Sitamarhi District Health Society, Sitamarhi

Developed & Designed

 Mr.Durgesh Kumar (DPM)  Mr. Upendra Kr. Jha (DPC)  Mr. Binay Bhushan (BHM)

Dr. Omprakash Panjiyar Mr.Daya Nidhan Pandey, IAS Civil Surgeon cum Member Secretary District Magistrate cum Chairman District Health Society, Sitamarhi District Health Society, Sitamarhi

DHS Sitamarhi

Foreword

Recognizing the importance of Health in the process of economic and social development and improving the quality of life of our citizens, the Government of India has resolved to launch the National Rural Health Mission to carry out necessary architectural correction in the basic health care delivery system.

This District Health Action Plan (DHAP) is one of the key instruments to achieve NRHM goals. This plan is based on health needs of the district.

After a thorough situational analysis of district health scenario this document has been prepared. In the plan, it is addressing health care needs of rural poor especially women and children, the teams have analyzed the coverage of poor women and children with preventive and promotive interventions, barriers in access to health care and spread of human resources catering health needs in the district. The focus has also been given on current availability of health care infrastructure in pubic/NGO/private sector, availability of wide range of providers. This DHAP has been evolved through a participatory and consultative process, wherein community and other stakeholders have participated and ascertained their specific health needs in villages, problems in accessing health services, especially poor women and children at local level.

The goals of the Mission are to improve the availability of and access to quality health care by people, especially for those residing in rural areas, the poor, women and children.

I need to congratulate the department of Health and Family Welfare and State Health Society of Bihar for their dynamic leadership of the health sector reform programme and we look forward to a rigorous and analytic documentation of their experiences so that we can learn from them and replicate successful strategies. I also appreciate their decision to invite consultants (NHSRC/ PHRN) to facilitate our DHS regarding preparation the DHAP. The proposed location of HSCs, PHCs and its service area reorganized with the consent of ANM, AWW, male health worker and participation of community has finalized in the block level meeting.

I am sure that this excellent report will galvanize the leaders and administrators of the primary health care system in the district, enabling them to go into details of implementation based on lessons drawn from this study.

Mr.Daya Nidhan Pandey, IAS DM cum Chairman District Health Society, Sitamarhi

Foreword

In a plan which is centrally made and driven, there is little room for such adaptation. District level planning is a necessary component of any effort at decentralization.

Districts vary widely in needs and even more widely in possibilities for intervention. Thus, in one district there may be a problem of poor infrastructure whereas in another district shortages of man power other resources. In one district there may be a problem of drug resistance in Malaria Control Programme, where as in another district the need may be to integrate malaria control with filarial control. Thus strategies have to be district specific not only because health needs vary, but because perceptions at people and capacities to conduct programmes also vary.

This District Health Action Plan (DHAP) is one of the key instruments to achieve NRHM goals. This plan is based on health needs of the district.

After a thorough situation analysis of district health scenario this document has been prepared. In the plan, it is addressing health care needs of rural poor especially women and children, the teams have analyzed the coverage of poor women and children with preventive and promotive interventions, barriers in access to health care and spread of human resources catering health needs in the district. The focus has also been given on current availability of health care infrastructure in public/NGO/private sector, availability of wide range of providers. This DHAP has been evolved through a participatory and consultative process, wherein community and other stakeholders have participated and ascertained their specific health needs in villages, problems in accessing health services, especially poor women and children at local level.

The goals of the Mission are to improve the availability of and access to quality health care by people, especially for those residing in rural areas, the poor, women and children.

I hope this District Health Action Plan will help in achieving the goals of National Rural Health Mission (NRHM). It will enable health care personnel to serve people smoothly. DHAP seeks to achieve pooling of financial and human resources allotted through various central and state programmes by bringing in a convergent and comprehensive action plan at the district level. DHAP and its subsequent implementation would inspire and give new momentum to the health services in the District of Sitamarhi.

Mr. RamaShankar Daftuar DDC cum Vice Chairman District Health Society, Sitamarhi

About the Profile

Even in the 21st century providing health services in villages, especially poor women and children in rural areas, is the bigger challenge. After formation of National Rural Health Mission, we are doing well in this direction. Launching Muskan- Ek Abhiyan we are try to achieve 100% immunization and Anti Natal Care. Janani Evam Bal Suraksha Yojana is another successful program that is ensuring safe institutional delivery of even poor and illiterate rural women. Like wise several other programs like RNTCP, Pulse Polio, Blindness control and Leprosy eradication are running and reaching up to last man of society. But satisfaction prevents progress. Still, we have to work a lot to touch miles stones. In this regard sometime, I personally felt that planning of any national plan made at center lacks local requirements and needs. That is why, despite of hard work, we do not obtain the optimum results. The decision of preparing District Health Action Plan at District Health Society level is good.

Under the National Rural Health Mission the District Health Action Plan of Khagaria district has been prepared. From this, the situational analysis the study proceeds to make recommendations towards a policy on workforce management, with emphasis on organizational, motivational and capability building aspects. It recommends on how existing resources of manpower and materials can be optimally utilized and critical gaps identified and addressed. It looks at how the facilities at different levels can be structured and reorganized.

The information related to data and others used in this action plan is authentic and correct according to my knowledge as this has been provided by the concerned medical officers of every block. I am grateful to the DHS consultants, ACMO, MOICs, MOs, Block Health Managers, Grade'A' Nurse, ANMs and AWWs from their excellent effort we may be able to make this District Health Action Plan of Khagaria District.

I hope that this District Health Action Plan will fulfill the intended purpose.

Dr. Omprakash Panjiyar Civil Surgeon cum Member Secretary District Health Society Sitamarhi

About the Profile

The goals of the Mission are to improve the availability of and access to quality health care by people, especially for those residing in rural areas, the poor, women and children.

Keeping in mind the goals of National Rural Health Mission (NRHM), this District Health Action Plan of Sitamarhi district has been prepared. From this, situational analysis the study proceeds to make recommendations towards a policy on workforce management, with emphasis on organizational, motivational and capability building aspects. It recommends on how existing resources of manpower and materials can be optimally utilized and critical gaps identified and addressed. It looks at how the facilities at different levels can be structured and reorganized.

The information related to data and others used in this action plan is authentic and correct according to my knowledge as this has been provided by the concerned medical officers of every block. I am grateful to the state level consultants, DPM, DAM, M & E Officer, DPC, DCM, MOICs, Block Health Managers, BCM, ANMs for their excellent effort.

We hope that this District Health Action Plan will fulfill the intended purpose.

ACMO cum Nodal officer District Health Action Plan, Sitamarhi

About the Profile

National Rural Health Mission was introduced to undertake architectural corrections in the public Health System of India. District health action plan is an integral aspect of National Rural Health Mission. District Health Action Plans are critical for achieving decentralization, interdepartmental convergence, capacity building of health system and most importantly facilitating people‟s participation in the health system‟s programmes. District Health Action Planning provides opportunity and space to creatively design and utilize various NRHM initiatives such as flexi –financing, Rogi Kalyan Samiti, Village Health and Sanitation Committee to achieve our goals in the socio-cultural context of Sitamarhi.

National Rural Health Mission (NRHM) is a comprehensive health programme launched by Government of India to bring about architectural corrections in the health care delivery systems of India. The NRHM seeks to address existing gaps in the national public health system by introducing innovation, community orientation and decentralisation. The mission aims to provide quality health care services to all sections of society, especially for those residing in rural areas, women and children, by increasing the resources available for the public health system, optimising and synergising human resources, reducing regional imbalances in the health infrastructure, decentralisation and district level management of the health programmes and community participation as well as ownership of the health initiatives. The mission in its approach links various determinants such as nutrition, water and sanitation to improve health outcomes of rural India.

The NRHM regards district level health planning as a significant step towards achieving a decentralised, pro-poor and efficient public health system. District level health planning and management facilitate improvement of health systems by 1) addressing the local needs and specificities 2) enabling decentralisation and public participation and 3) facilitating interdepartmental convergence at the district level. Rather than funds being allocated to the States for implementation of the programmes developed at the central government level, NRHM advises states to prepare their perspective and annual plans based on the district health plans developed by each district.

The concept of DHAP recognises the wide variety and diversity of health needs and interventions across the districts. Thus it internalizes structural and social diversities such as degree of urbanisation, endemic diseases, cropping patterns, seasonal migration trends, and the presence of private health sector in the planning and management of public health systems. One area requiring major reforms is the coordination between various departments and vertical programmes affecting determinants of health. DHAP seeks to achieve pooling of financial and human resources allotted through various central and state programmes by bringing in a convergent and comprehensive action plan at the district level.

It is our pleasure to present the Sitamarhi District Health Action Plan for the year 2012-13. The District Health Action Plan (including the Block Health Action Plan) seeks to set goals and objective for the District Health system and delineate implementing processes in the present context of gaps and opportunities for the Sitamarhi district health team.

I am very glad to share that all the BHMs/MOICs/ANMs of the district along with key district level Programme Officers (DIO)/DTO/DLO/DMO) for putting his sheer hardwork with dedication to complete the Action Plan on time. Participated in the planning process. The plan is a result of collective knowledge and insights of each of the District Health System Functionary. We are sure that the plan will set a definite direction and give us an impetus to embark on our mission.

Binay Bhushan Upendra Kr. Jha Durgesh Kumar Block Health Manager District Planning Coordinator District Programme Manager Sitamarhi Sitamarhi Sitamarhi

Table of contents Sl. Subject Page No. No.

1. Excutive Summary 7 – 10

2. Introduction of DHAP Under NRHM 11 – 18

3. About District 19 – 58

4. DHAP Process 59 – 62

Situation Analysis (Infrastructure, Equipment & Human Resource) i. HSC 5. ii. APHC 64 – 150 iii. PHC iv. Sadar Hospital Work Plan & Activities for Service improvement i. District Level Programme Analysis & Work Plan ii. Nutritional Rehabilitation Centre iii. Maternal Health iv. New Borne & Child Health v. Family Planning 6. vi. ASHA 151 – 311 vii. Routine Immunization viii. Revised National Tuberculosis Control Programme ix. National Leprosy Eradication Programme x. Malaria, Filaria & Kala-Azar Programme xi. Blindness Controll Programme xii. IDSP

7. Budget of Part A, B, C, D, E, F, G, H, I & other activity 312 – 330

EXECUTIVE SUMMARY

The National Rural Health Mission is a societal Mission & launched to strengthen public health systems to provide universal and equitable access to quality health care services and to improve the health status of people. The success of NRHM will depend on policy of reaching the last household in rural areas. There are still many difficult, most difficult and inaccessible areas where more effort has to be made to reach quality services to the people.With the growing concerns for health of the community, National Rural Health Mission (NRHM) is seen as a vehicle to ensure that preventive and promotive interventions reach the vulnerable and marginalized through expanding outreach and linking with local governance institutions. NRHM envisages achievement of ascertained goals by promotion of intersectoral linkages, which is anticipated as imperative for its effective implementation. These linkages can be within the public health system such as RCH, Family Planning, Routine Immunization and National Disease Control programmes or with other departments like Women and Child Development, Education, PRI and Water and Sanitation. These linkages could also be with the NGOs, the private health sector and the corporate sector with the overall objective of improvement of services and fragmentation of efforts. For making NRHM fully accountable and to facilitate the responsiveness of NRHM, need for formulation of District Health Action Plan (2007-12) has been recognized. DHAP intends to provide a guideline to develop a liable public health delivery system through intensive monitoring and performance standard.

The process for formulation of DHAP required participatory approach at various levels. To make the plan more practicable and to ensure that grass root issues are voiced and heard, the initial stages of process of plan development included consultations at village and block level. As NRHM emphasizes community participation and need based service delivery with an improved outreach to disadvantaged communities, village and block level consultations provided vital information to guide the district health action plan. The consultations endeavored to reach a consensus on constraints at community level and feasible solutions/interventions strategies regarding a particular subject matter. Based on discussions on both demand and supply side concerns in the blocks the priorities were set and agreed. Further to share the findings of village and block level process with a larger stakeholder group and to finalize a strategic action plan district level workshop was conducted.

Following the consultations at village and block level, consultations at district level involving a large range of stakeholders from different levels, aimed at delineating strategies to achieve identified district plan objectives. For effective implementation of suggested approaches it has been endeavored to carve out specific activities for each strategy and assign the activities a tentative time frame so as to indicate when a particular activity can happen.

Prior to consultative meetings, an attempt has been made to identify the performance gaps within the framework of existing health system by conducting situational analysis. It has been found that the situation of public health infrastructure in the district is not appalling however major gaps are found in human resource situation with high number of vacant staff positions for male MPWs, ANMs, specialists and lab technicians. The situation of convergence of health department with ICDS is notable. At the community level close collaboration exists between the ANMs and the AWWs. The activities of the two departments are integrated,

providing complementary job functions to ensure better accessibility and availability of health services. Involvement of PRI in issues of health through village health and sanitation committees is limited. Though the committees are constituted in most of the villages their functionality is unconvincing.

With the vision to improve the reproductive and child health condition within the district, increase in female literacy has been anticipated as the foremost strategy. The challenge of providing quality services to the poorest and remotest areas can be achieved by developing pro-people partnerships with the nongovernment sector and promoting convergence with other concerned departments and agencies such as ICDS, panchayat and education. To ensure universal access to quality services, upgradation of facilities and strengthening of technical capacity of existing human resources, especially with regard to emergency obstetric care needs to be focused. Improved fund flow, timely procurement of goods and services, cadre management, planning and monitoring through infusion of managerial skills is envisaged as necessary in order to reach the objectives of the mission. Intensified IEC activities by local health workers, panchayat leaders, community societies/local NGOs will provide much needed support for behaviour change of community regarding maternal care during pregnancy, ANC, institutional deliveries, breastfeeding practices as well as family planning. Need for using health facilities for deliveries and other issues related to RCH, family planning, female education and gender equity would be the central point of counseling during interactions between health workers and pregnant women.

To promote access to improved health care at household level through ASHAs, induction trainings of ASHAs are still needed to be finished. With a view to bring about decentralization, encourage community participation, and improve health service delivery, establishment of RKSs have been suggested at all CHCs and PHCs. However, specific guidelines for functioning mechanism as well as trainings of members will ensure streamlined activities under RKS. Upgradation and strengthening of health infrastructure needs urgent recruitment of required number of gynecologists, anesthetists, pediatricians, staff nurses, ANMs, MPWs and lab technicians either on permanent or contractual basis, as well as assurance of adequate procurement and logistic supply. For upgrading standard of services, multi-skilling of doctors/ paramedics is envisaged by imparting refresher training courses. Increased outreach of services is also envisioned to be achieved by initiating medical mobile units, which will operate within the most vulnerable areas. To make MMUs functional there is need for deployment of staff, availability of conveyance, equipments and drugs. Further, since Ayurveda, Unani and Homeopathy system of medicine have had a long presence in the State, specially in the remote and rural areas it is suggested to use their potential for improving accessibility to health services by mainstreaming of AYUSH within the framework of primary health delivery.

With the objective of achieving the targets of child immunization there is a felt need for strengthening. The service delivery mechanism by increasing manpower as well streamlined adequate supply of vaccines. Besides, regular in-service trainings can help build the capacity of health workers on various managerial aspects as well as improve the efficiency of delivery. In order to deal with the critical cultural issues, that might be hampering the performance of child immunization indicators, convergence with PRI through gram panchayat, other influential members of the community and local NGOs/CBOs is considered significant. Involvement of panchayat to ascertain better coverage of immunization is envisioned through

establishment and activation of VHSCs, which motivate community for higher acceptance of vaccination by organizing various innovative activities and by inter-personal communication.

As far as vector borne diseases are concerned, the risk of malaria is high in the district. To tackle the performance of indicators of malaria, institutional strengthening is suggested by upgradation of existing laboratories and increasing the number of laboratories for malaria microscopy. Need of filling up vacant posts for staff workers and lab technicians are highly recognized. Outreach of services delivery is expected to be achieved by co-opting with private institutions with the vision to increase slide collection rate. Intersectoral coordination between health department, ICDS, PRI, education dept, NGOs and water and sanitation department is primarily emphasized for IEC on issues related to general health and environmental hygiene.

For improvement in RNTCP indicators intensified case detection activities are proposed. To ensure high responsiveness from the community regarding acceptance of services, sensitization of community through PRI and collaboration with private practitioners is presumed. In addition to this availability of advanced diagnostic techniques with quality assurance are expected to build faith among the community members towards institutional health care services. For easy accessibility to treatment facility, increasing the number of DOTS providers is also proposed. In addition to this, the much needed behavioural change of staff members can be achieved by imparting trainings for orientation and better counseling skills.

Outreach of NBCP services can be attempted by increasing the number of outreach camps in un-reached and remote areas. For improving eye care delivery services there should be adequate supply of diagnostic equipments as well as drugs. Gaps in service delivery are felt due to non-posting of eye specialists at health facilities even in Sadar Hospital, Sitamarhi. Thus filling up vacancies for eyesurgeons and imparting refresher training courses on new techniques and interventions will help in accomplishment of required targets. In this regard, convergence with schools is envisaged for organization of school eye-screening camps.

With the view of reduction of leprosy regular surveys are proposed for case detection along with constant monitoring and reporting mechanism. Service delivery can be strengthened by recruitment of motivated and dedicated staff for field activities. To tackle the identified cases, it is important to convince community members for rebuttal of prevailing misconceptions associated with the disease. Initiatives on IEC and BCC can be attempted by collaboration of activities with panchayat, which is supposed to be the most efficient medium for sensitization of community.

However in order to expedite the process and to make it more effective, convergence at various levels require detailing of effective operational approaches, laying out clear roles and outcomes, and clear mechanism for joint planning and monitoring. This will not only ensure streamlining of strategies but also ensure accountability of the public health system of different departments, be it health department, ICDS, PRI, education or water and sanitation. Continuous monitoring will keep a check on effective collaboration of services related to immunization and institutional delivery, AYUSH infrastructure, supply of drugs, upgradation of CHCs to IPHS, utilization of untied fund, and outreach services through operationalization of mobile medical unit

INTRODUCTION OF DHAP UNDER NRHM

In the process of economic and social development for improving the quality of life, importance of health has long been recognized. In order to galvanize the various components of health system, Government of India has endeavoured to launch the National Rural Health Mission (NRHM). NRHM was launched in April 2005, to provide effective health care to rural population throughout the country with special focus on 18 states which have weak public health indicators and/or weak infrastructure.

The mission aims to expedite achievements of policy goals by facilitating enhanced access and utilization of quality health services, with an emphasis on addressing equity and gender dimension.

Specific objectives of the mission are:

 Reduction in child and maternal mortality  Universal access to services for food and nutrition, sanitation and hygiene, safe drinking water  Emphasis on services addressing women and child health; and universal immunization  Prevention and control of communicable and non-communicable diseases, including locally endemic diseases  Access to integrated comprehensive primary health care  Revitalization local health traditions and mainstreaming of AYUSH

One of the main approaches of NRHM is to communities, which will entail transfer of funds, functions and functionaries to Panchayati Raj Institutions (PRIs) and also greater engagement of Rogi Kalyan Samitis (RKS), hospital development committees or user groups. Improved management through capacity development is also suggested. Innovations in human resource management are one of the major challenges in making health services effectively available to the rural/tribal population. Thus, NRHM proposes ensured availability of locally resident health workers, multi-skilling of health workers and doctors and integration with private sector so as to optimally use human resources. Besides, the mission aims for making untied funds available at different levels of health care delivery system. Core strategies of mission include decentralized public health management. This is supposed to be realized by implementation of District Health Action Plans (DHAPs) formulated through a participatory and bottom up planning process. DHAP enable village, block, district and state level to identify the gaps and constraints to improve services in regard to access, demand and quality of health care. In view with attainment of the objectives of NRHM, DHAP has been envisioned to be the principle instrument for sitamarhi dhs

NRHM covers the entire country, with special focus on 18 states where the challenge of strengthening poor public health systems and thereby improve key health indicators is the greatest. These are Uttar Pradesh, Uttaranchal, Madhya Pradesh, Chhattisgarh, Bihar, Jharkhand, Orissa, Rajasthan, Himachal Pradesh, Jammu and Kashmir, Assam, Arunachal Pradesh, Manipur, Meghalaya, Nagaland, Mizoram, Sikkim and Tripura. The mission envisions targeting especially rural/ tribal people, poor women and children for providing equitable, affordable, accountable and effective primary health care.planning, implementation and monitoring, formulated through a participatory and bottom to up planning process. NRHM-DHAP is anticipated as the cornerstone of all strategies and activities in the district. DHAP integrates the various interrelated components of health to ensure quality of care and access to service with specific reference to various interrelated paradigm as mentioned below:

• Resources: health manpower, logistics and supplies, community resources and financial resources, voluntary sector health resources.

• Access to services: public and private services as well as informal health care services; levels of integration of services within public health system.

• Utilization of services: outcomes, continuity of care, factors responsible for possible low utilization of public health system.

• Quality of care: technical competence, interpersonal communication, and client satisfaction, client participation in management, accountability and redressal mechanisms. • Community: needs, perceptions and economic capacities, PRI involvement in health, existing community organizations and modes of involvement in health. • Socio-epidemiological situation: local morbidity profile, major communicable diseases and Transmission patterns, health needs of special social groups (e.g. Adivasis, migrants, very remote Hamlets)

For effective programme implementation NRHM adopts a synergistic approach as a key strategy for community based planning by relating health and diseases to other determinants of good health such as safe drinking water, hygiene and sanitation. Implicit in this approach is the need for situation analysis, stakeholder involvement in action planning, community mobilization, inter-sectoral convergence, partnership with Non Government Organizations (NGOs) and private sector, and increased local monitoring. The planning process demands stocktaking, followed by planning of actions by involving program functionaries and community representatives at district level.

This manual is intended to be a user-friendly tool to assist range of stakeholders, to be engaged in the district health planning, in developing the DHAP. The intended target group for this document includes:

 Members of State and District Health Missions  District and Block level program managers of line departments i.e., Health and Family Welfare, Women and Child Development including Integrated Child Development Scheme (ICDS) and Water/sanitation departments.  State Program Management Unit and District Program Management Unit Staff  Members of PRIs and MNGOs/ FNGOs and civil society groups (in case these groups are involved in the DHAP formulation)

Besides above referred groups, this document will also be found useful by public health managers, academicians, faculty from training institutes and people engaged in programme implementation and monitoring and evaluation.

Objectives of the DHAP

The aim of the present study is to prepare DHAP based on the broad objective of the NRHM . Specific objectives of the process are:

 To identify critical health issues and concerns with special focus on vulnerable /disadvantage groups and isolated areas and attain consensus on feasible solutions.  To examine existing health care delivery mechanisms to identify performance gaps and develop strategies to bridge them  To actively engage a wide range of stakeholders from the community, including the Panchayat, in the planning process  To identify priorities at the grassroots level and set out roles and responsibilities at the Panchayat and block levels for designing need-based DHAPs  To espouse inter-sectoral convergence approach at the village, block and district levels to make the planning process and implementation process more holistic

The District Health Action Plan of Sitamarhi has been prepared under the guidance of the Chief Medical Officer, Additional Chief Medical Officer, All District Programme officer of Sitamarhi and District Programme Management Unit (DPMU) DHS with a joint effort of the Block Programme Management Unit (BPMU), Rogi Kalyan Samiti, District Health Educator, the BMOs and various M.O-PHCs as well as other concerned departments under a participatory process. The field staff of the department has also played a significant role. Public Health Resource Network has provided technical assistance in estimation and drafting of various components of this plan.

Preparation of DHAP

The Plan has been prepared as a joint effort under the guidance of Civil Surgeon, all incharge programme officers as well as the MOICs, Block Health Managers, ANMs, as a result of a participatory processes as detailed below. After completion the DHAP, a meeting is organized by Civil Surgeon with all MOIC of the block and all programme officer. Then discussed and displayed prepared DHAP. At last it has been approved by the chairman of the District Health Society. If any comment has came from participants it has added then finalized. The field staffs of the department too have played a significant role. District officials have provided technical assistance in estimation and drafting of various components of this plan. After a thorough situational analysis of district health scenario this document has been prepared. In the plan, it is addressing health care needs of rural poor especially women and children, the teams have analyzed the coverage of poor women and children with preventive and promotive interventions, barriers in access to health care and spread of human resources catering health needs in the district. The focus has also been given on current availability of health care infrastructure in pubic/NGO/private sector, availability of wide range of providers. This DHAP has been evolved through a participatory and consultative process, wherein community and other stakeholders have participated and ascertained their specific health needs in villages, problems in accessing health services, especially poor women and children at local level.

District Health Action Plan Planning Process

- State level Fast track training on DHAP. - Collection of Data through various sources - Understanding Situation -Assessing Gap -Orientation of Key Medical staff, Health Managers on DHAP at district level

-Block level Meetings -Block level meetings organized at each level by key medical staff and BMO

-District level meetings -District level meeting to compile information -Facilitating planning process for DHAP

Approval12 from the District Magistrate

Methodology

Planning process started with the orientation of the different programme officers, MOICs, Block Health Manager and our health workers. Different group meetings were organized and at the same time issues were discussed and suggestions were taken. Simple methodology adopted for the planning process was to interact informally with the government officials, health workers, medical officers, community, PRIs and other key stake holders.

Data Collection

Primary Data: All the Medical Officers were interacted and their concern was taken in to consideration. Daily work process was observed properly and inputs were taken in account. District officials including CMO, ACMO, DIO, DMO, DLO, RCHO and others were interviewed and their ideas were kept for planning process.

Secondary Data:Following books, modules and reports were taken in account for this Planning Process:  RCH-II Project Implementation Plan  NRHM operational guideline  DLHS Report  Report Given by DTC  Report taken from different programme societies e.g. Blindness control, District Leprosy Society, District TB Center , District Malaria Office  Census-1991,2001,2011.  National Habitation Survey-2003  Bihar State official website

Tools: Main tools used for the data collection were:  Informal In-depth interview  Group presentation with different district level officials  Informal group discussions with different level of workers and community representative  Review of secondary data

Data Analysis:

Primary Data: Data analysis was done manually. All the interviews were recorded and there points were noted down. After that common points were selected out of that.

Secondary Data: All the manuals books and reports were converted in to analysis tables and these tables are given in to introduction and background part of this plan.

SWOT ANALYSIS OF THE DISTRICT

 STRENGTHS

1. Involvement of C.S cum CMO: - C.S cum CMO take interest, guide in every activity of Health programme and get personally involved.

2. Support from District Administration:- District Magistrate and Deputy Development Commissioner take interest in all health programmes and actively participate in activities. They provide administrative support as and when needed. They make involvement of other sectors in health by virtue of their administrative control.

3. Support from PRI (Panchayati Raj Institute) Members:- Elected PRI members of District and Blocks are very co-operative. They take interest in every health programmes and support as and when required.

4. Well established DPMU and BPMU:- Since Four year, all the posts of DPMU & BPMU are filled up. Facility for office and automation is very good. All the members of DPMU & BPMU work harmoniously and are hardworking.

5. Effective Communication: - Communication is easy with the help of internet facility at block level and land line & Mobile phone facility which is incorporated in most of PHCs of the district.

6 .Facility of vehicles: - Under the Muskan Ek Abhiyan programme every Block have the vehicles for monitoring.

7. Support from media: - Local newspapers and channel are very co-operative for passing messages as and when required. They also personally take interest to project good and worse things which is very helpful for administration to take corrective measures.

 WEAKNESS

1. Lack of Consideration in urban area: - Urban area has got very poor health infrastructure to provide health services due to lack of manpower.

2. Non availability of specialists at Block level: - As per IPHS norms, there are vacancies of specialists in most of the PHCs . Many a times only Medical Officer is posted, they are busy with routine OPD and medico legal work only, so PHC do not fulfill the criteria of ideal referral centers and that cause force people to avail costly private services.

3. Non availability of ANMs at PHCs to HSCs level - As per IPHS norms, there are vacancies of ANMs in most of the HSCs. Out of 534 Sanctioned post of contractual

ANMs only 115 ANMs are Selected so HSCs do not fulfill the criteria of ideal Health Sub Centre and that cause force people to travel up to PHCs to avail basic health services.

4. Apathy to work for grass root level workers: - Since long time due to lack of monitoring at various level grass root level workers are totally reluctant for work. Even after repeated training desired result has not been achieved. Most of the MO, Paramedical & other Health workers do not stay at HQ. Medical Officers, who are supposed to monitor the daily activity of workers do not take any interest to do so. For that reason workers also do not deliver their duties regularly and qualitatively. Due to lack of monitoring & supervision some aim, object & program is suffering allot.

5. Lack of proper transport facility and motarable roads in rural area:- There are lack of means of transport and motarable roads in rural areas. Rural roads are ruled by „Jogad‟, a hybrid mix of Motor cycle and rickshaw, which is often inconvenient mean of transport. The fact that it is difficult to find any vehicle apart from peak hours is still the case in numerous villages.

6. Illiteracy and taboos:-The literacy rate in rural area has still not reached considerable mark. Especially certain communities have constant trend of high illiteracy. This causes prevalence of various taboos that keep few communities from availing benefits of health services like immunization or ANC, institutional delivery…etc

 OPPORTUNITIES

1. Health indicator in Sitamarhi district is not satisfactory . Services like Institutional delivery, Complete Immunization , Family Planning, Complete ANC, School Health activity , Kala-azar eradication may required to be improved. So there are opportunities to take the indicator to commendable rate of above 75+% by deploying more efforts and will.

2. Introduction of PPP Scheme: Through introduction of PPP Scheme we can overcome shortfall of specialist at Block level.

3. Involvement of PRIs: - PRI members at district, Block and village level are very co- operative to support the programmes. Active involvement of PRI members can help much for acceptance of health care deliveries and generation of demand in community.

4. improvement of infrastructure: -. With copious funds available under NRHM, there is good opportunity to make each health facility neat and clean, Well Equipped and Well Nurtured.

 THREATS

1. Flow of information if not properly channeled to the grass root stakeholder

2. Natural calamities like every year flood adversely affected the progress of Health Programme.

PROFILE OF SITAMARHI DISTRICT

Sl. Parameter/ Data No Variable 1. Total area 2293 Sq. Km 2. Latitude 26*49`N 3. Longitude 85*05`E 4. Altitude 85 Meter In North – Nepal (International Border), South – Muzaffarpur District, East – Darbhanga & Sitamarhi 5. Boundary / Border line District, West – East Champaran & Sheohar District. 1991 2001 2011 Description Total Rural Urban Total Rural Urban Total Rural Urban

Population (%) 100% 94.06% 5.94% 100% 94.29% 5.71% 100% 94.42% 5.58% Actual Population 20,13,796 18,94,203 1,19,593 26,82,720 25,29,407 1,53,313 34,19,622 32,28,904 1,90,718 Male 10,69,132 10,69,132 64,897 14,17,611 13,35,214 82,397 18,00,441 16,98,885 1,01,556 Female 9,44,664 89,968 54,696 12,65,109 11,94,193 70,916 16,19,181 15,30,019 89,162 Population Growth 23.72% 32.58% 27.47% 12.1% SC Population(%) 0.02% ST Population(%) Proportion to Bihar 3.23% 3.29% Population

6. Sex Ratio (Per 1000) 884 886 846 892 894 861 899 901 878

Child Sex Ratio (0-6) 921 918 965 924 925 915 932 934 881 Total Child Population 556,582 643,851 614,408 29,443 (0-6 Age) Male Population (0-6 289,273 ` 333,315 317,660 15,655 Age) Female Population (0-6 267,309 310,536 296,748 13,788 Age) Child Proportion (0-6 20.2 20.75% 18.83% 19.03% 15.44% Age) Boys Proportion (0-6 19.8 20.41% 18.51% 18.70% 15.42% Age) Girls Proportion (0-6 20.64 21.13% 19.18% 19.40% 15.46% Age)

% of Population with 86.8% Low Standard of Living % of Population with 7. Medium Standard of 6.7%

Living

% of Population with 6.5% High Standard of Living 8. Density/km2 878 1,170 1,491 Literates 817,711 1,485,896 1,365,865 120,031 Male Literates 556,936 917,879 848,694 69,185 Female Literates 260,775 568,017 517,171 50,846 9. Average Literacy 28.49 26.53 58.67 38.46 36.71 66.23 53.53 52.24% 74.43% Male Literacy 39.86 37.86 69.67 49.36 47.73 74.72 62.56 61.45% 80.54% Female Literacy 15.49 13.63 45.22 26.13 24.28 56.24 43.4 41.93% 67.46% 10 32234 45662 58379 Eligible Couple

Sl. Parameter/ Data No Variable No. of Sub-Divisions 03 No. of Blocks/PHCs 17 No. of` Nagar Parishad 01 No. of Nagar Panchayat 05 No. of Gram Panchayat 273 No. of Revenue Village 835(Inhabited – 802 , Uninhabited – 33 ) No. of A P H Cs 36 No. of HSCs 273 No. of Sub-Divisional 1

Hospitals No. of Referral Hospitals 1 No. of Doctors 133 No. of ANMs 272 – Regular & 98 – Contractual in Position. No. of Grade A Nurse 37 No. of paramedicals Total ICDS Projects 18 No. of Anganwari 2700

Centres/Workers No. of ASHA 2223/2965 No. of MAMTA 85 No. of M.L.A. 08 No. of M.P. 01 Educational & Research Primary Schools-1479

Institutes Project Girls High School-17 I.T.I-01 Sanskrit School-20 Important Rivers Bagmati , Lakhandei , Lalbakea , Adhwara group Average Rainfall 1100 MM to 1300 MM Highest Temperature 32* C to 41* C Soil Balui , Domat. Paddy , Wheat , Sugar Cane , Marua , Arhar , Mustard , Main Crop Mung etc. Ram Janaki Temple at Sitamarhi (Janaki Sthan), Janaki Temple at Punaura, Haleshwar Sthan, Panth-Pakar, Main Tourist Palace Bodhayan-Sar, Baghi Math, Pupri, Goraul Sharif, Shukeshwar Sthan, Sabhagachhi Sasaula Transportation/Communicatio NH-77 & NH-104 , Railway Braud Gauge.

Introduction

The district is popularly known as the “Land of Goddess Sita”. This is the place where Sita was born, the main character of the epic Ramayana. The district is situated along the border of Nepal.In 1875, a Sitamarhi subdistrict was created within the Muzaffarpur district. Sitmarhi detached from Muzaffarpur and became a separate district as of December 11, 1972. 1994 saw the split of Sheohar district from Sitamarhi. It is situated in the northern part of Bihar. The district headquarters are located in Dumra, five kilometers south of Sitamarhi. The district headquarter was shifted here after the town of Sitamarhi was devastated in one of the worst ever earthquake in January 1934.Sitamarhi is a sacred place in Hindu mythology. Its history goes back to Treta Yug. Sita, the wife of Lord Rama sprang to life out of an earthenware pot, when Raja Janak was ploughing the field somewhere near Sitamarhi to impress upon Lord Indra for rain. It is said that Raja Janak excavated a tank at the place where Sita emerged and after her marriage set up the stone figures of Rama, Sita and Lakshman to mark the site. This tank is known as Janaki-kund and is south of the Janaki Mandir.

The Sitamarhi district is bounded by Nepal on the north, Muzaffarpur on the south, by the districts Darbhanga and Sitamarhi on the east and on the west by the districts East Champaran and Sheohar. In course of time, the land lapsed into a jungle until about 500 years ago, when a Hindu ascetic, named Birbal Das came to know the site by divine inspiration where Sita was born. He came down from Ayodhya and cleared the jungle. He found the images set up by Raja Janak, built temple over there and commenced the worship of Janaki or Sita. The Janaki Mandir is apparently modern and is about 100 years old only. The town however contains no relics of archaeological interest.

In course of time, the land lapsed into a jungle until about 500 years ago, when a Hindu ascetic, named Birbal Das came to know the site by divine inspiration. He came down from Ayodhya and cleared the jungle. He found the images set up by Raja Janak, built a temple over there and commenced the worship of Janaki or Sita. The Janaki Mandir is apparently modern and is about 100 years old only. The town however contains no relics of archaeological interest. It has witnessed communal violence led by local politicians in the past but on the whole both the leading communities here a good rapport. This district is often bereaved by natural calamities. One of the most devastating is excess flooding due to mis-management of the banks by both civilians and government officials.

The district is currently a part of the Red Corridor.

Important places to visit are Ram Janaki Temple at Sitamarhi (Janaki Sthan), Janaki Temple at Punaura, Haleshwar Sthan, Panth-Pakar, Bodhayan-Sar, Baghi Math, Pupri, Goraul Sharif, Shukeshwar Sthan, Sabhagachhi Sasaula

Geography

The initial provisional data suggest a density of 1,491 in 2011 compared to 1,170 of 2001. Sitamarhi district occupies an area of 2,294 square kilometres (886 sq mi), comparatively equivalent to Australia's Groote Eylandt.

Rivers: Bagmati, Lakhandei, Adhwara Group.

Economy In 2006 the Ministry of Panchayati Raj named Sitamarhi one of the country's 250 most backward districts (out of a total of 640). It is one of the 36 districts in Bihar currently receiving funds from the Backward Regions Grant Fund Programme (BRGF).

Divisions Subdivisions  Sitamarhi  Sadar  Belsand  Pupri

Blocks The district is divided into 17 blocks (Taluks)  Bairgania  Bajpatti  Bathanaha  Belsand  Bokhra‡  Chorout‡  Dumra  Majorganj  Nanpur  Parihar  Parsauni‡  Pupri  Riga  Runni Saidpur  Sonbarsa  Suppi‡  Sursand (‡ = Recently created)

Villages  Gorhaul sharifBath Asli  Akhta  Koily  Dumari  Sahiyara  Mahuain Pathrahi (Bajpatti)

 Kharka  Ajamgarh  Andahara  Bhasepur  Gosaipur  Tilaktajpur  Sarhachia  Kodhiyar  Rasalpur  Bela  Dheng  Maniyari  Madhopur  Bela Bahadurpur  Amanpur  Rudauli  Matiyar  Baduri  Hanuman, Nagar  Punaura  Ratwara  Basdev Pur Boha  Madhopur Chaturi  Bhalani Madan  Soura  Lalpur  Kauriya  Kodariya  Manik Chauk  Runi Saidpur  Hardiya  Durgauli  Koeli  Sirsi  Nanpur  Bhadiyan  Humayunpur(Dipu)  Jogiyara  kamtaul  Paktola  Mehsaul  Madhuban  Chakmahila  Dumra  Mohanpur  Bhavdepur  Bhairokothi  Bhupbhairo  Bariyarpur  Jainagar

 Dostia  Chhaurahiya  Janipur  Madhesra  Bishnupur Kam deo  Barma(Choraut)  Barari Behta  malmalla  mirjadpur  Pakri  Rewasi  Sahwajpur  Kharsan  Kushmari  (Balua panchayat)runni saidpur)  Chainpura  Hariharpur  Narayanpur  Balha  Rasalpur  madhubani  Ram Nagar  Ram nagra

Transport Connectivity: National Highway 77 connects the area to the Muzaffarpur district and Patna to the South. State highways link it to the Madhubani (to the east) and Sheohar (to the west) districts. Railroad lines connect Sitamarhi to Darbhanga, Sitamarhi to Runnisaidpur and Sitamarhi to Bairgania(Broad-Gauge) and Muzaffarpur, Raxaul and Narkatiaganj Converting meter gauge to broad gauge work in progress. Nearest airport is Janakpur (45Km), Tribhuwan(Kathmandu),Patna(145Km),Gaya(235Km) & Varanasi(395Km).

Demographics According to the 2011 census Sitamarhi district has a population of 34,19,622 of which male & female were 18,00,441 & 16,19,181respectively roughly equal to the nation of Panama or the US state of Connecticut. This gives it a ranking of 96th in India (out of a total of 640). The district has a population density of 1,491 inhabitants per square kilometre (3,860 /sq mi) . Its population growth rate over the decade 2001-2011 was 27.47 %. In the previous census of India 2001, Sitamarhi District recorded increase of 32.58 percent to its population compared to 1991. Sitamarhi has a sex ratio of 899 females for every 1000 males compared to 2001 census figure of 892.The average national sex ratio in India is 940 as per latest reports of census 2011 Directorate. Average literacy rate of Sitamarhi in 2011 were 53.53 % compared to 38.46 of 2001 census. If things are looked out at genderwise, male & female literacy were 62.56 & 43.40 respectively.For 2001 census same figures stood at 49.36 & 26.13 in Sitamarhi District. Total literate in Sitamarhi District were 14,85,896 of which male & female were 9,17,879 & 5,68,017 respectively. In 2001 Sitamarhi District had 8,17,711 in its total region.

Culture Languages:- It is located in at the confluence of Mithila, Vajji(Licchvians) and Bhojpur region of Bihar. Most of the people are either Maithils or Vajji. But their culture is deeply

affected by Bhojpur too. Language spoken is Hindi, English, Bajjika (Vajjika), Bhojpuri, Maithili,Urdu and.Nepali But the local people used to talk in Bajjika which resembles with Maithili, bhojpuri and Hindi which is a consequence of its location being surrounded by these regions. Festivals:- The major festival of this area is Chhath puja in which people offer their prayer to Lord Sun.Almost all the people wherever they are, their major desire is to celebrate Chhath puja at their home with their family members and villagers.Holi and Diwali are other two festivals celebrated with so much of gaiety. Other festivals such as Dusshera, Makar sakranti,Id, Christmas and others are also celebrated with full enjoyment. Among all festival celebrated here what remains common is enjoyment , co-operation and brotherhood. The culture festival such as Sama which is played by girls of the area for their brothers good wish is one of the most famous one. It is really enjoyable to see this festival in the chilling cold of the winter season.

Marriage:- The major cultural event is marriage in this area which takes a large amount of preparations and arrangement with many cultural rituals. Cuisine:-"Khichdi", the both of rice and lentils, seasoned with spices, and served with several accompanying items like curd, chutney, pickles, papads, ghee (clarified butter) and chokha (boiled mashed potatoes, seasoned with finely cut onions, green chilies) constitutes the lunch for most on Saturdays and is a staple food here. Afternoon meals mostly consists of Rice, Lentil and vegetables while the dinner will consist of Rotis (flatbread) and Vegetables.

Fairs:- Maha Shivratri Mela, Vivah-Panchami Mela & Ramnavami Mela (huge market of cattles, horses and elephants are the main feature of these fairs) Crops:-The major food crops are rice, wheat and maize. Apart from it this area is major producers of sugarcane, tobacoo and other cash crops. People here are very laborious. Lentils, sun flower and mustard is also grown in this area. Crop and agriculture has given rise to many agro based industries in this area.

Fruits:-This area is famous for litchi sahi and china. The litchi crop is available from May to June only.There are large number of mango and litchi orchards in this area. Export of these licthi bring a large amount of foreign currency to the country. At the same time it is boosting the economic scenario of the whole area.

Education  Thakur Jugal Kishore Singh College  Kendriya vidyalya jawahar nagar  Srk Goenka College  Lakshmi High School  Delhi Public School  S.H.B.S. Boarding School  D.A.V. Public School  Mathura High School  J.B. High School Majorganj  High School Runi Saidpur  High School Bela Shanti Kutir  High School Pupari  Middle School Bela Shanti Kutir  Middle School Basdev Pur Boha  Middle School Bhadiyan

 Middle School Sahiyara  shri Lakhan Narayan Memorial High School Choraut  Mahanth sri Ayodhya Ramanuj High School, Rewasi  MP HIGH SCHOOL DUMRA SITAMARHI**  high school balua ()panchayat)  amshobha mandal (Samajsevi) Sports Heman Trophy (cricket) is organised every year at the Goenka College Ground, which adds some zeal to the life of the youths. Cricket is played in every nook and corner of the district.

Health profile of Sitamarhi District

Sitamarhi has shown consistent improvement in some of the key health indicators across the years. Still the overall situation of the district leaves much to be desired. According to a survey by International Institute of Population Sciences conducted in 2006, the key RCH and other health indicators of the district are as follows: Table 2 :rhi Health Profile Key population Infant Mortality rate 52 indicators Maternal mortality rate 430 Crude birth rate 31.9 Death rate 5.0 DLHS 3 DLHS 2 District Level Household & Facility Survey Bihar DLHS 3 (07-08) (02-04) Key RCH Girls marrying below 18 yrs. 44.4 61.3 46.2 Indicators Birth order 3+ 56.3 62.0

(in percentages) Current use of any FP method 25.3 25.3 32.4 Total unmet need 41.2 39.5 37.2 Pregnant women who registered in the first trimester 22.0 Pregnant women with 3 + ANC 22.9 11.4 26.4 Pregnant women receive at least 1 TT injections 66.2 20.7 58.4 Delivery assisted by a skilled attendant at home 4.7 4.6 5.9 Institutional births 16.4 8.0 27.7 Children with full immunization 39.1 32.1 41.4 Children with Diarrhea treated within last two weeks 79.0 92.5 73.7 who received treatment Children with Acute Respiratory infections in the last 76.5 73.4 two weeks who were given treatment Children who had check up within 24 hours after 19.1 delivery Children who had check up within 10 days of delivery 20.0

1. Health Facilities in Sitamarhi District Sitamarhi district has one Sadar Hospital (DH) located in Sitamarhi City. Sub Divisional Hospital is under Construction in Pupri. The district has a total of 17 Primary Health Centres (PHCs), 54 Additional Primary Health Centres (APHCs) and 341 Health Sub centres (HSCs). The district has One Referral Hospitals located at Mejarganj. The two operational blood bank is at one in Sadar Hospital & second in Pupri in Sitamarhi district. The planning team for the DHAP undertook a comprehensive mapping and situational analysis of these health facilities in terms of infrastructure, human resources and service delivery.

Human Resources for Health in Sitamarhi

2(A) Medical Officers

Sitamarhi currently has 144 regular doctors sanctioned out of which 104 are present. Similarly 56 contractual positions are sanctioned for doctors against which only 35 MBBS & 41 AYUSH, are posted. 15 Specialist doctors are also posted.

2(B) Staff Nurses

The total number of positions sanctioned under this category is 17, in position 12 Grade A nurses (Regular) and contractual staff nurse is 108 out of which 59 is in positioned.

2(C) ANM

The total number of positions sanctioned under the regular ANM is 341, in position 202. And ANM(R) sanctioned post is 341 out of which 115 are in position.

2(D) LHV

Total number of positions sanctioned post is 29 out of which 5 are in position.

2(E) Health Educator

Total number of positions sanctioned post is 28 out of which 20 are in position.

DHAP PROCESS IN DISTRICT SITAMARHI

Process of Plan Development

Preliminary Phase

The preliminary stage of the planning comprised of review of available literature and reports. Following this the research strategies, techniques and design of assessment tools were finalized. As a preparatory exercise for the formulation of DHAP secondary Health data were complied to perform a situational analysis. Main Phase – Horizontal Integration of Vertical Programmes

The Government of the State of Bihar is engaged in the process of re – assessing the public healthcare system to arrive at policy options for developing and harnessing the available human resources to make impact on the health status of the people. As parts of this effort present study attempts to address the following three questions:

1. How adequate are the existing human and material resources at various levels of care (namely from sub – center level to district hospital level) in the state; and how optimally have they been deployed? 2. What factors contribute to or hinder the performance of the personnel in position at various levels of care? 3. What structural features of the health care system as it has evolved affect its utilization and the effectiveness?

With this in view the study proceeds to make recommendation towards workforce management with emphasis on organizational, motivational and capacity building aspects. It recommends on how existing resources of manpower and materials can be optimally utilized and critical gaps identified and addressed. It also commends at how the facilities at different levels can be structured and organized. he study used a number of primary data components which includes collecting data from field through situation analysis format of facilities that was applied on all HSCs and PHCs of Sitamarhi district. In addition, a number of field visits and focal group discussions, interviews with senior officials, Facility Survey were also conducted. All the draft recommendations on workforce management and rationalization of services were then discussed with employees and their associations, the officers of the state, district and block level, the medical profession and professional bodies and civil society. Based on these discussions the study group clarified and revised its recommendation and final report was finalized. Government of India has launched National Rural Health Mission, which aims to integrate all the rural health services and to develop a sector based approach with effective intersectoral as well as intrasectoral coordination. To translate this into reality, concrete planning in terms of improving the service situation is envisaged as well as developing adequate capacities to provide those services. This includes health infrastructure, facilities, equipments and adequately skilled and placed manpower. District has been identified as the basic coordination unit for planning and administration, where it has been conceived that an effective coordination is envisaged to be possible. is Integrated Health Action Plan document of Sitamarhi district has been prepared on the said context.

Preparation of DHAP

District Health Action Plan Planning Process

-Block level Meetings -Block level meetings organized at each level by key medical staff and BMO

-District level meetings -District level meeting to compile information -Facilitating planning process for DHAP

Approval from the District Magistrate

District Profile

District Health Administrative Setup

Sitamarhi SHS

State

District Zila Parisad Magistrate DHS,

Civil Surgeon

ACMO District

Programme District Program MO Manager Officers PHC-MOIC DCM 1. NLEP 1. Medical Specialist 2. RNTCP 2. Surgical Specialist Panchayat Samiti 3. Malaria 3. Gynecologist APHC-MO 4. Filaria 4. Anesthetist

Rogi kalyan 5. Kala Azar Samiti 6. Immunization BHM HSC- 7. Blindness ANM Gram Panchayat BCM 8. IDSP M

Community ASHA VHSC AWW LRG(Local Resource Group- Dular)

Situational Analysis:

SITUATION ANALYSIS OF HSC, APHC, PHC, RH, & DH

The three tiers of the Indian public health system, namely village level Sub centre, Additional Primary Health Centre and Primary Health Centres were closely studied for the district of Sitamarhi on the basis of three crucial parameters:

1) Infrastructure 2) Human resources and 3) Services offered at each health facility of the district.

The Indian Public Health System (IPHS) norms define that a Village Health Sub centre should be present at the level of 5000 population in the plain regions and at 2500-3000 population in the hilly and tribal regions. As most of the Sitamarhi is situated in the plain terrain, the norm of Sub centre per 5000 population is expected to be followed. A sub centre is supposed to have its own building with a small OPD area and an examination room.. Sub centres are served by an ANM, Lady Health Volunteer and Male Multipurpose Health Worker and supported by the Medical Officer at the APHC. Sub centres primarily provide community based outreach services such as immunisation, antenatal care services (ANC), prenatal and post natal care and management of mal nutrition, common childhood diseases and family planning. It provides drugs for minor ailments such as ARI, diarrhoea, fever, worm infection etc. The Sub centre building is expected to have provisions for a labour room, a clinic room, an examination room, waiting area and toilet. It is expected to be furnished with essential equipment and drugs for conducting normal deliveries and providing immunisation and contraceptive services. In addition equipment for first aid and emergency care, water quality testing and blood smear collection is also expected to be available.

The Primary Health Centre (PHC) is required to be present at the level of 30,000 populations in the plain terrain and at the level of 20,000 populations in the hilly region. A PHC is a six bedded hospital with an operation room, labour room and an area for outpatient services. The PHC provides a wide range of preventive, primitive and clinical services. The essential services provided by the PHC include attending to outpatients, reproductive and child health services including ANC check-ups, laboratory testing during pregnancy, conducting normal deliveries, nutrition and health counselling, identification and management of high risk pregnancies and providing essential newborn care such as neonatal resuscitation and management of neonatal hypothermia and jaundice. It provides routine immunisation services and tends to other common childhood diseases. It also provides 24 hour emergency services, referral and inpatient services. The PHC is headed by an MOIC and served by two doctors. According to the IPHS norms every 24 *7 PHC is supposed to have three full time nurses accompanied by 1 lady health worker and 1 male multipurpose worker. NRHM stipulates that PHCs should have a block health manager, accountant, storekeeper and a pharmacist/dresser to support the core staff.

According to the IPHS norms, a Community Health Centre (CHC) is based at one lakh twenty thousand population in the plain areas and at eighty thousand populations for the hilly and tribal regions. The Community Health Centre is a 30 bedded health facility providing specialised care in medicine, obstetrics & gynaecology, surgery, anaesthesia and paediatrics. IPHS envisage CHC as an institution providing expert and emergency medical care to the community.

In Bihar, CHCs are absent and PHCs serve at the population of one lakh while APHCs are formed to serve at the population level of 30,000. The absence of CHC and the specialised health care it offers has put a heavy toll on PHCs as well as district and sub district hospitals. Moreover various emergency and expert services provided by CHC cannot be performed by PHC due to

non availability of specialised services and human resources. This situation has led to negative outcomes for the overall health situation of the state.

On different level, there are various institutions in the health system from where health facilities are being provided to the people. The IPH standard specifies the properties, requirements and service specifications of all institutions. In the network of health system of a district, there are following hierarchy of institutions at different level-:

DistrictHospital District Level

Sub-Divisional Sub- Division Level Hospital

FRU Referral Hospital/CHC

Block Level BPHC

APHC Halka Level

Village Level HSC

In the present situational analysis of Sitamarhi district, we will try to find out answer of the following questions-  Is there sufficient no. of HSC, APHC, BPHC, CHC, Sub-divisional hospital & District Hospital sanctioned as per IPH standard?  What are the gaps between no. of required and sanctioned institutions?  Whether all institutions have resources, manpower and infrastructure as per IPH norms or not?  Whether all institutions are providing the health services as per IPH norms or not?  Is there sufficient fund allotment for institutions and programs?  What are the activities that will improve the quality of services and will make it more reliable?District

DThe situation analysis on the basis of no. of institutions, infrastructure, manpower, services and budget is given below

Health Sub Center: Health Sub Center is the first line service deliverable institutions from where different types of services are provided to women and children. The objectives of IPHS for Sub-Centre's are:  To provide basic Primary health care to the community.  To achieve and maintain an acceptable standard of quality of care.  To make the services more responsive and sensitive to the needs of the community.

No. of Institutions (Health Sub Center) As per IPH standard at every 5000 population one HSC has to be established. District Maximum HSC required No. of Sub center Gaps in No. Population as per IPH Norms @ already sanctioned/ of HSC (2011) 5000 people established 34,19,622 684 341 343

To obtain 100% IPH standard -: Need to sanction 343 new HSC to achieve 100% IPH standard. Table presents the additional requirements of Sub centres as per population norms mandated by IPHS as well as according to the database available with District Health Society Sitamarhi. As per IPHS norms, Sitamarhi district requires a total of 684 Sub centres of which 213 are functioning in the district. 128 more have currently become functional and 343 more required as per IPHS. At the Sub centre level infrastructure poses major constraints. The analysis reveals that of the existing 213 HSCs, only 166 are situated in any building premises. Out of these 166, 71 are in a Government building and 95 are in rented buildings. Out of the 47 remaining Subcenters, buildings are under construction for 41 of them. 47 HSCs still do not have any building. The 41 HSCs operating in Govt buildings are currently being renovated. It is also important to note that no Sub centre in the district has received untied funds.

In the present situational analysis of the blocks of district Sitamarhi the vital statistics or the indicators that measure aspects of health/ life such as number of births, deaths, fertility etc. have been referred from census 2001,2011, report of DHS office, Sitamarhi and various websites as well as other sources. These indicators help in pointing to the health scenario in Sitamarhi from a quantitative point of view, while they cannot by themselves provide a complete picture of the status of health in the district. However, it is useful to have outcome data to map the effectiveness of public investment in health. Further, when data pertaining to vital rates are analyzed in conjunction with demographic measures, such as sex ratio and mean age of marriage, they throw valuable light on gender dimension. Table below indicates the Health indicators of Sitamarhi district with respect to Bihar and India as a whole.

GAPS IN INFRASTRUCTURE: BPHC Population 80000-120000

Population APHC 20000-30000

HSC Population 5000 First contact point with community

Introduction:

Health Sub Centre is very important part of entire Health System. It is first available Health facility nearby for the people in rural areas. We are trying to analyze the situations at present in accordance with Indian Public Health Standards (IPHS).

Infrastructure for HSCs:

IPHS Norms:

1.Location of the centre: The location of the centre should be chosen that: a. It is not too close to an existing sub centre/ PHC b. As far as possible no person has to travel more than 3 Km to reach the Sub centre c. The Sub Centre Village has some communication network (Road communication/Public Transport/Post Office/Telephone) d. Accommodation for the ANM/Male Health Worker will be available on rent in the village if necessary.

For selection of village under the Sub Centre, approval of Panchayats as may be considered appropriate is to be obtained. i. The minimum covered area of a Sub Centre along with residential Quarter for ANM will vary from 73.50 to 100.20 sq mts. depending on climatic conditions(hot and dry climate, hot and humid climate, warm and humid climate), land availability and with or without a labor room. A typical layout plan for Sub-Centre with ANM residence as per the RCH Phase-II National Programme implementation Plan with area/Space Specifications is given below

Typical Layout of Sub- Centre with ANM Residence

Waiting Area : 3300mm x 2700mm Labour Room : 4050mm x 3300mm Clinic room : 3300mm x3300mm Examination room : 1950mm x 3000mm Toilet : 1950mm x 1200mm

Residential accommodation : this should be made available to the Health workers with each one having 2 rooms, kitchen, bathroom and WC. Residential facility for one ANM is as follows which is contiguous with the main sub centre area. Room -1 (3300mm x 2700mm) Room-2(3300mm x 2700mm) Kitchen-1(1800mm x 2015mm) W.C.(1200mm x 900mm) Bath Room (1500mm x 1200mm) One ANM must stay in the Sub-Centre quarter and houses may be taken on rent for the other/ANM/Male Health worker in the sub centre village. This idea is to ensure that at least one worker is available in the Sub-Centre village after the normal working hours. For specifications the “Guide to health facility design” issued under Reproductive and Child Health Program (RCH-I and II) of Government of India, Ministry of Health and Family Welfare may be referred.

Item IPHS Norms Maximum Present Status Gaps Task for 2012-13 Budget for requirement (2012-13) Amount (in Rs.) The minimum covered area of 684 Sitamarhi have 213 341 100 100X2000000 a Sub Center along with (Max. HSC as established Health =20,00,00,000 residential Quarter for ANM per IPHS) Sub Centers and will vary from 73.50 to 100.20 128 more Health sq meters. sub centers are proposed to be establish new

building. Again, out Infrastructre of 213 established HSCs, only 68 have their own buildings

Physical and rest 145 run in rented houses. All these 68 HSCs need new buildings. Examination Table-1 1X 341 = 341 All HSc required 341 All 341X 12000= Writing table- 2 2X 341 = 682 Furnitures sanctioned/established 4092000 Armless chairs 3 3X 341 = HSc 682X 8000 = Medicine Chest 1 1023 5456000 Labour table 1 1X 341 = 341 1023X2000= Wooden screen 1 1X 341 =341 2046000 Foot step 1 1X341 = 341 341X 5000= Coat rack 1 1X 341 =341 1705000 Bed side table 1 1X 341 = 341 341X 8000= Stool 2 1X 341 =341 2728000 Almirahs 1 2X 341 = 682 341X 1000= Lamp 3 1X 341 = 341 341000 Side Wooden racks 2 3X 341 = 341X 200 = Fans 3 1023 68200 Tube light 3 2X 341 = 682 341X 1000 = Basin stand 1 3X 341 = 341000 1023 341X 500 = 3X 341 = 170500

Furniture 1023 341X 300 = 1X 341 = 102300 1023 341X12000= 4092000 1023 X 200= 204600 341 X 1500= 511500 1023X 1500= 1534500 1023X 250= 255750 341x 1500=511500 Total- 24159850

Basin Kidney 825ml 2X341=682 All HSc required 341 341 Tray instrument 1X341=341 equiepments Total - Jar Dressing 1X341=341 5,0000000 Hemoglobin meter 1X341=341 (Approx.) ForcepsTissue160mm 1X341=341 (To provide all Forceps sterilizer 1X341=341 listed Scissors surgical 1X341=341 Equipments to Reagent strips forurine 1X341=341 all

Scale, Infant metric 2X341=682 working 341 Sterilization kit 8X341=2728 HSC) Vaccine Carrier 20X341=6820 Ice pack box 12X341=4092 Forceps 12X341=4092 Equiepment Suture needle straight 12X341=4092 Suture needle curved 20X341=6820 Syringe 1X341=341 Disposable gloves 20X341=6820 Clinical Thermometer 1x 341= 341 Torch 1x 341= 341 weighing (baby) 1X341= 341 weighing (Women) 1X341= 341 Stethoscope 1X341= 341 Kit A All HSc required 341 341 Total - ORS 150X341= Drugs 5,0000000 IFA Tab. (large) 15000X341= (Approx.) IFA Tab. (small) 13000X341= (To provide all Vit. A Solution(100 ml) 6X341= listed CotrimoxazoleTab(child) 1000X341= Medicine to all Kit B working 341 Tab.Methylergometrine 480X341= HSC

Maleate (0.125mg) 500X341= Paractamol (500mg) 10X341=

Inj.Methylergometrine 300X341= Drugs Maleate 180X341= Tab.Mebendazole(100 mg) 5X341= Tab.Dicyclomine HCl. (10 125X341= mg) 120X341= Ointment Povidone Iodine5% 10X341= Cetrimide Powder Cotton Bandage Absorbant Cotton (100 gm each) Manpower Manpower IPHS Maximum Present Gaps Task for Budget for (2012-13) manpower Manpower 2012-13 required Health worker 2 2x341=682 162(Regular) 179+ 179+ 682X15000X12=110160000/00 (female) 115(ANM 226 226 R) Health worker 1 1x341=341 Nil 341 341 341X6000X12=24552000/00 (male) (funded and appointment by the state government) Support Services Minimum facilities like estimatIon of 341 341 341 341 40,00,000(Approx) haemoglobin by using a Approved

Haemoglobin Colour Scale, urine test for the presence of protein by using Uristix, and urine test for the presence of sugar by using Diastix should be available. Haemoglobin Laboratory Colour Scale Uristix Diastix

Wherever facility exists, 341 341 341 341 341x20000= Uninterrupted power supply has 68,20,000 to be ensured for which inverter facility /solar power facility is to be Electricity provided.Solar power set Potable water for patients and staff and water 341 341 341 341 for other uses should being adequate quantity. Towards this end, adequate water supply should be ensured and safe water may be provided by use of technology like filtration, chlorination, etc. as per the Water suitability of the center.

Where ever feasible, telephone facility / cell 341 341 341 341 341x1500+341x100x12=

phone facility is to be 9,20,700

phon e Tele Provided. Mobile phone Services and Others Sub Heads Gaps Issues Strategy Activities Budget

Out of 213 1. Non payment of 1. Ensuring 1. Budget to construct 341 HSC is given Rent for HSC only 68 HSC rent payment of rent till above. Construction of building is time 273X1000X12= have 2. Land own buildings are taking process. So, timely payment of rent 32,76,000 its own availability not constructed. is needed building, for new building 2. Involvement of 2. DM should instruct the CO to remaining are DM to arrange arrange land for HSC. running in land.

rented

building Purchasing No, excuse. There is no other way except Detail budget

Lack of Equipments, purchasing all required resources. has been given

structure Equipments, HSC are working Drugs, Furniture, above

Drugs, but without and Power etc. as Infrastructure

Infra Furniture , resources per IPH standard. Power Untide fund are available but problem in Formats/ Arrangements of handleling. Untide fund is operated jointly 341X10,000= Registers Always it is found fund for these by ANM & PRI people but they have no 34,10,000 and that HSC is miscellaneous proper knowledge to handle it. Only one Stationeries lacking expenses PRI e.i Mukhiya (Pradhan) should be (Untied fund stationeries authorized for joint account and then proper orientation should be given them. No Skilled staff to Arrange all Purchase Drug, equipments, furniture as per Detail budget institutional perform required IPHS. Arrangement of Ambulance at APHC has been given delivery at Institutional resources to & PHC level to quickly send patients in above HSC level delivery is perform bigger hospital in case of complications. available but institutional lacking delivery. resources. 1. In compare to 1. Make 1. Need to aware village women through Detail budget delivery there are community Orientation program. Regular supply of has been given Poor ANC poor percentages aware about the TT & IFA. above of pregnant merit of ANC 2. Ensure availability of drug and women 2. Make system Equipments necessary for check up registration. more reliable. 2. Minimum three antenatal checkups Poor Post 1.A minimum of 2 Ensuring Strict rule to compel ANM to visit at home. No need of Natal postpartum home minimum 2 Orientation & Training program of ANM extra Budget. Care visits Postpartum visits over early breast feeding, on diet & rest, Orientation &

2. Initiation of at home. hygiene, contraception, essential new Training early breast- Ensuring borncare program can feeding within counseling on be organized

half-hour of early breast from Untied

birth feeding, on diet & fund. 3. Counseling on rest, hygiene, diet & rest, contraception, Services of HSCs Services hygiene, essential newborn contraception, care essential new born care, Infant and young child feeding. Family Counseling and Start MTP First purchase the essential equipments and Detail budget Planning appropriate Services at drugs listed above. Training/refreshing of equipments and referral for safe HSC level. course of and drugs has Contraception abortion suitable ANM. been given services (MTP) for above those in need. RNTCP Eradication of Easy availability Referral of suspected symptomatic cases to Budget will be TB of drugs & referral the PHC/Microscopy center given under of Provision of DOTS at sub centre and proper RNTCP head patients. documentation and follow-up AIDS, Eradication & Making people IEC activities to enhance awareness and For IEC Blindness, Control aware about preventive measures about AIDS, 341X5000= Leprosy, these disease Blindness, Leprosy, Malaria, Kala 17,05,000 Malaria, azar, Japanese Encephalitis, Filariasis,

Kala azar, Dengue etc and control of Japanese Epidemics Encephalitis, Filariasis, Dengue etc and control of Epidemics Child 1. No 100% child Working at various 1. Preparation of micro plan at PHC Vaccine is Immunization immunization levels to obtain level. Special Plan for hard to reach supplied from 2. Drop out cases 100 % area. state. So, no 3. Shortage of Child 2. Proper monitoring. need to vaccine. immunization. 3. Filling up immunization card to follow prepare the up. budget at 4. Vaccine is supplied from state that is district level irregular. So, ensure availability of all vaccine to increase reliability. 5. To control drop out cases if possible new vaccine like Easy 5 and MMR should supply. Budget Summary (Health Sub Centre) Head Sub head Budget Remarks Infrastructure Physical Infrastructure 20,00,00,000 Furniture 2,41,59,850 Equiepments 5,00,00,000 Drugs 5,00,00,000 Laboratory 40,00,000 Electricity 68,20,000 Telephone 9,20,700 Manpower Health worker(Female) 11,01,60,000 Health worker(Male) 2,45,52,000 Services of HSc Infrstructure(Rent) 33,00,000 For 275 HSC Untied Fund 34,10,000 Annual Maintenance 17,50,000 25000*70=17,50,000 Grant(70) IEC 17,05,000 Total 48,07,53,550

Additional Primary Health Center are the cornerstone of rural health services- a first port of call to a qualified doctor of the public sector in rural areas for the sick and those who directly report or referred from Sub-center for curative, preventive and promotive health care. A typical Primary Health Center covers a population of 20,000 in hilly, tribal, or difficult areas and 30,000 populations in plain areas with 4-6 indoor/observation beds. It acts as a referral unit for 6 sub-center and refer out cases to PHC (30 bedded hospital) and higher order public hospitals located at sub-district and district level.

In Bihar Additional PHCs operate at the population of 30,000. The APHC is the cornerstone of the public health system since it serves as a first contact point for preventive, curative and promotive health services. It is the first port of the public health system with a full time doctor and provision for inpatient services. There are 36 functional APHCs in Sitamarhi. 22 new APHCs are newly sanctioned. In general the APHCs in Sitamarhi suffer from: 1) Lack of facilities including availability of building 2) Constant power and water shortages 3) Unavailability of doctors 4) Doctors not residing at the facility 5) Insufficient quantities of drugs and equipment 6) Lack of capacity to use untied funds.

The objectives of IPHS for APHCs are: I. To provide comprehensive primary health care to the community through the Additional Primary Health Center. ii. To achieve and maintain an acceptable standard of quality of care. iii. To make the services more responsive and sensitive to the needs of the community.

No. of Institutions (Additional Primary Health center) As per IPH standard at every 30,000 population one APHC has to be established.

District Population Maximum APHC No. of APHCs already Gaps in No. of APHC (2011) required as per IPH sanctioned/ Norms @ 30,000 people established

34,19,622 114 56 68

To obtain 100% IPH standard -: Need to sanction 68 new APHC to achieve 100% IPH standard. Task for 2012-13 -:Make functional(24X7) to 56 APHC

Item IPHS Norms Maximum Present Status Gap Task Budget for requireme s for (2012-13) nt 2012-13 It should be well planned with the entire necessary 114 Sitamarhi have 34 56 20 20X1,00,00,000= established infrastructure. It should be well lit and ventilated with (Max. Rs20,00,00,000 APHCs APHCs and 22 as much use of natural light and ventilation as possible. as more APHCs are proposed to be The plinth area would vary from 375 to 450 sq. meters per establish new depending on whether an OT facility is opted for. IPHS) building. Again, out of 34 established APHCs, only 8 have their own buildings and rest

26 run in rented Physical Infrastructre Physical houses. All these 08 APHCs need new buildings. Examination table 3 Sundry Articles including 114 All APHc 56 All 10,00,000(Apprx Writing tables with table Linen: required sanctio ) per APHC sheets 5 Buckets 4 Furnitures ned/est Total - Plastic chairs 6 Mugs 4 ablishe 10,00,000 X 56= Armless chairs 8 LPG stove 1 d 5,60,00,000 Full steel almirah 4 LPG cylinder 2 APHc (To provide all Labour table 1 Sauce pan with lid 2 listed furniture OT table 1 Water receptacle 2 to all Arm board for adult and child Rubber/plastic shutting 2 APHC) 4 meters Wheel chair 1 Drum with tap for storing Stretcher on trolley 1 water 2

Instrument trolley 2 I V stand 4 Wooden screen 1 Mattress for beds 6 Foot step 5 Foam Mattress for OT

Furniture Coat rack 2 table 1 Bed side table 6 Foam Mattress for labour Bed stead iron 6 table 1 Baby cot 1 Macintosh for labour and Stool 6 OT table 4 metres Medicine chest 1 Kelly‟s pad for labour and Lamp 3 OT table 2 sets Shadowless lamp light Bed sheets 6 (for OT and Labour room) Pillows with covers 8 Side Wooden racks 4 Blankets 6 Fans 6 Baby blankets 2 Tube light 8 Towels 6 Basin 2, Basin stand 2 Curtains with rods 20 Metres

• Normal Delivery Kit • Phototherapy unit Maximu All APHc 56 56 10,00,000(Apprx • Equipment for assisted • Self inflating bag and mask- m required ) per APHC vacuum delivery neonatal size APHC is equiepments Total - • Equipment for assisted • Laryngoscope and Endotracheal 114 10,00,000 X56= forceps delivery intubation tubes (neonatal) So 5,60,00,000 • Standard Surgical Set • Mucus extractor with suction tube requirem (To provide all • Equipment for New Born and a foot operated suction machine ent listed Care and Neonatal • Feeding tubes for baby 28 is equipments to all Resuscitation • Sponge holding forceps - 2 according APHC) • IUD insertion kit • Valsellum uterine forceps - 2 ly • Equipment / reagents for • Tenaculum uterine forceps – 2 essential laboratory • MVA syringe and cannulae of

investigations sizes 4-8 • Refrigerator • Kidney tray for emptying contents • ILR/Deep Freezer of MVA syringe • Ice box • Trainer for tissues

Equiepment • Computer with accessories • Torch without batteries – 2 including internet facility • Battery dry cells 1.5 volt (large • Baby warmer/incubator. size) – 4 • Binocular microscope • Bowl for antiseptic solution for • Equipments for Eye care soaking cotton swabs and vision testing • Tray containing chlorine solution • Equipments under various for keeping soiled instruments National Programmes • Residual chlorine in drinking • Radiant warmer for new water testing kits borne baby • H2S Strip test bottles • Baby scale • Table lamp with 200 watt bulb for new borne baby Oxytocin - Inj-Amp 1 ml Ranitidine Hydochloride Tablet 114 All APHc 56 56 Total - (5i.u./ml) 150mg required Drugs 10,00,00,000 5% Dextrose 500 ml bottle Metoclopramide Tablet- 10mg (Approx.) B Complex Tab Diethylcarbamazine Tablet- 50mg (To provide all Gentamicin - Ear/Eye Drop 5 Paracetamol Dicyclomine Tablet listed ml (500mg+20mg) Medicine to all Promethazine - Inj-Amp. 2ml Fluconazole Tablet 50mg APHC) amps (25 mg/ml) DiethylcarbamazineTablet Pentazocine Lactate Inj. Inj- 100mg Amp.- 1 ml (30 mg/ml) Xylometazoline Drops - 0.1% Diazepam - Inj-Amp. 2ml (Nasal) 10ml vial. amps (5mg/ml) A.R.V. Cough Expectorant 100 ml Theophyline IP Combn. 25.3mg/ml pack Aminophyline Inj. IP 25mg/ml Ampicillin 250mg Capsule Adrenaline Bitrate Inj. IP 1mg/ml Ampicillin 500mg Capsule Methyl Ergometrine Maleate Cetrizine Tablet - 10mg 125mg/Tablet, Injection Drugs Doxycycline Capsule-100mg Amoxycilline Trilhydrate IP Etophylline & Theophylline 250mg/Capsule Inj.2ml Amoxycilline Trilhydrate IP Fluconazole Tablet – 200mg 250mg/Dispersible Tab. Dicyclomine Tablets - 20mg Phenoxymethyl Penicillin Dexamethasone Inj.- 4mg/ml- 130mg/ml 10ml Vial Vit K3 (Menadione Inj.) Atropine Inj. 0.6mg/ml - 1ml USP100mg/ml Ampoule Lignocaine Solution Nalidixic Acid Tabs. 100mg/Tab 2% Solution 2%- 30ml Vial Phenytoin Sodium Inj. IP 50mg/2ml Diazepam Tablet- 5mg Chlorpromazine Inj.- 4mg/ml- 10ml Chlorpheniramine Maleate Vial Tablet 4mg Atropine In Cephalexin ) Capsule- 250mg Metronidazole Tablet- 200mg Support Services 1. Routine urine, stool and blood tests 114 56 56 56 Budget for 2. Bleeding time, clotting time, Laboratory 3. Diagnosis of RTI/ STDs with wet mounting, Grams stain, etc. Equipments=2,0

4. Sputum testing for tuberculosis (if designated as a microscopy center 0,000X56APHCs ry under RNTCP) = 1,12,00,000 5. Blood smear examination for malarial parasite. 6. Rapid tests for pregnancy / malaria Laborato 7. RPR test for Syphilis/YAWS surveillance 8. Rapid diagnostic tests for Typhoid (Typhi Dot) 9. Rapid test kit for fecal contamination of water 10. Estimation of chlorine level of water using orthotoludine reagent

Wherever facility exists, uninterrupted power supply has to be ensured 114 56 56 56 Generator for which Generator and inverter facility is to be provided. service can be out sourced. 56 X 1,00,000 X Electricity 12=6,72,00,000

Potable water for patients and staff and water for other uses should being 114 56 56 56 adequate quantity. Towards this end, adequate water supply should be

ensured and safe water may be provided by use of technology like Water filtration, chlorination, etc. as per the suitability of the center. Where ever feasible, telephone facility / cell phone facility is to be 114 56 56 56 Total 56 X1500

Provided. Mobile phone +56X12X100 = ne 84,000+67200=1

Telepho ,51,200 The APHC should have an ambulance for transport of patients. This may Ambulance

be outsourced. service may be

outsourced Total-56X 15000 X 12= Transport 1,00,80,000 Laundry and Dietary facilities for indoor patients: these facilities Laundry and can be outsourced. Dietary facilities

can be

outsourced 10,000 per

Laundry APHC per month facilities

and Dietary Total -56 X 1,00,000 X12 = 6,72,00,000

Services and Others Sub Heads Gaps Issues Strategy Activities Budget

Out of 56 1. Non 1. Ensuring 1. Budget to construct Rent forAPHC only 8 payment of payment of 56APHC is given above. 48X1000X12= APHC have rent rent till own Construction of building is 5,76,000 its own 2. Land buildings are time taking process. So, building, availability not timely payment of rent is remaining for new constructed. needed are running in building 2. Involvement 2. DM should instruct the CO

rented of DM to to

building arrange land. arrange land for HSC. Lack of HSC are Purchasing No, excuse. There is no other Detail budget

Equipments, working Equipments, way except purchasing all has been given

tructure Drugs, but without Drugs, required resources. above

Furniture resources Furniture, and Infrastructure

Infras Power Power etc. as per IPH standard. Formats/ Always it Arrangements Untide fund are available 56X25,000= Registers is found of fund for but.no initiation is taken by 14,00,000 and that HSC these APHC MO. Stationeries is miscellaneous (Untied fund lacking expenses stationeries No No Arrange all Purchase Drug, equipments, Detail budget Institutional services of required furniture as per IPHS. Hire has been given

delivery at delivery. resources to required manpower to support above HSC level perform this service. Arrangement of institutional Ambulance at APHC & PHC

delivery. level to quickly send patients

in bigger hospital in case of

ices of ices HSCs complications. Medical care Non OPD Services 6 hours in the morning and 2 Nothing new Serv Functional hours in the evening for 24 hours Minimum OPD Attendance these services emergency should be 40 patients per Detail budget

services doctor per day. has been given Appropriate management of above. Referral injuries and accident, First services In- Aid, Stabilization of the patient services condition of the patient before (6 beds) referral, Dog bite/snake bite/scorpion bite cases, and other emergency conditions Ambulance Service to support referral Provision of diet, light, laundry etc to start indoor service. Maternal Non Antenatal care Start immunization properly. Nothing new and functional Intra-natal care start JBSY at APHC level for Child Health Postnatal Care Establish lab for minimum these services Care New Born care investigations like Detail budget Care of the hemoglobin, urine albumin, has been given child and sugar, RPR test for above syphilis Nutrition and health counseling Promotion of institutional deliveries Conducting of normal deliveries Assisted vaginal deliveries including forceps /vacuum delivery whenever required Manual removal of placenta Appropriate and prompt referral for cases needing specialist care. Management of Pregnancy Induced hypertension including referral Pre-referral management A minimum of 2 Postpartum home visits, first within 48 hours of delivery, 2nd within 7 days through Sub-center staff. Initiation of early breastfeeding within half- hour ofbirth Education on nutrition, hygiene, contraception, essential new born care Family No FP 1. Start FP Education, Motivation and No need of Planning operation operation counseling to adopt extra Budget. Contraception at 2.Distribution appropriate Family Planning Orientation & & MTP APHC of methods. Training level. contraceptives Provision of contraceptives program can such as such as condoms, oral pills, be condoms, oral emergency organized pills, Contraceptives, IUD from emergency insertions. Untied fund. Contraceptives. Permanent methods like 3. IUD Tubal ligation and insertions vasectomy/ NSV. Follow up services to the eligible couples adopting permanent methods Counseling and appropriate referral for safe abortion services (MTP) for Those in need.

Counseling and appropriate referral for couples having infertility. RNTCP No DOT Treatment and All APHCs to function as Budget will be center at Distribution of DOTS Centers to given under APHC drug. deliver treatment as per RNTCP head RNTCP treatment guidelines through DOTS providers and treatment of common complications of TB and side effects of drugs, record and report on RNTCP activities as per Guidelines. Integrated No IDSP Need to start APHC will collect and Budget for Disease IDSP analyze data from sub-center Computer Surveillance and will report Information to operator and Project PHC surveillance unit. Stationary. (IDSP) Appropriate preparedness and 56X first level action in out-break 7500X12= situations. 50,40,000 Laboratory services for diagnosis of Malaria, Tuberculosis, Typhoid and tests for detection of faucal Contamination of water (Rapid test kit) and chlorination level. National No NPCB Need to start Diagnosis and treatment of Budget will be Program program NPCB common eye diseases. given under for Control Program Refraction Services. District of Detection of cataract cases Blindness Blindness and referral for cataract program head (NPCB) surgery. National Starting AIDS IEC activities to enhance Budget will be AIDS control awareness and preventive given under Control program at measures about STIs and District AIDS Program APHC level HIV/AIDS, Prevention of program head Parents to Child Transmission Organizing School Health Education Programme Screening of persons practicing high-risk behaviour with one rapid test to be conducted at the APHC level and development of referral linkages with the nearest VCTC at the District Hospital level for confirmation of HIV status of those found positive at one test stage in the high Prevalence states. Risk screening of antenatal mothers with one rapid test for HIV and to establish referral linkages with CHC or District Hospital for PPTCT Services. Linkage with Microscopy Center for HIVTB coordination. Condom Promotion & distribution of condoms to the high risk groups. Help and guide patients with HIV/AIDS receiving ART with focus on Adherence. 69

Leprosy, Eradication Making people IEC activities to enhance Malaria, & Control aware about awareness and preventive Kala- azar, these disease measures about Japanese and providing AIDS,Blindness, Leprosy, Encephalitis, treatments Malaria, Kala azar, Japanese Filariasis, Encephalitis, Filariasis, Dengue etc Dengue etc and control of and control of Epidemics Epidemics Starting treatment of patients if reported. Referral facilities for better treatment.

Budget Summary (APHCs)

ead Sub head Budget Remarks

Physical Infrastructure 20,00,00,000 Furniture 5,60,00,000 Equiepments 5,60,00,000 Drugs 10,00,00,000 Laboratory 1,12,00,000 Electricity 6,72,00,000

Infrastructure Telephone 1,51,200 Transport 1,00,80,000 Laundry & Dietry 6,72,00,000 For all 16,86,72,000 MO-30000x4x56x12=8,06,40,000,,ANM(A)-20000x4x56x12=5,37,60,000, Pharmacist-15000x1x56x12=100,80,000,,Accountant(RKS)-

wer 15000x56x12=100,80,000 Manpo Dresser-10000x3x56x12=2,01,60,000,Sweeper-6000x1x56x12=40,32,000

Infrstructure(Rent) 11,52,000 48APHC*Rs 2000/M Untied Fund 14,00,000 Annual Maintenance 1000000 10*100000 Grant Seed Money 52,00,000 IDSP 50,40,000 Services of APHC Services Total 9218719200

Primary Health Centers exist to provide health care to every citizen of India within the allocated resources and available facilities. The Charter seeks to provide a framework which enables citizens to know.  what services are available?  the quality of services they are entitled to.  the means through which complaints regarding denial or poor qualities of services will be addressed. Objectives  to make available medical treatment and the related facilities for citizens.  to provide appropriate advice, treatment and support that would help to cure the ailment to the extent medically possible.  to ensure that treatment is best on well considered judgment, is timely and comprehensive and with the consent of the citizen being treated.  to ensure you just awareness of the nature of the ailment, progress of treatment, duration of treatment and impact on their health and lives, and  to redress any grievances in this regard. No. of Institutions (Primary Health center) As per IPH standard at every 1,00,000 population one PHC has to be established. District Population Maximum PHC required No. of PHCs already Gaps in No. of PHC (2011) as per IPH Norms @ sanctioned/ 30,000 people established

34,19,622 34 17 17 To obtain 100% IPHS standard -: Need to sanction 8 new PHC to achieve 100% IPHS standard. Task for 2012-13 -:  Out of 17 sanctioned PHC all 13 PHC are established and functioning with 24x7Services . So, in financial year 2012-13, i.e. 4 PHCs will make functional 24x7 Services

Ite IPHS Norms Maximum Present Ga Task Budget for m Requireme Status ps for (2012-13) nt 2012-13 The PHC should have 30 indoor beds with one Operation 34 (Max. Sitamarhi 17 10 10x1,50,00,00

theatre, labour room, X-ray facility and laboratory facility. PHCs as per have17 0= It should be well lit and ventilated with as much use of IPHS) established 15,00,00,000 natural light and ventilation as possible. The plinth area PHCs & no would vary from 375 to 450 sq. meters depending on PHCs have

Physical Physical whether an OT facility is opted for. sufficient

Infrastructre Infrastructure for 30 beds.. Examination table 6 Sundry Articles including 34 All PHC 17 17 10,00000(App Writing tables with table Linen: required r sheets 5 Buckets 4 Furnitures x) per PHC Plastic chairs 50 Mugs 4 Total - Armless chairs 8 LPG stove 1 10,00,000 X Full steel almirah 10 LPG cylinder 2 17 = Labour table 6 Sauce pan with lid 2 1,70,00,000 OT table 5 Water receptacle 2 (To provide Arm board for adult and Rubber/plastic shutting 2 all child 4 meters listed furniture Wheel chair 1 Drum with tap for storing to all Stretcher on trolley 1 water 2 PHC) Instrument trolley 2 I V stand 4

Wooden screen 1 Mattress for beds 6 Foot step 5 Foam Mattress for OT Coat rack 2 table 1

Furniture Bed side table 6 Foam Mattress for labour Bed stead iron 6 table 1 Baby cot 1 Macintosh for labour and Stool 6 OT table 4 metres Medicine chest 1 Kelly‟s pad for labour and Lamp 3 OT table 2 sets Shadowless lamp light Bed sheets 6 (for OT and Labour room) Pillows with covers 8 Side Wooden racks 4 Blankets 6 Fans 6 Baby blankets 2 Tube light 8 Towels 6 Basin 2 Curtains with rods 20 Basin stand 2 Metres

• Normal Delivery Kit • Self inflating bag and Maximum All PHCs 17 17 20,00,000 • Equipment for assisted mask-neonatal size PHC is 34 required (Approx) per vacuum delivery • Laryngoscope and So Equiepments. PHC • Equipment for assisted Endotracheal intubation requirement Total - forceps delivery tubes (neonatal) is 3,40,00,000 • Standard Surgical Set • Mucus extractor with accordingly • Equipment for New Born suction tube and a foot Care and Neonatal operated suction machine Resuscitation • Feeding tubes for baby • IUD insertion kit 28 • Equipment / reagents for • Sponge holding forceps essential laboratory - 2 investigations • Valsellum uterine • Refrigerator forceps - 2 • ILR/Deep Freezer • Tenaculum uterine

• Ice box forceps – 2 • Computer with accessories • MVA syringe and including internet facility cannulae of sizes 4-8 • Baby warmer/incubator. • Kidney tray for

Equiepment • Binocular microscope emptying contents of • Equipments for Eye care MVA syringe and vision testing • Trainer for tissues • Equipments under various • Torch without batteries National Programmes – 2 • Radiant warmer for new • Battery dry cells 1.5 volt borne baby (large size) – 4 • Baby scale • Bowl for antiseptic • Table lamp with 200 watt solution for soaking bulb for new borne baby cotton swabs • Phototherapy unit • Tray containing chlorine solution for keeping soiled instruments • Residual chlorine in drinking water testing kits • H2S Strip test bottles

Paracetamol Tab- 500mg per Diethylcarbamazine- 34 All PHCs 17 17 Total - Tab. Tablet- 50mg required 17,00,00,000 Paracetamol Syrup- Paracetamol Drugs 125mg/5ml-60ml Dicyclomine- Tablet Atropine - Inj. 0.6 mg per (500mg+20mg) 1ml amps Fluconazole- Tablet 50mg Ciprofloxacin – Tab Diethylcarbamazine- 500mg/Tab Tablet- 100mg Co Trimoxazole Tab 160 + Xylometazoline- Drops - 800 mg Tab 0.1% (Nasal) 10ml vial. Gentamycin – Inj M.D. vial A.R.V. (40 mg/ml)- 30ml vial Theophyline IP Oxytocin - Inj-Amp 1 ml Combn.25.3mg/ml (5i.u./ml) Aminophyline Inj. IP 5% Dextrose 500 ml bottle 25mg/ml B Complex Tab Adrenaline Bitrate Inj. IP Gentamicin - Ear/Eye Drop 1mg/ml 5 ml Methyl Ergometrine Promethazine - Inj-Amp. Maleate 125mg/Tablet, 2ml amps (25 mg/ml) Injection Pentazocine Lactate Inj. Inj- Amoxycilline Trilhydrate Amp.- 1 ml (30 mg/ml) IP 250mg/Capsule Diazepam - Inj-Amp. 2ml Amoxycilline Trilhydrate amps (5mg/ml) IP 250mg/Dispersible Cough Expectorant 100 ml Tab. pack Phenoxymethyl Penicillin Ampicillin 250mg Capsule 130mg/ml Drugs Ampicillin 500mg Capsule Vit K3 (Menadione Cetrizine Tablet - 10mg Inj.)USP 100mg/ml Doxycycline Capsule-100mg Nalidixic Acid Etophylline & Theophylline Tabs.100mg/Tab Inj.- 2ml Phenytoin Sodium Inj. Fluconazole Tablet – 200mg IP50mg/2ml Dicyclomine Tablets - 20mg Chlorpromazine Dexamethasone Inj.- Hydrochloride 25mg/ml 4mg/ml- 10ml Vial Cephalexin /Ceptrofloxin Atropine Inj. 0.6mg/ml - 1ml 250mg/Tablet Ampoule Sodium Chloride Inj. IP Lignocaine Solution 2% I.V. Solution 0.9w/v Solution 2%- 30ml Vial Gama Benzine hexa Diazepam Tablet- 5mg Chloride As decided by Chlorpheniramine Maleate- CS Tablet- 4mg Plasma Volume Expander Cephalexin )- Capsule- As decided by CS 250mg Inj. Magnesium Inj. 50% Metronidazole- Tablet- preparation 200mg Hydralazine Misoprostol Ranitidine Hydochloride- 200mg/Tablet Tablet 150mg Metoclopramide- Tablet- 10mg

Support Services Laboratory 1. Routine urine, stool and blood tests 34 17 17 1 Budget for 2. Bleeding time, clotting time, 7 Laboratory 3. Diagnosis of RTI/ STDs with wet mounting, Grams Equipments=5,00,000X1 stain, etc. 7PHCs= 85,00,000 4. Sputum testing for tuberculosis (if designated as a microscopy center under RNTCP) 5. Blood smear examination for malarial parasite. 6. Rapid tests for pregnancy / malaria 7. RPR test for Syphilis/YAWS surveillance 8. Rapid diagnostic tests for Typhoid (Typhi Dot) 9. Rapid test kit for fecal contamination of water 10. Estimation of chlorine level of water using orthotoludine reagent Electricity Wherever facility exists, uninterrupted power supply 34 17 17 1 Generator serviceis has to be ensured for which Generator and inverter 7 out sourced. facility is to be provided.

Water Potable water for patients and staff and water for other 34 17 17 1 uses should being adequate quantity. Towards this 7 end, adequate water supply should be ensured and safe water may be provided by use of technology like filtration, chlorination, etc. as per the suitability of the center. Telephone Where ever feasible, telephone facility / cell phone 34 17 17 1 Total 2X17 X1500 facility is to be Provided. Mobile phone 7 +17X12X500 =1,53,000 Transport The APHC should have an ambulance for transport of Ambulance service is patients. This may be outsourced. Outsourced Total-17X 15000 X 12 = 30,60,000 Laundry and Dietary facilities for indoor patients: Laundry and Dietary

these facilities facilities can be

can be outsourced. outsourced 10,000 per APHC per

Month Total -17 X

Laundry facilities

and Dietary 1,00,000 X12 =2,04,00,000

Manpower IPHS Maximum Present Gaps Task Budget 12-13 manpower Manpower For 12- required 13 General Surgeon 1 17X1=17 0 17 17 40000*17*12=81,60,000 Obstetrician/ 1 17X1=17 0 17 17 40000*17*12=81,60,000 Gynecologist Pediatrics 1 17X1=17 0 17 17 40000*17*12=81,60,000 Anesthetist 1 17X1=17 5 12 12 40000*12*12=57,60,000 Physician 1 17X3=51 17 0 51 30000*51*12=1,83,60,000 Eye surgeon 1 17X1=17 0 17 17 40000*17*12=81,60,000 Dental Surgeon 1 17X1=17 5 12 17 30000*17*12=61,20,000 Health Manager 1 17X1=17 10 7 7 25000*17*12=51,00,000 Accountant 1 17X3=51 11 6 6 15000*17*12=30,60,000 Nurse-midwife 1 17X3=51 12 39 39 20000*51*12=1,22,40,000 Dresser 1 17X3=51 4 47 47 10000*34*12=40,80,000 Pharmacist/ 1 17X2=34 6 28 28 12000*34*12=48,96,000 compounder Lab. Technician 1 17X1=17 12 5 5 12000*17*12=24,48,000 Radiographer 1 17X1=17 0 17 17 15000*17*12=30,60,000 Ophthalmic 1 17X1=17 3 14 14 15000*17*12=30,60,000 Assistant Ward boys/ 1 17X3=51 0 51 51 8000*51*12=48,96,000 nursing Orderly Sweepers 1 17X3=51 4 47 47 6000*51*12=36,72,000 Chowkidar 1 17X3=51 0 Home Guard hired OPD attendant 1 17X3=51 0 51 51 10000*51*12=61,20,000 Statistical 1 17X1=17 0 17 17 10000*17*12=20,40,000 Assistant/ Data entry operator OT attendant 1 17X3=51 0 51 51 10000*51*12=61,20,000 Registration clerk 1 17X3=51 0 51 51 10000*51*12=61,20,000 Total ` 12,97,92,000

Sub Gaps Issue Strategy Activities Budget Heads s

Out of 17 sanctioned PHC Avail Upgradation of all Renovation of PHCs Bairagania : Bairagania PHC is able PHC into 30 purchase of Detail situated in the Border of Nepal. facili bedded facilities, furnitures priorities budget X-ray & Pathology services is ties strengthening of the equipments. has been required. PHC Bajpatti It has its are infrastructure and given own building. PHC Belsand, not operationalization Appointment of Dumra, Mejarganj, Nanpur, comf of construction block Accountants Parihar, Pupri, Riga, Runni ortab works. for all running PHCs. Saidpur, Sonbarsa, Sursand have le the own building, Bathanaha PHC servi Strengthening of For the proper work running in HSC building, Nanpur ces block management it is necessary to PHC running in rented building supp unit monitor the PHCs and Bokhara, Parsauni, Chorout & ort to facilities. Suppi Newly established. be Monitoring Formation of RKS deliv where it is not form. ered at PHC s. Lack of some Equipments, Drugs, PHC Purchasing No, excuse. There is Detail

Furniture, Power PHC Pupri & are Equipments, no other way except budget

Runni Saidpur 12 beded and work Drugs, Furniture, purchasing all has been

Bairagania, Bajpatti, Bathanaha, ing and Power etc. as required resources. given

Belsand, Dumra, Mejarganj, but per IPH standard

Nanpur, Parihar, Riga, Sonbarsa, witho Infrastructure Infrastructure Sursand, Bokhara, Chorout, ut Parsauni and Suppi is functional resou in APHC Sasaula building are rces available 6 beds but as per needs it requires 30 bedded Hospital hence for provision of 24 Extra bed which cost Rs. 10000 x 24 beds =240000 Rupees will be required. Alwa Arrangements of Untide fund are Formats/ Registers and ys it fund for these available but.no 17X25,00 Stationeries (Untied fund) is miscellaneous initiation is taken by 0= foun expenses PHC MO. 4,25,000 d That PHC is lacki ng Stati oneri es Huma Most of the PHCs have Lack of A Fillin Staff recruitment Selection and Detail n Grade Nurse, Lack of Specialist g up Capacity building recruitment of staff. budget Resour doctors, Lack of ANM, Lack of the Appointment of has been ce pharmacist, Lack of Trained Male short block health manager given workers, age and accountant. above staff Training need untra assessment PHC‟s ined level staff. Training staff. of other staff as per need.

Deliv Arrange all Purchase Drug, Detail Institutional delivery at PHC level ery required equipments, furniture budget servi resources and as per IPHS. has been ces manpower to Hire required given but improve the quality manpower to support with of institutional this service.. poor delivery. resou rces Medical care Not Care of routine and 6 hours in the Nothing upto emergency cases in morning and 2 hours new for mark surgery in the evening these Care of routine and Minimum OPD services emergency cases in Attendance should Detail medicine be 40 patients per budget New-born Care doctor per day. has been 24 hours Appropriate given emergency management of . services injuries and accident, Referral services First Aid, In-patient services Stabilization of the (30 beds) condition of the patient before referral, Dog bite/snake bite/scorpion bite

cases, and other

Cs emergency

PH conditions

Ambulance Service

to support referral Provision of diet,

light, laundry etc to Servicesof start indoor service. Maternal and Non 24-hour delivery improve quality of Nothing Child Health Care funct services including JBSY at PHC level new for ional normal and Establish lab for these assisted minimum services deliveries investigations like Detail Essential and hemoglobin, urine budget Emergency albumin, and sugar, has been Obstetric Care RPR test for syphilis given Antenatal care Nutrition and health Intra-natal care counseling Postnatal Care Promotion of New Born care institutional Care of the child deliveries Conducting of normal deliveries Assisted vaginal deliveries including forceps / vacuum Delivery when ever required Manual removal of placenta Appropriate and prompt referral for cases needing specialist care.

Management of Pregnancy Induced hypertension including referral/Pre-referral management A minimum of 2 Postpartum home visits, first within 48 hours of delivery, 2nd within 7 days through Sub-center staff. Initiation of early breast-feeding within half-hour of birth Education on nutrition, hygiene, contraception, essential new borncare Family Planning Contraception FP 1. Full range of Education,Motivatio No need & MTP opera family n and counseling to of tion Planning services adopt appropriate extra at Including Family Planning Budget. PHC Laparoscopic methods. Orientatio level. Services Provision of n & 2. Safe Abortion contraceptivessuch Training Services as condoms, oral program 3. Distribution pills, emergency can be of contraceptives Contraceptives, IUD organized such as condoms, insertions. from oral pills, Untied emergency Permanent methods fund. Contraceptives. like Tubal ligation 3. IUD insertions and vasectomy / NSV.

Follow up services to the eligible couples adopting permanent methods

Counseling and appropriate referral for safe abortion services (MTP) for Those in need.

Counseling and appropriate referral for couples having infertility. RNTCP Treatment and All PHC function as Budget DOT Distribution of DOTS Center to will be cente drug. deliver treatment as given r at per RNTCP under PHC treatment guidelines RNTCP through DOTS head providers and

treatment of common complications of TB and side effects of drugs, record and report on RNTCP activities as per Guidelines. Integrated Disease No Need to start IDSP PHC will collect and Budget Surveillance IDSP analyze data from has Project (IDSP) sub-center and will been report Information to given PHC surveillance above. unit. Appropriate preparedness and first level action in out-break situations. Laboratory services for diagnosis of Malaria, Tuberculosis, Typhoid and tests for detection of faucal Contamination of water (Rapid test kit) and chlorination level. National Program No Need to start Diagnosis and Budget for Control of NPC NPCB Program treatment of common will be Blindness (NPCB) B eye diseases. given progr Refraction Services. under am Detection of cataract Blindness cases and referral for program cataract surgery. National AIDS Starting AIDS IEC activities to Budget Control Program control program at enhance awareness will be APHC level and preventive given measures about STIs under and HIV/AIDS, District Prevention of Parents AIDS to Child program Transmission head Organizing School Health Education Programme Screening of persons practicing high-risk behaviour with one rapid test to be conducted at the APHC level and development of referral linkages with the nearest VCTC at the District Hospital level for confirmation of HIV status of those found positive at one test stage in the high Prevalence states.

Risk screening of antenatal mothers with one rapid test for HIV and to establish referral linkages with CHC or District Hospital for PPTCT Services. Linkage with Microscopy Center for HIVTB coordination. Condom Promotion & distribution of condoms to the high risk groups. Help and guide patients with HIV/AIDS receiving ART with focus on Adherence. Leprosy, Malaria, Kala- Eradi Making people IEC activities to azar,Japanese catio aware about these enhance awareness Encephalitis, Filariasis, Dengue n & disease and and preventive etc and control of Epidemics Contr providing measures about ol treatments AIDS,Blindness, Leprosy, Malaria, Kala azar, Japanese Encephalitis, Filariasis, Dengue etc and control of Epidemics Starting treatment of patients if reported. Referral facilities for better treatment.

Head Sub head Budget Remarks Infrastructure Physical Infrastructure 15,00,00,000 Furniture 1,70,00,000 Equiepments 3,40,00,000 Drugs 17,00,00,000 Laboratory 85,00,000 Telephone 1,53,000 Transport 30,60,000 Manpower 12,97,92,000 Laundry & Dietry 2,04,00,000 Services of PHC Untied Fund 4,25,000 Annual Maintenance 34,00,000 Rs2,00,000*17PHC Grant IEC 17,00,000 Total 63,96,05,000

District Health System is the fundamental basis for implementing various health policies and delivery of healthcare, management of health services for define geographic areas. Referral Hospital is an essential component of the district health system and functions as a secondary level of health care which provides curative, preventive and promotive healthcare services to the people in the area. The overall objective of IPHS is to provide health care that is quality oriented and sensitive to the needs of the people of the district. The specific objectives of IPHS for RHs are: i. To provide comprehensive secondary health care (specialist and referral services) to the community through the Referral Hospital. ii. To achieve and maintain an acceptable standard of quality of care. To make the services more responsive and sensitive to the needs of the people of the district and the hospitals/centers from which the cases are referred to the district hospitals No. of Institutions (Referral Hospital) As per IPH standard one Referral Hospital at every district. District Population Maximum RH required No. of RH already Gaps in No. of RH (2011) as per IPH Norms sanctioned/ established 34,19,622 2 2 0

To obtain 100% IPH standard -: Need to strength proposed for referral hospital to achieve 100% IPH standard. Task for 2012-13 -:  Need to provide required manpower, resources, drugs and equipments to minimize the gaps. Availability of furniture, equipments, drugs and supplies in different service providing Units/Wards in FRUS

13)

13 -

Item Item IPHSNorms Maximum requirement Present Status Gaps for Task 2012 Budget for (2012

An area of 65-85 m2 per bed has been 2 2 2 2

considered to be reasonable. The area will include the service areas such as waiting space, entrance hall, registration

counter, etc. In case of specific

Physical 0,00,000

requirement of a hospital, flexibility in 0

Infrastructre

x1,50,00,000= , 3 altering the area is kept. 2

Waste disposal should be carried out as

per the GOI guidelines, which is under

preparation

Waste Waste Disposal

Doctor's chair Instrument Tray 2 2 2 2 Doctor's Table Assorted Duty Table for Kidney Tray Nurses Assorted Table for Basin Assorted Sterilization use Basin Stand Long Benches Assorted Stool Wooden Delivery Table Stools Revolving Blood Donar Table Steel Cup-board O2 Cylinder Wooden Cup Trolley Board Saline Stand Racks -Steel – Waste Bucket Wooden Dispensing Table Patients Waiting Wooden Chairs Bed Pan Attendants Cots Urinal Male and Office Chairs Female Office Table Name Board for Foot Stools cubicals Filing Cabinets Kitchen Utensils (for records) Containers for M.R.D. kitchen Requirements Plate, Tumblers (record room use) Waste Disposal - Pediatric cots Bin / drums with railings Waste Disposal -

Cradle Trolley (SS) Fowler's cot Linen Almirah Ortho Facture Stores Almirah

Furniture Table Arm Board Adult Hospital Cots Arm Board Child Hospital Cots SS Bucket with Lid Pediatric Bucket Plastic Wooden Blocks Ambu bags Back rest O2 Cylinder with Dressing Trolley spanner ward Medicine type Almirah Diet trolley - Bin racks stainless steel ICCU Cots Needle cutter and Bed Side Screen melter Medicine Trolley Thermometer Case Sheet clinical Holders with clip Thermometer Bed Side Lockers Rectal Examination Torch light Couch Cheatles forceps Instrument assortted Trolley Stomach wash Instrument equipment Trolley Mayos Infra Red lamp82 Surgical Bin Wax bath

Assorted Emergency

Wheel Chair Resuscitation Kit- 000

Stretcher / Adult ,

10 (Apprx) (To provide listed all furniture 1 to RH)

• Imaging • Baby scale 2 2 2 2 Equipment • Table lamp with • X-ray room 200 watt bulb accessories for new borne baby • Cardiac • Photo therapy unit equipments • Self inflating bag • Labor ward and maskneonatal equipments size • Equipment for • Laryngoscope and New Born Care Endotracheal and Neonatal intubations tubes Resuscitation (neonatal) ENT equipment • Mucus extractor Eye equipment with suction tube Dental Equipment and a foot operated Laboratory suction machine equipments • Feeding tubes for OT equipment baby 28 Surgical • Sponge holding equipment forceps - 2 Physiotherapy • Valsellum uterine equipments forceps - 2 Endoscopes • Tenaculum equipments uterine forceps – 2 Anesthesia • MVA syringe and equipments cannulae of • IUD insertion sizes 4-8 kit • Kidney tray for • Equipment / emptying contents Equiepment reagents for of MVA syringe essential • Trainer for tissues laboratory • Torch without • Refrigerator batteries – 2 • ILR/Deep • Battery dry cells Freezer 1.5 volt (large • Ice box size) – 4 • Computer with • Bowl for accessories antiseptic solution including internet for facility soaking cotton • Baby swabs warmer/incubator. • Tray containing • Binocular chlorine microscope solution for • Equipments for keeping soiled Eye care and instruments vision testing • Residual chlorine • Equipments in drinking under various water testing kits

National • H2S Strip test

Programmes bottles • Radiant warmer 83

for new borne

(Approx) (To provide listed all equipmen Baby 2000000

Dicyclomine Inj- Carbamazepine 2 2 2 2 Atropine - Inj. Cephalexin Norfloxacin- Tab Metronidazole Ciprofloxacin - Metronidazole Tab Cefotaxime Ciprofloxacin - Atenolol Tab Furosemide Co Trimoxazole Ranitidine Tab Hydochloride Amoxicillin- Cap Metoclopramide Gentamycin - Inj Isosorbide Dinitrate Albendazole Diethylcarbamazine Alprazolam - Tab Ciprofloxacin Ranitidine - Inj Metronidazole Oxytocin - Inj- Cefotaxime Amp Enalapril Methyl Enalapril Ergometrine Chloramphenicol Glibenclamide Alprazolam 5% Dextrose Tramadol 5% Dextrose + Dexamethasone 0.9% Cefotaxime B Complex Amlodipine Silver Erythromycin Sulphadiazine Stearate oint - Cetrizine Promethazine - Omeprazole Inj-Amp. Prednisolone Pentazocine Diethylcarbamazine Lactate Inj. Ampicillin Sodium Diazepam - Inj- Atenolol

Amp. Hydroxy Cough progesterone

Drugs Expectorant acetate Ampicillin Xylometazoline Ciprofloxacin Prednisolone Thiopentone Betamethasone Cetrizine Chloram Phenicol Doxycycline Bupivacaine Ampicillin & Hydrochloride Cloxacilin Succinyl Choline Etophylline & Intermediate acting Theophylline insulin Dopamine Lente/NPH Insulin Hydrochloride Insulin injection Adrenaline (Soluble) - Inj. Sodium 40IU/ml Bicarborate premix insulin Tinidazole (30/70 Human) Fluconazole A.S.V.S. Clotrimazole ARV Cream 84 Dicyclomine Tablets Dexamethasone

Digoxin

Total Total 2,0000000 (Approx.) (To all provide listed Medicine workin to RH) 1

Support Services 1. Routine urine, stool and blood tests 2 2 2 2 2. Bleeding time, clotting time, 3. Diagnosis of RTI/ STDs with wet

mounting, Grams stain, etc.

4. Sputum testing for tuberculosis (if designated as a microscopy center

under RNTCP)

5. Blood smear examination for malarial parasite.

6. Rapid tests for pregnancy / malaria

Laboratory 7. RPR test for Syphilis/YAWS surveillance

8. Rapid diagnostic tests for Typhoid Laboratory

(Typhi Dot) 9. Rapid test kit for fecal contamination of water

10. Estimation of chlorine level of Equipments=5,00,000X2=10,00,000

water using orthotoludine reagent for Budget

Wherever facility exists, uninterrupted 2 2 1 2

power supply has to be ensured for

y which Generator and inverter facility is

Electricit

r r serviceis out sourced. to be provided. Generato Potable water for patients and staff and 2 2 1 2 water for other uses should being

adequate quantity. Towards this end, adequate water supply should be

ensured and safe water may be Water provided by use of technology like filtration, chlorination, etc. as per the

suitability of the center.

Where ever feasible, telephone facility / 2 2 1 2

cell phone facility is to be Provided.

,000 1500 1500

Mobile phone X12X

2 15

Telephon Total 2X + 500 =

The APHC should have an ambulance 2 2 2 2

X X 2

for transport of patients. This may be -

outsourced.

,60,000

Transpor t Ambulan ce is service outsourc ed Total X 15000 12 = 3

Laundry and Dietary facilities for 2 2 2 2

2 2

indoor patients: these facilities -

,000

0 and and

can be outsourced.

Dietary

Laundry

facilities

Laundry Laundry and Dietary facilities be can outsourc ed 10,000 per per month Total 10,000 X = X12 2,

Manpower IPHS Maximum Present Gaps Task Budget 12-13 manpower Manpower For required 12- 13 Medical Suprintendent 1 1X2=2 2 2X50000X12=12,00,000 Medical Specialist 3 3X2=6 6 6X40000X12=28,80,000 Surgery Specialist 3 3X2=6 6 6X40000X12=28,80,000 O & G Specialist 6 6X2=12 0 12 12X40000X12=57,60,000 Psychiatrist 1 1X2=2 0 2 2X40000X12=9,60,000 Dermatologist/Venerologist 1 1X2=2 0 2 2X40000X12=9,60,000 Pediatrician 3 3X2=6 6 6X40000X12=28,80,000 Anesthetist 6 6X2=12 12 12X40000X12=57,60,000 ENT surgeon 2 2X2=4 4 4X40000X12=19,20,000 Opthalmologist 2 2X2=4 4 4X40000X12=19,20,000 Orthopedician 2 2X2=4 4 4X40000X12=19,20,000 Radiologist 1 1X2=2 2 2X40000X12=9,60,000 Casualty Doctors / 20 20X2=40 40 40X30000X12=72,00,000 General Duty Doctors Dental Surgeon 1 1X2=2 2 2X30000X12=7,20,000 Health Manager 1 1X2=2 2 2X20000X12=4,80,000 Accountant 1 1X2=2 2 2X15000X12=3,60,000 AYUSH Physician 4 4X2=8 8 8X15000X12=14,40,000 Pathologist 2 2X2=4 4 4X40000X12=19,20,000 Staff Nurse 20 20X2=40 40 40X20000X12=96,00,000 Hospital worker (OP/ward 20 20X2=40 40 40X10000X12=48,00,000 +OT+blood bank) Ophthalmic Assistant 2 2X2=4 4 4X20000X12=9,60,000 ECG Technician 1 1X2=2 2 2X20000X12=4,80,000 Laboratory Technician ( 4 4X2=8 1 8 8X12000X12=11,52,000 Lab +Blood Bank Maternity assistant (ANM) 4 4X2=8 8 8X12000X12=11,52,000 Radiographer 2 2X1=2 1 2 2X20000X12=4,80,000 Pharmacist 6 6X2=12 12 12X12000X12=17,28,000 Physiotherapist 2 2X2=4 4 4X12000X12=5,76,000 Statistical Assistant/ 1 1X2=2 2 2X10000X12=2,40,000 Data entry operator Total 5,68,08,000

Head Sub head Budget Remarks Infrastructure Physical Infrastructure 3,00,00,000 Untied Fund 100000 2*Rs 50000 Annual Maintenence Grant 600000 2*Rs 300000 Furniture 20,00,000 Equiepments 20,00,000 Drugs 2,00,00,000 Laboratory 10,00,000 Telephone 15,000 Transport 3,60,000 Manpower 5,68,08,000 Laundry & Dietry 2,40,000 Total 11,31,23,000

District Health System is the fundamental basis for implementing various health policies and delivery of healthcare, management of health services for define geographic areas. District hospitals is an essential component of the district health system and functions as a secondary level of health care which provides curative, preventive and promotive healthcare services to the people in the district. The overall objective of IPHS is to provide health care that is quality oriented and sensitive to the needs of the people of the district. The specific objectives of IPHS for DHs are:  To provide comprehensive secondary health care (specialist and referral services) to the community through the District Hospital.  To achieve and maintain an acceptable standard of quality of care. To make the services more responsive and sensitive to the needs of the people of the district and the hospitals/centers from which the cases are referred to the district hospitals No. of Institutions As per IPH standard one District Hospital at every district. District Population Maximum DH required No. of DH already Gaps in No. of DH (2011) as per IPH Norms sanctioned/ established

34,19,622 1 1 0

To obtain 100% IPH standard -: Need to strength sanction district hospital to achieve 100% IPH standard. Task for 2010-11 -: Need to provide required manpower, resources, drugs and equipments to minimize the gaps. Availability of furniture, equipments, drugs and supplies in different service providing Units/Wards in DH

13)

13 -

Item Item IPHSNorms Maximum requirement Present Status Gaps Taskfor 2012 Budgetfor (2012

An area of 65-85 m2 per bed has 1 Sitamarhi 410b Renovatio 1x10,0 been considered to be reasonable. have1 eds n 0,00,00 The area will include the service established &Upgradat 0= areas such as waiting space, DH have ion of DH 10,00,0 entrance hall, registration counter, no for 300 0,000 etc. In case of specific requirement sufficient beds of a hospital, flexibility in altering Infrastructu the area is kept. re for 500

PhysicalInfrastructre beds.. Waste disposal should be carried

out as per the GOI guidelines,

which is under preparation

Waste Waste Disposa l

Doctor's chair Instrument 1 Inadequate 1 1 10,000 Doctor's Table Tray Assorted 00(App Duty Table for Kidney Tray r Nurses Assorted x) per Table for Basin DH Sterilization use Assorted Total - Long Benches Basin Stand 10,00,0 Stool Wooden Assorted 00 Stools Revolving Delivery Steel Cup-board Table Wooden Cup Blood Donar Board Table Racks -Steel – O2 Cylinder Wooden Trolley Patients Waiting Saline Stand Chairs Waste Bucket Attendants Cots Dispensing Office Chairs Table Wooden Office Table Bed Pan Foot Stools Urinal Male Filing Cabinets and Female (for records) Name Board M.R.D. for cubicals Requirements Kitchen (record room use) Utensils Pediatric cots Containers for with railings kitchen Cradle Plate, Fowler's cot Tumblers Ortho Facture Waste Table Disposal - Bin Hospital Cots / drums Hospital Cots Waste Pediatric Disposal -

Wooden Blocks Trolley (SS) Back rest Linen Almirah Dressing Trolley Stores

Furniture Medicine Almirah Almirah Arm Board Bin racks Adult ICCU Cots Arm Board Bed Side Screen Child Medicine Trolley SS Bucket Case Sheet with Lid Holders with clip Bucket Plastic Bed Side Lockers Ambu bags Examination O2 Cylinder Couch with spanner Instrument ward Trolley type Instrument Diet trolley - Trolley Mayos stainless steel 88 Surgical Bin Needle cutter Assorted and melter Wheel Chair Thermometer Stretcher / clinical

• Imaging • Baby scale 1 20,00,000 1 1 20,00,0 Equipment • Table lamp (Approx) 00 • X-ray room with 200 watt per (Appro accessories bulb DH x) • Cardiac for new borne equipments baby • Labor ward • Photo equipments therapy unit • Equipment for • Self inflating New Born Care bag and and Neonatal maskneonatal Resuscitation size ENT equipment • Eye equipment Laryngoscope Dental and Equipment Endotracheal Laboratory intubations equipments tubes OT equipment (neonatal) Surgical • Mucus equipment extractor with Physiotherapy suction tube equipments and a foot Endoscopes operated equipments suction Anesthesia machine equipments • Feeding • IUD insertion tubes for baby kit 28 • Equipment / • Sponge reagents for holding essential forceps - 2 laboratory • Valsellum • Refrigerator uterine

• ILR/Deep forceps - 2 Freezer • Tenaculum • Ice box uterine • Computer with forceps – 2

Equiepment accessories • MVA including internet syringe and facility cannulae of • Baby sizes 4-8 warmer/incubator • Kidney tray . for emptying • Binocular contents of microscope MVA syringe • Equipments for • Trainer for Eye care and tissues vision testing • Torch • Equipments without under various batteries – 2 National • Battery dry 89 Programmes cells 1.5 volt • Radiant warmer (large for new borne size) – 4 Baby • Bowl for

Dicyclomine Inj- Carbamazepi 1 DH 1 1 Total - Atropine - Inj. ne required 1,00,00 Norfloxacin- Tab Cephalexin Drugs ,000 Ciprofloxacin - Metronidazol Tab e Ciprofloxacin - Metronidazol Tab e Co Trimoxazole Cefotaxime Tab Atenolol Amoxicillin- Cap Furosemide Gentamycin - Inj Ranitidine Albendazole Hydochloride Alprazolam - Tab Metoclopram Ranitidine - Inj ide Oxytocin - Inj- Isosorbide Amp Dinitrate Methyl Diethylcarba Ergometrine mazine Glibenclamide Ciprofloxacin 5% Dextrose Metronidazol 5% Dextrose + e 0.9% Cefotaxime B Complex Enalapril Silver Enalapril Sulphadiazine oint Chloramphen - icol Promethazine - Alprazolam Inj-Amp. Tramadol Pentazocine Dexamethaso Lactate Inj. ne Diazepam - Inj- Cefotaxime Amp. Amlodipine Cough Erythromycin Expectorant Stearate Ampicillin Cetrizine Ciprofloxacin Omeprazole Thiopentone Prednisolone Drugs Cetrizine Diethylcarba Doxycycline mazine Ampicillin & Ampicillin Cloxacilin Sodium Etophylline & Atenolol Theophylline Hydroxy Dopamine progesterone Hydrochloride acetate Adrenaline Xylometazoli Sodium ne Bicarborate Prednisolone Tinidazole Betamethaso Fluconazole ne Clotrimazole Chloram Cream Phenicol 90 Dicyclomine Bupivacaine Tablets Hydrochlorid Dexamethasone e Digoxin Succinyl

Support Services 1. Routine urine, stool and blood tests 1 1 0 1 Budget for 2. Bleeding time, clotting time, Laboratory 3. Diagnosis of RTI/ STDs with wet Equipments= mounting, Grams stain, etc. 10,00,000 4. Sputum testing for tuberculosis (if designated as a microscopy center

under RNTCP)

5. Blood smear examination for malarial parasite. 6. Rapid tests for pregnancy / malaria

Laboratory 7. RPR test for Syphilis/YAWS surveillance 8. Rapid diagnostic tests for Typhoid (Typhi Dot) 9. Rapid test kit for fecal contamination of water 10. Estimation of chlorine level of water using orthotoludine reagent Wherever facility exists, 1 1 0 1 Generator

uninterrupted power supply has to be serviceis ty ensured for which Generator and out sourced.

Electrici inverter facility is to be provided. Potable water for patients and staff 1 1 1 1 and water for other uses should being

adequate quantity. Towards this end, adequate water supply should be

ensured and safe water may be Water provided by use of technology like filtration, chlorination, etc. as per the suitability of the center.

Where ever feasible, telephone 1 1 1 1 12,000

facility / cell phone facility is to be hone Telep Provided. Mobile phone The DH should have an ambulance Ambulance for transport of patients. This may be service is outsourced. outsourced Total-2X 15000 X 12

Transport = 3,60,000 Laundry and Dietary facilities for Laundry and indoor patients: these facilities Dietary

can be outsourced. facilities can

be outsourced 1,00,000 per

month

Laundry facilities

and Dietary and Total -1 X 1,00,000 X12 = 12,00,000

Manpower IPHS Maximum Present Gaps Task Budget 12-13 manpower Manpower For required 12- 13 Medical Suprintendent 1 1 1 0 1X50000X12=12,00,000 Medical Specialist 3 3 3X40000X12=14,40,000 Surgery Specialist 3 3 3X40000X12=14,40,000 O & G Specialist 6 6 0 6X40000X12=28,80,000 Psychiatrist 1 1 0 1X40000X12=4,80,000 Dermatologist/Venerologist 1 1 0 1X40000X12=4,80,000 Pediatrician 3 3 3X40000X12=14,40,000 Anesthetist 6 6 6X40000X12=28,80,000 ENT surgeon 2 2 2X40000X12=9,60,000 Opthalmologist 2 2 2X40000X12=9,60,000 Orthopedician 2 2 2X40000X12=9,60,000 Radiologist 1 1 1X40000X12=4,80,000 Casualty Doctors / 20 20 20X30000X12=36,00,000 General Duty Doctors Dental Surgeon 1 1 1X30000X12=3,60,000 Hospital Manager 1 1 1X30000X12=3,60,000 Accountant 1 1 1X15000X12=1,80,000 AYUSH Physician 4 4 4X15000X12=7,20,000 Pathologist 2 2 2X40000X12=9,60,000 Staff Nurse 20 20 20X20000X12=48,00,000 Hospital worker (OP/ward 20 20 20X10000X12=24,00,000 +OT+blood bank) Ophthalmic Assistant 2 2 2X20000X12=4,80,000 ECG Technician 1 1 1X20000X12=2,40,000 Laboratory Technician ( 4 4 4X12000X12=5,76,000 Lab +Blood Bank Maternity assistant (ANM) 4 4 4X12000X12=5,76,000 Radiographer 2 2 2X20000X12=4,80,000 Pharmacist 6 6 6X12000X12=8,64,000 Physiotherapist 2 2 2X12000X12=2,88,000 Statistical Assistant/ 1 1 1X10000X12=1,20,000 Data entry operator Total 3,24,84,000

Head Sub head Budget Remarks Infrastructure Physical Infrastructure 5,00,00,000 Annual Maintenance Grant 10,00,000 Furniture 10,00,000 Equiepments 20,00,000 Drugs 1,00,00,000 Laboratory 10,00,000 Telephone 12,000 Transport 3,60,000 Manpower 3,24,84,000 Laundry & Dietry 12,00,000 Total 9,90,56,000

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lnj vLirky lhrke

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fFk,Vj 1 ¼orZeku½ 1,00,000=00 1,00,000=00 ● O.T lgk;d 03

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4 vkW[k foHkkx 1,50,000=00 2,50,000=00 @10,000x03x12 =3,60,000=00 13,00000=00

vkblksys'ku │

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6 HkaMkj x`g 5,00,000=00 │ 5,00,000=00

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8 IykLVj #e 1,00,000=00 1,00,000=00 │ 2,00,000=00

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10 ¼ejht ijhtu½ 5,00,000=00 lfgr ½ @ 5000=00x3x12 = 1,80,000=00

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iksLVekVZe gkml dh ejEerh ,oa foljk l[kus gsrq ,d dejk dk fuekZ.k] 28 feÍh HkjkbZA 3,00,000=00 3,00,000=00

Setting Objectives and Suggested Plan of Action

Introduction District health action plan has been entrusted as a principal instrument for planning, implementation and monitoring of fully accountable and accessible health care mechanism. It has been envisioned through effective integration of health concerns via decentralized management incorporating determinants of health like sanitation and hygiene, safe drinking water, women and child health and other social concerns. DHAP envisages accomplishing requisite amendments in the health systems by crafting time bound goals. In the course of discussions with various stakeholder groups it has been anticipated that unmet demand for liable service provision can be achieved by adopting Intersect oral convergent approach through partnership among public as well as private sectors. Targeted Objectives and Suggested Strategies During consultation at district level involving a range of stakeholders from different levels, an attempt has been made to carve out certain strategies to achieve the specific objectives that are represented by different indicators. The following segment of the chapter corresponds to the identified district plan

objectives demonstrating current status of the indicators along with the expected target sets that are projected for period of next financial year. Strengthening of District Health Management Objectives / District Health Society to make functional and empower to plan, implement and Monitor the progress of Milestones the health status and services in the district. 1. Capacity building of the members of the District Health Mission and District Health Society regarding the program, their role, various schemes and mechanisms for monitoring and regular reviews Strategies 2. Establishing Monitoring mechanisms 3. Provide ASHA as link workers to mobilize the community to strengthen health seeking behavior and to promote proper utilization of health services. 1. Orientation Workshop of the members of the District health Mission and society on strategic management, financial management & GoI Guidelines. 2. Issue based orientation in the monthly Review and planning meetings as per needs. 3. Improving the Review and planning meetings through a holistic review of all the programmes under Activities NRHM and proper planning. 4. Formation of a monitoring Committee from all departments. 5. Development of a Checklist for the Monitoring Committee. 6. Arrangements for travel of the Monitoring Committee 7. Sharing of the findings of the committee during the Field visits in each Review Meeting with follow-up of the recommendations. 1. Technical and financial assistance needs to be imparted for orientation and integration of societies. Support 2. A GO should be taken out that at the district level each department should monitor the meetings closely required and ensure follow-up of the recommendations. 3. Instructions & directions from GoI for proper functioning of the societies and monitoring committee. 4. Funds to maintain society office & staff. 2012-13 1.Orientation Workshops of the members of the District Health society 1. Issues based workshops will be organized. Timeline 2. Formation of the monitoring Committee and will start the monitoring visits. 3.Reorientation Workshops 4.Workshops as per need 5.Strengthening of the Monitoring Committee District Programme Management Unit 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 DPMU, five skilled personnel i.e. Programme Manager, Accounts Manager ,Dist. Nodal M & E Officer ,District Planning Coordinator and District Community Mobilizer have being provided in each district. These personnel are there for providing the basic Status support for programme implementation and monitoring at district level.The District Programme Manager is 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 computerized FMS. The Dist. Nodal M & E Officer 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 & evaluation, HMIS, data collection and reporting at district level. Objective Strengthened District Programme Management Unit Strategies 1. Support to the civil surgeon for proper implementation of NRHM. 2. Capacity building of the personnel 97

3. Development of total clarity at the district and the block levels amongst all the district officials and Consultants about all activities 4. Provision of infrastructure for the personnel 5. Training of district officials and MOs for management 6. Use of management principles for implementation of District NRHM 7. Streamlining Financial management 8. Strengthening the Civil Surgeon‟s office 9. Strengthening the Block Management Units 10. Convergence of various sectors 1. Support to the Civil surgeon for proper implementation of NRHM through proper involvement of DPMU and more consultants for support to civil surgeon for data analysis, trends, timely reports and preparation of documents for the day-to-day implementation of the district plans so that the Civil Surgeon and the other district officers: • Finalizing the TOR and the selection process • Selection of consultants, one each for Maternal Health, Civil Works, Child health, Behavior change. If properly qualified and experienced persons are not available then District Facilitators to be hired which may be retired persons. 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 & Child Health • Accounts and Finance Management • Human Resources & Training • Procurement, Stores & Logistics Activities • Administration & Planning • Access to Technical Support • Monitoring & HMIS • Referral, Transport and Communication Systems • Infrastructure Development and Maintenance Division • Gender, IEC & Community Mobilization including the cultural background of the Meos • Block Resource Group • Block Level Health Mission • Coordination with Community Organizations, PRIs • Quality of Care systems 4. Provision of infrastructure for officers, DPM, DAM, DNM&E Officer, DPC, DCM and the consultants of the District Project Management Unit. • Provision of office space with furniture and computer facilities, photocopy machine, printer, Mobile phones, digital camera, fax, Laptop 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 Civil Surgeon • Compendium of Government orders for the DC, Civil surgeon, district officers, hospitals, CHCs, PHCs and the Subcentres need to be taken out every 6 months. Initially all the relevant documents 98

and guidelines will be compiled for the last two years. 6. Strengthening the Block Management Unit: The Block Management units need to be established and strengthened through the provision of : • Block Health Managers (BPM), Block Accounts Managers (BAM) and Block Data Assistants (BDA) for each block. These will be hired on contract. 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, DNM&E Officer, DPC & DCM . 5. Developing the capacities of the Civil Surgeons and other district officials to utilize the capacities of the DPM, DAM, DNM&E Officer, DPC & DCM fully. 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. Time 2012-13 Frame • Selection of District level consultants, their capacity building and infrastructure • Development of an operational Manual 2012-13 • Selection of Block management units and provision of adequate infrastructure and office automation • Capacity building up of District and Block level Management Units • Training of personnel Reorientation of personnel

REPRODUCTIVE & CHILD HEALTH

CHILD HEALTH

High levels of child malnutrition and low levels of female literacy, particularly in rural areas increase risk of child mortality and morbidity. Failure of family to properly plan their family in matters related to delaying and spacing of births leads to significantly high mortality among children. Failure of programme to effectively promote breastfeeding immediately after birth and exclusive breastfeeding is yet another factor affecting IMR. A high level of child malnutrition, particularly in rural areas and in children belonging to disadvantaged groups adds to the problem. The Anganwadi centre and Sub Centre often lacks drugs, ORS packets, weighing scales, etc. The plan for child health takes these factors into consideration. Goal

Reduce Infant Mortality Rate (IMR) (target – from 551(AHS-2010-11) to 50 by 2013) Reduce under five mortality rate from 70(AHS 2010-11) to 60 Objectives:-  To promote early and exclusive breast feeding to infant  To reduce mortality and morbidity due to diarrhea through use of Zinc and ORS  To reduce mortality and morbidity due to ARI  To reduce the prevalence of anemia among children  To ensure full immunization of the children Strategies:- Promotion of early and exclusive breastfeeding  Promote early and exclusive breastfeeding to the child  Appropriate infant and young child feeding  Strengthen essential home based newborn care (HBNC)  Universal coverage of routine immunization of Children  Universal coverage of Vitamin A, IFA supplementation  Training on IMNCI and FIMNCI A.2.6. Management of Childhood Diarrhea Through the Use of Zinc and ORS District-Sitamarhi

1. Introduction India has a national policy for management of diarrhoea among children that recommends the use of Zinc tablets along with ORS in the treatment of diarrhoea as per the MOHFW, GoI directive dated 2nd Nov. 2006. A high-level meeting held under the chairmanship of Dr. M.K. Bhan, Secretary, Department of Biotechnology recommends for every case of diarrhoea, a dose of 20 mg/day for 14 days for children above age 6 months and 10mg/day for children aged 2-6 months. The high-level committee recommendations emphasize that: a) Zinc tablets should be available in all parts of the country including Anganwadi centers. b) An effective communication strategy be put in place c) Health care providers including Anganwadi Workers and ASHAs are oriented and trained in the use of zinc along with ORS.

2. Situation Analysis:- The district Sitamarhi is the 11th most populous districtof Bihar having one polio high risk block namely Dumra.There are 11blocks(Belsand, Runni, Saidpur, Parsauni, Sursand, Baiginia, Bathnaha, Bazpatti, Dumra,Parihaar, Sonbarsha) which were severely affected due to flood in the current year (2011-12). The diarrhea prevalence is also very high which is 12.5% as compared to the state average of 12.1%.

100

Indicator Sitamarhi Bihar Source District State Children suffered from Diarrhea 12.5 12.1 DLHS-3 in the last two weeks prior to survey (%) Children with Diarrhea in the 79 73.7 DLHS-3 last two weeks who were given treatment (%) Children with Diarrhea in the 21.6 22 DLHS-3 last two weeks who were received ORS (%) Women aware of ORS (%) 10.8 23.8 DLHS -3 IMR 67 55 Annual Health Survey,10-11 Under 5 Child Death 106 77 Annual Health Survey,10-11

4. Progress update during the current year (2011-12) : The district implemented the childhood diarrhea management program in 2011-12. Micronutrient Initiative (MI) provided technical and operational support to the district through the placement of Divisional Coordinator and provided training on childhood diarrhea management to all MOs, CDPOs, BHMs, BCMs, LHVs, Staff Nurses, Pharmacists, ANMs, ASHAs and Anganwadi Workers. MI also supplied 2,25,160 combo kits (each kit consists of two packets of ORS and 14 tablets of Zinc DT), recording and reporting formats, compliance cards, IPC tool for counseling. Further, MI trained all Data Entry Operators in the block PHCs and

District on record keeping and reporting. MI also imparted two days training to all BCMs on supportive supervision and provided printed supportive supervision checklists.

The district introduced reporting on Zinc –ORS from August, 2011immediately after completion of training. The supply of combo kits was distributed to all AWWs, ASHAs, HSCs, PHCs and Sadar Hospital. The report for the month of August, September & October reveals that5419number of cases reported in which 4990 treated with both Zinc &ORS which is 92%. The BCMs have started supportive supervision visits from December 2011 as per their plan.

5. Plan of Action for 2012-13:-

5.1 Specific Objectives (2012-13): I) At least 4,09,328(50% of the total expected diarrheal cases in a year) childhood diarrheal episodes treated with ORS & Zinc through public health system (Sadar Hospital, PHCs, APHCs,HSCs, ASHAs and Anganwadi Workers) II) At least 4,09,328 numbers of Zinc syrup bottles and 8,18,657 packets of ORS are procured and distributed to AWWs, ASHAs, HSCs, APHCs, PHCs &Sadar Hospital. Population 0-5 years Expected Target for 2012- No. of No. of as per 2011 Children yearly 13 (At least 50% bottles of ORS census (14.35% of Childhood cases will be Zinc Syrup packets to

101

the total diarrheal reported and to be be population as cases treated through procured for procured per the (@1.71 per public health 2012-13 (@ for 12-13 CBR(28.7), child/annu care system (At 1 bottle per (@ 2 Annual al as per present 28.6% episode) packets Health NCMH, cases reported in per Survey, 10- 2005, GoI) govt. health episode) 11 facilities as per forSitamarhi) DLHS-3, India) 34,19,622 4,78,747 8,18,657 4,09,328 4,09,328 8,18,657

5.2Implementation Strategies (2012-13):  Procurement of Zinc Syrup & ORS packets at the district level.  Distribution of ZincSyrup& ORS packets to AWWs, ASHAs, HSCs, APHCs, PHCs & District Hospital.  Ensure no stock out of Zinc& ORS at all levels at all times  Continue the involvement of BCMs in Supportive Supervision.  Refresher training of all ANMs,AWWs, ASHAsonchildhood Diarrhea management and recording and reporting.  Print & distribute training module for the refresher training of ANMs, AWWs, and ASHAs.  Refresher training of Data Entry Operators on recording & reporting.  Refresher training of BCM on Supportive supervision.  Print & distribute registers (ANM, ASHA, AWW) reporting forms (PHC, APHC, HSC, ASHA, AWW), Supportive supervision checklist for BCMs.  Print & distribute inter personal communication (IPC) tool kit & Compliance cards for counseling by ANM, ASHA, AWW.  Create awareness in the community about the importance of Zinc& ORS through various BCC& Social Mobilization activities.  Celebrate important events like ORS- Zinc day / Week.  Quarterly review at district level under the chairmanship of DM/CS with key Health and ICDS officials andquarterly review at block level under the chairmanship of MOIC with the presence of Health and ICDS officials.  Monthly review meeting with BCMs on the supportive supervision visit findings at the district level& monitoring visits by DCM to BCMs during supportive supervision visits.  Strong coordination with the development partners.

5.2 Supports by other Development Partners (2012-13):- Micronutrient initiative will continue to provide the following support in 2012-13 to district Sitamarhi:  Continue to provide techno-managerial support through the placement of Divisional Coordinator.  Provide technical support in refresher training of ANMs, AWWs, ASHAs, BCMs& Data Entry Operators.

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 Provide prototype soft copy of training module, Inter Personal Communication (IPC) tool kit, Compliance Cards, Registers, Reporting forms, Poster, Wall Painting & Display Board.  Support in organizing district and block level review meetings.  Continue to provide mobility support to the BCMs for the supportive supervision visits.

5.4 Following activities proposed under NRHM budget (2012-13):  Procurement of Zinc Syrup (4,09,328) and ORS packets (8,18,657) for 4,09,328 diarrheal episodes  Print and distribute posters and display boards at Sadar Hospital, PHCs, APHCs, HSCs, AWCs  Mobility support for hiring vehicle for the distribution of Zinc and ORS from the district to block PHCs  Undertake wall paintings in villages  Print & distribute training module, Registers, Reporting forms, Supportive Supervision Checklist, Compliance Cards, Inter Personal Communication (IPC) tool kit.  Mobility support for DCM to carry out monthly monitoring visits.  Monthly Review meeting of BCMs at the district level.  Celebrate ORS –Zinc day and week at the district and block levels 

MATERNAL HEALTH Logical Framework Sl. Goal Sl. Impact indicators 1 To improve 1.1 Reduction in MMR maternal health Sl. Objectives Sl. Outcome Sl. Strategy Sl. Output indicators indicators 1 To increase 1.1 % of 1.1.1 To make functional 1.1.1.1 % of PHC institutional safe institutional PHC (24hr x7days) having delivery by50% delivery for institutional functional to 70% by year reported deliveries in all OT and 2012-13 PHC. Labour room with equipment 1.1.1.2 % of PHC having Obestetric First Aid medicine 24hrx 7 days

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1.1.1.3 % of Grade A nurse available 24hrx7days 1.1.1.4 % of PHC having functional Neo-natal care units 1.1.2 To make functional 1.1.2.1 No of FRUs FRU for having institutional functional deliveries blood storage units linkage with blood banks and 24hr ready referral transport 1.1.2.2 No of FRUs having EmOc and BmOc facilities 1.1.2.3 No of FRUs having specialist doctors/ multiskilled Medical Officers 1.1.2.4 No of FRU having functional Neo-natal care units 1.1.3 To provide Referral 1.1.3.1 No of transport services pregnant at FRU /PHC women availed the referral facilities (pick up and drop) 1.1.4 To strengthen 1.1.4.1 % of Janani Suraksha pregnant Yojana / JSY women reecieved JBSY payments immediately

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after delivery and how many PHCs having JBSY facilities 2 To increase safe 2.1 Proportion of 2.1.1 To ensure support 2.1.1.1 % of home delivery by birth attendant of SBA at home deliveries trained ANM by skilled health deliveries attended by 100% personnel SBA 3 To increase 3.1 % ANC 3.1.1 To strengthen 3.1.1.1 % of HSCs ANC coverage reported through HSC for providing having with quality HMIS formats / outreach maternal ANMs 18.9% to 50% Form -7 care 3.1.1.2 % of HSCs by year 2010 conducted fixed ANC and clinics ( planned & held) 3.1.2 To organize 3.1.2.1 % of RCH integrated RCH camps camps specially planned and for hard to reach held areas, isolated population and Maha Dalit Tolas 3.1.3 To improve 3.1.3.1 No of adolescent pregnant reproductive and adolescent sexual health counseled by ANM/ AWW/ASHA 3.1.4 To accelerate 3.1.4.1 % of OPD APHC for OPD clinics and Fixed AN organized at clinics APHC level. 4 To provide safe 4.1 % MTP cases 4.1.1 To provide MTP 4.1.1.1 No of abortion reported through services at health facilities services at all HMIS formats / facilities having MTP facilities Form -7 services (public and private ) 5 To increase 5.1 % of Mahila 5.1.1 To strengthen 5.1.1.1 % of mothly community mandal Monthly Village Village participation in meetings Health and Health & maternal care conducted. Nutrition Days Nutrition Days planned and held MATERNAL HEALTH Sl. Strategy Sl Gaps Sl Activities

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To make Infrastructure A1 functional 1.1 Out of 17 PHC 1.1.1 Need based ( PHC (24hr 14 PHC running Service x7days) for in own building delivery)Estimation institutional and one in of cost for deliveries running APHC upgradation of Building, one in PHCs. running HSC Building & one in rented Building. 1.2 At present no 1.2.1 Preparation of PHCs are priority list of working with interventions to delivery deliver services. planning and 80-100 OPD per day in each PHC. This huge workload is not being addressed with only six beds inadequate facility. 1.3 The 1.3.1 Sending the comparative recommendation analysis of for the certification facility survey with existing (08-09) and services and DLHS3 facility facility detail. survey (06-07), the service availability tremendously increased but the quality of services is still the area of improvement. 1.4 Lack of 1.4.1 Prioritizing the equipments as equipment list per IPHS norms according to and also under service delivery utilized and IPHS norms. equipments. 1.4.2 Purchase of equipments 1.5 Lack of 1.5.1 Purchase of appropriate Furniture furniture

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1.5.2 Lack of 1.5.2.1 Construction of facilities/ basic PHCs amenities in the PHC buildings To make 1.6 As per IPHS functional norms each PHC (24hr PHC requires x7days) for the following institutional clinical deliveries staffs:(List attached) 1.6.1 The actual Selection and position is not recruitment of sufficient as per ANMs, Nurse IPHS norms Grade A, Doctors List of Human on contractual basis resource is and give priority in attached selection those who are living in same PHC. Salary of Contarctual Grade A nurses Selection and recruitment of grade A nurses for conducting delivery Selection and recruitment of dresser Selection and recruitment of Pharmasist. Three month induction training of Grade A nurse under supervision of District level resource team. 1.7.1 Training need Assessment of 1.7 PHC level staffs

Mobility support to BHMs 1.8.1 Appointment of 5 1.8 Accountants

Trainings of BHMs

on Health statistics

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Training on Program, Finance management and HMIS Drug Supply 1.9 Irregular supply 1.9.1 Ensuring the of drugs because availability of of unavailability FIFO list of drugs supply of drugs with store keeper. agency. 1.10 Only 38 1.10.1 2.Implementing essential drugs computerized are rate invoice system in contracted at all PHCs state level . Purchase of Drug invoice software Lack of fund for 1.10.2 3.Fixing the the responsibility on transportation of proper and timely drugs from indenting of district to medicines blocks. ( keeping three months buffer stock) 1.11 There is no 1.11.1 4. Orientation clarity on the meetings/ training guideline for on guidelines of need based drug RKS for operation. procurement and transportation. 1.12 Drugs are not 1.12.1 5. Enlisting of properly stored equipments for safe storage of drugs. 1.12.2 6. Purchase of enlisted equipments. 1.12.3 7.training of store keepers on invoicing of drugs To make 1.13 17 PHCs are 1.13.1 Ensure 24 hrs new functional lacking 24 hrs born care services PHC (24hr new born care in PHC. x7days) for services. institutional 1.14 A few PHCs 1.14.1 Ensure 24 hrs deliveries provides 24 hrs BEmoC services at BEmoC PHC services.

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Training of one Doctor from each PHC on BEmoC. Equipments for BEmoC 1.15 PHC does not 1.15.1 Deputation of have laboratory regular Lab tech at facilities on PPP PHC level for based srvices. providing free of Phc have T.B cost lab services to lab Technician. all pregnant women and BPL families. 1.16 1.16.1 Recruitment of lab technicians as required for regular support of lab activity Training of TB lab technician on other pathological tests. Purchase reagent (recurring) for strengthening lab. Purchase of equipments/ instruments if needed. Fund could be rooted through RKS and if it is not utilized it could be diverted to other women and child friendly activities. 1.14 Referral Services 1.14.1 No pick up 1.14.1.1 Provision for pick facility for BPL up & drop pregnant patients. mothers and BPL families free of cost using existing Ambulance services at PHC level. Provide EDD list of pregnant women to Ambulance driver and Number of ambulance driver and 102 /PHC tel No to all Pregnant 109

women

Prepare list of Vehicle those are utilized in Monitoring work in PHC that can be use in pick up and dropping facility. 1.15 Quality of food, 1.15.1 Assigning mothers cleanliness committees of local (toilets, Labour BRC for food room, OT, supply to the wards etc) patients in govt‟s electricity approved rate. facilities are not Review of satisfactory in Cleanliness activity any of the PHC. in all PHC by Quality assurance committee and payment of agency should be link with it. 1.15.2 Hiring of workers for cleanliness of OT and Labour room in PHC Purchase equipments and uniform for cleanliness in all PHC Training of Workers on using machine/ equipments and importance of cleanliness. Develop mechanism for monitoring of cleanliness work 1.16 Non availability 1.16.1 Printing of formats of HMIS and purchase of formats/registers stationeries

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and stationeries 1.16.2 Biannual facility survey of PHCs through BHM as per IPHS format 1.16.3 Regular monitoring of PHC facilities through PHC level supervisors in IPHS format. 1.17 Operation of 1.17.1 Ensuring regular RKS: monthly meeting of RKS. 1.17.2 Appointment of Block Health Managers, Accountants in all institutions. 1.18 Lack in uniform 1.18.1 Training to the process of RKS RKS signatories for operation. account operation. 1.18.2 Trainings of BHM and accountants on their responsibilities. 1.19 Lack of 1.19.1 Meeting with community community (School participation in children or other) the functioning representatives on of RKS. erecting boundary, beautification etc, 1.19.2 Meeting with local public representatives/ Social workers and mobilizing them for donations to RKS. 1.20 In serving 1.20.1 Meeting in RKS emergency with Local Police cases, there are Station in charge to maximum handle emergency chances of situation. misbehave from the part of attendants, so staffs reluctant to handle emergency cases.

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To make 1.37 No guidance to 1.38.1 Pictorial wall functional the patients on painting on every PHC (24hr the services section of the x7days) for available at building denoting institutional PHCs. the facilities and deliveries attached trained volunteers to guide patients. 1.38 Non friendly 1.39.1 Name plates of attitude of staffs Doctors towards the poor patients in general and women are disadvantaged group in particular. Displaying Name Photograph and DOB of all staff of PHC and put cleanliness staff name on top of the

list. Lack of There are 2 LHV 1.41 counseling 1.41.1 in the district we services can utilize their experience in counseling work of women and adolescent girls after training. 1.42 There is no hot 1.42.1 Installation of solar water facility for heater system and PW and there is light with the help no adequate of BDO/Panchayat lighting facility at PHC or purchase at adjoining area equipments from of PHC market. 1.43 Lack of 1.43.1 Convergence convergence meeting by RKS & DHS 1.44 Lack of timely 1.44.1 Orientation of the reporting and staffs on indicators delay in data of reporting collection formats 1.44.2 Purchase of Lack of space Laptops for DPM, 1.45 for waiting, DAM, DNM&EO environmental and BHMs with

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cleanliness internet facility. around PHC, provision for 1.45.1 Gardening hospitality etc

1.45.2 Sitting arrangement for patients Construction of patients waiting shade 1.45.3 Installation of LCD projector for manage wait over time of OPD patients. 1.45.4 Installation of safe drinking water equipments/water cooler, Welcome PW at 1.45.5 Apron with name 2.3 Institution and plates with every PHC and FRU doctors 1.45.6 Presence of staffs with uniform and name plates. 1.45.7 “MAMTA” should also be appointed at PHC level as well. 2.3.1 Provision of food for the delivered mothers and mothers under gone in tubectomy in all the health facilities. 2.3.2 Mobilize community Resources for providing Free Reporting of food for PW at maternal death Institution. Maternal death 2.3.3 Quality indicators 2.4 reporting is (clean usually not environment, wards reported by with clean linen, worker clean toilets , clean labour rooms, running waters supply, hot water

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and safe water for inpatients, new born corners, treatment protocols, aseptic precautions, immediate disbursement of JBSY funds 2.4.1 Training of ASHA & ANM on reporting of Maternal deaths and conduct Verbal Autopsy 2.4.2 Incentives for maternal death reporting by ASHA @ Rs 50/-per maternal death 2.4.3 Reporting line should be in five columns – name of mother, place of death, date of death, cause of death and no. of birth. 2.4.4 Institution and urban center also to Biomedical report Maternal waste death to the district

management is CS/ACMO. 2.5 not properly 2.4.5 Maternal Death taken care off at should be reported all institution by ASHA, AWW, ANM Staff Nurse & Doctors to the district data center . 2.4.6 Investigation of maternal death by district team. and third party review(District magistrate) 2.4.7 Training of ASHA and investigation team objective and process of

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investigation and review of maternal death 2.5.1 Procurement of equipment 2.5.2 As per example Introduce color coded buckets for Tracking of facilities as per pregnant women rule.

from first 4.1.1 Review of early 4.1 Trimester is not registration with 3 done form the AN checkup ,two register. TT.100/200 IFA Tab. in ASHA Diwas. 4 To 4.2 Too much 4.2.1 Ensure 100 strengthen documentation %Pregnancy Test Janani process. Photo Kit is to ASHA and Suraksha required for regular supply. Yojana / mother and JSY baby. 4.2.2 Direct transfer of funds from district to PHC through core banking / directly from DHS 4.2.3 Finger print technology for JSY beneficiaries at facility level where computer with internet facility is available. This will help in financial monitoring. 4.2.4 The photo system should be replaced by some other alternatives like- bank account opening of pregnant women in first trimister and directaly transfer the money to their account after delivery.

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Incentive for institutional delivery. If postoffice saving account is opened for all the ASHAs then payment process will be easier for them. 5.1 Home Delivery 5.1.1 Home Delivery is still should be prevailing conducted by SBA through trained Staff Nurse untrained or ANM. traditional Dai‟s 5 To ensure 5.1.2 Provision of Dai support of Delivery kit(DDK) SBA at to TBA where home institution access is deliveries poor. And it should be supervised by ANM for home deliveries. 5.1.3 Delivery kit Reporting of (equipment, home delivery is medicine)for ANM 5.2 not done so the should be supplied PNC is not 5.1.4 Supply of delivery provided Kits as per number of deliveries conducted in home. 5.2.1 Incentive based system for reporting of home delivery by ASHA and it should be linked with ANM 5.3 Non payment 5.3.1 The JSY money to of Home the mother who has delivery through delivered baby at JSY Home paid by ANM. 10.1 Out reach camps 10.1.1 Identifying are not orgnised Socially Backward, in plan manner. Slums & Maha It is totally Dalit Tolas. based on demand of orgnisation and eventually it is

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not reported to respective HSCs and PHCs.

10 To organise 10.1.2 Hiring trained integrated alternate RCH camps vaccinator/ retired specially for ANMs and Medical hard to officer .hiring reach areas, vehicle for fixed isolated day out reach population camps with drugs. and Maha 10.1.3 Fixed day OPD Dalit Tolas clinics at APHC level and adjoining HSC of respective APHCs. with dedicated MO and support staff. 10.1.4 To make calendar for camps with date

and identified No training areas.and link programme for NGOs those who 11.1 adolescent are willing to particularly orgnise Camps health and sex. 10.1.5 Community based reporting system through SMS. involve PRI members and training on reporting and Camp approach 11.1.1 Multipurpose counsellor can be used for adolescent care. For this services of LHV can be used.and callender of activity could be devloped.

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11 To improve 11.2 Preventions of 11.2.1 Linkage with adolescent anemia in adolescent anemia reproductive adolacencent control programme and sexual girls in Schools with health Unicef. And training to one teacher from the school 11.3 Marriage before 11.3.1 Public legal age. Sensitization particularly women 11.4 Preventions of 11.4.1 Adolescent teen age pregnancy should pregnancy and be addressed with abortion. priority care( eclampsia, 3 ANC, anemia, 100 IFA, 100% institution delivery, low birth Wight baby, Breast feeding.PNC with in 48 hours. 11.6 Limited 11.6.1 Family counseling interventions for for adolescent empowering pregnancy tracking adolescent girls on above mentioned through ASHA and AWW. 11.6.2 State to develop and issue guidelines for implementation of Kishori MandalsFormation of Kishori Mandals by registration of all girls(11-18 yrs) 11.6.3 Prepare a monthly MTP services plan of activities 12.1 are not available for one day per in Public sectors week To improve 11.6.4 Counseling adolescent nutrition, health reproductive and social issues and sexual every week at health AWCs by AWW 11.6.5 Weekly distribution of IFA Tablets to out-of- school girls at

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AWCs

11.6.6 Deworming adolecent every 6 months 11.6.8 Initiate family schools for learning child care , safe motherhood life skills and Family life education 12.1.1 Selection of facilities for provision of safe abortion services 12 To provide 12.1.2 Location of facility MTP availability of services at trained service health provider, space, facilities equipments. 12.1.3 To Provide appropriate equipments at all facilities and MVA syringes. 12.1.4 Putting the trained doctors at

appropriate Nutrition and facilities to Counselling commence the Component is services not visible in 12.1.5 Training of 13.1 VHND and Medical officers there is no and Para medical monitoring of staffs on Safe VHND activity abortion services by Community. training including awareness about legal aspects of MVA/ EVA and Medical abortion by IPAS . 12.1.6 Formation of district level committee (DLC) to accredit private sites as per GOI guide line .

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12.1.7 Develop reporting system of MTP services in private and public secter. 12.1.8 Through training program make the govt doctors skilled to perform MTP in the approved sites. 12.1.9 To Involve community to aware about location of services , process and legal aspects of MTP services through - AWW, ASHA & ANM, LRG and mass media.(IEC) To provide 12.1.10 The services of MTP Pregnancy testing services at should be health strengthened and it facilities should be linked with MTP services. 12.1.11 NGO‟s and local Practitioner should be involved for counseling and information of facility 12.1.12 Assurance of privacy and link with family welfare services counseling at all facility. 12.1.13 Linkage with MTP services with NGOs (PPP) those who are working in Safe abortion services. and create one nodal center at district and PHC level. 12.1.14 Training of ASHA on medical abortion.

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13.1.1 AWC should be developed as a Hub of activities (VHND) 13 To 13.1.2 Develop an activity strenghten plan calendar for Monthly VHND as Village seasonality. Health and 13.1.3 Counseling of Nutrition mothers on ANC, Days preparation for Child care ,STI/RTI, and AYUSH, adolescent Health 13.1.4 Organize VHND in Four Table concept regularly where One place is for registration, one is for weighing, one is for immunization and fourth is for counseling 13.1.4 Meeting of VHSC and preparation for

area specific Infrastructure epidemiological planning and community based monitoring. 13.1.5 Skill development training is required to ANM , ASHA & AWW and Dular (LRG) 13.1.6 Develop monitoring plan map of each village and displaced at AWC with identification of priority houses with PW, lactating women ,Malnourished children , New born, DOTs and other services

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13.1.7 SMS reporting system of conducting VHND and ANM collect Data from field level and compile it in weekly/Monthly formats. B APHC 1.3 Out of 56 1.3.1 Registration of APHCs only 8 RKS are having own building To form 1.4 Existing 28 1.4.1 Rennovation of /strenghten buildings are APHCs buildings APHC in not properly from RKS Fund Phase maintained manner Human Resource 2 2.1 in the district no 2.1.1 Operationalising any APHC one APHC in each functioning as PHC by conducting per IPHS norms daily OPD by Doctor and support staff. 2.2 2.2.1 Notification from district for oprationaliing APHC Drug Supply 3 3.1 No drug kit as 3.1.1 Purchasing 23 such for the listed OPD Drugs APHCs as per of PHC for APHC IPHS norms., 5.1 No regular 5.1.1 Trained service clinic at all provider on PHCs & syndrome APHCs. management of RTI/STI (As per GOI guide line) up to APHC level. 5 RTI/STI 5.1.2 Logistics of setting services at of clinics and free health drugs availability facilities 5.1.3 Integrated Counselling services in four public sector facilities by trained personnel .

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5.1.4 IEC/BCC for awareness available RTI/STI services at all health facilities.

Chid Health Logical Framework Sl. Goal Sl. Impact indicators 1 1.1 Reduction in IMR To improve 1.2 Child performance in the school - enrolment, attendence and dropout Child health & achieve child survival Sl. Objectives Sl. Outcome indicators Sl. Strategy Sl. Output indicators 1 To increase 1.1 % increase of ORS 1.1.1 Home Based Newborn Case ORS distribution . Care/HBNC increasement distribution 80.4% to 100% 2 To increase % increase of treatment treatment of of diarrohoea within two diarrohoea weeks 60.4% to 100% 3 To increase % increase of treatment treatment of of ARI/Fever in the last ARI/Fever in two weeks the last two weeks 66.5% to 100% 4 To increase of % increase of infant care Strengthening of Facility Based No of PHC infant care with with in 24hr of delivery . Newborn Care/FBNC and trained initiated in 24hr of workers on using equipments. FBNC with delivery from trained 9.6% to 50% MAMTA on facility based new born care.. 5 To increase % % increase of 1.1.2 Infant and Young Child No of training of breastfeeding within 1 Feeding/IYCF orgnised in breastfeeding hr of birth . PHC on IYCF from 8.3% to 100% within 1 hr of birth 6 To increase % increase of intiation of complimentry feeding complimentry among 6month of feeding among children. 6 month of children from 86.1% to 100% 7 To increase % increase of exclusive exclusive breastfeeding among 0-6 breastfeeding month of children . among 0-6 month of children from 24.4% to 100% 8 To increase % increase of full immunization immunization coverage . coverage from 56.3% to 100%

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9 To increase vit To increase Vit A 1.1.3 Management of diarrhea, ARI and Two round of A coverage of reported adequte Micronutrient Malnutrition Child survival received atleast coverage among (9m to through Child srvival months Month one dose 5ys ) organised in (9month to 35 one financial months ) from year 30% to 100%

10 To decrese % of decrese 1.1.4 Care of Sick Children and Severe No of VHND Malnutrition Malnutrition age group Malnutrition and strenthen orgnised vs of (0 to 5 yrs) VHND at all AWCs Planned. 2.1 2.1.1 School Health Programme School health Camp are being organized

Sl. Strategy Gaps Activities Unit Cost Home Based Assessment of Training load and NA Newborn Training Gaps(AWW- prepare calendar of training Care/HBNC ,ASHA,ANM1,MPW- Incorporate ASHA in IMNCI NA No ASHA is trained on training team IMNCI ASHA kit regular supply and incorporate use of ASHA Kit in training curriculum.

Inadequate monitoring of Division of area among all NA this activity at field level trained supervisors for revision of IMNCI activity in their area. BHM will be responsible for NA review of health supervisor sand LS(ICDS)on given format.Unicef staff will support in devloping review mechanism in PHC. Incorpate IMNCI reports in HIMS NA formate Encouraging mother regarding NA child care.in VHND Frequent checkups of babies by NA Paediatrician. Distribute telephone number to AWW and ANM of respective doctors those who are supervising them in the field. Wednusday could be fixed a day NA for IMNCI related work at HSC level Community based Monitoring support system devlop with SHG in one PHCTraining of Group membersseed money to SHG for reffral services and other need based services. Facility Based Lack of Baby warmer All PHCs should be equipped Newborn machines with baby warmer machines. Care/FBNC ANMs and Doctors are Training of Doctors and ANMs to not trained to operate operate baby warmer machine. these machines There is no provision of Organize training programme for stay of mothers of newborn care for the nurses in the neonates at PHC. district hospitals Neonatal Care Unit not District level Supporting up to mark. supervisory team should be devlope with the responsibility of nunfuctioning of neonatal care

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unit. Training of team on monitoring of NCU Non availability of Training of Mamta and staff “MAMTA” at PHC level. nurse on logistics of New born Care units.by district level supervisory Team. Infant and Non awareness of breast Colostrum feeding and breast Young Child feeding and proper diet feeding inclusively for six Feeding/IYCF of young children. months. Baby friendly hospital Training of one doctor from each Nursing hospital at District Level Two days training of one staff nurse from each private hospital on counselling skill. Accreditation of nursing home and facility according to norms of baby friendly hospital initiatives Poor knowledge Development and Printing of regarding new born care BCC materials and child feeding Preparing adolescent and practices pregnant mother on IYCF by IPC through AWW, LRP and ASHA Linking JBSY with colostrums feeding Myths and Counselling and orientation of misconceptions about local priests, opinion leaders, early initiation of breast fathers, mother in laws by ICDS/ feeding, exclusive breast Health functionaries in mothers feeding and meetings and VHSCs meetings complementary feeding Folk performance to promote exclusive breast feeding Uniform message on radio from state head quarter Lack of awareness on Organize social events through importance of appropriate VHSCs and timely IYCF Strengthening of Mahila Mandal meetings- fortnightly with involvement of adolescent girl Organize healthy baby shows, healthy mother / pregnant woman. Appreciation and reorganization of positive practices in community. For this purpose hiring a documentation specialist. Celebration of “Annaprashan( Muhjutthi) Day” at AWC Demonstration of recipes. Exposure visits to existing NRCs to observe different models in the country Care of Sick There is not a single unit Establish rehabilitation center in Children and in the district where district hospital, FRU and one Severe severly malnourished PHC and promote locally Malnutrition children could be treated. available food formula Management of There is high privlance of Procurement of ,ORS , Vitamin diarrhea, ARI PEM and anemia among A supplementation(9m to 5 years and childrn because of Child children) with De-worming Micronutrient nutrition is least priporty pediatric IFA syrup. Malnutrition among service providers. Include covrage of Vitamin A and IFA,children in New HIMS format. Insure two round of Vitamin A and deworming for the age group of (9m to 5 yrs) & (2 yrs to 5

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yers) respectivly in the month of April And Oct as per GOI guide line. Involvement of ICDS, school teachers and PRI for monitoring and evolution School Health No Pre School Health Half yearly health checkup camp Programme checkup & complete for children in schools should be Immunization card. organized. Implementation through selection NGO. No training of school Training of school teacher by the teacher for basic health medical personnel with support of care and personnel administrative person. hygiene. No regular health Quarterly meetings of VEC checkup camp at school. representatives by attending existing meetings of VECs representatives at block level by the concerned MOICs and BHMs. No Training & Screening Linking existing 7 opthalmic of school‟s teacher for paramedics with this program and eye sight test. developing school wise calender. No other specific School health anemia control program has been programme should be formulated in the district. strengthened with biannually de worming . Organizing competitions/Debates/Painting competitions/Essay/demonstration and model preparation of nutritional food and health. Half yearly Health checkups and health card of all school going children. Films shows on health, sanitation and nutrition issues Social science Lab activities. Rally and Prabhat Phery in epidemic areas. (Kala-azar & Malaria) Referral system for the school children for higher medical care.

Family Planning Logical Framework Sl. Goal Sl. Impact indicators 1 Population 1.1 To decrease TFR upto replacement level stablisation To increase sex ratio Sl. Objectives Sl. Outcome Sl. Strategy Sl. Output indicators indicators 2 To increase 2.1 % increase in 2.1.1 Terminal/Limiting 2.1.1.1 % of terminal/limiting female sterlization female Methods methods use sterilsation 2.1.2 All PHCs must be 2.1.2.2 No of facilities providing equipped with all quality manuals on logistics. sterilization standards of Dissemination of sterilization services. manuals on sterilization standards & quality assurance of sterilization services 2.1.3 Female Sterilization 2.1.3.3 No of camps orgnised for camps female sterlization .

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2.1.4 Compensation for 2.1.4.4 % of Female received female sterilization compensation 2.1.5 IUD camps 2.1.5.5 No of IUD used in Camps 2.1.6 Accreditation of 2.1.6.6 No of Private providers private providers for accrediate for IUD Insertion IUD insertion services services. 3 To increase male 3.1 % increase in 3.1.1 3.1.1.1 No of NSV Camps sterilization from male NSV camps orgnised. which is almost sterilization 3.1.2 Compensation for 3.1.2.2 % of Male received nil only one male sterilization compensation sterilization done. 3.1.3 Accreditation of 3.1.3.3 No of Private providers private providers for accrediated for Sterilization sterilization services services. 4 To increase use of 4.1 % increase in the 4.1.1 Promotion to Social 4.1.1.1 No of Condoms distributed condoms from use of condoms Marketing of condoms through Social Marketing. 0.4% to 5% 4.1.2 Contraceptive Update 4.1.1.2 No of Seminars Orgnised seminars on Contraceptive Update. 5 To increase use of 5.1 % increase in the 5.1.1 5.1.1.1 No of Pills distributed pills from 1.2% to use of pills Promotion to Social through Social Marketing. 5% Marketing of pills Sl. Gaps Activities Strategy Ensure one MO trained on minilep and NSV up to PHC Training of nurses Lack of and ANMs on IUD Terminal/Limiting knowledge of and other spacing Methods small family methods at PHC norms. level. Ensure availability of contra ceptives (indenting , logistic Trained doctors on laparoscopy.

Female Laparoscopy Procure Sterilization surgery not Laparoscopy camps done. equipments for trained doctors Training of doctors needed. Procurement of Trained equipment. NSV camps doctors are not available. Immediate Compensation for disbursement of female sterilization incentive after sterilization camps. Logistic planning is Compensation for needed before male sterilization organizing camps.

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Block Health manager can hire one support staff for logistic support. Immediate disbursement of incentive after sterilization camps. Logistic planning is needed before organizing camps. Block Health manager could be hire one support staff for disbursement for logistic support. Accreditation of private nursing home. As per GOB Training of ANM & IUD camps Camps not held staff nurse for IUD insertion. Procurement of IUD. No Equipments for IUD Accreditation of accreditation of insertion private providers private Accreditation of for IUD insertion providers for private providers for services IUD insertion IUD insertion services services. As per GOI guide lines. Social marketing of need based OC & IUD. Monitoring of Increasing access to Social Marketing Social Markiting of contraceptives is not monitored contraceptive by PHC. through communities based distribution system free of cost. seminars for MO and other through Professional bodies (FOGSI. BMA, Nursing association Contraceptive etc..on Not being held. Update seminars Copper-T 380-A should be popularized. Awareness for emergency contraceptive.

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INSTITUTIONAL STRENGTHENING IN TERMS OF SERVICE Logical Framework Sl. Goal Sl. Impact indicators 1 To improve 1. Improved service delivery for women and children friendly with quality institutional 1 setup as per IPHS norms 2 To bring required architectural correction in the Institutional System Sl. Objectives Sl. Outcome Sl. Strategy Sl. Output indicators indicators 1 To strengthen 1. No and Type of 1.1.1 To enforce PNDT 1.1.1.1 % decrease in NGOs 1 MOU signed Act and to sex selective Partnership/ PPP between NGO increase sex ratio abortions. % for and DHS/RKS of female child increase in communitization for birth of female of Health strengthening of babies ( services . communitization delivery of health servies registers) and NGO 1.1.2 To make Public 1.1.2.1 No of cases partnership/ PPP Private supported by in place Partnerships for referral referral transport, transport IPD care canteen system under facility, STD PPP. booth and other 1.1.2.2 No of canteen routin facility facility where it is not functional at functional. insttutional facility level. 1.1.2.3 No of STD booth and other routine facility carried out under PPP. 1.1.2.4 No of cases supported and payments made by RKS/ DHS to BPL families in availing these services

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1.1.2 To develop 1.1.2.1 No of partnership partnership with with NGO for programme NGO implementation Programmes in for MCHN, the districts Micronutrient supplimentation, national programme implementation specially Kalazar elimination Strengthen 1.1.2.2 No and % of Logistics drug & management equipments system for regular available and supply of Drugs supplied ( and equipments stock ledger) Devlop a strong 1.1.2.3 Regular Monitoring & monitoring Evaluation / and evaluation HMIS System in reports all PHC 3 To devlop IEC 3. No of IEC 3.1.1 Establising BCC 3.1.1.1 Functional and BCC and 1 materials and training cell BCC cell at Training support developed and at District & DHS/ RKS system . BCC event BPHC level level carried out No of training Net working with 3.1.1.2 No of folk support system folk media team media team developed engaged in BCC activity. Type and No. of BCC event oragnised 4 To strengthen 4. No of ASHA 4.1.1 Develop ASHA 4.1.1.1 Establishment ASHA support 1 capacities support System in of ASHA System all PHC(One support person per 20 system at DHS ASHA) and RKS level 4. No of activities 4.1.2 Strengthening 4.1.1.2 No of RKS 2 carried out by RKS having RKS monthly meetings. 4.1.1.3 % of untied fund, JSY fund, referral transport etc utilised Sl. Strategy Gaps Activities

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To make Public Out sourcing of Private services is not as District /PHC Partnerships for per the need of level managers referral local Need and should be aware transport, IPD BPL families are about the TOR of care canteen not exampted PPP which is facility, STD from Fee of out finalized at State booth and other source services level. routeen facilty Build the capacity where it is not of manager to

functional. manage contracts of PPP There is an Accreditation of NA acute shortage institutions and to of para medics set standards, an like institute of radiographer, paramedical lab technician, sciences may be ECG technician started in the etc. in the state. This would District. create more

employment opportunities in addition availability of para medical personnel for absorption into the government health system. Devlop listing of NGOs NA partnership with those who are NGO working in F.P Programmes in A few ,MTP,programme,

the districts involvement of Institutional NGO in F.P delivery, programme, Blindness control Institutional programme. delivery, Accreditation of NA Blindness these facility from control state Health programme. Socity. There is no Process of MOU NA MOU with should be NGO/VO dicentralization /individuals for and it should Donation and oprationlise voluntary through RKS. support in PHC

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Strengthening of NGO NA DMU management process in the NGOs district and Management ASHA Faclitators aspects is one of will be managed the area of at the PHC level improvement Honourarium to DPM, DAM and DA Capacity building training programme for NGOs office bearer with the help of professionals on linkage with health system strengthening component. Mentoring Group NA at district level. Reporting NA mechanism should be developed of NGOs work in the district. There is no any Co-ordination NA VHSC in the with community district. based orgnisation at SHG, LRG, VEC, ,PRI for VHSC formation. Capacity Expoure visit of building of DPM/BHM Managers and selected ASHA to Doctors. other state where facility is comparatively working better.

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ASHA/ AWW If ASHA career worker is advancement trained programme may then she be planned to would be retain them in the able to system. Seats in inject the ANM course, medicine staff nurses and s and other paramedical immuniz courses may be ation. reserved for the qualified ASHAs Preparation of First time five Trainings of decentralized members of the DPMU,BPMU District Health districts were members on Action Plan trained on implementation of DHAP services/ various National program preparation and district Health action Plan through distance education Start prepration of plan from the month of October with situtional anlysis,Facility survey, line reporting system and qulitative finding from Community and users of facility. Devlop a strong Monitoring of Distribution of NA Monitoring & all programme is role and Evaluation / one of the responsbility HMIS System in weakest link of among MO and all PHC all programme. Managers of programme Lack of implementation. Supervisers in Use Process NA all PHC indicatore as monitoring of Lack of skill of respective use of data programme. Devlop NA Community is Programme not aware about review calander monitoring for review of aspects of HSC/PHC Health performance as

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Programme. per form 6 & 7

Gradation of NA Health Sub centers in three categories. Information NA exchange visits among ANM acording to Grade. Social recognition NA of Grade one ANM. Devlop four potentioal VHSCs in all PHC on Community based Monitoring of Health and Nutrition programme. Organise"JAN ADALAT" in with PRI & VHSC and invite nearby VHSC to observe thr process of "JAN ADALAT" Devlop Health and Nutrition Report Card by using growth monitoring chartsof Village and present in "JAN ADALAT" By VHSC

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Strengthen There is no Weekly meeting Logistics system of of HSC staffs at management logistic PHC for system for management of promoting HSC regular supply Drugs and other staffs for regular of Drugs and supply at any and timely equipments level. submission of indents of drugs/ Only vaccine vaccines supply according to management is services and comparatively reports stronger than Hiring vehicles other logistic for supply of drug work. kits Hiring of courriers as per need Developing three coloured indenting format for the HSC to PHC(First reminder-Green, Second reminder- Yellow, Third reminder-Red) Training of all ANM and Stock keepers on Indenting and Logistic Management. Develop TMC model for Logistic Management in the state. Strengthening RKS are not Ensure RKS uniformally registration of functioning in RKS of all the district functional PHC & APHC Training of RKS signatory and BHM on financial Management of RKS

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Presentation of case study of functional RKS in district level Meeting. Strengthening Poor monitoring Appointment of community mechanism of PHC level ASHA process through ASHA program facilitator supportive supervision of ASHA program Provide training cum supervisory support @ one supervisor for 20 ASHA Media Wrong and Media Sensitization provocative Sensitization Reporting work shop Having baseless News.

SITAMARHI DISTRICT

DISTRICT HEALTH ACTION PLAN 2012-13

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DDA DCM DPM Civil Surgeon DHS,Sitamarhi DHS, Sitamarhi DHS, Sitamarhi DHS, Sitamarhi

Geographical Profile:

 Latitude - 260 12' 51'' N to 260 49' 17'' N  Longitude – 850 12' 0'' E to 850 42' 48'' E  Height – 85m above sea level  International Border – 90 kms  Total Area – 2294 Sq. Kms.  Irrigated Land – 737.33 Sq. Kms.

Bordering Districts/ Countries:

 North – Nepal  South –Muzaffarpur  East – Darbhanga, Madhubani ,  West – East Champaran, Sheohar

Agriculture: Paddy, Wheat, Sugar cane, Maize, Lentils Industries : Sugar Factory (RIGA), Rice and Oil Mills. Rivers: Bagmati, Lakhandei

It is situated in the northern part of Bihar. The district headquarter is located in Dumra, five kilometers south of Sitamarhi.

 Festivals: Deepawali, Eid, Chhath Puja, Durga puja, Vishwakarma puja, Sarswati puja, Maha-shivratri, Holy deep in Baghmati on kartik Purnima and other festivals are celebrated with great enthusiasm.  Fairs: Maha Shivratri Mela, Vivah-Panchami Mela & Ramnavami Mela (huge market of cattles, horses and elephants are the main feature of these fairs)  Languages: Vajjika, Maithili, Hindi, Urdu

Temple: Maa Vaishno Devi Mandir & Maa Janki Madir.

Government Health Infrastructure:

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Block 17 Town 2 Sub Division 3 Nagar Parisada 1 Nagar Panchayat 05 Primary Health Center 17 Additional PHCs 36 Gram Panchayats 273 Revenue Village 835 Sub Centers 273 Sub divisional Hospital 1 District Hospital (Sadar Hospital) 1 Referral Hospital 1

Nepal

Nepal Sheohar

Darbhanga Motihari

Madhubani

Darbhanga Muzaffarpur

Profile of the district:

Total Population Male Population Female Population 34,34,108(2011sensus Projected) 18,14,662 16,19,446 Total Area – 2294 Sq. Kms. Urban Population 119593 Rural Population 1894203 Percentage of SC 12.1 Percentage of ST 0.02

Literacy rate 38.46% Sex Ratio (Total):- Male-1000 Female-892

HR POSITION (ARC), SITAMARHI

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SL.NO NAME OF THE POST SANCTIONED Working VACANT POST POST 1 District Community 1 1 0 Mobilizes 2 District Data Assistant 1 1 0

2 Block Community 17 16 1 Mobilizes 3 ASHA Facilitator 142 112 30 4. ASHA 2965 2662 303

Profiles of ASHA Resource Centre/ASHA Mentoring System

 ASHA Resource Centre/ASHA Mentoring group will oversee the implementation of the scheme and facilitate in developing the policy guidelines.  It will act as a think-tank for the programme.  It will provide technical inputs and support mechanism.  It will provide support to implementation of all health programmes at village level through ASHA.

Roles & Responsibility are following:-

 Create awareness to ASHA.  Support to ASHA for Health, Nutrition, basic sanitation, hygienic practices, healthy living and working conditions, information on existing health services and need for timely utilization of health, nutrition and need for timely utilization of health, nutrition and family welfare services.  To Organise village level meeting.  In one month BCM will organise more than 08 meeting at village level.  In village level meeting he will see the work of ASHA & give necessary sugestion to Asha &Villager.  Supportive Supervision of ASHA Worker.  Ensure timely incentive Paid to ASHA.  Motivate to ASHA.  Participate in VHSC Meeting.  Ensure utilization fund of VHSC.  Regular & Supportive Supervision of VHSND Programme by DCM, DDA & BCM.  Participate in VHSND Meeting.

Major Issue 139

 No Proper office is available at District level & Block level.  Not any amount given for office setup.  Mobility fund available for only two days at district level.  Few amounts given for office expenses.  Incentive payment of ASHA not given timely.  No monthly incentive given to ASHA.

Major Stakeholder and her roles Accredited Social Health Worker (ASHA)

One of the key components of the National Rural Health Mission is to provide every village in the country with a trained female community health activist-„ASHA‟ or Accredited Social Health Activist. Selected from the village itself and accountable to it, the ASHA will be trained to work as an interface between the community and the public health system. Following are the key components of ASHA :

 ASHA must primarily be a women resident of the village – married/widowed/divorced, preferable in the are group of 25 to 45 years.

 She should be a literate woman with formal education up to class eight. This may be relaxed only if no suitable person with this qualification is available.

 ASHA will be chosen through a rigorous process of selection involving various community groups, Aganwadi Institutes, the Block Nodel Officer, District Nodal Officer, the village Health Committee and the Gram Sabha.

 Capacity building of ASHA is being seen as a continuous process. ASHA will have to undergo series of training episodes to acquire the necessary knowledge, skills and confidence for performing her spelled out roles.

 The ASHAs will receive performance based incentives for promoting universal immunization, referral and escort services for Reproductive & Child Health (RCH) and other healthcare programmes, and construction of household toilets.

 Empowered with knowledge and a drug-kit to deliver first-contact healthcare, every ASHA is expected to be a fountainhead of community participation id public health programmes in her village.

 ASHA will be the first port of call for any health related demands of deprived sections of the population, especially women and children, who find it difficult to access health services.

 ASHA will be a health activist in the community who will create awareness on health and its social determinants and mobilize the community towards local health planning and increased utilization and accountability of the existing health services.

 SHE would be a promoter of good health practices and will also provide a minimum package of curative care as appropriate and feasible for that level and make timely referrals.

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 ASHA will provide information to the community on determinants of health such as nutrition, basic sanitation & hygienic practices, health living and working condition, information on existing health services and the need for timely utilization of health & family welfare services.

 She will counsel women on birth preparedness, importance of safe delivery, breastfeeding and complementary feeding, immunization, contraception and prevention of common infection including Reproductive Tract infection/Sexually Transmitted infection (RTIs/STIs) and care of the young child.

 ASHA will mobilize the community and facilitate them in accessing health and health related services available at the Anganwadi/sub-centre/primary health centers, such as immunization, Ante Natal Checkup (ANC), Post Natal Check-up supplementary nutrition, sanitation and other services being provided by the government.

 She will act as a depot older for essential provisions being made available to all habitations like Oral Rehydration Therapy (ORS), Iron Folic Acid Tablet (IFA), Chloroquine, Disposable Delivery Kits (DDK), Oral Pills & Condoms, etc.

B.1.1.5 ASHA Resource Center, Sitamarhi Budget for the year 2012-13 Strategies Activity Budget Total Total Sl. Amount S.No. Physical Target Rate Amount No. (in (in Rs.) lakh) 1.1 Salary of DCM 1 290400 290400 2.90 1.2 Salary of DDA(ASHA) 1 198000 198000 1.98 1.3 Accounts Manager 1 150000 150000 1.50 1.4 Data entry operator 1 120000 120000 1.20 1.5 Peon 1 96000 96000 0.96 Asha 1.6 Office expense:- Resource 1.6.1 Office Rent 12 5000 60000 0.60 centre/ 1.6.2 Office setup (one time) 1 150000 150000 1.50 Asha 1 1.6.3 Stationary & Misc.(Include Mobile phone & internet bill) 12 10000 120000 1.20 mentoring 1.6.4 Mobility Support for DCM & DDA(ASHA) 12 18000 216000 2.16 group at District 1.6.5 Laptop for DCM & DDA(ASHA) for one time 2 35000 70000 0.70 level 1.6.6 Purchase of Mobile Phone for DCM & DDA (ASHA) 2 5000 10000 0.10 1.6.7 ASHA Sammelan for one time 1 500000 500000 5.00 1.7 Capacity Building for District level ARC staff 2 50000 100000 1.00 1.8 Capacity Building for Block level ARC staff 5 25000 125000 1.25 1.9 Capacity Building for ASHA Facilitator 34 10000 340000 3.40 Sub Total A 2057000 20.57 2.1 Salary of BCM 17 174240 2962080 29.62 2.2 Salary of Block Accountant 17 144000 2448000 24.48 2.3 Salary of office Assistant 17 96000 1632000 16.32 Asha 2.5 Incentive for ASHA Facilitator 150 36000 5400000 54.00 Resource 2.6 Office expense:- centre/ 2.6.1 Office Rent 17 36000 612000 6.12 2 Asha 2.6.2 Office setup (one time) 17 50000 850000 8.50 mentoring 2.6.3 Stationary & Misc.(Include Mobile phone & internet bill) 17 72000 1224000 12.24 group at 2.6.4 Mobility Support for BCM 17 180000 3060000 30.60 Block level 2.6.5 Laptop for BCM for one time 17 30000 510000 5.10 2.6.6 Purchase of Mobile Phone for BCM (One time) 17 3000 51000 0.51 2.6.7 ASHA Saree & others 5930 1000 5930000 59.30 2.6.8 CUG Mobile with Sim for ASHA 2965 1500 4447500 44.48

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2.6.9 Mobile Recharge for ASHA 2965 1200 3558000 35.58 Sub Total B 29126580 291.27 Grand Total (A+B) 31183580 311.84

HMIS Strengthening Computer System for HMIS Additional skilled persons are required at District level for effective implementation and maintenance of HMIS in the District. The details of skilled persons with their job responsibilities and salary are as follows-

SN Designation No. Positioned Job responsibilities Salary Total of Staff of at (Rs.) Salary Staff per per year month (Rs.)

1 Jr. System 1 DHS Data entry, preparation 15,000/- 1,80,000/- Administrator ,Sitamarhi of Cum Data documents and reports Operator etc (HMIS) Total 1,80,000/-

Strengthening Computer System for HMIS SN Items Amount in Rs.(Approx) 1. Up gradation of Computer with hardware/software as per 50,000/- requirement. As like RAM, Hardisk, Stable Storage, Devices, Switch, Firewall etc. 2. Anti- Virus (Quantity 4) 20,000/- 3. Designing, Creation, Maintenance, Registration, Hosting of 40,000/- Website of District. 4. Laptops for DPM, DAM , M & E Officer, DPC , & DCM 2,00,000/- 5. USB Data Card ( For Internet Connection) (Quantity 23) 92,000/- 6. BSNL Post Paid Mobile Connection with Mobile Set and 525 30,000/- Monthly Plan For DPMU (QTY-5) Total 4,32,000/- HMIS Training District as well as Block level Capacity Building Workshop (HMIS Training) for the year 2012-13 on Revised HMIS Reporting Formats and Web Portals of NRHM and NHSRC has been completed with the help of resource persons from National Health System Resource Centre (NHSRC), New Delhi for District M & E Officer, District Programme Manager,DPC , DCM , DS of District/Sub Div. Hospital,Hospital Manager , MOIC, BHM,BCM and BAM but training on HMIS is the continuous process for quality movement.

Therefore in FY 2012-13, Training on HMIS for the whole state is required for  District Level other Programme Officers/Consultants  MOIC

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 BHM  BCM  BAM  Health Educator  Grade “A” Nurses  ANM  LHV etc.

The details are as follows:-

SN Designation Number 1. District Level other Program 10 Officers/Consultants 2. DS/MOIC 19 3. MO (APHC) 36 4. Hospital Manager 02 5. BHM 17 6. BCM 17 7. BAM 17 8. Health Educator 17 9. Computer 17 10. ANM (Regular & contractual) 273+19=292*2 11. Grad- „A‟ Nurse 36*2 12. LHV 17 13. Data Operators 19 Total 844

Budget (i) TA/DA Cost for Trainees (for 2 days) = Rs. 200/- per day per trainee x 2 days x 844 = Rs3,37,600/- per annum (ii) Miscellaneous for Trainees (for 2 days) = Rs. 100/- Per day Per trainee x 2 days x844 = Rs. 1,68,800/- Total annual Budget = Rs. 5,06,400 /- per annum.

Total Annual Budget

SN Activities Budget 1. Strengthening HR for HMIS 1,80,000/- 2. Strengthening Computer System for 4,32,000/- HMIS in DHS 3. HMIS Training 5,06,400 /- Total 11,18,400/- Total :- Eleven Lac Eighteen thousand four hundred rupees only.

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Aim is to immunize all pregnant Women for TT & Children up to 1 year for BCG, 3 Doses of DPT & POLIO & Measles Under this programme all PHCs are to be covered on all Wednesday & AWCs are to be covered at least once a month on Friday. HD & PHCs will provide Immunization services on all working days. Incentives are provided under this achievements. Contractual ANMs have been provided training for RI with the help of UNICEF regular ANMs have poor skill even after training, so training for Routine Immunization has to be taken on a regular basis. There is shortage of Cold Chain equipments such as ILR, DF, Cold Boxes & Vaccine Carriers. This year the RI coverage is low due to Strike by Employees. PHCs have been instructed to do RI works other than Wednesday & Friday in the week. There is no provision for maintenance and repair of cold chain. Repairing of cold chain equipments should & available at district level. Currently appointed company do nothing in this regard in our district. Wast Management practices for the disposal of syrings & needles are to be improved. Strategies :  Increasing awareness generation of society through AWW & ASHA  Insuring regular monthly tracking of pregnant women & new born child  Availability of cold chain equipment.  Maintenance and repair of cold chain equipment within the District.  Maintenance & repairing of Vaccine Van.  Ensuring vehicle of PHC especially for Muskan Supervision.  Safe disposal of syring & needles.

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 Availability of skilled vaccinator.  Supervisory level staff of PHCs to be involved in Muskan supervision.  Special provision in case of flood situation. Activities :  Regular training of RI/IEC/IPC & BCC  Organizing regular meeting of ANM, AWW & ASHA to brief the importance of tracking.  State to ensure availability of cold chain equipment.  Maintenance of cold chain at district level.  State to allot fund for maintenance and repair Vaccine Van.  State to decide for the funds of vehicle for supervision at the PHCs level.

VITAMIN-A SUPPLEMENTATION PROGRAMME

Background The National Policy Guidelines (N. Z. 28020/ 30/ 2003-CH, GOI, MOHFW, dated 02 November 2006) recommends Vitamin-A Supplementation Program for the children of age group 9 months to 5 years should receive two doses of Vitamin at 6 months interval which is considered adequate. These months would have intensive activities during which it was suggested that health sub-center level workers in close coordination with the ICDS workers and ASHAs will deliver services in the given month as per detailed micro-plans. All children should receive prophylactic nine doses of Vitamin A before the fifth birthday at the interval of six months. Post measles Vitamin A supplementation is the part of strategy.

The National Workshop on Micronutrients organized by ICMR on the 24-25 November 2003 which recommended that Biannual Child Health and Nutrition Promotion Months be held, six months apart i.e. usually in April/May and October/November which would offer a package of child health & nutrition services of which Vitamin-A supplementation of target children would be an integral part. 1. Vitamin-A Supplementation: Provide prophylactic dose of Vitamin-A solution to all children between 9 months to 5 years. The recommended dosage schedule is as under: a)The 1st dose 1, 00,000 I.U. (1 ml or half spoon) is given with routine measles immunization at 9 months completed age; b)The 2nd dose 2, 00,000 I.U. (2ml or full spoon) is given with First DPT/OPV booster (16- 18 months) and c)The next 7 doses (each dose 2 ml or full spoon) are given After every 6 months up to 5yrs of age.

2. Promotion of Breast feeding and timely introduction of complementary feeding: Accelerating community Participation and BCC on components of breast-feeding, i.e. a) Early Initiation b) Exclusive Breastfeeding c) Introduction of Complimentary feeding at the age of 6 months

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Problematic Areas Objective:- 1. Achieve universal coverage of 9 doses of Vitamin-A 2. Reduce the prevalence of night blindness to below 1% and Bitots spots To below 0.5% in children 6 months to 6 years age. 3. Eliminate Vitamin-A deficiency as public health problem. Strategies: 1. Biannual Rounds of Vitamin-A Supplementation in fixed months, i.e. April & October every year. 2. To Cover the Children through 4 days Strategy Day 1- Cover children of 9m-5yrs at site i.e. AWCs/ HSCs/ APHCs/ PHCs Day 2- Cover children of 9m-5yrs through house to house visits Day 3- Cover children of 9m-5yrs at site i.e. AWCs/ HSCs/ APHCs/ PHCs Day 4- Cover children of 9m-5yrs through house to house visit: mopping-up Gaps: 1. Infrastructure - Urban strategy for Identification of stakeholders and service providers in urban agglomerations, slums, notified areas to cover left out children residing in areas devoid of health & ICDS infrastructure. 2. Manpower- Lack of skilled manpower for implementation of program 3. Drugs- a) Non-supply of RCH Kit-A for ensuring first dose of Vitamin-A along with the measles vaccination at 9 months. b) Procurement of Vitamin-A bottles by the district for biannual rounds 4. Reporting. Lack of coordination among health & ICDS workers for report returns & existing MIS ( form-VI) 5. Monitoring- Lack of joint monitoring & supervision plans & manpower Activities: 1. Updation of Urban and Rural site micro .plan before each round. 2. Improving intersectional coordination to improve coverage 3. Capacity building of service provider and supervisors 4. Bridging gaps in drug supplies 5. Urban Planning for Identification of Urban site and urban stakeholder 6. Human resource planning for Universal coverage 7. Intensifying IEC activities for Community mobilization 8. Strengthening existing MIS system and incorporating 9 doses of Vitamin-A in existing reporting structure 9. Strong monitoring and supervision in Urban areas

Goal  To reduce the burden of morbidity and mortality due to various diseases in the district.

Objective  Establishing a sustainable decentralized system of disease surveillance for timely and effective public health action.  Integrating disease surveillance activities. To avoid duplication and facilitate sharing of information across all disease control programmes so that valid data are available for appropriate health decision.

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Epidemic branch deals with Communicable Diseases, i.e. Waterborne Diseases such as Cholera, Gastroenteritis, Typhoid and Infective hepatitis, Zoonotic Diseases like, Plague and Leptospirosis, Arthropod borne diseases like, Dengue fever, Kala-azar and Malaria , Air borne disease like Meningococcal Meningitis and provides health relief services in the wake of natural calamities like heavy rain, floods, draught, cyclone etc. to prevent post calamity disease outbreak. The collection and a good analysis of data analysis of this data gives us the indication when to apply what method to stop epidemic and control it.

Strategies adopted  Operationalization of norms and standards of case detection, reporting format.  Streamlining the MIS system- Establishing Web based & channels for data collection within the district and transmission mechanisms to state level.  Analyzing line listing of cases and Geographical Information Systems (GIS) mapping approach Preparation of graphs & charts on the basis of reports for planning strategies during epidemic outbreak.  Training to all the grass root level workers, MO’s & CHC staff in Data Collection, and data transfer mechanisms.

Summary of Proposed Budget for the Year 2012-13, Sitamarhi Total Amount FMR Code Budget Head Proposed (in Rs.) A Reproductive and Child Health-II 839181284 B NRHM Additionalities 1192647018 C Immunization + Pulse Polio 37735099 D Iodine Deficiency Disorder 54000 E Integrated Disease Survillance Project 1602000 F National Vector Borne Disease Control Programme 74964865 G National Leprosy Elimanation Programme 1230115 H National Programme for Control of Blindness 34046500 I Revised National Tuberoculosis Control Programme 8869800 Grand Total 2190330681

DPM CS cum member Secretary DM cum Chairman DHS, Sitamarhi DHS, Sitamarhi DHS, Sitamarhi

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Detail Proposed Budget for the year 2012-13, Sitamarhi

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Annexure 2 Proposed Budget for the year 2012-13, Sitamarhi

Budgetary Proposal: FMR Budget Head/Name Baseline Physical Target (where applicable) Unit Cost Financial Requirement (in Rs.) Committe Responsib Code of activity /Curren (in Rs.) d Fund le Agency t Status requireme (State/SH (as on nt (if any SB/Name Decemb Q1 Q2 Q3 Q4 Total Q1 Q2 Q3 Q4 Total Annual in Rs.) of er 2011) no of proposed budget (in Developm Units Rs.) Unit ent Partner) of meas H Sta ure H S H S HF S HF S HF S HFD S HFD S HFD S HFD S HFD S Remarks F te (in F t FD t D t D t D t t t t t t D Tot word D a a a a a a a a a a al s) t t t t t t t t t t * e e e e e e e e e e T T T T T T T T T T o o o o o o o o o o t t t t t t t t t t a a a a a a a a a a l l l l l l l l l l A RCH Flexipool MATERNAL A.1 HEALTH Operationalise A.1.1 Facilities No. of A.1.1 Operationalise FRUs 1460 2 2 730000 0 0 0 1460000 730000 See detail in Annexure .1 FRUs- opera 000 tional Dissemination A.1.1 Workshop 0 0 0 0 0 0 348000 .1.1 for FRU Guidelines No. of Monitor Progress revie A.1.1 and Quality 2500 2500 2500 2500 quaterly meeting to monitor the w 1 1 1 1 4 25000 100000 37500 .1.2 of Service 0 0 0 0 progress Delivery meeti ngs No. of APHC Operationalise opera 14 APHC has been proposed in the A.1.1 24x7 PHCs 1 tional 4000 4000 6000 year 2011-12,for MCH center which 4 4 6 0 14 100000 0 1400000 348000 .2 (Mch Center- 4 ise as 00 00 00 are not fully functional yet; so, we are Aphc) MCH not incresing the target. cente r- L1 A.1.1 MTP Services at 0 .3 Health Facilities RTI/STI Services A.1.1 at Health 0 0 .4 Facilities DHS Sitamarhi

No. of HSCs Operationalise opera 2 HSC has been proposed in the year A.1.1 Sub-Centres tional 1000 1000 2011-12, which are not fully functional 2 1 1 0 0 2 100000 0 0 200000 96000 .5 (MCH Center- ise as 00 00 yet; so, we are not incresing the Hsc) MCH target. cente r L-1 Referral A.1.2 Transport Integrated A.1.3 Outreach RCH Services No. of Outre ach A.1.3 RCH Outreach 3 5 20 5100 5100 5100 5100 camp 51 51 51 10000 2040000 223000 1 Camp per PHC per month .1 Camps/ Others 2 1 4 00 00 00 00 s organ ised 2 5 5 7 Monthly Village See budget detail in Annexure. No. of 8 Health Sanitation p 35 No. of Sanctioned AWW- A.1.3 VHSN 9 89 89 89 5399 5399 5399 5399 and Nutrition Day e 61 2159700 1303200 2642+Additional AWW= .2 D 0 04 04 04 25 25 25 25 (VHSND) r 6 173+sanctioned mini AWW 153=2968. held 4 Nutrition Days m So, 2968 VHSND per month o n t h No. of ELA for ANC for the yaer 2011-12 is Benifi 5 107205. ELA for 2012-13 will be Janani Suraksha 3 22 A.1.4 cairy 5 55 55 55 2786 2786 2786 2786 107205+10% of 107205 = 117926. Yojana / JSY 6 28 500 11144000 180000 .1 got 7 72 72 72 000 000 000 000 Considering 10% pregnancy wastage Home 2 8 the 2 the ELA for delivery will be-106133. benit Considering the guideline of JSY i.e. the benefit will be given to only those person having age more than 19 yrs and up to 2 child; we will take 70% of A_1. Institutional ELA for delivery for ELA of JSY for the 4.2 Deliveries year 2012-13, whic is- 74293. Now considering 30 % Home delivery, Home delivery will be 22288. No. of Considering 70% institutional delivery, 1 1 Benifi Institution Delivery will be- 52005 in 4 1 11 11 11 45 A.1.4 Institutional cairy 2258 2258 2258 2258 which we consider 8% C- Section 8 2 29 29 29 17 2000 90350000 31500000 .2.A Deliverie-Rural got 8000 6000 8000 8000 delivery which will be 4160 and as per 8 9 3 4 4 5 the census 2011 Rural Population is 8 4 benit 94.42% and Urban Pouplation is

No. of 5.58%. so, Institutional delivery rural Benifi will be 45175 and Institutional 4 6 A.1.4 Institutional cairy 66 66 66 26 8016 8004 8016 8004 Delivery urban will be 2670 5 6 1200 3204000 745000 .2.B Deliveries-Urban got 7 8 7 70 00 00 00 00 8 8 the benit No. of Benifi 1 Institutional A.1.4 6 cairy 0 10 10 10 41 1560 1560 1560 1560 Deliveries- C- 1500 6240000 450000 .2.C 6 got 4 40 40 40 60 000 000 000 000 section the 0 benit No. of 1 visit per PHC per quarter visit A.1.4 Administrative 1 1 4250 4250 4250 4250 and 17 17 17 68 25000 1700000 1223445 .3 Expenses 7 7 00 00 00 00 expen ces

A.1.4 Incentive to

.4 ASHAs

No. of meeti Maternal Death 1000 1000 1000 1000 A.1.5 ng 1 1 1 1 4 100000 400000 94000 1 meting per quarter at district level Review 00 00 00 00 organ ised Other Strategies/Activiti es A.1.6 0 (ICTC for HIV Testing of ANC Cases)

No. of This is to orient the private health Quaterly meeting meeti facilities regarding data collection for A.1.6 5000 5000 5000 5000 with Private ng 1 1 1 1 4 50000 200000 all indiactors, so that it will .1 0 0 0 0 Health Facilities organ incorporate in district data every ised month

A.2 CHILD HEALTH

A.2.1 IMNCl 50000 Implementation of No. of A.2.1 IMNCI 1500 1500 1500 1500 Monthly meeting and monitoring of meeti 3 3 3 3 12 50000 600000 .1 Activities in 00 00 00 00 IMNCI activities Districts ngs Monitor Progress Against A.2.1 Plan; Follow Up 0 0 0 0 0 0 .2 with Training, Procurement, Etc

No. of Incentive for 3 PNC 1 ELA for delivery for the year 2012-13= 9 HBNC to ASHA Visit 0 10 10 10 42 106133. Considering complication, A.2.1 4 1061 1061 1061 1061 /AWWs(State per 6 61 61 61 45 100 4245300 Low Birth Weight and other factors, .3 1 300 300 400 300 Iniative) 3 PNC Nora 1 3 4 3 3 Normal Baby will be 40% of 106133= 9 for Normal Baby ml 3 42453. Baby No. of 6 PNC Incentive for visit 1 3 ELA for delivery for the year 2012-13= HBNC to ASHA per 3 13 13 13 55 A.2.1 8 2759 2759 2759 2759 106133. Considering Low Birth (State Iniative) Low 7 79 79 79 19 200 11038000 .4 3 600 400 600 400 Weight Baby 52%, Low Birth Weight 6PNC for Low Birth 9 7 8 7 0 9 Baby will be 52% of 106133= 55190. Birth Baby weigh 8 t Baby Facility Based Newborn Care/ No. of FBNC NBSU 1000 1000 A.2.2 1 1 1 2 1000000 0 0 2000000 For 2 FRUs (Operationalise opera 000 000 40 tional NBSUs) Home Based A.2.3 Newborn Care/ 0 0 0 0 0 0 3644100 HBNC Infant and Young A.2.4 Child Feeding 0 0 0 0 0 0 / IYCF Care of Sick Children and A.2.5 0 0 0 0 0 0 Severe Malnutrition(NRC)

Management of No. of Diarrhoea, ARI Batch and Micronutrient 1126 1126 1126 disch 1126 A.2.6 Malnutrition 1 3 3 3 3 12 375461.25 383.7 383.7 383.7 4505535 2424689 See detail in Annexure arged 383.8 ( Nutritional 5 5 5 Rehabilitation from Centres) NRC

Childhood A.2.6 diarrhea 7073 1 1 7073840 0 0 0 7073840 3500000 See detail in Annexure .1 Management 840 Programme Other Strategies/activiti 5687 5687 A.2.7 es 1 1 2 568738.5 0 0 1137477 0 See detail in Annexure 38.5 38.5 (Vitamin A Biannual Round) No. of Meeti 5000 5000 5000 5000 A.2.8 Infant Death Audit 0 1 1 1 1 4 50000 200000 0 Quaterly Meeting ngs 0 0 0 0 held

Incen tive to ASHA Incentive to 2 5000 5000 5000 5000 A.2.9 for 20 20 20 20 25000 2000000 0 ASHA Under CH 0 00 00 00 00 Newb orn Child care FAMILY A.3 0 0 0 0 0 0 0 PLANNING Terminal/ Limiting A.3.1 0 0 0 0 0 0 Methods No. of Healt Dissemination of h Manuals on facilit Distribution of Manuals, Statndard A.3.1 Sterilisation 1 34 41 1700 5600 3410 1 y 56 10000 0 4140000 20000 Protocols and QA manuals in each .1 Standards & QAC 7 1 4 00 00 000 of Sterilisation reciev health facilities Services d the manu als No. of Female 4 Camp 1 A.3.1 12 12 12 48 6000 6000 6000 6000 2 camp per month for 17 PHC, 2 Sterilisation 5 s 2 5000 2400000 150000 .2 0 0 0 0 00 00 00 00 referrals and 1 sadar hospitals Camps 6 organ 0 ised No. of Camp A.3.1 2500 2500 2500 2500 1 camp in a year for 17 PHC, 2 Referral NSV Camps 1 s 5 5 5 5 20 5000 100000 35000 .3 0 0 0 0 and 1 for sadar Hospital organ ised ELA for the year 2011-12 for Family 3 1 Planning services is 34196. so, ELA for 1 Compensation for 8 No. of 63 11 11 31 the year 2012-13 will be A.3.1 9 3191 6382 1116 1116 Female 3 Sterili 82. 17 17 91 1000 31914000 2167895 34196+34196*10%= 37616. ELA for .4 1 400 800 9900 9900 Sterilisation 7 sation 8 0 0 4 Female Streriization will be- 36864 . 5 and ELA for NSV will be- 752 (2% of 4 total ELA) . From the above ELA we have taken 5000 for private facilities (3950 for Female sterilization and 50 Compensation for for NSV). so, ELA for Female Male sterilization will be- 31914 and NSV 3 No. of A.3.1 Sterilisation 7 14 24 24 70 1053 2106 3685 3685 will be 702. 1 Sterili 1500 1053000 150000 .5 (Compensation 0 0 6 6 2 00 00 50 50 We have distributed the ELA in the 8 sation for NSV formula of 10% for 1st quarter, 20% Acceptance) in 2nd Quarter, 35% in 3rd Quarter and 35% in 4th Quarter.

Accreditation of 3 Private No. of 5 A.3.1 1 10 17 17 50 7500 1500 2625 2625 Providers for Sterili 0 1500 7500000 3000000 .6 8 00 50 50 00 00 000 000 000 Sterilisation sation 0 Services 4

A.3.2 Spacing Methods No. of Camp 1 camp in each quarter for 36 A.3.2 1 5 22 1960 1960 1960 1960 IUD Camps s 56 56 56 3500 784000 functional APHC, 17 PHC, 2 Referral .1 9 6 4 00 00 00 00 organ and 1 Sadar Hospital ised No. of Healt h 4 Facilit 1 A.3.2 IUD Services at 12 12 12 50 1250 1250 1250 1250 4 y 2 1000 500000 .2 Health Facilities 5 5 5 0 00 00 00 00 9 havin 5 g IUD servic es Accreditation of Private A.3.2 Providers for IUD 0 0 0 0 0 0 0 .3 Insertion Services No. of Contraceptive semin A.3.2 5000 5000 Update 0 ars 0 1 0 1 2 50000 0 0 100000 0 .5 0 0 Seminars organ ised POL for Family No. of Planning (for Monit Rs. 12,000 for Per PHC per Year and 1 3400 1360 1190 A.3.3 District Level + oring 0 2 8 7 17 17000 0 289000 120000 Rs. 5,000 at District for per PHC per 7 0 00 00 State Level visit year Monitoring) done Repairs of 1000 A.3.4 1 1 100000 0 0 0 100000 0 Laparoscopes 00 Other Strategies/ A.3.5 0 0 0 0 0 0 0 Activities State Level A.3.5 Worshop/Review 0 0 0 0 0 0 .1 for FP A.3.5 Orientation 0 0 0 0 0 0 0 .2 Family Planning Incentive/ A.3.5 Award to Best 0 0 0 0 0 0 .3 Performer District/other Personel

Provide IUD Services at A.3.5 Health 0 0 0 0 0 0 135000 .4 Facility (IUD Camps) Social Marketing A.3.5 of 0 0 0 0 0 0 0 .5 Contraceptives Awar A.3.5 Award for best 3 1000 Yearly award, 1st- Rs. 50,000; 2nd Rs. d 0 0 0 1 1 100000 0 0 0 100000 0 .6 performer 00 30,000; 3rd Rs. 20,000. given ADOLESCENT REPRODUCTIVE A.4 AND 0 SEXUAL HEALTH / ARSH No. of Adolescent facilit Services at y We are planning to develop ARSH Health provi 5000 A.4.1 0 0 2 0 0 2 250000 0 0 0 500000 0 center at Sadar Hospital, Sitamarh and Facilities (ARSH ding 00 1 FRU Corners in 3 ARSH DHs and PHCs) servic es School Health A.4.2 0 5000000 0 0 0 0 5000000 5000000 Programme Other Strategies/ Activities 5000 A.4.3 1 1 5000000 0 0 0 5000000 2500000 (Menstrual 000 Hygiene) A.5 URBAN RCH 0 0 0 0 0 0 URBAN RCH(Urban A.5 Health 0 0 0 0 0 0 4000000 Center Through PPP) A.6 TRIBAL RCH 0 0 0 0 0 0 0

A.6 TRIBAL RCH 0 0 0 0 0 0 0

A.7 PNDT & Sex Ratio 0 0 0 0 0 0 Support to PNDT A.7.1 0 0 0 0 0 0 0 Cell PNDT cell Other PNDT functi Activities oning 4760 A.7.2 (Monitoring of 0 1 0 0 1 476000 0 0 0 476000 50000 See detail in Annexure and 00 Sex Ratio at Birth) activit ies done

INFRASTRUCTUR E (Minor Civil A.8 Works) & HUMAN 0 0 RESOURCES (Except AYUSH)

Contractual Staff A.8.1 0 0 0 0 0 0 & Services

ANMs, Staff Nurses, A.8.1 Supervisory 0 0 0 0 0 0 .1 Nurses (Salary of Contractual ANM/ Contractual SN) No. of Staff 1 A.8.1 Contractual Staff 11 3062 Total Sanctioned Post of Staff Nurse= Nurse 1 0 0 0 264000 0 0 0 30624000 13440000 .1 Nurse 6 4000 116 @ Rs. 22000 pm Recru 6 ited No. of 3 A.8.1 Contractual ANM 34 5176 Total Santioned Post for ANM= 4 0 0 0 151800 0 0 0 51763800 16871000 .1 ANM® Recru 1 3800 341HSc @ Rs 12650 pm 1 ited No. of LT Laboratory recrui A.8.1 9504 3LT for 2 Blood Bank=6 @ Rs 13200 as Technicians/(LT ted 6 0 0 0 6 158400 0 0 0 950400 360000 .2 00 RNTCP Technician in Blood Banks) for Blood Bank No. of Laboratory LT A.8.1 1 2692 Technician at recrui 0 0 0 17 158400 0 0 0 2692800 1 LT in each HC .3 7 800 PHC ted at PHC

6 MPW for 6 ward at DH, 3 MPW each No. of MPW 5 for 2 referral, 17 PHC and 56 APHC A.8.1 MPW 57 5148 (honorarium to 7 0 0 0 90000 0 0 0 51480000 0 and 1 MPV each at 341 HSC. Total .2.1 recrui 2 0000 voluntary worker) 2 MPW proposed= 6+6+51+168+341= ted 572

Specialists (Anaesthetists, Paediatricians, Ob/Gyn, No. of Surgeons, Speci Total Sanctioned post of Specialist= 68 A.8.1 Physicians, 2 1200 7800 alists 13 0 0 33 600000 0 0 19800000 in which 35 are filled and 33 are .3 Dental 0 0000 000 Surgeons, recrui vaccant Radiologist, ted Sonologist, Pathologist, Specialist for 7

CHC )

No. of A.8.1 PHNs at CHC, PHN 1 3000 2100 7 0 0 17 300000 0 0 5100000 We are proposing PHN for 17 PHC .4 PHC Level recrui 0 000 000 ted No. of Medical Officers Speci at CHCs / A.8.1 alists 8400 PHCs (Salary of 1 2 0 0 0 0 420000 0 0 0 840000 5040000 M.D. Patho for Blood Bank .5 for 00 MOs in Blood Banks) Blood Bank Additional Allowances/ A.8.1 Incentives to M.O. 0 0 0 0 0 0 .6 of PHCs and CHCs A.8.1 Others - FP 4800 2 2 0 0 0 2 240000 0 0 0 480000 .7 Counsellors 00 Incentive/ Awards Etc. to SN, ANMs Etc. 8 35 A.8.1 (Muskaan 8 88 88 88 2668 2668 2668 2668 2965AWC for 12 Months @ Rs 100 for 58 300 10674000 3145000 .8 Programme- 9 95 95 95 500 500 500 500 ANM & Rs 200 for ASHA=10674000 0 Incentive to 5 ASHA and ANM) Human Resources HSc-2,45,52,000,APHC- Development 1 11,49,12,000,PHC-12,97,92,000,RH- A.8.1 (Other Than 2 12 12 12 50 8963 8963 8963 8963 859827.34 358548000 5,68,08,000 & DH-3,24,84,000,For .9 Above)As per 5 51 51 51 04 7000 7000 7000 7000 Details see Situation analysis of IPHS Norms for 1 DH,RH,PHC,APH HSC,APHC,PHC,RH & DH. C & HSC Other Incentives A.8.1 Schemes 0 0 0 0 0 0 _10 (Pl. Specify) A.8.2 Minor Civil Works 0 0 0 0 0 0 Minor Civil Works A.8.2 for 0 0 0 0 0 0 .1 Operationalisatio n of FRUs Minor Civil Works for A.8.2 Operationalisatio 0 0 0 0 0 0 .2 n of 24 Hour Services at PHCs 8

A.9 TRAINING 0 0 Strengthening of Training Institutions 1000 A.9.1 (Repair/renovatio 1 1 1000000 0 0 0 1000000 n 000 of Training Institutions) Development of A.9.2 Training 0 0 0 0 0 0 Packages Maternal Health A.9.3 0 0 0 0 0 0 Training No. of Skilled A.9.3 SBA 5000 5000 5000 5000 Attendance at 5 5 5 5 20 100000 2000000 592350 1 batch per month .1 traini 00 00 00 00 Birth ng Comprehensive No. of A.9.3 EmOC Training 1000 1000 traini 1 1 2 100000 0 0 200000 0 2 training in a year .2 (Including C- 00 00 Section) ngs Life Saving A.9.3 Anaesthesia 0 0 0 0 0 0 .3 Skills Training No. of A.9.3 1500 1500 1500 1500 MTP Training traini 3 3 3 3 12 50000 600000 0 1 batch per month .4 00 00 00 00 ngs No. of A.9.3 6000 6000 6000 6000 2 batch for MOIC and 2 batch for RTI / STI Training traini 1 1 1 1 4 60000 240000 0 .5 0 0 0 0 SN/ANM/LT) ngs No. of A.9.3 5000 5000 5000 5000 BEMOC Training traini 1 1 1 1 4 50000 200000 1 batch per quarter .6 0 0 0 0 ngs Other MH Training (Any Integrated Training, Etc.)- No. of A.9.3 Training of MOs 1000 1000 1000 1000 traini 1 1 1 1 4 100000 400000 230000 1 per quarter .7 and 00 00 00 00 Paramedics at ngs Sub-District Level (Convergence with BSACS)

A.9.4 IMEP Training 0 0 0 0 0 0 Child Health A.9.5 Training No. of A.9.5 2 4200 4200 IMNCI traini 28 56 150000 0 0 8400000 5261420 .1 8 000 000 ngs A.9.5 F-IMNCI 0 0 0 0 0 0 .2

No. of A.9.5 Home Based 5000 5000 5000 5000 traini 1 1 1 1 4 50000 200000 1 per quarter .3 Newborn Care 0 0 0 0 ngs Care of Sick A.9.5 Children and 0 0 0 0 0 0 .4 Severe Malnutrition A.9 Other CH Training A.9.5 5140 (Training Plan for 68 68 756 0 0 0 51400 0 As per SHS guidelines _5 MAMTA Training) 0 A.9.5 TOT on FBNC 0 0 0 0 0 0 0 .5.1 Training on FBNC A.9.5 for Medical 0 0 0 0 0 0 0 .5.2 Officers No. of A.9.5 NSSK Training 1200 1200 1200 1200 5 traini 2 2 2 2 8 60000 480000 264500 2 per quarter .5.3 (SN/ANM) 00 00 00 00 ngs Family Planning A.9.6 0 0 0 0 0 0 0 Training Laparoscopic A.9.6 Sterilisation 0 0 0 0 0 0 .1 Training No. of A.9.6 7500 7500 7500 7500 Minilap Training 1 traini 1 1 1 1 4 75000 300000 70237 1 per quarter .2 0 0 0 0 ngs No. of A.9.6 5000 5000 NSV Training traini 1 1 2 50000 0 0 100000 0 2 in a year .3 0 0 ngs A.9.6 IUD Insertion 0 0 0 0 0 0 0 _4 Training Training of No. of A.9.6 Medical Officers 6000 6000 6000 6000 1 traini 1 1 1 1 4 60000 240000 55289 1 per quarter .4.1 in IUD 0 0 0 0 Insertion ngs

Training of ANMs No. of A.9.6 8000 8000 8000 8000 / LHVs/SN in IUD 3 traini 2 2 2 2 8 40000 320000 88260 2 per quarter .4.2 0 0 0 0 Insertion ngs A.9.6 Contraceptive 0 0 0 0 0 0 0 .5 Update A.9.6 Other FP Training 0 0 0 0 0 0 _6 (Pl.SSpecify) Post Partum Family Planning (With Emphasis on A.9.6 IUCD Insertion) 0 0 0 0 0 0 0 .6.1 Master Trainers at All 38 Districts Hospitals Training of Family A.9.6 Planning 0 0 0 0 0 0 .6.2 Counsellors 10

ARSH Training No. of (MOs, 5000 A.9.7 traini 1 1 50000 0 0 0 50000 0 ANM/Nurses, 0 Nodal Officers) ngs Programme No. of 1000 A.9.8 Management traini 4 4 25000 0 0 0 100000 0 For all Blocks 00 Training ngs A.9.8 SPMU Training 0 0 0 0 0 0 0 .1 No. of A.9.8 5000 5000 5000 5000 DPMU Training traini 1 1 1 1 4 50000 200000 50000 .2 0 0 0 0 ngs Other Training A.9.9 0 0 0 0 0 0 0 (Pl. Specify) Continuing A.9.9 Medical and 0 0 0 0 0 0 0 .1 Nursing Education

Post Graduate A.9.9 Diploma in Family 0 0 0 0 0 0 0 .2 Medicine for MO

A.9.9 DNB in Family 0 0 0 0 0 0 0 .3 Medicine for MO PGD in Public A.9.9 Health 0 0 0 0 0 0 .4 Management for MO (IIPH) PGD in Public Health Management for A.9.9 2 2000 PGD in Public Health for Capacity Health and 20 100000 0 0 0 2000000 0 .5 0 000 Building to all Health Managers Management Personnel (IIPH at SIHFW) A.9_ Training 0 10 (Nursing) Strengthening of A.9.1 Existing Training 5347 1 1 53475000 0 0 0 53475000 See Deatil in Annexure 0.1 Institutions/ 5000 Nursing School New Training A.9.1 Institutions/ 0 0 0 0 0 0 0 0.2 School A.9_ Training (Other 0 0 0 0 0 0 0 11 Health Personnel)

Promotional Training of Health A.9.1 Workers 0 0 0 0 0 0 0 1.1 Females to Lady Health Visitor Etc. Training of ANMs, No. of A.9.1 1000 1000 1000 1000 Staff Nurses, traini 1 1 1 1 4 100000 400000 0 1 per quarter 1.2 00 00 00 00 AWW, AWS ngs 11

Other Training No. of A.9_ and Capacity 5000 5000 5000 5000 traini 1 1 1 1 4 50000 200000 0 11_3 Building 0 0 0 0 Programmes ngs Training of A.9.1 Faculty / Post 0 0 0 0 0 0 0 1.3.1 Basic B.Sc / Basic B.Sc Community Visit A.9.1 for Students & 0 0 0 0 0 0 50000 1.3.2 Teachers PROGRAMME / NRHM A_10 MANAGEMENT 0 0 COSTS

Strengthening of SHS/ SPMU (Including HR, A.10. Management 0 0 0 0 0 0 1 Cost, Mobility Support, Field Visits ) Liability on A.10. Current Staff at 0 0 0 0 0 0 1.1 Prevailing Salary Additional A.10. Manpower Under 0 0 0 0 0 0 1.2 SHSB State Monitoring A.10. Cell for Blood 0 0 0 0 0 0 1.3 Banks/BSUs Provision of Equipment/furnitu A.10. re and Mobility 0 0 0 0 0 0 1.4 Support for SPMU Staff Mobility Support A.10. 1800 (District Malaria 1 1 1 180000 0 0 0 180000 180000 1.5 Office) 00 A.10. Strengthening of 0 0 0 0 0 0 1.6 Directorate Liability on Various New Posts Approved A.10. in PIP 2010-11, 0 0 0 0 0 0 1.7 Already Advertised and Shortlisting Underway Strengthening of DHS/ DPMU (Including HR, A.10. Management 0 0 0 0 0 0 0 2 Cost, Mobility Support, Field Visits ) 12

Contractual Staff A.10. for DPMU 2717 1 1 1 2717312 0 0 0 2717312 989284 See deatil in Annexure 2.1 Recruited and in 312 Position Provision of Equipment/furnitu A.10. 3000 re and Mobility 1 1 300000 0 0 0 300000 2.2 00 Support for DPMU Staff A.10. Strengthening of 1 1 1375 17 809160 0 0 0 13755720 10710200 See detail in Annexure 3 Block PMU 7 7 5720 A.10. Strengthening 0 0 0 0 0 0 0 4 (Others) A.10. Tally Purchase 0 0 0 0 0 0 0 4.1 for RAM A.10. Renewal 5000 1 1 1 50000 0 0 0 50000 8100 4.2 (Upgradtion) 0 A.10. AMC (State, 1000 1 1 1 100000 0 0 0 100000 22500 4.3 Regional & DHS) 00 A.10. AMC (Block 1 1700 1 17 10000 0 0 0 170000 0 4.4. Level) 7 00 A.10. 1 5000 3500 Training on Tally 7 17 5000 0 0 85000 4.5 0 0 0 Training in A.10. 1 5000 3500 Accounting 7 17 5000 0 0 85000 0 4.6 Procedures 0 0 0 Capacity Building A.10. 1 1000 7000 & Exposure Visit 7 17 10000 0 0 170000 0 4.7 0 00 0 of Account Staff Regional A.10. Programme 0 0 0 0 0 0 4.8 Management Unit Management Unit A.10. at FRU ( Hospital 6600 2 2 2 330000 0 0 0 660000 500000 4.9 Manager & FRU 00 Accountant) A.10. Audit Fees 0 0 0 0 0 0 5 Annual Audit of A.10. 1 5000 3500 the Programme 7 17 5000 0 0 85000 63000 5.1 (Statutory Audit) 0 0 0 A.10. Internal Auditor 0 0 0 0 0 0 5.2 A.10. TA for Internal 0 0 0 0 0 0 5.3 Auditor Training of A.10. Internal Audit 0 0 0 0 0 0 0 5.4 Wing A.10. Concurrent Audit 3000 1 1 1 300000 0 0 0 300000 120000 6 (State & District) 00 Mobility Support A.10. 1 3060 to BMO/ MO/ 17 180000 0 0 0 3060000 0 For each block 7 Others 7 000 13

A RCH Flexipool 0 0 0 0 0 0 117541048 Total 839181284 1 Mission Flexible B 0 0 0 0 0 0 0 Pool B.1 ASHA 0 0 0 0 0 0 0

B.1.1 ASHA COST 0 0 0 0 0 0 0 No. of 2 11 30 ASHA per Batch for 6 days @ Rs. B.1.1 Selection & ASHA 9 29 29 29 6855 6855 6855 6855 86 2312 27420320 27420320 69350. so, for 2965 ASHA, 100 Batch is .1 Training of ASHA Train 6 65 65 65 080 080 080 080 0 required 4 times. ed 5 No. of ASHA ASHA facilitator 1 B.1.1 Facilit 4942 30 ASHA Facilitator per Batch for Training for 1st 5 3295 0 0 0 494250 1341900 .1.1 ator 50 round 1 Round 0 Train ed No. of ASHA ASHA facilitator 1 B.1.1 Facilit 15 15 3754 3754 3754 30 ASHA Facilitator per Batch for Training for 2,3 & 5 2503 0 1126350 1126350 .1.2 ator 0 0 50 50 50 round 2,3,4 4th round 0 Train ed No. of ASHA 2 Procurement of B.1.1 havin 9 29 1482 ASHA Drug Kit & 500 0 0 0 1482500 741250 .2 Replenishment g 6 65 500 Drug 5 Kit No. of ASHA got the 8 Other Incentive to 35 B.1.1 TA/D 8 88 88 88 8895 8895 8895 8895 ASHAs (TA/DA 58 100 3558000 2700000 Rs. 100 per ASHA/Month/ASHA diwas .3 A per 9 95 95 95 00 00 00 00 for ASHA Divas) 0 mont 5 h for ASHA Diwas Awards to B.1_ ASHA's/Link 0 1.4 Workers No. of Best Performance Yearly award- 1st prize- Rs. 2500, 2nd B.1.1 awar 9350 Award to ASHAs 17 17 5500 0 0 0 93500 34000 Prize- Rs. 1500. 3rd Prize- 1000 and .4.A ds 0 at District Level 500 for printing per block given No. of Torch 2 B.1.1 Rechargeable distri 9 29 7412 250 0 0 0 741250 593000 .4.B Torch to ASHA buted 6 65 50 to 5 ASHA

No. of Identi 2 B.1.1 Identity Card to ty 9 29 7412 25 0 0 0 74125 13700 .4.C ASHA Card 6 65 5 Issue 5 d No. of 2 Umbr B.1.1 9 29 4447 Umbrella to ASHA ella 150 0 0 0 444750 .4.D 6 65 50 distri 5 buted ASHA Resource B.1.1 3118 Centre/ASHA 1 1 31183580 0 0 0 31183580 1500000 See detail in Annexure .5 3580 Mentoring Group

B.2 Untied Funds 0 0 0 0 0 0 0

Untied Fund for 1000 B.2.1 2 2 50000 0 0 0 100000 100000 SDH/CHC 00 B.2.2 Untied Fund for 1 4250 17 25000 0 0 0 425000 425000 .A PHCs 7 00 B.2.2 Untied Fund for 5 1400 56 25000 0 0 0 1400000 900000 .B APHC 6 000 3 Untied Fund for 34 3410 B.2.3 4 10000 0 0 0 3410000 2130000 Sub Centres 1 000 1 8 Untied Fund for 84 8460 B.2.4 4 10000 0 0 0 8460000 8460000 VHSC 6 000 6 Annual B.3 Maintenance 0 0 0 0 0 0 0 Grants 6000 B.3.1 CHCs 2 2 300000 0 0 0 600000 00 B.3.1 SDH 0 0 0 0 0 0 0 .A 1 3400 B.3.2 PHCs 17 200000 0 0 0 3400000 1700000 7 000 B.3.2 5 5600 APHC 56 100000 0 0 0 5600000 1800000 .A 6 000 3 34 8525 B.3.3 Sub Centres 4 25000 0 0 0 8525000 1 000 1 1000 B.3.4 DH 1 1 1000000 0 0 0 1000000 1000000 000 Hospital B.4 0 0 0 0 0 0 0 Strengthening Up Gradation of CHCs, PHCs, 2 2000 for 17 PHC, 2 Referral and 1 Sadar B4.1 20 1000000 0 0 0 20000000 Dist. Hospitals to 0 0000 Hospital IPHS) B.4.1 District Hospitals 0 0 0 0 0 0 0 .1

Construction of B.4.1 7500 SNCU in District 1 1 7500000 0 0 0 7500000 .1.A Hospitals 000 Up Gradation of 1000 B.4.1 05 DHs by 10000000 Upgradation of Sadar Hospital from 90 1 1 0000 0 0 0 100000000 .1.B Increase Number 0 Bedded to 500 Bedded. of Beds 900 0 B.4.1 CHCs (Hospital 0 0 0 0 0 0 0 .2 Strengthening) PHCs (Construction of 3 1700 B.4.1 1 Construction of Doctors & Staff Doctors & 4 Staff 17 10000000 0000 0 0 0 170000000 .3 7 Quarters for all 17 PHCs. Nurse Quarters in 0 38 PHCs)\ Sub B.4.1 Centres(Hospital 0 0 0 0 0 0 0 .4 Strengthening) Others (Up Gradation of 2 Health Facilities (Rajendra Nagar) B.4.1 Eye Hospital & 0 0 0 0 0 0 0 .5 Lok Nayak Jay Prakash Narayan Hospital) Into Super Speciality As Per IPHS Strengthening of Districts, Sub- B4.2 Divisional 0 0 0 0 0 0 0 Hospitals, CHCs, PHCs Installation of Solar Water B4.2. 2 1000 for 17 PHC, 2 Referral and 1 Sadar System in 25 20 50000 0 0 0 1000000 179500 A SDH, 10 RH and 0 000 Hoapital 150 PHC Accreditation / ISO : 9000 B4.2. Certification of 90 1000 2 2 500000 0 0 0 1000000 for 2 Referral hospital B Health Facilities ( 000 15 DH+15 SDH+ 10 RH+ 50 PHC) Sub Centre Rent 2 27 3300 B.4.3 and 7 12000 0 0 0 3300000 612000 5 000 Contingencies 5 B.4.3 4 1152 APHC Rent 48 24000 0 0 0 1152000 785400 .1 8 000 Logistics Management/ Improvement B.4.4 (G2P Bihar Health 0 0 0 0 0 0 0 Operations Payment Engine HOPE)

New Constructions/ B.5 Renovation and 0 0 0 0 0 0 0 Setting Up

Construction of Complete Office 1250 B.5.1 Set up & 1 1 12500000 0 0 0 12500000 residential 0000 quarter for DPMU

B.5.1 CHC 0 0 0 0 0 0 0 1500 1 Construction of Runni Saidpur, Dumra, B5.2 PHCs 10 15000000 0000 0 0 0 150000000 0 Sursand, Bazpatti and Bathnaha PHC 0

Construction of Lalpur, Bhuthi, Barri Bheta, Basotara, Premnagar, Patahi 2000 B5.2. Construction of 2 Chowk, Rasalpur, Sahiyara, Sirsiya, 20 10000000 0000 0 0 0 200000000 A APHC (PHC) 0 Paktola, Raipu, Suthihara, Gisara, 0 Rewasi, Sasaula, Lalpur, Rajwada, Ratanpur, Kanhauli APHC

Construction of Kumma, Akhtha, Bachharpur, Amanpur, Bhantawari, Gadha, Ramnagar bedaul, Dumharpatti, Singhyahi, Madhopur Chatri, Mirzapur, Barharwa, Madhurapur, Madhuban Got, Mohni, Bahera, Sirsi, Bath, Janipur, Dhadhi, Sirkhiriya, Korlahiya, Lalpur, Kodariya, Baligadh, Koria lalpur, Balua, Govind Pitozha, Kharka, Hanuman Nagar, Baghari, Gadhwa Sukhi, Hira Kanhauli, Pachnaur, Patahi, Madanpur, Chakki, 1 2000 B.5.2 Construction of Kachor, Parsa Mahind, Bisanpur, 0 2000000 0000 0 0 0 200000000 .B HSC Rasulpur, Gharwara, Pachharwa, 0 0 Betha, Sisiya, Sahargama, Lahuria, Bhawanipur, Indarwa, Laxmipur, Pachtaki, Patahi, Musachak, Masha, Majhaulia, Tirkaulia,Mahuwa, Diankothi, Haribela, Mahadev, Pasurampur, Sonar, Imlibazar, Babhangama, Rampur Ganguli, Muradpur, Bhubharo, Maniyari, Amghatta, Bariyarpur, Bhithha, Quari, Sundarpur, Sahniyapatti, Jawahi, Baghari, Parsa, Tikauli, Rakasia, Belahi HSC

Construction of Residential B5.2. Quarters for 2 4000 20 2000000 0 0 0 40000000 B Doctors & Staff 0 0000 Nurses in 38 Old APHC

B5.2. Strengthning of 1000 1 1 1000000 0 0 0 1000000 800000 C Cold Chain 000

Infrastructure of B_5_ Training 0 0 0 0 0 0 0 10 Institutions Strengthening of Existing Training Institutions/Nursi ng School( Other B.5.1 Than HR)- 0 0 0 0 0 0 0 0.1 Strengthening of Nursing Education- at IGIMS Bihar 18

New Training B.5.1 Institutions/Scho 0 0 0 0 0 0 0 0.2 ol(Other Than HR) SHCs/Sub B5.3 0 0 0 0 0 0 0 Centres Setting Up Infrastructure Wing for Civil Works (9 Executive Eng, 38 B5.4 0 0 0 0 0 0 0 Asst. Eng & 76 JE Under Bihar Medical Services and Infrastructure Corporation Ltd) Govt. Dispensaries/ B5.5 0 0 0 0 0 0 0 Others Renovations Construction of BHO, Facility Improvement, B5.6 0 0 0 0 0 0 0 Civil Work, BemOC and CemOC Centers\ Major Civil Works for B.5.7 0 0 0 0 0 0 0 Operationalisatio n of FRUS Major Civil Works for 1 2550 Upgradation & Boundarywall to all 17 B.5.8 Operationalisatio 17 1500000 0 0 0 25500000 n of 24 Hour 7 0000 PHCs Services at PHCs Civil Works for Operationalising Infection B.5.9 Management & 0 0 0 0 0 0 0 Environment Plan at Health Facilities Corpus Grants to B.6 0 0 0 0 0 0 0 HMS/RKS 5000 B6.1 District Hospitals 1 1 500000 0 0 0 500000 500000 00 2000 B6.2 CHCs (SDH) 2 2 100000 0 0 0 200000 00 1 1700 B6.3 PHCs - RKS 17 100000 0 0 0 1700000 1700000 7 000 5 5600 B6.4 Other (APHC) 56 100000 0 0 0 5600000 3700000 6 000 District Action Plans (Including 2222 B.7 1 1 2222000 0 0 0 2222000 689256 See Detail in Annexure Block, Village) 000

Panchayati Raj B.8 0 0 0 0 0 0 0 Initiative Constitution and Orientation of No. of 4 Community orient 42 84 8460 8460 B8.1 2 2000 0 0 1692000 409500 Leader & of ation 3 6 00 00 3 VHSC,SHC,PHC,C done HC Etc Orientation Workshops, Trainings and No. of 4 Capacity Building works 42 84 8460 8460 B.8.2 2 2000 0 0 1692000 180150 of PRI at hop 3 6 00 00 3 State/Dist. Health done Societies, CHC,PHC Others State Level Activities (IEC+Monitoring+ Need Based B.8.3 0 0 0 0 0 0 0 Training for VHSC Members in 5 CBPM Focus Districts) Mainstreaming of B.9 0 AYUSH No. of Medical Officers AYUS at DH/CHCs/ 5 1344 B.9.1 H 56 240000 0 0 0 13440000 7900000 PHCs (Only 6 0000 AYUSH) recrui ted B.9.1 AYUSH 0 0 0 0 0 0 0 .A Specialists Other Staff Nurse/ Supervisory B.9.2 0 0 0 0 0 0 0 Nurses (for AYUSH) B_9. Activities Other 0 0 0 0 0 0 0 3 Than HR Training of AYUSH Doctors & Paramedical B.9.3 Staffs W.R.T 0 0 0 0 0 0 0 .1 AYUSH Wing and Establishment of Head Quarter Cost B_10 IEC-BCC NRHM 0 0 0 0 0 0 0 Strengthening of BCC/IEC Bureaus B.10 0 0 0 0 0 0 0 (State and District Levels) Development of B.10. 1104 State BCC/IEC 1 1 11040000 0 0 0 11040000 315390 See Seatil in Annexure 1 Strategy 0000

B_10 Implementation of 0 0 0 0 0 0 0 .2 BCC/IEC Strategy

B.10. BCC/IEC 2 2100 For 17 PHC, 2 Referral, 1 Sadar and at 21 10000 0 0 0 210000 2.1 Activities for MH 1 00 District level

B.10. BCC/IEC 2 2100 For 17 PHC, 2 Referral, 1 Sadar and at 21 10000 0 0 0 210000 2.2 Activities for CH 1 00 District level

B.10. BCC/IEC 2 2100 For 17 PHC, 2 Referral, 1 Sadar and at 21 10000 0 0 0 210000 2.3 Activities for FP 1 00 District level BCC/IEC B.10. 2 2100 For 17 PHC, 2 Referral, 1 Sadar and at Activities for 21 10000 0 0 0 210000 2.4 1 00 District level ARSH No. of Healt 2 B.10. h 27 2730 Health Mela 7 10000 0 0 0 2730000 4000 1 Health Mela per Panchayat 3 Mela 3 000 3 Organ ised No. of meeti Creating ngs 2 B.10. Awareness on 27 2730 and 7 10000 0 0 0 2730000 4 Declining Sex 3 000 Ratio Issue. orient 3 ation done B.10. Other Activities 0 0 0 0 0 0 0 5 Mobile Medical Units (Including 5616 B_11 Recurring 1 1 5616000 0 0 0 5616000 4212000 Expenditures) 000

Referral B_12 0 0 0 0 0 0 0 Transport Ambulance/ B.12. EMRI/Other 0 0 0 0 0 0 0 1 Models Ambulance/ B.12. EMRI/Other 0 0 0 0 0 0 0 1 Models B.12. Operating Cost 0 0 0 0 0 0 0 2 (POL) Emergency Medical B.12. Service/102- 0 0 0 0 0 0 0 2.A Ambulance Service B.12. 1911- Doctor on 0 0 0 0 0 0 0 2.B Call & Samadhan Advanced Life B.12. Saving 1800 1 1 1800000 0 0 0 1800000 900000 2.C Ambulance (Call 000 108)

Referral B.12. 2 3120 For 17 PHC, 2 Referral and 1 Sadar Transport in 20 1560000 0 0 0 31200000 1404000 2.D Districts 0 0000 Hospital B_13 PPP/ NGOs 0 0 0 0 0 0 0 Non- Governmental B.13. Providers of 0 0 0 0 0 0 0 1 Health Care RMPs/TBAs Non- Governmental B.13. Providers of 0 0 0 0 0 0 0 1 Health Care RMPs/TBAs B.13. Public Private 0 0 0 0 0 0 0 2 Partnerships NGO Programme/ B_13 Grant in Aid to 0 0 0 0 0 0 0 .3 NGO Setting Up of Ultra-Modern Diagnostic Centers in Regional B.13. Diagnostic 0 0 0 0 0 0 0 3.A Centers (RDCs) and All Government Medical College Hospitals of Bihar Outsourcing of Pathology and Sadar Hospital 1- @ Rs 2500000 per B.13. 2 1200 Radiology 20 600000 0 0 0 12000000 1500000 year, Referral Hospital and PHC-19 @ 3.B 0 0000 Services From Rs. 500000 per year PHCs to DH Strengthening of 2 1000 One unit for each DH,2RH & 17 PHC @ 20 500000 0 0 0 10000000 Govt. Laboratory 0 0000 cost of Rs 500000. Outsourcing of B.13. HR Consultancy 0 0 0 0 0 0 0 3.C Services B.13. IMEP(Bio-Waste 7 1900 For 56 APHC, 17 PHC, 2 Referral and 1 76 25000 0 0 0 1900000 3.D Management) 6 000 Sadar Hospital

B_14 Innovations 0 0 0 0 0 0 0

Innovations( If Any) (Rajiv B.14. Gandhi Scheme 7612 1 1 761270 0 0 0 761270 330050 See detail in Annexure A for Empowerment 70 of Adolescent Girls Or SABLA)\

YUKTI Yojana Accreditation of B.14. 5000 Public and 1 1 500000 0 0 0 500000 305274 B 00 Private Sector for Providing Safe 22

Abortion Services

Planning, B_15 Implementation 0 and Monitoring Community Monitoring B (Visioning 0 0 0 0 0 0 0 .15.1 Workshops at State, Dist, Block Level) B15. State Level 0 0 0 0 0 0 0 1.1 District Level (Purchase of 830 3 B15. Mobile Handsets 9 0 0 0 0 1.2 From BSNL/By 7 Tender Process) B15. Block Level 0 0 0 0 0 0 0 1.3 Mobile Handsets for 56APHC & 341 B15. Other(APHC & 39 1071 2700 0 0 0 1071900 HSc@Rs 1500+Exp Rs 1200/Yr for 397 1.4 HSC) 7 900 units. B.15. Quality 0 0 0 0 0 0 0 2 Assurance B15. Quality 6000 1 1 600000 0 0 0 600000 2 Assurance 00 B.15. Monitoring and 0 0 0 0 0 0 0 3 Evaluation Monitoring & Evaluation/HMIS/ For 17 Block, 2 Referral and 1 Sadar B.15. MCTS (State, 2 1500 20 75000 0 0 0 1500000 Hospital. Including 1 Data assistant for 3.1 District , Block & 0 000 Divisional Data MCTS @ Rs. 10000 per month Centre) State, District, B15. 1 1800 Divisional, Block 18 10000 0 0 0 180000 1200000 For 17 Block and 1 District Data Center 3.1.A 8 00 Data Centre B15. CBPM 0 0 0 0 0 0 0 3.1.B Computerization HMIS and E- B.15. Governance, E- 3000 1 1 300000 0 0 0 300000 256031 3.2 Health (MCTS, RI 00 Monitoring, CPSMS) B.15. MCTS and HRIS 0 0 0 0 0 0 0 3.2.A B.15. 1800 RI Monitoring 1 1 180000 0 0 0 180000 180000 3.2.B 00 B.15. CPSMS 0 0 0 0 0 0 0 3.2.C 23

Hospital Management B.15. System, 0 0 0 0 0 0 0 3.2.D Telemedicine and Mobile Based Monitoring B.15. Other Activities 1000 1 1 100000 0 0 0 100000 3.3 (HMIS) 00 Strengthening of HMIS (Up- B.15. Gradation and 5000 1 1 50000 0 0 0 50000 3.3.A Maintenance of 0 Web Server of SHSB) Plans for HMIS B15. Supportive 5000 1 1 500000 0 0 0 500000 3.3.B Supervision and 00 Data Validation B_16 PROCUREMENT 0 0 0 0 0 0 0

Procurement of For 1 Sadar, 2 Referral, 17 PHC, 14 B.16. 3 7200 Equipment MH 36 200000 0 0 0 7200000 2300000 APHC identified for MCH Center L-1 1.1 6 000 (Labor Room) and 2 HSc identified for HSC Procurement of B.16. 6795 Equipment : CH 3 3 2265258 0 0 0 6795774 393750 For 2 Referrals and 1 Sadar Hospital 1.2 774 (SCNU- NBCC) B.16. Procurement of 0 0 0 0 0 0 1.3 Equipment: FP 1 B16. Procurement of 10 3000 For 17 PHC, 2 Referral, 1 sadar 0 3000 0 0 0 300000 255000 1.3.A Minilap Set (FP) 0 00 Hospital, 5 Kit per center 0 B16. Procurement of 5 5 1100 5500 0 0 0 5500 5500 1.3.B NSV Kit (FP) Procurement of B16. 7 1140 For 56 APHC, 17 PHC, 2 Referrals and IUD Kit (FP) (PHC 76 15000 0 0 0 1140000 15000 1.3.C Level) 6 000 1 Sadar Hospital B16. Procurement of 0 0 0 0 0 0 1.4 Equipment: IMEP

B16. Procurement of 0 0 0 0 0 0 0 1.5 Others(Furniture) B16. Dental Chair 0 0 0 0 0 0 1357894 1.5.A Procurement B16. Equipments for 6 0 0 0 0 0 0 0 1.5.B New Blood Banks

A.C. 1.5 Ton B16. Window for 28 2500 1 1 25000 0 0 0 25000 25000 1.5.C (Running Blood 0 Banks) POL for Vaccine B16. Delivery From 0 0 0 0 0 0 0 1.5.E State to District and to PHC/CHC

Procurement of B.16. Equipment: MH 0 0 0 0 0 0 0 1.1 (Labour Room) Procurement of B.16. Bed, ANC 0 0 0 0 0 0 0 1.1A Instrument and ARI Timer B Procurement of 16.1. Equipment : CH 0 0 0 0 0 0 0 2 (SCNU- NBCC) Procurement of B Drugs and 0 0 0 0 0 0 0 16.2 Supplies Drugs & Supplies B16. for MH 0 0 0 0 0 0 0 2.1

Parental Iron Sucrose (IV/IM) As Therapeutic B16. 5000 Measure to 1 1 500000 0 0 0 500000 500000 2.1.A Pregnant Women 00 with Severe Anaemia 5 IFA Tablets for 3 53 53 53 21 B.16. 1061 1061 1061 1061 Pregnant & 0 06 06 06 22 20 4245320 135271 2.1.B 320 340 320 340 Lactating Mothers 6 7 6 7 66 6 B16. Drugs & Supplies 0 0 0 0 0 0 0 2.2 for CH 1 Budget for IFA 1 Small Tablets and 11 11 11 46 B.16. 6 7859 7859 7859 7859 Syrup for 69 69 69 78 6.72 3143629 420844 2.2.A 9 04 11 11 04 Children (6 -59 51 51 50 02 Months) 5 0 2 10 B16. 5 25 25 25 6250 6250 6250 6250 IMNCI Drug Kit 00 250 2500000 1440000 2.2.B 0 00 00 00 00 00 00 00 0 0 B16. Drugs & Supplies 0 0 0 0 0 0 0 2.3 for FP B16. Supplies for IMEP 0 0 0 0 0 0 0 2.4

General Drugs & 4 B16. 41 2085 Supplies for 1 50000 0 0 0 20850000 14841100 2.5 7 0000 Health Facilities 7

Regional Drugs Warehouses (PROMIS to Be B.17 Established and 0 0 0 0 0 0 0 Implemented in District Drug Warehouse)

New Initiatives/ Strategic Interventions (As Per State Health Policy)/ Innovation/ Projects (Telemedicine, B.18 Hepatitis, Mental 0 0 0 0 0 0 0 Health, Nutrition Programme for Pregnant Women, Neonatal) NRHM Helpline) As Per Need (Block/ District Action Plans)

Health Insurance B_19 0 0 0 0 0 0 0 Scheme Research, Studies, Analysis (Research Study to Be Conducted B.20 on Assessment of 0 0 0 0 0 0 0 New Initiative Taken for Enhancing R.I. Coverage) State Level Health B_21 Resource 0 0 0 0 0 0 0 Centre(SHSRC) B_22 Support Services 0 0 0 0 0 0 0 Support B.22. Strengthening 0 0 0 0 0 0 0 1 NPCB Support Strengthening B.22. Midwifery 0 0 0 0 0 0 0 2 Services Under Medical Services Support B.22. Strengthening 0 0 0 0 0 0 0 3 NVBDCP Support B.22. 1 3060 Strengthening 17 18000 0 0 0 306000 234000 4 RNTCP 7 00 Contingency B.22. Support to Govt. 0 0 0 0 0 0 0 5 Dispensaries Other NDCP B.22. Support 0 0 0 0 0 0 0 6 Programmes Other Expenditures B_23 0 0 0 0 0 0 0 (Power Backup, Convergence 26

Etc)-

Payment of B.23. 5000 Monthly Bill to 1 1 500000 0 0 0 500000 280630 A 00 BSNL Mission Flexible B 0 0 0 0 0 0 Pool Total 0 0 0 0 0 1192647018 Routine C Immunisation & 0 0 0 0 0 0 PP Routine C.1 0 0 0 0 0 0 Immunisation Mobility Support 1800 C.1.a for Supervision 1 1 180000 0 0 0 180000 for DIO 00 C.1b Review Meetings 0 0 0 0 0 0 Printing & dissemination of 1 Imm formats,tally 2 12 sheets,monitorin 3 6810 C.1.c 38 5 0 0 0 681049 g formats forms 8 49 27 etc(@Rs 5/-per 2 beneficiaries)+10 7 %extra Out reach C.1.d 0 0 0 0 0 0 services Qtrly Review meeting exclusive for RI at district level with 1000 1000 1000 1000 C.1.e 1 1 1 1 4 10000 40000 MOIC,CDPO & 0 0 0 0 other stake holders @Rs 100/participants Qtrly Review meeting exclusive for RI at block level 2 11 @Rs50/-PP as 9 29 29 29 2223 2223 2223 2223 C.1.f 86 75 889500 travel for ASHA & 6 65 65 65 75 75 75 75 0 Rs 25 per 5 persons for meeting expenses Focus on slum & underserved areas in urban 2500 C.1.g 1 1 250000 0 0 0 250000 areas/Alternate 00 Vaccinator for slums Mobilization of 8 35 Children through 8 88 88 88 1779 1779 1779 1779 C.1.h 58 200 7116000 ASHA under 9 95 95 95 000 000 000 000 0 Muskan Ek 5 27

Abhiyaan

Alternate Vaccine 6 60 60 60 24 6000 6000 6000 6000 C.1.i delivery in hard to 0 100 240000 0 0 0 00 0 0 0 0 reach areas 0 7 Alternate Vaccine 29 4 74 74 74 3715 3715 3715 3715 C.1.j delivery in Other 72 50 1486200 3 31 31 31 50 50 50 50 areas 4 1 To develop 3 34 3410 C.1.k microplan at sub- 4 100 0 0 0 34100 1 0 centre level 1 For consolidation 1 1700 C.1.l of microplans at 17 1000 0 0 0 17000 block level 7 0 POL for Vaccine C.1. Delivery From 1 1830 17 9000 0 0 0 183000 m State to District 7 00 and to PHC/CHC Consumables for computer including provision for 1 2160 C.1.n 18 12000 0 0 0 216000 internet access 8 00 for RIMs Rs 400 per month per district 1 Red/Black Plastic 2 bags etc 12 C.1.o 3 2476 Bleach/Hypchlorit 38 2 0 0 0 247654 & p 8 54 e Solution/twin 27 bucket 2 7 Safety Pits for those PHC/Hospitals 1 1020 C.1.q 17 6000 0 0 0 102000 where there is no 7 00 Pit or is not in working condition Alternate vaccinator hiring for Access Compromised Areas,POL of 1000 C.1.r Generators for 1 1 100000 0 0 0 100000 Cold Chain & for 00 serious AEFI cases investigation for every district Salary of C.2A 0 0 0 0 0 0 contractual staff

Computer Assistants support for District level @Rs 1320 C.2.b 1 1 132000 0 0 0 132000 10000/-per person 00 per month for one computer assistant District level orientation training including Hep- 1000 C.3.a 1 1 1000000 0 0 0 1000000 B,Measles,JE for 000 2 days ANM,MHW,LHV & Other staffs Training under 2500 2500 2500 2500 C.3.b 1 1 1 1 4 25000 100000 immunization 0 0 0 0 One day cold chain handlers 1 8500 8500 C.3.d training for block 17 34 5000 0 0 170000 level cold chain 7 0 0 handlers One day cold chain handlers 1 3400 3400 C.3.e training for block 17 34 2000 0 0 68000 7 0 0 level data handlers Cold Chain 2 2400 C.4 20 12000 0 0 0 240000 Maintenance 0 00 Vaccine van 4000 C.4a 1 1 40000 0 0 0 40000 repairing 0 c5 ASHA Incentive 0 0 0 0 0 0 6050 6050 6050 6050 c6 Pulse Polio 3 3 3 3 12 2016883 24202596 See deatil in Annexure 649 649 649 649 Total 0 0 0 0 0 37735099

D IDD 0 0 0 0 0 0

Establishment of D.1 0 0 0 0 0 0 IDD Control Cell D.1. Technical Officer 0 0 0 0 0 0 A D.1. Statistical Officer 0 0 0 0 0 0 B / Staffs D.1. LDC Typist 0 0 0 0 0 0 C Establishment of D.2 IDD Monitoring 0 0 0 0 0 0 Lab D.2. Lab Technician 0 0 0 0 0 0 A D.2. Lab Assistant 0 0 0 0 0 0 B

IEC/ BCC Health Education and 5400 D.3 1 1 54000 0 0 0 54000 see detail in annexure Publicity 0

IDD Surveys/Re- D.4 0 0 0 0 0 0 Surveys Supply of Salt D.5 Testing Kit (Form 0 0 0 0 0 0 of Kind Grant) D DD 0 0 0 0 0 0

Total 0 0 0 0 0 54000

E IDSP 0 0 0 0 0 0 4950 4950 4950 4950 E.1 Operational Cost 3 3 3 3 12 16500 198000 0 0 0 0 3750 3750 3750 3750 E.1.1 Mobility Support 3 3 3 3 12 12500 150000 0 0 0 0 E.1.1 1500 1500 1500 1500 Office Expense 3 3 3 3 12 5000 60000 .1 0 0 0 0 ASHA incentives E.1.1 3 12 for Outbreak 30 30 30 100 3000 3000 3000 3000 12000 .2 0 0 reporting Collection & E.1.1 transportation of 1 1 1 1 4 2500 2500 2500 2500 2500 10000 .3 samples 1000 E.1.2 Lab Consumables 1 1 100000 0 0 0 100000 00 E.1.3 Review Meetings 1 1 1 1 4 5000 5000 5000 5000 5000 20000

E.1.4 Field Visits 0 0 0 0 0 0 Formats and E.1.5 1 1 1 1 4 2500 2500 2500 2500 2500 10000 Reports Human E.2 0 0 0 0 0 0 Resources Remuneration of 4320 E.2.1 1 1 432000 0 0 0 432000 Epidemiologists 00

Remuneration of E.2.2 0 0 0 0 0 0 Microbiologists

Remuneration of E.2.3 0 0 0 0 0 0 Entomologists Consultant- 1800 E.3 1 1 180000 0 0 0 180000 Finance 00 Consultant- E.3.1 0 0 0 0 0 0 Training 1620 E.3.2 Data Managers 1 1 162000 0 0 0 162000 00 Data Entry 1200 E.3.3 1 1 120000 0 0 0 120000 Operators 00 4800 E.3.4 Others 1 1 0 0 0 48000 0 E.4 Procurements 0 0 0 0 0 0 30

Procurement - E.4.1 0 0 0 0 0 0 Equipments Procurement - E.4.2 0 0 0 0 0 0 Drugs & Supplies Innovations E.5 0 0 0 0 0 0 /PPP/NGOs IEC-BCC E.6 0 0 0 0 0 0 Activities Financial Aids to E.7 Medical 0 0 0 0 0 0 Institutions 1000 E.8 Training 1 1 100000 0 0 0 100000 00 E IDSP 0 0 0 0 0 0

Total 0 0 0 0 0 1602000 7496 F NVBDCP 1 0 0 0 1 74964865 0 0 0 74964865 See deatil in Annexure 4865 Total 0 0 0 0 0 74964865

1230 G NLEP 1 1 1230115 0 0 0 1230115 115 Total 0 0 0 0 0 1230115 See deatil in Annexure 3404 H NPCB 1 1 34046500 0 0 0 34046500 6500 Total 0 0 0 0 0 34046500 8869 I RNTCP 1 1 8869800 0 0 0 8869800 See deatil in Annexure 800 Total 0 0 0 0 0 8869800

Grand Total 0 0 0 0 0 2190330681

Annexure

DHS Sitamarhi

A.1.1.1 Operationalise FRU

S. No. Activity Physical Target (Unit) Unit Cost Total Amount (in Rs.) Remarks

1 Purchese of Generator of 10 KVA 2 250000 500000

2 Geanerator and Fuel+ POL+ Misc. exp 2 288000 576000 3 Contingency Fund 2 72000 144000 4 Blood Donation Camp 2 120000 240000 Total 1460000 730000

A.1.3.2 VHND S. No. Activity Physical Target Unit Cost Total Amount (in Rs.) Remarks 1 District level meeting 1 2500 2500 ANM participation in Microplanning and 2 500 200 100000 Capacity building for 2 days @ Rs. 100 AWW participation in Microplanning and 3 2968 200 593600 Capacity building for 2 days @ Rs. 100 ASHA participation in Microplanning and 4 2965 200 593000 Capacity building for 2 days @ Rs. 100 VHSC-PRI member participation in 5 Microplanning and Capacity building for 2 273 200 54600 days @ Rs. 100 POL for monitoring VHSND site for MOIC, 6 85 9600 816000 CDPO, BCM, BHM, PHED Er. @ Rs. 100 Total 2159700 539925

DHS Sitamarhi

A.2.6 Nutrition Rehabilitation Center S. Physical Total Cost per Total Cost/Month Total Amount Activity Unit Cost Remarks No. Target Batch (in Rs.) (in Rs.) (in Rs.) 1 Running Cost Will be Those medicine which are not 1.1 Medicines provided by available should be procurred by the govt DHS

1.2 Incentive to Mobilizer 20 100 2000 4000 ASHA/AWW will work as mobilizer

1.3 Food for child 420 70 29400 42000 1.4 Food for Mother 420 70 29400 42000 1.5 Loss of wages to mother 420 100 42000 63000 1.6 Transportation cost to bring Children 20 125 2500 5000 Will be given to ASHA/AWW 1.7 Transportation cost after 21 days 20 125 2500 2500 Will be given to ASHA/AWW Will be given to mother to bring 1.8 Transportation cost for Follow up visit 80 100 8000 12000 the child to NRC 1.9 Fuel and Generator 15000 15000 1.10 Miscellaneous 16000 1.11 Paediatrician-1 1 35000 35000 35000 1.12 A- Grade Staff Nurse-3 3 20000 60000 60000 1.13 CBC Extender-1 1 9500 9500 9500 1.14 Feeding Demonstrator-2 2 9000 18000 18000 1.15 Caretaker-3 3 3800 11400 11400 1.16 Cook-2 2 3800 7600 7600 1.17 security Guard-3 3 3800 11400 11400 1.18 Sweeper/Cleaner-2 2 3300 6600 6600 Total 361000 4332000 2 Training Training of ANMs and Local Supervisors 2.1 2 10000 on NRC of 2 focused block Training of ASHA/AWW of 2 focussed 2.2 2 60000 block 3 Annual Maintanance cost (one Time) 1 103535 Grand Total 4505535 1

A.2.6.1 Childhood Diarrehea Management Programme Physical Unit Cost Total Cost Sl.No. Name of Activity Target (Rs.) (Rs.) 1 Procurement 1.1 Zinc Sulphate Suspension (20mg/5 ml-100 ml bottle) 4,09,328 5.58 22,84,050.2 1.2 ORS Packet 8,18,657 2.29 18,74,725 Sub Total 41,58,775 2 Refresher Training Refresher training of ANMs (384) at block level ( @ Rs. 200 /per participant which includes 2.1 384 200 76,800 TA (Rs.100) & Food ( Rs.75),Stationaries (Rs.25) (Writing pad, pen & folder) Refresher training of ASHAs (2965) & AWWs (2567) at block level ( @ Rs. 200 /per 2.2 participant which includes TA (Rs.100) & Food ( Rs.75), Stationeries (Rs.25) (Writing pad, 5532 200 11,06,400 pen & folder) Refresher training of BCMs (17) at district level ( @ Rs. 250 /per participant which 2.3 17 250 4,250 includes TA (Rs.150) & Food ( Rs.75),Stationaries (Rs.25) (Writing pad, pen & folder) Refresher training of Data Entry Operators (28) at district level ( @ Rs. 250 /per participant 2.4 which includes TA (Rs.150) & Food ( Rs.75), Stationaries (Rs.25) (Writing pad, pen & 20 250 5,000 folder) 2.5 Design & Print training module for ANM (384), ASHA (2965), AWW (2565) 5914 40 2,36,560 Sub Total 14,29,010 3 Recording & Reporting 3.1 Design & Print Registers for HSCs (213), ASHAs(2965), AWWs (2565) 5743 20 1,14,860 Design & Print Reporting forms for Sadar Hospital (1), PHC (17), APHCs (37),HSCs (213), 3.2 5585 20 1,11,700 ASHAs (2965, AWWs (2565) Sub Total 2,26,560 4 Mobility Support 4.1 Hiring Vehicle for transportation of Zinc syrup and ORS from the district to PHCs 17 3000 51,000 Hiring vehicle for visit by DCM to blocks and field for monitoring supportive supervision 4.2 48 1000 48,000 visits undertaken by BCM(@4 visits/month) Sub Total 99,000 5 Review Meeting 2

TA to BCMs to attend the monthly review meeting at the district level (@Rs.150/- per 5.1 204 150 30,600 BCM per month)

Provision of refreshment (working lunch) for monthly review meeting of BCMs at district 5.2 204 100 20,400 level including logistics arrangements like hiring chairs etc.(@ Rs.100/- per BCM)

Sub Total 51,000 6 BCC and Social Mobilization activities Design and print poster on Zinc-ORS for Sadar Hospital (1), PHC(17), APHC (37), HSCs (213) 6.1 2833 25 70,825 & AWCs (2565) 6.2 Design and Print Display Board for Sadar Hospital (1), PHC(17), APHC (37), HSCs (213) 268 300 80,400 Wall Painting (4*4)(@ 2 numbers in HSC catchment villages)(213HSC*2=426)(@Rs.12 per 6.3 426 192 81,792 sqft) Design & Print Inter Personal communication Tool kit for HSC (213), ASHA (2965), AWW 6.4 5743 50 2,87,150 (2565) Design & Print Compliance Cards for 5,22,030 diarrheal cases which would be distributed 6.5 409328 1 409328 to the care givers through ASHA, AWW, ANM, APHC, PHC, Sadar Hospital. Sub Total 9,29,495 7 Celebration of ORS-Zinc Week/Day at District and Block levels Rallies and other mobilization activities at block PHCs (20) and district (1) (Drawing, prize, 7.1 18 10000 180000 banners, refreshment for rally, poster competition) Sub Total 180000 Grand Total 70,73,840

A.2.7 Vitamin A Biannual Round S. No. Activity Physical Target Unit Cost Total Amount (in Rs.) Remarks 1 Meeting of District Coordination Committee 2 2500 5000 2 Meeting of Block Coordination Committee 36 1000 36000 3 Orientation of ANM/AWW/ASHA 6068 25 151700 4 Monitoring support for ASHA as additional site worker 792 300 237600 5 Monitoring support for ASHA Facilitator for additional site 79 400 31680 6 Monitoring by district official 2 3000 6000 7 Monitoring by Block official 36 500 18000 8 Fund requirement for Vitamin A bottles 12010 44.32 532283 9 Marker pen 6444 18.5 119214 Total 1137477

A.7.2 PNDT Activities S. No. Activity Physical Target Unit Cost Total Amount (in Rs.) Remarks 1 District level meeting 4 25000 100000 Quaterly Meeting 2 Honorarium of Data Entry Operator 1 96000 96000 One time expenditure Minimum 2 visit per 3 Mobility support for field visit 24 5000 120000 month Cost of establishment of PNDT Cell 4 (including Computer, Hard Disk, Printer, 1 100000 100000 Recurring expenditure Scanner, Fax, Internet, Furniture) 5 Contingency (paper, internet and others 12 5000 60000 Total 476000

A.9.10.1 Stregthening Nursing School, Sitamarhi S. No. Activity Physical Target Unit Cost Total Amount (in Rs.) Remarks 1 Junior Sister Tutor 3 246000 738000 2 PHN 4 246000 984000 3 Data Entry Operator 1 120000 120000 4 Class -IV 3 96000 288000 5 Contingency (paper, internet and others) 1 18000 18000

6 Demonstartion 1 843000 843000 7 Audio/Video Lab 1 334000 334000 8 Library 1 150000 150000 Construction and Rennovation of Nursing 9 1 50000000 50000000 School and Hostel Total 53475000

A.10.2.1 District Programme Management Unit S. No. Activity Physical Target Per month Unit Cost Total Amount (in Rs.) Remarks 10% increment from last 1 District Programme Manager 1 42858 514298 514298 year 10% increment from last 2 District Accounts Manager 1 35937 431244 431244 year 10% increment from last 3 District M&E Officer 1 29948 359370 359370 year 10% increment from last 4 District Planning Coordinator 1 24200 290400 290400 year 10% increment from last 5 Recurring Expenditure 1 93500 1122000 1122000 year Total 2717312

A.10.3 Block Programme Management Unit S. No. Activity Physical Target Per month Unit Cost Total Amount (in Rs.) Remarks 1 Block Health Manager 1 23958 287496 287496 10% increment from last year 2 Block Accountant 1 15972 191664 191664 10% increment from last year 3 Recurring Expenditure 3.1 Mobility Expenses 1 16500 198000 198000 10% increment from last year 3.2 Office Expenses 1 11000 132000 132000 10% increment from last year Total 809160

B.1.1.1 Training of ASHA S. No. Activity Physical Target Unit Cost No. of Days Total Amount (in Rs.) Remarks 1 ASHA Compensation 30 100 6 18000 2 ASHA food, Accomodation, Venue 37 150 6 33300 3 TA ASHA 32 100 1 3200 4 Honoraruim for Trainers 3 350 6 6300 5 TA for Trainers 3 150 1 450 6 ASHA Facilitator 2 150 6 1800 Total 63050 7 Miscellaneous 10% 6305 Grand Total 69355 2312 Unit Cost Per ASHA per batch = Rs. 2312

B.1.1.1.1 Training of ASHA Facilitator 1 Batch (30 ASHA Facilitator) for Module 5,6 & 7 (1st Round) S. No. Activity Physical Target Unit Cost No. of Days Total Amount (in Rs.) Remarks 1 ASHA Facilitator Compensation 30 150 8 36000 2 ASHA Facilitator food, Accomodation, Venue 35 150 8 42000 3 TA ASHA Facilitator 30 100 1 3000 4 Honoraruim for Trainers 3 350 8 8400 5 TA for Trainers 3 150 1 450 Total 89850 6 Miscellaneous 10% 8985 Grand Total 98835 Unit Cost Per ASHA Facilitator Round-1 = Rs. 3295

B.1.1.1.2 Training of ASHA Facilitator 1 Batch (30 ASHA Facilitator) for Module 5,6 & 7 Round 2,3 & 4 S. No. Activity Physical Target Unit Cost No. of Days Total Amount (in Rs.) Remarks 1 ASHA Facilitator Compensation 30 150 6 27000 2 ASHA Facilitator food, Accomodation, Venue 35 150 6 31500

3 TA ASHA Facilitator 30 100 1 3000 4 Honoraruim for Trainers 3 350 6 6300 5 TA for Trainers 3 150 1 450 Total 68250 6 Miscellaneous 10% 6825 Grand Total 75075 Unit Cost Per ASHA Facilitator Round-2,3 & 4 = Rs. 2503

B.1.1.5 ASHA Resource Center, Sitamarhi Budget for the year 2012-13 Strategies Activity Budget Total Total Sl. S.No. Physical Target Rate Amount Amount Remarks No. (in Rs.) (in lakh) 1.1 Salary of DCM 1 290400 290400 2.90 1.2 Salary of DDA(ASHA) 1 198000 198000 1.98 1.3 Accounts Manager 1 150000 150000 1.50 1.4 Data entry operator 1 120000 120000 1.20 1.5 Peon 1 96000 96000 0.96 1.6 Office expense:- Asha Resource 1.6.1 Office Rent 12 5000 60000 0.60 centre/ 1.6.2 Office setup (one time) 1 150000 150000 1.50 1 Asha mentoring 1.6.3 Stationary & Misc.(Include Mobile phone & internet bill) 12 10000 120000 1.20 group at District 1.6.4 Mobility Support for DCM & DDA(ASHA) 12 18000 216000 2.16 level 1.6.5 Laptop for DCM & DDA(ASHA) for one time 2 35000 70000 0.70 1.6.6 Purchase of Mobile Phone for DCM & DDA (ASHA) 2 5000 10000 0.10 1.6.7 ASHA Sammelan for one time 1 500000 500000 5.00 1.7 Capacity Building for District level ARC staff 2 50000 100000 1.00 1.8 Capacity Building for Block level ARC staff 5 25000 125000 1.25 1.9 Capacity Building for ASHA Facilitator 34 10000 340000 3.40 Sub Total A 2057000 20.57 7

2.1 Salary of BCM 17 174240 2962080 29.62 2.2 Salary of Block Accountant 17 144000 2448000 24.48 2.3 Salary of office Assistant 17 96000 1632000 16.32 2.5 Incentive for ASHA Facilitator 150 36000 5400000 54.00 2.6 Office expense:- Asha Resource 2.6.1 Office Rent 17 36000 612000 6.12 centre/ 2.6.2 Office setup (one time) 17 50000 850000 8.50 2 Asha mentoring 2.6.3 Stationary & Misc.(Include Mobile phone & internet bill) 17 72000 1224000 12.24 group at Block 2.6.4 Mobility Support for BCM 17 180000 3060000 30.60 level 2.6.5 Laptop for BCM for one time 17 30000 510000 5.10 2.6.6 Purchase of Mobile Phone for BCM (One time) 17 3000 51000 0.51 2.6.7 ASHA Saree & others 5930 1000 5930000 59.30 2.6.8 CUG Mobile with Sim for ASHA 2965 1500 4447500 44.48 2.6.9 Mobile Recharge for ASHA 2965 1200 3558000 35.58 Sub Total B 29126580 291.27 Grand Total (A+B) 31183580 311.84

B.7 District Action Plan S. No. Activity Physical Target Unit Cost Total Amount (in Rs.) Remarks 1 Workshop for DPIP 2 25000 50000 2 Preperation of DPIP at district level 1 50000 50000 3 Preperation of BHAP 17 10000 170000 4 Preperation of HSC Plan 341 5000 1705000 5 Coputer Assistant at district Level 1 96000 96000 6 Laptop Purchase for DPC 1 35000 35000 7 Mobile recharge for DPC 1 6000 6000 8 Furniture 1 50000 50000 9 Contingency 12 5000 60000 Total 2222000 8

B.10.1 BCC/IEC Activity S. No. Activity Physical Target Unit Cost Total Amount (in Rs.) Remarks 1 BCC/IEC Consultant 1 240000 240000 For 56 APHC, 17 PHC, 2 Referrals and 1 2 Hoardings 76 25000 1900000 Sadar Hospital 3 Wall Painting 846 10000 8460000 For 846 Revenue Village For 56 APHC, 17 PHC, 2 Referrals and 1 4 Sign Board 76 5000 380000 Sadar Hospital 5 Contingency 12 5000 60000 Total 11040000

B.14.A SABLA S. No. Activity Physical Target Unit Cost Total Amount (in Rs.) Remarks 1 District Level Orientation 1.1 TA for 1 MOIC/CDPO per PHC 34 200 6800 1.2 Refreshment 34 50 1700 1.3 Stationery 34 50 1700 1.4 Contingency 1 1000 1000 Sub Total 11200 2 Block Level Orientation 2.1 TA for MO/BHM/BCM/ANM/AWW/ASHA 6518 50 325900 2.2 Refreshment 6518 40 260720 2.3 Stationery 6518 25 162950 2.4 Contingency 1 500 500 Sub Total 750070 Grand Total 761270

C.6 Pulse Polio Total Amount Total Amount (in S. No. Activity Physical Target Unit Cost (in Rs.) for 1 Remarks Rs.) for 12 round round Incentive Money to vaccinator (H-H) 1 6976 100 697600 8371200 team (working days) 1057*6+10%=6976.2 Incentive Money to vaccinator transit 2 1240 100 124000 1488000 team (working days) 188*6+10%=1240 Incentive Money to vaccinator Mobile 3 284 100 28400 340800 team (working days) 43*6+10%=283.8 Incentive Money to vaccinator One 4 85 100 8500 102000 Man team (working days) Incentive to Supervisor (Working 5 2300 100 230000 2760000 Days) 6 POL for Supervisor (working days0 2300 100 230000 2760000 Incentive to Cold Chain Hander per 7 102 100 10200 122400 Sub- Depot Hiring Vehicle for District and Sub- 8 71 5000 355000 4260000 Depot 9 Ice Pack for Vaccinator/Supervisor 29437 4 117748 1412976 6976(V)*4+384(S)*4=29437.33333333333 10 Ice pack for Sub Depot 12240 4 48960 587520 102*6*20=12240 11 Ice pack for DHQ 1 3000 3000 36000 Logistics supply for Team and 12 1967 25 49175 590100 Supervisor 13 IEC and Social Mobilization 26 1000 26000 312000 14 Contingency for DHQ 1 5000 5000 60000 15 Contingency for PHC 17 2500 42500 510000 Per diem for Cold Chain Handler at 16 18 100 1800 21600 PHC and DHQ 17 Hiring Vehicle at District 1 5000 5000 60000 18 Hiring vehicle at PHC 17 2000 34000 408000 Total 2016883 24202596 2016883

D.3 BCC/IEC Health education and Publicity S. No. Activity Physical Target Unit Cost Total Amount (in Rs.) Remarks 1 Orientation of AWW/ASHA 17 2000 34000 2 Meeting at district level 2 10000 20000 Total 54000

National Vector Borne Disease Control Programme Proposed Budget for the Year 2012-13, Sitamarhi

During Spray Period (IRS operational Cost, intensive spray for 2 round ,120 days(4 months):-

HEADS Unit cost Total Amount in Rs. 1 Wages For FW & SFW(Intensive spray) For 191 squads x 2 round 16846200 2 Office expenses for (@Rs 250 /per squad) @ Rs. 250 x191 x 2 round 95500 3 Contingency for Dist.( @Rs 250 / per squad) @ Rs. 250 x 191 x 2 round 95500 4 Dist. Mobility for CS Vehicles @ Rs. 10,000 x 2 months x 2 rounds 40,000 5 Dist. Mobility for ACMO Vehicle @ Rs. 10,000 x 2 months x 2 rounds 40,000 6 Mobility for DMO and VBD Consultant vehicle. @ Rs.20,000 x 2months x 2 rounds 80,000 7 Mobility For PHCs MOs @Rs.650/day X120 days X 17 1326000 8 Transportation of DDT (including loading and unloading) Dist. To PHCs 17 x @ Rs. 2000 x 2 round 68000 @Rs 2000/per affected PHCs 9 Transportation of DDT( including loading and unloading) PHCs to Villages 17 x@1500 X 2 round 51000 @Rs 1500/per affected PHCs 10 Repair of equipments @ Rs150/per squad @150 x 191 x 2 round 114600 11 Purchase of Nozzle tips @ Rs 800/squad (Rs 40 x 16 nozzles tips x 8 weeks) @Rs 800 x 191 x 2 round 152800 12 DA for supervision of IRS @ Rs 2000/per affected PHCs 17 x @ Rs. 2000 x 2 rounds 68000 13 POL for KTS motorcycle@ Rs100/per day @Rs 100 x 60 days x 6 KTS= 72000 14 IEC @ Rs 3000/per PHCs @Rs3000 x 17 x 2 round 102000 15 Evening Debriefing DHQ @Rs 200 x 120days 24000 16 Evening Debriefing PHCs @Rs 150 x 120days x 17 306000 TOTAL GROSS 19481600

Budget during non spray period

HEADS Unit cost Total Amount in Rs. 1 2 Office expenses. @ Rs 5000/per months(8 months) 8 X Rs.5000/- 40000 3 Hiring of ware house for DDT storage @ Rs 5000/per months for 12 months 12 X Rs. 5000/- 60000 4 Kala Azar search programme@ Rs 750/PHC x 8 months 17 X 8 months X @Rs.750/- 102000 5 IEC visibility during search programme @ Rs 750/PHCs @Rs.750/- X 17 12750 6 Miking during kala azar camp @ Rs 500 per camp/PHCs x 8 months @ Rs. 500/- X 17 X 8 CAMP 68000 7 For refreshment @ Rs 250 per camp/Per PHCs x 8 months @ Rs.250/-per camp X 8 X 17 34000

8 For camp Box @ Rs 1000/Per PHCs 17 X Rs 1000/- 17000 10 Mobility for DMO and VBD Consultant vehicle.@ Rs 20000/per month during 8 X Rs 20000/- 160000 non spray period 11 Loss Of Wages to KA patients @ Rs 100/per day/30 days/per case for 1500 1500 X @Rs. 3000/- 4500000 Cases 12 Incentive to ASHA @ Rs 200/per case for1500 Cases 1500 X @Rs 200/- 300000 13 Food supplement for KA patients @ Rs 35/- per patient/day x 45 days x total 1500 X @Rs 35/- X 45 days 2362500 patients 14 Ampho-B storage at Dist. Level @ Rs 500 x 12 months 12 X Rs 500/- 6000 15 Mobile phones for DMO, VBD Consultant and other KA concerning staffs @ 10 X Rs.5000/- 50000 Rs 5000 x 10 nos. 16 For strengthening of office Computer, printer, Photo copier ,UPS etc. 200000 17 IEC @ Rs 5000 /per PHCs 17 X Rs 5000/- 85000 18 Treatment card @Rs 5.00/treatment card for 2 cards per case.+ 20% extra 3300 X @Rs 5/- 16500 19 Registers for (line listing ,loss of wages, ASHA Records, Drug records)@ Rs @ Rs.50/- X 90 Reg.(17 PHCs + 22 reg for D.HQ) 4500 50.00/ register-4 registers / PHC)and 20 registers for District 20 Training to MOs, BCM(ASHA)& paramedical in the district 500000 21 Training of ASHA @ Rs 2000/-per batch(50 participants in each batch) @Rs 2000 x46 batch(2300 ASHA) 92000 22 Training of spray workers @ Rs 2000/-per batch(50 participants in each batch) @Rs2000/- X 50 batch 100000 23 VBD Consultant salary @ Rs 40,000 x 12 months @Rs.40000/-per month 480000 24 KTS salary @ Rs 12500 x 6 x 12 months @Rs.12500/-per month 900000 25 DEO salary @ Rs 7500 x 12 months @ Rs.7500/- per month 90000 26 FLA salary @ Rs 9000 x 12 months @Rs.9000/-per month 108000 27 Short funding by State(LOWs head) Rs.3614000=00( up to Nov.11) +Rs426000=00(284 cases 4040000 projected from Dec.11 to mar.11) 28 Short funding by State(ASHA Incentive head) @Rs200/-per pts. x 1000 pts 200000 29 Short funding by State (DDT Store)17/12/2009 to Mar-12(Committed @ Rs5000/-/month 137742 Expenditure) 30 IRS committed expenditure of 4 PHCs 414941 Total 15080933 Budget for curative measures of kala azar Budget for Preventive measures of kala azar 2012- Committed expenditure during financial year 2011-12 with short funding Grand Total 2012-2013 2013 by state. Rs. Rs.10288250=00 Rs. 19481600=00 Rs.4792683=0012 Rs. 34562533=00

Budget for MDA 2012-13

District Name: Sitamarhi Budget in Rs. Short funding by SHSB for MDA(Filaria) Prog. District Coordination Meeting(Two Meeting) 20000 IEC(for DHQ) 50,000 Publicity campaign 40000 Handbills and hoarding for BCC 50000 Training for MO 60,000 Training for Para medical staff 70,000 Line Listing 50,000 Night Blood survey 20,000 POL 50.000 Honorarium of Supervisors @145/- x 1078 156310 Training of Supervisors@145/- x 1078 156310 Training of Drug Distributors@118/- x 11447 1350746 Honorarium of Drug Distributors@118/-x 11447 1350746 Office expenses 60000 Incentive for hydrocele operation (Target 1000 pts.) @Rs1500/- 1500000 Short funding by SHSB for MDA (Filaria)Prog. (Committed expenditure) 740687 Total 5724799 Grand Total

Budget for Malaria control Programme:

District Name-Sitamarhi Total Amount in Rs. Remarks

IEC Materials for PHCs @Rs.5000 x 17 PHCs= 85000

For Malaria Month 30000

Grand Total 115000

National Leprosy Elimination Programme proposed budget for the year 2012-13, Sitamarhi Total Amount S.No. S.No. Activity (in Rs.) 1 Rural 1 1. One Day Training of Trained M.O. 24050 2 2. Training of New Entrance M.O. 24750 3 3. Sensitization of AWW/ ASHA 364000 4 4. School Quiz 85000 5 5. PRI Meeting 68000 6 6. Incentive of ASHA 93500 7 7. Training of Supervisor 12640 Rural Total 671940 2 Urban 1 1. One Day Training of Trained M.O. 6925 2 2. Training of New Entrance M.O. 11950 3 3. Sensitization of IMA Members 5000 4 4. Training of AWW/ NGO Volunteers 17000 5 5. School Quiz 5000 6 6. Leprosy Awareness 6000 7 7. Incentive 7000 8 8. Health Mela 5000 9 9. Slide 1000 10 10. Cable 5000 11 11. Leprosy Day Rally 10000 12 12. Hand Bill 10000 Urban Total 89875 3 District Level Expenses 1 1. Remuneration of Driver 295000 2 2. Honorarium for A/C 4800 3 3. Audit fee 6000 4 4. Rent/Tel/P&T/Elec./Misc 18000 5 5. Stationary 14000 6 6. Vehicle Operation 75000 7 7. Supportive Medicine 25000 8 8. Lab Reagent 12000 9 9. Patient Welfare 6000 10 10. D.P.M.R 12500 District Level Expenses Total 468300 Grand Total 1230115

Remarks: Lack of fund 2 (Two) Contractual Driver‟s remuneration Rs. 187,000 (One Lack Eighty Seven Thousnd) are pending. 14

National Programme for Control of Blindness Annexure 1 IEC CAMPAIGN: PROPOSED BUDGET FOR IEC ACTIVIYIES DURING 2012-2013 Sl. No. IEC Materials Tentative Quantity Estimated Cost (Rs) 1 Hand Bill (For eye) 70000 35000 2 Hand Bill ( For children) 70000 35000 3 Leaflet 35000 52000 4 Poster 35000 140000 5 Banner 200 80000 6 Hoarding & Hanging 20 240000 7 Tin Plate Poster & wall Painting 100 96000 8 Doordarhan Telecast, scroll for TV channel,slogan & broadcasting in Radio channels 85000 9 IEC Activities:- 150000 1. Eye donation fornight. 19 2. World sight day. 19 200000 3. World glaucoma day. 19 100000 TOTAL 1213500

Annexure B Grant in Aid other components- 1 Recurring GIA for Eye Donation 2 Vision Center 150000 3 Eye Bank 2500000 4 Eye Donation Center 1500000 5 Non-recurring Grant to NGO for strengthening/ expansion of eye care unit on 1:1 sharing basis 2 @ 30 lakh 3000000 6 Traning of Ophehalmic & support man power 50000 7 IEC - Annex.1 1213000 8 GIA for free cataract Operation for DHS-Blindness Division 1500000 9 GIA for School Eye Screening for DHS-Blindness Division @ 2 lakh per district 500000 10 For eye ward end eye Ots @ Rs 75Lakhs for district 8500000 Support towards salaries of Ophtalmic Man power to State A. Demand for Manpower 7140000 11 1. Demand surgeon in district for dist. @ 35000/- per month 2. Ophthalmic Assistant in district Hospital/PHC @ 15000 per month. 1980000 12 Strengthening/ setting up of Regional Institutes of Ophthalmology(Non Recuring Assistance for pediatrics Ophthalmology). 0 13 Strengthening of medical colleges @ 40 Lakh for Medical Colleges. 0 14 Strengthening of District hospital @ 20 Lakhs For dist. 2500000 15 Grant-in-aid to district Health Societies ( Recurring Assistant) @ 5 lakhs. 700000 16 Back log dues in district (Approx.) NGO payment 800000 17 Non-recurring GIA for maintenance of Ophthalmic equipment @ 5lakhs per unit. 800000 Total 32833000

Revised National Tuberculosis Control Programme Proposed Budget for the year 2012-13, Sitamarhi

Budget estimate for the coming FY 2010- 11 S.No. Category of Expenditure (To be based on the planned activities and expenditure in Section C) 1 Civil works 10,60,500 2 Laboratory materials 4,65,000 3 Honorarium 11,23,000 4 IEC/ Publicity 2,25,000 5 Equipment maintenance 69,000 6 Training 3,61,700 7 Vehicle maintenance 1,50,000 8 Vehicle hiring 5,58,000 9 NGO/PP support 1,68,000 10 Miscellaneous 4,50,000 11 Contractual services 38,79,600 12 Printing 30,000 13 Research and studies 0 14 Medical Colleges 0 15 Procurement –vehicles 2,50,000 16 Procurement – equipment 80,000 TOTAL 88,69,800

Additionality Funds from NRHM-Details of the activities for which Additionality Funds are proposed to be sought.  Rs. 9,95,500 for the major repair of the DTC building for which estimate from PWD Building Dept.  Rs. 2,34,000 for 13 LTs @ the rate of Rs. 1500/month at par with the NRHM LTS  Total Fund under NRHM Additionality is Rs. 12, 29, 500

DHS Sitamarhi