2 March 2009

NRHM PIP 2009-10

Department of Health & Medical Education Government of Jammu & Kashmir

2nd March 2009

PREFACE

Though the State has been rather late in gearing up for effective implementation of the NRHM, there has been a substantial increase in the levels of activities over the past couple of years. The realization that the NRHM provides an excellent mechanism and opportunity to rejuvenate and strengthen the rural health system has grown enormously. This has led to serious thinking about the possible solutions to the bottlenecks being faced in the implementation of the programme. The implementation of NRHM has been affected mainly due to certain key factors such as shortage of doctors (particularly specialists and nurses) especially in rural and remote areas, serious shortages in the availability of infrastructure, non-implementation of JSY, inadequate systems for procurement and rather inadequate community effort. The State has, accordingly, decided to remove these gaps taking full advantage of the NRHM in a focused and effective manner. There has been a realization that payment of meagre emoluments to contractual doctors has been a major reason for non- availability of contractual doctors particularly in rural and difficult areas. It is, therefore, proposed to increase the remuneration of contractual doctors and paramedical staff. Additional financial incentives are also being proposed for doctors (in-service and contractual) working in notified difficult areas. In addition to these measures, the State is contemplating several measures to improve conditions of service of doctors especially those serving in difficult areas. Two years rural service has been made mandatory for the PG entrance examination. 10% seats in the PG courses are reserved for those who have served in rural areas for 5 years. Now, additional financial and non-financial incentives are under consideration. These include better avenues of promotion to the specialists, additional weightage in the PG entrance examination for service in notified difficult areas, linkage of time-bound promotions to service in certain category areas etc. The approach is to

make whatever efforts resources permit to provide doctors in rural and difficult areas. When health services are made available to the people closer to their door-steps in the remote areas of the State, targets under NRHM can be achieved while reducing avoidable load from secondary and tertiary sectors. Needless to emphasize, close and regular monitoring and evaluation of work done as well as referral audits would also be required to enhance accountability.

Simultaneously, we realize the serious gaps in our infrastructure. To explain the present scenario 19 % of CHCs/SDHs, 59 % of PHCs and 89 % of HSCs, are housed either in rented buildings or have insufficient accommodation. The level of health services that are possible to deliver in this situation can be well imagined. A large number of building works have been taken up in the past and the cost of completing these is huge. The State had earlier prepared a project for World Bank funding for providing funds for health infrastructure. Subsequently, the State was advised by the Govt. of India to explore the possibility of accommodating this requirement under NRHM. The State has prepared a comprehensive proposal for infrastructure development. This includes requirement for much needed equipments. The State will, however, provide for the creation of staff positions as required. Resources need to be provided in adequate measure for this purpose. The focus will be on completing on-going works and filling up critical gaps in the shortest possible time without seeking expansion. Need has also been felt to take urgent steps to reduce the excessive burden on the two main maternity hospitals at Srinagar and Jammu. The State has already proposed construction of two new 400 bedded maternity hospitals at Srinagar and Jammu. The proposal of the State needs to be supported.

The implementation of JSY was stopped in April 2007, although, subsequently only the ASHA component was allowed. Now, it has been realized that this has adversely affected the progress under NRHM. The previous decision has, accordingly, been reviewed and the

implementation of JSY has been resumed with adequate safeguards recently. It is now expected that expenditure under JSY will increase and so will the institutional deliveries.

Another major hindering factor in the past has been inadequate systems of procurement. Procurement through a centralized purchase committee in the Secretariat which was cumbersome and inefficient has been done away with. Procurement has been decentralized to a substantial extent. The state is also contemplating to set up a dedicated Directorate for procurement of medical supplies which will attend to this task on a full time basis, replicating thereby the TNMSC model in a state specific manner.

Lastly, the State could not achieve the desired communitization as envisaged under NRHM. This is chiefly because PRIs are not in place. As such, it has been decided to involve other community based organizations existing in the villages. It is proposed to focus on capacity development of Village Health and Sanitation Committees (VH&SCs) to achieve effective mobilization of community effort. The State will also focus on a State specific IEC strategy which is result oriented.

While the State makes concerted efforts to address the bottlenecks in a focused manner, the necessity for central support and assistance cannot be over-emphasized. Now that the structures are in place and functioning, and specific efforts are being made to remove the bottlenecks, the implementation of NRHM is expected to register substantial improvement in the forthcoming year.

CONTENTS

PREFACE EXECUTIVE SUMMARY PREAMBLE PROGRESS MADE PROPOSED ACTIONS PRIORITIES FOR 2009-10 RESPONSE TO COMMENTS /SUGGESTION BY VARIOUS DIVISION OF MINISTRY 1. SITUATIONAL ANALYSIS- GEOGRAPHIC, DEMOGRAPHIC & SOCIO ECONOMIC HUMAN RESOURCES FOR HEALTH –ISSUES, INTIATIVES HEALTH SYSTEM INFRASTRUCTURE HEALTH SERVICES A RCH-II B. NATIONAL DISEASE CONTROL PROGRAMME C. NRHM INITIATIVES

2. TECHNICAL COMPONENTS PART A- RCH-II PART B- NRHM INITIATIVES PART C- IMMUNIZATION PART D- NATIONAL DISEASE CONTROL PROGRAMME PART E- INTERSECTORAL CONVERGENCE

ANNEXURES A. STATUS OF TRAININGS B. BUDGET SHEETS OF TRAININGS & WORKSHOPS C. BUDGET SHEETS (STATE & DISTRICT DISTRIBUTION)

ABBREVIATIONS

ANC Ante natal Care ANM Auxiliary Nurse and Midwife ASHA Accredited Social Health Activist CHC Community Health Centre CMO Chief Medical Officer

DoHFW Department of Health and Family Welfare DH Block Hospital ENMR Early Neo-natal Mortality Rate EmOC Emergency Obstetric Care EAP Externally Aided Projects FRU First Referral Unit FNGO Field NGO HMIS Health Management Information System HIV Human Immuno-deficiency Virus IPHS Indian Public Health Standards ISM Indian System of Medicine IMNCI Integrated Management of Neo-natal and Childhood Illnesses

JSY Janani Suraksha Yojana IMR Infant Mortality Rate NMR Neo-natal Mortality Rate

MTP Medical Termination of Pregnancy MMR Maternal Mortality Rate MNGO Mother NGO MO Medical Officer MH Maternal Health NNMR Neo-natal Mortality Rate NGO Non-Government Organization NRHM National Rural Health Mission NAMP National Anti Malaria Programme NLEP National Leprosy Eradication Programme NKAP National Kala-Azar Programme NFP National Filaria Programme NIDDP National Iodine Deficiency Disorder Programme

NBCP National Blindness Control Programme OPD Out Patient Department PNMR Primary Neo-natal Mortality Rate PHC Primary Health Centre RH Rural Hospital RCH II Reproductive and Child Health Programme-II RI Routine Immunization RNTCP Revised National Tuberculosis Control Programme SDH Sub-Divisional Hospital SHRC State Health Resource Centre SHSDP II State Health System Development Project-II SRHM State Rural Health Mission

EXECUTIVE SUMMARY The perspective plan for the NRHM aims to revamp the State health system to be more responsive, efficient and effective through a multi-pronged approach. The state plans to strengthen the provision of accessible, affordable, and quality health care to the rural population, especially the vulnerable section as envisaged in the NRHM and other Government Policy Documents. Primary focus would be to effectively operationalize the vast infrastructure available through hiring of doctors and paramedics from modern and AYUSH systems of medicine under NRHM. NRHM in J&K seeks to reduce Maternal Mortality Rate to 100 per 1,00,000 live births, Infant Mortality Rate to 30 per 1000 births and the Total Fertility Rate to 2.1 by the year 2011-2012 in line with the National Goals. Towards this direction, State plans to strengthen the existing health institutions through a number of interventions. 120 PHCs out of 375 will be made functional for 24x7 days services and 57 out of 85 CHCs will be upgraded as FRUS during 2009-10 as per the GOI Guidelines.. Besides, efforts will be continued to strengthen left out PHCs as 24X7 and CHCs as FRUs. This should be possible if our proposals in this regard are agreed to. In addition, it is proposed to strengthen 100 PHCs located in notified remote and difficult areas in an effort to make them effectively operational to provide health care services closer to the door steps of the people living in these areas. A special proposal to effectively operationalize these 100 PHCs in the remote and difficult areas of the State is to appoint on contract one each AYUSH and MBBS doctor in these institutions. There has been a realization that payment of meagre emoluments to contractual doctors has been a major reason for non- availability of contractual doctors particularly in rural and difficult areas. It is, therefore, proposed to increase the remuneration of contractual doctors and paramedical staff. Additional financial incentives are also being proposed for doctors (in-service and contractual) working in notified difficult areas. In addition to these measures, the State is contemplating several measures to improve conditions of service of

doctors especially those serving in difficult areas. Two years rural service has been made mandatory for the PG entrance examination. 10% seats in the PG courses are reserved for those who have served in rural areas for 5 years. Now, additional financial and non-financial incentives are under consideration. These include better avenues of promotion to the specialists, additional weightage in the PG entrance examination for service in notified difficult areas, linkage of time-bound promotions to service in certain category areas etc. The approach is to make whatever efforts resources permit to provide doctors in rural and difficult areas. When health services are made available to the people closer to their door-steps in the remote areas of the State, targets under NRHM can be achieved while reducing avoidable load from secondary and tertiary sectors. Needless to emphasize, close and regular monitoring and evaluation of work done as well as referral audits would also be required to enhance accountability. It is noteworthy that the two Government Medical Colleges at Srinagar and Jammu are being upgraded to level of AIIMS under PMSSY. This is expected to strengthen these colleges and lead to increase in the intake of PG courses. Under the Infrastructure Development Plan a requirement of Rs.340.00 Crores has been projected for 2009-10 so as to facilitate completion of ongoing works and remove critical gaps in infrastructure in a time bound manner. It also provides for construction of two new 400 bedded Maternity Hospitals, one each in the capital cities of Srinagar and Jammu. The projected requirement includes provision for equipments. The State will, however, provide for the manpower requirement. State had earlier submitted a proposal for an External Aided Project to the Government of India for Rs.1051.57 Cr. in the year 2004-05. After various discussions on the subject, State was advised to route the proposal under NRHM. Accordingly, State has submitted Health Infrastructure Development Plan (Phase-I) for Rupees 1105.42 Cr. (2008-12) for release of funds under NRHM. The implementation of JSY was stopped in April 2007, although, subsequently only the ASHA component was allowed. Now, it has

been realized that this has adversely affected the progress under NRHM. The previous decision has, accordingly, been reviewed and the implementation of JSY has been resumed with adequate safeguards recently. It is now expected that expenditure under JSY will increase and so will the institutional deliveries. Autonomy has been given to DHs, CHCs & PHCs through Rogi Kalyan Samitis to improve the quality and range of services. Similarly, additional RKS are proposed in all the existing Allopathic Dispensaries (238) so that these are also brought under the community ownership. This initiative is being taken as State plans to upgrade these Allopathic Dispensaries into PHCs, in line with GOI guidelines. Similarly, as part of strengthening of AYUSH and its mainstreaming RKS are proposed to be established for all the AYUSH facilities viz ISM Hospitals and 418 ISM Dispensaries in the State during 2009-10. It is pertinent to mention here that Unani and Ayurveda are quite popular in the State. We are pleased to inform through SPIP that Department of ISM, as it is called in the State has reported 25 lacs OPD cases having been registered in the last year (ending December 31 st 08). To further strengthen the AYUSH many other initiatives are proposed. Earlier, State had hired one AYUSH Doctor & Pharmacist for every PHC (375) in the State. Having achieved this with great success, we have proposed, one AYUSH doctor along with a pharmacist for all the DHs (14) ,all CHCs/SDHs (85) so that the people get the choice of services according to their desire under one roof. It is felt that while collocation of ISM institutions with the allopathic institutions is a laudable objective, it should not result in the existing facilities getting closed. In addition, one AYUSH doctor and a pharmacist are proposed for the 78 existing mobile medical teams (currently manned by a Pharmacist from health Department) that move along with the Gujjar & Bakarwals(tribes) that move up the mountains during summer and down to the plains in winter. This is a unique initiative to serve the population that does not get the benefits of public health system. In addition, special funds are being provided to procure drugs especially for the Tribals.

AMCHI HEALING is an indigenous System of Medicine in District Leh and some portion of Kargil District which is very popular with the Buddhist population. There are more than 200 Amchis (basic training is of 5 years after 10+2) in Ladakh and several active associations of Amchis. Currently, AMCHIs are successfully treating primary and complex ailments and are fully supplementing the allopathic system of medicine in Ladakh and this system is being strengthened and mainstreamed by providing one AMCHI in all the PHCs, CHCs & DH in that region (Leh & Kargil). This proposal is in line with the Government of India Policy of providing services of Traditional & Modern facilities under one roof and thus it is proposed to integrate practicing AMCHIs with the formal health care system in the best interest of the population and survival of this ancient system of Medicine. Focus would also be given to Multi Skill Training of MOs (only MBBS Doctors) for Basic and Comprehensive Emergency Obstetric Care, Life Saving Anaesthesia and other courses. MOs would be encouraged to be trained in Child Health with special 3 month short course as designed by IAP. IMNCI training to MOs & Health Workers, SBA training to SNs/ANMs/LHVs and, MDP training to senior officers managing the block, district, division etc (in collaboration with Public Health Foundation of India, New Delhi) are envisaged. Training at least 4 MBBS Doctors in Public Health Diploma (short course specially designed course by the GOI) from each Division are planned during 2009-10 so as to develop Public Health Cadre in the State. Provision of funds for AYUSH dispensaries for organising RCH sessions, incentives to community based volunteers for reporting maternal death, provision of additional funds for referral transport, incentives to ASHAs for early registration of pregnant women, integrated RCH camps in underserved areas, strengthening maternal death audits, are specifically proposed. It is also proposed to provide additional ambulances for referral transport. MMUs & AMMUs for reaching out to underserved areas are also proposed.

The Infant Morality Rate (IMR) in J&K has declined from 71/1000 live births in 1988 to 51 in 2008( SRS data). However, current trend in IMR is a cause for alarm and strengthening Child Health would be a natural priority. State proposes establishment of SNCU in all the 14 DHs (old Districts) and Stabilization Units in the FRUs as recommended by UNICEF for improving Neonatal Care. Additional Kits containing Iron Folic acid, liquid and tablets, co-trimaxazole, Zinc, ORS, de-worming tablets and liquid are being provided to AWW & ASHAs. Under Family Planning, male participation is being encouraged, and NSV is being promoted through routine & special camps. Quality of FP services is being ensured through State, Divisional & district level committees. The two Regional Institutes of Health & Family Welfare along with all the ANMTs are being further strengthened through funding under NRHM. We propose to hire additional faculty for these institutions in addition to providing learning & teaching aids, repairs and renovations to improve their performance. Accreditation through QCI is envisaged in this proposal for a few hospitals, from tertiary, secondary & primary care including Departments of Blood Transfusion, Bio-chemistry, Pathology, Microbiology & Radiology from the two GMCs so as to improve the quality of services. Subsequently, more hospitals and other departments would be taken up under this programme. A State wide structure (at state, divisional & district level) of doctors specializing in Quality is proposed to be created for ensuring quality of services with the overall support of Quality Council of India. HRD & Quality Assurance Cell would also be strengthened through recommendations of the QCI. As an innovation State had proposed incentives to the AWW @ Rs. 75/- per day for strengthening the quality of monthly VH&ND. This year we propose to increase this incentive to Rs.100/VH&ND. During VH&ND, special focus would be on Child Health including Nutrition.

Adolescent Reproductive Health was neglected in earlier SPIPs, and in this plan, establishment of two Divisional level Nodal Centres in the two GMCs is proposed. Similarly, 7 District Level Adolescent Clinics are proposed in the first phase. Such clinics would be proposed in all the DHs subsequently. Lady Counsellors, Data Operators and lady doctors have been proposed for these including additional funds so that these can be operationalized as conceived. Adolescent Group orientation and SHG orientation at HSCs is also proposed. Focused IEC material is also proposed for all CHCs (Block) targeting this age group. All schemes of Government of India, under various Departments would be brought under, and interfaced with this programme for better results. Health Department would initiate process for this with ICDS and other Departments. School Health programme is being strengthened with additional support from NRHM. Special focus is on prevention of non- communicable diseases through HRIDAY –SHAN Programme and taking care of Anaemia, especially in the girls. Under Urban Health Programme, two capital cities of Jammu /Srinagar have been provided funds for rent for urban health posts and UH centres. Additional Doctors, ANMs, Link workers have been provided to strengthen these as per the need of these two cities in sync with GOI guidelines. Under Tribal Health additional medicines for mobile clinics, hiring of AYUSH doctor for each mobile unit along with a pharmacist is proposed. 78 Mobile Units are proposed to be strengthened. In addition, one room cum store is being proposed in all the 13 PHCs, 3 CHCs and 1 DH in Leh District and for few facilities in Kargil District. All these facilities would have an AMCHI each, hired on contract @ Rs.10000.00 per month. Each AD/ PHC would be provided drugs worth Rs. 2500. 00 per month, and CHC with drugs worth Rs.5000.00 and DHs @ Rs 20000.00 per month. 21 AMCHIs are proposed to be hired under this scheme. For vulnerable groups, viz SC, ST & BPL population Specific Health activities to reach out to them at the doorstep are being

proposed. For each of these outreach sessions Rs 300 for medicine and Rs 300 for mobility of team for the purpose has been proposed. Procurement process for drugs and equipment, ambulances including MMUs/AMMUs got delayed because of inadequate systems of procurement. Procurement through centralized purchase committee in the Secretariat which was cumbersome and inefficient has been done away with. Procurement has been decentralized to a substantial extent. The state is also contemplating to set up a dedicated Directorate for procurement of medical supplies which will attend to this task on full time basis. MIES is another issue that is being taken seriously. Operationalisation of the HMIS formats has been completed. Data from most of the districts is being provided directly to NHRSC, New Delhi and after some additional trainings, the Districts would Directly log the Data to HMIS Website as desired by GOI. State level, district & Block level nodal officers have been identified. State Data officer is in touch with HMIS Division in the Ministry, In collaboration with NHRSC New Delhi, State Health Society has trained the DPMU and other staff involved in MIES at District, Division & State Levels. To strengthen it further so that all the reporting is done by the Districts directly on the MOHFW, GOI website, trainings of in-service and contractual staff are proposed during 2009-10. In last year’s SPIP, State had proposed Training of 2000 Village Health & Sanitation Committees @ 10 VH&SCs per medical Block for thoroughly orienting them about NRHM. However, this could not be achieved and now State is requesting MOHFW, and reputed NGOs like KARUNA Trust to train Block level NGOs as Trainers for achieving the communitization of the NRHM through Village Health & Sanitation Committees. Intersectoral convergence among different departments and agencies is an integral part of the State PIP and would be strengthened further. MNGO scheme is operational now, and will be further strengthened.

PPP mode by involving private & NGO hospitals, wherever available, for institutional deliveries for women living in urban slums/BPL would be given greater thrust. Currently, 6 hospitals are providing service, under this scheme, 3 each from Kashmir & Jammu Divisions respectively. In a nutshell, the state Health Action Plan 2009-10 seeks to make concerted efforts to remove the bottlenecks faced in the implementation of the NRHM. These efforts are likely to register substantial improvement in the implementation of the programme in the next year facilitating rejuvenation of the Rural Health System. The proposals of the State in the State PIP 2009-10 were discussed in the Sub Group meeting of NPCC on 19 th February 2009. Several valuable suggestions have been received from various Divisions of the Ministry of Health & Family Welfare. Action on many of these suggestions has been taken and appropriate changes in the PIP have been made. During the Sub Group meeting the State was asked to prioritize the proposal down in line with the expected availability of funds i.e.; allocation for 2009-10 and expected unspent balance of 2008-09. Subsequently, the officers of Ministry of Health & Family Welfare conveyed the likely availability of resources from the Government of India resources envelope is expected to be Rs. 107.25 crores. To this, 15% State share, provision for over planning and likely unspent/uncommitted balances as on 01-04-2009 have been added. The total expected availability of resources comes to around Rs. 200 crores. Accordingly, the prioritized proposal has also been prepared. However, it is expected that the Ministry of Health & Family Welfare would approve the proposal in the original PIP and that it would be possible to provide funds for the original PIP when the annual budget is approved by the Parliament. The details regarding the prioritized proposal have been given in a subsequent chapter.

PREAMBLE

Recognizing the importance of Health in the process of economic and social development and improving the quality of life of its citizens, the Government of India has launched the National Rural Health Mission to carry out fundamental corrections necessary in the basic health care delivery system. The Goal of the Mission is to improve the availability of, and access to, quality health care by people, especially those residing in rural areas, and among them more specifically, the poor downtrodden, the women and the children.

The Mission adopts a synergistic approach by relating health to determinants of good health viz. segments of nutrition, sanitation, hygiene and safe drinking water. It also aims at mainstreaming the Indian systems of medicine to augment health care delivery to the common man. The Plan of Action includes increasing public expenditure on health, reducing regional imbalances in health infrastructure, pooling resources, integration of organizational structures, decentralization and district management of health programmes, community participation and ownership of assets, induction of management and financial personnel into district and State health system, and operationalising community health centres into functional hospitals meeting Indian Public Health Standards in each block of the country. It aims at achieving equity in health by reducing IMR, MMR and TFR to a level that is required for sustainable socio- economic development.

INTRODUCTION

Jammu and Kashmir initially had 14 districts namely Srinagar, Kupwara, Baramulla, Budgam, Pulwama, Anantnag, Leh and Kargil in Kashmir Division and Doda, Udhampur Rajouri, Poonch, Jammu and Kathua in Jammu Division. But their number has now been increased to 22 by the Government. The newly added districts in Jammu Division are: Ramban, Kishtwar, Samba and Reasi and in Kashmir Division they are: Ganderbal, Shopian, Kulgam and Bandipora. All the New Districts have the District Societies and NRHM is being implemented through these Societies. Total population of the State was 1,00, 69,917 in 2001.

NRHM VISION & MISSION STATEMENTS • The National Rural Health Mission (2005-12) seeks to provide effective healthcare to rural population throughout the country with special focus on those States, which have weak public health indicators and/or weak infrastructure. • The Mission is an articulation of the commitment of the Government to raise public spending on Health from 0.9% of GDP to 2-3% of GDP. • It aims to undertake architectural corrections of the health system to enable it to effectively handle increased allocations as promised under the National Common Minimum Programme and promote policies that strengthen public health management and service delivery in the country. • The key components include provision of female health activist (ASHA) in each village; a village health plan prepared through a local team headed by the Health, Water & Sanitation Committee of the Gram Panchayat; strengthening of the rural hospitals for effective curative care, made measurable and accountable to the community through Indian Public Health Standards (IPHS), integration of vertical Health & Family Welfare Programmes and Untied Funds for improving service environment and quality of

services, optimal utilization of infrastructure and strengthened delivery of primary healthcare. • It plans to revitalize local health traditions and mainstream AYUSH into the public health system. • It aims at effective integration of health concerns with determinants of health like sanitation & hygiene, nutrition, and safe drinking water through Integrated District Health Action Plans. • It seeks decentralization of programmes at district and blocks levels, and further down. • It addresses inter-State and inter-district health disparities, especially among the States, including unmet needs for public health infrastructure. • It seeks to improve access of rural people, especially poor women and children, to equitable, affordable, accountable and effective primary healthcare with time-bound goals and report publicly on their progress.

THE GOALS & OBJECTIVES OF THE MISSION • Reduction in maternal and infant mortality. • Universal access to public services for food and nutrition, Sanitation and hygiene and universal access to public health care services with emphasis on services addressing women’s and children’s health and universal immunization. • Prevention and control of communicable and non- communicable diseases, including locally endemic diseases. • Access to integrate comprehensive primary health care. • Population stabilization, gender and demographic balance. • Revitalize local health traditions & mainstream AYUSH. • Promotion of healthy life styles.

TO ACHIEVE THESE GOALS AND OBJECTIVES NRHM WILL: • Facilitate increased access and utilization of quality health services by all.

• Forge a partnership between the Central, state and local governments.

• Set up a platform for involving community in the management of Primary Health programmes and infrastructure.

• Provide an opportunity for promoting equity and social justice. • Establish a mechanism to provide flexibility to the states and the community to promote local initiatives.

• Develop a framework for promoting inter-sectoral convergence for Health promotion and disease prevention.

THE EXPECTED OUTCOMES OF THE MISSION IN JAMMU & KASHMIR The NRHM in the State expects to achieve the following health outcomes by 2012: • Reduction in Maternal Mortality Rate to 100 per 100,000 live births.

• Reduction in Infant Mortality Rate from the current level of 51 (SRS 2008) to 30 per 1,000 live births.

• Reduction in Total Fertility rate from the current level of 2.38 (NFHS 2005-06) to 2.1.

• Reduction in communicable & Non communicable Diseases, especially TB, Leprosy, Malaria, Dengue, Blindness and water borne diseases etc.

• Improvement in Adolescent Sexual Reproductive Health through integrated Adolescent’s Friendly Health Services. .

STRATEGIES To achieve the above goals, the following strategies will be used in the State; (a) Core Strategies: • Identifying 2000 village Health & Sanitation Committees and orienting them about NRHM and utilization of grants of Sub centres for their related improvements.

• Strengthening 1907 sub-centres through untied funds operated through joint accounts to enable local planning and action to ensure good quality

Primary Health care available to villagers.

• Operationalization of 57 FRUs and 187, 24X 7 PHCs by 2010.

• Strengthening 120 PHCs and 57 FRUs/ CHCs to Indian Public Health Standards for improved health care.

• Implementing integrated District Health Plans prepared by the District Health Mission

Increasing access to improved healthcare at household level through the female health activist (ASHA), especially to the vulnerable population.

• Strengthening capacities for data collection, assessment and review for evidence based planning, monitoring and supervision through a focussed.

• M&E system

• Introducing Community monitoring and Concurrent Evaluation of the health programmes.

Formulating transparent policies for recruitment, induction and career development of Human Resources for health.

• Developing capacities of the State Health System through the Operationalisation of SHSRC and ASHA Resource centre/ Support system.

• Promoting non-profit sector involvement particularly in under-served areas.

(b) Supplementary Strategies:

• Regulation of Private Sector including the informal rural practitioners to ensure availability of quality service to citizens at reasonable cost.

• Promotion of Public Private Partnerships for achieving public health goals.

• Mainstreaming AYUSH – revitalizing local health traditions.

• Reorienting medical education to support rural health issues including regulation of Medical care and Medical Ethics.

• Effective and viable risk pooling and social health insurance to provide health security to the poor by ensuring accessible, affordable, accountable and good quality hospital care.

• Decentralisation of Health Programme Management to district, block and further down to improve health service delivery specific to local needs.

• Incorporating the Maternal & Child Health along with general Health care services in cities of Jammu & Srinagar as “Urban Health “ amied at providing services to the Urban poor and slum dwellers.

• Strengthening the mobile Medical Units which move to higher reaches (summer) along with tribes ( Gujjars & Bakarwals)

• PHCs in the remote areas which are semi functional due to non availability of staff are being strengthened by way of providing additional AYUSH and allopathic doctor under NRHM

PROGRESS MADE In accordance with the National Rural Health Mission, Jammu & Kashmir State has launched the National Rural Health Mission in the State. It has set up required institutional mechanisms at the State and District levels for implementing the Mission activities. The State has entered into a Memorandum of Understanding with the Central Government to access funds under the NRHM from the centre through mechanism of preparation of a well defined Annual Plan and its approval processes. The State has established a State Programme Management Unit and all 22 Districts have set up Program Management units under RCH II. The State Programme Management Unit has State Programme Manager, Finance Manager, Accounts Manager and a Data Officer. District Programme Manager, District Accounts Officer and a District Data Assistant form the present DPMU team. The Block level Program Units have been established in 109 Blocks through NRHM resources with the support of a Block Accounts Manager. To further strengthen the State Health Society, 4 officers serving in the government have been inducted on deputation. They include, Director Finance & Accounts, State and Divisional Nodal Officers. Divisional level Accounts Manager and Data Managers have been appointed keeping in view the peculiar geographical division of the State. Divisional level strengthening has also been done by providing support staff under NRHM recently. In order to upgrade the health facilities to IPHS, a facility survey has been prepared, based on which the facilities requiring repair, renovations and new constructions have been identified. Now plans are being developed to upgrade these facilities and funds received have been utilised accordingly. 477 Rogi Kalyan Samitis (Hospital management committees) stand registered as per the GOI guidelines. Rogi Kalyan Samitis for DHs, CHCs and PHCs have been provided corpus funds amounting to Rs. 5.00 lacs, Rs 1.00 lac, and Rs. 1.00 lac each respectively. More significantly, these samitis have also been allowed to retain user charges including other revenue generated through sale of OPD Tickets etc for overall development of the facility

as envisaged. 9764 voluntary, Female Accredited Social Health Activists (ASHA) are in place in all the villages and most hamlets of the State who have been trained in Module I & module II. ASHA kits having generic drugs (both Allopathic and AYUSH) have been supplied to ASHAs. However, State needs additional 500 ASHAs to cover all the hamlets because of sporadic distribution of population. To be more effective, there is a need to establish a support system for ASHA training and mentoring. 6745 Village Health and Sanitations Committees have been constituted, and a few of these have been trained. A Website of State Health Society has been hosted (www.jknrhm.com ) and is dynamic to inform the public about developments under the Mission.

The State has completed Facility Surveys. The District Actions Plans for all the 22 districts have been prepared and are being used in the planning process for current SPIP.

J&K State Health Society has just accelerated the pace of implementing the mission in the year 2008-09 and is confident that in 2009-10, it will perform better. Achievements as reported to GOI are as follows:

Statement Showing Funds Received by State Health Society and Expenditure incurred under NRHM

Table: 1

S. No Year Funds Received Expenditure 1 2005-06 2700.57 144.02 2 2006-07 3946.61 954.24 3 2007-08 13525.15 4910.62 4 2008-09 1189.00 5712.45* Total 21361.33 11721.33

*Rs 5712.45 does not include expenditure of Pulse Polio which is Rs 91.29 lacs

Table: - 2

STATUS OF FUNDS UNDER BASE FLEXIPOOL FOR THE YEAR 2008-09 Amount (Rs. In Lakhs)

Activity Amount Released upto Exp. Reported Admissible as Jan.2009 up to Jan.2009 per ROP Maternal Health 287.18 146.78 63.82

JSY 2807.30 1032.00 103.65

Child Health 116.94 13.44 4.02

Family Planning 178.64 53.97 8.64

Sterilization 200 197.00 91.56 Compensation Adolescent 61.45 55.15 10.26 Health

Urban RCH 134.94 104.06 23.00

Tribal RHC 29.20 14.4

Vulnerable 16.80 0.00 Group

BCC/IEC 117.8 22.89 22.89

Procurement 1000.00 0.00

Innovation 275.80 14.00 3.05 /PPP/NGO Infrastructure & 868.00 360.66 302.56 Human Resource Programme 116.82 77.70 110.04 Management

154.39 17.21 22.16 Training TOTAL 6365.26 2109.26 765.65

Table: - 3 STATUS OF FUNDS UNDER NRHM ADDITIONALITIES FOR THE YEAR 2008-09 Amount (Rs. In Lakhs)

Activity Amount Released Exp. Reported up Admissible as upto to Jan.2009 PIP Jan.2009 United Funds 426.95 326.95 292.97 AMG 336.90 281.9 369.03 Corpus fund 570.00 540.00 297.85 ASHA Training 348.65 0.00 47.59 Innovations 210.73 109.65 12.38 Human resources and 1231.20 1217.05 411.13 Management Cost & Contingencies Infrastructure 3850.00 3775.00 3142.00 Development Plan Mobile Health Units 574.00 0.00 0.00 Procurement of 1000.00 0.00 0.00 Ambulance Est of HRD & QA Cell 35.52 0.00 0.00 Telemedicine 7.00 7.00 0.00 MIES 35.00 1.86 0.00 Estab. of Handi cap Centre 55.00 55.00 2.50 at Leh District Action Plan 40.00 15.00 0.00 Procurement of Drug Kits 150.00 0.00 16.29 Bio Medical Waste 50.00 15.00 0.00 Piolting Health Insurance 50.00 3.00 0.00 Concurrent Evaluation 50.00 0.00 0.00 MDP in HMIS 3.60 0.00 0.00 Intersectoral convergence 74.40 4.25 0.00 Upgradation CHC to IPHS 0.00 0.00 42.26 Health Mela 0.00 8.00 32.56 Neonatal care 0.00 0.00 20.68 Strengthening of District 0.00 0.00 159.50

Hospitals Programme Management 26.50 11.08 11.08 TOTAL 9125.45 6370.74 4857.82

Table: - 4

STATUS OF FUNDS UNDER ROUTINE IMMUNISATION FOR THE YEAR 2008-09

Amount (Rs. In Lakhs)

Activity Amount Released Exp. Reported up Admissible as upto to Jan.2009 PIP Jan.2009 Mobility Support for 122.63 24.312 11.65 alternate vaccine delivery Mobilisation of 91.60 171.00 61.47 Children by ASHA, AWW and link workers Expenditure in 12.00 13.20 5.92 Strengthening monitoring & supervision Computer Asstt.to 18.48 15.12 5.26 DIOs Immunisation 22.5 0 0.47 Cards/Immunisation Registers Vehicles for 356.94 35.08 distribution of vaccines in remote areas (for POL) POL & Maintenance 39.60 13.20 0.47 for vaccine delivery 3..74 van at district level 663.75 271.912 91.23 TOTAL( including Pulse Polio Immunisation)

Funds released to other agencies/ Deptts. – 125.31 lacs Procurement of Iron Folic acid Tabs. – 40.00 Lacs Total Releases till Jan. 2009 - 8917.22 lacs Total Expenditure till Jan. 2009 - 5803.71lacs

The provisional UC’s for the F.Y. 2007-08 had been submitted to the GOI vide Letter No. RCH/J&K / NRHM/UC/07-08/10060 dated 19-08.2008 and the audit Report for the F.Y. 2007-08 has also been submitted to GOI on 27-01-2009.

J&K State

National Rural Health Mission

S.No Action Point Status

Administrative Structure of the State ( as per RHS Bullentin-2007 published by RHS Division) 1. Rural Population ( in Lakhs) 12187549

2. Number of Districts 22

3. Number of Sub Division / Talukas

4. Number of Blocks 109

5. Number of Villages 7537

Health Indicators

6. CBR SRS-2007 18.7

7 CDR SRS-2007 5.9

8 IMR SRS-2007 51

9 MMR SRS-2003

10 TFR NFHS-III 2.4

11 Sex Ratio 892

12 Life Expectancy Rate 65.0 M 67.0 F

13. Neo Natal Mortality Rate 39

14. Contractive Prevalence Rate 53%

15. %Unmet Need (NFHS-III) 15%

Institutional Framework of NRHM

16. Number of Meeting 06-07 of State Health Mission held during 07-08 1

08-09

17. Number of Meeting 06-07 of State Health Mission held during 07-08 23

08-09 12

18. Merger of Societies State Level Y/N Yes

Number of Districts Yes

19. Number of Rogi District Hospital (DH) 14 Kalyan Samitis registered CHCs 85

Other than CHC at or above block level but Below District Level PHCs 375

Other Health Facilities above SC than CHC at or above block level but below block level ( may include APHC etc.) Appointment of ASHA / Link Workers ( as certified by training division)

20. 9764 Number of ASHA to be selected 2005-06 2773

2006-07 6727

Number of ASHA 2007-08 264 21 selected during 2008-09 0

Total 9764

2005-06

2006-07 Total Number of Link 2007-08 22 Worker other than ASHA Selected 2008-09

Total

Ist Module 9500

2nd Module 8900 Number of ASHAs & 3rd Module 0 23 Link Worker who received training 4th Module 0

5th Module 0

24. Number of ASHAs in position with drug Kits 9500

25. Total Number of 2006-07 Monthly Village Health & Nutrition 2007-08 48464 Days (VHND) held in the State 2008-09 38677

Total 87141

Infrastructure & Manpower

26. Number of Aanganwadi Centers as per WCD Website 18643

27. Number of Village Constituted 6788 Health & Sanitation Committee (VHSC) Operational Joint Account 4193 (Pradhan & ANM) Sub Centres (SC’s) 28. Number of SC’s ( as per RHS 2007) 29. In Govt. Building (RHS 2007) 654

With One ANM (RHS 2007) 1588 Without ANM (RHS 2007) 376 Number of SCs which are functional With Second ANM 228

Total Contractual ANMs 323 recruited for all levels including SCs 30 Number of SCs 2005-06 1907 which have submitted Utilization 2006-07 1907 Certificate(UCs) for untied Fund 2007-08 1907 released during 2008-09

Primary Health Centres

31 Number of PHCs (as per RHS 2007)

32 At the Start of NRHM 31/3/2005 Total Number of As on 31/3/2008 85 PHCs functioning as 24X& Basis As on Date 96

33 Without a Doctor (RHS 2007) 1 Number of PHCs Where three staff nurses have 9 been posted 34. Other Health Functioning as 24X7as on date Facilities above Sc But Below Block Strengthened with three Staff Nurses Community Health Centres

35. Number of Community Health Centres as per RHS 80 (2007) 36. At the Start of NRHM 31/3/2005 Total Number of As on 31/3/2008 24 CHCs functioning as 24X7 basis As on Date 39

37. Facilities other than Functioning as 24X7as on date CHC at or above block level but below Functioning with three Staff District level Nurses 38. Selected for up gradation to 70 IPHS Facility Survey Completed 70 Number of CHCs Physical Up gradation Started 69

Physical Up Gradation 18 Completed 39. Total number of Required (RHS 2007) 320 specialists at CHCs Sanctioned (RHS 2007) 276

In Position (RHS 2007) 142

Appointed under NRHM 8

40. In position at the start of NRHM 7 Specialist at other level than CHC In position as on Date 58

41. Required at CHC

Sanctioned at CHC Total Number of Staff Nurses (SN) In position at CHC at Start of NRHM Appointed on Contract under 223 including PHCs NRHM at CHCs 42. Number of General Duty Medical Doctors (GDMOs) in 193 position on contract as on date 43. Paramedics in position on contract under NRHM as on 377 including X-ray, Date Lab Tech., OT Tech. 44. Number of District Hospitals 14

45. Number of District Level Health Facilities other than 0 District 46. Number of DHs functioning as FRUs as on Date 14

47. Number of DHs which have been taken up for up 14 gradation under NRHM 48. 14 DH SDH Total number of centers operational CHC and others Level 39 as FRUs as on Date Total 53

49. Number of District As on 31/3/2005 Hospital Working as a FRUs As on 31/3/2008 14

50. Number of SDH As on 31/3/2005 Working as a FRUs As on 31/3/2008

51. Number of CHCs As on 31/3/2005 and others working as FRUs As on 31/3/2008 24

State Programmer Management UNIT, District PMU & Block PMU

52. Programme Management Unit (SPMU) set up at the Yes State Level (Y/N) 53. District Programme Manager 14 (Managerial) is in Position Number of Districts District Accounts Manger 16 where (Accountant) is in Position District Data Manager (MIS) is 17 in Position 54. Block Manager is in Position 83 Number of Blocks where Accountant is in Position 0

55. Number of PHCs where Accountant is in Position 0

Institutional Delivery

56. % of Institutional Deliveries as per NFHS-III

57. 05-6 91234

06-07 113698 Number of 07-08 151144 Institutional Deliveries (in Lakhs) 08-09 106218

Total 462294

58. 05-6

06-07 Number of 07-08 10568 Institutional Deliveries (in Lakhs) 08-09

Total 10568

59. Number of Pvt. Institutions accredited under JSY 6

Decentralized Planning

60 PIP Received 2006-07 (as reported by 2007-08 NRHM Div) 2008-09 YES

61 Number of Districts 06-07 1 which prepared Annual Integrated District Health Action 07-08 22 Plan (IDHAP) under NRHM 08-09

IMMUNISATION

62 Number of Polio 2006 1 Cases during (as per 2007 0 UIP division) 2008 0 63 % of fully immunized NFHS-I children (as per NFHS-II NFHS data) NFHS-III 66.70% 64 Number of children BCG During 1 April, 320383 vaccinated (in ‘000) 2007 to 31 st March, 2008 Since April 08 223738 During last month 22792 DPT3 During 1 April, 299670 2007 to 31 st March, 2008 Since April 08 194627 During last month 23625 Measles During 1 April, 282151 2007 to 31 st March, 2008 Since April 08 183193 During last month 19644 Full During 1 April, 282151 Immunizati 2007 to 31 st on March, 2008 Since April 08 183193 During last month 19644 OTHERS 65 Number of Districts where Mobile Medical Unit (MMU) 2 are 66 Number of Health 2005-06 Melas held during 2006-07 2007-08 1 2008-09 4 67 Number of 2006-07 456 beneficiaries of Male 200708 1499 Sterilizations during 2008-09 1097 68 Number of 2006-07 18826 beneficiaries of 2007-08 19969

Female Sterilizations 2008-09 8662 during 69 Number of cases prosecuted under PNDT Act till date 0 70 Number of cases in which action has been taken under 0 PNDT 71 Number of districts where IMNCI is implemented 8 72 Total number of people trained on IMNCI as on date 75 73 Total number of districts covered by MNGOs 12 74 Total number of as on 31-03-2005 1 MNGOs in the State As on 31-03-2008 13 As on date 12 75 Number of Patients DH 2006-07 451826 seen in OPD (‘000) 2007-08 1152618 During last 116240 month Since Apr 08 1128309 CHC 2006-07 773219 2007-08 1936298 During last 379866 month Since Apr 08 1969303 Other than 2006-07 197587 CHC at or 2007-08 25055 During last 12693 month Since Apr 08 192514 PHC 2006-07 213917 2007-08 1244506 During last 167554 month Since Apr 08 1497158 Other health 2006-07 28046 facilities 2007-08 40746 above During last 2498 month Since Apr 08 18299 76 Number of Patients DH 2006-07 29219 admitted (in ‘000) 2007-08 71876 During last 6625 month Since Apr 08 61080 CHC 2006-07 28294 2007-08 122960 During last 9241 month Since Apr 08 130919 Other than 2006-07 0 CHC at or 2007-08 0

above block During last 0 month Since Apr 08 5688 PHC 2006-07 4993 2007-08 31125 During last 1470 month Since Apr 08 34100 Other health 2006-07 0 facilities 2007-08 0 above SC During last 0 month Since Apr 08 0 Ayurveda Yoga Unani Siddha Homeopathy (AYUSH) 77 AYUSH components included in NRHM PIP Yes 78 Whether AYUSH Health Society Yes person included in State Health Mission Yes (Y/N) Rogi Kalyan Samities Yes ASHA Trainings Yes 79 Number where DH AYUSH facilities is CHC available as on date Other than CHC at or above block PHC 319 Other health facility at or above SC Total 319 80 Number of Doctors 319 contractual appointment under Paramedical Staff 238 AYUSH Financial Matters

FINANCIAL MANAGEMENT UNDER NRHM (Rs. In Crore)

81 Allocation in State Amount in Rs Budget for Health & Family Welfare % of total State Budget Department Amount in Rs

% of total State Budget Amount in Rs

% of total State Budget

Amount in Rs % of total State Budget

FINANCIAL MANAGEMENT UNDER NRHM (Rs. in Crore)(as per data by division) 82. Allocation by 2005-06 GoI under 2006-07 Items Immunization 2007-08 5.21 subsumed 2008-09 within NRHM Total 2005-06 2006-07 RCH JSY 2007-08 2008-09 Total 2005-06 2006-07 RCH Flexi -Pool 2007-08 13.22 2008-09 Total 2005-06 2006-07 IPPI (Pulse Polio) 2007-08 2008-09 Total 2005-06 2006-07 NRHM Flexipool 2007-08 24.08 2008-09 Total 2005-06 2006-07 NVBDCP 2007-08 0.186 2008-09 Total 2005-06 2006-07 NLEP 2007-08 0.5752 2008-09 Total 2005-06 2006-07 RNTCP 2007-08 2.2793 2008-09 Total 2005-06 2006-07 NIDDCP 2007-08 2008-09 Total NPCB 2005-06 2006-07

2007-08 1.69 2008-09 Total 2005-06 2006-07 IDSP 2007-08 1.21 2008-09 Total 2005-06 2006-07 Total State Wise Allocation under 2007-08 NRHM 2008-09 Total 2005-06 2006-07 Others at Central Level 2007-08 2008-09 Total 2005-06 2006-07 Total Allocation 2007-08 2008-09 Total 83 Amount of PIP 2005-06 sent by the 2006-07 State to GOI Immunization 2007-08 3.44 for items 2008-09 12.674 subsumed Total RCH within NRHM 2005-06 RCH 2006-07 Flexipool(Including 2007-08 46.08 JSY) 2008-09 66.4292 Total 2005-06 2006-07 NRHM Flexipool 2007-08 561.29 2008-09 Total 2005-06 2006-07 NVBDCP 2007-08 0.788 2008-09 0.5588 Total 2005-06 2006-07 NLEP 2007-08 2.09 2008-09 0.1107 Total

2005-06 2006-07 RNTCP 2007-08 2008-09 Total 2005-06 2006-07 NIDDCP 2007-08 2008-09 0.215 Total 2005-06 2006-07 NPCB 2007-08 20.6187 2008-09 5.35 Total 2005-06 2006-07 IDSP 2007-08 11.48 2008-09 Total 2005-06 1.1029 84 Amount 2006-07 0.6075 released by Immunization 2007-08 0.7277 GoI under 2008-09 items Total RCH subsumed 2005-06 6.045 within NRHM 2006-07 10.5296 RCH Flexipool 2007-08 9.1938 2008-09 7.62 Total 2005-06 2006-07 IPPI(Pulse Polio) 2007-08 2008-09 Total 2005-06 19.8578 2006-07 28.329 NRHM Flexipool 2007-08 125.33 2008-09 2.21 Total 2005-06 2006-07 IEC 2007-08 2008-09 Total Training 2005-06 2006-07 2007-08

2008-09 Total 2005-06 2006-07 SIP 2007-08 2008-09 Total 2005-06 2006-07 NVBDCP 2007-08 2008-09 Total 2005-06 0.225 2006-07 0.3597 NLEP 2007-08 0.3258 2008-09 0.2676 Total 1.1781 2005-06 2.43 2006-07 1.55 RNTCP 2007-08 2.3 2008-09 1.7 Total 7.98 2005-06 2006-07 NIDDCP 2007-08 2008-09 Total 2005-06 2006-07 NPCB 2007-08 2008-09 Total 2005-06 2006-07 IDSP 2007-08 2008-09 Total 2005-06 2006-07 BOP(Cash & Kind) release to 2007-08 States 2008-09 Total 2005-06 2006-07 Total State wise NRHM 2007-08 Expenditure 2008-09 Total

85 Amount of 2005-06 0.0939 Expenditure 2006-07 0.8079 done by the Immunization 2007-08 0.8786 States under 2008-09 0.3226 items Total RCH subsumed 2005-06 1.2351 within NRHM 2006-07 5.1951 RCH Flexipool 2007-08 10.2118 including JSY 2008-09 4.32 Total 2005-06 2006-07 PPI 2007-08 2008-09 Total 2005-06 0.1112 2006-07 3.5403 NRHM Flexipool 2007-08 35.6214 2008-09 10.5 Total 2005-06 2006-07 NVBDCP 2007-08 2008-09 Total 2005-06 0.3142 2006-07 0.3439 NLEP 2007-08 0.3202 2008-09 0.1643 Total 2005-06 2.46 2006-07 2.03 RNTCP 2007-08 2.36 2008-09 1.61 Total 2005-06 2006-07 NIDDCP 2007-08 2008-09 Total 2005-06 2006-07 IDSP 2007-08 2008-09 Total BOP (Cash & Kind) Expenditure to 2005-06 the States 2006-07 2007-08

2008-09 Total 2005-06 2006-07 Total Statewise NRHM Expenditure 2007-08 2008-09 Total 86 Unspent 2005-06 0.1009 amount 2006-07 0.8086 available with Immunisation 2007-08 0.2225 states out of 2008-09 the funds Total RCH released by 2005-06 4.8099 GoI under 2006-07 10.1444 RCH Flexipool items 2007-08 9.1264 including JSY subsumed 2008-09 within NRHM Total 2005-06 2006-07 IPPI(Pulse Polio) 2007-08 2008-09 Total 2005-06 19.7466 2006-07 44.5353 NRHM Flexipool 2007-08 134.2439 2008-09 Total 2005-06 2006-07 NVBDCP 2007-08 2008-09 Total 2005-06 18.56 2006-07 20.92 NLEP 2007-08 21.93 2008-09 32.52 Total 93.93 2005-06 0.81 2006-07 0.35 RNTCP 2007-08 0.19 2008-09 0.33 Total 1.68 2005-06 2006-07 NIDDCP 2007-08 2008-09 Total NPCB 2005-06

2006-07 2007-08 2008-09 Total 2005-06 2006-07 IDSP 2007-08 2008-09 Total 2005-06 2006-07 Total NRHM Fund 2007-08 2008-09 Total DETAIL FINANCIAL DATA ON NRHM ADDITIONALITIES(Rs. in Crores)(for 2007- 08 & 2008-09 as per State PIP approved amount) Funds released for selection/training of ASHAs 2005-06 1.7188 2006-07 87 2007-08 2008-09 Total Untied Grant 2005-06 1.879 2006-07 SC 2007-08 2008-09 Total 2005-06 2006-07 88 CHC 2007-08 2008-09 Total 2005-06 2006-07 0.835 PHC 2007-08 2008-09 Total Up gradation of CHCs 2005-06 8.4 2006-07 5.6 89 2007-08 2008-09 Total IDHAP 2005-06 0.14 2006-07 90 2007-08 2008-09 Total 91 Drug Procurement 2005-06 5.98 2006-07

2007-08 2008-09 Total Health Mela 2005-06 2006-07 0.48 92 2007-08 2008-09 Total Annual 2005-06 Maintenance 2006-07 Grant CHC 2007-08 2008-09 Total 93 2005-06 2006-07 1.67 PHC 2007-08 2008-09 Total RKS corpus Funds 2005-06 2006-07 94 2007-08 2008-09 Total Village Health & Sanitation Committee Untied Grant 2005-06 2006-07 95 2007-08 2008-09 Total Status of Financial Reporting Financial IV Qtr 2007-08 due on March 08 Yes Management I Qtr 08-09 due on 30 th June 08 Yes 96 Report(FMR) II Qtr 08-09 due on 30 th Sep 08 sent (Y/N) III Qtr 08-09 due on 31 st Dec 08 97 Audited NRHM Yes Utilization RCH Yes Certificates NVBDCP (UCs) for NLEP 2005-06 RNTCP submitted NIDDCP (Y/N) due NBCP dated 31/3/2006 IDSP Audited NRHM Yes Utilization RCH Yes Certificates NVBDCP (UCs) for NLEP 2006-07 RNTCP submitted NIDDCP (Y/N) due NBCP

dated IDSP 31/3/2007 Audited NRHM Yes Utilization RCH Yes Certificates NVBDCP (UCs) for NLEP 2007-08 RNTCP submitted NIDDCP (Y/N) due NBCP dated 31/3/2008 IDSP NATIONAL LEPROSY ERADICATION PROGRAMME(NLEP) as per data by Divisions 98 Prevalence Rate/10,000 0.33 99 Annual New Case Detection Rate/10,000 3.33 Among newly Multi Bacillary% 70.1 detected cases Female% 19.4 100 Child % 0.74 Visible deformity % 2.2 National Programme for Control of Blindness(NPCB) (as per data by divisions) Total Cataract Surgeries(in Lakhs) 2006-07 0.0734 101 2007-08 0.05774 2008-09 0.04721 102 % Achievement 2008-09 103 #intra Ocular Lens(IOL) implanted 4515 104 %IOL Number of School going Screened ( in Lakhs) 0.66172 105 Children Detected with Refractive Errors 0.01794 Provided Free Glasses 0 2005-06 0 2006-07 0 106 Eye/ Cornes Donations in 2007-08 0 2008-09 0 Total 0 National Vector Borne Diseases Control Programme (NVBDCP) 107 Annual Blood Examination Rate for Malaria 394922 108 Annual Parasitic Incidence of Malaria 217 109 Deaths Due to Malaria 1 Cases of Kala Azar 2006 0 110 2007 0 2008 0 Deaths due to Kala Azar 2006 0 111 2007 0 2008 0 Suspected cases of 2006 0 112 Japanese Encephalitis 2007 0 2008 0 113 Deaths due to Suspected 2006 0 Japanese Encephalitis 2007 0

2008 0 Suspected cases of Dengue 2006 0 114 2007 0 2008 0 Deaths due to Dengue 2006 0 115 2007 0 2008 0 No. of Confirmed cases if 2006 0 116 Chikungunya 2007 0 2008 0 National Iodine deficiency Disorder Control Programme (NIDDCP) 117. Number of Districts Surveyed 0 118. Number of Endmeic Districts 0 Total number of samples 2005-06 0 Iodine salts collected 2006-07 0 119 2007-08 21 2008-09 0 Number of Samples of iodized salt found confirmed to the 19 120 Standards Revised National Tuberculosis Control Programme (RNTCP) 121 Annualized new smear positive case detection rate (%) 43.00 122 Success rate of new smear positive patients (in %) 87.00 Integrated Diseases Surveillances Programme (IDSP) State (Y/N) No 123 IDSP Unit Functional at At Number of District 0 124. Number of Persons Trained 4*

PRIORITIES FOR 2009-10

The next year priorities aim at making the health system fully functional with the following activities;

1. Undertake and complete unfinished activities of the last year

2. Complete ongoing construction works in all the facilities on priority through funds for Infrastructure Development.

3. Implement JSY uninterruptedly with adequate safeguards to increase institutional deliveries thereby improving maternal and child health.

4. Operationalize additional, selected facilities through supplementary human resources for health, to be hired at a higher remuneration, provision of special incentives to in-service & contractual manpower for serving in remote/difficult areas, providing specialists on contract for operationalizing FRUs in difficult areas with similar mechanism, strengthening training cells in the Departments of Paediatrics, Gyn & obst and Anaesthesia in the two Government Medical colleges of the State in lieu of the time devoted for regular, round the year Trainings imparted by the Faculty of these Departments.

5. Setup a separate dedicated Directorate of Procurement of Medical supplies which will attend to this task on full time basis, replicating thereby the TNMSC model in state specific manner.

6. Strengthening Integration of AYUSH into public health system at PHC, CHC,DH.

7. Strengthening of the two Regional Institutes, and in ANMTCs .

8. Training and strengthening selected 2000 VH&SCs for Implementation of NRHM activities in villages through support from MOHFW, GOI and NGOs like Karuna Trust, Bangalore

9. Strengthen 1907 sub centres with at least one ANM in place for services and provide them supportive supervision.

10. State has 1907 Health Sub Centres. One ANM is in place in 1755 HSCs. Till date additional ANM has been hired for 212 HSC only. Now our priority is to put in place in other sub centres that are eligible under the GoI guidelines. (Where Male Worker is in place)

11. Operationalize 120 PHCs for 24x7 days services and 57 FRUs, (14 DHs are already providing these services).

12. Special focus on targeted sections (different campaigns for Gujjar Bakarwals, Paharis etc).

13. Strengthening monitoring and supportive system through the strengthening of HRD & QA Cell. 11 part time (doctors/specialists/nurses/HR specialists), for the Districts, for not more than 10 days in a month, would be hired;

14. Enhance accountability through closer and regular monitoring of work done as well as referral audit.

15. Establish health services in tourist and pilgrim areas through internal resources including disease surveillance system and emergency outreach services and transportation.

16. All ASHAs to be Trained in Module III and provided with regular ASHA Kit and an additional Kit to focus on Child Health and ANAEMIA.

17. All AWW to be provided with a special Drug Kit for Child Health (Iron Folic Acid, Zinc, Deworming Tablets/liquid, Co-trimaxzole, tablet & liquid, ORS, etc).

18. Best facilities would be provided financial incentives through RKS (Best in State, Division & District) Different rewards for DH, CHC, PHC & HSCs.

19. Incentive of Rs. 25000, 15000, 10000 and 5000 will be given to specialists at district level, CHC level, MO at PHC level and ANM at SC level respectively for best performance.

20. Provide additional ambulances for referral transport. Also provide MMUs/ AMMUs for better coverage of underserved areas.

21. A system of education and behaviour change communication would be in place with an objective of promoting a healthy life style through State, Division & District Specific campaigns on communicable & non-communicable diseases (hypertension/ Diabetes etc).

22. Formulate State Specific Drug Policy in sync with WHO Guidelines.

23. Campaigns on malnutrition including Anemia, health education and IEC to launch public health campaigns for promoting environmental hygiene, family health, including campaign against use of Tobacco & Alcohol.

24. Special focus on Child Health, School Health including education on non-communicable diseases, Adolescent Reproductive Health Programme, Gender and Equity, Implementation of PNDT Act, Innovations etc.

25. Develop an HR Policy for the Health Department.

26. Increase the quality of effective communication both vertically & horizontally within & with other departments including civil society.

27. Implement an innovative service model in every District to improve service coverage. Special funds would be allocated to each and every District

28. Developing and implementing an integrated BCC/ IEC programme for improving health and health seeking behaviour of the population.

29. Consolidation and strengthening of NRHM/ RCH II implementation in the State through sharing of know-how, periodic reviews, and technical back up support mechanisms and resource allocations.

30. Rejuvenating the health care system through reforms, ie actions that do not require additional resources, (only government orders or documentation)

31. Setting up state level ASHA support/monitoring system and involve them in the activities related to determinants of good health.

32. Strengthening State Health Society through induction of in- services officers.

33. Focused Attention on Chronic Disease Prevention through Health Awareness and Advocacy

34. Undertake health sector reforms to strengthen State Health system.

Table :- 5

TOTAL PROPOSED BUDGET NRHM ( 2009-10)

AMOUNT (RS. IN LAKHS) RCH BASE FLEXIPOOL 7985.38

NRHM ADDITIONALITIES 47467.46

IMMUNIZATION 240.55

NIDDP 20.00

NLEP 156.79

NBCP 344.50

IDSP 375.26

NVBDCP 100.95

RNTCP 752.79

TOTAL 57443.68

PRIORITIES UNDER NRHM (INCORPORATED AFTER SUB GROUP MEETING)

PROPOSALS IN PRIORATISED -SPIP – 2009-10

The State had submitted a comprehensive State PIP for 2009-10. The State had focused only on certain important activities as visualized by the health system as well as those suggested by the Ministry of Health & Family Welfare, Govt. of India from time to time. All initiatives proposed were deliberated and then incorporated in it so as to improve the health services in J&K and achieve NRHM goals.

The emphasis was mainly on completion of ongoing works including provision of equipment in consonance with the Health Infrastructure Development Project proposal submitted separately by the State to the Central Government, improving the availability of doctors and specialists in different hospitals, especially those located in remote and difficult areas, provision of two new 400-bedded Maternity Hospitals, setting up of an Emergency Management Response System and strengthening of procurement system. Special incentives (financial & non-functional) were proposed and budgeted. In addition, remuneration for the contractual staff was proposed to be enhanced from current Rs.8,000/- for doctors to Rs.18,000/- from 2009-10. All major issues related to availability of human resources for health, especially for facilities located in difficult areas were addressed. State had worked hard in planning the PIP, where bottlenecks were identified and many appropriate interventions were budgeted thoughtfully.

The State had considered several important issues and budgeted for support under the PIP. For example, keeping the stagnant IMR in view, State had desired to establish SNCUs in all the 14 District Hospitals with Stabilization Units in FRUs along with other strategies to address the shortcomings in Child Health. Many other proposals were projected for improving the Child Health in the PIP for 2009-10, after discussions with experts, from within and outside the State.

The final PIP, with the proposed budget of Rs.57,433.68 lakhs was presented in the “Sub-Group meeting of NPCC” held with the senior officers of the MOHFW, GOI under the Chairmanship of MD, NRHM on 19th February where many of those present commended the SPIP for addressing all the essential bottlenecks being currently faced by the State. Besides, a number of welcome suggestions were received for further refining and improving the PIP.

The summary of proposal that was submitted before the Sub-Group is as follows:-

NRHM additionalities Rs.474.67 crores RCH Base flexible pool Rs.79.85 crores Immunization Rs.2.40 crores Family Welfare (Treasury Route – Infrastructure Rs.44.81 crores Maintenance)

Disease Control Programmes, (RNTCP, NLEP, Rs.17.50 crores IDSP, NPCB, NVBDCP, NIDDCP)

During the meeting, after the deliberations, State was asked to prioritize the proposal and bring the proposal down, in line with the expected availability of funds, i.e., allocations for 2009-10 + expected unspent balance from 2008-09.

Subsequently, the officers of the Ministry of Health & Family Welfare communicated the likely availability of resources from Government of India under various heads. Taking this into account, expected availability of resources work out as follows:-

DRAFT RESOURCE POOL WISE ALLOCATION FY 2009-10 IN LAKH SN Budget Item Likely GoI o. unspent/unc Resource ommitted Envelope balance on under 1.4.2009 NRHM 1 Infrastructure Direction & Administration 854.36

Maintenance Urban UFWCs 59.48 Family under NRHM Health 0 Welfare Total Services Posts 4172.76 Sub Centre 2,975.28 Training ANM/LHV 247.28 HFWTC 36.36 Trg of 0 MPHW 2 Other FW RCH Flexipool 2006.00 * 3060.00 Schemes NRHM Flexipool 4490.00 ** 2700.00 Total 6260.10 Immunization operating cost 500.10 3 Disease RNTCP 269.92 Control NLEP (incl. Kind grant) 62.00

Programme IDSP ( incl. kind grants 60.62 Total NIDDCP 18.00 577.49 NPCB 100.00 NVBDCP 17.95 ( incl. Kind in grants 4 Total funds available for the FY 09-10 6496.00 10961.35 1 25% increase 2740.33 2 1 15% State Share 2055.00 3 1 Total size of the PIP 22252.68 4

*This includes Rs.1906 Lakhs recently released by the GOI and expected unspent balance of Rs.100 lacs.

** This includes Rs.1810 Lakhs recently released by the GOI and Rs.2680 lakhs (Rs.1700 lakhs with State Health Society and Rs.980 lakhs with District Health Societies) which could be counted as unspent/uncommitted .

This chapter was drafted keeping in view the constraints of resources and also taking into consideration very useful and elaborate comments provided by different Divisions of the Ministry. However, it is expected that the Ministry of Health & Family Welfare would approve the proposal in the original PIP and that it would be possible to provide funds for the original PIP when the annual budget is approved by the Parliament. Prioritization of activities was a difficult and painful task. The State has received very useful comments from various divisions of Govt. of India for incorporation. However, not all the valuable suggestions could be incorporated because of financial constraints. Keeping all this in mind, the prioritized proposal is for Rs.152.74 crores only. This includes the Infrastructure Maintenance under NRHM which the State receives through the Treasury route from Govt. of India.

The summary of proposals after discussions in NPCC meeting held on 2-03- 2009 is as under:

Activity Amount (Rs. in crores) RCH Base flexi pool 42.29 NRHM Additionalities 131.27 Immunization 2.08 NVBDCP (incl. kind grants) 0.18 RNTCP 2.70 NPCB 1.00 NIDDCP 0.18 IDSP (incl. kind grants) 0.60 NLEP (incl. kind grants) 0.62 Direction & Administration 41.72 (Treasury Route – Salary of Family Welfare staff) Total 222.64

Accordingly, keeping the State’s original Programme Implementation Plan unchanged, the prioritized proposal/budget sheets are attached with this chapter. Briefly speaking, the following are some of the important changes resulting from prioritization:-

A. NRHM Additionalities :

i) Initially untied funds and annual maintenance grant including Corpus Funds had been proposed for ISM dispensaries/hospitals also. In the Sub-Group meeting it was said that the Department of AYUSH will be separately providing for this and accordingly this is not being incorporated. However, untied funds and annual maintenance grant for Allopathic Dispensaries stand proposed under NRHM

ii) As required by Govt. of India, the proposal for setting up of ASHA Mentoring Group had been proposed earlier. In view of budget constraints this is being dropped. However, adequate funds, have been propoposed for ASHA Trainings, including monthly meetings at PHCs, ASHA Drug Kits.

iv) Initially, Rs.300 crores were proposed for completion of ongoing works including provision of equipment in consonance with the Health Infrastructure Development Project proposal submitted separately by

the State to the Central Government. This will have to be reduced to Rs.40 crores now in the prioritized proposal. The Additional Secretary to Govt. of India & Mission Director, NRHM said that the Ministry of Health & Family Welfare is separately examining the proposal for funding by the Planning Commission.

v) Previously it was decided to provide Rs.40 crores for taking up the work on two 400-bedded Maternity Hospitals at Srinagar and Jammu. The Managing Director, NRHM said that the Ministry of Health & Family Welfare is separately examining the proposal for funding by the Planning Commission. This is being accordingly dropped from the prioritized PIP.

vi) In the previous proposal it had been proposed to provide 4 MMUs, 8 AMMUs and 25 ambulances. This is being changed to 2 MMUs, 6 AMMUs and 135 ambulances. This includes the 125 ambulances proposed to purchase during 2008-09 which, however, could not be procured. This purchase has only been postponed to 2009-10.

vii) The State had previously proposed expansion of HRD Cell to 22 Consultants. It is now proposed to retain it at the present strength of 11 Consultants.

viii) The State had previously included a small proposal for creating additional Nodes for tele-medicine. In the meantime as advised by the Govt. of India, a separate proposal has been submitted for establishing rural tele-medicine network which is being considered by GOI separately for funding. As such this is not being included now.

ix) Previously the State had proposed certain activities for cold chain maintenance which include construction of two dry rooms each at Divisional Stores and 22 District Headquarters, provision of Store Keeper and procurement of 22 Generators. In light of budgetary constraint and the fact that cold chain is being maintained reasonably well by the present system, this activity is proposed to be deferred.

x) Previously the State had proposed Rs.30 crores for taking steps for establishing Emergency Management Response System. In view of budgetary constraint, this proposal is also being deferred.

xi) Previously the State had proposed to take up Concurrent Evaluation as approved in ROP. In view of budgetary constraint, this proposal is also being deferred

xii) The funds which had been proposed for various activities like trainings, workshops, mobility etc. have been reduced drastically in view of the budgetary constraint.

xiii) The state had previously proposed Accreditation of 6 Hospitals and 10 Departments of Government Medical Colleges, Jammu/Srinagar. Now it is proposed to restrict the Accreditation process to 4 Hospitals.

xiv) Previously, the State had proposed second ANM at each sub-centre. However, Govt. of India has insisted that this can be provided only where a male worker is in position. We do not have many such locations. It is accordingly proposed to reduce the number of second ANMs to 500.

xv) It was previously proposed to provide 4 staff nurses per FRU and 3 staff nurses/ANM per PHC (24x7). The number is now being reduced to 2 staff nurses per FRU and 2 staff nurses/ANMs per PHC (24x7).

xvi) Previously X-ray Technicians were proposed for each 24x7 PHC. This is being dropped now. However, two X-ray Technicians and two OT Technicians per FRU continue to be provided.

xvii) Previously it had been proposed to provide 3 doctors per FRU and 2 doctors per PHC (24x7). Now the number is being restricted to 2 doctors per FRU and 1 doctor per PHC (24x7).

xviii)Previously it had been proposed to hire one additional MBBS doctor and one ISM doctor in 100 PHCs located in difficult areas. In view of budgetary constraint, this is being dropped for 75 PHCs only.

xix) Previously, 16 Gynecologists, Anesthetists & Pediatricians were proposed to be engaged on contract basis @ Rs.40,000/- per month per FRU which are deficient in this regard. The proposal has now been reduced to 10 Specialists of each category.

xx) 4 Specialists of each category (Gynaecologist, Paediatrician, Anaesthetist) have been proposed (2 for each GMC) to strengthen the Medical Colleges to facilitate training programmes under NRHM.

xxi) 10 Specialists (Surgeons, Physicians, Eye specialists, Orthopedician etc), wherever required (in facilities in difficult & remote areas only) are proposed to be hired under NRHM.

xxii) Special incentive to in-service doctors and specialists working in remote areas has been proposed. However, the budget has been reduced in view of the fact that there are a large number of vacancies and it may not be possible to fill up all these vacancies in the notified difficult areas during the year.

xxiii) One additional ISM (Ayurvedic or Unani or Homeopathic doctor) doctor one each has been proposed for 85 CHCs and 14 doctors (Ayurvedic or Unani or Homeopath doctor) district hospitals along with one Dawasaz.

xxiv) One ISM Doctor and Dawasaz has already been provided for each PHC previously. This will be continued and the vacancies will be filled up.

xxv) It is proposed to pay the doctors and paramedical staff engaged by Army under BADP for Mobile Medical Units out of NRHM funds on the revised scales being proposed under NRHM.

xxvi) It is proposed to strengthen State Health Society by providing 4 Facilitators looking after child health & immunization, maternal health, planning and disease control.

xxvii) Previously it had been proposed to set up 14 SNCUs (Special New born Care Units). Each SNCU was proposed to be provided with one Child Specialist, 10 Staff Nurses, 1 Lab. Assistant and 1 Data Operator as per guidelines of Govt. of India. The proposal is being reduced to 2 Special New Born Care Units reducing thereby the human resources component.

B. RCH Flexi pool:

i) The amounts proposed earlier for workshops, training programmes, out-reach sessions, mobility, camps etc. have been now reduced drastically in view of the budget constraints.

ii) The provisions have been continued in respect of providing incentives for reporting maternal death, investigation of maternal deaths, provision of referral transport for pregnant women and incentives to ASHAs for early registration of pregnant women.

iii) Provision for JSY is now being kept at Rs.27.81 crores as per realistic estimates.

iv) It was proposed to provide 39 Stabilization Units in Child Health at FRU level which is now being reduced to 10 Stabilization Units.

v) The provision for Family Planning activity has been slightly reduced keeping in view the realistic/achievable targets for which compensation for sterilization will have to be provided.

vi) There is a proposal to provide 7 Clinics and 2 Nodal Centres at Jammu/Srinagar for Adolescent Reproductive and Sexual Health (ARSH). Each clinic will have a Lady Counselor and Data Entry Operator. Nodal Centres will also have a lady doctor in addition to lady Counselor and Data Entry Operator.

vii) Under Urban RCH certain doctors had been proposed to be engaged for establishment of health centres.

viii) Previously it had been proposed to provide 1 ISM Doctor and 1 Dawasaz for each of the 78 Mobile Centres for Tribals (Gujjar & Bakerwal). In view of budgetary constraint, this is being dropped for the time being.

ix) It has been proposed to engage 21 Amchis in Leh/Kargil districts and provide them with medicines. Construction of one room has also been proposed in 21 institutions. As advised, this activity is being shifted to the head ‘NRHM additionalities’.

x) While working out requirement of procurement of drug kits, availability of drugs under other programmes of the Govt. of India has now been taken into account and the provision has been accordingly reduced. Besides, as advised by the GOI, this activity has been shifted to the head ‘NRHM additionalities’.

xi) Provision for NGO projects has also been reduced keeping in view the limited availability of credible NGOs.

CHAPTER ON

RESPONSE TO COMMENTS /SUGGESTION BY VARIOUS

DIVISION OF MINISTRY

S.No. Comments Response Targets for outcome and intermediate Annexure 3b enclosed with indicators as per Annex 3b of the the SPIP Operating Manual need to be provided.

Progress made during the previous year Enclosed as Annexure with on the continuing strategies needs to be the SPIP provided. JSY The state has budgeted Rs. 3108.20 As per experience of State lakhs under JSY for 20,000 home Health Society, the trend in deliveries, 1,44,000 rural institutional J&K is that only around 60% deliveries, and 38,000 urban institutional pregnant women are deliveries. However, the calculation is accompanied by ASHAs incorrect. Only 84,000 rural institutional when they come for deliveries have been budgeted for ASHA institutional deliveries incentive. The state has under-budgeted this by Rs. 112.00 lakhs. This may be corrected

Provide facility wise break up of JSY Incentive to Mother institutional delivery in 2008-09, i.e. Beneficiaries was stopped in percentage of JSY institutional deliveries J&K for the last 2 years. JSY in SCs, PHCs, CHCs, SDH, DH and has just been resumed in private facilities, and average number of January 2009. The requisite beneficiaries per institution. Further, state information will be reported at needs to strengthen (staffing, equipment, the end of the Quarter i.e. 31- drugs, infrastructure, etc) facilities with a 03-2009 large number of JSY deliveries.

Ensure that the proposed institutional deliveries can be met through increased operationalisation of FRUs and 24/7 All such institutions are being PHCs, and PPP. In particular, match strengthened on priority. facility operationalisation targets with targets for recruitment of specialists and multiskilling of MOs. Use the facility surveys conducted to map the gaps.

Ensure that facilities located in unserved/low performing districts, those Steps on the action have having high demand and requiring been initiated. marginal inputs should be prioritised for operationalisation.

Payment is made at the time of delivery Being followed. through cheque.

Two days stay after delivery is instituted Every effort is made to and newborn care essentials (counselling ensure the Stay. and equipments) are focused upon in the Being followed. PHCs and other facilities

Referral package is as per guidelines Yes

A mechanism for monitoring the quality of Due to resource constraint, services provided in the public facilities as budget of Rs. 103.00 lacs for well the private facilities needs to be administrative cost of JSY for established. The state has budgeted Rs. POL/hiring of Vehicles has 103.00 lakhs for administrative costs of been dropped in the revised JSY for POL/ Hiring of vehicles. State PIP. However all the needs to ensure proper monitoring of the Divisional/District/Block scheme, since this is the first year it is Officers have been directed being fully implemented, and ensure to monitor the JSY as an regular detailed physical and financial essential activity whenever reports on JSY progress to GoI they on tour. Grievance redressal mechanism for JSY The Grievance redressal has been set up at the local level; listing Cells already exist in the of beneficiaries outside the PHC/ CHC, State from Block to the State etc should be instituted for ensuring level. transparency and for facilitating grievance redressal Other Maternal Health strategies There is no progress in FRU operationalisation so far in 2008-09. With During the year 2008-09, 15 the high load on the public facilities, and PHCs have been upgraded JSY being finally implemented, State as FRUs and the total needs to ensure coordinated provision of number of FRUs now is 39 inputs for operationalisation of facilities against 24 at the start of the (infrastructure strengthening, training of year. These have been providers, equipments, and IEC/ BCC). strengthened by way of Additional comments in previous section providing additional under JSY. Infrastructure, Manpower and Equipments. Training provided to the Health Personnel.

While strengthening PHCs for BEmOC Besides providing 24 hrs services, State should ensure the Water Supply and power essential newborn care component is backup, Newborn Care also in place. Corners have been established in the PHCs. Besides one additional

Medical Officer and 2 SN/ANM are being provided to make these 24X7 functional.

State needs to ensure full package of Suggestions will be followed services at VHNDs, regular conduct of holistically sessions, and monitoring of service utilisation. State should update beneficiary/ eligible couple registers (ECR) in April to get the list of potential clients; give cards to clients and track services received at VHNDs and home visits; and match cards with ECR to track left outs.

Training of staff nurses in MTP is not SNs are not being trained to permitted, since they are not allowed to perform MTP but as Team provide MTP services under the MTP Act. member to Assist the Doctor performing MTP (including MVA)

Provide list of FRUs and 24-hour PHCs to be fully operationalised as at March 31, List enclosed as Annexure 2009 and planned for the year 2009-10.

Child Health IMNCI implementation has yet to take place in the State. It is important that the Trainings in IMNCI have been State initiates this important child survival planned during 2009-10 and strategy at the earliest. The State could District Training Centres have consider developing multiple IMNCI been strengthened although training centres so that multiple trainings only one per District. could be carried out at the same time. Adequate pool of trainers at these centres could be planned so that the capacity building could occur at fast pace. The 11 districts planned for the year 2009-10 should have a minimum of two training centres functioning in the district. The District Training Centres (DTC) along with the District Hospital could be strengthened for IMNCI training. This would help faster implementation of IMNCI.

VHNDs is being used many States to All these activities are being being about behaviour change in the covered in the VHNDs. community. The State may consider However emphasis will be using VHNDs to bring about awareness laid on improving the no. among communities and families to regularity and quality of the address sick child, essential new born VHNDs. care (care at birth, early initiation of breast feeding and exclusive breast The percentage of Children feeding, prevention of hypothermia and put to Breast feeding within prevention of infection) etc. State may one hour after birth is likely to plan for operationalising VHNDs for child improve by VHNDs. health on a large scale. NFHS III shows initiation of breast feeding within one hour as only 31.6%. This is low for the State and should be increased. Breast Feeding is evidence based intervention for child survival.

Diarrhoea management to include an integrated strategy for training of providers, counselling of clients, procurement and provision of ORS/ ORT, A strategy to involve not only and treatment. Health Personnel & ASHAs ARI management to include an integrated but Anganwari Workers also strategy for improving health care seeking to counsel and provide and access. treatment ORS/ORT to the Management of Malnutrition is missing in cases of Diarrhoea. the child health interventions. The State could look at including this in the overall strategy. Suggestions has been taken up and the issue incorporated in the convergence (with ICDS) and IEC/BCC School Health National guidelines could be followed for School Health is already in screening, services, and referrals. practice in the State whereby a Doctor alongwith Para Medical Staff visits the school and Screens the children for refractory errors, skin disorders, congenital defects, dental caries, anaemia, worm infestation and any other disability.

Health promoting schools as a pilot is a Considering the high no. of good initiative; state may do process schools in cities of Jammu & documentation for best practices. Srinagar, a Doctor alongwith

LHV has been posted with CMO office for School health activity.

Teacher’s capacity building for screening Detailed document will be continuously could be proposed for a brought out in due course. sustainable model. In J&K state, teachers from primary and middle schools of rural areas have been provided training for 3 months in first aid and management of minor illnesses and they have been designated as Strategy for SHP needs to be worked out, Rehbar-e-Sehat teachers along with a detailed action plan. who also are members of the VH&SC of their respective village. These teacher provide services to the villagers and also assist in school health programme.

Suggestion will be complied. Family Planning Total training Load for all FP Services CTP could not be furnished and the training load for FP Services for alongwith the draft PIP. Now the 09-10 have not been calculated for the CTP with all details is the state even though the trainings have being submitted incorporating been planned for 09-10. trainings in the Family planning excluding training in Mini Lap Sterilization which has not picked up in the State in spite of all efforts by the department.

State may plan and budget for: TOTs for Budgeted except Mini Lap. Laparoscopic Sterilization, Mini Lap & NSV; Mini Lap Training for Service Providers; and NSV Training for MOs. The number of trainings for IUCD for Suggestion excepted and block level trainers at the districts and maximum use will be made of ANMs/LHVs in the blocks may be trainers and the trainees. increased to utilise effectively the trainers trained in high number. State should plan for rational & effective use of all trainers

trained.

ARSH Role/ ToRs for the counsellors may be expanded to cover youth mobilization, Suggestion accepted awareness generation, referral link and other community based activities. Capacity building of the counsellors needs to be planned.

Institutional linkages between RCH II/ The clinics will work in NRHM (through DHS/ RKS) and NACO collaboration with should be specified for management of NACO/SACS under overall the adolescent health clinics. management of Hospitals including RKS.

Strategy for reaching out-of-school youth Suggestion Accepted needs be planned. Local NGOs/ MNGO may be involved.

Proper IEC material should be developed or translated in the local language which can be distributed to the adolescents Suggestion Accepted during school based and community based activities. Relevant resource material should also be made available at the Adolescent Clinics. Urban Health In the State PIP, no explanation regarding status of any survey/mapping exercise Detailed chapter incorporated undertaken has been given. The rationale in the document for proposing 47 Health Posts and 10 Urban Health Centres has not been provided Programme management/ Institutional arrangements Suggestion Accepted PMUs to be trained for oversight of technical programmes.

The state needs to plan for and fast track Not being taken up due to setting up of SHSRC or any other resource constraint. structure with similar functions through appropriate state-specific mechanisms, e.g. outsourcing, linking up with and strengthening an existing institution. Indicate strategy, timelines and costs in the PIP.

IEC/ BCC There is a need to develop an integrated BCC strategy with clearly defined outputs, Suggestion Accepted objectives, implementation plan, manpower etc.

There is a need to rework the BCC component in the PIP ad also make appropriate budget allocations. Most of Suggestion Accepted the components in the budget are either under budgeted or over budgeted.

State should take steps to strengthen the IEC function with expertise in (1) communication planning and monitoring (2) media planning and implementation Suggestion Accepted and (3) monitoring through appropriate combination of (a) engaging consultants (b) outsourcing certain functions to NGOs or communication agencies (c) establishing an expert advisory committee (d) training existing staff.

IEC to be linked to service provision, including awareness about the service Suggestion Accepted and behaviour change. Training State has budgeted for number of trainings with a very ambitious training load. State needs to have a re-look into this and integrate the trainings Comprehensive training strategy and plan

needs to be provided with: (i) estimates of Comprehensive training plan total number of trained staff by skill has been prepared as per category required to reach the outcome format of the National targets and of number of staff trained so Revised training strategy. far/likely to be trained by March 31, 2009 (ii) assess the shortfall in training capacity; and identify steps required to plug the gap including PPP where feasible (iii) put mechanisms in place to ensure that persons to be sent for training are selected from facilities which have high demand and also have full complement of inputs in terms of equipments, infrastructure, etc especially in the case of FRUs and 24x7 PHCs.

Overall Procurement of drugs, drug kits, Comment Accepted equipment kits, and laparoscopes is not permissible under RCH II. These may be budgeted from State budget/ Mission flexi pool.

HRA for contractual staff is not HRA has not been budgeted permissible. Salaries for contractual staff and the highest limit of salary should be within the overall permissible has been kept at Rs. 18000/- limit of Rs. 26000 per month under RCH per month. II.

Incentives on a per case basis are not permissible. There needs to be minimum These incentives/awards are threshold above which incentives should meant for the best be allowed. Incentives should be performance RKS/VHSC consolidated wherever feasible. Clear only, which will reciprocally performance benchmarks for the imbibe competition and incentives as well as monitoring improve performance. mechanisms (e.g. VHSC, RKS, District/ State level authorities, etc.) need to be articulated in the PIP.

Construction is not permissible under Not included RCH II. Repairs/ renovations of existing OTs/ labour rooms for operationalisation of FRUs and 24/7 PHCs may be permitted.

Program management costs to be within Comment Accepted 6% limit.

Activities carried over from 2008-09 Can only be reflected at the should also be reflected in the PIP/work end of financial year i.e. 31- plan and budget for 2009-10. 03-2009

Lump sums There are a number of lump sum amounts, for which details are required. For example:

Baby care corners at /PHC level: Rs. @ Rs. 0.25 lacs per unit for 25.00 lakhs 100 PHCs

Establishment of stabilization unit in 39 FRUs (Equipment + renovation): Rs. As per UNICEF guidelines

117.00 lakhs.

Establishment of SCNUs in all District Hospitals (Old Districts) As per UNICEF guidelines Construction/renovation / Additional alternation and equipments: Rs. 770.00 lakhs.

Establishment of 7 clinics in selected District Hospitals @ Rs. 50000.00 each: Minimum budgeted Rs. 3.50 lakhs.

Save the Girl Child: Rs. 38.00 lakhs. For all the Activities budget has been decreased.

Establishment of PNDT Cell for Legal Minimum budgeted support and Monitoring: Rs. 10.00 lakhs.

Strengthening of system/ process of Minimum budgeted procurement: Rs. 15.00 lakhs.

Tribal RCH services (Medicines for the The budged for the medicines Nomadic groups): Rs. 31.20 lakhs. has been decreased.

Hiring of One Medical Officer (ISM) for Mobile Medical Aid Centres which move Dropped with the migratory tribal population (Gujjar & Bakarwals) twice in a year: Rs. 126.36 lakhs.

Hiring of One Pharmacists/Dawasaz (ISM) for Mobile Medical Aid Centres Dropped which move with the migratory tribal population (Gujjar & Bakarwals) twice in a year: Rs. 49.14 lakhs

1 Room / AMCHIs in 21 institutions (DH- 1; CHC-4; PHCs-16): Rs. 1.26 lakhs.

Honorarium for 21 AMCHI Healers (DH- 1; CHC-4; PHCs-16): Rs. 25.20 lakhs.

Procurement of Medicines for AMCHIs in The budget for the medicines District Hospital (1 No.) @ Rs. 2.40 lacs of AMCHI, their salaries has per annum: Rs. 2.40 lakhs. been reduced considerably. However the activity cannot Procurement of Medicines for AMCHIs in be dropped altogether as CHCs (4 No.) @ Rs. 2.00 lacs per AMCHI is the only indigenous annum: Rs. 8.00 lakhs. system which is popular and

also the only Health Care Procurement of Medicines for AMCHIs in Service available in certain PHCs (16 No.) @ Rs. 1.20 lacs per areas of Ladakh region which annum: Rs. 19.20 lakhs is the largest tribal area in the country. Specific health activities targeting These medicines are local vulnerable communities such as SCs, need specific only and should STs, and BPL populations living in urban be allowed to be procured and rural areas (not covered by Urban locally as per past practice. and Tribal RCH) visits by the Medical Teams from Block HQs. Rs. 300.00 for Medicines: Rs. 5.11 lakhs – procurement of medicines may be budgeted under State budget/ Mission flexi pool. The following drug kits/ equipment kits may be budgeted under State budget/ Mission flexi pool: - Comment Accepted : Procurement of drug kits for DH, PHC, Budget shifted to Mission CHC, FRU: Rs. 1000 lakhs. Flexipool Procurement of MVA Kits having (Canula No. 6,7,8,9): Rs. 13.50 lakhs. Procurement of Laparoscopes: Rs. 176.00 lakhs. Procurement of NSV kits: 20.00 lakhs. Repair/ Maintenance of Laparoscopes: Rs. 6.00 lakhs. Procurement of mannequins for IUD training at district level: Rs. 6.60 lakhs – Comment Accepted, Item have already been supplied by UNFPA Deleted (see comment from Family Planning division in Annex 1). IMMUNIZATION Scope for Improvement

The State may like to do a situation analysis based on the Survey and other Comment Accepted data to identify critical bottlenecks as well as strategies to address these issues.

The State has not planned any session in Planned for Vulnerable rural areas, and all sessions have been Groups residing in far Flung planned in urban areas. and difficult areas.

The State needs to strengthen AEFI Comment Accepted reporting further to improve reporting of AEFI cases.

It is absolutely essential to submit the Comment Accepted:

component-wise expenditure during Component wise expenditure previous years to justify will be submitted hence forth. increase/decrease in demand for funds.

Further there seems to be under- The components have been budgeting since the State has projected incorporated in the budget for 2.4 crores for 09-10 as against the taking into consideration the approved PIP of 6.63 crores last year (08- State specific needs and 09). ground realities.

The PIP for 2009-10 may be re-submitted Complied. with suggested modifications (see Annex 1) as per revised norms in the format provided to the state.

Budget

The state has proposed Rs. 240.55 lakhs for RI in 2009-10, of which Rs. 151.87 Budget revised to 208.30 lakhs is justified budget. PERSPECTIVE PLAN

State should prepare a longer-term perspective plan, with budget for Will be forward achieving RCH II goals.

State should keep outcome indicators for the each year consistent with recent trends & inputs proposed for the year.

NFHS indicators for the state are modest. Low 3 ANCs & full ANC indicates gaps in quality of service provision. State needs Comments Accepted to provide quality & full range of ANC services through the platform of VHND & also upgrade the health facilities like PHC/ CHC/ FRUs etc.

Only 27.3 % mothers in the state consumed IFA tablets (DLHS III), the state may plan intervention to improve supply & uptake of IFA .

To achieve the goals of the reduction for the MMR and also to achieve the national roadmap, it is important that these parameters are improved.

State may please ensure that the plans includes a holistic approach for operationalization which not only looks at infrastructure strengthening , provision of equipment but also training of all cadre of health staff on key training strategies. INDICATORS

There is no improvement in the state in State is upgrading the making FRUs functional vis-à-vis 2008-09 institutions to FRUs. As on as functional FRUs are 53 only. 01-04-2008 24 CHC level and 14 DH (38) existed to which 15 have been added during current year to make it to 39+14.

What is the status of blood storage centres in 53 CHCs/FRUs? Does it also Full fledged Blood banks mean that even their so called functional exist in 14 DH and 2 CHCs. FRUs are not yet functional? The facility of blood storage has been established in the remaining FRUs including training to the blood storage handlers.

To achieve the national target of 70 FRU At the end of 2009-10, 57 for the state holistic, planning for FRUs FRUs would be made should be done linking HR, procurement, functional besides 14 District BSCs, logistics etc. Hospitals totalling to 71 which is at par with the national target of 70.

10 MBBS doctors have been trained in Posted to FRUs LSAS, it is not known if they have been posted to functional FRUs & their services are utilized for tackling complicated deliveries.

All such resources should be utilized for Comment Accepted making the facilities functional.

Funds should also be kept for monitoring Incorporated visits for operationalization of FRUs.

Information about blood bank functional List of registered & functional status & details of expansion of services Blood banks enclosed as may also kindly be provided. Annexure

No details of special incentives, hiring of specialist, incentives to MOs given. Incorporated

Does it mean that doctors are not working No; but to encourage Doctors during emergencies without incentives? for posting in difficult areas and ensuring their stay at the place of posting.

No fund indicated for monitoring quality of Incorporated services.

Accreditation of private health facilities should be as per GoI guidelines. Comment Accepted

Drugs cost to be put under NRHM/ state budget Complied with Cost of physical infrastructure may be kept under infrastructure. AYUSH Doctors & Operationalizing FRU through AYUSH Pharmacists are proposed staff, the state may share outcome of not to operationalize the previous year- can they handle all nature facility but as a strategy of complications to be handled by FRUs. towards main streaming of AYUSH

Comment Accepted Ayush staff are not permitted to use allopathic drugs, nor skilled enough for special procedures like caesarian operation etc. Thus they can be supportive hand to specialists.

Facility Operationalization: 24 * 7 PHCs

The state should provide separate write In the year 2008-09 only 11 up on functional 24*7 PHCs v/s target. PHCs were taken for strengthening to function as The national no. of 24*7 PHCs target set 24X7 PHCs taking the tally to for the set for the state is 187, of which 96 (as on 01-04-2008 24X7

how many are presently functional, is not PHCs = 85). mentioned. The write up is confusing. In the year 2009-10 24 PHCs are proposed to be added to The state may kindly clarify how many this list. This number is short 24*7 PHC it plans to make functional by of national target of 187 but is 2009-10 and also keeping in mind the based on the ground realities already existing 24*7 PHC vis-à-vis the (difficulties). Emphasis is national target. being laid on consolidation rather than expansion. The above also stands to be checked for contractual staff Funds should also be kept for monitoring visits for operationalization of 24*7. Comment accepted

While strengthening PHCs for BEmOC Comment accepted & services, state should ensure that ENBC incorporated component is also in place.

Under operationalization plan for 24* 7 Comment accepted & training PHCs, besides planning for infrastructure, incorporated in the CTP. procurement, drugs/medicines, state has also to plan for training of MOs esp. in Basic Obstetric Care and SNs/LHVs/ANMs in Skilled Birth Attendance.

Drugs should be budgeted under Complied state/NRHM initiative.

Incentives on ‘per case basis’ should be Comment accepted avoided, however the same can be given to a group of service providers i.e. doctor, staff nurses etc. if a particular protocol of the service is maintained for e.g. conducting normal delivery should be linked with 48 hrs stay, EBF and provision of PNC protocols to both the mother and child. Such incentives can be restricted to Rs 200/- to team of providers.

GoI has already prepared a Already in practice in comprehensive HMIS reporting system collaboration with NRHSC which should be utilized for monitoring, duplication of reporting should be avoided.

Duplication of expenditure should be Comment accepted avoided for incentives, procurements, hiring additional staff.

ANC, INC AND PNC

IEC component on Awareness should be budgeted under comprehensive IEC plan.

A separate outreach for ANC & also for home visits for service provision should be avoided.

For provision of the services, platform of VHND for all desired range & quality of services and capacity of PHCs and CHCs be ensured.

State is requested to ensure that post Comments accepted. Out delivery mother should stay for at least 48 Reach sessions not only hours which is quite necessary to provide cover ANC but all possible full range of care. components of MH & CH.

Monitoring during OR sessions should be strengthened so that quality of ANC including IFA tab etc, PNC is ensured.

Tracking of missed out and left out cases of ANC, PNC should be done.

Details of pregnancy tracking needs to be indicated. Integrated RCH camp - details may be provided.

Considering VHND being organized universally, duplication must be avoided in respect to activities like Mobile Medical Units, Outreach RCH camps etc which provide almost same services.

Does the state mean to say that earlier ANC is being provided in all the FRUs were not providing ANC the facilities but has been services? Fixed day clinic is social planned through MMU for the approach but objective of quality ANC areas which are isolated and should be insured. un reached so for and where the nearby Health facility does not exist.

What special incentive to ANM & ASHA is Incentive for ASHA for proposed? Give details of mobilizing early registration of

implementation. ANC cases was proposed in the draft PIP but has been withdrawn on comments of the NPCC. MMU also involves staff like ANM at grass root level. YES Will state will be able to sustain RCH-ll interventions proposed?

Instead of mentioning every strategy in write up, state should choose few & The comment is in conformity implement. However focus should be on with the State policy. operationalization of health facilities.

In proposed drug kit to AWW, - what are the contents, who has approved it, is it beyond ASHA kit? ORS, Albendazole, IFA, Liquid and Tablet Septran, Paracetamol, Zinc and Will the Ayush doctors will carry out dressing material. ANCs through their own way or though allopathic system? Will they be re- AYUSH Doctors have been oriented? involved for main streaming of AYUSH. Drug kit may be budgeted under NRHM

Micro-planning may be linked to JSY Complied.

Already in practice.

Institutional Delivery Including JSY

Micro Birth Planning should be emphasized as a part of JSY.

48 hr stay post delivery; breast feeding & Already in Practice FP counselling should be emphasized especially among JSY beneficiaries.

Micro plan should promote primary and secondary facilities for services to avoid over loading of tertiary care facilities. Comment Accepted

Infrastructural up-gradation is needed to meet the demand generated under JSY

Grievance-redressal mechanism not in Upgrading is ongoing process place. in majority of Health Facilities.

Funds should also be kept monitoring visits. Already in Place

Guidelines on record up-keeping Incorporated (physical and financial) should be disseminated. Comment Accepted

Budget under JSY should be as per JSY norms. Comment Accepted What incentives beyond JSY are proposed for encouraging women? NIL

Safe Abortion Services

Number of facilities providing abortion services in public & private sector may DH – 14 please be indicted. CHC – 70 PHC – 45

State should plan for Comprehensive Abortion services. Comment Accepted

There should be focus on comprehensive abortion services (MVA, EVA, MA) upto Comment Accepted FRU/CHC level and at least MA, MVA at 24*7 PHCs.

Provision of Medical Abortion services Comment Accepted should also be made available at PHCs and FRUs. Made available under the Funds should also be kept for monitoring head HRD cell for monitoring the operationalization of Safe Abortion overall activities Services Comment accepted but State should budget for provision of safe budget constraint abortion services Staff nurses are provided Training of staff nurses for MTP, Who training to assist the doctor permitted? Under the act it is not as a team member and not permitted till now. for conducting MTP

Are trained doctors are being utilized. YES

IEC/BCC should be budgeted under IEC Comment Accepted

head Provision of RTI/STD Services

Training should be as per the GoI guidelines on RTI/STIs. Comments accepted

State has not mentioned strengthening of facilities where it proposes for provision of All the FRUs and 24X7 PHCs RTI/STI services.

Holistic Plan including training of staff, provision of drugs, lab investigations and Comment Accepted convergence with SACS and VTCT is advised for comprehensive RTI/STI services. Incorporated in CTP Funds for strengthening of facilities for RTI/STI services have not been kept.

MATERNAL HEALTH Life Saving Anaesthesia Training

Existing medical colleges should be utilized fully for the trainings

Batches should be initiated & state should ensure that DHs should also be strengthened simultaneously for the Comment Accepted practical part of the training.

State should operationalize the health facilities on priority.

State should undertake regular monitoring both during and post training.

State should ensure that MOs are posted at Facilities which have been operationalized for CEmOC services. Funds should be kept for monitoring during and after training. Batch wise monitoring and supportive supervision plan should be shared. GoI norms should be followed in training. EmOC training

The state has not provided details of training plan. Although Master Trainers are trained. Comment Accepted and Both LSAS & EmOC training should be incorporated in the PIP linked with operationalization of FRUs BEmOC training

The state has not provided details of training plan. BEmOC training is essential for operationalizing 24* 7 PHCs for BEmOC services.

Training institutes at which these training are to be conducted has not to be mentioned and needs strengthening.

Trainings should be conducted as per GoI Comment Accepted and norms of 10 days for MOs & 3 weeks for incorporated in PIP ANMs.

State should undertake regular monitoring both during and post training.

State should ensure that MOs are posted at Facilities which have been operationalized for BEmOC services at 24*7 PHCs.

Budget should be kept for the monitoring of the training. Skilled Birth Attendance training

State is very slow in implementing SBA training. There is a need to take up all the The state is slow in districts immediately for conducting this implementing SBA training training. because of lack of trainers in most of Districts and with a DH should be strengthened as per the view to maintain the quality of protocols of training institute SBA training

State is requested to emphasize that District Hospitals are being training centres follow protocols of SBA strengthened so as to equip training i.e. practice of partograph, all the training centres to AMTSL, ENBC etc. follow the protocols of SBA Training.

State is requested to evaluate the SBA

training in the State. Whether the trained persons are practicing the skills needs to be reviewed and reported.

State should undertake regular Comment Accepted monitoring both during and post training.

Funds for monitoring of the training and HRD cell has been post training follow up should be kept. established at state level and Batch wise monitoring and supportive one monitor has been allotted supervision plan should be shared with 1-2 districts for supervising GoI. /monitoring all activities including SBA training. Besides the CTP (including SBA training) is being share LHV/ANM training is being planned/ with NIHFW. implemented in 15 of the 20 districts. What about the remaining 5 districts. Please read 10 instead of 15, the remaining 12 Districts will be taken up in phased manner. Blood Storage Training

State requested to share the details of current status & proposed Blood Storage The Blood storage training for Training the concerned Health personnel has been tied up This should be linked to establishment of with Deptt of Blood BSCs & operationalization of FRUs transfusion in GMC Srinagar/Jammu & NACO MTP training

Details of the type of the training not indicated, where are the training site, Training is taken for MOs in does the training load matches with MTP and MTP with MVA facilities to be operationalized? technique. Training site is dept. of Gynae/Obst, GMC Jmu/Sgr. Training load is calculated for all CHCs and 50% of PHCs

State is also requested to plan for training Training centre for MTP of MOs in 2nd trimester abortion services including MVA has been (Surgical EVA etc), as these services established in GMC Jammu. should be made available at CHCs/FRUs. Trainers have been trained Also strengthening of facilities should be by FOGSI. The Mos from done for same. FRUs and 24X7 have been

planned to be trained during Training institutes should be strengthened 2009-10. 2 No. as per the GoI protocols. Gynaecologist/ Anesthetics are being proposed for GMC Srinagar/Jammu in lieu of State should undertake regular faculty providing training. monitoring both during and post training.

There should be focus on comprehensive Comment Accepted abortion training (MVA, EVA, MA) upto FRU/CHC level and at least MA, MVA at 24*7 PHCs.

Medical officers from PHCs and FRUs should be given priority on training Explained above Staff nurses should not be trained for MTP as under the act it is not permitted till now.

Referral Transport

There is a need for assured referral Comments accepted linkage both from the beneficiary/ community to the facilities and also between the facilities.

In the strategy for ensuring referral The Ambulances are system, the state has not mentioned any available in all the FRUs and government vehicles/ambulances in the Majority of 24X7 PHCs which mechanism? Are they in place? Is will be first preference for manpower (drivers) in place? It is transportation however suggested that if the above resources are private vehicles will be hired available, they should be mobilized. by the VHSC/RKS wherever ambulances service is not available EMRI model should be evaluated for cost benefit over other models. Comment Accepted

Outsourcing the transport is better way. Comment Accepted The payouts can be fixed on per KM basis. Maternal Death review

The findings of Verbal Autopsy at community level is usually comes to already known causes of maternal deaths. So the focus should be on organizing FGD on maternal and infant

deaths in the village by using the platform Comments Accepted of VHNDs.

State can take up facility based maternal death audit at selected tertiary and secondary health facilities. The result of the same can then be analyzed before scaling up.

The tools of the MDR/IDR may please be shared and should be limited to 2-3 districts as a pilot and cost involved in such pilots vis-à-vis benefits be analyzed before scaling up.

It is suggested that state can take up facility based maternal death audit for those facilities that are functional at tertiary and secondary level.

VHNDs

Since VHNDS is a platform all RCH activities, so state should ensure that all these activities should take place holistically.

It was reflected under last year PIP also but MCH focus is not there and instead only immunization is emphasized.

Funding for VHNDs should be as per GoI Every effort is being made to norms. organize maximum no. of VHNDs focusing on MCH The efforts should be for providing all sanitation, monitoring plan. planned services like ANC, PNC, Immunization and Counselling services as per the GOI guidelines.

Monitoring and ensuring quality in all VHNDs should be done.

Funds for monitoring of VHNDs session should be kept. VHND not captured as integrated service delivery & community mobilization

platform for maternal, child & adolescent health component in PIP. QUALITY ASSURANCE

State is requested to enlarge the scope of QA cells for RCH services including FP QA committees are in place services. at all the District Head quarters. Who are Monitoring QA cell should be established both at the & supervising the quality of level of State and District for all MCH services activities at State and District Level.

TORs of the QA cell communicated to the State should be followed.

QA cell should ensure quality and monitoring of all MCH activities which should also include monitoring of the training.

Miscellaneous: (NRHM flexipool)

Incentive should be linked to performance. Comment accepted in principle.

BUDGET

Budgeting for core MH indicators should

be more.

Budgeting should be as per GoI criteria

and norms, and should not be duplicated.

RCH Drugs/Any other drugs should be

budgeted under State head or under Proposals limited because of NRHM. budget constraint Budget head under each activity for previous years should include both allocation and expenditure.

Incentives to workers/ providers under all components should be given in one table to monitor avoid duplication for same activity.

The state needs to take note of the following The state should undertake: An exercise of finding out the total no. of deliveries at the levels that is SC, PHCs, Comment Accepted CHCs, etc.

The total no. of deliveries in the accredited private institutions must also be mapped.

The state should find out the average load per institution. Comment Accepted An exercise must be done where the state must work backwards from its desired goals to arrive at additions/improvements under various categories for example, number of personnel required, training equipment etc. Being practised State should confirm that the following steps have been taken to strengthen implementation of JSY : Yes Payment is made to the beneficiary at the time of delivery through bearer cheque Yes Referral package is as per guidelines Monitoring of JSY is as per directives of GOI, including verification of a certain percentage of beneficiaries by specific Already in place being officers. strengthened Grievance redressal mechanism for JSY is set up at the local level; listing of beneficiaries outside the PHC/ CHC, etc should be instituted for ensuring transparency and for facilitating grievance redressal. Quality of deliveries at public health Comment Accepted facilities is monitored; private sector facilities are accredited and monitored.

For operationalisation of facilities the PIP should articulate the steps for preparation of micro-plans. These would include: Criteria for prioritisation of facilities for operationalisation. Facilities in underserved areas, those having high Comment Accepted demand and requiring marginal inputs should be prioritised for

operationalisation. Steps to plug the gaps identified in the facility survey. This would also involve putting in place mechanisms to ensure Comment Accepted that persons to be sent for training are selected from the prioritised facilities. State should show how the expected demand for home deliveries through The State is promoting skilled providers would be met. opening of Para Medical Institutes both in Govt. and Pvt. Sector to increase the Provide list of FRUs and 24-hour PHCs to availability of skilled be fully operationalised as at March 31, manpower to meet the future 2009 and planned for the year 2009-10. needs.

Micro Birth Planning should be emphasized as a part of JSY. Tertiary Enclosed facilities are overloaded so micro plan should promote primary and secondary facilities for services

48 hr stay post delivery should be Accepted emphasized especially among JSY beneficiaries.

JSY deliveries should be co-linked with Comment Accepted service provision and facility upgradation and budgeted accordingly.

The state has reported Nil deliveries Comment Accepted under JSY however the expenditure is shown at Rs. 68 Lakhs. This may be The incentive to beneficiaries clarified. However the state has increased which was stopped has been their target from 1.9 Lakhs in FY 2008-09 resumed in January 2009 to 2.02 Lakhs in FY 2009-10. only but incentive to ASHA was continuously being paid. As such Rs. 68.00 lacs has been incurred on payment to ASHA accompanying the mothers.

ANNEX 3 B

INDICATIVE FORMAT FOR CURRENT STATUS AND TARGETS

ANNEX 3b

INDICATIVE FORMAT FOR CURRENT STATUS AND TARGETS

RCH II STATE INDIA GOAL Current status Target Current status Target (specify year & 08-09 09-10 06-07 09-10 source ) MMR 200 301(SRS 01- 200 <100 03)

IMR 40 57 (SRS 2006) 45 <30

TFR 2.2 2.9 (SRS 2005) 2.3 2.1

RCH OUTCOMES Current TARGET Status 08-09 09-10 (year & source ) Maternal Health

1. % of pregnant women receiving full ANC coverage (3 ANC checks, 2 TT injections & 100 IFA Tablets) Overall 74.2 80 SC/ST 2. % of pregnant women age 15-49 who are anaemic Overall 54.0 45.0 SC/ST 3. % of births assisted by a doctor/nurse/LHV/ANM/other health personnel Overall 60.5 70 SC/ST 4. % of institutional births Overall 54.3 65 SC/ST 5. % of mothers who received post partum care from a doctor/ nurse/ LHV/ ANM/ other health personnel within 2 days of delivery for their last birth Overall 48 60 SC/ST Child Health

6. % of neonates who were breastfed within one hour of life Overall 31.9 60 SC/ST 7. % of infants who were breastfed exclusively till 6 months of age Overall 42.3 60 SC/ST 8. % of infants receiving complementary feeds apart from breast feeding at 9 months

RCH OUTCOMES Current TARGET Status 08-09 09-10 (year & source ) Overall 58.3 75 SC/ST 9. % of children 12-23 months of age fully immunized Overall 66.7 80 SC/ST 10. % of children 6-35 months of age who are anaemic Overall 68.1 50 SC/ST 11. % of children under 5 years age who have received all nine doses of Vitamin A Overall 42.0 SC/ST 12. % of children under 3 years age with diarrhoea in the last 2 weeks who received ORS Overall 29.4 SC/ST 13. % of children under 3 years age who are underweight Overall 29.4 15 SC/ST Family Planning

14. Contraceptive prevalence rate (any modern method) Overall 44.9 52.5 SC/ST 15. Contraceptive prevalence rate (limiting methods) Male Sterilization 2.6 4.0 Female Sterilization 26.3 29.0 16. Contraceptive prevalence rate (spacing methods) Oral Pills 4.7 5.7

RCH OUTCOMES Current TARGET Status 08-09 09-10 (year & source ) IUDs 2.7 4.7 Condoms 8.1 9.1 17. Unmet need for spacing methods among eligible couples Overall 6.0 3 SC/ST 18. Unmet need for terminal methods among eligible couples Overall 9.0 4.0 SC/ST

CURREN TARGET (cumulative) b T RCH INTERMEDIATE STATUS 08–09 (quarter-wise) a INDICATORS 09–10 (year, Q1 Q2 Q3 Q4 source) Infrastructure

1. No. and % of PHCs upgraded 96 120 to provide 24X7 RCH services (as per GOI guidelines) 2. No. and % of health facilities upgraded to FRUs, fulfilling the minimal criteria per the FRU guidelines (at least 3 critical criteria) a. District Hospitals 14 14 (All) b. Sub-district/ Civil Hospitals c. CHCs 39 57 d. Block PHCs 3. No. and % of functional Sub- 1755 1907 Centres c 4. No. and % of health facilities that have operationalised IMEP guidelines Human Resources 5. No. and % of ANM positions 1755 1907 filled d 6. No. and % of specialist 71% positions filled at FRUs d Programme Management

7. % of district action plans ready 22 22 Financial Management

8. % of districts reporting quarterly 41 100 financial performance in time Logistics / Procurement

CURREN TARGET (cumulative) b T RCH INTERMEDIATE STATUS 08–09 (quarter-wise) a INDICATORS 09–10 (year, Q1 Q2 Q3 Q4 source) 9. % of district not having at least one month stock of a. Measles vaccine b. OCP NIL 1907 c. EC Pills d. Surgical Gloves 10. % of sub-centres supplied Kit A

and Kit B in the last 6 months Training

11. No. and % of Medical Officers trained in

a. Management of Common 0 Obstetric Complications

b. Life-saving anaesthesia skills 9 16

c. EmOC 48

d. RTI/STI 96

e. Safe Abortion Services 66

f. MTP using other methods 88

g. IMNCI 264

h. Facility Based Newborn care

i. Care of sick children and severe malnutrition

j. NSV 44

k. Laparoscopic sterilisation 66

l. Minilap

m. IUD insertion 80

n. ARSH 100

o. IMEP 90

CURREN TARGET (cumulative) b T RCH INTERMEDIATE STATUS 08–09 (quarter-wise) a INDICATORS 09–10 (year, Q1 Q2 Q3 Q4 source) 12. No. and % Staff trained in SBA

a. ANM

b. LHV 2 30

c. Staff nurse 6 30 13. No. and % Staff trained in RTI/ STI

a. ANM 154

b. LHV 66

c. Staff nurse 264

d. Lab Technician 76 14. No. and % Staff trained in IMNCI

a. ANM 88

b. LHV 44

c. AWW

d. Staff nurse 8 132 15. No. and % of staff nurses trained in Facility Based Newborn Care 16. No. and % of ASHAs trained in Home Based Newborn Care 17. No. and % Staff trained in IUD insertion

a. ANM 40

b. LHV 12 20

c. Staff nurse 30 18. No. and % of staff trained in ARSH

a. ANM 110

b. LHV 55

CURREN TARGET (cumulative) b T RCH INTERMEDIATE STATUS 08–09 (quarter-wise) a INDICATORS 09–10 (year, Q1 Q2 Q3 Q4 source) c. Staff nurse 165

d. Programme Managers 19. No. and % of state and district program managers trained on IMEP 20. No. and % of health personnel 60 who have taken Contraceptive Updates Maternal Health 21. % of ANC registrations in first trimester of pregnancy 22. % of 24 hrs PHCs conducting 80 120 minimum of 10 deliveries/month 23. No. and % of health facilities providing RTI/STI services

a. DHs 14 14 (All)

b. CHCs 85 85

c. PHCs 120 24. No. and % of health facilities providing Safe Abortion services (including MVA/ EVA and medical abortion)

a. DHs Nil 6

b. SDHs Nil

c. CHCs Nil 10

d. PHCs

CURREN TARGET (cumulative) b T RCH INTERMEDIATE STATUS 08–09 (quarter-wise) a INDICATORS 09–10 (year, Q1 Q2 Q3 Q4 source) 25. No. and % of planned Monthly 38677 2,00,0 Village Health and Nutrition ending 00 Days held (even if budgeted Decemb under NRHM Part B) er Child Health 26. No. of districts where IMNCI Nil 11 logistics are supplied regularly 27. No. and % of health facilities Nil with at least one provider trained in Facility Based Newborn Care Family Planning 28. No. and % of health facilities providing Female Sterilization services

a. DHs 14 14 (All)

b. SDHs

c. CHCs 77 85

d. PHCs 25 29. No. and % of health facilities providing Male Sterilization services

a. DHs 14 14

b. SDHs

c. CHCs 77 85

d. PHCs 93 120 30. No. and % of health facilities providing IUD insertion services

a. CHCs 81 85

b. PHCs 345 375

c. Sub centres 1030 1100

CURREN TARGET (cumulative) b T RCH INTERMEDIATE STATUS 08–09 (quarter-wise) a INDICATORS 09–10 (year, Q1 Q2 Q3 Q4 source) 31. No. of accredited private institutions providing:

a. Female sterilisation services 6

b. Male sterilisation services 6

c. IUD insertion services 6 32. % of districts with Quality 6 22 Assurance Committees (QACs) 33. % of district QACs having 2 22 quarterly meetings 34. % of planned Female 8 30 Sterilisation camps held in the quarter 35. % of planned NSV camps held 0 24 in the quarter Adolescent Reproductive and Sexual Health 36. % of ANC registrations in first trimester of pregnancy for women < 19 years of age 37. No. and % of health facilities providing ARSH services

a. FRUs 07

b. CHCs

c. PHCs

d. Others 07 38. No. and % of health facilities with at least one provider trained in ARSH Innovations/PPP/NGO 39. No. of districts covered under 12 14 MNGO scheme 94

CURREN TARGET (cumulative) b T RCH INTERMEDIATE STATUS 08–09 (quarter-wise) a INDICATORS 09–10 (year, Q1 Q2 Q3 Q4 source) 40. No. of MNGO proposals under 6 12 implementation (received funding for planned activities) Monitoring and Evaluation 41. % of districts reporting on the 10 22 new MIES format on time BCC/ IEC 42. No. and % of districts with 22 decentralised BCC/IEC strategy/ plans

*Current status at the end of December 2008

PROGRESS DURING THE YEAR 2008-09 Activity Physical Progress

Maternal Health 15 FRUs made operational during the Year Operationalization of FRUs & PHCs 24X7 2008-09 and total no of FRUs at present are 39 taking the total to 120. 11 PHCs have been made functional as

Operationalization PHC 24X7 24X7 during 2008-09 raising the number of PHCs 24X7 from 85 to 96 This was new activity introduced this year Incentive to ASHA for early registration of to encourage early registration of Pregnant women in first Trimester pregnancy. 3600 ASHAs were benefited.

RCH Outreach Camps 107 Camps organized in unserved areas. This activity was started at the Block Level by providing imprest money to the In- charge Medical Officer where by he/ she is allowed to hire private transportation for Referral Transport referring the Seriously Sick New Born and Sick Pregnant Women to DH/CHCs. 893 cases benefited the provision of Referral transport. The Scheme was stopped by state government for the last two years and JSY resumed w.e.f Jan 2009. However ASHAs Component of incentive was continued.

Child Health 14 New Baby Care Corners established Baby Care Corners during 2008-09 in addition to the existing 89.

Well Baby Shows 202 Baby Shows held at PHC level. 19 District Level Trainers including

Specialists & MOs were trained in IMNCI at New Delhi.

Family Planning NSV – 1295 Laproligation 11854 conducted. NSV is getting focused attention. 35 Sterilization camps organized for Male /

female in J&K. All efforts are being made to increase male participation Adolescent Health 20 Special awareness generation camps were organized. 1 camp per District per Year. 750 Orientation Camps were held at Sub Centers level for Group Orientation among adolescent by staff of Family Welfare 652 Orientation Camps held at Sub Center level whereby social health groups &

Women groups were involved for Counseling.

10 Urban Health Centres and 47 Urban URBAN HEALTH Health Posts have been established in Jammu & Srinagar Cities. 1. 287 Tribal Leaders and teachers trained and provided with Drug kits TRIBAL HEALTH 2. 78 Mobile Health Units manned by Pharmacists provided drug @RS 5000.00 per Quarter through respective Directors of

each division. Theses medical units move along with Tribals when they migrate to higher reaches during summers. Vulnerable Groups 88 Out Reach Sessions Organized by

Medical Officers in the Unserved areas. 6 Private Hospitals accreditated 3 in each Division. Rs 3.00 Lacs per Hospital released for 100 deliveries each. More such institutions are to be roped in

PPP/ NGO 2. 6 MNGOs have been selected during 2008-09 out of which project report of 2 MNGOs approved and financial Aid have been released and 4 MNGOS have completed Base line survey. BCC/IEC Regular Radio Programme highlighting Maternal & Child health activities including Breast feeding, Anemia, Immunization against VPT is being highlighted in Govt. &

Private media. Scroll bars in local TV channels displaying different activities. Hoardings are displayed at prominent places through out the State

NRHM ADDITIONALITIES Corpus funds for 14 District Hospitals

Corpus Funds Corpus funds for 85 CHCs released

Corpus funds for 375 PHCs released

AMG for 84 CHCs released AMG

AMG for 268 PHCs released

AMG for 644 Sub centers released

Untied funds for 85 CHCs

Untied Fund Untied funds for 375 PHCs Untied funds for 1907 Sub Centers 8900 ASHAs have been trained in Module Training of ASHA- II II & 9500 stands trained din Module -I New initiative started this year Anganwari Incentives to Anganwari Workers workers being paid Incentive @ Rs, 75/- per month. 6200 AWW benefited 38677 Village Health & Nutrition Days VHNDs Organized till at all Anganwari Centers

4 Health Mela Organized under MP Health Mela Constituency

1 Handi Cap centre for Children is being Handicapped Centre at Leh established at LEH & work is in-progress. IMMUNISATION Mobility support to ANMs for vaccine 2637 ANMs benefited by providing delivery i.e Rs. 100.00 /Month mobility support for Vaccine delivery Mobilization of Children for Complete 40983 Sessions assisted by ASHAs for Immunization by ASHA (Left out/Drop out providing mobilization only) @ Rs.150/month

Trainings:- Life Saving An. Skills = 9 ( Rs 5.88 released. Exp. Awaited) ISM Doctors = 138 ( 1 Batch of 25 @ 73875.00 ) EMOC by FOGSI) = 5 ( Rs 30.00 Lacs released Exp. Awaited ) SBA at District Level is in progress in 2 nos. of districts. 6 ANMs & 2 SNs trained in SBA in 2 Districts. 19 Nos of trainer trained in EMNCI Quality Insurance workshop on Accreditation of Hospital experts (60) Workshop on Planning of MH & CH Strategy (40) Establishment of SNCU (36 Participants) Trg. of MOs in MDP (15 Participants in GMC) HMIS workshop (87 Participants trained) 9 State Level TOT in EMOc have been trained by FOGSI and 3 District level trainer under going training through FOGSI .

110 Participants oriented during workshop on Quality Assurance at District Level 60 Health service providers trained during contraceptive updated Health seminars at District Level

Workshop on PNDT Act held at Divisional level. 2 in Jammu Division & 1 in Kashmir Division, whereby appropriate authorities and other private players participated 1 State level Work shop on Health Insurance organized. 60 Participants were oriented about the Health Insurance 1 State Level workshop under Bio Medical waste disposal organized through State Pollution control Board & District Level Workshops for awareness of Bio Medical Waste being organized. 299 VHSCs members trained at Block Level.

100

List of CHCs upgraded as FRUs (J&K State)

S. No Name of the District Name of the CHCs 1 Jammu R.S.Pura 2 Akhnoor

3 Bishnah 4 Sohanjana 5 Ramgarh Samba 6 Samba 7 Hiranagar 8 Billawar Kathua 9 Bani 10 Basholi 11 Doda Gandoh 12 Kishtwar Kishtwar 13 Ramban Banihal 14 Mendhar Poonch 15 Surankote 16 Sundherbani Rajouri 17 Darhal 18 Reasi Reasi 19 Ramnagar Udhampur 20 Chenani 21 Dooru 22 Anantnag Bijbehera 23 MCH Anantnag 24 Kupwara 25 Sogam 26 Kupwara Tangdhar 27 Sopore 28 Uri 29 Tangmarg 30 Baramulla Gurez 31 Srinagar Gousain Hospital 32 Ganderbal Kangan 33 Leh Khalsi 34 Kargil Drass 35 Beerwa 36 Budgam Chadoora 37 Shopian 38 Pampore 39 Pulwama Tral

101

List of Primary of Health Centres working as 24 X 7

S.No Name of District Name of PHC 1 Achabal

2 Verinag Anantnag 3 Mattan 4 Qazigund

5 Devsar 6 Frisal 7 Nehama 8 Mohamand Pora 9 Bugam Kulgam 10 Katrsoo

11 Qaimoh 12 K.B.Pora 13 Manzgam 14 Tarigam 15 Pahloo

16 Soibagh

17 Hardpanzoo Budgam 18 Khaq 19 Ompora

20 Dangiwachi 21 Boniyar Baramulla 22 Kalantra 23 Ruhama 24 Mulgam

25 Bandipora Hajian

26 Gund 27 Ganderbal Lar 28 Kulan

29 Kupwara Wadipora 30 Trehgam 31 Drugmullah 32 Chogal 33 Machil 102

34 Keran 35 Villagam 36 Punzgam 37 Kalamchakla

38 Dadsara 39 Awantipora 40 Pulwama Parigam 41 Newa 42 Kakapora

43 Tangtase 44 Khalsti 45 Panamik Leh 46 Chuchul

47 Nyoma 48 Turtuk 49 Tingmosgam

50 Shergole 51 Kargil Panikher

52 Assar Doda 53 Ghat

54 Ukhral Ramban 55 Ramsoo

56 Padder 57 Kishtwar Dachhan 58 Chatroo

59 Sungal 60 Mehra Mandrian 61 Arnia 62 Rehal 63 Dansal Jammu 64 Kot Bhalwal 65 Kanachak 66 Pallanwala 67 Pargwal 68 Gho Manhasan

103

69 Vijay Pur 70 Samba Purmandal 71 Ghagwa

72 Chandak 73 Loran Poonch 74 Ajote 75 Fazalabad

76 Manja Kot 77 Shahdra Sharif 78 Budhal Rajouri 79 Lamberi 80 Moughla 81 Siot

82 Basant Garh 83 Panchari 84 Sudh mahadev Udhampur 85 Bhugtarian 86 Majalta 87 Tikri

88 Dharmari Reasi 89 Pouni

90 Hutt 91 Ramkote 92 Machedi 93 Kathua Lohai 94 Dinga Amb 95 Parole 96 Lakhanpur

104

Budget for Improving in RIHFWs & ANMT Schools

( Rs. in lacs) S. Name of the Const. Furnitur Teachin Contractu Misc. Total No Institutes including e/ g Aids al Staff Repairs/ Fixture Maintenance 1 RIHFW, 10.00 5.00 5.00 42.00 3.50 70.50 Dhobiwan 2 RIHFW, 50.00 10.00 10.00 42.00 3.50 115.50 Nagrota 3 ANMT School 5.00 2.00 2.00 6.00 1.00 16.00 G. Nagar, Jammu 4 ANMT School 25.00 10.00 2.00 9.60 1.00 47.60 kathua 5 ANMT School, 3.00 5.00 2.00 9.60 1.00 20.60 Udhampur 6 ANMT School, 3.00 5.00 2.00 6.50 1.00 17.50 Rajouri 7 ANMT School, 3.00 5.00 2.00 9.60 1.00 20.60 Poonch 8 ANMT School, 10.00 5.00 2.00 7.20 1.00 25.20 Doda 9 ANMT School, 10.00 5.00 2.00 6.00 1.00 24.00 Anantnag 10 ANMT School, 10.00 5.00 2.00 9.60 1.00 27.60 Baramulla 11 ANMT School, 10.00 5.00 2.00 6.00 1.00 24.00 Kupwara 12 ANMT School, 10.00 5.00 2.00 4.00 1.00 22.00 Leh 13 ANMT School, 10.00 3.00 2.00 9.60 1.00 25.60 Kangan Grand Total 456.70

105

LIST OF BLOOD BANKS IN JAMMU AND KASHMIR

1. Command Hospital, Udhampur

2. District Hospital, Udhampur

3. District Hospital, Doda

4. District Hospital ,Ramban

5. Sub District Hospital, Kishtwar

6. District Hospital, Rajouri

7. Gen. Hospital, Rajouri

8. District Hospital, Kathua

9. Government Medical College, Jammu

10. SMGS Hospital, Jammu

11. Government Hospital, Gandhi Nagar, Jammu

12. 161 Military Hospital, Satwari, Jammu

13. ASCOMS, Hospital, Jammu

14. B.N. Charitable Hospital, Jammu

15. SMHS Hospital, Srinagar

16. SKIMS, Srinagar

17. 92 Base Head Quarter, Srinagar

18. Lal Ded Hospital Srinagar

19. District Hospital, Baramulla

20. District Hospital, Pulwama

21. 153, Army Hospital, Leh

22. District Hospital, Budgam

23. District Hospital,, Kargil

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Name of State/UT: Jammu & Kashmir No. of Districts: 22 S. No Name of the Category Total Trained Venue Duratio No. of Training Funds Budget Remarks Training of Traini Till Date n of Participant load as requirement Estimat Programme Trainees ng Trainin s per projected for training e Load g batch for during 2009- (Rs. in coverage 10 per batch Lakhs) during (Rs. In 2009-10 Lakhs)

1 2 3 4 5 6 7 8 9 10 11 12 A RCH Maternal Health 1 Divisional Level MOs & 162 35 RIHFW, One 25 50 1.08 2.16 Workshop for Divisional Dhobiwan Day Training of level /Nagrota Trainers for officers Skilled Attendance Birth (SBA) at RIHFW, J/K 2 District Level Staff 396 6 District 21 2 20 0.27 2.63 Training trainings for SNs Nurses Hospital Days load for SBA at calculated District Hospital ( for 10 for Districts districts of selected during the state phase1st , selected excluding Leh) 4 Namely batches per Anantnag, district Baramulla, Srinagar, Leh, Udhampur

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and Kathua) during phase1 & Jammu, Rajouri, Kupwara and Pulwama during phase 2 3 District Level Staff 330 0 District 21 2 10 0.27 1.31 do trainings for SNs Nurses Hospital Days for SBA at District Hospital ( for Districts selected during phase 2nd ) 2 batches per district

4 District Level ANM/ 734 34 District 30 2 20 0.44 4.40 do trainings for LHV Hospital Days ANMs/LHVs for SBA District Hospital ( for Districts selected during phase1st, excluding Leh ) 8 batches per district

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5 District Level ANM/ 688 0 District 30 2 10 0.44 2.20 do trainings for LHV Hospital Days ANMs/LHVs for SBA District Hospital ( for Districts selected during phase 2nd ) 5 batches per district 6 Training for MOs & 200 76 GMC,Jm 3 Days 4 44 0.10 1.14 Blood Storage Lab u/Sgr Tach. 7 Training for MOs 439 9 GMC,Jm 18 4 16 2.94 11.76 Training Medical Officers u/Sgr Weeks load in Life Saving calculated Skill for Obstetric for 22 Anesthesia at districts of GMC, Jmu/Sgr the state 8 Training of MOs 439 9 GMC,Jm 6 8 48 3.97 23.85 Training Doctors in u/Sgr Weeks load EMOC Skills by calculated FOGSI at GMC, for 22 Jmu/Sgr districts of the State. Districts of Jammu, Udhampur, Kathua, Rajouri, Anantnag, Baramulla, Budgam & Srinagar

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taken up during current year 2009- 10.

9 Training of MOs 439 0 GMC,Jm 2 Days 24 96 Training Medical Officers u/Sgr load as District calculated Trainers for for 22 RTI/STI Case districts of Management at the GMC, Jmu State.Traini ng to be conducted through NACO for selected districts of Kishtwar, Reasi, Samba, Jammu, Udhampur, Ramban, Kupwara, Srinagar, Pulwama, Kulgam, Budgam, Baramulla) during phase 1

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10 Training for ANMs/LH 2195 0 District 2 Days 30 660 Training RTI/STI Case Vs/SNs/ Hospital load Management at Lab. calculated District Hospital Asst. for 22 districts. Training to be conducted through NACO for selected districts of Kishtwar, Reasi, Samba, Jammu, Udhampur, Ramban, Kupwara, Srinagar, Pulwama Kulgam, Budgam, Baramulla) during phase 1 11 MTP training as MOs 439 223 GMC,Jm 15 3 66 0.33 7.28 Training per GoI by u/Sgr Days load Medical Officers calculated (GMC, for 22 Jammu/Sgr.) districts of the State.

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12 Training of MOs/SNs 878 GMC,Jm 12 4 88 0.30 6.71 20 Gyne. & Medical Officer u/Sgr Days SNs in MVA trained as Technique district posted in 24 X 7 trainer of PHCs and CHCs Jammu, at District Level Doda, Kathua, Udhampur, Poonch & Rajouri. Child Health

1 Training of MOs 24 To be District level /Nursing trained as Trainers in Tutors district IMNCI with trainer for support from districts UNICEF in Rajouri, Kalavati Children Poonch & Hospital, New Budgam. Delhi Expenditur e to be met by UNICEF 2 Training of Mos MOs 308 69 GMC,Jm 8 Days 24 264 1.32 14.53 Training and /Nursing u/Sgr load Pediatricians in Tutors calculated IMNCI 11 District for 11 in GMC, districts of Jammu/Srinagar the State posted in 24x7 namely : PHC/FRU Anantnag, Baramulla, Pulwama,

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Kupwra,Bu dgam and Leh, Rajouri, Udhampur, Jammu Kathua & Poonch 3 Training of LHVs/AN 1114 District 8 Days 264 0.88 9.73 Training LHVs/ANMs/SN Ms/SNs Hospital load s/AWWs in calculated IMNCI in 11 for 11 Districts in districts of District the State Hospitals. namely : Anantnag, Baramulla, Pulwama, Kupwra,Bu dgam and Leh, Rajouri, Udhampur, Jammu Kathua & Poonch. 24 LHVs/ANM s/SNs/AW Ws trained in essential new born care in the year 2009- 10 upto

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30th December.

4 Consultative Med. 36 Divisional 1 Day 30 60 0.93 1.87 Workshop for Suptds./ HQ Establishment of Paediatri SNCUs in 2 cians/GM selected District C Hospitals. faculty/St ate Level Officers 5 Divisional Level Faculty Divisional 1 Day 25 50 1.25 2.51 Workshop on of HQ Pre-Service Departm training on ent of IMNCI Paediatri cs GMC Jammu/S rinagar, Pediatrici ans and ANMT Faculty

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6 Workshop on Faculty 40 Divisional 1 Day 40 80 1.51 3.02 Planning of of HQ Maternal and Departm Child Health ent of Strategies Pediatric s' and Gynae GMC Jammu/S rinagar, Pediatrici ans, Gynecolo gists and Division level Program me Officers 7 Training of staff Staff of 0 10.00 Funds to be deployed Stabilizati calculated in Stabilization on Units as units at FRU of FRUs Lumpsump Level 8 Multiskilling of Mos(MB 0 GMC To be 4 12 15.00 Funds MOs (MBBS in BS in JMU/ decide calculated Neonatal and Neonatal SGR d as Child Health) and Child Lumpsump being finalized Health) as per GoI Protocol Immunization

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1 Orientation HEALTH 2 Days 50 0.45 0.45 Funds Training WORKE calculated RS OF @ Rs. 450 NURSIN per trainee G per day HOMES 2 Training of Mos MOs 11.00 Funds on RI using calculated revised training as module Lumpsump 3 Refresher Comp. 22 1 Day 22 22 0.45 0.10 Funds Training of on Asstt. calculated RIMS/ HMIS and @ Rs. 450 immunization per trainee format per day 4 Training for Block 975 0 District 1 Day 20 663 30.00 11.70 handling Cold level cold HQ Chain chain Maintenance handlers 5 Training for Block/Dis 131 0 District 1 Day 109 3.88 reporting formats trict level HQ of immunization data and NRHM handlers Family Planning Trainings 1 Laparoscopic Gynae. 155 21 GMC,Jm 12 Day 3 66 0.19 4.12 Training Sterilization /OT u/Sgr load Training Tech/OT calculated Nurse onlu for CHCs

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Training in Training to alternative be taken methodology in only in IUD Jammu Division as no state level master trainers trained for Kashmir Division. 1 Training of Gyne/AN 80 0 RIHFW, 6 Day 10 80 0.54 5.39 district level MTC Nagrota trainers at Faculty/ Divisional level MOs/FO GSI Members 2 Training of block MOs 160 0 District 6 Day 10 80 0.34 3.42 level trainers at /SNs/ Hospital district Level LHVs 3 Training of ANMs 1033 0 District 6 Day 20 40 0.64 1.29 ANMs of 24x7 Hospital PHCs& CHCs at District Level Adolescent Training Reproductive during and Sexual Phase-I to Health/ARSH be Training conducted in the districts of Jammu,

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Reasi, Kathua, Udhampur, Ramban, Srinagar, Budgam, Kupwara, Baramulla, Anantnag & Pulwama(T raining load also calculated for selected districts) 1 Training of MOs 270 0 GMC,Jm 3 Days 25 100 0.69 1.38 Medical Officer u/Sgr for Adolescent Friendly Reproductive and Sexual Health Services ( ARSH) 2 Training of SNs/ SNs/ 1651 0 District 5 Days 30 330 0.75 8.22 ANMs/LHVs on ANMs/LH HQ Adolescent Vs Reproductive and Sexual health (ARSH) PMU

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1 Training cum SPMU/D 185 45 RIHFW 3 Days 30 150 1.11 5.54 Workshop of PMU/BP Nagrota/ DPMSU, BPMU MU Dhobiwan and Consultants including State Programme Officers at State Level Training of ASHAs 1 Training of ASHAs 9500 0 District 10 25 9500 0.14 54.15 ASHAs module HQ days III,IV & V Other Trainings/Work shops 1 International / MOs 5.00 Funds National calculated Trainings/ as Seminars at LumpSump reputed institutions State/ Divisional level/ SHS/ DHS members 2 Postgraduate MOs 0 4 1.35 5.40 To be Diploma in organized Public Health by NIHFW, Management ( in Refer D.O. No. collaboratio P-12011/4/2006- n with other PH dated 14th institutes March 2008

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received from G.C. Chaturvedi, Additional Secretary & Mission Director (NRHM) GoI (4 doctors to be nominated)

3 Planning for Hospital 60 Divisional 1 Day 30 60 1.87 Accreditation of experts HQ Hospital experts at Divisional level Quality Assurance Workshops 1 Divisional Level Health 97 RIHFW 1 Day 35 70 1.03 2.06 Service Nagrota/ Providers Dhobiwan 2 District Level Health 110 District 1 Day 25 550 0.23 5.03 Service HQ Providers Gender & Equity Training 1 Workshop at Private 0 RIHFW 1 Day 25 100 0.41 1.63 Divisional level Health Nagrota/ providers Dhobiwan /Govt Health Service providers Religious

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leaders/c aste leaders/ MLAs

2 Workshop at Private 0 District 1 Day 25 550 0.20 4.37 distt level Health HQ providers /Govt Health Service providers Religious leaders/c aste leaders/ MLAs/opi nion leaders of Block level 3 Orientation 2.00 Funds Workshop at calculated State Level for as Appropriate Lumpsump Authorities (PC&PNDT) of State/Divisional/ District Level. 4 Workshop at Doctors Divisional 1 Day 2.00 4.00 Funds Divisional Level and other HQ calculated Stake as holders Lumpsump

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5 Orientation on doctors 22 0.03 0.55 Funds Gender Equality both batches calculated & PC PNDT Act Govt and @ Rs. at District level private 2500.00/Di members strict of District Appropri ate Authority NGOs Training under NRHM Additionalities 1 Workshop/Traini DPM/ 200 88 Divisional 2 Days 50 100 4.00 Calculated ng for capacity DDA/ HQ as building of Staff DAM/SA/ Lumpsump in Health BAM Management Information System(HMIS) 2 Workshop/Traini 15.00 Workshop ng for Bio cum Medical Waste Trainings Management to be conducted through PPP 3 Training on CMOs/D 110 0 Divisional 3 Days 20 80 3.80 15.21 using y.CMOs/ HQ management DHOs/DI tools to improve Os/BMO District Health s Services (MDP).

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Trainings under Intersectoral Convergence 1 Training of CDPOs/ 836 52 RIHFW 2 Days 38 76 0.67 1.34 District level Doctors Dhobiwan Trainers for / Nagrota Strengthening of NRHM through inter sectoral convergence 2 Training of AWWs & 2040 0 District 2 Days 37 (35 1628 0.39 16.83 AWWS for Supervis 9 HQ AWWs & Strengthening of ors of 2 NRHM at Distt ICDS Supervis trg. Center ors) 3 Training of AYUSH 375 138 GMC 5 Days 25 100 0.94 7.56 AYUSH doctors Doctors JMU/ on (ayurvedic / SGR unani / homeopathic etc.) on National Programmes 4 Training of AYUSH 375 112 District 5 Days 25 238 0.61 5.45 medical Medical HQ assistants, Assistant Dawasaz s/Dawas etc.working in az ISM department(ayur vedic / unani / homeopathic) on National Rural Health Mission

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5 Reorientation AYUSH 375 0 District 3 Days 25 375 0.39 5.83 Training of Medical HQ medical Assistant assistants, s/Dawas Dawasaz az etc.working in ISM department(ayur vedic / unani / homeopathic) on National Rural Health Mission 6 Reorientation AYUSH 375 0 GMC 3 Days 25 200 0.69 5.54 Training of ISM Doctors JMU/ doctors on SGR mainstreaming of AYUSH under NRHM ( to Doctors already trained on National Programmes under NRHM at GMC, J/S) 7 Training of Allopathi 10.00 Training to Allopathic c Doctors be Doctors in conducted AYUSH as per as per GOI GoI guidelines. guidelines Trainers from and GoI Training load for the current year will be

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calculated accordingly . Funds calculated as Lumpsump Workshops Convergence through outsourcing 1 Divisional level Members 0 Divisional 1 Day 50 100 1.96 7.23 workshop from HQ departme nts of Educatio n, Rural Health, Health, ICDS, WCD etc. 2 District Level Members 0 District 1day 55 770 0.33 15.84 Workshop from HQ departme nts of Educatio n, Rural Health, Health, ICDS, WCD etc. 3 TOTs for Village CHO/BE 20.00 Funds Health E/LHVs/ calculated Committees for Mos as LumpSump.

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selected Trainings to VH&SCs be planned through in PPP/NGO collaboratio n with PPP/NGO members 4 Block level VHSC 3400 299 Block HQ 2 Days 20 2160 0.34 36.50 Training of members 0 Village health & sanitation Committee Members through PPP/NGOs Trainings under Disease Control Programme 1 Integrated MOs 439 Divisional 5 25 100 0.945 3.78 Trainings HQ Days (DCP)under NRHM 2 Integrated ANMs/LH 2185 District 3 Days 25 550 0.388 8.53 Trainings Vs/SNs HQ (DCP)under NRHM 3 Integrated HW/HA( 272 District 3 Days 25 100 0.388 1.55 Trainings Male) HQ (DCP)under NRHM 4 Integrated Lab. 85 Divisional 5 Days 25 75 0.69 2.07 Trainings Tech. HQ (DCP)under NRHM

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SITUATIONAL ANALYSIS

Geographic, Demographic & Socio-Economic

J & K is situated between 32.17 degree and 36.58 degree north latitude and 37.26 degree and 80.30 degree east longitude with a total area of 22,22,236 sq. Kms. It has four geographical zones of: Sub-mountain and semi-mountain plain known as kandi or dry belt

The Shivalik ranges,

The high mountain zone constituting the Kashmir Valley, Pir Panchal range and its off-shoots covering Doda, Poonch and Rajouri districts and part of Kathua and Udhampur districts

The middle runs of the Indus river comprising Leh and Kargil.

The State of Jammu and Kashmir is the northern most state of India comprising three distinct Climatic regions viz. Arctic cold desert areas of Ladakh, temperate Kashmir valley and sub- tropical region of Jammu. Jammu and Kashmir initially had 14 districts namely Kupwara, Baramulla, Srinagar, Budgam, Pulwama, Anantnag, Udhampur (Ladakh), Kargil, Doda, Udhampur, Poonch, Rajouri, Jammu and Kathua. The number has now been increased to 22 to ensure efficient functioning. The newly added districts are; in Jammu division: Ramban, Kishtwar, Samba & Reasi, and in Kashmir division: Ganderbal, Shopian, Kulgam and Bandipora. State Administration is divided into 2 Divisions, 22 Districts. Health Department has 109 Medical Blocks. The health system functions through various health facilities:

A Health Sub Centre (HSC) covers a population of 3000 in hilly/ tribal and 5000 in plain areas 127

A Primary Health Centre (PHC) caters to a population of 20000 in hilly/ tribal areas and 30000 in plain areas. One PHC acts as a referral centre for 5- 6 HSCs (on average).

A Community Health Centre (CHC) services a population of 80000 in hilly/ tribal areas and that of 120000 in plain areas. 4 PHCs drain into 1 CHC

Table No: - 6

Category No. of Units Divisions 2

Districts 22 Medical Blocks 109 Villages /hamlets 7537

Following are some of the basic socio-demographic indicators of J & K: Table: - 7

S. No. Indicators Values 1 Geographical Terrain Hilly/ Mountainous/ Plain with Leh and Kargil being snowbound for 6 months 2 Villages/Halmets 7265 3 Population 11414000 (projected for 2009) 4 Males 5990000 (projected for 2009) 5 Female 5424000 (projected for 2009) 6 Population density 100 7 % BPL population 37 8 % SC Population 10 9 % ST Population 20 10 Literacy rate Total 55.5% Female 43% Male 57% 11 Boys married below 21 23.1 yrs (%) 12 Girls married below 18 22.0 yrs (%)

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Table: - 8 State Data : Jammu & Kashmir

CBR CDR IMR NNMR

2003 18.6 5.7 44 NA

2004 18.7 5.6 49 38

2005 18.9 5.5 50 36

2006 18.7 5.9 52 39

2007 19.0 5.8 51 NA

2008 19.0 5.8 51 NA

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INDIA, J&K & DISTRCITS OF J&K (CENSUS 2001) Table: - 9

India and Population 2001 Decadal growth rate Sex ratio State/ Union Persons Males Females 1981- 1991- 1991 2001 territory*/Di 1991 2001 strict 1 2 3 4 5 6 7 8 INDIA 1,027,015, 531,277,0 495,738,16 23.86 21.34 927 933 247 78 9 Jammu & 10,069,917 5,300,574 4,769,343 30.34 29.04 896 900 Kashmir Kupwara 640,013 331,783 308,230 40.47 38.59 893 929 Baramula 1,166,722 611,131 555,591 32.72 31.18 890 909 Srinagar 1,238,530 661,923 576,607 33.02 31.45 872 871 Badgam 593,768 309,574 284,194 27.81 26.50 899 918 Pulwama 632,295 326,186 306,109 25.69 24.49 917 938 Anantanag 1,170,013 608,720 561,293 34.33 32.70 905 922 Leh 117,637 65,166 52,471 31.91 30.42 845 805 (Ladakh) Kargil 115,227 60,629 54,598 32.89 31.39 878 901 Doda 690,474 362,471 328,003 28.09 26.76 905 905 Udhampur 738,965 394,949 344,016 28.32 26.95 888 871 Punch 371,561 193,970 177,591 29.40 28.08 902 916 Rajauri 478,595 253,129 225,466 26.38 25.19 898 891 Jammu 1,571,911 835,635 736,276 29.78 28.39 899 881 Kathua 544,206 285,308 258,898 21.94 20.91 912 907

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Table: - 10

Projected Population S. No. District 2008 2009 2010 2011 2012 2013 2014 2015 1 Anantnag 889493 913127 937388 962295 987863 1014110 1041055 1068716 2 Bandipore 423204 434449 445992 457842 470007 482495 495315 508475 3 Baramulla 974527 1000420 1027001 1054289 1082301 1111058 1140579 1170884 4 Budgam 727692 747026 766875 787251 808168 829641 851685 874314 5 Ganderbal 255631 262423 269396 276554 283902 291445 299189 307138 6 Kargil 143346 147155 151065 155079 159199 163429 167771 172229 7 Kulgam 519174 532969 547130 561667 576591 591911 607638 623783 8 Kupwara 781440 802203 823518 845399 867861 890920 914592 938892 9 Leh 140853 144595 148437 152381 156430 160586 164853 169233 10 Pulwama 530187 544274 558736 573581 588821 604466 620527 637014 11 Shopian 253913 260660 267585 274695 281994 289486 297178 305074 12 Srinagar 1225260 1257815 1291235 1325543 1360763 1396918 1434034 1472137 Kashmir Reg 6864720 7047116 7234358 7426576 7623900 7826465 8034416 8247889 13 Doda 384784 395008 405503 416278 427338 438692 450348 462314 14 Jammu 1614509 1657406 1701443 1746651 1793059 1840701 1889608 1939815

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15 Kathua 642776 659856 677387 695386 713862 732829 752301 772289 16 Kishtwar 229296 235388 241643 248063 254654 261420 268366 275497 17 Poonch 447691 459586 471797 484333 497201 510412 523974 537896 18 Rajouri 580661 596089 611927 628186 644877 662011 679601 697658 19 Ramban 258253 265115 272159 279390 286813 294434 302257 310288 20 Reasi 297602 305509 313626 321959 330514 339296 348311 357565 21 Samba 312528 320832 329356 338107 347091 356313 365780 375499 22 Udhampur 554729 569468 584599 600132 616077 632446 649250 666501 Jammu Reg 5322829 5464257 5609440 5758485 5911486 6068554 6229796 6395322 Total J&K State 12187549 12511373 12843798 13185061 13535386 13895019 14264212 14643211

*Directorate of Economics & Statistics, J&K Govt.

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Table: - 11

A FEW IMPORTAINT HEALTH INDICATORS J&K / INDIA Current Status S. No INDICATOR India J&K Estimated Birth Rate 1 23.5 18.7 (SRS 2007) Estimated Death Rate 2 7.5 5.9 (SRS 2007) Infant Mortality Rate 3 57 51 (SRS 2007) Sex Ratio 4 933 892 * (Census 2001) 5 Total Fertility Rate 2.9 2.4 Institutional Deliveries 6 40.7% 54.3% (NFHS-III) Full Immunization 7 43.5% 66.7% (NFHS-III) 8 Any Antenatal Check- 73.4 87.7 *Sex ratio: As per NSS 60 th Round (June 2004) = 923. Sex Ratio Survey 2006 conducted by DES = 925

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The Department of Health has shown a remarkable expansion from 124 institutions, 184 doctors & 100 beds in 1951 to current status shown in table below: TABLE No: - 12

HEALTH INSTITUTIONS S. No. Health Institutions Number 1 Institute of Medical Sciences. 1 2 Medical Colleges 4 * 3 Associated Hospitals with Med. Colleges 12 * 4 Ayurvedic/ Unani Hospital 2 5 Dental Colleges 3 * 6 District Hospitals 14+ 8* 7 Community Health Centre/Sub District Hospitals 85** 8 Primary Health Centres 375 9 Allopathic Dispensaries 238 10 Sub Centres 1907 11 Medical Aid Centres 346 12 ISM Dispensaries 417 * Includes one each in Private Sector **8 CHCs out of 85 are being upgraded to DHs in newly created Districts

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In addition to the public health infrastructure, there is a presence of private sector albeit very low with 55 private clinics/ hospitals and 35 health sector NGOs. PUBLIC HEALTHINSTITUTION DISTRICT WISE ARE SHOWN IN THE TABLE BELOW: Table No: - 13

Name of District DHs CHCs PHCs Sub Centres

Anantnag 1 6 30 115 Pulwama 1 2 17 74 Budgam 1 9 35 132 Baramulla 1 6 30 135 Kupwara 1 7 31 141 Srinagar 1 1 11 51 Leh 1 3 13 23 Kargil 1 4 2 35 Bandipora 3 7 43 Ganderbal 2 13 48 Shopian 4 9 57 Kulgam 3 15 85 Kashmir Total 8 50 213 939 Rajouri 1 7 22 143 Poonch 1 3 17 102 Kathua 1 4 24 137 Doda 1 3 13 75 Jammu 1 5 27 194 Udhampur 1 2 21 97 Reasi 3 11 68 Ramban 4 7 34 Kishtwar 2 7 40 Samba 2 13 78 Jammu Total 6 35 162 968 State Total 14 85 375 1907

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HEALTH SERVICES

The state health system caters to the population of the State residing in a widely scattered mix of 7537 inhabited villages/hamlets and around 75 towns. J&K State is sparsely populated and road connectivity is poor as compared to other States. There are two distinct administrative units, for Health and Medical Education. • Department of Medical Education. • Department of Health and Family Welfare.

The Department of Health and Family Welfare works through: • Director Health: Two divisional Directors of Health, one for Jammu and the other for Kashmir Division. All administrative functions are with Director (Health). He supervises the work of all the Chief Medical Officers at the district level. • Director Family Welfare & RCH , J&K (with HO in Jammu during winter and in Srinagar during summers). Director (Family Welfare) is in charge of the Family Welfare Programme and looks after the State Health Society implementing NRHM in the State. • Project Director for HIV/AIDS. The Project Director position was created to implement and manage HIV/AIDS programmes. • Director for Indian System of Medicine (AYUSH): Director of Indian Systems of Medicine is independent functionary with his own staff and office. • Controller for Food and Drug Control Organisation: looks after the Drug Control organisation in the state, which includes the Drug Testing Laboratories

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Directors of Health for Jammu and Kashmir divisions are supported by: Deputy Director (Schemes), Deputy Director (Planning and Evaluation), Epidemiologists, Deputy Director (HQ Administration), Controller (Stores), State Malariologist and State Veneriologist, among others.

The Chief Medical Officer (CMO) of the district is assisted by four officers for the national disease control programmes. Deputy CMOs of Family Welfare directly report to CMO on the one hand and to Director Family Welfare at the state level. In addition to the Dy CMO, there is a District Immunisation Officer, a District Health Officer and a District TB Officer. The Medical Superintendent at district level, who is equal in rank to the CMO, looks after the District hospitals at the district level. The Medical Superintendent and the CMO function independently, but both report to the Director, Health Services of their respective divisions. The network of government health facilities includes District Hospitals, Community Health Centres, Primary Health Centres, Dispensaries (Allopathic, Ayurvedic, Unani) Health Sub-Centres and Medical Aid Centres.

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Organisational Structure at District

Chief Medical Medical Officer Superintendent

Deputy District District Immunisation Chief Health TB Officer MO Officer Officer

Community Primary Health Allopathic Health Centres Centres Dispensaries

Medical Colleges and Other Institutions in the State There are three Government Medical Colleges in the State, one in Jammu and two in Srinagar, besides Sher-e-Kashmir Institute of Medical Sciences at Soura in Kashmir, the only super speciality referral Centre in the State. In addition, there are three Dental Colleges, one in Private sector in Jammu and two Government Dental Colleges, one each in Jammu and Srinagar. 12 Associated Hospitals of Srinagar and Jammu are affiliated with respective Medical Colleges to provide undergraduate & Post graduate trainings including health care. One Medical College, ASCOMS, in private sector is catering for MBBS, PG courses in Jammu at Sidhra,.

INDIAN SYSTEM OF MEDICINE (Ayurveda, Unani, Amchi & Homoeopathy) There are no government colleges imparting training in the Ayurvedic/Unani systems that form a part of the Indian System of Medicine in the state. However, 2 ISM private colleges have been established. Tibetan Medicine (also known as Amchi) is very popular in the Ladakh region They play an important role in the delivery of traditional healthcare. 138

J&K SPECIFIC CONSTRAINTS

External Factors:

• Topography & Inaccessibility: Most of Districts are mountainous areas with extreme climatic conditions, some of the pockets remain cut off in winter, makes even outreach session difficult and retention of staff a problem.

• On going Militancy: Movement in many areas including border areas restricted. Retention & mobility of staff is a problem.

• Poor Road Connectivity: Shortfall of 6600 KMs road length, 2060 inhabitations without connectivity, Road Density- 13%, amongst lowest, (Leh- 2.6%, Kargil- 4.8%, Doda- 5.2%, Poonch- 7%)

• Absence of Pvt Sector : Absence of private health service providers / NGOs overload Govt. Institutions, 91 % patients load on Public HIs against 41.7 % at national level

• Low density of population : 99 per sq km against 338 at national level;

• Poor public Transport System: Barrier in patients reaching facilities during emergencies

• The area covered by an institution and radial distance between the two health institutions are much more than the national average.

Internal Factors:

• Shortage of specialists, specially in Kashmir Division a major constraint in operationalizing FRUs

• Delayed Reporting: Reporting from most of the blocks is delayed, incorrect.

• Private Practice: PP leads to non commitment of doctors to services

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• Poor status of infrastructure.

• Lack of motivation for rural posting: Overwhelming majority of service providers reluctant to move out of Capital cities

• Difficulty to engage MBBS doctors at Rs. 8000/- Per month specially in far-flung/difficult hard to reach areas like Leh, Kargil, Kupwara and some parts of Uri, Doctors are not applying for contractual positions at meagre remuneration.

• In some districts, “District Programme Management Support Units” got delayed due to non-availability of candidates possessing the requisite qualification

• Inadequate procurement system affecting purchase of equipments necessary to upgrade DHs /CHCs/PHCs.

In the year 2008-09, nearly three months were lost due to ongoing agitation in both the regions of the State due to Shri Amaranth Shrine land controversy. Subsequently the State Assembly elections were held and model code of conduct was enforced for two and half months restricting number of initiatives. Due to the above factors hindering the progress in the development, the necessary results could not be achieved.

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HUMAN RESOURCES FOR HEALTH- ISSUES, INITIATIVES

A: DEFICIENCY OF MANPOWER:

The State is beset with manpower deficiency in health institutions especially in District hospitals, newly constructed health buildings and in some specified institutions where the workload is more. The responsibility for providing adequate manpower for both existing as well as new/proposed health institutions lies exclusively with the State Government. The deficiency of specialist doctors in some specific disciplines is also a cause of concern. Towards this, the State is regularly deputing specialists for TOT and doctors for skill up-gradation under NRHM. The trainings conducted within the State will also overcome the difficulty to some extent. Specialist doctors (including retired specialists) are being hired on contractual basis. Under PMSSY, Medical Colleges Srinagar and Jammu are being upgraded to the level of AIIMS. Much headway has been in this regard. It is expected both the Medical Colleges shall have more PG seats available in a number of disciplines once the project gets fully implemented.

B: STEPS TAKEN TOWARDS HUMAN RESOURCES DEVELOPMENT

Availability of appropriately prepared, deployed and supported health workforce is critical in achieving the national health goals. It is therefore highly imperative that the human resources are properly managed and motivated to enhance their productivity and attain optimum level of utilization. The issues related to Human Resources Development such as manpower planning, rules related to induction and recruitment, deployment procedures, policies on compensation, benefits, reservation of seats, private practice and matters of promotion, transfers and trainings etc. are being taken up on priority by the State Govt. and are constantly being reviewed and improved. It is noteworthy to mention that the State Govt. has taken number of steps towards Human Resources Development and to quote a few: 141

All vacancies of Paramedics, Doctors and Specialists have been referred to Services Selection Board / Public Service Commission. For contractual engagements of paramedics and doctors, the vacancies have been referred to concerned Dy. Commissioners. The process of selection by SSRB /PSC and Dy. Commissioners is in advanced stage. Three time-bound promotions for doctors /paramedical staff have been introduced in the State. These include ISM doctors as well. 10% reservation of PG seats has been provided for those doctors who have served in rural areas for at least 5 years. For being eligible to seek admission in PG courses, it has been made compulsory for in-service doctors to have served at least for 2 years in rural areas. 50% of MBBS seats in Medical Colleges of the State have been reserved for female candidates. A comprehensive manpower planning exercise has been undertaken with a view to work the requirement of various categories of posts of doctors, specialists, para-medicals and other supportive staff. The exercise has been conducted on the basis of bed capacity, State/IPHS norms, and work-load duly prioritised with reference to various category of posts. Accordingly, the Department has formulated a proposal for creation of 8341 posts of various categories in 54 health institutions. The annual financial implications on account are to the extent of Rs. 129.00 Crores. Despite, weak resources base, the State Government in Planning and Development has agreed to the proposal and conveyed concurrence in the matter. The case has been referred to State Finance Department for approval. As a matter of policy, the period of posting of doctors and para-medical staff is minimum two years and maximum three years except where otherwise necessitated in extreme cases. Doctors/Para-medical staff who were attached in various health institutions have been detached to report to their original place of postings where from they were withdrawn before such attachment. 142

In-service doctors belonging to Recognized Backward Area (RBA) / Actual Line of Control (ALC) category are required to serve in their respective areas for atleast seven years during their service. A proposal to provide four-advance increments in favour of doctors who have served in notified difficult areas for atleast 2 years is under consideration. Time bound promotion in case of specialists is being speeded up Career progression is being improved by enhancing the prospects of promotion for various categories of doctors particularly for the specialists. The department has proposed enhancement of monthly contractual pay of doctors from Rs. 8000/ to Rs. 18,000/- and also that of paramedical staff. With a view to motivate the Allopathic/ISM doctors to serve in remote/far-flung areas, department has formulated a scheme for providing special incentive (as lump sum allowance over and above the existing pay/salary structure) of Rs. 10,000/- per month to category A (areas which are very difficult considering the remoteness, inaccessibility etc.) and Rs. 4000/- per month for category B (other areas covered under SRO-201 of 2006 but which are not included in category A) subject to performance and a certificate that the doctor has stayed at the place of posting for which incentive is applicable. Doctors and paramedical staff are deputed for attending trainings and workshops both within and outside the side regularly to update their skills. Rationalization of workforce viz-a-viz the work load, institution of a mechanism of accountability for effective delivery of services and other issues are under consideration. The H&ME Department has already initiated the necessary exercise in this behalf.

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C: EXPLANATORY NOTE ON INCENTIVES FOR DOCTORS SERVING IN NOTIFIED DIFFICULT AREAS IN JAMMU & KASHMIR .

1. The Health Department is faced with a challenge of providing Doctors/Specialists in far-flung and remote areas. The experience of the past has been that most Doctors/Specialists are unwilling to serve in remote and far flung areas due to which the people living in these areas suffer on account of non-availability of Doctors/Specialists. A large number of posts of Doctors in these areas remain vacant for long periods. In particular, certain areas are known to be difficult areas for posting. In these areas compensatory/border allowance is paid to the employees posted there. Despite that doctors are reluctant to go to these areas. Even the Doctors and Specialists who hail from these areas are hesitant to be posted in such areas. 2. Increasing and improving availability of human resources in rural areas is a priority area under National Rural Health Mission (NRHM). In the State, doctors have been/are being appointed/posted in rural areas as follows:- • Doctors appointed on regular basis through Public Service Commission. • Doctors who have been appointed on adhoc basis etc. in the past. • Doctors appointed on contractual basis under SRO 255 dated 05.08.2003. • Doctors appointed on contractual basis under NRHM over and above the sanctioned strength for which salary is being paid out of NRHM funds.

3. Out of these four categories, the doctors appointed on adhoc basis in the past are generally being paid a consolidated salary equivalent to the minimum of the scale of the post on lump sum basis. Those appointed under SRO 255 are being paid minimum of the scale of the post (Rs.8,000/-) without any allowances etc. However, recently vide SRO 297 dated 13.10.2008 compensatory allowance/border allowance has been allowed in case of those contractual appointees who are serving in the notified areas.

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4. The doctors who are appointed on contractual basis under NRHM are being paid Rs.8,000/- per month. However, in areas which are 20 kms. away from the district headquarters they are paid Rs.10,000/- per month. In the difficult areas notified under SRO 201 (pertaining to compensatory/border allowance) these doctors are being paid Rs.12,000/- per month.

5. It is observed that low salaries are partially responsible for doctors being unwilling to serve in difficult areas. Although doctors are allowed to do private practice (since they are not allowed Non Practicing Allowance), it is observed that in these difficult areas private practice is not practicable leading the doctors to a loss of another source of income. The scale of compensatory allowance/border allowance is quite low which does not provide a reasonable incentive. The living conditions in these areas are also quite difficult and basic amenities are usually not available.

6. In view of the above position the following proposals are thought appropriate for providing a reasonable financial incentive to the doctors serving in the difficult areas:-

• Enhancing the consolidated pay of contractual appointees under NRHM to Rs.18,000/- per month.

• Allowing a special incentive to all categories of doctors irrespective of the fact whether they are appointed on regular basis or on adhoc basis or under SRO 255 on contract basis or under NRHM on contract basis in lieu of the loss of private practice in the difficult areas.

7. It is felt appropriate to recommend a special incentive (to be paid as additional lump-sum allowance over and above the existing pay/salary structure) to the doctors posted in the areas notified under SRO 201 of 2006 (which provides compensatory allowance in notified areas). The 145

areas covered under SRO 201 have been proposed to be divided into two categories viz., ‘A’ & ‘B’. ‘A’-category includes areas which are very difficult considering the remoteness, inaccessibility etc. The rest of the areas covered under SRO 201 (which are not included in Category-A) would comprise Category-B areas. It is proposed to provide a special incentive of Rs.10,000/- per month for Category-A areas and Rs.4000/- per month for Category-B areas. The list of the Category-A and Category- B areas of Jammu/Kashmir divisions is attached. The incentive is being proposed for both allopathic and AYUSH doctors. Funds on this account would be placed at the disposal of District Health Society/RKS and will be paid to the concerned doctors only after production of a certificate from the CMO/ADMO concerned that his performance during the period of report has remained good. The CMO/ADMO shall further certify that the doctor has been staying at the place of posting for which incentive is applicable and has also done adequate work in terms of conduct of deliveries, immunization, anti natal and post natal check, treatment of OPD & IPD etc. Statement of work done shall also be attached with the certificate. Certified from the local Sarpanch (whenever in place) will also be insisted upon. 8. Under NRHM, one of the strategies to improve availability of human resources in rural areas is to provide incentive for rural posting. Hence remuneration for all those hired under NRHM is being raised and projected in the Programme Implementation Plan for 2009-2010.

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TABLE No: - 14

Table ‘A’ SHOWING CATEGORY OF CHCS & PHCS PROPOSED FOR SPECIAL INCENTIVE.

District Doda S.No. Name of institution Distance by Distance on Category Road foot Block Gandoh 1 PHC Tipri 249 KM 20 KM A Block Ghat 2 PHC Bharat 213 KM 07 KM A 3 PHC Gundna 210 KM 09 KM A District Kathua Block Bani 4 PHC Dhaggar 250 KM 25 KM A 5. PHC Kotichandiar 245 KM 15 KM A Block Billawar 6 PHC Malhar 140 KM 10 KM A 7. PHC Lohai 140 KM 12 KM A 8. PHC Guduphalal 105 KM 6 KM A District Kishtwar Block Kishtwar 9 PHC Nali 270 KM 6 KM A Block Dachhan 10. CHC Marwah A 11. PHC Warwan A 12. PHC Dachhan A Block Paddar 13. PHC Massu 340 KM 10 KM A

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District Rajouri Block Drahal 14 PHC Jamola 180 KM 12 KM A Block Kandi 15. PHC Peeri 180 KM 10 KM A District Ramban Block Ukhral 16 PHC Khari 180 KM 06 KM A District Reasi Block Mahore 17 PHC Bana 250 KM 8 KM A 18. PHC Lar 165 KM 10 KM A 19. PHC Bhagodass 250 KM 30 KM A Block Reasi 20. PHC Tote 90 KM 40 KM A District Udhampur Block Chenani 21. PHC Laldhar 115 KM 5 KM A Block Ramnagar 22. PHC Rang 103 KM 6 KM A District Leh 23 SDH Nobra A District Kargil 24 CHC Zanskar A 25 CHC Drass A 26 PHC Panikhar A District Bandipore 27 NTPHC A Sheikhpora District Kupwara 28 SDH Tangdhar A

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TABLE No: - 15

Table ‘B’ SHOWING CATEGORY OF CHCS & PHCS PROPOSED FOR SPECIAL INCENTIVE.

District Doda Block Bhaderwah S.No. Name of institution Distance by Distance on Category Road foot 1. PHC Chinta 233 KM B 2. PHC Premnagar 203 KM B Block Gandoh 3 CHC Gandoh 243 KM 2 KM B 4 PHC Changa 249 KM B 5 PHC Malanoo 205 KM 04 KM B Block Ghat 6 PHC Bhagwah 205 KM B Block Assar 7 PHC Goha 220 KM B District Kathua Block Bani 8 CHC Bani 250 KM B 9 PHC Lowang 265 KM B Block Billawar 10 PHC Machedi 146 KM B District Kishtwar Block Kishtwar 11. PHC Chingaon 276 KM B Block Paddar 12 PHC (Old) Paddar 340 KM B District Reasi Block Mahore 13 CHC Mahore 150 KM B 14. PHC Ghota 250 KM B 15. PHC Dharmari 120 KM B 16 PHC Arnas 140 KM B District Udhampur Block Basantgarh 17. PHC Basantgarh 140 KM B 18. PHC Latti 135 KM B Block Tikri 19. PHC Mongri 125 KM B

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District Poonch Block Mandi 20. CHC Mandi 250 KM B 21. PHC Sawajin 270 KM B 22. PHC Loran 261 KM B Block Mendhar 23 PHC Bruti 220 KM B Block Surankote 24 PHC Hari Marote 234 KM B 25. PHC Chandi Marh 222 KM B District Rajouri Block Drahal 26 PHC Gambir 210 KM B Mogla 27. PHC 210 KM B Shadrasharief Block Kandi 28 CHC Kandi 200 KM B 29. PHC Budhal 220 KM B 30. PHC Dalouri 200 KM B Block Sunderbani 31. PHC Upper Hathal 90 KM B District Ramban Block Batote 32. PHC Rajgarh 122 KM B 33. PHC Batni 160 KM 10 KM B Block Ukhral 34 PHC (Old) Ukhral 175 KM B 35. PHC Trigam 170 KM B District Leh 36. PHC Noyama B District Kupwara 37 PHC Machil B

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HEALTH INFRASTRUCTURE DEVELOPMENT PLAN (2008-2012)

A : BACKGROUND OF INFRASTRUCURE DEVELOPMENT PLAN

The Project report for Rs. 1051.57 Cr. for development of Health Infrastructure was submitted to MOH&FW / Planning Commission for seeking external assistance during 2004-05. It envisaged Rs. 933.18 Crores for civil work and Rs. 118.39 Crores for machinery / equipment. The Ministry of Health & FW and also the Planning Commission cleared the project and forwarded the same to Department of Economic Affairs, Ministry of Finance, GOI for approval. In a meeting Chaired by the Hon’ble Union Home Minister at SKICC Srinagar on 30th June 2007, the then Hon’ble Chief Minister observed that the submission of the project report to world bank for funding may take a long time and therefore, it may be a non-starter in the State. The HCM desired that the project be funded under PM’s Re-construction Plan instead of posing it to the world bank for funding.

Additional Secretary (Economic Affairs), Ministry of Finance, GOI convened a meeting on 18/09/2007 in which Commissioner Secretary, Finance & the Secretary, H&ME (J&K) also participated. It was decided that the State Govt and the Ministry of Health & Family Welfare will discuss the possibility of meeting the additional requirement of the State for upgrading its health infrastructure under the ongoing NRHM programme, with relaxation of some of the requirements, if necessary. If this is not possible, providing of funds for the project under the PM’s Re- construction Plan can be explored by the Planning Commission & the Department of Expenditure. The State Government reflected the requirement in NRHM PIP 2008-09. Subsequently, a modified version of Health Infrastructure Development Plan (HIDP) was submitted to Ministry of Health and Family Welfare GOI in September 2008. The plan was discussed in the Ministry and the State was asked to re-look the HIDP in light of their observations and resubmit the proposal. 151

B: INFRASTRUCTURE DEVELOPMENT PLAN

Objectives:

The focus of Infrastructure Development Plan is on financial closure of ongoing developmental projects (including construction/completion of new District Hospitals in newly created districts), construction of health buildings housed in rented accommodations including ISM dispensaries, providing adequate space in health institutions having in-sufficient accommodation and construction of staff quarters. The plan also envisages providing requisite equipments in health institutions besides, development of new infrastructure and meeting manpower requirements.

C: STATUS OF HEALTH INFRASTRUCTURE- PROBLEM AREAS Completion Cost of On-going Hospital Projects: Presently 221 important health institutions/projects are under execution in the State. Given the resources of the State, these projects are likely to stretch not only upto the end of 11 th Plan period but many of these may also spillover to the 12 th Plan. The total balance cost of these projects is to the extent of Rs. 961.85 Crores. It is imperative to mention here that the State has taken up the construction of District Hospitals in a big way on receipt of funding from GOI under NRHM and Additional Central Assistance (Prime Ministers Reconstruction Plan) and these need to be completed before the end of 2011-2012. Besides, there is need to augment/strengthen 6 specified health institutions by improving the infrastructure for which Rs. 109.15 Crores.

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D: Rented Buildings / Insufficient Accommodation: To provide effective health care services, it is imperative for the State to ensure that the health institutions are housed in well- designed govt. buildings and have sufficient accommodation as per the status. However, the position of the State is quite unsatisfactory on both the fronts. 2022 health institutions (including 267 ISM Dispensaries) are housed in rented buildings. Similarly 655 health institutions have in-sufficient accommodation. The problem is more complex in primary health sector which affects the health care delivery system of the State quite seriously. However, the summary details are as under;

Status of Health Buildings

Table: - 16

Sr.N Health Total no. Housed in Insufficient Rented bldgs o Institution of health Rented accommoda + Insufficient institutio building tion accommodat ns (%age to (%age to ion total) total) (%age to total) 1 CHCs/SDHs 85 - 19% 19% 2 PHCs 375 16% 43% 59% 3 Allopathic 238 53% 21% 74% Dispensarie s 4 SCs 1907 71% 18% 89% 5 MACs 346 63% 23% 86% Total 2951 59% 22% 81%

E: Health Institutions without Staff Quarters:

While expansion of health care facilities in the State especially in remote and far-flung areas is a priority, it is equally important to ensure good residential facilities for the doctors/paramedical staff who are working in these institutions. However the figures reveal that 40 (47%) CHCs, 146

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(24%) PHCs/ADs, & 411 (18%) SCs/MACs do not have staff quarters. These figures are related only to institutions which are housed in Govt. buildings and exclude those which are housed in rented accommodation. If rented buildings are accounted for, then 54% of PHCs/ADs and 88% of Sub-Centres/MACs are without staff quarters. This is a cause of serious concern for the State. The details are given as under;

Health Institutions without Staff Quarters

Table: - 17

S.No Name of the Total Health Health Health . Health No. Institutions Institutions Institutions Institution constructe constructe without d without d without staff staff staff quarters quarters quarters as (constructe %age of d and total Health rented) as Institutions % age to total health institutions 1 CHCs/SDHs 85 40 47% 47% 2 PHCs/Allopath 613 146 24% 54% ic Disp. 3 Sub- 2253 411 18% 88% Centres/MACs Total 2951 597 20% 80%

F: Infrastructure Gaps: On the basis of norms adopted by the State Government and projected population worked out at 30% decadal growth rate with respect to population of 2001, the State should have 112 SDHs / CHCs as compared to the existing number of 85. Similarly there should be 3940 Sub Centres/Medical Aid Centres while as only 2253 are sanctioned. There is no shortfall in respect of PHCs as there are 238 Allopathic Dispensaries. However, these Infrastructure Gaps are required to be met

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and phased out with reference to availability of resources. The details are given as under:-

Table: - 18

Existing and projected requirement of Health Institutions Population 126.02 130.40 134.31 138.34 142.49 (lakh Nos) (2007-08) (2008-09) (2009-10) (2010-11) (2011- @ 12) Facility Existing Requireme Projected requirement 2007-08 nt for 2007-08 2008-09 2009-10 2010-11 2011-12 District 22 22 22 22 22 22 Hospitals SDH/CHC 85 104 108 112 116 120 PHC 375* 383 392 403 415 428 Sub Centre/ 2253** 3692 3825 3940 4058 4180 MAC Total 2735 4201 4347 4477 4611 4750 @Calculated decadal growth rate of 30 as per the Population of 2001 * In addition, there are 238 ADs in the State. ** SC 1907 and MACs 346 N:B The requirement for opening of new health institutions for each category has been calculated after reducing the number of health institutions above that particular category. For instance CHCs have been worked out after reducing the number of District Hospitals. Similarly, for PHCs, the number has been arrived at after reducing the number of DHs /CHCs and so on.

G: LACK OF EQUIPMNTS

Facility Survey was conducted by EPOS Health India Ltd. As per the report, the institutions of the State as part of Facility do not have adequate equipments to provide effective health care facilities. The survey details the availability of equipments at CHCs/SDHs/PHCs and Sub-centres levels. In Jammu Division, only 44% of CHCs/SDHs have adequate equipments while as in Kashmir Division, the percentage is only 33%. Similarly at PHC level, 155

availability of adequate equipments is to the extent of 35% and 26% for Jammu/Kashmir Divisions respectively. The figures are more disappointing in respect of Sub centres where the availability is of order of only 23% and 20% for Jammu and Kashmir Division respectively. The details are given in a tabular form below: Table: - 19

Present availability of equipments in Health Institutions

S. No. Category of Institution (%age) of availability of equipments in health institutions

Jmu Kmr. 1 CHC/SDH 44 33

2 PHC 35 26

3 Sub Centres 23 20

H: Phasing of Plan

The Plan has been phased out with a view to arrive at realistic projections for requirement of funds on account of construction of health buildings and provision of equipments. Phase I includes provision for completion of all on-going works (some hospital modules have been projected in Phase-II), construction of buildings housed in rented accommodations in respect of PHC and SCs (50%), Insufficient accommodations for SDHs/PHC and SCs (50%), and construction of staff quarters for SDHs and PHCs (50%). Similarly phase second has been worked out which mostly relate to construction of buildings related to Allopathic Dispensaries, Medical Aid Centres, ISM Dispensaries and expansion of health institutions.

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I: Time-Frame:

It is proposed to implement Phase-I of the Infrastructure Plan in a span of 3 years from 2009-10 to 2011-12. Phase-II is proposed to be taken-up for a period of three years from 2012-13 to 2014-15.

J: Executing Agencies:

The Jammu & Kashmir Project Construction Corporation Ltd. shall be the executing agencies for construction of major health institutions in the State. However, for smaller projects, the works shall be entrusted to R&B Department. It shall be obligatory for the executing agencies to ensure the completion of the projects in a time bound manner.

K: Priorities:

Availability of manpower and work-load shall be the guiding factor for implementation of Infrastructure Development Plan. The priorities are , however, listed as under; (a) Completion of all existing on-going works and making them fully functional by providing equipments and manpower by the time construction is completed during the stipulated time frame. This would avoid further cost overrun.

(b) Health Institutions housed in Govt. buildings especially having services of specialists/doctors available shall be upgraded by providing requisite equipments and infrastructure facilities to ensure that their potential is utilized to the maximum.

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(d) Health institutions with high work load and located in districts other than capital cities of Srinagar and Jammu shall be given first preference.

L: Financial Implications: Financial implications for Phase-1 is Rs. 1105.42 Crores and for Phase-II Rs. 1221.96 Crores. Total cost of Health Infrastructure Development Plan is Rs. 2327.38 Crores.

N.B: (However, this excludes Rs. 300.00 Crores earmarked for meeting a portion of balance cost of on-going projects and Rs. 152.65 Crores required for providing salaries to the staff being created in various health institutions, as this would be borne by the State Government itself.)

M: Source of funding: The infrastructure development plan formulated earlier during 2004- 05 for external funding at the cost of Rs. 1051.57 Crores is a part of “Prime Ministers Re-construction Plan (PMRP).” Since the external financial assistance could not fructify over the years, it is proposed that GOI may provide special dispensation for funding the present Infrastructure Development Plan for both the phases under NRHM. It is imperative to mention that NRHM is also a part of PMRP. However, the State Govt. is committed to meet recurring cost in terms of salaries and maintenance of the existing/new health institutions besides providing enhanced allocations each year for various hospital project/works

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Table: - 20

Phase – I Summary of Funds required for Construction/Equipments for existing health institutions

Sr. Items Funds No. required (Rs. In Crores) A) Construction 1 Completion of On-going Projects (other than New 666.54 DHs) 2 Distirct Hospitals in newly created Districts 160.63 3 Aug/Strengthening of Health Institutions 98.43 4 Health Institutions in rented buildings 194.26 5 Health Institutions having Insufficient accommodation 192.48 6 Staff Quarters for existing institutions 47.20 Sub Total 1359.54 B) Equipment 7 Machinery & Equipment required for existing health 29.88 institutions 8 Machinery & Equipment required for DHs in newly 16.00 created Districts Sub Total 45.88 Total funds required 1405.42 Likely amount available under State Plan (2009- 300.00 12) Shortfall of funds 1105.42 Phasing of funds required to meet the shortfall 2009-10 300.00 2010-11 400.00 2011-12 405.42 1105.42

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Table: - 21

Phase - II Summary of funds required for Construction/Equipments for new/proposed health institutions Sr. No. Items Funds required (Rs. In Crores)

1 2 3 Construction (For Allopathic Dispensaries & MACs only) A) Completion of On-going Projects (other than New DHs) 134.67

1 Aug/Strengthening of Health Institutions 10.72

2 Health Institutions in rented buildings 485.22

3 Health Institutions having Insufficient accommodation 57.73

4 Staff Quarters for existing institutions 45.15

Construction of buildings for new health instituions (including 5 475.80 Staff Quarters) Sub Total 1209.29

B) Equipments (For Allopathic Dispensaries & MACs only)

6 Machinery & Equipment required for existing health institutions 2.35

7 Provision of Equipments for proposed/new health institutions 10.32

Sub Total 12.67

Total funds required 1221.96 Summary (Phase I & II)

Phase -I 1105.42

Phase -II 1221.96

Total 2327.38

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TECHNICAL COMPONENTS

PART A REPRODUCTIVE & CHILD HEALTH PROGRAMME-II

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Part A- RCH II

Reproductive and Child Health The vision of the State is to achieve the goal of ‘health for all’ as envisaged in the National Population Policy 2000 and National Health Policy 2002. The State aims to improve maternal and child health status by reducing maternal and infant deaths and to stabilise the population through the increased use of modern methods of family planning. The RCH II programme translates the above goals into specific objectives, strategic interventions and actions to realise the above stated goals by improving the reproductive and child health and achieving population stabilisation. Now RCH II is brought under the umbrella of the NRHM.

Goal

Improve overall health status of the people living in the state of Jammu & Kashmir. To improve the reproductive and child health indicators in the state of Jammu & Kashmir, as envisaged under NRHM, the National Population Policy (NPP- 2000), the National Health Policy (NHP- 2002) and the Millennium Development Goals (MDGs)

Objectives 1. Reduce Maternal Mortality from the current level to 100 by 2012 2. Reduce Infant Mortality from the current level to 30 by 2012 3. Reduce Total fertility rate from the current level to 2.1 by 2012

The state has adopted an overall strategy aimed at minimizing the shortcomings and constraints faced during the previous year’s 162

programme implementation, using innovative processes and activities along with institutional strengthening to improve service delivery. The technical strategies for improving health outcomes under the components of the RCH include: • Improving Maternal Health • Enhancing Neonatal and Child survival • Stabilising Population • Improving Adolescent health, and • Preventing RTI/ STIs

PART A- RCH II Progress of Component of RCH in the State Overall, the programme has achieved considerable progress within four years of its implementation. To begin with the program emphasis was on putting a situational mechanism in place, capacity building of the service providers and managers, strengthening program monitoring and review, and improving quality and coverage of the services. The major achievement during the recent years of implementation has been summarised below.

The State Health Mission and District Health Missions have been constituted and the all the societies constituted for national health programmes integrated in to State and District Health Societies. To meet the additional capacity requirements for RCH programme management, a state PMU has been established and 22 district PMUs for supporting implementation have been planned in the State Program Implementation Plan. These PMUs have consultants for supporting technical and institutional components of the program.

• Establishment of DPMUs: District PMU is functioning in 22 districts. 163

State PMU has been made fully functional. With the strengthening of state PMU, both, the technical and institutional components of the program have started delivering results. In view of peculiar geographical & administrative situation of J&K., Divisional level strengthening of the SPMU has been done by inducting Divisional Accounts & Divisional Data Officers among other support staff. This initiative has started giving results. The initiatives taken to reduce maternal mortality and morbidity through a range of good quality antenatal care, safe deliveries services, postnatal care, and safe abortion services have started paying dividends. Though the utilization pattern is yet to be analyzed, the off- take of services shows increasing trend, as has been reported from the institutional deliveries (21.9% NFHS-1, 35.7% NFHS-2, and 54.3% NFHS-3) in most of the districts, due to efforts made to strengthen these services. The TFR also shows a declining trend from 3.1 to 2.4 during the period of NFHS-1 to NFHS-3.

According to NFHS-3 (2006), there is 66.7 per cent coverage of routine immunization in the state. This has been achieved through extensive IEC campaigns, which were intensified following the launch of the RCH II programme in the state. This created increased awareness in the community leading to demand-driven routine immunisation even in remote areas of Jammu and Kashmir; the ANM is under pressure from the community to conduct maternal and child health sessions at regular intervals in villages. The state has an acute shortage of doctors and nurses, particularly in remote areas. (Doctors & paramedics do not join when posted in difficult areas) This was one of the main reasons why the programme could not be implemented to its full potential in the previous years. In the areas of child health, the state had taken 164

five districts to implement IMNCI (Integrated Management of Neonatal and Childhood Illnesses) programme. Due to unavoidable circumstances, in the year 2007-08 and 2008-09 IMNCI Training including other CH strategies could not be taken up. This primarily was because of inadequate faculty in both the Government Medical Colleges in the State, and also because of shortage of doctors/specialists within the health Department who could be spare for these trainings. However, in all districts, there has been a marked intensification of the routine immunization program, newborn care and critical newborn care through CHCs with the aim of reducing neonatal and infant deaths. IMNCI as Strategy, both pre-service and in-service is being taken up with vigour and all bottlenecks affecting this component are been removed. Because of acute shortage of medical officers and specialists in government run facilities, many CHCs render partial services in the absence of anaesthetists, Child Specialists and gynaecologists, especially in the Kashmir Division. There is an urgent need to find the ways and means to make it attractive for medicos and paramedics to take up residential postings in remote and difficult areas. These HR issues have been taken care of administratively and are under consideration of government for decision. However, this bottleneck would be addressed through budgetary provisions under NRHM so that an incentive can be paid to those who work in remote facilities. . All doctors/specialists, in- service or contractual would be incentivized to serve in remote areas. Additional, incentives are proposed for different categories and budgeted so as to overcome this bottleneck.

Infrastructure is another area that needs to be focussed on as a large number of government health facilities function from rented buildings that are not having adequate facilities. Once the renovations and repairs are completed, the facilities will be 165

adequately equipped and trained staff will be placed for FP (Family Planning) services. This effort would ensure increased access for RCH.

During the current year, the department would strive to bring about attitudinal and behaviour changes in health seeking behaviour of the community through an integrated BCC Strategy. All discrimination against the girl child before and after birth will be eliminated through coordinated efforts of all, within and outside the department. It shall try to meet people’s expectations and protect their rights, dignity and privacy and help individuals to take correct decisions with regard to their health.

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Table: - 22 Comparison of some Important Indicators in the State of J&K

NFHS-I, NFHS-II and NFHS-III (1992-93; 1998-99 and 2005-06)

S.No Indicators Jammu & Kashmir NFHS-I NFHS-II NFHS-III 1 Age at Marriage (Median) – NA 18.7 * Female 2 Neo Natal Mortality 31.9 40.3 * 3 Infant Mortality Rate 45.4 65.0 46.0 4 Child Mortality Rate 14.3 16.1 * 5 Total Fertility Rate 3.1 2.7 2.4 6 Contribution of Higher Order Birth 44.1 50.3 * 3 above 7 % of mothers received ANC 79.5 83.2 82 8 Contraceptive Prevalence Rate 49.4 49.1 46 9 % of children fully vaccinated: 65.7 56.7 65 10 Institutional Delivery (%) 21.9 35.7 54.3 11 Safe Delivery (%) 31.2 42.4 60.5 12 % of children with anaemia NA 71.1 55 13 % of women with anaemia NA 58.7 58.7 14 Unmet need NA 20.0 15 15 Exposure to Spacing NA 7.4 * 16 Exposure to Media [Women] NA 74.5 78

Sources: NFHS-I, NFHS-II and NFHS-III, 1993, 1999, 2007 . [*Detailed facts awaited]

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Maternal Health Strategies Main strategies to improve maternal healthcare delivery consist of those already under implementation and some with new dimensions. These are as follows: • Early registration of pregnant women through strengthened home visits and outreach programme including incentives to ASHAs for ensuring registration in first trimester.

• Increasing full ANC among pregnant women • Increasing institutional deliveries by providing basic obstetric care services by giving incentives for promoting institutional deliveries through Dais and ASHAs.

• Improving safe delivery services through Skilled birth attendants • Organising Integrated Village Health and Nutrition days for providing a wide range of services including counselling, antenatal and post natal check ups, TT vaccination and IFA distribution, immunization of children, distribution of oral pills, condoms, etc

• Integrated RCH Camps in underserved areas • Camps for Vulnerable Communities/Tribes • SBA Training for LHVs/SNs/ANMs • Multi- skilling of MOs for improving range and quality of services at sub centres, PHC and FRUs.

• Operationalising selected facilities for 24x7 days PHCs and FRUs • Training MOs for providing sterilization services [both male and female] to meet the significant unmet need for family limiting methods.

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• Emergency contraceptives training for MOs- as also creating awareness on their availability and use. Logistics for supplying emergency contraceptives will also be streamlined.

• IUCD Insertion Training for Staff nurses and ANMs • Increasing the demand for services by conducting Integrated communication campaigns to target different segments of population having unmet demand for family planning and also promoting acceptance of NSV. Also Demand Generation for services related to pregnancy through improving awareness levels among women for birth and complication preparedness. Outreach sessions conducted by medical officers ensuring availability of complete ANC services for pregnant women. • Improved implementation of Janani Suraksha Yojana through the involvement of ASHAs, AWWs, and village committees. As per guidelines, payment of the JSY benefits to mothers will be made through cheques to increase accountability and transparency of the scheme.

• Upgrading institutional infrastructure, putting qualified personnel in position and improving counselling skills.

• Towards improving the healthcare of neonates and children, establishing SNCUs in all DHs; establishing stabilisation units in all FRUs including the Creation of “Newborn Care Corners” in all the strengthened CHCs and PHCs in the state.

• “Integrated Management of Neonatal and Childhood Illnesses” (IMNCI) implementation in all 11 districts through training of providers, improved case management, health systems

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strengthening and improved household practices, thereby bringing down the prevalence of diarrhoea and ARI and other childhood diseases. Conducting folk-media campaigns and social marketing of ORS to supplement the activities will be part of integrated IEC/ BCC.

• Improving early and exclusive breast-feeding practices through a comprehensive BCC campaign.

• Promoting complete immunization of children by mobilizing the healthcare providers, providing knowledge and awareness regarding the same to community members. Ascertaining that all PHCs have vaccine depots and the cold chain system is streamlined and strengthened.

• PPP and Joint Venture initiatives for taking on board private practitioners and hospitals having the essential facilities and staff to provide emergency obstetric care services to BPL/SC/ST & people living in urban slums.

• Safe Abortion Services Training programs would be conducted for MOs working at CHCs/PHCs. This would ensure availability and greater acceptability of safe MTP services at the public health-care facilities. The ANMs would also be oriented to provide counselling advice regarding the appropriate time and safe methods of MTP and the location of the nearest available MTP clinic.

• Enforcement of PNDT act would be made more stringent. Awareness about its implementation would be given focused attention.

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• “Referral Transport Scheme” which entails providing referral transport charges to pregnant women requiring emergency obstetric care being strengthened. • Provision of AYUSH Doctor & additional Drugs as a special innovative activity for delivering services to the seasonal, temporary and shifting tribal and nomadic settlements.

• Providing “Quality Emergency Obstetric Care Services” by strengthening all the CHCs and selected PHCs.

• Conducting community level interventions including sensitization of VH&S committee members and community based organizations, and increasing awareness level among community regarding post-natal services with the help of state wide multimedia campaign, folk campaign, etc.

• Promoting local best practices for improving the nutritional status of community members

• Involve AYUSH/AMCHIs in RCH initiatives for additional coverage of services

• Identify and manage RTI/STIs in the community through strengthening linkages between AIDS Control Society and the RCH programme with training of all the medical officers and field level functionaries.

• Towards addressing the healthcare problems associated with adolescents, the Adolescent Health Initiative (AHI) is envisaged to achieve optimum development of the adolescents by promoting Adolescent Friendly Health Services (AFHS) at public

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health facilities. To implement the AHI, the lead role will be taken by the District Health Societies, in the first phase from the selected Districts, through District Partnership for Adolescent Health (DPAH)/ ARSH teams consisting of representatives from the Departments of Health, Education, WCD (ICDS), and others.

Other Interventions proposed under RCH-II Various cross-cutting issues have been taken up for strengthening the overall infrastructure and strengthening of the programme. These are:

• District action plans prepared for effective decentralized decision- making and implementation of the program. They are based on the local needs and conditions of the district with flexibility given for implementing locally relevant and innovative interventions for improving healthcare services in the state.

• As an integrated Health Management Information System (HMIS) is essential for efficient management of health data and reports, it is being strengthened as a priority. • Accelerating the reduction of maternal and child undernutrition through inter-sectoral convergence is another priority.

• Hoardings will be put up at prominent sites - displaying important health and family welfare messages in local languages.

• Management Development Programme (MDP) will be conducted for State, Divisional & District level officers to make them better managers. The module of MDP will cover programme planning, programme management, organization development, monitoring and evaluation with strong emphasis on state financial code,

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rules and regulations and other management techniques. Public Health Foundation of India has agreed to Support this initiative

• Urban health posts and health centres have been set up (in Jammu and Srinagar cities initially) to provide healthcare to the urban slums and cater to the health needs of the neglected urban poor population. Eventually, this would converge with the GoI proposed National Urban Health Mission activities.

• Convergence would be attempted between various state departments (such as health, public health, education and social welfare) including paramilitary forces and other agencies in the process of implementing various RCH-II activities

• Mobile Medical Units working in border Areas under support and supervision are being strengthened. Meagre salary being paid to doctors/paramedics working in this scheme is being raised through support from NRHM.

• Migratory Population of Gujjars/Bakarwals is being given special attention. In 2009-10, one AYUSH Doctor along with an AYUSH Pharmacist is being provided to all 78 Mobile Units that would move with the population to provide care with focus on MCH.

• Promote ownership of the programme by the community and the other health determinant departments through COMMUNITISATION. Kauna Trust has agreed to Train Trainers for VH&SCs.

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• Put in place Quality Assurance measures to improve the quality of services being provided at various levels by orienting health professionals towards providing good-quality services and attaining higher quality standards. QCI is being involved.

• Thorough accounting and audit procedures will be followed during the implementation as per the Financial Guidelines issued by the Ministry. • Furthermore, a performance-based financial evaluation and disbursement systems will be put in place.

• Partnerships with private providers and appropriate NGOs will be initiated, wherever possible in order to improve the availability and accessibility of services especially in areas that are remote and difficult to reach by existing government systems to improve outreach and health care delivery.

• Promote Gender Equity through the reduction of disparities between men and women and promote efforts to improve the health status of women by integrating with the existing system i.e. mainstreaming gender sensitive activities and providing women the power of choice of healthcare services.

• M & E cell of the J&KHS to put in place performance based evaluation and monitoring systems. Design objectively verifiable indicators for monitoring and evaluation of the program.

• . Concurrent Evaluation is proposed based on UP Model, developed under SIP. This would be done through PSM Department of the three Govt. Medical Colleges in the State. CE got delayed and MOU has been signed between SHS and the

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Nodal Officer (Senior Professor & Head, PSM, SKIMS, Soura, Srinagar, who heads the consortium of PSM Departments of the three Institutions, the other two being the two GMCs in the State)

The four components of RCH, that is, Maternal Health; Child Health; Family Planning, Adolescent Health and RTI/STI are described below giving the current status regarding the situation, problems faced and the strategies to be put into place. The activities proposed are then detailed and budgets are proposed.

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MATERNAL HEALTH Current Status The current and aspired status of these indicators is depicted in the tabular form as given below: Table: - 23 Goal The state goal for RCH-II is to reduce Maternal Mortality Ratio to 200 per 100000 live births by the year 2010.

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S.No Objectives Present status Expected outcomes NFHS III (2005-06) by 2010 1 Increase coverage and quality of NFHS III antenatal care MMR- MMR- < 200 TFR – 2.4 TFR – 2.2 3+ ANC – 74.2% 3 + ANC - 80% Consumed 90+ IFA –7.5% 100 IFA-60% 2TT/Booster-90% Prevalence of Anemia in ever Married women Age 15-49 53.1% < 45

2. Increase Institutional delivery Facilities (24x7) Increase facilities providing 24 DH – 14 14(All) hrs delivery services CHC - 85 85(All) PHC – 96 120 3. Increase Safe delivery NFHS III 70% Institutional delivery 54.3% Births attended by doctor/nurse 60.5% 75% 4. Increase coverage of timely 48 60% post-partum care 5. Increase access to quality Emergency Obstetric Care: Basic Emergency Obstetric Care at PHC PHC – 96 120

Comprehensive Emergency DH – 14 14(All) Obstetric Care at DH/CHC CHC –39 57

6. Provide quality RTI/STI DH – 14 14(All) screening and treatment CHC -85 85 facilities PHC -- 120

7. Provide comprehensive DH – 14 14(All) abortion services along with CHC- 70 85 quality MTP services at PHC – 45 120 BPHCs and above. 44.9 65 Couple Protection Rate

Source: NFHS-3 and RCH II -2007-08 document 177

Maternal and Reproductive Health: Even though no estimates of maternal mortality are available, the maternal mortality could be taken to be approximately similar to that reported at the national level. It is thus, assumed that the state’s maternal mortality would also be approximately 300 maternal deaths per 100,000 live births. One of the RCH program’s main goals is that each pregnant woman receives at least three antenatal check-ups, two tetanus toxoid vaccines and a full course of iron and folic acid supplementation. In J&K, 85 per cent of mothers received antenatal check-ups as per the NFHS-III. The all-India average for antenatal check ups is 65.4%. Of all the antenatal women, 27.5 percent received iron and folic acid supplementation during their pregnancies. Two tetanus toxoid injections were given to 78% of all pregnant women. Table below gives the targets and achievements in the state during 2006-07,2007-08 and December ending 08 in terms of TT vaccine administration.

About 54 % of women delivered their child in a medical facility and remaining were deliveries conducted at home. 60.5 % of births in the State were attended by a health professional, including 34% of these by a doctor and 7% by an ANM. In J&K, while traditional birth attendants attended about half the births, friends, relatives and others attended another 7%. Only 28 per cent of births which had taken place outside the institutions were followed up for postpartum checkups within two months of delivery. Majority of women in the state did not receive postpartum services. Women are not consuming adequate quantity of IFA during their pregnancies. The RCH-II programme in the state would focus on informing pregnant women about the advantages of IFA and TT vaccines and ensure that anaemia Free J&K becomes a reality.

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Table: - 24 Targets Achieved in Provision of Antenatal Care services in the State

Vaccines/Coverage Jammu & Kashmir

TT (PW) II+B (% achieved)

Target (No.) 344239

Achievement. 05-06 240410 (69.8 %)

Target (No.) 375800

Achievement. 06-07 269468 (71.7 %)

Target (No.) 294600

Achievement. 07-08 175678 (59.6%)

Target (No) Ending December 08-09 278743

Achievement. Ending 08-09 170711 (61.2%)

Source: as per Department of FW, Government of J&K,

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Breast Feeding Practices:

Initiation of breastfeeding Percentage of children born during the three years preceding the survey who started breastfeeding within one hour and within one day of birth and percentage of children 0 to 5 months exclusively breastfed & children 6-9 months receiving supplementary foods in addition to breast milk.

Table :- 25

%age of % of Children % of Children age 6- children under age 0-5 9 Months receiving 3 years Months solids or semi-solids breastfed exclusively food & breast milk within 1 hr of breastfed birth J & K 34.8 41.7 56.9 NFHS II J&K NFHS 31.9 42.3 58.3 III

Interventions proposed for Maternal Health under RCH-II For reducing MMR, all women must have access to high quality antenatal, natal, postnatal, referral and EmOC (Emergency Obstetric Care) services. This is possible through the following key interventions: • Achieving 100% registration of pregnancies preferably before 12 weeks. • Providing minimum three ANC check-ups. • Training of SBAs (Skilled Birth Attendants)

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• Promoting safe deliveries: 80% institutional deliveries and 90% by Skilled Birth Attendants.

• Strengthening Postnatal Care. • Referring high-risk cases. • Mechanism for transportation of complicated cases to appropriate facilities.

• Strengthening of Preventive and curative services for RTI/ STI management

• Training of MOs in EmOC and Anaesthetic Skills for c- sections and in CH.

• Training of MOs and LTs for safe blood storage at CHC & FRUs • Strengthening observance of VHNDs with focused attention on MCH. • Integrated RCH out reach camps especially in underserved and difficult areas

• Camps for Vulnerable /Tribal Population • 78 established Mobile Health Units that move with the migratory population (Gujjars/Bakarwals) are being strengthened. One AYUSH Doctor is being provided in addition to the existing staff.

IMPLEMENTING STRATEGIES FOR IMPROVING MATERNAL HEALTH

Though the percentage of ANC registration in the first trimester is 54.8, the state aims to achieve 70% early ANC registration by 2010. The strategies proposed include increasing the coverage of Village health and Nutrition day and improved field/ household visits of ANMs along with the involvement of ASHAs in identifying and motivating for early registration of pregnancies.

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1. Increasing early Registration and ANC Component among Pregnant Women Increase in early registration, especially in the first Objective trimester, from 54.8% (NFHS II) to 70% by 2010. • Low awareness about importance of early registration and ANC among pregnant women and their families Problem • Inaccessibility to services in difficult areas Identification • Age old myths and misconception put ANC as lesser priority among community • Lack of group interaction at grass root • Increasing awareness about importance of early registration through IEC/BCC • Organising outreach ANC sessions on fixed days in rural areas in sub centres/villages by LHVs assisted by ANMs on fixed days. • More focus on Home visits by health workers/ASHAs • Organising weekly ANC clinics at FRUs, 24 x 7 facilities, CHCs and PHCs. Strategy • Organising ANC clinics sessions in remote, tribal and inaccessible areas through mobile health units. • Organising Integrated RCH Camps in underserved areas of the State • Involvement of AYUSH and private practitioners and institutions as well as NGOs in popularising the concept. • Increasing coordination linkages between

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ASHA/AWWs and ANMs to know about presence of pregnant women. • Provision of special incentive for AWW for VH&ND • Provision of special incentive to ASHA for early registration • Provision of drugs and equipments required at Subcentre and PHC/CHC level • Incentive proposed to AWW for organising monthly VH&ND will go a long way in improving coordination between ICDS/Health Dept. • Mechanisms for early registration need to be strengthened through better coordination Support needed between Health Dept & ICDS. for implementing • Special incentives to be given to village that has changes the maximum early registrations (to be earmarked from state budget ) • Community based organizations and religious institutions to be involved to promote early registrations • The Out reach sessions on fixed days will be organized in rural areas on fixed days by LHVs assisted by ANMs • AYUSH functionaries will also be involved to provide ANC services during RCH sessions. Activities Monthly RCH sessions will be organized by AYUSH departments in all ISM dispensaries in the rural area in the state for better coverage of services. Funds earmarked in the Budget. • ANC outreach sessions will be inbuilt activity through MMU routine session. In addition

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Integrated RCH camps will also provide ANC services to strengthen ANC services in Remote and difficult areas • The comprehensive IEC strategy will be developed and activities will be carried out with support of different agencies, including MNGOs and FNGOs for demand generation for Early registration and complete antenatal check ups .( Discussed in IEC/BCC) • AWW being provided a special DRUG KIT • ASHA will be provided an incentive @ Rs. 50 per case to ensure registration of pregnant women in first trimester • VH&ND will be used to promote ANC • JSY will be implemented effectively to increase the ANCs especially among women belonging to BPL/SC/ST families • The Sub centre Kit-A, Kit-B, PHC kits will be provided along with other required supplies to all rural health facilities. • The Routine monitoring will be ensured and also revised in quarterly meetings

Time needed to On going process started in April 2008 is to continue implement during the plan period 2009-10 changes

Fixed ANC sessions, effective outreach programme, involvement of mobile medical units and AYUSH Sustainability functionaries, support from AWW, ASHA and convergence with other sectors as well as involvement of private and voluntary sector would 184

sustain this activity.

3 ante-natal check ups in at least 90% of Benchmarks BPL/SC/ST pregnant women in the year 2009-10. Derived from the Increase in Complete ANC among women in all Components categories

Component 2. Promoting Safe deliveries

Objective Promotion of institutional and safe deliveries assisted by SBAs • As maternal health indicators for Jammu and Kashmir are not very encouraging, there is a need to generate demand for ANC,NC and PNC services.

• MMR is 300.9 per 100000 births, IMR 51 per 1000 live births

• Reasons for low demand are not only related to travel, cost or time but most of the women Problem believe that there is no need to access such Identification services.

• Since pregnancy is considered a normal phenomenon and not a special condition, many women do not feel the need to access health services during the course of pregnancy.

• Only 4% SCs and 18% PHCs have labour rooms therefore the strengthening of infrastructure is required in rural areas • Providing Skill birth attendance (SBA) training to MOs/ Staff nurses/ LHVs and ANMs to improve Strategy services in Health facilities in rural areas. • Adequate capacity building of health care service 185

providers in counselling and provision of IEC material especially at CHC, PHC, and SC levels • Providing Basic Obst Care in PHCs • Operationalising CEmOC services in all FRUs in phased manner • Developing partnership with private hospitals, trust hospitals, etc for BEmOC. • The institutional infrastructure will be improved, contracting of staff nurses already done shall be monitored for performance • The mechanism for easy accessibility through Referral Transport developed would be further strenghtened . • Advocacy for inter sector collaboration in improving Safe delivery • Provisioning of adequate supplies of medicines & drugs and equipments at all levels in public sector • Annual evaluation of IEC/ BCC campaign will be conducted to know about the reach and effectiveness of messages. Necessary modifications will be made in communication strategies to make them more effective. • Coordination in State and District IEC strategy implementation • Support from AIR, FM and TV channels Support needed • Support from CBOs, religious institutions and for implementing other partners organisations changes • Technical assistance agency for developing BCC strategy and its implementation and concurrent evaluation. 186

• Capacity Building through SBA training : 1. Divisional level workshop for ToT for Skill birth attendant (SBA) proposed 2. District Level training of staff LHV/SNs/ANMs/ for SBA at District hospitals proposed 3. Monitoring of SBA Training by experts from within the State and outside so as to ensure the quality • The PHCs will be strengthened in phased manner to provide 24 hour services • All FRUs, CHCs, PHCs will be provided with necessary equipment, furniture, consumables, and medicines without duplicating the existing resources. • Private clinics, hospitals and practitioners will be Activities identified and involved in various schemes for increasing institutional deliveries for BPL/SC/ST & population living in Slums. • The institutional deliveries will be promoted through counselling and referral of cases to appropriate health facility in monthly Integrated Village Health and Nutrition days • The identified cases will also be counselled and referred for institutional deliveries during RCH sessions at ISM dispensaries, Integrated RCH camps in remote areas and services rendered through MMUs • A comprehensive IEC strategy will be developed and implemented to increase the demand for Institutional deliveries • Wide publicity will be given to Janani Suraksha

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Yojana through the RIS teachers, ANMs and AWWs networks to increase institutional deliveries among BPL/SC/ST. • Private transport owner’s network in remote rural areas of hilly districts will be created for providing transport to pregnant women particularly during nights. • The referral transport scheme will be implemented to encourage the institutional deliveries • The regular quarterly monitoring of all maternal health strategy will done by state as well as districts

Time needed to On going process started in April 2008 is to continue implement during the plan period up to 2012 changes Sustainability Will be reflected in the improved indicators

Benchmarks 3 ante-natal check ups in at least 90% of Derived from the BPL/SC/ST pregnant mothers and 80% institutional Components deliveries in the year 2012.

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3. Integrated RCH camps for RCH package in Component Difficult areas • To increase the access to Health services in remote and underserved areas through Camps, till such time as the Rural Health Care system becomes fully operational to render Primary Health Care. • RCH Services including detection & treatment of Hypertension, Diabetes, increase the coverage with focus on National Disease Control Programmes (Control of Blindness, Objective TB, HIV/AIDS, Leprosy among others) • To provide an array of good quality RCH services in a safe, client friendly and infection free environment. • To involve the Community in providing Reproductive Health Care to create awareness and generate support.

The Health care services in various remote/ difficult areas are very limited and therefore inaccessible to Problem Identification people.

The integrated Camps for Complete RCH Package are planned to render services in remote, underserved and un served areas in the state. Strategy and Different underserved PHCs will be selected activities covering difficult areas in all the medical blocks of the state and the integrated RCH camp shall be organized after every two months in the year 2009- 10. These Camps will be held once in two months

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on a pre determined date. The Place of Camp will be the PHC situated in remote /tribal/difficult areas. Six Camps will be conducted in the selected PHCs per year. Site of RCH Camps:

Different underserved PHCs in a block will be selected and IRCH camps will be organised every 2 months on pre-determined date. i. PHCs (Well Equipped):- having an Operation Theatre and equipment for MTP, Sterilisation, IUD Insertion and MVA Kits etc. Generator present/hired. ii. Remote PHCs (not fully equipped):- Lacking adequate facilities, the surgical procedures will not be carried out in the camps held in these areas. All other services, including IUD insertions , however, will be carried out. Service Providers:- The team of Gynaecologist, Paediatrician Anaesthetist (in case sterilization operations are also conducted),MOs, Staff Nurse, Lab Technician, LHV, Theatre Assistant, ANM, Sweeper will provide services during Camp Range of Services to be provided:-

Antenatal Care i. Counseling on Safe deliveries Post Natal Care, Identification and management of any complication. ii. MTP Services

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iii. IUD Insertions iv. Sterilization v. Post Camp Follow up vi. Counseling on birth spacing vii. RTI/STI Management and counseling including for HIV/AIDS viii. Management of other gynaecological problems ix. Immunization services x. Services for other National Health Programmes xi. Management of newborns and childhood diseases – ARI/Diarrhoea xii. Adolescent Health xiii. Detection of Hypertension, Diabetes xiv.Laboratory services – HB, Blood Group, Blood Sugar, Urine examination, slides for RTI/STI examination. xv. Referral Wherever cases requiring referral for treatment are identified, facilities to transport them should be provided as part of the camp. Patients treated at the camps should be made aware of the nearest referral facility where they should go in case of any problem.

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Other Activities : i. Calendars should be prepared for at least a month in advance and publicized through banners and Interpersonal communication (IPC). ii. Essential Equipments for under utilized PHCs like laparoscopes if required will be got by the team coming from District Hospital, FRU or Medical College. Essential equipment for the Remote PHCs needs to be transferred from the FRUs/CHCs well in advance of the date of the Camp. iii. For Transportation, vehicles need to be fixed and budget for POL provided to transport doctors to Camp sites and to provide transport for sterilization clients. iv. Recurring cost for Medicines, Consumables, transportation and publicity will be given per camp basis. v. All arrangements will be made by the CMO’s office with active participation of Deputy CMO, DIO, & DHO. All the required equipment and supplies will be dispatched from the district to Camp site well in advance. vi. It would be ensured that all patients attending the camp are provided free

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medication. The patients, who have undergone any operative procedure, would be given a full course of antibiotics for at least 5 days. Antibiotics like Amoxycillin, Ampicillin may be prescribed. vii. National AIDS Control Organization conducts National Family Health Awareness campaign periodically. Since RCH Camps also provide services relating to RTI/STI and counselling for HIV/AIDS, RCH camps and the awareness campaign by NACO are compiementary to each other and will be organized simultaneously.

Publicity i. Publicity is needed to make people aware of the constellation of good quality services available near their doorstep. The services available will be listed in wall paintings at Campsites and at prominent places. Cloth banners at Road Crossing will be put up in all large villages, fairs and markets. ii. The specific information will be provided to the community regarding the details of services available and not available at the camps. iii. A few days prior to each Camp, pre recorded loud hailer messages with attractive jingle set to film music will be played in towns and in important markets and villages in the catchment area of each

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Camp to attract prospective clients. Loud speakers placed in rickshaws will be used for announcement of date and place of the Camp. iv. Opinion leaders, Religious Leaders & NGOs will be involved in Community Mobilization. v. The ANMs, ASHA, AWW, MSS, TBA will also motivate patients to attend RCH Camps.

Monitoring and Evaluation : I. Pre Camp Monitoring :- Camp Planning Checklist to be completed for Manpower requirement, Publicity actions, campsite arrangements, Transport provisions , Arrangement of medical equipments and medicines The role and responsibilities are fixed and communicated to respective officials for necessary actions

II. Camp day/follow up Monitoring :- Each camp will be attended by CMO or Deputy CMO of the district who will be responsible for providing support in mobilizing cases and closely monitoring the quality at sites and follow up of cases. A Divisional level review of approach to RCH Camps to be attended by CMOs, Deputy CMOs, DIOs & DHOs would be

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held every 3 months to identify and solve problems under the Director Health Services of the Division.

III. Other information part of the review systems of Camp:-

• District schedule for the RCH Camps along with Camps actually held • Progress and Financial Reports of Camps held by the district. • Deputy CMOs/ DFWOs Quality Assessment Report for each Camp

IV. Evaluation should be done by an external agency. The evaluation could be on Impact assessment, effect on regular services, quality of services provided, number of clients served and range of services provided

The publicity will be as per above mentioned strategy and also part of comprehensive strategy developed with technical support agency mentioned in IEC/ BCC chapter

Support needed Collaboration with WCD, Civil society organizations, for implementing MNGOs, FNGOs changes and CBOs Collaboration with WCD, AYUSH, Mass media

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Time needed to On going process started in April 2008 is to continue implement during the plan period upto 2010 changes Reduced morbidity and mortality and demand Sustainability generation for seeking health care services Benchmarks Increased access to ANC/PNC and basic health Derived from the care services in remote, inaccessible and difficult Components areas

Component 4. Referral Transport system

Ensuring access to the health facilities for safe Objective institutional delivery specially in case of emergency Problem • Availability of Transport especially at night is a Identification problem faced by almost all the pregnant women in the state in rural areas • Availability of Transport is particularly scarce in remote and inaccessible areas. • The non availability or delayed availability of transport facility leads to serious problems in case of emergency referrals • Due to lack of systematic provision of transport the private transporters charge exorbitant price which is not affordable by many people

Strategy 1. Emergency Referral transport for pregnant

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women and sick new borne Referral Transport Schemes entails providing Transport facilities in shape of cash/PoL for ambulance to a pregnant woman including serious newborn infant/child in emergencies from PHC/Block to the nearest FRU/DH. A maximum amount of Rs. 1000.00 per case has been earmarked. The District Health Society will decide the detailed modalities including rate to be paid in their respective District to the beneficiaries, based on local conditions. DHS, would formally decide the rates, and same will be circulated to all MOs in-charge. The funds will be kept with the Medical Officer in-charge of the institution who supposed to reimburse the amount to the actual payee against proper receipt. Full particulars of the beneficiary shall be sent to District Health Society for incorporation in the quarterly/monthly physical/financial progress for State Health Society.

1. A transport owner network at state or divisional level and for id entified difficult and remote areas covering all the districts will be established. The Modus operandi shall be decided by State Health Society and Respective District Health Society. The detailed operational frame work for the same will be developed keeping in view the local availability of transporters/ taxis operators,

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local conditions, terrain, road accessibility conditions etc for the district. (The preparation of detailed operational frame work may be out sourced to external technical support agency.) 2. Publicity : The referral transport facility schemes will be popularised among the providers and community 3. Periodic Monitoring of the schemes • Coordination with local transporters • Private Public Partnerships • Govt level decision for involving expert private Support needed agency to develop detailed operational for implementing framework as done in West Bengal, Himachal changes Pradesh and some other states • Joint ventures with private practitioners • Special incentives for Doctors /ANMs attending to the referrals • The locally available private transport facilities will be mapped and listed at state, division and district level especially in rural and remote areas. • It is proposed to prepare a village-wise referral plan for EmOC by ANM along with ASHA. The plan would consider the available resources Activities in and around the villages. Referral transport, in some case, would involve travel from hills or remote are to the connecting road, from where Referral transport is available. This may be on ponies or manually by Doli etc. The caseload and local resources / private transporters availability plan will be shared with

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Distt. Health society, which in turn will frame the detailed operational framework. The Private transporters will be invited to participate under PPP for 24 hr emergency transport facilities. The selected Private partners will be empanelled after signing the contract with DHS The details of rate/ KM for different places and contact points & details of empanelled Private partners will be publicised through wall paintings, mass media ( AIR- Doordarshan- local channels) among the community. The detail of operational scheme will also be shared with all health facility in-charge. The provision of Rs. 3 Lakh for establishment of Private transport network at state/ division is made in year 2008-09, and to establish these services in remote and rural areas in all districts, Rs. 75000 per district is allocated. The schemes will be monitored and reviewed by District and State Health Societies at district and state level respectively on quarterly basis.

Time needed to On going process started in April 2008 is to continue implement during the plan period changes

Will be reflected in the improved maternal and child Sustainability health indicators.

Benchmarks Safe deliveries with minimal maternal and infant Derived from the loss of life Components Increased Institutional deliveries

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5. Comprehensive Emergency Obstetric Care Component Services (CEmoC) Improving Basic /Comprehensive Emergency Objective Obstetric Care Services • 57 facilities are expected to be functional as FRU and 120 facilities for providing 24 x 7 services by 2010. All first referral units are expected to provide emergency obstetric care services. However, majority of these facilities are not fully equipped to provide such services. • There is a need for comprehensive area specific operational plan for making these facilities fully Problem Identification functional • There is a shortage of gynaecologist, paediatricians, and anaesthetists especially in Kashmir valley due to non-availability of these specialists even in the Private Sector. • Mobility and Transport especially at night is a problem faced by the health care providers as well. • Development of a comprehensive operational plan for making selected facilities fully operational as FRU, 24x7 service providers, • Human Resources : Strategy i) To meet the deficiency of specialists like gynaecologists, anaesthetists and child specialists the special training for MOs in both the Government Medical Colleges

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with support of FOGSI is proposed in phases. Master Trainers trained at CMC Vellore ii) Hiring of specialists for identified facilities iii) Special incentives to specialist ready to provide services in remote FRUs/PHCs iv) Contractual ANMs/Junior staff Nurse would be employed for making PHCs operational for 24-hour delivery services. v) Hiring of other support staff in identified facilities • Physical infrastructure improvement i) OT facilities will be improved and blood storage facilities will be set up in the identified FRUs. ii) In addition to providing 24 hours electricity and running water, generators, including overhead/ under ground water storage tank with pumping facilities would also be provided to the identified FRUs [solar facilities to be experimented with]. • Ensuring provision of medicines, drugs and other supplies to all the facilities identified as FRUs and 24x7 facilities • Ensuring provision of reagents and other supplies to all the facilities identified as FRUs and 24x7 facilities for blood storage units • Ensuring Provision of ambulance/ transport facilities for referral • Developing partnership with private

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hospitals, trust hospitals, etc for CEmOC.

• Coordination with local transporters • Private Public Partnerships, the Punjab Model of Support needed SURAKHIT JANEPA YOJNA (SJY) is being for implementing replicated in State and stand budgeted changes • Special incentives for MOs/ANMs attending to emergencies successfully • Two state level workshops will be organized to develop a need based comprehensive plan for making all identified FRUs, and 24x7 facilities fully operational as per the IPHS. The comprehensive plan will also include the detail plan of action to strengthen MTP, RTI/STI management services and other services required to execute the proposed strategy for improving the maternal and child health indicators • Essential personnel required to operationalize Activities the facilities will be placed / recruited/ hired including Specialists, Doctors and other paramedical staff ( the details are covered under HR chapter ) • To operationalize the selected facilities in Kashmir valley for 24x7 services the Specialists i.e. Gynaecologist , Child specialist and Anaesthetist ( for each 12 selected facilities) will be hired @ Rs 30000 PM • Special incentives will be provided to specialists (Gy naecologist , Child specialist and Anaesthetist) who are willing to serve in

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identified FRUs functioning in remote areas in the state of J&K • Private institutions will be identified, accreditation will be given to private hospitals having all facilities and staff to provide emergency obstetric care service • Availability of referral transport will be ensured through private transport network and referral transport scheme. • OT, blood storage facility, consumables and medicines will be provided in adequate quantity to all FRUs. • All FRUs will be linked to nearest blood banks, through telephone networks and a mode of transportation. • Generator sets will be provided to the FRUs wherever not available and adequate budget will be provided for diesel and maintenance for the rest of the CHCs. • PHC MOs, staff nurses, ANMs and LHVs at each upgraded facility will be trained in clinical procedures, counselling, infection prevention and teamwork as a part of the IMNCI and other trainings. • The MOs will be trained in EMOC Skills at Master Nodal Centre under NRHM with technical support of Medical College and FOGSI at state and district level . • 3 day training of the two teams comprising of 4 participants (2MOs s and 2 Lab technicians) in blood transfusion for all the districts will be

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organized at GMC Srinagar/ Jammu • CHC MOs will be trained in local anaesthesia techniques at the Government Medical Colleges (Department of Anaesthesia). This training programme will be of 3 months duration and Mos will be trained to have one trained person in each CHC. • The quality services will be ensured through periodic district health society and State QA cell Time needed to On going process started in April 2008 is to continue implement during the plan period up to 2010 changes Will be reflected in the improved emergency delivery Sustainability services. Benchmarks Safe deliveries with minimal maternal and infant Derived from the loss of life Components

Component 6. Strengthening of MTP Services

Decrease in Maternal morbidity and mortality, due to Objective unsafe abortions 1. Unsafe and poorly conducted MTP endangers the life of the woman undergoing the procedure. 2. The stigma and cultural taboos involved with the process of getting an abortion done make it Problem absolutely necessary to protect the confidentiality Identification of the women seeking care, besides providing safe and reliable abortion services. 3. Most of the abortions are due to non-use of contraceptives even after completion of

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desired family size. 4. Some of the abortions are also due to son preference. 5. Women spend significant amount of money on abortion services. 6. Women have a tendency to seek abortion related services from untrained/ quacks due to lack of awareness

Safe Abortion services will be provided to the population of Jammu & Kashmir through the following strategies:

• Creation of the necessary physical infrastructure including the MVA service availability in all 24x7 facilities • Capacity building of MOs/ SNs of all facilities having MTP facilities. The preference will be given to MOs who are not trained yet ( In last five years 175 doctors have already being trained ). Training of Strategy MOs and SNs in MVA techniques is also taken up. • Un-interrupted supply of all the equipments and drugs/ medicines and MVA e quipment to Public health facilities having MTP Centres • IEC /BCC activities to generate awareness about removing myths and misconception, promotion of Service availability in Public health facilities and various provision of MTP act • Effective implementation of MTP act provisions in the state including registration 205

and monitoring of private sector MTP centres

Private Practitioners Support Support needed Support from Training institutions at the state for implementing and District level changes

• 15 days training for master trainers for Safe MTP services including MVA technique will be organized at GMC Jammu for MOs of the State. • After completion of training the trainers will act as resource persons in district Level trainings. • 12 Days Training on MTP and MVA technique for 4 participants ( 2 MOs & 2 staff nurses ) will be organized in GMC, Jammu from each District. • MVA Kits having ( Cannula No. 6,7,8,9 ) along with other required equipment necessary for providing MTP services will be provided to the Activities CHCs and PHCs. All FRUs, 24x7 facilities will be covered on priority. • All other MH- training programmes conducted for ANMs, LHVs and MOs will emphasize the need to maintain confidentiality and privacy. • Strict Implementation of MTP act will be constantly reviewed and all necessary measures will be taken by the registrar in the district for public and private sector • IEC campaign will be launched addressing both private and public health service providers and also general community of MTP act. Time needed to On going process started in April 2008 is to continue implement during the plan period upto 2010

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changes

Will be reflected in the improved safe abortion Sustainability services. Benchmarks Increased access to MTP services and Safe Derived from the Abortions with minimal loss of life Components

Component 7. Post-Natal Care Services

Improving Post Natal Care Services and ensuring Objective three PNC contacts • In Jammu and Kashmir, 48 % women avail services after the birth of their child. • Percentage of women availing themselves of these services varies substantially between regions and districts as well. Problem Identification • The proportion of rural women availing themselves of this service is lower as compared to urban women. • Infrequent field visits of ANMs limits effective outreach services to the mothers. • Ensuring home visits (ANM, AWW, LHV) within three days of delivery in case of home delivery • Increasing awareness levels among community Strategy about advantages of post-natal services with the help of state wide multimedia campaign, (including folk campaigns ) • Establishing suitable linkages with the health

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facilities and ensuring that the health facilities are equipped to handle any post natal emergency

• Support needed Public Private partnerships • for implementing Supply of need based equipments and changes instruments as well as drugs and supplies. • ANMs/ LHVs / SNs / CHOS and others will be oriented about the need for post-natal services as well as a part of IMNCI training. • Provision of neonatal care and integrated mother-child care during PNC visit. • IEC materials on post-natal services will be provided and ANMs/LHVs will be trained in the Activities use of IEC materials in the above-mentioned training. • ANMs will coordinate with ASHAs, AWWs and TBAs for field movement plan and provide services • Folk campaigns on post-natal services will be integrated in second and third phase of the campaign for increasing demand for pregnancy related services and thereby also increasing the utilization of services at the public healthcare facilities.

On going process started in April 2008 is to continue during the plan period Time needed to implement Changes

Sustainability Will be reflected in the improved PNC.

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Benchmarks Reduced maternal complications and deaths Derived from the during post partum period. Components

Component 8. RTI/ STI Services

Decreasing the prevalence of RTI/ STI in population Objective especially among women • More than one third of the women reported Problem having one or the other kind of reproductive tract Identification problem.

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• The proportion of women having such problems was much higher in the Kashmir region as compared to Jammu, though the incidence was almost similar in both rural and urban areas. • In general 63% women do not seek any kind of treatment for RTI/STI. • Majority of those who seek treatment do not depend on government health units for services. Most seek services from private practitioners and quacks, which add to mounting health care cost to families. • Capacity building of health officials in RTI/STI management • Providing RTI/ STI services in all facilities with curative care services at PHC –level upwards • Providing Counselling at all health facilities. Strategy • Early referrals to appropriate facilities • Establish strong linkages between HIV/AIDS programme and RCH programme. • Creating public awareness about RTI/ STI, source of treatment, and importance of timely treatment including partner treatment. •

• Partnership with private providers

Support needed • Training of MOs and other staff for implementing • Provision of RTI/ STI reagents and drugs in changes PHCs and CHCs

• ToT for MOs as District trainers for RTI/STI case Activities

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management for 2 Days at GMC Jammu/ Srinagar for 24 trainers • Training of ANMs/SNs/Med. Astts./ Lab astt.s for 12 selected districts for 2 days each having 30 participants • Strengthening Laboratory services and supply of drugs, reagents, VDRL kits. • All ANMs and female supervisors will be oriented in identifying RTI/STI symptoms and counselling skills. • Diagnostic facilities will be strengthened at all CHCs and PHCs by equipment and supplies. • Coordination linkages will be established both at the state and the district level with HIV/AIDS interventions.

Time needed to On going process started in April 2008 is to implement continue during the plan period upto 2010 changes

Sustainability Integrated into PHC services

Benchmarks Derived from the Components Increased community awareness and decreased prevalence of RTI/STIs.

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Component 9. Anaemia among Women

Objective Reducing anaemia among women

• In Jammu & Kashmir more than fifty percent women suffer from anaemia. • The nutrition status of the women in the state is poor with almost one-third of the female population being undernourished. • Nutritional deficiency is more in rural areas than Problem urban. Identification • The nutrition status of women in reproductive age group is much poorer in the Jammu region as compared to Kashmir. • About 55 percent of women in Jammu and Kashmir are moderately to severely anaemic.

To reduce the incidence of anaemia in women following strategy will be followed: • Ensuring that the health facilities and the outreach health staff are trained at identifying the symptoms of anaemia and provide suitable guidance to the adolescent girls and women • All the necessary supplements (IFA tablets etc) Strategy are available at all the health facilities • Creating awareness among the community to identify anaemia and the local dietary supplements required to counter it. • Awareness about services available at the health facilities to prevent and control anaemia. • Targeting anaemia eradication during

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Adolescence ( 12 by 12 Initiative) through IEC/BCC being taken up in first phase • The mass media campaign including folk media

• Coordination between VHWSCs, ANMs, AWWs, Support needed ASHA for implementing • Regular supply of IFA tablets to health facilities change and depot holders. Additional supplies proposed through ASHAs/AWCs • Folk performances and other BCC activities will be integrated with other maternal health interventions such as increasing the early registration of pregnancy • Appropriate information for anaemia prevention and control will be provided in VHNDs. • Multipurpose depots stocking IFA, condoms, oral pills, ORS will be established in all the villages in the state through VHSCs. • Additional ASHA & AWW Kit containing ORS, Zn Activities etc proposed. • Nutrition demonstration would be provided to pregnant women along-with adolescent girls during awareness activities carried out for Maternal and Child health • Selection of communication agency to undertake a review of local practices and locally grown iron- rich commodities in different regions of the state & develop messages on locally available best practices. • Electronic media messages will be

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transmitted/broad-casted through Doordarshan/ cable network and AIR.

Time needed to On going process started in April 2008 is to continue implement during the plan period upto 2010. changes

Sustainability Will be reflected in the improved health status of women.

Benchmarks Derived from the Components Reduced anaemia among pregnant women.

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Component 10 Maternal Death Audits

Conduct the maternal death audits to plan

Objective appropriate interventions for reduction of maternal mortality • Many instances of deaths during pregnancies get unreported especially in case of non institutional deaths . Institutional deaths during Problem Identification pregnancies may also be averted some times if appropriate timely action is taken by victim, her family members or service providers. • Maternal death audits will be conducted for both institutional maternal deaths as well as non institution deaths during pregnancies or post natal period. The institutional maternal death will be recorded and reported by facility incharge to concerned BMO. For death out side institution the volunteers will be sensitized and provided incentive for first reporting the case to BMO or CMO. The reasons for deaths will be Strategy investigated immediately by CMO, BMO or other appropriate officials designated by District Health Society. The monthly review for maternal deaths will be taken by concerned Deputy commissioner. The monthly reports will be sent to State government along with investigation reports. The medical college or external expert agency identified by state government will do the quarterly, compilation analysis and

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documentation of maternal death audit. • The Quarterly audit report prepared by agency will be shared with state health society, District Health societies and Government of India. The follow up action will be taken by SHS/DHS in case required or recommended in Quarterly audit report. , • Coordination with Medical colleges and private providers • Support from other departments i.e. WCD and Support needed AYUSH for implementing • DHS takes update on Maternal mortality analysis changes in monthly review meetings • State Health Society discusses the maternal death audit report on a quarterly basis. • Orientation of District and block level officials on conducting investigation • Sensitization of MOs, ANMs, AWWs, ASHAs and VHWSCs for reporting all maternal deaths to district authorities. • Provision of incentive to community based volunteers for reporting maternal deaths and helping in investigation of cause of death @ Rs. Activities 100 per case of death. The incentive will be available for estimated 1000 maternal deaths in current year • The scheme will be disseminated to community at large by Health personnel, ASHAs, AWWs , AYUSH personnel during their out reach sessions in rural and urban areas • The investigation cost will be provided @ Rs 250

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per case to designated investigation officers. The investigation report will be promptly shared by investigation officer with concerned Block medical officer and Chief medical officer • Monthly review of report by deputy commissioners • After the review meeting the monthly reports will be shared with State government • An external agency or Medical college will be identified to conduct quarterly compilation, analysis and documentation of Maternal death audit • The Quarterly report along with recommendations will be shared with SHS and concerned DHS for any follow up action in case required . The suitable intervention will also be planned and implemented by DHS and SHS to reduce the maternal mortality. The report will also be shared with GoI. Time needed to On going process started in April 2008 is to continue implement during the plan period and thereafter. changes Sustainability Will be a part of the state HMIS Benchmarks Derived from the Safe deliveries with minimal loss of life Components

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Component 11. Janani Surakha Yojana [JSY]

Strengthening of Janani Suraksha Yojana for Objective encouraging institutional/safe deliveries among BPL /SC/ST families According to Planning commission 1993-94 (CSO- 1999) 30% of Rural Population and 9% of Urban Population are below the poverty line in the State. The implementation of JSY is a real challenge especially in remote, backward and difficult areas where the population is scattered and health facilities are inaccessible. By and large following problems are identified : • Lower registration of pregnancies among BPL/SC/ST women. Problem Identification • Lesser number of institutional deliveries and safe home-deliveries. • Low accessibility/ affordability for institutional delivery. • Higher maternal mortality and infant mortality rates among BPL/SC/ST. • Lack of neo-natal natal and post-natal care services • Inadequate service delivery mechanism for implementation of JSY in remote areas • Ensuring that all pregnant women are registered under JSY and provided with all the services, facilities and benefits as per GoI guidelines Strategy • Ensure 100% registration of pregnant women among BPL/SC/ST families by providing special incentives to ASHAs

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• Enhancement in 24x7 facilities in remote and identified far flung areas • Encouraging institutional deliveries or safe home delivery by giving incentive to mothers. • Identification of high risk pregnancies and their referral to First Referral Unit (FRU), where caesarean section can be conducted. • Establishing a sound system for payment disbursement • Effective documentation of JSY scheme details Print of JSY Guidelines and JSY Cards. • To computerize data on beneficiaries Support needed • Coordination with VHSCs for implementing • Coordination with ANM/AWWs , ASHA changes • Increased participation of Private providers • Timely release of payments • Incentives to Beneficiary Provision and disbursement of incentives as per JSY guidelines. Incentive to ASHA For each case the ASHA will be provided an incentive @ Rs. 600/- for ensuring institutional delivery • Payments Activities Payment of JSY benefits to client and ASHA will be made as per Govt. of India guidelines e.g. client (expectant Mother) will be made payment in one instalment at time of discharge from Hospital/Health institution and it will be responsibility of ANM/ASHA to ensure that the assistance is made to client on discharge. The payment to clients will be made through cheques. Payment to ASHA shall be made 219

in two instatements to cover the transport charges and other logistics support. Balance amount will be treated as cash incentive to ASHA & 50% of this will be paid after discharge of JSY beneficiary from institution and 50% will be given one month after delivery when she gets the infant of that particular JSY Beneficiary immunized for BCG and has helped the JSY Mother through Post natal care and registration of the birth of that new born. • The awareness about the benefits of schemes will be made as planned under Comprehensive IEC strategy planned for maternal and child health .

• The JSY cards and guidelines will be printed and distributed to service providers • Monitoring & Evaluation There will be mandatory meeting of all ASHA’s on third Friday of every month at the Sub centre where ANM will prepare a monthly work Schedule for each ASHA. The feed back from each ASHA will also be obtained after taking into account the number of children immunized, number of pregnant women visited, number of post natal visits and cases referred in the month. The Details of JSY scheme will be compiled and computerized at BPMU for block and at DPMU for the district. Reporting Mechanism By 7th of Each Month: 1. ANM/Health worker will submit account statement of previous month on prescribed format to BMO along with progress report.

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By 10th of Each Month: 2. Block Medical officer will submit the consolidated report of expenditure/Disbursement to CMO on the prescribed format. By 15th of Each Month: 3. District Nodal officer for JSY/CMO will send the detailed consolidated report of Physical financial progress to SHS/SPMU on prescribed format. 4. The SHS will send six-monthly District-wise composite report along with SOE’s/UC/ARS in the prescribed format to Nodal Division of JSY of Govt. of India, which will form basis for release of grants to State.

On going process started in April 2008 is to continue Time Line during the plan period Sustainability Will contribute in improving the health seeking behaviour regarding issues of ANC and Institutional delivery among the BPL, SC/ ST families. Benchmarks 3 ante-natal check ups in at least 90% of pregnant Derived from the mothers Components

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FERTILITY AND FAMILY PLANNING

Current Status Table: - 26 Indicator Current level 2012 Couple Protection Rate 52.6 75 (Modern Methods) Unmet needs (%) 18 10 Source: NFHS-III

OBJECTIVES Fertility and Family Planning At current fertility level, women in J&K will have an average of 2.71 children each (NFHS-II), throughout their child bearing years. Among women 25-49 years, the median age at first birth is now 21.4 years, and women aged 15-19 account for only 4.2 per cent of the total fertility (NFHS-III). By contrast, however women, who are currently aged 40-49, have an average of 4.79 children each. Efforts to encourage the trend towards lower fertility might usefully focus on groups within the population that have higher fertility than average. Regional variations in fertility were not significant. TFR is at 2.4. 59.6 per cent of currently married women were found using any method of contraception in J&K state. As per NFHS-III the contraceptive prevalence by modern methods was 44 per cent only. Contraceptive prevalence is higher in urban areas (68%) than in rural areas (46%). Female sterilization is by far the most popular method while only 2.6 per cent males have accepted vasectomy.

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Table: - 27 Current Contraceptive Use* in the State of J&K, NFHS-III, 2005-06. Any method 52.6 Any modern method 44.9 Pill 4.7 IUD 2.7 Condom 8.1 Female Sterilization 26.3 Male Sterilization 2.6 * Among currently married women aged 15-49.

The following table gives the achievement in terms of use of contraceptives and population stabilization methods the State.

Performance achieved in Family Planning services in the State during 2007-08 and ending December 2008-09. Table: - 28

FP method/Coverage Achievement 1.Sterlization Achievement. 07-08 21468 Achievement. 08-09 9759 2. IUD Achievement. 07-08 16414 Achievement. 08-09 18415

3. Oral pills Achievement. 07-08 181299 Achievement. 08-09 139299 4. Condom Achievement. 07-08 3055446 Achievement. 08-09 1344289 5. MTP Achievement. 07-08 8331 Achievement. 08-09 6199

Source: Directorate of FW, Government of J&K

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Unmet Need for Family Planning:

According to NFHS-III (2005-06), about 15% currently married women in Jammu and Kashmir have unmet need for family planning. Unmet need for spacing the birth is 6.0 and the unmet need for limiting the births is 9.0. The data further reveals that the unmet need for family planning is more than twice as high in rural areas as in urban areas. Indicators suggest that there was a need for improving informed choice, information about possible side effects, greater exposure to media and sustained follow-up, especially for spacing methods.

Interventions for Family Planning

The main factors identified for high unmet need for FP in the state are lesser involvement of males in the processes of family planning and lack of awareness in the community about the availability of emergency contraceptive methods. Understanding these issues, the state has planned FP programmes with the following objectives;

Component 1. Increasing the Demand for FP Services Increased awareness and demand for FP Objective services Even though awareness of modern contraceptive methods is high, the demand for family planning services, especially the spacing methods is low. Problem Identification Only 19969 Female sterilization and 1499 male sterilization were done in the year 2007-08 and in this year ending Dec 08 female 8662 and male 1097 sterilization in

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which, in Kishtwar Only 2 female sterilization were done. Three districts namely Kishtwar, Kupwara and Kargil do not have a single case of male sterilization. A total number of 16414 IUD insertions were done 2007-08 and 18415 ending Dec 08 for the year 2008-09. In the state, unmet need for both limiting and spacing is high, more-so for limiting methods of family planning.

• The salient features of the strategy for increasing the demand for FP services are: • Intensive IEC/ BCC campaign • Orientation of the health staff to providing Strategy FP services through sensitization, informed choices and counselling • The Communication strategy to be followed by provision of adequate FP services uniformly across the state

• AWWs, ASHAs, VH&SCs to extend total Support needed for support implementing • Private Sector/NGOs, CBOs involvement in changes FP programme

• Folk-performer’s teams will be hired to Activities disseminate the messages in the local languages among population in tribal and far

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flung areas. • The printed education material will be distributed to sub centres and to folk teams touring the villages for distribution • Tin plates, laminated posters and flip charts will be provided to all sub centres. • The ANMs will be oriented in monthly meetings who in turn will take up Sensitization of eligible couples and adolescent girls • Regular supplies of contraceptives to health facilities especially Sub Centres . Time needed to On going process started in April 2009 is to implement changes continue during the plan period and beyond Will be reflected in the improved demand for FP Sustainability services. Benchmarks Derived from the Increased use of FP services Components

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2. FP sterilisation services in all the PHCs, Component CHCs and FRUs ( including Services through PPP ) To strengthen sterilization services under FP in Objective all PHCs, CHCs , FRUs and through PPP There is a significant unmet need for limiting methods of family planning in the state. Not many trained NSV and mini-lap service providers are available in the state Problem Acceptance of male sterilization method is Identification low Remote and far flung areas are not served Limited involvement of Private providers in FP services Capacity Building of MOs and other OT staff in NSV during NSV camps. Provide FP sterilisation services in all FRUs and CHCs on fixed days Organise FP camps in PHCs at regular intervals Initiate PPP for FP on a pilot basis and scale up Strategy Dove tail JSY and FP compensation for PPP Provision of Compensation to sterilization accepter / beneficiary Wide publicity will be given to these camps through banners, print material public announcements and personal contacts to attract a large number of clients. Monitoring and Evaluation for quality assurance

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Coordination with VHSCs Coordination with AWWs Support needed for Coordination with private health service implementing providers changes Policy reforms for partnerships Technical assistance to initiate and monitor PPP

Capacity building of Public Services providers • 12 days training of 2 participants ( 1 Gynae/ surgeon and 1 OT Nurse/ OTA ) for each district on laparoscopic sterilization at GMC- Jammu/ Srinagar The trainings shall stress on the complete range of services/ interventions for sterilisation so that the population is able to make an informed decision on utilisation of a particular service. Equal importance will be accorded to promoting Activities male sterilisation vis-a-vis female sterilisation.

Services Provisions at facilities 1. 1 Camp per district per quarter will be organized at FRU/ CHC/ DH and in year 2009-10 total 88 sterilization camps for male as well as female will be organized ( @ Rs. 35000/- camp) and @15000/- respectively 2. Provision has been kept for procurement and maintenance of 2 Laproscopes per district (22 districts) and 1200 NSV kits

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Compensations for beneficiaries i. Female sterilization for BPL families @ Rs. 1000/ case (Expected level of performance 10,000 cases for state) 2.Female sterilization for other categories @ Rs. 1000/case (Expected level of performance 4000 cases for state) 3. NSV accepter @ Rs. 1500 / case (Expected level of performance 3200 cases for state).

• Sterilization acceptors will be provided with free transport services to the nearest facility with the help of hired vehicles. • Government of Jammu & Kashmir has strategized the activities under innovations and PPP as follows: a) Setting up guidelines and operational framework for accreditation of private health care facilities to ensure quality of FP services in private sector b) Initiate PPP for FP services c) Compensation to accredited Private Practitioners @ Rs. 1500 / Case ( expected cases in a year 400) • FP Performance will be monitored at district level by the District society and suitable steps will be initiated to improve quality as

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per guidance of state quality assurance cell. The quality assurance committees will monitor and audit the services on quarterly basis .

Time needed to On going process started in April 2008 is to implement changes continue during the plan period upto 2012

Will be reflected in the improved indicators on Sustainability FP services use.

Benchmarks Derived Reduced TFR from the Components

4. Promotion of spacing methods through Component IUCD Insertion services at health facilities Popularise IUD as means of spacing method Objective and reducing TFR The IUCD services are not available in rural areas and therefore maximum women do not avail the benefit of service In Jammu and Kashmir, from 1999 to 2004, Problem only 956 ANMs have received training on Identification IUCD insertion. IUD services are limited due to lack of trained service providers and low awareness about the access and availability. Capacity building of relevant staff for provision of IUCD services especially in rural Strategy areas Provide IUD supplies to all health facilities

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where trained manpower for IUCD services is available Publicity for the availability of IUD services Monitor quality of IUD services

Support needed for Coordination with District Hospitals and Medical implementing colleges for training changes • The 6 days ToT will be organized at GMC Jammu for 2 participants (Preferably 2 MOs one Male, One female) each from all 22 districts. The trainers will in turn train the district cadre on IUCD • The hands on training for IUCD skill up gradation will be organized for ANMs/LHVs/SNs covering FRUs and 24 x 7 facilities on priority basis in all districts. • Each district will be provided with supply of two Maniquins for IUD trainings at district Activities level in Phase-I for 14 districts @ Rs. 15000 each • Each team will train 3 participants at a time in a six-day programme. • 22 sites will be selected depending on the availability of trained lady medical officer or staff nurse for IUCD insertion training. • All trained ANMs will be provided with manuals, Training material for IUCD insertion, IUCD insertion kit and relevant supplies. • The required equipments and other supplies

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will be made available to all the facilities providing IUCD services. • The staff for rest of the facility will be sensitized to provide counselling about spacing methods and after informed choices if client opt for IUCD the same will be referred to nearest Health facility having IUCD insertion facility. • HRD centre of JK-SHS will monitor this intervention. The quality assurance during trainings and service delivery will be guided and monitored by QA cell and It’s designated officials • The DHS in each district will take up regular monitoring in quarterly review meetings

On going process starting April 2008 to continue Time needed to during the plan period up to 2010 implement changes

Will be reflected in the improved spacing Sustainability methods preference Benchmarks Derived from the Increased contribution of IUD in reducing TFR Components

Component 5. Emergency Contraception

Providing emergency contraception services in Objective all health facilities especially CHCs and PHCs Medical officers are not fully aware about Problem Identification emergency contraceptives and it’s use and therefore hesitate to recommend

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Emergency contraceptives though available are not prescribed. Irregular supply of EC Social stigma in popularising EC Lack of community awareness on EC • Enabling Environment in medical fraternity • Ensure availability of EC in all PHCs and CHCs • To promote emergency contraceptives b y addressing lack of knowledge and skills on part of MOs and their hesitation owing to different reasons, Strategy • To sensitize ANMs and RIS teachers about the availability of emergency contraceptives at PHC/CHC level so that they spread the message among couples in general and counsel them to avail the services. • Streamlining Logistics for supply of emergency contraceptives. Uninterrupted supply of EC Support needed for Resource persons for orientation of Mos implementing Training changes Integrated IEC materials and service guidelines • The enabling environment will be created to propagate EC concept and supplies by a. A state level workshop for two days will be Activities organized at Department of Obst./ Gynaecology –GMC-Srinagar for 60 participants including following i) Deputy CMOs of 8 districts from Kashmir

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region ii) Two Gynaecologists from each districts i.e. 16 participants iii) Private practitioners -28 b. Training programme for 2 days each will be organized for 20 participants each in all district hospitals on contraceptives updates. • Emergency contraceptives will be made available to all CHCs and PHCs, through the GoI supply. • Material on emergency contraception will be collected, collated and printed in local languages. Time needed to On going process started in April 2008 is to implement changes continue during the plan period and beyond Sustainability Part of RCH services package • Greater acceptance of FP services and less resorting to unsafe abortions. Also mitigates Benchmarks Derived the dangers arising from contraceptive from the Components failure. • Reduction in teen age and unwanted pregnancies

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URBAN HEALTH – SLUMS AND URBAN POOR

A- INTROCUDTION

According to the Census 2001, in India, out of the total population of 1027 million about 285 million live in urban areas and 742 million in rural areas. Thus, around twenty-eight out of every one hundred persons in India live in urban areas. This is only two more than the number that lived in urban areas a decade ago. For every one hundred persons living in rural area of India, thirty-nine live in urban areas, which is four more than the number in 1991. Table 1 shows the share of urban population in states and union territories of India.

Table1: Share of urban population in states and union territories of India – 2001 Census (Arranged in descending order)

Share of India/States/Union Urban Share of urban India/States/Union Urban urban territories population population territories population population

India 285,354,954 100 Assam 3,389,413 1.2 Maharashtra 41,019,734 14.4 Jammu & Kashmir 2,505,309 0.9 Uttar Pradesh 34,512,629 12.1 Uttaranchal 2,170,245 0.8 Tamil Nadu 27,241,553 9.5 Chandigarh 808,796 0.3 West Bengal 22,486,481 7.9 Goa 668,869 0.2 Andhra Pradesh 20,503,597 7.2 Pondicherry 648,233 0.2 Gujarat 18,899,377 6.6 Himachal Pradesh 594,881 0.2 Karnataka 17,919,858 6.3 Manipur 570,410 0.2 Madhya Pradesh 16,102,590 5.6 Tripura 543,094 0.2 Rajasthan 13,205,444 4.6 Meghalaya 452,612 0.2 Delhi 12,819,761 4.5 Mizoram 441,040 0.2 Bihar 8,679,200 3 Nagaland 352,821 0.1 Kerala 8,267,135 2.9 Arunachal Pradesh 222,688 0.1 Andaman & Nicobar Punjab 8,245,566 2.9 116,407 0 Islands Haryana 6,114,139 2.1 Sikkim 60,005 0 Jharkhand 5,986,697 2.1 Daman & Diu 57,319 0 Orissa 5,496,318 1.9 Dadra & Nagar Haveli 50,456 0 Chhatisgarh 4,175,329 1.5 Lakshadweep 26,948 0

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As against one third in Maharashtra and West Bengal and one fourth in Karnataka, only one fifth of the population in J&K resides in urban areas. 23.83 % population has been recorded as urban in the state against the National Average of 25.72%. Jammu city has recorded very rapid growth and presently ranks as the 48th biggest city in the country. Besides the cities of Jammu and Srinagar, other important towns are the district headquarters of Anantnag, Pulwama, Budgam, Baramulla, Kupwara, Udhampur, Kathua, Rajouri ,Poonch , Doda, Leh and Kargil.. The remaining towns continue to have many rural features and pursuits reflecting the state’s predominant Agro-pastoral economy. 1 In RCH Phase-I, rural health was taken on priority basis but very little attention was given towards urban health, especially to urban slums and urban poor. In J&K State about 21% population live in urban areas mostly in two cities viz. Srinagar and Jammu. Both the cities lack an effective infrastructure for providing secondary and primary health care. In RCH Phase-II, it is envisaged that urban health posts and health centres will be set up to provide healthcare to the urban slums. The CMO would be the overall incharge of the centres and DHO (District Health Officer) would be the nodal person who will be responsible for the smooth running of the whole programme.

B- Objective:

The main objective of the program is to provide integrated and sustainable system for primary health care services delivery in the urban areas of the State, with focus on urban poor living in slums and other health vulnerable groups. To attain this, the specific objectives are 1. To strengthen the existing urban health infrastructure by renovation/ upgradation of existing facilities. 2. Provision of establishing new facilities in uncovered urban slums areas.

1 Source: http://jammukashmir.nic.in/profile/facts.htm 236

3. To support the development of a referral system for institutional deliveries, emergency obstetric care and terminal method of family planning. 4. Involvement of the NGOs/Private Sector in the provision of Primary Health Care Services and also as part of the referral system. 5. Integration of the existing health infrastructure with the proposed urban health program.

C- Service delivery model: C-1 I Tier: C-1-1 Staff Urban Health Centre (1 for 50000 population) with the following proposed staff 1. Medical Officer (LMO) - 1 2. ANMs - 3-4 @ 12000-15000 population 3. Lab assistant - 1 4. PHN/LHV - 1 5. Staff/clerk - 1 6. Chowkidar - 1 7. Peon - 1 To develop and maintain a link between health facility and the community, the program envisages engagement of social community workers/link volunteers, preferably in the age group 25- 35, a female from the community able to spare 3-4 hours a day acceptable to the community, preferably to be engaged through local NGOs. The need for volunteers would be reassessed periodically. Once, link workers are in a position to shoulder the responsibilities, the volunteer/ NGO will be phased out. C-1-2 Prerequisites: 1. Efforts will be made to re-deploy the existing staff from the existing facilities, wherever possible. 2. The new staff will need to be appointed through contractual appointment. 237

3. Existing service delivery system will be reorganized and restructured to serve a defined geographical area for a defined population. The new facilities to be established to serve the remaining area or target population. 4. ANM would be given an identified area for outreach services.

C-1-3 Services The I Tier Health Centre will provide only the outdoor services.

1. Family planning services including IUD, referral for terminal methods 2. Antenatal care (Urine and blood testing, T immunisation, IFA supplements, nutrition counselling, early registration, weighing, blood pressure, position of baby, check against danger signals and identification of high risk pregnancies) 3. Referral for institutional deliveries, 4. Immunization, Postnatal care, 5. Services under national programs like DOTS, NMCP Etc., 6. Lab services 7. Treatment of minor ailments including RTI/STI 8. Depot holder services for contraceptive and ORS , Promoters/Education and help 9. ANMs for outreach services through social community/link volunteers.

C-2 II Tier Referral Hospital (City /District Hospital/ Maternity Home/ Private & NGO Nursing Homes/Hospitals The support envisages strengthening of existing centres with public-private partnership, recognition of private nursing 238

homes/hospitals to provide the pre-determined services & mobile support for floating/ migrating population /temporary slums/construction workers. .

C-2-1 Services The complicated referral cases and indoor services will be available only at the II Tier viz. Referral Institutions.

1. Institutional delivery 2. Emergency obstetric care 3. Terminal methods of family planning (tubal ligation and vasectomy) 4. MTP services 5. Child and Newborn care

D- Activities

I Tier Health Centre: Renovation/upgradation of existing facilities Renting of accommodation for establishing new Urban Health Centres. This facility will include provision of space for services, office, minor OTs, Lab and storeroom for equipments etc. besides patient waiting area. No new construction will be supported under the program. Equipments & furniture for services to be provide from the urban health centre (to be ascertained through a facility survey for the existing facility and as per the standard list for the new facilities to be established) Support for additional manpower on contractual basis only after redeployment of the existing staff. Needs based drugs & supplies (excluding supplies being made under other programs/schemes)

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Mobility support (hired vehicle for referral services) A support for services to be provided by NGOs will be considered on similar pattern as per specific agreement reached.

II Tier Referral Centre: Renovation/upgradation of existing referral facilities Support for improving lab /indoor facilities. Equipments & furniture for services to be provide from the referral centres (to be ascertained through a facility survey for the existing referral facilities Support for local contractual arrangements for specialist/part time Specialist medical officer. Needs based drugs & supplies (excluding supplies being made under other programs/schemes) A support for services to be provided by NGOs will be considered on similar pattern as per specific agreement reached.

E- Proposed activities for improving urban health

The State proposes to provide primary health care to the needs of urban population through the following institutions:

♦ Urban Health Centres ♦ Urban Health Posts ♦ Anganwadi Centres

Urban Health Post will be like the Rural Sub Centre and will cater to the need of urban population on the pattern of sub-centres in rural areas, by performing out-reach activities. Urban Health Centre will be equivalent to the rural Primary Health Centre and will provide all the services related to components of primary health care.

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Through the urban health activities, it is envisaged that 2 cities of Srinagar, Jammu, would be covered with special focus on urban poor. i. Infrastructure development

a. Urban health posts :

♦ A total of 30 urban health posts would be set-up in the slum localities of Jammu and 17 in Srinagar (Total 47) catering to the urban poor population. These will be set-up in rented accommodations over the first two years of the RCH program.

♦ All the required furniture and the equipment, as available in the SCs, will be provided to the UHPs.

♦ IUD insertion kit will be provided to all the UHPs.

♦ Two ANMs and a cleaner (safaiwala) would be employed in each UHP.

b. Urban health centres :

♦ A total of 7 urban health centres would be set-up in the slum localities of Jammu and 3 in Srinagar, (Total 10)over the first two years. These will be set-up in rented accommodations and provided with furniture, equipment, MTP sets, IUD instruments, midwifery kits and drugs.

♦ The staff that is already posted in the evening clinics would be re-deployed in the newly formed UHCs.

♦ IEC activities would be conducted through the urban health centres by conducting various folk-activities and print media.

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ii. Package of services

The staff of the UHP shall hold regular outreach sessions in every AWC in its area. The outreach sessions shall provide the ANC and immunization services besides conducting BCC activities related to health and family welfare. iii. Capacity building/ trainings

All the staff members involved in the urban health projects ranging from medical officers, paramedical health personnel to AWWs shall be provided training on a range of issues at the various stages of the project so as to handle the responsibilities bestowed upon them.

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Detailed proposal is budgeted under the UH Component of RCH.

URBAN RCH

1. Initiating Urban RCH programme at strategically Component important sites According to the Census 2001,out of the total population of 10143700, total 25,16, 638 persons are living in urban area 24.80 % population has been recorded as urban in the state against the National Average of 25.72%. Jammu city has recorded very rapid growth and presently ranks as the 48th biggest city in the country. Besides the cities of Jammu and Srinagar, other important towns are the district headquarters of Anantnag, Pulwama, Budgam, Baramulla, Kupwara, Udhampur, Kathua, Rajouri ,Poonch , Doda, Leh and Kargil.. The remaining towns continue to have many rural features and pursuits reflecting the state’s predominant Agro-pastoral economy. 2 Current status

Key Urban RCH indicators for Jammu & Kashmir - NFHS-3 (2005-06 ) Tot Urb al an Rural Maternal and Child Health Mothers who had at least 3 antenatal care visits for their last birth (%) 74.2 90.5 69.9 Mothers who consumed IFA for 90 days or more when they were pregnant with their last child (%) 27.5 35.1 25.5 Births assisted by a doctor/nurse/LHV/ANM/other health personnel (%) 1 60.5 83.0 54.8 Institutional births (%) 1 54.3 75.8 48.8

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Mothers who received postnatal care from a doctor/nurse/LHV/ANM/other health personnel within 2 days of delivery for their last birth (%) 1 48.0 73.0 41.4 Children 12-23 months fully immunized (BCG, measles, and 3 doses each of polio/DPT) (%) 66.7 73.0 64.9 Children 12-23 months who have received BCG (%) 90.9 96.8 89.2 Children 12-23 months who have received 3 doses of polio vaccine (%) 82.2 84.1 81.6 Children 12-23 months who have received 3 doses of DPT vaccine (%) 84.5 88.9 83.2 Children 12-23 months who have received measles vaccine (%) 78.3 87.3 75.7 Children age 12-35 months who received a vitamin A dose in last 6 months (%) 15.2 25.9 12.4 Children with acute respiratory infection or fever in the last 2 weeks taken to a health facility (%) 77.6 86.1 75.6 Child Feeding Practices and Nutritional Status of Children 1 Children under 3 years breastfed within one hour of birth (%) 31.9 20.9 34.8 Children under 3 years who are stunted (%) 27.6 25.2 28.3 Children under 3 years who are wasted (%) 15.4 12.2 16.1 Children under 3 years who are underweight (%) 29.4 20.6 31.6 Nutritional Status of Ever-Married Adults (age 15- 49) Women whose Body Mass Index is below normal (%) 21.3 9.1 26.1 Men whose Body Mass Index is below normal (%) 19.9 14.1 22.2 Women who are overweight or obese (%) 22.7 41.8 15.1 Anaemia among Children and Adults

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Children age 6-35 months who are anaemic (%) 68.1 72.0 67.3 Ever-married women age 15-49 who are anaemic (%) 53.1 51.5 53.6 Pregnant women age 15-49 who are anaemic (%) 54.0 54.8 53.8 Ever-married men age 15-49 who are anaemic (%) 17.9 18.6 17.6 Marriage and Fertility Women age 20-24 married by age 18 (%) 14.0 4.9 17.1 Men age 25-29 married by age 21 (%) 15.3 8.9 17.5 Total fertility rate (children per woman) 2.38 1.63 2.69 Women age 15-19 who were already mothers or pregnant at the time of the survey (%) 4.2 1.7 5.0 Median age at first birth for women age 25-49 21.4 22.5 21.0 Family Planning (currently married women, age 15–49) Current use Any method (%) 52.6 68.3 46.2 Any modern method (%) 44.9 55.8 40.4 a. Female sterilization (%) 26.3 32.8 23.7 b. Male sterilization (%) 2.6 4.0 2.0 c. IUD (%) 2.7 2.8 2.7 d. Pill (%) 4.7 3.7 5.1 e. Condom (%) 8.1 11.8 6.5 Unmet need for family planning Total unmet need (%) 15.0 7.5 18.0 a. For spacing (%) 6.0 2.7 7.3 b. For limiting (%) 9.0 4.8 10.7 Women’s Empowerment Currently married women who usually participate in household 38. decisions (%) 9 45.2 36.3 Ever-married women who have ever experienced spousal violence 12. (%) 6 13.1 12.4

The above tables gives a bird eye view of various RCH indicators in urban areas in J&K. The broad analysis of

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indicator among urban population is comparatively better than rural population except the lesser child feeding practices in urban areas and comparatively higher prevalence of anaemia among pregnant women, men and infants. The obesity is again very high in urban women than rural women.

In J&K State about 24.80% population live in urban areas mainly in two cities viz. Srinagar and Jammu. Both the cities lack an effective infrastructure for providing secondary and primary health care. In RCH Phase-II, it is envisaged that urban health posts and health centres will be set up to provide healthcare to the urban slums and high risk population including the migrants.

To Provide Essential Health care services through Urban Objective RCH programme to urban poor and slum population Rapid interstate inward and outward migration especially in urban pockets Prevalence of sexually high risk group at various sites Problem Identification Pilgrim camps Lack of coordination with State AIDS Control Society. Tourist destinations.

I. The urban RCH programme is being run under over all control of Chief Medical Officer. The team of DHO (District Health Officer) and other district level nodal officers is assisting him in planning , monitoring and evaluation of programme Strategy II. Structure of intervention There will be three levels of Urban RCH Service delivery Infrastructure a. Urban Heath Posts b. Urban Health Centre

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c. District Hospital, nearest FRU a. Urban Health Post (Status, Man power and Roles ) :

The UHP is akin to the Sub Centre in rural area. It is mainly catering to the needs of urban population on the pattern of sub-centres in rural areas, by performing out-reach activities. The UHPs are working under the Urban Health centres .Every UHP is being run through a rented accommodation. The UHPs are manned by two ANMs/ Health workers, 1 Link worker and one cleaner (optional). The Link worker will be provided the essential training during induction as well during service from time to time. The UHP is being provided need based stock of medicines and other supplies. Role : The staff of the UHP is providing the ANC and immunization services besides conducting BCC activities related to health and family welfare. The identified high-risk cases are being referred to appropriate higher health facility. The staff is also maintaining the daily register and update the information required under RCH programme. b. Urban Health Centre (Status, Manpower and Roles ) : The UHC are akin to the PHCs in rural area. These are mainly catering to the needs of urban population on the pattern of PHCs in rural areas, by performing curative as well as out-reach activities. The UHCs are working under the Chief Medical Officer. UHC are being run in rented accommodation. The UHCs are manned by Two

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Medical officers (Doctor), 3 ANMs/ Health workers, 1 Link worker and one cleaner (optional). The UHCs are being provided need based stock of medicines and other supplies.

Role : The staff under UHC are providing the basic health care services including following : i. Family planning services including IUD, referral for terminal methods ii. Antenatal care (Urine and blood testing, immunisation, IFA supplements, nutrition counselling, early registration, weighing, blood pressure, position of baby, check against danger signals and identification of high risk pregnancies) iii. Referral for institutional deliveries, iv. The role of UHC staff will be guided from time to time government orders

C ) District Hospital, nearest FRU : The nearest district hospital or operational FRU is the referral Institution from UHC.

II Capacity Building : The staff involved in the urban health programme including medical officers, paramedical health personnel, ANM and Link worker will be provided training on a range of issues periodically to handle the tasks assigned to them time to time

III Monitoring and Evaluation :

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The monitoring is a regular feature and Monthly reports are being provided by UHP to UHC and UHC shall compile and send the report to District on prescribed formats

Quarterly meetings are being organized at district level to review the progress Support needed • Main streaming with health & FW system for • Adequate capacity building of urban RCH staff implementing • Provisions for furniture fixtures etc. in beginning by changes state government a. Activities to establish and run Urban health posts:

♦ A total of 47 urban health posts have been set-up at identified localities in the state under urban Health centres catering to the urban poor population. These are set-up in rented accommodations at monthly rental @ Rs. 1000 each per month. A provision of Rs. 2000 Activities PM/urban Health Posts have been kept due to escalation of rent in cities.

♦ All the required furniture and the equipment, as available in the SCs, will be provided to the UHPs. ( Provisioning to be created by DHS and State )

♦ The yearly medicines and other supplies worth Rs. 2000 P.A. will be provided to each UHPs. ( This exclude the GoI direct supplies for UHPs under various National Health Programmes)

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♦ Two ANMs will be appointed @ Rs. 5000 Per Month each 1 link worker @ Rs.1000 PM and a part time cleaner will also be hired in each UHP.

♦ A he Lump sum of building Rs. 1000 per UHP will be provided for capacity building. b. Activities to establish and Manage Urban health Centre :

♦ A total of 10 urban health Centres have been set-up at identified localities in the state catering to the urban poor population. These are set-up in rented accommodations at monthly rental @ Rs. 10000 each per month. Now the provision of rent has been increased to Rs. 12000/- per month due to escalation in rent in the cities.

♦ All the required furniture and the equipment & medicines, are being provided to the UHPs. ( Provisioning to be created by DHS and State besides the GoI direct supplies ) Provision of Rs 1000 PA is made to meet out the requirements of essential supplies

♦ 2 medical officers will be appointed per UHC @ Rs 18000 P.M.

♦ Two ANMs will be appointed @ Rs. 5000 Per Month each, 1 link worker @ Rs.1000 PM and a part time cleaner will also be hired in each UHP.

♦ 4 quarterly review meetings will be organized to monitor the progress of Urban RCH

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Programme

Time needed to On going process started in April 2008 is to continue implement during the plan period upto 2012 changes Sustainability Improved access to RCH services in urban areas Benchmarks Derived from Improved RCH indicators the Components

RCH services for tribal population and other Component vulnerable groups According to the Census 2001, about 11% of the total population is tribal in the state of J& K. The tribal population is residing in almost all the districts especially in Leh, Kargil region. Besides other tribes the Gujjars constitute a significant part of tribal population. The State of J&K has five big Sub-Tribe of Gujjars which include - Current Status Banhara / Dodhi Gujjars , Bakarwal Alahiwal, Kanhari, Semi-nomad Gujjars.

The tribal areas of leh –ladakh region remain inaccessible during a significant part of year due to snow. The access to health care services in tribal area is also very difficult. Improve RCH indicator among tribal population with out Objective disturbing their cultural fabric

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Low awareness and lack of health care seeking behaviour Problem Scattered population Identification Fully equipped health facilities are rare in tribal areas Inaccessibility to existing facility due to hilly terrain and poverty • Health care services through integrated camps • Provision of medicines and supplies to nomadic groups • Providing one number ISM Doctor and one number Strategy Dawasaz with the Mobile Medical Units which moves with the migratory tribals. • Mainstreaming of traditional system of medicine in tribal areas viz; AMCHI. • Regular services as planned by MMUs. Already 78 Support needed number Mobile Medical Units are moving with the for migratory(tribal) population, who move to higher implementing reaches during summers. changes

• The Complete package of services will be provided through Mobile medical Units ( Details under NRHM- Initiatives) • The service delivery camps will be organized at 56 identified places to give coverage to tribal, unserved and underserved areas in the state. Activities • The medicines and other supplies worth Rs. 5000 will be provided quarterly to each MMU to be distributed and used for service delivery to Nomadic tribes • Infrastructure (room) and honorarium support to AMCHI’s ( traditional healers under Tibetan system of medicine will be provided to all selected AMCHI’s. The

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modus operandi for the same will be decided by DHS of concerned districts where AMCHI’s are currently operational. • The other vulnerable groups which are not covered under any intervention under RCH will be mapped. This will include SC/ST and other vulnerable groups in rural as well as urban areas. The special Outreach Basic health Care Camps will be organized once in every quarter covering all the block of the state Time needed to implement 2008-2010 changes Sustainability Mainstreaming Benchmarks Improvement in vital RCH indicators including behaviour Derived from change among tribal population the Components

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CHILD HEALTH

The picture in J&K

The Infant Morality Rate (IMR) in J&K has declined from 71/1000 live births in 1988 to 51 in 2008( SRS data). However, an adverse in IMR is a cause for alarm. (see table below). This is being addressed on priority through diverse approaches which have been successfully put into practice in the other parts of country in the recent past: Table; - 29

SRS 2003 (for the period 2001-03) 44 SRS 2004 49 C SRS 2005 50 a SRS 2006 52 u s SRS 2007 52 e SRS 2008 51 s of childhood mortality

Indicator Current 2010 IMR SRS 2008 51 45 Neonatal Mortality[NFHS-II] 40.3 30 Children 0-3 months exclusively breastfed 41.5% 85% [NFHS-II] Percentage of children receiving full 65% 85% immunization NFHS-III] Children with diarhoea taken to a health 69.1% 40% facility [NFHS-III] Children with Acute Respiratory Infection 77.6% 40% and taken to a health facility [NFHS-III] Children 0-5 months who were exclusively 42.3% 75% breastfed [NFHS-III] Children aged 6-35 months who are 68.1% 35% anaemic [NFHS-III] Children aged 6-35 months who received a 15.2% 75% Vit-A dose in last 6 months [NFHS-III]

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The major killers of children are – acute respiratory infections, dehydration due to diarrhea, measles and neonatal tetanus and in some areas malaria. The high prevalence of malnutrition contributes to over 50% of child deaths. In India, a significant proportion of child deaths (over 40% of under-five Mortality and 64% of infant mortality) take place in the neonatal period. Apart from infections, other causes like asphyxia, hypothermia and pre- maturity are responsible for neonatal mortality. About one-third of the newborns have a birth weight less than 2500 gram (low-birth weight). A significant proportion of mortality occurs in low-birth weight babies. It has been recognized that further reduction of IMR will require focused attention on Neonatal mortality.

Strategy for child health in RCH II

A two pronged strategy for child health is proposed in RCH II.

Strengthening existing child health services Essential newborn care (Breast feeding, warmth, Hygiene, cord care and recognition of danger signs) Immunization Skilled care at and after birth Control of diarrhoeal diseases and ARI Breastfeeding and complementary feeding Micronutrient supplementation (Vitamin A, Iron)

A focused strategy for child health is proposed in RCH II.

In this year, and thereafter, focus would be primarily to make all the health care facilities WOMEN & BABY Friendly. State would secondly focus on accelerating the reduction of maternal and child undernutrition, with concerted effort on ANAEMIA. Initiation of early breast-feeding within half-hour of birth would be the other initiative among several other explained briefly below.

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1. Expand Community Based Care for Newborns & Children through Community Health Workers

For all adolescent girls Focus on nutrition anemia in school going & out of school girls (Focus through School Health Programme & ARSH Programme)

Strengthen care at birth and link with JSY-promote stay of Newborn and mother for 48hrs at facility. Influence this through a specific IEC/BCC Campaign so that communities understand the importance of this. Service providers including ASHAs would be trained to focus on this aspect.

For all newborns Home Visits by ASHAs or Equivalent worker on 1,3,7 days of birth,

preventive and promotive care to all newborns promote early initiation and exclusive breast feeding detecting sickness and timely referral

For all infants Household contacts by ASHAs / Equivalent worker (at 6, 10, 14 weeks, 6 and 9 months of age) for Promotion of appropriate feeding practices Mobilizing for immunization services Detection & primary management of sick children.

2. Strengthen Care of Newborns & Children at Health Facilities Improve access and quality of care for newborns & children at all levels.

• PHCs – Essential newborn care & referral for sick children (supported by Newborn Corners)

• FRUs – Essential newborn care & management of sick children and newborns (supported by Stabilization Units)

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• District Hospitals – Essential Newborn Care & Management of sick children and newborns (supported by SNCUs)

• Upgrade standards for newborn and child care as per IPHS

Ensure 24x 7 facilities with functional infrastructure, uninterrupted & adequate supply, human resource in position and implementing standard clinical and practice guidelines.Ongoing capacity building and training of doctors and paramedics out-patient and in-patient management of sick newborns and children by observership at higher centre or by using integrated training packages.

3. Strengthen implementation of Integrated Management of Neonatal & Childhood Illnesses (IMNCI) for MOs working in DHs & FRUs and for Workers (ANMs/ASHA, AWWs including supervisors LHV, ICD Supervisors) in the selected Districts, Anantnag, Baramulla, Pulwama, Kupwara, Budgam, Leh, Jammu, Kathua, Rajouri, Poonch, Udhampur where District Level trainers stand trained and modules have been printed. This Training got delayed as the SHS could not complete the process of getting the IMNCI Modules printed.

Accelerate pace of implementation through forging partnerships, and using innovative approaches in the implementing districts, including ensuring supportive supervision of trained workers.

Strengthen preservice education of nurses and doctors in infant and young child feeding skills and IMNCI

4. Expand package of health services for newborn and child health at Village Health & Nutrition day (VHND)- This should include

• Growth monitoring and early detection of PEM 257

• Mobilization for immunization • Deworming ,Vit A and iron folic acid supplementation • Linkgaes with sanitation committees and provision of safe water supply • Intensified Diarrhea and ARI Control • This should be a priority in districts in which IMNCI has not been started

A. Diarrhea Actively promote ORS/ ORT and Zn use at the community level through leveraging on available opportunities of contact with community at household level and during outreach services,, periodic distribution of ORS / Zn at household level, and social marketing of ORS etc

Engage and encourage private providers including alternate providers (pharmacists/ AYUSH and RMPs) to prescribe ORT and Zinc for diarrhea

Strengthen case management at health facility level including training (as part of integrated package) & equipping all FRUs and 24 X7 PHCs for management of severe diarrhea. Promote setting up of ORT corners in health facility

B. Acute Respiratory Infections Expand Immunization especially measles and HiB based on multi-year plan for immunization

Promote adequate nutrition & exclusive breast-feeding Expand treatment coverage for pneumonia through community-based case management by trained workers and

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facility based case- management including equipping all FRUs & 24 X7 PHCs, especially free access to oxygen

5. Human resources:

A. Multi-Skilling of MOs for newborn and child health There is shortage of pediatricians in the State, much more in the Kashmir Division. To meet this need, following is proposed:

Multi-skilling of Medical Officers in neonatal and child health (pediatrics) on the line of multi-skilling for EMOC and anesthesiology Setting up rules and incentives for placement and retention of these multi-skilled doctors at FRUs and district hospitals

6. Training of AYUSH doctors as per MOHFW, GOI guidelines

7. Expanding the role of private public partnership

Other initiatives : Newborn Corners have been established in 47 PHCs. We propose to establish New borne care corners in 100 more PHCs so as to provide immediate care to all newborns at birth. This area would be MADNATORY for all the PHCs . Services to be provided and requirements for training, equipments and supplies would be as per the “TOOL-KIT FOR SETTING UP NEWBORN CARE FACILITY (SNCU) developed by UNICEF/GOI”

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ESTABLISHING SNCU & STABILIZATION UNITS

In the ROP for 2007-08 “Establishment of Neonatal ICU at District Hospitals” was “approved in principle & to be taken up in phases”. Rs. 7.00 lacs each was provided to 7 selected DHs for these initiatives. The DHs, provided funds under this component were Gandhinagar Hospital, DH, Udhampur, Kathua, Anantnag, Leh & Baramulla. However, these Hospitals could not show much progress to-wards establishing these units as envisaged. The lacked the capacity to plan and establish these units. As such, a workshop was organized in Jammu wherein, Dr. Vinod Paul, Professor & Head, Department of Neonatology, AIIMS, New Delhi was invited as guest faculty to guide State on the subject. During the meeting the following decisions were taken: State should at this stage, endeavor to start, a facility in District Hospital for looking after the sick & neonates. These Units should not be called NICUs (Neonatal Intensive Care Units) because that connotes a high tech neonatal care at the tertiary level. He suggested few names, the best may be Special Care Newborn Unit (SCNU) as is being increasingly accepted. A consensus was reached after deliberations that a typical facility in the District Hospital to take care of sick new born, should preferably have 10- 12 beds. Each newborn care unit shall have a minimum of 100 sq feet of clear floor space per bed excluding hand washing station, columns as elicited in the UNICEF document “Tool Kit for setting up Special New Born Care Unit, Stabilizing Unit and New Born Corner at the District- September 2008” All agreed to demistify the new born care…. from Pediatricians to nurses ! In places where nurses are not available, even ANMs can provide the vital care if they are trained for the assignment.

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It was agreed to hire 8-10 Nurses/ANMs, 1-2 General Duty Doctors (MBBS) and one Pediatrician & two to three helpers for keeping the units clean in each proposed unit.

Subsequently, on 14 th January 2009, Professor S Aneja, HOD, Department of Paediatrics, Lady Harding College along with Dr. V K Manchanda, consultant ( RCH) the World Bank, New Delhi interacted with the Senior Officers & CMOs, Child Specialists & Gynecologists from the State where worsening trend in IMR was discussed and it was agreed to have stabilization units in all the Proposed FRUs in the State as is being done in other States. The success of SNCU is critically dependent on the committed manpower provided for the unit under NRHM. Accordingly, a proposal has been incorporated in the SPIP and budgeted. The total funds required for establishing the SNCUs, & Stablization Units, including recurrent cost of hiring manpower & Training in the Department of Paediatrics, in the two GMCs with the Support from AIIMS.

Establishing SNCU (Sick New Born Care Units) and Stabilization Units: During 2009-10, SNCUs are proposed in all the DUs (14) and Stabilization Units in existing FRUs (39).

Establishment of Special Care Neonatal Units in the District Hospitals under NRHM as a component of a comprehensive continuum of care including IMNCI/IMNCI Plus at the community level, skilled attendance at birth at the facility, neonatal care and support at birth and special care of neonates requiring the support, SCNU completes the essential chain of services aimed at reducing neonatal and infant mortality in the district. SCNU is a neonatal unit in the vicinity of Labour Room which would provide level-II care (all

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care except assisted ventilation and major surgery) for sick newborns. The SCNU are proposed to be established and made functional at District Hospitals. This has been decided after discussions on the subject with eminent experts from outside & within the state. The SCNU would address the need for immediate and specialized care of neonates at high risk of mortality - equipped with radiant warmer and resuscitation kit, for immediate handling of the neonate. This continuum of care is expected to significantly reduce the neonatal mortality at the facility and in the district by early and appropriate management of severely sick and high-risk neonates. The SCNU is 12 bedded Level II unit, created over a space of 1400 sq. feet. There is a dedicated Pediatrician who has been trained in Essential Newborn Care including care at birth and neonatal resuscitation. The units would be equipped with essential equipment for neonatal stabilization, management and resuscitation. Neonatal Stabilization Unit is a facility within or close proximity of the maternity ward where sick and low birth weight newborns can be cared for short periods. All FRUs need to have a Neonatal Stabilization Unit, in addition to the neonatal corner. Details of services provided and requirements for equipments, supplies, training and HR as available in the TOOL KIT would be provided. As such, Neonatal Stabilization Units are proposed to be established in all the 39 FRUs where the neonates who require specialized care would be stabilized in these facilities before referral to SNCU/NICU.

All the above mentioned initiatives, focused on the Child Health are going to bring in improvements in child health. However, all these would require accelerating the reduction of maternal & child undernutrition in the State for which a major IEC/BCC campaign 262

including provision of Iron Folic Acid Kits to all AWC/ASHAs are also proposed. Malnutrition is one of the biggest problems that rural areas. It’s the leading cause of mortality in children 0-5 years of age. Undernourished children grow into undernourished adults with poor intellectual and work capacity. Undernourished girls become weak mothers, giving birth to underweight babies thus continuing the vicious cycle of poverty and ill health. Anganwadis set up by the Indian Govt. only provide food to preschool children above 3 yrs of age and Health department is working with ICDS to tackle this problem.

A massive IEC/BCC campaign is envisaged to inform communities on the importance of good nutrition for children & pregnant mothers. NGOs and other would be encouraged to help the Government. Improving women’s status is widely seen as a strategy for improving family health and nutrition hence involvement of Civil Society and other concerned Department for improvements is important. A holistic approach is proposed to be taken to deal with the problem. Balanced diet is the long-term goal.

Special provision has been made in the budget for Drugs that would help us in improving Child Health. These are:

SC Kit A & Kit B. Drug Kit for Sick New born & Child Health for PHC, CHC, FRU

Emergency Drug Kit for New Born & Child Health for FRU Drug Kit for all AWCs having Iron Folic Acid (Tablet/Liquid), drug for Deworming, Vit A, Zinc, ORS & Co-trimoxazole.

Special Drug kits for Child Health for ASHAs containing Iron

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Folic Acid (Tablet/Liquid), drug for Deworming, Vit A, Zinc, ORS & Tab. Paracetamol, Co-trimoxazole. Etc.

Table: - 30

Expenditure on Child Health 974.74 (other than Trainings )

Trainings 102.84

Total 1077.58

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ADOLESCENT REPRODUCTIVE AND SEXUAL HEALTH (ARSH)

IV. ADOLESCENT HEALTH

Table: - 31 Current Status Current Goals Intermediate Indicators Status 2012 Proportion of teenage women (15-19 yrs.) 8.0 5.0 ever married Proportion of teenage women who were 4.2 95 already married or pregnant Percentage of adolescents who are 21.3 20 Undernourished (BMI lower than 18.5 kg/m2) Prevalence of RTI/STI among 15-19 age 70.8 40 group ever-married women Percentage of 15-19 using any modern 44.9 30 spacing method Unmet need for spacing methods among 6.00 20.0 15-19

Source: NFHS-III

Adolescents between the ages of 10 and 19 years form about 25% of the population. This large segment of population has its own health need related to physical and psychological changes. Therefore any intervention for improving their reproductive health should also focus on issues related to education and stress management, relationships, career/ livelihood and socio economic adjustments.

Further, in societies with strong age- and gender-based hierarchies, the needs, actions and options of youth are governed by family, 265

social, economic and cultural systems. In such settings, a holistic perspective and program approach is needed to improve the health and well-being of young people, particularly in impoverished communities.

In J&K Almost 11 percent of adolescents in the age group of 10-14 years and 15 percent in age-group 15-19 years are illiterate. The median age at marriage is almost 20 years in the state. Around 70% of the ever-married women in the age group of 15-19 years reported one or more symptoms of reproductive tract infections. With the literacy levels being low, it is very important to evolve a comprehensive adolescent health strategy with special focus on out-of-school boys and girls who are either single or recently married.

Situation analysis Though adolescence (10 – 19 years) is the most important period in the life of a woman or man, unfortunately not much attention has been given to this phase of human life specifically in the developing countries. The recognition of adolescent needs and their sexual and reproductive health has been growing. The adolescents form a heterogynous population with different experiences and expectations. Adolescents (10-19) constitute over 23% of the population in India and constitute over 27 lacs in J&K. They are located in rural areas and urban areas including slums. They are in schools and out-of-schools and some of them are involved in economic activities either in formal or informal sector.

Reasons for Special focus on needs of Adoloscents:

• Lack of formal or non-formal education. High drop-out rates among girls is noted - Secondary School Enrolment is less for Girls

• Not informed about physiological changes in their bodies. 266

• High prevalence of malnutrition and anaemia 53 % of adolescent girls suffer from malnutrition and Anaemia in J&K

• Socio-cultural practices of early marriage followed by early pregnancy.

• Higher maternal mortality rates and adverse neonatal outcomes associated with adolescent pregnancy.

• A relatively high percentage of girls still get married below age of 18 years. According to NFHS 3, around 14 % of women aged between 20-24 years were married by age of 18 years in J&K. Moreover 4.2% of women aged 15-19 years were already mothers or pregnant by the time of survey.

• The percentage of girls getting married below 18 years is higher in some districts.

• Poor personal and vaginal hygiene leading to reproductive tract infections in adolescent girls. • Increasing risk of physical, mental and sexual abuse.

• Gender discrimination

• Lack of information about HIV/AIDS

• Inadequate provision for youth friendly services

• Less opportunities for adolescent girls for growth and development

• Limited space to voice their opinions

It is essential that we work with both adolescent girls and boys and equip them with skills and knowledge to adopt responsible and healthy lifestyle to ensure a better, more healthy future. Among the adolescents the girls remain further disadvantaged owing to the traditional practices and beliefs perpetuated by patriarchy and the resultant social positioning of girls and women.

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The out–of–school adolescent girls remain most marginalized without almost any opportunities for development and education and having very few choices in front of them. They are married off early by parents under social pressures and soon become mothers as well even if their physical and mental health gets compromised. They are mostly limited within their houses with limited access to information /resources of any kind, they are often involved in supporting the family through engagement in productive work in informal sector (as unskilled workers who are low paid). They hardly find a space for themselves in family and society and are not able to express their needs. Adolescent Programme Initiatives in the state

Adolescent Clinic and Counseling Services are proposed to be started as pilot project in the two GMCs of the State and 7 selected District Hospitals.

RCH II A comprehensive Adolescent Health Initiative (AHI) is envisaged under RCH II in collaboration with partner departments and other stakeholders like ICDS, Education Dept., Professional Bodies, NGOs. An essential package for adolescent health will be implemented universally in the entire state including services for prevention of anemia for in school and also for out of school adolescent girls in collaboration with ICDS and NGOs. The expanded service package is being proposed in phased manner for in-school and out of school adolescents and will include—Adolescent friendly health services, including counseling and awareness generation on adolescent issues.

Anaemia Control Programme among school going adolescent girls. This initiative is being implemented in a phased manner. 268

In the first phase, Poonch, Kathua, Udhampur, Anantnag, Baramulla, & Kulgam, Leh districts would be taken up covering adolescent girls (10-19 years) in all government schools and adolescents out of school through weekly distribution of IFA tablets and half-yearly de worming).

Implementation of ARSH strategy in the State: Activities to be undertaken at State level: 1. State level workshop for sharing plan/strategy with all the stake holders within the government Departments and other members of the Civil Society 2. Disemmination of ARSH guidelines 3. Printing of modules, reporting registers and formats 4. Preparation of operational plan for ARSH services across the districts (including training, BCC/IEC, equipment, dugs, and supplies etc) 5. Communication activities through media. 6. Youth festivals addressing Health, gender 7. Training of MOs, ANMs, counsellors, state and district level programme managers. State level Trainers (faculty from GMCs among others) would be trained outside the State. 8. Operationalise and make functional the adolescent clinics in the 7 District Hospitals.

At the Divisional level, the two Government Medical Colleges will be functioning as the Nodal Centre(s) for implementation of all activities related to ARSH. (Department of PSM) The nodal centre will be responsible for the capacity building of all levels of staffs. It will also be responsible for monitoring and supervision of the ARSH activities at the block and district level of the identified Districts of

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respective Divisions. For providing such assistance a special cell will be established in the Department of PSM of the two GMCs.

Operationalization of Adolescent Health Clinics at District Hospitals

The Adolescent Health clinics at district level are proposed to be set up in the DHs of 7 Districts. The adolescent health clinics would be functioning in close linkage with related initiatives under RCH/NACO. The overall programme would be managed by the District Health Society through RKS of the DH.

Operational Mechanism:

ADOLESCENT HEALTH CLINIC AT DISTRICT LEVEL

Lady Medical SN/ANM-in- Lady Data Entry Officer-on service to be Counsellor- Operator-on contract provided on on contract contract rotation basis depending on demand in the Clinic

Adolescent Health Clinic will cater to the target population in the age group of 10 to 19 years. Requirement for setting up of such clinics : A reasonably sufficient space or a room has been identified within the District Hospital itself The clinic has the following: - an examination table - curtains for privacy

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- Furniture e.g. table and chairs etc for the counselors and other logistic support as may be required. - A sign board indicating the name of the clinic along with hours and days on which they will remain open. • Other necessary equipments and consumables may be used from the District Hospitals supply of consumables and medicines. • The clinics shall remain open 5 days a week from Monday to Friday. On Saturdays couselling services related to maternal and child health especially to married adolescents would be provided within the hospitals.

Services provided at the Adolescent Health Clinic: The district level clinic(s) will provide preventive, promotive and curative services related to adolescent problems and some RTI/STD services along with this. Promotive Services: • Information / advice on sexual and reproductive issues. • Counselling for adolescent specific Psycho-Social issues. This should also include: • Psychological and physical problems due to hormonal changes during this phase along with environmental problems. • Counselling on issues like delayed pregnancy, importance of family planning and other psycho- social issues. Preventive Services: • Services for Prophylaxis against Nutritional anaemia.

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• Taking appropriate steps for services for early and safe termination of pregnancy and management of post operative complications. • Counselling for safe sex and problem of early marriage and early pregnancy. Curative Services: • Treatment for common ailments and problems. • Treatment for menstrual and gynecological problems. Referral Services: • Referral to other Departments for treatment of specific illness. • Referral to Voluntary counselling and testing centre if need arises. • Besides the General Health staff will be sensitized about ARSH special Awarness generation camps one /year/District and 2 camps/year in 1907 subcentres will be held to provide the preventive, curative & promotive ARSH services

Manpower for Adolescent Health Clinics at district level:

One Lady Medical Officer - A Lady Medical Officer on contract would be appointed in the proposed clinics in the two GMCs. Similarly, one Lady Medical Officer would be engaged at the Adolescent Clinics at the 7 District Hospitals who would be supported under RCH (@ Rs 18,000/- per month per Lady Medical Officer).

Lady Counsellors are being placed at all the proposed Adolescent Clinics at the two GMCs and 7 DHs for enhancing the access to quality and responsive health

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services to the adolescent population. These Lady Counsellors would be supported under RCH II (@ Rs 7,000/- per month per Lady Counsellor).

One AN/ANM is to be provided from the two GMCs/ District Hospital itself

One Data Entry Operator (Graduate with knowledge in Computer) is proposed in the 9 facliities (2 GMCs/7 DHs). He / She should also be a resident of the concerned district - contractual monthly remuneration should be Rs. 7000 (consolidated). To be selected by the GMCs/RKS of the DHs. They would be maintaining a database for the services rendered, for generating relevant information for feeding into the HMIS for decision-making and action planning for improving the services.

HEALTH EDUCATION & IEC: • In each school of the selected 7 Districts - quiz contest, debates, skits, community orientation and other activities to be held quarterly, to keep the parents and communities aware and supportive of the programme and explore possibilities of reaching to the out of school girls. This is to start from mid-2009 after some printed literature on the subject is provided to all the private & government schools. One teacher from the school would be the teacher in-charge of the programme. Dedicated staff from the Health Department would be participating as facilitators. • A month in the year may be earmarked when all schools will hold classes where anemia and other related issues as a topic will be discussed. IEC activities like quiz, debates, and

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skit competitions by school students may also be held at this particular month.

FUNDING MECHANISM:

• The funds for the implementation of the programme will be transferred to the District Health Society & the Principal of two GMCs. • The DHS/Principal GMCs will in turn transfer the fund to the RKS and Department of PSM • The District Health Society and Principal GMCs will furnish a monthly SOE to the State and a utilization certificate at the end of the financial year.

MANAGEMENT OF THE PROGRAMME IN THE STATE/DIVISION & DISTRICT:

• SHS will be the implementing agency for the State. A nodal officer as mentioned above will be selected, who will be responsible for coordinating the programme. S/he will have to be preferably supported by the SPMU. • In addition, the Dy CMO will oversee the programme in the District which would be implemented through RKS. • At the Division level support will be provided to the two GMCs, that stands budgeted.

In addition to above, the activities already initiated in 2008-09, like translation & printing of documents including other IEC materials focusing on Adolescent & Reproductive Health, Special awareness generation camps one/year/district (in remaining 17 Districts), Adolescent Group orientation 4 times /year/Subcentre (all the 1907 SCs) and Women group and SHG orientation on Adoloscent issues at all the SCs would be carried on . 274

Budget under ARSH = 104.18 Lacs (Other than trainings) Trainings 17.82 Lacs Total 122.00 Lacs SCHOOL HEALTH PROGRAMME- IN J&K

INTRODUCTION: School Health Programme in J&K is being implemented in J&K through internal resources. The SHP was taken up in the pilot Districts of Jammu & Srinagar initially. A doctor designated as School Health Officer was posted with the Chief Medical Officer of Jammu & Srinagar. The School Health Officer along with 2 No LHVs was exclusively responsible for visiting the schools for medical checkup of the Students. However, due to huge number of schools in Jammu & Srinagar cities the programme remained confined to the city schools only and the schools located in the periphery, farflung areas of these two Districts could not be covered as desired. The new posts of School Health Officer could not be created in the other Districts of the State. Nevertheless, keeping in view the importance of looking after the health of school going children, the School Health Checkups in all the State are being done by the Medical Officers of the CHCs, PHCs and Allopathic Dispensaries for their respective areas. This strategy also met with initial success but with passage of time the spirit of the Health Workers diminished and now the School Health Checkups are done by only those who are enthusiastic about work and perform their duty consciously. The Medical Officer along with the accompanying Health works perform the Check-up for the following : 1. Visual Aquity 2. Common Skin Disorder 3. Hearing Disorder 4. Worm Infection 5. Anaemics 6. Congenital Disorders 275

7. Malnutrition

The progress of School Health for last 2 years and the 10 Months of current Year is as under: Year No. of No. of No. of No. of Children Schools Children Children found with Health visited examined found Healthy problems 2005-06 2539 126006 92146 33860 2006-07 2720 127671 91108 36563 2007-08 3453 260234 201025 59209 2008-09 1002 44093 35734 8359 Till date

Now the School Health program is being strengthened under National Rural Health Mission. In addition to focused attention on the programme,now the State Health Society intends to supplement and further strengthen the programme by imparting training to Teachers, AWWs, ANMs and others concerned as a part of Inter Sectoral Convergence. All programmes addressed to the School Going population, through the Department of Education, Social Welfare (ICDS), Women & Child Development would be ensured for success of this program.

Management Structure for effective management:

i. The NRHM convergence mechanism will apply to this programme as well. The teacher(s) and Health workers will work closely together for the success of this programme. The involvement of State Health Society, and District Health Society shall ensure success of the school health programme;

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ii. The Village Health & Sanitation Committees will supervise & monitor the programme and ensure the regularity of Visits of ANMs/FMHW to the School. The VH&SC would be supported & supervised by the DHS/RKS of PHCs/CHCs.

Total Budget required for the Programme under NRHM:

• IEC (109 Blocks x Rs 0.50 per Block ) = 54.50 • Drugs(iron & De-worming) o (109 Blocks x Rs 0.50 per Block ) = 54.50 • Printing of School Health Card = 15.00 o (New as developed by UNICEF o Soft copy available (Lump sump )

Sub Total = 124.00 Training = 5.50 Total Budget = 129.50

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Chronic Disease Prevention through Health Awareness and Advocacy through and by Youth- A Special initiative (Part of School Health Programme)

Background Health promotion initiatives, a core function of public health needs to strongly focus on youth as they are increasingly adopting unhealthy lifestyles leading to lifestyle related disorders such as heart disease, cancer, diabetes and obesity at a very early stage in life. There is a major need to increase awareness among youth about behaviours which positively influence health (like appropriate diet and nutrition, physical activity, personal hygiene and avoidance of addictions like tobacco) and also inculcate requisite skills to advocate for supportive health promoting policies.

Rationale Health Related Information Dissemination amongst Youth – Student Health Action Network (HRIDAY- SHAN) is an organization of health professionals and social scientists, engaged in health promotion activities aiming at prevention of chronic diseases among school and college students in India, since 1992. HRIDAY- SHAN works in collaboration with the World Health Organization (WHO), the Ministry of Health and Family Welfare, Ministry of Environment and Forestry, Government of India. The health promotion programmes of HRIDAY- SHAN aim at enhancing health awareness among school/college students and training them to pursue peer education for adoption of healthy lifestyle norms. HRIDAY- SHAN will partner the Ministry of Health, Government of Jammu and Kashmir to implement a model of school health promotion within the selected districts. This programme can be integrated into the National Rural Health Mission which has prevention of chronic disease as a major area of focus.

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Methodology

A school health programme on various health issues can include activities at three levels: school, home and community level in selected districts with schools being the focus of intervention.

Target group

Students of Std VI (age group 10- 11 years) for health awareness component of school health programmes and Std IX students (age group 14- 15 years) for health advocacy component of programme can be taken as the target group for the programme.

Activities to be undertaken

Consultative meetings Various consultative meetings will be organized with state government officials to develop and plan implementation of a socio- culturally contextualized model of health promotion for the state of Jammu and Kashmir, taking HRIDAY- SHAN’s model of school health promotion as the base.

Adapting HRIDAY– SHAN model of school health promotion for rural setting The existing model of HRIDAY- SHAN school health promotion programme is designed for urban schools. The same will be adapted for rural setting in consultation with state level stakeholders.

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Identification of NGOs HRIDAY- SHAN will assist the state government to identify and select state level NGOs which have some experience of working on school health programmes and also facilitate their capacity building.

Identification of Schools In each of selected districts, requisite number of schools will be selected and recruited for programme implementation with equal representation from government and private schools keeping in mind gender balance. Intent should be to recruit all types of schools: girls only, boys only and co-ed schools.

Designing of Evaluation Tool HRIDAY – SHAN will assist the state government in developing a Survey questionnaire which will be administered to students of class VI & IX to assess the perceptions, intentions, knowledge, attitude and practices of student with respect to various health issues. Qualitative methods (e.g. FGDs) will also be used for evaluation.

These evaluation tools will be used to collect baseline and endline data to assess the impact of intervention and to evaluate any change in the knowledge, perception, intentions, attitudes and practices of students, teachers, parents and community members.

Development of Learning Resource Material Learning resource material will be adapted from existing materials developed by HRIDAY- SHAN as per local requirements for students, teachers and community members. These materials will also be tailor made for rural settings as the existing materials are

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designed for urban set up. Some of the resource materials are listed below: Teachers: Teachers training manual Peer leaders: Peer leader Manuals Students: Booklets, Fact Sheets, Students Manual, Health Education Games, Posters, Worksheets etc. Parents: Home Team Material, Pictorial Postcards Community: Posters • Capacity Building

o Capacity building of various stakeholders HRIDAY- SHAN will help the state government in organizing capacity building sessions for various stakeholders involved in implementing the school health programmes including government officials and NGO personnel on the various components of intervention. The intent of organizing these workshops will be to sensitize the NGO representatives about the problem and to train them on existing methodology of implementing health promotion programmes in schools. o Training of Teachers As part of the programme, teachers of every section of Std VI and IX will be trained on the issue of health promotion and methodologies to conduct classroom activities o Training of Peer Leaders One peer leader for approximately every 25 students will be selected and trained on the issue and the various activities to be conducted at school and home level for awareness on the issue.

Classroom Activities The teachers trained will conduct classroom activities, mentioned in the teachers training manual with help of trained peer leaders. They

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also will be orienting the students on home team material and to conduct activities at home with their parents and siblings.

School Level Policy Initiatives The teachers and students will be trained to sensitize the school and college authorities to make their school a ‘health promoting school’ as per the criteria laid down in the health promotion model.

Community Outreach Programme HRIDAY- SHAN will assist the state government in adopting and developing a model of community outreach programme entitled: “Humne Seekha Hai (we have learnt)”. In this model, schools serve as facilitators of community health education, for transfer of knowledge from health experts (represented by governmental agencies and health NGOs) to the wider community. Periodic programmes involving such interactions between school students and neighbourhood communities provide for a sustainable tobacco control programme.

Community outreach programme can be organized with display of posters at prominent places and distribution of other IEC materials. Activities like street plays, rallies etc. can also be organized to sensitize the community members on health promotion issues.

Evaluating the Effectiveness of the Programme The responses of students at pre and post intervention level to the student survey can be statistically analyzed to study the impact of intervention on the knowledge, attitudes, and practices, lower the intention to use tobacco and to enhance the advocacy skills of students related to tobacco avoidance.

This component stands budgeted. 282

TRIBAL HEALTH

Background:

20% of the Total population in the State is TRIBAL as J&K is home to a total of eleven major tribes, namely Gujjars, Bakarwals, Gara/Garba, Mon, etc. (details are attached in Table I.), who constitute 10.9% of the total population of the state. Among these, Gujjars and Bakarwals constitute a significant proportion of the population of the State with major concentration in Jammu, Rajouri, Udhampur, Poonch, Uri, Ganderbal, Anantnag, Daksum and Kandi areas of Jammu and Kashmir Divisions. The Gujjars in the state are divided into two sections on the basis of their occupation –the Zamindar and Dodhi. The primary occupation of the Zamindar Gujjar is agriculture, supported by animal husbandry whereas the Dodhi Gujjar practise pastoral nomadism. On the other hand, Bakarwals is a tribe identical to the Gujjars who have descended from the same ancestry. This group still extensively practices nomadic livestock rearing. The government of J&K has put special emphasis on the promotion & welfare of these backward tribes taking into account the vulnerable position of these groups.

Table I: Major Scheduled Tribes of Jammu & Kashmir 3 • Bakarwal Pastoral Nomadic Community of Doda, Rajauri, Poonch and Parts of Udhampur

• Balti Majority group among the Muslims of Ladakh, i.e., Leh and Kargil

• Beda Partly sedentary and partly nomadic community of Ladakh. They inhabit cold desert regions at a high altitude which have a heavy snowfall

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• Bodh Also known as Ladakhi-Bodh, they live in the Zanskar and Nubra region.

• Broq-Pa Also called Shin, they inhabit the high hills of Ladakh

• Champa /ChangpaAlso known as Fangpa and Phalpa (nomadic) the people have derived their name from the territory they inhabit, chang meaning north and thang meaning plains. Hence Champa/Changpa are the people of the northern plains of Ladakh.

• Dokhpa Also known as Drokpa or Brokhpa, meaning people of the meadow, they are descendants of the Dards and have immigrated from Gilgit. They inhabit the villages of Da, Hanu, Darchik and Garkun on the banks of the river Indus.

• Gara/Garba A majority of them live in the Leh and Kargil districts.

• Gujjar Gujjars are distributed in Srinagar, Anantnag, Pulwama,Doda, Jammu and other districts. The Gujjar of this state are divided into two sections on the basis of their occupation – the Jamindar and Dodhi. The primary occupation of the Jamindar Gujjar is agriculture, supported by animal husbandry. The Dodhi Gujjar practise pastoral nomadism.

• Mon They are musicians and flute players of the Ladakh region (mainly Ladakh and Kargil) and move in the company of the Beda. Most of the Ladakhi villages have one or two Mon households.

• Purig-Pa The ancient name of the Kargil area of Jammu and Kashmir state is Purig or Purik. The inhabitants of Purig or Kargil mainly the area lying between Nameik-la in the east and Zojila in west, are known as Purig-pa, a term which has a territorial rather than an ethnic connotation.

Percentage of children age 12-23 months fully immunized by background characteristics 4 Table :- 32 Residence Caste RURAL URBAN SC/ST OTHERS J&K 77.8 93.5 72.1 83.6 India 58.4 74.3 61.2 63.9

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Percentage of children age 12-23 months received vit A by background characteristics 5 Table :- 33

Residence Caste RURAL URBAN SC/ST OTHERS J&K 53.7 65.1 50.0 57.9 India 57.0 61.0 60.4 56.8

Institutional delivery with key background characteristics 6

Table :- 34

Residence Caste

RURAL URBAN SC/ST OTHERS

J&K 59.0 91.8 50.9 70.1 India 52.0 80.7 55.3 64.9

Focused initiatives were taken up in 2008-09:

• 287 teachers belonging to Tribal community (Gujjars & Bakerwals ) who are mostly posted in mobile schools have been trained in providing information on importance of sanitation , Nutrition and providing first Aid to the people residing in higher reaches. Drug Kits Provided to the trained tribal teachers

• Construction of one room for AMCHI Practioners (in Leh/Kargil District);

• Additional Funds for for supplementing annual supplies to Mobile Medical Aid Centres who move along with Tribal groups during migration.

• Funds for holding special health camps in blocks having Tribal Population released to Districts

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In 2009-10, a new AYUSH doctor and a pharmacist are proposed for the 78 existing mobile medical teams (currently manned by a Pharmacist from health Department) that move along with the Gujjar & Bakarwals(tribes). As a normal practice Gujjars/Bakarwals, move up the mountains during summer and return down to the plains in winter. This is a unique initiative to serve the population that does not get the benefits of public health system. In addition, special funds are being provided to procure drugs especially for the Tribals.

Total budget proposed under this component is Rs.268.64 lacs.

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TRAININGS UNDER NRHM

Trainings under NRHM were planned as per the RCH- II/NRHM Guidelines. Comprehensive Training Plan (CTP) was discussed and submitted to National Institute of Health & Family Welfare, New Delhi.(NIHFW) for the 2008-09 and also to Training Division of the MOHFW, GOI. Achievements for 2008-09 are Annexed at Annexure-1. However, the State could not adhere to the plan due to various bottlenecks, at the level of Training Institutes (In-service Training Infrastructure not fully functional, Shortage of Facuilty in GMCs and ANMTs in State). Shortages of Staff in the rural health services were also a bottleneck since shortages did not permit service providers to leave for trainings. However, the bottlenecks stand identified and several actions are proposed in the PIP to remove these. Budget sheets for Trainings & Workshops are attached as Annxure-2

MNGO SCHEME - IMPLEMENTATION IN J&K To Supplement the State Health Society in Health Care delivery system, the NGO are playing a pivitol role under the MNGO Scheme. State NGO Coordinator is working in the SHS and co- ordinationg all the activities of the schemes under overall supervision of the Director FW & RCH. The SHS has taken initiative to strengthen the NGO component. As a result of which, now there are 10 MNGO covering 12 Districts. In 2009-10, it is proposed to place one MNGO in each of the 22 Districts to achieve the target of RCH indicators working in the State. The external monitoring has been initiated from the year 08-09 and done for JKESL MNGO of Udhampur/Rajouri.

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In the coming year it is proposed that regular external monitoring will be done by the Department of PSM in both the Government Medical Colleges. MNGOs Scheme stands budgeted for 2009-10. GENDER & EQUITY

The Population Policy, National Health Policy (2001) and the 10th Five Year Plan highlight the disparities in health and family welfare outcomes across the country and the importance of reducing gender inequities to enable the country to attain its health and development goals. The policy position emphasizes on equity as an essential and central objective. The national policies identify where the greatest disparities exist in health outcomes by geographical location, gender, caste status, and tribal status, and also identify specific underserved population groups, namely adolescents, the elderly and migrant workers. To achieve greater health equity, State is “addressing access, equity, vulnerability and gender issues” at all the levels of service provision, through various generic interventions. Efforts have been initiated to reduce the disparities between men and women and to improve the health status of women by integrating with the existing system i.e. mainstreaming gender sensitive activities. As the first step towards attaining equity, the knowledge awareness gaps regarding reproductive health information, knowledge about their rights – for seeking health services, knowledge about their sexual and reproductive rights would be identified and exact information needs would be identified. Under RCH-II, J&K, initiated steps to transform the conventional family planning program into a rights-based, gender and socially equitable reproductive and child health program. The focus in RCH phase-II shall be on services and service providers who would be trained to provide women in the State to have autonomy in reproductive health matters. Involving more men is a priority.

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Moreover, State Government is taking all steps, through print, electronic & radio, to inform public on the implementation of the PNDT Act in State. A helpline is functioning wherein common man has been requested to report, through help line (telephone, email or in person) on practice of female foeticide or discrimination on the basis of sex. However, preference for boy in Districts of Kathua & Jammu is recognized for which several Workshops for the Media persons including Training of Appropriate Authorities, Specialists (Gynaecologists, Radiologists) and Medical Students were organized in the State. Data compiled by the Directorate of Economics and Statistics of the State government shows that the population of female child needs close watch. In Kathua district, the latest ratio is 796 girls to 1,000 boys in the urban side and 847 females to 1,000 boys in the rural part. The following are initiatives proposed under this component: 1. Orientation Workshop at State Level for Appropriate Authorities ( PC&PNDT) of State/ Divisional/District Level.

2. Under Save the Girl Child component, rallies/ debates in schools/ Colleges and massive advertisements in the Newspapers, printing of Newsletter/ Modules for Gender Issues , and

3. Establishment of PNDT Cell for Legal support and Monitoring at Divisional level, one in Jammu and another in Srinagar

Total budget proposed for 2009-10 is 156.92 lacs

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Part B NRHM INITIATIVES

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PART B- NRHM INITIATIVES

PROGRESS AT A GLANCE NRHM ADDITIONALITIES IN JAMMU & KASHMIR

S. Activities Phasing and Status No. Time Line 1. Fully trained Accredited Social Health 50% by 2007 Total ASHAs in place 9764. Activist (ASHA) for every 1000 100% by Trained in Module-1, 9500, population/ large isolated habitation. 2008 Trained in Module II- 8900. 2. Village Health and Sanitation 30% by 2007 A total of 6788 VHSCs Committee constituted in over 7537 100% by constituted against target of villages and grants provided to them. 2008 7537 3. 2 ANM Sub Health Centres 30% by 2007 212 2nd ANM recruited.. strengthened/established to provide 60% by 2009 1543 to be hired in 2009-10. service guarantees as per IPHS. 100% by 2010 4. 187* PHCs strengthened 30% by 2007 96 PHCs functioning on /established with 3 staff nurses to 60% by 2009 24x7 basis. 24 PHCs to be provide service 24x 7 days services. 100% by operationalised as 24X7 in 2010 2009-10 5. 39* CHCs strengthened/ established 30% by 2007 17 CHCs proposed to be with 7 specialists and 9 staff nurses to 60% by 2009 upgrade in 2009-10. provide service guarantees as per 100% by IPHS. 2012 6. 14 District Hospitals strengthened to 30% by 2007 Physical infrastructure provide quality health services. 60% by 2009 upgradation is going on in 100% by 14 DHs and is in progress in 2012 8 CHCs in New Districts being upgraded to new DHs 7. Rogi Kalyan Samitis/ Hospital 50% by 2007 474 RKS registered and 7Development Committees 100% by operational; established in all CHCs / Sub 2009 DHs-14

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Divisional Hospitals/ District Hospitals. CHCs-85 PHCs-375

8. District Health Action Plan 2008-2012 50% by 2007 DAPs prepared for all 22 prepared by each district of the state. 100% by (100%) districts of the state. 2008 9. Untied grants provided to each village 50% by 2007 Untied funds not disbursed Health and Sanitation Committees, 100% by to VH&SC. However funds Sub Centres, PHCs, CHCs to 2008 for 1907 SCs & 374 PHCs. promote local health action. 85 CHCs disbursed. 10 Annual maintenance grants provided 50% by 2007 AMG released for 644 SCs, to every Sub Centres, PHC, CHC and 100% by 268 PHCs & 84 CHCs. (only one time support to RKSs at Sub 2008 to those institutions housed Divisional/ District Hospitals. in the Government buildings) 11 State and District Health Society 50% by 2007 State Health Society and established and fully functional with 100% by district health society for all requisite management skills. 2008 22 Districts functioning. 12 Systems of community monitoring put 50% by 2007 Since PRIs are not in place 100% by functional in state. Process 2008 to empower community through VH&SC is in envisaged. 2000 VH&SCs are proposed to be Trained in 2009-10.

13 Procurement and logistics streamlined 50% by 2007 Decentralised Procurement to ensure availability of drugs and 100% by System in place. A New medicines at Sub-Centres/ 2008 Directorate, replicating PHCs/CHCs. TNMSC model with state specific changes envisaged.

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14 SHCs/ PHCs/ CHCs/ Sub Divisional 30% by 2007 14 DHs, 70 CHCs and 71 Hospitals/ District Hospitals fully 50% by 2008 PHCs are equipped to equipped to develop intra health 70% by 2009 provide given services. sector convergence, coordination and 100% by service guarantees for family welfare, 2012 vector-born disease Programme, T.B., HIV/AIDS.

15 District Health Plan reflects the 30% by 2007 IDHAPs of all 22 districts convergence with wider determinants 60% by 2008 have focussed on of health like drinking water, 100% by convergence issues. sanitation, women’s empowerment, 2009 child development, adolescent, school education, female literacy etc.

16 Facility surveys carried out in each 50% by 2007 Facility survey has been and every district of the State. 100% by completed by the state and 2008 findings used for PIP.

17 Mobile Medical Units provided to each 30% by 2007 MMUs proposed for 4 district of the state. 60% by 2008 Districts & AMMUs for 8 100% by Districts. 2009

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NRHM INITIATIVES

Village Health & Sanitation Committees:

Untied funds to village Health & Sanitation Committees @ Rs. 10,000 so as to undertake various activities like the IEC, household survey, preparation of health register, organization of meetings at the village level. Monitoring the functioning of the health facilities.

• On pilot basis 10 villages from each medical block have been identified across the state. • VH&SCs will be trained (training workshops) - on NRHM, their roles and responsibilities, untied funds, village health improvement activities. Karuna Trust, Bangalore has agreed to support TOT for this component.

State NRHM Mission will prepare a guideline on the role of the VH&SC in local language and disseminate to all VH&SC. However, the VH&SC are expected to do the following activities in their villages: 1. Implementation of village health plan and related activities. 2. Create awareness and promote village level public health activity like cleanliness drive, sanitation drive, school health activities, etc. 3. Disinfection of water sources, wells in the village, promote activities relating to mosquito eradication. 4. Facilitate successful holding of monthly VH&NDs at AWWCs and help to organize Health Mela, Sishu Mela, and camps for the differently abled. 5. Promotion of use of safe & clean drinking water and conducting water quality survey etc. 6. Promote use of public health facilities by the community

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7. Discuss every maternal death & neonatal death that occurs in their village, analyse it and suggest necessary action to prevent such deaths & get them registered in the Panchayat. 8. Management of untied funds in coordination with ANM 9. Be catalyst for improving health and Intersectoral convergence

ACCREDITED SOCIAL HEALTH ACTIVIST (ASHA)

The state has selected 9500 ASHA to support village level health programmes in 7537 inhabited villages of the state. The scheme will not only benefit the health system, but also give opportunity to empower women in the rural areas. The budget for the same has been budgeted under NRHM.Rs. 358.15 lacs are budgeted for ASHA Trainings, Drug Kits for ASHA and establishing ASHA Mentoring & Support Mechanism. Government of India would be requsted to give us a State Specific Model for this. The training of ASHA using government of India supplied modules will be taken up in different phases. In the state of Jammu and Kashmir, ASHA training for module 1 for all 9500 ASHAs has been already completed and 8900 Trained in Module II.

Budget for training would be covered through NRHM.

B-1. ASHA – Accredited Social Health Activist

Objectives/ To establish ASHA Mentoring Group to train and Milestones/ Benchmarks support ASHAs as envisaged under NRHM to enhance health outcomes To have a operational ASHA Resource Centre Strategies a. Establishment of ASHA Mentoring Group. b. Support required for training of ASHAs c. Availability of ASHA drug kits

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Activities • All ASHAs will be trained in all the Modules by the end of this year • Provision of drug kits and timely refilling is to be ensured. To provide the link worker at grass root level to mobilize the community so as to • Address unmet needs for primary health care. • Increase institutional deliveries. • Enhance immunization coverage, nutrition education and ANC/ PNC coverage Improvement • To generate demand for health services through ASHA (to act as communication resources, service provider, guide, mobiliser and an escort to village people to access health services. • Counselling women on birth preparedness, immunization, contraceptive, RTI, STI. • Mobilize the community and assist them in accessing the services, already available at Anganwadi, sub-centre PHC. To work with village health and sanitation committees under panchayat and act as depot holder for ORS, IFA, chloroquine, delivery kits, oral pills, condoms etc. Promote construction of toilets under TSC. Support • From GOI for establishing Support Mechanism for required ASHA • Contracting of agency Use/ availability of ANMTs/DHs/PHCs/ CHCs, DTCs and other health facilities as Training sites

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PROGRAMME MANAGEMENT STRUCTURE:

At State Level: State Health Society is implementing the programme under overall guidance of Governing Body headed by the Chief Secretary to Govt; of the State. However, for day to day decisions are taken by the Executive Committee of the State Health Society headed by the Commissioner/ Secretary to Govt; Health and Medical Education Department. The roles of the respective bodies are as follows:

• The primary implementing agency is the State Health Society. It is implementing the NRHM Programme in the State • The Chairman, Executive Committee of State Health Society is empowered for executing the programmes under NRHM. • All the financial powers on approved programmes vested with the Executive Committee of State Health Society. • The RCH Directorate headed by Director, Family Welfare & RCH alongwith Director Finance are empowered to sign cheques and other documents on behalf of State Health Society • State Programmme Management Support Unit guides evidence based decision-making for the Programme to Director, FW &RCH and Executive Committee of the State Health Society. • At Divisional level two Divisional Programme Management Unit one for Jammu Division and another for Kashmir Division are established and supporting the implementation and monitoring of the Mission..

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At District Level: • District Health Societies are fully operational in all the districts. The Deputy Commissioner is the Chairman, Chief Medical Officer as Vice Chairman and other District Officers from Education, Rural Development , PHE, PDD, ICDS etc are the members of the society. • All Deputy Commissioners have been requested to support NRHM on priority • The District Health Societies have engaged District Programme Units (DPM, DAM & DDO etc) to support implementation of the Mission. • The Deputy Chief Medical Officer, along with the CMO is the signing authority for operating Bank Account of the DH S. Deputy CMO also acts as Nodal Officer of JSY Scheme. • The State Health Society disburses funds to the districts through DHS through e-banking. SOEs from Districts flow to State Health Society and from there to GOI after compilation.. Any other state specific initiatives/ others.

1. Civil registration System (CRS) The CRS is incomplete in the state.If this is taken up, it would help the state in monitoring Sex ratio at birth and progress thereafter. This would be a part of NRHM plan. The State has initiated various steps for completion of CRS up to 95%. This would also help the State in implementing and monitoring the PNDT Act more rigorously.

2. Advance Mobile Units Advance Mobile Units with emergency care facilities for dealing with injuries from IED Blast, Granades explosions etc. (Recommended by Working Group III – PMO) Mobile Medical Units (MMU)

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B- 7 Mobile Medical Units (MMU) Current Medical mobile units are envisaged under Situation/Challenge NRHM. Apart from providing health care to the far flung areas and the areas where desirable quality services could not be provided due to lack of staff, there mobile units would be the visible face of the mission Objectives/ To strengthen Mobile Medical Units Benchmarks All MMUs functional and reaching health services to remote locations

Strategies To strengthen MMUs to provide outreach services to unserved and underserved areas.

Activities ♦ Provide recurring cost for the functioning of the MMUs • Procuring 4 MMUs in the year 2009-10 • Procuring 8 advanced Mobile Medical units for Block levels • Procurement of tracking system for Mobile units. Support required • All procedures followed to ensure an early procurement of MMUs for outreach care

Implementation of a Computerized Health Management Information System for Monitoring The success of any programme to have an impact will depend to a large extent on the planning, its timely execution and continuous monitoring of the activities. From the very beginning, monitoring and evaluation system has been established to monitor implementation of the programme on a continuous basis. To ensure proper 299

implementation and monitoring of the programme it has formed the following forums and committees:

AT THE STATE LEVEL; 1. State Health Mission headed by Chief Minister 2. State Health Society headed by Chief secretary 3. Executive Committee headed by the secretary (Health & Medical Education) 4. State Programme Support Unit under the overall control of Director FW &RCH

AT THE DIVISIONAL LEVEL; 1. Divisional Nodal Officers (2) 1 each for Jammu/ Srinagar. 2. Divisional Accounts Managers(2) 1 each for Jammu/ Srinagar. 3. Divisional Data Assistants (2) 1 each for Jammu/ Srinagar. 4. Supporting Staff (Junior Assistants) (2) 1 each for Jammu/ Srinagar.

AT THE DISTRICT LEVEL: 1. District Health Mission and District Health Society headed by Deputy Commissioner (here Zilla Parishad is not functional) 2. Executive Committee headed by CMO. 3. District Programme Support Unit

The above committees monitor the progress on a regular basis. The state level committees primarily consist of state level officials with invitees/ representatives from NRHM related departments’ officials/ civil society institutions to closely work with the Health & Medical Education department. These committees monitor and support the programme direction and implementation..

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STRNGHTENING OF STATE PROGRAMME MANAGEMENT UNIT

One of the bottlenecks identified in poor implementation of NRHM in the State is the lack of capacity of the State Health Society to manage numerous components under it. Although improvements did happen when officers (Director Finance, State & Divisional Nodal officers) from State Government were inducted into the SHS, last year,there is need to further strengthen & support the SHS. Some of the initiatives already taken include regular involvement of the two GMCs in the State (through the Department of PSM, Gyn & Obst and Pediatrics) All the three Departments are being indirectly supported through NRHM for supporting in this endeavor. It is proposed that contractual Specialists to the Department of Gyn & Obst and Pediatrics would be provided in lieu of their support for Trainings, proposed to be held regularly, one batch per month, without any break. In addition, it is proposed to induct additional manpower having appropriate motivation to perform along with requisite qualification and experience. It is as such proposed that 4 officers are inducted through support under PIP for 2009-10: The proposed to be inducted are for : 1. Facilitator (Planning & Development in health department under NRHM); 2. Facilitator (Maternal Health)\ 3. Facilitator (Child Health, & Immunization who will also look after School Health, Adolescent Health) 4. Facilitator (Disease Control and Intersectoral convergence, to look after all other components under NRHM)

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All these officer are proposed to be reinducted on deputation to the SHS from the Government Department and as per their present scales. However, deputation allowance would be paid as per entitlement to these persons.

Development of HMIS : One of the priority areas identified for strengthening is monitoring systems and programmes in the State for improving programme effectiveness and coverage. Towards this, the Health Management Information System (HMIS) in the state needs to be refined to include the NRHM components. Extensive data are being collected by various sources and compiled; deficiencies and gaps exist. Support from NHSRC, New Delhi has improved the quality and quantity of data. It needs to be strengthen further for which different actions have been proposed and budgeted. Block Programme Management Support Units Block Programme Management Units Current • Under the umbrella of the NRHM block situation/challange management units at the block level have been constituted. • The BPMU comprises one Block Accounts Manager who is hired on contract @ Rs 10,000/-per month; • These personnel are given travel and DA as per the SHS Rules • These personnel are placed at the Block Head Quarters • There are 109Medical Blocks in the State. Objectives/ • To strengthen Block Programme Milestones/ Management Support units at the block level Benchmarks by hiring experts in the field of Programme Management and Data/ IEC etc in subsequent

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year. Strategies • Support to the BMO for proper implementation of NRHM. • Capacity building of the personnel • Provision of infrastructure for the personnel • Convergence of various sectors Activities 1.Support to the BMO for proper implementation of NRHM 2. Monitoring the Physical and Financial progress in Block 3 Assisting SHS in Yearly Auditing of accounts Support required • State Health Society through SPMU & Div PMU, supports the Block Accounts Manager • State level review of the BPMU on a regular basis is proposed from 2009-10. • Development of clear-cut guidelines for the roles and responsibilities as per theGOI Documents Other initiatives proposed under NRHM are: 1. Strengthening of RIHW & ANMTCs 2. Procurement of Mobile Medical Units & Advanced Mobile Medical Units 3. Procurement of Ambulances 4. Telemedicine Nodes 5. Biomedical Waste Trainings 6. Piloting Health Insurance 7. Cold Chain Maintenance

QUALITY IMPROVEMENT PROGRAMME- JAMMU & KASHMIR

Proposed Journey towards quality Several schemes have been taken up to improve the health of the people of the State under NRHM. Another scheme through SPIP

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for 2009-10 is being proposed for improving the Quality of Health Services. The scheme of Accreditation of Hospitals & Laboratories. Now there is a growing recognition of the need for quality of care in Health programmes, which increases efficiency as well as effectiveness of service being provided by the public health system. Recognising Quality as an essentiality, State Government, basically aims to make all hospitals and medical institutions under the government attain the Quality standards specified by the National Accreditation Board for Hospitals and Healthcare Providers (NABH) for accreditation within next decade. Hence we propose a Quality Management system in our Medical College Hospitals, District & Sub-district Hospitals as per National Accreditation Board for Hospitals and Health Care Providers (NABH) and National Accreditation Board for Testing and Calibration Laboratories (NABL) Standards. This is a long term strategy and would be completed in next 10 years. Under the initial phase of this move, the Quality enhancement work will be undertaken in two MCH Hospitals, the Lal Ded & SMGS Hospitals, located in two Capital cities of the State. The Departments of Pathology, Microbiology & Bio-chemistry from both the Government Medical Colleges, are also proposed along with two selected DHs and 3 selected FRUs from the two Divisions of the State.. The exercise will take care of all the key aspects of the functioning of a hospital: Access, Assessment and Continuity of Care, Patients’ Rights, and Education, Care of Patients, Management of Medications, Hospital Infection Control, Continuous Quality Improvement, including Responsibilities of Management, Facility Management and Safety, Human Resource Management and Information Management Systems. However in the First phase, Strategies proposed are:- 304

Sensitization of service providers in public & private sector with the support of the QCI, New Delhi. A beginning has already been made in this direction. Two Awareness Workshops, one in Jammu and another in Srinagar have been organised during 2008-09.

Signing of Memorandum of understanding, after approval of the SPIP, between Government of J&K and Quality Council of India, New Delhi after negotiations.

Beginning the process of Accreditation of identified hospitals and laboratories as approved by state government.

Development of quality steering committee for the state, at all levels.

This initiative will benefit the Staff, hospitals & community. Some of the benefits would be as follows: Benefits to Staff: Quality Control

Improves professional staff development Provides education on consensus standards Provides leadership for quality improvement within medicine and nursing

Increases satisfaction with continuous learning, good working environment, leadership and ownership.

Benefits to Hospital

Improves care Brings in Corporate Governance Stimulates continuous improvement Demonstrates commitment to quality care 305

Raises community confidence Opportunity to benchmark with the best

Benefits to the Community:

Quality revolution Disaster preparedness - Epidemics - Physical Access to comparative database

Benefits to patients: High Quality care and patient safety. Quality services by the credential medical staff. Patient satisfaction is regularly evaluated.

Factors like health insurance and patient rights have fuelled a big demand for hospital accreditation/Quality Control. Besides Accreditation will provide an objective system of access to reliable and certified information on facilities infrastructure and level of care. The proposed budget for this initiative, for 2009-10 would be around Rs 108.31 Lacs.

CONCURRENT EVALUATION OF NRHM

Proposal for Concurrent and Baseline Evaluation of National Rural Health Mission in Jammu and Kashmir was approved in the ROP for 2009-10. Rs 50.00 lacs were allowed. However, this evaluation would not be taken up because of paucity of funds.

STRENGHTENING OF HRD & QA Cell Human resource being the most important component of the health system's inputs, it is imperative for State to focus attention on human resource development in the state. Government of India has 306

accorded in-principle approval for this intervention in ROP for 2008- 09. The establishment got delayed due to procedural Delays. However, during 2009-10, this Cell is being strengthened further. 22 MBBS doctor/ specialist /NURSE/HRD Specialist are proposed to be hired for maximum 10 Days in a month for various districts of the state. They will monitor the implementation of the programme, do supportive supervision and interface directly between the SHS and the District Health Societies. Although, this activity is budgeted in the SPIP at agreed rate per day, however, if SHS gets experts/consultants with higher qualification from within the State or outside, Perdiem for them could be higher than proposed. This Perdiem would be mutually decided between the consultant/SHS, which can only be done with the prior approval of the Chairman of the Executive Committee of the SHS. In addition, it is proposed that, QCI would be consulted in strengthening this cell with specific focus on quality issues in the health Department. Strengthening of this cell ultimately will in due course, help the State to develop similar Cells at the District Level in a phased manner. All recommendations of the QCI would be incorporated subsequently and if additional funds are required to strengthen it, the same shall be projected to GOI for approval. This Cell, in the long run is expected to advise the State on short and long term interventions required to improve the health services through an appropriate mix of human resources for health, keeping the cost within the range the State exchequer can afford

MAINSTREAMING OF AYUSH: Mainstreaming of ISM including AMCHI system, as envisaged under AYUSH in NRHM, is a priority for the government including involving AMCHI system, that is extremely popular in Ladakh region of the State

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The ISM doctors would play a major role in School Health Programme with focus on two conditions- worm infestation and Skin disorders including Geriatric Care. Ayurveda is one of the AYUSH Systems which has an important role in the prevention and management of many life style related chronic aliments where modern medicines are not so successful. The effectiveness of Panchkarma and Ksharsutra therapy in the management of certain disease conditions is already proved. Similarly Regimental Therapy in Unani System for the management of certain chronic disease would be utilized effectively, giving choice to the client to select the system of treatment of his/her choice. Homeopathy, wherever popular would be promted. Involvement of AYUSH personnel in policy and planning bodies as well as monitoring and implementation bodies at national, state, district, block and facility levels is envisaged in the guidelines under NRHM. Following bodies at various levels has AYUSH representation in some form or the other. • State Health Mission • State Health Society • District Health Mission • District Health Society • Rogi Kalyan Samiti • Village Health and Sanitation committee

Participation in all decision making activities is important for systemic mainstreaming and incorporation of the principles of AYUSH & LHT into the public health system. This would also ensure judicious distribution of resource between the dominant and AYUSH system.

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Twice a week (on Friday & Saturday) Geriatric clinics in PHCs, CHCs & DHs are envisaged and IEC Campaign launched for the same so that chronic, life style diseases are taken care through AYUSH.

VILLAGE HEALTH AND NUTRITION DAY AT ANGANWADI CENTRES

NRHM envisages close working relationship and convergence with ICDS, Public Health Engineering, Water & Sanitation, PRI, etc. This forum actually is the interface between community and health system. Convergence of all Departments through ANM/AWW/ASHA & VH&SC is being ensured for best results through optimization of all resources available with various Departments. VHNDs is proposed to be a vehicle to being about behaviour change in the community. State plans for operationalising VHNDs for MCH on a large scale, hence incentives to AWW.. Using VHNDs to bring about awareness among communities and families to address sick child, essential new born care (care at birth, early initiation of breast feeding and exclusive breast feeding, prevention of hypothermia and prevention of infection) etc would be ensured .. Management of Malnutrition, Breast Feeding, use of ORS would also be part of IEC/BCC with special focus on nutition of Mother & Child during the monthly VH&NDs. Since every AWC is being provided a special drug Kit, Weekly 1 tab of IFA (Elemental Fe 100mg & Folic Acid 0.5mg) on a fixed day and 1 tablet of Albendazole (400mg) bianuually -to be administered to all school going/out of school l students (10-19 years of age) with special focus on Girl Child.

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Activity With this objective in mind, it is proposed organise the Village Health & Nutrition Day at Anganwadi Centres in the state, at the village. Following activities are proposed to organised at the centre; 1. Maximum population of the village around AWC would be motivated/invited to attend the VH&ND; 2. All pregnant women would be invited at Anganwadi centre. This initiative would provide an opportunity for early registration of pregnancy, besides offering nutritional and other ANC related advice; 3. Tracking Drop outs, discussions on Maternal Death & importance of availing health services would be a regular feature 4. The opportunity would also be taken to engage the community on meaningful dialogue on health and related topic. 5. MO PHC would provide supportive supervision through staff and others (NGOs); 6. AWWs and others are being Trained. Similarly, VH&SCs of selected villages are being trained, which would allow improvement in holding of VH&NDs in the AWCs.

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PART C - IMMUNISATION

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J&K PIP IMMUNIZATION A. Baseline information:

Table :- 35

S.No. Target Beneficiaries 2008-09 2009-10 1. Pregnant Women 2.20 3.84 2. 0 to 1 Yr infants 2.20 3.84 3. 1-2 yr 9.92 10.24 4. 2-5 yr 8.68 8.96 5. 5 yr 2.20 3.84 6. 10 yr 2.20 3.84 7. 16 yr 2.20 3.84

Table :- 36 S.No. Routine Immunization 2008-09 2009-10 Sessions 1. Session planned in Urban Areas 11144 133728 2. Session planned in Rural Areas - 3. Total Sessions Planned 11144 133728 4. No. of session with hired - 3500 vaccinators* 5. No. of hired vaccinators* - -

*No of sessions and vaccinations hired in 2008-09 and planned in for 2009-10.

B. Trend of IMR Table :- 37 S.No. Year IMR of the State /UT Source 1. 2003 44 SRS 2003 2. 2004 49 SRS 2004 3. 2005 50 SRS 2005 4. 2006 52 SRS 2006 5. 2007 52 SRS 2007 6. 2008 51 SRS 2008

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District Wise Coverage reports (In Numbers) Yearly Target Yearly Target BCG OPV-1 OPV-3 DPT-1 DPT-3 S. Name of District (2007 -08) (2008-09) No. Infants Pregnant Infants Pregnant 2007-08 2008-09 2007-08 2008-09 2007-08 2008-09 2007-08 2008- 2007-08 2008-09 Women Women 09 1 Anantnag/ 40500 44500 41730 41730 21048 27068 24553 24055 24266 24979 24553 24055 24266 24979 Kulgam 2 Baramulla/ 41640 26600 42900 42900 34453 42107 19910 35524 21683 32282 19910 35524 21683 32282 Bandipora 3 Budgam 26040 46900 26800 26800 25398 15846 23765 18449 23230 18643 23765 18449 23230 18643

4 Srinagar/ 42660 28600 43900 43900 35316 34510 39454 21605 42359 21997 39454 21605 42359 21997 Ganderbal 5 Pulwama / 24270 45800 24900 24900 21753 22223 23763 19653 25456 19555 23763 19653 25456 19555 Shopian 6 Kupwara 24540 26900 25200 25200 24443 20232 21922 18290 22379 18963 21922 18290 22379 18963

7 Kargil 4020 4400 4100 4100 2972 3089 2743 2154 2765 2033 2743 2154 2765 2033 8 Leh 3960 4300 4000 4000 2155 2815 2102 2430 2100 2389 2102 2430 2100 2389 9 K. Div.Total 207630 228000 21353 213530 167538 167890 158212 142160 164238 140841 158212 14216 16423 140841 0 0 8 10 Doda 22365 24800 25350 25347 26383 8257 24344 9553 19049 8486 24344 9553 19049 8486 11 Kishtwar - - - - - 2193 - 3472 - 2709 - 3472 - 2 709 12 Ramban - - - - - 4553 - 6052 - 5006 - 6052 - 500 6

13 Udhampur 23000 27000 23500 23500 21953 9295 21237 9260 20456 8787 21237 9260 20456 8787

14 Reasi - - - - - 5521 - 5632 - 5414 - 5633 - 5414

15 Jammu 51000 59500 48870 55230 47408 27656 45013 22438 44273 21811 45013 22438 44273 21811

16 Samba - - - - 4419 - 5400 - 5080 - 5400 - 5080

17 Kathua 19400 21300 18215 21410 16304 10886 16431 11316 15734 11034 16431 11316 15734 11034 18 Rajouri 17000 18300 18175 19190 17637 12410 17158 13151 16762 11671 17158 13151 16762 11671

19 Poonch 13900 13900 12470 13360 14443 9627 17769 10006 13727 9120 14769 10006 13727 9120

20 Jmu. Div. Total 146665 164800 146580 158037 144128 94817 141952 96280 130001 89118 138952 96280 130001 89118

21 Grand Total 354295 392800 36011 371576 311666 262707 300164 238440 294239 229959 297164 23844 29423 229959 State 0 0 9

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HEPATITIS B

S.N Name of Hep B- Birth Hep B-1 Hep B-3 Measles TT2+Booster JE Routine Vit -A Ist Dose o. District (wherever applicable) 2007- 2008- 2007- 2008- 2007- 2008- 2007- 2008- 2007- 2008- 2007- 2008- 2007- 2008- 08 09 08 09 08 09 08 09 08 09 08 09 08 09 1 Anantna - 200 - 11618 - 6405 23349 20883 19547 26885 NA* NA 11630 8084 g/ Kulgam 2 Baramull - - - 18438 - 8389 17118 34913 37430 22661 NA NA 14887 5231 a/ Bandipor a 3 Budgam - 169 - 10045 - 4813 23914 18134 21643 19049 NA NA 6257 3343 4 Srinagar/ - - - 10550 - 4794 13160 21626 20581 18716 NA NA 10145 4908 Ganderb al 5 Pulwam - - - 15570 - 11313 37427 19158 21748 21957 NA NA 10923 5647 a/ Shopian 6 Kupwara - - - 19051 - 5384 21612 19076 22562 14117 NA NA 7982 5259

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7 Kargil - - - 0 - 1764 3756 2540 2957 2379 NA NA 1398 1656 8 Leh - - - 1883 - 1256 1876 2162 1585 1717 NA NA 1760 1867 9 K. Div. - 369 - 87155 - 44118 14221 13849 14805 12748 NA NA 64982 35987 Total 2 2 3 1 10 Doda - - 874 1553 368 2331 21374 7601 16429 6403 NA NA 7970 1553 11 Kishtwar - - - 2631 - 1155 - 2193 - 2756 NA NA - 1791 12 Ramban - - - 4164 - 3630 - 4104 - 3442 NA NA - - 13 Udhamp - 299 20565 9176 19882 8597 21191 7779 19487 7181 NA NA 13016 1942 ur 14 Reasi - - - 5635 - 5391 - 6084 - 10052 NA NA - 2658 15 Jammu - 811 9128 21577 2285 14434 35665 21490 34738 17700 NA NA 19227 8901 16 Samba - - - 2389 - 1320 - 4103 - 5120 NA NA - 1657 17 Kathua - - 13489 9397 8126 7084 15871 10888 13304 9421 NA NA 7614 4179 18 Rajouri - - 17158 13151 17026 11671 15307 10441 17480 10786 NA NA 16416 13651 19 Poonch - - 9379 13162 2053 4751 13720 6900 12958 8266 NA NA 9472 2641 20 Jmu. - 1110 70593 82835 49740 60364 12312 8183 11439 81127 NA NA 73715 38973 Div. 8 6 Total 21 Grand - 1479 70593 16999 49740 10448 26534 14667 26244 20860 NA NA 13869 74960 Total 0 2 0 5 9 8 7 State

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D. District –Wise VPD reports in 2008-09 (in numbers)

S.N Name of Diphtheria Pertusis Neonatal Tetanus Measles Polio-P1 Polio-P3 AES o. District Tetanus (other) Cas Deat Cas Deat Cas Deat Cas Deat Cas Deat Cas Deat Cas Deat Cas Deat es hs es hs es hs es hs es hs es hs es hs es hs 1. Anantnag/ ------Kulgam 2. Baramulla/ ------Bandipora 3. Budgam ------4. Srinagar/ ------Ganderbal 5. Pulwama/ ------73 ------Shopian 6. Kupwara - - 58 - - - - - 160 ------7. Kargil ------8. Leh ------9. K. Div. Total - - 58 - - - - - 233 ------10 Doda ------11 Kishtwar ------

316

12 Ramban ------13 Udhampur ------14 Reasi ------15 Jammu ------16 Samba ------17 Kathua ------18 Rajouri ------19 Poonch ------20 Jmu. Div. Total ------21 Grand Total - - 58 - - - - - 233 ------State

317

E. Total Reported Outbreaks (Jammu & Kashmir)

No. of outbreaks No. of outbreaks No. of Cases in No. of Deaths in Measures Remarks VPDs reported investigated outbreaks outbreaks taken

2007-08 2008-09 No Diphtheria Nil Nil Nil Nil Nil Nil Nil Nil Nil outbreaks reported during 2007- Pertusis Nil Nil Nil Nil Nil Nil Nil Nil Nil 08 and 2008- 09. Measles Nil Nil Nil Nil Nil Nil Nil Nil Nil

AES Nil Nil Nil Nil Nil Nil Nil Nil Nil

*Report for 2008-09 till Dec’08

318

F. District wise – AEFI Surveillance Name of District Team AEFI AEFI No. of No. of No. of Remarks S.No. Constituted cases Deaths FIRs PIRs DIRs (Y/N) (till (till sent sent sent Dec’08) Dec’08) 1. Anantnag/Kulgam Y Nil Nil 2. Baramulla/Bandipora Y Nil Nil 3. Budgam Y Nil Nil 4. Srinagar/Ganderbal Y Nil Nil 5. Pulwama/Shopian Y Nil Nil 6. Kupwara Y Nil Nil 7. Kargil Y Nil Nil 8. Leh Y Nil Nil 9. Total 0 Nil Nil 10. Doda Y Nil Nil 11. Kishtwar Y Nil Nil 12. Ramban Y Nil Nil 13. Udhampur Y Nil Nil 14. Reasi Y Nil Nil 15. Jammu Y Nil Nil 16. Samba Y Nil Nil 17. Kathua Y Nil Nil 18. Rajouri Y Nil Nil 19. Poonch Y Nil Nil 20. Jmu. Div. Total 0 Nil Nil 21. Grand Total State 0 Nil Nil * Teams have been constituted at State level as well as at District Level.

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G. RIMS Status

S.No. Name of RIMS Compute District Installed & r Asstt. In RIMS uploaded* Operational position Apr’08 May June’ July’0 August’ September’ October’ November’ Decem Remarks ‘08 08 8 08 08 08 08 ber’08 1. Anantnag/ Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Kulgam 2. Baramulla Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes /Bandipor a 3. Budgam Yes No Yes Yes Yes Yes Yes No No No No

4. Srinagar/ Yes No Yes Yes Yes Yes Yes Yes Yes No No Ganderbal 5. Pulwama/ Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Shopian 6. Kupwara Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

7. Kargil No No No No No No No No No No No

8. Leh Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

9. Doda/Kish No Yes No No No No No No No No No twar/Ram ban 10. Udhampur No No No No No No No No No No No /Reasi 11. Jammu/ No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Samba 12. Kathua No Yes No No No No No No No No No

13. Rajouri No Yes No No No No No No No No No

14. Poonch No Yes No No No No No No No No No *Write Yes/No for the month of the district has uploaded RIMS data of district. Note: Installation of RIMS and appointment of Computer Assistants in the newly created eight districts of Jammu & Kashmir namely Kulgam, Bandipora, Ganderbal, Shopian (of Kashmir Division) & Ramban, Reasi, Samba, Kishtwar (of Jammu Division) is under process.

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H. Vaccine Cold Chain and other logistics.

S.No. Item Requirement Remarks Stock (functional)** 2009-10 2010-11 1 Cold Chain Equipments - 2 WIC 2 - - 3 WIF - 1 - 4 ILR-140 L (Small) 540 214 - 5 ILR-300 L (Large) 109 44 - 6 DF-140 L (Small) 554 229 - 7 DF-300 L (Large) 96 46 - 8 Cold Boxes 290(L) 162(S) 201(L) 10(S) - 9 Vaccine Carrier 16322 6500 - 10 Ice Pack 70000 20000 - 11 Vaccine Van 16 11 - Vaccine stock and requirement ( including 25% wastage and 25% buffer) 12 TT 0.81 21.40 lac Doses - 13 BCG 1.02 9.2 - 14 OPV 0.63 18 - 15 DPT* 2.32 23.0 - 16 Measles 0.62 4.60 - 17 Hep B 0.21 13.82 - 18 JE (Routine) NA NA - Syringes including wastage of 10% and 25% buffer 19 0.1 ml 0 3.74 - 20 0.5 ml 0.25 47.31 - 21 Reconstitution Syringes (5 ml) 0.92 1.12 - 22 Hub Cutters 0 0.16 -

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BUDGET SUMMARY FOR IMMUNIZATION (2009-2010)

S.No. Component Budget (Amount in lacs) 1 Mobility support for supervision 14.0 2 Cold Chain Maintenance 10.0 3 Focus on Slum areas 9.0 4 Mobilization of children through 50.0 ASHA 5 Alternative Vaccine Delivery 10.0

6 Support for Computer 23.52 7 Printing of Immunization cards 10.0 8 Expenditure on Review Meetings 4.68 9 Trainings 27.13 10 Microplanning 1.25 11 Expenditure on POL for vaccine 11.00 delivery 12 Consumables for computer 1.0

13 Injection Safety 7.80 14 Construction of pits 28.92 15 Total 208.30 Two Crore Eight Lakhs and Thirty Thousands

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PART D NATIONAL DISEASE CONTROL PROGRAMME

323

NATIONAL LEPROSY ERADICATION PROGRAMME

(A) TREND OF LEPROSY

The state of Jammu & Kashmir has made major progress towards elimination of leprosy as a Public health Problem during the year 2008. The State falls under low endemic zone. Year 2008-09 started with 169 number of cases on record, ending March 2008. The prevalence rate was 0.33 per 10000 of population with ANCDR of 3.60 per 100000 of population. 185 new cases were detected during the year 2007 – 08. Out of new cases detected 23% were female cases, 0.5% child cases and 2.1% with grade 2 disability. MB proportion was 63 %, with PD ratio less than 1. Ending November 2008, total 125 number of new cases were detected and 177 number of cases were on treatment. A lot of variations in the prevalence of leprosy was noted in various districts of Jammu Division with highest in Jammu district.

(B) SITUATION ANALYSIS For purpose of giving focal attention to the endemic pockets the division was divided into four zones. 1. Zone I—Urban areas 2. Zone II— Plain area with good accessibility 3. Zone III- Hilly unapproachable areas 4. Zone IV—Snow bound areas On situation analysis, it was noted that lot of migratory cases from endemic states are coming to Jammu for want of work and then settle down there in urban slums of Jammu city. These patients are mostly seeking medical help from Govt. Medical College Jammu & one private Medical College Jammu These cases after registration are followed up by District Nucleus staff of Jammu for purpose of examination of their healthy contacts & for ensuring regularity of treatment. The area of concern was of Zone III & IV. In Zone III some villages of the districts of Ramban, Udhampur, Poonch & Rajouri are still endemic.

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In Zone IV some endemic pockets of district Kathua block Bani, village Gool of district Ramban & Budhal area of block Kandi in Rajouri were noticed.

District wise New Case detection and cases on record year wise

2004-05 2005-06 2006-07 2007-08 2008-09 ending Nov. 08 Jammu 128 146 130 148 109 139 90 80 64 79 Kathua 28 22 21 18 15 10 22 17 17 26 Udhampur 28 23 25 21 32 31 31 21 10 12 Rajori 24 29 22 10 23 16 20 9 10 9 Poonch 29 31 17 28 19 24 12 12 8 10 Doda 7 35 17 28 31 45 10 30 4 5 Samba 0 2 Reasi 09 27 Ramban 4 5 Kishtwar 2 3

Financial Achievement Opening balance as on 1-4-08 1756090 Interest 13294 Funds received during the year 08-09 740000 Total 2509384 Expd as on 30-11-2008 1126719 Balance as on 1-12-08 1382665

Details of Expd. W.ef 1-4-08 to 30-11-08 (1) Supportive medicine) 14089 (2) Trainings 287963 (3) IEC 64647 (4) Contractual payment 430530 (5) Professional services 52000 (6) Honorarium 21400 (7) POL & Maintenance 150315 (8) O.E 86671 (9) Consumable Stationery 17984 (10) Review meeting 1120

Total 1126719

(B) INFRASTRUCTURE

RURAL SETUP

District Hospitals 10 Community Health Centre 25 Primary Health centre 160 325

Allopathic dispensary 126 Sub centre 952

Vertical Staff and District Nucleus position

S.N Staff Sanctioned post No. in position No. trained in

o leprosy 1. DLO Nil DHOs 6 working as 2 MO 5 Nil Nil

3 NMS 11 6 6

4 PMA/NMA 24 18 18 5 Physio Technician Nil NIL NIL

6 HE NIL NIL NIL

7 Any other 7 (Contractual) 7 7

URBAN SETUP

Medical College 2 Gen. Hospital 2 Urban Health Unit 15

Position of Vehicles

MLTU Vehicle 6 DLO Vehicle One (Poonch) ZLO Vehicle One Position of Anti Leprosy drugs ending November 2008

MB A 988 BCP MB C Nil PB A 754 BCP PB C 396 BCP

OBJETIVE, STRATEGIES AND WORK PLAN 2009 -2010

OBJECTIVE 1) To continue the efforts to sustain elimination of Leprosy through existing MDT services. 2) To maintain the gains achieved so far & to continue the efforts to achieve elimination at Block level and Village level. 3) To make quality leprosy services available through integrated general health care system. 326

4) Enhanced Disability Prevention and Medical Rehabilitation for deformity in LAP.

STRATEGIES 1) Focal activities in endemic pockets of Zone III & IV:- 2) Disability care and prevention 3) Institutional Development 4) Strengthening and integration of Service Delivery 5) Training 6) Information, Education and communication 7) Urban Leprosy Elimination Programme

1) Focal activities in endemic pockets of Zone III & IV:- (a) 3 days Random sampling cum skin camp is proposed for a sample population of 10,000 of village Senapati & surrounding areas of block Ukhral district Ramban where 5 new cases were detected during last 3 quarters & total number of 11 patients are under treatment. Budget required Rs. 20,000 (b) Focal IEC activities in Gool block of district Ramban covering a population of 30,000 Budget required Rs. 30,000 © Followup of skin camp held previously during which 2 new cases were detected in Tikri block in district Udhampur. Budget required Rs. 5,000 (d) 6 days Focal IEC activities in Pancheri area of Chenani block in district Udhampur covering population of 30,000. Budget required Rs. 30,000 (e) 3 days Special activity of Koti chandyar area of block Bani in district Kathua covering a population of 20,000 Budget required Rs. 20,000 (f) Special one day skin camp in Chenab Textile Mills in District Kathua Budget required Rs. 5,000 (g) 6 days Sample Survey cum awareness in village Paddar, Marwa & Dachhan in district Kishtwar

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Budget required Rs. 50,000 (h) one day special skin camp in Loran Mandi & Sabzian area of district Poonch Budget required Rs. 10,000

Total(a+b+c+d+e+f+g+h) Rs. 1,70,000 2) Disability care & Prevention Prevention of ulcer & its cure in insensitive feet Budget required Rs. 50,000 for Procurement of ulcer kits Procurement of MCR chappals Procurement of Shoes with soft sole

3) Institutional Development

Integration of leprosy services with the General Health services is almost complete. The DPMR services shall be made available in all the district hospitals as well as in the skin department of Medical College Jammu specially for treatment of complicated cases referred from different blocks by way of proper referral & feedback. The district Nucleus staff shall supervise & monitor the programme & its activities at the peripheral level. The district nucleus staff has been trained for updating their knowledge & skill for better management of the programme. (4) Strengthening & Integration of service delivery:- Diagnosis & treatment : Disgnosis & treatment facilities have been made available closer to the people

through daily outdoor services in the block PHC’s/CHC’s/New PHC’s. The sub centres are actively involved in delivery of 2nd & subsequent doses of MDT. MDT stock is kept with the Pharmacist in most of the PHC’s. While in others the charge of MDT & other relevant record is kept with health supervisor whoso ever is available. Referral Services: The patients difficult to diagnose and manage at the PHC’s are being referred to sub district hospital or District hospital for further care. The patient who cannot be managed at district hospital are referred to the dermatologist Medical College Jammu.

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Budget Required For Rs. 50,000

Procurement of Referral slips for strengthening of Referral system

Procurement of disability registers (5) Training Plan (i) Two day refresher training course for Medical Officers Jammu 3 batch of 30 Samba 1 batch of 30 Kathua 1 batch of 30 Udhampur 2 batch of 30 Reasi 1 batch of 30 Doda 1 batch of 30 Ramban 1 batch of 30 Kishtwar 1 batch of 30 Poonch 1 batch of 30 Rajouri 1 batch of 30 13 batches Budget @ Rs. 22000 per batch 22000 x 13 Rs. 2,86,000/- (ii) Four days training in DPMR for newly appointed Medical Officers, Health Supervisors & Health workers of District Hospital & PHC’s Jammu 1 batch of 30 Samba 1 batch of 30 Kathua 1 batch of 30 Udhampur 1 batch of 30 Reasi 1 batch of 30 Doda 1 batch of 30 Ramban 1 batch of 30 Kishtwar 1 batch of 30 Poonch 1 batch of 30 Rajouri 1 batch of 30 10 batches Budget @ Rs. 50000 per batch 50000 x 10 Rs. 5,00,000/- (iii) Training of Private Practitioners, Dermatologist and other registered Medical Practitioners in District/Sub District hospital Jammu Divisional Headquarter 2 Batch Budget required @ Rs. 10,000 per batch 10,000 x 2 Rs. 20,000

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(iv) 5 days training to District Hospital Lab. Technicians of 15 trainees Jammu 2 batch

Budget @ Rs. 30000 per batch 30000 x 2 Rs. 60,000/-

(v) Training of ASHA for half day Jammu 5 batch Samba 5 batch Kathua 5 batch Udhampur 5 batch Reasi 5 batch Doda 5 batch Ramban 5 batch Kishtwar 5 batch Poonch 5 batch Rajouri 5 batch 50 batches Budget @ Rs. 2000 per batch 2000x 50 Rs. 1,00,000/-

(Total i+ii+iii+iv+v) Rs. 9,66,000/-

(6) Information, Education and communication (a) These activities shall mostly be of interpersonal communication with good

involvement of the local volunteers, social organizations, school children, village Panchayat members. Debates & symposium shall be organized in schools involving school children so that the message reaches each household. School IEC and quiz competition shall be carried out through out the year.

Efforts shall be made for continuous planning, implementation and detection of Leprosy cases and prompt MDT by the General Health Care staff so as to sustain the leprosy elimination status in our Division.

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Awareness amongst the community shall be generated through strong IEC activities through village health & nutrition camp, Rogi Kalyan Samitis & Health Melas with collaboration with NRHM. Other IEC activities will be done through:-

i) Posters ii) Diagnostic cards

iii) Folders iv) Hoardings v) Handbills vi) Wall Paintings vii) Other Print & Electronic media

Activities to be taken up Activities No Time Schedule

Divisional Level meeting 2 May 2009 Oct. 2009 Distt. Level meeting 4 each distt. May 2009 July 2009 Oct. 2009 Jan. 2010 Block Level meeting One meeting every month

Each block

Village level meeting one meeting every month Each village Requirement of IEC material

Posters 15,000 per Distt. Leaflet 40,000 each distt. Flash cards 10000 each distt. 331

Tri folders 50,000 per Distt (a) Budget Required for IEC material procurement @ 1 lac per district Total (a) Rs. 10,00,000

(b) Other Logistics i) Orientation camps

Total 40 camps @ Rs. 2000/- per camps Rs. 80,000 ii) Rallies and banners

Total 20 rallies @ 5000/- per rally Rs. 1,00,000

iii) Hoardings 2 hoardings per district @ 10000 per hoarding 10000 x 20 Rs. 2,00,000 iv) Wall Painting Total 1500 @ 200 per painting Rs. 3,00,000 v) Quiz Competition Total 50 @ 500 Rs. 25000 vi) Debates & symposium Rs.1,00,000 vii) Newspaper adds; Rs. 20,000 Total requirement of funds (b) Rs. 8,25,000 Total (a+b) Rs. 18,25,000

(7) Urban Leprosy Control Programme

Under Urban Leprosy Control Programme one project for Jammu Urban has been sanctioned by GOI & implemented during 2005-06. Plan of Action

a. Sensitization Meeting: Once in three months under Chairmanship of Municipal Commissioner

332

b. Sensitization Workshop of staff & local leaders: Once in three months. c. Diagnosis and treatment facilities: The facilities shall be made available in all the

health institutions. IEC Activities

IEC activities shall be in the form of:- a. IPC (Inter Personal Communication).

b Special Campaigns c. Skin camps MDT services:- shall be provided in all the Health Facilities. MDT treatment shall be provided to those leaving the area temporarily. Availability of MDT :- shall be available at District Stores and issued after proper SIS indenting system. MDT supply shall be made available at all Urban Health facilities Monitoring and Supervision. Strict vigil shall be made for frequent population movement in the township and this shall be made a essential competent of the program. This shall be done by the mobile squad constituted for the purpose. Medical Officer Urban Leprosy Shall supervise the overall activities in the area. District. Leprosy Officer Jammu shall coordinate the activities and shall be responsible for overall activities. Budget required (a) Monthly Meeting @ 200 per month Rs. 2400

Quarterly review meeting @ 500 per quarter Rs. 2000 Yearly meeting with stake holders Rs. 2000 Total (a) Rs. 6400

(b) Supportive medicine for Urban Leprosy control programme

Rs. 30,000 IEC material Rs. 1,00,000 (b) Rs. 1,30,000 Total (a+b) Rs. 1,36,400 333

(8) Budget requirement for Procurement of other logistics

(a) Supportive Medicine:

Supportive medicine required for skin camp shall be procured by adopting local shopping procedure. Four OT camps per districts are planned during

the year 2008-09. Budget Required 10 x 4 camps @ Rs. 5000 per camp = Rs. 2,00,000

(b) Material & supplies

LRPU for making MCR chappals at LRPU digiana by Shoe maker. Budget Required @ 250 per pair 10 x 15 =150 250 x 150 Rs. 37500 (d) Splints & Crutches: Budget required Rs. 1000 per district Rs. 10000 (e)Patient Welfare Fund: @ 6000 per District Budget Required 6000x10 Rs. 60,000 (f) RCS (Re-constructive Surgery) 10 surgeries @ 5,000 per case Rs. 50,000

Total (a+b+c+d+e+f) Rs. 3,57,500 (9) Contractual Services: The Contractual services sanction during 2008-09 shall

continue during 09-10 also. B&FO 1 @Rs. 14300 pm 171600 Epidemiologist 1 @ Rs. 22000 pm 264000 DEO/IMA 2 @ Rs. 7150 pm 171600 Driver 8 @ Rs. 3850 x 8 369600 Honorarium for Account work @ 400 per district 48000

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TA /DA 100000 Audit Fee 80000 Total Rs. 12,04,800 (10) Office Expenses & Consumables

SLS Rs. 1,00,000

@ Rs. 50,000 per district . Rs. 5,00,000 Total Rs. 6,00,000

(11) Incentive to ASHA for treatment completion of MB cases

@ 500 per case 500 x 100 Rs. 50000 Incentive to ASHA for treatment completion of PB cases @ 300 x 60 Rs. 18000 Total Rs. 68000

(12) Other Activities (i) Awards: Awards to best out of many shall be given during 2009-010 on the

basis of work done during 2008-09 Dy. CMO shall initiate & recommend the name to Zonal Leprosy Officer . Budget Required Rs. 15,000

(iii) Celebration: (a) 2nd Oct.: On the birth anniversary of Mahatma Gandhi, the Father of the Nation ,special one week campaign shall be launched and intensive IEC activities shall be performed during the week. @ Rs. 5000 per district Rs. 50,000

335

(b) 30 th Jan.: On the occasion of Martyrdom day of Mahatama Gandhi. One week IEC

activities shall be undertaken to make the community aware about the disease & its

treatment. In addition at district level Anti Leprosy Day function shall be celebrated. Budget provision for celebrations & publications Rs. 1,00,000

Total (a+b) Rs. 1,50,000

(13) Vehicle POL & maintenance

POL for 7 vehicles @ Rs. 30,000 Rs. 2,10,000

Vehicle maintenance & POL for ZLO Rs. 1,20,000 Total Rs. 3,30,000 ANNEXURE Amount . Focal activities in endemic pockets Zone III & IV 1,70,000 Disability care & Prevention 50,000 Strenthening & Integration of service delivery 50,000 Trainings 966000 IEC and other logistics 1825000 ULE 136400 Budget required for Procurement Plan 157500 Contractual Payment 12,04,800 Office Expenses & Consumables 6,00,000 Incentive to ASHA 68000 Awards 15000 Other celebration 150000 Vehicle hiring & operation 330000 Grand Total 57,22,700/- Rs. Fifty Seven Lac, twenty two thousand and seven hundred only

The budget projected may please be sanctioned & conveyed well in time so that the expd. is done in planned manner. 336

NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAMME

INTRODUCTION:-

The State of Jammu and Kashmir is located in extreme north of India between 320-15’ to 370-05’ latitude north and 720-35’ to 800-20’ longitude east. It is bound by China in the north and east. Afghanistan, in the North West and by Pakistan in the west. The Indian states of Punjab and Himachal Pradesh border it in the South. J&K has a total geographical area of 222, 236 Sq. Kms. Out of which a portion is under illegal occupation of Pakistan and China. Only 101387 Sq. Kms. With a population of 10069,917 (As per 2001 census) forming density of 99 persons per sq. Kms is under Indian control. This area has been divided into three geographically, culturally and lingually distinct regions of Jammu, Kashmir and Ladakh. This area has been further demarcated into 22 districts (including 8 newly created during 2007) The entire ladakh and most of Kashmir province (Except Uri-Teetwal-Keran belt of Baramulla and Kupwara districts) being 5000 feet and above height from sea level, is free from transmission of vector borne diseases and is not being covered under NVBDCP surveillance. Whole of Jammu province with approximate population of 47.89 Lacs and 1.21 Lac population in narrow Uri-Teetwal-Keran belt of twin districts of Baramulla and Kupwara with a total estimated population of 49.1 lac forms the Malarious zone of the state. Since four additional districts of Samba, Reasi, Ramban and kishtwar in Jammu province have been created in May 2007 and creation of additional posts under Health Department and NVBDCP is under consideration and till date no additional staff has been provided, the NVBDCP is being carried under old reporting pattern.

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A. Status of Health facilities

S.No Health facility No.

1 District Hospital 12 2 Block PHC(Jammu Province) 166 3 Add PHC/Mini PHC 122 4 Sub-Centre 967 5 Villages 3084 6 FTD 259 7 ASHA 1124 8 Rapid Response Team formed( Yes/No) Yes

B. Human Resources

S.No Health facility Sanctioned In Place Trained 1 DMO (full Time) 6 6 3 2 AMO 1 1 1 3 MO 1075 1007 - 4 Lab. Technician 287 280 50 5 Lab. Technician 76 76 - (Contractual)* 6 Health Supervisor M 40 28 - 7 Health Supervisor F - - - 8 MPW M 299 224 - 9 MPW M Contractual# - - - 10 MPW F 212 212 - 11 Malaria Technical - - - Supervisor Contractual * 12 ASHA 1124 1124 -

*GFATM/World Bank # Applicable to state that have been sanctioned.

GFATM States Only State PMU In Place Consultant M&E - Project Director/Programme Officer - Finance Consultant - IEC Consultant - Data Entry Operator - Secretarial Assistant -

338

District Year Populat BSC/BSE ABE Total Pf API SPR SFR Death Malaria s due ion R Cas Cases to es malari a

Jammu 200 107576 112859/1 10.49 33 3 0.03 0.02 0.002 - 4 2 12859

200 109166 119677/1 10.96 54 3 0.04 0.04 0.002 - 5 0 19677

200 113191 125208/1 11.06 42 4 0.03 0.03 0.003 - 6 0 25208

200 113823 101853/1 8.94 45 1 0.03 0.04 0.000 - 7 7 01853

200 935984 74574/74 799 44 4 0.04 0.05 0.005 - 8 574 (11/ 08) Kathua 200 557921 61093/61 10.95 18 5 0.04 0.02 0.008 - 4 093 200 585153 51951/51 8.87 10 1 0.01 0.01 0.001 - 5 951

200 585753 54531/54 9.31 16 1 0.02 0.02 0.001 - 6 531

200 586641 51859/51 8.83 15 - 0.02 0.02 - - 7 859

200 553435 49089/49 8.86 14 4 0.02 0.02 0.008 1 8 089 (11/ 08)

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Samba 200 272541 26660/26 9.78 2 0.01 0.007 - 8 660 (11/ 08) Rajouri 200 511003 43968/43 8.60 80 - 0.15 0.18 - - 4 968

200 511003 48975/48 9.58 78 - 0.15 0.15 - - 5 975

200 521688 46225/46 8.86 24 - 0.04 0.05 - - 6 225

200 554827 47647/47 8.58 16 - 0.02 0.03 - - 7 647

200 580560 47509/47 8.18 22 1 0.03 0.04 0.002 - 8 509 (11/ 08) Poonch 200 358656 36960/36 10.30 66 - 0.18 0.17 - - 4 960

200 368851 42504/42 11.52 59 1 0.14 0.13 0.002 - 5 504

200 368851 40830/40 11.06 40 - 0.10 0.,09 - - 6 830

200 431627 39091/39 9.05 74 15 0.17 0.18 0.003 1 7 091

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200 440955 39921/39 9.05 87 4 0.19 0.21 0.010 - 8 921 (11/ 08) Udham 200 738965 73991/73 10.01 14 - 0.01 0.01 - - pur 4 991

200 759212 77085/77 10.15 35 2 0.04 0.04 0.002 - 5 085

200 768335 79628/79 10.36 28 - 0.03 0.03 - - 6 628

200 793306 82849/82 10.44 75 - 0.09 0.09 - - 7 849

200 490420 59861/59 12.11 11 - 0.02 0.01 - - 8 391 (11/ 08) Reasi* 200 294403 17201/17 5.84 4 - 0.01 0.02 - - 8 201 (11/ 08) Doda 200 732736 40561/40 5.53 19 - 0.02 0.04 - - 4 561

200 732736 51109/51 6.97 5 - 0.006 0.009 - - 5 109

200 732736 47186/47 6.43 3 - 0.004 0.006 - - 6 186

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200 732736 50147/50 6.84 6 1 0.008 0.01 0.001 - 7 147

200 351075 34572/34 9.84 4 - 0.01 0.01 - - 8 572 (11/ 08) Ramban 200 219233 5764/576 2.62 ------* 8 4 (11/ 08) Kishtwa 200 185163 10183/10 5.49 1 - - 0.09 - - r* 8 183 (11/ 08) Baramu 200 121000 512/512 0.43 ------lla&Kup 4 wara

200 121000 Reports not received 5

200 121000 Reports not received 6

200 121000 Reports not received 7

200 125000 Reports not received 8

200 Reports not received 8

342

250

200

150 Total Malaria Cases Total Pf Cases. 100

0 2004 2005 2006 2007 2008

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SITUATION OF MALARIA CASES C2 High Risk Areas: C3 S.No API District PHCs Sub Villages Population@village(No) %population (No) (No) Centres (No) of State (No) 1 <1 12 166 967 3084 5000764 45.46 1-2 ------2-5 ------5-10 ------>10 ------Total ------

H Commodity Requirement

Item Previous Requirement Balance Net Year’s for current available(no) Requirement utilization (no) Year (2-3) (no) 1 2 3 4 Insecticide for 5800 58.1 MT 5800( For IRS(Kg) (Expired) Focal Spray) Insecticide for ITMN(Ltrs) ITNs Chloroquine(No) 790128 1000000 1432552 800000 Primaquine 2.5 956 10000 8930(Expiring 10000 on 9/2009). Primaquine 7.5 1570 10000 31980(Expired) 10000 126429 (Expiring on 9/2009) Baytex 124 Lt. 100 Lt. ---- 200Lt. Artesunate Tabs. Abate 41 Lt. 143 Lt. 143 Lt.(3/09 to 20 Lt. be expire) Quinine injection Quinine Sulphate Arteether Inj. RDK 5000 5000 Micro Slides 336800 500000 100000 400000 Pumps 100 100 Pyrethrum 2% 155 Lt. 200 Lt. 225 Lt. 100 Lt.

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I Training: mention no. of batches to be trained

S.No Training Cost Previous Current Year per Year(no) batch Q1(No) Q2(No Q3(No) Q4(No) Total Total ) No. Cost ( Rs) 1 Med. 120000 25 (1 25(1 120000 Specialists Batch) Batch) at district Hosp. 2 Medical 120000 25(1 25(1 25(1 25(1 100( 4 480000 Officer Batch) Batch) Batch) Batch) Batche s) 3 Lab.Tech. 75000 25(1 25(1 50( 2 150000 (Induction) Batch) Batch) Batche s) 4 Lab.Tech. 75000 25(1 25(1 75000 (reorientation) Batch) Batch) 5 Health 30000 25(1 25(1 25(1 75( 3 90000 supervisor Batch) Batch) Batch) Batche M s) 6 Health supervisor F 7 Health 30000 25(1 25(1 25(1 25(1 100( 4 120000 Workers M Batch) Batch) Batch) Batch) Batche s) 8 Health Workers F 9 ASHA 30000 100 100( 2 100( 100( 2 400( 120000 ( 2 Batche 2Batch Batche 8Batch Batches) s) es) s) es) 10 Community Volunteers other than ASHA 11 Others specify. Total 1155000

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J BCC/IEC

S.No Activities Unit Previous Current Year Total Total Cost Year (no) cost ( Rs) (no) (Rs) Q1(no) Q2(no) Q3(no) Q4(no) A Print Media 1 Posters 1.20 50000 50000 50000 50000 200000 2,40,000 2 Hoardings 3000 4 10 1,20,000 3 News Paper 10000 5 5 10 100000 Advt. B Electronic Media 4 TV 9000 2 2 2 2 2 8 72000 campaigns 5 Radio 30000 1 1 1 1 4 12000 Campaigns C Community Level 6 Health 50000 1 1 50000 Camps 7 Village Level aware ness camps for IRS 8 Others ( 1000 80 80 160 160000 Wall Writing) TOTAL 754000

K PPP involvement S.No Schemes Previous Year Planned in Cost (No) current Year(No) 1 Scheme I - 3 5000 Monthly Reporting private from the nursing homes and labs. 2 Scheme II - - IEC/BCC 3 Scheme III - - - 4 Scheme IV - - - 5 Scheme V - - - TOTAL 5000

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L Larvivorius Fish

S.No District Hatcheries Seasonal Perennial Water Planned Cost Water water bodies in Bodies Bodies released current with fish year(No) previous year(No) 1 Jammu 1 - - 30 10 50000 2 Samba 1 - - 6 10 50000 3 Kathua 1 - - 16 24 50000 4 Doda 1 - - - 5 50000 5 Ramban 1 - - - 4 50000 6 Kishtwar 1 - - - 3 50000 7 Reasi 1 - - 2 9 50000 8 Udhampur 1 - - 19 12 50000 9 Rajouri 1 - - - 20 50000 10 Poonch 1 - - - 15 50000 11 Kupwara ------12 Baramulla ------TOTAL - - - 73 122 500000

SWOT Analysis

Strength:- Action to be taken:-

• Dedicated NVBDCP Staff. Provision of incentive • Short Transmission Season in the State • Availability of required logistics

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Weakness:- • Inadequate Staff but increased • Already reported to higher work load authorities. • Insufficient fever and Ento • Strengthening of fever surveillance Surveillance by involving Blood Banks, labs of • Non availability of alternate Anti Govt. Medical College GMC, Police Malarial Drugs and RDKs Hospital and Paramilitary Forces • Poor mobility support Hospitals, private clinics, AYUSH and labs. • During school health programmes camps can be organized for fever and IEC activities especially in slum areas. • Requisition for ACT drugs for imported cases. Opportunities:- • Low parasitic load in the cases. • Short Transmission Season in the State • No Chloroquine resistant strains cases. • Use of pesticides and insecticides in agriculture sector

Threats:- • Influx of imported population from • Intensified surveillance. endemic areas of other states. • Militancy infested areas. • Inter sectoral non- cooperation • Provision of Funds

O Performa for Urban Malaria Scheme Status of hatcheries/up-scaling of larvivorus fish in the state

S.No Name of the No. of No. of hatcheries No. of water state hatcheries at at bodies district level Block/PHC/Village seeded level 1 Jammu and 3 7 65 Kashmir

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MONTH WISE EPIDEMIOLOGICAL REPORT FOR THE YEAR 2008

POPULATION OF THE CITY (JAMMU):- 5.52 Lac .

JAN FEB MA APR MAY JUN JUL AUG SEPT OCT NOV DEC R No. 234/ 241/ 320/ 281/ 309/ 253/ 167/ 106/ 249/249 223/223 205/205 of 234 241 320 281 309 253 167 106 BSC/ BSE No. - 1 - - 1 1 1 1 4 1 1 - of Pv. No.of ------Pf No. - 1 - - 1 1 1 1 4 1 1 - of Total Positi ve SPR 0.42 SFR ABE 0.47 R RT 1 1 1 1 1 4 1 1 - - Give n Deat ------h if any.

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Expenditure (Financial Performance)-Budget Proposal 2008-09(Expenditure) 2009-10(Proposed) up to 11/2008 MALARIA DBS Training(TOT) 77300 IEC/BCC 75081 1400000 WORLD BANK TRAINING MO 480000 DMO/AMO/MI/JHI 90000 MPW/BHW 120000 ASHA 120000 Lab.Tech. 225000 TOTAL 1035000 Monitoring and Evaluation Hiring of vehicles 2650000 Districts 11 State with POL and vehicle 350000 TOTAL MALARIA 4000000 UMS Vehicle with Trolley 700000 Van fog Machine 2 nos. 1500000 POL 120000 TOTAL 2320000 DENGUE AND CHIKUNGUNYA 500000 DHO/MO/DMO 2 Batches 240000 NGOs at district Level 3 100000 Trainings IEC/BCC 1500000 TOTAL 2340000 GRAND TOTAL 8660000

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• No SSH has been identified in the district • No contingency plan formulated to deal with a large no. of patients in the districts. • No contingency plan formulated to deal with large number of patients. Innovations/Strategies • To integrate and strengthen the duisease surveillance at state and district level • Involving Path lab,blood banks,ITCT centres of GMC/SMGS/ASSCOM hospital ,Pvt. Nuring homes and Labs. • Identification of SSH at DH Rajouri and Udhampur. • Strengthening of surveillance by providing dengue kits to Path Labs. GMC Jammu. • Involving Police, Paramilitary Hospitals for reporting of fever cases. • Involving ASHA workers NGO and other related department for IEC( Action Plan attached)Capacity building( Detail Attached in Action Plan) • Intensified monitoring and supervision. Quarterly SOE along with unspent balance position as on 30-06- 2008 and 30-09-08. .

S.NO COMPONENT UNSPENT FUNDS EXP. UNSPENT BALANCE RECEIVED DURING BALANCE AS ON DURING 2008-09 AS ON 1-4-08 THE (UPTO 30-6- 30-6-08 QUARTER 08) 1 EAC Nil Nil Nil Nil

World Bank Nil Nil Nil Nil

GFATM 56608 60000 56409 60199 (State Health Society) Sub-Total 56608 60000 56409 60199

2 DBS Nil Nil Nil Nil

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Others Nil Nil Nil Nil

Sub-Total Nil Nil Nil Nil

3 GRAND 56608 60000 56409 60199

TOTAL

S.NO COMPONENT UNSPENT FUNDS EXP. UNSPENT BALANCE RECEIVED DURING BALANCE AS ON DURING 2008-09 AS ON 1-7-08 THE (UPTO 30-9- 30-9-08 QUARTER 08) 1 EAC Nil Nil Nil Nil

World Bank Nil Nil Nil Nil

GFATM 60199 Nil 8672 51527

Sub-Total 60199 Nil 8672 51527

2 DBS Nil Nil Nil Nil

Others Nil Nil Nil Nil

Sub-Total Nil Nil Nil Nil

3 GRAND 60199 Nil 8672 51527

TOTAL

------

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DENGUE AND CHIKUNGUNYA Situation analysis The state is free from dengue and Chikungunya.How ever in year 2006 26 cases was diagnosed and there was 1 death as per reports from the districts of Jammu Kathua and Rajouri. No out break has been reported so far Constrains . • No SSH has been identified in the district • No contingency plan formulated to deal with a large no. of patients in the districts. • No contingency plan formulated to deal with large number of patients. Innovations/Strategies • To integrate and strengthen the duisease surveillance at state and district level • Involving Path lab,blood banks,ITCT centres of GMC/SMGS/ASSCOM hospital ,Pvt. Nuring homes and Labs. • Identification of SSH at DH Rajouri and Udhampur. • Strengthening of surveillance by providing dengue kits to Path Labs. GMC Jammu. • Involving Police, Paramilitary Hospitals for reporting of fever cases. • Involving ASHA workers NGO and other related department for IEC( Action Plan attached)Capacity building( Detail Attached in Action Plan) • Strengthening of Entomological surveillance. • Intensified monitoring and supervision.

Filariasis-J.E and Kala-azar

No case of these diseases have been reported till now. The state is free from theses NVBDs

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INTEGRATED DISEASE SURVEILLANCE PROJECT

Integrated Disease Surveillance Project (IDSP) is a decentralized state based surveillance system. IDSP is intended to detect early warning of signals of impending outbreaks and help initiate an effective response in a timely manner. It is also expected to generate a essential data to monitor progress of on going disease control programmes. The objective of programme is to take precautionary measures within the existing health infrastructure at the earliest warning of outbreaks to reduce risk minimize the magnitude of such outbreaks. For implementing this strategy the health personnel have to be sensitized / trained so as to remain alert for identification of early burning signals of various disease outbreaks. At the same time their capacity has to be build so that they are able to initiate specific recommended interventions in a timely manner. Under this programme district surveillance units have been established at the district head quarters who will be reporting to the surveillance unit at the Divisional level who in turn will be reporting to the central surveillance unit (IDSP) New Delhi. In this programme the reporting is to be done on weekly basis for the following Disease entities:- 1. Acute Diarrhoeal Disease, including Cholera & Dysentery. 2. Malaria 3. Hepatitis A& E; Hepatitis B 4. Typhoid Fever 5. Acute Respiratory infection including Pneumonia 6. Vaccine Preventable Disease(Measles, Pertussis, Diphtheria) 7. TB

The District Surveillance Officer, Medical Officer and Health workers play an important role in the surveillance activity listed below: 1. Conduct passive surveillance of important disease identify under IDSP.

2. Supervision and quality control of activity surveillance by health workers in the field.

3. Compilation and transmission of reports to District Surveillance Officers at weekly intervals from PHCs and CHCs. 354

4. Involve the Private Particitioners in the Programme from their respective areas.

5. Initiate emergency response to the Surveillance on receipt of out- break reports.

6. Facilitate and coordinate epidemic investigations and response by the District Surveillance Units.

7. The reporting of surveillance by the MOs will be presumptive in nature or syndromic in nature were as reporting by the health workers will only be syndromic. These cases will be confirmed by the participating Laboratories.

IDSP is being implemented in the country in all the states. Jammu and Kashmir has been included in the phase-III. In Jammu Division funds have been provided to the following districts for Carrying out civil works and equipping the District Surveillance Units and District Laboratories with the necessary fixtures and equipments: 1. Divisional Headquarter, Jammu 2. Doda 3. Kathua 4. Poonch 5. Rajouri 6. Udhampur In Jammu District the above mentioned infrastructure for district Laboratory and District Surveillance Office has already been created under NSPCD. The Surveillance Officers of Jammu Division and District Surveillance of Poonch, Kathua, Doda and Rajouri have been trained as Trainers at NIHFW, New Delhi during the year 2008-09.

The creation of above mentioned infrastructure is being proposed to be included in the PIP 2009-10 in the remaining 4 Nos. Districts of Jammu Division viz Kishtwar , Ramban, Reasi and Samba. The District Surveillance Officers from these districts and the remaining old districts need to be trained at the National Level.

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Besides the Surveillance Unit of Jammu Division proposes to carry-out the training of Medical Officers and Paramedical workers of the implementing districts. The tentative number of trainees/ batches and the expenditure to be incurred on the same is as below:

TRAINING OF MEDICAL OFFICERS AT THE DISTRICT LEVEL

S.No. Name of District Number/size Budget for 1 Total Budget of Batches batch 1 Doda 2 ( 25) 107150.00 214300.00 2 Jammu 4 ( 25) 107150.00 428600.00 3 Kathua 2 (25) 107150.00 214300.00 4 Kishtwar 1 (25) 107150.00 107150.00 5 Poonch 2 (25) 107150.00 214300.00 6 Rajouri 2 (25) 107150.00 214300.00 7 Ramban 1 (25) 107150.00 107150.00 8 Reasi 1(25) 107150.00 107150.00 9 Samba 1 (25) 107150.00 107150.00 10 Udhampur 2 (25) 107150.00 214300.00 Total 1928700.00

Training of Health Workers ( ANMs/SNs /LHVs /Pharamacists /BHWs/ JHIs/Malaria Inspectors /Laboratory Assistant & Technicians, CHOs and other supervisiors). S.No. Name of District Number/size Budget for 1 Total Budget of Batches batch 1 Doda 5 ( 30) 27,405.00 1,37,025.00 2 Jammu 10 ( 30) 27,405.00 2,74,050.00 3 Kathua 5 (30) 27,405.00 1,37,025.00 4 Kishtwar 3 (30) 27,405.00 82,215.00 5 Poonch 4 (30) 27,405.00 1,09,620.00 6 Rajouri 5 (30) 27,405.00 1,37,025.00 7 Ramban 3 (30) 27,405.00 82,215.00 8 Reasi 3(30) 27,405.00 82,215.00 9 Samba 3 (30) 27,405.00 82,215.00 10 Udhampur 5 (30) 27,405.00 1,37,025.00 Total 12,60,630.00

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Training of Health Workers (Laboratory Technicians) under IDSP at Divisional Level, Jammu. S.No. Name of District Number/size Budget for 1 Total Budget of Batches batch 1 Doda 1 ( 30) 89295 89,295.00 2 Jammu 1 ( 30) 89295 89,295.00 3 Kathua 1 (30) 89295 89,295.00 4 Kishtwar 1 (30) 89295 89,295.00 5 Poonch 1 (30) 89295 89,295.00 6 Rajouri 1 (30) 89295 89,295.00 7 Ramban 1 (30) 89295 89,295.00 8 Reasi 1 (30) 89295 89,295.00 9 Samba 1 (30) 89295 89,295.00 10 Udhampur 1 (30) 89295 89,295.00 Total 8,92,950.00

Training of Health Workers (Laboratory Technicians) under IDSP at District Level.

S.No. Name of District Number/size Budget for 1 Total Budget of Batches batch 1 Doda 1 ( 30) 46897 46897.00 2 Jammu 1 ( 30) 46897 46897.00 3 Kathua 1 ( 30) 46897 46897.00 4 Kishtwar 1 ( 30) 46897 46897.00 5 Poonch 1 ( 30) 46897 46897.00 6 Rajouri 1 ( 30) 46897 46897.00 7 Ramban 1 ( 30) 46897 46897.00 8 Reasi 1 ( 30) 46897 46897.00 9 Samba 1 ( 30) 46897 46897.00 10 Udhampur 1 ( 30) 46897 46897.00 Total 4,68,970.00

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FINANCIAL GUIDELINES FOR TRAINING OF MEDICAL OFFICERS UNDER IDSP (Jammu Division)

VENUE OF TRAINING : RIHFW, Nagrota.

DURATION OF TRAINING : 6 Days

NUMBER OF PARTICIPANTS: 25

DA to participants @ Rs. 200 per day x 6 days x 25 participants 30,000.00 Honorarium to Trainers Rs. 500 x 2 trainers x 6 days 6,000.00 Working Lunch/Tea & Snacks Rs. 200 x 25 participants x 6 days 30,000.00 Institutional overhead @ 15% of actual expenses on col. No. 9900.00 1,2& 3 Total 75900.00 Incidental expenditure, photocopying, job aids, flips charts LCD etc; Rs. 250 x 25 participants 6,250.00 TA for MOs ii) Rs. 1000 X 25 Participants 25000.00 Note: - TA/D.A. to be disbursed as actual, as per State Govt. rules. The DDO shall certify that the payment of T.A./D.A. has been made to the actual payee after obtaining a certificate from participant that they shall not draw such claim from any other source.

TOTAL 107150.00

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FINANCIAL GUIDELINES FOR TRAINING OF HEALTH WORKERS ( ANMs/SNs/LHVs/ PHARAMACISTs/ BHWs /JHIs/MALARIA INSPECTORs/LABORATORY ASSISTANT & TECHNICIANS, CHOs AND OTHER SUPERVISORs) UNDER IDSP (Jammu Division)

VENUE OF TRAINING : Block Headquarter.

DURATION OF TRAINING : 2 Days

NUMBER OF PARTICIPANTS : 30

1. D.A to participants

Rs. 125 x 2 days x 30 Participants 7,500.00

2. Honorarium for trainers

Rs. 200 x 2 days x 3 Trainer 1,200.00 3. Working Lunch/Tea & Snacks

Rs. 100 x 2 days x 30 Participants 6,000.00 4. Institutional overhead @ 15% of actual expenses on 2,205.00

col. No. 1,2& 3 Total 16,905.00

5 Incidental expenditure, photocopying, job aids, flips charts LCD etc;

Rs. 250 x 30 Participants 7,500.00 6. T.A

Rs. 100 per person x 30 participants 3,000.00

Note:- TA/D.A. to be disbursed as actual, as per State Govt. rules. The DDO shall certify that the payment of T.A./D.A. has been made to the actual payee after obtaining a certificate from participant that they shall not draw such claim from any other source.

Grand Total 27,405.00

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FINANCIAL GUIDELINES FOR TRAINING OF HEALTH WORKERS (Laboratory Technicians) UNDER IDSP (Jammu Division)

VENUE OF TRAINING : RIHFW, Jammu.

DURATION OF TRAINING : 6 Days

NUMBER OF PARTICIPANTS : 30

1. D.A to participants

Rs. 125 x 6 days x 30 Participants 22500.00

2. Honorarium for trainers

Rs. 200 x 6 days x 4 Trainers 4800.00

3. Working Lunch/Tea & Snacks

Rs. 200 x 6 days x 30 Participants 36000.00 4. Institutional overhead @ 15% of actual expenses on 9495.00

col. No. 1,2& 3 Total 72795.00

5 Incidental expenditure, photocopying, job aids, flips charts LCD etc;

Rs. 250 x 30 Participants 7500.00 6. T.A

Rs. 300 per person x 30 participants 9000.00

Grand Total 89295.00

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FINANCIAL GUIDELINES FOR TRAINING OF HEALTH WORKERS (Laboratory Technicians) UNDER IDSP (At District Level)

VENUE OF TRAINING : District Headquarter.

DURATION OF TRAINING : 3 Days

NUMBER OF PARTICIPANTS : 30

1. D.A to participants

Rs. 125 x 3 days x 30 Participants 11250.00

2. Honorarium for trainers

Rs. 200 x 3 days x 4 Trainers 2400.00

3. Working Lunch/Tea & Snacks

Rs. 200 x 3 days x 30 Participants 18000.00 4. Institutional overhead @ 15% of actual expenses on 4747.00

col. No. 1,2& 3 Total 36397.00

5 Incidental expenditure, photocopying, job aids, flips charts LCD etc;

Rs. 250 x 30 Participants 7500.00 6. T.A

Rs. 100 per person x 30 participants 3000.00

Grand Total 46,897.00

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INTEGRATED DISEASES SURVEILLANCE PROJECT (IDSP)

Proposed activities and expenditure thereof on strengthening of the District Laboratories under IDSP during the year 2009-10.

Name of the Civil works Furniture/Fixtures Office District (Renovation of (DSU & District Equipments DSU & District Lab) Lab) (DSU) (Lakhs) (lakhs) (lakhs) Kishtwar 2.80 1.20 1.00 Reasi 2.80 1.20 1.00 Ramban 2.80 1.20 1.00 Samba 2.80 1.20 1.00 Total 11.20 4.80 4.00 Grand Total Rs. 20.00 lakhs

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Integrated Diseases Surveillance Project (IDSP)

Statement of financial implications of Action Plan 2009-10 of Jammu Division. S.N0 Name of Activity Amount Proposed ( Lakhs) 1 Strengthening of District Laboratories Rs. 20.00 Lakhs 2 Training of Medical Officers at the District level Rs. 19.28 Lakhs

3 Training of Health Workers (Laboratory Rs. 8.92 lakhs Technicians) at divisional Level under IDSP at Divisional Level, Jammu.

4 Training of Health Workers Rs. 12.60 lakhs (ANMs/SNs/LHVs/Pharmacists/BHWs/JHIs/Malaria Inspectors/Laboratory Assistant & Technicians, CHOs and other Supervisiors) 5 TRAINING OF HEALTH WORKERS (Laboratory Rs. 4.68 lakhs Technicians) at District Level UNDER IDSP (Jammu Division)

6 Contingency & Miscellaneous for the Districts Rs. 6.00 lakhs Grand Total Rs. 71.48 lakhs

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NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS IN

INTRODUCTION

The National Programme for Control of Blindness is 100% Centrally Sponsored Scheme with the goal of achieving a prevalence rate of senile cataract 0.3% of population. The scheme is being implemented in all the Districts of Jammu Division. The scheme is very successful in District Jammu where as the achievements in other Districts are comparatively low. This is because of the availability of Specialists services in the two Medical Colleges Hospitals and Govt. Hospital Gandhinagar. In the remaining Districts the Ophthalmologists and allied staff is either insufficient or not in place at all. The Cataract operations are being conducted as a regular feature in the Medical College Hospitals, all the District Hospitals and some Community Health Centers. The Cataract operations in the remaining blocks are performed by holding camps by the respective District Blindness Control Societies. There are two Mobile Eye Units in the Jammu Division located at Rajouri and Udhampur. Besides, Ophthalmology department of the Govt. Medical College Jammu is also providing Eye Care Services through one mobile unit.

ACTIVITIES UNDERTAKEN UNDER NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS:- 1. Cataract Surgery (Both in hospital and Camps). 2. Screening of School Children for refractory errors. 3. Provision of Spectacles to the School Children. 4. Providing grant in aid to the NGOs and private Institutions includes Medical Colleges performing Cataract operations. 5. Procuring drugs, consumable and equipment and IOLs for the implementation of NPCB. 6. Planning and organizing training of community level workers, teachers, Ophthalmic Assistants and other Health workers involved in Eye Care Services.

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Physical Achievements in Control of Blindness Programme.

Cataract Operations performed

Year Jammu Kashmir Total in J&K State Division Division 2005-06 7893 7316 15209 2006-07 7336 12257 19593 2007-08 5774 12706 18480 2009-10 5296 10845 16141 (till 12/2008)

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Financial Achievements in Control of Blindness Programme. (Rs. in Lakhs)

2005-06 2006-07 2007-08 2008-09 ( till 12/08) Jammu Kashmir Total Jammu Kashmir Total Jammu Kashmir Total Jammu Kashmir Total Division Division Division Division Division Division Division Division Opening 9.44 - 9.44 5.65 2.58 8.23 2.23 2.31 4.54 13.65 2.36 16.01 Balance GIA 4.00 2.55 6.55 2.55 0.30 2.85 19.00 - 19.00 10.00 - 10.00

Interest 0.21 .007 0.21 0.24 0.05 0.29 0.35 0.50 0.85 0.27 0.01 0.28 Earned Total Funds 13.65 2.557 16.2 8.44 2.93 11.37 21.57 2.81 24.38 23.92 2.37 26.29 in Hand Expenditure 8.02 - 8.02 6.21 0.60 6.81 7.93 - 7.93 7.91 1.41 9.32

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Revised National Tuberculosis Programme

Jammu & Kashmir State comprises of two Divisions viz Kashmir & Jammu which are totally different geographically, culturally and climate wise. The terrain of the State is extreme; plain (Kandi) areas in most of Jammu region and hilly in some areas of Jammu region and almost all Districts of Kashmir Division except District Areas of Srinagar and Budgam. Most of the hilly areas remain snowbound during winter season. Besides road connectivity is very less when compared to National level and this problem is more in Jammu than in Kashmir region. In one of the blocks of Kishtwar District, viz Dachan has no road connectivity and It takes upto 2 days to reach certain villages. The literacy rate in these areas is also very low. Because of this situation implementation of RNTCP has faced many hurdles in its implementation in these areas. In the current financial year 8 new Districts have been created in Jammu & Kashmir where new District TB Centers are to be established. LEH & Kargil Districts are located on a plateau which remains cut off from rest of India & State for six months by road. The only communication during Winter in these Districts is by Air. Inspite of all the above mentioned difficulties, RNTCP has been implemented in all the Districts with moderate to very good results. Due to clear-cut geographical distinction, separate State TB societies were sanctioned and then constituted in the State one for Jammu and one for Kashmir Division. The no. of TUs and Microscopic Centres is as under:-

( Treatment Units (TUs) Designated Microscopic Centers

Jammu Kashmir Total Jammu Kashmir Total 17 30 47 81 96 177

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The no. of Contractual Staff recruited under RNTCP is as under:-

MOs STS STLS TBHB

Jammu Kashmir Total Jammu Kashmir Total Jammu Kashmir Total Jammu Kashmir Total

3 2 5 17 25 42 17 25 42 6 17 23

The Financial Achievement during past 3 Years & current year are as under:- Year Opening GIA Interest Total Funds Expenditure Balance Balance available Jammu 991336 11300000 40300 12331636 7668025 4663611 2005- Kashmir 7389429 13000000 137757 20527186 17000106 3527080 06 Total 8380765 24300000 540757 32858822 24668131 8190691 Jammu 4663611 3000000 90128 7753739 7045211 708528 2006- Kashmir 3527080 12500000 132238 16159318 13348766 2810612 07 Total 8190691 15500000 222366 23913057 20393917 3519140 Jammu 708528 9500000 44756 10253284 10183027 70257 2007- Kashmir 2810612 13500000 221931 16532543 13466389 1913154 08 Total 3519140 23000000 266687 26785827 23649416 1983411 Jammu 502719 7000000 74892 7577611 5349786 2227825 2008- Kashmir 1913154 10000000 92923 12006077 10845485 1160592 09 Total 2415873 17000000 167815 19583688 16195271 3388417

As explained above in spite of 2 separate TB societies for Kashmir & Jammu Divisions, the various Indicators are calculated by amalgamating the Physical Achievements of the Central TB Division New Delhi and performance is evaluated on the basis of consolidated figures. In this context it is observed that the achievement in various indicators is better in the Jammu Division vis-a- vis Kashmir Division e.g. The ACDR is much lower in Kashmir where as It is 54 in Jammu Division. The Central TB Division has calculated It is as 43 which is clear cut dilution of Achievements of the Jammu Division. However the State is better in achieving the required Sputum Conversion rate and the Cure rate. The Death, Defaulter and failure rates which were much higher in the preceding years have remarkably come down and at par with the desirable targets.

368

PART E

INTERSECTORAL CONVERGENCE

369

INTERSECTORAL CONVEGENCE

THE CONCEPT OF INTER-SECTOR COORDINATION IS A KEY STRATEGY TO BE INITIATED DURING RCH II BECAUSE THIS CAN LEAD TO COST-EFFECTIVE RESULTS AND SUCH RESULTS MAY BE SUSTAINED IN THE LONG RUN THROUGH SUCH NATURAL CONVERGENCE BEING REALIZED AND NURTURED.THE CONCEPT OF INTER-SECTOR COORDINATION EMANATES FROM THE FOLLOWING:

• Outcomes jointly determined by policies in multiple sectors • Sectors providing services to the same target groups/locations • Different programs reaching the same target group can also be effectively utilized to build on them or utilize the services offered by them

Inter-sectoral coordination, especially between the Departments of Health, ICDS, Rural development, Education, Army in J&K is critical for increasing the coverage of the Family Welfare Program and improving implementation. Hence, under NRHM, health Department decided to work in close coordination with other sectors to bring about a common objective of good health, with special focus on people living in rural areas. During, 2009-10, convergence would be further Strengthened between various state departments such as education, PHE, Rural Development and Social Welfare Department (Anganwari centres), paramilitary forces and other agencies doing health and developmental work in the state.

The ICDS Programme of the Social Welfare Department is aimed at providing nutrition and Health Education to Pregnant/ Lactating mothers and the pre-school children. Anganwari Workers (AWWs) are engaged in carrying out useful health activities under the ICDS Programme. Though the ICDS functionaries are expected to cover a total of six activities, four of these excluding non-formal education and supplementary nutrition are related to health department. These are - immunization, growth monitoring, minor ailment treatment and nutritional advice. The MO, at PHCs is 370

expected to visit every Aanganwadi on a regular basis for health check up of each beneficiary attending Anganwadi including supervision/ growth monitoring. He is expected to identify grade III and grade IV Malnourished children for providing medical management as well as nutritional advice.

In RCH-II the State firmly desires to Increase the Coordination between the ICDS Workers and Health Workers. We intend to Involve ICDS workers to: • Encourage the registration of pregnant ladies. • Antenatal care • To impart knowledge of dangerous signs of pregnancy • Post- natal care (home visits during 1st week). • Neo-natal care. • Promotion of early and exclusive breastfeeding for 3 months. Hold monthly VH&ND in the AWC for which she would be provided Rs.100/per day instead of Rs.75 being paid as incentive .

Under RCH-II, State is imparting Trainings to AWW for RCH activities. In addition the AWW would, along with ICDS Supervisors be trained in IMNCI. Idea is to develop a proper team of ANM; ASHA & AWW for better results. In addition ,convergence with Army is being strengthened. Mobile Teams are already working in remote areas (under Border Area Project) of the State in collaboration with the ARMY This Mobile team comprising a team of Doctor & a pharmacist is being incentivized with a higher salary from funds under NRHM. Steps are also proposed to strengthen the convergence at all levels, (non – budgetary) i.e. State, Division, District, Block and Village level so that better results are produced. Under School Health, Adolescent Health components, focused actions are proposed by Health Department with the support of Education and Social Welfare Department. Total Budget Proposed is Rs 94.22 lacs

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372

Annexure - A

Status of Trainings/Workshops conducted under NRHM in the Year 2008-09 (as on 31-1-09)

Through State Health Society

S.No. Name of Training No. of person Trained 1 Training of District Trainers (TOTs) in 14 IMNCI at New Delhi 2 Training of Doctors in EmOC at CMC, 5 Vellore 3 Training of Doctors in Anesthetic skills 9 4 Training of doctors of ISM department on 138 National Programmes 5 Training of District Officers/BMOs on MDP 15 6 Workshops on Quality Assurance 97 7 Workshop on Awareness on accreditation 60 process of Hospitals. 8 Consultative Workshop on Health 60 Insurance 9 Workshop cum training on HMIS Tool Kits 88 developed by GoI 10 Consultative Workshop on Planning of 40 Child and Maternal Health Strategies 11 Consultative Workshop on Establishment 36 on SNCUs 12 Training of Lab Assistants of Schools 20 under School Health Programme 13 Training of MOs in MTP 3 14 Training of Gyn/Sur. Specialist and Theatre 6 Nurse/Asstt. in Laparoscopic Sterilization

373

(ANNXURE-A CONTD)

Through District Health Societies

S.No. Name of Training No. of person trained 1 IUD Skill upgradation Training of 12 ANMs/LHVs posted in 24x7 PHCs/FRUs 2 NSV training for MOs during NSV camps 6 3 Workshops on Quality Assurance 110 4 Training of LHVs/ANMs/SNs/AWWs in 24 Essential New Born Care 5 Contraceptive update Seminars for 60 Health Service Providers 6 Training of Village Health and Sanitation 299 Committee members 7 Training of Pharmacist/Dawasaz of ISM 112 department on National Programmes.

8 Training of ANMs/LHVs in Skilled Birth 4 Attendance

374

ANNEXURE – B

BUDGETS SHEETS FOR TRAININGS AND WORKSHOPS

375

FINANCIAL GUIDELINES FOR DIVISIONAL LEVEL WORKSHOP FOR TOT FOR SKILLED ATTENDANCE AT BIRTH (SBA)

VENUE OF TRAINING : TO BE DECIDED BY DIRECTOR FW&RCH

DURATION OF TRAINING : One Day

NUMBER OF PARTICIPANTS : 25 (excluding 10 Divisional level officers)

Divisional Level Workshop for TOT for SBA

DA i) Guest faculty from outside the State 4000.00 @ Rs. 1000 per day x 2 days x 2 Guest faculty ii) 35 participants @ Rs. 200 x 2 days 14000.00 Honorarium Rs. 1000 x 2 trainers x 2 days 4000.00 Working Lunch/Tea & Snacks Rs. 200 x 35 participants x 2 days 14000.00 Incidental expenditure, photocopying, job aids, flips charts LCD etc; Rs. 250 x 35 trainees 8750.00 TA i) Guest faculty from outside the State 28000.00 2 @ Rs. 14000 per Guest faculty. ii) Participants 25 No. @ Rs. 1000 25000.00 Rent for venue hiring 10000.00 Note: - TA/D.A. to be disbursed as actual, as per State Govt. rules. The DDO shall certify that the payment of T.A./D.A. has been made to the actual payee after obtaining a certificate from participant that they shall not draw such claim from any other source.

TOTAL 107750.00

376

FINANCIAL GUIDELINES FOR DISTRICT LEVEL TRAINING OF STAFF NURSEs FOR SBA

VENUE OF TRAINING : District Hospital DURATION OF TRAINING : 21 days NUMBER OF PARTICIPANTS : 2

1. D.A Rs. 125 x 21 days x2 trainees 5250.00

2. Honorarium for trainers Rs. 200 x 21 days x 2 trainers 8400.00

3. Working Lunch/Tea & Snacks Rs. 200x 21 days x 2 trainees 8400.00

4. Institutional overhead @ 15% of actual expenses on col. No. 3307.00 1,2& 3

Total 25357.00 5 Incidental expenditure, photocopying, job aids, flips charts

LCD etc;

Rs. 250 x 2 trainees 500.00

6. Travel for trainees

Rs. 200 per person x2 participants 400.00

Grand Total 26257.00

377

FINANCIAL GUIDELINES FOR DISTRICT LEVEL TRAINING OF ANMs/LHVs FOR SBA

VENUE OF TRAINING : District Hospital DURATION OF TRAINING : 30 days NUMBER OF PARTICIPANTS : 2

1. D.A Rs. 125 x 30 days x 2 trainees 7500.00 2. Honorarium for trainers Rs. 200 x 30 days x 3 trainers 18000.00 3. Working Lunch/Tea and snacks Rs. 200x 30 days x 2 trainees 12000.00 4. Institutional overhead @ 15% of actual expenses on col. No. 1,2 5625.00 & 3 Total 43125.00 5 Incidental expenditure, photocopying, job aids, flips charts LCD etc; Rs. 250 x 2 trainees 500.00 6. Travel for trainees Rs. 200 per person x2 participants 400.00

Grand Total 44025.00

378

FINANCIAL GUIDELINES FOR TRAINING OF A TEAM COMPRISING OF MOs & LAB TECHNICIANS IN BLOOD TRANSFUSION

VENUE OF TRAINING : GMC, SRINAGAR/JAMMU

DURATION OF TRAINING : 3 DAYS NUMBER OF PARTICIPANTS : 4 (Two teams comprising of MO & Lab. Tech from each district)

a. Training programme of Gynae or Surgeon Specialist/OT Nurse or OT Tech) 1. D.A for trainees for MOs Rs 200 per day x 3 days x 2 participants 1200.00

2. D.A for trainees Lab Technicians Rs 125 per day x 3 days x 2 participants 750.00

3. Honorarium for trainers Rs. 500 per day x 3 days x 1 person 1500.00

4. Working Lunch/Tea and snacks Rs. 200 per Person x 4 participants x 3 days 2400.00

5. Institutional overhead @ 15% of actual expenses on 877.00 item no. 1, 2, 3 & 4 Total 6727.00

6 Incidental expenditure, photocopying, job aids, flips charts

LCD etc; Rs. 250 x4 trainees 1000.00

7 T.A. to trainees Rs. 1000/participants x 2 MOs 2000.00 Rs. 300/participantsx 2 Lab. Tech. 600.00 Note:- TA/D.A. to be disbursed as actual, as per State Govt. rules. The DDO shall certify that the payment of T.A./D.A. has been made to the actual payee after obtaining a certificate from participant that they shall not draw such claim from any other source. Grand Total 10327.00

379

FINANCIAL GUIDELINES FOR SAFE ABORTION SERVICES (MTP)

VENUE OF TRAINING : GMC

DURATION OF TRAINING : 15 DAYS

NUMBER OF PARTICIPANTS : 3

1. D.A Rs 200 per day x 15 days x 3 participants 9000 .00

2. Honorarium for trainers Rs. 500 per day x 15 days x 1 trainer 7500.00

3. Working Lunch/Tea & Snacks Rs. 200 per Person x 3 participants x 15 days 9000.00

4. Institutional overhead @ 15% of actual expenses on item no. 1, 2 & 3825 .00 3 Total 29325 .00 5 Incidental expenditure, photocopying, job aids, flips charts LCD etc; Rs. 250 x 3 trainees 750.00 6. Travel for trainees Rs. 1000 per person x 3 participants 3000.00

Note: - TA/D.A. to be disbursed as actual, as per State Govt. rules. The DDO shall certify that the payment of T.A./D.A. has been made to the actual payee after obtaining a certificate from participant that they shall not draw such claim from any other source.

Grand Total 33075.00

380

FINANCIAL GUIDELINES FOR TRAINING OF MEDICAL OFFICERS IN MTP WITH MVA TECHNIQUE AT DISTRICT LEVEL

VENUE OF TRAINING : DISTRICT HOSPITAL

DURATION OF TRAINING : 12 Day

NUMBER OF PARTICIPANTS : 4 (2 MOs & 2 Staff Nurses)

1 Honorarium Rs. 500 x 12 days x 1 ToT 6000.00

2 D.A. to Participants i) Rs. 200 x 12 days x 2 M.O.s 4800.00 Rs. 125 x 12 days x 2 Staff Nurses 3000.00 3 Working Lunch/Tea & Snacks

Rs. 200 x 4 participants x 12days 9600.00 4 Institutional overhead @ 15% of actual expenses 1,2&3 3510.00 Total 26910.00 5 Incidental expenditure, photocopying, job aids, flips charts LCD etc; Rs. 250 x 4 trainees 1000.00 6 T.A. i) Medical Officers Rs. 1000 x 2 M.O. 2000.00 ii) Staff Nurses Rs. 300 x 2 Staff Nurses 600.00 Note:- TA/D.A. to be disbursed as actual, as per State Govt. rules. The DDO shall certify that the payment of T.A./D.A. has been made to the actual payee after obtaining a certificate from participant that they shall not draw such claim from any other source.

TOTAL 30510.00

381

FINANCIAL GUIDELINES FOR TRAINING OF MOs in LIFE SAVING SKILLS FOR OBSTETRIC ANESTHESIA.

VENUE OF TRAINING : GMC, Jammu/Srinagar

DURATION OF TRAINING : 16 WEEKS

NUMBER OF PARTICIPANTS : 4

Venue of Training GMC

Duration of Training 16 weeks

No. of participants 4

Unit cost / trg. 18922+ other cost @ (TA/DA to trainees)

104800

TOTAL 294000.00

382

FINANCIAL GUIDELINES FOR TRAINING OF MOS AS DISTRICT TRAINERS FOR RTI/STI CASE MANAGEMENT

(For 12 Districts in First Phase namely: Kishtwar, Reasi, Samba, Jammu, Udhampur, Ramban, Kupwara, Srinagar, Pulwama Kulgam, Budgam, Baramulla)

VENUE OF TRAINING : GMC, Jammu/Srinagar DURATION OF TRAINING : 2 days NUMBER OF PARTICIPANTS : 24 (4 participants per Distt.)

1. DA to trainees 24 participants x Rs. 200 x 2 days Rs. 9600.00 2. Honorarium to Trainers Rs. 500 x 2 trainers x 2 days Rs 2000.00 3. Working Lunch/Tea & Snacks Rs. 200 x 24 participants x 2 days Rs. 9600.00 4. Institutional Overhead @ 15% of actual expenditure incurred on item No. 1, 2 & 3 Rs. 3180.00 Total Rs. 24380.00 5 Incidental expenditure, photocopying, job aids, flips charts LCD etc; Rs. 250 x 24 Participants Rs. 6000.00 6 T.A to trainees

24 participants x Rs.1000 Rs. 24000.00 Note:- TA/D.A. to be disbursed as actual, as per State Govt. rules. The DDO shall certify that the payment of T.A./D.A. has been made to the actual payee after obtaining a certificate from participant that they shall not draw such claim from any other source.

Total 54380.00

383

FINANCIAL GUIDELINES FOR TRAINING OF ANMS/LHVS/SNS/MED. ASSTT/LAB. ASSTT FOR RTI/STI CASE MANAGEMENT

(For 12 Districts in First Phase namely: Kishtwar, Reasi, Samba, Jammu, Udhampur, Ramban, Kupwara, Srinagar, Pulwama Kulgam, Budgam, Baramulla)

VENUE OF TRAINING : To be decided by district authorities

DURATION OF TRAINING : 2 days

NUMBER OF PARTICIPANTS : 30

1. D.A

30 Participants x Rs. 125 x 2 days 7500.00 2. Honorarium to Trainers

2 Trainers x Rs. 300 x 2 days 1200.00 3. Working Lunch/Tea & Snacks Rs. 200 x 30 participant x 2 days 12000.00

4. Institutional Overhead

@ 15% of actual expenditure incurred on item No. 1, 3105.00 2 & 3 Total 23805.00 5 Incidental expenditure, photocopying, job aids, flips charts LCD etc; Rs. 250 x 30 Participants 7500.00 6. T.A

30 participants x Rs. 100 3000.00 Note:- TA/D.A. to be disbursed as actual, as per State Govt. rules. The DDO shall certify that the payment of T.A./D.A. has been made to the actual payee after obtaining a certificate from participant that they shall not draw such claim from any other source. [ TOTAL 34305.00

384

FINANCIAL GUIDELINES FOR TRAINING OF MOs and Pediatricians IN 11 IMNCI DISTRICTS (posted in 24 x 7 PHCs/FRUs)

(Anantnag, Baramulla, Pulwama, Budgam, Rajouri, Udhampur, Jammu, Kathua, Leh, Kupwara & Poonch)

VENUE OF TRAINING : GMC, Jammu/Srinagar DURATION OF TRAINING : 8 days

NUMBER OF PARTICIPANTS : 24

1. DA to Trainees Rs. 200 x 8 days x 24 participants 38400.00

2. Honrarium to 3 trainées Rs. 500 x 8 days x3 trainers 12000.00

3. Working Lunch/Tea & Snacks Rs. 200/ participant x 8 days x 24 participants 38400.00

4. Institutional Overhead 13320.00 @ 15% of actual expenditure incurred on item No.1, 2 & 3 Total 102120.00 5 Incidental expenditure, photocopying, job aids, flips charts LCD etc; Rs. 250 x 24 Participants 6000.00 6. TA to trainées

Rs. 1000 x 24 participants 24000.00

Note: - TA/D.A. to be disbursed as actual, as per State Govt. rules. The DDO shall certify that the payment of T.A./D.A. has been made to the actual payee after obtaining a certificate from participant that they shall not draw such claim from any other source.

TOTAL 132120.00

385

FINANCIAL GUIDELINES FOR TRAINING OF LHVs/ANMs/SNs/ASHAs/AWWs in 11 IMNCI Districts

(Anantnag, Baramulla, Pulwama, Budgam, Rajouri, Udhampur, Jammu Kathua, Leh, Kupwra & Poonch) VENUE OF TRAINING : District Hospital

DURATION OF TRAINING : 8 days

NUMBER OF PARTICIPANTS : 24

1. DA to trainees

Rs.125 x 8 days x 24 participants 24000.00

2. Honorarium to Trainers

Rs. 300 x 3 trainers x 8days 7200.00

3. Working Lunch/Tea & Snacks Rs. 200 x 24 participants x 8 days 38400.00

4. Institutional Overhead

@ 15% of actual expenditure incurred on item No. 1, 2 & 3 10440.00

Total 80040.00 5 Incidental expenditure, photocopying, job aids, flips charts LCD etc;

Rs. 250 x 24 Participants 6000.00

6 T.A to trainees

Rs.100 x 24 participants 2400.00

TOTAL 88440.00

386

FINANCIAL GUIDELINES FOR TRAINING OF LAPROSCOPIC STERILIZATION

VENUE OF TRAINING : GMC, SRINAGAR/JAMMU

DURATION OF TRAINING : 12 DAYS

NUMBER OF PARTICIPANTS : One team comprising of Gynae or Surgeon specialist & OT Nurse or OT Tech

a. Training programme of Gynae/Surgeon specialist or OT Nurse or OT Tech ) 1. D.A for trainees for MOs Rs 200 per day x 12 days x 1 participants 2400.00

2. D.A for trainees OT Nurse/OT Technician Rs 125 per day x 12 days x 1 participant 1500.00

3. Honorarium for trainers Rs. 500 per day x12 days x 1 Trainer 6000.00

4. Working Lunch/Tea & Snacks Rs. 200 per Person x 2 participants x 12 days 4800.00

5. Institutional overhead @ 15% of actual expenses on item no. 1,2,3&4. 2205.00 16905.00 Total 6 Incidental expenditure, photocopying, job aids, flips charts LCD etc; Rs. 250 x 2 trainees 500.00 7 Travel for trainees Gynae/Surgeon specialist Rs. 1000 per person x 1 participant 1000.00

8 Travel for trainees (OT Nurse or OT Tech) Rs. 300 per person x 1 participants 300.00

Note: - TA/D.A. to be disbursed as actual, as per State Govt. rules. The DDO shall certify that the payment of T.A./D.A. has been made to the actual payee after obtaining a certificate from participant that they shall not draw such claim from any other source.

Grand Total 18705.00

387

FINANCIAL GUIDELINES FOR WORKSHOP ON CONTRACEPTIVE UPDATES

VENUE OF WORKSHOP : DEPARTMENT, OBSTETRIC & GYNAECOLOGIST, GMC, SRINAGAR.

DURATION OF WORKSHOP : TWO DAYS

NUMBER OF PARTICIPANTS : 30

1.D.A. to participants Rs. 200 x 30 participants x 2 days 12000.00 2. Honorarium to Guest faculty @ Rs. 1000 x 2 Guest faculty x 2 days 4000.00 3.Working Lunch/Tea & Snacks

Rs. 200 x 30 participants x 2 days 12000.00 Incidental expenditure, photocopying, job aids, flips charts LCD etc; Rs. 250 x 30 participants 7500.00 Travel to Guest faculty Rs. 12000 x 2 Guest faculty 24000.00

Travel to participants 45000.00 Rs.1000x 45 participants

Total 104500.00

CATEGORY OF PARTICIPANTS:

Deputy Chief Medical Officer’s of Kashmir Division, Two Gynecologists for each District, Private Practitioners and Faculty Members of Department

388

FINANCIAL GUIDELINES FOR DISTRICT LEVEL WORKSHOP ON CONTRACEPTIVE UPDATES FOR HEALTH SERVICE PROVIDERS AT DISTRICT LEVEL

VENUE OF TRAINING : DISTRICT HOSPITAL

DURATION OF TRAINING : 2 DAYS

NUMBER OF PARTICIPANTS : 20

1 Honorarium Rs. 300 x 2 days x 3 trainer 1800.00 2 D.A. to Participants i) Rs. 200 x 2 days x 20 Participants 8000.00 3 Working Lunch/Tea & Snacks

Rs. 200 x 20 participants x 2 days 8000.00 Institutional overhead @15% S.No. 1,2 &3 2670.00 Total 20470.00 4 Incidental expenditure, photocopying, job aids, flips charts LCD etc ; Rs. 250 x 20 participants 5000.00 5 T.A. Rs. 300 x 20 Participants 6000.00 Note:- TA/D.A. to be disbursed as actual, as per State Govt. rules. The DDO shall certify that the payment of T.A./D.A. has been made to the actual payee after obtaining a certificate from participant that they shall not draw such claim from any other source.

TOTAL 31470.00

389

FINANCIAL GUIDELINES FOR TRAINING OF MEDICAL OFFICERS in ADOLESCENT REPRODUCTIVE & SEXUAL HEALTH (ARSH) . (Jammu, Reasi, Kathua, Udhampur, Ramban, Srinagar, Budgam, Kupwara, Baramulla, Anantnag & Pulwama)

VENUE OF TRAINING : GMC, JAMMU/SRINAGAR

DURATION OF TRAINING : 3 days

NUMBER OF PARTICIPANTS : 25

1. DA to trainees Rs.200 x 3 days x 25 participants Rs. 15000.00

2. Honorarium to Trainers Rs.500 x 2 trainers x 3 days Rs 3000.00

3. Working Lunch/Tea & Snacks Rs. 200 per Person x 25 participants x 3 days Rs. 15000.00

4. Institutional Overhead @ 15% of actual expenditure incurred on item No. 1, 2 & 3 Rs. 4950.00

Total Rs. 37950.00 5 Incidental expenditure, photocopying, job aids, flips charts LCD etc; Rs. 250 x 25 participants Rs. 6250.00 6 T.A to trainees Rs.1000 x 25 participants Rs. 25000.00

TOTAL Rs. 69200.00

390

FINANCIAL GUIDELINES FOR TRAINING OF SNs/ANMs/LHVs/MPWs on ADOLESCENT REPRODUCTIVE & SEXUAL HEALTH (ARSH) .

(Jammu, Reasi, Kathua, Udhampur, Ramban, Srinagar, Budgam, Kupwara, Baramulla, Anantnag & Pulwama)

VENUE OF TRAINING : To be decided by district authorities

DURATION OF TRAINING : 5 days

NUMBER OF PARTICIPANTS : 30

1. DA to trainees

Rs.125 x 5 days x 30 participants Rs. 18750.00 2. Honorarium to Trainers Rs.300 x 3 trainers x 5 days Rs 4500.00

3. Working Lunch/Tea & Snacks Rs. 200 x 30 participants x 5days Rs. 30000.00

4. Institutional Overhead @ 15% of actual expenditure incurred on item No. 1, 2 & Rs. 7987.00 3 Total Rs. 61237.00 5 Incidental expenditure, photocopying, job aids, flips charts LCD etc; Rs. 250 x 30 participants Rs. 7500.00 6 T.A. to trainees Rs.200 x 30 participants Rs. 6000.00

TOTAL Rs. 74737.00

391

FINANCIAL GUIDELINES FOR TRAINING /WORKSHOP OF DPMSU, BPMU & CONSULTANTS INCLUDING STATE PROGRAMME OFFICER (AT STATE LEVEL + RESOURCE PERSON)

VENUE OF Training : TO BE DECIDED BY DIRECTOR FW&RCH

DURATION OF TRAINING : 3 Days

NUMBER OF PARTICIPANTS : 4 0

Honorarium to Guest faculty i) Guest faculty @ Rs. 1000 per day x 3 day x 2 Guest faculty 6000.00 Honorarium to In-house resource person Rs. 300 x 3 days x 3 In-house resource person 2700.00 D.A. to Participants Rs. 200 x 40 participants x 3 days 24000.00 Working Lunch/Tea & Snacks

Rs. 200 x 40 participants x 3 days 24000.00 Incidental expenditure, photocopying, job aids, flips charts LCD etc; Rs. 250 x 40 participants 10000.00 T.A. i) 2 Guest faculty from outside the State @ Rs. 12000 24000.00 ii) Participants 40 No. @ Rs. 500 20000.00 Note:- TA/D.A. to be disbursed as actual, as per State Govt. rules. The DDO shall certify that the payment of T.A./D.A. has been made to the actual payee after obtaining a certificate from participant that they shall not draw such claim from any other source.

Hiring of Venue 10000.00 TOTAL 110700.00

392

FINANCIAL GUIDELINES FOR WORKSHOP ON ACCREDITATION OF HOSPITAL EXPERTS (FROM QCI AND GOI)

VENUE OF WORKSHOP : To Be Decided By DFW&RCH

DURATION OF WORKSHOP : ONE DAY

NUMBER OF PARTICIPANTS : 30 (Medical Superintendents from Govt Hospitals & Private Hospitals of the State among others)

1 D.A. to participants

Rs. 200 x 30 participants x 1 day 6000.00

2 Honorarium to Guest faculty

i) Rs. 1000 x 2 Guest faculty x 2 days 4000.00

3 Working Lunch/Tea & Snacks

Rs. 200 x 30 participants x 1 day 6000.00

4 Incidental expenditure, photocopying, job aids, flips charts LCD etc; Rs. 250 x 30 participants 7500.00

5 T.A.+ Boarding lodging charges + Conveyances charges i) 2 Guest faculty @ Rs. 15000.00 30000. 00 ii) Lumpsump for 30 participants 30000.00

Hiring of Venue 10000.00

Total 93500.00

393

FINANCIAL GUIDELINES FOR DIVISIONAL LEVEL QUALITY ASSURANCE WORKSHOP

VENUE OF TRAINING : To be decided by Director FW&RCH

DURATION OF TRAINING : One Day

NUMBER OF PARTICIPANTS : 35 participants

Divisional Level Quality Assurance Workshop

Honorarium to Guest faculty i) Guest faculty @ Rs. 1000.00 per day x 2 days x 2 Guest faculty 4000.00 Honorarium to In-house resource person Rs. 500.00 x 1day x 2 In-house resource person 1000.00 D.A. to Participants Rs. 200.00 x 35 participants x 1 day 7000.00 Working Lunch/Tea & Snacks

Rs. 200.00 x 35participants x 1 day 7000.00 Incidental expenditure, photocopying, job aids, flips charts LCD etc; Rs. 250 x 35 participants 8750.00 T.A.+ Boarding lodging charges + Conveyances charges i) Guest faculty from outside the State 2 @ Rs. 15000.00/ Guest faculty 30000.00 ii) Participants Lumpsump 35000.00 Rent for venue hiring 10000.00 Note:- TA/D.A. to be disbursed as actual, as per State Govt. rules. The DDO shall certify that the payment of T.A./D.A. has been made to the actual payee after obtaining a certificate from participant that they shall not draw such claim from any other source.

TOTAL 102750.00

394

FINANCIAL GUIDELINES FOR DISTRICT LEVEL QUALITY ASSURANCE WORKSHOP

VENUE OF TRAINING : To be decided by district authorities.

DURATION OF TRAINING : One Day

NUMBER OF PARTICIPANTS : 25 participants (i ncluding 5 district officers )

District Level Quality Assurance Workshop

Honorarium to In-house resource person

Rs. 300 x 1day x 2 In-house resource person 600.00

D.A. to Participants

Rs. 200x 25 participants x 1 day 5000.00

Working Lunch/Tea & Snacks

Rs. 200 x 25 participants x 1 day 5000.00

Incidental expenditure, photocopying, job aids, flips charts LCD etc; Rs. 250 x 25 participants 6250.00 T.A.

Participants (Lumpsump) 6000.00

TOTAL 22850.00

395

FINANCIAL GUIDELINES FOR WORKSHOP ON ORIENTATION ON GENDER & EQUALITY AND PC/PNDT ACT WITH PRIVATE PROVIDERS/GOVT HEALTH SERVICES PROVIDER, RELIGIOUS LEADERS/ CASTE LEADERS/MLAS

VENUE OF TRAIING : TO BE DECIDED BY DIRECTOR FW&RCH

DURATION OF TRAINING : 1 Day

NUMBER OF PARTICIPANTS : 25

Honorarium to In-house resource person

Rs. 500 x 1 day x 4 In-house resource person 2000.00

D.A. to Participants

Rs. 200 x 25 participants x 1day 5000.00

Working Lunch/Tea & Snacks

Rs. 200 x 25 participants x 1day 5000.00

Incidental expenditure, photocopying, job aids, flips charts LCD etc; Rs. 250 x 25 participants 6250.00 T.A.

Participants 25 No. @ Rs. 500/ participant 12500.00

Venue hiring 10000.00

TOTAL 40750.00

396

FINANCIAL GUIDELINES FOR WORKSHOP ON ORIENTATION ON GENDER & EQUALITY AND PC/PNDT ACT WITH PRIVATE PROVIDERS/GOVT HEALTH SERVICES PROVIDER, RELIGIOUS LEADERS/ CASTE LEADERS/MLAS AT BLOCK LEVEL

VENUE OF TRAINING : To be decided by District Authorities.

DURATION OF TRAINING : 1 Day

NUMBER OF PARTICIPANTS : 25

Honorarium to In-house resource person

Rs. 300 x 1days x 2 In-house resource person 600.00

D.A. to Participants

Rs. 200 x 25 participants x 1day 5000.00

Working Lunch/Tea & Snacks

Rs. 200 x 25 participants x 1day 5000.00

Incidental expenditure, photocopying, job aids, flips charts LCD etc;

Rs. 250 x 25 participants 6250.00

T.A.

Participants (Lumpsump) 3000.00

TOTAL 19850.00

397

FINANCIAL GUIDELINES FOR WORKSHOP ON PRE SERVICE IMNCI IN THE DEPARTMENT OF PAEDIATRICS, AT GMC, JAMMU UNDER NRHM

VENUE OF WORKSHOP : GMC, Jammu/Srinagar

DURATION OF WORKSHOP : ONE DAY

NUMBER OF PARTICIPANTS : 25

1 Honorarium to experts i) Outside experts 2 nos. @ Rs. 1000.00/expert 4000.00

ii)Outside experts (from UNICEF/ World Bank) 10000.00 2 nos. @ Rs. 5000.00/expert

2 D.A. to participants

i) Rs. 200 x 25 participants x 1 day 5000.00

3 Working Lunch/Tea & Snacks Rs. 200 x 25 participants x 1 day 5000.00 4 Incidental expenditure, photocopying, job aids, flips charts LCD etc; Rs. 250 x 25 participants 6250.00 5 T.A.+ Boarding lodging charges + Conveyances charges i) 4 Guest faculty @ Rs. 15000.00 60000. 00

ii) 25 participants (25 @Rs. 1000.00) 25000.00

Note: - TA/D.A. to be disbursed as actual, as per State Govt. rules. The DDO shall certify that the payment of T.A./D.A. has been made to the actual payee after obtaining a certificate from participant that they shall not draw such claim from any other source.

Hiring of Venue 10000.00 Total 125250.00

398

FINANCIAL GUIDELINES FOR WORKSHOP ON PLANNING OF CHILD HEALTH STRATEGIES

VENUE OF WORKSHOP : To Be Decided By DFW&RCH

DURATION OF WORKSHOP : TWO DAYS

NUMBER OF PARTICIPANTS : 40 (Child Specialists among senior State level officers)

1 D.A. to participants

Rs. 200 x 40 participants x 2 days 16000.00

2 Honorarium to Guest faculty

i) Rs. 1000 x 4 Guest faculty x 2 days 8000.00

3 Working Lunch/Tea & Snacks

Rs. 200 x 40 participants x 1 day 16000.00

4 Incidental expenditure, photocopying, job aids, flips charts LCD etc; Rs. 250 x 40 participants 10000.00

5 Travel to participants

i) 4 Guest faculty @ Rs. 12000.00 48000. 00

ii) Lumpsump for 40 participants 40000.00

Note: - TA/D.A. to be disbursed as actual, as per State Govt. rules. The DDO shall certify that the payment of T.A./D.A. has been made to the actual payee after obtaining a certificate from participant that they shall not draw such claim from any other source.

Total 138000.00

399

FINANCIAL GUIDELINES FOR CONSULTATIVE WORKSHOP FOR ESTABLISHMENT OF SNCUs IN 7 DISTRICT HOSPITALS (PHASE –I)

VENUE OF WORKSHOP : To Be Decided By DFW&RCH

DURATION OF WORKSHOP : ONE DAY

NUMBER OF PARTICIPANTS : 30 (7 Medical Superintendents of DHs, 7 CMOs and 7 Child Specialists and officers from State Level)

1 D.A. to participants

Rs. 200 x 30 participants x 1 day 6000.00

2 Honorarium to Guest faculty

i) Rs. 1000 x 2 Guest faculty x 2 days 4000.00

3 Working Lunch/Tea & Snacks

Rs. 200 x 30 participants x 1 day 6000.00

4 Incidental expenditure, photocopying, job aids, flips charts LCD etc; Rs. 250 x30 participants 7500.00

5 T.A.+ Boarding lodging charges + Conveyances charges i) 2 Guest faculty @ Rs. 15000.00 30000. 00

4 ii) Lumpsump for 30 participants 30000.00

Hiring of Venue 10000.00

Total 93500.00

400

FINANCIAL GUIDELINES FOR CONSULTATIVE WORKSHOP ON FOR ESTABLISHMENT OF SNCUs IN 7 DISTRICT HOSPITALS NICU (PHASE –II)

VENUE OF WORKSHOP : To Be Decided By DFW&RCH

DURATION OF WORKSHOP : ONE DAY

NUMBER OF PARTICIPANTS : 30 (7 Medical Superintendents of DHs, 7 CMOs and 7 Child Specialists and officers from State Level)

1 D.A. to participants Rs. 200 x 30 participants x 1 day 6000.00 2 Honorarium to Guest faculty i) Rs. 1000 x 2 Guest faculty x 2 day 4000.00

3 Working Lunch/Tea & Snacks Rs. 200 x 30 participants x 1 day 6000.00 4 Incidental expenditure, photocopying, job aids, flips charts LCD etc; Rs. 250 x30 participants 7500.00 5 T.A.+ Boarding lodging charges + Conveyances charges i) 2 Guest faculty @ Rs. 15000.00 30000. 00

ii) T.A. Lumpsump for 30 participants 30000.00

6 Rent for Hiring of venue 10000.00 Total 93500.00

401

FINANCIAL GUIDELINES FOR WORKSHOP FOR TRAINING OF DISTRICT LEVEL TRAINERS OF KASHMIR DIVISION FOR STRENGTHENING OF NRHM AT RIHFW DHOBIWAN/NAGROTA

VENUE OF WORKSHOP : RIHFW Dhobiwan

DURATION OF WORKSHOP : TWO DAYS

NUMBER OF PARTICIPANTS : 38 (8 DHOs +30 CDPOs)

1 D.A. to participants Rs. 200 x 38 participants x 2 days 15200.00 2 Honorarium to faculty members i) Rs. 300 x 3 in house x 2 days 1800.00 ii) Rs. 600 x 1 Guest faculty x 2 days 1200.00 Sub Total 3000.00 3 Working Lunch/Tea & Snacks

Rs. 200 x 38 participants x 2 days 15200.00 Institutional over head charges @15% of actual 5010.00 expenses 1,2&3 Total 38410.00 4 Incidental expenditure, photocopying, job aids, flips charts LCD etc; Rs. 250 x 38 participants 9500.00 5 Travel to participants 19000. 00 Rs. 500 x 38 participants

Total 66910.00

402

FINANCIAL GUIDELINES FOR AWWS for Strengthening of NRHM

VENUE OF TRAINING : To be decided by District Authorities.

DURATION OF TRAINING : 2 Days

NUMBER OF PARTICIPANTS : 37 (35 AWWS & 2 ICDS Supervisors)

1 i) DA to Supervisors Rs.125 x 2 participants x 2days Rs. 500.00

ii) DA to AWWS Rs.70 x 35 participants x2days Rs. 4900.00

2 Honorarium Rs. 300 x 3 trainers x 2days Rs 1800.00

3 Working Lunch/Tea and snacks Rs. 200 x 37 participants x 2days Rs. 14800.00

4 Institutional overhead @ 15% of actual expenses 1,2&3 Rs. 3300.00

Total 25300.00 5 Incidental expenditure, photocopying, job aids, flips charts LCD etc; Rs. 250 x 37 participants 9250.00 6 T.A to trainees Rs.100 x 37 participants Rs. 3700.00

TOTAL Rs. 38250.00

403

FINANCIAL GUIDELINES FOR TRAINING OF ISM DOCTORS (AYURVEDIC / UNANI / HOMEOPATHIC ETC.) ON NATIONAL PROGRAMMES

VENUE OF TRAINING : GMC, Jammu/Srinagar (Deptt of PSM) DURATION OF TRAINING : 5 Days

NUMBER OF PARTICIPANTS : 25

1 DA to trainees Rs.200 x 25 participants x5 days Rs. 25000.00

2 Honorarium Rs. 500 x 2 trainers x 5days Rs 5000.00

3 Working Lunch/Tea and snacks Rs. 200 x 25 participants x 5days Rs. 25000.00

4 Institutional overhead @ 15% of actual expenses 1,2&3 Rs. 8250.00 Total Rs.63250.00 5 Incidental expenditure, photocopying, job aids, flips charts LCD etc; Rs. 250 x 25 participants Rs. 6250.00 6 T.A to trainees Rs.1000 x 25 participants Rs. 25000.00

TOTAL Rs. 94500.00

404

FINANCIAL GUIDELINES FOR TRAINING OF MEDICAL ASSISTANTS, DAWASAZ ETC.WORKING IN ISM DEPARTMENT(AYURVEDIC / UNANI / HOMEOPATHIC) ON NATIONAL RURAL HEALTH MISSION

VENUE OF TRAINING : DISTRICT TRAINING CENTRE

DURATION OF TRAINING : 3 Days

NUMBER OF PARTICIPANTS : 25

1 DA to trainees Rs.125 x 25 participants x 3 days 9375.00

2 Honorarium Rs. 300 x 2 trainers x 3 days 1800.00

3 Working Lunch/Tea and snacks Rs. 200 x 25 participants x 3days 15000.00

4. Institutional overhead @ 15% of actual expenses 1,2&3 3926.00 Total 30101.00 5 Incidental expenditure, photocopying, job aids, flips charts LCD etc; Rs. 250 x 25 participants 6250.00 6 T.A to trainees Rs.100 x 25 participants 2500.00

TOTAL 38851.00

405

FINANCIAL GUIDELINES FOR TRAINING OF ISM DOCTORS (AYURVEDIC / UNANI / HOMEOPATHIC ETC.) ON MAINSTREAMING OF AYUSH UNDER NRHM.

VENUE OF TRAINING : GMC Jammu/ Srinagar/Directorate of ISM

DURATION OF TRAINING : 3 Days

NUMBER OF PARTICIPANTS : 25

1 DA to trainees Rs.200 x 25 participants x 3 days Rs. 15000.00

2 Honorarium Rs. 500 x 2 trainers x 3 days Rs 3000.00

3 Working Lunch/Tea and snacks Rs. 200 x 25 participants x 3days Rs. 15000.00

4 Institutional overhead @ 15% of actual expenses 1,2&3 Rs. 4950.00 Total Rs.37950.00 5 Incidental expenditure, photocopying, job aids, flips charts LCD etc; Rs. 250 x 25 participants Rs. 6250.00 6 T.A to trainees Rs.1000 x 25 participants Rs. 25000.00

TOTAL Rs. 69200.00

406

FINANCIAL GUIDELINES FOR DIVISIONAL LEVEL WORKSHOP ON INTERSECTORAL CONVERGENCE THROUGH OUTSOURCING

DURATION OF TRAINING : 1 Day

NUMBER OF PARTICIPANTS : 50

Honorarium to Guest faculty i) Guest faculty @ Rs. 1000.00 per day x 1 day x 10 Guest faculty 10000.00

D.A. to Participants

Rs. 200.00 x 1day x 50 participant 10000.00

Working Lunch/Tea and snacks

Rs. 200.00 x 50 participants x 1 day 10000.00

Institutional overhead @ 15% of actual expenses on col. No. 1,2& 3 4500.00

Total 34500.00

Incidental expenditure, photocopying, job aids, flips charts LCD etc;

Rs. 250 x 50 trainees 12500.00

T.A. i) Participants 50 Nos. @ Rs. 500.00 25000.00

TOTAL 72000.00

407

FINANCIAL GUIDELINES FOR DISTRICT LEVEL WORKSHOP ON INTERSECTORAL CONVERGENCE THROUGH OUTSOURCING

DURATION OF TRAINING : 1 Day

NUMBER OF PARTICIPANTS : 35

Honorarium @ Rs.300.00 per day x 1 day x 3 expert 900.00 D.A. to Participants Rs. 200.00 x 1day x 35 participant 7000.00 Working Lunch/Tea and snacks

Rs. 200.00 x 35 participants x 1 day 7000.00 Institutional overhead @ 15% of actual expenses on col. No. 1,2& 3 2235.00 Total 17135.00 Incidental expenditure, photocopying, job aids, flips charts LCD etc; Rs. 250 x 35 trainees 8750.00 T.A. Participants 35 Nos. @ Rs. 200.00 7000.00 Note:- TA/D.A. to be disbursed as actual, as per State Govt. rules. The DDO shall certify that the payment of T.A./D.A. has been made to the actual payee after obtaining a certificate from participant that they shall not draw such claim from any other source.

TOTAL 32885.00

408

FINANCIAL GUIDELINES FOR DIVISIONAL LEVEL QUALITY ASSURANCE WORKSHOP

VENUE OF TRAINING : To be decided by Director FW&RCH

DURATION OF TRAINING : One Day

NUMBER OF PARTICIPANTS : 40 participants

Divisional Level Quality Assurance Workshop

Honorarium to Guest faculty i) Guest faculty @ Rs. 5000.00 per day x 2 days x 2 Guest faculty 20000.00 D.A. to Participants Rs. 200.00 x 40 participants x 1 day 8000.00 Working Lunch/Tea & Snacks

Rs. 200.00 x 40 participants x 1 day 8000.00 Incidental expenditure, photocopying, job aids, flips charts LCD etc; Rs. 250 x 40 participants 10000.00 i) T.A.+ Boarding lodging charges + Conveyances charges 30000.00 Guest faculty from UNICEF/World Bank 2 @ Rs. 15000.00/ Guest faculty ii) T.A. to Participants 40 No. @ Rs. 1000.00 40000.00 Rent for venue hiring 10000.00 Note:- TA/D.A. to be disbursed as actual, as per State Govt. rules. The DDO shall certify that the payment of T.A./D.A. has been made to the actual payee after obtaining a certificate from participant that they shall not draw such claim from any other source.

TOTAL 126000.00

409

WORKSHOP CUM TRAINING FOR IMPROVING PERFORMANCE OF HEALTH FACILITIES THROUGH BETTER MANAGEMENT

VENUE OF WORKSHOP : To Be Decided By DFW&RCH

DURATION OF WORKSHOP : ONE DAY

NUMBER OF PARTICIPANTS : 40 (Child Specialists among senior State level officers)

1 D.A. to participants

Rs. 200 x 40 participants x 1 day 8000.00

2 Honorarium to Guest faculty from UNICEF/World Bank

i) Rs. 5000 x 3 Guest faculty x 2 days 30000.00

3 Working Lunch/Tea & Snacks

Rs. 200 x 40 participants x 1 day 8000.00

4 Incidental expenditure, photocopying, job aids, flips charts LCD etc; Rs. 250 x 40 participants 10000.00

5 T.A.+ Boarding lodging charges + Conveyance charges 45000.00 Guest faculty from UNICEF/World Bank 3 @ Rs. 15000.00/ Guest faculty 5 Travel to participants

i) Lumpsump for 40 participants 40000.00

Note: - TA/D.A. to be disbursed as actual, as per State Govt. rules. The DDO shall certify that the payment of T.A./D.A. has been made to the actual payee after obtaining a certificate from participant that they shall not draw such claim from any other source.

Rent for venue hiring 10000.00

Total 151000.00

410

FINANCIAL GUIDELINES FOR TRAINING OF TRAINERS FOR TRAINING OF VILLAGE HEALTH AND SANITATION COMMITTEE MEMBERS AT DISTRICT LEVEL

VENUE OF TRAINING : District Headquarter.

DURATION OF TRAINING : 2 Days

NUMBER OF PARTICIPANTS : 20

1. DA to trainees Rs.200 x 2 days x20 participants Rs.8000.00

2. Honorarium to Trainers Rs.300 x 3 trainers x 2 days Rs 1800.00 3. Working Lunch/Tea & Snacks Rs. 200 x 20 participants x 2 days Rs 8000.00

4. Institutional Overhead @ 15% of actual expenditure incurred on item No. 1, 2 & 3 Rs.2670.00

Total Rs. 20470.00 5 Incidental expenditure, photocopying, job aids, flips charts LCD etc; Rs. 250 x 20 participants Rs. 5000.00 6 T.A to trainees Rs.100 x 20 participants Rs. 2000.00

TOTAL Rs.27470.00

411

FINANCIAL GUIDELINES FOR TRAINING OF DISTRICT LEVEL TRAINERS AT DIVISIONAL LEVEL IN ALTERNATIVE TRAINING METHODOLOGY IN IUD SERVICES

VENUE OF TRAINING : RIHFW, JAMMU.

DURATION OF TRAINING : 6 DAYS

NUMBER OF PARTICIPANTS : 10

D.A. to participants

Rs. 200 x 10 participants x 6 days 12000.00 Honorarium

@ Rs. 500 x 4 faculty members x 6 days 12000.00

Working Lunch/Tea & Snacks 12000.00 Rs. 200 x 10 participants x 6 days

5400.00 Institutional Overhead Charges @ 15% of actual expenses.

Total 41400.00 Incidental expenditure, photocopying, job aids, flips charts LCD etc; 2500.00 Rs. 250 x 10 participants

10000.00 T.A. Rs. 1000 X 10 Participants Note:- TA/D.A. to be disbursed as actual, as per State Govt. rules. The DDO shall certify that the payment of T.A./D.A. has been made to the actual payee after obtaining a certificate from participant that they shall not draw such claim from any other source.

53900.00 Grand Total

412

FINANCIAL GUIDELINES FOR TRAINING OF BLOCK LEVEL TRAINERS AT DISTRICT LEVEL IN ALTERNATIVE TRAINING METHODOLOGY IN IUD SERVICES

VENUE OF TRAINING : District Hospital.

DURATION OF TRAINING : 6 DAYS

NUMBER OF PARTICIPANTS : 10

D.A. to participants

Rs. 125 x 10 participants x 6 days 7500.00 Honorarium Rs. 300 x 4 faculty members x 6 days 7200.00

Working Lunch/Tea & Snacks Rs. 200 x 10 participants x 6 days 12000.00

Institutional Overhead Charges 4005.00 @ 15% of actual expenses.

Total 30705.00 Incidental expenditure, photocopying, job aids, flips charts LCD etc; Rs. 250 x 10 participants 2500.00

T.A. 1000.00 Rs 100 X 10 Participants Note:- TA/D.A. to be disbursed as actual, as per State Govt. rules. The DDO shall certify that the payment of T.A./D.A. has been made to the actual payee after obtaining a certificate from participant that they shall not draw such claim from any other source.

Grand Total 34205.00

413

FINANCIAL GUIDELINES FOR TRAINING OF ANMS/SNS/LHVS OF 24 X 7 PHCS & CHCS IN ALTERNATIVE TRAINING METHODOLOGY IN IUD SERVICES

VENUE OF TRAINING : District Hospital.

DURATION OF TRAINING : 6 DAYS

NUMBER OF PARTICIPANTS : 20

D.A. to participants Rs. 125 x 20 participants x 6 days 15000.00

Honorarium Rs. 300 x 6 faculty members x 6 days 10800.00

Working Lunch/Tea & Snacks Rs. 200 x 20 participants x 6 days 24000.00

Institutional Overhead Charges 7470.00 @ 15% of actual expenses.

Total 57270.00 Incidental expenditure, photocopying, job aids, flips charts LCD etc;

Rs. 250 x 20 participants 5000.00 T.A. Rs 100 X 20 Participants 2000.00 Note:- TA/D.A. to be disbursed as actual, as per State Govt. rules. The DDO shall certify that the payment of T.A./D.A. has been made to the actual payee after obtaining a certificate from participant that they shall not draw such claim from any other source.

Grand Total 64270.00

414

FINANCIAL GUIDELINES FOR TRAINING OF VILLAGE HEALTH AND SANITATION COMMITTEE MEMBERS AT BLOCK LEVEL

VENUE OF TRAINING : Block Headquarter.

DURATION OF TRAINING : 2 Days

NUMBER OF PARTICIPANTS : 20

1. DA to trainees Rs.125 x 2 days x20 participants Rs.5000.00

2. Honorarium to Trainers Rs.200 x 3 trainers x 2 days Rs 1200.00

3. Working Lunch/Tea & Snacks Rs. 200 x 20 participants x 2 days Rs 8000.00

4. Institutional Overhead @ 15% of actual expenditure incurred on item No. 1, 2 & 3 Rs.2130.00

Total Rs. 16330.00

5 Incidental expenditure, photocopying, job aids, flips charts LCD etc; Rs. 250 x 20 participants Rs. 5000.00

6 T.A to trainees Rs.100 x 20 participants Rs. 2000.00

TOTAL Rs.23330.00

415

FINANCIAL GUIDELINES FOR TRAINING OF VILLAGE HEALTH AND SANITATION COMMITTEE MEMBERS (Outsourced to various Departments/Private Agencies)

VENUE OF TRAINING : DISTRICT TRAINING CENTRE

DURATION OF TRAINING : 2 DAYS

NUMBER OF PARTICIPANTS : 20

1. DA to trainees Rs.200 x 2 days x 20 participants Rs.8000.00

2. Honorarium to Trainers Rs.1000 x 3 trainers x 2 days Rs 6000.00

3. Working Lunch/Tea & Snacks Rs. 200 x 20 participants x 2 days Rs 8000.00

4. Institutional Overhead @ 15% of actual expenditure incurred on item No. 1, 2 & 3 Rs.3300.00 Total Rs. 25300.00 5 Incidental expenditure, photocopying, job aids, flips charts LCD etc; Rs. 250 x 2 days x 20 participants Rs. 5000.00 6 T.A to trainers Rs 500 x 3 trainers Rs. 1500.00 T.A to trainees Rs.100 x 20 participants Rs. 2000.00

TOTAL Rs. 33800.00

416

FINANCIAL GUIDELINES FOR USING MANAGEMENT TOOLS TO IMPROVE DISTRICT HEALTH SERVICES

VENUE OF TRAINING : RIHFW, Nagrota/Dhobiwan

DURATION OF TRAINING : Three Days

NUMBER OF PARTICIPANTS : 25

CATEGORY OF PARTICIPANTS : CMOs/ Medical Superintendent/Dy.CMOs /DHOs/DIOs/BMO

DA to participants i) 25 participants @ Rs. 200 x 3 days 15000.00 Honorarium to Trainers i) Guest faculty from outside the State @ Rs. 1000 per day x 3 days x 4 Guest faculty 12000.00 Working Lunch/Tea & Snacks Rs. 300 x 25 participants x 3 days 22500.00 Incidental expenditure, photocopying, job aids, flips charts LCD etc; Rs. 250 x 25 trainees 6250.00 Institutional overhead charges @ 15% of above 8362.00 Total 64112.00 T.A.+ Boarding lodging charges + Conveyances charges i) 4 Guest faculty @ Rs. 30000.00 each faculty 120000.00

ii) Participants 25 No. @ Rs. 2000 50000.00 Note: - TA/D.A. to be disbursed as actual, as per State Govt. rules. The DDO shall certify that the payment of T.A./D.A. has been made to the actual payee after obtaining a certificate from participant that they shall not draw such claim from any other source.

TOTAL 234112.00

417

FINANCIAL GUIDELINES FOR TRAINING OF MEDICAL ASSISTANTS, DAWASAZ ETC.WORKING IN ISM DEPARTMENT(AYURVEDIC / UNANI / HOMEOPATHIC) ON NATIONAL RURAL HEALTH MISSION

VENUE OF TRAINING : DISTRICT TRAINING CENTRE

DURATION OF TRAINING : 5 Days

NUMBER OF PARTICIPANTS : 25

1 DA to trainees Rs.125 x 25 participants x 5 days 15625.00

2 Honorarium Rs. 300 x 3 trainers x 5 days 4500.00

3 Working Lunch/Tea and snacks Rs. 200 x 25 participants x 5days 25000.00

4. Institutional overhead @ 15% of actual expenses 1,2&3 6769.00 Total 51894.00 5 Incidental expenditure, photocopying, job aids, flips charts LCD etc; Rs. 250 x 25 participants 6250.00 6 T.A to trainees Rs.100 x 25 participants 2500.00

TOTAL 60644.00

418

TRAINING BUDGET SHEETS FOR INTEGRATED DISEASE CONTROL PROGRAMMES UNDER NRHM

419

FINANCIAL GUIDELINES FOR INTEGRATED TRAINING OF MEDICAL OFFICERS OF DISEASE CONTROL PROGRAMMES UNDER NRHM

VENUE OF TRAINING : Divisional Head Quarter

DURATION OF TRAINING : 5 Days

NUMBER OF PARTICIPANTS : 25

1 DA to trainees Amount Rs.200x 25 participants x 5 days 25000.00

2 Honorarium Rs. 500 x 2 trainers x 5 days 5000.00

3 Working Lunch/Tea and snacks Rs. 200 x 25 participants x 5days 25000.00

4. Institutional overhead @ 15% of actual expenses 1,2&3 8250.00 Total 63250.00 5. Incidental expenditure, photocopying, job aids, flips charts LCD etc; Rs. 250 x 25 participants 6250.00 6 T.A to trainees Rs.1000 x 25 participants 25000.00

TOTAL 94500.00

420

FINANCIAL GUIDELINES FOR INTEGRATED TRAINING OF ANMs/LHVs/SNs OF DISEASE CONTROL PROGRAMMES UNDER NRHM

VENUE OF TRAINING : District Head Quarter

DURATION OF TRAINING : 3 Days

NUMBER OF PARTICIPANTS : 25

1 DA to trainees Amount Rs.125x 25 participants x 3 days 9375.00

2 Honorarium Rs. 300 x 2 trainers x 3 days 1800.00

3 Working Lunch/Tea and snacks Rs. 200 x 25 participants x 3days 15000.00

4. Institutional overhead @ 15% of actual expenses 1,2&3 3926.00 Total 30101.00 5. Incidental expenditure, photocopying, job aids, flips charts LCD etc; Rs. 250 x 25 participants 6250.00 6 T.A to trainees Rs.100 x 25 participants 2500.00

TOTAL 38851.00

421

FINANCIAL GUIDELINES FOR INTEGRATED TRAINING OF HW/ HA (MALE) OF DISEASE CONTROL PROGRAMMES UNDER NRHM

VENUE OF TRAINING : District Head Quarter

DURATION OF TRAINING : 3 Days

NUMBER OF PARTICIPANTS : 25

1 DA to trainees Amount Rs.125x 25 participants x 3 days 9375.00

2 Honorarium Rs. 300 x 2 trainers x 3 days 1800.00

3 Working Lunch/Tea and snacks Rs. 200 x 25 participants x 3days 15000.00

TOTAL 38851.00

422

FINANCIAL GUIDELINES FOR INTEGRATED TRAINING OF LAB. TECH. OF DISEASE CONTROL PROGRAMMES UNDER NRHM

VENUE OF TRAINING : Divisional Head Quarter

DURATION OF TRAINING : 5 Days

NUMBER OF PARTICIPANTS : 25

1 DA to trainees Amount Rs.125x 25 participants x 5 days 15625.00

2 Honorarium Rs. 500 x 3 trainers x 5 days 7500.00

3 Working Lunch/Tea and snacks Rs. 200 x 25 participants x 5days 25000.00

4. Institutional overhead @ 15% of actual expenses 1,2&3 7219.00 Total 55344.00 5. Incidental expenditure, photocopying, job aids, flips charts LCD etc; Rs. 250 x 25 participants 6250.00 6 T.A to trainees Rs.300 x 25 participants 7500.00

TOTAL 69094.00

423

J&K STATE PIP BUDGET SHEETS FOR NRHM 2009-10

424

BUDGET SUMMARY FOR RCH-II BASE FLEXIPOOL (FINAL)

Activity Amount ( Rs. in Lakhs)

Maternal Health 103.30

Child Health 192.87

JSY 2781.00

Family Planning 270.02

Adolescent Health 41.32

Urban RCH 153.92

IEC/BCC 61.53

PPP/Strengthening NGO 84.98

Gender & Equity 53.55

Programme Management 196.04

Training/Workshops 258.59

Rent for Sub centres 32.00 Total 4229.12

425

DETAILED BUDGET MATERNAL HEALTH (RCH II FLEXI POOL)

Budget Physical Q1 Q2 Q3 Q4 Total Remar head Target ks Unit Bas Target Rate Amou Targe Rate Amount Target Rate Amount Targ Rate Amou of e for (Rs./u nt t for (Rs./u (Rs. for the (Rs./u (Rs. et for (Rs./u nt meas Line the nit) (Rs. the nit) Lakhs) quarte nit) Lakhs) the nit) (Rs. ure (cur quarte Lakhs quart r quart Lakhs rent r ) er er ) stat us) MATERNA L HEALTH

Operationa lise facilities Planning Lump 3.00 3.00 workshops sum for facility operationali sation, including FRUs, 24x7 PHCs, RTI/STI services and Safe abortion services

426

Incentive to No. 250 100 0.25 250 100 0.25 250 100 0.25 250 100 0.25 1.00 community of based death volunteers s for reporting maternal death and helping in investigatio n for cause of death @ Rs.100 per death X 1000 maternal deaths in a year Maternal No. 150 250 0.375 150 250 0.375 150 250 0.375 150 250 0.375 1.50 Death audit of by death Dy.CMO/B s MO /MO@ Rs.250.00 per investigatio nx1000 maternal deaths in a year. Enquiry report will be communicat ed to GoI

427

Referral No. 825 1000 8.25 825 1000 8.25 825 1000 8.25 825 1000 8.25 33.00 transport for of pregnant referr women and al sick cases newborns / children in emergencie s from Block to FRU/ DHs @ Rs. 500.00 - Rs.1000.00. Actual amount to be decided by District Health Societies/ RKS Integrated No. 108 15000 16.20 108 15000 16.20 108 15000 16.20 108 15000 16.20 64.80 RCH Camps to be held in remote PHCs and underserve d areas (after every two months at the same place @ Rs. 15000.00/c amp ) SUB 25.08 28.08 25.08 25.08 103.30 TOTAL

428

Janani Suraksha Yojana / JSY (details of IEC/BCC Benef 5000 500 25.00 5000 500 25.00 5000 500 25.00 5000 500 25.00 100.00 Compensati iciarie on Amount s (Home Delivery)

Compensati 32000 1400 448.00 32000 1400 448.00 32000 1400 448.00 32000 1400 448.00 1792.00 on Amount (Institutional delivery) Rural

Compensati Benef 9500 1000 95.00 9500 1000 95.00 9500 1000 95.00 9500 1000 95.00 380.00 on Amount iciarie (Institutional s delivery) Urban Benef 21000 600 126.00 21000 600 126.00 21000 600 126.00 21000 600 126.00 504.00 Compensati iciarie on Amount s to ASHA.

Printing of JSY 5.00 5.00 JSY Card Guidelines s and JSY Cards SUB 699.00 694.00 694.00 694.00 2781.00 TOTAL

429

DETAILED BUDGET CHILD HEALTH (RCH II FLEXIPOOL)

Budget head Phys Q1 Q2 Q3 Q4 Total Rema ical rks Targ et Unit Base Targ Rate Amount Tar Rate Amo Targe Rate Amo Tar Rate Amount of Line et (Rs./unit (Rs. get (Rs./u unt t for (Rs./u unt get (Rs./unit) (Rs. mea (curr for ) Lakhs) for nit) (Rs. the nit) (Rs. for Lakhs) sure ent the the Lakh quart Lakh the statu quar qua s) er s) qua s) ter rter rter CHILD HEALTH Preparing Work 2 200000 4.00 4.00 detailed shop operational plan for IMNCI for all districts through State Level Workshop. IMNCI to be implemented in 10 districts ( ToT's & Training cost reflected in trainings) Anantnag, Baramulla, Pulwama, Rajouri, Udhampur, Jammu, Kathua, Leh, Kupwara & Poonch

430

Baby care No of 25 25000 6.25 25 25000 6.25 25 25000 6.25 25 25000 6.25 25.00 corners at corne /PHC level rs

Training of Lump 15.00 15.00 Child sum Specialists and Nurses at AIIMS (to be hired to work in SNCU)

Cost on Lump 2.00 2.00 account of sump Visits of Consultants / experts from GoI in District Hospitals having SNCUs

Establishment 2 300000 6.00 2 300000 6.00 3 300000 9.00 3 300000 9.00 30.00 of stabilization unit in 10 FRUs ( Equipment + renovation)

Cost on Lump 1.25 1.25 1.25 1.25 5.00 account of sum Field Visit of experts in IMNCI Districts

431

Consultative 30 2 2 93500 1.87 1.87 Workshop for partic Work Establishment ipant shop of SNCUs in 2 s/ selected batch District Hospitals.

Establishment Lump 2 2 5500000 110.00 110.00 of SCNUs in 2 sump Distric Nos. selected t District Hospi Hospitals tals Construction/re novation/Additi onal alternation and equipments Rs. 50-60 lacs

Establishment Lump 2 of SCNUs in 2 sump Distric Nos. selected t District Hospi Hospitals tals Salary of Contractual staff (Budgetted in NRHM Additionalities under Human Resources)

432

Drug Kit for Sub Centre (Kit A& Kit B), Sick New Born and Child Health for PHC/CHC/FRU , Emergency Drug Kit for New Born and Child Health for FRU, Drug Kit for all AWWs and Special Drug Kit for Child Health for ASHA ( Budgeted else where) IMNCI Trainimg budgetted under trainings and Multiskilling of MBBS Doctors for Newborn and Child Health ( Budgeted under Trainings) Training of AYUSH Doctors & Dwasaz as per GoI guidelines (Budgetted under Traings)

433

Special focus on Child Health including Nutritution during VH& N Days ( Special incentive to AWW budgetted under NRHM Additionalities) Massive IEC/BCC Campaign for promotion of breastfeeding etc, Intensified Diarrhea and ARI Control, Immunization etc ( budgetted under IEC) SUB TOTAL 129.37 13.50 16.50 33.50 192.87

434

DETAILED BUDGET FAMILY PLANNING (RCH II FLEXI POOL)

Budget Physical Q1 Q2 Q3 Q4 Total Re head Target mar ks

Unit Bas Targ Rate Amo Targ Rate Amount Targe Rate Amo Targe Rate Amount of e et for (Rs./u unt et (Rs./u (Rs. t for (Rs./u unt t for (Rs./u (Rs. mea Line the nit) (Rs. for nit) Lakhs) the nit) (Rs. the nit) Lakhs) sure (cur quart Lakh the quart Lakh quart rent er s) quar er s) er stat ter us) FAMILY PLANNING Compensa tion Compensati No. 5000 1000 50.00 5000 1000 50.00 5000 1000 50.00 5000 1000 50.00 200.00 on for female sterilization Compensa No. 1000 1500 15.00 500 1500 7.50 500 1500 7.50 1000 1500 15.00 45.00 tion for NSV Acceptance Compensati No 7000 20 1.40 6000 20 1.20 8000 20 1.60 8000 20 1.60 5.80 on for of of IUD IUD insertion inser tion Sub Total 66.40 58.70 59.10 66.60 250.80

Organise No. 8 35000 2.80 8 35000 2.80 8 35000 2.80 8 35000 2.80 11.20 Sterilization (Male) camps @ Rs. 35000.00 per camp

435

Organise No. 10 15000 1.50 0.00 10 15000 1.50 10 15000 1.50 4.50 Sterilization (Female) camps @ Rs. 15000.00 per camp. Monitor Distri 22 4000 0.88 22 4000 0.88 22 4000 0.88 22 4000 0.88 3.52 progress, ct quality and utilization of services by Quality Assurance Committees . Procureme nt of Equipment already mentioned in Procureme nt Chapter Involvemen t of Private Sector in Family Planning (already budgeted) Sub Total 5.18 3.68 5.18 5.18 19.22

Grand 71.58 62.38 64.28 71.78 270.02 Total

436

DETAILED BUDGET ARSH (RCH II FLEXIPOOL ) Budget head Physical Q1 Q2 Q3 Q4 Total Rem Target arks

Unit Bas Targ Rate Amount Targ Rate Amou Targ Rate Amou Targ Rate Amount of e et (Rs./u (Rs. et for (Rs./un nt et (Rs./un nt et for (Rs./un (Rs. mea Line for nit) Lakhs) the it) (Rs. for it) (Rs. the it) Lakhs) sure (cur the quart Lakhs the Lakhs quart rent quar er ) quar ) er stat ter ter us) ADOLESC ENT REPRODUC TIVE AND SEXUAL HEALTH ( ARSH) Adolescent friendly services

Special No. 10 20000 2.00 7 20000 1.40 3 20000 0.60 2 20000 0.40 4.40 awareness generation camps one/year/distri ct. (IEC/BCC) Adolescent No. 907 400 3.63 1000 400 4.00 1000 400 4.00 907 400 3.63 15.256 groups orientation 2 events/year/ sub centre Women group No. 500 250 1.25 500 250 1.25 500 250 1.25 407 250 1.02 4.77 and SHG orientation on Adolescent issues /SCs

437

Establishment Lum 3.50 3.50 of 7 clinics in psu selected mp District Hospitals @ Rs. 50000.00 each Stationary for 7 10000 0.70 7 10000 0.70 7 10000 0.70 7 10000 0.70 2.80 above clinics

Furniture/ 7 25000 1.75 7 25000 1.75 7 25000 1.75 7 25000 1.75 7.00 Fixture for 7 Clinics

Establishment Lum 2.00 2.00 of two Nodal psu Centre @ Rs. mp 100000.00 each in Govt Medical Colleges, Jammu and Srinagar Statationary 2 20000 0.40 2 20000 0.40 2 20000 0.40 2 20000 0.40 1.60 and other ancelluary items for nodal centres Total 9.73 9.50 8.70 13.40 41.32

438

Budget head Physical Q1 Q2 Q3 Q4 Total Re Target ma rks Unit Base Targ Rate Amo Targ Rate Amou Tar Rate Amo Targ Rate Amou of Line et (Rs./un unt et (Rs./u nt get (Rs./u unt et (Rs./u nt (Rs. meas (curre for it) (Rs. for nit) (Rs. for nit) (Rs. for nit) Lakhs ure nt the Lakh the Lakh the Lakh the ) statu quar s) quar s) qua s) quar s) ter ter rter ter URBAN RCH

Urban RCH Services

Rent for urban No. 47 6000 2.82 47 6000 2.82 47 6000 2.82 47 6000 2.82 11.28 health post @ Rs.2000/month x 47 UHPx12 M

Hiring part time No. 47 3000 1.41 47 3000 1.41 47 3000 1.41 47 3000 1.41 5.64 cleaner @ Rs.1000/per month x 47 UHP Rent for urban no. 10 36000 3.60 10 36000 3.60 10 36000 3.60 10 36000 3.60 14.40 health center @ Rs.12000/month x 10 UHC x 12 months Monitor progress, No. 1 5000 0.05 1 5000 0.05 1 5000 0.05 1 5000 0.05 0.20 quality and utilization of services. 4 quarterly review meetings/year @ Rs. 5000 / meeting

439

ANM Urban No. 124 15000 18.60 124 15000 18.6 124 15000 18.60 124 15000 18.6 74.40 Health Centre@ Rs. 5000.00/Month ( 3 per UHC) and Urban Health Posts ( 2 per UHP)

Cleaner Urban No. 10 9000 0.90 10 9000 0.90 10 9000 0.90 10 9000 0.90 3.60 Health Centre@ Rs. 3000/month

Link Worker 10 3000 0.30 10 3000 0.30 10 3000 0.30 10 3000 0.30 1.20 Urban Health Centre Hon. Rs. 1000/monthx12

Medical Officers 20 54000 10.80 20 54000 10.80 20 54000 10.80 20 54000 10.80 43.20 Urban Health Centre

Total 38.48 38.48 38.48 38.48 153.92

440

DETAILED BUDGET BCC/ IEC (RCH II FLEXIPOOL)

Budget head Physical Q1 Q2 Q3 Q4 Total Re Target ma rks Unit Bas Targ Rate Amount Targ Rate Amou Tar Rate Amo Tar Rate Amount of e et for (Rs./u (Rs. et (Rs./u nt get (Rs./unit) unt get (Rs./u (Rs. meas Lin the nit) Lakhs) for nit) (Rs. for (Rs. for nit) Lakhs) ure e quart the Lakh the Lakh the (cur er quar s) qua s) qua rent ter rter rter stat us) BCC / IEC

Production of 8 Lump 2.00 2.00 Videospots sum

Finalizing Lump 2.00 2.00 IEC/BCC sum Message in local languages including cost of translation from English to Urdu and other regional languages and vice versa. Broadcast of video Lump 3.00 3.00 4.00 4.00 14.00 spots on Radio sum Kashmir/Jammu

News paper Lump 0.50 0.50 0.50 0.50 2.00 insertions sum Folk Media in village 400 1000 4.00 400 1000 4.00 300 1000 3.00 300 1000 3.00 14.00 selected SCs shows

441

IEC Materials like , 1.00 1.00 1.00 1.00 4.00 Display boards, Wall hanging posters Hoardings per Hoardi 22 12000 2.64 22 12000 2.64 5.28 district (2/districts) ngs TV spots numb 1.75 1.75 1.75 1.75 7.00 advertisement on ers Local cable network Awareness 0.50 0.50 0.50 0.50 2.00 Leaflets CDs Posters & Newspaper advertisement for making Pregnancy safer, Targeting Anemia Eradication during Adolescence ( 12 by 12 Initiative) Setting up of No. 43 5000 2.15 42 5000 2.10 4.25 Adolescent Clinics at health facilities under ARSH (at CHCs, Printing of IEC Material) Hiring of External 2.50 2.50 5.00 agency for media planning and Implementation of IEC Strategies TOTAL IEC / 10.75 19.54 17.99 13.25 61.53 BCC

442

DETAILED BUDGET PPP (RCH II FLEXIPOOL) Budget Physical Q1 Q2 Q3 Q4 Total Rem head Target arks

Uni Ba Targ Rate Amount Targe Rate Amou Targ Rate Amou Targ Rate Amou t of se et for (Rs./unit) (Rs. t for (Rs./unit) nt (Rs. et for (Rs./unit) nt (Rs. et (Rs./unit) nt (Rs. me Lin the Lakhs) the Lakhs) the Lakhs) for Lakhs) asu e quart quart quart the re (cu er er er quar rre ter nt stat us) Public Private Partnershi p (PPP) Public 100 4170 4.17 100 4170 4.17 100 4170 4.17 100 4170 4.17 16.68 Private Partnershi ps-to reduce Matrnal Mortality Rate by providing services to population below overty line/SC/ST with special focus on Urban Slums. Sub Total 4.17 4.17 4.17 4.17 16.68

443

Strengthe ning of State NGO Coordinat or

MNGO 1 45000 0.45 1 45000 0.45 1 45000 0.45 1 45000 0.45 1.80 Workshop

Base Line 3 100000 3.00 3 100000 3.00 6.00 Survey

Project 1 1500000 15.00 1 1500000 15.00 1 1500000 15.00 1 1500000 15.00 60.00 Proposal

PPP 1 50000 0.50 0.50 Workshop

Sub Total 18.45 18.45 15.95 15.45 68.30

Grand 22.62 22.62 20.12 19.62 84.98 Total

444

DETAILED BUDGET GENDER AND EQUITY (RCH II FLEXIPOOL)

Budget head Physical Q1 Q2 Q3 Q4 Total Rem Target arks

Unit Base Tar Rate Amo Targ Rate Amo Tar Rate Amount Targ Rate Amount of Line get (Rs./un unt et for (Rs./uni unt get (Rs./un (Rs. et (Rs./un (Rs. mea (curr for it) (Rs. the t) (Rs. for it) Lakhs) for it) Lakhs) sure ent the Lakh quart Lakh the the statu qu s) er s) qua quar s) art rter ter er Gender & Equity

Orientation Lum 2.00 2.00 Workshop at psu State Level for mp Appropriate Authorities (PC&PNDT) of State/Divisional/D istrict Level. Workshop at Lum 2 200000 4.00 4.00 Divisional Level psu for Doctors and mp other Stake holders

445

Orientation on 6 2500 0.15 6 2500 0.15 5 2500 0.13 5 2500 0.13 0.55 Gender Equality & PC PNDT Act for doctors both Govt and private members of District Appropriate Authority NGOs@ Rs. 2500.00/ District IEC Campaign on 800 1000 8.00 800 1000 8.00 800 1000 8.00 600 1000 6.00 30.00 Gender Issues (Symposium folk/traditional)

Save the Girl Child

Ralies/ Debates 6 50000 3.00 6 50000 3.00 5 50000 2.50 5 50000 2.50 11.00 in Schools/ Colleges

Printing of 2.00 2.00 2.00 6.00 Newsletter/ Modules for Gender Issues Total 15.15 13.15 12.63 12.63 53.55

446

DETAILED BUDGET PMU (RCH II FLEXIPOOL)

Budget head Physical Q1 Q2 Q3 Q4 Total Re Target m ar Unit Base Tar Rate Amou Tar Rate Amo Targ Rate Amount Targ Rate Amou ks of Line get (Rs./un nt get (Rs./unit) unt et for (Rs./unit) (Rs. et for (Rs./uni nt (Rs. mea (curr for it) (Rs. for (Rs. the Lakhs) the t) Lakhs) sure ent the Lakhs the Lakh quart quart statu qu ) qu s) er er s) art art er er PROGRAMME MANAGEMENT

Strengthening of State society/State Programme Management Support Unit Contractual 1 75000 0.75 1 75000 0.75 1 75000 0.75 1 75000 0.75 3.00 Staff for SPMSU recruited and in position a) One -State Programme Manager @ Rs. 25000. 00/month b) One Finance 1 75000 0.75 1 75000 0.75 1 75000 0.75 1 75000 0.75 3.00 Manager @ Rs. 25000.00/ month c) One- State 1 60000 0.60 1 60000 0.60 1 60000 0.60 1 60000 0.60 2.40 Accounts Manager @ Rs. 20000.00/month

447 d) One- State 1 54000 0.54 1 54000 0.54 1 54000 0.54 1 54000 0.54 2.16 Data Officer @ Rs. 18000.00/month f) One NGO Co- 1 75000 0.75 1 75000 0.75 1 75000 0.75 1 75000 0.75 3.00 coordinator @ Rs. 25000.00/month e) One IEC 1 60000 0.60 1 60000 0.60 1 60000 0.60 1 60000 0.60 2.40 Consultant @ Rs. 20000.00/month Mobility Support 3 30000 0.90 3 30000 0.90 3 30000 0.90 3 30000 0.90 3.60 for State Level officials of ARSH Clinics for Field Visits Sub Total 4.74 4.74 4.74 4.74 18.96

Annual 0.50 0.50 0.50 0.50 2.00 Performance based increase of contract fees- 10% Total 5.39 5.39 5.39 5.39 21.56

Contingency SHS 1 5.00 5.00 5.00 5.00 20.00

T.A. SHS 2.50 2.50 2.50 2.50 10.00

Monthly Review 3 30000 0.90 3 30000 0.90 3 30000 0.90 3 30000 0.90 3.60 meetings at SHS Purchase of 5.00 5.00 5.00 5.00 20.00 computer/ Equipments for SHS and Divisional offices

448

Sub Total 13.40 13.40 13.40 13.40 53.60

Strengthening of District society/District Programme Management Support Unit Contractual Staff 22 111000 24.42 22 111000 24.42 22 111000 24.42 22 111000 24.42 97.68 for DPMSU recruited and in position SubTotal 24.42 24.42 24.42 24.42 97.68

Annual 2.50 2.50 2.50 2.50 10.00 Performance based increase of contract fees- 10% Total 26.92 26.92 26.92 26.92 107.68

Contingency for 22 10000 2.20 22 10000 2.20 22 10000 2.20 22 10000 2.20 8.80 District Health Societies T.A. for District 22 5000 1.10 22 5000 1.10 22 5000 1.10 22 5000 1.10 4.40 Health Societies Sub Total 3.30 3.30 3.30 3.30 13.20

Grand Total 49.01 49.01 49.01 49.01 196.04

449

DEATILED BUDGET TRAINING (RCH-II FLEXIPOOL)

S.N Budget Physical Q1 Q2 Q3 Q4 Total Remarks o. Head Target

Unit of Bas Targ Rate Amou Ta Rate Amou Targ Rate Amoun Ta Rate Amou Measure e et (Rs./unit nt rg (Rs./uni nt et (Rs./unit) t (Rs. rg (Rs./unit) nt Lin for ) (Rs. et t) (Rs. for Lacs) et (Rs. e the Lacs) for Lacs) the fo Lacs) (cur quar th quar r rent ter e ter th stat qu e us) art q er ua rt er Maternal Health A Skilled Based Attendanc e Training i Establishm 5 5 25000 1.25 1.25 ent of Training Centre at five New SBA Districts ii Divisional 25 part. 2 2 107750 2.16 2.16 Level (incl. 10 bat Workshop Div. che for Training officer) s of Trainers for Skilled Attendance Birth (SBA) at RIHFW, J/K

450 iii District 2 part. for 10 5 26257 1.31 5 26257 1.31 2.63 Level 21 days Bat trainings for che SNs for s SBA at District Hospital ( for Districts selected during phase1st , excluding Leh) 4 batches per district iv District 2 part. for 5 5 26257 1.31 1.31 Level 21 days Bat trainings for che SNs for s SBA at District Hospital ( for Districts selected during phase 2nd ) 2 batches per district

451 v District 2 part. for 10 5 44025 2.20 5 44025 2.20 4.40 Level 30 days Bat trainings for che ANMs/LHV s s for SBA District Hospital ( for Districts selected during phase1st, excluding Leh ) 8 batches per district vi District 2 part. for 5 5 44025 2.20 2.20 Level 30 days Bat trainings for che ANMs/LHV s s for SBA District Hospital ( for Districts selected during phase 2nd ) 5 batches per district vii Training on 2 teams 11 11 10327 1.14 1.14 Blood /batchfor batc hes Transfusion 3 days (5 Bt for Mos and for Lab. Tech jmu, at GMC, 6 bt for Jmu/Sgr Kmr )

452

B Safe Abortion Services Training i MTP 3 MOs 22 5 33075 1.65 5 33075 1.65 6 33075 1.98 6 33075 1.98 7.28 training as for 15 Bat per GoI by days che Medical s Officers (GMC, Jammu/Srg .) ii Training of 4 22 6 30510 1.83 5 30510 1.53 6 30510 1.83 5 30510 1.53 6.71 Medical participa bat Officer in nts for 1 che MVA 2 days s Technique (2 Mos & posted in 2 SNs) 24 X 7 PHCs and CHCs at District Level C Life saving Anaesthesi a skills training i Training for 4 4 2 294000 5.88 2 294000 5.88 11.76 Medical participa bat Officers in nts for che Life Saving 16 weeks s Skill for Obsetric Anesthesia at GMC, Jmu/Sgr

453 ii For taking batch 4 2 80000 1.60 2 80000 1.60 3.20 up of Tier 3 bat exams for che Life saving s skill for Obsetrtic Anesthesia

D EMOC Training i Recuring 16.00 16.00 cost as per GoI guidelines ii Training of 8 6 2 397440 7.95 2 397440 7.95 2 397440 7.95 23.85 Doctors in doctors/ bat EMOC batch for che Skills by 6 weeks s FOGSI at GMC, Jmu/Sgr iii For taking 6 2 80000 1.60 2 80000 1.60 2 80000 1.60 4.80 up of bat exams for che EMOC s iv Establishm Lumpsu 30.00 30.00 ent of mp DistrictTrain ing Centre 2 each in Jammu and Kashmir Division E RTI/STI Training

454 i Training of 24 Part/ 4 Training Medical batch for Bat to be Officers as 2 days che conducte District s d by NACO Trainers for RTI/STI Case Manageme nt at GMC, Jmu (For 12 Districts in First Phase namely: Kishtwar, Reasi, Samba, Jammu, Udhampur, Ramban, Kupwara, Srinagar, Pulwama Kulgam, Budgam, Baramulla) ii Training of 30 Part. 22 Training ANMs/LHV For 2 Bat to be s/SNs/Medi days che conduct cal s ed by Assistant/ NACO Lab. Assistants for RTI/STI Case Manageme nt at District Hospital

455

Child Health Training ii Training of Expendit District ure to be level met by Trainers in UNICEF IMNCI with support from UNICEF in Kalavati Children Hospital, New Delhi iii Establishm Lumsum 2 10.00 10.00 20.00 ent of p Training Cell for IMNCI and New Born care at GMC, Jammu/Srin agar

456 iv Training of 24 Mos 11 3 132120 3.96 5 132120 6.61 3 132120 3.96 14.53 Mos and /batch for bat Peadiatricai 8 days che ns in s IMNCI 11 District in GMC, Jammu/Srin agar posted in 24x7 PHC/FRU ( namely : Anantnag, Baramulla, Pulwama, Kupwara, Budgam and Leh, Rajouri, Udhampur, Jammu Kathua & Poonch) v Training of 24 11 3 88440 2.65 5 88440 4.42 3 88440 2.65 9.73 LHVs/ANM part./batc bat s/ SNs/ h for 8 che AWWs in days s IMNCI in 11 Districts in District Hospitals. ( namely : Anantnag, Baramulla, Pulwama, Kupwara, Budgam and Leh, Rajouri, Udhampur,

457

Jammu Kathua & Poonch) vi Divisional 25 2 1 125250 1.25 1 125250 1.25 2.51 Level participa Wor Workshop nts/ ksh on Pre- batch ops Service training on IMNCI vii Workshop 40 2 2 151000 3.02 3.02 on participa Wor Planning of nts for 1 ksh Maternal day ops and Child Health Strategies ix Training of Lumpsu 10.00 10.00 staff to be mp deployed in Stabilizatio n units at FRU Level x Multisklling Lumpsu 4 1 500000 5.00 1 500000 5.00 1 500000 5.00 15.00 of MOs mp for 3 part (MBBS in batches icip Neonatal ant and Child s/b Health) atc being h finalized as per GoI Protocol

458

Family Planning Training i Laproscopi One 22 6 18705 1.12 6 18705 1.12 5 18705 0.94 5 18705 0.94 4.12 c team for Bat Sterilization 12 days che Training of s Gynae./OT Tech/OT Nurse iii Cost of 0.30 0.30 Training Cell for training of Mos in IUD insertion at Govt Hospital, G. Ngr Jammu Training in alternative methodolo gy in IUD Training of 10 8 2 53900 1.08 2 53900 1.08 2 53900 1.08 2 53900 1.08 4.31 district level participa Bat trainers at nts che Divisional /batch for s level 6 days

Training of 10 8 2 34205 0.68 3 34205 1.03 3 34205 1.03 2.74 block level participa Bat trainers at nts che district /batch for s Level 6 days

459

Training of 20 2 2 64270 1.29 1.29 ANMs/Staff participa Bat Nurse/LHV nts che s of 24x7 /batch for s PHCs& 6 days CHCs at District Level

Adolescen t Reproducti ve and Sexual Health/AR SH Training i Training of 25Part/ 4 2 69200 1.38 2 69200 1.38 2.77 Medical batch for bat Officer for 3days che Adolescent s Friendly Reproductiv e and Sexual Health Services ( ARSH) at Divisional level

460 ii Training of 30 11 3 74737 2.24 4 74737 2.99 4 74737 2.99 8.22 Programme Part/batc bat Manager/S h for 5 che Ns/ days s ANMs/LHV s/MPW on Adolescent Reproductiv e and Secual health (ARSH) at District Hospital (Namely:Ja mmu, Reasi, Kathua, Udhampur, Ramban, Srinagar, Budgam, Kupwara, Baramulla, Anantnag & Pulwama) Programm e Manageme nt Training

461 i Training 40 Part. 5 2 110700 2.21 2 110700 2.21 1 110700 1.11 5.54 cum for 3 bat Workshop days che of DPMSU, s BPMU and Consultants including State Programme Officers at State Level School Health Training i Learning Lumsum 5.50 5.50 Resource p Material ( Adaptatio n & Content Developme nt) Teacher Training Mannual, Peer Leader Manual, Student Bookelts, Student Factsheets, Students Manual, Posters, Worksheets , Parents Home Team Material,

462

Pictorial Postcards, Community Posters

Other Trainings i Internationa Lumpsu 5.00 5.00 l / National mp Trainings/ Seminars at reputed institutions State/ Divisional level/ SHS/ DHS members

463 ii Postgradua 1 4 4 135000 5.40 5.40 te Diploma doctor/ba doc in Public tch tors Health Manageme nt to be orgainzed by NIHFW, in collobration with other institutes ( Refer D.O. No. P- 12011/4/20 06-PH dated 14th March 2008 received from G.C. Chaturvedi, Aqdditional Secretary & Mission Director (NRHM) GoI (4 doctors to be nominated )

464 iii Honorarium 5.00 5.00 & T.A./D.A. Hospitatlity, conveyance etc payable to experts invited to visit the State from outside iv Planning for 30 2 1 93500 0.94 1 93500 0.94 1.87 Accerdation participa of Hospital nts experts at /batch for Divisional 1 day level

Quality Assurance Workshop s i Divisional 35 2 2 102750 2.06 2.06 Level participa bat nts for 1 che day s ii District 25 22 5 22850 1.14 5 22850 1.14 6 22850 1.37 6 22850 1.37 5.03 Level participa bat nts for 1 che day s (including 5 distt officers)

Gender & Equity Training

465 i Workshop 25 4 1 40750 0.41 1 40750 0.41 1 40750 0.41 1 40750 0.41 1.63 with Private participa bat providers/G nts for 1 che ovt Health day s Service providers Regilious leaders/cas te leaders/ML As ii Workshop 25 22 3 19850 0.60 6 19850 1.19 7 19850 1.39 6 19850 1.19 4.37 with Private participa bat providers/G nts for 1 che ovt Health day s Service providers Regilious leaders/cas te leaders/ML As/opinion leaders of Block level at distt level Total 37.30 78.69 54.43 88.17 258.59

466

Detailed Budget of Rent for Sub Centres Budget head Physical Target Q1 Q2 Q3 Q4 Total Re mar ks Unit Base Targe Rate Amou Target Rate Amount Target Rate Amount Target Rate Amount of Line t for (Rs./ nt for the (Rs./ (Rs. for the (Rs./ (Rs. for the (Rs./ (Rs. meas (current the unit) (Rs. quarter unit) Lakhs) quarter unit) Lakhs) quarter unit) Lakhs) ure status) quart Lakhs er )

Rent for 1000 Health Sub Centres

Rent for 1000 1000 800 8.00 1000 800 8.00 1000 800 8.00 1000 800 8.00 32.00 Health Sub Centres

Total 8.00 8.00 8.00 8.00 32.00

467

Budget Summary for NRHM Additionalities (Final)

S.No. Activity Amount (Rs. Lakhs) 1 Untied Funds 1084.75 2 AMG 333.80 3 Corpus fund 588.00 4 Training and Meeting of ASHAs including ASHA Drug Kits 420.65 5 Tribal RCH 53.54 6 Vulnerable Groups 10.22 7 Strengthening of RIHFW & ANMT Schools 356.00 8 Management Cost & Contingencies 4.00

9 Infrastructure Development Plan 4000.00 10 Mobile Health Units/AMUs 330.00 11 Procurement of Ambulance 1000.00

12 Est of HRD & Q A Cell 34.00 13 HMIS 19.00 14 Biomedical Waste 15.00

15 Planning for Health Insurance 10.00

16 Improvement in Management 29.21 17 Intersectoral Convergence 87.43 18 Training/Workshops/Seminars/Conferences 116.50 19 Liability on account of rent for subcentres 40.00 20 Innovations 326.33 21 Procurement 659.35 22 Human Resource 3609.34 Total 13127.12

468

DETAILED BUDGET SHEETS ( NRHM ADDITIONALITIES) Budget Physical Target Q1 Q2 Q3 Q4 Total Re head mar ks Unit Base Targ Rate Amount Targ Rate Amount Target Rate Amount Targe Rate Amount of Line et for (Rs./unit) (Rs. et for (Rs./unit) (Rs. for the (Rs./uni (Rs. t for (Rs./uni (Rs. meas (curre the Lakhs) the Lakhs) quarter t) Lakhs) the t) Lakhs) ure nt quart quart quart status er er er ) Untied Funds Communit 85 12500 10.63 85 12500 10.63 85 12500 10.63 85 12500 10.63 42.50 y Health Centres 3 Nos. 3 12500 0.38 3 12500 0.38 3 12500 0.38 3 12500 0.38 1.50 CHC level Hospitals viz Rajiv Gandhi Hospital, Jmu &Mahatm a Gandhi Hospital, Kathua & Maternity Hosp, Anantnag Primary 375 6250 23.44 375 6250 23.44 375 6250 23.44 375 6250 23.44 93.75 Health Centres Medical 346 2500 8.65 346 2500 8.65 346 2500 8.65 346 2500 8.65 34.60 Aid Centre

Allopathic 238 3750 8.93 238 3750 8.93 238 3750 8.93 238 3750 8.93 35.70 Dispensar y Sub 1907 2500 47.68 1907 2500 47.68 1907 2500 47.68 1907 2500 47.68 190.70 Centres

469

Village 500 10000 50.00 2000 10000 200.00 2000 10000 200.00 2300 10000 230.00 680.00 Health & Sanitation Committe es Special 1 150000 1.50 1 150000 1.50 1 150000 1.50 1 150000 1.50 6.00 untied Funds for PHC at Shri Mata Vashno Devi at Bhawan ( Katra) Sub 151.19 301.19 301.19 331.19 1084.75 Total Annual Maintena nce Grant Communit 84 25000 21.00 84 25000 21.00 84 25000 21.00 84 25000 21.00 84.00 y Health Centres 3 Nos. 3 25000 0.75 3 25000 0.75 3 25000 0.75 3 25000 0.75 3.00 CHC level Hospitals viz Rajiv Gandhi Hospital, Jmu &Mahatm a Gandhi Hospital, Kathua & Maternity Hosp, Anantnag Primary 268 12500 33.50 268 12500 33.50 268 12500 33.50 268 12500 33.50 134.00 Health Centres

470

Medical 199 2500 4.98 199 2500 4.98 199 2500 4.98 199 2500 4.98 19.90 Aid Centre

Allopathic 114 6250 7.13 114 6250 7.13 114 6250 7.13 114 6250 7.13 28.50 Dispensar y Sub 644 2500 16.10 644 2500 16.10 644 2500 16.10 644 2500 16.10 64.40 Centres

Sub 83.45 83.45 83.45 83.45 333.80 Total RKS (Corpus Funds) District 22 125000 27.50 22 125000 27.50 22 125000 27.50 22 125000 27.50 110.00 Hospitals Govt; 3 125000 3.75 3 125000 3.75 3 125000 3.75 3 125000 3.75 15.00 Hospital Sarwal, Jmu & G.B. Pant Hospital, Sgr; Maternity Hosp; Sanatnag ar Communit 85 25000 21.25 85 25000 21.25 85 25000 21.25 85 25000 21.25 85.00 y Health Centres

3 Nos. 3 25000 0.75 3 25000 0.75 3 25000 0.75 3 25000 0.75 3.00 CHC level Hospitals viz Rajiv Gandhi Hospital, Jmu &Mahatm a Gandhi Hospital,

471

Kathua & Maternity Hosp, Anantnag

Primary 375 25000 93.75 375 25000 93.75 375 25000 93.75 375 25000 93.75 375.00 Health Centres

Sub 147.00 147.00 147.00 147.00 588.00 Total Support to Deptt of ISM through budget from MOHFW, Deptt of AYUSH, GoI Untied Funds ISM 418 3750 15.68 418 3750 15.68 418 3750 15.68 418 3750 15.68 62.70 Dispensar y Sub 15.68 15.68 15.68 15.68 62.70 Total Annual Maintena nce Grant ISM 148 6250 9.25 148 6250 9.25 148 6250 9.25 148 6250 9.25 37.00 Dispensar y Sub 9.25 9.25 9.25 9.25 37.00 Total

472

RKS (Corpus Funds) ISM 2 125000 2.50 2 125000 2.50 2 125000 2.50 2 125000 2.50 10.00 Hospitals Sub 2.50 2.50 2.50 2.50 10.00 Total Total 27.43 27.43 27.43 27.43 109.70

Training and Meeting of ASHAs including ASHA Drug Kits Drug Kits 9500 800 76.00 76.00

Trainings 9500 3627.89 344.65 344.65 of ASHA Module III, IV &V Sub 420.65 420.65 Total Tribal No. of 78 5000 3.90 78 5000 3.90 78 5000 3.90 78 5000 3.90 15.60 RCH Mobil services e Aid ( Medicin Centr es for the e Nomadic groups) Outreach Difficu 56 3000 1.68 56 3000 1.68 56 3000 1.68 56 3000 1.68 6.72 Camps lt blocks 1 Room 21 1500 0.32 21 1500 0.32 21 1500 0.32 21 1500 0.32 1.26 /Amchi in 21 institutions ( DH-1; CHC-4; PHCs-16)

473

21 24000 5.04 21 24000 5.04 21 24000 5.04 21 24000 5.04 20.16 Honorariu m for 21 AMCHI Healers ( DH-1; CHC-4; PHCs-16) @ Rs. 8000.00/m onth Procurem 1 25000 0.25 1 25000 0.25 1 25000 0.25 1 25000 0.25 1.00 ent of Medicines for AMCHIs in District Hospital (1 No.) @ Rs. 1.00 lacs per annum Procurem 4 15000 0.60 4 15000 0.60 4 15000 0.60 4 15000 0.60 2.40 ent of Medicines for AMCHIs in CHCs (4 No.) @ Rs. .60 lacs per annum Procurem 16 10000 1.60 16 10000 1.60 16 10000 1.60 16 10000 1.60 6.40 ent of Medicines for AMCHIs in PHCs (16 No.) @ Rs. .40 lacs per annum

474

Holding of Bud Laproligati gete on and d NSV und Camps in er the the areas/poc hea kets d inhabited Fam by Tribals ily Plan ning Sub Total 13.39 13.39 13.39 13.39 53.54

VULNER ABLE GROUPS (Primitive Tribes) Specific Month 142 1800 2.56 142 1800 2.56 142 1800 2.56 142 1800 2.56 10.22 health activities targeting vulnerable communiti es such as SCs, STs, and BPL population s living in urban and rural areas (not covered by Urban and Tribal RCH) visist by the Medical Teams

475 from Block HQs. Rs. 300.00 for Medicines and Rs. 300.00 for Mobility of team.

Sub Total 2.56 2.56 2.56 2.56 1 0.22

Strengthe ning and improve ment of RIHFWs and ANMT Schools Strengthe 31.50 31.50 ning and Lumps improvem ump ent of RIHFWs, Dhobiwan Strengthe 54.50 54.50 ning and improvem ent of RIHFWs Nagrota

476

270.00 270.00 Strengthe Lumps ning and ump improvem ent of 11 existing ANMT Schools

Total 356.00 356.00

Managem ent Cost & Continge ncies Mobility 1 100000 1.00 1 100000 1.00 1 100000 1.00 1 100000 1.00 4.00 Support for State Level Officers/ Officials

Sub Total 1.00 1.00 1.00 1.00 4 .00

Infrastruct ural Developm ent Plan

477

Completion Lump 4000.00 4000.00 of ongoing sump Civil Works & equipping the District Hospitals CHCs, PHCs; Upgradatio n of CHC being upgraded to FRUs; Upgradation of PHC to fully operationali sed as 24x7 Establishm ent College of Nursing in GMC, Jmu Constructio 0.00 Prop n of osal Maternity sub Hospitals at mitte Jammu and d to Srinagar GoI ( DPRs for fundi submitted ng to GoI for unde Rs. r 10200.00 Infra Lacs) struc ture Deve lopm ent Plan Sub Total 0.00 0.00 0.00 4000.00 4000.00

478

Mobile Health Units Districts and Advance d Mobile Medical Units for Blocks Level Cost of 2 7500000 150.00 150.00 Mobile Van for staff and complete Mobile Unit with accessori es and Diagnostic facilities and recurring cost ( as per GoI guidelines for operationa lising of North Eastern States, H.P. and J&K). Advanced 6 3000000 180.00 180.00 Mobile Medical Units for Blocks Level

479

Sub Total 330.00 330.00

Procurem ent of Ambulan ces

Procurem 125 800000 1000.00 1000.00 ent of 125 Ambulanc es for DHs, CHCs and PHC @ Rs. 8.00 / ambulanc e. Already approved in ROP 2007 could not procured due to unavoida ble circumsta nces. Sub Total 1000.00 1000.00

Establish ment of HRD & Quality Assuranc e Cell

480

Office 1.00 1.00 setup cost

Recurring 5.00 5.00 5.00 5.00 20.00 cost of Salary for 11 Consultant s Part time ( 1 HRD Consultant , 1 Child Specialist as envisaged as part of establishm ent of IMNCI State Cell , 1 Gynecolog ist as part of EMoC Training of MBBS Doctors GoI guidelines, 1 Public Health Specialist, 1 Nurse with post graduate qualificatio n ( each to be hired for 10 days in month @ Rs. 1000.00 per day

481 excluding travel expressive 1 person for Secretarial Asstt @ Rs. 6000.00 per month

Recurring 0.75 0.75 0.75 0.75 3.00 Cost for office expenses including commun.

Travel and 2.50 2.50 2.50 2.50 10.00 Stay of consultant s to place outside HQ as & when deputed, like District Hospitals &Trainees workplace among others

Sub Total 9.25 8.25 8.25 8.25 3 4.00 HIMS

482

2Nos. 2 200000 4.00 4.00 Workshop s/ trainings for capacity building of staff Quality Lump 3.00 3.00 Assurance sump in HIMS reporting ( in Phases) Piloting as per GoI guidelines Purchase Lump 2.00 2.00 of sump Computer s for the units ( Block/Di strict) where not available. Printing of 5.00 5.00 HIMS formats

Provision Lump 1.25 1.25 1.25 1.25 5.00 for e- sump communic ation Sub Total 6.25 5.25 1.25 6.25 1 9.00

Bio 15.00 15.00 Medical Waste through PPP

483 including Worksho ps/ trainings

Sub Total 15.00 15.00

Planning Lump 10.00 10.00 for sump Health Insurance in the State Sub Total 10.00 10.00

Improvin g Managem ent Training 20 4 2 380250 7.61 2 380250 7.61 15.21 on using part batche managem for 3 s ent tools days to improve District Health Services for CMOs/Dy. CMOs/DH Os/DIOs/ BMOs.

484

Incentive 2.00 2.00 2.00 2.00 8.00 of Rs. 25000, 15000, 10000 and 5000 will be given to specialists at district level, CHC level, MO at PHC level and ANM at SC level respective ly for best performan ce Performan 4.00 4.00 ce based rewards to ANMs, MOs and specialists and CMOs for increasing institution al deliveries and best performin g 4 districts. Performan 0.50 0.50 0.50 0.50 2.00 ce based awards for Blocks for improving

485 sex ratio at births.

Sub Total 2.50 10.11 10.11 6.50 29.21

Intersect oral Converge nce Training of 38 2 1 66910 0.67 1 66910 0.67 1.34 District Part./ batch level batch Trainers for Strengthe ning of NRHM through inter sectoral convergen ce at RIHFW Dhobiwan/ Nagrota Training of 37(35 44 11 38250 4.21 11 38250 4.21 11 38250 4.21 11 38250 4.21 16.83 AWWS for AWW batche Strengthe s & 2 s ning of Super NRHM at visrs)f Distt trg. or 2 Center days

486

TRAININ 25 4 8 94500 7.56 7.56 G OF Part/b batche AYUSH atch s doctors on for 5 (AYURVE days DIC / UNANI / HOMEOP ATHIC ETC.) ON NATIONA L PROGRA MMES TRAININ 25 22 3 60644 1.82 6 60644 3.64 6 60644 3.64 7 60644 4.25 13.34 G OF Part/b batche MEDICAL atch s ASSISTA for 5 NTS, days DAWASA Z ETC.WOR KING IN ISM DEPART MENT(AY URVEDIC / UNANI / HOMEOP ATHIC) ON NATIONA L RURAL HEALTH MISSION

487

TRAININ 25 15 6 38851 2.33 4 38851 1.55 5 38851 1.94 5.83 G OF Part/b batche MEDICAL atch s ASSISTA for 3 NTS, days DAWASA Z ETC.WOR KING IN ISM DEPART MENT(AY URVEDIC / UNANI / HOMEOP ATHIC) ON NATIONA L RURAL HEALTH MISSION Training of 25 8 3 69200 2.08 5 69200 3.46 5.54 ISM Part/b batche Doctors atch s on for 3 mainstrea days ming of AYUSH under NRHM ( to Doctors already trained on National Programm es under NRHM at GMC, J/S

488

Training of Lump 5.00 5.00 10.00 Allopathic sump Doctors in AYUSH as per GoI guidelines . Trainers from GoI Worksho ps Converge nce through outsourcing Divisional 50 2 1 196000 1.96 1 196000 1.96 3.92 level partici batche workshop pants s for 1 day District 35 22 11 32885 3.62 11 32885 3.62 7.23 Level partici batche Workshop pants s for 1 day Concurren 22 22 18000 3.96 22 18000 3.96 22 18000 3.96 22 18000 3.96 15.84 t Audit of District Health Societies and their respective Blocks Sub Total 19.51 27.46 14.03 26.43 87.43

Others

489

One time Incl Maintena ude nce grant d in of health Infr institution astr s for uct repair ure and Dev elo maintena pm nce ent buildings Pla and n equipmen ts of health units damaged by militancy and terrorism based on the report of PMs Task Force on developm ent of J&K ( Rs. 30.00 crore over a period of 3 years)

NRHM Additional ities (Training/ Workshop s/Seminar

490 s/Confere nces)

National Lump 8.00 7.00 5.00 5.00 25.00 Tabcco sump Control Programm e, and Prevention of Chronic Diseases Holding of Workshop s , Seminars, Conferenc es for awareness Generation s

Training of Lump 5.00 5.00 5.00 5.00 20.00 Trainers sump for Village Health Committe es for Selected VH&SC through PPP/NGO )

Workshop Lump 10.00 10.00 5.00 25.00 s/ sump Conferenc es/Semina rs for formulation and visits outside the

491

State for formulation of State Drug Policy Block level 20 108 36 33800 12.17 36 33800 12.17 36.00 33800 12.17 36.50 Training of partici batche Village pants s health & For 2 sanitation days Committee Members through PPP/NGO s Monitoring Lump 2.5 2.50 2.50 2.50 10.00 of all sump Trainings under NRHM Total 8.75 20.92 20.92 20.92 116.50

Liability on 10.00 10.00 10.00 10.00 40.00 account of rent for subcentres (based on the assessme nt of rent assessme nt committee Total 10.00 10.00 10.00 10.00 4 0.00

492

DETAILED BUDGET INNOVATIONS Budget head Physical Q1 Q2 Q3 Q4 Total Re Target mar ks

Unit Bas Target Rate Amo Target Rate Amount Target Rate Amou Target Rate Amount of e for the (Rs./un unt for the (Rs./unit (Rs. for the (Rs./uni nt (Rs. for the (Rs./unit (Rs. meas Lin quarter it) (Rs. quarter ) Lakhs) quarter t) Lakhs quarter ) Lakhs) ure e Lakh ) (cu s) rre nt stat us) Innovation

Incentive to 16409 300 49.23 16409 300 49.23 16409 300 49.23 16409 300 49.23 196.91 AWWS for organizing Village Health & Nutrition Days @ Rs. 100/month. (For Aanganwad i Centres as per annual report 2007- 08 , Ministry of Women & Child Developme nt)

493

Additional 16409 400 65.64 65.64 Drug Kit under NRHM to all AWs centres containing Iron Folic acid, Vit A solution, Deworming Tablet, ORS, Zinc & Paracetamo l to check the trend of IMR in the State. (For Aanganwad i Centres as per annual report 2007- 08 , Ministry of Women & child Developme nt) Cost for Lump 2.50 2.50 Scientific sump Consultanc y towards capacity buildings for various stakeholder s ( Governme nt Officils, NGO

494

Personnel, School teachers, Peer Leaders)

Disseminati Lump 5.00 5.00 ng Hriday- sump Shan Model of Health Promotion (Travel, Resource, Inputs & Background Documentat ion) Piloting of Lump 2.50 2.50 2.50 2.50 10.00 Strategies sump for combating anamenia in one medical block each under GMC, Jmu/Sgr. Sub Total 51.73 117.36 51.73 59.23 280.04

Accreditati on of Selected Hospitals in Phase-I by sigining of MoU with the Quality

495

Council of India for the following

Funds for 4 1 1000000 10.00 1 1000000 10.00 1 1000000 10.00 1 1000000 10.00 40.00 accreditatio Nos. n of selected Hospitals in the State Lum 1.20 1.20 Administrati psu mp ve cost at 30% for above Services 5.09 5.09 Charges as applicable (currently 12.36%) Total for 16.29 10.00 10.00 10.00 46.29 Accreditati on Grand 68.02 127.36 61.73 69.23 326.33 Total

496

DETAILED BUDGET PROCUREMENT (RCH II FLEXIPOOL)

Budget head Physical Q1 Q2 Q3 Q4 Total Remar Target ks

Unit Bas Target Rate Amou Targ Rat Amo Tar Rate Amou Targe Rate Amo of e for the (Rs./uni nt et e unt get (Rs./ nt t for (Rs./ unt mea Line quarter t) (Rs. for (Rs. (Rs. for unit) (Rs. the unit) (Rs. sure (curr Lakhs the /uni Lakh the Lakhs quart Lakh ent ) quar t) s) qua ) er s) stat ter rter us) S.N o. PROCUREMENT

1 Sub Centre Kit A 1907 5500 104.89 104.89

2 Sub Centre Kit B 1907 1000 19.07 19.07

3 PHC Kit 375 12000 45.00 45.00

5 FRU 57 97000 55.29 55.29

SUB TOTAL 224.25

497

7 Drug Kit for 10 Skilled Birth Attendant ( SBA) 10 DHs

8 Drug kit for Sick 170 New born & Child Health for PHC

9 Drug kit for Sick 57 New born & Child Health for FRU

10 Emeregency 170 Drug Kit for New Born & Child Health for PHC

12 Emeregency 57 Drug Kit for New Born & Child Health for FRU Lumpsump300.00 Rs. SUB TOTAL 300.00

13 Procurement of 900 1500 13.50 13.50 MVAKits having (Cannula No. 6,7,8,9)

498

15 Procurement of No. 8 125000 10.00 10.00 equipment of blood storage facility

16 Procurement of No. 44 200000 88.00 88.00 Laparoscopes

17 Procurement of No. 1200 800 9.60 9.60 NSV kits

18 Repair/ Lum 4.00 4.00 Maintenance of psu Leproscopes mp

20 Strengthening of Lum 10.00 system/ process psu of procurement mp

SUB TOTAL 135.10

Grand Total 659.35

499

DEATILED BUDGET NRHM ADDITIONALITIES (HUMAN RESOURCE )

Budget head Physical Q1 Q2 Q3 Q4 Total Re Target mar ks Uni Bas Targ Rate Amoun Tar Rate Amoun Targ Rate Amount Tar Rate Amount t of e et (Rs./uni t (Rs. get (Rs./uni t (Rs. et for (Rs./unit (Rs. get (Rs./unit (Rs. me Line for t) Lakhs) for t) Lakhs) the ) Lakhs) for ) Lakhs) asu (cur the the quart the re rent quar qua er qua stat ter rter rter us) Human Resources ANMs

In year 2008- 212 18000 38.16 212 18000 38.16 500 18000 90.00 500 18000 90.00 256.32 09_644_2nd ANMs were proposed, @ Rs. 5000.00/month - under NRHM Additionalities. However 212 2nd ANMs are in Position. and for the year 2009-10; 500 ANMs(FMPHW) are proposed to be hired for the equal no. of sub centres where Male Multipurpose workers are in position remumeration hiked to Rs. 6000.00/month. Total 38.16 38.16 90.00 90.00 2 56.32

500

Staff Nurse In year 2008- 98 24000 23.52 98 24000 23.52 114 24000 27.36 114 24000 27.36 101.76 09_340_SNs were proposed for FRUs/CHC @ Rs. 5000.00/month and budgeted under Heads RCH Base Flexipool and Additionalities both. However 98 SNs are in Position. and for the year 2009-10; 114 (2 /FRU) are proposed to be hired @ Rs. 8000.00/month (Now all being budgeted under Additionalities). In year 2008- 133 24000 31.92 133 24000 31.92 240 24000 57.60 240 24000 57.60 179.04 09_170_SNs were proposed for PHC- @ Rs. 5000.00/month and budgeted both in RCH Base Flexipool and Additionalities. However 133 SNs were in Position. and for the year 2009-10; 240 are proposed to be hired (2 /PHCs) @ Rs. 8000.00/month. In case of non availability of SNs; ANMs will be recruited. (Now all being budgeted under Additionalities). Total 55.44 55.44 84.96 84.96 2 80.80

501

OT Technicians

In year 2008- 67 21000 14.07 67 21000 14.07 114 21000 23.94 114 21000 23.94 76.02 09_170_OT Tech were proposed for FRUs @ Rs. 5000.00/month - and budgeted under Head Additionalities. However 67 OT Techs are in Position and for the year 2009-10; 114 (2 /FRU) is proposed to be hired @ Rs. 7000.00/month (Being budgeted under Additionalities).

Total 14.07 14.07 23.94 23.94 76.02

502

X-ray Technicians In year 2008- 104 21000 21.84 104 21000 21.84 114 21000 23.94 114 21000 23.94 91.56 09_170_X-ray Tech were proposed for FRUs @ Rs. 5000.00/month - and budgetted under Head Additionalities. However 104 X- ray Tech. are in Position and for the year 2009-10; 114 x- ray Techs are proposed to be hired; for FRUs (2 /FRU) @ Rs. 7000.00/month (Being budgeted under Additionalities).

Total 21.84 21.84 23.94 23.94 91.56

503

Lab. Technicians

In year 2008- 171 21000 35.91 171 21000 35.91 234 21000 49.14 234 21000 49.14 170.10 09_255_Lab. Tech were proposed for FRUs and 24 x7 PHCs ( 2/FRUs and 1/PHCs) @ Rs. 5000.00/month and budgeted under Heads RCH Base Flexipool and Additionalities both. However 171 Lab. Tech. are in Position. and for the year 2009-10; 234 (2 /FRU=114 and 1/PHC=120) are proposed to be hired @ Rs. 7000.00/month (Now all being budgeted under Additionalities).

Total 35.91 35.91 49.14 49.14 170.10

504

Doctors

In year 2008-09; 176 54000 95.04 176 54000 95.04 234 54000 126.36 234 54000 126.36 442.80 425 Doctors were proposed for FRUs (1/FRUs and 2/PHC) @ Rs. 10000.00/month and budgeted under Heads RCH Base Flexipool and Additionalities both. However 176 Doctors are in Position and for the year 2009-10; 234 are proposed to be hired @ Rs. 18000.00/month. ( @ 2/FRU and 1/PHC)(Now all being budgeted under Additionalities). Hiring of one 75 54000 40.50 75 54000 40.50 75 54000 40.50 121.50 contractual Doctor MBBS for the PHCs located in difficult areas which are deficit in manpower (for 75 PHCs )

505

Hiring of one 75 54000 40.50 75 54000 40.50 75 54000 40.50 121.50 contractual Doctor ISM, Ayrudea, Unani & Homopathy for the PHCs located in difficult areas which are deficit in manpower (for 75 PHCs ) Total 95.04 176.04 207.36 207.36 685.80 Specialist- Operationalsing facilities like District Hospitals and FRUs in the State for 24hrs services In year 2008-09; 10 120000 12.00 10 120000 12.00 24.00 12 Gyna/ Obst specialist were proposed to be hired for equal number of facilities in Kashmir Division @ Rs. 30000.00 / month was budgeted in under RCH Base Flexipool. For the year 2009-10. 10 are proposed to be hired for 8 FRUs & 2 Nos. Hosp; ( G.B. Pant Hosp, Sgr & Mat Hosp sanatnagar) @ Rs. 40000.00/month for both Divisions of the State.

506

In year 2008-09; 10 120000 12.00 10 120000 12.00 24.00 12 Child Specialist were proposed to be hired for equal number of facilities in Kashmir Division @ Rs. 30000.00 / month was budgetted in under RCH Base Flexipool. For the year 2009-10. 10 are proposed to be hired for 8 FRUs & 2 Nos. Hosp; ( G.B. Pant Hosp, Sgr & Mat Hosp sanatnagar) @ Rs. 40000.00/month for both Divisions of the State.

507

In year 2008-09; 10 120000 12.00 10 120000 12.00 24.00 12 Anaesthetic specialists were proposed to be hired for equal number of facilities in Kashmir Division @ Rs. 30000.00 / month was budgetted in under RCH Base Flexipool. For the year 2009-10. 10 are proposed to be hired for 8 FRUs & 2 Nos. Hosp; ( G.B. Pant Hosp, Sgr & Mat Hosp sanatnagar)@ Rs. 40000.00/month for both Divisions of the State. Gynaecologists, Anaesthetists and Paediatricians proposed to be recruited two each in GMC, Jammu & Srinagar to compensate the faculty member from Department of Gyane and Paed; who is responsible for training purpose under NRHM.

508

Gynaecologist, 4 40000 1.60 4 40000 1.60 4 40000 1.60 4.80 GMC, Jammu/ Srinagar Anesthetists , 4 40000 1.60 4 40000 1.60 4 40000 1.60 4.80 GMC, Jammu/Srinagar Pediatricians, 4 40000 1.60 4 40000 1.60 4 40000 1.60 4.80 GMC, Jammu/ Srinagar

Hiring of 10 120000 12.00 10 120000 12.00 10 120000 12.00 10 120000 12.00 48.00 Specialist (Physicians, Surgeons, Ortho , Eye Specialist etc) @ Rs. 40000.00/ month ( 30000.00 - 50000.00 /month for the difficult area CHCs on need basis.

Special incentive Lu 200.00 100.00 100.00 400.00 to in service mp specialist for su doctors/specialist mp s for serving in difficult/remote areas @ Rs. 4000.00 - 10,000.00 depending on areas through RKS

Total 12.00 216.80 152.80 152.80 534.40

509

SNCU In year 2008-09; 2 120000 2.40 2 120000 2.40 4.80 14 Child Specialists were proposed for 14 SNCUs @ 25000.00/month were budgeted under Base Flexipool. However No Child Specialists is in Position. and for the year 2009- 10; 2 Child specialists are being budgeted under Additionalities @ Rs.40000.00/mont h In year 2008-09; 10 21000 2.10 10 21000 2.10 4.20 28 Nurses for SNCUs @ 6000.00/month - were proposed under Base Flexipool. however No Nurse is in Position. and for the year 2009-10; 10 SNs /ANMs (5/SNCU) are being proposed @ Rs. 8000.00 per month/ @Rs. 6000.00 /month are being budgeted under NRHM Additionalities.

510

In year 2008-09; 2 21000 0.42 2 21000 0.42 0.84 14 Lab. Tech for SNCUs @ 6000.00/month - were proposed under Base Flexipool. However No Lab. Tech is in Position. and for the year 2009-10; 2 Lab. Tech are being proposed @ Rs. 7000.00 per month are being budgeted under NRHM Additionalities.

In year 2008-09; 7 2 21000 0.42 2 21000 0.42 0.84 Data Entry Operator for SNCUs @ 6000.00/month - were proposed under Base Flexipool. however No DEO is in Position. and for the year 2009-10; 2 DEOs are being proposed @ Rs. 7000.00 per month are being budgeted under NRHM Additionalities.

Total 0.00 0.00 5.34 5.34 10.68

511

ISM ISM Doctors for 14 54000 7.56 14 54000 7.56 15.12 District Hospitals ( Old) for mainstreaming AYUSH services in these hospitals. [1 ISM doctor ( Ayurveda or Unani or Homeopathy)/ DH] ISM Doctors 85 54000 45.90 85 54000 45.90 91.80 (CHC) @ Rs.18000.00/mont h -NRHM Additionalities. 85 Doctors are being projected in the year 2009-10 and are being budgeted under NRHM Additionalities. In year 2008-09 357 54000 192.78 357 54000 192.78 375 54000 202.50 375 54000 202.50 790.56 375 ISM Doctors were proposed for PHCs (1 /PHCs) @ Rs. 10000.00/month and budgeted under Additionalities. However 357 Doctors were in Position and for the year 2009-10; 375 are proposed to be hired @ Rs. 18000.00/month.(B eing budgeted under Additionalities).

512

ISM Dawasaz 85 21000 17.85 85 21000 17.85 35.70 (CHC) @ Rs.7000.00/month -NRHM Additionalities. . All 85 Dawasaz are projected in the year 2009-10 which is being budgeted under NRHM Additionalities. ISM Dawasaz( 14 21000 2.94 14 21000 2.94 5.88 District Hospitals) @ Rs.7000.00/month -NRHM Additionalities. . All 14 Dawasaz are projected in the year 2009-10 which is being budgeted under NRHM Additionalities.

513

In year 2008-09; 250 21000 52.50 250 21000 52.50 375 21000 78.75 375 21000 78.75 262.50 375 ISM Dawasaz were proposed for PHCs (1 /PHCs) @ Rs. 5000.00/month and budgeted under Additionalities. However 250 Dawasaz are in Position and for the year 2009-10; 375 are proposed to be hired @ Rs. 7000.00/month.(B eing budgeted under Additionalities).

Total 245.28 245.28 355.50 355.50 1201.56

Doctors for MMU- Additionalities

Salary of 13 Nos. 13 54000 7.02 13 54000 7.02 13 54000 7.02 13 54000 7.02 28.08 Doctors engaged for Mobile Medical Teams under BADP (run through Army) All 13 Doctors Nos. are projected in the year 2009-10

514

Salary of 13 Nos. 13 21000 2.73 13 21000 2.73 13 21000 2.73 13 21000 2.73 10.92 Pharmacist engaged for Mobile Medical Teams under BADP (run through Army). All 13 Pharmacist Nos. are projected in the year 2009-10 Total 9.75 9.75 9.75 9.75 39.00

Total 529.49 813.29 1002.73 1002.73 3346. 24

Programme Management Block Managers 109 30000 32.70 109 30000 32.70 109 30000 32.70 109 30000 32.70 130.80

Annual 3.50 3.50 3.50 3.50 14.00 Performance based increase of contract fees- 10% Total 36.20 36.20 36.20 36.20 144.80

Strengthening of State Health Society by deputation of officers from Govt Service/Contractu al staff Director Finance 1 187500 1.88 1 187500 1.88 1 187500 1.88 1 187500 1.88 7.50 State Nodal Officer 1 187500 1.88 1 187500 1.88 1 187500 1.88 1 187500 1.88 7.50

Divisional Nodal 2 187500 3.75 2 187500 3.75 2 187500 3.75 2 187500 3.75 15.00 Officer

515

Facilitator ( 1 187500 1.88 1 187500 1.88 1 187500 1.88 1 187500 1.88 7.50 Planning and Development) Facilitator Maternal 1 187500 1.88 1 187500 1.88 1 187500 1.88 1 187500 1.88 7.50 Health Facilitator Child 1 187500 1.88 1 187500 1.88 1 187500 1.88 1 187500 1.88 7.50 Health & Immunization Facilitator Disease 1 187500 1.88 1 187500 1.88 1 187500 1.88 1 187500 1.88 7.50 Control & Intersectoral Convergences Contribution 2.00 2.00 2.00 2.00 8.00 towards Leave Salary and Pension of the deputatoinists Two Divisional 2 45000 0.90 2 45000 0.90 2 45000 0.90 2 45000 0.90 3.60 Accounts Manager

Two Divisional 2 36000 0.72 2 36000 0.72 2 36000 0.72 2 36000 0.72 2.88 Data Officers Computer 1 36000 0.36 1 36000 0.36 1 36000 0.36 1 36000 0.36 1.44 Assistant (In charge e –records) Computer Assistant 2 30000 0.60 2 30000 0.60 2 30000 0.60 2 30000 0.60 2.40 (2) Ledger Keeper (2) 2 24000 0.48 2 24000 0.48 2 24000 0.48 2 24000 0.48 1.92

Junior Assistant to 2 21000 0.42 2 21000 0.42 2 21000 0.42 2 21000 0.42 1.68 Divisional Nodal Officer (2) Class IV (4) ( Two 4 15000 0.60 4 15000 0.60 4 15000 0.60 4 15000 0.60 2.40 for SHS and one each for Divisional Office of NRHM) Part Time Sweeper 1 6000 0.06 1 6000 0.06 1 6000 0.06 1 6000 0.06 0.24 (1)

516

Hiring of 9 Lady 9 21000 1.89 9 21000 1.89 9 21000 1.89 9 21000 1.89 7.56 counsellors @ Rs. 7000.00/month. 7 for ARSH Clinics and 2 for Nodal Centres in Jammu and Srinagar Hiring of 9 Data 9 13500 1.22 9 13500 1.22 9 13500 1.22 9 13500 1.22 4.86 Entry Operators @ Rs. 4500.00/month. 7 for ARSH Clinics and 2 for ARSH Nodal Centres in Jammu and Srinagar Medical Colleges Hiring of two Lady 2 54000 1.08 2 54000 1.08 2 54000 1.08 2 54000 1.08 4.32 Doctor as Divisional Level Facilitators @ Rs. 18000.00/month for ARSH Nodal Centres established in GMC Jammu/Srinagar. Hiring of Vehicle for 2 15000 0.30 2 15000 0.30 2 15000 0.30 2 15000 0.30 1.20 providing technical Support for 5 days in a month ( for Nodal Centres) Total 25.63 25.63 25.63 25.63 102.50

Monthly Review 3 20000 0.60 3 20000 0.60 3 20000 0.60 3 20000 0.60 2.40 meetings/ other meetings ( at Divisional Level)

Incentive/allowance 45000 0.45 45000 0.45 45000 0.45 45000 0.45 1.80 to employees from Health Department working in society

517

Miscellaneous 2.50 2.50 2.50 2.50 10.00 (Training and Medical Reimbursement for deputatoinists and contractual staff in SHS, office furniture for new offices) Contingency for 2 20000 0.40 2 20000 0.40 2 20000 0.40 2 20000 0.40 1.60 Divisional Office (SHS) Sub Total 3.95 3.95 3.95 3.95 15.80

Grand Total 593.27 879.07 1068.51 1068.51 3609.34

518

BUDGET SUMMARY OF IMMUNIZATION (2009-2010)

13 Injection Safety 7.80 14 Construction of pits 28.92 15 Total 208.30 Two Crore Eight Lakhs and Thirty Thousands

519

Service Delivery Norms* Expenditure & Achievement 2009-10 Remarks

2005-06 2006-07 2007-08 2008- (Dec’08) Expendit Expenditur Expenditu Achievement Expenditu Achievemen Funds Targe ure e re re t t Mobility support for Rs. 50,000 per 359700 1592059 No. of sessions 592265 No. of No. of supervision district for district Supervised sessions sessio level officers (this Supervised ns includes POL and Super maintenance) per vised year 22 District x50000 11.00 264 lac Supervisory visits By state level No. of Districts No. of 3.0 No. of by state and district officers @ Rs. visited for RI review Districts lac Distric level officers for 100,000/year visited for RI ts monitoring and One review visited supervision of RI Director 2 Ads at for RI provincial level revie w 22 Cold Chain @Rs. 500 per 118185 211623 % Funds used 374173 % Funds % Maintenance phc/chc per year used Funds District Rs. used 10,000 per year Lump sum 10.0 lac Focus on slum & Hiring an ANM @ 29400 10800 Number of sessions 94000 Number of Numb underserved areas Rs. 300/session with hired sessions er of in urban areas for four vaccinators with hired sessio Slum areas = 53 sessions/month/s vaccinators ns 53x1400x12 lum of 1000 with population and hired Rs. 200 per vaccin month as ators contingency per slum of i.e. total expense of Rs. 1400/per month

520

per…

9.0 636 lac Mobilization of @Rs 150/session 2648000 4577719 Number of sessions 6147499 Number of Numb children through (for all with ASHA sessions er of ASHA/mobilizers states/UTs) with ASHA sessio ASHAs = 9500 ns with ASHA (Lump sum) 50.0 lac Alternative Vaccine Geographically 2329515 1194714 No. of Sessions 1165012 No. of 10.0 No. of Delivery For Leh & hard to reach with AVD Sessions lac Sessi Kargil only* 252 areas (e.g. with AVD ons Sub Centers Pilot Session site>30 with District 2 blocks kms from vaccine AVD from each Division delivery point, 3024 (Lump sum) river crossing etc.) @ Rs 100 per RI Session NE States and Hilly terrains @ 100 per RI session For RI session in other areas @ Rs. 50 per session

521

Support for State @ Rs 728955( Pro 54863 525727 2.40 Computer** (with 10000 2 x 12 x curement of annual increment 10000 Computers) of 10% w.e.f. 2010- 11) Districts @ Rs 76627 446121 No. of C.A. In No. of C.A. 21.12 No. of 8000 per month position In position C.A. 22 x 12 x 8000 In positi on 22 22 23.52 22 lacs Printing Rs 5 per 10.0 dissemination of beneficiary 3.99 lac immunization infants population cards, tally sheets. (0 – 1 year) Monitoring forms, etc Review Meetings Support for 4.0 Participants = 50 Quarterly State lac 1250x80x4 level Review Meetings of district officers @ Rs 1250/participant/ day for 3

522

Participants = 170 Quarterly review 0.68 4 170x100x4 & feedback lac meeting for exclusive for RI at district level with one Block MOs, ICDS, CDPO and other stakeholders@R s. 100 per participant for meeting expenses (lunch, organizational expenses)

Trainings No. of persons No. of No. of trained persons perso trained ns traine d B.Orientation 50*2*450 0.45 training for 2 days Lac TO HEALTH WORKERS OF NURSING HOMESPARTICIP ANTS =50 Three days training As per revised No. of persons No. of 11.0 No. of of Medical Officers norms for training trained persons lac perso on RI using revised under RCH, copy trained ns MO training attached. MO = traine module 717 (Lump sum) d

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One day refresher As per revised 0.10 training of District norms for training lac RI Computer under RCH, copy Assistants on attached. RIMS/HMIS and Computer immunization Assistants=22 formats under 22x450x1 NRHM One day Cold As per revised No. of persons No. of 11.70 No. of Chain handlers norms for training trained persons lac perso training for block under RCH, copy trained ns level cold chain attached. 975 traine handlers by State handlers to be d and District Cold trained in 39 chain Officers and batches @ 30000 DIO for batch of per batch. 15-20 trainees and three trainers. One day training of As per revised No. of persons No. of 03.88 No. of block level data norms for training trained persons lac perso handlers by under RCH, copy trained ns DIO ………. To attached. Block traine train about the level data d reporting formats handlers = 109 of immunization 109x450 DIOs = and NRHM 22 22x800 Participation of Implementation 1.25 Updat ANM, ASHA, AWW of microplan at lac ed Blocks = 109 PHC/CHC level micro 109x1000 District = @ Rs 1000/- plans 22 22x2000 block & at district every level @ Rs year 2000/- per district POL for vaccine Rs. 50,000/ % funds used % funds 11.0 % delivery from State district/year used lac funds to District and from District = 22 used districts to 22x1.0 lac PHC/CHCs

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Consumables for 400/ - 1.0 computer including month/district lac provision for 400x12x22

Construction of pits @ 6000 per pit 28.92 at PHC/CHC/SDH lac CHCs/PHCs/DH= 482 Injection safety %funds used %funds used %fun ds used Red/Black plastic Rs 3.66 bags etc Sub 2/bags/session lac centers =1907 1907x2x2x48 Sessions = 48 Bleach/Hypochlorit Rs 500 per 2.30 e solution PHC/CHC per lac year 460x500 Twin bucket Rs 400 per PHC 1.84 /CHC per year lac 400x460 Any State specific 10 % of total %funds used %funds used 7.80 %fun Need with amount of lac ds justification approved PIP used (stationary and others) Total Expenditure 93900 6812054 8260636 8898096 on Immunization Strengthening

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