mar'12 4.4

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3ANC Check up against estimated 33% 39% 41% Deliveries pregnancies Institutional Deliveries (Public+Private) against estimated 28% 34% 28% Institutional Delivery deliveries 20.8

Met need for EmOC * 1.06% 1% 2.91% Home Delivery 79.2

Reported Live Births against 54% 65% 65% Home Delivery by SBA estimated Live Births 7.3 New born & post BCG to Measles dropout rate -10% -10% 13% natal care Fully Immunised against estimated Abortion (Induced + 55% 66% 64% Live Births Spontaneous) 2.4 Immunisation session held as % of 115% 115% 115% Still Birth required VHNDs

Childhood Disease Diphtheria 0 0 0 Live Birth

Breastfed within 1 hour Childhood Disease Pertussis 0 0 0 of birth 24.1 PNC within 48 hrs of Childhood Disease Measles 8 9.6 42 delivery 67.6 Childhood Disease Malaria 435 522 414 Immunisation Sterilization - Female per 1000 BCG eligible couple 8.90 10.68 12.87 91.3 Sterilization - Male per 1000 eligible DPT3 couple 0.29 0.35 0.88 72.4 Reported Abortion Rate per 1000 8.2 2.4 Measeles Estimated live births 9.8 61.6

OPD All (per 1000 population) 220.2 274.1 Full immunisation 264.3 45.7

IPD (per 1000 population) 9.2 9.3 Unmet need for FP 11.0 Operation Major (per Lakh 1.1 7.451 Spacing population) 1.3 17.1

Reported Infant and Child Deaths 3 1 Limiting 3.6 23.1

Reported Maternal Deaths 4 2 Total 4.8 40.2 * Total Maternal complications ( C-section deliveries + Eclampsia cases )treated against estimated maternal complication

Jharkhand-Palamu - Apr'12 - Jan'13 AHS 2011

Population (Census-2011) Estimated Pregnancies ANC 1936319 49,753 ANC Check-up in first CBR (AHS-2011) 22.8 Estimated Deliveries 45,230 trimester 38.4

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Apprehended Infant Deaths ( IMR = 3 or more ANC Check- 2163 Estimated Live Births 44,148 49 taken from AHS - 2011 ) up 34.8 Estimated Maternal Estimated Eligible couples ( 17% of Complications( 15% of Atleast 1 TT received population) 3,29,174 7,463 Estimated pregnancies) 75.2 Apr'12 - Projected for April'12 to Last Year Apr'11- Indicator 100 IFA Tablets Jan'13 Mar'13 Mar'12 8.3

3ANC Check up against estimated 51% 61% 62% Deliveries pregnancies Institutional Deliveries (Public+Private) against estimated 46% 56% 46% Institutional Delivery deliveries 31.0

Met need for EmOC * 33.70% 40% 5.78% Home Delivery 68.9

Reported Live Births against 67% 81% 73% Home Delivery by SBA estimated Live Births 19.1 New born & post BCG to Measles dropout rate 7% 7% 8% natal care Fully Immunised against estimated Abortion (Induced + 70% 84% 80% Live Births Spontaneous) 2.9 Immunisation session held as % of 89% 89% 90% Still Birth required VHNDs

Childhood Disease Diphtheria 4 4.8 10 Live Birth

Breastfed within 1 Childhood Disease Pertussis 0 0 7 hour of birth 31.7 PNC within 48 hrs of Childhood Disease Measles 98 117.6 383 delivery 56.4 Childhood Disease Malaria 777 932.4 2772 Immunisation Sterilization - Female per 1000 BCG eligible couple 15.00 18.00 32.65 91.1 Sterilization - Male per 1000 DPT3 eligible couple 0.42 0.50 2.04 65.2 Reported Abortion Rate per 1000 5.9 9.8 Measeles Estimated live births 7.1 69.2

OPD All (per 1000 population) 317.5 390.5 Full immunisation 381.0 54.2

IPD (per 1000 population) 17.7 24.2 Unmet need for FP 21.2 Operation Major (per Lakh 63.8 33.362 Spacing population) 76.5 16.6

Reported Infant and Child Deaths 1 7 Limiting 1.2 16.9

Reported Maternal Deaths 24 1 Total 28.8 33.5 * Total Maternal complications ( C-section deliveries + Eclampsia cases )treated against estimated maternal complication

Jharkhand-Purbi Singhbhum - Apr'12 - Jan'13 AHS 2011

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Population (Census-2011) Estimated Pregnancies ANC 2291032 53,611 ANC Check-up in first CBR (AHS-2011) 21 Estimated Deliveries 48,737 trimester 72.3 Apprehended Infant Deaths ( IMR = 3 or more ANC Check- 1251 Estimated Live Births 48,112 26 taken from AHS - 2011 ) up 76.4 Estimated Maternal Estimated Eligible couples ( 17% of Complications( 15% of Atleast 1 TT received population) 3,89,475 8,042 Estimated pregnancies) 95.0 Apr'12 - Projected for April'12 to Last Year Apr'11- Indicator 100 IFA Tablets Jan'13 Mar'13 Mar'12 35.1 3ANC Check up against estimated 52% 62% 67% Deliveries pregnancies Institutional Deliveries (Public+Private) against estimated 53% 63% 62% Institutional Delivery deliveries 63.0

Met need for EmOC * 43.66% 52% 37.38% Home Delivery 36.8

Reported Live Births against 63% 75% 78% Home Delivery by SBA estimated Live Births 25.2 New born & post BCG to Measles dropout rate 9% 9% 10% natal care Fully Immunised against estimated Abortion (Induced + 67% 81% 82% Live Births Spontaneous) 3.5 Immunisation session held as % of 77% 77% 82% Still Birth required VHNDs

Childhood Disease Diphtheria 0 0 0 Live Birth

Breastfed within 1 Childhood Disease Pertussis 0 0 0 hour of birth 52.0 PNC within 48 hrs of Childhood Disease Measles 181 217.2 334 delivery 67.5 Childhood Disease Malaria 516 619.2 887 Immunisation Sterilization - Female per 1000 BCG eligible couple 13.26 15.92 16.68 97.1 Sterilization - Male per 1000 DPT3 eligible couple 0.36 0.43 0.54 86.4 Reported Abortion Rate per 1000 33.9 41.0 Measeles Estimated live births 40.7 93.0

OPD All (per 1000 population) 559.4 683.5 Full immunisation 671.2 82.7

IPD (per 1000 population) 16.6 25.6 Unmet need for FP 20.0 Operation Major (per Lakh 336.7 494.057 Spacing population) 404.0 11.5

Reported Infant and Child Deaths 174 170 Limiting 208.8 9.6

Reported Maternal Deaths 36 52 Total 43.2 21.1 * Total Maternal complications ( C-section deliveries + Eclampsia cases )treated against estimated maternal complication

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Jharkhand-Ranchi - Apr'12 - Jan'13 AHS 2011

Population (Census-2011) Estimated Pregnancies ANC 2912022 76,593 ANC Check-up in first CBR (AHS-2011) 23.5 Estimated Deliveries 69,630 trimester 69.9 Apprehended Infant Deaths ( IMR = 3 or more ANC Check- 2395 Estimated Live Births 68,433 35 taken from AHS - 2011 ) up 63.2 Estimated Maternal Estimated Eligible couples ( 17% of Complications( 15% of Atleast 1 TT received population) 4,95,044 11,489 Estimated pregnancies) 93.0 Apr'12 - Projected for April'12 to Last Year Apr'11- Indicator 100 IFA Tablets Jan'13 Mar'13 Mar'12 14.8

3ANC Check up against estimated 35% 42% 47% Deliveries pregnancies Institutional Deliveries (Public+Private) against estimated 50% 60% 60% Institutional Delivery deliveries 52.3

Met need for EmOC * 63.57% 76% 54.46% Home Delivery 47.0

Reported Live Births against 61% 74% 78% Home Delivery by SBA estimated Live Births 36.4 New born & post BCG to Measles dropout rate 11% 11% -24% natal care Fully Immunised against estimated Abortion (Induced + 50% 59% 99% Live Births Spontaneous) 5.2 Immunisation session held as % of 82% 82% 91% Still Birth required VHNDs

Childhood Disease Diphtheria 0 0 23 Live Birth

Breastfed within 1 Childhood Disease Pertussis 0 0 0 hour of birth 46.5 PNC within 48 hrs of Childhood Disease Measles 144 172.8 520 delivery 63.3 Childhood Disease Malaria 2163 2595.6 3695 Immunisation

Sterilization - Female per 1000 BCG eligible couple 9.09 10.91 15.18 94.5

Sterilization - Male per 1000 DPT3 eligible couple 1.60 1.92 2.03 80.9

Reported Abortion Rate per 1000 56.3 68.4 Measeles Estimated live births 67.5 89.7

OPD All (per 1000 population) 367.6 364.7 Full immunisation 441.1 76.4

IPD (per 1000 population) 9.1 8.4 Unmet need for FP 10.9 Operation Major (per Lakh 0.5 57.795 Spacing population) 0.7 16.2

Reported Infant and Child Deaths 40 31 Limiting 15.9

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48.0

Reported Maternal Deaths 38 19 Total 45.6 32.1 * Total Maternal complications ( C-section deliveries + Eclampsia cases )treated against estimated maternal complication

Jharkhand-Sahibganj - Apr'12 - Jan'13 AHS 2011

Population (Census-2011) Estimated Pregnancies ANC 1150038 31,778 ANC Check-up in first CBR (AHS-2011) 24.4 Estimated Deliveries 28,889 trimester 49.1 Apprehended Infant Deaths ( IMR = 3 or more ANC Check- 1656 Estimated Live Births 28,061 59 taken from AHS - 2011 ) up 35.4 Estimated Maternal Estimated Eligible couples ( 17% of Complications( 15% of Atleast 1 TT received population) 1,95,506 4,767 Estimated pregnancies) 78.0 Apr'12 - Projected for April'12 to Last Year Apr'11- Indicator 100 IFA Tablets Jan'13 Mar'13 Mar'12 4.1

3ANC Check up against estimated 33% 39% 41% Deliveries pregnancies Institutional Deliveries (Public+Private) against estimated 61% 73% 42% Institutional Delivery deliveries 22.8

Met need for EmOC * 9.25% 11% 7.78% Home Delivery 76.9

Reported Live Births against 80% 96% 78% Home Delivery by SBA estimated Live Births 13.1 New born & post BCG to Measles dropout rate 7% 7% 5% natal care Fully Immunised against estimated Abortion (Induced + 65% 78% 84% Live Births Spontaneous) 2.5 Immunisation session held as % of 102% 102% 97% Still Birth required VHNDs

Childhood Disease Diphtheria 0 0 0 Live Birth

Breastfed within 1 Childhood Disease Pertussis 0 0 0 hour of birth 28.6 PNC within 48 hrs of Childhood Disease Measles 75 90 146 delivery 49.6 Childhood Disease Malaria 458 549.6 709 Immunisation Sterilization - Female per 1000 BCG eligible couple 8.28 9.94 14.50 88.0 Sterilization - Male per 1000 DPT3 eligible couple 0.11 0.13 0.31 71.7 Reported Abortion Rate per 1000 12.2 22.0 Measeles Estimated live births 14.6 63.5

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OPD All (per 1000 population) 281.3 372.7 Full immunisation 337.6 54.9

IPD (per 1000 population) 26.6 25.8 Unmet need for FP 32.0 Operation Major (per Lakh 60.2 95.127 Spacing population) 72.2 20.6

Reported Infant and Child Deaths 70 57 Limiting 84.0 18.0

Reported Maternal Deaths 33 24 Total 39.6 38.6 * Total Maternal complications ( C-section deliveries + Eclampsia cases )treated against estimated maternal complication

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